#214 — A Conversation with Siddhartha Mukherjee
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Summary
Siddhartha Mukherjee joins me to talk about the SARS-CoV2 pandemic, and why it is different from other pandemic viruses in that it is deadly and can be spread quickly and widely. We also talk about what went wrong, and what could have gone wrong, with the response to the crisis in the United States and around the world. And we talk about why SARS CoV2 is different than other viruses in terms of its ability to spread, and how we can learn to deal with a pandemic like this in the 21st century. This episode was produced and edited by Sam Harris. Our theme music is by my main amigo, Evan Handyside. The album art for the podcast was done by our super talented Ameya. Additional music written and performed by my band, The Weakerthans, and our ad music was made by Ian Dorsch. We are working on transcribing this podcast and putting it on SoundCloud. If you'd like access to full episodes of the podcast, you can get access to the full episode by subscribing to the podcast by becoming a patron patron of The Making Sense Podcast, wherever you get your podcasts, free of charge, no questions asked. Thanks for listening and sharing the podcast! Sam Harris and I hope you find value in this episode and share it on your social media platforms! . Thank you for listening to the Making Sense? - Sam Harris and the MMS Podcast Subscribe to the Podcast by clicking here and spreading the word to your friends and posting it everywhere else on your Insta-tweet Thanks again, Sam Harris is a big thank you're listening to this podcast is amazing, and I really appreciate it! Love you're making sense? - your comments and I'm making sense, you're amazing, I'll be listening to it, too much of it, thank you, and you're lovely, thanks you're beautiful, good night, good day, and thank you so much, good morning, bye, bye bye, good bye, and good night. - MMS - Thank you, bye - your day, bye - KISS - - Cheers, -- bye, MAGIC AND KAVY AND KELLY AND RYAN MURDERER AND KEPTER, MALAYTERTER AND KETTERING, MURTER
Transcript
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Sid, thanks for joining me again on the podcast.
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The Emperor of All Maladies, which is really the definitive book on cancer in our lifetime.
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And so we've spoken about both of those books at length on the podcast.
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I recommend anyone interested in those broader topics consult those previous conversations.
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But today, I just want to talk to you about the COVID pandemic in general and just get
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your kind of expert eye view of what has been happening here these long, now five months
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in the U.S. that we've been dealing with this, I think, ineptly by any objective criterion.
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You know, our ineptitude is fairly well established here.
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So, and I'll just, I'll remind people who may not know it, you are a famous oncologist
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and also writer, but your background is in virology.
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So you actually have a wheelhouse that is relevant to our current concerns.
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So just to start off here, and we can go anywhere you want to go, Sid, but what has been your
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experience watching this all play out and watching, in particular, watching the spread
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of misinformation and just the way in which it's been given topspin by political cynicism
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And also, just in the beginning, there was a fair amount of, you know, actually good faith
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uncertainty about the biology and epidemiology of COVID.
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And so it's, it really has been hard to draw the line at various points between a valid
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contrarian opinion and a dangerously irresponsible one.
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And that, you know, granted that that line is probably getting clearer, but what's it been
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like for you these last five months watching this unfold?
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So I think there are several threads in that conversation that I want to break apart because
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So I want to make a very clear distinction between the uncertainties of which there are
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many and the ineptitudes of which there are many.
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So we can talk about them separately because those are important.
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So let's first talk about what went wrong and what could have not gone wrong in the United
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Well, before that, let's talk a little bit about why this particular virus of all viruses
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And the answer lies in the biology of the virus.
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There are two features or three features of the virus that make it particularly a pandemic
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causing virus that obviously is not true for many viruses.
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We have never encountered it before, as far as we know.
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And so therefore, humans are immunologically naive to the virus.
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The second thing, and now we're getting to really important things, is the fact that the
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virus has a high degree of high capacity to spread.
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The virologists use one measure of this, a measure called R-naught, which is a measure of
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And obviously, mathematically speaking, if that number is above one, then the infection
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Measles is a very, very highly infectious virus.
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It's hard to estimate exactly what that number is because it varies depending on the population
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And the third feature, which is actually probably the one that we realize very late and perhaps
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too late in the game and is the most insidious feature, is that asymptomatic people, people
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with absolutely no symptoms, seem to be able to carry the virus and spread the virus.
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That is not true, for instance, for Ebola or other very lethal viruses.
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When you have symptoms, you usually then become a transmitter.
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We might be familiar with other viruses that it's true for.
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You can be completely asymptomatic but still transmit the virus.
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You can have virus in your blood and transmit the virus.
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These viruses that have this capacity to have asymptomatic transmission are particularly
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difficult because you cannot simply find people by symptoms alone.
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And if you want to contain the virus using public health strategies, such as containment
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or quarantine or isolation, you have to essentially find them.
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They will not find you because they don't know whether they, by you, I mean a medical doctor
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And that's because they don't know if they're carriers, asymptomatic carriers, or they really
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So that covers the territory of why this virus, of all viruses, has and had the capacity to
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So this brings us to the next piece of conversation, which is the conversation about ineptitudes.
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So very important to remember that the ineptitudes started right from day zero in Wuhan, China.
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We should have known about this virus long before we actually did as a global community.
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Several attempts by Chinese doctors in full good faith to communicate the urgency of what
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was going on in China were essentially blocked, we think, or we now know to some extent.
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And in fact, as you very well know, the ophthalmologist who sounded the alarm on the virus was essentially
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And unfortunately, as you also know, he died of that viral infection.
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It's very important because that tells us something about the virus, I think.
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That is also, I mean, people have conspiracy theories around it.
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I don't know what to believe and what not to believe because the investigation has not
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The Chinese government has been extremely reluctant to share many crucial pieces of
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information around that first, you know, those first few days.
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Are you referring to the speculation that this came from a lab as opposed to a wet market?
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So one is that I think we still don't know the origin of the virus.
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I think that there was an there is an interview in Science Magazine from one of the workers who
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cultivates coronavirus in the Wuhan coronavirus facility.
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And she's adamant that it did not come from the lab.
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But, you know, the question is that lab has not been appropriate.
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You know, that incident has not been fully investigated.
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I don't think it was a bioterror weapon, for instance.
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Nor do I think that that it was a intentional infection of someone.
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But I do think that we need to investigate and find out where the virus came from and
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perhaps even track back the very first index case, which is usually possible if we have
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access to full free information, which we do not at this point of time.
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Just to linger there for a second, Sid, does it actually matter?
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You know, within a very short period, we had the full sequence of the virus and we're
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now dealing with the basics of vaccine design and treatment design and, you know, epidemiology.
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Does it really matter what the origin moment was?
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It matters for future pandemics and it matters for future surveillance.
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One of the things that, you know, we have to learn from this and never let it happen again.
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And doubtless, there are hundreds of thousands of viruses, xenoviruses that lurk in bats and
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I mean, one question is, you know, why bats seem to carry so many viruses?
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It's because they're, you know, they're very social and they live in very dense populations
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So it matters for the next pandemic because we cannot let this happen again.
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But moving to the United States, the ineptitudes or the, I would say, the glaring errors began
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So one error that began from the start was that obviously it was, the first response here
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That's obviously now not been the case, but that was a completely misplaced response.
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The first index case was seen at the end of January in Seattle.
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And that should have been the, that should have been an immediate call for urgent action
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because, because we knew, as I said, that this was a xenovirus.
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And we knew by that time there was enough suspicion in the virological community that
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It wasn't definitive, but as soon as that suspicion is raised, you need to start acting on it.
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That should have sounded a major alarm to the CDC and a major alarm to, you know, every
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health authority saying there is, the virus has now entered the United States and we should
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The second major, I would say, glaring error, which should never be repeated, was probably
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And that is, once the virus was in the United States, there was no test for the virus for
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So there was no FDA approved test for the virus for 40 full days.
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I cannot emphasize as an immunologist or a virologist that that is, that, that is a, it is inconceivable
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But for 40 full days, there was no test for it.
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And that was partly because the, the CDC tried to make a test and the test, the first batch
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And there's a big piece that I wrote in the New Yorker about this.
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It was actually, in the end, it was a good test.
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But when they expanded the batches of the test and send it out, sent it out to the public
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health services, which is where these tests are usually then monitored, the test failed
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One probe, one of the pieces of the test, didn't, you know, kept showing up with false positives,
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which meant the entire test was, was not reliable.
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Now, in that meantime, in that same period of time, so as the clock is ticking now, day
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one, day two, day three, several academic investigators, including folks like Alex Greninger at the University
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of Washington, who I interviewed for the piece in the New Yorker, and I, you know, have had
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a long communication with, Alex Greninger had by himself in his lab developed a test for
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But that test had to be, in order to be used, it had to be licensed by the FDA and the CDC.
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Now, the FDA and the CDC, you know, we have something which allows such licensing to proceed
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very quickly, which is called the Emergency Use Authorization, EUA.
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And if you speak to the FDA and the CDC, they will tell you that, oh, God, you know, gosh,
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We were just waiting for our tests to be corrected.
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If you ask people in the private laboratories, they will say just the opposite.
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They will say, well, we applied for the EUA, but it took, by the time it turned around, you
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And I think you describe, and I think this was in your New Yorker piece, you describe doctors
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spending nearly 100 hours filling out forms to get permission to test.
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And these forms couldn't even be emailed, right?
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And it just sounds like the infrastructure over there is a generation old.
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So the, I spoke with the FDA and I spoke with the CDC.
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The FDA says that it was a parallel infrastructure, that you had to do a snail mail, but they would
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And it also says that, and it maintains that they were processing these as fast as they
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The laboratory investigators say that that's not the case, that in fact, the snail mail
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One problem, of course, you have to realize that there was an intrinsic problem at this
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point of time, which is that no one had samples.
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So in order to validate a test, you need samples to validate a test.
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But if you have only, it's a perfectly circular argument.
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So in other words, if you don't have a test that works, you don't know who to validate
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And how can you prove that a test works if you don't have samples to validate it on?
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So it's a perfectly, I mean, we really need to learn about these pieces of logic or these,
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you know, these sort of failures, some of which are, I would say, some of which are
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intentional, some of which are non-intentional.
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But this is a perfect example, and it could be applied to any business.
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If asymptomatic individuals can carry the virus, which happens to be in this case, then how
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What's the, what is the, was it a positive, what does a, how do you test whether the test
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You can't because you don't have samples to test it on.
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Anyway, in any case, by, you know, 15, 20 days in, Greninger and others had scrambled
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together enough material from various sources to be able to test, to show that their test
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And eventually, of course, the FDA CDC test also began to work there.
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But by all of this time, you know, 40 odd days had passed, 30 odd days had passed, for the
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I mean, of course, there was testing going on as well.
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But about, and that's a critical period of time, because that is when the infection was
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And we don't even know what happened in those 30 to 40 days.
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We don't know how many people flew from Seattle to, for instance, New York and New Jersey.
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We don't know how many people came in from, there was no travel ban, remember, on Europe.
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So we just went through mistake number one, which was the absence of testing.
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Mistake number two was to dismiss the idea, or was to say, this is a Chinese problem, this
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is a problem that is in China, and not recognize the fact that the slopes of infection rates
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were climbing rapidly in Europe, in Italy and Spain.
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So during the time that we had no test, there were people coming in and going out of major
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cities, New York being probably the major epicenter, and there are several genetic clues that clearly
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suggest that the infection in New York, at least, was primarily seeded by European travel
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The infection in Europe was seeded, in turn, from Asian travelers who came into Italy and
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But the infection in New York, we have genetic evidence to suggest that it was from people
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So not putting in a travel ban, testing ban, or even a quarantine and isolation during that
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period of time when we didn't have tests is a crucial error, and that was error too.
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I should say that, just backtracking a little bit, I should add that the FDA and the CDC have
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had a long history of working with public health laboratories, but they have had actually
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not a very long history of working with private academic laboratories, so like the University
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of Washington or like Columbia University, etc.
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So that is in some ways error number three, because if the FDA had had a well-established
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track of, or if they had vetted and pre-authorized, as countries like South Korea and other places
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did, some academic laboratories as being good enough or of high enough caliber that if they
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were to apply for a test, a successful test, that the FDA would say, okay, ours doesn't seem
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to be working, we'll take yours until ours gets to work.
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That infrastructure was present within the FDA, but present in a very infant form.
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That's what the academic laboratory folks told me, so academic pathologists told me.
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The FDA says that that's not true, and so the question is, when we perform the autopsy,
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Either the FDA has had a long tradition, and it's quite smooth and streamlined their capacity
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to work with academic laboratories, pathology laboratories like Greninger's and Columbia's
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and New York hospitals, or it is in fact was not streamlined and had to be streamlined in
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So now we keep moving, the clock keeps ticking forward.
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So now we have people from Europe traveling into the United States, carrying virus, symptomatic,
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There is nothing going on in the borders except for originally, as you very well know, a ban
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But of course, that was not where the leak came from.
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And they're coming into New York, and they are spreading the virus asymptomatically because
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there's, and we don't even know where they're going, what they're doing, where they're spreading
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the virus, and we don't even know how many because the test is still lacking.
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So move the clock forward a little bit forward again.
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Actually, before we advance, I'm wondering, let's just linger on the testing piece for a
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So what ensures that we learn the right lessons here?
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It seems to me that some lessons seem genuinely hard to learn because in normal times, you would
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view this sluggishness from the FDA and the CDC as a feature, not a bug in that, I mean,
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we obviously, it's got to be motivated to some degree by wanting to ensure quality control.
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You don't want to just approve labs all over the place to get their competing tests to scale.
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And I got to think the status quo was motivated to some degree by an awareness that there's
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a trade-off between safety and speed in situations like this.
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The last thing we want is a trigger-happy FDA or a trigger-happy CDC, so that we certainly
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But what we do want is a CDC and an FDA that is able to respond to pandemic situations in
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a different way than it responds to the approval of any drug or test in normal circumstances.
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So there has to be some kind of hysteresis or some kind of space, as it were, a dial-up-dial-down
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system in which you can dial up or dial down the responsiveness based on the situation.
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One way that I've proposed in the New Yorker piece and subsequent pieces, I'm on several
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panels that have to do with COVID response and what we learned from the COVID response.
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But one way is to do exactly what I told you, which is to do some kind of pre-authorization
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so that the FDA would have, rather than waiting to receive applications in the setting where
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their own test was not working, to go and seek out people that they have already vetted
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and ask them, you know, can you help us figure out at least an interim test?
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We will validate that test and at least launch that while we wait for our test to come and
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And this pre-authorization process or pre-vetting process could be quite stringent.
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You know, the FDA has lots of time in between pandemics to ensure that, you know, the University
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of Washington is not just, you know, out to make a fast buck and that their, you know,
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their PCR machines and their, this is their, you know, what their capabilities are.
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How many, what is the reliability of their testing infrastructure?
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Can they report out those tests, et cetera, et cetera.
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So that rather than waiting and, and being, being passive, the FDA would have been, or
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the CDC and the FDA would have been active during this process.
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You don't want to trigger happy FDA, but you do want an FDA that is prepared to what I would
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call dial up and dial down in the circumstances of a pandemic.
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So take me to the border where we now have people pouring in from Europe, many under the
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increased load precipitated by the, the sudden announcement that if you don't get in, in
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the next 15 hours or whatever it was, you're not getting in.
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So we just had people flooding the airports of Europe, trying to catch the next plane out,
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obviously breathing heavily on one another all the while.
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So, so we're, we're, we're then now in a situation where, as I said, in New York city,
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And what is happening in Europe is just the opposite.
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So what is happening in Europe is that everyone is reacting to the situation in Europe and they
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are getting on planes and jumping on planes and, and essentially coming as soon as they can.
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They're arriving into New York city and New York city very, very soon is full of people
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from Europe who are trying to catch the next flight back.
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And there is no way to know how long they will stay, whether they are tourists, whether
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Um, so that's, that brings us, you know, the clock now ticks and we are now back in, we
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And we're beginning to see the uptick in New York infection rates by now.
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There's a, you know, there's a surge or the beginning of the surge.
00:24:00.260
And that's usually when a, usually when we start to do things like quarantining and now
00:24:08.760
things, you know, isolation, contact tracing and masking becomes important.
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So at this stage, what's important is to have one clear, consistent message saying, we're
00:24:21.900
We don't know if people have been quarantined or not.
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We don't know if people have been isolated or not.
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But the first thing you should do is start social distancing, you know, avoid crowded
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But, but most importantly, we don't know, and we'll come back to this point in a second,
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We don't know if masks work or not, but they have historically worked against other respiratory
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So if you're symptomatic, wear a mask, and particularly if you're a frontline healthcare
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worker, wear a mask and wear, probably wear full PPE, because that's what we learned from
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the, from the Chinese, that it's a highly contagious virus.
00:25:15.320
I don't know if this was the CDC or the World Health Organization or both, but someone at
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that point, I think, clearly concerned that there was going to be a, a, you know, a run
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on PPE and therefore not enough for frontline workers.
00:25:31.120
There was messaging around masks, not only maybe not working, but being counterproductive,
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that you'd be more likely to be touching your face.
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You're more likely to get sick, perhaps, by wearing a mask.
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So people were actively discouraged at one point from wearing masks.
00:25:47.460
And the Surgeon General at that point in time also said that masks were not required.
00:25:51.560
And the, the logic that I have heard is that it's, it was because, you know, people were
00:25:59.020
saying that it wouldn't, that there wasn't, that there'd be a run on PPE, personal protective
00:26:03.640
equipment, then that doctors would be, would therefore not be able to get, get any.
00:26:08.400
But that doesn't, that obviously the public, to the public, that makes no sense.
00:26:11.760
How can, how can, how can it, how can it work for doctors, but not work for you?
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It just, just doesn't make, it doesn't, it just doesn't make any sense.
00:26:19.720
And so, so we then go through this moment in which we don't know if masks work or not.
00:26:27.320
You can't give people coronavirus and say, you know, either half wear masks or half don't
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And remember, masks work both ways based on a whole bunch of experience with respiratory
00:26:40.540
They protect a spreader from spreading and they protect an uninfected person from getting
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And we're in this kind of limbo around masking.
00:26:53.900
And so what's happening in the hospitals, meanwhile, is just really terrifying in New York hospitals
00:27:00.640
because they also don't have enough protective gear.
00:27:05.180
So they don't have enough N95 masks, the kind of mask that really is fitted and, you know,
00:27:10.840
lets through only a very small fraction of, of respiratory particles.
00:27:15.760
These are not that heavy duties that are, you know, they're not, they're not that fancy.
00:27:21.140
They cost less than a dollar typically, but hospitals are running out of masks and the
00:27:26.880
emergency rooms and the hospitals are becoming progressively crowded with people who have symptoms.
00:27:34.840
So there is a complete breakdown of communication between all the folks concerned about what, what
00:27:44.540
The doctors are, and nurses, and I should say, especially the nurses, don't have equipment
00:27:52.140
So they're cobbling together whatever they can get.
00:27:57.420
They're cobbling together whatever they can get and they're trying to move forward.
00:28:06.080
And as you know, some people are going to the ICU because they don't have, some patients
00:28:12.920
are going to the ICU because they're beginning to develop these severe complications of COVID.
00:28:17.520
So that is where sort of all of a sudden we are in the middle of, we're now in the mid,
00:28:24.400
And, and people, many people start obviously having, having severe problems.
00:28:30.320
The second thing that happens at this stage, which is another mistake, is that some people
00:28:36.800
get discharged from the hospital after being tested and they are asked to return to nursing
00:28:43.760
homes where also they don't have PPE and nor do they actually have any real equipment to
00:28:50.940
protect the workers or protect residents from each other.
00:28:54.620
So we have a situation in which people are basically going back and these nursing homes
00:29:00.220
become petri dishes because the virus then goes and infects, you know, via nursing home
00:29:07.600
workers, healthcare workers, or through direct contact, people who are elderly and who are
00:29:16.560
So you go to the emergency room because you feel sick.
00:29:20.380
You aren't sick enough that they would admit you to the emergency room.
00:29:28.760
Some of those people are sent back to their, you know, rehab facilities, nursing homes, et
00:29:33.180
cetera, because they aren't sick enough to be in the hospital because the hospital beds
00:29:36.740
are too full and they go and be, and they become new sort of sources of infection at the nursing
00:29:44.240
Meanwhile, the government is saying publicly, don't wear masks.
00:29:49.120
You know, we have a federal system, as you know, which is a, which is a problem in a pandemic.
00:29:54.940
The, it's, it's the governor's individual decision about what to do, whether to isolate,
00:29:58.780
whether to quarantine, whether to close schools.
00:30:01.200
New York ultimately closes schools, in my opinion, late, too late, two weeks too late,
00:30:07.140
And then by then it is, it is too late in this city, at least to do anything.
00:30:12.100
So from that moment forward, I mean, I know New York became its own version of Italy and
00:30:19.780
so many things happened from the public perception side of this that are just frankly bizarre.
00:30:26.260
I mean, the fact that we were sitting here watching, I mean, I guess it's understandable
00:30:30.660
to hear that there's a flu in Wuhan and who knows if it's going to get here.
00:30:35.480
But, you know, once it's starting to get here, and once we see what's happening in Italy,
00:30:41.180
our lassitude seems fairly inexplicable from my point of view.
00:30:45.700
But even if you could explain that somehow psychologically, that this intuition that never
00:30:51.080
really had to be stated, that might be some law of nature that would prevent this thing
00:30:55.820
from spreading to, you know, every corner of the earth and every inch of our society,
00:31:03.780
Once it hit New York and New York became, you know, fairly similar to Lombardy, you still
00:31:12.080
saw a country that was incredibly slow to respond.
00:31:17.760
I mean, with some exceptions, California responded pretty quickly.
00:31:21.700
But even the places that have responded, even, you know, even California and went through a
00:31:27.760
significant lockdown, it still was a fairly piecemeal effort and, you know, all the while
00:31:35.420
undermined by our basic failure to get any of these necessary ingredients of a response
00:31:43.800
I mean, testing, tracing, PPE took a long time.
00:31:47.560
I don't even know if PPE is in danger of running out now.
00:31:50.540
How do you explain this general picture of, forget our initial missteps.
00:31:55.900
Once we understand the gravity of the problem, how do you explain our failure to get up to
00:32:02.140
speed and to perform the way you'd expect the leading technical and medical power on
00:32:12.040
Well, there's several explanations, Sam, and you've identified most of the problems right
00:32:16.860
One explanation is that in this federal system, or really in a system where governors have
00:32:24.820
independent choices and decisions to make and have full authority or large authority, unless
00:32:30.520
you have a system in which under emergency, a task force takes over and tells people exactly
00:32:40.880
So what happens in this particular situation is that states, you know, essentially have
00:32:47.840
or use their own metrics, their own decisions, and they're quite wildly different.
00:32:55.140
So California and New York, New York is in the mid-pandemic.
00:32:58.920
California reacts early, and many places impose lockdowns.
00:33:03.440
But in general, these lockdowns are not really severe or compliant.
00:33:09.900
So businesses are locked down, which of course causes great economic loss.
00:33:18.180
Now, that's the opposite of what you want, right?
00:33:21.120
So you want businesses, obviously, to remain open as long as you can.
00:33:25.360
And you want people to stay in their homes and be tested and be contact traced.
00:33:30.880
But in many places we've seen in the United States, just the opposite happens.
00:33:34.900
Businesses have to comply for lots of reasons, including the fact that they have to protect
00:33:42.840
You remember in Spain and Italy and many other countries, you know, there was really
00:33:47.340
a quasi-military intervention to prevent people from entering the streets.
00:33:53.380
You know, if you went to the streets, a police officer would come up to you or a military
00:33:57.380
officer would come up to you and say, what are you doing?
00:34:01.580
That was the state of lockdown, which is a real lockdown.
00:34:05.080
A quasi-lockdown is worse because it hurts the businesses and it doesn't prevent the spread
00:34:12.260
And unfortunately, in many cases, there was a quasi-lockdown.
00:34:17.940
In New York, we quickly made masking mandatory.
00:34:20.780
And I suppose I'm proud to say that's one of the things that I and others pushed very early
00:34:27.520
on, saying that, yes, we'll never have the final evidence and maybe we won't get it in
00:34:33.080
But from lots and lots of respiratory viruses, we know that social distancing and mask wearing
00:34:39.020
does reduce viral load, does reduce viral transmission, especially if both the infected
00:34:44.520
and the infectee or the naive, if both of them wear it, you get a double effect and potentially
00:34:51.980
So what you have in the United States is this kind of bizarre crisis in which there is what
00:34:59.920
I would call a quasi-lockdown with enough leak through that, in fact, as soon as the lockdown
00:35:06.000
is opened in some places, the virus starts spreading again.
00:35:10.420
Now, in New York, the lockdown was very strongly enforced.
00:35:14.220
And to some extent, we saw the worst of things.
00:35:18.420
We saw the worst of the pandemic, a huge number of cases and a huge number of deaths.
00:35:23.040
But then once the lockdown was in place, there was quite a lot of compliance.
00:35:28.440
There's a high degree of compliance in New York and New York State on masking.
00:35:32.940
There's a high degree of compliance on social distancing.
00:35:36.560
And New York opened in phase, is still going through phases, but New York opened in phases.
00:35:42.020
And that's important because when you didn't open in phases, what we've seen in other places,
00:35:47.160
when you went from lockdown to complete open situation, what happened is we've seen that
00:35:53.880
once again, the curve of not just infected cases, but deaths has begun to rise again.
00:36:02.080
These are lessons that we've learned actually from cancer and from other diseases.
00:36:05.140
It's very important to count deaths because deaths are not sensitive to testing.
00:36:11.180
You know, if you increase testing, you'll detect more people.
00:36:19.060
And I would urge anyone who's listening or reading to this to, you know, you can just,
00:36:23.520
it's very easy to Google, you can just Google US COVID deaths and you'll see exactly the whole
00:36:31.600
You'll see the rise, which is mostly in New York, New Jersey, et cetera, rise, the lockdown,
00:36:39.840
And that is, of course, in states such as Arizona, Southern California, especially more
00:36:45.680
than Northern California, and other states, Texas.
00:36:49.440
Except, Sid, even here, there's been room for doubt and conspiracy theories, right?
00:36:55.500
Even fairly prominent people have come forward saying that the death statistics are completely
00:37:02.320
false because hospitals have been incentivized to more or less presume or assert COVID as
00:37:10.560
the cause of death, even when, you know, someone is, you know, stage four pancreatic cancer
00:37:16.000
and, you know, had a week to live anyway, or they didn't even test them.
00:37:21.240
They had a fever and that's compatible with a COVID diagnosis.
00:37:24.160
And you've had people, again, you know, you've had obvious crackpots and lunatics saying this,
00:37:31.480
but then you've had extremely prominent people who don't have any expertise here, you know,
00:37:35.680
people like Elon Musk, you know, out on social media saying these things.
00:37:40.620
So can you put this particular concern to rest that our fatality statistics can't be remotely
00:37:53.720
One is from our own hospital, from the New York experience.
00:37:57.520
I know from people, from my patients at least, no one that I know was incorrectly marked as
00:38:06.780
dead from COVID when they actually were dying or dead from something else.
00:38:12.080
But more than anecdotal, actually, we have numerical evidence of this being true.
00:38:15.320
And that is the fact that the case fatality rate for COVID, which is the number of people
00:38:21.940
who die upon getting infected, has really hovered across the world around 0.7%.
00:38:30.720
You know, a little bit higher, a little bit lower.
00:38:33.120
And obviously, it depends on age groups, you know.
00:38:35.080
So if you're in the worst category of the most susceptible category to death, it would rise
00:38:44.560
These are elderly people or having comorbid conditions.
00:38:47.620
But if you look overall, the pattern of, you know, the numbers, you know, end up being
00:38:56.880
And when we were doing adequate testing, we have now slowed down in the United States because
00:39:01.660
now the test is, you can't get a test, you know, the test turnaround time has now gone
00:39:09.400
But when we were doing adequate testing and appropriate testing, the mortality rate was
00:39:21.260
So if you just use simple math, it will tell you that the simple math would tell you that
00:39:28.240
as long as the deaths don't go a logfold, let's say, or tenfold higher or lower than
00:39:34.460
what has been seen all around the world, then the deaths are real.
00:39:40.720
Now, of course, these people have premorbid conditions or comorbid conditions.
00:39:45.660
And yes, of course, I mean, some of them may have indeed have had other reasons to be
00:39:52.600
And maybe they had premorbid conditions that were quite severe.
00:39:56.520
But again, pure mathematical reasoning will tell you that it can't be, even if there is
00:40:02.760
a conspiracy, that it can't be such a large conspiracy to completely distort the distorted
00:40:12.320
So how do you explain the fact that even at this late stage, we seem to be losing ground
00:40:20.280
I mean, again, the picture is one of an Aristotle medical and technical superpower struggling
00:40:32.160
Why are we not testing and tracing like a supercharged South Korea at this point?
00:40:40.360
Well, that's partly because we don't have all the equipment to do that.
00:40:45.740
And we didn't, you know, we have, unfortunately, and again, I would refer back to the piece I
00:40:52.460
There's a very, there's a very important interview there of one of the people who makes N95 masks
00:40:58.900
And basically, his business, this is a guy named Mike Bowen, his business of making N95
00:41:06.500
masks couldn't survive because he was constantly getting out-competed by the Chinese.
00:41:12.920
And because of cost-cutting and because of efficiency in hospitals, their business was
00:41:21.200
And so we became progressively dependent on other countries, including China in particular,
00:41:27.140
to produce valuable reagents, which are important in the medical process.
00:41:34.400
So we have a situation in which all of a sudden one reagent for a test isn't available, and the
00:41:45.780
So one thing that has become very clear is that supercharged as you are, you may be supercharged
00:41:53.780
on efficiency, but you are not, in this case, supercharged on resilience.
00:42:00.840
You need to be supercharged on efficiency, and that's great.
00:42:04.220
But when things are in short supply, you need to have stockpiles, which are not efficient.
00:42:10.140
You need to have a backup system, which is not efficient.
00:42:13.320
You may need to have, again, you may need to have manufacturers, local manufacturers, not
00:42:19.480
beholden to Chinese goods or to goods from any other country.
00:42:23.320
I don't want to blame one country over another in this particular situation, but not beholden
00:42:28.000
to any particular country in which you are essentially so beholden to some good from that country
00:42:34.300
that if that part fails, you can no longer work.
00:42:44.900
Now, how have you perceived the role of public health communication here?
00:42:50.740
I'm thinking in particular about Robert Redfield, who's heading the CDC, and Deborah Birx, who
00:42:58.760
was heading the task force, you know, Pence's task force on corona.
00:43:06.540
These have been the most, to my eye, the most public medical voices.
00:43:11.980
And to varying degrees, I mean, most of their public statements have seemed, you know, fairly
00:43:18.700
constrained and even, you know, abject attempts to simply avoid embarrassing President Trump.
00:43:26.060
They're walking a line which really, in many cases, can't coherently be walked, you know,
00:43:33.180
around his misstatements in their efforts to communicate public health information.
00:43:38.680
And again, to varying degrees, I mean, I would say Fauci has escaped comparatively unscathed.
00:43:45.480
But I mean, both Birx and Redfield, again, I mean, forgive me if these are friends of yours
00:43:51.340
and I now seem to be disparaging them, but they...
00:43:57.720
I don't know Deborah or Dr. Birx, I should say, and nor any of the other folks in that.
00:44:03.520
This is now getting to be a very old story where you have people who have real reputations
00:44:08.160
and who have accomplished a lot in their lives, right?
00:44:11.580
Whether it's in business or the military, or in this case, medicine, who I can only assume
00:44:17.580
have reputations for integrity and probity and just a host of virtues that are worth protecting.
00:44:25.320
And they undergo this horrible transformation in proximity to Trump.
00:44:30.480
I mean, it's almost a visible diminishing of their integrity just standing next to the man.
00:44:39.220
Every second they spend standing too close to the reactor core, you can see them withering.
00:44:45.140
And so, I mean, for Birx and Redfield, this has been fairly painful to watch when they're
00:44:51.040
at the podium trying to make sense and say something responsible in the wake of whatever
00:44:56.920
insane bloviation just came out of the president.
00:45:01.100
And Fauci has had to navigate that same space as well.
00:45:04.120
And the result has been a pretty just, frankly, ineffectual communication about the public health
00:45:13.140
I mean, that's just been my experience watching CNN whenever I happen to catch these press
00:45:23.580
I mean, I think, you know, of the people there, I know Tony Fauci the best.
00:45:27.940
And I've worked with Tony on various things before.
00:45:31.540
I think that it's been quite clear that he's had really a task that, a completely unenviable
00:45:39.360
task, he's had a task that I just don't know how you could possibly navigate, given the
00:45:46.000
situation and given the problems that have arisen.
00:45:51.360
I mean, you can't keep saying it at the same prep form.