WEBVTT - COVID-19 Chapter 15: Disease, Take 2 0:00:01.280 --> 0:00:05.400 My name is Vince Slaughter, thirty six years old from 0:00:05.440 --> 0:00:09.000 New York, and I work in the veterinary field, and 0:00:09.280 --> 0:00:14.480 this is my COVID experience. Last April, I had become ill. 0:00:14.840 --> 0:00:18.680 I thought that I had like a sinus infection or something. 0:00:20.960 --> 0:00:24.480 I tried to wait it out until I just started 0:00:24.480 --> 0:00:29.840 coughing up blood constantly. I went to the hospital and 0:00:30.800 --> 0:00:34.720 sure enough, I was COVID positive, and I also had 0:00:34.760 --> 0:00:39.879 pneumonia that I'd gotten through COVID. So I was admitted 0:00:40.440 --> 0:00:43.599 and I was in that hospital for a month and 0:00:43.720 --> 0:00:48.960 I really didn't improve. But at the end of that month, 0:00:50.200 --> 0:00:56.800 that hospital they were becoming overcrowded with COVID patients. They 0:00:57.960 --> 0:01:00.800 kind of rushed me out, even though I told them 0:01:00.800 --> 0:01:03.800 that I didn't feel like I was any better or 0:01:03.840 --> 0:01:10.840 ready to go, but they discharged me. And two days 0:01:11.160 --> 0:01:15.000 after they discharged me, not only was I still coughing 0:01:15.080 --> 0:01:21.720 up blood, but when I moved around, I felt like 0:01:21.760 --> 0:01:25.880 I was going to black out. I would just lose 0:01:26.720 --> 0:01:30.759 all my energy that was just exhausted. So I went 0:01:30.800 --> 0:01:35.520 back to the hospital and I was only there for 0:01:35.560 --> 0:01:39.800 about a day and they transferred me to a larger, 0:01:40.080 --> 0:01:46.000 far more competent hospital. And two things were found out 0:01:46.040 --> 0:01:50.600 at that hospital. The first being that I had an 0:01:50.640 --> 0:01:57.000 abnormal blood clot in one of my lungs that effectively 0:01:57.120 --> 0:02:01.840 killed off one third of my lung The other being 0:02:02.200 --> 0:02:06.920 that since I was fighting COVID pneumonia and I was 0:02:06.960 --> 0:02:11.760 compromised from the damage to my lung, ME, who was 0:02:11.880 --> 0:02:16.240 a at the time, a thirty five year old athlete, 0:02:16.960 --> 0:02:21.520 was in clinical heart failure. The virus had attacked my 0:02:21.639 --> 0:02:26.240 heart aggressively and I was in heart failure. That's what 0:02:26.400 --> 0:02:30.200 was going on. I was taken to ICU and a 0:02:30.280 --> 0:02:33.959 number of things were done. There was a tube placed 0:02:34.000 --> 0:02:38.240 in my back that was constantly pumping out all sorts 0:02:38.280 --> 0:02:42.760 of gunk from my lungs. I had neck congelos placed 0:02:42.800 --> 0:02:47.399 on both sides of my neck. I had some sort 0:02:47.440 --> 0:02:51.400 of port put in my chest. I was barely conscious 0:02:51.440 --> 0:02:56.960 a lot. I was hallucinating as well. Things got really 0:02:57.000 --> 0:03:01.080 bad and they had to install balloon pump in my 0:03:01.240 --> 0:03:05.280 leg to keep my heart beating. The only solution was 0:03:05.360 --> 0:03:08.560 that I needed a heart transplant. They found a donor 0:03:09.520 --> 0:03:12.760 and that's what happened. I had to have a heart transplant. 0:03:13.520 --> 0:03:17.160 I was in the hospital for over three months, just 0:03:17.200 --> 0:03:21.440 shy four months actually, and I've had to go back 0:03:21.520 --> 0:03:24.920 several times since just because my immune system is compromised 0:03:24.960 --> 0:03:29.200 now due to the transplant. When I was healthy enough 0:03:29.960 --> 0:03:34.520 after the transplant to be weighed, I went from going 0:03:34.520 --> 0:03:38.640 into the hospital as a two hundred and ten pound 0:03:39.760 --> 0:03:46.520 combat athlete to being one hundred and fifty three pounds. 0:03:47.240 --> 0:03:50.480 Life's been hard since. I can honestly say, it's ruined 0:03:50.480 --> 0:03:54.960 my life. People tell me, oh, you're so lucky you survived, 0:03:55.360 --> 0:03:58.360 but you know what, like, I don't feel lucky. I 0:03:59.160 --> 0:03:59.839 don't feel lucky. 0:04:02.080 --> 0:04:04.680 I work as a case investigator on the COVID response 0:04:04.720 --> 0:04:08.280 in Georgia. My role includes calling people who have tested 0:04:08.320 --> 0:04:11.600 positive to gather data about their symptoms and medical history, 0:04:11.960 --> 0:04:16.080 collect their close contacts for contact tracing, give guidance for isolation, 0:04:16.360 --> 0:04:20.000 and connect the cases to resources. I've spoken to hundreds 0:04:20.040 --> 0:04:22.440 of people who have had COVID, most of whom who 0:04:22.480 --> 0:04:25.360 have had mild to moderate cases, and many of whom 0:04:25.400 --> 0:04:29.960 have had severe cases, some later died. The emotional toll 0:04:30.040 --> 0:04:32.600 can be a lot to bear, and the work never stops. 0:04:33.200 --> 0:04:35.840 In the current surge, we cannot even begin to reach 0:04:35.880 --> 0:04:37.960 everyone who is sick, and the most we can do 0:04:38.040 --> 0:04:41.360 is hope that they are okay. The story I want 0:04:41.400 --> 0:04:45.240 to share happened shortly before Christmas. My team was focusing 0:04:45.240 --> 0:04:48.000 on school aged children in an effort to control transmission 0:04:48.040 --> 0:04:51.279 in schools before they return from break. I spoke to 0:04:51.320 --> 0:04:53.800 a mother whose two children had tested positive and she 0:04:53.880 --> 0:04:54.960 was quite sick herself. 0:04:56.160 --> 0:04:56.960 She was very. 0:04:56.800 --> 0:04:59.400 Helpful in giving me information about her children and very 0:04:59.440 --> 0:05:02.240 attentive to the the guidance I gave her. Towards the 0:05:02.320 --> 0:05:04.720 end of the call, she revealed her husband had tested 0:05:04.720 --> 0:05:07.600 positive first and was now in the hospital on a ventilator. 0:05:08.600 --> 0:05:11.080 I offered my condolences and told her I would connect 0:05:11.080 --> 0:05:13.839 her to available resources to help pay his medical bills. 0:05:14.600 --> 0:05:17.320 She replied, thank you for your help. I just hope 0:05:17.320 --> 0:05:20.520 he doesn't die on Christmas. I don't want our kids 0:05:20.560 --> 0:05:24.800 to associate his death with Christmas. I have dealt with 0:05:24.880 --> 0:05:26.279 death and grieving loved ones. 0:05:26.120 --> 0:05:26.800 For months now. 0:05:27.320 --> 0:05:29.080 It was all a part of the training, and the 0:05:29.160 --> 0:05:32.080 mortality rates have become background noise to my daily life. 0:05:33.000 --> 0:05:34.680 But this woman's story hit me in the pit of 0:05:34.720 --> 0:05:37.479 my stomach. I took a few minutes to gather my 0:05:37.560 --> 0:05:40.479 thoughts and then moved on to the next case. I 0:05:40.520 --> 0:05:42.680 found out a week later that this father passed away 0:05:42.720 --> 0:05:45.839 the day after Christmas. I knew the hospital he was 0:05:45.880 --> 0:05:48.400 in was using tablets on tripods to allow people to 0:05:48.440 --> 0:05:51.320 say goodbye to their loved ones. The image in my 0:05:51.400 --> 0:05:53.880 mind of this woman and her children saying goodbye for 0:05:53.920 --> 0:05:56.960 the last time on a screen turns my stomach. I 0:05:57.000 --> 0:06:00.000 am angry, I am heartbroken, and I am so tired. 0:06:00.760 --> 0:06:02.880 The only hope that I have is that the vaccine 0:06:02.880 --> 0:06:04.640 will be able to win the war that those of 0:06:04.720 --> 0:06:07.240 us working in public health have been fighting for almost 0:06:07.279 --> 0:06:07.640 a year. 0:06:09.240 --> 0:06:12.520 Hello. My name is John and I'm a paramedic in 0:06:12.560 --> 0:06:15.480 northeast Texas. I have worked for eight years in a 0:06:15.520 --> 0:06:18.679 small community approximately an hour and a half east of Dallas. 0:06:19.320 --> 0:06:22.000 I staff a duel medic and ice you on twelve 0:06:22.000 --> 0:06:25.400 hour rotating shifts. Many of the patients in our community 0:06:25.480 --> 0:06:29.400 are older. They reside in rural farming areas. We also 0:06:29.440 --> 0:06:32.240 have a large Latin American population in our community due 0:06:32.240 --> 0:06:35.960 to a sizeable manufacturing industry. We began to see an 0:06:35.960 --> 0:06:38.599 influx of cases in late March at one of the 0:06:38.600 --> 0:06:42.360 industrial plants in town. Due to many cultural as well 0:06:42.360 --> 0:06:46.120 as socio economic reasons, The virus spread like wildfire, faster 0:06:46.200 --> 0:06:48.560 than we expected and faster than we were prepared for. 0:06:49.640 --> 0:06:52.480 By mid May, our town of less than thirty thousand 0:06:52.960 --> 0:06:55.440 had more than eight hundred and fifty cases and made 0:06:55.480 --> 0:06:59.280 regional as well as national headlines. We had no more 0:06:59.480 --> 0:07:03.920 ICU bed or ventilators. Our dispatch was completely unprepared, and 0:07:03.960 --> 0:07:06.560 we had no system in place to properly warn crews 0:07:06.600 --> 0:07:10.200 of probable cases. In April, my partner and I were 0:07:10.240 --> 0:07:12.640 sent to a house for a simple anxiety attack. That's 0:07:12.680 --> 0:07:15.760 all the information that we had. Upon entering the home, 0:07:15.960 --> 0:07:18.560 the patient was found sitting in the floor, gasping for breath, 0:07:19.160 --> 0:07:21.960 and a tinged hue of blue around her lips let 0:07:22.040 --> 0:07:26.200 us know she was in severe respiratory distress. She began 0:07:26.240 --> 0:07:29.400 to plead in one word sentences for help. The patient 0:07:29.440 --> 0:07:32.120 was using a nebulized breathing treatment, which we know to 0:07:32.160 --> 0:07:35.560 be contra indicated in COVID patients. The haze of the 0:07:35.600 --> 0:07:39.280 expired vapor of that breathing treatment surrounded my partner and I. 0:07:39.400 --> 0:07:42.160 Blindsided by these severe symptoms. My partner and I were 0:07:42.200 --> 0:07:45.000 caught with our metaphorical pants around her angles. We were 0:07:45.040 --> 0:07:48.240 wearing none of the appropriate PPE. We had gloves and 0:07:48.280 --> 0:07:49.160 surgical masks. 0:07:49.240 --> 0:07:49.720 That's it. 0:07:50.560 --> 0:07:54.400 The patient's oxygen saturation was fifty percent. The decision was 0:07:54.440 --> 0:07:58.080 made to innovate her despite her lack of PPE. That 0:07:58.160 --> 0:08:01.200 same patient died and our ICU two days later due 0:08:01.240 --> 0:08:05.280 to complications of the novel coronavirus. Three days after the incident, 0:08:05.320 --> 0:08:08.120 I began running fever. I had body aches, a cough. 0:08:08.600 --> 0:08:11.520 I was more tired than I've been in my entire life. 0:08:11.720 --> 0:08:16.239 Ostensibly I contracted that very disease that was ravaging our community. However, 0:08:16.360 --> 0:08:19.040 I'm thirty years old, I'm physically fit, and I have 0:08:19.120 --> 0:08:21.960 no pre existing conditions. Due to the lack of the 0:08:22.000 --> 0:08:25.480 testing nationally, I was denied a test. Needless to say, 0:08:25.560 --> 0:08:27.960 I recovered. I've been back on the front line since 0:08:27.960 --> 0:08:32.760 returning fourteen days after my initial symptoms. I believe mts 0:08:32.800 --> 0:08:35.640 and paramedics have a unique perspective as well as a 0:08:35.720 --> 0:08:39.680 unique challenge during this pandemic. Hospitals, clinics, and other health 0:08:39.679 --> 0:08:42.720 care facilities have some amount of control over their environments, 0:08:43.640 --> 0:08:46.920 entering into patients' homes and interacting with these patients in public, 0:08:47.080 --> 0:08:49.960 many times without full knowledge of what the circumstances are. 0:08:50.520 --> 0:08:52.960 We are many times at the mercy of our environment. 0:08:54.000 --> 0:08:56.880 We have had to adapt and overcome the ever changing 0:08:57.000 --> 0:09:00.800 variables as they occurred during this pandemic. I have been 0:09:00.880 --> 0:09:04.120 lucky to work alongside many wonderful employees, and I have 0:09:04.240 --> 0:09:07.520 exceptional leadership where our work, including a chief who has 0:09:07.559 --> 0:09:09.920 been an immense help through it all. He's helped us 0:09:10.240 --> 0:09:12.480 with all the challenges that we face, giving us the 0:09:12.520 --> 0:09:14.840 resources that we need, as well as helping us with 0:09:14.880 --> 0:09:19.479 the physical and mental toll that this has taken on us. Obviously, 0:09:19.559 --> 0:09:22.439 my story is not unique. Nearly half a million MS 0:09:22.480 --> 0:09:25.760 personnel in this country have endured the same hardships for months. 0:09:26.440 --> 0:09:30.080 Some have even lost their lives doing so. Now, with 0:09:30.160 --> 0:09:33.000 the rates increasing in and the hospitals working at the 0:09:33.000 --> 0:09:36.120 cusp of full capacity, we continue to work and continue 0:09:36.120 --> 0:09:38.199 to adapt day after day to this pandemic. 0:10:22.200 --> 0:10:25.480 Thank you so much to everyone who provided their first 0:10:25.480 --> 0:10:28.920 hand account for this episode, and thanks to everyone who 0:10:28.920 --> 0:10:31.079 has sent in a first hand account or filled out 0:10:31.080 --> 0:10:32.679 the form. We really appreciate it. 0:10:32.960 --> 0:10:35.800 Yeah, thank you so much for sharing your stories with us. 0:10:36.360 --> 0:10:38.120 Hi, I'm Aaron Welsh. 0:10:38.080 --> 0:10:40.679 And I'm Erin Allman Updike and this. 0:10:40.640 --> 0:10:42.280 Is this podcast will Kill You. 0:10:42.800 --> 0:10:49.480 Yeah, welcome to a long awaited another update episode in 0:10:49.520 --> 0:10:52.400 our Anatomy of a Pandemic series, where we cover all 0:10:52.480 --> 0:10:53.880 things COVID nineteen. 0:10:54.400 --> 0:10:58.320 Yeah, this is Aaron. This is our fifteenth episode. 0:10:58.640 --> 0:11:02.120 I honest, we can't believe that we've made this many episodes. 0:11:02.200 --> 0:11:03.439 That's so many episodes. 0:11:03.559 --> 0:11:06.760 It's a lot, it's a lot, but. 0:11:07.040 --> 0:11:10.040 There's so much to cover when it comes to this pandemic, 0:11:10.240 --> 0:11:12.760 and so we just feel like we really have to 0:11:12.800 --> 0:11:13.400 cover it all. 0:11:14.920 --> 0:11:15.160 Yeah. 0:11:15.200 --> 0:11:18.040 I mean, we've learned so much in terms of virology 0:11:18.200 --> 0:11:22.240 or epidemiology, but we've also learned as this pandemic has 0:11:22.280 --> 0:11:25.320 gone on, just how much we still don't know or 0:11:25.679 --> 0:11:29.119 how much our knowledge about this virus, or about this pandemic, 0:11:29.240 --> 0:11:31.960 or about the disease that the virus causes, how much 0:11:32.000 --> 0:11:36.480 all of these things have changed from our earlier understandings. 0:11:35.960 --> 0:11:40.280 Exactly, which brings us to the focus of this particular episode. 0:11:41.000 --> 0:11:43.360 This week, we're addressing all of the new things that 0:11:43.360 --> 0:11:46.800 we've learned about the disease caused by the stars COVID 0:11:46.840 --> 0:11:51.000 two virus, that is, COVID nineteen. We'll touch on things 0:11:51.040 --> 0:11:54.280 like what is long COVID or how long does immunity 0:11:54.320 --> 0:11:57.280 actually last? Or what is the impact of infection on 0:11:57.400 --> 0:11:58.120 pregnant people? 0:11:58.360 --> 0:12:01.360 But before we get to that and so many other 0:12:01.480 --> 0:12:06.480 questions about COVID nineteen, we have some very important business 0:12:06.480 --> 0:12:09.400 to take care of. Yeah, we do, Aaron. It is 0:12:09.960 --> 0:12:14.120 quarantin any time, It's quarantin any time. What are we 0:12:14.200 --> 0:12:15.440 drinking this week? 0:12:15.760 --> 0:12:20.560 We're, of course drinking Quarantiny fifteen, so creatively named. 0:12:21.960 --> 0:12:26.280 Quarantini fifteen has vodka, It has grapefruit juice, It has 0:12:26.320 --> 0:12:30.520 some Maraschino liqueur and a little splash of grenadine. And 0:12:30.520 --> 0:12:33.240 we will post the full recipe for this quarantini as 0:12:33.240 --> 0:12:36.000 well as the non alcoholic Lasybrita on our website this 0:12:36.040 --> 0:12:38.520 podcast will Kill You dot com, as well as on 0:12:38.559 --> 0:12:40.040 all of our social media channels. 0:12:40.480 --> 0:12:43.760 Any other business Aaron, that we have to discuss. 0:12:43.720 --> 0:12:44.760 There's the usual. 0:12:45.559 --> 0:12:45.839 You know. 0:12:45.960 --> 0:12:49.200 We have a bookshop dot org affiliate account, We have 0:12:49.320 --> 0:12:51.760 a good Reads list. You can find those things on 0:12:51.800 --> 0:12:55.040 our website, where you can also find transcripts, alcohol free 0:12:55.120 --> 0:13:02.400 episodes and merch, oh merch. Yeah, and we also are 0:13:02.520 --> 0:13:06.520 still soliciting first hand accounts for this COVID nineteen series. 0:13:06.679 --> 0:13:09.880 And so if you would like to submit yours, please 0:13:09.920 --> 0:13:11.920 head to our website where you can find a link 0:13:11.920 --> 0:13:13.160 at the top of the page as well. 0:13:13.559 --> 0:13:16.760 All right, let's get to the meat of this episode, 0:13:16.960 --> 0:13:17.360 shall we. 0:13:17.720 --> 0:13:18.319 Let's do it. 0:13:18.720 --> 0:13:21.640 We were fortunate enough to chat with not just one, 0:13:21.840 --> 0:13:26.760 but two awesome people today who answered our many, very 0:13:26.800 --> 0:13:30.000 long list of questions about all the things that we've 0:13:30.040 --> 0:13:32.040 learned about COVID nineteen in this past year. 0:13:32.720 --> 0:13:36.880 We were joined by doctor Critika Capali, infectious diseases physician 0:13:37.000 --> 0:13:40.280 and assistant professor at the Medical University of South Carolina 0:13:40.760 --> 0:13:43.360 and whom you may have heard on a previous episode 0:13:43.400 --> 0:13:47.800 in this series, as well as doctor Jason KINDRICHUK, Assistant 0:13:47.800 --> 0:13:51.559 Professor and Canada Research Chair in Molecular Pathogenesis and Emerging 0:13:51.640 --> 0:13:53.840 Viruses at the University of Manitoba. 0:13:54.160 --> 0:13:57.160 We recorded this interview on March sixteenth, so keep that 0:13:57.240 --> 0:14:00.000 in mind. If you hear any numbers, things may have changed. 0:14:00.679 --> 0:14:03.559 And we'll let them introduce themselves right after this break. 0:14:32.440 --> 0:14:34.760 I'm Jason Kinderchuck, I'm a PhD. 0:14:35.120 --> 0:14:38.760 I have an Assistant professor in Canada Research Chair in 0:14:38.840 --> 0:14:43.160 the Molecular Pathogenesis of Emerging Viruses at the University of Manitoba. 0:14:43.280 --> 0:14:46.280 In the Department of Medical Microbiology. Most of my work 0:14:46.560 --> 0:14:51.080 focuses on both the pathogenesis as well as the transmission 0:14:51.360 --> 0:14:55.920 and circulation of emerging viruses, including ebola and coronaviruses. 0:14:56.600 --> 0:14:58.320 And I'm Kritica Capoli. 0:14:58.440 --> 0:15:01.560 I'm an infectious disease It's phys position and assistant pro 0:15:01.560 --> 0:15:04.800 foster in the Division of Infectious Diseases at the Medical 0:15:04.880 --> 0:15:09.440 University of South Carolina, and my area of research and 0:15:09.560 --> 0:15:16.440 interest is in emerging infections and biosecurity. I am interested 0:15:16.520 --> 0:15:20.680 in looking at the clinical care and pathogenesis of emerging 0:15:20.680 --> 0:15:26.000 infections and understanding how we can better prepare for outbreaks 0:15:26.080 --> 0:15:27.240 and pandemics. 0:15:27.240 --> 0:15:30.640 And I was doing that before commentavirus Hite awesome. 0:15:31.160 --> 0:15:33.400 Thank you so very much for taking the time to 0:15:33.480 --> 0:15:36.880 chat with us today. We're very excited to hear what 0:15:36.920 --> 0:15:39.200 you have to say about all of our many questions. 0:15:39.240 --> 0:15:44.720 So let's dive in. So in our Virology Update episode, 0:15:44.760 --> 0:15:47.920 which we released a few months ago, we talked about 0:15:47.960 --> 0:15:51.120 how this virus is transmitted, but how much does the 0:15:51.160 --> 0:15:53.840 infectious dose or the amount of virus that a person 0:15:53.920 --> 0:15:56.280 is exposed to, how much does that play a role 0:15:56.320 --> 0:15:59.760 in whether they will get the disease or how severe 0:15:59.800 --> 0:16:00.760 the disease might be. 0:16:01.760 --> 0:16:03.840 Yeah, so this is such a good question, right, And 0:16:04.080 --> 0:16:07.360 I think really we're maybe getting a better glimpse into 0:16:07.360 --> 0:16:10.120 what this looks like in particular when we think about 0:16:10.120 --> 0:16:12.920 this idea of infectious dot So certainly, I think we're 0:16:12.960 --> 0:16:16.400 still somewhat of an infancy in understanding what is the 0:16:16.640 --> 0:16:19.720 specific amount of virus that you need to be exposed 0:16:19.720 --> 0:16:23.560 to to get infected. There's been some modeling studies that 0:16:23.600 --> 0:16:26.600 have suggested it's a bit higher than SARS, but a 0:16:26.920 --> 0:16:29.640 little lower than MERS, so somewhere in the kind of 0:16:29.760 --> 0:16:33.360 the hundred particle range. But a lot of that is 0:16:33.440 --> 0:16:37.080 somewhat subjective, right, So we're saying, okay, that that is 0:16:37.400 --> 0:16:39.800 the number you need. But there's also this aspect of 0:16:40.280 --> 0:16:43.120 exposure time, and I think that's become maybe a little 0:16:43.120 --> 0:16:46.080 bit more prominent the past few months. We've talked about 0:16:46.080 --> 0:16:49.360 these super spreader events, We've talked about things like people 0:16:49.360 --> 0:16:52.320 being in closed settings. That it's not just a function 0:16:52.640 --> 0:16:55.400 of the amount of virus that somebody is exposed to 0:16:55.440 --> 0:16:58.040 it at one moment in time or that static moment 0:16:58.040 --> 0:17:00.280 in time, as much as it may be about the 0:17:00.280 --> 0:17:04.600 accumulation over a specific period of time, and I think 0:17:04.640 --> 0:17:07.640 that's really important. I think we're we're getting to gain 0:17:07.880 --> 0:17:10.840 a better understanding of the fact that listen, a few 0:17:10.840 --> 0:17:13.480 of people that are in in closed settings and they 0:17:13.560 --> 0:17:17.240 are you know, uh, you know, subject to poor ventilation, 0:17:17.680 --> 0:17:21.000 and you have somebody that is releasing virus, even if 0:17:21.000 --> 0:17:23.920 they're releasing virus at a low rate, you probably are 0:17:23.920 --> 0:17:25.920 going to have people that are going to be continually 0:17:25.960 --> 0:17:29.920 exposed and you have that overall accumulation. So I think 0:17:29.920 --> 0:17:32.359 that that is is starting to give the syndication of 0:17:32.359 --> 0:17:34.679 the fact that we have to think about this not 0:17:34.800 --> 0:17:38.240 as just a static number, but also a function of 0:17:38.359 --> 0:17:41.920 the situation as well as a gain the person themselves 0:17:42.000 --> 0:17:46.520 and whether or not there are biological consequences that allow 0:17:46.640 --> 0:17:50.200 them to to basically take up more virus or are 0:17:50.240 --> 0:17:55.119 more vulnerable or susceptible to virus than others. 0:17:54.840 --> 0:17:56.000 That makes sense. 0:17:56.520 --> 0:17:59.679 So, speaking a bit more about viral shedding by in 0:17:59.720 --> 0:18:04.280 fact people, how soon after being exposed does someone become 0:18:04.400 --> 0:18:08.600 infectious and how does that infectivity change over the course 0:18:08.800 --> 0:18:10.120 of a person's infection. 0:18:11.160 --> 0:18:13.560 Yeah, this has been a kind of a long standing question, 0:18:13.680 --> 0:18:16.399 right is you know, when somebody's exposed, how long does 0:18:16.440 --> 0:18:18.639 it take for them to start shedding virus, and I 0:18:18.640 --> 0:18:21.679 think again, we're getting a much better picture. You know, 0:18:21.760 --> 0:18:24.840 doctor Moode Sebek has done some really great work, I 0:18:24.880 --> 0:18:29.040 think in providing good kind of contextual data looking at 0:18:29.600 --> 0:18:34.200 you know, overall infectiousness and periods of infectiousness for COVID 0:18:34.280 --> 0:18:37.520 nineteen and in for shedding and stars COVD two. And 0:18:37.560 --> 0:18:39.720 I think again, we look back at this idea that 0:18:39.800 --> 0:18:43.560 the majority of people within five to six days post 0:18:44.920 --> 0:18:50.040 contact or post infection or are likely going to start 0:18:50.080 --> 0:18:52.800 to have symptoms. In some cases that may trail out 0:18:52.840 --> 0:18:56.080 a little bit longer to twelve days. But if we 0:18:56.119 --> 0:18:57.919 look at that and we take that average, we take that, 0:18:58.000 --> 0:19:00.720 say that five to six days when people are usually 0:19:00.720 --> 0:19:03.600 showing symptoms, well we know that now it looks like 0:19:03.640 --> 0:19:06.400 that infectious period when you can actually recover it affectious 0:19:06.480 --> 0:19:11.080 virus from that person tends to be about two days 0:19:11.119 --> 0:19:15.000 prior to symptom onset and then somewhere in the neighborhood 0:19:15.000 --> 0:19:17.160 of up to about ten days. 0:19:17.160 --> 0:19:19.760 Post symptom onset. So that starts to give us a 0:19:19.800 --> 0:19:20.400 picture that. 0:19:20.320 --> 0:19:23.080 Even within you know, the span of a day three 0:19:23.200 --> 0:19:26.680 or day four post exposure, that you would potentially have 0:19:26.760 --> 0:19:30.880 somebody that is starting to be able to release virus. 0:19:30.960 --> 0:19:32.840 And then I think, again, when we look at all 0:19:32.840 --> 0:19:35.679 the clinical data that's kind of been a crude over time, 0:19:35.920 --> 0:19:38.080 what we're getting, I think a good perspective of is 0:19:38.080 --> 0:19:41.080 the fact that people are are likely most infectious in 0:19:41.119 --> 0:19:43.720 that you know that kind of one day to two 0:19:43.760 --> 0:19:46.800 days just prior to symptom onset to about five days 0:19:46.840 --> 0:19:47.879 post symptom onset. 0:19:48.480 --> 0:19:52.280 Okay, gotcha. And so because you know, we know that 0:19:52.359 --> 0:19:56.440 the amount of virus shed changes throughout clinical disease, how 0:19:56.520 --> 0:19:58.639 much does it change, you know, sort of looking at 0:19:58.680 --> 0:20:00.960 a different sort of snapshot, how much does it change 0:20:01.160 --> 0:20:04.399 across different severity of disease? So are people who are 0:20:04.440 --> 0:20:07.640 severely infected, are they shedding more virus? Are they more 0:20:07.680 --> 0:20:10.040 contagious than those who are asymptomatic? 0:20:10.600 --> 0:20:12.879 Yeah, Again, I think we're starting to get a better 0:20:13.080 --> 0:20:15.000 picture of what this looks like, right, And I think 0:20:15.000 --> 0:20:18.359 in particular, when we think about this idea of asymptomatic 0:20:18.760 --> 0:20:21.359 patients versus those that are pre symptomatic versus those that 0:20:21.400 --> 0:20:25.720 are symptomatic, certainly, you know, some of the household contact 0:20:25.800 --> 0:20:29.840 data suggested that people that are asymptomatically infected seem to 0:20:29.840 --> 0:20:34.200 have a much lower secondary attack rate than what people 0:20:34.240 --> 0:20:37.440 that are symptomatic or pre symptomatic do. So that sorts 0:20:37.480 --> 0:20:40.840 of suggest that people that have you know, basically mild 0:20:40.960 --> 0:20:45.960 or asymptomatic infections likely are going to lead to lower 0:20:46.040 --> 0:20:49.359 numbers of infections based on the amount of virus that 0:20:49.440 --> 0:20:52.679 they release as compared to people that have more moderate 0:20:52.720 --> 0:20:55.760 or more severe symptoms. But there's also kind of a 0:20:55.800 --> 0:20:57.800 converse to that when we think about this idea of 0:20:57.840 --> 0:21:00.879 people that are severely ill. I certainly know that that 0:21:00.920 --> 0:21:03.600 people that are severely ill may have a longer period 0:21:03.960 --> 0:21:08.480 at which they're able to release infectious virus, But the 0:21:08.640 --> 0:21:12.000 likelihood is also that those severe disease cases are probably 0:21:12.080 --> 0:21:15.240 also going to be hospitalized or receiving care. So the 0:21:15.359 --> 0:21:17.760 likelihood is that those people that are severely ill, even 0:21:17.760 --> 0:21:19.880 though they're releasing a lot of virus, are probably not 0:21:20.000 --> 0:21:22.960 going to be, you know, in a position where they're 0:21:23.000 --> 0:21:26.000 going to be exposing a lot of additional people in public. 0:21:26.440 --> 0:21:28.200 So again, I think we get back to this phase 0:21:28.240 --> 0:21:30.720 of saying that somewhere, you know, kind of in between, 0:21:31.040 --> 0:21:34.240 you know, people that are mild to moderately ill and 0:21:34.680 --> 0:21:37.720 kind of looking at the viral loads from the data 0:21:37.720 --> 0:21:40.399 that we have in that kind of primary infectious period, 0:21:40.720 --> 0:21:43.480 it probably still follows that, you know, somewhere again in 0:21:43.840 --> 0:21:47.080 that zero to five day range that people that are 0:21:47.119 --> 0:21:51.120 moderately ill or mildly ill probably are going to have 0:21:51.240 --> 0:21:54.880 the greatest ability to release virus during that period. 0:21:55.760 --> 0:22:00.439 That makes sense. So overall, we're now like a full 0:22:00.840 --> 0:22:05.119 year into this or even longer, and we've got a 0:22:05.200 --> 0:22:08.840 much better picture of the spectrum of disease that SARS 0:22:08.840 --> 0:22:11.719 covid two can actually cause, like you mentioned already, from 0:22:11.800 --> 0:22:17.159 asymptomatic infections to very severe or even fatal outcomes. So 0:22:17.359 --> 0:22:20.040 could you walk us through a little bit this spectrum 0:22:20.119 --> 0:22:24.200 of disease in terms of symptoms or clinical observations, first 0:22:24.280 --> 0:22:27.879 talking about like how many people really are asymptomatic, and 0:22:27.880 --> 0:22:30.640 then what a mild infection looks like and what moderate 0:22:30.760 --> 0:22:34.119 or severe cases are like, Like what proportion of cases 0:22:34.119 --> 0:22:37.439 are we talking about that are very severe versus mild 0:22:37.520 --> 0:22:39.280 versus completely asymptomatic. 0:22:39.960 --> 0:22:42.680 Sure, so, as you mentioned, we have a much greater 0:22:43.080 --> 0:22:47.280 understanding of the clinical syndrome that we see now, and 0:22:47.720 --> 0:22:50.560 I think that you know there are very various definitions 0:22:50.560 --> 0:22:53.960 out there for patients who are infected, and you know, 0:22:54.000 --> 0:22:57.520 some of these criterias may overlap or vary across the 0:22:57.520 --> 0:23:00.800 different guidelines that we see, but for the most part, 0:23:00.920 --> 0:23:03.200 you know, when we talk about patients are asymptomatic or 0:23:03.240 --> 0:23:07.840 pre symptomatic, these are people who test positive for socoby 0:23:07.880 --> 0:23:12.480 two via the nucleic acid amplification test or amagen test, 0:23:12.800 --> 0:23:16.159 but they have no symptoms consistent with COVID nineteen. And 0:23:16.200 --> 0:23:18.800 then the next step up that we would consider patients 0:23:18.800 --> 0:23:21.679 who have mild disease, and these are people who have 0:23:21.840 --> 0:23:24.280 you know, various signs and symptoms of COVID nineteen. 0:23:24.400 --> 0:23:28.320 So these are the very non specific symptoms. 0:23:27.880 --> 0:23:34.840 So patients who could have fever, cough, headaches, muscle aches, nausea, vomiting, diarrhea, 0:23:35.760 --> 0:23:37.920 and then loss of taste or smell, which has become 0:23:37.960 --> 0:23:41.560 one of the characteristics that we see with this viral disease. 0:23:42.240 --> 0:23:45.840 But typically these people don't have any shortness of breath, 0:23:46.080 --> 0:23:50.439 they don't have any abnormal chest imaging. And then the 0:23:50.440 --> 0:23:52.640 next stage of disease that we tend to see are 0:23:52.720 --> 0:23:55.720 people of moderate disease, and these are people who have 0:23:55.920 --> 0:24:01.280