It s been almost three weeks since President Trump issued his 15-day warning to slow the spread of the coronavirus, urging everyone to stay at home and only leave for essential business. While the healthcare industry works to defeat this virus, infection and death rates are constantly changing based on incoming data. Every day, more and more people go without work and paychecks, propelling the debate of how important the stability of the economy is to public health, not just the importance of public health to the economy. Today, we re looking at the models used by governments to determine whether to shut down the economy, the question of balancing economics and public health and when we finally get back to normal. Dr. Bob Wachter is Professor and Chair of the Department of Medicine at the University of California, San Francisco, and the author of about 300 articles and six books. He s past President of the Society of Hospital Medicine and past Chair of The Board of Internal Medicine, and is author of six books, including The Coronavirus: A Guide to Preventing It and Treating It. In this episode, we talk to Dr. Wachters about the science behind the latest diagnosis and treatment of the virus, and why hand washing is a good idea and a bad idea at the same time. and why we should all be wearing face masks in public, no matter who you are with the flu. And, yes, even if you don t have the flu, you should be doing it. . And if you do get sick, it s going to get better, you ll get better by the next time you get sick or you re going to the hospital, right? at least you ll have a chance to get a shot of the flu to keep your flu shot but you ll be better off if you re not getting sick, right in the hospital because it s not going to have to go to the ICU so you ll need to stay in a better place that s a good chance to recover fully not , right or ? you ll right to we ll get better than well maybe it s the flu? and do don t get sick? And is can you get better? or do it .
00:00:00.000When my girls came home, they were really unsettled.
00:00:03.000So what we decided to do is every day we would sit down and talk about what's happening on the coronavirus, and importantly, what to expect.
00:00:12.000And this notion of, I don't know for sure, but this is what I'm looking for, has helped people enormously because you give them a roadmap.
00:00:19.000It's been almost three weeks since President Trump issued his 15 days to slow the spread recommendations, urging everyone to stay at home and only leave for essential business.
00:00:28.000Those recommendations have now been extended through the entire month of April, which leaves a lot of uncertainty for everyone as we grow increasingly more concerned with our health and well-being, as well as our financial stability.
00:00:39.000By ordering every non-essential business to close, the economy came to a crashing halt, spurring a $2 trillion stimulus package, another $4 trillion of spending from the Federal Reserve, and the highest rate of unemployment this country has ever seen.
00:00:51.000While the healthcare industry works on defeating this virus, infection and death rates are constantly changing based on incoming data.
00:00:57.000Every day, more and more people go without work and paychecks, propelling the debate of how important the stability of the economy is to public health, not just the importance of public health to the economy.
00:01:07.000Today, we're going to look at that argument from both a healthcare perspective and an economist perspective.
00:01:12.000We're going to be talking the models used by governments to determine whether to shut down the economy, the question of balancing economics and public health, and when we finally get back to normal.
00:01:32.000He is professor and chair of the Department of Medicine at the University of California, San Francisco, and the author of about 300 articles and six books.
00:01:39.000He is past president of the Society of Hospital Medicine and past chair of the American Board of Internal Medicine.
00:01:44.000Dr. Wachter, thanks so much for joining the show.
00:01:46.000I want to start by asking you some basic biological questions about coronavirus.
00:01:50.000Let's start with the sort of conflicting messaging we've been seeing about face masks.
00:01:54.000Are they a good idea or a bad idea at this point?
00:01:57.000I think the science has evolved in the last couple of weeks, Ben.
00:02:00.000I think we now better understand that people can have the virus and be asymptomatic and be shedding virus at that time.
00:02:08.000And so now that we understand that, it is, I believe, marginally safer if everybody wears face masks out in public.
00:02:15.000I think if people do it, it will become destigmatized the way it has in many Asian countries.
00:02:43.000There have been sort of these funny studies where they look at people's hands that have soil or germs on them and wash them for various periods of time to see which ones So, let's talk about the hospitalization rates for folks with coronavirus.
00:03:08.000So, what percentage of folks with coronavirus end up going to the hospital?
00:03:11.000What percentage of those people end up having to go to an ICU?
00:03:14.000What percentage of the ICU people end up on a ventilator?
00:03:26.000A lot of the answer to that, Ben, depends on the population of patients, because we know that older people and people with other diseases before they got sick with coronavirus do worse.
00:03:35.000So, for example, the very high mortality rates and ICU rates in Italy are partly related to the fact that it was an older population.
00:03:43.000But if you take all comers, about 80% of people who get the virus do just fine.
00:03:49.000In fact, some of them we now know are asymptomatic through the entire time, but most of them will have a flu-like illness, recover fully, and be fine.
00:03:56.000About 20% of people will get sick enough, and a decent percentage of them, 15 to 20% of all comers, will need to go to the hospital.
00:04:04.000Of those, somewhere around a quarter to a third, again depending on the overall health of the population, might need to go to an intensive care unit.
00:04:15.000Not everybody who goes to an ICU needs to be on a mechanical ventilator, needs to be intubated and ventilated, but if you can't breathe without it, you do.
00:04:24.000And then the overall death rate nationally in the U.S.
00:04:28.000is around 1% of all people that get the illness.
00:04:33.000If you are unfortunate enough to need to go on a mechanical ventilator in the ICU, the studies vary, but on the low side, the mortality rate is 50%.
00:04:44.000On the high side, some of the early studies from China showed a mortality rate closer to 90%.
00:04:49.000So, not everybody who gets sick enough to be on a ventilator dies, but it's a bad thing, and the outcomes are at best 50-50.
00:04:58.000So looking across the country, obviously the hotspot right now is New York.
00:05:02.000We've seen emerging hotspots in places like New Orleans and Detroit.
00:05:05.000But in San Francisco, you've suggested that the curve has been rather successfully flattened.
00:05:11.000In Seattle, it looks like the curve has been rather successfully flattened.
00:05:14.000What do you think is the difference between cities like New York, Detroit and San Francisco or Seattle?
00:05:20.000It's hard to know fully, and I suspect that multiple factors are at play.
00:05:25.000But here in San Francisco, there was a concerted amount of action by both government leaders and, I think very importantly, corporate leaders.
00:05:41.000They believed the science, and I think the science is relatively clear, that the best chance that we had to stay safe was early and aggressive action.
00:05:51.000And the action was sheltering in place, the action was avoiding close contact, the action was hand washing, things like that.
00:05:57.000And so here in the Bay Area, as early as March 5th, leaders of the big companies, that was Google, Facebook, Salesforce and others, basically told all their employees to stay home and work from home.
00:06:10.000Now, they're advantaged in doing that because their employees are all digital and they all have ways of working from home.
00:06:23.000March 16th, the mayor of San Francisco and the mayors of the five counties around San Francisco all issued a sheltering-in-place order, and the governor of California did the same thing on March 19th.
00:06:35.000Those were earlier than any large areas in the country.
00:07:31.000But first, let's talk about the fact that we're spending an enormous amount of time online right now, and that is like a hacker's paradise.
00:07:37.000They're looking for your information, and now would be a great time for them to steal it from you.
00:08:32.000So we've been relying very heavily on the models to determine exactly what we ought to do here.
00:08:37.000One of the questions about the models has been exactly how far they extend.
00:08:39.000So the IMHE model from the University of Washington has been heavily used as sort of the source for we're going to experience maybe up to 100,000 deaths.
00:08:49.000That model only extends until the very beginning of August.
00:08:52.000It doesn't take into account the possibility of a second wave.
00:08:55.000And that raises questions as to what exactly the purpose of the curve flattening is.
00:09:00.000So on the one hand, obviously we want to flatten the curve so that we Don't exceed the medical capacity that is out there for ventilators or for ICU beds.
00:09:08.000On the other hand, if there's going to be a second wave in the fall and we are all going to get it, and how do we calculate exactly when it is worth it to go back to work, considering that the economy is taking unprecedented hits right now, 10 million people unemployed in the last two weeks?
00:09:25.000Yeah, it's a brutally difficult question.
00:09:28.000I'm not going to accept the idea that we're all going to get it.
00:09:32.000Particularly for myself, being over 60, I'm in one of the risk groups, so I can't go to sleep at night buying that it's inevitable that we're all going to get it.
00:09:41.000I think what we are trying to do is tamp this thing down as much as possible so that hopefully it then dies down during the summer.
00:09:50.000There's some seasonality about it so that then when it comes back in the fall, which is likelier than not, we're prepared for it.
00:10:00.000We can immediately institute the kind of public health measures that this time I think we instituted on the late side.
00:10:07.000We have widespread testing available so that we can aggressively find people that have it early and quarantine them and isolate them from the rest of the public.
00:10:16.000And all of this, I guess, if this went on forever and we never found a vaccine, then there is a good chance that ultimately probably we wouldn't all get it.
00:10:26.000There's this thing called herd immunity that when you reach a certain amount of the population who's gotten it and has antibodies, it begins to die out.
00:10:33.000But that's 70 or 80 percent of the population.
00:10:35.000So that's that's a pretty nasty vision.
00:10:38.000The hope is we tamp this thing down over a long enough time that, yes, we don't overwhelm the health care system, but more importantly, we come up with treatments or vaccines and can get rid of this thing once and for all.
00:10:50.000I guess one of the difficulties in the modeling is because so few of the models extend out a full year, and because there are so many variables, it's difficult to see exactly what the sort of counterfactuals are in the various assumptions.
00:11:00.000You have the assumption where we do nothing and 2.2 million people die, but it's difficult to see, okay, we have over the course of a year, not the course of three months, over the course of a year, how many people die if we engage in social distancing and mask wearing for people who are under the age of 60 or 65?
00:11:16.000People who are 65 shelter in place to the best of their ability.
00:11:20.000We isolate people who are in old age homes and have inherent vulnerabilities.
00:11:24.000What is the counterfactual to that or lock down for three months and then do it?
00:11:28.000There's so many variables, it's hard to tell what is worth it at this point.
00:11:32.000What do you think emerging from this looks like and when do you think we start to emerge from this?
00:11:38.000Yeah, I mean, we need to put our best minds and our best models to this to help guide us as to what the right thing to do is.
00:11:45.000There is no question that a stance like we now have in California and increasingly around the country that everybody stays at home and the economy shuts down can't be our stance forever.
00:11:59.000And eventually there will be so much harm from that that you begin having to weigh the harm from the virus against the harm from the economy.
00:12:08.000And they harm to health from people not going out and getting health care.
00:12:12.000There are competing demands here that we've got to be thoughtful about.
00:12:16.000I'll tell you a quick metaphor for that, which is at UCSF, where I work, we prepared for a New York-like surge.
00:12:43.000And so there's a balancing act that we all have to do.
00:12:46.000It appears that the best models seem to say that sometime in the next four to six weeks, and it depends on how prevalent it is in the community and how much of a spike you had, because you come down faster if you had a big spike, The rates of the prevalence of the virus will go down in communities to the point that we can begin entering a new phase where we begin to relax some of the strict standards that we have now, begin to let people go out.
00:13:13.000But the key thing there is going to be testing and contact tracing, which we haven't done very much of.
00:13:17.000When you have tens of thousands of cases, you can't do contact tracing.
00:13:23.000But if you can tamp this down, my analogy is that of a wildfire that You have tamped down the worst of the wildfire and now you're out there looking for embers.
00:13:32.000And you see an ember and it pops up and you stomp on it and make sure that it doesn't spread.
00:13:37.000So we can, I think, reach that kind of a mode where we've tamped it down so it's not rampant in the community.
00:13:44.000Hopefully it goes away, or mostly goes away over the summer.
00:13:47.000And by the time it comes back in the fall, we're ready for it.
00:13:50.000If someone has any symptoms, we immediately test them.
00:13:55.000People probably are still wearing masks.
00:13:57.000And if we find a case, those people get isolated, separated from the community, probably, or at least we consider separating from their families as well.
00:14:06.000And that we can keep this thing at a low enough level that then there is time to go ahead and find the vaccine and the treatments.
00:14:14.000So given the variability in the models, and given the fact there was an article in the Washington Post talking about how even the White House's estimate, 100,000 to 240,000 dead, it was completely vague.
00:14:23.000We have no idea over what term even they were talking about.
00:14:26.000We don't know what the factors were in coming to those statistics.
00:14:29.000So I've been asking sort of a wide variety of people to ballpark where they think we are over the next year, given the fact that there seems to be pretty wide consensus that we're going to have to tranche people back into the workforce.
00:14:39.000By mid-May, perhaps by June at the very latest.
00:14:46.000So if that is what happens, if we start to test people, move people back into circulation, isolate people who are most at risk, tell people to hunker down until there's a vaccine if they are really, truly the most at risk.
00:14:57.000If we do that, what do you think the numbers look like?
00:15:01.000Well, I believe the models, I think 100,000 is looking like the minimum, and that is extraordinarily tragic if you think about what that means.
00:15:12.000But we're seeing New York, but New York is just the leading edge of what we are likely to see in Detroit, New Orleans, potentially Florida, a number of other cities, Illinois.
00:15:28.000It's 90,000 still pretty terrible, but I think it is a big number.
00:15:32.000My confidence that the fall will not be as bad as the spring.
00:15:38.000is that I think we're smart enough to have learned the lessons of this.
00:15:42.000It's awfully hard to tell people to disrupt your life and basically screw up the economy based on a theory or based on something that's happening in China.
00:15:51.000Once it's happened in New York, once it's happened in big cities, I think people get it.
00:16:01.000I think we will find treatments and vaccines, and almost as importantly, new technology ways to track cases and follow people.
00:16:11.000If you look at what happened, it's hard to know whether the numbers coming out of China But what's happened in prior epidemics, what the experience in Korea, for example, seems to show that after that initial spike, if everybody gets their act together, we can keep this thing at bay to a large extent.
00:16:32.000And the analogy, I think people always say, well, there was a big surge in the Spanish flu.
00:16:39.000Well, yes, but the Spanish would think about what they had to do tracing.
00:17:16.000When does life go back to normal, either post-vaccine or not?
00:17:20.000And when do we actually start to emerge from the groundhog holes that we've been burrowing for the past several weeks?
00:17:30.000Anybody's guess, but I'm guessing that, you know, a May to June, probably mid-May is the best estimate of being able to come out of our burrow and get back to something that resembles, more closely resembles normal is right.
00:17:47.000And in terms of when we reach a time that things are truly back to normal, the best estimates for a vaccine are 12 to 18 months.
00:17:57.000And the minute people find it, it's not trivial to get it into the arm of 350 million people.
00:18:04.000So, you know, you've got to think it's 18 to 24 months.
00:18:08.000So question number two, with all that said, what does America look like in six months?
00:18:11.000I mean, are we still presumably social distancing?
00:18:15.000What do you think that American life looks like six months from now?
00:18:18.000I think masks are going to become a norm.
00:18:21.000I don't know if it'll be quite like Tokyo or other places in Japan where it is absolutely the norm, but you're going to see a lot of people wearing masks.
00:18:29.000I think people are going to be cleaning their hands incessantly.
00:18:32.000I think people are going to keep a distance from one another.
00:18:35.000And it may vary community by community.
00:18:38.000If there are no cases in your community, What should America do?
00:18:42.000What are the big steps that we can take to prevent the next pandemic?
00:18:46.000And if you do find a case, then you begin to do the contact tracing and those sort of things.
00:18:51.000But in communities where there still is virus in the zeitgeist, I think you are going to see people walking around with masks, keeping their distance and cleaning their hands religiously.
00:19:00.000And I think that's the right thing to do.
00:19:08.000I mean, if you look at how well some of the countries in Asia reacted, it was in large part because they had a playbook that they could pull off the shelf.
00:19:18.000And they had a national strategy for dealing with this.
00:19:20.000And the national strategy had every had Have included what should the population be told and what do they need to do?
00:19:28.000And it can't be a patchwork if you do it this way in this city, do it this way in this state.
00:19:31.000It really has to be a national strategy because this thing permeates state and city lines.
00:19:43.000And part of the challenge here was, you know, we don't have a way of getting testing throughout the entire country, so we have to have a rapid-fire way.
00:19:53.000Somebody at CDC has to be able to, obviously with the White House and with the health leaders, has to be able to push a button and say, there's been an outbreak in this place, and it looks awfully like coronavirus, and here is the playbook, let's roll it out.
00:20:08.000And I think At least if it happens in the next five or ten years, I think people will remember this and believe it.
00:20:13.000If it happens 20 or 30 years from now, people will forget this and we'll go through the same trauma, I'm afraid.
00:20:18.000So, how should we treat the government of China after this?
00:20:20.000Obviously, the government of China not only prevaricated about the virus in the beginning, they openly lied to the WHO.
00:20:26.000They said there was no human-to-human transmission.
00:20:57.000A virus that starts in China is going to end up here and vice versa.
00:21:02.000China reacted and didn't do some of the things they should have done.
00:21:08.000On the other hand, once they reacted, they reacted with an aggressiveness that I think probably saved a bunch of lives in China and may have saved a bunch of lives around the world.
00:21:18.000They did things that we're not capable of doing and we shouldn't be capable of doing in terms of what an authoritarian regiment can do.
00:21:24.000But in some ways, I think I can understand us being unhappy with them and that influencing our relationships.
00:21:31.000On the other hand, it just shows how extraordinarily interconnected all the countries are.
00:21:35.000And if we isolate from one another, it doesn't work.
00:21:39.000The virus gets through and we'd have to work together better.
00:21:42.000But finally, the measures that everybody is taking.
00:21:45.000You mentioned before that we're going to be wearing masks for a while.
00:21:48.000Is there ever a point where we go back to full normal, meaning like giant events, 60,000 people at baseball games?
00:21:56.000I sort of think at this point that all mass events are basically going to be canceled until there's a vaccine.
00:22:00.000Are all the measures we're taking right now temporary or permanent?
00:22:16.000I gotta think that this is, we'll be back to something resembling normal in a couple of years.
00:22:24.000It might be a little shorter than that.
00:22:25.000I don't think it will be that much longer than that.
00:22:28.000You think about the quality of the American scientific and medical enterprise, the idea that we're not going to be able to find a vaccine for this, I find hard to believe if we completely put our full resources, full attention to it.
00:22:40.000I think for a year, year and a half, things are going to be pretty weird.
00:22:43.000I think they are going to, they're not going to be full lockdown like they are now for the next, probably the next month or two, probably two.
00:23:10.000Nice to talk to you. - Joining us next is Dr. Scott Atlas, a medical doctor, senior fellow at Stanford University's Hoover Institution, and a member of the institution's working group on healthcare policy.
00:23:27.000He is previous chief of neuroradiology at Stanford Medical Center, is the author of the leading textbook on MRIs, and has written over 120 scholarly articles.
00:23:35.000Dr. Atlas, thanks so much for joining the show.
00:23:52.000I guess my question with these models is we are all now locking down for the next few weeks at a bare minimum in order to flatten the curve for the next few months.
00:24:00.000But none of these models seem to extend far beyond that.
00:24:03.000And we've been told that the vaccines are only going to be ready 12 to 18 months from now.
00:24:06.000It's obviously unrealistic to suggest that we are going to Yeah, I mean, this is, of course, a very tricky question.
00:24:11.000I would say a couple of points to understand.
00:24:12.000Number one, the models are really just those.
00:24:13.000So how exactly should we balance the needs of public health and the needs of the economy in a time when we are at such a lack for data as to what happens next?
00:24:23.000Yeah, I mean, this is, of course, a very tricky question.
00:24:27.000I would say a couple of points to understand.
00:24:30.000Number one, the models are really just those.
00:24:33.000And like all projections, they're likely to be wrong, no matter how good the people are that are doing them, because there's so many incoming assumptions that underlie each projection.
00:24:44.000And it's something very important to understand because, as you know, the definition of a case could be a positive test only, could be a symptomatic person.
00:24:52.000The testing is very different and heterogeneously distributed.
00:24:57.000Second point is that to re-enter, I would call, I use that word re-enter society.
00:25:04.000I think we're going to see something first Clearly gradual.
00:25:08.000And secondly, there's going to be a sort of a different way to look at re-entry.
00:25:15.000I make the analogy, it's possible that we will see what people call a new normal.
00:25:19.000Remember after 9-11, everything changed in airport security.
00:25:23.000We never had that sort of waiting lines.
00:25:25.000And I used to run up to a plane minutes before it took off.
00:25:30.000This might be the same in that, at least in the beginning, I think it's very likely we will need some sort of testing to permit and allow reentry.
00:25:41.000And that testing is likely to be twofold.
00:25:45.000One is antibody testing, which involves a blood test of some sort.
00:25:50.000And that will say if you're immune or not, meaning you've already had it and you're highly unlikely to get it again, judging from all biology of previous virus infections.
00:26:01.000And those people clearly will be safe and actually fine to re-enter.
00:26:05.000And the other test might be a test of active virus presence.
00:26:11.000And I think that's possible and actually easier But probably less likely to be done.
00:26:23.000So I think we will have some sort of testing at point of entry.
00:27:09.000They need meaning isolation from people who are either asymptomatic or sick, clearly.
00:27:15.000And that is going to need testing of people who deal with those people.
00:27:19.000And those people, the older people who are much more likely to have a serious illness or die, are going to need special sort of re-entry public health formulations.
00:27:30.000So with all of that said, and looking at sort of the fact that these models and studies are not taking into account really the possibility of a second wave or the reality that people are going to reenter the workforce, there are a lot of skeptics out there who have been kind of rearing their heads and saying, OK, well, maybe We could take this for a week, but we can't take this for another two months.
00:27:49.000And the economy is losing 10 million jobs every couple of weeks here.
00:27:53.000And we are going to enter economic levels not seen since ever in the United States in terms of unemployment.
00:27:57.000So why not pursue a policy like Sweden, for example, where we isolate everybody who's over the age of 60.
00:28:04.000If you're over the age of 60, or if you have a pre-existing health condition, you're expected to stay in your house and self-isolate.
00:29:44.000There's, as you are alluding to, a huge cost to individuals and to really sickness but death when there's a depression sort of economic situation.
00:30:35.000There's fundamental biology to understand.
00:30:38.000And we are going to have enough immunity.
00:30:40.000We are going to allow, and it's actually beneficial to allow more people to mingle, given that the overwhelming majority are not going to die.
00:30:51.000And the overwhelming majority are going to have a mild or a symptom course.
00:30:55.000We need so-called herd immunity because there's a natural way to eliminate viruses like this.
00:31:32.000So realistically speaking, it seems as though a lot of the press that's being done, Dr. Atlas, on this sort of stuff from the White House, from other folks who talk about it, has focused on this sort of idea that we're all going to avoid the disease, but that obviously is not reality.
00:31:47.000It's gonna be, it may become seasonal like the flu, in which case we're probably all gonna get this at some point in our lives.
00:31:52.000So would it be better for people who are speaking about this publicly to simply say, look, the purpose of what we are doing right now is to avoid the overwhelming of the healthcare systems, That's really what this is about.
00:32:01.000It's not preventing people from getting infections in the long term.
00:32:04.000It's not preventing people from getting this and receiving treatment.
00:32:06.000The idea is to delay because we weren't ready for this and then to ramp up production of the ICUs and the ventilators and the mitigating treatments that we have so that when there's a second wave, it's not as cruel in the fall.
00:32:19.000Wouldn't that be a more realistic way to go about explaining to people what exactly we are doing than the way that has been generally explained, which seems sort of vague?
00:32:25.000It's almost as though, well, you know, we're going to flatten the curve and then everything is going to go away by September.
00:32:30.000And that does lead to some pretty significant questions about the modeling.
00:32:34.000Yeah, well, I mean, if you listen closely, I think it has been said by the White House Task Force, at least, and Fauci specifically, as well as Dr. Birx, that there is an anticipated second wave, if you want to call it, or it is being thought of as, OK, if you want to call it, or it is being thought of as, OK, we're probably going to get this somewhat like the flu in terms of seasonal, So,
00:33:00.000So the real direction of health policy in this is twofold.
00:33:05.000It's not just not overwhelm the health care system.
00:33:08.000It's number one to save lives, to protect the people who are going to die.
00:33:13.000And when we look at just looking at the New York data, OK, New York data alone, Something like 1.5% of deaths are in people without any previous underlying condition.
00:33:25.000Okay, so that's very impactful on the decision-making because we know who's going to die.
00:33:32.000No one's saying there's no exceptions, but exceptions don't disprove the rule.
00:33:35.000So the number one goal is to stop people from dying.
00:33:38.000The number two goal is to make sure that we don't overwhelm the system so that we can take care of sick people and so that we don't endanger our health care provider network of doctors and nurses and respiratory therapists etc.
00:33:55.000And so that to me I think the appropriate policy is to have Isolation of the people who are vulnerable.
00:34:03.000I mean, in a very strict way, making sure that people understand that there is a strategic isolation going.
00:34:10.000That is the vulnerable and the people who interact with it.
00:34:15.000People who are sick, everyone who's sick absolutely must assume, with or without testing, they should assume they have the virus and then proceed in an isolation mode for the two weeks that are recommended.
00:34:28.000And number three, a prioritization of testing.
00:34:36.000People who are in the hospital, who have the symptoms and are sick, make sure they have, they do or do not have this so they can be isolated.
00:34:45.000People that are interacting with older people, like nursing home workers.
00:34:56.000It's not true that there's this urgent, equally urgent need to test everybody immediately.
00:35:02.000That is not really... that's a bad message, I think, to send out.
00:35:07.000And the second thing to understand is that if you're sick and otherwise healthy, you don't need to go in to seek medical care.
00:35:14.000You can call your doctor, but if you just have a mild fever or cough and you don't have shortness of breath or high fever, you should assume you have the virus and stay home.
00:35:24.000That prevents overwhelming of the system.
00:35:27.000There is no urgent need for testing of people just out of curiosity or fear.
00:35:33.000We should, if you're sick, again, assume you have it, be isolated.
00:35:37.000The goal here is to really stop the people from getting it who are vulnerable.
00:35:42.000There is a topic that I think is worth knowing about, which is this idea of herd immunity, which means that there's a societal benefit to have people who have the disease, meaning our carriers, sort of get it and develop their own immunity.
00:36:00.000And the more people that have that, the virus ultimately does disappear as is the case for every other virus that we encounter.
00:36:11.000And you know, the other part of the equation that I didn't mention is that we should not underestimate the work being done on the drugs.
00:36:20.000that are being used in clinical trials.
00:36:22.000And we will start seeing results this month, meaning within a couple of weeks, perhaps even within one week, I've been told by one of the big companies being testing, testing the drug in clinical trials.
00:36:34.000And these drugs, the intravenous drugs by, for instance, the Gilead drug is a life, if it works, And there's plenty of reason to believe it will work.
00:38:12.000But how would you sort of rate various responses from state and federal governments on this thing so far, considering it is a Black Swan event?
00:38:20.000I mean, the first, before I even comment, I would say that there is no scenario whereby a health care system would not be overwhelmed by a massive need.
00:39:02.000And it was, uh, it was imperfect by our, by our government and by our officials, because we didn't have the information and we assumed we did.
00:39:11.000And if you look at the quotes by somebody who's really been fantastic, which is.
00:39:15.000Dr. Fauci in the end of January, he was saying there's no problem here.
00:39:20.000You have to realize that the president, and luckily for us, the president and the government officials are not winging it here.
00:39:28.000They're going by what they're told from public health and other experts.
00:39:33.000So, you know, decisions were made based on flawed information and that information was really, frankly, lies coming out of China and a lot of obscuration of what happened.
00:40:33.000Uh, I think we implemented the right policies to try to at least immediately capture the kind of containment mode of isolating.
00:40:42.000Given we're not a society where we're going to put people in jail and bar them in their homes with physical barriers, I mean, we're a little bit different than some of the other societies, but I think our response has been good with that.
00:40:57.000We have fantastic experts working on this.
00:42:17.000Because A, those places have ventilators.
00:42:20.000Let's just say on average, the estimate is five per ambulatory surgery center.
00:42:25.000That's 29,000 ventilators right away that have been freed up because elective surgeries and elective uses of those centers have been stopped.
00:42:36.000We can shift and move around things very quickly, and we are.
00:42:41.000And we've relaxed rules on ambulatory surgery centers, by the way, for healthcare providers for admitting people for more than 24 hours, which was forbidden before.
00:42:52.000We've relaxed rules on the use of nurse practitioners and physician assistants to prescribe medicine.
00:42:58.000to do things that they're capable of but not really authorized to do in a normal circumstance without physician input.
00:43:06.000We've authorized distance monitoring of patients.
00:43:11.000So, I mean, there's a lot of things being done that we can do and have done and are doing because we are a nimble, non-government centralized healthcare system.
00:43:22.000I think we're, you know, we have a lot of problems because it's a very difficult new virus to deal with.
00:43:30.000We have the most innovative system in the world.
00:43:33.000Our system has the appropriate incentives in place for drug development, for vaccine development, and our private entrepreneurs and private sector medical technology system, which is by far the best in the world in terms of just quantity as well as quality, is working very well on this.
00:43:55.000Our FDA is streamlining, I think, you know, tremendously in getting through new approvals, new drugs, new clinical trials.
00:44:06.000I mean, there's so much going on that people don't realize and I'm very confident that this A is temporary, biologically speaking.
00:44:20.000But B, I'm optimistic that this is going to be controlled and we are going to get back to work and less and less people are going to die because of the way our system operates.
00:44:33.000Last question on the death rates and the models.
00:44:37.000So we've seen models that suggest anywhere from 36,000 people to 2.2 million people dying in the United States.
00:44:43.000Where do you think that, given the measures that are currently being taken by states and that probably are not likely to let up, I would say, at this point until May, it seems is sort of the common denominator, where do you think that those numbers end up over the course of, say, a year?
00:44:55.000Yeah, I mean, it's obviously impossible to predict, but I would put it this way.
00:45:00.000When you look at the models, they've been coming down significantly from the original models.
00:45:18.000So when you look at the model that the government is really using, which the sort of average of the range of prediction in that model by Murray and others is roughly in the US, maybe 80,000 or so deaths, which is
00:45:37.000dramatic and huge and tragic for all the reasons that of course we know with the range of really being in the order of 30 to maybe a hundred and some thousand and so my guess as we proceed and again you know nobody really can predict is we're going to see more and more cases by virtue of more and more testing and by virtue of spread also
00:46:06.000We're going to see a lower and lower fatality rate on the order of under 1%.
00:46:12.000I think that's highly likely, if not already proven.
00:46:16.000And we're going to see, you know, I'm hoping we see tens of thousands of people die in the United States as a maximum.
00:46:26.000And the perspective on that Can also be ascertained from looking at the modelers, a different group of modelers who came out with this first estimate that you mentioned, 2.2 million in the US, 500,000 in the UK.
00:46:39.000They changed in three days to saying 20,000 in the UK instead of 500,000.
00:46:47.000This is not a criticism of the modelers.
00:46:49.000This is understanding that the, the inputs are really making all kinds of assumptions and those, those inputs change dramatically.
00:46:58.000I want to put a little bit about perspective on deaths, and this is not at all to be minimizing anything.
00:47:04.000I don't want any viewer to interpret this as a minimization.
00:47:09.000But when you look at the number of deaths from the flu every year in the United States, we have between 30,000 and 60,000 people die in the U.S. 30,000 to 60,000 people die in the U.S. every year.
00:47:41.000But we do have to realize that if we get out of this with under 100,000 people dying, it's It could have been a lot worse and was projected to be a lot worse.
00:48:03.000If you have to set an end date for this particular crisis, when people start to go back to work, what do you think the end date is when people start to go back to work here?
00:48:11.000OK, it's a guess, but I'm thinking there's going to be a re-entry into the workforce sometime early summer.
00:48:19.000What do you think America is going to look like six months from now?
00:48:21.000Do you think we're all going to be wearing masks?
00:48:23.000Are we all going to be socially distancing still?
00:48:25.000Are all the concerts and the sports leagues going to be closed still?
00:49:27.000Not just with vaccines, but technology to generate new drugs and vaccines, the infrastructure.
00:49:35.000And also, and I'm involved with a big effort now, making sure we understand that health security is national security.
00:49:44.000How should we treat China after all of this, considering the lies that they told, considering the fact that if they had let everybody know what was going on, that we'd probably prevent, according to some studies, 90% and 95% of all casualties from this thing?
00:49:55.000How should the world health community treat China?
00:49:58.000You know, I think that China, I think this sort of opens people's eyes.
00:50:02.000I hope it opens people's eyes to what the economists have known all along, which is that their economic numbers are not to be believed.
00:50:09.000This is clearly nothing they're saying about how many cases they have or anything is to be believed.
00:50:14.000They did something really heinous here in covering this up.
00:50:19.000I think China has really lost a tremendous amount of credibility in the rest of the world.
00:50:26.000And I think that changes their position tremendously.
00:50:31.000And by the way, I think a lot of other countries will be understanding they cannot depend on China for a lot of things, including And finally, the measures that we're taking now on a personal level, the sort of social distancing, no handshaking, staying away from elderly people more.
00:50:50.000Are those going to be temporary or do you expect those to be permanent?
00:50:53.000I think those are going to be temporary.
00:50:54.000I think we'll be more conscious of things and we'll be conscious of it just like we have been in the past with the flu, getting flu immunizations.
00:51:20.000Now that we've heard the public health perspective, let's turn to the economy.
00:51:29.000Bringing us the economist's point of view is Mohamed El-Erian, the Chief Economic Advisor to financial services company Allianz and President-elect of Queen's College at the University of Cambridge.
00:51:39.000He's the Senior Advisor at Gramercy and Professor of Practice at Wharton.
00:51:42.000He's an opinion columnist for Bloomberg and has authored The Only Game in Town and When Markets Collide.
00:51:51.000So let me start by asking you about the sort of balance that we have to draw between public health and economic need.
00:51:58.000There's this weird dynamic that crops up mostly on Twitter, where one side of the debate suggests that the economy is real life and therefore we should sort of ignore the public health warnings.
00:52:27.000Look, there is an inherent contradiction, and that's why you get what you mentioned, an inherent contradiction between what this phase of the health policy is social distancing, separation, isolation, and what the economy is wired for.
00:52:43.000And the economy and society are both wired for connectivity, integration.
00:52:49.000So there is this tension that's playing out, and understandably so.
00:52:55.000I think you have to think about this sequentially.
00:52:57.000It's not an either-or, it's just a sequence over time.
00:53:01.000Priority number one is to get control of the virus, contain its spread, treat the ill better, and hopefully increase immunity.
00:53:11.000Until we get the first two things done, it's going to be very hard to restart this economy without going into a W. You start, and then you have to come down again.
00:53:21.000And we don't want a W. Having said that, we have to protect the economy.
00:53:26.000And this stage is about relief, about containing the damage.
00:53:29.000And there'll come a next stage, which is going to be about trying to return the economy to some sense of normalcy.
00:53:35.000So I want to ask you about the relief measures that have been taken in just a second, but you've been looking at the same models that I've been looking at, you know, the models from University of Washington or the Imperial College models.
00:53:44.000And one of the problems I have in looking at the models, especially when we're thinking in terms of the economy, is trying to figure out when people go back to work is pretty difficult when these models end in August.
00:53:53.000Nobody seems to be taking into account what happens in a second wave.
00:53:55.000Nobody seems to be suggesting what level of medical capacity will have to be in September in order for us not to go back into that W-shaped lockdown that you've talked about.
00:54:04.000And so it makes it almost impossible to determine at what point we have a metric of success.
00:54:10.000From an economist's point of view, what would a metric of success look like such that we could have a permanent return to the workforce for at least a segment of the population?
00:54:17.000So, Ben, you've zeroed on an issue that's going to come up, I suspect, in everything we discussed today.
00:55:00.000I don't think anybody knows what the answer is.
00:55:02.000The key issue here is to have an open mindset, to be able to make trade-offs, and to be honest about the trade-offs we're making.
00:55:09.000Because we're going to make some trade-offs, and we're going to make some mistakes.
00:55:12.000I want to talk about how long, realistically speaking, from an economic perspective, we can last like this.
00:55:18.000So we've had a full-on economic stop globally.
00:55:21.000I mean, the United States, we're going to see unemployment rates like we've literally never seen in American history.
00:55:26.000We're going to see people thrown out of their jobs.
00:55:28.000It's going to give the lie to the myth that companies somehow have safes full of cash in their back rooms that they're just withholding from their employees, because everybody's going to go basically bankrupt within the next few weeks, because it turns out that's not how companies actually operate.
00:55:41.000How long can we just keep floating along on basically taking out a credit card when nobody is going to buy our debt?
00:55:48.000I mean, it's basically a bunch of countries that are selling their debt to each other at this point.
00:55:52.000How long is that sustainable before you start to see shortages, before you start to see No underlying economic activity have the sort of permanent significant impacts on the economy that we just can't recover from.
00:56:08.000And we have to be honest with the American people that we are facing a very difficult economic outlook that will make the sense of health and security feel compounded by economic insecurity.
00:56:20.000And I wish I could have another message, Ben, but that's the reality.
00:56:23.000Already we've seen 10 Now, the good news is relative to every other country in the world, we can manage this awful journey a lot better.
00:57:42.000So let's talk now about the relief efforts that have been attempted here.
00:57:46.000So Congress obviously passes the largest spending package in the history of the world, $2 trillion.
00:57:50.000The Federal Reserve is injecting another $4 trillion into the system.
00:57:53.000So for folks who don't understand exactly what Congress did here and what the Federal Reserve did here, what exactly did Congress do?
00:57:58.000What exactly did the Federal Reserve do?
00:58:00.000So the Federal Reserve tried to stop, and so far has been successful, a crisis that originated in health and paralyzed the economy from creating a financial crisis.
00:58:12.000We came this close, this close, Ben, on a Monday, two weeks ago, to having both a 1930s-like depression and having a 2008-like global financial crisis.
00:58:27.000And the Fed simply had to flood certain segments of the market because the Treasury market, the senior market, the mother of all markets, the most senior market in the world, was dysfunctional.
00:58:40.000And that means that the pipes were clogged.
00:58:43.000I know we don't pay attention to the pipes, and many people watching this will say, I don't know anything about the pipes.
00:58:49.000But you know in your house, when the pipes are problematic, you have a major problem.
00:58:53.000And we came this close to the pipes clogging.
00:59:27.000If you don't deal with your liquidity problem, you go bankrupt.
00:59:31.000And what happens when you go bankrupt?
00:59:32.000Lots of bad things happen and the productive capacity of the whole economy contracts, which means we hit ourselves now and we hit ourselves in the future.
00:59:41.000That is what Congress and the White House are trying to do.
00:59:44.000It's not easy because Many pipes aren't there yet.
00:59:48.000So when we talk about the Federal Reserve buying up commercial paper or backing bank loans, it seemed to me one of my recommendations early on was that the first chief response here should be to prevent the banks from being forced to call in all of the loans, from being forced to call in the mortgages, from seeing the sort of stuff we saw in 2007, 2008.
01:00:07.000Instead, it looks like the government is going to start floating basically direct loans to businesses as opposed to via banks.
01:00:13.000Do you think it would be better to go via the banks, or do you think that it would be better to start giving out direct loans via the government, as some have called for?
01:00:28.000They have had constraints on them taken off.
01:00:32.000I can go through them, but they're very technical.
01:00:35.000And there's no excuse for the banks not stepping up to their responsibility.
01:00:39.000And I think they really want to be part of the solution, because they were part of the problem last time around.
01:00:44.000And when it comes to the possibility of inflation, a lot of people have been worried deeply about what comes due on the other end of this.
01:00:49.000So obviously, we've been spending out of control for literally decades at this point.
01:00:53.000We just added $6 trillion, presumably, to the national debt over the course of about three weeks here.
01:00:59.000The appetite for debt out there has to be fairly low, considering that literally every other country in the world is incurring its own set of debts.
01:01:08.000So is this going to be a situation where the United States is either going to have to radically raise taxes two years from now, or where we are going to have to radically inflate the currency?
01:01:21.000This period we've lived where we haven't had to worry about inflation, and to the extent that the policymakers did, it was because inflation was too low.
01:02:26.000You and I are going to be talking about this.
01:02:28.000It's going to be a messy spaghetti ball because all these things are being done ad hoc.
01:02:34.000So, can you talk a little bit about that?
01:02:46.000What specifically, give an example, do you mean by that sort of entanglement that we should worry about?
01:02:52.000Because I think there are a lot of people who are fiscally conservative, like I am, who say, well, my goal, as soon as the thing is over, is to get government the hell out of this as fast as humanly possible, since government Obviously did a terrible job preparing for it.
01:03:04.000And then I sort of believe the government is a giant lumbering idiot.
01:03:07.000And that doesn't mean you don't need a giant lumbering idiot every so often to intimidate people to stay in their homes.
01:03:12.000But it does mean that you want it out of a more nimble private sector as fast as possible.
01:03:16.000What's that entanglement look like coming out of this?
01:03:39.000Every sector I know, except for a few, are having a simultaneous destruction of consumption and production.
01:03:49.000So the line for bailouts is going to be very, very long.
01:03:54.000So if you embark on a bailout strategy without having clear principle who you're going to bail out, why you're going to bail them out, how long for, on what term and what the exit policy is, you end up with a spaghetti bowl.
01:04:08.000And the danger is... Now, what is that spaghetti bowl?
01:04:11.000OK, so Boeing survives because of government help.
01:04:17.000So what's the government's claim on Boeing when they recover?
01:04:20.000How long should the government be an equity holder in Boeing?
01:04:24.000Where should it be when it's to other equity holders?
01:04:26.000None of this has been discussed, and this has got to be sorted out.
01:04:30.000Would it be better, in your opinion, to avoid that sort of spaghetti ball if the government were just providing basically zero-interest loans to these firms as opposed to trying to grab chunks of them?
01:04:39.000We saw Boeing actually turn down the possibility of government ownership in a stake.
01:04:43.000They said, we'll fire people before we allow the government to run our business.
01:04:46.000If you're trying to encourage businesses to keep people employed, one of the questions I've had about the bill that Congress passed is the interference in how businesses are run, the idea that if you're a small business, that we are going to float you a loan specifically so you can maintain your employment base.
01:04:59.000But as you said, there is literally no market for your employees to cater to.
01:05:04.000So would it not be better for the government to provide zero interest loans to companies via banks that can assess risk and then to just increase the unemployment insurance on the other side so that we are not actually providing incentives for companies to keep people on the payrolls?
01:05:17.000And then the minute that this thing ends, fire everybody, which is presumably what will happen because the market is not going to recover simultaneously with the end of this pandemic.
01:05:25.000So they're trying to stop that by saying if you keep them on, some of your existing loans you're going to get are going to be...
01:06:25.000And neither of these things have informed enough The design of the program for understandable reason, but they must inform the implementation because we are going to learn as we go along and we have to have an open mindset.
01:06:38.000I keep on telling people, when you deal in massive uncertainty, you're going to make mistakes.
01:06:45.000No one wants to make mistakes, but you're going to make a mistake.
01:06:48.000Make sure you can learn quickly and correct it.
01:06:58.000So you're warning for years that use of central banks as the as the chief policymakers in finance was going to be a large scale mistake because governments were basically avoiding their responsibility.
01:07:08.000We had already brought the interest rates down to extreme lows in the United States, even leading up to this, which meant that there was just less water in the hose.
01:07:15.000Now, there may have been enough water in the hose to forestall something for the moment, but looking forward to the future, is that failure to abide by actual policymaking across countries, not just in the United States, but in Europe as well, and the overuse of central banks as chief policymakers, has that watered down the ability of central banks to do what they need to do, and is it going to make the recovery a lot steeper on the other end?
01:07:37.000Yes, and yes, and it's really unfortunate because this was an avoidable mistake.
01:07:42.000You know, I wrote this book in 2016 called The Only Game in Town, and the last bit of it was avoiding the next collapse.
01:07:50.000And I argued then, and an update of the book is coming up, I argued then that within five years, we will come to what I call the T-junction.
01:07:59.000That the path we were on, that relied only on central banks, would plant the seeds of its own destruction.
01:08:06.000And then we would have to make a choice, turn towards better policy, genuine growth, genuine financial stability, none of the artificial stuff that we've done, or alternatively, recession.
01:09:15.000There are going to be some permanent landscape shifts in how the economy works.
01:09:18.000I mean, at least for the next year, restaurants, the entertainment industry, movies, sports, How office buildings work, all of this is going to change.
01:09:27.000What does the post-crisis landscape look like, and how do we win the piece?
01:09:32.000So I have a piece of paper here where I keep on writing down how a difference is going to look.
01:09:36.000I ran out of one side, I started the second side.
01:11:04.000We can manage it, but we have to plan from now.
01:11:08.000The aftermath of the crisis is going to be as important as what seems pretty horrible now.
01:11:14.000So how do we plan for stuff like that?
01:11:16.000So to take for an example, you mentioned the breaking of global supply chains.
01:11:19.000Now, there are going to be a lot of firms that look at China, for example, and say, we're not locating there because of what just happened.
01:11:24.000But presumably, there will be one or two firms that say, OK, well, the reward is worth the risk.
01:11:29.000I'm going to undercut my competitors by continuing to manufacture from China and hope that for 5 or 10 years, there's not another wet market outbreak like this.
01:11:35.000And so without any sort of government measure that prevents people from undercutting one another by taking that riskier supply chain line, Are those changes going to be permanent, or is the institutional memory here going to be short?
01:11:48.000So I think it's going to be permanent.
01:11:49.000And again, we all have a role to play.
01:11:51.000The last thing you and I want for our kids is the notion that any company is international when it makes profit and national when it fails.
01:12:02.000Because it means that when it's making profit, everybody else benefits.
01:12:07.000And when it fails, They come to us, the taxpayer, okay?
01:12:13.000So there has to be incentives to stop people abusing this notion that you can be international when everything's going well, and then you become national when things go badly.
01:12:26.000We just have to realize that that's the world we're going into, and we have to stop the abuse that you talked about.
01:12:32.000So let's talk about the stock market for a second.
01:12:33.000You've mentioned before you were ahead of the curve, as you very often are on this sort of stuff.
01:12:38.000When the stock market started to drop and people were saying, now's a great time to buy, you were saying, well, wait a second, because it's going to drop some more.
01:12:45.000How far do you think the stock market is going to drop?
01:12:47.000You don't have to put a number on it, but how long do you think it's going to drop?
01:12:50.000Given the uncertainty, have we reached sort of baseline uncertainty and now the news starts to get better?
01:12:56.000Or do you think that the uncertainty continues for months and months and months?
01:12:59.000And is this a buying opportunity or should we all just sort of So I think it's the latter.
01:13:06.000I think it's still time to be very cautious.
01:13:08.000And I've gone out of my way through my social media and my publication to try and increase the amount of information going to retail investors, small investors in particular, because the tendency of this industry is to tell you, buy, buy, buy, buy, buy.
01:13:56.000I tell people, expect volatility around a declining trend for now.
01:14:02.000And realize that in such an uncertain environment, you're gonna likely make a mistake.
01:14:08.000No one wants to make a mistake, but you're gonna make a mistake.
01:14:10.000Ask yourself, what mistake can you afford to make?
01:14:14.000Is it missing the 5% jump immediately when the bottom is formed?
01:14:20.000Or is it avoiding another 10 to 15% drop?
01:14:24.000Regret minimization, in my mind, is what should lead So you mentioned earlier there may come a time when we have to make hard choices with regard to the economy.
01:14:34.000Too late back into the market, then too early.
01:14:37.000So you mentioned earlier there may come a time when we have to make hard choices with regard to the economy.
01:14:42.000That right now we can afford to take the public health hit based on the modeling, that we can all hope that the summer kills this thing off, that we have measures in place by September.
01:14:51.000But it's pretty obvious that we can't do this indefinitely.
01:14:53.000We're already starting to see some rioting in southern Italy.
01:14:55.000We've already seen talk about the EU breaking up and we're only a few weeks into this thing.
01:15:00.000One of the things that's been bothersome about some of the experts in public health talking about this sort of stuff is the models they put out there.
01:15:06.000We'll assume things like we're all going to remain home for the next year or 18 months, which obviously is not true.
01:15:11.000So when does, economically speaking, the pedal hit the metal?
01:15:14.000When does it basically make or break point where if we don't at least start getting people back to work, then the house of cards completely collapses?
01:15:22.000Is there a point where we basically have to say if it's a choice between the economy and public health, we just have to choose the economy or there will be no more economy left to choose?
01:15:30.000So everybody will tell you being risk-averse doesn't mean not taking any risk, okay?
01:16:40.000It's about all these other things that we also have to take into account.
01:16:43.000We're not there yet, and we have time, but if we don't get our arms around this horrible virus, we're going to have some pretty nasty trade-offs.
01:16:55.000My great fear is that now's the time when we should be listening to experts, but it's also a time when experts are able to provide us less information than any other time.
01:17:02.000So we have this sort of backwards behavioral problem, which is we have to listen to the experts to stay home, but they can't provide us enough information that causes us to stay home other than providing these sort of very big top line numbers.
01:17:14.000And when you say to people, stay home indefinitely, and meanwhile, people are losing their jobs, I wonder how long that can last indefinitely speaking.
01:17:20.000I mean, I wonder if six weeks from now, when the checks still have not arrived, and when people's bills are still due, whether they just say to the experts, listen, you're not even providing us an end date here.
01:17:29.000You can't tell people to diet indefinitely.
01:17:31.000You have to tell them what the end date of the diet is.
01:17:33.000Otherwise, people start ignoring the dietician.
01:17:36.000And it was called adjustment fatigue, that at some point we get tired.
01:17:40.000And the biggest risk we face as a society is the lag effects.
01:17:44.000So we have made, every single American is making massive sacrifices right now.
01:18:02.000And what I worry about most is because the lagged effects of the so-called curve is at least two to three weeks, at some point we are going to say, collectively or parts of us, hey, wait a minute, you mean I've made all these sacrifices and I haven't flattened the curve?
01:18:20.000Obviously, Leaders don't know what they're doing, and we're not going to realize that there was a lagged effect there.
01:18:26.000So it's going to be hard, and this adjustment fatigue is serious.
01:18:30.000I tell people, you've got to provide honest information.
01:18:35.000I don't know, Ben, if I may, but I'll give you an example.
01:18:37.000When my girls came home, they were really unsettled.
01:18:41.000So what we decided to do is every day we would sit down and talk about what's happening on the coronavirus, and importantly, what to expect.
01:18:49.000And this notion of, I don't know for sure, but this is what I'm looking for, has helped people enormously because you give them a roadmap.
01:18:56.000We do not have a sufficiently clear roadmap on health and we have no roadmap on the economy.
01:19:02.000And we've got to share both with the American people.
01:19:05.000Otherwise, they do, you know, they create their own roadmaps.
01:19:10.000And if you're worried about the expert not being informed, we individually are going to have, you know, another spaghetti bowl of roadmaps.
01:19:29.000If they had revealed this information a month in advance, there are some studies that suggest 95% of all casualties could have been avoided.
01:19:34.000So how should the world treat China after this?
01:19:36.000I've heard suggestions from people that I don't think are doable, like we should just cancel our debt to China.
01:19:43.000How should we deal with China and what sort of reparations should China be forced to pay for what has been incurred here?
01:19:48.000So starting with the trade war, I think we've emerged from this happy talk that China is a global responsible player.
01:19:58.000China is not a global responsible player.
01:20:00.000China does not play to the global rules.
01:20:03.000And we haven't held China accountable for a very long time.
01:20:06.000We should continue to hold China accountable and we should do it with our allies.
01:20:11.000But this is a moment to say enough is enough.
01:20:19.000We will not tolerate you being part of the export of a virus.
01:20:25.000So I think we got to hold China much more accountable to its global responsibilities now that we've allowed it to be part of the global economy.
01:20:33.000Will the measures that we are now taking be temporary or permanent?
01:20:36.000This is my great fear, is that people tend to use crises as an opportunity to confirm their priors.
01:20:41.000And when it comes to the growth of government, we've never seen anything like this in so quick a time.
01:20:45.000Are the measures that we are taking now expedient, or do you think that these become a permanent feature of the American landscape?
01:20:50.000So I, like you, worry about short-term measures becoming long-term measures.
01:20:55.000OK, that's why we have to think about this very carefully as we implement it.
01:20:59.000Look, that risk is there and we've got to collectively make sure that it doesn't reach critical mass, because if it does, then our longer term prosperity will be threatened.
01:21:09.000What can we do to prevent a couple of things that we can do to prevent this kind of economic meltdown next time a black swan event hits like this?
01:21:18.000So we need to develop three things that we haven't developed.
01:21:21.000Resilience, the ability to live through shocks, and that starts at the government level, the household level, and the corporate level.
01:21:29.000Two, optionality, this ability to change our minds as we get better information.
01:21:52.000It will look different, but we have the best initial conditions, Ben, to respond with agility and be able to bounce back, not fully, but certainly faster than we would otherwise.
01:22:03.000What do you think America will look like six months from now?