The Wolf Of All Streets - Eric Feigl-Ding, Renowned Epidemiologist and Health Economist, on the Current State of Covid-19

Episode Date: July 7, 2020

Dr. Eric Feigl-Ding, Senior Fellow at the Federation Of American Scientists, returned for a second appearance on the podcast to cover everything new regarding Covid-19. Characterized by cautious optimism and outspoken advocacy for science, Dr. Eric Feigl-Ding foresees a hopeful future win against Covid-19, even after a failed US response to the virus. Scott Melker and Dr. Eric Feigl-Ding further discuss the Covid-19 fog of war, rugged individualism mixed with a virus, selling the middle seat on an airplane, why Americans suffer from a “see it to believe it mentality,” how to determine if it's safe for your kids to go to school, the paradox of increased cases and decreased deaths, why the U.S. is like a leaky ship, and a positive outlook for a quick vaccine arrival. --- ROUNDLYX RoundlyX allows you to dollar-cost-average into crypto with our spare change "Roundup" investing tool, manage multiple crypto exchange accounts in one dashboard and access curated digital asset content and services. Visit RoundlyX and use promo code "WOLF" to learn more about accumulating your favorite digital assets when making everyday purchases and earn $4 in free Bitcoin. --- VOYAGER This episode is brought to you by Voyager, your new favorite crypto broker. Trade crypto fast and commission-free the easy way. Earn up to 6% interest on top coins with no lockups and no limits. Download the Voyager app and use code “SCOTT25” to get $25 in free Bitcoin when you create your account --- If you enjoyed this conversation, share it with your colleagues & friends, rate, review, and subscribe.This podcast is presented by BlockWorks Group. For exclusive content and events that provide insights into the crypto and blockchain space, visit them at: https://www.blockworksgroup.io

What's up, everybody? This is your host, Scott Melker, and you're listening to the Wolf of All Streets podcast. Every week, I'm talking to your favorite personalities from the worlds of Bitcoin, finance, trading, art, music, sports, politics, and basically anyone else with an interesting story to tell. So sit down, strap in, and get ready, because we're going deep. I'd like to thank my sponsors, Round the X and Voyager, for making today's episode possible. We'll hear much more about them later on in the episode. This podcast is powered by BlockWorks Group, the only events and podcast production company I trust. For access to the premier digital asset conferences and in-depth podcast content, visit them at blockworksgroup.io. I promise you will not be disappointed.

This is a special occasion because this is the first time that I've ever had a guest on twice on the show. Eric Feiglding and I spoke a few months ago when the COVID crisis was really starting back in March. New York was getting absolutely hammered. But we had a bit of cautious optimism as to the late but hopefully effective plans in the United States for dealing with the virus. And now we're back here to talk about it once again. If you don't know who Eric is, as I've mentioned in the previous episode, he's a senior fellow at the Federation of American Scientists, which is a nonpartisan think tank in DC. He's a world-renowned epidemiologist, and maybe most importantly in this case was arguably the first person who sounded the alarm on COVID-19 in the United States all the way back in January when all of us should have been listening.

So, Eric, thank you so much for coming back on the show. Thanks. Happy to be here. So, here we are, three months later. Everything was shutting down last that we talked. As I said, New York was getting bombarded, but the rest of the country looked good. How's America doing now? America's doing much worse. And we actually didn't really get much better, surprisingly. New York, New Jersey, and New England declined.

But if you subtract out those states, U.S. never actually had a dip outside of those states. U.S. has been pretty much climbing steadily ever since March. And that's what's really sad. I think the U.S. is actually getting worse in many ways and exponentially worse very recently. It's interesting because it seems like we're the only first world country that's actually getting worse. Even places that we kind of were laughing at last we talked at their lack of response or how bad it was seem to have flattened the curve and be declining. Why do you think

it's the case that Europe is doing, I wouldn't say well, but certainly improving, and we are not. Yeah. Europe as a whole is doing amazingly better. Sweden still has a pretty high mortality. No surprise. Multiple, multiple fold higher. As you know, unlike their Scandinavian neighbors, they took the plow through approach to chase this mythical herd immunity without the vaccine, which you're never supposed to chase without the vaccine. So UK,

it's on the downward trajectory, but it's, you know, Scotland is much, Scotland is approaching zero, while lower England is not. But as a whole, Europe is doing well. And in certain ways, Europe is a union, but they have borders. Like Italy can shut its borders from France, from Switzerland and Slovenia and Austria. But U.S., we don't. You know, if New York Governor Cuomo decides to put a blanket travel quarantine rule on travelers from the Sunbelt states, yes. But how are you going to enforce? Are you going to put checkpoints on the hundreds of borders? Thousands of roads, right?

Yeah, thousands of roads. And what if someone's just passing through? There's no way to enforce that in the U.S. There's no such thing as borders. And so U.S., it's like a big ship in which there's no bulkheads. Normally ships, you can, the forward compartment is flooding,

you can bulkhead it off. We can't bulkhead anything off because we're so fluid of a country. And so if, you know, that there's 30 holes, there's 33 states with double digit increases in the past week. If we plug half of them, we're still going to keep flooding. And that's the problem in which we're at in the US right now. That was my favorite analogy that you offered on the last time we spoke. And I was going to ask you about that, which was the leaky ship. And it's so accurate. And it's, I mean, you had such foresight in saying it three months ago,

because it is exactly what we're seeing happen. I think it's really funny that people, at least politicians, and a lot of people on social media, talk about this second wave. And it seems like they don't understand how a wave works. I mean, in my opinion, this is still a massive first wave that's rolling through and we can't even talk about a second wave yet. Is that the case or is what we're seeing a second wave? Yeah, it's the second peak of the first wave. It's definitely not the second wave because if you actually look at it, a lot of these Sun Belt states, they never really had a New York, you know, big first wave and then they're up. These were the Sun Belt

states, they have kind of like a dip but this is their first real trajectory rise. So you can either call a second peak of first wave, or it's the first wave for these other states that were not part of it. Like the whole country, the first wave is sort of rolling through. It really is rolling through the country. And New York is now on a downward trajectory. But clearly there's still, there's some people say like, oh, New York has fought it off. New York has reached herd immunity. That is not true at all. We just know that New York has been much more aggressive. And in certain ways, if you look at other countries like Singapore, rebounded from

zero. Israel, Israel had like this huge curve down to almost zero, reopened, and now they're back up again. And you can say what you want about Israel, but Israel is one of the most tightly knit countries in terms of enforcement of any rule. And yet here they are as well. So no one is immune. And California had its initial small wave and now it's clearly popping back up. So the big question that a lot of parents are certainly asking now is what happens in August? What happens for school?

It seems there's a lot of studies starting to come out. Perhaps some of it is anecdotal, but because Europe has opened to some degree and their kids have gone back to school and they haven't really seen spikes among the kids, it seems that there may be some emerging evidence that children do not really transmit it to their parents or to adults or to each other. And that really maybe it's the teachers and staff that are at risk. Is that true? What is the evidence of that? Because if it is obviously that's like the amazing silver bullet for every

parent who's praying that they can like send their kids to the grandparents and those things. So kids do get infected. There are some studies that say it's slower, but I've seen other studies in which kids are infected at the exact same rate as adults. And kids, I think a new study came out that kids transmit the virus just the same. And I think people are confusing that kids don't get sick as much. That's true.

But they carry it all the same, just like young people. Young adults don't get sick that much and go to the hospital and die that much. Some do, of course, but they are the outbreak carriers. They analyzed 61 clusters of outbreaks, 61 outbreaks, and they found that young adults, 20 to 29, were the largest plurality of the initiators at each of the clusters. And we see that now. A lot of the transmission is in young adults under 35. And the mortality is not increasing, first of all, because there's a lag, but it will also require them to transmit it to more vulnerable adults,

either elderly or not just elderly, but also those with diabetes, immunocompromised diseases, heart disease. Heck, obesity is a risk factor. And you know how many Americans are obese. And so all these things, the universe of vulnerable people is a lot bigger than people think. It's not just 70, 80 year olds. Right. That's such an insane myth. And also, it's so dismissive and just like petty to say, well, it's only old people, let them stay inside or let the old people die. I mean, it just blows my mind that that's even a sentiment that's...

I was just on an interview today. And, you know, there was this other conservative commentator who said, well, we just need to shield our elderly. It's just a shielding. We'll approach, we just, we can go out and get infected. It's okay. As long as we shield our elderly, that is so narrow vision because there's so many other risk factors that put people at risk. And the risks actually jump pretty quickly between 30 and 40 and 50 years old. So that's the largest working population. It also implies that like people who are in their 60s and 70s should be spending their golden years away from their grandchildren and locked in a house, which to me is just like, I'll do anything to get my parents out of their house. If you tell me that I have to like wear a unicorn helmet, I'll do that, right? the older population, it's really just a different kind of world than it was in their generation, I think, where they, you know, the greatest generation in World War II and fighting these wars, they would do anything for each other. And now we're in this world where people just of the United States and this selfish individualism is really great in some sense, but terrible for pandemics. Because pandemics requires collective action, collective community protection.

My mask protects you, your mask protects me. But that collectivism is socialism. And you don't even have to make a partisan. It's caring for your neighbor. And the other key thing I get annoyed with is, you know, on both sides of the aisle, sometimes there's a shot in Friday. It's like, ooh, they're going to that rally. And then someone

throws up a Darwin meme in which he's pushing. And I'm realizing that the schadenfreude is destructive because they could get infected, but they could be your neighbor, or they could be your parents' neighbor. And in the end, we all lose, especially since our goal is, we don't just want to protect our elderly, which this epidemic is already killing off at huge rates, but we want to protect our next generation. And to protect them, we want them to go to school.

And I think the biggest, best argument is, look, protect everyone. Don't get political about this. And the ultimate goal is so that our children can go to school and our children do not become this developmentally damaged, scarred generation in which they're out of school for a year and a half. That's the best message, I think. Yeah. And would it be a year and a half? Or if there's, you know, I guess that it speaks to like, when does this end? If we continue on the same path, and like you said, herd immunity actually somewhat requires a vaccine. Maybe there won't

be a vaccine. Maybe the vaccine will be like a flu shot that's only partially effective. You know, what is the end game there if we are trying to send our kids back to school or trying to get any sort of normal life going if we don't take further steps? There will be an end game. The end game is the vaccine. And there will be many vaccines. Some Fauci expects will be 70% effective. Some we're hoping will be 90, 95% effective. And I'm hoping for the 90, 95% because we know a huge population of our current state

does not want to do that. They're not going to take them. They're not going to take them. And that's really sad. And because in certain ways, like you not taking them actually hurts all of us because there is a lot of elderly immunocompromised people with organ transplants, with immunity diseases who,

who are, you know, medically can't take them, but now you're actually endangering them as well. So it's like a social responsibility thing. But clearly, there's this anti-vaxxer movement that's very upsetting. But that's why I'm saying we need a vaccine that has probably 90, 95%. So we can account for those who don't. And if it's not effective enough, you have to combine it with masks plus the vaccine. And hopefully that will get the R low enough that it will eventually taper off and disappear. Right. But a 70% effective vaccine does not get our parents out of their houses.

It will be very slow in containment. I think 70% will be good enough if we combine it with masks. Right. But we can't even get people to wear masks now. I know. Without a vaccine. Our current compliance in masks is, again, I think this is why New York City and Massachusetts have much lower rates because they've seen the virus up close. Right.

And therefore, people wear masks much more vigilantly. And America has this, and anyone has this kind of reality. You have to see it to believe it. If they haven't seen or know someone who has gotten sick or died, they don't take it seriously. And if they know no one, they think it's a hoax or it's overblown. And I think that is where the disparity, this is why the wave is traveling to the South,

where those were the areas that were least seeded by the initial European and Asian travel, and didn't see that many cases and didn't take the mask wearing seriously and reopened very aggressively, obviously. But New England is keeping it low because they are the most vigilant. They have the highest prevalence of mask wearing. And I think mask wearing will make the ultimate difference here.

So how did masks become such a political issue then? If it's such an obvious thing and it's so simple, why did it become such a political issue and why do we have that issue here? I think historians and sociologists will have to study this in detail because this is one of the most pressing questions of how the hell did we get here? You know, there is some truth that there was early confusion about masks. There was.

And early on, what they were trying to do is they were actually trying to preserve N95 respirator masks for health care workers. And that's why they say, don't hoard masks. You don't need masks yet. But obviously, that message was misinterpreted. And, you know, they were wrong initially in terms of this importance. Now we know how important. But I think now it's gotten political as in it becomes a sign of manliness because, you know, the macho where you are.

Yeah, it was. It's a sign of masculinity, machoness guy-ness i'm not sheep um and come on it's the it's a small it's a really petty thing but how did it get here i don't know i think there might be some misinformation campaigns out there too um because there's lots of bad actors out there they're trying to want to throw grenades and watch the world burn. And I think- And would benefit tremendously from seeing the United States struggle. Yeah.

There's a lot of people who have schadenfreude at watching America burn. And I think, you know, like there's also like this weird misinformation with carbon dioxide poisoning. I was just going gonna say it's the weirdest thing in the world that is the weirdest thing because if that was true surgeons would be being poisoned every single day and that's just not true welders welders anyone who you know um work in a shop and has to, you know, work with wood and the wood dust and everything. It's just not true.

It's the most easily debunked thing. But it's oftentimes coming from these like biblical groups. You saw some of these city council testimonies. Yeah, I live in Florida, sadly. So, yes, it's my reality. It's also in Orange County, too. It's many places. And I think, like, there's not also in Orange County. It's also in Orange County, too. It's many places. And I think, like, there's not many people pushing that.

Like, it's an easily refuted falsehood. So I think there must be some disinformation campaigns out there. Again, I'm speculating, but it is so strange because no one would be really pushing that. And that's so easily refuted because you can wear a mask and measure your pulse ox. And there's been videos on this and it's clear. Yeah, people wearing five masks and wearing a pulse oximeter and still having like a 99. Yeah. I mean, it's such an absurd assertion that it's almost hard to understand, as you said. But, you know, you said that some

of that early information was misinterpreted. I do remember that the U.S. Surgeon General flat out said, don't wear a mask. You don't need them. I remember that. Right. So Adams was a little bit too emphatic on that. Right. So in a country where people, you know, basically read a headline and form a permanent opinion, which is what happens here, right? You know, you never see, a lot of people don't seek further information once they have their confirmation bias or they hear what they want to hear. And so they'll look and say that, you know, the CDC, Surgeon General, WHO, they all said don't wear a mask. And they don't even, they don't want to hear any new information on it. So there is some responsibility, I think, with, you know,

the medical community at the top for this problem. I do agree. I think it was, it's a, it will be, again, one of the classic examples of how the, I would say not drop the ball, they failed to look around the corner and failed to be very precise in messaging. Like oftentimes when WHO said something wrong, it's not that, you know, when they said there's no human-to-human transmission in January,

what they actually meant was there's no current evidence confirming human-to-human transmission. Not that there's evidence that shows there's no current evidence confirming human-human transitions. Not that there's evidence that shows there's no human. I think that is a key information, and it gets lost. Like, you don't have evidence yet that whether or not this is true. And I think that's what they should have said. Instead of there's no, there's none. And when you read there's none, it means, oh, there's

none. And when quickly, though, again, the fog of war around this is just amazing. We've never had this kind of thing. Normally, science is always, you know, solved in a back room, not back room, but behind academia circles, and eventually prevented presented as a guideline once the science kind of settles. But, you know, we're racing through this all. And, again, not all scientists are good communicators. They're really good at, you know, explaining the nuance of their studies. But actually communicating this, it's tricky. And they don't see politically the around the corner issue of,

say, did Black Lives Matter? You know how there was a lot of talk about that. Yeah, there's a lot of discussion of did Black Lives Matter protests cause the epidemic? The last evidence, the NBER and several other studies show that there's, it did not cause a spike. And you can also see in the positivity rates in which Minnesota and Massachusetts aggressively tested protesters, and their positivity rates were exactly the same, if not lower, than the general state population who did not go to the protests. And so that also gives evidence. But what they did not realize by day, I mean, the scientists in the public health community, is that on the outside, there's a hypocrisy of these lockdown protesters. Remember the lockdown protesters? Feels like eons ago, but that was just a couple months ago. They didn't quite explain during the Black Lives Matter how it's different. You know, the lockdown protesters were not wearing masks, right? They were like shouting and going to state capitals like in Michigan,

while Black Lives Matters were outdoors, majority wearing masks, except for the cops. A lot of the cops did not wear masks. But they didn't explain it. And the problem with that is it creates a set of hypocrisy if you don't explain why, how this is different. They just said, Black Lives

Matter. And yes, absolutely, I'm behind Black Lives Matter. But if you don't explain how it's different from the anti-lockdown, it just smacks of hypocrisy and, you know, cherry picking. It does. And that requires, like, political, you have to, like, understand political optics and

public PR optics. And I think this optics was completely missed by a lot of the community in explaining this and seeing around the corner of, okay, if you say this, then next week or the month after, they're going to come back at you about XYZ hypocrisy. And I think right now, we're seeing that whether it's the imprecision in the human to human transmission or the mask wearing they weren't precise enough and now they uh it's it's coming home to roost this this well you said then this now you say this even though there's there is a difference well there's nuance and people generally miss it. Um, and you know,

not to play devil's advocate, but like when you look at some of the media outlets and you see them demonizing people, when they went to the beach, like I remember Florida opened in Jacksonville beaches and like, it was like, you're all going to kill your grandmothers. Like, and they're all going to die. But these people, you know, whether they were socially distanced or not, I don't but they were outdoors they were on a beach they weren't wearing masks given but then like two weeks later the same pundits are on tv saying you know

supporting i guess the the the protests and stuff and and all these people are heroes so that's just poor like like you said it's just there's a you can understand why somebody would get would get misinformation or see a disconnect there. And then they, as we do in this country, take the jump to it's all a hoax. It's all crap. It's all the media. And sadly, that's credibility for being hypocrite, even though there is a slight nuance to the difference. But in terms of, you know, 15 seconds of headline, you know, blazing. But now we have all this data that does point to maybe the fact that outdoors, socially distanced, and especially with a mask, you're really not at risk. I mean, is that pretty accurate at this

point or tremendously less risk? Again, mask wearing is one of those, I will say mask wearing because you're at low risk, but it's about how many people around you wear it. Because cloth masks, because when we say masks, we mean cloth masks. So surgical masks are better than cloth. N95 are better than surgical. But cloth masks, their main function is to catch your cough. So if this was a mask, it catches your droplets when you cough or talk, because you're always spraying saliva. Right. Cloth, that's the goal. So again, my mask protects you, your mask protects me. But if half the people are not wearing masks, then the protection, it's kind of a little bit like herd immunity it works if huge numbers of people wearing masks and then the risk is reduced so i would say yes outdoors where i'm wearing mask

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on the iTunes or Google Play store and get $25 in free Bitcoin when you use the promo code SCOTT25. That's investvoyager.com, promo code SCOTT25 for $25 in free Bitcoin and start trading today. I think I read something like if 80% of the local population is wearing masks, it reduces the risk of spread by 90% or something like that. But if you dip even below 80%, those numbers go completely out of whack. Is that about accurate? Yeah, there is this exponential benefit where the higher you are past 75%, 80%, the better

it is, which is approximately the amount you need for herd immunity. So there's a similar phenomenon where the transmission chain is cut off if there is 70%, 80% blockade. And the blockade here is either immunity or droplet blockade by a mask. So wear a mask. Bottom line, just by a mask. So wear a mask. Bottom line, just wear a mask. It's pretty easy. It's so tricky. And this is why we need leadership. Because everywhere we, you know, Pence and Trump tour places, they almost never wear masks. Only once or twice have they worn a mask.

And this has a bad example. And members of Congress, Republican members of Congress, not wearing masks, getting affected. And again, governors, they need to wear masks. Like leadership, this is where leadership matters the most. How quickly are you going to do something? How aggressively you're going to set an example. And in the most critical time in our society where we needed leadership, it's missing. I'm reminding of the best quote. I'm not sure if people have seen the movie, Kirk Douglas, not Kirk Douglas,

Michael Douglas movie, The American President. And Michael J. Fox, he says, Americans are so thirsty for leadership that they'll crawl to a mirage. And when they get there, and they realize it's not there, they'll drink the sand. Michael Douglas, President Shepard in the movie says, No, people don't drink the sand, because they're thirsty. They drink the sand because they don't know the difference. And the difference here is leadership and good evidence and science. And that's what people are looking for. And without that, again, you're drinking the sand of junk that is floating,

whether it's misinformation or just opportunistic pundits or political hacks trying to polarize this. I mean, and that's a polite way of saying it, because it's not like we're just lacking leadership. Our leadership is actually pushing the dangerous and opposite narrative of what needs to be pushed to save lives because it's an election year and the machismo that you discussed. But I mean, we don't have to go down that rabbit hole because I think it's look, some people think it's like a purposeful dunk on Trump. No, it's not a dunk. I would, you know, I would criticize any leader who doesn't set these examples. It's just we need, like, I would really beg, I would erect a monument, a museum for Trump if he would please set examples of wearing a mask, being aggressive with contact tracing, funding the CDC more, invoking the Defense Production Act, I would happily give him a statue to calm his ego, if he really wants a statue in a museum, because

I don't care about those things as much as I want to save lives, and everyone should come together on this. And, and I think that's, I think saving lives is the key part. It's not partisan. Wear a mask to save your neighbor. And so our kids can go to school. I mean, this should be like one of those, you know, blockbuster disaster movies where aliens are attacking and everybody in the entire world comes together to fight it. And it's just not the way, you know, Will Smith and his fighter jet attacking the aliens. But it's been almost the opposite. It's very, you know, it's very tribal and very

separated and politicized. And to me, it's just really sad. But hopefully, we will be able to overcome that soon and beat this thing. But I want to talk about antibodies and immunity. I don't know if there's a lot of misinformation or I think the nature of obviously a novel virus. It's called novel for a reason. We just don't know. But where do we stand now with serology, with understanding the chance that you would be immune if you'd had it before, you know, antibodies, things like that? Yeah, I think the antibody thing is evolving very quickly.

We know that you get antibodies if you're infected, or you can, but the problem is that there's two kinds of antibodies. There's neutralizing antibodies, and there's antibodies that bind to the virus, but not necessarily neutralizing. And so in vaccines, you're trying to find the neutralizing. And I think some of the vaccine trials are finding that we are going to find it. The other issue is antibodies, they do disappear after a couple months, it seems, after like two, three, four months, depending on which study. And some people are saying, well, does that mean your immunity disappears? I don't think so, because the antibodies, they naturally disappear. By disappear, I mean your body actually has like a library archive. It's called your B-memory cells.

And these B-memory cells store a repository of the recipe for these antibodies against various pathogens that you've encountered in your life. And so this is why kids get sick all the time initially, because they're learning each time they get infected. And adults who have good robust immune systems, they've learned all this in their life, and so their library of antibody recipes against previous viruses and bacteria is much better. That said, this library, some people say it's a capacity, and people have different capacities. And this is where I'm not an expert. By the way, I want to clarify, I'm not a virology or immunology expert, but this is my general understanding from what I've studied and

obviously what the ongoing discussion that I've been monitoring closely has been. I think you will have, even if the antibodies disappear, you will have some sort of immunity. But that also means that these antibody tests, which try to find these antibodies, after three, four months, you're going to miss the fact that you actually have these antibodies and actually have them stored away, again, not below detection levels. So, you know, if you do a test for six months from now, your antibody is negative. You could have actually already had it, but it just disappeared by then. So it's really hard to say. That's a better scenario. Having immunity in a negative test is a better scenario than a positive test and you're not immune yeah so i would say like there's there's

false positive false negative and it's a true negative but it's just you're past the window to find right um that makes sense so this is why i'm saying the immunity passports are not the answer because they don't give you a definitive answer. Right. But I'm hopeful for convalescent plasma trials. I think convalescent plasma, it's been well shown in many, many previous viruses. As a treatment. As a treatment, yeah. And I think you can, I would say antibody testing for, you know, a potential donor for convalescent plasma is valid.

But again, the best is obviously to check, to use the convalescent plasma of someone who's directly recovered. But I think immunity, let's wait. I think the vaccines will be here relatively soon there's a lot of vaccine trials that are ongoing and these vaccine trials take about one to two months i mean like the phase threes or something trial yeah two and three combos like china has already approved one after a phase two yeah for the military and then they're testing it on the military. I don't know. It's Chinese military. So we will find a vaccine. I'm pretty sure. There's many different types. There's, you know, the Oxford group is using adenovirus

vector, which is another way of creating the vaccine, while China's using the inactivated and the attenuated virus. So I think we will find it. It's just a matter of time. It will be effective to some degree. That is the ultimate exit strategy. Makes sense. I want to talk about data because it's funny. Even facts are controversial these days.

Every time there's a new study or a new anything, the data, people question it. They say it's faked. They're undercounting. The hospitals are getting paid to report COVID deaths, all these things. So we've seen an obvious and huge spike in positive cases. That's pretty clear whether that's a function of more testing or not. We're seeing a positivity rate, so that's probably not the case. But people love to point to the fact that deaths are dropping in this country while cases are rising. What's the explanation for that?

The explanation is the lag. The lag, it takes anywhere from three to four weeks. And then there's the reporting lag also. Right, it's based on death certificates or something, right? So it can take weeks for, yeah. Yeah, and sometimes like New Jersey actually did a big data dump of like 1,700 cases this week of cases that happened like weeks ago. Right. So the lag is big. And also the lag also depends, you know, the lag is shorter

in countries that do testing much earlier than testing. If you test only those who are shortness of breath, it's a shorter lag than if you just test someone off. If you have testing only people who are hospitalized, it's an even shorter lag. And then also, if it's elderly, the lag is much shorter than if you find the same person with a cough who's young. And so oftentimes, I would say, like, given that half the cases are under 35, you would have to wait, you know, obviously, some of them will get sick directly and die, but it's low. You will have to wait until they transmit it again to someone else before the mortality goes up, given how many young people. And also, treatments have gotten better. We know how to fine-tune the ventilator pressure a little better.

We know it's a clotting disease, so a lot of doctors are using anticoagulants a lot progressively. We know that dexamethasone works. Remdesivir shortens the duration and improves how quickly people recover. So I think this epidemic is so different now than when it first hit New York or Italy. When back then people were still like grasping at straws at what is this virus and what is it doing to us and all the different dimensions around it. But I guarantee it will catch up with us in a few weeks. And we're actually already seeing it.

In Mississippi, it's already ticking up. Arizona, the mortality is already ticking up, I think. And so, you know, there's no getting around it. It will happen. It will be maybe a little bit gentler of a mortality curve than New York, but it will definitely happen. And also, it depends. If the cases are surging 10% a week versus cases are surging 90% to 150% a week, that surge is going to go over the hospital capacity.

If you go over hospital capacity, then the mortality will stack up much quicker than if it's a gentle rise. In Taiwan, there's almost no one who's died in Taiwan because they have so few cases. Every case is meticulously monitored and treated. They get the best treatment. If you're overwhelmed, people start dying in gurneys in the hallways. So what's the pie in the sky? We know it's not going to happen, but what's the answer in a country like the United States?

It's seeing this huge spike. The curve is going up. I mean, is it a full shutdown again in theory? Is that what works or is it everyone wears a mask and, you know, doesn't gather indoors? I mean, what should we be doing in an ideal situation? I think what we should do is, look, shutdowns are incredibly painful. Yeah. And make people, make them see, are we, do we want to do a full shutdown of our lives? Or do you want to wear a mask and do things outdoors? So I would avoid indoor things as much as possible.

And keep it outside with masks. And try to distance. And airlines, United Airlines and American, if you're listening, please leave the seat in the middle empty. That's so true. I think it is a very safe precaution to do. Because in certain ways, I personally think that if you offer to book the seats 100%, you might actually get less bookings because people know that you're offering every single seat booking. They will rather book an airline which has an empty middle seat. So actually, it might just avoid you completely.

Yeah, it actually has the opposite effect. I think that's the goal create some sacrifices until the vaccine arise. And I'm hopeful the vaccine will offer, you know, as high protection as quickly as possible and that is universally affordable because that's a huge issue. Right. Of course.

Do you think that can really happen by the end of the year? Like Trump had said months ago? No, it will we will have limited supplies for first responders health care workers essential workers i think personally that grocery store workers and yeah and a lot of people who work on the front lines should get yeah people who are working in them, food, food plants and delivering. Yeah.

I mean, come on. Yeah. If you invoke the defense production act, you should give them the vaccine. But again, I think we should have invoking the defense production act for, you know,

N95 masks and other PPEs instead of burgers and sausages, to be honest. But, but, you know, the agriculture industry is suffering a lot. Everyone is suffering. And, and, and sausages, to be honest. But, you know, the agriculture industry is suffering a lot. Everyone is suffering. And this is why epidemiology and public health scientists

are in a really tough rock and a hard place, almost as much as, if not more than political. Because political people, they can say, well, I listen to the experts. Right, they can say, well, I listened to the experts. Right. They blame you. Experts have to basically like, it's choosing between two extremely difficult things. And this is why the problem is a lot of scientists out there, they're really great at explaining their science, but they don't understand politics and seeing around the corner around what is going to happen next on the political horizon.

What is the counter attacks? What is, what is the optics for the lay public around this? And, you know, I left academia. I had a very long academia career, but I left it because I saw that, you know, I left academia, I had a very long academia career, but I left it because I saw that, you know, scientists, there's a science translation aspect. And

I know I'm getting really dense. But the issue is, you know, a lot of scientists are creating the missteps, and then we're having to clean it up. And a lot of scientists are being torpedoed and being fired or being forced to resign or threatened with death um death threats yeah because you know you're giving you're really giving really complicated results and um you know mask mandates that creates the public backlash that, look, no one else wants to make these recommendations, but we kind of have to in the aim of saving lives. And if you go pro-business, you're going to kill people. And in the end, you're also going to ruin your career and reputation or destroy the public in some way. So it is an extremely tough situation. And that's what I'm saying.

If everyone just wears masks, and again, ignore the misinformation out there. If everyone wears masks, 90%, we could get this under control. And it's a respect for others. And within months, right? I mean, we're not talking about controlling it in years. We're talking about... Yeah, we don't have to wait until next year when hundreds of millions of doses of vaccine

are available and given out to everyone. We can do it within a few months. Czech Republic did it, and they put a mask law for everyone. Within a few weeks, few months, the epidemic was almost gone. And now kids are back in school in the Czech Republic. And kids are back in school in Faroe Islands. Kids are back in school in Central Europe. And yeah, I'm very jealous of that. What would it take for you to send your kids back to school? I would look at the, I think the key thing is look at the local transmission, not just

the state level, go to your state department of health website, look at your county. And if your county is really big, look in your zip code or your neighborhood and see what is the positivity rate in your area. If the positivity rate is really, really low, as in like under 5%, I think it's pretty safe. And if it's under 10%, I'm like, it's decently safe. If it's over 10%, 15%, oh, you know, it becomes like really tricky. Should I send my kids there? But also, how much of it depends on the steps that the schools are taking? Let's say we're below 5%. If we're below 5%, that doesn't mean everyone goes back to a crowded public school like normal, right? What does the school need to be doing on the other side?

And that is a really good statement there. And I wanted to clarify, schools obviously need to be very vigilant. Some schools are thinking about half the kids on alternate days or a.m. p.m., kind of like kindergarten. It's not optimal, but it might be necessary. Kids are wearing masks at all times, in addition to teachers. There's a lot of proposals. Building ventilation, improving the filtration, as well as potentially installing UV sanitation into HVAC system. I think all these things need to be done. But again, everyone else has a different level of risk. If I say it's okay, some people, if you have an immunocompromised child who has,

I have a friend who has a kid who got an organ transplant for their cancer, my recommendation is not what he should be following. Right, of course. Everything's individualized. My kid has asthma or has some extreme respiratory or inflammatory disease. I would be much more careful than if my kid was healthy. So everyone has different risk thresholds, and the local school district is very different in different approaches,

right, in terms of how much, you know, sanitization and UV, you know, lamps and not UV lamp, but UV radiation in their HVAC system, can they install? Not every school can. So again, it's very tough and it's very local specific. But I think the key first key is look at the, what is the positivity percentage in your local area in zip code? That makes sense.

So, I mean, I guess parting words before we're done. What is the moral of the story here? Is there anything else that you want to make sure that people know before we go? I think we will get through this. It is one of those things that will test our civilization's ability to come together because we need to do things collectively to protect ourselves. And we have to be super vigilant against all the misinformation out there. Please, please don't, you know, just listen to a random person who's proselytizing about

something. Just listen to your public health leaders. Don't demonize them. They're trying their best. And for individual families, I think just look at what is your personal family's risk profile and risk tolerance. And altogether, wear a mask. And vaccines, please take them when they come out. And I'm pretty sure Fauci will be quite a hawk

in making sure that there is no, like an unsafe vaccine will not be released prematurely. Yeah, I agree. There's some people talking about October surprise around that, but I don't think about you with NIH. The election vaccine, right, of course. No, I think we will get through this. But again, it's ask your neighbor who may or may not be pro-mask or may or may not think that this is real is if you want your kid to go back to school please do everything you can i think that is the best message for the kids yeah ultimately

is the is the takeaway not just yourself Think of your kids. I love it. So where should everybody follow you moving forward? And we'll probably have to have you again in three months. I hope in three months that we're not talking about... Different coverage. Oh, gosh. Here we are again. I'm hoping if we come back in three months,

it's like we can talk about how we can move forward, you know, in the after times. Yeah. This, but you know, follow me on Twitter. I also have a direct SMS line that people can also contact me. Oh, cool. Yeah. And it's the direct line is, um, let me get the number right here. It's 703-552-5771. 703-552-5771 and just text join. And I sometimes send out updates there.

But again, don't just listen to me. Listen to other public health officials. Trust Fauci. And realize no one's perfect in this fog of war. But please listen to those who do not have any financial or political or political motives. Yeah, that really is the bottom line. Well, thank you again so much for taking the time and for being a voice of reason against a, I see Twitter.

So against a tidal wave of trolling, hatred and negativity. People I don't think appreciate how difficult it is to stay the course with a positive message in a situation like this. So we really appreciate that you do that. And we'll look forward to doing this again down the road with a much more positive conversation. Thanks. Stay safe. Thank you. Hey, everyone. Thanks for listening. New episodes go live every Tuesday at 7am Eastern Standard Time. Links to our Apple and Spotify channels are in the show notes. You can also follow me on Twitter at Scott Mel, to continue the conversation.

See you next week.