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All Podcasts Toolkit: How to Build a Bubble

Toolkit: How to Build a Bubble

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Description

Frankly, it’s a little embarrassing it’s taken this long to do this toolkit, but better late than never: In the Bubble answers your questions about bubbles. Andy and Lana enlist the help of epidemiologists Emily Gurley and Saskia Popescu to get a better understanding of what a bubble is (and what it isn’t), how to build a safer one, what to do if someone in your bubble gets sick, and more. Plus, why the UK has bad bubbles.

 

Keep up with Andy on Twitter @ASlavitt and Instagram @andyslavitt.

 

Follow Saskia Popescu @SaskiaPopescu and Emily Gurley @EmilyGurley3 on Twitter.

 

In the Bubble is supported in part by listeners like you. Become a member, get exclusive bonus content, ask Andy questions, and get discounted merch at http://lemonadamedia.com/inthebubble/

 

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Check out these resources from today’s episode: 

 

To follow along with a transcript and/or take notes for friends and family, go to www.lemonadamedia.com/show/in-the-bubble shortly after the air date.

 

Stay up to date with us on Twitter, Facebook, and Instagram at @LemonadaMedia. For additional resources, information, and a transcript of the episode, visit lemonadamedia.com.

Transcription

SPEAKERS

Andy Slavitt, Dr. Emily Gurley, Lana Slavitt, Dr. Saskia Popescu, Lynn

Andy Slavitt  00:07

Welcome IN THE BUBBLE. This is Andy Slavitt. Lana and I have a great podcast for you today. We’re very excited. It’s about HOW TO BUILD A BUBBLE, how not to build a bubble. And who better to do this podcast than the IN THE BUBBLE team. We’ve got two great guests who are really experts in this. Emily Gurley, she’s an infectious disease epidemiologist at Hopkins. She’s done a lot of great work around contact tracing, and bubbles. She’s a super expert at it. And then the really wonderful Saskia Popescu, who is also an infectious disease epidemiologist. She is at the University of Arizona and George Mason University. And they’re going to take your questions on how to build a bubble, and to lower your risk as much as possible. So let’s hit it.

Andy Slavitt

Everybody.

Lana Slavitt

Hi! Good afternoon.

Andy Slavitt 

Thanks for being IN THE BUBBLE to talk about how to build the bubble. I feel like this is an episode we would been remiss in having we probably should have had this conversation. months ago, probably I’ve contributed to the great, difficult plight this country’s having by not having Emily and Saskia on before. And Lana and I are both very excited to have you because like everybody else, we go through this, this question about how do we, how do we stay safe? How do we build a bubble? And this is a new concept. That is one I think we’re gonna have to be familiar with for some time. So welcome to both of you.

Andy Slavitt 

Hi, Emily.

Dr. Emily Gurley 

Hi. Glad to be here.

Andy Slavitt 

And hi, Saskia.

Dr. Saskia Popescu 

Hi, thanks for having me.

Andy Slavitt

Lana, will fire in questions along the way, as well, we have some things we’re all curious about. Maybe we can start with just, can you define what a bubble is? Maybe Emily, if you want to start?

Dr. Emily Gurley 

Sure I’m happy to take a pass. So I’ll start first by just acknowledging that this virus, like many viruses, takes advantage of our connections to each other, and uses those connections to transmit and propagate and the world. This transmission happens through what we call social networks. And I think we all have some even you know, in lay terms have some idea of the concept of a social network. You can think about six degrees of separation from Kevin Bacon, for example, we talked about how people are all connected to each other in some way or another. And so our risk of infection comes from that social network.

Andy Slavitt  02:41

I hope Kevin Bacon does not get COVID or we’re all in trouble.

Dr. Emily Gurley

We don’t want anybody to get COVID. Um, but you know, the idea of the social of a bubble is that you sort of close off some of those connections, so that they’re limited. And, you know, it’s a, it’s a way of mitigating? Well, not just the number of people you have contact with, but who, the people you’re having contact with or having contact with. So it’s a way of closing off those social networks, not to, I really don’t like the word safe. And you know, in this context, I think we all have, there’s all a risk to some of us in some way or another, but trying to mitigate that risk trying to make our activities and our lives as low risk as we can manage.

Andy Slavitt

That’s a good definition. Saskia?

Dr. Saskia Popescu

So I think part of it when I’m looking at it from like an epidemiological infection control standpoint, I think of a household, a place where you are interacting with, with people that is unmasked close interaction for a prolonged period of time, like really getting into the weeds and that, but I entirely agree with Emily, it’s really about those social interactions and connections. So when we talk about a household, that’s not just the nuclear definition of it, but also, you know, do you have roommates that you live with, or people that frequently stay with you? So you know, I think really, when we discuss bubble, I like to think of it more of as a pod. You know, it’s my pod of people that I live with, that I am frequently interacting with, and I’m having an unmasked time with. And for some people that is in there, their little home, and some people that’s a little bit bigger if they’re alone.

Dr. Saskia Popescu  04:27

So I think it’s really important to be cognizant of that. Because one of the challenges when we say household has been that people think, well, if my home is the safe place that people coming into my home is safe. One of the examples that I always thought was really great was actually Dwayne Johnson, “the rock”. When he got COVID-19. He said, you know, we had been being so safe, and we had our family friends over and they were being really safe and they came into our household. And that’s how they got exposed. And it was this really great “aha” moment of everybody thought that they were safe in their household so when they merged households that suddenly infused safety. And I think it’s such an important piece when we’re discussing what a bubble is that we explain what the context of the household is, you know, people you’re living with, that you are having unmasked living space with.

Andy Slavitt

Yeah. But you know, you’re right. People do have different definitions of safety. And so when you make this decision to open your bubble up or your household up, your pod up, that can happen.

Lana Slavitt 

I also think people don’t have a common set of questions that they should ask, in order to even assess whether or not somebody is being as safe as you it’s, it’s almost like it’s embarrassing for people to ask those questions. You feel like you’re casting aspersions, just by asking. And so they don’t. And they make this assumption that other people are being just as safe as they think they are.

Dr. Saskia Popescu

I think we all have our own unique risk perception, I experienced this so much in healthcare, where we were really obsessed with our safety when we were dealing with patients or patient facing interactions. But then when we were in break rooms, or in touchdown areas, there was unmasked interaction, because it was the sense of it was safer. And that’s where we actually had a lot of outbreaks. And I see the same sense kind of in the community where we have our own assessment or determination of what’s considered high risk. And that really impacts our behavior elsewhere. So if you have people that you’re living with, I think one of the most important things we can do is communicate about what risk is. I always like the example of listing five to 10 activities and everybody rank where they view them in the terms of risk. And do we all do the same things as high risk? What does that mean? And how can we make sure we’re all on the same page?

Dr. Emily Gurley

I do think in the language that we’ve used around the pandemic, and transmission sort of, is misinterpreted. So home is a good example, doing things Outdoors is another where I see now people putting up tents where people gather outdoors, but in a tent, I mean, they’re sort of getting out, you know, it’s like a technicality. That’s not really what we mean, we mean open air. And we mean, your home is, you know, a safe place to be if it’s just you and the people you live with. So I think using a bit of different language for this can also be useful. So I like to think about context. So asking people, you know, if we’re talking within our bubble, even in our household, we talk a lot about contacts, how many people have you had a contact with today, if you are proposing doing something outside your normal activities, how many new contacts you acquire by doing them? And it gives us a way to sort of quantify and compare high low risks that’s not as reliant on your own interpretation of what that means.

Andy Slavitt

Okay, so before we get to people’s questions, maybe we start with good to start with Lana’s question is, are there three or four or five questions that you should ask somebody if you’re going to let them into your bubble, either temporarily, or, you know, or you’re forming a bubble? What are the questions that you would ask that you’d want to know the answers to?

Dr. Emily Gurley  08:05

I mean, I’ll start by one that’s just really I think, low hanging fruit. And that’s, have you had contact with anyone who has COVID in the past two weeks, or anyone who’s sick, who’s awaiting a test? Ideally, those folks should be in quarantine anyway, but we know that a lot of programs can’t keep up. So that’s one quick, quick one, that should be universally acceptable.

Andy Slavitt 

That’s a good one to start with.

Dr. Saskia Popescu 

Yeah, I would throw in how do you define an exposure? I think you know; we have a very specific public health approach. But various people have different things, some people view going to the grocery store is very high risk, and some viewed as low risk. So how would you define an exposure? Because part of forming a pod is everybody’s on the same page about when high risk activity or exposure might happen that could potentially burst the “bubble” quote, unquote. So what are those activities that would fall into that category?

Andy Slavitt 

I get the sense; a lot of people think they’re being safer than they are. But then when they let their guards down, they’re not conscious of it, like a delivery person may come to their apartment, or something like that. So are there a few kinds of common mistakes that you said, you know, if they answer these questions pretty well, then I think you’ve got someone who’s probably more likely to be safe.

Dr. Saskia Popescu

So Emily had a great example that I love, and that’s outdoors. One of the biggest things I see is people eating outdoors. And assuming because it’s outdoors, they don’t need to wear a mask when they’re interacting with people that are outside of their little bubble, their little pod. And I think that’s a huge misconception. They’re not spaced, they’re eating and drinking so no mask, and they think, “well, I’m outside of dining. It’s safer. I can get together with the people I might not normally be able to endorse,” and that’s a misperception I often see happening so asking if they go out to eat instead of do eat indoors. For various specific questions like that, you know, I also really think asking people, how they handle transparency and how they approach having difficult conversations, because one of the biggest problems we have is stigma and blame and shame around this right now. So, if you are going to form a pod, making sure that this is kind of a no fault, no shame environment so that people feel comfortable coming forward, if they slipped up, you know, if they had an exposure at work even

Andy Slavitt  10:29

No glaring.

Dr. Emily Gurley 

Yeah. Well, and I think that that’s really important. So when we say, you know, if someone is infected within your pod, I think to label that  as a failure of the pod is not correct, right? The again, there’s no life, that’s no risk here, where you’re trying to do is reduce your risk. So I think we need to be careful even about like, Okay, did this work or not? I mean, it works. If you’re talking about exposures, if you have an understanding of what the exposures are, of the people around you, then I think the pod concept is working, or the bubble concept is working. But everyone makes their own decisions about what risk they you know, what they prioritize as, as an activity and what risks they’re willing to take on.

Lana Slavitt 

It almost feels like you need a contract or something like, here’s what we’re doing. And you know, are you willing to agree to do the same?

Dr. Emily Gurley 

Certainly a social contract.

Dr. Saskia Popescu 

There’s actually a really great document that Joe Johnson put together that basically explains what a corn pod is. And it’s a whole set of questions. And I really love that because it also asks, what you know, what do you do if somebody gets sick? Do you have a plan for that? One of the things I think, fundamentally, we have to go back and ask people, though, is, what do they define as a pod, as a bubble? Because I’m very specific in mind. But if somebody might think, well, it’s myself and our in laws, and our siblings, that’s a pretty significant bubble. I mean, they might think it’s much larger. So having those conversations about truly what they define as a bubble is, in my opinion, the first and foremost important,

Andy Slavitt  12:13

Maybe we’ll put a link to that document in our show notes. We’ll also put a couple of the images that you’re very familiar with about people what their bubble is, what they think their bubble is, let’s get to some of these questions from people because they have a lot on people’s minds. Let me start with Carly. Who writes:

Andy Slavitt

“What are the questions and issues that you should discuss with bubble friends? Do retail visits, grocery store visits, rule out normal contact within the bubble? What’s the best practice if one of the families wants to see extended family outside the bubble?”

Andy Slavitt 

Saskia, you want to start?

Dr. Saskia Popescu

So I think there’s a few questions everything from what you’re considering risk, risky, and not risky. How you handle exposures or illnesses, testing frequency, even how to handle if you know, for the last question about family breaks in the bubble, transparency, all of those things. I personally don’t view grocery shopping as high risk, but I think part of the process of forming a bubble is deciding what is an okay, outdoor out of the bubble activity, except that everybody is comfortable with and then what’s not. So for grocery shopping, I’m okay with that, you know, for those essential errands, I’m okay with that. But I would not be comfortable with somebody saying that they’re going to be going to restaurants and sitting indoors and things like that. So I think that’s an important question you have to define as a bubble, perhaps (unclear) says, No, we’re gonna do everything, you know, remote and order online. And that’s fine. But that’s part of the bubble process is to look at the risks, decide what everyone is comfortable with, and then determine those activities.

Dr. Emily Gurley

Yeah, I’d add that. We all have some, again, we all have our own internal risk filter, right? Because some of us are at higher risk than others. So we have different thresholds. And we have to acknowledge that. What we know about transmission is that there are some types of contacts that are empirically much higher risk than others. Being indoors for prolonged periods of time, next to other people who are unmasked, is significantly higher risk from an empirical perspective than a grocery store visit, where it may not be crowded, and everyone has a face covering on and it’s, you know, last 15 minutes, right? So I think we have a risk perception based on our own risk profiles. But we have to acknowledge that there certainly are different scenarios that are much higher risk for transmission than others. But I think as Saskia mentioned, it does all come back to communication, right? So regardless of what the empirical evidence says, if you’re going to link up fates with somebody else, then you should be on the same page.

Andy Slavitt  14:54

“So what’s the most manageable size?”

Andy Slavitt 

This is a question that comes from Maggie, what’s the typical outer limit for manageable size for a bubble?

Dr. Saskia Popescu 

I don’t think there is one. I mean, we know the more people the more risk, high risk, it becomes I think..

Andy Slavitt 

Would you be at 100% bubble?

Dr. Saskia Popescu 

No, I would not. I mean..

Andy Slavitt 

Would you be on 10% bubble?

Dr. Saskia Popescu 

It depends on how many different households that bubble is, are we talking to households of five or five of two? And I think that’s part of the piece too. And my question is, does everybody in that bubble want to be in that bubble? Or are they kind of being pressured to be in that bubble, because one thing I’ve seen are a couple of families merging and a particular family member is not really feeling it, but they’re doing it because you know, their spouse wants to, and that becomes a little bit problematic. And it can lead to some bubble breaks or some friction. But ultimately, I think, we know any increase in exposure or contacts outside your household is going to increase risk. California has a rule of no more than 10 people gathering. I mean, I think the truth is, there’s no magic number, it’s about having the people, the right people in your bubble that are on the same page with you that have the same approach to risk and transparency, and harm reduction. Because you could bubble with two other people. But if those people don’t have the same risk awareness and decide to go out to the bars all the time and are traveling everywhere, probably not the safest thing to do. But ultimately, that’s higher risk that if you were bubbling with five people that were all on the same page.

Dr. Emily Gurley  16:33

it’s not it’s not the number of people that are in your bubble. It’s the number of people that are in your bubble and the number of contacts that they have. That’s the equation you have to think about. So you’ve got to think a couple orders out.

Andy Slavitt

So what I’m hearing his consistency of philosophy and being honest about what and then the second thing you said is around disclosure and transparency. So if someone you know gets exposed. To me I’d want if I felt like it was somebody who I trusted enough to know that if they got exposed, they’d cut they would notify everybody. So you know what? “I got exposed I’m out.” That’s the kind of person who probably I would trust in the bubble, anyway.

Dr. Emily Gurley 

Trust is important, right? You have to trust two things, I think you have to trust that people understand what contact is, understand how would they would know if they were exposed and sort of be keeping an eye on that. And you have to trust that they would tell you.

Andy Slavitt 

So let’s go to Lorie. She writes:

Andy Slavitt 

“What if you’re in a bubble, but know that some of the people in your bubble are unlikely to follow CDC recommendations? Our situation is a family farm. But one and a half of the three households are, quote “done.” And by done I think they mean, “I’m done,” like, done with COVID and have a lot more exposure to people in the community.

Dr. Saskia Popescu  18:14

I would say that’s not really a bubble. It’s quite a porous bubble. And I would say, if you have people in your bubble that do not subscribe to that same philosophy about following..

Andy Slavitt 

Get out.

Dr. Saskia Popescu 

Yeah, I mean, you have to just say that’s not a bubble then, it really isn’t, and have those conversations, there’s nothing wrong with saying, you know, we just disagree, and that’s okay. But this is about my safety, too. You know, and I, I would appreciate transparency, if somebody felt that I was not being as safe as they would have preferred me to. So I would suggest quite a porous bubble.

Andy Slavitt

Here’s another question. This is from Julianne:

Andy Slavitt 

“How do I ask a family to let me, a single, into their bubble? Should I even ask or just tough it out, alone?

Dr. Emily Gurley

It’s kind of heartbreaking, right? To hear that kind of question. Because we all need social connections to be well. So I would ask, you know, I assume that this person is friends with a family already. But in terms of, you know, folks, you let into your bubble, people who really don’t have other social connections, who live alone. It’s much easier, I think, to bubble with those folks. And we need each other and we need to have some way to connect. So I would ask.

Dr. Saskia Popescu 

Yeah, I entirely agree. I think actually, early on the Netherlands really piloted this and said, you know, yes, we’re kind of in closures and people are having to stay at home orders. But we recognize the importance of social interaction and of intimacy and that, you know, not a sexual nature even but just the need to be around people to hold each other and they really piloted The process to get people to be vocal about that and do it safely, that harm reduction approach is so important in a situation.

Andy Slavitt  20:07

So don’t go to the grocery store with a sign that says, Let me into your bubble. And just hope that you meet some strangers.

Dr. Saskia Popescu 

Probably not.

Andy Slavitt 

No, but you know, maybe at another time, but if they would think it would make sense, this is my own amateur view that if you find someone that you obviously trust and you want them in your bubble The great thing to be assure them why you’re safe, say, Look I’ve just been endorsed for the last X number of months, I haven’t interacted with anybody. This is how I; this is what I do for my occupation this is how I interact. And this is why and what else would it take for you to feel comfortable. And asking that question. Maybe that helps.

Dr. Saskia Popescu

Definitely, I think part of this is also deciding what your bubble interactions are going to be. So for some people, that might mean they have you over to their homes, but you’re still wearing masks. For some that might be you’re wearing no masks at all. And it’s you know, it’s really truly as if you’re all in the same home and household. So I think that is an important piece. And perhaps if you were entering a bubble, and the other people would feel more comfortable. If you wore a mask for a couple weeks. I think that’s okay. You know, we all have to decide what those interactions look like.

Lana Slavitt

I think there’s a latent opportunity here for match.com, they can help you match you up with like, your ideal single, so get some of the singles together.

Andy Slavitt 

Get your risk profile.

Dr. Emily Gurley

I mean, yeah, I mean, it’s just a new, it’s a new form of monogamy, right? Or sort of, you know, you’re making contracts about social interactions with a specific group of people.

Lana Slavitt

I mean, I think Honey, you know, my mom is gonna bubble with the family next door, she lives alone. And they’re both teachers their distance teaching in Northern California, they have a four-year-old who is not in daycare because they’re worried about exposure. And so she’s been helping them with childcare while they distance teach, and they are all getting everything delivered. And it’s been, I think, a lifesaver for her.

Dr. Saskia Popescu  22:02

That’s a great idea. I also want to add, a bubble doesn’t have to be this like super long term permanent thing, you can form temporary bubbles, especially around the holidays. So for example, we bubbled with my parents for the holidays, we all quarantine for 14 days, got tested on day 10 or 11. And then got to see each other on masks, which had been the first time since like January. And that was a really nice way that it kind of took the pressure off of everything. And we could only do that because my stepdad travels. So you know, kind of forming those temporary bubbles, I think are also an option. I just I’ve heard from so many people, they think that bubbly means like months on end or for the entire duration of the pandemic and that I mean, it can’t be of course, but it doesn’t have to be I think there are safe ways to of course do this temporarily. So you can get together, you know, for a small like birthday or holiday.

Andy Slavitt

Do a little breakup, your breaking out of our bubble. Okay, here’s an email from Liz. It’s totally comprehended, but you guys will. It’s over my head.

Andy Slavitt

“I heard an interview in October with an infectious disease researcher, she said, If everyone is serious about precautions that your bubble doesn’t have to be strictly a circle.” This intrigues me. This is me talking. So I’m going to chain a very small bubbles. I live alone, I’m in a bubble with two households. Each of those households has a second household in their bubble. We never combine the bubbles, we are all vocal about testing status, quarantine, etc. and see each other maybe once weekly, with cases rising, is this still a safe practice? Or should we further close ourselves in, the chain bubble?”

Andy Slavitt 

What do we think Emily?

Dr. Emily Gurley  23:46

I mean, again, I really don’t like this word safe. It’s like it denotes this place. That you know, I’m safe in here and you’re not. And it sort of dichotomized things when really, I think, again, what we’re trying to do here is get to a lower risk, right? So I but I think if you say we don’t combine bubbles, my guess is what they’re saying is that they don’t all meet together. However, if you’re meeting the same people over the course of a week, you are effectively combined because you have links to each other. So I think that it’s functioning more like a big bubble. I mean, what how you know how much higher risk that is totally depends on the context those people have and what they do. And I think also this idea of you can take things very seriously, but by virtue of your job, or something else have significant risks outside the home. So I want to de-link taking things seriously with having any kind of risk in your daily life. But to me, this doesn’t sound like a closed bubble. Although, if you’re, you know, anytime you’re limiting your contacts, you are reducing your risk. To a certain extent.

Dr. Saskia Popescu

I think the piece that worries me is, if one household has an exposure or an illness, it’s going to trickle all the way through potentially. So making sure that people are aware that they’re part of a chain, instead of very separated as important. So, you know, as Emily mentioned, there’s no safe, they’re safer. And risk reduction. But part of that is communicating because my concern would be, they might not realize the implications of having a little bit more of a linked bubble set. And what would happen if one had an exposure, then theoretically, all of them could potentially need isolation or quarantine, depending on any illness and things like that, or what’s the process? If one bubble has an illness? Does the bubble you know, further down need to start testing or ramp up something? I mean, you know, you have to go through that contact tracing process, but essentially, what does it mean? So that needs to be a clear conversation, in my opinion, what is our process, if a bubble twice removed has an has an infection.

Lana Slavitt  26:09

You touched on something a little bit earlier about, you know, people who work outside the home, and it’s in specific types of jobs, and I think about my friends who are nurses and doctors, and none of them feel like they could be in a bubble with anyone else, just because of the type of exposure that they get at work. It’s just not feasible.

Dr. Saskia Popescu

I mean, there was a reason I didn’t see my parents for so long, because I was in COVID units every single day. And even though I knew I was being safe, I just there’s always that tiny little chance that my assumption of safety was, you know, there was a slip up somewhere, and I had an exposure. And because in health care, you really don’t get tested very often unless you’re sick. So that I mean, that was my personal decision. I do know people that work in healthcare that have formed bubbles, usually they’re with other families that also work in healthcare that kind of understand the risk dynamics involved. Because I think it can be very daunting, if you are forming a bubble, or somebody who works in a higher risk environment. That’s not only healthcare, but having those conversations about what that means. And so everybody is comfortable is really important. I personally just didn’t feel comfortable, because I have parents that have, you know, they’re at risk for severe disease.

Andy Slavitt

You know, one of the things that remind people love who’s thinking or thinking about this idea of a link bubble, in addition to your points about not having had the ability to communicate with everybody, which is very important, is to recall that wedding there was over the summer in Maine, where a number of people at the wedding were infected. And then a number of people died. But nobody who died was at the wedding. The people who died were people who were in contact with people who were at the wedding. So just remember, being a link in the chain is just as bad of transmission. Let me play a voicemail now from Lynn.

Lynn 

Hi, my name is Lynn. I’m wondering what the impact of vaccines being rolled out, will have on our thinking about the social bubbles we have, how long we need to maintain them, and other things related to that. Thanks for considering my question. Bye, bye.

Dr. Emily Gurley  28:20

Well, anyone who has antibodies is at lower risk for being infected, and perhaps also being infectious. There are caveats around that, right, we know that people can be infected more than months, I don’t think we understand the effect of the vaccines that look very promising for preventing illness, which is fantastic. We don’t really know how those vaccines affect viral shedding, or ability to transmit. So I think we’re still holding our breath on that and waiting for some data. But in general, if someone who was infected and recovered a few weeks ago, probably has antibodies. And unless they’re, you know, at high risk for other reasons, it’s they may be at lower risk for being infected for the near future. We don’t have a lot of specific information about that yet.

Dr. Saskia Popescu 

I think, you know, we do know that for about 90 days, is when you’ll have some pretty good coverage from both natural infection but also the vaccines have been showing immunity for about 90 days. But as Emily mentioned, viral shedding is a big piece to this. So we don’t know how effective the vaccines will be in preventing asymptomatic transmission. That’s a big piece that we’re still learning. And that could potentially lead to viral shedding that would cause secondary transmission. So another piece to this also is let’s say you did have somebody Who was sick? they recovered, that’s wonderful. Another question is, did anybody at home get sick too? You know, we know household contacts, of course do happen, you know, they have a higher (unclear) rate. So my question would be, if somebody tests positive in one of your bubbles, we probably all obviously need to quarantine. But then what are your decisions for testing at that point, if nobody has symptoms, because you know, of course, asymptomatic transmission, what we are seeing is that about one in five cases of COVID-19 are asymptomatic. So I would encourage people, if you do have somebody that gets sick with COVID-19, in your bubble, come up with a plan for other people, if you do want to get tested after that, you know, before that, the end of that 14-day quarantine.

Andy Slavitt  30:46

Do you mind about repeating your point about 90 days just to make sure that everyone understands what you’re saying?

Dr. Saskia Popescu 

Yeah, so the CDC recommends that you don’t retest people within 90 days, because we know that they’ve recovered, they can still have viral shedding of noninfectious virus for 90 days, meaning a PCR would pick it up, but they’re not really infectious. So we know that you do have immunity for about 90 days. After that, I mean, it’s likely you have some week, it’s just varies quite a lot. So usually, the rule of thumb is you’ve got protection for 90 days, for sure. Beyond that, just kind of depends.

Andy Slavitt 

We’re still learning.

Dr. Saskia Popescu 

Yeah, exactly I think it’s so easy for people to forget that we’re on month, barely into month 12 of this, we’re learning so rapidly, that what we know right now is likely going to change in a month, but 90 days seems to be that sweet spot where we feel really confident and protection. It’s likely after that, but.

Andy Slavitt 

So were still learning. We think T cells help and all of those things that we’ve talked about. So but the relative risk increases after 90 days is what we’re hearing.

Andy Slavitt  32:01

I’ve got a question from Dave Berlin. I really want us to get Dave a good answer because I like what he’s asking. Dave’s dad has participated in the Moderna vaccine trial, presuming Moderna gets in the UA this month. And they disclose to him that he received the vaccine and not the placebo, “can I invite him over immediately to celebrate. Can he come over anytime he wants to give us all hugs?” That’s the part of the question. I like the best. “He lives with my mom who has not received a vaccine yet, and does enough outside of the home that we are not comfortable seeing them now except outdoors, masked in distance. So what do we think? We up for hugs? Would you hug your dad in this situation? Saskia?

Dr. Saskia Popescu

I think the hard part, though, is again, we’re still learning how susceptible people are who have been vaccinated to asymptomatic transmission, you know, are they potentially gonna be virally shedding? So that information we’re still getting from the trials. I also want to point out COVID-19 is not the only respiratory infection we have out there right now. So if anybody feels sick, even if they test negative for COVID-19, you still need to take those respiratory precautions. So my concern would be with his mom, is there a potential? Where Yes, he has some protection, but we’re still learning about what that looks like. And he could be he could honestly become asymptomatic. that would be a piece that would worry me, honestly.

Andy Slavitt 

So you’re, you’re a no on the hug?

Dr. Saskia Popescu

Yes, on the hug with a mask, a brief hug, of course. But I wouldn’t say it’s a free for all.

Dr. Emily Gurley 

So there are two concerns, right? When I think when he’s the person posing this question, I would assume hypothetically could have two concerns. One is the concern that they’re going to infect him. The vaccine works great. If he’s a very high-risk individual, there’s still I would still wonder, like, the vaccines aren’t perfect. You still wouldn’t want to expose someone that you cared about, right? So I there’s a lot about his situation that I’d want to know about first, from that perspective, if the question is, is he going to infect them? We expect that that risk is lower than if he had not been vaccinated if he had not been immunized. But we don’t know exactly how much lower. And so again, there’s this sort of sidebar story where maybe he’s at high risk for being infected, you know, all the time, and maybe he won’t get sick now, because the vaccine, which is great, but we don’t know if he’s going to be infected.

Dr. Emily Gurley  34:36

I think when more people become vaccinated, and there’s less transmission in the community, for whatever reason, I think that changes, that changes the scenario. So I think we can’t separate this from community context. If you’re in a community where lots of people are infected, and any contact you have has sort of a higher than usual risk of infection, that’s got to be part of it. If you’re in a low-risk context, probably fine. But I, you know, I, again, it’s all on a continuum. And I’m being non-committal here to a certain extent, because there are so many variables that would affect that.

Andy Slavitt 

So Lana and I were looking at a great article this morning, that was in the New York Times about kind of what would an epidemiologist do? It was you may have seen the, who was it from Lana, who wrote it again?

Lana Slavitt 

Margot Sanger-Katz was one of the authors.

Andy Slavitt

That’s right. And so they basically polled several 100 epidemiologists and said, you know, do you dine indoors? Do you go to grocery stores, you know, etc. And there was a large enough volume of I forget how many people she talked to.

Lana Slavitt 

Andy Slavitt

700 people. And you know, and so the reason I didn’t have to push you is because a lot of people really, that it’s helpful for them, because they understand, most people understand that there’s no 100%, safe things, and most people understand what really, really risky things are, but they’re trying to figure it out. And you know, to me, it’s a very reasonable question that hopefully, people are going to be facing all over, which is a loved one comes back with the vaccine. And they’ve had a chat in the room, and they’re like, Hey, come on over, because they’ve been waiting a long time. And why wouldn’t they? And we’ve not yet done a great job communicating what the standards and protocols will be, hopefully, the CDC will, but people do want to know how you would approach these situations, understanding that, you know, you can’t guarantee anybody anything,

Dr. Emily Gurley  36:34

The vaccine should reduce the risk. We expect that we just can’t quantify we can’t quantify really how much. And I think the article about the 700 I, for me, when I read that, I was like, wow, I’m just not a particularly cautious epidemiologist, it seems, I definitely pick up my mail and go to the grocery store, I need food, and I let my kids play outside play. They’re a bit older, but you know, go on a run with a friend. Outside of course, with the appropriate discussions before anybody sick anybody say in your household, we know the drill here, I guess. I mean, I felt most out of step as well was sort of people’s projections about and pessimism about our ability to ever get back to anything that resembles normal life. I’m feeling rather optimistic, and maybe you know, who knows nobody has a crystal ball. But I feel like later sort of summertime, we have more, you know, more coverage of vaccines. Yeah, probably travel again, if I’ve been vaccinated, then it’s a chance.

Andy Slavitt

Ashish Jha was on an episode promising that we could all have Fourth of July barbecues, so we’re holding that and so if somebody to be angry at if it doesn’t happen.

Dr. Saskia Popescu  38:01

I also think it’s important to note when they refer to epidemiologist, they’re referring to all kinds, not just infectious disease, so I think there truly is a spectrum. And I think we’re kind of a different breed. I mean, we spent our entire lives doing this. So it’s likely we approach things a little bit differently.

Lana Slavitt 

They definitely weren’t getting haircuts; I’ll tell you that.

Dr. Saskia Popescu

Which is but at the same time, I mean, I’ve got my hair trimmed, you know, we both wore masks, I know she quarantines, you know, first appointment of the day. So, I personally, I thought that was quite interesting, you know, masks and face shield for her. So it was Yeah, I think Emily’s point is really important, where some are a little bit more risk adverse, but it’s also about risk perception to in the conversations you have when you are doing those things like running with a friend or getting a haircut.

Andy Slavitt

Yeah, my hair is ridiculous. And my bubble partner Lan is going to cut it today, she promised. She’s never asked me to cut hers, however.

Lana Slavitt 

Yeah, I’m not trusting anyone I live with to cut my hair.

Andy Slavitt 

You guys have much more. You guys all have much better assets to play with. And I do. There’s the cost of messing my hair is not as high.

Lana Slavitt

I actually had a question. I’m wondering if either one of you had saw any of the articles on the Christmas bubbles that they’re allowing in the UK this year? So between December 23 and 27th, three households can form a Christmas bubble and mix indoors and stay overnight.

Dr. Saskia Popescu

So is that like a closed circuit? Or is that that chain that we were talking about though?

Lana Slavitt

I know it sounds like they’re it. They’re hoping for that period of time it would be a closed circuit but of course, you know, they could be infected before they came in, they could be exposed. And they’re just asking to people to be quote as safe as possible and keep them as small as possible. But there doesn’t seem to be much in the way of rules around travel and masking or anything.

Dr. Saskia Popescu  40:02

So one of the things that always fascinates me is when we roll out these initiatives or these guidelines, we really don’t spend as much time doing the science communication behind it and explaining the rationale, and the limitations of it. And I think that really has failed us, especially in the US, like, for example, the six-foot rule, people think there’s this invisible force field at six feet. And for the longest time, it was, it was really impressive. And that’s why we I mean, we did see, you know, situational airborne, become a hot topic and really a piece that we had to explain them, just because you’re at six and a half feet inside, doesn’t mean you can take off your masks and eat, drink and be merry. So I think when that guidance comes out, we have to take the time to explain to people what it means, why it’s important, and how they can apply it pragmatically to their lives.

Dr. Emily Gurley 

You can form those bubbles anytime, right? There’s nothing special about Christmas, either. But anything, it’s the prep time on the front side, about having conversations and limiting contacts before you’re entering into that that’s the most important, you know, it’s hard to reach into the minds of the people who came up with that. But, you know, one, if what they’re trying to do is get people from getting together with 10 other families down to three as a risk reduction strategy. You know, even if you do nothing on the prep side, it does reduce, you know, overall risk if you’re just limiting the contacts.

Andy Slavitt

I think it sounds absolutely stupid. To be totally honest with you, because I think what I’ve learned over time is that when the government says it’s okay to do X, people just assume it’s okay and safe. And so if you close the restaurants at 10, people assume Okay, at 11, the restaurants were must have been unsafe, if you close the restaurants entirely. And they take these signals very literally. And I’ve learned that over the course of the year, I didn’t know that going in. I thought people had their own meter that they put over things, but a lot of people don’t because they’re you know, they’re tired and whatnot, but they so you tell people, three families, you’re like, Okay, we’ve got a second family. Let’s go find a third, right?

Dr. Saskia Popescu  42:08

What was like, even with the 15 minutes, we saw classrooms that were changing groups at 14 minutes, because they thought that somehow just eliminated risk. And it’s, I you know, I think, as you mentioned, very literal translation of the guidance. But that’s why we really, for every little tidbit of information you’re throwing out to the public, you have to spend the time to discuss what it means, you know, and really look at risk as an entire package, that Swiss cheese model, you know, risk reduction is additive, it’s not a single thing, and nothing is safe. It’s all safer.

Dr. Emily Gurley

Yeah, you’ve got to tell people why things might work and what the risks are.

Lana Slavitt

I mean, I was concerned about the Christmas bubble thing, because most people don’t, you know, visit the equivalent of the CDC, you know, in England and Northern Ireland and things like that. I’m sure that’s not where they get most of their information from. They’re watching television and reading the newspapers like we do. And none of the articles I read on it mentioned any kind of like guidance for what to do before that December 23rd, period. And you know, how to interact with each other during that little Christmas bubble respite, and I just thought people are just gonna, like, come directly from their job at the pub, like, enter the bubble. And this just feels so risky.

Dr. Saskia Popescu

I can’t imagine it will also create a lot of drama if you weren’t selected for someone’s three household group.

Lana Slavitt

That’s true. If you’re a family with four adult children, somebody is gonna get left out.

Dr. Saskia Popescu 

Yeah.

Andy Slavitt

Always number four. Let’s get this get to some more questions really quickly. This is from Rob Pickering. “I am a career firefighter EMT”. By the way, Rob, thank you for all you do. “My work bubble is also very social. We meal together and often sleeping open bunk rooms, or wearing masks around each other, but don’t have to in our sleeping quarters. What can we do to increase our safety at night? We’re also in the northeast, so windows open, It’s not a good year-round option.”

Dr. Saskia Popescu  44:12

I would say that’s not a that’s not a bubble. Sorry. Go for it, Emily.

Dr. Emily Gurley

Yeah. Well, I mean, I don’t know what they’re doing. You know, it’s also sort of shift work, right? And so are the same folks working together all the time. I know that some places have really thought about that, to try and reduce the total, to reduce the network sizes. If they’re not doing that they could consider it. They have this reality where they’re sleeping together. You know, that, that long in an enclosed space together is very close contact, it’s as if they’re all household members even closer. You know, not everybody in most households sleeps in the same room. So there is some evidence that some kind of air purifier might help. I don’t know how big the room is, you know, anything you could do to increase distance, improve the air circulation and air exchange with the outside.

Andy Slavitt

Just listen to our winter and air ventilation podcast. I have one more one more question that I know you guys have to get back to saving people’s lives and I’ve got to get back to talking people’s ear off. So it’s about college students. How long should college students quarantine after returning home? And other people traveling to visit you? giant hole in the Swiss cheese is a college student. Not gonna lie. We all have to be suspicious. So Saskia, why don’t you started then maybe you could ask if you have any closing comments as well that you want to guide people to? That would be great. Yeah.

Dr. Saskia Popescu 

So gold standard 14 days, the new CDC guidance has said, you know, especially if there’s testing availability, and being cognizant that I’m not everybody can honestly quarantine for 14 days, 10 days, if you’re not having any symptoms, seven days if you can test but you don’t test earlier than day five after you travel, if we’re assuming that travels, the exposure period, that last known date of exposure. So I you know, I always tell people aim for 14 days. quarantining at home, though, is really hard. That is probably one of the bigger challenges we don’t really give enough attention to. So please take the time to review the CDC guidance about how you can safely quarantine someone at home, and the resources they might need to do so. But at the bare minimum, it’s seven days with a negative test before they come out. And they’re still doing those daily symptom checks and being cognizant of that. So what I definitely encourage people is if you’re doing the bare minimum, you can only do seven days with the test, have conversations with them ahead of time about being safe before they travel.

46:55

And you know, and we keep saying being safe making safer decisions before they travel and travel safety, you know, wearing a mask the whole time being cognizant of when you eat and drink on a plane if everybody else is doing the same thing. So that’s how I would really encourage people to look at it. I know a lot of universities are very cognizant of this. So they’re saying, “hey, once you’ve gone home for Thanksgiving, stay home, you know, be online.” And if that’s an option, I would definitely encourage it. But that would be my bare minimum. You know, when it comes to kind of any thoughts at the end, I would definitely say, you know, we’re all really suffering from pandemic fatigue right now, I think we’re all varying levels of burned out. And I really tried to approach this, again, from that risk reduction being additive, we’ve not spent enough time doing that.

And I have realized spending more time talking to friends and family about what that means is really important. Because I know what it means. I know that the people I work with know what it means. But if we just take that time to explain. It’s not just the mask. It’s not just the social distancing. You know, I live in Arizona, so everybody’s outside right now. And that’s why we had tournaments in Arizona with hundreds of people with the assumption that it was safe because they were outdoors. So I think it behooves us to spend a little bit more time discussing how exposures happen and how we can reduce them through an additive approach.

Andy Slavitt  48:14

Great, Emily?

Dr. Emily Gurley 

I’ve got to say, on the CDC guidance, I think 10 days is reasonable when you get to seven days, even with a test. If you’ve been infected, there’s still a significant chance that you’re going to be sick after seven days. So I feel like I needed to at least say that I’m not I don’t really endorse the seven days, it’s better than nothing, for sure. But it’s, uh, if I had a student coming home, they’d be in the basement for longer than seven days.

Andy Slavitt 

Go for ten.

Dr. Emily Gurley 

Yeah, look, we all we all have to, you know, do the best we can, really prioritize the things that mean the most to us in life, and then go about those the safest way we can. It’s not easy.

Andy Slavitt 

Well, Lana and I really appreciate you guys coming on. I know everybody else does, too. This is an imperfect process. But I think you’ve really helped people today to figure out, you know, we just need to be cautious in how we do these things. Trusted for sure. And if the one thing I take away with is maybe to look for that one individual who isn’t part of a bubble, and it was lonely, and see if we could invite them into our bubble somehow. And tell them how to do that. And if everyone did that, you know, that might help somebody.

Dr. Emily Gurley

Thank you.

Dr. Saskia Popescu

Thank you so much.

Andy Slavitt 

I’m learning hard to build a big bubble. I would keep that bubbles fairly small. But if you can invite someone into your bubble, I think we should all do that. Everybody should invite one person into their bubble. All right, let me tell you about the next episodes. Heidi Larson from The Vaccine Confidence Project, me being confident again, that is coming up on Wednesday. Then we have another TOOLKIT: BACK TO WORK, and how to get back to work in the safest way possible. And then the following Wednesday, Anthony Fauci, who we’ve been meeting to have in the show for a long time and should be a great episode. You can’t listen to that one until you listen to all the ones before then though, sorry, you must listen all our episodes. I’m kidding. Have a great day. We’ll talk to you on Wednesday.

CREDITS

50:32

Thanks for listening IN THE BUBBLE. Hope you rate as highly. We’re a production of Lemonada Media. Kryssy Pease and Alex McOwen produced the show. Our mix is by Ivan Kuraev. My son Zach Slavitt, is emeritus co-host and onsite producer improved by the much better Lana Slavitt, my wife. Jessica Cordova Kramer and Stephanie Wittels Wachs still brew our lives and executive produced the show. And our theme was composed by Dan Molad and Oliver Hill and additional music by Ivan Kuraev. You can find out more about our show on social media at @LemonadaMedia. And you can find me at @aslavitt on Twitter or at @AndySlavitt on Instagram. If you like what you heard today, most importantly, please tell your friends to come listen, but still tell them at a distance or with a mask. And please stay safe, share some joy and we will get through this together. #stayhome

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