The Munk Debates Podcast - Be it resolved: The reintroduction of shutdowns needs to be considered in U.S. states where COVID-19 infections are surging.

Episode Date: August 12, 2020

Over five million cases. More than 160,000 deaths and counting. The US currently leads the global tally for the highest number of COVID-19 cases. Meanwhile some countries, originally devastated by the coronavirus, are reopening successfully after driving new infections down to manageable levels. Some say the only way to prevent tens of thousands of more deaths in the U.S. is a second wave of shutdowns targeting the hardest hit areas. Critics argue that with shutdowns the supposed “cure” is worse than the disease. Millions will be denied essential medical treatment, including mental health. Jobs and businesses will be permanently lost. And, closed schools will prevent a much-needed return to normalcy for children and parents alike.  In this episode of the Munk Debates podcast leading epidemiologists, John Ioannidis and Andrew Noymer, debate the essence of these two competing arguments.Sources: MSN.com, NBC News, ABC, MSNBC, CNBC, WHAS11.com, 11Alive, Reuters, Fox NewsBecome a Munk Donor ($50 annually) to get 72-hour advanced access to the full length editions of Friday Focus and Munk Dialogues. Go to www.munkdebates.com to sign up. Hosted on Acast. See acast.com/privacy for more information.

I think it's time for this toxic binary zero-sum madness to stop. We're not an imperial power. We're a revolutionary power. We are no longer in a world where you can plot out moves statesmen to statesmen like a chessboard. You don't know anything about my background to where I came from. It doesn't matter to you because fundamentally I'm a mean white man. We can't do this to the next generation because America will cease to exist. Welcome to the Monk Debates podcast. Every episode we provide you with a civil and substantive debate on the big issues of the day, free of spin, focused on the facts, and animated by smart conversation.

To arm you, the listener, with enough information to make up your own mind. Today's debate, be it resolved, the reintroduction of shutdowns needs to be considered in U.S. states where COVID infections are surging. It has been another deadly day in the fight against COVID-19. Georgia also surpassing a milestone of 200,000 total. ICU beds in Mississippi are full. One hospital describing its staff as stretched thin, exhausted, and running on fumes. Meanwhile, Dr. COVID-19 cases continue to rise in Illinois. This is the highest number since the end of May right now. Take a look at the map. Deaths are rising in 35 states and Puerto Rico. California reporting a record 219 deaths and more than 500,000.

Hello, I'm your moderator, Rudyard Griffiths. More than 5 million cases, over 160,000 deaths and counting. The United States currently leads the global tally for the highest number of COVID-19 cases. California, an early success story, has aggressively rolled back the reopening of schools and businesses. Louisiana, Idaho, Texas, and Nevada are among dozens of states experiencing surging case counts, rising hospital, and increased deaths. Meanwhile, some countries, originally devastated by the coronavirus, are successfully reopening after driving new infections down to manageable levels. When public health policies such as physical distancing, hand-washing masks, and increased testing can't bend the curve

in new infections, some say the only way to prevent tens of thousands of new deaths is a second wave of shutdowns targeting the hardest-hit areas. If we prematurely end that physical distancing and the other measures, keeping it at bay, deaths could skyrocket into the hundreds of thousands, if not a million. We cannot return to normal until there's a vaccine. Conferences, concerts, sporting events, religious services, dinner in a restaurant. None of that will resume until we find a vaccine, a treatment, or a cure. Critics say with shutdowns the supposed cure is worse than the disease.

millions will be denied essential medical treatment, including mental health. Jobs and businesses will be permanently lost, and closed schools will prevent a much-needed return for children and parents alike. Shutdowns are not the answer to the ongoing threat of COVID-19. We have to remember that there's another side to this. Keeping them out of school and keeping work close is causing death also, economic harm, but causing death for different reasons. death, probably more death.

On this installment of the Monk Debates podcast, we challenge the essence of these arguments by debating the motion. Be it resolved, the reintroduction of shutdowns needs to be considered in U.S. states where COVID-19 infections are surging. Arguing for the motion is Andrew Neumer, an epidemiologist, population health scientist at the University of California, Irvine, where he specializes in infectious disease mortality. He is an associate professor in the university's Department of Population Health and Disease Prevention. Arguing against the motion is epidemiologist John Ionides,

the CF Renborg Chair in Disease Prevention, Professor of Medicine of Epidemiology, and Population Health at Stanford. He is co-director of the university's Meta Research Innovation Center, Metrics. Andrew John, welcome to the Monk Debates podcast. Thank you for having us. Thank you for the kind invitation. Well, I'm really looking forward to this debate today. I think if we had to think of one of the critical issues, both in terms of public policy, public health, it is what should the response be going forward as the United States and many other countries around the world confront surging COVID-19 infections and to have two people with your experience and knowledge of epidemiology of this particular virus. is a privilege indeed. We're going to debate today. Be it resolved, the reintroduction of

shutdowns needs to be considered in U.S. states where COVID-19 infections are surging. Andrew, you're going to be speaking in favor of the motion on today's debate. So let's have your opening statement, please. Thank you for having me on your podcast. I have been following this pandemic closely, and I regularly tweet my thoughts on the pandemic as. it evolves, that my Twitter is at Andrew Neumer. And this health crisis is unprecedented in our lifetime. And it needs to be taken seriously. Nothing since the 1918 influenza pandemic really compares to it in terms of scope, potential impact. And shutdowns or shelter in place or lockdowns is something that nobody wants. But I do believe that they may be necessary in

some cases in the United States as we head into the fall of 2020. I am not arguing today in favor of a blanket nationwide shutdown, but on a state-by-state basis or a county-by-county basis, where the data justify it, I believe a reimposition of shelter-in-place is something that in some cases will be necessary and certainly may be necessary in some places. We need to lower the boil, the A pandemic is boiling over in many locations in the United States, and we need to turn off the heat. There are different ways to do that, but the most effective way is to go into another shutdown. The problem is that masking works and social and physical distancing work, but epidemics are past-dependent processes, meaning doing something at the start and doing something in the middle does not have the same

effect, even if you're doing the same thing. So masking, if we had all masked early on, we would be in a different place now than if we all start masking now, because the genie is out of the bottle, so to speak. And the pandemic so far is something that we have consistently underestimated. We have approaching 200,000 deaths in the United States today. These are excess deaths. So these are real deaths. These are not robbing Peter to pay Paul in terms of mortality. So this is an epidemic that serious and we need to approach it cautiously. Sorry, I wanted to add that I have no conflicts of interest. Thank you for that succinct and focus opening statement. John, you're speaking against our motion, be it resolved, the reintroduction of shutdowns needs to be considered in U.S.

states where COVID-19 infections are surging. Let's hear your argument against what Andrew has just proposed. There's no doubt that we are dealing with a major crisis. both in health and with reverberations across our society. We need to act decisively. We need to act promptly. We need to act with precision. We need to act in a way that will optimize our chances of saving lives and also minimizing the harms, both from the pandemic

and from the measures that we have to take. Shutdowns are an extreme measure. We know very well that they have tremendous harms. They have tremendous harms on people, on their lives, on their health, on their mental health, on their ability to get the best care for major problems like heart attacks, like cancer care. They can take a major toll on unemployment. They can take a major toll on leaving people who are disadvantaged, even more disadvantaged.

It protects some of us who have the means to shelter, but it lets essential workers. It lets disadvantaged populations pretty much unprotected. Does it have any benefits? There is some data that suggests benefits, but as we will discuss, most of these data suggest that the benefits are actually modeling artifacts. They're not real. Do we have effective measures to deal with the crisis? We do.

We have many measures to deal effectively with lowering the caseload and decreasing the deaths that would ensue from them. We know far more than when this pandemic started. We know whom to protect. We know where are the settings that are the disasters. potential, like nursing homes that account for 40 to 65 of all deaths, both in the U.S. and in Europe, like noosocomone infections, like high-risk individuals that we need to protect with very draconian measures.

We know how to act with precision, and we should do that rather than just destroying our entire society, our entire country, and eventually also the entire world, because much depends also on what the U.S. is doing. I need to add also that I have no conflicts of interest either. Thank you. Thank you, John, for that opening statement. So just for the benefit of our listeners, let me just quickly summarize your respective opening arguments here. Andrew, you're saying, I think it's an interesting idea that there's little utility at this point in trying to halfway through a pandemic,

reinstitute measures, which the science seems to suggest could be effective, for instance, masking. John, you're saying that the detrimental effects on mental health, on physical health, on the economy, need to be weighed here when we're considering shutdowns. Do shutdowns really work? Do they provide the kind of panacea in terms of stopping the virus cold or certainly regressing its growth that proponents of shutdowns have argued? So let's move on to our rebuttals now. And this is an opportunity for you both to react to each other's opening statements. Andrew, let's have a couple minutes on the clock for you to reflect on what John has said off the top. So I just want to clarify one point about masking. What I intended to mean is that masking and other measures are not something that are of no use now.

It's just that the effect they have when people start masking in the middle of an epidemic and the effect that masking has if it had been started at the start of the epidemic are not the same. So I absolutely am a proponent of masking and other physical and as it's sometimes called social distancing. I just think that right now that's not enough. The issue is that I don't believe that precision measures are working in the United States right now. They work, in my opinion, on paper, but in some cases some states will need, or at least some counties of some states will need to go back to some sort of shutdown slash shelter in place. It's one thing to say that, you know, we know how to stop this precisely, but, you know, These measures don't seem to be working in the United States.

We have over 50,000 new confirmed cases a day, every day in the United States, and over 1,000 deaths being recorded on weekdays. It's not sustainable. We need a reset. Once we get the reset through a shelter in place, we can go to precision measures. But in certain places, we need a reset. I'm not in favor of a national lockdown, because that would be ridiculous. There are plenty of states that are either in lulls or have,

gotten the pandemic under control or some of both. But shelter in place needs to be a weapon in our arsenal because precision measures are not working. There's plenty of community transmission now, particularly in the west and south. It is not just a question of nursing homes, although I agree that the mortality has been concentrated there. We're not destroying society by doing a three-week or six-week shelter-in-place. That is a straw man. We didn't destroy. We didn't destroy society when we did it the first time around and we will not destroy society when we do it the second time around. You know, we could have a million deaths from COVID-19 in the United States. We certainly are headed very quickly to 200,000. So it's a very serious situation. You know,

serious measures need to be on the table. It's a matter of what works in the real world, not what works in theory. Thank you, Andrew. Interesting rebuttal points there. So, John, your opportunity now to react to Andrew's opening statement or what he's just said in response to your opening bid in this debate? I think that I fully agree with with Andrew that we're dealing with a serious problem and that our priority should be to try to save as many lives as possible. We just need to look at the full big picture, though. And I think that lockdown and shutdowns have not really worked in the past. I think that they did cause tremendous harm. I think if you look at multiple indicators of health, at multiple indicators of societal well-being, of economy, of unemployment, they have been devastating, both in this

country and elsewhere. Do we have a large number of cases? Yes, we do. Actually, I would argue we have far more than 50,000. We just do some testing and we're missing many, many more. So probably the number of cases is far, far more than what we are detecting. However, even with increased testing, we do see that even in these hot epicenters that are still brewing, the number of cases is going down. If you look at California, Texas, Florida, the number of cases, even with increased uptake of testing, has peaked around July 12 to 22nd and has been plateauing and going down since then. if you look at deaths that follow a peak in cases by a couple of weeks, they're also starting to go down. So it's a little bit after the fact. Actually, the time that we diagnose cases is not when people get infected.

It's already a week. Sometimes it may be much more than a week. It could be even several weeks or a month and a half after people have been infected. So I think that shut down at this point would make no sense. Even the claim benefits of lockdown in some modeling studies, as I said, they seem to be modeling artifacts. Imperial College in London released a COVID-19 report, and that's where most of our U.S. leaders are getting the information they're basing their decision-making on. The report runs us through a few different ways this could turn out depending on what our responses are. If you take the Imperial College model that suggested that millions of lives were saved in Europe by shutdowns and lockdowns, if you use their own model that they apply to the U.S., you see that there's no benefit.

So lockdown and shutdown is a nuclear weapon that destroys everything other than doing what it's supposed to do. Thank you, John. Now is the opportunity for us to kind of move through, I think, some of the key issues that are going to be on our listeners' minds as they engage with this podcast. And I think first and foremost there is what parents and school boards and others are confronting right now, which is the return of millions of children across North America to the classroom. And Andrew, I know this is something you've written and you're thinking about a lot. Talk to us a bit about how you could see potentially the return of children to school, the effect of that having on this pandemic and your views as to how that could speak. spill out in terms of the need possibly for lockdowns, shelter in place as a policy response to the possibility of a surge in cases as a result of the return of the educational system.

So here in the Northern Hemisphere, school is going to be starting again soon. And K-12's education and also even, indeed, higher education strategies are probably the most complex and most important policy problem before us right now, as this podcast is being recorded in August 2020. I don't have easy answers for what to do with K-12 schools, but I do have some important thoughts. First of all, schools are so important for building educational and social capital in young people. And closing schools or changing schools such that they're done remotely is not something to be done lightly. I am not worried that we will have lots and lots of sick children

if school proceeds in a business-as-usual model because the data are clear that kids, for the vast, vast, vast, vast majority of cases do not get sick and certainly do not get severely ill when they are infected with SARS-CoV-2. but kids, we know, can be infected. They just don't show symptoms very much. And we know from a recent summer camp study in the state of Georgia, USA,

that they can transmit to each other and they can transmit to adults. First, tonight, a CDC report details a major COVID-19 outbreak at an overnight summer camp in North Georgia. More than 200 campers and staff tested positive after attending the YMCA's Camp High Harbor in Brabden County.

So my fear is that kids will inadvertently be a catalyst for a fall wave of COVID-19. So I'm worried about adults who work in education, teachers, teachers' age, school nurses, school administrators, and I'm worried about adults who share households with school-aged children, parents, principally, but in multi-generational households or et cetera, et cetera. So we know that respiratory diseases are seasonal with the winter dominance. We see this in tuberculosis. We see this in measles. We see this in respiratory cytokal virus. We see this in influenza.

We have every reason to believe that we'll see the same pattern in the temperate northern hemisphere with COVID-19. And believe it or not, kids are one of the reasons why many diseases are thought to be seasonal. because K-12 education catalyzes the seasonal epidemics. It's one of the theories of why diseases are so seasonal. So I'm worried that starting school, in some cases, will catalyze the epidemic and create second waves. There are enormous benefits of school going beyond education, including nutrition, including the general welfare of kids,

and the role that schools play, let's be honest in de facto child care for working families. So it's an incredibly thorny problem, but very sick parents is also a very thorny problem. It's a complicated issue. And let's have you, John, weigh in on schools, because in some ways it goes to the heart of this debate that we're having, which is about shutdowns as a tool. And have we, in a sense, move forward with school openings across North America preemptively without a case count at a low enough level to do this safety?

I think that schools are an extremely important component in solving that difficulty equation. And I fully agree with Andrew on many points. I think that you mentioned all the major benefits that we reap from schools, from education. Many kids cannot really afford nutrition other than what is given to them through the school system. Integration into society. Parents, their lives would be tremendously disrupted, let alone their hands. health by having schools continue to be closed, our whole society is disrupted if our educational

system is not functioning. So I think that there's a lot at stake. And at the same time, as Andrew mentioned, kids do not really have any chance of dying from that disease with very, very, very rare exceptions. I think that if you look at the number of things that can go wrong in our lives for children to have serious disease or to die, COVID-19 is extremely low down the list. So I think that the main issue we need to debate, because it seems we agree on everything else, is to what extent kids would possibly infect vulnerable adults and therefore lead to a higher death load. And I think that this is where I would disagree with Andrew. I think that we have evidence from dozens and hundreds of super spreader events and from disaster situations where COVID-19

has massacred large numbers of people. And we don't have in that list situations that have originated from schools. We know that kids, yes, they tend to be infected and they tend to be asymptomatic. They may transmit the virus, but it's not to a level that would be of such concern. that would lead to disasters. I think that they're one of the least likely type of transmission that would affect the highly vulnerable individuals. At the same time, I recognize that we need to allow for maybe that 5% or 10% of kids

where they would have highly vulnerable individuals within their immediate environment, that they live with them like every day in the same house, and they cannot avoid but live with them. And we should have some way that we would allow for a small proportion to join the class remotely. And I think that we can be flexible, I think that we can be precise about that.

I think it's unrealistic that we will shut down our educational system for everyone and suffer all these major consequences on all of these fronts while we can do things much more, targeted for situations where we have the need to intervene. The same applies also to a few kids that may have serious diseases themselves, and they may be at high risk. Of course, we need to find ways to integrate them in our educational experience, and probably they would need to protect themselves more. But we shouldn't use the nuclear option. We shouldn't just destroy our educational system.

We shouldn't just destroy the lives of children, parents, many of them very disadvantaged. every movement in the shutdown direction is just causing more inequality. Thank you, John. I want to kind of pivot back to what I think has emerged as one of the key points of disagreement between you, which is, John, you're feeling that there are a set of, quote, precision responses here that can be implemented, that can be effective and at least mitigating the continued surge of the virus. And, Andrew, you're saying that those precision responses haven't really worked,

to date, and that's why we're seeing this virus explode, especially across the continental U.S. So, Andrew, can you go a little bit deeper on that? Because I think, you know, John is channeling the frustration of a lot of people to shut downs or shelter in place is that they do seem like a nuclear option. They do seem like a response that isn't calibrated, ham-fisted, and causes all of these, you know, secondary and third- and fourth-level effects that have perfect. found negative consequences for public health, the very thing that shut down or lockdown or shelter in place is supposedly supposed to address. Let's go a little bit deeper on that, Andrew. Sure. And I don't want to sort of destroy society in order to save it. But I do recognize that

that would be a caricature way to see the position I'm arguing. I'm not arguing that we blanket shut down right away and everywhere. But I'm not principally a modeler. I'm not relying on the Imperial College model for my arguments in favor of shutdowns. I also wanted to add, I'm not just worried about death. This is a new virus known to science, so we don't know what the long-term sequela are. But I am worried about long-term consequences for those who survive. I think it's important for the listeners at home to understand that death is not the only severe outcome. Like I said, I don't want to crush society to save it. And, you know, the real reason we care about improving people's health is because that's an very important component of

their overall welfare. You know, we don't want to reduce other dimensions of people's welfare just for the health dimension. But there are ways we can approach, you know, this. I don't want to say we can have our cake and eat it too, but, you know, and it's not going to come without some cost, but it may be possible, for example, for children to repeat this school year. Now, that's not without tremendous logistical problems because we'll have to do, instead of K through 12, have to do K through 13. So it's going to take, you know, outside the box thinking, but it won't be a detriment to kids to repeat a year if everyone is repeating a year. We can find ways to deal with situations like that, but we don't know how to bring someone back who died of COVID-19.

Thanks, Andrew. So, John, similar question back to you, but I want to focus on Melbourne, because Melbourne right now is a really interesting experiment that's underway in terms of a large city of over five million people that has been shut down for the next six weeks. Now Melbourne in Australia is back in lockdown because of a spike in COVID cases. Stay at home means just that. This is, I know, further than we went last time, but we are in many respects in a more precarious, challenging and potentially tragic position now than we were some months ago. So part of the reason of the rationale for the shutdown in Melbourne was just the lack of compliance that people weren't following social distancing rules. Masks weren't being

worn according to guidelines. Contact tracing. People don't call back the contract tracer, something which seems supposedly quite prevalent in the United States. So John, talk to us about Melbourne and again, why you think that these precision mechanisms can work in the real world. Some people would say all that human behavior kind of suggests that shutdowns, lockdowns is really the only tool that works. I think that there's no doubt that for any measure in medicine and in public health, there is a difference between its theoretical benefit, its efficacy, and what it can achieve in terms of effectiveness in real life. So, you know, hand washing works, wearing masks and proper situations work, social distancing,

has some benefit in given settings, avoiding mass gatherings has a benefit. But as you say, none of them is implemented 100% with perfection. But the very same thing applies to shutdown. When we're saying shutdown or lockdown or complete lockdown, in fact, a very large segment of the society continues to work and be exposed actually to very high risk. And it's usually disadvantaged people. Essential workers are heroes. They're working for us.

they get exposed in high-risk jobs that we cannot really live without them. From the very beginning of our discussion, I mentioned that what I do care about is saving lives. I don't think that shutdowns are saving lives. I think that they're killing people, and they're killing some people immediately, but they're killing even more kind of in the midterm or long term through the consequences of all of these disasters on multiple fronts of public health, of society, of well-being, of mental health, of violence, of people just getting crazy. It's become an all-too-familiar scene at the intersection of coronavirus and gun violence in Chicago compared to last year.

...uptick in domestic violence cases as stay-at-home orders force victims into close quarters with abusers and make escape. But people have stayed home for myriad reasons, even if it meant ignoring chest pain. I think that there's just too many harms. Now, could it be that we have a vaccine and therefore just shutting down everything and waiting for the vaccine to save us? I believe vaccines are like one of the greatest achievements of humans of science. But despite some promising results, we're not going to have a vaccine in six weeks. We're not going to have one for wide distribution even in six months. We will be lucky if we have it within a year or two years.

So what are we going to do? Are we going to go for shutdowns for how long? even a few weeks can be devastating. Doing it again, I think we'll be more devastating than the first time. We just need to focus where we need to focus. It's unacceptable, for example, not to test all the personnel and nursing homes and all the people who are residents there. It is unacceptable not to test our healthcare workers and hospitals

when we know that they can have devastating impact through asymptomatic infections on people who are hospitalized and, are at very high risk of having a severe outcome. Instead, we're thinking of locking down little kids and healthy adults and people like me who will be enjoying it doing research and publishing papers. I think it's just the wrong recipe. It's destroying society and it's destroying also the most vulnerable and the most disadvantaged people among us.

Thank you, John. Before I go to closing statements, I just want to have you both weigh on one more important issue that I think is top of mind for listeners, which is, This certainly wasn't our first global pandemic, and it's not going to be our last. So what have we learned to apply to next time? Andrew, what have we learned? Yeah, thanks. I just want to touch on something John said, because I think it's important for the listeners, because he and I are an agreement. And I think, you know, where he and I agree is probably something where people can really pay attention because we have such different takes on this.

that where we overlap, I think, is a sign of consensus. And that is that I don't believe the vaccine will be here in six weeks and probably not in six months and maybe not even in 12. And so I tweeted a long time ago, the point of these lockdowns is not to save ourselves, you know, for our big vaccine night, you know, one that may never, in fact, come. The point of the lockdowns is just sort of lower the heat. As we approach COVID-19 in the fall, I think the average person needs to bear in mind that the vaccine is probably not imminent.

This is a really important point you're making. You know, Dr. Anthony Fauci in the last couple of a week or so has been saying quite definitively, we will have a vaccine by the end of the year. Vaccine, as you know, there are multiple candidates that are in various stages of clinical trial. So we're pretty cautiously optimistic that at the end of the year, beginning of this coming 2021, we will have one and maybe more, I hope more than one vaccine, that would be available. I mean, what do you think of that public messaging around those types of comments? I've been, I'm skeptical of presaging the results of a clinical trial before the results are in. Anthony Fauci has been a public health leader for a very long time, and he's just an amazing scientist, but even he doesn't have a crystal ball and cannot see the results of a phase three vaccine trial before they're in.

And vaccines have to be safe, effective, available, and affordable. And so let's not call the outcome of the trial before the results are in. But to get to your question about what do we do in 2030 or what do we do the next time? I think we need stronger public health institutions. The pandemic was very politicized, and I don't just mean electoral politics in the U.S. I mean, the World Health Organization dragged their feet on declaring a pandemic, which cost a lot of time, and it really set the wrong tone early on. And so we need stronger institutions, and not just at the World Health Organization in Geneva,

but in the United States, the Centers for Disease Control and Prevention has really been a disappointment in this pandemic. We need stronger federal leadership. We need the federal government to coordinate among the states. We need the CDC to step in and be the public health resource that it can be. So what we need are, among other things, are strong, resilient public health institutions

that can play a coordinating role so that we're not just all wandering around like headless chickens, wondering what to do. And Andrew, a lockdown is the initial response to the threat? I think John may disagree with me, but I think a more comprehensive lockdown early on could have saved a lot of pain now. And, you know, doing things now, once the genie's out of the bottle and doing things in the early stages when we can nip things in the bud do not have the same effect because

epidemics are non-linear phenomena. So I'm not saying, you know, it's futile to do things now. We should all be social distancing and masking. And I do share John's concern about disparate impact, that when we do these so-called lockdowns, they're not actually no lockdown. They're still essential workers. And we know in the United States context that essential workers are disproportionately people of color. And so we're disproportionately exposing socially economic disadvantage people and people of color to a risk. So that's a concern. But I also do worry that as we open up, it seems like you go from the frying pan to the fire because as we open up, people of color are facing the brunt of the disease burden. So inequalities in health are not flattering to

American society, and it's something that the pandemic is bringing into sharp relief. But I don't see that it's necessarily an argument one way or the other in terms of how to approach the pandemic, because we're seeing these inequalities no matter which way you slice it. Thanks, Andrew. So, John, final question for you before we go to closing statements, would you recommend, again, we don't know the nature of the pathogen, but if we're confronted by something similar to COVID-19, in the future, would you recommend lockdown as an initial response, both on the basis of the precautionary principle and on if you look at possibly the example of China as something that

seems to be quite effective in terms of allowing a meaningful reopening of the economy of Chinese schools? I mean, people are enjoying movie theaters in Beijing today, something I'm not able to do. I would be very cautious in interpreting the data from China. There's no doubt that the number of infections is vastly larger than the number of infections that were documented. And even the number of deaths may be off. The Chinese have revised these numbers, but I think that they're still pretty suboptimal compared to their reality.

I don't think that really lockdown was what worked in China. I think that the lockdown happened after the epidemic wave had peaked. My colleague at Stanford Michael Levitt has shown. pretty convincingly looking at the epidemic wave curves and modeling them with Gombard's functions that this might be the case, both in China and in other places. Would I go for lockdown in other future pathogens? First of all, we need to survive COVID-19. And I really worry that even though human civilization will not disappear because of COVID-19 itself, I think that our society and our world and our civilization can really have tremendous harm if we don't really

use proper measures to deal with that. If we have a new pathogen, I think that we need to mobilize science as quickly as possible. We need to mobilize public health. To mobilize public health, we need to have public health. And unfortunately, public health, as Andrew mentioned, has really not been given enough attention over the years. And I think that we need to strengthen our public health institutions. They should be given priority. Our prioritization in medicine so far over the years is to spend 20% almost of our GDP in this country trying to create medicine that is extremely expensive and not really helping too many people. It is medicine that is not offering health to everyone. It leaves many people outside with no health care, with no access to some minimum prevention

and therapeutic options. So we need to buttress public health. We should see more preparedness. We should see our hospitals really be ready to deal with. with it? Will we be able to get a vaccine faster, even faster than what we're trying to do now? I have great respect for Tony Fauci. I really love him. He's my hero. He's a giant. And I hope that he proves right and that we do get this vaccine soon. But we cannot promise that we will get a vaccine for a pathogen that we don't have a vaccine already. And I think that when we get the next pathogen in 2025 or 2035, we just cannot promise that. We will do our vaccine. We will do our best, but we need to depend on public health and we need to depend on smart knowledge, learning

about the virus, learning about who it attacks, who it kills, how does it do that, where do we need to focus our protection and our measures? When COVID-19 hit, we knew very little. We thought that this would be like 1918. It is not. It is a devastation, but it has nothing to do compared to 1918. It's very comparable to probably 1957, 1958, or 1968, 1969. We had somewhere between one to four million deaths in these years. And I hope that we do not get to that level with COVID-19, but we should do our best to really save every life that we can save, both for COVID-19 and learning on what we did right and also what we did wrong to prepare for the next virus or the next pathogen.

You're listening to the Monk Debates podcast. If you like this podcast, check out our other episodes, including debates on everything from the U.S. election to the future of globalization to whether it's time to defund the police. All free to download or stream on our website, monkdebates.com. Let's go to closing statements now. This is an opportunity just to wrap up any final thoughts. You want to leave with our listeners, points of agreement, disagreement, the podium is yours. Andrew, we're going to start with you for your closing remarks. Thank you.

John and I obviously have some differences of opinion on the fine points, but I think he would agree that we're both on the same side that we want to reduce the disease burden of COVID-19. We're in the summer now in the northern hemisphere where the United States is and where the most of the world's population lives. And, you know, these respiratory pathogens are winter dominant. You know, we see this over and over again with different viral pathogens that infect the respiratory tract. So I am very apprehensive about the fall as we head into winter. And I think it's too early to say that this won't be 1918. I mean, I don't believe the overall mortality and other impacts of this pandemic will will quite approach 1918, even in the worst case scenario.

So that's good news and perhaps a point of agreement. But I think it remains to be seen whether or not the overall burden of COVID-19 will be the same as 1957 flu pandemic or the 1968-69 flu pandemic. I just think it's too early to call. And we need every weapon in our arsenal. I'm not saying that you people in Maryland or you people in Illinois are going to need to lock down right away. But I am saying that shut downs for three to six weeks to reduce the boilover may be something that needs to be a weapon in our arsenal.

We shouldn't take it off the table. People need to understand it. We need to steal ourselves for the fall wave. We need to prepare for the worst, hope for the best. And when we're preparing for the worst, we need every arrow in our quiver. And shutdowns, as regrettable as they are, and as difficult. as they are in terms of other impacts, and I'm not ignoring those. Even net of, you know, the other problems that shutdowns cause, they may save more lives and cause less disease burden in the long

run. And we need to constantly try to get the upper hand on this pandemic or else it will hurt us. And there are plenty of people who said this is going to kill less than flu. And it's already taken the lives of 160,000 Americans. These are real deaths. These are not just borrowing deaths from heart attacks. The numbers show that we have increased mortality in the United States in calendar year 2020 relative to expectations. So it's a very serious situation, and it's been a pleasure, you know, discussing the points with Professor Unitas and he and I, you know, differ on a lot of things.

We also agree on a lot of things. And I wish all of that. the listeners, health and stay safe, everybody. Thank you, Andrew. John, we're going to give you the last word in this debate. Take us home. It was a great pleasure to debate with Andrew on this topic and to hear his insights. I think that we agree on 90% of what we discussed. The major point where we disagree is whether shutdown should be on the table. I think they should not. I think that we have enough evidence that they can be devastating. It's a lot. It's a lot of is a blind measure. It is kind of a medieval measure. It's the equivalent of just cutting your arm

because you have some joint pain in your hand. And I think that we should just not repeat this. We know far more about these virus. We know far more about who it affects, where it kills, where it strikes hard, whom to protect, what to do. We should struggle to really implement all this knowledge towards saving lives. I think that shutdown really protects those who do not necessarily need to be protected. It destroys those who have no risk. It destroys those who have risk. I think that it creates far more problems than we have. I don't think that this will be 1918. Of course, every virus can come back, even for influenza. Every year it kills about 300 to 800,000 thousand people. We don't know whether this year is going to be a good year or a bad year. Same thing

for COVID-19. I think we should prepare for the worse. And I think that we should use the knowledge that we have to protect those people in those settings where we can make a difference. We haven't done that. You know, surprisingly, we haven't done that. We still have people dying in nursing homes, in hospitals. We have disadvantaged people dying. And at the same time, we could avoid many of these deaths. So it is a major problem. We should do our best, but please, don't shut down the world. Thank you, John.

And thank you, Andrew. This is, as I said, at the outset of this debate. This is the big issue. I think we're all debating going into the autumn. And both of you have brought civility and substance to this conversation and service of our audience and expanding our knowledge and awareness of these vital issues. So on behalf of the Monk Debates community, thank you for coming on the Monk Debate podcast today. A million thanks for organizing this.

Thank you for having both of us. While that wraps up today's debate, I want to thank Andrew Neumer and John Aionidis for a terrific, thoughtful discussion of one of the big known unknowns of our time. How will we control COVID-19 until if and when we get a vaccine that works? Well, we've certainly dug into that issue today with some interesting food for thought. thought, I know I'm going to be thinking about this debate for days to come. Remember, the Monk Debates podcast is that special place for civil and substantive debate on the big issues of the day. To listen to more debates on everything from how COVID-19 is changing cities, to the growing

geopolitical rivalry between China and the United States, to big topics like the future of human progress, visit our website, monkdebates.com. You can also find show notes on today's debate. Thank you for helping us. Bring back the art of public debate, one conversation at a time. I'm your moderator, Rudyard Griffith. The Monk Debates are produced by Antica Productions and supported by the Monk Foundation. Redyard Griffiths, Maryland, Missouri, and Christina Campbell are the producers.

The Monk Debates podcast is mixed by Kieran Lynch. The president of Antica Productions is Stuart Cox. Be sure to download and subscribe wherever you get your podcast. And if you like us, feel free to give us a five-star rating. Thanks again for listening.