This Podcast Will Kill You - COVID-19 Chapter 12: Control, Take 2

Episode Date: December 10, 2020

That’s right, we are rebooting our Anatomy of a Pandemic series in which we cover various aspects of the COVID-19 pandemic that has held the world in its grip since early 2020. Since our first episodes in the series dropped in March of this year, we have learned quite a lot about the SARS-CoV-2 virus, the disease it causes, patterns in its transmission, and of course, how we can best control it. In our first episode back, we focus on this last facet by exploring what we now know about policies and practices that work best to slow the spread of this virus and dive into some of the nuance surrounding masks, infection hot spots, and traveling. For this episode, we were so delighted to chat with Dr. Saskia Popescu, infectious disease epidemiologist and infection preventionist and Assistant Professor of Biodefense at George Mason University (interview recorded December 4, 2020) (Twitter: @SaskiaPopescu). As always, we wrap up the episode by discussing the top five things we learned from our expert. To help you get a better idea of the topics covered in this episode, we’ve listed the questions below: What have we seen so far in terms of regional or statewide control policies or practices that seem to best work for infection control? How might something like a nationwide mask mandate or even just fact-based, rational messaging have changed the course of this pandemic in the US? Can you highlight some of the patterns in the policies or practices of the countries where COVID-19 has been pretty well managed, in your opinion? Basically, what are other countries doing better than we are? Which individual behaviors or practices have been shown to be the most effective for virus control? Can you break down some of the different types of masks and explain which types of masks seem to be doing a pretty great job of slowing transmission and which ones may not be as effective? Our knowledge of where transmission is most likely to occur has become more nuanced as the pandemic has continued. How do things like grocery store visits and outdoor runs compare to indoor dining or working out in a gym? What are we seeing as hot spots of infection and what are safer than we previously thought? Although we know much more now than we did at the beginning of this pandemic, the fundamentals of the virus’s transmission and the ways we can control it haven’t really changed. So where is this surge of cases coming from? Do you think the lockdowns or increased restrictions being put into place in some high prevalence locations will have the same effect in flattening this third wave as they seemed to earlier in this pandemic? Do you think we’ll see a reduction in seasonal respiratory infections overall due to the mask wearing, increased handwashing, and social distancing people are practicing? What are the steps people can take to be as safe as possible if they are committed to traveling during this holiday season? What would you say to those experiencing COVID fatigue? See omnystudio.com/listener for privacy information.

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Terms and conditions apply. Visit blueapron.com slash terms for more information. This is Special Agent Regal, Special Agent Bradley Hall. In 2018, the FBI took down a ring of spies working for China's Ministry of State Security, one of the most mysterious intelligence agencies in the world. The Sixth Bureau podcast is a story of the inner workings of the MSS, and how one man's ambition and mistake. opened its fault of secrets.

Listen to the Sixth Bureau on the IHeart Radio app, Apple Podcasts, or wherever you get your podcasts. I'm Amanda Knox, and in the new podcast, doubt the case of Lucy Letby, we unpack the story of an unimaginable tragedy that gripped the UK in 2023. But what if we didn't get the whole story? Evidence has been made to fit.

The moment you look at the whole picture, the case collapsed. What if the truth was disguised by a story we chose to believe? Oh, my God, I think she might be innocent. Listen to Doubt, the case of Lucy Letby, on the IHeartRadio app, Apple Podcasts, or wherever you get your podcasts. My name is Andrew. I live in Pennsylvania, and I've been a registered nurse for about four and a half years. I work on a respiratory-focused ICU, and shortly after the pandemic hit, we became the designated COVID unit for the hospital. We saw many patients, but one question always hovered in our minds.

Why do some people get it worse than others? This was never more poignant than when we had a husband and wife couple on our floor. Each patient on my unit has a single room with no roommate, but we had these two patients visit each other for as long as possible every day, coordinating with respiratory physical therapy or technical partners and our doctors to make it happen. Their status ebbed and flowed for quite a while, but eventually on one really tough date for the staff and obviously the patients. A decision was made to put the husband on what we call comfort measures only,

where we switch our goal from treating. the disease to treating the symptoms and making the patient comfortable, and we removed the high flow oxygen that was keeping him alive. His wife was wheeled into his room, hooked up to her own high flow oxygen the whole time, and she held his hand while he passed. She survived and transferred out of our unit a while later. On a day previously where I had been taken care of her, she had told me that the only thing she wanted was for both of them to have the same outcome, either both live or both die and COVID decided differently. My name is Heather. I work in theater and film and TV as a costume designer and assistant

costume designer in New York and across the country. Or I did. Every single arch job I know of stopped due to COVID. New York is an expensive place to live. I personally had to leave and move my whole life into a storage unit. I'm lucky and I'm able to live with friends in D.C. Everyone I work with is suffering. Many, many of my friends and coworkers got sick very early in the pandemic. Some world told not to get tested because there were not enough tests. Everyone has been watching their bank accounts drain with very little possible work on the horizon. Recently, some work has restarted in TV and film.

However, it's not enough work for everyone to get back at it, not to mention that TV and film is an incredibly exhausting experience at its best of times. And now, with limited contact with coworkers, isolated lunch hours, and pod work groups, much of the joys of the job are gone. All socializing, and most of the collaboration, the heart of arts work, has been restricted. It's also not a guaranteed safe space. You don't have a lot of space between you and 500 background actors. It's not just your personal health you have to worry about. It's your family and your neighbors. It's a dense city that takes its civic duties seriously. No one wants to be part of the spread,

But how can we earn our rent money? Theater, my primary source of work, is still completely gone. Broadway is dark. All of the beautiful and kind people I work with on stage and backstage are living on pennies and hoping for some kind of magic to restore our safest and most sacred space. The arts are a local, national, and international community about coming together and telling the truth. Whether it's funny, serious, scary, or satirical, bearing witness to someone's truth, is essential to our human condition.

How much TV have you binge? How much music have you listened to? How much has it helped to soothe your anxiety and lift you out of your depression? Not just during this pandemic, but always. The arts affects you every day. We want to come back. Often our industry is painted as worthless.

However, Winston Churchill himself said, when asked if he should cut arts funding during World War II, do. If we cut the arts, then what are we fighting for? We want to work. We want to do it safely for ourselves, our loved ones, and our local and global communities. Thank you. Hi, I'm Aaron Welsh. And I'm Aaron Alman Updike. And this is, this podcast will kill you. Yay! Welcome back to our anatomy of a pandemic series. Yes. It has been nearly nine months. Is that right? That's since we like first did that that big drop of episodes. Wow.

Yeah. A lot has happened in that time period. So much. So we thought that for a number of different reasons, it's about time for an update. Yeah. So I think like reason number one is that we've learned so much more about SARS-CoV-2, the disease that it causes, how it's transmitted, and the steps that we have or have. have not taken that seem to best control its spread.

Yeah. The second reason is that right now, especially, cases are enormously and terrifyingly on the rise. Yes, they are. And the third reason is that the mistrust in science and the disinformation that has been spread by the Trump administration and some other elected officials has already done unfathomable damage. And so, you know, let's inject a bit of rational science-based thinking back into our lives. Let's do that. I think that sounds really great, Aaron. Yeah. Yeah. For this new batch of episodes, we'll be revisiting some of the topics that we covered earlier this year, including aspects of the disease, virology, the epidemiological characteristics,

and of course the one that everyone wants to know about, vaccines. Yes, vaccines. But we want to get these episodes to you as fast as we can get them ready, which means that the schedule for their release might look a bit wonky. So definitely subscribe to us through your podcast app and on social media to see when we drop a new episode. Exactly. You don't want to miss anything. And if there are additional aspects that you'd like to see us cover or particular questions that you have, feel free to send them to our email. this podcast will kill you at gmail.com or through the contact us form on our website this podcast will kill you.com. And of course we are still soliciting firsthand accounts for these episodes. So if you

would like to share your story, please head to our website and click on the COVID-19 firsthand tab, which will take you to a Google form that you can fill out. And also a huge thank you to everyone who has already filled out this form and shared your stories with us. We are honored to get to read them or hear them and wish that we could share every single one. Yeah. As with our earlier anatomy of a pandemic series, these episodes are not going to replace our normal season episodes, which will still be coming out every other Tuesday like they always do. And on those episodes, we'll be keeping the COVID talk to a minimum as much as we can because we know that sometimes an escape from the COVID reality is necessary for our collective mental health. Absolutely.

So, okay, now on to the important bits. Aaron, what are we drinking this episode? Well, of course, we're drinking Quarantini 12. Such a descriptive name. I love it. Such clever quarantini names for these COVID episodes. I mean, I'm actually secretly very glad that we did not decide to get like super punny and like creative. We would have had to stop making episodes, quite honestly.

Yeah, yeah, for sure. So what is in the Quarantini 12? It's basically a Campari spritz. Oh, so good. I mean, you could use apparel if you prefer. I like the bitterness of Campari. Awesome. Me too.

Plus, I happen to have it, and I don't have Apari. Yeah, I feel like I use Campari much more in other drinks as well. So I always have Campari. I rarely have apparel. Yep. Anyway. Exactly. Anyways.

So on to what we are covering this episode. Yeah. This episode, we're talking all about control, as in how do we control? the spread of this virus. But most of that, we already know, and we have known it since the beginning of this pandemic. So what we really wanted to get at in this episode is what we have learned works and what maybe doesn't work as well as we thought or isn't as important, nine months into this thing. Because we've learned a heck of a lot. And some of that knowledge, like the benefits of wearing masks, both for those around the mask wearer as well as the mask wearer themselves, has played a

large role in the shifting guidelines that we've seen from public health departments. Controlling the spread of this virus takes action at both the individual as well as the regional or community level. And so in this episode, we wanted to examine both what we can do to protect ourselves and those around us from this disease, as well as understand why certain restrictions are being put into place as this pandemic surges. Yeah. For this episode, we were so lucky to chat with Dr. Saskia Popescu, who answered our many many questions about control. And also, she was just a phenomenally fun person to get to chat with an interview. It was like such a fun. It was such a great, like, this is such a great start to our Friday.

It was wonderful. And also she like mentioned a Zoom happy hour and I'm like really jealous that we're not invited. But anyways. So anyways, we recorded this interview on Friday, December 4th. So keep that in mind whenever we're talking numbers. Okay. We will let her introduce herself and dive into the interview right after this break. Dinner shows up every night, whether you're prepared for it or not. And with Blue Apron, you won't need to panic order takeout again. Blue Apron meals are designed by chefs and arrive with pre-portioned ingredients so there's no meal planning and no extra grocery trip. There, assemble and bake meals take about five minutes of hands-on prep. Just spread the pre-chopped ingredients on a sheet pan, put it in the oven, and that's it.

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This is unlike anything I've ever seen before. I'm Stephanie Young. This is Love Trapped. This season, an epic battle of He Said, she said and the search for accountability in a sea of lies. Listen to Love Trapped on the IHeart Radio app, Apple Podcasts, or wherever you get your podcasts. So my name is Saskia Popescu. I'm an infectious disease epidemiologist and infection preventionist. And I'm an assistant professor of biodefence at George Mason University.

Awesome. Excellent. So our first question for you is kind of we're now, what, over eight months, I think, into this pandemic. And we've learned a lot about different control measures for preventing the spread of this virus, like mask wearing, that indoor dining needs to be restricted, contact tracing, all these different things. So we wanted to first talk to you about like the policies at the regional or statewide level that seem to actually be the most effective at reducing transmission. What have we seen so far that like really works? Well, we've seen in several states that widespread mask mandates have actually made a considerable difference, but those have also really come with concerted efforts to emphasize distancing, reduce the number of people indoors, and provide more

accessible testing. So on a national level, though, I think there's been more attention from the CDC on masking. More recently, they emphasize that it does protect the person wearing it and not just those around you, but also on limiting gatherings. So if you look at California, they have a rule about not gathering beyond 10 people. But I think what we've really learned in all of this is that there's no single strategy. Really, we have to take communication above and beyond and focus on risk reduction being additive, that Swiss cheese approach, because early on we noticed that when we were emphasizing six feet, people really got stuck on that nuanced thing. And they thought, you know, beyond six feet, if you were a six feet and two inches, it was this almost invisible force field.

So we really learned a lot about communication in that, and you'll see that a bit reflected in the policies. But then the truth is it's so varied by states in the United States. I mean, we really do see some states that have taken this above and beyond like Washington State, Washington, D.C., even in New York. But then you have the Florida governor who extended his order that essentially barred towns, cities, and counties from enforcing local mask mandates. In Arizona, where I'm from, the governor issued very little state efforts. and only allowed local leaders to implement mask mandates this summer when we were starting to really see a surge. So to be quite honest, there's not a lot of national control measures outside of the guidance the CDC is emphasizing. And in many ways, the national approach has kind of fizzled out

really a way this summer, leaving the onus on local leaders. Yeah, absolutely. And I think it's been interesting to see sort of the outcome of that. I think I saw a report about, I can't remember which state, but the state had different county by county measures for mask mandates. Yeah, it was Kansas. It was Kansas, yeah. Uh-huh. Yeah. And the counties that had mask mandates had the lower infection prevalence or lower

infection incidents than the counties that had no mask mandates. And it's like, well, of course. Like, but, you know, how does this translate into actually, like, you know, increasing mass mandates overall? But anyway, yeah. No, I mean, that Kansas example, I think, was so spot on because the counties that had no mask mandate saw a 100% increase in cases. And I think that's such a telling sign of the importance of masking. But I know for Arizona, you know, there was an MMWR that came out and you really focused on masking, but it was like, well, we did all of these other things.

So it's really important that we don't just focus on one intervention because I think that was the mistake we made very early on, like just masking or just distancing. And that's not given people the awareness and the understanding of how the transmission dynamics work. That's a really good point, yeah. Absolutely, yeah. So here in the U.S., on the national scale, we've seen no clear, consistent, you know, not only policies, but even like messaging, pro-science messaging from Donald Trump that would have led to perhaps a reduction rather than an increase in cases, which is what we've seen. So playing a bit with hypotheticals, how do you think something like a national mask mandate or even just fact-based rational messaging might have changed the course of the pandemic? Truly, I believe this would have made a huge effort. The lack of pro-science leadership and combative approaches to those recommendations coming from local leaders or even public health figures like Dr. Fauci really promoted partisanship within control measures.

And masks should not be a political statement. public health strategy. So had we emphasized some things earlier on, like this is going to take a while to get under control, guidance will likely change as the science improves, and that we need community-based efforts for masking, distancing, limiting at-risk activities, these things would have likely changed course. I also think national efforts to enhance public health communication would have really been impacting and could have combated that false dichotomy of public health versus the economy or the U.S. versus the WHO. So when we focus on support services, for people to stay home and the rational messaging that really emphasizes harm reduction and

reduces stigma and provides pragmatic guidance, we can really make a difference. So what we are seeing with President-elect Biden and Vice President-elect Harris is that emphasis on adequate communication, science-based messaging, and masking mandates. I think it was proposed for about 100 days, really to kind of curtail what we're seeing as uncontrolled transmission right now. So we need not just fact-based, but rational, practice. pragmatic, how can you translate this to people to get them to understand why it's important for them? You know, you can't just talk at people. You have to talk with them. And I think that's a huge failure we've had in the US. Oh, man. Yeah. I love too what you said about like telling people that guidance might change. I think that

that's been a really big sticking point for a lot of people where they just kind of can't get over how much things have changed as we've learned more. And I think that that's something that like part of the scientific process that people just haven't seen play out in real time before. No. I mean, if you think about it, this is outside of, you know, SARS, COVID-1 and MERS, this is really one of the first large scale. I mean, obviously, it's a pandemic, but it's the first novel disease we really had to face in the U.S., right? Ebola in 2014, we know Ebola. We know how to handle Ebola. We might not be good at it, but we know what to do. This is so novel, and I keep reminding people, you know, we identified this in January, you know, late December, early January. So we're not even a year. out. And sure, the mask expectations were different in March than they are now, but that's because we're getting better. In my opinion, I want the evolution of guidance. That means we are learning more, we're getting better. So I always tell people lean into those changes because that means we're getting better at control mechanisms. Absolutely. Yeah. So kind of looking more globally, there's been a large

amount of variation in the way that different countries have handled this pandemic and kind of responded. Could you highlight some of the patterns in either the policies or the practices of countries where COVID-19 has been pretty well managed in your opinion? Like what are some other places doing better than us? Yeah. So I think the shining example we've seen is really New Zealand. They have taken very early on a pro-science message that explained what transmission looked like, what was high risk. and they really prioritized contact tracing. So I was on a call when they were recently sharing how a single case was identified

and how rapidly contact tracing occurred and how everybody was notified. And they provided support services. So people could go to a hotel. They had areas where they could stay if they were supposed to be in quarantine. So I think we've learned a lot in that approach where it's not just as simple as throwing a bunch of money at testing and, you know, healthcare services. We know that's really important, but countries like Germany, New Zealand, you know, I think really have taught us a lot. And there's a lot that have done, you know, really, really amazing work.

But more and more, I find those that emphasized early communication that was simple and understandable to the public really did better. Japan did really amazing early on billboards, I think, about things to avoid. And that was crowded areas, indoor spaces, you know, very simple message. but got the point across. And I think those measures have been such role models for us to learn from that we have to invest in communication to the public because we can ramp up testing all we want. We can buy more ventilators all we want. But if the general public doesn't understand how transmission works and what they need to do to stay safe, then we failed them. I mean, the simple messaging of mask up or stay home is very limited, right? You know, and I think that was something that we

we have really struggled with in the U.S. Yeah, absolutely. Yeah. So moving now from sort of this regional practices and measures or nationwide practices and measures to the individual things that we can do for ourselves or we can put into place to help both protect ourselves and those around us, what are some of the things that have shown to be the most effective or that you think might be the most effective?

Well, we're in a really pivotal time right now with the state of the pandemic in the U.S., you know, we're seeing the highest case counts and hospitalizations ever coupled with the winter months and the holidays. But what we do know is that things like masking and distancing hand hygiene and avoided, crowded, and especially indoor spaces are important. But honestly, what I think is the most important is being cognizant that risk reduction is really additive. And as we discussed earlier, the studies in Kansas and even Arizona have shown a lot of impact on masking, but those requirements also came with a lot of concerted community education and awareness, but more so it's not just one thing. It's all of them. So just like testing before a

flight is helpful, but it doesn't eliminate risk. So more and more with the amount of transmission in the community, I really just encourage people to try and stay home when they can, but avoid those high risk activities or areas like bars and indoor dining gatherings where there's a lot of people. But I try to really emphasize that Swiss cheese approach, that additive measure to control efforts because I have found that when we say, well, you need to wear a mask when you're outside your house. Outdoors is protective. People think, well, if I'm outdoors and, you know, I'm around other people, but I'm outdoors, so that's helpful. So I don't need to wear a mask. And we know that if you are within close contact of people outside your household, even if you're outdoors, you still need to be wearing a mask.

So what I have really found is that discussing that additive approach has been the most helpful and that it's not just the masking. It's not just the distancing and trying to be outdoors and the hand hygiene. It's all of those things together because all of them, you know, work together. One is imperfect, but together they help reduce risk. Nothing is going to eliminate risk right now. So, you know, how can we give people the tools to think critically and make informed decisions? Absolutely. Yeah. If we could focus a little bit on masks, since that's been a large part of the conversation, we know that not all masks are the same. could you maybe break down some of the different types of masks and explain which ones seem to be doing a pretty good job of helping to slow down transmission and which ones

might not be quite as effective? So really what we see are three things. Cloths, face coverings, surgical masks, and respirators. Now, respirators are N95s and those half-face respirators that can be reprocessed. And they're very specific to health care settings where we're doing aerosol generating procedures. They require actually fit testing to make sure that you have a good seal and a good fit. and that you don't have a medical contraindication because they filter out about 95% of the particles

that are 0.3 microns in size or larger. So very highly protective, very helpful masks for health care workers, but they're very dependent on the fit and making sure you have the right seal. Below that, we have surgical masks. Those are more loose fitting. They're disposable.

We often use these for the physical barrier around your mouth and your nose, and that's for larger droplets and splashes, but not those smaller particles or aerosols. So next you would see the most common one we're seeing in the community right now. And those are cloth face coverings. These do act as more of a source control. We are more and more learning that they do have some variable level of protection for the person wearing them.

But part of the problem is that, you know, you did see for a while people wearing cloth face masks with an exhaust valve. And that's the exact opposite of what we want because you're basically exhausting potentially infectious air. So that's something that we really don't want to see people doing, whether it is a cloth face mask or any kind of other mask that has an exhaust valve without a filter on it. So research has really shown that both surgical masks and the unvented K and 95. So if you heard about K and 95s, those are the Chinese masks that have been granted emergency authorization for use in the United States. Early on, these were just for health care workers, but they became more widely available for the public. I always tell people, though, if you're going to buy some, make sure you check the CDC and the NIOSH. website because there have been some issues with counterfeits. So just check the manufacturing number,

but they do offer a higher level of filtration and protection. They're a little bit more fitted around the face, so they fit more snugly. And they do actually, between them and surgical masks, they can reduce the outward emission up to 90%. So we know that filtration, though, is lowest for the cloth mask. That's lower than a surgical mask and a respirator, but they do offer varying levels of support. More so we found that people wearing multi-layer cloth masks that are fitting a little bit more snugly around the face, have a better fit. Water-resistant fabric is always great. Finer weaves and a higher number of threads, they do offer some reasonable protection. So I think the moral of the story is those higher level at 95s are really for health care workers. And I've seen a lot of people

wear them, but unless you have a proper fit test and a seal, they're not giving you the protection you might think. So, you know, it's, it's, I'm a fan of the surgical masks when I'm out in public or K-N-95 if it's not a counterfeit one and you've validated that. But we've seen some good success with cloth masks. I just really encourage people to make sure it's fitted around the face. You have multiple layers and it's covering your nose and your mouth. Yes. That's one of the most important parts that you're actually wearing it to cover your nose and mouth. Oh my gosh. Just buy one that fits. It's, it's, it's, So much about masks is about the seal and the level filtration they offer. Yeah, totally.

So as we've talked about, you know, in this conversation, we've talked about how the risk of infection is this moving target and it's additive. Like you can control sort of the different levels of risk that you have. You know, it depends on things like where you live, what your health status is. And, you know, most importantly, what risk behaviors you engage in. And our knowledge of transmission and how transmission happens and where it happens has become a bit more nuanced as the pandemic has progressed. So going into sort of the breakdown of this, you know, large gatherings are likely to be more transmission than, you know, small gatherings. Or is that the case?

Our grocery store visits and outdoor runs, how do they compare to things like indoor dining or working out in a gym? You know, what are we seeing as hot spots of infection that we may not have seen at the beginning of this or we may not have identified as hot spots earlier on in this pandemic? Yeah, so I think that's a tough one because there's the environmental aspect of what is the environment, you know, are you in an office building or are you at a park remotta? And then there's the human factors aspect of it. So anything can be unsafe if a bunch of people come together, right? So we know that the riskiest places are indoors where there's a lot of people for a prolonged period of time.

They're close together. And in some cases, they're even far apart. But we know that, you know, if you've got a lot of people inside, they're not wearing their masks. Ventilation might be iffy. So that to me means bars, restaurants, right? Places where you are not wearing your mask consistently, even if you are spaced six feet apart. That automatically, though, puts kind of those environments into our context of high risk. but if you had a huge office building and people very, very spread apart, less risky.

But more and more, we are just emphasizing that indoors, you know, we have seen some cases where people along the air conditioning line, right, where it's venting out, it's blowing out, are at higher risk than people that aren't. So we've seen clusters and even super spreader events stem from house parties, weddings, choir practices early on a gym, and events like the nomination of Amy Coney Barrett at the White house. So when we look at those other areas like grocery stores, I think so much of the early emphasis on grocery stores and even gyms put a lot of attention on the infection control measures. And it was interesting because for the grocery store especially, those interactions

are very brief. But so early on in this pandemic, because there was so much attention to those areas, they put in so many wonderful control measures, like limiting the number of people inside, everybody's got to wear a mask, hand hygiene, you know, barriers for the cashiers and all of these little pieces. And I think that's really made a big difference. We have found that there have been some outbreaks associated with gyms, but a lot of that is because they weren't taking the necessary precautions. And, you know, it's simply that we weren't ensuring that those measures were in place. And part of it, I honestly believe, is it's really hard for a business to suddenly have to implement all of these infection control measures. without a little bit more guidance. So, you know, when we look at gyms, I've also seen many take great

precautions to ensure spacing, masks, disinfection, opened windows, and outdoor exercises. And it's funny because even Dr. Fauci said he wears his mask under his chin when he runs and then pulls it over his mouth and knows when he sees someone coming near him. And I think that's a great strategy for what we've been emphasizing with outdoor activities that you can be distancing but might come into contact with others. So really what it comes down to is, what are you doing in this activity? Are you unable to wear a mask, are you indoors, or are you around others? Or are you able to be outside distance and mask? I do think the challenge we see now is that people get fixated on one piece of the recommendation, like outdoor dining and forget the rest, which is why we're seeing

people create basically indoor dining experiences outdoors. You know, like those little igloos or they put up walls all around, and it's kind of defeating the purpose of those recommendations. Yeah, absolutely. So we are, unfortunately, very much in the middle of a massive surge in cases and COVID-related deaths here in the U.S. And even though we know a lot more now than we did at the beginning of the pandemic about like the fundamentals of the virus transmission and the ways that we can control it, a lot of these haven't really changed, right? Like even though we've learned a bit more. So where do you think this surge is really coming from? Well, you know, I do think we've learned more about infectiousness.

So we know that people are more contagious a couple of days before their symptoms and for about five days after. We've learned more that people can shed cultural virus for up to 10 days after their symptoms. So now we know really isolating people for 10 days is super important and that they can shed non-cultural virus and be PCR positive for like 80 to 90 days. We've also learned more about like situational airborne transmission and that while most transmission is through close contact We've seen cases where people were further than six feet apart Indoor's ventilation may not have been great and there were no masks so you know all of these really Contributed to transmission which really emphasizes the use of Masking when you're indoors and outside your home, but ultimately I think the surge that we're seeing right now is a product of a few things

First of all cold weather That moves people indoors. I know that there was a lot of questions about the seasonality of COVID-19. For the most part, virologists have really said, this isn't about seasonal, you know, warmth or air. It's about human factors, right? And virus needs a human, and it's all about our habits. So cold weather moves us all indoors.

We tend to be more social creatures around the holidays. And with that, plus pandemic fatigue and people, honestly, just deciding that this is going to be around for a while. so why are we taking it that seriously? This is why we're seeing over 210,000 cases a day and 100,000 people are hospitalized. This is such a serious inflection point in the U.S. I feel like we keep saying this,

but the impression I've really gotten from many and the one that scares me the most is that they're just tired of COVID-19 and the lack of leadership and efforts in the U.S. means it's either not serious or it's going to be around for a while. So why should that impact their activities, moving forward. You know, if this is going to be with us, why shouldn't they have a normal Thanksgiving or, you know, get together with friends at a barbecue? And those little nuances worrying me on top of what we know is pushing transmission, you know, people moving

indoors, more people are traveling now in holidays. Yeah. Yeah. And so that kind of brings me to ask whether, you know, with this COVID fatigue that, you know, I think probably everyone is feeling, do you think that these lockdowns or increased restrictions that are being put into place in some high prevalence locations, do you think that they'll have the same effect in flattening this third wave as they seemed to earlier in the pandemic when there was perhaps a bit less of the fatigue? Yeah, I mean, I think we've learned a lot about restrictions not being binary, right? It's not a closure or open. It's more of a light switch dimmer. So more targeted. I do think they will help, but it's honestly hard to tell right now because we're dealing with the holidays and cold weather.

Plus, a lot of these interventions take weeks to see the results, right? I think we're more aware of the importance of communication and strategic with it and being incremental and very targeted and knowing that we need to focus on things like bars and indoor dining and large gatherings and focus on those so that we can prioritize school openings. We know things like tournaments and weddings and gatherings are at risk for transmission, So there's been a lot of focused efforts around those. The issue, though, is that we're still seeing a lot of politicization of masks and public health measures.

So in Arizona, where I live, the city of Phoenix recently just said, we're going to close the parks to tournaments because they had had hundreds of people gathering for tournaments, which is a huge risk for transmission. And that was met with a lot of resistance. So, you know, ultimately, I think it's important to note that this is this massive wave, really across the entire U.S. that we're seeing is, It's rolling. You know, the U.S. is such a massive country, and it's very siloed in how it's approached this.

So what we saw this spring and summer was a rolling wave from the northeast to the sunbelt. So in some ways, this is very new. You know, we've not seen what we're kind of experiencing right now, and yet we're trying to apply the lessons we know we should learn. So I do find that a strategic approach often is more beneficial and often gets more public support, which is what we need for interventions to be successful. I think we've learned that lesson versus the first time where it was. everybody's got to close down and now it's let's be a little bit more specific a little bit more

targeted but really emphasize and take the time to communicate with the public so that we can get their buy-in because if people don't agree with or understand why you're closing certain things, it's not going to be successful. And that's been really confusing for people. Like why are we closing schools but bars and restaurants are still open? I am hopeful that these targeted efforts are going to be more successful but I always stress with people it takes time and it's going to take that much more time when we are seeing just such uncontrolled transmission in the community right now. Yeah, absolutely. Do you think, or maybe have we seen yet so far, any kind of reduction in other seasonal respiratory infections kind of overall because of, at least in places where risk reduction

strategies are being implemented? Do you think, have we seen or do you think that we could see a reduction in other infections? Yeah, I'm really hopeful. So, you know, we did see historic lows in the southern hemisphere like Australia, Chile, and South Africa for flu as a result of the interventions that were developed for COVID-19 and that big emphasis on flu vaccines. So I think a big piece of this is testing. Last year, I should say early this year, technically, suddenly we saw this massive drop in tests being done for influenza. And, you know, I can tell you just having, like, worked in health care during that time. it felt like everybody stopped testing for flu. Suddenly, if you came in with a cough and a fever, you were getting COVID-19 testing. You were not getting flu testing. So now I think we're so

hyper aware of the potential for it to be a double whammy that there is going to be a lot more emphasis on testing. So hopefully we'll have a better understanding of the flu activity. But overall, we know that these interventions for COVID-19 are the same for other respiratory infections, masking, distancing, hand hygiene, cleaning and disinfection, social distancing, those all will have a positive impact. So I'm very hopeful that we'll see what occurred in Australia happened here. You know, I think a lot of that, though, is going to be for us to test appropriately for it. Yeah. So public health officials have made it pretty clear that non-essential travel should not be conducted especially during this holiday season and maybe especially during this incredible surge.

But of course, people are going to travel anyway. And so, you know, knowing that, what are the steps that they can take to be as safe as possible if they are committed to traveling? Well, first, I'm always going to go back to risk reduction being additive. So it's not just the mask or the distancing or the pre-travel testing that many people do. It's everything. So I always encourage people to do a few things. And this is stuff I practice when traveling for work. You know, I'm never going to give guidance that I couldn't follow myself. And first and foremost is don't travel if you're sick or you've recently been exposed. And I hate that I have to say it, but I've unfortunately seen it. So try to build in some quarantine before and after you travel.

Be mindful of where you're going and where you're coming from. Are you going to an area of high prevalence from an area of low prevalence and vice versa because it's not just about the traveling it's also about the places you're going in the activities you're doing when you're at the airport i tell people you know on the airplane try to sit at a window airplanes have wonderful ventilation and air exchanges try to get that window seat that way you're around less people wear your mask at all times clean your hands frequently and avoid touching your face or under your mask one of the biggest things that i personally have seen is that we tend to not be mindful of when we're eating and drinking. So look at those around you. If you're on an airplane, when they hand out the

water and the snacks and these little baggies, everybody does the same thing at the same time. They tug off the masks, drink some water, and they eat a snack. It's the same time. And so I always, you know, and I think it's really fascinating because we've developed these wonderful little, you know, snack bags, but we're handing them out at the same time to everybody. So everybody is then engaging in maskless time of eating and drinking. So I try to be super mindful of that and I just kind of stagger when I eat and drink based off of those around me. And I see a lot of complacency at the baggage claim and at the gates. It's kind of like people think they got to the finish line. So please make sure you're still wearing your mask and distancing then. And moreover, I really think the biggest

thing is that, you know, you really need to ask yourself, do I need to travel or can I make this a safer approach through a virtual visit. Just because you test pre-travel does not mean you are not potentially sick when you travel, testing is one moment in time. Yeah, I think that's so important. I love those, the graphs that I've seen of like, you know, when certain tests might become positive based on when you were exposed and like how variable that can be. Oh, yeah. It's, and you know, it's so interesting to me. There was a study, I think, that just got a lot of attention or a case study where some was tested a few days before they traveled internationally and became infectious on the plane and it led to subsequent cases. But nobody mentioned that the test was five days before the travel.

And so, you know, it kills me because especially as we start to see testing delays in the U.S. with everybody going to get tested before the holidays or before they travel, no test is perfect, right? And even if you get tested the day of, there's still a percentage that it might be inaccurate or that, you know, you could become positive like the next day. So I really stress that testing is very reactionary. It's a secondary form of prevention and that it should not be used as a means for engaging and, you know, less safe behavior. Yeah, absolutely. So I think our last question is something that you have mentioned. of touched on a little bit, and that is COVID fatigue. I think that's a very real thing that so many people are experiencing. What would you like to say to someone that is experiencing COVID fatigue? I mean, it's real. COVID fatigue is real. I think we all need to appreciate

that we're living and working in a pandemic. And this is coming from somebody who has studied, you know, and lived pandemic preparedness my entire life. It's something. that I'm passionate about, and it is exhausting. You know, it's a true pandemic, something you don't see very often. And this one is really bad, and especially in the United States. So coupled with the fact that we're in the middle of an election year, with a lot of politicization of basic public health, we're all just trying to get by. So I really encourage people, just be safe, keep going and try to preserve some semblance of

mental health, reach out to people. I say that this will eventually get better, though. Instead of focusing on what we can't do, try to pivot to what we're able to do and creative ways to have holidays or normal activities. Ultimately, we're all in this together and we need to support each other. So that looks like a lot of different things, from not stigmatizing or using shame to checking in on people and taking time for yourself and honestly not being so hard on yourself right now. This is such, it's been the longest year. I think there's a joke for a lot of us. If you look at COVID symptoms, one of them is a headache. And it's like, well, we've all had a headache for 2020. We're all tired. But the truth is that, you know, it's hard working in it, but it's just hard living in it.

So I try to preserve that hope in that it will go away at some point. It might not be immediate. I think that was a mistake we made early on was giving people a date. And it might take a while. but we will get ahead of this, you know, whether it's through vaccine development or just getting better at community interventions or both. But we will get there. So now is just about protecting yourself and those around you and trying to, you know, focus on your mental and physical and, you know, just well-being. Well, people keep saying I just wanted to get back to normal.

Normal is what got us here. I want us to honestly get to a new point where we prioritize public health and pandemic preparedness, but also supports. services that make it possible for people to be safe and stay home. Anyone who works long hours knows the routine. Wash, sanitize, repeat. By the end of the day, your hands feel like they've been through something. That's why O'Keefe's Working Hands hand cream is such a relief. It's a concentrated hand cream that is specifically designed to relieve extremely dry,

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He became the first Bachelor to ever have his final rows rejected. The internet turned on him. If I could press a button and rewind it all I would, But what happened to Clayton after the show made even bigger headlines. It began as a one-night stand and ended in a courtroom with Clayton at the center of a very strange paternity scandal. The media is here. This case has gone viral. The dating contract. Agree to date me, but I'm also suing you.

Please search warrant. This is unlike anything I've ever seen before. I'm Stephanie Young. This is Love Trapped. This season, an epic battle of He Said She Said, and the search for accountability in a sea of lies. Listen to Love Trapped on the IHeart Radio app, Apple Podcasts, or wherever you get your podcasts. In 2023, a story gripped the UK, evoking horror and disbelief.

The nurse who should have been in charge of caring for tiny babies is now the most prolific child killer in modern British history. Everyone thought they knew how it had. ended. A verdict, a villain, a nurse named Lucy Lettby. Lucy Lettby has been found guilty. But what if we didn't get the whole story? The moment you look at the whole picture, the case collapses. I'm Amanda Knox, and in the new podcast, Doubt the case of Lucy Lettby, we follow the evidence

and hear from the people that lived it, to ask what really happened when the world decided who Lucy Lettby was. No voicing of any skepticism or doubt. It'll cause so much harm at every single level of the British establishment of this is wrong. Listen to Doubt, The Case of Lucy Letby on the Iheart Radio app, Apple Podcasts, or wherever you get your podcasts. That was such a great interview. Thank you. Thank you so much for taking the time to chat with us, Saskia.

Yes. And there was so much great information, and I feel like she explained it so well. and I learned so much. Absolutely. And because there's so much that we learned, just like with our earlier episodes in the series, we wanted to close out with a recap of five key things that we feel like we learned in this episode. Number one, this one doesn't come as much of a surprise, but communication is key. And we can see the effect that different types of communication or different messaging has had on the spread of the virus

by comparing, for instance, places that issued a mask mandate compared to those that did not. Early on, messaging about the pandemic should have included things like, hey, this is going to take a while to get under control. And we need community-based efforts for masking, distancing, and limiting at-risk activities. And crucially, guidance is likely to change as we learn more about the virus and its transmission. Yeah. And I liked that last point, especially. I thought it was super important because when we change our policies or practices based on

new information that we receive, that means science is working. That's what is supposed to happen in life. When you're presented with new information, you adapt, you incorporate that. Yeah. Like science is happening in real time and it's frustrating and it's kind of confusing, but we are putting into place the policies and practices that we believe are best at the time, based on the information and knowledge we have at that time. Exactly. And so now what we need to do is focus on presenting this information about control, about individual and community level practices in a pragmatic way.

Right. So there have been recently comparisons about abstinence-only sex education and some of the messaging regarding COVID-19 where it's like, we know that abstinence-only sex ed doesn't work. And so we need to focus on explaining the science behind why these control measures work and focus on risk reduction rather than risk elimination and endorse behaviors or practices that people can reasonably incorporate into their lives. And globally what we have seen is that countries that promoted a pro-science message and pushed for public understanding of how the virus is transmitted and why control measures work have fared much better than other countries like the U.S. U.S., which presented this false dichotomy of public health versus the economy, for example. So it's definitely, definitely way past time for a big pivot here in messaging if we want to

slow this virus from its current breakneck speed. Absolutely. Number two, masks. Masks are one of these really great examples of how guidance has changed as this pandemic has continued and as we have learned more about the science behind masking. We have learned that masks are hugely important in slowing community transmission of the virus and that wearing a mask not only protects those around the mask wear, but that they also provide at least some degree of protection to people wearing them, which is pretty new information. Another thing we've learned regarding masks is that

not all masks are the same. Of course, the N-19. and respirators are going to provide the highest degree of protection, but those are reserved for healthcare workers as they should be, because they're doing aerosol-generating procedures, for example. Next up are the Kn-95s, which are pretty good, but if you buy them, check the manufacturer's details to make sure that you have a legit one, because there's false ones out there, and surgical masks. The K-N-95s and surgical masks are more effective than regular cloth masks in reducing outward emission of viral particles, but even a cloth mask still does work, especially multilayer ones. What's really key about the effectiveness of all of these masks, though, is that they fit your

face and you're wearing them properly. Don't let that nose hang out, please. Adjustable ear loops or a wire nose piece tend to be really great for making sure that they actually fit on my face, for example. Another great thing about cloth masks is that they're washable, which means they don't have to be thrown away, but also means that you should wash them after you wear them. And exhaust valves essentially defeat the purpose of wearing a mask. Yeah. And most importantly, we said this in even one of our regular season episodes.

Masks aren't a political statement. They're a public health strategy, and they work. Yep, yep, yep, yep, yep, yep. And yep. Number three, strategies for risk prevention are additive, and no single strategy works completely and perfectly. Yep. If it did, we would have implemented it months ago, and we wouldn't be in a position that we are today. You may have seen the Swiss cheese approach that Dr. Pupescu mentioned a few times drawn out, but it goes something like this. you can think of each strategy as a piece of Swiss cheese. It's got holes. Also, I wonder, is it just in the U.S. that it's called Swiss cheese? Oh, good question. Like Yarlsburg? No, that's a

different kind of cheese. So basically, what we think of as Swiss cheese, it's a slice of, you know, square cheese and it's got a bunch of holes in it. So imagine that. Swiss cheese. Anyway, for example, masking is one strategy, one piece of Swiss cheese. It helps to a degree, but it still has those holes in it. It's still imperfect. And in those holes, the virus can pass through and still infect you. And so what you do is you add another layer of Swiss cheese, social distancing, which also has holes in it. But together with masks, you've got two layers. And so you add another layer, hand hygiene, et cetera, et cetera. And so, Because no two pieces of Swiss cheese look exactly alike, like snowflakes, as you layer these pieces of Swiss cheese together, you eventually get to a very, very minuscule risk of transmission. All of those holes end up overlapping with pieces of intact cheese, I guess you could say. Yeah, exactly. And there are personal strategies we can use, individual actions we can take, like the distancing

and masking and washing our hands, but also community strategies. strategies like testing, contact tracing, government support, and messaging surrounding the virus, and eventually vaccines. These strategies are additive. We need them all in order to reduce our risks of transmission. Yeah, that's, I feel like a big one. It's not all or nothing. Speaking of all or nothing, number four, lockdowns are not binary. They're not all or nothing either. I think early on in the pandemic, some places took a very all or nothing approach, and we've seen the effects that that has had on everything from the economy to our collective mental health. And now, especially that we know more about the ways that the virus is transmitted, there can and really

should be more nuance in our policies and strategies. So instead of shutting everything down everywhere, we can focus on the areas of high transmission or issue better guidelines, like we already mentioned on how to operate safely in a very pragmatic way. For example, we know that restaurants and bars are areas of high risk, but schools are maybe less risky for transmission than we previously thought. So targeted shutdowns and strategies can take into account not only things like percent positivity in an area and available hospital beds, but can also be location or activity specific, instead of lockdown versus normal pre-COVID activities. But we need public support for any interventions to be successful.

And that means I feel like we can't stress number one enough. Communication is key. Guidance has and will continue to change as we learn more and as this pandemic continues to progress. And it is good for our guidance and strategies to shift as we continue to learn more. Yeah. And number five, our last point is that this will all end eventually. Really, it will. But it's not going to be anytime soon. COVID-19 has taken millions of lives already and no single intervention, not even a vaccine, will stop it tomorrow or the next day or even in a week. COVID fatigue is very, very real. And it's something that we're going to be. We'll stop it tomorrow or the next day or even in a week. COVID fatigue is very real. And it's something that we'll stop it. We'll stop it. We'll stop it. We'll stop it. We'll be day or even in a week. COVID fatigue is very, very real, and it's something that we are all experiencing to one degree or another. So we have to find ways to continue to reduce our risk while maintaining sanity. And this might look different for each of us, but taking a risk mitigation approach is

key rather than just giving up and assuming we are all going to get infected or worse pretending that it's not real. It is very, very, very real. We can all continue to use a combination of strategies, masks, social distancing, staying home when we can, et cetera, et cetera, as best as we are able to continue reducing our individual risks while flattening that curve of community transmission. There is a light at the end of the tunnel. We're just still in that dang tunnel for the time being. It's a long tunnel and it's much longer than we wanted it to be. Yeah, it is. It's a very dark tunnel.

It's a very dark tunnel. It's a very dark tunnel. Well. But it's not like the minds of Moria. I mean, no, it is not as dark as the minds of Moria. Yeah. So with that. With that, we would like to thank D.E.

Dr. Saskia Pepescu once again for taking the time to chat with us. We had such a great time. Really, truly. And we are going to continue to be salty about not being invited to the Zoom happy hour. It's fine. We understand. We understand. Yes.

Anyways. Anyways. Keep an ear out. Keep an eye out for more episodes of these coming your way. As we mentioned, they're not going to be on a regular schedule format. And so please do, you know, add a. us on social media or subscribe to us on your podcatcher so that you don't miss an episode. And we promise a vaccine's episode is upcoming. And we really hope to answer all of your questions

regarding the COVID vaccines that have been all over the news lately. Yeah, definitely. Thank you to Bloodmobile for providing the music for this episode and all of our episodes. And thank you to you, listeners, for listening. Again, feel free to reach out with any questions, suggestions, don't forget to fill out the first-hand account if you are so inclined. And until next time, wash your hands. You filthy animals. This is Special Agent Regal, Special Agent Bradley Hall. In 2018, the FBI took down a ring of spies working for China's Ministry of State Security,

one of the most mysterious intelligence agencies in the world. The Sixth Bureau podcast is a story of the inner workings of the MSS and how one man's ambition and mistakes opened its fault of secrets. Listen to the Sixth Bureau on the IHeart Radio app, Apple Podcasts, or wherever you get your podcasts. I'm Amanda Knox, and in the new podcast, doubt the case of Lucy Letby, we unpack the story of an unimaginable tragedy

that gripped the UK in 2023. But what if we didn't get the whole story? Evidence has been made to fit. The moment you look at the whole picture, the case collapsed. What if the truth was disguised by a story, we chose to believe. Oh my God, I think she might be innocent.

Listen to doubt the case of Lucy Lettby on the Iheart Radio app, Apple Podcasts, or wherever you get your podcasts. I'm Clayton Eckerd. In 2022, I was the lead of ABC's The Bachelor. But here's the thing. Bachelor fans hated him. If I could press a button and rewind it all I would.

That's when his life took a disturbing turn. A one-night stand would end in a courtroom. The media. is here, this case has gone viral. The dating contract. Agree to date me, but I'm also suing you. This is unlike anything I've ever seen before. I'm Stephanie

Young. Listen to Love Trapped on the IHeart Radio app, Apple Podcasts, or wherever you get your podcasts.