In this episode of the podcast, we talk about how the current pandemic is affecting our society, and why we should all be worried about it. We also talk about the dangers of excessive drinking, and how we can combat it. This episode is sponsored by Tushy, which is a company that makes a bidet attachment that cleans your butt and keeps your butt dry. It's $79.99, and it's a great way to keep your butt clean and your butt free of germs. You should get one! To find a list of our sponsors and show-related promo codes, go to gimlet.fm/sponsors and enter promo code POWER10 at checkout to receive 10% off your first pack of Power10 when you place an order through Paypal. Thanks to Paypal for sponsoring this episode! Music by Nordgroove from Fugue Records and tyops, and special thanks to our sponsor, Tushys! We hope you enjoy this episode and that you enjoy the rest of the ones you listen to this week's episode. We'll see you next week for our next episode, Power10! Thank you so much for listening and supporting the podcast! Cheers, Jon and Sarah! Jon & Sarah -- Timestamps: 1: 2:00 - How do you feel about the pandemic? 3: 4:30 - What do you think about it? 5: What are you worried about? 6:40 - How does it affect you? 7:20 - What would you like to know more? 8:00 9: What s your thoughts on it's dangerous? 11: What is your worst enemy? 13:30 14: What do we need to do? 15: How can we do it better? 16:10 - What s the worst thing? 17:10 18: Does it make you feel like it s better than a pandemic 19: Is it better than it s more dangerous than that? 21:30 | What s a good idea? 22:40 15 - How would you think it s going to help you feel better than you can help you get a little bit more comfortable? 20:30 + 16: What kind of disease do you want to help me? 23:00 + 17:00 | How do I know it s not better than this?
00:00:29.000I have another friend of mine who stopped drinking altogether, and he said that it was making him cranky when he was drinking, and of course there were extra calories.
00:00:38.000And I listened patiently to him and thought I would love to do that, but at the same time it's hard to give up completely.
00:01:00.000Although when November kicks in and I know I can drink again, there's usually a few days of excess.
00:01:07.000Which is, speaking of the subject of COVID-19 and the current pandemic we're into, that's not a good thing.
00:01:14.000There's a lot of people out there destroying their immune systems drinking.
00:01:18.000There's a very funny video that I found online of this gentleman who runs around his neighborhood and he noticed that during the lockdown he would run around his neighborhood and he would see the recyclable bins and they were just filled With empty alcohol containers.
00:03:15.000How did you, what made you decide to write a book on the current pandemic and the disease?
00:03:22.000Well, I mean, for me it started, I was reading news reports in January about what was happening in China, but I wasn't paying a ton of attention.
00:03:32.000And then I have these Chinese colleagues with whom I've been doing research for a long time, and they contacted me in the middle of January.
00:03:39.000We had been using phone data in China.
00:03:42.000To study how earthquakes, for example, change human social interactions.
00:03:47.000So after an earthquake, who do people call?
00:03:49.000And we could imagine that the first person you call is very important to you, for instance, and so we could use the phone data to study social interactions.
00:03:57.000And so we decided to use the phone data to study the pandemic and to study the movement of people through China and how they might carry the virus with them, which started in Wuhan in November sometime.
00:04:13.000And then we noticed, or I saw in the data, that on January 24th, the Chinese were so concerned with the virus that they basically detonated a social nuclear weapon and they put 930 million people,
00:04:28.000almost a billion people, under home confinement starting January 24th.
00:04:46.000And it was clear to me that this was going to be a serious global pandemic.
00:04:51.000And so I began to redirect the activities of my laboratory at Yale to study more and more about what was happening with this virus.
00:05:00.000And we did a whole bunch of projects, some of which, if you're interested, we can talk about We released this app called Hunala, H-U-N-A-L-A, Hunala, which you can get thousands of people use it now.
00:05:15.000It's not a contact tracing app that looks backwards.
00:05:18.000It crowdsources information about who you're connected to, which is one of the things I study, is networks and where you live and forecast your risk.
00:05:27.000So people down the road from you are reporting a traffic jam or a cop And you can exit the highway and avoid that.
00:05:34.000And people, your friends, friends, friends are reporting a fever.
00:05:37.000It can ripple back through the network and feed this information to you.
00:06:00.000We did a whole bunch of other stuff, which maybe we'll talk about.
00:06:03.000And so in the month of February, as we were doing all this work, I was getting more and more worried and that our nation wasn't preparing.
00:06:12.000And so in March, I started sending out some Twitter threads like Epidemiology 101, like basic stuff.
00:06:20.000And a lot of those started to go viral and people were so hungry for information about it.
00:06:25.000It became clear to me, you know, factual information about what was happening.
00:06:29.000And then in the middle of March, my editor, my long-term editor at Little Brown, a woman by the name of Tracy Behar, contacted me and said, would you like to write a book?
00:07:02.000I didn't see our leaders as doing the things they needed to do.
00:07:06.000And I just wanted to help people understand what was happening and what was likely to happen.
00:07:11.000What do you think should have been done that wasn't initially?
00:07:14.000Like in the January, the month of January, it's when everyone was alerted to the fact that this was going on in China.
00:07:21.000The White House knew, everyone knew, but we didn't really lock anything down until March.
00:07:25.000What do you think should have been done?
00:07:27.000Well, first of all, people like me knew this was going to be a serious global pandemic for sure by the end of January.
00:07:36.000And the president, we now know, unsurprisingly, was briefed even earlier, right?
00:07:40.000I mean, if the president didn't have more information than me, then there's something wrong in our country.
00:07:48.000But certainly by the end of January, when China locked down, as we discussed, we should have begun immediately preparing our testing capacity, manufacturing PPE, We should have, I think, begun the incredibly important challenge of preparing the nation for the challenge we would face,
00:08:09.000You know, we were about to be invaded by the virus, so public messaging would have been really important to tell people, you know, we're facing a common threat.
00:08:18.000We're gonna have to endure some sacrifice.
00:08:20.000We're gonna have to work together to repel this threat.
00:08:23.000Here's some basic information about the nature of the threat.
00:08:27.000So all of these things are ventilators, for example, also another, you know, sort of material that we needed.
00:08:33.000Preparing our hospital systems, for example.
00:08:36.000We lost several months in which we didn't We didn't really prepare.
00:08:40.000And honestly, I don't understand why our leadership failed us in this way.
00:08:46.000There's also an issue where the pandemic response team that was in place for the previous administration was disbanded and sort of reassigned, correct?
00:08:59.000Yes, I don't know all the details about that.
00:09:01.000I know it wasn't just the Obama administration.
00:09:02.000They inherited the pandemic response From the Bush administration and the CIA has been identifying emergent pandemics as a serious national security threat for a number of decades now, as I actually discuss in the book.
00:09:17.000And of course people like Bill Gates have been warning about this.
00:09:20.000Tony Fauci was writing about this stuff when you and I were in elementary school.
00:09:25.000So there's a lot of institutional knowledge about the existence and nature of these threats.
00:09:31.000I don't know why we weren't better prepared when we saw what was happening in China.
00:09:37.000What could have been done differently?
00:09:39.000I mean obviously manufacturing of PPE and all those things.
00:09:46.000And that would have actually avoided a very unfortunate thing that happened where Fauci actually was telling people they don't have to wear masks.
00:09:55.000And he later admitted the reason why he did that is because he didn't want people rushing to get masks and that would take masks away from the first responders.
00:10:03.000That's a very, very unfortunate thing that he did because that eroded people's confidence in what he's saying.
00:10:11.000It lets you know That there are people that are in positions of power like himself or positions of influence that will lie for the better good but still lie.
00:10:22.000Yeah, so the details of the Fauci statement, I honestly don't know.
00:10:27.000I haven't dug deeply to know exactly what he said and when.
00:10:30.000I can retrace for you some basics, however, about mask wearing early on.
00:10:34.000I actually put it on my Instagram because it was so crazy when he was saying it.
00:10:39.000It was an interview that he did on television and he was saying for the general public, you know, you don't have to wear masks.
00:11:00.000It's advantageous to the wearer and it's advantageous to others.
00:11:04.000It reduces the stress on the system if everyone were to wear masks.
00:11:09.000And just to be very, very clear, it's neighborly.
00:11:12.000Wearing masks is like driving the speed limit or not driving on the opposite side of the road.
00:11:17.000And there's now abundant evidence on the benefits of mask wearing.
00:11:21.000And furthermore, and then I'll come back to your Fauci issue.
00:11:25.000If we were to all as a nation wear masks and adopt some other basic things, it would allow us to keep our economy running better and our schools open.
00:11:34.000In other words, we can't have everything.
00:11:39.000And so we're going to have to grow up and be mature, do some things that are uncomfortable and unpleasant and may even seem silly.
00:11:46.000But if we do those things, we can avoid doing other worse things like shutting down our economy.
00:11:52.000But anyway, Can I stop you for a second there?
00:11:54.000Because this is something that's actually kind of important.
00:11:56.000When people are wearing masks, this is the common argument against it, is that the virus particles are so small, if you're breathing in air and it's getting through gaps in your mask, the virus is going to get through.
00:12:07.000But the impact of having a mask, the positive impact, is that if there is some virus in the air or virus coming from you, it's going to be greatly reduced.
00:12:38.000Well, it's that the water molecules aren't coming down as molecules, they're coming down in droplets.
00:12:43.000So even though the virus is very small, much bigger than a water molecule, but still very small, and you're right that the virus itself could go through the fabric of a mask, that's not what's happening.
00:12:54.000Droplets are coming out of your mouth or are coming from someone else towards you.
00:12:58.000And the mask is extremely effective at stopping droplets.
00:13:02.000But hasn't it been shown that the virus is also aerosol now?
00:13:07.000Yes, so there's also aerosol transmission, and we can talk about that too.
00:13:11.000Obviously, yes, let's talk about that.
00:13:12.000But before we move to that, let's just say one more sentence on the droplets, which is that...
00:13:17.000When you exhale, think about how if you had a fire hose at your house and the water was spraying out of the fire hose and you had two different strategies for stopping the water from landing on the floor of your house.
00:13:32.000One strategy would be to run around with buckets and try to catch the water as it was landing from this arc of the fire hose.
00:13:39.000And another would be to put a kink We're good to go.
00:14:03.000And furthermore, in the case of coronavirus, one of the big problems is people don't know if they're sick.
00:14:58.000What you're talking about is some of the things that you exhale from your body are little dried particles of viruses that are suspended in the air, and these can go a further distance.
00:15:11.000And there is, in fact, evidence of aerosol transmission, which is different than droplets.
00:15:16.000Both go through the air, but droplets are big and fall to the ground, whereas it's like raindrops versus little particles of dust that can float in the air, for instance.
00:15:26.000And so there is aerosol transmission and the masks that we use don't necessarily stop that.
00:15:32.000You'd need like an N95 mask well fitted to stop that, but the masks still help.
00:15:38.000So I don't think there's a really good argument.
00:15:42.000I mean, I wish we didn't have to wear masks.
00:15:44.000I mean, it's unpleasant, but of all the unpleasant things we could choose from doing, if the choice is do I close the schools in my local community, Or do I have everyone wear masks?
00:16:00.000It's pretty straightforward and simple.
00:16:01.000There's a great video online that I saw this morning of a guy who held up a lighter and he used a bandana first and he blew through the bandana and put out the lighter and then he put on a cloth mask and it...
00:16:42.000Yes, although again, I would say that something is better than nothing.
00:16:45.000And one of the things that, one of the things I think is going to come up in our conversation, and we might as well tackle it now, I was trying to think of like, well, I was trying to think of sort of general principles that are relevant here is there's no, in a time of a deadly contagion,
00:17:52.000Or you can wear a mask and it reduces your risk, but it doesn't eliminate your risk.
00:17:58.000And so pretty much everything we do Is not perfect.
00:18:04.000And so we have to begin as a society and as households or as individuals, make decisions about what risks we're willing to tolerate.
00:18:14.000Jamie brought something up this morning that people that had SARS showed that they had immunity to COVID-19.
00:18:25.000Jamie, what were you talking about earlier?
00:18:28.000I might have misunderstood or said that to you, but they were comparing immunity to SARS. They said that they were still carrying important immune cells 17 years after recovery, and they're saying that might be the same sort of thing with coronavirus, that you might have immunity for a long time.
00:18:44.000But there have been people that have been reinfected in as early as three months.
00:18:49.000Yeah, so this is, again, another complicated topic.
00:18:52.000So, yes, we now have some evidence that some people can be reinfected, but it's probably extremely rare.
00:18:58.000We don't know 100%, but it is probably extremely rare.
00:19:02.000And part of the reason is that if you get COVID and they test you, and then three months later you get COVID again and they test you again, they found you.
00:19:12.000And they say, aha, this person had it before and isn't immune.
00:19:16.000But there could be hundreds of thousands of people who also had COVID who were re-exposed and didn't get infected, didn't get symptoms the second time, and so nobody tested them.
00:19:25.000So you see, we only ascertain, we only see the ones that in fact do get re-infected.
00:19:51.000But we do believe that immunity will be sustained, will be reasonably sustained.
00:19:56.000And furthermore, I don't want listeners to confuse the difference between antibody levels declining and your being immune.
00:20:03.000So when your body is infected, you mount a defense, a response, and you produce antibodies.
00:20:09.000And for almost all infections, those just decline over time.
00:20:13.000And in fact, with coronavirus, those circulating antibodies, those proteins that attack the virus, Go down to, you know, very close to zero by about a year, let's say.
00:20:43.000So Jamie was saying with SARS-1, which struck us in 2003, People can find evidence that even 17 years later you can mount an immune response because your body remembers that it fought off this thing 17 years ago.
00:20:57.000And one more thing And that is all different than the question of cross-immunity, which is also becoming now people are – I mean the whole country is getting an immunology lesson.
00:21:13.000I mean it's about time that people recognize that in terms of pandemics, this is – I don't want to diminish the death or the suffering or anything, but it could have been far worse.
00:22:19.000And in fact, the 2003 Coronavirus killed about 10% of the people that got symptoms from it.
00:22:25.000So it was about 10 times as deadly as the one we're facing now.
00:22:29.000Why has there been so little discussion, especially from our governments, our leaders, about methods to strengthen your immune system?
00:22:40.000That has been particularly frustrating to me.
00:22:42.000There's been so little discussion about vitamin supplementation, about changing your diet, about exercise, keeping yourself healthy, making sure you get enough sleep, lowering alcohol consumption, all these things that have been absolutely proven to boost your immune system.
00:23:00.000Not negating the use of masks or social distancing or all the other things that we know are effective, but why has there been no discussion about boosting your immune system?
00:23:13.000I don't know, but it's a really good question you just asked.
00:23:17.000So you're right, there are all these sort of healthy living things you can do from exercising, getting better sleep, reducing stress, losing weight, reducing alcohol and tobacco consumption, all of these things that enhance the ability of your immune system to fight off infection and that has not been part of the public health messaging campaign Yeah,
00:25:15.000There's ways that the government could have done it without shaming people that did get sick.
00:25:21.000I mean, it wouldn't have taken much time to tell people.
00:25:26.000I mean, I've had multiple health experts on this podcast that talk about different methods of strengthening the immune system, particularly supplementation with vitamin D. It seems to be, and Fauci's talked about this as well, seems to be particularly effective with boosting your immune system.
00:25:41.000And also, it's a giant problem with people who wind up in the ICU. There's a recent study that showed that 84% of the people in the ICU with COVID were deficient in vitamin C,
00:26:01.000I haven't followed that particular literature, but As someone who loves the sun, I could strongly endorse getting adequate sun exposure for vitamin D alone.
00:26:14.000Yeah, but you know the sun is the best way to get vitamin D, for sure.
00:26:18.000But the way to get it through the sun requires you to be in shorts and nothing else, like a Neanderthal, running around all day.
00:26:31.000That's really what we're supposed to be doing.
00:26:34.000It's very unfortunate that we figured out houses.
00:26:36.000I mean, it's kept us alive and kept us protected from predators and the elements and all sorts of other things that would have killed us, but it's severely diminished our ability to absorb vitamin D from the sun, and vitamin D being not just a vitamin, but also maybe even possibly mislabeled as a vitamin.
00:26:54.000Well, it can be a precursor to hormones, yes, but I think that, boy, you've wandered into an area that's sort of I'm trying to remember my medical school.
00:27:04.000The last time I thought about vitamin D synthesis.
00:27:07.000But my memory is it doesn't take much sun exposure per day for your body to produce adequate levels of vitamin D. I think an hour a day or something like that.
00:27:19.000That is to say that a lot of the ways we live in the modern world compromise our immune systems and their functioning.
00:27:25.000I think there's very few people that are actually getting their blood work done.
00:27:29.000So even when you say an hour a day give you sufficient levels, how many of these people are actually going an hour a day and then getting blood work done and finding out what the actual vitamin D levels in their blood are?
00:28:10.000And in a way, that's sort of what I'm trying to talk a little bit about with respect to the pandemic as well, which is that We all wish that we didn't have to endure this unpleasant reality that this virus is now afflicting us.
00:28:23.000It's a little bit, and we're all tired, you know, we all have COVID fatigue, but it's a little bit like being in the dentist chair and he's done two root canals and you don't want him to do any more.
00:28:33.000But you're not wanting any more root canals has nothing to do with whether you need them.
00:28:37.000You know, unfortunately, this is the reality that we're facing.
00:28:40.000And so what I really want And what I wanted to do in the book, in Apollo Zero, was to sort of help people to see the world for how it really is now, which is that something big has happened, something that doesn't happen but every 50 or 100 years or so.
00:28:57.000And more importantly, this way the virus has forced us to live, which feels so alien and unnatural to us.
00:29:06.000In fact, this way, it's not new to our species, it's just new to us.
00:29:37.000And, you know, in it, the beginning of it, he talks about famine and plague for most of the first chapter.
00:29:45.000And just the sheer numbers of people that have died in past plagues throughout human history, before antibiotics and before we even understood what viruses were.
00:30:05.000Or smallpox, when the Europeans landed in our continent and they brought with them old world diseases to the new world, smallpox would wipe out Native American populations.
00:30:26.000So we're very fortunate, as we said before, that this is the disease we're dealing with.
00:30:32.000I think in many ways this is going to give us a much better understanding of what could happen and give us a better understanding of what we need to do if something new comes along.
00:31:11.000And usually, if you look at the respiratory pandemics for the last 300 years...
00:31:17.000The inter-pandemic interval is about 10 to 20 years.
00:31:20.000That means we have a pandemic every 10 or 20 years, but they're not deadly, usually.
00:31:25.000So, for example, we had one in 2009, the H1N1 pandemic.
00:31:29.000Most listeners might have a vague memory of hearing about it, but people didn't really pay much attention because it didn't kill many people.
00:31:43.000The SARS-1 pandemic spread to about 30 countries, but for various reasons that pandemic extinguished and we only had about 8000 people worldwide who died of that.
00:31:56.000The last serious pandemic we had of influenza A virus, it's a different virus than the coronavirus, was in 1957. That was the second worst pandemic we've had in 100 years.
00:32:06.000And the previous leading killer was, of course, the 1918, the so-called Spanish flu pandemic.
00:32:12.000And the current pandemic we're having will be almost as bad as that in the sense that Just to be clear to listeners, it's not going to kill tens of millions like that pandemic killed, we don't think.
00:32:23.000But the point is, the current pandemic we have is the second worst that we have had in 100 years.
00:32:28.000Worse than the 57, which was the previous second worst.
00:32:32.000So pandemics come every 10 or 20 years.
00:32:36.000They're only really bad, let's say, every 50 or 100 years.
00:32:39.000But there's no reason that we couldn't have another one Soon, you know.
00:32:44.000And in fact, right now, there's surveillance systems in place in China which monitor the emergence of new influenza strains.
00:32:51.000And there was just a paper published a couple of months ago suggesting there's a serious strain of influenza brewing.
00:33:57.000So we have some sense of some of the reasons it varies, but not a huge understanding yet of the interpersonal variation.
00:34:06.000But I would like to go on a tangent based on that that highlights the ways in which these kind of protean manifestations of this disease, the fact that With this condition, you can go from everything from having no symptoms to mild symptoms like Jamie to more serious symptoms like your 28-year-old friend to really severe symptoms to being hospitalized to dying,
00:34:32.000There's this incredible range of symptoms.
00:34:37.000And in a way, this is very unfortunate for us because it makes it so much harder as a society to take the virus seriously and to combat it.
00:35:22.00010 of them once again get serious illness, like in world A. And one of them dies, again like in world A. So in this world, in world B, 100 people got sick and one died.
00:35:36.000In world A, 10% of the people that got sick died.
00:35:39.000In world B, 1% of the people that got sick died.
00:35:42.000Now many people hearing about this might think that it's better to be in world B because, you know, it seems like the virus is less deadly.
00:35:54.000Because if you stop and you think about it a little bit more clearly, World B is the same as World A, plus an extra 90 people got mild illness.
00:36:04.000In other words, no right-thinking person should prefer to be in World B than to be in World A. Ten out of a thousand people got seriously ill and one died.
00:37:11.000It also has this property of being transmissible when it's asymptomatic.
00:37:15.000So just to remind people, HIV is like that.
00:37:19.000You can have HIV for years and not know it.
00:37:21.000You're spreading it to your sexual partners and then it kills you much later.
00:37:25.000Versus smallpox, which you can't really spread smallpox before you have symptoms.
00:37:31.000The pustules erupt on your body and that's when you become infectious.
00:37:35.000So there's no asymptomatic transmission in smallpox, and there is in HIV. And SARS-1 from 2003 was more like smallpox.
00:37:47.000In other words, people didn't begin to transmit the virus until they actually had symptoms from it, which is one of the reasons it was easier to control, because when people got symptoms, we could isolate them.
00:37:56.000Whereas with the SARS that we're facing now, the SARS-CoV-2, COVID-19, People can transmit it when they're not symptomatic.
00:38:05.000And in fact, there's a lot of analyses that have been done that show about 75% of the infections have been acquired from people who are asymptomatic.
00:38:14.000There's another issue as well that we can compare to smallpox in that you can develop a vaccine for smallpox that actually works for your whole life.
00:38:23.000You can't really do that with COVID, correct?
00:38:32.000I'm hopeful that we'll be able to have a vaccine that confers long-term immunity, but I don't think we know that either way for sure.
00:38:40.000Can you describe what's going on with these mRNA vaccines and how they differ from a regular vaccine and what's coming down the pipe from Pfizer?
00:38:55.000It's different in that it doesn't actually contain the virus, but it boosts your body's ability to fight off the virus.
00:39:02.000Yeah, so there are many different ways of developing vaccines.
00:39:09.000And the general idea behind a vaccine is that we want to give you kind of an ersatz infection.
00:39:15.000We want to expose you, make it as if you had been infected, but without the risk of getting the disease, to trick your immune system into mounting an immune response so that your body is then prepared, if it gets the real infection, to fight it off.
00:39:30.000And one of the simplest ways you can think about it is so-called live attenuated virus.
00:39:37.000This is an old technology where you take the virus to the laboratory, you culture it hundreds of times and hope for mutations that weaken the virus's ability to make you sick, but nevertheless keep the virus able to elicit an immune response.
00:39:52.000And then we give you that strain as a shot.
00:39:56.000And you have, let's say, a mild illness, you develop antibodies and immunity, and it's sustained.
00:40:01.000Or you can have inactivated virus, like one of the Chinese, the Sinovac vaccine that was one of the first to start, which was out of China, is a live attenuated virus.
00:40:18.000But anyway, the Sinovac vaccine is a virus in which they take the virus.
00:40:23.000I'm sorry, no, it's not like the previous example.
00:40:25.000In this case, we take the virus and we treat it, let's say, with heat or with chemicals to kill the virus, but still have it be immunogenic.
00:40:36.000And there are many other approaches, a dozen or so, or nine or 10 different approaches, one of which is this mRNA idea.
00:40:43.000And here, what is done is I'm sorry, before I tell you about that, another approach might be to take Take the RNA from the coronavirus that codes for a very important protein, the spike protein on the surface of the coronavirus,
00:40:59.000and insert that into a really benign virus, let's say like a cold virus, for example.
00:41:04.000So we take this other species of virus, we genetically engineer it so that we insert some material, some RNA into it, let's say, that forces that virus, when it infects your cells, To give you a common cold, but also to express this protein as if you had been infected with COVID or coronavirus.
00:41:25.000And then you mount an immune system to that immune response to that protein, and now you're immune.
00:41:30.000So we gave you like a mild illness and we protected you from a more serious one.
00:41:35.000The mRNA vaccines are sort of like that.
00:41:38.000We inject you literally with RNA, and the idea is that your cells take up the RNA and start making the protein, the alien protein, that your body would have made.
00:41:51.000Like if we had infected you with a real coronavirus, the real coronavirus, as many people remember from high school biology, The virus can't reproduce on its own.
00:42:01.000It inserts its genetic material into our cells, which then start producing the virus itself.
00:42:08.000But now, in a sense, instead of giving you the whole virus, we give you a little part of it, just some part of its genetic material, the mRNA, which in an ideal world does the same thing, gets inserted into your cells.
00:42:19.000You start expressing this protein, which then your body attacks, and you develop an immune response to it.
00:42:26.000And we are We're amazingly lucky that our scientists have been able to develop not one, but two different vaccines.
00:42:34.000And we'll have many other vaccines using different modalities, I have no doubt, that come out in the next year or two.
00:42:40.000But the Moderna and the Pfizer vaccines, we're very lucky that they exist and that they are apparently quite effective.
00:42:50.000I don't know if you want to talk about that.
00:42:52.000It's good news, but I don't want people to get over-optimistic either, because it's my job to be a bit of a downer.
00:42:59.000Well, this is the unfortunate narrative that people keep saying.
00:43:05.000The virus is killing, it's like the average immune system is 99 point whatever percent effective in protecting you from the virus, meaning 99 point whatever percent of the people who get the virus survive.
00:43:22.000No, 99 percent of people overall survive.
00:44:03.000We have to have a way of ascertaining who's infected.
00:44:06.000And then we have to have a way of ascertaining of those how many die.
00:44:10.000And that's called the infection fatality rate.
00:44:14.000And there was just a recent meta-analysis looking at very good data from around the world, multiple studies using different approaches that estimated that the infection fatality rate is between 0.5% and 0.8%.
00:44:27.000And there's something called the case fatality rate is the fraction of people who have symptoms when infected who die.
00:44:36.000So about half the people get the virus and have no symptoms at all.
00:44:40.000So if you get symptoms, you have a higher risk of death.
00:44:43.000And so you can double 0.5 to 0.8 becomes 1 to 1.6% of people who develop symptoms from the disease die.
00:44:53.000And there was another very good study that was just released a couple of weeks ago that estimated the infection fatality rate to be about 1%.
00:45:01.000So there's a lot of little numbers I've thrown out at you, but the gist is...
00:45:07.000Yeah, but even without symptoms, the infection fatality rate is certainly not less than half a percent and could be as high as 1%.
00:45:13.000I would say it's going to be in that range, the IFR, the infection fatality rate.
00:45:18.000Isn't there a large percentage of people that get it that don't have symptoms?
00:45:44.000But the point being that, unfortunately, a lot of people are saying this vaccine is 94% effective or 90% effective, depending on who you ask.
00:45:57.000Yeah, but what that means is that if it reduces your risk of death by that fraction.
00:46:04.000So, for example, in the vaccine trial, in the Pfizer trial, these numbers are approximate.
00:46:12.000They had about 43,000 people in the trial.
00:46:15.000Half of them got the vaccine, half of them did not.
00:46:19.000And in the people who got the vaccine, nine people, up to nine, let's say nine or ten, got Even though they were vaccinated, still got coronavirus, still had the disease.
00:46:32.000And in the arm that did not get the vaccine, the other 20,000 people, let's say 90 people approximately got coronavirus.
00:46:42.000So what the vaccine did is it reduced your probability of getting the disease from 90 out of 20,000 people over the time window of the study to 10 out of 20,000 people.
00:46:54.000So the point here is that the vaccine is reducing your risk of getting seriously ill if you're infected.
00:47:01.000And you're certainly better off In other words, you would have had, let's say, a 1% chance of dying before, and now you have a 0.1% chance of dying, 90% lower than that because we've given you the vaccine.
00:47:18.000I understand exactly what you're saying.
00:47:20.000What I'm trying to say is there's an unfortunate narrative where people are saying, I'm not going to take a vaccine because the human immune system is more effective than the vaccine.
00:47:37.000Well, no, I'm saying the whole way vaccines work is it enhances your performance.
00:47:45.000It stimulates your immune system to make it even better at fighting the virus.
00:47:50.000There's no sense in which you could argue that An unchallenged immune system is superior to a challenged immune system, a system that has been given a vaccine.
00:48:01.000This is what's important to tell people, right?
00:48:03.000Because this narrative of 99% of the people who get it, 99 point whatever, your immune system is effective in fighting off this disease, right?
00:48:14.000Whereas with the virus, it's only 90 plus whatever percent effective in preventing the virus.
00:48:21.000So that's not a good narrative, correct?
00:48:25.000And the way to think about it is, just to pick some round numbers, as you were saying, and like me, you sometimes use the word virus when you mean vaccine, and you use the word vaccine when you mean virus.
00:49:07.000When you talk about the people that took the vaccine, and we know you have the data between the difference of the vaccine and the people that got the placebo, the people that got the vaccine that still wound up getting COVID, did they do health screens on these people and find out what comorbidity factors they may have had and see if there's anything that would indicate that there's particular risks?
00:49:34.000And also, what we don't know, so we don't know the answer to that, but we will know.
00:49:38.000And also what we don't know yet is we don't know how safe the vaccine is.
00:49:42.000So first of all, just to be very clear, both Pfizer and Moderna have released interim results.
00:49:47.000And we have every reason to believe that the final efficacy results will be about the same.
00:49:51.000So as they complete the trial in the coming month or two, and more people get sick in both arms, we don't expect suddenly The vaccine not to work.
00:49:59.000I mean, we've gotten to a point where we're pretty sure that the vaccine will be effective.
00:50:05.000But we don't yet know the safety of the vaccine is another thing we don't know.
00:50:08.000And we also don't know something else.
00:50:10.000It's very important for people to understand.
00:50:12.000Again, and since everyone needs to be an immunologist now, imagine that you're doing a trial and you're trying to see whether a vaccine works or not.
00:50:23.000You have to define what counts as works, what counts as an endpoint.
00:50:26.000So let me give you three possibilities.
00:50:29.000One possibility is we're going to measure, does the vaccine prevent you from even getting infected?
00:50:34.000Or do we say, the vaccine's not going to be able to stop you from getting infected, the virus is going to take root in your body, but the vaccine is going to prevent the virus from making you seriously ill.
00:50:46.000Or do we say, actually the outcome we really care about is death.
00:50:50.000Does the virus reduce your probability of death?
00:50:53.000So it's possible that the vaccine, for example, What if in both arms one person died?
00:51:18.000One out of the 10 in the vaccine arm died, and one out of the 90 in the other arm died.
00:51:24.000We would say that the vaccine was effective at lowering your probability of getting ill, which is great, but it had no effect on dying.
00:51:34.000It's possible that the vaccine will work at different levels The Pfizer trial revealed that there was a greatly reduced probability of people getting infected.
00:51:50.000The Moderna trial actually showed that its vaccine reduced the probability of people getting seriously ill, which is great, but it might in fact have no effect on mortality still.
00:52:01.000Furthermore, we also don't know whether this vaccine, even if it works, Even if it works to reduce your probability of getting sick or dying, whether it works to reduce your ability to infect other people.
00:52:17.000So maybe we start vaccinating the population, we're reducing the individual recipient's probability of getting sick, but they still can spread the disease.
00:52:27.000So this is something else that's not known.
00:52:29.000So we don't know the safety, we don't know which outcomes are really being affected, and we don't know if it affects infectiousness.
00:52:35.000And all of these things are things we will soon learn in the coming year.
00:53:13.000It's just this is a complicated topic.
00:53:14.000And there's, you know, all I've been thinking about is coronavirus for the last 10 months.
00:53:17.000I mean, there's just so much stuff in my mind about this thing that, oh, I remember because I thought I was wanted to talk to you about this.
00:53:25.000So I want people to also begin to think about who should we give the vaccine to?
00:53:30.000Like, what are the ethical and public health We're good to go.
00:53:58.000They clearly should get first dibs on the actual effective drug that's now been shown to be effective because of their contributions.
00:54:06.000Then, pretty uncontroversial, is that the next group of people to get it should be doctors, nurses, firemen, policemen, first responders, ambulance drivers, all of those people, healthcare workers.
00:54:17.000Those people, because they're putting themselves in harm's way during a contagious disease to protect the rest of us, they should be next.
00:54:28.000And here it gets very tricky, both ethically and from a public health point of view.
00:54:34.000And let me give you an example of this.
00:54:38.000So on the one hand, you might say we should vaccinate, let's say, vulnerable elderly people or people with chronic illnesses.
00:54:45.000They have the greatest chance of dying if they get infected.
00:54:48.000We should give the first 10 or 20 million doses should go to elderly people in nursing homes.
00:54:54.000And there's a lot of compelling reason to do that.
00:55:06.000It actually might make more sense and we might save more lives from a public health point of view if we vaccinated working age people, people who are out and about.
00:55:16.000Because if I vaccinate you and I, by virtue of making you immune, stop you from transmitting the disease to other people since you're out and about and seeing lots of other people, I might actually wind up saving more lives, paradoxically, by vaccinating the people at lowest risk.
00:55:37.000So that's – and our nation is going to face this dilemma very soon, in fact.
00:55:42.000Because when the initial – of course, if we had 300 million doses, we wouldn't have to make these choices.
00:55:46.000We could just give everyone the shot who wanted it.
00:55:48.000And incidentally, the cold chain requirements for this – this is another topic now, tangent on a tangent – Many rural parts of our country simply don't have the kind of refrigerators that are needed to stockpile and administer these vaccines.
00:56:05.000What kind of refrigerators are needed for these vaccines?
00:56:08.000Well, the Pfizer one needs a minus 80 refrigerator.
00:56:13.000These aren't common, like below dry ice cold.
00:56:16.000And so not every pharmacy, your local CVS or Walgreens doesn't have Usually this type of refrigeration.
00:56:24.000And plus all the trucks transporting it, like from the moment that the vaccine is manufactured till the moment it's injected, it has to be, many vaccines, not all vaccines, have to be in what is known as the cold chain.
00:56:41.000And building the logistics to distribute the vaccine is a big, big challenge.
00:56:46.000So not only do we have to invent a vaccine like we are, which is magnificent, but That our nation is able to do that.
00:56:53.000But we have to manufacture it, which is not easy.
00:56:56.000You know, we need little glass vials, we need millions of them, and we need factories that can produce this particular kind of vaccine, etc.
00:57:03.000We need to distribute it, like the cold chain, the refrigeration I mentioned.
00:57:08.000And most important, we need to persuade people to accept the vaccine.
00:57:13.000And this touches on what we were discussing earlier, whether people will believe that the vaccine is useful.
00:57:17.000And of course, we have an anti-vax population in our country and so on.
00:57:21.000So all of these challenges have to be overcome.
00:57:24.000So if we had 300 million doses of the vaccine, this would be less of a dilemma.
00:57:28.000But initially, we're not going to have that.
00:57:30.000We're going to have some lower number of doses, and those doses will be more easily administered in metropolitan areas that have the right refrigerators.
00:57:38.000So we as a nation are going to need to begin to think about this, about how to That's very complicated.
00:57:48.000Now, the difference between the Pfizer and the Moderna vaccine is what?
00:57:54.000Well, as I'm told, and I'm no expert on this narrow topic, that the Moderna vaccine actually doesn't require as cold refrigeration.
00:58:04.000For reasons that I don't understand, since they're both RNA vaccines, they both are encased in lipids.
00:58:36.000Is there any benefit in getting vaccinated with both vaccines?
00:58:40.000I doubt that because they're very similar in approach, but I can imagine that the time will come when there might be some benefit in getting two complementary vaccines, when we have developed still more approaches, as we were talking about earlier, when you can get this and also that.
00:58:55.000Now, it's also possible—I mean, we just don't know the answers to all these questions.
00:59:00.000It's also possible—so some significant fraction of people who die of coronavirus die because of their own body over-response to it.
00:59:10.000Their immune system is too dramatic, too dramatically responds.
00:59:15.000And it's possible that— That we may not want to give people multiple versions, different kinds of vaccines because we might overexcite their immune system in a way that actually harms them in some way.
00:59:28.000So these things are all going to be sorted out in the coming year.
00:59:34.000I just don't want people to think it's all simple because it's not.
00:59:39.000Now, Donald Trump is 74. He's overweight and eats cheeseburgers every day.
00:59:43.000When a guy like that catches COVID and is fine in four days, people get very dismissive of it, unfortunately.
00:59:55.000What kind of treatment did he receive?
00:59:57.000And how different is it than what the average person would receive if they got sick?
01:00:02.000So he faced a very significant risk of death, and I think he got lucky.
01:00:07.000So remember, his doctors put him on dexamethasone.
01:00:11.000So, so far, we only have one proven drug that lowers your risk of death if you're seriously ill from COVID, and that's a very simple steroid called dexamethasone.
01:00:23.000Remdesivir has not been shown to lower mortality.
01:00:27.000It has been shown to lower your length of hospital stay, so there's some benefit to it, but it doesn't appear to lower your risk of death.
01:00:34.000What would be the difference between lowering your risk of hospital stay and lowering your risk of death?
01:00:39.000Why would they let you out of the hospital if you hadn't shown significant health improvements?
01:00:44.000And wouldn't significant health improvements signify that your body's recovering better?
01:00:52.000Yeah, it's a mystery and it's confusing.
01:00:54.000And when the first remdesivir trial was published a few months ago, it didn't show a benefit for mortality, but it showed a trend.
01:01:02.000It looked like it would help and it made sense.
01:01:04.000Like if it's lowering your hospital duration, probably it's good for you and it'll also lower your risk of death.
01:01:09.000But then another trial came out, much bigger trial, as part of the, I think it was called the Solidarity Consortium, either the Solidarity or the Recovery, I can't remember right now, consortium out of England.
01:01:20.000Which showed that actually remdesivir had no benefit for mortality.
01:01:26.000Imagine that you have 100 people who are sick, and in the group that gets remdesivir, they only wind up spending an average of 10 days in the hospital, but 10 of the people die.
01:01:39.000And in the other study, the people that did not get remdesivir, 100 people get sick, and they spend an average of 12 days in the hospital, but again, 10 of them die.
01:01:49.000So the remdesivir has lowered the hospital duration from 12 to 10 days, but it hasn't affected the probability of people dying.
01:01:57.000And that is in fact what appears to have happened.
01:02:00.000And this was a study, you said, that was in England?
01:02:04.000Yes, it was a large study that was – I think the subjects were not just in England.
01:02:09.000It was organized by a group of English scientists, either the Solidarity or the Recovery Consortium.
01:02:14.000And I just don't remember right now the name of it.
01:02:16.000But I want to go back to your question about the president.
01:02:19.000So the president was given dexamethasone.
01:02:22.000And when that happened, I stated publicly that either the president was sicker than they were telling us.
01:02:31.000So he was sufficiently sick that they – Wanted to give him dexamethasone because giving dexamethasone early in the course of the disease before you're very sick actually can harm you.
01:02:42.000So you don't want to give it to someone at the beginning of their disease.
01:02:44.000You need to wait until they're sufficiently sick and then it helps you.
01:02:49.000So either he was sicker than they told us and so they were lying to us or he really needed the dexamethasone in which case he faced a significant risk of death.
01:02:59.000So people in the trials that showed that the dexamethasone worked 74-year-old overweight people, men, and men are at much greater risk of dying than women of this condition, who got the dexamethasone, they had about a 20% chance of death.
01:03:14.000So I think the president actually faced a 20% chance of death when he was at the hospital, which is a big risk of death.
01:04:16.000I meant the treatment, the overall treatment.
01:04:19.000Whatever they gave him when he was in the hospital, the response was for a 74-year-old guy to be back on the campaign trail with this rigorous campaign that he was doing four or five days later, pretty damn impressive.
01:05:28.000If you and I were in the hospital with COVID and we told our doctors, you know, I just want to go for a drive around the block right now and let me go to the hospital, I mean, they would say no, you know, that would not be an okay thing to do.
01:05:46.000I mean, I think one of the things – and I make this argument in Apollo Zero – One of the things that's very interesting to me about plagues, earlier you talked about how plagues were one of the four horsemen of the apocalypse,
01:06:11.000And in a way, you would even say that lies and denial, since they've occurred for thousands of years, whenever there's an outbreak, people have always developed superstitions.
01:06:21.000They've wanted to deny what's happening.
01:06:52.000And his whole hydroxychloroquine story, there was no evidence that this drug would work, but, you know, he was like a snake oil salesman selling it.
01:07:01.000And you could even make the argument that It is the perfection of our democracy.
01:07:07.000It's the fact that we have a democratic system that allows us the popular will to be reflected in the leaders that we elect so that if the people wish to be lied to, they will elect a liar.
01:07:22.000There was a lot of people that did believe that hydroxychloroquine at the time had some positive benefits, including my doctor, who is not a Donald Trump supporter.
01:08:54.000Yeah, so this is what I would like to say.
01:08:58.000And I set it up by saying, you know, it's a reflection of the perfection of our democracy that we are able to get the public will reflected in our leaders.
01:09:08.000And if the public will is to, as I said, have someone who tells you only good news and doesn't tell you bad news, we're going to get that.
01:09:14.000But I don't think that lets the leaders off the hook.
01:09:16.000And actually, before I explain that, let me just go back and say it's also true that many other leaders in other European nations, like in Italy or in England, So it's not the case that only Trump singularly botched the response.
01:09:30.000Now, there were leaders in South Korea, in New Zealand, even in Greece, you know, who had a successful response.
01:09:38.000But my point is, We're the United States of America.
01:10:03.000So I absolutely do fault him for flubbing this.
01:10:09.000But I also think the American people need to take some responsibility and need to sort of Man up, you know, and recognize that the world has changed.
01:10:18.000There's some serious stuff that's going on.
01:10:21.000And we have to do better in how we confront this threat.
01:10:27.000We can't be like children pretending that it's not there or fantasizing that it'll just miraculously go away.
01:10:42.000At the beginning of the end of this pandemic, we are just at the end of the beginning.
01:10:48.000And just to set the stage a little bit, here's what I think is going to happen.
01:10:53.000So it's great that the vaccine has been invented, and we'll have several of them.
01:10:57.000But as we've discussed, there are going to be some problems and challenges in manufacturing it and distributing it and persuading large numbers of people to get it and so on.
01:11:05.000And that's going to take time, let's say a year.
01:11:08.000So let's say the vaccine is approved In a couple of months, the beginning of 2021, I think we're going to spend all of 2021 doing all that other stuff, distributing the vaccine and so on.
01:11:18.000Meanwhile, the virus is still spreading.
01:11:21.000And right now, probably about 12% of Americans have been infected with the virus.
01:11:26.000In the end, for various calculations and reasons, probably about 50% need to be infected.
01:11:33.000The final attack rate probably needs to be about 50% before we reach this threshold known as herd immunity.
01:11:39.000So we're about a quarter of the way there, let's say.
01:11:41.000So the virus is going to keep spreading.
01:11:45.000And while we're doing all that other stuff, so either way, I think we get to 2022 before we've reached herd immunity, either naturally, because the virus has finally attacked that many people, or artificially, because we immunize that many people.
01:12:00.000So at that point, just to be clear, the virus isn't gone.
01:12:04.000It's still circulating, but it's epidemic epidemic.
01:12:07.000It's epidemic capacity now has been neutered, and the virus will be so-called endemic when we reach the herd immunity threshold, either by vaccines or naturally.
01:12:36.000This is going to be the world we're in for the next year or so.
01:12:41.000And then we'll get to the point where we have herd immunity one way or the other.
01:12:45.000But then you see we have to recover From the psychological, social, and economic shock.
01:12:53.000You know, let's not forget tens of millions of Americans are out of work.
01:12:57.000Many small businesses have gone out of business.
01:13:00.000We have sort of a reshaping of our economy in all kinds of radical ways.
01:13:05.000And it's going to take a while for that to unwind.
01:13:07.000Also, a lot of people are going to be disabled by this condition.
01:13:10.000So far we've been talking about death.
01:13:12.000Probably five times as many people will be disabled, will have some form of long-term disability, renal, cardiac, neurological, or pulmonary.
01:13:21.000So if we have, let's say, half a million Americans, for sure half a million Americans will die of this condition, maybe as many as a million.
01:13:27.000In the end, by the time the pandemic is over, it's going to be a number in that range.
01:13:32.000Whatever that number is, about five times as many will be disabled.
01:13:35.000So let's say half a million Americans die.
01:13:37.000We're going to have two and a half million Americans with some form of disability.
01:13:39.000We're going to have to cope with that as well.
01:13:42.000So if you look at the history of epidemic disease, it's going to take a year or two to recover from that.
01:13:49.000So I think it's 2024. Before we really begin to enter the post-pandemic period, when life will return approximately to normal with some persistent changes in our society.
01:14:03.000And I'll say one more thing and then I'll shut up.
01:14:06.000If you look at the history of previous pandemics, what typically happens is during the time of the germ hitting the society, people get more religious.
01:14:51.000One person, Neil Ferguson, actually, who kindly reviewed the book in the Times Literary Supplement, when he read this description, he goes, you know, here's hoping that this is what it'll be like.
01:15:02.000So I think come 2024, late 2023, that period, we're going to have like the roaring 20s again.
01:15:09.000When our society is going to really be unleashed from this shock that we are experiencing.
01:15:36.000Can be done to mitigate the economic impact and what what states do you think are doing it right versus what states you think are doing it wrong?
01:15:44.000It seems to me that one of the big problems that people are having with this pandemic is all of a sudden governors and mayors have these powers that they never had before and they don't seem to totally make sense like they're allowing people to have mass protests We're good to go.
01:16:22.000And this is right after the governor got caught going to a restaurant with a bunch of other people doing things that he specifically told people not to do.
01:16:32.000This is a problem that people have with the power that government has now assumed.
01:16:38.000And the real concern that many people have, myself included, is that we're never going to see them give that up.
01:16:46.000Is that the power that they have now to tell people to stay home, don't work, shut down schools, shut down gyms, shut down restaurants, that they're not going to let that go.
01:16:55.000People enjoy using power, and especially if they have a legitimate good cause for it like we do here in the pandemic.
01:17:06.000So I share your concerns, and I understand what you're saying, and there are many components to what you just said.
01:17:15.000Even during the bubonic plague in England, when the government wasn't ordering restaurants to close, the economy still collapsed.
01:17:25.000So we have to draw a distinction between what the germ is doing to us and our economy and what it would have done regardless of what government did.
01:17:54.000All right, well, I believe you on that.
01:17:55.000I don't know what's happening in Austin, but I don't think that the economy would necessarily be less fucked if the government took no action.
01:18:05.000In fact, the principle, the ideal principle at least, is that by the government acting, we can protect the economy.
01:18:12.000So for example, if the government were able to effectively force people to wear masks, and if everyone wore masks, I think we're good to go.
01:18:41.000You grabbing your gun and going to the frontier, it's useless, right?
01:19:07.000We save our skins by working together to repulse the invader.
01:19:12.000And in an ideal world, that's what government would do for us.
01:19:14.000It is an expression of the collective will for collective self-preservation.
01:19:21.000So I just want to, first of all, draw the distinction between what the virus did to us versus what we're doing to ourselves, which we seem to agree on.
01:19:26.000Now, the hypocrisy of our leaders, and then I'll come to the power issue.
01:19:30.000The hypocrisy is really worrisome to me.
01:20:21.000And also in Idaho and other parts of the northern part of our country right now.
01:20:27.000It's in the nature of exponential growth to be deceived.
01:20:31.000Exponential growth is not an intuitive concept.
01:20:33.000So when experts say the shit is going to hit the fan in a few weeks or it's really bad right now, The man on the street goes out or the woman on the street goes out and looks around and says, nothing is happening.
01:20:48.000And it seems like the expert is lying.
01:20:51.000But what happens with exponential growth is, you know, one becomes two, becomes four, becomes eight, becomes 16. It looks like nothing has happened.
01:20:58.000It becomes 32, becomes 64 cases or deaths.
01:21:11.000And by that time, by the time that explosion takes place, it's too late.
01:21:15.000And this is why leadership is so important and why we as a people need to try to elect or empower individuals who are honest with us, who are not hypocrites, who act according to their prescriptions, and who tell us the plain truth of what it is that we're facing.
01:21:30.000Because we are going to have to work together to get the best of this virus.
01:21:34.000What is happening in South Dakota and North Dakota?
01:22:43.000Having said that, however, It is also the case that different states are different.
01:22:48.000You know, the population density in New York City is completely different than the population density in Vermont or in North Dakota.
01:22:54.000And I can understand why people that live in rural states might say, well, we have one advantage, which they do have, you know, being less dense, the population density being lower.
01:23:02.000But that doesn't mean you can just count on that advantage and do nothing else.
01:23:38.000But if you add another piece of Swiss cheese where the holes are randomly positioned, Maybe there's only a couple of gaps left after that second piece of Swiss cheese where a couple of holes happen to line up, and then you add a third or a fourth slice, and by the fourth line of defense, there are no holes left to penetrate all four layers of Swiss cheese.
01:23:56.000This is what we need to do as a nation.
01:23:58.000Any one layer of defense is not enough.
01:24:03.000But the good news is, first, if we have enough layers, We don't necessarily need any more after that.
01:24:09.000So for example, if let's say we wear masks, we physical distance, we ban gatherings and we have testing, maybe that means we don't have to close schools because they don't add anything else.
01:24:21.000Adding another piece of cheese as the fifth layer is not necessary.
01:24:26.000And furthermore, this is what happened at the White House.
01:24:28.000They relied on one layer, which was testing.
01:24:56.000So if they're not asking him, if he's not answering that question, there's only one reason, because he doesn't want to lie, because he knows other people know.
01:25:04.000So he knows he's got an inner circle that is a little...
01:25:34.000Well, he's also using a rapid antigen test, correct?
01:25:37.000He's using the test where they're doing the nasal swab or the saliva test.
01:25:45.000I don't know exactly what testing methodology was in use at the White House, but what I suspect happened is He got infected from someone else.
01:25:54.000And then I think, and this is just rank speculation, I think he was the point source after that.
01:25:58.000Because if you look at the network pattern of who got the disease, including the person, the Coast Guard officer that was carrying the nuclear football who got infected.
01:26:07.000By the way, this is, just to be clear, it's, in my view, the height of irresponsibility to be so lax.
01:26:12.000The fact that our leadership was infected, including even the person holding the nuclear football, this is irresponsible, right?
01:26:18.000I mean, we should do, I expect more from the White House.
01:26:23.000If you look at the pattern of people, if you map out the network of who got infected, I think he was the common denominator for a lot of the infections.
01:26:59.000Apparently now has COVID. And one of the things that he was talking about is how two tests came back positive and two tests came back negative.
01:27:07.000And a lot of people are criticizing him about this on Twitter, complaining about it without researching the nature of these tests themselves.
01:27:15.000And that the issue being that these tests are not that effective if you have a very mild case of the virus or if you barely have any in your system.
01:27:27.000And that they might show positive and negative in the same day.
01:27:33.000I don't know the details of Elon Musk's testing.
01:27:35.000I have to imagine that Elon Musk has good testing.
01:27:38.000So I was surprised by his description.
01:27:40.000And I don't believe he released information on whether he was having PCR tests for the virus or antibody tests for immunity.
01:28:09.000I'm 99% sure because he was actually then questioning the effectiveness of PCR. Now, here's something that I wanted to discuss with you because I got confused about it.
01:28:20.000Someone was saying that with PCR tests, when you get to a certain number of tests, then it becomes problematic.
01:28:29.000Like an individual, an individual having a certain number of PCR tests.
01:28:35.000There's no way I can think of that would be the case.
01:28:38.000I mean, what the difference is, the PCR test is a test of saliva or nasal secretions for the virus.
01:28:50.000And typically after you recover, you don't shed the virus anymore.
01:28:55.000Now you can test positive for a while afterwards because you might still have some RNA from the virus in your system, but you're not infectious.
01:29:01.000So you can test positive, but you can't infect anyone else.
01:29:05.000But usually, after a number of weeks, you no longer test positive and that's done with.
01:29:10.000The antibody test is a test of your body's response to the virus, the proteins that you produce to fight the virus.
01:29:17.000Usually you take that from blood, but people have now developed saliva antibody tests, which is much more convenient.
01:29:25.000And those will be positive for a number of weeks or months, as we were discussing earlier.
01:29:29.000And there are two different kinds of antibodies.
01:29:31.000Actually, there are more than two, but there's a so-called IgM and IgG.
01:29:34.000The IgM spikes within two or three days, and some tests can detect that, very sensitive, and the IgG almost immediately afterwards.
01:29:42.000And you can use antibody tests to detect as your body is fighting off the virus.
01:29:48.000These are two different kinds of tests.
01:29:51.000The saliva test, this is something that I've heard of but I've never seen implemented.
01:30:18.000Yeah, they're different things and they're different tests.
01:30:20.000And the saliva is, of course, much easier for all of us than having blood drawn or having someone put a Q-tip in our nose.
01:30:26.000So people are scrambling and have developed saliva tests both for the virus and for the antibodies to the virus now, which is, again, great news.
01:30:34.000Incidentally, just to be clear to people, why did the nation make a sacrifice of flattening the curve?
01:31:19.000So all of these things have happened in the last nine months.
01:31:22.000This is why we did the sacrifices we did last spring.
01:31:27.000And incidentally, this is why further sacrifices might be called from us.
01:31:32.000If we continue to behave well, We might be able to spare a lot of deaths because then we'll have really good vaccines that have been shown to work.
01:31:42.000We'll have more medicines to treat the sick people.
01:33:06.000A lot of different things are doing it.
01:33:09.000The existence of a second wave right now is completely unsurprising to anyone that studies respiratory pandemics.
01:33:18.000I'm unfamiliar with a respiratory pandemic in the last hundred years that hasn't had multiple waves.
01:33:24.000Incidentally, I'm telling you now, maybe you'll have me back on the show in a year, There'll be a third wave.
01:33:29.000A year from now, there'll be a third wave, and actually probably a fourth wave, too.
01:33:32.000The amplitude of that wave, if we have a vaccine, will be lower, but we'll still have a blip up in cases a year from now, winter, compared to eight months from now, summer.
01:33:43.000So, respiratory pandemics come in waves, and they do that for a number of reasons.
01:34:21.000They have more close contact with each other.
01:34:23.000It's easier for respiratory pathogens to spread indoors than outdoors, as everyone knows by now.
01:34:29.000So human behavior changes in the winter.
01:34:31.000And this is why, incidentally, The germ typically goes to the southern hemisphere for its winter while we're having summer and then comes back north when our winter comes.
01:34:41.000Furthermore, there's physical and physiologic reasons.
01:34:47.000So the dryness of the air and the coldness of the air may facilitate the dispersion of the virus.
01:34:56.000And our bodies, our immune systems, as you were discussing earlier, may function differently in the summer and in the winter.
01:35:03.000So for a host of many reasons, it is very standard that respiratory diseases have this scalloping sinusoidal pattern up higher in the winter and then lower in the summer.
01:35:14.000So there's nothing surprising about what's happening right now.
01:35:17.000The one big unknown is how bad will the pandemic be now?
01:35:25.000In the 1918 pandemic, the second wave was four times as deadly as the first wave.
01:35:32.000And the question in many experts' minds right now is, is this COVID-19 pandemic, this second wave that America is beginning to experience now, will it be as deadly as the first wave or more deadly?
01:35:44.000And I fear that it will be more deadly.
01:35:48.000And, you know, over a thousand Americans are dying every day of this condition, every single day, day after day.
01:35:54.000And that number is likely to go up unless we really get our act together.
01:35:59.000And even when we do get our act together, it'll take about three weeks before we see the deaths plateauing and then beginning to decline.
01:36:06.000So we're going to have thousands and thousands of deaths, like a battleship turning.
01:36:10.000Like, even if we start to make the turn, it's going to take many miles before the battleship turns.
01:36:17.000And so I think, you know, we're gonna have, it's gonna be bad, unfortunately.
01:36:22.000I think many, many Americans are gonna die.
01:36:25.000And again, this is not diminishing the impact of the disease or the fact that it's a dangerous disease, but one of the things that the CDC had said was that only 6% of the people who died from COVID-19 had only COVID-19 and that the rest had an average of 2.6 comorbidity factors.
01:36:47.000Yeah, but a little bit, let me ask you a question.
01:36:49.000If you have diabetes and you're driving down the highway and you're in a car accident, What do we say killed you?
01:37:01.000We don't say, well, you had diabetes, so we're not going to say the car killed you.
01:37:05.000So the fact that people – and in fact, we all ultimately are going to die.
01:37:10.000Right, but you know that people will reverse that, right?
01:37:12.000Like people will say that people with leukemia who also had COVID, they're listing that as a COVID death when they really had leukemia anyway and they were probably likely going to die.
01:37:22.000Yeah, but the person with diabetes was probably going to die of their diabetes, but they got into a car accident.
01:37:27.000So my answer is – I can answer this question.
01:37:31.000So my answer is that the usual way we think of things that kill people, we think of the proximate cause.
01:37:37.000Let's say I had chronic obstructive pulmonary disease or I had end-stage renal disease and someone shot me.
01:37:44.000Just because I was getting dialysis and someone shot me doesn't mean that I was going to die anyway of my renal disease.
01:38:00.000I think it is fair because let's say you have – it's the same exact situation.
01:38:05.000Let's say you have cancer and you're getting chemotherapy and you're being treated for the cancer and then you get infected with a pneumonia and you die of the pneumonia.
01:38:13.000You wouldn't have died but for the pneumonia in this case.
01:38:17.000The scenario I'm putting to you is – now, if you're going to make the argument you're making, and I understand where it's coming from.
01:38:22.000I don't mean to dismiss it completely.
01:38:25.000You would also then have to apportion all deaths – To have a fraction due to different causes.
01:38:31.000So you would say this person had a diabetes and they also got coronavirus.
01:38:38.000So we're going to say it's 50% of the death is due to diabetes and 50% is due to the coronavirus.
01:38:45.000And you could go then, if you wanted to do that, you could like, for all causes of death, you could apportion them.
01:38:52.000And that would result in, you know, rejiggering multiple things.
01:38:55.000But it's not fair to just pick on coronavirus and say, Well, actually, people would have died of something else, so we're not going to count those deaths.
01:39:22.000And this is, incidentally, one of the reasons why...
01:39:25.000Sweden is having its own problems right now, but one of the reasons it wasn't really fair to hold up Sweden as a comparison for our strategy is that the Swedes are much healthier than we are.
01:39:37.000They're a completely different society.
01:39:40.000We're not, unfortunately, as healthy as the Swedes.
01:39:42.000Yeah, that is something that I feel like we could have gotten into people's heads eight months ago and perhaps made a dent in the impact of the virus.
01:39:54.000It's hard to tell people you have to be healthier.
01:39:58.000People have their habits and they have their vices and they have their behavior patterns that they're just accustomed to and it's very difficult to break people out of them.
01:40:09.000Some people, especially terrified, faced with the possibility of either surviving a pandemic or not, may have done something differently.
01:40:19.000And it's one of the things that frustrates me so much about not just the government response, but the media's response to this, is that I don't see anybody out there saying, you gotta get healthier.
01:40:29.000And it's the one thing that might save you.
01:40:32.000Yes, I mean, I agree completely with that.
01:40:37.000I have some of them in the book of elderly people who fear getting this and who are not only, let's say, withdrawing socially and limiting their contacts, but they're trying to get fitter.
01:40:51.000They're exercising more and trying to prepare their bodies for the possibility that they might get an infection and try to optimize their chances.
01:41:30.000So this is where we're getting back to the sacrifices expected of us.
01:41:33.000Like if you want, you know, if Americans were willing to work together to like, let's say, I'm going to make this up, but let's say for the sake of argument, we were given a choice.
01:41:41.000Either every American can lose 10 pounds or every American that's overweight, which is like 66% of Americans are overweight, two thirds of them or more are overweight.
01:41:52.000Every overweight American can lose 10 pounds or we're going to close the businesses in your community.
01:41:58.000Actually, you know, I mean, I haven't done the calculation.
01:43:27.000Well, that would be wonderful because there's plenty of peer-reviewed studies on the impact of specific vitamins and nutrients on your immune system.
01:44:07.000I don't think this patchwork approach will work.
01:44:10.000So these are all the things I think we should be doing.
01:44:13.000And in that messaging, incidentally, I would second what you said, which is encouraging people to take better care of themselves, which is a good thing to do anyway.
01:44:21.000So I think that's already a pretty tall order, Joe.
01:44:24.000I mean, I don't know what more we can do.
01:44:26.000We are making heavy investments in vaccine technology and in science, which I It's sort of a very unsexy thing to spend money on public health departments,
01:44:43.000You know, when this pandemic struck, we didn't even have contact tracing capabilities at the level we needed.
01:44:48.000It's very sort of bread and butter kind of public health capabilities, but compared to Asian countries, we didn't have that.
01:44:56.000So there are a number of strategic investments as a nation we need to make, all of which incidentally are peanuts compared to what's happening to us.
01:45:04.000I mean, Larry Summers, a former treasury secretary, a former colleague of mine from when I was at Harvard, now I'm at Yale, and a colleague of his, David Cutler, who's a health economist at Harvard, they published a paper about a month or two ago Which called the coronavirus the $16 trillion virus.
01:45:26.000And they estimated that the hit to our economy by the virus was $8 trillion and that there was a further $8 trillion loss because of the deaths, illnesses, and disability from the virus.
01:45:42.000So our nation has suffered from the moment this virus It took root in our society.
01:46:01.000And that's what we're facing as a country, actually.
01:46:05.000And I just think we, I mean, I'm repeating myself, I think we just need to Confront that and deal with that as sensibly as we can.
01:46:13.000I think one of the more unique things about America is that we have all these different states and we get to see all the different responses that different states have.
01:46:21.000And that's one of the more confounding things about California's draconian methods because it hasn't really been effective.
01:46:28.000There's still massive infections and deaths and it doesn't seem to have done that much, particularly right now with the giant wave that they're experiencing.
01:46:51.000I haven't tracked it at this level of detail, but I do want to emphasize that even if the government says you can have live sporting events, only certain, many people still won't go.
01:47:48.000I have a sense of how many Americans have died on any given day and the cumulative toll of death.
01:47:53.000But I don't – and occasionally I'm paying attention to different states.
01:47:57.000Like earlier, we were talking about the Dakotas.
01:47:58.000So I haven't paid close attention to Florida and California lately.
01:48:01.000Well, Florida, the governor had a press conference – this is why I'm bringing this up – where he was bringing up where he had different age groups.
01:48:08.000He had a chart, and he was showing that we have to protect the most vulnerable, which is people, particularly older folks and obese folks.
01:48:17.000But he was basically saying, for everyone else, this is not nearly as dangerous.
01:48:21.000Now, a lot of people got angry at him for this, and they said it was irresponsible, the way he was describing it.
01:48:26.000But I'm pretty sure they're basically opening up most things.
01:48:32.000I mean, they have Disney World is open at a limited capacity there, whereas Disneyland in California is completely shut down and has been since March.
01:48:41.000Yeah, but I have to make a point here about this.
01:48:44.000And this goes back to our issue of our conversation about risk.
01:48:48.000So it is the case that most young people, if infected with this disease, face a very small risk of death.
01:48:54.000You know, let's say if you're in your 20s, you have like 1 in 3,000 chance of dying if you get infected.
01:49:00.000On average, if you're sick or you have some other condition or whatever, okay, you're higher.
01:49:05.000But the truth of the matter is that young people face a low risk of death of all causes.
01:49:38.000Their risk of death is very low from all causes.
01:49:41.000So why you would willingly accept an extra cause of death Especially one that doesn't offer any benefits.
01:49:47.000It's not like you're driving a race car and risking death, but you're having fun driving the race car.
01:49:54.000Well, I think Florida's explanation for that would be that they want to open up their economy because they think there's a danger in closing the economy that is not discussed as often as the danger, like in terms of the risk to human life,
01:50:20.000And this is why, going back, I think the first thing we have to do is we have to tell the difference between what part of the economic damage is just due to the virus— And what part is something we can do, you know, like we're doing to ourselves so we can affect it?
01:50:35.000Because remember, people are going to stop going out and shopping just because they know there's a deadly virus out.
01:50:41.000So let's say for the sake of argument, 50% of the circulation of human beings that is reduced, that is lost, is because people themselves are making these decisions.
01:50:49.000So the economy is going to tank just because people don't want to shop anymore.
01:50:52.000And that's been happening for hundreds of years with epidemics.
01:50:58.000Then there's the next part, which is things that we're doing by, you know, banning gatherings or closing restaurants or whatever.
01:51:04.000And then now, if we're going to decide whether to do that or not, your argument begins to have traction.
01:51:10.000Because you can say, look, when we close down that part of the economy, we're contributing to poverty and suicide and drug use and depression and all these other adverse effects.
01:51:20.000And then we have to engage in the very difficult and transparent as a society that We're good to go.
01:51:57.000Because we are not closing the economy due to COVID. Whereas if we had closed the economy, we would have saved those lives, but we would have lost some other number of lives.
01:52:07.000Furthermore, dear Floridians, because we're not slowing the spread of the virus, some of you will get sick, will go to your local hospitals, and will be turned away to die because our beds are full capacity.
01:52:22.000And I'm making that decision that we're going to take those deaths and we're going to take that awful outcome of people being turned away at the hospital door.
01:52:29.000And we're doing that because we want to avoid these other deaths.
01:52:36.000But I don't see that that's what's happening.
01:52:38.000I don't think that deep thought is going into it.
01:52:41.000I don't think serious calculation is going into it, and I certainly don't see governors saying we're going to keep our economy open, but the price of that will be these deaths, and when XYZ happens in a week or in a month, I told you so.
01:53:15.000Or you might even do the calculation and say, look, actually, we've done the calculation and we would lose 40,000 people due to the economy being tanked versus 30,000 lives due to COVID. And so I had to make the difficult decision as your governor to not issue these stay-at-home orders because this will result in saving lives.
01:53:40.000Say, actually, if I issued stay-at-home orders, we would prevent 30,000 COVID deaths And if I don't issue stay-at-home orders, we would pay those 30,000 deaths from COVID, but we would have 20,000 deaths from the economy.
01:53:56.000I'm mixing it all up now because I'm moving too fast, and I hope listeners get the gist of it.
01:54:01.000The point is that there are lives on both sides of the ledger, and if you tally up those lives and you decide this is what you're going to do when you're honest with people, I have less of a problem with that.
01:54:11.000Now Nicholas, if I gave you a magic wand and I said, you're the king of the world, tell me what to do.
01:54:17.000If you could be the person, you've studied this obviously very deeply to write this book, probably more deeply than most, what do you think should be done?
01:54:28.000What step-by-step strategy to both preserve the economy and preserve the maximum amount of people's health?
01:54:34.000I don't think we can fully preserve the economy and I don't think we can prevent all deaths.
01:54:38.000So we have to accept that both are going to suffer.
01:54:41.000I think we can do better as a nation by jiggling and jostling to implement a variety of slices of Swiss cheese that we discussed earlier, that if we collectively implement, mean we can Protect more businesses and protect our schools so our kids can go to school.
01:55:01.000I'm not saying that it's 100% sure that we can do that.
01:55:03.000We might still have to close schools and close businesses.
01:55:06.000But if we did more testing, more masking, more physical distancing, if we limited gatherings, if we had better messaging so people said, you know what?
01:55:16.000If I don't have Thanksgiving gatherings, then I can keep the businesses open and I can keep the schools open.
01:55:22.000So I think it's just immature to think that we could just go about life as it was before because our world has changed.
01:55:29.000We have to accept this, at least for a while.
01:55:32.000If we do those things, and we have better messaging from our leaders, I think we will emerge from this pandemic, as we will inevitably in a couple of years, because plagues always end, we are going to see the other side of this,
01:55:49.000we will emerge with it relatively more unscathed.
01:55:53.000That is to say, with fewer deaths from the disease and less damage to our economy.
01:55:58.000But there's no way, unfortunately, to fully avoid Death and destruction.
01:56:07.000But would you institute a nationwide mask mandate?
01:56:12.000I don't think legally that's allowed, but I think if the nation were able to do that, I think we would greatly reduce the transmission of this germ.
01:56:20.000We would save lives and minimize the other hardships that we had to implement.
01:56:24.000Yes, I think masks is the simplest thing.
01:56:26.000I mean, look, I can just put on this mask And if I do that thing and we all do that thing, we don't have to do other more difficult things.
01:57:07.000There are many common sense, basic things that we can do as a nation, which if we did, would actually allow our grocery stores and restaurants and other places to I mean, that's what I would recommend.
01:57:35.000And it's such a massive machine that to take out a giant chunk of it due to the pandemic, to have all these businesses go under, to have all these apartments that are available for lease, all these businesses available for lease,
01:57:51.000I don't see any strategy on the table to bring that back.
01:58:04.000First of all, we're seeing an exodus from cities to rural parts of the country that has been seen with every plague for thousands of years.
01:58:14.000There's nothing surprising about the fact that in times of plague, people flee the cities.
01:58:58.000Also, with the working from home, people are beginning to realize, you know, I can do my job from home.
01:59:04.000Why should I be in a two-bedroom apartment in Philadelphia when I can just as soon live on a big farm in rural Pennsylvania and do my job from a distance and I'll get much more space for myself and my family and so on.
02:00:03.000And incidentally, the travel industry is going to take a while to recover because now all of us have realized that, hey, I don't have to fly.
02:00:10.000I think doing business face-to-face is not going to stop.
02:00:13.000I think there's something I hope the next time you have me on the show, I'll come down to Austin and we'll see each other, have a drink.
02:00:22.000It'll be a totally nicer experience, although this is great as far as I'm concerned.
02:00:26.000But anyway, many, many cases on the margin, people will say, why should I fly across the country to sign this contract or have a routine meeting?
02:01:24.000So not all households are heterosexual.
02:01:25.000Not all households does the man earn more than women.
02:01:27.000But the predominant, the modal, as we say, pattern is still that in our society.
02:01:32.000So when the market, when the economy is tanking, as it is, and schools are closing, many families sit around the kitchen table and they're deciding how to cope.
02:01:44.000And they say, well, the man is making more money.
02:01:51.000So the woman is going to quit her, let's say, job that wasn't paying as much as the husband.
02:01:55.000And anyway, women might have, on average, a preference for being with their kids compared to men.
02:02:00.000And we should absolutely allow individual households and families to make their own decisions about how to manage their own lives.
02:02:06.000But when millions of families reach similar decisions...
02:02:11.000We might find that the labor market gains that women have made over the last 10 or 20 years might have been reversed by this pandemic.
02:02:19.000That is to say, a few years from now, when we look at the labor force participation of women, we might see a changed landscape as a result of this virus.
02:02:28.000So there are all kinds of things that will persist.
02:02:33.000You know, that the world will have changed in some ways.
02:02:36.000So working from home, women's labor market participation, the travel industry, schooling, you know, colleges, for example.
02:02:44.000A lot of colleges now have gone to develop the infrastructure and the bureaucracy for online learning.
02:02:51.000And some colleges will say, you know, we can actually offer an online degree much more easily.
02:03:31.000So there are gonna be persistent changes in our society from all of these things.
02:03:36.000One of the things that disturbs me is that the stimulus package, that check that people got, the $1,200 check, was one check, and it never repeated, and that was it.
02:04:34.000I mean, I don't want, if you lose your job and you can't get healthcare for a contagious disease, you're gonna be out and about spreading this contagious disease.
02:04:45.000Or why we don't have sick leave policy for hourly workers.
02:04:57.000So I think there are going to be changes in how we couple insurance to employment and sick leave policies because having a contagious disease illustrates some of the demerits in the existing system.
02:05:09.000Now, same goes with universal basic income.
02:05:12.000Now, I'm not an expert in this area, but I think that the way the government handled, the way it just pumped out money, and I think there was also some corruption and, like, Who got the money?
02:06:47.000What happened is the Greeks were laying siege to Troy and they were periodically going on raids and sacking vassal states of Troy.
02:06:56.000And they would kill all the men, take all the treasure and enslave the women and children and bring them back to their camps and divide up the booty.
02:07:05.000So they had sacked a nearby city and there was a maiden girl by the name of Chryseus who was given to Agamemnon, the principal king of the Greeks, as his prize.
02:07:16.000And Chryseus' father, Chryses, was a priest of Apollo.
02:07:21.000Apollo was the ancient Greek god of healing and also of illness and disease.
02:07:27.000Chrises comes to the Greek camp to ransom his daughter.
02:07:30.000He brings a big treasure and he goes to Agamemnon's tent, the king of all the Greeks, and he falls on his knees and he begs him.
02:07:51.000Not only will I not give you my daughter, but she will grow old in my house, in my bed, basically working as a slave for me.
02:07:59.000And if I see you lingering around the ships, I will kill you.
02:08:03.000And he just smacks the man and sends him away.
02:08:07.000So the priest goes back down to the shore and he says a prayer.
02:08:11.000He says to Apollo, if I have ever served you, if I have ever given you sacrifices that have honored you, hear me now and come and punish the Greeks.
02:08:19.000And the prayer instantly goes to Mount Olympus and Apollo hears him.
02:08:23.000And Apollo is enraged and he picks up his big, I know you like archery, he was also the god of archery, picks up his big silver bow.
02:08:31.000And he comes flying through the air down among the ships that were encircling, you know, on the beachhead, encircling Troy.