Jay Bhattacharya on the Pandemic
Dec 21 2020

lockdown-202x300.jpg Economist and physician Jay Bhattacharya of Stanford University talks about the pandemic with EconTalk host Russ Roberts. Bhattacharya, along with Sunetra Gupta of the University of Oxford and Martin Kulldorff of Harvard University, authored The Great Barrington Declaration, which advocates a very different approach to fighting the pandemic than current policy and practice. Bhattacharya and his colleagues argue the best way to reduce overall harm is to focus protection efforts on those most at risk, while allowing low-risk populations to return to a more normal way of life. Bhattacharya argues that we have greatly neglected the costs of lockdown and self-quarantine.

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Explore audio highlights, further reading that will help you delve deeper into this week’s episode, and vigorous conversations in the form of our comments section below.

READER COMMENTS

krishnan chittur
Dec 21 2020 at 10:55am

Appreciate being able to hear this – it is so sad that “cancel culture” seems to have invaded science and scientific discourse – we will all suffer because of that.  And I agree – from what I have read, this is the first time EVER that we have seen fury at opinions that seem to be different from any message of alarm and death and that this virus is the greatest threat ever.  As to why this sort of alarmism and irrationality is on display this time around would be helpful to understand, in a philosophical sense.  I heard Martin Kulldoff say on a Soho Forum debate that in a Munk Debate he was asked to be on – no one would volunteer to debate him – groupthink has invaded and polluted science – with very few exceptions.  I hope we have sufficient numbers of people brave enough to withstand and respond to the assault from the cancel culture bullies who seem ignorant about science and the pursuit of truth.  The collateral damage from public policies implemented and demanded are going to be a lot worse – yes, poverty will increase, people will die of starvation around the world – and in these US of A we have punished the less well off – demanded they keep working to support the lives of the rich and wealthy.  The virus has brought on global insanity it seems and here is to hoping we wake up – deal with this virus as best as we can – and be prepared to deal with the next one rationally.  Life will not end with this or the next virus – humans have always adapted and will adapt.

Michael
Dec 21 2020 at 11:31am

This was an interesting episode, and I thought it particularly interesting that Dr Bhattacharya noted that the GB declaration is widely perceived as the “let it rip” declaration (including by people who think “let it rip” is a good idea) even though that is not his position.

I wish there had been more discussion of voluntary vs involuntary measures during the part of the discussion on tradeoffs. Instead, I think the discussion here felt to me like it kind of fed into the (false, IMO) idea that the response to the virus (rather than the virus itself along with peoples’ voluntary responses) was the main cause of the economic damage. Restaurants, for example, are a very low margin business, and you couldn’t pay me to eat inside one now, regudless of what the government permits.

Looking back, I think the government would have been better servied by policies that made it eaiser for people to do the right thing. Financial assistance for people to quarantine after a positive test, opening some hotels where exposed/infected people could voluntarily self-quarantine, etc.

Kevin Ryan
Dec 21 2020 at 12:14pm

Re the characterisation as ‘let it rip’;  I would suggest that a problem is that Jay seemed content to refute the characterisation without explaining why the strategy does NOT amount to ‘let it rip’.  Linked with this he did not set out what he saw as the end game – ie how the virus would finally be eliminated – if his proposed strategy was followed.

(To be clear, I do not know whether this strategy is better or worse than the lockdown ones followed by most governments.  I am just saying that in this podcast Jay was lite on the implications of what he was proposing)

Student of Liberty
Dec 28 2020 at 12:34am

I think he said what his strategy is: focus on the vulnerable. The rest will take care of itself.

As for the strategy to eliminate the virus, history tells us that chances are it will survive anybody still alive today (eradication of viruses are extremely rare and you really need to set a priority on this).

Of course, there is the Chinese communist party alternative whereby you announce lockdowns in order to get rid of the virus within a month and then reopen and declare that the problem has been solved. But you need to get a membership card to the CCP for that.

Danny Kao
Dec 21 2020 at 11:59am

Great discussion, with many excellent points.  Thank you.

I live in Northern California.  Our ICUs are full – 0% capacity.  I hear it’s even worse in Southern California.  I’m curious what the guest would suggest we do instead of a repeat lockdown?

Also, he suggests more focused policy towards protecting the most Covid-vulnerable.  But government policy works as a sledgehammer, not a scalpel.  I’m afraid, he’s falling into the trap of seeing the world as he’d like it to be, not as it is.

Stephen Williams
Jan 2 2021 at 4:54pm

Hi Danny, re lockdown, can you show me any data or stats that demonstrate that lockdown has worked anywhere in the world? I just can’t see that it has any beneficial effect except perhaps in small areas at extremely early stages.

Jeff Weekley
Jan 3 2021 at 2:45am

Not Danny, but I believe the point isn’t that a lock down will eradicate the virus but that it will slow it down enough such that the ICUs are not completely overwhelmed.

David Nehme
Dec 21 2020 at 12:05pm

The talk about deciding for yourself what risks to take misses the bigger point.  Your risk of dying or even requiring medical attention is small, but if you become infected, you are likely to infect others.  The study on how much a mask reduces the risk to the mask wearer misses the point of masks.  It’s not to protect you, it is to protect others.  On that measure, they do seem to work a lot better.

Todd Kreider
Dec 21 2020 at 1:08pm

Except there is no scientific evidence that “[masks] do seem to work a lot better.”

Alan Goldhammer
Dec 21 2020 at 1:25pm

You keep posting this on many blogs I read and you are wrong every time you post.  There are a number of observational studies that have come out showing that masks do work in societal situations.  There are school district studies here in the US, the Jena Germany data, and several others that point out the efficacy of this intervention.

Todd Kreider
Dec 21 2020 at 5:37pm

Mr. Goldhammer, you have not provided links. Please link to the scientific studies that show that masks protect those around the person wearing the mask to any degree. Viruses are tiny and according to a 2015 randomly controlled Australia study, in the case of cloth masks there is a 97% viral penetration. With surgical masks, it has been found that there is a 44% penetration rate.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4420971/

 

Alan Goldhammer
Dec 21 2020 at 7:49pm

All the information is contained in my daily newsletters that ran from the end of March through December 10 when the Pfizer/BioNTech vaccine neared EUA approval from FDA.  I have read numerous papers on masks, materials, and aerosol studies. You can find these references and a lot more on drug and vaccine researcher on my COVID-19 resource page.  All the papers are annotated.

Philip
Dec 22 2020 at 5:23pm

Masks don’t stop viruses, but they do stop the droplets that contain most of the viruses. They have been repeatedly proven effective in reducing spread of viral illnesses. I would recommend looking in pubmed or listening to the excellent virology podcast TWIV for more information.

JFA
Dec 22 2020 at 11:29am

I think the externality issues (while not nonexistent) are exaggerated for most people. If I am the type of person who goes out to restaurants, gyms, churches, etc., who is it that I’m likely to infect? Other people who go out to restaurants, gyms, churches, etc. If other people know that I do those things, they can choose not interact with me in settings that have higher risk of transmission (like coming to my house or having me over to their house).

You could argue that I am also more likely to spread it to the workers at those places, but they could choose to not work in those environments (the Aldi near my house is hiring people starting at $16/hour… if someone doesn’t want to be a waitress or a bartender, there are other opportunities). Bear in mind, if you find this callous, what do you think those workers would be doing if we close their places of work down… not working. So they can either choose to not work or be forced to not work, either way… they wouldn’t be working.

For those who don’t want to get infected or who don’t want to infect others, they can avoid being in settings that increase the risk of getting infected or infecting others.

There are certainly places that face higher externality costs, e.g. hospitals, nursing homes, retirement homes… basically all those places where high risk individuals are most likely to be. Perhaps more tracking on employees at those places would be called for to ensure they were not engaging in risky behavior that would affect the high risk population that they serve. Or you can heavily subsidize those places for them to set up temporary residence for staff.

Jayesh Ametha
Dec 25 2020 at 12:33pm

I do agree that masks intuitively should be helpful.

On a separate note, I also agree to let people assess their risks and make their decisions. It is presumptive to assume a few can decide better for millions of individuals on a new uncharted issue. No one is stopping those who want to go in a bunker. Restraining my freedom to run my business, so that someone’s neighbor’s aunt doesn’t die… is a form of socialism / communism

Bob
Dec 21 2020 at 12:19pm

A Great Barrington type approach made some sense when the major benefit of restriction was ‘flatten the curve,’ but if restriction protects people until they won’t be at risk (a vaccine 100% protective against serious illness), and that period of protection is measured in months, how can this even be an area of serious debate?

Skip Franklin
Dec 21 2020 at 12:44pm

I didn’t hear Russ and Jay talk about the overloaded medical system. If you don’t do a lockdown, cases go up, and hospitals are even more overloaded. I’d be happy to see a better option than lockdowns, but only if it addresses the issues we have…and allowing a whole bunch more people to get infected, even if they have a comparatively low risk of death, does not help.

Having said that, a lot of the ideas in the GB declaration make a lot of sense. I don’t see why we couldn’t both do those and continue lockdowns until the hospital capacity recovers enough that it could handle more sick folks.

Jayesh Ametha
Dec 25 2020 at 12:37pm

Focused targeted strategies is a very standard methodology, which we find in my situations for e.g. marketing, credit risk etc.

If the old and sick are protected through various means, then the remaining less-at-risk would naturally reduce the hospital load… as long as we don’t fear-monger like today, where mild cases rush to “reserve” their hospital beds

RAD
Dec 21 2020 at 1:19pm

Or people–let’s say kids, and actually let’s say people under 30–the flu is actually worse in terms of mortality. Right? So, there are more kids who have died of the flu this season than have died of COVID-19. More children in the United States.

Flu is down so far this season. Have more kids died? FluView in the U.S. shows much lower incidence and the numbers are more dramatic in Canada’s FluWatch system:

To date this season, 47 influenza detections have been reported (Figure 2), which is significantly lower than the past six seasons where an average of 4,354 influenza detections were reported between weeks 35-50.

JFA
Dec 22 2020 at 10:46am

Yes… flu has killed more children this year than Covid: https://www.cdc.gov/nchs/nvss/vsrr/covid_weekly/index.htm

To date there was a spike in flu deaths coinciding with the start of the pandemic; otherwise, flue deaths have been at the average of 2015-2019 (https://www.cdc.gov/nchs/nvss/vsrr/covid19/excess_deaths.htm, click on weekly number deaths by cause subgroup in the dashboard).

Maybe there will be fewer cases of flu this season just because of decreased interaction, but in 2020, flu has been deadlier for children than Covid-19.

Philip
Dec 22 2020 at 5:36pm

I think there is too much focus on the probability of death from flu vs. COVID-19. Even at a relatively low probability, if a lot of children get it, there will be a lot of unnecessary deaths. At this point without a vaccine, and without taking some measures, a lot of children will get this disease. Total lockdown may not been needed if people wear masks, wash their hands and keep a distance. Can’t we wait a few months to get the vaccine going and take a hit on the economy in return for saving all these children?

Also, it is not realistic to just protect the oldest people since we are already seeing more outbreaks in facilities despite precautions. The most practical protection for vulnerable populations is to reduce the infection rate in the whole population.

 

Jonathan Harris
Dec 21 2020 at 1:29pm

What Jay describes is quite different from what I have observed. From early on in the pandemic, you can find articles about the harm of “lockdowns”. For example, a google search for the period 03/01-03/31 finds articles such as https://www.sciencemag.org/news/2020/03/we-are-social-species-how-will-social-distancing-affect-us .
Other articles in the NYTimes from the period discuss harms from sparse abuse and starvation in India.

It appears overly simplistic to blame overreactions to public health officials. Some of it is purely loss-aversion–people not willing to accept an increase in their mortality, even if it is slight. I know plenty of people who are well aware of the best knowledge on the risk of death who nonetheless are limiting their interactions. The most careful seems to be medical professionals.

Secondly, very early on in the pandemic, it was well known and publicized that the death rate had a very steep age curve, that most cases were mild, and that some were asymptomatic.

A third point–he keeps repeating the claim that people used a 3.4 case fatality rate to make decisions. This is a cherry-picked number from a senior WHO person talking about case fatality rates in Wuhan. If you look at the Imperial College Report from 3/18, that many blame for “lockdowns” (even though Italy’s and China’s preceded the report), you can see their infection fatality rate estimate for the UK was 0.9%. NYC already has lost between 0.25-0.3% of its population to COVID with an estimated seroprevalence of under 30%, so the 0.9% is not unreasonable.

It seems that Jay is cherry-picking or exaggerating the views of his critics. This makes me question some of his other statements on issues I know less about.

krishnan chittur
Dec 21 2020 at 2:36pm

If indeed there were concerns about how lockdowns will cause collateral damage – clearly, those concerns were NOT listened to – and lockdown proponents were acting as if the collateral damage, even if existed can be or should be ignored – this is evident by examining what we have seen since the very beginning.  Indeed the idea that lockdowns were instituted late to have any effect was also clear in mid March to April -?  (sorry, do not have the reference).  The Ferguson simulation/calculations were infact used to trigger widespread lockdowns – with no regard for consequences (IMO).  I found his analysis and explanation compelling – and the fact that he and his colleagues of the declaration have been met with such ferocity for daring to offer alternate explanations that I do believe they were on the right track – almost as if people were afraid to allow them to speak lest the public at large lost confidence in the so called elites who instituted the policies.

Jonathan Harris
Dec 21 2020 at 6:10pm

Are you sure that those concerns were “not listened to” or just that others disagreed on the relative importance and likelihood of outcomes. I have discussed with others about the school issue (before there was the amount data we have now), and people merely disagreed with the weight i put on getting kids back in school. One who wanted kids to stay out of school knew the estimates of the fatality rate ranged from 0.2% to 0.9%, so it was not mistaken knowledge. Others have said that children can recover from a missed year, but not from a loss of a caregiver.

krishnan chittur
Dec 21 2020 at 10:44pm

Well – watching all this develop since about mid March, I got the distinct impression that this particular corona virus was being treated as if it was totally new, unknown and so the aversion to risk was not something I had ever seen (or read about) – even as it was clear that the number of people tested was still not very large to jump from a sample to the population as a whole.  The fear was palpable (to me) – and it did not make sense as to why – once the lockdowns started, there was no turning back – and as testing grew and cases grew – even as the IFR and CFR went down, people used positive tests as the end-all.  For example figures/graphs had labels as “covid19” when what they meant to report was positive tests by PCR tests – covid19 is the disease that is caused in some by SarsCov2.  I fear that even today, people say covid19 when they mean positive for the virus – and yes we are seeing large numbers of positives (though even that is a problem because the Ct values (as used in PCR, cycles) is often 35 or 40 – and so represent a very very tiny viral load (if at all – assuming that proper controls were run and so the PCR positive was a true positive) – so yea, I think concerns were not listened to.

What I am most afraid of is that we have changed in how we assess risk of all types – Here is a scary scenario – we know that the SarsCov2 is “antigenically drifting” – perhaps not very rapidly – but that there is some reason to believe that the current vaccine/immune response could be weaker against a possible future virus – so if this virus behaves like the flu virus (rapidly changing) – and if we stick to a goal of reducing “covid to zero” – and the virus keeps changing – we may be in lockdowns forever! (yea, perhaps unlikely – but is what I worry about – that we have lost perspective on risk – and forgot that we can when needed respond quickly (warp speed/whatever) – and deal with it.

 

Alan Goldhammer
Dec 21 2020 at 3:43pm

As others have already noted there was no discussion of the impact of COVID-19 on hospitals.  This was one of the key points for going into lockdown early on.  Nobody could predict what the true case fatality rate for SARS-CoV-2 would be and the reports coming in from Italy were quite disturbing.  New York City hospitals were overrun quickly and remediation efforts were being undertaken that fortunately were not required.  Even today with much more data, we still cannot say what the fatality rate will drop to (based on documented cases of COVID-19, it is still running at about 1.8%).  My own projection from April is that is would ultimately settle to 0.3-0.6% based on past influenza epidemics.

The experience of New York City has been repeated in numerous other geographic areas in the US and ICU beds continue to be in short supply in some regions.  For me this was and still is the main reason for public health intervention.  Masks, social/physical distancing and minimizing stays in enclosed spaces with poor ventilation were and are key.  I think Dr. Bhattacharya does not present the full picture of how these interventions work.  I don’t know anyone that believes will will drive case rates to zero but we could have driven them low enough that track and trace could have managed the pandemic.  The lessons of New York City were ignored as we entered the fall and it should have been apparent that what happened in Florida and Arizona over the summer could very easily translate to less densely populated regions (and it did with higher mortality numbers than the spring).

We are still unable to protect the most vulnerable (as even Sweden have also now admitted) such that the scope of the Great Barrington Declaration is close to worthless as a way forward.

Regarding the economic impact, many large businesses moved to a remote work environment and all the supporting industries (janitorial staff, restaurants, stores, etc.) are suffering as a result.  These companies are managing what they perceive to be a risk and that has nothing to do with lockdowns.  Similarly, as Russ noted, many of us are doing our own lockdowns to minimize our own personal risk.  We had a May trip to Italy canceled and won’t be boarding an airplane until the vaccine is widely distributed (we are goth 73 years old and in good health).  We are not going to restaurants, to plays, movies or concerts.  Our age group who have a fair amount of disposable income are spending it on streaming and books.  Until thinks change, this is where the economic damage is coming from and we have seen it with a number of restaurants in our area closing for good.

Adam S
Dec 21 2020 at 5:57pm

I didn’t find this to be a great interview. I appreciate Jay and Russ’s views, but a lot of the points just seemed inaccurate or disingenuous.

Public health officials and public information: It’s not public health officials’ responsibility to determine the appropriate policy response. Elected officials determine that, so why dump on the public health for creating inequity? Even so, our federal officials contradict public health officials constantly, so I struggle to see how health officials are driving policy at the federal level. At the state level (see Florida), we have elected officials actively suppress and intimidate people in the public health space. I have a hard time seeing an analogy with Sweden.
Age distribution: I’m under 40 and under no illusion that my chances of getting severely ill are small. But I am deeply concerned about spreading it to the vulnerable who must go outside for whatever reasons. I don’t think any young people seriously think they are at severe risk of death. It felt like a great mischaracterization to assume the young and old both consider their risk levels equally.
“Gaiter-gate”: If one type of mask is dramatically better than another, wouldn’t you want to know? I’m baffled with why Russ takes issue with this. I changed my behavior as a result of the study, it cost me next to nothing, and who knows, it could have helped. Maybe the argument is that Duke should be spending their money on more important research, but if a tiny costless action can help your neighbor, why not do it?
The US “panic” response: This is another bizarre assertion. Our federal government has emphatically told us it’s no big deal. Our president got the disease and told us it’s no big deal. State governments range from pure panic to not an issue. But putting the US in the category of countries that “panic” is profoundly bizarre.
Hospital capacity: Flattening the curve seems to make a lot of sense. But it seems like you wouldn’t support a lockdown that moves with ICU capacity. This is what California is doing now – is that such a poor response? Roll back reopening until capacity catches up, or build more hospitals / hire more medical workers. It seems deeply unfair to doctors and nurses who have been working diligently since the start of the pandemic to work even more overtime now. Tying ICU capacity to re-openings seems to be an objective and completely relevant metric in balancing safety with economics.
Vaccine: It’s right around the corner. How much should that change the calculus of all our choices? If anything, I’m much more likely to stay inside and avoid social contact. If we thought the virus was going to be with us for years, sure, I’d go to that wedding or birthday party. But since we’re likely to all be vaccinated by next summer, what’s the point? Shouldn’t that also influence policymakers’ decisions?

I hope Russ can invite some “lockdown advocates” on so we can hear their side of the story. I am somewhere in the middle, but I think a lot of issues that seem very relevant were glossed over or mischaracterized.

Gregory McIsaac
Dec 21 2020 at 9:36pm

I agree with much of this response, except for the suggestion that Russ and Jay might have been “disingenuous.” I see no reason to doubt their sincerity. Indeed, Jay concedes that he may be wrong. To suggest the other side is disingenuous is to claim mind reading ability, which is likely to be inaccurate and derail any genuine exchange of ideas.

I think Jay may have made  a similar mistake of presuming an ability to read minds when he said: “…promising people zero COVID…. People won’t say it explicitly but they have it in the back of their heads.”

The only person I heard promise zero COVID was President Trump, who was generally against “lockdowns.”

The message I heard from public health experts who were advising extreme closures was that these measures were needed  to prevent an overflowing of hospitals and other health care facilities with COVID patients as had occurred in Europe, New York City and elsewhere. Any false promises of zero COVID deaths from “lockdowns” was also not compatible with any realistic discussion of a need for vaccines.

An additional concern I have about the Russ and Jay discussion: there was much mention of “lockdowns” but no definition and little discussion of the variation in the specific lockdowns across the states.

With time and further analysis we may get a better sense of the relative impacts of the different types of lockdowns and hopefully that will inform our response to future pathogens. It is looking like school closures in many US communities were an over reaction. But there was and still is a great deal of uncertainty about how the virus spreads and its impacts on people.

Russ Roberts
Dec 23 2020 at 10:22am

The problem isn’t whether the Duke study was looking at something important or unimportant. It was a bad study. There is nothing in it that shows that gaiters are generally ineffective or worsen the risk of Covid. They tested ONE gaiter made of a particular material. Not generalizable. And they may have even misinterpreted the results they did find in that one case.

John Alcorn
Dec 21 2020 at 5:59pm

I admire Dr. Bhattacharya’s acuity, courage, and wisdom. Thank you, Russ, for an exemplary interview — fair, probing, well proportioned — about complex, crucial contentious issues.

I would like to add a point to the careful discussion of successful efforts by some countries durably to suppress the virus by lockdown, followed by test/trace/isolate + closed borders or international quarantine. (That discussion begins at minute 29 of the podcast). Dr. Bhattacharya clarifies that stable suppression can be achieved only by countries that nip contagion in the bud. Other countries experience what Tyler Cowen calls “the epidemic yoyo.” (China is the exception that confirms the rule.)

I would add that those happy few countries, which nipped contagion in the bud, really have in mind temporary suppression until a vaccine will arrive from elsewhere.  A vaccine’s efficacy can’t be established unless tested in control groups amid significant contagion prevalence. For example, see this report, written at a moment of low prevalence in the UK’s pandemic yoyo (24 May 2020):

“An Oxford University vaccine trial has only a 50 per cent chance of success because coronavirus is fading so rapidly in Britain, a project co-leader has warned. […] Professor Adrian Hill said an upcoming Oxford vaccine trial, involving 10,000 volunteers, threatened to return ‘no result’ because of low transmission of COVID-19 in the community. […] ‘It is a race, yes. But it’s not a race against the other guys. It’s a race against the virus disappearing, and against time,’ he said. ‘At the moment, there’s a 50 per cent chance that we get no result at all.’ Hill said that of 10,000 people recruited to test the vaccine in the coming weeks — some of whom will be given a placebo — he expected fewer than 50 people to catch the virus. If fewer than 20 test positive, then the results might be useless, he warned. ‘We’re in the bizarre position of wanting COVID to stay, at least for a little while. But cases are declining.'”

Indeed, China tests its vaccines in other countries. See this recent report in Nature (2 December 2020):

“Phase III trials are being conducted overseas by Chinese companies because China itself doesn’t have enough people who are ill with the coronavirus to reliably test the vaccines.”

Australia, New Zealand, China, etc.,  free ride on external pandemic burn. Indefinite global lockdown is impossible. However, a policy mix of test/trace/isolate + closed borders (or systematic international quarantine) is feasible for countries who nipped contagion in the bud (whether by lockdown or by other means), whilst they rely on significant prevalence elsewhere for vaccine testing.

PS: I would like to highlight Russ’ incisive, eloquent appraisal of big pharma, at the end of the podcast.

Katherine Joyner
Dec 21 2020 at 11:26pm

Australia did ‘nip in the bud’, with border closures and early lockdown in all states, however the state of Victoria in Australia experienced an outbreak which was suppressed with a severe lockdown for several months. This has only recently lifted. People were supported to survive during this period, although the economic fallout from business closure is yet to be fully determined. However, I suspect that, whatever the damage, Australians will have supported the policy of keeping people in the bomb shelter until help arrives. Yes, Russ, we all die. How many of our own people is it acceptable to lose to an untimely death?

Help arriving externally on which we ‘free ride?” A curious argument. Australia’s own vaccine development, with serious Government investment, had to be halted due to false positive for HIV, which would have undermined public confidence.  Doubtless Pfizer will accept our cheque.

John Alcorn
Dec 22 2020 at 9:05am

Thank you for your comment. I’ve followed news of pandemic policy through Aussie friends in the Melbourne region who are senior academic economists.

Let me clarify my argument. I didn’t assert that Australia’s lockdown was costless. I didn’t assert that Australia didn’t invest in vaccine research. And I didn’t assert that Australia won’t pay for vaccines developed elsewhere. Instead, my point is that vaccines can’t be fully developed anywhere (specifically, can’t be tested) unless there is substantial contagion prevalence somewhere to test them. If I understand correctly, this is a standard point in epidemiology.

The policy, “full suppression until there will be a vaccine,” can’t be a strategy for every country. (Fallacy of composition.) The vaccine would never arrive.

In this specific sense, Australia free rides on pandemic burn elsewhere. Australia will get vaccines without incurring Covid mortality associated with prevalence necessary to test vaccines.

Katherine Joyner
Dec 24 2020 at 12:31am

Hi John,

You say your “point is that vaccines can’t be fully developed anywhere (specifically, can’t be tested) unless there is substantial contagion prevalence somewhere to test them.”

Actually, vaccines must be tested on volunteers who do not have COVID-19, as the goal is prevention. Treatment studies use people who are COVID positive.

Many Australians have volunteered in our own (now halted) vaccine development.

 

John Alcorn
Dec 24 2020 at 9:03am

@Katherine Joyner,

Standard efficacy tests in vaccine development require randomized, double-blind trials. See the WHO’s primer, “How are vaccines developed?” (8 December 2020):

“Phase 3

The vaccine is next given to thousands of volunteers – and compared to a similar group of people who didn’t get the vaccine, but received a comparator product – to determine if the vaccine is effective against the disease it is designed to protect against and to study its safety in a much larger group of people. Most of the time phase three trials are conducted across multiple countries and multiple sites within a country to assure the findings of the vaccine performance apply to many different populations.

During phase two and phase three trials, the volunteers and the scientists conducting the study are shielded from knowing which volunteers had received the vaccine being tested or the comparator product. This is called ‘blinding’ and is necessary to assure that neither the volunteers nor the scientists are influenced in their assessment of safety or effectiveness by knowing who got which product. After the trial is over and all the results are finalized, the volunteers and the trial scientists are informed who received the vaccine and who received the comparator.”

Similarly, see  U.S. FDA guidelines for trial design in vaccine development:

“Later phase trials, including efficacy trials, should be randomized, double-blinded, and placebo controlled.”–Development and Licensure of Vaccines to Prevent COVID-19 (June 2020), p. 12

For example, Pfizer reports the following comparison results from its vaccine trial (43,000 persons):

“162 cases of COVID-19 were observed in the placebo group versus 8 cases in the BNT162b2 group. Efficacy was consistent across age, gender, race and ethnicity demographics. The observed efficacy in adults over 65 years of age was over 94%. [… .] There were 10 severe cases of COVID-19 observed in the trial, with nine of the cases occurring in the placebo group and one in the BNT162b2 vaccinated group.”

Now, by contrast, if prevalence is zero (or extremely low) in the population, from which the two comparison groups are selected–for example, if transmission has been suppressed (nipped in the bud)–then comparison of the two groups can’t establish vaccine efficacy. Specifically, in a setting of near-zero prevalence, if no one in the subset of persons in the trial who receive the vaccine presents COVID-19, then scientists cannot discriminate between two hypotheses: (a) no one got sick because the vaccine is efficacious, or (b) no one got sick because no one was exposed to the virus. See the quotations in my original comment.

Challenge trials are much less reliable than randomized, double-blinded, placebo-controlled trials. Moreover, a challenge trial for a vaccine uses an indirect method to estimate efficacy, by comparing (a) outcomes in the challenge group and (b) general demographic and epidemiological data in the wild about likelihood of contracting COVID-19 (and about likelihood that a case will be severe or fatal) upon exposure to the virus. Thus challenge trials in Australia, where prevalence has been extremely low, would largely free ride on external demographic and epidemiological data from substantial pandemic prevalence in other countries.

BTW, I’m not making a case against challenge trials. They might be useful in the mix. My point is that challenge trials, too, rely on data from pandemic burn somewhere to benchmark vaccine efficacy.

 

John Alcorn
Dec 24 2020 at 11:08am

@Katherine Joyner,

Yes, the goal of vaccines is prevention. However, vaccine efficacy in standard trials is assessed by comparing outcomes of (a) a group of persons who receive the vaccine and (b) a demographically comparable group of persons who don’t receive the vaccine.  Both groups remain ‘in the wild,’ by design, with potential exposure to the virus. If transmission has been suppressed in the source population (i.e., if prevalence is extremely low in the wild), then the comparison can’t yield evidence about vaccine efficacy, because participants don’t encounter the virus in the wild. Neither group would present illness (unless the candidate vaccine itself is flawed in ways that cause illness).

By contrast, challenge trials administer the candidate vaccine and the virus to volunteers, and compare outcomes to relevant data, from the wild, about outcomes conditional on infection. Again, the comparison can’t yield evidence about vaccine efficacy if transmission has been nipped in the bud everywhere.

I’ve written a fuller reply to your comment, with supporting links and quotations. I trust that EconTalk will publish it after checking the links.

[We don’t check people’s links. That’s up to you. However, if you have too many links your comment is automatically held by the spam filter because it looks like spam.–Econlib Ed.]

John Alcorn
Jan 2 2021 at 10:11am

WHO guidelines for challenge trials specify that background prevalence should be a criterion of site selection, in order to reduce the incremental risk that an individual incurs by participating in the trial:

“The design of initial SARS-CoV-2 challenge studies, if such studies proceed, should involve a range of risk minimization strategies […] Background risk of infection is an important consideration in site selection. […] when local background probability of infection is high (for example, during or soon before peak transmission of SARS-CoV-2 in the local community), participants face less marginal risk from being infected during study participation.[…] Higher background probability of infection reduces the marginal probability of infection accrued due to study participation (during which the proportion of participants infected is typically 90–100%).”–Key criteria for the ethical acceptability of COVID-19 human challenge studies, pp. 9 & 12-13

Thus optimal design of challenge trials free rides on the presence of substantial prevalence somewhere.

David Cook
Dec 21 2020 at 6:34pm

We have given this impression that everyone is at the same risk of death conditional on infection.

I really don’t like the linear logic JB employs here. There’s more than one risk to be considered. For those not at high risk of death, the highest risk is unknowingly passing it on to someone we care about who might be at a high risk of death. In fact, I could imagine this being a stronger predictor of people’s behaviour the risk of themselves dying. This should really be factored into his argument at this point.

Hunter McDaniel
Dec 21 2020 at 7:22pm

Toward the end of the discussion, JB talked about his hopes that we would employ the vaccines to provide focused protection of the most vulnerable.

But now it seems that we aren’t smart enough even to do that. At a time when the vaccine is in short supply, the latest CDC guidance is to prioritize tens of millions of “essential workers” ahead of the most vulnerable.

I truly believe we have lost our minds.

Bob Luxenberg
Dec 21 2020 at 11:44pm

As a long time listener of EconTalk, I must say that I was extremely disappointed in this interview. While cancel culture and illiberalism are major issues (that Russ has been superb at illuminating), not all negative reactions are necessarily due to ‘wokeness’. Normally Russ respectfully but forcefully calls out guest’s questionable assertions and MO. Dr Bhattacharya’s statement that mask are nearly useless should have been strongly disputed (see many posts, say, by Eric Topol et al). The ‘declaration’ was funded by a pretty far right libertarian organization (AIER) -this needed to be pointed out, strongly.

Dr Bhattacharya makes, imho, a fundamentally flaw comparing COVID to the normal flu. In flu season I don’t adjust my lifestyle. Like most of my friends, I get a nasty, bed ridden flu every 5-10 years; I accept a relatively low probability of extreme unpleasantness in order to live normally. But with COVID, given ZERO immunity, if the vast majority of people are going about their lives with minimal safeguards (as the declaration suggests) one is essentially guaranteed to get infected. And while most cases are ‘mild’ (aka no hospitalization), many ‘mild’ sufferers  have described it as ‘the worst flu of their life’. While some people might make the trade off of getting quite ill for a handful of days (or weeks) in exchange (assuming there is immunity) to resume their social life, many people who can afford it —say just about every high paid knowledge worker— would elect to minimize their social life to avoid getting getting ill.

 

Mark P
Dec 23 2020 at 11:38am

Bob,

Your assertion of ZERO covid immunity is not correct.  It is estimated that 30-40% of the population has T cell immunity due to possible factors like previous corona virus infection throughout their lives.  My mother (80) in law is a great example of this.  She travelled from Europe to the US on 3/17/20 over 2 days with my wife and quarantined at her house with my wife for 3 weeks.  My wife had symptoms of covid within a few days of returning (mild nasal congestion and loss of taste and smell).  The symptoms subsided after about a week and my wife tested positive for antibodies in July but my mother in law tested negative for antibodies.  Given the stated high infectiousness of this virus it seems incredibly likely that my mother in law was exposed – especially considering they were together on an airplane for many hours, slept in the same bed in Amsterdam and quarantined together in the same house for 3 weeks.

 

Bob Luxenberg
Dec 23 2020 at 7:43pm

Mark- that’s interesting. I wasn’t aware that the population immunity (might) be that high.

But nonetheless I believe, given the extremely high communicability of Covid, relative to a typical flu, that many people will choose a path of serious caution and (partial) social isolation rather than risk an extremely unpleasant / unnecessary illness.

Gregg
Dec 22 2020 at 2:09am

It’s infuriating to hear that we shouldn’t shame non mask wearers.

I live in Tokyo. Japan’s death toll for the entire year is at currently at 2833. Yes 2833 people since last Jaunary. That is 1000x less than the USA even though Japan didn’t lockdown to that same extent as the USA and for the most part Japan has far higher population density, higher percentage of old people, more people crowded into public transportation etc…

Why? Masks!!!

Victoria
Dec 22 2020 at 8:03am

A lot of countries in east Asia managed their epidemics terribly but none have the mortality we see in the Americas or Europe, which is strange.

I remember reading that the mutation of the virus that appeared in Italy is 10 times more contagious and also airborne and slightly less lethal ( but not by much) . This was a comparison using animal models so it isn’t perfect  but it would explain why it was so much easier to contain it in Asia and Oceania than in Europe.

Some scientists  also think there might be seasonal coronavirus similar to covid and that gives people living in Asia an immunity boosts.

As for mask some people believe that it is not only about getting the virus but also de virus load, with mask catching the bigger particles they could be beneficial even if they aren’t perfect.

Bob Luxenberg
Dec 22 2020 at 11:22am

Good point about Japan. Isn’t it odd that we are comparing ourselves mostly to EU countries (Russ did bring  up Israel)? Last time I looked Japan and South Korea were democracies; in what realm are are we American’s content to be on par with France and the UK? We used to be the US or A.

Matt
Dec 22 2020 at 4:01am

As other commenters have already stated, this was a disappointing interview. Not because of Russ, who I thought did a pretty good job pushing Dr. Bhattacharya on some key points – particularly the effect of voluntary ‘bottom-up’ behavioral change vs. top-down restrictions. But Dr. Bhattacharya was unfortunately reductive and uncharitable in his characterization of opposing views, and declined the opportunity to engage substantively on the issues.

More concerningly, Dr. Bhattacharya made a couple of assertions that flirted with being outright falsehoods. For example, his repeated assertion that SARS-Cov2 is no worse than the influenza virus among young people. I’m not sure on exactly what Dr. Bhattacharya is basing his claim, but the flu kills about 2 per 100,000 people between the ages of 18-49 every year. COVID-19 has already killed ~6 per 100,000 people between the ages of 15-44 in 2020 (CDC’s statistics are here: https://www.cdc.gov/flu/about/burden/2018-2019.html, https://www.cdc.gov/nchs/nvss/vsrr/covid_weekly/index.htm). And this is not just an American phenomenon – studies from other countries, like this recent paper from France in Lancent Respiratory Medicine, find that COVID19 is much more severe than influenza among younger age groups (https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(20)30527-0/fulltext).

Finally, Dr. Bhattacharya’s insistence that the entirety of the public response to the pandemic was ‘policy’ brought to mind this quote from Will Wilkinson’s piece on the Great Barrington Declaration (https://www.niskanencenter.org/the-useful-libertarian-idiocy-of-the-great-barrington-declaration/):

“..if you acknowledge that our baleful new reality of Zoom Kindergarten, grocery delivery, and infrequent masked forays into the outer world is more spontaneous than planned order, you’ll have to admit that, when a deadly contagious virus is afoot, unfettered individual choice scales up to a pattern of social life that feels oppressive and suffocating to pretty much everyone. Indeed, libertarians and devil-may-care individualists may feel especially oppressed and suffocated, but they won’t be keen to admit that the scope and value of freedom can shrink without coercion or imposition by the state. ”

JFA
Dec 22 2020 at 11:09am

I believe he was discussing deaths in children, and thus far in 2020 (according to CDC data), more children have died from flu than Covid-19.

Matt
Dec 22 2020 at 1:19pm

It’s true that in school-age children and younger, COVID-19 has a similar mortality profile to the flu (although the morbidity profile is worse). It’s because of this point that I favor school reopening for at least elementary and middle-school levels. But Dr. Bhattacharya made mention of his college-age child as someone who was in this favorable risk profile group, which the data does not support. And there’s also this quote from the interview:

“So, a very steep age gradient, and I think we know that pretty well: that there’s this steep age gradient in survival. Or people–let’s say kids, and actually let’s say people under 30–the flu is actually worse in terms of mortality.”

At best, we can say that he is being fairly careless and overbroad with his characterization of the data – the exact same rhetorical errors he is critiquing his opponents for.

JFA
Dec 22 2020 at 1:29pm

Thanks for the correction. I should’ve checked the transcript.

Alan Goldhammer
Dec 22 2020 at 8:10am

One final note from me.  I wonder if the interview was recorded today whether some of the comments from Dr. Bhattacharya would be different.  California is experiencing a large number of COVID-19 cases, likely a result of Thanksgiving travel.  There is only 2.5% spare ICU capacity available state wide according to the Washington Post, field hospital construction is ongoing and discussions of how to ration hospital care are underway.  This is what the pandemic has always been about.

Gregory McIsaac
Dec 22 2020 at 9:19am

Dr. Jay was interviewed a few days ago and did not appear to change his basic message California doctor calls lockdowns ‘failure of imagination,’ as state becomes epicenter of outbreak (msn.com)

 

Rich
Dec 22 2020 at 9:10am

It seems the majority of folks commenting here did not really listen to the interview. Dr. Bhattacharya is advocating for a more sophisticated approach to dealing with this virus than the strict governmental, one size fits all, control measure now in place. He advocates for protecting our most vulnerable while, at the same, time not destroying the livelihoods of those who are in the lowest risk cohorts.

I suspect those commenting here while safely ensconced in their quarantine quarters are also still getting paid or have enough savings to see them through the crisis. There are many who live in greater fear of losing their savings or simply not being able to pay even the most basic living expenses. Businesses are on the verge of collapse or have been completely destroyed by these draconian measures. I know people who would happily risk the disease in order to remain solvent, knowing that their mental health and emotional well being are at stake.

I get that there are those here who would say that it’s all well and good for these folks to take that risk, but if they get infected then they can infect others so they should not be allowed that choice. Really? They should not be allowed to earn a living because the most technologically advanced country in the world can’t figure out how to do two things simultaneously: protect the most vulnerable and keep people solvent? Oh yeah, sorry, forgot that folks are about to get $600 from our all loving federal government.

By the way, I’ve had Covid and my wife has had Covid. We are in our late 50s. We wear masks and keep our distance. We do not have underlying conditions though my wife is a cancer survivor. I’ve had worse flus. Everyone is different, but I trust the data and am not happy to be living in this fear based, overwrought environment. It’s ok to opt out of normal social life – you are free to do that, but I wish folks would stop advocating for everyone to stay home and hide under their beds until the miracle cure is available.

Here is what I am afraid of, though. That this is just the first of many crises to be used to curtail even the most basic civil liberties – our governmental betters now know that fear and hysteria can be used to effectively control the population and the majority are willing to go along and put pressure on others to do the same. It’s for our own good, after all. Climate change anyone?

Christy Bacque
Dec 22 2020 at 9:11am

I would like to chime in on the disingenuous use of the Denmark masking study, whose results are available online at: https://www.acpjournals.org/doi/10.7326/M20-6817

There are a number of factors in the study that are very specific to Denmark and at the time of the study there was no government directive for their citizens to wear masks and fewer than 5% of the population was wearing them. Here are some significant quotations from the study results:

“Based on the lowest adherence reported in the mask group during follow-up, 46% of participants wore the mask as recommended, 47% predominantly as recommended, and 7% not as recommended.”
“Three post hoc (not preplanned) analyses were done. In the first, which included only participants reporting wearing face masks “exactly as instructed,” infection (the primary outcome) occurred in 22 participants (2.0%) in the face mask group and 53 (2.1%) in the control group….”

So wearing a mask correctly saw a dramatic decrease in the infection rate. Further:

“These findings do offer evidence about the degree of protection mask wearers can anticipate in a setting where others are not wearing masks and where other public health measures, including social distancing, are in effect. The findings, however, should not be used to conclude that a recommendation for everyone to wear masks in the community would not be effective in reducing SARS-CoV-2 infections, because the trial did not test the role of masks in source control of SARS-CoV-2 infection. During the study period, authorities did not recommend face mask use outside hospital settings and mask use was rare in community settings (22). This means that study participants’ exposure was overwhelmingly to persons not wearing masks.”

My emphasis.

I live in Canada and we are voluntarily masking, and have had a much lower death rate than the US. I know there are many factors that make country to country comparisons sketchy, but wearing a mask has been known to reduce infection rates of disease for at least a century and it is really irksome that it is contentious.

US deaths per 100,00 is 97.10
Canada deaths per 100,000 is 38.44
https://coronavirus.jhu.edu/data/mortality

Using that one study to suggest mask wearing is ineffective when adopted by the vast majority is truly disingenuous.

Thanks for listening to my mask rant.

KM
Dec 22 2020 at 11:45am

There are many other risks Dr. Bhattacharya has not considered. For example, widespread infections, even among young people, can lead to many mutations of the virus, some of which might eventually turn out to be  even more dangerous variations of the original virus, and thereby drastically change the dynamics of the disease. The newly found cases in the UK is an evidence for this.

 

JK Brown
Dec 22 2020 at 12:11pm

Unlike past epidemics, such as the Swine Flu, a case for COVID only requires a positive test, even if none or mild symptoms are all that present and the person never seeks medical-assistance.  For Swine Flu, it required both influenza-like illness symptoms AND a positive test.  There is a “probable case” category that goes only by clinical criteria without a test.

Lance
Dec 22 2020 at 1:54pm

I felt the guest was often arguing against a straw man or an alternative that simply did not exist in reality.

For example, he claims public policy was to scare people “that the world is on fire.” That’s hardly the case in the US. Nancy Pelosi encouraged people to eat out as late as February. When BLM protests were happening, many public figures, including public health figures condoned the gatherings. When hundred of thousands gathered at the motorcycle rally in South Dakota, public officials did little to discourage the gathering. President Trump, who has the biggest bully pulpit on the planet, admitted to journalist Bob Woodward that he wanted to downplay the threat. Even the so-called lockdowns in the US at least were not real lock downs and didn’t last that long in most states.

Thus, when calculating the cost of the lockdown the counter factual cannot be economic activity absent public policy. Except for a few weeks at best, there was never a uniform public policy on the severity of the threat. Indeed, that may be the biggest problem in the US-the lack of a consistent policy. This means many people decided to stay home, not because of “public policy” but because they’re scared! I work at a private university. The university decided to hold classes remotely, not because of scare mongering “public policy” but because stakeholders at the university (faculty, students, staff) thought that was the safest thing to do.

[Formatting fixed–Econlib Ed.]

Lance Freeman
Dec 22 2020 at 5:08pm

I think JB at key points was arguing against a straw man or an alternative reality that simply did not exist in the US. First, to describe US “policy” as “‘The world’s on fire. Stay inside. Panic. You’re going to die if you go out.’ seems misleading at best. Trump admitted to Bob Woodward that he sought to downplay the threat of Covid-19. He’s on record as describing COVID as “going away” and not a big deal. Most states were opening up in April and May. That’s 7 months ago. When BLM protests occurred, many public officials condoned the protests. Sports leagues, including unpaid college students have been playing for months. So what lockdown is JB referring to, and what “policy” is he referring to?

JB and Russ criticize public health officials for being inconsistent. But elsewhere they decry the illiberal moment that we are in. Disagreement among public health officials is to be expected. Economists don’t all agree on economic policy, why would we expect the public health establishment to speak with one voice. It’s also peculiar to criticize public health officials for having different opinions while you complain about “groupthink” elsewhere.

 

Finally, the costs of lockdowns described by JB are not credible. Russ did push back a little, but not vigorously enough. For example, I work at a private university. Over the summer after deliberation among a committee made up of faculty, staff, and student representatives decided to hold classes remotely this fall. This means faculty and students are not commuting to campus, not buying coffee at the local coffee shop, not buying lunch at the local cafe and probably buying fewer clothes.This is certainly a major hit to the local economy this fall. But this is not due to “lockdown policy.” This private university, which includes a school of public health, business school and economic department,  decided it was better to hold classes remotely. When calculating the costs of “lockdown policies” one can’t simply assume the counter-factual is business as usual. Many businesses and people would have dialed back their economic activity.

When constructing a counterfactual, we also have to assume many people in high-risk groups would curtail their activity. In the US if one adds the elderly to other high-risk groups (e.g. the obese) that’s almost 40% of the population: https://www.kff.org/coronavirus-covid-19/issue-brief/how-many-adults-are-at-risk-of-serious-illness-if-infected-with-coronavirus/

If we add people living in multigenerational households it’s easy to imagine almost 50% of the population being in a high risk group or living in the same household as a high risk group. Thus, any estimate of the costs of lockdowns should use as the counterfactual an economy where 40% of the population is indeed “locking down.”

 

Jeremy
Dec 22 2020 at 7:39pm

A word about the Australian COVID response, which seems to be poorly understood by Americans including Russ and today’s guest: Australia’s success is best characterised as a triumph of localism. Let me explain.

It is correct that testing and tracing has been an important tool in the Australian COVID management response. But you have missed the absolutely crucial intervention: wherever an Australian State health authority detected an outbreak, they scaled up LOCAL interventions to prevent it from spreading to other areas, and all States implemented State border controls – or targeted local area restrictions – to prevent the movement of people from infected areas to other areas. It’s the movement of people that presents the biggest risk and is the cheapest to prevent with policies. As long as we allow the movement of food and goods, a policy requiring people to mostly stay in their city/town to work and play for a while is a hassle but just not that costly for the majority of people.

Most Australians experienced a short period of mild COVID restrictions in March and April, masks were recommended-but-not-compulsory and the restrictions were being eased by May in most States as case rates fell to zero. Specific locations subsequently affected by a major outbreak (so far only metro Melbourne) implemented more severe LOCAL restrictions, for longer. Let’s be clear: those costs were only borne by people *in Melbourne*.

The sacrifices made by Melbourne were made to protect the whole country. Consequently, life goes on as normal in most of Australia, and the economy is growing. This week, we have a local lockdown of a part of Sydney because hotel quarantine is imperfect (this is known and largely accepted). People can’t travel in or out of the affected area without a very good reason.

The Federal government has supported state and local efforts: people whose work was affected by any lockdowns received special social security benefits to get them through. However there are problems and gaps: eg precarious contract or app workers are not eligible for the social security payments, and the arrangements for compensating people who have to quarantine due to contact with an outbreak is patchy (which means some people have been out working when they should be in isolation). Too many healthcare workers in Melbourne got infected at work. People have ignored travel restrictions and some have gotten away with it. It is an imperfect system – as all policy interventions are.

I’d recommend revisiting NN Taleb’s EconTalk interview on the pandemic. He notes that the problem with a pandemic is not the infection-death rate, it is the infectiousness and how that scales up the risk. He recommended targeted quarantines as a time-honoured cost-effective solution to prevent geographic spread because otherwise the probability of infection will keep rising – everywhere. You simply cannot protect the vulnerable with low cost interventions if the virus is ubiquitous. Your discussion fell into binary thinking (let it rip or stop 400 million people from leaving their house for ever).

It is simply wrong to assert that by February it was ‘too late’ to suppress the virus in the USA. That’s flawed thinking. It wasn’t too late for North Dakota when New York was seeing its first cases. America made a policy choice to let the virus spread to other states.

Alan Goldhammer
Dec 23 2020 at 10:19am

I’d recommend revisiting NN Taleb’s EconTalk interview on the pandemic. He notes that the problem with a pandemic is not the infection-death rate, it is the infectiousness and how that scales up the risk. He recommended targeted quarantines as a time-honoured cost-effective solution to prevent geographic spread because otherwise the probability of infection will keep rising – everywhere. You simply cannot protect the vulnerable with low cost interventions if the virus is ubiquitous. Your discussion fell into binary thinking (let it rip or stop 400 million people from leaving their house for ever).

Plus One!! Taleb’s conversation was far better.

John Alcorn
Dec 23 2020 at 11:44am

Recent analysis of stored samples of U.S. blood donations from nine scattered States in December 2019-January 2020 indicates that contagion already was present in each of the nine States by mid-December/early January (i.e., before WHO announced the presence of a mysterious coronavirus-related pneumonia in in Wuhan, China):

“SARS-CoV-2 reactive antibodies were detected in 106 specimens, a small percentage of blood donations from California, Oregon, and Washington as early as December 13–16, 2019. [… .] Similarly, antibodies to SARS-CoV-2 were identified among donations occurring in early January in Connecticut, Iowa, Massachusetts, Michigan, Rhode Island, and Wisconsin prior to known introduction of SARS-CoV-2 into those states.”

Dr. Bhattacharya and Dr. Roberts did not “[fall] into binary thinking, (let it rip or stop 400 million people from leaving their house for ever).” Instead, they discuss an alternative policy mix of (a) accurate communication of public-health risks, (b) private adaptation by individuals and organizations, and (c) focussed protection according to differential vulnerability (by age and relevant co-morbidity). I understand Dr. Taleb’s point about prevalence and risk. However, IMO, critics fall too quickly into defeatism about focussed protection. Dr. Bhattacharya describes a number of specific, accessible policies and feasible reallocations of resources for focussed protection.

Todd Kreider
Dec 22 2020 at 9:30pm

“masks were recommended-but-not-compulsory”

This isn’t true. As with scientists in Europe, Australian scientists were recommending to not wear masks because there was no evidence of protection. yougov surveys show 20% of Australians were wearing masks in April and that rose to 50% in September.

Australia has not had success since the virus was so scarce in the first place. Why can’t we all have government and health care systems as those in Cambodia, Laos and Mongolia where they have had no Covid-19 deaths?

Jeremy
Dec 23 2020 at 5:15pm

“Australia has not had success since the virus was so scarce in the first place. ”

The data is publicly available which reveals this statement is untrue.

According to Worldometer,  on the 15th of February 2020:

* Australia had 15 known cases. An Australian lab was the first in the world to isolate the genomic sequence of covid, using a sample from an Australian resident returning from Wuhan.

* the United states had 15 known cases.

For context, please note the US total population is larger than Australia by a factor of 13 times.

I acknowledge that these statistics could reflect a failure by America to conduct early testing. However they indicate that on the same date in February Australia’s known population health burden was 13 times larger than the US. this is not surprising: the Australian population is more internationally mobile than the US’s.

So, starting from the same absolute number of cases on the same day…By the end of August 2020, Australia had almost 30,000 cases, or 0.1% of pop. The US had 7 million, or 2% of pop. Australia’s caseload has been pretty flat since August, despite thousands of international travellers arriving every week (these are mostly residents returning home as the border is closed to tourists).

Jeremy
Dec 30 2020 at 9:51pm

Edit: Australia was the first to sequence the genome *outside of China*. Apologies for the proofread fail.

James
Dec 23 2020 at 4:31am

I live part of the year in Taiwan and can attest that the public health measures here were highly effective as there as of December 23, 2020, only 770 cases and 7 deaths for a population of over 20 million. Also, the economic fallout has been mainly limited to hotels and other travel-related businesses. For most, life here goes on with more vigilance but otherwise as before the pandemic.

When the virus emerged in China, Taiwan acted quickly and early to implement mask-wearing, social-distancing, and contact-tracing. Also, Taiwan imposed strict controls on entering the country. In my case, I needed a negative Covid-19 test; my movements from arrival at the airport to my place of quarantine were tracked; during my 14-day quarantine, I had to respond to a daily question about my health status; and I received a call several times from the local police reminding me about the need to adhere to the quarantine.

What’s sad about watching the floundering of the U.S. from abroad is that the U.S. paid the high costs of multiple, uncoordinated lockdowns in return for minimal benefit beyond preserving some hospital capacity. In contrast, Taiwan’s swift and universal response minimized the economic costs, permitted an ongoing return to normal life, while achieving an extremely low level of infection and mortality.

A.G.McDowell
Dec 23 2020 at 5:36am

The practical effect of the UK lockdown so far has been the strategy mentioned above as not discussed: to maintain lockdown at a level just sufficient to avoid having the NHS overwhelmed. This also suggests vaccine policy: vaccinate those people most likely to consume NHS resources if infected.

You worry that “we can’t get there from here”. One benefit of focusing on the next step in a program of incremental change is that there is almost always a next step, even if the goal appears out of reach. Pointing out that public health will suffer (as it has in the past) if new ideas bring only retribution to their proposers would be one possible next step.

Patrick Brinich-Langlois
Dec 23 2020 at 12:38pm

So, people who have heard me have heard this litany, so I apologize if you’ve heard me before. […]

So, in April, the UN [United Nations] World Food Program, I think the group that won the Nobel Peace Prize this year, estimated that there will be an additional 130 million people who will die of starvation worldwide–this year–as a consequence of the lockdowns, the economic harm of the lockdowns.

This claim is laughably wrong. In 2019, 58 million people died total. Is it remotely plausible that in 2020 the number of deaths from starvation alone would be more than double that? Even if you added up all the deaths in the chart titled “Famine victims worldwide since the 1860s” on this page, you would fall short of 130 million.

The fact that someone would make such a claim, never mind include it in his talking points (as his preceding sentences suggest), is grounds for doubting his statistical literacy.

The claim made by the executive director of the World Food Program was that 130 million additional people would face “crisis levels of hunger or worse” in 2020 owing to all COVID-related causes (not just lockdowns):

821 million people go to bed hungry every night all over the world, chronically hungry, and as the new Global Report on Food Crisis published today shows, there are a further 135 million people facing crisis levels of hunger or worse. That means 135 million people on earth are marching towards the brink of starvation. But now the World Food Programme analysis shows that, due to the Coronavirus, an additional 130 million people could be pushed to the brink of starvation by the end of 2020.

Doug Archer
Jan 12 2021 at 4:21pm

First time commenter at econtalk and came here to say this same thing.  How this comment was made without provoking a patented Russ Roberts “maybe” or “I’m not so sure” reply is beyond me.  Jay claims 130 *million* people will die due to the lockdowns based on a ridiculously simplistic economic assertion.  And 1 million more TB deaths, etc. all without being challenged?  Come on Russ, where’s the skepticism on these claims :)?  (And then to disagree with mammogram necessity later but NOT object to these claims?)

I DO applaud Russ for having the courage to interview Jay given the current climate and agree that discussion and disagreement are absolutely necessary in finding the best path forward.  However, the GBD has fundamental flaws which needed more discussion:

His claim that the CFR is much lower than being reported.  This is a total straw man argument.  Public health organizations have stated from the beginning looking at data in China that the IFR is likely 10x less than the CFR so all he is doing is stating what pretty much everyone already knows but doing it in a way to make it seem like they are revealing some deep secret.
The fatality rate is highly sensitive to access to hospitals as a high fraction of (symptomatic) COVID cases require hospitalizations.  The GBD proclamation does not account for an overwhelmed health care system.
They offer no concrete solutions for how to “protect the most vulnerable”.  Countries like Sweden who tried this as a strategy largely failed.  And even in long-term care facilities, which house the most vulnerable people and, you would think, would have a much easier time controlling access and infection rates due to their restricting access even in normal times, STILL have issues with infection.  How we are supposed to protect the vulnerable amongst the general population is completely left as an exercise to the reader.

Do I believe that lockdowns are the only answer to COVID?  Absolutely not, and we need to have discussions about other things to try.  The lock everything down vs don’t do anything debate is a false dichotomy and we need to find some middle ground.  But the many false assertions of the GBD use the same fear-mongering tactics as those promoting a lockdown-only policy, and does more harm than good to the conversation.

Ivan
Jan 15 2021 at 4:51am

I truly enjoyed the interview, a bit fan of Russ and generally agree with Jay that lockdowns might very well done (and are doing) more harm than good, and that tradeoffs should have been analyzed, but this has definitely rubbed me the wrong way.

I later went to look for source and only thing I found was same claim linked above.

Claiming that 130M people would die of hunger this year is plain wrong. Jay should have been called out on this. Not blaming Russ – interviewing is tough and he might have missed that, but yeah…

Nick Ronalds
Dec 23 2020 at 6:44pm

Excellent discussion. It’s deeply dispiriting to think about what’s happened to our culture in recent years and how the trends have accelerated this year.

The one question that I wish Jay had addressed is the extent to which older people, defined in the discussion as those over 70, are more at risk mainly because co-morbidities are correlated with age. In other words, how much is a 80-year-old’s higher susceptibility due to the fact that he/she is more likely to be obese, diabetic, have heart disease, dementia, etc? We know that these diseases become more prevalent in older cohorts. To put it in statistical terms, how much does susceptibility to COVID19 increase if you control for co-morbidities?

Martin Brock
Dec 23 2020 at 10:42pm

“I’m probably gonna die anyway at some point …”

No. You’re definitely gonna die anyway at some point.

Greg G
Dec 24 2020 at 8:40am

I was really looking forward to this podcast but, like many commenters, I found it very disappointing in the end.

I don’t know what the right level of mandatory or voluntary lockdown is here.  There are countless factors affecting risk and they are different in different places, at different times, and for different people.  Certainly we shouldn’t view anyone who feels certain what the right public policy is as any kind of a Hayekian.

The best argument for some level of mandatory lockdown for healthy younger people  has always been to address the risk of overwhelming the health care system.  When that happens, deaths from all causes rise sharply beyond where they would have been with the healthcare system up to speed.  During the lockdown in the spring, healthcare workers were taking great risks, making great sacrifices, and working without even proper PPE.

How would Dr. B. have addressed the best argument for the lockdowns he so vehemently opposes?  I have no more understanding of that now than I did before I listened to the podcast.

Don Crawford
Dec 24 2020 at 2:02pm

The guest complains about the stigmatizing people who get COVID-19, as having “failed.”  Instead of compassion for those who get the disease, we question what they did wrong. He thinks this is some unfortunate coincidence.  In times past, “catching” a disease was a matter of bad luck, is was something accidental and unknown, not something to be blamed for.  What is different now is that public health establishment keeps harping on what we have to do to “prevent the spread” of the disease, as if they really know what can be done to avoid catching COVID-19.  That directly results in blaming people for not doing the things they were supposed to do to keep from getting sick. [This same thing happened with AIDS among conservative Christians, but politically correct people did not allow this to be spoken in polite company.] You can’t have it both ways. Either we know what causes transmission of the disease and therefore you’re responsible for preventing yourself and your family from getting it, or alternatively, it’s a random act of fate that we cannot expect to control.  Either, we have efficacy for preventing the spread or we do not.  If we do not, then the lockdowns are not sensible either.  I liked life better when “catching” a dread disease was something you “hoped” to avoid, but mostly went on about life normally while you hoped.

Jeremy
Dec 24 2020 at 2:56pm

Thank you for another interesting discussion!

At the end of the last crisis, the Financial Crisis Inquiry Commission (FCIC) was setup to interview and document all the actors across the housing and financial services industry (w/ materials made public to download, listen, and study).

We need a similar effort to address the successes and failures related to the COVID-19 pandemic.

Plenty of topics/ideas:

Medical supply-chain diversification
Hospital options for providing services during demand surges / pandemic (improved elasticity)
Local health agency standards and failures around isolation (NY sending sick nursing home residents back to homes from hospitals)
Vaccine speeds to production and potential benefits of human challenge trails
FDA review and approval process for testing
WHO independence (ex. the Taiwan story)
Travel industry testing and screening at points of entry (airports), ability to implement immediate full travel testing and/or lockdown requirements
Animal farming, wet-market standards, early detection of species jumping viruses
Alternative virus detection methods (air, water/sewage, blood) and monitoring
Etc, etc, etc

Greg Silverman
Dec 24 2020 at 3:46pm

The fantasy that lockdowns and masks can drive Covid-19 infections to zero is a fantasy some have about what Faucci has recommended. “Slow the spread” is not a zero infections goal. It is pragmatic and very much in line with good economic reasoning.

Jayesh Ametha
Dec 25 2020 at 12:52pm

There are no solutions. Only trade-offs. Never heard the policymakers clearly lay out honestly the death, health and economic costs of a strict lockdown. On masks, its a low cost thing that at-least doesn’t hurt, so no arguments on wearing them

Jayesh Ametha
Dec 25 2020 at 12:47pm

I mostly agreed with the discussion. Couple of things that Jay could have shared more inputs on:
1. Excess death metric.
Instead of Covid deaths (which is misleading). Even excess death is not perfect, but much better.
2. Excess hospital utilization%.
I have almost never seen this metric anywhere. Hospitals do get filled up in winter, and not a new situation due to Covid.

3. Hospital capacity.
He should have explained how to solve for it. I believe the solution is to (a) change communication from current fear-mongering (mildly infected folks rushing to hospitals), and (b) Do testing properly atleast for hospital staff. We can afford to isolate and lose resources unless they are truly sick or infectiousz

Dan
Dec 31 2020 at 2:55pm

Hi Russ,
I have been listening to you show for a long time and I have learned a lot. However, I feel this episode fell a bit short.

(1) Uncertainty verse Risk. Not enough discussion of the distinction here, particularly for early on in the pandemic. What state of the world is it? It seems that it takes a lot of careful analysis of non-random, observational data which is inherently difficult (as you have pointed out many times) to get an idea of the Covid disease profile. Even now my sense is that scientists cannot precisely state an individuals risk of Covid morality or mobility. Decision making under uncertainty is difficult for both individuals and policymakers. Another particular issue: How do we know whether or not a mitigation policy changes the integral under the case, morbidity, or mortality curves? This was not discussed enough, I believe.

(2) Marginal benefits and costs. The only time I recall marginal analysis being used was in the `marginal cost of getting a positive Covid test result’ and I agree with that. We made the real cost of that outcome way too high, and thus as a result certain groups get tested less than optimal. Indeed, once the pandemic status was achieved, then this became a social problem (as much as a medical one) leading to question: What are the social marginal costs and benefits of an agent’s action? Given the social costs from network spread effects, getting the costs and benefits properly weighed becomes quite the challenging.

(3) Market-based policies. Given my point about marginal analysis above, then what are the market-based policies that can achieve that balance? I did not hear many (any?) market-based suggestions on how to deal the social aspects of the pandemic. In the absence of market-based policies then we are left with command-and-control policies that are (will probability 1) going to overshoot or undershoot the optimal. Given risk-aversion in public choice then I suspect overshoot.

I did appreciate the segment at the end about the monopoly profits we have been paying Big Pharma. I said to a friend early on in this pandemic, “Now is their time to pay us back!”

Best, Dan

Nik Bear Brown
Jan 2 2021 at 4:13pm

I only occasionally listen to EconTalk as the discussions tend more to the philosophical rather than practical/empirical. I liked this one very much as it discussed what I think economists should discuss, which is cost in a more holistic manner.  I would like more guests in the future who discuss uncertainty and conveying uncertainty.  Most of the comments I have read, including many on this comments thread, have a  response that seems to come from people who try to give the appearance that they know what the appropriate policy is with certainty. Often coming from people with no training in either epidemiology or statistics.  Evidence, as broadly construed, is anything presented in support or opposition of an assertion. Cherry-picking this or that fact and not looking at the evidence as a whole seems to be a major problem as does attacking people as opposed to critiquing ideas.  Politically there also seems a bias towards taking action even if the action is a bad one.  Please invite more guests that discuss how to take public action under uncertainty. To me relaxing regulations to speed up vaccines seems a good idea, while shutting down many business without much evidence that they cause spread is a bad idea. As you say that wearing a mask should be a public health question not a politcal statement but it has somehow devolved into that.

L Burke Files
Jan 3 2021 at 11:45am

Excellent.  I am taking the time to share this pod cast with as many elected officials as I can.  This is the very type of adult conversation that needs to occur. Maybe this kernel of insight might spark the conversation. Maybe I’ll get banned.

John Alcorn
Jan 4 2021 at 3:32pm

New evidence in support of Dr. Bhattacharya’s case in favor of focussed protection:

See Casey Mulligan’s latest study, “Deaths of Despair and the Incidence of Excess Mortality in 2020” (NBER Working Paper 28304, January 2021)

Here is the abstract:

“Weekly mortality through October 3 is partitioned into normal deaths, COVID, and nonCOVID excess deaths (NCEDs). Before March, the excess is negative for the elderly, likely due to the mild flu season. From March onward, excess deaths are approximately 250,000 of which about 17,000 appear to be a COVID undercount and 30,000 non-COVID. Deaths of despair (drug overdose, suicide, alcohol) in 2017 and 2018 are good predictors of the demographic groups with NCEDs in 2020. The NCEDs are disproportionately experienced by men aged 15-55, including men aged 15-25. Local data on opioid overdoses further support the hypothesis that the pandemic and recession were associated with a 10 to 60 percent increase in deaths of despair above already high pre-pandemic levels.”

It’s hard to disentangle two causes of pandemic deaths of despair: 1) pandemic disruption of social interaction and vulnerable industries vs 2) restrictive policies by governments. But surely a substantial fraction of the 30,000 increase in deaths of despair in spring and summer 2020 in the USA is due to restrictive policies.

John Alcorn
Jan 4 2021 at 3:44pm

More fresh evidence supporting Dr. Bhattacharya’s case for focussed protection:

See the new study by Francesco Bianchi, Dongho Song, and Giada Bianchi, “The Long-Term Impact of the COVID-19 Unemployment Shock on Life Expectancy and Mortality Rates” (NBER working paper 28304, January 2021). Here is the abstract:

“We find that shocks to unemployment are followed by statistically significant increases in mortality rates and declines in life expectancy. We use our results to assess the long-run effects of the COVID-19 economic recession on mortality and life expectancy. We estimate the size of the COVID-19-related unemployment to be between 2 and 5 times larger than the typical unemployment shock, depending on race/gender, resulting in a 3.0% increase in mortality rate and a 0.5% drop in life expectancy over the next 15 years for the overall American population. We also predict that the shock will disproportionately affect African-Americans and women, over a short horizon, while white men might suffer large consequences over longer horizons. These figures translate in a staggering 0.89 million additional deaths over the next 15 years.”

Again, it’s hard to disentangle two causes of pandemic unemployment: 1) pandemic disruption of vulnerable industries vs 2) restrictive policies by governments. But surely a substantial fraction of the mass unemployment — and of the attendant “staggering” increment in deaths over time — is due to mis-targeted restrictive policies.

Dan
Jan 5 2021 at 5:00pm

Good conversation.  The comments demonstrate something alluded to in the conversation.  Most people’s minds are made up about the efficacy of masks, lock downs, etc.  What is good evidence for the costs and benefits of the policies seems to be whatever evidence supports our viewpoint.  It seems part of the issue is we want there to be a solution when there might not be one.  That is very unsatisfying to many people.

Gregory McIsaac
Jan 15 2021 at 12:20pm

Given the rapidly changing Covid situation, this may be “water under the bridge”, but I just stumbled upon this: In early November, Dr. Bhattacharya was interviewed by the editor-in-chief of the New England Journal of Medicine, along with Dr. Marc Lipsitch, epidemiologist and critic of the Great Barrington Declaration. Video and transcript here: Herd Immunity as a Coronavirus Pandemic Strategy | Coronavirus (COVID19) | JN Learning | AMA Ed Hub (ama-assn.org)

I thought this articulated the different points of view better than the Econtalk episode. Although they disagreed on several points, including the definition of “lockdown,” they agreed that opening schools is generally not a large risk.

At the end of their discussion, Dr. Bhattacharya made an example of Sweden: “In Sweden, 6,000 deaths to date from COVID, and only 1,800 total excess deaths. They have fewer excess deaths total, all cause, than COVID deaths. That’s lockdown harm avoided.”

He did not specify any dates or sources.  I obtained the mortality data from Sweden https://scb.se/hitta-statistik/statistik-efter-amne/befolkning/befolkningens-sammansattning/befolkningsstatistik/pong/tabell-och-diagram/preliminar-statistik-over-doda/

Data for 2020 are considered preliminary. Sweden defines excess (or deficit) mortality as the difference between the current year and the average of the five previous years. But there is a downward trend in mortality in Sweden that should be considered. Prior to significant Covid, from Jan 1 to March 15, 2020, Sweden had 1,400 fewer deaths than the 2015-19 average for the same period. Excess deaths in 2020 reached 1,800 in late April, but at that time there were 2,700 Covid deaths.  There were about 6,000 Covid deaths in early November, when the excess deaths were 3,500. In late December there were about 5,800 excess deaths and 9,000 Covid deaths.

So Dr. Bhattacharya’s specific numbers seem to have been remembered incorrectly, but it seems to be the case that there were fewer excess deaths (as defined above) than Covid deaths in 2020, but to attribute that to “lockdown harm avoided” ignores the role of the downward trend in mortality.

The Swedish statistical agency projected that Covid will result in shorter life expectancy in 2020 compared to 2019. This estimate assumed the mortality in October through December 2020, will be the same as Oct-Dec 2019, which will underestimate the Covid impact because Sweden experienced a surge in Covid during those months of 2020.

Projection: COVID-19 leads to lower life expectancy in Sweden in 2020 (scb.se)

Comments are closed.


DELVE DEEPER

Watch this podcast episode on YouTube:

This week's guest:

This week's focus:

  • Great Barrington Declaration, by Dr. Martin Kulldorff, Dr. Sunetra Gupta, and Dr. Jay Bhattacharya. October 4, 2020, Great Barrington, Massachusetts.

Additional ideas and people mentioned in this podcast episode:

A few more readings and background resources:

  • Integral. Mathematics/calculus term for the total area inside a curved space as opposed to that inside a rectangular space. Wikipedia.
  • Gavi.
  • "Tommy," by Rudyard Kipling. Kipling Society.

A few more EconTalk podcast episodes:


* As an Amazon Associate, Econlib earns from qualifying purchases.


AUDIO HIGHLIGHTS
TimePodcast Episode Highlights
0:33

Intro. [Recording date: November 20, 2020.]

Russ Roberts: Today is November 20, 2020, and my guest is economist and physician Jay Bhattacharya of Stanford University, where is Professor of Medicine, a senior fellow at the Stanford Institute for Economic Policy Research, and Director of the Stanford Center on the Demography of Health and Aging. Along with Martin Kulldorff of Harvard and Sunetra Gupta of Oxford, Jay is the author of the Great Barrington Declaration, which lays out an agenda for how to deal with the pandemic, which as we record this piece in late November of 2020, it seems to be getting worse here in the United States and in other places as well. Jay, welcome to EconTalk.

Jay Bhattacharya: Nice to be here, Russ. Thanks for having me.

1:10

Russ Roberts: What do you think we've learned about the pandemic so far? What do we know? There's a lot of things we don't know still, but what do you think we've learned?

Jay Bhattacharya: Let me just--there's a lot we have learned, but I want to cover just briefly two things that are very, very important, I think, for policy that we have learned.

So, in the early days of the pandemic, we thought that the mortality rate--the World Health Organization [WHO] put out a number saying that the case-fatality rate was 3.4%. This panicked governments around the world. There were similar estimates in places like the Journal of the American Medical Association [JAMA]--same case fatality rate--looking at Chinese data, 2.2%.

Two in a 100 people dying from a disease is a very high number.

And so, the question was: Is that actually right?

Something I worked on in this epidemic is to try to figure out how many people actually were infected. Because, a case is not the same thing as an infection.

An infection is--very often doesn't result in a case in the sense that--actually it turns out 30 to 40% of the people who get infected show no symptoms whatsoever. And, they are very unlikely to show up to the doctor and become a case, if you will. And, you know, a lot of people get mild symptoms.

So, it turns out, based on seroprevalence data, which is basically a study that looks at antibody levels in the population for evidence that when an infection actually had happened, that in the early days, where there wasn't a ton of testing, somewhere on the order of 30 to 40 times more infections than cases around here. Actually in places like in India, it was like 100 times or even [?] even 100 times more cases. Depending on the level of testing, you get a different multiplier.

But, it was basically the same kind of story everywhere. Many, many, many more infections than cases.

And, that's still true today, actually. I think there's a probably a multiplier in the United States something of order of 5 now, because there's so much more testing.

But, if you look and see what the death-infection-survival rate implied by that is, you get a fairly interesting story.

First you find that there's a very steep age gradient in the survival rate. People who are under 70--if now, there's now there's like 50-some of these studies--so you can criticize mine but now you got to go after 49 other people--if you're under 70, the infection survival rate is something like 99.95%. 99.95%, for under 70. Now, it increases with age--I'm sorry--the survival rate decreases with age, so say if you're 60, it'll be something like 99.5, or 99.4, might even be 99.

Now, if you're over 70, the infection survival rate is much lower. It's 95%.

So, if you get sick, 95% of the time you survive, 5% of the time you die.

So, a very steep age gradient, and I think we know that pretty well: that there's this steep age gradient in survival. Or people--let's say kids, and actually let's say people under 30--the flu is actually worse in terms of mortality. Right? So, there are more kids who have died of the flu this season than have died of COVID-19. More children in the United States.

4:31

Russ Roberts: Can you comment--we have to talk about this when we get to the Declaration, but what about this fear that, although the mortality rate is low, the long-term effects on who knows what--lung function, brain, kidney, people have suggested all kinds of long run impacts? And so, a college student might get the virus, survive, even without hospitalization, but have long-term damage to their body. How worrisome is that?

Jay Bhattacharya: I mean--okay, let me put it this way. If you have the flu--if you look at the flu--the flu actually also has extra-respiratory consequences. I tell--this is a true story. My son, when he was 10 years old, got the flu despite having had the vaccine. And, he woke up one morning unable to walk. There are very rare consequences sometimes of the flu and also the flu vaccine that are devastating, that result in muscular--all kinds of--as a medical student, you go through this, you read about these rare conditions, you're convinced you have them. That's what I went through with my son. And, it turned out to be something called benign myositis, which resolves very--within three days he was up and walking just fine again. But, for those three days, I was completely panicked. Right?

So, it wouldn't be surprising that this disease has some extra-respiratory consequences. And, in fact it does. So, it has--I think cardiomyopathy is one. There are some neurologic conditions. Some clotting. And, I think it's very important that we study all of these things; and we are studying all of these things, trying to understand them, how to treat them and maybe ameliorate some of the damage from them.

But, at the same time, if you read the papers--and that's the literature--they are terrible on the denominator. It seems really likely that these are going to be rare outcomes, just like they're rare outcomes with the flu. And, we shouldn't be panicking people over things where there's still a lot of scientific uncertainty, and the most likely thing is that it's rare.

6:38

Russ Roberts: So, right now, we're in the middle of a so-called surge. You could argue it's the second or the third. It looks like the third to my eye. Cases are going through the roof. I'm more than aware that cases are not the same as deaths. I'm aware of the fact that today, because of better understanding of treatment, because of higher testing, because of who gets it now versus in the past, that the death rate is much, much lower relative to the case rate. Not the infection rate, but the case rate.

What puzzles me--and I would love to hear your thoughts on this--what puzzles is me is why the death rate is as high as it is. So, it's lower, but who is getting this now? Who are the people getting this now, and how are they getting it that it's still killing large numbers of people?

And, I have to say that in my casual look at the age distribution of death--and I stopped looking at it about a month or so ago--but, for almost the entire run at least during the time, the first six months of the virus, the age distribution didn't change at all. All those numbers you were talking about--the mortality rate--the numbers have gone down for everybody who gets it. But, it's still the case that the mortality rate is very high for people over the age of 70 relative to people under the age of 70. And, it's also true that it gets worse the older you get: 80 and above is worse, 90 and above are worse. And, even though getting it is less likely to kill you today, it's still the case that the deaths are in the older groups.

How are people still getting exposed to it? What is going on there? I mean is it multi-generational households where people are exposed without their being able to protect themselves? Is it people going to work and coming back to those multi-generational households? Or is it nursing homes still struggling with this issue? Do you have any thoughts on that?

Jay Bhattacharya: Yeah. I mean I think--so, first what you just said is exactly right. I mean, the death rates are very much focused on older people. I think there's been some work, and it's really interesting work, trying to characterize the risk characteristic of population. So, if you have some chronic conditions also, you might be at higher risk. But, the single most important predictor for mortality, conditional on infection, is age. And, really advanced age. And, what you said about the mortality rate conditional on infection, even conditional on age, going down, that's also true.

So, there's a few things there, I think we can tease apart. There's still a lot that I don't know, and I think no one really knows. So, I'll give you my best--where my thinking is now. But, obviously we'll see as time goes on.

So, first: why has the infection survival rate improved, even conditional on age? I think in the early days of the disease, we--meaning doctors--didn't really know how to manage the condition. We thought of it as a severe viral pneumonia, not much else. We saw hypoxia, and we started giving essentially ventilators to people that really shouldn't have had them. In effect, we killed people iatrogenically with the ventilators. And, the other thing, we didn't really understand the immunological reaction that results in very, very severe pneumonias. So, for instance, I think the use of dexamethasone, which is a steroid that suppresses an excessive immune response, has been--it has really helped a ton with managing patients. So, in that sense we've kind of learned much better how to manage patients with severe condition.

And so, that's part of the story. Part of the story about decline in mortality is also that, because we're testing more, we're identifying a lot more people with relatively mild cases. So, I think there's some of that as well. There's some selection going on certainly. But I don't think that's all of it. I think it's--we actually are better at treating it.

Now let me return to--really, the root of your question, is: why is there still--

Russ Roberts: Why are there a thousand people dying a day in the United States? Over 1000. Heading towards, it looks like 2000. Who are these folks?

Jay Bhattacharya: So, let me return that. So, I think--and maybe this will be a good segue into the Great Barrington Declaration--I think the key thing for deciding whether a country or a state or a region has done well with the epidemic is that age distribution in the deaths.

Because, if--I think that's a function of policy, at least in part. Right? So, a policy that seeks to protect people--now I don't know the full answer to your question about what distribution of people living in multi-generational homes, nursing homes, and so on. I think nursing homes are a pretty substantial part of it, but also, people--I think we see this massive inequality in the United States in who gets infected and who dies from it. That's almost certainly, we're asking poor people, the essential, go expose themselves to the disease--

Russ Roberts: Because they have to work--

Jay Bhattacharya: Yeah. They have to work. Whereas, 52 years old, I can sit in my office and not be exposed. I mean, I think, that's certainly part of it.

But, these are policy decisions, not just medical facts. So, a country that does well, a region that does well, protects the vulnerable. That's really the key thing. That's a key idea behind The Great Barrington Declaration, is this idea of focused protection. We needs to reorient our thinking about the disease to protect the vulnerable.

At the same time--we haven't talked about this yet, but I think it's going to be really important when we talk about the economics of this--the lockdowns that we have engaged in--first, the severe quarantines and now the continuing lockdowns and the extensive set of lockdowns we're now currently reimposing--those have been extremely damaging for the population at large, not just in terms of money but in terms of health.

We can talk a lot about the evidence on that in a bit. I mean, I think it's overwhelming. And, it's not just the United States. It's had international consequences, too. Basically, every poor person in every poor country on the face of the earth, has been devastated by these lockdowns.

And so, I think we have to sort of think about that as well when we're thinking about--because I think part of the problem--this is, I think, a problem in economics. And, economists have done, with some exceptions, have done a very, very poor job of delineating the cost or the potential cost of this policy. Probably the single most consequential policy that I've seen in my lifetime, an economic policy we've undertaken; yet economists have not engaged, as best as I can tell. Our only job, which is really to point out cost. Isn't that our job description?

Russ Roberts: And, trade-offs. I would just say trade-offs. We've been extremely quiet. I mean, you're an exception; I'm an exception. But, in general, people don't seem to be talking about the fact that this is costly. And, it's not just a monetary cost. In particular, it's not a monetary cost. Partly a health cost, but it's more than a health cost. It's a cost in despair. It's a cost in loss of dignity. So, carry on.

Jay Bhattacharya: I frankly am thinking about giving up my economic license if I had one, an economist license. Since we don't require a license to practice, it's all good, I guess.

No, I mean, it's been dispiriting, actually, to see economists not engage wholeheartedly. I think partly because this is a medical thing, and I think economists have been reluctant because it doesn't fit our area of expertise. We're arguing with doctors and epidemiologists. And so, we sound crass when we do it.

But, I think we, as economists, have an obligation to point out these trade-offs, Russ. Absolutely. And, there are so many that it's beyond one or two people to point them out. Really, I think this is the single most consequential economic policy decision in my lifetime.

15:01

Russ Roberts: Well, let me press you on that, because I think there's a temptation on the part of some of my friends who are, like you, worried about these other costs, to confuse government mandates, like: Schools are closed. No restaurants. No concerts, no gatherings of over 25 people, etc. Those are government policies.

But, there's also the personal response that people have voluntarily chosen. So, even if it were--and I think it's legal to go to a bar in Maryland where I live right now. But, I wouldn't go. I wouldn't go in. I would go outside. I would wear a mask. Much of the restrictions that people are dealing with--which have economic consequences--are personal choices.

So, I guess the way I would ask you to frame this, is: If you had been President of the United States in March, would you have given a statement akin to what I understand Sweden did. What I understand Sweden did, is they said, 'Look. We're not going to close anything. It's up to you, citizens. Be careful. Don't do anything stupid. Don't crowd into a crowded venue without a mask, especially if you're old. And, if you're old, stay home as much as you can. And, if you can't stay home, find a way to get help so you don't have to go out.' Do you think that's what we should have done? Because, I think a lot of the costs of this pandemic have been the personal choices that people have made in the absence of full information. How do you feel about that distinction? Am I right?

Jay Bhattacharya: Yeah I've written on that, actually, in the context of the H1N1 Epidemic from 2009 [also known as the Swine Flu--Econlib Ed.]. In fact, that's one of the key animating ideas in economic epidemiology, is that people respond voluntarily to the risks they perceive.

And, I've been following this literature that economists have been having on what fraction of the economic harm from the pandemic is due to this--sort of, how much would've happened just because people responded versus--and the estimates range from, like, 10% of the harm to 80% of the harm. I don't think there's any consensus yet.

Russ Roberts: That's a little wide. Yeah.

Jay Bhattacharya: Yeah. Let's even take the low end. For sake of the discussion we can even take the low end if you'd like and say 10%.

So, I think one, just a little tweak on the way you've framed it, Russ. The panic itself is a policy decision.

Russ Roberts: It is. It is.

Jay Bhattacharya: You can see it in the way you talk about Sweden. Right? So, I think Sweden in the early days did a very poor job, especially in Stockholm, protecting its nursing homes. That it's why it had very death rate early on. Later in the epidemic, it did this much more: 'Let's give good risk communication to the population. Describe things that you might do to protect yourself as best we can, and then let the population do what it wants.' That's one approach.

The other approach is the approach that I think the United States and many, many other countries took, which is essentially to say, 'The world's on fire. Stay inside. Panic. You're going to die if you go out.' I think this has had a huge--that's a policy decision, right? So, in a sense, the economic literature on this misses the point. If it's 10%, it's 10% because we decided to tell people that it's the world on fire.

Russ Roberts: Yeah. So, right now it's November 20th. We're six days before Thanksgiving. The CDC [Centers for Disease Control] announced today, 'Don't travel for Thanksgiving. Don't go home. Don't celebrate the holiday. Stay home by yourself and your immediate family, if they're around.' My mom is 88. She's sitting by herself in Huntsville, Alabama. Thank God she's healthy enough that she can live independently. But, we're all worried about her. And, she was going to go to Memphis to my brother and sister for Thanksgiving. And, we had thought about even joining her there. And, now we've discouraged her because this thing--the world's on fire.

And, the part that's strange about this--it feels like because the cases are rising so dramatically and the deaths are rising, even though at a slightly less dramatic rate, they're rising--it feels like the disease is worse than we thought.

Now it's the same virus obviously. It's not any worse than we thought. If anything it might be milder as it mutates. At least we had hoped that originally. But, it suddenly feels worse. And people are making decisions based on that emotional reaction. Some people listen to the CDC as if they are coming from Mount Sinai--the mountain, not the hospital. And, some people treat the CDC like a clown show. That, 'Ahhh, they don't know anything. They're just a bunch of fake experts.'

So, we're kind of--I mean, you say it's a policy decision, but the truth is, is that we're in a very messy time for expertise and knowledge. And again, as somebody who is somewhat skeptical about overreacting, I'm more scared than I was two weeks ago. For better or worse. I don't know if it's the--I'm not reacting so much to the policy environment as to my perception of the data. Which is probably a--maybe a mistake.

Jay Bhattacharya: I mean, I think, look: One of the jobs of Public Health is to accurately communicate risk to the population. We shouldn't overstate or understate. And so, let me just describe what I think of as the huge mistakes that public health has made in the United States and many other countries actually. I don't think it's simply in the United States.

So, one: We have given this impression that everyone is at the same risk of death conditional on infection. What that's led to is my 80-year-old mom is much--I mean, she is a very social person, and she absolutely hates not being able to talk with her friends. It's been isolating. She lives essentially by herself in Southern California. It's really been difficult for her. She's lost weight, which is not good for someone who is 80, in that sense. I mean, it's been just a traumatic thing to have to be alone all the time.

Russ Roberts: Yeah, it's horrible.

Jay Bhattacharya: So, but for her, she--I've told her what the risk is, and I think I've done a good job with that. And, she can make her own choices based on that.

But, for many older people, they underestimate the risk because we've told everyone they have the same risk. Whereas, for many younger people, they vastly overestimated their risk.

All right, so, we've done a very poor job conveying what really people in different walks of life, what their risk really is.

And, that's a public health failure, right? That's communication by public health authorities. People don't trust them--because they've done poorly. I mean I could give you a couple more--I have a couple--sorry Russ.

Russ Roberts: Keep going. No, keep going.

Jay Bhattacharya: So, another failure, I think, of public health: We should never stigmatize anyone with a disease. And, we should, we should not create a sense of shame because you had a disease. And, public health has done an absolutely terrible job of this: If someone gets COVID, it's because they failed. They weren't wearing a mask, they walked around when they shouldn't have. They did something wrong.

That kind of stigma does not belong in the public health toolkit. And, it has divided people in very distressing ways.

So, you walk around, you see someone without a mask, you think, 'Oh they hate people.' That's not right. We should not be creating a situation where--I mean masks, the evidence is mixed honestly. I mean there's some evidence it does well. It's not a panacea, obviously. You can get sick even if you get a mask. Again, obviously. So, we shouldn't be creating this sort of sense of division as a public health community around these actions.

I mean, I'm not saying doing it. I wear a mask in crowded places. I tell my mom to wear a mask. I'm not against it. But we shouldn't create a sense of stigma around it. We should create a sense of compassion for people that have the illness. That's really vital to public health. Or else you end with the situation we're in: because now it's not just you get sick. There's a stigma of failure around your becoming sick.

The third big failure of public health has been this sort of lack of imagination in how to protect the vulnerable. We essentially, we've decided we're going to talk about the Great Barrington Declaration. I can talk more about that in some detail. But, that is shocking to me. Because, the public health folks I know have spent their careers thinking of ways to protect the vulnerable from a million other diseases. Why this one disease, all of a sudden we've thrown up our hands and said, 'No we can't do it.'

I think that's not right. I think there are concrete things we can and should do immediately, actually, to do this. Actually the vaccine presents enormous possibilities for that.

And, partly I think that's been driven by this--and you've mentioned this several times, Russ--this rise in cases creating panic. The thought behind the epidemiologic response to this, it has been that: If we control the number of cases, we can reduce the risk, the vulnerable face. That is an evident failure. Right? First, it's very, very difficult, maybe even impossible to control the rise in the number of cases in places like Europe, the United States, and the Americas. The disease is already too widespread.

By the way, I want to just a little, like side thing. I don't actually think it's a national conditional. I think this is a regional disease.

Russ Roberts: Right. Yeah. It's bouncing around.

Jay Bhattacharya: Yeah. So, right now we're seeing in the Midwest, really, that's really where the biggest cases are, right?

Russ Roberts: Crazy.

Jay Bhattacharya: And, actually, most places--there's a few places where it's come back. But, I'll give you an example. In Italy, in Bergamo, which was sort of the center of this, Lombardy as a whole has seen a rise in cases in the second wave. But Bergamo itself that saw a massive first wave has not seen a very large rise in cases. So, I think it's like, it's one of these things where it hits an area really hard, and it come back some in that area but it's going to come back sort of milder the next time.

And, I think that's what we're kind of seeing in the United States. It's sort of bouncing around the country, and it's sort of the Midwest's turn now, unfortunately.

25:32

Russ Roberts: Go ahead. I want to respond to something you said about the masks, but did you want to say something else?

Jay Bhattacharya: Yeah. So, the other thing that I think that we've failed at, that public health has failed at, is: public health normally has deeply embedded in it the sense of, like--the Swedes would call it solidarity, or this abhorrence of inequality. And, public health has done a very poor job in its--as we talked about earlier, it sort of sought to protect the well-off in its decision making about--so, like, the lockdowns, for instance, the quarantines, we already said, exempted essential works. Essentially poor----in the initial days, it located testing sites in areas where there was a lot rich people and not very many minorities. I think, as public health, we have forgotten something that should be in our DNA [Deoxyribonucleic acid], which is we ought to be caring for the least of us, in some sense, as part of our--how we think immediately.

Russ Roberts: The least well-off. Yeah.

Jay Bhattacharya: One other piece of evidence on masks: So, there was study that was just released from Denmark, a randomized study where I think there was about 5000 people. 2500 people had masks, randomly assigned, 2500 didn't. Early in the epidemic when most people in Denmark weren't wearing masks. And so, it's a test of whether the masks would protect the wearer, not slow the spread of the disease. And, if you treat that intervention as if it was a vaccine, you'd say it was a 14% efficacy. Right? 2.1% of the non-mask wearers got the disease. 1.8% of the mask wearers got the disease. And, it's not much of a difference, right?

Russ Roberts: Well, I wouldn't say that. You said two point--what was the ratio? Two point--

Jay Bhattacharya: 2.1% versus 1.8%.

Russ Roberts: 2.4 or 2.1?

Jay Bhattacharya: 2.1.

Russ Roberts: Well, that's not so much. 10%.

Jay Bhattacharya: It's about 14%. So, if you calculate the way we calculate vaccine efficacy, it's a 14% efficacy intervention. And, again, with massive standard errors. But, you know, whatever.

Russ Roberts: Yeah. But, the problem with all these kind of quote-"tests" are that they're very specific to certain situations.

I think the most appalling bit of evidence on this question came out when that--there was a study out of Duke University on different kinds of masks. I'm sure you saw this. And, they announced that the gaiter, the neck thing, didn't help at all. It may have made things worse. And, then they speculated on why. And, you know, then people immediately--my synagogue immediately banned neck gaiters. 'You can't wear a neck gaiter if you're coming to services because it's dangerous.' And, you look at--what?

Jay Bhattacharya: Bandanas are bad, too.

Russ Roberts: Bandanas. Bandanas and neck gaiters. Yeah.

And, I thought, 'That doesn't make any sense.' And, I looked at the actual study, and the actual study, they had one neck gaiter made out of fleece, whatever that is. I've never seen a neck gaiter made out of fleece, or a bandana made out of fleece, but okay.

But, it's so uninformative. That line should've been excised from the study.

And, maybe they had all the caveats. I don't remember.

But, the newspapers ran with that, as they have with most of these things.

So, I think a lot of the ignorance and over- and under-reaction, both, have to do with the challenging times we're in. I alluded to this earlier, that there's nobody to trust. A bunch of people are trusting--a lot of people don't trust anybody. There's other people who trust people who aren't trustable, reliable. And, there's a handful, presumably, of trustable sources that are reliable, and they're being trusted by a very small group of people. It's a very unfortunate time.

29:17

Russ Roberts: But, to go back to the main thrust: you're arguing that overall we've overreacted. We've pushed a set of reactions and actual policies that have tried to protect the population as a whole. That comes with an enormous cost for the least well-off among us. And, we should have devoted most of our effort to protecting the most vulnerable, and if we could've avoided, and still can avoid, much of the cost that's falling on poor people and on people who aren't nearly as vulnerable. Is that a good summary?

Jay Bhattacharya: Yeah. I mean the only thing I'd tweak a little bit is we've completely--I mean I don't think we completely overreacted. I think this is a serious condition. It definitely warrants a very, very serious policy response. But, I think what I'm proposing is a very serious policy response.

Russ Roberts: Okay, so, let's get to that. But, I just want to say one more thing. I got characterized mistakenly as somebody who's skeptical of lockdowns. Well, I am somewhat skeptical of lockdowns. I can imagine situations where it's the right thing to do. What is really dramatic to me, and tragic, is the countries that--many of the countries that locked down rigorously--did things that were much dramatic than happened here in the United States, and I'm particularly thinking of Israel. Israel had a very severe lockdown. Where you couldn't move--a lot of people weren't allowed literally to go outside unless they had an emergency, or unless they had to walk a dog. People tried to acquire dogs for that reason, of course. Economics in action. But, they were very successful. That lockdown really shut down the disease; and everybody celebrated. And, they went back to their life. And, then it surged again.

So, they've locked down again, and I think people think that--and let's pretend there is such a thing as a rigorous lockdown, meaning really works. It's not just a policy. It actually, either because you use the army as China did, or people are very obedient. They don't go outside.

The tragedy here is that it's not clear that has much effect other than the short-run--which is useless. So, you only get the costs of the lockdown--the loss of economic activity and then the loss of wellbeing that comes from that loss--and then you don't get any of the benefits. Because all you've done is, you've turned the light off. The disease is still there. When you come out of it, the light comes back on and it's like, 'Oh there it is.' Is that what's going on in many places?

Jay Bhattacharya: That's exactly what's going on, Russ. It's exactly what's going on. The math of these compartment models is very, very clear. So let's say you have, in theory, an entirely effective lockdown that stops it, slows--basically flattens it. When you lift the lockdown, the disease is still there floating around--asymptomatics--and it comes back. And, this is a worldwide thing. Right? If there's even a little bit of international travel, and one country has a few cases, it's going to come back as soon as you lift it up.

And, the math is very, very clear: as soon as you lift the lockdown, the diseases will come back. And, the integral over that curve is the same number of cases. The lockdowns just delay when the disease happens. It doesn't eradicate the disease. Lockdowns have never eradicated a disease in the history of mankind.

Russ Roberts: I'm a little puzzled by that, and of course some people have argued, I think rather monocausally, without much thought to the fact that the world is a complicated place, that 'These countries,'--fill in the blank, could be certain Asian countries, could be Australia, New Zealand--'they did this right. They figured it out. They've locked down, or they've restricted movements, and almost no one died in these countries. And, the United States should have emulated them.' So, you don't agree with that?

Jay Bhattacharya: No. Well, let's just take New Zealand. I think the problem with that reasoning is that it's very clear that those places, when they locked down, there were very few cases around. By February in the United States, in Europe, in the Americas, that was already too late.

The lockdowns, the theory of them, is that you reduce the number of cases to the point where you can do a testing and tracing regimen that actually has some hope of capturing all the cases, and you get zero COVID. That's New Zealand. They locked down very early, very hard, and they did a very rigorous testing and tracing program. There was a little resurgence in July where everyone panicked when there was a few cases, and they locked down again. And, every time someone flies into New Zealand they're in a 14-day quarantine. Or whatever. I'm not sure the exact policy now, but something like that. And, you end up with a situation where you have to be basically isolated from the world forever.

That might work if you have very few cases to start with.

By February, when President Trump issued this travel ban from China, it was already too late. And, it was already too late in Europe; it was already too late in the Americas. That policy cannot work when disease is already widespread.

Russ Roberts: But, shouldn't it kind of die out? I mean the original idea behind the sheltering in place, or the quarantine, or the lockdown, was to "flatten the curve"--that the integral would be the same, the number of cases would be the same, but the hospitals wouldn't be overwhelmed. And, there was a logic to that.

But, I noticed, and I noticed this in my own mind as well, that made sense to me. Reasonable idea, that you wanted to make sure that you don't--not only that you don't kill people who have it because they can't get a hospital bed, but the people who have other conditions now also have an issue with getting a hospital bed. So, smooth it out. Good idea.

But, very shortly after the smoothing-out idea caught on, I started to hope, 'Oh maybe we'll just kill it off.' Because, if we stay in place for x weeks, and it can't spread from person to person, then by the time we come out of the lockdown, it will be dormant and it won't spread. Is that not true?

Jay Bhattacharya: It's not true. It's too widespread already.

Russ Roberts: But, how is it going to spread after--let's just take a silly example. If everybody with the disease doesn't go outside for two weeks, and they don't have--is the problem that, even thought they're not symptomatic, they still spread it?

Jay Bhattacharya: Yeah. There's asymptomatic spread of this disease. We know that for a fact.

So, Peru is a good example of this. Or maybe Argentina. They've stayed locked down pretty sharply. I think Peru they actually had the military enforcing it. And, yet they've seen the highest deaths on the face of the earth per capita. The disease continues to spread.

It's not--we talk about lockdowns as this theoretical thing, where we literally just sit, shelter in place, forever and isolate. That is not how lockdowns actually work. Humans have to interact with one another, and those interactions will spread this disease. It's an incredibly infectious disease. It's not possible to get to zero COVID.

Russ Roberts: Well, there would be if we could all just chronically freeze ourselves for x number of months, but we still have to eat. We have to get to the grocery somehow, or the food has to get to us. Somebody's got to collect the food, pick up the food, drive the trucks. There are these "essential workers" who are going to be out in the world. They have to be. Otherwise we'll die. You can't literally lock down. That's the way I understand what you're saying.

Jay Bhattacharya: Yeah. Take care of cancer patients, teach our kids. I mean there are absolutely essential things that have to happen. So, I think it's like a chimera. You think of this, like, thing that, if we just had this ability to do this, it would be a perfect world. But, economists as a whole, I thought were immune to that kind of thinking. It's just not possible.

So, I think that dream of zero COVID has caused so much harm, Russ. We have no choice. We have to learn to cope with this disease. It's grim and unfortunate, but we just have to figure out the best way forward, muddling through. And, there really isn't--and promising people zero COVID--I think a lot of the pathology of the last 11 months, or 10 months or whatever, has been around this. People won't say it explicitly but they have it in the back of their heads. And, they've generated support for these policies that are absolutely devastating. And we still haven't talked about some of those costs. But, they're absolutely devastating. But, without any hope of actually achieving the end that they won't even state out loud.

Russ Roberts: No; the implication is that if we'd had a wise leader, we could've had zero deaths. And, I think that's kind of a fantasy. We can debate whether, how many deaths--it would be a foolish debate--but we could debate how well or poorly the President handled this crisis. And, I think he handled it poorly as a leader. Whether he handled it poorly as a policy-maker is, I think, a much, much more complicated question. And, he did some good things, and some really stupid things, I think. But, so did everybody else. But, we're not going to talk about that. I'm not interested in that at all.

Jay Bhattacharya: I think it's a dumb debate. The leadership is not the key thing. It's the ideas underlying the policy is really the key, I think.

38:39

Russ Roberts: So, let's talk about the costs, and then we'll segue from that into this question of how to protect the vulnerable in ways that reduce this cost. So, talk about the costs.

Jay Bhattacharya: So, people who have heard me have heard this litany, so I apologize if you've heard me before. But, let me just align [?outline?] some of them, just to get some sense of the scope of it.

So, in April, the UN [United Nations] World Food Program, I think the group that won the Nobel Peace Prize this year, estimated that there will be an additional 130 million people who will die of starvation worldwide--this year--as a consequence of the lockdowns, the economic harm of the lockdowns. I think the calculation is very simple. Just figure out what the economic hit is for a poor country: There's some distribution of income; what fraction goes below $2 a day of income or something, and say that person's now at risk of starvation. Eighty million people thrown into poverty.

So, we've had, I think in the past 20 years, a billion people lifted out of poverty. That's reversed, or starting to be reversed. Again, worldwide.

Tuberculosis, I think a million more deaths, because tuberculosis control programs have been stopped. Polio has resurged in Afghanistan and in Pakistan because the vaccination programs--we actually were on a track to eradicate polio, and that's been reversed. In fact, Gavi, which is this massive vaccination campaign worldwide, was stopped. MMR [measles, mumps, rubella] vaccines--

Russ Roberts: But, is that stopped because of a policy mistake? Or the existence of the virus?

Jay Bhattacharya: It's a policy decision. Right? So, you decide that the virus is too dangerous to send people out, or you don't have the resources. Those are policy decisions--because, maybe is COVID worse than measles, mumps and rubella? Diptheria? I don't know. It's one of these things where, like, we've just decided that this is the worst condition on the face of the earth and we're just going to throw aside so many of these things we thought were also deadly.

In the United States, one in four young adults seriously considered suicide this June. One in four. Normally it's something like 4 or 6%. Four to 5%. It's one in four just this past June.

Again, now, for young people, this is absolutely--lockdowns are devastating. Young people--not me, I'm a hermit. But, most of the other young people I know, I knew when I was little, they all liked to interact with one another. And, it's psychologically--I mean, I've seen it in my kids. The one success I've had is my wife, we convinced our neighbor to let their kid play with our kid during the epidemic--because kids are actually very low risk for this. They don't actually spread it very high. But, the risks in schooling--I mean the United States closing its schools is absolutely devastating. It's actually out of line with the rest of the world.

Russ Roberts: You're suggesting that's insane.

Jay Bhattacharya: Yeah. It absolutely--it has no basis in science whatsoever. There's an estimate that was just put out in JAMA [Journal of the American Medical Association] that, because of the loss of schooling in the United States for our kids, they will lose--because schooling investments are really, really productive. They result not just in higher income later in life but also better health. The estimate is that five and a half million life-years lost for our school kids this year.

Russ Roberts: Yeah, I don't believe that at all, Jay, but that's a subject for a different conversation.

But, what I do agree with is that the loss of learning; and also just the socializing part of it. I watch little kids--again, in my synagogue, we are praying in our parking lot--and I watch them, four-year-olds and six-year-olds in masks not getting close to each other, and it breaks my heart. Now if I had--if my kids were younger; they're not--but if my kids were that age, I think I'd probably put them in a mask and tell them to stay away from people also. But, you're suggesting that's not good advice?

Jay Bhattacharya: Yeah, the kids spread the disease much less efficiently, for reasons we don't fully understand, but it's just an empirical fact. And, they die at very low rates from this disease compared to other things that they face.

Russ Roberts: The hard part of that is that, as a parent, you think, 'Well, they die at lower rates, but it doesn't matter. I want to make them safe.' And, I think it's hard to see those costs on the other side.

Jay Bhattacharya: I would send my kids to school--I mean, in my kids' case, I told you my son got flu. The flu is more deadly for kids than COVID.

Russ Roberts: Right. And, we don't close school in the winter in America.

Jay Bhattacharya: And, I have reason. I saw my kid unable to walk for three days because of the flu.

But, the school is more important to him in his life than the small reduction in the risk of death from these diseases. It just is. I would send my kid happily to in-person school today.

43:32

Russ Roberts: Let me ask you a related question. The major sports in America have all coped with this in a slightly different way, but generally they've closed their stands. They don't have fans live. They've put a bunch of restrictions. Some sports--basketball actually had a literal quarantine of the players in one space. Other teams, other sports are just more testing. And, of course a lot of football players, where they're not quarantined in place, have gotten the disease. I don't think anyone's died of it.

Jay Bhattacharya: Zero have died. Yeah. No cardiomyopathy. I think one Major League Baseball player, but he had pre-existing cardiomyopathy. I mean we haven't seen the long-term effects.

Again, I think it's interesting, right? And, actually, you might ask why reopen sports? Of course, there's money involved. But, there's also a lot of psychological benefits to people from having this. It's part of what life means to some. It's part of--like, you know, I don't think it's nothing.

Russ Roberts: I mean, unless the Patriots are having a horrible season. I would've hoped they'd kind of shut down the whole season this year in football and I'd be spared a 2-and-5 start. But, I get your point.

Jay Bhattacharya: My Red Sox were so terrible. I almost regretted that.

Russ Roberts: Yeah. 'Why don't they shut that thing down?' But, okay. Yeah, I agree with you of course. The human side of this, the idea that only thing that matters is reducing the risk of disease as much as possible, is an insane idea that only a doctor can love, and an economist--you're right--should rebel against because we understand that there are costs that are not unimportant.

Jay Bhattacharya: Like, people stayed home from cancer treatment because they were more scared of COVID than cancer. That happened this year. Mammography dropped, I think, on the order, I think it was like 70 or 80% reduction of mammography.

Russ Roberts: Sure. People afraid to go to the hospital.

Jay Bhattacharya: Yeah. And, colonoscopy--like, no one likes it no matter what you do, and then you say, 'You might get COVID,' and they have this fear. They won't. And, they won't go get a colonoscopy. We're going to see Stage Four breast cancers rise in coming months. We absolutely will: because mammography prevents late-stage breast cancer diagnosis.

Russ Roberts: Well, I'm more skeptical about that, too. But, again that's a subject for another time. I think there's a lot of--we'll see. We'll see in the data.

Jay Bhattacharya: It's one of these things. It's a priori. You can't just dismiss it, right?

Russ Roberts: Agreed.

Jay Bhattacharya: We have seen this decline in mammography. That's a fact. What the consequences are, yeah it remains to be seen. I believe in mammography. I think the evidence on mammography is very effective in early diagnosis. So, I think that's why I've pushed this line.

In any case, you're right. It's empirical fact, but it's something we shouldn't dismiss out of hand.

Russ Roberts: No; I criticize it only because the evidence for it, certainly at younger ages, is very mixed in terms of actual survival rate. False positives are a huge problem. Intervention is a huge problem: it's not effective. But, that's a different issue.

46:31

Russ Roberts: I think you and I agree that there are many, many consequences of this reaction that we're enduring that are not measurable as deaths yet, that are not trivial. But, let's get to the Declaration, which has been quite interesting in terms of the reaction to it. And, I'm sure you've had some challenges, which I hope we'll talk about. But, lay out the centerpiece of the ideas behind the Declaration. It's called the Great Barrington Declaration. And, at the heart of it is this protection of the most vulnerable. So, after you've laid that out, tell us what we should be doing and should have done for the most vulnerable.

Jay Bhattacharya: Yeah. So, the Great Barrington Declaration--as you said at the beginning, I wrote it with Martin Kulldorff, who is a fantastic epidemiologist, at Harvard, and Sunetra Gupta, who is probably the world's premier theoretical epidemiologist, at Oxford. And then they agreed to include me, which is still a mystery to everyone.

The Declaration basically says that--it basically is a response to things we've been talking about. The key idea is that the lockdown harms are worse than COVID for the non-vulnerable--meaning younger people, people with few chronic conditions, or whatnot. And, for the older population, COVID is more deadly than lockdowns.

We spent trillions. The central idea, then, is: Let's spend those trillions to protect the vulnerable.

And, you can do that--there's some concrete ideas that we put forward, but I was hoping that the public health community would engage with this more. And, I actually think they've actually started to do so.

So, one is: Protect the nursing homes. That's the most obvious thing. That's where a lot of the deaths have happened. And, there's concrete things you can do, right? So, you can test staff members. It's actually pretty common for staff members in nursing homes to work in multiple nursing homes. So, reduce that from happening. Reduce the number of staff members that an individual in an nursing home sees. Test visitors. Now, you have to balance that with loneliness, because that is a major problem in nursing homes.

Russ Roberts: Yeah. Horrible.

Jay Bhattacharya: Yeah. And, I think--so, you have to figure out some way--and actually nursing homes, to my eye in some places, have started to do better. Like, we haven't seen the deaths that we saw in New York and New Jersey in the nursing homes. That was a really big mistake, like, sending COVID-infected patients back. If you get a COVID-infected patient in a nursing home, have a ward or place where they can be isolated from the rest of the people. I mean, just simple ideas.

PPE [Personal Protective Equipment]. I mean all these things are really, really important tools, not all of them perfect but they're useful tools and vital to use in this setting.

For people who live at home alone and older, we have these grocery hour for older people. But, then they still interact with a lot of people outside where they're exposed. Why not use the trillions we spend on grocery deliveries for old people?

So, actually, you don't even need to wait for the government to do that. If you know old people in your community, just ring them up and ask them, 'Can I help you with that?'

Another idea, another thing is, people who are essential workers that are older and at high risk. The 63-year-old janitor with diabetes. Right? Or the bus driver, or the Costco clerk, or whatnot. Why on earth did we decide that we can expose them to the virus? That is absolutely--I don't have the right vocabulary to describe what I feel about that policy. Instead of protecting those people we know to be vulnerable, we said, 'Go out and work. You have to make now a choice, between--'

And, there are policies and laws in place that we could use to protect them. Like the ADA [American Disabilities Act] could have declared them a disability for, during, the pandemic, because they're in this vulnerable class. And then their employers could provide reasonable accommodations. So, the schoolteacher who is 62 and has these pre-existing conditions that make them more likely to die if they get COVID, they can stay at home, teach on Zoom, help younger teachers with curricula and whatnot. And, younger teachers can go teach in-person because they face such little risk.

Russ Roberts: Yeah. Many private schools I think are doing just that voluntarily.

Jay Bhattacharya: Yeah. I think there's no reason why we couldn't have used our policy levers to try to do that.

For multi-generational homes, it's still a problem in the United States but it's even more a problem outside the United States. Like, in India it's a huge problem. It's a lot of the older people that got the disease got it in multi-generational homes in India.

But, in the United States, and actually in many, many places, the lockdowns actually created multi-generational homes. Young people lost their jobs. They went back and lived with their parents. And, we closed our universities down. We sent a vast number of kids back home to live with their--actually, I personally benefit. It's been fun to have my 19-year-old daughter come back home.

Russ Roberts: Yeah, I loved it.

Jay Bhattacharya: And, I mean I happily take the additional risk of COVID because she's going to do 19-year-old things. Fine.

But, we've created this risk. How do you address it? One, stop the lockdown. The lockdowns created the risk, and the unemployment and dislocation of the lockdowns, even it's just 10%, created this risk.

Second, you can use testing resources, like these rapid antigen tests. One of the major problems has been that we have this regulatory apparatus and it makes it very difficult to get at-home tests that you don't have to report outside. And, you know, you have to go to a lab to go get a test. And, the thinking has been, 'Well let's find every case, test and trace it, and go to zero.' But, that's prevented people from getting tests.

I mean, I don't want to go tell all my friends if I don't have to. I'd rather be able to tell, when, if my 80-year-old mom is going to come over, I want to be able to tell if I'm positive immediately on the spot. There are rapid antigen tests where you can do that, and you don't have to go to a lab to do it. We should make those very, very widely available. And, then people could--I mean if they report it, not report it, that's not the central thing. It's do they act on it in ways that are reasonable for their situation.

Russ Roberts: Yeah, we had Paul Romer in here talking about that. Obviously not everybody's going to--he's been pushing for more tests' availability, knowing that not everybody that gets a positive test is going to act responsibly. There will be people who do irresponsible things even with a positive test. But, it'd be better to have more people aware that they're putting other people at risk.

Jay Bhattacharya: I think that's completely reasonable. And, I mean it's a policy decision we made, in part because of this zero COVID aim. We said, 'Let's identify every single positive person and then work epidemiologically--isolate them, quarantine them.' We've created this situation--the cost of taking is test is not simply a medical decision or a personal decision about, like, 'Am I going to expose my mom or not?' It's now a huge economic hit. If I'm positive, 14 days without work. Right? Or whatever it is. Whatever the regulation is in your neighborhood. In any case, it's a huge cost. And, then I'm contract traced, so I have to be interrogated about every single I've interacted with.

And, sorry Russ, I'm going to give you up because we've talked on Zoom. I think it's one of those things where we really haven't thought about the economics of it in terms of the incentives its created, this testing measure.

In any case, I think there's lots of, like, creative ideas you could do protect people living multi-generational homes. You can make hotels available for someone who's sick inside--if my 19-year-old's sick, maybe allow my 80-year-old mom to live in a hotel for a brief time while my 19-year-old gets better, and then they can come back.

I mean, I think there are a lot of policies we could've adopted but didn't adopt, because we didn't think about protecting the vulnerable. We thought only controlling the spread of the disease would be the way to protect the vulnerable. And, very clearly that's not true.

So, that's the Great Barrington Declaration. I think, the other half of it, and probably you understand: The lockdowns are worse than the disease for the non-vulnerable. I'm not saying intentionally get infected. I'm saying let them live their lives so that they don't face the lockdown harms. On net, we're doing them a favor because the lockdowns are harming them more than the disease.

54:54

Russ Roberts: So, you're saying that if we had been more sensible, both in the communication of the risk and the treatment of the more vulnerable, that people who, say, work as a bartender or a barista or a clerk in a small store, those people could still have their jobs because the people who would engage in commerce--the eating out, the drinking, the picking up something at the hardware store or the grocery--those would be people who were not so much at risk. They might get the disease, but they're very unlikely to die from it. They might in turn infect the clerk, but that clerk's very unlikely to die from it. And, now what we've done is we've said to the clerk, 'We're going to reduce your risk, we hope'--in fact, we haven't, but, 'We're going to reduce your risk to what we hope is zero, and you're just not going to have a job.' Which is not attractive.

Jay Bhattacharya: Yeah: you're not going to have a job; you're going to face the depression that comes with unemployment; maybe you'll miss your health insurance and now you won't be able to get the cancer screening that you would normally have gotten. There's a million knock on effects. The economic harm has these results in less trade in developing countries. The price of food goes up in developing countries, so you get more people at risk of starvation.

I mean there are all kinds of knock on effects. The economy is not just a simply one-off thing. It's deeply interconnected. And, we've seen that, right? I think that's one thing we've learned from this epidemic, how deeply interconnected it actually is.

Russ Roberts: We have a wedding coming up soon in my family, and I don't think my 88-year-old mom is going to attend that in person. I think she's going to watch it on Zoom. And, that's, I think, okay for a lot of reasons. It can't be as joyous a wedding as it would have otherwise been--so what she's missing is not as exciting as it might have otherwise been. But, if she said to me, 'I want to be at that wedding,' I would say, 'Come.' Because, she's 88. She might die tomorrow, God forbid. I hope she lives for 10, 20 more years. But, I would never say to someone, 'To preserve your life you should skip every life cycle event for the next x years till we've found a vaccine, or this thing disappeared.'

And, I think the other point I want to make --which I think you sound horrible when you say it. I'm going to say it anyway, because like you said we're economists. There are things worse than death. I'll say it a different way. We're right now on the cusp of getting a vaccine soon. I'm very excited about that, obviously, because I think we're going to be able to travel again maybe, lead a somewhat normal life.

But, you know what really is unfortunate? Even if there is a vaccine, and I take it, and it works, I'm probably going to die anyway at some point. It's hard to remember that. What this pandemic has reminded of, is that we're mortal. Right?

But, it's a weird kind of remembrance of mortality. It's like, 'Ooh, I've just got to get through this. If I can just get through this horrible plague, then I'll get to the other side and I can have normal life again.' You will, but it's still finite. Which is just an unpleasant reality. Actually it's not even unpleasant. It's just a fact. It's how we live as human beings. And, we should live our lives accordingly. We should enjoy what we can. It's all temporary. It's important to live fully.

Jay Bhattacharya: Yeah : We live in the shadow in death. But, we should live in the light of life. That's really the--and think we've darkened our vision with the shadow of the higher mortality from COVID, and we've shuttered the light altogether for so many people. I think that's really the heart of the mistake we've made in this policy.

58:44

Russ Roberts: So, you had the courage to sign this statement, co-write it with two other people. It was a brave thing to do. I want to salute you--because I assume that you've gotten some hate mail, maybe some death threats, because obviously if you think we shouldn't lock down you're obviously a callous, horrible, heartless person who doesn't care about human beings. Is that a fair summary of what's happened to you? Or am I being overly dark?

Jay Bhattacharya: It has generated a huge reaction. I mean I kind of anticipated the reaction. I said early in the epidemic when I worked on these seroprevalence studies, I didn't anticipate the reaction. So, I wasn't quite ready for that. But, this time I was more ready, sort of emotionally, to deal with it.

I don't regret signing it at all. I think, I have this position for a purpose. It's not simply to be comfortable and have a happy life. I feel some sense of responsibility to express what my ideas are on this. I mean, I may be right, I may be wrong. And, of course it's for folks who are listening to decide. But, I mean, I think we all, as academics, have that responsibility--which is to say what we think.

Actually, it's been discouraging that we see both economists and non-economists, other scientists--I thought that we were in a liberal profession. Liberal, in the sense of free exchange of ideas. We're not aiming to destroy one and another: We're aiming to learn from one another. I might be wrong. You'll teach me something, Russ, and I'll change my mind. In fact, you've done that with your writing all the way across.

So, I think that sense of, like, humility and sense of desire to learn from one another has been, I think, utterly crushed in this epidemic. That's been disheartening.

A lot of the reaction to the Great Barrington Declaration has been to mischaracterize it as a 'herd immunity strategy.' Which, at this point I think of a propaganda term, where the idea is--in fact you see Dr. Fauci say this. It's a let-it-rip strategy. And, if you've been listening to this conversation so far, you hear--I don't want to let it rip. That is the farthest from my mind.

I think the key thing is: let's take the costs and benefits into account very carefully and protect the vulnerable. That's really the key idea of the Great Barrington Declaration. To call it a let-it-rip strategy basically is a desire not to engage with the ideas. And that is an illiberal--we've seen this instinct, this illiberal instinct. We've seen this with, like, the reaction, for instance, to Scott Atlas. Scott's saying some things--he may be right, he may be wrong. He has a very, very difficult job advising the President.

How do you react to that if you think you don't agree with him? Well, as someone who is in a field of science, if you don't agree, what do you do?

You write, 'Okay, what I think is right.' You don't attack the person, try to get them fired from a place. What you do is you say, 'Here's what the evidence says and we can have a discussion.' That sense, I think, has been lost.

In fact, there was a--I wrote a textbook on health economics. There's a movement by some economists to try to get people to boycott the textbook because I wrote the Great Barrington Declaration. I mean, you, it's like: If I write Paper A, and you agree with it, Russ, and you cite it. And then I write Paper B and you don't agree with it, and then you stop citing Paper A as a result. That's harmful for science.

Russ Roberts: No, I agree. I think a lot of it is this tribal moment that we're in, in America and the world. We've talked about it a lot on the program, and it saddens me deeply. I've talked about it before that--the idea that masks are a partisan issue is grotesque. It is the premier proof that we've gone off the rails as a country--that, that's a way we express our ideology and partisanship is whether we wear a mask or not. That is lunacy. It is so sad to me.

And, here's another example you're talking about, which is: We're in the middle of a horrible situation. Nobody's pretending that it's made up. It's horrible. But, to suggest different ways of dealing with it than we how we have dealt with it cannot be discussed among civilized, thoughtful people in many cases. And, talk about how the Internet has responded. I've read, I don't know if it's true, but that if you search for certain things now, that certain things have been taken down off of YouTube, or you can't find it on Google. Has that been part of your experience also?

Jay Bhattacharya: Well, when we first put out the Great Barrington Declaration, Google shadow banned it.

Russ Roberts: Google what?

Jay Bhattacharya: Shadow-banned it. So, if you typed in the Great Barrington Declaration, up would pop, like, 15 hit pieces and you'd have to go to page three or two or whatever to get actually get to the site. I think they've fixed that now in the United States. But, a lot of countries they still have that. Like, if you Google it from, you know, Slovakia, you would have that issue. I don't know if that's still true. I think that's sort of fixed itself. But, videos of people--prominent people--have been suppressed on YouTube. John Ioannidis talking about the--John Ioannidis is a very, very prominent scientist here at Stanford.

Russ Roberts: Former guest of EconTalk. Yeah. Past guest.

Jay Bhattacharya: Brilliant man. Right? And, again, he may be right or wrong, but to not allow people to hear him on YouTube is nuts.

I think Michael Yeadon just put out--he's another immunologist and infectious disease doctor in the United Kingdom--just got suppressed by YouTube.

I mean, how do you have science if you don't have people who are willing to say something that's different than what everyone else is saying? You just can't have science. You may as well just close up shop.

And, the public mechanisms of disseminating people's views, the modern ones--Google, YouTube, Twitter--have an absolute obligation to allow that to happen. And, I understand they're private companies and we can talk about--

Russ Roberts: Right. Tougher question.

Jay Bhattacharya: But, if they're private companies, they still have a public obligation, given the role they play in American society, the world society, to allow that. I mean it's a very illiberal instinct. I think we can all agree, even if you think that private companies can do whatever they want. I would characterize it as illiberal instinct to suppress that kind of conversation.

Russ Roberts: Yeah, no. It's deeply disturbing. It does raise interesting questions over who should have the right to constrain the spread of information--whether it's private companies: they should be free to do that, thereby damage or help their own brand.

Jay Bhattacharya: But, I mean, I'm less interested in the economic fight over competition on this, rather than, like, as a society--

Russ Roberts: Cultural--

Jay Bhattacharya: Yeah. I think that liberal norm is at the heart of--I'm at a university where the motto is 'Let the winds of freedom blow.' And, I'm afraid they're not really blowing that hard anymore here.

And, I think that's true worldwide. I think we're sort of in an illiberal moment; and figuring out mechanisms to get back to a liberal society is going to be very, very important.

Russ Roberts: I'm not sure we can get there from here. I think what's gone wrong with the ability and indulgence in tribalism that I mentioned earlier, is--I'm not sure we can put that horse back in the barn. We've got a real tough road ahead of us, in my view.

1:06:22

Russ Roberts: Let's close and talk about vaccines. What are your thoughts on where we stand? Again, we're in November. The Moderna and the Pfizer vaccine have had very encouraging early results. We don't know what their safety is. The efficacy numbers of 90 and 95%, when you look at what they actually are, are not quite what the average person thinks of when they think of 95 or 90% efficacy. It's a really particular technical definition, that to me is not so helpful. But, they seem to be--there's a lot of optimism about them. If they are available, will this change everything?

Jay Bhattacharya: So, yeah. I mean I think they will. It depends on how we decide to employ them. Let's take as given--obviously the data still haven't come out--but let's take as given that they're safe and very, very effective. So, just, how should we use them, will become the next question. Because the key constraint is getting sufficient--I think each vaccine you have to have two doses. So, with Operation Warp Speed we'll have something like enough doses for 35 to 50 million people. And, then we'll have to wait a long time for there to be sufficient number for the whole world to have it.

So, the question is: How do we use them? I think the right answer is to focused protection inside the Great Barrington Declaration. In fact--again conditional on us assuming the vaccine is safe and effective in these populations--you give it to the people who are vulnerable. That's effective protection. Now they're no longer at risk, or at such high risk, from disease because they're much less likely to get it.

And, then for the rest of the world who are not vulnerable, the disease is less, is worse than the lockdown. So, it's a perfect tool for focused protection, actually, if we choose to use it that way.

The other alternative I've seen, and people have said this, is, 'Well, why don't we just wait until we have enough doses for everybody and then open the world? Another six, nine months of lockdown.' As if that were the safe option. It is not the safe option, Russ. That will devastate the world in ways that we've already become familiar with, but even worse because we're already poor as a result of the 10 months' of policy we've adopted.

So, I think that's the debate going forward, is: How do you use that vaccine correctly? I think the right choice is focused protection.

1:08:54

Russ Roberts: And, let's close with the next time, because there will be a next time almost certainly, probably in our lifetimes, more likely in yours than mine. But, I'm not 70, Jay. I'm good. I'm fine. I've got four more years before I have to really worry. It was 65 for a while, was the cutoff when you had to be worried--so I was 65, like, right on the cusp. And, then I turned 66 in September. Uh, oh. Trouble. But, it is a fairly smooth line, as it turns out. It's not a hard cut at a particular age.

But, we're going to get another one of these. And, one thing I think is tragic about this whole conversation--national, international conversation--is that, again, for social, partisan, ideological reasons, we have not talked about the role of China as a nation in this. I mean the President did a little bit, and because it was him, then it went off the table for a whole different group of people. He didn't talk about it well, I don't think, or appropriately. So, it's just a tragedy there. But, the fact is that this disease came from China as far as I understand it, and we've not been able to investigate, in an open way, why that happened, and thereby potentially reduce the risk of it happening again.

So, that's a separate issue. Forget about that for now, it just really makes me sad and maddens me.

But, it will come again, almost certainly. When that happens, what would be your hope? I guess the problem is, is that the profile will be different, in terms of who is most vulnerable so we can't really generalize until we get the information we need from the beginning.

So, I guess my personal view is that we've done a terrible job generating the information people need to make the decisions that they would make as their own choices about risk. That should have been a priority. Instead we have the CDC [Centers for Disease Control] making pronouncements, which sometimes have been literally absolutely wrong and degraded their own institution. But, what are your thoughts on the next time, what we should do from what we've learned so far?

Jay Bhattacharya: I mean, it's very clear that our infrastructure for generating knowledge rapidly at a population level is really poor in the United States. And, actually a lot of countries. But certainly in the United States. I think, in some ways science has done really well. I mean, the fact that we have a vaccine so quickly is an absolute miracle to me--

Russ Roberts: Oh, unbelievable--

Jay Bhattacharya: I mean, if you asked me--in fact, some people did at the beginning of the epidemic--how long would it take to get a vaccinate, I said, 'Several years.' Because that is the norm for vaccine development. This is an absolute miracle.

And, actually the other thing, scientific knowledge about this--I sort of underplayed it when you asked me initially about this because I was focused on my own work. But, I should say, the science on this has been fantastic. Like, a lot of the knowledge about T-cell responses, about sort of treatments, and so on, have proceeded at a very rapid pace. Much more rapidly than I anticipated early in the epidemic.

So, I think in that sense we've done well.

We've done very poorly in population epidemiology. And, that's partly because how we--like, for instance, when we track the flu in the United States, we have a few sentinel labs that we get the flu tests from, and then we decide what we extrapolate.

You know, as economists, we're used to very large-scale surveys to track unemployment at a monthly level, the Current Population Study [CPS]. Why can't we have something like that for disease epidemiology? And have it be flexible? So, you have this massive panel of people that you go to; and you can take blood from them, or hair samples, or whatever you need as new diseases come up, and very rapidly deploy it.

I think the other thing we kind of talked about, is: We have to be very clear about our goals--as the CDC or whatever, as in public health.

So, the goal has been muddled from the beginning. There's essentially this fight between zero COVID and learning to live with it. And, if you don't know what the goal is, you can't have a good policy. I think a lot of the muddle has to do with that.

The science communication should be absolutely fundamental part of any public agency like the CDC. Like, so, for instance, like I just saw Director Redfield say that since 'the CDC never said to close schools.' You know, you couldn't have told that from the pronouncements from the epidemic. They closed--Dr. Fauci panicked the country over a relatively rare outcome from a few kids getting the disease. He called it [? 01:13:27 ?]--now it's called MIS-C [Multisystem Inflammatory Syndrome in Children].

In any case, that kind of mistake is absolutely devastating to trust in public health, and also to public policy outcomes.

I think there does need to be reform at the CDC, and in public health more generally. A: To have better systems of tracking disease. And, B: To--sort of--I mean, I think economists really should have a role here. Economists have some sense of, like: 'Look there are trade-offs to what you're doing.' So, there should be someone at the table saying, 'There's trade-offs to what you're doing. What is the goal?' These are tools that economists just have naturally. Again, if I ever get my economist card back, maybe I'll play some role with that.

Russ Roberts: Well, I think I burned mine long ago.

1:14:14

Russ Roberts: But, I just want to say one thing about the pharmaceutical industry, because I think it's important. And, I don't know if I've said it on the program. But, what I have said on the program many times is that--and we've had many guests talking about this: The current way that pharmaceutical research is structured is structured in a way to allow pharmaceutical companies to reach into my pocket and subsidize marginal, tiny improvements in health at enormous costs to me, and very small gains to the recipients of those pharmaceuticals who don't have to pay for them--because the way we've set up Medicare, and so on. And, I think that's an intellectually system. Dysfunctional. And, of course, with that we get some wonderful things from the pharmaceutical industry, as well.

But, to me, we spend--we get very bad bang for the buck for the average pharmaceutical dollar. Even though I concede that you can't say what those are in advance, and therefore it's good to try lots of different things.

But, we've set up an industry where a lot of things that we do get out of it, I don't think are worth what we pay for as taxpayer subsidizing Medicare for old people.

Having said that, because we have done that--and I have mentioned I have family in the pharmaceutical business in labs, so I say what I said just a minute ago well aware that that is bad for their--if my view is embraced, it would be bad for their wellbeing.

Having said that, the large cadre of chemists, biochemists. and the infrastructure of the large pharmaceutical world that we have in the United States is what has allowed this response to happen, of nine months into a tragic pandemic: we have two vaccines. And, we're going to have more, I have a feeling.

And, I like to quote the Kipling poem, 'It's Tommy this and Tommy that, and Tommy wait outside. / But, it's Thank you, Mr. Atkins when the ships are on the tide.' Meaning, in England when you're a soldier you don't get much respect. But, when there's a war, all of a sudden you're important.

So, for all my criticism of the pharmaceutical industry, this is a glorious success on their part. I'm glad they're making a ton of money from it, and I hope they do. There's a lot of voices out there saying, 'Yeah, well now they've found it, we should take it away from them because they shouldn't be allowed to make profit from it.' It is that profit, and the past profit which I have somewhat decried, which has allowed the stable of intellectual firepower that they have unleashed on this virus. And it's a glorious moment of human achievement. And I hope they make a lot of money from it, because they should.

And, then in the future I think we should scale things down. But, you want to react to that?

Jay Bhattacharya: Let me say something slightly smaller, but I come from--in line with what you are--I think there's very little incentive to explore small molecules that are off-patent. And, the NIH [National Institutes of Health] in principle could solve that. Essentially it's a market failure problem, right? Because no one owns that intellectual property.

But, I mean, and, I don't know the right answer to this, but there ought to be. If you think about the controversy over hydroxychloroquine--it's a cheap, small molecule. There really hasn't been a ton of evaluation of it, and there's just been this huge controversy over it. I mean this is something where you could answer the question if someone had the incentive to do it, with a simple trial. Right? And, there's been a few, but not a ton, sort of on point. There ought to be incentives to explore those kinds of ideas, rather than just ideas that are on patent.

Russ Roberts: Well, those incentives don't have to come from the government. A lot of wealthy people who care a lot about this, a lot of foundations, they could fund these more-thorough studies. And, I think they're going on right now. I think we'll learn some things we don't know yet from those efforts. So, there is some hope. But, it's not a good system right now, the way it's structured.

Jay Bhattacharya: I agree.

1:18:20

Russ Roberts: Want to close? Take us home, Jay. What do you got to say? Give me some optimism, or something you've learned from this that you've grown from. Maybe you're a better human being because you've been beat up? Your seroprevalence story, which we didn't talk much about in detail--I know you took an enormous amount of abuse for that study.

Jay Bhattacharya: Let me end with hope, Russ. I think that if we adopt good policies going forward, we can prevent a lot of the harm that lies in front of us. The vaccine is a godsend, and we can use it to reopen society if we choose to do so. And I think--so, that's my hope. I think if we think carefully about the costs and benefits, we actually can get back to a place where we can start talking, arguing about, 'Are the pharmaceutical companies too rich?' We can start arguing about should it be private. All those arguments are fun. But, here we're at a crossroads of our civilization.

Essentially, I think about these lockdowns as the nuclear bomb of public health, of epidemiology. It's like physics coming into fruition with the actual nuclear bomb when it was dropped in Hiroshima. We've dropped a nuclear bomb on society, and now the question is: How do we go forward?

We've structured our society so that we minimized the chance of that nuclear bomb ever being dropped again--the physical, literal one. We fought a Cold War designed around not dropping that bomb. I think we should do the same with this. That's my view now. And I think we can. We now have the ideas, the technology, to, when the next thing happens, we could be in a much better place if we just choose to do so.

Russ Roberts: My guest today has been Jay Bhattacharya of Stanford University, co-author of the Great Barrington Declaration, which we will link to so you don't have to Google for it. And, Jay, thanks for being part of EconTalk.

Jay Bhattacharya: Thanks Russ.


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