Dr. Nicholas Christakis has dedicated his life’s work to understanding public health, disease, and how pandemics shape our world. He is the author of the new book Apollo’s Arrow: The Profound and Enduring Impact of Coronavirus on the Way We Live and is a sociologist, physician, and professor at Yale University.
Nicholas discusses the state of the pandemic as we endure a spike in cases across the country, why we should be prepared for 500,000-1,000,000 Americans to die from COVID-19, as well as how much time it will take to achieve widespread immunity and why the development of vaccines won’t be an instant fix. Plus, he shares what the post-pandemic world could look like and why we might be in for another version of the Roaring Twenties.
This episode is a must listen. Nicholas is one of the ultimate voices of truth on coronavirus on the planet and we’re honored to have him back on the podcast.
Stay healthy and stay in the green!
2:35 – Nicholas Christakis Returns. Dr. Christakis first appeared on the WHOOP Podcast in March of 2020.
3:12 – A 100-Year Virus. “I knew that this would be in the neighborhood of the second-worst pandemic we’ve had in the last 100 years, the worst being 1918. … It’s not going to be as bad as 1918, I don’t think, but it’s far worse than the previous second-worst pandemic that we’ve had, which was the 1957 influenza [outbreak]. It’s definitely worse than that.”
3:45 – Sobering Fatality Forecast. “I think, in the end, before this pandemic is over in a year or two or three at the most, as this thing unfolds and as more people continue to get sick and some die, at least half a million Americans will die. And, depending on what we do, as many as a million [could die] over the duration of this pandemic. That’s awful. That’s a major calamity. … Roughly 5 times as many [could become] disabled.”
5:23 – New Book. Check out Apollo’s Arrow: The Profound and Enduring Impact of Coronavirus on the Way We Live. “I devoured your book,” Will says. “I think it’s going to become one of the core books to understand what we’re experiencing.”
6:14 – COVID-19 vs. Other Pathogens. “Diseases that are very deadly and kill their victims very fast often burnout and don’t become big pandemics. For example, the Ebola pathogens that emerge periodically in Africa, one of the reasons they haven’t become worldwide is they kill half or 80 percent of people that get those viruses, and rapidly,” Nicholas notes. “In a way, a milder disease, a less lethal disease, affords a greater opportunity for the pathogen to be transmitted. … That’s one of the differences between [the SARS outbreak in 2003] and [COVID-19]. SARS was perhaps 10 times as deadly and it killed people faster. Ironically, the lower lethality of [COVID-19] that we’re facing right now makes it a more potent threat globally.”
9:55 – The Nick Watney Story & Asymptomatic COVID Cases. Dr. Christakis recalls pro golfer Nick Watney’s experience with COVID-19 and how WHOOP helped detect his asymptomatic case by alerting him to a sudden spike in respiratory rate.
12:02 – A Wide Range of Outcomes. “One of the things that makes this disease so dangerous is that it can give you everything from being asymptomatic, maybe half the people who get infected with this pathogen never have symptoms, to mild symptoms, to serious symptoms, to disability, to death. It covers this whole broad range. Partly, this creates a messaging problem because it’s difficult to get people concerned about the disease. … The rarer occasions where someone gets it and gets seriously ill or dies are drowned out by the existence of these other more asymptomatic cases.”
15:46 – How Deadly is COVID? “We now know that the infection fatality rate of this pathogen is between 0.5 and 0.8 percent. That means that between 0.5 to 0.8 percent of the people who get the disease will die,” Nicholas says. “But remember, about half the people who [get COVID-19] have no symptoms. So there’s another thing called the case fatality rate, which is the fraction of people who come to medical attention who die, or, alternatively, the number of people who developed symptoms who die. … So you can double the numbers I just gave you for the [infection fatality rate]. If the IFR is 0.5 to 0.8 percent, the case fatality rate is between 1 and 1.6 percent.”
22:00 – Social Nuclear Weapon. Nicholas began studying COVID-19 in January and says he knew the seriousness of the matter when the Chinese government implemented strict restrictions on its population. “The Chinese passed rules that put 930 million people in home confinement. The Chinese thought that this disease was so bad, so severe, that the threat was so great, that they basically detonated a social nuclear weapon. … We should have been paying attention.”
23:24 – New York Hit Hard. “We did nothing to speak of until March when beginning in middle-to-late March New York started having a really bad epidemic. One out of 1,000 New Yorkers died in two or three months. And in minority populations in New York, as many as 3 out of 1,000 New Yorkers died. It was a huge toll of mortality.”
26:44 – Testing Problems. Dr. Christakis details some of the initial problems the United States had with testing. “It was a keystone cops kind of situation, honestly,” Nicholas says of the federal government’s testing rollout in the spring.
30:52 – Importance of Testing. “I think we all should have the [capability to conduct at-home tests]. They would be expensive, of course, and not every home can have them necessarily and that’s not a solution on a national scale, but certainly it should be available. Testing is a public good. Even if I can’t test myself, it’s great that you’re testing. Because when you test, when you act responsibly, you reduce the risk of transmission of the virus. You’re performing a public service by testing yourself.”
32:16 – Economic Impact. Former treasury secretary Larry Summers and David Cutler, a Harvard economist, released a study saying that the pandemic will end up costing the United States $16 trillion.
36:05 – Avoiding Misinformation. Will and Nicholas discuss how misinformation on coronavirus has made it hard for many to discern fact from fiction during the pandemic. “All those people who were not doctors and were not scientists who thought hydroxychloroquine would be effective, weren’t reading the right things. They were way out of their lane.”
42:41 – Death and the Economy. “Dying people is bad for the economy. Ironically, I think fighting the virus is the same thing that preserves the economy. I think it’s very important for listeners to understand that part of the economic collapse that we’re experiencing is things that we’re doing to ourselves, but most of the economic collapse is things the virus is doing to us.” Nicholas notes that history shows that economic activity slows during pandemics, whether or not there is government action to slow the spread of disease.
46:41 – The Dakotas. “Right now in the Dakotas, they have the highest per capita death rate from COVID of any place in the world. They’re thinly populated, rural states, but the fraction of people dying is higher there than anywhere else has been for this pandemic,” Nicholas notes. “They’re slowly now beginning to [take action after months of inaction], but how much wiser would it have been to have done it a few months ago and saved all these lives?”
48:43 – COVID Fatigue. “One of the things that has come up a lot is this notion of COVID fatigue. But I think it’s really important not to confuse our exhaustion with fighting this virus and the unpleasant steps that we’re required to take if we want to prevent death and disability with the reality of the condition we are in. … People are saying ‘I don’t want anymore of this,’ but that doesn’t have any bearing on the virus.”
49:50 – Herd Immunity. “Herd immunity is the idea that a population can be immune from a pathogen or immune from an epidemic, even though not everyone in that population is immune.” Nicholas goes on to note that the threshold for herd immunity is dependent on the contagiousness of a disease and that somewhere between 40 and 50% of Americans would need to be immune before we reach that point. An estimated 12% of Americans have been infected with COVID-19.
52:00 – How Close to the End Are We? “We’re not at the beginning of the end of this epidemic, we’re just at the end of the beginning. We’re at the opening act. And even though we’re going to invent a vaccine it’s going to take time to manufacture and distribute and get people to take the vaccine. I think probably we’ll be into late 2021, early 2022 before we have half the population vaccinated. Meanwhile, the virus is still spreading. My feeling is that in 2022 we’ll reach herd immunity either artificially because of vaccination or naturally because of the pathogen, so until that time, we’re going to be living as we are now.”
52:59 – Post-Pandemic World: Another Roaring 20’s. “We’re going to be in this changed world until 2022. And then, at that point, it’s still going to take some time to recover from the psychological, social, and economic shock of the virus … and then there will be the post-pandemic period [starting around 2024] which will be a little like the Roaring 20’s after the 1918 pandemic.”
56:48 – The Vaccine. “I think we all need to be vaccinated. I don’t know yet how safe the vaccines will be. I believe we will soon have convincing evidence of the efficacy of the vaccines. The trials have 40,000 people in them, so rare, serious complications with the vaccines, let’s say 1 in 100,000 people having a serious complication or death, would have been unlikely to have been detected in the trials. Usually, we expect safety levels from our vaccines of 1 in 1 million to 1 in 10 million serious complications. … We’ll know that it’s pretty safe, but we won’t know how safe until we start rolling it out. … If we’ve rolled it out to [healthcare workers and placebo trial volunteers] without much evidence of safety problems, I think pretty much everyone at that point should be really confident that it’s proper and safe to get the vaccine and they should get the vaccine.”
58:46 – COVID-19 Risk App. Nicholas and his team at Yale University have released Hunala, an app designed to forecast your individual risk level for coronavirus. Dr. Christakis describes it as “Waze for coronavirus,” and adds that the app crowdsources information about your social network and where you live. “It collects this information by using machine learning technology to predict your risk as often as you want. And, like a weather app, you can track the occurrence of coronavirus in other parts of the country.”
Connect with Nicholas on Twitter @NAChristakis