WEBVTT - How to Have a Life in the Pandemic 0:00:15.396 --> 0:00:22.036 Pushkin from Pushkin Industries. This is Deep Background, the show 0:00:22.076 --> 0:00:25.436 where we explore the stories behind the stories in the news. 0:00:26.036 --> 0:00:30.756 I'm Noah Feldman. The official start of summer is this Saturday. 0:00:31.556 --> 0:00:35.516 But what kind of summer will this be? Will we 0:00:35.796 --> 0:00:38.996 and our families be able to interact with others? Can 0:00:39.036 --> 0:00:43.556 we have a backdoor barbecue under social distancing? Can we 0:00:43.596 --> 0:00:47.756 go to a public pool? Can we go anywhere? What 0:00:47.836 --> 0:00:51.076 are the range of risks that it's rational to undertake 0:00:51.396 --> 0:00:54.636 in the middle of a pandemic. Here to help us 0:00:54.796 --> 0:00:58.636 work through these questions is doctor Julia Marcus. She's an 0:00:58.676 --> 0:01:02.796 infectious disease epidemiologist and an assistant professor at the Harvard 0:01:02.836 --> 0:01:06.876 Medical School in the Department of Population Medicine. She has 0:01:06.876 --> 0:01:11.116 been a forthright, clear, analytic voice trying to explain in 0:01:11.196 --> 0:01:13.996 practice what we can and cannot do and what our 0:01:14.076 --> 0:01:18.236 risks look like, specifically from the perspective of an expert 0:01:18.316 --> 0:01:21.996 who spends most of her non pandemic time thinking about 0:01:22.076 --> 0:01:27.036 public health and its relationship to HIV AIDS. For doctor Marcus, 0:01:27.076 --> 0:01:30.316 the central question we need to confront is how can 0:01:30.356 --> 0:01:33.676 you have a life in the pandemic? Julia, thank you 0:01:33.836 --> 0:01:37.836 very much for joining me. The crucial issue that I'm 0:01:37.876 --> 0:01:39.996 focused on, and I don't think I'm unique in this regard, 0:01:40.236 --> 0:01:43.356 is the fact that school is ending such as it was, 0:01:44.316 --> 0:01:47.156 and there is going to be tremendous pressure on all 0:01:47.196 --> 0:01:49.716 of us to come up with a game plan for 0:01:49.836 --> 0:01:53.756 the summer, including a game plan where our children are 0:01:53.836 --> 0:01:57.796 not in house lockdown for the entire summer. So I 0:01:57.876 --> 0:02:01.036 want to start by just asking you for your headlines 0:02:01.276 --> 0:02:04.796 about what we should be trying to do rationally going 0:02:04.836 --> 0:02:09.196 forward with our kids. Maybe I'll start by just tacking 0:02:09.236 --> 0:02:12.156 about the way that I'm thinking about this overall and 0:02:12.196 --> 0:02:15.876 what I've been writing about. So back in early May, 0:02:16.076 --> 0:02:20.876 I started thinking about how we were framing our public 0:02:20.876 --> 0:02:23.596 health messaging. And for the first few months in March 0:02:23.636 --> 0:02:27.836 in April, our public health messaging was really absolutist because 0:02:27.836 --> 0:02:31.316 it needed to be. It was just stay home only, 0:02:31.596 --> 0:02:34.156 go out for essential activities like going to the grocery 0:02:34.156 --> 0:02:36.996 store or the pharmacy, and other than that, stay home. 0:02:37.556 --> 0:02:40.956 And during that time a couple things happened. One is 0:02:41.516 --> 0:02:45.876 that our understanding of viral transmission evolved, so we started 0:02:45.876 --> 0:02:48.596 to learn more about places that were higher risk for 0:02:48.636 --> 0:02:52.116 transmission and places that were lower risk, and we also 0:02:52.636 --> 0:02:54.476 realized that we're going to be doing this for a 0:02:54.516 --> 0:02:57.476 lot longer than we had hoped. If you think back 0:02:57.516 --> 0:03:00.116 to early March, I think we all really hoped this 0:03:00.196 --> 0:03:01.796 was going to be like a couple weeks and then 0:03:01.796 --> 0:03:05.116 we'll go back to our lives, and that's not at 0:03:05.156 --> 0:03:08.756 all how things played out. And now we're starting to 0:03:08.796 --> 0:03:11.516 think about how we can adapt to live with this 0:03:11.636 --> 0:03:14.796 virus for a very long time, months, maybe even years, 0:03:14.836 --> 0:03:17.356 until we have an effective vaccine that can be scaled up. 0:03:18.036 --> 0:03:20.876 So now the question is how can we live our 0:03:20.916 --> 0:03:24.396 lives in a way that's sustainable while still keeping the 0:03:24.516 --> 0:03:28.596 risk of transmission low. And so what I proposed was 0:03:28.916 --> 0:03:32.596 rather than this abstinence only messaging which says have no 0:03:32.716 --> 0:03:36.676 social contact unless it's absolutely essential, just abstain. You know, 0:03:36.716 --> 0:03:39.076 we know that that's not going to be sustainable for 0:03:39.156 --> 0:03:41.556 everyone for the long term. So what if we approach 0:03:41.636 --> 0:03:45.196 this from a harm reduction perspective where we accept that 0:03:45.276 --> 0:03:48.836 some risks need to happen for various reasons, often for 0:03:48.876 --> 0:03:52.516 reasons that are out of people's control, and give people 0:03:52.636 --> 0:03:55.716 the guidance they need to be as safe as possible 0:03:55.756 --> 0:03:57.996 when they do take those risks, and we can think 0:03:58.036 --> 0:04:01.556 about how this approach has been used successfully in other 0:04:01.596 --> 0:04:05.076 areas of public health, like safer sex education is a 0:04:05.156 --> 0:04:07.156 key one and one that's close to my heart as 0:04:07.196 --> 0:04:11.356 an HIV researcher. Actually a harm reduction was developed for 0:04:11.676 --> 0:04:16.076 and also with collaboration with people who use drugs. That's 0:04:16.156 --> 0:04:20.076 kind of the core approach to reducing the potential harms 0:04:20.076 --> 0:04:23.876 of substance use. So now I think that that's how 0:04:23.916 --> 0:04:27.036 we should be thinking when we think about, you know, 0:04:27.076 --> 0:04:28.596 what are we going to do this summer? How are 0:04:28.596 --> 0:04:33.196 we going to keep our kids stimulated and happy and 0:04:33.556 --> 0:04:36.276 as parents stay sane. I think we need to think 0:04:36.316 --> 0:04:40.316 from this approach of sustainability while trying to keep our 0:04:40.436 --> 0:04:43.956 risk and others risk low. That I think is an 0:04:43.996 --> 0:04:46.916 incredibly helpful set of frameworks, and if you don't mind, 0:04:46.956 --> 0:04:48.636 I'd like to dig into each of them a little 0:04:48.676 --> 0:04:52.196 bit before we get to the concrete recommendations. One is 0:04:52.556 --> 0:04:54.876 this idea that we need to be able to sustain 0:04:54.956 --> 0:04:59.196 this for a longish period of time, and there I'm 0:04:59.196 --> 0:05:02.036 struck that there seems to be one major unknown, and 0:05:02.116 --> 0:05:05.116 that is the question of are we going to reach 0:05:05.156 --> 0:05:08.036 a point where we more or less at a measured pace, 0:05:08.476 --> 0:05:11.396 all to get or sixty or seventy percent of us 0:05:11.756 --> 0:05:16.156 have to actually be exposed to stars Cove two. If 0:05:16.236 --> 0:05:20.676 we thought that the two vaccines that are nearing human 0:05:20.716 --> 0:05:24.756 testing had a reasonable shot of succeeding, and we thought 0:05:24.836 --> 0:05:27.236 that maybe a year from now we would be in 0:05:27.236 --> 0:05:29.916 a position to actually have enough dosis of that vaccine 0:05:30.076 --> 0:05:32.036 to reach many people in the United States and perhaps 0:05:32.076 --> 0:05:35.996 in the world, then I can sort of imagine saying 0:05:36.196 --> 0:05:37.996 we should really still be on a plan where our 0:05:37.996 --> 0:05:40.236 goal is for us and our children and our family 0:05:40.236 --> 0:05:44.436 members just never to get exposure to this virus at all. 0:05:45.436 --> 0:05:48.996 But if the probabilities of those vaccines succeeding are lower 0:05:49.636 --> 0:05:54.756 than some enthusiastic people say, then it really seems crazy 0:05:55.556 --> 0:05:59.756 to attempt a kind of long term goal of just 0:05:59.876 --> 0:06:03.436 not getting this because then, you know, the best epidemiological 0:06:03.436 --> 0:06:06.156 studies that I've read suggest what we just have to 0:06:06.196 --> 0:06:08.836 do is accept trying not to break the hospitals, but 0:06:09.196 --> 0:06:11.276 have to basically all accept that we're going to get 0:06:11.276 --> 0:06:14.156 the virus over time. So how much is the background 0:06:14.156 --> 0:06:17.076 likelihood that a vaccine might work and be available in 0:06:17.116 --> 0:06:20.796 the next year affecting your calculus. I kind of go 0:06:20.836 --> 0:06:23.276 back and forth between the two things you just said. 0:06:23.476 --> 0:06:27.076 One is, let me just try as hard as I 0:06:27.116 --> 0:06:30.596 can to keep my family from getting this virus, and 0:06:30.796 --> 0:06:34.236 let's see what we can do to keep our risk 0:06:34.276 --> 0:06:36.516 as low as possible and the risk of our loved 0:06:36.516 --> 0:06:38.836 ones for an extended period of time, and the hopes 0:06:38.916 --> 0:06:41.636 that not only will there be an effective vaccine in 0:06:41.676 --> 0:06:45.356 the next let's say year, but also better treatment. There 0:06:45.396 --> 0:06:50.196 are ways that the landscape could change that would mean 0:06:50.236 --> 0:06:52.036 that it would be better to get this virus later 0:06:52.396 --> 0:06:54.956 rather than earlier. And then there are times when I 0:06:54.956 --> 0:06:57.556 feel sort of fatalistic, and I feel like, if three 0:06:57.636 --> 0:06:59.916 quarters of us need to get this eventually, why are 0:06:59.956 --> 0:07:02.636 we as a family, I don't mean as a country, 0:07:02.796 --> 0:07:06.156 but why is my family trying so hard to keep 0:07:06.156 --> 0:07:09.636 our risk low? But what you're talking about, I want 0:07:09.676 --> 0:07:13.636 to make a distinction between individual decision making around risk 0:07:13.796 --> 0:07:18.676 and what informs decision making versus what we, as a 0:07:18.916 --> 0:07:23.276 national public health body should be doing to approach this. 0:07:23.316 --> 0:07:27.116 And I don't support an approach from a national perspective 0:07:27.516 --> 0:07:29.956 of just saying, you know what, three quarters of us 0:07:30.036 --> 0:07:33.316 have to get this anyway, let's just reopen and let 0:07:33.356 --> 0:07:36.236 that happen. And that's the herd immunity approach, which I 0:07:36.276 --> 0:07:40.756 think has been roundly criticized in general by public health 0:07:40.836 --> 0:07:46.196 experts for leading to unnecessary and egregious amount of death 0:07:46.436 --> 0:07:49.836 and also being just an unethical approach to a public 0:07:49.876 --> 0:07:53.516 health strategy. I want to also go back to a 0:07:53.596 --> 0:07:57.116 point you kind of mentioned in passing about not breaking 0:07:57.156 --> 0:08:01.956 our hospitals. That's a very important point to be considering. 0:08:01.996 --> 0:08:05.276 And when we look at places that have reopened on 0:08:05.356 --> 0:08:09.156 the earlier end and are now approaching an emerge and 0:08:09.476 --> 0:08:14.156 situation already just a few weeks later, that really calls 0:08:14.156 --> 0:08:17.756 into question of what would happen if we just said, 0:08:18.516 --> 0:08:20.756 you know, what we're doing is not sustainable. We're all 0:08:20.756 --> 0:08:23.996 going to get this anyway, let's just reopen. I think 0:08:24.076 --> 0:08:28.356 we have to have an intelligent approach to life right 0:08:28.356 --> 0:08:31.716 now that doesn't look like business as usual simply because 0:08:31.716 --> 0:08:33.916 we will break our healthcare system if we do go 0:08:33.956 --> 0:08:37.156 back to business as usual. For other reasons as well, 0:08:37.196 --> 0:08:39.036 but that one, I think is a crucial one that 0:08:39.076 --> 0:08:42.636 we have to acknowledge. The other part of your framework 0:08:42.636 --> 0:08:44.916 that I really want to ask you about is the 0:08:44.956 --> 0:08:46.716 part that has to do with what you do every 0:08:46.796 --> 0:08:50.476 day when there isn't a COVID nineteen epidemic going on, 0:08:50.796 --> 0:08:56.116 and that is HIV prevention. And you gave two analogies 0:08:56.276 --> 0:08:59.756 sex and drugs to the question of sustainability and prevention. 0:09:00.116 --> 0:09:04.276 Those are really important cases and in certain respects different cases, 0:09:04.316 --> 0:09:07.236 but they both raise this issue of sustainability. How much 0:09:07.276 --> 0:09:08.996 can the human being, with a human being is now 0:09:09.156 --> 0:09:13.596 full desires and drives, actually go forth in an extreme 0:09:13.676 --> 0:09:16.756 absinate state of play. So would you say a little 0:09:16.756 --> 0:09:19.596 bit more about the philosophy according to which at some 0:09:19.716 --> 0:09:21.756 point we have to say, well, you know, some people 0:09:21.756 --> 0:09:23.236 are going to have sex, and some of that sex 0:09:23.356 --> 0:09:24.836 is going to be risky and we have to be 0:09:24.876 --> 0:09:26.836 realistic about that, and some of the that some people 0:09:27.356 --> 0:09:30.796 are going to have drug dependencies and are going to 0:09:30.876 --> 0:09:32.996 take drugs whether we like it or not, because we 0:09:32.996 --> 0:09:37.276 don't have perfect solutions to those problems. Yeah, the analogy 0:09:37.276 --> 0:09:39.996 that I made was thinking back to the early days 0:09:40.036 --> 0:09:42.356 of AIDS, when we didn't have a name for HIV. 0:09:42.476 --> 0:09:44.956 We knew there was this scary virus that was killing 0:09:44.996 --> 0:09:49.156 gay men, and the public health advice that gay men 0:09:49.156 --> 0:09:52.476 were getting was to just stop having sex that obviously 0:09:52.596 --> 0:09:55.636 was not going to be a sustainable approach for everyone 0:09:55.996 --> 0:09:59.116 or possibly anyone. So what gay men did as a 0:09:59.156 --> 0:10:03.196 community was several gay men came together with a physician 0:10:03.436 --> 0:10:06.796 expert and they came up with a guide to having 0:10:06.796 --> 0:10:10.116 sex in an epidemic. That was really the first kind 0:10:10.116 --> 0:10:17.196 of foundational safer sex approach to HIV. And that's essentially 0:10:17.196 --> 0:10:21.396 what we need to be doing right now is acknowledging 0:10:21.436 --> 0:10:25.236 that we cannot abstain from social contact indefinitely. It's just 0:10:25.396 --> 0:10:29.236 not possible. So the next best thing is figuring out 0:10:29.316 --> 0:10:32.916 the equivalent of safer sex for COVID, which is well, 0:10:32.956 --> 0:10:35.076 in some cases, it actually is about sexual contact. How 0:10:35.076 --> 0:10:38.516 can we help people have safer sexual contact, but more broadly, 0:10:38.556 --> 0:10:42.236 how can we help people have safer social contact that 0:10:42.356 --> 0:10:46.596 gives them enough to fulfill their human needs such that 0:10:46.636 --> 0:10:49.316 they can actually forego some of the really high risk 0:10:49.356 --> 0:10:52.156 things we want to avoid, like let's say a crowded 0:10:52.156 --> 0:10:56.036 dinner party. So if you give someone guidance around lower 0:10:56.156 --> 0:10:59.636 risk social contact, can you actually help them avoid those 0:10:59.716 --> 0:11:03.556 high risk situations that could become super spreader events? And 0:11:03.716 --> 0:11:06.116 if you can, then that's a public health win. But 0:11:06.196 --> 0:11:08.396 I think there are a lot of reasons why this 0:11:08.436 --> 0:11:12.156 country is is hesitant to take that HERM reduction approach 0:11:12.236 --> 0:11:14.876 and tends to be more absolutist in its public health 0:11:14.916 --> 0:11:17.716 messaging and just tell people here's the safest thing you 0:11:17.756 --> 0:11:21.156 can do, which is to stay home. There's something really 0:11:21.196 --> 0:11:25.636 profound about what you're saying to me, namely that human 0:11:25.676 --> 0:11:28.756 beings have a basic instinct to sociality. We have a 0:11:28.796 --> 0:11:32.476 basic need to be social. We are social beings in 0:11:32.516 --> 0:11:36.316 the same way that we need other forms of human contact. 0:11:37.116 --> 0:11:38.996 So if that's the case, I think what I hear 0:11:38.996 --> 0:11:42.756 you saying is that we need a model. Just like 0:11:43.076 --> 0:11:45.556 people at the beginning of the HIV AIDS crisis came 0:11:45.636 --> 0:11:47.716 up with a guide to sex in the pandemic, we 0:11:47.796 --> 0:11:52.116 need to start building a guide to socializing in the pandemic. 0:11:52.316 --> 0:11:54.156 Am I reading you right? Is that in fact analogy 0:11:54.196 --> 0:11:58.156 that you're offering. Yeah? Absolutely, that is exactly what I 0:11:58.196 --> 0:12:00.596 think we need. Is kind of the corollary to that 0:12:00.716 --> 0:12:02.916 manual on how to have sex in an epidemic. We 0:12:02.956 --> 0:12:05.236 need a manual on how to have a life in 0:12:05.316 --> 0:12:17.956 a pandemic. We'll be back in a moment. I'm gonna 0:12:18.036 --> 0:12:20.996 start by asking you to begin to fill in some 0:12:21.076 --> 0:12:23.236 of the elements of your model of how we can 0:12:23.316 --> 0:12:26.076 have a life in the pandemic. Eventually, I'm going to 0:12:26.116 --> 0:12:27.996 ask you about some of the details about including how 0:12:27.996 --> 0:12:29.596 to have sex in the pandemic, but let's start with 0:12:29.636 --> 0:12:32.676 how to have a life in the pandemic first. Yeah, So, 0:12:32.716 --> 0:12:35.996 I think what we need, and what we're just starting 0:12:35.996 --> 0:12:40.836 to see is public health guidelines that move beyond that 0:12:40.956 --> 0:12:45.516 absolutest message of just stay home, stay six feet apart, 0:12:45.596 --> 0:12:49.596 wash your hands, wear a mask, and instead of just 0:12:49.676 --> 0:12:53.036 telling people here's the safest thing you can do, start 0:12:53.076 --> 0:12:55.916 to tell people the next safest thing and the next 0:12:55.956 --> 0:12:58.236 safest thing, so that they get a sense of a 0:12:58.356 --> 0:13:01.956 spectrum of risk. There's a lot in between staying home 0:13:02.036 --> 0:13:05.436 by yourself and with your household members and having a 0:13:05.436 --> 0:13:08.956 crowded indoor dinner party. There's a lot of gray area. 0:13:09.356 --> 0:13:12.076 Risk is not binary. It's not that we stay home 0:13:12.076 --> 0:13:13.996 and we're safe, and then we walk out our front 0:13:13.996 --> 0:13:18.396 door and we're infected. So once you give people a 0:13:18.476 --> 0:13:21.836 sense of that spectrum of risk, then they can start 0:13:21.836 --> 0:13:24.636 to think about where they can place themselves on that 0:13:24.676 --> 0:13:27.116 spectrum of risk that will keep them as low risk 0:13:27.156 --> 0:13:29.556 as possible, but allow them to live their lives in 0:13:29.556 --> 0:13:32.676 a sustainable way. And if we don't do that, if 0:13:32.676 --> 0:13:37.356 we go back to that abstinence only messaging example, let's 0:13:37.356 --> 0:13:40.436 say we tell people just don't have sex. Inevitably, some 0:13:40.476 --> 0:13:42.836 people will have sex, and if we don't give them 0:13:42.956 --> 0:13:47.076 any information about how to reduce any potential harms if 0:13:47.116 --> 0:13:50.196 they do have sex, then we've missed an opportunity as 0:13:50.236 --> 0:13:52.836 a public health field. So we think if we think 0:13:52.836 --> 0:13:55.876 about teenagers who go and have sex and haven't heard 0:13:55.916 --> 0:13:58.996 anything about condoms or STIs or how to prevent pregnancy, 0:13:59.076 --> 0:14:02.996 then we've missed an opportunity there. And that's why abstinence 0:14:03.036 --> 0:14:07.036 only messaging is associated with worse health outcomes than safer 0:14:07.116 --> 0:14:10.516 sex education, and so the same applies here. We need 0:14:10.556 --> 0:14:12.676 to provide people with a sense of that spectrum of 0:14:12.796 --> 0:14:15.596 risk so that they can make more informed decisions when 0:14:15.636 --> 0:14:18.996 they inevitably, in some cases do take some risks. What 0:14:19.076 --> 0:14:22.396 does advice along that spectrum of risk concretely look like, 0:14:22.836 --> 0:14:25.476 Because there's more uncertainty here than there is, for example, 0:14:25.876 --> 0:14:28.196 in the case of ten sex. I mean, we don't 0:14:28.276 --> 0:14:32.476 necessarily understand fully all the mechanisms of transmission, So what 0:14:32.516 --> 0:14:35.116 does the spectrum practically look like to you? So, on 0:14:35.236 --> 0:14:38.156 a very simple level, and this is something that I 0:14:38.236 --> 0:14:41.316 put together in an infographic a few weeks ago, we 0:14:41.356 --> 0:14:45.316 can think about almost like a stop light sort of framework, 0:14:45.436 --> 0:14:48.756 where on the green end of things, the lowest risk end, 0:14:48.756 --> 0:14:51.596 you're at home, you're either alone or you're with your 0:14:51.596 --> 0:14:56.876 household members. And then maybe slightly closer to the yellow 0:14:57.236 --> 0:14:59.996 taking a little bit of risk but still fairly low risk, 0:15:00.116 --> 0:15:02.476 is just being outdoors. We know that the risk of 0:15:02.516 --> 0:15:06.316 transmission is lower outdoors than indoors, and you can think 0:15:06.316 --> 0:15:09.036 of different activities you can do outdoors with other people 0:15:09.316 --> 0:15:12.036 that are still fairly low risk, like going for a walk, 0:15:12.516 --> 0:15:15.476 going for a bike ride with somebody. In those cases 0:15:15.476 --> 0:15:19.356 you can still use other strategies like masks and social 0:15:19.396 --> 0:15:22.276 distancing to keep risk as low as possible. And then 0:15:22.316 --> 0:15:25.356 when we think about moving up a little bit toward 0:15:25.556 --> 0:15:29.316 the full on yellow, maybe even slightly orange end of things, 0:15:29.556 --> 0:15:32.836 would be having a group gathering outdoors where people are stationary, 0:15:32.956 --> 0:15:36.036 like a picnic or like an outdoor barbecue, they're talking 0:15:36.076 --> 0:15:39.236 face to face, the risk starts to go up again. 0:15:39.316 --> 0:15:42.556 Masks and distancing will minimize risk in that setting as well. 0:15:42.636 --> 0:15:45.276 And then finally on the red end of things, the 0:15:45.356 --> 0:15:48.396 highest risk end would be a group gathering indoors in 0:15:48.476 --> 0:15:53.556 an enclosed setting not well ventilated. And once we have 0:15:53.636 --> 0:15:56.316 that spectrum of risk, people can start they can apply 0:15:56.396 --> 0:15:59.236 that to their lives. So if the question is can 0:15:59.316 --> 0:16:02.036 I see this other family, they can think about that 0:16:02.076 --> 0:16:04.196 spectrum of risk and think, well, can I go on 0:16:04.236 --> 0:16:06.276 a walk with them? Can I go on a bike 0:16:06.356 --> 0:16:09.076 ride with them? Will that satisfy my need for social contact? 0:16:09.236 --> 0:16:12.236 If it doesn't, okay, what's the next safest thing that 0:16:12.276 --> 0:16:15.196 will satisfy my need? Is it having a picnic? And 0:16:15.236 --> 0:16:18.636 then how can I minimize risk in that setting? Masks, distancing, 0:16:19.116 --> 0:16:21.556 bringing your own food. There may be some other strategies 0:16:21.556 --> 0:16:24.436 in terms of hand hygiene to keep risk as low 0:16:24.476 --> 0:16:29.356 as possible. What about kids and play dates doesn't fit 0:16:29.436 --> 0:16:32.676 so neatly into your continuum because it might just be 0:16:32.876 --> 0:16:35.836 one kid going off to another family, but then your 0:16:35.916 --> 0:16:38.996 child has been exposed potentially to that family's risk and 0:16:39.116 --> 0:16:43.556 therefore comes home and potentially exposes your family. Right, So 0:16:43.676 --> 0:16:48.756 kids are tricky always, and it'll depend someone on the 0:16:48.876 --> 0:16:52.316 age of the kid and what the play date looks 0:16:52.356 --> 0:16:55.916 like not every play date will be created equal in 0:16:56.036 --> 0:16:59.956 terms of risk, and not every kid, depending on their age, 0:16:59.956 --> 0:17:04.036 will understand the need for distancing. Some may. In our family, 0:17:04.036 --> 0:17:05.836 we have a three year old and a six year old, 0:17:06.276 --> 0:17:11.756 they've actually been surprisingly to adapt to this new norm 0:17:11.756 --> 0:17:15.276 around distancing. We haven't really tried any play dates with 0:17:15.276 --> 0:17:18.076 other families, but in cases where they feel like we're 0:17:18.156 --> 0:17:21.356 getting too close to people, they will police us and say, Mama, 0:17:21.436 --> 0:17:23.876 you're too close to this person that's less than six feet. 0:17:24.516 --> 0:17:28.236 So I actually think it may be possible to have 0:17:28.396 --> 0:17:30.436 a six year old get together with another six year 0:17:30.476 --> 0:17:34.036 old in a way that's somewhat distant, like going on 0:17:34.076 --> 0:17:36.716 a bike ride, kicking a soccer ball around in the park, 0:17:37.116 --> 0:17:40.076 maybe playing ping pong. You know, there are some strategies 0:17:40.116 --> 0:17:43.676 we could potentially try, And I think it is harder 0:17:43.836 --> 0:17:47.516 with younger kids who don't understand that need for physical distancing. 0:17:47.516 --> 0:17:51.236 And also it gets weird where you're hovering over your kids, 0:17:51.356 --> 0:17:54.196 you're policing them, you're kind of stressing them out. The 0:17:54.236 --> 0:17:57.676 whole thing just feels sort of pathological and weird. And 0:17:57.756 --> 0:18:01.076 so is there another strategy. So one strategy that has 0:18:01.116 --> 0:18:05.316 been recommended in other countries is social bubbles. Can we 0:18:05.356 --> 0:18:09.796 think about ways to expand our social bubbles include one 0:18:09.836 --> 0:18:12.996 other family, Let's say that has kids the same age 0:18:13.036 --> 0:18:17.516 as ours or similar ages, and we just decide not 0:18:17.556 --> 0:18:20.236 to do any physical distancing from each other, but to 0:18:20.316 --> 0:18:22.796 keep doing it from other people and to keep that 0:18:22.916 --> 0:18:25.356 risk communication open in case there is some leak in 0:18:25.396 --> 0:18:27.476 the bubble and we need to take a break. But 0:18:27.596 --> 0:18:30.236 this has actually been shown in a recent modeling study 0:18:30.356 --> 0:18:35.116 to be a potentially very effective way to continue flattening 0:18:35.116 --> 0:18:38.836 the curve while giving people some social contact that they 0:18:38.836 --> 0:18:41.596 may need and hopefully helping them forego some of these 0:18:41.676 --> 0:18:46.516 higher risk situations like going to bars, having crowded dinner parties. 0:18:46.956 --> 0:18:49.836 That may be one strategy for play dates that's much 0:18:49.876 --> 0:18:52.596 more realistic than trying to have a play date where 0:18:52.596 --> 0:18:57.396 you're keeping kids physically apart. The bubble or pod strategy 0:18:57.916 --> 0:19:01.476 does model really well because the models tend to assume 0:19:01.636 --> 0:19:04.756 a high percentage of compliance. Now, you can always tweak 0:19:04.796 --> 0:19:07.476 the models to reduce the compliance and then see what happens. 0:19:07.476 --> 0:19:10.596 But these models are very respond to the number that 0:19:10.636 --> 0:19:12.916 you put in because it is just a model for 0:19:12.956 --> 0:19:15.476 how much people are complying, and the moment just a 0:19:15.516 --> 0:19:19.396 few people aren't complying, it becomes harder to sustain this 0:19:19.556 --> 0:19:21.916 kind of idea. So I'm wondering what your instinct is 0:19:21.916 --> 0:19:23.636 about that. I mean, I know all the recommendations say, 0:19:23.676 --> 0:19:26.676 will find another family whose values match your family. I mean, 0:19:26.716 --> 0:19:28.116 the whole thing sounds sort of like you're trying to 0:19:28.116 --> 0:19:32.076 marry the other family, and within some realistic bounds, you 0:19:32.076 --> 0:19:33.996 could perhaps do that. But then you imagine your family 0:19:33.996 --> 0:19:35.476 has a bunch of kids, another family has a bunch 0:19:35.516 --> 0:19:38.036 of kids. People live in blended families today and complex 0:19:38.076 --> 0:19:40.236 families where children move from one house to another house. 0:19:40.556 --> 0:19:44.196 There are just so many different variables that, to my 0:19:44.276 --> 0:19:47.316 mind at least, make it a little harder to say 0:19:47.316 --> 0:19:50.116 with great confidence that we can be any perfectly locked 0:19:50.116 --> 0:19:53.356 in bubble or pod. If you're perfectly locked in the 0:19:53.356 --> 0:19:55.796 bubble or pod, then sure it doesn't it does not 0:19:55.796 --> 0:19:58.916 a problem at all. Yeah, I mean, it does depend 0:19:58.956 --> 0:20:01.796 on compliance. But I think the question is, what is 0:20:01.876 --> 0:20:05.636 the comparison group here? If we're making a decision about 0:20:05.756 --> 0:20:08.996 creating a pod with another household, what is the alt 0:20:09.116 --> 0:20:11.596 tternative approach that we're considering. Is it going back to 0:20:11.636 --> 0:20:14.196 business as usual and just saying I can't do this anymore. 0:20:14.836 --> 0:20:17.836 In that case, trying to create a pod will be 0:20:17.956 --> 0:20:21.356 a lower risk strategy. I think it's always important here 0:20:21.436 --> 0:20:24.516 to be thinking about what the counterfactual is, what is 0:20:24.516 --> 0:20:29.196 our alternative approach, and is this strategy potentially keeping us 0:20:29.196 --> 0:20:32.716 from something that would be much higher risk. The Netherlands, 0:20:32.716 --> 0:20:35.076 which has a history, at least a modern history of 0:20:35.196 --> 0:20:39.956 being realistic about sex and drugs, was recommending, actually pretty 0:20:39.956 --> 0:20:42.636 early in this process, that people should have what they 0:20:42.716 --> 0:20:46.356 called a sex buddy. Their words funny how people take 0:20:46.396 --> 0:20:48.676 English words and turn them into their own language, and 0:20:48.716 --> 0:20:51.956 that that should be people's solution for having a sexual life, 0:20:51.996 --> 0:20:55.036 not just a social life. More broadly, what's your reaction. 0:20:55.596 --> 0:20:58.756 I think it's a fantastic harm reduction approach that's really 0:20:58.796 --> 0:21:03.356 analogous to the social bubbles idea for households the pods. 0:21:03.836 --> 0:21:08.156 It's basically like a sex pod, where the overall framework 0:21:08.276 --> 0:21:11.516 is keep your contacts as minimal as possible. You want 0:21:11.516 --> 0:21:15.316 a few contacts as possibles, both socially and sexually, and 0:21:15.876 --> 0:21:18.556 the Netherlands had originally said don't have sex with anybody 0:21:18.556 --> 0:21:21.956 outside of your household, and single people revolted and said 0:21:21.996 --> 0:21:26.116 that's not fair. Sexual contact is a human need for 0:21:26.156 --> 0:21:29.036 many of us. So the Netherlands said, okay, here's the 0:21:29.076 --> 0:21:32.116 lowest risk way to have sexual contact, which is picking 0:21:32.156 --> 0:21:35.036 one person and sticking with them as long as possible 0:21:35.076 --> 0:21:37.316 and at least having just one partner at a time. 0:21:37.996 --> 0:21:41.116 And it's a perfect example of how to approach this 0:21:41.196 --> 0:21:45.236 with empathy and with the acceptance of the reality of 0:21:45.356 --> 0:21:48.156 human needs. And I think that's the kind of messaging 0:21:48.196 --> 0:21:50.756 that we need in the US. But I think the 0:21:50.836 --> 0:21:53.756 US will be slow to adopt for fear that by 0:21:53.996 --> 0:21:58.596 saying get a sex buddy, we are promoting risk taking 0:21:58.836 --> 0:22:02.516 that we want people to actually avoid. Epidemiologists like you 0:22:02.676 --> 0:22:06.236 wear two hats. One is a hat, which is a 0:22:06.316 --> 0:22:08.196 normative hat. You know, you tell us what to do 0:22:08.236 --> 0:22:10.996 to be safe doing that, and I'm grateful. The other 0:22:11.116 --> 0:22:13.236 is a predictive hat, where you're trying to figure out 0:22:13.236 --> 0:22:14.756 what the world is going to look like. So let 0:22:14.796 --> 0:22:16.996 me ask you to put on their predictive hat. I'm 0:22:17.036 --> 0:22:19.516 curious to know what you really in the real world. 0:22:19.876 --> 0:22:22.116 I think this is all going to look like at 0:22:22.156 --> 0:22:25.596 the end of the summer. That's a tough question. I 0:22:25.676 --> 0:22:28.356 get a bit depressed when I think about what things 0:22:28.516 --> 0:22:33.756 may look like. I feel like our government nationally has 0:22:34.316 --> 0:22:37.876 given up, not even that it necessarily was ever trying 0:22:37.956 --> 0:22:42.436 that hard to respond to this pandemic, but certainly is 0:22:42.476 --> 0:22:46.436 no longer trying at all. I think some states have 0:22:46.596 --> 0:22:50.676