Welcome to the Megan says podcast. This is Sam Harris. Just a note to say that if you're hearing this, you are not currently on our subscriber feed and will only be hearing partial episodes of the podcast. If you'd like access to full episodes, you'll need to subscribe as Sam Harris dot-org there. You'll find our private RSS feed to add to your favorite podcast. True along with other subscriber only content.
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I am here with Siddhartha. Mukherjee said thanks for joining me again on the
podcast. Thank you very much. Thank you for having me.
So you've been here twice before we spoke about both of your fantastic tomes, the Emperor of all maladies, which is really the definitive book on cancer in our lifetime just an amazing book and also the gene, which was also amazing and we so we've spoken about both of those books at length on the podcast.
I recommend anyone interested in those broader topics consult those previous conversations. But today I just want to want to talk to you about the covid pandemic in general and and just get your kind of expert I view of what has been happening here these long now five months in the US that we've been dealing with this I think inept Ali by any objective Criterion, you know, our ineptitude is fairly well established.
Published here. So I'll just remind people who may not know what you are. You are a famous oncologist and also writer but your background is in biology. So you actually have a wheelhouse that is relevant to our current concerns. So just to start off here and we can go anywhere you want to go Sid, but what has been your experience watching this all play out and watching in particular watching the spread of
Misinformation and just the way in which has been given topspin by political cynicism in many cases. And also just in the beginning there was a fair amount of actually good faith uncertainty about the biology and epidemiology of covid and so it's it really has been hard to draw the line at various points between a valid contrarian opinion and a dangerously irresponsible one and that he
You know granted that that line is probably getting clearer. But what's it been like for you these last five months watching this unfold
so I think there are several threads in that conversation that I want to break apart because they're quite different. So I want to make a very clear distinction between the uncertainties of which there are many and the ineptitudes of which there are many so we can talk about them separately because those are important and there is gray zones.
In all those cases. So let's first talk about what went wrong and what could have not gone wrong in the United States and around the world. Well before that, let's talk a little bit about why this particular virus of all viruses has the capacity to cause a pandemic and the answer lies in the biology of the virus. There are two features or three features of the virus that make it particularly a pandemic causing virus that
Leslie is is not true for for many viruses one is that it's completely new we have never encountered it before as far as we know and so therefore humans are immunologically naive to to the virus. That's one the second thing and now we're getting two really important things is the fact that the virus has a high degree of high capacity to spread the viral adjusts use one measure of this a measure called are not which is the measure of how many people
Tristan infects and obviously mathematically speaking of that number is above 1 then the infection will spread exponentially. So some viruses have huge numbers measles is a very very highly infectious virus is our scope to sits actually in in the in the higher range. It's hard to estimate exactly what that number is because it varies depending on the population and the behavior of the population but it's got a high number and the third feature which is actually
Probably the one that we realized very late and perhaps too late in the game and is the most Insidious feature is that asymptomatic people people with absolutely no symptoms seem to seem to be able to carry the virus and spread the virus. Now, that's a big distinction that is not true. For instance for Ebola or other very lethal viruses. When you when you have symptoms you usually then become Transit transmitter, but it's true for this virus that you we might be familiar with other.
This is that it's true for HIV. Also. It's true for HIV. You can have be completely asymptomatic but still transmit the virus you can have virus in your blood and transfer the virus these viruses that have this capacity to have asymptomatic transmission are particularly difficult because you cannot simply find people by symptoms alone. You have to find them by testing and and if you want to contain the virus using public health strategies such as containment or quarantine or isolation.
Ation, you have to essentially find them you have to go and find them they will not find you because they don't know whether they whether they buy you I mean a medical doctor or a medical system and that's because they don't know if they're carriers asymptomatic carriers over they're really having the have the virus. Yeah. So so so that covers the territory of why this virus of all viruses has and had the capacity to start a global pandemic. So this brings us to the next piece of conversation, which is
The conversation about ineptitudes so very important to remember that the ineptitudes started right from Day Zero in Wuhan China. We should have known about this virus long before we actually did as a global Community. They we several attempts to buy Chinese doctors in full good faith to communicate the urgency of what was going on in China were essentially
locked we think or we now know to some extent and in fact as you very well know the the ophthalmologist who sounded the alarm on the virus was essentially censored and unfortunately, as you also know he died of that viral infection will come back to that. It will come back to that in a second. It's very important because that tells us something about the virus I think so that's where the ineptitude started I say. I would say that's a global ineptitude. That is all.
I mean people have conspiracy theories around it. I don't know what to believe and what not to believe because the investigation has not really preceded. The Chinese government has been extremely reluctant to share many crucial pieces of information around that first, you know those first few days.
Are you referring to the speculation that this came from a lab as opposed to a wet Market or what conspiracy are you thinking
about? So so many so one is that I think we still don't know the origin of the virus. I
I think that there was an there is an interview in Science magazine from one of the workers who cultivates coronavirus in the Wuhan coronavirus facility, and she's adamant that it did not come from the lab. But the you know, the question is that lab has not been appropriate, you know, that incident has not been fully investigated. I just don't know I do not think that it was an intense. I don't think it was a bioterror weapon for instance nor do I think that that it was a intention?
Infection of someone wrote but I do think that we need to investigate and find out where the virus came from and perhaps even track back the very first index case, which is usually possible if we have access to full free information, which we do not at this point of time
just to linger there for a second sit. Does it actually matter, you know within a very short period we had the full sequence of the virus and we're now dealing with the basics of vaccine design and treatment design
In and epidemiology, does it really matter what the origin moment was?
It matters for future pandemics and it matters for future surveillance. One of the things that you know, we have to learn from this and never let it happen again and doubtless. There are hundreds of thousands of viruses as Ino viruses that lurk in bats and other animals particularly social animals. I mean one question is, you know, why bats seem to carry so many viruses it's because they're you know, they're very social and they live
In very dense populations in an environment. So so it matters for the next pandemic because we cannot let this happen again, but moving to the United States. The ineptitudes are the I would say the the glaring errors began also very quickly and began from the start. So one error that began from the start was that obviously it was the first response here was so it's going to go away it's not going to come it's going to go away.
That's obviously now not been the case, but that was a completely misplaced a response. It was not going to go away. The first index case was seen at the end of January in Seattle. And that should have been the that should have been an immediate call for Urgent action because because we knew as I said that this was a Zeno virus, it had a rapid spread and we knew by that time there was enough suspicion in the viral logical community that there were asymptomatic sweaters. It wasn't definitive.
As soon as that suspicion is raised you need to start acting on it. So we're at the end of January. We're in a small Hospital outside Seattle. The first index case walks in that should have sounded in a major l'arme to the CDC and a major alarm to you know, every health authority saying there is it the virus is now entered the United States and we should do something about it. The second major I would say glaring error, which should never be
Repeated was probably the biggest of them all and that is once the virus was in the United States. There was no test for the virus for about 40 days. So there was no FDA approved test for the virus for 40 full days. I cannot emphasize as an immunologist or virologist that that is that that is a it is inconceivable that that would happen, but 444 days. There was no
For it and that was partly because the CDC tried to make a test and the test the first batch of the test worked. I interviewed virtually everyone. I could then there's a big piece that I wrote In The New Yorker about this the CDC made a test is actually where in the end it was a good test, but when they expanded the batches of the test and send it out sent it out to the public health services, which is where these tests are usually then monitored the
Test failed to work one probe one of the pieces of the test. It didn't, you know kept showing up with the false positives which meant the entire test was was not reliable. Now in that meantime in that same period of time says the clock is ticking now day 1 Day 2 Day 3 several academic investigators including folks like Alex groninger at the University of Washington who I interviewed for the piece in the New Yorker and I you know have had a long communication.
It Alex Granger had by himself in his lab developed a test for the virus. But that test had to be in order to be used. It had to be licensed by the FDA and the CDC and the CDC now the FDA and the CDC, you know, we have a we have something which allows such licensing to proceed very quickly, which is called the emergency use authorization eua and if you speak to the FDA and the CDC, they say they will tell you that. Oh God, you know gosh are
he uh was working fine. We were just waiting for our tests to be corrected. If you ask people in in the private Laboratories, they will say just the opposite they will say well we apply for the EU a but it took by the time it turned around, you know, it was already too
late and I think you described and I think this was in your New Yorker piece you describe doctors spending nearly a hundred hours filling out forms to get permission to test and these forms couldn't even
Email dry they had to be snail mailed to the FDA and is it just sounds like the infrastructure over there is a generation old.
So the I spoke with the FDA and I spoke with the CDC. The FDA says that it was a parallel infrastructure that you had to do a snail mail, but they would also accept emails. That's what the FDA says and it also says that and it maintains that they were
icing these as fast as they could the in laboratory investigators say that that's not the case that in fact the snail mail slowed them down one problem. Of course, you have to realize that there was an intrinsic problem at this point of time, which is that no one had samples. So in order to validate a test, you need samples to validate a test. But if you have only it's it's a it's a perfectly circular arguments in other words. If you don't have a test that works you don't
Who to validate it on because you don't know who's infected and how can you prove that a test works if you don't have samples to validate it on do you see what I mean? Yes, it's up. It's a perfectly in we really need to learn about these pieces of logic or these, you know, these sort of failures some of which are I would say some of which are intentional some of which are not intentional but it's this is a perfect example, and it could be applied into any business. It could be applied to any medicine if you if
If asymptomatic individuals can carry the virus which happens to be in this case then how do you get you know 20 people? What's the what is the positive pause? What does a how do you test whether the test works or not? You can't because you don't have samples to test or any way in any case by you know, 15 20 days in Gran injure and others had scrambled together enough material from various sources to be able to test to show that their test worked and eventually
Of course the FDA CDC test also began to work there. There was a faulty reagent that was corrected. But by all of this time, you know, 40 odd days had passed 30 or days had passed for the most part. I mean, of course it was testing going on as well but about and that's the critical period of time because that is when the infection was spreading and we don't even know what happened in those 30 to 40 days. We don't know how many people flew from Seattle to for instance, New York and, New Jersey.
We don't know how many people came in from there was no travel band remember on Europe. So that is mistake number two. So we just we just went through mistake number one, which was the absence of testing mistake. Number two was to dismiss the idea or was to say this is a Chinese problem. This is a problem that is in China and not recognize the fact that the slopes of infection rates were climbing rapidly in Europe in Italy and Spain. So during the time that we had no
Best there was a rap there were people coming in and going out of major cities New York being probably the major epicenter and there are several genetic clues that clearly suggests that the that the infection in New York at least was primarily seated by European travel and not by not travel from Asia, right? The infection in Europe was seated in turn from from Asian air Travelers who came into it.
Italy and Spain but the infection in the in New York. We have genetic evidence to suggest that it was from people who came in from Europe. So not putting in a travel ban testing band or even a quarantine and isolation during that period of time when we didn't have tests is a crucial error and and that was error to I should say that just backtracking a little bit I should add that the the FDA and the CDC have had a long history of working.
With of working with public health Laboratories, but they have had actually not a very long history of working with private academic Laboratories. So like the University of Washington or like Columbia University Etc. So that is in some ways error number 3 because if the FDA had had a well-established track of or a if they had vetted and pre-authorized as countries like South Korea and other places
did some academic Laboratories as being good enough or of high enough caliber that if they were to apply for a test a successful test that the FDA would say Okay ours doesn't seem to be working will take yours until ours gets to work that infrastructure was present in the within the FDA but present in a very infant form. That's what the academic laboratory folks told me. So academic Pathologists told me the FDA says that's not true.
So the question is when we perform the autopsy one of these one of these two things is correct. We don't know which one it is either. The FDA has had a long tradition and it's quite smooth and and streamlined their capacity to work with academic Laboratories pathology laboratories, like Grand injures, and Colombia is and and New York hospitals or it is in fact was not streamlined and had to be streamlined in kind of emergency setting so so now we
keep moving the clock keeps ticking forward. So now we have people from Europe traveling into the United States carrying virus symptomatic asymptomatic. We don't know there is nothing going on in the borders except for originally as you very well know a ban against Chinese travel, but of course that was not that was not where the leak came from and they're coming into New York and they are spreading the virus a symptomatically because there's and we don't even know where they're going what they're doing where they're spreading the virus and we don't even know how many because the
Test is still lacking. So move the clock forward a little bit forward again,
actually before we advance. I'm wondering let's just Linger on on the testing piece for a second. So what ensures that we learn the right lessons here. It seems to me that some lessons seemed genuinely hard to learn because you normal times. You would view this this sluggishness from the FDA and the CDC is
A feature not a bug in that. I mean we obviously it's got to be motivated to some degree by wanting to ensure quality control. You don't want to just approve Labs all over the place to get there competing test to scale and I got to think the status quo is motivated to some degree by an awareness that there's a trade-off between safety and speed in
situations like so so you're absolutely correct. I mean, you know, we the last thing we want is a trigger.
The FDA or a trigger-happy CDC so that we certainly don't want that. But what we do want is CDC and the FDA and an FDA that is able to respond to pandemic situations in a different way that it was standard response to the approval of any drug or test in normal circumstances. So there has to be some kind of Hysteria sis or some kind of space as it were dial dial up dial down system in which you know, you can dial up or dial down the responsiveness.
This based on the situation one way that I proposed in the New Yorker piece and subsequent pieces. I'm on several several panels that have to do with covid response and what we learned from the covid response, but one way is to do exactly what I told you which is to do some kind of pre-authorization so that the FDA would have acted rather than waiting to receive applications in the setting where their own test was not working to go and seek out people that they have
Ready vetted wrote and asked them, you know, can you help us figure out a at least an interim test? We will validate that test and at least launch that while we wait for our test to come and working so that would be that would have been one kind of solution and this pre-authorization processor pre vetting process could be quite stringent, you know, you don't, you know you the FDA has lots of time in between pandemics to ensure that you know, the University of Washington is not just, you know out to make a fast buck and that there are you
No, they're PCR machines and their get this is there. You know what their capabilities are. How many tests can they do per day how many what is the reliability of their testing State infrastructure? Can they report out those tests, etc, etc. So that rather than waiting and and being being passive. The FDA would have been or the CDC and the FDA would have been active during this process. So that's one thing that one can learn you don't want a trigger-happy FDA, but you do want an FDA that is prepared to what I would call dial up and dial down.
in the circumstances of a
pandemic
Here. Yeah. Okay. So take me to the Border where we now have people pouring in from Europe many under the increased load precipitated by the sudden announcement that if you don't get in in the next 15 hours or whatever it was you're not getting in. So we just had people flooding the airport's of Europe trying to catch the next plane out. Obviously Breathing heavily on one another all the while. How do you perceive that moment?
So so we're
We're then now in a situation. Where as I said in New York City. We don't have testing. We don't know what's happening here. And what is happening in Europe is just the opposite. So what is happening in Europe is that everyone is reacting to the situation in Europe and they are getting on planes and jumping on planes and and essentially coming as soon as they can. They're arriving into New York City and New York City very very soon is full of people.
From Europe who are trying to catch the next flight back and we have no quarantine for them. We have no isolation for them. We have no contact tracing for them. And there is no way to know how long they will stay whether they are tourists whether they are locals returning back. It's just Mayhem. So that's that brings us. We know the clock now chicks and we are now back in we're now sort of 60 days 50 to 60 days and we're beginning to see the
Uptick in New York infection rates by now. So clearly this is a signal that's a problem. There's a you know, there's a surge or the beginning of the Surge and that's usually when a usually when we start to do things like quarantining and now things, you know isolation contact tracing and masking becomes important. So at this stage what's important is to have one clear consistent message saying we're just
Beginning to test we don't know if people have been quarantined or not. We don't know if people have been isolated or not. We're just beginning to test. But the first thing you should do is start social distancing, you know, avoid crowded situations it cetera but most importantly we don't know and we'll come back to this point in a second Sam. We don't know if masks work or not, but they have historically worked against other respiratory viruses. So if your symptomatic
Wear a mask and particularly if you're a Frontline healthcare worker wear a mask and we're probably wear full PPE because that's what we learned from the from the Chinese that it's a highly contagious virus and essentially the CDC vacillates on masks first. It says Nope not required and we've spent a lot of time
said it was even worse than that. I don't know if this was the CDC or the World Health Organization or both but someone at that
point I think clearly concerned that there was going to be a you know, a run on PPE and therefore not enough for Frontline workers. There was messaging around masks. Not only maybe not working but being counterproductive that you'd be more likely to be touching your face. You've been where you're more likely to get sick perhaps by wearing a mask. So people were actively discouraged at one point from wearing masks.
That's exactly right and the Surgeon General at that point in time also said that masks were not
And the the logic that I have heard is that it was because you know people were saying that it wouldn't be that there wasn't that they'd be a run on PPE personal protective equipment. Then that doctors would be it would therefore not be able to get it get any but that doesn't that obviously the public to the public that makes no sense. How can you how can how can I how can I work for doctors but not work for you? It just doesn't make it doesn't it just doesn't make any sense and so
So we then go through this moment in which we don't know if masks work or not and you can't test it experimentally, right? You can't give people coronavirus and say, you know, either half wear masks or half don't wear masks and and see and remember masks work both ways based on a whole bunch of experience with respire tree viruses. They protect a spreader from spreading and they protect an uninfected person from getting virus from getting the virus. So so we don't know and we're in this
Kind of limbo around masking. And so what's happening in the hospital's meanwhile is just really terrifying in New York hospitals because they also don't have enough protective gear so they don't have enough n95 masks the kind of mask that really is fitted and you know, let's through only a very small fraction of respiratory particles. These are not that heavy duties that are not, you know, they're not they're not that
Fancy, they cost less than a dollar typically but hospitals are running out of masks and the emergency rooms and the hospitals are becoming progressively crowded with people who have symptoms. So there is a complete breakdown of communication between all the folks concerned about what is happening in the hospitals are getting crowded the doctors are and nurses and I should say especially the nurses don't have
Equipment to protect themselves. So they're cobbling together whatever they can get some hospitals have n95 masks some don't they're cobbling together whatever they can get and they're trying to move forward. But really it's an emergency situation many doctors are getting exposed. And as you know, some people are going to the ICU because they don't have some patients are going to the ICU because they're beginning to develop these severe complications of covid. So that is where sort of all of a sudden
We are in the middle of we're now in the mid pandemic and and people many people start obviously having having severe problems. The second thing that happens at this stage, which is another mistake is that some people get discharged from the hospital after being tested and they are asked to return to nursing homes. Where also they don't have PPE. And nor do they actually have any real equipment.
Protect the workers or protect residents from each other. So we have a situation in which people are basically going back and these nursing homes become Petri dishes because the virus then goes and infects, you know via nursing home Workers Health Care workers or through direct contact people who are elderly and who are the most vulnerable and this cycle begins to repeat itself. So you go to the emergency room because you feel sick.
You aren't sick enough that they would admit you to the emergency room. There is no quarantine in place. There's no isolation in place. There's no contact tracing in place. Some of those people are sent back to their you know, rehab facilities nursing homes Etc because they aren't sick enough to be in the hospital because the hospital beds are too full and they go and be and they become new sort of sources of infection at the nursing homes themselves. Meanwhile, the government is saying publicly don't wear masks, you know, we have a federal system as
No, which is a which is a problem in a pandemic will come back to that in a second the it's the governor's individual decision about what to do whether to isolate whether to quarantine whether to close schools New York, ultimately closed the schools in my opinion late too late two weeks too late perhaps and then by then it is it is too late in this city at least to do anything.
So from that moment forward. I mean, I know New York became its own version of Italy and so many
Things happened from the public perception side of this that are just frankly bizarre. I mean the fact that we were sitting here watching. I guess it's understandable to hear that. There's a flu in Wuhan and who knows if it's going to get here, but you know once it's starting to get here and once we see what's happening in Italy are lassitude seems fairly inexplicable from my point of view, but even if you could explain that somehow psychologically this intuition that
Never really had to be stated that might be some law of nature that would prevent this thing from spreading to you know, every corner of the earth and every inch of our society if we just sat there and did nothing about it. Once it hit New York and New York became you know, fairly similar to Lombardy. You still saw a country that was incredibly slow to respond and it with some exceptions, California.
Bonded pretty quickly, but even the places that have responded even, you know, even California and went through a significant lockdown. It's still was a fairly piecemeal effort and you know all the while undermined by our basic failure to get any of these necessary ingredients of a response to scale and testing tracing PPE took a long time. I don't even know if PPE is in danger of running out now.
You explain this General picture of forget our initial missteps. Once we understand the gravity of the problem. How do you explain our failure to get up to speed and to perform the way you'd expect the leading Technical and medical power on Earth to perform?
Well, there's several explanations salmon. You've identified most of the problems right off the bat one explanation is that in this federal system or really in a system where Governors have independent choices and decisions to make and have full Authority or larger Authority unless you have a system in which under emergency a task force takes over and tells people exactly what to do then things Begin to Fall Apart.
What happens in this particular situation is that states, you know essentially have or use their own metrics their own decisions and they're quite wildly different so California and New York New York is in the mid pandemic California reacts early and many places impose lockdowns, but in general these lockdowns are not really severe or compliant. So businesses are locked.
Down which of course causes great economic loss, but people are still wandering the streets. There is no systematic lockdown and that's the opposite of what what what you want. Right? So you want business tourism businesses obviously to remain open as long as you can and you want people to stay in their homes and be tested and be contact traced but in many places we've seen in the United States just the opposite happens businesses have to comply for lots of reasons including the fact that they're you know, they have to protect their employees, but people
Are not compliant you remember in Spain and Italy and many other countries, you know, there was really a quasi-military intervention to prevent people from from entering the streets, you know, if you went to the streets a police officer would come up to you or a military officer will come up to you and say what are you doing? And why are you out of your house? That was the state of lockdown which is a real lock down a quasi lockdown is worse because it hurts the businesses and it doesn't prevent the spread in.
People and unfortunately in many cases there was a quasi lockdown masking was not mandatory in New York. We quickly made masking mandatory and I'm I suppose I'm proud to say that's one of the one of one of the things that that I and others pushed very early on saying that yes, we will never have the final evidence and maybe we won't get it in time, but from lots and lots of respiratory viruses. We know that social distancing and mask-wearing does reduce viral load does reduce.
Viral transmission especially if both the infected and infect t or the naive if both of them wear it you get a double effect and potentially a synergistic effect. So so what you have in the United States is this kind of bizarre crisis in which there is you know, a what I what I would call a quasi lockdown with enough leak through that in fact, as soon as the lockdown is opened in some places the virus starts spreading again now in New York.
The lockdown was very strongly enforced and to some extent we saw the worst of things. We saw the worst of the pandemic a huge number of cases and a huge number of deaths. But then once the lockdown was in place there it was quite a lot of compliance. There's a high degree of compliance in New York and New York State on masking. There's a high degree of compliance on social distancing and New York opened in faith is still going through phases but New York opened.
Phases and that's important because when you didn't open in phases what we've seen in other places when you went from lock down to complete open situation what happened as is we've seen that once again the curve of of not just infected cases, but deaths has begun to rise again. It's very important here. These are lessons that we've learned actually from cancer and from other diseases. It's very important to count deaths because deaths are not sensitive to testing
You know, if you increase testing you'll detect more people. Well that's are not that's are not sensitive to testing that's are an absolute value and I would urge anyone who's listening or reading to this to you. No, you can just it's very easy to Google. You can just Google US covid debts and you see exactly the whole story laid out in front of you. You'll see the rise, which is mostly a New York, New Jersey Etc rise the lockdown and then you'll see a second Rise and that is of course in
Such as Arizona Southern California, especially more than Northern California and other states
Texas except said even here there's been room for doubt and conspiracy theories, right? So they're even fairly prominent people have come forward saying that the death statistics are completely false because hospitals have been incentivised to more or less presume or assert covid as the cause of death.
With even when you know, someone is, you know, stage four pancreatic cancer and you know had a you know a week to live any way or they didn't even test them. They had a fever and that's compatible with a covid diagnosis and you have you've had people again, you know, you've had obvious crackpots and lunatics saying this but then you've had extremely prominent people who don't have any expertise here, you know people like Elon Musk, you know out on social media saying these things, so, can you
You put this particular concern to rest that are fatality statistics. Can't be remotely trusted.
Yeah. Yes. I can or partly can I can do it from two angles one is from our own Hospital from the New York experience. I know from people from from from from my patients at least no one no one that I know was incorrectly marked as dead from covid when they actually were dying or dead from something else. So that's anecdotal.
So too, but more than anecdotal actually, we have numerical evidence of this being true. And that is the fact that the case fatality rate of for covid which is the number of people who died upon getting infected has really hovered across the world around 0.7% 0, you know little bit higher than we learned obviously depends on age groups, you know, so if you're in the in the worst category of the most susceptible category to death
It would rise to you know, five six seven. This is these are elderly people or having comorbid conditions. But if you look overall the pattern of is the you know, the numbers, you know end up being in the point seven two point eight percent range and when we were doing adequate testing we have now slowed down in the United States because now the test is you can't get a test, you know, the test turnaround time has now gone up again to about seven to eight days, but when we were doing adequate testing,
NG and appropriate testing the mortality rate was tracking that number point seven point eight point, you know 1% in wasn't tenfold Higher One for lower. So if you just use Simple Math, it will tell you that the simple math would tell you that that as long as the deaths don't go a log fold that's a or tenfold higher or lower than what has been seen all around the world the then then the the deaths are real now of
These people have premorbid conditions or comorbid conditions. And yes, of course, I mean some of them may have indeed I have had other reasons to be susceptible and to die and maybe they had pretty morbid condition conditions that were quite severe. But again pure mathematical reasoning will tell you that that it can't be even if there is a conspiracy that it can't be such a large conspiracy to completely distort the destroyed reality and then I making any sense did I am I making
sense? Yeah.
Yeah, yeah. No, that makes sense. So how do you explain the fact that even at this late stage we seem to be losing ground on testing. I mean again, the picture is one of and erised while medical and Technical superpower struggling to produce everything down to cotton swabs. Why are we not testing and tracing like a supercharged South Korea at this
point?
Well, that's partly because we don't have all the equipment to do that and we didn't you know we have unfortunately and again I would refer back to the piece. I wrote In The New Yorker is a very there is a very important interview. There was one of the people who makes n95 masks as an example and basically his business. This is the guy named Mike Bowen his business of making n95 masks couldn't survive because he was constantly getting out competed by
By the Chinese and because of cost cutting and because of efficiency in hospitals their business was unable to survive and so we became progressively dependent on other countries including China in particular to produce valuable reagents which are important in in the medical process. So we have a situation in which all of a sudden one reagent isn't is for a test isn't available.
And the whole tests testing system breaks down and that's what we've seen again. So so one thing that has become very clear. Is that supercharged as you are you may be supercharged on efficiency, but you are not in this case supercharged on on resilience and you need both you need to be supercharged and efficiency and that's great. But when things are in short supply you need to have stockpiles which are not efficient. You need to have a
Backup system which is not efficient. You may need to have again. You may need to have manufacturers local manufacturers not behold into Chinese Goods or two goods from any other country. I don't want to blame one country or over another in this particular situation, but not beholden to any particular country in which you are essentially so beholden to some good from that country that you can that that if the if that part fails you can no longer work and that's when
That's been the case in our
situation. Hmm how have you perceived the role of public health communication hiramasa thinking in particular about Robert Redfield who's heading the CDC and Deborah birx who was heading the task force, you know, the Pence's task force on Corona and I guess that you know, Anthony found you as well. These have been the most to my eye the most public Medical
Is end to varying degrees. I mean most of their public statements have seemed fairly constrained and even you know, abject attempts to Simply avoid embarrassing President Trump the walk in a line, which really in many cases can't coherently be walked, you know around his Miss statements in their efforts to communicate public health information and again to varying degrees a man would say
Say found she has escaped comparatively unscathed but I mean both Berks and Redfield again. I mean, I mean forgive me if these are friends of yours and I now seem to be disparaging them, but they
didn't I know about you I know about you very well. I don't know Debra or or dr. Brooks I should say and not any of the other folks right in that this
is now getting to be a very old story where you have people who have real reputations and who have accomplished a lot in their lives.
Right, whether it's in business or the military or in this case medicine who I can only assume have reputations for integrity and probity and just a host of Virtues that are worth protecting and they undergo this horrible transformation in proximity to Trump. I mean, it's almost a visible diminishing of their integrity just standing next to the Man. I mean, it's like radiation poisoning every second they spend
Being too close to the Reactor Core, you can see them withering and so I move for Berks and Redfield. This has been fairly painful to watch when they're at the podium trying to make sense and say something responsible in the wake of whatever insane blow VA Shin just came out of the president and found. She has had to navigate that same space as well. And the result has been a pretty just frankly ineffectual communication about the
Off imperatives of the moment and that's just been my experience watching CNN whenever I happened to catch these press conferences which happen less and less what has been your perception of this.
I mean, I think you know all of the people there. I know Tony felt you the best and I've worked with Tony on various things before I think that the it's been it's been quite clear that he's had really a task that completely unenviable task. He said a task that
At that, I just don't know how you could possibly navigate given the situation and given the problems that have Arisen. So I think you're absolutely right.
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