The Peter Attia Drive - #100 - Sam Harris, Ph.D.: COVID-19—Comprehending the crisis and managing our emotions

Episode Date: March 24, 2020

In this episode, Sam Harris, neuroscientist, author, and host of the Making Sense Podcast, joins Peter to discuss this unprecedented coronavirus (COVID-19) crisis. The discussion includes the important distinction between COVID-19 and influenza, the impact on the economy, the dire situation in New York, and the challenge of creating a safe and effective vaccine. Additionally, Sam brings insights from his extensive meditation practice to help those struggling with stress, anxiety, and fear in this extraordinary situation. We discuss: A time unlike any other—why many people don’t seem to fully grasp the magnitude of this situation [2:00]; Why comparing COVID-19 to influenza is a bad analogy [10:45] The impact on the economy of measures like shelter-in-place—Is the “cure” worse than the disease? [16:45]; Why are some places, like New York, getting hit so much worse? [24:45]; The trickle down effect of an overrun healthcare system on non-COVID-19 related health issues [34:45]; How to calm our minds and manage our emotions during this craziness [38:00]; Talking to kids about this situation without burdening them with undue stress [50:15]; Insights from meditation practice—Recognize and unhook yourself from a heightened emotional state [52:00]; How to make the most of a situation where you let your emotions get the best of you [59:15]; What are some potential positive things that Sam hopes could be learned from this crisis and applied to the future? [1:09:30]; The unfortunate politics being layered on top of this crisis [1:15:30]; The challenge of creating a safe and effective vaccine for COVID-19 [1:20:00]; and More. Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/samharris2 Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.

Hey everyone, welcome to the drive podcast. I'm your host, Peter Attia. This podcast, my website, and my weekly newsletter all focus on the goal of translating the science of longevity into something accessible for everyone. Our goal is to provide the best content in health and wellness, full stop. And we've assembled a great team of analysts to make this happen. If you enjoy this podcast, we've created a membership program that brings you far more in-depth content if you want to take your knowledge of this space to the next level. At the end of this episode, I'll explain what those benefits are, or if you want to learn more now, head over to peteratiamd.com forward slash subscribe.

Now, without further delay, here's today's episode. Welcome back to another special episode of The Drive Podcast, where we're really focusing on the COVID-19 pandemic. My guest today is my good friend, Sam Harris. Sam's been on the podcast in the past, as you may know, and we spend quite a bit of time on this episode talking about really two things. One is really talking about lessons learned. I offer some thoughts in response to Sam's questions around what I think is happening, what I think is going to happen. And at the time of this recording, which was Monday morning, as you'll tell, I was not especially optimistic, especially in New York. And again, this is less of me interviewing

Sam as it is a discussion. And then of course, we turn to talk about something that I think is equally important, which is how do we, as people sitting here watching this slow motion or fast motion train wreck in different parts of the world and different parts of the country, how do we manage ourselves, manage our own emotions, our thoughts, and our responses to it? And some of you may have noticed I put something up on social media last week where I just had a really, really bad day and did a bunch of stuff that I was pretty ashamed of as a dad. And that sort of prompted part of that discussion. So without further delay, let's get to this episode. And I think you'll enjoy the discussion today with Sam.

I am here with my friend, Peter Attia. Peter, you are a top flight physician and you have a background in finance. I can't imagine you had much to think about in the last few weeks. Yeah, very little. This has been, I'm sure everyone feels this way, this has been a period of time unlike any other in our lifetimes. There's really no analogy. Early on, I said 9-11 was an analogy, but in truth, this is really nothing like 9-11. Yeah, I actually had the same thought, which was, you know, I remembered where I was during 9-11. It's obviously everybody who's old enough can remember exactly where they were on that moment. And then, of course, in the hours, days and weeks that followed. But yeah, it is actually kind of different. And this has sort of an expanding array of confusion, at least for me. array of confusion, at least for me. And also somewhere in the back of your mind, you have to realize now that between SARS-1 and MERS and now SARS-CoV-2, it's not like coronaviruses are going away. Right. Yeah. And the idea that we

are so fundamentally surprised by this and caught back-footed is, frankly, scary. Bill Gates pointed this out some weeks ago, that this was perhaps the most predictable disaster. We knew this was coming. I think he even gave a TED Talk in 2015 on this topic. And everyone has been sounding this alarm in infectious disease for years, arm in infectious disease for years. And yet, I'm not even sure that after this, we will allocate the appropriate resources to have a network of virus detection or clamp down on the crazy bad eating practices in China. I mean, I just, I feel like once this is over and we rebound and we, in the best case, we have a successful antiviral treatment and a vaccine and the economy is booming again, I just feel like we're ready to go to sleep on this again. It just, we appear so masochistically

short-sighted in the way we focus on risk. I just, I'm to say nothing of our inability to think about something like climate change in light of what's going on here. I mean, just the idea that a slow moving emergency is something we could orient to when we can't even get our head together, when we have Italians Skyping us and giving TV interviews where they're bursting into tears, telling us about what's coming. And we're still debating whether we can keep Disney World open. Yeah, it is sort of sad when you put it that way, because it's sort of like the marshmallow problem everybody knows, which is most of us really aren't wired to make short-term concessions in exchange for make short-term concessions in exchange for long-term payoffs. And this one is not that hard because it's only a few years in the future. In other words, it's within our lifetime. It would

be hard to make the case that within our lifetime, we won't experience this again. Whereas presumably one can say, well, climate change is still from a disaster standpoint, 50 years away. The analogy to climate change is interesting to me because it is still abstract. The promise of disaster is still something that seems debatable to many people, even most people. It is hypothetical. It's based on models. We can see it sort of arriving, but even there, we can't attribute any one storm or any one heat wave to climate change in any rigorous sense. But in this case, we see the wave of contagion crashing on the hospitals in the countries of Europe. We're literally getting, we see the faces of doctors who in their all too infrequent downtime are

telling us what's happening. And I just, I see this through the lens of my personal relationships a lot now because I have a range of people in my life who have different enough information diets and political convictions and economic biases and incentives that lead the confirmation bias knobs to be tuned differently. And so I've spent a lot of time having to convince people one-to-one to take this seriously. And it's been an amazing experience because these are, by and large, very smart people. And you can show them the article that just got under your skin, and it doesn't work, or at least doesn't work as I think it should. And so it's just been very interesting to see the layers of denial and obfuscation present themselves and to have to kind of punch through them. I mean, even in oneself, I just noticed it's been disorienting to look back

over the course of a week where, you know, a week now seems like it's about a year long, and see what was at the beginning of the week felt to be kind of an extreme measure or a pessimistic hot take now seem like, oh, okay, I'm glad I was on the threshold of being rational then. I seem a little late in retrospect. It's just psychologically, it's very interesting to watch. Yeah, you're right. I was saying to my wife recently that each day seems to take, they just, they go by so quickly, but because it's seems like I'm doing the same thing every day. There's no, there's no difference between Sunday, Monday, Tuesday, Saturday, right? It's all Wednesday. It's just all the same day every day. And it goes by at alarming pace,

but week to week, when I think about last Monday or two Mondays ago, we were on our second day of quarantine. That seems like months ago to your point. I want to go back to something you said a second ago because it's something I've been struggling with, which is another challenge that is unique to the human condition. So if we struggle with appropriate discounting, I think we also struggle with understanding how to put uncertainty bounds on estimates. You've probably played this game before. It's a fun game to play where you take 20 questions for which there are known answers. And you ask a person each question and you say, look, give me a range that has a 95% confidence that it contains the answer to this question. And after 20 of these questions, they should have correctly captured the answer within their range 19 out of 20 times.

I've never seen anybody who can get close to it, by the way. Because they're, you know, really hard facts. Like, what is the distance from the sun to Mars? Most people wouldn't know that off the top of their head. And you sort of say, well, it's between this many miles and that many miles. And so it sort of speaks to, I think, one of the challenges of communicating things like climate change and pandemics to people, because error bars aren't a sexy part of scientific communication to the lay person. But there's sort of nothing that you can talk about as a projection,

let alone a measurement in science where it's backwards looking that doesn't have an error bar on it. And yet so much of what we talk about is binary. It's on this date, New York hospitals will be overrun. We're going to see this many cases with this percentage of them being fatal. But if we sort of force ourselves, and I'm just as guilty of this, by the way, as anybody, because it's just good shorthand to be able to rattle off numbers. rattle off numbers. But if you really had to start putting error bars on those things, like, well, we're 90 or 95% confident that it's this to this, I think that would be a better way to communicate this stuff. And I think it would be a little less alienating to people who are more naturally skeptical. Yeah. And there might be a role for something like betting markets and prediction markets. And just when you put things in terms of bets for people, it sharpens up their sense of probability. I've actually found myself consciously anchored to some clearly unscientific ways of thinking that have strangely seemed useful. One of the reasons why I feel like I... There have been a few memes here, which I think have been, frankly, confusing for people. And one is, the flu is worse than coronavirus. It's either just like the flu or the flu is worse. The flu

kills 50,000 people a year in the U.S. rather often. And if we were tracking that on an hourly basis, we would never leave our houses. And the flu kills kids, too, rather often. So we've now been enrolled in this vast social panic, delusion, and we're just not seeing it. And so the analogy to the flu, among those who use it, seems to be totally clarifying. And yet it has always struck me as just flat wrong. And it has, by a sheer accident, which has just primed in me, it was just a starkly unscientific way of thinking about this, which is I just happened to know one person who caught the virus fairly early. One of the guys who got it in Italy and came back to Los Angeles among a group

of, I think it was 13 skiers. I knew a guy who was in a group of five of them. And he and at least one of his friends quickly got sick enough to be hospitalized and then put on ventilators and induce comas. So I knew like a group of five where 40% of fairly young, I mean, 50-year-old fit guys without any comorbidities, non-smokers, 40% wound up in the ICU fighting for their lives. This is not a statistical sample. And yet, it has seemed anchored to that fact. I have just heard every comparison with flu sounding delusional. And I don't even know how to characterize the reasoning bias or error I'm making there. But it's actually seemed somewhat analogous to someone saying,

I've got 10,000 marbles in this urn and either 1% of them or 50% of them are black. Reach in and pull out a few. If you reach in and you pull out two of five being black, you feel like, okay, well, I'm not quite sure what's going on in the rest of that urn, but somehow I think betting on 50% sounds more reasonable. So I don't know what you think about that. But that's been just an accident in my own view of this from now going back a few weeks. And it's just, it's changed the way in which I've dealt with some of these memes that we've all been processing. dealt with some of these memes that we've all been processing. So I've sort of thought of it a little in a slightly different way, which is there's the beast you know versus the beast you don't. And the beast you know is pretty bad. I mean, nobody is

discounting the severity of influenza. But there are a couple of things to understand, which is influenza comes in a very predictable wave and it has a seasonal variation to it. But that mortality that you describe, let's even just look at the global mortality, it's spread out across a year and it's fairly uniform. So the rate at which it is changing is not enormous. We are still in a period of nonlinear geometric slash exponential growth, at least of new cases, and by extension, therefore, hospitalizations, critical care hospitalizations, and death. So there's no evidence yet that we are on the backside of that curve where that has stabilized. So we don't yet know what the absolute potential for mortality is from this virus because it's in its infancy. So it's sort of like there's a person who works on a job where they make $100,000 a year, plus or minus 10,000, depending on their performance bonus. And then there's someone working at a startup who's making $10,000 a year,

but has a whole bunch of equity in the company. Well, who's worth more? Well, it depends on what that equity is worth, right? That could very easily dwarf the value of that $100,000 a year. And so, I mean, again, maybe not a great analogy, but I think you get the point, right? There is this geometric component to this disease that is not present in influenza. And so as of today, if you could freeze the world and not one more person is going to get this disease, yeah, we may look back and say this was dwarfed by influenza even within a calendar year, but we can't say that. So to me, the real point is how can we take as many steps as possible to freeze this thing selectively?

And that's really, to me, the challenge, right? As we sit here recording this today, the stock market's got to be down 30% on the year, if not more. No one's going to look at this and say the cost of trying to arrest this was not enormous. And there were lots of really smart people out there saying the cost was too great. I really think that that's a, I think that's a pretty good argument. So the question is not just for this opportunity, but for the next one, not if, but when, what is a smarter way to go about locally addressing these problems without global economic calamity? Right. Yeah. And barring a great system of monitoring and a great system of producing antivirals and vaccines, I'm not sure what the fix is that protects the economy.

I actually want to say a few things about this notion that the cure might be worse than the disease, because that's cropping up a lot now. I mean, we've been, you know, you and I have been locked down for two weeks or so, but most people, it's at least a week less than that. And we're already hearing of this quarantine essentially beginning to fray. And people are saying, this is crazy. We need to find some other way of doing this. The economy is imploding. other way of doing this. The economy is imploding. And I definitely share the concern that the economic damage could be as bad or worse than anything the virus can do. I mean, I'm certainly worried about that. I'm worried that we might tip into a depression. I'm worried about the

loss of social cohesion that could follow upon that, none of that's trivial. And I think we have to guard against that. And hopefully the government will ram through a stimulus package that is appropriately targeted and takes away the immediate pain and shores up businesses of various sizes. But it's interesting to say, so when you hear the arguments of people, again, it comes back often to the flu analogy. Listen, we're all hiding in our houses, and only a few thousand people have died in the United States at this point. This is crazy. The flu has already killed 22,000 people this year. What the hell are we doing? There's kind of just this global faith that our health care system won't be overwhelmed. We'll be able to handle it. The virus is just going to peter out on its own by some dynamic that is just running against its apparent exponential growth. I've talked to smart people who just think there's this natural life cycle of a coronavirus or any cold virus that it just kind of peters out and you don't have to do much of anything about it. Again, these people are not

doctors or much less epidemiologists, but they're smart business people who want to get the economy started again. And one thing I would point out is that no one, to my knowledge, is running the opposite program of happy talk, which is to say no one is saying, as we're in our homes watching the economy fall off a cliff, that there's nothing to worry about economically. I mean, listen, businesses fail all the time. We have our Chapter 11 and Chapter 7 laws for a reason. There isn't actually any wealth destruction going on because even if the Dow goes to zero, we have our buildings and our roads and our factories and our laboratories. Are you noticing any of these things disappear? No, they're all there. People, it's just that there is no real wealth destruction here. This is all a fantasy, right? I mean, you could say something in that vein that would be analogous

to the kinds of things that are being said about the coronavirus so as to mollify or to attempt to mollify economic fears. But I think most people would recognize that it was delusional. I haven't heard anyone say it. I mean, everyone is worried about what could happen to the economy, and rightly so. But is there something in your cognitive toolkit around thinking about the health side of this that can help, that can actually arm people who are arguing that we should just let everyone get sick, essentially? I mean, we'll keep the 80-year-olds and the 70-year-olds maybe in their houses, but let's just go out there and get herd immunity. I mean, the UK was briefly on this path. I'm not sure what they're doing today, but they did a 180 and maybe they're going to do a 180 back. But I just feel like the shelter-in-place

mode that most of humanity is in at the moment, or at least attempting to be in, is beginning to unwind even only after about a week. And the idea that we're going to maintain this for months, if needed, seems fairly far-fetched. So I'm wondering what you're thinking about that. I'll come to that in a second, but I throw out one more analogy on why the influenza comparison is not great. And unfortunately, it's got its own political ramifications to it. So it's not a great analogy, but none of them are. You could almost think of influenza like the number of people who die in traffic accidents every year, which is frankly a lot higher than most people realize. Until you really scrutinize

those data, you'd be surprised at how devastating it is, what the odds are of a person dying in a car accident. And when 9-11 happened, a lot of people said, look, why are we getting all bent? I mean, no one said this in the immediate after fact, but for understandable reasons, there became a lot of political fatigue around the war on terror. And a lot of people said, wait a minute, why are we doing all of this? 3,000 people died on 9-11 and that's tragic, but do you know how many more people die in traffic accidents? And that's true, but it again, misses the non-linearity of terrorism. Now, again, I'm not even here to try to broach this discussion of whether our approach to a

post 9-11 world was the right approach or what could have been done different. But if you're, you know, a reasonable student of history, you could at least conclude that 9-11 had to be countered with a much more severe response than just the number of lives lost, as tragic as that was. It's the potential for what could happen if this situation is not rectified. And again, I think that's the issue here, which is not to discount how tragic influenza is, because it is, but to realize how much of an unknown we're dealing with right now. And then how do you balance that with, there's a way to immediately put this thing to

rest if you could wave a magic wand, which is you shut the world down. And then of course, what's the right way to thread that needle? And now to your question. Well, actually, could we linger on that one point first? I mean, why haven't we been able to communicate that solution better than we have? Because we know we're sort of stumbling into some mode of shutdown that risks cratering the economy. Why hasn't anyone articulated the total lockdown that only lasts a few weeks? I mean, that just seems like, let's just talk about the biology of that for a second. I mean, that just seems like, let's just talk about the biology of that for a second. I mean, that barring some crazy property of this virus that I think, I mean, I haven't heard anyone

allege, if we all sheltered in place for what, three weeks, this would burn itself out. I mean, you'd have the sick people still in hospitals getting treated and recovering or not. But everyone who's got this thing, if you denied them contact with anyone else, this thing would evaporate. Yeah, maybe call it four weeks to include the 95th percentile. It's a non-normal distribution. But yeah, you'd say four weeks of total lockdown, you could burn this thing out. And by the way, that's effectively what happened in the second wave in China. That's the best estimate of what really happened there. But you see, that's a political solution, not a

scientific solution. The steps that China took to be able to make that happen. I just don't see how you could do in a free society like the United States. I mean, Governor Newsom, how many days ago basically said, you got to shut this down, people don't leave your house unless it's absolutely essential. And I mean, I just saw the newspaper today. It's like people are running around the beach and playing patty cakes and doing this, that, and the other thing. And I'm sensitive to it. I get it. I mean, they're saying, hey, I'm not going to be defeated by this thing or whatever the logic might be. It's not the approach I would take. But the point is they're not even listening to the closest thing we have to a directive shy of enacting the police. So I just don't think we can do it. And that gets back to my point about the 95% confidence interval.

You know, I'm really starting to think that what we should have been doing all along was not thinking of the United States as one homogeneous entity, but rather thinking of each city as its own country. Because even within Italy, you know, I talked about this on social media recently, even within Italy, it looks totally different, right? Milan to Sicily to Rome have not one thing in common, not one. So Milan, you had almost 2,200 deaths out of 10 million people. That's a 2% mortality, not case fatality, total fatality to the population, 0.02%. I mean, that's staggering, right? And in Rome,

31 deaths on 6 million, Sicily, three deaths in 5 million. So the mortality on a per population basis was 40 times higher in Milan than Rome and 300 times higher in Milan than Sicily. So even within Italy, it doesn't make sense to think of it as Italy is horrible. No, it's like basically which part of Italy got a headstart on this. There's all these analogies. The one I like to use is they're all cars driving towards the edge of a cliff. Some of them are going faster. Some of them have more people on and they're heavier. Some of them have worse tires and some of them are on lousier surfaces and they apply the brakes at a different point in time. They're not all going off the cliff at the same time and some of them aren on lousier surfaces, and they apply the brakes at a different point in time. They're not all going off the cliff at the same time, and some of them aren't going to go off a

cliff. And so in retrospect, I wish I was smart enough to think of that a month ago. I wish our policymakers had a thought of that a month ago. And maybe we would have had a better shot at containing this if we'd been more directed towards where is there going to be grotesque mismatches between supply and demand. And obviously New York is now. That is unambiguously the case in New York as of right now. Right. So we're recording this on Monday the 23rd. And yeah, I think we're all expecting to learn a lot from the experience in New York over the course of the next week. What's your sense of the likelihood that we're going to discover that New York at least is much more like Italy than it is like South Korea? Well, and again, I would say Milan

more than anything else in Italy. So we've built a couple of models on this. And then we've even had, we've been really fortunate that some really great inbound people have just come to us and shared their models and then let us put our assumption there and theirs and vice versa. It kind of comes down to the following. How many people in New York do we know are positive? And as of this morning, the most conservative estimate I can find is about just under 11,000. And that's probably where we were last night. So it's probably closer to 12,000 based on something Cuomo said this morning. Okay. So that's how many people we know have the infection. So then the first question is, what is the population that is infected for whom yet we don't have

confirmation? So in other words, what's the known to unknown positives? This is where lots of models are spitting out unbelievable numbers, and they're based on several different things. They're based on looking at historical data within New York and looking at what is the number of people in the hospital tell you as a leading indicator for the lag on infection. They're also based on the Wuhan data. So we have a very clear case of the up and down cycle of infections in China. And so we are basically modeling approximations based on at any point in time when you go t minus one, two, three, four, five, six, seven days, what did you see in the past that helps you understand the future? Now, the problem with this, before I go any further, Sam, as you know, is you can't just

use straight up linear regression to solve this problem because if you do, you need a new model for every day because there's just no linear extrapolation from across the span of say five days. It just doesn't work that way. It's changing way too quickly. You use these things called vintage models and you start to have to look at first and second derivatives of change and things like that. So then we pivot to another question. So that whole series of questioning tries to get at the situation of what is going to be the number of infected people. And by the way, I've thrown in some really conservative estimates, which is take R naught to zero. In other words, pretend for a moment that you have enacted draconian enough measures that not one more person in New York who's infected will infect another person. Now, is that true? Based

on what my friends in New York who are looking out their windows are telling me, not a chance. But I like to sometimes play the what you have to believe game, which is let's make it as good as it gets. Before we go down that path, what do we think makes New York such a hotspot here? Is it the fact that this is just urban density and a very active subway system? And what would you attribute the problem to in New York? I think it's everything including that and bad luck. I don't think there's anything about Milan that makes it any better or worse than Rome. So I reject the idea that the climate in Milan is more suitable for this than Rome. I think that's just noise. I think the issue is bad luck.

So this is a stochastic problem. People were going to distribute from the epicenter of infection to different places, and they got there at different periods of time. And again, the growth is so nonlinear that if one city got a 10-day head start over another, it's a totally different world. Because remember, the other cities get to see that response and enact measures to slow it down. In other words, everybody's generally applying the brakes at the same time. But imagine if one person had a one-minute head start of pushing on the accelerator towards the cliff.

We need a different analogy for what goes down in Florida when they get to preview everyone's horror, then declare their world open for spring break. Yeah. Well, no, but that's the person who watches everybody apply the brakes and says, somehow I'm immune because I have a parachute on my car. Yeah. Maybe I can fly. Yeah. So I think New York just had a bad head start and then it's the perfect storm of population density, subways and proximity. And truthfully, I mean, based on what I'm hearing from everybody I know in New York, there's a little bit of a cultural difference as well, right? A little bit of a, hey, we're New York, right? Like we've got this thing. We survived 9-11. This thing is not going to be that bad. So sort of a, whatever,

all of these things sort of combine, I think, to just have enough kindling and oxygen and fuel to make this thing have burned from a little bit of a dull ember into kind of a big fire. So that's the supply side of the equation. So you're giving me an R naught of zero. Yes. I'm giving you an R naught of zero. And I'm saying, what's the most conservative estimate for how many people are infected relative in total relative to the ones we know. And I've never seen an estimate that's more conservative than five X. So for every person who we know is infected, only five X more are actually infected. So that would place your New York infections at 50,000 people by the most conservative estimate. By the way, the estimates that I've seen range from 5 to 40X.

So let's just take the lower bound, the 5X. R0 is zero. That's 50,000 people are infected. Now we ask the question, how many of those people require an ICU? And I think that's the more important question than how many of those people require a hospital bed. Because we can makeshift hospital beds pretty well. ICUs are a little harder to makeshift. So let's start on the availability. So the stock number of ICU beds in New York City, which basically is going to service not just New York City, but the Hamptons, beds in New York City, which basically is going to service not just New York City, but the Hamptons going to service the surrounding area. You've got at baseline about a thousand ICU beds. Now we've estimated from discussions, we basically know people at almost every hospital directly and

indirectly. We think they can repurpose 2000 beds. So you could take all the surgical ICUs and say, we're not doing elective surgery, so let's repurpose those and get those ready for medical and pulmonary ICU. You're still going to probably occupy 25% of your beds for non-COVID patients. Remember, people still have heart attacks and strokes and the things that require ICU care. So let's say you've got 1,500 ICU beds, and maybe you can stretch this up to 2,000 from a capacity standpoint, because you can start to double ventilate patients that are of the same size that have the same ventilator requirement. So now you then ask the question, how many of those at a minimum 50,000 patients who are infected, not growing at all, how many require an ICU? Well, if you look at everything

in Italy, it's about 4.8, 4.9%. And if you look at the numbers in New York today, they're almost 5%. So let's just be really conservative and say it's 4%. Well, if 4% of those patients are going to require ICU care. I mean, you're already talking about over 2000 beds. Yeah. You're full up already. So that when you play the, what you have to believe for New York, not to get overwhelmed game, you really have to come up with some conservative estimates. And, and I, we're losing faith in that game. And therefore, we think that there needs to be a really important strategy of mitigation in New York and that every other city like Miami, like San Francisco, like Los Angeles, and like Seattle, who are next in the crosshairs, needs to be pushing the brakes a little harder and also thinking about how you would bolster capacity should the unknown to known infections be higher

than we're estimating? Do you think we're going to get a good sense of the mortality associated with all of the other non-COVID conditions that got shoved aside or otherwise handled badly in the wake of this? So you have people who are electing to delay cancer surgeries, say, or as you say, they have routine or more routine emergencies like strokes and heart attacks, and either they are reluctant to go to the hospital or they go and the beds aren't there. I mean, is that all being modeled? We have not been looking at that internally. I trust that it will be looked at. And I mean, I've seen it indirectly just through our patients, right? I'll give you the silliest example, which is not life-threatening, but

we haven't drawn labs on a patient in two weeks. And I don't know when the next time is that we will draw labs on a patient. Okay. That's a trivial example, but you start to think about what can and can't be done. We've got two patients that are in need of a dental procedure right now. One of them chipped his tooth and needs a root canal. We're kind of on the fence about whether or not he should go and do that right now. Yeah, yeah. No, I've been thinking about that just personally when I see what, just how we live and how other people live and what we let our kids do. I'm basically viewing everything that runs any risk of physical injury as we're sort of out in the wilderness right now, not close to a hospital.

Because we don't want to go to a hospital unless absolutely necessary. So I want to do those things or not do those things that I wouldn't want to do if I were a thousand miles away from medical attention. Yeah. I'm just thinking about like, we just got a puppy, God, like maybe four or five weeks ago. And I mean, she's as cute as all hell, but she didn't finish her vaccinations. I'm just worried like, Oh God, I hope nothing goes wrong with her. Cause I sure as hell don't want to have to go and take her out to the vet. And secondly, I have two young kids. Two of my three kids are in that age group where they can do really stupid things and get bit by dogs. If you're not watching them, they can yank a dog's tail or do something

dumb. And so, I mean, that's constantly in the back of my mind, which is watching those kids like a hawk when they're with her. Because if one of them gets bit by her, yeah, we's constantly in the back of my mind, which is watching those kids like a hawk when they're with her. Because if one of them gets bit by her, yeah, we're going to the urgent care. I'd rather do a root canal on myself right now than have to take one of my kids into urgent care to get some IV antibiotics for a significant dog bite. Yeah, yeah. No, and it's amazing to see people who are not or apparently not making any of those accommodations. You know, I've seen people because you can obviously get out of your house and we're not locked down in that sense. It's not crazy to be out hiking or as long as you can stay away from people. mountain bike. And I mean, I'm just picturing all the people who take a fall on a mountain bike or

one of these scooters, then having to deal with the aftermath. And why add that to the risk profile of the moment? I mean, yeah, I'm embarrassed to admit the number of times a day I do that calculation with everything I'm doing of, don't let this be the moment you break something and have to go in and get taken care of. So I want to pivot to something else, Sam, because by the way, you and I could have this discussion an hour every day and it never gets old to me. But there's something I want to pivot to where just on a personal level could use your help. And I know a lot of other people can as well, which is our minds are running amok at the moment. And there are a few people who I think have been able to

articulate the nature of the mind and how we are not our thoughts. And yet right now, so many of my thoughts are unpleasant. They've permeated my dreams. I've never had more sort of disturbing dreams than I've had in the last two weeks, I think. And they're not always related to this, but they're just disturbing dreams in general. And I know that part of that is my mind playing out anxiety as I sleep. How have you dealt with that? As you know, based on having spent many years practicing meditation and seeing the mind through that lens, I have some tools which I now default to, which are incredibly helpful. So it's if you understand the mechanics of your own mental suffering, if you understand how anxiety arises from the first person side, I mean, not understanding it

as a matter of neurophysiology, but just actually able to witness it as a matter of experience moment to moment, that allows you to get off the ride whenever you can remember to. Now, the devil's in the details of just how infrequently you managed to do that, depending on how much this skill has been ingrained in you. And there really is, for most of us, there's no alternative but to practice it. First you have to learn it, and then you have to practice it. And then it becomes somewhat like any physical skill. If someone who is completely untrained and unfit, and you put them in the gym, and they have a fair amount of work to do to get even anything that's sort of acceptable in terms of fitness and preparation for real physical stress.

And then you have people who, they're Olympic athletes or they're jujitsu world champions or they're people who have taken some domain of physical training to a point where their default setting physically under stress is amazingly different than people tend to be. And there is a mental component to that. It's possible to be really resilient. I don't count myself among the super athletes here, but I've done enough practice so that when my wheels begin to spin and I'm suffering unnecessarily,

whether it's from anxiety or some other negative emotion, I can let it go. If it's pointed out to me by someone else or I just happen to notice it, I can drop the problem. That doesn't mean I don't pick it up again. I mean, then the thoughts come back and you don't notice them and it just feels like you worrying about getting sick in the middle of the night or whatever it is. But the question is, how long does it take to puncture that with a clear scene of the nature of mind? And for me, progress really is a matter of, it's not a matter of banishing any particular emotion or pattern of thought from your experience for all time. I mean, that's an unrealistic goal.

It's a matter of getting more and more agile in the face of these arising thoughts and emotions so that their time course is drastically shortened, or at least the time it takes you to puncture them by, in this case, the state of mind would be called mindfulness. But mindfulness really is just clear attention to what experience is like in the present. It's not some mystical piece of software that you have to get downloaded into you that you don't have. It actually is just a non-distracted, non-reactive, clear scene of, let's say, the physiology of anxiety. I mean, just feeling the energy in your body of anxiety. The moment you can merely feel it without judgment, without reaction, without contraction, without thinking about all the reasons why it's intolerable or thinking more about the reasons why it's justified,

if you just become willing to feel it in the moment, it loses its psychological content. For the moment you can merely feel it, it has no more psychological content than any other analogous feeling in the body does. You know, indigestion or pain in your back or itching on the surface of your skin. I mean, all of these things can be unpleasant, but they don't mean anything, really, or at least it's a further action of thought to link them up with some future state of the body or the world, which caches out their meaning. So anyway, I can talk more about what mindfulness actually is and how to practice it, but that's how I view this ongoing experience. I keep puncturing it with just clear attention and it really does help. No question. You said something on one of your podcasts, I think it

was last week, you said it and I'm paraphrasing, but look, it's not about getting rid of fear, but rather kind of letting an emotion like fear go when it no longer serves its purpose. Yeah. I mean, you want to feel fear when it's appropriate and useful to feel it, and you want to be able to release it the moment there's no point to it. And the punchline here, though, is that 95%, 99%, I mean, the vast majority of moments in which we feel fear or anxiety or shame or regret or any classically negative emotion, most of those moments are wasted. I mean, in most of those moments, the negative emotion is driving us to no good purpose. In fact, it's actually undermining our ability to recognize the happiness as a goad, its utility is delivered in those first

few moments very often. I mean, it's at the boundary of sort of the known and the unknown where you're trying to figure out what to do. I mean, around this COVID pandemic, I'm feeling anxiety when I don't know what I should be doing. How do we get groceries into the house? What should I be doing there? Do we eat salad anymore or is this a vector for disease? How do I wipe down a box or do I wipe down a box that was just delivered? How long does the virus live on cardboard? How long does it live inside a box that I open? Now I'm taking something that's packaged in plastic out of that box. Am I a lunatic for thinking any of these thoughts? All of that uncertainty is the basis for a durable state of anxiety. But once I figure out what I think is true and what I should be

doing, well, then there is no utility to the anxiety. Then just do the thing you think you should be doing. And the moment uncertainty reimposes itself, the moment I read an article which says, oh, actually, you know, coronavirus can get in in this other way that you hadn't been accounting for, well, then, okay, then I'll get anxious over that, but only for as long as it takes me to decide what my new policy is. And you can either do something about it or not. If you can do something about it, the anxiety is pointless. I mean, it should have a very short half-life. And the truth is, if you can't do something about it, the anxiety is pointless and should have a short half-life. So in either case, you want this punctate experience

of what's essentially an orienting response to danger. And the dangers are real. This is not a cartoon we're in. We're making potentially life and death decisions for ourselves and other people, but you don't have to remain in this state of anxiety, even if these decisions are actually very significant. Yeah, there aren't many examples I can point to in the last two or three years, which is about the period of time that I've been familiar with mindfulness-based meditation, where it's been more true to realize that what's happening in the moment is rarely that bad, but what's going on in my mind is often much worse. And in the case of what's happening now, it's usually more forward looking than backwards looking. Obviously there were periods in our lives when we can suffer more

based on the backwards looking emotions that tend to be more depressive and dysthymic. But here it's really this forward looking anxiety that can be devastating. And yet I put something up on Twitter the other day and I was like, you know, it sort of occurred to me that I had just reached my new record in 12 years, longest period of time, not traveling. And it's sort of funny because you are not going to meet someone who hates traveling more than me, Sam. I hate it. I hate airplanes. I hate airports. I hate being away from my home. And for someone who hates it so much, I do it an awful lot. And so for all the uncertainty and the everything that's going on right now, it's been, it's been a long time and

it's might be a long time before I travel again. There's huge value in that. And certainly if I appreciate it in the moment that I'm in, and yet so often I'm hijacked by my fear of uncertainty. Yeah. Well, I mean, one thing you're pointing to there are the many silver linings that many of us have found in this circumstance, People are reporting this on social media, just listing the things that are surprisingly nice about quarantine, essentially. The general circumstance, the reason why we're all doing this isn't nice, but yeah, many people are discovering

that there's a kind of a hard reset of their value system. And they're spending more time with family. And there's quality time of a sort that they haven't touched before or haven't touched in a long time. I totally share the less travel epiphany. I mean, it's just I sort of had that even before this and decided to just cancel a lot of travel just in general. I like it about as much as you do. But yeah, there's, especially for those of us who are so fortunate to more or less be able to do what we were doing before from home in isolation. I mean, obviously there are people for whom their careers were completely zeroed out

the moment they were told to stay home. And there's a ton of financial anxiety that comes with that. And everyone's feeling the financial anxiety to some degree. But some of us, I count myself among the luckiest here, were in a position to just either where everything was already distributed or we were in a position to make it distributed without really missing a step. And that's just sheer luck in many cases because there are certain things you just can't build from home and certain things you need to never even think about going into an office to accomplish. office to accomplish. So yeah, I mean, there's a lot that many of us are discovering about just how out of balance our lives became when everything was normal. And I think it's worth, insofar as any of those lessons seem like things we want to hold on to, it's worth taking stock of them. Have your kids voiced any sort of concern about this and how have you talked with them about it? Well, my oldest is 11 and she's definitely old enough to worry about it and to understand how non-normal this situation is.

My six-year-old is pretty oblivious to it. I mean, she has a general sense of what we're up to, but I don't get the sense that it's making her anxious at all. I mean, as you know, the core ethic in my life, and this translates into the family, is honesty. My daughters know that we will never lie to them. And we never find ourselves having to lie to them. But that doesn't mean we tell them everything. And my oldest daughter will ask a question to which I know she really doesn't want the answer. It's just going to make her anxious. And so I'll basically just acknowledge in that moment that there's a door that's locked,

that she's trying to open, but there's no point in opening it. I'll tell her what she needs to know there. And that's not the same thing as saying, oh, there's nothing to worry about or giving her some dishonest answer that totally assuages her anxiety. But it's a stronger foundation for a relationship. I mean, she knows, because the thing is, she knows now that when I say something is not worth worrying about, it's not a risk or she's fine, she knows I'm not bullshitting her. And in other moments where I can't say that honestly, I don't say it dishonestly. I just give her more of the attempt to give her more of the adult-grade tools of dealing with probability and risk and whether it's working or not. I mean, I don't have the counterfactual to go on, but at the very least she knows we don't lie to her. And that's, to my eye, that's a nice place to be. Have you struggled yourself with just

irritability or you're one of the least irritable humans I've ever met. So that's a pretty, it's a pretty high bar for you to tell that to my wife. Well, exactly. You'll get a big laugh out of her. That's the litmus test, right? So what would your wife say has been the impact of the uncertainty, the fear, all of the things we've just discussed? How has that impacted someone like you who for most of us, we would aspire to have sort of the degree of separation from thought and reaction that you have through, again, years of practice? Yeah. Well, again, it's not that I don't get angry or anxious or uptight or have a negative reaction to things. I do. And by tendency, I tend to be that sort of person. I mean,

I'm sort of on the anger, annoyed, pessimist channel more than, certainly more than the opposite, right? I mean, no one has ever accused me of being too joyful or Pollyannish. So yeah, I mean, I can definitely be a buzzkill and can be in a bad mood and can be irritable. The difference is that if she calls me on it, I can actually pull the brakes or get off the ride or just whatever metaphor you want for like the actual stoppage of the problem emotionally. stoppage of the problem emotionally. And this is not a matter of bearing down on yourself or repressing it or doing some maneuver which just bottles up the rage or something. It's not that. I can actually just let it go. That's just garden variety mindfulness taken to a certain level. variety mindfulness taken to a certain level. In my case, it's, I mean, if you know anything about how I view meditation practice and the nature of mind and the illusoriness of the self and

free will and all of these other, you know, nested topics. There's a pretty good app that I would recommend for people to help understand how you think about some of those things. What's it called again? This conversation is brought to you by the Waking Up app. Yeah. Though we eschew sponsors on this podcast. Yeah. Yeah. So, I mean, I taught, there's a lot to say about that, but the net result is it's possible to cut through the illusion there in a way that allows you to truly stand free of whatever emotional reaction you're having at that

moment, whether it's anger or sadness or anything. And you recognize that consciousness is just this open space in which everything is appearing on its own, and there is no durable self riding around in the middle of it. There's just consciousness in its contents and everything is in its own place. And consciousness actually isn't even harmed by that awful mind state that you were anchored to a second ago. There's just the energy of what used to be anger, essentially, passing through. And your freedom from a problem in the next moment isn't actually even predicated on that energy leaving yet. It's just in fact true that when you're no longer identified with the stream of angry thoughts, the peripheral physiology

of anger dissipates very, very quickly. I mean, over the course of seconds, 15 seconds at the most, whereas, and the thoughts disappear more or less instantly. If you break the spell, all of this, the time course of all of this falling off is pretty quick. But the truth is, the moment you break the spell, even while the body is still incandescent with the physiology of anger or anxiety or whatever, you're free even in that first moment. And that can take some doing to recognize that, and that's the reason why one would practice meditation. But having brought your practice to that point where you can actually do that,

yeah, I mean, the thing Annika would say about me is that I can actually, when push comes to shove, I can stop being an asshole and I can stop on a dime whether or not, and whether or not I do it in that moment, it can be influenced by some other factors. And so personally, the most stressful stuff that happens for us in this situation is if we're not on the same page with respect to something we're trying to decide. Again, I mean, we're talking about the boundary between the known and the unknown and trying to decide what we should do about the unknown, right? So if we can't agree about whether or not, whatever, to have someone over to the house, say, under these conditions, right? We're going to decide to have her mom over, but how's her mom living? Is her mom actually locked down? Is her

mom, wasn't your mom just at the supermarket and told you that such and such happened? Whatever it is, I mean, this is kind of hypothetical, but in that situation, if I'm trying to convince her to be more risk averse than she in fact is, or vice versa, that's where I'm going to tend just to get caught in my own sense of urgency. of urgency, then my stress will be just largely what I'm communicating, right? And I'll be uptight and she'll be annoyed at just how I'm having the conversation. And even in that moment, if she actually said, okay, listen, we can talk about this, but I don't like who you are right now. I don't like the way you're talking about this. That is something that as long as we can keep working to solve the problem at the level of the problem, I could drop the emotional contagion in that moment, which is an immense help. But the place where I get what really is my kryptonite is when the door gets closed to actually solving the problem. When I want to keep talking about something or keep trying to figure,

I feel like there's something to figure out. And she or someone in the world is shutting me down there. It's very easy for me to just feel like, okay, the emergency signals are still appropriate here. It would be inappropriate to be no longer anxious because the house is on fire and we're fighting about whether to use the fire extinguisher. But that's the exception, right? Yeah, I'm very rarely in that situation. But that's where my gears truly grind.

And again, you still want to be the person who can find the gear that allows for grace under pressure. that allows for grace under pressure. You do want to be the smooth Navy SEAL operator rather than the panicked grunt who's just firing his weapon in all directions. And so there's always an argument for unhooking from the heightened emotion in a situation once you're orienting to the problem. You touched on something there that I think is so helpful and doesn't get enough, I think, appreciation, which is the importance of having a spouse that understands the exercise and knows how to help you. In my case, I mean, that's something I feel really grateful for. I posted something on social media a week ago. It was, it was really sad. It was actually my birthday of all days. And the night before I had just absolutely berated my daughter for leaving the lights on. She left like

every single light on in the hallway. It's just a dumb pet peeve of mine that normally I just turn them off or just make some smart Alec remark like, Hey Olivia, you know, the light fairy is not working today. Maybe you could turn the lights off. But on this day, I just went nuts. And then the next morning, which again is my birthday, I'm on a conference call basically from six o'clock in the morning till 10 o'clock in the morning, one call after another. And my five-year-old just cannot understand for the life of him why I'm working on my birthday. He thinks your birthday is the day you get to play. And he keeps trying to come in the office and play. And finally, after like the fourth time, I just explode on him. Well, two things, right? One is

not a lot of mindfulness in that experience. Two, you then, at least for me, you cycle into a horrible place of shame where now you are doing that backwards looking thing that we just talked about. Again, I said most of it is anxiety, but then the shame is very backwards looking, equally unproductive. And you sort of spoil the rest of the day, but through a different mechanism, not by lashing out, but by detaching. And that's actually for me, my kryptonite is when I get in that place, I just, I pull back so far and it's equally troublesome. But then fast forward two, three days and I've reflected a lot on that experience and like, how did you get there, man? How is it

in the span of 14 hours, you lose it on two kids. So yesterday, my same five-year-old who's obsessed with Lego, and there are these train Legos that are very elaborate. They take a long time to put together. And I've told him like 400 times, you got to be careful with this thing. Well, sure enough, he drops it. It smashes into 50 pieces. And the next morning, which is Sunday morning, I wake up to put it together. And I don't know if you've ever done this with Lego, if you remember when you were a kid. Sometimes it's just easier to take the whole thing apart, all 500 pieces and start from scratch, then try to take the 50 that came off and figure out where they go. But needless to say, this is a ton of work. And at one point, I actually pull out a video to check something. And by now he's awake and he starts yipping at me. Like the video

is too loud that I'm trying to watch to fix his Lego. Admittedly, he's being totally obnoxious. And I'm just about to explode on him and basically say, what do you think I've been doing here for the past hour, buddy? And my wife looks at me and she goes, take a breath. And it was perfect, right? I just stood up. I went over to him and I said, Reese, I don't like the way you're talking right now. You're being really rude. And dad's been up for an hour before you even got up trying to fix the toy you broke. So I'd appreciate it if you'd talk a little nicer. And afterwards, my wife was like, look, you did it, man. Like you weren't the biggest jerk on earth. But my point

is she was the one who helped me there. Like, yeah, the practice that I had helps, but I'm still at the point where I need that cue sometimes from somebody else to just give me one more pause before I lose my mind. Yeah, no, that's great. That is the virtue of certainly one of the virtues of good company and having someone who shares your values. I mean, one thing I would add is that even when you totally screw up, you've blown up at your kids or someone else and you're now feeling ashamed by what you did, you know, your lack of compassion or resilience or mindfulness or however you're judging yourself for the previous misstep and you just feel bad about it and bad about yourself. Again, that is no less an opportunity to cut through the illusion of self than any other moment. It's like in this video game, that's just the next screen, right? This is the next boss fight. Now you're fighting the boss of shame. And it's no more

real ultimately. And yet it's an appropriate, again, like anxiety as a signal, it can be an appropriate guide to action. So for me, if that happens to me, if I do something that I'm subsequently ashamed of or embarrassed by, the signal for me there is how I want to use that information is I want to repair the relationship if I feel like I've done any kind of damage. if I feel like I've done any kind of damage. And therefore, it becomes a goad to very likely an apology. And it's not, and again, given my view of free will, I mean, it's interesting to just understand the psychology of this because, you know, as you know, I think free will is an illusion. I think there's just makes absolutely no sense to think that one could have done or should have done otherwise previous moment, or at least

thinking that isn't really thinking honestly about the past. What it is, is it's kind of an aspirational thinking, which is in fact directed at the future. It's like, given what just happened, I recognize that I'm not the person I want to be. I'm the person who lost his mind when, in this case, my kid came into the room and interrupted me during a conference call. I'm not satisfied being that person. This person is now in my past. This person is very likely to show up again in the future. What I want to do now is make that less likely.

And also I want to repair any damage I've done. In this case, an apology can really be healing. I don't know if you have an experience of apologizing for these kinds of missteps and feeling that actually the net result is in fact even better than zero. It's not just a matter of getting back to zero, but you can actually get past zero to your, in this case, your child understands that you can get angry and it's okay and it's okay to express it and grownups can apologize and the kid can be empowered with their own judgment of when you were in the wrong. I mean, so like whenever I've found myself apologizing to, this is more true of my older daughter than my younger because, again, she's a barbarian.

She's completely clueless. But my older, you know, it's like if she thinks I'm in the wrong and she's right, that's a message I want her to be able to internalize. So if I say or do something inappropriate, it makes her feel bad and I recognize that and then I subsequently apologize. I want her to actually take the win of having been right and having understood the situation. Her emotions were an appropriate guide to those previous moments. What I want to communicate in making my apology is that I was absolutely wrong, and my commitment to her is to not be that way again. And if I'm that way again, and she calls me on it, I'm going to see that, again, I'm going to see she was right. It just seems like it's a healthy dialogue. And again, the real toxicity in all of this

is in the duration over which we're caught. If this is all happening quickly, it's fine. If it's taking hours and days and weeks and months to sort out these problems, well, then you have a very unhappy life. Again, it's not a matter of never feeling shame again. It's just how long are you going to be stuck there? And for me, really the only tool is mindfulness on that front. Yeah, which really comes back to the idea of anxiety, fear can be constructive, but for most of us, they overstay their welcome. Yeah. I would put shame in precisely that bucket because it's a very toxic emotion, but arguably the most toxic emotion, but it's not that it's never appropriate. I don't think

you would want a mind- that was incapable of shame. Incapable of shame. I mean, that is a, the door to sociopathy is definitely left ajar there. I mean, even if you're, there's some meditation masters and gurus whose talents as meditators, I really, I can't doubt, but whose careers have completely spiraled out of control and essentially self-immolated for precisely this reason. I mean, there's a kind of enlightened sociopathy certain people have acquired. And shamelessness really is the master variable, so far as I can tell. It's like there are people who have immense charisma and an immense sense of personal well-being based on how much contemplative practice they've done.

And they very easily attract students and set up organizations and begin teaching. And the crucial piece is probably a doctrine that's easily found within Buddhism and other Eastern traditions that enshrines a kind of theocratic hierarchy, which justifies misuses of power rather often. But the shamelessness component of all of this seems to me to be very, very risky, if nothing else. I mean, it is the thing that is causing the downfall or has caused the downfall of many otherwise fairly impressive people. Yeah, there's no doubt about that. Sam, what are you most optimistic about right now? I mean, I feel like you and I have been on the phone almost every other day for the past two weeks. I think we were both, I think independently, frankly, came to very similar conclusions probably three weeks ago that at the time seemed probably reactionary. we're sort of shaking our head in a little bit of frustration over a lack of perceived response.

Is there something that you are more optimistic about today than you were three or four days ago? Optimism bias is not a bias I have in much quantity, but I have to think that there are certain errors of judgment that will become less common here. I mean, just what had become very common in this prior age of the earth that existed as recently as three weeks to a month ago is a fairly systematic denigration of expertise. The experts don't know anything. What we need are reality TV show stars running the world. And actually, frankly, it's not just on the right be just thrillingly obvious to everyone right now, no matter what their commitment to the anti-vax movement, that what everyone wants at this moment is a vaccine for coronavirus.

I mean, this is just, there's no, how anyone could demur on that point, I just don't know. And you're not hearing a lot from those people. I feel like there's a certain style of imagining that we can do without science and real data and real knowledge. And everyone with their humanities degrees can just criticize everything all the time. with their humanities degrees can just criticize everything all the time. And there's no difference between the people who are just making stuff up and the people who can actually get things done in some conformity with the principles of physics, chemistry, and biology, and reality as it is at large. I feel like that has to unravel to some degree. And I'm hoping we can secure those gains when this all blows over. But again, whether I'm truly optimistic about that or not, I don't know.

Well, actually, I think that's a pretty optimistic thought, actually. I also, like you, don't know what the half-life is on this pain and the realization that science is important. And there are a lot of unsexy things that we need a government to be able to do that are really convenient to forget about until you need them. Yeah, that's the other species of myth that I think has been knocked down a peg or two or entirely. There's just this libertarian idea. In several ways, I consider myself a quasi-libertarian, just insofar as I think we should cede to the private sector everything that can be best accomplished there. But it's just now painfully obvious that we need government to do certain crucial things and minimal government

cannot be a sacred principle anymore. I mean, we just, we need to figure out what we need government for, and then we should shore it up as much as we need to on all of those fronts. And pandemics are not something that we want a merely private piecemeal response to. Yeah. This is the perfect example of how a public private partnership is going to be essential. There are absolutely parts of this that are going to be best addressed for future pandemics in the private sphere, but there are things that just the natural owner to the risk is the government. And by the way, it's not just federal, it's local. I mean, I think that's the other thing we're seeing is this is as much a local issue as it is a national issue. It's actually probably, I think, more a local issue, frankly. And therefore, like I said, it's really at the

outset of the discussion, it's more relevant to me how New York handles New York right now than what Washington tells New York. And in the future, I think that's one area where I think we will learn that lesson. I think that's, I'm optimistic that in the future cities will take on some more of that risk stratification and planning such that when we're waiting for the CDC to develop a test, guess what? We're not going to wait for the CDC to develop a test because we saw that that test was already developed in China two months earlier. We're going to procure the test directly. I mean, little things like that. So it's sort of the, it is more of a federalist view. It's like, let's kind of empower these, let's decentralize some of these things as well. Yeah. Yeah. I mean, clearly we need to be more flexible, certainly under duress like this.

That's one thing I'm not optimistic about, but it's more aspirational and has the form of a prayer at this moment. I just think we have to capture all the lessons we're learning as we go here. I mean, there's just so much that has gone wrong. so much that has gone wrong. And in most cases, it seems so unnecessary to have screwed up in precisely the ways we have. And so I just feel like, I think I said this somewhere, there should just be a Google Doc for this entire crisis that people are adding to. And because it's, yeah, it's been amazing to witness. I mean, just the apparent thinness of our institutions and just as you keep punching through layers of ineptitude, what is going to actually stop the problem? It's been fascinating and and now an economic emergency. of this now for three years, and it's distorting everything. And people just have to learn to think apparently incompatible thoughts simultaneously, because they're only

seeming incompatible when you're a political dogmatist, right? So I'll give you one example that keeps coming up. Trump is showing an aptitude for weaponizing this phrase, the Chinese virus. This is a bright, shiny object that he's dangling in front of Democrats so that they can seize on it and castigate him as a xenophobe or a racist and thereby ignore all the other things he's done wrong, which are far more deplorable and therefore politically actionable and worth campaigning on. He's dangled this truly innocuous thing, whether he's a xenophobe or a racist or not. The reality is, is that this virus did originate in China. And it was born of absolutely bizarre and unacceptable cultural practices of eating bats and other wild species and housing them together still living so that they can brew up their various xenovirus cocktails.

And these are based on just patently insane beliefs about animal spirits and energies and traditional cures for whatever it is, insomnia, erectile dysfunction, or anything else that people are trying to treat with tiger bones and rhino horn and bats. And I mean, it's all colossal and colossally dangerous bullshit. And castigating the Chinese for it is not a sign of racism or colonialism or anything else. It's self-preservation. And so China has to be held responsible for these shitty traditions that it hasn't managed to purge. And undoubtedly, it's not only China, but it's certainly mainly China. And undoubtedly, it's not only China, but it's certainly mainly China. And on top of that, they have an authoritarian government that tried to conceal the gravity of this outbreak and did effectively conceal it to some degree, at least for some time, and failed to give the world adequate warning in a way, in a collaborative way that we have to figure out how to achieve globally. So Trump, whatever he means by the Chinese virus, he would be right to mean those two things.

And the world has to get its head straight vis-a-vis China on those two points. So for the Democrats to just cry racism and xenophobia when he uses phrase, is to utterly miss the point and to be successfully gamed politically. But of course, what the Democrats are actually worried about is also obviously true and worth worrying about. It's completely insane to absorb the facts I just put forward about China and on that basis, be a xenophobe? Because first of all, the virus is now global. It emerged in China, but now it's just as much the Italian virus or the New York virus. So it's everywhere all at once. And also most Chinese people have zero responsibility for any of this because they're not running their authoritarian government and

they're not eating bats. And presumably most Chinese people are as horrified by bat eating as I am. So racial animus makes absolutely no ethical sense here. Democrats are right to worry about that. So you can hold these truths in buffer simultaneously and not be deranged by it. But we don't have a politics or even a journalistic community, frankly, that is showing much aptitude for that. So it's the many needles like that that we increasingly have to thread. And whether I'm hopeful we're going to do that or not, I don't know. But it's just the imperative to do it is coming to us hourly. I am less hopeful on that one, Sam. I'm more hopeful on the, hopefully the scientific community now has some of the ammunition it needs to make sure that we have the right type of vaccine

program in the future. Again, coronaviruses are a family of viruses. They can be targeted with vaccines that can target both common and uncommon components to them. In other words, there are going to be pieces that are retained throughout them. So you can have sort of antiviral therapies that might have efficacy against a family of them. And then of course, secondarily, there are even vaccines that look like they might have efficacy against some of those common chains of the virus. So if I'm going to be optimistic about anything, I just have to believe we're not going to emerge from this with our head in the sand about an approach to the next round of this,

which again, not what people want to hear about today because that doesn't really address the situation at hand. If I'm going to close with one thing I'm optimistic about, hmm, definitely not. Before you give me any happy talk, let me drive you further into the darkness. What are the prospects in your view that a vaccine isn't really in the cards in the way that it hasn't been for AIDS or some other viruses. I mean, it's just hard to create a vaccine for certain viruses. And maybe even immunity, herd immunity, among those who have caught it and not been too harmed by it, maybe that isn't even in the cards in the way that it doesn't appear to be for flu

because it mutates so often. I mean, obviously we have a flu vaccine, but we need a new one every year. What if we get, what's the prospect that we're going to get doubly unlucky here? And it's just, it's going to be very hard to come up with a vaccine. And even if we had one, we'd have to have a new one every year. So I do think it will be harder to vaccinate against this than it is something like polio or measles or smallpox. But part of that's also technical. It's the nature of the coronaviruses. They sort of behave a bit more like RSV viruses, which to create enough immunity, you have to create a larger exposure,

basically. And the risk of the vaccine is higher. So anytime you vaccinate somebody, there's a risk that they get sick from the vaccine. And the perfect vaccine would be the vaccine for which you have no risk from the vaccine and you get perfect immunity. Obviously, nothing is there. So we now look at gradations of how close we get to that. And my discussions with a couple of virologists and people in this space say, we have to sort of caveat our optimism around how long it will take to make a vaccine for this and how safe it will be. And this gets into the question of, would you take a vaccine that had a 0.1% mortality? It would be very difficult to make that case unless you're over,

I don't know what age. You wouldn't even necessarily just say over 70 if you believed, because even though the mortality over 70, once you have it as high, you have to be multiplying that by the probability that you would contract it. So it's going to really come down to the technical challenges of making this vaccine safely. And again, for a bunch of technical reasons that I don't actually understand completely, this mirrors the type of virus for which vaccines have historically not been a great alternative because of the risk reward trade-off. So ironically, everything I just said about the anti-vax movement is going to go completely out the window because there will be legitimate concerns that this vaccine perhaps

could be more dangerous than your usual vaccine that is. Well, I think it's a different argument. So I think the anti-vax argument is the fear of unknowns like vaccines cause autism and things like that. Here, large clinical trials will give you very clear safety profiles. It's like, look, and I'm making up 0.1% like for effect, right? I can't imagine it could be that high, but 0.1% of people get really, really sick for two weeks and 0.001% of people require hospitalization and 0.0001% of people die. I mean, if you knew that, well, then that's a very legitimate discussion, whether you're pro-vaccine or anti-vaccine. I mean, that is the type of discussion we need to have around vaccines. The discussion we don't need

to have around vaccines is let's go back to one stupid paper written by some guy who completely falsified data. The paper was retracted. The guy has been disbarred from ever writing another paper in the history of his life, but a couple of knuckleheads, celebrity idiots pick up on it and turn it into an entire message that is completely false. I mean, those are different statements. I consider myself who is in favor of vaccine, but also thoughtful about they absolutely pose risk. There's nothing that doesn't pose a risk. So anyway, that's a whole other topic. Actually, but just to illuminate that, I mean, that's another example of being able to thread the needle on a very difficult to discuss but important topic, and very few people can do it. So if you're worried about the social consequences,

the consequences to public health of the anti-vax movement, you're someone who's very likely going to be uncomfortable hearing a doctor say anything about the legitimate risk of vaccines as a medical intervention. But of course, almost anything we do to our bodies poses some risk. I mean, taking ibuprofen poses some risk of actual death. So we have to be able to acknowledge these things. I mean, people know when we're lying to them. So as you point out, we need a more sophisticated conversation about risk and what is acceptable there, you know, just kind of the micro mortality points we are willing to accrue given the benefits, proffered benefits of doing anything, whether it's skiing or getting on an airplane or getting

vaccinated. And we owe it to ourselves to be able to have the sophisticated version of that conversation in public, as opposed to just hammering one side of the ideology space and denigrating the other. There are often right answers even when there's probabilistic uncertainty in any individual case. There are prudent things to do and there are idiotic things to do. And we can make those judgments even when some percentage of people have a very bad experience doing whatever it is, skiing, getting vaccinated or anything else that has a non-zero risk of bad outcome. That's absolutely right. There is a reincarnation, which I don't believe in, but if there is, and I get to come back for another ride, I want to dedicate my life to

teaching risk management to people. Like I would love to sort of make a career out of coming up with ways and tools to help people think through what we're talking about now, because I think it is such an essential way to go through life and appreciate the nuance and uncertainty that is much more present than we are led to believe. Yeah. We also just have to acknowledge that the answers on paper, I mean, the probability of death or injury in one circumstance may not actually seem better or worse or rationally what we know it to be because of some, you know, superficial differences in the situation that just we can't emotionally correct for. I mean, some things just seem sketchier than other things, even if on paper

they're not. And some aspects of human psychology here that we have to figure out how to navigate around. And I think we have to do that at the level of public policy. I mean, the public policy really does have to be driven by statistics and what is known for large groups of people to bear out in terms of risk of injury and death. And yeah, and then people are still afraid to get on an airplane just because they're afraid to fly. And they're never afraid to drive. Let the people who are doing policy acknowledge how much more dangerous our roads are than our skies are. But there are some ways in which we have to triangulate around human psychology to get

right answers made actionable. Yeah. Sam, I love that I get to call you up and bug you every day. Yeah, likewise. Likewise. I'm glad we were able to have a conversation today that we can share with everybody. I hope it's helpful. I know at this point, information overload is a problem. And I think what I appreciated about the discussion we had today, it was really less about information and new information and frankly, maybe more about how one can process it,

think about it, and hopefully not overreact to it, but react enough to it. And I suspect we'll have something different to say a week from now, and maybe we might have to hop back on a call and revisit anything we've learned. Yeah, let's just pledge to do that. I mean, if we get to a point where several other shoes have dropped and the story has changed in some material way, let's do a round two. And not so much for what I have to bring to it. I have a feeling my story isn't going to change very much, but yours, I think, will on the medical front. So I'd love to hear it. Yeah. Well, thank you for making time, Sam, and I wish you luck the rest of today. Likewise.

Thank you for listening to this week's episode of The Drive. If you're interested in diving deeper into any topics we discuss, we've created a membership program that allows us to bring you more in-depth exclusive content without relying on paid ads. It's our goal to ensure members get back much more than the price of the subscription. Now to that end, membership benefits include a bunch of things. One, totally kick-ass comprehensive podcast show notes that detail every topic, paper, person, thing we discuss on each episode. The word on the street is nobody's show notes rival these. Monthly AMA episodes or Ask Me Anything episodes, hearing these episodes completely. Access to our private podcast feed that allows you to hear everything without having to listen to spiels like this. The Qualies, which are a super short podcast, typically less than five minutes that

we release every Tuesday through Friday, highlighting the best questions, topics, and tactics discussed on previous episodes of The Drive. This is a great way to catch up on previous episodes without having to go back and necessarily listen to everyone. Steep discounts on products that I believe in, but for which I'm not getting paid to endorse. And a whole bunch of other benefits that we continue to trickle in as time goes on. If you want to learn more and access these member-only benefits, you can head over to peteratiamd.com forward slash subscribe.

You can find me on Twitter, Instagram, and Facebook, all with the ID peteratiamd. You can also leave us Twitter, Instagram, and Facebook, all with the ID PeterAttiaMD. You can also leave us a review on Apple Podcasts or whatever podcast player you listen on. This podcast is for general informational purposes only and does not constitute the practice of medicine, nursing, or other professional healthcare services, including the giving of medical advice. No doctor-patient relationship is formed. The use of this information and the materials linked to this podcast is at the user's own risk. The content on this podcast is not intended to be a substitute for professional medical advice, diagnosis,

or treatment. Users should not disregard or delay in obtaining medical advice from any medical condition they have, and they should seek the assistance of their healthcare professionals for any such conditions. Finally, I take conflicts of interest very seriously. For all of my disclosures and the companies I invest in or advise, please visit peterottiamd.com forward slash about where I keep an up-to-date and active list of such companies. Thank you.