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Speaker 1: Pushkin from Pushkin Industries. This is Deep Background, the show

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Speaker 1: where we explore the stories behind the stories in the news.

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Speaker 1: I'm Noah Feldman. The official start of summer is this Saturday.

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Speaker 1: But what kind of summer will this be? Will we

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Speaker 1: and our families be able to interact with others? Can

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Speaker 1: we have a backdoor barbecue under social distancing? Can we

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Speaker 1: go to a public pool? Can we go anywhere? What

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Speaker 1: are the range of risks that it's rational to undertake

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Speaker 1: in the middle of a pandemic. Here to help us

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Speaker 1: work through these questions is doctor Julia Marcus. She's an

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Speaker 1: infectious disease epidemiologist and an assistant professor at the Harvard

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Speaker 1: Medical School in the Department of Population Medicine. She has

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Speaker 1: been a forthright, clear, analytic voice trying to explain in

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Speaker 1: practice what we can and cannot do and what our

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Speaker 1: risks look like, specifically from the perspective of an expert

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Speaker 1: who spends most of her non pandemic time thinking about

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Speaker 1: public health and its relationship to HIV AIDS. For doctor Marcus,

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Speaker 1: the central question we need to confront is how can

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Speaker 1: you have a life in the pandemic? Julia, thank you

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Speaker 1: very much for joining me. The crucial issue that I'm

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Speaker 1: focused on, and I don't think I'm unique in this regard,

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Speaker 1: is the fact that school is ending such as it was,

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Speaker 1: and there is going to be tremendous pressure on all

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Speaker 1: of us to come up with a game plan for

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Speaker 1: the summer, including a game plan where our children are

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Speaker 1: not in house lockdown for the entire summer. So I

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Speaker 1: want to start by just asking you for your headlines

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Speaker 1: about what we should be trying to do rationally going

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Speaker 1: forward with our kids. Maybe I'll start by just tacking

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Speaker 1: about the way that I'm thinking about this overall and

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Speaker 1: what I've been writing about. So back in early May,

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Speaker 1: I started thinking about how we were framing our public

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Speaker 1: health messaging. And for the first few months in March

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Speaker 1: in April, our public health messaging was really absolutist because

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Speaker 1: it needed to be. It was just stay home only,

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Speaker 1: go out for essential activities like going to the grocery

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Speaker 1: store or the pharmacy, and other than that, stay home.

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Speaker 1: And during that time a couple things happened. One is

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Speaker 1: that our understanding of viral transmission evolved, so we started

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Speaker 1: to learn more about places that were higher risk for

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Speaker 1: transmission and places that were lower risk, and we also

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Speaker 1: realized that we're going to be doing this for a

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Speaker 1: lot longer than we had hoped. If you think back

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Speaker 1: to early March, I think we all really hoped this

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Speaker 1: was going to be like a couple weeks and then

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Speaker 1: we'll go back to our lives, and that's not at

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Speaker 1: all how things played out. And now we're starting to

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Speaker 1: think about how we can adapt to live with this

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Speaker 1: virus for a very long time, months, maybe even years,

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Speaker 1: until we have an effective vaccine that can be scaled up.

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Speaker 1: So now the question is how can we live our

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Speaker 1: lives in a way that's sustainable while still keeping the

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Speaker 1: risk of transmission low. And so what I proposed was

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Speaker 1: rather than this abstinence only messaging which says have no

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Speaker 1: social contact unless it's absolutely essential, just abstain. You know,

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Speaker 1: we know that that's not going to be sustainable for

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Speaker 1: everyone for the long term. So what if we approach

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Speaker 1: this from a harm reduction perspective where we accept that

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Speaker 1: some risks need to happen for various reasons, often for

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Speaker 1: reasons that are out of people's control, and give people

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Speaker 1: the guidance they need to be as safe as possible

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Speaker 1: when they do take those risks, and we can think

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Speaker 1: about how this approach has been used successfully in other

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Speaker 1: areas of public health, like safer sex education is a

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Speaker 1: key one and one that's close to my heart as

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Speaker 1: an HIV researcher. Actually a harm reduction was developed for

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Speaker 1: and also with collaboration with people who use drugs. That's

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Speaker 1: kind of the core approach to reducing the potential harms

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Speaker 1: of substance use. So now I think that that's how

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Speaker 1: we should be thinking when we think about, you know,

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Speaker 1: what are we going to do this summer? How are

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Speaker 1: we going to keep our kids stimulated and happy and

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Speaker 1: as parents stay sane. I think we need to think

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Speaker 1: from this approach of sustainability while trying to keep our

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Speaker 1: risk and others risk low. That I think is an

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Speaker 1: incredibly helpful set of frameworks, and if you don't mind,

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Speaker 1: I'd like to dig into each of them a little

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Speaker 1: bit before we get to the concrete recommendations. One is

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Speaker 1: this idea that we need to be able to sustain

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Speaker 1: this for a longish period of time, and there I'm

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Speaker 1: struck that there seems to be one major unknown, and

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Speaker 1: that is the question of are we going to reach

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Speaker 1: a point where we more or less at a measured pace,

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Speaker 1: all to get or sixty or seventy percent of us

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Speaker 1: have to actually be exposed to stars Cove two. If

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Speaker 1: we thought that the two vaccines that are nearing human

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Speaker 1: testing had a reasonable shot of succeeding, and we thought

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Speaker 1: that maybe a year from now we would be in

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Speaker 1: a position to actually have enough dosis of that vaccine

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Speaker 1: to reach many people in the United States and perhaps

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Speaker 1: in the world, then I can sort of imagine saying

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Speaker 1: we should really still be on a plan where our

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Speaker 1: goal is for us and our children and our family

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Speaker 1: members just never to get exposure to this virus at all.

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Speaker 1: But if the probabilities of those vaccines succeeding are lower

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Speaker 1: than some enthusiastic people say, then it really seems crazy

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Speaker 1: to attempt a kind of long term goal of just

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Speaker 1: not getting this because then, you know, the best epidemiological

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Speaker 1: studies that I've read suggest what we just have to

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Speaker 1: do is accept trying not to break the hospitals, but

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Speaker 1: have to basically all accept that we're going to get

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Speaker 1: the virus over time. So how much is the background

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Speaker 1: likelihood that a vaccine might work and be available in

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Speaker 1: the next year affecting your calculus. I kind of go

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Speaker 1: back and forth between the two things you just said.

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Speaker 1: One is, let me just try as hard as I

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Speaker 1: can to keep my family from getting this virus, and

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Speaker 1: let's see what we can do to keep our risk

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Speaker 1: as low as possible and the risk of our loved

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Speaker 1: ones for an extended period of time, and the hopes

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Speaker 1: that not only will there be an effective vaccine in

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Speaker 1: the next let's say year, but also better treatment. There

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Speaker 1: are ways that the landscape could change that would mean

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Speaker 1: that it would be better to get this virus later

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Speaker 1: rather than earlier. And then there are times when I

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Speaker 1: feel sort of fatalistic, and I feel like, if three

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Speaker 1: quarters of us need to get this eventually, why are

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Speaker 1: we as a family, I don't mean as a country,

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Speaker 1: but why is my family trying so hard to keep

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Speaker 1: our risk low? But what you're talking about, I want

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Speaker 1: to make a distinction between individual decision making around risk

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Speaker 1: and what informs decision making versus what we, as a

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Speaker 1: national public health body should be doing to approach this.

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Speaker 1: And I don't support an approach from a national perspective

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Speaker 1: of just saying, you know what, three quarters of us

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Speaker 1: have to get this anyway, let's just reopen and let

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Speaker 1: that happen. And that's the herd immunity approach, which I

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Speaker 1: think has been roundly criticized in general by public health

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Speaker 1: experts for leading to unnecessary and egregious amount of death

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Speaker 1: and also being just an unethical approach to a public

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Speaker 1: health strategy. I want to also go back to a

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Speaker 1: point you kind of mentioned in passing about not breaking

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Speaker 1: our hospitals. That's a very important point to be considering.

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Speaker 1: And when we look at places that have reopened on

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Speaker 1: the earlier end and are now approaching an emerge and

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Speaker 1: situation already just a few weeks later, that really calls

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Speaker 1: into question of what would happen if we just said,

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Speaker 1: you know, what we're doing is not sustainable. We're all

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Speaker 1: going to get this anyway, let's just reopen. I think

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Speaker 1: we have to have an intelligent approach to life right

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Speaker 1: now that doesn't look like business as usual simply because

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Speaker 1: we will break our healthcare system if we do go

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Speaker 1: back to business as usual. For other reasons as well,

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Speaker 1: but that one, I think is a crucial one that

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Speaker 1: we have to acknowledge. The other part of your framework

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Speaker 1: that I really want to ask you about is the

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Speaker 1: part that has to do with what you do every

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Speaker 1: day when there isn't a COVID nineteen epidemic going on,

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Speaker 1: and that is HIV prevention. And you gave two analogies

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Speaker 1: sex and drugs to the question of sustainability and prevention.

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Speaker 1: Those are really important cases and in certain respects different cases,

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Speaker 1: but they both raise this issue of sustainability. How much

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Speaker 1: can the human being, with a human being is now

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Speaker 1: full desires and drives, actually go forth in an extreme

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Speaker 1: absinate state of play. So would you say a little

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Speaker 1: bit more about the philosophy according to which at some

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Speaker 1: point we have to say, well, you know, some people

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Speaker 1: are going to have sex, and some of that sex

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Speaker 1: is going to be risky and we have to be

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Speaker 1: realistic about that, and some of the that some people

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Speaker 1: are going to have drug dependencies and are going to

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Speaker 1: take drugs whether we like it or not, because we

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Speaker 1: don't have perfect solutions to those problems. Yeah, the analogy

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Speaker 1: that I made was thinking back to the early days

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Speaker 1: of AIDS, when we didn't have a name for HIV.

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Speaker 1: We knew there was this scary virus that was killing

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Speaker 1: gay men, and the public health advice that gay men

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Speaker 1: were getting was to just stop having sex that obviously

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Speaker 1: was not going to be a sustainable approach for everyone

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Speaker 1: or possibly anyone. So what gay men did as a

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Speaker 1: community was several gay men came together with a physician

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Speaker 1: expert and they came up with a guide to having

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Speaker 1: sex in an epidemic. That was really the first kind

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Speaker 1: of foundational safer sex approach to HIV. And that's essentially

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Speaker 1: what we need to be doing right now is acknowledging

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Speaker 1: that we cannot abstain from social contact indefinitely. It's just

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Speaker 1: not possible. So the next best thing is figuring out

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Speaker 1: the equivalent of safer sex for COVID, which is well,

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Speaker 1: in some cases, it actually is about sexual contact. How

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Speaker 1: can we help people have safer sexual contact, but more broadly,

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Speaker 1: how can we help people have safer social contact that

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Speaker 1: gives them enough to fulfill their human needs such that

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Speaker 1: they can actually forego some of the really high risk

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Speaker 1: things we want to avoid, like let's say a crowded

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Speaker 1: dinner party. So if you give someone guidance around lower

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Speaker 1: risk social contact, can you actually help them avoid those

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Speaker 1: high risk situations that could become super spreader events? And

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Speaker 1: if you can, then that's a public health win. But

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Speaker 1: I think there are a lot of reasons why this

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Speaker 1: country is is hesitant to take that HERM reduction approach

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Speaker 1: and tends to be more absolutist in its public health

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Speaker 1: messaging and just tell people here's the safest thing you

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Speaker 1: can do, which is to stay home. There's something really

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Speaker 1: profound about what you're saying to me, namely that human

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Speaker 1: beings have a basic instinct to sociality. We have a

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Speaker 1: basic need to be social. We are social beings in

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Speaker 1: the same way that we need other forms of human contact.

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Speaker 1: So if that's the case, I think what I hear

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Speaker 1: you saying is that we need a model. Just like

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Speaker 1: people at the beginning of the HIV AIDS crisis came

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Speaker 1: up with a guide to sex in the pandemic, we

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Speaker 1: need to start building a guide to socializing in the pandemic.

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Speaker 1: Am I reading you right? Is that in fact analogy

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Speaker 1: that you're offering. Yeah? Absolutely, that is exactly what I

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Speaker 1: think we need. Is kind of the corollary to that

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Speaker 1: manual on how to have sex in an epidemic. We

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Speaker 1: need a manual on how to have a life in

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Speaker 1: a pandemic. We'll be back in a moment. I'm gonna

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Speaker 1: start by asking you to begin to fill in some

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Speaker 1: of the elements of your model of how we can

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Speaker 1: have a life in the pandemic. Eventually, I'm going to

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Speaker 1: ask you about some of the details about including how

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Speaker 1: to have sex in the pandemic, but let's start with

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Speaker 1: how to have a life in the pandemic first. Yeah, So,

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Speaker 1: I think what we need, and what we're just starting

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Speaker 1: to see is public health guidelines that move beyond that

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Speaker 1: absolutest message of just stay home, stay six feet apart,

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Speaker 1: wash your hands, wear a mask, and instead of just

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Speaker 1: telling people here's the safest thing you can do, start

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Speaker 1: to tell people the next safest thing and the next

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Speaker 1: safest thing, so that they get a sense of a

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Speaker 1: spectrum of risk. There's a lot in between staying home

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Speaker 1: by yourself and with your household members and having a

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Speaker 1: crowded indoor dinner party. There's a lot of gray area.

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Speaker 1: Risk is not binary. It's not that we stay home

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Speaker 1: and we're safe, and then we walk out our front

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Speaker 1: door and we're infected. So once you give people a

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Speaker 1: sense of that spectrum of risk, then they can start

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Speaker 1: to think about where they can place themselves on that

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Speaker 1: spectrum of risk that will keep them as low risk

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Speaker 1: as possible, but allow them to live their lives in

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Speaker 1: a sustainable way. And if we don't do that, if

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Speaker 1: we go back to that abstinence only messaging example, let's

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Speaker 1: say we tell people just don't have sex. Inevitably, some

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Speaker 1: people will have sex, and if we don't give them

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Speaker 1: any information about how to reduce any potential harms if

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Speaker 1: they do have sex, then we've missed an opportunity as

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Speaker 1: a public health field. So we think if we think

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Speaker 1: about teenagers who go and have sex and haven't heard

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Speaker 1: anything about condoms or STIs or how to prevent pregnancy,

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Speaker 1: then we've missed an opportunity there. And that's why abstinence

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Speaker 1: only messaging is associated with worse health outcomes than safer

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Speaker 1: sex education, and so the same applies here. We need

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Speaker 1: to provide people with a sense of that spectrum of

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Speaker 1: risk so that they can make more informed decisions when

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Speaker 1: they inevitably, in some cases do take some risks. What

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Speaker 1: does advice along that spectrum of risk concretely look like,

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Speaker 1: Because there's more uncertainty here than there is, for example,

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Speaker 1: in the case of ten sex. I mean, we don't

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Speaker 1: necessarily understand fully all the mechanisms of transmission, So what

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Speaker 1: does the spectrum practically look like to you? So, on

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Speaker 1: a very simple level, and this is something that I

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Speaker 1: put together in an infographic a few weeks ago, we

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Speaker 1: can think about almost like a stop light sort of framework,

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Speaker 1: where on the green end of things, the lowest risk end,

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Speaker 1: you're at home, you're either alone or you're with your

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Speaker 1: household members. And then maybe slightly closer to the yellow

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Speaker 1: taking a little bit of risk but still fairly low risk,

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Speaker 1: is just being outdoors. We know that the risk of

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Speaker 1: transmission is lower outdoors than indoors, and you can think

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Speaker 1: of different activities you can do outdoors with other people

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Speaker 1: that are still fairly low risk, like going for a walk,

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Speaker 1: going for a bike ride with somebody. In those cases

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Speaker 1: you can still use other strategies like masks and social

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Speaker 1: distancing to keep risk as low as possible. And then

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Speaker 1: when we think about moving up a little bit toward

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Speaker 1: the full on yellow, maybe even slightly orange end of things,

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Speaker 1: would be having a group gathering outdoors where people are stationary,

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Speaker 1: like a picnic or like an outdoor barbecue, they're talking

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Speaker 1: face to face, the risk starts to go up again.

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Speaker 1: Masks and distancing will minimize risk in that setting as well.

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Speaker 1: And then finally on the red end of things, the

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Speaker 1: highest risk end would be a group gathering indoors in

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Speaker 1: an enclosed setting not well ventilated. And once we have

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Speaker 1: that spectrum of risk, people can start they can apply

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Speaker 1: that to their lives. So if the question is can

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Speaker 1: I see this other family, they can think about that

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Speaker 1: spectrum of risk and think, well, can I go on

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Speaker 1: a walk with them? Can I go on a bike

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Speaker 1: ride with them? Will that satisfy my need for social contact?

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Speaker 1: If it doesn't, okay, what's the next safest thing that

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Speaker 1: will satisfy my need? Is it having a picnic? And

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Speaker 1: then how can I minimize risk in that setting? Masks, distancing,

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Speaker 1: bringing your own food. There may be some other strategies

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Speaker 1: in terms of hand hygiene to keep risk as low

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Speaker 1: as possible. What about kids and play dates doesn't fit

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Speaker 1: so neatly into your continuum because it might just be

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Speaker 1: one kid going off to another family, but then your

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Speaker 1: child has been exposed potentially to that family's risk and

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Speaker 1: therefore comes home and potentially exposes your family. Right, So

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Speaker 1: kids are tricky always, and it'll depend someone on the

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Speaker 1: age of the kid and what the play date looks

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Speaker 1: like not every play date will be created equal in

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Speaker 1: terms of risk, and not every kid, depending on their age,

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Speaker 1: will understand the need for distancing. Some may. In our family,

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Speaker 1: we have a three year old and a six year old,

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Speaker 1: they've actually been surprisingly to adapt to this new norm

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Speaker 1: around distancing. We haven't really tried any play dates with

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Speaker 1: other families, but in cases where they feel like we're

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Speaker 1: getting too close to people, they will police us and say, Mama,

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Speaker 1: you're too close to this person that's less than six feet.

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Speaker 1: So I actually think it may be possible to have

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Speaker 1: a six year old get together with another six year

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Speaker 1: old in a way that's somewhat distant, like going on

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Speaker 1: a bike ride, kicking a soccer ball around in the park,

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Speaker 1: maybe playing ping pong. You know, there are some strategies

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Speaker 1: we could potentially try, And I think it is harder

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Speaker 1: with younger kids who don't understand that need for physical distancing.

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Speaker 1: And also it gets weird where you're hovering over your kids,

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Speaker 1: you're policing them, you're kind of stressing them out. The

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Speaker 1: whole thing just feels sort of pathological and weird. And

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Speaker 1: so is there another strategy. So one strategy that has

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Speaker 1: been recommended in other countries is social bubbles. Can we

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Speaker 1: think about ways to expand our social bubbles include one

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Speaker 1: other family, Let's say that has kids the same age

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Speaker 1: as ours or similar ages, and we just decide not

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Speaker 1: to do any physical distancing from each other, but to

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Speaker 1: keep doing it from other people and to keep that

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Speaker 1: risk communication open in case there is some leak in

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Speaker 1: the bubble and we need to take a break. But

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Speaker 1: this has actually been shown in a recent modeling study

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Speaker 1: to be a potentially very effective way to continue flattening

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Speaker 1: the curve while giving people some social contact that they

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Speaker 1: may need and hopefully helping them forego some of these

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Speaker 1: higher risk situations like going to bars, having crowded dinner parties.

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Speaker 1: That may be one strategy for play dates that's much

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Speaker 1: more realistic than trying to have a play date where

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Speaker 1: you're keeping kids physically apart. The bubble or pod strategy

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Speaker 1: does model really well because the models tend to assume

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Speaker 1: a high percentage of compliance. Now, you can always tweak

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Speaker 1: the models to reduce the compliance and then see what happens.

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Speaker 1: But these models are very respond to the number that

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Speaker 1: you put in because it is just a model for

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Speaker 1: how much people are complying, and the moment just a

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Speaker 1: few people aren't complying, it becomes harder to sustain this

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Speaker 1: kind of idea. So I'm wondering what your instinct is

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Speaker 1: about that. I mean, I know all the recommendations say,

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Speaker 1: will find another family whose values match your family. I mean,

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Speaker 1: the whole thing sounds sort of like you're trying to

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Speaker 1: marry the other family, and within some realistic bounds, you

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Speaker 1: could perhaps do that. But then you imagine your family

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Speaker 1: has a bunch of kids, another family has a bunch

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Speaker 1: of kids. People live in blended families today and complex

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Speaker 1: families where children move from one house to another house.

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Speaker 1: There are just so many different variables that, to my

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Speaker 1: mind at least, make it a little harder to say

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Speaker 1: with great confidence that we can be any perfectly locked

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Speaker 1: in bubble or pod. If you're perfectly locked in the

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Speaker 1: bubble or pod, then sure it doesn't it does not

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Speaker 1: a problem at all. Yeah, I mean, it does depend

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Speaker 1: on compliance. But I think the question is, what is

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Speaker 1: the comparison group here? If we're making a decision about

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Speaker 1: creating a pod with another household, what is the alt

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Speaker 1: tternative approach that we're considering. Is it going back to

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Speaker 1: business as usual and just saying I can't do this anymore.

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Speaker 1: In that case, trying to create a pod will be

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Speaker 1: a lower risk strategy. I think it's always important here

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Speaker 1: to be thinking about what the counterfactual is, what is

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Speaker 1: our alternative approach, and is this strategy potentially keeping us

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Speaker 1: from something that would be much higher risk. The Netherlands,

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Speaker 1: which has a history, at least a modern history of

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Speaker 1: being realistic about sex and drugs, was recommending, actually pretty

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Speaker 1: early in this process, that people should have what they

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Speaker 1: called a sex buddy. Their words funny how people take

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Speaker 1: English words and turn them into their own language, and

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Speaker 1: that that should be people's solution for having a sexual life,

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Speaker 1: not just a social life. More broadly, what's your reaction.

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Speaker 1: I think it's a fantastic harm reduction approach that's really

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Speaker 1: analogous to the social bubbles idea for households the pods.

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Speaker 1: It's basically like a sex pod, where the overall framework

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Speaker 1: is keep your contacts as minimal as possible. You want

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Speaker 1: a few contacts as possibles, both socially and sexually, and

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Speaker 1: the Netherlands had originally said don't have sex with anybody

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Speaker 1: outside of your household, and single people revolted and said

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Speaker 1: that's not fair. Sexual contact is a human need for

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Speaker 1: many of us. So the Netherlands said, okay, here's the

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Speaker 1: lowest risk way to have sexual contact, which is picking

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Speaker 1: one person and sticking with them as long as possible

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Speaker 1: and at least having just one partner at a time.

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Speaker 1: And it's a perfect example of how to approach this

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Speaker 1: with empathy and with the acceptance of the reality of

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Speaker 1: human needs. And I think that's the kind of messaging

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Speaker 1: that we need in the US. But I think the

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Speaker 1: US will be slow to adopt for fear that by

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Speaker 1: saying get a sex buddy, we are promoting risk taking

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Speaker 1: that we want people to actually avoid. Epidemiologists like you

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Speaker 1: wear two hats. One is a hat, which is a

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Speaker 1: normative hat. You know, you tell us what to do

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Speaker 1: to be safe doing that, and I'm grateful. The other

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Speaker 1: is a predictive hat, where you're trying to figure out

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Speaker 1: what the world is going to look like. So let

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Speaker 1: me ask you to put on their predictive hat. I'm

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Speaker 1: curious to know what you really in the real world.

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Speaker 1: I think this is all going to look like at

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Speaker 1: the end of the summer. That's a tough question. I

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Speaker 1: get a bit depressed when I think about what things

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Speaker 1: may look like. I feel like our government nationally has

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Speaker 1: given up, not even that it necessarily was ever trying

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Speaker 1: that hard to respond to this pandemic, but certainly is

400
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Speaker 1: no longer trying at all. I think some states have

401
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Speaker 1: also adopted that approach and have essentially given up, and

402
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Speaker 1: we're now seeing the early results of that, with some

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Speaker 1: very stark increases and cases and hospitalizations, and I think

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Speaker 1: it's very hard to imagine going back to another lockdown

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Speaker 1: in those areas. I think people will not accept it.

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Speaker 1: Even if the state were to try to adopt it,

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Speaker 1: I don't think people will accept it. And so I

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Speaker 1: don't know how this is going to play out, but

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Speaker 1: I think it's not going to be pretty, and it's

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Speaker 1: I find it, actually, as a citizen, kind of heartbreaking.

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Speaker 1: Just to follow the line of that scenario, Let's imagine

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Speaker 1: that in a state like Arizona, the number of cases

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Speaker 1: goes up, the state wants to respond by pushing for

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Speaker 1: greater social distancing or even a lockdown, and the public

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Speaker 1: just won't comply. We get a kind of spontaneous adoption

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Speaker 1: by the public of the idea that we're going for

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Speaker 1: her community. I mean, that is something where the government

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Speaker 1: could in theory, really massively cracked down, But it's very

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Speaker 1: unlikely that would happen given the structure of our democracy.

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Speaker 1: If enough people don't want to comply, we probably won't

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Speaker 1: get compliance. Then we'd have some places in the United

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Speaker 1: States that we're actually adopting a everyone should get it strategy.

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Speaker 1: Other places are very unlikely to go down that road.

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Speaker 1: Does that seem inherently bad to you? You know, in

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Speaker 1: constitutional law, which is what I do is my day job,

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Speaker 1: we sometimes talk about the states as quote laboratories of democracy,

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Speaker 1: which is meant as a metaphor. In this instance, it's

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Speaker 1: not really even a metaphor. I mean, we're talking about

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Speaker 1: the possibility that different states will actually genuinely try completely

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Speaker 1: different things, and if there's a certain degree of isolation

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Speaker 1: between them, maybe we'll just find out which one works better,

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Speaker 1: works better for people's health, works better for the economy.

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Speaker 1: Does that seem to you completely crazy? Well, the very

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Speaker 1: states that are likely to go down the route you

435
00:24:35,876 --> 00:24:42,036
Speaker 1: just described of refusing to comply with any future lockdown

436
00:24:42,156 --> 00:24:47,756
Speaker 1: measures and just seeing what happens. Those are the states

437
00:24:48,076 --> 00:24:53,596
Speaker 1: where we are likely to see the greatest inequities in

438
00:24:53,876 --> 00:24:58,036
Speaker 1: how this pandemic plays out if we think about states

439
00:24:58,036 --> 00:25:02,676
Speaker 1: in the South, in particular, where racial inequities and health,

440
00:25:02,756 --> 00:25:06,716
Speaker 1: for example, are already stark, where the people who are

441
00:25:06,756 --> 00:25:09,396
Speaker 1: most likely to still be working. I mean this true

442
00:25:09,396 --> 00:25:11,756
Speaker 1: across the US. The people who are most likely to

443
00:25:11,796 --> 00:25:15,276
Speaker 1: still be working and be exposed to the virus are

444
00:25:15,596 --> 00:25:19,316
Speaker 1: people of color and people who are poor and need

445
00:25:19,356 --> 00:25:22,756
Speaker 1: to be at work. So I would guess that the

446
00:25:22,796 --> 00:25:26,076
Speaker 1: way that this natural experiment would play out would have

447
00:25:26,156 --> 00:25:32,636
Speaker 1: some really unjust inequities in terms of who is impacted

448
00:25:33,036 --> 00:25:35,596
Speaker 1: by the pandemic in ways that we've already seen, but

449
00:25:35,636 --> 00:25:38,876
Speaker 1: I think will become exacerbated if we take a herd

450
00:25:38,876 --> 00:25:41,916
Speaker 1: immunity approach. I mean, as you just as you said,

451
00:25:41,956 --> 00:25:44,796
Speaker 1: we're already seeing that you're already three times more likely

452
00:25:44,836 --> 00:25:48,716
Speaker 1: to die of COVID nineteen if you're African American. And indeed,

453
00:25:48,756 --> 00:25:49,796
Speaker 1: I mean one of the things I was going to

454
00:25:49,836 --> 00:25:53,876
Speaker 1: say about the spectrum of risk and the experiments with pods,

455
00:25:53,916 --> 00:25:59,076
Speaker 1: all of it assumes a kind of model of what's

456
00:25:59,116 --> 00:26:01,396
Speaker 1: the ideal thing. The ideal thing is the two parent

457
00:26:01,516 --> 00:26:06,036
Speaker 1: family in its picket white fenced home, you know, maybe

458
00:26:06,076 --> 00:26:09,436
Speaker 1: potting with another similar family, the idea being that everyone

459
00:26:09,436 --> 00:26:13,076
Speaker 1: can afford not to be exposed for financial reasons. And

460
00:26:13,116 --> 00:26:14,836
Speaker 1: then you know, if well, if she has somebody is

461
00:26:14,876 --> 00:26:17,316
Speaker 1: single then and they're looking for some human or sexual contact,

462
00:26:17,316 --> 00:26:19,836
Speaker 1: and you say, wow, monogamy at least would be the

463
00:26:19,876 --> 00:26:22,316
Speaker 1: next best step. You know, the whole thing follows a

464
00:26:22,396 --> 00:26:26,796
Speaker 1: kind of continuum towards the more more more normative picture

465
00:26:26,916 --> 00:26:30,036
Speaker 1: of what we imagine upper middle class or middle class

466
00:26:30,036 --> 00:26:32,396
Speaker 1: at least left to look like. So, I mean, what

467
00:26:32,436 --> 00:26:34,716
Speaker 1: you're saying is true. I don't dispute it at all.

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00:26:35,076 --> 00:26:39,156
Speaker 1: But aren't don't we already see that those models are

469
00:26:39,236 --> 00:26:42,836
Speaker 1: kind of dead ends. Yes, I think it's a great

470
00:26:42,916 --> 00:26:48,396
Speaker 1: point that the assumption that somebody can comfortably pod with

471
00:26:48,476 --> 00:26:53,476
Speaker 1: another family or have a sex buddy and make these

472
00:26:53,516 --> 00:26:59,236
Speaker 1: calculated choices around risk, it's based in an assumption that

473
00:26:59,596 --> 00:27:01,876
Speaker 1: somebody has some level of privilege to be able to

474
00:27:01,876 --> 00:27:06,556
Speaker 1: do that. And it's abundantly clearer that in general, social

475
00:27:06,596 --> 00:27:11,116
Speaker 1: distancing and calculated choices around risk are very much a

476
00:27:11,156 --> 00:27:15,316
Speaker 1: privilege that are not afforded to people who have to

477
00:27:15,356 --> 00:27:17,916
Speaker 1: return to work. Because the government has not supported them

478
00:27:18,036 --> 00:27:21,716
Speaker 1: enough to allow them to stay home, and people who

479
00:27:21,756 --> 00:27:25,356
Speaker 1: live in very crowded housing who can't necessarily distance and

480
00:27:25,396 --> 00:27:29,436
Speaker 1: then make these controlled decisions around which families they are

481
00:27:29,476 --> 00:27:31,796
Speaker 1: going to pod with. So I think it's a great

482
00:27:31,796 --> 00:27:35,556
Speaker 1: point that needs to be acknowledged. I still think the

483
00:27:35,596 --> 00:27:40,196
Speaker 1: public deserves some understanding of a spectrum of risk, and

484
00:27:40,276 --> 00:27:44,276
Speaker 1: that everyone can benefit to some extent from learning more

485
00:27:44,436 --> 00:27:48,916
Speaker 1: about their risk that goes beyond my risk is zero

486
00:27:48,916 --> 00:27:50,636
Speaker 1: if I'm in my house, and my risk is one

487
00:27:50,756 --> 00:27:52,596
Speaker 1: if I walk out my front door, which I think

488
00:27:52,636 --> 00:27:56,356
Speaker 1: has led to a lot of confusion around where risk

489
00:27:56,476 --> 00:27:59,996
Speaker 1: really lies and has prevented people from making the most

490
00:28:00,036 --> 00:28:04,036
Speaker 1: informed decisions about their everyday lives and the choices that

491
00:28:04,076 --> 00:28:07,596
Speaker 1: they've already been making for the last several months. Where

492
00:28:07,636 --> 00:28:10,996
Speaker 1: can listeners see your infographic with a spectrum of risk?

493
00:28:11,916 --> 00:28:14,436
Speaker 1: It is posted on Twitter and it has also been

494
00:28:14,476 --> 00:28:17,356
Speaker 1: adapted by Vox. They put out a much more professional

495
00:28:17,396 --> 00:28:22,236
Speaker 1: looking version, so I would encourage people to search for that. Julia,

496
00:28:22,396 --> 00:28:26,636
Speaker 1: thank you so much for this analysis. It's really insightful,

497
00:28:27,276 --> 00:28:29,076
Speaker 1: very powerful, and I think I and a lot of

498
00:28:29,076 --> 00:28:31,676
Speaker 1: other people will think about it very very carefully in

499
00:28:31,716 --> 00:28:34,156
Speaker 1: the weeks and months ahead. Thanks so much for having

500
00:28:34,236 --> 00:28:43,036
Speaker 1: this is a great conversation. Listening to doctor Julia Marcus,

501
00:28:43,436 --> 00:28:46,516
Speaker 1: I was deeply struck by a truth that seems to

502
00:28:46,556 --> 00:28:50,236
Speaker 1: me pretty profound that she was getting at. Human beings

503
00:28:50,276 --> 00:28:56,036
Speaker 1: have needs. Social life is indeed one of those fundamental

504
00:28:56,196 --> 00:28:58,716
Speaker 1: human needs. To be social is part of what makes

505
00:28:58,796 --> 00:29:02,916
Speaker 1: us human. And so says doctor Marcus, we need to

506
00:29:03,116 --> 00:29:07,076
Speaker 1: have a life in the pandemic, and what we need

507
00:29:07,116 --> 00:29:10,596
Speaker 1: to do then is to evaluate risk against the backdrop

508
00:29:10,676 --> 00:29:13,836
Speaker 1: of the reality that we still have an imperative to

509
00:29:13,916 --> 00:29:17,996
Speaker 1: have a life. Making that determination of how to have

510
00:29:18,076 --> 00:29:20,476
Speaker 1: a life in the pandemic will be at the level

511
00:29:20,516 --> 00:29:22,956
Speaker 1: of the individual and of the family. We need to

512
00:29:23,036 --> 00:29:24,996
Speaker 1: keep in mind that it's a decision that will always

513
00:29:24,996 --> 00:29:27,356
Speaker 1: be made against the backdrop of what privilege we may

514
00:29:27,396 --> 00:29:30,636
Speaker 1: in fact have. No matter who you are, though, you

515
00:29:30,716 --> 00:29:34,876
Speaker 1: still have to undergo some analysis of what the relative

516
00:29:34,956 --> 00:29:38,436
Speaker 1: risks are that you can and are willing to take.

517
00:29:39,396 --> 00:29:42,036
Speaker 1: And I, for one, believe we can do that better

518
00:29:42,396 --> 00:29:45,356
Speaker 1: in the presence of knowledge and understanding than we could

519
00:29:45,596 --> 00:29:48,236
Speaker 1: without it. Until the next time I speak to you,

520
00:29:48,876 --> 00:29:54,076
Speaker 1: be careful, be safe, and be well. Deep background is

521
00:29:54,116 --> 00:29:57,196
Speaker 1: brought to you by Pushkin Industries. Our producer is Lydia

522
00:29:57,276 --> 00:30:01,036
Speaker 1: Jane Cott, with mastering by Jason Gambrell and Martin Gonzalez.

523
00:30:01,356 --> 00:30:04,876
Speaker 1: Our showrunner is Sophia mckibbon. Our theme music is composed

524
00:30:04,876 --> 00:30:08,756
Speaker 1: by Luis GERA special thanks to the Pushkin Brass, Malcolm Gladwell,

525
00:30:08,876 --> 00:30:13,556
Speaker 1: Jake of Weisberg, and Mia Lobel. I'm Noah Feldman. I

526
00:30:13,676 --> 00:30:16,436
Speaker 1: also write a regular column for Bloomberg Opinion, which you

527
00:30:16,476 --> 00:30:20,556
Speaker 1: can find at bloomberg dot com slash Feldman. To discover

528
00:30:20,676 --> 00:30:24,436
Speaker 1: Bloomberg's original slate of podcasts, go to Bloomberg dot com

529
00:30:24,436 --> 00:30:28,676
Speaker 1: slash Podcasts. And one last thing. I just wrote a

530
00:30:28,676 --> 00:30:32,156
Speaker 1: book called The Arab Winter Patrogedy. I would be delighted

531
00:30:32,156 --> 00:30:34,996
Speaker 1: if you checked it out. If you liked what you

532
00:30:35,116 --> 00:30:38,196
Speaker 1: heard today, please write a review or tell a friend.

533
00:30:38,796 --> 00:30:40,476
Speaker 1: You can always let me know what you think on Twitter.

534
00:30:40,876 --> 00:30:45,196
Speaker 1: My handle is Noah R. Feldman. This is deep background