Andy enlists two experts — UC Davis Dean of Engineering Rich Corsi and “Mask Nerd” Aaron Collins — to better understand the importance of masking and indoor air quality during this Omicron wave. Fan favorite Rich returns to talk about how to think about ventilation, ways to reduce our inhalation dose, and how that’s changed with Omicron. Aaron breaks down everything you need to know about the different kinds of masks out there, including what masks are best for kids. Today’s episode is a battle of the nerds, and we all come out winners in the end with practical information to help us stay safer during this Omicron wave and beyond.
Keep up with Andy on Twitter @ASlavitt and Instagram @andyslavitt.
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Check out these resources from today’s episode:
- Check out Aaron’s YouTube channel for more mask testing and reviews: https://www.youtube.com/channel/UC3fF_rzkmZD0ufN685YE7lg
- Learn how to build a Corsi-Rosenthal box here: https://cleanaircrew.org/box-fan-filters/
- Here’s what the CDC has to say about the different types of masks and respirators: https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/types-of-masks.html
- Read more on the study out of the University of Bristol’s Aerosol Research Centre that Andy asked Rich about in today’s episode: https://www.theguardian.com/world/2022/jan/11/covid-loses-90-of-ability-to-infect-within-five-minutes-in-air-study
- Find a COVID-19 vaccine site near you: https://www.vaccines.gov/
- Order Andy’s book, Preventable: The Inside Story of How Leadership Failures, Politics, and Selfishness Doomed the U.S. Coronavirus Response: https://us.macmillan.com/books/9781250770165
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Rich Corsi, Andy Slavitt, Aaron Collins
Andy Slavitt 00:18
Welcome IN THE BUBBLE. This is your host, Andy Slavitt. We continue our Omicron 101 podcast episodes. Today, a whole heap of knowledge comes at you. It’s knowledge that like a lot of things with the pandemic, none of us can really be expected to know on our own, unless someone explains it to us. And today, knowledge can be coming at you in areas that people have a lot of interest in understanding and I think are more complicated than meets the eye. One is masks. How do they work? Which one should you wear a lot of controversy related to the CDC on this topic? We’ll straighten that out for you today with the mask nerd. Aaron Collins is on the show. He’s a mechanical engineer who’s got a background in aerosol science who doesn’t? He’s the guy who tests all these reviews masks and his YouTube channel. Very good, very entertaining. And aerosolization. How you keep spaces clean. What that means. How you make sure you’re in spaces that are either being filtered or have proper ventilation. Rich Corsi, yes, the dean of the engineering school at the University of California Davis, he is really one of the best indoor air quality experts, and a really good explainer out there. As an analogy, in this episode to the episode we did last week, on testing, and how to use at home testing and other types of tests how they work, it just dawned on me that these topics are so complex, but that people are smart enough that they just want to know if you tell people how it works, they’ll be able to make better decisions on what to use and what to do. And so that’s the approach we take today. These are tools that help us vaccines and boosters, save your life, but masks and filtered and well-ventilated air, prevent contagion and spread in the first place.
Andy Slavitt 02:15
You need them, even if you’re vaccinated and boosted. These are good things and they’re all around us. Whether you live in someplace that requires them or whether you live someplace that doesn’t, but you need them when you travel or whether you just want to stay safe. Good to know. So I think the questions that are on people’s minds today, what kinds what’s the difference in these NASS and then difference between 95 and N94? What are all the differences? How much exposure do you need in order to get sick? Is it true, you can get it in an elevator by yourself? All that stuff and these tools. So before we go on the conversation, that’s going to hopefully be very helpful to you. I want to discuss yet another tool that we have. Maybe it’s a tool that I find actually, in dangerously the lowest supply, perhaps more than any other tool right now. It’s a tool, that with it, amazing things can be done. People can be cared for. Exposures are much lower. Illness declines significantly. What does that tool, that tool that I’m thinking about is human empathy. Okay, this is the time when you roll your eyes, say, oh, come on, Slavitt. Stop being the […], stop with this vague human empathy stuff. We’re sick of it, we’re tired of it. You know, here we are. We’ve been through two years of this stuff. And even if you’re generally empathetic, so seeing that what’s going on around us that maybe just tough to reach, but I’m serious. I’m not talking about. This is some sort of nice philosophical emotion. I’ll give you an example. This morning, I went to the Children’s Hospital here in Los Angeles. And there were eight children in the hospital right now on ventilators. Most with COVID.
Andy Slavitt 04:12
Not all of them. 44 kids, they’re in the hospital in some form. Dramatic increases over the number that there usually are, I think, a tenfold increase in with the typically experiencing large chunks of nursing staff are out. You can feel and walk into these hospitals in this hospital. Looking at the parents, looking at the experience people going through the fear how awful it was. And at one point in time, one of the things I heard was that most of these kids in fact all of these kids that were in ventilators and most of the ones that were in the units were either unvaccinated or they’re people with other conditions, comorbidities, kids born with lung deformities and things like that. And, you know, I could see that there were some of the people that I’m with almost had a palpable relief, that well, this isn’t happening to every kid. And this is not dangerous unless there’s something else wrong with you. And I just looked at that, and I get this kind of a sick feeling in my stomach. Like, since when do we not care about people because they’re sick. I remember a two-year fight over the Affordable Care Act when everyone was out championing people with preexisting conditions. These are things that people’s choosing, and the unvaccinated, they don’t deserve to be sick, either. I hear people talk about, well, they shouldn’t get access to medical coverage. Again, that’s just the opposite of what I think we believe. And so I know that this is a function of the effect of seeing so many large numbers, and being at this for so long.
Andy Slavitt 06:04
And it’s just baffling to comprehend. And I see it, you know, it’s the logic no different than people who say, well, I’ve heard someone say this, I don’t wear a mask, because I’ve already had COVID. This is essentially an attitude understandably, perhaps, but selfish. And it’s just not really feeling the effects of what this does to other people. And the more we have solutions, that helps the lion’s share of people survive, the more the disease will continue to prey on people who are sick, people who are old, people who have difficult conditions, yes, some of them by choice would have been vaccinated. But we really want to be so judgmental about those folks, that we would lose our sympathy. I don’t know. I mean, I guess I understand how some people are angry. But I feel like this disappearance is just part of what’s been harming us the whole time. I mean, these actions across our society, all of them add up, and they make a big difference. You just compare us to South Korea, or Japan, in South Korea, is 120th. The death toll per capita is in the US. And it’s a society where people understand each other better. It’s a society where people wear masks without question. It’s a society where people perhaps have more similarities, perhaps their lives are more attached and connected. But I think it’s something that we have a really short supply. And I think we would make much better decisions, policy decisions, day to day decisions, if we could somehow not protect ourselves to this point to such a degree from the pain of others. And look, I know it’s hard. It was hard this morning to see parents in this situation, it’s not a pleasant thought.
And this whole Supreme Court case last week, which was just decided is another astounding example of people persecute prosecuting the case, to say, it doesn’t matter what happens to people get sick, doesn’t matter if people who have to show up in a workplace and have to be around people who are sick and not wearing a mask and vaccinated. We just don’t care about those people anymore. And I worry that now, the pandemic is gonna move into a stage where increasingly focuses more and more on the most vulnerable, and the most people at the margin on the people who already are carrying around risks. And that we’ve kind of lost our heart to care enough and support them just because we’ve been at this for so long. I don’t know what to do about it. And I’m not pointing any fingers, because I know what this feels like, I feel the same thing as others do here. It’s not easy.
Andy Slavitt 08:58
But we got to do the best we can do. We got to stay informed. And we can’t take our heart out of this. This can only be a thing we evaluate intellectually. So let’s keep that in mind, I suppose, the best we can as we listen now to Richard Corsi and Aaron Collins. Educate the heck out of us about how we stay safe, and how we keep others safe. And how to slow down the spread using the great tools that we have. So here they are.
Rich Corsi, welcome back to the show. World’s expert on, one of the world’s experts, I think he would humbly say there are many others I’m sure, on-air quality and really important resource to everybody. And it’s really been a terrific guest on the show. And Aaron Collins, who is among other things, and you could give your background more fully. You’ve got about on aerosol science, but you’ve become well known to be the mask nerd. Is that right?
Aaron Collins 10:06
Yeah, that is, self-declared mask nerd? I don’t think to the official title yet.
Lot of competition for that. Maybe we could just start with and we were gonna help people the purpose of this episode is to help people through Omicron and some of the things that they can do to protect themselves and to understand what’s happening. And people love to do it from the science out as opposed to just tell me the answer. And so maybe we could just if you don’t mind to start with a little bit of 101 and aerosolization, Rich, how it works, what’s happening, how the virus spreads, what it acts, how it actually works. And then Aaron, same to you, how does the mask and masking work relative to protecting people? In this context, things have changed over time, a lot of numbers move around. So what’s the current state of affairs that may be Rich, you can start?
Sure, so the current state of affairs is the same as it’s been the entire pandemic, which is, you know, this is largely an airborne infectious disease. So respiratory particles come out of different parts of the respiratory systems of effectors. Depending on where those particles come from out of our respiratory system, if we’re infected, the sizes of the particles will be a little bit different. And then when the particles come out, they tend to shrink when they get into air. Alright, so the volatile fraction kind of evaporates. And then they these aerosols sort of stay suspended in air in a room and are eventually removed by air exchange or deposition on materials. What’s really important is something that we don’t talk enough about, and I think that’s the level of inhalation dose that is received. So when we breed those aerosol particles that are virus, that have variants associated with them, there are virus like aerosol particles. The level of the virus laden particles per liter of air and our breathing zone is important, our respiratory minute volume, how much volume we’re bringing in per minute is important. And the time that we’re in that environment exposed to those virus […] aerosol particles is important. And those three things multiplied by one another is called inhalation dose. And that’s sort of a roadmap for us in terms of how we can take the precautions, we need to reduce our inhalation dose, so we either don’t get infected, or if we do get infected, we’re being infected with a lower dose, which is a better way to get infected than at a really high dose, right?
Rich Corsi 12:41
So respiratory minute volume basically means we shouldn’t be right now in environments in dance class with other people or in gyms or any environment where we’re breathing heavily and aerobic exercise can lead to 10 times the respiratory minute volume of sitting at a couch, for example. Right. So that’s important, spending less time in crowded environments is important in lowering concentrations and our breathing zone by having everybody wearing masks, which means the effectors are emitting less, the receivers are inhaling less. Right? Those are two good things in combination. By ventilating more to reduce the levels of virus laden aerosols in the air to improve filtration in HVAC systems to use portable air cleaners to test so that we remove sources from the indoor environment, when we can identify them, all those things will lower our inhalation dose. And I think that’s the roadmap for us to get through Omicron, Omicron, and any other variants that we find in the future.
Okay, so I’m gonna come back and try to get some examples of that and talk about the significance of this. But let me start go back to go to you, Aaron, tell us how the masks work to protect us against infection.
Yeah. And so when we talk about masks, of course, there’s a couple of things that we have to be a little careful about one, we have terms mask, that’s kind of a general colloquial term that we talked about anything that covers our face, but there is another type of mask called a respirator. And they feature you know, high technology materials like a melt blown polypropylene and it’s electrostatically charged, which allows it to basically suck particles to it. So we’re talking about K95 and KF94.
Andy Slavitt 14:22
So what does that do when they charge the particles? Explain to folks what that does?
So this electrode so that actual fibers, inside of the materials, so if you think about like a cotton mask, a cotton mask has fibers inside of it, and it does provide some filtration efficiency, but those fibers are big, and they’re pretty widely spaced. And so what happens is there’s a couple different mechanisms of how we talked about filtration, but basically those what kind of drive it and when we go to these high these engineered materials, they have really tiny fibers that are tightly spaced together, and then we charge them and when you charge them you can enhance like capturing really small particles because we basically suck them like a little vacuum cleaner. Like they basically pull them out of the air using electrostatic force right? So that enhances the filtration. And what you end up with is when you compare a cotton mask, versus let’s say a respirator is that for the same level of breathability, you’ll get maybe with a cotton mask, 50%, something like that. Whereas with you would get with a respirator, you might get 98%-99%, for the same breathability. And so what we find is that these masks are comfortable and easy to wear, but also provide incredibly good filtration efficiency at the same time.
So the masks aren’t just a physical shield.
No to your face. No, they are not a physical shield. So we are literally pulling a tiny particles. I mean, when we’re talking a half micron, you know, I might be on the small side, but we would expect for Covid or Covid respiratory aerosols, right, so I have micron particle, you know, that’s like 1200 the diameter of a human hair roughly or something like that. So you can’t see these things, and they collect on the material. And, and some scientists go and they use a laser scanning electron microscopes to look at how they collect on there. And these things are tiny little particles that collect on tiny little fibers. And that’s the beauty of the engineering part of this is that we can produce these things, right, you don’t need to use some other material that was not designed to do this, we can use what the engineer has been working on for 30 years to do this exact thing.
Andy Slavitt 16:10
So these materials, we’ll talk about the different types of materials and compare them at a bit. But they in effect, seek out and attract these particles so that you don’t breathe them, they in fact get taken up by the material.
Correct. So it’s just a really good filter. And so they use different mythology, right. So the fiber size, electrostatic all of these things together are what are used to create a really effective filter. I mean, we’re talking in practical use N95, do not filter 95%. That’s actually the worst-case condition at high flow rates and high like particle loading. When we talk about in 90 fives when they’re new out of the box. If you look at any of the test data, even at 85 liters per minute, which is like equivalent to you like running, that’s how hard you be breathing. They still filter at 99% for particles that are still even smaller than the COVID respiratory. So we’re looking like when the filter media on these things is insanely good. Yeah, so just comes down to just all comes down to fit, making sure the masks fit your face, because that’s the important thing, get the air to go through the filter, not around the filter, and you’re gonna get that really excellent protection.
Got it. Okay. So, by the way, you guys are free to debate each other anytime you’d like if you disagree with each other, like, go throw the deadly blow, hit the nerd.
Don’t pick on me.
Rich, I want to try to get some examples out of what you said earlier about the exposure in the inhalation dose. If I go into a concert hall or a gym, where everyone’s working out, nobody’s masked, everyone’s breathing heavily. I’m breathing heavily. And I’m there all day. That’s clearly I want to get a lot of inhalation dose in your terms, right? Now, if I get into an elevator, and it’s empty, but someone was in it before me, and maybe it’s been in use all day, and I’m getting into it at night, and it hasn’t been cleaned out. In that kind of circumstance. How is that still a concern? How much of a concern relative to that to that gym room? Or that […]? How much risk am I taking?
Rich Corsi 18:46
Well, yeah, so relative to the gym room, or the concert that you were in first several hours or all day, it’s a pretty low risk on an elevator, the time we spend in an elevator tends to be very, very short. And if there’s nobody else in there, I think that was the example you gave I’m not too concerned, there could still be some residual, you know, virus laden aerosols in the air from somebody that rode the elevator two minutes before, something like that. But the elevators generally are actually pretty well ventilated. They’re designed to be well ventilated when they’re operating. And when the doors open, there’s this additional significant amount of ventilation. So I think the levels of virus laden aerosols in the air if nobody else is in the elevator, very, very low, doesn’t mean that it doesn’t mean that you might be unlucky and you’re not wearing a mask and you do inhale some low dose of aerosols and you do get infected. But I think that scenario is probably hundreds of times less risk, 1000s of times less risk than the first scenario that you suggested, Andy, and by the way, I don’t think Aaron is a mask nerd and I agree with everything that he said he was dead on with everything.
Now you guys are gonna gang up on me. What about like a dormitory shower? where different people use it, they’re in it for a significant amount of time and people go in and they’re not should they will be wearing a mask. Or if they’re not wearing a mask, you know, what’s the relative risk there.
Rich Corsi 20:16
So the average American, I don’t know whether students and dormitories can be considered average American, but the average American takes about an eight-minute shower, that’s the average to wash up. That’s a pretty short period of time. I would be you know, more concerned if I was, you know, sitting on the toilet in the bathroom not feeling well for 20 minutes, and there happened to be somebody else who’s infected in the bathroom at that time. The biggest concern I have for dormitories is the eight hours a night when you have two or three students in a room that are not wearing masks while they’re sleeping. That is not a good situation, that’s a large amount of time being exposed to the respiratory aerosols coming out of unmasked people in the same space. So, have done some calculations for different types of filtration systems for dorm rooms, we can literally get in a standard 200 square foot dorm room with a couple people in it up to the order of 20 to 25 air changes per hour equivalent with good HEPA air cleaners or do it yourself air cleaners that’s much higher than design, air exchange rates in isolation rooms and hospitals. So we can make dorm rooms a lot safer. But that in on campuses, that’s where I think the real pinch point is.
What I’m trying to understand is this sense, we have a sense that Omicron In particular, because it’s growing so quickly, that it must be growing in ways that are difficult to detect. Because there are so many people who, you know, their story of when they tested positive was, well my only exposure was I was in an Uber for two minutes wearing a mask or I was at an outdoor lunch with a bunch of people or I was at a show at my dormitory. Either they becoming, in other words, they’re becoming harder and harder for them to piece together logical places where they might have gotten infected. And of course, we heard this story out of Hong Kong early. It was Hong Kong early in Omicron about air exchange, you know, one person wants to one hotel room and other person another hotel room, and then it spread. Like we don’t want to be so paranoid of things that are beyond reason. So what I’m trying to understand here is if you’re alone, and you walk into a room that people have exited, and you’re you know, what are your chances really those kinds of environments of getting Omicron, is it something people should really be worried about. If you go into a hotel room, that you moved in, and someone else had moved out, or you go to a dentist’s office and that somebody’s used before, and you’re the first one in there, how high really is the risk of getting COVID from people that were using the room before you.
So I think that the risks are higher than they have been for previous variants. Remember that I mentioned dose, right, these three things multiplied by each other the concentration, the breathing rate, the respiratory minute volume, and time, it appears with Omicron, that the dose response relationship is such that lower doses cause greater amounts of infection. I mean, that’s, if we can think of it in sort of very simple terms, right? Which means lower concentrations for the same respiratory minute volume and time and environment is going to increase the probability of infection. When I go into any indoor environment right now, I’m wearing my N95 mask, right. So I’m not taking any chances personally, I don’t think we should be thinking in terms of, well, this room is empty, and somebody was in it five minutes ago, and therefore I’m safe, right? I’m not taking that chance. But the risk is lower if somebody who’s not infected, if somebody who’s infected is no longer in that room. It’s not zero, because it takes some time for respiratory aerosols to decay. Just one reasons that you know, […] and many of us in the building science field had said don’t disable, you know, you should disable I’m sorry, demand control ventilation, we should continue to ventilate even when people aren’t in a space, right, to make sure we drive the aerosol concentrations down. But I’m, you know, I’m gonna wear my mask on an elevator, but I think my risk is a lot lower than the scenarios that you described previously.
Andy Slavitt 24:42
So what’s the I mean, what I’m really looking for is like that we know there’s this person-to-person transmission. You and Aaron are four, three feet from one another, have a conversation, get large particles to go back and forth. We know that that’s a source of infection. And then we know that this aerosolization this sort of somebody in the room had COVID. They exhaled a lot of those particles, and you ended up inhaling enough of them to get sick. Is there a way to distinguish like how often people are? Like, what? If you had a pie chart, you could say, what percentage of the pie was people who got COVID? In some sort of person to person? Transmission like that? What percentage of the time is it? It’s aerosolization, in a room with a number of people in it, in a situation that’s a super, could be super spread are like that, and what percentage of the time it will be that last sliver that elevator ride that getting into the shower, that situation that’s less frequent, if there are 100 cases of COVID. How would they be spread out among those three buckets?
You know, I hate to say this, because it sounds like a cop out. But it obviously depends on the scenario. If everybody’s wearing masks, then close contact, transmission is not going to be as important relative to the far field meaning further away from the individual in the room, right? So that’s a really important distinction right there. The greater the mixing conditions in the room, higher ventilation rates, or if you’re using a good portable air cleaner that basically brings a lot of air in and out or you have a ceiling fan on, the greater the mixing conditions you have in the room, the more you sort of break up that distinction between close contact and far field. So I’ve been involved with some experiments recently, where we use the chemical tracer in the breath of individuals sitting in a room and looking at different scenarios in the room, and measuring that tracer chemical two feet away, five feet away, seven feet away, and in the background of the room about 20 feet away, once you get to a certain amount of mixing, it really breaks down and disperses that plume of aerosols that are in close contact, so that you know two feet away doesn’t look that different than 15 feet away. So that’s why there’s these nuances associated with how the buildings operated. That sort of change that answer, I think the bottom line is the things we can do our wear masks, ventilate, use good filtration. And don’t spend large amounts of time in non-essential indoor environments with lots of people.
Yep. Right. And it will go back and reinforce those messages. But as it sits today, we’ve got we’ve got probably a few million people a day, getting Omicron, which is extraordinary to think about. Right? So I guess the question is, where are they are getting it? Are they getting it mostly from aerosolization? Are they getting it more from these kind of high-risk things that are in person that people are doing without masks that they, you know, that we know they shouldn’t be doing?
I think we can definitely get to the question of like, how is this disease spreading, right? And so the point is, is that it spreads person to person via these aerosols, droplets can happen to but they’re easy to control, the aerosols are difficult. So all of these events have the exact same mechanism. That is its people talking breathing that generate aerosols, and someone brings them in. So we have to remember that that is the mechanism. Everything else is ancillary. And I think one of the things I see you hitting on Andy, that you’re trying to get to is like, what is the risk for me in these different scenarios? And I think the challenge is that it’s incredibly hard to analyze each one of these situations. Because if you look at it from an engineering perspective, the ventilation might be different, right? The occupancy level, is that person a super spreader? Do they generally statistically produce more aerosol when they talk than the regular person? There’s way too many variables. And so when I look at these problems, from like an engineering perspective, I say, what controls can we put in place that the individual can do to make sure that they’re minimizing the risk? And that’s why, you know, of course, I’m the master. So of course, I’m going to say, you know, good masks are one of the best things we could do. Because we can’t control the ventilation of a room, we can’t control that elevator, we don’t know who was in it before us. Wearing the best good quality respirator is really going to reduce that viral dose.
Andy Slavitt 29:01
I get you, I’m totally synched up with both of you guys, and you know that, but here’s the thing, like, there are a ton of people now getting COVID for the first time that I spent two years avoiding it that are generally speaking very careful. They probably nobody’s perfectly compliant. None of us can be, but they probably wear masks as much as possible. They probably avoid indoor situations dining as much as possible. And then they have the one thing and that one thing may be something they can point to like yes, I did go to this indoor restaurant, or I did, or my son came home from college and, you know, it turned out he was positive and we spent some time together. But it feels like there is a set of activities that are happening really, really fast. The public is missing for this thing to be spreading so fast. And I’m just curious, if we know if there’s a dominant thing or a dominant activity that is outside of the Maybe it used to be safer. But it maybe it’s just the stuff we do every day talking to people going into the store. And maybe that you can say no, that’s not enough. It’s something that would require more time. Or maybe it’s a bunch of events with a, you know, the super spreader and countries just dropped his guard. And that’s why the numbers are so high.
Rich Corsi 30:23
Andy, I would suggest that part of the problem is human behavior. It’s there’s a lag time.
Blame the humans.
Yeah, well, there is this lag time between that it takes for people to adjust. So I’m on a university campus that actually has done a lot of things, right, we have had a very low positivity rate that’s gone way up in the last two weeks, right? It’s still relatively low, but it’s gone way up. But you know, for a year now, people that have tuned into wearing masks have been wearing cloth masks or surgical masks, not that many have been wearing N95 masks or KN95 masks, right. And all that Aaron jump in at any point here, but now we’re trying to educate people that that’s important. When I walk across my campus to lots of brilliant people on campus, right? Still a lot of people wearing cloth masks and surgical masks at a time with Omicron. I think that we want to lower our inhalation dose now because this thing is so contagious, right? So I don’t know if there’s any one environment, we can say, well, this is the environment that’s causing other things. I think it’s really that it’s taking some time for the public to catch on, that these additional precautions need to be taken to lower inhalation dose.
So let’s talk about what the additional cautions are, and we’ll go to your hearing for a second on upgrading the masks. But what are some of the other ones? Because you mentioned the way you said this. You said walking across your campus. Noticing people wearing masks? So you’re talking about people wearing masks outdoors? Is that something that you think?
I didn’t mean to imply I did, I did not mean to imply outdoor exposure. I’m just saying in general; those are the masks that they’re going to use when they’re outdoors. If they’re wearing a mask, they’re gonna walk indoors with that mask on, I don’t think they’re carrying multiple masks with them.
Andy Slavitt 32:05
So you’re not recommending that people need to wear masks outdoors?
That’s a great question. I might let Aaron weigh in on this. But, you know, to this point, before Omicron, it didn’t appear that there was much spread outdoors because of the tremendous additional dispersion of aerosol particles, and dilution are in an outdoor atmosphere with Omicron, I’m a little bit more careful now, if I’m going into an outdoor event where there’s lots of people around me, if it’s me with another person, and we’re six feet away across, you know, an outdoor table, I’m not that worried. But if there’s a lot of people around me and I’m in the middle of them, I’m wearing a mask.
An outdoor stadium, people yelling at the football game that you’re wearing a mask?
Yeah, I am personally I’m gonna do that.
So Aaron, what’s talking about where the threshold is? First of all, may be paid to spectrum you’ve got this gold standard you talked about, which is a surgical medical grade, N95 Mask, and then maybe paid the rest of the spectrum? Because there’s lots of you evaluated everything out there. So how does it scale down in terms of just filtration protection. Are there other features like wearability and other things? I’m sure that we may enter two things.
Yeah. So when we talk about masks, I think the three things I always want to talk about is filtration efficiency, fit, and comfort. And so those are the three defining features. So when we talk about let’s pick the cloth masks, right, the ubiquitous cloth masks, we all were wearing in the first few months of the pandemic, because we couldn’t really get a hold of that melt blown it was, you know, there’s only a limited supply of it, and suddenly everyone in the world was going to need it. In theory, if we had done it, right, but we’ve kind of forgot to pick that N95 up after a few months at the beginning but so that cotton mask, in terms of filtration efficiency, depending on the weave and the style, and versus all these things, it’s between, let’s say 30% to 60% filtration efficiency through that mask. Now the nice thing about cloth masks you can get a good fit right, we can design them with a metal nose bridge inside, I mean get a pretty good fit, but and the comfort breathability can be okay. But remember, so you get the fit, you can get maybe some comfort, but the filtration is just not there. So then you kind of move into the next realm of masking which is the surgical mask right, that blue square we’ve all seen. And those masks are typically ear loop and the surgical mask has the material in it. It has that melt blown material in it so it has really good it has the good filtration but the problem with surgical masks is they lack the fit, right? They don’t seal to your face. They have big gaps on the side. And of course you can do these hacks and do it yourself MacGyver things. to like, get a better seal, but at the end of the day, my kind of testing has shown that I was able to achieve
That’s like tape, right?
The twist and tuck method, and other techniques to improve that fit.
The twist and tuck.
It may be I think maybe everyone will be masked in 2024. Who knows. So that provided like, in my experience, a surgical mask was anywhere from around, you know, 50% all the way up, I could get me into the 80s percent for one that fit my face really well.
If it’s your face, if it’s poor fitting all bets are off.
Think of it like this. Yeah, I mean, if it’s like if the surgical mask is in your pocket, does it provide you protection magically? No, it has to the whole goal of this is to force that air to go through that filter material.
You got to put it on.
That’s right, you got to wear the chin diaper, you know, you can wear the best mask around your chin, it’s not gonna really do much for you. And so the surgical mask has the material but it lacks the fit and I argue lacks the comfort because when you wear those they suck to your mouth when you’re talking. It’s getting sweaty, it’s muffled to your speech and your glasses get foggy, there’s a long discussion about glasses fogging. So glasses fogging can be an indication of a bad fit. But it is not a guarantee of a bad a bad fit.
Andy Slavitt 36:14
I’m all about the foggy glass conversation, we’ll come back to that.
I can summarize it. But then we go to the next level. And so in the US, we have a little bit of a problem. So in the US, we have surgical mask. And then we have N95, which is like a big gap. So we’re going to go from the end near the 95. Although it’s commonly saying, Oh, it’s 95%, it’s like it’s not really it’s actually much better than N95, like 95%, its most of the time 99% plus through the filter material. Yeah, and the N95. The design target for that mask is to have 1% face leakage. So when we talk about the mask, so 99% of the air is designed to go through the mask only 1% is designed to go around your face. So that mean you’re gonna get roughly I mean, not perfectly, but if you got it well fitted mask, it’s going to give you 99% at that particular test conditional doesn’t guarantee and everything when you’re moving, jumping, doing stuff like that, but in general, that’s what the kind of target. So in the US, we have surgical mask 70-99 There’s nothing in between. So then you introduce these ear loop standards that you’re seeing a lot the KN95 and KF94. And the KN95 is a Chinese test standard, which I’ll talk about later. And then there’s the KF94 That’s a South Korean regulated respirator, it’s their general public respirator, so they design the KF94 For what to do if you had a pandemic that you needed, protection by a respirator worked out really well for them because they had them. And so in the second month, or you know, March or April, every South Korean was given 20 KF94 from the beginning. So that’s and if you look at the South Korean death rate and case rate, although drifting up now, because they’re trying to they’re battling all the same stuff, we are there like 1/20 of the death rate of us. So they’ve done per capita 20 times better than us. I mean, it doesn’t seem like a convenient thing. To me, it seems like there’s probably something to do with the masks they were wearing. But so the KF94 KN95 year loot mass, they feature that same high performance filter media that we talked about the 95 they all feature that the difference is that their ear loop and the ear loops give you slightly less protection. So the design target for those. So when we kind of look at that way, those design targets are between 8% and 11% leakage. So remember N95, 1% leakage, KN95, KN94 are targeting 8 to 11. Now that doesn’t guarantee you’re going to get that because face fit is very important. We talked about respirators, getting making sure that the air goes through the mask, not around it. So that’s not a guarantee you do need to still form it. In fact, I have used ear loop respirators, and I have achieved 99% because it fit my face wonderfully. But not all of them do if you look at my data.
Andy Slavitt 38:35
So you’re saying that the KF94 and the KN95. Those can be comparable or almost comparable to the N95?
I hear that all the time and I try to connect. So technically, they’re like in terms of filtration efficiency, let’s say it KN95, KN94 is going to be around the 90% range or better if you can get it to well fit. Like 90% roughly and the N95 if you get fitted properly, as per the specs of a fitted mass that would be 99. Now in reality, no one is getting a fitted mask because you need a specialty equipment. Healthcare professionals do that. And people that work in hazardous environments do that they do get that but the general public’s not, so in general what we’re talking about is headbands are gonna in general give you a better seal, N95, ear loops, although more comfortable are going to compromise a little bit of that protection for the comfort of being able to quickly put on and take off the mask
Are they easier to breathe through?
Great question. So the breathability on these masks is roughly all the same. And it depends on the particular brand. So example you know 3M’s 9105 is one of my favorite masks. It’s a goofy looking mask and that’s usually what most people say it’s a duckbill mask. It looks totally goofy. This mask right here cost 78 cents, you can buy it online. Well used to be able to everything’s kind of sold out right at the moment. 78 cents, this mask has the lowest, the lowest pressure or the highest breathability of any mask I’ve tested. I am 90% sure you could run a marathon in this mask, it does not limit your breathing, you can really not even tell you’re wearing a mask other than the fact that you feel the warm breath. And it’s you and you have something tight against your face. The breathability is amazing. So what this means is that these engineered materials far outperformed cotton and other materials, but you do have to spend a little bit of time to find one that’s kind of good. Because just like anything, you can buy a car, you might buy a Ford Pinto or a Maserati, you know, they’re gonna drive different, right. But that’s the nice thing about this is for 78 cents, you can get the Maserati. It’s kind of crazy, right?
Rich Corsi 40:26
If I can add something, I’m not going to argue with Aaron. But if I could add something to what he said, a lot of people will hear 99% and 90% is the difference between those two types of masks, it’s being they’re both in the 90%. Right? The difference between 99% and 90% is tenfold. It’s 10 times lower inhalation dose, if you were in the 95 compared to the KN95 for the KF94.
If it’s well fitted, I think I’ll just put that one cap. So what we want to strive for everyone is to wear a well fitted mask. And if you want the best protection, a headband in 95 that you can get as tight a seal as you can as good and well-fitting to your face, you’re gonna get excellent protection. And I think like Dr. Corsi said, I think we also should look at the cloth mask comparison. So you’re right, absolutely 10x improvement, but we started the cloth mask, if we’re at 50%. And we go to 90%. That’s not just a 40% delta, as he pointed out, that’s a 5x improvement, just but even if you were getting 90%, which would be a bad fitting in 95, or a decently fitting K and 95. It’s a 5x reduction, meaning you could be at the same scenario five times longer to get the same dosage which Dr. Corsi had talked about, right. So this is what we’re talking about is good masks by you time and or good mass by you protection. And so you don’t have a lot of control a lot of things in your environment. So this is one thing that you can an individual can do.
I think the new CDC guides, it’s coming down to the SEC, essentially saying, you know, N95, if you can, but if not, you should wear the next best thing down and the few because you don’t have access or because you find it uncomfortable, and then down to down to down from there, kind of along the scale that you described. Do you agree with that? Is that the right way to think about it?
Aaron Collins 42:03
Okay, that’s a tough question. So I think, um, so from my perspective, I think, as you said, with risk, right, we have to look at it a broad perspective, if I am outside walking, I might choose to rock a KF94 or KN95, if I’m going through a crowded walking area, because we’re kind of talking about that outside scenario, right? Because I don’t necessarily need the headband, super tight protection when I kind of outside where the risk is a lot lower. But if I’m going to go to a, let’s say, concert, although I don’t typically go but let’s say I was going to go to a concert, and it’s going to be packed, and I’m going to be there for multiple hours, I’m going to offer the best protection, I’m going to go up to the 95. So I think my perspective and my advocacy is really, I want to arrange a better masks, I want people to be able to purchase something that they know is legitimate, that they know is good, and provides them some level of protection. And then we can kind of easily educate the consumer to say, why a KN95 and KF94. Well, excellent masks are a little bit less in terms of protection as N95. And so I think I want to see a spectrum. And people can make that decision based on their own preferences, risk and all kinds of stuff.
And the implication here is that the N95 there, as you said there’s a downside in each scenario. And the downside of the NIT five, I assume is that they’re it’s difficult to where it’s uncomfortable for some people. I mean, there are reasons why we’re not putting, you know, seven-year-old kids in N95 masks, right? Well, that’s..
Well, that’s actually a very good point on itself. And this is the problem with N95. I’m all for it N95 for all. But if we say that you only are going to support in 95, we have one big glaring hole, which is that if you are a very small face or a child, they don’t make a 95 for you. It’s an occupational standard. It’s designed for industrial and healthcare use, right? NIOSH does not want to touch kids working, let alone kids in hazardous environments. Like this isn’t the 1890s Right. So like, they’re not going to touch that. So what happens is we have a glaring regulatory hole right now, which is kids, what do you wear when you’re a kid, you can’t wear N95. So this is why we’re KF94 and KN95 are filling in that kind of gap right now. And so they’re still they’re still an important part of the ecosystem. I think N95 for all is great, too. I mean, the other headband, they provide the best deal you’re going to get, I think, but in general, that’s you know, that’s where the KN94 and KN95 is kind of come in as for kids and stuff like that.
Andy Slavitt 44:10
Okay, Rich. Did you get it right?
Yeah, I agree with everything Aaron said. I didn’t know whether he said he doesn’t go to concerts ever or just now but if he doesn’t ever go to concerts then he’s officially.
Actually it’s I have been a guy that wants you to hold steady a few months ago before Omicron so I do have it but I did wear a good mask.
But I do agree and I agree that children are an issue within N95 masks. So that means that you know we can put our creative potential together and try to design better masks for children which I think some you know we should be doing or we already go with the next best thing.
Well and I’m not I’m not going to bring up the music topic kid with you Rich, don’t worry. I guess let me put a thesis statement out here I want you guys react to it, or check to it. Is that with a combination of proper filtration and proper mask wearing, meaning well fitting that you could make almost anything low risk. And for people relatively safe, there’s nothing that’s zero risk. But I mean, I’d say let’s put it in these terms, a risk about as acceptable as getting into a car and driving a couple of hours.
Yeah, absolutely. I agree with that. And I think that, you know, from my perspective, the kind of steps or vaccinate fully vaccinated, you know, if you can you got it, do that, right. And boosted number two is wearing a high-quality masks, that the combination of those two things right there, get you really far to lowering your, you know, to lowering your risk, right? And then after that, I think it’s in, you know, in environments that where you can’t increase ventilation significantly, there’s a lot of buildings where we simply can’t increase ventilation as much as we’d like, right. So in those environments, employing improved filtration in HVAC systems, and good right sized portable filtration systems, you know, HEPA air filters, or do it yourself air filters, I mean, that just becomes then kind of icing on the cake for lowering our risk to really low levels, but vaccinations and masks are the two things are the hard stop right now, we got to do that, you know, improvements.
Andy Slavitt 46:30
I want to challenge the interplay, a little bit between vaccinations, boosts and masking, and ventilation here, and then I’m doing this for a purpose. And I’ll be a little bit more extreme in description. But vaccines are really what’s keeping us out of the hospital keeping us alive. Presuming that we started out reasonably healthy without super high-risk factors. With Omicron they’re not reliable sources of preventing infection and spread. Okay, so I’m saying this, to be making a little bit stark, but saying the vaccines put aside the booster for a second, the vaccines serve one purpose. That’s to keep us alive, keep us from serious illness. But that there, at least as right now, they’re unreliable attempts to preventing infection or contagiousness, and that that’s where the role of masks and good ventilation come in. And then you say, fine, okay, great, I’m not gonna die. I feel great about that. I feel relieved. But I also don’t want to get sick. And I really don’t want to spread this to others, I don’t want to be part of the chain of transmission, I don’t want to end up inadvertently being someone that ends up with infecting someone that does die. So given that, that I look at these tools, the tools are making sure your spaces are well ventilated in your mask. For those purposes, is that the right way to look at it?
Rich Corsi 48:00
I think Aaron and I are both nodding. Yes. So I agree that’s the right way to look at it. Even if you’re vaccinated, I think it’s important to lower your inhalation dose by, you know, high quality masks, ventilation, filtration, etc. For one reason that is to avoid disruptions, like we’ve seen in our economy, and that you know, universities may have to close down or can’t function properly. I’m in a university world, because we have so many staff, right that get infected it, it’s just it’s a disruption, even if it’s not, if you’re vaccinated, even if it’s not gonna cause serious health outcomes. So, and we can, you know, we don’t want to spread it to others that are, you know, as much as I get frustrated with people that are not vaccinated, I don’t want to be responsible for getting them sick and having them have extreme health outcomes, right. So I don’t want to I don’t want to be responsible for harm to them.
And I think one thing, Andy to look at this as I think you hit the nail on the head, when we were talking earlier, we’re talking about how Omicron is spreading so fast, right? And we think about that. And that’s really what it is right? You don’t have the vaccines acting as the backstop to prevent transmission anymore. So we know and Dawn Milton and some other researchers had a preprint not maybe just right before Christmas, where they had actually tried to measure the aerosol dose for people with infected with Omicron. And they didn’t see a statistical difference between someone with Delta and Omicron, meaning they weren’t emitting more virus. So why are suddenly are we having this massive spread? And that’s because we were relying on the vaccines to stop the spread. And people haven’t been explained to them that that no longer works. And so we’re seeing massive spread, because there’s a lag between when we start talking about this, and when the public has fully immersed and soaked in the concept that oh, vaccination alone does not allow me to not wear a mask if I don’t want to get infected. And if I get infected, I will spread it to other people who both are vaccinated and unvaccinated. And so as a country if we’re not going to require vaccinations, then you need other methods in place to prevent our healthcare system for going overwhelmed. So that’s why other mechanisms like massing and ventilation are now so important. You either have a choice, good fast and ventilation make sure the public is doing that. Or you’re gonna have an overfilled hospital system. And I think we’re seeing the results of that choice.
Andy Slavitt 50:12
So how much outdoor how much outdoor spread is there?
I think it’s the million-dollar question. I’ve been trying to track this really closely seeing if anyone had any data and I can’t seem to find anything. I mean, I think when we talk about outdoors, I think I like to phrase it this way, outdoors is the safest option we have. Right. So when we talk about doing things, when we talk during a pandemic, we should be pushing everything we can to be doing outside outdoor dining, meeting with your friends, outdoor, have barbecues, everything that you can do outdoors is going to significantly reduce the transmission. Now that gets a problem in wintertime, I’m from Minnesota, it’s cold as heck right now here. So that becomes a problem. And that’s where other tools like masking and […], but outdoors is always going to be the safest option. Whether it’s safe or not, is another question.
Yeah, I agree with Aaron and I think, you know, that’s one of the reasons when we look at pre-Omicron and Omicron infections, and we just don’t see that much happening afterwards. That’s one of the, I think, strong arguments for the importance of aerosols relative to large droplets, right? If you’re outdoors and you’ve got large droplets are […] you know, dispersion outdoors isn’t going to affect the trajectory of those in close contact to the extent that it will aerosols, which can disperse really rapidly outdoors but large ballistic droplets 100 micron, 200, 300-micron droplets are not going to disperse outdoors. So the fact that we haven’t seen the level of infections outdoors when people are gathered in large events previously indicates to me that aerosol, you know inhalation of aerosols, suspended particles in areas are dominant.
Got it. Okay, I’m gonna wrap up with a couple things. First of all, Rich, there’s a new preprint out recently, which talked about the amount of infections is dropping by 90%, after I think it was a minute or 30 seconds or something like this. What do you think about this? Any thoughts on that preprint?
Rich Corsi 52:11
I think it was, if I recall correctly, was five minutes. And I have to admit that I have not reviewed the paper in detail. I looked at the Forbes article and I glanced at the paper. So I don’t want to do a critique of the work or the methods or anything, I think it’s probably a very good group at the University of Bristol, I will say the following I don’t think they tested the Omicron variant. And also the medium that you use to generate aerosols can have a huge impact on the decay rate of the aerosols. I will say the following though. And in this case, this is where the kind of the building science aspect of all this comes in. Even if we accept the results, that 90% decay of infectiousness of the of the viruses within five minutes, right? If you look at typical freestream airspeeds kind of sort of horizontal movement of air in buildings, typical values are 5 to 10 centimeters per second, something like that. So in five minutes, if you put a particle on that air stream, and you said, how far is this going to go, it’s going to go 15 to 30 meters, which is about 50 to 100 feet. And so there’s going to be a lot of opportunity for people that are not two feet away, to come in contact with those particles in the far field, as well as the close field. So I don’t think that unfortunately, the Forbes article kind of implied that this means that nothing but close contacts important and I just don’t think that that’s the case, it flies in the face of everything that we’ve learned in the last 18 months.
Okay, so in closing, there’s a clear, call out for better ventilation, and filtration. And you have among the many interesting things you’ve done. One of the most important is you’ve dropped the barrier to entry to do that in a classroom, a dorm room, your home and office anywhere else but with an invention. We’re gonna have a link to that invention on our show notes. If you want to mention it briefly if anybody out there is it feels like, gee, I’m in a stuffy place and I don’t know how to ventilate it, there’s no windows nearby, etc. There is a baker type solution out there.
Rich Corsi 54:21
Yeah, so develop that concept last summer, summer of actually, even before last summer of 2020, I think which is a do it yourself air cleaner that you take for MERV 13 filters and a piece of cardboard for the for the so you build a box you put a piece of cardboard on the bottom you put a good box fan on the top, you seal it all up with duct tape a bunch of universities have been testing these now and including my own UC Davis and finding what are called clean air delivery rates that can exceed 800 cubic feet per minute with one of these units which is you know over double To what a really good, portable HEPA air cleaner can provide over double that, and about a quarter of the price. So the idea here was to try to build something that would be more accessible to people that can’t afford the more expensive commercial, you know, HEPA air cleaner.
So how much would one have to spend, and how much time would one have to spend to put something like this together.
So if you’re just building one, it’s a little bit more expensive, because the price of the filters that you order go way down, if you’re going to build them in bulk, say, 5 to 10, or more, right. But if you’re just building one, the price is around $80. If you and a bunch of friends get together and say, Hey, let’s build 10 or 15 of these, you can get the price down about 60 bucks each.
So for somewhere between 60% and $80, you could take any room, and you could make it as high-quality air filter as you could with a much more expensive solution. And that’s a wonderful contribution. And the one of the most exciting things I’ve got is pandemic is somebody focusing on how to make these solutions accessible. And so the final question is, like, how long do you think we’ll be wearing masks for? Do you think we’ll be wearing it? How long will you be wearing them for? You know, listening to you makes me feel like you guys think that as long as we have the virus around, or a wave coming, that it’s going to be tough to be indoors without a very high quality approaching N95. If you can swing it mask with any kind of virus in the air. If you can swing it, if you can find it, then where we are this kind of a foreseeable future? Or do you see there’s that that’s not likely to be the case? And I’ll tell you that I gotta just give you some background. reason I ask is I think there are, I’m convinced that I’m sure you’re as well. There are a number of people to whom this is a completely sensible intervention, and a very modest inconvenience. And I put myself in that category for particularly to protect the health of others. There are a number of people who feel like it is not an acceptable long-term intervention for themselves for a variety of their own reasons.
Yeah, so we got a couple ways. I love masks, I’ve been testing. I mean, I don’t love masks. Do I want to wear a mask all the time? No, I don’t I would love to go back to not having to wear a mask. I think the question is, you know, it’s a public health discussion about how do we control the spread. So when we talk about something like Omicron, where we’re literally I mean, my, my school, my son is home upstairs remote learning right now, because the school shut down. Because you know, the problems are that when you have a rapid spread of a virus that the structures around you and the infrastructure around you starts to fall apart when people become sick and ill. And so we have these really easy things that we can adopt quickly to overcome that. So ventilation takes a long time, vaccines can take a long time to produce, but in the short term, you can do this immediate action to help slow that down to make sure that society can function we can minimize the spread of this. And so for me, when do we stop wearing a mask is what when we get those rates down low enough that the risk become very low. So it’s about it’s about a few things, right? It’s about what, what is our community spread rate? What kind of situations are we in? And you know, what’s our rate of vaccination? Right. So I think when you combine all those things together, if you get to a low risk, yeah, we can start wearing masks, I think, I think that’s what we should be striving for. We should be striving to get rid of a lot of the things that we have put in place because we do need to return to some level of normalcy, because I want to eat indoors again, I want to go to a restaurant.
Rich Corsi 58:26
Yeah, I don’t disagree with anything that Aaron said. I will say that, in general, I think that there’s some part of our population in the United States. That is finding that wearing a mask isn’t such a bad thing. That I think that we’re going to see more people wearing in the masks in the future, even for situations not involving this airborne infectious disease. You know, when it’s pollen season, I think we might see more people wearing masks when it’s wildfire season, we’ll see more people wearing masks. That’s a personal choice that people make, but I do think a larger fraction of our population just kind of getting used to it. And that’s not a bad thing, right? That’s a personal choice to reduce your inhalation dose to other things as well. Right? For me, personally, I’m hoping but I don’t know. Because this isn’t my area of expertise, that by the fall of 2022, that I won’t be wearing a mask anymore. I do worry I do have members of my family that that I worry about infecting for various reasons. And so my wearing a mask is not as much out of personal concern as it is for concerns of others around me that I love. And so I’m going to keep wearing a mask until I think it’s really safe to not be wearing one anymore and I end if I’m going to go out and eat in the future. I’m probably going because you can’t eat with your mask on. I’m probably going to go to a place where I can sit outdoors when I feel comfortable with doing that. Right and we’ve done that consistently during the pandemic when we go out to eat we eat outdoors, right even when it’s cold out, eat by the heaters outdoors. Great. So I’ll keep taking those steps. That’s perfect. and protection measures for not just myself, but people around me.
Andy Slavitt 1:00:04
Well, let’s finish on that note, you wear the masks, you take these precautions because of the people you love. And you know, we get through it. And it’s not pleasant. But there are answers. I mean, this is we can no longer say between all the things we’re talking about, that there aren’t answers to make our life safe and to get as much joy about it out of as possible. And even if that doesn’t mean we can eat indoors, during these sort of peak waves like this, there’s lots of other stuff. So thank you both. You’ve educated us. I salute the nerdiness.
You know, I think I think the way that I would also look at this Andy is that let give engineers problems. They’re good at solving it, right? So when we say it’s aerosol spread, let the engineers go solve it, right. When we, when we communicate the problem, us nerds can go off and be the best nerds we can and come up with really great solutions. And that’s it. That’s what I want to strive to. Let’s just be transparent about what’s going on. And we can go tackle this with our technology. There’s no reason of that in 2022. We can’t come up with great solutions. We got all this stuff out there. Well said,
Well said, Aaron, thank you.
I’ll bet on the nerds over the virus any day.
Thank you so much, Andy, thank you.
We got some great episodes coming up. Let me tell you about the want to know where all of our vaccines are, where they’re coming from, and what’s coming next you want to know about the other therapeutics and where they’re coming next. Have a very, very cool conversation on Wednesday with David Kessler, who’s the Chief Science Officer, the head of warp speed, for the Biden ministration. It is a very insightful conversation. David did a very interesting person. David doesn’t open up very, very often in long form, David and I really have a very, very open, challenging and interesting conversation that I think you’re gonna learn a lot from, and I hope you enjoy it on Wednesday. Next week, we have Jon Favreau. John was the speechmaker for Barack Obama. He is a co-founder of Crooked media. He’s got a tiny little podcast called What’s it called Pod Save America. And we’re gonna talk about another major threat facing us and that’s a threat to democracy. Then on Wednesday, we’re gonna go inside a hospital during a shift in the emergency department in Rhode Island, the place that is the epicenter of cases right now. And we’re going to go through what a shift it looks like feels like because we don’t get to see it. And this is another realm where so many important things are happening. Look forward to bringing those to you. I look forward to talking to you on Wednesday. Have a great couple days.
Thanks for listening to IN THE BUBBLE. Hope you rate us highly. We’re a production of Lemonada Media. Kryssy Pease and Alex McOwen produced the show. Our mix is by Ivan Kuraev and Veronica Rodriguez. Jessica Cordova Kramer and Stephanie Wittels Wachs are the executive producers of the show, we love them dearly. 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, please tell your friends and please stay safe, share some joy and we will definitely get through this together.