Focused Protection For COVID (w/Dr. Jay Bhattacharya)

Dr. Z: Hey guys, ZDogg. I got Jay Bhattacharya here. Dr. Jay Bhattacharya. He is a Professor of Medicine at Stanford, a health policy guy, health economisisist, health economist. And he’s been on the show before. You may know him from such hits as a lot of stuff during COVID welcome back, Jay. Why, why am I spending all this time introducing you, people know who you are. It’s nice to see you back

Dr. Z: Dude, it’s been what, months since we had you on the show?

Dr. Jay:  It feels like it’s been too long.

Dr. Z: Yeah. It’s like a whole pandemic between us and- . Now Jay, like the reason we want to reconnect is there’s so much stuff happening in the like in the pandemic news and notice I, I distinguished between the news and like the public messaging and what’s actually maybe happening in the world. What’s happening in scientific discourse. You’ve been very vocal in the side of the science that questions that says, you know what, our, is closing down the economy the right answer to this? Is, you know a putting masks on young children the right answer to this? Are vaccine passports a good idea? Are, is a broad approach to this a good idea versus a targeted approach. And you were one of the co-authors of the great Barrington declaration, which just saying that aloud is gonna get me demonetized and canceled.

Dr. Jay:  Oh dear. I’m very sorry.

Dr. Z: Yeah, thank you. You’ve cost me tens of dollars. So I think we can start by saying, you know first of all, you’ve been busy, but what is the the main concern you have right now, sort of in this whole…

Dr. Jay:  I mean, I think that the central problem right now I think is the fear that people still feel about COVID. Even after the vaccination effort has been actually in many ways in the US quite successful. I think that that, that we are so used to this fear that we’ve lived under for a year that we don’t know how to get out of it. So you can see this when people that are vaccinated they still are wearing the, my mom, okay. She’s 80. She got the vaccine, she got the second vaccine. It’s been about a month and some since she got the vaccines. And she tells me she can’t, she’s so used to wearing the mask that she still wears inside when there’s no one there because she’s just used to it. And there’s still this fear, how do we de-condition it?

Dr. Z: Well, and then the question would be, and this is common. Like, we’re seeing this at this sort of pall of conditioned fear and it’s taken about a year of conditioning. So now, like walking outside with a mask is like terrifying to a lot of people, even after vaccination. Now, you and I are both vaccinated. We shook hands. We don’t wear masks. We’re about three feet apart from each other. And in the early days of the pandemic that would’ve gotten us both hung. But now I can say with confidence because I’ve looked at the data, like our chances of giving each other COVID are-

Dr. Jay:  Are zero.

Dr. Z: Pretty much zero. So how do we, de-condition it, I, and and in the setting of continued uncertainty. So I think the part of the problem is, let’s forget about the press and how they portray it in the public health apparatus but just the general uncertainty. So if Michigan’s cases are surging in light of a lot of vaccination going on there, how do you think about that?

Dr. Jay:  Yeah, I mean, I think the key thing is like we look at cases, we say, oh, my gosh, deaths are coming. But I think that if the vaccination campaigns was successful, you’ll have a decoupling of the deaths and the cases. We should no longer look at in places that have been vaccinated or where the older population is vaccinated appropriately. We should no longer look at cases as a marker of doom to come. Right? Because the vaccine is incredibly effective. There’s just good news about the, I mean we can talk about the Johnson Johnson bit in a bit but like on the whole, the vaccine, or just it’s an incredible achievement. And in many ways has defanged the epidemic, it’s taken away the the specter of death and hospitalization that comes with the disease for the older population to the extent that the older population is vaccinated. And so the, the worry that we have, over running hospital systems, large numbers of people dying from getting COVID. We should stop thinking that way when we see cases. The key question is still just like it was before, actually in some sense, who’s getting these cases? And if it’s the older population, be very concerned if it’s a lot younger population I mean, it’s COVID, it’s not good, but it’s not, it’s not, it’s not quite the same thing.

Dr. Z: Yeah, so why do we keep hearing that about like these new variants affecting young people more or concerns about mortality in, in the new case surges in a way that it is younger people. Maybe why are we still hearing about this when I have not seen good evidence that variants are more deadly or, you know, so on?

Dr. Jay:  Yeah. I mean, I think it’s partly the fear, right? I think that it’s hard to let go of that. You’ve lived your, for a full year under it. It’s hard to let go. I’d say it’s, I mean in some ways you can understand it, right? It’s like we’ve been conditioned to be careful. And when the, when the danger is gone, we’re still careful.

Dr. Z: Do you think the danger is gone? Where are we in that?

Dr. Jay:  I mean, I think we’re close. I think we’re very, very close to that. I think that it, I mean, and in many places, it is gone, just be paid at a high cost of course, but it’s, but it’s very close to that.

Dr. Z: So Israel with 50% odd vaccination, we’re seeing cases decline, deaths decline, hospitalizations decline.

Dr. Jay:  I mean, for the most part, it looks like, I mean there’s still some cases that, I mean, it’s, it’s it’s an endemic disease. It’s not ever going to get to zero. I think that’s a fantasy. And so it will be with us essentially for the rest of time. I think just like the other coronaviruses are. And we just have to make sure we understand who’s at risk. And, and really, I mean, I, I think start to lift the lock downs cause the lockdown has been so harmful. It’s continuing to be harmful. My kids still aren’t in school. So, I think that we’re going to need to have a conversation about how to live with COVID. Without this thinking, like it’s the worst danger on the face of the earth.

Dr. Z: Well, you know, so one of your things, Jay, that I thought was really, it was controversial, right? But also in retrospect, probably correct. Which is the syrup, the seroprevalence study that you did early on was got a lot of criticism, et cetera, with Ionnidis. And, and how do you say John’s last name again?

Dr. Jay:  That’s it, you got it.

Dr. Z: Oh, I nailed it finally. And you guys had estimated the infection fatality rate somewhere in the point two-

Dr. Jay:  Yeah about 0.2.

Dr. Z:  Point two. Where did settle out, do you think?

Dr. Jay:  0.2 Yeah. I mean, this is worldwide. So this is one of these fallacies, like the people that sometimes having their heads. So like there isn’t a single seroprevalence number. I’m sorry, there’s isn’t a single infection fatality rate number. There’s a range of them. Some places had it worse, and some places had it better. Some places we had at worst for reasons we can understand, right? You had an older population. Its hospital systems didn’t do well in managing the patients. This is early in the epidemic and we’re killing patients with ventilators or something, right? So you can, you can have a high infection fatality rate in that setting. And in other settings did quite well. Like, so for instance, and again, for reasons we understand right, you just managed the patients better. We have better out inpatient, outpatient treatments, we’re managing patients better. And so you have a lower seroprevalence, or you have a younger population.

Dr. Z: Infection fatality rate-

Dr. Jay:  Is low. Keep making that mistake

Dr. Z: By the transitive property of seroprevalence I find-

Dr. Jay:  It is like one over the other. One to value, whatever. You get the .

Dr. Z: Exactly.

Dr. Jay:  So in any case, so the key thing is that there’s this distribution and some places we, it did, they did well and we don’t understand why, like Japan, the infection fatality rate number there is, is quite low, even though they have an old population. So we have this, like but the point is that there’s this massive distribution that the, the median estimate, I think is 0.2 worldwide. And I think the US is probably higher because, you know, New York and New Jersey got hit hard early and didn’t do well. But I mean, Santa Clara county, April last year, it was 0.2 and in fact there was another study done that included the Bay area, it included I think it was ESRD patients, seroprevalence, I think in July or August, and it was 0.2 in Santa Clara County or in the Bay area again and later. So it’s, I mean, I think there’s a distribution. I think we got that number right. In that, in April.

Dr. Z: And so that tells you something too, it says that, okay, there’s a, you know, a fatality figure that’s roughly, if we believe the flu IFR, which I’m not sure how accurate those number’s are, they’re not-

Dr. Jay:  I have no idea what the IFR is for the flu.

Dr. Z: Yeah.

Dr. Jay:  I don’t think anybody does.

Dr. Z:  Yeah.

Dr. Jay:  Yeah.

Dr. Z: We we throw around 0.1, right.

Dr. Jay:  Yeah. But I don’t know if it’s right.

Dr. Z: Yeah. Do you think it’s lower or higher?

Dr. Jay:  I have no idea.

Dr. Z:  No clue, right?

Dr. Jay:  I don’t know. I mean, we don’t actually, I mean, now that I’ve looked at it, we don’t actually have very good seroprevalence estimates on flu either season to season.

Dr. Z: Yeah. So incomplete data. Because you know the whole comparison with flu draws all kinds of knives out-

Dr. Jay:  But I will say one thing about the flu that we do know quite, quite well relative to the COVID is the age gradient. The age gradient of infection fatality for COVID is way steeper than it is for the flu. Right? So that older people are much much more likely to die from COVID versus young people dying from COVID. Whereas the flu, the age gradient still is a upward sloping, but not as steep.

Dr. Z: Yeah, and I think this is a central piece to your whole approach of looking at this pandemic which is a harm reduction approach across all sectors. So it’s not just how many, how many people are in hospitals? How many lives are you saving? How many, you’re looking at across everything how many lives you’re saving across a population? What happens when kids are not in school? What happens when you destroy economic livelihood? Because we, as we talked about last time health is wealth, they are to some degree interchangeable.

Dr. Jay:  Yeah. Well, I mean, I think, I don’t see any other moral approach to this. Right. This, what, what is a lockdown? A lockdown is essentially an attempt to reduce the level of human connection, human contact. Well, what does that mean? It means essentially an undoing of of a million things that, small things and big things that give our life meaning and purpose that keep us healthy and strong keep us, you know, sort of going. And if you think about what the lockdown effects are, you can’t simply just look at what affected on COVID. You have to think about what those kinds of effects are on every aspect of human life. And unfortunately, I think it’s even worse than that. It’s the effects, the negative effects of lockdown are worse on the poor than they are on the rich. The rich we can afford to like sit in and zoom in and up and have people deliver stuff to us. But if you’re, you know, I know in like Indian coconut water seller in Mumbai and your, the country’s locked down you’re forced to walk or, you know a hundred miles to go home and your livelihood’s gone. I mean that you’re gonna get hit hard. And there’s now like actually good data on this. There was a fantastic paper published out of a, I think a group in Berkeley that surveyed tens of thousands of poor people in countries like in Africa and Asia and they found enormous increases in poverty and enormous increases in food insecurity. The early predictions about that are coming true. About the lockdown effects on poor countries.

Dr. Z: I am gonna say something that I think is gonna, we’ll see what people think of this, but I think it’s true. And I think you have to speak the truth as you know it. I think that there’s a rich class of people, especially in the United States that can absolutely not just afford, but thrive in a world where the in-person stuff is shut down for the majority of people. They’re cheating often, they’re having family gatherings and they are able to make a living actually a better living. In fact, the wealth inequality has increased during the pandemic, and they’re the loudest, vocal-est folks when it comes to, hey, we should stay home and save every single life possible at whatever cost. What about the cost of lives and sanity and futures for children, the wealth disparity-

Dr. Jay:  I mean, I, I think a lot of times it worked for one group of people is exactly the group of people you said, right? So I’ll give you one statistic, right? If you look at LA County, the data in LA County they have age, on the LA County site. They have age adjusted mortality by zip code income. So like Beverly Hills, less than 10% poverty with like pretty low poverty rate there, it has one third the COVID related mortality age adjusted relative to the poorest parts of LA. It’s one third, right? So the poor, who has borne the burden of this epidemic, it’s the poor, especially in lockdown. Actually, funny enough in Florida which didn’t lock down, you have much more equal outcomes across, across income level. Interesting.

Dr. Z: So rich and poor are equally affected.

Dr. Jay:  Yes. And, and the age adjusted mortality rate is actually lower in Florida than it is in California.

Dr. Z: Age adjusted?

Dr. Jay:  Yes. ‘Cause you know, Florida-

Dr. Z:  ‘Cause they’re old.

Dr. Jay:  Is one of oldest and then California is one of the youngest.

Dr. Z: So, and that, that makes me ask about, cause again, you’re, what you’re trying to do, Jay. And I think people misunderstand you, you’ve been vilified because of, you know, any association with Great Barrington which was considered a, a taboo violation of the dogma that there’s no such thing as targeted interventions for a pandemic because young people walk around spreading disease. But I think your whole piece is that these approaches that have been very heavy handed are not equitable. They’re not compassionate. And that’s what drives you to go and continue to talk about it at great personal expense.

Dr. Jay:  I think the lockdowns have hurt basically every poor person on the face of the earth. And I think what we did is immoral and I don’t, I mean, that is what’s driven me to took to speak up because I think there needs to be some voice speaking about that. I think we could have done better. Right. I think that the reaction to the Great Barrington Declaration was, oh no, we can’t protect the vulnerable. We, the only way to protect the vulnerable, the old, is by lockdown. Well, we see the lockdown hasn’t protect the vulnerable. It’s, we failed, like 600,000 deaths. I mean, that’s like, you know, that’s, you know I just, I mean, we failed to protect the vulnerable. We have the lockdown arms in place that if we continue to lock down, instead of, instead of engaging and saying, well, how can we protect them? Well, that’s what I expected to happen. I expect the public health community to work together and say, well, okay, we haven’t done a good job protecting nursing homes. We haven’t done a good job protecting older people, living in the community in multi-generational homes. We haven’t done a good job protecting older workers. What kinds of policies can we adopt that would protect older workers? Let’s give them paid sick leave.

Dr. Z: Paid sick leave.

Dr. Jay:  Yeah. I mean, let’s get, multi-generational homes. You know, I was on a, it was it’s funny. Like I was on a, of the things we did with The Great Barrington Declaration, we said, well why don’t we make hotel rooms available to people, older people living in multi-generational homes. So some, you know, they’re 20 year old, you know a grand grandson comes home and says I might’ve been exposed. Let’s have a hotel room avail for the older person. So that while, that you check to make sure it’s it’s negative, just like we do with hotels for for the, for, you know, for homeless people, which is I think a good idea. But then, but that reaction. I actually was on a TV show with John Berry who’s who wrote this fantastic book about the 1918 flu. But his, his reaction to that idea was, oh, why do you want concentration camps for old people? I mean, what nonsense? Right? Like I, instead of trying to constructively engage with, to try to protect all people we just decided that we can’t do it.

Dr. Z: Yeah. Yeah. And I think that was the biggest criticism. And then there’s other more insidious stuff happening which is, oh, first of all, why did you even feel the need to do such a thing? Because I did a video where it’s like, why are we even, ’cause we have the dual declarations, right? Yeah. The great Barrington and the, who was the other guy?

Dr. Jay:  John Snow, yeah.

Dr. Z: John Snow. I mean, what is this, “Game of Thrones”? Like, are you guys gonna take the Black? It’s like whoever loses has to take the Black And go north of the wall.

Dr. Jay:  I think the irony is John Snow of course is the famous sort of founder of epidemiology. He found out that cholera was coming from this like-

Dr. Z: The pump.

Dr. Jay:  Yeah, the pump. The Broad Street pump, right? So, and the irony is John Snow argued for focused protection. He said, let’s not have like a broad lockdown of, of London. Let’s just fix the pump.

Dr. Z: Yeah, yeah, yeah.

Dr. Jay:  That’s infected.

Dr. Z: Right. Right. So that’s kind of ironic, but what, why did you, why did you guys actually feel the need to do that? Because it’s an unusual approach.

Dr. Jay:  Yeah. So I think at we were seeing a few things at the time. One is that there was basically no one really arguing for this. I think a lot of, a lot of epidemiologists, a lot of folks were uncomfortable with the lockdown approach, but very scared to voice their opposition to it. And this focus protection idea. It’s not a new idea. It was old as the hills. It’s still as old as the hills. It’s what we used to address many, many, many many other epidemics very effectively. And so there’s two things going on. One is we wanted the policy to change to protect the older population and we want, and we needed to give voice to that. The other thing is we wanted to get protection to other scientists who are afraid to speak up at the same around this. And I think, I mean, I think in some sense, we succeeded at that. Like you started to see after the Great Barrington Declaration more and more dissent. I think that that’s one of the scariest things about the epidemic actually is, has been this silencing of dissenting voices within the pandemic.

Dr. Z: And this is important because if you believe the opposing side on this, on Twitter, which is the majority of people who are vocal on Twitter.

Dr. Jay:  Yeah. But not the majority I don’t think it was scientists actually.

Dr. Z: I agree with you because when they talk to me they’re like, well, you know, we can’t say this because we’re gonna get-

Dr. Jay:  Yeah, killed.

Dr. Z: Deplatformed, yeah. What they’re saying is no, but there is consensus it’s and this is, this is not consensus, for example, consent. I’ll just list off things that for which they say there is consensus. Now, I don’t know whether these things work or not. I’m gonna say what they are masks for everybody. Closing restaurants, bars, schools. You know-

Dr. Jay:  Contract tracing.

Dr. Z: Contact tracing. What else is, is dogma?

Dr. Jay:  Let’s say mass asymptomatic testing

Dr. Z: Mass asymptomatic testing. That’s a great one. What else? What else else am I missing?

Dr. Jay:  Oh, I can, I can, let’s not, let’s not focus on the failure, shall we? I mean think that’s- I think, I’ve been trying to make sense of this, and I want to give folks on the, who disagree with me their due. ‘Cause I do think there is a point to this and, and like, you know, why this reaction, this sort of frankly, overreaction to a plan that is, again, as old as the hills. You know, like The Great Barrington policy. So the, I think there’s two norms that are competing with one another. And in one norm you have the public health, right? Public health in public health, you have to have basically some somewhat unified message, right? I mean, you have to say like, you know, this sort of, if you don’t have that unified message, you can’t be effective.

Dr. Z: It’s very tough. The public doesn’t get the nuance and so on.

Dr. Jay:  Yeah. And you’re trying to communicate in a mass way. You’re trying to say, you know, you’re trying to give them a simple message as can, as accurately as possible, that’s consistent with the science to get people to act a certain way. I mean, it is essentially a mechanism pf population control but a benevolent one, because you’re trying to get people to act for their own health.

Dr. Z: Right. You’re shaping a system so people will walk along a path that makes some sense that’s hopefully proven by data.

Dr. Jay:  Right. And so there dissent is dangerous.

Dr. Z: Right.

Dr. Jay:  Right? There dissent is, it’s edgy. You’re like trying to, you’re cutting against what the public you’re sort of this, like this, there’s a sense of solidarity that you’re cutting against. I think that’s the root of the the reaction to the Great Barrington Declaration was this, like this, this public health knows and violated. And obviously it was, because of that’s the point, right? The reason why is there’s a second norm and I think a more important one.

Dr. Z: And by the way you said the word dangerous, you said it’s dangerous in public.

Dr. Jay:  I’ve gotten that 500 million times.

Dr. Z: Because you’ve been called dangerous. I’ve been called dangerous. I’ve had people texting me saying, you know, your skepticism of cloth masks early on was dangerous. Okay. So show me the data.

Dr. Jay:  You were completely right about that. But look, I think so that’s one norm, right? One norm is this public health norm. The, the other norm is the norm of science. And in, in science, not permitting dissent is itself dangerous.

Dr. Z: It is the worst. Anathema to the scientific approach and method.

Dr. Jay:  Yeah. You have no, I mean, otherwise how are you gonna discover things, unless somebody says, no, no, I don’t think you’re right. And then we have disagree. It’s a dialectical process. That’s what science is, right? Like you think A, I think B, we disagree. We come up with some, we come up with C and if C is true, then you’re right. And is C is false I’m right. So we do it to experiment. C turns out to be true. You’re right. And I’m saying, ah dammit. And then the next time we go on and I say, no, no, A prime. And now, now we’re gonna have another fight over A and A prime. Right. I mean, it’s just, you have to have this sort of freedom to say, B one of you say A, in science, or else science cannot advance.

Dr. Z: Can’t work.

Dr. Jay:  And the public health norm is premised on a consensus, a well-known consensus on a deep body of science or else it’s immoral. Right? You don’t use public health as a mechanism of population control unless you have this deep body of science this truth, that really most people, you know, we’ve now gone down this dialectical path and arrived at something where we’re we’re pretty sure it’s right.

Dr. Z: You know, it’s interesting that you mentioned public health and population control. Now that that’s gonna trigger like a lot of people that what he’s calling us population control. No. What you’re saying is it’s benevolent. I mean, you’re asking a population to do something.

Dr. Jay:  It’s completely appropriate, right? When you have a consensus that really is solidly scientifically based. Right? So what’s good-

Dr. Z: Childhood vaccinations.

Dr. Jay:  Exactly. MMR vaccine is a godsend. Right? And there’s an enormous body of evidence that suggests it’s a godsend. And so the norm, the public health norm of not dissenting around that is very much justified. Now there could be, I don’t think so, but it could, it’s possible, this is science that could be some piece of evidence that comes up that underlines undermines that sort of consensus in science, in which case the public health messaging ought to change.

Dr. Z: Right. Right. You update your priors and you change the message.

Dr. Jay:  Right.

Dr. Z: Yeah.

Dr. Jay:  And so, but the science is the, the consensus in science is the moral backing for the sense that there’s danger in dissent in the public health norm.

Dr. Z: Yeah. Then, and that makes sense. And, you know, one interesting thing that, that a follow up on that, when you talk about public health being a kind of a population control, I don’t know if you saw the “Mercury News” piece here in the Bay area about they made public a Slack communication channel among all the public health officials here in the Bay. You know-

Dr. Jay:  I didn’t see that.

Dr. Z: It was fascinating. So Sarah Cody in Santa Clara and Scott Morrow here in San Mateo and Erica Pan-

Dr. Jay:  Oh, I would love to see it. Especially between them.

Dr. Z: Oh, it’s, it’s, it’s fascinating because they were struggling and wrestling with this new, this was early in the pandemic this new authority that had been given to them to control people’s behavior. Like we could shut down restaurants, we could shut down schools, we could shut down all non-essential businesses. Like this is crazy. And they struggled with that. And at some point, Scott Morrow in San Mateo asks so we’re saying gatherings of 30 people outside is good. What’s that based on? And they’re like, well, we have to put a number on it. So we’re gonna put a number on it. I mean, it was chaos. And so I think, I think this idea that, you know, this is some infallible science that we’re then communicating en masse is not true. They makes compromises, so questioning it is not, should not be-

Dr. Jay:  Yeah. Well again, the moral basis of that sense that there’s dissent is dangerous in public health, The moral basis of that is true consensus in science. But you have a new virus, you have all kinds of novel interventions. There is no consensus in science. And I don’t, I mean, especially last March, there was no consensus in science. I don’t think now. I mean, I think like, just, just look at the, is that the CDC changed from six foot distancing to three in schools.

Dr. Z: To three.

Dr. Jay:  I mean, that means three feet was okay all the way, all the way across. I mean, the plexiglass is no longer necessary. I’ve sort of lost track.

Dr. Z: Oh there’s a million of them.

Dr. Jay:  Yeah. Just, I just, I mean, I think science is changing on this because there it’s a new thing and we’re learning new things all the time.

Dr. Z: And you know, what’s crazy though. I don’t, I, all this year of research we’ve learned a little bit, not enough, because I don’t think we’ve questioned hard enough. We haven’t done real science hard enough. We haven’t done cluster randomized controlled trials of masks.

Dr. Jay:  Like we can just go back to the seroprevalence study. Why were, why was it like my group and a couple other groups doing the seroprevalence? Why wasn’t the CDC systematically tracking this? Or still systematically tracking frankly.

Dr. Z: Right. It’s like an operative central question. And I think the other operative thing that you said is this is a gradient disease. So elders, people with chronic disease.

Dr. Jay:  I mean, that’s one of the reasons actually for the policy argument, for the GBD, for the Great Barrington Declaration. The policy argument is that on many, many sort of different questions it doesn’t matter what the answer to them are. The, the focus protection idea is still the optimal policy. It’s harm reduction, right? It’s, it’s still the right policy, if the IFR is really high on average, as long as there’s this gradients, you still do focused protection.

Dr. Z: Right. Right.

Dr. Jay:  For instance, there’s, it’s invariant, the right policy options and very many of these uncertainties in the science.

Dr. Z: Right. So in other words, it allows for changes in data because there’s a broad applicability to that approach. And the question is, again, you know they’ll say, well, what about the feasibility of it? And so on. And now what they’re doing is I think there’s this mission creep that’s happening in public health, or or maybe it’s not public health. Maybe it’s just-

Dr. Jay:  The fear.

Dr. Z: A fear. And they’re saying, well, but now younger kids with these new variants, we don’t know it’s a little more infectious now, school age kids. What if they get really sick? And, you know, even though this thing has killed less than you know, or, or about as many as flu would kill in a normal year in kids, I say hardly any. I mean, again, it’s not, that’s not that’s not compassionate to the people who’ve lost children. Right? But understanding from a population standpoint, how, I mean, if we keep creeping it we will know we will cause inadvertent harm that you will recognize. You’ll go well, but then, so we’re gonna keep schools closed and do distance learning that’s been harmful for the majority of, especially poor children? And the only other thing I want to say about this is you know, when we talk about lockdowns that’s not one thing, we don’t even know what that means. Like what, when you say lockdown what are you talking about?

Dr. Jay:  Well, I mean, it’s a whole suite of policies. I mean, obviously you’re, you’re right. There’s a range, right? So school closures, business closures, church, synagogue, mosque closures. Those are like one set of stay at home policies probably the furthest along in that range. Restrictions on mass gatherings, recommendations that you shouldn’t, shouldn’t go over to dinner with other people’s houses, even though they’ve been vaccinated. I mean, these are all like forms of lock, anything that’s aimed at prohibiting human contact is a form of a lockdown

Dr. Z: Lockdown policy. So then let’s, let’s segue. That’s a nice segue into vaccine messaging currently. All right. As you mentioned, and I’ve continued to mention these are incredibly effective and almost miraculously effective-

Dr. Jay:  They are. Amazing.

Dr. Z:  Particularly the mRNA.

Dr. Jay:  Can I say like one, sometimes people will ask me what I got wrong. I’ll tell you like my mea cupla, what I, I did not anticipate in March of last year, that it would at all possible to produce an effective vaccine in the time it did. Absolute truth.

Dr. Z: That’s such a politically awesome answer. Is that, what did I get wrong? Why I didn’t predict the miracle of vaccines?

Dr. Jay:  I did not, but that’s just honestly, that’s the one. And actually, I was trying to think whether that would have affected my thinking in March.

Dr. Z: Right? Oh, well, let’s dig into that. If you knew that this vaccine was coming, would you have been more, more amenable to saying, well, then lock everyone down until we get there?

Dr. Jay:  Yeah. so I think, I mean, I think that’s the obvious, like you, I know the vaccine is coming day after tomorrow.

Dr. Z: Right?

Dr. Jay:  Fine. The vaccine coming in 10 months, I still think lockdown’s the wrong answer. Right. You still do focused protection in the meantime.

Dr. Z: Because of the ancillary harm.

Dr. Jay:  Yeah. Because of the ancillary harms, the lockdown harms are absolutely enormous and you cannot ignore that in a policy calculus. The other thing is the inequality of it. Right? So for 10 months, rich people can afford to do this. Poor people cannot. And you can’t blame poor people for that. That’s just a fact of life. And you don’t design policy around asking people to do the impossible which is essentially a 10 month lockdown policy.

Dr. Z: Come on, dude, they got 1400 bucks. That’s the equivalent of let them have cake.

Dr. Jay:  Right. Oh my God. It’s even worse, right?

Dr. Z: It’s worse. Yeah.

Dr. Jay:  Then that caused like a huge revolution in France if I understand it correctly.

Dr. Z: I believe that heads were lost.

Dr. Jay:  I apparently, but yeah.

Dr. Z: Decapitations defenestrations, people thrown out of windows.

Dr. Jay:  Yeah, but so I think, I think the answer still is focused protection. If it’s 10 months, if it’s two weeks, then it’s different.

Dr. Z: Yeah. And the other, you know the other issue with that, then let’s dig into that a little more. We now have vaccines. So I think people would say, well, now there is a finish point. Let’s keep everybody under wraps and do everything, we’ve met, double, that’s a double masking thing and all of this and these variants, let’s get as safe as we can until we can get everyone vaccinated. What do you think of that?

Dr. Jay:  It’s the same, it’s the same exact problem, right? It’s well, there’s, there’s more actually. So first is a failure of focused protection. It’s, it’s continuing, it’s continuing the lock down harms, right? Schools still are not open in California. Poor children are the ones that are suffering the most. And not only that-

Dr. Z:  Excuse me.

Dr. Jay:  Uh-oh.

Dr. Z:  Poor children, there we go. My OCD, I just, the mic was a little crooked. I had to do something. I had to make an intervention, focused microphone intervention people.

Dr. Jay:  Oh dear, oh my God.

Dr. Z: So back back to, back to what you were saying.

Dr. Jay:  I mean, this is like the you’re inviting like amateurs to your professional podcasts, I don’t know what you expected happen.

Dr. Z: You’re a pro dude. I saw you on Dr. Drew.

Dr. Jay:  Oh God.

Dr. Z: I was on Dr. Drew too.

Dr. Jay:  Okay. So you, you, you have these like situation where you have this fantastic vaccine and you’ve sent this message that your life will not change` even if you take it. Are you at all surprised that people were saying what’s the purpose of the vaccine? Is it any good? I mean, it’s the worst, it’s the most anti-vax message I’ve seen in my life.

Dr. Z: It’s so, it’s so an anathema to actually having people get the vaccine. Like, look, you and I are both vaccinated. I mean, what kind of sense of liberation did you feel? I mean, I, you know, and again, you’re less worried about COVID-

Dr. Jay:  I wasn’t particularly worried personally about COVID. ‘ Cause I mean, I’ve done the, the risk calculator. My risk was like 0.2. I mean, my IFR was 0.2. So, you know, I’m 50, my IFR is 0.2, every seven years of age, you double the IFR, so.

Dr. Z: So you did your math.

Dr. Jay:  Yeah, for 52 actually.

Dr. Z: 50, old man.

Dr. Jay:  I know, really.

Dr. Z:  I’m fine, I’m gonna be 48 this month then. So, so that, that tells you what my risk is, but I also have two clotting alleles, So I have Factor V Leiden and prothrombin too.

Dr. Jay:  Yeah, so then you’re going to be higher than me.

Dr. Z: Exactly right. So that’s why when I got the vaccine, I was like, oh, good. I am not gonna die of a massive pulmonary embolism. That’s induced by COVID.

Dr. Jay:  Right.

Dr. Z: Not by the vaccine, which we’ll talk about, but by COVID. So that, the reason I felt relief with that vaccine is I knew, I knew that I could go back to doing a lot of things with other vaccinated people or people that are low risk because I’m a doctor and I’ve looked at the science. If I listened to the public health apparatus I would still be-

Dr. Jay:  Well, they’re aiming for zero risk in every activity of surrounding, around COVID while at the expense of all the other things in your life that are not around COVID. It’s just so, it’s irrational, right? In monomaniacally focused on a single risk, minimization of a single risk. But if you do that, you’re going to harm other things in your life that are probably more important to you.

Dr. Z: Yeah. Yeah. And one thing I will say is this pandemic has been good in the sense that people are always talking about we got to get back to normalcy and I’m like, I don’t know about y’all, but normalcy kind of sucked before. Like we have a broken way of doing things in the world. So hopefully when we get back there will be a little bit of improvement in, oh, we’ve had time to spend with our families a little bit assuming we’re rich and we’re in the Zoom office.

Dr. Jay:  I mean, I think there are some things that are good for the lockdown. I mean, I just like the, if we actually can figure out a way to make work from remote, work for many people that’s actually a good outcome, right?

Dr. Z: That’s pretty good, yeah.

Dr. Jay:  So, I mean, there’s some potential that we should go back and look for lessons because that’s one of these I’m gonna be doing is, is trying to do research on the collateral effects of lockdown. I think that needs to be documented. And so if you go to a website, collateralglobal.org, there’s a project that I’m working on to try to try to start to document that.

Dr. Z: Quantify that.

Dr. Jay:  Yeah.

Dr. Z: So there’s a little mixed information come out on that. So for example, suicide CDC reported we’re actually down in 2020.

Dr. Jay:  I saw that at 4%, but on the other hand, suicidal ideation was up enormously, right? Up 25% in the 18 to 24 category last year.

Dr. Z: Yeah. And I just interviewed a psychiatrist Jud Brewer who said his practice has been just overwhelmed with anxiety

Dr. Jay:  Well, I mean, I think there’s like there’s this like mass anxiety, everyone’s felt it. I don’t, I mean, I don’t think anyone in the audience hasn’t felt it to some extent or other it’s just about unavoidable, right?

Dr. Z: A social contagion, yeah.

Dr. Jay:  And I think it’s surprising that the suicide rate is about the same as it was. But that shouldn’t change how you think about that. I mean, we should start, we need to, we need good science on this is the point, right? Like figure out what, we usually count the cost, right? And I think that’s part of the-

Dr. Z: What you’re trying to do, yeah. So one thing I think I got wrong is I was thinking that there was some existing natural T-cell immunity that would have caused cases to rise in young people in the winter, but not deaths. And then deaths rose. And I was like, wow, I was not right.

Dr. Jay:  Yeah. Well, we have failure to focus protection. Older people still got-

Dr. Z: Older people still are-

Dr. Jay:  It’s still 80% of the deaths are 65 and up in the US.

Dr. Z: That’s the statistic?

Dr. Jay:  Yeah.

Dr. Z: 80%.

Dr. Jay:  I think it’s somewhere along there, could be 70 something, 75, 76.

Dr. Z: It’s high enough that if, like you said a focused protection would have saved, if you could pull it off, but you know concentration camps for old people Jay.

Dr. Jay:  What nonsense.

Dr. Z: But I think it’s that kind of like, it’s almost an ad hominem to say something like that, because the minute you start making references to Hitler, Nazis, and et cetera, you’ve already lost the argument-

Dr. Jay:  Didn’t there used to be a thing in the internet as soon as the first person that makes that the refe rence has lost the argument.

Dr. Z: Has lost the argument.

Dr. Jay:  Yeah.

Dr. Z: It seems to happen routinely. So the T-cell thing is another interesting thing is now India is getting their second surge. And have you looked into this at all?

Dr. Jay:  A little bit? I mean it’s, it’s still, the death rates are still incredibly low. The IFR is still incredibly low in India-

Dr. Z: Yeah, just large numbers of people.

Dr. Jay:  Yeah. Large numbers of people. But I think what happened in India is the the poor population was the first surge. And the rich population is the second surge.

Dr. Z: Because they’re opening up.

Dr. Jay:  It’s incredibly unequal in India.

Dr. Z: Yeah, oh yeah.

Dr. Jay:  The lockdowns were essentially, they couldn’t enforce them in the poor population because you just would kill them. And so they, that lasted for like 15 seconds. And the disease spread everywhere. Right, I think there was a Mumbai survey in the in the Dharavi slums in, I think it was like August or September of last year. And it was like six 60% of the population. I mean, really, really high fraction of the population had antibodies. So I think, but that was the poor, right? And I think now we’re seeing, I think a lot of countries I think we’re sort of seeing this, this residential, in poor countries, there’s this like residential segregation between the rich and the poor and one population, in fact, in one way or another population, in fact, in another way that’s still needs to get sorted out, I think. I still haven’t seen good stuff on that as yet, but that’s, I think the primary hypothesis.

Dr. Z: Now, now we talk about vaccine messaging that the vaccine messaging around pausing Johnson and Johnson, pausing AstraZeneca, for what we’re seeing is these very rare clots, which I’ve done shows on, you know, roughly in America, we see so far about one in a million risk typically younger women, age 18 to 48, 49 is pausing the vaccination campaign the correct approach?

Dr. Jay:  No.

Dr. Z: Why not?

Dr. Jay:  I mean, it’s, it’s again, another failure of public health messaging. If you want to create vaccine hesitancy, do what you just did. Tell people, this is a dangerous vaccine on one in a million event.

Dr. Z: Shouldn’t we be hesitant in a one in a million event?

Dr. Jay:  No, I think the right thing to say is what we’ve found. We found that one, like one in, it will be more than one in a million ’cause it’s a, it’s a, but only a little bit. ‘Cause it’s in the under 50 group, whatever that population size is one in 700,000 whatever it is. You have one in 700,000 risk of this blood clot, here’s your risk of COVID, you know, you can decide what’s what’s right for you. If you’re over 50 it’s zero in a million. And you here’s your risk of COVID which is really high if you, if you were to get sick.

Dr. Z: So it’s easy.

Dr. Jay:  Yeah. I mean, that kind of messaging would go a lot, people are not stupid about this. You just trust people to make the right choice by giving them information.

Dr. Z: So how heaven forbid Jay that we tell the truth and, you know honestly I did a show exactly saying this yesterday a live show where I said, let’s talk about risk and COVID. And I, you know, in, in Europe, AstraZeneca they did a calculation. I think in Brits, in their twenties, it’s a one in a 100,000 risk of an adverse event to that particular vaccine based on what their, and I didn’t look into the primary data but their risk of COVID ICU hospitalization varied. So it was anywhere between 0.9 in 100,000 and 6.8 in a 100,000, depending on whether they were an essential worker, what their socioeconomic status was, what their zip code was, all the things you talked about. So making a decision depends on all those kinds of things right?

Dr. Jay:  Yeah.

Dr. Z: And now in the setting of having another vaccine too, the mRNA-

Dr. Jay:  Well, we do this with other vaccines, right? So we risk stratify for MMR. We say, look, if you’re 70, you don’t need an MMR vaccine.

Dr. Z: You don’t need an MMR. Exactly. That makes sense, that makes perfect sense. You know, it it’s, it’s just like, you know when I see a ninety year old put on a statin I always scratch my head a little bit. You know, what quality of life here saved are we doing?

Dr. Jay:  Yeah. I mean, I think you can trust people to make the right decision if you give them good information. And, but whereas if you try to try to like, just, I mean, this, this, if, I mean, I really regret that they, that they paused this vaccine. It just doesn’t make sense based on the data, at least that they made public. I mean, of course they could have some private data. I haven’t seen-

Dr. Z: That’s right. Yeah. Yeah. We don’t know. Yeah. My sources say, that’s not true though. Yeah. That this is what’s public is largely known, but I would say this, because believe me if I knew something that the public didn’t know it would infuse into my messaging because I don’t care. You know, I just want to tell the truth. And so the, you know, so that vaccine piece I think we’ve really we’ve bungled it because we then we throw this idea of variants in and this is a partially public health apparatus partially the press, but these new variants, for example, in Israel there was a study that Israelis who were vaccinated with the mRNA vaccines were more likely to be infected with the South African variant. Did you look at this data?

Dr. Jay:  Okay, so this is, this is nonsense, right?

Dr. Z: It’s idiotic.

Dr. Jay:  Right? So like the key question is the same question. If I get the vaccine, am I protected against death and hospitalization from the variants or from whatever? And the answer is still, yes, the answer is yes to that question. It’s still protective against the outcome you just don’t want. So why on earth are we scaring people around some like uncertain thing, most much of which has produced based on these modeling studies that, that, I mean I just don’t trust anymore. And so I think it’s-

Dr. Z: Yeah, they’re bad studies.

Dr. Jay:  I mean, I think as a general thing we should be giving people information based on things that we know that they care about. They know they care, we know they care about death and they know, we know they care about about avoiding hospitalizations. We should all care about that, right? It makes sense. And the evidence that I’ve seen anyways to date about the variants is that the vaccines still protect against those bad outcomes.

Dr. Z: That’s right. That’s my, that’s my interpretation of the data as well. And what’s interesting about this study that got pulled into the press by Reuters is that, so there was, you know 5.9% of the infections in the vaccinated group in Israel where the South African variant, much lower in the un-vaccinated. Yeah, duh, that’s from the new England journal of duh, why is that? Because if you have a vaccine that’s really good at stopping wild type virus, when you have a variant, the only way you’re going to get infected-

Dr. Jay:  Is with variant.

Dr. Z: Is with a variant.

Dr. Jay:  Yeah.

Dr. Z: And then you’re only gonna be a case, not a fatality, not a hospitalization, and it’s gonna be higher than in the unvaccinated population that can just get infected with the garden variety.

Dr. Jay:  Yeah. Same thing with the oh look, the fraction of the young people are getting the fraction of cases among young people are increasing. I saw a “New York Times” article on this-

Dr. Z: Yeah, I saw that too.

Dr. Jay:  As if we’re like, well, we’re vaccinating the old people. What did you expect to happen?

Dr. Z: What’s gonna happen, yeah.

Dr. Jay:  Preferentially.

Dr. Z: And, people are appropriately going, hey maybe we should start getting back to business here and hanging out with our friends and stuff. And they’re young people and their risk is low. And you know, now they’re not gonna affect grandma because grandma’s vaccinated, presuming that grandma’s vaccinated. Now at this point people should have the information to say, okay, I’m grandma. Well, I’m not gonna get back-

Dr. Jay:  Well I think 80% of the American population over 65 has been offered the vaccine.

Dr. Z: Has been offered it, yeah.

Dr. Jay:  Yeah, and I think, I think it’s on the order of 80% have got the first dose in. I mean we’ve done an incredible job in vaccinating the old. We should be celebrating instead, we’re like something, something on that order.

Dr. Z: Would you call that targeted protection Jay?

Dr. Jay:  It’s focused protection? I mean, I don’t, I didn’t want to like point it out, but like in the vaccination campaign we kind of adopted the Great Barrington Declaration, didn’t we? and that’s really good news.

Dr. Z: Do you remember when Stanford residents threw a fit? Because yeah.

Dr. Jay:  But you know what? That was okay. You know why? Because they actually see old patients.

Dr. Z: Yeah, yeah, no, no, no. I agree. Yeah. I thought it was okay. But it was interesting because it was the young revolting and saying, you know why are these old attendings who don’t even touch patients getting the first-

Dr. Jay:  You know, I was offered it actually when they made that mistake. ‘Cause I’m a professor at Stanford and I, but I don’t see patients. And I sit alone in my fricking office and I, I there’s no way in good conscious I could get vaccinated before my mom. That’s just like, so I just waited until she got vaccinated before I got vaccinated.

Dr. Z: Yeah, yeah, yeah. You know, when I decided to, you know I was waiting too, when I decided to do it, it was when I heard that the place that was doing the vaccinations at 40% of people were refusing it, declining it, healthcare workers. And I was like, okay-

Dr. Jay:  Yeah I think you should take it.

Dr. Z: I’m taking the shot. I’m taking your shot.

Dr. Jay:  Right.

Dr. Z: Yeah. Because I see guests, I, you know.

Dr. Jay:  Yeah.

Dr. Z: It’s a responsibility to them.

Dr. Jay:  I think when you have risk factors. I mean, I think, I don’t think, I think every, I mean, I don’t want to be moral or moralistic about this. I think we all have our own sense of like propriety about what’s what’s right. But I just didn’t couldn’t do it until my mom was vaccinated.

Dr. Z: I think that’s fair. Yeah. And that reminds me our messaging. Oh, you’ve had, COVID get yourself vaccinated stat. Why?

Dr. Jay: What on earth. These are immunities deniers. That’s who they are. They’re immunity-

Dr. Z: They’re immunity deniers.

Dr. Jay:  Yes.

Dr. Z: Man. You need another declaration. Like just pick another city that that’ll get pissed off that you made a declaration about like, like how about the Santa Cruz Declaration?

Dr. Jay:  I mean, I just, I, on that, on that business of, yeah. I think somewhere on the order of 120 to 170 million people in the US have had COVID infections based on if you depending on what you think the IFR is, you just take the number of deaths divided by your estimate of the IFR, you get some, somewhere in that order. Up to half of American population’s had COVID. Or infected with COVID, right? So if that’s true, why would we discriminate against them? Why we tell them the thing that they had suffer through to get to get immunity counts for nothing? Like, what is the reasoning there? I don’t understand it.

Dr. Z: The variants.

Dr. Jay:  I see.

Dr. Z: No, but natural immunity protects against the variants. Yeah.

Dr. Jay:  Again, with the severe disease from the variants.

Dr. Z: Right, right, right.

Dr. Jay:  So I think that, which is again the key thing.

Dr. Z: Yeah. And, and yeah, it’s very perplexing. And I think a part of this that I think you’ve talked about or would like to talk about because I would like to talk about it too, is how if we say this kind of thing, you know already YouTube has put a flag on this video. Facebook has put a flag on this video.

Dr. Jay:  This was the danger I told you, this is what might happen.

Dr. Z: And I accept it. It was like, you slapped me across the face with a white glove. D’Artagnan I challenge you to, to have me on the show. I’m like, yeah, let’s do this. I mean, what do I need 10 bucks in ad revenue for it? You know, it’s more, it’s an interesting conversation because who’s making those decisions as to what’s misinformation, right? And, and I, and I’ll tell you, Vinay looked into it, Vinay Prasad, he’s a mutual acquaintance, you know, he’s been on the show. He said, he looked at it. It’s people who have big Twitter presences who’ve already taken a stance on something that’s who they recruit to be their fact checkers. And of course, they’re going to disagree with, you know, Dr. Great Barrington and his crew.

Dr. Jay:  I mean, yeah, I think again, the, we can go back to our old, early part of the conversation like YouTube. They, we had, I had a conversation with Florida Governor DeSantis.

Dr. Z: How dare you. He’s a Republican.

Dr. Jay:  I mean, okay. There’s, there’s a few of them, I guess. So, yeah, and you kind of, stuff to do public health there. Right? So the conversation, one of the, one of the topics that it was pretty wide ranging was on TV. It was on like the Florida TV channels. And then it was, it was a pretty wide ranging conversation about COVID policy going forward, vaccinations and so on. And one of the questions that the Florida governor asked me was should children wear masks? So I’ve looked into this, right? So, you know, you can look, you can read those CDC guidelines. You can read this, the world health organization guidelines they disagree, right? So under the CDC says mask over age two, mm. World Health Organization says mask over age five, right? If you read the reasoning, well, the World Health Organization does a much better job with the reasoning that the CDC, but like the, what they say is the, there are lots of harms to children between two and five from, from masking. Developmental. So the key developmental stages that might get missed language, language, acquisition, so on and so forth. Right? And for over six, there’s still harm. Right. Social and emotional development are are harmed by masking, they say, or at least potentially.

Dr. Z: I believe it. Yeah. But then intuitively, but I don’t have data. Yeah.

Dr. Jay:  Yeah. Well, that’s what they say. I mean, I believe it too. So, I mean, I’m not a pediatrician, not a development expert. Right. But it’s consistent with, I learned in med school.

Dr. Z: I stayed in the Holiday Inn Express yesterday. I basically Piaget at this point.

Dr. Jay:  Right. But in any case, I mean, that’s what the that’s, there’s some harms from it, right? On the other hand, the, what are the what’s the benefit?

Dr. Z: The benefit, yeah.

Dr. Jay:  The benefit is slowing spread of disease. Well, I mean, what’s the literature say on this this actually I’ve read a about. So like from the, from the Iceland study, from early in the epidemic, kids are very inefficient spreaders of the disease, just straight up, they’re just, for reasons we don’t still don’t fully understand. They have a high viral loads in their nose and it’s still not spreading the damn disease, which is fantastic news. Right. That we should act on. Sweden. They’ve had children in school at one age, one to 15 and preschools for the whole epidemic without masks. And the teachers are at lower risk of COVID, bad COVID outcomes than the average of other professions.

Dr. Z: So the children are protective in some way.

Dr. Jay:  Yeah. And then no kids died either.

Dr. Z: They’re absorbing all the COVID and keeping it down low.

Dr. Jay:  Yeah. I guess, I mean, I don’t know what it is. I mean, whatever it is, like these are facts that are in the scientific literature that suggests that kids are not a huge risk of disease spread. That’s just a fact.

Dr. Z: It’s been consistent.

Dr. Jay:  Right. And there’s a ton of studies which now show this. The other thing is like, you know, like you ask a two year old to wear a mask. I mean, I’ve had two year olds. They’re not gonna, I mean, they’re gonna, they don’t, they’re not gonna wear it very effect, and, and you know, even 11 year olds, they’re running around they’re not gonna wear a mask effect effectively. Like you just, you can’t ask them to do that. And judge them on the fact that they’re being kids when you tell them to wear the mask and they don’t wear the mask. They just are. They’re not gonna wear one right.

Dr. Z: And they’re masking kids during sporting events and things like that.

Dr. Jay:  Yeah, so what, like, where, like people you have it down over the nose ’cause you’re gonna have to breathe. I mean, it’s just actually, the World Health Organization’s explicit about this. Shouldn’t wear masks during exercise. I, okay, so I’m looking at this, I looked at this information I do a very simple, I’m a health economist. I do a very simple cost benefit analysis, very little in the way of benefits and some costs.

Dr. Z: Yeah. So why do it?

Dr. Jay:  So why do it? So I said, no, you shouldn’t masks kids. For that, YouTube pulled the video now.

Dr. Z: Really?

Dr. Jay:  Yeah. They censored the whole video, the whole hour and a half conversation.

Dr. Z: They pulled the whole thing down?

Dr. Jay:  Yeah, and it wasn’t, it was posted by some local news station. So they’re like censoring the news. And then NBC wrote a story saying that it was effectively, that it was good that they censored the whole conversation.

Dr. Z: Of course, NBC did that.

Dr. Jay:  I didn’t realize news news media were in the in favor of censorship again.I mean, I just knew that’s news to me.

Dr. Z: Yeah. Well, I’ll tell you why I’ll speculate why. Because NBC would get more clicks on an article that’s politically polarizing than they would on one that’s milk toast facts. That’s just how the media is paid. It’s unfortunate. They’re good people in a bad incentive model.

Dr. Jay:  Yeah. I mean, it’s anyways, it’s a strange situation. You have a governor, you, you may like him or dislike him, but he’s trying to like show you through this conversation, what advice he’s getting and the basis for the decisions he’s making, that’s good government, right? Like when you-

Dr. Z: Transparently, right.

Dr. Jay:  So like, again, you may disagree or agree, but now you know what the, the base of his decision making, right? So, or at least some of the basis for decision making right? Why would you censor that? Yeah, I don’t understand, like again, it’s a misapplication of the public health norm.

Dr. Z: That’s exactly right. That public health norm, which says it’s dangerous to dissent from what the messaging is, but this is not what that is. This is policy and science and decision-makings based on not just what data we have, but what our values are and looking at the big picture of cost versus benefit across multiple sectors, which is what you’re trying to do when you influence policy.

Dr. Jay:  Exactly.

Dr. Z: I mean, heck could dude, look, no matter what people think about, whether you’re right or wrong you have to understand that the approach is correct. If there’s something to disagree with in your approach, well, then they can criticize you go, you know, I don’t like the fact that you go on Dr. Drew and say this. Like, okay, fine. I’ll take that criticism too. But the idea behind it, I think is unimpeachable. And, but it’s being impeached.

Dr. Jay:  Yeah, it’s really strange. Like, if they have a, I mean, you said there was like some, some intern or whatever doing this, right. Like if they that would be there, some algorithm I know to flag it.

Dr. Z: I’m the victim of algorithms a lot.

Dr. Jay:  Yeah, but okay, fine. But that’s not the right norm. Right? If you have a counter argument to make, I mean, YouTube essentially has editorial standards. And the editorial standards essentially say science can’t happen here.

Dr. Z: That’s what’s happening, yeah.

Dr. Jay:  Right, and so if they, now, if they don’t like what I said and they have reasons, they say, Jay, you missed this study, Jay, you got the cost benefit analysis wrong. Jay, I mean, that’s good science. Yeah. Contradicting what I said with other science. And then we can now have a conversation and a discussion and a debate. It’s the dialectic playing itself out. Right. But that’s not what they do. They just say, look, what you said was dangerous. We’re gonna make sure the public doesn’t see it.

Dr. Z: It’s nuts, I’ve said this many times. There’s some crazy crap that comes my way, Jay. I’m sure you get your inbox full of stuff, but I get stuff. Can you debunk this? Can you debunk that? Can you debunk this? And I just take one look, and I go this is conspiracy level, Defcon 1 garbage. I would never dream of censoring it, let it be out there and let, whoever wants to debunk it, debunk it. I’m not gonna waste my time because I don’t want to give them more platform. And it’s not big enough. But when something does get big enough then I I’ll do a video and say, you know I think “Plandemic” is wrong. This is not a thing. Or, you know, whatever it is. And, and that’s how it ought to be done. And then you present your case and people can decide.

Dr. Jay:  Yeah. I mean, the norm let’s take it out of science. Like the norm in American democracy has been how do you con counter bad speech? You, more good speech.

Dr. Z: Good speech, yeah.

Dr. Jay:  I mean, I think that norm ought to be, I think that was really a wise norm, let’s have that back.

Dr. Z: Yeah. Sam Harris has said this, you know, he, when you when you start censoring speech, you remove our only ability to resolve disputes without violence. You know, I mean, speech is how we do it.

Dr. Jay:  And John Mill, John Stuart Mill had, this, has this, I mean, I still remember, I read it in like 5 million years ago, and I still, like it is still with me. Like the, if I’m wrong, and I say something wrong. Well, I’ve done you a favor because I have given you a chance to refine your thinking about why I’m wrong. You’ve done me a favor by giving me good, good information that I might, you know, potentially change my mind around. It’s actually improved the entire conversation. The dialectic is a really valuable thing to arrive at something closer to the truth.

Dr. Z: That’s right. It’s an iterative process. And you need other human beings preferably in person by the way, but if you have to do it by Zoom. I’ve done videos on why I think Zoom is, there’s actually data now on why it’s-

Dr. Jay:  Why it’s hard to talk-

Dr. Z: less effective, especially in group collaborations because we have two types of synchrony in like, you and I, we can see each other right now in person and in unlimited bandwidth, we’re limited by consciousness, right? As consciousness limited-

Dr. Jay: In my case, very limited about this.

Dr. Z: Well, hey, both of us are primates barely out of the soup, but I’ll, I’ll say this. We can read each other’s body language. We can make eye contact. We know when to take turns when we’re talking, although I talk too much and I interrupt, and we synchronize our ability to exchange information. On Zoom what happens is we get, according to this data, we’re so focused on the visual cues that we ignore some of the subtle auditory cues and body language cues that allow us to not either dominate a conversation or be dominated and speak a turn, particularly in groups of more than two. And that’s why the argument is turn off the video and just go to audio only. And it’s more effective.

Dr. Jay: More like a phone call.

Dr. Z: Actually, yeah. It’s kind of interesting. So again, these are the things we’ll learn from this pandemic that, that will science this up and make us better, right? ‘Cause I, I don’t want to sit in traffic again, Jay. I don’t want to travel and do talks. It sucks. Like I like doing my talks from here.

Dr. Jay: Yeah. I mean, in some sense, that’s that, that is something that we’re gonna kind of get out, I mean, I think that that ability to work from away from home, at home effectively is something we have learned a lot about the pandemic. But for some professions.

Dr. Z: Telehealth a little bit too, I think.

Dr. Jay: Yeah, that could be, that certainly could be. I mean, I think, I think if we’re, if we’re honest we’ll do a, in science, we’ll be honest about this. Like what a full set of, of, of investigations, some of which will produce some good outcomes from the lockdowns, much of which I think will produce bad outcomes. But I think we just, we need the full scope-

Dr. Z: To understand it. Yeah. Yeah, exactly. And we need to have, that means you can’t have censorship. You have to have open dialogue and you have to assume good intent. I think that’s another problem. I’m an, I sometimes fall into this trap when I see one of these doom bait people online and they’re they’re like, well, the variants are gonna kill us all. You know, like there’s a particular person on Twitter which we can talk about not the person, but the behavior on Twitter that just it will take, it’s an epidemiologist. They’ll take any opportunity to spin a very fearful monologue. And the question is, who is that helping? You know, it, first of all I think scientifically they’re wrong, but let’s say even they’re correct, is that the approach that’s actually gonna motivate behavior change? It’s not. It’s being honest and having a dialogue and understanding, and actually even saying, well, there’s multiple sides to this on balance I think this.

Dr. Jay: Yeah. I mean, I think, I mean, I was thinking about this. I don’t know, again, I just sort of look, I’m a little bit hesitant to do this ’cause I’m not sure I believe, I’m not sure I fully believe what I’m about to say, but I think they’re kind of, you know, we, at Stanford we have this like fundamental standard. The fundamental standard is like a standard of how behavior that says how should we treat one another at Stanford? And it basically amounts to something like the golden rule, right? I mean, which is a ubiquitous standard for a reason. Twitter, in addition to arguing that academics and scientists on Twitter should drop the golden rule when they’re talking about other people. I think there’s another, another rule I want to add to it. Don’t say something you wouldn’t say in a referee report. Right? ‘Cause they’re not, there, they’re you that’s, that’s the norm of scientific discussion and debate, right? It takes usually place behind closed doors, but actually I think it’s healthy to take place outside closed doors so the public can see it. Because it’s a good debate. It’s a debate focused on facts and just disputes about how to interpret facts pointing out of it, of errors. In fact, I mean, all kinds of things. I mean, which is annoying if you’re trying to respond to them, but like, it’s actually good for science, right? That the kind of debate I think a responsible scientist should seek out on Twitter.

Dr. Z: Right. And was so lacking the ad hominem attacks, lacking the, you know what bothers me a lot on Twitter? I think the Vinay has talked about this too, is that you have a scientist who’s advocating a very strong political position, like they’re vote for this candidate. I mean more or less just putting it out there. And then the very next tweet is lock everything down or open everything up. And everyone who thinks otherwise is murdering grandma. And it’s like, well, you’ve already poisoned the scientific discourse by openly politicizing it ad hominem you use and violating the principles that you talked about.

Dr. Jay: Yeah. I mean, again, this is I don’t want to like moralize this ’cause I just I don’t think my, my particular approach may not be right for everyone, but like I’ve never donated any money to political candidate. ‘Cause I don’t feel comfortable, or a political party. I just don’t feel comfortable. I have to opine on health policy. I would like to reach all people, whatever their political is. ‘Cause I’m, I’m trying to find facts and I’ve tried to convince people that these are facts that don’t nothing to do with my particular political views, which are frankly not that interesting. I just don’t care that much about politics. I’ve never frankly, before the Great Barrington Declaration ever signed a petition before.

Dr. Z: Yeah, you know, it’s funny because petitions are like I just, I, the concept of it is just so off putting to me and yet there you did it because you believed in this idea.

Dr. Jay: Yeah. Now, now I’ve signed a couple. So like, there’s that And there’s a couple on, on like free academic freedom of science but those are like, I have to tell you, I’ve every time from The Great Barrington on, every time I signed a petition, I just I’m like, okay am I compromising my ability to persuade people about something? Of some fact I found.

Dr. Z: Right. And I think that’s a valid concern. I think you should have that concern always. You know, like in my profession, whatever that is, I call myself Alt-Middle, and that doesn’t mean I’m a centrist. It means that I have this radical, an unusual commitment-

Dr. Jay: To piss everyone off.

Dr. Z: To piss everybody off. Exactly.

Dr. Jay: Well done.

Dr. Z: Exactly. To hear all the sides and make decisions and then present it in a way that isn’t overtly, so if I’m politically biased in some way, I’ll say, okay here’s my bias. Now you may disagree. And this is why-

Dr. Jay: I don’t, I didn’t meet butter yet, but I actually I’ve been watching a lot of your videos since, since I’ve since we’ve spoken, I watched a few before that. I mean, you’re actually quite good at that. Like you’re trying to reach people that you wouldn’t naturally agree with. Right. I saw that like a, I think that’s, I think that’s, I think that’s the right norm for scientists to have like oh, like we should, we should aim at talking to everyone regardless of politics. I mean, in some sense, like in the scientific discussion around COVID, especially in elite circles there’s been this like bigotry against Republicans, against, and I think it’s really been harmful both for scientists themselves, because now what you have is created a distrust of science by, by a large part of the population-

Dr. Z: 50%.

Dr. Jay: ‘Cause, and they correctly sense that you’re bigoted against them. Why would you do that if you’re scientist. It doesn’t make any sense to me

Dr. Z: I agree so strongly about this because you know, and it doesn’t matter what your politics are. It’s a question of like, it’s the dumbest move to polarize and that, that’s why, that’s why I made that comment about scientists wearing their political beliefs on their sleeve on Twitter. I understand what Twitter rewards, it rewards politics and division. But by doing that, you’ve now alienated the other side of this thing. You’re never gonna convince them because they’re gonna brand you as an ideolog and somebody, if this is how we work as humans, we’re emotionally invested in our beliefs and whatever that tribal identity badge, if you violate it, you know, for example, Jay like if I were a far lefty I could just go, I’m not even gonna watch this show with Jay Bhattacharya because he’s been associated with you know, dissent, you know he just said he did a thing with, you know, the Florida governor, he’s a republican-

Dr. Jay: You wouldn’t write in a referee report an ad hominem attack.

Dr. Z: Never.

Dr. Jay: Or guilt by association attack.

Dr. Z: Right. You would never.

Dr. Jay: So that’s, that’s, that’s one notch in favor of my, if you would, what would you write it in a referee report rule?

Dr. Z: Exactly. Or a mind reading fallacy where it’s a, well, you know he clearly wants to poison old people. Okay. So you’re in his head. I mean, it’s true, but it’s actually, you’re the opposite. You want to poison young people and protect the old.

Dr. Jay: Oh God.

Dr. Z: You’re an ageist.

Dr. Jay: Yeah, I guess so.

Dr. Z: Yeah. You know what?

Dr. Jay: Actually, it’s COVID, that’s the ageist. We should blame COVID.

Dr. Z: You know what? All this time. We’ve been trying to blame it. It’s been xenophobic. Blame it on China. Blame it on the lab. No, COVID is racist.

Dr. Jay: It really is.

Dr. Z: And ageist.

Dr. Jay: Yes.

Dr. Z: It’s racist and ageist.

Dr. Jay: Yep. So are lockdowns by the way.

Dr. Z: Way to bring it all full circle on that, man. You’re right. Lockdowns are both racist. And why are they ageist?

Dr. Jay: Well, I think that, I mean, they harm the young differentially, I think.

Dr. Z: Yeah. I think you’re right. And, and you’re seeing this pent up thing with spring breaks and things that are happening and I, you know, okay. So actually that, that reminds me, Sweden, you know everybody’s talking about Sweden, then everybody’s like, oh, Sweden, oh, see, they were wrong because the cases went up and the deaths went up with the big surge in the winter. And so on. Now, where are we sitting with Sweden?

Dr. Jay: I mean, if you look at the overall excess mortality rate it’s actually in line with European norms. Actually lower I think, than most the majority of European countries, something like that.

Dr. Z: That’s the data I saw. Out of like, I think 26, they rank 19th lowest.

Dr. Jay: Yeah.

Dr. Z: In excess mortality.

Dr. Jay: And it makes sense, right? So they had a harm reduction approach. And so they had better outcomes on non-COVID mortality. Than other places that had a sort of, COVID only approach.

Dr. Z: Let me repackage that. They had less ancillary damage resulting in death than other countries. And that may have even balanced if they had slightly higher COVID-

Dr. Jay: Yeah, we should, COVID deaths are, are tragic. But so are non-COVID deaths.

Dr. Z: Non-COVID deaths.

Dr. Jay: And public health is a broad thing for a reason. There’s so many facets of human life and it’s and that’s why I always loved public health. It’s focused on the whole human being. And I think it’s lost that to some extent the last year.

Dr. Z: Yeah. No, I think you’re right. And, and it’s been, it’s been politicized and you can act, there’s plenty of blame to go on both sides of the aisle on that. But I’ll say, you know, the Swedish approach is not what people think. Oh, just wide open. And they didn’t, no, they actually had voluntary restrictions. They had some limits on large gatherings. They kept schools open.

Dr. Jay: And they told old people, older people who were vulnerable, you really should stay home. Now the mistakes they made were mistakes, especially early in the epidemic in Stockholm. I mean, a lot of people got infected in the nursing homes in Stockholm.

Dr. Z: Right, it was bad.

Dr. Jay: It was similar to the New York in some ways. I mean, that was an enormous error.

Dr. Z: Yeah, sending patients-

Dr. Jay: But that’s an error in focused protection. Like you have to, you have to, you have to do, so, I don’t think any country or any place got it perfect. But like take New Zealand people hold that as an example of success.

Dr. Z: Let’s talk about New Zealand, yeah.

Dr. Jay: Right, so they’ve had four lockdowns since they’ve declared zero COVID. They’re relying on a vaccine that could not in principle have been developed in their own population.

Dr. Z: Cause they didn’t have enough cases-

Dr. Jay: They didn’t have enough cases, right? It’s, it’s kind of like a beggar, thy neighbor, epidemiology policy.

Dr. Z:  I agree. I agree. It’s kind of like they have all these weird advantages. They’re geographically isolated. They were in the Southern hemisphere.

Dr. Jay: This is like, Martin Kulldorf says this. Like they were very clever. They located in themselves in the Southern hemisphere and the low COVID season.

Dr. Z: Exactly right.

Dr. Jay: And they’re smart to be an island so that they could like close the border very, very early in the course of their epidemic.

Dr. Z: Yup.

Dr. Jay: So they could actually get to zero.

Dr. Z: Yep. So they could do true suppression.

Dr. Jay: Yeah.

Dr. Z: They could get to COVID zero. And if a case pops up, they stamp it out.

Dr. Jay: So if, if we knew that COVID was in the country, let’s say we, we shut down the country in January. Maybe we kind of got to zero.

Dr. Z: Yeah?

Dr. Jay: We just didn’t know but by March it was too late.

Dr. Z: But then it would have taken constant vigilance because the rest of the world would not have done that. But you’re absolutely right. So when people hold up New Zealand and what about the Asian countries say Singapore? South Korea.

Dr. Jay: Yeah. I think like Japan and Singapore are true mysteries in some sense, like so the first in Singapore, the outcomes are really unequal right? So the Malaysian immigrants there have had COVID at very high rates.

Dr. Z: Ah, interesting.

Dr. Jay: But like take Japan, like you have an older population and yet the mortality rate, the IFR is really low from COVID. Even as the cases have gone up some. Right? So it’s a mystery, right? Like I like, I, I think, I think if there has to have been some X, so it’s not urban density. Right? So it’s like, I mean I’ve done some of the math around this. It’s not, it’s not a, ’cause they’re more like a Tokyo is one of the most urban densities in the country.

Dr. Z: Very dense, yeah.

Dr. Jay: So it’s-

Dr. Z: I watch anime. I know. I mean one monster can destroy a whole city instantly.

Dr. Jay: Maybe Godzilla is protecting it, I don’t know, I just. I don’t know. I mean, but like there there has to been some level of preexisting immunity is my primary process. And I still think we still don’t know the answer to that, but that’s my, that’s my leading up odds at this point.

Dr. Z: Right. Right. Because they talk about their different policies you know, closing, like paying bars-

Dr. Jay: They didn’t close. They didn’t have lockdowns. They didn’t, now of course they had masks. That’s true. But they’ve always had masks. The flu, despite all the masking never stopped. The flu still happened in, in Japan before. The flu is gone in Japan, this season. But they didn’t have a lockdown.

Dr. Z: Yeah. Yeah. Yeah. Well, let me ask you this. So how effective then do you think are masks, in your intuition and looking at the data.

Dr. Jay: I think mask mandates are likely not all that effective.

Dr. Z: Mandates?

Dr. Jay: Yes. I don’t, I’m still open on on like masks use, properly protect, protecting. I think that’s still possible.

Dr. Z: Right? Right. So like surgical masks or N95. N95, I imagine is pretty effective.

Dr. Jay: I mean, I think in certain situations, I’m very much was in favor and we wrote this in the Great Barrington Declaration, we’re in favor of masks, effective mask use in nursing home settings.

Dr. Z: Sure. Yeah. That’s a focused protector. Yeah, because we know they work in those settings in those closed-

Dr. Jay: Yeah. It’s just, but as far as like mandates go like we’ve had 80, 90%, like you do these surveys in the US and they say like 80%, 90% per se they are wearing masks. Now how are they wearing them? Are they wearing them all the time? Are they willing effectively? Are they, I mean, that’s really variable.

Dr. Z: And you look at the quality of the masks, it’s all these garbage-y, yeah..

Dr. Jay: Well, I can pull up mine and it’s not all that quality.

Dr. Z: But yours is a placebo.

Dr. Jay: Yes. But the thing is it’s like-

Dr. Z: Because you’re vaccinated.

Dr. Jay: Yeah I’m vaccinated, of course. I think the problem is like you have these like mandates and you look and see the timing of the mandate versus like the trend in cases, I see no correlation there. It just, you know, like, it just, it just seems like it’s noise and it’s not surprising the mandates, I don’t think are, are they’re they’re inconsistently enforced people don’t really wear the mask properly. They don’t wear it in right settings. Like, you know, so I think the, a lot of that will turn out to have been a lot of noise about nothing.

Dr. Z: Right, right, right. Yeah. I think effective mask wearing does have an effect. I don’t, I’m with you on the mandates. I feel like if you just give people information and individual businesses can make decisions. I mean, it’s a free country. They can say, yeah, you can’t enter without a mask, whatever. It does create a lot of conflict in the moral palate of different individuals

Dr. Jay: Yeah, well it’s created this, like more at the sense of like I’m protecting you by wearing it. So it’s like creating this like weird social division

Dr. Z: Right. It’s a virtue signaling kind of apparatus, especially on Twitter.

Dr. Jay: That was an enormous mistake from public health. Public health should seek to de-stigmatize disease, de-stigmatized behaviors around this. And instead we’ve created the stigma, like both, like in mask wearing, of course in the division, but also like round COVID like, if you got COVID you’re a failure.

Dr. Z: Yeah. That’s true. It’s on you. It’s on you.

Dr. Jay: Like I just don’t it’s shocking to me, like HIV. We, I thought we learned our lesson with HIV.

Dr. Z: You don’t do that. And Monica Gandhi talks a lot about that. The way we, we treat COVID, we’ve learned nothing from HIV. We’ve learned nothing from harm reduction. You know, you give people information you let them make it and you don’t shame them. You don’t put a, you put it-

Dr. Jay: You’re giving them compassion and treat them. I mean, you can’t, I just don’t, I don’t understand how public health got to this point. I thought we made a lot of progress, but I guess not.

Dr. Z: I blame social media, ’cause I like to. Because it’s my it’s my whipping boy and it’s probably 30% correct. You know, and that, you know, so that then brings us to another interesting public health proposal which is the vaccine passport. So, okay. I’ve talked about this. In the video I did, I said, okay, here are the issues involved in vaccine passports on the pro and the con side. Here’s what I think. And what I think I said, I didn’t take a strong stand on this, but I said I think we should shut up about vaccine passports and just get everyone vaccinated. And then you don’t have to worry about it because we’re gonna be back to normal, right? Now what’s your take on vaccine passports?

Dr. Jay: I mean, I think first, they are very, they’re definitely coercive. Right? So essentially now I can go fly on an airplane. Even before I got vaccinated that was allowed. I could go to a restaurant. If that, as long as the restaurants were open, that was allowed. Now, if you have a vaccine passport implemented about by airlines or by restaurants I can’t go unless I have this thing. So I’m basically forced. Like, and if my, if I, if I’m friends with somebody who was not vaccinated, I can’t go to dinner with them. Essentially it’s a coercive way to try to force people to be vaccinated.

Dr. Z: So, it was the argument that it’s helping businesses to then fill their restaurants and so on, your argument would be just open the restaurant.

Dr. Jay: Just open the restaurant, right? And you know, like ask people who are symptomatic not to come. Right? I mean, it’s for instance.

Dr. Z: But vaccinate everybody.

Dr. Jay: But vaccinate everybody, right? So, but, but then let’s take one more step. Well, if, if I’m being coerced into being the being vaccinated my natural reaction, and actually I suspect a lot of people share this is why they’re trying to push this on me? I’m gonna to start like doubting what you have to say. Why do you have to force me to take this thing if it’s good for me? Why not just actually just tell people, look, it’s good for you if under these situations. Here’s what the data is saying. Just be honest with people like you create, public health should seek to create trust in the population. So, and it’s a two way street by trusting the population you create trust in public health. Instead, the vaccine passport severs that trust. it says, I’m going to force you to take this even though I can’t convince you it’s good for you.

Dr. Z: Yeah, yeah, yeah. It’s billed as a carrot, but it’s really a stick.

Dr. Jay: Yes.

Dr. Z: Or a little mix of the both.

Dr. Jay: Yeah. Although I hate, that metaphor is always funny. ‘Cause like I think of the donkey and the stick and whatever.

Dr. Z: Yeah You know, the metaphor’s in the eye if the metaphorer.

Dr. Jay: Anyway. So, but I think that the vaccine passport idea is one of these ideas that it’s it’s a solution in search of a problem and actually can be dangerous because I didn’t get, it creates vaccine hesitancy.

Dr. Z: Yeah, I’m not sure I disagree with you.

Dr. Jay: You know, the other thing is just the inequality aspect of it. Like we have talked about the 120 million, 170 million people that have had already COVID. Are we gonna just say they’re going to be forced to like-

Dr. Z: You’re preaching to the choir on the inequality.

Dr. Jay: To create this like two tier society, vaccinated or not vaccinated. I thought we were done with that.

Dr. Z: No, no, but yeah, we’re not done with stratifying on income and, and age and so on.

Dr. Jay: Yeah. It’s the poor that have had it more. Right. So like, we’re just, we’re gonna exclude them from participating in normal human human society. It just doesn’t make sense.

Dr. Z: Yeah. I, you know, it’s, it’s crazy. I mean, what, so what is going on in Michigan where you have a little vaccine penetrance you’d think there’d be some assemblance of herd immunity from natural infection. Is this just a casedemic like you thought earlier?

Dr. Jay: Well, I didn’t say it was casedemic earlier. I mean, I think, but I would say for Michigan, they’ve had a lockdown for a very long time. If what lockdowns do is that it delays when the vaccine happen, I think that the lockdown population may be started to like, come back. I haven’t seen deaths rise as sharply as as you would expect, given the sharp case rise. So maybe we’ve seen a decoupling of cases and deaths there.

Dr. Z: Right. And we talked about it earlier, but I still am-

Dr. Jay: Casedemic would be nice, like if you decouple it is a casedemic

Dr. Z: If you decouple, yes.

Dr. Jay: Yes. It’s not a casedemic if it’s not decoupled, right?

Dr. Z: That’s right. Yeah. I was hoping that the winter surge would be a casedemic and it wasn’t. And with, with Michigan, that’s interesting this idea of lockdown smearing, you bend the curve so you are pushing it out, hopefully past vaccination. The problem is the vaccination uptake is still quite-

Dr. Jay: Yeah, I think that that wait until vaccination strategy, if that was the strategy from, in March of last year. Yeah. It’s failed. Right. It’s like we, the vaccine unfortunately came too late to protect large parts of the population.

Dr. Z: Right. Right. The, the most vulnerable parts but it’s still not too late to save lots of lives.

Dr. Jay: Lots of people.

Dr. Z: Lots of lives.

Dr. Jay: Lots of people. Get the vaccine stopped that hasn’t seen get generated good trust in public health, and get the vaccine in people’s arms, especially old people.

Dr. Z: Yeah. Yeah. What about kids by the way, kids and vaccines?

Dr. Jay: Of course not tested yet.

Dr. Z: Not tested yet.

Dr. Jay: So I can take the easy way out and just say I don’t think so because it’s not tested. I mean, I think the risk of harm from COVID is sufficiently low that my threshold for almost any vaccine related harm would be, very sensitive.

Dr. Z: Very sensitive. Right.

Dr. Jay: So, I mean, I think we should do a very careful cost benefit analysis because I understand they’re actually doing studies in kids.

Dr. Z: They are so, so Pfizer reported that between 12 to 18 a hundred percent efficacy. Why? Because they’re already pretty resistant-

Dr. Jay: But efficacy against infection, not against-

Dr. Z: No, right, because who’s having death in that-

Dr. Jay: They would never be able to power a study like that.

Dr. Z: They wouldn’t be able to power it. They’d have to have billion kids and then you’d have like a hundred deaths and in the placebo group. So it probably works the question like what you said is, well, if their risk of COVID is quite small and they’re not big spreaders, if those are coupled assumptions, then you say based on considerable data, but maybe not perfect data, but considerable data, then why would you vaccinate them, even if there’s a chance, I’ll put this out there. Even if there’s a chance they’re gonna miss two days of school because they have headache, fever and muscle aches from the vaccine.

Dr. Jay: I mean, I think I think vaccines have this positive externality, right? So partly we say you should be vaccinated, even if it’s not quite good for you-

Dr. Z: Because of the herd immunity component.

Dr. Jay: Yeah. ‘Cause of the herd immunity component. But, but generally when we recommend that somebody gets vaccinated, it’s good for you and for other people. We don’t usually ask people to be vaccinated which is not good for you on net?

Dr. Z: Yes. Yeah. It’s a tough sell.

Dr. Jay: It really is, right? And you can understand why someone would be hesitant?

Dr. Z: Right, because you’re assuming all the risks with none of the benefits, if the risk is minuscule.

Dr. Jay: Exactly. So I think that question of is it personally beneficial is really important.

Dr. Z: That’s what I tell people when they ask me, you know, well I’m 29 and I have this autoimmune condition and I’m worried about this. And I read about that and I read about this and I go, hey, look probably this vaccine is perfectly safe for you. However, if you have concerns, your risk of COVID is this. So now you can make a decision based on what is important to you.

Dr. Jay: Right. I mean, I think we have to, I mean, I think that that principle is really important for it to address vaccine hesitancy. Again, the individual, you know, ask your doctor and that’s, isn’t that what you always said? Go ask your doctor?

Dr. Z: Go ask your doctor about Lipitor, right.

Dr. Jay: No, it’s true. And a sure-fire way to vaccine hesitancy and anti-vax activism is an absolute stance on those things. And it’s also not true. It’s not how humans should work, especially with something that’s a risk modulator like vaccines. I don’t know that we’ll ever really achieve a true herd immunity with this thing, I think will happen is become endemic and just-

Dr. Z: Well I mean herd immunity is essentially endemic. That’s what it means. And the thing the thing is complicating about this is the herd immunity threshold is not a single number. It, it varies by season. It’s definitely seasonality. And so you’ll see, like there’s an overshoot, up passed the herd immunity threshold because we didn’t do a good job of slowing the spread or didn’t protect people enough. And then as immunity declines, ’cause, which it does over time for, for you eventually you will hit the herd immunity threshold is coming back up in another season. And so it’s- it’s an equilibrium-

Dr. Jay: You’ll end up with endemic equilibrium, which is essentially herd immunity.

Dr. Z: Essentially. Right. So it’s just by a different name. And I think, I think what’s interesting about that is I, I do speculate the coronaviruses that live with us that cause common colds probably caused a coronavirus like syndrome-

Dr. Jay: I saw a paper on this, like the, apparently there was a massive coronavirus outbreak in the late 19th century in Russia.

Dr. Z: Interesting.

Dr. Jay: That had like this huge, and the theory is that the one of the four circulating coronaviruses is one of the four that was introduced to the human population with this like mass death in Russia and then eventually sort of filtering through.

Dr. Z: It makes perfect sense. I mean, and there were reports, I think right in the Native American population that they brought in common cold from European just it decimated a good section of that. Yeah. So people’s initial, naive immune response can be, can be harmful in itself.

Dr. Jay: Like that, yeah.

Dr. Z: But that that’s good news. So when people say that, you know because this is another thing that in messaging, this thing’s gonna be with us forever. Oh, that’s miserable, but it’s not because that’s what exactly what a virus would do like this, you know, you don’t eradicate it like, you know, polio or smallpox.

Dr. Jay: Yeah, I think we’re realizing that zero COVID is an insane fantasy.

Dr. Z: It’s insane.

Dr. Jay: Right? I mean, like we have to learn to live with it and I don’t think eventually it will be all that bad.

Dr. Z: Right, right, right. I agree with you. Yeah. I think it’s gonna be like, you know, I got a cold. The nice thing is with a large segment of the population vaccinated, it might actually, it might be less problematic as a year to year, you know?

Dr. Jay: You may never need a booster actually. ‘Cause like, if you’re, if you have some T-cell immunity to this, which seems like the vaccines do-

Dr. Z: Enough to prevent death and hospitalization.

Dr. Jay: Then you get the second you get, you get reinfected a two, one, two years later and it’s much more, it’s a mild cold, right?

Dr. Z: That’s what they that’s the press hardly ever says, oh, there’s a reinfection. It’s like yeah, but how bad was it? He had some aches and-

Dr. Jay: All the cases of reinfection where it’s been severe it’s like either some underlying immune deficiency.

Dr. Z: Underlying immune deficiency, right.

Dr. Z: Right, right, and in fact, there’s some speculation that some of these variants emerged from immune deficient people who were getting like IV antibodies and so on. And so it, they were replicating virus but they weren’t getting the immune cascade that kills them. And these viruses were then allowed to select for variants. But you know, and again, this idea of variants like I think it’s funny. I was talking to Paul Offit offline. And I don’t think he’d mind me sharing this idea but virologists specialists, I mean, he’s not, I mean when people, the press reports about how variants are gonna escape immunity from vaccine soon. He’s like, no, that’s really unlikely.

Dr. Jay: Yeah. I think that, you know, this, this thing mutates all the time, I mean, it’s just there’s tens of thousands and maybe more mutations of this thing. And it’s not surprising when you’re nearing the end of an epidemic actually to have selective pressure to find like there’s only, the resources of the virus or other people that that are uninfected and still susceptible. They’re fighting to, even viruses with mutations with very slight, slight advantages in infectivity will take over-

Dr. Z: Exactly right.

Dr. Jay: For many cases. That doesn’t mean it’s not gonna explode again. It’s still, as long as there’s cross immunity across variants, which I think there is.

Dr. Z: There is, yeah. And I think that’s where, you know there’s people like this guy, Geert Vanden Bossch online who’s been saying we shouldn’t be vaccinating anybody because we’re putting selective pressure on the virus.

Dr. Jay: Oh, I think I saw that.

Dr. Z: You see this, yeah?

Dr. Jay: I think that’s not right.

Dr. Z: No, it’s wrong. Yeah. And now again, he’s a guy who did, did a YouTube video and it went viral and I got a million people send it to me and he’s a virologist in a, and in Europe and he’s an outlier in what he believes too, compared to the rest of the community in which he’s a member. You don’t censor him.

Dr. Jay: Of course not.

Dr. Z: You don’t turn him off.

Dr. Jay: You take him seriously-

Dr. Z: And address his issues. Right now he may disagree that I’ve addressed his issues, but-

Dr. Jay: That’s science.

Dr. Z: That’s science. Yeah. Go make a louder video. That’s hanging out. Everyone’s like, you should debate him. I’m like, he needs to debate another virologist. He doesn’t need to debate ZDoggMD. You know, now if it’s-

Dr. Jay: I would pay for that.

Dr. Z: Oh, I bet you would. Then we could be like an old school cockfight where, you know, the chickens are coming. Yeah, man. So what else is on your mind these days? I think we’ve covered a lot. We’ve covered a lot.

Dr. Jay: I mean, I think, yeah. I think, I think, I think we’ve, I mean maybe maybe we can come back some other time.

Dr. Z: Oh anytime dude. You have an open invite on this show. And it’d be good to do a post-mortem when this thing is over which is gonna be a couple of weeks, right? I don’t, I don’t know that it’ll be that fast. To really go through and go, where were we right and where were we wrong? What’s the new data say, because you know this is going to happen again in probably less than a hundred years.

Dr. Jay: Well, I think that that is, that’s really important actually. So I think there are lessons to be learned from this about pandemic management and the failures of pandemic management, when we know there’s gonna be fear in the population. So how do you create a situation, a process of good developing, good pandemic responses in the atmosphere of fear?

Dr. Z: Hmm. That is a great project. Because the early days of this, man, the pall of fear that descended, you know, when the Bay area here went silent and you could suddenly, there were no planes and there were no cars. And it was like 9-11. This just sense of dreadful awe that, what is going on and nobody knowing what the IFR was and, and yeah that fear really causes humans to behave in ways that-

Dr. Jay: We’re still not out of it.

Dr. Z: No, it’s it’s, if anything, some aspects of it are worse. ‘ Cause, we’ve conditioned it, so much anxiety. And, and, you know I have people yelling at me to stay away, like, you know in the elevator here in my own complex and I’m wearing a mask and I’m vaccinated. It’s like, we’ve conditioned. And that this is a young person. I keep telling you, I said these two young 20 year olds wearing like hazmat suits on a plane, on a flight I took to Hawaii. I’m like-

Dr. Jay: Dude, you don’t need this.

Dr. Z: What are you doing? I mean, it looks cool, but not really. So anyways, man, I, this is what I appreciate about about you J-Bhatt. You’re fearless, you’re compassionate, you’re rational. And whether you’re right or wrong, you’re probably right on some things, maybe we’ll learn that we’re all wrong on other things, that doesn’t matter. The idea is you’re out there.

Dr. Jay: I want to, if someone, if I’m wrong, I want to know. Yeah. Just, I don’t, I’m not, I don’t have any, you know sort of pride in that sense. Like I don’t, I don’t, but I think let’s have this debate. Like, it’s just, it’s just healthy, I think.

Dr. Z: Yeah. I agree. I agree. And let’s strip the politics and the emotion as much as we can out of it and just get down to brass tacks… Which is punching each other in the face when we disagree. I mean, that’s how it went down dogg I don’t know about where you trained, but at UCSF, someone stepped to you said you know what? I think that gate receptor ion channel actually is a cation and you’re like, oh, you think so, huh? And then you slap them across the face with a latex glove and then they have a latex allergy and then you’ve killed them. So, you know, I don’t know where this went.

Dr. Jay: Somehow like I see the Darth Vader mask on you when you’re saying things.

Dr. Z: Because that’s who I’m channeling in my Id. It’s a kind of improv Id, like Vader can tell no lies. That’s the thing about Doc Vader. He only tells the truth as the vehicle sees it in that moment. And sometimes that truth is painful. Sometimes it’s offensive, sometimes it’s wrong but he sees it as true.

Dr. Jay: It’s, and it’s hilarious.

Dr. Z: What can I say? Science. Oh, J-Bhatt. It’s I don’t know why I keep calling you J-Bhatt because it’s like-

Dr. Jay: I like that actually.

Dr. Z: I kind of dig it too. With two Ts, ’cause one is necessary, but not sufficient. So Jay Bhattacharya, a professor of medicine at Stanford, Health Economist, and general superstar during the pandemic at raising hackles on all sides which is what I love and speaking truth where truth needs to be spoke spake, thus spake J-Bhatt Thanks for coming, man.

Dr. Jay: Thank you for having me.

Dr. Z: And guys, you know we’re getting canceled, you know I’m not gonna be able to put ads on this video, you know, there’s, you know, there’s money in the ghetto as what was the rap group that said, that you don’t strike me as a hardcore rapper. Bottom line become a Supporter of the show. ZDoggMD.com/supporters. And you can put a tip in the tip jar and I’ll respond to your comment by PayPal. Paypal.me/zdoggmd This is how I do ads. Like instead of like, listen guys I have the perfect supplement. That’ll help your erectile dysfunction be 70% worse. All right, guys, I love you, share the video. We are out. Peace. Thanks man.