WEBVTT - What We Know About How Coronavirus Spreads 0:00:15.356 --> 0:00:22.356 Pushkin from Pushkin Industries. This is Deep Background, the show 0:00:22.396 --> 0:00:25.636 where we explored the stories behind the stories in the news. 0:00:26.076 --> 0:00:30.116 I'm Noah Feldman, and right now the only story that 0:00:30.196 --> 0:00:33.956 anyone is talking about is coronavirus. In order to make 0:00:33.996 --> 0:00:38.316 sense of coronavirus, we decided to speak to Sidhart Mukherjee, 0:00:38.636 --> 0:00:42.876 who is probably the foremost interpreter in my generation of 0:00:42.916 --> 0:00:46.636 the meaning of disease and how it affects our daily lives. 0:00:47.076 --> 0:00:49.716 You probably know his book The Emperor of All Maladies 0:00:49.836 --> 0:00:53.076 of Biography of Cancer, which one the twenty eleven Pulitzer 0:00:53.116 --> 0:00:56.396 Prize for General Nonfiction. You may also know his twenty 0:00:56.396 --> 0:01:00.716 seventeen book The Gene and Intimate History. Sidhart is a 0:01:00.836 --> 0:01:04.876 voice of reason, logic, and thoughtfulness, and he's the person 0:01:04.996 --> 0:01:08.276 I wanted to hear from at exactly this moment of panic. 0:01:09.836 --> 0:01:11.836 So Sid, maybe we can start by a my just 0:01:11.996 --> 0:01:17.116 asking you, how have you been thinking medically, statistically, personally, 0:01:17.196 --> 0:01:21.116 or otherwise about the coronavirus epidemic as it gradually rolls 0:01:21.156 --> 0:01:25.876 itself out. Well, so there are several questions in that, 0:01:26.036 --> 0:01:29.796 because there's that I've been thinking different medically, personally and statistically. 0:01:29.836 --> 0:01:32.996 But let me just tell you a very broad through 0:01:33.116 --> 0:01:38.276 landscape view. Right now, we're in a moment of some 0:01:38.596 --> 0:01:43.036 degree of confusion. There are, like any epidemic, or like 0:01:43.116 --> 0:01:48.036 any virus, coronavirus has some absolutes. In other words, there's 0:01:48.036 --> 0:01:51.356 some absolute things about the virus that are determined by 0:01:51.396 --> 0:01:54.396 its biology and by the interaction of that biology with 0:01:54.516 --> 0:01:59.076 the host. There's a real number which predicts how many 0:01:59.156 --> 0:02:01.836 people you infect if you you know what the so 0:02:01.956 --> 0:02:05.036 called are not value is and what the case fatality 0:02:05.156 --> 0:02:08.836 rate is, etc. And we need to know those very 0:02:08.916 --> 0:02:12.956 much in order to understand how to develop an effective 0:02:12.956 --> 0:02:16.396 strategy against it, whether it be quarantine or you know, 0:02:16.796 --> 0:02:21.196 medicines or whatever it might be. The problem is that 0:02:21.236 --> 0:02:28.636 those numbers are included by random chance events and by 0:02:29.076 --> 0:02:32.916 underreporting of the actual virus. So what do I mean 0:02:32.956 --> 0:02:34.956 that by that? If you look at the map of 0:02:36.036 --> 0:02:39.516 the spread, there are, as you know, eighty thousand odd 0:02:39.516 --> 0:02:44.516 cases in China, there are one thousand od cases in Japan. 0:02:45.116 --> 0:02:48.396 There are x thousand odd cases you know, in neighboring countries. 0:02:49.116 --> 0:02:53.836 But then there are some obviously some peculiar anomalies. There's 0:02:53.836 --> 0:02:56.236 this big case load in the Italy of all places 0:02:56.236 --> 0:02:59.956 in northern Italy and Lombardy and other places. Why did 0:02:59.996 --> 0:03:02.236 all of a sudden it skip all of Europe and 0:03:02.316 --> 0:03:08.356 become this major infection in northern Italy. It's not as 0:03:08.396 --> 0:03:11.676 if you know Han and you know Venus our major 0:03:11.756 --> 0:03:14.636 criss crossing destinations for each other. I mean, there is 0:03:14.676 --> 0:03:17.956 tourism of course between Italy and China. But something bizarre 0:03:17.996 --> 0:03:20.956 happened there, something that we can we cannot simply explain. 0:03:21.436 --> 0:03:24.956 So we are in a situation where we have to 0:03:24.996 --> 0:03:28.836 get we have to provide two kinds of explanations. One 0:03:28.956 --> 0:03:31.916 kind of explanation is as what I call are the 0:03:32.036 --> 0:03:37.276 viral absolutes, the epidemiological absolutes, and the statistical absolutes. What 0:03:37.436 --> 0:03:40.676 is the actual number of cases that is being detected 0:03:40.956 --> 0:03:43.436 or found? And then there are these things that, you know, 0:03:43.436 --> 0:03:47.276 how do we explain it that places that shouldn't seem 0:03:47.316 --> 0:03:52.076 to have any connection are suddenly epicenters of the worst 0:03:52.116 --> 0:03:55.476 parts of the epidemic. And that's what's that's what's very 0:03:55.476 --> 0:03:59.556 confusing about it at the moment. So from what you've said, 0:04:00.236 --> 0:04:04.156 the problem is that although there are absolutes, we definitely 0:04:04.156 --> 0:04:06.036 don't know them now and we may not know them 0:04:06.116 --> 0:04:09.716 until very very late in this process. They are there somewhere, 0:04:09.756 --> 0:04:12.036 but we can't get at them. The best way to 0:04:12.036 --> 0:04:14.956 get at them is is to let time is a 0:04:14.956 --> 0:04:16.796 little bit more time pass, And I'm not talking about 0:04:16.796 --> 0:04:19.316 a lot of time. I'm talking about, you know, a 0:04:19.396 --> 0:04:22.556 process of weeks, maybe a couple of weeks, three weeks, etc. 0:04:23.636 --> 0:04:27.756 And then also to in the meantime to separate the 0:04:28.116 --> 0:04:31.076 wheat from the shaft, so to separate out the things 0:04:31.076 --> 0:04:36.676 that are including these absolutes such as random movements and underreporting, 0:04:36.996 --> 0:04:39.516 and find out what the real numbers are, so that 0:04:39.556 --> 0:04:42.756 we get some sense in a given population what these 0:04:42.756 --> 0:04:47.476 epidemological absolutes are. What is the actual case fatality rate? 0:04:48.316 --> 0:04:50.396 So if you look, for instance, in the United States, 0:04:50.716 --> 0:04:54.556 there have been five hundred odd cases and twenty two deaths, 0:04:54.596 --> 0:04:57.596 that would put the case fatality rate at four percent, 0:04:57.756 --> 0:05:02.076 give or take. If you look at another place in 0:05:02.116 --> 0:05:05.556 parts of Europe, there've been a thousand cases and three deaths, 0:05:05.596 --> 0:05:08.916 which would put it a full magnitude less than the 0:05:09.196 --> 0:05:12.556 United States. But there is there is an actual number. 0:05:12.596 --> 0:05:14.636 There's a number to be had, or even a range 0:05:14.636 --> 0:05:16.796 of numbers to be had, of what the actual case 0:05:16.796 --> 0:05:19.796 fatality rate is and the decision of the severity of 0:05:19.836 --> 0:05:23.036 the epidemic will depend on that actual case fatality rate. 0:05:23.436 --> 0:05:27.036 There is an actual number, an absolute truth as to 0:05:27.076 --> 0:05:30.916 the number of people you are likely to infect under 0:05:30.956 --> 0:05:33.596 normal circumstances in it through going through a normal day. 0:05:33.836 --> 0:05:37.396 So it will take a few days, perhaps weeks, before 0:05:37.476 --> 0:05:40.836 some of these clouds clear and we begin to get actual, 0:05:40.956 --> 0:05:43.996 real estimates of what those numbers are. We're getting there. 0:05:44.076 --> 0:05:46.356 We have a sense of what it is, I think 0:05:46.396 --> 0:05:50.316 with COVID nineteen, but it's not all there yet and 0:05:50.636 --> 0:05:54.956 we're slowly getting there. So first point then for listeners, 0:05:54.956 --> 0:05:57.596 I think, is that this number, which we're all going 0:05:57.676 --> 0:05:59.996 to have to become very familiar with, the R zero 0:06:00.156 --> 0:06:02.116 or are not as you called it, which is the 0:06:02.196 --> 0:06:05.556 number that tells us for a person who's infected and 0:06:05.716 --> 0:06:08.476 is exposed to others, how many people will become infected, 0:06:08.916 --> 0:06:12.636 is going to become clearer in the relatively near future. 0:06:13.036 --> 0:06:16.076 And of course it might depend on the genetics of 0:06:16.116 --> 0:06:19.276 a population. That's a very important point, which is to 0:06:19.316 --> 0:06:23.676 figure out whether there's some populations that are particularly susceptible, 0:06:23.796 --> 0:06:28.076 whereas some populations are particularly non susceptible. We just don't 0:06:28.116 --> 0:06:31.516 know that yet. But again, these numbers will become clear. 0:06:32.556 --> 0:06:36.476 Once they do become clearer, what will the next step 0:06:36.836 --> 0:06:39.996 really be, Because then we leave the realm of absolutes 0:06:40.276 --> 0:06:45.156 and we enter the realm of social policy response. First 0:06:45.156 --> 0:06:46.876 of all, if it turns out that the number of 0:06:46.876 --> 0:06:50.716 people that you can infect while you're an asymptomatic carrier 0:06:50.756 --> 0:06:55.236 of the virus is large, then it makes most sense 0:06:55.316 --> 0:07:00.476 to impose quarantining and rather draconian quarantining in areas that 0:07:00.516 --> 0:07:03.836 are very severely affected, as China has done. As China 0:07:03.876 --> 0:07:07.236 has done. That's correct. So if both those things are true, 0:07:07.276 --> 0:07:10.836 if you're an asymptomatic carrier and you can infect a 0:07:10.916 --> 0:07:14.396 large number of people, then quarantining and other sort of 0:07:14.596 --> 0:07:19.756 I would say broadly prophylactic measures. Work Number two is 0:07:19.796 --> 0:07:23.716 to identify the susceptible population, like who is the most 0:07:24.036 --> 0:07:28.756 susceptible population to the exposure. Remember in the early days 0:07:28.836 --> 0:07:34.036 of the HIV epidemic in the United States, those numbers 0:07:34.076 --> 0:07:36.636 came about quite slowly, but eventually wor figure out there 0:07:36.756 --> 0:07:40.316 was a susceptible population men who had sex with men, 0:07:40.716 --> 0:07:43.916 and there was a susceptible population of hemophiliacs who are 0:07:43.956 --> 0:07:48.116 receiving blood transfusions. Of course, internationally, now that's no longer true. 0:07:48.156 --> 0:07:52.316 The vast number of people infectively HIV are no longer 0:07:52.316 --> 0:07:55.356 those two populations. It's now become a completely different disease. 0:07:55.876 --> 0:08:01.156 But when you identify susceptible populations where you have a 0:08:01.236 --> 0:08:04.716 high level of transmission of risk, then you can make 0:08:04.996 --> 0:08:08.276 social policy measures which are not as blunt as the 0:08:08.316 --> 0:08:11.676 ones that are are made without those so they can 0:08:11.716 --> 0:08:14.236 be much more targeted. You target the people at risk, 0:08:14.316 --> 0:08:16.596 and you try to figure out how to move about 0:08:16.716 --> 0:08:21.236 life in business and economy without imposing the kind of 0:08:21.436 --> 0:08:27.156 very draconian quarantining efforts that we've seen in places like China. 0:08:27.236 --> 0:08:30.196 So let's try to see if even under these conditions 0:08:30.196 --> 0:08:34.396 of uncertainty, you can't guide our listeners through some kind 0:08:34.436 --> 0:08:37.716 of rational behavior. I'm not saying rational behavior once we 0:08:37.836 --> 0:08:41.036 know the numbers, but rational behavior right now under conditions 0:08:41.036 --> 0:08:47.156 of uncertainty. So let's take a really simple example. You know, 0:08:47.236 --> 0:08:49.876 I planned a month ago to bring my kids on 0:08:50.116 --> 0:08:54.076 a spring break trip to New Orleans, so it's domestic 0:08:54.156 --> 0:08:57.636 travel their kids. Very few kids have gotten this. If 0:08:57.676 --> 0:09:00.556 they have gotten it, they haven't haven't had very bad symptoms. 0:09:01.076 --> 0:09:02.996 But of course New Orleans is a tourist destination. There 0:09:03.036 --> 0:09:04.716 are lots of people there. If you click on the 0:09:05.196 --> 0:09:07.676 Louisiana State Board of Health, they say there are no 0:09:07.756 --> 0:09:10.676 reported cases in Louisiana. Now you look at the CDC website, 0:09:10.956 --> 0:09:13.876 it doesn't tell you not to engage in any domestic travel. 0:09:14.436 --> 0:09:17.796 And yet, on the other hand, you know universities are 0:09:17.836 --> 0:09:20.836 in the process as we speak, of telling everybody that 0:09:20.876 --> 0:09:23.556 they're going to run their classes remotely, even in places 0:09:23.596 --> 0:09:27.556 with very few cases of the disease reported. How irrational 0:09:27.756 --> 0:09:31.316 is it or how rational is it to say, you know, 0:09:31.436 --> 0:09:33.676 we've planned this trip, we're going to go. We're not 0:09:33.716 --> 0:09:36.596 in any great risk factor. Airplane travel is not inherently 0:09:36.596 --> 0:09:40.356 more dangerous than getting on public transportation. There's a question 0:09:40.476 --> 0:09:45.196 of particular in dissociety. There's a question of personal liability 0:09:45.396 --> 0:09:49.836 versus I would say institutional liability. So, and they're different. 0:09:49.996 --> 0:09:52.996 When you're taking your children to travel with you to 0:09:53.116 --> 0:09:55.596 New Orleans, I agree with you that the risk is 0:09:55.836 --> 0:09:58.716 small children, as you very well know, don't seem to 0:09:58.756 --> 0:10:00.876 get the severe variant of the disease. In fact, i'd 0:10:00.876 --> 0:10:05.156 be more worried about you than your children. But you're 0:10:05.156 --> 0:10:09.676 taking that on as a personal liability. Institutions, as you know, 0:10:10.596 --> 0:10:16.716 especially in this climate, political climate, and social climate, don't 0:10:16.756 --> 0:10:20.236 want to take institutional liabilities. It's a difference between personal 0:10:20.276 --> 0:10:23.116 liability and institutional liability that we're talking about. I would 0:10:23.116 --> 0:10:26.116 say the likelihood that a Stanford student will get a 0:10:26.156 --> 0:10:31.276 severe variant of COVID nineteen is extremely low. The closure 0:10:31.276 --> 0:10:34.876 of the university and conversion of into remote classes is 0:10:34.916 --> 0:10:39.276 not the biggest deal, and so in that risk benefit analysis, 0:10:39.516 --> 0:10:44.636 the institution chose to diminish their institutional liability by saying, look, 0:10:44.676 --> 0:10:48.276 you know, we have the infrastructure already to do this, 0:10:48.836 --> 0:10:51.636 and so we'll go ahead. This is in great contrast too. 0:10:51.716 --> 0:10:55.276 For instance, the New York school system. As you very 0:10:55.276 --> 0:10:57.676 well know, the New York school system is not just 0:10:57.796 --> 0:11:00.916 a school system, but it's a social network, and it's 0:11:00.956 --> 0:11:06.036 a social network that provides meals, often to under privileged 0:11:06.116 --> 0:11:10.436 and kids from very poor back grounds. If they were 0:11:10.476 --> 0:11:13.076 to stay at home, they would mean that their parents 0:11:13.476 --> 0:11:16.636 would need to take time off work, and you know, 0:11:16.676 --> 0:11:20.036 the economic costs would be staggering. So it's closing down 0:11:20.076 --> 0:11:23.996 a school system where there is no simple infrastructure for 0:11:24.076 --> 0:11:27.636 remote schooling anyway. Plus the actual school provides a safe 0:11:27.636 --> 0:11:32.596 haven for millions of kids. The question of institutional liability 0:11:32.716 --> 0:11:37.716 is completely different. So in your particular case, I think 0:11:37.756 --> 0:11:40.876 that's a personal liability that you're taking with pretty minimal risk. 0:11:41.036 --> 0:11:42.716 And then that, by the way, that might not only 0:11:42.756 --> 0:11:45.796 be about any potential downside for a mere my kids. 0:11:45.796 --> 0:11:48.676 It might be about we don't want to become carriers. 0:11:48.836 --> 0:11:51.956 And the reality is that the more people circulating, the 0:11:52.036 --> 0:11:55.756 more difficult it becomes to restrain the spread of the virus. 0:11:55.796 --> 0:11:57.676 And so it might be as a publicly interested matter, 0:11:58.076 --> 0:12:00.236 you know, one arguably ought to stay home, right, And 0:12:00.636 --> 0:12:06.636 again the question really becomes a question of looking very 0:12:06.636 --> 0:12:11.556 dispassionately at risk versus benefit. So remember that if you 0:12:11.996 --> 0:12:15.556 look through as anyone might, you can it's all accessible. 0:12:16.076 --> 0:12:19.796 There are recommendations now for virtually every country where you 0:12:19.796 --> 0:12:24.596 could travel too, in terms of completely rest travel, restrict 0:12:24.676 --> 0:12:29.556 unnecessary travel, or be free to travel. It would be 0:12:29.596 --> 0:12:33.356 helpful to have that for the United States as well, 0:12:33.396 --> 0:12:36.596 in terms of potentially every city or state that you're 0:12:36.636 --> 0:12:41.116 traveling to, because the hotspot areas are known. So in 0:12:41.116 --> 0:12:44.476 other words, someone like you should be able to without 0:12:44.596 --> 0:12:48.316 multiple clicks, go to Louisiana, go to New Orleans, figure 0:12:48.316 --> 0:12:52.396 out what the case numbers are today, and figure out 0:12:52.476 --> 0:12:56.476 what the actual risk is, and make a personal decision 0:12:56.796 --> 0:12:58.956 whether to take on that risk, whatever it might be. 0:12:59.436 --> 0:13:01.756 Can I ask a policy question that follows from that? 0:13:01.876 --> 0:13:04.876 So one interesting thing to me is that no government 0:13:04.916 --> 0:13:10.276 website has said the following, we advise you not to 0:13:10.356 --> 0:13:13.836 engage in unnecessary travel, even to places where there are 0:13:13.836 --> 0:13:16.836 no reported cases. That has not been said on any 0:13:16.836 --> 0:13:21.116 government website. And yet my guess is that many physicians 0:13:21.156 --> 0:13:23.516 would say, well, this is common sense, don't engage in 0:13:23.596 --> 0:13:26.356 unnecessary travel, even to an unaffected place. I mean, my 0:13:26.476 --> 0:13:31.036 university sent around guidelines saying if it's university business, no 0:13:31.236 --> 0:13:36.196 unnecessary travel on university business anywhere within the domestic United States. 0:13:36.876 --> 0:13:39.476 So what I'm wondering is, as a physician, do you 0:13:39.516 --> 0:13:42.156 have the sense that there is some gap between what 0:13:42.916 --> 0:13:46.596 rational medical professionals would at this point recommend and what 0:13:46.676 --> 0:13:51.676 government agencies are recommending, maybe potentially for political reasons, you know. 0:13:51.876 --> 0:13:53.556 In other words, I I don't have the faith that 0:13:53.556 --> 0:13:56.356 I would like to have that the CDC hasn't advised 0:13:56.396 --> 0:14:01.756 me not to travel domestically because it's safe to do so, 0:14:02.116 --> 0:14:04.996 as opposed to the CDC hasn't recommended that I not 0:14:05.076 --> 0:14:07.556 traveled domestley because they're worried that the President will get 0:14:07.596 --> 0:14:11.356 angry at them because he'll say there's down the economy. Well, 0:14:11.396 --> 0:14:16.436 I think the CDC is being quite rational and careful here. 0:14:17.956 --> 0:14:21.516 I don't think. I'm not sure, but I don't think 0:14:21.556 --> 0:14:25.796 that the reason that the CDC has not issued a 0:14:25.836 --> 0:14:29.796 blanket statement against travel is that it's it's it's trying 0:14:29.836 --> 0:14:32.316 to appease the president. I just think the CDC is 0:14:32.836 --> 0:14:38.796 trying to be reasonable about shutting down, you know, things 0:14:38.836 --> 0:14:42.756 that make the normal business and the normal lives of 0:14:42.796 --> 0:14:49.676 Americans livable under these circumstances. Said, one of your superpowers 0:14:49.956 --> 0:14:53.356 is not only to be a top and scientist, but 0:14:53.476 --> 0:14:56.836 also to be able to explain to us the cultural 0:14:56.916 --> 0:15:02.036 meanings of our interaction with scientific reality. When you wear 0:15:02.196 --> 0:15:05.996 that hat, your interpreter of maladies had, how do you 0:15:06.036 --> 0:15:10.396 think about what we're going through at the moment. Well, 0:15:10.436 --> 0:15:15.316 I think that in some ways this reads like a 0:15:15.476 --> 0:15:21.196 modern version of Cameos. The plague. The first set of 0:15:22.076 --> 0:15:25.596 decisions that were made in Wuhan which we now know 0:15:25.956 --> 0:15:29.596 and understand a little bit better, were made out of 0:15:29.636 --> 0:15:35.436 fear and were actually extraordinarily erroneous decisions, which in turn 0:15:35.516 --> 0:15:40.756 points to the idea that given the globalization of the world, 0:15:40.836 --> 0:15:43.556 given the nature of travel, given the nature of the 0:15:43.556 --> 0:15:47.156 interactions between people, you know, this isn't this isn't a 0:15:47.316 --> 0:15:52.196 China only problem. It soon becomes a world problem. China's 0:15:52.236 --> 0:15:56.516 suffering grave economic consequences of this now, and it will 0:15:56.556 --> 0:16:00.036 continue to suffer grave economic consequences. But those grave economic 0:16:00.076 --> 0:16:05.076 consequences were themselves the consequences of a political regime which 0:16:05.156 --> 0:16:10.916 is fundamentally unable to be free with information. So the 0:16:10.996 --> 0:16:14.516 first thing it highlights, I think in the cultural realm 0:16:15.116 --> 0:16:18.436 is that information moves at light speed around the world today, 0:16:18.436 --> 0:16:21.156 and that's a good thing in the case of an epidemic. 0:16:21.476 --> 0:16:26.356 The suppression of information, a paternalistic attitude towards a grave 0:16:26.396 --> 0:16:31.276 disease is a terrible decision to make, And in some ways, 0:16:32.356 --> 0:16:35.596 there's a kind of reckoning that's going on within China, 0:16:35.596 --> 0:16:39.076 as many people have noted, there's a reckoning that's going 0:16:39.156 --> 0:16:41.956 on whether this can continue or not, I mean, can 0:16:42.276 --> 0:16:47.516 this statewide a suppression of facts we still don't know 0:16:47.596 --> 0:16:50.636 actually what's true and what's not true. The Chinese are 0:16:50.636 --> 0:16:55.276 now telling us that they're quarantining has been extraordinarily successful, etc. 0:16:56.156 --> 0:17:01.276 Strong Men presidents who believe in confining people are very 0:17:01.356 --> 0:17:03.636 likely to believe this kind of rhetoric. Oh, you know, 0:17:03.716 --> 0:17:07.276 just throw everyone into, you know, behind blue doors and 0:17:07.596 --> 0:17:10.876 it'll all be fine. So I think what it's revealed, 0:17:11.476 --> 0:17:15.916 I think is the is how vulnerable the world is 0:17:16.516 --> 0:17:21.236 to political regimes that have really become outdated, and how 0:17:21.276 --> 0:17:25.796 quickly information can move, how restricting that information can have 0:17:25.876 --> 0:17:30.636 grave consequences for the country itself. What if it turns out, though, that, 0:17:30.956 --> 0:17:35.236 notwithstanding China's restriction on information, and notwithstanding the fact that 0:17:35.276 --> 0:17:37.956 we of course can't trust what the government is saying 0:17:37.956 --> 0:17:41.756 about data, that the rather draconian response that they did 0:17:41.836 --> 0:17:44.396 worked really well. I mean, I can imagine, you know, 0:17:44.436 --> 0:17:46.076 this is just one of the possible states of the world, 0:17:46.116 --> 0:17:49.356 but I can imagine an outcome where it actually turns 0:17:49.356 --> 0:17:52.956 out that the draconian response was very effective, and that 0:17:53.116 --> 0:17:56.556 the less draconian responses that may be undertaken by more 0:17:56.596 --> 0:17:59.356 liberal countries like the United States turn out not to 0:17:59.436 --> 0:18:03.836 contain the disease as well, absolutely, and which is again 0:18:03.916 --> 0:18:09.636 why you know a kind of help from the the 0:18:09.796 --> 0:18:14.116 CDC would be is coming and is most appreciated. I 0:18:14.116 --> 0:18:17.916 should also say that the way to do this, it's 0:18:17.956 --> 0:18:23.036 really threading a needle, and threading a needle very carefully. 0:18:23.116 --> 0:18:24.916 This is going on right now in Italy, as you 0:18:24.996 --> 0:18:29.236 very well know. I mean, the Italians are famously suspicious 0:18:29.236 --> 0:18:33.756 of their political system. They enjoy an enormous number of 0:18:33.756 --> 0:18:37.636 liberties and freedoms, and you know their police cars parked 0:18:37.676 --> 0:18:41.796 along the major highways of in northern Italy making sure 0:18:41.836 --> 0:18:45.396 that people don't move. You can't imagine the conflict between 0:18:45.436 --> 0:18:48.636 those two cultures. Giving up the people who have enjoyed 0:18:48.676 --> 0:18:52.996 historical and continue to enjoy an enormous amount of personal freedoms, 0:18:53.796 --> 0:18:57.556 forcing them not to move, not to congregate in the square, 0:18:57.636 --> 0:19:01.116 or to go to their local bar for casual drink 0:19:01.756 --> 0:19:06.436 is obviously extraordinarily disruptive. So I think we'll have to 0:19:06.476 --> 0:19:10.436 thread a very fine needle in terms of identifying hotspots, 0:19:11.236 --> 0:19:17.236 identifying the vulnerable populations, and giving reasonable advice which takes 0:19:17.276 --> 0:19:20.876 the cost and benefit risk appropriately. And it has to 0:19:20.876 --> 0:19:24.116 be done on a case by case basis. It can't 0:19:24.156 --> 0:19:27.636 be done on a blanket basis. Yet, Now, if it 0:19:27.676 --> 0:19:31.516 turns out that the you know, there's more mutations coming more, 0:19:31.956 --> 0:19:33.436 you know, if it turns out that you can get 0:19:33.436 --> 0:19:37.556 reinfected by the virus, which we don't know yet. It's unlikely, 0:19:37.556 --> 0:19:40.076 but we don't know yet, then of course all bets 0:19:40.076 --> 0:19:42.156 are off. I wanted to ask you actually about that, 0:19:42.276 --> 0:19:45.076 about the genetic side of it, wearing your geneticis had. 0:19:45.756 --> 0:19:47.876 What do you think are Maybe it's impossible to say, 0:19:47.916 --> 0:19:53.036 but the probabilities of evolution happening rather quickly in the 0:19:53.036 --> 0:19:56.116 middle of the outbreak in such a way that we 0:19:56.236 --> 0:19:59.476 get not only the question of people getting reinfected, but 0:19:59.516 --> 0:20:02.876 also potentially just different strains of COVID nineteen, you know, 0:20:02.916 --> 0:20:06.996 COVID twenty or twenty one making their way into the population. Well, 0:20:06.996 --> 0:20:10.196 it depends on what the counter pressure are, as it were, 0:20:10.276 --> 0:20:18.916 because evolution happens through various mechanisms with these viruses, with 0:20:19.076 --> 0:20:24.596 these families of viruses, and usually the sort of the 0:20:25.196 --> 0:20:28.956 big evolutionary change, as it were, which is the assortment 0:20:29.036 --> 0:20:34.396 of the segments of RNA, have already happened. Most of 0:20:34.476 --> 0:20:39.636 these viruses come from other populations, other animals and so 0:20:39.756 --> 0:20:44.836 therefore usually have not developed strategies to evade the immune 0:20:44.836 --> 0:20:49.076 system and remain or become chronic in humans. In terms 0:20:49.076 --> 0:20:52.596 of new epidemics. It was an exception with HIV, but 0:20:52.676 --> 0:20:56.316 aside from that, most of these viruses usually once you 0:20:56.356 --> 0:20:59.036 get immunity to it, you get immunity to it and 0:20:59.196 --> 0:21:02.436 you don't get reinfected. We think that that's the case 0:21:02.636 --> 0:21:06.476 given what's happened. Otherwise you you know, WUHAN would still 0:21:06.516 --> 0:21:11.036 be flaring. So based on all the information that we have, 0:21:11.116 --> 0:21:14.036 if it's true information, we have a center of the 0:21:14.036 --> 0:21:17.276 epidemic where there was a wave of deaths unfortunately, but 0:21:17.316 --> 0:21:20.996 then it stopped brewing. It's not flaring still. So to 0:21:21.156 --> 0:21:24.836 some extent, the best information that we have so far 0:21:25.076 --> 0:21:27.796 is that the virus, of course it will mutate, but 0:21:27.836 --> 0:21:31.196 that immunity does develop to it, and that immunity is protective. 0:21:31.996 --> 0:21:35.076 That's very good news for future vaccines. A vaccine is 0:21:35.076 --> 0:21:37.356 not coming tomorrow, but that's very good news for a 0:21:37.396 --> 0:21:40.756 future vaccine because of course you need community. Is there 0:21:40.756 --> 0:21:44.196 anything that you think we're missing from the public discourse 0:21:44.436 --> 0:21:48.516 around COVID nineteen right now, Well, one thing that's missing 0:21:48.676 --> 0:21:51.196 is you know, look getting a vaccine will take a 0:21:51.196 --> 0:21:55.076 long time because vaccines are complicated to make. They're complicated 0:21:55.116 --> 0:21:58.116 a test. They have to be tested on populations to 0:21:58.196 --> 0:22:02.316 be produced at a very high standard. What's missing is 0:22:03.196 --> 0:22:07.956 why and why not for the people who are actually 0:22:07.956 --> 0:22:13.036 falling sick. Why or why not? We don't have either 0:22:13.596 --> 0:22:18.596 antibodies or in others biological or small molecules that are 0:22:18.636 --> 0:22:23.596 directed against the viral enzymes. We know them. The genome 0:22:23.636 --> 0:22:27.236 has been sequenced, we know what the what the vulnerabilities are, 0:22:27.396 --> 0:22:29.996 and I know that there's several facilities that are screening 0:22:30.116 --> 0:22:34.196 for small molecules as well as biologics that will help. 0:22:34.476 --> 0:22:37.636 These are not vaccines, right, so these are injected biologics 0:22:37.636 --> 0:22:42.636 that will enact, hopefully inactivate the virus. So an update 0:22:42.836 --> 0:22:49.636 from the CDC on that process, those kinds of ideas 0:22:49.796 --> 0:22:53.076 from the nation's highest authority in terms of the management 0:22:53.076 --> 0:22:55.676 of illness would be a helpful thing to have, because 0:22:56.156 --> 0:23:00.196 talking emptily about a vaccine which could really be months away, 0:23:00.516 --> 0:23:02.636 is not not going to help right now. If we 0:23:02.636 --> 0:23:05.436 could say to it to you that you know, if 0:23:05.436 --> 0:23:08.556 you get really, really sick, Here's where we are in 0:23:08.636 --> 0:23:12.356 terms of medicine development for this, and there's no better 0:23:12.396 --> 0:23:14.996 country in the world, I think, than the United States 0:23:15.036 --> 0:23:18.756 in developing medicines. Then I think there will be less 0:23:18.796 --> 0:23:22.276 uncertainty and a panic around what's happening next in terms 0:23:22.316 --> 0:23:27.436 of medical development against the virus. Last question for you, 0:23:27.476 --> 0:23:31.356 who said, where are you telling your kids? Well, so, 0:23:31.596 --> 0:23:34.436 I mean we've been following every day what the CDC 0:23:34.596 --> 0:23:38.036 has been recommending. I mean, thankfully, as I said, children 0:23:38.076 --> 0:23:43.116 are not the worst affected. We have not been doing 0:23:43.156 --> 0:23:47.556 anything except saying to them, try to in New York City, 0:23:47.556 --> 0:23:50.316 where now there are several cases, we've been telling them, 0:23:50.356 --> 0:23:53.236 try to avoid public places which are not you know, 0:23:53.276 --> 0:23:56.956 where there's where it's not necessary to go, wash your 0:23:56.956 --> 0:24:01.556 hands frequently, as frequently as possible. And if you know 0:24:01.676 --> 0:24:06.636 someone who's sick, or obviously if you have symptoms yourself, 0:24:07.076 --> 0:24:09.036 let us know at the earliest. I mean, nothing more, 0:24:09.396 --> 0:24:11.876 nothing less than that. I also led with my kids 0:24:11.876 --> 0:24:13.916 with the don't worry, you're going to be fine. Kids 0:24:13.916 --> 0:24:15.916 don't seem to be getting this, and that an amazingly 0:24:15.956 --> 0:24:18.996 calming effect on them. So I appreciate that part of 0:24:19.036 --> 0:24:21.196 the advice as well as the rest of it. Thank 0:24:21.236 --> 0:24:24.196 you so much for a really calm and rational account 0:24:24.236 --> 0:24:28.476 of an ongoing breaking story that continues to have scary parts, 0:24:28.516 --> 0:24:31.996 but that, as you say, canna, ultimately be managed by 0:24:32.196 --> 0:24:35.196 getting to the absolute truths that are out there and 0:24:35.236 --> 0:24:38.996 then using logic and reason and risk benefit analysis to 0:24:39.076 --> 0:24:42.556 try to get us to a manageable outcome and perhaps 0:24:42.636 --> 0:24:46.556 even to some potential treatments for the worst affected. Thank 0:24:46.596 --> 0:24:48.356 you very much for your time, my pleasure. Thank you 0:24:48.396 --> 0:24:56.596 so much. We'll be back with this week's playback in 0:24:56.636 --> 0:25:03.516 just a moment now for our playback. I want to 0:25:03.556 --> 0:25:07.756 tell you Gorezuch. I want to tell you Kavanaugh, you 0:25:07.876 --> 0:25:12.636 have released earl Wind and you will pay the price. 0:25:15.076 --> 0:25:19.116 That's Democratic Senator Charles Schumer last week, speaking in a 0:25:19.276 --> 0:25:22.116 slightly unhinged tone, if you ask me, in front of 0:25:22.116 --> 0:25:24.956 the Supreme Court at an abortion rights rally while an 0:25:25.076 --> 0:25:28.316 oral argument was going on about an important abortion rights case. 0:25:29.196 --> 0:25:33.276 Since then, Schumer received intense criticism from President Trump, but 0:25:33.396 --> 0:25:36.836 maybe more significantly from Chief Justice John Roberts and a 0:25:36.876 --> 0:25:41.676 number of Republican senators, and he apologized, kind of saying 0:25:42.076 --> 0:25:45.996 I shouldn't have used the words I did. Here's why 0:25:46.076 --> 0:25:49.276 this whole moment in the news is actually a pretty 0:25:49.316 --> 0:25:53.356 big deal. Ever since Donald Trump became president, and in 0:25:53.396 --> 0:25:55.676 fact even before that when he was running for office, 0:25:56.156 --> 0:25:59.396