In this episode, I speak with Nicholas Christakis, an MD, PhD, and a professor of social and natural science at Yale University, where he directs the Human Nature Lab and is the co-director of the Yale Institute for Network Science. He was elected to the National Academy of Medicine in 2006, and the American Association for the Advancement of Science in 2010. In 2017, he became a New York Times best-selling author. His latest book is Blueprint, which I ve read and discussed before on this podcast with Nicholas. And so here, Nicholas and I cover this emerging pandemic, from many sides, and again, whatever we don t cover here, you ll have them to ask me on because I'll be back with another episode with a doctor from Johns Hopkins on . As you know, things are changing very quickly, but here was a snapshot of what we knew on March 8th, 2019. I don't know if it extends across the political media bubble, but I don t know that it doesn t extend across the social media bubble either, which is all that I'm noticing... I mean, if you're in my bubble, it's all that doesn't extend across my bubble. Thanks for having me, so much for joining me, and I appreciate you so much. I'm sorry for not having a better episode last week. I find that I couldn't drop either of those podcasts into the current environment when we need to be thinking about this. I can t drop them into the next one, and it seems that I find myself in a place where I'm not in a good place... right? -- Sam Harris (Make Sense Podcast) (The Making Sense Podcast, ) (Making Sense Podcast ) (Social Distancing, ) . (Blinded by Myths, Myths and Myths? ) ... (Myths and Facts) Thank you, Sam Harris ( ) ( ) . , (A Good Thing? (Podcast) ) , & (Book Recommendation ? (Thank You, My Good Thing, My Bad Thing?) and (My Good Thing) ... (A Bad Thing, Please Like Me, Thank Me, My Great Thing, Good Things, And My Good Day, My Day, And So Much So Much, My Life, My Thoughts, My Other Good Day) ( )
00:14:38.720So, you know, the travel industry is being devastated even as we speak, and it's unclear how long that will last.
00:14:44.460But then, you know, we'll begin to have second-order effects, so breakdowns in the supply chain and, you know, factories not working.
00:14:52.600And, you know, if those things begin to happen, this epidemic, you know, could tip us into a significant recession.
00:14:59.260So that's – but that's another whole thing.
00:15:01.300And it's still a little bit early to forecast that and be certain about that.
00:15:04.240But it is the case that major epidemics, for example, the 1918 pandemic definitely played a role in the global depression.
00:15:11.380So I think it's too early to know that for sure, but it's not crazy to think about the economic implications.
00:15:16.820And incidentally, incidentally, on the economic issue, and I'm no expert on this, this is not a demand shock.
00:15:22.900This is a supply – potentially a supply shock.
00:15:26.040So a demand shock is, you know, when a recession due to declining demand and then a stimulus might work, for example, dropping interest rates as the Fed recently did.
00:15:34.620But a supply shock is more like the Arab oil crisis of the 1970s that many listeners may remember.
00:15:40.900And that's when you have a shock to the supply – on the supply side.
00:15:44.760And there, you know, lowering interest rates doesn't really help.
00:15:48.080So if for the sake of argument you begin to get disruption in the global supply chain, you know, this could be a very difficult thing to address until you get the factories working, you know, producing the goods and distributing them.
00:16:00.220So it's too early to know for sure what's going to happen in that regard.
00:16:05.620But I know that many sophisticated observers of this, you know, including many economists and many extremely wealthy individuals who are tracking this, are unsure still what's going to happen.
00:16:16.860Except the one thing we can be sure about here is that –
00:16:22.220Yeah, no, but I mean we can be sure that the incentives aren't aligned here so that to – and this is what has been worrying me for now at least, I would say, two weeks.
00:16:33.900The moment I recognized that the health incentives, you know, the reasons, say, to close schools seemed fairly straightforward.
00:16:42.380And yet the economic reasons to keep them open were and are incredibly powerful and pointing in the opposite direction.
00:16:49.700And, you know, my concern is that because the economic incentives are so powerful, I mean, they just take school closure as one variable.
00:16:58.680The fact that, you know, once you close the schools, then you have almost every working adult faced with the problem of what to do with their children.
00:17:47.520Well, first of all, with school closures, we have to make a distinction between reactive and proactive school closures.
00:17:53.000So let's talk first about reactive school closures.
00:17:56.040A reactive school closure is a school closure in which there's a case at the school.
00:18:00.460And when that happens, typically everyone is alarmed and is quite eager and willing to close the school.
00:18:05.480You know, it sort of makes sense to the man on the street or the woman on the street that, well, there's an epidemic raging and there's a case at the school and we should close the school.
00:18:14.080The problem is by the time you do reactive school closures, many, many analyses show that it doesn't delay the overall epidemic or doesn't help the overall epidemic very much.
00:18:23.780For example, an analysis of reactive school closures in the last influenza epidemic in Italy showed that a policy of reactive school closures, I think, reduced the epidemic by like 24 percent or 25 percent, the ultimate number of people afflicted, which is good, but not as good as you might want.
00:18:43.020So you can postpone the peak of the epidemic in your community and reduce the number of people ultimately infected if you close schools once someone gets sick in the school.
00:18:54.740A similar analysis done in Japan found basically the same conclusions.
00:18:58.980And modeling exercises, sort of mathematical models, sophisticated models, including a paper published in the journal Nature in 2006, also found that, you know, a policy of reactive school closure delayed.
00:19:11.260I'm just going to look the numbers up because I have them somewhere here.
00:19:14.660For a moderately transmissible disease, reduced the cumulative attack rate by about 24 percent and delayed the peak by about 13 days.
00:19:24.020So the models and the empirical results of prior school closures in Japan and Italy, which is the literature I'm familiar with, I'm sure there's an even vaster literature on this, suggests that reactive school closures help.
00:19:36.300But the real problem or the real dilemmas is whether we should have proactive school closures.
00:19:42.900And this is a much more difficult decision, but from my eye, something we should be doing, frankly.
00:19:49.140And the reason is that if you imagine you're in a – let's not pick a major – let's not pick New York or Miami yet because that's another whole kettle of fish.
00:19:58.080Let's pick a mid-sized town for the sake of argument.
00:20:00.500If you believe that the moment someone in your school is going to – the moment someone – if you believe that the moment someone in your school gets sick, you are going to close the school, probably what you really should do is the moment someone gets sick in your community or in what is known as the epidemiologically relevant region.
00:20:20.100So if you believe that – if you believe that the moment someone gets sick in the epidemiologically relevant region, you know, your town, you're going to – then it eventually will afflict your school, then the more rational policy is as soon as someone gets sick in your community, shut the school.
00:20:36.860Why not get – you're going to shut it anyway in a week, you know, because your school is going to be afflicted.
00:20:41.760But if you jump the gun and shut it, you actually might radically improve the course of the epidemic in your community.
00:20:48.700And so – and there is actually amazing evidence about this.
00:20:51.640So, again, just to crystallize the point, let's say you set some threshold, and we can discuss what the threshold is, some number of cases in some specified area in your town or in an adjoining town, or a case that you know is not an imported case.
00:21:06.040It's not like someone flew from Italy to your town and presented with the disease, but instead you find what is known as a community transmission, someone who has the disease and you don't know where they got it.
00:21:16.880That means the disease is loose in your community.
00:21:19.400If you set as a threshold one such case or two such cases in your town or in a nearby town, you could then proactively close your school, and then you would have much bigger benefit than the reactive closure.
00:21:32.880And there was a wonderful analysis that was done of 43 cities in the United States during the 1918 epidemic, which very carefully examined across these cities, when did they close their schools with respect to the pace of the epidemic and for how long were they closed?
00:21:50.080And it found, for example, if you use as a threshold, how far in advance of the epidemic reaching, if you create the standard of you have twice the level of respiratory deaths as you usually have in prior years, you have excess deaths, how far in advance of hitting that twice the amount level did you close your schools?
00:22:13.080It found that actually districts that closed their schools in advance proactively had dramatically lower death rates in the end.
00:22:21.840And so, for example, there's a comparison between St. Louis and Pittsburgh.
00:22:25.720St. Louis closed the schools in the 1918 influenza pandemic earlier and longer, and it had less than half the death rate of Pittsburgh, for example, ultimately.
00:22:35.880So this is the issue, and this is what's hard, but in general, my own bias, my own opinion, is that proactive school closures make sense.
00:22:44.840Yeah, I completely agree with you there, and there's one meme being spread, which is perhaps entirely factual, but I would argue misinterpreted, that is giving people comfort around this idea that we can just keep the schools humming along.
00:23:02.540This idea that kids aren't getting this, or if they're getting it, they're not getting a bad case of it.
00:23:08.240And that's great. That seems to be true thus far, but it also seems true that they could still carry it and pass it to the rest of the community.
00:23:18.080So, you know, your kid is coming home from school and hugging grandma, and this is a very different disease when grandma gets it.
00:23:24.320That's exactly right, and in fact, it is the case that everything we just said about school closure is especially important when kids themselves might die, but the requirement that the kids be sick is not the critical point.
00:23:38.160Schools are areas of congregation of large numbers of people, including all the adults, the parents, the drop-offs, the teachers, and the kids are little vectors.
00:23:46.880And so, and incidentally, as long as we're talking about how does school closure work, one of the ironies about one of the ways that school closures work, paradoxically, is precisely because they compel adults to stay home.
00:24:00.880So modelers that have modeled this have said, okay, what happens when we require the kids to stay home?
00:24:05.920So we reduce social clumping in our society because we're requiring the kids to stay home, but let's assume that 10% of the parents or 50% of the parents or 90% of the parents are staying home as a result of the school closure.
00:24:22.180And unsurprisingly, that also has a further effect, the number of parents that stay home.
00:24:26.560Right. And so much of this is psychological.
00:24:29.380I mean, just take that fact I just mentioned, that some comfort is being taken in this idea that this is not preferentially targeting kids.
00:24:40.320But if you flip that around, if this were a flu that had an inordinately high mortality rate that was targeting kids preferentially, well, we would have closed the schools already.
00:24:51.880I don't think we would be debating school closure.
00:24:56.740But, you know, there's another kind of moral issue here.
00:25:00.600You're right that very good data we now have on the mortality rate and how it varies by age.
00:25:06.000So young people, one study of 5,000 Koreans shows that basically nobody under the age of 30 afflicted with the condition died in that study.
00:25:14.800And another study of 44,000 Chinese, I think, showed a case fatality ratio of 0.2%.
00:25:21.300So two out of 1,000 young people might die.
00:25:24.500Now, that's still a bad, I mean, that's a high risk of death for a young person.
00:25:28.760But the number rises quite dramatically.
00:25:30.860So by middle age, it's 1% to 2% of people die.
00:25:33.680And by over the age 80, it's, let's say, roughly 20% of people die.
00:25:37.160So, yes, you're correctly summarizing the situation.
00:25:40.200But one of the things that's distressed me in reading all this is that I, too, like most people, would prefer that the young be spared and the old be afflicted.
00:25:50.460But the old are members of our society, too.
00:27:00.540If we were tracking the flu with the same paranoia that we're tracking this, well, then we would be alarmed every day of our lives.
00:27:07.780And then also there's the fact that, you know, though the mortality rate of this seems higher than the flu, it also seems clear that we're not testing widely enough to know what the actual denominator is to properly calculate the case fatality rate.
00:27:22.000So it's been reported that it's as high as, you know, 3.5%.
00:27:28.920But then there are estimates, it seems like the most sober estimates are more like, you know, half that, you know, between 1% and 2%.
00:27:35.820But there seems to be the expectation on the part of many people that at the end of the day, we're going to recognize this is just another flu, essentially, running in parallel with the flu that we deal with year after year.
00:27:50.940And nobody freaks out about it, nobody closes the schools.
00:27:59.980So first of all, let me back up and say a couple things, a bunch of things.
00:28:03.980First of all, if I told you that motor vehicle accidents were a leading killer in our society, and they are, about 35,000 people die of motor vehicle accidents every year.
00:28:13.260And our society is very gravely concerned about these deaths.
00:28:17.320We invest huge resources in improving the safety of our roads and cars.
00:28:21.480We have enormous campaigns and penalties for people who drive under the influence.
00:28:27.200We cry and are sad when we read about motor vehicle deaths.
00:28:31.380And the public health community and our government and the people on the street expend enormous resources and attention in driving down one of these leading killers in our society.
00:28:39.660And if I told you that I could wave a magic wand and remove that cause of death tomorrow, many people would be amazed and excited and incredibly proud.
00:28:49.360Well, right now, we're in the midst of adding such a cause of death in the case of the coronavirus.
00:28:55.320That is to say, our best estimates, the most optimistic estimate, is that only 35,000 Americans are going to die of this condition.
00:29:02.340So we've just added a whole other extra cause of death to the list of things that kill us right now in our society.
00:29:10.080So I just don't see the reason for nonchalance or optimism with respect to a new condition, a new killer that might kill us.
00:29:18.040Imagine if instead of being, quote, something that sounded so benign as influenza or the flu, imagine instead if I said it was Ebola.
00:29:25.020Imagine the panic that people would feel if I said we now have Ebola loose in our country, killing 35,000 people.
00:29:35.120Furthermore, there is a wide range of estimates as to how many people will get infected and or die.
00:29:41.540And this is still, we're in early days, and it's difficult.
00:29:44.880And it's difficult for people, it's difficult for me, just I'll speak for myself, because I don't want to be alarmist, you know,
00:29:50.960and I don't want to overestimate it and then have people call me to task and say, oh, you, you know, you were chicken little and, you know, you were an alarmist and, and, you know, and, and then maybe lose some credibility, let's say.
00:30:04.300On the other hand, I don't want to minimize it and underestimate it.
00:30:07.240And, and then people say, why didn't you warn us?
00:30:09.580You know, why didn't you tell us you should have been in a position to know, you know, you've, you've been studying this topic and related topics for so long.
00:30:16.520And of course, there's only going to be one outcome.
00:30:18.460It's not like I'm making a thousand predictions, and on average, I'm correct, or other experts who are in similarly situated as I am, there's going to be one outcome.
00:30:27.740And it'll, and so we, we have to speak in terms of a range of outcomes.
00:30:31.500So at the most optimistic end, I think we'll have over a million Americans infected with this pathogen and perhaps 35,000 dead.
00:30:40.060But that's just at the most optimistic end.
00:30:42.280And the much more likely scenarios or equally likely or other possible scenarios move up the range.
00:30:49.180So for example, Mark Lipschitz, a very famous epidemiologist at Harvard, who's an expert in this area, estimates, and he's revising his estimates as more data comes in.
00:30:59.060But he estimates as of last week that perhaps 20 to 60% of Americans will ultimately, over the course of a year, be infected with this pathogen.
00:31:08.500And if we use a lower bound of his current estimate, 20%, that means 60 million Americans will be infected.
00:31:15.020And if we use a lower bound of the case fatality ratio, which is 0.5%, that means 300,000 Americans are going to die of this condition.
00:31:24.220And that is like one of the top three killers in the United States.
00:31:29.280So, and that's within the realm of the possible.
00:31:31.640I'm not saying that's going to happen, but I'm saying we need to sit up and pay attention because that is possible.
00:31:39.160You know, it's not an extremely unlikely event.
00:31:41.980And it could even be worse than that, honestly.
00:31:44.860Now, I don't think, you know, if you force me to predict, you know, do I think 300,000 Americans?
00:32:30.920But what is also true is that China just executed the most draconian quarantine, perhaps, in human history.
00:32:40.440And we are not poised to be poised to do anything like that, ever.
00:32:46.720Yes, I'm actively writing about just that.
00:32:50.020And according to the New York Times reports, 700 million Chinese have been under some form of house arrest, basically, for the last, you know, since January the 25th.
00:33:00.920So, these people are, you know, basically homebound.
00:33:38.940...something miraculous would have to happen in our society for us to emulate that in any way.
00:33:44.700And, again, it seems the kind of thing that need not be accomplished at the point of a rifle, as in China.
00:33:51.460But the idea that we're going to accomplish it just by getting it into our thick heads, that we should practice social distancing to that degree, it seems very far-fetched.
00:34:02.120So, what we should anticipate is a much freer spread of this contagion in our society.
00:34:08.460Yes, although, and we'll come back to this, I'm sure, is what can people do?
00:34:13.620And I absolutely think Americans should be practicing social distancing.
00:34:17.640On Twitter, you know, I've been talking about this for quite a while.
00:34:21.600Sensible policies of, you know, not engaging in any non-essential travel, not going to meetings, washing your hands, not hugging or, you know, instead bowing or doing namaste or something, not touching people, not handshaking, which is very instinctive in our society.
00:34:36.680These are all basic things all Americans, in my view, should be implementing now.
00:34:40.840And the reason we do this, incidentally, just to be very clear, it's not just so that you don't get sick.
00:34:46.600When we do these things, we interrupt the contagion chains that flow through the network.
00:34:53.240In other words, we're stopping the virus in its tracks by interrupting the means with which it spreads from person to person.
00:35:00.000So the reason I don't shake your hand is not just so that I don't get sick, but that in not having shaken your hand, I block all paths of the virus from you to anyone else I might meet in the future.
00:35:14.640And social distancing repeatedly has been shown to be an effective so-called non-pharmaceutical intervention.
00:35:21.520But I want to tackle one other thing which relates to perhaps another meme on your list, I don't know, which is this claim that the Trump administration's cessation of international flights, you know, was effective.
00:35:34.640And this has been studied for an extremely long time by scientists of all stripes.
00:35:40.240And just to quote one analysis, typically, countries are not aware of the emergence of a pandemic until, let's say, the 30th day of the disease, which is, again, roughly what happened in this country with this coronavirus epidemic.
00:35:56.200By the time the disease emerges in Wuhan around late December, it's spreading throughout the district in the prefecture in Hubei for, you know, at least a month or so.
00:36:09.460And before, you know, some, we, let's say, we say we're no more flights from, you know, China or something.
00:36:15.660But again, here, economics weighs against it.
00:36:30.480So if you stop 90% of the flights on day 30 of a pandemic, you delay the peak in the epidemic in your country by about 10 or 12 days.
00:36:41.820If you stop 99% of the flights, you delay the peak of your epidemic by, let's say, 26 days.
00:36:48.220And if you stop 99.9% of the flights, you only have one out of 1,000 flights still coming into the country, you only delay the peak by 42 days.
00:37:14.980So this fantasy that we can somehow, in an age of pandemics, stop them at our border is not justified by the epidemiological modeling.
00:37:25.140Right. Well, let me just say, in defense of Trump, that's the one decision or one utterance attributable to him that I don't fault him for.
00:37:34.880I mean, it seemed like it was worth a shot.
00:37:36.880Why not try to delay it that way if you can?
00:38:03.380I mean, I think we should be firing on all cylinders here.
00:38:05.600But let's talk about the timeline for a second, because I want to just get our bearings here.
00:38:11.040And it's interesting to consider my own psychological timeline, you know, as these events unfold.
00:38:17.820So, as you said, at the end of December, actually December 31st, the World Health Organization reported that there was this mysterious pneumonia in China that seemed to be associated with the Wuhan live animal market.
00:38:30.260But perhaps we can just cut through all political partisanship here and agree that eating bats and pangolins is a bad idea.
00:38:49.180But just to be clear for your listeners, it's not necessarily the case that people were eating those animals.
00:38:54.080It seems like it's still a little bit unclear that the virus spent part of its time in pangolins, although to my knowledge, that's still not been resolved.
00:39:01.760But it's fairly clear that it originated in bats.
00:39:06.580Like even in the movie Contagion, the disease begins in a bat that drops some spit on a pig, you know, I think is sort of what is set up in that movie.
00:39:15.240But one speculation is that the immune system of bats may be very similar to the immune system of humans, after all, bats are mammals, and that when viruses adjust to the immune systems of bats, when they then somehow leap to us, they're already well-adjusted to infect us.
00:39:47.560So January 11th, China announced the first death in Wuhan.
00:39:54.420And then January 21st, we had the first confirmed case in the U.S.
00:39:58.860It was a man in his 30s, I believe, who actually traveled from Wuhan and came ashore here.
00:40:05.180So that was 10 days after we heard about the first death.
00:40:08.180So genetic studies now, reconstruction using genetic phyldynamics are suggesting that there was some transit, and this goes back to the stopping the air travel example we were discussing, that we can use the genetics of the cases in Seattle and what we know about mutation rates to reason backwards and discern how many introductions were there into Seattle and roughly when.
00:40:30.820And my understanding of the status of that science right now is that roughly in the middle of January, someone came from Wuhan to Seattle, and then the disease started having what we call community spread.
00:40:44.320That person, we don't know who they are, but the disease was then transmitted to other people and then still to others.
00:40:49.160And then eventually the epidemic broke, you know, a couple of weeks ago.
00:40:54.360And so by January 30th, the World Health Organization had declared a global health emergency, which they've only done six times since 1948.
00:41:03.420So January 30th is when those people whose job it is to keep watch over these things decided that this thing was going global and we had to worry about it.
00:41:15.580Now, then it seems like we had at least a month, you know, I mean, some people would say we had two full months, but we had at least a month here to get our bearings and prepare, assuming that community spread was already happening and that, you know, things like school closure would be, were things we need to think about.
00:41:37.760And now I have a couple of timelines here. I have a timeline of Trumpian insights.
00:41:43.920At the end of February, February 24th, Trump announced that the coronavirus is very much under control in the USA.
00:41:51.100And then he said, you know, crying, Chuck Schumer is complaining for publicity purposes only that I should be asking for more money than $2.5 billion to prepare for coronavirus.
00:41:59.340And there was just an absolutely transparent layer of political obfuscation and messaging essentially to the stock market rather than providing real information about this virus.
00:42:13.920February 26th, we had the first case of community transmission in the U.S. that was acknowledged.
00:42:21.120I'm sure it happened before that, but this is when we were talking about it.
00:42:24.540And on that same day, we've got Trump saying, I don't think it's going to come to closing the schools, especially the fact that we're going down, meaning that the rates of transmission and death are going down, not up.
00:42:37.340And then this is more of a quote, we're going very substantially down, not up.
00:43:02.500So this is where I come to my own psychological timeline because it's been fascinating for me to kind of watch my own mind here and watch my sense of the situation change and cease to second guess my emotional reaction to it.
00:43:19.240And so I actually went back and looked at my emails and texts over the last few weeks.
00:43:24.460So I can see that on February 22nd, I was thinking about canceling some upcoming trips and still feeling fairly crazy about even thinking that way.
00:43:35.720And by February 27th, five days later, I had canceled everything, right?
00:43:46.660So for instance, 10 days ago, Tim Ferriss and I, who we were both supposed to speak at South by Southwest, he was going to interview me for an episode of his podcast.
00:43:54.900He and I decided to pull out of the conference.
00:43:57.760And it was widely perceived at that moment, again, just 10 days ago to be slightly paranoid.
00:44:04.400And it was perceived among my circle of friends to be slightly paranoid.
00:44:18.780So I've been watching this unfold, and I've been feeling more or less a week ahead of where everybody is, or at least most of the people who I'm communicating with and most of what society is mirroring back to me.
00:44:34.600And, you know, way ahead of where the president is.
00:44:38.340On March 2nd, Trump said, we had a great meeting today with a lot of great companies, and we're going to have vaccines, I think, relatively soon.
00:44:44.440Okay, so he's promising a vaccine soon, whereas the only rational promise is that maybe by the first quarter of next year, what's the most aggressive timeline that we could have a widely distributed vaccine?
00:45:43.620But this is obviously a point after which the CDC had already announced community spread in Oregon and California, at least.
00:45:51.860It's just useful to keep reiterating how unreliable the administration's talking points have been.
00:45:59.380So here, again, six days ago, we have Trump saying, so if we have thousands or hundreds of thousands of people that get better by, you know, just sitting around or even going to work.
00:46:09.040Some even go to work, but they get better, right?
00:46:11.880I mean, this is Trump talking so sloppily—I believe this was an interview on Fox—that it seemed like he was saying that it was okay to go to work even if you have this virus, right?
00:46:25.340So, and then the final—this was truly phantasmagorical—on March 6th, just a few days ago, we have him at the CDC wearing a Keep America Great hat, and he's saying things like,
00:46:47.260Now, pause for a moment, and this is, you know, maybe rightly perceived as point scoring against the president, but, I mean, just pause for a moment to reflect on the fact that it is extraordinarily unlikely that even a single doctor said anything like that to him.
00:47:01.760He's standing in front of all these doctors, almost certainly lying about what they said to him in the middle of a press conference.
00:47:08.960But even if they sycophantishly said something like that to him, the real problem is the narcissism in believing that.
00:47:15.120For example, when I take my—I know a lot about certain things, and I know what I don't know, especially in my field.
00:47:21.820I'm extremely aware of my ignorance in my own field, but there are things I know about.
00:47:26.260But when I take my car to the mechanic or when I need to have, you know, thyroid surgery, I trust those people.
00:47:33.100Like, I don't think I know more about how to fix a car than my mechanic.
00:47:36.620That would be just the height of arrogance and presumption.
00:47:39.540Or when I go to my surgeon, I have my—I say, what do you think we should do?
00:47:43.520And I trust that that person has devoted their life to acquiring this expertise, and that's the whole reason I'm going to an expert.
00:47:49.280So the idea that President Trump, who may be a skilled businessman and may be a skilled politician, that he would think that he knows as much about epidemiology as the people at the CDC, the real problem there is the narcissism in this individual, not even what the sycophantish behavior that may have, you know, led him to that conclusion.
00:48:09.780So it's, you know, it's astonishing to me that someone would—and I think this is a broader problem in our society right now, both on the far right and on the far left, this sort of denigration of expertise, this idea that, you know, that the right doesn't trust experts because they, you know, they want to think that everything is a political decision.
00:48:31.020And the far left actually feels similarly, actually, about experts.
00:49:21.000Joe Schmo is not going to be producing a vaccine in his garage, I can assure you.
00:49:24.680Like that religious figure, I'm blocking on his name, that was saying that he was literally hawking some kind of substance that would cure coronavirus, he said.
00:49:33.880And it was like that awful character in Contagion that was selling forsythia.
00:49:41.800The analogy to a movie is disconcerting here because this is playing out a bit like a movie.
00:49:47.340I mean, you can feel like at several points here along the way, I felt like, okay, I'm the guy in the first act of the movie who's having an inappropriately sanguine response to facts that should be fairly alarming.
00:50:02.660And it's still, you know, who knows what part of the movie we're in here, but it's a disconcerting comparison.
00:50:07.500So anyways, so the last thing that Trump said at this press conference, which was truly appalling, was anybody who needs a test gets a test.
00:50:16.720Anybody that needs a test, as of right now and yesterday, anybody that needs a test can get one.
00:50:22.200Now, he was saying that at the moment when the most glaring feature of this crisis was the utter failure of the government to provide tests at scale, right?
00:50:32.940So I think there'd been something like 2,000 tests performed in the country at that point, and the CDC wasn't even answering the questions from the press about how many tests had been performed.
00:50:42.840I mean, they had to be reconstructed by asking everyone at the state level what had happened.
00:50:48.080So, I mean, perhaps people who only follow the president and his Twitter feed and watch Fox News can be forgiven for not understanding what this situation really is.
00:51:00.360But we have to break out of this political bubble and just encounter the facts here insofar as we can understand them.
00:51:08.700And I've had a slightly weird angle on just what we were not finding out about this in real time.
00:51:17.560Because, you know, I'm in Los Angeles.
00:51:19.980You know, for the longest time, the number of cases in L.A., according to the Johns Hopkins website, were reported to be at seven.
00:51:27.780But I happened to know, I happened to know a person who was skiing in Italy with five friends, and they all got it, and they all got on a plane and probably infected half the plane.
00:51:39.920And they got back here, and now at least two of them are hospitalized.
00:51:46.860He's not a close friend, but he's a very close friend of a very close friend.
00:51:50.120So I have a very close friend talking to his very close friend on a daily basis who has this thing who's—and this is at a moment where I'm hearing that there's seven cases in Los Angeles, and apparently I know five of them.
00:52:04.900We're also hearing that this thing is in reasonably healthy people, you know, people who are not immunocompromised or people who are not 80 years old.
00:52:15.340Well, this friend of a friend is now hospitalized and on a ventilator, and his other friend is hospitalized and in an induced coma, I think because the coughing associated with it was so bad.
00:52:29.900And so, again, this is—I'm well aware that, you know, these are two anecdotes, and this is not really data, but from this sort of ground-level experience of just hearing these stories, once removed, this isn't seeming like an ordinary flu.
00:52:45.540I mean, these guys are both extreme skiers.
00:53:17.360We know it's more severe than the flu, first of all.
00:53:20.320Well, second, I've been thinking about this issue, which is like, if you're going to get it anyway, is it better to get it sooner rather than later?
00:53:27.620And it's definitely better to get it later because this relates to another topic, which I can't remember if we've discussed already, but I've been talking about this notion of flattening the epidemic.
00:53:36.740So, imagine that you have a pulse of disease that's hitting our society so that a million people are going to get sick.
00:53:46.380Those million people could get sick in a very peaked way, like over the course of a month.
00:53:50.420But if we implement social distancing and other procedures like school closures and we flatten the epidemic, so we still get a million people sick, but now they're sick over six months so that, you know, we have a smaller number of cases on any given day, it decompresses the demand on our healthcare system and on our supply chain so that we can actually cope with the people who are sick and need ventilation.
00:54:13.840So, flattening the epidemic is a really important fundamental idea in epidemiology, which is one of the reasons we engage in what is called non-pharmaceutical interventions like social distancing and school closures and all of that stuff.
00:54:26.600So, that's why we need to do it, to flatten the epidemic so that if anyone gets sick, they get sick, fewer people are sick on any given day, and we push the cases out into the future so that some fraction of those cases occur at a time in which we've discovered perhaps some drugs that could treat the disease or have a vaccine available so we never get those cases, you know, because we've postponed them so far.
00:54:49.400So, there are many benefits to flattening the epidemic.
00:54:51.440Now, when you flatten the epidemic, it's also the case that the people at the beginning, they also aren't putting heavy demands on the healthcare system, so maybe if you're going to get it, if you get it sick sooner, you know, that might be a sensible strategy.
00:55:05.640But actually, neither from the individual nor from the collective point of view have I been able to discern any wisdom in that.
00:55:12.620Because, first of all, you might not actually get sick anyway, so rushing to get sick now is sort of stupid.
00:55:19.020You know, not everyone is going to get the disease.
00:55:23.420And second, from a public health point of view, if you encourage people to get sick now, you might actually compress the epidemic.
00:55:30.360You know, you're going to create a pulse upon a pulse of disease.
00:55:35.600So, no, I don't agree with your friend for multiple reasons in what they said.
00:55:40.440Just to be clear, a disease that has a 5 or 10 or 15 or 20x higher mortality rate than the flu is very unlikely to be just like the flu.
00:55:55.840Yes, and we haven't seen this pathogen before.
00:56:00.440And there's a whole other, just to telegraph, there's a whole other debate about whether the path, typically these pathogens mutate and get milder as they adapt to our species and as we fight it off.
00:56:12.700Also, they tend to kill off the more vulnerable members of our species to this pathogen.
00:56:17.180It's all very sad and clinical, honestly.
00:56:19.140But we also have to recognize there are likely, likely to be waves of this condition.
00:56:24.280So, we're right now at the beginning of the first wave of COVID-19.
00:56:28.540But, you know, probably we're going to see a second wave and even a third wave, perhaps.
00:56:33.000And that's very common for these types of pathogens.
00:56:36.340So, I just want to reiterate the point that you just made, but I just don't want it to get lost because it's probably the most important point here,
00:56:44.080which is even if we're all destined to get this thing, or even if 75% of us are destined to get it, getting it later is absolutely better when you consider the implications for our healthcare system.