WHOOP Podcast - Dr. Nicholas Christakis, Yale COVID-19 expert, returns to discuss booster shots and what to expect next with the pandemic

Episode Date: October 13, 2021

Yale coronavirus expert Dr. Nicholas Christakis returns for a discussion on the COVID vaccines, booster shots, and where we are headed as a society with COVID now that we are a year and a half into the pandemic. He explains why we are at "the end of the beginning" of the pandemic (2:58), how many deaths we are likely to experience in America (5:30), why it's likely that the vast majority of unvaccinated people will be infected eventually (8:04), the spread of misinformation (12:20), booster shots (17:26), vaccine induced immunity vs. natural immunity (22:12), the "Swiss Cheese" model for pandemic defense (31:43), denial during plagues (40:08), the origin of the outbreak (54:28), and the concern about new variants (56:55). 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 back to the WOOP podcast, where we sit down with top athletes, researchers, scientists, and more to learn what the best in the world are doing to perform at their peak. And what you can do to unlock your own best performance. I'm your host, Will Ahmed, founder and CEO of WOOP, where we're on a mission to unlock human performance. Remind, you can get 15% off of WOOP membership if you use the code Will. That's WOOP. I'll check it at whoop.com. Okay, this week's episode, Yale, coronavirus, expert, doctor, Nicholas, Christakis, returns. He's back. This is the third interview we've had with Nicholas at various stages of COVID-19. It's a fascinating discussion. We talk about COVID-19 vaccines, booster shots, masking policies. We talk about kids in schools.

Should they be wearing masks? Should they be vaccinated or not? where are we headed as a society with COVID now that we're a year and a half into the pandemic? What's going to get us out of what Nicholas describes as the end of the beginning and what's going to get us towards the beginning of the end? Nicholas joined us at the beginning of the pandemic and the end of 2020. So there are two other episodes that you can listen to. The first was really more about what is COVID-19, what is the coronavirus. The second was about how the pandemic has been spreading.

And now this is really a state of the union and what we're seeing with vaccines. We also go deep on the origin of COVID-19. That was an interesting theme. You should check out Nicholas's book, Apollo's Arrow, The profound and enduring impact of coronavirus and the way we live. I think it's the best book that's been written on COVID-19 to date. But without further ado, let's hear from Nicholas himself. Nicholas, welcome back to the WOOC podcast.

Hey, Will, it's good to be back. So a lot has happened in the last 10 months. You've done two amazing podcasts with us on COVID-19, the coronavirus, everything we need to know about it, where things are going. As you see it today, give us the state of COVID-19, some high-level statistics and just the general status. Well, honestly, and I don't mean to say. this in a like kind of I told you so fashion that's not the point but you know these respiratory pandemics have a very stereotypic trajectory and this one is unfolding along the trajectory that people like myself and i was not the only one uh anticipated right from the outset right from the

very first uh podcast we did and then we checked in as you said i don't know almost a year ago 10 months ago, and things continue to unfold, you know, with some provisals we can get into if you are interested, as anticipated. So I would say we are not at the beginning of the end of this pandemic, but we are approaching the end of the beginning. You know, the virus is continuing to whip its way through the human population. It actually has to whip its way through the whole planetary human population, and let's not be too America-centric, and we should care about what happens in the rest of the world, in part because it'll affect us in a variety of ways. And so the virus is still spreading and spreading and spreading in human population.

And eventually, everyone on the, very few people will escape this. Virtually everyone will either be infected or be vaccinated. And when that finally happens, then we will finally put the epidemic part of the pandemic behind us and move into the next phase, which will also take some time. And then ultimately we'll see the other side of this. Total COVID-19 deaths as of today. I think we've surpassed 700,000 in the United States and are nearing 5 million known deaths worldwide.

When you and I first spoke, I said, and at the time, I think there were fewer than 120,000 deaths. I said there'd be between half a million and a million deaths in the United States. And we've already surpassed the lower bound of that forecast, and we will, I think, approach the upper bound, unfortunately. And then, of course, it's not just the United States, it's the world. and, of course, many deaths we don't even know about that were caused by the pandemic. So it is a major thing that's happened to our society.

And I think people, in many ways, people don't fully appreciate this yet. And many listeners have occupations or family structures or are at an age or fitness level even where they either have a low risk of personally experiencing problems, clinical problems, or are able to manage your lifestyle to reduce their risk. And so many people listening may not have a lot of personal experience with this pathogen, although some will, and many will know, as the number of pandemic, as the number of cases rises to a million, for that a million deaths, that will be about 10 million people who knew those people who died personally,

and maybe 100 million who knew of the person who died. But even at that upper limit, 100 million means two, two out of three Americans at the end of this pandemic won't actually know anyone or know of anyone who, you know, who died. So the point is, is that people can have gotten to this stage of the pandemic and still not fully appreciated what's happened to our society. And just to put a couple of a few numbers on the table, as many as a million Americans will die. I mean, that is at a catastrophically large loss of life. Larry Summers, a former Treasury Secretary and David Cutler, another former colleague of mine who's an economist at Harvard, have

call this the $16 trillion virus, $8 trillion in economic damage, and $8 trillion in damage due to death, disability, illness, and so on. That $16 trillion lost to our society. It's like if you went the, you took the average household of four in this country and you destroyed $200,000 of their wealth. It's as if you burned like tens of millions of people's homes to the ground. That's how much wealth has been destroyed by the virus. And so death is high, economic impact is high, disability is high. One thing that is not getting as much attention as it should is that perhaps five times as many people as die of this virus will have some kind of long-term disability, some harm to their lungs or heart or pancreas or nervous system, the neurologic or psychiatric

problems. That's five million Americans. When this tsunami of the virus, when the water is finally received, we're still being hit by this wave, when the water is finally received, we're going to have an enormous amount of destruction and mess to clean up. And so I think people don't really appreciate yet what it's like. And it's because many people have been able to manage their affairs so they're not personally yet affected. Of course, millions of people have lost their jobs and millions of businesses have gone out of business and hundreds of thousands of people have died and so on. And also because in some sense as a society, we are borrowing money from the future. We're basically printing money right now in order to, you know, to soften the blow

of the virus. And I think that there's more ways in which the average person will come to appreciate the impact of this virus on them in the coming years. So the U.S. population today is roughly 60% fully vaccinated. I think it's about 55% fully vaccinated. It's like 65% one dose. Is that higher lower than you would have expected? Lower than I would have expected. I think if people really want to get our lives back and get lives back to normal, we have to increase the vaccination level as high as possible. In Portugal, I think they're at 85% on the national level.

And so we really, really need high levels of vaccination. And like I said earlier, and I'll repeat it because it's worth understanding. Although I think probably most of your listeners are vaccinated, you need to think of it in these terms, either, unless you're a hermit that lives in the mountains, or you're exceedingly lucky, given the new variants that have come out and the infectiousness of the new variants of the virus, the delta variant and other variants, basically, unless you're a hermit or exceedingly lucky, you will either be infected with a virus or you will get vaccinated. Those are your choices. And if you're infected with a virus on average of a 1% chance of death. It varies with age, but about overall

a 1% chance of death. Conversely, if you get the vaccine, your chance of dying from the vaccine are less than 1 in a million. So it's a really kind of an obvious choice, like what you should do, you know, you should get vaccinated. And in fact, the more people that get vaccinated in society, not only is advantageous to themselves, but it's the altruistic and neighborly thing to do because it enables our economy to stand up and us to have a more normal life. So in Portugal, for example, right now, they are taking up all the little stickers on floors that, you know, say you have to keep six feet apart because they have such a high level of vaccination that they have by vaccination reach this important threshold known as herd immunity.

And so they, you know, there's still going to be cases in Portugal of COVID, but many fewer in number and not growing. Well, one of the things I love about you is you've got such a nuanced way to look at all of these, you know, challenges. You're part physician, part public health expert, but, you know, also a sociologist, help explain, or maybe your point of view on why we've had trouble in this country getting to a higher vaccination rate. Because it's not because we don't have vaccines. I mean, they're everywhere now or that they're costly or difficult to get. I mean, they're free and easy. They're free and everywhere.

So what do you think is happening there? Well, I think there are many explanations of this. I mean, there was always a bit of an anti-vax movement in our society. Mostly this was a left-wing political movement. Now we have a right-wing anti-vax movement, specifically focused around COVID, which is unfortunate. Why we have politicized vaccination is a bit, I won't say random exactly. It's unnecessary that we have come to politicize this. particular thing. In other words, I understand and frankly love the fact that we live in a plural

democracy. We have ideological variety in our society. And how do we resolve our disputes? We vote. That's how we resolve our disputes. And it's totally fine that people have different political beliefs about a host and range of topics. But it's odd that we have acquired a range of political beliefs about what I would regard as a technocratic issue, which is vaccination. It's like it's like having political beliefs about whether you need an appendectomy. You know, we're the pro-ependectomy party. We're the anti-ependectomy party. I mean, ependectomy is just an appendectomy. I mean, we have to have, you know, a set of political beliefs about it. And yet we have come to see vaccination through a political lens,

which has harmed us enormously. You know, you could have communicated your political party affiliation or your beliefs in other means, putting a sign on your bumper sticker on your car, for example, or regarding other political topics that are well understood to divide right and the left. But vaccination is an odd one for us. And other countries have not politicized vaccination or even mask wearing. Now, I understand that those practices of vaccination and mask wearing can be inflected through an ideological lens. What I'm arguing is that they don't need to be and that it's a bit of a chance event that which political parties have come to hold which stances and why they even had political stances. So I think this has harmed us. It is

contributed to confusion. I think also the media environment and reluctance to be vaccinated, I also think the media environment that we live in, which is again to our credit, you know, we have a free and open media environment. You know, we don't have a kind of the government tells us what's true and we do what the government says. I mean, I wouldn't want that either. But we have an environment, and over the last 20 years with the onset of the internet, we've invented a set of tools which have enriched our lives and created great wealth, but have also harmed us, you know, contributed to epidemics of teenage suicide and epidemics of depression and made, you know, made people feel bad about themselves and, and, and, and, and, you know,

made people divide up into echo chambers, you know, it's become possible for every person to surround themselves only with like-minded individuals because these tools make it so easy, these internet tools, these online media, and so on. And so I think that has contributed to a kind of polar, an information polarization, which means that many people have plainly false ideas about the vaccine. You know, there are millions of people who believe that the vaccine has some kind of microchip in it, which is a preposterous belief. And yet they hold this belief. and as a result feel like, you know, the government will track them or something and they don't get vaccinated as a result. Or other people who wrongly believe that the vaccine, you know,

hasn't been adequately tested, for example. Now, there are, I need to be clear, there are concerns that people might express about vaccination that warrant a serious response. You know, someone might say, boy, these vaccines were developed very fast. I'm worried about the speed at which the vaccines were developed. Or they might have concerns, you know, this is a new technology, you know, this of RNA-M-R-N-A technology hasn't been used for vaccines before. I'm a little worried about that. You know, those are concerns that then you can address head-on, but some of these other concerns, you know, are just nuts and false.

And unfortunately, the media environment has made it possible. So these are some of the reasons, I will, that we have suffered and not have people as vaccinated as rapidly as we need, especially given the fact that the vaccine is so effective and free and widely available. It's some of it feels like expectation management too. You know, now just the existence of a booster shot is actually being used by anti-vaxxers as a sign that the vaccine doesn't work. And to me, you know, it's just a question of, is this vaccine going to increase or decrease the likelihood with which you contract COVID-19 and it becomes a big deal in your life or not? And so it's a pretty simple equation from that standpoint.

What do you make of booster shots and sort of the future of the COVID-19 vaccine? So, yeah, let's talk about boosters because there's a lot of this confusion about this. And let me just say a few things about that. So first, people should realize that there are booster shots for other sorts of vaccines, like tetanus vaccines. Most listeners and most people know that every five or 10 years, you need a tetanus booster. Or if you had chicken pox as a child, you might need a zoster vaccine. as a grown-up, you know, even though you had chickenpox as a child, or influenza,

flu shots. You know, you get a flu shot every year or something. This notion that you need a booster is not alien and not a novel concept with respect to vaccines. Now, let's talk about what we mean when we say a booster. So first of all, there are two kinds of boosters for coronavirus. The first kind is you get another shot, let's say, of the vaccines you already got, or another existing vaccine for the existing. strains. So let's say you had a couple of Pfizer shots and now it's six or 12 months later

and you get a third version of the same shot or the shot from another previously invented vaccine. There is some reason to believe if you're older than 65 or if you're immunocompromised that you might derive some personal benefit from this. Now let me explain a little bit about what's happened when you've been vaccinated. When you were vaccinated, initially your body mounted an antibody response and your blood levels of those antibodies went through the roof and are circulating in your blood. And so if you get exposed to the virus, you quickly wipe out the virus. But your body doesn't produce antibodies to every pathogen or vaccine that it's ever encountered forever. That would be wasteful. In other words, if you're naturally infected with a

pathogen, you start producing antibodies against that pathogen. And after you wipe out that pathogen, then you don't produce those antibodies at that high level for the rest of your life. Instead, you have something known as memory immunity, where you have an archive of T cells in your body, which stand ready to initiate a cascade of antibody production if you ever encounter that pathogen again. So if I'm a doctor and I'm measuring your antibody levels, initially when you are exposed to the pathogen naturally or you're vaccinated, your antibody levels are very high, over six or 12 months they come down to undetectable, that's totally normal and to be expected.

But if you were exposed to the virus or the pathogen again, you would quickly ramp up again. It would take a couple of days. You would produce the antibodies and do other things to immunologically and wipe out the infection. So the fact that people's antibody levels are declining was normal and expected and is not the reason we are giving people boosters. The reason we give people boosters is, first, because it might further stimulate the immune response and really equip you with an even stronger level of immunity, first point. Second point, in certain cases, having high circulating antibody levels would be useful to you. Because for example, like right now, I've been vaccinated, my antibody levels are close to zero months and months later. If I'm infected

with a virus, it might take a couple of days for me to mount an antibody response and fight it off. but if I've been recently vaccinated, I might not even need those couple of days. I might wipe it out more quickly. And for certain people, that extra little time might be helpful and advantageous. So that might be a reason for those people to get a booster. From a population point of view, why might the government encourage people to get boosters? Oh, and incidentally, we don't have a lot of evidence that for people our age, getting a third booster is useful. Right.

However, if you are going to get a booster, there's some evidence that getting a booster of a dissimilar vaccine might be better because you're exposed to a slightly different variant of the vaccine or virus and broadens your scope so that you don't need to stick with the original vaccine you got. Now, from a government point of view, it might make sense to recommend that everyone gets boosters because by having a very high antibody level so that even if I'm exposed, I don't get infected, I might wipe out the virus as soon as I'm infected and not even have the opportunity to spread it to anyone. So you might reduce the infectious period, the period of time in which I might spread the virus to others. So even though I might not derive any personal benefit from being vaccinated, from a population point of view, it might be very helpful to have people be vaccinated so that you reduce transmission in the society. All everything we just said, applies to the use of booster shots of existing vaccines for existing variants.

A whole other topic is how the pharmaceutical companies are going to start manufacturing new types of vaccines against new variants. In other words, that we will need to get boosters for the delta variance specifically, for example. And that's very likely to happen, that in the coming years, as coronavirus settles in and circulates among us forever, becoming what is known as endemic, most of us will need to get booster shots for new variants. You know, you hit an important theme there, which is this idea of getting vaccinated less so because you're concerned about whether you'll die if you get COVID-19,

but more so because it helps prevent the spread of COVID-19 to people who could in fact die from it. Yes. And I don't feel like that as a messaging strategy for the government or for other folks has been well pushed. You know, this idea that you're effectively improving society and doing a selfless thing. Yes. By getting vaccinated. Because I hear from healthy people. I mean, I talk to professional athletes all the time. And it's actually amazing the number of professional athletes that are refusing to get vaccinated. And the argument often given is, well, first of all, data shows that if I just get COVID-19 and build up antibodies from it, I'll actually be better suited than if I just get the vaccine. It's wrong on two accounts, but I can see that

people say that. Well, first of all, this is the debate about whether having a natural immunity is superior to having vaccine-induced immunity. Yeah, so let's hit that topic. Generally speaking, that's true that if you are exposed to a pathogen and survive, then your natural immunity is probably stronger than a vaccine-induced immunity. And the reason for that is, for example, if I'm exposed to natural coronavirus, my body might mount an antibody response to many different proteins in the virus. So I'm attacking different parts of the virus.

Whereas if I get a vaccine, many of the vaccines just involve the spike protein. So my antibody response is just to a narrow part of the virus, just a spike protein. And so the theory, and this is true for many other diseases, is that natural immunity, because it's broader, is superior to vaccine-induced immunity. That's often true. But there are exceptions. There are diseases for which vaccine-induced immunity outperforms natural infection. Human papillomavirus is an example. Tetanus is an example.

Rabies is an example. You die from rabies. I mean, you don't survive natural rabies, so you have to be vaccinated. And it turns out coronavirus is such an example, where you get a superhuman immunity from the vaccine that outperforms the immunity conferred by natural infection. First reason that, as it turns out, And how long does that last? Well, because it can't be forever, right?

Because we've talked about the declining value. No, no, the antibodies may decline, but the immunity may last forever. We don't know. I mean, you get one polio shot, for example, or one smallpox shot. I'm of an age where I was vaccinated for smallpox as a child, and you would just get one shot. Although we do know, right, because certain people are still getting COVID after they've been vaccinated. Or after they've been naturally infected. That's right.

we know there have been reinfections after natural infection and breakthrough infections after vaccine. For example, out of 100 people who are vaccinated, let's say for the sake of argument, I'm making up the numbers, one, it's actually much, much lower than one, but let's just say one person might have a breakthrough infection, whereas out of 100 people who survived a natural infection, you know, maybe five might be able to be reinfected. So the vaccine still outperforms in terms of protection, natural infection, but no vaccine is absolutely perfect. You know, all vaccines can have breakthroughs. I mean, that's just the way the human body works and the way vaccines work. But the point is these vaccines are exceedingly good,

these particular vaccines. Again, much better than many others, as it turns out, than in many other vaccines. But the second thing that people don't understand is that in order to acquire this level of natural immunity that you and I are glibly discussing right now, you have to get it, obviously, yeah. Well, no, you don't have to get it, but you have to survive. Right. You have to run the risk of death. So it's like saying, okay, a hundred people, a hundred people who get the disease naturally, five of them die, 95 survive, and among those 95, they have, you know, four out of 95 of them might eventually get the disease again because they have some immunity, versus 100 people, and we vaccinate 100 of them, none of them die, and only two of them might

eventually get the disease again. So it's wrong on two accounts, this belief that natural immunity superior. First of all, it elides. It just sort of glosses over the death. You have to run the risk of death to acquire that infection. One out of 100 people will die who are infected. First point, and second, it's actually not better most studies for most vaccines indicate to have a natural infection in this case, for this virus, than to have been vaccinated. are you on vaccinations for kids? I don't know. We have, as you know, my wife and I have grown kids in their 20s, but we also now have an 11-year-old boy, and he'll be 12 in December, and we've gone back and forth, but I've now decided that as soon as he's eligible in January, we will

vaccinate him. So I think if they're 12 and older, you know, I've been persuaded by the data that it's the safe and intelligent thing to do to vaccinate the children. I'm a little bit worried about some of these new variants have a different age profile. So remember, in one of our first conversations months and months ago, we talked about how if you put age of the patient on the X axis and mortality risk on the Y axis, you get this kind of this long, flat part of the curve, and then it inflects up in middle age. So just to really hammer that point, it's much riskier if you're older. Like the deaths for kids for COVID-19 are practically non-existent.

Is that fair? Yes, extremely low. So, for example, if you're less than 20, you have like a one in 10,000 chance of dying or something if you get infected. And then if you're in your 50s, you might have a one in 100 chance. And if you're in your 70s, you might have a one in five chance. That was the original strain. And we talked about that, the mortality curve. The so-called backward L-shaped mortality curve with age.

But the shape of that curve may be changing for certain of the new variants. So children may be at slightly higher risk with some of the new variants. So this has got my attention. The evidence is still not 100% clear. So the reasons to vaccinate your children include it's a safe vaccine, why not do? And let's draw a distinction between 12 and older and 12 and younger. We'll come back to the 12 and younger at a moment. So 12 and older we're talking about now.

The reasons of vaccination is, well, it benefits them. We have evidence that the vaccine is effective and helpful for them. The new variants may affect younger kids more. So we might be a little worried about that. And we might want to vaccinate them to. reduce outbreaks at schools so that schools don't close so the kids can go to school because we care about schooling for kids and reduce the ability of children to be transmitters, you know, to their family and love their loved ones.

Well, I mean, it seems like that last point's kind of the biggest, isn't it? Right. Like, if it's highly unlikely that a child's going to die from COVID and kids get sick all the time, aren't we really doing it to, again, try to drive towards this no transmission society? Yes. Yes, and I think these are, these here now, there is a range of opinions and it's a more difficult conversation. And as I said in Apollo Zero, the ultimate end of this pandemic is that it is going to become endemic. And meaning the virus is going to circulate among us forever.

It's going to infect people. There's evidence looking at prior coronaviruses. There are seven coronaviruses that infect humans that we know of so far. Four cause the common cold. And the other three of which COVID-19 is one, or SARS-CoV-2 is one. is SARS-1, the 2003 global pandemic of a deadlyer coronavirus, which actually only in the end was contained for a number of reasons, having mostly to do with the virus, only infected about 8,000 people worldwide and killed about 800. And MERS, Middle Eastern Respiratory Syndrome,

which appeared in 2012 approximately, and is very deadly, kills about 30% of the people that it infects. Those are the three serious coronaviruses. But what's likely to happen with SARS-CoV-2 is that it's likely to be a disease, a virus now that circulates among us, you'll be exposed to it as a child, you'll have a mild illness, as we know is typical. You will therefore have acquired some immunity. And if you're re-exposed in the future as an adult, you will fight off the infection, maybe with just a mild, no symptoms or mild symptoms like chicken pox you know like and and if you're if you're not exposed to it as a child and if you're freshly exposed to it as an adult you will get seriously ill or could get

seriously ill and that's if you think about it many of your listeners will know that is the typical story with chicken pox so people know that if you have chicken pox as a child you have pretty much lifelong immunity and if you're ever exposed later on it doesn't really matter you fight it off if you haven't had chicken pox and you get chicken pox as a child it sucks but you don't die. If you've never been supposed to chicken pox and you get chicken pox as an adult, you run like a 1 in 500 chance of death that you can die from chicken pox pneumonia. So people know it's bad to get chicken pox as an adult having never had it before. That I think is what coronavirus is going to be like in the end. It'll be a disease that you get exposed to unless we have

childhood vaccination for it. You'll get exposed as a child. You'll probably be fine. and then if you get re-exposed later on, you'll also probably be fine. And 12 over versus under? Why is that the cutoff? It's an arbitrary cutoff. I mean, the median age of menarche and girls is like 10 and a half or 11 now. I mean, 50% of 6th grade girls in our society have had their first period. Boys, I think the median age of puberty is now like 12ish. I mean, you're transitioning to adulthood physiologically, size-wise. I mean, these, these are arbitrary cutoffs. Younger kids, younger than 12, I think there is going to be,

there are going to be trials, there is evidence that the vaccine will be helpful. I think it'll be, you know, I think that's a bit more of a judgment call for parents. Now, some parents, you know, are anxious about their kids getting coronavirus. It's not like if you get it, you can't die. I mean, there are a few cases, more than a few of kids dying of COVID. You know, it's rare, but it's not zero. And there you hear people say, well, giving an untested or new vaccine with a new vaccine technology to small children who have a longer life to lay ahead of them, you know, I feel differently about that, people will say, than giving it to a 50-year-old. And, you know, I can see that. And I can see that you might

want to, you know, wait another couple of years before you decide what to do in that case. What do you think of masks in schools and what do you think masks in general now in this post-vaccine world? It's indisputable that masks are helpful during a respiratory pandemic. It's also, for reasons I'll explain in just a moment, wise to include masks in our armamentarium, even if there are vaccines present. But the issue of masks in school, especially elementary school, is complicated for a host of other reasons. Let me back up to the second part.

The middle part I want to want to say is something that I and others have called the Swiss cheese model of pandemic response. So you need to think about us fighting the virus as having layers of defense. School closure is one layer of defense. Quarantine is another layer of defense. Testing is another layer of defense. Border closure is a layer of defense. Gathering bans is a layer of defense.

Public hygiene procedures or handwashing is a layer of defense. Each of these is a layer of defense. And you can think of these layers as being very good but not perfect. They have little holes in them like a piece of Swiss cheese. So let's say you have, you know, testing protocols. testing protocols are good, but not perfect. Test can be false. Not everyone gets tested. And so there's some little holes in this barrier. And if the virus hits the piece of Swiss cheese and hits a solid part, it bounces back. But if it hits a hole, it gets through this layer

and into the next, it keeps going. So what you need to think about is that, like in the military, we don't just have one, you know, a battalion of anti-aircraft guns, you know, offshore for incoming planes, we have them every 50 miles coming inland. You know, defense and depth. You know, we have multiple layers of defense so that, you know, if someone's attacking us and we get through the first layer, well, we got the second layer of defense. Or like, you know, a moat and walls. You don't just have a moat around the castle. You also have walls, right? So if they get through the moat, well, then there's the wall that keeps them out. Just defense and depth. So the same thing you can think about for the virus, you need multiple layers. And you should have the intuition that

if you take each slice of Swiss cheese has a random number of holes and size of holes, and they're randomly positioned on the layer. If you have two or three layers of Swiss cheese, by the time you get to the third layer, the holes won't line up. So a virus trying to get through a stack of three pieces of Swiss cheese is not going to be able to see through the stack and get all the way to the other side. And that's what you need to think about in terms of vaccines and masks. Vaccines are excellent layer of Swiss cheese, the very few holes and very small holes.

But there are some holes. It's not perfect. So you might need to add masking. For example, if you're an employer, you might say, okay, we need all our workers to be vaccinated. That's excellent. You know, but we're also going to have gathering bans. We're not going to allow people to beat more than 10 people at a time in a room. Or we're going to also encourage outdoor meetings.

Or we're going to stagger work life. So we're going to have half the people in on any given day. We're going to thin out the workplace. Or we're going to require masks at the workplace unless you're by yourself or with one other person or something. You want an extra layer of defense, even with the excellent layer of vaccines. And so in your answer to your question about masking, I would say it might be sensible to require masking in addition to vaccination for the reasons I just explained. Now, in schools, the problem is that masking for very young children is very difficult and comes with costs. little children are learning to read each other's emotions and faces.

I think we've seen a lot. I've seen some evidence to suggest we've seen more fights on playgrounds among little kids. And I honestly think part of it is they can't see each other's face. You know, they can't read each other's emotions. Or little kids learning language or learning reading from their teacher. You need to see the teacher's face to see as he or she's smiling or how are they forming the words that you're trying to learn.

So there are costs, even if there's some benefit from masking, you know, preschool or kindergarten, there are also social and educational costs associated with masking. And so here I think the cost-benefit analysis becomes quite tricky indeed because you're trying to trade off the costs, the benefits of reducing infection against the costs that might be educational. And we do cost-effectiveness analyses all the time like this. You know, we might say, for example, well, a three-point seatbelt is superior, but it's more inconvenient. So what are we going to decide what to do? We're going to trade those off against and then they're going to come to some assessment using cost-benefit analysis. So in answer to your

question, I'm ambivalent about the need for masking very in elementary school. In high school, I think kids should be masked, even if they're vaccinated. But in elementary school, I'm ambivalent. And I don't know what to think yet. I'd like to have more data. Yeah, it does seem By the way, teachers should all be vaccinated. You should have mandated vaccination for teachers. Like that, I think, is a no-brainer. It does seem very complicated at the youngest age. I mean, I don't have kids yet, but it's hard to imagine, you know, a five-year-old or an eight-year-old having a productive school environment where they can't see what other people are smiling or laughing or crying and the teachers.

It feels like a totally unproductive learning environment. Well, I won't say it's totally unproductive, but I would say that it's definitely a reduced, you know, I mean, there is a cost there. You're absolutely right. But I mean, it's hard to pay attention as it is, you know, at that age. So the idea that you're then masks, it just seems so distracting. Yes. And also, at least in our society, getting kids to wear their masks properly is also not easy. You know, you might literally spend the whole school day trying to keep the kids, you know, in, you know, observing their respiratory precautions.

So yes, that's what I'm saying. It's there, I think it's a harder call. What you have to understand is there is no life without risk during, during the time. time of plague. You know, when a deadly germ is circulating in a society, we all have to tolerate more risk. So all of these conversations come down to, in the end, how much risk are you willing to tolerate? So if you tell me, Nicholas, I'm willing to tolerate the risk of a high school student dying. I recognize it's one in 10,000 or one in 100,000, some low risk, so that they don't have to wear masks. Or if you're willing to say to me, Nicholas, I'm willing to tolerate that we might have to

close the school for a week in the middle of the semester so that the students don't have to wear masks, then at least you're speaking rationally. We can debate that. And I might say, okay, if you're willing to take it, okay, I'm with you. But you can't tell me, I don't want them to wear masks and I don't believe there's any cost to that. That's false. I mean, that's not actually dealing with the reality of the predicament we're in. We have to decide as a nation or as a locality, let alone as individuals, what risk are we willing to tolerate? For example, some people listening to this podcast will say, you know, the mask, I, Nicholas find wearing a mask so irritating that because I've been vaccinated, I'm just not going to wear it anymore. And I know that I'm running a little risk of dying from doing that. Some small risk, but I'm willing to run that risk of dying so that I don't have to wear a mask. Other people will come to a different conclusion. They'll say, I, Nicholas, am vaccinated. And the risk is small of dying, but it seems so stupid to die of an infection. We're just wearing a mask might keep me alive. So I'm going to choose to wear the mask. each individual is going to have to make that decision for themselves.

It's like speeding, right? Those of us who sometimes exceed the speed limit, you know, on some level, we know that driving faster is a little bit of a risk, but we say, you know, I'm willing to risk my life and drive 70 instead of 65, and I know it increases my risk of death on this journey from one in a million to 1.5 in a million, but I'm willing to run that increased risk of death on this journey because I have to get to where I'm going fast or because I like driving fast or because I'm bored driving slower, whatever that hell your benefit is, but you choose that extra risk. It's naive to imagine that you can drive 80 miles an hour and not run it.

Or you're also willing to run the risk of having a cop pull you over. I mean, all these risks you have to choose to run if you're going to speed. And it's the same with, you know, COVID response. I mean, by that logic, though, just choosing to leave the home and get in a car, you've now entered into some risk assessment of, you know, whether you're going to live or not. Yeah, it's like Gandalf and Hobbit or Lord of the Rings, you know, leaving your house is a very dangerous thing. Yeah, right. So, you know, one thing that you write about in your amazing book, Apollo's Arrow, the profound and enduring impact of coronavirus on the way we live, is that

denial is central to pandemics. It always has been. And we were talking a little bit. about before we got on, just the sort of unique circumstances that may have amplified denial in our current society. Speak to what you're noticing about that. Well, first of all, you're right to highlight the fact that denial is an ancient handmaiden to plague. It's always been inconvenient for citizens and for leaders to accept that their city is being attacked by a plague. And we have accounts of this going back thousands of years, where contemporaneous observers noted the fact that people like superstition and lies were rife. And the leaders denied what was happening. The people denied what was happening. And of course, it's understandable because

nobody wants to, you know, admit unpleasant truths. I mean, nobody wants to admit that their world is changing because there's a deadly pathogen that's circulating. Incidentally, coronavirus, bad as it is, It's not that bad, actually. You know, if you look at smallpox or cholera, or buponic plague, or Ebola, or the original influenza from 1918, all of those killed many more people. Like in the movie Contagion, which is a good movie. The virus kills about one out of three people it infects.

Imagine if we had the same coronavirus. The lethality of the coronavirus, by the way, is an intrinsic property of the virus. It's not something that we determine. It's just the way the virus is. It's this deadly or that deadly. Imagine if everything else were the same about what we're experiencing, but this virus killed 10% or 25% of the people that infected, that could have happened. In fact, this is why pandemics have been seen as a national security threat, rightly so, in Republican and Democratic administrations for decades.

We are a rich nation, a powerful nation. We can be brought low by a pathogen much more easily than we could be brought low by a foreign adversary. So we rightly see epidemic disease as a national security threat and have been prepared. preparing for it. We didn't do as well as we should have, in my view, with coronavirus, but it's another topic. But imagine it. Yeah, imagine if this virus is just killing one out of four Americans. I mean, it would be an unbelievable event. It could have happened. And it could still happen in the future, by the way. There's no reason. Although ironically, it would have spread less. Well, right. I talk about that. That's a big theme of your book. Yeah. Well, if it was

more deadly, yes, but we would take it more seriously. It's complicated. And whether it's spread less is also a little bit more complicated. I don't mean to take you up topic. But I don't think we can just sort of barrier. There you are. You're engaging denial. You're trying to imagine that if it were dead. It wouldn't be so bad if it were deadly or Nicholas because it wouldn't spread as much. I mean, yes, I know what you mean because I made that argument. No, I'm not saying it wouldn't be as bad. It would be worse. I'm just saying that in your book, you talk about how if a virus is extremely deadly, it actually lowers the virus's ability to spread. And in fact, over time, viruses tend to become slightly less deadly because they want to spread. Yes, that's right.

From the virus's point of view, killing us fast, or killing us, let alone killing us fast, is not advantageous. It would rather have us be infectious for longer from a Darwinian point of view. Anyway, so the virus, so denial is a common feature of plagues. It has afflicted us now, despite the sophistication of our society and of our information, you know, that American citizens, and principle of access to terrific information from amazing scientists across, you know, immunologists and vaccinologists and epidemiologists and doctors and economists and sociologists and all of these people, medical historians. I mean, we have all this expertise in our society and anybody can get access to this expertise. And yet we didn't. We engaged in denial. Why?

Well, I think the virus struck us at a particular moment of vulnerability in our society where we already, even before the virus struck us, had problems. We had a kind of thinned out intellectual life in our society. And the number of factors were driving that. First of all, we had the political polarization we discussed earlier. So we were at very high levels of political polarization in our society. And challenges, instead of getting seen as challenges we face as a nation, as a people, are framed instead as political battles.

Right? Instead of saying, you know, how should we deal with problem X? It's climate change or it's the Afghanistan war or it's the coronavirus. Instead of us working together to confront the challenge, we start saying, oh, well, the Republicans are to blame, the Democrats are to blame, which is just done because the problem is outside us. It's not, you know, it's like that scene in Apollo 13 where the astronauts start to argue with each other and the character played by Tom Hanks says, we're just not going to do this now because we'll argue for the next few hours and then we'll still be in this metal can heading to the moon and it's not going to help us to argue. So let's focus on the problem. So the political polarization pre-existed the virus, but it made our response to the virus worse.

First point. Second, we had very high levels of economic inequality in our society. So we don't, again, another thing tearing at our union, you know, the very, that we have like hundred year highs of economic inequality, which leads to greater stratification, greater suspicion, less ability to work together. We had, furthermore, a kind of odd kind of distrust of expertise. We've come to see experts as elites and somehow to be, you know,

we should be suspicious of experts. But this is also foolish. I mean, the whole way our economy is organized is to trade expertise. When I have a problem with my car, I go to someone who's expert in fixing cars. And I'm grateful that person exists and I defer to them, right?

Right? I don't know anything about fixing my car. If I have a problem with any surgery, I'm lucky that surgeons exist. They spend decades acquiring this expertise. And it would be ridiculous for me to say, I know just as much as my surgeon about my problem. Now, I'm not saying experts are infallible, but there's a kind of ascendant, deep suspicion of expertise in our society right now preceding the virus, partly because people began to think that experts had it in for us. Like they were, they were self-serving you know like it's like if you believe that every car mechanic will lie to you and tell you do things are wrong with your car which are not wrong with your car and you're like now you're going to second guess the car mechanic all the time third problem we had in our society and the fourth problem we had is related to that is a kind of suspicion of science science has become very politicized on the right and on the left each political camp has different inconvenient truths they would rather ignore and um And so there's a kind of loss of belief that science, and I understand science can fail and I

understand it's a human activity and I understand the subjectivity in science. I get it. I'm not. But when done right, science is a self-correcting discipline that is an excellent way of approximating the truth about the world. And so we had all these problems, you see, when the virus struck us. And I think that paved the way for the virus to harm us more and paved the way for us to willingly deny what was clearly a serious threat to our society. The third point about a mistrust of experts, I mean, how have you felt that personally? Because you are an expert and you happen to be an expert now on a topic that everyone else thinks they're an expert on.

Well, I do have certain expertise. Yes. I mean, I would lie if I deny that. I mean, but I have, you know, I'm 59 and I've spent a lifetime being educated and Does it piss you off? Do you feel like, you know, no, I don't. I feel it's my duty. I mean, the life I've chosen for myself is as a scientist and as a teacher. So, and I'm lucky that universities exist in our society whose purpose is the preservation, production, and dissemination of knowledge. Yeah. That's my job. I'm not a military officer. I'm not an engineer. I don't build bridges. I'm not a judge. I'm not supposed to have a

set of skills that judges have to have of cultivating impartiality, you know, we all know what it means of a judicial demeanor, right? You carefully weigh the evidence, you withhold judgment, you check your emotions. This is what we want in judges. What do we want in soldiers? We want bravery and fearlessness. I've heard interviews of Marines and I listen to these young men and I'm like, my God, you know, how are they that way, you know? Yeah, or you, yeah, I'm not like that. You know, or poets, you know, you, you know, the people who are poets in our society, they're supposed to have other disposition skills. Anyway, what I'm supposed to do, what I'm supposed to do, my role is, is to preserve, produce, and disseminate knowledge, okay? So, so I don't get frustrated

when people question my expertise. I'm happy to go a few rounds with them, but at some point, if they're unwilling or uninterested, despite my patient efforts to share with them, whatever it is that I believe it's true and why I believe something is true, then I have to give up eventually. I'm not prepared to indoctrinate them to force people to see things the way I see it, but I do have some duty to try. That's my job in our society is to be an educator. And to acquire expertise that's worth transmitting.

So that's why, you know, I was, as you know, I'm in, well, I've had a lot of training. Let's just put it that way. And I've run a lab, you know, for a long time. And that's what I do. Businesses, I mean, for example, like when I look at people, like you are entrepreneurs, you know, you have a certain set of skills, which I don't have. And you play an important role in society, right? You're like building new industries and new technologies and you're taking risks in a certain way. I mean, these are, you know, that's what

you're doing. So each of us has it, you know, it may not be your job to be the expert person on epidemiology. That's my job, you know, and I'm happy to fulfill that job. So I don't get too frustrated. I get frustrated with people who, not just who can't think clearly, but who have no interest in learning to think clearly. You know, there's that wonderful cartoon that's circulating or that, I forgot what it's called, it's called like Breslow's Law or something, that the amount of effort required to refute bullshit is, you know, two orders of magnitude greater than to produce it. And there's a little cartoon where someone says, you know, I think the moon is made of cheese. And then the person responds, well, no, we know it's not made of cheese, because.

because we've done, we built telescopes that have looked at the moon and we've done spectrographic analysis of the moon. Plus, we invented rocketry and we put a person in the rockets and send them to the moon. And they confirmed that they couldn't eat the surface of the moon. And so it's not cheese. You know, so all this effort, you know, to refute the idea. And then the person goes, I don't know, I still think it's made of cheese. Well, you know, what can you do? What can you do with such a person, you know? You say, okay, well, good luck with that, believe, you know, that the moon is made of cheese. I got to ask you about the origin. of COVID-19. And I know you've done research on this. And I think one thing that has developed in the

last 10 or 11 months is at least some credence for the fact that this may have originated in a lab. Now, given the incredible importance of studying the origin of a virus, it does seem pretty important that we as a society know where this came from and use that as a method to make sure it doesn't happen again. Talk a little bit about the origin story and what you believe. Well, I think we know, scientists know, that so-called zoonoses, pathogens that afflict animals that then spread to humans are rising over the last. And, you know, even listeners will have heard of hauntavirus and St. Louis encephalitis and influenza infections every year, which come from ducks and pigs and coronavirus and SARS-1 for 2003. And it's,

Ebola outbreaks, which come from, or HIV was a zonosis. It started as an immunodeficiency virus in chimps and then spread to humans and so on. So there's a reason to believe that these are rising for a host of reasons, including population growth, migration patterns, climate change, and so on. So if I had to guess, I think it's more likely than not that COVID-19 was a zonosis, that it was a natural leap from a still-unyet-discovered intermediary from a back to some human in 2019, probably earlier, much earlier than the Chinese are willing to let on in China,

and that it then spread in a particular fashion. But I cannot exclude, nor do I exclude, the alternative possibility, which is that instead it was a virus harvested by Chinese scientists, taken to a laboratory, and then there was an accidental leak in the lab. do not think, and I think most experts do not believe that it was a genetically engineered bio-weapon, certainly not one that was deliberately released. But it's possible that even that

is theoretically possible, although it's very unlikely, but it's possible that this was a lab leak. And certainly the Chinese behavior, which has not been very transparent, raises suspicion and concerns about, you know, what actually happened. But I have to say that even, you know, imagine if it had leaked, even we, America, would have been challenged to let Chinese observers come to our bio-weapons labs and inspect them if we had screwed up in this way. But, you know, I think there could have been ways in which we could have handled it, and certainly duties of Chinese, I'm not excusing to Chinese behavior in the cover-up initially, not at all. And I discussed that in the book, but I'm just explaining that it's not easy to have this level of transparency. And most few are the nations that are able to do that. And we are, relatively speaking, a more transparent nation than many.

But anyway, so if I had to guess, I don't think we have enough evidence either way. And every week, new studies come out, new scientific studies come out that are on both sides of this. I try to tweet out evidence on both sides. Like, as I see things, I send them out. And I'm continuing to collect evidence myself to form an opinion. And we may, at some future date, know better what ultimately was the origin of this virus. and new discoveries may be made or new intelligence information may emerge or leaks from China or some other means we'll come to understand this better or we may never come to understand it.

We have in my laboratory been using some data that we published a paper very early on in partnership with some other scientists. We back in April of 2020, we published a paper looking at the movement of people using mobility data in China, using phone data in China, we published some data on predicting the course of the epidemic based on the movement of people. And subsequent to that, it became clear to me that we could use that same kind of data to reason backwards using known flows of people and known occurrences of the virus to reason backwards to when the virus first might have started.

And using such data, we were able to estimate that what we call patient zero prime, which is the first person to have left Wuhan and transmitted the disease to someone else, that that probably occurred sometime between October 20th and November 13th of 2019. And if you couple that with what is known about the epidemiology of the virus, that means that patient zero,

the first person to be infected with the virus, probably occurred as early as October 2nd of 2019. And these analyses in my laboratory actually amazingly triangulate with very different analyses done by geneticists that look at the mutation rate of the virus and tree backward to when the first case might have been. So more and more science from disparate disciplines is emerging that's pushing further and further back in time when the first case would have occurred. It doesn't tell us, it doesn't adjudicate between the zoonotic leap and the lab leak hypothesis,

but we at least can begin to bound the time when this event may have occurred. Well, that seems like, you know, breaking news in a way that you guys have identified that. So I'd encourage people to check that out on your website. Well, actually, those analyses are in the afterward to the paperback version of Apollo's Arrow. Okay, terrific. So people should check out the new Apollo's Arrow. Okay. In your last message to listeners, what do we need to do to pull us through?

What are sort of the Nicholas Christakis, three key things that will get us over to the other side and begin the beginning of the end, if you will? Well, we need to, if we want to minimize death, we need to vaccinate as many people as possible, and the higher the vaccination rate in our society, the better. We need to hope the thing that keeps me up at night is the potential emergence of new strains of the virus that evade the vaccine, which we have not yet seen in any material way.

If that were to happen, we might be back at square one, back at the beginning of a pathogen that evades the vaccine, and then we'd have to kind of hunker down again for six months while we wait for the pharmaceutical companies to invent wholly new vaccines, new kind of boosters, if you will, against these variants. So I think what we need to do is we need to remain mature to recognize that we are alive at a once-in-a-century event

that requires us the calls for us to sacrifice, the calls for us to be civilized and mature, we need to vaccinate, we need to be prepared, especially this coming winter, for the resumption of some of the so-called non-pharmaceutical interventions. But we will see the other side of it. We will move eventually to the next phase of the pandemic, which I call the intermediate phase, when we put the biological and epidemiological impact behind us, and then are coping with the psychological and economic aftershocks. And then ultimately, this will all be a distant memory. Like humans, for thousands of

years, we will have survived a plague. Well, you know, your message as as usual, Nicholas, is very on point and prescient. And so I really appreciate you spending time with us. Where can people find the new paperback? I don't know. It's where books are sold. Where books are sold, yeah. October 19th is the pub date of the paperback. Well, I'll make sure to get the update. And I think your coverage on COVID-19 has been very balanced and very, very important. So thank you, Nicholas. Thanks for coming on the podcast, and we'll talk to you soon. Thanks, Will. Thanks for having me.

Thanks to Nicholas, as always, for coming on the Wooop podcast. If you enjoyed this episode of the Whoop podcast, please leave us a review, a rating. Please subscribe, helps other people find the Whoop podcast, and keeps you updated. Check us out on social at Whoop, at Will Ahmed, and a reminder that you can get 15% off a Whoop membership by using the code Will. W-I-L. All right. That's it for now, folks. Stay healthy. Stay in the green.