Transcript
00:00:00 The following is a conversation with Jay Bhattacharya,
00:00:02 Professor of Medicine, Health Policy and Economics
00:00:06 at Stanford University.
00:00:08 Please allow me to say a few words about lockdowns
00:00:11 and the blinding, destructive effects of arrogance
00:00:14 on leadership, especially in the space of policy and politics.
00:00:19 Jay Bhattacharya is the coauthor
00:00:21 of the now famous Great Barrington Declaration,
00:00:24 a one page document that in October 2020
00:00:27 made a case against the effectiveness of lockdowns.
00:00:32 Most of this podcast conversation
00:00:33 is about the ideas related to this document.
00:00:36 And so let me say a few things here about what troubles me.
00:00:41 Those who advocate for lockdowns as a policy
00:00:44 often ignore the quiet suffering of millions
00:00:47 that it results in, which includes economic pain,
00:00:50 loss of jobs that give meaning and pride
00:00:52 in the face of uncertainty, the increase in suicide
00:00:55 and suicidal ideation, and in general,
00:00:58 the fear and anger that arises from the powerlessness
00:01:02 forced onto the populace
00:01:04 by the self proclaimed elites and experts.
00:01:08 Many folks whose job is unaffected by the lockdowns
00:01:11 talk down to the masses about which path forward
00:01:14 is right and which is wrong.
00:01:16 What troubles me most is this very lack of empathy
00:01:20 among the policymakers for the common man
00:01:22 and in general for people unlike themselves.
00:01:26 The landscape of suffering is vast
00:01:28 and must be fully considered
00:01:30 in calculating the response to the pandemic
00:01:33 with humility and with rigorous,
00:01:36 open minded scientific debate.
00:01:39 Jay and I talk about the email from Francis Collins
00:01:42 to Anthony Fauci that called Jay and his two coauthors
00:01:46 fringe epidemiologists and also called
00:01:49 for a devastating published take down of their ideas.
00:01:53 These words from Francis broke my heart.
00:01:57 I understand them, I can even steel man them,
00:02:00 but nevertheless, on balance,
00:02:02 they show to me a failure of leadership.
00:02:06 Leadership in a pandemic is hard,
00:02:09 which is why great leaders are remembered by history.
00:02:12 They are rare, they stand out and they give me hope.
00:02:17 Also, this whole mess inspires me
00:02:21 on my small individual level to do the right thing
00:02:24 in the face of conformity, despite the long odds.
00:02:29 I talked to Francis Collins,
00:02:31 I talked to Albert Burla, Pfizer CEO.
00:02:34 I also talked and will continue to talk
00:02:36 with people like Jay and other dissenting voices
00:02:39 that challenge the mainstream narratives
00:02:42 and those in the seats of power.
00:02:43 I hope to highlight both the strengths and weaknesses
00:02:46 in their ideas with respect and empathy,
00:02:49 but also with guts and skill.
00:02:53 The skill part, I hope to improve on over time.
00:02:56 And I do believe that conversation
00:02:59 and an open mind is the way out of this.
00:03:03 And finally, as I’ve said in the past,
00:03:06 I value love and integrity far, far above money,
00:03:10 fame and power.
00:03:12 Those latter three are all ephemeral.
00:03:15 They slip through the fingers of anyone
00:03:17 who tries to hold on and leave behind
00:03:19 an empty shell of a human being.
00:03:23 I prefer to die a man who lived by principles
00:03:26 that nobody could shake and a man
00:03:28 who added a bit of love to the world.
00:03:31 This is the Lex Friedman podcast.
00:03:33 To support it, please check out our sponsors
00:03:36 in the description.
00:03:37 And now, here’s my conversation with Jay Bhattacharya.
00:03:43 To our best understanding today, how deadly is COVID?
00:03:48 Do we have a good measure for this very question?
00:03:52 So the best evidence for COVID, the deadliness of COVID,
00:03:56 comes from a whole series of seroprevalence studies.
00:04:00 Seroprevalence studies are these studies
00:04:01 of antibody prevalence in the population at large.
00:04:04 I was part of the very first set of seroprevalence studies,
00:04:08 one in Santa Clara County, one in L.A. County,
00:04:10 and one with Major League Baseball around the U.S.
00:04:14 If I may just pause you for a second.
00:04:17 If people don’t know what serology is and seroprevalence,
00:04:20 it does sound like you say zero prevalence.
00:04:23 It’s not, it’s sero and serology is antibodies.
00:04:26 So it’s a survey that counts the number of antibodies.
00:04:29 Specific to COVID, yes.
00:04:31 People that have antibodies specific to COVID,
00:04:34 which perhaps shows an indication
00:04:37 that they likely have had COVID,
00:04:39 and therefore this is a way to study
00:04:41 how many people in the population
00:04:43 have been exposed to or have had COVID.
00:04:45 Exactly, yeah, exactly.
00:04:46 So the idea is that we don’t know
00:04:51 exactly the number of people with COVID
00:04:53 just by counting the people
00:04:54 that present themselves with symptoms of COVID.
00:04:57 COVID has, it turns out, a very wide range of symptoms,
00:05:01 ranging from no symptoms at all
00:05:04 to this deadly viral pneumonia
00:05:05 that has killed so many people.
00:05:07 And the problem is, if you just count the number of cases,
00:05:10 the people who have very few symptoms
00:05:12 often don’t show up for testing.
00:05:15 They’re outside of the can of public health.
00:05:18 And so it’s really hard to know the answer to your question
00:05:21 without understanding how many people are infected,
00:05:24 because you can probably tell the number of deaths,
00:05:26 even though there’s some controversy over that.
00:05:28 But that, so the numerator is possible,
00:05:31 but the denominator is much harder.
00:05:33 How much controversy is there about the death?
00:05:35 We’re gonna go on a million tangents.
00:05:36 Is that, okay, we’re gonna, I have a million questions.
00:05:40 So one, I love data so much,
00:05:43 but I’m like almost tuned out
00:05:45 paying attention to COVID data,
00:05:47 because I feel like I’m walking on shaky ground.
00:05:49 I don’t know who to trust.
00:05:52 Maybe you can comment on different sources of data,
00:05:54 different kinds of data.
00:05:55 The death one, that seems like a really important one.
00:05:59 Can we trust the reported deaths associated with COVID,
00:06:03 or is it just a giant, messy thing that mixed up?
00:06:06 And then there’s this kind of stories about hospitals
00:06:09 being incentivized to report a death as COVID death.
00:06:14 So there’s some truth in some of that.
00:06:16 Let me just talk about the incentives.
00:06:19 So in the United States, we passed this CARES Act
00:06:23 that was aimed at making sure hospital systems
00:06:26 didn’t go bankrupt in the early days of the pandemic.
00:06:29 The couple of things they did,
00:06:30 one was they provided incentives to treat COVID patients,
00:06:34 tens of thousands of dollars extra per COVID patient.
00:06:38 And the other thing they did is they gave a 20% bump
00:06:41 to Medicare payments for elderly patients
00:06:43 who are treated with COVID.
00:06:44 The idea is that there’s more expensive to treat them
00:06:46 at the early days.
00:06:48 So that did provide an incentive
00:06:49 to sort of have a lot of COVID patients in the hospital,
00:06:52 because your financial success of the hospital,
00:06:55 or at least not lack of financial ruin
00:06:57 depended on having many COVID patients.
00:07:00 The other thing on the death certificates
00:07:02 is that reporting of deaths is a separate issue.
00:07:04 I don’t know that there’s a financial incentive there,
00:07:06 but there is this sort of like complicated,
00:07:08 you know, when you fill out a death certificate
00:07:11 for a patient with a lot of conditions,
00:07:13 like let’s say a patient has diabetes,
00:07:15 a patient that, well, that diabetes could lead
00:07:17 to heart failure.
00:07:20 You know, you have a heart attack, heart failure,
00:07:22 your lungs fill up, then you get COVID and you die.
00:07:26 So what do you write on the death certificate?
00:07:28 Was it COVID that killed you?
00:07:29 Was it the lungs filling up?
00:07:31 Was it the heart failure?
00:07:32 Was it the diabetes?
00:07:34 It’s really difficult to like disentangle.
00:07:37 And I think a lot of times what’s happened
00:07:40 is that people have like erred
00:07:42 on the side of signing it as COVID.
00:07:44 Now, what’s the evidence of this?
00:07:46 There’s been a couple of audits of death certificates
00:07:49 in places like Santa Clara County,
00:07:51 where I live, in Alameda County, California,
00:07:54 where they carefully went through the death certificate
00:07:56 and said, okay, is this reasonable to say
00:07:57 this was actually COVID or it was COVID incidental?
00:08:00 And they found that about 25%, 20, 25% of the deaths
00:08:03 were more likely incidental than directly due to COVID.
00:08:08 I personally don’t get too excited about this.
00:08:10 I mean, it’s a philosophical question, right?
00:08:12 Like ultimately, what kills you?
00:08:16 Which is an odd thing to say if you’re not in medicine,
00:08:19 but like really, it’s almost always multifactorial.
00:08:23 It’s not always just the bus hits you.
00:08:25 The bus hits you, you get a brain bleed.
00:08:27 Was it the brain bleed that killed you?
00:08:28 Would it have burst anyway?
00:08:29 I mean, you know, the bus hits you, killed you, right?
00:08:32 The way you die is a philosophical question,
00:08:34 but it’s also a sociological and psychological question
00:08:36 because it seems like every single person
00:08:40 who has passed away over the past couple of years,
00:08:43 kind of the first question that comes to mind.
00:08:44 Was it COVID?
00:08:45 Was it COVID?
00:08:46 Not just because you’re trying to be political,
00:08:48 but just in your mind.
00:08:49 No, I think there’s a psychological reason for this, right?
00:08:51 So, you know, we spent the better part
00:08:55 of at least a half century in the United States
00:08:57 not worried too much about infectious diseases.
00:09:01 The notion was we essentially conquered them.
00:09:03 It was something that happens
00:09:04 in far away places to other people.
00:09:07 And that’s true for much of the developed world.
00:09:10 Life expectancy were going up for decades and decades.
00:09:13 And for the first time in living memory,
00:09:16 we have a disease that can kill us.
00:09:18 I mean, I think we’re effectively evolved to fear that,
00:09:21 like the panic centers of our brain,
00:09:23 the lizard part of our brain takes over.
00:09:26 And our central focus has been avoiding this one risk.
00:09:29 And so it’s not surprising that people,
00:09:32 when they’re filling out death certificates
00:09:33 or thinking about what led to the death,
00:09:36 this most salient thing that’s in the front
00:09:38 of everyone’s brain would jump to the top.
00:09:41 And we can’t ignore this very deep psychological thing
00:09:46 when we consider what people say on the internet,
00:09:51 what people say to each other,
00:09:52 what people write in scientific papers, everything.
00:09:55 It feels like when COVID has been brought onto this world,
00:10:05 everything changed in the way people feel about each other,
00:10:09 just the way they communicate with each other.
00:10:11 I think the level of emotion involved,
00:10:15 I think in many people, it brought out the worst in them.
00:10:20 For sometimes short periods of time
00:10:22 and sometimes it was always therapeutic,
00:10:24 like you were waiting to get out
00:10:25 like the darkest parts of you,
00:10:27 just to say, if you’re angry at something in this world,
00:10:30 I’m going to say it now.
00:10:31 And I think that’s probably talking
00:10:34 to some deep primal thing that fear we have
00:10:38 for formalities of all different kinds.
00:10:41 And then when that fear is aroused
00:10:43 in all the deepest emotions,
00:10:46 it’s like a Freudian psychotherapy session,
00:10:49 but across the world.
00:10:51 It’s something that psychologists are going to have
00:10:53 a field day with for a generation trying to understand.
00:10:56 I mean, I think what you say is right,
00:10:59 but piled on top of that is also this sort of,
00:11:04 this impetus to empathy,
00:11:05 the empathized compassion toward others,
00:11:08 essentially militarized, right?
00:11:11 So I’m protecting you by some actions
00:11:16 and those actions, if I don’t do them,
00:11:20 if you don’t do them,
00:11:21 well, that must mean you hate me.
00:11:24 It’s created this like social tension
00:11:26 that I’ve never seen before.
00:11:27 And we looked at each other
00:11:30 as if we were just simply sources of germs
00:11:35 rather than people to get to know,
00:11:37 people to enjoy, people to get to learn from.
00:11:41 It colored basically almost every human interaction
00:11:44 for every human on the planet.
00:11:47 Yeah, the basic common humanity.
00:11:49 It’s like you can wear a mask,
00:11:50 you can stand far away,
00:11:52 but the love you have for each other
00:11:54 when you’re looking into each other’s eyes,
00:11:56 that was dissipating by region too.
00:11:59 I’ve experienced having traveled
00:12:01 quite a bit throughout this time.
00:12:03 It was really sad,
00:12:06 even people that are really close together,
00:12:08 just the way they stood,
00:12:09 the way they looked at each other.
00:12:11 And it made me feel for a moment
00:12:15 that the fabric that connects all of us
00:12:17 is more fragile than I thought.
00:12:20 I mean, if you walk down the street,
00:12:21 or if you ever, if you did this during COVID,
00:12:23 I’m sure you had this experience
00:12:24 where you walk down the street,
00:12:25 if you’re not wearing a mask,
00:12:26 or even if you are,
00:12:27 people will jump off the sidewalk
00:12:30 that you walked past them,
00:12:31 as if you’re poison,
00:12:33 even though the data are that COVID spreads
00:12:37 indifferently outdoors,
00:12:39 or if at all, really, outdoors.
00:12:41 But it’s not simply a biological
00:12:43 or infectious disease phenomenon,
00:12:45 or epidemiological phenomenon.
00:12:46 It is a change in the way humans treated each other,
00:12:50 I hope temporary.
00:12:52 I do wanna say on the flip side of that,
00:12:54 so I was mostly in Boston, Massachusetts
00:12:58 when the pandemic broke out.
00:12:59 I think that’s where I was, yeah.
00:13:01 And then I came here to Austin, Texas
00:13:04 to visit my now good friend, Joe Rogan,
00:13:07 and he was the first person without pause,
00:13:11 this wasn’t a political statement,
00:13:12 this was anything,
00:13:13 just walked toward me and gave me a big hug
00:13:16 and say, it’s great to see you.
00:13:18 And I can’t tell you how great it felt
00:13:20 because I, in that moment,
00:13:21 realized the absence of that connection back in Boston
00:13:24 over just a couple of months.
00:13:26 And it’s, we’ll talk about it more,
00:13:30 but it’s tragic to think about that distancing,
00:13:34 that dissolution of common humanity at scale,
00:13:36 what kind of impact it has on society.
00:13:39 Just across the board, political division,
00:13:43 and just in the quiet of your own mind,
00:13:45 in the privacy of your own home, the depression,
00:13:47 the sadness, the loneliness that leads to suicide.
00:13:51 And forget suicide, just low key suffering.
00:13:55 Yeah, no, I think that’s the suffering,
00:13:58 that isolation, we’re not meant to live alone,
00:14:00 we’re not meant to live apart from one another.
00:14:02 I mean, that’s, of course, the ideology of lockdown
00:14:04 is to make people live apart, alone, isolated,
00:14:07 so that we don’t spread diseases to each other, right?
00:14:10 But we’re not actually designed as a species
00:14:12 to live that way.
00:14:14 And that, what you’re describing, I think,
00:14:16 if everyone’s honest with themselves, have felt,
00:14:19 especially in places where lockdowns have been
00:14:22 sort of very militantly enforced,
00:14:23 has felt deep into their core.
00:14:26 Well, if I could just return to the question of deaths.
00:14:30 You said that the data isn’t perfect,
00:14:31 because we need these kind of seroprevalence surveys
00:14:35 to understand how many cases there were
00:14:37 to determine the rate of deaths.
00:14:39 And we need to have a strong footing
00:14:42 in the number of deaths.
00:14:42 But if we assume that the number of deaths
00:14:45 is approximately correct, like what’s your sense,
00:14:49 what kind of statements can we say about the deadliness
00:14:52 of COVID across different demographics?
00:14:55 Maybe not in a political way or in the current way,
00:14:58 but when history looks back at this moment of time,
00:15:03 50 years from now, 100 years from now,
00:15:05 the way we look at the pandemic 100 years ago,
00:15:09 what will they say about the deadliness of COVID?
00:15:12 I mean, I think the deadliness of COVID depends on
00:15:14 not just the virus itself, but who it infects.
00:15:18 So probably the most important thing about it,
00:15:20 about the deadliness of COVID,
00:15:21 is this steep age gradient in the mortality rate.
00:15:26 So according to these seroprevalence studies
00:15:28 that have been done, now hundreds of them,
00:15:32 mostly from before vaccination,
00:15:34 because vaccination also reduces
00:15:35 the mortality risk of COVID,
00:15:37 the seroprevalence studies suggest that the risk of death,
00:15:42 if you’re, say, over the age of 70, is very high.
00:15:47 You know, 5% if you get COVID.
00:15:50 If you’re under the age of 70, it’s lower, 0.05.
00:15:54 But there’s not a single sharp cutoff.
00:15:56 It’s more like, I have a rule of thumb that I use.
00:15:59 So if you’re 50, say, the infection fatality rate
00:16:03 from COVID is 0.2%, according to the seroprevalence data.
00:16:07 That means 99.8% survival if you’re 50.
00:16:11 And for every seven years of age above that, double it.
00:16:14 Every seven years of age below that, halve it.
00:16:17 So a 57 year old would have a 0.4%.
00:16:20 Mortality, a 64 year old would have a 0.8% and so on.
00:16:24 And if you have a severe chronic disease,
00:16:26 like diabetes or if you’re morbidly obese,
00:16:29 it’s like adding seven years to your life.
00:16:32 And this is for unvaccinated folks?
00:16:35 This is unvaccinated before Delta also.
00:16:38 Are there a lot of people that would be listening to this
00:16:41 with PhDs at the end of their name
00:16:43 that would disagree with the 99.8, would you say?
00:16:47 So I think there’s some disagreement over this.
00:16:49 And the disagreement is about the quality
00:16:52 of the seroprevalence studies that were conducted.
00:16:56 So as I said earlier, I was the senior investigator
00:16:58 in three different seroprevalence studies
00:17:00 very early in the epidemic.
00:17:03 I view them as very high quality studies.
00:17:07 In Santa Clara County, what we did is we used a test kit
00:17:10 that we obtained from someone who works
00:17:16 in major league baseball, actually.
00:17:18 He had ordered these test kits very early in March, 2020,
00:17:21 that measures, very accurately measures antibody levels,
00:17:25 antibodies in the bloodstream.
00:17:28 These test kits were eventually were approved by the,
00:17:31 had an EUA by the emergency use authorization by the FDA,
00:17:35 sort of shortly after we did this.
00:17:37 And it had a very low false positive rate,
00:17:40 false positive means if you don’t have
00:17:43 these COVID antibodies in your bloodstream,
00:17:46 the kit shows up positive anyways.
00:17:48 That turns out to happen about 0.5% of the time.
00:17:52 And based on studies, a very large number of studies
00:17:56 looking at blood from 2018, you try it against this kit,
00:18:00 and 0.5% of the time, 2018,
00:18:03 there shouldn’t be antibodies there to COVID.
00:18:05 So if it turns positive to false positives, 0.5% of the time.
00:18:08 And then like a false negative rate, about 10%, 12%,
00:18:14 something like that, I don’t remember the exact number,
00:18:16 but the false positive rate is the important thing there.
00:18:18 So you have a population in March, 2020 or April, 2020,
00:18:22 with very low fraction of patients
00:18:25 having been exposed to COVID,
00:18:26 you don’t know how much, but low,
00:18:28 even a small false positive rate
00:18:30 could end up biasing your study quite a bit.
00:18:34 But there’s a formula to adjust for that.
00:18:36 You can adjust for the false positive rate,
00:18:37 false negative rate.
00:18:38 We did that adjustment, and those studies found
00:18:42 in a community population,
00:18:43 so leaving aside people in nursing homes
00:18:45 who have a higher death rate from COVID,
00:18:48 the death rate was 0.2% in Santa Clara County
00:18:52 and in LA County.
00:18:53 Across all age groups in a community,
00:18:56 community meaning just like regular folks.
00:18:58 Yeah, so that’s actually a real important question too.
00:19:00 So the Santa Clara study,
00:19:02 we did this Facebook sampling scheme,
00:19:05 which is, I mean, not the ideal thing,
00:19:08 but it was very difficult to get a random sample
00:19:11 and during lockdown,
00:19:14 where we put out an ad on Facebook
00:19:17 soliciting people to volunteer for the study,
00:19:19 randomly selected set of people.
00:19:22 We were hoping to get a random selection of people
00:19:24 from Santa Clara County, but it tended to,
00:19:26 the people who tend to volunteer
00:19:27 were from the richer parts of the county.
00:19:28 Like I had Stanford professors writing,
00:19:31 begging to be in the study
00:19:32 because they wanted to know their antibody levels.
00:19:34 So we did some adjustment for that.
00:19:36 In LA County, we hired a firm
00:19:38 that had a preexisting representative sample of LA County.
00:19:44 But it didn’t include nursing homes,
00:19:46 it didn’t include people in jail, things like that,
00:19:48 didn’t include the homeless populations.
00:19:49 So it’s representative of a community dwelling population,
00:19:53 both of those.
00:19:54 And there we found that both in LA County
00:19:57 and Santa Clara County in April, 2020,
00:20:00 something like 40 to 50 times more infections
00:20:04 than cases in both places.
00:20:06 So for every case that had been reported
00:20:09 to the public health authorities,
00:20:10 we found 40 or 50 other infections,
00:20:15 people with antibodies in their blood
00:20:17 that suggested that they’d had COVID and recovered.
00:20:20 So people were not reporting,
00:20:21 or severe, at least in those days, underreporting.
00:20:25 Yeah, I mean, there was testing problem.
00:20:26 I mean, there weren’t so many tests available.
00:20:29 People didn’t know.
00:20:30 A lot of them, we asked a set of questions
00:20:32 about the symptoms they’d faced,
00:20:34 and most of them said they’d faced no symptoms,
00:20:36 or at the most, 30, 40% of them said
00:20:38 they’d faced no symptoms.
00:20:40 And I mean, even these days,
00:20:42 how many people report that they get COVID
00:20:44 when they get COVID?
00:20:45 Okay, have those numbers, that 0.2%,
00:20:49 has that approximately held up over time?
00:20:51 That is, so Professor John Ioannidis,
00:20:53 who’s a colleague of mine at Stanford,
00:20:55 is a world expert in meta now,
00:20:56 so probably the most cited scientist on Earth, I think,
00:21:00 at least living.
00:21:01 He did a meta analysis of now 100 or more
00:21:04 of these seroprevalence studies.
00:21:08 And what he found was that that 0.2%
00:21:11 is roughly the worldwide number.
00:21:13 In fact, I think he cites this lower number, 0.15%,
00:21:17 as the median infection fatality rate worldwide.
00:21:20 So we did these studies,
00:21:21 and it generated an enormous amount of blowback
00:21:25 by people who thought that the infection fatality rate
00:21:27 is much higher.
00:21:28 And there’s some controversy over the quality
00:21:30 of some of the other studies that are done.
00:21:32 And so there are some people who look at this
00:21:34 same literature and say, well,
00:21:36 the lower quality studies tend to have lower IFRs.
00:21:39 The higher quality studies.
00:21:40 IFR?
00:21:41 Oh, infection fatality rate, I apologize.
00:21:43 I do this in lectures, too, I apologize.
00:21:45 And I’m going to rudely interrupt you
00:21:48 and ask for the basics sometimes, if it’s okay.
00:21:51 No, of course.
00:21:52 So these higher quality studies, they say,
00:21:55 tend to produce higher IFR.
00:21:56 But the problem is that if you want
00:21:58 a global infection fatality rate,
00:22:00 you need to get seroprevalence studies from everywhere,
00:22:04 even in places that don’t necessarily
00:22:05 have the infrastructure set up
00:22:07 to produce very, very high quality studies.
00:22:09 And in poor places in the world,
00:22:14 places like Africa,
00:22:15 the infection fatality rate is incredibly low.
00:22:20 And in some richer places, like New York City,
00:22:23 the infection fatality rate is much higher.
00:22:25 There’s a range of IFRs, not a single number.
00:22:30 This sometimes surprises people,
00:22:32 because they think, well, it’s a virus,
00:22:34 it should have the same properties no matter where it goes.
00:22:36 But the virus kills or infects or hurts
00:22:42 in interaction with the host.
00:22:44 And the properties of both the host and the virus
00:22:47 combine to produce the outcome.
00:22:50 But you also mentioned the environment, too?
00:22:53 Well, I’m thinking mainly just about the person.
00:22:55 Like if I’m gonna think about it,
00:22:56 the most simplest way to think about it is age.
00:22:58 Age is the single most important risk factor.
00:23:01 So older places are going to have a higher IFR
00:23:05 than younger places.
00:23:07 Africa, 3% of Africa is over 65.
00:23:10 So in some sense, it’s not surprising
00:23:12 that they have a low infection fatality rate.
00:23:15 So that’s one way you would explain
00:23:16 the difference between Africa and New York City
00:23:18 in terms of the fatality rate, is the age, the average age?
00:23:22 Yeah, and especially in the early days of the epidemic
00:23:24 in New York City, the older populations
00:23:29 living in nursing homes were differentially infected
00:23:33 based on, because of policies that were adopted,
00:23:35 to send COVID infected patients back to nursing homes
00:23:39 to keep hospitals empty.
00:23:40 What do you mean by differentially infected?
00:23:42 The policy that you adopt determines who is most exposed.
00:23:47 Right, okay.
00:23:48 So that’s what I mean by different.
00:23:49 The policy, it’s the person that matters.
00:23:52 I mean, it’s not like the virus just kind of doesn’t care.
00:23:56 I mean, the policy determines the nature of the interaction.
00:23:59 And there’s also, I mean, there is some contribution
00:24:01 from the environment, different regions
00:24:04 have different proximity maybe of people interacting
00:24:08 or the dynamics of the way they interact.
00:24:10 Yeah, like if you have situations
00:24:12 where there’s lots of intergenerational interactions,
00:24:17 then you have a very different risk profile
00:24:19 than if you have societies
00:24:21 that are where generations are more separate
00:24:23 from one another.
00:24:25 Okay, so let me just finish real fast about this.
00:24:27 So you have in New York, you have a population
00:24:32 that was infected in the early days
00:24:34 that was very likely going to die,
00:24:36 had a much higher likelihood of dying if infected.
00:24:40 And so New York City had a higher IFR,
00:24:43 especially in the early days than like Africa has had.
00:24:49 The other thing is treatment, right?
00:24:50 So the treatments that we adopted
00:24:52 in the early days of the epidemic,
00:24:54 I think actually may have exacerbated the risk of death.
00:24:58 Which treatments?
00:25:00 Using ventilators, like the over reliance on ventilators
00:25:03 is what I’m primarily thinking of,
00:25:04 but I can think of other things.
00:25:06 But that also we’ve learned over time
00:25:09 how better to manage patients with the disease.
00:25:12 So you have all those things combined.
00:25:14 So that’s where the controversy over this number is.
00:25:18 I mean, New York City also is a central hub
00:25:23 for those who tweet and those who write powerful stories
00:25:29 and narratives in article form.
00:25:31 And I remember those quite dramatic stories
00:25:34 about sort of doctors in the hospitals
00:25:36 and these kinds of things.
00:25:37 I mean, there’s very serious, very dramatic,
00:25:40 very tragic deaths going on always in hospitals.
00:25:44 Those stories, loved ones losing each other on a deathbed,
00:25:50 that’s always tragic.
00:25:52 And you can always write a hell of a good story about that.
00:25:55 And you should, about the loss of loved ones.
00:25:58 But they were doing it pretty well, I would say,
00:26:01 over this kind of dramatic deaths.
00:26:04 And so in response to that, it’s very unpleasant to hear,
00:26:09 even to consider the possibility
00:26:11 that the death rate is not as high as you might feel.
00:26:17 Yeah, I was surprised by the reaction,
00:26:20 both by regular people and also the scientific community
00:26:23 in response to those studies,
00:26:25 those early studies in April of 2020.
00:26:29 To me, they were studies.
00:26:31 I mean, they’re the kinds of,
00:26:33 not exactly the kinds of work I’ve worked on all my life,
00:26:35 but kind of like the kind of, you write a paper
00:26:39 and you get responses from your fellow scientists
00:26:42 and you change the paper to improve it,
00:26:45 you hopefully learn something from it.
00:26:47 Well, but to push back, it’s just a study.
00:26:50 But there’s some studies, and this is kind of interesting,
00:26:53 because I’ve received similar pushback on other topics.
00:26:59 There’s some studies that, if wrong,
00:27:04 might have wide ranging detrimental effects on society.
00:27:09 So that’s the way they would perceive the studies.
00:27:12 If you say the death rate is lower,
00:27:13 and you end up, as you often do in science,
00:27:16 realizing that, nope, that was a flaw
00:27:19 in the way the study was conducted,
00:27:21 or we’re just not representative of a broader population,
00:27:23 and then you realize the death rate is much higher,
00:27:26 that might be very damaging in people’s view.
00:27:29 So that’s probably where the scientific community
00:27:33 sort of just steel man the kind of response,
00:27:36 is that’s where they felt like,
00:27:40 there’s some findings where you better be damn sure
00:27:43 before you kind of report them.
00:27:45 Yeah, I mean, we were pretty sure we were right,
00:27:47 and it turns out we were right.
00:27:48 So we released the Santa Clara study
00:27:54 via this open science process
00:27:56 and this server called MedArchive.
00:27:59 It’s designed for releasing studies
00:28:02 that have not yet been peer reviewed
00:28:03 in order to garner comment from the scientists
00:28:06 before peer review.
00:28:08 The LA County study,
00:28:09 we went through this traditional peer review process
00:28:12 and got it published in the Journal
00:28:13 of American Medical Association sometime in like July,
00:28:16 I think, I forget the date, of 2020.
00:28:19 The Santa Clara study released in April of 2020
00:28:22 in this sort of working paper archive.
00:28:25 The reason was that we felt we had an obligation,
00:28:28 we had a result that we thought was quite important,
00:28:31 and we wanted to tell the scientific community about it
00:28:35 and also tell the world about it.
00:28:36 And we wanted to get feedback.
00:28:38 I mean, that’s part of the purpose
00:28:39 of sending it to these kinds of places.
00:28:42 I think a lot of the problem is that
00:28:45 when people think about published science,
00:28:47 they think of it as automatically true.
00:28:50 And if it goes through peer review,
00:28:51 it’s automatically true.
00:28:52 If it hasn’t gone through peer review,
00:28:53 it’s not automatically true.
00:28:54 And especially in medicine,
00:28:56 when we’re not used to having this access
00:28:59 to pre peer reviewed work.
00:29:03 I mean, in economics, actually, that’s quite normal.
00:29:05 You takes years to get something published.
00:29:07 So there’s a very active debate over
00:29:10 or discussion about papers before they’re peer reviewed
00:29:13 in this sort of working paper way,
00:29:16 much less normal or much newer in medicine.
00:29:20 And so I think part of that,
00:29:21 the perception about what process happens in open science
00:29:26 when you release a study, that got people confused.
00:29:29 And you’re right, it was a very important result
00:29:31 because we had just locked the world down
00:29:33 in middle of March with, I think, catastrophic results.
00:29:38 And if that study was right, if our study was right,
00:29:41 that meant we’d made a mistake.
00:29:44 And not because the death rate was low,
00:29:45 that’s actually not the key thing there.
00:29:47 The key thing is that we had adopted these policies,
00:29:51 these test and trace policies,
00:29:53 these policies, these lockdown policies
00:29:55 aimed at suppressing the virus level to close to zero.
00:30:00 That was essentially the idea.
00:30:01 If we can just get the virus to go away,
00:30:04 we won’t have to ever worry about it again.
00:30:07 The main problem with our result
00:30:09 as far as that strategy was concerned wasn’t the death rate,
00:30:11 it was the 40 to 50 times more infections than cases.
00:30:14 It was the 2.5% or 3% or 4% prevalence rate
00:30:19 that we identified of the antibodies in the population.
00:30:23 If that number is right, it’s too late.
00:30:25 The virus is not going to go to zero.
00:30:28 And no matter how much we test and trace and isolate,
00:30:30 we’re not going to get the viral level down to zero.
00:30:34 So we’re gonna have to let the virus
00:30:36 go through the entire population in some way or some other?
00:30:39 We can talk about that in a bit.
00:30:41 That’s the Great Barrington Declaration.
00:30:42 You don’t have to let the virus go through the population.
00:30:44 You can shield preferentially.
00:30:46 The policy we chose was to shield preferentially
00:30:50 the laptop class,
00:30:52 the set of people who could work from home
00:30:54 without losing their job.
00:30:56 And we did a very good job at protecting them.
00:30:59 Well, let me take a small tangent.
00:31:04 We’re gonna jump around in time,
00:31:06 which I think will be the best way to tell the story.
00:31:09 So that was the beginning.
00:31:10 Yeah, okay, actually, can I go back one more thing for that?
00:31:13 Because that’s really important
00:31:14 and I should have started with this.
00:31:17 What led me to do those studies was a paper
00:31:22 that I had remembered seeing
00:31:23 from the H1N1 flu epidemic in 2009.
00:31:26 This is where I’ve been much less active
00:31:28 in writing about that.
00:31:29 I had written like a paper or two about that in 2009.
00:31:34 There was actually the same debate over the mortality rate,
00:31:38 except it unfolded over the course of three years,
00:31:41 two or three years.
00:31:43 The early studies of the mortality rate in H1N1
00:31:47 counted the number of cases in the denominator,
00:31:52 counted the number of deaths in the numerator,
00:31:53 cases meaning people identified as having H1N1,
00:31:56 showing up the doctor, tested to have it.
00:32:00 And the earliest estimates of the H1N1 mortality
00:32:04 were like 4%, 3%, really, really high.
00:32:08 Over the course of a couple of more years,
00:32:11 a whole bunch of seroprevalence studies,
00:32:12 seroprevalence studies of H1N1 flu came out.
00:32:15 And it turned out that there were 100 or more times
00:32:20 people infected per case.
00:32:23 And so the mortality rate was actually something like 0.02%
00:32:27 for H1N1, not the three, like 100 fold difference.
00:32:32 So this made you think, okay,
00:32:34 it took us a couple of two or three years
00:32:36 to discover the truth behind the actual infections
00:32:40 for H1N1, and then what’s the truth here
00:32:43 and can we get there faster?
00:32:45 Yeah, and it spreads in a similar way as the H1N1 flu did.
00:32:49 I mean, it spreads via solization,
00:32:51 via person to person breathing, kind of contact up.
00:32:55 It may be some by fomites, but it seems less likely now.
00:32:59 In any case, it seemed really important to me
00:33:01 to speed up the process
00:33:03 of having those seroprevalence studies
00:33:05 so that we can better understand who was at risk
00:33:09 and what the right strategy ought to be.
00:33:12 This might be a good place to kind of compare influenza,
00:33:17 the flu, and COVID in the context of the discussion
00:33:20 we just had, which is how deadly is COVID?
00:33:24 So you mentioned COVID is a very particular
00:33:26 kind of steepness, where the X axis is age.
00:33:32 So in that context, could you maybe compare influenza
00:33:36 and COVID, because a lot of people outside the folks
00:33:41 who suggest that the lizards who run the world
00:33:45 have completely fabricated and invented COVID,
00:33:48 outside of those folks, kind of the natural process
00:33:51 by which you dismiss the threat of COVID is, say,
00:33:54 well, it’s just like the flu.
00:33:55 The flu is a very serious thing, actually.
00:33:58 So in that comparison, where does COVID stand?
00:34:03 Yeah, the flu is a very serious thing.
00:34:04 It kills 50, 60,000 people a year,
00:34:07 something I found out,
00:34:08 depending on the particular strain that goes around,
00:34:11 that’s in the United States.
00:34:12 The primary difference to me,
00:34:15 there’s lots of differences,
00:34:15 but one of the most salient differences
00:34:17 is the age gradient and mortality risk for the flu.
00:34:21 So the flu is more deadly to children than COVID is.
00:34:26 There’s no controversy about that.
00:34:29 Children, thank God, have much less severe reactions
00:34:34 to COVID infection than they do to flu infections.
00:34:39 And rate of fatalities and stuff like that.
00:34:41 Rate of fatality, all of that.
00:34:42 I think you mentioned,
00:34:44 I mean, it’s interesting to maybe also comment on,
00:34:47 I think in another conversation you mentioned
00:34:48 there’s a U shape to the flu curve,
00:34:54 so meaning there’s actually quite a large number of kids
00:34:57 that die from flu.
00:34:59 Yeah, I mean, the 1918 flu, the H1N1 flu,
00:35:03 the Spanish flu in the US killed millions of younger people.
00:35:09 And that is not the case with COVID.
00:35:13 More than, I’m gonna get the number wrong,
00:35:16 but something like 70, 80% of the deaths
00:35:19 are people over the age of 60.
00:35:21 Well, we’ve talked about the fear the whole time, really.
00:35:24 But my interaction with folks,
00:35:27 now I wanna have a family, I wanna have kids,
00:35:30 but I don’t have that real firsthand experience,
00:35:32 but my interaction with folks is at the core of fear
00:35:35 that folks had is for their children.
00:35:39 Like that somehow I don’t wanna get infected
00:35:46 because of the kids.
00:35:47 Because God forbid something happens to the kids.
00:35:50 And I think that obviously that makes a lot of sense
00:35:54 this kind of the kids come first no matter what,
00:35:57 that’s number one priority.
00:35:58 But for this particular virus,
00:36:02 that reasoning was not grounded in data, it seems like,
00:36:05 or that emotion and feeling was not grounded in data.
00:36:09 But at the same time, this is way more deadly than the flu
00:36:12 just overall, and especially to older people.
00:36:15 Yes.
00:36:16 Right, so.
00:36:17 The numbers, when the story is all said and done,
00:36:21 COVID would take many more lives.
00:36:24 Yeah, so, I mean, 0.2 sounds like a small number,
00:36:27 but it’s not a small number worldwide.
00:36:29 What do you think that number will be
00:36:31 by the, you know, that’s not like me,
00:36:34 but would we cross, I think it’s in the United States,
00:36:37 it’s the way the deaths are currently reported,
00:36:40 it’s like 800,000, something like that.
00:36:42 Do you think we’ll cross a million?
00:36:44 Seems likely, yeah.
00:36:46 Do you think it’s something that might continue
00:36:49 with different variants, what?
00:36:50 Well, I think, so we can talk about the end state of COVID.
00:36:53 The end state of COVID is it’s here forever.
00:36:56 I think that there is good evidence of immunity
00:37:01 after infection, such that you’re protected
00:37:05 both against reinfection and also against
00:37:08 severe disease upon reinfection.
00:37:11 So the second time you get it, it’s not true for everyone,
00:37:13 but for many people, the second time you get it
00:37:15 will be milder, much milder than the first time you get it.
00:37:18 With the long tail, like that lasts for a long time.
00:37:22 Yeah, so just, there are studies that follow, of course,
00:37:26 people who are infected for a year,
00:37:28 and the reinfection rate is something like
00:37:30 somewhere between 0.3 and 1%.
00:37:33 And like a pretty fantastic study out in Italy
00:37:36 has found that, there’s one in Sweden, I think,
00:37:38 there’s a few studies that have found similar things.
00:37:41 And the reinfections tend to produce much milder disease,
00:37:46 much less likely to end up in the hospital,
00:37:48 much less likely to die.
00:37:50 So what the end state of COVID is,
00:37:52 it’s circulating the population forever
00:37:54 and you get it multiple times.
00:37:56 Yeah, and then there’s, I think, studies and discussions
00:38:00 like the best protection would be to get it
00:38:04 and then also to get vaccinated.
00:38:06 And then a lot of people push back against that
00:38:08 for the obvious reasons from both sides,
00:38:10 because somehow the discourse has become
00:38:13 less scientific and more political.
00:38:14 Well, I think you wanna, the first time you meet it
00:38:18 is gonna be the most deadly for you.
00:38:20 And so the first time you meet it,
00:38:21 it’s just wise to be vaccinated.
00:38:22 The vaccine reduces severe disease.
00:38:25 Yeah, we’ll talk about the vaccine,
00:38:27 because I wanna make sure I address it carefully
00:38:30 and properly and in full context.
00:38:35 But yes, sort of to add to the context,
00:38:38 a lot of the fascinating discussions we’re having
00:38:40 is in the early days of COVID
00:38:43 and now for people who are unvaccinated.
00:38:46 That’s where the interesting story is.
00:38:49 The policy story, the sociological story and so on.
00:38:52 But let me go to something really fascinating
00:38:55 just because of the people involved,
00:38:57 the human beings involved,
00:38:59 and because of how deeply I care about science
00:39:03 and also kindness, respect and love and human things.
00:39:07 Francis Collins wrote a letter in October 2020
00:39:12 to Anthony Fauci and I think somebody else.
00:39:15 I have the letter, oh, it’s not a letter, email, I apologize.
00:39:20 Hi, Tony and Cliff, cgbdeclaration.org.
00:39:29 This proposal, this is the Great Barrington Declaration
00:39:32 that you’re a coauthor on.
00:39:34 This proposal from the three fringe epidemiologists
00:39:38 who met with the secretary
00:39:40 seem to be getting a lot of attention
00:39:42 and even a co signature from Nobel Prize winner,
00:39:45 Mike Levitt at Stanford.
00:39:48 There needs to be a quick and devastating
00:39:51 published take down of its premises.
00:39:54 I don’t see anything like that online yet.
00:39:57 Is it underway, question mark, Francis.
00:40:00 Francis Collins, director of the NIH,
00:40:03 somebody I talked to on this podcast recently.
00:40:06 Okay, a million questions I wanna ask.
00:40:09 But first, how did that make you feel
00:40:12 when you first saw this email come to light,
00:40:17 when did it come to light?
00:40:20 This week, actually, I think, or last week.
00:40:22 Okay, so this is because of freedom of information.
00:40:25 Yeah.
00:40:26 Which, by the way, sort of maybe,
00:40:30 because I do wanna add positive stuff
00:40:32 on the side of Francis here.
00:40:36 Boy, when I see stuff like that,
00:40:37 I wonder if all my emails leaked, how much embarrassing stuff.
00:40:43 Like, I think I’m a good person,
00:40:45 but I haven’t read my old emails.
00:40:49 Maybe, I’m pretty sure sometimes I could be an asshole.
00:40:53 Well, I mean, look, he’s a Christian,
00:40:54 and I’m a Christian, I’m supposed to forgive, right?
00:40:57 I mean, I think he was looking at this
00:41:01 Great Barrington Declaration as a political problem
00:41:03 to be solved, as opposed to a serious
00:41:07 alternative approach to the epidemic.
00:41:09 So maybe we’ll talk about it in more detail,
00:41:12 but just in case people are not familiar,
00:41:15 Great Barrington Declaration was a document
00:41:18 that you coauthored that basically argues
00:41:22 against this idea of lockdown as a solution to COVID,
00:41:26 and you propose another solution that we’ll talk about.
00:41:29 But the point is, it’s not that dramatic of a document,
00:41:34 it is just a document that criticizes
00:41:36 one policy solution that was proposed.
00:41:38 But it was the policy solution that had been put forward
00:41:41 by Dr. Collins and by Tony Fauci,
00:41:44 and a few other science, I mean, I think a relatively
00:41:48 small number of scientists and epidemiologists
00:41:50 in charge of the advice given to governments worldwide.
00:41:56 And it was a challenge to that policy
00:42:00 that said that, look, there is an alternate path,
00:42:02 that the path we’ve chosen, this path of lockdown
00:42:06 with the aim to suppress the virus to zero effectively,
00:42:09 I mean, that was unstated.
00:42:11 Cannot work and is causing catastrophic harm
00:42:14 to large numbers of poor and vulnerable people worldwide.
00:42:19 We put this out in October 4th, I think, of 2020,
00:42:23 and it went viral.
00:42:25 I mean, I’ve never actually been involved
00:42:27 with anything like this,
00:42:28 where I just put the document on the web,
00:42:31 and tens of thousands of doctors signed on,
00:42:34 hundreds of thousands of regular people signed on.
00:42:37 It really struck a chord of people,
00:42:40 because I think even by October of 2020,
00:42:41 people had this sense that there was something really wrong
00:42:45 with the COVID policy that we’ve been following.
00:42:48 And they were looking for reasonable people
00:42:52 to give an alternative.
00:42:52 I mean, we’re not arguing that COVID isn’t a serious thing.
00:42:56 I mean, it is a very serious thing.
00:42:57 This is why we had a policy that aimed at addressing it.
00:43:03 But we were saying that the policy we’re following
00:43:05 is not the right one.
00:43:06 So how does a democratic government deal with that challenge?
00:43:12 So to me, that, you asked me how I felt.
00:43:14 I was actually, frankly, just,
00:43:16 I suspected there’d been some email exchanges like that,
00:43:19 not necessarily from Francis Collins,
00:43:21 around the government around this time.
00:43:24 I mean, I felt the full brunt of a propaganda campaign
00:43:29 almost immediately after we published it,
00:43:31 where newspapers mischaracterized it
00:43:34 in the same way over and over and over again,
00:43:39 and sought to characterize me
00:43:41 as sort of a marginal fringe figure or whatnot.
00:43:45 Sunetra Gupta, Martin Kulldorff,
00:43:47 or the tens of thousands of other people that signed it.
00:43:50 I felt the brunt of that all year long.
00:43:53 So to see this in black and white,
00:43:56 in the handwriting, essentially,
00:43:58 I mean, the metaphorical handwriting of Francis Collins
00:44:01 was actually, frankly, a disappointment,
00:44:02 because I’ve looked up to him for years.
00:44:05 Yeah, I’ve looked up to him as well.
00:44:07 I mean, I look for the best in people,
00:44:12 and I still look up to him.
00:44:15 What troubles me is several things.
00:44:19 The reason I said about the asshole emails
00:44:23 I send late at night is I can understand this email.
00:44:28 It’s fear, it’s panic, not being sure.
00:44:34 The fringe, three fringe epidemiologists.
00:44:37 Plus Mike Leavitt, who won a Nobel Prize, I mean.
00:44:40 But using fringe, maybe in my private thoughts,
00:44:45 I have said things like that about others,
00:44:47 like a little bit too unkind.
00:44:50 Like, you don’t really mean it.
00:44:52 Now, add to that, he recently, this week,
00:44:56 whatever, doubled down on the fringe.
00:45:00 This is really troubling to me,
00:45:02 that I can excuse this email,
00:45:04 but the arrogance there, Francis, honestly,
00:45:10 I mean, broke my heart a little bit there.
00:45:12 This was an opportunity to, especially at this stage,
00:45:16 to say, just like I told him,
00:45:20 to say I was wrong to use those words in that email.
00:45:23 I was wrong to not be open to ideas.
00:45:27 I still believe that this is not,
00:45:29 like, say, like, actually argue with the proposal,
00:45:33 with the policy, the proposed solution.
00:45:36 Also, the devastating published,
00:45:41 devastating takedown, devastating takedown.
00:45:45 As you say, somebody who’s sitting on billions of dollars
00:45:50 that they’re giving to scientists,
00:45:54 some of whom are often not their best human beings
00:45:58 because they’re fighting with each other over money,
00:46:00 not being cognizant of the fact
00:46:02 that you’re challenging the integrity,
00:46:06 you’re corrupting the integrity of scientists
00:46:08 by allocating them money,
00:46:10 you’re now playing with that
00:46:13 by saying devastating takedown.
00:46:15 Where do you think the published takedown will come from?
00:46:19 It will come from those scientists
00:46:21 to whom you’re giving money.
00:46:23 What kind of example would they give
00:46:25 to the academic community that thrives on freedom?
00:46:28 Like, this is, I believe Francis Collins is a great man.
00:46:34 One of the things I was troubled by
00:46:36 is the negative response to him
00:46:38 from people that don’t understand
00:46:40 the positive impact that NIH has had on society,
00:46:44 how many people it’s helped.
00:46:45 But this is exactly the, so he’s not just a scientist.
00:46:50 He’s not just a bureaucrat who distributes money.
00:46:53 He’s also a scientific leader
00:46:55 that in difficult times we live in,
00:46:58 is supposed to inspire us with trust,
00:47:01 with love, with the freedom of thought.
00:47:04 He’s supposed to, you know those fringe epidemiologists?
00:47:08 Those are the heroes of science.
00:47:10 When you look at the long arc of history,
00:47:13 we love those people.
00:47:15 We love ideas, even when they get proven wrong.
00:47:18 That’s what always attracted me to science.
00:47:20 Like somebody, the lone voice saying,
00:47:23 oh no, the moon of Jupiter does move.
00:47:29 But the funny thing is,
00:47:30 Galileo was saying something truly revolutionary.
00:47:32 We were saying that what we proposed
00:47:34 in the Great Barbarian Declaration
00:47:35 was actually just the old pandemic plan.
00:47:38 It wasn’t anything really fundamentally novel.
00:47:42 In fact, there were plans like this
00:47:46 that lockdown scientists had written
00:47:49 in late February, early March of 2020.
00:47:52 So we were not saying anything radical.
00:47:54 We were just calling for a debate effectively
00:47:57 over the existing lockdown policy.
00:48:00 And this is a disappointment,
00:48:02 a really, truly a big disappointment
00:48:04 because by doing this, you were absolutely right, Lex.
00:48:08 He sent a signal to so many other scientists
00:48:12 to just stay silent, even if you had reservations.
00:48:15 Yeah, devastating take down that people,
00:48:18 you know how many people wrote to me privately,
00:48:21 like Stanford, MIT,
00:48:23 how amazing the conversation with Francis Collins was?
00:48:28 There’s a kind of admiration because,
00:48:31 okay, how do I put it?
00:48:33 A lot of people get into science
00:48:38 because they wanna help the world.
00:48:40 They get excited by the ideas
00:48:42 and they really are working hard to help
00:48:46 in whatever the discipline is.
00:48:47 And then there is sources of funding
00:48:50 which help you do help at a larger scale.
00:48:53 So you admire the people that are distributing the money
00:48:58 because they’re often, at least on the surface,
00:49:01 are really also good people.
00:49:02 Oftentimes they’re great scientists.
00:49:04 So like, it’s amazing.
00:49:06 That’s why I’m sort of,
00:49:10 like sometimes people from outside
00:49:12 think academia is broken some kind of way.
00:49:14 No, it’s a beautiful thing.
00:49:16 It really is a beautiful thing.
00:49:17 And that’s why it’s so deeply heartbreaking
00:49:19 where this person is,
00:49:23 I don’t think this is malevolence.
00:49:26 I think he’s just incompetence of communication twice.
00:49:31 I think there’s also arrogance at the bottom of it too.
00:49:34 But all of us have arrogance at the bottom.
00:49:36 There’s a particular kind of arrogance.
00:49:38 So here it’s of the same kind of arrogance
00:49:40 that you see when Tony Fauci gets on TV
00:49:43 and says that if you criticize me,
00:49:46 you’re not simply criticizing a man,
00:49:48 you’re criticizing science itself.
00:49:51 That is at the heart also of this email.
00:49:55 The certainty that the policies that they were recommending,
00:49:59 Collins and Fauci were recommending
00:50:01 to the president of the United States were right.
00:50:03 Not just right, but right so far right
00:50:06 that any challenge whatsoever to it is dangerous.
00:50:11 And I think that is really the heart of that email.
00:50:13 It’s this idea that my position is unchallengeable.
00:50:19 Now to be completely, to be as charitable as I can be
00:50:22 to this, I believe they thought that.
00:50:25 I believe some of them still think that,
00:50:27 that there was only one true policy possible
00:50:31 in response to COVID.
00:50:32 Every other policy was immoral.
00:50:36 And if you come from that position,
00:50:37 then you write an email like that.
00:50:39 You go on TV, you say effectively la science est moi, right?
00:50:42 I mean, that is what happens
00:50:44 when you have this sort of unchallengeable arrogance
00:50:47 that the policy you’re following is correct.
00:50:50 I mean, when we wrote the Great Bank Declaration,
00:50:52 what I was hoping for was a discussion
00:50:55 about how to protect the vulnerable.
00:50:57 I mean, that was the key idea to me in the whole thing
00:51:00 was better protection of the older population
00:51:02 who were really at really serious risk
00:51:04 if infected with COVID.
00:51:06 And we had been doing a very poor job, I thought,
00:51:08 to date in many places in protecting the vulnerable.
00:51:12 And what I wanted was a discussion by local public health
00:51:16 about better methods, better policies
00:51:18 to protect the vulnerable.
00:51:20 So when we were met with instead a series
00:51:25 of essentially propagandist lies about it.
00:51:27 So for instance, I kept hearing from reporters in those days,
00:51:31 why do you want to let the virus rip?
00:51:33 Let it rip, let it rip.
00:51:34 The words let it rip does not appear
00:51:37 in the Great Bank Declaration.
00:51:40 The goal isn’t to let the virus rip.
00:51:42 The goal is to protect the vulnerable,
00:51:45 to let society go open schools and do other things
00:51:49 that function as best it can
00:51:51 in the midst of a terrible pandemic, yes,
00:51:54 but not let the virus rip
00:51:56 where the most vulnerable aren’t protected.
00:51:58 The goal was to protect the vulnerable.
00:52:00 So why let it rip?
00:52:01 Because it was a propaganda term
00:52:03 to hit the fear centers of people’s brains.
00:52:06 Oh, these people are immoral.
00:52:08 They just want to let the virus go through society
00:52:09 and hurt everybody.
00:52:11 That was the idea.
00:52:12 It was a way to preclude a discussion
00:52:15 and preclude a debate about the existing policy.
00:52:19 So this is an app called Clubhouse.
00:52:23 I’ve gone back on it recently to practice Russian,
00:52:28 unrelated for a few big Russian conversations coming up.
00:52:32 Anyway, it’s a great way
00:52:33 to talk to regular people in Russian.
00:52:35 But I also, I was nervous.
00:52:37 I was preparing for a Pfizer CEO conversation
00:52:40 and there was a vaccine room and so I joined it.
00:52:43 And it was a pro science room.
00:52:49 These are like scientists
00:52:50 that were calling each other pro science.
00:52:52 The whole thing was like theater to me.
00:52:55 I mean, I haven’t thoroughly researched,
00:52:57 but looking at the resume,
00:52:58 they were like pretty solid researchers and doctors.
00:53:04 And they were mocking everybody who was at all,
00:53:10 I mean, it doesn’t matter what they stood for,
00:53:11 but they were just mocking people
00:53:13 and the arrogance was overwhelming.
00:53:15 I had to shut off because I couldn’t handle
00:53:18 that human beings can be like this to each other.
00:53:21 And then I went back just to double check,
00:53:24 is this really happening?
00:53:25 How many people are here?
00:53:26 Is this theater?
00:53:28 And then I asked to come on stage on Clubhouse
00:53:31 to make a couple of comments.
00:53:32 And then as I opened my mouth, I said, thank you so much.
00:53:36 This is a great room, sort of the usual civil politeness,
00:53:39 all that kind of stuff.
00:53:41 And I said, I’m worried that the kind of arrogance
00:53:47 with which things are being discussed here
00:53:51 will further divide us, not unite us.
00:53:55 And before I said even the unite us, further divide us,
00:54:00 I was thrown off stage.
00:54:02 Now, this isn’t why I mentioned platform,
00:54:04 but like I am like Lex Friedman, MIT,
00:54:08 also, which is something those people seem
00:54:11 to sometimes care about, followers and stuff like that.
00:54:15 Like, did you just do that?
00:54:18 And then they said, enough of that nonsense.
00:54:21 Enough of that nonsense.
00:54:22 They said to me, enough of that nonsense.
00:54:27 Somebody who is obviously interviewed, Francis Collins,
00:54:31 is the Pfizer CEO.
00:54:35 To bring you on, French epidemiologist also, so just.
00:54:37 Yeah, exactly.
00:54:38 But this broke my heart, the arrogance.
00:54:40 And this is, echoes of that arrogance
00:54:43 is something you see in this email.
00:54:44 And I really would love to have a million things
00:54:47 to talk about to try to figure out
00:54:48 how can we find a path forward?
00:54:50 I think a lot of the problems we’ve seen
00:54:54 in the discussion over COVID,
00:54:57 and especially in the scientific community,
00:54:59 there’s two ways to look at science, I think,
00:55:02 that have been competing with each other for a while now.
00:55:05 One way, and this is the way that I view science
00:55:08 and why I’ve always found it so attractive,
00:55:10 is an invitation to a structured discussion
00:55:14 where the discussion is tempered by evidence,
00:55:18 by data, by reasoning and logic, right?
00:55:22 So it’s a dialectical process where if I believe A
00:55:25 and you believe B, well, we talk about it.
00:55:29 We come up with an experiment
00:55:30 that distinguishes between the two.
00:55:32 And while B turns out to be right,
00:55:34 I’m all frustrated, but I buy you dinner
00:55:37 and I say, no, no, no, no, C.
00:55:38 And then we go on from there, right?
00:55:40 That’s what science is at its best.
00:55:43 It’s this process of using data in discussion.
00:55:46 It’s a human activity, right?
00:55:48 To learn, to have the truth unfold itself before us.
00:55:54 On the other hand, there’s another way
00:55:57 that people have used science or thought about science
00:55:59 as truth in and of itself, right?
00:56:03 Like if it’s science, therefore it’s true automatically.
00:56:07 And what does the science say to do?
00:56:10 Well, the science never says to do anything.
00:56:12 The science says, here’s what’s true.
00:56:13 And then we have to apply our human values to say,
00:56:17 okay, well, if we do this, then this is likely to happen.
00:56:21 That’s what the science says.
00:56:23 If we do that, then that is likely to happen.
00:56:25 Well, we’d rather have this than that, right?
00:56:27 But science doesn’t tell us
00:56:29 that we’d rather have this than that.
00:56:30 It’s our human values that tell us
00:56:31 that we’d rather have this than that.
00:56:32 Science plays a role, but it’s not the only thing.
00:56:36 It’s not the only role.
00:56:36 It’s like, it helps understand the constraints we face,
00:56:40 but it doesn’t tell us what to do
00:56:41 in face of those constraints.
00:56:43 But underneath it, at the individual level,
00:56:45 at the institutional level,
00:56:46 it seems like arrogance is really destructive.
00:56:52 So the flip side of that, the productive thing is humility.
00:56:55 So sort of always not being sure that you’re right.
00:57:03 This is actually kind of,
00:57:05 Stuart Russell talks about this for AI research.
00:57:07 How do you make sure that AI,
00:57:09 super intelligent AI doesn’t destroy us?
00:57:11 You built in a sort of module within it
00:57:15 that it always doubts its actions.
00:57:18 Like, it’s not sure.
00:57:20 Like, I know it says I’m supposed to destroy all humans,
00:57:23 but maybe I’m wrong.
00:57:24 And that maybe I’m wrong is essential for progress,
00:57:27 for actually doing in the long arc of history better,
00:57:30 not the perfect thing,
00:57:31 but better and better and better and better.
00:57:33 I mean, the question I have here for you is this,
00:57:37 this email so clearly captures some maybe echo,
00:57:41 but maybe a core to the problem.
00:57:44 Do you put responsibility of this email,
00:57:47 of the shortcomings and failures
00:57:49 on individuals or institutions?
00:57:52 Is this Francis Collins, Anthony?
00:57:53 No, this is an institutional failure, right?
00:57:55 So the NIH, so I’ve had two decades of NIH funding.
00:57:59 I’ve sat on NIH review panels.
00:58:01 The purpose of the NIH is what you said earlier, Lex.
00:58:03 The purpose of the NIH is to support the work of scientists.
00:58:08 To some extent, it’s also to help scientists,
00:58:10 to direct scientists to work on things
00:58:12 that are very important for public health
00:58:14 or for the health of the public.
00:58:17 So, and the way you do that is you say,
00:58:18 okay, we’re gonna put $50 million
00:58:21 on the research in Alzheimer’s disease this year
00:58:24 or $70 million on HIV or whatever it is, right?
00:58:27 And that pot of money then scientists compete
00:58:30 with each other for the best ideas to use it
00:58:33 to address that problem.
00:58:36 So it’s essentially an endeavor
00:58:38 to support the work of scientists.
00:58:40 It is not in and of itself a policy organ.
00:58:45 It doesn’t say what public health policy should be.
00:58:48 For that, you have the CDC and what happened
00:58:53 during the pandemic is that people in the NIH
00:58:58 were called upon to contribute
00:59:01 to public health policymaking.
00:59:04 And that created the conflict of interest
00:59:06 you see in that email, right?
00:59:09 So now you have the head of the NIH in effect saying
00:59:13 to all scientists, you must agree with me
00:59:17 in the policy that I’ve recommended
00:59:20 or else you’re a fringe.
00:59:23 That is a deep conflict of interest.
00:59:25 It’s deep because first he’s conflicted.
00:59:27 He has this dual role as the head of the NIH,
00:59:31 supporter of scientific funding
00:59:33 and then also inappropriately called
00:59:35 to set or help set pandemic policy.
00:59:39 That should never have happened.
00:59:40 There should be a bright line between those two roles.
00:59:44 Let me ask you about just Francis Collins.
00:59:47 I had a chance to talk to him on a podcast.
00:59:49 I don’t know if you maybe by chance
00:59:51 gotten a chance to hear a few words.
00:59:52 I heard some of it, yeah.
00:59:54 Well, I have kind of a question to that
00:59:56 because a lot of people wrote to me quite negative things
01:00:01 about Francis Collins and like I said,
01:00:03 I still believe he’s a great man and a great scientist.
01:00:09 One of the things when I talked to him off mic
01:00:13 about the vaccine,
01:00:16 the excitement he had about when we were recollecting
01:00:21 when they first gotten an inkling
01:00:23 that it’s actually going to be possible to get a vaccine,
01:00:26 just he wasn’t messaging,
01:00:28 just in the private or of our own conversation,
01:00:31 he was really excited and why was he excited?
01:00:34 Because he gets to help a lot of people.
01:00:36 This is a man that really wants to help people
01:00:40 and there could be some institutional self delusion,
01:00:43 the arrogance, all those kinds of things
01:00:45 that lead to this kind of email.
01:00:47 But ultimately the goal is this,
01:00:49 I don’t think people quite realize this.
01:00:51 The reason he would call you a fringe epidemiologist,
01:00:55 the reason there needs to be a devastating published
01:00:58 take down, he, I believe really believes
01:01:01 that it could be very dangerous
01:01:05 and it’s a lot of burden to carry on his shoulders
01:01:09 because like you said, in his role
01:01:11 where he defines some of the public policy,
01:01:16 depending on how he thinks about the world,
01:01:19 millions of people could die
01:01:20 because of one decision he make.
01:01:22 And that’s a lot of burden to walk with.
01:01:24 Yeah, no, I think that’s right.
01:01:25 I don’t think that he has bad intentions.
01:01:29 I think that he was basically put,
01:01:31 was put or maybe put himself in a position
01:01:34 where this kind of conflict of interest
01:01:38 was going to create this kind of reaction, right?
01:01:42 The kind of humility that you’re calling for
01:01:44 is almost impossible when you have that dual role
01:01:48 that you shouldn’t have as funder of science
01:01:51 and also setter of scientific policy.
01:01:53 I agree with everything you just said,
01:01:54 except the last part.
01:01:55 The humility is almost impossible.
01:02:00 Humility is always difficult.
01:02:01 I think there’s a huge incentive
01:02:04 for humility in that position.
01:02:06 Now look at history.
01:02:08 Great leaders that have humility are popular as hell.
01:02:14 So if you like being popular,
01:02:16 if you like having impact, legacy,
01:02:19 these descendants of ape seem to care about legacy,
01:02:22 especially as they get older in these high positions.
01:02:25 I think the incentive for humility is pretty high.
01:02:28 Well, the thing is there’s a lot
01:02:30 that he has to be proud of in his career.
01:02:32 I mean, the Human Genome Project
01:02:34 wouldn’t have happened without him.
01:02:36 And he is a great man and a great scientist.
01:02:39 So it is tragic to me that his career
01:02:41 has ended in this particular way.
01:02:44 Can I ask you a question
01:02:46 about my podcast conversation with him?
01:02:50 By way of advice or maybe criticism,
01:02:54 there’s a lot of people that wrote to me
01:02:56 kind words of support and a lot of people
01:03:00 that wrote to me respectful, constructive criticism.
01:03:03 How would you suggest to have conversations
01:03:06 with folks like that?
01:03:07 And maybe, I mean,
01:03:11 because I have other conversations like this,
01:03:12 including I was debating whether to talk to Anthony Fauci.
01:03:17 He wanted to talk.
01:03:19 And so what kind of conversation do you have?
01:03:22 And sorry to take us on a tangent,
01:03:24 but almost from an interview perspective
01:03:27 of how to inspire humility and inspire trust in science
01:03:31 or maybe give hope that we know what the heck we’re doing
01:03:34 and we’re gonna figure this out?
01:03:35 I mean, I think you’re,
01:03:38 I’ve had been now interviewed by many people.
01:03:41 I think the style you have really works well, Lex.
01:03:44 You have to,
01:03:45 because I don’t think you’re gonna be ever an attack dog
01:03:48 trying to go after somebody and force them to like,
01:03:53 sort of admit that they were wrong or whatever about,
01:03:55 I mean, I also actually find that form of journalism
01:03:58 and podcasting really off putting.
01:04:00 It’s hard to watch.
01:04:02 Also, it’s a whole other tangent.
01:04:04 Is that actually effective?
01:04:05 I don’t think so.
01:04:06 Do you wanna ask Hitler,
01:04:09 and I think about this a lot, actually interviewing Hitler.
01:04:11 I’ve been studying a lot about the rise and fall
01:04:13 of the Third Reich.
01:04:15 I think about interviewing Stalin.
01:04:16 Like I put myself in that mindset,
01:04:18 like how do you have conversations with people
01:04:22 to understand who they are so that,
01:04:24 not so you can sit there and yell at them,
01:04:28 but to understand who they are
01:04:29 so that you can inspire a very large number of people
01:04:32 to be the best version of themselves
01:04:33 and to avoid the mistakes of the past.
01:04:36 I believe that everyone that’s involved in this debate
01:04:39 has good intentions.
01:04:41 They’re coming at it from their points of view.
01:04:44 They have their weaknesses.
01:04:48 And if you can paint a picture in your questioning
01:04:50 by sympathetic questioning of those strengths and weaknesses
01:04:55 and their point of view, you’ve done a service.
01:04:57 That’s really all I personally like to see
01:05:00 in those kinds of interviews.
01:05:02 I don’t think a gotcha moment is really the key thing there.
01:05:06 The key thing is understanding where they’re coming from,
01:05:09 understanding their thinking,
01:05:10 understanding the constraints they faced
01:05:12 and how did they manage them.
01:05:14 That’s gonna provide a much,
01:05:15 I mean, to me, that’s what I look for
01:05:17 when I listen to podcasts like yours,
01:05:19 is an understanding of that person and the moment
01:05:24 and how they dealt with it.
01:05:26 I mean, I guess the hope is to discover in a sympathetic way
01:05:30 a flaw in a person’s thinking together.
01:05:33 Like as opposed to discovering the positive thing together,
01:05:37 you discover the thing, well,
01:05:39 I didn’t really think about that.
01:05:40 Yeah, I mean, that’s how science is, right?
01:05:42 That’s why we find it so attractive is this,
01:05:46 I like it when a student shows me I’m thinking incorrectly.
01:05:51 Right, I’m really grateful to that student
01:05:53 because now I have an opportunity to change my mind about it
01:05:57 and then start thinking even more correctly.
01:05:58 I mean, and there are moments when,
01:06:02 I mean, like this is probably a good time to say
01:06:05 like what I think I got wrong during the pandemic, right?
01:06:07 So like for instance, you said Francis Collins had a moment
01:06:10 when he learned that there was quite possible
01:06:14 to get a vaccine going.
01:06:16 He must’ve learned that quite early.
01:06:19 And I didn’t learn that early.
01:06:21 I mean, I didn’t know, in March of 2020,
01:06:25 in my experience with vaccine development,
01:06:28 it would’ve take, I thought it would take a decade or more
01:06:30 to get a vaccine.
01:06:33 That was wrong, right?
01:06:34 I didn’t, and I was so happy
01:06:38 when I started to see the preliminary numbers
01:06:40 in the Pfizer trial that strongly suggested
01:06:43 it was going to work.
01:06:46 And I was, I mean, like very few times in my life
01:06:49 I’m so happy to be wrong.
01:06:50 And it changes kind of, I think I’ve heard you mention
01:06:55 that a lockdown is still a bad idea
01:06:58 unless the vaccine comes out in like tomorrow.
01:07:01 There’s still like suffering and economic pain,
01:07:05 all kinds of pain can still happen
01:07:07 in even just a scale of weeks versus months.
01:07:13 Yeah.
01:07:14 Well, let’s talk about the vaccine.
01:07:16 What are your thoughts on the safety and efficacy
01:07:18 of COVID vaccines at the individual and the societal level?
01:07:22 So for the vaccine safety data,
01:07:26 it’s actually challenging to convey to the public
01:07:30 how this is normally done.
01:07:31 Like normally you would do this in the context of the trial,
01:07:34 you’d have a long trial with large numbers,
01:07:37 relatively large numbers of people,
01:07:38 you’d follow them over a long time
01:07:40 and the trial will give you some indication
01:07:42 of the safety of the vaccine.
01:07:43 And it did, I mean, but the trial,
01:07:47 the way it was constructed, when it came out
01:07:51 that it was protective against COVID,
01:07:52 it was no longer ethical to have a placebo arm.
01:07:56 And so that placebo arm was vaccinated, large part of it.
01:08:00 And so that meant that from the trial,
01:08:02 you were not going to be able to get data
01:08:05 on the longterm safety profiles of the vaccine.
01:08:09 And also the other thing about trials,
01:08:10 although there’s tens of thousands of people enrolled,
01:08:13 that’s still not enough to get
01:08:14 when you deploy a vaccine at population scale,
01:08:18 you’re gonna see things that weren’t in the trial,
01:08:21 guaranteed, populations of people
01:08:23 that weren’t represented well in the trial
01:08:25 are gonna be given the vaccine
01:08:27 and then they’re gonna have things that happen to them
01:08:29 that you didn’t anticipate.
01:08:32 So I wasn’t surprised when people were a little bit
01:08:35 skeptical when the trial was done about the safety profile,
01:08:38 just the way the nature of the thing was gonna make it
01:08:40 so that it was gonna be hard to get a complete picture
01:08:43 from the trials itself.
01:08:45 And the trial showed they were pretty safe
01:08:47 and quite effective at preventing both you
01:08:51 from getting COVID,
01:08:52 like I said, I think the main endpoint of the trial itself
01:08:54 was a symptomatic COVID, right?
01:08:57 So that was like, that was, I mean, it was really to me,
01:09:03 like it was about as amazing achievement as anything,
01:09:06 organizing a trial of that scale and running it so quickly.
01:09:10 And the final results being so surprisingly high.
01:09:14 So good, right?
01:09:16 And so, but the problem then was,
01:09:20 normally it would take a long time,
01:09:23 the FDA would tell Pfizer to go back
01:09:25 and try it in this subgroup,
01:09:27 they’d work more on dosing,
01:09:28 they do all these kinds of things
01:09:31 that kind of didn’t, we really didn’t have time for
01:09:33 in the middle of the pandemic, right?
01:09:34 So you have a basis for approval that it’s less full
01:09:40 than normally you would have for a population scale vaccine.
01:09:44 But the results were good, the results looked really good.
01:09:47 And actually, I should say for the most part,
01:09:49 that’s been born out when we’ve given the vaccine at scale
01:09:53 in terms of protection against severe disease, right?
01:09:56 So people who have got the vaccine
01:09:59 for a very long time after they’ve had
01:10:01 for the full vaccination have had great protection
01:10:04 against being hospitalized and dying if they get COVID.
01:10:08 Let’s separate, because this seems to be,
01:10:11 there’s critics of both categories, but different.
01:10:16 Kids and kids, not older people,
01:10:20 like let’s say five years old and above or something,
01:10:24 or 13 years old and above.
01:10:26 So for those, it seems like the reduction
01:10:31 of the rate of fatalities and serious illness
01:10:35 seems to be something like 10X.
01:10:38 I mean, for older people, it is a godsend, this vaccine.
01:10:42 It transforms the problem of focus protection
01:10:47 from something that’s quite challenging,
01:10:49 possible, I believe, but quite challenging
01:10:50 to something that’s much, much more manageable.
01:10:53 Because the vaccine in and of itself when deployed
01:10:56 in older populations is a form of focus protection.
01:11:00 Yes, by the way, we’ll talk about the focus protection
01:11:03 in one segment, because it’s such a brilliant idea
01:11:05 for this pandemic or for future pandemics.
01:11:08 I thought the sociological, psychological discussion
01:11:11 about the letter from Francis Collins is,
01:11:15 because it was so recent, it has been so troubling to me,
01:11:17 so I’m glad we talked about that first.
01:11:20 But so there seems to be, the vaccines work
01:11:24 to reduce deaths, and that has especially
01:11:29 the most transformative effects for the older folks.
01:11:33 I’ve told you one thing that I got wrong in the pandemic.
01:11:35 Let me tell you the second thing I got wrong,
01:11:36 for sure, in the pandemic.
01:11:38 In January of this year, 2021,
01:11:43 I thought that the vaccines would stop infection.
01:11:48 Yes.
01:11:48 Right, it would make it so that you were much less likely
01:11:51 to be infected at all, because the antibodies
01:11:55 that were produced by the vaccines
01:11:56 looked like they were neutralizing antibodies
01:11:58 that would essentially block you from being infected at all.
01:12:01 That turned out to be wrong, right?
01:12:06 So I think, and it became clear as data came out
01:12:10 from Israel, which vaccinated very early,
01:12:12 that they were seeing surges of infection,
01:12:14 even in a very highly vaccinated population,
01:12:17 that the vaccine does not stop infection.
01:12:21 So you’re a used car salesman,
01:12:24 and you were selling the vaccine,
01:12:26 and the features you thought a vaccine would have,
01:12:28 I mean, I have a similar kind of sense
01:12:30 when the vaccine came out.
01:12:31 Vaccine would reduce, if you somehow were able to get it,
01:12:37 it would reduce rate of death and all those kinds of things,
01:12:40 but it would also reduce the chance of you getting it,
01:12:44 and if you do get it, the chance of you transmitting it
01:12:47 to somebody else.
01:12:48 And it turns out that those latter two things
01:12:52 are not as definitive, or in fact,
01:12:55 I mean, I don’t know to which degree they’re not there at all.
01:12:57 I think it’s a little complicated,
01:12:59 because I think the first two or three months
01:13:01 after you’re fully vaccinated, after the second dose,
01:13:04 you have 60, 70% efficacy peak against infection.
01:13:10 So that, which is pretty good, I mean, right?
01:13:12 But by six, seven, eight months, that drops to 20%.
01:13:16 Some places, some studies, like there’s a study
01:13:19 out of Sweden that suggests it might even drop to zero.
01:13:21 But, and then you’re also infectious
01:13:23 for some period of time, if you do get it,
01:13:25 even though you’re vaccinated.
01:13:27 Correct.
01:13:27 It seems to be lucidated that the period of time
01:13:30 your infectious is shorter.
01:13:31 Is shorter, but the infectivity per day is about as high.
01:13:36 So you still, the point is that the vaccine
01:13:39 might reduce some risk of infecting others,
01:13:41 but it’s not a categorical difference.
01:13:44 So, it’s not safe to be in the presence
01:13:49 of just vaccinated people.
01:13:51 You can still get infected.
01:13:53 Right, so, I mean, there’s a million things
01:13:56 I wanna ask here, but is there in some sense
01:13:59 because the vaccine really helps
01:14:04 on the worst part of this pandemic,
01:14:06 which is killing people.
01:14:08 Yes.
01:14:09 Doesn’t that mean, where does the vaccine hesitancy
01:14:14 come from in terms of, it seems like,
01:14:17 obviously a vaccine is a powerful solution
01:14:20 to let us open this thing up.
01:14:22 Yeah, so I wrote a Wall Street Journal op ed
01:14:24 with Sunetra Gupta in December of last year.
01:14:26 Yes.
01:14:27 A very night with a very naive title,
01:14:29 which says we can end the lockdowns in a month.
01:14:32 And the idea is very simple.
01:14:33 Vaccinate all vulnerable people
01:14:39 and then open up.
01:14:40 Open up.
01:14:41 Right, and the idea was that the lockdown harms,
01:14:44 this is directly related to the Great Barrington Declaration.
01:14:47 Great Barrington Declaration said the lockdown harms
01:14:49 are devastating to the population at large.
01:14:53 There’s this considerable segment of people
01:14:55 that are vulnerable, protect them.
01:14:58 Well, with the vaccine, we have a perfect tool
01:15:00 to protect the vulnerable, which is, I still believe,
01:15:02 I mean, it’s true, right?
01:15:04 You vaccinate the vulnerable, the older population,
01:15:07 and as you said, there’s a tenfold decrease
01:15:09 in the mortality risk from getting infected,
01:15:13 which is, I mean, amazing.
01:15:14 So that was the strategy we outlined.
01:15:17 What happened is that the vaccine debate got transformed.
01:15:20 So first there’s, so you’re asking about vaccine hesitancy.
01:15:22 I think first there’s the inherent limitations
01:15:27 of how to measure vaccine safety, right?
01:15:29 So we talked about a little bit about the trial,
01:15:31 but also after the trial, there’s a mechanism,
01:15:35 and this is the work I’ve been involved with before COVID,
01:15:37 on tracking and identifying and checking
01:15:42 whether the vaccines actually are safe.
01:15:43 And the central challenge is one of causality.
01:15:47 So you no longer have the randomized trial,
01:15:50 but you wanna know is the vaccine,
01:15:52 when it’s deployed at scale, causing adverse events.
01:15:57 Well, you can’t just look at people who are vaccinated
01:16:00 and see what adverse events happen,
01:16:02 because you don’t know what would have happened
01:16:03 if the person had not been vaccinated.
01:16:06 So you have to have some control group.
01:16:09 Now, what happened is there’s several systems
01:16:12 to check this that the CDC uses.
01:16:14 One very commonly known one now is called VAERS,
01:16:18 the Vaccine Adverse Event Reporting System.
01:16:20 There, anyone who has an adverse event,
01:16:23 either a regular person or a doctor can just go report,
01:16:26 look, I had the vaccine and two days later I had a headache
01:16:28 or whatever it is, the person died
01:16:32 a day after I had the vaccine, right?
01:16:34 Now, the vaccine was rolled out to older people first,
01:16:38 and older people die sometimes with or without the vaccine.
01:16:42 So sometimes you’ll see someone’s vaccinated
01:16:44 and a few days later they die.
01:16:46 Did the vaccine cause it or something else cause it?
01:16:48 Really difficult to tell.
01:16:50 In order to tell, you need a control group.
01:16:53 For that, there are other systems the FDA and CDC have,
01:16:58 like there’s one called VSD, Vaccine Safety Datalink.
01:17:02 There’s another system called BEST,
01:17:05 I forget what the acronym is,
01:17:06 to essentially to track cohorts of people,
01:17:11 vaccinated versus unvaccinated,
01:17:13 with as careful of matching as you can do.
01:17:15 It’s not randomized,
01:17:17 and then see if you have safety signals
01:17:21 that pop up in the vaccinated
01:17:23 relative to the control group unvaccinated.
01:17:27 And so that’s, for instance,
01:17:28 how the myocarditis risk was picked up
01:17:32 in especially young men.
01:17:34 It’s also how the higher risk of blood clots
01:17:38 in middle age and older women
01:17:41 with the J&J vaccine was picked up.
01:17:43 There, what you have are situations
01:17:46 where the baseline risk of these outcomes are so low
01:17:50 that if you see them in the vaccinated arm at all,
01:17:54 that it’s not hard to understand that the vaccine did this.
01:17:57 Young men should not be having myocarditis.
01:18:00 Middle age women should not be having
01:18:02 huge blood clots in the brain.
01:18:04 So when you see that, you can say it’s linked.
01:18:05 Now, the rates are low.
01:18:07 So young men, maybe one in 5,000,
01:18:09 one in 10,000 of the vaccine,
01:18:11 vaccine related myocarditis, pericarditis.
01:18:14 Young women, middle age women, I don’t know.
01:18:17 I’m not sure what the right number might be,
01:18:19 but like I’d say, it’s like one in hundreds of thousands,
01:18:23 something like that.
01:18:26 So these are rare outcomes,
01:18:27 but they are vaccine linked outcomes.
01:18:30 How do you deal with that as a messaging thing?
01:18:33 I think you just tell people.
01:18:35 You tell people here are the risks.
01:18:36 You transparently tell them.
01:18:37 And just, you’re not,
01:18:38 so they’re not getting into something that they don’t know.
01:18:41 And don’t treat people like they’re children
01:18:45 and need to be told lies
01:18:47 because they won’t understand
01:18:48 the full complexity of the truth.
01:18:50 People, I think, are pretty good at,
01:18:54 or actually, people with time are good at understanding data,
01:18:59 but better than anything.
01:19:01 They’re better at,
01:19:04 they’re extremely good at detecting arrogance and bullshit.
01:19:08 And you give them either one of those.
01:19:10 I mean, I’ll give you one
01:19:11 that’s where I think it’s greatly undermined vaccine,
01:19:14 greatly undermined the demand for the vaccine,
01:19:16 is this weird denial that if you recover from COVID,
01:19:20 you have extremely good immunity,
01:19:24 both against infection and access to disease.
01:19:27 And that denial leads to people distrusting the message
01:19:31 given by like the CDC director, for instance,
01:19:33 in favor of the vaccine, right?
01:19:35 Why would you deny a thing that’s such an obvious fact?
01:19:39 Like you can look at the data and it just,
01:19:42 I mean, it just pops out at you
01:19:43 that people that are COVID recovered
01:19:45 are not getting infected again at very high rates,
01:19:48 much lower rates.
01:19:50 After these kinds of conversations,
01:19:53 I’m sure after this very conversation,
01:19:55 I often get a number of messages from Joe, Joe Rogan,
01:19:59 and from Sam Harris, who to me are people I admire,
01:20:03 I think are really intelligent, thoughtful human beings.
01:20:06 They also have a platform.
01:20:08 And I believe, at least in my mind,
01:20:11 about this COVID set of topics,
01:20:14 they represent a group of people.
01:20:19 Each group has smart, thoughtful,
01:20:25 well intentioned human beings.
01:20:27 And I don’t know who is right,
01:20:30 but I do know that they’re kind of tribal a little bit,
01:20:36 those groups.
01:20:37 And so the question I wanna ask is like,
01:20:41 what do you think about these two groups
01:20:45 and this kind of tension over the vaccine
01:20:49 that sometimes it just keeps finding different topics
01:20:54 on which to focus on,
01:20:55 like whether kids should get vaccinated or not,
01:20:57 whether there should be vaccine mandates or not,
01:21:00 which seem to be often very kind of specific policy
01:21:03 kinds of questions that miss the bigger picture.
01:21:06 I think it’s a symptom of the distrust
01:21:08 that people have in public health.
01:21:10 I think this kind of schism over the vaccine
01:21:13 does not happen in places
01:21:15 where the public health authorities
01:21:16 have been much more trustworthy, right?
01:21:18 So you don’t see this vaccine
01:21:20 hasn’t seen Sweden, for instance.
01:21:23 What’s happened in the United States
01:21:25 is that the vaccine has become first because of politics,
01:21:30 but then also because of the scientific arrogance,
01:21:33 this sort of touchstone issue,
01:21:35 and people line up on both sides of it,
01:21:37 and the different language you’re hearing
01:21:39 is structured around that.
01:21:40 So before the election, for instance,
01:21:42 I did a testimony in the House
01:21:46 on measurement of vaccine safety.
01:21:49 And I was invited by the Republicans.
01:21:52 There were, I think, four other experts
01:21:54 invited by the Democrats,
01:21:55 or three other experts invited by Democrats,
01:21:57 each of whom had a lot of experience
01:21:59 in measuring vaccine safety.
01:22:00 I was really surprised to hear them each doubt
01:22:04 whether the FDA would do a reasonable job
01:22:06 in assessing vaccine safety,
01:22:08 including by people who have long records
01:22:11 of working with the FDA.
01:22:12 I mean, these are professionals, great scientists,
01:22:17 whose main sort of goal in life
01:22:19 is to make sure that unsafe vaccines
01:22:22 don’t get released into the world.
01:22:24 And if they are, they get pulled.
01:22:26 And they’re casting down on the vaccine
01:22:28 the ability to track vaccine safety before the election.
01:22:32 And then after the election,
01:22:34 the rhetoric switched on a dime, right?
01:22:38 All of a sudden, it’s Republicans that are cast
01:22:40 as if they’re vaccine hesitant.
01:22:42 That kind of political shift, the public notices.
01:22:46 If all it takes is an election to change
01:22:49 how people talk about the safety of the vaccine,
01:22:51 well, we’re not talking science anymore,
01:22:53 many people think, right?
01:22:54 I think that created its hesitancy.
01:22:58 The other thing I think,
01:22:59 I think the hesitancy,
01:23:04 some politicians viewed it as a political,
01:23:07 as sort of like a political opportunity
01:23:10 to sort of demonize people who are hesitant.
01:23:14 And that itself fueled hesitancy, right?
01:23:16 Like if you’re telling me I’m a rube
01:23:18 that just doesn’t want the vaccine
01:23:19 because I want everyone to die,
01:23:20 well, I’m gonna react really negatively.
01:23:25 And if you’re talking down to me
01:23:27 about my legitimate sort of concerns
01:23:32 about whether this vaccine is safe to take,
01:23:34 I mean, I’ve heard from women
01:23:36 who were thinking about getting pregnant,
01:23:37 should I take the vaccine?
01:23:38 I don’t know.
01:23:39 I mean, there are all kinds of questions,
01:23:41 legitimate questions that I think
01:23:44 should have good data to answer
01:23:45 that we don’t necessarily have good data to answer.
01:23:47 So what do you do in the face of that?
01:23:50 Well, one reaction is to pretend
01:23:52 like we know for a fact that it’s safe
01:23:55 when we don’t have the data to know for a fact
01:23:57 in that particular group
01:23:58 with that particular set of clinical circumstances you know.
01:24:01 And that I think breeds hesitancy.
01:24:03 People can detect that bullshit.
01:24:06 Whereas if you just tell people, you know, I don’t know.
01:24:09 Yeah, leave with humility.
01:24:10 Yeah, you will end up with a better result.
01:24:14 Let me ask you about,
01:24:15 I’ve recently had a conversation with the Pfizer CEO.
01:24:19 This is part therapy session, part advice,
01:24:24 because again, I really want us to get through this together
01:24:29 and it feels like the division is a thing
01:24:31 that prevents us from getting through this together.
01:24:35 And once again, just like with Francis Collins,
01:24:38 a lot of people wrote to me words of support
01:24:43 and a lot of people wrote to me words of criticism.
01:24:48 I’m trying to understand the nature of the criticism.
01:24:53 So some of the criticism had to do with against the vaccine
01:24:57 and those kinds of things.
01:24:58 That I have a better understanding of.
01:25:02 But some kind of deep distrust of Pfizer.
01:25:07 So actually looking at Big Pharma broadly,
01:25:13 I’m trying to understand am I so naive
01:25:19 that I just don’t see it?
01:25:21 Because yes, there’s corrupt people and they’re greedy,
01:25:26 they’re flawed in all walks of life.
01:25:29 But companies do quite an incredible job
01:25:35 of taking a good idea at the scale
01:25:37 and making some money with that idea.
01:25:39 But they are the ones that achieve scale on a good idea.
01:25:43 I don’t know, it’s not obvious to me.
01:25:46 I don’t see where the manipulation is.
01:25:49 So the fear that people have and I talked to Joe
01:25:53 about this quite a bit.
01:25:55 I think this is a legitimate fear
01:25:57 and a fear you should often have
01:26:00 that money has influenced,
01:26:01 this proportional influence, especially in politics.
01:26:04 So the fear is that the policy of the vaccine
01:26:10 was connected to the fact that lots of money
01:26:13 could be made by manufacturing the vaccine.
01:26:17 And I understand that.
01:26:19 And it’s actually quite a heck of a difficult task
01:26:22 to alleviate that concern.
01:26:24 Like you really have to be a great man or woman or a leader
01:26:27 to convince people that you’re not full of shit,
01:26:30 that you’re not just playing a game on them.
01:26:32 I don’t know, it’s a difficult task.
01:26:35 But at the same time, I really don’t like
01:26:38 the natural distrust every billionaire,
01:26:41 distrust everybody who’s trying to make money
01:26:44 because it feels like under a capitalistic system at least,
01:26:47 the way to do a lot of good,
01:26:50 like to do good at scale in the world
01:26:53 is by being at least in part motivated by profit.
01:26:57 I mean, I share your ambivalence, right?
01:26:59 So on the one hand, you have a fantastic achievement.
01:27:02 The discovery of the vaccine
01:27:06 and then the manufacturing at scale
01:27:08 so that billions of people can take the vaccine
01:27:12 in a relatively short time.
01:27:14 That is a remarkable achievement
01:27:15 that could not have happened without companies like Pfizer.
01:27:20 And on the other hand,
01:27:21 there is this sort of corrupting influence of that money.
01:27:25 Just to give you one example,
01:27:27 there’s an enormous controversy over whether
01:27:30 relatively inexpensive repurposed drugs
01:27:32 can be used to treat the disease.
01:27:38 None of, no company like Pfizer
01:27:40 has any interest whatsoever in evaluating it.
01:27:43 Even Merck, I think it was Merck,
01:27:45 that had the patent on ivermectin now expired,
01:27:50 has no interest at all in checking to see if it works.
01:27:54 Not only do they not have interest,
01:27:57 they have a way of talking about people
01:28:01 who might have a little bit of interest
01:28:04 that’s again.
01:28:06 Fringe.
01:28:07 Full of arrogance.
01:28:09 Yeah.
01:28:10 And that is what troubles me.
01:28:12 Is there not a, it’s back to the play of science.
01:28:15 It’s not, they’re not a bit of curiosity.
01:28:17 One, okay, one, the natural curiosity of a human being
01:28:20 that should always be there and an open mind is.
01:28:23 And second, in the case of ivermectin
01:28:25 and other things like that,
01:28:27 you have to acknowledge
01:28:28 that there’s a very large number of people
01:28:31 who care about this topic.
01:28:33 And this is a way to inspire them
01:28:36 to also play in the space of science,
01:28:38 to inspire them with science.
01:28:39 You can’t just like dismiss everybody
01:28:42 that you can’t just dismiss people, period.
01:28:45 Yeah.
01:28:46 Well, I mean, I think here, take ivermectin, right?
01:28:48 There’s actually a study funded by the NIH,
01:28:51 by Tony Fauci’s NIAID and the NIH
01:28:56 called ACTIV6 that’s a randomized trial of ivermectin.
01:29:02 It’s due to be completed in March, 2023.
01:29:07 So normally when you have private actors
01:29:10 like these big drug companies that have no interest
01:29:13 in conducting some kind of scientific experiment
01:29:16 that would have some public benefit,
01:29:18 it’s the job of the government,
01:29:20 and in this case, the NIH to fund that kind of work.
01:29:24 The NIH has been incredibly slow
01:29:29 in its evaluations of these repurposed drugs.
01:29:32 And it’s been left to lots of other private activities
01:29:37 of uneven quality.
01:29:39 And hence, that’s why you have these big fights.
01:29:42 Because the data are not solid,
01:29:44 you’re gonna have these big fights.
01:29:45 Yeah, but also, okay, forget the process of science here,
01:29:50 the studies, not enough effort being put into the studies,
01:29:53 just the way it’s being communicated about.
01:29:55 Yeah, no, like to horse paste, I mean, come on.
01:29:57 The FDA put a tweet out telling people who are like,
01:30:01 they’re taking ivermectin
01:30:02 because they’ve heard good things about it
01:30:04 and they’re sick and they’re desperate.
01:30:06 And to call it horse paste, that was terrible.
01:30:09 That was deeply irresponsible.
01:30:10 My hope is grounded in the fact
01:30:13 that young people see the bullshit of this,
01:30:16 young PhD students, graduate students,
01:30:18 young students in college,
01:30:20 they see the less than stellar way
01:30:25 that our scientific leaders
01:30:27 and our political leaders are behaving,
01:30:29 and then the new generation
01:30:30 will not repeat the mistakes of the past.
01:30:33 That is my hope, because that’s the cool thing I see
01:30:36 about young people is they’re good at detecting bullshit
01:30:40 and they don’t want to be part of that.
01:30:43 That’s my hope in the space of science.
01:30:46 Let me return to this idea
01:30:48 of the Great Barrington Declaration,
01:30:50 return to the beginning.
01:30:52 So what are the basics?
01:30:54 Can you describe what the Great Barrington Declaration is?
01:30:57 What are some of the ideas in it?
01:30:58 You mentioned focused protection.
01:31:01 What are your concerns about lockdowns?
01:31:04 Just paint the picture of this early proposal.
01:31:07 Sure, so the Great Barrington Declaration,
01:31:09 first, why is it called Great Barrington Declaration?
01:31:11 It’s such a great name.
01:31:14 I mean, it’s such an epic name,
01:31:16 but the reason why it’s called that is way less than epic.
01:31:20 It was because the conference,
01:31:23 which is organized by Martin Kulldorff,
01:31:25 who was a professor at Harvard University,
01:31:27 by a statistician, he actually designed the safety system,
01:31:33 the statistical system that the FDA uses
01:31:36 for tracking vaccine safety.
01:31:38 He and I had met previously just the summer before,
01:31:43 that summer, and he invited me
01:31:45 to come to this small conference
01:31:47 where he was inviting me and Sunetra Gupta,
01:31:50 who is a professor of theoretical epidemiology at Harvard,
01:31:53 sorry, at Oxford University.
01:31:54 And I mean, I jumped at the chance
01:31:57 because I knew that Martin and Sunetra
01:32:00 were both smarter than me,
01:32:02 and it would be fun to talk about
01:32:04 what the right strategy would be.
01:32:07 On the drive in, I didn’t know what the name of the town was
01:32:10 and I asked, they said it was Great Barrington,
01:32:13 and I had it in the back of my head.
01:32:16 Martin and I arrived a little early
01:32:17 and we were writing an op ed about some of the ideas,
01:32:20 I hope we’ll get to talk about very soon,
01:32:22 about focused protection and the right strategy.
01:32:25 And when Sunetra arrived,
01:32:27 we realized we’d actually come basically to the same place
01:32:30 about the right way to deal with the epidemic.
01:32:34 And I thought, well, why don’t we write something
01:32:37 like the Port Huron Statement,
01:32:39 is what I had in the back of my head.
01:32:41 And I’m like, well, what’s the name of this town again?
01:32:43 It was Great Barrington.
01:32:44 Yeah, so it’s not Barrington, it’s Great Barrington.
01:32:47 Which is fantastic, right?
01:32:50 It’s so over the top that it’s perfect.
01:32:53 It’s literally like the Big Bang.
01:32:55 There’s something about these over the top fun titles
01:32:58 that just really delivered the power.
01:33:01 That’s my main contribution was the title,
01:33:03 the name Great Barrington Decorate.
01:33:05 But yeah, so it was kind of a,
01:33:07 so the idea is actually, well, the title is great.
01:33:12 And I think that it was written in a very stylish way.
01:33:14 It’s less than a page, you can go look online and read it.
01:33:18 It’s written for, not for scientists,
01:33:21 but for the general public
01:33:23 so that people can understand the ideas really simply.
01:33:26 But it is not actually a radical set of ideas.
01:33:29 It actually represents the old pandemic plans
01:33:32 that we’ve used for a century
01:33:35 dealing with other similar pandemics.
01:33:38 And it’s twofold.
01:33:41 First, let me talk about the science it rests on,
01:33:43 and then I’ll talk about the plan.
01:33:45 The science actually, some of it we already talked about.
01:33:47 There’s this massive age gradient
01:33:49 in the risk of COVID infection.
01:33:51 Older people face much higher risk than younger people.
01:33:55 The second bit of science is all,
01:33:57 that’s not controversial, right?
01:33:58 Even if you think the IFR is 0.7 or 0.2,
01:34:01 no matter what, everyone thinks,
01:34:03 everyone agrees on this age gradient.
01:34:06 The second bit of science is also not controversial.
01:34:09 The lockdown focused policies that we’ve followed
01:34:13 have absolutely devastating consequences
01:34:16 on the health of the population.
01:34:20 Let me just give you some examples.
01:34:21 And this was known in October of 2020 when we wrote it.
01:34:24 So the UN was sounding alarms
01:34:28 that there would be tens of millions of people
01:34:31 who would starve as a consequence
01:34:34 of the economic dislocation caused by the lockdowns.
01:34:37 And that’s come to pass.
01:34:38 Hundreds of thousands of children
01:34:40 in places like South Asia dead from starvation
01:34:43 as a consequence of lockdowns.
01:34:47 The priorities like the treatment of patients
01:34:53 with tuberculosis in poor countries stopped
01:34:57 because of lockdowns.
01:35:00 Childhood vaccinations of measles, mumps, rubella,
01:35:04 DPT, diphtheria, so on, pertussis, tetanus,
01:35:07 all those standard vaccination campaigns stopped.
01:35:11 Tens of millions of children skipping these doses
01:35:15 for diseases that are actually deadly for them.
01:35:19 Is there, just on a small tangent,
01:35:22 is it well understood to you what are the mechanisms
01:35:26 that stop all those things because of lockdowns?
01:35:28 Is it some aspect of supply chain?
01:35:30 Is it just literally because hospital doors are closed?
01:35:34 Is it because there’s a disincentive to go outside
01:35:37 by people even when they deeply need help?
01:35:40 It’s all of the above.
01:35:42 But a lot of those efforts,
01:35:43 especially those vaccination efforts are funded
01:35:46 and run by Western efforts.
01:35:49 Like Gavi is a, I think it’s a Gates funded thing actually
01:35:53 that provides vaccines for millions of kids worldwide.
01:35:57 And those efforts were scaled back.
01:36:00 Malaria prevention efforts.
01:36:02 So in the developing world,
01:36:04 it was a devastating effect, these lockdowns.
01:36:07 There was also direct effects.
01:36:08 Like in India, the lockdowns, when they first instituted,
01:36:13 there was an order that 10 million migrant workers
01:36:16 who live in big cities and they live hand to mouth,
01:36:19 they buy coconuts, they sell the coconuts with the money,
01:36:23 they buy food for themselves and coconuts
01:36:25 for the next day to sell,
01:36:27 walk back to their villages
01:36:29 or go back to their villages overnight.
01:36:33 So 10 million people walking back to their villages
01:36:35 or taking a train back, 1,000 died on route.
01:36:39 Overcrowded trains dying essentially on the side of the road.
01:36:42 I mean, it was absolutely inhumane policy.
01:36:46 And the lockdowns there,
01:36:50 it’s kind of like what’s happened in the West as well,
01:36:53 but it was so severe.
01:36:55 There was a seroprevalence study done in Mumbai
01:36:58 by a friend of mine at the University of Chicago.
01:37:00 What he found was that in the slums of Mumbai,
01:37:03 there were 70% seroprevalence in July or August of 2020,
01:37:08 whereas in the rest of Mumbai, it was 20%, right?
01:37:12 So it was incredibly unequal.
01:37:14 The lockdowns protected the relatively well off
01:37:17 and spread the disease among the poor.
01:37:22 So that’s in the developing world.
01:37:25 In the developed world, the health effects of lockdowns
01:37:27 were also quite bad, right?
01:37:31 So we’ve talked already about isolation and depression.
01:37:34 There was a study done in July of 2020
01:37:37 that found that one in four young adults
01:37:41 seriously considered suicide.
01:37:43 Now, suicide rates haven’t spiked up so much,
01:37:47 but the depths of despair that would lead somebody
01:37:51 to seriously consider suicide itself
01:37:53 should be a source of great concern in public health.
01:37:57 Yeah, this is one of the troubling things about measuring
01:38:01 well being is we’re okay at measuring death and suicide.
01:38:06 We’re not so good at measuring suffering.
01:38:08 It’s like people talk about maybe even Holodomor
01:38:14 under Stalin or the concentration camps with Hitler.
01:38:19 We talk about deaths, but we don’t talk about the suffering
01:38:23 over periods of years by people living in fear,
01:38:27 by people starving, psychological trauma
01:38:30 that lasts a lifetime, all of those things.
01:38:33 I mean, and just to get back to that point,
01:38:36 we closed schools, especially in blue states,
01:38:38 we closed schools.
01:38:40 Now, richer parents could send their kids
01:38:42 to private schools, many of which stayed open
01:38:44 even in the blue states.
01:38:45 They could get pods, they could get tutors,
01:38:47 but that’s not true for poor and middle class parents.
01:38:51 And as a result, what we did is we took away
01:38:54 life opportunities for kids.
01:38:56 We tried to teach five year olds to read via Zoom
01:38:59 in kindergarten, right?
01:39:02 And the consequence actually, you think, okay,
01:39:05 we can just make it up, but it’s really difficult
01:39:07 to make that up.
01:39:08 There’s a literature in health economics that shows
01:39:12 that even relatively small disruptions in schooling
01:39:18 can have lifelong consequences, negative consequences
01:39:21 for kids, right?
01:39:22 So they end up growing up poorer, they lead shorter lives
01:39:27 and less healthy lives as a consequence.
01:39:30 And that’s what the literature now shows is likely to happen
01:39:32 with the interruptions of schooling that we had
01:39:35 in the United States.
01:39:36 Many European countries actually managed to avoid this.
01:39:39 There were in the early days of the epidemic
01:39:40 great indications that children first were not
01:39:43 very severely at risk from COVID itself,
01:39:46 nor are they super spreaders.
01:39:49 Schools were not the source of community spread,
01:39:51 communities spread the disease to schools,
01:39:54 not the other way around.
01:39:57 And we can talk about the scientific base of that
01:39:59 if you’d like, but that was pretty well known
01:40:01 even in October.
01:40:04 We closed hospitals in order to keep them
01:40:07 available to COVID patients, but as a result,
01:40:10 women skipped breast cancer screening.
01:40:14 As a result, they are showing up with late stage
01:40:16 breast cancer that should have been picked up last year.
01:40:19 Men and women skipped colon cancer screening,
01:40:21 again, with later stage disease that should have been
01:40:24 picked up last year with earlier stage.
01:40:26 For patients with diabetes, it’s very important
01:40:29 to have regular screening for blood sugar levels
01:40:33 and sort of counseling for lifestyle improvement.
01:40:36 And we skipped that.
01:40:38 People stayed home with heart attacks
01:40:39 and died at home with heart attacks.
01:40:43 So you had this like sort of wide range of medical
01:40:47 and psychological harms that were being utterly ignored
01:40:51 as a result of the lockdowns.
01:40:53 Plus there’s the economic pain.
01:40:57 So like you said, whatever is a good term
01:41:00 for the non laptop class, people would lose their jobs.
01:41:05 Yes, there might be in the Western world support
01:41:07 for them financially, but the big loss there
01:41:11 that is perhaps correlated with depression and suicide
01:41:14 is loss of meaning, loss of hope for the future,
01:41:19 loss of kind of a sense of stability,
01:41:23 all the pride you have in being able to make money
01:41:30 that allows you to pave your own way in the world.
01:41:32 And yes, just having less money than you’re used to
01:41:35 so your family, your kids are suffering,
01:41:37 all those kinds of things.
01:41:38 And there’s, again, an economics literature on this,
01:41:41 on deaths of despair it was called.
01:41:43 2009, there was the great recession.
01:41:45 It led to an enormous uptake in overdose from drugs,
01:41:50 suicidality, depression, as a result of the job losses
01:41:55 that happened during the great recession.
01:41:57 Well, that’s happening again,
01:41:59 like an enormous increase in drug overdoses.
01:42:03 That’s not an accident, that’s a lockdown harm, right?
01:42:07 Same thing with the job losses.
01:42:10 The job losses, by the way, are like, it’s so interesting
01:42:12 because the states that stayed open
01:42:15 have had much, much lower unemployment
01:42:18 than the states that stayed closed.
01:42:20 The labor force participation rates declined by 3%.
01:42:23 It’s women that separated
01:42:25 because they stayed home with their kids.
01:42:28 We’ve reversed a generation of women,
01:42:33 improving women’s participation in the labor force.
01:42:37 Do you think it has to do with the institutions
01:42:41 that we mentioned that there was so much priority given
01:42:44 or so much power given to maybe NIH
01:42:48 versus other civilian leaders?
01:42:51 Or do people just not care about the economic pain?
01:42:54 The leaders, I mean, because to me it was obvious.
01:42:59 I mean, probably it’s just studying history.
01:43:03 Whenever I listen to people on Twitter
01:43:06 or on mainstream news or just anything,
01:43:09 I realize that’s the very kind of top.
01:43:14 The people that have a voice
01:43:17 represent a tiny selection of people.
01:43:19 And so whenever there’s hard times,
01:43:21 I always kind of think about the quiet, the voiceless,
01:43:27 the quiet suffering of the tens of millions,
01:43:30 of the hundreds of millions.
01:43:33 Do the political leaders not just give a damn?
01:43:36 I mean, I think it was actually a very odd ethical thing
01:43:39 at the beginning of the pandemic
01:43:41 where if you brought up economic harms at all,
01:43:44 you were seen as callous.
01:43:47 So I had a reporter call me up
01:43:50 almost at the very beginning of the epidemic
01:43:51 asking me about a very particular phenomenon.
01:43:56 So he was anticipating a rise in child abuse
01:44:00 because children were gonna be staying at home.
01:44:02 Child abuse is generally picked up at school.
01:44:04 And that actually happened.
01:44:06 So the reported child abuse dropped,
01:44:08 but actual child abuse increased
01:44:11 because normally you pick up the child abuse at school
01:44:14 and that you have the intervention, right?
01:44:16 So yeah, so I was talking about like,
01:44:17 well, there’s gonna be some economic harms
01:44:19 and they’re gonna have health consequences,
01:44:20 but the economic harms matter.
01:44:21 But he counseled me.
01:44:24 And I think he had my best interest at heart.
01:44:27 Like if you were to put that in the story,
01:44:29 I would be, I’d essentially be canceled.
01:44:31 Because what the narrative that arose in March of 2020
01:44:36 is if you care about money at all,
01:44:39 you’re evil and crass, you must only care about lives.
01:44:43 The problem with that narrative is that that money,
01:44:46 which we’re talking about,
01:44:47 is actually lives of poor people, right?
01:44:51 When you throw 100 million people around the world
01:44:54 into poverty, you’re going to see enormous harm
01:44:58 to their health, enormous increases in their mortality.
01:45:01 It is not immoral to think about that and worry about that
01:45:04 in the context of this pandemic response.
01:45:07 Our mind focused so much on COVID that it forgot
01:45:11 that there are so many other public health priorities as well
01:45:13 that need our attention desperately.
01:45:16 And this is the thing I sensed about San Francisco
01:45:21 when I visited, I was thinking of moving there for a startup.
01:45:24 This is the thing I’m really afraid of,
01:45:26 especially if I have any effect on the world
01:45:30 through a startup, is losing touch in this kind of way.
01:45:34 That you mentioned the laptop class,
01:45:38 living in this world where you’re only concerned
01:45:40 about this particular class of people.
01:45:44 And also, perhaps early on in the pandemic,
01:45:48 amongst the laptop class,
01:45:50 there was a legitimate concern for health,
01:45:51 like you’re not sure how deadly this virus is.
01:45:55 You’re not sure who to listen to, so there’s a real concern.
01:45:58 And then at a certain point when the data starts coming in,
01:46:02 you start becoming more and more detached from the data.
01:46:05 You don’t start caring less and less,
01:46:07 and you start just swimming in the space of narratives,
01:46:10 like existing in the space of narratives,
01:46:12 and you have this narrative in San Francisco
01:46:15 in the laptop class that you just are very proud
01:46:19 that you know the truth,
01:46:21 you’re the sole possessors of the truth,
01:46:22 you congratulate yourself on it,
01:46:25 and you don’t care what actually gigantic detrimental effect
01:46:28 that has on society, because you’re mostly fine.
01:46:34 I’m so terrified of that.
01:46:36 Well, actually, I think the antidote to that
01:46:38 is just to remember.
01:46:39 You remember.
01:46:40 Yeah. Yeah.
01:46:41 I don’t think, you know, remember where you came from
01:46:44 and remember who you’re doing this for.
01:46:46 At the back of your head should always be,
01:46:48 what’s the purpose?
01:46:49 Like, why am I here?
01:46:50 What’s the purpose of this?
01:46:51 And if the purpose is simply self aggrandizement,
01:46:56 then you should rethink,
01:46:57 because it’ll just end up being a hollow life.
01:47:01 All of us will be forgotten in the end.
01:47:04 Focused protection, the idea, the policy,
01:47:08 what is focused protection?
01:47:09 Right, so I was saying that there’s two scientific bases,
01:47:12 right, so one is this steep age gradient,
01:47:15 and the second is the existence of locked arms.
01:47:17 Again, I think there’s very little disagreement
01:47:19 in the scientific community on both of those facts.
01:47:22 If you put those facts together,
01:47:24 the obvious policy is to protect the people
01:47:27 who are at the most severe risk from the disease itself.
01:47:31 And that’s the idea of focused protection.
01:47:33 That’s the general principle of it.
01:47:35 The actual implementation of it
01:47:37 depends on the living circumstances
01:47:39 of the people that are at risk,
01:47:41 the resources that are available in the community,
01:47:44 the technology that’s available to do this.
01:47:49 And so it’s almost always going to be,
01:47:51 in fact, it’ll always be a local thing,
01:47:54 because it’ll depend on all of those things
01:47:58 which are all local in nature.
01:48:00 Right, so one very, very obvious thing,
01:48:02 in a country like ours,
01:48:04 where so many older people live in institutionalized settings
01:48:08 and nursing home settings,
01:48:10 and that’s where older, really vulnerable,
01:48:13 chronically ill patients often live,
01:48:16 and you know this disease affects that group,
01:48:18 most commonly, it is absolutely vital
01:48:21 to protect that group.
01:48:23 We should have known that in February 2020,
01:48:26 just from the Chinese data.
01:48:30 And we should have thought about that group
01:48:33 as the key constraint in our policymaking.
01:48:38 Instead, we thought about, in February and March 2020,
01:48:41 as hospital beds as the key constraint.
01:48:44 Hospital beds and ventilator shortages,
01:48:46 and so we ran around trying to address
01:48:49 that constraint, like a linear programming problem,
01:48:53 you figure out which constraint’s binding
01:48:55 and you address that one thing
01:48:56 and then you go on to the next one, right?
01:48:58 If that one constraint,
01:49:00 we said, okay, the constraint is hospital beds.
01:49:04 That led to the decision in many of the Northeast states
01:49:08 to send COVID infected patients who were on the verge
01:49:12 or looked like they were about to recover
01:49:14 back to nursing homes,
01:49:17 who then spread the disease all through there,
01:49:19 because they wanted to preserve the hospital beds.
01:49:21 Well, for somebody who loves numerical optimization,
01:49:25 I love the way you frame this.
01:49:27 But those are kind of connected, right?
01:49:30 If you actually focus on protecting the vulnerable,
01:49:33 you will also have the effect
01:49:36 of not hitting the ceiling of the available hospital beds.
01:49:40 That’s the irony.
01:49:41 If we protected the vulnerable,
01:49:44 the vulnerable are the most likely to be hospitalized,
01:49:47 and so by protecting the hospital,
01:49:48 by protecting the vulnerable,
01:49:49 we will also have addressed the shortage of hospital beds
01:49:53 more effectively.
01:49:53 So that little shift in priority
01:49:55 would have had a big impact.
01:49:57 Okay, but specifically, the idea is to,
01:50:01 and we could talk about different ideas
01:50:03 of how to actually do this,
01:50:04 but you basically do a lockdown or something like that
01:50:10 on a very small set of people.
01:50:12 You may have to do that
01:50:13 if community spread is very high,
01:50:14 but generally, I think it would depend on, again,
01:50:18 the living circumstances and the,
01:50:20 so for instance, if you are in a,
01:50:23 if you have a, here’s a very simple idea
01:50:25 that doesn’t require a lockdown forced on them.
01:50:28 I don’t actually generally,
01:50:29 I’m not in favor of that kind of forced lockdown
01:50:31 because you just won’t get cooperation.
01:50:33 But what you could do is provide resources
01:50:36 to that group of people.
01:50:38 So imagine you live next door to somebody, an older couple,
01:50:43 and there’s high community spread.
01:50:46 Well, they have to go grocery shopping.
01:50:48 We did like, some communities did these
01:50:50 like senior only grocery hour, right?
01:50:53 But they have to still have to go out
01:50:55 and they might get exposed
01:50:56 when they’re shopping amongst other seniors.
01:50:59 Well, why not organized home delivery of groceries to them?
01:51:03 We did that for the laptop class, right?
01:51:06 Or you can even just use a volunteer effort.
01:51:09 The older people living next door,
01:51:10 just call them up and say,
01:51:11 can I help you go out and go shopping for you?
01:51:13 And so you would have potentially federal support
01:51:16 of that kind of thing.
01:51:17 So these kinds of efforts.
01:51:19 Identify where the vulnerable people live.
01:51:22 It’s really challenging in multigenerational homes.
01:51:24 In LA County, for instance,
01:51:25 there’s a lot of older people living together
01:51:28 with younger people in relatively crowded,
01:51:31 there it’s really quite a challenge.
01:51:34 But there again, you can use resources.
01:51:35 So if grandma is worried that grandson has come home,
01:51:40 but is potentially been exposed,
01:51:42 grandson calls grandma says, I mean,
01:51:43 I might’ve been at a party where COVID was.
01:51:47 Grandma calls public health, public health,
01:51:49 and says, okay, you can have this hotel room
01:51:50 for a couple of days until you check to turn negative.
01:51:54 In case it wasn’t clear,
01:51:56 the idea of focused protection
01:51:58 is the people that are vulnerable, protect them.
01:52:03 And everybody else goes on with their lives,
01:52:06 open up the economy, just do as it was before.
01:52:09 There was still fear abroad.
01:52:10 So there still would be some restrictions
01:52:12 that people would pose on themselves.
01:52:14 They probably would go to parties less.
01:52:15 The grandsons probably wouldn’t go so many parties, right?
01:52:19 There would be less participation in big gatherings.
01:52:23 And you may even say like big gatherings
01:52:25 in order to restrict community spread again.
01:52:27 I’m not against any of that,
01:52:29 but you shouldn’t be closing businesses.
01:52:31 You shouldn’t be closing churches and synagogues.
01:52:34 You shouldn’t be forcing people to not go to school.
01:52:38 You should not be shuttering businesses.
01:52:41 You should just allow society to go on.
01:52:44 Some disease will spread, but as we’ve seen,
01:52:46 the lockdown didn’t stop the disease from spreading anyways.
01:52:50 Right.
01:52:50 So what do you make of the criticism that this idea,
01:52:54 like all good ideas cannot actually be implemented
01:52:59 in a heterogeneous society
01:53:01 where there’s a lot of people intermixing?
01:53:03 And once you open it up,
01:53:06 people like the younger people will just forget
01:53:09 that this is even existing.
01:53:11 And they’ll stop caring about the older people
01:53:13 and mess up the whole thing.
01:53:14 And the government will not want to fund
01:53:16 any kind of the great efforts you’re talking about
01:53:18 about food delivery and then the food delivery services
01:53:21 be like, why the heck am I helping out on this anyway?
01:53:24 Because like, it’s not making me much money.
01:53:26 And so therefore like all good ideas, it will collapse.
01:53:30 That might be true.
01:53:31 I mean, I think it’s always a risk with policy thing,
01:53:34 but I think if you think back to the moment,
01:53:37 but we actually felt like we were in this together
01:53:39 to some extent.
01:53:39 Yes.
01:53:40 Right, I think that that empathy that we had
01:53:44 that was used to like tell people to stay in
01:53:48 and like happily, not go in happily,
01:53:51 but like stay in to like wear a mask
01:53:55 or to do all these things that we thought
01:53:57 would help other people could have been redirected
01:53:59 to actually helping the people who most needed to be helped.
01:54:02 Especially, I do remember March.
01:54:08 So this is even way before Barrington,
01:54:10 all that kind of stuff.
01:54:12 March, April, May, there was a feeling like
01:54:16 if we all just work together, we’ll solve this.
01:54:20 And that maybe started to, when did that start breaking down?
01:54:24 I mean, unfortunately the election is mixed into this.
01:54:28 That it became politicized.
01:54:30 But I think it lasted quite a long time.
01:54:32 I think into the summer,
01:54:33 I think there was some of that sense.
01:54:36 I don’t know, it obviously varied among different people.
01:54:39 But I think that it’s true it would have been challenging.
01:54:42 It’s also true that it’s heterogeneous,
01:54:44 exactly the way you said.
01:54:46 But what that means is you need a local response,
01:54:49 a response, so like my vision of a public health officer
01:54:53 is someone that understands their community,
01:54:56 not necessarily the nation at large, but their community,
01:54:59 and then works within their community
01:55:01 to figure out how to deploy the resources
01:55:03 that they have available
01:55:05 to do the kind of protection policies we’re talking about.
01:55:08 That’s what should have happened.
01:55:10 Instead, they spent a huge amount of efforts
01:55:12 closing, making sure businesses stayed closed.
01:55:15 Businesses that, I mean,
01:55:17 they’re like hardware stores that closed.
01:55:20 What good did closing a hardware store do
01:55:23 for the spread of COVID?
01:55:24 If it had an effect on COVID spread,
01:55:26 I mean, it’s gonna be March.
01:55:28 Checking to make sure that plexiglass
01:55:30 was put up everywhere,
01:55:31 which now in retrospect turns out
01:55:32 to have probably made the disease worse.
01:55:37 Masking enforcement, so shaming around masks,
01:55:40 I mean, a huge amount of effort on things
01:55:42 that were only tangentially related to focus protection.
01:55:47 What if we turned our energy,
01:55:49 that enormous energy put into that,
01:55:52 instead into focus protection of the vulnerable?
01:55:54 That’s essentially the conversation I was calling for.
01:55:57 And it wasn’t, I mean, I didn’t think of it
01:55:59 as we had every single idea.
01:56:01 I mean, we gave some concrete proposals,
01:56:03 but the criticism we got was that
01:56:05 those concrete proposals weren’t enough.
01:56:08 And the answer to that is that’s true.
01:56:10 They weren’t enough.
01:56:11 I wasn’t thinking of them as enough.
01:56:12 I was thinking that I wanted to involve
01:56:15 an enormous number of people in local public health
01:56:17 to help think about how to do focus protection
01:56:20 in their communities.
01:56:22 The question that’s interesting here is about the future too.
01:56:29 So COVID has very specific characteristics,
01:56:32 like you mentioned, about the curve of the death rate
01:56:36 based on the, like it seems like with COVID,
01:56:39 it’s a little bit easier to actually identify
01:56:42 a group of people that you need to protect.
01:56:45 So other viruses may not be this way.
01:56:47 So might lockdown be a good idea, like hardcore lockdown
01:56:53 for a future virus that’s 10 times deadlier,
01:56:57 but spreads at the same rate as COVID?
01:56:59 Or maybe another way to ask that is imagine a virus
01:57:02 that’s 10 times deadlier, what’s the right response?
01:57:06 I mean, I think it’s always gonna be focus protection,
01:57:08 but the group that needs the focus protection may change
01:57:12 depending on the biology of the virus, right?
01:57:14 So the polio epidemic in the 40s and 50s in the US,
01:57:18 the great, the people at most risk were children.
01:57:23 We didn’t know really at the beginning
01:57:24 there was this fecal oral spread.
01:57:27 And so we did all kinds of crazy things,
01:57:30 including like spraying DDT in communities,
01:57:33 which somehow was supposed to get rid of polio.
01:57:37 But the focus was on whenever there was an outbreak,
01:57:40 they would close the school down.
01:57:42 And that was the right thing to do
01:57:43 because that group that needed protection was children.
01:57:48 And the disease was spread, we thought in schools.
01:57:53 I don’t think there’s a single formula that works,
01:57:56 but there’s a single principle that works, right?
01:57:59 No matter, it’s hard to imagine a disease
01:58:02 that’s uniformly deadly across every group
01:58:05 in every single person.
01:58:07 There’s always gonna be some group
01:58:09 that’s differentially harmed.
01:58:13 There’s always gonna be some group
01:58:14 that’s differentially protected.
01:58:16 And that may change over time, right?
01:58:17 So like in this disease, in this epidemic,
01:58:23 as people got infected and recovered,
01:58:25 we now had a class of people
01:58:27 that were pretty well protected against the disease.
01:58:30 They should be, like instead of ostracizing them
01:58:34 because they don’t want a vaccine,
01:58:36 we should be allowing them to work.
01:58:37 I mean, we’re having staffing shortages in hospitals now
01:58:41 because we forgot that principle.
01:58:43 Is quite a bit of this a technology problem?
01:58:46 So being able to,
01:58:49 how much of it is a sociological problem?
01:58:53 How much of it is a technology problem?
01:58:56 Like where do you put the blame
01:58:59 sort of on why this didn’t go so great
01:59:01 and how it can go great in the beginning?
01:59:04 I mean, think about lockdowns.
01:59:05 Like if we didn’t have Zoom,
01:59:06 we wouldn’t have lockdowns.
01:59:08 There’s a reason in 2009 we didn’t lock down.
01:59:11 I mean, we didn’t have the technology to replace work
01:59:13 with this remote technology.
01:59:17 So we had good lockdown technology in Zoom.
01:59:21 We didn’t have good focus protection technology.
01:59:25 Yeah, I mean, focus protection
01:59:26 is always gonna be complicated,
01:59:27 especially for something like this that spreads so easily,
01:59:29 it’s gonna be complicated.
01:59:30 And I’m the last person to say it would have been perfect.
01:59:34 There would have been people that would have gotten sick,
01:59:37 but they got sick anyways.
01:59:39 The hope was that if we suppress community spread
01:59:41 low enough, we can protect the vulnerable.
01:59:44 That was the hope by lockdown.
01:59:47 The reality was that only a certain class of people
01:59:50 were able to benefit from lockdown.
01:59:51 The rest of society, we call them essential workers,
01:59:53 had to keep working and they got sick.
01:59:56 And the disease kept spreading.
01:59:58 It didn’t actually have a substantial effect
02:00:00 on community spread in non laptop class populations.
02:00:05 And also we should probably expand the class of people
02:00:08 we call vulnerable to those who would suffer,
02:00:12 who have the capacity to suffer,
02:00:15 given the policies you’re weighing.
02:00:19 It’s very disingenuous to call the vulnerable
02:00:22 just the people, obviously we had the very specific meaning,
02:00:26 but broadly speaking, vulnerable should include anybody
02:00:31 who can suffer based on the policies you take
02:00:34 in response to a virus.
02:00:36 That principle you just said is completely agree with
02:00:39 is something I think has been lost.
02:00:42 And unfortunately lost, right?
02:00:44 So the policies themselves, if they have harm,
02:00:49 those are real and we shouldn’t pretend like they’re not.
02:00:53 And essentially demonize the people that suffer them.
02:00:58 Or pretend, I mean like a lot of times like the depression
02:01:01 that we’ve been talking about,
02:01:02 that’s thought of as like not so important,
02:01:06 but it is important.
02:01:08 And especially the harm to the people in poor countries,
02:01:12 it’s like been out of sight, out of mind
02:01:14 in much of the rich parts of the world.
02:01:16 Once again, I’ve hoped that we seeing this,
02:01:20 learning lessons of history with the communication tools
02:01:22 who have now will learn this.
02:01:24 It’s like going to another country
02:01:26 and bombing targeted terrorist locations,
02:01:29 and there’s going to be some civilians who die,
02:01:32 pretending that the child who watches their dad die
02:01:37 is not going to grow up, first of all, traumatized,
02:01:40 but second of all, potentially bring more hate to the world
02:01:43 than the hate that you were allegedly fighting
02:01:46 in the first place.
02:01:47 That’s another sort of considering only one kind of harm
02:01:52 and not the full range of harms
02:01:54 that are being caused by your policies.
02:01:55 You know, like the good return to focus protection,
02:01:59 we still should be following the policy now for COVID
02:02:01 and we’re not, right?
02:02:03 So the vaccines, there’s a great shortage of vaccines.
02:02:06 You wouldn’t know it in the United States
02:02:08 and the rich parts of the world,
02:02:09 but there’s a great shortage of vaccines.
02:02:11 We’re not going to be able to vaccinate the most of the,
02:02:15 like the entire set of elderly at least,
02:02:17 and or larger groups until late 2022.
02:02:20 Huge numbers of older people around the world
02:02:24 in poor countries that have not COVID recovered yet,
02:02:27 so they’re still quite vulnerable, have not had the vaccine.
02:02:30 And yet we’re talking about vaccinating five year olds
02:02:34 who benefit, if at all, from the vaccines
02:02:37 of just a very little bit
02:02:38 because they face such a low risk of harm from COVID.
02:02:43 Well, something that’s a little bit near and dear
02:02:45 to our specific, the two of our hearts.
02:02:49 So you’re at Stanford.
02:02:51 So Stanford recently announced
02:02:53 that they’re going back to virtual,
02:02:55 at least for some period of time in response to the,
02:02:59 maybe you can clarify, but I think it’s in response
02:03:01 to the escalated, how would they phrase it?
02:03:05 It’s related to Omicron.
02:03:07 And a few other universities are kind of like
02:03:12 considering back and forth.
02:03:13 In my perspective, as somebody who loves
02:03:16 in person lectures, who sees the value of that
02:03:23 to students, to young minds, also looking at the data,
02:03:28 seems the risk aversion in university policies
02:03:36 around this, given how healthy the student population is,
02:03:40 seems not well calibrated.
02:03:44 Let’s put it this way.
02:03:44 Also, pathological is one way to put it.
02:03:48 Given that, I believe, depending on the university,
02:03:50 but I think many universities require
02:03:53 that the student body is vaccinated at this point.
02:03:57 So I think it’s a big mistake by Stanford to do this.
02:04:01 And I’d like to say that because I just hope MIT doesn’t.
02:04:07 But what are your thoughts about Stanford?
02:04:09 Is there a student?
02:04:10 I completely agree with you.
02:04:11 I think we have failed in our mission
02:04:14 to educate our students by this decision.
02:04:18 And I think, frankly, just more broadly,
02:04:20 I think we failed generally over the course
02:04:22 of the last year and a half in living up
02:04:24 to our educational mission.
02:04:27 In person teaching is vital.
02:04:31 Now, I can understand, if you have older faculty,
02:04:35 the principle of focus protection says,
02:04:37 provide some alternative teaching arrangements for them.
02:04:40 That makes sense to me.
02:04:42 From the kid’s point of view,
02:04:44 they’re more harmed by not getting the education
02:04:46 we promised them than by COVID.
02:04:51 So applying this principle of this focus protection,
02:04:54 let young professors teach in person.
02:04:58 This is before the vaccine.
02:04:59 After the vaccine, let everyone teach in person.
02:05:01 Yeah, this is the part,
02:05:02 I don’t understand the discussion we’re even having
02:05:04 because, okay, let’s leave focus protection aside here
02:05:09 because that’s a brilliant policy for,
02:05:12 perhaps for the future when there’s no vaccine.
02:05:15 Now with the vaccine, I’m misunderstanding something here
02:05:20 because we’re now in a space that’s psychological.
02:05:24 It’s no longer about biology
02:05:27 because with the booster shots,
02:05:30 which I believe MIT is now requiring before January,
02:05:34 with the booster shots, the data shows,
02:05:37 no matter how old you are, the risks are very low
02:05:41 for ending up in a hospital
02:05:44 relative to all the other risks you face when you’re older.
02:05:49 I don’t understand.
02:05:51 Can you explain the policy around closing a university
02:05:57 but also just a policy about just being so scared still
02:06:04 in the university setting?
02:06:06 I think the great universities have done great harm
02:06:09 by modeling this kind of behavior.
02:06:12 Yes, to me, sorry to keep interrupting,
02:06:15 but to me, the university should be the beacon
02:06:17 of great behavior, not the beacon of scared, conservative,
02:06:24 let’s not mess up.
02:06:26 Pathological.
02:06:27 Let’s not make it pathological.
02:06:27 Let’s not make anybody angry.
02:06:31 It should be a place to play in the space of ideas.
02:06:33 Yes, so I think the central problem is,
02:06:37 actually related to the central problem
02:06:39 of COVID policy more generally,
02:06:41 the goal seems to be to stop the disease from spreading
02:06:46 rather than to reduce the harm from the disease.
02:06:51 If the goal is to stop the disease from spreading,
02:06:54 the sad fact is we have no technology to accomplish that.
02:06:59 At this point.
02:07:00 Yes.
02:07:01 Like it’s already deeply integrated into human civilization.
02:07:05 Well, I mean, it’s here forever, right?
02:07:07 There’s a zero survey of white tail deer in the US.
02:07:11 It turns out 80% of white tail deer in the US
02:07:13 have COVID antibodies.
02:07:15 Dogs get it, cats get it.
02:07:18 There’s almost certainly human animal transmission of it.
02:07:22 I mean, presumably, I mean, I’ve heard bats get it,
02:07:24 apparently, so you have a situation
02:07:28 where you have this disease that’s here to stay.
02:07:30 Yeah.
02:07:31 And the vaccines don’t stop the spread of it,
02:07:33 the lockdowns don’t stop the spread of it.
02:07:34 We have no technology to stop the spread of it.
02:07:38 And so we’re burning the earth trying to stop,
02:07:41 do something that’s impossible
02:07:42 rather than working on what’s possible.
02:07:47 And so like letting regular college happen,
02:07:51 that’s a great good.
02:07:53 Universities are a wonderful invention
02:07:56 and it’s contributed so much to society.
02:07:58 Just decide to shut it down.
02:08:00 The universities should be fighting tooth and nail
02:08:03 to not be shut down, not the other way around.
02:08:07 Whatever the mechanisms that results
02:08:09 in the universities doing that,
02:08:10 that’s probably, this is me talking,
02:08:12 it probably has to do with certain incentives
02:08:14 for the administration, probably has to do with lawyers
02:08:16 and legal kinds of things to avoid legal trouble.
02:08:21 But once again, it’s when the administration
02:08:24 has too much power and too much definition
02:08:27 of what the policy is for the university,
02:08:29 that’s when you get into trouble.
02:08:30 The beauty, the power of the university
02:08:33 should be about the faculty and the students.
02:08:36 Administration just gets in the way, get out of the way.
02:08:41 I mean, they can help organize things.
02:08:43 They play some important role, but they certainly do.
02:08:45 But they need to remember what the mission is.
02:08:47 The mission is not safety.
02:08:50 The mission, actually, universities should be
02:08:52 dangerous places for ideas and whatnot.
02:08:55 What is the role of fear in a pandemic?
02:08:59 We’ve been dancing around it.
02:09:00 Is it useful?
02:09:01 Is it destructive?
02:09:03 Or is there sort of a complicated story here?
02:09:05 Because they’re taking us back into January 2020.
02:09:10 There was so much uncertainty.
02:09:11 This could have been a pandemic that is Black Death,
02:09:16 the bubonic plague.
02:09:17 It could have killed hundreds of millions of people.
02:09:21 We don’t know that.
02:09:22 We’re very new to this.
02:09:24 It’s been a while.
02:09:25 We’re rusty.
02:09:26 So there is some value to fear
02:09:29 so that you don’t do the stupid thing.
02:09:31 You don’t just go on living.
02:09:33 I guess where I come from,
02:09:34 I think it’s almost entirely counterproductive.
02:09:36 I think fear should never be used as a tactic
02:09:39 to manipulate human behavior by public health.
02:09:44 So the fear on the individual level,
02:09:47 that feeling of fear,
02:09:48 you should be very hesitant about that feeling
02:09:51 because it could be easily manipulated by the powerful.
02:09:53 Exactly.
02:09:54 I think that fear is natural.
02:09:57 And it’s not something that you have to stoke to get
02:10:03 when the facts on the ground suggest it, right?
02:10:07 In fact, the tendency for humans
02:10:09 in the face of threats from infectious disease
02:10:12 is to exaggerate the fear in their own minds
02:10:16 of being contaminated by the environment and by others.
02:10:19 That’s just natural to humans.
02:10:21 And the role of public health
02:10:24 is not necessarily to eradicate the fear,
02:10:27 but obviously technological advances
02:10:28 can help eradicate the fear,
02:10:29 but it’s really to help manage that fear
02:10:32 and help people put the sort of incentives
02:10:38 that come out of that to useful things
02:10:40 as opposed to harmful things.
02:10:43 What’s happened in this pandemic
02:10:45 is that there’s been a deliberate policy to stoke the fear,
02:10:49 to help make people think that the disease
02:10:51 is worse than it actually is.
02:10:53 In survey after survey, you see this.
02:10:56 And that’s been incredibly damaging.
02:10:58 So young people have readily given away
02:11:02 their willingness to participate in regular life
02:11:04 because A, they fear COVID more than they ought,
02:11:09 and B, they fear that they’re gonna harm the vulnerable
02:11:13 in their lives.
02:11:14 You put those two together
02:11:15 and you get this powerful demand for lockdowns.
02:11:18 You see this all over the world.
02:11:20 Broadly speaking, you have a powerful demand
02:11:23 for irrational policies, irrational policies,
02:11:26 because I would like to mention the flip side of that.
02:11:29 I’ve been saddened to see how much money
02:11:32 there is to be made by the martyrs,
02:11:37 the people, the conspiracy theorists
02:11:40 that tell you you should be afraid of the government.
02:11:46 You should be afraid of the man.
02:11:49 It feels like fear is the problem.
02:11:51 I think there’s some guy that once said something
02:11:53 about we should fear fear itself.
02:11:58 He was a president or something.
02:11:59 I vaguely remember that.
02:12:01 So I’m worried about both sides here, that.
02:12:06 Well, I think the general principle
02:12:07 is that should not be a tool of public policy, right?
02:12:11 The public policy should attempt,
02:12:13 and public health policy in particular,
02:12:15 should attempt to address that fear.
02:12:16 It’s not that you should tell people lies, of course not.
02:12:22 Tell people accurately what the risk is.
02:12:26 Give people tools that have evidence
02:12:29 that they can address their risk with
02:12:32 and level with people when we don’t know.
02:12:36 I think that is the right adult way
02:12:38 to deal with this pandemic from a public health point of view.
02:12:41 And that is not the policy we have followed.
02:12:44 Instead, public health is intentionally stoked the fear
02:12:47 in order to gain compliance with its edicts.
02:12:50 And I think the consequence of that
02:12:53 is people distrust public health.
02:12:56 What you’re talking about, the distrust of government,
02:12:58 I think is partly a consequence of that.
02:13:00 That movement, which is much smaller once upon a time,
02:13:03 is much larger now because of essentially
02:13:06 people look at what public health has done
02:13:09 and said they’ve lied to me a whole bunch of times
02:13:12 and a whole bunch of things is the general sense.
02:13:15 And there are consequences to that.
02:13:17 We’re gonna have to work in public health for a long time
02:13:20 to try to regain the trust of the public.
02:13:22 Throughout all of this, you’ve been inspiring to me,
02:13:26 to a lot of people.
02:13:27 So you’ve been fearless, bold,
02:13:32 in these kind of challenging the policies
02:13:35 and not in a martyr kind of way
02:13:38 because you’re walking the line gracefully
02:13:42 and beautifully, I would say.
02:13:44 And looking at that, I think you’re an inspiration
02:13:49 to a lot of young people.
02:13:50 So I have to ask, what advice would you give them
02:13:53 if they’re thinking of going into science,
02:13:56 if they’re thinking of having an impact in the world,
02:13:59 what advice would you give them about their career
02:14:03 and maybe about their life?
02:14:05 Thinking about somebody in high school,
02:14:07 maybe in undergraduate college.
02:14:09 I’d say a few things.
02:14:10 One is, this is a wonderful profession.
02:14:13 You have an opportunity to improve the lives of so many
02:14:17 and do it by having fun,
02:14:19 the kind of play we’re talking about.
02:14:20 It’s an absolute privilege to be able to work
02:14:24 in this kind of area.
02:14:27 And to young people looking to say,
02:14:28 that have some gifts or desire for this area,
02:14:32 I say, please, go for it.
02:14:35 So this area of science broadly.
02:14:37 Yeah, I mean, it could be,
02:14:39 I mean, I don’t have any gifts in AI,
02:14:41 but like, it could be your buddy,
02:14:43 or in health or in medicine or whatever,
02:14:46 whatever your gifts lie, develop them,
02:14:48 work hard and develop them,
02:14:49 because it’s worth it.
02:14:50 It’s worth it, not just because you get some status,
02:14:54 but because the journey is fun.
02:14:56 And the result is improvements in the lives of so many.
02:15:00 So I think that is the encouragement I give.
02:15:03 I’d also say, if you’re looking at this ugliness
02:15:06 of this debate that’s happened over the pandemic,
02:15:09 I’d say to young people,
02:15:10 we need you to come in and help transform it.
02:15:13 Many of the people you see in this debate
02:15:15 that behave poorly, I ask you forgive them.
02:15:18 I’ve done my best to try,
02:15:21 because many of them are acting out of their own sense
02:15:25 that they need to do good,
02:15:27 but the mistake they’ve made is in this arrogance
02:15:31 and this power.
02:15:32 So when you come in, remember that example
02:15:34 as a negative example.
02:15:35 And so that when you join the debate,
02:15:38 you’ll join it in a spirit of humility
02:15:40 and a spirit of trying to learn
02:15:42 while keeping that love that led you
02:15:45 to enter the field in the first place.
02:15:48 And yeah, choose forgiveness versus like derision.
02:15:54 Like the people that you know have messed up,
02:15:57 like give them a pass,
02:15:59 because it feels like that’s how improvement starts.
02:16:03 Funny, I’ve been thinking this is like,
02:16:05 I told you I’m Christian, right?
02:16:06 So like God has given me many opportunities
02:16:10 to forgive people, learned to practice how to do that.
02:16:12 Gave you a gift.
02:16:13 It’s a very humbling thing, I guess.
02:16:15 Is there a memory from when you were young
02:16:19 that was very formative to you?
02:16:22 So you just gave advice to some young people.
02:16:24 Is there something that stands out to you
02:16:26 that a decision you made, an event that happened
02:16:32 that made you the man you are today?
02:16:35 I actually grew up in a relatively poor environment.
02:16:38 Like I was born in India and we moved when I was four.
02:16:42 My dad had eight brothers and sisters
02:16:46 and my mom had four brothers and sisters.
02:16:48 She grew up in the slum in Calcutta.
02:16:52 My dad, his dad died when he was young
02:16:54 and he supported his family, his brothers and sisters
02:16:57 with university scholarship money.
02:16:59 Came to the US and my dad worked in a McDonald’s,
02:17:02 even though he’s an electrical engineer,
02:17:04 couldn’t find a job in 1971.
02:17:06 And so he worked at McDonald’s.
02:17:09 We lived in a, like this, basically the housing port
02:17:14 like development in Cambridge,
02:17:16 this like this middle building on the 17th floor,
02:17:19 this like housing development.
02:17:20 I mean, I think that was transformative for me.
02:17:25 Like I didn’t realize so much at the time
02:17:27 how that experience of being essentially like poor,
02:17:32 lower middle class, what effect it had on my outlook.
02:17:36 You mentioned to me offline
02:17:37 that you listened to the conversation
02:17:38 that I had with my dad.
02:17:40 What impact did your dad have on your life?
02:17:42 What memories do you have about him?
02:17:44 He was a rocket scientist actually.
02:17:46 He helped design rocket guidance systems.
02:17:51 He died when I was 20 and I still miss him to this day.
02:17:55 And I think that experience of seeing him
02:17:58 sacrifice himself for his family, brilliant man,
02:18:05 but in many ways frustrated with like his opportunities
02:18:08 in the world, which is probably what led him
02:18:10 to come to the US in the first place.
02:18:12 That’s transformed, that’s had a transformative effect on me
02:18:16 and I wish I could tell him that looking back.
02:18:21 Do you think about your own mortality?
02:18:25 Do you think about your death?
02:18:26 Your dad is no longer with us.
02:18:29 You’re the old wise sage that represents.
02:18:35 I’ve only worried about death once in this pandemic.
02:18:39 Although I’ve had two, my cousin was 73
02:18:43 and my uncle who’s 74 died in India during the pandemic.
02:18:47 And I grieve them both from COVID.
02:18:52 Like the fear of COVID really has only hit me
02:18:55 only really once during this and it wasn’t for me.
02:18:58 And I recognize it’s irrational.
02:19:01 So on the eve of the Santa Clara County seroprevalence study,
02:19:06 it was a really interesting thing
02:19:07 because so many people volunteered to help.
02:19:10 And my daughter who’s 20, I guess she was 19 at the time
02:19:16 and my wife also volunteered to help
02:19:18 with like various aspects of the study.
02:19:21 And so the eve of the study,
02:19:22 they were going to go out in public
02:19:24 and I didn’t know what the death rate was
02:19:25 because we hadn’t done the study.
02:19:27 And I suspected it was lower than people were saying
02:19:30 but I didn’t know.
02:19:31 I knew about the age gradient
02:19:33 because I’d seen the Chinese data and my daughter’s young
02:19:37 but my wife is my age and I didn’t know the death rate.
02:19:40 And I couldn’t sleep the night before.
02:19:43 Like what if I’m putting my family,
02:19:45 my daughter and my wife at risk
02:19:48 because of some activity that I’m doing.
02:19:52 It was kind of, I don’t know.
02:19:53 I mean, it was.
02:19:54 So it’s worried about the wellbeing of others.
02:19:58 Yeah.
02:19:59 When you look in the mirror.
02:20:00 If I die, I die.
02:20:01 I mean, like I just, it’s not, again, I’m Christian.
02:20:04 So I don’t, death is not the end for me, I believe.
02:20:07 And so I don’t particularly worried about my own death
02:20:10 but I do, I mean, I just, I think we can’t help
02:20:14 but we worry about the wellbeing of our loved ones.
02:20:17 So from the perspective of God, then let me ask you,
02:20:23 what do you think is the meaning
02:20:24 of this whole journey we’re on?
02:20:25 What do you think is the meaning of life?
02:20:28 You know, it’s very simple.
02:20:29 Love one another.
02:20:30 Treat your neighbor as yourself.
02:20:32 It’s love, as simple as that.
02:20:35 Well, I’d love to see a little bit more of that
02:20:38 in this pandemic.
02:20:39 It’s an opportunity for the best of our nature to shine.
02:20:44 It’s, I’ve seen some of the worst
02:20:47 but I think some of that is just good therapy.
02:20:49 And I’m hoping in the end, what we have here is love.
02:20:54 At the very least, make your dad proud
02:20:57 with some incredible rockets that we’re launching.
02:21:01 I think you’d get along well with my dad, Lex.
02:21:04 I definitely would.
02:21:05 Thank you so much.
02:21:06 This is an incredible honor to talk to you, Jay.
02:21:08 You’ve been an inspiration to so many people
02:21:11 and keep fighting the good fight.
02:21:13 Thank you so much for spending your valuable time
02:21:15 with me today.
02:21:16 Thank you for having me here, appreciate it.
02:21:18 Thanks for listening to this conversation
02:21:20 with Jay Bhattacharya.
02:21:21 To support this podcast,
02:21:22 please check out our sponsors in the description.
02:21:26 And now let me leave you some words from Alice Walker.
02:21:29 The most common way people give up their power
02:21:33 is by thinking they don’t have any.
02:21:35 Thank you for listening and hope to see you next time.