Making Sense with Sam Harris - #190 — How Should We Respond to Coronavirus?

Episode Date: March 10, 2020

Sam Harris speaks with Nicholas Christakis about the coronavirus pandemic. They discuss the likely effects on society, proactive vs reactive school closures, community transmission, false comparisons between coronavirus and flu, the imperative of social distancing, the timeline of the pandemic, Trump’s political messaging, the widespread distrust of expertise, the importance of "flattening the curve" of the epidemic, the possible failure of our healthcare system, gradations of personal response to this threat, and other topics. If the Making Sense podcast logo in your player is BLACK, you can SUBSCRIBE to gain access to all full-length episodes at samharris.org/subscribe.

Welcome to the Making Sense Podcast. This is Sam Harris. Okay, so it is all coronavirus all the time now in my world. I'm actually going to be releasing two podcasts on coronavirus this week. This has preempted the other things I have in the pipeline. As I think you know, if you've been listening, I've been doing a series on nuclear war, and I also have a podcast on child sexual abuse. The podcast seems to have taken a dark turn, and I find that I cannot drop either of those podcasts into the current environment when we need to be thinking about coronavirus and

its resultant disease, COVID-19. So I will try to find some good cheer for you at some point, but let's talk about the problem at hand. So this is the first of two podcasts I'll do this week, if everything holds together. I just want to say a couple of things up front, lest they get lost. I've been spending a fair amount of time focusing on this, as many of you have. I've been frankly alarmed by several encounters I've had with very smart people, both in person and online, which have revealed a mismatch between what I think is true and what many smart people believe. Here are a few statements which I think are true. COVID-19 is worse than the flu in every way. So comparisons with the flu are highly

misleading. And it is not just bad if you catch it and you're over 70 or you're immunocompromised. There are healthy, fit people getting killed by this virus. Another point I want to make up front, which we make at some length in this podcast, is that even if we're all destined to catch this virus eventually, social distancing at this point is essential. So-called flattening the curve is actually a very big deal, right? So just think about this. To get the worst flu in your life is bad, but to get it when the healthcare system has collapsed under the pressure of everyone else getting this flu is very different than getting it when hospitals are functioning normally. And the only lever within reach right now, in the absence of a vaccine, the only thing we can do is delay the

spread of this by changing our behavior. So the time for hugging people and shaking hands is over. You are not being friendly by shaking someone's hand. In fact, you're being quite rude. You're advertising your obliviousness to the risk you're posing to others. And wherever you are on Earth at the moment, if you can work from home, you should work from home. And this should be a company policy, right? If you have a company where some percentage of the work can be accomplished by telecommuting, you should implement that policy right now.

And this is also true for schools. Stanford, two days ago, announced that all their classes would be moved online. Schools everywhere should implement that policy as quickly as they can. Now, there's an obvious trade-off between economic incentives and containing the spread of this disease. We should be privileging the latter. This is absolutely the time to avoid social gatherings and public transport as much as possible. And anyone who is taking his or her cues from President Trump at this point is dangerously out of contact with reality. Anyway, all of that and more will be made clear

in this episode, and there's no paywall for this one, obviously. This was yet another public service announcement. Today I'm speaking with Nicholas Christakis. Nicholas is an MD-PhD and a professor of social and natural science at Yale University, where he directs the Human Nature Lab and is the co-director of the Yale Institute for Network Science. He was elected to the National Academy of Medicine in 2006, and the American Association for the Advancement of Science in 2010, and the American Academy of Arts and Sciences in 2017. And his New York Times best-selling book, in 2017. And his New York Times best-selling book, which is just coming out in paperback,

is Blueprint, which I've read and discussed before on this podcast with Nicholas, and I highly recommend it. And so here, Nicholas and I cover this emerging epidemic, now certainly a pandemic, from many sides. And again, whatever we don't cover here, if you have remaining questions, please direct them to me on Twitter, because I'll be recording another episode with a doctor from Johns Hopkins. As you know, things are changing very quickly here, but this conversation was a very good snapshot of what we knew on March 8th. And now I bring you Nicholas Christakis. I am here with Nicholas Christakis. Nicholas, thanks for joining me.

Thank you so much for having me, Sam. We are going to talk about coronavirus, which is, if you're in my particular bubble, it is all that anyone is thinking about. I don't know how wide that bubble extends. I'm noticing that it doesn't extend perfectly across the political spectrum. On social media, I'm noticing many people who seem to be in Trumpistan thinking that this is much ado about nothing. And we'll talk about the political implications of this as well. But how much of your bandwidth is being taken up by coronavirus at the moment? Well, a huge amount of my scientific bandwidth around January 25th. I have a long standing collaboration with a group of scientists from

Hong Kong who in turn are connected to some other scientists in China. And around January 24th or 25th, we started emailing about the situation there and what kind of work we might be able to do. I began to think more deliberately about how I might turn my laboratory over to trying to help with a pandemic, which was, for me at least, obviously going to happen. I had done some research with the H1N1 pandemic 10 years ago related to using social networks as a way of forecasting the course of the epidemic. So I began to resurrect that work and some other work and began these new collaborations with my Chinese colleagues. And so basically, and I haven't slept much, honestly, in the last month, because we've been working nonstop on a number of fronts. So my scientific bandwidth is totally devoted to that right now, although we have a few other projects going on. And my personal bandwidth, you know, I'm concerned. You know, I'm monitoring the situation. Right. We should just remind people who you are. You've been on the podcast before.

Last time we spoke about your wonderful book, Blueprint, which I believe is just now coming out in paperback. Is that right? Yeah, by coincidence this week. Okay, cool. So people want to hear that podcast. It's in the archive. And I certainly encourage that people get the book. You have a great background for this conversation because you're an MD, PhD, who has also focused of late primarily on networks and the way really anything spreads in a network. Do you want to give a potted bio here to get us rolling? Well, you know, I have become obsessed over the last 15 years with the study of networks in general. And of course, there are networks of computers and networks of neurons and networks of genes, and of course, networks of people. And it is through these networks that everything from germs to ideas to norms to behaviors spread. And they are not the only lens

with which we can understand spreading processes, but they're very powerful and important lens. And right now we have, for example, what I would consider to be a dueling contagion between a biological contagion, namely the coronavirus, which is spreading on this network from person to person to person. And in parallel with that, we have another set of social contagions, which is, for example, ideas about whether people should be vaccinated or whether people should self-isolate. And those spread. Your probability of vaccinating depends on whether your friends get vaccinated, for example.

So we have these parallel biological and sociological contagions. And in some sense, the fate of what happens in our country will depend in part, not completely, but in part on who wins in those contagions. Yeah. Okay. So our goal here is to spread some good and useful contagious ideas. And I think before we dive into the details, I went out on Twitter asking for questions and suggested topics, and I got close to a thousand responses so far. So there's no want of interest here. But I think I should just mention that I see some obvious ways in which people can fail to absorb what we're saying in good faith here. And one variable is certainly political. I think that any criticism of the

government's response to this crisis thus far will be interpreted by many, many people as both of us or one of us, I mean, certainly in my case, trying to score a partisan political point against the president. And I can just assure you, dear listener, this isn't the case. I've made no secret about how unfit I believe Trump is to be leading this country. And he has proven that to me in spades in the last few weeks. But everything I'm going to say at any point in this conversation that touches on what seems to be political obfuscation and general cluelessness from this administration, I would say about any administration that was responding this way in the face of a clear public health emergency. Yeah, I mean, the virus is

wholly apolitical. And, you know, I think there is a biology and a sociology and an epidemiology to the virus that doesn't really care what politicians say or do. And I think it's important to remember that we can speak about plain facts about the epidemiology of coronavirus and in doing so, says nothing about our political leadership. Now, it is the case that the political leadership may also be failing, and that's a distinct topic, but merely discussing facts about the epidemic is not an indictment of the administration per se. Or discussing facts like the fact that the Trump administration cut the U.S. pandemic response team in 2018 because they thought we didn't need it. And this is at best a short-sighted view of reality.

I mean, one of the most prescient and relevant things that's been said in recent weeks about this whole moment is that whether or not coronavirus is as bad as the most alarmed people think it is, or whether it might just be a dress rehearsal for some coming pandemic that really is as bad as people fear, two things are true. One is we're failing the dress rehearsal to an impressive degree. I mean, we in particular, the United States, and that should matter to us. And two, some pandemic, whether this is the one or not, is guaranteed to come. And this is, you know, Bill Gates made this point, whether this is the one or not, is guaranteed to come. And this is, you know, Bill Gates made this point, like this is the most predictable emergency you could possibly name.

This was guaranteed to happen. And if this isn't it, let's learn all the lessons we can from our missteps here. But this is a gift courtesy of evolution that we knew was coming. And the fact that we have an administration that seems to think that a pandemic response team is optional is pretty depressing. Well, I agree with much of that in the sense that I totally agree that the predictability of these pandemics, and this can also be reassuring to listeners, we have pandemics of viral pathogens, including in the category of coronaviruses, which is the category we're facing now, every 10 or 15 years. People will remember the SARS outbreak and the H1N1 outbreaks of the last decade. We can talk about the ways in which this virus is different than those outbreaks. And people who've studied history

know that there was a major global pandemic in 1918. So every century or so, there's like a major pandemic like that in which the pathogen is both very deadly and very transmissible. And other times we have pathogens that are very transmissible and not so deadly. And those prove to be, to burn out very quickly, like the pandemic in 2006, 2007. And other times we have pandemics of diseases that are very deadly, but not so transmissible, for example, SARS. And then when the disease is too deadly, it actually works against itself. If it kills its victims, it doesn't transmit as much. So in a way, right now, we have a disease that's moderately deadly and moderately transmissible. And that could be quite

a perfect storm. It could be a condition that, you know, is let's say in every 50-year event. But the main point is, is that these influenza-like, influenza pandemics come every 10 or 15 years, and sometimes they fizzle out, and sometimes they don't. Sometimes they're very serious, and when they're very serious, they wreak havoc not only in terms of the health and people's lives, but they can wreak economic havoc as well, which is another thing that many observers are beginning to be concerned about. Yeah, yeah, and there really is a tension between the focus on the epidemiology and the straightforward health concerns and this other concern about the economics and the social implications of people not going to restaurants

and closing schools and all the rest. Those are the first order effects. So the travel industry is being devastated even as we speak, and it's unclear how long that will last. But then we'll begin to have second-order effects, so breakdowns in the supply chain and factories not working. And if those things begin to happen, this epidemic could dip us into a significant recession. But that's another whole thing, and it's still a little bit early to forecast that and be certain about that. But that's another whole thing. And it's still a little bit early to forecast that and be certain about that. But it is the case that major epidemics, for example, potentially a supply shock. So a demand shock is, you know, when a recession due to declining demand and then a stimulus might work, for example, dropping interest rates as the Fed recently did. But a supply shock is more like the Arab oil crisis of the 1970s that many listeners may remember. And that's when you have a shock to the supply on the supply side. And there, you know, lowering

interest rates doesn't really help. So if for the sake of argument, you begin to get disruption in the global supply chain, you know, this could be a very difficult thing to address until you get the factories working, you know, producing the goods and distributing them. So it's too early to know for sure what's going to happen in that regard. But I know that many sophisticated observers of this, including many economists and many extremely wealthy individuals who are tracking this, are unsure still what's going to happen. Except the one thing we can be sure about here is that... On the economic side, I mean unsure.

Yeah, no, but I mean, unsure. seemed fairly straightforward, and yet the economic reasons to keep them open were and are incredibly powerful and pointing in the opposite direction. And, you know, my concern is that because the economic incentives are so powerful, I mean, just take school closure as one variable. The fact that, you know, once you close the schools, then you have almost every working adult faced with the problem of what to do with their children. How do you get to work? How do you care for your children? Do you homeschool them? Does that cut the workforce more or less in half? I mean, this is just a huge hassle with economic implications. And so the reasons not to have the epiphany that we should close the schools

yesterday are legion, and yet the health wisdom of closing the schools has been fairly obvious for some time. We're going to get to lots of specific questions in a minute, but let's just touch this topic of school closure, just to give a sense of the problem and microcosm. What are your thoughts on that? Well, first of all, with school closures, we have to make a distinction between reactive and proactive school closures. So let's talk first about reactive school closures. A reactive school closure is a school closure in which there's a case at the school.

And when that happens, typically everyone is alarmed and is quite eager and willing to close the school. You know, it sort of makes sense to the man on the street or the woman on the street that, well, there's an epidemic raging and there's a case at the school and we should close the school. The problem is by the time you do reactive school closures, many, many analyses show that it doesn't delay the overall epidemic or doesn't help the overall epidemic very much. For example, an analysis of reactive school closures in the last influenza epidemic in Italy showed that a policy of reactive school closures, I think, reduced the epidemic by like 24% or 25%, the ultimate number of people afflicted, which is good, but not as good as you might want. So you can postpone the peak of the epidemic in your community and reduce the number of people ultimately infected if you close schools

once someone gets sick in the school. Similar analysis done in Japan found basically the same conclusions. And modeling exercises, sort of mathematical models, sophisticated models, including a paper published in the journal Nature in 2006, also found that a policy of reactive school closure delayed, I'm just going to look the numbers up because I have them somewhere here, for a moderately transmissible disease, reduced the cumulative attack rate by about 24% and delayed the peak by about 13 days. So the models and the empirical results of prior school closures in Japan and Italy, which is the literature I'm familiar with, I'm sure there's even vaster literature on this, suggest that reactive school closures help. But the real

problem or the real dilemmas is whether we should have proactive school closures. And this is a much more difficult decision, but from my eye, something we should be doing, frankly. And the reason is that if you imagine you're in a... Let's not pick a major... Let's not pick New York or Miami yet, because that's another whole kettle of fish. Let's pick a mid-sized town for the sake of argument. If you believe that the moment someone in your school is going to... If you believe that the moment someone in your school gets sick, you are going to close the school. Probably what you really should do is the moment someone gets sick in your community or in what is known as the epidemiologically relevant region. So if you believe that the moment someone gets sick in the epidemiologically relevant region, your town, then it eventually will afflict your school, then the more rational policy is as soon as someone gets sick in your community, shut the school. Why not get – you're going to shut it anyway in a week because your school is going to be afflicted.

But if you jump the gun and shut it, you actually might radically improve the course of the epidemic in your community. And there is actually amazing evidence about this. So again, just to crystallize the point, let's say you set some threshold, and we can discuss what the threshold is, some number of cases in some specified area in your town or in an adjoining town, or a case that you know is not an important case. It's not like someone flew from Italy to your town and presented with the disease. But instead, you find what is known as a community transmission, someone who has the disease and you don't know where they got it. That means the disease is loose in your community. If you set as a threshold one such case or two such cases in your town or in a nearby town, you could then

proactively close your school, and then you would have much bigger benefit than the reactive closure. And there was a wonderful analysis that was done of 43 cities in the United States during the 1918 epidemic, which very carefully examined across these cities, when did they close their schools with respect to the pace of the epidemic and for how long were they closed? And it found, for example, if you use as a threshold, how far in advance of the epidemic reaching, if you create the standard of you have twice the level of respiratory deaths as you usually have in prior years. You have excess deaths. How far in advance of hitting that twice the amount level did you close your schools? It found that actually districts that closed their schools in advance proactively had dramatically

lower death rates in the end. And so, for example, there's a comparison between St. Louis and Pittsburgh. St. Louis closed the schools in the 1918 influenza pandemic earlier and longer, and it had less than half the death rate of Pittsburgh, for example, ultimately. Many fewer people died. So this is the issue, and this is what's hard. But in general, my own bias, my own opinion is that proactive school closures make sense. In general, my own bias, my own opinion is that proactive school closures make sense. Yeah, I completely agree with you there. And there's one meme being spread, which is perhaps entirely factual, but I would argue misinterpreted, that is giving people comfort around this idea that we can just keep the schools humming along.

This idea that kids aren't getting this, or if they're getting it, they're not getting a bad case of it. And that's great. That seems to be true thus far. But it also seems true that they could still carry it and pass it to the rest of the community. So, you know, your kid is coming home from school and hugging grandma. And this is a very different disease when grandma gets it. Yes, that's exactly right. And in fact, it is the case that everything we just said about school closure is especially important when kids themselves might die, but the requirement that the kids be sick is not the critical point. Schools are areas of congregation of large numbers of people, including all the adults, the parents, the drop-offs, the teachers,

of large numbers of people, including all the adults, the parents, the drop-offs, the teachers, and the kids are little vectors. And incidentally, as long as we're talking about how does school closure work, one of the ironies about one of the ways that school closures work, paradoxically, is precisely because they compel adults to stay home. So modelers that have modeled this have said, okay, what happens when we require the kids to stay home? So we reduce social clumping in our society because we're requiring the kids to stay home. But let's assume that 10% of the parents or 50% of the parents or 90% of the parents are staying home as a result of the school closure. And unsurprisingly, that also has a further effect, the number of parents that stay home. Right. And so much of the school closure. And unsurprisingly, that also has a further effect,

the number of parents that stay home. Right. And so much of this is psychological. Let me just take that fact I just mentioned, that some comfort is being taken in this idea that this is not preferentially targeting kids. Rather, it's targeting old people. But if you flip that around, if this were a flu that had an inordinately high mortality rate that was targeting kids preferentially, well, we would have closed the schools already. I don't think we would be debating school closure. Well, we might. Yes, we might have. But there's another kind of moral issue here. You're right that very good data we now have on the mortality rate and how it varies by age. So young people, one study of 5,000 Koreans shows that basically nobody under the age of 30 afflicted with the condition died in that study. And another study of 44,000 Chinese,

I think showed a case fatality ratio of 0.2%. So two out of a thousand young people might die. Now that's still a bad. I mean, that's a high risk of death for a young person, but the number rises quite dramatically. So by middle age, it's one to 2% of people die. And by over the age 80, it's let's say roughly 20% of people die. So yes, you're correctly summarizing the situation. But one of the things that's distressed me in reading all this is that I, too, like most people, would prefer that the young be spared and the old be afflicted. But the old are members of our society, too. They are our neighbors.

They're our parents. They're our teachers. I mean, I hate this idea that, oh, well, it's just like afflicting old people. Who cares? It's ridiculous. I mean, these are human beings. old people. Who cares? It's ridiculous. I mean, these are human beings. So this is, again, a situation in which we can talk about the epidemiology of the condition, but I don't think we should lose sight of what's happening, which is that people will die from this condition.

Well, let's tackle another meme here, which seems to be doing an inordinate amount of work in people's reaction to this. And it does seem, at this point, frankly misleading, which is the idea that this is essentially just like the flu. Here are some of the factoids that come in this cluster. One is 50,000 people die every year in the United States from flu. In 2018, it was something like 80,000, which I think is the worst year in recent memory. So comparatively, only about 4,000 people, just nearly 4,000 people have died worldwide from coronavirus thus far. This really is a tempest in a teapot. If we were tracking the flu with the same paranoia that we're tracking this, well, then we would be alarmed every day of our lives.

And then also there's the fact that, you know, though the mortality rate of this seems higher than the flu, it also seems clear that we're not testing widely enough to know what the actual denominator is to properly calculate the case fatality rate. So it's been reported that it's as high as, you know, three and a half percent. No, it won't be that high. It won't be that high, but then there are estimates, it seems like the most sober estimates are more like, you know, half that, you know, between one and two percent. But there seems to be the expectation on the part of many people that at the end of the day, we're going to recognize this is just another flu essentially running in parallel with the flu that we deal with year after year, and nobody freaks out about it. Nobody closes the schools. What are your thoughts on that?

Yeah, I think that's all wrong, and I can explain why. So first of all, let me back up and say a couple things, a bunch of things. First of all, if I told you that motor vehicle accidents were a leading killer in our society, and they are, about 35,000 people die of motor vehicle accidents every year, and our society is very gravely concerned about these deaths. We invest huge resources in improving the safety of our roads and cars. We have enormous campaigns and penalties for people who drive under the influence. We cry and are sad when we read about motor vehicle deaths. And the public health community and our government and the people on the street expend enormous resources and attention in driving down one of these leading killers in our society. And if I told you that I could wave a magic wand and remove that cause of death tomorrow,

many people would be amazed and excited and incredibly proud. Well, right now, we're in the midst of adding such a cause of death in the case of the coronavirus. That is to say, our best estimates, the most optimistic estimate, is that only 35,000 Americans are going to die of this condition. So we've just added a whole other extra cause of death to the list of things that kill us right now in our society. So I just don't see the reason for nonchalance or optimism with respect to a new condition, a new killer that might kill us. Imagine if instead of being, quote, something that sounded so benign as influenza or the flu, imagine instead if I said it was Ebola. Imagine

the panic that people would feel if I said we now have Ebola loose in our country, killing 35,000 people. So I totally reject that. Furthermore, there is a wide range of estimates as to how many people will get infected and or die. And this is still, we're in early days and it's difficult. And it's difficult for people, it's difficult for me, just I'll speak for myself, because I don't want to be alarmist, you know, and I don't want to overestimate it and then have people call me to task and say, oh, you, you know, you were chicken little and, you know, you were an alarmist and, and, you know, and then maybe lose some credibility, let's say. On the other hand,

I don't want to minimize it and underestimate it. And then people say, why didn't you warn us? You know, why didn't you tell us you should have been in a position to know, you know, you've been studying this topic and related topics for so long. And of course, there's only going to be one outcome. It's not like I'm making a thousand predictions and on average, I'm correct or other experts who are in similarly situated as I am. There's going to be one outcome and on average, I'm correct, or other experts who are in similarly situated as I am, there's going to be one outcome. And so we have to speak in terms of a range of outcomes. So at the most optimistic end, I think we'll have over a million Americans infected with this pathogen and perhaps 35,000 dead. But that's just at the most optimistic end. The much more likely scenarios, or equally likely,

or other possible scenarios, move up the range. So for example, Mark Lipschitz, a very famous epidemiologist at Harvard who's an expert in this area, estimates, and he's revising his estimates as more data comes in, but he estimates as of last week that perhaps 20 to 60 percent of Americans will ultimately, over the course of a year, be infected with this pathogen. And if we use the lower bound of his current estimate, 20 percent, that means 60 million Americans will be infected. And if we use the lower bound of the case fatality ratio, which is 0.5 percent, that means 300,000 Americans are going to die of this condition. And that is like one of the top three killers in the United States. And that's within the realm of the possible. I'm not saying that's going to happen, but I'm saying we need to sit up and pay attention because that is

possible. It's not an extremely unlikely event. And it could even be worse than that, honestly. Yeah. Now, I don't think, you know, if you force me to predict, you know, do I think 300,000 Americans? It seems so inconceivable to me. But look what's happening in Italy. 16 million Italians are now under lockdown. Their hospitals are full to the brim. What makes us think we're so special? We think we're different than the Italians or than the Chinese? We're not. Well, no, the truth is we are different from the Chinese. And this is another meme that is doing some mad work in the brains of otherwise very smart people. I even saw a Stanford doctor reference China as a source of optimism.

And China has the spread of the disease has been fairly well contained, it seems, at the moment. It's, you know, the fatalities are dropping off. and so far as we can trust the information coming out of China. That's true. Yeah, it seems to be true. But what is also true is that China just executed the most draconian quarantine, perhaps, in human history. And we are not poised to be poised to do anything like that ever. fifth. So these people are basically homebound. And that's extraordinary. I mean, that's just an extraordinary intervention. And it is the case that Chinese have miraculously driven their cases down to about 100 a day, which is unbelievable in the whole nation. But it's through the imposition of such a cordon sanitaire. Technically, it's not a quarantine. A quarantine is when you put

sick people in quarantine. When you put healthy and sick people, it's a cordon sanitaire, which is what they've done. would have to happen in our society for us to emulate that in any way. And again, it seems the kind of thing that need not be accomplished at the point of a rifle, as in China, but the idea that we're going to accomplish it just by getting it into our thick heads, that we should practice social distancing to that degree, it seems very far-fetched. So what we should anticipate is a much freer spread of this contagion in our society. Yeah. Yes. Although, and we'll come back to this, I'm sure, is what can people do? And I absolutely think Americans should be practicing social distancing. On Twitter, I've been talking about this for quite a while, sensible policies of not engaging in any non-essential travel, not going to meetings, washing your hands, not hugging or instead bowing or doing namaste or

something, not touching people, not handshaking, which is very instinctive in our society. These are all basic things all Americans, in my view, should be implementing now. And the reason we do this, incidentally, just to be very clear, it's not just so that you don't get sick. When we do these things, we interrupt the contagion chains that flow through the network. In other words, we're stopping the virus in its tracks by interrupting the means with which it spreads from person to person. So the reason I don't shake your hand is not just so that I don't get sick, but that in not having shaken your hand, I block all paths of the virus from you to anyone else I might meet in the future. And that's extremely effective. And social distancing repeatedly has been shown to be an effective so-called non-pharmaceutical intervention. pharmaceutical intervention. But I want to tackle one other thing, which relates to perhaps another meme on your list, I don't know, which is this claim that the Trump administration's cessation

of international flights was effective. And this has been studied for an extremely long time by scientists of all stripes. And just to quote one analysis, typically, countries are not aware of the emergence of a pandemic until, let's say, the 30th day of the disease, which is, again, roughly what happened in this country with this coronavirus epidemic. By the time the disease emerges in Wuhan around late December, it's spreading throughout the district in the prefecture in Hubei for, you know, at least a month or so. And before, you know, some, we, let's say, we say we're no more flights from, you know, China or something. But again, here, economics weighs against it. People are reluctant

to do this. But the point is that it's been studied repeatedly how effective is cessation of international flights on day 30 of a pandemic. And I'll just read you some numbers. So if you stop 90% of the flights on day 30 of a pandemic, you delay the peak in the epidemic in your country by about 10 or 12 days. If you stop 99% of the flights, you delay the peak of your epidemic by, let's say, 26 days. And if you stop 99.9% of the flights, you only have one out of 1,000 flights still coming into the country, you only delay the peak by 42 days. Now, that's good. Delaying the peak is good. But it's not this panacea that, oh, we're going to stop the thing at our border, because it's still going to come to us. Either it already came to us by the time we stopped the

flights, and it's now brewing, or we cannot totally hermetically seal our country, so it's going to afflict us. So this fantasy that we can somehow, in an age of pandemics, stop them at our border is not justified by the epidemiological modeling. Well, let me just say, in defense of Trump, that's the one decision or one utterance attributable to him that I don't fault him for. I mean, it seemed like it was worth a shot. Why not try to delay it that way if you can? But yeah, I mean, I take all your points. Well, but earlier, yes, but earlier we were talking about how economic considerations might lead us to not close down schools.

But here, economic considerations do not lead us to abandon the effort to stop flights. And yet, the school stoppage is known to be effective, whereas the flight stoppage is known not to be effective. Yeah, no, no, no. Point taken. I mean, I think we should be firing on all cylinders here. But let's talk about the timeline for a second, because I want to just get our bearings here. And it's interesting to consider my own psychological timeline as these events unfold. So as you said, at the end of December, actually December 31st, the World Health Organization reported that there was this mysterious pneumonia in China that seemed to be associated with the Wuhan live animal market. Perhaps we can just cut through all political partisanship here and agree that eating bats and pangolins is a bad idea. Can we agree on that?

We don't think people were eating bats. We do think they were eating pangolins. And the pangolin thing is still a little bit on. Well, first of all, yes, I don't think we should be eating those things, correct. But just to be clear for your listeners, it's not necessarily the case that people were eating those animals. It seems like it's still a little bit unclear that the virus spent part of its time in pangolins, although to my knowledge, that's still not been resolved. But it's fairly clear that it originated in bats. And this is also a bit of a mystery. Even in the movie Contagion, the disease begins in a bat that drops some spit on a pig, I think is sort of what is set up in that movie.

But one speculation is that the immune system of bats may be very similar to the immune system of humans, after all, bats are mammals, and that when viruses adjust to the immune system of humans, after all, bats are mammals, and that when viruses adjust to the immune systems of bats, when they then somehow leap to us, they're already well adjusted to infect us. That's a theory. So all of you who are against cultural appropriation, I think I'm with you here. This is culture that we should not appropriate. This is culture that we should not appropriate. So, okay, back to a timeline here. So, January 11th, China announced the first death in Wuhan. And then January 21st, we had the first confirmed case in the U.S.

It was a man in his 30s, I believe, who actually traveled from Wuhan and came ashore here. So that was 10 days after we heard about the first death. Genetic studies now, reconstruction using genetic phylogenetics are suggesting that there was some transit, and this goes back to the stopping the air travel example we were discussing, that we can use the genetics of the cases in Seattle and what we know about mutation rates to reason backwards and discern how many introductions were there into Seattle and roughly when. My understanding of the status of that science right now is that roughly in the middle of January, someone came from Wuhan to Seattle, and then the disease started having what we call community spread.

That person, we don't know who they are, but the disease was then transmitted to other people and then still to others. And then eventually the epidemic broke a couple of weeks ago. And so by January 30th, the World Health Organization had declared a global health emergency, which they've only done six times since 1948. So January 30th is when those people whose job it is to keep watch over these things decided that this thing was going would say we had two full months, but we had at least a month here to get our bearings and prepare, assuming that community spread was already happening and that things like school closure would be were things we need to think about. I have a timeline of Trumpian insights. At the end of February, February 24th, Trump announced that the coronavirus is very much under control in the USA. And then he said,

you know, crying Chuck Schumer is complaining for publicity purposes only that I should be asking for more money than $2.5 billion to prepare for coronavirus. And it was just an absolutely transparent layer of political obfuscation and messaging essentially to the stock market rather than providing real information about this virus. February 26, we had the first case of community transmission in the U.S. that was acknowledged. I'm sure it happened before that, but this is when we were talking about it. acknowledged. I'm sure it happened before that, but this is when we were talking about it. And on that same day, we've got Trump saying, I don't think it's going to come to closing the schools, especially the fact that we're going down, meaning that the rates of transmission and death are going down, not up. And then this is more of a quote, we're going very substantially

down, not up. We have it so well under control. I mean, we've really done a very good job. Yeah, that's just really irresponsible. I mean, it's a lie. That's a lie. It's not true, and it's really irresponsible. Yeah. Okay. So that's... Two things are irresponsible. Not doing anything or not doing enough is irresponsible, and then misrepresenting the situation is irresponsible. Right. Yeah. So this is where I come to my own psychological timeline, because it's been fascinating for me to kind of watch my own mind here and watch my sense of the situation change and cease to second guess my emotional reaction to it. And so I actually went back and looked at my emails and texts over the last few weeks. So I can see that on February 22nd, I was thinking about canceling some upcoming trips

and still feeling fairly crazy about even thinking that way. And by February 27th, five days later, I had canceled everything, right? And so that was exactly 10 days ago. We're recording now on March 8th. So for instance, 10 days ago, Tim Ferriss and I, who were both supposed to speak at South by Southwest, he was going to interview me for an episode of his podcast. He and I decided to pull out of the conference. And it was widely perceived at that moment, again, just 10 days ago to be slightly paranoid. And it was perceived among my 10 days ago to be slightly paranoid. And it was perceived

among my circle of friends to be slightly paranoid. Sam is being alarmist again. Yeah, exactly. And yet, you know, eight days later, you know, that is two days ago, the whole conference got canceled. Yes. So I've been watching this unfold and I've been feeling more or less a week ahead of where everybody is, or at least most of the people who I'm communicating with and most of what society is mirroring back to me. And way ahead of where the president is. On March 2nd, Trump said, we had a great meeting today with a lot of great companies and we're going to have vaccines, I think, relatively soon. Okay, so he's promising a vaccine soon, whereas the only rational promise

is that maybe by the first quarter of next year. What's the most aggressive timeline that we could have a widely distributed vaccine? I would say 18 months. And we don't have any other vaccines against coronaviruses. I mean, the common cold is a coronavirus. If we could stop the common cold, people would make billions of dollars for a common cold vaccine. You think that pharmaceutical companies haven't been trying? I'm sorry, the common cold is many viruses.

There are some coronaviruses that cause the common cold. Yeah, okay, so I mean, I've heard that the most optimistic timeline is a year from now. Yeah, and it probably will be some kind of inactive virus vaccine that we'll have. So there are difficulties. You know, we have to grow. We have to get culture. There's a lot of steps involved in being able to produce such a vaccine.

That's correct. So, you know, Trump, again, six days ago, is saying there's only one hotspot, and that's pretty much in a home, as you know, in a nursing home. But this is obviously a point after which the CDC had already announced community spread in Oregon and California, at least. It's just useful to keep reiterating how unreliable the administration's talking points have been. So here again, six days ago, we have Trump saying, so if we have thousands or hundreds of thousands of people that get better by, you know, just sitting around or even going to work, some even go to work, but they get better, right?

I mean, this is Trump talking so sloppily, I believe this was an interview on Fox, that it seemed like he was saying that it was okay to go to work even if you have this virus, right? Yes, which is wrong. Right. So, and then the final, this was truly phantasmagorical, on March 6th, just a few days ago, we have him at the CDC wearing a Keep America Great hat, and he's saying things like, I love this stuff, I really get it, people are really surprised I understand this stuff. Every one of these doctors said, how do you know so much about this? Maybe I have a natural ability. Now, pause for a

moment, and this is, you know, maybe rightly perceived as point scoring against the president, but I mean, just pause for a moment to reflect on the fact that it is extraordinarily unlikely that even a single doctor said anything like that to him. He's standing in front of all these doctors, almost certainly lying about what they said to him in the middle of a press conference. But even if they sycophantously said something like that to him, the real problem is the narcissism in believing that. For example, I know a lot about certain things, and I know what I don't know, especially in my field. I'm extremely aware of my ignorance in my own field, but there are things I know about. But my ignorance in my own field. But there

are things I know about. But when I take my car to the mechanic or when I need to have thyroid surgery, I trust those people. I don't think I know more about how to fix a car than my mechanic. That would be just the height of arrogance and presumption. Or when I go to my surgeon, I say, what do you think we should do? And I trust that that person has devoted their life to acquiring this expertise. And that's the whole reason I'm going to an expert. So the idea that President Trump, who may be a skilled businessman and may be a skilled politician, that he would think that he knows as much about epidemiology as the people at the CDC, the real problem there is the narcissism in this individual, not even what the sycophantish behavior that may have led him to that conclusion. So it's astonishing to me that someone would, and I think this is a broader problem in our society right now, both on the far right and on the far left, this sort of denigration of expertise, this idea that the right doesn't trust experts because they want to think that everything is a political decision.

And the far left actually feels similarly, actually, about experts. They don't like the hierarchy. They don't like the idea that someone knows more than you do. But this is absurd. I mean, our society has some of the best scientists, if not the best scientists in the world. We feel we have the best soldiers in the world. Aren't those guys experts at doing battle? You know, we feel we have all these people that are really terrific.

We feel we have the least corrupt judges in the world. You know, we have expert judges. You pick. We think we're great at it. Are we really going to throw that out? Are we really going to think that there's nothing to say about the role of expertise? I think that's just misguided. I think this is a moment where most people are going to acquire a taste for expertise.

A healthy respect for expertise, yes. We're waiting for experts to produce a vaccine for this thing. Yes, yes, correct. That's right. Joe Schmoe is not going to be producing a vaccine in his garage, I can assure you. Like that religious figure, I'm blocking his name, that was saying that he was literally hawking some kind of substance that would cure coronavirus, he said. And it was like that awful character in Contagion that was selling forsythia. I mean, this is, you know, this is the thing. The analogy to a movie is disconcerting here because this is playing out a bit like a movie. I mean, you can feel like at several points here along the way, I felt like, okay, I'm the guy in the first act of the movie who's having an inappropriately sanguine response to facts that should be fairly alarming. Yes. fairly alarming. And it's still, who knows what part of the movie we're in here, but it's a disconcerting comparison. So anyways, so the last thing that Trump said at this press conference, which was truly appalling, was anybody who needs a test gets a test. Anybody that needs a test, as of right now and yesterday, anybody that needs a test can get one. Now, he was saying that at the moment when the most glaring feature of this crisis was

the utter failure of the government to provide tests at scale, right? So I think there'd been something like 2,000 tests performed in the country at that point. And the CDC wasn't even answering the questions from the press about how many tests had been performed. I mean, that had to be reconstructed by asking everyone at the state level what had happened. So, I mean, perhaps people who only follow the president and his Twitter feed and watch Fox News can be forgiven for not understanding what the situation really is. But we have to break out of this political bubble and just encounter the facts here insofar

as we can understand them. And I've had a slightly weird angle on just what we were not finding out about this in real time. Because, you know, I'm in Los Angeles, you know, for the longest time, the number of cases in LA, according to the Johns Hopkins website, were reported to be at seven. But I happen to know a person who was skiing in Italy with five friends, and they all got it, and they all got on a plane and probably infected half the plane. And they got back here, and now at least two of them are hospitalized. I only know one member of this group. He's not a close friend, but he's a very close friend of a very close friend. So I have a very close friend talking to his very close friend on a daily basis who has this thing.

And this is at a moment where I'm hearing that there's seven cases in Los Angeles, and apparently I know five of them. That seems very unlikely. and apparently I know five of them. That seems very unlikely. We're also hearing that this thing is in reasonably healthy people, you know, people who are not immunocompromised or people who are not 80 years old. This is just like the flu. Well, this friend of a friend is now hospitalized and on a ventilator, and his other friend is hospitalized and in an induced coma, I think because the coughing associated with it was so bad. And so, again, this is, I'm well aware that, you know, these are two anecdotes and this is not really data, but from this sort of ground level experience of just hearing these stories once removed, this isn't seeming like an ordinary flu. I mean, these guys

are both extreme skiers. They're fit and 50 years old. They're not in the cohort that you'd think would be on death's door associated with a flu. And so let's just linger on this claim that, honestly, I've heard this from doctors in social situations. I had a doctor say to me, well, maybe we should just all get this thing. We're going to get it anyway, and we'll be fine. You know, you're fit, Sam, you'll be fine. What do you say to this notion that this is basically the flu? all. Second, I've been thinking about this issue, which is like, if you're going to get it anyway, is it better to get it sooner rather than later? And it's definitely better to get it later, because this relates to another topic, which I can't remember if we've discussed already, but I've been talking about this notion of flattening the epidemic. So imagine that you have a pulse of disease that's hitting our society so that a million people are going to get sick.

Those million people could get sick in a very peaked way, like over the course of a month. But if we implement social distancing and other procedures like school closures, and we flatten the epidemic so we still get a million people sick, but now they're sick over six months so that we have a smaller number of cases on any given day, it decompresses the demand on our healthcare system and on our supply chain so that we can actually cope with the people who are sick and need ventilation. So flattening the epidemic is a really important fundamental idea in epidemiology, which is one of the reasons we engage in what is called non-pharmaceutical interventions like social distancing and school closures and all of that stuff. That's why we need to do it, to flatten

the epidemic so that if anyone gets sick, they get sick, fewer people are sick on any given day, and we push the cases out into the future so that some fraction of those cases occur at a time in which we've discovered perhaps some drugs that could treat the disease or have a vaccine available, so we never get those cases, you know, because we've discovered perhaps some drugs that could treat the disease or have a vaccine available, so we never get those cases, you know, because we've postponed them so far. So there are many benefits to flattening the epidemic. Now, when you flatten the epidemic, it's also the case that the people at the beginning, they also aren't putting heavy demands on the healthcare system. So maybe if you're going to get it, if you get it sick sooner, you know, that might be a sensible

strategy. But actually, neither from the individual nor from the collective point of view have I been able to discern any wisdom in that. Because first of all, you might not actually get sick anyway. So rushing to get sick now is sort of stupid. Not everyone is going to get the disease. And second, from a public health point of view, if you encourage people to get sick now, you might actually compress the epidemic. You know, you're going to create a pulse upon a pulse of disease. So, no, I don't agree with your friend for multiple reasons in what they said. Just to be clear, a disease that has a 5 or 10 or 15 or 20x higher mortality rate than the flu is very unlikely to be just like the flu. Yes, and we haven't seen this pathogen before.

It's a new pathogen for us. And there's a whole other, just to telegraph, there's a whole other debate about whether the path, typically these pathogens mutate and get milder as they adapt to our species. And as we fight it off, also, they tend to kill off the more vulnerable members of our species to this pathogen. It's all very sad and clinical, honestly, but it's, and, but we also have to recognize they're likely, likely to be waves of this condition. So we're right now at the beginning of the first wave of COVID-19. here, which is even if we're all destined to get this thing, or even if 75% of us are destined to get it, getting it later is absolutely better when you consider the implications for our healthcare system. Because here are just the numbers. And we have something like a million hospital beds. Speaking now about the United States, there's something like 2.5 beds for every thousand people. We have bed capacity that's much lower than many other countries.

Australia has more beds than we do. We have about as many beds as England does per capita. But we don't have a great number of beds per capita. That's correct. And so just imagine in a situation where everyone gets this more or less all at once, it's just a tsunami of illness. You have the breakdown of the health care system. You have, forget about just the lack of beds, you have doctors and nurses also getting sick, right, and unable to work. Yes. And that's also true. And we can look to China for what the healthcare professionals in

Wuhan have been doing. And I have friends there, or friends of friends there, let's say, or have reports from there via indirectly. And it's unbelievable what those doctors, they've been working around the clock, taking great personal risks. Many of them have died and they're exhausted. So it's serious. And if you even look at Seattle right now, there is concerns in Seattle they're going

to run out of medical supplies to care for their patients there. they're going to run out of medical supplies to care for their patients there. We have a regional sharing system set up in our society so that if a hospital has a crisis and needs many dialysis machines or respirators, they can be loaned regionally. But when you have a pandemic situation where they're needed everywhere, we don't have the excess capacity for, for example, respirators. So it's a very serious situation we're facing. And I hope, I pray, that we do not run out of respirators in our society. But we need to consider the possibility, we do, that we don't have enough of them.

And the fact that we are in that situation is alarming. Yeah. So let's talk practically about what people can do and what is likely to await us in the future. It was just a few more questions about the disease or about the virus. And this is some questions we've gotten from Twitter. trying to send out rational information for weeks now to help people. Part of me, you know, as I noticed the breakdown, I noticed this interesting phenomenon, which many of my scientific colleagues have been sort of stepping up. Like earlier, we talked about how they're redirecting their laboratories to see how they could help the nation. But I've also noticed that many people are like tweeting out more information. And I think they're trying to fill the vacuum, the lack of information or the spread of lies. So for weeks now, I've been trying to send out the most precise, scientifically accurate

information that I can, partly to help educate the public about different things like social distancing, like why does handwashing work? Like what's the latency period for the virus? How does it spread? What are reservoirs of the virus? What about school closures? These are all topics that I think the American public needs to be educated about. Yeah, yeah. Okay, so what about the prospect of acquiring immunity for this once you have it? data that I've seen so far suggests that that either doesn't occur or it's extremely unlikely. That is to say, once you're infected and recover, you have immunity for some period of time, at least a few months, probably a few years. That's still not fully known. But the fears that you could be reinfected rapidly, and there have been some case reports of this,

those case reports were probably false negative tests. So in other words, you had the condition, you had positive tests, then you had a negative test. We think, words, you had the condition, you had positive tests, then you had a negative test. We think, oh, you're cured. And then you have a positive test afterwards. Probably what happened is, is that negative test was a false negative, not that you were reinfected. Right. Right. I mean, even the fact that we're doing this podcast is a noble or makes me happy because, you know, I think you have like a million listeners or some huge number of people. And you could think of it as a public service, you know, to try to get out some basically accurate information. I hope people listening to this will think, what's the harm in my engaging

in social distancing? You know, I could do it for a week or two or three. If it turns out that the epidemic fizzles out, oh, you know, I just didn't shake people's hands for a week and canceled a few meetings. On the other hand, if it turns out the epidemic is large, I've done some stuff to protect myself and I've made a contribution to the well-being of our society. When you social distance, when you engage in these basic practices, you're interrupting the flow of the pathogen through our society. You are part of a superorganism. I argue this in my book. You're part of a collective that's engaged in the battle with this virus, and you're doing your part. Let's put a fine point on that recommendation, because this is advice that I have taken as of

two days ago. So we decided to pull our girls out of school on Friday. So spring break is not for three more weeks, but we're starting now and we're going to homeschool them and just to wait and see what happens, right? Because it just seemed like the school was the weak link in our world. And we have at least one person in our family who's got chronic lung disease who really can't afford to get this virus. So we decided we're just going to pull up the draw bridge, and we're now going to practice fairly extreme social distancing. I mean, we're not going to restaurants. I cut all travel. The TED conference is probably going to get canceled anyway. But on the 27th of February, I pulled out of everything I was supposed to do. And we're just

going to lie low. But I'm half expecting this is going to be a fairly long experiment in social distancing. I mean, I'm wondering whether I just pulled my girls out of school for the rest of the year here. It's hard to know for sure, but let me do a thought experiment with you. If, in fact, your girls were going to be pulled out of the school for the whole year, you've just added a couple of weeks to pulling them out. And those weeks may have been the wisest weeks in the whole period. Right. Yeah. So, I mean, I've been following your tweets and I took them to heart. And frankly, I felt a little late. And the only thing standing between me and doing it several days earlier was just a sense of social stigma. It's like I didn't want to be the first. Yeah. And you don't want to be alarmist, right? You don't want to be like, but you know, that's the problem. You know, these are type one, type two error. Yeah. But everyone's feeling some version of that.

Yes. They're feeling paranoid and yet ineffectual, even when they're taking steps, which seem fairly extreme. But the thing is, but what I want to emphasize is that it's not, it's like so much else in our society has become polarized and dichotomized and people think you either, people think in terms of dichotomies. There are shades of behavior. So we are not, I don't want anyone listening to this podcast to think that you and I think that people need to, you know, go to the woods to their bunkers or something. It's not what I'm saying. What I'm saying is, is that there, there's a shade, there's a range of behaviors from proceed as if there's no epidemic and go about your business with usual social

interactions, to total social isolation, you know, sail off on a sailboat or something or whatever, and in between. So what I'm recommending is adopt some simple practices already that are in between that will reduce your own personal risk and help our society. Don't shake hands, wash your hands several times a day for, you know, what is it, the wording is now, till you sing happy birthday twice. Avoid all non-essential travel and meetings. Just do those things. It helps you. It helps our society. And we'll know more in a few weeks as to what the situation is really like. That's a reasonable thing to do. Yeah. I mean, the other way to think about it is just probabilistically. If there are a thousand ways you might get this thing. If you cut out 900 of them, you've reduced your risk by 90%.

And as you say, you've blocked that path through society to all the other people you're going to be in contact with. So the reason why most people can't do that is just the health argument is straightforward. It's just there's an economic and social argument that is pressing for so many people. Yeah, but no, but hold on. I'm not saying that people, the things that I was recommending did not include stay home yet. What I'm saying is things that you can do right now are non-essential travel, non-essential meetings, hand washing, avoid handshaking and physical contact. Those are things people can do and still go to work. Right. Anything that can be done from home probably should be done from home, right?

There are many companies where people can telecommute. Yes, yes. I would imagine many have not pulled the trigger on that yet as a matter of policy. Yes, that's right. That's exactly right. And also in the past, let's say you shop for food three times a week. Now might be a time to consolidate your shopping list and go once a week. You know, there are different sorts of ways you can manage your life to reduce social

contact for a while until we see what's happening with this thing. That's correct. And I don't see that as alarmist. I think that's just common sense you can do. And that doesn't require you to quit your job or lose your income yet. Right. So a related question there is just, you know, what about panic? Panic is bad. What alarms me is that when government is clearly, like in any of

these press conferences, when the purpose is transparently to reassure without actually giving good information, it's just they're just trying to dampen panic. That is, you know, in the uncanny valley of reassurance. And it actually is just, frankly, alarming to see people obfuscating for the purpose of dampening emotional arousal. So how do you think the government and scientists should speak about this, given that panic and the reality of social contagion is also worth worrying about. Yeah. So how do you think we've been speaking about it? Do you think

that when I agreed to come on, I was trying to make sure that I communicated factual information, that I was balanced, and that I was not alarmist? And I hope I have not been alarmist, and I hope I've communicated factual information in a balanced way. That's my objective, and you're listeners and you can decide that. But we have very sober-minded scientists that speak in calm and rational ways, for example, in Dr. Anthony Fauci. And these are the sorts of people that if I were president, I would be putting before the public. These people will, sort of like when we are, when they're matters of military

importance, you know, the generals that speak, they may be misinformed, they may not know everything, but they speak in measured and serious ways about the matters of, you know, military operations. And I think that's what we need right now. And we have such people in our government and in our society, and I think we should be listening to them and we should be allowing them to speak. It would be a related benefit to social distancing if we had a new norm around how people behaved when they were sick with anything, with anything infectious, a cold or a flu. If people simply did not go to work sick, that would exert an evolutionary pressure on all these bugs to become less symptomatic, right? Well, I mean, that's another thing relatedly that we should be doing in our society.

If you don't have an essential health problem, you should not be seeking medical care right now. Not only because you don't want to go to a health care and be exposed to other people, but in order to unburden the health care system. What the Chinese did, which was unbelievable, is they moved 50% of their medical care online when the epidemic struck. Anyone that just needed a prescription refill, for example, they just started doing that online. You don't have to go see your doctor to get your heart medication. Just call your doctor and say, okay, we're going to do that. So it decompresses the health system, frees the doctors up and nurses

up to do other stuff that's more important. And it reduces the risk of exposure, mixing, the social mixing, especially of sick patients. So people listening to this, they should say, you know, if I don't need to, you know, if I have, if I'm not seriously ill or I have routine healthcare stuff, I should help my country by not seeking medical care right now. Now is not the time to do that. my country by not seeking medical care right now. Now is not the time to do that. Yeah. But the point I was making is that if social distancing were the norm whenever people got sick, you know, personally, if you just didn't go to work when sick, that would exert evolutionary pressure on all of these bugs, whether bacteria or viruses, to mitigate their symptoms so that, you know, like colds wouldn't be as bad if you only

spread them when they were truly almost undetectable, you know, from your point of view. So what do you do with the fact, though, that it seems that people are infectious prior to being symptomatic, you know, perhaps for as long as two weeks? I mean, that seems like a disaster. No, I don't think it's too, I don't think it's that long. I mean, we don't know yet exactly. That's still unknown. So there are two epidemiologically relevant facts here. There's something known as the incubation period. That's from the time you're infected to the time you're symptomatic. And then there's something known as the latent period. And that's from the time you're not infectious to the time you become infectious. And the difficult thing is if the latent period ends before the incubation period ends. In other words, if you transition to being infectious before you transition to being symptomatic. for a fact yet whether asymptomatic coronavirus patients can transmit the disease, and if so,

for how long. But there are people actively working on it. But it's not more than a couple of days, even if it is. But if that's the case, that's worrisome, because that means people are out there spreading the disease without, you know, they can't even use their own symptoms as a heuristic for staying at home. Right. What do you see as the possibility of our taking extreme steps of the sort that China or even Italy have taken at this point to contain the spread in any given city or any given region? Well, I don't think it's culturally or politically viable for us to do what the Chinese have done. I don't know how similar we are to the Italians. My understanding of the authority that governors of our states have, and I don't know what the federal authorities are, but I'm pretty sure the state governors have authorities to basically shut

stuff down in the public interest and enforce it with a state national guard and sort of power. So the power of quarantine exists in our society. And I'm not a legal expert, so I don't know the details of where those powers are vested and how they're enforced. But, you know, I can imagine that there would be a lot of political will to do such things if the situation got really bad. You know, there would be checkpoints on roads to reduce transit. The president can order the flights not to fly, you know, there would be checkpoints on roads to reduce transit. The president can order the flights not to fly, you know, and this has been modeled, you know, internal restrictions on air traffic have been modeled as a way to reduce the epidemic. So I don't know. I can't forecast

what would happen. But I do believe the government at multiple levels has the authority to do such things as it should. You know, as a society, if we're trying to confront this, we need to do it in an ordered, cooperative way. There's a point that I think we might have made, although perhaps we dropped it in differentiating this from influenza. From everything we know, coronavirus is more infectious than influenza. It's difficult to measure. So the so-called R-naught, or actually

more precisely something called the effective reproductive rate, which is the number in a steady state, the number of new cases for every old case, people are estimating is between two and four. So we don't know yet exactly how it is. And just to be clear, that number is related to intrinsic properties of the virus, but it's not solely determined by that. So for example, the transmission rate of a pathogen depends, for example, on the extent of social mixing. If I suddenly obliged everyone to sit in a prison cell, if one person got sick, they wouldn't transmit it to anyone else. So it's something about how we're organized socially that determines the RE, the effective reproductive rate. And so we estimate

right now that it's around between two and four, which is high. The Chinese, at the beginning of the epidemic, there was a nice paper that was just written by a group of Chinese scholars in collaboration with some investigators at the Harvard School of Public Health. At the beginning of the epidemic, if I'm remembering these numbers correctly, they estimated the effective reproductive rate at around 3.8. So for every sick person, 3.8 new sick people were created. But because of their social engineering in China, where they have, as we discussed earlier, have this, you know, incredible quarantine, basically, that's nationwide, they have driven that down to like below one. And when you get the number below one, that's when the epidemic peters out, because each cases aren't replacing themselves. What about the prospect that this is essentially always going to be with us, you know, once it's a pandemic. Yes, that's what's going to happen.

So if it's always with us and it's much worse than flu, and I mean, flu, we need a new flu vaccine every year because the old one didn't do the trick because it's mutated. What's a rational picture of the future if, in fact, this just keeps circling the globe and mutating, either getting worse or getting better, depending? What do we expect of the future here? — It's hard to know for sure. Many experts believe that this will join the existing coronaviruses that afflict humans or be like another common cold-type virus. You know, we've just now added a pathogen to the list of pathogens that circulates in human beings. It'll become what's known as endemic, you know, always there in us.

It's a little unclear still. Earlier, we discussed how the virus might become less problematic as time goes by, you know, as it adapts to us and we modify it with our collective immune systems, you know, fighting it off. Yeah. So I don't think it's going to disappear completely. I think it will remain in the human population. I, it's hard, very hard. I'm not willing to forecast how serious it will remain as time goes by, but, you know, I think we're going to have this current wave, which I think will be, is there's a good chance it will be serious. And then we will have another wave or two and, you know, in a few years we'll know, you know, what is the status of this virus with respect to us, like other viruses that affect us. Can you think of something we haven't touched that you

think we should be hitting? No, I mean, I think we've covered a lot of things. We've covered, you know, some basic facts about the virus and what it is that we can do. You know, we've talked about, you know, the prospects for pharmaceutical interventions versus non-pharmaceutical interventions, which we clearly need to implement as a society. You know, we've sort of benchmarked the severity of the condition. We've talked about flattening the epidemic, which is really important. You know, we've covered, I think, the gamut of sort of basic epidemiology, as such as it is, of epidemic, a pandemic influenza. I think I'd like to end on an optimistic note.

I mean, I think our species, this is not the first time. It's already not sounding optimistic. If you're, if you're going to the species level, our society is not the first time America has been afflicted with pandemic disease. And, you know, I think we will see the other side of this, but I think it's going to take

a lot of working together to address it. I think it'll take the full attention of our political leaders and of our scientific establishment. Our commercial sector is going to have to rise to the occasion to build more respirators and more masks and whatever else we need in order to confront the condition. And I think people on the street are going to have to adjust their lifestyle for a while in order to contribute to our society, in order to confront this disease. And I hope that it is much milder than it could be. And there's a range of outcomes as we've discussed. And I hope it's on the milder end of that range. Yeah, yeah, as do I. I certainly hope that my

current state of mind seems like an overreaction in retrospect. I mean, the only point in my life that had an analogous feeling was 9-11, where it's just like, okay, this is a moment in history, right? This is not life as you have taken it for granted, you know, year after year. I think this could be a moment in history. I think in a few months, we'll know whether in, you know, in the early spring or late winter of 2020, you know, the world was afflicted with a pandemic and a serious pandemic. I mean, the pandemic, by the way, just means an epidemic that strikes multiple regions. And you could have a mild pandemic or a severe pandemic, you know, that's a different topic. And so I think

we'll know within a few months, you know, how serious this is. And, you know, we'll all remember where we were when we first heard about it. Or if it's mild, we'll forget. Nobody remembers very much about SARS and H1N1, and maybe it'll go that way, and I hope it does. Okay. Well, I will be touching this topic again, no doubt, and you and I will be talking about happier things at some point, I trust. Thank you for having me again, Salmon. Thank you so much. Yeah, to be continued.