Ologies with Alie Ward - Vaccine Infodemiology (COVID-19 IMMUNITY) with Jessica Malaty Rivera

Episode Date: January 6, 2021

The Coronasode we’ve been waiting for! Vaccines. Finally. But what does this mean? As a Vaccine Infodemiologist and science communication lead for The COVID Tracking Project, Jessica Malaty Rivera specializes in infectious disease epidemics and the surge of misinformation that accompanies them. The very first human trials of the COVID-19 vaccine occurred in March 2020, and Alie asks Jessica one million questions about the differences between the two available vaccines, rollout schedules, herd immunity, mRNA, vaccine hesitancy, mutated virus strains, picnics, vision boards, the post-holiday spike, how history can influence current vaccine rates, whether you should wipe down your groceries and more. Consider it a critical booster shot to the info we’ve gathered all year. Follow Jessica at instagram.com/jessicamalatyrivera and Twitter.com/jessicaMalatyRivera More info on Jessica Malaty Rivera: https://linktr.ee/jessicamalatyrivera Sponsor links: www.alieward.com/ologies-sponsors A donation went to 500WomenScientists.org More links and info at alieward.com/ologies/vaccineinfodemiology Become a patron of Ologies for as little as a buck a month: www.Patreon.com/ologies OlogiesMerch.com has hats, shirts, pins, totes! Follow twitter.com/ologies or instagram.com/ologies Follow twitter.com/AlieWard or instagram.com/AlieWard Sound editing by Jarrett Sleeper of MindJam Media & Steven Ray Morris Theme song by Nick ThorburnSupport the show: http://Patreon.com/ologies

Oh, hey. It's your college roommate who used to mix beer into metamucil, alley word, the vaccine, vaccines, COVID-19 vaccines. What is the what? Who gets it? What's in it? How does it work? When can people make out with strangers again?

All good questions, which we will get to, but first, some thanks up top to everyone at patreon.com. For making this show a reality, you can join for one hot dollar a month. And thank you to everyone who has subscribed and rated, especially reviewed this show because you know that I read them like a goblin, so I can select a freshy each week. And this one, it's from Little Glass Fox who said, thank you, internet dad. That's me. For this beautiful piece of internet art, I am but a chicken nugget in the sweet and

sour ocean of knowledge that is inologies. Hop in, folks. Let's get sticky. Okay. Vaccine infodemiology. So infodemiology, it is a real word and it is the science of managing infodemics, which is also a real word. It's an overabundance of information, some accurate and some not occurring during an

epidemic. Can you even believe that there is the perfectology for these times and also the perfectologist? So I was waiting for the right time to do another coronasode and with the vaccines rolling out, I knew we all had questions. So about four days ago, I all caps asked thisologist that day what her afternoon was like and she is the champion, hopped on the horn. So she is the psychome lead at the COVID tracking project, which collects and publishes the most complete COVID-19 data available for the U.S. and territories.

It's helmed by the Atlantic, which is doing stellar pandemic coverage. Big shout out to Ed Young, personal hero there. FYI, remember that this is a podcast. It is not an appointment with your doctor. So please seek advice from your own medical professionals when you're making choices about your health. Cool? Cool.

The first 20 or 30 minutes of the interview delivers some critical updates to COVID protocol. So please listen and spread the word on that. And also we talk about how curves are measured, why testing before a gathering is not a good safety measure, fomites on surfaces and more, and then the vaccine talk. Okay. So thisologist you're about to meet is a microbiologist who got her master's in emerging infectious diseases from Georgetown University School of Medicine. She's also an infectious disease epidemiologist with the COVID-19 dispersed volunteer research

network and an expert contributor for all kinds of news outlets. So speaking from just a few miles apart in LA, we cover the curves, the spikes, how the holidays will affect the data, what to expect in the next few months, the difference between vaccines, how they work, mRNA, Tom Cruise, how many people need to be vaccinated in order to have widespread protective effects, why there is a vaccine hesitancy, historical fashion blunders, sore biceps, outdoor picnics, and why it's not time yet to wistfully pack your masks in mothballs with this wizard of data, this matriarch of metrics and slayer of flimflam. Vaccine infodemiologist, Jessica Milotti Rivera.

This is one of those that I'm obsessed with already. My name is Jessica Milotti Rivera, and my pronouns are she, her. Great. Oh my gosh. I'm so excited to talk to you. And I'm thinking that this would be the subject of vaccine infodemiology, would that be correct? Totally, yeah. An infodemic is when there is an overabundance of information, some of it accurate, some

of it not, that is occurring kind of simultaneous to an epidemic. It makes it really hard for people to find trustworthy sources and reliable guidance when they need it most. And they kind of go hand in hand with infectious disease outbreaks. I mean, since the origin of studying infectious diseases, we've seen that there have always been in tandem outbreaks of bad information when it comes to an outbreak of also pathogens. And so have people been studying infodemiology since before the digital era, like were there pamphlets during the Spanish flu that were like, it's actually transmitted by leeches?

Yeah. I mean, it didn't have the name infodemiology, but people have been tracking misinformation and disinformation for a long time. I mean, you could even go back to when the smallpox vaccine was derived, which was done through the process of variation, and they used cowpox virus to determine how to do to inoculate people. And there were rumors about people turning into cows if they took the cowpox vaccine. And of course, they had to do counter misinformation campaigns to kind of correct public perception

of things. It just didn't get named infodemiology until much later. So these counter misinformation campaigns came about because vaccine itself comes from the word vacca for cow after Dr. Edward Jenner poked a farm boy in the late 1700s with a needle full of pus, giving him a mild intentional case of cowpox that also delivered immunity from the more deadly smallpox. This farm boy was the son of a landless laborer. His name was James Phibbs, and he lived well into old age.

Dr. Edward Jenner let Phibbs and his family stay for free in a cottage, which later became the Edward Jenner Museum. And on the property is a little thatched hut known as the Temple of Vaccinia, where Dr. Jenner would chill and write and maybe play video games and would also administer vaccinations free of charge to the poor, none of whom turned into cows. Just in case you wanted to cry a little every time you think of the word vaccine. What drew you to this field? Yeah, I mean, my background is in emerging infectious diseases.

And I love all things related to infectious diseases, including how they're talked about. I do a lot of science communication. And, you know, when you are talking about science and when you're talking about infectious diseases, there needs to be a lot of precision about how you do so. Otherwise, things get misconstrued and misinterpreted. And then you end up dealing with two outbreaks. My work years ago was on a lot of vaccine preventable illnesses and vaccines is a fraught space of misinformation and disinformation.

And so to kind of help advance my work as an infectious disease researcher, I had to also study the infodemiology that surrounds it. Did you get chickenpox as a kid or did you get the vaccine? I got I'm a parent sent me to school to get it. I remember that. I was a kid of the 80s. I remember when when it happened, my parents were like, you're going to school, you're getting the chickenpox.

We're doing the Avino bath. Itchy. Yeah, we didn't have a vaccine for it. You know, grew up in the 80s, too. So it was just like, you're going to get it at some point, get it, get it into your system to get it out of your system, essentially. Yeah. OK, so PS, the chickenpox vaccine was developed in 1985, but it would be another decade before

it entered the arms of American littles in 1995. Japan and Korea were early adopters. They got it back in 88, but side note, fun fact. So shingles that excruciating swath of blisters that erupts across your chest and armpits is caused by the same virus. So if you had the chickenpox vaccine, you likely will not get shingles. But if you had chickenpox, you can still get shingles later in life, unless you get a vaccine for shingles.

Isn't it fun that there's a party in your body? OK, so if your kids are pissed that you couldn't get them a PS5, just remind them that you had to walk up hill both ways, covered in crusty blisters, and then start crying about shingles. That'll make them disperse, unless they're future vaccinologists or immunologists or vaccine infodemiologists. Growing up, were you ever kind of morbidly curious about these kinds of phenomena or history or anything like that?

You know, as a kid, I always loved science and I thought I would actually be a doctor. And to my parents' dismay, I decided to not become a doctor and just do research instead. And honestly, I think it worked out for the best because at the heart of my kind of hesitation is that I'm a giant softy. And so I don't think I could have handled the clinical side of it. I'd really much rather have a separation by a computer screen. So and when when it came to doing your thesis and getting your masters in this,

how did you decide what you wanted to to really focus on for that? Yeah, so back in the early 2000s, I was recruited to be part of this group at Georgetown that was in the School of Medicine, funded by the government. And it was in the Division of Integrated Biodefense. Remember, on the heels of 9-11 and Y2K, the early 2000s was an era of quiet chaos. Face rhinestones and low rise cargo pants with whale tail peekaboos. There was a lot to fear. It was essentially a contract to track emerging threats that were in animals,

plants, humans to essentially predict the next pandemic. So we were tracking everything in about 50 languages all over the world. Outbreaks of Ebola, outbreaks of influenza. In fact, our team detected the emergence of the 2009 H1N1 pandemic in Mexico. A lot of people have been saying it's not a matter of if it's a matter of when. We've been saying that for a long time. So very unsurprised that we're in the situation that we're in right now. And my work at Georgetown led me to the program at Georgetown

where I got my master's in emerging infectious diseases. And when you first heard the news about SARS-CoV-2. Tonight, U.S. airports on high alert screening passengers for symptoms of a deadly new virus. Do you remember where you were or what you were doing when you first heard, yeah, there's some virus, but you know, where do you hear? I remember it was kind of mid December when we were hearing whisperings of it. I the first thing I did was look up some of my professors and see if they were tweeting about it and kind of some people that I know in the space.

And, you know, there were some kind of raised eyebrows and like we got to follow this. We got to see what's going on. But I like many people even in the space in January and February was like, you know, it's probably just going to be a respiratory virus. If it's like SARS-1, you know, it may kind of die out in a bit. I did not expect in the very beginning for it to be such a devastating global pandemic with so many confounding factors. It wasn't until the first week of March and I remember the day was March 8th

when I was like, oh, shit, this is actually happening. When it comes to SARS-CoV-2, this is such a huge question. But we've been writing this since March, obviously. And, you know, 300,000 deaths now in America only. Where are we at with this virus in terms of a curve? And how do you how do you track that? I mean, you're you are heading up the analytics like over tracking. How do we even measure that?

You know, we're in a really bad place to be completely frank. We are kind of in the thick of what is a terrible surge that's reflected in our case data and especially in our hospitalization data. The amount of people that are in the hospital right now is record high. And we're seeing a number of hospitals throughout the country sounding the alarms if they are at their breaking point. ICUs are either at full capacity or nearing full capacity. And, you know, the data kind of flows in a very linear direction.

You have an increase in cases. You expect an increase in hospitalizations. And then eventually some deaths to follow considering the lag in the data. You'll probably see them a few weeks after hospitalizations start spiking. So we're about to see, unfortunately, a lot more loss in the months of January and February. And I think that that is going to be very sobering, especially in light of the fact that now we have a vaccine or two vaccines available. We're still going to have to go through some dark days before

we can start seeing the light at the end of the tunnel. And what is different about this wave than initial waves? I know nobody is at this point hoarding hand sanitizer and upcharging for N95 masks. But why are we seeing these kinds of devastating losses when we're this far into it? Yeah, there are so many reasons for it. I will say that there is a degree of seasonality to consider here. And what I mean by that is, you know, when there's cold temperature,

it drives people indoors. And we know that indoor activity is very high risk, especially unmasked indoor activity on top of the fact that it's the holiday season, which is another reason why people end up congregating indoors. And so those two things are kind of, you know, some of the main reasons why, you know, flu season is seasonal, it drives people indoors when cold weather and holidays, et cetera. There's also a degree to which the virus can transmit better in these kinds

of climate. The social aspect of it, too, is that people have pandemic fatigue, which is a completely understandable sentiment, especially now that we're 10 months in. And a lot of people have been like, you know, I've sacrificed a lot. I've canceled trips. I've postponed weddings and deferred all these things. And for what? And this is the part of public health that's so tricky is that it's you don't see what you're preventing because you're preventing it, right? And it's really hard to see the fruit of something that just seems

really painful. And it's about encouraging people to, you know, remember that their sacrifices are not in vain. And now you deal with infodemiology, maybe too much information that can be conflicting. There was a study that came out maybe two months ago about masks. And essentially the 100 character headlines were study proves that masks aren't effective at all. So for a little more background, at the beginning of this pandemic, scientists weren't sure if masks were going to help. And then they were like,

yes, no, totally. Yes. In late November, another study blared from the headlines saying that masks didn't help the spread of SARS-CoV-2 or COVID-19. Wait, what? Okay. Well, in the age of, I read the tweet, so I pretty much get the article. A lot of folks got confused. Now, the headlines about masks not being effective were about a Danish study. And if you read the actual paper, it explains that masks do help prevent the spread of COVID-19, but that participants just didn't use their masks correctly or frequently enough. But more people read and retweet splashy headlines than actually click the story.

So is exasperated mask chatter common among infodemiologists? Yeah, I mean, that's such a great question. And honestly, we just, a group of researchers and myself just submitted a paper on what, you know, how public trust shifted because of the conflicting messages on masks. I think that in many cases, masks being the primary example, a lot of scientists have just been in damage control mode because of how poorly we spoke about COVID-19 and the ways to prevent COVID-19. To come out swinging and saying, don't buy masks, don't wear masks, masks don't work to a 180 of masks do work, masks prevent

transmission created a lot of legitimate confusion and distrust. And to rebuild the trust has been an upward battle because it just gave enough of the people who are the pandemic denying type just enough ammunition to kind of so discord and create more division. Were there plague deniers? Were there Spanish flu deniers? Were there cholera deniers? Absolutely. There were. Okay. Absolutely. Yeah, there were in 1918, pandemic influenza. There were anti-maskers. There were anti-mask clubs in San Francisco.

That's the worst idea I've ever heard in my life. I mean, it was a thing. And you have to think about this in the sense that humans haven't evolved too much. There are skepticism is something that is a common sentiment. Fear is also a common sentiment. And honestly, infectious disease outbreaks are scary. There are a lot of unknowns. And I think that when that happens, the emergence of snake oil salespeople and people who are trying to kind of create alternative responses to mainstream media or whatever it was, publications, newspaper publications back in the day, they come out of the woodwork

because they're trying to make sense of the chaos. See a certain modern wellness brand proving that it could sell rocks to shove into your cooter for $66, then got sued for selling them and then continued to sell them. So I can imagine that actual snake oil face serum would sell like organic non-GMO hotcakes. The field of emerging infectious diseases is not new. And it's been of interest, a federal interest for a long time. But we've just devalued it and defunded it for so long, taking away from the research, taking away from public health, that it put us at this very vulnerable position where pandemic

preparedness was an afterthought. Looking back at somebody who worked on pandemic prediction, it kills me because a lot of people are like, why don't we have a weather system, weather forecasting system for diseases? I keep saying we did. We had it. It was funded. Just heads up, the National Security Council's Directorate of Global Health Security and Biodefense was dismantled under John Bolton in 2018. So it was funded. And then it wasn't. And in so many ways, we are still dealing with the consequence of devaluing public health as a country. I mean, the COVID tracking project started because we were trying to find data on testing that just wasn't publicly available in one place.

And, you know, so much of why this virus kind of went so rampant in our community was because we didn't have an infrastructure for testing and then related contact tracing that could have stopped new outbreaks. And if you're wondering how much worse is COVID-19 than the flu, will the influenza death toll in 2019, 34,200 Americans, COVID-19 around 350,000 and counting with lockdowns and masks and hand sanitizer and everything canceled. So COVID-19, why are you like this? I think that this one is unique in the sense that it is highly infectious and has caused a number of ailments beyond the kind of asymptomatic transmission, which is, you know, of course, confusing and frustrating. These completely unknown long-term effects and the

duration of these long-term effects is kind of what makes this especially concerning. It's not just one of those diseases that kind of leaves you when you fully recover. In fact, recovered is a term that is very kind of problematic when we talk about COVID-19 because what does recovery even mean? There are people that are months out of their diagnosis who are still dealing with cardiovascular issues and lung damage and neurological issues. And so because of that, it makes this so much more of a pandora's box than any other coronavirus we've seen. I know we have much more readily available tests than we did, you know, in March and maybe even through May. But how are you looking at the data and saying, okay, well, we didn't have a lot of tests. So how do we know how many

cases we had versus now versus how how virulent the strain is? What kind of numbers are you crunching? Yeah, that's such a good question because, you know, one thing that we try to emphasize with the data is that no single metric can be looked at in a vacuum, right? They all are pieces of a puzzle that you need to look at together because one metric by itself doesn't tell the full picture. So, you know, in the beginning, we didn't have a lot of testing and that definitely influenced the number of cases that we were able to see and kind of the scale, the proportion of which people were hospitalized and dying. Right now, testing has increased, but we're still not testing enough. In fact, we've never tested enough. You know, the Harvard Global Health Institute has estimated

that we should be doing millions of tests per day in order to kind of out test the virus so that we can get to what they call suppression levels of disease response. And the data requires some caveats and some context of saying, okay, well, if you compare what's happening today to the March, you have to remember back in March, there wasn't a lot of testing. And right now there is a lot of testing. But that also causes people to make incorrect kind of causal claims like, oh, we're seeing more cases because we're testing more. But if you look at the charts, if you look at the slopes of these lines, a lot of times you'll see that cases are outpacing the growth of tests, which is again, reinforcing the fact that we're not testing enough.

And Jessica says that even with enough tests, there's still the aspect of infodemiology of the disease surrounding the positivity rates. So it's important to compare apples to apples to get a comprehensive view. So you're not cherry picking the data that has better optics and using it to justify policy change. So in a country that's not super big on the metric system or Celsius, what kind of metrology are we talking? Yeah. So some jurisdictions will define tests as unique people or as specimens or as encounters. And so those can mean different things. So one data point can be reflected in different calculations as different things. You can have an individual who is testing positive on Monday, but he had

six samples collected in that week. And so is he one test or is he six specimen? And so it's making sure that we understand how each state and jurisdiction defines the terms and then can make those calculations accurately. I think where it gets really tricky is when you try to compare the metrics. When you try to say the state looks like this and the state looks like that, when if you look at the way that they're doing their math, it's different. However, they record it could work for them, but it also makes comparisons less clean because of that. Yeah, that makes sense. One versus six, that's a big old difference. It is. Yes, exactly. Now, testing, I noticed in LA that the lines before Thanksgiving were

absolutely bananas. And I got exposed before Thanksgiving, so I ran out to go get a test, right? Which was not fun. And lines were crazy. So I assume a lot of people were getting tested before a family gathering so they could say, hey, I'm clean, let's eat some mashed potatoes. How is that affecting the case rates? Because you can test negative and still have it. Yep. And just not have enough to show up on a swab. What's happening? Yeah, it's really important to remember that you don't test to justify a change in your behavior. All a test result is telling you is if there's a presence of detectable virus at the moment of testing. That's it. It doesn't tell you anything about the rest of your day or the future.

So testing as a strategy is not really an effective way to control the disease. It's really kind of a diagnostic for that moment. That's why it needs to be considered in tandem with things like a proper quarantine so that you can reduce your likelihood of having virus that's not detected when you get tested and then you end up doing what you're going to end up doing. So it was a very flawed strategy for a lot of people to test and travel. And we even saw some places, I think it was in South Carolina, where they even created a slogan like, take a test to take some Turkey or something like that or test to Turkey. And they just thought that was just so misguided because it's telling people that this is like a immunity passport, that a negative

test was somehow a license to do whatever you wanted to do. And that's just not the case. Detectable virus could have been detected later that evening, or you could be exposed the moment you walk out of the testing clinic. So in the process of traveling itself is kind of where the risk of exposure is greatest. So we are definitely seeing an impact on the data from Thanksgiving in a number of places. And unfortunately, right now, the data is still a little bit shaky because we just finished the Christmas holiday and we're about to go into the New Year's holiday. So the data itself is going to be pretty wacky for the next couple of weeks and then also negatively affected because of people's behavior during the holidays. Right. I imagine if more people are

traveling, they might not be getting tested during that week too, or the testing facilities are closed around New Year's or Christmas. So I'm recording these asides in my closet on January 5th, 2021. And currently, the global death toll is $1.84 million, with the U.S., of course, leading those numbers. Now, according to covidtracking.com, 125,544 people in the U.S. are hospitalized for COVID-19. Some of them, as reported by the LA Times, dying in hallways. Now, that is the wide, wide angle lens. Let's zoom into life's minutiae with one question you likely have. Should we still be wiping off our groceries? Yeah, I mean, I get this question honestly, probably every day.

I'm sorry. No, no, it's a legitimate question. So I always say personally, I don't. I found it to be wasteful of the resources that we were using to clean things like all the spills that my children have around the house on a normal day. Like, I don't need to be going through these things faster. If I feel like concerned, if there was somebody who just recently touched it, like a delivery man, what I'll do is I'll just usually wash my hands after I handle the package, just out of an abundance of caution. But what we know from the data is that thomite or surface transmission is not a main driver of infections, that the main driver of infections is prolonged

exposure to a confirmed case. And so because of that, I think it can make people just chill out a little bit and not worry so much about touching things and getting sick from that stuff. And by prolonged exposure, is that defined as like 15 minutes, you know, a six by two room or 20 minutes into 10 by 10? Like, how do they figure that out? Unfortunately, that's also a variable calculation. So the CDC changed their metric for what is considered, you know, prolonged exposure or now it's 15 cumulative minutes with somebody who is a confirmed case in a 24 hour period. It used to be 15 consecutive minutes. And cumulative is very easy to tabulate because if you were around somebody working with somebody

and there were intermittent interactions and they kind of totaled 15 in a full 24 hour period, like that's considered exposure. But again, some jurisdictions define it differently. I would say that in that statement, it's usually an extended period of time, several minutes, much more exacerbated by the presence of or lack of presence of masks. That is going to be the main driver of infection that you are exposed to a direct person. You know, and I think one thing that's funny is human beings are so used to getting together to eat or drink something. So it's like, well, I haven't seen you in a while, we're just going to eat outside. And like the one thing you can't do with a mask is smell roses and eat stuff.

And so do you think that part of the driving of these exposures is that we are trying to gather to take our masks off to eat? Yeah, I think that there's a lot of activity that's happening that's causing people to kind of cut some corners. I'm actually reminded of a few weeks ago, the Mayo Clinic reported that 900 people and their staff were exposed to the virus or tested positive. And they were saying that it's probably directly linked to their eating quarters, like the cafeteria and the facility, because that's where people were eating. And you're like, God, that it's just, it's so easy for that to happen. And, and yes, outdoor dining is definitely going to be on the safer end. But if you're doing it at the same table inches away from each other,

I think people get really kind of legalistic about the six feet rule. And they think that if we're, you know, six feet or more that like droplets can't transfer, but they absolutely can. I mean, it's a relative space of when we think droplets kind of usually fall to the ground from gravity, but droplets can travel much farther. And if there are different conditions in the air like wind, they can take them even further. So it's, it's not a failproof system to just be eating outside to avoid transmission. In fact, I'd be much more comfortable people just kept their masks on and like socialized with masks on the whole time and avoided putting things in their mouth while they're with other people because, you know, when you do that, you let your guard down,

you take sips, you eat and it's just, that's where the exposure happens. And now vaccines. Let's talk about them. I think from the beginning, we were like, as soon as this vaccine rolls out, I am going to a foam party. I'm going to host a rave like, and that's not quite how it works. I know I have not gotten one yet. I'm not in that top tier of frontline workers as someone who hosts a podcast that I record in a closet. Can you tell me a little bit about vaccine, flim flam? Like, what do we need to know? I know that there's a Moderna one, there's a Pfizer one. How are they working? Yeah. So, you know, I'll start by saying that I get choked up every time I talk about this because

it just exceeded our expectations. Like, I remember early in the spring, when the FDA was trying to come up with some of the guidelines of which they were saying, if it is at least X, then we will approve it. I mean, they were shooting for 50% efficacy, which is like around the ballpark of the flu vaccine. The fact that we have two vaccines that are over 90% effective, like literally gives me chills. It's just so, so spectacular. And I think that that is something that should cause people to not only feel relief, but also just great expectation for what's going to happen. Assuming, though, that the vaccines don't just stay effective in their vials, vaccines are one thing, vaccinations are another. We need people to

take the vaccine. And that's how we're going to see the efficacy data in practice. And I think there's a lot of misinformation when it comes to these particular vaccines, namely on the technology that was used for the vaccines, which is not technically very new. I mean, we've been studying mRNA vaccines and the research behind this for decades. And they've been in trials in various forms for a number of years. So it's just because we had this concentrated effort that didn't have any of the red tape and the bureaucracy that usually slows down clinical trials. It was like the best case scenario for a group project, all hands on deck. Everybody did their part, no distractions. And we got to the end and we had amazing results.

Is it true that one of the vaccines was kind of developed within like 48 hours, but a lot of it took a lot more testing? Yeah. So when we got the full genome of the virus early in the year, I think it was January 11th when we got the full sequence from China. And within 48 hours, Moderna was able to derive what would be kind of the prototype for their mRNA vaccine. So more on mRNA in a minute. And several weeks after that, I think March 16th was the first dose of the first phase one trial. I mean, we are talking about record speed. And that's kind of one of the major advantages of mRNA is that it's so easy and quick to produce. And it allowed us to kind of go straight into phase one with the preclinical stuff happening at the same time.

There were no steps that were skipped. It allowed them to get into clinical trials very soon after that isolation. And do you know who got it? Do we know who that the first sticky pokey was? Yes, we do. And I remember the picture. Okay. So I looked up the photos from March 16th, 2020, when most of us were still dubious about this disease's impact. And we were considering it at most a one week stay at home order to maybe binge through our Netflix queue or Marie Kondo closet or, you know, ring our hands at tweets saying that Shakespeare flourished during the plague. But on that day, Jennifer Holler, a 43 year old mother of two, were a tank top, a tattoo greasing one shoulder. She has a wavy bob. She seems like someone that I would have hung out with

in college, maybe sneaking off to see the cure. No pun intended. Anyway, on March 16th, 2020, she sat on the edge of a doctor's table outside of Seattle and became the first human COVID-19 vaccine recipient. She said about the experience, quote, I wanted to do something because there's so many millions of Americans that don't have the same privileges that I've been given. I want to make her a Bundt cake and give her a gloved high five in the non shot arm. Now, if all of this was going down way back in March, why have I been wearing pajamas nearly every day for a year? So the clinical pipeline varies, right? And it in general takes about 10 to 15 years sometimes from things to go from bench to market. And that's because clinical trials take a long

time. They're really expensive. And sometimes you don't get as much enrollment in them as you want. And those are all the issues that were directly addressed with the unfortunately named operation warp speed. They were fully financed. They had tons of money to kind of keep them from having any interruptions going from face to face. There was a ton of interest. People were very enthusiastically enrolling to become participants. And there were no kind of bureaucratic steps that needed to be dealt with. It was a runway had been paved prior because of all the research. Hey, just a little data. So 95% of people named me can't say mRNA on the first try. So just feel free to celebrate this with a tiny imperceptible butt dance or just enjoy my failures. And when you talk about

MNRA, mRNA, oh my gosh, I can't. When you talk about mRNA vaccines and that we had them for a while, can you explain a little bit about how they work and why people kind of have eyebrows raised about them or are curious about them? Yeah. So people hear mRNA and they immediately think, oh, that's genetic material. That makes me think of genetically modifying things. That means it's going to change my DNA. And then you just quickly end up in the 5G GMO tracking microchip conversation that is just so scientifically not the case. It is just straight out of fiction. But I can understand how that can be confusing because a lot of people don't remember things like mRNA and what RNA does and what DNA does. But to put it simply, so mRNA essentially is giving your body

a message. It's kind of giving it a cheat sheet telling the body, this is what the spike protein looks like. You should make the spike protein so that if you see it again, the actual virus, you can fight it. That message, I can't remember who put it, somebody had a tweet that was like, think of it like a Snapchat message. It just, it disappears after some time. It just sends you the message and it's gone. Giving your body the framework of like how to build it. I think an important detail about the biology of this too is that the mRNA just kind of goes in and it's in the cytoplasm. It doesn't actually enter the nucleus of the cell and the nucleus is where the DNA is. So the mRNA and the DNA of your cells do not interact at all. So it cannot,

it is not possible to modify our DNA. And I think a lot of people are really stuck on the kind of genetic material, but in fact, all viruses have genetic material. There are RNA viruses or DNA viruses and what happens when you get a viral infection is that that virus injects its genetic material into your cells and tells the cells to make more and then explode more infected cells outside of the original cell, the host cell. So it's kind of language that people are familiar with, but don't really understand the details of how it works, but it's in fact extremely safe and very affordable to produce and is probably going to be a new kind of frontier for vaccine development. Yeah, is this the first time that it will be widely used or what's the corner that

we've turned with it? So this is the first time we've had an mRNA vaccine advanced to this level in clinical trials and have at least emergency use authorization. They're going to continue for full authorization. They're going to continue being evaluated, but they have been attempted trials for things like Zika and even flu and rabies. So yes, we've been working on mRNA vaccines for other viruses, including the one that causes mono and the fragile messenger RNA is protected in a little fat bubble and those disappearing instructions tell our immune cells, hey, build the spiky proteins that are the hallmark of this coronavirus because corona means crown, which would be very cute if it weren't so deadly. So our cells then churn out this little spiky protein, our immune

system sees them and builds antibodies to have in its arsenal in case we get the real SARS-CoV-2 in our system. Now previously, vaccines have schooled our immunity not through this messenger RNA, but via inactive or dead viruses like in the polio and flu vaccines, although attenuated or milder live viruses like in the chickenpox and measles, mumps, rubella vaccine also exist. There's also toxoid vaccines with inactive toxins like the tetanus vaccines. There's heterotypic vaccines in which you're inoculated with one type of disease, i.e. cowpox, to protect against another, i.e. smallpox. And there's also recombinant vaccines and those use an organism with the DNA of a different organism and those are being explored for an Ebola vaccine. But these COVID-19

vaccines are, yes, the mRNA type, which is exciting because rather than give you the whole virus, it's just telling your cells, hey, make examples of this protein and then the antibodies to match. So keep an eye out for these spiky bastards is what it's telling your cells. Now, if the mRNA vaccines have been in the works for rabies and mono and Zika, why are these COVID vaccines the first to be approved? But because those situations are not nearly as emergent as SARS-CoV-2, those pipelines weren't as, you know, financed and prioritized because they weren't as severe. But because we are in a public health emergency and because this virus was not slowing down, it wasn't, you know, kind of dying out the way SARS-1 did or even the way Zika kind of subsided

in its severity, it continued on with full force. And when it comes to the difference between Moderna and Pfizer, is this a Pepsi Coke situation? Is this a Mr. Pib, Dr. Pepper, same difference? And who gets what? Right. Yeah. You know, I don't think that we're going to be in a consumer market when it comes to these vaccines. I think it's going to be based on what is shipped where and what is available to you. And both of these vaccines are excellent. The differences between the two are so nominal and don't actually affect the recipient much at all. In fact, I think the bigger thing is the logistics of storage where, you know, Moderna has the advantage of being stored at lower temperatures and is much more durable for in the refrigerator for a longer period of time. I think that is more

of a logistical advantage. But when it comes to the physiology and what it does to the body, these are both amazing vaccines with very similar safety and efficacy profiles. Bring it on. Do both of them need a second shot weeks later? Yes, they both do. So Pfizer is two doses separated by 21 days and Moderna is two doses separated by 28 days. And that booster, that second dose kind of ensures that we get that full efficacy measured. One dose is not sufficient. If people think that that's the case, that would be really problematic. We really need people to have the complete dosage to ensure that we're seeing the maximum effect of the vaccine. And when are normal Joe's who are just

podcasting in a closet? When do they get stuck with it in a good way? Yeah, I think so. Personally, I've had the kind of expectation that I as a healthy average aged adult will probably not get vaccinated before end of late summer or early fall of next year, just because there are so many logistics that need to go in place to get all the priority people vaccinated first. So we've seen about 2 million doses administered, but we've already seen 11 million doses shipped. That already is raising a red flag to me about kind of the efficiency of how we're getting to these priority groups. We need to make sure that all frontline healthcare workers are vaccinated, that people who are living and working in long

term care facilities are protected because so long term care facilities represent 1% of our population, but 40% of COVID-19 deaths. That is a absolute tragedy. So we need to be protecting those vulnerable populations. And then kind of in a trickle down effect going from, you know, elderly people, people who are at risk for severe outcomes, and then average Joe's and Jayden's like us. I have so many questions from listeners. Can I lightning round you? Yes, of course. Okay, amazing. Okay, so a thunderstorm of lightning round in just a minute. But first, we donate to a charity of theologists choosing each week. And this week, Jessica requested that it go to 500 women scientists whose mission is to serve society

by making science open, inclusive, and accessible, and transform society by fighting racism, patriarchy, and oppressive societal norms. So you can find out more about them at 500womenscientists.org, which is linked in the show notes. And that donation was made possible by sponsors of the show who you may hear about now. All right, let's give your questions a shot. So a lot of you had the same question about percentage of folks needing to be vaccinated, including Emily Oakerland, RJ Doge, Emily A., Amanda Chris, and Nicole Wackerel. Okay, so many questions. Audrey Ledger asks, possible outcomes if a large percentage of the population refuse to get vaccinated or just fail to return for the second dose of a vaccine?

Such an important question. So, you know, when it comes to vaccines, that is the only context in which we can talk about herd immunity. I know people were so desperate to achieve herd immunity in the context of natural infection, but herd immunity is specific to vaccines. The measles vaccine is one of the most effective vaccines that we have. It's over 95% effective. And when we have the population dip under 90% vaccinations, we start to see outbreaks. So that is informing kind of how we're determining what the threshold is for COVID-19. Now, COVID-19, nothing really compares to the way in which measles is infectious that lingers in the air for hours. It's why you get advisories if somebody has passed through LAX with measles,

because it can persist in the atmosphere for a while. That's not necessarily the case of COVID-19, but because it is so lethal and problematic and disruptive, the thresholds I've heard have been anywhere from 70 to 85% of the population. That's a lot of people. We have 330 plus million people in America. I've heard at least 200 million will need to be vaccinated, fully vaccinated, in order to get any sort of semblance of herd immunity. And it is concerning that vaccine hesitancy is a persistent theme that could prevent people from getting any doses. It's also concerning that people might not complete their dosage, which would not ensure full protection for the person being vaccinated. Do you have any stats on how many folks out there, at least in America,

are like, nah, I'm good? Yeah, there have been a number of studies or like polls that have been done. And I've seen various percentages. I've seen 30%. I've seen 40%. One poll said 52%, which made me fall out of my chair. And the thing is, you have to also remember that vaccine hesitancy, that's not a monolithic community. There are a number of communities, and I would say namely black communities and people of color who have legitimate reasons to distrust the medical community because of reasons like Tuskegee, gynecological experimentation on black bodies, even what happened with birth control studies in Puerto Rico. So an all too quick but very important aside, in case you're not familiar with these historical

crimes. So the Tuskegee experiment was conducted in the US from 1932 to 1972, and it was run by the US Public Health Services and the Center for Disease Control. And it observed the effects of untreated syphilis in 600 black men, men whom were told the study was for six months, but it lasted 40 years. They were told that they would be treated for the condition, but they were lied to. They all waited for healthcare promise to them, but it was withheld so that scientists could simply observe how they died. 128 of them did from complications. Also in the US, over 60,000 people, typically of color and suffering financially, were forcibly sterilized between 1907 and 1963 under eugenic legislation. And fast forward to now when systemic racism still puts people at risk

and higher proportions of black, Latinx, and native populations are dying from COVID. So before sigh dying, those who sigh die, some medical procedures, this history context and outreach is really important. You know, these are legitimate reasons that have caused the institutions of pharmaceutical companies and medical institutions to become untrustworthy. And that's why I think that this enormous vaccine campaign that none of us in our lifetime have ever experienced or witnessed needs to have as tailored and as concentrated of a vaccine communications campaign to. And with very tailored messaging for communities that may have various reasons for distrusting the vaccine. What's the best way to get the information out to the communities that need it

the most? Yeah, it's not a simple answer because I think, again, these communities, even these communities within the communities are not monolithic, right? And I think they have various degrees of trauma and distrust and confusion because of the messages that have been put out. I think that when it comes to COVID data, I mean, it's already bad, but we already know that it's not even complete. This is like scratching the surface. Our demographic data is just so inconsistent from jurisdiction to jurisdiction that what we think we're seeing is that, you know, black people are dying at a rate that it's at least two times greater than white people in the United States. That alone is just an indication of a widespread problem when it comes to equity and access and

care in the United States. I think that being said, the kinds of messaging needs to come from community leaders. I think we can't just be having top-down white leaders speaking to everybody with one message about the safety and efficacy of it. I think it has to be from black leaders in science and black researchers and other people of color who are in positions of leadership and even community leaders, like I'm talking to everybody from church leaders and mosque leaders and barbershop owners, everybody so that it's becoming a community conversation. I think it's also important to know that this is something that needs to change when it comes to how we even do clinical trials. You know, very early on in the phase one data, the representation

in those trials was really bad. And I was encouraged to see that in the phase three data, we had, you know, I think it was 10% representation with black people in phase three data and 20% in the Latinx community. And we just need more of that. We need more people to participate and to be part of this process. And I love seeing the advocacy for that, but it's shaping the narrative to be a little bit different. It's instead of saying they are not trusting, it's saying the medical institutions are not trustworthy. How do we rebuild that trust? And I think it's through leading through example, it's putting people of color in positions of leadership so that they're running it. I think Dr. Kizmekia Corbett is a perfect example of

a champion for this. She was the lead researcher at the NIH for the Moderna vaccine and has been a huge advocate for representation in trials and even representation in the vaccine and making sure that communities of color are getting the vaccine. Yeah, she's amazing. She should be followed on social media. Everyone follow her. Yeah, she's great. I'm hoping to get her on for a vaccinology episode when things calm down just a tiny bit. She's got kind of a lot on her plate. Moment. So we are fawning over 34-year-old vaccinologist Dr. Corbett, a.k.a. Kizzy PhD on Twitter, whoms you should follow immediately, BTW. Her Twitter bio says, virology, vaccinology, vaginology, veno-ology, my tweets are my own, my science is the world's. So yes,

you'd better believe I am crossing all of my fingers that one day I get to quietly fangirl into a mic with her. She's all over the news for being just an incredible vaccine badass. Also in the news, a New York Times article published last week brought up the lopsided distribution of vaccines, saying, quote, the world that emerges from this terrifying chapter in history will be more unequal than ever. Poor countries will continue to be ravaged by the pandemic, forcing them to expend meager resources that are already stretched by growing debts to lenders in the United States, Europe, and China. And a lot of folks, namely Debra, Lydia Zimmerman, and Hartke, Natalie Bates, and first-time question asker, Meadow Christie, had questions about this.

And a lot of folks on that equity tip wanted to know how do they make sure that everyone has equal access to this, even around the world, in terms of making sure that, yeah, that it's that it's not just the privilege to get get access to this. Yeah. So one of the goals of Operation Warp Speed was that the vaccine would be free to and everybody in the United States, regardless of insurance status, which I think is a good goal. I hope that in practice, that actually happens. I've heard something about maybe the dose itself is paid for, but the vaccine administration is something that is paid for like a copay. I hope that that's not the case. But the intention was that there would be,

you know, free vaccines available to everybody in the United States. Now, there is a very real issue of vaccine deserts that exist in the United States, because of like rural places and even vaccine deserts all over the world. And I think that that is one of the challenges of having these vaccines that require such cold storage. I think Moderna was thinking ahead in the sense that they wanted something that was more shelf stable or I guess refrigeration stable and much more affordable to shift. But these are really expensive logistics and the cold chain process of administering and delivering vaccines and other drugs to remote places is really complicated. I mean, we have seen

war in Pakistan and Afghanistan, you know, cause be directly linked to polio resurgence because they couldn't get the cold chain all the way through without it being disrupted because of lack of refrigeration, lack of power. That's a very real concern when it comes to access globally for the vaccine. So someone just doesn't leave a hot truck on a loading dock? No, they shouldn't. So patrons Deb Berlin, Rosa, Amanda Miller, Leanne Schuster and Rachel wanted to know in Rachel's words, why do different vaccines need different temperatures and other very chill questions? Can you explain briefly what the cold chain process really means why these vaccines have to be so chilled? Yeah. So the mRNA vaccines have to be stored at

extremely cold temperatures because mRNA itself is very fragile. It degrades easily when it's outside of its normal environment inside cells, right? So think of it like food. If you take meat out of an animal, it's not going to just be okay outside. It needs to be refrigerated to preserve it. And because it is so fragile, it needs to be stored at such a cold temperature. Now what they did in making it less fragile, previous iterations of mRNA vaccines proved to degrade much faster. They created these lipid layers outside of it, these fat layers to make sure that it was a little bit more stable. I've got a lot of questions from people about like, oh, can our bodies take injections that cold? It's not administered frozen. It is thought and it's given to people at normal

temperatures. It would not be an injectable. It's a liquid, so it would need to be thought first before it's injected into our bodies. Rene Fuentes had a question. I heard that one of the COVID vaccines prevents symptoms and the other may also prevent transmissions. So what mechanisms in the vaccine could account for and contribute to the difference? Are you still contagious if you've had the vaccine? Such a good question. And it's not necessarily the mechanism that we're looking at. It's how the study was designed. So the Moderna vaccine trial ended up having some data that showed that asymptomatic transmission was reduced because they looked for it, right? It's kind of like a project where you put out all your questions

that you want to answer and you collect the data that you were able to answer. Pfizer didn't have that on theirs, but it's not to say that it's not. It's intended to do both. It's intended to prevent severe illness because what we want to do is avoid people going to the hospital and dying. But it's also intended to prevent infection, primary infection and secondary infection. The real way to know that is through real life. And the way to measure it in a trial would have been to do a ton more testing to see kind of who was testing positive and if they were getting sick or getting other sick. So Jessica reminds us that these trials were designed with the priority of reducing severe illness. And they're going to be analyzing this data for a lot longer and

observing the duration of the immunity. Now, phase three trials involved tens of thousands of people and they found that the vaccines prevented severe illness in around 95 percent of them. That's huge. And remember, these rates were determined seven to 14 days after the second dose. So by no means is someone in the clear if they've just got the first shot. The CDC says that no matter how your body learns about the enemy, whether it's through attenuated live virus or dead viral strains or in this case mRNA protein building instructions, the body is left with a supply of memory T lymphocytes as well as B lymphocytes that will remember how to fight the virus in the future. And the CDC says it typically takes a few weeks for the body to produce the T lymphocytes

and B lymphocytes after vaccination. Therefore, it is totally possible that a person could be infected with the virus that causes COVID-19 just before or after vaccination and then get sick because the vaccine just didn't have enough time to provide protection. It's kind of like you can't expect to harvest carrots the same day you buy the seed packet. Your immune system has some work to do. So please see my blood boiling reading a misleading clickbait headline about someone who came down with COVID a week after vaccination. Now, as for contagious ability, which is sadly not a word, scientists don't know yet if the vaccine prevents a symptomatic infection or if vaccinated people can transmit the virus if they have an asymptomatic infection.

So they have some numbers to crunch. They have some data to collect. Just give them a second people. In the same reason why we haven't said that once you get it, you're immune for life because we haven't had long-term data to make any conclusions about anybody's immunity. But what we do know is that vaccines typically induce a much more robust immune response, more robust than a natural infection. In a case like this, we expect that a vaccine will produce a stronger immune response than a natural infection. Oh, okay. That's good, right? That's the hope, yes. Now, what about shape-shifting? Is SARS-CoV-2 the virus that causes COVID-19 symptoms mutating? So I think all of us, including patrons Rachel Weiss, Tanya Hoochert up in Canada, Casey Kaiser, Vanessa

Frye, John Galvin on behalf of their favorite person, Sam Kilger, Melissa Wise, Caitlin Powell, Starr, Kat Lindsay, Rebecca Wolford, and first-time question-askers Sarah Gandy, Madison Campbell, and Perry Wilson are curious and probably a little-skirt TBH. Many people asked about different strains. What's going on with the new flavors? Yeah. So in many ways, they're not new. I think the one thing that can be very comforting to people is knowing the fact that RNA viruses mutate all the time, and they mutate as they replicate, and they replicate through new transmission. So those are a lot of big words there. It means that the more cases, the more bodies that it finds to go into, each time it replicates, makes more of itself, it has

these mutations. Now, mutations sound like a very Frankenstein scary, apocalyptic kind of thing, but it's really not. Sometimes it's as benign as a typo when you're sending an email. Now, yes, some typos can be horrible, but we're not seeing this turn into something that is so unrecognizable, that we have concerns about the vaccine efficacy. I think that's on everybody's mind right now, is that are we basically vaccinating ourselves against something that is no longer the threat? I think that's not the case. We don't have any data to suggest that the mutation has outpaced what the vaccine will prevent. In fact, it's much more likely that this vaccine will still be effective against all of these vaccines because the vaccine is triggering the very infamous

characteristic trait of the virus, which is the spike protein. And I think that we still need to be studying this, but I don't think it's any cause for panic. Viruses mutate. It's very normal. We probably have had cases of these mutant strains or these variants of the virus in the United States for months, and we're just identifying it now, and I don't think it's any cause to panic. But in case you're wondering, does this strain seen in a rise of London cases have a name? Sure, you can call it SARS-CoV-2-VOC-2020-1 or B117 for short. Now, it's got a few mutations, one being in the receptor-binding domain of a spike protein at a very specific position, but vaccines are what is called polyclonal, which means that they reproduce

a few different spike proteins to teach the immune system what to look out for. Scientists think this strain doesn't cause more severe COVID-19, but it does appear to be more contagious. And with 1.3 million travelers just loping through US airports just this past Sunday after the holidays, well, get cozy in your jammies, folks. Southern California already has six cases of this new strain at press time. New York's got one, so there's still plenty of time to Marie Kondo, the linen closet, maybe the entire garage. I think what the underlying theme of this topic should be is trying not to get it, period. This should be the biggest reminder to folks that we're in this until everybody gets vaccinated. So keep wearing your mask,

keep practicing physical distancing, keep saying no to social gatherings, and stay outdoors as much as possible because the less opportunities that the virus has to infect new people, the less opportunities it has to mutate. Good point. And so to all the folks who asked, can you transmit it if you're vaccinated, such as Rene Fuentes, Jim Ottaviani, Hannah Sawyer, Alison Lopez, Pandora too, Amanda Chris, Samantha Steeleman, Erin Doherty, Camisha Cassidy, and toxinology guest, Anna Thompson. Right now, transmission is not the focus of the vaccine, and they're still gathering data on that. What they do know is that getting the vaccine prevents you from developing serious illness from SARS-CoV-2 in the form of severe COVID-19. So it's not an eraser

for the virus. As one patron, Samantha Wolff wrote in, please, please address vaccination versus being able to spread COVID. People need to understand that vaccinated people can still spread COVID. My vaccine is to protect me. My mask is to protect you, they said. And Jessica echoes that. There's still a lot of data to collect, and that process will be ongoing. Amy Meager wants to know, when will we have evidence that the vaccine works to prevent infection? All of the trials were essentially designed to have a readout when they got a certain number of cases that were testing positive, right? And that is because they wanted to know who's getting sick, even when they got the vaccine and versus the placebo based on kind of normal

circumstances. And they know that these cases, the ones who got sick, were very benignly sick. What we don't know is the ones who are asymptomatically sick because they may not have been tested. But again, it requires so much more testing than what was available in the trials to determine if that was happening. And I think that in the next several months to a year, we'll know more about people who were vaccinated who did not get sick at all, whether asymptomatically or mildly symptomatically. When it comes to infodemiology, is that hard to explain the difference between getting the vaccine being infected, but being asymptomatic versus getting the vaccine and being impervious to further infection? Yeah. So I think a lot of people want to know if you get

vaccinated, can you still transmit it? Ideally, the answer would be no, right? That you would prevent yourself from getting the virus and transmitting to others. But we do know that people who got the vaccine in the trials still got sick. They just got very benignly sick, like very mildly sick. And so if that's the case, they could theoretically still shed infectious virus to others, which is why I think, again, it means that we're going to be wearing masks for a lot longer until we can make sure that most healthy people who are able to get the vaccine are protected. That makes sense. So Biden has said that he plans to roll out 100 million doses in the first 100 days of his presidency. Dr. Anthony Fauci is like, it's doable. So right now, 15 million

vaccine doses have been distributed in the US, but only around four and a half million of them have been administered. Meanwhile, the more contagious variant SARS-CoV-2 VOC 2020-1201 or B117, if you're nasty, is out there. So if you can get the shot, stay alive and let's kick this thing. Let us get reacquainted with pants again. Some people who might be perhaps a little bit scared, Jillian, first-time question asker, says, with how quickly the vaccine was made, we have no long-term studies on how long it will affect us. Is this as scary as it sounds? And Brenna says my question exactly. And Marina Grubanov, who is a first-time question asker, says the vaccines have only been tested with adults. How do we know if it's safe for kids?

How do you allay those fears even in a scientific podcast listening community? There are some people who are like, should I be freaked out? Yeah, that's a legitimate question. And I think the answer for the long-term thing is actually quite simple. So the majority of effects adverse events that happen from vaccination happen within hours or weeks of vaccination. We don't see people years later down the line having severe adverse reactions to vaccines, which is precisely why the FDA did not allow either of the vaccine companies to submit for an EUA until they had at least two months post vaccination data, because it is typically the time frame in which most adverse events,

specifically severe adverse events, will manifest in somebody's body. So because of that, I'm not concerned about long-term effects because what we know about the biology of how vaccines work in people is that events would have happened within the time frame of these trials and in the first few months. So if it hasn't happened yet, it's unlikely. And that's great news. Now speaking of expectations and expecting, what about folks with a bun in the oven just out there all prego or nursing? So a lot of you, including Deborah, lactation consultant Betsy Hoffmeister, Diana Burgess, Michelle Krebs, Alison Lopez, and Samantha Wolfe. Oh, and a few people, Zoe Jane and Courtney Jones, essentially asked vaccine and pregnancy slash breastfeeding. What do we know?

What are the unknowns? What's the what? And Courtney Jones says, came here to ask this too. Okay, perfect. I realized I didn't answer the other question about kids. I will say that there are protocols being written right now. Moderna has planned to do a pediatric trial come next year, so that data is going to come because children have not experienced the most severe outcomes of the disease in general. They're not the highest risk. This sounds callous, but they're not as highly ranked in the order of who needs to be vaccinated right now. But I think that'll change in the next year or so with some trial data and availability. Now with pregnancy and breastfeeding, this is something I care deeply about because this is an issue of autonomy.

So no pregnant folks were enrolled in the trial. However, some people in lockdown may have binged their entire streaming catalog and gotten a little busy doing other things. But there were pregnancies reported in both Pfizer and Moderna. And those pregnant people who got the vaccine had much better outcomes than the pregnant people who got the placebo. In fact, all the adverse events that happened in pregnancies were involved in the placebo arm. So I think that that should be reassuring for a couple of things. I think it's showing that one, it's not causing infertility because we know that there were pregnancies that happened in both of those trials and two, that it was protective. Now, another thing to consider is the fact that

pregnant people are often not included in these trials. And that's because of this abundance of caution and not wanting to cause any kind of concerns for the fetus. But there is two people involved here, right? There is the autonomy of the woman who is pregnant, the person who is pregnant, who should make that choice for themselves. And I think this brought up a really important question for people about who can make that choice for a pregnant person. And flu vaccine is a perfect example of we have decades and decades of data from its public use in pregnant people to show that it is safe and effective. We're probably going to see the same thing with the COVID-19 data. And a number of groups, I think it's the American Academy of

Obstetric Care and another one group of physicians who said that they do recommend that pregnant people and people who are lactating not only just be given the right, but they can get the vaccine to prevent infection. What we do know about the virus is that it is not good for pregnant people because being pregnant is considered an immunocompromised state. And the risks of a COVID-19 infection far outweigh the unknowns of the COVID-19 vaccine, which we don't expect to be bad. So getting the virus itself while pregnant could be very risky. And the vaccine may be less risky than getting a bad case of COVID, but more testing is needed. Also, what if you have a kiddo? When can they get the vaccine? Well, the Pfizer vaccine is approved

for 16 and older and the Moderna is for adults aged 18 and up. And according to the CDC, among people who participated in these clinical trials, 22.3% had at least one high risk condition, which included lung disease, heart disease, obesity, diabetes, liver disease, or HIV infection. But vaccines may not be an option for every individual, which is why keep those masks in rotation, folks, and wash them. I'm talking to myself. I know I have a couple of funky ones. In my car, I'm a human. You know, on that note, Nolan Childerhouse says how is testing going on immunosuppressed people getting COVID, getting the vaccine? And they say after my second organ transplant in July, will I have to wait for herd immunity? Yeah. So that's a good question that I

think I can't answer because, one, I'm not a physician and I think this is going to be very personalized per person. I have seen pictures today on my Instagram of people who have chronic illnesses and immunocompromised states who were getting the vaccine, people who are frontline healthcare workers who are also dealing with comorbidities themselves. And I think that has to be a decision that is decided between your provider and that person. They weren't specifically enrolled in the trials because the trials intended to get healthy adults first. We don't have data for it. But again, I think this is going to be one of those things where do the risks outweigh the benefits or do the benefits outweigh the risks?

We did get a lot of questions too about the cytokine storms and autoimmune response being a huge factor of risk when it comes to this infection. And how does that affect those with autoimmune disorders getting the vaccine? Yeah. Again, I think that that's going to be a very tailored response. I've heard from doctors who like MS doctors, whose patients are on immunosuppressive drugs that can tend to fare better because of the way that their body responds in produces cytokines. It's going to be very, very specific to the type of immunosuppressive state that you're in, whether it's medically induced through medicine induced or just because of the illness itself. And I think that, you know, I remember early on, a lot of doctors were

saying that what was causing people to die were these cytokine storms and the body's immune system just attacking itself. And I think we're getting better at caring for COVID and trying to prevent that. And I think that we'll continue to get better at that. And I think that some of the therapies is probably the next frontier for major innovation because right now it looks like dexamethasone, which is a steroid, is probably our best bet. But we need some more solutions to prevent these types of things happening. And, you know, one listener wrote in named face, and they said, this isn't so much of a question as much as an expression of gratitude. Thanks, Jessica, for all the extra stuff you do on Instagram, as well as your real life work and the

COVID tracking project, and says about you that your stories have been an absolute rock of information through the rough seas of this pandemic. And I'm so thankful that she had shown up to help us non-doctor scientists, people navigate absolute superhero. Thank you, thank you, thank you. That is someone named face. Oh my gosh, that's so sweet. That's so sweet. Thank you. It's my joy. It's overwhelming, but it's truly my joy. Oh, another fun fact. If you have just shrugged yourself out of the entire vaccine conversation because you've already had COVID-19, first off, I'm very glad that you are on this side of the grass, as my pops would say. And I hope you're doing well, and I'm so, so sorry to everyone who has lost someone. But if you have had COVID-19,

you still need a vaccine. Scientists say because reinfection is possible, and it can, let's be honest, be brutal, it's recommended that people who have already had COVID-19 get a COVID-19 vaccine. My 2021 vision board involves Oprah with a syringe just doling out vaccines like cars while I just lose my mind. Also, I'd like to have more milkshakes. We got a few questions about the essentially the heart of vaccine infodemiology, which is information, a lot of information, and not knowing what to trust, especially nowadays when before you'd have to own a newspaper to put out widespread misinformation, and now you just have to kind of click send. And Hannah Sawyer wrote in and said, first time asker and proud disabled woman with compromised respiratory system.

I had read recently that the majority of children who aren't vaccinated are the kids of white parents who have a household income of above $75,000 a year. What's the deal with certain populations being given information that makes them distrust that? Yeah. There are a lot of interesting facts about the demographics of people who are vaccine hesitant or anti-vaccine. I think that there is a case for the typically white privilege type of demographic that happens. You see that with kind of what's been represented in like the outbreaks in the Waldorf schools in California that usually is a type of demographic that is privileged and has access to a lot of information, but also chooses to kind of partake in a lot of maybe pseudoscience and wellness stuff

that is scientifically not very sound. And then you also see the disproportionate burden of misinformation, targeted misinformation that happens in immigrant populations and communities of color, where people may not have access to social media or the internet or other resources that can help them parse through what is good information and what's not. And so I think that this group is also not monolithic. Vaccine hesitancy is not monolithic. You'll see general diversity in the people who are against it, which is why I think that vaccine communication needs to be very nuanced and very targeted. When it comes to a lot of vaccine misinformation right now, and social media is just a hot bed of it. It's really overwhelming. I report

false information constantly on Instagram. And I think that a lot of it is intended to emotionally manipulate. And I think that what it comes down to is a strategy to create fear and panic among parents who are trying to make informed decisions. And I'm trying to look at it with the same lens in the sense that I'm saying, I as a parent too want to make informed decisions, but I don't want to be making them out of fear. I want to be making them based on data, based on scientific consensus. And quick history. So in 1998, a gastroenterologist by the name of Andrew Wakefield did a very small, unethical, and now fully repeatedly debunked study on the role of measles, mumps, and rubella vaccines in autism rates. And certain pop cultural figures ran with it.

Now, again, repeatedly debunked. Now the damage has been done from that and it's been immeasurable. And Jessica notes that social media sites giving more attention to the most shared posts means that disinformation disguised as whistleblower campaigns gets much farther than the reach of vetted journalism sources. A lot of parents, historically moms and women and people who raise children may have experiences of exclusion from major health studies or have their symptoms shrugged off by sexist doctors of the past. So they may also have a distrust of Western medicine. So if public health and ending a pandemic that is killing people's loved ones is a team effort, how do we have these conversations? And a lot of you wanted to know.

I'm looking at you, Rainbow Warrior and veterinarian Mary Ann Thomas, Rebecca Kitter, Rachel Kasha, Riley McInnis, Adam Weaver, Liana Herrick, Deb Berlin, Julia Heyman, Julia Splitorf, and Dawn Swart. You know, on that note, Jessica Janssen and Jessica Freyland both asked, how can we, in Jessica Freyland's words, the non experts help others trust the science and the vaccine? Any easy talking points or what can you tell people who are completely against vaccines and Jessica Janssen says, I have heard that anti-vaxxers is not a nice term. But what can you tell folks who are vaccine hesitant? Yeah, you know, as a science communicator, a lot of my job is discerning what's worth debunking. Sometimes if you give attention to

something that seems so outlandish, you end up breathing more life in it than is necessary. And I think that some things just need to like die because it's probably less of a concern than you think. It's also important to remember that this is a loud minority. They are not the majority of people and I agree that anti-vaxx, anti-vaxxer can be divisive terms. I try not to use them unless I'm kind of being specifically targeted by somebody who is, you know, aggressive. People who are vaccine hesitant, they're also kind of a different group. They're the ones who earnestly want to make choices but feel either overwhelmed, know somebody with a vaccine injury, which again, I think is an important thing to remember,

that to deny a vaccine injury is very ignorant. They happen, they're just extremely rare. So I think it's about knowing which battles to pick, whether to pick it, and encouraging people to just be good consumers of information. So a lot of times, if you ask yourself the questions of who, what, when, where, why, when it comes to sources on social media, you could probably determine a lot of details about the information. So who, check the source, make sure that the person is, you know, coming from either scientific consensus or if they're not, that's a red flag. What is it? Are they, is it a hot take? Is it a forwarded message from a WhatsApp chat room or something? You know, when a lot of times this data, this stuff that they're sharing is outdated,

a lot of times they're posting links that are broken but it looks like a PubMed link of some sorts and people think, oh, that must be data. And why? You know, ask yourself, like, why are they posting this? Is it to send you to buy supplements? Is it sending to buy some essential oils and some detox tea that's going to like take the metals out of your body? I mean, there's a lot of very simple questions you can ask to kind of get to the bottom of why these posts exist online and how you can train people to be good consumers of information. Is there typically a money trail when it comes to disinformation? Oh, absolutely. I mean, snake oil sales people have been around since the beginning of time.

Anybody who's going to take you away from what they're calling, you know, big pharma. And if you look at people who are trying to say, oh, big pharma is corrupted, full of money, these people are getting paid to do all this stuff. If you look at the other side of it, like, well, you know, there are these, you know, multi-level marketing schemes of selling different products that are intended to take people away from what they call too allopathic of care. I think there's a lot of benefit to things being non-traditional and non-allopathic, but it's now created a whole brand of care that causes delayed diagnoses and fraudulent testing and supplements that are not only expensive but not helpful. I feel like emotionally, there must be a lot of sociology behind

understanding the fear, some sort of expression of control over your own fate if you are deviating from what you think is being fed you. Yeah, there's a lot of pathology to this. So there is a insatiable hunger, you know, for solutions and for remedies and for answers to these very big unknowns. But when you get people when they're emotionally weak like this and desperate, that's where it becomes extremely dangerous. You know, the misinformation, the disinformation, which is intended to harm, travels faster and farther than the actual data and science, which makes the job of scientists and science communicators that much more challenging because we're putting out two fires at the same time and one of them is growing faster. So if you need to have this

conversation with someone in your life, there are a few ways that you can broach it. You can always remind them that we know the effects of COVID-19 and they can be long-lasting. The Mayo Clinic lists them as lasting damage to the heart muscle, even in people who experienced only mild COVID-19 symptoms. And this can increase the risk of heart failure in the future. There is scar tissue that can develop in the lungs, leading to long-term breathing problems. There's also neurological effects. And the Mayo Clinic says, even in young people, COVID-19 can cause strokes, seizures, and Gillian Barr syndrome, which is a condition that can cause temporary paralysis. COVID-19 can also increase the risk of developing Parkinson's disease and Alzheimer's disease.

There's also mood changes and simply surviving this experience, the Mayo Clinic says, can make a person more likely to later develop post-traumatic stress disorder, depression, and anxiety. Now, as for the vaccine side effects, right now it's known that soreness and the injection site and fever, both to be expected as the immune system response, are common. Sometimes just being an alive human means dealing with shitty or unsafe circumstances. No one wants a virus. But how lucky are we that people have committed their lives to finding solutions that can help us dodge this bullet? I found a really interesting piece by Dr. Robert James Kim Farley in the American Journal of Public Health. It's from 2017. So he writes this analogy

about a disease being like a curve on the side of a mountain where there's a cliff. And 100 people a year go off of the cliff and die. That's like the disease. So what do you do? You build a guardrail and that prevents those 100 people from dying every year. But let's say three people a year get injured hitting the guardrail. Some might argue, let's nix the guardrail. Guardrail is dangerous. However, what you have to do is say, well, 100 people would have died. So overall, the guardrail is a wise precaution to take. So the cliff is the disease. The guardrail is the vaccine. So guardrails, they're here for you. Now speaking of side effects of vaccines, this next question was asked by Julie McDonald and Vesper Holly and Justin Roberts, who wrote, I received my first round

of the Pfizer vaccine on December 18th and experienced mild to moderate pain at the injection site on days one and two, and then some mild fatigue, chills, and bone pain at the end of day two, which went away after a dose of naproxen and a full night's rest. No other side effects after that. So first off, to anyone who's gotten it, yes, way to go. I have several friends in medicine who have had their first dose and are so thrilled. But why the ouch after a vaccine? And yes, tell anyone who asks that Dr. Ward said that you deserve a lollipop or a milkshake or whatever you need. A lot of people had questions about they just wanted to know, why do vaccines make my arm sore? What's the biology there? Do we have any idea? Yeah, you know, that's actually a good

sign. And what I'll also say on the flip side of it, if you don't get a sore arm, it's not a bad sign, but it's a good sign because what's happening is your body is saying, wait a second, there's something in here that should not be in here. I'm going to fight it. It is a physical sign of your body mounting an immune response, identifying a foreign thing and saying, I need to fight this. And a lot of times, it's injected intramuscularly, so that whole fight, that brawl is happening in your muscle, so it can cause some soreness. I think I'm pretty sure I know the answer, but last questions I always ask, the hardest thing about your job. So it's in your title, like a vaccine infodemiologist, pretty sure it's misinformation, but anything that just really

sticks in your craw. You know, I would say two things. You know, being this close to the data wears on you because it's not just numbers. It's not just spreadsheets. It's not just plots on a graph. It's people. When these numbers become so astronomically high, it can be desensitizing, but then it can also just hit you like a ton of bricks. And when we started seeing hospitalizations creeping up into them, you know, over 100,000 and plateauing there and staying high in the hundreds thousands, and deaths now exceeding, you know, over 330,000, it gets to be very emotionally taxing. And I think that is connected to the second thing, which is the misinformation about those specific data points. To me, seems just impossibly insensitive. I think the fact

that there are people who still question the validity of the death count and the validity of what's happening in hospitals is so, it's so deeply insulting to me as somebody in the data, and to the 330,000 families whose lives will never be the same because of the loss that they had this year, who had to say bye to their loved ones probably via FaceTime and to the hospital staff people who are absolutely risking their lives and trying to just keep people alive while they're doing it. It just seems especially, especially dark. I mean, I'm used to vaccine misinformation prior to this pandemic because I worked on pediatric vaccine education. But this is a next level type of insensitivity when they specifically question the motives of healthcare providers

and even the data itself. I can't imagine having that be part of your work where you can't just tune it out and go back to your normal job and hear about it in blips on the news. And especially being in Los Angeles right now, we're both in LA, not too far from each other, any message that you would give Angelinos in particular who are hearing this? Yeah, I think the situation in Los Angeles right now is deeply concerning. I think that a lot of it has to do with the fact that there are a lot of people who feel tired of all the negativity and tired of the sacrifice and tired of the burden that this has had on us, but we're just not through it yet. We're actually in the worst of it. In many ways,

the CDC gave the city, the county, a very high social vulnerability score and that's based on a lot of things. It's based on income averages and education averages and housing averages. And this county has 10 million people. That's right. LA County has doubled the population of New Zealand with some of the highest priced real estate in the nation and $1,200 plus $600 of economic relief so far. In case you're wondering, the average price for rent in LA is $2,375 a month for roughly 800 square feet. So the COVID rates and the rent are both just too damn high. And there are a lot of people who are essential workers working in places that super spreading events are happening. Yes, there might be a lot of cases that are happening among

homeless people and among people who live in multi-generational crowded homes, but those people don't live in vacuums. They don't live in bubbles. Those people interact with you because they're the ones that are providing your meals. They're the ones that are cleaning up in the hospital that you're maybe going to. They're the ones that are interacting with you on the street or in the grocery store. So I think it's important to know that this city, you're one degree separated from a lot of these cases given how high the incidence is in this county. And I think that we're in for some dark days in LA County and in California in general. And I think it was prudent for the state to actually order things like refrigeration trucks and extra body bags because there are reports of

people in hospitals that are being turned away or just being shuttled around in ambulances because they can't find a bed and beds even popping up in gift shops. I mean, this is as acute as it could get. So this is serious. And this is an industry built on tourism, on multi-million dollar film and TV sets. And the networks expect you to get it done somehow. I mean, I've been shooting intermittently since July, but the Screen Actors Guild just issued a statement today as of this recording asking to halt productions. And when I tell you to ask smart people absurd questions, I want you to know that I live this. When you heard Tom Cruise's rant, were you like, yes, tell it like it is?

No, because I think that what he was doing is in public health considered very, very ineffective. You know, I mean, I was like, yes, in the sense that like, please stop cutting corners and be safe and etc. But you know, shame is not, shame and fear and anger are not good approaches when it comes to helping behavior modification. We know that from sex education. Like that's just not how you get people to avoid risk. It's repetition. It's giving people the benefit of the doubt. It's saying things with gentleness and kindness. Hey, buddy, I understand why you're closer than three meters, but I would be so funk and grateful if you just kept a protocol so this set doesn't get shut down, nut or fluffers. And that's why I feel very strongly about, you know, my platform

being a judgment free zone. Do I need to call people bleeping bleeps and screaming at them and telling them that they're going to be like cut off because they're doing it? No, that's just not how it works. Public health requires a lot of nuance and it requires a lot of empathy. That's such a good message. I'm so glad you said, I'm so glad I asked a Tom Cruise question. Never thought I would, never thought I would ask one. We live in a cynical world, a cynical world. What about your favorite thing about your job? Oh man, I mean, honestly, it's so surreal that I'm doing what I'm doing. I, in grad school, 10 years ago, I was like the girl at parties who would people be like, so you're studying infectious diseases, like why? Like because there's probably

going to be a pandemic again. And you know, I just, I remember having conversations with friends and then asking me like, what are you most afraid of? And I was like, a pandemic of respiratory disease. And like here we are living my actual nightmare. Nailed it. Oh my God. But also the thing that I feel so prepared for and the fact that I can share this information. I mean, the only reason why I started doing these explainers on social media was because I started just getting all these texts from friends and emails saying like, can you explain this and what's the cytokine storm? And all this stuff. And I thought, you know, I'll just do some like science 101. And I had no idea it would turn into what it turned into. So what it's turned into,

by the by, are 173,000 people following her on Instagram for her great COVID updates. Isn't it kind of nuts to think that you've saved lives? Well, I can't even think about it that way. It's overwhelming. I mean, that must be like to think that just by disseminating correct and helpful information, you have avoided families having to have Zoom funerals. Oh my gosh. I mean, I try to tell people and empower people that every one of those sacrifices they make is saving a life. You don't know what you're preventing. And in many ways, public health is a thankless job. You know, you don't look back and say, oh, look what didn't happen. You look at it retroactively and say, oh gosh, it could have been so much better if we had done these things.

And I think we'll still say that. But I also think that those who have been valiant and dedicated in their sacrifices, they should know that none of these things are for nothing. Such a good message. Thank you for doing what you do. Thank you for hopping on the phone with me and like literally like a moment's notice. This is so fun. I loved it. So ask smart infodemiologists questions about Tom Cruise because you know what? You only live once and hopefully it is not cut short by a pandemic very sincerely. So to see more stats, you can head to thewonderfulcovidtracking.com. You can follow our guest at the links in the show notes. There will also be a link to her link tree in the show notes, as well as 1 to 500 women scientists.

We are at oligies on Twitter and Instagram. You can be my friend on both at Alliward with just one lonely Ellen. You can support the show for a buck a month and have me awkwardly lob your questions at experts. That's at patreon.com. You can get oligiesmerch at oligiesmerch.com and you can find other oligites in the wild. We do have masks and they accommodate a filter, folks, if you need them. Shannon Feltis and Bonnie Dutch manage the merch. They also host a podcast called You Are That, which is hilarious. Thank you, Erin Talbert for admitting the oligies podcast Facebook group. Thank you, Emily White and all the transcribers for helping make this podcast available to deaf and hard of hearing folks. Those transcripts are available to anyone.

They're up at alliward.com slash oligies-extras. There's a link to that in the show notes. Thank you, Caleb Patton for bleeping episodes to make them kid safe. Those are up at the same link. No, well, it's a worth. Make sure I show up to interviews at the right time in the right time zone. Assistant editor, Jared Sleeper, helps put it all together each week alongside the man, the mustache, Stephen Ray Morris, who hosts the podcast The Percast and see Jurassic Wright. Nick Thorburn wrote the theme music and he is in a very good band called Islands. If you listen to the end of the episode, I tell you a secret. This week, the secret is that I started using this app called Freedom. They are not a sponsor and they block certain websites

for certain periods of time so you don't wander off like a lost donkey. But one thing they have is a cafe option where you can play ambient noise. And I realized that I kind of miss working in coffee shops. And sometimes I think that when I get distracted from work, it's just sometimes because I feel lonely and I just want to hear people chattering. So listening to ambient coffee sounds, I think they also have some cough fettivity. It's kind of like the anti-pandy days, which means before the pandemic. And I wanted it to become a thing like anti-pandy, but I'm just going to keep trying to fetch it. Nobody wants this term, though, except for me. Anyway, okay, stay safe, get your shots, wash your mask, teach from your fingers. We got this. Bye-bye.

Just give me a shot.