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April 5, 2020 - The Ben Shapiro Show

01:24:15

Coronavirus Pandemic: Doctor vs. Economist | The Ben Shapiro Show Sunday Special Ep. 89

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	When my girls came home, they were really unsettled.
	So what we decided to do is every day we would sit down and talk about what's happening on the coronavirus, and importantly, what to expect.
	What to expect.
	And this notion of, I don't know for sure, but this is what I'm looking for, has helped people enormously because you give them a roadmap.
	It's been almost three weeks since President Trump issued his 15 days to slow the spread recommendations, urging everyone to stay at home and only leave for essential business.
	Those recommendations have now been extended through the entire month of April, which leaves a lot of uncertainty for everyone as we grow increasingly more concerned with our health and well-being, as well as our financial stability.
	By ordering every non-essential business to close, the economy came to a crashing halt, spurring a $2 trillion stimulus package, another $4 trillion of spending from the Federal Reserve, and the highest rate of unemployment this country has ever seen.
	While the healthcare industry works on defeating this virus, infection and death rates are constantly changing based on incoming data.
	Every day, more and more people go without work and paychecks, propelling the debate of how important the stability of the economy is to public health, not just the importance of public health to the economy.
	Today, we're going to look at that argument from both a healthcare perspective and an economist perspective.
	We're going to be talking the models used by governments to determine whether to shut down the economy, the question of balancing economics and public health, and when we finally get back to normal.
	Kicking it off is Dr. Bob Wachter.
	He is professor and chair of the Department of Medicine at the University of California, San Francisco, and the author of about 300 articles and six books.
	He is past president of the Society of Hospital Medicine and past chair of the American Board of Internal Medicine.
	Dr. Wachter, thanks so much for joining the show.
	I want to start by asking you some basic biological questions about coronavirus.
	Let's start with the sort of conflicting messaging we've been seeing about face masks.
	Are they a good idea or a bad idea at this point?
	I think the science has evolved in the last couple of weeks, Ben.
	I think we now better understand that people can have the virus and be asymptomatic and be shedding virus at that time.
	And so now that we understand that, it is, I believe, marginally safer if everybody wears face masks out in public.
	I think if people do it, it will become destigmatized the way it has in many Asian countries.
	It'll be weird.
	It's going to take a lot of getting used to.
	But I think while the virus is out there in the communities, it seems like a prudent thing to recommend.
	I also want to ask about the handwashing.
	So obviously we're all doing it.
	All of our hands are raw and bloody.
	So when it comes to handwashing, why 20 seconds?
	Is there something magical about 20 seconds versus 15 or 25?
	Not magical.
	There have been sort of these funny studies where they look at people's hands that have soil or germs on them and wash them for various periods of time to see which ones So, let's talk about the hospitalization rates for folks with coronavirus.
	So, what percentage of folks with coronavirus end up going to the hospital?
	What percentage of those people end up having to go to an ICU?
	What percentage of the ICU people end up on a ventilator?
	Are those coincident?
	And what percentage of people on ventilators actually end up surviving?
	Okay, how long we got?
	A lot of the answer to that, Ben, depends on the population of patients, because we know that older people and people with other diseases before they got sick with coronavirus do worse.
	So, for example, the very high mortality rates and ICU rates in Italy are partly related to the fact that it was an older population.
	But if you take all comers, about 80% of people who get the virus do just fine.
	In fact, some of them we now know are asymptomatic through the entire time, but most of them will have a flu-like illness, recover fully, and be fine.
	About 20% of people will get sick enough, and a decent percentage of them, 15 to 20% of all comers, will need to go to the hospital.
	Of those, somewhere around a quarter to a third, again depending on the overall health of the population, might need to go to an intensive care unit.
	Not everybody who goes to an ICU needs to be on a mechanical ventilator, needs to be intubated and ventilated, but if you can't breathe without it, you do.
	And then the overall death rate nationally in the U.S.
	is around 1% of all people that get the illness.
	If you are unfortunate enough to need to go on a mechanical ventilator in the ICU, the studies vary, but on the low side, the mortality rate is 50%.
	On the high side, some of the early studies from China showed a mortality rate closer to 90%.
	So, not everybody who gets sick enough to be on a ventilator dies, but it's a bad thing, and the outcomes are at best 50-50.
	So looking across the country, obviously the hotspot right now is New York.
	We've seen emerging hotspots in places like New Orleans and Detroit.
	But in San Francisco, you've suggested that the curve has been rather successfully flattened.
	In Seattle, it looks like the curve has been rather successfully flattened.
	What do you think is the difference between cities like New York, Detroit and San Francisco or Seattle?
	It's hard to know fully, and I suspect that multiple factors are at play.
	But here in San Francisco, there was a concerted amount of action by both government leaders and, I think very importantly, corporate leaders.
	They saw what happened in China.
	They saw what was happening in Italy.
	And they took it very seriously.
	They believed the science, and I think the science is relatively clear, that the best chance that we had to stay safe was early and aggressive action.
	And the action was sheltering in place, the action was avoiding close contact, the action was hand washing, things like that.
	And so here in the Bay Area, as early as March 5th, leaders of the big companies, that was Google, Facebook, Salesforce and others, basically told all their employees to stay home and work from home.
	Now, they're advantaged in doing that because their employees are all digital and they all have ways of working from home.
	It's not so easy.
	If you're an Uber driver, you're working in manufacturing or in other places.
	But that was as early as March 5th.
	March 16th, the mayor of San Francisco and the mayors of the five counties around San Francisco all issued a sheltering-in-place order, and the governor of California did the same thing on March 19th.
	Those were earlier than any large areas in the country.
	So I think it was all of that.
	And I think people did it.
	People just kind of believed that this was real.
	We better pay attention.
	I think part of that was being on the West Coast.
	We're particularly close to China.
	We have a very large Asian population.
	We saw what happened in China.
	We kind of, we took it very seriously.
	And the second reason I think is Seattle was the first part of the United States to get hammered.
	And San Francisco and Seattle are pretty, are almost sister cities.
	They're very similar in many In many ways, and we saw that, you say, if it can happen in Seattle, it can happen here.
	So I think it's, and then there's just some luck.
	I think that, you know, New York may have gotten unlucky.
	There are places where it just breaks out.
	And even if you did all the right stuff, you're still going to have a big problem.
	But I think those actions really did make a difference.
	So, Dr. Walker, in just a second, I want to ask you about some of the modeling that's being used to justify the entire economic shutdown.
	We'll get to that in just one second.
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	So we've been relying very heavily on the models to determine exactly what we ought to do here.
	One of the questions about the models has been exactly how far they extend.
	So the IMHE model from the University of Washington has been heavily used as sort of the source for we're going to experience maybe up to 100,000 deaths.
	That model only extends until the very beginning of August.
	It doesn't take into account the possibility of a second wave.
	And that raises questions as to what exactly the purpose of the curve flattening is.
	So on the one hand, obviously we want to flatten the curve so that we Don't exceed the medical capacity that is out there for ventilators or for ICU beds.
	On the other hand, if there's going to be a second wave in the fall and we are all going to get it, and how do we calculate exactly when it is worth it to go back to work, considering that the economy is taking unprecedented hits right now, 10 million people unemployed in the last two weeks?
	Yeah, it's a brutally difficult question.
	I'm not going to accept the idea that we're all going to get it.
	Particularly for myself, being over 60, I'm in one of the risk groups, so I can't go to sleep at night buying that it's inevitable that we're all going to get it.
	I think what we are trying to do is tamp this thing down as much as possible so that hopefully it then dies down during the summer.
	There's some seasonality about it so that then when it comes back in the fall, which is likelier than not, we're prepared for it.
	We know what to do.
	We can immediately institute the kind of public health measures that this time I think we instituted on the late side.
	We have widespread testing available so that we can aggressively find people that have it early and quarantine them and isolate them from the rest of the public.
	And all of this, I guess, if this went on forever and we never found a vaccine, then there is a good chance that ultimately probably we wouldn't all get it.
	There's this thing called herd immunity that when you reach a certain amount of the population who's gotten it and has antibodies, it begins to die out.
	But that's 70 or 80 percent of the population.
	So that's that's a pretty nasty vision.
	The hope is we tamp this thing down over a long enough time that, yes, we don't overwhelm the health care system, but more importantly, we come up with treatments or vaccines and can get rid of this thing once and for all.
	I guess one of the difficulties in the modeling is because so few of the models extend out a full year, and because there are so many variables, it's difficult to see exactly what the sort of counterfactuals are in the various assumptions.
	You have the assumption where we do nothing and 2.2 million people die, but it's difficult to see, okay, we have over the course of a year, not the course of three months, over the course of a year, how many people die if we engage in social distancing and mask wearing for people who are under the age of 60 or 65?
	People who are 65 shelter in place to the best of their ability.
	We isolate people who are in old age homes and have inherent vulnerabilities.
	What is the counterfactual to that or lock down for three months and then do it?
	There's so many variables, it's hard to tell what is worth it at this point.
	What do you think emerging from this looks like and when do you think we start to emerge from this?
	Yeah, I mean, we need to put our best minds and our best models to this to help guide us as to what the right thing to do is.
	There is no question that a stance like we now have in California and increasingly around the country that everybody stays at home and the economy shuts down can't be our stance forever.
	That can't possibly work.
	And eventually there will be so much harm from that that you begin having to weigh the harm from the virus against the harm from the economy.
	And they harm to health from people not going out and getting health care.
	There are competing demands here that we've got to be thoughtful about.
	I'll tell you a quick metaphor for that, which is at UCSF, where I work, we prepared for a New York-like surge.
	We have not seen it.
	We completely canceled all surgeries, essentially, unless it was absolutely a hyper-emergency for a couple of weeks.
	We're now beginning to open up to do more urgent surgeries.
	And that's because at some point you say, all right, we're not seeing the same kind of surge.
	We need to take care of other people.
	And so there's a balancing act that we all have to do.
	It appears that the best models seem to say that sometime in the next four to six weeks, and it depends on how prevalent it is in the community and how much of a spike you had, because you come down faster if you had a big spike, The rates of the prevalence of the virus will go down in communities to the point that we can begin entering a new phase where we begin to relax some of the strict standards that we have now, begin to let people go out.
	But the key thing there is going to be testing and contact tracing, which we haven't done very much of.
	When you have tens of thousands of cases, you can't do contact tracing.
	It's overwhelming the system.
	But if you can tamp this down, my analogy is that of a wildfire that You have tamped down the worst of the wildfire and now you're out there looking for embers.
	And you see an ember and it pops up and you stomp on it and make sure that it doesn't spread.
	So we can, I think, reach that kind of a mode where we've tamped it down so it's not rampant in the community.
	Hopefully it goes away, or mostly goes away over the summer.
	And by the time it comes back in the fall, we're ready for it.
	If someone has any symptoms, we immediately test them.
	We're checking people's temperatures.
	People probably are still wearing masks.
	And if we find a case, those people get isolated, separated from the community, probably, or at least we consider separating from their families as well.
	And that we can keep this thing at a low enough level that then there is time to go ahead and find the vaccine and the treatments.
	So given the variability in the models, and given the fact there was an article in the Washington Post talking about how even the White House's estimate, 100,000 to 240,000 dead, it was completely vague.
	We have no idea over what term even they were talking about.
	We don't know what the factors were in coming to those statistics.
	So I've been asking sort of a wide variety of people to ballpark where they think we are over the next year, given the fact that there seems to be pretty wide consensus that we're going to have to tranche people back into the workforce.
	By mid-May, perhaps by June at the very latest.
	This cannot last forever.
	So if that is what happens, if we start to test people, move people back into circulation, isolate people who are most at risk, tell people to hunker down until there's a vaccine if they are really, truly the most at risk.
	If we do that, what do you think the numbers look like?
	Do you think it looks like 100,000?
	Well, I believe the models, I think 100,000 is looking like the minimum, and that is extraordinarily tragic if you think about what that means.
	But we're seeing New York, but New York is just the leading edge of what we are likely to see in Detroit, New Orleans, potentially Florida, a number of other cities, Illinois.
	It's 90,000 still pretty terrible, but I think it is a big number.
	My confidence that the fall will not be as bad as the spring.
	is that I think we're smart enough to have learned the lessons of this.
	It's awfully hard to tell people to disrupt your life and basically screw up the economy based on a theory or based on something that's happening in China.
	Once it's happened in New York, once it's happened in big cities, I think people get it.
	This is the real deal.
	I think we will take the kind of actions.
	I think science will move quickly.
	I think we will find treatments and vaccines, and almost as importantly, new technology ways to track cases and follow people.
	If you look at what happened, it's hard to know whether the numbers coming out of China But what's happened in prior epidemics, what the experience in Korea, for example, seems to show that after that initial spike, if everybody gets their act together, we can keep this thing at bay to a large extent.
	And the analogy, I think people always say, well, there was a big surge in the Spanish flu.
	Well, yes, but the Spanish would think about what they had to do tracing.
	There were no treatments.
	There were no vaccines.
	There was no Zoom.
	There was no Netflix.
	And you're telling people to stay at home.
	I think our ability to weather this and act responsibly and communicate effectively is massively better today than it was 100 years ago.
	So I don't think the fall will be as bad as it's been and will be in the spring.
	Dr. Wachter, I want to do a quick lightning round.
	I have five questions for you.
	So, number one, what do you see as the actual sort of end date for the crisis?
	Well, two end dates.
	When does life go back to normal, either post-vaccine or not?
	And when do we actually start to emerge from the groundhog holes that we've been burrowing for the past several weeks?
	Anybody's guess, but I'm guessing that, you know, a May to June, probably mid-May is the best estimate of being able to come out of our burrow and get back to something that resembles, more closely resembles normal is right.
	And in terms of when we reach a time that things are truly back to normal, the best estimates for a vaccine are 12 to 18 months.
	And the minute people find it, it's not trivial to get it into the arm of 350 million people.
	So, you know, you've got to think it's 18 to 24 months.
	So question number two, with all that said, what does America look like in six months?
	I mean, are we still presumably social distancing?
	Is everybody wearing masks?
	What do you think that American life looks like six months from now?
	I think masks are going to become a norm.
	I don't know if it'll be quite like Tokyo or other places in Japan where it is absolutely the norm, but you're going to see a lot of people wearing masks.
	I think people are going to be cleaning their hands incessantly.
	I think people are going to keep a distance from one another.
	And it may vary community by community.
	If there are no cases in your community, What should America do?
	What are the big steps that we can take to prevent the next pandemic?
	active case finding.
	And if you do find a case, then you begin to do the contact tracing and those sort of things.
	But in communities where there still is virus in the zeitgeist, I think you are going to see people walking around with masks, keeping their distance and cleaning their hands religiously.
	And I think that's the right thing to do.
	What should America do?
	What are the big steps that we can take to prevent the next pandemic?
	Because this obviously is not the first and it will not be the last.
	Yeah.
	I mean, if you look at how well some of the countries in Asia reacted, it was in large part because they had a playbook that they could pull off the shelf.
	And they had a national strategy for dealing with this.
	And the national strategy had every had Have included what should the population be told and what do they need to do?
	And it can't be a patchwork if you do it this way in this city, do it this way in this state.
	It really has to be a national strategy because this thing permeates state and city lines.
	It goes to red and blue states.
	It's got to be a uniform playbook.
	It has to include a testing strategy.
	And part of the challenge here was, you know, we don't have a way of getting testing throughout the entire country, so we have to have a rapid-fire way.
	Somebody at CDC has to be able to, obviously with the White House and with the health leaders, has to be able to push a button and say, there's been an outbreak in this place, and it looks awfully like coronavirus, and here is the playbook, let's roll it out.
	And I think At least if it happens in the next five or ten years, I think people will remember this and believe it.
	If it happens 20 or 30 years from now, people will forget this and we'll go through the same trauma, I'm afraid.
	So, how should we treat the government of China after this?
	Obviously, the government of China not only prevaricated about the virus in the beginning, they openly lied to the WHO.
	They said there was no human-to-human transmission.
	They knew better.
	Obviously, they've been using some of their propaganda efforts to actually suggest that the United States put out the virus.
	How should the world community be treating China in the aftermath of this from a health perspective?
	Well, I think this shows how interconnected we all are.
	And I'm not a diplomacy expert, so it's difficult for me to know how we should treat them.
	But I think what it has made clear is that we can't completely isolate from one another.
	The borders are permeable.
	A virus that starts in China is going to end up here and vice versa.
	China reacted and didn't do some of the things they should have done.
	On the other hand, once they reacted, they reacted with an aggressiveness that I think probably saved a bunch of lives in China and may have saved a bunch of lives around the world.
	They did things that we're not capable of doing and we shouldn't be capable of doing in terms of what an authoritarian regiment can do.
	But in some ways, I think I can understand us being unhappy with them and that influencing our relationships.
	On the other hand, it just shows how extraordinarily interconnected all the countries are.
	And if we isolate from one another, it doesn't work.
	The virus gets through and we'd have to work together better.
	But finally, the measures that everybody is taking.
	You mentioned before that we're going to be wearing masks for a while.
	Is there ever a point where we go back to full normal, meaning like giant events, 60,000 people at baseball games?
	I sort of think at this point that all mass events are basically going to be canceled until there's a vaccine.
	Are all the measures we're taking right now temporary or permanent?
	I really hope they're not permanent.
	My son works for the Atlanta Braves, and I can't imagine that we're never going to go to a baseball game again.
	That's too hard to even imagine.
	I gotta think that this is, we'll be back to something resembling normal in a couple of years.
	It might be a little shorter than that.
	I don't think it will be that much longer than that.
	You think about the quality of the American scientific and medical enterprise, the idea that we're not going to be able to find a vaccine for this, I find hard to believe if we completely put our full resources, full attention to it.
	I think for a year, year and a half, things are going to be pretty weird.
	I think they are going to, they're not going to be full lockdown like they are now for the next, probably the next month or two, probably two.
	But they are not going to be normal.
	People are going to be walking around with masks.
	People are going to be keeping their distance and cleaning their hands all the time.
	But I think we're going to reach a point in a couple of years where things will be back to something resembling normal.
	Well, Dr. Walker, I really appreciate your time.
	And as I've been saying to folks, stay safe in there because we can't be out there.
	- Thank you. - I really appreciate it, sir.
	- You're welcome.
	Nice to talk to you. - Joining us next is Dr. Scott Atlas, a medical doctor, senior fellow at Stanford University's Hoover Institution, and a member of the institution's working group on healthcare policy.
	He is previous chief of neuroradiology at Stanford Medical Center, is the author of the leading textbook on MRIs, and has written over 120 scholarly articles.
	Dr. Atlas, thanks so much for joining the show.
	Really appreciate your time.
	So let's start with some questions about the modeling that's been used so far.
	Some models that I've seen really only go out a couple of months.
	The model from the University of Washington has been heavily relied upon that says that we could see up to 100,000 deaths.
	That only goes up to August.
	I guess my question with these models is we are all now locking down for the next few weeks at a bare minimum in order to flatten the curve for the next few months.
	But none of these models seem to extend far beyond that.
	And we've been told that the vaccines are only going to be ready 12 to 18 months from now.
	It's obviously unrealistic to suggest that we are going to Yeah, I mean, this is, of course, a very tricky question.
	I would say a couple of points to understand.
	Number one, the models are really just those.
	So how exactly should we balance the needs of public health and the needs of the economy in a time when we are at such a lack for data as to what happens next?
	Yeah, I mean, this is, of course, a very tricky question.
	I would say a couple of points to understand.
	Number one, the models are really just those.
	And like all projections, they're likely to be wrong, no matter how good the people are that are doing them, because there's so many incoming assumptions that underlie each projection.
	And it's something very important to understand because, as you know, the definition of a case could be a positive test only, could be a symptomatic person.
	The testing is very different and heterogeneously distributed.
	Second point is that to re-enter, I would call, I use that word re-enter society.
	I think we're going to see something first Clearly gradual.
	And secondly, there's going to be a sort of a different way to look at re-entry.
	I make the analogy, it's possible that we will see what people call a new normal.
	Remember after 9-11, everything changed in airport security.
	We never had that sort of waiting lines.
	And I used to run up to a plane minutes before it took off.
	All those things change.
	This might be the same in that, at least in the beginning, I think it's very likely we will need some sort of testing to permit and allow reentry.
	And that testing is likely to be twofold.
	One is antibody testing, which involves a blood test of some sort.
	And that will say if you're immune or not, meaning you've already had it and you're highly unlikely to get it again, judging from all biology of previous virus infections.
	And those people clearly will be safe and actually fine to re-enter.
	And the other test might be a test of active virus presence.
	And I think that's possible and actually easier But probably less likely to be done.
	So I think we will have some sort of testing at point of entry.
	We will still have restrictions.
	And most importantly, we will have restrictions, and I'm talking about as we re-enter, on the people who are the vulnerable people.
	Remember, the number one goal is to stop people from dying.
	And it doesn't really matter if you get a mild version of this, which the overwhelming majority of cases are mild.
	The question is how to protect those who are vulnerable.
	And this is the number one focus and most urgent thing of any policy.
	So older people, particularly people with underlying chronic diseases, need protection.
	They need isolation.
	They need meaning isolation from people who are either asymptomatic or sick, clearly.
	And that is going to need testing of people who deal with those people.
	And those people, the older people who are much more likely to have a serious illness or die, are going to need special sort of re-entry public health formulations.
	So with all of that said, and looking at sort of the fact that these models and studies are not taking into account really the possibility of a second wave or the reality that people are going to reenter the workforce, there are a lot of skeptics out there who have been kind of rearing their heads and saying, OK, well, maybe We could take this for a week, but we can't take this for another two months.
	And the economy is losing 10 million jobs every couple of weeks here.
	And we are going to enter economic levels not seen since ever in the United States in terms of unemployment.
	So why not pursue a policy like Sweden, for example, where we isolate everybody who's over the age of 60.
	If you're over the age of 60, or if you have a pre-existing health condition, you're expected to stay in your house and self-isolate.
	Everybody else goes to work.
	Everybody else wears masks.
	Everybody else social distances.
	And life goes back to quasi-normal.
	It appears that that may, in fact, be what ends up happening after three months of this.
	Is that sort of the plan?
	That after three months, if the summer knocks this thing down, or if the curve actually flattens, that we all go back to life in that way?
	And if so, then what is the end date of that sort of thing?
	Yeah, I sort of think there's going to be something like that.
	I don't think it will be.
	Okay.
	There's so many parts to the question.
	I mean, one part is how do we reenter and who reenters and, uh, you know, we are a certain sort of society.
	So the main thing to get the economy going.
	Is to allow people in the workforce to get going.
	And as you obviously must realize people over 65 are not a big part of the workforce.
	And so, uh, it's clearly less impactful to restrict those people.
	I do think that testing is going to be part of this.
	And you know, there's a lot of new tests.
	There are more than 20 tests being worked on.
	Some have been approved even today for antibody testing.
	We do testing all the time at home and at points of care for things.
	You know, there are simple pregnancy tests.
	We don't have that sort of thing yet, but I envision some sort of like at-home diabetic people use a blood pinprick test.
	So I think that to re-enter You know, there's a public health concern and there's an individual concern.
	And the working economy is critical.
	There's, as you are alluding to, a huge cost to individuals and to really sickness but death when there's a depression sort of economic situation.
	This is not going to go on.
	I think we have to realize a couple things.
	Number one, the isolation policies actually work and are working.
	And this is a message that I think people don't quite understand.
	Yes, more and more people are dying, but the rate of increase of deaths is slowing all over the world.
	And we have to realize that there are causes for optimism.
	This is reality, not just panic mode.
	And so as we see these death rates, the increase in deaths go down, which they are, eventually we're going to get a handle on that.
	This is a virus.
	There's fundamental biology to understand.
	And we are going to have enough immunity.
	We are going to allow, and it's actually beneficial to allow more people to mingle, given that the overwhelming majority are not going to die.
	And the overwhelming majority are going to have a mild or a symptom course.
	We need so-called herd immunity because there's a natural way to eliminate viruses like this.
	And that is by natural immunity.
	And yes, you're right.
	We don't have an immunization.
	We won't have an immunization as we re-enter.
	But the immunization technology is very good.
	We'll have it in theory.
	Projections are at least by early this coming year, maybe sooner.
	We don't know.
	But there's going to be a reentry and it's essential for health reasons as well as simply the economic survival.
	of individuals and families.
	So realistically speaking, it seems as though a lot of the press that's being done, Dr. Atlas, on this sort of stuff from the White House, from other folks who talk about it, has focused on this sort of idea that we're all going to avoid the disease, but that obviously is not reality.
	It's gonna be, it may become seasonal like the flu, in which case we're probably all gonna get this at some point in our lives.
	So would it be better for people who are speaking about this publicly to simply say, look, the purpose of what we are doing right now is to avoid the overwhelming of the healthcare systems, That's really what this is about.
	It's not preventing people from getting infections in the long term.
	It's not preventing people from getting this and receiving treatment.
	The idea is to delay because we weren't ready for this and then to ramp up production of the ICUs and the ventilators and the mitigating treatments that we have so that when there's a second wave, it's not as cruel in the fall.
	And then hopefully we get a vaccine.
	by sometime next year.
	Wouldn't that be a more realistic way to go about explaining to people what exactly we are doing than the way that has been generally explained, which seems sort of vague?
	It's almost as though, well, you know, we're going to flatten the curve and then everything is going to go away by September.
	And that does lead to some pretty significant questions about the modeling.
	Yeah, well, I mean, if you listen closely, I think it has been said by the White House Task Force, at least, and Fauci specifically, as well as Dr. Birx, that there is an anticipated second wave, if you want to call it, or it is being thought of as, OK, if you want to call it, or it is being thought of as, OK, we're probably going to get this somewhat like the flu in terms of seasonal, So,
	So the real direction of health policy in this is twofold.
	It's not just not overwhelm the health care system.
	It's number one to save lives, to protect the people who are going to die.
	And when we look at just looking at the New York data, OK, New York data alone, Something like 1.5% of deaths are in people without any previous underlying condition.
	Okay, so that's very impactful on the decision-making because we know who's going to die.
	There are exceptions.
	No one's saying there's no exceptions, but exceptions don't disprove the rule.
	So the number one goal is to stop people from dying.
	The number two goal is to make sure that we don't overwhelm the system so that we can take care of sick people and so that we don't endanger our health care provider network of doctors and nurses and respiratory therapists etc.
	And so that to me I think the appropriate policy is to have Isolation of the people who are vulnerable.
	I mean, in a very strict way, making sure that people understand that there is a strategic isolation going.
	That is the vulnerable and the people who interact with it.
	People who are sick, everyone who's sick absolutely must assume, with or without testing, they should assume they have the virus and then proceed in an isolation mode for the two weeks that are recommended.
	And number three, a prioritization of testing.
	So that means who should be tested?
	People who are in the hospital, who have the symptoms and are sick, make sure they have, they do or do not have this so they can be isolated.
	People that are interacting with older people, like nursing home workers.
	People in the healthcare profession.
	This is the... that are taking care of patients.
	These people need to be tested.
	It's not true that there's this urgent, equally urgent need to test everybody immediately.
	That is not really... that's a bad message, I think, to send out.
	And the second thing to understand is that if you're sick and otherwise healthy, you don't need to go in to seek medical care.
	You can call your doctor, but if you just have a mild fever or cough and you don't have shortness of breath or high fever, you should assume you have the virus and stay home.
	That prevents overwhelming of the system.
	There is no urgent need for testing of people just out of curiosity or fear.
	We should, if you're sick, again, assume you have it, be isolated.
	The goal here is to really stop the people from getting it who are vulnerable.
	There is a topic that I think is worth knowing about, which is this idea of herd immunity, which means that there's a societal benefit to have people who have the disease, meaning our carriers, sort of get it and develop their own immunity.
	And the more people that have that, the virus ultimately does disappear as is the case for every other virus that we encounter.
	And you know, the other part of the equation that I didn't mention is that we should not underestimate the work being done on the drugs.
	that are being used in clinical trials.
	And we will start seeing results this month, meaning within a couple of weeks, perhaps even within one week, I've been told by one of the big companies being testing, testing the drug in clinical trials.
	And these drugs, the intravenous drugs by, for instance, the Gilead drug is a life, if it works, And there's plenty of reason to believe it will work.
	There's no guarantee.
	It's not proven.
	But it did work in other coronavirus models previous to this.
	In animal models, it does have safety profiles proven already.
	In fundamental biology, it should work.
	And if it works, it will save lives.
	And the other drug that we hear a lot about is the hydroxychloroquine with or without the antibiotic azithromycin.
	And there is fundamental biology.
	It's not just some sort of strange anecdote report.
	There's fundamental reasons on the mechanism of action of the drug, why this will work.
	And so I think that's another cause for optimism.
	It's not a steady state here.
	We're not where I believe there's reasonable optimism to be held that we will be able to treat the disease.
	And given that over time, That changes what happens next in terms of, let's just say this comes back next January, February.
	Okay, by then it's very possible we will have drugs to prevent people from dying.
	And that changes the whole equation.
	So how would you rate the federal and state response so far, Dr. Atlas, in terms of responding to this thing?
	Obviously, there were shortages of ventilators in New York.
	The government, on a federal level, had been warned for 15, 20 years that they needed to be producing more ventilators.
	The mask stockpile was not renewed.
	But how would you sort of rate various responses from state and federal governments on this thing so far, considering it is a Black Swan event?
	Yeah.
	OK.
	I mean, the first, before I even comment, I would say that there is no scenario whereby a health care system would not be overwhelmed by a massive need.
	If, for instance, if 200 million people needed a ventilator tomorrow, that's just not going to happen.
	That's not realistic.
	We're not going to be sitting there with hundreds of millions of these machines.
	It's just it's unrealistic and sort of silly to contemplate that.
	I would say that there is, you know, a good but imperfect response.
	I mean, the first issue was Uh, knowing as soon as possible that there was something serious going on.
	And that was imperfect.
	And it was, uh, it was imperfect by our, by our government and by our officials, because we didn't have the information and we assumed we did.
	And if you look at the quotes by somebody who's really been fantastic, which is.
	Dr. Fauci in the end of January, he was saying there's no problem here.
	You have to realize that the president, and luckily for us, the president and the government officials are not winging it here.
	They're going by what they're told from public health and other experts.
	So, you know, decisions were made based on flawed information and that information was really, frankly, lies coming out of China and a lot of obscuration of what happened.
	So no one in the world was prepared.
	But I think we did implement a pretty quick, I think President Trump implemented a pretty quick travel ban on incoming China flights.
	That was good.
	I wish there was a stronger and quicker response to bans on incoming flights from other centers of the infection, including Europe.
	It's hard to do.
	I think that the response of our system has been Uh, I think very good.
	And I would say that, uh, given that, okay, I'm not minimizing it.
	People are dying.
	Probably tens of thousands of people.
	That's a huge tragedy, but not everything in retrospect, uh, is, is that it was done wrong.
	Certain things are insurmountable.
	Uh, I think we implemented the right policies to try to at least immediately capture the kind of containment mode of isolating.
	Given we're not a society where we're going to put people in jail and bar them in their homes with physical barriers, I mean, we're a little bit different than some of the other societies, but I think our response has been good with that.
	We have fantastic experts working on this.
	Tremendous amount of uncertainty.
	You know, models are fallible.
	People are fallible.
	I think our numbers of capacity for critical care beds is the highest in the world.
	per capita, and particularly per capita of people vulnerable to die.
	Okay, when you look at the data, which I have, and you calculate it, we have anywhere from two to ten times what every other country has.
	Okay, we're not sitting there with our pants down, having an inadequate health care system.
	It's just that this is a very, very urgent situation.
	In terms of ventilators, I mean, yes, you know, it's a common Concept that, okay, we don't have enough ventilators.
	On the other hand, I think we are short in the hot spot of Manhattan.
	There's no question.
	But we're mobilizing.
	We have a very nimble healthcare system compared to other systems.
	I'll give you an example.
	CMS just authorized, waived a lot of rules on ambulatory surgery centers.
	Uh, which we have, which are mainly private.
	They're not government run.
	And we have 5,800 ambulatory surgery centers in the country, by far more than any other country.
	And why is that important?
	Because A, those places have ventilators.
	Let's just say on average, the estimate is five per ambulatory surgery center.
	That's 29,000 ventilators right away that have been freed up because elective surgeries and elective uses of those centers have been stopped.
	Other countries can't do that.
	We can shift and move around things very quickly, and we are.
	And we've relaxed rules on ambulatory surgery centers, by the way, for healthcare providers for admitting people for more than 24 hours, which was forbidden before.
	We've relaxed rules on the use of nurse practitioners and physician assistants to prescribe medicine.
	to do things that they're capable of but not really authorized to do in a normal circumstance without physician input.
	We've authorized distance monitoring of patients.
	So, I mean, there's a lot of things being done that we can do and have done and are doing because we are a nimble, non-government centralized healthcare system.
	I think we're, you know, we have a lot of problems because it's a very difficult new virus to deal with.
	We have the most innovative system in the world.
	Our system has the appropriate incentives in place for drug development, for vaccine development, and our private entrepreneurs and private sector medical technology system, which is by far the best in the world in terms of just quantity as well as quality, is working very well on this.
	Our FDA is streamlining, I think, you know, tremendously in getting through new approvals, new drugs, new clinical trials.
	I mean, there's so much going on that people don't realize and I'm very confident that this A is temporary, biologically speaking.
	That's just simply factual.
	But B, I'm optimistic that this is going to be controlled and we are going to get back to work and less and less people are going to die because of the way our system operates.
	Last question on the death rates and the models.
	So we've seen models that suggest anywhere from 36,000 people to 2.2 million people dying in the United States.
	Where do you think that, given the measures that are currently being taken by states and that probably are not likely to let up, I would say, at this point until May, it seems is sort of the common denominator, where do you think that those numbers end up over the course of, say, a year?
	Yeah, I mean, it's obviously impossible to predict, but I would put it this way.
	When you look at the models, they've been coming down significantly from the original models.
	And there's a reason for that.
	The original models were worst case scenarios, and they assumed that nothing was being done.
	We know that this isolation works.
	So when you look at the model that the government is really using, which the sort of average of the range of prediction in that model by Murray and others is roughly in the US, maybe 80,000 or so deaths, which is
	dramatic and huge and tragic for all the reasons that of course we know with the range of really being in the order of 30 to maybe a hundred and some thousand and so my guess as we proceed and again you know nobody really can predict is we're going to see more and more cases by virtue of more and more testing and by virtue of spread also
	We're going to see a lower and lower fatality rate on the order of under 1%.
	I think that's highly likely, if not already proven.
	And we're going to see, you know, I'm hoping we see tens of thousands of people die in the United States as a maximum.
	And the perspective on that Can also be ascertained from looking at the modelers, a different group of modelers who came out with this first estimate that you mentioned, 2.2 million in the US, 500,000 in the UK.
	They changed in three days to saying 20,000 in the UK instead of 500,000.
	And so the models are fluid.
	This is not a criticism of the modelers.
	This is understanding that the, the inputs are really making all kinds of assumptions and those, those inputs change dramatically.
	I want to put a little bit about perspective on deaths, and this is not at all to be minimizing anything.
	I don't want any viewer to interpret this as a minimization.
	But when you look at the number of deaths from the flu every year in the United States, we have between 30,000 and 60,000 people die in the U.S. 30,000 to 60,000 people die in the U.S. every year.
	every year from the flu.
	600,000 people in the world die from the flu per year, roughly.
	And so it's a tragedy.
	It's horrible.
	But we do have to realize that if we get out of this with under 100,000 people dying, it's It could have been a lot worse and was projected to be a lot worse.
	And we will move forward.
	This will end.
	Dr. Atlas, I want to do a quick lightning round with you.
	Five questions specifically.
	If you have to set an end date for this particular crisis, when people start to go back to work, what do you think the end date is when people start to go back to work here?
	OK, it's a guess, but I'm thinking there's going to be a re-entry into the workforce sometime early summer.
	What do you think America is going to look like six months from now?
	Do you think we're all going to be wearing masks?
	Are we all going to be socially distancing still?
	Are all the concerts and the sports leagues going to be closed still?
	What do you think America looks like?
	I think we're going to have some sort of new normal, which might involve some sort of testing before group events.
	I could see that happening.
	I think many people wear masks.
	It's their choice.
	I'm not a, I don't think there's sound medical evidence to use general population masks.
	And I do not think that that warning, by the way, was absent because of some kind of shortage.
	That's not the reason it's medical science.
	So I don't think that, but I think a lot more people will be wearing masks.
	I think we're going to be more prepared.
	This has really heightened the alert.
	We're going to see another one.
	We've seen, this is the third since 2003, 2004.
	There's no question we will see another one.
	I think this is really going to be much, we're going to try to be more prepared.
	We're going to learn from this.
	Not just with vaccines, but technology to generate new drugs and vaccines, the infrastructure.
	And also, and I'm involved with a big effort now, making sure we understand that health security is national security.
	How should we treat China after all of this, considering the lies that they told, considering the fact that if they had let everybody know what was going on, that we'd probably prevent, according to some studies, 90% and 95% of all casualties from this thing?
	How should the world health community treat China?
	You know, I think that China, I think this sort of opens people's eyes.
	I hope it opens people's eyes to what the economists have known all along, which is that their economic numbers are not to be believed.
	This is clearly nothing they're saying about how many cases they have or anything is to be believed.
	They did something really heinous here in covering this up.
	I think China has really lost a tremendous amount of credibility in the rest of the world.
	And I think that changes their position tremendously.
	And by the way, I think a lot of other countries will be understanding they cannot depend on China for a lot of things, including And finally, the measures that we're taking now on a personal level, the sort of social distancing, no handshaking, staying away from elderly people more.
	Are those going to be temporary or do you expect those to be permanent?
	I think those are going to be temporary.
	I think we'll be more conscious of things and we'll be conscious of it just like we have been in the past with the flu, getting flu immunizations.
	Everyone should get that.
	Everyone will get these immunizations.
	I think there'll be a new normal, but it will fade into a near normal.
	Well, Dr. Atlas, really appreciate your time and your insight.
	Thank you so much for your hard work and stay safe out there or in there as the case may be.
	Okay, thanks very much.
	Now that we've heard the public health perspective, let's turn to the economy.
	Bringing us the economist's point of view is Mohamed El-Erian, the Chief Economic Advisor to financial services company Allianz and President-elect of Queen's College at the University of Cambridge.
	He's the Senior Advisor at Gramercy and Professor of Practice at Wharton.
	He's an opinion columnist for Bloomberg and has authored The Only Game in Town and When Markets Collide.
	Well, Mohammed, great to see you.
	I'm glad that you and your family are safe.
	Thanks so much for joining us.
	So let me start by asking you about the sort of balance that we have to draw between public health and economic need.
	There's this weird dynamic that crops up mostly on Twitter, where one side of the debate suggests that the economy is real life and therefore we should sort of ignore the public health warnings.
	After all, is this worth losing?
	Tens of millions of jobs and tens of trillions of dollars.
	And on the other side, you have people who are saying, if we even save one life, then we have to all lock down for the rest of time.
	As an economist, how do you determine where exactly these sorts of lines should be drawn, how we create these balances?
	And thank you, Ben, for having me.
	Look, there is an inherent contradiction, and that's why you get what you mentioned, an inherent contradiction between what this phase of the health policy is social distancing, separation, isolation, and what the economy is wired for.
	And the economy and society are both wired for connectivity, integration.
	So there is this tension that's playing out, and understandably so.
	I think you have to think about this sequentially.
	It's not an either-or, it's just a sequence over time.
	Priority number one is to get control of the virus, contain its spread, treat the ill better, and hopefully increase immunity.
	Until we get the first two things done, it's going to be very hard to restart this economy without going into a W. You start, and then you have to come down again.
	And we don't want a W. Having said that, we have to protect the economy.
	And this stage is about relief, about containing the damage.
	And there'll come a next stage, which is going to be about trying to return the economy to some sense of normalcy.
	So I want to ask you about the relief measures that have been taken in just a second, but you've been looking at the same models that I've been looking at, you know, the models from University of Washington or the Imperial College models.
	And one of the problems I have in looking at the models, especially when we're thinking in terms of the economy, is trying to figure out when people go back to work is pretty difficult when these models end in August.
	Nobody seems to be taking into account what happens in a second wave.
	Nobody seems to be suggesting what level of medical capacity will have to be in September in order for us not to go back into that W-shaped lockdown that you've talked about.
	And so it makes it almost impossible to determine at what point we have a metric of success.
	From an economist's point of view, what would a metric of success look like such that we could have a permanent return to the workforce for at least a segment of the population?
	So, Ben, you've zeroed on an issue that's going to come up, I suspect, in everything we discussed today.
	Which is we don't know.
	There's lots of things we don't know.
	We are learning as we go along.
	This is a shock that was unthinkable.
	If you happened like me when I was young, when I was your age, I worked on a fragile and failed economy.
	I saw what that looks like.
	Most people haven't.
	And we've never seen a sudden stop hit us at a level of the country as a whole, let alone the global economy.
	So we're learning in crisis management mode.
	We are basically trying to keep a plane in the air while trying to build engines and figuring out what to do with it.
	So this is really hard.
	I don't know what the answer is.
	I don't think anybody knows what the answer is.
	The key issue here is to have an open mindset, to be able to make trade-offs, and to be honest about the trade-offs we're making.
	Because we're going to make some trade-offs, and we're going to make some mistakes.
	I want to talk about how long, realistically speaking, from an economic perspective, we can last like this.
	So we've had a full-on economic stop globally.
	I mean, the United States, we're going to see unemployment rates like we've literally never seen in American history.
	We're going to see people thrown out of their jobs.
	It's going to give the lie to the myth that companies somehow have safes full of cash in their back rooms that they're just withholding from their employees, because everybody's going to go basically bankrupt within the next few weeks, because it turns out that's not how companies actually operate.
	How long can we just keep floating along on basically taking out a credit card when nobody is going to buy our debt?
	I mean, it's basically a bunch of countries that are selling their debt to each other at this point.
	How long is that sustainable before you start to see shortages, before you start to see No underlying economic activity have the sort of permanent significant impacts on the economy that we just can't recover from.
	So first, it's going to be horrific.
	It's going to be worse than anything we've ever seen.
	And there's no hiding this.
	And we have to be honest with the American people that we are facing a very difficult economic outlook that will make the sense of health and security feel compounded by economic insecurity.
	And I wish I could have another message, Ben, but that's the reality.
	Already we've seen 10 Now, the good news is relative to every other country in the world, we can manage this awful journey a lot better.
	Not smoothly, but a lot better.
	Why is that?
	we decide to sacrifice the health issue.
	Now, the good news is relative to every other country in the world, we can manage this awful journey a lot better.
	Not smoothly, but a lot better.
	Why is that?
	Because we are part of a neighborhood that's being hit hard.
	So we have better capacity to avoid the things you said, Shortage.
	Avoid temporary problems becoming permanent ones.
	And we've got to get money to people quickly.
	Now we're going to make trade-offs that you and I don't like.
	I can tell you right now, we're not going to like what we're going to do.
	But in crisis management, you've got to contain the crisis first and then try to clean things up.
	We have that ability, but it's not going to be perfect.
	There's going to be a lot of casualties out there.
	And then you and I should talk later.
	This is not just about winning the war.
	And it is a war.
	This is also about winning the peace.
	And what we learned in 2008-9, that if you don't win the peace, you come out fragile.
	And we've got to avoid that.
	So let's talk now about the relief efforts that have been attempted here.
	So Congress obviously passes the largest spending package in the history of the world, $2 trillion.
	The Federal Reserve is injecting another $4 trillion into the system.
	So for folks who don't understand exactly what Congress did here and what the Federal Reserve did here, what exactly did Congress do?
	What exactly did the Federal Reserve do?
	So the Federal Reserve tried to stop, and so far has been successful, a crisis that originated in health and paralyzed the economy from creating a financial crisis.
	We came this close, this close, Ben, on a Monday, two weeks ago, to having both a 1930s-like depression and having a 2008-like global financial crisis.
	We came this close.
	And the Fed simply had to flood certain segments of the market because the Treasury market, the senior market, the mother of all markets, the most senior market in the world, was dysfunctional.
	And that means that the pipes were clogged.
	I know we don't pay attention to the pipes, and many people watching this will say, I don't know anything about the pipes.
	But you know in your house, when the pipes are problematic, you have a major problem.
	And we came this close to the pipes clogging.
	That was the Fed.
	Congress and the administration are trying something else completely.
	They're trying to stop short-term problems from becoming long-term solvency issues.
	Let me give an example.
	A company right now cannot sell anything.
	If you're a restaurant, if you are cutting hair, whatever, you have no earnings.
	It doesn't mean you can't cut hair in future.
	It's just you can't do it now.
	It's a liquidity problem.
	If you don't deal with your liquidity problem, you go bankrupt.
	And what happens when you go bankrupt?
	Lots of bad things happen and the productive capacity of the whole economy contracts, which means we hit ourselves now and we hit ourselves in the future.
	That is what Congress and the White House are trying to do.
	It's not easy because Many pipes aren't there yet.
	So when we talk about the Federal Reserve buying up commercial paper or backing bank loans, it seemed to me one of my recommendations early on was that the first chief response here should be to prevent the banks from being forced to call in all of the loans, from being forced to call in the mortgages, from seeing the sort of stuff we saw in 2007, 2008.
	Instead, it looks like the government is going to start floating basically direct loans to businesses as opposed to via banks.
	Do you think it would be better to go via the banks, or do you think that it would be better to start giving out direct loans via the government, as some have called for?
	So both, okay?
	And I think the banks are under pressure not to do what you said.
	And they have been provided massive relief.
	Massive relief.
	They have had constraints on them taken off.
	I can go through them, but they're very technical.
	And there's no excuse for the banks not stepping up to their responsibility.
	And I think they really want to be part of the solution, because they were part of the problem last time around.
	And when it comes to the possibility of inflation, a lot of people have been worried deeply about what comes due on the other end of this.
	So obviously, we've been spending out of control for literally decades at this point.
	We just added $6 trillion, presumably, to the national debt over the course of about three weeks here.
	The appetite for debt out there has to be fairly low, considering that literally every other country in the world is incurring its own set of debts.
	So is this going to be a situation where the United States is either going to have to radically raise taxes two years from now, or where we are going to have to radically inflate the currency?
	So there's three issues here.
	First, the inflation risk.
	Yes, it is going up.
	This period we've lived where we haven't had to worry about inflation, and to the extent that the policymakers did, it was because inflation was too low.
	That has gone away.
	We are going to have high inflation coming out of this.
	That's part of winning the peace, is understanding that we have to deal with this.
	And why?
	Because when we restart the economy, which we'll do, You and I will want to buy things much faster than they will be available.
	So we're going to put pressure.
	Demand is going to recover before supply does.
	So we're going to have inflation.
	Second issue.
	No, we're not going to have a problem selling the debt.
	You know, I call it the cleanest dirty shirt.
	You and I are, you know, anybody's on a trip.
	The trip is extended suddenly because the airlines don't fly.
	We can't get to a laundry.
	We've got to wear a shirt.
	We're going to wear the cleanest dirty shirt.
	We are the cleanest dirty shirt by far in the world.
	So we will be able to sell our debt.
	We have the reserve currency.
	However, we are going to come out of this with a really deep entanglement of government and private sector activity.
	It will be a spaghetti ball bet.
	You and I are going to be talking about this.
	It's going to be a messy spaghetti ball because all these things are being done ad hoc.
	So, can you talk a little bit about that?
	What specifically, give an example, do you mean by that sort of entanglement that we should worry about?
	Because I think there are a lot of people who are fiscally conservative, like I am, who say, well, my goal, as soon as the thing is over, is to get government the hell out of this as fast as humanly possible, since government Obviously did a terrible job preparing for it.
	And then I sort of believe the government is a giant lumbering idiot.
	And that doesn't mean you don't need a giant lumbering idiot every so often to intimidate people to stay in their homes.
	But it does mean that you want it out of a more nimble private sector as fast as possible.
	What's that entanglement look like coming out of this?
	So let's take bailouts, okay?
	That's a perfect example.
	So we've already identified Boeing and the airlines as recipients of bailouts.
	We did so because they were at the front end of this process.
	There was this notion that they're exceptions.
	They're not exceptions.
	They're leading indicators, right?
	Every sector I know, except for a few, are having a simultaneous destruction of consumption and production.
	So the line for bailouts is going to be very, very long.
	So if you embark on a bailout strategy without having clear principle who you're going to bail out, why you're going to bail them out, how long for, on what term and what the exit policy is, you end up with a spaghetti bowl.
	And the danger is... Now, what is that spaghetti bowl?
	OK, so Boeing survives because of government help.
	So what's the government's claim on Boeing when they recover?
	How long should the government be an equity holder in Boeing?
	Where should it be when it's to other equity holders?
	None of this has been discussed, and this has got to be sorted out.
	Would it be better, in your opinion, to avoid that sort of spaghetti ball if the government were just providing basically zero-interest loans to these firms as opposed to trying to grab chunks of them?
	We saw Boeing actually turn down the possibility of government ownership in a stake.
	They said, we'll fire people before we allow the government to run our business.
	If you're trying to encourage businesses to keep people employed, one of the questions I've had about the bill that Congress passed is the interference in how businesses are run, the idea that if you're a small business, that we are going to float you a loan specifically so you can maintain your employment base.
	But as you said, there is literally no market for your employees to cater to.
	So would it not be better for the government to provide zero interest loans to companies via banks that can assess risk and then to just increase the unemployment insurance on the other side so that we are not actually providing incentives for companies to keep people on the payrolls?
	And then the minute that this thing ends, fire everybody, which is presumably what will happen because the market is not going to recover simultaneously with the end of this pandemic.
	So they're trying to stop that by saying if you keep them on, some of your existing loans you're going to get are going to be...
	Forgiven.
	But your way is a critical point.
	If I was to play it again, you know what?
	The Monday morning quarterbacking is really tempting, but I've been in crisis management situations.
	You are making decisions with imperfect information, and you're making it up as you go along.
	And that's what happened with this $2 trillion package.
	And having a T ahead of the rest of it makes us really worried, because that's a really large number.
	It was unthinkable just three months ago.
	Look, you raise two issues that I wish in the next phase, because there will be a next phase, implementation, we think about.
	One is incentive alignment.
	You talk about incentive alignments.
	It's really important to us to align public and private sector incentives.
	And the second one that is as important when you do this is behavioral science.
	Understand how people respond.
	And neither of these things have informed enough The design of the program for understandable reason, but they must inform the implementation because we are going to learn as we go along and we have to have an open mindset.
	I keep on telling people, when you deal in massive uncertainty, you're going to make mistakes.
	No one wants to make mistakes, but you're going to make a mistake.
	Make sure you can learn quickly and correct it.
	Most mistakes are recoverable.
	It's the failure to learn from this mistake that makes it non-recoverable.
	And we must avoid that then.
	So you're warning for years that use of central banks as the as the chief policymakers in finance was going to be a large scale mistake because governments were basically avoiding their responsibility.
	We had already brought the interest rates down to extreme lows in the United States, even leading up to this, which meant that there was just less water in the hose.
	Now, there may have been enough water in the hose to forestall something for the moment, but looking forward to the future, is that failure to abide by actual policymaking across countries, not just in the United States, but in Europe as well, and the overuse of central banks as chief policymakers, has that watered down the ability of central banks to do what they need to do, and is it going to make the recovery a lot steeper on the other end?
	Yes, and yes, and it's really unfortunate because this was an avoidable mistake.
	You know, I wrote this book in 2016 called The Only Game in Town, and the last bit of it was avoiding the next collapse.
	And I argued then, and an update of the book is coming up, I argued then that within five years, we will come to what I call the T-junction.
	That the path we were on, that relied only on central banks, would plant the seeds of its own destruction.
	And then we would have to make a choice, turn towards better policy, genuine growth, genuine financial stability, none of the artificial stuff that we've done, or alternatively, recession.
	and financial stability.
	And I argued that the vulnerability to a shock was very high.
	I never imagined the shock would be as big as this, Ben.
	Never imagined.
	But now it caught us weak.
	It caught us fragile.
	Our ability to recover is going to be less strong because of that.
	And that's what I meant about coming out of the global financial crisis.
	We didn't win the peace.
	We just won the war.
	We didn't win.
	And this time around, we've got to be much more thoughtful.
	You and I can talk for the whole show about how different the post-crisis landscape is going to look like.
	Let's prepare for it now.
	So let's talk about that.
	What will the post-crisis landscape look like, and how exactly do we prepare for it?
	There was a lot of talk early on when this first broke that this was going to be a V-shaped recovery.
	OK, so everybody loses their job for a month, and then we all go back to work.
	And it's basically summer vacation, except paid for by the government.
	But obviously, that is not the case.
	There are going to be some permanent landscape shifts in how the economy works.
	I mean, at least for the next year, restaurants, the entertainment industry, movies, sports, How office buildings work, all of this is going to change.
	What does the post-crisis landscape look like, and how do we win the piece?
	So I have a piece of paper here where I keep on writing down how a difference is going to look.
	I ran out of one side, I started the second side.
	We're going to look very different.
	Very different.
	If you're a company, you're going to swing from efficiency to resilience.
	You're going to say, forget all about this just-in-time inventory management.
	Forget about these globalized supply chains.
	I want to increase my resilience.
	So we're going to de-globalize the world.
	Households are going to become much more cautious.
	They are going to increase their precautionary savings.
	So we're going to see a change in household behavior.
	We are going to see a change in work practices.
	You just mentioned some of them.
	We're going to see a change in so many things we do.
	Institutions are going to come out of this battered.
	Our trust in the establishment is going to be even weaker after this.
	So there's going to be lots of things.
	We are going to have massive debt.
	We would have lowered our productivity because we're going to rewire the economy.
	And when you rewire the economy, productivity goes down.
	So our ability to afford that debt will be less.
	Central banks will have massive balance sheets that we need to deal with.
	Just to give you an example, in two weeks alone, we've increased the balance sheet by over a trillion dollars.
	And like you said, four trillion expansion is on the cards.
	That is incredible.
	So it is a very different landscape.
	We can manage it, but we have to plan from now.
	The aftermath of the crisis is going to be as important as what seems pretty horrible now.
	So how do we plan for stuff like that?
	So to take for an example, you mentioned the breaking of global supply chains.
	Now, there are going to be a lot of firms that look at China, for example, and say, we're not locating there because of what just happened.
	But presumably, there will be one or two firms that say, OK, well, the reward is worth the risk.
	I'm going to undercut my competitors by continuing to manufacture from China and hope that for 5 or 10 years, there's not another wet market outbreak like this.
	And so without any sort of government measure that prevents people from undercutting one another by taking that riskier supply chain line, Are those changes going to be permanent, or is the institutional memory here going to be short?
	So I think it's going to be permanent.
	And again, we all have a role to play.
	The last thing you and I want for our kids is the notion that any company is international when it makes profit and national when it fails.
	Because it means that when it's making profit, everybody else benefits.
	And when it fails, They come to us, the taxpayer, okay?
	So there has to be incentives to stop people abusing this notion that you can be international when everything's going well, and then you become national when things go badly.
	So we can do this.
	Again, these are about tax incentives.
	We can do this.
	We just have to realize that that's the world we're going into, and we have to stop the abuse that you talked about.
	So let's talk about the stock market for a second.
	You've mentioned before you were ahead of the curve, as you very often are on this sort of stuff.
	When the stock market started to drop and people were saying, now's a great time to buy, you were saying, well, wait a second, because it's going to drop some more.
	How far do you think the stock market is going to drop?
	You don't have to put a number on it, but how long do you think it's going to drop?
	Given the uncertainty, have we reached sort of baseline uncertainty and now the news starts to get better?
	Or do you think that the uncertainty continues for months and months and months?
	And is this a buying opportunity or should we all just sort of So I think it's the latter.
	I think it's still time to be very cautious.
	And I've gone out of my way through my social media and my publication to try and increase the amount of information going to retail investors, small investors in particular, because the tendency of this industry is to tell you, buy, buy, buy, buy, buy.
	Because they make fees when you buy.
	Look, go back to the uncertainties.
	We are just about understanding the severity of this shock.
	We had no idea about this duration.
	We don't quite understand in the marketplace that it's going to take time for the relief measures to work.
	We certainly haven't incorporated in the marketplace that the restart isn't about turning on a button, turning on a switch.
	And none of these things that you and I have talked about, about the post-crisis landscape is priced in.
	So we are still at an early phase.
	I tell people, expect volatility around a declining trend for now.
	And realize that in such an uncertain environment, you're gonna likely make a mistake.
	No one wants to make a mistake, but you're gonna make a mistake.
	Ask yourself, what mistake can you afford to make?
	Is it missing the 5% jump immediately when the bottom is formed?
	Or is it avoiding another 10 to 15% drop?
	Regret minimization, in my mind, is what should lead So you mentioned earlier there may come a time when we have to make hard choices with regard to the economy.
	Too late back into the market, then too early.
	So you mentioned earlier there may come a time when we have to make hard choices with regard to the economy.
	That right now we can afford to take the public health hit based on the modeling, that we can all hope that the summer kills this thing off, that we have measures in place by September.
	But it's pretty obvious that we can't do this indefinitely.
	We're already starting to see some rioting in southern Italy.
	We've already seen talk about the EU breaking up and we're only a few weeks into this thing.
	One of the things that's been bothersome about some of the experts in public health talking about this sort of stuff is the models they put out there.
	We'll assume things like we're all going to remain home for the next year or 18 months, which obviously is not true.
	So when does, economically speaking, the pedal hit the metal?
	When does it basically make or break point where if we don't at least start getting people back to work, then the house of cards completely collapses?
	Is there a point where we basically have to say if it's a choice between the economy and public health, we just have to choose the economy or there will be no more economy left to choose?
	So everybody will tell you being risk-averse doesn't mean not taking any risk, okay?
	It means taking calculated risk.
	And we do this all day long.
	We take calculated risk.
	When we cross the street, we take a calculated risk.
	If we were completely risk-averse, we wouldn't even cross the street.
	So at some point, we're going to get to a stage where you're going to have to take a calculated risk.
	In my opinion, it's going to be when we have gotten control, we've understood how this virus spreads.
	It's going to be when we have testing facilities out there.
	When we are better at identifying who has it.
	And finally, when we can treat the ill better.
	When we have ventilators, etc.
	When we get to that stage, we can start talking about taking calculated risks.
	And we're going to have to.
	Because you're right.
	If we shut down the economy for a year, for two years, the cure is going to end up being just as bad as what got us here.
	Because when you shut down the economy, it's not just about economic insecurity.
	It's about Domestic violence.
	It's about social unrest.
	It's about all these other things that we also have to take into account.
	We're not there yet, and we have time, but if we don't get our arms around this horrible virus, we're going to have some pretty nasty trade-offs.
	My great fear is that now's the time when we should be listening to experts, but it's also a time when experts are able to provide us less information than any other time.
	So we have this sort of backwards behavioral problem, which is we have to listen to the experts to stay home, but they can't provide us enough information that causes us to stay home other than providing these sort of very big top line numbers.
	And when you say to people, stay home indefinitely, and meanwhile, people are losing their jobs, I wonder how long that can last indefinitely speaking.
	I mean, I wonder if six weeks from now, when the checks still have not arrived, and when people's bills are still due, whether they just say to the experts, listen, you're not even providing us an end date here.
	You can't tell people to diet indefinitely.
	You have to tell them what the end date of the diet is.
	Otherwise, people start ignoring the dietician.
	And it was called adjustment fatigue, that at some point we get tired.
	And the biggest risk we face as a society is the lag effects.
	So we have made, every single American is making massive sacrifices right now.
	by staying home.
	Yes, they're trying to protect their health, but they're also losing jobs.
	Those who are employed are getting their income cut.
	So, massive sacrifice.
	And what I worry about most is because the lagged effects of the so-called curve is at least two to three weeks, at some point we are going to say, collectively or parts of us, hey, wait a minute, you mean I've made all these sacrifices and I haven't flattened the curve?
	Obviously, Leaders don't know what they're doing, and we're not going to realize that there was a lagged effect there.
	So it's going to be hard, and this adjustment fatigue is serious.
	I tell people, you've got to provide honest information.
	I don't know, Ben, if I may, but I'll give you an example.
	When my girls came home, they were really unsettled.
	So what we decided to do is every day we would sit down and talk about what's happening on the coronavirus, and importantly, what to expect.
	What to expect.
	And this notion of, I don't know for sure, but this is what I'm looking for, has helped people enormously because you give them a roadmap.
	We do not have a sufficiently clear roadmap on health and we have no roadmap on the economy.
	And we've got to share both with the American people.
	Otherwise, they do, you know, they create their own roadmaps.
	And if you're worried about the expert not being informed, we individually are going to have, you know, another spaghetti bowl of roadmaps.
	And we can't have that.
	Mohammed, I have five questions for a quick lightning round.
	So number one, how should the world treat China after this?
	Obviously, China did not shut this thing down.
	They lied to the WHO.
	If they had revealed this information a month in advance, there are some studies that suggest 95% of all casualties could have been avoided.
	So how should the world treat China after this?
	I've heard suggestions from people that I don't think are doable, like we should just cancel our debt to China.
	How should we deal with China and what sort of reparations should China be forced to pay for what has been incurred here?
	So starting with the trade war, I think we've emerged from this happy talk that China is a global responsible player.
	China is not a global responsible player.
	China does not play to the global rules.
	And we haven't held China accountable for a very long time.
	We should continue to hold China accountable and we should do it with our allies.
	But this is a moment to say enough is enough.
	We've tolerated Intellectual property theft.
	We've tolerated all that.
	We will not tolerate you being part of the export of a virus.
	So I think we got to hold China much more accountable to its global responsibilities now that we've allowed it to be part of the global economy.
	Will the measures that we are now taking be temporary or permanent?
	This is my great fear, is that people tend to use crises as an opportunity to confirm their priors.
	And when it comes to the growth of government, we've never seen anything like this in so quick a time.
	Are the measures that we are taking now expedient, or do you think that these become a permanent feature of the American landscape?
	So I, like you, worry about short-term measures becoming long-term measures.
	OK, that's why we have to think about this very carefully as we implement it.
	Look, that risk is there and we've got to collectively make sure that it doesn't reach critical mass, because if it does, then our longer term prosperity will be threatened.
	What can we do to prevent a couple of things that we can do to prevent this kind of economic meltdown next time a black swan event hits like this?
	So we need to develop three things that we haven't developed.
	Resilience, the ability to live through shocks, and that starts at the government level, the household level, and the corporate level.
	Two, optionality, this ability to change our minds as we get better information.
	Don't get stuck on an old model.
	And finally, agility.
	The good news, and I think there are silver linings, when we emerge from this, we are going to have an opportunity set.
	What do you think America will look like six months from now?
	I'm worried.
	I'm worried.
	to respond.
	It will look different, but we have the best initial conditions, Ben, to respond with agility and be able to bounce back, not fully, but certainly faster than we would otherwise.
	What do you think America will look like six months from now?
	I'm worried.
	I'm worried.
	I think six months from now, there's a big chance that our economy is still hit hard, that we have pockets of social unrest.
	And I'm worried.
	This is going to be a hard journey.
	It's one of these things, you know, it's like taking your kids on a trip.
	Even if you're going to Disneyland, if it's an 11-hour car journey, they're going to find the journey really long.
	And at some point, you're fed up with hearing, are we there yet?
	Are we there yet?
	Are we there yet?
	Okay.
	I'm afraid that that's what it's going to look like.
	The journey is going to be horrific.
	And I'm worried that our social fabric is going to be really stressed.
	Prior to all of this, obviously, the stock market was at all-time highs.
	Unemployment was at all-time lows.
	How long do you think it is before we return to those sorts of numbers?
	So, on the unemployment side, a long time.
	A long time.
	Because certain businesses aren't going to come back.
	And people are going to have to retool.
	And, you know, I'm worried about this.
	And I hope, you know, I make predictions and I normally hope I'm right.
	This time around, I hope I'm completely wrong on all these predictions.
	I hope it turns out that it is a V, that we simply flick on a switch and this is just a bad nightmare.
	But it's going to take a long time.
	And same with the markets.
	We've come from a very special period, but we're being hit with a deadly virus that's going to create permanent scars.
	Well, Mohamed, I really appreciate your time.
	I really appreciate your insight.
	Stay safe out there or in there, as the case may be.
	Great to talk to you.
	You too.
	Thank you, Ben.
	As always, folks, I really appreciate you watching and listening.
	Stay safe out there or in there, as the new phraseology goes.
	And we'll see you here next week.
	week.
	This is the Ben Shapiro Show Sunday Special.
	The Ben Shapiro Show Sunday Special is directed by Mike Joyner and produced by Mathis Glover.
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