Call Me Back - with Dan Senor - IS THIS THE END OF C-19’s BEGINNING? - with Yale University’s Nicholas Christakis

Episode Date: October 22, 2021

In the middle of the pandemic, Dr. Nicholas Christakis released a sweeping book, called “Apollo’s Arrow: The Profound and Enduring Impact of Coronavirus on the Way We Live”. In it, he drew on scientific, medical, and sociological research, and assessed the transmission of the virus, responses worldwide, and prognosis for the pandemic’s end, including some bold predictions. The paperback edition is just out with some new material.

It is in the intrinsic nature of a contagious disease that it is a collective threat. It is not a threat that individuals acting alone or even a group of individuals acting independently can effectively confront. It's like an invading army. You don't confront an invading army by grabbing your gun and going to the frontier. It's not very effective. Welcome to Post-Corona, where we try to understand COVID-19's lasting impact on the economy, culture, and geopolitics. I'm Dan Senor. During the early phase of COVID-19, one public intellectual and health professional who I checked in with from time to time was Dr. Nicholas Christakis. And then in the middle of the pandemic, Nicholas released an extraordinary

and sweeping book called Apollo's Arrow, the profound and enduring impact of coronavirus on the way we live. His thinking was a constant narrator for me over the past 18 months. His book is an authoritative analysis of the COVID-19 pandemic from its beginning to its hoped-for end. In the book, he draws on scientific, medical, sociological research, and he basically assesses the transmission of the virus, the responses worldwide, and then the prognosis for the pandemic's end. And he includes some pretty bold predictions, some of which we'll talk about today. And then in addition, if you're a history buff, Nicholas places COVID-19 in the context of past pandemics. The plague in ancient

Athens, the Black Death in medieval Europe, polio epidemics in 1916 and in the 1950s, obviously the great influenza, the Spanish flu of 1918, and then HIV in the 1980s. Really, it's a sweeping history, and the paperback edition is just out, like this week, with some new material, fresh analysis, so I encourage our listeners to go to Barnes & Noble and order a copy. I've been wanting to have Nicholas on our podcast for some time, but thought now was the ideal time, as we transition this podcast and we truly may be entering a post-corona world. Now, to be clear, Nicholas isn't as beat on that front as I am. He still thinks we are only at the end of the beginning, but we'll get into all of that with him when we talk. This episode and next week's episode comprise a two-part closing of the Post-Corona Podcast

in which we delve into some of the core issues we've talked about in this series. And before we transition to our new series, in which we'll be focusing more broadly on these Revenant 2020s. So for the two-parter, today we have Nicholas Christakis, and the next week we'll have Scott Gottlieb, a past guest. With each of them, we'll focus on different areas, but there'll be some common threads that run through the conversations. As for Nicholas, he's a physician and sociologist. He directs the Human Nature Lab at Yale University, where he's the Sterling Professor of Social and Naturalologist. He directs the Human Nature Lab at Yale University, where he's the Sterling Professor of Social and Natural Science, and he's the co-director of the Yale Institute for Network Science and the co-author of the book Connected and the author of the book Blueprint. Are we at

the end of the beginning? This is Post-Corona. And I'm pleased to welcome Nicholas Christakis to the Post-Corona Conversation. Hi, Nicholas. Hi, Dan. How are you? I'm good. Where do I find you? This particular moment, you find me in Vermont, up in the woods, in the backcountry. Vermont, which has had a very successful vaccination campaign. If it were a nation, it would be on the top of the league tables up there with Portugal or something. Yes. Very few cases, very high rates of vaccination. Good old little Vermont. The little engine that could. Okay. So I want to jump right off with something you say in your book, I think specifically in the new preface to the new paperback edition, which is just out this week, where you basically seem to paraphrase Churchill,

where you say, you know, we're not at the end, I guess we're not even at the beginning of the end, but you basically say we're at the end of the beginning of this pandemic. So if we're historians looking back at this pandemic 10 years from now or 20 years from now, if you were sort of writing the Apollo's Arrow version decades from now, looking back at this period, where would you write that we are in this trajectory right now? Like, how should we think about it? Well, I do think we're at the end of the beginning, even now, in October of 2021. I don't think we are at the beginning of the end, no. The way I like to think about these types of plagues

and the subclass of them, which are the respiratory pandemics, which is what we're experiencing, is that they have three phases. There is the initial phase, the intermediate phase, and the post-pandemic phase. And the initial phase, which is going to last until 2022 approximately, is when we're feeling the biological and epidemiological impact of the virus. What's happening is that the virus is like any other living thing, and there's

a little debate about whether viruses are living things, but all intents and purposes, it's acting like other living things. It's like an invasive species. It's like we've released rats on an isolated Pacific island, and our bodies are the island to the virus, which is the rats. And it's just going to spread and spread and spread among us, because we have no material natural immunity to this disease, until it has basically infected everyone on the planet. Almost everyone on the planet, 90% or more, will either be infected by the virus or will be vaccinated. And we are still at that sort of opening act of the virus, which is going to last at least in the United States and other rich countries until in 2022. Keep in mind,

the whole world has to go through these phases. But anyway, the initial phase is when you feel the epidemiological and biological impact of the virus. And then like a tsunami that has washed ashore and devastated the countryside, eventually the waters recede. But now we have to clean up the mess, right? There's going to be an enormous devastation caused by this virus. And we're beginning to see some of those things, the supply chain problems, the children having missed school problems, the recapitalizing our businesses problems, and so on. So we're going to have to cope in the intermediate phase with the clinical, psychological, social, and economic aftershocks of the virus. For example, just clinically, to pick one small example, probably five times as many people as die of

the virus will have some kind of long-term disability. I'm not talking about long or short COVID. You've recovered from your infection, but now your body has been damaged. You didn't die, but your body's been damaged. You have kidney problems or pulmonary fibrosis or cardiac problems or pancreatic problems or neurological or psychiatric deficits as a result of having been infected. And if up to a million Americans die of the condition, that means we'll have 5 million Americans who will be clinically harmed. And they're going to need our attention in the post-pandemic period, in the intermediate period. So during the intermediate phase, which I think will last until 2023, 2024, we're going to be cleaning up the mess.

We're going to have to be addressing and catching up with all of these impacts in our society. And then come 2024, approximately, we're going to enter the post-pandemic phase. And I think that's going to be a little bit like the roaring 20s of the 21st century compared to the roaring 20s of the 20th century. I think it's going to be a little bit of a party. You know, like when the war ends or the famine ends, people go into the streets and rejoice. And when the pandemic ends, I think we're going to see that. I think people will have been cooped up.

We're already beginning to see some people, you know, now that the vaccination rates are rising, we're beginning to see some of this behavior already, or this past summer we did. People have been cooped up. And I think when the pandemic is finally behind us, I think they're going to relentlessly seek out social interactions in nightclubs and restaurants and sporting events and political rallies and musical concerts. We might see some sexual licentiousness and some loosening of social mores. People have been constrained all this time. My sister says

whenever I mention this, she says, you need to be very careful, Nicholas, to clarify that this prediction only applies to unmarried couples, not also to married couples. But anyway, but I think nevertheless, I think people will want and crave social interaction. During times of plague, people save their money, and they have for hundreds of years. We have records. They're abstemious. They're risk-averse. Death is in the streets. We see that with the rising savings rates in this pandemic. And I think when it finally is over, people will relentlessly spend their money. And I think we'll have an economic boom. We might see an efflorescence of the arts and so on. So I think there are three phases. The immediate phase, which we're just approaching.

Tourism and travel boom? Yes, for sure. I think that'll happen. Although I think there'll be, I think there are three phases. The immediate phase, which we're just approaching. Tourism and travel boom? Yes, for sure. I think that'll happen. Although I think there'll be, I think the hospitality industry is going to be a little bit transformed with some persistent changes for the intermediate term. But so that's how I think about it. Is the immediate phase, which is going to end sometime in 2022, when we reach this herd immunity threshold, when finally enough people have either been infected or been vaccinated, then with the intermediate phase and the post-pandemic phase. And then I'll say one more thing and I'll shut up. I think a lot depends. This all presupposes we do not have the emergence of new, more worrisome strains of the virus, specifically ones that are either much

more deadly or ones that, the worst of all for us would be ones that evade the vaccine and i think the probability of the emergence we can talk about this if you're interested of a strain which evades the vaccine is probably between one and ten percent fully evaded so so so let's spend a minute on that because if that happens we get a strain that evades the vaccine we're back to square one uh And then we're going to have to square one is what square one is is spring of 2020. Yeah, I think it's gathering bands and, you know, alarm rising death rates and so on. And I think we'll be sort of back to taking extreme measures until the pharmaceutical companies invent boosters specifically for the new strains, which I think, amazingly,

we have the technological capability to do now. But that's what's going to be required if we have the emergence of strains that evade the current, substantially evade the current vaccines. We know that some of the strains trivially evade the current vaccines, but not enough to cause us grave concern. And part of the reason for this is that these vaccines that we've invented, the mRNA vaccines and the adenovirus vaccines, offer a kind of superhuman immunity.

They're exceptionally good. And so we can afford to take a little bit of a hit on them and still have an effective vaccine. In terms of the long-term negative health consequences, not long-form COVID, but just other health consequences that we may not have fully anticipated, calculated, forecasted, what about the fact that during the pandemic, a lot of people just didn't do their basic non-COVID-related health care maintenance, checkups, screenings for cancer, cholesterol checks,

any kind of basic diagnostic maintenance that serves as an early marker for the onset of disease. It seems, I just noticed anecdotally, a lot of people have just punted on those kinds of routine checkups. And I wonder if that's going to come back to bite us. And we're going to learn that later on. For sure, that's likely to happen. Also, other kinds of implications, as we fill our hospitals with COVID cases, we lose the ability to take good care of people with non-COVID diseases because we don't have beds for them or the medical staff are harried or so many nurses have retired because they were approaching retirement anyway, and they just couldn't

take it anymore. So yes, this is why, by the way, because pandemics can have such complex roots by which they degrade health, for example, by directly infecting you and killing you or harming you, or by indirectly harming you in the way that you just outlined or incidentally by helping you. For example, in the opening phases of the epidemic, we had a reduction in motor vehicle accidents. So those are benefits to the pandemic. Or we had a reduction in so-called iatrogenic illnesses, fewer doctor-induced deaths. About 100,000 people every year in the United States die from medical errors. And when you reduce medical care, you reduce medical errors. Those are savings in terms of lives. So this is why, in fact, ever since William Farr invented it in the middle of the 19th century,

we've had this notion of computing the impact of epidemics using the metric of excess deaths. In other words, we could count how many people got COVID with tests or diagnostic criteria and then count how many of them died and tally them up. And as you may be aware, there's been a lot of debate about how to do this methodologically. And other people have gotten in on the argument and said, well, some of those people would have died anyway of other stuff. How are we really going to ascribe them to a COVID death? By the way, I think that's a stupid argument. But people are making some arguments like that. Well, you can skirt all of that by just simply saying, look, in the United States every year, about 2 million people die. And this year, 3 million people died. And we're

going to declare that that excess million people is caused by the pandemic. In total, some lives were saved by the pandemic. Some lives were lost directly due to the pandemic. Some lives were lost indirectly due to the pandemic. The total mortality burden, therefore, is X that we can calculate. And this method was introduced, as I said, by William Farr in the middle of the 19th century, in part because in those days, remember, they didn't have very good nosologies. They didn't have good ways of diagnosing diseases. And the vital statistics were often a bit sloppy, but they could count deaths, you know? And so you just say, well, a lot more people died this year than last, and it was due to the pandemic.

You wrote in your book, and I'm going to quote you here, this is in the paperback edition, while the way we have come to live in the time of the COVID-19 pandemic might feel alien and unnatural, it is actually neither of those things. Plagues are a feature of the human experience. What happened in 2020 was not new to our species. It was just new to us. It was a reminder that despite all of our technology, we are still biologically vulnerable. Now, I guess I have two questions in response to that. One is, you're basically, you're going back,

because you do in your book, you go back hundreds of years. I mean, you look back at plagues like in Athens in the, you know, centuries ago, you go back to all the way up to the Spanish flu, obviously, in the 20th century. So you're basically saying not much has changed. This is normal. But I feel like a lot has changed. Our economies are more advanced. Technology is more advanced.

Life sciences are more advanced. Like, everything is more advanced. And you seem to be saying, yes, but as far as plagues are concerned, nothing is new. Yes, but our bodies and our psychology is not more advanced. If you look around, our predilection to believing charlatans and lies is the same as it ever was. During every plague, there's an emergence of quack doctors and superstitions. There's one story I tell in the book, I forgot which episode of the bubonic plague it was, where then a living observer said that the rumors spread in the city that if you threw pots from the second story window, it would ward off the plague. So much so that it became dangerous to walk through the streets of the city for fear of being hit by a pot coming out of the window of someone's house. You know, this type of superstition, we saw it again.

People, you know, even the president, former president of the United States saying, you know, inject yourself with bleach or irradiate yourself with ultraviolet rays or all of this stuff, which was just false. Or take hydroxychloroquine, for which there was no evidence that it worked when he was promoting it. In fact, there was evidence that it was harmful. So this is a very typical behavior. Another typical behavior is the blame, blaming of others. During the bubonic plague, you know, it was anti-Semitism. The Jews were to blame. Thousands of Jews were put to death, buried alive or burnt at the stake, being blamed for the plague. Or during HIV, let's not forget, another major pandemic that has stricken during our lifetime. Gays were blamed or Haitians were blamed or IV drug users were blamed. And now during this

plague, Asians are blamed or migrants are blamed. Always we want to blame someone else. That's typical. That hasn't changed. Our psychology hasn't changed. So there's so many features of our response. You see our features of us. Now, you're right, the technological environment has changed, our urbanicity has changed, the fraction of people living in cities, there's so much has changed, but there's so much that hasn't changed. And our bodies haven't changed. We have the same soft on the outside bodies we ever have. We are prone to death from infection, unfortunately. Incidentally, this particular pathogen is sort of a plague light. It's nothing compared to bubonic plague or smallpox or cholera or even influenza, right?

The great influenza of 1918. This plague only kills about 1% of the people that it infects, on average. And it's barely touched children. It sometimes feels like divine intervention that children have been so underrepresented in the fatalities. Yes, it's haunting to the point of moving to the point of haunting that spares the kids. Now, incidentally, one of the worrisome things that could happen to us, and there is some evidence with the Delta variant and with other more recent variants, that the age profile, the age mortality profile is shifting so that kids are a little bit more vulnerable. But yes, that's exactly right. So the point is, though, that if anything, we're having sort of plague light.

We are not having a plague that our ancestors faced, which would devastate. Like when the settlers came to the New World, Native American populations were decimated. There are case studies of 95% of the people in an area dying in the space of six or 12 months. You can't even imagine that kind of annihilation. Or in the bubonic plague, certain cities, same level of mortality, wiped out. 50% of the people in the city dying in a few months. Bodies everywhere. The saying that not enough of the living were left to bury the dead. So we are not facing that, thank goodness. But the point is that our bodies are susceptible to these things, and our bodies are the same bodies we've had for thousands of years. So these are the things that have not changed,

which allow us to understand the human response and the social response to these pandemics. I'll also say that while it is the case that we can form a corpus of plagues of diverse sorts, which stretched back thousands of years, at least till the time we invented cities, it's a little bit ambiguous when we were still hunter-gatherers, were there plagues? I don't think we had the population density and the lifestyle that necessarily supported that. But with the agricultural revolution, and then first with the domestication of crops and animals and then with the invention of cities around 8,000 years ago or so, we set ourselves up for the types of epidemics we're facing. And we have records going back certainly 2,500 years or almost 30 more, I would say. For example,

the Iliad, this canonical work of Western fiction, 3,500 years, accounts events from the Bronze Age, begins with a plague. Plagues are not new to our species. They're just new to us. They're in the Bible. They're in the Iliad. They're in Shakespeare. They're in Cervantes.

Our religions and our literatures try to warn us about this human experience because our ancestors endured it. So that you can form a corpus of plagues of diverse sorts and diverse severities going back hundreds or thousands of years. respiratory pandemics of the last 300 years for which we have decent records, or especially the last 100 years, everything that is happening to us has been experienced by humans before. So you're right. We live in a different world in many ways, but in many fundamental ways, our world is unchanged. And that's why we are having the same experience that our ancestors did. So you quote in your book, the elite science journal science from a piece in May of 1919 by, uh, by, uh, I think an epidemiologist or an engineer named George Soper, who noted three main factors stand in the way of prevention of a pandemic. So this is the midst of the Spanish flu of 1918, 1919 that he wrote this. And one of the features of the Spanish flu that he writes about that you quote is, quote, the personal character of the measures which must be employed. It does not lie in human nature for a man who thinks he is only a slight cold to shut

himself up in rigid isolation as a means of protecting others. Now, we often hear punditry, heated, histrionic punditry today saying, you know, one of the things that has hurt us so much during this pandemic is we're a much more fiercely selfish, self-absorbed, less kind of communal-minded society, and that's dooming us. We don't think about the fellow man, we just think about ourselves, and that's what leads to such reckless behavior. And you quote a journal article here that basically says it was the same thing 100 years ago, that it wasn't intuitive for anyone to think, for the sake of the health of my society, I've got to hunker down. That's right. I mean, I think that

I do think that we lack a sufficient commitment to our neighbors right now to cope optimally with a pandemic. I think that the politicization of this pandemic in the United States has harmed us. We live in a plural democracy. I like the fact that there's variation in political beliefs in our society. I have friends across the political spectrum, and I love debating them, and I recognize that they're different. I believe that most people wish to have a better society, and the disagreement is how to achieve that objective, and we need to argue about that. And we resolve our disputes in our society by voting.

And so it is fine to have disparate beliefs. But the problem has been that people have come to signal their beliefs, not just by bumper stickers, which is what we should be doing, but by whether they choose to get vaccinated, which is dumb. There is no reason to choose vaccination status as a signal of your political identity. And other countries didn't do that. Other countries saw vaccination for what it is, which is a technocratic, technological intervention to save lives. And everyone right and left got vaccinated and they signaled their political identity by other means. But we in our society, unfortunately, have come to politicize these very basic public health measures like mask wearing and vaccination and see them either on the right as signals of our bravery and independence or on the left on symbols of our virtue and neighborliness. And this is stupid that we have come to politicize them. So now with that

preamble, let me just say that it's true that this politicization and this framing of why should I do anything, it's difficult to compel a person to do something if the motivation is to benefit others. That's a classic right-left dichotomy. And as you point out, there were observers who noted this 100 years ago. But what I would say is that it is in the intrinsic nature of a contagious disease that it is a collective threat. It is not a threat that individuals acting alone or even a group of individuals acting independently can effectively confront. It's like an invading army.

You don't confront an invading army by grabbing your gun and going to the frontier. It's not very effective. Nor if each person hodgepodge runs to the frontier, can you repel an invader easily? You need some organization to fight an invading army. It is a collective threat. And contagious diseases, which spread from person to person, are a collective threat. Your actions affect me. If you choose not to get vaccinated, it's not just your body, you're affecting me. It's like speeding on the highway or secondhand smoke. It's not just you're choosing whether to put smoke in your body,

you're putting smoke in my body. And so for these reasons, which I think are well understood, the state can act to constrain individual liberty, at least in my view, given the nature of the threat and given the so-called externalities. So and the constraint here is actually pretty trivial. You know, in exchange for getting vaccinated or wearing masks or taking other basic precautions, we get to save hundreds of thousands of lives and keep our economy functioning. Whereas the alternative is to allow the germ to spread and willy-nilly and harm us, which is what it's been doing. Do you think that some in the public health community have, and I choose the word some very carefully because I don't want to apply a broad stroke to this. But do you think some of the public health community have created confusion that has allowed some segments of the U.S. population, many experts, I'm quoting here, many experts who had previously opined that schools had to close and that even small funerals were dangerous now seemed willing to overlook the risks of mass gatherings you say most of the protesters wore masks and the protests were outdoors, which is much less risky, but the public health messaging was inconsistent.

Yes. Close quote. Yes. And I hate it. So people weren't allowed to attend their family's funerals or send their kids to schools or go to Trump rallies, but they were allowed to storm the streets and protest after the George Floyd killing. Yes. And I thought that was awfully inconsistent. Let me draw a distinction between scientists and public health experts who in good faith revise their views, which is what we want from scientists, right? It's religion that is ostensibly unchanging. You know, when a scientist says, I used to think this, and now I think this, that's how science works. It's a feature, not a bug. And that's what you want from scientists.

Science said, I told you not to wear masks six months ago, and I told you to wash your surfaces six months ago, because then we thought that fomite transmission, you know, transmission through contact was a potential mechanism for the virus to spread. Now we've done a lot of work and we know that that's not necessary. So remember at the beginning of the pandemic, we were all cleaning our mail and our groceries when we brought them into the house. Now we're not doing that because now we know. I remember we ordered, my wife and I would order pizza and the pizza delivery guy guy delivered and we wiped down the pizza yes exactly exactly now we know that that's actually exactly and now we've done a lot of tons of work and we know that's not really necessary so when a scientist says i used to tell you this and now i tell you that that's how science is

supposed to work you revise your opinions and now i don't think there's enough of an understanding in the public on the part of the citizenry that this is because we unfortunately don't have the level of science education we should in our society. I don't think people fully understand that that is first of all how it works. First point. Second point. However, where we can hold scientists responsible is overconfident statements and a failure to educate the public as to the provisionality of what they're saying. So it's very important when you're confronting a plague to maintain public confidence. In fact, public messaging, public health education is a key pillar of public health preparedness and

public health response. So what I would have done and what I tried to do personally from the beginning is you tell people, here's what I believe. Here's why I believe it. Here's the evidence for my belief. And here's my confidence in what I'm telling you. And then if in two months I revise my opinion, I say, I used to tell you, yes, you're right. I told you that before. But now I'm telling you something different. Here's why I'm telling you something different. And here's my updated estimate of my confidence. I think that doesn't show weakness. That shows strength and builds credibility so that people can – but it requires a willing public, a non-snarky public, a public that's not

willing to be snarky. Now, that's the second point. The third point is unfortunately some scientists did allow themselves to be politicized and as in the example you gave, I thought – personally I thought we're very inconsistent. Just as I outlined in the book as you said, some were very, personally, I thought were very inconsistent. You know, just as I outlined in the book, as you said, you know, we, some scientists went from saying, well, we can't have, you know, we can't have funerals of 10 people, you know, outdoor graveside funerals, but now we can have... Or people can't go play in playgrounds or go to beaches or go to parks. Yes, yes, yes, which is nuts. It's absolutely nuts. Now, to be clear...

At the same time, though, you can storm the streets in high densities. Yes. And so it's inconsistent, right? And we lost, some scientists, I hope not myself, lost some credibility as a result of that. Now, in retrospect, we now know that actually outdoor assemblies are vastly safer. And there have now been a much bigger corpus. And it is, in fact, much safer to be outside. And right now, for example, I think if you're vaccinated and you go to an outdoor gathering, unless it's like a huge rock concert with thousands of people yelling and screaming, I think you're very safe to do that. But the personal weakness or inconsistency of some

scientists is different than the fact that sometimes scientists revise their opinions and is different than that that's what we want. We want scientists, we don't want them to stick to their guns even in the face of new evidence. There's that famous British wit that said, you know, when the facts change, I change my mind. What do you do, sir? No, I stick to my guns even if if the facts change. That's ignorance. Right, right. No, no. So I completely agree. It's one thing to say that we've learned new things, and therefore we have to adjust. The blowback against the confused messaging on summer of 2020 was that these public health officials signed a letter invoking combating racism as a

public health issue as a basis for allowing the- Yeah, so here's how I think that might have been done in a bit more reasonable a fashion. If they had been willing to say, given the then available knowledge, we estimate that these protests that are occurring will result in an extra 5,000 deaths, based on our current calculations. And we furthermore estimate that based on these protests we might have the following policy impact, which will save a hundred thousand lives. And therefore, in the cold-hearted utilitarian calculus that is always public health, we are supporting these protests. But they would have had to do the work, right? They would have had to actually do the homework and defend the position,

I would say, on technocratic grounds, not on abstract moral grounds. I don't think, because imagine if instead of what happened, imagine if the converse was that we had had a boom in cases after those, and hundreds of thousands of extra Americans had died as a result of the protests. We wouldn't even be having this conversation. We would be denouncing that those those irresponsible acts of protesting and in the time of a plague and of abetting it. Now, it didn't turn out that way, but, you know, that happens to be because of the details of how the protests took place and the details we now know about how the virus is transmitted. Okay, so in terms of what's the good news, what is better coming out of this pandemic? Obviously, there's a lot of human catastrophe, but you do write, despite how much of it feels so familiar, you do write, quote, we are the first generation

of humans alive who've been able to confront this ancient threat, meaning pandemics, by formulating a specific and effective countermeasure to a new pathogen in real time and to perhaps materially alter the overall course of a pandemic as it was unfolding. We have developed incredible vaccines at incredible speed, close quote. So on this point, what are the implications of this incredible innovation? And I agree with you, it's extraordinary. The idea that we can develop a vaccine basically through code that's like emailed around between scientists in real time. I mean, it is like science fiction. What are the implications beyond this pandemic?

Well, I you know, your listeners don't know me, but I'm a physician and a social scientist, and I've been teaching public health for years and years. And there are some basic principles in public health, which is that medicine actually makes very little difference in the health of the public. And that the real reason we're living so much longer now than we did hundreds of years ago is, first of all, that we are richer. About a third of the mortality improvements, you know, we've gone, I mean, life expectancy at birth was like 50, 100 years ago, it was like 50, and now it's about 80. So we've gained like 30 years of life expectancy at birth in the last 100 years. And most of that improvement is simply due to rising wealth. About a third of it, we're just richer, we eat better food, we live in safer environments,

and so on. About a third of it is due to public health innovations like hygiene and vaccination and stuff like that and only about a third if that is due to uh medical care like medical inventions and among medical inventions there are actually a very few that have actually made a huge impact uh and you know for example penicillin the discovery of penicillin was an unrepeatable event like a once in human history event like just an extraordinary advance that took conditions that were uniformly fatal pneumococcal pneumonia and made them totally survivable okay I mean you read accounts I've read accounts by William Osler Sir William Osler of taking care of people with pneumococcal pneumonia 100 years ago with Johns Hopkins. And he would write in detail the cases of young people dying.

And I read those clinical cases, and I realized that I could walk into that patient's room and lift my pinky and save their lives. Like just like that, save these people from death by the administration of hydration and antibiotics. So this is miraculous, okay? And there have been a few miraculous interventions. Now, usually when I teach this, I say one of the downsides of that is that humans have come to expect too much of medicine, and there will never be another penicillin. There was just a one-off type thing in that we think that, oh, just around the bend, we'll cure cancer. Just around the bend, we'll do this. Just around the bend, we'll do that. But it is truly, they're rare. You can count on one hand these types of innovations. And even I,

skeptic though I am about the benefits of modern medicine, even I will admit that mRNA vaccine technology is unbelievable and that it does and will continue to make a difference in our capacity to fight infectious diseases. Now, I am not going to forecast, because I don't believe it, the end of infectious disease. That's not true. These pathogens have been around for hundreds of millions of years. They are vastly more numerous than we are. They don't mind dying. They have many inventive ways to kill us. And so, as I discuss in the book, there's a long history of people predicting the end of infectious disease. No, we're not there. But we have a powerful new tool, in fact, a platform for confronting infectious diseases, we will be able to rapidly develop, not for all of them, but for many of them, rapidly develop effective vaccines, which is unbelievable, frankly. And so, yes, I do think this is a big change. the Israeli innovation sector and the Israeli tech ecosystem. And the digital health sector is a burgeoning sector in Israel and has been for some time. So I've had my eye on it. And then

during the pandemic here, I saw something similar going on here. And you wrote in your book that one study found that 40, you cite a study that 46% of consumers, 46%, so almost half of healthcare consumers used a telehealth or digital health service during the early months of 2020, which was up from just 11%, from 11% of healthcare consumers in 2019. And this occurred against, you're right, this occurred against a backdrop of a precipitous decline in health screenings for cancer and other diseases, suggesting that a boom in such conditions will eventually be felt, which we discussed, but an inverse sort of indirect adverse health, which is an indirect adverse health consequence of the pandemic. But if people are getting accustomed

to digital health for at least diagnostic procedures, that could be here to stay. No, I think that is, I think there are going to be some persistent changes in our healthcare delivery systems. Everything from changes in licensing laws, you know, we have a patchwork of licensing for doctors in this country, which makes little sense in the 21st century, to modes of healthcare delivery, to interoperability of healthcare records, lots of these things are going to change. You know, you don't, you know, if you previously were required to go see a doctor to get a prescription refill because of insurance regulations, not because it was medically needed, neither doctors nor patients nor insurers actually are likely to want to persist in that. It's inefficient. You know, why not just have you do a Zoom call or

whatever with a doctor or with someone else? So there are many things that can be done. And we have also advances in sensors where people can wear equipment at home and measure all kinds of things at home that can provide doctors some insights. I think there was a famous study that I read 30 years ago now when I was in medical school that someone quantified the fraction of the time a doctor could make a correct diagnosis based on history. And it was something like 80% of the time you can diagnose the condition just based on history alone. And that an additional 15%, you need to examine the patient. So physical exam actually adds very little to your ability to diagnose. And then only 5% requires tests of some kind. You really can't figure out what's going on unless you take an x-ray or a blood test

or something else. These numbers probably have changed in the intervening years. But the gist of the point is this is what I'm trying to make. Well, if that's true, you can diagnose a lot of conditions, as you just said, using this type of technology that we're using now where we're looking at each other on a screen. So yes, I think that that is going to be more efficient. It's more desired by everyone involved. And so long as we can work out the payment mechanics. And for this, I think people like Zeke Emanuel have rightly argued that we should not pay less for online

versus in person, because if we do, we'll change the incentive structure and it won't be what we want. We want to incentivize people being at home to reduce the burden on our healthcare system. Then I think we will see some changes, just as you allude. Now the issue of the holy grail of the interoperable electronic— By the way, just before—the other impact will be just in terms of people's lives. I mean, you think about not just the actual visits to doctor's offices, but just the logistics. You know, you think about a parent, you know, with a kid who's diabetic. Think about how much

of that parent's time is built around the logistics, the appointments, making the appointments, getting the kid to the doctor, getting the kid back from the doctor, pulling the kid out of school. I mean, you're talking, in aggregate, weeks lost. For a year, and then you kind of extrapolate that out, the amount of time sucked out of the economy is extraordinary. And if you could slice a lot of that away, because people can do a lot of it on a smartphone,

it's potentially transformational. Yes, that's exactly right. And there are many things for which we, for example, well-child visits for pregnant women, which we've done in a particular way because it's tradition, or dermatology visits visits or psychiatric care. You know, why do we have patients driving back and forth to see their shrinks when they could do it online, for example?

And so all of these things are inefficiencies that I think now with the demonstration that has been forced upon us by the pandemic, I think people are going to question the old way of doing things and hopefully become more rational. So, yeah, I think we are going to see some persistent changes in the healthcare sector as a result of this. What I was going to say was about the holy grail of the electronic health record, which people have been chasing for years and years. My colleague, Zach Cohane at Harvard, the Department of Biomedical Informatics, for example, among others, and my friend, Kurt Langlotz at Stanford. I've been talking about this since I've known them for like 30 years, as have many people. They're just my two points of contact on this topic. And, you know, it's just

been a nightmare to try to get this to work. But I think that the pandemic will have demonstrated the utility, for instance, of being able to check someone's vaccine status or being able to have a patient share their records easily from place to place. In many European countries, for example, my family in Greece, every middle class Greek family, or not every, but many middle class Greek families will have a closet in their house, which is for their health care records. So when you are discharged from the hospital, they just give them to you. Your x-rays, why should the hospital keep all these records? It's expensive. And anyway, they don't care. You've paid them. They're done with you. Take your records and go home. So these records pile up. And if the loved one is admitted to the hospital, you know, the niece is sent to the home to fetch

the records. You know, where was that chest x-ray that was done 10 years ago? Oh, here it is. And they have an incentive to keep it and to produce it when needed. So, you know, when I was a house officer at the University of Pennsylvania, I met a wonderful master clinician, much beloved, a man by the name of Dan Brokhoff. And Dan got tired of patients would come. Patients would have some kind of tiny cardiac abnormality and they would come into the ER and maybe a homeless patient or a patient that was on the margins, let's say, of society, and they would have an aberrancy on their EKG, which could potentially be a heart attack. In those days, there wasn't a rapid test. They would have to be admitted for 24 hours in order to work them up. And these people consumed, people with minor long-term cardiac abnormalities consumed a lot of dead weight loss in our healthcare system because of these things. And they also didn't necessarily want to be admitted all the time.

They came in for some kind of abdominal pain, chest extra routine, EKG noted a problem, and up, they have to be admitted. And they're like, I don't want to be admitted. We're like, you have to stay because we have to be sure it's not a heart attack. So he just came up with an expedient idea of just simply in old Xerox machines, like take their EKG and shrink it down and laminate it and put it in their wallet and say, just take this with you. And if you ever go to another hospital in Philadelphia, just show them this card, you know, to prevent hospitalization. And he just started doing this, you know, but now imagine if instead those were all in the cloud, you know. So, yes, people have been talking about this for a very long time.

And I think maybe the pandemic will help with that. You and I talked off of this podcast, outside of this conversation. I raised how surprised I was when the pandemic kicked in and I was looking for literature about the 1918-1919 Spanish flu, which seemed the most recent, most relevant. I guess maybe the pandemic in the 1950s could be equally as relevant. And I was struck by how little literature there was. Now, you say there was a lot of literature in the public health domain, but I'm talking about in the popular nonfiction domain. It feels like, other than John Barry's book, The Great Influenza, which had a huge impact on President George W. Bush, which is largely why we know so much about that book, and maybe, I mean, other than that

book and maybe a couple of others, I'm struck by how much little there is, that it's not more salient in our kind of societal memory of what happened, because it just seems like it would be so relevant on so many levels, both the public response, the epidemiological response, how we organize as a country, the federal government, state governments, municipal governments. There's a lot here to learn. And there seems to be very little recorded. Well, I don't know if that's true. I mean, I'm just looking over, I'm trying to stand up and look at my library. I mean, yeah. Yeah, but you're in the public health business. I mean, your library is not representative of most people's library. Well, I suppose that's true. But at the same time, I think there have been, I don't know, I'm making up a number, some number of books, 20, 30, 50, maybe 100 books on the 1918 pandemic.

Maybe some directed as specialized medical historians. But it happened at the same time as World War I. Right. So take the number of books about World War I and multiply it by hundreds. Yes. We know a lot about World War I. Yes. We don't know a lot about this.

That's right. But I also think that wars make for better movies than plagues, although there are exceptions. The movie Contagion comes to mind, and the movie World War Z comes to mind. Actually, each of which offers something to the people who want to understand what's happening to us right now. Contagion, of course, more than World War Z. But, you know, you're right. There haven't been as many nonfiction books about 1918, but there are enough. But the more general point, and of course, there's a specialized literature. I mean, Tony Fauci was writing about respiratory pandemics when I was in high school. You know, there's a, you know, I learned about this in medical school in the 1980s. I mean, this is what you learned about, you know,

respiratory disease and previous pandemics and pandemic cycles and all of this stuff. It's, this is the thing that I love about our society, by the way, is that if you think about it, we have an economy which exchanges money for expertise, goods and services, right? And we have all kinds of expertise. We have specialized knowledge about every damn thing you could possibly want. You need gallbladder surgery. You need a carburetor rebuilt. You need a beautiful dovetailing on your cabinets. You need someone who can invent rockets or build rockets or manufacture styrofoam or you pick any damn thing and we have people who know how to do that, it's amazing. And of course, we had a lot of people

who were really expert in epidemics, who'd spend their whole life studying respiratory epidemics in our society, because we're a rich nation with a commitment to science and to free expression and open exchange of ideas. And all of those are our strengths. But we didn't bring them fully to bear, unfortunately, on the pandemic. And this is, you know, for example, I contrast the Chinese response with the American response, that the Chinese are an authoritarian government with a

collectivist culture. But they're not as rich as we are, and they're not as open as we are. In fact, their lack of openness got them into trouble, right? Their first response was to try to squelch the bad news, which is the typical response in that type of society. Whereas we, ostensibly, although we fell for that trap too, very unfortunately, they brought their strengths to their game. And they locked everyone down for a billion people beginning January 24th in 2020. So you say in your book it's like Maoist. I mean it's like the biggest shutdown in human history in response to a – Yes, and they ordered 930 million people to stay home, and they did.

And I'm not saying that we should have done that. That we should aspire to that. Right. No, I'm not saying that. But I'm saying that they brought whatever strengths they had to their game, and they brought their deaths down to zero. Okay? Now, we had other strengths. We're not that kind of society.

But we didn't bring our strengths. You know, we had the world's best epidemiologists. We do. We had the best, and we had the world's best epidemiologists. We do. We had the best and it's been we have the world's best vaccinologists. We have industry that can produce vaccines. And we did. I mean, we invented miraculously good vaccines in record time. These are amazing strengths that we brought. And yet we turn our nose up at them now. You know, like 65 percent of Americans, I think approximately of adult Americans have been vaccinated compared to 90% of Portuguese. Why is that? I mean, why are we not getting vaccinated? That's just dumb. So anyway, so I forgot how I got onto this tangent about the Chinese bringing our strengths. Oh, so we have expertise in our society, which is a wonderful feature of our society, that we have this type of specialized expertise

in the form of people who know about such things, just like there are people who know about everything we could want. Thank goodness. And yet we did not. Well, and we have a system, unlike China's or in some parts of Europe, that's much more free market oriented, that allows entrepreneurs in the life sciences sectors to really take risks and innovate that, I think, talk about one of our strengths. I mean, that allowed real problem solving. Well, this is like the book, you know, how the, how the allies won the war, you know, in the second world war, you know, we used a profit motive. We needed to get General Motors and Ford to just make war material. And so we said, we'll pay you. And they manufactured, you know, millions of Jeeps, the Germans, and they were all the same and you could fix them

in the field. Whereas the Germans couldn't believe, you know, that they were just how many Jeeps we were making. And so, yes, we brought our strengths to that war. So, yeah, I think that's, you know, that's exactly right. But anyway, the point is, is that we had in our society medical historians, professional epidemiologists, immunologists, microbiologists. We had many people in many disciplines who knew what was happening. And our government did not listen to them. And I put the fault primarily at the White House and the former president, but not exclusively. It's not a right-left thing. We had plenty of Democratic governors or mayors who were also incompetent and or didn't listen. But you know, I expect more

from the White House, and I expect more from our country. You know, you also are critical of the of the permanent medical public health bureaucracy in the federal government in terms of early days around testing. Well, I think here the problem is, again, it was lack of leadership. I mean, I have great respect for the CDC. And I think there was a problem with the tests. But they knew what the problem was able to rapidly invent tests and distribute them with great success. I think this was during the Obama administration. And during the 2019 COVID pandemic, there was a little goof, a failure in cleanliness standards in some of the laboratories where the test was being invented in the CDC. And one of the three components of the test was defective. What they should have done is the FDA, as I understand the rules, should have permitted health care providers around the country to use the test, even lacking this third component, and or just let hospitals.

There were dozens or hundreds of hospitals in this country which could have made the test on their own. But they didn't have permission to do that, to actually feel the clinical test given our bureaucracy. And that, I think the White House could have issued an executive order and said, no, it's a national emergency. Any hospital with more than 500 beds or any hospital with a CLIA certified lab, we will allow them. And they could have invented their own tests and deployed them rapidly. We should have done that. We didn't.

All right. I want to hit you with three short – I'll keep them short questions. Okay. Because I want to be respectful of your time here. One, you say in the book – We were getting really inside baseball there, like little nitty-gritty details. Hey, you know, don't you want fully engaged readers? I'm a fully engaged reader of nicholas kristakis

so with me i probably know the book better than you do okay probably you say the border closings don't don't work in a pandemic yes so in light of that first of all do you think had we sealed borders to the u.s sooner it would have made a difference and two does that mean at this point we should be less stringent about borders? Well, imagine you're trying to close the border to prevent deer from getting across the Canadian American border. I mean, just think about that task for a moment, or mice to get across the border. It's impossible. I mean, the fence, even if you were able to build the fence for the whole distance, it would require a level of maintenance that constantly would break periodically. Some deer would leap over, a tree would fall on the fence, or they'd

figure out some other way. Maybe they'd swim, you know, they'd like drift off on a piece of driftwood and then land on the southern part of the border. I mean, it is extremely difficult to seal your borders against the natural world, especially over something like a virus, especially a virus that can also be enzootic, meaning it something like a virus, especially a virus that can also be enzootic, meaning it can live in animals, not just in us. Even in other words, if you stopped all the people from crossing the border, some animals would carry the virus. So it's not, generally speaking, a realistic strategy to close yourself off. Even island democracies like Iceland and New Zealand had checkered success with this.

Now, New Zealand was amazing. They closed their borders because they're a rich island and they did it rapidly. And they had, because of their proximity to China, perhaps more rapid information and they took it more seriously right from the beginning. But even that's only a temporary solution until you can vaccinate the population. We've seen even in New Zealand, especially with the more transmissible variants, that the virus gets through. Part of the reason it gets through, by the way, is that this quarantine of two weeks is probabilistic. In other words, we know that, I forgot the numbers right now, but if you look at the probability of transmission across time if you're infected, it peaks at around four or five or six days after

infection and then falls up to about 14 days, and you're no longer it peaks at around four or five or six days after infection and then falls up to about 14 days and you're no longer symptomatic at 14 days, but it doesn't drop to zero at 14 days. There's a long tail there where someone who's been asymptomatic for three weeks might just miraculously transmit the virus. So even if you impose a two-week quarantine on everyone coming in, one out of 10,000 people will wind up transmitting the virus, you know, two weeks later. And therefore, the virus is loose now in your community. So it's just not practical to totally seal borders, unless you couple that with rapid vaccination, where you can get everyone vaccinated very quickly. First point. Second point, it's not

practical. And studies have shown that even if you stop 99.9% of incoming flights, just that one out of a thousand flights that you let in is enough to recede your population and given the modern world that we are in. And so you might delay the peak of the pandemic by a couple of months, but the virus will come inexorably to your shore. So border closure, in my judgment, and I'm willing to be persuaded otherwise, I don't have a political dog in this fight. So border closure, in my judgment, and I'm willing to be persuaded otherwise, I don't have a political dog in this fight. In other words, my reading of the literature on border closure is that it doesn't do much. It postpones the peak by some amount of time,

which may be useful, right? Like if you're really, for example, if we had rapidly closed our borders and used that time to manufacture personal protective equipment and educate the public on what was coming to prepare them to wear masks and so on, then that could have been very helpful. Of course, we didn't do that. The White House was saying, you know, it's going to go away, it's going to go away, it's going to go away. They said that for six months. It was total BS. It was not going to go away, and nor did it go away. So anyway, so I am very skeptical of the benefits of inter-country and intra-country restrictions on movement. Let me give you an example of the latter one. You have a difficult problem. When you impose within a country patchwork restrictions, you can actually potentially make things worse than no restrictions at all.

It's a little bit like declaring one side of the swimming pool as suitable for urination and hoping for the best. It doesn't work. The urine will just contaminate the whole pool. So imagine, for example, that you have two states side by side, and one state has a very rigorous regime of controls, like we're going to close our churches, and we're going to close our schools, and we're going to restrict curfew our businesses and do all of this stuff, and the adjoining state does not, what you might wind up doing is increasing interstate movement between people and actually increasing population mixing instead of decreasing it. You would have been better off having no restrictions in either state so people aren't moving as great distances and spreading

the germ as a result. And some analyses that have since been done that show adjoining areas with dissimilar policies actually can make a pandemic worse than having no restrictions at all. So you need a kind of collective response, like we said at the very beginning of our conversation. Contagious diseases call for a collective, coordinated response. In the first edition of your book, you seem not to be skeptical of the conventional wisdom on the origins of the virus. In the new edition, you don't come down one way or the other, but you do give some air to the lab leak theory from the Wuhan lab. You give it air, like you don't come down and favor it on one side, but you basically sound a little less skeptical. Am I reading you right? No, I don't think completely.

I mean, I wasn't skeptical. I thought a year and a half ago, and I still think that a zoonotic leap is the more likely to be what happened. So from a bat or... Yes, or with some other intermediate, yes. I think that's still the most likely explanation. But then, as now,

I don't think we can exclude a lab leak theory. And I don't think the Chinese secrecy is doing them any favors. Although in fairness to them, we also would have a serious problem if the Chinese demanded access to our Fort Detrick, we would be like, I don't know about that. You know, let me be clear, our government is vastly more transparent than the Chinese government. And it's not what I'm saying. But But I'm just saying I know it's a heavy ask we're making of them. But unfortunately, I think they have to honor that ask because, you know, millions of people have died if it was a lab leak. And I think it is the burden is on them to provide evidence that of what happened. And they have not done themselves any favors with their secrecy.

But I think I have no political dog in this fight. I mean, I think the facts will lead where they lead. And either we'll have more and more evidence for a zoonotic leap, or we'll have more and more evidence for a lab leak. And either way, eventually, we may know, or we may never know, candidly, but I suspect we will know, you know, in 10 or 20 years, I think evidence will accrue on the balance of one or the other. But so my position is I think it's probably more likely a natural zoonotic leap, but not certainly so. Do you think we will get some version of like the 9-11 Commission, the Baker-Hamilton Commission for the origins of the pandemic? I hope we do. Commission for the Origins of the Pandemic? I hope we do. I have been in touch with Philip Zelikow, who was the executive director of the 9-11 Commission,

who is now at UVA and with support from a number of foundations, including the Schmidt Foundation and the Koch Foundation. I'm not sure who else is supporting him. A number of four or five foundations are supporting the creation, perhaps, of a public 9-11 Commission, if it's not authorized by the government. But either way, we should have such a commission. And they have been consulting broadly with many people, myself included. And I certainly believe we should do that. We need to understand what happened. And we need to try to provide better guidance of how to cope with it. Let me be clear. This is not the last pandemic we've had. There's evidence that because from climate change and

population growth and a host of reasons that zoonotic leaps are happening more often. Hanta virus, HIV, Ebola, Zika. Every one of us is aware, has read in the news accounts of these new pathogens and they're rising. There's scientific evidence that they're becoming more common. And these respiratory pandemics in particular come every 10 or 20 years, and there's some evidence that they're coming more frequently. So we could face this again, you pick, not in 50 or 100 years, maybe in 10 or 20 or 30 years. And furthermore, that pathogen in the future, there's no God-given reason the pathogen won't be vastly more deadly. So SARS-2 kills 1% of the people it infects. Maybe the next one will

kill 30%, like the movie Contagion. Now, of course, we have these mRNA vaccines. Maybe they'll be really helpful if that happens and so on. But we need to take these threats very seriously. This is why it's rightly been considered by Republican and Democratic administrations for decades as a national security threat. And we need to do a better job preparing, in my view, for this threat. Nicholas, last question. U.S. life expectancy. So as you said earlier, we've seen extraordinary gains in life expectancy over the last half century or so. And over the last number of years, we've seen, at best, a flattening of the increase in life expectancy, and at worst, actually, it's starting to turn a little bit, and obviously exacerbated by

the pandemic. I remember Kremlinologists and demographers who followed the former Soviet Union pointed to when life expectancy started to go on the decline in the Soviet Union, that that was an early sign that really was important to follow because that was representative of a lot of things going on in Soviet society that could spell the unwinding of the Soviet Union. How do you feel about the data right now that we're seeing on life expectancy in the U.S.? So you're absolutely right that life expectancy, even before the pandemic, there was some drags on the growth in life expectancy. So every year that went by, I'm going to make up a number, we were gaining a month in life expectancy. So for example,

two years ago, life expectancy at birth might have been 80, and now it's 80.2 or something. But the obesity epidemic was putting a drag. So as you said, it had flattened. And the opioid epidemic, which kills the young especially, was really a drag. And we were losing, as a nation, we were not gaining as much life expectancy as we used to. There are estimates that the COVID pandemic has made us, set us back about 10 or 20 years, that we've lost about a year in life expectancy at birth. So before the COVID pandemic, let's say we might have had life expectancy at birth might have been 80. And now it's, let's say, 79 as a result of COVID. So that's a serious, serious shock to our system and has really set us back. And in this regard, I would say that, and I don't mean to say this pessimistically nor

to end on a pessimistic note, but I don't think people fully appreciate the magnitude of what has happened to us. We are alive at a once in a century event. It has been catastrophic with the point of view of the loss of life and disability. We reviewed some of those numbers. As many as a million Americans will die. As many as 5 million Americans will have some kind of disability. 100 million Americans will know someone who died. Larry Summers and David Cutler estimated the cost of this virus at $16

trillion, $8 trillion in economic costs, and $8 trillion in health costs. This is a catastrophic economic impact on our society. Yeah. Now, our friend Neil Ferguson, which is how we know each other, has pointed out to me that actually the economic cost, we'll look back from a historical standpoint, the economic cost will eclipse the health impacts, the physical health impacts. Oh my God, the economic costs are vast. It's as if every family of four had the destruction of $200,000 in wealth, or as if we burnt to the ground tens of millions of people's homes. I mean, this is an enormous thing that has happened to our society. And for a variety of reasons, including the fact that we're borrowing money from the future, including the changes in the nature of the economy where many people can work from home,

including the fact that this virus is- Potentially this wave of inflation we're in right now and where that's going to go. Blah, blah, blah. So the point is I don't think people really understand the magnitude of what has hit us. And this is why, returning to how we started, I think we are not at the beginning of the end of this pandemic. But thankfully we are approaching the end of the beginning. So Apollo's Arrow, the first edition of Apollo's Arrow, I devoured when it came out. And I, as many of my friends and colleagues know, I bought a lot of copies for people

and widely disseminated it. And I would say normally with new releases of paperback editions, you don't expect that much updating, but I actually found the updates, both the preface and the afterward, to actually have a lot of new info. So I encourage our listeners, even if you read Apollo's Arrow,

the first edition, you should still purchase the paperback edition because there's some new material in it. I highly recommend it. And even if you don't want to read it, just buy it. I always tell listeners. I mean, it's fine if you read it. It's fine if you don't read it, but buy the friggin' book. Nicholas Christakis,

thanks for joining us on the podcast, and I'll see you in a few days, actually. Thank you so much for having me, Dan. Good luck with this. That's our show for today. If you want to follow Nicholas Christakis' work, you can find him on Twitter. He's at N.A. Christakis. C-H-R-I-S-T-A-K-I-S.

And as I mentioned, you can purchase all of his books, but most importantly and most timely is his most recent new edition of Apollo's Arrow. You can find that book and all of his books at barnesandnoble.com or your favorite independent bookstore or that other e-commerce site. I think they're calling it Amazon. Remember, you can also email me if you have any questions or comments or ideas for future episodes, especially as it relates to the new podcast. We'll start reading some of those questions and addressing them as we move forward. You can do that at dan at unlocked dot fm, as in Frank Mary. Post Corona is produced by Ilan Benatar.

Until next time, I'm your host, Dan Senor.