Making Sense with Sam Harris - #222 — A Pandemic of Incompetence

Episode Date: October 28, 2020

Sam Harris speaks with Nicholas Christakis about the Covid-19 pandemic. They discuss the breakdown of trust in institutions and experts, the corruption of science by politics, the ineptitude of the Trump administration in handling the pandemic, whether the gravity of Covid-19 has been exaggerated, preparing for future pandemics, whether Covid deaths are being over-reported, bad incentives in the medical system, tracking "excess death" statistics, the prospect that the novel coronavirus will evolve to become more benign, the efficacy of current treatments, safety concerns about a rushed vaccine, the importance of public health communication, when life might return to normal, the economic impact of the pandemic, long term social changes, the future of universities, Nicholas's personal habits during the pandemic, the importance of rapid testing, 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.

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Okay, the briefest possible housekeeping. We are one week away from the presidential election in the United States, and I am sure I will have a Zoom call for podcast subscribers at some point immediately following a result. We don't know how long it will take to get a result, but I will pick my moment and we will announce it by the usual channels, probably email and Twitter, and it'll be another video Q&A on Zoom. And if you want to participate in that, you can subscribe to the podcast at samharris.org. Okay, today I'm speaking with Nicholas Christakis. Nicholas is a physician and sociologist, and he directs the Human Nature Lab at Yale University, where he is the Sterling

Professor of Social and Natural Science in the Departments of Sociology, Medicine, Ecology and Evolutionary Biology, Statistics and Data Science, and Biomedical Engineering. He is also the co-director of the Yale Institute for Network Science, and he's the author of several books, Connected, Blueprint, and most recently, Apollo's Arrow, the profound and enduring impact of coronavirus on the way we live. And that is the topic of today's conversation. Nicholas and I cover a lot of ground. We talk about the breakdown of trust in institutions and experts, the corruption of science by politics, the ineptitude of the Trump administration

in handling the pandemic, whether the gravity of COVID-19 has been exaggerated, using this experience to prepare for future pandemics, whether it's true that COVID deaths are being over-reported, bad incentives in the medical system, the prospect that the coronavirus will evolve to become more benign, the efficacy of current treatments, safety concerns about a rushed vaccine, the importance of public health communication, when life on earth might return to normal, the economic impact of the pandemic, long-term social changes that may result, the future of universities, Nicholas's personal habits to keep from getting the coronavirus, the importance of rapid testing, and other topics. Anyway, this is an up-to-the-minute look at the state of the pandemic and certainly a timely conversation prior to the

election. And now I bring you Nicholas Christakis. I am here with Nicholas Christakis. Nicholas, thanks for coming back on the podcast. Sam, thank you so much for having me. It's good to be back. podcast. Sam, thank you so much for having me. It's good to be back. So yeah, you are now a multi-repeat guest. And so I know I'm in good company. The first couple of times were just a dress rehearsal, but now you can be a co-host whenever you want. But briefly remind people what your station in life is and how you come to know or have strong opinions about many of the topics we're going to touch? Oh, goodness. Well, I'm a physician and a social scientist, and I've spent my life or my career in academia doing scientific research and taking care of patients up until about 10 years ago. I was a hospice doctor taking care of people who are dying. But I run a moderately decent-sized

lab at Yale University now doing science of different kinds. We have a bunch of different groups in my laboratory. We do everything from sort of quantitative public health research to work on the microbiome to classic sociology research. We have actually a social robotics division. We work on artificial intelligence. Anyway, we do a whole bunch of cool things. I'm very proud of them, this group of mine. And I teach students as well. And I've lately become very interested in the evolutionary origins of human social interactions,

and most recently, in the pandemic, in the COVID pandemic. Yeah, well, you, unlike many people, have managed to put this pandemic to very good use. I mean, we've been under the shadow of this thing for about eight months now, and you have managed not only to write a book about the pandemic, but to publish it. And that is astonishing, if you are at all familiar with the usual time course of writing books and publishing them. And that book is Apollo's Arrow, the profound and enduring impact of coronavirus on the way we live. And that is out just this week. As we release this, that should be available to anyone online or in your bookstore if you are intrepid enough to visit your local bookstore.

So I want to talk about COVID, obviously, and I want you to bring us all up to the present in terms of what we should know about it at this point, and also to forecast what you expect to see in the next year or so. But I want us to use the pandemic as a lens through which to consider much else that's ailing us, because we're living with a significant breakdown in our ability to acknowledge a shared reality. And this is based on the deliberate spread of disinformation, which I've devoted a few podcasts to. It's also based on how our natural biases are being amplified by technology. I mean, social media has weaponized our confirmation bias and our tribalism and our other less than epistemic ways of thinking. And the result is that we're finding it harder and harder

to collectively acknowledge the same set of facts, much less agree about what to do in response to those facts. So we're dealing with this total pollution of our information space, and it's affecting everything. And as a result, our trust in institutions, whether it's the government or the press or universities or scientific journals, or the press or universities or scientific journals is at an all-time low. And worse, given what is happening, it probably should be at an all-time low. I mean, it's just, I'll just give you one sign of the times that happened recently. The New England Journal of Medicine published a truly blistering editorial about how badly the Trump administration has handled COVID. And I read that and I basically agreed with every word of it. And we'll get into the details there. But

then I noticed that my Twitter feed just lights up with allegations that the New England Journal of Medicine is financially tied to the Chinese Communist Party at this point, right? Now, I don't even have time to figure out whether or not that's true, right? But nothing at this point would surprise me. But I have no time for this because you can literally hold your breath until the next scandal arises that seems worthy of your attention. They happen over the time course of minutes now. So it's just a crazy space to even be having this conversation. And so I want us to focus on COVID and get deeply into it. But I think we should talk about the way in which politics, in particular, is deranging the information space and science

itself at this point. Yeah, I mean, in a way, we could even start with that. I mean, I was scribbling some notes about topics for us to discuss as you were speaking, and there's so many directions we could go in. But I guess with one predicate, we could start with that, which is that we happen to be alive at a moment when we are experiencing something very unusual in the history of our species. And that is that a new, serious, widespread pathogen has been introduced into our midst. This only happens once every 50 or 100 years. And one of the themes, actually, of my book is that this feels very alien to us, this risk of death, this fact that we have to spread out, this collapse of our economy. But I guess a very important idea is that plagues are not unusual for our species.

This is just new to us. We think this is so weird. We think this is so unusual. We think this is so unfair. But really, epidemics of this kind have been afflicting us for thousands of years. There's actually an interesting story about prior to 10,000 years ago, prior to the agricultural revolution, what were such epidemics possible? And the gist of it is probably not. But anyway, from the time we invented

agriculture and moved into cities, we've been prone to this. And in fact, the title of the book, Apollo Zero, comes from the opening of the Iliad, in which, in fact, there's a plague. I mean, that's how old this phenomenon is. 3,000 years ago, Homer was writing about this. Anyway, so this germ has, you know, which has its own, it's a, we can debate whether viruses are living things or not, but for the sake of argument, this germ is acting like any other living thing. It's found untouched virgin territory, namely our bodies, and it's just having what's known as an ecological release. It's just And it's just having what's known as an ecological release. It's just spreading relentlessly among us. Just like if you had let rats loose on New Zealand a thousand years ago, they would take over the whole of the country. So there's no natural immunity to this pathogen, and it's just having its way, just going about its business. But leaping ahead now with that background to the point you put on the table for us to discuss initially, it's odd to me the way this virus is striking us at a

particular moment in our own national history. I don't know about global history, but certainly national history. Because the virus has struck us at a moment in our political life, which is very inauspicious for us, but perfect for the virus. So we have what I would call a thinning out of our intellectual culture. We have a denigration of expertise. We think that there's something evil about experts or that they're self-serving, which is really odd because when you need a car mechanic, you want an expert, right? And there's this famous saying in sociology that one man's occupation is

made up of the emergencies of other people. So when you have a flood in your basement, it's a rare event and an emergency for you, but it's the routine daily experience of the expert plumber who comes to repair it. So why we have this attitude or this posture towards expertise is itself very odd, but we have a kind of anti-expertise, which is a reflection, I think, of a kind of anti-elitism that we have in our society right now. There is, in addition to that, as you described, a kind of denigration of science or a disbelief in science or a politicization of science whereby scientists are seen as just any other like any other interest group you know trying to feed at the public trough instead of seeing i think more

rightly of course i'm very partial to scientists and science but i recognize science's limitations and we can talk about that as well. But this idea that if scientists tell us something, there must be an ulterior motive rather than trying to engage science as science is also a very dangerous ascendant ideology in our society right now. And there are two more items which I'll mention, and all of this causes quite a witch's brew. Another, of course, that everyone is familiar with is the political polarization, which by many metrics by political scientists show that we're at a moment in our history when we're very politicized, such that even a simple act like wearing a mask becomes seen either as an indicator of virtue, oh, you know, the left, I'm a good citizen, I wear a mask,

this mask symbolizes my commitment to the commonweal, or the mask is seen as an infringement on my liberty, like I'm on the right, I should be allowed to do what I want, how dare anyone tell me to wear a mask? This is ridiculous. It's just a mask. It's just a barrier to the spread of droplets. It doesn't need to be politicized. And many other countries, incidentally, do not politicize mask wearing. It's not seen as a political act. And finally, to this witch's brew, is this extraordinary loss of capacity for nuance in our society. And I know you talk about this a lot, Sam, on this podcast, which is why things are seen as black or white. I mean, every topic, why we can't acknowledge that there's shades of gray, there's uncertainty, there are intermediate

steps. You know, you don't have to be with me or against me. You can be partly with me, you know, or you can recognize that this is a complicated topic, you know, whether it's whatever we're talking about. There's this sort of desire for simple perspectives on the world that I think is not in keeping with the nature of the real world. So all of these things, the denigration of expertise, the disbelief in science, the polarization, the loss of nuance, this is when the virus is striking us. And boy, has this sapped our ability to respond effectively. Let's focus on the political co-opting of science. And this has happened, the pressure has come from

both the right and the left here in different ways. And in different topics. Yeah. But to a degree on both sides that has revealed scientists themselves to be all too human, right? So some of the skepticism and despair over the loss of the stature of scientific opinion here is understandable given just how craven so many scientists have shown themselves to be. I mean, so to see what's happening on the right, or at least in Trumpistan, where you locate that on the political spectrum is sometimes difficult. But what we see is this effort to please the delusional boy king. And it results in some of the most reputable people in public health walking on eggshells around this monstrously ignorant and belligerent president. And so we have Anthony Fauci, who has the most stellar reputation of anyone.

He's been writing about respiratory pandemics since before, not before you and I were born, but for decades. Yes, we're very lucky to have him. But still, most of his energy seems to be bound up in an effort to not embarrass the president, right? And he's found that almost impossible to avoid doing. And then we have someone like Dr. Birx, who, you know, in those first weeks and couple months of her prominence, you know, seemed more and more like a hostage with Stockholm syndrome. Right. And then Robert Redfield, who's running the CDC, appears just visibly neutered whenever he's communicating about COVID in public. And none of this inspired confidence in the beginning. And since most of these people have almost entirely disappeared, I trust also for political reasons. So there's that sort of

lack of credibility in the public face of the messaging. But then there's a reasonable concern that the Trump administration has so vitiated the scientific expertise in government, whether it's at the CDC or the FDA or in the EPA. I mean, just across the board, pre-COVID this was happening and has been replacing career civil servants and scientists with political lackeys and industry lobbyists. And given the ineptitude of our response to COVID, it seems worth worrying that maybe we're no longer the medical and technical superpower we once were or thought we were. And this culminates in things like Harold Varmus, another person with a totally stellar reputation, writing an op-ed in the New York Times declaring that we can't trust the CDC's guidance about whether to reopen schools. So there's a breakdown in authority here. Yes. And then from the left, we see this, the moral panic around wokeness in the aftermath of the killing of George Floyd in the midst of the

pandemic. And we see this insane double standard endorsed by literally thousands of public health officials, where they declare that the protests against the lockdown were murderously irresponsible, but protests in support of Black Lives Matter, as if by magic, are not only okay, they're actually necessary. And so that's where we have the left and the right competing in this insane sort of reputational potlatch to see who can destroy their gravitas more quickly. And so that's the space in which our political partisanship has just made a mockery of scientific communication. Well, I mean, this is a very complicated topic, obviously, that goes in many directions, and

you've alluded to quite a few of them. And I know you've thought deeply about this too. But first of all, one of the principles of democracy is that we get to elect our leaders and we have an executive branch that is responsive to the people we elect. Now, you could make the argument that the people voted for Donald Trump. There are, of course, side arguments about how more people voted for Hillary and blah, blah, blah, but we had the system we had. He won the election. And therefore, it's a reflection of our democracy that the will of the people is that the scientists be muzzled,

which is a kind of an odd conclusion to come to. But you could, in fact, somehow make that argument that it is reasonable or correct or a working of a democratic right that the scientists are being muzzled. And yet, we believe, all of us, certainly I do, that there should be a way in which science could be outside of politics. Otherwise, you get a kind of Lysenkoism, right? During Stalinist time, you know, genetics was seen as a discoveries in evolutionary biology and genetics were seen as a great threat to communism because the communist belief wanted to believe that we could change social structure and therefore change human nature. And so, you know, in writ large, discoveries in evolutionary biology and genetics were seen to subvert that, you know, that there could be a kind of innate human nature. And so, of course, Lysenko had a kind of Lamarckian

idea about acquired traits, and he arranged for people who didn't agree with him to be shot, you know, other scientists. As one does when reviewing scientific papers, one doesn't like... Yes, yes, exactly. Who among us wouldn't want his peer reviewers to be shot? So this temptation to have politics interfere, as you said, is longstanding. And also, incidentally, another historical strand in this is that science often is expensive and is a luxury and has been done at the public purse, whether it's Da Vinci or Galileo working for the Medicis or Seneca or Euripides working in the King of Syracuse, et cetera. I mean, since time immemorial, there's this sense, which is that scientists work for the king in a sense. But the problem we have right now is even more complicated than that,

for various reasons, not just the fact that it's the modern era and we have institutions which are supposed to provide ballast against the boy king, as you said, is that what is the dilemma of a good and wise person when there is incompetent leadership? And, you know, Socrates writes about this, Plato writes about this as well. Let's say you're General Mattis, or you're General Kelly, or you're Tony Fauci, or you're anyone else who is trying to figure out, like, my allegiance is to the nation, and if I serve in this administration, will I be tainted? Or do we want competent people to refuse to serve on the grounds that their reputations will be harmed? Well, that can't be the right answer because we want competent people running. On the other hand, if these

competent people serve, do they then lose their souls? Or do we get this kind of subversion of the scientific process? I mean, when do you resign? When do you say, no, I will not implement this policy or I will not be quiet? So there are rules how quickly Fauci cannot easily be fired. There's a process whereby he can be fired, unlike the Secretary of Health and Human Services. I don't know about Redfield and his position specifically, how easily he can be fired. But many of these people are probably reasoning, his position, specifically how easily he can be fired. But many of these people are probably reasoning, I can do more good than harm. I know I look like an idiot, not Fauci, but some of the others, but I need to help the country and I can moderate some of these ridiculous extremes that the political elites are forcing on us. Anyway, it's hard. I mean, it's very hard to know what to do

in this type of a situation. And I'm not making apologies for anyone. And I put the blame squarely at the feet of the political leadership, Trump and the administration, for the utterly inept response the United States has had. Let me just say one more sentence about why I think it's especially appropriate to hold Trump responsible. Because unlike, let's say, you could reasonably argue that certain other leaders, you know, like the British and the Italians, for example, also got it wrong. But the difference is that the President of the United States has the CDC working for him and the National Security Agency working for him. And he was told in December what was going to happen. Unlike the rest of us who couldn't necessarily have known what was going to happen, the very best epidemiologists on the planet

work at the CDC. And we have, I believe, the best intelligence agencies. And by the time we'll probably come back to this, by the time I started paying attention to this in January, we now know that even as early as December, the president was briefed. So that's really a dereliction of duty. to be told that a pandemic is coming by people you should know are reputable, are not making this up, and to ignore that or fail to take action, to fail to use the wealth of this nation to prepare, to put PPE in place, to build testing capacity, to do all the things that are recommended. Incidentally, the CDC has released every three to five years a playbook on how to cope with respiratory pandemics.

The Obama White House, actually after the Bush White House, had also bequeathed to Trump such a playbook. But even leaving aside the political transmission of this information, in the CDC, you can go online and it says, you know, plans for a respiratory pandemic. Bill Gates released a TED Talk, I forgot if it was five or 10 years ago, that has 30 million views talking about exactly what's happening to us. So I can understand why the, quote, man or woman on the street are shocked and surprised that this is happening to us, like we discussed a little while ago. But our political leaders who are entrusted with the duty to protect us should not have been surprised. In fact, we're not surprised, and therefore rightly are being held to account for the hundreds of thousands of deaths. And incidentally, I think we are going to surpass

half a million deaths in the United States. When you and I spoke about this last March, I can't remember what my forecast was. It was hundreds of thousands, I'm pretty sure. But it's gone up since then. I mean, this is going to be the leading killer of Americans this year. And per capita will be, for sure, the second worst pandemic we've had in this nation for over 100 years. Maybe approach 1918. It depends. Okay. Well, I want to talk about the future, but before we get there, let's talk about the past and present here. I had you on pretty early in the pandemic, just when I began to take it very seriously. I was not especially prescient,, as I've said several times on the podcast, I was palpably at least a week or two earlier than almost anyone in my sphere, right? parents and getting these looks of astonishment and concern. When I said we're pulling our girls

out of school on Monday, and we looked like hypochondriacs, and it was scarcely a week or 10 days before schools throughout the city and in many other places in the country were closed. The experience of being a week early was one of living on another planet, right? Like my last trip to the supermarket was one where it was a completely normal trip to the supermarket. And a few days later, I was hearing stories of people literally running down the aisles and sticking their straight arm out and just scooping 30 bags of pasta into their carts, right? being 30 bags of pasta into their carts, right? So, you know, I don't give myself much credit for being early, but once I got clear about or thought I was clear about the nature of this problem, I initiated some conversations with people like yourself. And at that point, there was a general

concern that there was a trade-off between public health and the economy, right? If we take this too seriously, we're going to torpedo the economy, and that's just an intrinsically bad thing. And to say nothing of the fact that when that happens, people die for other reasons. There's a mortality calculus on both sides here. And many people were persuaded, you know, at great effort, and obviously incompletely, but many people were persuaded that whatever your concerns about this, you know, maybe not being that much of a lethal pandemic and, you know, we're going to do intense harm to the economy, but it makes sense to so-called bend the curve. We need to keep our hospitals from being overwhelmed. And people got on board with that project for about a month or six weeks or so before our lack of full commitment to that became evident. And also, we did successfully bend the curve to the point where, okay, our hospitals survived, right? That we had some

fairly scary reports of ICUs filling up, but basically we kept the ship afloat. And since then, there's just been this total bifurcation in people's thinking about this pandemic. I still know people, and you can certainly see them in many others on social media, who think we had a colossal overreaction to this thing. No. The story here is not that we didn't sufficiently prepare. The story is that we panicked and that something like herd immunity is an inevitable terminus to this globally and locally. And, you know, this kills people in old age homes, but it doesn't kill all that many people who weren't going to die of something soon anyway. And this, again, this is broken along predictably political lines. I know you're going

to want to talk about how catastrophically bad our response has been to this and how much we need to learn from this episode. But I don't see ourselves poised to learn those lessons because so much of our society seems to think that this is, if not a hoax, just hoax adjacent, right? Okay. But first of all, there's so much again to unpack there. We need to come back to the herd immunity. We can come back a little bit to the flattening the curve thing. But I do want to also talk to you, and I made some notes here about notions of quantifying risk, and maybe that's where I'll dip into what you just said. So on the one hand, the country has been confused and the public health messaging has been confused by people thinking, because this, unfortunately for us, this disease has a variety of things that can happen to you, from no symptoms to mild symptoms to serious symptoms and long-term disability to death.

very heterogeneous presentation, and in a way that has muddied the public health message, because so many people have such a benign course that it becomes possible to imagine, well, this might not be so bad, in the way that if it were cholera or smallpox, people wouldn't be saying that. So the intrinsic nature of the pathogen, which is its protean manifestations, ironically, have made it more difficult for us to combat. In addition to its protean nature, the disease is deadly, is 10 times deadlier than the flu, but it's not as deadly as the bubonic plague or as smallpox or cholera, which were called the holy trinity of infections in the Indian subcontinent for centuries. You know, they were so deadly. And that also is ironic because if this disease had been as deadly as smallpox or Ebola, you better believe Americans would be taking it more seriously. And incidentally,

I just want to highlight for your listeners, we are lucky it's not that deadly. There's no ex-ante reason as known to God that this disease is only as bad as it is. It could have been so much worse. And in fact, the pathogen SARS-1 that afflicted us in 2003 in a pandemic that petered out for reasons I actually discuss in the book compared to the current pandemic, it had some subtly different biology that made that germ peter out. That germ was, by some metrics, 10 times deadlier than the current one. So the SARS-CoV-2 kills about 1% of the people that get symptoms from it, kills between 0.3% and 0.5%, or 0.3% and 0.6% of the people who become infected with it, and about 0.5% to 1.2% of the people who develop symptoms from it.

And it varies a lot by age, but let's just say roughly about one out of 100 people who developed symptoms from it. And it varies a lot by age, but let's just say roughly about one out of 100 people who are symptomatic from this condition will die. And the original SARS probably was 10 times deadlier. And in some ways, the lower lethality of this condition have made it harder for us to take seriously. Because even if the disease had been left unfettered in our society, to just run loose, and probably in that scenario, maybe 200 million Americans would have been infected. And of those, let's say 100 million would have had symptoms. And of those, maybe a million would have died.

Even in that scenario, that's only 1 million out of 330 million Americans. And this has led to some people doing calculations that say, well, don't worry about it. You know, one out of 300 chance of dying isn't so bad, they say. But that's a completely wrong way to understand and compute risks of disease in general, let alone infectious diseases. A million deaths is a catastrophe. It's an enormous number, is a catastrophe. It's an enormous number, an enormous amount of death and destruction in a year in our nation. But our nation will survive. I mean, we are going to see the other side of this. And this is another thing that's so interesting about plagues, is that even the bubonic plague, which would sweep through cities and kill often half, sometimes nearly all of the people in a city, ended. I mean, we have accounts, for example,

among Native American populations that were annihilated by smallpox. You know, 95% of the people dying within a month, like everyone is dead, you know, just like, and we have accounts from medieval Europe of people thinking that this was the second coming, you know, that the world was being utterly, completely destroyed. So bad was the toll of death. We thankfully do not have that situation with this pathogen. But I just want listeners to understand that it's dumb luck that that's the case. I mean, this could have been a much worse pathogen. It's not. And therefore, the fact that we should take that as a blessing, not as an opportunity to be reckless and then say,

oh, well, let's just go about our business and ignore it. There's no reason we need to lose as many Americans as I fear we are going to lose. Before you continue, let's just secure that one epiphany here, because I think everyone, regardless of their politics, should be able to agree about this, that there is simply no guarantee that the next pandemic won't be an order of magnitude worse than this or even worse than that, right? I mean, there's no guarantee. Yeah, it could be, but you're absolutely right. But also to be clear, these types of pandemics, part of the problem is there's no one alive that remembers this experience from before. You know, the 1918 pandemic was 100 years ago. And so all the learnings, yes, we should learn

our lesson, but it is true that it is unlikely in our lifetime we will have personally to deploy these lessons again. Except when you think about the possibility of bioterrorism, right? I mean, an engineered pandemic. Yeah, or it could, I mean, there's stochasticity. I mean, there's already a pretty bad flu, influenza A germ that's brewing in China. We know from surveillance, from epidemic surveillance procedures. You're right. I mean, there could be in 10 years or in 20 years or in one year or in 30 years, we don't know. The usual inter-pandemic interval is about 10 to 15 years. And most of those are not so serious, like the 2009 influenza pandemic. The reason people don't remember that one, although it was

a pandemic, was that it was very mild. It was like the common cold. You got it, but you didn't die. But there absolutely could be another pandemic, and we absolutely should be better prepared respond intelligently and at minimal economic and social cost to a terrifyingly lethal pandemic should such a thing emerge. And on some level, it is just a matter of time, whether it's one year, 10 years, 100 years. We know that nature is continually cooking something up like that for us. And there are bird flus that can jump into the human population and have 60% lethality. And we know that there are bad actors who will increasingly get their hands on the means to produce engineered viruses and other pathogens. This is something we want to be good at.

And during this dress rehearsal, we proved that we're actually bad at responding to this problem. So we have to get better at this, whatever you think about COVID. Yeah, no, I agree with that. But I also want to pick up another thread of what you were saying, which is there's only so good one can get. I mean, a circulating deadly germ is a circulating deadly germ. It's hard to imagine having the economy escape unscathed. Even the Koreans or the Chinese or the New Zealanders or the Greeks or people who have done reasonably well with a pandemic, their economies are devastated. And it's because in order to cope with a germ, you have to cease social interactions, and the economy requires social interactions.

And so I think you can test and trace and wear masks, and you can do a lot to maintain a semblance of normality. But it's hard to argue that a world in which suddenly you've introduced a deadly contagious pathogen through implementation of certain responses can be neutralized. So it's not completely neutralized, but we absolutely can do vastly better than we have been doing. But it will cost. I mean, there will be at some significant socioeconomic cost. It's unavoidable. So just whatever you think about what's happened so far and what's likely to happen in the future, you should agree that whatever lessons there are to be learned about how to respond to a pandemic, we should learn those lessons. You can't be skeptical about that project, even if you think COVID was not at all what the libtards cracked it up to be. Yeah, right. I mean, I certainly wouldn't argue

about that, but this is going back to our argument about science. Yes, this is what science is about. We should learn. We should observe the world. We should make inferences, and we should record them, and we should learn from them. Absolutely. And yeah, absolutely. But I also want to emphasize, in fact, that's one of the things that I discuss in Apollo Zero. One of the ironies of this pathogen is that the way contagious diseases work, of course, is to exploit our social nature. of course, a previous book as well, you know, Blueprint, The Evolutionary Origins of a Good Society. But anyway, we humans live socially for very particular sets of reasons. And just to summarize a couple of the key ones, one is to cooperate. I mean, this seems obvious, but we band together to be able to achieve things we weren't able to achieve on our own, and also to be able to learn from each other. So most animals can learn independently. A little fish in the sea

can learn that if it swims up to the light, it will find food there. That's independent learning. But we can observe each other and learn. So you put your hand in the fire and you learn that it burns. That's independent learning. And that you learn something, but at great cost. Or I can watch you put your hand in the fire, and I gain almost as much learning, you know, fire burns, but pay none of the cost, you know, my hand is unburnt. Or you eat a red berry in the woods and die, and I watch you eat a red berry, and I don't eat it, so I survive. That kind of social imitation, that kind of social learning is incredibly efficient, and this is one of the reasons we evolved to live together. But we also do something else, which is we teach each other things. We accumulate knowledge and we transmit it across space and time. Now, so one of the arguments that

I like to make about human social life is that the spread of germs is the price we pay for the spread of ideas. So I come near you to learn from you, but in so doing, I set myself up for contagions of infections. And so therefore, the pathogen is exploiting our social networks, our social interactions, our evolved desire to touch and hug each other, our desire to band together in order to learn from each other, and the virus moves along these social pathways, killing us. And so how are we going to respond? Well, we respond by exploiting our capacity for cooperation and learning. We work together to live apart. We have learned from the past. We're not the first humans to confront a pandemic. We inherited a playbook

about what to do. That's a kind of teaching. So one of the deep ironies is that the very same things that the pathogen is exploiting to kill us are the tools we need to use to best it. And this is one of the reasons I'm so particularly invested, as are you, in us learning from this experience. There's no reason future generations of us should do the job as poorly as we have done it right now. And in fact, I should also say, we don't even need to look to future generations. There's still time for us to learn now and do a better job in the coming year or so. And we can discuss what I think is going to happen next. But we still have about a year and a half, in my view, of serious immediate impact of the pathogen, where we're going to need to wear masks and

physically distance and do a bunch of other self-protective interventions. But eventually, the tide will turn. But nevertheless, in the interval, there are things we need to do. Well, so let's talk about that. But the reasonableness of any intervention turns on some appraisal of how bad this disease is. And the core of any claim about its badness rests on how many people are actually dying from it. And this is where I've encountered that one source of skepticism, which seems to me to be harder than most to dismiss, and this has been trumpeted by many prominent people. I've had to encounter this both publicly and privately, but it's this concern that the mortality statistics of COVID are being amplified because doctors have been incentivized

to over-report COVID deaths. We rely on doctors to fill out death certificates, and the CDC guidance for reporting a COVID death does not require a positive test for COVID, and this seems to be a concession to how inept we were at testing and still are at testing. So rather, doctors simply need to deem it probable that COVID was part of the picture in accounting for this death. So they presume a COVID death, in many cases, based on a constellation of symptoms, whatever else may be wrong with the patient. And of course, you know, there are many respiratory conditions that people die from. You know, there's COPD and asthma and pneumonia, and they also kill some hundreds of thousands of Americans each year,

right? So these are not tiny sources of mortality. It's easy to imagine that if doctors are simply admonished to check the COVID box whenever it's plausible against this background of other respiratory diseases, that could inflate the number of COVID deaths. And just to add one final wrinkle here, which is perhaps the most troubling, this was happening in the context where there was actually, and probably still is, a financial incentive to presume COVID's involvement because, you know, hospitals, many hospitals were on the verge of bankruptcy because all elective procedures were being canceled because nobody wanted to get COVID. they were given money. I think HHS allocated something like $50 billion for hospitals that were having to deal with a surge of COVID cases. So there was a financial incentive to say, oh yeah, this is yet another COVID case that's hit our ICU. No, I don't think any of this makes any sense on any level, and we can discuss this. I don't know about the details of how HHS reimbursed for the care.

I do know that, ironically, our healthcare system was organized in such a fashion that in our reimbursement system, that precisely when we needed it most, hospitals started losing money. As you alluded to, you make much more money with elective surgeries than you do with caring for acutely ill people during a time of an epidemic, which is nuts. That is to say, this is when our hospitals were most needed, when money should have flowed to them liberally. And the idea that many hospitals, I understand it, quite a few rural hospitals almost went out of business. I read some news reports about Maine. I'm not 100% sure about this. Yes, the government tried to compensate hospitals to make up for the losses, but my understanding is it wasn't enough. In any case, that is nuts that hospitals providing

care in a time of a pandemic, that this would be a loss leader, or that they would lose money is crazy that that would happen. Now, on the issue of are we correctly finding it, there's so much evidence that that's not the case that I don't even know where to begin. That it's not the case that we're over-reporting COVID deaths. No, no, absolutely not. And the evidence for that comes from multiple sources, one of which is, of course, the consistency in the death rate in places around the world with very different systems of recording deaths, of detecting deaths, of very different financial incentives. We even have situations in which, for know, for example, we could look at the,

we had those famous cases early on in the epidemic of the Diamond Princess, you know, cruise ships where no one could come or leave. We knew exactly who got sick and we could count which of them died. So, you know, we could assess the lethality of the pathogen. And we now have a focus studies around the world of sort of case studies of Manaus in Brazil or villages in Lombardy or in Austria, where early on the epidemic just swept through the community and we can enumerate who died during the time of the epidemic. Furthermore, there's another technique that was introduced in the middle of the 19th century by William Farr, one of the founders of the field of demography that ironically is still in use today, which is the notion of counting excess deaths. And

scientists use this even now when we're trying to look at historical epidemics. Let's say you want to figure out how bad was the bubonic plague or how bad was the Spanish flu in 1918. how bad was the bubonic plague or how bad was the Spanish flu in 1918. You don't have the capacity to test people. The death records at the time were very incompetent or incomplete. How can you tell? Well, Farr proposed that we can assess the impact of an epidemic by counting up how many people are dying of all causes during the time of the plague, and comparing that to the number of people expected to die if the plague had not been there, for instance, in the prior five years in this time window. And when you do an exercise like that, that's how we get estimates that the current count of people confirmed COVID deaths that we have in the United States,

which is something like 230,000, that it's probably an underestimate by a factor of about 25%. Probably 300,000 Americans have already died of COVID. In other words, what we're doing, if anything, is undercounting the deaths we know simply by looking at who's dying. Now, in fairness, some of those deaths are due to COVID, but not necessarily due to COVID infection. For example, if COVID causes you to become depressed and suicide goes up, that's swept up in the COVID deaths, using the excess death metric. But in any case, the point is that there's really no reason to- Although there are obvious reasons why there will be fewer than normal deaths based on all the behavioral changes due to any kind of lockdown during a pandemic. There had to be a period where there were fewer

motor vehicle deaths. Yes. Yeah. So the excess death metric captures all of that, both the benefits of COVID and the extra costs of COVID. Exactly right. So let's say there were more suicides, but fewer motor vehicle accidents. Some people have argued that there was less overtreatment of patients. You know, iatrogenesis, which is medical doctor-caused injuries, they were likely lower. In other words, in the past, if you had a mild heart attack, probably the right thing to do was not to have a doctor do anything. But the doctors would do things to you, actually increasing your risk of death. But under COVID, people with mild heart attacks maybe stayed at home or didn't come to medical attention. And ironically, then, they failed to die, which they otherwise would have.

So maybe COVID saved their lives. But the point of doing this calculation is that it combines all of that stuff together and says, okay, here are the total direct and indirect risks and benefits of COVID. And that number is higher even than the number of known COVID deaths as reported by doctors along the lines that you described. I would also add that if in fact deaths that should have been ascribed to other respiratory illnesses like COPD or asthma or pneumonia were being inaccurately coded as COVID deaths, we'd be able to see the rates of COPD and asthma and pneumonia-related deaths go down. Because we know what to expect from those. Yes, that's right. And in fact, reassigning COVID deaths, COP deaths to be COVID deaths, wouldn't affect the excess death calculation. So this excess

death calculation is a kind of more objective way of looking at the impact of an epidemic, which has been used for 150 years for real-time epidemic monitoring and for assessment of historical epidemics when we didn't have good death records, cause of death, rather, information. So no, I don't think that there is some kind of conspiracy or some kind of a misassessment of deaths in our society. And picking up a little bit on what we said earlier, see, one of the ironies is that even if a million Americans die, there are probably only going to be about, let's say, 10 people for each of those people who knew them personally. So that'll be like

10 million Americans will know someone who died of COVID, and probably 100 million Americans. So like 100, I'm sorry, 10 Americans per decedent who are intimately connected to this decedent. And now, let's say, are really upset and worried about COVID. And then even if a million Americans die, there will be, let's say, 100 people who know of that person. So there'll only be 100 million Americans who know of someone who died personally. This is a very crude approximation for many reasons that I don't go into right now. But the point is, even after the epidemic has swept through our society, the majority of Americans will neither have died of it nor know someone who has died of it. And so this is one of the reasons that it's difficult to why President Trump can get up there and say, oh, nothing bad is happening,

because in the everyday experience of most people, in fact, they're not going to come up close and personal with this pathogen, again, for the reasons we discussed earlier about the fundamental nature of this pathogen. But that doesn't make it less of a threat. It doesn't. And furthermore, one more thing, we've been talking about death, but it's very important to highlight the fact that we're also going to see an epidemic of disability in our society that's going to persist for a long time. So most people who get the

disease, including, for example, the president, survive the condition. But 5% of them, we don't know the precise number yet, and we won't for a while, but probably about 5% will have serious long-term disability. They'll have pulmonary fibrosis. They'll have renal insufficiency. They'll have cardiac abnormalities. They might have neurological abnormalities. So we're going to have many millions of Americans who have post-COVID syndrome. And this also doesn't include all the children whose parents will be sick or disabled, you know, all the adverse health events, the adverse events on children whose parents have lost their jobs, whose parents are dead or sick. There's just all of this sadness and badness that

come in a time of plague. And unfortunately, there's no way to escape it. I mean, it is just an ineluctable truth about plague that it is ruinous, that this is what it does to societies. It is one of the four horsemen, you know, for precisely this reason. It seems reasonable to worry even about mild, so-called mild cases here. I think there was one study that showed that there was some crazy percentage, it was something like 78% of mild cases had detectable heart irregularities as a result. So it just seems fairly clear that we don't know enough about what COVID is doing to us. And in some sense, it's not even principally a respiratory illness. I mean, it's a vascular illness. And also, as you say, a neurological one.

We certainly know about coronaviruses. I mean, we have some evidence. There are four coronaviruses that cause the common cold. In my book, I speculate, in keeping with speculations by others, that the 1890 pandemic was actually not influenza, but may have been a coronavirus. And over time, that virus has now become the virus that one of the four coronaviruses that causes the common cold. It's become more benign. We've evolved as well, some natural immunity to it. We get the disease as children. And then when we're re-exposed as adults, we have a minor illness. There's a whole set of human diseases that behave this way. So it's possible that this current coronavirus, you know, in 100 years or perhaps sooner will, I should just emphasize, the virus is not going to disappear.

I mean, it's going to keep circulating among us forever. The only issue is how will we cope with it? And hopefully we'll have a vaccine. And we haven't talked about that yet. And we can. But one thing that is likely to happen is that the virus will, over a period of years, will evolve to be less lethal. And probably we will be exposed to it as children when we, as we already know, are relatively less adversely affected by it,

as is also typical of other coronaviruses. For example, the 2003 coronavirus is all discussed in my book, by the way. And then when we were re-exposed as adults, they have a more benign course. It's a little bit like chickenpox. If you get chickenpox as a kid, you get a pretty benign condition. If you've never had chickenpox and you get it for the first time as an adult, you can die from it. So that's why exposure to chickenpox early on might be a rational strategy. So there are lots of diseases like that, and it's possible that this will join, you know, that that will be the pattern for this particular condition as well. But as you said, it's early to speculate.

And furthermore, as you also said, and as I was saying, it's a serious condition. It doesn't just cause us death, it causes us disability. And the disease is having, as we were discussing earlier, an ecological release. It is just spreading, it is doing what living things do. It is just spreading across all of humanity. And how is it spreading? Early on, many of us began speaking about the are not of this and just how contagious is this and how will that respond to the things we do to modify our behavior. But now we're speaking more in terms of super spreaders and super spreader events. How do you think about the spread of this now? events? How do you think about the spread of this now? Well, we know now much more than we did when you and I last spoke in March. I mean, the intrinsic transmissibility of the virus, the so-called R0, the reproduction number, the number of new cases that arise in a non-immune

population that is interacting normally is between 2.5 and 3.5. So for each case of SARS-CoV-2, each infection, on average, between 2.5 and 3.5 new cases will arise if people aren't immune and they're interacting normally. That's the fundamental transmissibility of the virus. In my book, I use an R0 of 3 as a benchmark. Now that is a pretty high R0, like seasonal flu has an R0 of between 0.9 and 1.6 or so. If you have an R0 of one, that means that for each case, you create one new case, so you don't really get an epidemic. There's no growth in cases. If it's below one, then of course, the case count declines with time because each case on average cannot reproduce itself. Diseases like chickenpox, I think, have an R0naught of about six or something.

Measles, which is the most contagious disease known, has an R-naught of 18 or something. And this, incidentally, this also relates to the issue of herd immunity, which we haven't discussed, and also the fraction of people that will need to be vaccinated in order for the population to be immune. So the more transmissible the disease, the higher percentage of people have to have acquired immunity for herd immunity to kick in naturally, or the higher the fraction of people have to be vaccinated in order to protect the unvaccinated people in the population. So the higher the transmissibility of the disease, the higher those percentages need to be. So this disease, we now know about how transmissible it is, but there's another number, which is not the R0, is the so-called R sub E, the effective reproduction number,

or effective reproductive rate, which is what we manipulate when we engage in physical distancing and when we try to flatten the curve. So when we change our behavior, we modify the transmissibility of the virus. And you can measure and monitor the RE, and you can see, oh my goodness, everyone is staying at home. Each new case of the virus is creating less than one new case. We brought the RE below one, and that's exactly what we're trying to do, and we have brought it down. we have brought it down. And just to pick up a little abandoned thread from our conversation earlier, the whole reason we rightly social physical distanced and tried to flatten the curve nine months ago was not like what the Chinese achieved by locking down their country or what we achieved by engaging in the kind of physical distancing that we did was not the eradication of the pathogen. That pathogen, we can't eradicate it. It's loose now. What we achieved instead was a postponement of its impact and may, as a result, also have saved some lives. Let me explain why. When the disease first struck, we had no medicines to treat it.

By engaging in the sort of lockdown behavior that we engaged in, in the closing the schools and the masking and everything else, we gave our hospitals and our doctors and our scientists and our supply chains time to work so we could make more PPE, which would then ultimately save lives if people had PPE, or so our doctors could do research to discover how to treat the condition. And over the summer, we had the first drug that was shown to actually lower mortality from coronavirus, which is a very cheap and old drug, a drug called dexamethasone. We had a landmark randomized controlled trial of a very large number of people, the so-called recovery trial out of England, that showed that dexamethasone reduced mortality by 20%. That's huge. So you would much rather get

COVID now than COVID in March, because now we have a drug that we can give you that reduces your risk of dying if you're seriously ill with it by 20%, which is amazing. Plus, doctors have learned all kinds of other stuff, like to put you on your stomach when you're in the hospital instead of on your back, for example. In addition, there's some other drugs like remdesivir, which none of the trials have so far shown that it has an impact on mortality. We had a very depressing trial that was just released a couple of weeks ago with a large number of people which

failed to show an impact on mortality. But nevertheless, that drug might also be helpful. So we will continue to innovate on drugs. There will not be a drug that cures coronavirus. It's very difficult to find, to stop viral infections, to cure viral infections, unlike bacterial infections. But we will likely have drugs that are more and more effective that are discovered over time. And this is why we had to flatten the curve. And of course, we bought ourselves time to invent a vaccine. And I do believe we will see a vaccine in 2021. There are over 130 efforts afoot of over 10 different approaches to vaccine development around the world.

I think sometime in 2021, we may discover a vaccine. How safe it is or how effective it is, it's hard to predict. I think in our rush to develop these vaccines, we may find a safety profile that's not so great, which may dampen enthusiasm for the vaccine. a safety profile that's not so great, which may dampen enthusiasm for the vaccine. But the problem is even if we invent a vaccine, we then have to manufacture it, which is not trivial, distribute it, which is not trivial. We need to maintain something known as a cold chain. From the moment of manufacture to the moment of injection, the vaccine always has to be in a refrigerator. That's not a trivial thing. And finally, and most importantly, we need to have acceptance. People have to want the vaccine and have to take it up in large numbers. So I think that's going to take

us into 2022. So from my desk, what I see is that either we will invent a vaccine and accomplish everything else I just described, which will take time and take us into 2022. Or meanwhile, the virus is still spreading, which means we need another couple of annual cycles of this pathogen, which is what respiratory pathogens do. Only about 10% of Americans have been infected. And according to some network science-informed estimates, I think about 40% or 45% need to be infected before we have herd immunity, which I think then we will reach by 2022, just because we're so incompetent right now, and the germ is just spreading. So one way or the other, from my desk, we're going to be physical distancing. We're going to have periodic school closures. We're going to be wearing masks. We're not going to be shaking hands. We're going to have a suppression of our economy until 2022. And then the immediate pandemic period will end, but it's not going to be an immediate

return to life as normal. Because if you look at what's happened with the centuries of epidemics, people are going to be shell-shocked. Our economy will have been adversely affected. People's psychology, people aren't going to suddenly want to go to airports or suddenly start shaking hands again or going to crowded bars and restaurants or nightclubs. It'll take time for people to recover from that. So I put the intermediate pandemic period until 2024. And then I think in 2024, we're going to have the post-pandemic period where I think

we will return to normal with some persistent changes. I think people will be working from home more. I think there'll be a number of other changes in our society. I think gender relations are going to change in certain ways as a result of the pandemic. We can discuss that. And then we're going to have in 2024, a kind of roaring 20s. There'll be an efflorescence. People will pack political protests and sports events and restaurants and nightclubs and religion, which is rising, by the way, right now, will go back down again. You know, during times of plague, people find God. There'll be a kind of licentiousness, a sexual licentiousness and a kind of intemperance and joie de vivre.

And this is typically what has happened with past epidemics. So these aren't hard landmarks, 2022 and 2024, but approximately that is what I think is going to happen. It's October and already you're so full of Christmas cheer, Nicholas. Well, no, I mean, the good news is... 2024. So no, no, we have to traverse some of this ground again. I thought we were going to bring this conversation in around the hour mark, but I see no hope of that. So first of all, let me just check your time, Nicholas.

You got another half hour in you? Yeah, no, I'm available. Okay, so I want to talk about the future. The prospect that nothing like normal life returns until 2024 is not something that I have foreseen. So let's talk about the near time horizon here. Let's talk about the next six months. We have a president who is promising a vaccine any week now and is fairly sure that that can be distributed by the military

and back to the military. 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 I've been having on the Waking Up app. Thank you.