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.
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.
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.
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.
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.
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?
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.