Sawbones: A Marital Tour of Misguided Medicine - Sawbones: RSV

Episode Date: December 13, 2022

Parts of the US are currently in the midst of a triple-demic, a very scary phrase, so Dr. Sydnee is here to break down the third illness: Respiratory Syncytial Virus, or RSV. It’s a virus that’s common among everyone, but can be dangerous for some people. Dr. Sydnee and Justin talk about what it is, why it is suddenly prevalent in adults, and what can be done to help prevent the spread (hint: wear a mask).Music: "Medicines" by The Taxpayers https://taxpayers.bandcamp.com/

Sawbones is a show about medical history, and nothing the hosts say should be taken as medical advice or opinion. It's for fun. Can't you just have fun for an hour and not try to diagnose your mystery boil? We think you've earned it. Just sit back, relax, and enjoy a moment of distraction from that weird growth. You're worth it. that weird growth. You're worth it. Alright, talk is about books. One, two, one, our Miss Guy and Medicine. for the mouth. Wow. Hello, everybody, and welcome to Saul Bones, Meryl Tour of Miscite and Medicine.

I'm your co-host Justin McElroy. And I'm Sydney McElroy. And what a thrill it is to be back with you, Siddster, sitting across the, here at the Saul Bones Studios. Finally, things are finally, so it was a wild few weeks there. Yeah.

We went out of town, you had hospital service that was the, that was the candlemites getting ready for that, if you haven't, if you haven't, bit.ly-forutslashcanline-2020-22. It's gonna be so good. We have so much fun stuff in there. Man, we worked our butts off.

Yeah, we were really, putting that together. December 17th at 9 p.m. Eastern Standard Time, tickets, five bucks, but you can give them more and we encourage you too, because all the money goes to Harmony House, which is sheltered, cities very personally invested in here. For people who are experiencing homelessness. Not financially invested, just like emotionally spirited.

Right, we don't have stock in the... No, in the filter. No, everything I do there is volunteer. I do not profit from it except in good feelings. When I see Harmony House doing well and the people I take care of they're doing well, I profit emotionally. We got it. My heart grows in another size.

One of our most epic Christmas movie, medicine called Christmas Trailers, I don't know, it was like part five in the non-going series. Is that right? Five, I think part five. I can't put the two live ones, you know. Anyway, it's gonna be great to show a bit. I know I forward touch candle 9 to 2022, December 17th, at 9 p.m. Easier standard time, get there,

you can watch it for like a month after or something like that. So it's okay if you can't see it right when it goes live. No, no, but please, we think you'll enjoy it and it's for a great cause. Oh, I know you'll enjoy it. Also, it's been, we alluded to this. Yes, ma'am. We alluded to this last week

that part of why things got so wild there and why Justin so nicely filled in doing the research for our last flatulence-based episode was because I did a stent of inpatient service as I do periodically where I take care of patients who see providers within our family medicine department who are then admitted to the hospital, our team takes care of them.

I am part of a team of residents and students and we care for patients together. And we teach and we learn and we grow. Laugh and we love and grow. And we cry. And a lot of crying, a lot of rough times recently because we all are aware that, and I've heard this term thrown about

that perhaps we're in the midst of a triple-demic. I don't like that. I don't like it either. You don't like it. You don't like the neologism or you don't like the idea that we are in a triple dimmick. Well, I don't like that either. I don't like the neologism. I also, I think that sometimes if you give things these names, it's alarming. And I don't, I don't know. It's alarming without informing. I believe in alarming with informing when appropriate.

I do not believe in alarming without informing because then what do you do with that? It's also the fact that somebody has come up with a new word makes you feel like a dumb person. Right. And it's not. I mean, certainly things like this have occurred many times in here.

Everything has happened before. Yeah, except in the sense that everything's always unprecedented, but you know, because it's got its own flavor, its own factor, not completely unprecedented. I don't know, not completely. Everything has happened before. See, there are multiple dimensions. Honey, I've been thinking a lot about time lately, as I approach 40.

Anyway, so there are a lot of respiratory illnesses happening right now. I've been sick. I wanted to talk a little bit about that and what you can do. And about RSV, we've never covered RSV. I do not believe on this show. I couldn't find, I had to search our own archives. Yeah. Sometimes I forget that we talked about something because it's been a almost a decade. Almost a decade. Almost a decade.

Almost a decade that we've been doing this show. And so sometimes I forget that we did cover something, um, but I, I'm pretty sure we have never talked extensively about respiratory sensitial virus, RSV human RSV, because it also happens in cows. That's different. Yeah. Not really different, but it's different. It's different that there's cows and then we're humans.

But one thing I wanted to talk about is we get it kind of get into the the history of RSV and where we are now and exciting news on the RSV front is This kind of concept. I think a lot of I've heard a lot of people sort of say that like right now what we're seeing happening with RSV and influenza and still COVID and then all of the other respiratory viruses, right? Like I can tell you, we do these panels in the hospital. And most hospitals will have their own sort of respiratory virus panel. I'm sure there are different ones. But in ours, we test for the most common and then the ones that matter the most in terms of management, respiratory viruses. So flu, obviously COVID is on there now.

Perin, fluins is on there. Rhino and intero viruses are on there. Old-school coronaviruses, metanumavirus. And some of these, it doesn't really matter other than to say like, that is the virus you have. Sometimes it helps us direct if we're thinking like, is this caused by bacteria and you need antibiotics or is this caused by virus and antibiotics won't do anything? It's nice to have a re- we like reasons. We like to know what's going on. But as we've been doing those respiratory viral panels, they're just lighting up. People who are coming

in with multiple viruses. Many. Many. Is that part I didn't know that was possible? I kind of thought a virus like made it kind of stretched out and then leave a lot of room for other virus. You get more than one at a time. Oh, yeah. And it is not because our immune systems have been weakened. I have heard that comment made like, well, our immune systems all got weak the last couple years.

You're collectively and I'm not, you individually may have some sort of reason to have a compromised immune system, and certainly I'm not talking about those specifics. Generally speaking, isolating, quarantining, staying home, whatever you've done, wearing a mask for the last couple of years, did not weaken your immune system. That has not happened. Your immune system is fine, unless of course you're one of the specific cases I've already talked about. Your immune system is fine.

What happened is a couple of things. One, we didn't, because we masked and distanced, we didn't get exposed to things at the same rate the last couple years Which so we are building of an immunity towards things well what but yes But you'll build the immunity when you get it. It's just we don't generally expect everybody to get it all at the same time It's the same thing we talked about during COVID it this idea of overwhelming healthcare systems as being a whole independent like morbidity factor. If you go into the hospital and you're the only person with COVID and we can devote all of our resources to you, that's a better

situation than if a hundred people come in at this exact same time and need all those resources, like other things are going to go wrong. Does that make sense? Yeah. Well, that is part of what's going on. Everybody's getting sick at the same time. Maybe you delayed getting RSV or flu for a year, but now you've all got it. That's definitely part of it. The other thing we've thrown off is the seasonality of this stuff. We have expectations for when people get flu, for when people get RSV. We call them seasons. We talk about cold and flu season.

All of that has been sort of like we through a wrench in it because we spent all this time isolating and then all of a sudden we all stopped. I mean most of us stop. I think it's out of sync. It's all out of sync. So things are happening at times of year where we don't expect and then you get overlap. So then you get what is happening right now for instance. This is early for RSV season, right? This is not typically, like, well, as we're getting into January, that is more when we see the peak of RSV season

traditionally January, February. It starts earlier, but that's when we see the high point on the bar graph. All that got shifted earlier. We were seeing way more RSV a lot earlier than we normally do. And it was overlapping with flu season. And also COVID is still a thing. This is where the triple dimming name came in because of these three viral entities overlapping

and overwhelming hospital systems. And at this point, I haven't, I mean, we have seen at our hospital a huge number of patients and certainly our pediatric floor was feeling the strain. I believe most pediatric floor were feeling that across the country all at the same time. But like you said, it isn't unprecedented and there are things you can do, but this is why it's happening. Your immune system haven't been weakened,

wearing a mask does not harm you. It never has harmed you, wearing a mask would be great. And if you did that during cold and flu season, if we always did that, I mean, we wouldn't see so many people get sick. I mean, yeah, but if a frog had wings, he wouldn't bump his butt when he hopped. You know?

Yes. Think about it. Let's, so the beginning of RSV, to kind of walk you through what I'm talking about here. RSV was first discovered back in 1956, okay? And it was called the chimpanzee cariza virus. Cariza's like a cold. Not super catchy, I guess.

Well, it also like, if you heard that there was a chimpanzee cariza virus, you probably wouldn't be very worried. Is cariza the same like root? Is like corona the same? No, cause cariza references a cold. Like the constellation of symptoms, we think of as cold symptoms, like cough and sneeze and sore throat and running nose. That's cariza Now I get what you're coming from though, although corona has come it comes from the sun

chimpanzee cold chimpanzee cold doesn't sound very scary It sounds kind of cute But it was isolated in chimpanzees. And then there were some humans that were sick too with what seemed to be this chimpanzee virus. Man yellow hat. And this was confirmed only a year later by Dr. Robert Chanuk, who was a pediatrician and a virologist who would eventually become the head of the laboratory of infectious diseases at the National Institute of Allergy's and infectious diseases. We're our friend, Dr. Fauci.

Oh yeah. Yes, he did a bunch of it. This was a very, he could be a whole other episode. He was very famous doctor who did a ton of work, basically discovering RSV and figuring out what it was all about, and then working to help develop, to grow and develop vaccines for other diseases as part of his job.

Okay. So, famous cool guy who, and at the time, though, they, well, I mean, I assume, I don't know, I didn't know, personally, seems like it. So, he isolated it from more kids and was like, yes, this is this thing called RSV. It's funny as I was reading articles, I actually found some like archived articles from 1960 about like, because they would, you'd find this new entity. And so then maybe at a specific hospital or institution, they'd be like, okay, let's see if we've got that here. And you start testing a bunch of sick people, like, well, you've all got these cold symptoms. Maybe you've got that new virus.

So then you would test a bunch of people and then figure out is it the same agent that that other guy found and what does it look like and describe it. And in this one paper I was reading, I enjoyed that they kept calling it the Randall agent. Wow, that sounds cool. I'm not really sure why But it's RSV, but they keep referring to the Randall agent and for the purposes of this paper

We will call it the Randall agent and I was thinking like I think I'd be scared RSV now has connotations that are scary especially I think as parents we have scary connotations with RSV But the Randall agent sounds scarier to me. I try to Google it, see what I'm figuring it out. RSV is the name that stuck. Respiratory, you get, it infects your respiratory system. Virus, we get, it's a virus. Do you know where the sensitial part comes from? No. Okay. I thought that's would be helpful to understand. It's not a chip in my tongue. be helpful to understand. So is it because the virus can form syncychms, which are like

mass of cytoplasm with multiple nuclei in there, so like cells sort of mushed together. Does that make sense? A syncychium, a mushy mass. Mushed, the cells are mushed. They can, because as they infect the cells, they sort of change their shape and then they cause them to slough and like stick together. That's one of the worst ones to guys use, by the way. Slough is like the pit. I wish you all would come up, it's like moist for me, like slough. That's what's happening up there. It's infecting the cells in your respiratory tract and causing them to like slough off and fall down into your respiratory tract.

And as long as they're up there in the upper respiratory tract, it's the stuff that we're used to getting. It's cough, congestion, runny nose, sore throat, maybe a fever, especially in little kids or in older people, a fever, although a lot of us wouldn't even have a fever, you'd get a cold. The problem is when an upper respiratory tract infection becomes a lower respiratory tract people a fever, although a lot of us wouldn't even have a fever, you'd get a cold. The problem is when an upper respiratory tract infection becomes a lower respiratory tract infection. That's when we start getting into pneumonia and such that are way more concerned. Lower respiratory tract. Like your lungs. Your major broncus and lungs and all that. As opposed to the upper respiratory tract,

we're talking about like your trachea and the initial little bronchioles and things. So if something's in your upper respiratory tract, you're probably not going to think to go to the doctor. So we call it head cold, right? Um, don't think upper is in head. Think of upper as in like the top of your respiratory tree. Your trachea being like the entrance to the respiratory tract. But when you're distinguish between head cold and chest cold. Well, I mean, a head cold could also be an upper respiratory infection, yes. Okay, got it. But like, but I'm conflating them, but you don't use these terms head cold

and chest cold, right? So I'm not really layman's terms with, I mean, we're talking about like the difference between a bronchitis or bronchialitis or a sinusitis. So like I think you're talking about chest colds and head colds. I'm just localizing them to the system. Okay. Which is only is only useful in the sense that it helps direct treatment, right? Like why would I make that distinction? Not to be pedantic. There are different sort of pathogens that infect different parts. And the duration of that and the symptomology and all that might help me determine what kind of treatment course you do or don't need, especially when it comes to the majority of stuff that causes these, what we think of as cold symptoms are viruses, the vast majority of viruses.

And so an antibiotic, for instance, does nothing. So that's why these distinctions are helpful. So I'm asking for antibiotics so much, or bakes. It's still a big problem. I think that that is actually one of the things that COVID has helped people understand a little better is the concept of like sometimes, I think there was this sort of thought process

that if you get sick enough, it must be bacterial, right? Like if you're sort of sick, it's a virus, if you're really sick, it's a bacteria. And I think COVID has helped kind of clarify that that like severity does not correlate with microorganism. Microorganism helps us determine treatment plan, but unfortunately sometimes a virus is what's making you really sick and there is no treatment for that other than supportive care.

So anyway, so for most of us, and this is the thing about RSV, what they determine pretty early, because it's funny, you see him talking about how like all the people with RSV are hospitalized in this trial because that's who they're testing. And so like that could indicate that it's a pretty severe illness and that it causes severe disease because you're hospitalized. Except, well, no, because maybe only a fraction of people who get it becomes severely ill, which is what we eventually figured out.

There were all these people outside the hospital who also had RSV. We just weren't testing them yet. So most of us will get RSV by the age of two. That's where I'm going with all this. By the age of two, the vast majority of people have had RSV. All right. So it's very common. You're not saying that I just macro have had RSV.

We have both almost certainly had RSV. Wow. Yes. I mean, I've never been tested for it. But you're feeling like. But it's contagious, it's common, it's seasonal, it comes around every year, and you're gonna get it at some point in your life. But obviously, it can be a bigger deal for other people.

Right. And so I wanna talk about when RSV becomes something we're more concerned about, but first we get to go to the billing department. Let's go. The medicines, the medicines, the escalate macabre for the mouth. I'm Jordan Kershiela, the host of Feeling Scene, where we talk about the movie characters that make us feel sea. And I'm the showsershiel of the host of Feeling Scene, where we talk about the movie characters that make us feel sea. And I'm the show's producer, Urissa.

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And your old-time email radio. So Sid, for whom is RSV more of a problem? Okay, so age is a big factor in how concerned we are about you getting respiratory sensual virus. Age isn't anything but a number. This is what I've been taught by pop of their music. So you tell me how that figures in. Well, but it does figure out more talking about disease severity.

They should add that to the song. Prognosis. They should add that to age, you know. That would not be a very good song. So like I said, the majority of us have gotten it by the age of two and you may or may not have noticed if you're like if you or your kid got it because it may have just been a cold. Usually it's cold. Now the are not by the way in case you're curious, you're likely to infect about three people. If you have RSV, you will probably give it to three other people.

Which is enough that I mean, and it's spread by respiratory droplets, so a cough for a sneeze. And because it is spread so frequently among children, you can see why it's so, I mean, like, yeah, kids just like wipe their noses on everything. We watched Cooper wipe her nose on a dollar bill. Which was, I mean, from like anti-cap capitalist perspective, it was like very cool and punk, but it was very gross. Well, then, then we're just, then we have this snotty dollar bill to decide what to do with.

Well, no, she decided she was threatening other children and her sister with the snotty dollar bill that everybody was grossed out by. Cooper's a rogue agent. So anyway, you get sick about four to six days after you've been exposed. That's about how long incubation period is. It takes a week or two for all your symptoms to resolve depending on the severity of illness, of course. And it can live on surfaces for a few hours. So somebody sneezes on a table and then you put your hand on the table and then you touch your face.

There you go. It tends to live on your hands for less handwas is all you need to do there. Wash your hands. Our old friend hand washing. Not just for COVID anymore. But you can see with all this why wearing a mask would have cut down greatly on the transmission of RSV. At this point, we do not believe it is spread, it is not airborne. Now, I know our understanding of such things can evolve over time, but no, it's respiratory droplets. So a mask or hand washing could easily cut down

on the spread of RSV. And you can be contagious even if you aren't showing symptoms. So if you're under six months, it's a bigger deal. We find that you can get sicker with RSV. It is more likely to progress to a lower respiratory tract infection, or just like your little teeny bronchioles are tiny, and there's not a lot of room in there for stuff. So you can become sicker, especially under two months. And that's even more so if we're talking about people who were born prematurely.

Oh, for sure. For instance, a lot more vulnerability there. And then you can get, you know, the bronchialitis becomes a pneumonia at that point and we're more concerned. Now, only about one to two percent of children under six months who get RSV need hospitalization. So it's pretty low percentage. Now, if it's your family member, you don't care how low the percentage is. That's always the way it works in medicine. I would say any statistic is a lot like that, right? About 58,000 children are hospitalized with RSV each year, and out of those anywhere from one to 500 in the last few years have actually succumbed to RSV. So it is a big deal in that I think that what we've

all seen is if something is preventable, if a death is preventable, what measures are we willing to take to do that? I mean, we've been rustling like that with that question as a society for several years now. I don't feel like it's been a particularly healing, a particularly healing question as a nation, that particular hypothetical question. I don't feel like we have a sust out an answer that we all feel great about. Well, it was tough.

They asked Dr. Chanuk initially after he discovered RSV. They said, what can we do? Because there wasn't a vaccine. There wasn't a good treatment. Most people weren't going to get that sick, but obviously some were, and it's babies. So, the emotional response to that is much more significant. And he said, have your babies in the spring, which I mean, obviously it was being facetious, but there was no, there was no other good advice, which one reflects the seasonality. We have an expected course of this. So if your baby's born in the spring, by the time they get RS fever, over two months old. I love that detachment from scientists

that will like work for years to figure something out when they figured it out. They're like, well, that's about the size of it. Bomber. Okay. I'm going to do some more stuff. Well, the other, I mean, at the time, that was the best advice. I mean, because, well, the things that you'd have to do to prevent the spread of RSV, we have begged people to do for the last couple of years.

And like you said, we've seen the results of that. If you do socially distance and you wash your hands and you wear a mask and especially stay home when you're sick, because this is the thing to remember, we kind of think of like RSV is something that kids get because we notice the symptoms and kids more, right? Because they can get sicker. Which by the way, before we go on with this conversation, the other end of the age spectrum is also severely affected by RSV. We have found that people over 65 and especially people who have any kind of chronic lung disease

or heart disease can become very ill and also die from RSV. Every year it is estimated about 177,000 older adults are hospitalized with RSV and about 14,000 people die from it. More. So that's more, the number for kids was less. We don't really talk about that until recent years where we've started to say like, oh, I guess RSV is a big deal for adults too. And then of course, also in that conversation is anybody with a compromised immune system for which this disease can be more severe no matter what age they are. But- And anybody that has any, it's not a big deal for you as we talk about with COVID, you're still a carrier of it. You're spreading it around them.

That's the point. So RSV for those of us who, and this is sort of the problem when you have a society that doesn't value taking time off when you're ill, that doesn't value the wellness of a worker or an employee as much as their whatever like work you can get out of them. When we go to work sick with a little bit of a cold and we spread that cold to all of

these other more severely impacted groups, this is why we see morbidity and mortality from something like RSV. Right. I mean, we are driving it, right? People under two months who are suffering from this are not driving the spread of this illness. I mean, you see we are driving the spread of it. You see these very few two-month-olds in the office. I mean, literally the only one I can think of is boss, baby.

And I think he was like six months old, you know what I mean? That was a six month old. Honey, he was walking. Yeah, when the parents weren't looking, but like, that's like a whole other. I don't think he was walking when the parents are looking. It was muffin'. I think he was walking.

It was like, it was toy story rules. I mean, six months would be really early for walking. We need to talk about a full episode on Boss Baby and just figuring that out. How old is Boss Baby? How old is Boss Baby, you know? So anyway, my point is that, you know, what we figured out is that in order to decrease the spread of RSV, what everybody said is,

well, we need you to stay home when you're sick, we need to wash your hands. And, you know, wearing a mask didn't enter into the conversation, I would say before COVID, at least in this country. Now, of course, that's been normalized in other parts of the world, right? During cold and flu season to walk around with a mask on? That was not considered abnormal in other places outside of the US prior to COVID, just in the US, where our you know, our value as a worker is all that... I want to say it. I won't go on a rant. But the point is if we stayed home when we were sick, then that would decrease the spread among the most vulnerable parts of the population who aren't necessarily

out there getting it, they're just falling victim to the fact that we are out there giving it and getting it. But as I said, right now now because RSV season sort of got thrown out of whack, flu season got thrown out of whack. And we're seeing all of the flu's, all your best hits, H1N1, I saw quite a bit of H1N1 in the hospital. That's one flu. Yes. In addition to other H1 or other Hs and Ns, all of that is happening at the same time. And then the big fear, I think, in the back of everyone's minds is what does COVID do next?

We don't know if there will be another big surge of a new, I mean, we have models that predict that could happen. And where will these other respiratory viruses be in there disease severity curve? You know, they kind of merge. Right. Like that's a thing. A combination of symptoms that are tough to handle.

Our ability to predict when we're going to see the most cases of these things has been thrown off and will be for a while. I imagine we'll settle back into a pattern, of course, but until then things are gonna be wild. Now, we have been working on a vaccine for RSV since the 60s. So almost since we discovered it. When she says we, she means me and her.

Me and Justin, now, scientists have been working on one since the 60s, but it's been hard. What they found initially is that on one since the 60s, but it's been hard. What they found initially is that in some of the early early, and this has nothing to do with the vaccines that are coming out now, let me just go ahead and say that. In some of our early attempts to make a vaccine, they found that if you then, after you've been vaccinated, it got reinfected with the virus again later on, which we expected could happen, you could actually having more severe reaction.

So those were abandoned attempts early on, like this is not the way to make this vaccine. Technology has evolved. And just last month, Pfizer announced the results of their, what they called, Matisse trial, maternal immunization study for safety and efficacy. And basically the idea, and I actually had a friend who was in this trial, you vaccinate a pregnant person against RSV, because if they are immune through that early neonatal period.

That's protective for the baby. Does that make sense? And they've had some really good success from that trial. They just announced that in November. So it's not out yet, maybe though within the next few months, we would see this vaccine released, targeting first pregnant people to protect that early neonatal period. And then I would imagine our next steps would be we need to vaccinate people over 65.

And ultimately this would be a vaccine that you would hope everybody would have access to because if we are less likely to get because if we are less likely to get it, we are less likely to spread it, even though for me as an example, I personally would not be high risk. More than likely, if I got RSV, it would be a mild course. And I may not even realize that I'm particularly ill, but I can also spread it.

Even if you're not contagious. Speaking very theoretically, is this the kind of thing that we could like vaccinate our way to like stamping out, or is it more like the flu where it's like, I don't know, we just are trying to keep up with it. More like the flu. Yeah. But if you look at the numbers of people who are getting severely ill from RSV as opposed

to the flu, what you're seeing, so the flu is already being impacted by the presence of a vaccine. So those numbers are already lower than they would be without the vaccine. So those RSV numbers, they're lower than our current flu numbers, in terms of severe disease, right? You get sicker and are more likely to die

from the flu still. So if the RSV numbers were also lowered through the use of a vaccine, I mean, that could be really low. We could make death from RSV incredibly rare. I'm not saying, of course, that will happen just like with flu, but we could really drastically drop those numbers with vaccination. So there is no RSV vaccine widely available yet, but I would encourage you to keep an eye out for it and pay attention because as you are someone who, you know, if you are in the groups that are first able to get it, it is obviously meaningful. And I would get it if I were in that group. And if you have not been vaccinated against the flu this year, please go get your flu vaccine.

Influenza is still a higher cause of morbidity and mortality. We talk about RSV a lot again because I think it affects people who are so vulnerable. But we are still seeing people severely ill and dying from flu. And that can be greatly decreased by getting your flu vaccine. If you haven't. Even if you're fine, you're using resources, even if you pull through and whatever, it's not just you that gets impacted. You're spreading it to the people,

you're using resources at the hospital, et cetera, et cetera. Because everybody's getting sick at the same time right now. And so our systems are gonna be strained. And so we need to be, we need to be aware of that. Stay home when you're sick. Wear a mask. If you're going to go out when you're, when you're ill, if you must wear a mask, I don't know what our cat is doing. Our cats are like, they're like crashing in the closet. They never play while we're recording,

but they've just been in and out of here. You probably heard them anyway. Um, and then I think we've been really professional about it. We haven't scolded them. If you haven't gotten all of your available appropriate COVID boosters. Come on, y'all, get them, jabs. We're not out of this. It's not over. COVID is, I know that it was declared over.

Mission accomplished better. But it wasn't. It didn't end. People are still getting COVID. I'm still taking care of people with COVID. People are still getting sick. So it is still important to get immunized. And is it a little bit,

does Sydney kind of clock her tongue, like that's a little out of date? Is a little played to have COVID, of course. Was so last year. Is so last year, but still, get your shot. Just keep getting them. I'll take all the ones you got. Hey, thanks so much for listening to our show.

One brief reminder, bit.au.wifordslash.candlelight 2020 to $5. We'll get you in to see this show. But if you would give more, that would be great because all that money is going to harm the house. It's going to have people with made videos. There are special guests. There are more songs that have been written for this than you would think. Some of them even have a company sheet music for the flute. It is a wild show. And you are really going to like it.

I promise. I promise. Yes. And it's for a great cause. Harmony House does amazing work in our community and they need all the help they can get right now. Thanks. Here, we are overwhelmed. Thanks to the taxpayers for use. So, their song Medicines is the intro and outro of our program.

Hey, speaking of Harmony House being overwhelmed, we were scrambling around here for winter coats, and are still scrambling around here for winter coats. If you got a shelter, not unlike Harmony House in your area, it might be, and you got some spare coats. You might want to check and see if there's a need there. Some folks were asking me how they could send coats to Harmony House and you can absolutely do that. If you want to send adult coats to Harmony House, you look up the address and go for it. But you probably got some folks in your area that could use a coat. Yeah. You got more than one, you know, you can spare it. There are a lot of communities that are seeing an increase in people experiencing unsheltered homelessness,

meaning that they are staying outside right now. So I guarantee there's probably somewhere close to you that could use coats, that could use blankets, that could use gloves, that could use underwear, that all of the sort of socks, the essentials that we talk about all the time, I bet there's somebody close to home as well. That's where it's checking into. Yeah. I think the taxpayers will do it again, just be safe for it.

Thanks to taxpayers for reviews. There's song, Medicines is the Internature Report Program. Thanks to you for listening. That's going to do it for us for this week. Until next time, my name is Justin McRoy. I'm Sydney McRoy. And as always, don't drill a hole in your head. Alright!