Making Sense with Sam Harris - #214 — A Conversation with Siddhartha Mukherjee

Episode Date: August 13, 2020

Sam Harris speaks with Siddhartha Mukherjee about our ongoing failure to adequately respond to the Covid-19 pandemic. They discuss the significance of asymptomatic spread, the lack of Chinese cooperation, the failures of testing, travel restrictions, the missteps of the FDA and the CDC, controversy around masks, the lack of coordination among the states, conspiracy thinking about mortality statistics, the political contamination of public health information, electronic medical records, preparing for the next pandemic, the immunology of Covid-19, the long term consequences of the disease, concerns about a vaccine, the coming prospect of school openings, 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. Just a note to say that if you're hearing this, you are not currently on our subscriber feed and will only be hearing partial episodes of the podcast. If you'd like access to full episodes, you'll need to subscribe at samharris.org. There you'll find our private RSS feed to add to your favorite podcatcher along with other subscriber-only content. And as always, I never want money to be the reason

why someone can't listen to the podcast. So if you can't afford a subscription there's an option at SamHarris.org to request a free account and we grant 100% of those requests. No questions asked. I am here with Siddhartha Mukherjee. Sid, thanks for joining me again on the podcast. Thank you very much. Thank you for having me.

So you've been here twice before. We spoke about both of your fantastic tomes, The Emperor of All Maladies, which is really the definitive book on cancer in our lifetime, just an amazing book, and also The Gene, which was also amazing. And so we've spoken about both of those books at length on the podcast. I recommend anyone interested in those broader topics consult those previous conversations. in those broader topics, consult those previous conversations. But today, I just want to talk to you about the COVID pandemic in general and just get your kind of expert eye view of what has been

happening here these long, now five months in the U.S. that we've been dealing with this. I think ineptly, by any objective criterion. You know, our ineptitude is fairly well established here. So, and I'll just, I'll remind people who may not know it, you are a famous oncologist and also writer, but your background is in virology. So, you actually have a wheelhouse that is relevant to our current concerns. So just to start off here, and we can go anywhere you want to go, Sid, but what has been your experience watching this all play out and watching, in particular, watching the spread of misinformation and just the way in which it's been given top spin by political cynicism in many cases.

And also, just in the beginning, there was a fair amount of actually good faith uncertainty about the biology and epidemiology of COVID. And so it really has been hard to draw the line at various points between a valid contrarian opinion and a dangerously irresponsible one. And, you know, granted that that line is probably getting clearer, but what's it been like for you these last five months watching this unfold? So I think there are several threads in that conversation that I want to break apart because they're quite different. So I want to make a very clear distinction between the uncertainties of which there are many and the ineptitudes of which there are many.

So we can talk about them separately because those are important. And there's gray zones in all those cases. So let's first talk about what went wrong and what could have not gone wrong in the United States and around the world. Well, before that, let's talk a little bit about why this particular virus of all viruses has the capacity to cause a pandemic. And the answer lies in the biology of the virus. There are two features or three features of the virus that make it particularly a pandemic-causing virus. That obviously is not true for many viruses. One is that it's completely new. We have never encountered it before, as far as we know.

And so, therefore, humans are immunologically naive to the virus. That's one. The second thing, and now we're getting to really important things, is the fact that the virus has a high degree of high capacity to spread. The virologists use one measure of this, a measure called R0, which is a measure of how many people one person infects. And obviously, mathematically speaking, if that number is above one, then the infection will spread exponentially. So some viruses have huge numbers. Measles is a very, very highly infectious virus. SARS-CoV-2 sits actually in the higher range. It's hard to estimate exactly what that number is because it varies depending on the population and the behavior of the population, but it's got a high number. And the third feature, which is actually probably the one that we realized very late and

perhaps too late in the game and is the most insidious feature, is that asymptomatic people, people with absolutely no symptoms, seem to be able to carry the virus and spread the virus. Now, that's a big distinction. That is not true, for instance, for Ebola or other very lethal viruses. When you have symptoms, you usually then become a transmitter. But it's true for this virus that we might be familiar with other viruses that it's true for. HIV also, it's true for HIV. You can be completely asymptomatic, but still transmit the virus. You can have virus in your blood and transmit the virus. These viruses that have this capacity to

have asymptomatic transmission are particularly difficult because you cannot simply find people by symptoms alone. You have to find them by testing. And if you want to contain the virus using public health strategies, such as containment or quarantine or isolation, you have to essentially find them. You have to go and find them. They will not find you because they don't know whether they, by you, I mean a medical doctor or a medical system. And that's because they don't know if they're carriers, asymptomatic carriers, or they're really having the virus. So that covers the territory of why this virus, of all viruses, has and had the capacity to start a global pandemic. So this brings us to the next piece of conversation, which is the conversation about

ineptitudes. So very important to remember that the ineptitudes started right from day zero in Wuhan, China. We should have known about this virus long before we actually did as a global community. Several attempts to buy Chinese doctors in full faith, to communicate the urgency of what was going on in China, were essentially blocked, we think, or we now know to some extent. And in fact, as you very well know, the ophthalmologist who sounded the alarm on the virus was essentially censored. And unfortunately, as you also know, he died of that viral infection. We'll come back to that. We'll come back to that in a second. It's very important because that tells us something

about the virus, I think. So that's where the ineptitude started. I would say that's a global ineptitude. I mean, people have conspiracy theories around it. I don't know what to believe and what not to believe because the investigation has not really proceeded. The Chinese government has been extremely reluctant to share many crucial pieces of information around that first, you know, those first few days. Are you referring to the speculation that this came from a lab as opposed to a wet market or what conspiracy are you thinking about? So many. So one is that I think we still don't know the origin of the virus. I think that there was an interview in Science magazine from one of the workers who cultivates

coronavirus in the Wuhan coronavirus facility, and she's adamant that it did not come from the lab. But the question is, that lab has not been appropriate, that incident has not been fully investigated. I just don't know. I don't think it was a bioterror weapon, for instance, nor do I think that it was an intentional infection of someone. But I do think that we need to investigate and find out where the virus came from and perhaps even track back the very first index case, which is usually possible if we have access to full free information, which we do not at this point of time. Just to linger there for a second, does it actually matter? Within a very short period, we had the full sequence of the virus,

and we're now dealing with the basics of vaccine design and treatment design and epidemiology, does it really matter what the origin moment was? It matters for future pandemics, and it matters for future surveillance. One of the things that we have to learn from this and never let it happen again. And doubtless, there are hundreds of thousands of viruses, xenoviruses, that lurk in bats and other animals, particularly social animals. I mean, one question is, you know, why bats seem to carry so many viruses? It's because they're, you know, they're very social, and they live in very dense populations in environments. So it matters for the next pandemic, because we cannot let this happen again.

But moving to the United States, the ineptitudes or the, I would say, the glaring errors began also very quickly and began from the start. So one error that began from the start was that obviously it was the first response here was, oh, it's going to go away. It's not going to come. It's going to go away. That's obviously now not been the case, but that was a completely misplaced response. It was not going to go away. that should have been an immediate call for urgent action. Because we knew, as I said, that this was a xenovirus, it had a rapid spread. And we knew by that time, there was enough suspicion in the virological community that there were asymptomatic spreaders. It wasn't definitive. But as soon as that suspicion is raised, you need to start acting on it. So we're at the end of January, we're in a small hospital outside Seattle. The first index case walks in. That should have sounded a major alarm to the CDC and a major alarm to every health authority saying the virus has now entered the United States and

we should do something about it. The second major, I would say, glaring error, which should never be repeated, was probably the biggest of them all. And that is, once the virus was in the United States, there was no test for the virus for about 40 days. So there was no FDA approved test for the virus for 40 full days. I cannot emphasize as an immunologist or a virologist that it is inconceivable that that would happen. But for 40 full days, there was no test for it. And that was partly because the CDC tried to make a test, and the test, the first batch of the test worked. I interviewed virtually everyone I could, and there's a big piece that I wrote in The New Yorker about this.

The CDC made a test. Actually, in the end, it was a good test. But when they expanded the batches of the test and sent it out to the public health services, which is where these tests are usually then monitored, the test failed to work. One probe, one of the pieces of the test, kept showing up with false positives, which meant the entire test was not reliable. Now, in that meantime, in that same period of time, so as the clock is ticking now, day one, day two, day three, several academic investigators, including folks like Alex Greninger at the University of Washington, who I interviewed for the piece in The New Yorker, and I have had a long communication with, Alex Greninger had by himself in his lab developed a test for the virus. himself in his lab developed a test for the virus. But that test had to be, in order to be used,

it had to be licensed by the FDA and the CDC. Now, the FDA and the CDC, you know, we have something which allows such licensing to proceed very quickly, which is called the Emergency Use Authorization, EUA. And if you speak to the FDA and the CDC, they will tell you that, oh, gosh, our E-U-A was working fine. We were just waiting for our tests to be corrected. If you ask people in the private laboratories, they will say just the opposite. They will say, well, we applied for the E-U-A, but by the time it turned around, it was already too late. And I think you describe, and I think this was in your New Yorker around, you know, it was already too late. And I think you describe, and I think this was in your New Yorker piece, you describe doctors spending nearly 100 hours filling out forms to get permission to test. And these forms couldn't even be emailed, right? They

had to be snail mailed to the FDA. And it just sounds like the infrastructure over there is a generation old. So I spoke with the FDA and I spoke with the CDC. The FDA says that it was a parallel infrastructure, that you had to do a snail mail, but they would also accept emails. That's what the FDA says. And it also says that, and it maintains that they were processing these as fast as they could. The laboratory investigators say that that's not the case, that in fact, the snail mail slowed them down. One problem, of course, you have to realize that there was an intrinsic problem at this point of time, which is that no one had samples. So in order to validate a test, you need samples to validate a test. But if you have only, it's a

perfectly circular argument. So in other words, if you don't have a test that works, you don't know who to validate it on because you don't know who's infected. And how can you prove that a test works if you don't have samples to validate it on? Do you see what I mean? So it's a perfectly, I mean, we really need to learn about these pieces of logic or these, you know, these sort of failures, some of which are, I would say, some of which are intentional, some of which are non-intentional, but this is a perfect example. And it could be applied to any business, it could be applied to any medicine. If asymptomatic individuals can carry the virus, which happens to be in this case,

then how do you get, you know, 20 people, what's the, what is the, was it a, what does a, how do you test whether a test works or not? You can't because you don't have samples to test it on. Anyway, in any case, by 15, 20 days in, Greninger and others had scrambled together enough material from various sources to be able to test, to show that their test worked. And eventually, of course, the FDA CDC test also began to work there. There was a faulty reagent that was corrected. But by all of this time, you know, 40 odd days had passed, 30 odd days had passed, for the most part. I mean, of course, there was testing going on as well. But about, and that's a critical period of time, because that is when the infection was spreading. And we don't even know what happened in those 30

to 40 days. We don't know how many people flew from Seattle to, for instance, New York and New Jersey. We don't know how many people came in from, there was no travel ban, remember, on Europe. So that is mistake number two. So we just went through mistake number one, which was the absence of testing. Mistake number two was to dismiss the idea or was to say, this is a Chinese problem, this is a problem that is in China, and not recognize the fact that the slopes of infection rates were climbing rapidly in Europe, in Italy and Spain. So during the time that we had no test, there were people coming in and going out of major cities, New York being probably the major epicenter. And there are several genetic clues that clearly suggest that the infection in New York, at least,

was primarily seeded by European travel and not travel from Asia. The infection in Europe was seeded in turn from Asian travelers who came into Italy and Spain. But the infection in New York, we have genetic evidence to suggest that it was from people who came in from Europe. So not putting in a travel ban, testing ban, or even a quarantine in isolation during that period of time when we didn't have tests is a crucial error, and that was error two. I should say that, just backtracking a little bit, I should add that the FDA and the CDC have had a long history of working with public health laboratories, but they have had actually not a very long history of working with private academic laboratories, so like the University of Washington or like Columbia University, etc. So that is in some ways error number three, because if the FDA had had a well-established track of, or if they had vetted and pre-authorized, as countries like South Korea and other places did, some academic laboratories as being good enough or of high enough caliber that if they were to apply

for a test, a successful test, that the FDA would say, okay, ours doesn't seem to be working. We'll take yours until ours gets to work. That infrastructure was present within the FDA, but present in a very infant form. That's what the academic laboratory folks told me. So academic pathologists told me. The FDA says that's not true. And so the question is, when we perform the autopsy, one of these two things is correct. We don't know which one it is. One of these two things is correct. We don't know which one it is. Either the FDA has had a long tradition, and it's quite smooth and streamlined their capacity to work with academic laboratories, pathology laboratories like Greninger's and Columbia's

and New York hospitals, or it is, in fact, was not streamlined and had to be streamlined in a kind of emergency setting. So now we keep moving. The clock keeps ticking forward. So now we have people from Europe traveling into the United States, carrying virus, symptomatic, asymptomatic. We don't know. There is nothing going on in the borders, except for originally, as you very well know, a ban against Chinese travel. But of course, that was not where the leak came from.

And they're coming into New York, and they are spreading the virus asymptomatically. And we don't even know where they're going, what they're doing, where they're spreading the virus. And we don't even know how many, because the test is still lacking. So move the clock forward a little bit forward again. Actually, before we advance, I'm wondering, let's just linger on the testing piece for a second. So what ensures that we learn the right lessons here? It seems to me that some lessons seem genuinely hard to learn because in normal times, you would view this sluggishness from the FDA and the CDC as a feature, not a bug. I mean, obviously, it's got to be motivated to some degree by wanting to ensure quality control. You don't want to just approve labs all over the place to get their competing tests to scale.

They're competing tests to scale. And I got to think the status quo was motivated to some degree by an awareness that there's a trade-off between safety and speed in situations like this. So you're absolutely correct. I mean, the last thing we want is a trigger-happy FDA or a trigger-happy CDC, so that we certainly don't want that. But what we do want is a CDC and an FDA that is able to respond to pandemic situations in a different way than it responds to the approval of any drug or test in normal circumstances. So there has to be some kind of hysteresis or some kind of space, as it

were, a dial-up, dial-down system in which you can dial up or dial down the responsiveness based on the situation. One way that I proposed in the New Yorker piece and subsequent pieces, I'm on several panels that have to do with COVID response and what we learned from the COVID response. But one way is to do exactly what I told you, which is to do some kind of pre-authorization so that the FDA would have, rather than waiting to receive applications in the setting where their own test was not working, to go and seek out people that they have already vetted and ask them, you know, can you help us figure out at least an interim test? We will validate that test and at

least launch that while we wait for our test to come in working. So that would be, that would have been one kind of solution. And this pre-authorization process or pre-vetting process could be quite stringent. You know, you don't, you know, the FDA has lots of time in between pandemics to ensure that, you know, the University of Washington is not just, you know, out to make a fast buck and that their, you know, their PCR machines and their, this is their, you know, what their capabilities are. How many tests can they do per day? How many, what is the reliability of their testing infrastructure? Can they report out those tests, et cetera, et cetera. So that rather than waiting and being passive, the FDA would have been, or the CDC and the FDA would have been active during this process. So that's one thing that one can learn. You don't want a

trigger-happy FDA, but you do want an FDA that is prepared to what I would call dial up and dial down in the circumstances of a pandemic. Yeah. Yeah. Okay. so take me to the border. We now have people pouring in from Europe, many under the increased load precipitated by the sudden announcement that if you don't get in in the next 15 hours or whatever it was, you're not getting in. So we just had people flooding the airports of Europe, trying to catch the next plane out, obviously breathing heavily on one another all the while. How do you perceive that moment? So we're then now in a situation where, as I said, in New York City, we don't have testing,

we don't know what's happening here. And what is happening in Europe is just the opposite. So what is happening in Europe is that everyone is reacting to the situation in Europe and they are getting on planes and jumping on planes and essentially coming as soon as they can. They're arriving into New York City. And New York City very, very soon is full of people from Europe who are trying to catch the next flight back. And we have no quarantine for them. We have no isolation for them. We have no contact tracing for them. And there is no way to know how long they will stay, whether they are tourists, whether they are locals returning back. It's just mayhem. So that brings us, you know, the clock now ticks and we are now back in, we are now sort of 60 days, 50 to 60 days, and we're beginning to see the uptick in New York infection rates by now. So

clearly this is a signal that's a problem. There's a, you know, there's a surge or the beginning of the surge. And that's usually when we start to do things like quarantining and now things, you know, isolation, contact tracing and masking becomes important. So at this stage, what's important is to have one clear, consistent message saying we're just beginning to test. We don't know if people have been quarantined or not. We don't know if people have been isolated or not. We're just beginning to test. We don't know if people have been quarantined or not. We don't

know if people have been isolated or not. We're just beginning to test. But the first thing you should do is start social distancing, you know, avoid crowded situations, etc. But most importantly, we don't know, and we'll come back to this point in a second, Sam, we don't know if masks work or not, but they have historically worked against other respiratory viruses. So if you're symptomatic, wear a mask. And particularly if you're a frontline healthcare worker, wear a mask and probably wear full PPE, because that's what we learned from the Chinese, that it's a highly contagious virus. And essentially, the CDC vacillates on masks. First, it says, nope, not required. And we've spent a lot of time... Said it was even worse than that. I don't know if this was the CDC or the

World Health Organization or both, but someone at that point, I think, clearly concerned that there was going to be a run on PPE and therefore not enough for frontline workers. There was messaging around masks, not only maybe not working, but being counterproductive, that you'd be more likely to be touching your face. You're more likely to get sick, perhaps, by wearing a mask. So people were actively discouraged at one point from wearing masks. That's exactly right. And the Surgeon General at that point in time also said that masks were not required. And the logic that I have heard is that it was because, you know, people were saying that there'd be a run on PPE, personal protective equipment,

that there'd be a run on PPE, personal protective equipment, and that doctors would therefore not be able to get any. But that obviously, to the public, that makes no sense. How can it work for doctors but not work for you? It just doesn't make any sense. And so we then go through this moment in which we don't know if masks work or not. And you can't test it experimentally, right? You can't give people coronavirus and say, you know, either half wear masks or half don't wear masks and see.

And remember, masks work both ways based on a whole bunch of experience with respiratory viruses. They protect a spreader from spreading and they protect an uninfected person from getting the virus. So they don't have enough N95 masks, the kind of mask that really is fitted and, you know, lets through only a very small fraction of respiratory particles. These are not that heavy duties. You know, they're not that fancy. They cost less than a dollar, typically. But hospitals are running out of masks and the emergency rooms and the hospitals are becoming progressively crowded with people who have symptoms. So there is a complete breakdown of communication between all the folks concerned about what is happening. The hospitals are getting crowded.

The doctors are, and nurses, and I should say especially the nurses, don't have equipment to protect themselves. So they're cobbling together whatever they can get. Some hospitals have N95 masks, some don't. They're cobbling together whatever they can get, and they're trying to move forward. But really, it's an emergency situation. Many doctors are getting exposed. And as you know, some people are going to the ICU because they don't have, some patients are going to the ICU because they're beginning to develop these severe complications of COVID. So that is where sort of all of a sudden we are in the middle of, we're now in mid-pandemic and people, many people start obviously having severe problems. The second thing that happens at this stage, which is another mistake, is that some people get discharged from the hospital after being tested and they are

asked to return to nursing homes where also they don't have PPE and nor do they actually have any real equipment to protect the workers or protect residents from each other. So we have a situation in which people are basically going back and these nursing homes become petri dishes because the virus then goes and infects, you know, via nursing home workers, healthcare workers, or through direct contact, people who are elderly and who are the most vulnerable. And this cycle begins to repeat itself. So you go to the emergency room because you feel sick. You aren't sick enough that they would admit you to the emergency room. There is no quarantine in place. There's no isolation in place. There's no contact tracing in place. Some of those people

are sent back to their, you know, rehab facilities, nursing homes, et cetera, because they aren't sick enough to be in the hospital because the hospital beds are too full. And they go and they become new sort of sources of infection at the nursing homes themselves. Meanwhile, the government is saying publicly, don't wear masks. We have a federal system, as you know, which is a problem in a pandemic. We'll come back to that in a second. It's the governor's individual decision about what to do, whether to isolate, whether to quarantine, whether to close schools. New York ultimately closes schools, in my opinion, late, too late, two weeks too late, perhaps. And then by then it is too late, in this city at least, to do anything.

So from that moment forward, I know New York became its own version of Italy. And so many things happened from the public perception side of this that are just frankly bizarre. I mean, the fact that we were sitting here watching, I mean, I guess it's understandable to hear that there's a flu in Wuhan and who knows if it's going to get here. But, you know, once it's starting to get here, and once we see what's happening in Italy, our lassitude seems fairly inexplicable from my point of view. But even if you could explain that somehow psychologically, that this intuition that never really had to be stated, that might be some law of nature that would prevent this thing from spreading to every

corner of the earth and every inch of our society, if we just sat there and did nothing about it. inch of our society if we just sat there and did nothing about it. Once it hit New York and New York became fairly similar to Lombardy, you still saw a country that was incredibly slow to respond. I mean, with some exceptions, California responded pretty quickly. But even the places that have responded, even California, and went through a significant lockdown, it still was a fairly piecemeal effort and all the while undermined by our basic failure to get any of these necessary ingredients of a response to scale. I mean, testing, tracing, PPE took a long time. I don't even know if PPE is in danger of running out now. How do you explain this general picture of, forget our initial missteps, once we understand

the gravity of the problem, how do you explain our failure to get up to speed and to perform the way you'd expect the leading technical and medical power on earth to perform? Well, there's several explanations, Sam, and you've identified most of the problems right off the bat. One explanation is that in this federal system, or really in a system where governors have independent choices and decisions to make and have full authority or large authority, unless you have a system in which under emergency, a task force takes over and tells people exactly what to do, then things begin to fall apart. So what happens in this particular situation is that states essentially have or use their own metrics, their own decisions, and they're quite wildly different. So California

and New York, New York is in the mid-pandemic, California reacts early, and many places imposed lockdowns. But in general, these lockdowns are not really severe or compliant. So businesses are locked down, which of course causes great economic loss, but people are still wandering the streets. There is no systematic lockdown. Now that's the opposite of what you want, right? So you want businesses, obviously, to remain open as long as you can, and you want people to stay in their homes and be tested and be contact traced. But in many places we've seen in the United States, just the opposite happens. Businesses have to comply for lots of reasons, including the fact that they have to protect their employees, but people are not compliant. You remember in Spain and Italy and many other countries,

you know, there was really a quasi-military intervention to prevent people from entering the streets. You know, if you went to the streets, a police officer would come up to you or a military officer would come up to you and say, what are you doing and why are you out of your house? That was the state of lockdown, which is a real lockdown. A quasi-lockdown is worse because it hurts the businesses and it doesn't prevent the spread

in people. And unfortunately, in many cases, there was a quasi-lockdown. Masking was not mandatory. In New York, we quickly made masking mandatory. And I suppose I'm proud to say that's one of the things that I and others pushed very early on, saying that, yes, we'll never have the final evidence, and maybe we won't get it in time. But from lots and lots of respiratory viruses, we know that social distancing and mask wearing does reduce viral load, does reduce viral transmission, especially if both the infected and the infectee or the naive, if both of them wear it, you get a double effect and potentially a synergistic effect.

So what you have in the United States is this kind of bizarre crisis in which there is, you know, what I would call a quasi-lockdown with enough leak-through that, in fact, as soon as the lockdown is opened in some places, the virus starts spreading again. Now, in New York, the lockdown was very strongly enforced. And to some extent, we saw the worst of things. We saw the worst of the pandemic, a huge number of cases and a huge number of deaths. But then once the lockdown was in place, there was quite a lot of compliance. There's a high degree of compliance in New York and New York State on masking. There's a high degree of compliance on social distancing. And New York is still going through phases, but New York opened in phases. And that's important

because when you didn't open in phases, what we've seen in other places, when you went from lockdown to complete open situation, what happened is we've seen that once again, the curve of not just infected cases, but deaths has begun to rise again. It's very important here. These are lessons that we've learned actually from cancer and from other diseases. It's very important to. These are lessons that we've learned actually from cancer and from other diseases. It's very important to count deaths because deaths are not sensitive to testing. You know, if you increase testing, you'll detect more people. Deaths are not sensitive to testing. Deaths are an absolute value.

And I would urge anyone who's listening or reading to this to, you know, you can just, it's very easy to Google. You can just Google US COVID deaths, and you'll see exactly the whole story laid out in front of you. You'll see the rise, which is mostly in New York, New Jersey, etc. rise, the lockdown, and then you'll see a second rise. And that is, of course, in states such as Arizona, Southern California, especially more than Northern California, and other states, Texas. Except, Sid, even here, there's been room for doubt and conspiracy theories, right? death statistics are completely false because hospitals have been incentivized to more or less presume or assert COVID as the cause of death, even when, you know, someone is, you know, stage

four pancreatic cancer and, you know, had a, you know, a week to live anyway, or they didn't even test them, they had a fever, and that's compatible with a COVID diagnosis. And you've had people, again, you know, you've had obvious crackpots and lunatics saying this, but then you've had extremely prominent people who don't have any expertise here, you know, people like Elon Musk, you know, out on social media saying these things. So can you put this particular concern to rest that our fatality statistics can't be remotely trusted? Yes, I can, or partly can I know was incorrectly marked as dead from COVID when they actually were dying or dead from something else. So that's anecdotal. But more than anecdotal, actually, we have numerical evidence of this being true. And that is the fact that the

case fatality rate for COVID, which is the number of people who die upon getting infected, which is the number of people who die upon getting infected, has really hovered across the world around 0.7%. You know, a little bit higher, a little bit lower. And obviously it depends on age groups, you know. So if you're in the worst category of the most susceptible category to death, it would rise to, you know, 5, 6, 7. These are elderly people or having comorbid conditions. But if you look overall, the pattern of, you know, the numbers, you know,

end up being in the 0.7 to 0.8% range. And when we were doing adequate testing, we have now slowed down in the United States because now the test is, you can't get a test, you know, the test turnaround time has now gone up again to about seven to eight days. But when we were doing adequate testing and appropriate testing, the mortality rate was tracking that number, 0.7, 0.8, 0.1%. It wasn't tenfold higher, onefold lower. So if you just use simple math, it will tell you that the simple math would tell you that as long as the deaths don't go a log fold, let's say, or tenfold higher or lower than what has been seen all around the world, then the deaths are real. Now, of course, these people have premorbid conditions or comorbid conditions. And yes, of course, I mean, some of them may have conspiracy, that it can't be such a large conspiracy to completely distort reality. Am I making sense? Yeah, no, that makes sense. So how do you explain

the fact that even at this late stage, we seem to be losing ground on testing? I mean, again, the picture is one of an erstwhile medical and technical superpower struggling to produce everything down to cotton swabs. Why are we not testing and tracing like a supercharged South Korea at this point? this point? Well, that's partly because we don't have all the equipment to do that. And we didn't, you know, we have, unfortunately, and again, I would refer back to the piece I wrote in The New Yorker. There's a very important interview there of one of the people who makes N95 masks as an example. And basically, his business, this is a guy named Mike Bowen, his business of making N95 masks couldn't survive because he was constantly getting out-competed by the Chinese. And because of cost-cutting and because of efficiency in hospitals, their business was unable to survive. able to survive. And so we became progressively dependent on other countries, including China in particular, to produce valuable reagents, which are important in the medical process. So we have a situation in which all of a sudden one reagent for a test isn't available,

and the whole testing system breaks down. And that's what we've seen again. So one thing that has become very clear is that supercharged as you are, you may be supercharged on efficiency, but you are not in this case, supercharged on resilience. And you need both. You need to be supercharged on efficiency, and that's great. But when things are in short supply, you need to have stockpiles, which are not efficient. You need to have a backup system, which is not efficient. You may need to have, again, you may need to have manufacturers, local manufacturers, not beholden to Chinese goods or to goods from any other country. I don't want to blame one country over

another in this particular situation, but not beholden to any particular country in which you are essentially so beholden to some good from that country that if that part fails, you can no longer work. And that's been the case in our situation. the task force, you know, Pence's task force on corona, and I guess, you know, Anthony Fauci as well. These have been the most, to my eye, the most public medical voices. And to varying degrees, I mean, most of their public statements have seemed, you know, fairly constrained and even, you know, abject attempts to simply avoid embarrassing President Trump. They're walking a line which really, in many cases, can't coherently be walked around his misstatements in their efforts to communicate public health information. And again, to varying degrees,

I would say Fauci has escaped comparatively unscathed. But I mean, both Birx and Redfield, again, I mean, forgive me if these are friends of yours and I now seem to be disparaging them, but they... No, I know Fauci very well. I don't know Deborah or Dr. Birx, I should say, and nor any of the other folks in that. Right. This is now getting to be a very old story where you have people who have real reputations and who have accomplished a lot in their lives, right? Whether it's in business or the military, or in this case, medicine, who I can only assume have reputations for integrity and probity and just a host of virtues that are worth protecting. And they undergo this horrible

transformation in proximity to Trump. I mean, it's almost a visible diminishing of their integrity just standing next to the man. I mean, it's like radiation poisoning. Every second they spend standing too close to the reactor core, you can see them withering. And so, I mean, for Birx and Redfield, this has been fairly painful to watch when they're at the podium trying to make sense and say something responsible in the wake of whatever insane bloviation just came out of the president. And Fauci has had to navigate that same space as well. And the result has been a pretty just, frankly, ineffectual communication about the public health imperatives of the moment. I mean, that's just been my experience watching CNN whenever I happen to catch these press conferences,

which happen less and less. What has been your perception of this? I mean, I think, you know, of the people there, I know Tony Fauci the best, and I've worked with Tony on various things before. I think that it's been quite clear that he's had really a task, a completely unenviable task. He's had a task that I just don't know how you could possibly navigate, given the situation and given the problems that have arisen. So I think you're absolutely right. I mean, you can't keep saying it the same way. If you'd like to continue listening to this podcast, you'll need to subscribe at SamHarris.org. You'll get access to all full-length episodes of the Making Sense podcast and to other subscriber-only content, including bonus episodes and AMAs and the conversations

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