#222 — A Pandemic of Incompetence
Episode Stats
Length
1 hour and 5 minutes
Words per Minute
171.74196
Summary
In this episode, I speak with Nicholas Christakis, a physician and sociologist, about the coronavirus pandemic and its impact on the way we live. We discuss the breakdown of trust in institutions and experts, the corruption of science, the ineptitude of the Trump administration in handling the pandemic, and the economic and social effects that may result. We also talk about the importance of rapid testing and the need for rapid response to pandemics, and other topics related to the crisis. This is an up-to-the-minute look at the state of the Pandemic and a timely conversation prior to the election, and I'm excited to have Nicholas back on the podcast. I hope you enjoy this episode and that it makes you think about how important it is to be prepared for a pandemic like the one we are facing. If you can t afford a subscription, there's an option at Samharris.org to request a free account and get 100% of the podcast's premium features including ad-free episodes, unlimited access to the podcast, and much more. You can also join the Making Sense Podcast for as little as $1.99 a month! You get access to all the latest episodes and access to our most popular podcasts, plus access to special bonus episodes, including the latest podcasts, videos, books, and events happening throughout the week. Thanks for listening to Making Sense. - Sam Harris and Making Sense! to help spread the word about the podcast and podcasting. Make sense. to the world. Sam Harris and I are making sense, and making sense of it all. (and we hope you re making sense. Thank you! - To find a list of our sponsorships, check it out here: bit.ly/makingsensepodcasts. We'll be looking out for the best of the best places to get the best deals on the best and the most affordable and affordable things you can get the most of your best listening experience in the best possible listening experience possible. We'll send you the most amazing places to help you find the most compelling listening experience on the highest quality of your day to you can be the best place to listen to the most profound and most affordable podcast experience possible, everywhere else in the world, everywhere you get it. Thank you, making sense? - Thank you for listening and sharing it on social media and sharing your thoughts on the internet.
Transcript
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We are one week away from the presidential election in the United States, and I am sure
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I will have a Zoom call for podcast subscribers at some point immediately following a result.
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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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announce it by the usual channels, probably email and Twitter, and it'll be another video
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And if you want to participate in that, you can subscribe to the podcast at samharris.org.
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Nicholas is a physician and sociologist, and he directs the Human Nature Lab at Yale University,
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where he is the Sterling Professor of Social and Natural Science in the departments of
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Sociology, Medicine, Ecology and Evolutionary Biology, Statistics and Data Science, and Biomedical
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He is also the co-director of the Yale Institute for Network Science, and he's the author of
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several books, Connected, Blueprint, and most recently, Apollo's Arrow, The Profound and Enduring
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We talk about the breakdown of trust in institutions and experts, the corruption of science by politics,
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the ineptitude of the Trump administration in handling the pandemic, whether the gravity
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of COVID-19 has been exaggerated, using this experience to prepare for future pandemics, whether
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it's true that COVID deaths are being over-reported, bad incentives in the medical system, the prospect
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that the coronavirus will evolve to become more benign, the efficacy of current treatments,
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safety concerns about a rushed vaccine, the importance of public health communication,
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when life on earth might return to normal, the economic impact of the pandemic, long-term
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social changes that may result, the future of universities, Nicholas's personal habits to
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keep from getting the coronavirus, the importance of rapid testing, and other topics.
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Anyway, this is an up-to-the-minute look at the state of the pandemic, and certainly a timely
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Nicholas, thanks for coming back on the podcast.
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So yeah, you are now a multi-repeat guest, and so I know I'm in good company.
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The first couple of times were just a dress rehearsal, but now you can be a co-host whenever
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you want, but briefly remind people what your station in life is and how you come to know
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or have strong opinions about many of the topics we're going to touch.
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Well, I'm a physician and a social scientist, and I've spent my life or my career in academia
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doing scientific research and taking care of patients up until about 10 years ago.
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I was a hospice doctor taking care of people who are dying.
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But I run a moderately decent-sized lab at Yale University now, doing science of different
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We have a bunch of different groups in my laboratory.
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We do everything from sort of quantitative public health research to work on the microbiome
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I'm very proud of them, this group of mine, and I teach students as well, and I've lately
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become very interested in the evolutionary origins of human social interactions, and most recently
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Well, you, unlike many people, have managed to put this pandemic to very good use.
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I mean, we've been under the shadow of this thing for about eight months now, and you have
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managed not only to write a book about the pandemic, but to publish it, and that is astonishing
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if you are at all familiar with the usual time course of writing books and publishing them.
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And that book is Apollo's Arrow, The Profound and Enduring Impact of Coronavirus on the Way We
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And that is out just this week as we release this.
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That should be available to anyone online or in your bookstore if you are intrepid enough
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So I want to talk about COVID, obviously, and I want you to bring us all up to the present
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in terms of what we should know about it at this point, and also to forecast what you
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But I want us to use the pandemic as a lens through which to consider much else that's
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ailing us, because we're living with a significant breakdown in our ability to acknowledge a shared
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And this is based on the deliberate spread of disinformation, which I've devoted a few
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It's also based on how our natural biases are being amplified by technology.
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I mean, social media has weaponized our confirmation bias and our tribalism and our other less
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And the result is that we're finding it harder and harder to collectively acknowledge the same
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set of facts, much less agree about what to do in response to those facts.
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So we're dealing with this total pollution of our information space, and it's affecting everything.
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And as a result, our trust in institutions, you know, whether it's the government or the
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press or universities or, you know, scientific journals, is at an all-time low.
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And worse, given what is happening, it probably should be at an all-time low.
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I mean, it's just, I'll just give you one sign of the times that happened recently.
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The New England Journal of Medicine published a truly blistering editorial about how badly
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And I read that, and I basically agreed with every word of it.
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And, you know, we'll get into the details there.
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But then I noticed that my Twitter feed just lights up with allegations that the New England
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Journal of Medicine is financially tied to the Chinese Communist Party at this point, right?
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Now, I don't even have time to figure out whether or not that's true, right?
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It's like, like it's, you know, but nothing at this point would surprise me.
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But I have no time for this because you can literally hold your breath until the next scandal
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I mean, they happen over the time course of minutes now.
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So it's just a crazy space to even be having this conversation in.
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And so I want us to focus on COVID and get deeply into it.
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But I think we should talk about the way in which politics, in particular, is deranging
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the information space and science itself at this point.
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Yeah, I mean, in a way, we could even start with that.
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I mean, I was scribbling some notes about topics for us to discuss as you were speaking.
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But I guess with one predicate, we could start with that, which is that we happen to be alive
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at a moment when we are experiencing something very unusual in the history of our species.
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And that is that a new, serious, widespread pathogen has been introduced into our midst.
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And this only happens once every 50 or 100 years.
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And one of the themes, actually, of my book is that, you know, this feels very alien to us,
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this risk of death, this fact that we have to spread out, this collapse of our economy.
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But I guess a very important idea is that plagues are not unusual for our species.
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But really, epidemics of this kind have been afflicting us for thousands of years.
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That is actually an interesting story about prior to 10,000 years ago, prior to the agricultural
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But anyway, from the time we invented agriculture and moved into cities, we've been prone to this.
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And in fact, the title of the book, Apollo's Arrow, comes from the opening of the Iliad,
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I mean, that's, you know, that's what, that's how old this phenomenon is.
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You know, 3,000 years ago, Homer was writing about this.
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Anyway, so this germ has, you know, which has its own, it's a, we can debate whether viruses
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But for the sake of argument, this germ is acting like any other living thing.
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It's found untouched virgin territory, namely our bodies.
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And it's just, it's just having what's known as an ecological release.
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Just like if you had let rats loose on New Zealand 1,000 years ago, they would take over
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So there's no natural immunity to this pathogen, and it's just doing, having its way, you know,
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But leaping ahead now with that background to the point you put on the table for us to
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discuss initially, it's odd to me the way this virus is striking us at a particular moment
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I don't know about global history, but certainly national history.
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Because the virus has struck us at a moment in our political life, which is very inauspicious
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So we've had what I would call a thinning out of our intellectual culture.
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You know, we think that there's something evil about experts or that they're self-serving,
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which is really odd because when you need a car mechanic, you want an expert, right?
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And there's this famous saying in sociology that, you know, one man's occupation is made
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So when you have a flood in your basement, it's a rare event and an emergency for you,
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but it's the routine daily experience of the expert plumber who comes to repair it.
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So why we have this attitude or this posture towards expertise is itself very odd, but we
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have a kind of anti-expertise, which is a reflection, I think, of a kind of anti-elitism that we
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There is, in addition to that, as you described, a kind of denigration of science or a disbelief
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in science or a politicization of science, whereby scientists are seen as just any other,
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like any other interest group, you know, trying to feed at the public trough instead of seen,
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I think more rightly, of course, I'm very partial to scientists and science, but I recognize
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science as limitations, and we can talk about that as well.
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But this idea that if scientists tell us something, there must be an ulterior motive rather than
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trying to engage science as science is also a very dangerous ascendant ideology in our society
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And there are two more items which I'll mention, and all of this causes quite a witch's brew.
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Another, of course, that everyone is familiar with is the political polarization, which by
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many metrics by political scientists show that we're at a moment in our history when we're
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very politicized, such that even a simple act like wearing a mask becomes seen either as
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an indicator of virtue, oh, you know, I'm on the left, you know, I'm a good citizen, I wear
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a mask, this symbol, this mask symbolizes my commitment to the commonweal, or, you know,
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the mask is seen as an infringement on my liberty, you know, like I'm on the right, you know, I
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should be allowed to do what I want, how dare anyone tell me to wear a mask?
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It's just a mask, you know, it's just a barrier to the spread of droplets, you know, it doesn't
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And many other countries, incidentally, do not politicize mask wearing.
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And finally, to this witch's brew, is this extraordinary loss of capacity for nuance in
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And I know you talk about this a lot, Sam, on this podcast, which is why things are seen
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I mean, every topic, why we can't acknowledge that there's shades of gray, there's uncertainty,
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You know, you don't have to be with me or against me.
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You can be partly with me, you know, or you can recognize that this is a complicated topic,
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you know, whether it's whatever we're talking about.
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There's this sort of desire for simple perspectives on the world that I think is not in keeping
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So all of these things, the denigration of expertise, the disbelief in science, the polarization,
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the loss of nuance, this is when the virus is striking us.
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And boy, has this sapped our ability to respond effectively.
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Well, let's focus on the political co-option of science.
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And this has happened, the pressure has come from both the right and the left here in different
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And it, but in, to a degree on both sides that has revealed scientists themselves to be all
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So, so the, some of the skepticism and despair over, over the, kind of the loss of the stature
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of scientific opinion here is understandable given just how craven so many scientists have
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I mean, so to see what's happening on the right, or at least in Trumpistan, where you locate that
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on the political spectrum is sometimes difficult.
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But what we see is this effort to please the delusional boy king.
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And it results in some of the most reputable people in public health walking on eggshells
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around this monstrously ignorant and belligerent president.
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And so we have, you know, Anthony Fauci, you know, who has the, the most stellar reputation
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He's been writing, he's been writing about respiratory pandemics since before, not before
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you and I were born, but, but, you know, for decades.
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But still most of his energy seems to be bound up in an effort to not embarrass the president,
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And he's found that almost impossible to avoid doing.
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And then we have someone like Dr. Birx, who, you know, in those first weeks and a couple
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months of her prominence, you know, seemed more and more like a hostage with Stockholm
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And then Robert Redfield, who's running the CDC, appears just visibly neutered whenever
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And none of this inspired confidence in the beginning.
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And since most of these people have almost entirely disappeared, I trust for also for political
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So there's that sort of the lack of credibility in the public face of the messaging.
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But then there's a reasonable concern that the Trump administration has so vitiated the
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scientific expertise in government, you know, whether it's at the CDC or the FDA or, you know,
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I mean, just across the board, pre-COVID, this was happening and has been replacing career
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civil servants and scientists with political lackeys and industry lobbyists.
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And given the ineptitude of our response to COVID, it seems worth worrying that maybe we're
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no longer the medical and technical superpower we once were or thought we were.
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And, you know, this culminates in things like Harold Varmus, another person with a totally
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stellar reputation, writing an op-ed in the New York Times declaring that we can't trust
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the CDC's guidance about whether to reopen schools, right?
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And then from the left, we see this, the moral panic around wokeness in the aftermath of the
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killing of George Floyd in the midst of the pandemic.
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And we see this insane double standard endorsed by literally thousands of public health officials
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where they declare that the protests against the lockdown were, you know, murderously irresponsible,
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but protests in support of Black Lives Matter, you know, as if by magic are not only okay,
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And so that's where we have the left and the right competing in this insane sort of
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reputational potlatch to see who can destroy their gravitas, you know, more quickly.
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And so that's the space in which our political partisanship has just made a mockery of scientific
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Well, I mean, this is a very complicated topic, obviously, that goes in many directions,
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And I know you've thought deeply about this too.
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But first of all, you know, one of the principles of democracy is that we get to elect our leaders
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and we have an executive branch that is responsive to the people we elect.
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Now, you could make the argument that the people voted for Donald Trump.
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There are, of course, side arguments about how more people voted for Hillary and blah, blah, blah.
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And therefore, it's a reflection of our democracy that the will of the people is that the scientists
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be muzzled, which is a kind of an odd conclusion to come to.
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But, you know, you could, in fact, somehow make that argument that it is reasonable or correct
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or a working of a democratic right that the scientists are being muzzled.
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And yet, we believe, all of us, certainly I do, that there should be a way in which science
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Otherwise, you get a kind of Lysenkoism, right, during Stalinist time.
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You know, genetics was seen as a, discoveries in evolutionary biology and genetics were seen
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as a great threat to communism because the communists' belief wanted to believe that we
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could change social structure and therefore change human nature.
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And so, you know, in writ large, discoveries in evolutionary biology and genetics were seen
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to subvert that, you know, that there could be a kind of innate human nature.
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And so, of course, Lysenko, you know, had a kind of Lamarckian idea about acquired
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traits and he arranged for people who didn't agree with him to be shot, you know, other
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As one does when reviewing scientific papers, one doesn't like.
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Who among us wouldn't watch his peer reviewers to be shot?
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So this temptation to have politics interfere, as you said, is longstanding.
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And also, incidentally, another historical strand in this is that science often is expensive
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and is a luxury and has been done at the public purse.
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You know, whether it's da Vinci or Galileo, you know, working for the Medicis or Seneca
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or Euripides, you know, working in the king of Syracuse, et cetera.
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I mean, since time immemorial, there's this sense, which is that, you know, scientists work
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But the problem we have right now is even more complicated than that for various reasons,
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not just the fact that it's the modern era and we have institutions which are supposed
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to provide ballast against the boy king, as you said, is that what is the dilemma of
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a good and wise person when there is incompetent leadership?
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And, you know, Socrates writes about this, Plato writes about this as well.
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Now, let's say you're General Mattis or you're General Kelly or you're Tony Fauci or you're
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anyone else who is trying to figure out, like, my allegiance is to the nation and if I serve
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in this administration, will I be tainted or do we only, do we want competent people to
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refuse to serve on the grounds that their reputations will be harmed?
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Well, that can't be the right answer because, you know, we want competent people running.
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On the other hand, if these competent people serve, do they then lose their souls or do
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we get this kind of subversion of the scientific process?
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When do you say, no, I will not implement this policy or I will not be quiet?
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So there are rules how quickly Fauci cannot easily be fired.
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There's a process whereby he can be fired, unlike the Secretary of Health and Human Services.
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I don't know about Redfield and his position specifically, how easily he can be fired.
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But, you know, many of these people are probably reasoning, I can do more good than harm.
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You know, I know I look like an idiot, not Fauci, but, you know, some of the others.
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But, you know, I need to help the country and I can moderate some of these, you know,
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ridiculous extremes that the political elites are forcing on us.
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I mean, it's very hard to know what to do in this type of a situation.
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And I'm not making apologies for anyone, and I put the blame squarely at the feet of the
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political leadership, Trump and the administration, for the utterly inept response the United States
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Let me just say one more sentence about why I think it's especially appropriate to hold
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Because unlike, let's say, you could reasonably argue that certain other leaders, you know,
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like the British and the Italians, for example, also got it wrong.
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But the difference is that the President of the United States has the CDC working for
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him and the National Security Agency working for him.
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And he was told in December what was going to happen.
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Unlike the rest of us who couldn't necessarily have known what was going to happen, the very
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best epidemiologists on the planet, you know, work at the CDC.
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And we have, I believe, the best intelligence agencies.
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And by the time we'll probably come back to this, by the time I started paying attention
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to this in January, we now know that even as early as December, the president was briefed.
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So that's really a dereliction of duty, you know, to be told that a pandemic is coming
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by people you should know are reputable, are not making this up, and to ignore that or fail
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to take action, to fail to use the wealth of this nation to prepare, to put PPE in place,
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to build testing capacity, to do all the things that are recommended.
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Incidentally, the CDC has released every three to five years a playbook on how to cope with
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The Obama White House, actually after the Bush White House, had also bequeathed to Trump
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But even leaving aside the political transmission of this information, in the CDC, you can go
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online and it says, you know, plans for a respiratory pandemic.
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Bill Gates released a TED Talk, I forgot if it was five or 10 years ago, that has 30 million
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views, talking about exactly what's happening to us.
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So I can understand why the, quote, man or woman on the street are shocked and surprised
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that this is happening to us, like we discussed a little while ago.
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But our political leaders who are entrusted with the duty to protect us should not have
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In fact, we're not surprised and therefore rightly are being held to account for the hundreds
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And incidentally, I think we are going to surpass half a million deaths in the United States.
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When I, you and I spoke about this last March, I can't remember what my forecast was.
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I mean, we, you know, this is going to be the leading killer of Americans this year.
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And per capita will be for sure the second worst pandemic we've had in this nation for,
00:25:05.020
Okay, well, I want to talk about the future, but before we get there, let's talk about the
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So when we last, I had you on pretty early in the pandemic, you know, just when I began
00:25:20.220
And I was not especially prescient, but I was, as I've said several times on the podcast,
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I was palpably at least a week or two earlier than almost anyone in my sphere, right?
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So I was the, you know, the dad at school talking to the other parents and getting these
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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.
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And, you know, it was, it was scarcely, you know, a week or 10 days before schools throughout
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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
00:26:11.640
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
00:26:35.360
And at that point, there was a general concern that there was a trade-off between public health
00:26:44.740
If we take this too seriously, we're going to torpedo the economy and that's just an intrinsically
00:26:52.020
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
00:27:36.620
And also, we did successfully bend the curve to the point where, okay, our hospitals survived,
00:27:44.420
That we got, we had some fairly scary reports of ICUs filling up, but basically we kept the
00:27:52.140
And since then, there's just been this total bifurcation in people's thinking about this
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
00:28:24.120
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.
00:29:06.740
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
00:29:41.560
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
00:30:03.580
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.
00:30:22.080
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.
00:30:43.640
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
00:31:03.900
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
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
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,
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.
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
00:41:22.300
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,
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.
00:55:42.460
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
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
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
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
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01:04:35.020
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01:04:39.860
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