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 I see you, 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 tape for the staff and obviously the patient's, 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 taking 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, where I did every single arch job I know, I've 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 DC. Everyone I work with a 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 account's strain 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 lunchhowers 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 five hundred 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 art. It's our local, national, and international community about coming together and telling the truth, whether it's funny, serious, secary, or satirical. Bearing witness to someone's truth is essential to our human condition. How much TV
have you binged? 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 Two, 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 Allman. Updyke 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 since.
We like first did 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 Kobe two, the disease that it causes, how it's transmitted, and the steps that we have or have not taken that seem to best control it's 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.
That's let's do that. I think that sounds really great, aren 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 dot com or through the contact us form on our website This Podcast will kill You dot Com.
And of course we are still soliciting first hand account for these episodes, so if you would like to share your story, please head to our website and click on the COVID nineteen first hand 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 onto the important bits. Aaron, what are we drinking this episode, Well.
Of course we're drinking QUARANTINEY twelve.
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 we.
Would have had to stop making episodes quite honestly.
Yeah, yeah, for sure.
So what is in the Quarantine E twelve?
It's basically a Campari sprits Oh so good.
I mean, you could use aperal if you prefer. I like the bitterness of Campari me too.
Plus I happen to have it and I don't have Apperal.
Yeah, I feel like I use Campari much more in other drinks as well, So I always have Campari.
I rarely have apperl yep anyway, exactly.
Anyways, so onto what we are covering this episode. 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 doctor Saskia Popescu, who answered our many many questions about control and also she was just a phenomenally fun person to get to chat with and interview.
It was like such a fun this is such a great like, this is such a great start to our Friday, no wonderful.
Well and also she mentioned a Zoom happy hour and I'm not really jealous that we're not invited, but anyways, so anyways, We recorded this interview on Friday, December fourth, 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.
So my name is Oskia Propescu.
I'm an infectious disease epidemiologist, an infection preventionist, and i am an assistant professor of biodefense at your 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 conservative 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 gathering. So if you look at California, they have a rule about not gathering beyond ten 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 that's 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 and 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 issue 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 approaches kind of fizzled out really a way to summer, leaving the onus on local leaders.
Yeah.
Absolutely, And I think it's 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.
It was Kansas.
It was it 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, but you.
Know, how does this translate into actually, like, you know, increasing mass mandates overall?
But anyway, yeah, no, I.
Mean in that Kansas example, I think was so spot on because the counties that had no mask mandates saw a one hundred percent 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 US, 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 doctor Fauci really promoted partisanship within control measures and masks should not be a political statement their 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 US 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 reduce a stigma and
provides pragmatic guidance, we can really make a different. So what we are seeing with President elect Biden and Vice President elect Haris is that emphasis on adequate communications, science based messaging and masking mandates. I think it was proposed for about one hundred days really to kind of curtail. What we're seeing is uncontrolled transmission right now. So we
need not just fact based, but rational, 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, Kobe 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've really had to face in the US. Right Ebola in twenty fourteen. We know 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 nineteen 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 in 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 messaging, 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've really struggled with in the US.
Yeah, absolutely, Yeah. So moving now from sort of this regional practices and 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 US. 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's 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 cheeze 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 cloth face coverings, surgical masks, and respirators. Now, respirators are n ninety fives and those half face respirators that can be reprocessed, and they're very specific to healthcare 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 ninety five percent of the particles that are point three microns in size are larger, so very highly protective, very helpful masks for healthcare workers, but they're very dependent on the fit and making sure you have the right seal below that we have 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 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 ninety five, So if you heard about K ninety fives, those are the Chinese masks that have been granted emergency authorization for use in the United States.
Early on, these were just for healthcare 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 in 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 ninety percent. 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 higher number of threads. They do offer some reasonable protection. So I think the moral of the story is those higher level and ninety fives are really for healthcare workers, and I've seen a lot 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 mask when I'm out in public, or K ninety five 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 in your mouth.
Yes, that's one of the most important parts that you're actually wearing it to cover your nose and mouth.
Buy one that fits.
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 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 ramata? And then there's the human factor's aspect of it. So anything can be unsafe if a bunch of people come together, right, So we know that the riskiest place 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 space six feet apart. That automatically though, puts kind of those environments into our contacts 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 higher risk than people that aren't. So we've seen clusters and even super spread or 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, open windows, and outdoor exercises. And it's funny because even doctor 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, 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 Oh yeah, a.
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 case and COVID related deaths here in the US. 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 ten days after their symptoms, so now we know really isolating people for ten days is super important, and that they can shed non cultural virus and BPCR
are positive for like eighty to ninety 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 indoors, then eletion 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 nineteen. For the most part, virologists have really said this isn't about seasonal you know, warmth, or air. It's about human factors, right, 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 two hundred and ten thousand cases a day and one hundred thousand people are hospitalized. This is such a serious inflection point in the US.
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 nineteen and the lack of leadership and efforts in the US 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 those little nuances worrying me on top of what we know is pushing transmission. You know, people moving indoors. More people are traveling now on holidays.
Yeah, yeah, And so that kind of brings me to ask whether you know, with this, 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 seem too 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 in 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 or 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 turn 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 US that we're seeing is it's rolling. You know, the US is such a massive country and it's very siloed and how it's approached this. So what we saw this spring in summer was a rolling wave from the northeast to the sun Belt. 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 results of the interventions that were developed for COVID nineteen 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 and tests being done for influenza. And 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 nineteen 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 nineteen 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 happen 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 production 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 masks a 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. And 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 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 somebody 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. Oh and so you know, it kills me because especially as we start to see testing delays in the US, 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 and we've kind 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, you know, 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 way 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, you know. I think there's a joke for a lot of us that if you look at COVID symptoms, one of them is a headache and it's like, well, we've all had a headache for twenty twenty.
We're all tired.
So but the truth is that, you know, it's it's hard working in it, but it's just hard living in it. So I try to preserve that hope and 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 it's just about protecting yourself and those around you and trying to you know, focus on your mental and physical and 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 support services that make it possible for people to be safe and stay home.
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 in 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 YEA 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. So there have been recently comparisons about abstinence only sex education and some of the messaging regarding COVID nineteen where it's like, we know that abstinence only sex ad 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 US, which presented this false
dichotomy of public health versus the economy, for example. So it's definitely, definitely way pastime 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 and 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 ninety fives 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 K and ninety fives, 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 kN ninety fives 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 multi layer 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 wied 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. Yep, and exhaust valves essentially defeat the purpose of wearing a mask.
Yeah.
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, Yeah 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 doctor pepesc 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 justin in the US 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 is Swiss cheese. It's a slice of you know, square.
Cheese, and it's got a bunch of holes is 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 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 reach are 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 nuanced 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 nineteen has taken millions of lives already and no single intervention, not even a vaccine, we'll stop it tomorrow or the next 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 Maria, Like I.
Mean, no, it is.
It is not as dark as the minds of Maria.
Yeah.
So with that, with that we would like to thank doctor Saskia Pipescu once again for taking the time to chat with us.
We had such a great.
Time, really, 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 add us on social media or subscribe to us on your podcatcher so that you don't miss an episode. And we promise a vaccines 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.
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