Making Sense - Sam Harris - #222 — A Pandemic of Incompetence

00:00:00.000 Welcome to the Making Sense Podcast.

00:00:08.460 This is Sam Harris.

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00:00:46.520 Okay, the briefest possible housekeeping.

00:00:49.740 We are one week away from the presidential election in the United States, and I am sure

00:00:57.200 I will have a Zoom call for podcast subscribers at some point immediately following a result.

00:01:06.080 We don't know how long it will take to get a result, but I will pick my moment and we will

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00:01:20.260 Q&A on Zoom.

00:01:22.760 And if you want to participate in that, you can subscribe to the podcast at samharris.org.

00:01:29.200 Okay.

00:01:30.540 Today I'm speaking with Nicholas Christakis.

00:01:33.760 Nicholas is a physician and sociologist, and he directs the Human Nature Lab at Yale University,

00:01:40.900 where he is the Sterling Professor of Social and Natural Science in the departments of

00:01:46.240 Sociology, Medicine, Ecology and Evolutionary Biology, Statistics and Data Science, and Biomedical

00:01:53.120 Engineering.

00:01:54.120 He is also the co-director of the Yale Institute for Network Science, and he's the author of

00:01:59.960 several books, Connected, Blueprint, and most recently, Apollo's Arrow, The Profound and Enduring

00:02:07.840 Impact of Coronavirus on the Way We Live.

00:02:11.180 And that is the topic of today's conversation.

00:02:14.520 Nicholas and I cover a lot of ground.

00:02:16.440 We talk about the breakdown of trust in institutions and experts, the corruption of science by politics,

00:02:24.440 the ineptitude of the Trump administration in handling the pandemic, whether the gravity

00:02:29.400 of COVID-19 has been exaggerated, using this experience to prepare for future pandemics, whether

00:02:36.020 it's true that COVID deaths are being over-reported, bad incentives in the medical system, the prospect

00:02:42.780 that the coronavirus will evolve to become more benign, the efficacy of current treatments,

00:02:50.040 safety concerns about a rushed vaccine, the importance of public health communication,

00:02:56.080 when life on earth might return to normal, the economic impact of the pandemic, long-term

00:03:03.040 social changes that may result, the future of universities, Nicholas's personal habits to

00:03:10.620 keep from getting the coronavirus, the importance of rapid testing, and other topics.

00:03:18.680 Anyway, this is an up-to-the-minute look at the state of the pandemic, and certainly a timely

00:03:24.860 conversation prior to the election.

00:03:27.100 And now I bring you Nicholas Christakis.

00:03:36.360 I am here with Nicholas Christakis.

00:03:38.600 Nicholas, thanks for coming back on the podcast.

00:03:41.040 Sam, thank you so much for having me.

00:03:42.420 It's good to be back.

00:03:43.880 So yeah, you are now a multi-repeat guest, and so I know I'm in good company.

00:03:49.440 The first couple of times were just a dress rehearsal, but now you can be a co-host whenever

00:03:54.260 you want, but briefly remind people what your station in life is and how you come to know

00:04:01.020 or have strong opinions about many of the topics we're going to touch.

00:04:05.120 Oh, goodness.

00:04:05.800 Well, I'm a physician and a social scientist, and I've spent my life or my career in academia

00:04:11.660 doing scientific research and taking care of patients up until about 10 years ago.

00:04:16.520 I was a hospice doctor taking care of people who are dying.

00:04:19.740 But I run a moderately decent-sized lab at Yale University now, doing science of different

00:04:26.540 kinds.

00:04:27.060 We have a bunch of different groups in my laboratory.

00:04:31.020 We do everything from sort of quantitative public health research to work on the microbiome

00:04:36.920 to classic sociology research.

00:04:39.840 We have actually a social robotics division.

00:04:42.260 We work on artificial intelligence.

00:04:44.340 Anyway, we do a whole bunch of cool things.

00:04:45.820 I'm very proud of them, this group of mine, and I teach students as well, and I've lately

00:04:52.020 become very interested in the evolutionary origins of human social interactions, and most recently

00:04:59.540 in the pandemic, in the COVID pandemic.

00:05:03.280 Yeah.

00:05:03.440 Well, you, unlike many people, have managed to put this pandemic to very good use.

00:05:09.640 I mean, we've been under the shadow of this thing for about eight months now, and you have

00:05:15.480 managed not only to write a book about the pandemic, but to publish it, and that is astonishing

00:05:21.940 if you are at all familiar with the usual time course of writing books and publishing them.

00:05:27.860 And that book is Apollo's Arrow, The Profound and Enduring Impact of Coronavirus on the Way We

00:05:33.260 Live.

00:05:33.660 And that is out just this week as we release this.

00:05:37.280 That should be available to anyone online or in your bookstore if you are intrepid enough

00:05:43.100 to visit your local bookstore.

00:05:44.940 So I want to talk about COVID, obviously, and I want you to bring us all up to the present

00:05:51.700 in terms of what we should know about it at this point, and also to forecast what you

00:05:56.760 expect to see in the next year or so.

00:05:59.820 But I want us to use the pandemic as a lens through which to consider much else that's

00:06:05.720 ailing us, because we're living with a significant breakdown in our ability to acknowledge a shared

00:06:14.060 reality.

00:06:15.160 And this is based on the deliberate spread of disinformation, which I've devoted a few

00:06:20.440 podcasts to.

00:06:21.720 It's also based on how our natural biases are being amplified by technology.

00:06:28.220 I mean, social media has weaponized our confirmation bias and our tribalism and our other less

00:06:35.520 than epistemic ways of thinking.

00:06:37.840 And the result is that we're finding it harder and harder to collectively acknowledge the same

00:06:44.300 set of facts, much less agree about what to do in response to those facts.

00:06:48.800 So we're dealing with this total pollution of our information space, and it's affecting everything.

00:06:54.440 And as a result, our trust in institutions, you know, whether it's the government or the

00:07:00.400 press or universities or, you know, scientific journals, is at an all-time low.

00:07:06.340 And worse, given what is happening, it probably should be at an all-time low.

00:07:12.320 I mean, it's just, I'll just give you one sign of the times that happened recently.

00:07:17.300 The New England Journal of Medicine published a truly blistering editorial about how badly

00:07:24.340 the Trump administration has handled COVID.

00:07:26.900 And I read that, and I basically agreed with every word of it.

00:07:30.500 And, you know, we'll get into the details there.

00:07:33.060 But then I noticed that my Twitter feed just lights up with allegations that the New England

00:07:40.080 Journal of Medicine is financially tied to the Chinese Communist Party at this point, right?

00:07:47.300 Now, I don't even have time to figure out whether or not that's true, right?

00:07:52.180 It's like, like it's, you know, but nothing at this point would surprise me.

00:07:55.620 But I have no time for this because you can literally hold your breath until the next scandal

00:08:01.160 arises that seems worthy of your attention.

00:08:03.780 I mean, they happen over the time course of minutes now.

00:08:06.900 So it's just a crazy space to even be having this conversation in.

00:08:11.360 And so I want us to focus on COVID and get deeply into it.

00:08:14.520 But I think we should talk about the way in which politics, in particular, is deranging

00:08:19.960 the information space and science itself at this point.

00:08:24.840 Yeah, I mean, in a way, we could even start with that.

00:08:27.460 I mean, I was scribbling some notes about topics for us to discuss as you were speaking.

00:08:31.620 And there's so many directions we could go in.

00:08:33.340 But I guess with one predicate, we could start with that, which is that we happen to be alive

00:08:39.280 at a moment when we are experiencing something very unusual in the history of our species.

00:08:45.340 And that is that a new, serious, widespread pathogen has been introduced into our midst.

00:08:52.220 And this only happens once every 50 or 100 years.

00:08:55.040 And one of the themes, actually, of my book is that, you know, this feels very alien to us,

00:09:01.860 this risk of death, this fact that we have to spread out, this collapse of our economy.

00:09:08.940 But I guess a very important idea is that plagues are not unusual for our species.

00:09:16.080 This is just new to us.

00:09:18.400 We think this is so weird.

00:09:20.500 We think this is so unusual.

00:09:21.780 We think this is so unfair.

00:09:24.180 But really, epidemics of this kind have been afflicting us for thousands of years.

00:09:29.720 That is actually an interesting story about prior to 10,000 years ago, prior to the agricultural

00:09:35.240 revolution, what were such epidemics possible?

00:09:38.640 And the gist of it is probably not.

00:09:40.800 But anyway, from the time we invented agriculture and moved into cities, we've been prone to this.

00:09:47.240 And in fact, the title of the book, Apollo's Arrow, comes from the opening of the Iliad,

00:09:52.180 in which, in fact, there's a plague.

00:09:55.000 I mean, that's, you know, that's what, that's how old this phenomenon is.

00:09:59.180 You know, 3,000 years ago, Homer was writing about this.

00:10:02.200 Anyway, so this germ has, you know, which has its own, it's a, we can debate whether viruses

00:10:10.160 are living things or not.

00:10:11.320 But for the sake of argument, this germ is acting like any other living thing.

00:10:15.760 It's found untouched virgin territory, namely our bodies.

00:10:20.140 And it's just, it's just having what's known as an ecological release.

00:10:24.180 It's just spreading relentlessly among us.

00:10:27.380 Just like if you had let rats loose on New Zealand 1,000 years ago, they would take over

00:10:33.140 the whole of the country.

00:10:34.260 So there's no natural immunity to this pathogen, and it's just doing, having its way, you know,

00:10:40.000 just going about it, about its business.

00:10:42.080 But leaping ahead now with that background to the point you put on the table for us to

00:10:47.520 discuss initially, it's odd to me the way this virus is striking us at a particular moment

00:10:53.380 in our own national history.

00:10:55.520 I don't know about global history, but certainly national history.

00:10:58.480 Because the virus has struck us at a moment in our political life, which is very inauspicious

00:11:05.280 for us, but perfect for the virus.

00:11:08.720 So we've had what I would call a thinning out of our intellectual culture.

00:11:14.360 We have a denigration of expertise.

00:11:16.980 You know, we think that there's something evil about experts or that they're self-serving,

00:11:21.800 which is really odd because when you need a car mechanic, you want an expert, right?

00:11:27.960 And there's this famous saying in sociology that, you know, one man's occupation is made

00:11:33.720 up of the emergencies of other people.

00:11:35.700 So when you have a flood in your basement, it's a rare event and an emergency for you,

00:11:40.640 but it's the routine daily experience of the expert plumber who comes to repair it.

00:11:46.660 So why we have this attitude or this posture towards expertise is itself very odd, but we

00:11:52.220 have a kind of anti-expertise, which is a reflection, I think, of a kind of anti-elitism that we

00:11:58.520 have in our society right now.

00:12:00.900 There is, in addition to that, as you described, a kind of denigration of science or a disbelief

00:12:05.360 in science or a politicization of science, whereby scientists are seen as just any other,

00:12:11.480 like any other interest group, you know, trying to feed at the public trough instead of seen,

00:12:16.220 I think more rightly, of course, I'm very partial to scientists and science, but I recognize

00:12:21.620 science as limitations, and we can talk about that as well.

00:12:24.280 But this idea that if scientists tell us something, there must be an ulterior motive rather than

00:12:30.320 trying to engage science as science is also a very dangerous ascendant ideology in our society

00:12:37.340 right now.

00:12:38.480 And there are two more items which I'll mention, and all of this causes quite a witch's brew.

00:12:42.520 Another, of course, that everyone is familiar with is the political polarization, which by

00:12:47.240 many metrics by political scientists show that we're at a moment in our history when we're

00:12:52.140 very politicized, such that even a simple act like wearing a mask becomes seen either as

00:13:00.160 an indicator of virtue, oh, you know, I'm on the left, you know, I'm a good citizen, I wear

00:13:05.820 a mask, this symbol, this mask symbolizes my commitment to the commonweal, or, you know,

00:13:12.140 the mask is seen as an infringement on my liberty, you know, like I'm on the right, you know, I

00:13:16.420 should be allowed to do what I want, how dare anyone tell me to wear a mask? 0.96

00:13:19.920 This is ridiculous. 0.92

00:13:20.840 It's just a mask, you know, it's just a barrier to the spread of droplets, you know, it doesn't 0.98

00:13:27.880 need to be politicized.

00:13:29.040 And many other countries, incidentally, do not politicize mask wearing.

00:13:31.960 It's not seen as a political act.

00:13:33.940 And finally, to this witch's brew, is this extraordinary loss of capacity for nuance in

00:13:42.280 our society.

00:13:42.900 And I know you talk about this a lot, Sam, on this podcast, which is why things are seen

00:13:47.600 as black or white.

00:13:49.140 I mean, every topic, why we can't acknowledge that there's shades of gray, there's uncertainty,

00:13:55.640 there are intermediate steps.

00:13:57.440 You know, you don't have to be with me or against me.

00:14:00.660 You can be partly with me, you know, or you can recognize that this is a complicated topic,

00:14:06.100 you know, whether it's whatever we're talking about.

00:14:09.200 There's this sort of desire for simple perspectives on the world that I think is not in keeping

00:14:15.880 with the nature of the real world.

00:14:17.220 So all of these things, the denigration of expertise, the disbelief in science, the polarization,

00:14:22.360 the loss of nuance, this is when the virus is striking us.

00:14:26.300 And boy, has this sapped our ability to respond effectively.

00:14:29.960 Hmm.

00:14:31.220 Well, let's focus on the political co-option of science.

00:14:35.380 And this has happened, the pressure has come from both the right and the left here in different

00:14:42.240 ways.

00:14:43.340 And in different topics.

00:14:44.820 Yeah.

00:14:45.260 And it, but in, to a degree on both sides that has revealed scientists themselves to be all

00:14:52.260 too human, right?

00:14:53.280 So, so the, some of the skepticism and despair over, over the, kind of the loss of the stature

00:15:00.180 of scientific opinion here is understandable given just how craven so many scientists have

00:15:09.240 shown themselves to be.

00:15:10.480 I mean, so to see what's happening on the right, or at least in Trumpistan, where you locate that

00:15:15.500 on the political spectrum is sometimes difficult.

00:15:17.760 But what we see is this effort to please the delusional boy king.

00:15:24.920 And it results in some of the most reputable people in public health walking on eggshells 1.00

00:15:31.840 around this monstrously ignorant and belligerent president. 0.97

00:15:36.520 And so we have, you know, Anthony Fauci, you know, who has the, the most stellar reputation 0.98

00:15:41.840 of anyone.

00:15:42.640 He's been writing, he's been writing about respiratory pandemics since before, not before

00:15:47.200 you and I were born, but, but, you know, for decades.

00:15:50.220 I mean, yes, we're very lucky to have him.

00:15:53.020 But still most of his energy seems to be bound up in an effort to not embarrass the president,

00:16:00.500 right?

00:16:00.860 And he's found that almost impossible to avoid doing.

00:16:04.580 And then we have someone like Dr. Birx, who, you know, in those first weeks and a couple

00:16:11.080 months of her prominence, you know, seemed more and more like a hostage with Stockholm

00:16:16.160 syndrome, right?

00:16:17.180 And then Robert Redfield, who's running the CDC, appears just visibly neutered whenever

00:16:23.040 he's communicating about COVID in public.

00:16:25.100 And none of this inspired confidence in the beginning.

00:16:28.680 And since most of these people have almost entirely disappeared, I trust for also for political

00:16:34.400 reasons.

00:16:35.500 So there's that sort of the lack of credibility in the public face of the messaging.

00:16:40.020 But then there's a reasonable concern that the Trump administration has so vitiated the

00:16:47.000 scientific expertise in government, you know, whether it's at the CDC or the FDA or, you know,

00:16:53.820 in the EPA.

00:16:54.640 I mean, just across the board, pre-COVID, this was happening and has been replacing career

00:17:01.300 civil servants and scientists with political lackeys and industry lobbyists.

00:17:06.740 And given the ineptitude of our response to COVID, it seems worth worrying that maybe we're

00:17:13.240 no longer the medical and technical superpower we once were or thought we were.

00:17:17.800 And, you know, this culminates in things like Harold Varmus, another person with a totally

00:17:22.900 stellar reputation, writing an op-ed in the New York Times declaring that we can't trust

00:17:27.660 the CDC's guidance about whether to reopen schools, right?

00:17:31.640 So there's a breakdown in authority here.

00:17:35.320 And then from the left, we see this, the moral panic around wokeness in the aftermath of the

00:17:43.220 killing of George Floyd in the midst of the pandemic.

00:17:46.040 And we see this insane double standard endorsed by literally thousands of public health officials

00:17:52.580 where they declare that the protests against the lockdown were, you know, murderously irresponsible,

00:17:59.100 but protests in support of Black Lives Matter, you know, as if by magic are not only okay,

00:18:04.660 they're actually necessary, right?

00:18:06.840 And so that's where we have the left and the right competing in this insane sort of

00:18:12.780 reputational potlatch to see who can destroy their gravitas, you know, more quickly.

00:18:19.880 And so that's the space in which our political partisanship has just made a mockery of scientific

00:18:27.100 communication.

00:18:28.400 Well, I mean, this is a very complicated topic, obviously, that goes in many directions,

00:18:33.160 and you've alluded to quite a few of them.

00:18:34.720 And I know you've thought deeply about this too.

00:18:36.360 But first of all, you know, one of the principles of democracy is that we get to elect our leaders

00:18:41.440 and we have an executive branch that is responsive to the people we elect.

00:18:46.660 Now, you could make the argument that the people voted for Donald Trump.

00:18:53.240 There are, of course, side arguments about how more people voted for Hillary and blah, blah, blah.

00:18:56.420 But we had the system we had.

00:18:58.040 He won the election.

00:18:59.500 And therefore, it's a reflection of our democracy that the will of the people is that the scientists

00:19:04.760 be muzzled, which is a kind of an odd conclusion to come to.

00:19:08.300 But, you know, you could, in fact, somehow make that argument that it is reasonable or correct

00:19:13.240 or a working of a democratic right that the scientists are being muzzled. 0.92

00:19:17.560 And yet, we believe, all of us, certainly I do, that there should be a way in which science

00:19:22.080 could be outside of politics.

00:19:23.620 Otherwise, you get a kind of Lysenkoism, right, during Stalinist time.

00:19:27.120 You know, genetics was seen as a, discoveries in evolutionary biology and genetics were seen

00:19:31.580 as a great threat to communism because the communists' belief wanted to believe that we

00:19:35.940 could change social structure and therefore change human nature.

00:19:39.020 And so, you know, in writ large, discoveries in evolutionary biology and genetics were seen

00:19:44.040 to subvert that, you know, that there could be a kind of innate human nature.

00:19:47.320 And so, of course, Lysenko, you know, had a kind of Lamarckian idea about acquired

00:19:51.920 traits and he arranged for people who didn't agree with him to be shot, you know, other

00:19:57.460 scientists.

00:19:58.480 As one does when reviewing scientific papers, one doesn't like.

00:20:01.560 Yes, yes, exactly.

00:20:02.760 Who among us wouldn't watch his peer reviewers to be shot?

00:20:07.860 So this temptation to have politics interfere, as you said, is longstanding.

00:20:14.260 And also, incidentally, another historical strand in this is that science often is expensive

00:20:20.000 and is a luxury and has been done at the public purse.

00:20:24.540 You know, whether it's da Vinci or Galileo, you know, working for the Medicis or Seneca

00:20:30.320 or Euripides, you know, working in the king of Syracuse, et cetera.

00:20:34.500 I mean, since time immemorial, there's this sense, which is that, you know, scientists work

00:20:39.920 for the king in a sense.

00:20:41.560 But the problem we have right now is even more complicated than that for various reasons,

00:20:45.920 not just the fact that it's the modern era and we have institutions which are supposed

00:20:49.820 to provide ballast against the boy king, as you said, is that what is the dilemma of

00:20:55.960 a good and wise person when there is incompetent leadership?

00:21:02.940 And, you know, Socrates writes about this, Plato writes about this as well.

00:21:06.480 Now, let's say you're General Mattis or you're General Kelly or you're Tony Fauci or you're

00:21:13.980 anyone else who is trying to figure out, like, my allegiance is to the nation and if I serve

00:21:20.820 in this administration, will I be tainted or do we only, do we want competent people to

00:21:27.060 refuse to serve on the grounds that their reputations will be harmed?

00:21:31.280 Well, that can't be the right answer because, you know, we want competent people running.

00:21:35.180 On the other hand, if these competent people serve, do they then lose their souls or do

00:21:40.580 we get this kind of subversion of the scientific process?

00:21:43.460 I mean, when do you resign?

00:21:44.900 When do you say, no, I will not implement this policy or I will not be quiet?

00:21:49.460 So there are rules how quickly Fauci cannot easily be fired.

00:21:53.920 There's a process whereby he can be fired, unlike the Secretary of Health and Human Services.

00:21:58.800 I don't know about Redfield and his position specifically, how easily he can be fired.

00:22:02.320 But, you know, many of these people are probably reasoning, I can do more good than harm. 0.98

00:22:07.000 You know, I know I look like an idiot, not Fauci, but, you know, some of the others. 0.97

00:22:12.120 But, you know, I need to help the country and I can moderate some of these, you know, 0.99

00:22:17.840 ridiculous extremes that the political elites are forcing on us.

00:22:22.200 Anyway, it's hard. 0.56

00:22:23.520 I mean, it's very hard to know what to do in this type of a situation.

00:22:27.100 And I'm not making apologies for anyone, and I put the blame squarely at the feet of the

00:22:32.980 political leadership, Trump and the administration, for the utterly inept response the United States

00:22:39.000 has had.

00:22:39.460 Let me just say one more sentence about why I think it's especially appropriate to hold

00:22:42.600 Trump responsible.

00:22:44.500 Because unlike, let's say, you could reasonably argue that certain other leaders, you know,

00:22:50.280 like the British and the Italians, for example, also got it wrong.

00:22:53.640 But the difference is that the President of the United States has the CDC working for

00:22:57.960 him and the National Security Agency working for him.

00:23:00.660 And he was told in December what was going to happen.

00:23:04.440 Unlike the rest of us who couldn't necessarily have known what was going to happen, the very

00:23:08.500 best epidemiologists on the planet, you know, work at the CDC.

00:23:13.180 And we have, I believe, the best intelligence agencies.

00:23:16.700 And by the time we'll probably come back to this, by the time I started paying attention

00:23:19.340 to this in January, we now know that even as early as December, the president was briefed.

00:23:24.620 So that's really a dereliction of duty, you know, to be told that a pandemic is coming

00:23:28.720 by people you should know are reputable, are not making this up, and to ignore that or fail

00:23:34.600 to take action, to fail to use the wealth of this nation to prepare, to put PPE in place,

00:23:41.020 to build testing capacity, to do all the things that are recommended.

00:23:44.120 Incidentally, the CDC has released every three to five years a playbook on how to cope with

00:23:50.100 respiratory pandemics.

00:23:51.280 The Obama White House, actually after the Bush White House, had also bequeathed to Trump

00:23:56.140 such a playbook.

00:23:56.940 But even leaving aside the political transmission of this information, in the CDC, you can go

00:24:03.440 online and it says, you know, plans for a respiratory pandemic.

00:24:06.600 Bill Gates released a TED Talk, I forgot if it was five or 10 years ago, that has 30 million

00:24:12.640 views, talking about exactly what's happening to us.

00:24:15.880 So I can understand why the, quote, man or woman on the street are shocked and surprised

00:24:21.020 that this is happening to us, like we discussed a little while ago.

00:24:24.500 But our political leaders who are entrusted with the duty to protect us should not have

00:24:31.220 been surprised.

00:24:32.100 In fact, we're not surprised and therefore rightly are being held to account for the hundreds

00:24:36.780 of thousands of deaths.

00:24:37.780 And incidentally, I think we are going to surpass half a million deaths in the United States.

00:24:41.800 When I, you and I spoke about this last March, I can't remember what my forecast was.

00:24:45.960 It was hundreds of thousands, I'm pretty sure.

00:24:48.000 But it's gone up since then.

00:24:49.940 I mean, we, you know, this is going to be the leading killer of Americans this year.

00:24:54.820 And per capita will be for sure the second worst pandemic we've had in this nation for,

00:25:00.540 you know, for over a hundred years.

00:25:02.320 Maybe, maybe approach 1918, it depends.

00:25:05.020 Okay, well, I want to talk about the future, but before we get there, let's talk about the

00:25:10.580 past and present here.

00:25:13.100 So when we last, I had you on pretty early in the pandemic, you know, just when I began

00:25:18.380 to take it very seriously.

00:25:20.220 And I was not especially prescient, but I was, as I've said several times on the podcast,

00:25:27.020 I was palpably at least a week or two earlier than almost anyone in my sphere, right?

00:25:35.740 So I was the, you know, the dad at school talking to the other parents and getting these

00:25:41.900 looks of astonishment and concern, you know, when I said, you know, we're pulling our girls

00:25:47.940 out of school on Monday and we looked like hypochondriacs.

00:25:52.680 And, you know, it was, it was scarcely, you know, a week or 10 days before schools throughout

00:25:57.600 the city and in many other places in the country were closed.

00:26:00.940 You know, the experience of being a week early was one of living on another planet, right?

00:26:06.640 Like my last trip to the supermarket was one where it was a completely normal trip to the

00:26:11.220 supermarket.

00:26:11.640 And a few days later, I was hearing stories of people literally running down the aisles just

00:26:17.480 and sticking their straight arm out and just scooping 30 bags of pasta into their carts

00:26:22.620 So, you know, I don't give myself much credit for being early, but once I got clear about

00:26:29.440 or thought I was clear about the nature of this problem, I initiated some conversations

00:26:33.460 with people like yourself.

00:26:35.360 And at that point, there was a general concern that there was a trade-off between public health

00:26:43.440 and the economy, right?

00:26:44.740 If we take this too seriously, we're going to torpedo the economy and that's just an intrinsically

00:26:51.240 bad thing.

00:26:52.020 And to say nothing to the fact that when that happens, people die for other reasons.

00:26:56.740 There's a mortality calculus on both sides here.

00:26:59.700 And many people were persuaded, you know, at great efforts and obviously incompletely, but

00:27:05.940 many people were persuaded that whatever your concerns about this, you know, maybe not being

00:27:11.840 that much of a lethal pandemic and, you know, we're going to do intense harm to the economy,

00:27:18.640 but it makes sense to so-called bend the curve.

00:27:21.940 We need to keep our hospitals from being overwhelmed.

00:27:25.960 And people got on board with that project for about a month or six weeks or so before our lack

00:27:34.060 of full commitment to that became evident.

00:27:36.620 And also, we did successfully bend the curve to the point where, okay, our hospitals survived,

00:27:44.200 right?

00:27:44.420 That we got, we had some fairly scary reports of ICUs filling up, but basically we kept the

00:27:50.940 ship afloat.

00:27:52.140 And since then, there's just been this total bifurcation in people's thinking about this

00:27:59.640 pandemic.

00:28:00.120 I still know people and, you know, you can certainly see them in many others on social

00:28:04.300 media who think we had a colossal overreaction to this thing.

00:28:09.740 The story here is not that we didn't sufficiently prepare.

00:28:14.280 The story is that we panicked and that something like herd immunity is an inevitable terminus to

00:28:22.180 this globally and locally.

00:28:24.120 And, you know, this kills people in old age homes, but it doesn't kill all that many people

00:28:29.340 who are not, weren't going to die of something soon anyway.

00:28:32.580 And this, again, this is broken along predictably political lines.

00:28:36.240 Yeah, but I know you want, you're, you're going to want to talk about how catastrophically

00:28:41.920 bad our response has been to this and how much we need to learn from this episode.

00:28:46.920 But I don't see ourselves poised to learn those lessons because so much of our society

00:28:54.460 seems to think that this is, if not a hoax, just hoax adjacent, right?

00:29:01.060 Okay, but first of all, there's so much again to unpack there.

00:29:05.120 We need to come back to the herd immunity.

00:29:06.740 We can come back a little bit to the flattening the curve thing.

00:29:09.220 But I do want to also talk to you, and I made some notes here about notions of quantifying

00:29:14.100 risk, and maybe that's where I'll dip into what you just said.

00:29:17.260 So on the one hand, we, the country has been confused and the public health messaging has

00:29:23.840 been confused by people thinking, because this, unfortunately for us, this disease is, has

00:29:31.580 a variety of things that can happen to you from no symptoms to mild symptoms to serious

00:29:37.040 symptoms and long-term disability to death.

00:29:39.340 So it's a very heterogeneous presentation.

00:29:41.560 And in a way that has muddied the public health message, because so many people have such a

00:29:46.420 benign course that it becomes possible to imagine, well, this might not be so bad in

00:29:51.380 the way that if it were cholera or smallpox, people wouldn't be saying that.

00:29:55.780 So the intrinsic nature of the pathogen, which is its protean manifestations, ironically have

00:30:01.840 made it more difficult for us to combat.

00:30:03.580 In addition to its protean nature, the disease is deadly, is 10 times deadlier than the flu,

00:30:11.740 but is not as deadly as the bubonic plague or as the smallpox or cholera, which were called

00:30:16.600 the holy trinity of infections in the Indian subcontinent for centuries.

00:30:20.480 You know, they were so deadly.

00:30:22.080 And that also is ironic, because it's, it's, if, if this disease had been as deadly as smallpox

00:30:28.020 or Ebola, you better believe Americans would be taking it more seriously.

00:30:32.380 And incidentally, I just want to highlight for your listeners, we are lucky it's not that deadly.

00:30:36.600 There's no ex-ante reason as known to God that this disease is only as bad as it is.

00:30:41.900 It could have been so much worse.

00:30:43.640 And in fact, the pathogen, a SARS-1 that afflicted us in 2003 in a pandemic that petered out for

00:30:50.880 reasons I actually discuss in the book compared to the current pandemic, it had some subtly different

00:30:55.660 biology that made that, that germ peter out, that germ was, by some metrics, 10 times deadlier

00:31:02.920 than the current one.

00:31:03.900 So the SARS-CoV-2 kills about 1% of the people that get symptoms from it, kills between 0.3

00:31:11.660 and 0.5%, or 0.3 and 0.6% of the people who become infected with it, and about 0.5 to 1.2%

00:31:19.860 of the people who develop symptoms from it. And it varies a lot by age, but let's just say roughly

00:31:27.000 about one out of 100 people who are symptomatic from this condition will die. And the original 0.97

00:31:31.920 SARS probably was 10 times deadlier. And in some ways, the lower lethality of this condition have

00:31:37.300 made it harder for us to take seriously. Because even if the disease had been left unfettered in our

00:31:43.320 society, to just run loose, and probably in that scenario, maybe 200 million Americans would have

00:31:50.160 been infected. And of those, let's say 100 million would have had symptoms. And of those, maybe a

00:31:55.540 million would have died. Even in that scenario, that's only 1 million out of 330 million Americans.

00:32:02.160 And this has led to some people doing calculations that say, well, don't worry about it. You know,

00:32:07.400 one out of 300 chance of dying isn't so bad, they say. But that's a completely wrong way to

00:32:14.080 understand and compute risks of disease in general, let alone infectious diseases. A million deaths

00:32:19.800 is a catastrophe. It's an enormous number, an enormous amount of death and destruction in a year

00:32:25.980 in our nation. But our nation will survive. I mean, we are going to see the other side of this. And this

00:32:32.580 is another thing that's so interesting about plagues, is that even the bubonic plague,

00:32:37.400 which would sweep through cities and kill often half, sometimes nearly all of the people in a

00:32:43.340 city, ended. I mean, we have accounts, for example, among Native American populations that

00:32:48.920 were annihilated by smallpox. You know, 95% of the people dying within a month. Like, everyone is dead.

00:32:55.080 You know, just like a... And we have accounts from medieval Europe of people thinking that this was

00:32:59.940 the second coming, you know, that the world was being utterly, completely destroyed. So bad was the

00:33:06.120 toll of death. We thankfully do not have that situation with this pathogen. But I just want

00:33:11.120 readers, listeners to understand that it's dumb luck that that's the case. I mean, this could have

00:33:16.200 been a much worse pathogen. It's not. And therefore, the fact that we should take that as a blessing,

00:33:21.900 not as an opportunity to be reckless and then say, oh, well, let's just go about our business and

00:33:27.420 ignore it. There's no reason we need to lose as many Americans as I fear we are going to lose.

00:33:32.380 Before you continue, let's just secure that one epiphany here, because I think everyone,

00:33:40.660 regardless of their politics, should be able to agree about this, that there is simply no guarantee

00:33:47.160 that the next pandemic won't be an order of magnitude worse than this, or even worse than

00:33:54.620 that, right? I mean, there's no guarantee. Yeah, it could be, but you're absolutely right. But also,

00:33:59.040 to be clear, these types of pandemics, part of the problem is there's no one alive that remembers

00:34:03.800 this experience from before. You know, the 1918 pandemic was 100 years ago. And so all the

00:34:10.900 learnings, yes, we should learn our lesson, but it is true that it is unlikely in our lifetime we will

00:34:17.080 have personally to deploy these lessons again. Except when you think about the possibility of

00:34:22.700 bioterrorism, right? I mean, an engineered pandemic.

00:34:27.060 Yeah, or it could, I mean, there's stochasticity. I mean, there's already a pretty bad flu,

00:34:31.720 influenza A germ that's brewing in China, we know from surveillance, from epidemic surveillance 0.85

00:34:37.320 procedures. You're right. I mean, there could be in 10 years or in 20 years or in one year and 30

00:34:43.220 years, we don't know. The usual inter-pandemic interval is about 10 to 15 years. And most of those

00:34:50.260 are not so serious, like the 2009 influenza pandemic. The reason people don't remember

00:34:54.980 that one, although it was a pandemic, was that it was very mild. It was like the common cold. You

00:34:58.780 got it, but you didn't die. But there absolutely could be another pandemic, and we absolutely should

00:35:04.640 be better prepared and do a better job of it. I'm not saying we shouldn't. I'm just saying it's,

00:35:10.400 you know, probabilistically unlikely we're going to have another SARS-CoV-2 event, you know,

00:35:15.840 in the near future. Right. So at a minimum, I think we should agree that we want to be able

00:35:22.680 to respond intelligently and at minimal economic and social cost to a terrifyingly lethal pandemic

00:35:32.820 should such a thing emerge. And on some level, it is just a matter of time, whether it's one year,

00:35:38.580 10 years, 100 years. We know that nature is continually cooking something up like that for us.

00:35:45.840 And there are, you know, there are bird flus that can jump into the human population and have,

00:35:50.940 you know, 60% lethality. And we know that there are bad actors who will increasingly

00:35:56.780 get their hands on the means to produce engineered viruses and other pathogens. This is something we

00:36:03.820 want to be good at. And during this dress rehearsal, we proved that we're actually bad at responding

00:36:11.200 to this problem. So we have to get better at this, whatever you think about COVID.

00:36:17.220 Yeah, no, I agree with that. But I also want to pick up another thread of what you were saying,

00:36:20.700 which is there's only so good one can get. I mean, a circulating deadly germ is a circulating

00:36:27.120 deadly germ. It's hard to imagine having the economy escape unscathed. Even the Koreans, 1.00

00:36:34.100 even the Koreans or the Chinese or the New Zealanders or the Greeks or, you know, people who have done

00:36:38.740 reasonably well with a pandemic, their economies are devastated. And it's because in order to cope

00:36:44.140 with a germ, you have to cease social interactions and economy requires social interactions. And so,

00:36:51.800 you know, I think you can test and trace and wear masks and you can do a lot to maintain a

00:36:56.700 semblance of normality. But it's hard to argue that a world in which suddenly you've introduced a

00:37:02.620 deadly contagious pathogen through implementation of certain responses can be neutralized. So it's

00:37:10.860 not completely neutralized, but we absolutely can do vastly better than we have been doing.

00:37:16.080 But it will cost. I mean, there will be at some significant socioeconomic cost. It's unavoidable.

00:37:21.860 So just whatever you think about what's happened so far and what's likely to happen in the future,

00:37:25.960 you should agree that whatever lessons there are to be learned about how to respond

00:37:31.260 to a pandemic, we should learn those lessons. Like you can't be skeptical about that project,

00:37:37.680 even if you think, you know, COVID was not at all what the libtards cracked it up to be. 0.99

00:37:44.080 Yeah, right. I mean, I certainly wouldn't argue about that, but this is going back to our argument

00:37:47.860 about science. Yes, this is what science is about. We should learn. We should observe the world.

00:37:52.920 We should make inferences and we should record them and we should learn from them. Absolutely.

00:37:58.840 And yeah, absolutely. But I also want to emphasize, in fact, that's one of the things that I

00:38:03.400 discuss in Apollo Zero. One of the ironies of this pathogen is that the way contagious diseases work,

00:38:10.260 of course, is to exploit our social nature. We humans live socially for a very specific set of

00:38:16.660 reasons. And this was the topic of a previous conversation you and I had, and of course, a previous

00:38:20.620 book as well, you know, a blueprint, the evolutionary origins of a good society. But anyway, we humans

00:38:26.880 live socially for very particular sets of reasons. And just to summarize a couple of the key ones,

00:38:31.360 one is to cooperate. I mean, this seems obvious, but we band together to be able to achieve things

00:38:35.880 we weren't able to achieve on our own and also to be able to learn from each other. So most animals

00:38:42.420 can learn independently. You know, a little fish in the sea can learn that if it swims up to the

00:38:47.100 light, it will find food there. That's independent learning. But we, we can observe each other and

00:38:53.660 learn. So you put your hand in the fire and you learn that it burns. That's independent learning.

00:38:59.660 Or I can, and that you learn something, but at great cost. Or I can watch you put your hand in

00:39:04.260 the fire and I gain almost as much learning, you know, fire burns, but pay none of the cost. You know,

00:39:09.260 my hand is unburnt. Or, or you eat a red berry in the woods and die. And I watch you eat a red berry

00:39:15.740 and I don't eat it. So I survive. That kind of social limitation, that kind of social learning is

00:39:21.200 incredibly efficient. And this is one of the reasons we evolved to live together. But we also do something

00:39:26.440 else, which is we teach each other things. We, we accumulate knowledge and we transmit it across

00:39:31.820 space and time. Now, so, so one of the arguments that I like to make about human social life is that

00:39:37.960 the spread of germs is the price we pay for the spread of ideas. So I come near you to learn from

00:39:45.300 you, but in so doing, I set myself up for contagions of infections. And so therefore the, the, the, the

00:39:53.040 pathogen is exploiting our social networks, our social interactions, our evolved desire to touch and hug

00:39:59.380 each other, our, our desire to band together in order to learn from each other. And the virus moves

00:40:04.700 along these social pathways, killing us. And so how are we going to respond? Well, we respond by

00:40:12.260 exploiting our capacity for cooperation and learning. We work together to live apart. We have learned from

00:40:20.420 the past. We're not the first humans to confront a pandemic. We inherited a playbook about what to do.

00:40:26.580 That's a kind of teaching. So one of the deep ironies is that the, the very same things that

00:40:31.840 the pathogen is exploiting to kill us are the tools we need to use to best it. And, and this is one of

00:40:39.520 the reasons I'm so particularly invested as are you in us learning from this experience. There's no reason

00:40:45.960 future generations of us should do the job as poorly as we have done it right now. And in fact, I should

00:40:52.340 also say, we don't even need to look to future generations. There's still time for us to learn now and do a

00:40:57.500 better job in the coming year or so. And we can discuss what I think is going to happen next, but we still

00:41:03.800 have about a year and a half in my view of serious immediate impact of the pathogen, where we're going to

00:41:09.820 need to wear masks and, and, and, and, and, and physically distance and do a bunch of other self-protective

00:41:15.080 interventions, but eventually the tide will turn. But nevertheless, in the interval, we, there are

00:41:20.400 things we need to do.

00:41:22.300 Well, so let's talk about that, but the reasonableness of any intervention turns on some appraisal of how

00:41:31.440 bad this disease is. And the core of, of any claim about its badness rests on how many people are

00:41:40.740 actually dying from it. And this is where I've encountered that one source of skepticism, which

00:41:48.120 seems to me to be harder than, than most to dismiss. And this has been trumpeted by many prominent

00:41:54.780 people. I've had to encounter this both publicly and privately, but it's this concern that the mortality

00:42:01.420 statistics of COVID are being amplified because doctors have been incentivized to over-report COVID deaths.

00:42:09.600 We rely on doctors to fill out death certificates and the CDC guidance for reporting a COVID death

00:42:17.420 does not require a positive test for COVID. And this seems to be a concession to how inept we were

00:42:24.920 at testing and, and, and still are at testing. So rather doctors simply need to deem it, you know,

00:42:30.540 probable that COVID was part of the picture in accounting for this death. So they, they presume a COVID death

00:42:38.900 in many cases based on a constellation of symptoms, whatever else may be wrong with the patient. And,

00:42:45.000 and of course, you know, there, you know, there are many respiratory conditions that people die from,

00:42:49.040 you know, there's COPD and asthma and pneumonia and, and they also kill some hundreds of thousands of

00:42:55.740 Americans each year, right? So these are not tiny sources of mortality. It's easy to imagine that if doctors

00:43:04.100 are simply admonished to check the COVID box whenever it's plausible against this background

00:43:11.900 of other respiratory diseases, that could inflate the number of COVID deaths. And just to add one final

00:43:17.800 wrinkle here, which is perhaps the most troubling, this was happening in the context where there was

00:43:24.620 actually, and probably still is a financial incentive to presume COVID's involvement because,

00:43:31.000 you know, hospitals, many hospitals were on the verge of bankruptcy because all elective procedures

00:43:36.220 were being canceled because nobody wanted to get COVID. And they were given money, you know,

00:43:42.140 I think HHS allocated something like $50 billion for hospitals that were having to deal with a surge of

00:43:50.160 COVID cases. So there was a financial incentive to say, oh yeah, this is yet another COVID case that's

00:43:55.660 hit our ICU. No, I don't, I don't think any of this makes any sense on any level. And we can discuss

00:44:01.160 this. I'm not, I don't know about the details of how HHS reimbursed for the care. I do know that

00:44:07.620 ironically, our healthcare system was organized in such a fashion that in our reimbursement system,

00:44:13.400 that precisely when we needed it most, hospitals started losing money. As you alluded to, you make

00:44:18.520 much more money with elective surgeries than you do with caring for acutely ill people during a time

00:44:24.100 of an epidemic, which is nuts. That is to say, this is when our hospitals were most needed,

00:44:28.820 when money should have flowed to them liberally. And the idea that many hospitals, I understand it,

00:44:33.980 quite a few rural hospitals almost went out of business. I read some news reports about Maine.

00:44:39.760 I'm not a hundred percent sure about this. Yes, the government tried to compensate hospitals to make

00:44:44.240 up for the losses, but my understanding is it wasn't enough. In any case, that is nuts that,

00:44:49.740 that hospitals providing care in a time of a pandemic, that this would be a loss leader,

00:44:55.740 you know, or that they would lose money is, is crazy that that would happen. Now on the issue

00:45:00.440 of, are we correctly finding it? There's so much evidence that, that, that that's not the case that

00:45:05.460 I don't even know where to begin. That it's not the case that we're over-reporting COVID deaths.

00:45:10.000 No, no, absolutely not. And the evidence for that comes from multiple sources.

00:45:15.000 One of which is of course the consistency in the death rate in places around the world with very

00:45:20.240 different systems of recording deaths, of detecting deaths, of very different financial incentives.

00:45:25.440 We even have situations in which, you know, for example, we could look at the,

00:45:28.640 we had those famous cases early on in the epidemic of the diamond princess, you know, cruise ships

00:45:32.800 where no one could come or leave. We knew exactly who got sick and we could count which of them died.

00:45:38.260 So, you know, we could, we could assess the lethality of the pathogen. And we now have a

00:45:44.960 focus studies around the world of sort of case studies of, you know, Manaus in Brazil or, or

00:45:51.720 villages in Lombardy or in Austria, where early on the epidemic just, you know, swept through the

00:45:58.240 community and we can enumerate who died during the time of the epidemic. Furthermore, there's another

00:46:04.440 technique that was introduced in the middle of the 19th century by William Farr, one of the

00:46:08.240 founders of the field of demography that ironically is still in use today, which is the notion of

00:46:12.700 counting excess deaths. And, and scientists use this even now when we're trying to look at

00:46:17.660 historical epidemics. Let's say you want to figure out how bad was the bubonic plague or how bad was

00:46:23.040 the night, the Spanish flu in 1918. You don't have the capacity to test people. The death records at the

00:46:29.420 time were very incompetent or incomplete. How can you tell? Well, Farr proposed that we can assess the

00:46:36.940 impact of an epidemic by, by counting up how many people are dying of all causes during the time of

00:46:43.900 the plague and comparing that to the number of people expected to die if the plague had not been

00:46:49.780 there, for instance, in the prior five years in this time window. And when you do an exercise like

00:46:55.160 that, that's how we get estimates that the current count of people confirmed COVID deaths that we have

00:47:01.060 in the United States, which is something like 230,000, that it's probably an underestimate by a factor

00:47:06.440 of about 25%. Probably 300,000 Americans have already died of COVID. In other words, what we're doing,

00:47:12.780 if anything, is undercounting the deaths we know simply by looking at who's dying. Now, in fairness,

00:47:19.560 some of those deaths are due to COVID, but not necessarily due to COVID infection. For example,

00:47:25.000 if COVID causes you to become depressed and suicide goes up, that's swept up in the COVID deaths,

00:47:32.580 you know, using the excess death metric. But in any case, the point is, is that there's really,

00:47:38.580 there's no reason to- Although there are obvious reasons why there will be fewer than normal deaths

00:47:43.440 based on all the behavioral changes due to any kind of lockdown during a pandemic. There had to be a

00:47:50.320 where there were fewer motor vehicle deaths and- Yes. Yeah. So the excess death metric

00:47:56.360 captures all of that, both the benefits of COVID and the extra costs of COVID. Exactly right. So

00:48:02.400 let's say there were more suicides, but fewer motor vehicle accidents. Some people have argued that

00:48:07.520 there was less overtreatment of patients. You know, iatrogenesis, which is medical doctor-caused

00:48:13.800 injuries, they were likely lower. In other words, in the past, if you had a mild heart attack,

00:48:18.680 probably the right thing to do was not to have a doctor do anything. But the doctors would do

00:48:23.980 things to you, actually increasing your risk of death. But under COVID, people with mild heart

00:48:28.740 attacks maybe stayed at home or didn't come to medical attention. And ironically, then they failed

00:48:34.740 to die, which they otherwise would have. So maybe COVID saved their lives. But the point of doing this

00:48:40.340 calculation is that it combines all of that stuff together and says, okay, here are the total direct

00:48:45.800 risks and indirect risks and benefits of COVID. And that number is higher even than the number

00:48:53.040 of known COVID deaths as reported by doctors along the lines that you described.

00:48:57.980 I would also add that if, in fact, deaths that should have been ascribed to other respiratory illnesses

00:49:05.840 like COPD or asthma or pneumonia were being inaccurately coded as COVID deaths, we'd be able to see the rates

00:49:14.780 of COPD and asthma and pneumonia-related deaths go down. Yes. Because we know what to expect from those

00:49:21.600 Yes. Yes, that's right. And in fact, reassigning COVID deaths, COP deaths to be COVID deaths,

00:49:28.060 wouldn't affect the excess death calculation. So this excess death calculation is a kind of more objective

00:49:32.820 way of looking at the impact of an epidemic, which has been used for, you know, 150 years for real-time

00:49:39.560 epidemic monitoring and for assessment of historical epidemics when we didn't have good death records,

00:49:45.700 cause of death, rather, information. So no, I don't think that there is some kind of conspiracy

00:49:51.100 or some kind of a misassessment of deaths in our society. And picking up a little bit on what we said

00:49:59.300 earlier, see, one of the ironies is that even if a million Americans die, there are probably only going

00:50:04.800 to be about, let's say, 10 people for each of those people who knew them personally. So that'll be like

00:50:11.480 10 million Americans will know someone who died of COVID. And probably 100 million Americans, so like

00:50:19.380 100, you know, I'm sorry, 10 Americans per decedent who were intimately connected to this decedent.

00:50:25.240 And now, let's say, are like really upset and worried about COVID. And then even if a million Americans die,

00:50:31.500 there will be, let's say, 100 people who know of that person. So there'll only be 100 million Americans

00:50:37.180 who know of someone who died personally. This is a very crude approximation for many reasons that I

00:50:42.100 don't go into right now. But the point is, even after the epidemic has swept through our society,

00:50:46.820 the majority of Americans will neither have died of it nor know someone who has died of it.

00:50:51.140 And so this is one of the reasons that it's difficult to why President Trump can get up there and say,

00:50:55.980 oh, nothing bad is happening, because in the everyday experience of most people, in fact,

00:51:00.560 they're not going to come up close and personal with this pathogen, again, for the reasons we

00:51:05.280 discussed earlier about the fundamental nature of this pathogen. But that doesn't make it less of a

00:51:10.180 threat. And furthermore, one more thing, we've been talking about death, but it's very important

00:51:16.640 to highlight the fact that we're also going to see an epidemic of disability in our society that's

00:51:21.700 going to persist for a long time. So most people who get the disease, including, for example,

00:51:26.620 the president, survive the condition. But 5% of them, we don't know the precise number yet,

00:51:32.600 and we won't for a while, but probably about 5% will have serious long-term disability. They'll have

00:51:38.280 pulmonary fibrosis. They'll have renal insufficiency. They'll have cardiac abnormalities.

00:51:43.500 They might have neurological abnormalities. So we're going to have many millions of Americans

00:51:48.520 who have post-COVID syndrome. And this also doesn't include all the children whose parents

00:51:56.920 will be sick or disabled, you know, all the adverse health events, the adverse events on children whose

00:52:04.420 parents have lost their jobs, whose parents are dead or sick. You know, there's just all of this

00:52:09.700 sadness and badness that come in a time of plague. And unfortunately, there's no way to escape it.

00:52:17.680 I mean, it is just an ineluctable truth about plague that it is ruinous, that this is what

00:52:25.500 it does to societies. It is one of the four horsemen, you know, for precisely this reason.

00:52:32.220 It seems reasonable to worry even about mild, so-called mild cases here. I think there was

00:52:37.360 one study that showed that there was some crazy percentage, it was something like 78% of mild cases

00:52:44.160 had detectable heart irregularities as a result. So it was, it just seems fairly clear that we don't

00:52:52.580 know enough about what COVID is doing to us. And in some sense, it's not even principally a

00:52:59.440 respiratory illness. I mean, it's a vascular illness. And also, as you say, you know, a neurological one.

00:53:06.740 We certainly know about coronaviruses. I mean, we have some evidence. There are four coronaviruses that cause

00:53:13.280 the common cold. In my book, I speculate, in keeping with speculations by others, that the 1890

00:53:21.080 pandemic was actually not influenza, but may have been a coronavirus. And over time, that virus has now

00:53:28.000 become the virus that, one of the four coronaviruses that causes the common cold. It's become more benign.

00:53:33.520 We've evolved as well, some natural immunity to it. We get the disease as children. And then when

00:53:38.940 we're re-exposed as adults, we have a minor illness. There's a whole set of human diseases

00:53:43.060 that behave this way. So it's possible that this current coronavirus, you know, in 100 years or

00:53:48.680 perhaps sooner will, I should just emphasize, the virus is not going to disappear. I mean,

00:53:53.080 it's going to keep circulating among us forever. The only issue is how will we cope with it? And

00:53:58.140 hopefully we'll have a vaccine. And we haven't talked about that yet, and we can. But one thing that is

00:54:02.880 likely to happen is that the virus will, over a period of years, become more, will evolve to be

00:54:08.620 less lethal. And probably we will be exposed to it as children when we, as we already know, are

00:54:16.520 relatively less adversely affected by it, as is also typical of other coronaviruses. For example,

00:54:22.140 the 2003 coronavirus. This is all discussed in my book, by the way. And then when we're re-exposed as

00:54:27.520 adults, we have a more benign course. It's a little bit like chickenpox. You know, if you get

00:54:32.800 chickenpox as a kid, you get a pretty benign condition. If you've never had chickenpox and you

00:54:37.220 get it for the first time as an adult, you can die from it. So that's why exposure to chickenpox

00:54:42.300 early on might be a rational strategy. So there are lots of diseases like that, and it's possible

00:54:47.660 that this will join, you know, that that will be the pattern for this particular condition as well.

00:54:52.860 But as you said, it's early to speculate. And furthermore, as you also said, and as I was

00:54:58.720 saying, it's a serious condition. It doesn't just cause us death, it causes us disability. And the

00:55:05.540 disease is having, as we were discussing earlier, an ecological release. You know, it is just spreading,

00:55:11.760 you know, it is doing what living things do. It is just, you know, spreading across all of humanity.

00:55:17.040 And how is it spreading? I mean, early on, many of us began speaking about the R-naught of this, 1.00

00:55:26.600 and just how contagious is this, and how will that respond to the things we do to modify our

00:55:33.480 behavior. But now we're speaking more in terms of super spreaders and super spreader events.

00:55:40.720 How do you think about the spread of this now?

00:55:42.460 Well, we know now much more than we did when you and I last spoke in March. I mean,

00:55:47.960 the intrinsic transmissibility of the virus, the so-called R-naught, the number of new,

00:55:52.680 the reproduction number, the number of new cases that arise in a non-immune population that is

00:55:58.580 interacting normally is between 2.5 and 3.5. So for each case of SARS-CoV-2, each infection,

00:56:06.860 on average, between 2.5 and 3.5 new cases will arise if people aren't immune and they're

00:56:13.180 interacting normally. That's the fundamental transmissibility of the virus. In my book,

00:56:17.480 I use an R-naught of 3 as a benchmark. Now, that is a pretty high R-naught. Like seasonal flu has an

00:56:23.540 R-naught of between 0.9 and 1.6 or so. So if you have an R-naught of 1, that means that for each case,

00:56:30.000 you create one new case, so you don't really get an epidemic. There's no growth in cases.

00:56:34.920 If it's below one, then of course, the case count declines with time because each case,

00:56:39.560 on average, cannot reproduce itself. Diseases like chickenpox, I think, have an R-naught of about

00:56:44.060 6 or something. Measles, which is the most contagious disease known, has an R-naught of 0.93

00:56:49.220 18 or something. And incidentally, this also relates to the issue of herd immunity, which we

00:56:55.340 haven't discussed, and also the fraction of people that will need to be vaccinated in order for the

00:56:59.780 population to be immune. So the more transmissible the disease, the higher percentage of

00:57:04.840 people have to have acquired immunity for herd immunity to kick in naturally, or the higher

00:57:11.380 the fraction of people have to be vaccinated in order to protect the unvaccinated people in the

00:57:15.980 population. So the higher the transmissibility of the disease, the higher those percentages need to

00:57:20.480 be. So this disease, we now know about how transmissible it is, but there's another number,

00:57:26.860 which is not the R-naught. It's the so-called R-sub-E, the effective reproductive reproduction number,

00:57:31.880 or effective reproductive rate, which is what we manipulate when we engage in physical distancing

00:57:38.760 and when we try to flatten the curve. So when we change our behavior, we modify the transmissibility

00:57:45.140 of the virus. And you can measure and monitor the R-E, and you can see, oh my goodness, everyone is

00:57:50.640 staying at home. Each new case of the virus is creating less than one new case. We brought the R-E 0.97

00:57:56.140 below one, and that's exactly what we're trying to do, and we have brought it down. And just to pick

00:58:02.600 up a little abandoned thread from our conversation earlier, the whole reason we rightly social,

00:58:07.780 physical distanced and tried to flatten the curve nine months ago was not like what the Chinese

00:58:13.620 achieved by locking down their country, or what we achieved by engaging in the kind of physical

00:58:18.080 distancing that we did, was not the eradication of the pathogen. That pathogen, we can't eradicate it.

00:58:24.180 It's loose now. What we achieved instead was a postponement of its impact and may, as a result,

00:58:31.320 also have saved some lives. Let me explain why. When the disease first struck, we had no medicines

00:58:36.400 to treat it. By engaging in the sort of lockdown behavior that we engaged in, in the closing the

00:58:42.560 schools and the masking and everything else, we gave our hospitals and our doctors and our scientists

00:58:48.060 and our supply chains time to work so we could make more PPE, which would then ultimately save lives

00:58:54.320 if people had PPE, or so our doctors could do research to discover how to treat the condition.

00:58:59.580 And over the summer, we had the first drug that was shown to actually lower mortality from coronavirus,

00:59:05.340 which is a very cheap and old drug, a drug called dexamethasone. We had a landmark randomized

00:59:09.760 controlled trial of a very large number of people, the so-called recovery trial out of England,

00:59:14.780 that showed that dexamethasone reduced mortality by 20%. That's huge. So you would much rather get

00:59:21.540 COVID now than COVID in March, because now we have a drug that we can give you

00:59:26.160 that reduces your risk of dying if you're seriously ill with it by 20%, which is amazing.

00:59:31.320 Plus, doctors have learned all kinds of other stuff, like to put you on your stomach when you're

00:59:35.100 in the hospital instead of on your back, for example. In addition, there's some other drugs like

00:59:39.660 remdesivir, which none of the trials have so far shown that it has an impact on mortality.

00:59:45.320 We had a very depressing trial that was just released a couple of weeks ago with a large

00:59:49.600 number of people which failed to show an impact on mortality. But nevertheless, that drug might

00:59:53.840 also be helpful. So we will continue to innovate on drugs. There will not be a drug that cures

01:00:00.420 coronavirus. It's very difficult to find, to stop viral infections, to cure viral infections,

01:00:06.400 unlike bacterial infections. But we will likely have drugs that are more and more effective

01:00:11.200 that are discovered over time. And this is why we had to flatten the curve. And of course,

01:00:16.340 we bought ourselves time to invent a vaccine. And I do believe we will see a vaccine in 2021.

01:00:23.920 There are over 130 efforts afoot of over 10 different approaches to vaccine development

01:00:28.480 around the world. I think sometime in 2021, we may discover a vaccine, how safe it is or how

01:00:35.140 effective it is. It's hard to predict. I think in our rush to develop these vaccines, we may find a

01:00:40.260 safety profile that's not so great, which may dampen enthusiasm for the vaccine. But the problem

01:00:46.340 is even if we invent a vaccine, we then have to manufacture it, which is not trivial, distribute it,

01:00:52.100 which is not trivial. We need to maintain something known as a cold chain. From the moment of manufacture

01:00:57.100 to the moment of injection, the vaccine always has to be in a refrigerator. That's not a trivial thing.

01:01:01.520 And finally, and most importantly, we need to have acceptance. People have to

01:01:05.280 want the vaccine and have to take it up in large numbers. So I think that's going to take us into

01:01:11.620 2022. So from my desk, what I see is that either we will invent a vaccine and accomplish everything

01:01:19.460 else I just described, which will take time and take us into 2022. Or meanwhile, the virus is still

01:01:26.040 spreading, which means we need another couple of annual cycles of this pathogen, which is what

01:01:31.780 respiratory pathogens do. Only about 10% of Americans have been infected. And according to

01:01:37.940 some network science-informed estimates, I think about 40 or 45% need to be infected before we have

01:01:44.000 herd immunity, which I think then we will reach by 2022, just because we're so incompetent right now

01:01:50.120 and the germ is just spreading. So one way or the other, from my desk, we're going to be physical

01:01:55.460 distancing. We're going to have periodic school closures. We're going to be wearing masks. We're

01:01:59.040 not going to be shaking hands. We're going to have a suppression of our economy until 2022. And then 0.80

01:02:05.380 we're going to, the immediate pandemic period will end, but it's not going to be an immediate return

01:02:12.180 to life as normal. Because if you look at what's happened with the centuries of epidemics,

01:02:17.100 people are going to be shell-shocked. Our economy will have been adversely affected.

01:02:20.900 People's psychology, you know, people aren't going to suddenly want to go to airports or suddenly start

01:02:25.060 shaking hands again or going to crowded bars and restaurants or nightclubs. It'll take time for

01:02:31.140 people to recover from that. So I put the intermediate pandemic period until 2024. And then I think in 2024,

01:02:40.000 we're going to have the post-pandemic period where I think we will return to normal with some

01:02:45.740 persistent changes. I think people will be working from home more. I think there'll be a number of

01:02:49.880 other changes in our society. I think gender relations are going to change in certain ways

01:02:53.860 as a result of the pandemic. We can discuss that. And then we're going to have, in 2024,

01:02:59.700 a kind of roaring 20s. You know, there'll be an efflorescence. People will pack political protests

01:03:06.240 and sports events and restaurants and nightclubs and religion, which is rising, by the way, right now,

01:03:12.880 will go back down again. You know, during times of plague, people find God. There'll be a kind of

01:03:17.620 licentiousness, a sexual licentiousness, and a kind of intemperance and joie de vivre. And this is

01:03:22.760 typically what has happened with past epidemics. So these aren't hard landmarks, you know, 2022 and

01:03:28.620 2024, but approximately that is what I think is going to happen.

01:03:33.800 It's October and already you're so full of Christmas cheer, Nicholas.

01:03:38.620 Well, no, I mean, 2024, you know, for the good, no, no, no, we have to traverse some of this ground

01:03:46.000 again. I thought we were going to bring this conversation in around the hour mark, but I see

01:03:51.620 no hope of that. So first of all, let me just check your time, Nicholas. You got another half hour in

01:03:56.060 you? Yeah, no, I'm available. All right. Okay. So I want to talk about the future. The prospect that

01:04:03.040 nothing like normal life returns until 2024 is not something that I have foreseen. So let's talk

01:04:13.440 about the near time horizon here. Let's talk about the next six months. We have a president who is

01:04:18.920 promising a vaccine any week now. And, you know, it's fairly sure that that can be distributed

01:04:28.700 by the military. If you'd like to continue listening to this podcast, you'll need to

01:04:35.020 subscribe at SamHarris.org. You'll get access to all full length episodes of the Making Sense

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01:04:58.700 So let's see you guys again.

01:05:00.820 See you guys next time.

01:05:09.300 Bye.

Making Sense - Sam Harris - October 28, 2020

#222 — A Pandemic of Incompetence

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