WEBVTT - The Coronavirus Isn't Going Away 0:00:15.356 --> 0:00:22.796 Pushkin from Pushkin Industries. This is Deep Background, the show 0:00:22.796 --> 0:00:25.956 where we explore the stories behind the stories in the news. 0:00:26.356 --> 0:00:29.636 I'm Noah Feld. Today we wanted to share with you 0:00:30.156 --> 0:00:34.556 a special episode special because its subject matter just seemed 0:00:34.596 --> 0:00:37.756 so pressing that we didn't think it was appropriate to wait. 0:00:38.556 --> 0:00:42.796 We're going to talk to Mark Lipsch about the coronavirus 0:00:42.996 --> 0:00:47.196 COVID nineteen. Mark isn't just another expert on these topics. 0:00:47.516 --> 0:00:51.276 He's Professor of epidemiology at the Harvard chance School of 0:00:51.316 --> 0:00:54.756 Public Health and director of the Center for Communicable Disease 0:00:54.836 --> 0:00:58.276 Dynamics there. In other words, Mark is someone who has 0:00:58.316 --> 0:01:02.276 spent his entire career trying to understand the behavior of 0:01:02.356 --> 0:01:05.196 viruses and what they do when they spread around the world, 0:01:05.556 --> 0:01:08.596 and he is at the forefront of analyzing what's going 0:01:08.676 --> 0:01:12.716 on with the coronavirus right now in real time. What 0:01:12.796 --> 0:01:18.116 Mark has to say is more than a little bit disturbing. Mark, 0:01:18.196 --> 0:01:20.436 thank you so much for taking time out of your 0:01:20.476 --> 0:01:22.596 busy schedules saving the world to talk to me. I'm 0:01:22.676 --> 0:01:25.796 very very grateful, happy to do it. I want to 0:01:25.796 --> 0:01:28.916 just start by diving into something that you said to 0:01:28.956 --> 0:01:31.436 the Washington Post the other day, and I know because 0:01:31.476 --> 0:01:33.116 I know you, that you said much more than this. 0:01:33.476 --> 0:01:36.236 They quoted you as saying there was a chance, and 0:01:36.276 --> 0:01:38.796 they didn't say how big a chance that forty to 0:01:38.876 --> 0:01:42.476 seventy percent of the world's population could end up infected 0:01:42.516 --> 0:01:44.956 with the coronavirus. And now knowing you, you would never 0:01:44.996 --> 0:01:47.916 have said that unless you assign some probability to that judgment. 0:01:48.436 --> 0:01:50.436 What did you actually say and what would you say 0:01:50.436 --> 0:01:53.796 about that subject? That is a roughly correct quote I 0:01:54.836 --> 0:01:58.276 should have said of the adult population, and I'm trying 0:01:58.316 --> 0:02:01.276 to make amends for that, and I'll explain that in 0:02:01.316 --> 0:02:04.716 a little bit. But I think that there's a very 0:02:04.716 --> 0:02:06.476 good chance that we are in the beginning of a 0:02:06.476 --> 0:02:11.676 pandemic of this novel coronavirus right now, and that pandemic 0:02:11.716 --> 0:02:15.436 spread of that virus, given what we currently understand about 0:02:15.476 --> 0:02:21.516 its epidemiology, is likely to infect something on that order 0:02:21.636 --> 0:02:25.876 of the adult population. The reason for the adult qualification 0:02:26.116 --> 0:02:29.916 is that we don't really understand what's going on with children. 0:02:29.916 --> 0:02:32.796 They are very few known cases in children, and that 0:02:32.836 --> 0:02:35.636 either means that they're not getting infected, or perhaps means 0:02:35.676 --> 0:02:40.436 that they are getting infected, maybe transmitting, but just sufficiently 0:02:40.516 --> 0:02:45.036 mild cases that we aren't detecting them with current surveillance. 0:02:45.716 --> 0:02:50.636 So forty percent infected doesn't mean forty percent get very 0:02:50.716 --> 0:02:53.756 very ill or that forty percent die, but it does 0:02:53.876 --> 0:02:57.916 mean that some proportion of them get symptomatic. And of those, 0:02:58.516 --> 0:03:01.596 the current estimates are that around one or two percent 0:03:01.716 --> 0:03:05.276 may die, with a very much larger risk of dying 0:03:05.316 --> 0:03:11.556 if you're over sixty five. So I really did say 0:03:11.956 --> 0:03:16.036 essentially what they quoted me as saying, and with the 0:03:16.076 --> 0:03:19.676 caveat about the adults, I still mean it. Mark what's 0:03:19.716 --> 0:03:24.236 your confidence level in that forty to seventy percent estimate. 0:03:26.436 --> 0:03:30.956 It's hard to put a number exactly on that sort 0:03:30.956 --> 0:03:34.316 of hyper prior, but I think the justification for it 0:03:34.396 --> 0:03:40.676 is that transmission of novel viruses with contagiousness level, which 0:03:40.676 --> 0:03:44.956 we quantify as a reproductive number similar to this, is 0:03:44.956 --> 0:03:49.436 something we've observed before, and that's influenza during pandemics, and 0:03:49.676 --> 0:03:54.956 in the two largest pandemics of the twentieth century, around 0:03:55.036 --> 0:03:59.276 thirty to almost forty percent of people became symptomatically infected. 0:03:59.956 --> 0:04:05.036 And that's lower than the proportion that got infected because 0:04:05.236 --> 0:04:08.596 some people don't get very sick even with flu. So 0:04:08.636 --> 0:04:11.636 we have an analog which is one reason for that number, 0:04:12.036 --> 0:04:17.196 And we also have mathematical models, which are simplifications of reality, 0:04:17.236 --> 0:04:20.276 and we know that and we don't believe their outputs literally, 0:04:20.396 --> 0:04:24.156 but mathematical models would say that it could be that 0:04:24.276 --> 0:04:27.356 range or higher depending on how much mixing there is 0:04:27.356 --> 0:04:30.836 in the population. So that's the basis for it. The 0:04:30.916 --> 0:04:34.996 ways it could be wrong are if transmission outside of 0:04:35.076 --> 0:04:40.116 China is fundamentally different in some way from transmission in Wohan, 0:04:41.356 --> 0:04:45.956 if there's unexpectedly much benefit from warm or weather, we 0:04:45.956 --> 0:04:50.836 expect that the seasonal changes will modestly reduce transmission, but 0:04:50.956 --> 0:04:54.516 not very much and certainly not enough to stop it. 0:04:55.476 --> 0:05:03.036 Or if interventions are sufficiently intensive as to stop the 0:05:03.116 --> 0:05:06.436 spread or very much slow the spread. That I think 0:05:06.516 --> 0:05:10.236 is a possible scenario, at least in certain play. It's 0:05:10.316 --> 0:05:13.156 challenging because those interventions would have to be in place 0:05:13.156 --> 0:05:15.796 for a very long time and will be very unpleasant 0:05:15.876 --> 0:05:19.716 for many people, are worse than unpleasant. But I think 0:05:20.316 --> 0:05:23.716 probably another qualification that should have gone into that forty 0:05:23.756 --> 0:05:27.636 to seventy percent is in the absence of strong countermeasures. 0:05:28.156 --> 0:05:33.036 Mark when you say interventions, you're picturing quarantines, shelter in place, 0:05:33.756 --> 0:05:36.556 something stronger in terms of lockdown, what's the kind of 0:05:36.556 --> 0:05:40.356 intervention that you're describing. They are kind of two categories. 0:05:40.476 --> 0:05:43.836 The one that I think increasingly we think won't work 0:05:44.316 --> 0:05:48.436 is isolation of cases and quarantine of their contacts and 0:05:48.476 --> 0:05:50.916 then making them isolate. I mean, I think that will 0:05:50.956 --> 0:05:54.396 be a part of it, and obviously people will self 0:05:54.476 --> 0:05:57.836 isolate to protect their family and to protect their contacts 0:05:57.916 --> 0:06:02.076 if they're sick, and because they're sick, they'll isolate to 0:06:02.116 --> 0:06:06.556 some extent. But it looks like those kinds of interventions 0:06:06.596 --> 0:06:10.276 by themselves probably aren't good enough for a virus like this, 0:06:10.436 --> 0:06:12.796 where there seems to be evidence of at least some 0:06:13.036 --> 0:06:15.996 transmission from people who are mildly ill or not yet ill. 0:06:17.116 --> 0:06:19.916 So I think the complement to that and the sort 0:06:19.956 --> 0:06:24.796 of more large scale interventions will be population level interventions 0:06:24.796 --> 0:06:27.876 where they don't depend on knowing who's sick and who's transmitting, 0:06:28.196 --> 0:06:32.716 and those are things like canceling public gatherings, potentially closing schools, 0:06:32.756 --> 0:06:36.076 although the relevance of that is unclear until we understand 0:06:36.076 --> 0:06:40.676 better how children are involved in transmission, and other kinds 0:06:40.716 --> 0:06:44.836 of working from home and other kinds of ways of 0:06:44.916 --> 0:06:49.636 reducing contact between people regardless of whether they're currently showing 0:06:49.676 --> 0:06:53.196 any symptoms. And that's what the Chinese have successfully done, 0:06:53.436 --> 0:06:57.316 among other things, is very much clamped down on letting 0:06:57.356 --> 0:07:00.196 people out on the streets. As I understand it, there's 0:07:00.236 --> 0:07:03.236 a sort of you can go out a certain frequency 0:07:03.356 --> 0:07:07.596 per week, you have to have a pass, you get 0:07:07.596 --> 0:07:13.116 your food and other supplies delivered with electronic payment. Not 0:07:13.236 --> 0:07:16.116 every place can do that, but some places can do 0:07:16.236 --> 0:07:19.396 that to some extent. I think China may be one 0:07:19.436 --> 0:07:23.876 of the most able to do that of anywhere in 0:07:23.916 --> 0:07:25.876 a world. I want to talk about consequences now for 0:07:25.916 --> 0:07:27.916 a moment. In a world where let's say in the 0:07:27.996 --> 0:07:30.556 United States, between forty and seventy percent of the adult 0:07:30.596 --> 0:07:35.676 population is infected on a daily basis, when it reaches 0:07:35.676 --> 0:07:39.396 that depth of penetration, I assume you can't diagnose that 0:07:39.436 --> 0:07:41.356 forty to seventy percent of the people. You can only 0:07:41.436 --> 0:07:43.916 diagnose the symptomatic ones because there's just too many people. 0:07:44.676 --> 0:07:47.756 And so do people more or less go about their 0:07:47.836 --> 0:07:50.316 daily lives, or everyone is expected to more or less 0:07:50.316 --> 0:07:53.516 shelter in place, except for the people who are necessary 0:07:53.596 --> 0:08:00.676 to preserve basic services. We're not going to identify every case, 0:08:00.716 --> 0:08:03.356 as you say, for the reasons you say, it won't 0:08:03.356 --> 0:08:05.916 be forty to seventy percent at the same time. Obviously 0:08:05.916 --> 0:08:08.596 it will take it will go over some period of time. 0:08:09.716 --> 0:08:12.596 And the problem is, even if we could diagnose every 0:08:12.596 --> 0:08:16.076 one of those people, there seems to be some transmission 0:08:16.916 --> 0:08:19.716 at least and maybe a fair amount of transmission from 0:08:19.756 --> 0:08:23.916 people who are not yet diagnosed able. So that's why 0:08:23.916 --> 0:08:26.476 I say there are these two categories of interventions, those 0:08:26.516 --> 0:08:30.356 that depend on cases and those that depend on general 0:08:30.516 --> 0:08:35.396 social distancing and for disinfection. It's looking for now, unless 0:08:35.516 --> 0:08:38.916 our picture of it changes like the second category is 0:08:38.956 --> 0:08:42.636 going to be more important. And unfortunately, as we'll see, 0:08:42.756 --> 0:08:46.076 if China goes back to work as they're talking about doing, 0:08:46.756 --> 0:08:51.116 those interventions only work while they're in place as long 0:08:51.156 --> 0:08:54.436 as there's some virus still circulating. When you let up 0:08:54.876 --> 0:08:59.316 on the interventions to keep people at home, transmission begins again. 0:08:59.996 --> 0:09:06.156 So it's a real challenge. And the ways to get 0:09:06.236 --> 0:09:09.276 to the end of it are either that enough will 0:09:09.316 --> 0:09:13.836 get infected so that transmission can't take off again, and 0:09:14.316 --> 0:09:17.356 given our current estimates, forty or fifty percent would be 0:09:17.436 --> 0:09:20.756 enough to do that. The seventy percent scenario would be 0:09:20.796 --> 0:09:22.636 the sort of tail end of that after the virus 0:09:22.676 --> 0:09:26.436 is starting to go away. But if fifty percent, and 0:09:26.476 --> 0:09:30.036 this is very rough because the numbers are changing about 0:09:30.076 --> 0:09:32.396 how contagious this is every time I have a phone call, 0:09:33.676 --> 0:09:36.716 but if say forty or fifty percent got infected, then 0:09:36.836 --> 0:09:40.356 that would be enough to prevent new outbreaks in that 0:09:40.476 --> 0:09:46.476 population until immunity declines, which it may do. So that's 0:09:46.516 --> 0:09:50.476 one way, and all these control measures will make it 0:09:50.516 --> 0:09:53.836 more likely that that happens, that the minimum number needed 0:09:53.956 --> 0:09:57.876 rather than more than that minimum. And the other way 0:09:58.116 --> 0:10:02.516 is that we delay it long enough to have a vaccine, 0:10:03.276 --> 0:10:06.316 but I think the timescale for that is not realistic 0:10:06.796 --> 0:10:08.836 to do that for most of the world, in most 0:10:08.836 --> 0:10:12.436 of the unless we get extremely lucky with the quality 0:10:12.436 --> 0:10:18.036 and producibility of the vaccines. I think I'm experiencing some 0:10:18.236 --> 0:10:22.676 cognitive denial in listening to you, as I indeed I 0:10:22.836 --> 0:10:26.356 was when I read your initial forty to seventy percent 0:10:26.516 --> 0:10:28.396 estimate it. So I guess I'm wondering if you can 0:10:28.476 --> 0:10:32.876 help me and help listeners in sort of taking on 0:10:32.916 --> 0:10:35.516 board whether we just I'm just being irrational, you know, 0:10:35.636 --> 0:10:38.756 is my denial irrational when I'm saying to myself, I 0:10:38.836 --> 0:10:42.076 just can't picture a world where something like half of 0:10:42.076 --> 0:10:46.516 the US population adult population has coronavirus, where we're sort 0:10:46.556 --> 0:10:49.516 of looking at each other, where you know every other 0:10:49.516 --> 0:10:53.196 person is infected at one point or another, where you know, 0:10:53.236 --> 0:10:55.436 potentially in the United States, that would mean well over 0:10:55.436 --> 0:10:58.876 a million people could die, and globally obviously much much, much, 0:10:58.956 --> 0:11:03.916 much more. I mean, is my reaction just standard denialism, 0:11:04.116 --> 0:11:08.476 or is there some underlying sense where maybe my skepticism 0:11:08.556 --> 0:11:12.276 is warranted in light of the imperfection of statistical projections. 0:11:14.396 --> 0:11:18.596 I think it depends on how on whether you can 0:11:18.676 --> 0:11:22.436 find an reason to think that the pieces of the 0:11:22.516 --> 0:11:26.356 projections are wrong. I mean, all projections could be wrong 0:11:26.436 --> 0:11:29.276 for reasons that we can't imagine. So I'll give you 0:11:29.356 --> 0:11:32.676 ten percent or even twenty percent chance that there's just 0:11:32.756 --> 0:11:36.996 something nobody's thought of that is going to completely invalidate this. 0:11:37.996 --> 0:11:40.396 Beyond that, you know, I've been thinking as hard as 0:11:40.436 --> 0:11:43.076 I can because I don't like the conclusion either. I 0:11:43.116 --> 0:11:46.236 think the data on which we're basing this are not 0:11:46.836 --> 0:11:50.756 very good, So the bounds around what we're trying to 0:11:50.876 --> 0:11:54.436 estimate are very large. But I mean, I think one 0:11:54.436 --> 0:11:57.036 way to think of it is this is not an 0:11:57.036 --> 0:11:59.756 existential threat as the people who think about those things 0:12:00.596 --> 0:12:04.396 define it. This is a really potentially very bad thing 0:12:04.436 --> 0:12:07.836 that could happen, that we'll touch many lives in a 0:12:07.876 --> 0:12:11.396 bad way. But I think that's sort of how I'm 0:12:11.436 --> 0:12:13.436 thinking about it, and it's not fun to think about. 0:12:14.916 --> 0:12:19.596 You wrote a terrific piece in the Scientific American trying 0:12:19.676 --> 0:12:22.476 to explain to the rest of us how we should 0:12:22.516 --> 0:12:25.716 think about what we read any here. I think it 0:12:25.716 --> 0:12:28.516 would be great for listeners if you would share your 0:12:28.556 --> 0:12:32.476 three categories in your analysis, because I found it really helpful. Sure, 0:12:33.556 --> 0:12:37.356 we wrote this because when I've been talking to journalists, 0:12:37.516 --> 0:12:40.796 I find that I'm constantly trying to hedge and say 0:12:41.156 --> 0:12:43.796 this is a fact, this is something I believe but 0:12:44.236 --> 0:12:47.876 isn't yet resolved as true or false. And so the 0:12:47.916 --> 0:12:51.236 three categories that we laid out with Bill Hannage, my colleague, 0:12:51.276 --> 0:12:55.156 were that when scientists talk about this pandemic, they can 0:12:55.196 --> 0:13:01.636 describe facts, they can describe informed inference, where facts are 0:13:01.636 --> 0:13:04.716 at the base of it, but some extrapolation is being 0:13:04.756 --> 0:13:10.356 made based on analogies to other viruses or information. We 0:13:10.436 --> 0:13:12.916 know from different sources that we're putting together in a 0:13:12.956 --> 0:13:16.996 particular way. And then the third category is opinion and 0:13:17.036 --> 0:13:20.876 speculation on topics like other people's motives, which are sort 0:13:20.876 --> 0:13:23.876 of irresolvable as matters of fact. But the first two 0:13:23.876 --> 0:13:28.036 categories I think are interesting in that they're very fluid. 0:13:28.156 --> 0:13:33.156 So matters like whether there was undetected transmission in many 0:13:33.196 --> 0:13:39.556 countries that were matters of speculation informed by some calculations 0:13:39.596 --> 0:13:45.156 and facts are now becoming matters of fact, meaning we 0:13:45.236 --> 0:13:47.796 now know there were a lot of undetected cases in Italy, 0:13:47.876 --> 0:13:50.196 there were a lot of undetected cases in Iran. A 0:13:50.276 --> 0:13:52.916 week ago, there were no detected cases in either place, 0:13:53.356 --> 0:13:55.276 and I wouldn't have picked those as the countries I 0:13:55.316 --> 0:13:58.036 would expect first to pop up. I would have picked 0:13:58.076 --> 0:14:01.836 perhaps Indonesia or some other countries, and I got a 0:14:01.836 --> 0:14:05.316 lot of flak for that. But the fact is now 0:14:05.356 --> 0:14:08.636 we know there are cases in a bunch of countries 0:14:08.636 --> 0:14:11.356 where we were just speculating that because of the low 0:14:11.396 --> 0:14:15.516 amount of testing we couldn't know, and there probably was some. 0:14:16.196 --> 0:14:21.156 So I think in this epidemic, hopefully most topics are 0:14:21.156 --> 0:14:25.956 moving up the list from speculation informed by facts to 0:14:26.156 --> 0:14:30.596 real facts. But the public health surveillance system is not 0:14:31.196 --> 0:14:34.396 set up, unfortunately, to provide factual answers to all these 0:14:34.476 --> 0:14:38.556 questions at once, because we just don't have ways of 0:14:38.596 --> 0:14:42.076 detecting things we've never seen before until we invent them, 0:14:42.076 --> 0:14:43.756 and then those have to be rolled out. And so, 0:14:43.836 --> 0:14:46.916 for example, diagnostic testing is still a very very limiting 0:14:47.436 --> 0:14:51.556 factor in many countries, including the US. So we don't 0:14:51.596 --> 0:14:53.596 know how many cases there are in this country because 0:14:53.636 --> 0:14:57.356 we're testing only people who have contacts with China or 0:14:57.356 --> 0:14:59.996 with known cases. And so if somebody was missed in 0:14:59.996 --> 0:15:03.436 this country coming through the border, then anyone they infected, 0:15:03.436 --> 0:15:07.156 and anyone those people infected and so on is untestable 0:15:07.236 --> 0:15:11.356 under current protocols. That will change eventually, but at the moment, 0:15:11.356 --> 0:15:13.356 we can't see them because we're not looking at them. 0:15:13.556 --> 0:15:15.916 And I take it that in your view, it's overwhelmingly 0:15:15.996 --> 0:15:18.556 probable that there are such people. I mean, you say 0:15:18.596 --> 0:15:21.756 you got flack for expecting more cases in Indonesia, but 0:15:21.796 --> 0:15:23.876 really you should get some credit for saying that there 0:15:23.876 --> 0:15:27.356 were going to be undetected cases, you know, somewhere, and 0:15:27.516 --> 0:15:29.276 sure enough there were, So in that sense, there was 0:15:29.276 --> 0:15:34.556 a validation of your position. Thank you. I agree. I 0:15:34.596 --> 0:15:38.276 think that it's very very likely that there are cases, 0:15:38.956 --> 0:15:41.436 many cases in this country that have not been detected. 0:15:41.436 --> 0:15:45.556 And reading between the lines of statements from CDC officials, 0:15:45.556 --> 0:15:49.236 including the director last week or two weeks ago, it 0:15:49.356 --> 0:15:52.556 seems as if they think that's probably true also in 0:15:52.596 --> 0:15:56.956 that they're saying they expect ongoing transmission. Robert Redfield, the director, 0:15:56.996 --> 0:15:59.516 said that he expected that this would be to come 0:15:59.556 --> 0:16:03.036 the next seasonal virus and which would be just with 0:16:03.116 --> 0:16:07.276 us for the long term. You're forty to seventy percent 0:16:07.916 --> 0:16:10.956 in the adult population, as is that in category two 0:16:10.996 --> 0:16:15.076 for you? That's you know, an inference based on based 0:16:15.116 --> 0:16:19.596 on facts, yes, facts, models and analogies. And do you 0:16:19.676 --> 0:16:21.916 want to just say a word for listeners who might 0:16:21.956 --> 0:16:25.636 be interested about how you build those models. I'm fascinated 0:16:25.636 --> 0:16:28.076 by this. How do you go about doing this the 0:16:28.076 --> 0:16:29.956 rest of the time when you're not you know, all 0:16:29.996 --> 0:16:33.076 the preparation as it were, for when a potential pandemic 0:16:33.116 --> 0:16:35.396 actually does it and suddenly you're, you know, on the 0:16:35.396 --> 0:16:37.596 front page of the newspapers making your predictions. But the 0:16:37.596 --> 0:16:39.796 rest of the time you're building the models and gathering 0:16:39.836 --> 0:16:42.316 the data. How do you go about that at the 0:16:42.396 --> 0:16:45.436 at the broadest level of generality. Yeah, So I think 0:16:45.876 --> 0:16:50.156 the models that we work with are that they're base 0:16:50.316 --> 0:16:53.076 very simple. They they are models in which, in a 0:16:53.076 --> 0:16:57.796 computer or on a mathematical formula, you take one infectious 0:16:57.836 --> 0:17:01.436 individual and one susceptible individual. They bump into each other 0:17:02.276 --> 0:17:06.436 figuratively and create another infectious individual out of the susceptible. 0:17:06.596 --> 0:17:08.836 So it's like a chemical reaction A S plus I 0:17:09.356 --> 0:17:13.796 too I susceptible plus infected equals to infected, and then 0:17:13.876 --> 0:17:18.916 the other chemical reaction is infected yields recovered over some timescale. 0:17:19.516 --> 0:17:23.276 That's at the heart of all of these models. So 0:17:24.076 --> 0:17:26.356 in the very simplest version of this, where we're all 0:17:26.396 --> 0:17:30.596 like little atoms bouncing around in an ideal gas, if 0:17:30.636 --> 0:17:33.076 you build that model and put the parameters in that 0:17:33.236 --> 0:17:38.596 have been measured and estimated for this virus, you run 0:17:38.636 --> 0:17:41.876 it to its end and you end up with about 0:17:42.396 --> 0:17:45.116 eighty to ninety percent of the population infected, depending on 0:17:45.116 --> 0:17:48.676 which numbers you put in. But we know that people 0:17:48.716 --> 0:17:52.476 are not ideal gases, and there's structure in the population, 0:17:52.636 --> 0:17:58.396 and there's seasonal variability, and there's different levels of susceptibility 0:17:58.476 --> 0:18:02.276 and different age groups and things, and so when you're 0:18:02.276 --> 0:18:05.996 building a model for an infection that you know something 0:18:06.036 --> 0:18:09.596 about and where there's already data, you can upbrate all 0:18:09.636 --> 0:18:14.036 of those types of heterogeneity based on measurements from the data, 0:18:14.156 --> 0:18:16.716 sometimes with more certainty and sometimes with less, and then 0:18:16.756 --> 0:18:19.556 you can run the model and see what happens. And 0:18:19.756 --> 0:18:23.476 usually the almost always the ideal gas kind of approximation 0:18:23.596 --> 0:18:27.276 is the worst case, and all the structure tends to 0:18:27.276 --> 0:18:30.476 reduce infection levels, which is one reason I wouldn't have 0:18:30.636 --> 0:18:35.996 put eighty percent out there. So that's kind of the approach, 0:18:36.036 --> 0:18:39.156 and then there are many kind of curly cues you 0:18:39.196 --> 0:18:41.756 can build on top of it that are ways of 0:18:41.876 --> 0:18:46.676 accommodating the particularities of certain infections. Like some infections there's 0:18:46.716 --> 0:18:50.276 a carrier state where you're not sick, but you are transmitting. 0:18:51.236 --> 0:18:54.276 Some infections you become immune and you stay immune. Others 0:18:54.316 --> 0:18:56.636 you become a little more immune, and then a little 0:18:56.636 --> 0:19:00.196 more immune after multiple exposures. So you can elaborate that 0:19:00.236 --> 0:19:06.076 basic structure, but the fundamental idea is that you're catalyzing 0:19:06.076 --> 0:19:09.036 new infections with old infections, and then people are recovering 0:19:10.036 --> 0:19:13.596 and everything else is a variation on that mark, What 0:19:13.636 --> 0:19:17.356 are you doing in your own real life to prepare 0:19:17.396 --> 0:19:20.076 for this? I mean from what you're doing for your 0:19:20.076 --> 0:19:24.116 family to did you cash out your your retirement accounts 0:19:24.156 --> 0:19:26.036 out of the market and go into cash. I mean, 0:19:26.356 --> 0:19:28.956 I just really curious, in practical, real world terms, what 0:19:29.236 --> 0:19:32.716 are you doing? Yeah, I mean, I think at the moment, 0:19:32.716 --> 0:19:35.156 we're all we're all a little in denial because this 0:19:35.196 --> 0:19:40.236 doesn't seem it really doesn't feel real because nothing's happening 0:19:40.476 --> 0:19:46.556 visibly in our country. So it's a process and I 0:19:46.596 --> 0:19:49.436 think we're all kind of coming to the idea that 0:19:49.716 --> 0:19:53.116 if this scenario plays out as it feels like it might, 0:19:53.676 --> 0:19:57.956 then we might be doing a lot of work from home, 0:19:59.116 --> 0:20:01.836 we might have our schools canceled for goodness knows how 0:20:01.876 --> 0:20:05.716 many months, and in the short term, you know, the 0:20:05.756 --> 0:20:11.356 recommendations from the government about getting supplies of essential goods, 0:20:11.396 --> 0:20:16.676 including medications, seem like a good idea to me. Not 0:20:16.836 --> 0:20:19.756 a year's supply, but a ninety days supply is what 0:20:20.036 --> 0:20:23.996 they often recommend, and so we are trying to do that. Obviously, 0:20:24.156 --> 0:20:26.476 the ability to do that is a luxury that not 0:20:26.596 --> 0:20:30.116 everybody has, and that's a problem. I mean, what are 0:20:30.116 --> 0:20:32.796 people anticipated to do about food if they're sheltering in 0:20:32.796 --> 0:20:35.036 place in that way. Well, I think that's a really 0:20:35.076 --> 0:20:37.916 good question. I'm kind of astonished how well it seems 0:20:37.956 --> 0:20:41.876 to have worked from what I hear in China and 0:20:42.236 --> 0:20:46.076 my friends attribute that to the completely electronic economy. That 0:20:46.116 --> 0:20:50.316 everybody uses phones to pay for things with one of 0:20:50.316 --> 0:20:53.276 the two systems that they have there, and so that 0:20:53.636 --> 0:20:56.436 eases things. So everything is basically being delivered. In other words, 0:20:56.476 --> 0:20:59.236 it's all being paid for electronically and delivered. Everything's being delivered, 0:20:59.236 --> 0:21:01.236 but of course there have to be delivery people, and 0:21:01.316 --> 0:21:04.156 those people have to have some contact with one another 0:21:04.196 --> 0:21:08.796 and with the warehouse, etc. And this has been thought 0:21:08.796 --> 0:21:12.636 through bit in this country for just this reason, when 0:21:12.636 --> 0:21:16.316 people were more concerned about bird flu pandemics a decade ago. 0:21:17.156 --> 0:21:20.036 So I think we will have to see, and it's 0:21:20.036 --> 0:21:22.916 not my expertise, but I'm concerned about that as well. 0:21:23.636 --> 0:21:25.956 What am I not asking you that you think is 0:21:25.996 --> 0:21:31.716 important for people to hear in terms of preparing. I 0:21:31.756 --> 0:21:35.156 think the things that I described and just sort of 0:21:35.836 --> 0:21:40.476 mentally getting in the into the idea that there is 0:21:40.836 --> 0:21:44.716 a possibility, a significant possibility of a really disrupted time 0:21:45.596 --> 0:21:50.276 is kind of my major recommendation and making some material 0:21:50.356 --> 0:21:53.476 plans for that, in so far as people can Where 0:21:53.476 --> 0:21:55.796 should people look up guidance on this? If they're not 0:21:55.796 --> 0:21:57.916 sure what are the essential medicines? I'm not sure? I 0:21:57.996 --> 0:21:59.356 know what are the essential medicines I ought to have 0:21:59.356 --> 0:22:02.716 for ninety days? Right? Well, what you have prescribed to you. 0:22:02.956 --> 0:22:06.836 There's not very many essential non prescription medicines, but right 0:22:06.996 --> 0:22:13.356 maybe some painkiller or anti fever medications. And there's a 0:22:13.356 --> 0:22:17.436 good website called ready dot gov slash pandemic which has 0:22:17.716 --> 0:22:21.076 got some of that information on it. You know. Politically, 0:22:21.876 --> 0:22:24.956 I think it would be good if people recognize that 0:22:24.996 --> 0:22:30.236 the administration has just asked for a tiny appropriation of 0:22:30.276 --> 0:22:32.476 two and a half billion dollars to deal with this, 0:22:33.076 --> 0:22:35.996 half of which is supposed to come from Ebola funding 0:22:36.756 --> 0:22:40.156 that was not yet spent. That's not a serious response, 0:22:40.516 --> 0:22:46.316 and I hope that people will recognize that and press 0:22:46.356 --> 0:22:49.956 for more. I hope they will demand better leadership than 0:22:49.996 --> 0:22:54.836 having the President say repeatedly again recently, that this is 0:22:54.876 --> 0:22:57.436 all going to go away the way SARS did. SARS 0:22:57.476 --> 0:23:01.236 didn't go away. SARS was beaten back with very intensive measures, 0:23:01.796 --> 0:23:05.036 and this is much bigger than SARS, so I think 0:23:05.076 --> 0:23:08.956 there's the political dimension to it. I'm concerned also about 0:23:09.196 --> 0:23:13.996 the impact on our elections. If the virus really does 0:23:14.196 --> 0:23:17.276 start to be detected in more places in the United States, 0:23:17.916 --> 0:23:21.116 I think it could lead to people not wanting to 0:23:21.156 --> 0:23:24.476 go vote in the primaries. I think that could be 0:23:25.316 --> 0:23:29.956 used by various sides to try to make mischief over 0:23:29.996 --> 0:23:34.756 the results. You know, I think there are lots of 0:23:35.596 --> 0:23:38.996 downstream consequences that will understand better when we see them, 0:23:39.676 --> 0:23:44.116 But those are some of my concerns. Mark. I'm really 0:23:44.156 --> 0:23:48.236 grateful to you for speaking so clearly and so calmly 0:23:48.436 --> 0:23:51.356 about something that, as you say, doesn't really feel real 0:23:51.476 --> 0:23:55.476 yet and therefore is really susceptible to our powerful instinct 0:23:55.516 --> 0:23:57.556 to deny. But you know, as we all know, denying 0:23:57.596 --> 0:23:59.916 something doesn't mean it's not going to happen. So I 0:23:59.956 --> 0:24:02.236 think we all do need to change our mindset and 0:24:02.276 --> 0:24:05.556 start being a little more realistic about what the probabilities 0:24:05.556 --> 0:24:07.436 are as as you've laid them out. So I just 0:24:07.476 --> 0:24:10.156 want to really thank you for the time to clarify 0:24:10.196 --> 0:24:11.996 this and first saying a little bit about how you 0:24:12.036 --> 0:24:15.156 reach these conclusions. Getting behind the story can also help us. 0:24:15.516 --> 0:24:18.436 I think get to terms with the reality. So really, 0:24:18.476 --> 0:24:21.316 thank you very very much for what you're doing. Thank 0:24:21.356 --> 0:24:30.356 you for having me. Having spoken to Mark, I still 0:24:30.396 --> 0:24:33.436 am having trouble with my sense of unreality. I just 0:24:33.476 --> 0:24:36.356 don't want to believe what he's telling us about the 0:24:36.356 --> 0:24:40.236 forty to seventy percent number of adults around the world 0:24:40.556 --> 0:24:44.196 who can end up infected with the coronavirus. And yet 0:24:44.276 --> 0:24:47.956 at the same time, I know I'm talking to Mark Lipsitch. 0:24:48.236 --> 0:24:53.716 I'm talking to a calm, reasonable, extremely brilliant epidemiologist who's 0:24:53.796 --> 0:24:57.316 made a career of studying the questions that he's working on. Now, 0:24:57.956 --> 0:25:00.996 if he's not the expert to be believed, there is 0:25:01.156 --> 0:25:04.116 no expert to be believed. So I think what I'm 0:25:04.156 --> 0:25:05.876 going to be trying to do going forward, and maybe 0:25:05.876 --> 0:25:08.116 you'll choose to do the same, is to try to 0:25:08.356 --> 0:25:11.476 update my understanding of where we are and where we're 0:25:11.556 --> 0:25:15.956 going on the basis of his data. When I do that, 0:25:16.196 --> 0:25:19.556