1
00:00:15,396 --> 00:00:21,996
Speaker 1: Pushkin from Pushkin Industries. This is Deep Background, the show

2
00:00:22,036 --> 00:00:25,196
Speaker 1: where we explore the stories behind the stories in the news.

3
00:00:25,716 --> 00:00:30,276
Speaker 1: I'm Noah Feldman. After months of lockdown, people are beginning

4
00:00:30,356 --> 00:00:33,476
Speaker 1: to come out of their houses. Many are coming out

5
00:00:33,516 --> 00:00:36,436
Speaker 1: to protest. The death of George Floyd has set off

6
00:00:36,476 --> 00:00:40,116
Speaker 1: demonstrations across the country. Protests in the midst of a

7
00:00:40,156 --> 00:00:46,996
Speaker 1: pandemic raise unprecedented and unclear questions about both science and ethics. Crucially,

8
00:00:47,076 --> 00:00:51,236
Speaker 1: they center on the question of transmission outdoors. How does

9
00:00:51,276 --> 00:00:54,356
Speaker 1: the CSARS cove two virus move outdoors and how do

10
00:00:54,396 --> 00:00:59,196
Speaker 1: the circumstances of protest affect that transmission. To analyze these

11
00:00:59,196 --> 00:01:03,236
Speaker 1: pressing questions, we are joined today by doctor Menisha Jutani.

12
00:01:03,956 --> 00:01:07,756
Speaker 1: Doctor Jutani is an Associate Professor of medicine specializing in

13
00:01:07,836 --> 00:01:11,436
Speaker 1: infectious disease at the Yale School of Medicine. She's also

14
00:01:11,516 --> 00:01:14,956
Speaker 1: an attending physician at the Yale New Haven Hospital, where

15
00:01:14,996 --> 00:01:19,596
Speaker 1: she's been instrumental in leading the infectious disease efforts. Addressing

16
00:01:19,796 --> 00:01:25,556
Speaker 1: COVID nineteen Minsha, thank you so much for being here.

17
00:01:25,796 --> 00:01:30,156
Speaker 1: You've been following the question of how the stars covy

18
00:01:30,236 --> 00:01:35,796
Speaker 1: two virus spreads very closely, and then in the middle

19
00:01:35,996 --> 00:01:38,996
Speaker 1: of the scientific effort to make sense of this very

20
00:01:39,076 --> 00:01:44,596
Speaker 1: very important question, we suddenly were faced with the protests

21
00:01:44,676 --> 00:01:47,316
Speaker 1: about the death of George Floyd, and we're in a

22
00:01:47,476 --> 00:01:51,636
Speaker 1: completely new universe where the question of transmission is being

23
00:01:51,676 --> 00:01:54,956
Speaker 1: filtered through a new form of social interaction that it

24
00:01:54,996 --> 00:01:58,956
Speaker 1: hadn't occurred on this scale previously. It's sort of like

25
00:01:59,036 --> 00:02:04,076
Speaker 1: an advanced course transmission with ethical dimensions as well as

26
00:02:04,076 --> 00:02:07,276
Speaker 1: scientific dimensions. I want to start by asking you about

27
00:02:07,316 --> 00:02:11,796
Speaker 1: the scientific dimension. What do we know about outdoor transmission

28
00:02:12,316 --> 00:02:16,516
Speaker 1: of this virus? To begin with, science on outdoor transmission

29
00:02:16,836 --> 00:02:20,676
Speaker 1: is still evolving. What we know so far is that

30
00:02:21,116 --> 00:02:26,156
Speaker 1: in series of outbreaks that have been identified from China

31
00:02:26,356 --> 00:02:29,556
Speaker 1: to start and other areas of the world, including Japan,

32
00:02:30,276 --> 00:02:35,356
Speaker 1: it appears that most transmission is occurring indoors, when people

33
00:02:35,436 --> 00:02:39,716
Speaker 1: are face to face and spending more than ten minutes

34
00:02:39,796 --> 00:02:42,516
Speaker 1: of time, let's say, talking to each other. This is

35
00:02:42,556 --> 00:02:45,956
Speaker 1: the highest risk of exposure. Now, what we've seen happen

36
00:02:46,676 --> 00:02:50,916
Speaker 1: is that families and the household setting is probably the

37
00:02:51,036 --> 00:02:54,596
Speaker 1: number one way that this virus is transmitted. Part of

38
00:02:54,596 --> 00:02:57,316
Speaker 1: that is because that's where people have been stuck. People

39
00:02:57,316 --> 00:03:00,636
Speaker 1: who got infected were at home and they were with

40
00:03:00,676 --> 00:03:03,636
Speaker 1: each other, and so they went on to infect each other.

41
00:03:03,676 --> 00:03:05,996
Speaker 1: And people buy and large have not been wearing masks

42
00:03:06,076 --> 00:03:09,276
Speaker 1: in their own homes. The next way that we saw

43
00:03:09,356 --> 00:03:12,676
Speaker 1: that this virus was transmitted, probably in highest proportion, is

44
00:03:12,716 --> 00:03:16,356
Speaker 1: in transportation settings. Again, this makes sense that people are

45
00:03:16,556 --> 00:03:19,036
Speaker 1: on a train for prolonged period of time. Let's say

46
00:03:19,076 --> 00:03:22,036
Speaker 1: you're taking an hour ride from the suburbs of New

47
00:03:22,116 --> 00:03:25,036
Speaker 1: York City into New York City or Boston or other

48
00:03:25,076 --> 00:03:28,716
Speaker 1: big cities of the like. If you're in a setting

49
00:03:28,796 --> 00:03:30,396
Speaker 1: where you are with a group of people for a

50
00:03:30,436 --> 00:03:33,156
Speaker 1: prolonged period of time, potentially sitting side by side, face

51
00:03:33,196 --> 00:03:37,116
Speaker 1: to face, maybe you cough, maybe you're talking on your phone,

52
00:03:37,636 --> 00:03:41,996
Speaker 1: and the person next to you is getting that transmission

53
00:03:42,116 --> 00:03:45,036
Speaker 1: of virus that This is the second, probably most common

54
00:03:45,036 --> 00:03:48,156
Speaker 1: way people have been infected. So getting to the outdoors.

55
00:03:48,876 --> 00:03:53,436
Speaker 1: Outdoors has been the lowest risk identified mechanism of transmission.

56
00:03:54,036 --> 00:03:56,516
Speaker 1: So in one series that was looked at, there was

57
00:03:56,516 --> 00:03:59,436
Speaker 1: only one person that was clearly identified to risk of

58
00:03:59,556 --> 00:04:03,116
Speaker 1: outdoor transmission. Most transmission events that have been able to

59
00:04:03,156 --> 00:04:06,156
Speaker 1: be tracked have been to some sort of indoor setting,

60
00:04:06,436 --> 00:04:12,316
Speaker 1: which gives us additional confidence that the outdoors is likely

61
00:04:12,636 --> 00:04:17,596
Speaker 1: a much lower risk place where people can get COVID nineteen.

62
00:04:18,116 --> 00:04:20,556
Speaker 1: I was very affected by the Wuhan study that you

63
00:04:20,596 --> 00:04:23,676
Speaker 1: were just describing, where by my reading of the study

64
00:04:23,676 --> 00:04:25,476
Speaker 1: and correct me if I get it wrong. They looked

65
00:04:25,476 --> 00:04:29,436
Speaker 1: at seventy five hundred individual cases, and only one of

66
00:04:29,476 --> 00:04:32,996
Speaker 1: those cases could they show definitively had been transmitted outdoors.

67
00:04:33,476 --> 00:04:35,636
Speaker 1: I had recognized it's only one study. I recognize it

68
00:04:35,676 --> 00:04:38,476
Speaker 1: was the winter, and that most people also may have

69
00:04:38,516 --> 00:04:40,556
Speaker 1: been under lockdown, so that may be the reason it

70
00:04:40,596 --> 00:04:43,116
Speaker 1: was such a small number. I did have an instinctive

71
00:04:43,156 --> 00:04:46,396
Speaker 1: reaction to that, thinking, wow, it must be pretty difficult

72
00:04:46,476 --> 00:04:50,156
Speaker 1: to transmit the virus outdoors. Why what is it about

73
00:04:50,196 --> 00:04:52,716
Speaker 1: being outdoors that has this effect? I mean, the most

74
00:04:52,716 --> 00:04:54,436
Speaker 1: obvious thing to me is a layers and is there's

75
00:04:54,436 --> 00:04:56,636
Speaker 1: a whole lot of air outdoors. I think there are

76
00:04:56,636 --> 00:05:00,396
Speaker 1: several factors. Number One, most of the time when people

77
00:05:00,436 --> 00:05:03,436
Speaker 1: are outdoors, they tend to be further apart from each other.

78
00:05:03,596 --> 00:05:08,396
Speaker 1: Not always. There are certain contexts like the recent rallies

79
00:05:08,396 --> 00:05:13,356
Speaker 1: and protests, when people are in closer proximity to each other. However,

80
00:05:13,756 --> 00:05:16,476
Speaker 1: a lot of times if people are even if they

81
00:05:16,516 --> 00:05:19,956
Speaker 1: are going to public pools or they are going in

82
00:05:20,036 --> 00:05:24,516
Speaker 1: a park or they're watching an outdoor concert, they tend

83
00:05:24,556 --> 00:05:28,796
Speaker 1: to be a little bit further apart. Secondly, as you mentioned,

84
00:05:28,916 --> 00:05:31,796
Speaker 1: the air is blowing, and that may be part of

85
00:05:31,836 --> 00:05:36,876
Speaker 1: the reason that this infection cannot perpetuate as much in

86
00:05:36,916 --> 00:05:40,396
Speaker 1: the outdoor setting. People have postulated that while maybe win

87
00:05:40,516 --> 00:05:42,876
Speaker 1: could make it worse, that you have aerosols that are

88
00:05:42,876 --> 00:05:45,396
Speaker 1: in the air and it can blow from one person

89
00:05:45,476 --> 00:05:47,956
Speaker 1: on the end of a field to another person on

90
00:05:47,996 --> 00:05:51,076
Speaker 1: the other end of the field. Although in theory that

91
00:05:51,236 --> 00:05:54,596
Speaker 1: is possible, I think from what we've seen so far,

92
00:05:55,156 --> 00:05:58,436
Speaker 1: I suspect that the science will be able to show

93
00:05:58,516 --> 00:06:02,076
Speaker 1: us over time that droplets that are generated through coughing

94
00:06:02,196 --> 00:06:04,476
Speaker 1: or talking or singing, or all the activities that we

95
00:06:04,556 --> 00:06:08,876
Speaker 1: know through human projection of voice that occur that win

96
00:06:09,236 --> 00:06:13,076
Speaker 1: an air and just sort of the natural barriers that come,

97
00:06:13,116 --> 00:06:15,916
Speaker 1: whether it bay trees or leaves or benches or other

98
00:06:15,956 --> 00:06:18,436
Speaker 1: things that get in the way of these droplets along

99
00:06:18,476 --> 00:06:21,716
Speaker 1: the way, maybe more likely to break up those droplets

100
00:06:21,876 --> 00:06:25,716
Speaker 1: and make the particles less likely infectious or non infectious

101
00:06:25,716 --> 00:06:30,316
Speaker 1: at all. Turning to the protests, What were the circumstantial

102
00:06:30,356 --> 00:06:34,476
Speaker 1: events or what have been so far that would potentially

103
00:06:35,076 --> 00:06:38,116
Speaker 1: change this calculus, again on the scientific not the ethical level.

104
00:06:38,196 --> 00:06:41,756
Speaker 1: So if your tear gased, is that likely to cause

105
00:06:41,796 --> 00:06:45,396
Speaker 1: you to aerosolize? I mean, you cry, you cough, maybe

106
00:06:45,436 --> 00:06:47,956
Speaker 1: you sneeze. I don't think crying is an aerosolizing event,

107
00:06:48,036 --> 00:06:57,556
Speaker 1: but the others are right. Certainly the coughing, chanting, screaming, talking, loudly, singing,

108
00:06:57,996 --> 00:07:02,676
Speaker 1: these are all very clearly aerosol generating events. Now, I

109
00:07:02,716 --> 00:07:05,916
Speaker 1: would say there's some protests I've seen where people are

110
00:07:05,916 --> 00:07:10,276
Speaker 1: not wearing masks, but by and large I have visualized

111
00:07:10,396 --> 00:07:14,556
Speaker 1: even firsthand, is that almost everybody is wearing a mask,

112
00:07:15,076 --> 00:07:19,916
Speaker 1: and that is certainly good. However, the thing that we

113
00:07:19,996 --> 00:07:24,396
Speaker 1: don't know is that the outdoor data that has been

114
00:07:24,396 --> 00:07:27,956
Speaker 1: collected so far, at least in the one case that

115
00:07:27,996 --> 00:07:30,396
Speaker 1: you described in that study that we talked about again,

116
00:07:30,556 --> 00:07:33,236
Speaker 1: was a person talking face to face with somebody else.

117
00:07:34,116 --> 00:07:36,756
Speaker 1: If we have a setting where there are a lot

118
00:07:36,836 --> 00:07:40,996
Speaker 1: of people who are together and you have multiple aerosol

119
00:07:41,076 --> 00:07:46,236
Speaker 1: generating events happening all at once, will the risk go up?

120
00:07:46,316 --> 00:07:48,596
Speaker 1: We just don't know the answer to that. We are

121
00:07:48,676 --> 00:07:52,436
Speaker 1: living in a real life, real time natural experiment. That

122
00:07:52,596 --> 00:07:55,956
Speaker 1: is what's going on right now, and only the facts

123
00:07:55,996 --> 00:07:58,156
Speaker 1: are going to show us what happens. And I don't

124
00:07:58,156 --> 00:08:02,756
Speaker 1: think it's necessarily in the next week or two, because

125
00:08:03,436 --> 00:08:07,356
Speaker 1: in my calculus, in the next couple of weeks, it

126
00:08:07,436 --> 00:08:12,876
Speaker 1: might be that some people will have asymptomatic infection, that

127
00:08:12,956 --> 00:08:16,476
Speaker 1: some people will have mild cases of infection, may or

128
00:08:16,516 --> 00:08:19,756
Speaker 1: may not go to get tested, but it depends what

129
00:08:19,796 --> 00:08:23,116
Speaker 1: they go and do after that. Are they going back

130
00:08:23,196 --> 00:08:28,876
Speaker 1: to individual units where if they did get infected, potentially

131
00:08:28,916 --> 00:08:33,276
Speaker 1: they're staying quarantining or not engaging as much in public

132
00:08:33,396 --> 00:08:38,076
Speaker 1: life as maybe they were months ago, And if they

133
00:08:38,116 --> 00:08:40,836
Speaker 1: did get infected, maybe that'll be the end and that'll

134
00:08:40,956 --> 00:08:44,636
Speaker 1: self terminate the cascade of infection versus people who are

135
00:08:44,676 --> 00:08:49,276
Speaker 1: going home to maybe multigenerational homes where a month from now,

136
00:08:49,756 --> 00:08:51,356
Speaker 1: not just a week or two from now, but a

137
00:08:51,396 --> 00:08:54,436
Speaker 1: month from now, we now see people who are older

138
00:08:54,596 --> 00:08:58,676
Speaker 1: and debilitated or have multiple other chronic conditions now coming

139
00:08:58,716 --> 00:09:03,396
Speaker 1: to the hospital and getting a spike in hospitalizations at

140
00:09:03,436 --> 00:09:06,036
Speaker 1: that point. So I think that's what we are living

141
00:09:06,036 --> 00:09:08,116
Speaker 1: with and we just have to wait and see what happens.

142
00:09:08,156 --> 00:09:10,876
Speaker 1: Now you set something that actually makes me think the

143
00:09:10,916 --> 00:09:12,356
Speaker 1: science is going to be a lot harder than I

144
00:09:12,396 --> 00:09:14,636
Speaker 1: had originally imagine it would be, for the following reason.

145
00:09:15,316 --> 00:09:18,796
Speaker 1: If we could see a result in two weeks, let's say,

146
00:09:19,396 --> 00:09:23,316
Speaker 1: then I think a good statistician looking at national data

147
00:09:23,356 --> 00:09:27,356
Speaker 1: and matching where people live to where there were protests

148
00:09:27,396 --> 00:09:31,316
Speaker 1: of different sizes, could begin to draw an association and

149
00:09:31,396 --> 00:09:34,916
Speaker 1: interpret the natural experiment that you describe. But if it's

150
00:09:34,916 --> 00:09:37,876
Speaker 1: going to take a month, I'm concerned that there's going

151
00:09:37,916 --> 00:09:40,436
Speaker 1: to be the possibility again, just from an analytic perspective,

152
00:09:40,956 --> 00:09:46,196
Speaker 1: of a conflation between the fact of the protests and

153
00:09:46,556 --> 00:09:49,436
Speaker 1: the fact that so many places across the United States

154
00:09:49,756 --> 00:09:52,956
Speaker 1: are gradually opening up and began to do so at

155
00:09:52,996 --> 00:09:56,436
Speaker 1: almost exactly the same time that the protests began, namely

156
00:09:56,476 --> 00:09:58,876
Speaker 1: the very end of May and the beginning of June.

157
00:09:59,356 --> 00:10:03,196
Speaker 1: And if that's the case, maybe a very very skilled

158
00:10:03,236 --> 00:10:07,156
Speaker 1: statistician could begin to pluck out data from the noise.

159
00:10:07,636 --> 00:10:09,036
Speaker 1: But it actually sounds to me like it's going to

160
00:10:09,076 --> 00:10:11,076
Speaker 1: be really hard to do if it's going to take

161
00:10:11,116 --> 00:10:14,196
Speaker 1: a month. That is my exact same concern. I have

162
00:10:14,276 --> 00:10:17,276
Speaker 1: a feeling that it's going to be very very difficult

163
00:10:18,036 --> 00:10:21,916
Speaker 1: to sort that out when you're looking at broad strokes.

164
00:10:23,036 --> 00:10:27,836
Speaker 1: What you could do is look at specific, smaller subsets

165
00:10:27,876 --> 00:10:31,676
Speaker 1: of the population and smaller groups. One thought I've had,

166
00:10:31,716 --> 00:10:34,716
Speaker 1: for example, is that there are many physicians that have

167
00:10:34,836 --> 00:10:38,436
Speaker 1: also been protesting. On Friday, there was a large movement

168
00:10:38,516 --> 00:10:42,116
Speaker 1: for white coats for Black Lives, and there were many

169
00:10:42,156 --> 00:10:45,836
Speaker 1: physicians who were out there. Now, if these physicians have

170
00:10:45,996 --> 00:10:50,036
Speaker 1: been using Personal Protective Equipment PPE in the hospital, and

171
00:10:50,076 --> 00:10:53,516
Speaker 1: we've seen that when you use PPE, the risk of

172
00:10:53,556 --> 00:10:57,156
Speaker 1: transmission is quite low. In fact, we know that the

173
00:10:57,236 --> 00:11:00,716
Speaker 1: PPE works. That's what our first experiment has shown us

174
00:11:01,036 --> 00:11:03,876
Speaker 1: that in fact, we can be protected as healthcare providers

175
00:11:03,916 --> 00:11:06,676
Speaker 1: if we use it. So the question is if these

176
00:11:06,716 --> 00:11:13,116
Speaker 1: people are used masks in protests, if they are using

177
00:11:13,156 --> 00:11:17,556
Speaker 1: PPE in the hospital, and maybe are re engaging in

178
00:11:17,636 --> 00:11:21,076
Speaker 1: society a little bit. With some of the loosening of

179
00:11:21,116 --> 00:11:25,916
Speaker 1: restrictions that have happened in certain areas, you might be

180
00:11:25,996 --> 00:11:28,356
Speaker 1: able to say, well, okay, if these people are getting

181
00:11:28,356 --> 00:11:31,076
Speaker 1: screened and tested maybe on a more regular basis, because

182
00:11:31,116 --> 00:11:33,476
Speaker 1: that's also part of what we're doing. Do we see

183
00:11:33,476 --> 00:11:36,596
Speaker 1: associations with people who went to a protest versus those

184
00:11:36,636 --> 00:11:39,076
Speaker 1: who did not. That's a very defined group of people

185
00:11:39,156 --> 00:11:42,196
Speaker 1: where maybe you might be able to get at that question.

186
00:11:42,556 --> 00:11:45,556
Speaker 1: But if we just look at sort of the epidemiologic

187
00:11:46,156 --> 00:11:48,716
Speaker 1: way that we might look at some of these questions,

188
00:11:48,756 --> 00:11:51,036
Speaker 1: I think exactly what you highlighted is going to be

189
00:11:51,156 --> 00:11:54,676
Speaker 1: very difficult to tease out. So there's the potential for

190
00:11:54,756 --> 00:11:58,516
Speaker 1: challenge in that. I like your experiment idea to look

191
00:11:58,556 --> 00:12:00,796
Speaker 1: at medical professionals who went to the protest, but I

192
00:12:00,836 --> 00:12:03,436
Speaker 1: can immediately think of a confound which is that they're

193
00:12:03,436 --> 00:12:07,236
Speaker 1: going to be disproportionately likely to use PPE correctly and

194
00:12:07,356 --> 00:12:09,836
Speaker 1: to maintain social distance at the protest tests because they

195
00:12:09,836 --> 00:12:12,716
Speaker 1: are medical professionals. So you might be able to make

196
00:12:12,716 --> 00:12:15,436
Speaker 1: a comparison between them and other medical professionals, but that

197
00:12:15,476 --> 00:12:18,436
Speaker 1: won't necessarily give you any external validity for trying to

198
00:12:18,436 --> 00:12:20,676
Speaker 1: figure out what that means for the rest of us.

199
00:12:20,716 --> 00:12:23,196
Speaker 1: When we went to the protests, I totally agree, and

200
00:12:23,436 --> 00:12:27,596
Speaker 1: I'll speak as a protester myself. I stood on the

201
00:12:27,716 --> 00:12:34,036
Speaker 1: way periphery and I did not go near chanting crowds

202
00:12:34,436 --> 00:12:38,756
Speaker 1: myself because I felt that that was a safer way

203
00:12:38,876 --> 00:12:42,676
Speaker 1: given what I know, without having to necessarily be right

204
00:12:42,796 --> 00:12:45,756
Speaker 1: in the middle of the protest. We'll be back in

205
00:12:45,756 --> 00:12:57,636
Speaker 1: a moment. So I'm fascinated when you talk about your

206
00:12:57,676 --> 00:13:01,996
Speaker 1: own experience at the protests that, notwithstanding your very clear

207
00:13:02,036 --> 00:13:05,996
Speaker 1: analysis that the data suggests that risks of transmission outdoor

208
00:13:06,116 --> 00:13:11,236
Speaker 1: are actually arguably pretty low, that nevertheless, were concerned enough

209
00:13:12,036 --> 00:13:14,996
Speaker 1: about chanting and singing to stay on the periphery and

210
00:13:15,036 --> 00:13:18,196
Speaker 1: to avoid loudly chanting protesters. And I want to ask you,

211
00:13:18,316 --> 00:13:21,716
Speaker 1: I guess a personal question. Is that because you on

212
00:13:21,836 --> 00:13:24,796
Speaker 1: the whole or a person who likes to make assurance

213
00:13:24,836 --> 00:13:28,076
Speaker 1: double shore and be safe, or was that your assessment

214
00:13:28,116 --> 00:13:31,836
Speaker 1: that rationally speaking, everybody in the crowd actually should have

215
00:13:31,916 --> 00:13:34,876
Speaker 1: not chanted very loudly and not sung and stated a

216
00:13:34,876 --> 00:13:36,676
Speaker 1: greater distance from each other. Did you have an instinct

217
00:13:36,716 --> 00:13:39,156
Speaker 1: to want to warn everybody else about this too, Yes,

218
00:13:39,316 --> 00:13:41,396
Speaker 1: I did have an instinct to want to do that.

219
00:13:41,596 --> 00:13:43,876
Speaker 1: But I know also that people are entitled to their

220
00:13:43,996 --> 00:13:47,236
Speaker 1: right to do what they feel is appropriate in the

221
00:13:47,276 --> 00:13:50,196
Speaker 1: moment in time that we're in. And I'm not going

222
00:13:50,196 --> 00:13:55,116
Speaker 1: to deny that I would have liked to participate in

223
00:13:55,156 --> 00:13:58,796
Speaker 1: that way myself, but as a public health measure for

224
00:13:58,956 --> 00:14:03,836
Speaker 1: myself if I am asymptomatically infected, I didn't want to

225
00:14:03,876 --> 00:14:07,556
Speaker 1: put others at risk. And so there is a way

226
00:14:07,596 --> 00:14:12,356
Speaker 1: to show civil disobedience and to show protests even in silence,

227
00:14:13,156 --> 00:14:15,916
Speaker 1: and I felt that I was able to do that

228
00:14:15,956 --> 00:14:18,756
Speaker 1: in a way that was comfortable for me. But I

229
00:14:18,796 --> 00:14:22,196
Speaker 1: also understand people are in a very difficult position right

230
00:14:22,196 --> 00:14:24,436
Speaker 1: now and are entitled to do what they feel is

231
00:14:24,556 --> 00:14:29,156
Speaker 1: right for them. But I have encouraged people to try

232
00:14:29,676 --> 00:14:36,716
Speaker 1: to maintain distance, not scream, shout, or saying or chant,

233
00:14:37,476 --> 00:14:40,476
Speaker 1: as a way to protect themselves and protect others because

234
00:14:40,516 --> 00:14:44,276
Speaker 1: I do fundamentally believe that the outdoors is so much

235
00:14:44,316 --> 00:14:49,676
Speaker 1: safer than anything indoors, So protesting outside I think can

236
00:14:49,716 --> 00:14:53,436
Speaker 1: be done in a low risk environment. I cannot say

237
00:14:53,476 --> 00:14:56,316
Speaker 1: that it's no risk. I tell people all the time,

238
00:14:56,396 --> 00:14:59,836
Speaker 1: if you're a very anxious person and you are worried

239
00:14:59,836 --> 00:15:03,436
Speaker 1: about risk, you should just stay home and stay indoors. However,

240
00:15:03,516 --> 00:15:06,276
Speaker 1: if you are trying to engage in a way that

241
00:15:06,356 --> 00:15:09,836
Speaker 1: feels comfortable to you and in a way that at

242
00:15:09,836 --> 00:15:13,476
Speaker 1: the moment we think is the safest what I've described,

243
00:15:13,516 --> 00:15:17,956
Speaker 1: which is to try to exhibit silence, wear a mask,

244
00:15:18,396 --> 00:15:24,676
Speaker 1: keep distance, and still protest. That is what I would

245
00:15:25,116 --> 00:15:29,836
Speaker 1: advocate for. I think that people will be seen and

246
00:15:29,996 --> 00:15:34,116
Speaker 1: heard even in silence. One of the really complex ethical

247
00:15:34,156 --> 00:15:36,436
Speaker 1: issues that you've already alluded to, but I want to

248
00:15:36,436 --> 00:15:39,676
Speaker 1: ask you more about, is the question of medical professionals

249
00:15:39,676 --> 00:15:43,796
Speaker 1: white coats protesting in their white coats. White coats for

250
00:15:43,876 --> 00:15:47,076
Speaker 1: black lives is sometimes the slogan that's used, and that's

251
00:15:47,116 --> 00:15:51,676
Speaker 1: raised an ethical question about the consequences not just for them,

252
00:15:51,836 --> 00:15:55,876
Speaker 1: but for everybody of engaging in protest in a situation

253
00:15:55,916 --> 00:15:59,436
Speaker 1: where there is at least a possibility of transmission. Karl Bergstrom,

254
00:15:59,476 --> 00:16:01,876
Speaker 1: the epidemiologist and statistician whom we've had on the show,

255
00:16:02,436 --> 00:16:06,836
Speaker 1: has been posting, not without a lot of opposition, on Twitter,

256
00:16:06,916 --> 00:16:09,556
Speaker 1: that he wants to remind people that you're not only

257
00:16:09,636 --> 00:16:14,156
Speaker 1: carrying risk for yourself in a situation of epidemic, but

258
00:16:14,236 --> 00:16:17,236
Speaker 1: you're actually imposing an externality. You're creating a risk for

259
00:16:17,316 --> 00:16:21,596
Speaker 1: other people if you're engaged in risky behavior with respect

260
00:16:21,676 --> 00:16:26,436
Speaker 1: to transmission. How do you think about that concern? In healthcare,

261
00:16:27,756 --> 00:16:31,756
Speaker 1: there has been systemic racism for a long time. I've

262
00:16:31,796 --> 00:16:39,916
Speaker 1: spoken to students, residents, fellows, attending physicians who have experienced

263
00:16:40,716 --> 00:16:46,236
Speaker 1: racism in their careers for decades as a South Asian American,

264
00:16:46,476 --> 00:16:51,196
Speaker 1: as a woman of Indian descent, I've had many comments myself.

265
00:16:51,876 --> 00:16:56,796
Speaker 1: I've been called Gandhi as a young person in a

266
00:16:57,076 --> 00:17:00,756
Speaker 1: mall on nine to eleven. My husband, who's also of

267
00:17:00,796 --> 00:17:04,556
Speaker 1: Indian descent. We lived in New York City and our doorman,

268
00:17:04,636 --> 00:17:08,636
Speaker 1: who saw us every single day, wouldn't allow him in

269
00:17:08,676 --> 00:17:11,356
Speaker 1: the building and told us to go back to where

270
00:17:11,396 --> 00:17:16,556
Speaker 1: we came from. I believe that as a healthcare professional

271
00:17:17,196 --> 00:17:22,356
Speaker 1: to stand up for patience and providers that have experienced

272
00:17:22,396 --> 00:17:25,516
Speaker 1: this kind of racism in their lives, and as a

273
00:17:25,556 --> 00:17:30,156
Speaker 1: medical educator to say, if I'm a bystander and see

274
00:17:30,236 --> 00:17:32,956
Speaker 1: something that's wrong, I'm not going to stand for it,

275
00:17:33,196 --> 00:17:36,196
Speaker 1: and I'm going to stand up for somebody who maybe

276
00:17:36,516 --> 00:17:39,316
Speaker 1: is having a hard time speaking on behalf of themselves.

277
00:17:40,596 --> 00:17:43,276
Speaker 1: I want to make a point to say that I

278
00:17:43,316 --> 00:17:45,676
Speaker 1: will do that, and I'm going to stand on the

279
00:17:45,716 --> 00:17:48,876
Speaker 1: side of what I think is right. And this is

280
00:17:48,876 --> 00:17:53,196
Speaker 1: a critical juncture in our country. And as much as

281
00:17:53,236 --> 00:17:56,316
Speaker 1: I'm on the side of protecting people from COVID nineteen,

282
00:17:57,316 --> 00:17:59,796
Speaker 1: there is a confluence of events that is happening right

283
00:17:59,796 --> 00:18:03,116
Speaker 1: now and we have to recognize what is going on.

284
00:18:03,916 --> 00:18:07,956
Speaker 1: And so I have struggled with this myself. As you mentioned,

285
00:18:08,636 --> 00:18:11,756
Speaker 1: how can I go about and express what I think

286
00:18:11,836 --> 00:18:16,036
Speaker 1: is an equally important message to get out there at

287
00:18:16,036 --> 00:18:20,356
Speaker 1: the same time as trying to prevent a potential huge

288
00:18:20,396 --> 00:18:23,756
Speaker 1: second wave. The way that I see that being able

289
00:18:23,796 --> 00:18:28,356
Speaker 1: to happen is I went to one protest. I went

290
00:18:28,436 --> 00:18:32,116
Speaker 1: in my white coat. I showed people around them that

291
00:18:32,316 --> 00:18:35,796
Speaker 1: should something happen, I am a white coat. I am

292
00:18:35,836 --> 00:18:38,716
Speaker 1: ready to help those that might be in need. But

293
00:18:39,156 --> 00:18:41,356
Speaker 1: I'm going to stay on the periphery because that's what

294
00:18:41,396 --> 00:18:43,476
Speaker 1: I'm comfortable with. I don't want to put other people

295
00:18:43,516 --> 00:18:45,716
Speaker 1: at risk, and I don't want to be at risk

296
00:18:46,076 --> 00:18:48,716
Speaker 1: because I need to keep doing my job. I need

297
00:18:48,716 --> 00:18:52,316
Speaker 1: to continue being able to be a physician taking care

298
00:18:52,316 --> 00:18:57,356
Speaker 1: of patients, and continue being an educator, educating trainees and

299
00:18:57,556 --> 00:19:01,796
Speaker 1: educating the public. So I think there is a conflict here,

300
00:19:01,836 --> 00:19:03,316
Speaker 1: but at the end of the day, we all are

301
00:19:03,436 --> 00:19:05,516
Speaker 1: human beings and we all have to stand on the

302
00:19:05,556 --> 00:19:08,636
Speaker 1: side of what we think is right. In this moment,

303
00:19:09,476 --> 00:19:12,476
Speaker 1: when I hear the phrase systemic racism in the context

304
00:19:12,516 --> 00:19:15,516
Speaker 1: of health outcomes, I tend to think of the long

305
00:19:15,716 --> 00:19:19,796
Speaker 1: range consequences of slavery and segregation in the United States

306
00:19:19,836 --> 00:19:24,476
Speaker 1: and economic inequality, primarily for African Americans, and the consequences

307
00:19:24,476 --> 00:19:28,196
Speaker 1: that that has had for the health of African American people.

308
00:19:28,556 --> 00:19:33,636
Speaker 1: And the COVID nineteen epidemic is a perfect instantiation of this,

309
00:19:33,716 --> 00:19:36,676
Speaker 1: and that's the reason that African Americans seem to be

310
00:19:36,716 --> 00:19:40,356
Speaker 1: around three times more likely to die of COVID than

311
00:19:40,436 --> 00:19:43,236
Speaker 1: white people. That's a question of the effects of that

312
00:19:43,316 --> 00:19:46,076
Speaker 1: kind of systemic racism. And so I think for those

313
00:19:46,116 --> 00:19:51,596
Speaker 1: who have expressed trepidation around the protests, one of the

314
00:19:51,596 --> 00:19:55,036
Speaker 1: things that they've been saying is African Americans might be

315
00:19:55,076 --> 00:19:58,116
Speaker 1: disproportionately likely to be protesting in Black Lives Matter, and

316
00:19:58,236 --> 00:20:02,836
Speaker 1: African Americans are disproportionately likely to be contracting and becoming

317
00:20:02,876 --> 00:20:05,676
Speaker 1: ill from the disease. And here, I guess what I'm

318
00:20:05,676 --> 00:20:09,436
Speaker 1: wondering is is it your instinct that the risk of

319
00:20:09,476 --> 00:20:13,756
Speaker 1: transmission aren't so great in protests as to make this

320
00:20:14,036 --> 00:20:17,836
Speaker 1: as pressing a dilemma as some people would like to

321
00:20:17,876 --> 00:20:20,316
Speaker 1: make it out to be. I think that's a difficult

322
00:20:20,796 --> 00:20:23,876
Speaker 1: call on a question. And the reason I say that

323
00:20:24,076 --> 00:20:30,356
Speaker 1: is because I'm extremely concerned about outbreaks to come, particularly

324
00:20:30,436 --> 00:20:35,036
Speaker 1: in communities where the current prevalence of infection is still

325
00:20:35,116 --> 00:20:39,876
Speaker 1: high and rising. So there are many communities where protests

326
00:20:39,876 --> 00:20:44,836
Speaker 1: are happening where the incidence of infection is quite low

327
00:20:45,116 --> 00:20:49,356
Speaker 1: or getting even lower, and so I'm less concerned in

328
00:20:49,476 --> 00:20:54,436
Speaker 1: those communities, but still extremely concerned. But I also fully

329
00:20:54,596 --> 00:20:59,516
Speaker 1: respect the need to protest right now, and everybody has

330
00:20:59,556 --> 00:21:01,956
Speaker 1: to take the risks that they think are appropriate for them.

331
00:21:02,156 --> 00:21:05,476
Speaker 1: But from my vantage point, if you wear a mask,

332
00:21:05,836 --> 00:21:08,476
Speaker 1: if you try to prevent touching your face, if you

333
00:21:08,556 --> 00:21:11,596
Speaker 1: watch your and try to protect yourself and others by

334
00:21:11,636 --> 00:21:16,196
Speaker 1: not screaming, shouting, or yelling while maintaining distance, I think

335
00:21:16,236 --> 00:21:20,916
Speaker 1: you can still have an equally effective protest. And I

336
00:21:21,076 --> 00:21:22,996
Speaker 1: know that that is hard to do. I know what

337
00:21:23,036 --> 00:21:28,436
Speaker 1: I'm asking for is almost impossible, and that maybe I'll

338
00:21:28,476 --> 00:21:31,996
Speaker 1: convince a few others to protest in that way, but

339
00:21:32,116 --> 00:21:34,956
Speaker 1: that the majority of people won't want to do that,

340
00:21:35,236 --> 00:21:38,716
Speaker 1: And I understand that, and I respect that decision, but

341
00:21:38,836 --> 00:21:42,836
Speaker 1: I do feel that the risk that you're potentially putting

342
00:21:42,836 --> 00:21:47,636
Speaker 1: others too, and you yourself are putting yourself at is

343
00:21:47,956 --> 00:21:52,276
Speaker 1: potentially significant. I fully acknowledge that the outdoors is better,

344
00:21:52,716 --> 00:21:56,276
Speaker 1: But we don't have the science of riots and protests

345
00:21:56,596 --> 00:22:01,036
Speaker 1: to say that we can extrapolate the data we have

346
00:22:01,116 --> 00:22:03,556
Speaker 1: so far to these settings. I don't think is accurate,

347
00:22:03,916 --> 00:22:06,556
Speaker 1: and so I think as an infectious disease doctor, as

348
00:22:06,596 --> 00:22:08,836
Speaker 1: an epidemiologist, I'm going to be on the side of

349
00:22:08,836 --> 00:22:12,116
Speaker 1: cause I'm going to be on the side of putting

350
00:22:12,316 --> 00:22:17,116
Speaker 1: into place the measures that can most likely result in

351
00:22:17,156 --> 00:22:21,956
Speaker 1: the least number of infections, not no infections. I'm not

352
00:22:22,036 --> 00:22:26,396
Speaker 1: expecting that, I'm just expecting to reduce the number. Fast

353
00:22:26,476 --> 00:22:30,276
Speaker 1: forward a month. Imagine, just for the sake of argument,

354
00:22:30,436 --> 00:22:35,236
Speaker 1: that we haven't seen a substantial spike in cases correlated

355
00:22:35,316 --> 00:22:38,276
Speaker 1: in any way, shape or form with the locations of protests.

356
00:22:38,476 --> 00:22:41,596
Speaker 1: Imagine a best case scenario. Would you then think that

357
00:22:41,636 --> 00:22:45,996
Speaker 1: it would be plausible for public health officials to say, Okay,

358
00:22:45,996 --> 00:22:50,076
Speaker 1: it's the summer, the beach is really pretty safe because

359
00:22:50,116 --> 00:22:52,276
Speaker 1: it's not as extreme as a protest, and there's no

360
00:22:52,316 --> 00:22:57,956
Speaker 1: tear gas there, and pools are outdoors and therefore reduced

361
00:22:57,996 --> 00:23:02,276
Speaker 1: transmissions substantially, and outdoor restaurants should be opened, and we

362
00:23:02,276 --> 00:23:05,676
Speaker 1: should basically treat the summer while we can as before

363
00:23:05,676 --> 00:23:07,756
Speaker 1: the fall comes and we are all indoors in high

364
00:23:07,756 --> 00:23:11,156
Speaker 1: transmission environments, again as an opportunity to get out there

365
00:23:11,156 --> 00:23:14,196
Speaker 1: and live a little bit of life. Can you imagine

366
00:23:14,196 --> 00:23:16,356
Speaker 1: a scenario like that, and if the data doesn't spike

367
00:23:16,436 --> 00:23:19,316
Speaker 1: by then, do you think you would be comfortable making

368
00:23:19,316 --> 00:23:22,476
Speaker 1: recommendations like that. I think I might. I think you know,

369
00:23:22,516 --> 00:23:25,916
Speaker 1: I'd like to see where we go. But I think

370
00:23:26,316 --> 00:23:30,076
Speaker 1: in an ideal best case scenario, if that's the case,

371
00:23:30,996 --> 00:23:34,676
Speaker 1: I think I would listen to your local public health

372
00:23:34,716 --> 00:23:39,196
Speaker 1: officials and governors and people making regulations for your local

373
00:23:39,276 --> 00:23:41,636
Speaker 1: districts because every area is going to be a little

374
00:23:41,676 --> 00:23:46,036
Speaker 1: bit different, and the nuance and reasoning in different areas

375
00:23:46,076 --> 00:23:49,236
Speaker 1: are going to be different. But for me personally, if

376
00:23:49,276 --> 00:23:52,436
Speaker 1: we see that, I'll feel even better about what I

377
00:23:52,516 --> 00:23:56,396
Speaker 1: recommend people to do in terms of the outdoors. But again,

378
00:23:57,316 --> 00:24:00,076
Speaker 1: what I've seen is that most of these places people

379
00:24:00,116 --> 00:24:03,156
Speaker 1: have been wearing masks. So if you're going to be

380
00:24:03,236 --> 00:24:05,836
Speaker 1: up close and personal with somebody, I'm not going to

381
00:24:05,876 --> 00:24:08,156
Speaker 1: tell you to take your mask off. I'm going to

382
00:24:08,236 --> 00:24:10,676
Speaker 1: say keep your mouth gone, which is hard in the

383
00:24:10,716 --> 00:24:13,756
Speaker 1: summer and being outdoors and all that. But if you're

384
00:24:13,796 --> 00:24:16,796
Speaker 1: on the beach, and you're spread out and you have

385
00:24:16,876 --> 00:24:19,076
Speaker 1: your mask off and you're not necessarily getting all on

386
00:24:19,116 --> 00:24:23,156
Speaker 1: top of other people. I will absolutely feel comfort with that.

387
00:24:23,276 --> 00:24:25,476
Speaker 1: I think I would say again, it's not a no

388
00:24:25,676 --> 00:24:30,396
Speaker 1: risk situation, it's an extremely low risk situation. I hope

389
00:24:30,396 --> 00:24:32,996
Speaker 1: that we end up there. I really do, because I

390
00:24:33,036 --> 00:24:39,356
Speaker 1: am concerned about December January February, our typical flu season spike,

391
00:24:39,836 --> 00:24:44,356
Speaker 1: and to have the mental health of the American people

392
00:24:44,916 --> 00:24:47,876
Speaker 1: be in a place where they're ready for our next

393
00:24:47,916 --> 00:24:51,956
Speaker 1: typical flu season, to have had time where they got

394
00:24:51,996 --> 00:24:56,036
Speaker 1: outside and reengaged with friends and family and had some

395
00:24:56,116 --> 00:25:00,836
Speaker 1: time to be able to maybe reduce the anxiety, fear,

396
00:25:01,156 --> 00:25:06,156
Speaker 1: and preoccupation with getting infected. It would be a great

397
00:25:06,396 --> 00:25:08,756
Speaker 1: way to give people a little bit of a release

398
00:25:09,236 --> 00:25:12,836
Speaker 1: before going into the next season. But I think, as

399
00:25:13,076 --> 00:25:16,276
Speaker 1: you've kind of alluded to, none of these things are

400
00:25:16,316 --> 00:25:19,636
Speaker 1: going to be all or none, light on, light off.

401
00:25:20,396 --> 00:25:22,836
Speaker 1: It's going to be Can we phase a little bit

402
00:25:22,876 --> 00:25:26,236
Speaker 1: in the direction of loosening things up and enjoying what

403
00:25:26,276 --> 00:25:28,996
Speaker 1: we can while we can in the summer, and then

404
00:25:29,036 --> 00:25:32,916
Speaker 1: potentially locking down, clamping down a little bit more when

405
00:25:32,916 --> 00:25:34,516
Speaker 1: it's going to be cold and people are going to

406
00:25:34,556 --> 00:25:37,916
Speaker 1: be stuck inside, and that's when disease transmission usually we

407
00:25:37,956 --> 00:25:40,876
Speaker 1: would anticipate is going to be higher. Anyway, thank you

408
00:25:40,996 --> 00:25:44,796
Speaker 1: Manasa so much for this detailed analysis of the science

409
00:25:44,836 --> 00:25:48,996
Speaker 1: and ethics of transmission and protesting, and thanks for your

410
00:25:49,196 --> 00:25:52,676
Speaker 1: amazing work, and thanks for joining me. Thank you so

411
00:25:52,756 --> 00:25:55,916
Speaker 1: much for having me listening to doctor Jutani's a very

412
00:25:55,956 --> 00:26:01,236
Speaker 1: cogent analysis. I think there are a few pretty straightforward takeaways. One,

413
00:26:01,836 --> 00:26:05,356
Speaker 1: at least as we know from the data, transmission of

414
00:26:05,396 --> 00:26:10,516
Speaker 1: the virus outdoors seems to be extremely unusual. Two, that

415
00:26:10,716 --> 00:26:15,036
Speaker 1: same body of data can not yet be safely extrapolated

416
00:26:15,316 --> 00:26:18,116
Speaker 1: to the circumstances of a protest, because that data was

417
00:26:18,156 --> 00:26:22,596
Speaker 1: collected in winter in China, under circumstances where many people

418
00:26:22,596 --> 00:26:25,956
Speaker 1: were in lockdown, and when there were not protests, with

419
00:26:26,036 --> 00:26:32,236
Speaker 1: people singing, chanting, coughing, and engaging in other aerosolizing events

420
00:26:32,356 --> 00:26:37,196
Speaker 1: potentially in proximity to each other. Third, the difficult ethical

421
00:26:37,276 --> 00:26:41,236
Speaker 1: question of whether protest is appropriate under circumstances of pandemic

422
00:26:41,796 --> 00:26:45,716
Speaker 1: is very much inflected by an empirical prediction without knowledge

423
00:26:45,716 --> 00:26:49,076
Speaker 1: of exact science about how likely it is for the

424
00:26:49,116 --> 00:26:52,116
Speaker 1: disease to spread. And I thought that Menetia was particularly

425
00:26:52,156 --> 00:26:55,876
Speaker 1: insightful when describing her own decision to go out in protest,

426
00:26:56,116 --> 00:26:57,956
Speaker 1: but to do it from the periphery of the crowd

427
00:26:58,116 --> 00:27:02,756
Speaker 1: and to avoid chanting and singing. Fourth and last, in

428
00:27:02,796 --> 00:27:06,436
Speaker 1: a month or so, we may actually have some preliminary

429
00:27:06,476 --> 00:27:10,556
Speaker 1: sense of new science about what mission looks like under

430
00:27:10,556 --> 00:27:14,756
Speaker 1: circumstances of protest. And maybe, just maybe, if we're lucky

431
00:27:14,956 --> 00:27:18,636
Speaker 1: and we don't see significant disease spike in the next month,

432
00:27:18,996 --> 00:27:21,636
Speaker 1: it might be possible over the summer for us to

433
00:27:21,676 --> 00:27:26,916
Speaker 1: conclude that spending time outdoors, albeit with masks, places us

434
00:27:26,956 --> 00:27:31,076
Speaker 1: in relatively low risk of transmission. But it's too soon

435
00:27:31,116 --> 00:27:34,116
Speaker 1: to know that. We won't know that till sometime around

436
00:27:34,276 --> 00:27:38,476
Speaker 1: the July fourth weekend. We will continue to follow closely

437
00:27:38,796 --> 00:27:41,836
Speaker 1: the question of how the virus spreads and what is

438
00:27:41,876 --> 00:27:45,236
Speaker 1: safe for people to do outdoors over the course of

439
00:27:45,276 --> 00:27:47,756
Speaker 1: the summer. Until the next time I speak to you,

440
00:27:48,316 --> 00:27:52,796
Speaker 1: Be careful, be safe, and be well. Deep background is

441
00:27:52,836 --> 00:27:55,996
Speaker 1: brought to you by Pushkin Industries. Our producer is Lydia

442
00:27:56,076 --> 00:27:59,516
Speaker 1: Jane Cott, with research help from zoo Win and mastering

443
00:27:59,516 --> 00:28:04,036
Speaker 1: by Jason Gambrel and Martin Gonzalez. Our showrunner is Sophie mckibbon.

444
00:28:04,596 --> 00:28:07,876
Speaker 1: Our theme music is composed by Luis Guerra. Special thanks

445
00:28:07,876 --> 00:28:11,596
Speaker 1: to the Pushkin Brass, Malcolm Gladwell, Jacob Weisberg, and Mia Lobel.

446
00:28:12,276 --> 00:28:15,236
Speaker 1: I'm Noah Feldman. I also write a regular column for

447
00:28:15,316 --> 00:28:18,756
Speaker 1: Bloomberg Opinion, which you can find at Bloomberg dot com

448
00:28:18,756 --> 00:28:23,076
Speaker 1: slash Feldman. To discover Bloomberg's original slate of podcasts, go

449
00:28:23,156 --> 00:28:27,356
Speaker 1: to Bloomberg dot com slash podcasts. And one last thing,

450
00:28:27,796 --> 00:28:30,956
Speaker 1: I just wrote a book called The Arab Winter, The Tragedy.

451
00:28:31,316 --> 00:28:33,236
Speaker 1: I would be delighted if you checked it out. You

452
00:28:33,236 --> 00:28:34,916
Speaker 1: can always let me know what you think on Twitter

453
00:28:35,156 --> 00:28:38,116
Speaker 1: about this episode, or the book or anything else. My

454
00:28:38,196 --> 00:28:41,836
Speaker 1: handle is Noah R. Feldman. This is deep background