Joe Rogan Experience #1566 - Nicholas Christakis

1. 0:00 – 0:06

   Intro

   1. NCNicholas Christakis0:02

      (instrumental music plays) Joe Rogan podcast, check it out. The Joe Rogan Experience.

2. 0:06 – 1:41

   Sober October, cigars, and lockdown drinking habits

   1. JRJoe Rogan0:06

      Train by day, Joe Rogan podcast by night. All day. (instrumental music plays) Yeah, I got into cigars lately. I did sober October and, uh, during the month of October, uh, no drinking at all and I started smoking cigars.

   2. NCNicholas Christakis0:21

      How did the sober October work for you?

   3. JRJoe Rogan0:22

      It's great. Do it every year. It's nice. A little reset.

   4. NCNicholas Christakis0:26

      It's interesting, you know.

   5. JRJoe Rogan0:27

      Very nice.

   6. NCNicholas Christakis0:27

      I mean, uh, I have another friend of mine who stopped drinking all together, uh, and, uh, he, he said that it was making him cranky when he was drinking and of course there were extra calories. And, uh, I listened patiently to him and thought, "I would love to do that," but at the same time, it's hard to give up completely, so.

   7. JRJoe Rogan0:46

      I enjoy a glass of wine with a meal. That, that I miss the most. That, that was the worst when I was, uh, you know, having a steak and just like, "God, I'd like a nice glass of red wine right now."

   8. NCNicholas Christakis0:57

      Yeah.

   9. JRJoe Rogan0:57

      But other than that, I don't drink much. I'm not much b- much of a boozer. Although when November kicks in and I know I can drink again, there's usually a few days of excess.

   10. NCNicholas Christakis1:06

       (laughs)

   11. JRJoe Rogan1:07

       Which is, uh, speaking of the subject of, uh, COVID-19 and the current pandemic we're into, that's not a good thing. Um, there's a lot of people out there destroying their immune systems drinking. There's a very funny video that I found online of this gentleman who runs around his neighborhood and, uh, he noticed that during the lockdown, he would run around his neighborhood and he would see the recyclable bins and they were just filled with empty alcohol containers. He's like, "This is crazy. This w- this is for the weak. Like how much are these people drinking? Just vodka and wine and..." There's a lot of that going on.

3. 1:41 – 3:13

   Toilet paper shortages and the bidet detour

   1. NCNicholas Christakis1:41

      Yeah, people have actually looked a little bit at that, at alcohol consumption, and it's a little bit like the toilet paper shortage. I, I don't know if you followed the whole toilet paper-

   2. JRJoe Rogan1:49

      Yeah.

   3. NCNicholas Christakis1:49

      ... shortage thing. Well, what's happening is there's a shift in consumption. You know, a lot of the drinking that was taking place in restaurants and, uh, you know, at, uh, at, uh, bars is now taking place at home. So I think it's like half and half. Like half the consumption in the past was at home and half was out of the home, and now it's almost all at home which is part of it. But I also think as you're suggesting, the actual amount is going up too, so, so yes, it's, um, you know, and it's contributing to weight gain and other problems in our society.

   4. JRJoe Rogan2:20

      The toilet paper thing, there's an easy fix for this folks that's way better, and I hate to do this to plug a sponsor but it's a good sponsor. There's a sponsor called Tushy and Tushy makes a bidet attachment that just fits onto a regular toilet and it cleans your butt.

   5. NCNicholas Christakis2:34

      (laughs)

   6. JRJoe Rogan2:34

      They're only 79 bucks and it's, it's fantastic. It cleans your butt so much better than just toilet paper-

   7. NCNicholas Christakis2:42

      (laughs)

   8. JRJoe Rogan2:42

      ... and your, it cuts your toilet paper consumption down by like 85, 90%-

   9. NCNicholas Christakis2:47

      (laughs)

   10. JRJoe Rogan2:47

       ... 'cause you just need a little bit of toilet paper to pat your butt dry at the end.

   11. NCNicholas Christakis2:50

       (laughs)

   12. JRJoe Rogan2:51

       Do you ever use one of those? Bidet attachments?

   13. NCNicholas Christakis2:53

       Well my, in Greece, they're not uncommon to have bidets so you know in this-

   14. JRJoe Rogan2:57

       Yeah.

   15. NCNicholas Christakis2:58

       ... I, I of course am familiar with them, but we don't have one here. But it's interesting we-

   16. JRJoe Rogan3:03

       You should get one.

   17. NCNicholas Christakis3:03

       Say that again?

   18. JRJoe Rogan3:04

       You should get one. You should get one. I'm telling you-

   19. NCNicholas Christakis3:05

       Yeah, well we're-

   20. JRJoe Rogan3:06

       ... it's so much better.

   21. NCNicholas Christakis3:07

       We may. We may in fact.

   22. JRJoe Rogan3:09

       You should.

   23. NCNicholas Christakis3:10

       So, uh, I can't believe we've covered alcohol and bidets on the program already. (laughs)

4. 3:13 – 7:11

   Why Christakis wrote a COVID book: early China data and a billion-person lockdown

   1. JRJoe Rogan3:13

      (laughs) Yeah. So let's talk about this. How did you... What, what made you decide to write a book on the, the current pandemic and the disease?

   2. NCNicholas Christakis3:23

      Well, I mean, uh, for me it started... I, I was reading news reports in January about what was happening in China but I, I wasn't paying a ton of attention, and then I have these, uh, Chinese colleagues with whom I've been doing research for a long time and they contacted me in the middle of January. We, we had been using phone data in China to study how, uh, earthquakes for example change human social interactions. So after an earthquake, who do people call? And we could imagine that the first person you call is very important to you for instance and so we could use the phone data to study social interactions. And so we decided to use the phone data to study the pandemic and, um, and to study the movement of people through China and how they might carry the virus with them which started in Wuhan, uh, in November sometime. And, uh, and, and then we noticed or I saw in the data that on January 24th, the Chinese were so concerned with the virus that they basically detonated a social nuclear weapon and they put 930 million people, almost a billion people under home confinement starting January 24th. And I could see that in the data and that really got my... 'cause emotion ceased. People stopped moving in the whole country, and that, that really got my attention and, uh, as I and I got worried and it was clear to me that this was going to be a serious global pandemic. And so I began to redirect the activities of my laboratory at Yale to study more and more about, about what was happening with this virus and we did a whole bunch of projects some of which if you're interested we can talk about. We released this app called Hunala. H-U-N-A-L-A. Hunala which you can get... Thousands of people use it now. It's like, it's like Waze for Coronavirus. It's, it's not a contact tracing app that looks backwards, it, it crowdsources information about who you're connected to, which is one of the things I study is networks, and where you live and forecasts your risk. So people down the road from you are reporting a traffic jam or a cop and you can exit the highway and avoid that, and people, your friends' friends' friends are reporting a fever, it can ripple back through the network and feed this information to you. All anonymous. It's, it's anonymized, it's, it doesn't, um, uh, you know, doesn't report who is having what. Anyway and, and the app incidentally temporarily, uh, a- accesses your contacts. It... We don't copy the contacts, it doesn't copy that but it makes it easier for you to identify who your social connections are. Anyway so we did that, we did a whole bunch of other stuff which maybe we'll talk about and so in the month of February as we were doing all this work I was getting more and more worried.... and, and that our nation wasn't preparing. And so in March, I started sending out some Twitter threads, like epidemiology 101, like basic stuff, and a lot of those started to go viral. And, and people were so hungry for information about it, it became clear to me, you know, factual information about what was happening. And then in the middle of March, my editor, my long-term editor at Little Brown, a woman by the name of Tracy Behar, contacted me and said, "Would you like to write a book?" And I thought, "Yes." And my motivation was that I wanted to help the American public understand what we were facing, and I was very worried that people weren't taking this seriously enough. And so, so that's why I wrote the book. I, I wrote the book because I thought, "This is something I know about. This is something I care about. I care about our country." I didn't see our leaders as doing the things they needed to do, and I just wanted to help people understand what was happening and, and what was likely to happen.

5. 7:11 – 9:37

   What the U.S. should have done earlier: testing, PPE, messaging, surge prep

   1. JRJoe Rogan7:11

      What do you, what do you think should've been done that wasn't, initially? Like in the January, the month of January, it's when everyone was alerted to the fact this was going on in China. The White House knew. Everyone knew. But we didn't really lock anything down till March. What do you think should've been done?

   2. NCNicholas Christakis7:28

      Well, first of all, the, I, m- people like me knew this was gonna be a serious global pandemic for sure by the end of January. And the president, we now know, unsurprisingly, (laughs) was briefed even earlier, right? I mean, if the president, you know, wasn't, didn't have more information than me, then there's something wrong, (laughs) there's something wrong with our country. And, um, but certainly by the end of January when China locked down, as we discussed, we should've begun immediately preparing our testing capacity, uh, manufacturing PPE. Um, we should've, I think, begun the incredibly important challenge of preparing the nation for the challenge we would face, like gearing up for a kind of war. You know, we were about to be invaded by the virus. So public messaging would've been really important to tell people, you know, we're, we're facing a common threat. We're gonna have to endure some sacrifice. We're gonna have to work together to repel this threat. Here's some basic information about the nature of the threat. So all of these things, uh, ventilators, for example. Also, another in, you know, sort of materiel that we needed. Um, preparing our hospital systems, for example. We lost several months in which we didn't, we didn't really prepare, and I, honestly, I don't understand why our leadership failed us this, in this way. I mean-

   3. JRJoe Rogan8:45

      W- who was responsible for that? There w- there was a, there's an also an issue where the pandemic response team that was in place for the previous administration was disbanded and sort of reassigned. Correct?

   4. NCNicholas Christakis8:58

      So, I don't know... Yes. I don't know all the details about that. I know it wasn't just the Obama administration. They inherited the pandemic response from the Bush administration, and the CIA has been identifying emergent, um, pandemics as a serious national security threat for a number of decades now. It was actually discussed in the book. And of course, people like Bill Gates have been warning about this. Tony Fauci was writing about this stuff when you and I were in elementary school. So, so there's, there's a lot of institutional knowledge about the existence and nature of these threats, and, and so I don't, I don't know why they weren't, we weren't better prepared when we saw what was happening in China.

6. 9:37 – 11:54

   Masks, trust, and early mixed messaging (including Fauci controversy)

   1. JRJoe Rogan9:37

      What could have been done differently? I mean, obviously, manufacturing of PPE and all those things. W- that, that, that absolutely should've happened, and that would've actually avoided a, a very unfortunate thing that happened where Fauci actually was telling people they don't have to wear masks.

   2. NCNicholas Christakis9:55

      Yeah.

   3. JRJoe Rogan9:55

      And he later admitted the reason why he did that is 'cause he didn't want people rushing to get masks and that would take masks away from the first responders. That's a very, very unfortunate thing that he did, because that eroded people's confidence in, in what he's saying. It, it, it, it, it lets you know that there are people that are in positions of power, like himself, or positions of influence, that will lie for the better good, but still lie.

   4. NCNicholas Christakis10:23

      Yeah, so let's not f- uh, so the details of the Fauci statement, I honestly don't know. Like I haven't dug deeply to know exactly what he said and when. I can retrace for you some basics, uh, however, about mask wearing early on.

   5. JRJoe Rogan10:34

      I actually put it on my, my Instagram because it was so crazy when he was saying it. It was an interview that he did, on television, and he was saying-

   6. NCNicholas Christakis10:42

      Yes.

   7. JRJoe Rogan10:42

      ... for the general public, you know, "You don't have to wear masks. It's not helping you." And he was actually saying it might be bad because you'd be messing around with it and touch your face.

   8. NCNicholas Christakis10:50

      Yeah, you could... So, so initially, it was a little bit... Initially, there was ostensibly some confusion about whether it was advantageous to wear masks or not. It's clearly advantageous. It's advantageous to the wearer and it's advantageous to others. It, it reduces the, this, the stress, um, on the system by, if everyone were to wear masks. And just to be very, very clear, it's neighborly. Uh, wearing masks is like driving the speed limit or not driving on the opposite side of the road. And it's, there's now abundant evidence on the benefits of mask wearing, and furthermore, and then I'll come back to your Fauci issue. The, um, the, if we were to all, as a nation, wear masks and adopt some other basic things, it would allow us to keep our economy running better and our schools open. In other words, we can't have everything. There's a, there's a deadly virus that's afoot, and so we're gonna have to grow up and be mature, do some things that are uncomfortable and unpleasant and may even seem silly. But if we do those things, we can, we can avoid doing other worse things like shutting down our economy. But anyway-

   9. JRJoe Rogan11:53

      Can I, can I stop you for a second there?

   10. NCNicholas Christakis11:54

       Yeah.

7. 11:54 – 16:45

   Droplets vs aerosols: why masks still matter and which masks work best

   1. JRJoe Rogan11:54

      Because this is something that's actually kind of important. When people are wearing masks, here's s- uh, like this is the common argument against it, is that the virus particles are so small. If you're breathing in air and it's getting through gaps in your mask, the virus is gonna get through. But the, the impact of having a mask, the positive impact, is that you're, if there is a ma- some virus in the air or virus coming from you, it's gonna be-... greatly reduced, correct? Like-

   2. NCNicholas Christakis12:21

      Well-

   3. JRJoe Rogan12:21

      ... especially an N95 mask.

   4. NCNicholas Christakis12:23

      Yes, there's two- You know, there are two parts to what you're saying. First of all, uh, w- water molecules are infinitesimally small, and they're much smaller than the pores on the fabric of your umbrella. But your umbrella stops the rain. Why is that? Well, it's that the water molecules aren't coming down as molecules, they're coming down in droplets. So even though the virus is very small, much bigger than a water molecule, but still very small, and you're right that the virus itself could go through the fabric of a mask, that's not what's happening. Droplets are coming out of your mouth, or are coming from someone else towards you. And the mask is extremely effective at stopping droplets.

   5. JRJoe Rogan13:02

      But isn't, uh, hasn't it been shown that the virus is also aerosol now?

   6. NCNicholas Christakis13:07

      Yes. So there's also aerosol transmission, and we can talk about that too if you, obviously, yes, let's talk about that. But before we move to that, let's just say one more sentence-

   7. JRJoe Rogan13:14

      Okay.

   8. NCNicholas Christakis13:14

      ... on the droplets, which is that, uh, when you exhale, uh, think about how if, if you wanted to, if you had a fire hose at your house, and the water was spraying out of the fire hose, and you had two different strategies for s- for stopping the water from landing on the floor of your house. One strategy would be to run around with buckets and try to catch the water as it was landing from this arc of the fire hose, and another would be to, like, put a kink at the end of the fire hose and stop the water from coming out in the first place. One of the reasons that masks are so effective, even homemade, handmade masks, forget the N95s which is what I wanted to come back to, is that they are like plugging a fire hose or a garden hose at the opening. It's much more effective than trying to have someone else wear a mask, for example. So you're wearing the masks, uh, and furthermore, in the case of coronavirus, one of the big problems is people don't know if they're sick. This particular germ is very nasty. It, you can transmit it before you have symptoms. So one of the reasons for people to wear masks is they don't know they're transmitting the disease, it's very efficient to stop the viral drop, the droplets before they leave their mouth and s- from spreading to others. And when you wear a mask, you also protect yourself from inhaling droplets of other people. The N95s are a more medical grade mask. They're even better than the cloth masks that you can, you know, buy on the internet. But those, if you're gonna use those effectively, you have to seal them around your face and use them. And, and you don't really need to use them, those. I mean, you can if you have them, there's nothing wrong with it, but you also don't want the ones with valves. Those don't really help you.

   9. JRJoe Rogan14:49

      Yeah, the valve ones are kind of silly, aren't they?

   10. NCNicholas Christakis14:51

       Yes.

   11. JRJoe Rogan14:51

       It doesn't, it defeats the whole purpose.

   12. NCNicholas Christakis14:54

       It can do. It, it still helps, but yes. These are all relative things. Now on the aerosol thing, what you're talking about is some of the things that you exhale from your body are little dried particles of, and, of viruses that are- are suspended in the air. And these can go a further distance. And there is, in fact, evidence of aerosol transmission, which is different than droplets. Both go through the air, but droplets are big and fall to the ground, whereas it's like, um, it's like raindrops versus little particles of dust that can float in the air, for instance. And, uh, so there is aerosol transmission, and the, and the masks that we use don't necessarily stop that. You'd need like an N95 mask, well-fitted, to stop that. But the masks still help. So I don't think there's a really good argument. Uh, I mean, I wish we didn't have to wear masks. I mean, I- I- I, you know, it's unpleasant. But i- of all the unpleasant things, you know, we could choose from doing, you know, if the choice is do I close the schools in my local community or do I have everyone wear masks, to me, that's, you know-

   13. JRJoe Rogan15:59

       Yes. Wear a mask.

   14. NCNicholas Christakis16:00

       ... wearing the mask.

   15. JRJoe Rogan16:00

       It's pretty straightforward and simple. There's a great, uh, video online that I saw this morning of a- a guy who held up a lighter and he used a bandana first, and he blew through the bandana and put out the ma- the, uh, the lighter. And then he put on a cloth mask, and it, it l- it was hard to blow through, but he did it and put out the lighter. Then he put on an N95 and it didn't do a damn thing. Put on a surgical mask, it just wiggled the flame a little bit, but couldn't put it out. So it just shows you the difference in the quality of the masks.

   16. NCNicholas Christakis16:31

       Yes.

   17. JRJoe Rogan16:32

       My doctor does not recommend bandanas. He was saying, "Don't wear that." He's like, "Please. It barely stops anything, and i- if you want, if you're gonna wear something, please wear a mask. An actual mask."

   18. NCNicholas Christakis16:43

       Yes. Yes, although again, I would say that something is better than nothing, and-

   19. JRJoe Rogan16:45

       Yes.

8. 16:45 – 18:14

   Living with risk: why no measure is perfect (quarantine, masks, vaccines)

   1. NCNicholas Christakis16:45

      ... one of the things that, one of the things I think is gonna come up in our conversation, and we might as well tackle it now, I was trying to think of, like ... Well, I was trying to think of sort of general principles that are relevant here is, there's no, in a time of a deadly con- contagion, Joe, there's no life without risk. And many people are used to this, used to thinking about risk in their lives, but many are not. And I think what I would like people to understand is, is that there's, the world has changed, there's a new virus that's entered our species. It's not gonna go away, it's gonna be with us forever. And we have to, first of all, accept that. Second, take steps to address it. And third, recognize that no single step is perfect. Even a vaccine is not perfect. So everything is shades of gray and degrees of risk. So for example, even the 14-day quarantine rule, that's just a statistical distribution. 2.5% of people are still infectious after 14 days. We, we just cut it off at 14 days because well almost everyone can't spread the virus anymore after 14 days, but- but not, it's not true that no one can spread the virus. So there's still some risk. Or you can wear a mask and it reduces your risk, but it doesn't eliminate your risk. And so, so pretty much everything we do, uh, is not perfect, and there's, and so we have to begin as a society and as- as households or as individuals, make decisions about what risks we're willing to tolerate.

   2. JRJoe Rogan18:13

      J-

   3. NCNicholas Christakis18:13

      And ... Yeah?

9. 18:14 – 33:05

   Immunity, reinfection, and cross-immunity: antibodies vs T-cells

   1. JRJoe Rogan18:14

      No, Jamie was brought- brought something up this morning that people that h- had SARS...... um, sh- it showed that they had immunity to COVID-19. Uh, Jamie, what were you talking about earlier?

   2. NANarrator18:27

      No, no, the... (clears throat) It was, uh, saying that I- I might have misunderstood or mis-said that to you, but they were comparing, uh, immunity to SARS. They said that they were still carrying important immune cells 17 years after recovery, and they're saying that might be the same sort of thing with coronavirus, that you might have immunity for a long time.

   3. JRJoe Rogan18:44

      But there have been people that have been re-infected in as early as three months. Isn't that correct?

   4. NCNicholas Christakis18:49

      Yeah, so this is, again, another complicated topic. So, yes, we now have some evidence that some people can be re-infected, but it's probably extremely rare. We, we don't know 100%, but it is probably extremely rare. And part of the reason is that if you get COVID and they test you, and then three months later you get COVID again and they test you again, they found you. And they say, "Aha! This person had it before and isn't immune." But there could be hundreds of thousands of people who also had COVID who were re-exposed and didn't get infected, didn't get symptoms the second time, and so nobody tested them. So you see, we, we only ascertain, we only see the ones that in fact do get re-infected. So you are right. There have been now some cases proven with genetic testing that have been in- infected more than once. But we still think it's rare. The thing that Jamie was alluding to is there are two parts to it. One is, uh, how long does the immunity last? And honestly, we won't know the answer for sure until time passes. There's no way to be certain. But, but we do believe that immunity will be sustained, will be reasonably sustained. And furthermore, I don't want listeners to confuse the difference between antibody levels declining and your being immune. So when your body's infected, you mount a, a re- a defense, a response, and you produce, you produce antibodies. And for almost all infections, those just decline over time. And in fact, with coronavirus, those, those an- circulating antibodies, those proteins that attack the virus, go down to, you know, very close to zero by about a year, let's say. And this was completely expected. There's nothing surprising about this. But your body has, in the interim, also begun to develop something called memory immunity or T-cell immunity, and that's what protects you from re-infection. And we believe, we have evidence for that people have sustained such T-cell memory immunity. How long that lasts, so Jamie was saying with SARS1 which struck us in 2003, people can find evidence that even 17 years later, you can mount an immune response 'cause your body remembers that it fought off this thing 17 years ago. And, and one more thing. And that is all different than the question of cross-immunity, which is also becoming now, people are... I mean, the whole country is getting an immun- (laughs) immunology lesson.

   5. JRJoe Rogan21:08

      Yeah.

   6. NCNicholas Christakis21:08

      Which is that-

   7. JRJoe Rogan21:09

      Which is probably good.

   8. NCNicholas Christakis21:10

      ... is it or is it... What'd you say?

   9. JRJoe Rogan21:12

      I said, which is probably good. I mean, it's, it's about time that pe- people recognize that in terms of pandemics, this is... I, I don't wanna diminish the death or the suffering or anything, but it could have been far worse.

   10. NCNicholas Christakis21:28

       I'm so glad you said that, because, um, because we're j-... On the one hand, it's, this is a bad germ. You know, so roughly speaking, it'll kill about 1% of the people that, uh, get, get it symptomatically. You get this disease, you have symptoms, you've got a 1% chance of death. It varies by age, and we can come back to that too if you're interested. Uh, but as you're saying, it could have been so much worse. I mean, there's no God-given reason this virus isn't killing 10% of us or 50% like the bubonic plague. And if, if you remember the movie Contagion, I think in, in the movie Contagion, it killed about a third of the people that got it. And there's honestly no reason that this... I mean, we, we could have been facing that situation, you know? There's no necessary reason we're not facing that situation. So you're right. It, it could have been much worse. And in fact, the 2003 coronavirus killed about 10% of the people that got symptoms from it. So it was about 10 times as deadly as the one we're facing now.

   11. JRJoe Rogan22:29

       Why has there been so little discussion, especially from our, our governments and our leaders, about methods to strengthen your immune system? That has been particularly frustrating to me. There's been so little discussion about vitamin supplementation, about changing your diet, about exercise, keeping yourself healthy, making sure you get enough sleep, lowering alcohol consumption, all these things that have been absolutely proven to boost your immune system. Why has there been... Not, not negating the use of masks or social distancing or-

   12. NCNicholas Christakis23:05

       Yes.

   13. JRJoe Rogan23:05

       ... all the other things that we know are effective, but why has there been no discussion about boosting your immune system?

   14. NCNicholas Christakis23:13

       I, (laughs) I don't know, but it's a really good question you just asked. So you're right, there are all these sort of healthy living things you can do from, um, exercising, getting better sleep, uh, reducing strace- stress, losing weight, reducing alcohol and tobacco consumption. All of these things that, uh, enhance the ability of your immune system to fight off infection, and that has not been part of the public health messaging campaign. I, I don't know the reason for that. It should be, actually, now that you mention it. We should be encouraging people to do that. I have to say, however, that I don't want us to get into a situation in which... 'Cause many very fit people can get this germ and die.

   15. JRJoe Rogan23:53

       Yes.

   16. NCNicholas Christakis23:53

       Uh, and I, I don't... And, and, and also people can be behaving well or poorly and get this germ and die. And, and as a doctor, you know, I'm very understanding of human beings' frailties. You know, we all are human. We, we, we're soft on the outside, and we don't deserve to die, uh, of a germ or anything else as far as I'm concerned. And so, I don't want us to say, "Oh, well, so-and-so was obese or so-and-so, you know, uh..."... was a smoker and so, you know, they (laughs) deserved their fate. So, I, I, I-

   17. JRJoe Rogan24:25

       No, no, no. We're not saying that, but, but-

   18. NCNicholas Christakis24:26

       I know.

   19. JRJoe Rogan24:27

       But-

   20. NCNicholas Christakis24:27

       I know you're not, but I'm saying, on the one hand I want to encourage good behavior. On the other hand, I want us to be careful not to suggest that, uh ... Which you weren't doing, but I'm just sort of clarifying the point.

   21. JRJoe Rogan24:36

       That it's your fault if you catch it and die.

   22. NCNicholas Christakis24:38

       Yes.

   23. JRJoe Rogan24:38

       Right. Of course.

   24. NCNicholas Christakis24:39

       Or that-

   25. JRJoe Rogan24:39

       Of course.

   26. NCNicholas Christakis24:40

       Y- yeah.

   27. JRJoe Rogan24:41

       Yeah, no.

   28. NCNicholas Christakis24:41

       And, and people who ... And, and I think ... You know, and I think, um ... I think people should be, should prepare their bodies for the possibility of being infected, but realize that there's no guarantee. You know, it's like those poor marathon runners that drop dead, you know, having run marathons their whole lives. You know, it's-

   29. JRJoe Rogan24:58

       Jim Fixx.

   30. NCNicholas Christakis24:58

       Seems really unjust.
10. 33:05 – 38:40

    Why COVID feels ‘sneaky’: asymptomatic spread and the World A vs World B model

    1. JRJoe Rogan33:05

       This one is a weird one, right? Whereas a lot of people get it and they're asymptomatic. Um, I've, I've had several friends that got it and literally experienced no, no symptoms. They were around people that had it, they got it, um, they tested positive and got as little as a mild headache or a, a slight cough for a day. Um, Jamie had it and he thought he had a sinus infection. He thought he... He has allergies and he thought it was just his allergies kicking in. Turns out he was positive, but he was very fortunate is, uh, it was a very mild case. Do we know why with some people get it... when some people get it, it's devastating? Including young people. I have a young friend, he's 28, he got it, and he was really ill for two weeks. Whereas some people get it and it's nothing.

    2. NCNicholas Christakis33:56

       Yes. So we, we have some sense of some of the reasons it varies, but, um, not a huge understanding yet of the interpersonal variation. But I would like to, uh, go on a tangent based on that, that highlights the ways in which these kind of protean manifestations of this disease, the fact that with this condition, you can go from everything from having no symptoms, to mild symptoms like Jamie, to more serious symptoms like your 28-year-old friend, to really severe symptoms to being hospitalized, to dying, right? There's this incredible range of diseases that this particular virus can cause. And in a way, this is very unfortunate for us because it makes it so much harder as a society to take the virus seriously and to combat it. Let me, let me give you an analogy. So I want listeners to imagine that there are two worlds. I'm about to describe two different worlds. In World A, there are a 1,000 people and a virus infects 10 people in this world, makes them seriously ill, and one person dies. So we would say that in this world, 10% of the people that got sick died of the virus. That's World A. In World B, there are a 1,000 people. The virus infects a 100 people. 90 of them get mild illness, 10 of them once again get serious illness like in World A, and one of them dies, again, like in World A. So in this world, in World B, a 100 people got sick and one died, so we might say 1% of them died. In World A, 10% of the people that got sick died. In World B, 1% of the people that got sick died. Now, many people hearing about this might, might think that it's better to be in World B because, you know, it seems like the vir- virus is less deadly. But that's a delusion. Because if you stop and you think about it a little bit more clearly, World B is the same as World A, plus an extra 90 people got mild illness. In other words, nobody right... no right thinking person should prefer to be in World B than to be in World A. In World A, 10 out of a 1,000 people got seriously ill and one died. And in World B that happened, plus another 90 people got mildly sick. So it's clearly worse, the overall situation is worse in World B. And that is in fact the situation that we are facing.We are in a, like a World B situation with this virus. And the reason it's hard is that i- all these extra people, those 90 people who got mild illness, make people take the disease more s- you know, casually.

    3. JRJoe Rogan36:41

       Mm.

    4. NCNicholas Christakis36:42

       Whereas in World A, people might say, "Well, not many people are getting sick, but when they get sick, 10% of them die. Wow, we should take this disease seriously." Do- do you see what I'm saying?

    5. JRJoe Rogan36:51

       Yeah, I do see what you're saying. So this, this virus is very sneaky in that way.

    6. NCNicholas Christakis36:54

       Yes.

    7. JRJoe Rogan36:55

       It's really like, uh, if you wanted to engineer a virus that's going to spread the most, that's kinda how you would do it. Have it affect so many people where they're like, "It was nothing." And then some people where, you know, they're dead within a few days.

    8. NCNicholas Christakis37:08

       Yes. And also, as you pointed out earlier, it also has this property of being transmitt- transmissible when it's asymptomatic.

    9. JRJoe Rogan37:15

       Mm-hmm.

    10. NCNicholas Christakis37:15

        So just to, just to remind people, HIV is like that. You can have HIV for years and not know it. You're spreading it to your sexual partners, and then it kills you much later. Versus smallpox, which you can't really spread smallpox before you have symptoms. You- the pustules erupt on your body, and that's when you become infectious. So there's a, there's a, there's a, uh, there's no asymptomatic transmission, uh, in smallpox and there is in HIV. And SARS 1 from 2003 was more like smallpox. In other words, people didn't begin to transmit the virus until they actually had symptoms from it, which is one of the reasons it was easier to control, because when people got symptoms, we could isolate them. Whereas with the SARS that we're facing now, the SARS-CoV-2, COVID-19, uh, people can transmit it when they're, when they're not symptomatic. And in fact, there's a lot of analyses that have been done that show about 75% of the infections have been acquired from people who were asymptomatic.

    11. JRJoe Rogan38:13

        There's another-

    12. NCNicholas Christakis38:13

        So-

    13. JRJoe Rogan38:14

        There's another issue as well that we can compare to smallpox in that you can develop a vaccine for smallpox that actually works for your whole life. You can't really do that with COVID. Correct?

    14. NCNicholas Christakis38:27

        We don't know for sure. We don't know that for sure. We- I don't know that for sure. I'm hopeful that we'll be able to have a, a vaccine that has long-term- confers long-term immunity, but I don't think we know that either way for sure.

11. 38:40 – 49:32

    mRNA vaccines explained: how they work and what ‘90–95% effective’ means

    1. JRJoe Rogan38:40

       Can you describe what's going on with these mRNA viruses and how they differ... Excuse me, mRNA vaccines, and how they differ from, uh, a regular vaccine and what, what's coming down the pipe from Pfizer? Th- these are mRNA vaccines.

    2. NCNicholas Christakis38:55

       Yes.

    3. JRJoe Rogan38:55

       It's different in that it doesn't actually contain the virus, but it boosts your body's ability to fight off the virus.

    4. NCNicholas Christakis39:03

       Yeah. So, um, so there're many different ways of developing vaccines, uh, and the idea, the general idea behind a vaccine is, is that we want to give you kind of an ersatz infection. We want to expose you, make it as if you had been infected, but without the risk of getting the disease, to trick your immune system into mounting an immune response so that your body is then prepared, if it gets the real infection, to fight it off. And, uh, one of the simplest, uh, ways you can think about it is so-called live attenuated virus. This is an old technology where you, you take the virus to the laboratory, you culture it hundreds of times, and hope for mutations that weaken the virus's ability to make you sick, but nevertheless keep the virus able to elicit an immune response. And then we give you that strain as a shot and you have, let's say, a mild illness, you've- you develop antibodies and immunity and it's sustained. Or you can have inactivated virus like one of the Chinese... The so-called, the Sinovac vaccine that's inact- was one of the first to, to start, uh, which was, uh, o- out of China, is a, is a live attenuated virus. So that is, uh... Oh, I'm sorry, did I say live attenuated already? I can't remember. But anyway, the Sinovac vaccine is a virus in which they, they take the virus... I'm sorry. No, it's not like the previous example. In this case, we take the virus and we treat it, let's say, with heat or with chemicals to kill the virus, but still have it be immunogenic. And, um, that's another approach. And there are many other approaches, a, a dozen or so, or nine or ten, uh, different approaches, one of which is this mRNA idea. And here, what is done is, um... So, so I'm sorry. Before I tell you about that, another approach might be to take, take, uh, the RNA from the coronavirus that codes for a very important protein, the spike protein on the surface of the coronavirus, and insert that into a, a really benign virus, let's say like a cold virus, for example. So we take this other species of virus, we genetically engineer it so that we insert some, uh, material, some RNA into it, let's say, that forces that virus when it infects your cells t- to give you a common cold, but also to express this protein as if you had been infected with COVID or coronavirus. And then you mount an immune system to that immune response to that protein, and now you're immune. So we gave you like a mild illness and we protected you from a more serious one. The mRNA viruses are, uh, vaccines are sort of like that. We inject you literally with, with, with RNA and the idea is, is that your cells take up the RNA and start making the protein, the alien protein, uh, that your, uh, body, uh, would have made, like if, if we had infected you with a real coronavirus. The real coronavirus, as many people remember from high school biology, the virus can't reproduce on its own. It inserts its genetic material into our cells, which then start producing the viral, uh, the virus itself. But now in a sense, instead of giving you the whole virus, we give you a little part of it, just some part of its genetic material, the mRNA, which in an ideal world does the same thing, gets inserted into your cells, you start expressing this protein, which then your body attacks and you develop an immune response to it. And we are amazingly lucky...... that, um, that our scientists have been able to develop not one but two different vaccines, and we'll have many other vaccines using different modalities, I have no doubt, that come out in the next year or two. Uh, but the Moderna and the Pfizer vaccines, we're very lucky that they exist and that they are apparently quite effective. But the s- but the story's not over on those. I don't know if you wanna talk about that, but, but... It's good news, but I don't want people to get over-optimistic either, because, you know, it's my job to be a bit of a downer.

    5. JRJoe Rogan42:59

       (sniffs) Well, the, this is the, this is the unfortunate narrative that people keep saying. Uh, the v- the virus is killing... It's, like, uh, the average immune system is 99 point whatever percent effective in protecting you from the virus, meaning 99 point whatever percent of the people who get the virus survive. Whereas-

    6. NCNicholas Christakis43:23

       No, 99% of people overall survive. One percent will die, of all people who are infected, approximately. And if you're older than 70 or 80, 20% will die.

    7. JRJoe Rogan43:33

       So why, why is the number that people keep, uh, talking about far less than that? Why is the, the, the reported number of people that get the virus who actually wind up dying, it's, it's not one percent? We're not, we're not seeing one percent nationwide in terms of people getting the virus and dying?

    8. NCNicholas Christakis43:51

       No, we know the answer to that question, and I don't think there's any ambiguity scientifically. So, so, um, it, so in order to, in, in order to really compute these numbers, it's not easy, you're right. Um, we have to look at how many people... We have to have a way of ascertaining who's infected, and then we have to have a way of ascertaining, of those, how many die. And, and, uh, and that's called the infection fatality rate. And there was just a recent meta-analysis looking at very good data from around the world, multiple studies using different approaches, that estimated that the infection fatality rate is between .5 and .8%. And there's something called the case fatality rate is the fraction of people who have symptoms who g- when infected who die. And that number's about twice that, so about half the people get the virus and have no symptoms at all, so if you get symptoms, you have a higher risk of death. And so you can double .5 to .8 becomes 1 to 1.6% of people who, um, who develop symptoms from the disease die. And there was another very good study that was just released a couple of weeks ago that estimated the infection fatality rate to be about one percent. So there's a lot of little numbers I've thrown out at you, but-

    9. JRJoe Rogan45:03

       Right, but this is people-

    10. NCNicholas Christakis45:04

        But the gist is-

    11. JRJoe Rogan45:05

        ... with symptoms.

    12. NCNicholas Christakis45:07

        Yeah, but even without symptoms, the infection fatality rate is certainly not less than half a percent and could be as high as one percent. I would say it's gonna be in that range, the IFR, the infection fatality rate.

    13. JRJoe Rogan45:18

        But isn't there a large percentage of people that get it that don't have symptoms?

    14. NCNicholas Christakis45:22

        Half, about half we think. That's right.

    15. JRJoe Rogan45:24

        Okay.

    16. NCNicholas Christakis45:24

        Of the people who get it don't have symptoms. But you said 99 point something percent-

    17. JRJoe Rogan45:29

        Right.

    18. NCNicholas Christakis45:29

        ... of people who get it survive. And that point something is, is important. So I would say that if you said 99.5% of the people who get infected survive, I would say, yeah, could be.

    19. JRJoe Rogan45:40

        Okay.

    20. NCNicholas Christakis45:40

        But it's somewhere in there, 99-

    21. JRJoe Rogan45:41

        Well, I don't think, I don't think I gave a number. I think I said 99 point something. But the point-

    22. NCNicholas Christakis45:45

        Yeah, okay.

    23. JRJoe Rogan45:45

        ... point being that unfortunately a lot of people are saying this vaccine is 94% effective or 90% effective-

    24. NCNicholas Christakis45:55

        Yeah, what that means is that-

    25. JRJoe Rogan45:56

        ... depending on who you ask.

    26. NCNicholas Christakis45:57

        Y- yeah, but that, what that means is, is that if you're, uh, if it reduces your risk of death by that fraction, so for example, in the vaccine trial, in the, uh, Pfizer trial, uh, these numbers are approximate. Uh, in, they l- they had about 43,000 people in the trial. Half of them got the vaccine. Half of them did not. And in the people who got the vaccine, nine people, up to nine, let's say nine or ten, got, even though they were vaccinated, still got coronavirus, still had the disease. The vaccine was not perfect. And in the peop- in the arm that did not get the va- vaccine, the other 20,000 people, let's say 90 people approximately got coronavirus. So what the vaccine did is, is it reduced your probability of getting the disease from 90 out of 20,000 people over the time window of the study to 10 out of 20,000 people. So the, the point here is, is that the, the v- the vaccine is reducing your risk of getting seriously ill if you're infected. And, um, and it, it, and, and it's not, and you're certainly better off. In other words, you would have had, let's say, a 1% chance of dying, uh, before, and now you have a .1% chance of dying, 90% lower than that because we, you know, we've given you the vaccine.

    27. JRJoe Rogan47:17

        I completely-

    28. NCNicholas Christakis47:17

        Does that make sense?

    29. JRJoe Rogan47:18

        I completely, I understand exactly what you're saying. What I'm trying to say is there's an unfortunate narrative where people are saying, "I'm not going to take a vaccine because the human immune system is more effective than the vaccine." See-

    30. NCNicholas Christakis47:32

        That's not true.
12. 49:32 – 59:39

    Vaccine unknowns and rollout realities: safety, transmission blocking, prioritization, cold chain

    1. NCNicholas Christakis49:32

       We don't know that yet. Those results haven't been released. And also, what we don't know, so we don't know the answer to that, but we will know. And also what we don't know yet is we, we don't know how safe the vaccine is. So first of all, just to be very clear, both Pfizer and Moderna have released interim results, and we have every reason to believe that the final efficacy results will be about the same. So as they complete the trial in the coming month or two, and more people get sick in both arms, we don't expect suddenly the vaccine not to work. I mean, we've gotten to a point where it's, we're pretty sure that the vaccine will be effective. And, um, but we don't yet know the safety of the vaccine, is one thing we, another thing we don't know. And we also don't know something else, it's very important for people to understand, again, and since everyone needs to be an immunologist now, imagine that you're doing a trial and you're trying to see whether a vaccine works or not. Uh, you have to define what counts as works, what counts as an end point. So let me give you three possibilities. One possibility is we're gonna measure, does the vaccine prevent you from even getting infected? Or does the vaccine say, you're not... Or do we say, the vaccine's not gonna be able to stop you from getting infected. The virus is gonna take root in your body, but the vaccine is gonna prevent the virus from making you seriously ill. Or do we say, actually the outcome we really care about is death. Does the virus reduce your probability of death? So, it's possible that the vaccine, for example, might, just to illustrate this point, prevent you from getting seriously ill, but not reduce the probability of death. In other words, in the, but in the Pfizer trial that I just described to you with the ni- in the, in the vaccine arm, uh, 10 people got sick, and in the non, in the placebo arm, 90 people got sick. What if in both arms one person died? One out of the 10 in the vaccine arm died, and one out of the 90 in the, in the other arm died. We would say that the vaccine was effective at lowering your probability of getting ill, which is great, but it had no effect on dying. That's possible. It's possible that the vaccine will work at different, uh, phases of the illness process. And so, the Pfizer trial, uh, revealed that there was a greatly reduced probability of people getting infected. The Moderna trial actually showed that its vaccine reduced the probability of people getting seriously ill, which is great. But it might in fact have no effect on mortality still. We don't know. Furthermore, we also don't know whether this vaccine, even if it works, reduces, re- reduce, even if it works to reduce your probability of getting sick or dying, whether it works to reduce your ability to infect other people.

    2. JRJoe Rogan52:17

       Mm.

    3. NCNicholas Christakis52:18

       So m- so maybe we, we start vaccinating the population, we're reducing the individual recipient's probability of getting sick, but they still can spread the disease. (laughs) So, so this is something else that's not known. So we don't know the safety, we don't know which outcomes are really being affected, and we don't know if it affects infectiousness. And all of these things are things we will soon learn in the coming year. But we don't yet know them. So I just, it's fantastic news that we have a vaccine, but I just don't want people to get, think it's a panacea.

    4. JRJoe Rogan52:47

       Is the...

    5. NCNicholas Christakis52:48

       And-

    6. JRJoe Rogan52:48

       Go ahead. Please go, continue.

    7. NCNicholas Christakis52:50

       No, no, I was just gonna say one more thing, which is that, um, which is that, uh, is that, um... Hold on, let me just remem- recover what I was about to say about, uh, the, the vaccine and um, um... I forgot what I was gonna say, but go on, you were gonna say something.

    8. JRJoe Rogan53:07

       (laughs) Sorry.

    9. NCNicholas Christakis53:08

       No, no, it's my fault.

    10. JRJoe Rogan53:09

        This is the problem with Skype calls. Um-

    11. NCNicholas Christakis53:12

        Well, no, it's not just that, it's just, this is a complicated topic and there's, you know, all I've been thinking about is coronavirus for the last 10 months. I mean, there's just so much stuff in my mind about this thing that, uh... Oh, I remember. 'Cause I thought, I was wanting to talk to you about this. So I want people to also begin to think about, who should we give the vaccine to? Like, what are the ethical and public health issues associated with, as we start producing the vaccine, you know, first we'll have a million doses. Well, who should get the first million doses? It's pretty ethically uncontroversial that the very first doses should go to the people in the placebo arm of the trial, (laughs) because those people took the risk of being s- experimental subjects. They were randomly assigned to the placebo arm. Uh, they clearly should get first dibs on the actual effective drug that's now been shown to be effective because of their contributions. Okay, great. Then, m- pretty uncontroversial is that the next group of people to get it should be doctors, nurses, firemen, policemen, first responders, ambulance drivers, all of those people, healthcare workers. Those people, because they're putting themselves in harm's way during a contagious disease to protect the rest of us, they should be next. Okay, fine. But then who? Who's next after that? And here it gets very tricky, both ethically and from a public health point of view. And let me give you one, an, an example of this.So on the one hand, you might say we should vaccinate, let's say, vulnerable elderly people or people with chronic illnesses. They have the greatest chance of dying if they get infected. We should give the vac- First 10 or 20 million doses should go to elderly people in nursing homes. And there's a lot of compelling reason to do that. But it turns out that such individuals, from a network science perspective, are at- at- at what's called the end of the transmission chain. It actually might make more sense, and we might save more lives from a public health point of view, if we vaccinated working-age people, people who are out and about. Because if I vaccinate you, and I, by virtue of making you immune, stop you from transmitting the disease to other people, since you're out and about and seeing lots of other people, I might actually wind up saving more lives, paradoxically, by vaccinating the people at lowest risk. And this is-

    12. JRJoe Rogan55:32

        How do you educate people on that? That seems like a complicated one to explain.

    13. NCNicholas Christakis55:36

        Yes. So that's, and- and our nation's gonna face this dilemma very soon, in fact. Because when the initial... Of course, if we had 300 million doses, we wouldn't have to make these choices. We could just give everyone the shot who- who wanted it. And incidentally, the cold chain requirements for this, this is another topic now, tangent on a tangent, but you know, many rural parts of our country simply don't have the kind of refrigerators that are needed to, uh, stockpile and administer, uh, these vaccines. So-

    14. JRJoe Rogan56:05

        What kind of refrigerators are needed for these vaccines?

    15. NCNicholas Christakis56:08

        Well, the- the- the Pfizer one needs a minus 80, uh, refrigerator. Uh, these aren't common. Like, below- below dry-ice cold. And so, um, and so not every pharmacy, you know, your local CVS or Walgreens doesn't have usually this type of refrigeration. And so you, so you ha- And plus, all the trucks transporting it, like, from the moment that- that the vaccine is manufactured till the moment it's injected, it has to be most- many vaccines, not all vaccines, have to be in what is known as the cold chain. They can never be defrosted. And building the logistics to distribute the vaccine is a big, big challenge. So not only do we have to invent a vaccine like we are, which is magnificent that our nation is able to do that, but we have to manufacture it, which is not easy. You know, we need little glass vials. We need millions of them, and we need factories that can produce this particular kind of vaccine, et cetera. We need to distribute it, like the cold chain, the refrigeration I mentioned, and most important, we need to persuade people to accept a vaccine. And this touches on what we were discussing earlier, whether people will believe that the vaccine is useful, and of course, we have an anti-vax population in our country and so on. So, all of these challenges have to be overcome. So if we had 300 million doses of the vaccine, this would be less of a dilemma, but initially we're not gonna have that. We're gonna have some lower number of doses, and those doses will be more easily administered in metropolitan areas that have the right refrigerators. So we as a nation are gonna need to begin to think about this, about how to, you know, um, choose or distribute the vaccine.

    16. JRJoe Rogan57:47

        That's very complicated. Now, the- the difference between the Pfizer and the Moderna vaccine is what?

    17. NCNicholas Christakis57:54

        Well, as I- I'm told, and I'm no expert on this narrow topic, that the Moderna vaccine actually doesn't require as cold refrigeration for reasons that I don't understand. Since they're both RNA vaccines, they both are encased in lipids. Uh, one of them requires a much colder temperature f- uh, for distribution than the other. So the Moderna one, I'm pretty sure, is the one that is- uh, is- uh, can- can- uh, doesn't require quite as cold a refrigeration, which makes the logistics of distribution much easier.

    18. JRJoe Rogan58:26

        Do we know- We don't have any idea why?

    19. NCNicholas Christakis58:30

        I'm sure experts know that. I don't know the answer to that, why-

    20. JRJoe Rogan58:32

        Well-

    21. NCNicholas Christakis58:32

        ... uh, why it does.

    22. JRJoe Rogan58:34

        Is there anyone who's tried both? Like, is there any benefit in getting vaccinated with both vaccines?

    23. NCNicholas Christakis58:41

        I doubt that because they're very similar in approach, but I can imagine that the time will come when, uh, there might be some benefit in getting two complementary vaccines, when we have developed still more approaches, as we were talking about earlier, when you can get this and also that. Now, it's also possible, and- You know, I mean, we just don't know the answers to all these questions. It's also possible... So some significant fraction of people who die of coronavirus die because of their own body, um, over-response to it. Their immune system is too- too dramatic, uh, too dramatically responds. And it's possible that- uh, that we may not want to give people multiple versions, different kinds of vaccines, because we might over-excite their immune system in a way that actually harms them in some way.

    24. JRJoe Rogan59:28

        Mm.

    25. NCNicholas Christakis59:29

        So, these things are all gonna be- uh, are all gonna be sorted out, you know, in the coming year. We just- I just don't want people to think it's all ver- all simple, because it's- uh, it's not.

13. 59:39 – 1:32:40

    Trump’s COVID case, therapeutics (dexamethasone/antibodies), and misinformation dynamics

    1. JRJoe Rogan59:39

       Now, Donald Trump is 74. He's overweight and eats cheeseburgers every day. When a guy like that catches COVID and is fine in four days, people get v- very dismissive of it, unfortunately.

    2. NCNicholas Christakis59:53

       Yeah.

    3. JRJoe Rogan59:53

       Right? What did he receive? What kind of treatment did he receive, and how different is it than what the average person would receive if they got sick?

    4. NCNicholas Christakis1:00:02

       So he- he faced a very significant risk of death, and I- I think he got lucky. Um, so remember his doctors put him on dexamethasone. So, so far we only have one proven drug, uh, that lowers your risk of death if you're seriously ill from COVID, and that's a very simple steroid called dexamethasone. And, um, remdesivir has not been shown to lower mortality. Um, it has been shown to lower your length of hospital stay, so there's some benefit to it, but it doesn't appear to lower your risk of death. And-

    5. JRJoe Rogan1:00:34

       What would be the difference between lowering your risk of hospital stay and lowering your risk of death? Why would they let you out of the hospital if you hadn't shown significant health improvements?And wouldn't significant-

    6. NCNicholas Christakis1:00:45

       Yeah, it's a mystery. It sounds-

    7. JRJoe Rogan1:00:45

       ... health improvements, wouldn't significant-

    8. NCNicholas Christakis1:00:47

       It sounds-

    9. JRJoe Rogan1:00:47

       ... health improvements sig- signify that your body's recovering better?

    10. NCNicholas Christakis1:00:52

        Yeah, it's a mystery and it's confusing. And when the first Remdesivir trial was published a few months ago, it didn't show a- a benefit for mortality, but it showed, but it showed a trend. It looked like it would help and it made sense, like if it's lowering your hospital duration, probably it's good for you and it'll also lower your risk of death. But then another trial came out, much bigger trial, as part of the, um, think it was called the Solidarity Consortium, either the Solidarity or the Recovery, I can't remember right now, Consortium, out of England, which showed that actually Remdesivir had no benefit for, uh, mortality. Now how can that be? Imagine that, imagine that, uh, you have 100 people who are sick and in the group that gets Remdesivir, uh, they only wind up spen- spending an average of 10 days in the hospital, but, um, 10 of the people die. And in the other study, uh, the people that did not get Remdesivir, uh, 100 people get sick and they spend an average of 12 days in the hospital, but again, 10 of them die. So the Remdesivir has lowered the hospital duration from 12 to 10 days, but it hasn't affected the probability of people dying. That's entirely possible.

    11. JRJoe Rogan1:01:58

        So there-

    12. NCNicholas Christakis1:01:58

        And that is in fact what appears to have happened.

    13. JRJoe Rogan1:02:00

        And this was a study you said that was in England?

    14. NCNicholas Christakis1:02:04

        Yes. It was a large study that was... I- I- I think, I- I- I think the subjects were not just in England. It was organized by a group of English scientists, either the Solidarity or the Recovery Consortium, and I just don't remember right now the- the name of it. But- but I want to go back to your question about the president. So the president was given dexamethasone and when that happened, I stated publicly that either the president was sicker than they were telling us, so he was sufficiently sick that they wanted to give him dexamethasone, because giving dexamethasone early in the course of the disease, before you're very sick, actually can harm you. So you don't want to give it to someone at the beginning of their disease. You need to wait until they're sufficiently sick and then it helps you. So either he was sicker than they told us, and so they were lying to us, or he was, uh, really needed the dexamethasone, in which case he faced a significant risk of death. So people in the trials that showed that the dexamethasone worked, 74-year-old overweight people, men, and men are at much greater risk of dying than women of this condition, who got the dexamethasone, they had about a 20% chance of death. So I think the president actually faced a 20% chance of death when he was at the hospital, which is a big risk of death. And I think he- he got lucky. He, you know, he survived. He was also given the- this cocktail of- of, um, artificial antibodies to the disease, which I think is another promising approach to treating this condition. We don't yet have the results of those randomized control trials, but we'll also know soon if those drugs, uh, you know, help.

    15. JRJoe Rogan1:03:40

        So this was an experimental treatment that they gave him?

    16. NCNicholas Christakis1:03:43

        Yes. They gave him not the dexamethasone. That was a well-documented treatment.

    17. JRJoe Rogan1:03:47

        Right. But the antibody-

    18. NCNicholas Christakis1:03:48

        But the antibody cocktail was apparently, the CEO of the company, of Regeneron, was his golfing buddy or something. I'm not exactly sure.

    19. JRJoe Rogan1:03:57

        So whatever it was, it seemed to be very effective. And- and then immediately-

    20. NCNicholas Christakis1:04:02

        No, I wouldn't conclude that.

    21. JRJoe Rogan1:04:03

        ... he went on a wild tweet storm. It seemed like he had a lot of energy.

    22. NCNicholas Christakis1:04:07

        Well, the dexamethasone may have given him (laughs) , yeah, a steroid high. I- I wouldn't conclude that the antibody cocktail was necessarily effective. We don't-

    23. JRJoe Rogan1:04:15

        No, no, no.

    24. NCNicholas Christakis1:04:15

        ... know the answer to that.

    25. JRJoe Rogan1:04:15

        I didn't- I didn't mean that. I meant-

    26. NCNicholas Christakis1:04:17

        Oh, yeah.

    27. JRJoe Rogan1:04:17

        ... the treatment, the overall treat-

    28. NCNicholas Christakis1:04:19

        Yep.

    29. JRJoe Rogan1:04:19

        ... whatever they gave him when he was in the hospital, the response was, for a 74-year-old guy to be back on the campaign trail with this rigorous campaign that he was doing four or five days later, pretty damn impressive.

    30. NCNicholas Christakis1:04:32

        Yes, that... Yes, I did not expect that at all. And, uh, and I, as I said, I think he got lucky. And I do think, you know, dec- steroids can give you, um, can make you a little psychotic and a little manic actually. And I- and I think, I mean, you know, s- can't really know from a distance, but to me, he had a, as a doctor, I- I, looking at him, I thought, "This man has a little bit of a manic feel to him." But then, you know, they take-

Episode duration: 2:10:41