The Joe Rogan Experience - Joe Rogan Experience #1566 - Nicholas Christakis

00:00:08.000 Yeah, I got into cigars lately.

00:00:13.000 I did Sober October, and during the month of October, no drinking at all, and I started smoking cigars.

00:00:20.000 How did the Sober October work for you?

00:00:22.000 It's great.

00:00:22.000 We do it every year.

00:00:24.000 It's nice.

00:00:24.000 A little reset.

00:00:26.000 It's interesting, you know?

00:00:27.000 Very nice.

00:00:29.000 I have another friend of mine who stopped drinking altogether, and he said that it was making him cranky when he was drinking, and of course there were extra calories.

00:00:38.000 And I listened patiently to him and thought I would love to do that, but at the same time it's hard to give up completely.

00:00:45.000 I enjoy a glass of wine with a meal.

00:00:48.000 That I miss the most.

00:00:50.000 That was the worst when I was having a steak and I'm just like, God, nice glass of red wine right now.

00:00:57.000 But other than that, I don't drink much.

00:00:59.000 I'm not much of a boozer.

00:01:00.000 Although when November kicks in and I know I can drink again, there's usually a few days of excess.

00:01:07.000 Which is, speaking of the subject of COVID-19 and the current pandemic we're into, that's not a good thing.

00:01:14.000 There's a lot of people out there destroying their immune systems drinking.

00:01:18.000 There's a very funny video that I found online of this gentleman who runs around his neighborhood and he noticed that during the lockdown he would run around his neighborhood and he would see the recyclable bins and they were just filled With empty alcohol containers.

00:01:32.000 He's like, this is crazy.

00:01:34.000 This is for the weak?

00:01:36.000 How much are these people drinking?

00:01:37.000 Just vodka and wine.

00:01:39.000 There's a lot of that going on.

00:01:41.000 Yeah, people have actually looked a little bit at that, at alcohol consumption, and it's a little bit like the toilet paper shortage.

00:01:48.000 I don't know if you followed the whole toilet paper shortage thing.

00:01:51.000 Well, what's happening is there's a shift in consumption.

00:01:53.000 A lot of the drinking that was taking place in restaurants and restaurants You know, at bars is now taking place at home.

00:02:01.000 So I think it's like half and half.

00:02:04.000 Like half the consumption in the past was at home and half was out of the home.

00:02:07.000 And now it's almost all at home, which is part of it.

00:02:10.000 But I also think, as you're suggesting, the actual amount is going up too.

00:02:14.000 So yes, it's...

00:02:16.000 You know, and it's contributing to weight gain and other problems in our society.

00:02:20.000 The toilet paper thing, there's an easy fix for this, folks, that's way better.

00:02:24.000 And I hate to do this to plug a sponsor, but it's a good sponsor.

00:02:27.000 There's a sponsor called Tushy. 0.99

00:02:28.000 And Tushy makes a bidet attachment that just fits onto a regular toilet and it cleans your butt. 1.00

00:02:34.000 They're only 79 bucks and it's fantastic. 0.99

00:02:37.000 It cleans your butt so much better. 0.97

00:02:40.000 Than just toilet paper. 0.98

00:02:41.000 And it cuts your toilet paper consumption down by like 85-90%. 0.91

00:02:47.000 Because you just need a little bit of toilet paper to pat your butt dry at the end.

00:02:51.000 Do you ever use one of those bidet attachments? 0.91

00:02:53.000 Well, in Greece, they're not uncommon to have bidets.

00:02:57.000 I, of course, am familiar with them, but we don't have one here.

00:03:01.000 You should get one.

00:03:02.000 You should get one.

00:03:03.000 Say that again?

00:03:03.000 You should get one.

00:03:05.000 I'm telling you, it's so much better.

00:03:07.000 We may.

00:03:08.000 We may, in fact.

00:03:09.000 You should.

00:03:10.000 So I can't believe we've covered alcohol in bidets as well.

00:03:13.000 Yeah, so let's talk about this.

00:03:15.000 How did you, what made you decide to write a book on the current pandemic and the disease?

00:03:22.000 Well, I mean, for me it started, I was reading news reports in January about what was happening in China, but I wasn't paying a ton of attention.

00:03:32.000 And then I have these Chinese colleagues with whom I've been doing research for a long time, and they contacted me in the middle of January.

00:03:39.000 We had been using phone data in China.

00:03:42.000 To study how earthquakes, for example, change human social interactions.

00:03:47.000 So after an earthquake, who do people call?

00:03:49.000 And we could imagine that the first person you call is very important to you, for instance, and so we could use the phone data to study social interactions.

00:03:57.000 And so we decided to use the phone data to study the pandemic and to study the movement of people through China and how they might carry the virus with them, which started in Wuhan in November sometime.

00:04:13.000 And then we noticed, or I saw in the data, that on January 24th, the Chinese were so concerned with the virus that they basically detonated a social nuclear weapon and they put 930 million people, 0.93

00:04:28.000 almost a billion people, under home confinement starting January 24th.

00:04:34.000 And I could see that in the data.

00:04:36.000 And that really got my, because the emotions ceased.

00:04:39.000 People stopped moving in the whole country.

00:04:41.000 And that really got my attention.

00:04:43.000 And I got worried.

00:04:46.000 And it was clear to me that this was going to be a serious global pandemic.

00:04:51.000 And so I began to redirect the activities of my laboratory at Yale to study more and more about what was happening with this virus.

00:05:00.000 And we did a whole bunch of projects, some of which, if you're interested, we can talk about We released this app called Hunala, H-U-N-A-L-A, Hunala, which you can get thousands of people use it now.

00:05:13.000 It's like Waze for coronavirus.

00:05:15.000 It's not a contact tracing app that looks backwards.

00:05:18.000 It crowdsources information about who you're connected to, which is one of the things I study, is networks and where you live and forecast your risk.

00:05:27.000 So people down the road from you are reporting a traffic jam or a cop And you can exit the highway and avoid that.

00:05:34.000 And people, your friends, friends, friends are reporting a fever.

00:05:37.000 It can ripple back through the network and feed this information to you.

00:05:40.000 All anonymous.

00:05:41.000 It's anonymized.

00:05:43.000 It doesn't report who is having what.

00:05:47.000 Anyway, and the app, incidentally, temporarily...

00:05:52.000 Accesses your contacts.

00:05:53.000 We don't copy the contacts.

00:05:55.000 It doesn't copy that, but it makes it easier for you to identify who your social connections are.

00:05:59.000 Anyway, so we did that.

00:06:00.000 We did a whole bunch of other stuff, which maybe we'll talk about.

00:06:03.000 And so in the month of February, as we were doing all this work, I was getting more and more worried and that our nation wasn't preparing.

00:06:12.000 And so in March, I started sending out some Twitter threads like Epidemiology 101, like basic stuff.

00:06:20.000 And a lot of those started to go viral and people were so hungry for information about it.

00:06:25.000 It became clear to me, you know, factual information about what was happening.

00:06:29.000 And then in the middle of March, my editor, my long-term editor at Little Brown, a woman by the name of Tracy Behar, contacted me and said, would you like to write a book?

00:06:38.000 And I thought, yes.

00:06:40.000 And my motivation was that I wanted to help the American public understand what we were facing.

00:06:47.000 And I was very worried about That people weren't taking this seriously enough.

00:06:52.000 And so that's why I wrote the book.

00:06:54.000 I wrote the book because I thought this is something I know about.

00:06:58.000 This is something I care about.

00:07:00.000 I care about our country.

00:07:02.000 I didn't see our leaders as doing the things they needed to do.

00:07:06.000 And I just wanted to help people understand what was happening and what was likely to happen.

00:07:11.000 What do you think should have been done that wasn't initially?

00:07:14.000 Like in the January, the month of January, it's when everyone was alerted to the fact that this was going on in China.

00:07:21.000 The White House knew, everyone knew, but we didn't really lock anything down until March.

00:07:25.000 What do you think should have been done?

00:07:27.000 Well, first of all, people like me knew this was going to be a serious global pandemic for sure by the end of January.

00:07:36.000 And the president, we now know, unsurprisingly, was briefed even earlier, right?

00:07:40.000 I mean, if the president didn't have more information than me, then there's something wrong in our country.

00:07:48.000 But certainly by the end of January, when China locked down, as we discussed, we should have begun immediately preparing our testing capacity, manufacturing PPE, We should have, I think, begun the incredibly important challenge of preparing the nation for the challenge we would face,

00:08:07.000 like gearing up for a kind of war.

00:08:09.000 You know, we were about to be invaded by the virus, so public messaging would have been really important to tell people, you know, we're facing a common threat.

00:08:18.000 We're gonna have to endure some sacrifice.

00:08:20.000 We're gonna have to work together to repel this threat.

00:08:23.000 Here's some basic information about the nature of the threat.

00:08:27.000 So all of these things are ventilators, for example, also another, you know, sort of material that we needed.

00:08:33.000 Preparing our hospital systems, for example.

00:08:36.000 We lost several months in which we didn't We didn't really prepare.

00:08:40.000 And honestly, I don't understand why our leadership failed us in this way.

00:08:45.000 Who's responsible for that?

00:08:46.000 There's also an issue where the pandemic response team that was in place for the previous administration was disbanded and sort of reassigned, correct?

00:08:58.000 I don't know.

00:08:59.000 Yes, I don't know all the details about that.

00:09:01.000 I know it wasn't just the Obama administration.

00:09:02.000 They inherited the pandemic response From the Bush administration and the CIA has been identifying emergent pandemics as a serious national security threat for a number of decades now, as I actually discuss in the book.

00:09:17.000 And of course people like Bill Gates have been warning about this.

00:09:20.000 Tony Fauci was writing about this stuff when you and I were in elementary school.

00:09:25.000 So there's a lot of institutional knowledge about the existence and nature of these threats.

00:09:31.000 I don't know why we weren't better prepared when we saw what was happening in China.

00:09:37.000 What could have been done differently?

00:09:39.000 I mean obviously manufacturing of PPE and all those things.

00:09:45.000 That absolutely should have happened.

00:09:46.000 And that would have actually avoided a very unfortunate thing that happened where Fauci actually was telling people they don't have to wear masks.

00:09:55.000 And he later admitted the reason why he did that is because he didn't want people rushing to get masks and that would take masks away from the first responders.

00:10:03.000 That's a very, very unfortunate thing that he did because that eroded people's confidence in what he's saying.

00:10:11.000 It lets you know That there are people that are in positions of power like himself or positions of influence that will lie for the better good but still lie.

00:10:22.000 Yeah, so the details of the Fauci statement, I honestly don't know.

00:10:27.000 I haven't dug deeply to know exactly what he said and when.

00:10:30.000 I can retrace for you some basics, however, about mask wearing early on.

00:10:34.000 I actually put it on my Instagram because it was so crazy when he was saying it.

00:10:39.000 It was an interview that he did on television and he was saying for the general public, you know, you don't have to wear masks.

00:10:45.000 He's not helping you.

00:10:46.000 And he was actually saying it might be bad because you'd be messing around with it and touch your face.

00:10:50.000 Yeah, you could...

00:10:51.000 So initially, there was ostensibly some confusion about whether it was advantageous to wear masks or not.

00:10:59.000 It's clearly advantageous.

00:11:00.000 It's advantageous to the wearer and it's advantageous to others.

00:11:04.000 It reduces the stress on the system if everyone were to wear masks.

00:11:09.000 And just to be very, very clear, it's neighborly.

00:11:12.000 Wearing masks is like driving the speed limit or not driving on the opposite side of the road.

00:11:17.000 And there's now abundant evidence on the benefits of mask wearing.

00:11:21.000 And furthermore, and then I'll come back to your Fauci issue.

00:11:25.000 If we were to all as a nation wear masks and adopt some other basic things, it would allow us to keep our economy running better and our schools open.

00:11:34.000 In other words, we can't have everything.

00:11:37.000 There's a deadly virus that's afoot.

00:11:39.000 And so we're going to have to grow up and be mature, do some things that are uncomfortable and unpleasant and may even seem silly.

00:11:46.000 But if we do those things, we can avoid doing other worse things like shutting down our economy.

00:11:52.000 But anyway, Can I stop you for a second there?

00:11:54.000 Because this is something that's actually kind of important.

00:11:56.000 When people are wearing masks, this is the common argument against it, is that the virus particles are so small, if you're breathing in air and it's getting through gaps in your mask, the virus is going to get through.

00:12:07.000 But the impact of having a mask, the positive impact, is that if there is some virus in the air or virus coming from you, it's going to be greatly reduced.

00:12:20.000 Correct?

00:12:20.000 Especially an N95 mask.

00:12:23.000 You know, there are two parts to what you're saying.

00:12:24.000 First of all, water molecules are infinitesimally small, and they're much smaller than the pores on the fabric of your umbrella.

00:12:35.000 But your umbrella stops the rain.

00:12:37.000 Why is that?

00:12:38.000 Well, it's that the water molecules aren't coming down as molecules, they're coming down in droplets.

00:12:43.000 So even though the virus is very small, much bigger than a water molecule, but still very small, and you're right that the virus itself could go through the fabric of a mask, that's not what's happening.

00:12:54.000 Droplets are coming out of your mouth or are coming from someone else towards you.

00:12:58.000 And the mask is extremely effective at stopping droplets.

00:13:02.000 But hasn't it been shown that the virus is also aerosol now?

00:13:07.000 Yes, so there's also aerosol transmission, and we can talk about that too.

00:13:11.000 Obviously, yes, let's talk about that.

00:13:12.000 But before we move to that, let's just say one more sentence on the droplets, which is that...

00:13:17.000 When you exhale, think about how if you had a fire hose at your house and the water was spraying out of the fire hose and you had two different strategies for stopping the water from landing on the floor of your house.

00:13:32.000 One strategy would be to run around with buckets and try to catch the water as it was landing from this arc of the fire hose.

00:13:39.000 And another would be to put a kink We're good to go. 0.97

00:14:03.000 And furthermore, in the case of coronavirus, one of the big problems is people don't know if they're sick.

00:14:09.000 This particular germ is very nasty.

00:14:11.000 You can transmit it before you have symptoms.

00:14:14.000 So one of the reasons for people to wear masks is they don't know they're transmitting the disease.

00:14:17.000 It's very efficient to stop the viral droplets before they leave their mouth from spreading to others.

00:14:24.000 And when you wear a mask, you also protect yourself from inhaling droplets of other people.

00:14:30.000 The N95s are more medical-grade masks. 1.00

00:14:32.000 They're even better than the cloth masks that you can buy on the internet.

00:14:36.000 But those, if you're going to use those effectively, you have to seal them around your face and use them.

00:14:41.000 And you don't really need to use those.

00:14:43.000 I mean, you can if you have them.

00:14:44.000 There's nothing wrong with it.

00:14:45.000 But you also don't want the ones with valves.

00:14:47.000 Those don't really help you. 0.86

00:14:49.000 Yeah, the valve ones are kind of silly, aren't they? 0.96

00:14:51.000 Yes. 0.95

00:14:51.000 It defeats the whole purpose. 0.95

00:14:53.000 It can do it.

00:14:54.000 It still helps.

00:14:55.000 But yes, these are all relative things.

00:14:56.000 Now, on the aerosol thing...

00:14:58.000 What you're talking about is some of the things that you exhale from your body are little dried particles of viruses that are suspended in the air, and these can go a further distance.

00:15:11.000 And there is, in fact, evidence of aerosol transmission, which is different than droplets.

00:15:16.000 Both go through the air, but droplets are big and fall to the ground, whereas it's like raindrops versus little particles of dust that can float in the air, for instance.

00:15:26.000 And so there is aerosol transmission and the masks that we use don't necessarily stop that.

00:15:32.000 You'd need like an N95 mask well fitted to stop that, but the masks still help. 0.98

00:15:38.000 So I don't think there's a really good argument.

00:15:42.000 I mean, I wish we didn't have to wear masks.

00:15:44.000 I mean, it's unpleasant, but of all the unpleasant things we could choose from doing, if the choice is do I close the schools in my local community, Or do I have everyone wear masks?

00:15:57.000 To me, that's...

00:15:59.000 Yes, wear a mask.

00:16:00.000 It's pretty straightforward and simple.

00:16:01.000 There's a great video online that I saw this morning of a guy who held up a lighter and he used a bandana first and he blew through the bandana and put out the lighter and then he put on a cloth mask and it...

00:16:27.000 Yes.

00:16:28.000 Yes.

00:16:42.000 Yes, although again, I would say that something is better than nothing.

00:16:45.000 And one of the things that, one of the things I think is going to come up in our conversation, and we might as well tackle it now, I was trying to think of like, well, I was trying to think of sort of general principles that are relevant here is there's no, in a time of a deadly contagion,

00:17:01.000 Joe, there's no life without risk.

00:17:03.000 And many people are used to this, used to thinking about risk in their lives, but many are not.

00:17:08.000 And I think what I would like people to understand is, is that there's, the world has changed.

00:17:12.000 There's a new virus that's entered our species.

00:17:15.000 It's not going to go away.

00:17:17.000 It's going to be with us forever.

00:17:19.000 And we have to, first of all, accept that.

00:17:22.000 Second, take steps to address it.

00:17:23.000 And third, recognize that no single step is perfect.

00:17:26.000 Even a vaccine is not perfect.

00:17:28.000 So everything is shades of gray and degrees of risk.

00:17:31.000 So for example, Even the 14-day quarantine rule, that's just a statistical distribution.

00:17:38.000 2.5% of people are still infectious after 14 days.

00:17:42.000 We just cut it off at 14 days.

00:17:44.000 We say, well, almost everyone can't spread the virus anymore after 14 days.

00:17:48.000 But it's not true that no one can spread the virus.

00:17:51.000 So there's still some risk.

00:17:52.000 Or you can wear a mask and it reduces your risk, but it doesn't eliminate your risk.

00:17:58.000 And so pretty much everything we do Is not perfect.

00:18:04.000 And so we have to begin as a society and as households or as individuals, make decisions about what risks we're willing to tolerate.

00:18:14.000 Jamie brought something up this morning that people that had SARS showed that they had immunity to COVID-19.

00:18:25.000 Jamie, what were you talking about earlier?

00:18:28.000 I might have misunderstood or said that to you, but they were comparing immunity to SARS. They said that they were still carrying important immune cells 17 years after recovery, and they're saying that might be the same sort of thing with coronavirus, that you might have immunity for a long time.

00:18:44.000 But there have been people that have been reinfected in as early as three months.

00:18:48.000 Isn't that correct?

00:18:49.000 Yeah, so this is, again, another complicated topic.

00:18:52.000 So, yes, we now have some evidence that some people can be reinfected, but it's probably extremely rare.

00:18:58.000 We don't know 100%, but it is probably extremely rare.

00:19:02.000 And part of the reason is that if you get COVID and they test you, and then three months later you get COVID again and they test you again, they found you.

00:19:12.000 And they say, aha, this person had it before and isn't immune.

00:19:16.000 But there could be hundreds of thousands of people who also had COVID who were re-exposed and didn't get infected, didn't get symptoms the second time, and so nobody tested them.

00:19:25.000 So you see, we only ascertain, we only see the ones that in fact do get re-infected.

00:19:30.000 So you are right.

00:19:32.000 There have been now some cases proven with genetic testing that have been infected more than once.

00:19:37.000 But we still think it's rare.

00:19:39.000 The thing that Jamie was alluding to is there are two parts to it.

00:19:42.000 One is, how long does the immunity last?

00:19:46.000 And honestly, we won't know the answer for sure until time passes.

00:19:50.000 There's no way to be certain.

00:19:51.000 But we do believe that immunity will be sustained, will be reasonably sustained.

00:19:56.000 And furthermore, I don't want listeners to confuse the difference between antibody levels declining and your being immune.

00:20:03.000 So when your body is infected, you mount a defense, a response, and you produce antibodies.

00:20:09.000 And for almost all infections, those just decline over time.

00:20:13.000 And in fact, with coronavirus, those circulating antibodies, those proteins that attack the virus, Go down to, you know, very close to zero by about a year, let's say.

00:20:23.000 And this was completely expected.

00:20:25.000 There's nothing surprising about this.

00:20:27.000 But your body has, in the interim, also begun to develop something called memory immunity or T-cell immunity.

00:20:33.000 And that's what protects you from reinfection.

00:20:36.000 And we believe, we have evidence for, that people have sustained such T-cell memory immunity.

00:20:41.000 How long that lasts?

00:20:43.000 So Jamie was saying with SARS-1, which struck us in 2003, People can find evidence that even 17 years later you can mount an immune response because your body remembers that it fought off this thing 17 years ago.

00:20:57.000 And one more thing And that is all different than the question of cross-immunity, which is also becoming now people are – I mean the whole country is getting an immunology lesson.

00:21:08.000 Yeah.

00:21:08.000 Which is probably good.

00:21:11.000 What did you say?

00:21:12.000 I said which is probably good.

00:21:13.000 I mean it's about time that people recognize that in terms of pandemics, this is – I don't want to diminish the death or the suffering or anything, but it could have been far worse.

00:21:27.000 Yeah.

00:21:28.000 I'm so glad you said that because on the one hand, this is a bad germ.

00:21:38.000 So roughly speaking, it'll kill about 1% of the people that get it symptomatically.

00:21:45.000 You get this disease, you have symptoms, you've got a 1% chance of death.

00:21:48.000 It varies by age and we can come back to that too if you're interested.

00:21:53.000 But as you're saying, it could have been so much worse.

00:21:56.000 I mean, there's no God-given reason this virus isn't killing 10% of us or 50% like the bubonic plague.

00:22:03.000 And if you remember the movie Contagion, I think in the movie Contagion, it killed about a third of the people that got it.

00:22:09.000 And there's honestly no reason that this, I mean, we could have been facing that situation.

00:22:14.000 You know, there's no necessary reason we're not facing that situation.

00:22:17.000 So you're right.

00:22:18.000 It could have been much worse.

00:22:19.000 And in fact, the 2003 Coronavirus killed about 10% of the people that got symptoms from it.

00:22:25.000 So it was about 10 times as deadly as the one we're facing now.

00:22:29.000 Why has there been so little discussion, especially from our governments, our leaders, about methods to strengthen your immune system?

00:22:40.000 That has been particularly frustrating to me.

00:22:42.000 There's been so little discussion about vitamin supplementation, about changing your diet, about exercise, keeping yourself healthy, making sure you get enough sleep, lowering alcohol consumption, all these things that have been absolutely proven to boost your immune system.

00:23:00.000 Not negating the use of masks or social distancing or all the other things that we know are effective, but why has there been no discussion about boosting your immune system?

00:23:13.000 I don't know, but it's a really good question you just asked.

00:23:17.000 So you're right, there are all these sort of healthy living things you can do from exercising, getting better sleep, reducing stress, losing weight, reducing alcohol and tobacco consumption, all of these things that enhance the ability of your immune system to fight off infection and that has not been part of the public health messaging campaign Yeah,

00:23:42.000 I think.

00:24:02.000 You know, I'm very understanding of human beings' frailties.

00:24:06.000 You know, we all are human.

00:24:09.000 We're soft on the outside, and we don't deserve to die of a germ or anything else as far as I'm concerned.

00:24:15.000 And so I don't want us to say, oh, well, so-and-so was a beast or so-and-so, you know...

00:24:21.000 Was a smoker, and so, you know, they deserve their fate.

00:24:24.000 No, no, no.

00:24:25.000 We're not saying that, but...

00:24:26.000 I know.

00:24:27.000 I know you're not, but I'm saying, on the one hand, I want to encourage good behavior.

00:24:30.000 On the other hand, I want us to be careful not to suggest that you weren't doing, but I'm just sort of clarifying the point. 0.65

00:24:36.000 That it's your fault if you catch it and die. 0.96

00:24:38.000 Yes. 1.00

00:24:38.000 Right. 1.00

00:24:38.000 Of course. 1.00

00:24:39.000 Of course.

00:24:40.000 Yeah.

00:24:41.000 Yeah, I know.

00:24:42.000 And I think...

00:24:46.000 I think people should prepare their bodies for the possibility of being infected, but realize that there's no guarantee.

00:24:51.000 It's like those poor marathon runners that drop dead having run marathons their whole lives.

00:24:58.000 Jim Fix.

00:24:59.000 Yeah, that was Jim Fix.

00:25:01.000 He's a famous guy who wrote books on running, and Bill Hicks had a hilarious joke about him running and dying.

00:25:07.000 Yeah, that's unfortunate, but that's probably some sort of cardio disease that he had.

00:25:13.000 There's...

00:25:15.000 There's ways that the government could have done it without shaming people that did get sick.

00:25:21.000 I mean, it wouldn't have taken much time to tell people.

00:25:26.000 I mean, I've had multiple health experts on this podcast that talk about different methods of strengthening the immune system, particularly supplementation with vitamin D. It seems to be, and Fauci's talked about this as well, seems to be particularly effective with boosting your immune system.

00:25:41.000 And also, it's a giant problem with people who wind up in the ICU. There's a recent study that showed that 84% of the people in the ICU with COVID were deficient in vitamin C,

00:25:56.000 and only 4% had sufficient levels.

00:26:01.000 I haven't followed that particular literature, but As someone who loves the sun, I could strongly endorse getting adequate sun exposure for vitamin D alone.

00:26:14.000 Yeah, but you know the sun is the best way to get vitamin D, for sure.

00:26:18.000 But the way to get it through the sun requires you to be in shorts and nothing else, like a Neanderthal, running around all day. 0.85

00:26:28.000 That's how we're designed.

00:26:31.000 That's really what we're supposed to be doing.

00:26:34.000 It's very unfortunate that we figured out houses.

00:26:36.000 I mean, it's kept us alive and kept us protected from predators and the elements and all sorts of other things that would have killed us, but it's severely diminished our ability to absorb vitamin D from the sun, and vitamin D being not just a vitamin, but also maybe even possibly mislabeled as a vitamin.

00:26:52.000 It's really a hormone, right?

00:26:54.000 Well, it can be a precursor to hormones, yes, but I think that, boy, you've wandered into an area that's sort of I'm trying to remember my medical school.

00:27:04.000 The last time I thought about vitamin D synthesis.

00:27:07.000 But my memory is it doesn't take much sun exposure per day for your body to produce adequate levels of vitamin D. I think an hour a day or something like that.

00:27:17.000 But yes, in general, you're right.

00:27:19.000 That is to say that a lot of the ways we live in the modern world compromise our immune systems and their functioning.

00:27:25.000 I think there's very few people that are actually getting their blood work done.

00:27:29.000 So even when you say an hour a day give you sufficient levels, how many of these people are actually going an hour a day and then getting blood work done and finding out what the actual vitamin D levels in their blood are?

00:27:40.000 Very few.

00:27:43.000 It's highlighting a weakness in our understanding of our own bodies.

00:27:48.000 See, this part I would certainly agree with, Joe, in the sense that as a nation, in a way, we've...

00:27:55.000 How to put this exactly?

00:27:58.000 I don't want to say we've become soft, because that's not exactly what I want to say.

00:28:01.000 It's sort of like...

00:28:02.000 I'll say it.

00:28:03.000 What?

00:28:03.000 You'll say it.

00:28:06.000 No, I mean, we're not...

00:28:08.000 We want our cake and eat it, too.

00:28:10.000 And in a way, that's sort of what I'm trying to talk a little bit about with respect to the pandemic as well, which is that We all wish that we didn't have to endure this unpleasant reality that this virus is now afflicting us.

00:28:23.000 It's a little bit, and we're all tired, you know, we all have COVID fatigue, but it's a little bit like being in the dentist chair and he's done two root canals and you don't want him to do any more.

00:28:33.000 But you're not wanting any more root canals has nothing to do with whether you need them.

00:28:37.000 You know, unfortunately, this is the reality that we're facing.

00:28:40.000 And so what I really want And what I wanted to do in the book, in Apollo Zero, was to sort of help people to see the world for how it really is now, which is that something big has happened, something that doesn't happen but every 50 or 100 years or so.

00:28:57.000 And more importantly, this way the virus has forced us to live, which feels so alien and unnatural to us.

00:29:06.000 In fact, this way, it's not new to our species, it's just new to us.

00:29:12.000 You and I think, this is outrageous.

00:29:13.000 How can we have to do all of this stuff?

00:29:16.000 But, you know, our ancestors have been dealing with this for thousands of years.

00:29:20.000 We're not the first generation to have to do this.

00:29:22.000 This is our time in the crucible, and I would hope for better for us.

00:29:27.000 And in terms of crucibles, it's so small.

00:29:31.000 I mean, again, not to minimize the death and the suffering, but I'm in the middle of reading Harari's book, Homo Deus.

00:29:37.000 Yeah.

00:29:37.000 And, you know, in it, the beginning of it, he talks about famine and plague for most of the first chapter.

00:29:45.000 And just the sheer numbers of people that have died in past plagues throughout human history, before antibiotics and before we even understood what viruses were.

00:29:55.000 I mean, it's horrific.

00:29:56.000 Yeah.

00:29:57.000 Terrific.

00:29:58.000 I mean, the bubonic plague would sweep through cities in Italy and kill half the people.

00:30:03.000 Like, within a month, half are dead.

00:30:05.000 Or smallpox, when the Europeans landed in our continent and they brought with them old world diseases to the new world, smallpox would wipe out Native American populations. 0.96

00:30:18.000 95% of the people would die.

00:30:21.000 Yeah, yeah.

00:30:22.000 Insane.

00:30:23.000 Yeah.

00:30:24.000 Yeah.

00:30:26.000 So we're very fortunate, as we said before, that this is the disease we're dealing with.

00:30:32.000 I think in many ways this is going to give us a much better understanding of what could happen and give us a better understanding of what we need to do if something new comes along.

00:30:47.000 Yes.

00:30:48.000 I mean, I think that's right.

00:30:51.000 I mean, you're kind of...

00:30:52.000 I'm actually glad that you're going there because one of the things I don't want...

00:30:55.000 I don't want to be seen as this nihilistic, doomsaying, pessimistic guy.

00:31:02.000 Too late.

00:31:03.000 Too late, yes.

00:31:05.000 I'm glad you are bringing up the fact that actually there could be another pandemic.

00:31:11.000 Yes.

00:31:11.000 And usually, if you look at the respiratory pandemics for the last 300 years...

00:31:17.000 The inter-pandemic interval is about 10 to 20 years.

00:31:20.000 That means we have a pandemic every 10 or 20 years, but they're not deadly, usually.

00:31:25.000 So, for example, we had one in 2009, the H1N1 pandemic.

00:31:29.000 Most listeners might have a vague memory of hearing about it, but people didn't really pay much attention because it didn't kill many people.

00:31:36.000 It was like a common cold.

00:31:37.000 So we had a pandemic, but it wasn't very deadly.

00:31:40.000 Then we had the 2003 pandemic.

00:31:43.000 The SARS-1 pandemic spread to about 30 countries, but for various reasons that pandemic extinguished and we only had about 8000 people worldwide who died of that.

00:31:53.000 So we'd also sort of forgotten that.

00:31:56.000 The last serious pandemic we had of influenza A virus, it's a different virus than the coronavirus, was in 1957. That was the second worst pandemic we've had in 100 years.

00:32:06.000 And the previous leading killer was, of course, the 1918, the so-called Spanish flu pandemic.

00:32:12.000 And the current pandemic we're having will be almost as bad as that in the sense that Just to be clear to listeners, it's not going to kill tens of millions like that pandemic killed, we don't think.

00:32:23.000 But the point is, the current pandemic we have is the second worst that we have had in 100 years.

00:32:28.000 Worse than the 57, which was the previous second worst.

00:32:32.000 So pandemics come every 10 or 20 years.

00:32:36.000 They're only really bad, let's say, every 50 or 100 years.

00:32:39.000 But there's no reason that we couldn't have another one Soon, you know.

00:32:44.000 And in fact, right now, there's surveillance systems in place in China which monitor the emergence of new influenza strains.

00:32:51.000 And there was just a paper published a couple of months ago suggesting there's a serious strain of influenza brewing.

00:32:59.000 So, you know, we'll see.

00:33:04.000 This one is a weird one, right?

00:33:07.000 Whereas a lot of people get it and they're asymptomatic.

00:33:10.000 I've had several friends that got it and literally experienced no symptoms.

00:33:17.000 They were around people that had it.

00:33:18.000 They got it.

00:33:19.000 They tested positive and...

00:33:23.000 Got as little as a mild headache or a slight cough for a day.

00:33:29.000 Jamie had it, and he thought he had a sinus infection.

00:33:33.000 He has allergies, and he thought it was just his allergies kicking in.

00:33:36.000 Turns out he was positive, but he was very fortunate.

00:33:40.000 It was a very mild case.

00:33:41.000 Do we know why when some people get it, it's devastating, including young people?

00:33:47.000 I have a young friend.

00:33:48.000 He's 28. He got it.

00:33:50.000 And he was...

00:33:51.000 Really ill for two weeks, whereas some people get it and it's nothing.

00:33:56.000 Yes.

00:33:57.000 So we have some sense of some of the reasons it varies, but not a huge understanding yet of the interpersonal variation.

00:34:06.000 But I would like to go on a tangent based on that that highlights the ways in which these kind of protean manifestations of this disease, the fact that With this condition, you can go from everything from having no symptoms to mild symptoms like Jamie to more serious symptoms like your 28-year-old friend to really severe symptoms to being hospitalized to dying,

00:34:32.000 right?

00:34:32.000 There's this incredible range of symptoms.

00:34:37.000 And in a way, this is very unfortunate for us because it makes it so much harder as a society to take the virus seriously and to combat it.

00:34:47.000 Let me give you an analogy.

00:34:50.000 So I want listeners to imagine that there are two worlds.

00:34:54.000 I'm about to describe two different worlds.

00:34:56.000 In world A, there are a thousand people.

00:34:59.000 And a virus infects 10 people in this world, makes them seriously ill, and one person dies.

00:35:08.000 So we would say that in this world, 10% of the people that got sick died of the virus.

00:35:12.000 That's world A. In world B, there are 1,000 people.

00:35:17.000 The virus infects 100 people.

00:35:20.000 90 of them get mild illness.

00:35:22.000 10 of them once again get serious illness, like in world A. And one of them dies, again like in world A. So in this world, in world B, 100 people got sick and one died.

00:35:33.000 So we might say 1% of them died.

00:35:36.000 In world A, 10% of the people that got sick died.

00:35:39.000 In world B, 1% of the people that got sick died.

00:35:42.000 Now many people hearing about this might think that it's better to be in world B because, you know, it seems like the virus is less deadly.

00:35:52.000 But that's a delusion.

00:35:54.000 Because if you stop and you think about it a little bit more clearly, World B is the same as World A, plus an extra 90 people got mild illness.

00:36:04.000 In other words, no right-thinking person should prefer to be in World B than to be in World A. Ten out of a thousand people got seriously ill and one died.

00:36:16.000 And in World B, that happened.

00:36:18.000 Plus, another 90 people got mildly sick.

00:36:21.000 So it's clearly worse.

00:36:22.000 The overall situation is worse in World B. And that is, in fact, the situation that we are facing.

00:36:28.000 We are in like a world B situation with this virus.

00:36:32.000 And the reason it's hard is that all these extra people, those 90 people who got mild illness, make people take the disease more casually.

00:36:42.000 Whereas in world A, people might say, well, not many people are getting sick, but when they get sick, 10% of them die.

00:36:47.000 Wow, we should take this disease seriously.

00:36:49.000 Do you see what I'm saying?

00:36:51.000 Yeah, I do see what you're saying.

00:36:52.000 So this virus is very sneaky in that way.

00:36:54.000 Yes.

00:36:55.000 It's really like if you wanted to engineer a virus that's going to spread the most, that's kind of how you would do it.

00:37:01.000 Have it affect so many people where they're like, it was nothing.

00:37:04.000 And then some people where they're dead within a few days.

00:37:08.000 Yes.

00:37:11.000 It also has this property of being transmissible when it's asymptomatic.

00:37:15.000 So just to remind people, HIV is like that.

00:37:19.000 You can have HIV for years and not know it.

00:37:21.000 You're spreading it to your sexual partners and then it kills you much later.

00:37:25.000 Versus smallpox, which you can't really spread smallpox before you have symptoms.

00:37:31.000 The pustules erupt on your body and that's when you become infectious.

00:37:35.000 So there's no asymptomatic transmission in smallpox, and there is in HIV. And SARS-1 from 2003 was more like smallpox.

00:37:47.000 In other words, people didn't begin to transmit the virus until they actually had symptoms from it, which is one of the reasons it was easier to control, because when people got symptoms, we could isolate them.

00:37:56.000 Whereas with the SARS that we're facing now, the SARS-CoV-2, COVID-19, People can transmit it when they're not symptomatic.

00:38:05.000 And in fact, there's a lot of analyses that have been done that show about 75% of the infections have been acquired from people who are asymptomatic.

00:38:14.000 There's another issue as well that we can compare to smallpox in that you can develop a vaccine for smallpox that actually works for your whole life.

00:38:23.000 You can't really do that with COVID, correct?

00:38:27.000 We don't know for sure.

00:38:29.000 We don't know that for sure.

00:38:31.000 I don't know that for sure.

00:38:32.000 I'm hopeful that we'll be able to have a vaccine that confers long-term immunity, but I don't think we know that either way for sure.

00:38:40.000 Can you describe what's going on with these mRNA vaccines and how they differ from a regular vaccine and what's coming down the pipe from Pfizer?

00:38:53.000 These are mRNA vaccines.

00:38:55.000 It's different in that it doesn't actually contain the virus, but it boosts your body's ability to fight off the virus.

00:39:02.000 Yeah, so there are many different ways of developing vaccines.

00:39:09.000 And the general idea behind a vaccine is that we want to give you kind of an ersatz infection.

00:39:15.000 We want to expose you, make it as if you had been infected, but without the risk of getting the disease, to trick your immune system into mounting an immune response so that your body is then prepared, if it gets the real infection, to fight it off.

00:39:30.000 And one of the simplest ways you can think about it is so-called live attenuated virus.

00:39:37.000 This is an old technology where you take the virus to the laboratory, you culture it hundreds of times and hope for mutations that weaken the virus's ability to make you sick, but nevertheless keep the virus able to elicit an immune response.

00:39:52.000 And then we give you that strain as a shot.

00:39:56.000 And you have, let's say, a mild illness, you develop antibodies and immunity, and it's sustained.

00:40:01.000 Or you can have inactivated virus, like one of the Chinese, the Sinovac vaccine that was one of the first to start, which was out of China, is a live attenuated virus.

00:40:14.000 So that is...

00:40:16.000 Oh, I'm sorry, did I say live attenuate already?

00:40:17.000 I can't remember.

00:40:18.000 But anyway, the Sinovac vaccine is a virus in which they take the virus.

00:40:23.000 I'm sorry, no, it's not like the previous example.

00:40:25.000 In this case, we take the virus and we treat it, let's say, with heat or with chemicals to kill the virus, but still have it be immunogenic.

00:40:34.000 And that's another approach.

00:40:36.000 And there are many other approaches, a dozen or so, or nine or 10 different approaches, one of which is this mRNA idea.

00:40:43.000 And here, what is done is I'm sorry, before I tell you about that, another approach might be to take Take the RNA from the coronavirus that codes for a very important protein, the spike protein on the surface of the coronavirus,

00:40:59.000 and insert that into a really benign virus, let's say like a cold virus, for example.

00:41:04.000 So we take this other species of virus, we genetically engineer it so that we insert some material, some RNA into it, let's say, that forces that virus, when it infects your cells, To give you a common cold, but also to express this protein as if you had been infected with COVID or coronavirus.

00:41:25.000 And then you mount an immune system to that immune response to that protein, and now you're immune.

00:41:30.000 So we gave you like a mild illness and we protected you from a more serious one.

00:41:35.000 The mRNA vaccines are sort of like that.

00:41:38.000 We inject you literally with RNA, and the idea is that your cells take up the RNA and start making the protein, the alien protein, that your body would have made.

00:41:51.000 Like if we had infected you with a real coronavirus, the real coronavirus, as many people remember from high school biology, The virus can't reproduce on its own.

00:42:01.000 It inserts its genetic material into our cells, which then start producing the virus itself.

00:42:08.000 But now, in a sense, instead of giving you the whole virus, we give you a little part of it, just some part of its genetic material, the mRNA, which in an ideal world does the same thing, gets inserted into your cells.

00:42:19.000 You start expressing this protein, which then your body attacks, and you develop an immune response to it.

00:42:26.000 And we are We're amazingly lucky that our scientists have been able to develop not one, but two different vaccines.

00:42:34.000 And we'll have many other vaccines using different modalities, I have no doubt, that come out in the next year or two.

00:42:40.000 But the Moderna and the Pfizer vaccines, we're very lucky that they exist and that they are apparently quite effective.

00:42:46.000 But the story is not over on those.

00:42:50.000 I don't know if you want to talk about that.

00:42:52.000 It's good news, but I don't want people to get over-optimistic either, because it's my job to be a bit of a downer.

00:42:59.000 Well, this is the unfortunate narrative that people keep saying.

00:43:05.000 The virus is killing, it's like the average immune system is 99 point whatever percent effective in protecting you from the virus, meaning 99 point whatever percent of the people who get the virus survive.

00:43:22.000 No, 99 percent of people overall survive.

00:43:25.000 One percent will die.

00:43:27.000 Of all people who are infected, approximately.

00:43:29.000 And if you're older than 70 or 80, 20% will die.

00:43:33.000 So why is the number that people keep talking about far less than that?

00:43:39.000 Why is the reported number of people that get the virus who actually wind up dying?

00:43:44.000 It's not 1%.

00:43:45.000 We're not seeing 1% nationwide in terms of people getting the virus and dying.

00:43:50.000 No, we know the answer to that question.

00:43:52.000 I don't think there's any ambiguity scientifically.

00:43:54.000 So In order to really compute these numbers, it's not easy.

00:44:00.000 You're right.

00:44:01.000 We have to look at how many people...

00:44:03.000 We have to have a way of ascertaining who's infected.

00:44:06.000 And then we have to have a way of ascertaining of those how many die.

00:44:10.000 And that's called the infection fatality rate.

00:44:14.000 And there was just a recent meta-analysis looking at very good data from around the world, multiple studies using different approaches that estimated that the infection fatality rate is between 0.5% and 0.8%.

00:44:27.000 And there's something called the case fatality rate is the fraction of people who have symptoms when infected who die.

00:44:34.000 And that number is about twice that.

00:44:36.000 So about half the people get the virus and have no symptoms at all.

00:44:40.000 So if you get symptoms, you have a higher risk of death.

00:44:43.000 And so you can double 0.5 to 0.8 becomes 1 to 1.6% of people who develop symptoms from the disease die.

00:44:53.000 And there was another very good study that was just released a couple of weeks ago that estimated the infection fatality rate to be about 1%.

00:45:01.000 So there's a lot of little numbers I've thrown out at you, but the gist is...

00:45:07.000 Yeah, but even without symptoms, the infection fatality rate is certainly not less than half a percent and could be as high as 1%.

00:45:13.000 I would say it's going to be in that range, the IFR, the infection fatality rate.

00:45:18.000 Isn't there a large percentage of people that get it that don't have symptoms?

00:45:22.000 Half.

00:45:22.000 About half, we think.

00:45:23.000 That's right.

00:45:24.000 Okay.

00:45:24.000 Other people who get it don't have symptoms.

00:45:26.000 But you said 99 point something percent of people who get it survive, and that point something is important.

00:45:32.000 So I would say that...

00:45:34.000 If you said 99.5% of the people who get infected survive, I would say, yeah, it could be.

00:45:40.000 But it's somewhere in there.

00:45:41.000 I don't think I gave a number.

00:45:43.000 I think I said 99 point something.

00:45:44.000 But the point being that, unfortunately, a lot of people are saying this vaccine is 94% effective or 90% effective, depending on who you ask.

00:45:57.000 Yeah, but what that means is that if it reduces your risk of death by that fraction.

00:46:04.000 So, for example, in the vaccine trial, in the Pfizer trial, these numbers are approximate.

00:46:12.000 They had about 43,000 people in the trial.

00:46:15.000 Half of them got the vaccine, half of them did not.

00:46:19.000 And in the people who got the vaccine, nine people, up to nine, let's say nine or ten, got Even though they were vaccinated, still got coronavirus, still had the disease.

00:46:31.000 The vaccine was not perfect.

00:46:32.000 And in the arm that did not get the vaccine, the other 20,000 people, let's say 90 people approximately got coronavirus.

00:46:42.000 So what the vaccine did is it reduced your probability of getting the disease from 90 out of 20,000 people over the time window of the study to 10 out of 20,000 people.

00:46:54.000 So the point here is that the vaccine is reducing your risk of getting seriously ill if you're infected.

00:47:01.000 And you're certainly better off In other words, you would have had, let's say, a 1% chance of dying before, and now you have a 0.1% chance of dying, 90% lower than that because we've given you the vaccine.

00:47:17.000 Does that make sense?

00:47:18.000 Completely.

00:47:18.000 I understand exactly what you're saying.

00:47:20.000 What I'm trying to say is there's an unfortunate narrative where people are saying, I'm not going to take a vaccine because the human immune system is more effective than the vaccine.

00:47:31.000 That's not true.

00:47:33.000 That's what I wanted to get out of you.

00:47:34.000 Yeah, yeah, that's not true.

00:47:36.000 Yeah, go ahead.

00:47:37.000 Well, no, I'm saying the whole way vaccines work is it enhances your performance.

00:47:45.000 It stimulates your immune system to make it even better at fighting the virus.

00:47:50.000 There's no sense in which you could argue that An unchallenged immune system is superior to a challenged immune system, a system that has been given a vaccine.

00:48:01.000 This is what's important to tell people, right?

00:48:03.000 Because this narrative of 99% of the people who get it, 99 point whatever, your immune system is effective in fighting off this disease, right?

00:48:14.000 Whereas with the virus, it's only 90 plus whatever percent effective in preventing the virus.

00:48:21.000 So that's not a good narrative, correct?

00:48:24.000 That's right.

00:48:25.000 And the way to think about it is, just to pick some round numbers, as you were saying, and like me, you sometimes use the word virus when you mean vaccine, and you use the word vaccine when you mean virus.

00:48:35.000 Yeah, I'm sorry.

00:48:36.000 I do that all the time.

00:48:37.000 Yeah.

00:48:38.000 I do that all the time.

00:48:39.000 It's so annoying.

00:48:40.000 Yeah.

00:48:41.000 Let's say for the sake of argument, you have an unvaccinated, you have a 99% chance of surviving if you get infected.

00:48:47.000 Right.

00:48:48.000 You have to add to that the benefit of the vaccine, which is a 90%, let's say, effectiveness.

00:48:53.000 So it'll reduce your probability from 99% chance of surviving to 99.9% chance of surviving.

00:49:02.000 Thank you.

00:49:02.000 That's exactly what I wanted to get out of you.

00:49:04.000 Yes.

00:49:07.000 When you talk about the people that took the vaccine, and we know you have the data between the difference of the vaccine and the people that got the placebo, the people that got the vaccine that still wound up getting COVID, did they do health screens on these people and find out what comorbidity factors they may have had and see if there's anything that would indicate that there's particular risks?

00:49:32.000 We don't know that yet.

00:49:33.000 Those results haven't been released.

00:49:34.000 And also, what we don't know, so we don't know the answer to that, but we will know.

00:49:38.000 And also what we don't know yet is we don't know how safe the vaccine is.

00:49:42.000 So first of all, just to be very clear, both Pfizer and Moderna have released interim results.

00:49:47.000 And we have every reason to believe that the final efficacy results will be about the same.

00:49:51.000 So as they complete the trial in the coming month or two, and more people get sick in both arms, we don't expect suddenly The vaccine not to work.

00:49:59.000 I mean, we've gotten to a point where we're pretty sure that the vaccine will be effective.

00:50:05.000 But we don't yet know the safety of the vaccine is another thing we don't know.

00:50:08.000 And we also don't know something else.

00:50:10.000 It's very important for people to understand.

00:50:12.000 Again, and since everyone needs to be an immunologist now, imagine that you're doing a trial and you're trying to see whether a vaccine works or not.

00:50:23.000 You have to define what counts as works, what counts as an endpoint.

00:50:26.000 So let me give you three possibilities.

00:50:29.000 One possibility is we're going to measure, does the vaccine prevent you from even getting infected?

00:50:34.000 Or do we say, the vaccine's not going to be able to stop you from getting infected, the virus is going to take root in your body, but the vaccine is going to prevent the virus from making you seriously ill.

00:50:46.000 Or do we say, actually the outcome we really care about is death.

00:50:50.000 Does the virus reduce your probability of death?

00:50:53.000 So it's possible that the vaccine, for example, What if in both arms one person died?

00:51:18.000 One out of the 10 in the vaccine arm died, and one out of the 90 in the other arm died.

00:51:24.000 We would say that the vaccine was effective at lowering your probability of getting ill, which is great, but it had no effect on dying.

00:51:32.000 That's possible.

00:51:34.000 It's possible that the vaccine will work at different levels The Pfizer trial revealed that there was a greatly reduced probability of people getting infected.

00:51:50.000 The Moderna trial actually showed that its vaccine reduced the probability of people getting seriously ill, which is great, but it might in fact have no effect on mortality still.

00:52:00.000 We don't know.

00:52:01.000 Furthermore, we also don't know whether this vaccine, even if it works, Even if it works to reduce your probability of getting sick or dying, whether it works to reduce your ability to infect other people.

00:52:17.000 So maybe we start vaccinating the population, we're reducing the individual recipient's probability of getting sick, but they still can spread the disease.

00:52:27.000 So this is something else that's not known.

00:52:29.000 So we don't know the safety, we don't know which outcomes are really being affected, and we don't know if it affects infectiousness.

00:52:35.000 And all of these things are things we will soon learn in the coming year.

00:52:38.000 But we don't yet know them.

00:52:40.000 So I just – it's fantastic news that we have a vaccine, but I just don't want people to get – think it's a panacea.

00:52:48.000 Go ahead.

00:52:49.000 Please continue.

00:52:50.000 No, no.

00:52:50.000 I was just going to say one more thing, which is that – hold on.

00:52:57.000 Let me just recover what I was about to say about the vaccine and – I forgot what I was going to say, but go on.

00:53:06.000 You were going to say something.

00:53:07.000 Sorry.

00:53:08.000 No, no, it's my fault.

00:53:09.000 This is the problem with Skype calls.

00:53:11.000 Well, no, it's not just that.

00:53:13.000 It's just this is a complicated topic.

00:53:14.000 And there's, you know, all I've been thinking about is coronavirus for the last 10 months.

00:53:17.000 I mean, there's just so much stuff in my mind about this thing that, oh, I remember because I thought I was wanted to talk to you about this.

00:53:25.000 So I want people to also begin to think about who should we give the vaccine to?

00:53:30.000 Like, what are the ethical and public health We're good to go.

00:53:58.000 They clearly should get first dibs on the actual effective drug that's now been shown to be effective because of their contributions.

00:54:05.000 Okay, great.

00:54:06.000 Then, pretty uncontroversial, is that the next group of people to get it should be doctors, nurses, firemen, policemen, first responders, ambulance drivers, all of those people, healthcare workers.

00:54:17.000 Those people, because they're putting themselves in harm's way during a contagious disease to protect the rest of us, they should be next.

00:54:25.000 Okay, fine.

00:54:26.000 But then who?

00:54:27.000 Who's next after that?

00:54:28.000 And here it gets very tricky, both ethically and from a public health point of view.

00:54:34.000 And let me give you an example of this.

00:54:38.000 So on the one hand, you might say we should vaccinate, let's say, vulnerable elderly people or people with chronic illnesses.

00:54:45.000 They have the greatest chance of dying if they get infected.

00:54:48.000 We should give the first 10 or 20 million doses should go to elderly people in nursing homes. 0.66

00:54:54.000 And there's a lot of compelling reason to do that.

00:55:06.000 It actually might make more sense and we might save more lives from a public health point of view if we vaccinated working age people, people who are out and about.

00:55:16.000 Because if I vaccinate you and I, by virtue of making you immune, stop you from transmitting the disease to other people since you're out and about and seeing lots of other people, I might actually wind up saving more lives, paradoxically, by vaccinating the people at lowest risk.

00:55:32.000 How do you educate people on that?

00:55:33.000 That seems like a complicated one to explain.

00:55:37.000 Yes.

00:55:37.000 So that's – and our nation is going to face this dilemma very soon, in fact.

00:55:42.000 Because when the initial – of course, if we had 300 million doses, we wouldn't have to make these choices.

00:55:46.000 We could just give everyone the shot who wanted it.

00:55:48.000 And incidentally, the cold chain requirements for this – this is another topic now, tangent on a tangent – Many rural parts of our country simply don't have the kind of refrigerators that are needed to stockpile and administer these vaccines.

00:56:05.000 What kind of refrigerators are needed for these vaccines?

00:56:08.000 Well, the Pfizer one needs a minus 80 refrigerator.

00:56:13.000 These aren't common, like below dry ice cold.

00:56:16.000 And so not every pharmacy, your local CVS or Walgreens doesn't have Usually this type of refrigeration.

00:56:24.000 And plus all the trucks transporting it, like from the moment that the vaccine is manufactured till the moment it's injected, it has to be, many vaccines, not all vaccines, have to be in what is known as the cold chain.

00:56:39.000 They can never be defrosted.

00:56:41.000 And building the logistics to distribute the vaccine is a big, big challenge.

00:56:46.000 So not only do we have to invent a vaccine like we are, which is magnificent, but That our nation is able to do that.

00:56:53.000 But we have to manufacture it, which is not easy.

00:56:56.000 You know, we need little glass vials, we need millions of them, and we need factories that can produce this particular kind of vaccine, etc.

00:57:03.000 We need to distribute it, like the cold chain, the refrigeration I mentioned.

00:57:08.000 And most important, we need to persuade people to accept the vaccine.

00:57:13.000 And this touches on what we were discussing earlier, whether people will believe that the vaccine is useful.

00:57:17.000 And of course, we have an anti-vax population in our country and so on.

00:57:21.000 So all of these challenges have to be overcome.

00:57:24.000 So if we had 300 million doses of the vaccine, this would be less of a dilemma.

00:57:28.000 But initially, we're not going to have that.

00:57:30.000 We're going to have some lower number of doses, and those doses will be more easily administered in metropolitan areas that have the right refrigerators.

00:57:38.000 So we as a nation are going to need to begin to think about this, about how to That's very complicated.

00:57:48.000 Now, the difference between the Pfizer and the Moderna vaccine is what?

00:57:54.000 Well, as I'm told, and I'm no expert on this narrow topic, that the Moderna vaccine actually doesn't require as cold refrigeration.

00:58:04.000 For reasons that I don't understand, since they're both RNA vaccines, they both are encased in lipids.

00:58:26.000 We don't have any idea why.

00:58:29.000 I'm sure experts know that.

00:58:31.000 I don't know the answer to that, why it does.

00:58:33.000 Is there anyone who's tried both?

00:58:36.000 Is there any benefit in getting vaccinated with both vaccines?

00:58:40.000 I doubt that because they're very similar in approach, but I can imagine that the time will come when there might be some benefit in getting two complementary vaccines, when we have developed still more approaches, as we were talking about earlier, when you can get this and also that.

00:58:55.000 Now, it's also possible—I mean, we just don't know the answers to all these questions.

00:59:00.000 It's also possible—so some significant fraction of people who die of coronavirus die because of their own body over-response to it.

00:59:10.000 Their immune system is too dramatic, too dramatically responds.

00:59:15.000 And it's possible that— That we may not want to give people multiple versions, different kinds of vaccines because we might overexcite their immune system in a way that actually harms them in some way.

00:59:28.000 So these things are all going to be sorted out in the coming year.

00:59:34.000 I just don't want people to think it's all simple because it's not.

00:59:39.000 Now, Donald Trump is 74. He's overweight and eats cheeseburgers every day.

00:59:43.000 When a guy like that catches COVID and is fine in four days, people get very dismissive of it, unfortunately.

00:59:54.000 What did he receive?

00:59:55.000 What kind of treatment did he receive?

00:59:57.000 And how different is it than what the average person would receive if they got sick?

01:00:02.000 So he faced a very significant risk of death, and I think he got lucky.

01:00:07.000 So remember, his doctors put him on dexamethasone.

01:00:11.000 So, so far, we only have one proven drug that lowers your risk of death if you're seriously ill from COVID, and that's a very simple steroid called dexamethasone.

01:00:21.000 And...

01:00:23.000 Remdesivir has not been shown to lower mortality.

01:00:27.000 It has been shown to lower your length of hospital stay, so there's some benefit to it, but it doesn't appear to lower your risk of death.

01:00:34.000 What would be the difference between lowering your risk of hospital stay and lowering your risk of death?

01:00:39.000 Why would they let you out of the hospital if you hadn't shown significant health improvements?

01:00:44.000 And wouldn't significant health improvements signify that your body's recovering better?

01:00:52.000 Yeah, it's a mystery and it's confusing.

01:00:54.000 And when the first remdesivir trial was published a few months ago, it didn't show a benefit for mortality, but it showed a trend.

01:01:02.000 It looked like it would help and it made sense.

01:01:04.000 Like if it's lowering your hospital duration, probably it's good for you and it'll also lower your risk of death.

01:01:09.000 But then another trial came out, much bigger trial, as part of the, I think it was called the Solidarity Consortium, either the Solidarity or the Recovery, I can't remember right now, consortium out of England.

01:01:20.000 Which showed that actually remdesivir had no benefit for mortality.

01:01:25.000 Now, how can that be?

01:01:26.000 Imagine that you have 100 people who are sick, and in the group that gets remdesivir, they only wind up spending an average of 10 days in the hospital, but 10 of the people die.

01:01:39.000 And in the other study, the people that did not get remdesivir, 100 people get sick, and they spend an average of 12 days in the hospital, but again, 10 of them die.

01:01:49.000 So the remdesivir has lowered the hospital duration from 12 to 10 days, but it hasn't affected the probability of people dying.

01:01:56.000 That's entirely possible.

01:01:57.000 And that is in fact what appears to have happened.

01:02:00.000 And this was a study, you said, that was in England?

01:02:04.000 Yes, it was a large study that was – I think the subjects were not just in England.

01:02:09.000 It was organized by a group of English scientists, either the Solidarity or the Recovery Consortium.

01:02:14.000 And I just don't remember right now the name of it.

01:02:16.000 But I want to go back to your question about the president.

01:02:19.000 So the president was given dexamethasone.

01:02:22.000 And when that happened, I stated publicly that either the president was sicker than they were telling us.

01:02:31.000 So he was sufficiently sick that they – Wanted to give him dexamethasone because giving dexamethasone early in the course of the disease before you're very sick actually can harm you.

01:02:42.000 So you don't want to give it to someone at the beginning of their disease.

01:02:44.000 You need to wait until they're sufficiently sick and then it helps you.

01:02:49.000 So either he was sicker than they told us and so they were lying to us or he really needed the dexamethasone in which case he faced a significant risk of death.

01:02:59.000 So people in the trials that showed that the dexamethasone worked 74-year-old overweight people, men, and men are at much greater risk of dying than women of this condition, who got the dexamethasone, they had about a 20% chance of death.

01:03:14.000 So I think the president actually faced a 20% chance of death when he was at the hospital, which is a big risk of death.

01:03:21.000 And I think he got lucky.

01:03:23.000 You know, he survived.

01:03:25.000 He was also given this cocktail of artificial antibodies to the disease, which I think is another promising approach to I think?

01:03:57.000 So whatever it was, it seemed to be very effective.

01:04:02.000 No, I wouldn't conclude that.

01:04:03.000 He went on a wild tweet storm.

01:04:05.000 It seemed like he had a lot of energy.

01:04:07.000 Well, the dexamethasone may have given him a steroid high.

01:04:10.000 I wouldn't conclude that the antibody cocktail was necessarily effective.

01:04:14.000 No, no, no.

01:04:15.000 I didn't mean that.

01:04:16.000 I meant the treatment, the overall treatment.

01:04:19.000 Whatever they gave him when he was in the hospital, the response was for a 74-year-old guy to be back on the campaign trail with this rigorous campaign that he was doing four or five days later, pretty damn impressive.

01:04:32.000 Yes.

01:04:32.000 Yes, I did not expect that at all.

01:04:34.000 And as I said, I think he got lucky.

01:04:37.000 And I do think steroids can make you a little psychotic and a little manic, actually.

01:04:43.000 And I think, I mean, you can't really know from a distance.

01:04:47.000 But to me, as a doctor, looking at him, I thought, this man has a little bit of a manic feel to him.

01:04:53.000 But then they tapered his steroids and that went away.

01:04:57.000 Just from the Twitter feed?

01:04:59.000 Yeah.

01:05:00.000 But isn't that how he always is?

01:05:03.000 Well, I'm not an expert on Donald Trump's tweets, but if you just looked at some of the – you're right.

01:05:07.000 Maybe he was always that way.

01:05:10.000 But if you look at some of the things he did, like I think having the Secret Service drive him around the hospital was a bit manic.

01:05:22.000 That was like a very irresponsible thing to do.

01:05:24.000 It exposed people to risk it.

01:05:28.000 If you and I were in the hospital with COVID and we told our doctors, you know, I just want to go for a drive around the block right now and let me go to the hospital, I mean, they would say no, you know, that would not be an okay thing to do.

01:05:40.000 He wanted to wave to people, right?

01:05:43.000 Yes.

01:05:43.000 Yeah, hilarious.

01:05:45.000 Yes.

01:05:46.000 I mean, I think one of the things – and I make this argument in Apollo Zero – One of the things that's very interesting to me about plagues, earlier you talked about how plagues were one of the four horsemen of the apocalypse,

01:06:01.000 is that...

01:06:04.000 That lies and denial are like the squire of the horsemen.

01:06:09.000 They follow right behind.

01:06:11.000 And in a way, you would even say that lies and denial, since they've occurred for thousands of years, whenever there's an outbreak, people have always developed superstitions.

01:06:21.000 They've wanted to deny what's happening.

01:06:23.000 There's been a lot of lying.

01:06:24.000 There's been a lot of snake oil salesmen.

01:06:27.000 There's just a lot of mendacity That follows the germ. 0.99

01:06:33.000 So the germ is spreading through social connections and bullshit is spreading through social connections. 0.97

01:06:40.000 We saw this even in the president where he was, you know, frankly misrepresenting what was happening. 0.98

01:06:45.000 We now know that he was told that it was going to be a pandemic in December, but was saying, oh, it's just a flu.

01:06:49.000 Nothing's going to happen.

01:06:50.000 Nothing's going to happen.

01:06:51.000 He was lying.

01:06:52.000 And his whole hydroxychloroquine story, there was no evidence that this drug would work, but, you know, he was like a snake oil salesman selling it.

01:07:01.000 And you could even make the argument that It is the perfection of our democracy.

01:07:07.000 It's the fact that we have a democratic system that allows us the popular will to be reflected in the leaders that we elect so that if the people wish to be lied to, they will elect a liar.

01:07:19.000 Can I pause you for a second there?

01:07:22.000 There was a lot of people that did believe that hydroxychloroquine at the time had some positive benefits, including my doctor, who is not a Donald Trump supporter.

01:07:32.000 No evidence at all.

01:07:35.000 There was some suggestion that, based on in vitro studies, that the drug might work.

01:07:40.000 It wasn't crazy to consider that it would work.

01:07:43.000 I mean, it wasn't a crazy idea to say, maybe this drug works.

01:07:45.000 But there was no clinical evidence that it worked.

01:07:47.000 There was no randomized controlled trials that should have worked.

01:07:50.000 But isn't that also because there was no time for any randomized controlled trials because this was the initial stages of the pandemic?

01:07:57.000 Yeah.

01:07:58.000 So I'm not saying that it wasn't crazy to think that it might work.

01:08:01.000 But to say that it does work is a different statement.

01:08:04.000 I agree with you wholeheartedly that his endorsing of it as being some sort of a miracle cure was irresponsible.

01:08:11.000 Yes.

01:08:12.000 But that's also kind of what he does, right?

01:08:15.000 Like when he was sitting next to – I'm sorry.

01:08:18.000 What is her name?

01:08:20.000 Birx? 0.97

01:08:21.000 What was her name?

01:08:22.000 Yes.

01:08:23.000 And he was saying maybe we can – Yeah, maybe we can use some sort of internal disinfectant on people.

01:08:32.000 He's riffing.

01:08:35.000 He's the guy that likes to have the answers when he's giving these speeches.

01:08:38.000 And he likes people to pay attention.

01:08:41.000 And I think in that response, that's how he usually is as a human being.

01:08:48.000 He gets to be 70 years old.

01:08:49.000 Now all of a sudden he's the President of the United States and he's doing this.

01:08:52.000 Now it becomes a problem.

01:08:54.000 Yeah, so this is what I would like to say.

01:08:58.000 And I set it up by saying, you know, it's a reflection of the perfection of our democracy that we are able to get the public will reflected in our leaders.

01:09:08.000 And if the public will is to, as I said, have someone who tells you only good news and doesn't tell you bad news, we're going to get that.

01:09:14.000 But I don't think that lets the leaders off the hook.

01:09:16.000 And actually, before I explain that, let me just go back and say it's also true that many other leaders in other European nations, like in Italy or in England, So it's not the case that only Trump singularly botched the response.

01:09:30.000 Now, there were leaders in South Korea, in New Zealand, even in Greece, you know, who had a successful response.

01:09:38.000 But my point is, We're the United States of America.

01:09:41.000 I expect more of us.

01:09:43.000 We have the CDC. We're the richest nation on earth.

01:09:47.000 We have scientists and doctors.

01:09:51.000 We spend 17.7% of our GDP on healthcare.

01:09:54.000 We have the National Security Agency.

01:09:57.000 We have everything you would need to do better.

01:10:02.000 And I expect more from us.

01:10:03.000 So I absolutely do fault him for flubbing this.

01:10:09.000 But I also think the American people need to take some responsibility and need to sort of Man up, you know, and recognize that the world has changed.

01:10:18.000 There's some serious stuff that's going on.

01:10:21.000 And we have to do better in how we confront this threat.

01:10:27.000 We can't be like children pretending that it's not there or fantasizing that it'll just miraculously go away.

01:10:34.000 That's not a mature response.

01:10:35.000 And we have, unfortunately, a long road ahead.

01:10:40.000 You know, we are not...

01:10:42.000 At the beginning of the end of this pandemic, we are just at the end of the beginning.

01:10:48.000 And just to set the stage a little bit, here's what I think is going to happen.

01:10:53.000 So it's great that the vaccine has been invented, and we'll have several of them.

01:10:57.000 But as we've discussed, there are going to be some problems and challenges in manufacturing it and distributing it and persuading large numbers of people to get it and so on.

01:11:05.000 And that's going to take time, let's say a year.

01:11:08.000 So let's say the vaccine is approved In a couple of months, the beginning of 2021, I think we're going to spend all of 2021 doing all that other stuff, distributing the vaccine and so on.

01:11:18.000 Meanwhile, the virus is still spreading.

01:11:21.000 And right now, probably about 12% of Americans have been infected with the virus.

01:11:26.000 In the end, for various calculations and reasons, probably about 50% need to be infected.

01:11:33.000 The final attack rate probably needs to be about 50% before we reach this threshold known as herd immunity.

01:11:39.000 So we're about a quarter of the way there, let's say.

01:11:41.000 So the virus is going to keep spreading.

01:11:45.000 And while we're doing all that other stuff, so either way, I think we get to 2022 before we've reached herd immunity, either naturally, because the virus has finally attacked that many people, or artificially, because we immunize that many people.

01:12:00.000 So at that point, just to be clear, the virus isn't gone.

01:12:03.000 It's still in our world.

01:12:04.000 It's still circulating, but it's epidemic epidemic.

01:12:07.000 It's epidemic capacity now has been neutered, and the virus will be so-called endemic when we reach the herd immunity threshold, either by vaccines or naturally.

01:12:18.000 That's 2022, let's say.

01:12:21.000 But that's just then we've overcome the biological and epidemiological impact of the virus.

01:12:26.000 And until that time, we're going to be wearing masks.

01:12:28.000 There are going to be intermittent school closures.

01:12:30.000 We're going to have to have physical distancing.

01:12:31.000 There's going to be gathering bans.

01:12:34.000 Hospitals will be full periodically.

01:12:36.000 This is going to be the world we're in for the next year or so.

01:12:41.000 And then we'll get to the point where we have herd immunity one way or the other.

01:12:45.000 But then you see we have to recover From the psychological, social, and economic shock.

01:12:53.000 You know, let's not forget tens of millions of Americans are out of work.

01:12:57.000 Many small businesses have gone out of business.

01:13:00.000 We have sort of a reshaping of our economy in all kinds of radical ways.

01:13:05.000 And it's going to take a while for that to unwind.

01:13:07.000 Also, a lot of people are going to be disabled by this condition.

01:13:10.000 So far we've been talking about death.

01:13:12.000 Probably five times as many people will be disabled, will have some form of long-term disability, renal, cardiac, neurological, or pulmonary.

01:13:21.000 So if we have, let's say, half a million Americans, for sure half a million Americans will die of this condition, maybe as many as a million.

01:13:27.000 In the end, by the time the pandemic is over, it's going to be a number in that range.

01:13:32.000 Whatever that number is, about five times as many will be disabled.

01:13:35.000 So let's say half a million Americans die.

01:13:37.000 We're going to have two and a half million Americans with some form of disability.

01:13:39.000 We're going to have to cope with that as well.

01:13:42.000 So if you look at the history of epidemic disease, it's going to take a year or two to recover from that.

01:13:49.000 So I think it's 2024. Before we really begin to enter the post-pandemic period, when life will return approximately to normal with some persistent changes in our society.

01:14:03.000 And I'll say one more thing and then I'll shut up.

01:14:06.000 If you look at the history of previous pandemics, what typically happens is during the time of the germ hitting the society, people get more religious.

01:14:16.000 They become more abstemious.

01:14:19.000 They save money.

01:14:21.000 They withdraw from social contact.

01:14:25.000 They avoid risks.

01:14:26.000 Risk aversion increases, risk-taking declines.

01:14:29.000 All of these things happen.

01:14:30.000 And then when finally the epidemic is over, all of those things reverse.

01:14:36.000 People relentlessly seek out social interactions.

01:14:39.000 You know, sporting events and nightclubs and restaurants and political rallies.

01:14:44.000 Sexual licentiousness goes up.

01:14:47.000 Spending, people start spending money.

01:14:49.000 Risk taking comes back.

01:14:51.000 One person, Neil Ferguson, actually, who kindly reviewed the book in the Times Literary Supplement, when he read this description, he goes, you know, here's hoping that this is what it'll be like.

01:15:02.000 So I think come 2024, late 2023, that period, we're going to have like the roaring 20s again.

01:15:09.000 When our society is going to really be unleashed from this shock that we are experiencing.

01:15:17.000 I'm looking forward to that.

01:15:19.000 One thing I've got to urge you is, please, every time you get excited and slap your table, we get a loud bang out of your microphone.

01:15:26.000 Okay.

01:15:27.000 Sorry.

01:15:29.000 We talked about the economic issue.

01:15:32.000 You briefly just touched on it.

01:15:34.000 What do you think...

01:15:36.000 Can be done to mitigate the economic impact and what what states do you think are doing it right versus what states you think are doing it wrong?

01:15:44.000 It seems to me that one of the big problems that people are having with this pandemic is all of a sudden governors and mayors have these powers that they never had before and they don't seem to totally make sense like they're allowing people to have mass protests We're good to go.

01:16:09.000 We're good to go.

01:16:21.000 Where they're shutting everything down.

01:16:22.000 And this is right after the governor got caught going to a restaurant with a bunch of other people doing things that he specifically told people not to do.

01:16:32.000 This is a problem that people have with the power that government has now assumed.

01:16:38.000 And the real concern that many people have, myself included, is that we're never going to see them give that up.

01:16:46.000 Is that the power that they have now to tell people to stay home, don't work, shut down schools, shut down gyms, shut down restaurants, that they're not going to let that go.

01:16:55.000 People enjoy using power, and especially if they have a legitimate good cause for it like we do here in the pandemic.

01:17:06.000 So I share your concerns, and I understand what you're saying, and there are many components to what you just said.

01:17:15.000 Even during the bubonic plague in England, when the government wasn't ordering restaurants to close, the economy still collapsed.

01:17:25.000 So we have to draw a distinction between what the germ is doing to us and our economy and what it would have done regardless of what government did.

01:17:37.000 I think?

01:17:54.000 All right, well, I believe you on that. 0.96

01:17:55.000 I don't know what's happening in Austin, but I don't think that the economy would necessarily be less fucked if the government took no action. 0.74

01:18:05.000 In fact, the principle, the ideal principle at least, is that by the government acting, we can protect the economy. 0.80

01:18:12.000 So for example, if the government were able to effectively force people to wear masks, and if everyone wore masks, I think we're good to go.

01:18:41.000 You grabbing your gun and going to the frontier, it's useless, right?

01:18:45.000 You can't stop the army by yourself.

01:18:47.000 It's solitary action.

01:18:48.000 It's not adequate in this situation.

01:18:50.000 Furthermore, everyone else on their own running to the frontier in a disorganized way also is not effective.

01:18:56.000 You need leaders.

01:18:57.000 You need structure.

01:18:58.000 You need platoons.

01:18:59.000 You need weapons.

01:19:00.000 You need strategy.

01:19:01.000 You need all that other stuff, that coordination, to repel the invader.

01:19:05.000 And it's the same with this.

01:19:07.000 We save our skins by working together to repulse the invader.

01:19:12.000 And in an ideal world, that's what government would do for us.

01:19:14.000 It is an expression of the collective will for collective self-preservation.

01:19:21.000 So I just want to, first of all, draw the distinction between what the virus did to us versus what we're doing to ourselves, which we seem to agree on.

01:19:26.000 Now, the hypocrisy of our leaders, and then I'll come to the power issue.

01:19:30.000 The hypocrisy is really worrisome to me.

01:19:33.000 And we talked about this earlier.

01:19:34.000 I think public messaging is a crucial part of the battle we had ahead of us.

01:19:39.000 So we have to have people be honest with us.

01:19:42.000 And we have to have them be consistent.

01:19:43.000 We can't say, oh, this is what you need to do, but I'm going to the French Laundry for dinner.

01:19:49.000 You know, that's...

01:19:51.000 It's not okay.

01:19:52.000 Exactly.

01:19:53.000 So I totally agree with that.

01:19:55.000 And that's why I want our leaders, for example, when they appear in public to wear masks.

01:19:58.000 I don't think that, you know, a lot of the political politicians who are going, you know, to public events not wearing masks.

01:20:06.000 You know, Vice President Pence, for example, went to some event at the Mayo Clinic.

01:20:10.000 Everyone else was masked.

01:20:11.000 He wasn't masked.

01:20:12.000 That's not the right message, in fact.

01:20:14.000 Right.

01:20:14.000 And here's the other thing, just to be clear.

01:20:17.000 I know what's happening in North and South Dakota right now.

01:20:20.000 I've been following it a little bit.

01:20:21.000 And also in Idaho and other parts of the northern part of our country right now.

01:20:27.000 It's in the nature of exponential growth to be deceived.

01:20:31.000 Exponential growth is not an intuitive concept. 0.97

01:20:33.000 So when experts say the shit is going to hit the fan in a few weeks or it's really bad right now, The man on the street goes out or the woman on the street goes out and looks around and says, nothing is happening. 0.96

01:20:46.000 It's not so bad right now. 0.99

01:20:47.000 What are you talking about?

01:20:48.000 And it seems like the expert is lying.

01:20:51.000 But what happens with exponential growth is, you know, one becomes two, becomes four, becomes eight, becomes 16. It looks like nothing has happened.

01:20:58.000 It becomes 32, becomes 64 cases or deaths.

01:21:01.000 There's not so many deaths.

01:21:02.000 It doesn't look so bad.

01:21:03.000 But then it explodes, right?

01:21:06.000 Exponential growth, as we all learned in high school algebra.

01:21:10.000 And that's the problem.

01:21:11.000 And by that time, by the time that explosion takes place, it's too late.

01:21:15.000 And this is why leadership is so important and why we as a people need to try to elect or empower individuals who are honest with us, who are not hypocrites, who act according to their prescriptions, and who tell us the plain truth of what it is that we're facing.

01:21:30.000 Because we are going to have to work together to get the best of this virus.

01:21:34.000 What is happening in South Dakota and North Dakota?

01:21:36.000 I'm not aware.

01:21:41.000 I think North Dakota has the highest per capita death rate of any place in the world right now.

01:21:47.000 But it's a rural and not a very populous state.

01:21:50.000 They're also pretty wide open, right?

01:21:52.000 They really didn't enforce any restrictions at all.

01:21:56.000 Correct.

01:21:57.000 And on the one hand, I am not saying, and this is important, I'm not saying that every place...

01:22:02.000 Well, there are some things that I think we need a national strategy for.

01:22:05.000 So, for example, Inconsistent rules from place to place can harm us.

01:22:10.000 It's like designating one part of the swimming pool for pissing and just hoping for the best.

01:22:15.000 I mean, it doesn't work when there's a contagious disease.

01:22:19.000 That's a great example.

01:22:20.000 I wish it were mine if someone else came up with this.

01:22:23.000 But anyway, so that's not...

01:22:26.000 We need to have some kind of national strategy.

01:22:28.000 We need some consistency.

01:22:30.000 We can't have every little town.

01:22:32.000 This town is masked.

01:22:33.000 The next door town is not masked.

01:22:35.000 This town closes its schools.

01:22:36.000 The other town doesn't close its schools.

01:22:38.000 This state bans gatherings, but the adjoining state does not ban gatherings.

01:22:42.000 We need some consistency.

01:22:43.000 Having said that, however, It is also the case that different states are different.

01:22:48.000 You know, the population density in New York City is completely different than the population density in Vermont or in North Dakota.

01:22:54.000 And I can understand why people that live in rural states might say, well, we have one advantage, which they do have, you know, being less dense, the population density being lower.

01:23:02.000 But that doesn't mean you can just count on that advantage and do nothing else.

01:23:06.000 And this is something I wrote about.

01:23:10.000 It's called the Swiss cheese model of pandemic control.

01:23:14.000 So imagine that every layer of defense is a piece of Swiss cheese.

01:23:17.000 For example, school closures, or physical distancing, or wearing masks, or banning gatherings, or testing, for example.

01:23:26.000 So each one of those is a layer of defense, but each of them is not perfect.

01:23:31.000 They have little holes in them.

01:23:32.000 You should have the intuition that if you have just one layer of defense, it's imperfect.

01:23:36.000 They're holes.

01:23:36.000 The virus can get through.

01:23:38.000 But if you add another piece of Swiss cheese where the holes are randomly positioned, Maybe there's only a couple of gaps left after that second piece of Swiss cheese where a couple of holes happen to line up, and then you add a third or a fourth slice, and by the fourth line of defense, there are no holes left to penetrate all four layers of Swiss cheese.

01:23:56.000 This is what we need to do as a nation.

01:23:58.000 Any one layer of defense is not enough.

01:24:02.000 We need multiple layers.

01:24:03.000 But the good news is, first, if we have enough layers, We don't necessarily need any more after that.

01:24:09.000 So for example, if let's say we wear masks, we physical distance, we ban gatherings and we have testing, maybe that means we don't have to close schools because they don't add anything else.

01:24:21.000 Adding another piece of cheese as the fifth layer is not necessary.

01:24:26.000 And furthermore, this is what happened at the White House.

01:24:28.000 They relied on one layer, which was testing.

01:24:31.000 They didn't have masking.

01:24:32.000 They didn't have physical distancing.

01:24:33.000 They thought, oh, we're just going to do testing.

01:24:35.000 It's not enough.

01:24:36.000 Did they though?

01:24:38.000 Because I don't think they did.

01:24:39.000 I don't think he was getting tested.

01:24:42.000 I don't think he was either, honestly.

01:24:45.000 But I have no inside knowledge.

01:24:47.000 Well, all I need to hear is when they asked him, when was the last time you had a negative test?

01:24:51.000 You asked me, when was the last time you had a negative test?

01:24:53.000 Yesterday.

01:24:54.000 I get tested every day.

01:24:56.000 So if they're not asking him, if he's not answering that question, there's only one reason, because he doesn't want to lie, because he knows other people know.

01:25:04.000 So he knows he's got an inner circle that is a little...

01:25:07.000 The little chatty Cathy.

01:25:09.000 Talk a little bit.

01:25:10.000 And they're going to rat him out, especially if he doesn't win the election, right?

01:25:15.000 Yes.

01:25:15.000 I think he wasn't getting tested.

01:25:17.000 I think that's right.

01:25:18.000 I think they probably had the idea that we'll test everyone else that comes in contact with the president.

01:25:22.000 Yes.

01:25:23.000 And they also, by the way, tests are also not perfect.

01:25:26.000 Remember we said there's no life without risk.

01:25:28.000 These are all probability distributions.

01:25:29.000 So some tests are exceptionally good, but they're not perfect.

01:25:33.000 You get a false negative.

01:25:34.000 Well, he's also using a rapid antigen test, correct?

01:25:37.000 He's using the test where they're doing the nasal swab or the saliva test.

01:25:45.000 I don't know exactly what testing methodology was in use at the White House, but what I suspect happened is He got infected from someone else.

01:25:54.000 And then I think, and this is just rank speculation, I think he was the point source after that.

01:25:58.000 Because if you look at the network pattern of who got the disease, including the person, the Coast Guard officer that was carrying the nuclear football who got infected.

01:26:07.000 By the way, this is, just to be clear, it's, in my view, the height of irresponsibility to be so lax.

01:26:12.000 The fact that our leadership was infected, including even the person holding the nuclear football, this is irresponsible, right?

01:26:18.000 I mean, we should do, I expect more from the White House.

01:26:23.000 If you look at the pattern of people, if you map out the network of who got infected, I think he was the common denominator for a lot of the infections.

01:26:32.000 And so I think he got it somehow.

01:26:34.000 He wasn't being tested.

01:26:35.000 I speculate.

01:26:36.000 This is speculation.

01:26:37.000 And then he spread it to lots of other groups of people.

01:26:39.000 So basically, the president is a super spreader.

01:26:42.000 Say it.

01:26:43.000 Yes, I think the data fit with the claim that the president was a super spreader, yes.

01:26:51.000 Yeah.

01:26:53.000 So clearly that's a gigantic problem.

01:26:59.000 Apparently now has COVID. And one of the things that he was talking about is how two tests came back positive and two tests came back negative.

01:27:07.000 And a lot of people are criticizing him about this on Twitter, complaining about it without researching the nature of these tests themselves.

01:27:15.000 And that the issue being that these tests are not that effective if you have a very mild case of the virus or if you barely have any in your system.

01:27:27.000 And that they might show positive and negative in the same day.

01:27:33.000 I don't know the details of Elon Musk's testing.

01:27:35.000 I have to imagine that Elon Musk has good testing.

01:27:38.000 So I was surprised by his description.

01:27:40.000 And I don't believe he released information on whether he was having PCR tests for the virus or antibody tests for immunity.

01:27:48.000 He did.

01:27:48.000 He released it that it's rapid antigen test.

01:27:53.000 So he wasn't getting PCR tests for the virus.

01:27:55.000 He didn't this particular time when he tested four times, two negative and two positive.

01:28:00.000 He's pretty specific about it on Twitter.

01:28:02.000 And that's when people were criticizing his response.

01:28:05.000 And those were all antibody tests, Joe?

01:28:07.000 Yes, I believe.

01:28:09.000 I'm 99% sure because he was actually then questioning the effectiveness of PCR. Now, here's something that I wanted to discuss with you because I got confused about it.

01:28:20.000 Someone was saying that with PCR tests, when you get to a certain number of tests, then it becomes problematic.

01:28:28.000 Correct?

01:28:29.000 Like an individual, an individual having a certain number of PCR tests.

01:28:35.000 There's no way I can think of that would be the case.

01:28:38.000 I mean, what the difference is, the PCR test is a test of saliva or nasal secretions for the virus.

01:28:50.000 And typically after you recover, you don't shed the virus anymore.

01:28:55.000 Now you can test positive for a while afterwards because you might still have some RNA from the virus in your system, but you're not infectious.

01:29:01.000 So you can test positive, but you can't infect anyone else.

01:29:05.000 But usually, after a number of weeks, you no longer test positive and that's done with.

01:29:10.000 The antibody test is a test of your body's response to the virus, the proteins that you produce to fight the virus.

01:29:17.000 Usually you take that from blood, but people have now developed saliva antibody tests, which is much more convenient.

01:29:25.000 And those will be positive for a number of weeks or months, as we were discussing earlier.

01:29:29.000 And there are two different kinds of antibodies.

01:29:31.000 Actually, there are more than two, but there's a so-called IgM and IgG.

01:29:34.000 The IgM spikes within two or three days, and some tests can detect that, very sensitive, and the IgG almost immediately afterwards.

01:29:42.000 And you can use antibody tests to detect as your body is fighting off the virus.

01:29:48.000 These are two different kinds of tests.

01:29:51.000 The saliva test, this is something that I've heard of but I've never seen implemented.

01:29:57.000 Is there a more effective version?

01:30:01.000 Is saliva more effective than the nasal swab?

01:30:04.000 Well, just to be clear, the saliva test could be the saliva test for the virus or saliva test for the antibodies.

01:30:15.000 Two different ones.

01:30:17.000 There's two different ones.

01:30:18.000 Yeah, they're different things and they're different tests.

01:30:20.000 And the saliva is, of course, much easier for all of us than having blood drawn or having someone put a Q-tip in our nose.

01:30:26.000 So people are scrambling and have developed saliva tests both for the virus and for the antibodies to the virus now, which is, again, great news.

01:30:34.000 Incidentally, just to be clear to people, why did the nation make a sacrifice of flattening the curve?

01:30:41.000 Like, why did we have...

01:30:42.000 The school closures and the lockdowns and all of that stuff back in the spring.

01:30:46.000 The reason we did it was to stop the percussive force of the virus.

01:30:51.000 It's like a tidal wave was going to come ashore and we built breakers offshore so that the amplitude of the wave would be reduced.

01:30:58.000 Still the water would come ashore, but it would come ashore more slowly than this huge wave hitting us.

01:31:03.000 And the reason we did that was so that we could have our healthcare system begin to function Discover that dexamethasone works.

01:31:13.000 Invent vaccines.

01:31:14.000 Invent tests.

01:31:16.000 Improve the tests.

01:31:17.000 Make the tests easier for us to take.

01:31:19.000 So all of these things have happened in the last nine months.

01:31:22.000 This is why we did the sacrifices we did last spring.

01:31:27.000 And incidentally, this is why further sacrifices might be called from us.

01:31:32.000 If we continue to behave well, We might be able to spare a lot of deaths because then we'll have really good vaccines that have been shown to work.

01:31:42.000 We'll have more medicines to treat the sick people.

01:31:44.000 Our hospitals won't be inundated.

01:31:47.000 Doctors can take care of you better when the hospital is 60% full than when the hospital is 120% full.

01:31:54.000 They're not as exhausted as the doctors.

01:31:56.000 Do you want an exhausted doctor with lack of supplies that's worried that he or she is going to get sick?

01:32:02.000 Or do you want a well-rested doctor with adequate supplies that is mentally fit and ready to care for you?

01:32:09.000 So all of these are reasons we're flattening the curve back then and now.

01:32:12.000 So these tests, these miraculous tests that we have for saliva now, have all been invented in the last couple of months.

01:32:19.000 Jamie, did you find anything on the PCR? Nothing?

01:32:25.000 Okay.

01:32:26.000 I know I read something about it.

01:32:28.000 Joe, I can't imagine a way that the testing itself...

01:32:36.000 Could be worse for you.

01:32:37.000 No, no, no.

01:32:38.000 No one's saying that.

01:32:40.000 No, it was something saying that it becomes ineffective after a certain number of cycles.

01:32:45.000 Here's another question.

01:32:47.000 Why do we have these upswings and why do we have waves?

01:32:52.000 Like, what is the cause of waves?

01:32:54.000 Is it people relaxing?

01:32:56.000 Is it people gathering, going to bars?

01:33:00.000 Seems to be particularly problematic, right?

01:33:03.000 What is causing these waves?

01:33:04.000 Is it that people get relaxed?

01:33:06.000 A lot of different things are doing it.

01:33:09.000 The existence of a second wave right now is completely unsurprising to anyone that studies respiratory pandemics.

01:33:18.000 I'm unfamiliar with a respiratory pandemic in the last hundred years that hasn't had multiple waves.

01:33:24.000 Incidentally, I'm telling you now, maybe you'll have me back on the show in a year, There'll be a third wave.

01:33:29.000 A year from now, there'll be a third wave, and actually probably a fourth wave, too.

01:33:32.000 The amplitude of that wave, if we have a vaccine, will be lower, but we'll still have a blip up in cases a year from now, winter, compared to eight months from now, summer.

01:33:43.000 So, respiratory pandemics come in waves, and they do that for a number of reasons.

01:33:48.000 One has to do with We're good to go.

01:34:10.000 And parents drop off their kids and pick them up and chat at the school.

01:34:14.000 So there's just a lot of social mixing that takes place in schools.

01:34:17.000 In the wintertime, people live differently.

01:34:20.000 They move indoors.

01:34:21.000 They have more close contact with each other.

01:34:23.000 It's easier for respiratory pathogens to spread indoors than outdoors, as everyone knows by now.

01:34:29.000 So human behavior changes in the winter.

01:34:31.000 And this is why, incidentally, The germ typically goes to the southern hemisphere for its winter while we're having summer and then comes back north when our winter comes.

01:34:41.000 Furthermore, there's physical and physiologic reasons.

01:34:47.000 So the dryness of the air and the coldness of the air may facilitate the dispersion of the virus.

01:34:56.000 And our bodies, our immune systems, as you were discussing earlier, may function differently in the summer and in the winter.

01:35:03.000 So for a host of many reasons, it is very standard that respiratory diseases have this scalloping sinusoidal pattern up higher in the winter and then lower in the summer.

01:35:14.000 So there's nothing surprising about what's happening right now.

01:35:17.000 The one big unknown is how bad will the pandemic be now?

01:35:25.000 In the 1918 pandemic, the second wave was four times as deadly as the first wave.

01:35:32.000 And the question in many experts' minds right now is, is this COVID-19 pandemic, this second wave that America is beginning to experience now, will it be as deadly as the first wave or more deadly?

01:35:44.000 And I fear that it will be more deadly.

01:35:48.000 And, you know, over a thousand Americans are dying every day of this condition, every single day, day after day.

01:35:54.000 And that number is likely to go up unless we really get our act together.

01:35:59.000 And even when we do get our act together, it'll take about three weeks before we see the deaths plateauing and then beginning to decline.

01:36:06.000 So we're going to have thousands and thousands of deaths, like a battleship turning.

01:36:10.000 Like, even if we start to make the turn, it's going to take many miles before the battleship turns.

01:36:15.000 Same is going to happen here.

01:36:17.000 And so I think, you know, we're gonna have, it's gonna be bad, unfortunately.

01:36:22.000 I think many, many Americans are gonna die.

01:36:25.000 And again, this is not diminishing the impact of the disease or the fact that it's a dangerous disease, but one of the things that the CDC had said was that only 6% of the people who died from COVID-19 had only COVID-19 and that the rest had an average of 2.6 comorbidity factors.

01:36:47.000 Yeah, but a little bit, let me ask you a question.

01:36:49.000 If you have diabetes and you're driving down the highway and you're in a car accident, What do we say killed you?

01:36:58.000 Car accident?

01:36:59.000 Yeah.

01:37:00.000 We say the car accident killed you.

01:37:01.000 We don't say, well, you had diabetes, so we're not going to say the car killed you.

01:37:05.000 So the fact that people – and in fact, we all ultimately are going to die.

01:37:10.000 Right, but you know that people will reverse that, right?

01:37:12.000 Like people will say that people with leukemia who also had COVID, they're listing that as a COVID death when they really had leukemia anyway and they were probably likely going to die.

01:37:22.000 Yeah, but the person with diabetes was probably going to die of their diabetes, but they got into a car accident.

01:37:27.000 So my answer is – I can answer this question.

01:37:31.000 So my answer is that the usual way we think of things that kill people, we think of the proximate cause.

01:37:37.000 Let's say I had chronic obstructive pulmonary disease or I had end-stage renal disease and someone shot me.

01:37:44.000 Just because I was getting dialysis and someone shot me doesn't mean that I was going to die anyway of my renal disease.

01:37:49.000 Therefore, I wasn't murdered.

01:37:50.000 I was murdered.

01:37:51.000 That's what killed me.

01:37:52.000 Right, but you're talking about violent actions versus diseases and comorbidity factors.

01:37:56.000 I don't think that's a fair comparison.

01:37:59.000 No, I think...

01:38:00.000 I think it is fair because let's say you have – it's the same exact situation.

01:38:05.000 Let's say you have cancer and you're getting chemotherapy and you're being treated for the cancer and then you get infected with a pneumonia and you die of the pneumonia.

01:38:13.000 You wouldn't have died but for the pneumonia in this case.

01:38:17.000 The scenario I'm putting to you is – now, if you're going to make the argument you're making, and I understand where it's coming from.

01:38:22.000 I don't mean to dismiss it completely.

01:38:25.000 You would also then have to apportion all deaths – To have a fraction due to different causes.

01:38:31.000 So you would say this person had a diabetes and they also got coronavirus.

01:38:38.000 So we're going to say it's 50% of the death is due to diabetes and 50% is due to the coronavirus.

01:38:45.000 And you could go then, if you wanted to do that, you could like, for all causes of death, you could apportion them.

01:38:52.000 And that would result in, you know, rejiggering multiple things.

01:38:55.000 But it's not fair to just pick on coronavirus and say, Well, actually, people would have died of something else, so we're not going to count those deaths.

01:39:01.000 But that's not what we're saying.

01:39:02.000 What people are saying is that the actual danger of the disease is greatly exacerbated by the poor health of America.

01:39:12.000 That's true.

01:39:13.000 This is what I'm getting at.

01:39:14.000 Yeah, yeah.

01:39:15.000 That is true.

01:39:16.000 That is 100% true.

01:39:18.000 And the comorbidities greatly increase your risk of death.

01:39:21.000 So that is true.

01:39:22.000 And this is, incidentally, one of the reasons why...

01:39:25.000 Sweden is having its own problems right now, but one of the reasons it wasn't really fair to hold up Sweden as a comparison for our strategy is that the Swedes are much healthier than we are.

01:39:37.000 They're a completely different society.

01:39:40.000 We're not, unfortunately, as healthy as the Swedes. 1.00

01:39:42.000 Yeah, that is something that I feel like we could have gotten into people's heads eight months ago and perhaps made a dent in the impact of the virus.

01:39:54.000 It's hard to tell people you have to be healthier.

01:39:57.000 They don't want to listen.

01:39:58.000 People have their habits and they have their vices and they have their behavior patterns that they're just accustomed to and it's very difficult to break people out of them.

01:40:07.000 But some people would have listened.

01:40:09.000 Some people, especially terrified, faced with the possibility of either surviving a pandemic or not, may have done something differently.

01:40:19.000 And it's one of the things that frustrates me so much about not just the government response, but the media's response to this, is that I don't see anybody out there saying, you gotta get healthier.

01:40:29.000 And it's the one thing that might save you.

01:40:32.000 Yes, I mean, I agree completely with that.

01:40:35.000 And there are anecdotal...

01:40:37.000 I have some of them in the book of elderly people who fear getting this and who are not only, let's say, withdrawing socially and limiting their contacts, but they're trying to get fitter.

01:40:51.000 They're exercising more and trying to prepare their bodies for the possibility that they might get an infection and try to optimize their chances.

01:41:00.000 I totally agree with that.

01:41:02.000 But it's hard to persuade people to behave in a healthy way.

01:41:06.000 It's always hard, let alone...

01:41:08.000 But you're saying, I think correctly, you're saying, look, it should be easier to motivate them to do it now.

01:41:14.000 It might be hard, but it's not impossible.

01:41:18.000 There's been zero effort.

01:41:20.000 Zero.

01:41:20.000 It's almost like it's not going to work.

01:41:22.000 Let's just not try that and let's just shut down all the businesses. 0.99

01:41:26.000 That seems to me to be asinine. 0.94

01:41:29.000 Yeah, so I think that's right. 0.91

01:41:30.000 So this is where we're getting back to the sacrifices expected of us.

01:41:33.000 Like if you want, you know, if Americans were willing to work together to like, let's say, I'm going to make this up, but let's say for the sake of argument, we were given a choice.

01:41:41.000 Either every American can lose 10 pounds or every American that's overweight, which is like 66% of Americans are overweight, two thirds of them or more are overweight.

01:41:52.000 Every overweight American can lose 10 pounds or we're going to close the businesses in your community.

01:41:58.000 Actually, you know, I mean, I haven't done the calculation.

01:42:00.000 We'd have to do it.

01:42:01.000 But you can imagine doing such a calculation and concluding that, you know, actually that would be equivalent.

01:42:06.000 And so we should tell people, you know, this is your dilemma.

01:42:09.000 You're being called to action.

01:42:11.000 You're not being drafted into a war.

01:42:14.000 But you need to sacrifice.

01:42:15.000 You need to do your part.

01:42:16.000 And your part is, you know, this.

01:42:18.000 So I agree with you, Joe.

01:42:20.000 I mean, I think that's right.

01:42:21.000 I don't even think that you're going to get them to be motivated that way.

01:42:24.000 Tell them people they have to sacrifice and do your part. 1.00

01:42:26.000 People are fucking selfish. 0.99

01:42:28.000 Tell them, listen, this is going to save you. 1.00

01:42:31.000 We're good to go.

01:42:56.000 And strategies and having health experts talk about proven strategies for boosting your immune system.

01:43:03.000 There's been none of that.

01:43:05.000 Yes.

01:43:05.000 I think that should be part of the messaging.

01:43:07.000 And I actually know some people that I can relay that to that may influence the national messaging on this topic, actually.

01:43:19.000 So I made a note of this point, and I know someone I can communicate this to.

01:43:24.000 It may affect national policy.

01:43:27.000 Well, that would be wonderful because there's plenty of peer-reviewed studies on the impact of specific vitamins and nutrients on your immune system.

01:43:35.000 Yeah.

01:43:37.000 What else do you think we need to do that we're not doing?

01:43:46.000 I think we talked about some of that already.

01:43:49.000 I think we need to get much better with testing.

01:43:51.000 We need to get better with masking.

01:43:53.000 We need to, unfortunately, avoid gatherings.

01:43:56.000 We need to be better with public messaging.

01:43:58.000 We need to prepare the nation a bit more to understand what we're facing.

01:44:05.000 I think we do need more coordination.

01:44:07.000 I don't think this patchwork approach will work.

01:44:10.000 So these are all the things I think we should be doing.

01:44:13.000 And in that messaging, incidentally, I would second what you said, which is encouraging people to take better care of themselves, which is a good thing to do anyway.

01:44:21.000 So I think that's already a pretty tall order, Joe.

01:44:24.000 I mean, I don't know what more we can do.

01:44:26.000 We are making heavy investments in vaccine technology and in science, which I It's sort of a very unsexy thing to spend money on public health departments,

01:44:42.000 but we need them.

01:44:43.000 You know, when this pandemic struck, we didn't even have contact tracing capabilities at the level we needed.

01:44:48.000 It's very sort of bread and butter kind of public health capabilities, but compared to Asian countries, we didn't have that. 1.00

01:44:56.000 So there are a number of strategic investments as a nation we need to make, all of which incidentally are peanuts compared to what's happening to us.

01:45:04.000 I mean, Larry Summers, a former treasury secretary, a former colleague of mine from when I was at Harvard, now I'm at Yale, and a colleague of his, David Cutler, who's a health economist at Harvard, they published a paper about a month or two ago Which called the coronavirus the $16 trillion virus.

01:45:23.000 $16 trillion.

01:45:24.000 These are vast sums of money.

01:45:26.000 And they estimated that the hit to our economy by the virus was $8 trillion and that there was a further $8 trillion loss because of the deaths, illnesses, and disability from the virus.

01:45:42.000 So our nation has suffered from the moment this virus It took root in our society.

01:45:49.000 It has suffered a $16 trillion loss.

01:45:52.000 It's like having a big house that just is burnt to the ground.

01:45:56.000 It's gone.

01:45:58.000 It's just a big loss.

01:46:01.000 And that's what we're facing as a country, actually.

01:46:05.000 And I just think we, I mean, I'm repeating myself, I think we just need to Confront that and deal with that as sensibly as we can.

01:46:13.000 I think one of the more unique things about America is that we have all these different states and we get to see all the different responses that different states have.

01:46:21.000 And that's one of the more confounding things about California's draconian methods because it hasn't really been effective.

01:46:28.000 There's still massive infections and deaths and it doesn't seem to have done that much, particularly right now with the giant wave that they're experiencing.

01:46:38.000 Florida!

01:46:39.000 Is weird, right? 1.00

01:46:41.000 Because Florida's essentially said, fuck it. 1.00

01:46:43.000 You can do whatever you want. 1.00

01:46:45.000 Haven't they?

01:46:46.000 They've basically opened up everything.

01:46:48.000 Live sporting events, concerts, restaurants.

01:46:51.000 I haven't tracked it at this level of detail, but I do want to emphasize that even if the government says you can have live sporting events, only certain, many people still won't go.

01:47:00.000 So there is still...

01:47:01.000 Yeah, but you're talking about Florida.

01:47:04.000 I bet they'll go.

01:47:05.000 I said you're talking about Florida.

01:47:07.000 I bet they'll go.

01:47:09.000 They're the test monkeys.

01:47:11.000 They're the test monkeys for America. 0.94

01:47:14.000 I mean, people in Florida are wild folk.

01:47:17.000 They'll do some wild stuff.

01:47:18.000 Yeah, I... They're out there wrestling alligators. 0.97

01:47:22.000 Yeah, I haven't tracked every state and what every state is doing.

01:47:29.000 I don't track it at that level.

01:47:31.000 I definitely have a...

01:47:32.000 And also, incidentally, I also don't look at I look at deaths because deaths are much less ambiguous.

01:47:40.000 Like testing numbers can go up and down because we test more or less.

01:47:45.000 But deaths are much harder to fudge.

01:47:47.000 So I monitor deaths.

01:47:48.000 I have a sense of how many Americans have died on any given day and the cumulative toll of death.

01:47:53.000 But I don't – and occasionally I'm paying attention to different states.

01:47:57.000 Like earlier, we were talking about the Dakotas.

01:47:58.000 So I haven't paid close attention to Florida and California lately.

01:48:01.000 Well, Florida, the governor had a press conference – this is why I'm bringing this up – where he was bringing up where he had different age groups.

01:48:08.000 He had a chart, and he was showing that we have to protect the most vulnerable, which is people, particularly older folks and obese folks.

01:48:17.000 But he was basically saying, for everyone else, this is not nearly as dangerous.

01:48:21.000 Now, a lot of people got angry at him for this, and they said it was irresponsible, the way he was describing it.

01:48:26.000 But I'm pretty sure they're basically opening up most things.

01:48:32.000 I mean, they have Disney World is open at a limited capacity there, whereas Disneyland in California is completely shut down and has been since March.

01:48:41.000 Yeah, but I have to make a point here about this.

01:48:44.000 And this goes back to our issue of our conversation about risk.

01:48:48.000 So it is the case that most young people, if infected with this disease, face a very small risk of death.

01:48:54.000 You know, let's say if you're in your 20s, you have like 1 in 3,000 chance of dying if you get infected.

01:49:00.000 On average, if you're sick or you have some other condition or whatever, okay, you're higher.

01:49:05.000 But the truth of the matter is that young people face a low risk of death of all causes.

01:49:09.000 Like I have kids in their 20s.

01:49:11.000 I wouldn't want my kids to get sick.

01:49:13.000 If they did get sick, I would take some solace in the fact that this particular pathogen seems to spare the young.

01:49:19.000 It needn't have been this way.

01:49:21.000 Other pathogens kill the young and spare the old.

01:49:24.000 Like Spanish flu.

01:49:25.000 Yeah, like that's not the case here.

01:49:27.000 So I do take as a parent some solace in the fact that my kids, if sick, would be very likely to survive.

01:49:34.000 But I would not say, oh, never mind if you get sick.

01:49:37.000 That's not true.

01:49:38.000 Their risk of death is very low from all causes.

01:49:41.000 So why you would willingly accept an extra cause of death Especially one that doesn't offer any benefits.

01:49:47.000 It's not like you're driving a race car and risking death, but you're having fun driving the race car.

01:49:54.000 Well, I think Florida's explanation for that would be that they want to open up their economy because they think there's a danger in closing the economy that is not discussed as often as the danger, like in terms of the risk to human life,

01:50:09.000 suicide, drug addiction.

01:50:11.000 There's a lot of factors in a depressed economy.

01:50:15.000 Yeah, and poverty is deadly.

01:50:17.000 I mean, people losing their job, 100%.

01:50:19.000 I totally agree.

01:50:20.000 And this is why, going back, I think the first thing we have to do is we have to tell the difference between what part of the economic damage is just due to the virus— And what part is something we can do, you know, like we're doing to ourselves so we can affect it?

01:50:35.000 Because remember, people are going to stop going out and shopping just because they know there's a deadly virus out.

01:50:41.000 So let's say for the sake of argument, 50% of the circulation of human beings that is reduced, that is lost, is because people themselves are making these decisions.

01:50:49.000 So the economy is going to tank just because people don't want to shop anymore.

01:50:52.000 And that's been happening for hundreds of years with epidemics.

01:50:57.000 So there's that part.

01:50:58.000 Then there's the next part, which is things that we're doing by, you know, banning gatherings or closing restaurants or whatever.

01:51:04.000 And then now, if we're going to decide whether to do that or not, your argument begins to have traction.

01:51:10.000 Because you can say, look, when we close down that part of the economy, we're contributing to poverty and suicide and drug use and depression and all these other adverse effects.

01:51:20.000 And then we have to engage in the very difficult and transparent as a society that We're good to go.

01:51:57.000 Because we are not closing the economy due to COVID. Whereas if we had closed the economy, we would have saved those lives, but we would have lost some other number of lives.

01:52:06.000 And here is what I'm doing.

01:52:07.000 Furthermore, dear Floridians, because we're not slowing the spread of the virus, some of you will get sick, will go to your local hospitals, and will be turned away to die because our beds are full capacity.

01:52:22.000 And I'm making that decision that we're going to take those deaths and we're going to take that awful outcome of people being turned away at the hospital door.

01:52:29.000 And we're doing that because we want to avoid these other deaths.

01:52:32.000 That would at least be honest.

01:52:34.000 And, you know, I would respect that.

01:52:36.000 But I don't see that that's what's happening.

01:52:38.000 I don't think that deep thought is going into it.

01:52:41.000 I don't think serious calculation is going into it, and I certainly don't see governors saying we're going to keep our economy open, but the price of that will be these deaths, and when XYZ happens in a week or in a month, I told you so.

01:52:55.000 That I don't see happening.

01:52:57.000 Well, that's political suicide.

01:52:58.000 We can have our cake and eat it too.

01:53:00.000 That is kind of political suicide, right?

01:53:02.000 To say that, to say we're calculating that a lot of you are going to die because of this decision, but the economy is going to do better.

01:53:10.000 No, we're going to say fewer of you will die.

01:53:14.000 Yes, you could do that.

01:53:15.000 Or you might even do the calculation and say, look, actually, we've done the calculation and we would lose 40,000 people due to the economy being tanked versus 30,000 lives due to COVID. And so I had to make the difficult decision as your governor to not issue these stay-at-home orders because this will result in saving lives.

01:53:39.000 Or not.

01:53:40.000 Say, actually, if I issued stay-at-home orders, we would prevent 30,000 COVID deaths And if I don't issue stay-at-home orders, we would pay those 30,000 deaths from COVID, but we would have 20,000 deaths from the economy.

01:53:56.000 I'm mixing it all up now because I'm moving too fast, and I hope listeners get the gist of it.

01:54:01.000 The point is that there are lives on both sides of the ledger, and if you tally up those lives and you decide this is what you're going to do when you're honest with people, I have less of a problem with that.

01:54:11.000 Now Nicholas, if I gave you a magic wand and I said, you're the king of the world, tell me what to do.

01:54:17.000 If you could be the person, you've studied this obviously very deeply to write this book, probably more deeply than most, what do you think should be done?

01:54:28.000 What step-by-step strategy to both preserve the economy and preserve the maximum amount of people's health?

01:54:34.000 I don't think we can fully preserve the economy and I don't think we can prevent all deaths.

01:54:38.000 So we have to accept that both are going to suffer.

01:54:41.000 I think we can do better as a nation by jiggling and jostling to implement a variety of slices of Swiss cheese that we discussed earlier, that if we collectively implement, mean we can Protect more businesses and protect our schools so our kids can go to school.

01:55:01.000 I'm not saying that it's 100% sure that we can do that.

01:55:03.000 We might still have to close schools and close businesses.

01:55:06.000 But if we did more testing, more masking, more physical distancing, if we limited gatherings, if we had better messaging so people said, you know what?

01:55:16.000 If I don't have Thanksgiving gatherings, then I can keep the businesses open and I can keep the schools open.

01:55:22.000 So I think it's just immature to think that we could just go about life as it was before because our world has changed.

01:55:28.000 It's just not the same.

01:55:29.000 We have to accept this, at least for a while.

01:55:32.000 If we do those things, and we have better messaging from our leaders, I think we will emerge from this pandemic, as we will inevitably in a couple of years, because plagues always end, we are going to see the other side of this,

01:55:49.000 we will emerge with it relatively more unscathed.

01:55:53.000 That is to say, with fewer deaths from the disease and less damage to our economy.

01:55:58.000 But there's no way, unfortunately, to fully avoid Death and destruction.

01:56:04.000 Of course.

01:56:04.000 There's no way to avoid that.

01:56:06.000 We're in it, right?

01:56:07.000 But would you institute a nationwide mask mandate?

01:56:12.000 I don't think legally that's allowed, but I think if the nation were able to do that, I think we would greatly reduce the transmission of this germ.

01:56:20.000 We would save lives and minimize the other hardships that we had to implement.

01:56:24.000 Yes, I think masks is the simplest thing.

01:56:26.000 I mean, look, I can just put on this mask And if I do that thing and we all do that thing, we don't have to do other more difficult things.

01:56:38.000 Why wouldn't we?

01:56:39.000 It's the simplest thing you can do is to put on a mask.

01:56:41.000 And the second simplest thing you can do is minimize your social interactions.

01:56:45.000 These are much easier and your distance that you keep from other people.

01:56:49.000 For example, in my household, we try to make a shopping list and we go out shopping once a week instead of twice a week.

01:56:56.000 I mean, we're having our social interactions.

01:56:58.000 We're thinning out the crowds at the grocery store.

01:57:01.000 We still buy the same amount of groceries.

01:57:03.000 We're just not buying it.

01:57:04.000 We're not having as many crowds.

01:57:07.000 There are many common sense, basic things that we can do as a nation, which if we did, would actually allow our grocery stores and restaurants and other places to I mean, that's what I would recommend.

01:57:18.000 Yes.

01:57:35.000 And it's such a massive machine that to take out a giant chunk of it due to the pandemic, to have all these businesses go under, to have all these apartments that are available for lease, all these businesses available for lease,

01:57:51.000 I don't see any strategy on the table to bring that back.

01:57:56.000 I don't see that being discussed.

01:57:58.000 Is this something you considered when you wrote the book?

01:58:01.000 Yeah.

01:58:01.000 No, I think those will come back.

01:58:03.000 I mean, I think...

01:58:04.000 First of all, we're seeing an exodus from cities to rural parts of the country that has been seen with every plague for thousands of years.

01:58:14.000 There's nothing surprising about the fact that in times of plague, people flee the cities.

01:58:18.000 But the cities always come back.

01:58:20.000 So I have no doubt.

01:58:21.000 If I were a very rich person, I would be buying Manhattan real estate in a year or two.

01:58:31.000 Not now, though?

01:58:33.000 What?

01:58:33.000 Not now?

01:58:34.000 In a year or two?

01:58:35.000 Well, I think it's still going to go down for a while, right?

01:58:38.000 I mean, people are still leaving the cities and it takes a while for the market to clear.

01:58:41.000 I'm no expert on Manhattan real estate.

01:58:43.000 I made up that example.

01:58:44.000 I'm not exactly sure.

01:58:45.000 I'm not giving this.

01:58:46.000 But the gist is, clearly, our economy is reshaping and people are moving to more rural parts.

01:58:54.000 Anecdotally, we see rising house prices rising.

01:58:57.000 In rural parts and in suburbs.

01:58:58.000 Also, with the working from home, people are beginning to realize, you know, I can do my job from home.

01:59:04.000 Why should I be in a two-bedroom apartment in Philadelphia when I can just as soon live on a big farm in rural Pennsylvania and do my job from a distance and I'll get much more space for myself and my family and so on.

01:59:16.000 So I think we're seeing that.

01:59:20.000 But I do think the cities will come back because the intrinsic appeal of cities is so great.

01:59:40.000 I don't have them handy right now, but like 30 million Americans have lost their jobs.

01:59:45.000 I mean, many people are unemployed.

01:59:47.000 Let alone the loss of life.

01:59:49.000 And as I said, we're not through with this yet.

01:59:51.000 So I think this is a big shock.

01:59:55.000 The airline industry, the hospitality industry.

01:59:58.000 You think Boeing is selling a lot of planes right now?

02:00:01.000 The travel industry.

02:00:03.000 And incidentally, the travel industry is going to take a while to recover because now all of us have realized that, hey, I don't have to fly.

02:00:10.000 I think doing business face-to-face is not going to stop.

02:00:13.000 I think there's something I hope the next time you have me on the show, I'll come down to Austin and we'll see each other, have a drink.

02:00:22.000 It'll be a totally nicer experience, although this is great as far as I'm concerned.

02:00:26.000 But anyway, many, many cases on the margin, people will say, why should I fly across the country to sign this contract or have a routine meeting?

02:00:38.000 Skip it.

02:00:38.000 We'll just do it by Zoom.

02:00:40.000 So I think that's going to be persistent and that's going to have an effect on our economy.

02:00:43.000 I do think there's a benefit in that.

02:00:48.000 I think there's gonna be a change in women in sort of gender, some of the gender dynamics. 1.00

02:00:53.000 Because, so if you look at the typical, like the stereotypical heterosexual couple in this country.

02:01:02.000 So there are, of course, homosexual couples. 0.96

02:01:04.000 There are single family, single head of household families, single moms, single dads, much less common, raising their children.

02:01:12.000 But most households are heterosexual couples.

02:01:16.000 And furthermore, it's stereotypic, still, typical, that men earn more than women in the labor market.

02:01:23.000 Not always the case.

02:01:24.000 So not all households are heterosexual.

02:01:25.000 Not all households does the man earn more than women.

02:01:27.000 But the predominant, the modal, as we say, pattern is still that in our society.

02:01:32.000 So when the market, when the economy is tanking, as it is, and schools are closing, many families sit around the kitchen table and they're deciding how to cope.

02:01:44.000 And they say, well, the man is making more money.

02:01:47.000 He should remain in the labor market.

02:01:50.000 And someone needs to watch the kids.

02:01:51.000 So the woman is going to quit her, let's say, job that wasn't paying as much as the husband. 1.00

02:01:55.000 And anyway, women might have, on average, a preference for being with their kids compared to men. 0.83

02:02:00.000 And we should absolutely allow individual households and families to make their own decisions about how to manage their own lives.

02:02:06.000 But when millions of families reach similar decisions...

02:02:11.000 We might find that the labor market gains that women have made over the last 10 or 20 years might have been reversed by this pandemic. 0.78

02:02:19.000 That is to say, a few years from now, when we look at the labor force participation of women, we might see a changed landscape as a result of this virus. 0.99

02:02:28.000 So there are all kinds of things that will persist.

02:02:33.000 You know, that the world will have changed in some ways.

02:02:36.000 So working from home, women's labor market participation, the travel industry, schooling, you know, colleges, for example. 0.99

02:02:44.000 A lot of colleges now have gone to develop the infrastructure and the bureaucracy for online learning.

02:02:51.000 And some colleges will say, you know, we can actually offer an online degree much more easily.

02:02:56.000 We were forced to do it.

02:02:59.000 Healthcare, insurance companies.

02:03:00.000 Insurance companies used to not pay for, you know, why did you have to go to your doctor to get a prescription refill? 0.92

02:03:06.000 This is ridiculous. 1.00

02:03:07.000 It's just stupid. 1.00

02:03:08.000 Well, now, you know, everyone moved. 1.00

02:03:10.000 People didn't want, doctors didn't want to see patients for such silly things.

02:03:14.000 And we didn't want patients coming to hospitals and getting infected or infecting others.

02:03:18.000 So we made an exception and we said, oh, you can, doctors can refill prescriptions without physically seeing the patient.

02:03:25.000 You think that's gonna come back?

02:03:26.000 I mean, people are gonna, you know, for two years, they will have been easily getting the prescription refilled, and now?

02:03:31.000 No.

02:03:31.000 So there are gonna be persistent changes in our society from all of these things.

02:03:36.000 One of the things that disturbs me is that the stimulus package, that check that people got, the $1,200 check, was one check, and it never repeated, and that was it.

02:03:47.000 It was crazy.

02:03:49.000 It didn't make any sense.

02:03:51.000 I can't imagine they thought that it really helped people, especially over the long term.

02:03:57.000 What...

02:04:04.000 Yes, I think.

02:04:26.000 Is why health insurance is tied to your employment in this country.

02:04:32.000 And it makes no sense, right?

02:04:34.000 I mean, I don't want, if you lose your job and you can't get healthcare for a contagious disease, you're gonna be out and about spreading this contagious disease.

02:04:45.000 Or why we don't have sick leave policy for hourly workers.

02:04:48.000 That also doesn't make sense.

02:04:50.000 In other words, many hourly workers kept going to work when they were sick, spreading the virus.

02:04:55.000 This doesn't make any sense.

02:04:56.000 We don't want that.

02:04:57.000 So I think there are going to be changes in how we couple insurance to employment and sick leave policies because having a contagious disease illustrates some of the demerits in the existing system.

02:05:09.000 Now, same goes with universal basic income.

02:05:12.000 Now, I'm not an expert in this area, but I think that the way the government handled, the way it just pumped out money, and I think there was also some corruption and, like, Who got the money?

02:05:23.000 I didn't track all this in detail.

02:05:25.000 You may know this more than I do.

02:05:28.000 I think we're going to have to rethink that.

02:05:30.000 And I don't think we're done, unfortunately, with restructuring and rethinking the unemployment benefits.

02:05:37.000 I do think we're going to have to do more to provide for people because all of that stuff is about to end.

02:05:43.000 And I think there's going to be a wave of mortgage foreclosures and other financial hardships that people are going to experience.

02:05:52.000 Yeah.

02:05:52.000 No, I agree with you.

02:05:54.000 Listen, Nicholas, next time we do this, I do hope we do it in person.

02:05:57.000 But please tell people – do you have a copy of your book so you can hold it up?

02:06:01.000 I do have a copy of the book.

02:06:03.000 Hold on.

02:06:04.000 I put on – I had a – it has this nice cover.

02:06:08.000 The mask.

02:06:08.000 Yeah, I put on the mask because this was swag that my publisher sent me, which I thought was really cool swag.

02:06:14.000 So I have a limited of five of those masks that I'm going to wear.

02:06:18.000 What is the name?

02:06:19.000 Apollo's arrow it comes from.

02:06:21.000 It's a nice thing to finish on.

02:06:24.000 Hold it up again so I can see the spelling of it.

02:06:29.000 Apollo's arrow.

02:06:30.000 Okay.

02:06:31.000 Yes.

02:06:31.000 And it comes from a story at the beginning of the Iliad.

02:06:34.000 So the Greeks, this was events 3,000 years ago.

02:06:37.000 So the Iliad, which is a Homer story about the Trojan War, describes events that took place 3,000 years ago.

02:06:45.000 And the book begins with a plague.

02:06:47.000 What happened is the Greeks were laying siege to Troy and they were periodically going on raids and sacking vassal states of Troy.

02:06:56.000 And they would kill all the men, take all the treasure and enslave the women and children and bring them back to their camps and divide up the booty. 0.74

02:07:05.000 So they had sacked a nearby city and there was a maiden girl by the name of Chryseus who was given to Agamemnon, the principal king of the Greeks, as his prize.

02:07:16.000 And Chryseus' father, Chryses, was a priest of Apollo.

02:07:21.000 Apollo was the ancient Greek god of healing and also of illness and disease.

02:07:27.000 Chrises comes to the Greek camp to ransom his daughter.

02:07:30.000 He brings a big treasure and he goes to Agamemnon's tent, the king of all the Greeks, and he falls on his knees and he begs him.

02:07:37.000 He says, please release my daughter.

02:07:39.000 And not only does Agamemnon say he will not release the daughter, but he treats this man extremely rudely in front of the Greek army.

02:07:47.000 He treats this priest, this important priest.

02:07:49.000 And he says, away with you.

02:07:51.000 Not only will I not give you my daughter, but she will grow old in my house, in my bed, basically working as a slave for me. 1.00

02:07:59.000 And if I see you lingering around the ships, I will kill you. 1.00

02:08:03.000 And he just smacks the man and sends him away. 0.99

02:08:07.000 So the priest goes back down to the shore and he says a prayer.

02:08:11.000 He says to Apollo, if I have ever served you, if I have ever given you sacrifices that have honored you, hear me now and come and punish the Greeks. 1.00

02:08:19.000 And the prayer instantly goes to Mount Olympus and Apollo hears him.

02:08:23.000 And Apollo is enraged and he picks up his big, I know you like archery, he was also the god of archery, picks up his big silver bow.

02:08:31.000 And he comes flying through the air down among the ships that were encircling, you know, on the beachhead, encircling Troy.

02:08:39.000 And he crouches among the ships.

02:08:41.000 And the ancient Greeks thought of diseases as Apollo's arrows.

02:08:45.000 You know, invisible.

02:08:46.000 You were just stricken by an invisible arrow.

02:08:48.000 And he crouches among the ships.

02:08:50.000 And the book goes, the story goes...

02:08:56.000 We're good to go.

02:09:20.000 We're good to go.

02:09:42.000 But his pride was so wounded that he then set into motion Other events that ultimately led the last year of the war on Troy.

02:09:54.000 Well, that makes a lot more sense because I was wondering.

02:09:57.000 I thought it was one word.

02:09:58.000 Apollo Zero.

02:10:00.000 That's what I thought you were saying.

02:10:01.000 So I was like, how is that spelled?

02:10:03.000 So there we see.

02:10:04.000 We see the book now.

02:10:05.000 It's on the screen.

02:10:06.000 Nicholas, thank you very much.

02:10:08.000 Good luck with the sales of your book.

02:10:09.000 Thank you very much for writing it.

02:10:10.000 Thank you very much for having such a reasonable and objective perspective on this.

02:10:14.000 And I really appreciate you very much.

02:10:17.000 Joe, thank you for everything you do, and thank you for having me back, and I look forward to doing this in person in Austin in a year.

02:10:23.000 Absolutely.

02:10:24.000 Thank you.

02:10:24.000 Take care.

02:10:25.000 Bye-bye.

The Joe Rogan Experience - November 18, 2020

Joe Rogan Experience #1566 - Nicholas Christakis

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