The following is a conversation with Jay Bhattakarya,
professor of medicine, health policy,
and economics at Stanford University.
Please allow me to say a few words about lockdowns
and the blinding destructive effects of arrogance
on leadership, especially in the space of policy and politics.
Jay Bhattakarya is the co-author
of the now famous Great Barrington Declaration,
a one-page document that in October, 2020,
made a case against the effectiveness of lockdowns.
Most of this podcast conversation is about the ideas
related to this document.
And so, let me say a few things here
about what troubles me.
Those who advocate for lockdowns as a policy
often ignore the quiet suffering of millions,
that it results in, which includes economic pain,
loss of jobs that give meaning and pride
in the face of uncertainty,
the increase in suicide and suicidal ideation,
and in general, the fear and anger that arises
from the powerlessness forced onto the populace
but the self-proclaimed elites and experts.
Many folks whose job is unaffected by the lockdowns
talk down to the masses about which path forward is right
and which is wrong.
What troubles me most is this very lack of empathy
among the policymakers for the common man,
and in general, for people unlike themselves.
The landscape of suffering is vast
and must be fully considered in calculating the response
to the pandemic with humility
and with rigorous open-minded scientific debate.
Jay and I talk about the email from Francis Collins
to Anthony Fauci that called Jay and his two co-authors,
fringe epidemiologists, and also called
for a devastating published takedown of their ideas.
These words from Francis broke my heart.
I understand them, I can even steelman them,
but nevertheless, on balance,
they show to me a failure of leadership.
Leadership in a pandemic is hard,
which is why great leaders are remembered by history.
They are rare, they stand out, and they give me hope.
Also, this whole mess inspires me
on my small individual level to do the right thing
in the face of conformity, despite the long odds.
I talk to Francis Collins.
I talk to Albert Burla, Pfizer CEO.
I also talked and will continue to talk with people like Jay
and other dissenting voices that challenge
the mainstream narratives and those in the seats of power.
I hope to highlight both the strengths and weaknesses
in their ideas with respect and empathy,
but also with guts and skill.
The skill part I hope to improve on over time.
And I do believe that conversation
and an open mind is the way out of this.
And finally, as I've said in the past,
I value love and integrity
far, far above money, fame, and power.
Those latter three are all ephemeral.
They slip through the fingers
of anyone who tries to hold on
and leave behind an empty shell of a human being.
I prefer to die a man who lived by principles
that nobody could shake
and a man who added a bit of love to the world.
This is the Lex Friedman podcast.
To support it, please check out our sponsors
in the description.
And now here's my conversation with Jay Barakaria.
To our best understanding today, how deadly is COVID?
Do we have a good measure for this very question?
So the best evidence for COVID, the deadliness of COVID
comes from a whole series of seroprevalence studies.
Seroprevalence studies are these studies
of antibody prevalence in the population at large.
I was part of the very first set of seroprevalence studies,
one in Santa Clara County, one in LA County,
and one with Major League Baseball around the US.
If I may just pause you for a second.
If people don't know what serology is in seroprevalence,
it does sound like you say zero prevalence.
It's not, it's sero and serologies antibodies.
So it's a survey that counts the number of antibodies.
Specific to COVID, yes.
People that have antibodies specific to COVID,
which perhaps shows an indication
that they likely have had COVID.
And therefore this is a way to study
how many people in the population
have been exposed to or have had COVID.
Exactly, yeah, exactly.
So the idea is that we don't know exactly
the number of people with COVID
just by counting the people that present themselves
with symptoms of COVID.
COVID has, it turns out,
a very wide range of symptoms possible,
ranging from no symptoms at all
to this deadly viral pneumonia
that's killed so many people.
And the problem is like in,
if you just count the number of cases,
the people who have very few symptoms
often don't show up for testing.
We just don't, they're outside of the can of public health.
And so it's really hard to know
that the answer to your question
without understanding how many people are infected
because you can probably tell the number of deaths.
That's even though that there's some controversy over that.
But that, so the numerator is possible,
but the denominator is much harder.
How much controversy is there about the death?
We're gonna go on million tangents.
Is that, okay, we're gonna, I have a million questions.
So one, I love data so much,
but I almost tuned out paying attention to COVID data
because I feel like I'm walking on shaky ground.
I don't know who to trust.
Maybe you can comment on different sources of data,
different kinds of data, the death one.
That seems like a really important one.
Can we trust the reported deaths associated with COVID
or is it just a giant, messy thing that mixed up?
And then there's this kind of stories about hospitals
being incentivized to report a death as COVID death.
So there's some truth in some of that.
Let me just talk about the incentives.
So in the United States, we passed this CARES Act
that was aimed at making sure hospital systems
didn't go bankrupt in the early days of the pandemic.
The couple of things they did,
one was they provided incentives to treat COVID patients,
tens of thousands of dollars extra per COVID patient.
And the other thing they did is
they gave a 20% bump to Medicare payments
for elderly patients who are treated with COVID.
The idea is that there's more expensive to treat them
at the early days.
So that did provide an incentive
to have a lot of COVID patients in the hospital
because your financial success of the hospital
or at least not lack of financial ruin
depended on having many COVID patients.
The other thing on the death certificates
is the reporting of deaths is a separate issue.
I don't know that there's a financial incentive there,
but there is this sort of like complicated,
you know, when you fill out a death certificate
for a patient with a lot of conditions,
like let's say a patient has diabetes,
a patient that while that diabetes
could lead to heart failure,
you know, you have a heart attack, heart failure,
your lungs fill up, then you get COVID and you die.
So what do you write on the death certificate?
Was it COVID that killed you?
Was it the lungs filling up?
Was it the heart failure?
Was it the diabetes?
It's really difficult to like disentangle.
And I think a lot of times what's happened is
that people have like aired on the side of signing COVID.
Now, what's the evidence of this?
There's been a couple of audits of death certificates
in places like Santa Clara County
where I live in Alameda County, California,
where they carefully went through the death certificate
and said, okay, is this reasonable to say
this was actually COVID or was COVID incidental?
And they found that about 25%,
20, 25% of the deaths were more likely incidental
than directly due to COVID.
I personally don't get too excited about this.
I mean, it's a philosophical question, right?
Like ultimately, what kills you?
Which is an odd thing to say if you're not in medicine,
but like really it's almost always multifactorial.
It's not always just the bus hits you.
The bus hits you, you get a brain bleed.
Was the brain bleed that killed you?
Would it have burst anyway?
I mean, you know, the bus hits you, killed you, right?
The way you die is a philosophical question,
but it's also a sociological and psychological question.
Cause it seems like every single person
who was passed away or the past couple of years,
kind of the first question that comes to mind.
Was it COVID?
Was it COVID?
Not just because you're trying to be political,
but just in your mind.
No, I think there's a psychological reason for this, right?
So, you know, we've spent the better part
of at least a half century in the United States
not worried too much about infectious diseases.
And the notion was we'd essentially conquered them.
It was something that happens in far away places
to other people.
And that's true for much of the developed world.
Life expectancy were going up for decades and decades.
And for the first time in living memory,
we have a disease that can kill us.
I mean, I think we're effectively evolved to fear that.
Like the panic centers of our brain,
the lizard part of our brain takes over.
And our central focus has been avoiding this one risk.
And so it's not surprising that people
when they're filling our death certificates
or thinking about what led to the death,
this most salient thing that's in the front
of everyone's brain would jump to the top.
And we can't ignore this very deep psychological thing
when we consider what people say on the internet,
what people say to each other,
what people write in scientific papers,
everything.
It feels like when COVID has been brought onto this world,
everything changed in the way people feel about each other.
It's just the way they communicate with each other.
I think the level of emotion involved,
I think in many people, it brought out the worst in them.
For sometimes short periods of time
and sometimes it was always therapeutic.
Like you were waiting to get out like the darkest parts of you.
Just to say, if you're angry at something in this world,
I'm going to say it now.
And I think that's probably talking to some deep primal
thing that fear we have for formalities
of all different kinds.
And then when that fear is aroused
and all the deepest emotions,
it's like a Freudian psychotherapy session,
but across the world.
It's something that psychologists are going to have a field day
with for a generation, trying to understand.
I mean, I think what you say is right,
but piled on top of that is also this sort of,
this impetus to empathy,
to empathize compassion toward others,
essentially militarized, right?
So I'm protecting you by some actions.
And those actions, if I don't do them,
if you don't do them, well, that must mean
you don't just, you hate me.
It's created this like social tension
that I've never seen before.
And we have started, we looked at each other
as if we were just simply sources of germs
rather than people to get to know, people to enjoy,
people to get to learn from.
It colored basically almost every human interaction
for every human on the planet.
Yeah, the basic common humanity.
It's like you can wear a mask, you can stand far away,
but the love you have for each other
when you're looking to each other's eyes,
that was dissipating by region too.
I've experienced having traveled quite a bit
throughout this time.
It was really sad.
Even people that are really close together,
just the way they stood, the way they looked at each other.
And it made me feel for a moment
that the fabric that connects all of us
is more fragile than I thought.
I mean, if you walk down the street,
or if you did this during COVID,
I'm sure you had this experience where you walk down the street
if you're not wearing a mask, or even if you are,
people will jump off the sidewalk that you walked past them
as if you're poison.
Even though the data are that COVID spreads
indifferently outdoors, or if at all, really outdoors.
But it's not simply biological,
or in fact, it's disease phenomenon,
or epidemiological phenomenon.
It is a change in the way he was treated to each other.
I hope temporary.
I do want to say on the flip side of that,
so I was mostly in Boston, Massachusetts,
when the pandemic broke out.
I think that's where I was, yeah.
And then I came here to Austin, Texas
to visit my now good friend, Joe Rogan.
And he was the first person without pause.
This wasn't a political statement, this was anything.
Just walked toward me and gave me a big hug,
and say, it's great to see you.
And I can't tell you how great it felt
because I in that moment realized the absence
of that connection back in Boston
over just a couple of months.
And we'll talk about it more,
but it's tragic to think about that distancing,
that dissolution of common humanity at scale,
what kind of impact it has on society.
Just across the board, political division,
and just in the quiet of your own mind,
in the privacy of your own home, the depression,
the sadness, the loneliness, at least the suicide,
and forget suicide, just low-key suffering.
Yeah, no, I think that's the suffering,
that isolation, we're not meant to live alone.
We're not meant to live apart from one another.
I mean, that's of course the ideology of lockdown
is to make people live apart alone, isolated,
so that we don't spread diseases to each other, right?
But we're not actually designed as a species to live that way.
And that, what you're describing,
I think if everyone's honest with themselves,
have felt, especially in places where lockdowns
have been sort of very militantly enforced,
has felt deep into their core.
Well, if I could just return to the question of deaths,
you said that the data isn't perfect
because we need these kind of seroprevalence surveys
to understand how many cases there were
to determine the rate of deaths.
And we need to have a strong footing in the number of deaths.
But if we assume that the number of deaths
is approximately correct, like what's your sense,
what kind of statements can we say
about the deadliness of COVID
across different demographics?
Maybe not in a political way or in the current way,
but when history looks back at this moment of time,
50 years from now, 100 years from now,
the way we look at the pandemic 100 years ago,
what will they say about the deadliness of COVID?
I mean, I think the deadliness of COVID
depends on not just the virus itself, but who it infects.
So probably the most important thing about it,
about the deadliness of COVID is this steep age gradient
in the mortality rate.
So according to these seroprevalence studies
that have been done, now hundreds of them,
mostly from before vaccination,
because vaccination also reduces the mortality risk of COVID,
the seroprevalence studies suggest
that the risk of death, if you say over the age of 70,
is very high, you know, 5% if you get COVID.
If you're under the age of 70, it's lower, 0.05.
But there's not a single sharp cutoff.
It's more like, I have a rule of thumb that I use.
So if you're 50, say, the infection fatality rate
from COVID is 0.2%, according to the seroprevalence data,
that means 99.8% survival if you're 50.
And for every seven years of age above that, double it.
Every seven years of age below that, have it.
So a 57-year-old would have a 0.4%.
Mortality, a 64-year-old would have a 0.8% and so on.
And if you have a severe chronic disease like diabetes
or if you're morbidly obese,
it's like adding seven years to your life.
And this is for unvaccinated folks.
This is unvaccinated before Delta also.
Are there a lot of people that will be listening to this
with PhDs at the end of their name
that would disagree with the 99.8, would you say?
So I think there's some disagreement over this.
And the disagreement is about the quality
of the seroprevalence studies that were conducted.
So as I said earlier, I was a senior investigator
in three different seroprevalence studies
very early in the epidemic.
I view them as very high-quality studies.
In Santa Clara County, what we did is we used a test kit
to, that we obtained from someone
who works in Major League Baseball, actually.
He'd ordered these test kits very early in March, 2020
that measures, very accurately measures antibody levels,
antibodies in the bloodstream.
This test kits were proven by the, had a EUA
by the Emergency Use Authorization by the FDA
sort of shortly after we did this.
And it had a very low false positive rate.
False positive means if you don't have
these COVID antibodies in your bloodstream,
the kit shows up positive anyways.
That turns out to happen about 0.5% of the time.
And based on studies, a very large number of studies
looking at blood from 2018,
you try it against this kit.
And 0.5% of the time, 2018,
there shouldn't be antibodies there.
So for COVID, if it turns positive, it's a false positive.
It's 0.5% of the time.
And then, like a false negative rate, about 10%, 12%,
something like that, I don't remember the exact number.
But the false positive rate is the important thing there.
So you have a population in March, 2020 or April, 2020
with very low fraction of patients
having been exposed to COVID.
You don't know how much, but low,
even a small false positive rate could end up
biasing your study quite a bit.
But there's a formula to adjust for that.
You can adjust for the fourth false positive rate,
false negative rate.
We did that adjustment.
And those studies found in a community population,
so leaving aside people in nursing homes
who have a higher death rate from COVID,
that the death rate was 0.2% in Santa Clara County
and in LA County.
Across all these groups in a community meeting
just like regular folks.
Yeah, so that's actually a real important question too.
So the Santa Clara study,
we did this Facebook sampling scheme,
which is, I mean, not the ideal thing,
but it was very difficult to get a random sample
during lockdown, where we put out an ad on Facebook
soliciting people to volunteer for the study,
a randomly selected set of people.
We were hoping to get a random selection of people
from Santa Clara County, but it tended to,
the people who tended to volunteer
were from the richer parts of the county.
Like, I had Stanford professors
begging to be in the study
because they wanted to know their antibody levels.
So we did some adjustment for that.
In LA County, we hired a firm
that had a pre-existing representative sample
of LA County.
So, but it didn't include nursing homes.
It didn't include people in jail, things like that.
It didn't include the homeless populations.
So it's representative of a community dwelling population,
both of those.
And there we found that both in LA County
and Santa Clara County in April, 2020,
something like 40 to 50 times more infections
than cases in both places.
So for every case that had been reported
to the public health authorities,
we found 40 or 50 other infections,
people with antibodies in their blood
that suggested that they'd had COVID and recovered.
So people were not reporting or severe,
at least in those days, under reporting?
Yeah, I mean, there was, you know, there's testing problem.
I mean, there weren't so many tests available.
People didn't know.
A lot of them, we asked a set of questions
about the symptoms they'd faced.
And most of them said they faced no symptoms,
or the most, 30, 40% of them said they faced no symptoms.
And I mean, even these days,
how many people report that they get COVID
when they get COVID?
Okay, have those numbers, that 0.2%,
has that approximately held up over time?
That is, so if Professor Johnny Inides,
who's a colleague of mine at Stanford,
is a world expert in meta-analysis,
one of the most cited scientists on earth, I think,
at least living, he did a meta-analysis of now 100
or more of these seroprevalence studies.
And what he found was that that 0.2%
is roughly the worldwide number.
I mean, in fact, I think he cites us lower number, 0.15%,
as the median infection fatality rate worldwide.
So we did these studies,
and it generated an enormous amount of blowback
by people who thought that the infection
of the high rate is much higher.
And there's some controversy over the quality
of some of the other studies that are done.
And so there are some people who look at this same literature
and say, well, the lower quality studies
tend to have lower IFRs, the higher quality studies.
IFR?
Oh, infection fatality, right, I apologize.
I do this in lectures too, I apologize.
And I'm going to rudely interrupt you
and ask for the basics sometimes if it's okay.
No, of course.
So these higher quality studies,
they say are pretending to produce higher,
but the problem is that if you want
a global IFR infection fatality rate,
you need to get seroprevalence studies from everywhere,
even in places that don't necessarily have
the infrastructure set up
to produce very, very high quality studies.
And in poor places in the world, places like Africa,
the infection fatality rate is incredibly low.
And in some richer places, like New York City,
the infection fatality rate is much higher.
There's a range of IFRs in a single number.
This sometimes surprises people
because they think, well, it's a virus,
it should have the same properties no matter where it goes.
But the virus kills or infects or hurts
in interaction with the host.
And the properties of both the host
and the virus combine to produce the outcome.
But you also mentioned the environment too?
Well, I'm thinking mainly just about the person.
Like if I'm going to think about it,
like the most simplest way to think about it is age.
Age is the single most important risk factor.
So older places are going to have a higher IFR
than younger places.
Africa, 3% of Africa is over 65.
So in some sense, it's not surprising
that they have a low infection fatality rate.
So that's one way you would explain the difference
between Africa and New York City
in terms of the fatality rate.
Is the age the average age?
Yeah, and especially in the early days of the epidemic
in New York City, the older populations living
in nursing homes were differentially infected
based on because of policies that were adopted
to send COVID infected patients back to nursing homes
to keep hospitals empty.
What do you mean by differentially infected?
The policy that you adopt determines who is most exposed.
Right, okay.
So that's what I mean by different.
The policy, it's the person that matters.
I mean, it's not like the virus just kind of doesn't care.
I mean, the policy determines the nature of the interaction.
And there's also, I mean, there is some contribution
from the environment, different regions
of different proximity maybe of people interacting
or the dynamics of the way they interact.
The heterogeneity.
I'm like, if you have situations
where there's lots of intergenerational interactions,
then you have a very different risk profile
than if you have societies
that are where generations are more separate
from one another.
Okay, so let me just finish, we're a little fast about this.
So you had in New York, you have a population
that was infected in the early days
that was very likely going to die,
but had a much higher likelihood of dying if infected.
And so New York City had a higher IFR,
especially in the early days than Africa has had.
The other thing is treatment, right?
So the treatments that we adopted in the early days
of the epidemic, I think actually may have exacerbated
the risk of death.
So like using ventilators,
like the over reliance on ventilators
is what I'm primarily thinking of,
but I can think of other things.
But that also we've learned over time
how better to manage patients with the disease.
So you have all those things combined.
So that's where the controversy over this number is.
I mean, New York City also is a central hub
for those who tweet and those who write powerful stories
and narratives in article form.
And I remember there was quite dramatic stories
about sort of doctors in the hospitals
and these kinds of things.
I mean, there's very serious, very dramatic,
very tragic deaths going on always in hospitals.
Those stories,
loved ones losing each other on a deathbed,
that's always tragic.
And you can always write a hell of a good story about that.
And you should about the loss of loved ones,
but they were doing it pretty well, I would say,
over this kind of dramatic deaths.
And so in response to that,
it's very unpleasant to hear,
even to consider the possibility that the death rate
is not as high as you might otherwise, as you might feel.
Yeah, I was surprised by the reaction,
both by regular people and also the scientific community
in response to those studies,
those early studies in April of 2020.
To me, they were studies.
I mean, they're the kinds of,
not exactly the kinds of work I've worked on all my life,
but kind of like the kind of,
that you write a paper and you get responses
from your fellow scientists
and you change the paper to improve it,
you hopefully learn something from it.
Well, but to push back, it's just a study,
but there are some studies,
and this is kind of interesting
because I've received similar pushback on other topics.
There's some studies that if wrong
might have a wide-ranging detrimental effects on society.
So that's the way they would perceive the studies.
If you say the death rate is lower
and you end up, as you often do in science,
realizing that nope, there was a flaw
in the way the study was conducted
or we're just not representative of a broader population,
and then you realize the death rate is much higher,
that might be very damaging in people's view.
So that's probably where the scientific community
sort of just steelman the kind of response
is that's where they felt like there's some findings
where you better be damn sure
before you kind of report them.
Yeah, I mean, we were pretty sure we were right,
and it turns out we were right.
So we released the Santa Clara study
via this open science process
and this server called Med Archive.
It's designed for releasing studies
that have not yet been peer reviewed
in order to garner comment from the scientists
before peer review.
The LA County study,
we went through the traditional peer review process
and got it published in the Journal
or Medical Medical Association sometime in July, I think,
to get the date of 2020.
The Santa Clara study released in April of 2020
in this sort of working paper archive.
The reason was that we felt we had an obligation,
we had a result that we thought was quite important,
and we wanted to tell the scientific community about it
and also tell the world about it.
And we wanted to get feedback.
I mean, that's part of the purpose
of sending it to these kinds of places.
I think a lot of the problem is that
when people think about published science,
they think of it as automatically true.
And if it goes through peer review, it's automatically true.
If it hasn't gone through peer review,
it's not automatically true.
And especially in medicine,
when we're not used to having this access
to pre-peer reviewed work.
I mean, in economics, actually, that's quite normal.
You take years to get something published.
So there's a very active debate over or discussion
about papers before they're peer reviewed
in this sort of working paper way,
much less normal or much newer in medicine.
And so I think part of that,
the perception about what process happens in open science
when you release a study, that got people confused.
And you're right, it was a very important result
because we had just locked the world down
in middle of March with, I think, catastrophic results.
And if that study was right, if our study was right,
that meant we'd made a mistake.
And not because of the death rate was low.
That's actually not the key thing there.
The key thing is that we had adopted these policies,
these test and trace policies, these policies,
these lockdown policies aimed at suppressing
the virus level to close to zero.
That was essentially the idea.
If we can just get the virus to go away,
we won't have to ever worry about it again.
The main problem with our result,
as far as that strategy was concerned,
it wasn't the death rate, it was the 40 to 50 times
more infections than cases.
It was the 2.5% or 3% or 4% prevalence rate
that we identified of the antibodies in the population.
If that number is right, it's too late.
The virus is not going to go to zero.
And no matter how much we test and trace and isolate,
we're not going to get the viral level down to zero.
So we're gonna have to let the virus go through
the entire population in some way or in some way.
Well, we can talk about that in a bit.
That's the Great Barrington Declaration.
You don't have to let the virus go through the population.
You can shield preferentially.
The policy we chose was to shield preferentially
the laptop class, the set of people who could work
from home without losing their job.
And we did a very good job at protecting them.
Well, let me take a small tangent.
We're gonna jump around in time,
which I think will be the best way to tell the story.
So that was the beginning.
Yeah.
Okay, actually, can I go back one more thing for that?
Cause that's really important.
And I should have started with this.
What led me to do those studies was a paper
that I had remembered seeing
from the H1N1 flu epidemic in 2009.
This is where I've been much less active
in writing about that.
I had written up like a paper or two about that in 2009.
There was actually the same debate over the mortality rate,
except it unfolded over the course of three years,
two or three years.
The early studies of the mortality rate in H1N1
counted the number of cases in the denominator,
kind of the number of deaths in the numerator.
Cases meaning people identified as having H1N1
showing up the doctor, you know, tested to have it.
And the early estimates of the H1N1 mortality
were like 4%, 3%, really, really high.
Over the course of a couple of more years,
a whole bunch of seroprevalence studies,
seroprevalence studies of H1N1 flu came out.
And it turned out that there were 100 or more times
people infected per case.
And so the mortality rate was actually something like 0.02%
for H1N1, not the three episodes,
like a hundred full difference.
So this made you think, okay, it took us a couple
of two or three years to discover the truth
behind the actual infections for the H1N1.
And then what's the truth here
and can we get there faster?
Yeah, and it spreads in a similar way
as the H1N1 flu did.
I mean, it spreads via solidization via, you know,
so person-to-person breathing, kind of contact up.
It may be some by film eyes,
but seems like that's less likely now.
In any case, it seemed really important to me
to speed up the process
of having those seroprevalence studies
so that we can better understand who was at risk
and what the right strategy ought to be.
This might be a good place to kind of compare
influenza, the flu and COVID in the context
of the discussion we just had,
which is how deadly is COVID.
So you mentioned COVID is a very particular kind of steepness
where the X-axis is age.
So in that context,
could you maybe compare influenza and COVID?
Because a lot of people outside of the folks
who suggest that the lizards who run the world
have completely fabricated and invented COVID,
outside of those folks, kind of the natural process
by which you dismiss the threat of COVID is say,
what's just like the flu, the flu is a very serious thing, actually.
So in that comparison, where does COVID stand?
Yeah, the flu is a very serious thing.
It kills 50,000, 60,000 people a year,
something I found out,
or depending on the particular strain that goes around,
that's in the United States.
The primary difference to me,
there's lots of differences,
but one of the most salient differences
is the age gradient and mortality risk for the flu.
So the flu is more deadly for two children than COVID is.
There's no controversy about that.
Children, thank God,
have much less severe reactions to COVID infection
than due to flu infections.
And rate of fatalities and stuff like that.
Rate of fatality, all of that.
I think you mentioned,
I mean, it's interesting to maybe also comment on,
I think in another conversation you mentioned,
there's a U-shape to the flu curve.
So meaning like,
there's actually quite a large number of kids
that die from flu.
Yeah, I mean, the 1918 flu,
the H1N1 flu that the Spanish flu in the U.S.
killed millions of younger people.
And that is not the case with COVID.
More than, I'm gonna get the number wrong,
but something like 70, 80% of the deaths
are people over the age of 60.
Well, we've talking about the fear the whole time, really.
But my interaction with folks,
now I wanna have a family, I wanna have kids,
but I don't have that real first hand experience.
But my interaction with folks is at the core of fear
that folks had is for their children.
Like that somehow,
I don't wanna get infected because of the kids.
Like, because God forbid something happens to the kids.
And I think that, obviously that makes a lot of sense.
This kind of, the kids come first,
no matter what, that's their own priority.
But for this particular virus,
that reasoning was not grounded in data, it seems like.
Or that emotion and feeling was not grounded in data.
It wasn't, but at the same time,
this is way more deadly than the flu just overall.
And especially to older people.
Yes.
Right, so.
The numbers, when the stories all said and done,
COVID would take many more lives.
Yeah.
So, I mean, point two is, sounds like a small number,
but it's not a small number worldwide.
What do you think that number will be by the,
that's not like me, but would we cross,
I think it's in the United States,
it's the way the deaths are currently reported,
it's like 800,000, something like that.
Do you think we'll cross a million?
Seems likely.
Yeah.
Do you think it's something that might continue
with different variants?
What?
Well, I think, so we can talk about the end state of COVID.
The end state of COVID is it's here forever.
I think that there is good evidence
of immunity after infection,
such that you're protected both against reinfection
and also against severe disease upon reinfection.
So the second time you get it,
it's not true for everyone,
for many people the second time you get it
will be milder, much milder than the first time you get it.
Would the long tail, like that last for a long time?
Yeah.
So just their studies that the follow course
of people who were infected for a year
and the reinfection rate is something like
somewhere between 0.3 and 1%.
Yeah.
And like a pretty fantastic study out of Italy
has found that there was one in Sweden, I think,
there's a few studies that found this similar things.
And the reinfections tend to produce much milder disease,
much less likely to end up in the hospital,
much less likely to die.
So what the end state of COVID is,
it's circulating the population forever
and you get it multiple times.
Yeah.
And then there's, I think studies and discussions
like the best protection would be to get it
and then also to get vaccinated.
And then a lot of people push back against that
for the obvious reasons from both sides
because somehow this discourse has become
less scientific and more political.
Well, I think you want to,
the first time you meet it is going to be
the most deadly for you.
And so the first time you meet it,
it's just wise to be vaccinated.
The vaccine reduces severe disease.
Yeah.
Well, we'll talk about the vaccine
because I want to make sure I address it carefully
and properly and full context.
But yes, sort of to add to the context,
a lot of the fascinating discussions we're having
is in the early days of COVID
and now for people who aren't unvaccinated.
That's where the interesting story is.
The policy story, the sociological story and so on.
But let me go to something really fascinating
just because of the people involved,
the human beings involved
and because of how deeply I care about science
and also kindness, respect and love and human things.
Francis Collins wrote a letter in October, 2020
to Anthony Fauci, I think somebody else.
I have the letter, it's not a letter, email, I apologize.
Hi, Tony and Cliff, cgbdeclaration.org.
This proposal, this is the Great Barrington Declaration
that you're a co-author on.
This proposal from the three fringe epidemiologists
who met with the secretary
seemed to be getting a lot of attention
and even a co-signature from Nobel Prize winner,
Mike Levitt at Stanford.
There needs to be a quick and devastating
published takedown of its premises.
I don't see anything like that online yet.
Is it underway?
Question mark, Francis.
Francis Collins, director of the NIH,
somebody I talked to on this podcast recently.
Okay, a million questions I wanna ask,
but first, how did that make you feel
when you first saw this email come to light?
When did it come to light?
This week, actually, I think, or last week.
Okay, so this is because of freedom of information,
which by the way, sort of maybe,
because I do wanna add positive stuff on the side of Francis
here, boy, when I see stuff like that,
I wonder if all my emails leaked.
How much embarrassing stuff.
Like, I think I'm a good person,
but I haven't read my old emails.
Maybe, I'm pretty sure sometimes I could be an asshole.
Well, I mean, look, he's a Christian
and I'm a Christian, I'm supposed to forgive, right?
I mean, I think he was looking at this great Barrington
Declaration as a political problem to be solved,
as opposed to a serious alternative approach
to the epidemic.
So maybe we'll talk about it in more detail,
but just in case people are not familiar,
great Barrington Declaration was a document
that you co-authored that basically argues
against this idea of lockdown as a solution to COVID
and you propose another solution that we'll talk about.
But the point is, it's not that dramatic of a document,
it is just a document that criticizes
one policy solution that was proposed.
But it was the policy solution that had been put forward
by Dr. Collins and by Tony Fauci and a few other scientists.
I mean, I think a relatively small number
of scientists and epidemiologists
in charge of the advice given to governments worldwide.
And it was a challenge to that policy
that said that, look, there is an alternate path
that the path we've chosen, this path of lockdown
with an aim to suppress the virus to zero effectively,
I mean, that was unstated, cannot work
and is causing catastrophic harm
to large numbers of poor and vulnerable people worldwide.
If we put this out in October 4th, I think of 2020,
and it went viral.
I mean, I've never actually been involved
with anything like this
where I just put the document on the web
and tens of thousands of doctors signed on,
hundreds of thousands of regular people signed on.
It really struck a chord of people,
because I think even by October of 2020,
people had this sense that there was something really wrong
with the COVID policy that we've been following.
And they were looking for reasonable people
to give an alternative.
I mean, we're not arguing that COVID isn't a serious thing.
I mean, it is a very serious thing.
This is why we had a policy that aimed at addressing it.
But we were saying that the policy we're following
is not the right one.
So how does a democratic government deal with that challenge?
So to me, that, you asked me how I felt.
I was actually, frankly, just,
I suspected there'd been some email exchanges like that,
not necessarily from Francis Collins,
around the government, around this time.
I mean, I felt the full brunt of a propaganda campaign,
almost immediately after we published it,
where newspapers mischaracterized it
in the same way over and over and over again.
And sought to characterize me as sort of,
as sort of a marginal French figure or whatnot.
And Sunetra Gupta, Martin Koldor,
for the tens of thousands of other people that signed it.
I felt the brunt of that all year long.
So to see this in black and white,
in, you know, with the handwriting essentially,
I mean, the metaphorical handwriting of Francis Collins,
was actually, frankly, disappointment,
because I've looked up to him for years.
Yeah, I've looked up to him as well.
I mean, I look for the best in people,
and I still look up to him.
What troubles me is several things.
The reason I said about the asshole emails
I sent late at night, is I can understand this email.
It's fear, it's panic, not being sure.
The fringe, three fringe epidemiologists.
Plus Mike Levitt, who won a Nobel Prize, I mean.
But using fringe, maybe in my private thoughts,
I have said things like that about others,
like a little bit too unkind,
like you don't really mean it.
Now, add to that, he recently, this week,
whatever, doubled down on the fringe.
This is really troubling to me.
That I can excuse this email,
but the arrogance there, that Francis honestly,
I mean, broke my heart a little bit there.
This was an opportunity to, especially at this stage,
to say, just like I told him,
to say I was wrong to use those words in that email.
I was wrong to not be open to ideas.
I still believe that this is not,
like actually argue with the policy or the solution.
Also, the devastating, publish,
take devastating take down, devastating take down.
As you say, somebody who's sitting on billions of dollars
that they're giving to scientists,
some of whom are often not their best human beings
because they're fighting with each other over money,
not being cognizant of the fact
that you're challenging the integrity.
You're corrupting the integrity of scientists
by allocating the money.
You're now playing with that,
by saying devastating take down.
Where do you think the published take down will come from?
It will come from those scientists
to whom you're giving money.
What kind of example would they give
to the academic community that thrives on freedom?
Like this is, I believe Francis Collins is a great man.
One of the things I was troubled by
is the negative response to him
from people that don't understand
the positive impact that NIH has had on society.
How many people has helped?
But this is exactly the, so he's not just a scientist.
He's not just a bureaucrat who distributes money.
He's also scientific leader
that in difficult times we live in,
it's supposed to inspire us with trust,
with love, with the freedom of thought.
He's supposed to, you know those fringe epidemiologists?
Those are the heroes of science.
When you look at the long arc of history,
we love those people.
We love ideas even when they get proven wrong.
That's what always attracted me to science.
Like somebody, the lone voice saying,
oh no, the moon of Jupiter does move.
I mean, but the funny thing is,
Galileo is saying something truly revolutionary.
We were saying that what we proposed
in the great branch of declaration
was actually just the old pandemic plan.
It wasn't anything really fundamentally novel.
In fact, there were plans like this
that lockdown scientists had written in late February,
early March of 2020.
So we were not saying anything radical.
We were just calling for a debate effectively
over the existing lockdown policy.
And this is a disappointment,
a really, truly a big disappointment
because by doing this, you were absolutely right Lex.
He sent a signal to so many other scientists
to just stay silent even if you had reservations.
Yeah, devastating takedown that people,
you know how many people wrote to me privately
like Stanford, MIT, how amazing the conversation
with Francis Collins was, there's a kind of admiration
because, okay, how do I put it?
A lot of people get into science
because they wanna help the world.
They get excited by the ideas
and they really are working hard to help
in whatever the discipline is.
And then there is sources of funding
which help you do help at a larger scale.
So you admire those, the people that are distributing
the money because they're often,
at least on the surface, are really also good people.
Oftentimes they're great scientists.
So like, it's amazing.
That's why I'm sort of like sometimes people
from outside think academia has broken some kind of,
no, it's a beautiful thing.
It really is a beautiful thing.
And that's why it's so deeply heartbreaking
where this person is, I don't think this is malevolence.
I think he's just incompetence of communication twice.
I think there's also arrogance at the bottom of it too.
Yes, but all of us have arrogance at the bottom.
Yes, but there's a particular kind of arrogance, right?
So here, it's of the same kind of arrogance
that you see when Tony Fauci gets on TV and says
that if you criticize me,
you're not simply criticizing a man,
you're criticizing science itself, right?
That is at the heart also of this email.
The certainty that the policies that they were recommending,
Collins and Fauci were recommending
to the president of the United States were right,
not just right, but right so far right
that any challenge whatsoever to it is dangerous.
And I think that is really the heart of that email.
It's this idea that my position is unchallengeable.
Now, to be completely, to be as charitable as I can be
to this, I believe they thought that,
I believe some of them still think that,
that there was only one true policy possible
in response to COVID, every other policy was immoral.
And if you come from that position,
then you write an email like that, you go on TV,
you say effectively, la science c'est moi, right?
I mean, that is what happens when you have this sort of
unchallengeable arrogance that the policy
you're following is correct.
I mean, when we wrote the Great Bank Declaration,
what I was hoping for was a discussion
about how to protect the vulnerable.
I mean, that was the key idea to me in the whole thing
was better protection of the older population
who really at really serious risk,
if infected with COVID.
And we had been doing a very poor job, I thought,
to date in many places in protecting the vulnerable.
And what I wanted was a discussion by local public health
about better methods, better policies
to protect the vulnerable.
So when I was, when we were met with instead
a series of essentially propagandist lies about it.
So they, for instance, I kept hearing from reporters
in those days, why do you want to let the virus
rip, let it rip, let it rip.
The words, let it rip does not appear
in the Great Barrington Declaration.
The goal isn't to let the virus rip.
The goal is to protect the vulnerable,
to let society go as, you know, open schools
and do other things that function as best it can
in the midst of a terrible pandemic.
Yes, but not let the virus rip
where the most vulnerable aren't protected.
The goal was to protect the vulnerable.
So why let it rip? Because it was a propaganda term
to hit the fear centers of people's brains.
Oh, these people are immoral.
They just want to let the virus go through society
and hurt everybody.
That was, that was, that was the idea.
There's, it, it was a way to preclude a discussion
and precluded debate about the existing policy.
So I've, this is an app called Clubhouse.
I've gone back on it recently to practice Russian,
unrelated for, for a few big Russian conversations coming up.
Anyway, it's a great way to talk to regular people in Russian.
But I also, there was a, I was, I was nervous.
I was preparing for a Pfizer CEO conversation
and there was a vaccine room.
And so I joined it.
And there's a, there's a pro science room.
As they, they, these are like scientists
that were calling each other pro science.
It, the whole thing was like theater to me.
I mean, I haven't thoroughly researched
but looking at the resume, they were like pretty solid
researchers and doctors.
And they were mocking everybody who was at all.
I mean, it doesn't matter what they stood for,
but they were just mocking people.
And the arrogance was overwhelming.
I had to shut off because I couldn't handle the human beings
can be like this to each other.
And then I went back to just a double check.
Is this really how, how many people are here?
Is this theater?
And then I asked to come on stage on clubhouse
to make a couple of comments.
And then as I opened my mouth and say, thank you so much.
This is a great room.
Sort of the usual civil politeness, all that kind of stuff.
And I said, I'm worried that the kind of arrogance
with which things are being discussed here
will further divide us, not unite us.
And before I said even the unites further divide us,
I was thrown off stage.
Now, this isn't where I mentioned platform,
but like I am like Lex Friedman, MIT.
Also, which is something those people seem to sometimes care
about the followers and stuff like that.
Like, did you just do that?
And then they said enough of that nonsense.
Enough of that nonsense.
They said to me enough of that nonsense.
Somebody who is obviously interviewed Francis Collins
is the Pfizer CEO.
You're bringing on French epidemiologist also.
So just.
Yeah, exactly.
But this broke my heart, the arrogance.
And this is echoes of that arrogance
is something you see in the email.
And I really would love to have a million things to talk about
to try to figure out how can we find a path forward.
I think a lot of the problems we've seen
in the discussion over COVID,
especially in the scientific community,
you know, there's two ways to look at science, I think,
that have been competing with each other for a while now.
One way, and this is the way that I view science
and why I've always found it so attractive,
is an invitation to a structured discussion
where the discussion is tempered by evidence,
by data, by reasoning and logic.
Right.
So it's a dialectical process where if I believe A
and you believe B, well, we talk about it.
We come up with an experiment that distinguishes
between the two.
And while B turns out to be right,
I'm all frustrated by a Bayou dinner.
And I say, no, no, no, no, C,
and then we can go on from there.
Right.
That's what science is at its best,
it's this process of using data in discussion.
it's a human activity, right, to learn, to have the truth unfold itself before us.
On the other hand, there are, there's another way that people have used science or thought about
science as a, as truth in and of itself, right? This like, if it's, if it's science, therefore,
it's true automatically. And there are, you know, what does the science say to do? Well,
the science never says to do anything. The science says, here's what's true. And then we have to
apply our human values to say, okay, well, if we do this, well, this is likely to happen. That's
what the science says. If we do that, then that is likely to happen. Well, we'd rather have this
than that, right? And, but it doesn't, does science doesn't tell us that we'd rather have this than
that? Is there human values that tell us that we'd rather have this than that? Science plays a role,
but it's not the only thing. It's not the only role. It's like, it helps understand the constraints
we face, but it doesn't tell us what to do in face of those constraints. But underneath it,
at the individual level, at the institutional level, it seems like
arrogance is really destructive. So the flip side of that, the productive thing is humility.
So sort of always not being sure that you're right. This is actually kind of,
Stuart Russell talks about this for AI research. How do you make sure that AI,
super intelligent AI doesn't destroy us? You built in a sort of module within it that it always
doubts its actions. Like it's not sure. Like I know it says I'm supposed to destroy all humans,
but maybe I'm wrong. And that maybe I'm wrong is essential for progress for actually doing in the
long arc of history, but not the perfect thing, but better and better and better and better. I mean,
the question I have here for you is this, this email so clearly captures some maybe echo, but
maybe a core to the problem. Do you put responsibility of this email, of the shortcomings
and failures on individuals or institutions? Is this Francis Collins, Anthony?
No, this is an institutional failure. So the NIH, so I've had two decades of NIH funding,
I've sat on NIH review panels. The purpose of the NIH is what you said earlier, Lex. The purpose
of the NIH is to support the work of scientists. To some extent, it's also to help scientists,
to direct scientists to work on things that are very important for public health or for the health
of the public. And the way you do that is you say, okay, we're going to put $50 million on the
research in Alzheimer's disease this year or $70 million on HIV or whatever it is. And that pot
of money then scientists compete with each other for the best ideas to use it to address that problem.
So it's essentially an endeavor to support the work of scientists. It is not in and of itself
a policy organ. It doesn't say what public health policy should be. For that, you have the CDC. And
what happened during the pandemic is that people in the NIH were called upon to contribute to public
health policymaking. And that created the conflict of interest you see in that email.
Right. So now you have the head of the NIH in effect saying to all scientists, you must agree with me
in the policy that I've recommended or else you're a fringe. That is a deep conflict of
interest. It's deep because first, he's conflicted. He has this dual role as the head of the NIH
supporter of scientific funding and then also inappropriately called to set or help set pandemic
policy. That should never have happened. There should be a bright line between those two roles.
Let me ask you about just Francis Collins. I don't know if you had a chance to talk to him on a
podcast. I don't know if you maybe by chance gotten a chance to hear a few words. I heard some of it.
Yeah. Well, I have a kind of a question to that because a lot of people wrote to me quite negative
things about Francis Collins. And like I said, I still believe he's a great man, a great scientist.
One of the things when I talked to him off mic about the vaccine,
the excitement he had about when we were recollecting when they first
gotten an inkling that it's actually going to be possible to get a vaccine.
He wasn't messaging. Just in the private or of our own conversation, he was really excited.
And why was he excited? Because he gets to help a lot of people. This is a man
that really wants to help people. And there could be some institutional self-delusion,
the arrogance, all those kinds of things that lead to this kind of email. But ultimately,
the goal is, I don't think people quite realize this. The reason he would call you a fringe
epidemiologist, the reason there needs to be a devastating published takedown, he, I believe,
really believes that this could be very dangerous. And it's a lot of burden to carry on his shoulders.
Because like you said, in his role where he defines some of the public policy, depending
on how he thinks about the world, millions of people could die because of one decision he
make. And that's a lot of burden to walk with. Yeah. No, I think that's right. I don't think
that he has bad intentions. I think that he was basically put or maybe put himself in a position
where this kind of conflict of interest was going to create this kind of reaction.
Right? The kind of humility that you're calling for is almost impossible when you have that dual
role that you shouldn't have as funder of science and also setter of scientific policy.
I agree with everything you just said except the last part. The humility is almost impossible.
Humility is always difficult. I think there's a huge incentive for humility in that position.
Now look at history. Great leaders that have humility are popular as hell. So if you like
being popular, if you like having impact, legacy, these descendants of Ape seem to care about
legacy especially as they get older in these high positions. I think the incentive for humility is
pretty high. The thing is, there's a lot that he has to be proud of in his career. The Human Genome
Project wouldn't have happened without him. And he is a great man and a great scientist.
But so it is tragic to me that his career has ended in this particular way.
You asked a good question about my podcast conversation with him. By way of advice or maybe
criticism, there's a lot of people that wrote to me kind words of support and a lot of people
that wrote to me respectful constructive criticism. How would you suggest to have conversations
with folks like that? Because I have other conversations like this, including I was debating
whether to talk to Anthony Fauci. He wanted to talk. And so what kind of conversation do you have?
I'm sorry to take us on a tangent, but almost from an interview perspective of how to inspire
humility and inspire trust in science or maybe give hope that we know what the heck we're doing
and we're going to figure this out. I mean, I think I've been now interviewed by many people.
I think the style you have really works well, Lex. I don't think you're going to be ever an
attack dog trying to go after somebody and force them to sort of admit that they were wrong or
whatever about them. I mean, I also actually find that form of journalism and podcasting
really off-putting. It's hard to watch. Also, it's a whole lot of the tangent. Is that actually
effective? I don't think so. Do you want to ask Hitler? And I think about this a lot actually
interviewing Hitler. I've been studying a lot about the rise and fall of the Third Reich.
I think about interviewing Stalin. Like I put myself in that mindset, like how do you
have conversations with people to understand who they are so that not so you can sit there and
yell at them, but to understand who they are so that you can inspire a very large number of people
to be the best version of themselves and to avoid the mistakes of the past.
I believe that everyone that's involved in this debate has good intentions. They're coming at
it from their points of view. They have their weaknesses. And if you can paint a picture in
your questioning by sympathetic questioning of those strengths and weaknesses and their point
of view, you've done a service. That's really all I personally like to see in those kinds of
interviews. I don't think a gotcha moment is really the key thing there. The key thing is
understanding where they're coming from, understanding their thinking, understanding the
constraints they faced, and how do they manage them. That's going to provide a much, I mean,
to me, that's what I look for when I listen to podcasts like yours, is an understanding of
that person and the moment and how they dealt with it.
I mean, I guess the hope is to discover in a sympathetic way a flaw in a person's thinking
together. Like, as opposed to discovering the positive thing together, you discover
the thing. Well, I didn't really think about that.
Yeah. I mean, that's what that's how science is, right? That's why we find it, I think,
find it so attractive is this, I like it when a student shows me I'm thinking incorrectly, right?
I'm really grateful to that student because now I have an opportunity to change my mind about it
and then start thinking even more correctly. I mean, that's, and there are moments when,
I mean, like this is probably a good time to say like what I think I got wrong
during the pandemic, right? So like, for instance, you said Francis Collins had a moment when he
learned that there was quite possible to get a vaccine going. He must have learned that quite
early and I didn't learn that early. I mean, I didn't know in March of 2020,
in my experience with vaccine development, it would have taken, I thought it would take a decade
or more to get a vaccine. That was wrong, right? I didn't, and I was so happy when I started to
see the preliminary numbers in the Pfizer trial that strongly suggested it was going to work.
Yeah. And I was, I mean, like a very few times in my life, I'm so happy to be wrong.
And it changes kind of, I think I've heard you mentioned that a lockdown is still a bad idea
unless the vaccine comes out in like tomorrow. There's still like suffering and economic pain,
all kinds of pain can still happen in even just a scale of weeks versus months.
Yeah. Well, let's talk about the vaccine. What are your thoughts on the safety and
efficacy of COVID vaccines at the individual and the societal level?
So for the vaccine safety data, it's actually challenging to convey to the public how this
is normally done. Like normally you would do this in the context of the trial. You'd have a
long trial with roughly large numbers of people. You'd follow them over a long time,
and the trial will give you some indication of the safety of the vaccine. And it did. I mean,
but the trial, the way it was constructed, when it came out that it was protective against COVID,
it was no longer ethical to have a placebo arm. And so that placebo arm was vaccinated,
what large part of it. And so that meant that from the trial, you were not going to be able to get
data on the long-term safety profiles of the vaccine.
And also the other thing about trials, although there's tens of thousands of people enrolled,
that's still not enough to get when you deploy a vaccine to the population scale,
you're going to see things that weren't in the trial, guaranteed.
Populations of people that weren't represented well in the trial are going to be given the
vaccine and then they're going to have things that happened to them that you didn't anticipate.
So I wasn't surprised when people were a little bit skeptical when the trial was done about the
safety profile, just the way the nature of the thing was going to make it so that it was going
to be hard to get a complete picture from the trials itself. And the trials showed they were
pretty safe and quite effective at preventing both you from getting COVID. I think the main
endpoint of the trial itself was symptomatic COVID. So that was, to me, about as amazing
achievement as anything, organizing a trial of that scale and running it so quickly.
And the final results being so surprisingly high.
So good. But the problem then was normally it would take a long time. The FDA
would tell Pfizer to go back and try it in this subgroup, they'd work more on dosing,
they do all these kinds of things that kind of didn't, we really didn't have time for in the
middle of the pandemic. So you have a basis for approval that it's less full than normally you
would have for a population scale vaccine. But the results were good. The results looked really
good. And actually, I should say, for the most part, that's been borne out when we've given the
vaccine its scale in terms of protection against severe disease. So people who have got the vaccine
for a very long time after they've had the full vaccination have had great protection against
going, being hospitalized and dying if they get COVID.
Let's separate because this seems to be, there's critics of both categories, but different.
Kids and not older people, like let's say five years old and above or something like
or 13 years old and above. So for those, it seems like the reduction of the rate of fatalities and
serious illness seems to be something like 10x. I mean, for older people, it is a godsend
to this vaccine. It transforms the problem of focus protection from something that's quite
challenging, possible, I believe, but quite challenging to something that's much, much
more manageable. Because the vaccine in and of itself, when deployed in older populations,
is a form of focus protection. Yes. Well, by the way, we'll talk about the focus protection
in one segment because it's such a brilliant idea for this pandemic of a future pandemic.
I thought the sociological, psychological discussion about the letter from Francis Collins
is, because it was so recent, it was been so troubling to me. So I'm glad we talked about
that first. But so there seems to be the vaccines work to reduce deaths. And that has especially
the most transformative effects for the older. So can I let me give you, I've told you one thing
that I got wrong in the pandemic. Let me tell you the second thing I got wrong for sure in the
pandemic. In January of this year, 2021, I thought that the vaccines would stop infection.
Yes. Right. It would make it so that you were much less likely to be infected at all,
because the antibodies that were produced by the vaccines looked like they're neutralizing
antibodies that would essentially block you from being infected at all.
That turned out to be wrong. I think it became clear as data came out from Israel,
which vaccinated very early, that they were seeing surges of infection,
even in a very highly vaccinated population, that the vaccine does not stop infection.
So you're a used car salesman and you were selling the vaccine,
and the features you thought a vaccine would have, I mean, I have a similar kind of sense
when the vaccine came out. Vaccine would reduce, if you somehow were able to get it,
it would reduce rate of death and all those kinds of things, but it would also reduce the chance of
you getting it. And if you do get it, the chance of you transmitting it to somebody else.
And it turns out that those latter two things are not as definitive, or in fact, I mean,
I don't know to what degree they're not. I mean, I think it's a little complicated,
because I think the first two or three months after you're fully vaccinated after the second dose,
you have 60, 70% efficacy peak against infection, which is pretty good, I mean, right? But by
six, seven, eight months, that drops to 20%. Some studies, like there's a study out of
Sweden that suggests it might even drop to zero. And then you're also infectious for some period
of time, if you do get it, even though you're vaccinated, although there seems to be
lucid data that the period of time you're infectious is shorter.
It's shorter, but the infectivity per day is about as high. So the point is that the vaccine might
reduce some risk of infecting others, but it's not a categorical difference. So it's not safe to be
in the presence of just vaccinated people. You can still get infected.
Right. So, I mean, there's a million things I want to ask here, but is there in some sense,
because the vaccine really helps on the worst part of this pandemic, which is killing people?
Yes. Doesn't that mean where does the vaccine hesitancy come from in terms of it seems like
obviously a vaccine is a powerful solution to let us open this thing up?
Yeah. So I wrote a Wall Street Journal op-ed with Sinatra Gupta in December of last year
with a very naive title, which says, we can end the lockdowns in a month.
And the idea was very simple. Vaccinate all vulnerable people and then open up.
Open up.
Right. And the idea was that the lockdown, this is directly related to the Great Barrington
Declaration. The Great Barrington Declaration said the lockdown harms are devastating
to the population at large. There's this considerable segment of people that are vulnerable,
protect them. Well, with the vaccine, we have a perfect tool to protect the vulnerable,
which I still believe, I mean, is true. You vaccinate the vulnerable, the older population,
and as you said, it's a 10-fold decrease in the mortality risk from getting infected,
which is, I mean, amazing. So that was the strategy we outlined. What happened
is that the vaccine debate got transformed. So first, you're asking about vaccine hesitancy.
I think there's, first, there's like, there's the inherent limitations of how to measure
vaccine safety, right? So we talked about a little bit about the trial, but also after the trial,
there's a mechanism and the work I've been involved with before COVID on tracking and
identifying and checking whether the vaccines actually are safe. And the central challenge is
one of causality. So you no longer have the randomized trial, but you want to know,
is the vaccine, when it's deployed at scale, causing adverse events? Well, you can't just
look at people who are vaccinated and see what adverse events happen because you don't know
what would have happened if the person had not been vaccinated. So you have to have some control
group. Now, what happened is there's several systems to do to check this in that the CDC uses.
One very, very, very commonly known one now is called VAERS, the Vaccine Adverse Event Reporting
System. There, anyone who has an adverse event, either a regular person or a doctor can just
go report, look, I had the vaccine and two days later, I had a headache or whatever it is.
The person died a day after I had the vaccine, right? Now, the vaccine was rolled out to older
people first. And older people die sometimes with or without the vaccine. So sometimes you'll see
someone's vaccinated into a few days later, they die. Did the vaccine cause it or something else
cause really difficult to tell? In order to tell, you need a control group. For that, there are
other systems the FDA and CDC have, like there's one called VSD, Vaccine Safety Data Link. There's
another system called BEST, I forget what the acronym is, to essentially to track cohorts of
people vaccinated versus unvaccinated with as careful and matching as you can do. It's not
randomized, but and then see if you have safety signals that pop up in the vaccinated relative
to the control group unvaccinated. And so that's, for instance, how the myocarditis risk was picked
up in young, especially young men. It's also how the higher risk of blood clots in middle
age and older women with the J&J vaccine was picked up. There, what you have is our situations
where the baseline risk of these outcomes are so low that if you see them in the in the vaccinated
arm at all, then it's not hard to understand that the vaccine did this, right? Young men
should not be having myocarditis. Middle-aged women should not be having huge blood clots in
the brain, right? So when you see that, you can say it's linked. Now, the rates are low. So young
men, maybe one in 5,000, one in 10,000 of the vaccine, vaccine-related myocarditis,
paracarditis, young women, middle-aged women, I don't know. I'm not sure what the right number
might be, but like I'd say it's like in the, you know, one in hundreds of thousands, something
like that. So these are rare outcomes, but they're, they are vaccine-linked outcomes.
How do you deal with that as a messaging thing? I think you just tell people. You tell people
here are the risk. You transparently tell them and just, you're not, you're not, so they're not
getting into something that they don't know. Yeah. And don't treat people like they're children
and need to be told lies because they won't understand the full complexity of the truth.
People, I think, are pretty good at, or actually, you know, people with time are good at understanding
data, but better than anything, they're, they're better at, they're extremely good at detecting
arrogance and bullshit and give them either one of those. I mean, I'll give you one that's,
where I think it's greatly undermined vaccine has, greatly undermined the demand for the vaccine,
is this weird denial that if you are recovered from COVID, you have extremely good immunity
both against infection and actually, and that denial leads to people distrusting
the message given by like the CDC director, for instance, in favor of the vaccine.
Right. Why would you deny a thing that's such an obvious fact? Like you can look at the data,
and it's just, I mean, it just, just pops out at you that people that are COVID recovered
are not getting infected again at very high rates, much lower rates.
After these kinds of conversations, I'm sure after this very conversation,
I often get a number of messages from Joe, Joe Rogan, and from Sam Harris, who to me
are people I admire. I think are really intelligent, thoughtful human beings.
They also have a platform. And I believe, at least in my mind about this COVID set of topics,
they represent a group of people. Each group has smart, thoughtful,
well-intentioned human beings. And I don't know who is right, but I do know that they're kind of
tribal a little bit of those groups. And so the question I want to ask is like,
what do you think about these two groups and this kind of tension over the vaccine
that sometimes it just keeps finding different topics on which to focus on,
like whether kids should get vaccinated or not, whether there should be vaccine mandates or not,
which seem to be often very kind of specific policy kinds of questions that missed the bigger
picture. I think it's a symptom of the distrust that people have in public health.
I think this kind of schism over the vaccine does not happen in places where the public health
authorities have been much more trustworthy. So you don't see this vaccine as in seen Sweden,
for instance. What's happened in the United States is the vaccine has become first because
of politics, but then also because of the scientific arrogance, this sort of touchstone
issue and people line up on both sides of it. And the different language you're hearing is
structured around that. So before the election, for instance, I did a testimony in the House
on measurement of vaccine safety. And I was invited by the Republicans. There were, I think,
four other experts invited by the Democrats or three other experts invited by Democrats,
each of whom had a lot of experience in measuring vaccine safety. I was really surprised to hear
them each doubt whether the FDA would do a reasonable job in assessing vaccine safety,
including by people who have long records of working with the FDA. I mean, these are
professionals, great scientists whose main goal in life is to make sure that unsafe vaccines
don't get released into the world. And if they are, they get pulled. And they're casting down on
the vaccine, the ability to track vaccine safety before the election. And then after the election,
the rhetoric switched on a dime, right? All of a sudden it's Republicans that are cast as if
they're vaccine hesitant. That kind of political shift, the public notices. If all it takes is
an election to change how people talk about the safety of the vaccine, well, we're not talking
science anymore than many people think, right? I think that created its hesitancy. The other thing,
I think the hesitancy, some politicians viewed it as a political, as sort of like a political
opportunity to sort of demonize people who are hesitant. And that itself fueled hesitancy, right?
Like if you're telling me I'm a Rube that just doesn't want the vaccine because I want everyone
to die, well, I'm going to react really negatively. And if you're talking down to me
about my legitimate sort of concerns about whether this vaccine is safe to take,
I've heard from women who are thinking about getting pregnant. Should I take the vaccine?
I don't know. I mean, there are all kinds of questions, legitimate questions that I think
should have good data to answer that we don't necessarily have good data to answer.
So what do you do in the face of that? Well, one reaction is to pretend like we know for a fact
that it's safe when we don't have the data to know for a fact in that particular group with
that particular set of clinical circumstances you know. And that, I think, breeds hesitancy.
People can detect that bullshit. Whereas if you just tell people, you know, I don't know.
Yeah, leave with humility.
Yeah, you'll end up with a better result.
Let me ask you about, I've recently had a conversation with the Pfizer CEO.
This is part therapy session, part advice. Because again, I really want
us to get through this together. And it feels like the division is a thing that
prevents us from getting through this together. And once again, just like with Francis Collins,
a lot of people wrote to me words of support. And a lot of people wrote to me words of criticism.
I'm trying to understand the nature of the criticism. So some of the criticism had to do
with against the vaccine and those kinds of things that I have a better understanding of.
But some kind of deep distrust of Pfizer. So actually looking at Big Pharma broadly,
I'm trying to understand, am I so naive that I just don't see it? Because yes,
there's corrupt people and they, they're greedy, they're flawed in all walks of life.
But companies do quite an incredible job of taking a good idea to scale and making some
money with that idea. But they are the ones that achieve scale on a good idea. I don't know.
It's not obvious to me. I don't see where the manipulation is. So the fear that people have,
and I talked to Joe about this quite a bit. I think this is a legitimate fear and a fear you
should often have that money has influence, this proportional influence, especially in politics.
So the fear is that the policy of the vaccine was connected to the fact that lots of money could be
made by manufacturing the vaccine. And I understand that. And it's actually quite a heck of a difficult
task to alleviate that concern. Like you really have to be a great man or woman or a leader
to convince people that you're not full of shit, that you're not just playing a game on them.
I don't know. It's a difficult task. But at the same time, I really don't like the natural
distrust every billionaire, distrust everybody who's trying to make money, because it feels like
under a capitalistic system at least, the way to do a lot of good, like to do good at scale on the
world is by being at least in part motivated by profit. I mean, I share your ambivalence, right?
So on the one hand, you have a fantastic achievement, the discovery of the vaccine
and then the manufacturing at scale so that billions of people can take the vaccine
in a relatively short time. That is a remarkable achievement that could not have happened
without companies like Pfizer. On the other hand, there is this sort of corrupting influence of
that money. Just to give you one example, there's an enormous controversy over whether
relatively inexpensive repurposed drugs can be used to treat the disease.
None of, no company like Pfizer has any interest whatsoever in evaluating it. Even Merck, I think
it was Merck, that had the patent on ivermectin now expired, has no interest at all in checking
to see if it works. Not only do they not have interest, they have a way of talking about people
who might have a little bit of interest that's again, fringe, full of arrogance. That is what
troubles me. It's back to the play of science. They're not a bit of curiosity. One, the natural
curiosity of a human being that should always be there and an open mind is. Second, in the case
of ivermectin and other things like that, you have to acknowledge that there's a very large number
of people who care about this topic and this is a way to inspire them to also play in the space
of science, to inspire them with science. You can't just dismiss everybody. You can't just
dismiss people, period. Yeah. Well, I mean, I think here take ivermectin. There's actually a study
funded by Tony Fauci's NIAID and the NIH called Active Six that's a randomized trial of ivermectin.
It's due to be completed in March 2023. Normally, when you have private actors like
these big drug companies that have no interest in conducting some kind of scientific experiment
that would have some public benefit, it's the job of the government and in this case, the NIH
to fund that kind of work. The NIH has been incredibly slow in its evaluations of these
repurposed drugs and it's been left to lots of other private activities of uneven quality
and hence, that's why you have these big fights. Because the data are not solid,
you're going to have these big fights. Yeah. But also, okay, forget the process of science here,
the studies, not enough effort being put into the studies, just the way it's being communicated.
Yeah. No, like horse paced. I mean, come on. The FDA put a tweet out telling people who are like,
they're taking ivermectin because they've heard good things about it and they're sick and they're
desperate and just call it horse paced. That was terrible. That was deeply responsible. My hope
is grounded in the fact that young people see the bullshit of this. Young PhD students,
graduate students, young students in college, they see the less than stellar way that our
scientific leaders and our political leaders are behaving and then the new generation will not repeat
the mistakes of the past. That is my hope because that's the cool thing I see about young people
is they're good at detecting bullshit and they don't want to be part of that. That's my hope
in the space of science. Let me return to this idea of the Great Barrington Declaration.
Return to the beginning. So what are the basics? Can you describe what the Great Barrington Declaration
is? What are some of the ideas in it? You mentioned focus protection. What are your
concerns about lockdowns? Just paint the picture of this early proposal.
Sure. So the Great Barrington Declaration, first, why is it called Great Barrington
Declaration? It's such a great name. I mean, it's just such an epic name, but the reason
why it's called that is way less than epic. It was because the conference, which is organized by
Martin Kulldorf, who was a professor at Harvard University by a statistician, he actually designed
the safety system, the statistical system that the FDA uses for tracking vaccine safety.
He and I had met previously just the summer before that summer and he invited me to come
to this small conference where he was inviting me and Sunnetra Gupta, who was a professor of
theoretical epidemiology at Oxford University. And I mean, I jumped at the chance because I
knew that Martin and Sunnetra were both smarter than me and it would be fun to talk about what
the right strategy would be. On the drive in, I didn't know what the name of the town was
and I asked. They said it was Great Barrington and I had it in the back of my head.
Martin and I arrived a little early and we were writing an op-ed about some of the ideas.
Hopefully, we'll get to talk about very soon about focus protection and the right strategy.
When Sunnetra arrived, we realized we'd actually come basically to the same place about the right
way to deal with the epidemic. And I thought, well, why don't we write something like the
Port Huron statement. It was what I had in the back of my head. And I'm like, well, what's the
name of this town again? It was Great Barrington. Yeah. So it's not Barrington. It's Great Barrington.
Which is fantastic, right? It's so over the top that it's perfect. It's literally like the Big
Bang. There's something about these over-the-top fun titles that just really deliver them.
That's my main contribution with the title, the name Great Barrington Decorate.
But yeah, the idea is actually, while the title is great, and I think that it was written in a
very stylish way, it's less than a page. You can go look online and read it. It's written
not for scientists, but for the general public so that people can understand the ideas really
simply. But it is not actually a radical set of ideas. It actually represents the old pandemic
plans that we've used for a century dealing with other similar pandemics. And it's twofold.
First, let me talk about the science it rests on, and then I'll talk about the plan.
The science actually, some of what we already talked about, there's this massive age gradient
in the risk of COVID infection. Older people face much higher risks than younger people.
The second bit of science is all, that's not controversial, right? Even if you think the
IFR is 0.7 or 0.2, no matter what, everyone agrees on this age gradient.
Mm-hmm. The second bit of science is also not controversial.
The lockdown-focused policies that we followed have absolutely devastating consequences
on the health of the population. Let me just give you some examples. And this was known
in October of 2020, we wrote it, right? So the UN was sounding alarmed that there would be tens
of millions of people who would starve as a consequence of the economic dislocation caused
by the lockdowns. And that's come to pass. Hundreds of thousands of children in places
like South Asia dead from starvation as a consequence of lockdowns.
The priorities like the treatment of patients with tuberculosis in poor countries stopped
because of lockdowns. Childhood vaccinations of measles, mumps, rubella, DPT, diphtheria,
so on, pertussis, tetanus, all those standard vaccination campaigns stopped. Tens of millions
of children skipping these doses for diseases that are actually deadly for them.
Is there just on a small tangent, is it well understood to you what are the mechanisms that
stop all those things because of lockdowns? Is it some aspect of supply chain? Is it just
literally because hospital doors are closed? Is it because there's a disincentive to go
outside by people even when they deeply need help? It's all of the above. But a lot of those
efforts, especially those like vaccination efforts, are funded and run by Western efforts.
Like Gavi is a, I think it's a Gates-funded thing, actually, that provides vaccines for
millions of kids worldwide. And those efforts were scaled back, malaria prevention efforts.
So in the developing world, it was a devastating effect, these lockdowns. There was also direct
effects. Like in India, the lockdowns, when they first instituted, there was an order that 10 million
migrant workers who live in big cities and they live hand-to-mouth, where they buy coconuts,
they sell the coconuts with the money, they buy food for themselves and coconuts for the next day
to sell, walk back to their villages or go back to their villages overnight. So 10 million people
walking back to their villages or taking a train back, 1,000 died en route over crowded trains,
dying essentially on the side of the road. I mean, it was absolutely inhumane policy.
And the lockdowns there, it's actually, it's kind of like what's happened in the West as well, but
it was so severe. There was a seroprevalence study done in Mumbai by a friend of mine at the University
of Chicago. What he found was that in the slums of Mumbai, there were 70% seroprevalence in July
or August of 2020, whereas in the rest of Mumbai, it was 20%. So it was incredibly unequal. The
lockdowns protected the relatively well off and spread the disease among the poor.
So that's in the developing world. In the developed world, the health effects of lockdowns
were also quite bad. So we talked already about isolation and depression. There was a study done
in July of 2020 that found that one in four young adults seriously considered suicide.
Now, suicide rates haven't spiked up so much, but the depths of despair that would lead somebody
to seriously consider suicide itself should be a source of great concern in public health.
Yeah, this is one of the troubling things about measuring well-beings. We're okay at
measuring death and suicide. We're not so good at measuring suffering. It's like people talk about
maybe even Holodomor in the under Stalin or the concentration camps with Hitler. We talk about
deaths, but we don't talk about the suffering over periods of years by people living in fear,
by people starving, psychological trauma that lasts the lifetime, all of those things.
I mean, and just to get back to that point, we close schools, especially in blue states,
we close schools. Now, richer parents could send their kids to private schools, many of
which stayed open even in the blue states. They could get pods, they could get tutors,
but that's not true for poorer and middle-class parents. And as a result, what we did is we took
away life opportunities for kids. We tried to teach five-year-olds to read via Zoom in kindergarten.
And the consequence actually, you think, okay, we can just make it up, but it's really difficult
to make that up. There's a literature in health economics that shows that even relatively small
disruptions in schooling can have lifelong consequences, negative consequences for kids.
So they end up growing up poorer. They lead shorter lives and less healthy lives as a consequence.
And that's what the literature now shows is likely to happen with the interruptions of
schooling that we had in the United States. Many European countries actually managed to avoid this.
There were, in the early days of the epidemic, great indications that children first were not
very or severely at risk from COVID itself, nor are they super spreaders. Schools were not the
source of community spread. Community spread, spread the disease to schools, not the other way
around. And we can talk about the scientific base of that if you'd like, but that was pretty well
known even in October. We closed hospitals in order to keep them available to COVID patients.
But as a result, women skipped breast cancer screening. As a result, they are showing up with
late-stage breast cancer that should have been picked up last year.
Men and women skipped colon cancer screening, again, with later-stage disease that should
have been picked up last year with earlier stage. For patients with diabetes,
it's very important to have regular screening for blood sugar levels and sort of counseling for
lifestyle improvement. And we skipped that. People stayed home with heart attacks and died
at home with heart attacks. So you had this like sort of wide range of medical and psychological
harms that were being utterly ignored as a result of the lockdowns.
Plus, there's the economic pain. So like you said, whatever is a good term for the non-laptop
class, people would lose their jobs. Yes, there might be in the western world support for them
financially. But the big loss there that is perhaps correlated with the depression and
suicide is loss of meaning, loss of hope for the future, loss of kind of a sense of stability,
all the pride you have in being able to make money that allows you to pave your own way in
the world. And yes, just having less money than you're used to. So your family, your kids are
suffering, all those kinds of things. There's, again, an economics literature on this,
on deaths of despair, it was called. 2009, there was the Great Recession. It led to
an enormous uptick in overdose from drugs, suicidality, depression as a result of the
job losses that happened during the Great Recession. Well, that's happening again,
like an enormous increase in drug overdoses. That's not an accident. That's a lockdown
harm. Same thing with the job losses. The job losses, by the way, are like, it's so interesting
because the states that stayed open have had much, much lower unemployment than the states that
stayed closed. The labor force participation rates declined by 3%. It's women that separated
because they stayed home with their kids. We've reversed a generation of women,
improving women's participation in the labor force.
Do you think it has to do with the institutions that we mentioned that there was so much priority
given or so much power given to maybe NIH versus other civilian leaders? Or do people just not
care about the economic pain? The leaders, I mean, because to me it was obvious. I mean,
probably is just studying history. Whenever I listen to people on Twitter, on mainstream news,
or just anything, I realize that's the very kind of top. The people that have a voice
represent a tiny selection of people. And so whenever there's hard times, I always kind of
think about the quiet, the voiceless, the quiet suffering of the tens of millions, of the hundreds
of millions. Do the political leaders not just give a damn?
I mean, I think it was actually a very odd, ethical thing at the beginning of the pandemic
where if you brought up economic harms at all, you were seen as callous.
Right. So I had a reporter call me up almost at the very beginning of the epidemic asking me
about a very particular phenomenon. So he was anticipating a rise in child abuse because
children were going to be staying at home. Child abuse is generally picked up at school.
And that actually happened. So the reported child abuse dropped, but actual child abuse increased
because normally you pick up the child abuse at school and you had the intervention.
Right? So yeah, so I was talking about like, well, there's going to be some economic harms
and they're going to have health consequences, but the economic harms matter. But he counseled me
and I think he had my best interest at heart. If you were to put that in the story, I would be,
I'd essentially be canceled because what the narrative that arose in March of 2020 is if you
care about money at all, you're evil and crass. You must only care about lives.
The problem with that narrative is that that money, which we're talking about, is actually
lives of poor people. Right? When you throw 100 million people around the world into poverty,
you're going to see enormous harm to their health, enormous increases in their mortality.
It is not immoral to think about that and worry about that in the context of this pandemic response.
Our mind focused so much on COVID that it forgot that there are so many other public health priorities
as well that need our attention desperately. And this is the thing I sensed about San Francisco
when I visited. I was thinking of moving there for a startup. This is the thing I'm really afraid of,
especially if I have any effect on the world through a startup, is losing touch in this kind
of way. That you mentioned the laptop class, living in this world where you're only concerned
about this particular class of people. And also, perhaps early on in the pandemic, amongst the
laptop class, there was a legitimate concern for health. Like, you're not sure how deadly this
virus is. You're not sure who to listen to. So there's a real concern. And then at a certain
point when the data starts coming in, you start becoming more and more detached from the data.
You don't start caring less and less. And you start just swimming in the space of narratives,
like existing in the space of narratives. And you have this narrative in San Francisco,
in the laptop class, that you just are very proud that you know the truth. You're the sole possessors
of the truth. You congratulate yourself on it. And you don't care what actually gigantic detrimental
effect it has on society because you're mostly fine. I'm so terrified of that.
Well, I think the answer to that is just to remember.
You remember. Yeah. I don't think you remember where you came from and remember who you're doing
this for. At the back of your head should always be what's the purpose? Like, why am I here? What's
the purpose of this? And if the purpose is simply self-aggrandizement, then you know,
should rethink because it'll just end up being a hollow life.
All of us will be forgotten in the end. Focus protection, the idea, the policy,
what is focus protection? Right. So, I was saying that there's two scientific bases, right? So,
one is this the steep age gradient. The second is the existence of locked arms. Again, I think
there's not very little disagreement in the scientific community about both of those facts.
If you put those facts together, the obvious policy is to protect the people who are at
the most severe risk from the disease itself. And that's the idea of focus protection. That's
the general principle of it. The actual implementation of it depends on the living
circumstances of the people that are at risk, the resources that are available in the community,
the technology that's available to do this. And so, it's almost always going to be, in fact,
it'll always be a local thing because it'll depend on all of those things which are all local in
nature, right? So, one very, very obvious thing in a country like ours where so many older people
live in institutionalized settings, in nursing home settings, and that's where older, really
vulnerable, chronically ill patients often live. And you know this disease affects that group most
like most, most commonly. It is absolutely vital to protect that group. We should have known that
in February 2020 from just from the Chinese data. And we should have thought about that
group as the key constraint in our policymaking. Instead, we thought about in February and March
2020 as hospital beds as the key constraint. Hospital beds and ventilator shortages and that
we, so we, we ran around trying to like address that constraint, you know, like a linear programming
problem. You figure out what the, which constraints binding and you address that one thing and then
you go to the next one, right? If that's, if that one constraint, we said, okay, the constraint is
hospital beds. That led to the decision in many of the Northeast States to send COVID-infected
patients who were on the, on the verge of or like looked like they were about to recover
back to nursing homes, who then spread the disease all through there because they wanted
to preserve the hospital beds. Well, for somebody who loves numerical optimization,
I love the way you frame this. But those are kind of connected, right? If you actually focus
on protecting the vulnerable, you will also have the effect of not hitting the ceiling of the
available hospital beds. That's the irony. If we protected the vulnerable, the vulnerable,
the most likely to be hospitalized. And so by protecting the hospital, by protecting the
vulnerable, we will also have addressed the shortage of hospital beds more effectively.
So that little shift in priority would have had a big impact. Okay. But specifically,
the idea is to, and we can talk about different ideas of how to actually do this, but you know,
you basically do a lockdown or something like that on a very small set of people.
You may have to do that if it's community spread is very high, but generally, I think
it would depend on, again, the living circumstances. So for instance, if you are in a, if you have a,
here's a very simple idea that doesn't require a lockdown forced on them. I don't actually,
generally, I'm not in favor of that kind of forced lockdown because you just won't get
cooperation. But what you could do is provide resources to that group of people. So imagine
you live next door to somebody, an older couple, and there's high community spread.
Well, they have to go grocery shopping. We did like some of these, some communities did these
like senior only grocery hour, right? But they have to still have to go out and they might get
exposed in when they're shopping amongst other seniors. Well, why not organize home delivery
of groceries to them? We did that for the laptop class, right? Or it can even just as a volunteer
effort, you know, the older people living next door, just call them up and say, can I help you
get, go out and go shopping for you. And so you would have potentially federal support of that
kind of thing. So these kinds of efforts. And identify where the vulnerable people live.
It's really challenging in multi-generational homes in LA County, for instance, there's a lot of
older people living together with younger people in relatively crowded. There, it's really quite
a challenge. But there, again, you can use resources. So if grandma is worried that grandson
has come home, but is potentially being exposed, grandson calls grandma says, I mean, I might
have been at a party where I might do that where COVID was. Grandma calls public health,
public health and says, okay, you can have this hotel room for a couple of days until you check
turn negative. In case it wasn't clear, the idea of focus protection is the people that are vulnerable
protect them. And everybody else goes on with their lives, open up the economy, just do as it
was before. There was still fear abroad. So there still would be some restrictions that people would
pose on themselves. They probably would go to parties less. The grandsons probably wouldn't
go so many parties, right? There would be less participation in big gatherings. And you may
even say like big gatherings in order to restrict community spread again. I'm not against any of
that. But you shouldn't be closing businesses. You shouldn't be closing churches and synagogues.
You shouldn't be closing. You shouldn't be forcing people to not go to school. You should
not be shuttering businesses. You should just let, just allow society to go on. Some disease will
spread. But as we've seen, the lockdown didn't stop the disease from spreading anyways.
Right. So what do you make of the criticism that this idea, like all good ideas, cannot
actually be implemented in a heterogeneous society where there's a lot of people intermixing.
And once you open it up, people like the younger people will just forget that this is even existing
and they'll stop caring about the older people and mess up the whole thing. And the
government will not want to fund any kind of the great efforts you're talking about about food
delivery and then food delivery services will be like, why the heck am I helping out on this anyway?
Because like it's not making me much money. And so therefore, like all good ideas, it will collapse.
That might be true. I mean, I think it's always a risk with policy thing. But I think,
like think back to the moment, we actually felt like we were in this together to some extent.
Yes. Right. I think that that empathy that we had that was used to like
tell people to stay in like happily, not really happily, but like stay in to like wear a mask
or to do all these things that we thought would help other people could have been redirected
actually helping the people who most needed to be helped.
Especially, I do remember March. So this is even way before Barrington, all that kind of stuff.
March, April, May, there was a feeling like if we all just work together, we'll solve this.
Right. And that may be started to, when did that start breaking down? I mean,
unfortunately, the election is mixed into this that it became politicized. But I think it lasted
quite a long time. I think into the summer, I think there was some of that sense.
I don't know. It obviously varied among different people. But I think that it's true,
it would have been challenging. It's also true that it's heterogeneous, exactly the way you said.
But what that means is you need a local response, a response. So like my vision of a public health
officer is someone that understands their community, not necessarily the nation at large,
but their community. And then works within their community to figure out how to deploy the resources
that are available to do the kind of protection policies we're talking about. That's what should
have happened. Instead, they spent a huge amount of efforts closing, making sure businesses stayed
closed, businesses that, I mean, they're like hardware stores that closed. What good did
closing a hardware store do for the spread of COVID? If it had an effect on COVID spread,
I mean, it's going to be more checking to make sure that plexiglass was put up everywhere,
which now in retrospect turns out to probably made the disease worse.
Masking enforcement, so shaming around mask, I mean, a huge amount of effort on things that were
only tangentially related to focus protection. What if we turned our energy, that enormous
energy put into that, instead into focus protection of the vulnerable? That's essentially the
conversation I was calling for. And it wasn't, I mean, I didn't think of it as we had every
single idea. I mean, we gave some concrete proposals. But the criticism we got was that
those concrete proposals weren't enough. And the answer to that is that's true. They weren't
enough. I wasn't thinking of them as enough. I was thinking that I wanted to involve an enormous
number of people in local public health to help think about how to do focus protection in their
communities. The question that's interesting here is about the future too. So COVID has very
specific characteristics, like you mentioned, about the curve of the death rate based on the,
like it's, it seems like with COVID, it's a little bit easier to actually identify
a group of people that you need to protect. So other viruses may not be this way. So
might lockdown be a good idea, like hardcore lockdown for a future virus that's 10 times
deadlier, but spreads at the same rate as COVID? Or maybe another way to ask that is,
imagine a virus that's 10 times deadlier, what's the right response?
I mean, I think it's always going to be focus protection. But the group that needs the focus
protection may change depending on the biology of the virus, right? So the polio epidemic in the
40s and 50s in the U.S., the great, the people at most risk were children. We didn't know really
at the beginning there was this fecal oral spread. And so we did all kinds of crazy things,
including like spreading DDT in communities, which was somehow supposed to get rid of polio.
But the focus was on whenever there was an outbreak, they would close the school down.
And that was the right thing to do because that group that needed protection was children and
the disease was spread, we thought, in schools. I don't think there's a single formula that works,
but there's a single principle that works, right? It's hard to imagine a disease that's
uniformly deadly across every group and every single person. There's always going to be some
group that's differentially harmed. There's always going to be some group that's differentially
protected. And that may change over time, right? So like in this disease, in this epidemic,
as people got infected and recovered, we now had a class of people that were pretty well protected
against the disease. Instead of ostracizing them because they don't want a vaccine,
we should be allowing them to work. I mean, we're having staffing shortages in hospitals now
because we forgot that principle. It's quite a bit of this, a technology problem. So being able to,
some of it, how much of it is this sociological problem? How much of it is a technology problem?
Like where do you put the blame sort of on why this didn't go so great and how it can go great
in the beginning? I mean, think about lockdowns. Like if we didn't have Zoom, we wouldn't have
lockdowns. There's a reason in 2009 we didn't lock down. I mean, we didn't have the technology
to replace work with this remote technology. So we had good lockdown technology in Zoom.
We didn't have good focus protection technology. Yeah. I mean, focus protection is always going
to be complicated, especially for something like this that spreads so easily. It's going to be
complicated. And I'm the last person to say it would have been perfect. There would have been
people that would have gotten sick, but they got sick anyways. The hope was that if we suppress
community spread low enough, we can protect the vulnerable. That was the hope by lockdown.
The reality was that only a certain class of people were able to benefit from lockdown. The
rest of society, we'd call them essential workers, had to keep working and they got sick.
Yeah. And so the disease kept spreading. It didn't actually have a substantial effect
on community spread in non-laptop class populations. And also we should probably
expand the class of people we call vulnerable to those who would suffer, who have the capacity
to suffer, given the policies that you're weighing. It's very disingenuous to call the
vulnerable just the people. Obviously, we had the very specific meaning, but broadly speaking,
vulnerable should include anybody who can suffer based on the policies you take in response to
a virus. I mean, that principle we just said is a completely agree with is something I think has
been lost and unfortunately lost, right? So the policies themselves, if they have harm,
those are real and we shouldn't pretend like they're not and essentially demonize the people
that suffer them or pretend, I mean, a lot of times like the depression that we've been talking
about, that's thought of as not so important, but it's important. And especially the harm to
the people in poor countries, it's like being out of sight, out of mind in much of the rich
parts of the world. Once again, I've hoped that we seeing this, learning the lessons of history
with the communications, those who have now will learn this. It's like going to another country
and bombing targeted terrorist locations. And there's going to be some civilians who die
pretending that the child who watches their dad die is not going to grow up, first of all, traumatized,
but second of all, potentially bring more hate to the world than the hate that you were allegedly
fighting in the first place. That's another sort of considering only one kind of harm and not the
full range of harms that are being caused by your policies.
You know, like to good return to focus protection, we still should be following the policy now for
COVID and we're not, right? So the vaccines, there's a great shortage of vaccines. You wouldn't
know it in the United States and the rich parts of the world, but there's a great shortage of
vaccines. We're not going to be able to vaccinate the most of the, like the entire set of elderly,
at least, or larger groups until late 2022. Huge numbers of older people around the world
in poor countries that have not had COVID recovered yet, so they're still quite vulnerable,
have not had the vaccine. And yet we're talking about vaccinating five-year-olds
who benefit, if at all, from the vaccine of just a very little bit because they face such a low
risk of harm from COVID. Well, something that's a little bit near and dear to our specific,
the two of our hearts. So you're at Stanford. So Stanford recently announced that they're going
back to virtual, at least for some period of time, in response to the, maybe you can clarify,
but I think it's in response to the escalated, how would they phrase it, it's related to Omicron.
And a few other universities are kind of like considering back and forth. In my perspective,
as somebody who loves in-person lectures, who sees the value of that to students, to young minds,
also looking at the data seems the risk of version in university policies around this,
given how healthy the student population is, seems not well-calibrated. Let's put it this way.
Pathological. Pathological is one way to put it. Given that,
I believe, depending on the university, but I think many universities require that the
student body is vaccinated at this point. So I think it's a big mistake by Stanford to do this.
And I'd like to say that because I just hope MIT doesn't. But what are your thoughts about
Stanford? I agree with you. I completely agree with you. I think we have failed in our mission
to educate our students by this decision. And I think, frankly, just more broadly,
I think we failed generally over the course of the last year and a half in living up to our
educational mission. In-person teaching is vital. Now, I can understand if you have older faculty,
the principle of focus protection says provide some alternative teaching arrangements for them.
That makes sense to me. From the kid's point of view, they're more harmed by not getting
the education we promised them than by COVID. So applying this principle of this focus protection,
let young professors teach in-person. This is before the vaccine. After the vaccine,
let everyone teach in-person. Yeah, this is the part I don't understand the discussion we're
even having because, okay, let's leave focus protection aside here because that's a brilliant
policy for perhaps for the future when there's no vaccine. Now with the vaccine, I'm misunderstanding
something here because we're now in a space that's psychological. It's no longer about biology
because with the booster shots, which I believe MIT is now requiring before January,
with the booster shots, the data shows no matter how old you are, the risks are very low for
ending up in a hospital relative to all the other risks you face when you're older.
I don't understand. Can you explain the policy around closing a university but also just the
policy about just being so scared still in the university setting?
I think the great university has done great harm by modeling this kind of behavior.
Yes. To me, I decided to keep interrupting, but to me, the university should be the beacon
of great behavior, not the beacon of scared, conservative, let's not mess up, let's not
make it pathological, let's not make anybody angry. It should be a place to play in the space of
ideas. I think the central problem is actually related to the central problem of COVID policy
more generally. The goal seems to be to stop the disease from spreading rather than to reduce
the harm from the disease. If the goal is to stop the disease from spreading, the sad fact is we
have no technology to accomplish that. At this point, yes.
Because it's already deeply integrated to the human civilization.
It's here forever. There's a zero survey of whitetail deer in the US. It turns out 80%
of whitetail deer in the US have COVID antibodies. Dogs get it, cats get it. There's almost
certainly human animal transmission of it. I've heard bats get it apparently. You have a
situation where you have this disease, it's here to stay. The vaccines don't stop the spread of
it. The lockdowns don't stop the spread of it. We have no technology to stop the spread of it.
We're burning the earth trying to stop, do something that's impossible rather than
working on what's possible. Like letting regular college happen, that's a great good.
Universities are a wonderful invention and it's contributed so much to society to decide to shut
it down that the universities should be fighting tooth and nail to not be shut down, not the other
way around. Whatever the mechanisms that results in universities doing that, that's probably,
this is me talking, it probably has to do with certain incentives for the administration, probably
has to do with lawyers and legal kinds of things to avoid legal trouble. But once again,
it's when the administration has too much power and too much definition of what the policy is
for the university, that's when you get into trouble. The beauty, the power of the university
should be about the faculty and the students. Administration just gets in the way. Get out
of the way. They can help organize things. They play some important role, but they certainly do.
But they need to remember what the mission is. The mission is not safety. The mission actually,
universities should be dangerous places for ideas and whatnot.
What is the role of fear in a pandemic? We've been dancing around it. Is it useful? Is it
destructive? Or is there a complicated story here? Because taking us back into January 2020,
there was so much uncertainty. This could have been a pandemic that is black death,
the bubonic plague. It could have killed hundreds of millions of people. We don't know that.
We're very new to this. It's been a while. We're rusty. So there is some value to fear
so that you don't do the stupid thing. You don't just go on living.
I guess where I come from, I think it's almost entirely counterproductive. I think fear should
never be used as a tactic to manipulate human behavior by public health.
So the fear on the individual level, that feeling of fear should be very hesitant about that
feeling because it could be easily manipulated by the powerful.
Exactly. So I think that fear is natural. And it's not something that you have to
you have to stoke to get when the facts on the ground suggest it. In fact, the tendency for
humans in the face of threats from infectious disease is to exaggerate the fear in their own
minds of being contaminated by the environment and by others. That's just natural to humans.
And the role of public health is not necessarily to eradicate the fear, but obviously technological
advances can help eradicate the fear. But it's really to help manage that fear and help people
put the incentives that come out of that to useful things as opposed to harmful things.
What's happened in this pandemic is that there's been a deliberate policy to stoke the fear,
to help make people think that the disease is worse than it actually is.
In survey after survey, you see this. And that's been incredibly damaging. So young people
have readily given away their willingness to participate in regular life because A,
they fear COVID more than they ought. And B, they fear that they're going to harm the vulnerable
in their lives. You put those two together and you just get this powerful demand for
lockdowns. You see this all over the world.
Now, broadly speaking, you have a powerful demand for irrational policies, irrational policies,
because I would like to mention the flip side of that. I've been saddened to see how much money
there is to be made by the martyrs, the people, the conspiracy theorists that tell you you should be
afraid of the government. You should be afraid of the man. It feels like fear is the problem.
I think there's some guy that once said something about we should fear fear itself.
He was a president or something. I vaguely remember that.
So I'm worried about both sides here.
I think the general principle is that should not be a tool of public policy.
The public policy should attempt and public health policy in particular should attempt
to address that fear. It's not that you should tell people lies, of course not.
Tell people accurately what the risk is. Give people tools that have evidence that they can
address their risk with and level with people when we don't know. I think that is the right
adult way to deal with this pandemic from a public health point of view. That is not the policy we
have followed. Instead, public health has intentionally stoked the fear in order to gain
compliance with this edict. I think the consequence of that is people distrust public health.
What you're talking about is distrust of government. I think it's partly a consequence of that.
That movement, which is much smaller once upon a time, is much larger now
now because of, essentially, people look at what public health has done and said,
they've lied to me a whole bunch of times and a whole bunch of things is the general sense
and their consequences of that. We're going to have to work in public health for a long time
to try to regain the trust of the public. Throughout all of this, you've been inspiring
to me to a lot of people. You've been fearless, bold in these kind of challenging the policies
and not in a martyr kind of way because you're walking the line gracefully and beautifully,
I would say. Looking at that, I think you're an inspiration to a lot of young people,
so I have to ask, what advice would you give them if they're thinking of going into science,
if they're thinking of having an impact in the world? What advice would you give them about
their career and maybe about their life, thinking about somebody in high school,
maybe in undergraduate college? I'd say a few things. One is, this is a wonderful profession.
You have an opportunity to improve the lives of so many and do it by having fun. The kind of
play we're talking about, it's an absolute privilege to be able to work in this kind of area.
And to young people looking to say that have some gifts or desire for this area, I say,
go for it. So, this area signs broadly? Yeah. I don't have any gifts in AI,
but in health or in medicine or whatever, whatever your gifts lie, develop them, work hard and
develop them because it's worth it. It's worth it not just because you get some status because the
journey is fun and the result is improvements in the lives of so many. So, I think that is the
encouragement I give. I'd also say, if you're looking at this ugliness of this debate that's
happened over the pandemic, I'd say to young people, we need you to come in and help transform it.
Many of the people who've seen this debate that behave poorly, I ask you forgive them. I've done
my best to try because many of them are acting out of their own sense that they need to do good,
but the mistake they've made is in this arrogance and this power. When you come in,
remember that example as a negative example. And so, when you join the debate, you'll join it in
a spirit of humility, in a spirit of trying to learn while keeping that love that led you to
enter the field in the first place. And yeah, choose forgiveness versus derision.
The people that have messed up give them a pass because it feels like that's how improvement starts.
Funny, I've been thinking this is like, I told you I'm Christian, right? So, God has given me
many opportunities to forgive people, learned to practice how to do that.
Gave you a gift.
It's a very humbling thing, I guess.
Is there a memory from when you were young that was very formative to you? So, you just gave
advice to some young people. Is there something that stands out to you that a decision you made,
an event that happened that made you the man you are today?
I actually grew up in a relatively poor environment. I was born in India, and I moved when I was four.
My dad had eight brothers and sisters, and my mom had four brothers and sisters. She grew up in
the slum in Calcutta. His dad died when he was young, and he supported his family, his brothers
and sisters with the university scholarship money. Came to the US, and my dad worked in a McDonald's,
even though he was an electrical engineer, couldn't find a job in 1971. And so, he worked
in McDonald's. We lived in a, like this, basically, the housing development in Cambridge,
this middle building on the 17th floor, this housing development. I think that was transformative
for me. I didn't realize so much at the time how that experience of being essentially poor,
lower middle class, what effect it had on my outlook. You mentioned to me offline that you
listened to a conversation that I had with my dad. What impact did your dad have in your life?
What memories do you have about him? He was a rocket scientist, actually. He helped design
rocket guidance systems. He died when I was 20, and I still miss him to this day. And I think that
experience of seeing him sacrifice himself for his family, a brilliant man, but in many ways,
frustrated with his opportunities in the world, partly what led him to come to the US in the
first place. That's had a transformative effect on me, and I wish I could tell him that looking
back. Do you think about your own mortality? Do you think about your death? Your dad is no longer
with us. You're the old wise sage that represents. I've only worried about death once in this
pandemic, although I've had two of my cousins, who's 73, and my uncle who's 74, die in India
during the pandemic, and I grieve them, both from COVID. The fear of COVID really has only hit me
literally once during this. It wasn't from me, and I recognize it as irrational. So on the eve
of the Santa Clara County Ciro Prevalent Study, it was a really interesting thing because so many
people volunteered to help. And my daughter, who's 19 at the time, and my wife also volunteered to
help with various aspects of the study. And so the eve of the study, they were going to go out in
public, and I didn't know what the death rate was because we hadn't done the study. And I suspected
it was lower than people were saying, but I didn't know. I knew about the age gradient because I'd
seen the Chinese data. And my daughter's young, but my wife is my age, and I didn't know the
death rate. And I couldn't sleep the night before. What if I'm putting my family, my kid, my daughter,
and my wife at risk because of some activity that I'm doing? It was kind of, I don't know.
So it was worried about the well-being of others when you look in the mirror?
If I die, I die. I mean, it's not, again, I'm Christian, so death is not the end for me,
I believe. And so I don't particularly worried about my own death. But I do,
I mean, I just think we can't help but worry about the well-being of our loved ones.
So from the perspective of God, then let me ask you, what do you think is the
meaning of this whole journey we're on? What do you think is the meaning of life?
You know, it's very simple. Love one another. Treat your neighbors yourself.
It's love. As simple as that. Well, I'd love to see a little bit more of that in this pandemic.
It's an opportunity for the best of our nature to shine. I've seen some of the worst,
but I think some of that is just good therapy. And I'm hoping in the end, what we have here is love.
At the very least, make your dad proud with some incredible rockets that we're launching out there.
I think you get along well with my dad, Lex. I definitely would. Thank you so much. This is
incredible honor to talk to you, Jay. You've been an inspiration to so many people
and keep fighting in a good fight. Thank you so much for spending your valuable time with me today.
Thank you for having me here. Appreciate it. Thanks for listening to this conversation with Jay
Barakaria. To support this podcast, please check out our sponsors in the description. And now,
let me leave you some words from Alice Walker. The most common way people give up their power
is by thinking they don't have any. Thank you for listening and hope to see you next time.