March 19, 2020 - Rubin Report - Dave Rubin
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| It's an epidemic that's coming to us. | ||
| It's this wave, a pulse of the virus as it's spreading from person to person and growing exponentially. | ||
| And the reason that this is very important is that let's say, for the sake of argument, 100,000 Americans are going to die of this condition in the next year. | ||
| It makes all the difference in the world whether those 100,000 die over the course of the next year or whether all 100,000 die in the next month. | ||
| If they die in the next month, they're going to overwhelm our healthcare system. | ||
| And many more Americans will die than would have died if we allowed our healthcare system | ||
| and our supply chain to work. | ||
|
unidentified
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(dramatic music) | |
| Joining me today is a sociologist and physician known for his research on social networks | ||
| and on the socioeconomic, bio-social, and evolutionary determinants of behavior, | ||
| health and longevity. | ||
| Nick Christakis, welcome back to The Rubin Report. | ||
| Thank you for having me, Dave. | ||
| I'm glad to have you back. | ||
| Wish we could be doing this live, but obviously we're practicing a little social distancing right now. | ||
| With everything going on with Corona, I've been trying to find a wide array of people to talk to. | ||
| You put out what I thought was a really fantastic Twitter thread. | ||
| I rarely send people to Twitter, but you put out a great Twitter thread. | ||
| that covered this through all of the disciplines that I just read there in your bio, which are quite extensive. | ||
| So let's just start one at a time. | ||
| The two things that people have heard the most about at the moment, social distancing and flattening the curve. | ||
| Can you just explain both and why they're important right now? | ||
| Yeah. | ||
| So the virus takes advantage of the fact that we are social animals, that we assemble in groups, that we have friends, that we touch each other and hug each other. | ||
| And it uses those connections that we assemble ourselves into these networks. | ||
| It uses those connections as a highway to travel through our species. | ||
| And so the challenge for us right now is how to interrupt that highway, how to break the paths that the virus uses to travel from person to person to person to person. | ||
| The reason that's important is that this flattening the curve idea. | ||
| So we're going to engage in social distancing. | ||
| We're going to stop interacting with each other. | ||
| We're going to Keep physically apart from each other. | ||
| That's the most important thing. | ||
| In fact, I've been advocating for a shift in terminology to physical distancing from social distancing. | ||
| In other words, we can still interact socially, but from a distance like you and I are doing now. | ||
| Right. | ||
| And so we want physical distancing. | ||
| The irony is we want to bond together at the same time as we are sort of separating from each other in terms physically. | ||
| Anyway. | ||
| The reason we're engaging in that physical distancing is to cut the paths through the network, and the reason we're doing that is to flatten the curve. | ||
| What does that mean? | ||
| Well, it's an epidemic that's coming to us. | ||
| It's this wave, a pulse of the virus as it's spreading from person to person and growing exponentially. | ||
| And the reason that this is very important is that let's say, for the sake of argument, 100,000 Americans are going to die of this condition in the next year. | ||
| It makes all the difference in the world whether those 100,000 die over the course of the next year or whether all 100,000 die in the next month. | ||
| If they die in the next month, they're going to overwhelm our health care system. | ||
| And many more Americans will die than would have died if we allowed our health care system and our supply chain to work. | ||
| So we want to flatten the curve. | ||
| We've got this peak of a curve where everyone, you know, the epidemic is coming at us and it's going to hit lots of people at the same time. | ||
| Stop it from doing that and flatten the curve and push it out into the future. | ||
| And when we do that, we achieve a number of objectives. | ||
| First of all, at any given point, fewer people are sick so our health care system can take care of them. | ||
| Many more might live as a result of that. | ||
| Second, we push some of the cases out into the future so that maybe some of the people that get sick eventually will get sick at a time when we've invented a vaccine. | ||
| Or we know better how to treat the people. | ||
| So we also gain that benefit by flattening the curve. | ||
| And as I said, not only do we decompress our healthcare system, not only do we push people into the future when we might be better able to care for them, but we reduce mortality as well. | ||
| So maybe instead of 100,000 dying, maybe 90,000 die if we push it forward. | ||
| So that's why we're social distancing, and that's what flattening the curve means. | ||
| So I guess the obvious follow-up then is, do we have any evidence that the things that we are doing at the moment or being told to do is working? | ||
| Is the curve being flattened? | ||
| We cannot know yet because we have not had adequate testing in this country. | ||
| We don't have adequate surveillance like they did in China and Korea. | ||
| And so we really can't be sure. | ||
| We know that this type of behavior, this social distancing behavior, the banning of public gatherings, The closure of schools, the reduction in group size, the self-isolation. | ||
| We know that that works from other epidemics, but we cannot yet know how much it's working in the United States right now. | ||
| Because we don't have the kind of surveillance we need to see it. | ||
| So I think when people hear about social distancing, and as you called it, physical distancing, I think people are confused or worried. | ||
| What about the people that are actually in the house with them, family, kids, parents, whatever it is, that might have to go out and then come back into the house? | ||
| Yeah, that's a risk that we run, and that the Chinese ran when they locked down 930 million people in their country since January. | ||
| 25th. | ||
| So typically what you do is you try to compress all of your shopping. | ||
| In fact, Americans should begin to be doing that right now. | ||
| Instead of going out three times a week to buy stuff, go out once a week. | ||
| Compress everything. | ||
| Minimize the amount of time you're out and about. | ||
| When the person does go out, they should ideally try to wash their hands frequently, not press elevator buttons. | ||
| The Chinese have all these ingenious things where when you go into an elevator, there's like a little pincushion of toothpicks. | ||
| And you take a toothpick, you press your button, and then you discard the toothpick so that you're not touching buttons because the virus can spread on smooth surfaces. | ||
| That's called fomites. | ||
| So a person leaving the household should do that. | ||
| If someone in the household does get sick and they are tested positive, you can in principle isolate that person for two weeks from other members of the household, or in the worst case scenario, they infect the other people in the household. | ||
| But nevertheless, it's then constrained to one household. | ||
| Keep in mind that most people infected by this pathogen do fine. | ||
| The great majority of people will have no symptoms or will have minor symptoms. | ||
| Some people, however, maybe 25% overall, will get sick, and of those, maybe a fifth of those, so a total of 5% maybe of the people infected, will get seriously ill. | ||
| And then, of course, on average, we don't know exactly how many of the people who are infected will die. | ||
| And the reason, again, we don't know is we don't have good testing. | ||
| So we don't know what the denominator is. | ||
| We don't know, you know, of 10,000 people who are infected, we know that because they were tested, let's say, what happens to them? | ||
| And how many of them get sick? | ||
| And how many of them need ICU care? | ||
| And how many of them die? | ||
| We don't know that denominator accurately. | ||
| But our best estimate is that of those infected, somewhere between half a percent and one and a half percent will die. | ||
| And it is, that's a large number, but it's very graded by age. | ||
| So if you're younger than 25, your risk of death is very small, maybe 0.2%. | ||
| That's a big risk for a young person, but nevertheless, it's a small risk. | ||
| And then middle-aged people around 50 or 60, it's about 1%. | ||
| And then above 80, it's about 20%. | ||
| So it's a very steep curve with age. | ||
| Do you have a recommendation then, if you're in the household right now, and you're any of these ages, let's say you're 25, you're 50, and you're 80, let's just go with those three ages, and you're not feeling great, should you be then trying to go to the hospital? | ||
| Or I guess maybe if you're 80, you are, or just stay home and deal with it the best you can? | ||
| Yeah, in general, so in general, one of the things we all need to be very good about doing right now is giving our healthcare workers a break. | ||
| So you should not be going to the hospital with the sniffles right now. | ||
| There are a few things that Americans should do. | ||
| You should get a flu shot. | ||
| One of the reasons you should get a flu shot is not because the flu shot prevents you from getting coronavirus. | ||
| It does not. | ||
| But if you get a flu shot, it lowers your risk of actually getting the flu. | ||
| And therefore, you won't go to the hospital with the flu. | ||
| And now is not a good time for you to be burdening our health care system for your own sake or for the sake of the system. | ||
| Furthermore, going to the hospital if you're not actually sick, or if you're just mildly sick, if there are a lot of actually seriously sick people there, you might get the germ from them. | ||
| So it's not like in a hospital waiting room is not a time to be right now unless you actually need it. | ||
| So generally speaking, the symptoms of coronavirus are variable. | ||
| You should have a fever above 101.5. | ||
| It's in about 85% of people, not everyone, but most people have a fever. | ||
| A dry cough would be a symptom. | ||
| And then there's a Shortness of breath, certainly. | ||
| If you have shortness of breath and a fever, absolutely, you should go to the hospital. | ||
| And then there's a whole host of other symptoms at lower percentages. | ||
| So if you're a 25-year-old person and you have a runny nose and low-grade temperature and some muscle aches, it's probably not coronavirus, stay home until you get sicker. | ||
| That would be a reasonable choice. | ||
| If you're an older person, then you should have a lower threshold. | ||
| And ideally, if you went, we would test you. | ||
| Right? | ||
| And, but again, we don't have enough testing yet. | ||
| We're hopefully the country will get better at that in the coming months. | ||
| Yeah. | ||
| All right. | ||
| I want to keep going through this Twitter thread because you hit every, you hit it just sort of at every possible level. | ||
| So you talk about reasons to close schools, even if kids there aren't sick. | ||
| Yeah. | ||
| I mean, school closures, there's a lot of debate about this. | ||
| There are two kinds of school closures and most of the country is shutting the schools anyway now. | ||
| So this point is behind us. | ||
| I was sending out this information like three or four weeks ago. | ||
| But school closures are two kinds. | ||
| There's reactive school closure, when there's a case in the school and you close the school. | ||
| And that's pretty uncontroversial. | ||
| I mean, most parents, teachers, public health experts, there's an outbreak of epidemic in the school, let's close the school. | ||
| And it's been shown that if you do that, you lower the, if you close the schools in an area, you lower the cumulative prevalence of the condition by about 25% and postpone the epidemic by a week or two, which is good. | ||
| So reactive school closure is helpful, but you know, it's not as good as we can do. | ||
| Even better is something called proactive school closure. | ||
| When you close the schools, even before there's a case in the schools, for instance, you living in a mid-sized town, there's a case in the community. | ||
| It's something called the community acquired case. | ||
| So it's not like someone from Italy or China flew to your town, landed, had symptoms and you diagnosed them. | ||
| That would be an imported case. | ||
| Maybe you could isolate that person and self-quarantine the people who they connected with. | ||
| No, we're talking about a situation in which someone in the community is diagnosed and we have no idea where they got it. | ||
| They're like a canary in the coal mine. | ||
| And if that's happening, you can be quite confident that within a week or two, it's going to be in the school. | ||
| So why not close the school now? | ||
| Reduce the force of the epidemic by decreasing social mixing. | ||
| And ironically, even though the kids aren't affected by this condition, they still can transmit the pathogen, even though they themselves aren't sick. | ||
| And furthermore, one of the ways that school closure works is precisely because it compels the parents to stay home. | ||
| So it reduces the parents interacting with each other. | ||
| That's how it works, in part. | ||
| And it sounds like we've basically done this pretty well, maybe a little later than you wanted to, but it sounds like now we're there, right? | ||
| Definitely later than we wanted to. | ||
| And for schools that are still open, what I would strongly recommend, and my wife and I had an article in the Atlantic about this a few days ago, is if you insist on staying open, and I don't think that's the best course of action, at least You can implement a whole host of other harm mitigation strategies. | ||
| For example, give parents the choice. | ||
| If they want to keep their kids home, they should stay home. | ||
| I want to mention this because it's also relevant to employers and workers. | ||
| Allowing any worker who can work at home to work at home, it's not just good for that worker from like their selfish point of view. | ||
| It helps everybody because you reduce the number of people at the office. | ||
| So only the people that have to be there should be there. | ||
| Same with schools. | ||
| If some parents want to keep, the school should let them keep their kids home. | ||
| You can broaden drop-off and pick-up hours. | ||
| So not everyone is arriving between 8 and 8.15 to drop off their kids, bumping against each other as they come through the door, parents interacting. | ||
| Let's say you give a 45-minute drop-off. | ||
| It needs a bit more manpower on the part of the school, but you reduce the social density at pick-up and drop-off. | ||
| Cancel staff meetings. | ||
| Provide cafeteria seating. | ||
| Broaden the lunch hour and have the kids sit every other chair. | ||
| These are things that schools can do if they insist on staying open, maybe in our southern states, for instance, where maybe the virus hasn't hit so much yet, but that nevertheless are helpful. | ||
| So you sort of hit this one already, but do you want to add anything generally on how the flu spreads within social networks? | ||
| Well, first of all, we call this the flu, and there's a broad category of respiratory diseases. | ||
| Influenza, the flu, is a particular kind of virus. | ||
| This is a coronavirus, which is a little different, but I call it the flu too. | ||
| Maybe, you know, I'm lazy, you know, but this is a kind of flu. | ||
| The coronavirus, there are other coronaviruses, like the common cold is caused by about 200 different viruses. | ||
| About five of them are coronaviruses, just like COVID-19 or SARS-CoV-2, which is affecting us now. | ||
| And we've gotten used to it just to, just to cut ahead to the chase. | ||
| The ultimate outcome of this situation is that a new virus has been introduced into our species. | ||
| It's going to become what's called endemic. | ||
| It's just going to be there all the time, like the common cold, like the flu. | ||
| We hope it'll reduce in its severity. | ||
| We hope we humans will eventually slowly become immune to it and we will get sort of herd immunity. | ||
| So some people will continue to get this forever now, but hopefully at less intensity and not all at once so that our healthcare system can care for them. | ||
| Anyway, so the coronavirus, and the flu, and influenza, and other pathogens, rhinovirus that causes the common cold, these are all cause respiratory disorders, and the coronavirus is one of them. | ||
| I actually forgot your question, I'm sorry. | ||
| Oh, the question was how it spreads within social networks, which you've sort of been hitting throughout this. | ||
| Yeah, yeah, yeah. | ||
| So it spreads, exactly, across social ties, and in the Twitter thread you're alluding to, I have an animation that shows If you map a network, you can see it light up. | ||
| And one of the things that's been so difficult for people to understand, and it's a little bit related to this network idea, is that epidemics start slowly. | ||
| For the longest time, it seems like nothing is happening. | ||
| But it's in the nature of exponential growth that nothing is happening, nothing is happening, nothing is happening, and then all of a sudden, a lot happens. | ||
| And this has been why it's been so difficult for many Americans to appreciate. | ||
| They look around and they're like, Nothing's happening. | ||
| But if we monitor the situation, we see the cases are doubling. | ||
| The virus is on the loose. | ||
| We go from 10, a week later to 20, a week later to 40. | ||
| And we think, oh, there are just 40 cases in the United States. | ||
| Who cares? | ||
| Then it's 80. | ||
| Then it's 160. | ||
| Oh, there are 160 cases. | ||
| But then, before you know, we have 10,000, 20,000, 40,000, 100,000, 200,000. | ||
| And it's just on the loose. | ||
| And that's why everyone is so alarmed right now, all the public health professionals. | ||
| So that's actually the perfect segue to what your next tweet in the thread was, which is how these epidemics come in waves, and then, interestingly, how this is actually related to weather. | ||
| Yeah, so one of the things to understand about this is that probably, judging from previous pandemics, maybe 40% of Americans will be infected with this, maybe less, maybe 10 or 20%, maybe up to 60%. | ||
| With the 1957 pandemic, ultimately about 40% of Americans were infected, but it comes in waves. | ||
| So we're hit by the first pulse of it. | ||
| Typically in the summer, for a combination of reasons, including that human beings go outside, we're not as densely packed. | ||
| Maybe the ventilation outside reduces the transmission of the pathogen. | ||
| Maybe the heat or the humidity play a role in reducing the transmissibility of the pathogen. | ||
| So our behavior changes. | ||
| The biology of the pathogen is such that the temperature and humidity affect it. | ||
| Transmission tends to decline. | ||
| But then, the virus has gone to the southern hemisphere, where it's winter there, during our summer. | ||
| And then, when we return to work and school in September, it comes back. | ||
| This is a very typical scenario. | ||
| So unfortunately, it's likely, not certain. | ||
| And I need to again emphasize that everything I'm telling you today is based on the best available knowledge, to the best of my knowledge. | ||
| It's possible that a year from now people will watch this video and think I was right about this and wrong about that, and that's just the knowledge we have now. | ||
| This pathogen's only been with us for three months. | ||
| I mean, it just started, we think, in mid-December in Wuhan, and it started spreading around the world in mid-January. | ||
| It was already in Seattle by mid-January, we know from genetic analyses, and then was sort of spreading. | ||
| And now here we are, March 18th, you know, two months after mid-January. | ||
| That's not a lot of time for scientists to figure out what's going on. | ||
| So anyway, so we think it'll spend the summer mostly in the southern hemisphere, although we'll have some cases, and then it'll come back in the fall. | ||
| And in the 1918 pandemic, the second wave was deadlier than the first wave. | ||
| So in 1957, that wasn't as much the case. | ||
| So we don't know exactly what's going to happen, but then there'll probably be a second, maybe a third wave, and eventually, basically, we'll get used to it. | ||
| And it'll just sort of be there all the time. | ||
| So since you mentioned Seattle and we're talking about weather, so Seattle, it sounds like they've got a strange situation or a more severe situation going on there perhaps. | ||
| It also rains a lot there. | ||
| I'm here in SoCal where it's sunny and 70 every day, although it has been raining the last week. | ||
| I mean, could that alone, just the weather patterns like that affect any of this? | ||
| Well, the Chinese scientists have done some research on this. | ||
| We don't know, is the answer to that question. | ||
| People hope. | ||
| There are hints at multiple directions. | ||
| I do not think we're going to have a complete weather cure. | ||
| That is to say, I don't think the disease is simply going to disappear because of the weather. | ||
| The evidence is conflicting. | ||
| If I had to guess, I would say that probably we'll get some reduction in cases from the warmth and the humidity. | ||
| But it's hard to know what. | ||
| The Chinese did some analyses because their country is so large. | ||
| Where they looked at transmission all throughout China, and in some parts of China it was hot, and some parts cold, and some parts humid, and some parts not, and they kind of looked and saw where was transmission the worst. | ||
| And it seems like optimal transmission is at around 40 degrees Fahrenheit on average daily temperature. | ||
| So cold. | ||
| So when you get much colder, much hotter, that seems to be better. | ||
| Less transmission, but not zero. | ||
| And then they looked at humidity, and it looks like very dry weather is bad. | ||
| So if humidity is less than 5%, That's not particularly good. | ||
| But if you look at weather patterns for where the virus has struck so far, it seems that countries closer to the equator seem to be doing better. | ||
| So it's a mixed picture. | ||
| I don't know the answer, but if I had to guess, I think the weather will make some difference, but I don't think it'll be a definitive difference. | ||
| So I think I'm actually gonna skip the next one in the thread because you were talking about vulnerable groups, but since you're talking about, because I think we've sort of hit that already, unless there's anything else you want to add about older people or sick people. | ||
| Well, I think, yeah, I mean, I think we have to be mindful of people on dialysis, people with chronic illnesses, institutionalized people, the elderly, homeless populations. | ||
| And one of the things that's really important to understand about a pandemic is that it's the great equalizer. | ||
| We're all in this together. | ||
| Actually, the reason you should care about, let's say, the homeless or people who are chronically ill is not just because you should be kind and compassionate and altruistic. | ||
| It's actually your own selfish interest, too, because we do not want populations that are reservoirs of this pathogen. | ||
| We want to take care of everybody so we all can be safer. | ||
| This is why social distancing, even when you practice social distancing, You're actually showing kindness to others. | ||
| One of the ironies is that people think, oh, I'm going to be brave and show kindness by shaking people's hands and being out and about. | ||
| Ironically, that's not the kind thing to do. | ||
| The kind thing to do is to remove yourself from circulation so that you're not circulating the pathogen. | ||
| That's the best thing you can do for your group or your society. | ||
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Yeah. | |
| I actually didn't mean to diminish any of those groups, but because you were hitting on the China part, which was the next tweet, I was going to jump over that. | ||
| So you actually, in the thread you called it- I wasn't suggesting you were. | ||
| No, I know, I know. | ||
| I wasn't suggesting, I was just saying, I was taking advantage of the opening to point out to people, in case it wasn't obvious, why it's not just a question of compassion It's actually in our self-interest to take care of these populations. | ||
| So you talked a little bit about China. | ||
| You know, we live in this time where it's like half the people are saying China unleashed this on the world, half the people are saying China has done nothing wrong. | ||
| You called, in your Twitter thread, you called China's response astonishing. | ||
| Can you explain that? | ||
| Well, first of all, we know, we would know from genetic analyses if this was an engineered weapon. | ||
| And that's a conspiracy theory. | ||
| There's absolutely no evidence that any such thing happened. | ||
| Okay. | ||
| And so they certainly didn't release it deliberately and because they're killing their own people and because of the study. | ||
| So that's ridiculous. | ||
| No, what I was describing is China, because of its totalitarian or authoritarian rather government and its collectivist culture, was able to put 930 million people under a kind of home-based quarantine Beginning January the 25th, for like eight weeks. | ||
| Never in the history of public health has so many people been under such restriction for so long, to my knowledge. | ||
| It's unbelievable what they were able to do because of their culture and their government. | ||
| And I call this a social nuclear weapon because it gives you a sense of what they were fighting. | ||
| You know, the power of this pathogen that they were confronting, that they resorted to this. | ||
| China did not decide to do this for fun. | ||
| And what I was trying to communicate with that thread that was now weeks ago was to try to get attention in the United States. | ||
| Like, look what's happening in China. | ||
| This is not going to just stay there. | ||
| This is not like a Chinese problem that's, you know, they've decided to put a billion people under home arrest, you know, for two months for fun. | ||
| We need to prepare. | ||
| We need to think about this because the virus is going to reach our shores. | ||
| In fact, already when I was writing that, it had reached our shores. | ||
| This is what happens in pandemics. | ||
| No matter where the disease starts, it spreads around the globe. | ||
| And by the time you're aware of it, even if you're aware of it 30 days after inception, it's too late. | ||
| Given movements of people, even frankly 100 years ago, given movements of people on steamboats and on trains and big compact cities, the virus spreads. | ||
| So anyway, I was trying to describe what the Chinese had done. | ||
| And it is astonishing what they did. | ||
| And they have brought down their cases in a country of 1.4 billion people to, you know, under, under, now it's like, I don't even know, it's like 10 cases a day or something in the whole nation. | ||
| So this is unfortunately what we are facing in our country. | ||
| And we have different strengths and different weaknesses compared to China. | ||
| One of their weaknesses, we have an open, a commitment to free and open expression in our society. | ||
| And in China, unfortunately, the doctor who first tried to sound the alarm, Dr. Wenliang Li, he was brought in on charges of rumor mongering. | ||
| He was basically using the Facebook equivalent in China and messaging his friends and saying, oh my God, I'm seeing all these patients in the hospital with this particular kind of pneumonia. | ||
| I'm worried we have a new pathogen. | ||
| And the local authorities called him in and accused him of rumor mongering, which is not a crime in our society. | ||
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unidentified
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Not yet. | |
| No. | ||
| So, I mean, so our strengths in our society include our wealth, our openness, our tremendous scientists, but we haven't been playing to those strengths. | ||
| We've not been listening to our scientists. | ||
| We've not been deploying our wealth. | ||
| We haven't been acting the way we should be acting and taking our strengths to cope with this. | ||
| And, you know, the Chinese use different strengths and they, frankly, cope very effectively with this. | ||
| I should say, just to be clear, what the Chinese accomplished was they stopped the spread of the pathogen, but they did not eradicate it. | ||
| So the pathogen is still there and it will come back, even to China, as it will come back to us. | ||
| But they have bought themselves a huge amount of time to organize their response now so they don't lose, you know, countless lives. | ||
| Okay, so actually, I think most of the other things in the thread you've already hit, so I'll only ask you one more, and then I just want to do two or three audience questions real quick. | ||
| You mentioned the 1957 flu pandemic before. | ||
| Can you talk about some of the similarities and differences to what we're dealing with now? | ||
| Well, 1957... 1918, of course, was the big one. | ||
| That was the so-called Spanish flu, which swept the world, you know, killed many millions of people, including our country. | ||
| It was a different time, of course. | ||
| People were starving because of the war, there was a lot of disruption because of the war, and it was a different pathogen. | ||
| And there was no modern medicine, no antibiotics even, against bacteria. | ||
| And many people in that, we think, many of those people died not just because of the viral infection, but then their lungs got so-called super-infected with bacterial pneumonia, which killed them, many people. | ||
| So a lot was different then. | ||
| Earlier we talked about how it came in three waves and, you know, it was awful. | ||
| And there was a Great Depression, of course, afterwards as well. | ||
| So, I don't think—around the same time—anyway, I don't think that this pandemic is thankfully going to be that bad. | ||
| But the nearest analog I can see, even though it was a different pathogen and in some ways had different epidemiology, For example, in 1957, the pathogen also killed young people, whereas this one does not. | ||
| I think 57 might be a good model for what we're facing. | ||
| So every 10 years or so, reliably but at an unpredictable time, the world has a pandemic. | ||
| Most of your listeners will remember SARS or H1N1 or MERS, and those have petered out. | ||
| So people weren't taking them, they'll take them seriously, and they peter out for a variety of reasons. | ||
| Ironically, one of the reasons is that Sometimes they're too deadly. | ||
| For instance, SARS was about 10 times as deadly as the COVID that we're facing now. | ||
| And when a disease is too deadly, it kills its victim too fast, so the person can't spread it. | ||
| So this particular pathogen we're facing has sort of middling-level lethality. | ||
| It's neither too benign nor too deadly. | ||
| It's not as deadly as the 1918 virus. | ||
| And it has middling-level transmissibility. | ||
| Very difficult to transmit, and it's not too hard to transmit. | ||
| And it's sort of in the middle there. | ||
| And in my view, it seems to be behaving similar to the 57 pandemic, which to be clear, some of your listeners, older ones, may remember it, but many people won't. | ||
| And part of the reason people don't remember it is we didn't have the same media environment then. | ||
| And of course, people were dealing with polio and other deadly diseases. | ||
| But that pandemic swept over the United States and killed, we think, about 110,000 people. | ||
| Which back then was half as deadly as all of the cancer in the United States. | ||
| So today, if we have a 57 pandemic, we're talking hundreds of thousands of Americans dying from COVID if the disease is half as deadly as cancer. | ||
| So, as a group. | ||
| So, it's serious. | ||
| It could be quite serious. | ||
| I also want to just take an opportunity again to say, we don't know exactly what's going to happen. | ||
| And what's very important for your listeners is to understand that Despite political polarization, and despite our desire to simplify our choices, should we have Rice Krispies or should we have Corn Flakes, there are shades of grey and there's nuance when it comes to serious policy dilemmas and serious scientific questions. | ||
| So there's a range of outcomes we could observe in the United States from this. | ||
| We don't know exactly what's going to happen, but at best, 35,000 Americans are going to die, in my view, at best. | ||
| And it's quite possible that 20% of Americans will get infected. | ||
| That's 60 million Americans in the next year. | ||
| And our best estimate is that half a percent of those people might die. | ||
| That's 300,000 Americans dying in the next year of this condition. | ||
| And that's possible. | ||
| We're not sure it's going to happen. | ||
| It might not happen. | ||
| I hope it doesn't happen. | ||
| But it's possible, and that is a very, very heavy burden. | ||
| That's the 1957 pandemic. | ||
| That's half as deadly as cancer, approximately. | ||
| So that's why everyone is taking it seriously. | ||
| So I got a ton of questions specifically for you because I posted in the Rubin Report community, I posted that we're having you on, I had everyone look at the thread. | ||
| So what I thought I'd do is I'll just ask you two or three now and then I'm just going to email you one email with all these questions and maybe as you have a little time here and there you can throw some things on Twitter. | ||
| that are maybe a little more specific. | ||
| Obviously that's totally up to you, but I'll just ask you two or three now. | ||
| I thought this was really interesting. | ||
| And I got a lot of this type of question. | ||
| What is the acceptable level of risk in terms of disease and death that we're willing to accept | ||
| in order to have a normally functioning society and healthy economy? | ||
| Well, I would ask you to think about what we do when it comes to mining safety | ||
| or other dangerous occupations, like whether we equip our police with bulletproof vests, | ||
| We spend money in a preventive way to prevent deaths in hazardous occupations all the time. | ||
| Now, we don't spend limitlessly. | ||
| You know, we don't equip each police officer. | ||
| We expect people to take some risk of death. | ||
| We don't spend limitlessly even to secure our highways. | ||
| You know, not every highway is a divided highway, which we know is safer because it would cost too much. | ||
| So there's some calculation we make about how much money we're willing to spend in order to save lives. | ||
| And what you have to understand in this case is that we're dealing with a threat. | ||
| And incidentally, death is expensive, too. | ||
| Like, all these people dying and consuming health care is expensive. | ||
| So preventing those deaths saves us money as well. | ||
| I acknowledge, as most experts do, that tanking our economy is a devastating thing. | ||
| But I would suggest that if people started dying Like flies? | ||
| If 300,000 Americans started dying, our economy would have tanked anyway. | ||
| So the problem again is not that 300,000 extra Americans are going to die, although that's not good. | ||
| It's that they're going to die very compressed. | ||
| We're not just spreading them out. | ||
| And so that's a devastating blow to our society no matter what. | ||
| So I guess I would say that in answer to your question that We always are willing to pay some economic cost to save lives, and I acknowledge that going into a major depression or a major recession and possibly a depression is a huge cost for our society, but I would suggest to you that we would likely have faced that anyway if we had done nothing, but then we also would have had all of these deaths. | ||
|
unidentified
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All right. | |
| So I think it's necessary. | ||
|
unidentified
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Yeah. | |
| All right. | ||
| So we're just going to do two more and then I know you, I know you've got a crazy day ahead of you. | ||
| Uh, then I'm just going to email you some of these and maybe you can get to some of them. | ||
| Uh, but there were also a bunch about this. | ||
| Is there any confirmation whether airborne transmission is possible? | ||
| I mean, if someone has it and you're at the store and you're avoiding everybody the best you can and you're wearing gloves and the rest of it, but somebody breathes on you or sneezes on you or something like that, I think there's a little confusion as to what airborne transmission actually means maybe. | ||
| Yeah, so droplet transmission is when a liquid, like I sneeze or cough or spit, and they're droplets that go through the air and land on you in your nose or your mouth and transmits it to you. | ||
| And that's why we're supposed to stay four or five or six feet away from each other, because if I sneeze and I'm six feet away from you, the droplets would go through the air and then fall into the ground and not reach you. | ||
| Airborne is when tiny particulates, maybe the virus itself, are floating through the air, maybe, and can reach you. | ||
| We believe that there is both droplet and airborne transmission, and there probably is probably fecal transmission as well, which is a little bit concerning of this pathogen, and something called fomite transmission, which is that the pathogen can stay on surfaces, especially smooth surfaces. | ||
| So porous things like paper money or fabrics, less so, but smooth surfaces like elevator buttons, doorknobs, kitchen counters, and more. | ||
| It can stay more so, but the virus is also very fragile. | ||
| It's encapsulated in a lipid coat. | ||
| Uh, when, when the virus, uh, the virus has worked by taking over our own cells and they grow inside ourselves and then they explode out of ourselves. | ||
| And as they explode out, they take a little bit of our cell membrane with them. | ||
| So they're encapsulated in this lipid membrane, but, and they, and that helps them to be more transmissible, but it makes them very vulnerable to soap. | ||
| So cleanliness, this is why washing your hands. | ||
| And when you wash your hands, you should wash between your fingers and the backs of your hands. | ||
| Many people are saying, sing the happy birthday song twice while you wash your hands. | ||
| It's true, but that does kill the virus. | ||
| So when you go out and about, if you avoid touching your face, if you wash your hands before you return home, that is very basic hygiene. | ||
| That's actually very helpful. | ||
| And experiments have shown this, by the way, it's not just old wives tales. | ||
| Like people actually do studies where they touch stuff and then they wash their hands and they see if the virus goes away. | ||
| Yeah. | ||
| All right. | ||
| So the last one then is I got a couple of versions of this that, you know, we're all concerned about this. | ||
| And even the way I'm trying to do these shows, I'm not trying to overload people too much. | ||
| And I don't want everyone glued to their TVs endlessly. | ||
| What else do you make of just sort of the human condition in the midst of a pandemic like this? | ||
| Well, as you know, because we talked about it the last time you and I met, I just wrote this book. | ||
| Yeah. | ||
| You've got a whole book about it. | ||
| It's right over there. | ||
| I know. | ||
| I wrote this book called Blueprint, The Evolutionary Origins of a Good Society. | ||
| And as you know, Dave, I'm an optimist. | ||
| I believe in human beings. | ||
| I marvel at our capacity for goodness. | ||
| I recognize our capacity for evil and selfishness and tribalism and violence. | ||
| But I also revere and admire our capacity for love and friendship and cooperation and teaching. | ||
| In fact, all of these are things that we are using right now to confront this virus. | ||
| We are banding together and working together to fight off this invader. | ||
| We are using our capacity for teaching. | ||
| The reason we know what to do in this case is because previous humans who confronted this virus wrote down, here's what you do when you're facing a pandemic. | ||
| You literally can go, there's a book right here I can look over and see. | ||
| It's called National Strategy for Influenza Pandemics. | ||
| Like there are books that you can open up like a cookbook and they say, here's what you do when there's a pandemic. | ||
| It's amazing! | ||
| We can transmit this knowledge to each other and therefore cope with this enemy, the virus, that is attacking us. | ||
| So this is why I'm hopeful and optimistic. | ||
| The virus will eventually pass. | ||
| Our species will survive. | ||
| It is unfortunate that many will die. | ||
| We don't know how many. | ||
| The virus will become endemic. | ||
| We will see the other side of this. | ||
| But we do have to work together as a society to shore up our industries, to protect our healthcare workers, from whom we're going to ask tremendous amounts, and from whom we're going to ask to take tremendous risks. | ||
| It's one thing, when I was a doctor, I mean, I'm a physician, and I don't see patients anymore, but when I was seeing patients, especially in the 1990s, the HIV epidemic was very prominent. | ||
| And there was a lot of concern that if you took care of patients with HIV, and a lot of those patients were gay, or they were from Haiti, or they were drug users, There were groups that back then were especially stigmatized. | ||
| And so there was a lot of like kind of, oh, well, you know, we won't take care of those people. | ||
| And there was fear among health care providers, like if you stuck them and you got their blood on you, you might contract this deadly disease. | ||
| But we were expected to take personal risks. | ||
| We were expected to care for these patients. | ||
| It's a calling to be a doctor or a nurse. | ||
| It's a moral obligation. | ||
| And so we expect a huge amount from our doctors and nurses and health care providers right now. | ||
| We expect them to take these risks, but it's not the same to expect them to take the risks with the proper equipment versus to send them to certain death. | ||
| That is to say, without masks, gloves, protective equipment. | ||
| And so I'm very concerned that we're not taking this seriously. | ||
| We don't have the right equipment to equip our frontline medical personnel to deal with this. | ||
| And this is why I'm also upset that we squandered the six weeks that the Chinese bought for us by locking down their nation We should have been planning to equip our hospitals with this personal protective equipment, with ventilators, with staffing, with procedures, which we can discuss, it's too technical and boring, to confront this epidemic. | ||
| So we're running up, we're behind now, is the problem, and I hope very much we can catch up. | ||
| And this is again why social distancing is so important, to slow this thing down so we can let our supply chain, our scientists, our politicians, frankly, You know, catch up so that we can cope with this. | ||
| Well, Nick, I always consider you one of the cleanest, clearest thinkers that we've got, and especially in a time like this. | ||
| So I appreciate you taking the time, and maybe we'll get you back on in a couple weeks as this thing continues to unfurl. |
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