Speaker 1: Pushkin from Pushkin Industries. This is Deep Background, the show
Speaker 1: where we explore the stories behind the stories in the news.
Speaker 1: I'm Noah Feldman. The official start of summer is this Saturday.
Speaker 1: But what kind of summer will this be? Will we
Speaker 1: and our families be able to interact with others? Can
Speaker 1: we have a backdoor barbecue under social distancing? Can we
Speaker 1: go to a public pool? Can we go anywhere? What
Speaker 1: are the range of risks that it's rational to undertake
Speaker 1: in the middle of a pandemic. Here to help us
Speaker 1: work through these questions is doctor Julia Marcus. She's an
Speaker 1: infectious disease epidemiologist and an assistant professor at the Harvard
Speaker 1: Medical School in the Department of Population Medicine. She has
Speaker 1: been a forthright, clear, analytic voice trying to explain in
Speaker 1: practice what we can and cannot do and what our
Speaker 1: risks look like, specifically from the perspective of an expert
Speaker 1: who spends most of her non pandemic time thinking about
Speaker 1: public health and its relationship to HIV AIDS. For doctor Marcus,
Speaker 1: the central question we need to confront is how can
Speaker 1: you have a life in the pandemic? Julia, thank you
Speaker 1: very much for joining me. The crucial issue that I'm
Speaker 1: focused on, and I don't think I'm unique in this regard,
Speaker 1: is the fact that school is ending such as it was,
Speaker 1: and there is going to be tremendous pressure on all
Speaker 1: of us to come up with a game plan for
Speaker 1: the summer, including a game plan where our children are
Speaker 1: not in house lockdown for the entire summer. So I
Speaker 1: want to start by just asking you for your headlines
Speaker 1: about what we should be trying to do rationally going
Speaker 1: forward with our kids. Maybe I'll start by just tacking
Speaker 1: about the way that I'm thinking about this overall and
Speaker 1: what I've been writing about. So back in early May,
Speaker 1: I started thinking about how we were framing our public
Speaker 1: health messaging. And for the first few months in March
Speaker 1: in April, our public health messaging was really absolutist because
Speaker 1: it needed to be. It was just stay home only,
Speaker 1: go out for essential activities like going to the grocery
Speaker 1: store or the pharmacy, and other than that, stay home.
Speaker 1: And during that time a couple things happened. One is
Speaker 1: that our understanding of viral transmission evolved, so we started
Speaker 1: to learn more about places that were higher risk for
Speaker 1: transmission and places that were lower risk, and we also
Speaker 1: realized that we're going to be doing this for a
Speaker 1: lot longer than we had hoped. If you think back
Speaker 1: to early March, I think we all really hoped this
Speaker 1: was going to be like a couple weeks and then
Speaker 1: we'll go back to our lives, and that's not at
Speaker 1: all how things played out. And now we're starting to
Speaker 1: think about how we can adapt to live with this
Speaker 1: virus for a very long time, months, maybe even years,
Speaker 1: until we have an effective vaccine that can be scaled up.
Speaker 1: So now the question is how can we live our
Speaker 1: lives in a way that's sustainable while still keeping the
Speaker 1: risk of transmission low. And so what I proposed was
Speaker 1: rather than this abstinence only messaging which says have no
Speaker 1: social contact unless it's absolutely essential, just abstain. You know,
Speaker 1: we know that that's not going to be sustainable for
Speaker 1: everyone for the long term. So what if we approach
Speaker 1: this from a harm reduction perspective where we accept that
Speaker 1: some risks need to happen for various reasons, often for
Speaker 1: reasons that are out of people's control, and give people
Speaker 1: the guidance they need to be as safe as possible
Speaker 1: when they do take those risks, and we can think
Speaker 1: about how this approach has been used successfully in other
Speaker 1: areas of public health, like safer sex education is a
Speaker 1: key one and one that's close to my heart as
Speaker 1: an HIV researcher. Actually a harm reduction was developed for
Speaker 1: and also with collaboration with people who use drugs. That's
Speaker 1: kind of the core approach to reducing the potential harms
Speaker 1: of substance use. So now I think that that's how
Speaker 1: we should be thinking when we think about, you know,
Speaker 1: what are we going to do this summer? How are
Speaker 1: we going to keep our kids stimulated and happy and
Speaker 1: as parents stay sane. I think we need to think
Speaker 1: from this approach of sustainability while trying to keep our
Speaker 1: risk and others risk low. That I think is an
Speaker 1: incredibly helpful set of frameworks, and if you don't mind,
Speaker 1: I'd like to dig into each of them a little
Speaker 1: bit before we get to the concrete recommendations. One is
Speaker 1: this idea that we need to be able to sustain
Speaker 1: this for a longish period of time, and there I'm
Speaker 1: struck that there seems to be one major unknown, and
Speaker 1: that is the question of are we going to reach
Speaker 1: a point where we more or less at a measured pace,
Speaker 1: all to get or sixty or seventy percent of us
Speaker 1: have to actually be exposed to stars Cove two. If
Speaker 1: we thought that the two vaccines that are nearing human
Speaker 1: testing had a reasonable shot of succeeding, and we thought
Speaker 1: that maybe a year from now we would be in
Speaker 1: a position to actually have enough dosis of that vaccine
Speaker 1: to reach many people in the United States and perhaps
Speaker 1: in the world, then I can sort of imagine saying
Speaker 1: we should really still be on a plan where our
Speaker 1: goal is for us and our children and our family
Speaker 1: members just never to get exposure to this virus at all.
Speaker 1: But if the probabilities of those vaccines succeeding are lower
Speaker 1: than some enthusiastic people say, then it really seems crazy
Speaker 1: to attempt a kind of long term goal of just
Speaker 1: not getting this because then, you know, the best epidemiological
Speaker 1: studies that I've read suggest what we just have to
Speaker 1: do is accept trying not to break the hospitals, but
Speaker 1: have to basically all accept that we're going to get
Speaker 1: the virus over time. So how much is the background
Speaker 1: likelihood that a vaccine might work and be available in
Speaker 1: the next year affecting your calculus. I kind of go
Speaker 1: back and forth between the two things you just said.
Speaker 1: One is, let me just try as hard as I
Speaker 1: can to keep my family from getting this virus, and
Speaker 1: let's see what we can do to keep our risk
Speaker 1: as low as possible and the risk of our loved
Speaker 1: ones for an extended period of time, and the hopes
Speaker 1: that not only will there be an effective vaccine in
Speaker 1: the next let's say year, but also better treatment. There
Speaker 1: are ways that the landscape could change that would mean
Speaker 1: that it would be better to get this virus later
Speaker 1: rather than earlier. And then there are times when I
Speaker 1: feel sort of fatalistic, and I feel like, if three
Speaker 1: quarters of us need to get this eventually, why are
Speaker 1: we as a family, I don't mean as a country,
Speaker 1: but why is my family trying so hard to keep
Speaker 1: our risk low? But what you're talking about, I want
Speaker 1: to make a distinction between individual decision making around risk
Speaker 1: and what informs decision making versus what we, as a
Speaker 1: national public health body should be doing to approach this.
Speaker 1: And I don't support an approach from a national perspective
Speaker 1: of just saying, you know what, three quarters of us
Speaker 1: have to get this anyway, let's just reopen and let
Speaker 1: that happen. And that's the herd immunity approach, which I
Speaker 1: think has been roundly criticized in general by public health
Speaker 1: experts for leading to unnecessary and egregious amount of death
Speaker 1: and also being just an unethical approach to a public
Speaker 1: health strategy. I want to also go back to a
Speaker 1: point you kind of mentioned in passing about not breaking
Speaker 1: our hospitals. That's a very important point to be considering.
Speaker 1: And when we look at places that have reopened on
Speaker 1: the earlier end and are now approaching an emerge and
Speaker 1: situation already just a few weeks later, that really calls
Speaker 1: into question of what would happen if we just said,
Speaker 1: you know, what we're doing is not sustainable. We're all
Speaker 1: going to get this anyway, let's just reopen. I think
Speaker 1: we have to have an intelligent approach to life right
Speaker 1: now that doesn't look like business as usual simply because
Speaker 1: we will break our healthcare system if we do go
Speaker 1: back to business as usual. For other reasons as well,
Speaker 1: but that one, I think is a crucial one that
Speaker 1: we have to acknowledge. The other part of your framework
Speaker 1: that I really want to ask you about is the
Speaker 1: part that has to do with what you do every
Speaker 1: day when there isn't a COVID nineteen epidemic going on,
Speaker 1: and that is HIV prevention. And you gave two analogies
Speaker 1: sex and drugs to the question of sustainability and prevention.
Speaker 1: Those are really important cases and in certain respects different cases,
Speaker 1: but they both raise this issue of sustainability. How much
Speaker 1: can the human being, with a human being is now
Speaker 1: full desires and drives, actually go forth in an extreme
Speaker 1: absinate state of play. So would you say a little
Speaker 1: bit more about the philosophy according to which at some
Speaker 1: point we have to say, well, you know, some people
Speaker 1: are going to have sex, and some of that sex
Speaker 1: is going to be risky and we have to be
Speaker 1: realistic about that, and some of the that some people
Speaker 1: are going to have drug dependencies and are going to
Speaker 1: take drugs whether we like it or not, because we
Speaker 1: don't have perfect solutions to those problems. Yeah, the analogy
Speaker 1: that I made was thinking back to the early days
Speaker 1: of AIDS, when we didn't have a name for HIV.
Speaker 1: We knew there was this scary virus that was killing
Speaker 1: gay men, and the public health advice that gay men
Speaker 1: were getting was to just stop having sex that obviously
Speaker 1: was not going to be a sustainable approach for everyone
Speaker 1: or possibly anyone. So what gay men did as a
Speaker 1: community was several gay men came together with a physician
Speaker 1: expert and they came up with a guide to having
Speaker 1: sex in an epidemic. That was really the first kind
Speaker 1: of foundational safer sex approach to HIV. And that's essentially
Speaker 1: what we need to be doing right now is acknowledging
Speaker 1: that we cannot abstain from social contact indefinitely. It's just
Speaker 1: not possible. So the next best thing is figuring out
Speaker 1: the equivalent of safer sex for COVID, which is well,
Speaker 1: in some cases, it actually is about sexual contact. How
Speaker 1: can we help people have safer sexual contact, but more broadly,
Speaker 1: how can we help people have safer social contact that
Speaker 1: gives them enough to fulfill their human needs such that
Speaker 1: they can actually forego some of the really high risk
Speaker 1: things we want to avoid, like let's say a crowded
Speaker 1: dinner party. So if you give someone guidance around lower
Speaker 1: risk social contact, can you actually help them avoid those
Speaker 1: high risk situations that could become super spreader events? And
Speaker 1: if you can, then that's a public health win. But
Speaker 1: I think there are a lot of reasons why this
Speaker 1: country is is hesitant to take that HERM reduction approach
Speaker 1: and tends to be more absolutist in its public health
Speaker 1: messaging and just tell people here's the safest thing you
Speaker 1: can do, which is to stay home. There's something really
Speaker 1: profound about what you're saying to me, namely that human
Speaker 1: beings have a basic instinct to sociality. We have a
Speaker 1: basic need to be social. We are social beings in
Speaker 1: the same way that we need other forms of human contact.
Speaker 1: So if that's the case, I think what I hear
Speaker 1: you saying is that we need a model. Just like
Speaker 1: people at the beginning of the HIV AIDS crisis came
Speaker 1: up with a guide to sex in the pandemic, we
Speaker 1: need to start building a guide to socializing in the pandemic.
Speaker 1: Am I reading you right? Is that in fact analogy
Speaker 1: that you're offering. Yeah? Absolutely, that is exactly what I
Speaker 1: think we need. Is kind of the corollary to that
Speaker 1: manual on how to have sex in an epidemic. We
Speaker 1: need a manual on how to have a life in
Speaker 1: a pandemic. We'll be back in a moment. I'm gonna
Speaker 1: start by asking you to begin to fill in some
Speaker 1: of the elements of your model of how we can
Speaker 1: have a life in the pandemic. Eventually, I'm going to
Speaker 1: ask you about some of the details about including how
Speaker 1: to have sex in the pandemic, but let's start with
Speaker 1: how to have a life in the pandemic first. Yeah, So,
Speaker 1: I think what we need, and what we're just starting
Speaker 1: to see is public health guidelines that move beyond that
Speaker 1: absolutest message of just stay home, stay six feet apart,
Speaker 1: wash your hands, wear a mask, and instead of just
Speaker 1: telling people here's the safest thing you can do, start
Speaker 1: to tell people the next safest thing and the next
Speaker 1: safest thing, so that they get a sense of a
Speaker 1: spectrum of risk. There's a lot in between staying home
Speaker 1: by yourself and with your household members and having a
Speaker 1: crowded indoor dinner party. There's a lot of gray area.
Speaker 1: Risk is not binary. It's not that we stay home
Speaker 1: and we're safe, and then we walk out our front
Speaker 1: door and we're infected. So once you give people a
Speaker 1: sense of that spectrum of risk, then they can start
Speaker 1: to think about where they can place themselves on that
Speaker 1: spectrum of risk that will keep them as low risk
Speaker 1: as possible, but allow them to live their lives in
Speaker 1: a sustainable way. And if we don't do that, if
Speaker 1: we go back to that abstinence only messaging example, let's
Speaker 1: say we tell people just don't have sex. Inevitably, some
Speaker 1: people will have sex, and if we don't give them
Speaker 1: any information about how to reduce any potential harms if
Speaker 1: they do have sex, then we've missed an opportunity as
Speaker 1: a public health field. So we think if we think
Speaker 1: about teenagers who go and have sex and haven't heard
Speaker 1: anything about condoms or STIs or how to prevent pregnancy,
Speaker 1: then we've missed an opportunity there. And that's why abstinence
Speaker 1: only messaging is associated with worse health outcomes than safer
Speaker 1: sex education, and so the same applies here. We need
Speaker 1: to provide people with a sense of that spectrum of
Speaker 1: risk so that they can make more informed decisions when
Speaker 1: they inevitably, in some cases do take some risks. What
Speaker 1: does advice along that spectrum of risk concretely look like,
Speaker 1: Because there's more uncertainty here than there is, for example,
Speaker 1: in the case of ten sex. I mean, we don't
Speaker 1: necessarily understand fully all the mechanisms of transmission, So what
Speaker 1: does the spectrum practically look like to you? So, on
Speaker 1: a very simple level, and this is something that I
Speaker 1: put together in an infographic a few weeks ago, we
Speaker 1: can think about almost like a stop light sort of framework,
Speaker 1: where on the green end of things, the lowest risk end,
Speaker 1: you're at home, you're either alone or you're with your
Speaker 1: household members. And then maybe slightly closer to the yellow
Speaker 1: taking a little bit of risk but still fairly low risk,
Speaker 1: is just being outdoors. We know that the risk of
Speaker 1: transmission is lower outdoors than indoors, and you can think
Speaker 1: of different activities you can do outdoors with other people
Speaker 1: that are still fairly low risk, like going for a walk,
Speaker 1: going for a bike ride with somebody. In those cases
Speaker 1: you can still use other strategies like masks and social
Speaker 1: distancing to keep risk as low as possible. And then
Speaker 1: when we think about moving up a little bit toward
Speaker 1: the full on yellow, maybe even slightly orange end of things,
Speaker 1: would be having a group gathering outdoors where people are stationary,
Speaker 1: like a picnic or like an outdoor barbecue, they're talking
Speaker 1: face to face, the risk starts to go up again.
Speaker 1: Masks and distancing will minimize risk in that setting as well.
Speaker 1: And then finally on the red end of things, the
Speaker 1: highest risk end would be a group gathering indoors in
Speaker 1: an enclosed setting not well ventilated. And once we have
Speaker 1: that spectrum of risk, people can start they can apply
Speaker 1: that to their lives. So if the question is can
Speaker 1: I see this other family, they can think about that
Speaker 1: spectrum of risk and think, well, can I go on
Speaker 1: a walk with them? Can I go on a bike
Speaker 1: ride with them? Will that satisfy my need for social contact?
Speaker 1: If it doesn't, okay, what's the next safest thing that
Speaker 1: will satisfy my need? Is it having a picnic? And
Speaker 1: then how can I minimize risk in that setting? Masks, distancing,
Speaker 1: bringing your own food. There may be some other strategies
Speaker 1: in terms of hand hygiene to keep risk as low
Speaker 1: as possible. What about kids and play dates doesn't fit
Speaker 1: so neatly into your continuum because it might just be
Speaker 1: one kid going off to another family, but then your
Speaker 1: child has been exposed potentially to that family's risk and
Speaker 1: therefore comes home and potentially exposes your family. Right, So
Speaker 1: kids are tricky always, and it'll depend someone on the
Speaker 1: age of the kid and what the play date looks
Speaker 1: like not every play date will be created equal in
Speaker 1: terms of risk, and not every kid, depending on their age,
Speaker 1: will understand the need for distancing. Some may. In our family,
Speaker 1: we have a three year old and a six year old,
Speaker 1: they've actually been surprisingly to adapt to this new norm
Speaker 1: around distancing. We haven't really tried any play dates with
Speaker 1: other families, but in cases where they feel like we're
Speaker 1: getting too close to people, they will police us and say, Mama,
Speaker 1: you're too close to this person that's less than six feet.
Speaker 1: So I actually think it may be possible to have
Speaker 1: a six year old get together with another six year
Speaker 1: old in a way that's somewhat distant, like going on
Speaker 1: a bike ride, kicking a soccer ball around in the park,
Speaker 1: maybe playing ping pong. You know, there are some strategies
Speaker 1: we could potentially try, And I think it is harder
Speaker 1: with younger kids who don't understand that need for physical distancing.
Speaker 1: And also it gets weird where you're hovering over your kids,
Speaker 1: you're policing them, you're kind of stressing them out. The
Speaker 1: whole thing just feels sort of pathological and weird. And
Speaker 1: so is there another strategy. So one strategy that has
Speaker 1: been recommended in other countries is social bubbles. Can we
Speaker 1: think about ways to expand our social bubbles include one
Speaker 1: other family, Let's say that has kids the same age
Speaker 1: as ours or similar ages, and we just decide not
Speaker 1: to do any physical distancing from each other, but to
Speaker 1: keep doing it from other people and to keep that
Speaker 1: risk communication open in case there is some leak in
Speaker 1: the bubble and we need to take a break. But
Speaker 1: this has actually been shown in a recent modeling study
Speaker 1: to be a potentially very effective way to continue flattening
Speaker 1: the curve while giving people some social contact that they
Speaker 1: may need and hopefully helping them forego some of these
Speaker 1: higher risk situations like going to bars, having crowded dinner parties.
Speaker 1: That may be one strategy for play dates that's much
Speaker 1: more realistic than trying to have a play date where
Speaker 1: you're keeping kids physically apart. The bubble or pod strategy
Speaker 1: does model really well because the models tend to assume
Speaker 1: a high percentage of compliance. Now, you can always tweak
Speaker 1: the models to reduce the compliance and then see what happens.
Speaker 1: But these models are very respond to the number that
Speaker 1: you put in because it is just a model for
Speaker 1: how much people are complying, and the moment just a
Speaker 1: few people aren't complying, it becomes harder to sustain this
Speaker 1: kind of idea. So I'm wondering what your instinct is
Speaker 1: about that. I mean, I know all the recommendations say,
Speaker 1: will find another family whose values match your family. I mean,
Speaker 1: the whole thing sounds sort of like you're trying to
Speaker 1: marry the other family, and within some realistic bounds, you
Speaker 1: could perhaps do that. But then you imagine your family
Speaker 1: has a bunch of kids, another family has a bunch
Speaker 1: of kids. People live in blended families today and complex
Speaker 1: families where children move from one house to another house.
Speaker 1: There are just so many different variables that, to my
Speaker 1: mind at least, make it a little harder to say
Speaker 1: with great confidence that we can be any perfectly locked
Speaker 1: in bubble or pod. If you're perfectly locked in the
Speaker 1: bubble or pod, then sure it doesn't it does not
Speaker 1: a problem at all. Yeah, I mean, it does depend
Speaker 1: on compliance. But I think the question is, what is
Speaker 1: the comparison group here? If we're making a decision about
Speaker 1: creating a pod with another household, what is the alt
Speaker 1: tternative approach that we're considering. Is it going back to
Speaker 1: business as usual and just saying I can't do this anymore.
Speaker 1: In that case, trying to create a pod will be
Speaker 1: a lower risk strategy. I think it's always important here
Speaker 1: to be thinking about what the counterfactual is, what is
Speaker 1: our alternative approach, and is this strategy potentially keeping us
Speaker 1: from something that would be much higher risk. The Netherlands,
Speaker 1: which has a history, at least a modern history of
Speaker 1: being realistic about sex and drugs, was recommending, actually pretty
Speaker 1: early in this process, that people should have what they
Speaker 1: called a sex buddy. Their words funny how people take
Speaker 1: English words and turn them into their own language, and
Speaker 1: that that should be people's solution for having a sexual life,
Speaker 1: not just a social life. More broadly, what's your reaction.
Speaker 1: I think it's a fantastic harm reduction approach that's really
Speaker 1: analogous to the social bubbles idea for households the pods.
Speaker 1: It's basically like a sex pod, where the overall framework
Speaker 1: is keep your contacts as minimal as possible. You want
Speaker 1: a few contacts as possibles, both socially and sexually, and
Speaker 1: the Netherlands had originally said don't have sex with anybody
Speaker 1: outside of your household, and single people revolted and said
Speaker 1: that's not fair. Sexual contact is a human need for
Speaker 1: many of us. So the Netherlands said, okay, here's the
Speaker 1: lowest risk way to have sexual contact, which is picking
Speaker 1: one person and sticking with them as long as possible
Speaker 1: and at least having just one partner at a time.
Speaker 1: And it's a perfect example of how to approach this
Speaker 1: with empathy and with the acceptance of the reality of
Speaker 1: human needs. And I think that's the kind of messaging
Speaker 1: that we need in the US. But I think the
Speaker 1: US will be slow to adopt for fear that by
Speaker 1: saying get a sex buddy, we are promoting risk taking
Speaker 1: that we want people to actually avoid. Epidemiologists like you
Speaker 1: wear two hats. One is a hat, which is a
Speaker 1: normative hat. You know, you tell us what to do
Speaker 1: to be safe doing that, and I'm grateful. The other
Speaker 1: is a predictive hat, where you're trying to figure out
Speaker 1: what the world is going to look like. So let
Speaker 1: me ask you to put on their predictive hat. I'm
Speaker 1: curious to know what you really in the real world.
Speaker 1: I think this is all going to look like at
Speaker 1: the end of the summer. That's a tough question. I
Speaker 1: get a bit depressed when I think about what things
Speaker 1: may look like. I feel like our government nationally has
Speaker 1: given up, not even that it necessarily was ever trying
Speaker 1: that hard to respond to this pandemic, but certainly is
Speaker 1: no longer trying at all. I think some states have
Speaker 1: also adopted that approach and have essentially given up, and
Speaker 1: we're now seeing the early results of that, with some
Speaker 1: very stark increases and cases and hospitalizations, and I think
Speaker 1: it's very hard to imagine going back to another lockdown
Speaker 1: in those areas. I think people will not accept it.
Speaker 1: Even if the state were to try to adopt it,
Speaker 1: I don't think people will accept it. And so I
Speaker 1: don't know how this is going to play out, but
Speaker 1: I think it's not going to be pretty, and it's
Speaker 1: I find it, actually, as a citizen, kind of heartbreaking.
Speaker 1: Just to follow the line of that scenario, Let's imagine
Speaker 1: that in a state like Arizona, the number of cases
Speaker 1: goes up, the state wants to respond by pushing for
Speaker 1: greater social distancing or even a lockdown, and the public
Speaker 1: just won't comply. We get a kind of spontaneous adoption
Speaker 1: by the public of the idea that we're going for
Speaker 1: her community. I mean, that is something where the government
Speaker 1: could in theory, really massively cracked down, But it's very
Speaker 1: unlikely that would happen given the structure of our democracy.
Speaker 1: If enough people don't want to comply, we probably won't
Speaker 1: get compliance. Then we'd have some places in the United
Speaker 1: States that we're actually adopting a everyone should get it strategy.
Speaker 1: Other places are very unlikely to go down that road.
Speaker 1: Does that seem inherently bad to you? You know, in
Speaker 1: constitutional law, which is what I do is my day job,
Speaker 1: we sometimes talk about the states as quote laboratories of democracy,
Speaker 1: which is meant as a metaphor. In this instance, it's
Speaker 1: not really even a metaphor. I mean, we're talking about
Speaker 1: the possibility that different states will actually genuinely try completely
Speaker 1: different things, and if there's a certain degree of isolation
Speaker 1: between them, maybe we'll just find out which one works better,
Speaker 1: works better for people's health, works better for the economy.
Speaker 1: Does that seem to you completely crazy? Well, the very
Speaker 1: states that are likely to go down the route you
Speaker 1: just described of refusing to comply with any future lockdown
Speaker 1: measures and just seeing what happens. Those are the states
Speaker 1: where we are likely to see the greatest inequities in
Speaker 1: how this pandemic plays out if we think about states
Speaker 1: in the South, in particular, where racial inequities and health,
Speaker 1: for example, are already stark, where the people who are
Speaker 1: most likely to still be working. I mean this true
Speaker 1: across the US. The people who are most likely to
Speaker 1: still be working and be exposed to the virus are
Speaker 1: people of color and people who are poor and need
Speaker 1: to be at work. So I would guess that the
Speaker 1: way that this natural experiment would play out would have
Speaker 1: some really unjust inequities in terms of who is impacted
Speaker 1: by the pandemic in ways that we've already seen, but
Speaker 1: I think will become exacerbated if we take a herd
Speaker 1: immunity approach. I mean, as you just as you said,
Speaker 1: we're already seeing that you're already three times more likely
Speaker 1: to die of COVID nineteen if you're African American. And indeed,
Speaker 1: I mean one of the things I was going to
Speaker 1: say about the spectrum of risk and the experiments with pods,
Speaker 1: all of it assumes a kind of model of what's
Speaker 1: the ideal thing. The ideal thing is the two parent
Speaker 1: family in its picket white fenced home, you know, maybe
Speaker 1: potting with another similar family, the idea being that everyone
Speaker 1: can afford not to be exposed for financial reasons. And
Speaker 1: then you know, if well, if she has somebody is
Speaker 1: single then and they're looking for some human or sexual contact,
Speaker 1: and you say, wow, monogamy at least would be the
Speaker 1: next best step. You know, the whole thing follows a
Speaker 1: kind of continuum towards the more more more normative picture
Speaker 1: of what we imagine upper middle class or middle class
Speaker 1: at least left to look like. So, I mean, what
Speaker 1: you're saying is true. I don't dispute it at all.
Speaker 1: But aren't don't we already see that those models are
Speaker 1: kind of dead ends. Yes, I think it's a great
Speaker 1: point that the assumption that somebody can comfortably pod with
Speaker 1: another family or have a sex buddy and make these
Speaker 1: calculated choices around risk, it's based in an assumption that
Speaker 1: somebody has some level of privilege to be able to
Speaker 1: do that. And it's abundantly clearer that in general, social
Speaker 1: distancing and calculated choices around risk are very much a
Speaker 1: privilege that are not afforded to people who have to
Speaker 1: return to work. Because the government has not supported them
Speaker 1: enough to allow them to stay home, and people who
Speaker 1: live in very crowded housing who can't necessarily distance and
Speaker 1: then make these controlled decisions around which families they are
Speaker 1: going to pod with. So I think it's a great
Speaker 1: point that needs to be acknowledged. I still think the
Speaker 1: public deserves some understanding of a spectrum of risk, and
Speaker 1: that everyone can benefit to some extent from learning more
Speaker 1: about their risk that goes beyond my risk is zero
Speaker 1: if I'm in my house, and my risk is one
Speaker 1: if I walk out my front door, which I think
Speaker 1: has led to a lot of confusion around where risk
Speaker 1: really lies and has prevented people from making the most
Speaker 1: informed decisions about their everyday lives and the choices that
Speaker 1: they've already been making for the last several months. Where
Speaker 1: can listeners see your infographic with a spectrum of risk?
Speaker 1: It is posted on Twitter and it has also been
Speaker 1: adapted by Vox. They put out a much more professional
Speaker 1: looking version, so I would encourage people to search for that. Julia,
Speaker 1: thank you so much for this analysis. It's really insightful,
Speaker 1: very powerful, and I think I and a lot of
Speaker 1: other people will think about it very very carefully in
Speaker 1: the weeks and months ahead. Thanks so much for having
Speaker 1: this is a great conversation. Listening to doctor Julia Marcus,
Speaker 1: I was deeply struck by a truth that seems to
Speaker 1: me pretty profound that she was getting at. Human beings
Speaker 1: have needs. Social life is indeed one of those fundamental
Speaker 1: human needs. To be social is part of what makes
Speaker 1: us human. And so says doctor Marcus, we need to
Speaker 1: have a life in the pandemic, and what we need
Speaker 1: to do then is to evaluate risk against the backdrop
Speaker 1: of the reality that we still have an imperative to
Speaker 1: have a life. Making that determination of how to have
Speaker 1: a life in the pandemic will be at the level
Speaker 1: of the individual and of the family. We need to
Speaker 1: keep in mind that it's a decision that will always
Speaker 1: be made against the backdrop of what privilege we may
Speaker 1: in fact have. No matter who you are, though, you
Speaker 1: still have to undergo some analysis of what the relative
Speaker 1: risks are that you can and are willing to take.
Speaker 1: And I, for one, believe we can do that better
Speaker 1: in the presence of knowledge and understanding than we could
Speaker 1: without it. Until the next time I speak to you,
Speaker 1: be careful, be safe, and be well. Deep background is
Speaker 1: brought to you by Pushkin Industries. Our producer is Lydia
Speaker 1: Jane Cott, with mastering by Jason Gambrell and Martin Gonzalez.
Speaker 1: Our showrunner is Sophia mckibbon. Our theme music is composed
Speaker 1: by Luis GERA special thanks to the Pushkin Brass, Malcolm Gladwell,
Speaker 1: Jake of Weisberg, and Mia Lobel. I'm Noah Feldman. I
Speaker 1: also write a regular column for Bloomberg Opinion, which you
Speaker 1: can find at bloomberg dot com slash Feldman. To discover
Speaker 1: Bloomberg's original slate of podcasts, go to Bloomberg dot com
Speaker 1: slash Podcasts. And one last thing. I just wrote a
Speaker 1: book called The Arab Winter Patrogedy. I would be delighted
Speaker 1: if you checked it out. If you liked what you
Speaker 1: heard today, please write a review or tell a friend.
Speaker 1: You can always let me know what you think on Twitter.
Speaker 1: My handle is Noah R. Feldman. This is deep background