Relax After Vax? Masks, Schools, & More w/Dr. Vinay Prasad

Dr. Z: ZDoggMD, Vinay Prasad, VP, Welcome back to the show, brother.

Dr. Prasad: It’s good to be back. It’s good to be able to talk face-to-face with somebody.

Dr. Z: I know.

Dr. Prasad: Anybody, but especially you.

Dr. Z: Especially you. Both of us have gotten series one of the vaccine.

Dr. Prasad: That’s right.

Dr. Z: And so we’re on our way to at least purported immunity. So that’s exciting, but you know, you wrote a piece. So this is like, you did a piece in MedPage, but every piece you do in MedPage, I read it with a mix of horror that somebody is that smart and it’s not me. And I’m jealousy, envy and then just like, I’m clapping, right, like, cause is awesome. So that the piece you did in MedPage basically more or less said, listen, the public messaging around vaccination is once you get vaccinated you still need to wear a mask and you still need to social distance, you still need to all this. And when I first heard that messaging I was like, that’s nonsense. You want people not to vaccinate? Tell them that. It’s also not true, I don’t think. And you wrote that basically more or less. And so tell me what your position is on this.

Dr. Prasad: Yeah, so I guess it was, it was great fun to do this because it was a pair of dueling op-eds, you know, that’s the thing we can still do today which is have like two people who have looked at the same evidence, who have different expertise, different points of view, making two different cases. And so my colleague, David Aronoff who’s an infectious disease doctor at Vanderbilt he made the case for what you’re saying which is that even after vaccination, you know, you ought to keep up with those interventions just as you kept up with before. I made a different case. My case is you get two vaccines, you go 14 additional days of asymptomatic period and I think you’re allowed some concession. And I make that argument in the piece. By some concession I mean, like concession might be that in a situation where you were gonna wear a cloth mask, you might not wear it. The concession might be something different. It might be, you have a dinner party with three or four people, all people who have been vaccinated. The concession might be, you go meet your mother, your older mother and give her a hug. Different people have different things they’ve been craving. And I’m happy to go through the data for as to why I hold my position which is that vaccination is a protective thing. And after some period of time after vaccination, you know, you ought to be allowed some concession.

Dr. Z: So I think you nailed it and I will go through the data.

Dr. Prasad: Sure.

Dr. Z: I think it is important. But this, this is what, this is what I think about this. Exactly the same thing. You got vaccinated, this thing is 90, you know, 95% efficacious after the second shot, like you said, 14 days, because that’s when the maximum immunogenicity in the trials, and at that point to tell people, look good, don’t go see, look, look, look, my both my parents are elderly, Central Valley, it’s gonna be a minute before they get vaccinated ’cause you know, the rollout is a disaster.

Dr. Prasad: I’ve heard, I have heard, yeah.

Dr. Z: And, but I haven’t seen them in a year. And the thing is, they’re not, you know, they, I wanna see my parents.

Dr. Prasad: Ah, of course you do.

Dr. Z: Once I get my second shot, February 3rd, and I wait enough time, I’m gonna go see my parents. And they’re cool with that. They’re both doctors, they understand risk. It’s not zero, but you can’t make zero risks.

Dr. Prasad: There’s no such thing as zero risk. Right. And I think that’s a fallacy that a lot of people don’t appreciate, is that there is no zero risk. It’s possible that even after everybody who we could possibly vaccinate is vaccinated. There still may be some outbreaks of SARS-CoV-2, we may never be done with this virus. Are we to forever have these restrictions? Which is a whole nother conversation which is like, you know, what does it mean getting back to normal? And that faction of people say will never be normal again. And whether or not that’s true. But let me just run through this data real quick. Yeah, yeah. I guess, I think people will want to hear. I guess, I based my argument on a on a few strings of data, a few, three threads. One is that I think 95% is the wrong percentage to hang on to when it comes to these vaccine trials. In my piece, I argue that the right thing to look at is if you have been vaccinated two doses and if 14 days after that you remained asymptomatic, what is the probability that you then get COVID from that moment in time until the end of the study? Not from when you enrolled in this study because a bunch of people got COVID between first and second dose. Right. And the answer to that question is in Pfizer, there’s a 99.95% chance you won’t get COVID, and in Moderna 99.92. Not, not 100%, not zero, but pretty dang close. The next question is what is the probability to get severe COVID? Severe COVID plus hospitalization. And the answer is zero cases in the Moderna study out of about 14,000 people, one case in the Pfizer study, and there’s some question marks there. The probability of getting severe COVID in the control arm of Moderna is 30 people. So already I’m showing you symptomatic COVID, it’s way down. Severe COVID, almost gone. Now what about asymptomatic carriage? Right. So we don’t know asymptomatic carriage 14 days after but we do know dose two. Dose two in Moderna we swab participants and there was a 60% reduction approximately, 60% reduction in asymptomatic detection of PCR positivity of SARS-CoV-2. And the absolute rate of that detection was about one in 1,000, which is pretty low. And, and that doesn’t necessarily mean, well, okay, so let me put these three things together. The three things together means, you know, you have good immunity against symptomatic COVID, you have exquisite immunity against severe COVID. You’re less likely to be carrying the virus and we know from the monoclonal antibody studies that very likely when you are in contact with the virus your body’s gonna mobilize antibodies, neutralize it faster, clear the respiratory passages much quicker. All these things put together tell the story that you will be less infectious, dramatically less infectious, less of a threat to others after vaccination. Of course, no surprise, that’s why we’re vaccinating, right?

Dr. Z: That’s the whole point.

Dr. Prasad: Right.

Dr. Z: And the data bears it out.

Dr. Prasad: Right.

Dr. Z: What you said about asymptomatic carriers is important because a lot of people are like, well, you know, like, you know, Fauci is messaging as well. You know, you can still be an asymptomatic carrier because the trials were really mostly powered to look at symptomatic cases.

Dr. Prasad: Right.

Dr. Z: And we don’t know about asymptomatic, but in Moderna they did look at that after the second dose. And like you said, 60% reduction. And even then we could just say how much, if we just swab the entire population, how much just is sitting around, how transmissible is it? So how much does it matter? Now, at some point you just have to say

Dr. Prasad: That was a good point.

Dr. Z: Human beings need to be together, they need to get back into the economy, we need to open our schools, we needed to open our schools.

Dr. Prasad: Yes, yes, oh, yes.

Dr. Z: Already that’s another conversation.

Dr. Prasad: Oh, yes.

Dr. Z: So the vaccine is our clear path out of this. And yet we’re acting like we’re hedging, and I think Fauci’s doing it because while he doesn’t wanna get you know how the messaging is. I know, yeah. Be honest with us

Dr. Prasad: That’s what, that’s what I say. I say that you just have to be as transparent about the facts as possible. And ultimately, you know, if we’re perfectly honest, people are gonna make the decision for themselves and people are savvy and smart and they can encounter this information. The last thing I wanted to say about this particular question is, you know, one of the things people tossed to me is what evidence do you have that you no longer need a mask 14 days after this period of two vaccinations? And my point is, what evidence do you have- That it works. That it works. I mean, you, we have a lot of different types of evidence, strands of evidence we draw upon in the current situation, in the pre-vaccine world, but in a post-vaccinated world where people have at 95. Sorry.

Dr. Z: No worries man. You think I’m editing that out, you got another coming. That’s staying right there, do you need to get it? No. Okay, yeah.

Dr. Prasad: I’ll take it later.

Dr. Z: That’s staying right in there

Dr. Prasad: That’s a, this is the classic. This is why you leave your phone out. You know, I always tell people when I record my podcast, turn the phone off, turn the Outlook off. Their damn Outlook ZDogg.

Dr. Z: Yeah.

Dr. Prasad: It’s nonstop, nonstop.

Dr. Z: First of all, my heart breaks for you that you’re even on Outlook ’cause that means you’re somewhere Microsoft.

Dr. Prasad: I’m a cognitive machine, man, I’m a cognitive machine.

Dr. Z: You’re a cognitive machine. I always knew you were, you were the man.

Dr. Prasad: You’re The Man, if you have an Outlook account you are The Man.

Dr. Z: You’re The Man.

Dr. Prasad: You work for The Man in some way.

Dr. Z: If you ever use Microsoft Teams, you are The Man. So-

Dr. Prasad: What were we saying?

Dr. Z: We talked about the mask.

Dr. Prasad: Yeah, we talked about the mask, yeah. And I guess my point is that like all medical interventions in this case, you know, we don’t know exactly the effect size. It’s likely to be moderate effect size. And as you take your event rate and drop that to zero as you lower the overall likelihood that you’re carrying the virus and the overall likelihood that you have a case of COVID, the delta on wearing a, or having a restriction like a mask, the delta on not seeing your loved one, that’s shrinking too and at some point, you know, it’s likely to confer very little additional safety. And those are just sort of general principles of I think, medical reasoning. So I put it all together and I’m like, you know, there’s, you know, I use this analogy of Chuck E Cheese. I don’t know if it’s a

Dr. Z: I love me some Chuck E Cheese, man.

Dr. Prasad: It dates us, right?

Dr. Z: It really does. And I got to say, for some reason I have this memory that the pizza was good, it’s not.

Dr. Prasad: It’s not good, dude. It’s not good, but, but I remember it as the pinnacle. The best, it was the best.

Dr. Z: Like we’re going to Chuck E Cheese, the pizza is so delicious, melty cheese. Then you go there, it’s like that soggy slice that you get at your high school cafeteria. Yeah, yes. So tell me about Chuck E Cheese.

Dr. Prasad: You didn’t go there for the pizza, you went there for the fun and games. It was fun. And when you played those games and you won you got a thick stack of tickets and you took those tickets up to the front counter and the world was your oyster. You could pick, you know, a bouncy ball. You could pick a yo-yo, you know, I don’t know what they had but they had all these

Dr. Z: Crack pipe, that was my Chuck E Cheese. Central Valley.

Dr. Prasad: Central Valley. You know, you get to decide what you cash in your, your tickets for. And I use that as an as a sort of a playful analogy to point out that vaccination does give you something and you should be allowed some concession to do the things you want to do. And if we’re perfectly honest, I think the average person doesn’t really mind wearing the mask in the grocery store. And in fact, I talk about in the piece, that I’m not really talking about that, the grocery store is gonna set their own rules anyway, but the average person what we’re craving is what you were talking about. You wanna see your, your, your parents. The average person is craving human contact and you never gonna get a 100% safety. You never had a 100% safety. You could have been hit in a car, a car accident on your way to the Central Valley all these years. 100% safety is not what any of us crave, it’s not what we seek, it’s unattainable. It doesn’t exist. What we crave is a reasonable safety. And I believe, and I make the case in the article, that the vaccine gives you reasonable safety to do something like that, that you think is important.

Dr. Z: Yeah, and I think this word safety is important because I think what we’re seeing here is this idea of safety creep, which we’re gonna talk about, I think, when we talk about Jonathan Haidt’s book, “The Coddling of the American Mind,” this idea that we’ve, we’ve somehow obsessed as a society that we get a little safety. Well, oh, we can have more, we can have more, we can have more. Now we have perfect safety, we can save everybody from COVID, we can reduce the risk to zero and if we can’t, we need to hide in our houses, triple-bag our masks and just rock back and forth while our parents die of neglect, they die without seeing us because we weren’t there, because we’ve been terrified. And so, you know, we have to ultimately think reasonably, I like this idea of cashing in your Chuck E, well, kid can be a kid, by the way.

Dr. Prasad: Kid can be a kid. That was the slogan.

Dr. Z: Yeah, that slogan in that Chuck E Cheese, and you know, so a kid should be able to take their tickets and go, okay, now I have a little immunity ticket. Now, and also it’s, if you’re trying to do the best, least harm public health-wise, wouldn’t you wanna tell people, hey, there’s a reward for being vaccinated.

Dr. Prasad: Of course.

Dr. Z: Not just being a nice guy.

Dr. Prasad: I wanna talk about that in a sec.

Dr. Z: Yeah, yeah.

Dr. Prasad: I call that a second order effect. But first I wanna say that, like, you know what, people are doing it. Like we, you have to live in a fantasy world to think people aren’t already doing it. Doctors were getting vaccinated or having people over to the house for dinner who are vaccinated. People are already doing it. There’s nothing you can say that’s gonna stop people from making these kinds of choices, because these are natural human things. And you talk about safety. What you’re really nicely highlighting is that we are trying to minimize some types of risk and there all these other trade-offs that we’re making, harms, then we’re not trying to minimize because we’re ignoring them. Like, what is the impact on your elderly parents have not seen their son, you’ve never, you haven’t gone and seen them and checked up on them. What is the impact to their wellbeing, their life, all this time and that is being lost from the discussion. And frankly, that’s, that’s your decision to make, that’s your parents’ decision to make as you’re going to make very shortly. It’s no one else’s to make once you’re armed with the facts. But then let’s talk about a second order effect. So I call these, they’re all second order thinking, and I try not to engage in it too much because I’m worried that I’m gonna burn myself, and like, I won’t see something. But, you know, people argue on the other side that, you know, if you start to tell people they can relax restrictions, maybe they’ll slack too much, they won’t take it seriously and all these things. So they have these kinds of very fearful stories of what people will do. And I say, well, you know, maybe, but I trust people to make smart decisions for themselves when they’re empowered with the facts. You make another good argument, a second order argument, which is that if you really keep downplaying this vaccine as a path to normalcy maybe you will discourage people from getting it. That’s also potentially possible. I don’t know if that’s a true or not true but I’m just trying to, you know, put out the facts as I see them and let people decide. And I worry that the more we try to play those, if we say this, and then they’ll do this, and if we play this, then we do this, we’re gonna get ourselves in trouble because that leads to a shifting recommendations.

Dr. Z: And it seems like what’s been happening from the beginning of the pandemic. And that’s why people don’t trust. And that’s why even vaccine hesitancy is so high. That’s why, because we have all these shifting recommendation then people don’t trust authorities to just say, what’s true instead of say what they need to say to manipulate what they think is the outcome they want. And by the way, it’s not nefarious, it’s not like these guys are bad people. It’s not like Fauci is a bad guy. He’s trying his best to do the best for the most people. It’s just reasonable people can disagree with how to message that. And that’s right. That’s what you and I are saying, yeah.

Dr. Prasad: I think, and that’s a great example, you know, Anthony Fauci somebody who I have a lot of respect for, I got his book on my bookshelf, you know, Harrison’s. Harrison’s, yeah. I have admired him for decades. I still think he’s this phenomenal extemporaneous speaker. I love the accent, but he, he made two, I think miscalculations, one in early March around mask messaging, which still haunts us to this day and likely will haunt us this entire pandemic. There will be some faction of people that will never embrace it because of the mixed messaging. And the other mistake I think he made was in that recent New York Times article where he told the reporter, and I don’t know why he told the reporter this, but he told the reporter when asked why is the percent of people you say need to be vaccinated for herd immunity it keeps creeping up in your public statements from 60, 65, 70, 70, 80, 85, and he said, well, I check the polls and see how many are people willing to get the vaccine and I see that’s going up, so I think I can push this number a little bit. And I was like, oh my God. I was like, well, one, I don’t think you should be doing that. But two, if you are doing that, why the hell are you admitting that to New York Times reporter?

Dr. Z: That was terrible.

Dr. Prasad: What are you doing?

Dr. Z: That was really bad. I mean, and again, again, again, again, respect for the guy, I mean- Respect for the guy, I love the guy. Harrison’s, like, it’s a gold standard and- Gold standard. You know, I was on a call with Fauci years ago during Ebola. It was like a public call where like a few doctors were invited and I was impressed with the guy’s- Of course. Reasonableness. So, but this, this messaging is terrible because you know, humans were already, and we’re so divided which we’re gonna talk about why that is, but we’re divided and polarized and then there’s the political component, there’s the tribal badge component. And you throw all that in a mix with this pandemic and what you have is just a disaster of a harm caused by messaging problems and reception. You said something that I think people, a lot of people will disagree with, and I actually agree with it. When people have reasonable information and it’s given in an appropriate context, they will make decisions that are best for them. I think they will. And I think, you know, what we’ve seen instead is people making decisions based on bad information or miscommunication that going and hanging out in big groups indoors when we close restaurants in California outdoors and just stuff like that, you’re like, ah, if we just got the messaging right, you know.

Dr. Prasad: I mean, I guess the other challenge is this is a free society. And if what’s the alternative to telling people the unvarnished truth, distorting it, lying, deceiving them, and that is something that you maybe you can do once, fool me once, shame on you, fool me twice, shame on me. You don’t get to do that over and over again. There’s a huge loss of credibility that comes when people get the sense that you are distorting your messaging to get them to do something. I talk about it in this piece I wrote about Fauci, where if the moment I get the sense that he’s willing to distort facts to get me to do something- He’s done- He’s done. Everything and everything he says from then on, I’m playing through my own mind, which is okay, he’s saying this but maybe he’s trying to get me to do something. So what might he really mean? And when I start playing that with somebody, trust is gone and I think trust is so important here. The other thing that’s interesting to me about this discussion is messaging. I guess I would say I’m not the public health authority, I’m one professor with my own biases, my own habits of evidence and interpretation, I have my own beliefs about how evidence should be interpreted, how science should be talked about, other people are free to have their own other views. We’re never all going to be able to agree. Herding every doctor’s messaging on Twitter is like herding cats, you know. And so then the question comes what is the range of opinions we’re allowed to have, and I favor quite broad ranges of opinions in a free society, broad discussions as long as we agree to sort of rational basis of discussion.

Dr. Z: And this is where your piece comes in as a great illustration. So you put this thing out. Yeah. I’ve read it with great interest and was like, oh, excellent. Sometimes I feel like the emperor trying to pervert young Vinay to the dark side of medical communication. I see this piece and I’m like, “Oh, he’s very powerful with the force, I like this, very persuasive. He would get hatred. And that hatred will destroy him and then they will be mine.”

Dr. Prasad: And I’ll join you here.

Dr. Z: But it’s amazing. So you immediately, you know, you got a bunch of people agreeing with you especially in private, especially in private.

Dr. Prasad: Oh my God, I got like, I don’t know, maybe a hundred, a hundred plus messages, professors, epidemiologists, ID doctors, multiple ideas. I mean, dude, even to be honest with you, even before I put my piece out I had it read by a lot of professors.

Dr. Z: Yeah.

Dr. Prasad: Infectious disease experts. People who are just to make sure I’m not, I don’t have any blind spots, you know, and

Dr. Z: Right sure, that is very smart.

Dr. Prasad: To be perfectly honest the person who disagreed and I we both read each other’s piece before they came out because we each made each other’s piece stronger even though we’re arguing the different sides. Okay, so

Dr. Z: That’s, that’s beautiful.

Dr. Prasad: Right, right. And that’s, you know, a technique that a lot of people who deal with ideas do which is you always want to hear about from the opinion of somebody who doesn’t see things exactly the same or somebody who sees it mostly like you, or, you know, things like that. So I had already had a great deal of opinions. And if we’re perfectly honest, probably, you know, the ratio of positive to negative is 90 to 10, it’s mostly positive. But we can talk about the 10%.

Dr. Z: 10%, so the 10% are using terms like “you are dangerous.” Now, see, they

Dr. Prasad: I’ve always wanted to be, ZDogg.

Dr. Z:  I mean, I can tell by the scruff that you wanna be perceived as edgy, slightly dangerous.

Dr. Prasad: As a, as a nerdy Indian kid growing up in the Midwest, I had never been perceived as dangerous. You know, I’d whip out my TI-89 calculator and who knows what trouble I get myself into?

Dr. Z: Man stay cold pony boy. Yeah, it’s really true, so they called you dangerous.

Dr. Prasad: I would say

Dr. Z: These are scientists.

Dr. Prasad: That’s what, that’s the case. Purportedly, purportedly. They’re scientists but maybe it’s their first rodeo of debate because a lot of scientists have not been in the rodeo debate. I’ve been in the debate rodeo few times, genome driven oncology, I debated that on the center stage of some conferences, cancer screening tests, a perennial debate, I’ve debated in medicine for, you know, at least six, seven years now about a number of issues. I’m comfortable with debate on those stages. I know what wins the audience. You’re not gonna win the audience if you name-call your opponent. If you grew in, you’re not gonna win. You’re, you’re gonna look really foolish and people are gonna pull you aside and say what are you doing, you’re making a fool of yourself. You’re only gonna win if you really figure out the core premises to their argument and you take the legs out of every one of those premises. And you know, in some of these debates we’ve spent inordinate amount of time to try to do that. And I do believe I’ve, I’ve won some of these debates over a long haul. But in this case, you post this article, you get this 10% of garbage. Of the 10% garbage, 90% of the 10% is nameless, faceless trolls who don’t seem to subscribe to reason or evidence. They don’t know anything about anything and so it’s easy to say it. Non playable characters. Exactly. Easy to say, be done with you. I mean, you have nothing interesting to say, and really, I don’t think you’re persuading anybody and I don’t even know who you are. But there’s a few people who have some of the affiliations with major centers and they come out a little too hot and they say things like this article is dangerous, or I even heard disinformation. I was like, disinformation! You can’t point to a single thing incorrect in this article and say disinformation? Disinformation, dangerous, that’s not just if you disagree. I mean, you can’t go all the way there. And, and I think it does a disservice to debate. And the real people who pay the price is not me, I might, guess for better or worse, in early mid-career academic, the people who pay the price are the people who are just starting. There might be some junior person out there, they have some opinions about this controversy and they see, look, VP puts his opinion out there and he’s getting called “dangerous.” Well, then I don’t wanna put my opinion out there. And so we are not stifling me perhaps, but stifling that person. And that’s who I really fear for.

Dr. Z: Yeah, and I think you’re, you’re absolutely right. And I think what it is is it’s, again, a function I’ve been complaining about this for some time now that is social media environment has created a zero sum game where you’re not scoring for truth, you’re not debating for truth, you’re debating for social points, for prestige within a tribe, and you stake your tribe out and then you just pound ideologically on whatever that is. And so a free thinker like yourself who’s willing to debate points, who’s willing to listen to the other side and actually incorporate, that that’s rare now because you won’t do as well, even though you’ve done well because you’ve, again, transcended that. But I think the people that are trying to score points there on Twitter, and they have legitimate disagreement with you, right? So they’re saying, no, I don’t disagree with this. Okay, fine. But to say “dangerous” and to say “disinformation” is a direct ad hominem attack, really. -Yeah. Because they’re accusing a physician, a professor, and an academic of causing physical harm.

Dr. Prasad: Like, like my goal is physical. Exactly. I mean, I guess the first thought is like, I was like, if you, if you, if you believe, if you really believe that everyone who disagrees with you is ill motivated in the world, that’s not a cognitively, psychologically that’s not a good way to be in the world.

Dr. Z: No.

Dr. Prasad: I mean, you will disagree with people thousands of times in your life. And if every one of them is a bad person, I mean, I’m really, we’re kind of already talking about “The Coddling of the American Mind.” We’re getting into the themes of this book.

Dr. Z: Yes.

Dr. Prasad: Very prescient and very wise book about why we have reached the state we’ve reached where debate, dialogue, discussion is being stifled, where people are taking extremely polarized positions, where everything is a matter of good and evil, the good guys, the bad guys. This is a very unhealthy ways of being in the world. And they are unfortunately very common. But I guess I wanted to say about this. I mean, if I were to do the justice to their side of the argument, I guess their side of the argument is all about, they would probably argue that it is theoretically possible that something bad could happen if these restrictions were to be relaxed.

Dr. Z: Right.

Dr. Prasad: Theoretically possible. I think they don’t tend to quantify that because the more they quantify that, the absolute numbers are gonna be so abysmally low that the average person watching the debate will be put off by that. So they want to leave, I think that non, not quantified but rather qualitative that, you know the safest thing to do is all these additional precautions. And I think they think that for you to prove, for you to say that we can get away with not doing them, the burden of proof is on you to just really show nothing bad will ever happen and that will take you a long time. They’re trying to transfer the burden of proof. And I guess what I wanna say is I think the burden of proof is on you to show that the restrictions still confer benefit. And I would tell you that all of the ways you can quantify the problem with suggest that it’s unlikely to do so because the absolute numbers are really, really low. So I think that’s the crux of the academic debate. And again, this is risk perception. Risk perception, you ask a thousand people what they are willing to tolerate in terms of risk, it’s all over the place. We have different risk thermostats. We are all wired differently. And you can’t just do what the least risk-averse person thinks. The other thing is we all have different amounts of social craving. Some of us may desire to see your parents more than others. How do you value that? Every one of us must reach our own, sort of, the point.

Dr. Z: Sometimes I wonder if some of these guys that attack online are truly the introvert, a little bit on the spectromy kind of folks that are, which I give as a compliment by the way, because I

Dr. Prasad: It’s not bad, it’s just a different personality.

Dr. Z: It’s a different personality that it’s not important to them. It’s just like for me, I weigh risk, right, so when I get vaccinated, I’m gonna go see my parents because I’ve weighed that risk and the risk of not seeing them in case something were to happen, heaven forbid, versus the risk of infinitesimal risk of them getting COVID which I will feel terrible about.

Dr. Prasad: Of course.

Dr. Z: But at the same time, I will say, you know what, that was a risk that we all too discussed, by the way they’re a part of that calculation. It’s not like I’m just gonna show up and be like, hey guys, I’m vaccinated. I think we’re good, no mask. No, it will be more complex than that. But it’s understanding the risk. Like for example, young people under 24 they’re 36 times more likely to die in a car accident than die of COVID. But for elders, it’s twice as likely to die in COVID than a car accident. So then you weigh, you’re all right, well, if the car accident is the gold standard of risk we do it every day.

Dr. Prasad: You know, the other analogy that comes to me is, I didn’t even see it until this moment, but I’m a cancer doctor, we’ve given so many regimens that make people transiently neutropenic or we do an autologous STEM cell transplant or an Allo transplant and they have some functional immunity and they always struggle with these decisions of can I meet my grandson? Can I hug my grandchild? Can I see my family? Can I have a dinner party? Do I need to wear a mask? And we do so much counseling in this space where there is some risk, probably higher than the risk we’re talking about with SARS-CoV-2 after vaccination asymptomatic period. And we negotiate that, we realize that every person is different, people come in different places on that, people need that contact more than others, that, that life is not this thing where we just keep our hearts beating for as long as possible. There are all these other things to factor. And so I guess I’ve been in this business for so long. I mean, this is my career, my professional career, negotiating these kinds of very difficult risk propositions and to be told categorically that my opinions on the topic are disinformation, is disingenuous, it’s anti-reason, it’s illogical, and I don’t see that coming from any sort of good place in somebody. I think, I mean, the joke I made online was some of these people, I think they need a hug. But the problem is even after vaccinated they won’t let me hug him. So I don’t know how they’re gonna get the hug, but they need a hug. I mean, they need a hug, we all need a hug man.

Dr. Z: They need a hug, I’ve seen it. There are many people that need a hug. Sometimes I need a hug.

Dr. Prasad: I need a hug too. I’m not saying it’s not a bad thing, we all need a hug sometimes.

Dr. Z: We all need a hug. I mean, in “The Codling the American Mind” he has these three great untruths that have become the common feeling now that might have generated a lot of the drama that we see in, in this space. And I think it might be worth just kind of going through some of those. I think one of them was, was trust your feelings.

Dr. Prasad: Yes okay. All right so I had to pull it up because, you know, it’s like the first few chapters of this book, okay, so we have to- Yeah, yeah. Here they are. Yeah. “What doesn’t kill you makes you weaker.” Oh! “Always trust your feelings.” Yes. And “Life is a battle between good people and evil people.”

Dr. Z: Brilliant. Those are “The Three Great Untruths” according to Haidt et al.

Dr. Prasad: Who’s his coauthor again? Greg Lukianoff.

Dr. Z: Lukianoff, yeah.

Dr. Prasad: And he’s somebody who has got some experience with cognitive behavioral therapy. Yeah. So I guess this is a book that you turned me on to. I mean, people have been telling me about the book but I think you were the person who pushed me over the top to read this book.

Dr. Z: I kinda tied you down and was like you have to read it. Every time we talk.

Dr. Prasad: Every time we talk. Yeah, yeah. And I owe you one because it was a transformative book for me, in the sense that it articulated a lot of feelings that I’ve been having. And it opens with these, this really great opening where I think Greg Lukianoff admits that he has suffered from depression and he underwent cognitive behavioral therapy. And one of the things about cognitive behavioral therapy is that your internal monologue about the way you’re experiencing the world is often drives you towards negative thoughts, bad feelings. And the whole point of the theory is that you need to train yourself not to go to those automatic negative instincts. And those instincts are, one, what doesn’t kill you makes you weaker. The idea that something that challenges you it’s going to hurt you or leave long-term damage, he says, you don’t always have to view the world that way, you can view the world as things that challenge you make you stronger, more resilient, anti-fragile.

Dr. Z: Anti-fragile.

Dr. Prasad: As Taleb would say.

Dr. Z: Exactly.

Dr. Prasad: Always trust your feelings. This idea is the idea that when somebody says something you may feel like, oh, that’s personal, that’s about me. That really is meant to hurt me, but they don’t mean anything by it. They were just saying something, it wasn’t about you, they didn’t mean it that way. And CBT trains you to say perhaps this is not about me personally, it’s not meant to denigrate me. And then the last thing is life is a battle between good people and evil people. Just a classic mistake people make is thinking that they’re the good guys, the bad guys, the good girls, the bad girls. They’re the people who are on the good side of the issue and people who are on the bad side of the issue, this splitting. And he thinks that all of these are just unhelpful, unproductive, automatic negative thoughts. And the whole point of the, I think the first part of the book is to convince you that these manifest in these discussions in higher education, some of the reason why we have difficulty in letting two professors of medicine discuss what should the messaging be around vaccination is that we’re so quick to view one as hurting us, dangerous to us, threatening us. This is the good person, this is the bad person. But that’s not true. We’re both probably equally good and bad. We’re not good, you know, we’re not perfect people. We just have different opinions on how this data should be translating into practice.

Dr. Z: I mean, and that’s it. And I think all the, a lot of the evil that we see now, “evil”, is stemming from these three great untruths which are basically cognitive distortions. So that, which does not kill you, makes you, that which does not kill you, makes you weaker. It’s a fascinating one because it comes to the sense of we’re creating this fragile generation and we’re fragilizing ourselves because we’re afraid of words, ideas that will hurt us we need protection from, if JK Rowling says something that is controversial about trans people then she needs to be silenced because words are violence, right?

Dr. Prasad: That’s one of the things that they talk about which is, is an idea, is a thought is a word, a form of violence? And I think they’re very careful to argue they do not want those two to be conflated. They don’t wanna be equalized. And I think they, they say so because they believe that, that takes away something from real violence. Yeah. Like actually being violent acts is diminished when you say everything is violent. And actually disinformation is diminished when you say Vinay Prasad, associate professor of epidemiology at the University of California, San Francisco is spreading disinformation, that really takes something away from people who are actually making up nonsense.

Dr. Z: Like how can you compare, how can you compare a disagreement to somebody saying there’s a cult of Satan worshiping pedophiles infiltrating government, and the whole Q theory. I mean, that’s disinformation.

Dr. Prasad: Right.

Dr. Z: What we’re saying here is no, these are just different ideas, looking at the same dataset and saying well, this is how I interpret that based on my understanding of the science and my values actually, and my own biases which you, in early onset, these are my biases. This is all kinda.

Dr. Prasad: Yeah, I mean, my bias in this debate is of course I know what happens to medical interventions as event rates get lower. And that is that the interventions no longer confer the absolute benefits you think, of course, and many often times they confer no benefits at all.

Dr. Z:  That’s right.

Dr. Prasad: And that is my sort of core bias that comes from a lot of work in meta research.

Dr. Z: Right, and in cancer research and drugs.

Dr. Prasad: Cancer research and drugs and drugs products.

Dr. Z: And you’re referring to tie back in, just to make sure people understand, you’re referring to these idea of continuing to use masks- restrictions, yes. And restrictions after vaccination.

Dr. Prasad: Right, right.

Dr. Z: Right, because now the absolute benefit of that mask is low. It may still have a high relative benefit.

Dr. Prasad: It may, yeah.

Dr. Z: If you compare two groups, you may say, well, it’s 50% more likely that you’re gonna not transmit wearing a mask.

Dr. Prasad: Yes.

Dr. Z: So what’s the absolute?

Dr. Prasad: But I would actually suspect that it’s- It is even lower.

Dr. Z: Yeah.

Dr. Prasad: I think it’s gotta be abysmally low. I agree with you. And to the point where, and when you factor in like real-world compliance and real-world adherence, I think it’s gotta be zero. Yeah, but, and that comes from a lot of work on like, you know, we’ve studied the topography of medical research and how things flip-flop and all this stuff for, for over well, over a decade now.

Dr. Z: Medical reversals, which you wrote a whole book on. And, and you know, the

Dr. Prasad: Speaking of ways in which I’m not qualified to talk, which is another, another common thing. Which is like

Dr. Z: What do they say? What do they say?

Dr. Prasad: It’s not just me. I mean, I feel like I just, on one day it happened to be me, but this is the new way in which you argue online, which is, you know, ZDogg says something I don’t like, well, you know, he’s not an expert, he’s not a doctor. Oh, he is a doctor. Oh, well, he never practice medicine. Did you? Oh, you did practice. Oh, he was never a hospitalist for several. Oh, he was. Oh, well, he was only on teaching services. Oh, no, he wasn’t. Okay, well, he’s not an infectious disease doctor. I mean, they just keep making up some other thing. And meanwhile, when they find the person who says the stuff they like to hear, it’s like, oh

Dr. Z: Inflate their credentials.

Dr. Prasad: Yeah, they’re like, this person is a computer science major. Well, they didn’t quite finish, but they’re an amateur expert. They’re savant really. I mean, it’s like, how do you not even see what you’re doing? Which is, if you disagree with someone, they can not have any credential that lends you to give credence to them. And if you agree with them, you’ll take anything.

Dr. Z: This is the fundamental poison of it. And I’ll take it one step further and say that because humans evolved to focus, they have unconscious belief, and then they have conscious ways to argue those beliefs.

Dr. Prasad: Yes.

Dr. Z: When confronted with something that offends that belief or goes against it they will use their higher faculties to do anything possible, to defend the core.

Dr. Prasad: Of course.

Dr. Z: And that means picking fake experts, moving the goalposts, cherry-picking data, all the other stuff that we do. And we do, and the problem is it’s fine, people do that. To do it unconsciously, to do it without a what meta awareness of yourself, that’s it. So you and I have both done this. I’m sure you’ve done it even though you’re brilliant and all that.

Dr. Prasad: I’m sure I’m guilty of it. We all do it, I’ve done it.

Dr. Z: And when I see something that, that contradicts it I’m always trying to find the holes in the credibility of the person who said it, it’s the same thing. But then I’ll step back and go look what I’m doing, what is it that I’m doing, why is this? And sometimes it’s a political thing or there’s something politically offensive to me, and I’m like, well, this has gotta be wrong. So therefore, let me find all the holes. What we need to be doing is going, oh, and that made me feel this way. That’s interesting. All right, now I’m in danger of screwing this up. Let me see, like, when you talked about writing your piece you floated that shit around.

Dr. Prasad: Oh, a lot.

Dr. Z: You were like, hey-

Dr. Prasad: Like 15, 15 people read it before I even, you know, and that’s the other thing that gets lost from this discussion is that I, I pick every word carefully, you know.

Dr. Z: Yeah, yeah.

Dr. Prasad: I’m not giving anyone anything and-

Dr. Z: You’re the opposite of me, I’m just like “penis!” Why did you say that?

Dr. Prasad: Well, I do a podcast where I don’t pick every word carefully but luckily, nobody listens to that. No one has listened to that. No one has listened to that. But when you write, you know, people are gonna come after you. And then I screen it with people. And, and actually there were some people, I don’t wanna name this person. This person was really thoughtful, and this person said in the first draft, you know, you’re focusing too much on masks. That’s not really the concession people want. And I slept on it. And I woke up and I was like, my God, this person is totally right. They, they want the Chuck E Cheese tickets and that’s one of the metaphor, right. You know, so that’s how good ideas work out. It’s not that this person said, “You’re guilty of disinformation. You’re not an expert, you know.” But I wanted to say one thing about “The Coddling of American Mind.” Yeah, yeah. Which is the thing I’ve been meaning to tell you, which is, I thought it was a splendid book and it’s a really good book because it illustrates, I think where we are in a society and how, more than the issues we disagree with about, the ways in which we allow disagreement and how we handle that is sort of something that we really need to solve or we’re gonna have some deep problems. The one thing in the book that I, that I feel differently than the author is the author spent a lot of time to show why this is generational, why this is worse in teenagers or young adults because of how parenting has changed. And I guess I agree with their criticism of the parenting, the safetyism culture. I agree that it is prevalent in those age groups. But the thing I think differently is that I think everyone is suffering from these problems in our society. And I think SARS-CoV-2 unmasked it, that there are 70-year old professors, 60-year old professors, 50-year old professionals, they’re all falling into the same cognitive errors. They’re all getting angry, they’re all tribal. In fact, I’ll give you one example of what somebody said that I thought was just really shameful, and honestly shameful, somebody said something like it isn’t a bad virus that’s killing people, it’s bad behavior. And I thought to myself, like, no, it’s a, it’s a virus. It’s a virus. It’s a virus, it’s not people.

Dr. Z: You are now moralizing about people’s actions.

Dr. Prasad: You really, and also like

Dr. Z: It’s a victim shaming kind of thing.

Dr. Prasad: Yeah, and I’m like, look, I’m a political liberal. I am, I’ve been a liberal for a long time. This is not something we do. We don’t go to people who suffer from drug addiction and blame them. We don’t go to people who have sexually transmitted illnesses and blame them. In fact, we’ve gone through great pains to appreciate that those strategies do not help. In fact, they hinder our progress and that we need to to do harm reduction, meet people where they are, move people forward, empower them, realize that people are sometimes the product of systems, they’re the product of circumstance. They don’t get to make all the choices in our lives. We’re, we’re lucky to be born in, you know, some of us in sheltered existences and for this person to say that like when many people who are maybe getting COVID are getting it because they have to be picking fruit in the fields of California and then get SARS-CoV-2 because of the housing conditions there. So that’s bad behavior, it’s not a bad virus? I mean this, it’s inhuman to say these sorts of horrible things.

Dr. Z: It’s inhuman and it was interesting, it’s an interesting cognitive error on the left because the left is supposed to value this idea that systems thinking and individual responsibility sometimes isn’t the best route. And it’s more conservative to say, you know, you need to step up and take accountability for your shit. And so it’s funny ’cause now they’re saying, well, you’re killing grandma by not wearing your mask. I think that’s the opposite of harm reduction. Because again, if you’re, if the person’s belief structure is that this thing is an affront and you’re attacking it directly, they’re gonna double down. You’re not, you’re not gonna, and we’ve already expended all the capital, you know, on on the public health messaging early on, we’ve talked about that before. It’s like you keep saying the flip-flopping and doing this and changing the messaging and changing the goalpost. What are people gonna do? They’re just gonna throw up their hands, like with Fauci, like you said, they’re just gonna say, well, now, now I’m done with it.

Dr. Prasad: I mean, there are liberals, like there are liberals, and I’m a liberal, there are liberals who say things like, you know, when somebody commits a murder, they’re like don’t view this person as a bad person. This is a person that’s a product of their upbringing, they grew up in a tough childhood. They grew up exposed to a lot of unsavory elements. The schools didn’t provide for them, they had no safety net. Their parents have struggled with alcohol, depression and drugs. And they were brought into a gang because that was the only sense of community they had. They had to be in the gang to survive and then they eventually committed a murder. We should have some sympathy for those persons. In addition to acknowledging that with the wrongdoing they did, we should rehabilitate these people, we should try to help this community. But that entire line of thinking is gone for SARS-CoV-2 because it’s just bad people and their bad behavior and not the bad virus. And I actually think we don’t extend that same courtesy to I think, I mean, I’m willing to say this, that like there are some people who don’t believe that SARS-CoV-2 is a virus or whatever, you know. Right. Totally crazy.

Dr. Z: Total hoax, yeah.

Dr. Prasad: And they don’t wanna wear the mask. And I disagree with that view. I’ll say that, you know, it’s a real virus and you should probably should do it. It’s pretty, if you haven’t been vaccinated. But they’re a product of their upbringing too. -Absolutely. They were born in a county that may have been blighted because the industry moved away. Their parents may not have had a lot of opportunities. They may not have gone to great schools, they may not have had a lot of upward mobility. Then finally, this guy comes along and he says, you know, here’s the problem in society. It’s the other, it’s the other people coming in, they’re taking your jobs, they’re robbing you of this. This person is also a product of where they grew up and this sort of cult of thinking. And yeah, we can say like it would be nice if they would do these things and heed the importance of the virus, but we shouldn’t also forget that there are a lot of systemic failures that led this person to where they are in this moment and maybe blaming them and shaming them and pointing at them and hating them, maybe that’s not the solution. Maybe the solution is trying to help those people have an education system where they don’t feel pushed and marginalized, and they don’t look for a con man to come and sell them a fairy tale, you know.

Dr. Z: Yeah, yeah. And you know, I’ll even take it a step further and say there are a lot of smart, very educated people who have some of those sentiments. And I think in that case, you can kind of look at the root and go, well, there’s a deep distrust because of some of the things in “The Coddling of the American Mind.” The stifling of speech, the idea that this kind of changing, shifting information, the fact that maybe they have an economic stake in this and it’s hurt them very deeply. And so to defend that, they will say, well, maybe this thing isn’t even real because I don’t know anybody who’s died of it or whatever it is. And you have to, this is, and I’ve said this early on, I go people who think it’s a hoax, you’re not crazy. You’re just behaving exactly as you should, given the dataset that you have and your everything else, everything that led you to that point. Here’s what I would say to try to convince you that it isn’t a hoax while still understanding the moral pallet that you come from that says, you know, like he talks about in the book, there’s this these moral taste buds and elephant and rider and these analogies that Haidt uses, by acknowledging that you can then actually come to some understanding even if you still disagree without villainizing or the worst is that this kind of elite thing that you and I probably tend to do it too. It’s we’re, you know, we’re hyper educated and all that sort of, well, you know, these people just don’t know, it’s just they’re not educated. And it’s like, well, but if you were molecule from molecule of them, you would behave exactly the same way. And again, there is a certain component of, I hate the word “privilege” but there’s a component of like we got lucky and we’re able to have this education. So now to then go, well, you’re just stupid, man. Like your behavior’s bad, you’re killing grandma. Why are people so dumb? That that’s just not, first of all, was not helpful. Second, was not true. Yeah, for sure. So it’s very hard, man. And I think that’s a problem, especially, now in our polarized, you know, black and white, that was the other one, there’s, the world is, is split between good and bad people. Exactly, yes. How can you even, I mean, you can say, so 50% of the people who voted for someone you don’t agree with, whoever it is are evil people. That’s what you’re implying. That’s just not true. Cognitive distortion.

Dr. Prasad: It’s a cognitive distortion. Yeah. Yeah, yeah. Now, I mean, I think, I think one of the, I mean, one of the things that I, somebody told me recently he listens to my podcast and this person pointed out you’re much harder with people who mostly agree with you than you are with people who really disagree with you. And I thought about it for a day or two

Dr. Z: You specifically?

Dr. Prasad: Yeah, me specifically on my podcasts.

Dr. Z: Interesting, yeah. Yeah, yeah.

Dr. Prasad: And it’s true. Of course, it’s true. And I was like, there’s a reason why it’s true. It’s like, like, like the people who are close in agreement to me, but we’re still have some disagreements I’m hard on them because I think that those are holding our cause back. That they’re, perseverating on bad people and their bad behavior is preventing us from really making substantive progress on, on broader socioeconomic issues, on broader issues in medicine, that you’re not going to win people by finding somebody who said some view that you find offensive or hostile and just hanging them in the town square. I’m critical of that because I think we’re not, we’re not getting people in our tent that way. We are scaring people away from our cause, from our beliefs. And if we want to build an inclusive and successful view and coalition, I think on the progressive left, we have to be more accommodating and tolerant and kinder to people who have different points of view. And I think in this case, I said many times on Twitter, and some people got mad at me for saying that I’ve never seen people on the progressive left shame other people for their behavior, for natural human behavior, to want to see loved ones, want to go on dates, want to eat with friends. I’ve never seen shame like this on the progressive left my entire life. And I thought it was antithetical to the progressive left and yet we find ourselves in this moment. And I think anxiety, fear, and being alone and isolated and needing a hug are reasons why we sink to these sort of base instincts.

Dr. Z: I think you’re right. And, you know, coming from this like Alt-Middle perspective that I’m sitting in, the people more on the right have a very enhanced sense of disgust actually. So that it’s like a sanctity degradation moral pallet and they feel disgust, and they’ve done surveys about this, people with more conservative views tend to feel they have a lower threshold for disgust. Now imagine you’re watching someone on the left saying, you know, you can’t see your mom and you got to put this on your face before you go on your trail hiking.

Dr. Prasad: Yes, right. Ridiculous things, yes.

Dr. Z: We’re gonna close the playgrounds on the schools. I mean, think how that, if your sanctity is based on some of those things, you’re gonna feel an overwhelming sense of disgust. And you’re gonna feel disgust at the way it’s framed too. So you’re not influencing anybody on the right.

Dr. Prasad: Not influenced anybody.

Dr. Z: And nobody’s coming together over that. And then it just generates more polarity. So I like that, that you’re actually disagreeing with people that are more on your side. And, and I find myself disagreeing with both sides more than anything, but also agreeing with aspects and going, oh, you know, there’s, yeah.

Dr. Prasad: But both of us are serving the same purpose which is that we’re trying to bring people together. That’s right. The next I wanna talk to you about before our time runs out, the schools. Yeah. It’s a fiasco, man.

Dr. Z: It’s a disaster.

Dr. Prasad: It’s a disaster. And I guess I would say like, look, you know, I I had a position of neutrality, like July, August and then I read like, you know, 40 academic papers, 50 academic papers, maybe 100 academic papers and I spent like 12 hours on my podcast interviewing experts from people who study school policy, the impact of schools on kids’ livelihood, longevity, people who study viral transmission, what we know about propagation in schools, whether or not schools are driver, which studies are the robust studies and which studies have some holes in it. And when you put all this information together, and then the reality of where we are in America, where, there are schools that are open, there are schools that have closed, it has nothing to do with any property of the virus, it doesn’t have to do with the case rate, it doesn’t have to test positivity, it has to do with whether or not it’s private, more likely to be open, then public more likely to be closed, whether or not it’s in district that voted Republican, more likely to be open, or Democrat, more likely to be closed. This makes no sense. When you look at the trade-off of schools I think the risk to children is extremely, extremely low. We had the Swedish study research letter in the New England Journal of Medicine. It looked at 1.95 million kids who were in school from March until June. And in this cohort of kids, 1.9 million, 1.95 million kids, 15 required ICU care, which is about one in 130,000. Zero kids died from SARS-CoV-2 at a time of transmission. This is when they didn’t close schools. Teachers, they had no higher rate of being severe SARS-CoV-2 than people who had different occupations in this Swedish dataset. So there was no increased risk to teachers in this, in this time period. And again, this is, they didn’t wear masks. They, they weren’t doing much of, in terms of mitigation. We have data from North Carolina, which looked at the North Carolina experience. This was at a time where the case rate in North Carolina was brisk, one to two per 1000. That’s a brisk case rate, that’s transmission. And yet they were only able to document something like 70 cases in schools. When if you assume that case rate and extrapolated it to the population in schools, you would expect about 800 cases. So schools do not appear to be a big driver. And then there’s a German study that I won’t bore you with but it took advantage of a fact that in Germany they have pre-specified vacation, summer vacation, and they’re staggered. So you can, separate schools were opened from when interventions took place in the country. And this beautiful quasi-experimental study suggests no increased transmission from a school opening and no reduction in transmission from school closing.

Dr. Z: So you, if you look at this from just a scientific standpoint, as if this were a big fat mass, massive social study, you would say the number needed to treat, to save a life in school by closing schools is probably a 100,000?

Dr. Prasad: Well, since not maybe for kids, probably maybe we’re talking a million dollar, million club, million people will have to be out of school.

Dr. Z: Million people have to be out of school to save one child. And even that is probably overestimating. The number needed to harm.

Dr. Prasad: And we can talk about that.

Dr. Z: In terms of missing lunches, in terms of domestic or child abuse at home untreated, in terms of destroying their economic future and therefore their lifespan, the number needed to harm is probably much, much smaller.

Dr. Prasad: It’s order of magnitude, more harms than, than benefits from this closure. And that, and that’s the way I come to it. And those harms are not distributed equally. I’ve seen some people say like, oh, my kids are doing fine. I was like, you’re a doctor and a professor and you have two doctorates. Of course your kids are doing fine. And to be honest, some people say, even with two doctorates my kids are not doing fine.

Dr. Z: Yeah.

Dr. Prasad: Let alone, what about somebody whose mom has to go to the grocery store, who’s watching the six year old kids? Some of them are being left alone at home.

Dr. Z: Yeah.

Dr. Prasad: What about, there are 3 million kids no one has spoken with since March. What about sexual abuse? What about physical abuse? There’s a story that came out of Orlando. Orlando has in-person restaurants. They brought some kid in, the kid has bruises on the arms and the parents didn’t, yeah, the parents didn’t let the kid eat. They only caught the child abuse because they have in-person restaurants in Orlando, that wouldn’t have been caught in the Bay Area because we don’t have in-person restaurants. This kid is lost. I think when you look at this transaction, that being made the sacrifice that we are taking from these kids for a theoretical and uncertain benefit to other people it is a horrendous, it is a horrendous trade-off. And, and I think one of the biggest reasons why people do not feel differently about this, I’ve said on my, in Twitter, that this is gonna be the Iraq War. Right now, people are saying it’s fine to close schools. It’s okay, I don’t know. I don’t feel strongly about it. That’s how people said about the Iraq War. Maybe they have weapons of mass destruction, maybe we should go in there. 10 years later, how do they feel about the Iraq War? It was a biggest mistake, universal sentiment. The moment the stories come out, you know, I believe that there’s gonna be a 60 minutes episode. On the 60 minutes episode, they’re gonna get four kids. The only, it only has to be four, four kids just gonna tell what happened to them. No one, and one of them is gonna say something like, you know, nobody came to help me and and the public sentiment will shift on a dime. They’ll say, why did we do this? Why did we close schools? Why did we close schools only in Democratic strongholds? Why do we only close public schools for the poor kids and kept the private schools for the rich kids? Why did we do this? When places in the Bay Area when there were no test positivity in the summer we still closed schools in September, why?

Dr. Z: They like, you know, and the thing is that to keep the private schools open, these are the exactly the Zoomocracy that can handle this. Like, you know, my kids are doing okay but I still put them, they’re in public school, so they’re at home because it’s the Bay Area and everything’s closed. And it’s been closed since March. They have not stepped foot in a classroom since March. The only socialization they get to have is going to their Ninja Warrior camp where now they make them wear masks and everything and they, they come back lit up and going about it because that’s what kids need, right. No, the teachers are safe, they’re wearing their stuff. But, but this idea that in California, for example, liberal stronghold, right? We’re supposed to be this progressive beacon for the world. We were so aggressive early on when we didn’t know and then we never really relented. People stopped even trying. They’re like, you know what, this is never gonna stop. Newsom’s at the French Laundry, having his thing, the rich people do whatever they want, I still have to go to work. Let’s just go, I’m gonna see some friends, we’re gonna go to Thanksgiving, we’re gonna do this, and now we have some of the highest numbers in the country and very comparable

Dr. Prasad: In Southern California.

Dr. Z: It’s Southern Cal, it’s Southern Cali. Right, right. What’s different about the Bay you think?

Dr. Prasad: I guess I would say, I think the full story about Southern California is not yet been reported. I’ve looked at some of the demographic data and among hospitalized patients I saw something like 70% were Hispanic. I think we, maybe it is, we will learn more about what’s going on in Southern California and what exactly tipped it over. In the Bay, it’s a place of opulence. It’s a place of wealth. People can sequester and cloister themselves away. There are probably many people who haven’t had much contact with other people. And again, they have yards and space and can get food delivered by Uber Eats. And I think that’s probably, to some degree, we have a, we have a high workforce where they can work completely from home.

Dr. Z: Right, right. Well, you know, what’s funny is it in Marin County, one of the most affluent places on the planet. There’s a working class, Hispanic population. Yeah. They were getting COVID all over the place.

Dr. Prasad: And I wonder what’s going on in Southern California that it happens to do with maybe food pickers in the Central Valley. Maybe some of these occupations that we didn’t protect. You know, for a progressive system lockdown, where is the, where’s the resources you’re providing for people who are, who need resources. But just one more thing to hammer on the schools. Every 70 degree day in California, that schools are closed and not outside is an embarrassment, you know.

Dr. Z: I agree, yeah.

Dr. Prasad: This is 70 degrees sunny days.

Dr. Z: Harness the global warming.

Dr. Prasad: Harness this beautiful weather. This, this school’s transaction I think is only because of moral availability. The availability of SARS-CoV-2 deaths, COVID 19 deaths, is always available. It’s at the top of the New York Times webpage. And that ticker goes up every day, and damn it, I want that number to come down. I don’t want that number to be that high, it’s outrageous. But where is the ticker up there with kids were abused, with kids who have falling grades, with kids who will never have, never be able to be an engineer, or a doctor or a lawyer because they have fallen back too much, with kids who are gonna be teen pregnant, with kids who are gonna get shot. Where are the counters for that all the harms? There is no saliency of those, of those harms. And if those tugged on your heart the same way, everyone would flip. And it astonishes me that my friends, my progressive friends will not budge on this issue even though Europe is the example. In Europe they bend over backwards to get the schools open. They do anything to open schools. They’re back open in Sweden, they’re back open in Denmark, even when B.1.1.7 is exploding, they say we’ll suspend school, but very briefly. And the moment we can turn this around, we’re gonna get these schools back open. We don’t have that attitude here. I think, I don’t know what to, what’s gonna happen.

Dr. Z: You kind of nailed this sentiment when you said the ticker issue. Because we empathize with certain things, but it’s very narrow. Our focus of empathy is narrow. We have to feel it. You can feel all the deaths and everything, you can fear, and then you’re okay. I’m not going to school. Ah, but then, like you said, when they have that 60 Minutes episode, five years from now, and it’s these kids sitting there, and you’re just going, oh, what did we do? Then you’ll feel it, and it’s too late. Too late. The need to feel it now. Why can’t we feel? Because where are the stories.

Dr. Prasad: Yeah, they’re hidden, they’re hidden.

Dr. Z: They’re hidden. They’re all, it’s all seething under the surface and the mental illness and the future substance abuse and the economic travesty that rich, the rich are getting richer. Talk about in progressive values. California billionaires have been minting money during the pandemic and it’s led to a budget, like a surplus of money, which they ought to be giving to people who pick the food.

Dr. Prasad:  ZDogg, every time I look at my retirement account, you know, I didn’t create it, but it’s, it’s I had worked at university and they put it on this, you know, some retirement fund and it’s exploding, the stock market it’s exploding. Stock market blown up. It’s, it’s disgusting.

Dr. Z: It’s really ill, yeah.

Dr. Prasad: It’s, it’s disgusting. We live in a time where people are suffering more than they ever suffered. And if you have money, you’re getting richer than you’ve ever been. And that is a deep poison. And it’s, you take away schools, you take away upward mobility, you get the rich richer and the poor poorer, it is a volatile situation. I think the next 10 years are going to be highly volatile, politically volatile. I literally think that, you know, people were easy to demonize, John Ioannidis, of course, you know, he’s Mr. Satan, he’s Mr. Evil, his original stat article, you know, he talked a lot about how we don’t have evidence to know about SARS-CoV-2 where they should be spot checks and all these things. He got a lot of flack for it. One of the throwaway lines in a sentence, one of the throwaway sentences in his article was something like if you institute these restrictions you don’t know what will come, there will be a civil unrest, instability, threats to democracy.

Dr. Z: It was a throwaway line, it was prescient.

Dr. Prasad: He might be, he might be. I worry about that he might be.

Dr. Z: It’s already happened, a little bit.

Dr. Prasad: I mean, we’ve seen some, a lot of anxiety.

Dr. Z: Do you think, do you think the Capitol riots had some component of people who are just fed up?

Dr. Prasad: I think

Dr. Z: I mean, and craziness. But yeah.

Dr. Prasad: And they have somebody who’s feeding them disinformation. Right, right, again. And lit a fuse.

Dr. Z: Yeah, exactly.

Dr. Prasad: They have an agitator but the agitator himself is a symptom of a deeper disease.

Dr. Z: Absolutely. You know, we should have

Dr. Prasad: We should get a political scientist to talk about it.

Dr. Z: We really should.

Dr. Prasad: When income and wealth inequality is so absolute, these are the preconditions for these kinds of people.

Dr. Z: It’s amazing because we did elect a guy, who is by, on paper anyways, or at least in theory, very rich and

Dr. Prasad: That’s uncertain, but yes.

Dr. Z:  I guess uncertain, right. What a poor person thinks a rich person should be. -Yes, right, yes, yes- And he’s saying I’m gonna help you to attain this. Now, that we should have love for the people who are moved by that because they are the ones who are suffering in this economy. You know, the elite can sit here and go, “I don’t understand Trump, I don’t get it at all,” minting cash and the retirement, and actually, you know, all of Trump’s cheerleading for the stock market actually probably does pump it up and they’re benefiting from it. It’s like

Dr. Prasad: I would say that, and I think there are a lot of pundits who say this, you can hate a politician, all you want, but don’t hate everyone who follows him.

Dr. Z: Yeah.

Dr. Prasad: You need to win their hearts. Yeah, yeah. If you want to do good in this world, you need to win their hearts. And if you hate everybody who follows somebody, someone can be followed by some bad people but no politician is followed by, everybody who follows that politician is bad. That’s just not possible. There are too many good people in America. And the majority of Americans are good people, you got to win their opinion if you

Dr. Z: The majority of Americans are good people, I would agree with that. I would say the vast.

Dr. Prasad: Vast majority. Vast majority. Vast majority.

Dr. Z: Yeah, and then, and that’s why I think, I think honestly, I think folks on the right get very hurt when they see signs of hypocrisy like, oh, you know, the Capitol riot guys were treated this way in terms of like everybody’s outraged. But then people were burning their own communities and the police were standing by and no one was saying anything. It wasn’t okay to say anything because then you’re not for, you know, racial justice. And we should be able to talk about these issues, right. We can do it. Man, we did a thing today, you and I.

Dr. Prasad: We talked about a lot of things.

Dr. Z: We talked about a lot of things. Was there anything else on your, gosh, I mean

Dr. Prasad: My two, my two big things are the schools.

Dr. Z: Yeah, I’m with you.

Dr. Prasad: Which I think people are wrong about.

Dr. Z: I’m with you.

Dr. Prasad: And I, and I say that as a policy person who spends a lot of time thinking about complex trade-offs. And then my other big thing is that after two doses of vaccines and 14 days asymptomatic, you got, people gonna be people, man. They’re gonna be people. And, and you can say whatever you wanna say but I know what people are really gonna do because people have already called me and told me what they doing.

Dr. Z: Dude, that’s something I wanted to say when you brought it up initially, and that’s a good way to end. If you think that all these virtue signaling people on Twitter are behaving the way they’re telling people to behave with their mask avatar and their Vinay wear a damn mask Prasad. That’s not you, but you know, with like five pronouns to show that they care about people they know nothing about, and all of that. If you think that they’re not going and having social events and getting vaccinated and taking off their mask and doing all that, you’re crazy ’cause that’s what they’re doing. And if we can just be honest about that, then maybe we can start to come together on this thing. So I’m with you, man. We did a thing, guys. Okay, so here’s the thing

Dr. Prasad: It’s good to talk.

Dr. Z: It always is good, man. So Vinay has, he writes in MedPage Today, he has Plenary Session, which is his podcast which is fantastic. If you really wanna go deep and you wanna hear him completely unfiltered. He’s unfiltered now, but

Dr. Prasad: It’s the Donnie Darko of Podcasts. It’s got a, it’s a cult classic, a cult classic.

Dr. Z: Oh my God, what a great analogy, oh. What a great movie! Great movie for people who get it. I mean, most people will just go, “huh?” They’ll say “Chuck E Cheese, what the hell is that? Chuck E Cheese, what’s he talking about? What, is he a 1,000 years old?” You’re 10 years younger than me. That’s a sad thing. If you guys like what we do and you wanna overthrow the social media hegemony come follow us in these supporter groups because they’re quite closed groups, people have skin in the game. Locals.com is one of my favorites now because it’s completely off the social media, like scoring points game. People just have nice discourse, and it helps support the show so we don’t have to go all commercial and do stupid stuff which we don’t wanna do ever again. So love you guys hit share and we out. Peace. Thanks Vinay.