WHOOP Podcast - Dr. Nicholas Christakis, Yale coronavirus expert

Episode Date: March 25, 2020

Dr. Nicholas Christakis of Yale University has emerged as one of the nation's leading experts on coronavirus. He joins Will Ahmed to discuss how the virus started, why it's spreading so quickly, and what we can do to limit the number of cases moving forward. Nicholas and Will discuss how China used a "social nuclear weapon" to address the outbreak (6:38), what experts believe may have started the pandemic (11:33), how many cases one case can reproduce (12:18), mortality rates compared to other diseases (14:47), how Korea was successful in combating COVID-19 (18:33), what led to Italy's collapse (19:49), the risk healthcare workers are facing (23:05), the best and worst-case scenarios for the United States (25:08), the importance of testing and the next steps the US should take (32:33), if we will experience a second wave of coronavirus (37:30), how technology can help us fight the disease (40:17), why young people aren't out of the woods (49:30), and the importance of trusting experts (55:14).Support the showFollow WHOOP: www.whoop.com Trial WHOOP for Free Instagram TikTok YouTube X Facebook LinkedIn Follow Will Ahmed: Instagram X LinkedIn Follow Kristen Holmes: Instagram LinkedIn Follow Emily Capodilupo: LinkedIn

Hello, folks. Welcome to the Whoop podcast. I'm Will Ahmed, your host, the founder and CEO of WOOP. And at WOOP, we are on a mission to unlock human performance. So we build technology across hardware and software and analytics to better understand the human body. And wow, does that feel like an important time right now? I'm thinking of everyone listening to this and wishing my absolute best for you and your family as you stay healthy during this crazy time of coronavirus COVID-19. We feel at WOOP, it's incredibly important to do as much research as possible on coronavirus and COVID-19. We've added COVID-19 tracking to the WOOP journal, which many WOOP members will have noticed by now. We've gotten hundreds of positive responses to that, people saying that

they believe they have COVID-19 or have tested positive for it. So we are doing lots of research on what that data may look like before, during, and after COVID-19, our goal is to share that with the whoop community and potentially society at large. Now, my guest today is Nicholas Christakis, who is brilliant in so many ways and happens to have become really one of the leading experts to talk about COVID-19. Nicholas Christakis is MD, Ph.D., M.P.H. Sociologist and physician who conducts research in the areas of social networks and bioscience. He's the Sterling Professor of Social and Natural Science, internal medicine, and biomedical engineering at Yale University.

And literally the two topics that he focuses on in his research are the social, mathematical, and biological rules governing how social networks form, which you can think of as connection, and the social and biological implications of how they operate to influence thoughts, feelings, and behaviors, literally the contagion. So there's really very few people who are better equipped to be analyzing coronavirus as Nicholas. And he was on this from, I want to say, mid-January, he started tweeting about it. Aggressively, his lab started doing an enormous amount of research.

And so we dive in to all things coronavirus today on this episode. What caught his attention about this? We just in very simple terms, define coronavirus and COVID-19. We talk about transmission. We talk about a lot of the different countries and what their policies have been, some good, some bad. Nicholas shares what his forecast is for this going forward, which frankly is pretty grim. And, you know, what could be positive going forwards? What can we as society learn from this and grow from this?

So it's a fascinating episode. I hope you enjoy it. without further ado, here's Nicholas. Nicholas, welcome to the WOOP podcast. Will, thank you so much for having me. So how do you like to describe yourself? Oh, goodness, I don't know. I mean, I'm a physician and a sociologist.

I do research on human social networks and human behavior, and I run a lab at Yale University called the Human Nature Lab, which is engaged in a very wide range of research projects. Well, you and I originally met while you were a professor at Harvard, and I believe it was maybe late 2012, early 2013, and I came to you with this goofy-looking prototype telling you we were going to build a network for measuring physiology, and here we are eight years later,

and you've been an advisor to the company along the way, so thank you. Yeah, I was an advisor, right? I think I was an inaugural member of the scientific advisory board. Yeah, I remember when you guys came to see me, and I remember that prototype, and I remember the office we were sitting in. Yeah, totally. Yeah, and I'm really, you know, I'm really glad. You still have your hair, which is not common for startup founders.

Eight years later, the joke is typically that eight years later, you know, all the founders are bald, but that's not the case in your case. We got hooked up because, you know, you've done such a. phenomenal job studying networks. And, you know, I thought originally our podcast together would be about talking about networks in the context of health and fitness, but here we are in this amazing moment in time with coronavirus, and you've become one of the leading experts that people are turning to to talk about it.

You wrote recently in The Washington Post, since I've spent much of my professional career studying marriage, friendship, and social networks, and the health benefits they are. offer, I'm finding it ironic to be strongly advising against human contact, but that's what I'm doing. What caught your attention about coronavirus? Because you've been on this, I want to say, from the very, very beginning. I was listening to your tweets, maybe early January on it. Well, I actually began, I may have been aware about it in a kind of formal sense as in early January, but I think I really began to pay serious attention by late January. So I got contacted by some Chinese colleagues with whom I've been doing some research on networks for

quite a while around January 24th or 25th, just when the quarantine or the cordon sanitaire was imposed on Wuhan in China. And we began to think about how some network ideas could be merged with some big data, let us to say, some data they had about. the Chinese population and began to think about how we might study the spread of the pathogen and then I started paying serious attention and over the course of early February I became aware of the fact that the Chinese had chosen to implement regulations that required 930 million people to stay at home yeah and they have kept that until now. So for two months, 930 million people have been under a functional

form of home confinement where, let's say, one person per household can leave once a week to go shopping. And this is coupled with all kinds of other social distancing measures. And in early March, on March, I can't remember when the date is anymore, I finally, well, what happened then is that I was paying attention to what the Chinese were doing, and it was dawning on me that they were using what I ultimately called a social nuclear weapon. They weren't just doing this for fun. I mean, they were fighting a viral enemy, and that viral enemy was sufficiently powerful in their judgment

that they needed to put a billion people under house arrest, basically, for two months. So I began to pay much more serious attention in February to this pathogen, and it was clear to me that it was going to go be pandemic. we have pandemics every 10 years or so. Bill Gates has a powerful, I think it's a TED Talk or some kind of speech he gave five years ago about pandemics. They come every 10 years or so. Many listeners will remember the SARS pandemic from 2003,

the H1N1 from 2009, the MERS, but those others peter out like many of them do. But occasionally, they don't. And this is one of those times and it's not going to peter out. So I was watching what the Chinese were doing, as you said. And beginning in sort of late February, early March, I became very concerned that I didn't think Americans were taking it seriously.

And I had this tiny Twitter following of like 50,000 people. And so I decided that I would, you know, in addition to doing the research in my lab, I decided that I would start, you know, tweeting out basic factual information about pandemics and coronavirus. And to my amazement, people were very interested in this. And a lot of those tweets went completely viral and got many tens of millions of impressions. So I started redirecting some of my time not only to do actual

research and we're doing a whole bunch of projects in the lab to try to help the United States confront the coronavirus, but also I decided to commit some of my time to trying to enhance public understanding of what we were facing. And so then I started doing a few media appearance. and podcasts, and among other reasons, that's why I'm talking to you now. I guess just in very simple terms, we're going to go from simple to complex quickly here. In simple terms, just to find coronavirus COVID-19. Well, first of all, COVID-19 is the medical, the SARS-CoV-2 is the name of the virus, and COVID-19 is the name of the condition, the illness you get.

The coronavirus is a class of viruses. It's a ribo-virus. It's an RNA virus. Other, this virus is similar to the SARS-1, COVID-1, that was from, you know, 17 or however many years ago. And there are other coronaviruses that circulate in our population. For example, the common cold is caused by a wide variety of viruses. And a few of those viruses are coronaviruses. I think four of them, I don't know, I think there are dozens or maybe even a couple hundred viruses that can cause the common cold, and which is incidentally one of the reasons it's so hard to cure the common cold. It's not one condition. It's many conditions. And a few of

those are coronaviruses. And we get a mild illness from, you know, we get a common cold and it goes away. It's a virus. It's an RNA virus. It's encapsulated in when it, when the virus takes over our cells and forces our cells to produce more of the viral RNA, and then the little viroid, the little virus particle that's produced as a result erupts from our cells, and it takes with it a little bit of lipid layer, a little bit of the cellular membrane from ourselves, which is kind of made up of lipid, which is like fat. And that, on the one hand, is what makes the virus much more transmissible. So when it goes from me to you, it already kind of has a human coating. It's like camouflaged. But it's that lipid layer that is completely

destroyable with soap. And that's why the virus can be easily killed with hand washing and other basic cleanliness routines. We're lucky about that. It's not a very hardy virus. So anyway, so that's the virus. Like many of these things, it, and in fact, very similar to the movie Contagent, incidentally. I watched that recently. to teach each of. Yes. Well, just like in contagion, we're pretty sure

that this virus came from bats. And for reasons we don't fully understand viruses that evolved to, people speculate that the bat immune system is similar in material ways to the human immune system. And so viruses that adapt to the bats, then when they occasionally do leap to humans

by still incompletely understood mechanisms, those viruses already like pre-adapted to thrive in us. maybe with a couple of tiny mutations and then bang, they take root in our species and then we've never seen this. And incidentally, we are all immunologically naive. This virus is new to us. That's one of the reasons it's spreading so fast.

There's no natural immunity to this pathogen in our species. And that's why it's spreading. Now, let's talk about the spread for a second. So the R not, right, which is the rate at which one person, in fact, other people, or how many people effectively are infected, excuse me, by one person being infected. Is that correct? Yes, the R-not is the unfettered spread of the virus. So it's the spread of the virus in a non-immune, in a susceptible population from one case gives rise to how many other cases. Essentially, if it's more than one, it's going to keep growing. Correct. But a very

similar number, which is a better number to discuss, is something called the RE, the effective reproductive rate. That is, in an epidemic that's taking place, how many new cases arise as a result of an old case. And the estimates of the effective reproductive rate in Wuhan, when near the beginning of the epidemic, was about 3.8. Which is huge. Huge. Yeah. Measles is like 18. Measles is highly contagious. Ebola is about two, let's say. So each Ebola case might make another. And this disease has about 3.8, which is large. Yes, that's correct. But I need to emphasize that this R-E, this or R-Not, is not a property solely of the virus. Yes. Right. Right. It also has to do with all kinds of social conditions. Exactly. Right. If China's on lockdown and Britain's

not, those are two perfect case studies in R-not. Exactly. That's exactly right. And so, or the environment, you know, how hot is the environment or how humid is the environment. So many different things can affect the propagation. That is to say, how many new cases, each old case yields in an epidemic. And China, by basically locking down, as we said, these 930 million people, scientists have quantified what they did to their RE, and they moved it from 3.8 to 0.3. In other words, by an order of magnitude, they brought it down. And when you bring it down, as you just said, will below one, then the epidemic extinguishes because each case cannot reproduce itself. So that's what they have done.

But I need to emphasize what the Chinese have done and what we are attempting to do is they have stopped the spread of the pathogen. They have not eradicated the pathogen. So this is going to come back and this disease is going to become what's known as endemic in human populations. That is to say, it's just going to become like the flu, exactly. It's going to become like the flu. deadlier than the flu. And as time goes by, it's possible and it is often typical that pathogens

mutate to be less deadly. The pathogen doesn't really, from the point, from the Darwinian point of view, from the pathogen's point of view, it doesn't really want to kill you. Because then it won't spread you, you won't be able to spread it. Exactly. Yeah. That's exactly right. So pathogens that are too fatal, they kill you before you can spread it, that's not good. So pathogens that evolve to be milder, actually spread farther. And this is one of the reasons the original SARS, the original SARS from 17 years ago or whatever, that pathogen was too fatal,

and that's one of the reasons that pandemic died out. So I think the case fatality rate of that pathogen was like 10%. And this pathogen is, let's say, between half a percent and 1%, we don't know yet. And just to benchmark you, the common flu is about 0.1%. 1 in 1,000 people with the flu die. And we think 5 to 10 times as many will die. We think this pathogen, a COVID-19, or SARS-CoV-2, is about 5 to 10 times as deadly.

If we look at, which is amazing, if we look at some of the different policies that a bunch of different countries enacted, right? I mean, this is such an interesting moment in human history, first of all. You've got China, which has put 700 million people. 930 million. Excuse me. 930 million people under house arrest. And if you look at the data now coming out of China, they're claiming to have zero new cases a day. And I believe them. You believe that. Yeah, I do believe the Chinese data for various reasons. Why do you believe it? Because there's also all sorts of reasons to not necessarily believe it. I can't discuss because the paper is under embargo, but we have done some research with certain types of analyses that have convinced me that the Chinese data are mostly correct. Okay. So that's very encouraging, isn't it, that they've been able to plateau this at around 80,000 people, given the size of that country? Yes, it's encouraging. But like I said,

they've used a social nuclear weapon. I mean, the force they've applied. I mean, they've tanked their economy. The people haven't been able to move. I mean, it's not sustainable. And as they liberalize, I suspect what the Chinese are planning to do in here, I don't know for sure, is probably slowly released. They're just beginning. to let the kids go back to school now, they are going to slowly release their cities from quarantine, but what they've done is they've bought themselves time to

build hospitals, to I'm hearing rumors that they have acquired all the personal protective equipment on the planet. Honestly, in our country, what amazes me about our country is why we've been so asleep at the switch. I mean, what did we think that the Chinese were over there,

you know, putting a billion people under house confinement for two months, and we thought, I mean, What did we think? I mean, it's going to come. And we know now from genetic studies that the pathogen was already in the United States by middle of January. And it's in the nature of pandemics. They spread around the globe. And so we should have been preparing ourselves. We should have been preparing the public for the battle. We should have been preparing the public to understand the difficult tradeoffs between lives lost and economic consequences. And we can talk

about that if you want. It's not easy. Yeah. We should have been preparing our of buying ventilators. We should have been getting our factories to manufacture personal protective equipment. You know, it's... So if it were up to you, like in, I don't know, late January, as soon as we learn that there's a case in the United States, would you have shut everything down? Would you have gone shelter in place? No, no, no, no. What would you have done? Well, early on, if we had had testing, if we had rolled out massive testing, like the Koreans did, Massive testing seems obvious in hindsight, right? We should have had massive testing, and we're still struggling to keep up with that.

Yes, and we need to talk about the different kind of testing. There's an opportunity not to make the same mistake we made with the virus testing with the next challenge, which is going to be the so-called serology testing to see who's immune. But what the Taiwanese did, the Taiwanese were badly burned with SARS, you know, 2003 or whatever, and South Koreans as well, they, of course, are. closer and, you know, to China and were, you had a little bit of more understanding of what was about to happen. They are rich democracies. They're smaller than us, but, you know, not hugely smaller. You know, they're fifth or sixth of our size in the case of Korea, I think. And they moved

immediately to detecting cases and engaging in homebound quarantine. You know, the people weren't put in prison. They were said, okay, you're sick, go home. And contact tracing. And this was incredibly effective. And if you look at the charts that the Financial Times puts out, you know, they're in a very gradual slope and they're able to cope. We did not do that. And I mean, just to be fair, we're also a bigger country. We're more spread out. We have different strengths and weaknesses compared to South Korea. You know, we're less collectivist society. On the other hand, we have many strengths. So, you know, we didn't deploy our strengths effectively. Just to frame the status of South Korea for those who aren't super up to speed on all the numbers, they've also now gotten

to effectively a bell curve of new cases where, you know, it peaked and now the the rate of new cases is declining, which means the growth rate's declining. It means they have it under control. Let's talk about Italy for a second. What factors have made Italy, in your opinion, sort of the case study on how dangerous this is? I think when Northern Italy collapsed, I think it got everyone's attention. You know, here's a rich European democracy, which is brought low very fast by this epidemic. There were a few things that we don't know exactly why Italy was so bad. I do think France and Germany are just lagging behind. The German case is a little bit mysterious, but Spain and France, I think, are just like Italy, but eight or nine days behind Italy, although

with the Italian case, I think those other countries acted more swiftly. For example, Greece shut down at schools very quickly because they'd just seen what happened in Italy next door. The Italians were a little later, but they were caught flat-footed. The number of idiosyncratic things happened in Italy. First of all, as far as we know, the Italian case began when two people had contact with China and brought the disease back to Italy. I think they were businessmen. And one of them turned out to be a super spreader, which is, you know, it happens sometimes.

And I think he infected 43 people. So the beginning of the epidemic was very abrupt in Italy. First point. Second, Italy has an older population. So if you infect 1,000 young people, none of them will die. If you affect 1,000 old people, 20% of them might die or 10% of them might die. So the Italy has an old population, so they started dying fast. A third factor is that Italy has a very high prevalence of intergenerational household. where grandparents live at home. Your grandparents probably don't live with you.

For many Americans, they don't have multiple generations. So what happened in that situation is that young people would go to school, go to work, get the pathogen, maybe be asymptomatic or whatever, and bring it home. Incidentally, that's typical of most pandemics. They're very young. The babies, the newborns, and the very old are the last links in the transmission chain. There are the people at home that aren't moving around, and then middle-aged and young adults go out into the world and bring the pathogen home and then infect

those other people. And that's what happened in Italy. And very rapidly, their health care system was overwhelmed. And anecdotes began to emerge of what was functionally battlefield triage in Italy. And I have asked some people I know there in Italy whether those were just anecdotes that, you know, got the world's attention or was it a more accurate description of the state of affairs. And I've been told that it's an accurate description of state of affairs, that they literally did not have enough ventilators and equipment or beds to take care of the volume of people dying. And they had to resort to triage, just like in Hurricane Katrina in our country, when the hospitals were flooded, and the doctors had to make very difficult.

I mean, yeah, unbelievable. I mean, reading about that Italian situation where doctors are choosing effectively who to treat and who not to, it reminded me of that. famous Sandell class at Harvard around like morality and you know like which path of philosophy do you want to take in order to save people's lives it's it's pretty unbelievable what they've had to go through and obviously the doctors are unbelievably brave now well the the healthcare workers are and and you know I I was a doctor during the HIV crisis in the 90s and you know we we took personal risks to care for people who were sick.

It was just a necessary part of the job. But that's different. Expecting doctors and nurses and other health care personnel to take some risk, it comes with the territory. It's like being a cop or a firefighter. Right, right, right. I think that's reasonable, and I think most healthcare workers see it as a calling,

and we'll assume those risks happily. But that's completely different than sending them into battle without equipment. You know, that's like asking, you know, that's, you know, that's ridiculous. Like setting a firefighter to fight a fire with no hose and no uniform and no acts. I mean, this is craziness. And that's the problem we're facing now. And I'm worried. I'm very worried. And incidentally, I'll say, here's the thing. I have sympathy for politicians as well. So I'm sympathy. It's difficult to know what to do in the situation. Like how are we going to weigh, how can we take in the uncertainty in the estimate and how many lives might be lost? And the

epidemiologists and other experts are still give a range, and I have my own ideas about what that range is and what's likely to happen, how can we take in that uncertainty and weighed against the social disruption and the economic disruption of asking people to stay at home? And furthermore, if we don't take action, and the American military is now setting up field hospitals in front of our hospitals, like tents, and doctors, they are saying, you can have a ventilator and you cannot, the American public is not used to this. This will not go over well. And so we will have huge numbers of deaths and this disaster of this happening. So it's difficult. It's difficult to know what to do. You have your point

of view on how many people this is going to affect? I think at best, at very best, we escape with a few million Americans infected and 35,000 deaths at best. And over what time frame? Because that's important too, right? If this keeps coming back. Yeah, over the next year, let's say. Okay. Just to frame it, 35,000 deaths is as deadly as motor vehicle accidents.

And we spend many billions of dollars a year dividing our highways and mandating safety equipment and cars and training for young drivers. We print newspaper articles about people who die in collisions and we're sad about it. If I told you I could, and we were trying to bring down the rate of motor vehicle accidents, if I told you that I could wave a magic wand and stop the carnage on the highway, you would be, we'd all be ecstatic. Well, what I'm telling you is that at best, we have added that level of mortality to our society. It's not replaced.

It's a new thing that's going to kill us. But you're saying best case scenario, it's on the level of motor vehicle accidents. What do you think is a more extreme example? Okay, well, within the realm of the possible is that in most pandemics, about 40% of the population eventually gets infected. For example, the 1957 pandemic, which was a different virus. So if we say 40% of Americans get infected, that is, whatever that is, that's 130, 120 million Americans or something.

Yeah. And then let's say that on the conservative side, that 0.3% of Americans, Americans die from that. In other words, that the condition has a fatality rate that's only three times as bad as the flu. It could be five or ten times as bad as the flu. We don't know yet, partly again, because we didn't do testing, so we don't know how often someone gets infected and doesn't die. We, you know, we didn't observe the denominator, so we can't know what the fraction is. But let's say best estimates are that it's the most optimistic estimate that I've seen anywhere is about 0.3% case fatality ratio. Now, if that happens, if 120 million Americans get

infected and 0.3% get it, that's 360,000 deaths. That's a top three killer in our society. It's catastrophic that many deaths. And it could be worse. You know, more, maybe 60% of Americans get affected, maybe the case rate's a big higher. It could be better. We don't know. And this is one of the frustrating things, which is to try to communicate to the public that we cannot know for sure what's likely to happen. There's a range of outcomes, but what I can't tell you is that we need to take this seriously. You know, this is not a drill. You know, this is like a real thing. We have no good options here. We could tank our economy, but tanking our economy will cost a lot of lives. Poverty is deadly. Other health conditions might go untreated

or poorly treated. And so we have a very difficult decision to make as a nation, which is how many deaths we are willing to tolerate. And this is what the Brits were trying to do initially, but then they got this famous Imperial College report, which suggested that the crush of deaths would be so dramatic, it would be politically unsustainable. Like, I don't think the person on the street would tolerate battlefield triage

in our country or in England. you know, where you just, you're sick, but you just are left to die because we just don't have the equipment to care for you. Which, to reference this paper for a second for our audience, the paper effectively said, because Britain was going down this path of we want to build immunity. We're not going to take the economy. We're not staying at home. There were concerts in Britain a few days ago.

I mean, well, yeah. And there was, we had in Florida, we had spring break in Florida, which was nuts, honestly. Their point of view initially was we're going to build towards immunity. So if China goes, it says we're going to do full lockdown, we don't want people exposed. Britain was literally the other end of the spectrum. Yes. And now it's not, and it's not a crazy irrational strategy. That is to say, it's not, it's not devoid of, of rationality.

It's, it is a strategy which you can describe. And it says, look, eventually the only exit from this thing is to get herd immunity, that's to say to have large fractions of people be immune, where it's going to become endemic eventually. Why don't we just get the pain over with now, take it on the chin, let it sweep over us. But when they actually did the calculations on how many people would die, and they recognized how it would look, they probably concluded that in that scenario, they would tank the economy and take all the deaths. Remember, deaths, you know, hundreds of thousands of people dying and hospitals overflowing isn't good for the economy either. I mean, people are losing

their family members or relatives. Huge amounts of resources are going to take care of, you know, so then you get the worst of both outcomes. Neither did you lock down and prevent the deaths, nor did you prevent the economic collapse. Basically, none of our choices are good, honestly. And this is why careful thinking, careful estimation of the costs,

and clear communication to the public about what are these tradeoffs. So people understand, you know, why we are taking the choices that we're taking and what the risks are, both upside and downside risks of what we're doing. And the deep irony is if we self-isolate and reduce the impact of the epidemic and nothing happens, that's success. And so people will be like, well, why did we stay at home?

Nothing happened. Well, the reason nothing happened is because we stayed at home. So it's difficult to communicate this, I think. Right. There's going to be a lot of confirmation bias after the fact. Yes. It's going to be hard to unpack exactly what happened, too. Although there's a fascinating case study right now I just saw online today between Tennessee and Kentucky,

where Kentucky adopted social distancing measures. They start at the same level of prevalence of conditions, and Tennessee is always lagging like a week behind Kentucky in what Kentucky is doing. And Kentucky is closing its schools and banning public gatherings and making all these steps. And now Tennessee has like four times the rate of Kentucky of cases. So we know that social distancing works. I mean, this has been studied. School closures have been studied.

I mean, it's not, you know, you can, one of the things that I find so amazing about this is that we should not be surprised or shocked about this. You can, you can reach over and get a book that says national strategy for influenza pandemic. You can open up the book. I'm looking at you open this book right in front of it. Yeah.

I was like, okay, you know, page 87, transportation and border preparedness. You know, page, page, I don't know, page 151. responding, communicating and mitigating risks. Yeah, right. Page 182, planning requirements for pandemic influenza continuity of operations. I mean, this is not an unexpected thing, you know, and we had warning. I mean, the Chinese, they did it for their own sake.

I mean, I don't think they were trying to be generous to anyone else, but the Chinese were, you know, bought us six weeks. So honestly, I think we should have been preparing. Moving forwards from today, I think we've, obviously there's some things that we wish in hindsight we should have done. You mentioned testing, we don't have enough testing kits, and there's a few different types of tests. Yes, yes, that's what's crucial. So I think we, so the kinds of tests that everyone's been talking about so far have been a polymerase chain reaction based tests for the viral RNA. That is to say we put a swab, you're infected, you come in with symptoms, or you very recently had symptoms.

you come into the hospital, I put a certain kind of swab, which, incidentally, we don't have enough of those in the country right now. They're like sophisticated. Ridiculous. They're like sophisticated Q-tips, but we can't, we don't have them. They're gone. Yeah. And so you put it in the back of the person's throat and you take a swab and you do a test in

the laboratory to detect the viral RNA. It's kind of like the strep throat test, right? Yes. Okay. That's right. Everyone's other strep throat test. Yeah. And you detect the viral RNA and you can confirm, does the person have COVID or not?

And that's what everyone's been talking about the testing, and that's, we should have done that, and we still need to do that. It's not like it's past us. We should be doing that. But the next battle we want to fight is we want a different kind of test called a serology test. The tests, not for whether or not you've had the viral RNA right now, but whether you've been exposed to the virus in the past by testing for your bodies, your physical body's production of antibodies against the virus. We'd like to know. So there are all these people in the United States right now that are saying, you know, I read in the newspaper that the virus came to the United States in the middle of January, which it did. We know this from genetic tests, genetic analyses. And I had this really nasty cold that I, different than any other cold I've ever had before at the end of January. And I think I probably had COVID and I'm immune now, because if you had it and you survived it, you're immune. Right. And we, and that person would like a test to know. If you test for the virus, you can't tell the virus has gone from their body they're healed so what you need to test for is

are there antibodies to the virus in their body so important yeah so important yeah yeah and then that person doesn't have to be under quarantine that person gone about good go work can drive a cab and transport the rest of us can deliver food potentially help out uh you know help help out with health care workers too right yes health care workers doing the serology for health care workers hugely important. It makes all the difference in the world. To a health care worker, to know, I've had the condition, I'm immune. Yeah. So, yes. So what we need is these serology tests. The Chinese, the number of, these are commercially very valuable and clinically very valuable. And there are a number of them that have already been invented, that what we need

to do is we need to ramp up production. We need to get the best tests we can with the optimal, what's known as sensitivity and specificity, the optimal test performance, the optimal accuracy. We need to be able to produce them at scale, at low price, distribute them. They should be free because we all care. It's, to my advantage, if you get tested and are shown to be immune. You can return to work and help restore the economy, and you can provide services to me. Furthermore, if you're immune, you can't spread the disease to me. So these tests, we need rapid change in regulations. We need financing. We need production work to bring these tests, line and here we have an opportunity not to make the same mistakes we made with the viral RNA test

we can actually move ahead now fast and get those tests available to as wide a public as we can well i'm optimistic about that because i if there's anything america produces it's it's the private sector and entrepreneurs and and people who can yeah but they the entrepreneurs will need some help they'll need to know that there is uh demand and they need well the demand's obvious right yeah but someone has to buy these tests. Like it's unclear who's going to, you know, maybe we'll expect private citizens to pay as well if it's a free market. But that's your point is the federal government has to say, look, we're going to buy, you know, yes, a hundred million of these. Yes. 100 million. Sure. Yes. And furthermore, more important even is regulatory relief so that these,

because, you know, we can't have the usual procedure for reviewing and approving these tests. It has been done extremely rapidly. So that's a good segue, right, to, to, uh, drugs and vaccines. I am optimistic about a vaccine. Sure, but that's going to be 18 months, right? Yes, that's right. Maybe 12 at best. Yes, that's correct. 12 at best, 18 if we're lucky. Because that to me feels like if there were something that would make people as a society, much less anxious and willing to go back out into the world, it would be knowing if I got this thing, I can treat it with a fairly well-known drug. What point do we go back to a society that shakes hands and hugs and whatever, right?

It's going to take a while. Or do you think that ship sort of like sailed for the next 18 months until there's a vaccine? I think we may get a little relief as is typical of pandemics like this in the summer and also people will be fed up with the isolation. So society may return a little to normal in July or June, July, August, and say we'll have some cases. Maybe by then we'll have borne the brunt of the impact that we're about to feel in the next two or three weeks in this country in April, and maybe by then we'll have learned more how to

cope with it. We'll have some routines in place. Maybe we'll have more equipment. Maybe we'll have flatten the curve some. People will return to normal life, but then what's going to happen, as is typical, is the schools will reopen in September, and people will go back to work, and then we'll have a second wave. And in 1918, the second wave was four times as deadly as the first wave. And I don't think that's going to happen in this case. I think this will will be more like the 57 pandemic, but we're very, very likely to have a second wave. And incidentally, I'm very concerned it's going to interfere with our election because you can't have large numbers of people going to the polls. I mean, we're going to have to double

the number of polling places we have. Wow. Yeah. Or we're going to have to shift to online balloting and then we're, of course, subject to hacking by the Russians. We, or we need to have absentee balancing procedures in many more districts and states in the union. I mean, we got to start now, my judgment, thinking about how we're going to cope with the election if we're still engaging in, you know, like today I went out shopping where I live here in Vermont right now and everyone was maintaining a, you know, a six feet distance between people in the shopping, you know, when you were in line. And there were signs everywhere saying, you know, space yourselves out. Well, we've all been to polling.

stations in this country, we can't have, people can't be sharing a pen to, you know, fill in the holes. We, people, you know, you have to, the lines will stretch around. They already stretch around the block in many districts. Now they'll stretch around the whole county. So we're going to need to prepare for that in my view. And many other things will need to prepare for. It's a great point. One thing that's frustrated me is, I feel like the lack of sophistication of access to data, for example, in forecasting this forwards, right? Yes. You know, like I was watching your lecture, which will include in the show notes,

you gave a brilliant lecture at Yale very early in March, predicting that everything was going to close, and a lot of that's turned out to be true, of course. And you were talking briefly about phone data, but I cannot think a better use of phone data than to understand where the hell did everyone go in order to figure out, okay, If I test positive for COVID-19, is there a way for me to volunteer my cell phone data to show all the people I may have come in contact with? Yes, we're working on that idea ourselves in my laboratory, and we're working on a similar idea with an app that we hope to launch very soon.

And depending on when you post this, we may append to the notes. We haven't decided on the final name of the app, so I don't want to mention it now in case we change. the name. But we hope to launch that out very soon, and we would very much be grateful if people would download it. It's sort of like ways for the flu. And it's built on ideas that I was working on when I first met you with the H1N1 epidemic, where we built this little monitoring tool, exploiting social network ideas. I actually gave a TED talk about this called using social networks to predict epidemics. And it's all of the ideas in science we developed 10 years ago, but we're bringing them forward to 2020

and building an app that works off of that. And so we have a beta version of the app and we hope to release it very soon and the wider the adoption, the better it gets. Well, to me, that's one very obvious use case that would be interesting. And frankly, at Whoop, we've added over-19 tracking and sickness

into the Whoop Journal so that you can track these things, which to me was so obvious as something that hopefully we can do research around to understand. Yeah, I love that. And I'd love to do that. And I know you and I've been talking about social aspects to WOOP technology since the very beginning. And to the extent that people, like a very useful set of ideas would involve exploiting what's known about how WOOP users are connected to each other, coupled with self-reported COVID-19 status, actually could

yield a fairly powerful tool for the user base. Now, there's a whole, there's like five different if this, if this, if this state, you know, buried in what I just said. Sure. But, you know, it's conceivable. Okay, let's take some counterpoints here, right? So I pulled a bunch of, I pulled a bunch of things from people who are skeptical, who are also, I would say, in the camp of, we're doing so much damage to the economy that at this point outweighs any damage that could be done by this virus.

It's possible. Yes, that's possible. But then I have, and I would love, I'm not a modeler, but there are very sophisticated people in our country who could actually answer this question and could compute, you know, what is the cost, if we tank a trillion dollar economy, how much money are we spending per life saved? And we know that calculations like that are done, for example, with mining safety regulations. You know, we, our miners take a risk of death because we don't spend $100 million per minor to prevent them from dying. We spend $7 million or whatever the calculation is to prevent the

deaths. So we could, and similarly for highways, we don't divide every highway in the nation. If we did that, we might save an extra 10,000 lives, but we say, oh, to divide every single highway in the nation would take a trillion dollars, and we would save 10,000 lives, and we're not willing to spend it. So we make that calculation. So we could do that calculation with respect to this. We could say, look, we are saving, you know, 100,000, we're renting 100,000 deaths, but we're tanking the American economy, and we don't want to do that. But in order to do that. Well, we would have to prepare the public, not just for the deaths, but for the wave of deaths, for the scenes that will occur in our hospital. Right, right, right, right. No, I understand.

Well, okay, well, on the first counterpoint, and this seems like a very fundamental one, there are smart people out there experts. Again, I'm not saying I agree with this. There's smart people out there experts that claim that the coronavirus is actually spread. spreading slowly if you look at the data. So here's an Israel Nobel laureate, Michael Levitt, American, British, Israeli biophysicist, who won the 2013 Nobel Prize for Chemistry, development of multi-scale models for complex chemical systems. And this is a very, very smart guy, brilliant guy.

He's looked at the data in China. He predicted in mid-March that by the end of March, new cases would go away. That seems to be accurate now. And he says based on both data from China and both data from the Diamond Princess cruise ship, this is a cruise ship that had about 600 people on it, the worst conditions for spreading this thing, central air conditioning, population density, communal eating, and about 20% of people were infected, which is a lot, but it's not 100% and it's pretty similar to the common flu. And his claim based on both of those examples is that the rate of transmission is significantly

lower than we're projecting outwards. What are your thoughts on that? I think he's wrong. And I would suggest that the reason he's wrong is that the reason the Chinese rate has slowed down is that the Chinese people put 930 million people in house arrest since January 25th. So calculating the rate of spread in China since January 25th is not the realistic thing to do. Yes, we could, if all Americans did what the Chinese have done, we could also slow the rate in the United States. That's what we're being asked to do. We're being asked to do something short of what the Chinese have done. We've been asked to socially isolate to retard the spread of the pathogen.

Although a lot of factories are back up and running in China. They kept their factories up. And the Italians are doing the same thing. You can, you know, factories that have a lot of automation, where the workers can stay six feet apart. You know, there's no reason those factories have to shut, in fact. Well, Apple was at full production, like, by the first week of March. And I know there's not a lot, like, obviously there's some things that are

automated, but there's an enormous number of people to make those Apple products. Oh, for sure. I think that many, many types of factories, there's no reason. I think if we can get people to comply with the middling level rules, then we don't have to go to the extreme. If we say to people, look, you can leave your house, but do so one at a time. And then if we see people are violating the rule, then we have to say, okay, nobody gets to leave their house. Or we could say, yes, you can operate your factory, but your workers have to wear masks, you have to check temperature twice a day. This is what Singapore did, by the way. They didn't close their schools, but they organized the kids in the schools to wash their hands three times a day

under teacher supervision, and they check the temperature of every kid twice a day, and they send February kids home. Now, if we were willing to do that kind of stuff, well, we could get away with it then, but that's going to be crucial. And I think we should do that and keep our factories open. Yes, that's what I think we should do. Okay, here's another critique. So, for example, when New York first rolled out drive-through testing, out of 600 people tested, only 7% were positive for COVID-19. And those were people that had symptoms and a doctor's note in order to be tested. So there's this broad question of anyone who's sick right now thinking they have COVID-19. What do you make of that? We don't know what the true prevalence in our country is right

now. We can look at the rate of mutation of the virus, and there's kind of an international collaboration where geneticists are sequencing viral strains around the world and uploading their data, and then we can use conventional tools from genetics to kind of tree backwards and see how fast the virus is changing and when different viruses were introduced to different locations. So my understanding is that geneticist, a viral geneticist, by the name of Trevor Bedford, who's at the University of Washington, who's been looking at this, his is a estimation was that I think about a week ago. I don't remember that they were using such data. There were about a quarter million of Americans that were infected. Now, that's a tiny drop in

the bucket in our country. So the fact that you told me that they were seven out of 600 cases in some unclear sample in New York doesn't surprise me at all. But a quarter million, the doubling time of this epidemic is about six days without social distancing. So there's probably already half a million Americans. And next week there'll be a million Americans. And this is a the thing about epidemic growth and exponential growth that people don't understand is that for a very long time nothing is happening nothing is happening nothing is happening and then all of a sudden a lot happens you know you go from a quarter million and a week later it's half a million and a week later it's a million and then two and four and eight and so forth you get the idea yeah right you know

come the end of april could be many millions of americans that are infected and if five percent of them need ICU care we're in trouble and it sounds like you think that's where we may be headed. I mean, I'm very, you know, I don't want to alarm people and I, and I don't want to be, you know, I don't want to be the guy that cried wolf and I don't want to be chicken little. And so it's very hard for me. You know, I don't know what to say to you. I'm telling, what I'm saying is, is that in my judgment, at least 35,000 Americans are going to die of this. And in my judgment, it is quite possible. It's not certain at this point, we'll know more in a couple of weeks, but it's possible that as many as 300,000 or even more could die. We don't know yet. It's very hard to know, and I'm not being evasive. It's just there's a range of outcomes. You know, I don't know exactly what's going to happen, but it's serious. Do you find it encouraging that children and teens aren't susceptible?

So there haven't been any deaths in 10 years old? Yes, or any deaths under, in a large, in a cohort of 44,000 in China, I think. 0.2% of those under 30 or something died. In a large sample in Korea, nobody died. I don't know that. I think the story is still out on infants under two. but certainly young people don't die. But they absolutely can get the disease and they can spread it.

And furthermore, they can actually get quite sick. If large numbers of young people are getting this condition, there are now reports of fit, healthy people that are felled by the condition. And if we start filling up our ICUs, maybe they survive because they get excellent medical care. But if we can no longer provide that medical care, because our ICUs are fulled, maybe young people will start to die. Well, let's try to try to end this with a somewhat optimistic point of view,

which is what are some things that this could actually do that were positive for society? I have a couple ideas, but I'll let you go first. Well, I wrote that sort of optimistic essay in the Washington Post a week or so ago that was based in part on my book, Blueprint, The Evolutionary Origins of a Good Society. and that book, I mean, it sounds like I'm promoting it, but what I'll mention is that it was a New York Times bestseller in hardcover, and it was, it came out in paperback on March the 10th, and it was a terrible timing because, you know, we're in the middle of a pandemic. But the book, in that book, I make a set of arguments, and in this particular, in this op-ed, I made a set of arguments, which is the following. The virus, we evolved, we humans evolved to live socially in a very particular way. We assemble in groups. We have friends, which is very unusual in the animal kingdom. We form long-term non-reproductive unions to other members of our species. Other animals don't do this. Other animals live in family groups, but they don't have friendships. We do it. Elephants do it. Certain cetaceans do it. Certain other primates do it. Anyway,

so we assemble ourselves in groups. We have friends. We touch and we hug each other, as you said earlier. And so the virus exploits that to spread. And so as we opened up our conversation an hour ago, we were talking about how, like, ironically, we have to stop doing that. But there are other things we evolved to do that the virus does not take away from us. One of those things is we're a cooperative species. So even as we're distancing ourselves from each other, we have to band together to fight the pathogen. So I do foresee, and I see evidence that Americans are getting together to, and so are the Italians, so are the Chinese, so are all the people that are affected, banding together to fight this thing. And the second thing, which many

listeners will take for granted, is that our species is a species which engages in teaching. Now, many animals learn, they learn independently. A little fish can learn that if it swims up to the light, it'll find food there. Some animals learn socially by imitation or observation. For example, you put your hand in the fire and you learn independently that it burns so you learn not to put your hand in the fire, or I can watch you put your hand in the fire, and I get almost as much knowledge for none of the price. That's called social learning and that's extremely efficient. Quite a few animals do that too. But we do something that's very rare in the animal kingdom. We teach each other things. I teach you to build the fire. And that's very rare. That's not

seen in many species at all. And that is a fundamental aspect of our species, which the virus also has not taken away from us. So we can use knowledge like we were joking earlier about the books on the shelf that are like national strategy for influenza pandemic or countless articles that have been published about how to cope with a pandemic or the knowledge of Italy or China or your neighbors. We can teach each other how to confront this threat.

So I see those as really appealing features of our species, cooperation and teaching, and I'm relying on those for us to see the other side of this pandemic. Well, I like that a lot, And I also love the references to how humans are so unique in the animal kingdom, because sometimes I feel like we forget that we're part of an animal kingdom to begin with, right? Yes. And, I mean, one thing I find encouraging is just this feels to me like it could pull the healthcare system forwards by like a decade.

If you think about telehealth medicine now being talked about regularly, and you know, you shouldn't have to go in to see your doctor, to tell your doctor you have a off. You should be able to do a FaceTime with that person and have wearable data, you know, transmit to the doctor. And, you know, a lot of this stuff should be remote. I don't need to spend an hour with my doctor. I need to spend probably five minutes on a, you know, a Zoom call with my doctor. And, you know, some of those things are going to get pulled forwards in a dramatic way because of how unprepared our health care system was for this moment. Yes, I think distance learning will get a big boost. I think video conferencing will get a big boost. I think our health care system will be

tweaked in certain ways. Shamus Khan, one of my colleagues, who's the chair of sociology at Columbia, sent out a tweet that went viral, which is a pandemic really shows you why we shouldn't tie health insurance to employment because people are losing their jobs at precisely the moment when the pandemic is striking. Such a good point. And so there's a lot of things that I think this will be a stress test on our society. And I also think it will have affect, I hope it will affect, you know, we've had a kind of deterioration in the intellectual fabric of our society in the last 20 years. We've become as a society less capable of grasping the relevance of expertise. People think that it's elitist to be an expert, which is

ridiculous. Like when you need your car repair, do you want an expert mechanic? And when you need surgery, you want an expert surgeon. I mean, the whole point of an economy is that different people specialize in different things. So there are people who are experts in whatever it is that you're interested in, and I think it's proper to pay them deference. They've devoted their lives to whatever it is this topic. And yet in our society right now, to be an expert is seen as somehow to be hoity-toity and holding it over others. I think we've lost the capacity for nuance. We're so polarized that we see things as either black or white in every aspect of our lives. And that's wrong. I mean, most of life involves compromises. We're going to have

difficult tradeoffs to make with this pandemic. And I think the better we accept that, the better. We've also, the public understanding of science is not so great. You know, we have let scientific education lapse in our country. And, you know, I think the average American doesn't know what antibodies are. And yet that's really important to understand what antibodies are, if we're going to have an intelligent conversation about how we're going to confront the pandemic. So there are lots of things about our intellectual fabric and the media environment, you know, kind of long-form, educational journalism has been replaced with a lot of clickbait stuff, and the attention spans are shorter. So, you know, sometimes it takes 10 or 20 minutes to understand something. You can't

get the point in 30 seconds. And so we have to have a longer attention span. So all of these things you see are making it hard, I think, for us to confront this threat. And I hope that we will, when we see the other side of this, emerge with some of those things addressed, let's say. Well, I think that you've covered a lot of brilliant things here, Nicholas, and a lot of the work that you're doing right now is as important as ever. So I feel fortunate to get to speak to an expert like yourself. And I think we're all grateful to have experts like you doing the research and crunching the numbers. Thank you so much for having me, Will. And I'm very glad to be associated with Whoop. Yeah, of course. And where can people find you online? Well, on Twitter, I'm at N.A. Christakis

And my lab where all of our research is freely available is human nature lab.net.netterlap. And you can find all of our stuff there. We have lots of cool tools and stuff. And my book, Blueprint, The Evolutionary Origins of a Good Society is, as they say, available in bookstores everywhere, online as well. Well, we'll include all of that in the show notes. Nicholas, stay safe out there. Best to you and your family. And I hope to see you soon.

Thank you so much, Will. Thanks again to Nicholas coming on the podcast. Thank you to all of our listeners. Stay safe out there. Stay green. I'm going to answer some questions from WOOP members. But before I do that, I want to remind everyone that you can get 15% off on a WOOP membership. That includes hardware and software and analytics and a better understanding of your body.

You can get 15% off if you use the code Will Ahmed. That's W-I-L-L-A-H-M-E-D. I'm going to take a couple questions from WOOP members. So these have come through, Instagram, Twitter, email. We try to be as accessible as possible in that regard. Okay, Matt asks, What have you learned so far from the COVID-19 tracking? Will you be publishing this soon?

Very good question. So, again, we added COVID-19 tracking to the WOOP journal within the WOOP app. And we've had a really strong response to that. We've also had hundreds of volunteers reach out saying they want to share their personal data to help us better understand it. It's very early. We're doing an enormous amount of research. We are going to come out with a podcast on this specific topic. I have done interviews with other WOOP members who have coronavirus, and we talk about what they saw in their data.

So stay tuned for that that's coming out very shortly. We just want to make sure we get all the research right before we say anything. Second question, Sarah asks, can you add a time window for intermittent fasting in the Whoop Journal? Obviously, the Whoop Journal has been a popular talking point this week and last because it lets you track everything about your body and your behaviors. In this specific case, we actually already updated the Whoop Journal to now allow for that intermittent fasting time window. So if that's something you do, you'll now see that in the Whoop Journal as metadata that you can add. And we've added other things like sleep at altitude, CPAC machine, and in general, we're going to continue adding to this list. So if there's something that you want to track that you don't see in the Whoop Journal, let us know, and we will add it.

That's all for now, folks. Again, stay safe out there, stay green, and thank you for listening.