S3E03: Special episode! The light at the end of the COVID tunnel with Dr. Jeremy Faust
As the choral community begins to consider a post-COVID return to singing, we wanted to take a moment to check in with frontline COVID physician and IOCSF founder, our good friend Dr. Jeremy Faust. We’ll get caught up on the latest with regards to vaccinations, singer safety, and what it’ll take to return to singing in person.
Music excerpts
“Go, Lovely Rose,” by Eric Whitacre, performed by IOCSF, conducted by Dr. Jeremy Samuel Faust
“Adam lay i-bowndyn,” by Dr. Jeremy Samuel Faust, performed by IOCSF
“into the wind,” by Dr. Jeremy Samuel Faust, text by Philip Littell, performed by IOCSF
Episode references
Theme Song: Mr. Puffy by Avi Bortnik, arr. by Paul Kim. Performed by Dynamic
Episode Transcript
[00:00:03] [Music Excerpt: "Go, Lovely Rose," by Eric Whitacre, performed by the International Orange Chorale of San Francisco, conducted by Dr. Jeremy Samuel Faust. Music Description: A rich, modern choral sound with lush harmonies and clustery chords, singing the text, "Go, lovely rose. Tell her, that wastes her time and me. That now she knows, when I resemble her to me. How sweet, and fair she seems to be." The music continues beneath the next part of the podcast for a while.]
Zane [00:00:47] Hey, everyone, today we wanted to offer up a special episode to all you choral music makers out there. As the choral community begins to consider a post-covid return to singing, we wanted to take a moment to check in with frontline covid physician and our good friend, Dr. Jeremy Faust. This episode was recorded on May 19th, 2021, and in it, we’ll get caught up on the latest with regards to vaccination, singer safety, and what it’ll take to return to singing in person. Dr. Faust is definitely someone we can trust as a credible source of information about covid. He is an attending physician at Brigham and Women's Hospital's Department of Emergency Medicine in the Health Policy Division, as well as an instructor at Harvard Medical School. He is also editor in chief of Brief19 and ACEP Now, associate editor of News and Perspectives for the Annals of Emergency Medicine, and has written for The New York Times, Slate, The New York Daily News, The Washington Post, and many others. Dr. Faust's writing has also appeared in peer-reviewed journals, including the Journal of the American Medical Association, and Lancet Oncology. Dr. Faust is also particularly well-suited to join us on In Unison because he is a composer, conductor and otherwise very accomplished musician. Jeremy, thanks so much for joining us.
Jeremy [00:02:21] Great to be here. You also forgot my favorite accomplishment, which was that I was a co-founder of the International Orange Chorale of San Francisco.
Zane [00:02:27] Yes.
Giacomo [00:02:28] Indeed.
Jeremy [00:02:29] That's one of my most proud accomplishments. Thanks for having me.
Zane [00:02:31] Yeah, man. Welcome. So let's start off with a quick update on covid. Just give us a general summary kind of where we are both nationally and globally with the pandemic.
Jeremy [00:02:42] For the first time, the United States is behaving as we might expect, which is to do well. We now see the light at the end of the tunnel. The vaccine story is the only success story that we have had. So now this pandemic has a light at the end of the tunnel locally. But then we have to turn our attention to the global concerns because we really aren't done with this until everyone is safe. So now you have a situation that's starting to emerge where its vaccine haves and have nots. And we, again, are doing well with that. I think that we need to do better, but we also have to turn our attention overseas because this crisis can roar up at any time if new variants emerge. And the way to prevent that is to suppress cases, and the way to do that is vaccines.
Zane [00:03:32] Yeah, what about those variants? I saw a headline today that said "California's variants versus the vaccines race: the vaccines are winning." And that seems like good news in California. But what about other variants that we're seeing globally?
Jeremy [00:03:46] The variant story is totally emerging and changing every day, but so far the story has been the same. It's been that these variants have sometimes been more infectious, maybe a little more morbidity and mortality with a couple of them. But they haven't really changed the overall character of the pandemic in my mind, especially with regard to the vaccine. The biological assays, the tests in the laboratory absolutely show that some of these variants kind of wiggle away from the antibodies a little better. If you think of an antibody attacking a virus, it's sort of like a clasp, you know, two hands together. And the variants just kind of get out of that handshake a little more easily. But so far, even though we can detect that difference quantitatively in a laboratory test, in these assays that test that. We haven't seen any real proof or any sign at all that any of the variants change the overall success of the vaccine, which is to keep people from having to be hospitalized and keep people from dying. Certainly some of the variants may cause a few more infections to occur. But if those infections end up being mild, we aren't so concerned as we would be if the variants were actually causing people who are vaccinated in large numbers to require hospitalizations or to die. We know of a few cases where that's occurred. But again, the top line message is that the vaccines are still performing extremely well in turning covid-19 from this menace to, for most people, either nothing or a barely noticeable bother.
Giacomo [00:05:23] So I myself am privileged and lucky enough to say that I have been vaccinated myself. It was an incredibly easy process. I feel like I followed the science. I got the news and it was an absolute snap. It was totally an easy thing to do. But there does seem to be a lot of vaccine hesitancy out there. Some of it maybe is politically motivated, but there's also a lot of maybe misinformation and skepticism out there. Can you help dispel some of that misinformation for our listeners?
Jeremy [00:05:53] Mm hmm. Yeah, and there is a terminology that some people are using called vaccine deliberation, which is the idea of thinking about this, as opposed to hesitancy, which kind of implies like maybe an anti vax or that they're not sure. It's really that people have questions and a lot of those questions are really good ones. So I think one common misperception is that this was rushed, that we didn't do science. And in fact, really no steps were skipped. This is a technology that's been in development for a very long time. And quite frankly, the reason that we didn't have really good data on these mRNA vaccines, for example, is simply that we didn't have a very convenient virus to test them on. You need a very impressive outbreak to show that. So I can't think of anything where people were willing to try this, where you actually would have enough cases in the number of people who got the vaccine to compare to the number of cases in the people who didn't get the vaccine. Well, with covid-19, the N—the number of people we could enroll—was just endless. It was very easy to get a lot of people, and it didn't take very long for the signals to emerge that people who got vaccinated didn't get sick and the people who did not get vaccinated, sorry, the people who got vaccinated did not get sick and the people who didn't get vaccinated did get sick.
Jeremy [00:07:12] So the only silver lining to the uncontrolled spread of covid-19 was that we got quick good data on how well these vaccines work, which would have taken years in other situations. So that wasn't a cut corner, it was just that we actually had the opportunity, unfortunately, to study this well, quickly. Another thing that people worry about is the long term effects of the vaccines. And quite frankly, no one knows. Right? We certainly don't know because we've only had the main vaccines for a little while. What I can say is we also don't know the long term effects of covid. We know the long term effects of covid for a lot of people is to be dead, and that's not a good outcome. We know that long covid is certainly becoming a thing that people are worried about. And we also know that vaccines in general don't seem to have a very long tail of any side effects. Additionally, especially with the mRNA vaccines, mRNA is a very flimsy molecule, it doesn't last very long. So the idea that it would cause long term effects seems pretty implausible. And the packaging in which it comes is also just a series of molecules that we're familiar with anyway. So my main thing is to tell people that the science is really good and that it's not the vaccine versus nothing. It's the vaccine versus covid. And I have seen covid many times. You don't want it.
Jeremy [00:08:23] Can I add one thing about that?
Zane [00:08:24] Please.
Jeremy [00:08:26] Vaccine deliberation and hesitancy is kind of like cancer: it's not one disease, it's actually a conglomeration of problems. So you can't just solve it with one thing. So there's some vaccine hesitancy or deliberation that comes from a political line of thinking. They've bought into a certain line of thinking, and that's going to be really difficult to to address. But other people may have vaccine deliberation because there's mistrust for the science community in general. So people will refer to the fact that in the past there have been medical studies done in the United States that were really deplorable, like the Tuskegee experiments. And so people will have some skepticism about the scientific community that's earned by us, you know? There's a legacy that we need to confront. So there's many different reasons. So the idea that you can just kind of solve it with one thing is not quite correct. You guys didn't suggest that, but I'm responding to what I hear all the time. Access is a big, huge deal. So, yes, one way to make this better is access. Another way to make this work is to make people feel like they'll be supported with the side effects so they can get paid sick leave so they don't have to make a sacrifice that they can't afford to make to get it. Another one is to really understand what's driving any sort of philosophical thing. For some people, it's really about carrot and stick. So, OK, fine, I'll get the vaccine if that means I don't have to wear a mask. So whatever it is, you have to dig in to find out what it is and then you can hopefully approach that person with the information that they need to make a better choice.
Zane [00:09:59] What about how long immunity lasts once you've gotten the vaccine? Do we have data about that?
Jeremy [00:10:04] We don't have much. We keep on hearing that the people who were vaccinated during the trials haven't had red breakthrough cases or breakthrough serious cases, right? So now we've had people who are enrolled in the trials, thousands and thousands of people who got one of the vaccines in the middle of last year. And we haven't heard that those folks are dropping like flies or anything. So there are follow up antibody tests, which, again, antibody tests and titers give you a number, but it doesn't tell you what that number means. So you can have a 10 percent drop in your titers or a 50 percent drop in your titers and you could still have ninety nine percent of the protection. We don't know. So we're going to see over time. So far, I have yet to really have any pause. Every day that goes by. It's another day where we have immunity. There are some experts who think we'll never need a booster and there are other experts who think we will. I think that no one knows.
Zane [00:10:52] Yeah.
Giacomo [00:10:53] One of the things that we're concerned about that you've touched upon is... I think you have a very interesting perspective, because as a doctor, you certainly get to have these one on one conversations with folks and patients and people that have concerns. And they can bring you those things. And you probably are uniquely positioned to help dispel any myths or misinformation that folks have. What are your thoughts about what we as individuals can do to help combat misinformation?
Jeremy [00:11:20] Well, I think one thing we can do is to not lecture people. It certainly feels good, but it doesn't necessarily help anything. But one thing I try to do is to express my concerns, like, look, I'm really worried that something bad is going to happen and here's why I'm worried or just find out what it would take. There is the movable middle. There's the idea of people who just aren't sure. And that talking it through, and if you happen to be armed with a bunch of statistics, you can kind of help them with that. Or you can refer them to any resource like Brief19 or any really good medical resources. The movable middle is really an opportunity for us to meet our colleagues, friends, family, whatever, where they are, and just talk it through. If you find someone who's just completely against it, or a conspiracy theorist, or they start talking nonsense in your direction, I generally find that there's not much of a point in the moment. And so I don't try to necessarily move the needle. But what I do try to do in those situations is to show that I'm listening because they may not listen to me today, but they think I'm listening to them today, they might listen to me later. So there's a little bit of like let me use this opportunity to at least establish a baseline that I'm listening. And then later on, there could be a conversation. It's pretty unusual that it leads to anything. But that's just my approach. If you get in a shouting match, or you get resistance, just disengage, because it's impossible. But most people if you just ask them what they're worried about or what they're thinking about, then, again, you can sort of either offer any information you have, and validate their concerns, or say, oh, let me think about that. Let me ask somebody and refer them to something. So I think one of the great things that I learned in coming out of medical school is that it's like you don't want to say, oh, I'm a doctor. I know all this stuff and you don't know anything, let me just tell you what I think. That doesn't get you very far. What gets you a lot farther is OK, look, I'm a doctor. Here's the information that I have, and let's match them with your values and figure out what the right fit is. So there really is... I think there is a correct answer, I think you should be vaccinated. But in many, many medical situations, there is not one correct answer. And so I'm used to that kind of conversation. And so I think that I've learned that these sort of, you know, the conductor is always right aspect doesn't necessarily translate well to like conversations regarding medical choices.
Giacomo [00:13:42] It's an interesting choice of words, actually, because I think you touch upon something that many of us may be experiencing, which is the dynamics, the interpersonal dynamics you're describing are ones where there are peer relationships. But sometimes the dynamics of power and leadership structures can affect the way misinformation is spread and can sometimes have an outsized influence. What do you do when you're faced with a situation like that where let's say I mean, you brought up the conductor analogy with the conductor metaphor, but that may actually be quite literal, right? You may have a conductor or a choir conductor who is saying, hey, I don't believe in any of the science at all. I think that, you know, the vaccines are terrible and they're going to give you autism or whatever. I mean, who knows? I mean, what do you do when you're faced with a leadership that's caught in a web of misinformation and science denial? Whose responsibility is it to to help that out? What do you do?
Jeremy [00:14:35] I think we're going to confront this in the coming months. We've never really had to deal with this before. My sense is that these kinds of problems, when they occur, are going to be hashed out within the organizational structure of those organizations. In other words, if a singer doesn't feel safe going to rehearsal or if they feel like the environment is toxic for any reason, whether it's a union job and they go to their union representative or whether it's a volunteer gig like International Orange, and they just wanna go to like, you know, whatever representatives singers have within the board structure or within any organizational structure there may be. I think that that's the place, that's the time when a really solid organizational structure where people's concerns can be heard outside of the rehearsal environment can be entertained and can be pursued because you just cannot have a situation in which people don't feel safe or they don't feel even welcome in a way. So I anticipate that there will be a few cases, some difficult conversations, but sort of not in the artistic space. The goal is that by the time you get to the artistic music making moment that all that's been worked out. You can't have it playing out when you're trying to, like, learn the Brahms Requiem.
Zane [00:15:54] Right.
Giacomo [00:15:55] Very true. Yeah. I mean, we're all taking those steps. I mean, speaking of which, maybe Zane you can give us a little overview of what we've been doing here. But IOC is indeed trying to get back together in relatively short order. The Golden Gate Men's Chorus has also announced that starting on August 3rd, we're going to be coming back to rehearsals. And we've had a bit of a process of getting there, engaging with the leadership and the membership of the group to openly have this conversation. Zane, maybe you can tell some of the details of what IOC is doing as well.
Zane [00:16:25] Yeah, I mean, obviously, one of the most important things for me as a leader is to make sure that, as Jeremy just said, make sure the singers feel safe and that they feel that coming to rehearsal is not a risk for them health wise. So, you know, we're beginning by surveying all the singers and asking them to tell us whether or not they're vaccinated and if they plan to be vaccinated and when they will be fully vaccinated and if they would be willing to prove that they're vaccinated. And to be perfectly honest, I have no qualms about requiring that every member prove that they're vaccinated, because that's what we're seeing, you know, from the CDC, from the city of San Francisco, is that, you know, if you're fully vaccinated, it's safe to sing together. And that's what we're seeing. And we'll talk a little bit more about that in a moment. But that's what we're doing, is we're just trying to get everybody to put that information out there so that we can feel safe as an organization and as an ensemble to get together and be in person. And I think that's probably the right way of going about it. But there are a few people who are kind of holdouts, a little you know, there's a little bit of a privacy thing, too, for some reason that's come up. Have you seen any of that, Jeremy, where people are like, oh, I don't want to... It's a privacy thing. I don't want to talk about my vaccine status.
Jeremy [00:17:43] Mm hmm. Well, there is the medical legal perspective as a physician for me. So I have to work with my patients. There is a privacy issue about discussing my patients. But when I put on the hat of, like, running an organization, a private organization or nonprofit organization like you, my understanding of the law is you have the right to associate with you like to, would not like to. And especially with regards to safety, I don't sense that there's a legal issue of saying to somebody, look, we're going to require X, Y or Z the same way that, you know, lots of people would... Schools would say, we won't let you come in if you don't have your vaccines, they have to volunteer that to the schools. They have to give that information to the schools. I say volunteered... they have to give it. So there's the privacy concerns about our medical information. I would mention, though, that medical privacy is not a universal thing. And even HIPAA, which is this law that helps us keep information secure and allows health care providers to communicate with each other securely and safely, but also protects patients and their rights is not an absolute universal thing. So, for example, in cases of emergency, HIPAA will be suspended because you want to be able to communicate safely what's going on. So in, for example, a mass casualty situation, you can't have a doctor saying, I can't tell you because literally then police officers and public health officials and everywhere else, even just families trying to find out where their loved ones are would just be completely screwed. So the idea of medical privacy is a really important one, but actually we forget to balance that against public needs sometimes. So the classic example is kindergartners have to have their vaccines to get started in school. That's just a thing. And so I suspect the same thing is going to be true here, especially with private organizations, institutions. There could be some kind of legal battle to be had and I'm not sure how to play out among like federal agencies, government agencies requiring something in a vaccine that is FDA authorized but not FDA approved. So we have an emergency authorization as opposed to a full approval. And there could be some legal battles there. But that's going to be in public accommodations; whether or not you work for the government or that kind of thing. As regarding this, I think that you're probably OK.
Zane [00:20:12] Yeah.
Giacomo [00:20:13] So we sort of described what both of our groups are doing here, the GGMC, IOCSF as well, and lots of other choirs are getting back to normal (air quotes). How are we doing? Anything else you would recommend or say, hey, think about this as you're thinking about getting back together?
Jeremy [00:20:31] The CDC guidance is pretty clear. If everyone's vaccinated, everyone can be in the room without a mask. That seems to be what we're dealing with. To me, the question is, how will we know if something changes? How will we know if that's no longer the case? What if breakthrough cases are occurring? What if the vaccines are turning out to be only 80 percent effective against severe disease instead of ninety five or whatever or one hundred percent? Then we're going to be in a different situation. And I can't get ahead of that just yet. But I'll tell you is you'll know that there's a problem if Anthony Fauci starts wearing a mask indoors again. If that happens again, that's a pretty good bellwether... Or somebody like that. So people who have been willing to go with the science, who put the mask on when the mask science said we needed to and who took them off when it looked like it was OK to do so. So you can read these headlines... ah, breakthrough cases and all this, but you'll know because people like me will be saying it's a problem folks. What I think is actually really interesting in general is the idea of going forward with making music in person together. We're all going to do it. And whether it's covid or not, the one thing I really hope happens is from now on, if people are sick, they don't have to come to rehearsal when they're sick. But they could stay home and watch on Zoom. I'm excited for people to watch rehearsal on Zoom and not have to like give them the notes from rehearsal and you know, they're never going to make it into their score. Like I love the idea that like, I'm contagious, I don't feel well... Great you can watch it on Zoom and your scores will be out and great. So to me it's like, the long term implication is we're going to have healthier choirs and we're going to have choirs that even in a sick year still manage to not lose too many sick days. That's my pie in the sky hope.
Zane [00:22:14] Yeah, that's something that I have in the back of my mind as something to incorporate as we move forward is just set up a nice microphone and a computer and just stream the rehearsal. So that way anyone who can't come because of whatever reason, because they're ill or or even if they're out of town, they can watch the rehearsal after the fact and not have lost that rehearsal time. And I think that's going to be super valuable, something we definitely learned from this pandemic.
Zane [00:22:41] Let's just take a little break from the conversation to hear one of Jeremy's compositions. This is "Adam lay i-bowndyn," performed back in 2015 by the International Orange Chorale of San Francisco.
[00:23:02] [Music description: A four-part chorus sings in a pseudo-renaissance style with more modern harmonies. The tempo is moderate, but steady, and the piece ends with a very satisfying resolution.].
Zane [00:24:26] I want to, since we keep talking about wearing masks, there was this one study that I did want to bring up with you that I came across through social media sharing, of course, and the study's conclusion was that wearing a mask was a bad thing for your voice, that it actually hurt your voice. And I thought that was well, my immediate reaction was that's ridiculous. But I thought I would see if you had seen that study and what your thoughts were about that.
Jeremy [00:24:53] Mm hmm. Yeah, I did see that study. And let's contextualize this. First of all, there is a subset of people who have the wacky idea that masks are harmful in general. That if you wear a mask, that you can have a buildup of carbon dioxide or that you could be inhaling bacteria in and out too much. OK, surgeons operate for 12 hours in a row with masks on. They're not becoming like... Their carbon dioxide levels don't rise to the point where they're acting all crazy. And yes, optimally, we should not have been saying to people, you need to go running with a mask on because eventually you want to exhale the junk that comes into your upper airways. But for the most part, wearing a mask, it is totally safe. It has no implication on oxygenation. And so for the past year, it's been fascinating to watch people who are not afraid of covid-19 (and they should be), be afraid of masks (and they shouldn't be). So it's been a very strange sort of counterintuitive thing. The same people who are advocating for the things that will stop this virus—staying apart—are actually the same ones who are now advocating for the thing that will stop this virus: the vaccine. It's like, a broken clock is right twice a day, but some of these jerks end up being wrong more than that. So that's the context. But the issue with the study you mentioned, which unlike a lot of garbage studies that get bandied about on social media, this study was actually in a reputable journal. So you have to look carefully at what it said. And that doesn't mean that it's true, per se, but it means that it's not complete junk science. However, let's just say a few things. They were looking at health care workers who wore masks all the time while treating patients in the hospital. So for like eight, 10, 12 hours a day and they are yelling at patients who are hard of hearing part of the time, who are themselves wearing masks. Or sometimes there's suction in the room, there's oxygen, they're raising their voices and they're asking these people, by the way, how is your voice doing now that you're wearing masks 10, 12 hours a day? And it turns out that one thing you need to do to know that information is to compare that to something. Like, oh, the people who aren't wearing masks or the people who were, you know, surveyed before the mask mandate, and during the mask mandate. This study had no control group. It just reports a bunch of people saying, you know, yeah, actually wearing a mask does make my voice kind of hurt at the end of the day. If you look at the scoring system they use, it's a voice health index, the VHI, it's this questionnaire and some of the questions are things like sometimes people have trouble hearing me speak. Yeah, occasionally... Look, I'm a health care provider. I've been in the hospital where I'm working an N95 mask, and the patients are like, I'm having trouble hearing you doc. I'm like, sorry, let me just come closer, or raise my voice. So yeah, at the end of a long day of a shift, yeah, I felt like I used my voice that day, I felt that way after choral rehearsals sometimes.
Zane [00:27:53] I was just going to say, at the end of a choir rehearsal, like a hardcore three hour rehearsal, my voice is tired.
Jeremy [00:28:00] When I'm at my peak vocal shape, and what I mean by that is I'm using my voice a lot vocally, chorally, and my technique is really good, I can actually not be tired after long rehearsals, but it's pretty unusual. Usually I'll feel some degree of that. And it's completely what we call self limited. It goes away. So for this study to be weaponized as proof that masks are harmful to singers... This study did not study singers. It did not study people in a regular situation. It did not have a control group. And it didn't have an outcome that is meaningful for singers. So it wasn't like they tested a bunch of singers. And I was like, oh, you know, after I wear the mask, I just, you know, the Juilliard judging said I was worse. Or I couldn't practice as long. No, it's just a complete misapplication of a study that basically has no action item for us to do. Like I can't think of what the action item even in the health care setting other than vaccinate. OK, vaccinate. Even in that case, look, I'm not wearing a mask in those situations anymore. But I mean, let's be honest, at work I am. When I see patients, I am. So I don't even know what that study can really help anyone do. But I did see it get weaponized by anti mask zealots, and that was not surprising, but disappointing.
Zane [00:29:16] You mentioned that this study in particular was in a reputable journal, and yet it still is getting twisted and used to state something that's not true. And, you know, I consider myself a skeptic, you know, and by that I mean a person that follows science and is about using rationale and thinking critically about the things that I see and hear. But yet, even so, as I look through news sources and my Apple news feed or wherever it is that I'm looking at the news, there's just so much out there. And it seems like there's so many different sources of information and it's hard to know what to trust, because even when you see something from a reputable journal, a peer reviewed journal, it still may not have the implications that it's being reported to have. And so what are your suggestions, for us lay people as those of us who are not medical professionals, you know, where is the best place to find the most concise information?
Jeremy [00:30:21] Well, there's no one source. But one thing that I think is really important is to realize that there are thousands and thousands of medical journals and even the top five percent of the most prestigious ones, there are still so many of those. And at every major medical center, there are hundreds and thousands, if not thousands of professionals associated with those places. So you can have one person who has really left their cognitive zenith behind, if you will, you can have one person who has just gone off the rails at Stanford or Harvard and Johns Hopkins or whatever, and suddenly someone can say, oh, look, a very respected Johns Hopkins guy said this. It's like, well, yeah, but 99.9 Percent of that person's colleague says the other thing... They might be right. Let's find out. Take a look. Oh, look, they're wrong. That's usually the story. It's very, very rare that when one of my colleagues here at Brigham and at Harvard says something completely wrong, that they're right and the rest of us are wrong. It can happen. But I haven't seen it much in covid. For the most part, it's just been people who's marbles are not intact, unfortunately. How do you tell that? It's hard for me to say, other than to say, does this match with other things, with other information? There's a little bit of a so what factor for example. The so what factor is even if what this person, this headline or study says is true, so what? Then what? So for example, you hear about the variants: oh my God, the variants, you know, decrease the vaccine's affinity for the binding by 50 percent. So what? Does it mean that this 50 percent of people are now going to get sick who aren't going to get sick? Absolutely not. Doesn't mean that, right? So these headlines are unfortunately driven to drive clicks, written to drive clicks. And so I just say, never trust one thing, get a preponderance of things, and read carefully. And then, of course, over time, you can understand that some outlets are better than others. But even so, look, The New York Times... My wife writes for The New York Times, I've written for The New York Times. I love The New York Times. There's a couple of writers of The New York Times who occasionally get something wrong. It makes my head explode. So even with your trusted sources, just never turn off your brain. At the end of the day, you are the only person who can actually make those calls. But fortunately, we're all connected. We can reach out to experts, so... A little unsatisfying of an answer, but it's a huge problem.
Giacomo [00:32:56] And maybe when in doubt, you know, talk to a healthcare professional, talk to your doctor, talk to someone you have a long history with, who you trust, perhaps.
Jeremy [00:33:04] I love that.
Giacomo [00:33:05] Who's far more... Who's far more knowledgeable.
Zane [00:33:09] Yeah.
Jeremy [00:33:09] Yeah, just let me dig into that for a second, because, wow is expertise not a transferable skill. In other words, if you are the world's leading constitutional law scholar and you know more about the First Amendment and the Fifth Amendment, and the 14th than anybody else, that does not mean that you can read ten covid papers and be a covid expert. Now, I'm not saying that that person is wrong about covid. But if a person like that is saying something about covid that is completely counter to what really intelligent people in that space are saying, then guess what? They're not like the outsider coming in to fix medicine, right? Like, I'll just say, like, you know, Nate Silver, he's great at polling, but he doesn't know how to read epidemiological studies, but he thinks he does because he thinks he knows data. But he actually doesn't know how to read medical data. And so therefore, he gets it right a bunch of times. And then when he gets it wrong, he actually doesn't know that. So the expertise as nontransferable is a huge, huge thing. It makes my blood boil just a touch when people are like, I know a lot about medicine because I read 10 papers, or because I was, you know, whatever a Bio Major or, you know, whatever. I mean, look, I don't know what I know because I went to medical school. I know what I know because I study public health all the time. And I spend time in this space. So it's frustrating sometimes, when, to your point, Giacomo, it's like this sort of transferable expertise thing, it's pretty bad juju.
Zane [00:34:46] Yeah. That plays into the whole Dunning Kruger effect too, right? Isn't it some of that?
Jeremy [00:34:50] Absolutely.
Zane [00:34:50] Yeah, absolutely. So if I can maybe summarize what your advice is for us to be able to seek out, you know, good information is that we should put our thinking caps on and be critical thinkers and not trust just any one source, and always try to find multiple examples of information. But the biggest takeaway that I just got from you is that we really need to be careful and cautious. And this is the problem with social media being the source of information for so many people is that it's like headline after headline after headline. And that's the only thing that folks read sometimes. And they just scroll through their feed and they just see that headline. Oh, a new study shows this. Well, that's the truth. And that's the biggest thing that I think we should be encouraging our listeners and everybody out there to do is to not just read the headline because the headline is so often developed, or designed, to be click bait. It's designed to be a thing to click on.
Jeremy [00:35:53] Yup.
Giacomo [00:35:54] And when and when in doubt, talk to a healthcare professional.
Jeremy [00:35:57] Yeah. By the way Zane, I gotta hire you my PR guy? I'm starting this new project and literally the description of it is we go beyond health headlines. And the idea is, here's not only what you need to know, but how we know that. And how we don't know that. So one of the things that I think you just said that was so important is "science says this. Studies show that. This proved this. It's like, well, actually, that's rarely the case. Usually some study in the media is one piece of data. And what's really undermined, or downplayed, is how that piece of information was actually found. And unfortunately, when you dig into that, you find out that there's probably some grain of truth to it at some angle. But actually what we really know is a lot less than what's being suggested. So how we know what we know is actually such an important thing. And this is another reason why expertise is so hard in my space. Like most people who would read like a study in a medical journal, they'll skip the part that's the boring part, which is the method section: like we did this, here's what we did, we used this approach and this statistical thing, and we did that. That's the part where they tell you if it's good or not. And so if you're unable to assess the difference between, like, whether they did like a year over year difference in difference versus a seasonal arima versus a [inaudible] progression and projection. It's not just jargon, it's whether or not people are talking in the same language and saying, oh, I know how rigorous this was. And so most people who are doing this kind of sharing of stuff, they have no idea how to assess that.
Zane [00:37:25] Let's talk a little bit about some music real quick. So you just recently sent me a score for a piece of music that you wrote, which is called "Winter is Past," a Song of Songs setting for cello and chorus. And it's absolutely lovely. And you had some Harvard doctors and scientists record it. And the purpose of the piece is for the Harvard commencement, which is next month. So is the performance going to be a live performance? Or are you just going to play that recording that y'all made?
Jeremy [00:37:53] So I'll say what happened? Harvard University reached out to me because I conduct this choir of doctors, nurses, students, researchers, anyone who is in some health... We have social workers. It's an amazing group; 70-80 singers.
Zane [00:38:09] What's the name of the group?
Jeremy [00:38:10] The Longwood Chorus. Thank you. And they knew about us and they said, look, for graduation, we would love to have like a short piece by, like, a few of the singers or maybe a few people who have worked with before. They asked me to put together like a small group. And this would be recorded, filmed, and streamed during the Harvard main commencement, so this is like a lot of people. So they said, "what do you want to perform? By the way, it has to sort of be vetted at the top levels, like it has to please everybody in terms of like it can't be too religious, it can't be too political." It has to sort of thread this needle that's impossible to thread. Can you imagine? And I started looking around for pieces and I just couldn't find anything.
Zane [00:38:54] Yeah, you reached out to me. You were like, hey Zane, you got some ideas? And I was like, oh, boy, I don't know.
Jeremy [00:39:00] Right? It's a hard needle to thread.
Zane [00:39:00] Yeah, it is.
Jeremy [00:39:03] So actually, I was thinking about that text, which is from the Song of Songs, which is yes, it's a religious text, but it's pretty non-religious as religious texts go. And I actually thought of it because of an International Orange connection, the piece "Nigra sum," by Cole Thomason-Redus. It was written, actually, not *for* International Orange, but the second performance ever of that piece was International Orange's, like first ever concert. And Cole wrote this piece, "Nigra sum," in which he has Latin and English settings of Song of Songs. And one of the lines that he set was this paragraph that I was like, oh, that'd be perfect for this, which is "for behold, the winter is past, the rain is over and gone. The flowers appear on the earth. The time of the singing has come." And I thought for this moment, like where we have this intense sadness, but also this moment of optimism, that's like a great kind of paragraph. So thank you, International Orange and Cole for planting that seed. And so I asked them if I could write something and Harvard said, yeah, you can, but we're going to have to approve it. So I had to go write it and make a demo and send it to them. And it was actually almost like working in theater. They sent back edits and like requests and changes to be made. And I was like, oh, that's annoying. But actually they were right because they wanted a certain feeling. So it's actually interesting as a composer to actually have to answer to that kind of thing. They were right. You know, the revision is snappier and gets there quicker. And actually, I added some stuff that I omitted from the original. Intentionally... I was like, oh, the ear will hear that, you know, the ear will interpret that. And then I was like, no, I need to actually be explicit. So I wrote the thing and then they said, sure, do it. So then we recorded it. We rehearsed ten singers in a large room. Everybody was vaccinated. At that point, the mask rules were changing. So we were in a big, huge room, like eight feet apart, everyone wearing masks in the rehearsal. And then in the recording, it was an even bigger space, but for takes, we actually took the masks off. And then we filmed it outdoors in the beautiful Harvard Medical School quad, just beautiful. And they're going to apparently take all that and mash it up into this montage that's going to play at the graduation. So it felt so good to be singing and conducting again. I have to tell you, it was seriously the greatest. You're in for some fun.
Zane [00:41:38] I'm so jealous right now.
Giacomo [00:41:43] Oh god, we're all beaming. Yeah, I want to do that. Let's go.
Jeremy [00:41:45] Yeah.
Zane [00:41:46] I know, god. Yeah, that experience must have been so wonderful for you to be able to be in front of singers and have your music performed and oh god...
Jeremy [00:41:57] It was great. And I will say this as well. I wrote this piece in early April and I was at the end of a bunch of research, in my medical research, where I was trying to tie a bunch of things together and it was sort of a period of slogging through a bunch of stuff I'd already put together. It wasn't anything new intellectual work, but it was like just let's get this all together. And I hadn't written music in a while. And I noticed, like after I finished that piece, the next three or four weeks after that, I have had this, like, creative explosion in my research. I have made these kinds of connections that have been staring me in the face...that should have been staring me in the face for months. And I'm proud of them. I'm like, oh, no one's ever seen this before. I go to researchers, my mentors like, nope, that's new. And I swear to you, it's because I wrote that piece. Because when you write music, you solve problems. You look at things from different perspectives. You open your mind. If there is like a ringing endorsement to be had for a liberal arts education, I think I just lived it because writing that piece made me a better scientist.
Zane [00:42:56] Fantastic. Wow, what a great, that's that seems like a good sentiment to wind up on and to end up on here. So we can sing together now, if we're vaccinated, right? Is that, that's true?
Jeremy [00:43:10] Absolutely. I'm ready for it.
Zane [00:43:12] I'm so excited about that. And earlier we talked quickly about, you know, we should keep an eye on Dr. Fauci. If he starts wearing a mask again, we should be considering what the implications are of that. But are there any other things that choral organizations you think should be considering as we get back to resuming regular activity?
Jeremy [00:43:32] There are a few things. I think that we, first of all, should start to always have contingency plans. San Francisco is a great situation. I said this last summer to you guys, I think in other settings, I don't think we ever needed to stop singing outdoors. Like we could have had rehearsals outdoors, like, you know, six feet apart on a yoga mat or whatever is going to be. And we could have kept doing this. I think the fact we shut down the arts for a year, including outdoors, was unnecessary. At first we didn't know. But I think we knew, kind of fairly early on, that outdoors was going to be OK. The problem was we had such an explosive crisis on our hands that there was no time for nuance. Right? And so I wasn't going to be the guy to fight that battle. And I think many people felt the same way. But going forward, if there is something that kind of comes back and rears its head, I think that this time around, people will A, have less appetite for those kinds of extreme restrictions. And B,I think we know it's not entirely necessary. So I think that planning for OK, well, up until November, in San Francisco you can do outdoors, heat lamps, whatever is going to take. What about rapid testing? I think that rapid testing could have saved hundreds of thousands of lives in the United States and could have kept organizations safely open, such as, even choral groups. If you had an outbreak and rapid testing and masks, you could do a short term fix. So what I'd say is at the moment, I feel like now is a very safe time. If everyone's vaccinated and we know the variants aren't breaking through, like, now's a great time. But I would say to organizations: think ahead. What if there is a little bit of a worsening situation? What's your plan for that? Part of that could be outdoors. Part of that can be using masks. Part of that can be rapid testing. So think ahead because, you know, you can't plan for everything, but you can plan for some of the stuff. And if we do have another crisis that's covid-related or a non covid thing, I very much hope that we don't have to have another year of not making art. So I think that that can be avoided if we do the right things.
Giacomo [00:45:25] Yeah. And I think it is worth stating that, boy, what a difference the right leadership makes. You know, just harkening back to what we were talking about before, it feels great to feel like science is back at the helm and that we're really letting that sort of lead what we're doing as a country. And hopefully more folks are listening there.
Jeremy [00:45:45] Can I just... Yes, can I just tell you, like, the difference is so palpable for me. I'm in this little, like, internecine fight with a few people about some data. And the CDC has this thing where they don't even realize it, but they contradict themselves. They have like one group says this at the CDC, another says the other. And I went to them and I said, folks, there's a contradiction in your own data from two different centers. And it matters. Like there's a moment where it didn't matter before, but now it matters. And their answer is, yeah, you know, we should look into that. That's a problem. You know, I'm not sure what they're going to do about it, but the point is that their responsiveness was like, huh? Yeah, this could have been an issue. There's a conversation to be had. Like, I don't know, the outcome of that conversation is going to be. But there is an actual conversation which is so refreshing. I can't even begin to tell you.
Zane [00:46:30] Yeah, there isn't somebody just standing up with their fingers in their ears going, la, la, la, I can't hear you.
Giacomo [00:46:35] Yes, indeed.
Jeremy [00:46:36] It's a huge difference.
Zane [00:46:38] Well, Jeremy, we really appreciate you taking some time out of your busy schedule to chat with us and for taking some time out of your busy schedule to write some new music. And I think that there's a possibility we might find that piece in front of the International Orange chorale in the future as well.
Jeremy [00:46:57] Cool man, I'll send you guys to the montagey video when it's ready.
Zane [00:47:01] I love it. Can't wait to see it. Yeah, for sure. Awesome. Well, you take care of yourself and we'll have you back on again in the future when we have more stuff to talk about.
Jeremy [00:47:11] All right, Zane, Giacomo, you guys are awesome. International Orange. Love you all. Love the community. Proud to be part of it. Have a good one.
Zane [00:47:18] All right. Take care.
Giacomo [00:47:20] Bye, Jeremy.
Zane [00:47:21] Let's finish off today's special episode with one more of Jeremy's choral works. Here is "into the wind," a setting of an original text written by one of Jeremy's longtime collaborators, Philip Littell, and performed in 2014 by the International Orange Chorale of San Francisco.
Speaker 1 [00:47:44] [Music Description: Modern, dissonant choral music plays, but quickly evolves into sonorous melodies and harmonies. The tempo ebbs and flows, following the character of the text, which is very dramatic and literary. The text of the piece is: "into the wind; button your coat; just turn around and the wind's at your back, little boat; he steers as she founders; she's shipping watter; she's lost a rudder; she lists to leeward; she used to dance on the waves; she always was hard to handle but worth it; a beauty he liked her (shrugging); he liked her lines; low on supplies and blown off course; is it always a shipwreck, love; is it down to this raft? down with all hands, she's going down with all hands. BOATS ARE ALL WOMEN AND WOMEN ARE ALWAYS UNLUCKY ON BOATS; so button your coats, a wind's coming up; button your coat."]
Outro [00:51:30] Thanks for listening to this week’s episode of the In Unison podcast. Be sure to check out episode extras and subscribe at inunison podcast dot com. You can follow us on all social media @inunisonpod. And leave us a review on Apple podcasts to let us know what you think!
Chorus Dolores [00:51:46] Pianos tuned by chorus Dolores, who thinks a brilliant title for an early music concert would be Where's Gesualdo?