WHOOP Podcast - World-renowned COVID-19 expert Dr. Nicholas Christakis discusses the second wave, the vaccine, and the post-pandemic world

Episode Date: December 2, 2020

World-renowned COVID-19 expert Dr. Nicholas Christakis returns to the WHOOP Podcast to share everything you need to know about the second wave, vaccines, and how long it will take until things return to normal. Nicholas has dedicated his life’s work to understanding public health, disease, and how pandemics shape our world. He is the author of the new book Apollo's Arrow: The Profound and Enduring Impact of Coronavirus on the Way We Live. Dr. Christakis discusses his sobering fatality forecast for the United States (3:45), how COVID-19 compares to other pathogens (6:14), the wide range of coronavirus outcomes (12:02), how deadly COVID-19 is (15:46), the March New York outbreak (23:24), testing issues and government missteps (26:44), economic impacts (32:16), misinformation during times of plague (36:05), how death impacts the economy (42:41), COVID fatigue (48:43), the herd immunity threshold (49:50), how close we are to the end (52:00), a post-pandemic world and a new Roaring 20’s (52:59), and the vaccine (56:48).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

What's up, folks? Welcome to the WIPP podcast. I'm your host, Will Lomit, the founder and CEO of Woop, where we are on a mission to unlock human performance. This is a big theme right now. COVID-19. Unfortunately, we're seeing a second wave, maybe a third wave, depending on how you look at it. And we've got world-renowned COVID-19 expert Dr. Nicholas Christakis. He returns to share everything you need to know about this new wave. the vaccines and how long it's going to take until things return to normal. Nicholas joined us in March, episode 66, to really predict a lot of what's played out with COVID-19. I mean, it's not surprising.

He's dedicated his life's work to understanding public health disease and how pandemic shape our world. So there's no surprise that he's been on top of this. But it's pretty amazing just to see how it's played out. And this conversation was really, really insightful. Nicholas also just wrote the book, Apollo's Arrow, the profound and enduring impact of coronavirus on the way we live. And I believe that's going to be one of the most important books written about COVID-19 and this crazy time that we live in. Nicholas and I discuss on this podcast, the state of the

pandemic as we endure a spike in cases across the country. Just how many people could die from this condition in the United States alone. He previewed 500,000 to a million people, unbelievable. How many people need to be immune for us to reach herd immunity? Reflecting on things that the government did well and didn't do well over the course of the year, the development of vaccines and why they're not an instant fix. And what a post-pandemic world could look like, which for those of you looking for some optimism, a post-pandemic world does sound really fun from what we've learned from previous pandemics. I think this is a must-listen to episode. Nicholas is one of the ultimate voices of truth on the coronavirus, on the planet, and we're honored to have them

back on the podcast. A reminder as well that you can get 15% off a WOOP membership if you use the code Will Ahmed, that's WI-L-L-H-M-E-D, and also a reminder that you can use respiratory rate tracking on the WOOP app to help understand if something is in your system that shouldn't be. Without further ado, here is Nicholas and the podcast. Nicholas, welcome back to the WOOP podcast. Will, thanks so much for having me back. You know, we had a phenomenal podcast together in March. You gave a bunch of fascinating insight onto COVID-19

and the coronavirus that we're all living with. And how do you feel like things have evolved? Big picture, just starting there, from March to today, what are a few of the things that you feel like are the most obvious surprises or the most obvious developments? Well, most things have. unfolded as sort of expert epidemiologists had forecast. You know, we have a second wave. It's become a pandemic. We've had a lot of economic hardship. People have died. Most of those things have

unfolded, I think, along the lines we had discussed. But there are a couple things that have surprised me. One, of course, is that there's been more death than I expected. I knew that this would be in the neighborhood of the second worst pandemic we've had in the last hundred years, the worst being 1918, and now it's blown by that. It's not going to be as bad as 1918, I don't think, but it's far worse than the previous second worst pandemic we had, which is the 1957 influenza, which I suspect we talked about. I don't remember. Yeah, we did.

Yeah. So it's definitely worse than that. You know, I think in the end, before this pandemic is over in a year or two or three at the most, you know, as this thing unfolds, as more people continue to get sick and some die, at least half a million Americans will die. And depending on what we do, as many as a million, excess deaths over the duration of this pandemic. So that's awful.

And, you know, that's a major calamity. And, of course, we may or may not talk about it, but, you know, many, roughly five times as many, it's unknown exactly still. That's a big unknown. And I don't think it's something we discussed the last time is how many will be disabled. And that's sort of unknown. And there's a difference between disability and long COVID, which we can talk about if you want. So the big two things I think that are different or sort of better, two important things that were sort of unexpected when we last spoke.

One is the sheer magnitude of the mortality. We had considered this magnitude, but now we know it's bad. And the second is the fact that in fact we have been able to develop vaccines so fast. we had talked about this. I'm not surprised we're able to develop vaccines and there are existing veterinary vaccines for coronaviruses and that afflict our domesticated animals. So it's not a shocker. But, you know, we now know that we can do it. And furthermore, it's been done astonishingly fast. I had, when I wrote the book, I thought we would get there in the, in 2021, probably early in 2021. And we're slightly ahead of that schedule. So those are two big astonishing differences. The sheer scale, the more

and our ability to invent an effective vaccine. Well, I devoured your book, Apollo's Arrow, the profound and enduring impact of coronavirus on the way we live. Congratulations, first of all. You wrote that in a very short period of time, and I think it's going to become one of the core books to understand what we're experiencing. Now, one of the things that I found really fascinating in the book,

and I kind of want to start this podcast by helping people really understand COVID-19 and SARS-2, is you talk about the difference between SARS-1 and SARS-2. And the interesting thing is that SARS-1 was actually 10 times deadlier than SARS-2. But when you actually work through understanding the severity and, so to speak, like the danger of SARS-2 to society, you conclude that SARS-2 in some ways is more dangerous, because of the way that it's able to be both highly contagious and still have a meaningful fatality rate. Explain some of those differences.

Well, there are a lot of subtleties there, but let's start with some basic ideas. And then don't let me forget to come back to the population A and population B. Yeah, I love that. If I forget to do that, I'll come back because it's an interesting idea. And the first time I learned it, I was like, wow, that's really interesting. And now when I tell people about it, they're like, oh, that's really interesting. Anyway, so I'll come back to that. But let me back up first. Diseases that are very deadly and kill their victims very fast often burn out and don't become big pandemics. For example, the Ebola pathogens that emerge periodically in Africa, one of the reasons they haven't become worldwide is that they kill half or 80% of the people that get those viruses and rapidly. So a disease that kills you too uniformly and too swiftly, it interferes with the capacity of the sick person. to transmit the disease to other people.

So in a way, a milder disease, a less lethal disease, affords a greater opportunity for the pathogen to be transmitted. If I am felled quickly by the disease and take to my bed, I don't interact with too many people. Whereas if I am walking around and, you know, sort of okay, then I can transmit the disease to more people. So there's one basic principle there. And that's one of the differences between SARS-1 and SARS-2,

which is the SARS-1 in 2003, was perhaps 10 times as deadly, and it killed people faster, and ironically, the lower lethality of SARS-2 that we're facing right now makes it a more potent threat globally. More people will die globally, in part because on a per-case basis, it's less lethal. But that's only one of the reasons. Another very basic reason that SARS-2 is so dangerous and so difficult for us to cope with is that it has this property of asymptomatic transmission. So if you think about a disease like smallpox, you can't transmit smallpox. You can't transmit smallpox really until you have symptoms of it. So you get these big pustules on your body.

But then people know you, you know you have it and people know you have it so they can stay away from you. Contrast that, for example, with HIV where you could have the disease for years without knowing it and transmit it to other people. And consider now the two SARS cases that we've been discussing. SARS-2, the one we're facing now, is more like HIV. You can transmit the disease before you have symptoms from it. In fact, some estimates are that 75% of the cases acquire in a typical population are acquired from other people who are asymptomatic. So we can't use symptoms to identify and isolate people who are at risk of transmitting the disease. And it's tricky because the latent period, right, is shorter than the incubation period.

Exactly. That's what we're saying. The latent period is the time between becoming infected and being able to transmit it. And the incubation period is the time interval between becoming infected and having symptoms. And those two are different. And in the case of SARS 2, the latent period is shorter. So you start being able to transmit the disease many times, many people do, before they have symptoms of it. Conversely, SARS-1, those two periods aligned more. So people didn't really become infectious until they got symptoms. And as a result, they were more easy to detect and to isolate. That's another thing. Like in very simple terms, right? Okay, I'm not feeling well. I'm going to stay home, right? Okay, well, that's going to help stop the spread if late, you know,

if those two periods, the latent period and the incubation period are the same, right? If the latent period shorter, then you don't realize you're sick and you're spreading it. Yes, and isn't that one of the incredible sort of anecdotal stories about, whoop, I don't mean to plug the product, but just made the news, right? Like a few months at some golfer or something wasn't aware, but the device detected some changes. Isn't that right? Something like that? Well, that was a great plug, but yes, whoo measures respiratory rate and an elevated respiratory

rate we've been able to show can be predictive of that, of that latent period where you may not even have symptoms yet, but having an elevated respiratory rate in turn. Yeah, but there was some, I can't remember the anecdote. I didn't mean to, we don't have to. Well, so, no, we'll hit it. So Nick Watney, a professional golfer. Yeah. And he, he had whoop for 10 months, His respiratory rate was 14 every day, respiratory rate breaths per minute. And one morning he woke up and it was in 18 and he was about to go play in a professional golf tournament on the PGA tour. And he went to the doctors and said, you know, I've got this elevated respiratory rate

on whoop. I think I need to be tested. And he got tested and sure enough, he was positive for COVID-19. Did he have any other symptoms? Do you know the story? He was asymptomatic for two weeks. But the crazy thing is if you looked at his whoop data, you could tell. something was completely wrong.

Because not only was his respiratory rate off the charts, he had this suppressed heart rate variability, had a really high resting heart rate, he had disruptions in his sleep. So it goes back to, you know, the whole phenomenon of whoop, which is that feelings are overrated and there are things that you can actually measure about your body. And honestly, almost every day I'm getting a message from a WOOP member showing me an elevated respiratory rate that helped them detect that they had COVID-19 or at least take some precautions. So we're happy to help. I wasn't deliberately going there, but I mean, I did story, you know, and since we're talking about, you know, asymptomatic. But there's another thing,

and this is the set of ideas that's really interesting, the population A, population B situation. So this disease, and Tony Fauci has been talking about this too, has very protean manifestations. One of the things that makes this disease so dangerous is that it can give you everything from being asymptomatic, maybe half the people who get infected with this pathogen, never have symptoms, to mild symptoms, to serious symptoms, to disability to death. And it covers this whole broad range that it can do. And so partly this creates a problem where a messaging problem, because it's sort of difficult to get people concerned about the disease. If many people think, oh, you know, my friends got the disease and nothing happened to them. And in fact, if that's what

most of the time happens, the rarer occasions where someone gets it and gets seriously ill or dies are drowned out by the existence of these other more asymptomatic cases. But the model that I'd like the listeners to think about for a moment or viewers, that is interesting and that when I was first taught this, it really had an impact on me, is consider the following two germs, okay? So in one society, in one population, population A, you have a thousand people, ten of them, get seriously ill from the germ and one of them dies. So one out of 10 sick people died, that's 10 percent fatality. That sounds pretty bad. In population B, you have 1,000 people, a hundred of them

get sick, but 90 get mild illness and recover completely. Nine get against serious illness, and one get serious illness and also dies. So in population B, one out of 100 people who got sick died, so 1%. superficially, you might say the pathogen in population A is a worse pathogen, 10% of the people who got the disease died, whereas in the second population, population B, only 1% died. But if you stop and think about it, there is no scenario under which if you were a person and you could choose which population to be in, you would prefer to be in population B, which ostensibly had the lower fatality. Because in that world, in both worlds, one person died.

In both worlds, nine people got seriously ill. but in world B, in addition, another 90 got mildly ill. So it's clearly worse overall to be in that world. And ironically, that's what's happening to us right now. SARS 2 is more like that. You see, it's potentially just as fatal as SARS 1, but it also infects additional people that it doesn't make quite so sick. And it muddies the waters for us in terms of our public health messaging

and in terms of how we experience the illness, deluding us into thinking this isn't such a serious pathogen. In fact, I would argue that if the same number of people were dying of SARS-2, but no one was getting it and having a mild illness and recovering, our nation would be doing a better job of fighting it. We'd be taking it more seriously. Yeah, it does seem like there's a number of things that from a communication standpoint, we could have done way, way better going back to March.

And we'll get to that in half a second. I want you to explain what we know today about the case fatality rate and the IFR and the phenomenon of those two statistics. I mean, there are a number of basic epidemiological properties of a pathogen, but the two most basic are how contagious is it, how easily does it transmit from person to person, which is captured by the R not, the R sub-zero, which we can talk about if you want, and how deadly is it? And the deadliness can be characterized in a number of ways. The most basic is something known as the infection fatality rate, the IFR, which is, of all the people who get infected, how many die? It's a very simple calculation. If you infect 100 people, does one person die, do 10 people die, do 50 people die?

What's the percent of people that you infect that die? We now know, nine months into this, that the IFR of this pathogen, using multiple studies and combining them using something called meta-analysis, which combines all the estimates from multiple studies, and there was a recent meta-analysis that was just released a couple of months ago, that the infection fatality rate of this pathogen is between 0.5 and 0.8%. That means 0.5 to 0.8% of the people who get the disease will die. And there was another recent paper that just came out that actually put that number a little bit higher at around 1%. But remember, about half the people have no symptoms. So there's another thing called the case fatality rate, which is the

fraction of people who come to medical attention who die, or, alternatively, the fraction of people who develop symptoms who die. Now, this is a little bit, I don't like to use this measure quite as much because it can depend on the kind of health care system you have. If you have a, or testing, you know, if you have a lot of testing, for example, and people can discern that they have the condition if they have certain symptoms, for example. But about half the people, as we said earlier, don't get symptoms. So you can double the numbers I just gave you for the IFR. So if the IFR is 0.5 to 0.8%, the case fatality rate is between 1 and 1.6%.

Let's say about 1% of the people who get symptomatic COVID will die. Finally, this varies, as everyone knows now, by age. So as a parent, I'm very relieved that I don't have to worry so much if my children get sick. But if you're in your 20s and you get this condition, you have a maybe 1 in 3,000 to 1 in 5,000 probability of death. If you're in your 50s or 60s, it's about 1 in 100 to maybe 2 in 100. And if you're in your late 70s or 80s, it's about 1 in 5, about 20 to 25 percent of the people who get symptomatic COVID will die. In fact, when President Trump got the disease and when he was put on dexamethosone, those indicators, He had a rather substantial risk of dying and did not, actually, which was amazing.

Anyway, so this is the probability of death with age. This is the famous backward L-shaped curve, you know, the way in which age affects the probability of death. But before I stop on that topic, let me just say one more thing. So on the one hand, it's great news that if a young person gets a disease, they face a low risk of death. And many young people hearing this might think, oh, that's great. And it is great. As a parent, it's great. As a young person, it's great. But actually, you have to stop and think for a moment because young people have a low probability of death from any cause. Getting COVID substantially increases your baseline risk of death. It's affirmatively foolish to seek out the disease or to not care about getting it. It's a needless risk of death. You don't have to take it. You have a low risk of dying in the next year. There's absolutely no reason to add on to that another low risk of dying that you could avoid completely.

especially since within a year or so, you might get access to a vaccine, which would be protective. So, and finally, young people can also transmit the disease. So even if you don't care about your own life, it's socially irresponsible of you to say, oh, well, I'll just, who cares if I get sick? But you could get sick and harm others. So for all these reasons, I would encourage people who hear this not to take this disease lightly. It's a serious infectious disease, and it kills a goodly number of people. It's not the flu.

it's 10 times deadlier than the flu well the the two things which we just touched on and i'm glad we laid this foundation that i feel like if we could go back in time in march and just really communicate um they would have really meaningfully improved the way uh everyone performed and a lot of policy decisions and it screen it comes out very clear in your book tell me if you think these are two fair things that we should have gotten communicated better the first is this phenomenon of the fact that asymptomatic, you can spread it, right? For whatever reason, I don't feel like that really was broadcast appropriately and loud enough and early enough. There was this idea, if you can get it and you don't have symptoms, that's a sign, in fact, that this isn't that big a deal.

Right? Whereas actually, the secret was, well, that person's now spreading it to a bunch of people who might have a really bad result. And the second thing is this idea of, people who are at super high risk versus people who are at super low risk of dying. Because, of course, you don't want everyone to get it, but if people are going to get it, you want it to be the people who are lower risk, right? And if you look at certain things that have happened in nursing homes, some of the policy decisions relating to nursing homes, pure insanity in hindsight, right, where you have people who are infected with COVID-19 going back into nursing homes, right? Like, that is insanity now knowing what we know. Do you think

that's the right takeaway, those two phenomenons? Well, I think those two are important to highlight. I don't think those are the only. Certainly not the only ones, but those two. I think those were sort of known, honestly, certainly by March, we had enough evidence from China and from Italy. I mean, the lack of preparedness of our country, it makes me ashamed, honestly, and disappointed in ourselves. We're a great nation, I think, and I don't mean that in a jingoistic sense. I mean, we, we are a very wealthy nation. We, we mostly have a functioning political system. We have tremendous scientists. We have the CDC. We have tremendous expertise. We have the capacity to invent vaccines in nine months. Amazing. Amazing. Amazing. The vaccine development's amazing. Everything's amazing. But we also have

epidemiologists. We have a public health system. We hadn't invested in as much as we should have. But nevertheless, we had a functioning public health system. And for various reasons, I think our political leadership interfered with the ability of the system to perform. But I think everyone also, many people, including the people on the street, sort of the man and woman on the street, I think weren't paying adequate attention. And so I started looking at this condition when we discussed it in March. I had already begun research on this topic in January. And because of my work, I was really focused on what was happening in China. And on January 24th in China, the Chinese passed rules that put 930 million people.

in home confinement. Like the Chinese thought that this disease was so bad, was so severe, the threat was so great that they, I think maybe I used this expression before with you, they basically detonated a social nuclear weapon. I mean, I love that expression, the social nuclear weapon, but it's so true. I mean, if there was ever anything that should have signaled, hey, this is a big deal. Yes, we should have been paying attention. And we now know that the president, I mean, if I was aware of this and my colleagues around

the country were aware of this in late January. I would certainly hope that the President of the United States was aware. And in fact, we now know the President was briefed by the NSA and by others earlier, you know, in December even, and knew what was coming. And even if we had ignored that, and we should have then started preparing, we should have prepared testing capacity, we should have prepared PPE, we should have prepared our health care system, we should have prepared the citizenry. We should have said, this thing is coming, it's going to be serious, it's going to call for sacrifice.

We're going to have to ban together as a nation to cope with this. this is a once-in-a-century event, et cetera, et cetera. We should have leveled with the American people. But certainly, even if we ignored that, then Italy was stricken, okay, in February. It's a rich European democracy. So what were we thinking? I mean, why did we think we wouldn't be afflicted, you see? And then we did nothing to speak of until March, when beginning in sort of middle to late March,

New York starts having a really bad epidemic, where one out of a thousand, New Yorkers died in two or three months. And in minority populations in New York, one, three out of, as many as three out of a thousand New Yorkers died. This is a huge toll of mortality. You may think, oh, one out of a thousand is not such a big deal. That's a lot of people to die in a couple of months. Totally.

Now, a lot of them also fell into those older populations that we talked about earlier, in part because of the mismanagement of nursing homes. Yes, of course, that's true. But it wasn't just the elderly. And furthermore, even that narrative, and I know you're not suggesting that, oh, it's just the elderly. I mean, these people are our grandparents, our parents, our neighbors, their fellow citizens. It's not like, yes, I am happy and relieved that the young are spared, you know, I think that's great. But that doesn't make me unmindful of the burden on the other end of the age spectrum, you know?

Oh, not at all. I wasn't implying that. What I was saying is that I feel like the approach to these different age groups could have been so different as well, right? like the way that we talked about this virus for a certain age of population versus a younger population could have been different. Let's talk about two organizations that I think screwed a lot up. The first is the World Health Organization, which as late as April, was saying that you don't need to wear a mask. I was wearing an N95 mask on planes in late January. And the fact that the Who was saying this in April, I thought it was pure insanity. Can you defend that?

No, and I have to say you're not the first person to ask me about this. In the book, you probably noticed I don't. And you mentioned it a little bit. A little bit, but I don't do a deep dive on, I didn't have time or interest to deeply excavate WHO's missteps. And there were quite a few on the masking. Early on, I think some of the criticisms about WHO, for whatever reason, not being swift on the uptake in China. Some people think it was for political reasons, whatever. I haven't done a deep dive to really study that. But yes, the WHO has occasionally released nonsense statements.

For example, there was another famous thing that I did pay attention to that they released a statement that the case fatality rate was 3.4 percent, which was absurdly high. And I'm like, how on earth, don't they have epidemiologists working at the WHO? Like, how is this possible that they would, they did a certain kind of naive calculation, which it's not worth going into. But I did look at that. And I was astonished by that. And the advice against masking, their statement early on that there wasn't interpersonal transmission. This was in January, but we already knew there was. interpersonal. By January 24th, it was widely known among experts that there was interpersonal transmission.

So here the issue was, at the very beginning of the outbreak, people were wondering, well, are the humans that are getting this condition simply getting it from contact with the same source, like bats? Or once it infects a human, can it spread from human to human? This is a very important thing to figure out. The Chinese did figure it out quickly. And this was known to experts in January. But the WHO still was slow on the uptake on this. So there were a number of missteps by the WHO, yes. And then the CDC managed to screw up the original test kits. Yes. And you wrote about this in the book. And then it took forever to rectify it. Yes. Really, Keystone cops kind of situation, honestly. And that story hasn't been fully told. I'm sure there'll be leaks of documents and

interviews, and I'm sure there'll be long-form journalism about this, or others will explore this. No doubt, there'll be many books written about the pandemic and this aspect of it, and the failure of the various federal agencies and political leaders, of course. No, the gist of what happened there is there were the capacity. So the Chinese released, I forgot the date, sometime in January, maybe the 21st of January, they released the sequence, the genetic sequence of the RNA of the virus. They made it publicly available. Incidentally, the Chinese scientists that did that, the Chinese Communist Party, didn't like this and closed her lab immediately, which was ridiculous. I mean, the woman was doing exactly what she should have done. She did a great

service to the scientific community and to the world. In fact, the Moderna scientists took that public sequence and immediately started developing an RNA vaccine like that day. And within 40 days or something, I may have these numbers wrong, already had targeted segments that were going to be the core of their vaccine. Amazing. Amazing. But that same sequence could also be used to develop tests. And in 2009, during the H1N1 influenza pandemic, the CDC was able to develop tests. Influenza is a different virus than coronavirus, but nevertheless similar kinds of issues, was able to develop tests and distribute millions of tests within a few weeks or something. I mean, they know what to do, they know how to do it,

they've done it before. But this time, oh, and this technology, this ability to be make these tests is widely available in every sort of elite hospital in the country. But the concern was that those people developing those tests, they didn't have FDA approval to do that and to use them in patients. And also there was some concern about inconsistency, you know, like one hospital might develop a slightly better test than another or for a different part of the genome, et cetera. So because of these reasons, initially the government said you can only use CDC tests. And the CDC wasn't able to produce enough of them first. and second, there were three components to the test. And because of some lab contamination,

one of the components was contaminated and didn't work properly. But the other two components did work. And labs around the country said, okay, you won't let us make our own tests. You insist we use the CDC test. We now know the CDC test isn't working. It's this one component. Can we use the other two components? And the government said, no, you can't do that. And sorry, what would be the explanation for saying no? Like, it seems indefinitely. defensible, but what would be the explanation? That the test wasn't being used as designed or something. I mean, or I don't remember exactly right now what the reason was.

But there was a lot of finger pointing that you need to get FDA approval to do this and the if you're going to modify the test, someone other agency needs to approve that the bureaucracy at the FDA was not, hadn't been galvanized by our political leadership to move heaven and earth to make things happen. So there are a lot of professionals. I mean, the expertise at the CDC and the FDA, I just have to emphasize is world class, okay? The scientists and the, and even the bureaucrats that work at these organizations are phenomenal.

And yet they were almost fighting with one hand behind their back. They were being restrained, I believe, by a lot of the political appointees and politicians from doing their jobs. And they may also have screwed up. There may have been some, you know, mistakes. And so then private labs said, well, we can do it. You know, so the private lab said, we can make the test. You know, American capitalism, let us solve the problem. And this was also not allowed because, you know, ordinarily for you to sell a commercial test, you need to have all kinds of other approvals.

And the politicians didn't step in and said, no, you know, you should be allowed to do that. So we lost precious weeks when we were flying blind because we didn't have the testing capacity, the amount of testing, the quality of testing, and the location of testing that we needed. Yeah, I would argue, though, it's a lot more than weeks. I mean, the fact that I'm not taking an at-home test every single morning is a travesty. I mean, imagine if every single person in the country is able to take an at-home test every morning. Yes, I think that's, we all should have these appliances at home. I mean, they'll be expensive, of course, and not every home can have them necessarily, and that's not a solution on a national scale, but certainly it should be available.

And incidentally, on this thing, testing is a public good. In other words, I'm glad to hear that you're testing every day. Even if I can't test myself, it's great that you're testing, because when you test, if you act responsibly, you reduce the risk of transmission of the virus. You're performing a public service by testing yourself. Totally. In my extended family, we've repeatedly on different occasions in the last nine months tried to get tests. And we've had every sort of problem. My wife was sick with a pretty bad respiratory illness in March. She could have had COVID. I'm not sure. She went to an elite teaching hospital and was told that she had too many symptoms. And therefore, they wouldn't assign one of the precious tests to her. We had so few tests.

Initially, we only tested people that came back from China, for example, which was also foolish. Another time, my daughter needed to get a test to go from one state to another state, but the time that it would take to get the test result back was 10 days. So she just might as well have quarantined for 14 days, which was the alternative rather than taking the test, plus the expense, $200, $300, $150. It should cost nothing. And by the way, the way that we've spent money as a government, we should have had the budget to have every citizen tested all the time. It would have been peanuts compared to our losses.

Larry Summers, a former Treasury Secretary and David Cutler, a professor of health economics at Harvard, former colleagues of mine, they published a paper two or three months ago now that said the SARS-CoV-2 was the $16 trillion virus. That's the damage to our economy. These are enormous sums. Eight trillion, eight trillion due to the economic damage and eight trillion due to the death, illness, and disability that the virus will cause. And so spending a few hundred billion dollars to on testing, for instance, and it wouldn't have been a few hundred billion, is peanuts compared to the loss that. I know. Yeah, you could have done it for that. No question. I mean, you call out these mistakes in your brilliant book, but it's so obvious. I mean, the FDA should have allowed hospital

to develop their own tests, and the Department of Health and Human Services should have helped make commercial tests available, right? Those two things could have dramatically increased testing. Yes, early on when it was especially helpful, yes. But we need it today still. I mean, that's the scary things. We need it today. Yes. Yes. Can you believe it? We're the United States of America, and we still can't test everyone as easily and it's inexpensively, as we should be, nine months in? Well, I do think that it was a perfect storm to happen in an election year as well because the whole thing got so politicized.

And in reading your book, you have a great chapter about misinformation. And I've even found myself, this is why I'm part of so excited to read your book and so excited to spend time with you, Nicholas, is like, I consider you a source of truth on this. But you see the CDC have these false steps. At WHO, the moment they said masks weren't real in April, I completely, no longer they became a source of truth. Other people can make their own decisions. But it made me realize along the way this year that I personally felt like I didn't know where to find the right information related to this virus. And so, you know, I would read research studies.

I would read the Internet. You know, you read various publications, the Times, others. But then you start to realize they have these different biases often going back to the election. And so it was just frustrating. And I wonder what that was like for you, naturally knowing the facts. It must have been so frustrating. It was frustrating.

I mean, but also honestly exciting because there was so much knowledge being produced by so many different kinds of scientists every day. I mean, I was spending an hour or two hours a day just reading the work of other scientists, virologists, epidemiologists, biochemists, social scientists from all over the world. you know, Chinese, Italian, British, Swedish scientists. I mean, it is still very exciting. I mean, the volume of information is just is enormous. Although, just to interrupt you for a second, you had access to the right information also, right?

You knew where to find it. These guys don't have 80 million followers on Twitter. Yes, so you're right. It was easier for me to kind of sort out fact from fiction and digest the information, correct. But I do think that it was possible. to identify, to do two things as an ordinary citizen. First, to take responsibility for the information that you acquired and passed on. So, you know, to cultivate a sense of discipline, to think about what you're reading,

to think about the source of what you're reading, to look for other ideas about what you're reading, like the number of people who were not, let me put this way, all those people who were not doctors and were not scientists who thought hydroxychloroquine was. would be effective, weren't reading the right things. They were, like, way out of their lane, you know? And it was not crazy to consider that hydroxychloroquine would be effective. There was some biochemical reason to suspect it might be, and there was some in vitro evidence that it might reduce viral replication,

but there was no material clinical evidence that held up to scrutiny that it would work. And then randomized control trial after randomized control trial kept coming out, and I would look at these trials, and I'd be like, this is a pretty good trial. I don't think there's any evidence that this drug works. In fact, Doug does not work. And then another trial will come out and confirm that. And so it was very clear that it wasn't effective. And yet many, many people believe that it was, in part, for example, because the president

promulgated this, but it was false. I mean, you just look at it. The reason that these things got so out of control, and I'm completely there with you on that, is that I remember the Lancet actually published a huge research study on hydroxychloroquine and then it came out later that that whole study was like a fraudulent study with fake information and if you were someone who was pounding your chest that was like no this could work this could work and then you find out that one of the leading research institutions completely fake the study and had all these bad actors that showed it didn't work and the president of the

United States is pushing it, you're all of a sudden immediate, that's reaffirmation that your idea was right. And so this is where the whole thing got so out of control. Yes. Yes. Yes. Yes. Yes. And shame on the Lancet. I mean, that's a real publication. I don't know how that happened. The Lancet is a leading medical journal, one of the most elite journals to publish it in the world. And the scientists that published that, one of them is a very good scientist who got snookered by one of his colleagues who, as you said, made up the data to show that hydroxychloroquine was ineffective in a large observational study. Now, to be clear, when I saw that study, I immediately smelled a rat. And many of my friends smelled a rat. But you need a high level

of sophistication to have appreciated why that study was likely poor. I was surprised that it survived peer review because it was so implausible. I mean, it was just so implausible what they were reporting. And so I didn't put much credence in that study. But you're absolutely right. That study was reported widely. It did appear in an elite journal. And when it collapsed, just to remind listeners, that study showed that hydroxychloroquine did not work, which is in fact true. But the study was fraud. It totally gutted confidence in all the other well-conducted studies, which also showed that hydroxychloroquine did not work. So you're right. It was a mess. And it does highlight the difficulties in, you know, and the thing about science, though, just to be fair, is that when done

properly, and if it's done in keeping with the theory of science, the whole point of science is that it's a self-correcting pursuit of the truth. That is the ultimate, it's like profit-seeking for for-profit companies. That's their purpose. You know, they're trying to make a profit, and that's how they judge whether their success or fair. And they cannot survive. If they, they lose money indefinitely, they don't go out of business. I mean, that you have to make money to survive. In science, the central focus is, can we discern something true about the world or not? And what are our procedures for discerning this truth? And how do we correct ourselves when we are seeing something false? And some people use the Lancet Fiasco actually to say, look, this vindicates a scientific

method. Yes, that was a fraud, but it was found out to be a fraud and corrected. The record was corrected. And look, everyone's moving at a pace that they're not used to moving. And if there's one criticism I've had of the research community, it's that it doesn't have the muscle to move at a fast enough pace sometimes. And that's also why at whoop, we've continued to try to really push research very fast. Okay, let's talk about a couple of the other negatives here. In your book, you talk about the comparison between 2020 and 2019 and the emotions that people reported feeling. right? 2020, 52% of people expressing worry, 2019, 35%. 2020 enjoyment, 64%, 2019, 83%. Sadness, 32% versus 23%. Anger, 24% versus 15%.

I mean, these are pretty meaningful changes in the way people are feeling. Yes, I mean, one of the things about contagious disease that has been observed for hundreds, or even thousands of years. I mean, we have accounts of the plague of Justinian 1500 years ago or the plague of Athens, 2,500 years ago, where people describe how contagious, you know, time of an epidemic is a time of grief, right? I mean, it's people are losing their lives. They're losing their livelihoods. They're losing their way of life. It's sad, right? And it's, it's frightening. It's, you know, it's maddening. And, and, and, and, and, and, and, and, and, and, and, and, and, and, in, and, in, In fact, in 2020, in America, in our time in the crucible, because just to digress for a moment, what made us think that we, unlike all previous humans, would be spared having to experience a plague.

I mean, this is our time in the crucible. This happens every so often, every few hundred, every hundred years, every 50 years, we get something serious like this. And now is our turn to face this. And like all prior humans who face this situation, we're sad and mad and angry and so on. And that's, I mean, as you describe, you summarize those statistics. That's exactly what is happening. I want to know if it were up to you, everything you know now. And we went back in time to March or even February.

And you were in control. And let's say first that you just wanted to maximize for economic prosperity. Right. So deaths aren't, quote unquote, as important to you, but you wanted to maximize for the economy. What kind of policies would you in place? And then we'll switch that and we'll do if you want to just maximize for no one dying. No, I don't think they're very different because. Okay, good.

So you're in control. Yeah, dying people is bad for the economy. I mean, I agree. I completely agree. But I'm just curious if there's a different lens for those two goals. No, I think ironically, fighting the virus is the same. thing that preserves the economy. So I think it's very important for listeners to understand that part of the economic collapse that we're experiencing is things that we're doing to

ourselves. But most of the economic collapse is things the virus is doing to us. Even for hundreds of years, even before states acted, for example, to close businesses, like there weren't orders you know, in medieval Europe to shut down schools, for example. The virus alone, the Buban plague in that case, the bacteria alone caused these behavior. So a lot of the slowing and ceasing of our economy, most of the economic damage is due to the virus. And in principle, some of the things we do which harm our economy, like closing schools or mandating, putting in travel restrictions, or closing firms, or telling people to work at home, or all of those kinds of things we're doing to decrease the spread of the virus. Yes, those have economic effects. But we,

imagine that those decisions are being made in the service of reducing the overall amount of death and economic hardship that the virus imposes. So this way in which people came to think that, oh, if the government hadn't been doing stuff, we'd be fine, is false. We would be in bad shape, even if the government had done, in fact, we'd be in worse shape if the government had done nothing. So I think it's very important for listeners to understand that the economic damage is a property of the virus. You've got to fight the virus. And we've got to prevent. event, death, disability, illness, and so on, in part because those things slow the economy. It's also waste money.

Like, we have to spend all this money caring for people who are sick now who otherwise wouldn't have been sick but for the virus. So it's a big, it's a drag on the economy, right? Having this, it's like, it would be like a so-called dirty bomb, you know, a nuclear bomb, not with nuclear fission, but, you know, just created radiation particles, blanketed the country. And every time you left your house, you had to put on a spacesuit. it would make everything much more difficult.

You have to drive more slowly. You couldn't go to certain kinds of, you know, everything. Okay, so we're in agreement. Deaths are bad. It's a kind of friction. But now you have to create the policies. Yeah, so policies I would implement would be, I would have loved to have done the New Zealand policy,

which is very secure borders and then immediate contact tracing. But New Zealand is an island, and even they couldn't completely stop the virus. It comes back from time to time. the virus, you really can't close borders as a technique for stopping the virus. You can postpone the entry of a virus, but it's very difficult to completely seal a border in a time of pandemic disease. In fact, I've never seen it successfully done.

New Zealand is as close as I've ever seen, but they still are closed and the virus still comes in from time to time. Short of that, what I would have done is I would have done sort of the South Korean model. I would have had widespread education on mask wearing. I would have encouraged physical distancing. I would have provided for widespread testing and encouraging people to isolate. I would not have implemented, given our civil liberties commitments, some of the techniques for contact tracing the Koreans did, which is, you know, the government had huge amounts

of data, private data about individuals. Like cell phone data and things like that. And credit card data. Like, for example, if I tested positive, they had the capacity to see, okay, I was in this store buying shoes at this time. Who else was in the store buying stuff at that time? to pull those records and then contact those people. I mean, just astonishing capabilities using data science.

So I wouldn't have done things like that. But I certainly would have done all the kind of basic stuff I would have done. And I would have been a bit more rapid, for example, on some of the gathering bands and thinning out some of the social mixing and considered schools, closures, and so on. We did, you see, the thing is we did a lot of these things, but we did them needlessly late. I mean, the same thing is happening in the Dakotas right now. Right now in the Dakotas, they have. the highest per capita death rate from COVID of any place in the world. Now, they're thinly

populated rural states, but the fraction of people dying is higher there than anywhere else has been for this pandemic. And they're slowly now beginning to do some stuff. So they avoided doing all this stuff that they didn't want to do earlier, but they're inexorably being pushed to do it now anyway. How much wiser it would have been to have done it a few months ago and saved all these lives? I mean, why are we finally when we're forced, you know, then we do this stuff. It was obvious we should have done, you know, three or four months ago. By the way, who branded social distancing? Isn't it physical distancing? I call it physical distancing. Yeah, it was, I kind of, early on, I tried to push against this and say,

we shouldn't be using the expression social distancing. We should be using the expression physical distancing because what we need right now is actually to band together to live apart. You know, we do need to keep physical distance, but we don't want to be isolated, in fact. So the lockdowns, the restaurants, closing, where would be your policy decisions on things like that? Well, I think that, I think it would be very data-driven. So, for example, in the state of Vermont right now, the governor recently announced that in looking at the data, what they found was that the main sources of transmission were house parties, were young adults or youngish people getting together with people outside their

household in large numbers and having parties involving alcohol, for example, and these were creating outbreaks, whereas the restaurants that had implemented, you know, some same policies and thinned out their crowds, there haven't been too many, if any, outbreaks at restaurants. So I think we could use data. I do think that you need to, you know, you need to be prepared to close the restaurants or close the bars or certainly close the nightclubs or or thin them out or put capacity limits. I mean, I think it's a collective threat of an epidemic disease is. And I think we have to be prepared to do these unpleasant things. I don't think, you know, one of the things that has come up a lot is this notion of COVID fatigue. But I think it's really important

not to confuse our exhaustion with fighting this virus and the unpleasant steps that we're required to take if we want to prevent death and disability with the reality of the condition we are in. In other words, let's say, I unfortunately have had to have quite a few root canals in my life. Let's say you need a few root canals and you're sitting in the dentist's chair and the dentist does two, and they're awful, root canals are just awful. And you're like, okay, I've had two, I don't want anymore. Well, that has absolutely no bearing on whether you need them. You need to have more of these unpleasant things, and you're, you know, being tired of having root canals has absolutely nothing to do with the quality of your dentition. So this is sort of the situation

we're in. People are saying, you know, I don't want any more of this, but that doesn't have any bearing on the virus. The virus is doing its own thing. It's going to continue to affect us. Let's, let's remember we haven't talked about this yet so there's we haven't talked about herd immunity have we talked about herd immunity in this so far i can't we've talked about so many things okay so just so herd immunity is the idea that a population can be immune from a pathogen or immune from an epidemic even though not everyone within that population is immune so for example if you vaccinate 96% of the population for measles even if one of the people one of the four percent who's not immune gets the disease, they can't really start an outbreak because they're not going to interact

with anyone who's susceptible. Most of the people are immune. So that means you have herd immunity. The herd is immune to the pathogen, even though not 100% of the people are immune. This herd immunity threshold, this percentage, you should have the intuition, varies according to the infectiousness of the germ. So measles is the most infectious disease we know. The lower the infectiousness, the lower the herd immunity threshold. So for example, for seasonal flu, It's not very contagious seasonal flu. Its R not is much lower. So if I have measles, on average, I might infect 16 or 18 other people.

If I have a seasonal flu, on average, I might infect 1.5 other people. And the fact that that number is higher than one is what means to be an epidemic. The cases grow. If each case just replaces itself, then the disease stays at the same level across time. SARS-CoV-2 has an R-not of three. And so that means that each case, the intrinsic infectiousness of the pathogen, each case can create three new cases in a non-immune, normally interacting host population. And if you take that number and then you plug it into another standard formula to compute the herd immunity threshold, it turns out that according to that formula, 66% of Americans would need to be immune for us to reach herd immunity. Now, it turns out also for certain network science reasons, which are interesting, but I don't think we'll go into, that number needs to come down a little.

And probably between 40 and 50 percent, let's say 45 percent of Americans would need to get this disease before we reach the herd immunity threshold. Well, where are we right now? Probably about 12 percent of Americans have been infected with this disease and have some natural immunity. We're just, we're not at the beginning of the end of this epidemic. we're just at the end of the beginning. We're at the opening act. And even though we're going to invent a vaccine, it's going to take time to manufacture and distribute

and get people to take the vaccine, I think probably will be into late 2021, early 2022, before we have half the population vaccinated. Meanwhile, the virus is still spreading. So my feeling is that until 2022, well, at 2022, we'll reach her, immunity, either artificially because of vaccination or naturally because of the pathogen. And so until that time, we're going to be living as we are now, having to wear masks,

physical distancing. I think, at least, as I said earlier, at least half a million Americans are going to die of this condition, maybe as many as a million. And we're just every day, 1,500 Americans are dying. And that number is just going to go up every single day. It's awful. So we're going to be in this changed world, as the virus does it, has its way with us, you know, it's just going to do what any living thing, there's a debate about whether viruses are living, but anyway, it's doing. I mean, you know, it's, it's found untouched terrain in our bodies and it's just spreading, you know, it's having a field day with us until 2022. And then at that point, it's still going to take some time to recover from the psychological,

social, and economic shock of the virus. You know, 30 million Americans are out of work. Countless businesses have gone out of business. Mental health, yeah. Mental health. All of that stuff, exactly. And then beginning in 2024, we're going to enter, so this is the immediate period where now, then there'll be the intermediate period until, let's say, roughly, 24. And then there'll be, I think, the post-pandemic period, which will be a little like the roaring 20s, I think, after the 1918 pandemic. So immediate 2020, 2022, intermediate 2022 to 22, and then post-2020-onwards. Let's talk about the intermediate or the post periods.

There's a lot to learn from previous pandemics in this regard, but it tends to be a period of excess and spending and frankly, it sounded like quite a lot of fun. Describe that. Well, usually during times of epidemics for hundreds of years, people get more religious. And we're seeing that now in the United States. religion is, religiosity is rising, virtual church attendance is going up. You know, people are finding God, which is very typical during times of plague. People save money. They don't spend money because they're uncertain. They're worried. Also, there are less places to spend money. It's the same thing is happening now. It's happened for hundreds of years. There's a kind of abstemiousness that takes

place, a kind of risk aversion. What I think is going to happen in 2024, when we finally put the biological and epidemiological shock of the virus behind us and the social and economic shock is I think all of that will unravel very dramatically. I think people are going to relentlessly seek out social opportunities at nightclubs and restaurants and sporting events and political rallies. I think spending will be liberalized. There'll be a lot of spending. It might be some sexual licentiousness, some joie de vivre, some risk-taking. One reviewer looking at how I described this in the book says, you know, here's hoping, sort of like what you just said. So, yes, I think that we're going to see a kind of, you know, people will have been caged in and closed in for

quite a while and, you know, they will, you know, break out, I think, of that is what's likely to happen. You know, approximately, I mean, we can't be sure about all this, but roughly speaking. And some of that may start earlier, right, than 2024. I mean, how would you frame that? Well, it depends. I mean, if you look at various expert forecasts of how long it'll take the airline industry to recover. And business travel is not going to come right back, Will. Even when a vaccine is widely available, many people are still going to be saying, you know, gee, why should I hop on a plane? The virus will still be around, so I could get the virus. Oh, I think business travels forever changed. Okay, well, there you are. So there's something that's going to take a while. People

are still going to be wearing masks. They're not going to want to avoid crowded places. People are still going to not have money to spend. They'll have been unemployed. Millions of people will be unemployed. Working from home, there'll be shifts in the real estate sector as businesses don't need as much square footage in the cities. Some people have relocated to rural areas. Eventually the cities will come back, by the way, that's for sure. But in the short term, there's going to be a lot of disruption in the economy. And so, and all of these industries will be affected. And it'll take a while for all of that to normalize. It's not going to suddenly happen when, you know, when the vaccine reaches 50 percent or the natural immunity reaches 50 percent. And so that's why I think it'll take you pick a

year or two years, you know, some amount of time. What's your pitch to someone who is nervous to take a vaccine? I think we all need to be vaccinated. I don't know yet how safe the vaccines will be. I believe we will soon have convincing evidence of the efficacy of the vaccines. The trials have ordered 40,000 people in them. So rare, serious complications of vaccines, let's say one in 100,000 people having a serious complication or death would have been unlikely to have been detected in the trials. And usually

we expect, we expect safety levels from our vaccines of one in a million to one in 10 million serious complications. Most of the widely available vaccines are incredibly safe. And from a public health point of view, there are no-brainers. You lose one in a million lives, but you save thousands of lives with the vaccines. So it's very easy to recommend them. And I'm vaccinated for every single disease for which there is a vaccine available, I think, except for rabies because I couldn't, I don't have a legitimate reason to get a rabies vaccine, but everything else I get vaccinated for. Now, in the case of the coronavirus vaccine, we won't know immediately when it's available how safe the vaccine is. It will know that it's pretty safe. We won't know how safe

until we start rolling it out. And the first people that get the vaccine, of course, will be the people that were in the placebo arm of the trials. They have first dibs, rightly so. They took a risk to, they took a personal risk in order to help us acquire the knowledge that the vaccine works. They should be first in line. Then we'll have health care workers, one or two million health care workers. And at that point, if we've rolled it out to health care workers without much evidence of safety problems, I think pretty much everyone at that point should be really confident that it's proper and safe to get the vaccine and they should get the vaccine. Yes. Very helpful. Well, Nicholas, look, thank you so much for the time that you've spent with me.

And I think thank you for all the hard work that you and your team is doing to help humanity understand this virus. Yeah, I'll say one last thing for listeners who are interested. We released an app called Hunala, H-U-N-A-L-A, Hunala, which is available on the Apple, on the Apple and Google Play and on the Apple App Store. And the app is like, it's not a contact tracing app. It's a risk forecasting app. It's like ways for coronavirus. virus. It predicts the likelihood that you will come into contact with the virus in the future by crowdsourcing information about your social network and about where you live. So just like when

you're driving on the highway, people five miles ahead of you say there's a police stop or a traffic jam there, and now you're alerted you can exit the highway. This app works very similar to that. When you sign up for the app, if you want, you can give it access to your contacts on your phone. It does not copy the contacts. It doesn't take them. But it makes it easier for you to identify who you're social, who you're interacting with. So you don't have to type in their names or their numbers. And then it captures that information

about your social network all anonymously. It captures where you live if you wish it to. It collects this information. It uses machine learning technology to predict your risk as often as you want daily or whatever. And like a weather app, you can track the occurrence of a coronavirus in other parts of the country. So if you want to see what's happening where mom lives

or where junior lives, You can do that too. Anyway, it's a product of my laboratory. It's released by Yale University. It is a tool that I use every day, and people may want to use it. And that's Hunala. H-U-N-A-L-A. And you can learn more about it as well at our website, which is Hunala.

com.yale. And where can people find your amazing book, Apollo's Arrow? Well, anywhere. All bookstores. Bookstores near you. Okay, good. Well, I'm glad we got it in. All right.

Nicholas, this has been an absolute pleasure and we'll include all those things we just mentioned in the show notes. Thank you so much. Thanks to Nicholas for coming on the WOOP podcast. I encourage everyone to check out Apollo's Arrow, an amazing, amazing book. I devoured it.

A reminder, you can use the code Will Ahmed to get 15% off your W-W-M-M-E-D. W-L-L-L-A-H-M-E-D. Check us out on social at W-W-O-W-A-W-A-M-M-D. If you're looking for more podcasts on COVID-19 on the coronavirus. Check out episode 66. That was with Nicholas Christakis from March. Check out episode 67 on respiratory rate and the benefits of measuring respiratory rate during this crazy time. Episode 71 in which we interview a number of WOOP members who got COVID-19

and how it affected their data. Episode 79 in which we talk about the COVID resilience project using WOOP data and demographic surveys to better understand the impact of this virus. Episode 80 interviewing Nick Watney, professional golfer who used WOOP to predict that COVID-19 was in his system. Episode 81, which is a recap on respiratory rate. So there's a lot of good COVID-19 content on the WOOP podcast. I encourage you all to check it out. And in the meantime, stay healthy and stay green. You know,

You know,