Joe Rogan Experience #1566 - Nicholas Christakis

Nicholas Christakis 0:02 (instrumental music plays) Joe Rogan podcast, check it out. The Joe Rogan Experience.

Joe Rogan 0:06 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.

Nicholas Christakis 0:21 How did the sober October work for you?

Joe Rogan 0:22 It's great. Do it every year. It's nice. A little reset.

Nicholas Christakis 0:26 It's interesting, you know.

Joe Rogan 0:27 Very nice.

Nicholas Christakis 0:27 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.

Joe Rogan 0:46 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."

Nicholas Christakis 0:57 Yeah.

Joe Rogan 0:57 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.

Nicholas Christakis 1:06 (laughs)

Joe Rogan 1:07 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.

Nicholas Christakis 1:41 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-

Joe Rogan 1:49 Yeah.

Nicholas Christakis 1:49 ... 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.

Joe Rogan 2:20 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.

Nicholas Christakis 2:34 (laughs)

Joe Rogan 2:34 They're only 79 bucks and it's, it's fantastic. It cleans your butt so much better than just toilet paper-

Nicholas Christakis 2:42 (laughs)

Joe Rogan 2:42 ... and your, it cuts your toilet paper consumption down by like 85, 90%-

Nicholas Christakis 2:47 (laughs)

Joe Rogan 2:47 ... 'cause you just need a little bit of toilet paper to pat your butt dry at the end.

Nicholas Christakis 2:50 (laughs)

Joe Rogan 2:51 Do you ever use one of those? Bidet attachments?

Nicholas Christakis 2:53 Well my, in Greece, they're not uncommon to have bidets so you know in this-

Joe Rogan 2:57 Yeah.

Nicholas Christakis 2:58 ... I, I of course am familiar with them, but we don't have one here. But it's interesting we-

Joe Rogan 3:03 You should get one.

Nicholas Christakis 3:03 Say that again?

Joe Rogan 3:04 You should get one. You should get one. I'm telling you-

Nicholas Christakis 3:05 Yeah, well we're-

Joe Rogan 3:06 ... it's so much better.

Nicholas Christakis 3:07 We may. We may in fact.

Joe Rogan 3:09 You should.

Nicholas Christakis 3:10 So, uh, I can't believe we've covered alcohol and bidets on the program already. (laughs)

Joe Rogan 3:13 (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?

Nicholas Christakis 3:23 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.

Joe Rogan 7:11 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?

Nicholas Christakis 7:28 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-

Joe Rogan 8:45 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?

Nicholas Christakis 8:58 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.

Joe Rogan 9:37 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.

Nicholas Christakis 9:55 Yeah.

Joe Rogan 9:55 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.

Nicholas Christakis 10:23 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.

Joe Rogan 10:34 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-

Nicholas Christakis 10:42 Yes.

Joe Rogan 10:42 ... 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.

Nicholas Christakis 10:50 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-

Joe Rogan 11:53 Can I, can I stop you for a second there?

Nicholas Christakis 11:54 Yeah.

Joe Rogan 11:54 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-

Nicholas Christakis 12:21 Well-

Joe Rogan 12:21 ... especially an N95 mask.

Nicholas Christakis 12:23 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.

Joe Rogan 13:02 But isn't, uh, hasn't it been shown that the virus is also aerosol now?

Nicholas Christakis 13:07 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-

Joe Rogan 13:14 Okay.

Nicholas Christakis 13:14 ... 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.

Joe Rogan 14:49 Yeah, the valve ones are kind of silly, aren't they?

Nicholas Christakis 14:51 Yes.

Joe Rogan 14:51 It doesn't, it defeats the whole purpose.

Nicholas Christakis 14:54 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-

Joe Rogan 15:59 Yes. Wear a mask.

Nicholas Christakis 16:00 ... wearing the mask.

Joe Rogan 16:00 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.

Nicholas Christakis 16:31 Yes.

Joe Rogan 16:32 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."

Nicholas Christakis 16:43 Yes. Yes, although again, I would say that something is better than nothing, and-

Joe Rogan 16:45 Yes.

Nicholas Christakis 16:45 ... 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.

Joe Rogan 18:13 J-

Nicholas Christakis 18:13 And ... Yeah?

Joe Rogan 18:14 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?

Narrator 18:27 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.

Joe Rogan 18:44 But there have been people that have been re-infected in as early as three months. Isn't that correct?

Nicholas Christakis 18:49 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.

Joe Rogan 21:08 Yeah.

Nicholas Christakis 21:08 Which is that-

Joe Rogan 21:09 Which is probably good.

Nicholas Christakis 21:10 ... is it or is it... What'd you say?

Joe Rogan 21:12 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.

Nicholas Christakis 21:28 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.

Joe Rogan 22:29 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-

Nicholas Christakis 23:05 Yes.

Joe Rogan 23:05 ... all the other things that we know are effective, but why has there been no discussion about boosting your immune system?

Nicholas Christakis 23:13 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.

Joe Rogan 23:53 Yes.

Nicholas Christakis 23:53 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-

Joe Rogan 24:25 No, no, no. We're not saying that, but, but-

Nicholas Christakis 24:26 I know.

Joe Rogan 24:27 But-

Nicholas Christakis 24:27 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.

Joe Rogan 24:36 That it's your fault if you catch it and die.

Nicholas Christakis 24:38 Yes.

Joe Rogan 24:38 Right. Of course.

Nicholas Christakis 24:39 Or that-

Joe Rogan 24:39 Of course.

Nicholas Christakis 24:40 Y- yeah.

Joe Rogan 24:41 Yeah, no.

Nicholas Christakis 24:41 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-

Joe Rogan 24:58 Jim Fixx.

Nicholas Christakis 24:58 Seems really unjust.

Joe Rogan 24:59 Yeah, that was-

Nicholas Christakis 25:00 What?

Joe Rogan 25:00 Jim Fixx. He's a famous-

Nicholas Christakis 25:02 Yeah.

Joe Rogan 25:02 ... guy who wrote books on running, and Bill Hicks had a hilarious joke about him running and dying. Uh, yeah, it's, that's unfortunate, but that's probably some sort of cardio disease that he had. Um-

Nicholas Christakis 25:12 Yeah.

Joe Rogan 25:13 Th- there's, there's ways that the government could have done it without shaming people that did get sick. There's, there's, there ... I mean, it, it wouldn't have-

Nicholas Christakis 25:23 Yeah.

Joe Rogan 25:23 ... taken much time to tell people... I mean, I've, I've had multiple health experts on this podcast that talk about different methods to strengthen your immune system, particularly supplementation with vitamin D. It part- it seems to be, and Fauci's talked about this as well, seems to be particularly effective with, uh, boosting your immune system. And also, it's a giant problem with people, um, who are, uh, who wind up, uh, in the ICU. Um, there's a recent study that showed that 84% of the people in the ICU with COVID, uh, were deficient in vitamin C, and only 4% had sufficient levels. Um, and y- I'm sure-

Nicholas Christakis 26:01 So-

Joe Rogan 26:01 Go ahead.

Nicholas Christakis 26:02 So no, I, I haven't followed that particular literature, but, you know, as someone who loves the sun, and, uh, you know, I could s- strongly endorse (laughs) you know, getting adequate sun exposure for vitamin D alone.

Joe Rogan 26:15 Yeah, but you know the w- the, the sun is the best way to get vitamin D, for sure. But the way to get it, if through the sun, requires you to be in shorts and nothing else, like a, like a Neanderthal running around all day. That's how we're designed. I mean, that's, like, that's really what we're supposed to be doing. That's, uh, it's very unfortunate that we figured out houses. I mean, it's kept us alive and kept us protected from predators and the elements, and all sorts of other things that would have killed us. But it severely diminished our ability to absorb vitamin D from the sun. And vitamin D being not just a vitamin, but also a- maybe even possibly mislabeled as a vitamin. It's really a hormone, right?

Nicholas Christakis 26:54 Well, it can be a precursor to hormones, yes. But, uh, I think that I, um, I ... Boy, you've wandered into an area that's sort of ... I'm trying to remember my medical school, the last time I thought about vitamin D synthesis and ... Uh, but my memory is it doesn't take much sun exposure per day for your body to produce adequate levels of vitamin D. Um, I think an hour a day or something like that. But yes, in general you're right. That is to say that, you know, the, a lot of the ways we live in the modern world compromise our immune systems and their functioning.

Joe Rogan 27:25 I think there's very few-

Nicholas Christakis 27:26 There are even some-

Joe Rogan 27:26 ... people that are actually getting their blood work done. So, even when you say, "An hour a day give you sufficient levels," how many of these people are actually going an hour a day and then getting blood work done and finding out what the actual vitamin D levels in their blood are? Very few. That, that's, it's, it's, it's highlighting a weakness in our understanding of our own bodies.

Nicholas Christakis 27:48 See, this I, I mean, this part I would certainly agree with, Joe, in the sense that, uh, as a nation in a way, we've ... Um, how to put this exactly? I don't wanna say we've become soft, 'cause that's not exactly what I wanna say. It's sort of like-

Joe Rogan 28:02 I'll say it.

Nicholas Christakis 28:02 ... you know, we ... What? You'll s- (laughs) you'll sa-

Joe Rogan 28:06 I'll say it. (laughs)

Nicholas Christakis 28:07 No, I mean, we're not ... You know, we, we want our cake and eat it too, and in a way, that's sort of what I, I'm trying to talk about a little bit with respect to the pandemic as well, which is that we all wish that we didn't have to endure this unpleasant reality that this virus is now afflicting us. It's a little bit ... And, and we're all tired. You know, we all have COVID fatigue. But it's a little bit like being in the dentist chair and he's done two root canals and you don't want him to do any more.

Joe Rogan 28:33 Right.

Nicholas Christakis 28:33 But your not wanting any more root canals has nothing to do with whether you need them.

Joe Rogan 28:37 Right.

Nicholas Christakis 28:37 You know? Unfortunately, this is the reality that we're facing, and so what I, I really want, uh, and what I wanted to d- do in the book, in Apollo's Arrow, was to sort of help people to see the world for how it really is now, which is that something big has happened, something that doesn't happen but every 50 or 100 years or so. It's, it's, it's ... It, and, and this, and, and, and more importantly, this, this way we've been aff- the virus has forced us to live, which feels so alien and unnatural to us ... In fact, this way, it's not new to our species, it's just new to us. You and I think this is outrageous. How, how can we have to do all of this stuff? But, you know, our ancestors have been dealing with this for thousands of years.

Joe Rogan 29:20 Yes.

Nicholas Christakis 29:20 We're not the first generation to have to do this. This is our time in the crucible, and I would h- I would hope for better for, for us.

Joe Rogan 29:27 And-

Nicholas Christakis 29:28 And-

Joe Rogan 29:28 ... in terms of crucibles, it's so small. I mean, again, not to minimize the death and the suffering, but I'm, I'm in the middle of reading Harari's book, Homo Deus.

Nicholas Christakis 29:37 Yeah.

Joe Rogan 29:37 And, you know, in it, the beginning of it, he talks about, uh, uh, famine and plague for most of the first chapter, and the, just the sheer numbers of people that have died in past plagues throughout human history be- before antibiotics and before-

Nicholas Christakis 29:53 Yes.

Joe Rogan 29:53 ... we even understood what, what viruses were. I mean, it's horrific what we're-

Nicholas Christakis 29:57 Horrific.

Joe Rogan 29:58 ... we're, what-

Nicholas Christakis 29:58 I mean, the bubonic plague would sweep through cities in Italy and kill half the people.

Joe Rogan 30:03 Yes. Yes.

Nicholas Christakis 30:03 Like, within a month, half are dead.

Joe Rogan 30:05 Yeah.

Nicholas Christakis 30:05 Or smallpox, when, when, uh, when the Europeans landed in, in, uh, in this co- in our continent, and they brought with them old world diseases, uh, to the new world, th- smallpox would wipe out Native American populations. You know, 95% of the people-

Joe Rogan 30:20 Yep.

Nicholas Christakis 30:20 ... would die.

Joe Rogan 30:21 Yeah. Yeah. Insane. Yeah.

Nicholas Christakis 30:24 I- yeah. And so, as you're ... Yeah.

Joe Rogan 30:26 So we're, we're very fortunate in term- uh, as we said before, that this is the disease we're, we're dealing with. I think in many ways this is going to give us a much better understanding of what could happen and, and give us a better, better understanding of what we need to do if something new comes along.

Nicholas Christakis 30:48 Yes. I mean, I, I think that's right. I mean, I think, um... I mean, you're, you're kind of... I'm actually glad that you're going there because one of the things I don't want, I don't wanna be seen as this like nihilistic doom-saying, you know, pessimistic guy.

Joe Rogan 31:02 Too late.

Nicholas Christakis 31:03 And so... Uh, too late, yes. (laughs)

Joe Rogan 31:05 (laughs)

Nicholas Christakis 31:05 So I'm glad (laughs) , I'm glad you are bringing up the fact that actually there could be another pandemic.

Joe Rogan 31:11 Yes.

Nicholas Christakis 31:11 And usually, usually the... if you look at the respiratory pandemics for the last 300 years, the inter-pandemic interval is about 10 to 20 years. That means we have a pandemic every 10 or 20 years, but they're not deadly usually. So for example, we had one in 2009, the H1N1 pandemic. Most listeners might have a vague memory of hearing about it, but people didn't really pay much attention because it didn't kill many people. It was like the common cold. So we had a pandemic, but it wasn't very deadly. Then we had the 2003 previous Coronavirus, the SARS1 pandemic. It spread to about 30 countries. But for various reasons, that pandemic extinguished and we only had about 8,000 people worldwide who died of that. So we'd also sort of forgotten that. The last serious pandemic we had of Influenza A virus, it's a different virus to the Coronavirus, was in 1957. That was the second worst pandemic we've had in a hundred years, and the previous leading killer was of course the 1918, the so-called Spanish Flu pandemic. And the current pandemic we're having will be almost as bad as that in the sense that, just to be clear to listeners, it's not gonna kill tens of millions like that pandemic killed, we don't think. But the point is, the current pandemic we have is the second worst that we have had in a hundred years. Worse than the '57, which was the previous second worst. So, so it... You know, so, so pandemics come every 10 or 20 years. They're only really bad, let's say every 50 or a 100 years, but there's no reason that we couldn't have another one soon, you know.

Joe Rogan 32:44 Right.

Nicholas Christakis 32:45 And in fact, right now, there's surveillance systems in place in China which monitor the emergence of new influenza strains, and there was just a paper published a couple of months ago suggesting there's a serious strain of influenza bluing, blooming, uh, brewing. I'm sorry. Uh, so, you know, we'll see.

Joe Rogan 33:05 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.

Nicholas Christakis 33:56 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.

Joe Rogan 36:41 Mm.

Nicholas Christakis 36:42 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?

Joe Rogan 36:51 Yeah, I do see what you're saying. So this, this virus is very sneaky in that way.

Nicholas Christakis 36:54 Yes.

Joe Rogan 36:55 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.

Nicholas Christakis 37:08 Yes. And also, as you pointed out earlier, it also has this property of being transmitt- transmissible when it's asymptomatic.

Joe Rogan 37:15 Mm-hmm.

Nicholas Christakis 37:15 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.

Joe Rogan 38:13 There's another-

Nicholas Christakis 38:13 So-

Joe Rogan 38:14 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?

Nicholas Christakis 38:27 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.

Joe Rogan 38:40 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.

Nicholas Christakis 38:55 Yes.

Joe Rogan 38:55 It's different in that it doesn't actually contain the virus, but it boosts your body's ability to fight off the virus.

Nicholas Christakis 39:03 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.

Joe Rogan 42:59 (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-

Nicholas Christakis 43:23 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.

Joe Rogan 43:33 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?

Nicholas Christakis 43:51 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-

Joe Rogan 45:03 Right, but this is people-

Nicholas Christakis 45:04 But the gist is-

Joe Rogan 45:05 ... with symptoms.

Nicholas Christakis 45:07 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.

Joe Rogan 45:18 But isn't there a large percentage of people that get it that don't have symptoms?

Nicholas Christakis 45:22 Half, about half we think. That's right.

Joe Rogan 45:24 Okay.

Nicholas Christakis 45:24 Of the people who get it don't have symptoms. But you said 99 point something percent-

Joe Rogan 45:29 Right.

Nicholas Christakis 45:29 ... 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.

Joe Rogan 45:40 Okay.

Nicholas Christakis 45:40 But it's somewhere in there, 99-

Joe Rogan 45:41 Well, I don't think, I don't think I gave a number. I think I said 99 point something. But the point-

Nicholas Christakis 45:45 Yeah, okay.

Joe Rogan 45:45 ... point being that unfortunately a lot of people are saying this vaccine is 94% effective or 90% effective-

Nicholas Christakis 45:55 Yeah, what that means is that-

Joe Rogan 45:56 ... depending on who you ask.

Nicholas Christakis 45:57 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.

Joe Rogan 47:17 I completely-

Nicholas Christakis 47:17 Does that make sense?

Joe Rogan 47:18 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-

Nicholas Christakis 47:32 That's not true.

Joe Rogan 47:33 That's what I wanted to get out of you.

Nicholas Christakis 47:34 Yeah, yeah, yeah, that's not true. And-

Joe Rogan 47:35 So people are saying... Yeah, go ahead.

Nicholas Christakis 47:38 Well, no, I'm saying the vaccine, the whole way vaccines sys- vaccines work is it, it, uh, enhances your, your performance. You know, it's like, uh, it, it stimulates your immune system to make it even better at fighting the v- the virus. There's, there's no sense in which you could argue that an unchallenged immune system is superior to a challenged immune system, a, a system that has been, you know, been given a vaccine. So, um-

Joe Rogan 48:01 This is what's important to tell people, right? Because this narrative of 99% of the people who get it, 99 point whatever, uh, your immune system is effective in fighting off this disease, whereas with the virus, it's only 90 plus whatever percent effective in prev- preventing the virus. So this is not a, this, that's not a good narrative, correct?

Nicholas Christakis 48:24 That's right. And you, the way to think about it is, just to pick some round numbers as you were saying, and, and like, and like, uh, like me, you sometimes use the word virus when you mean vaccine, and you use the word vaccine when you mean virus, so I-

Joe Rogan 48:35 Yeah, I'm sorry.

Nicholas Christakis 48:36 I do that all the time.

Joe Rogan 48:37 99... Yeah.

Nicholas Christakis 48:38 (laughs) I do that all the time, it's so annoying.

Joe Rogan 48:40 Yeah.

Nicholas Christakis 48:40 But anyway, let's say for the sake of argument, you have an, unvaccinated you have a 99% chance of surviving if you get infected.

Joe Rogan 48:47 Right.

Nicholas Christakis 48:49 Uh, you have to add to that the benefit of the vaccine, which is a 90%, let's say, effectiveness. So it'll reduce your probability from 99% chance of surviving, to 99.9% chance of surviving.

Joe Rogan 49:02 Yes. Thank you. That's exactly-

Nicholas Christakis 49:03 Yes.

Joe Rogan 49:03 ... what I wanted to get out of you.

Nicholas Christakis 49:05 Yes.

Joe Rogan 49:05 Um, there, there, that, when, when you talk about the people that took the vaccine, and, uh, we know you, you have the data between the difference of the vaccine, the people that got the placebo. The people that got the vaccine that still wound up getting COVID, did they do health screens on these people and find out what comorbidity factors they may have had and see if there's anything that would indicate that there's par- par- particular risks?

Nicholas Christakis 49:32 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.

Joe Rogan 52:17 Mm.

Nicholas Christakis 52:18 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.

Joe Rogan 52:47 Is the...

Nicholas Christakis 52:48 And-

Joe Rogan 52:48 Go ahead. Please go, continue.

Nicholas Christakis 52:50 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.

Joe Rogan 53:07 (laughs) Sorry.

Nicholas Christakis 53:08 No, no, it's my fault.

Joe Rogan 53:09 This is the problem with Skype calls. Um-

Nicholas Christakis 53:12 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-

Joe Rogan 55:32 How do you educate people on that? That seems like a complicated one to explain.

Nicholas Christakis 55:36 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-

Joe Rogan 56:05 What kind of refrigerators are needed for these vaccines?

Nicholas Christakis 56:08 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.

Joe Rogan 57:47 That's very complicated. Now, the- the difference between the Pfizer and the Moderna vaccine is what?

Nicholas Christakis 57:54 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.

Joe Rogan 58:26 Do we know- We don't have any idea why?

Nicholas Christakis 58:30 I'm sure experts know that. I don't know the answer to that, why-

Joe Rogan 58:32 Well-

Nicholas Christakis 58:32 ... uh, why it does.

Joe Rogan 58:34 Is there anyone who's tried both? Like, is there any benefit in getting vaccinated with both vaccines?

Nicholas Christakis 58:41 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.

Joe Rogan 59:28 Mm.

Nicholas Christakis 59:29 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.

Joe Rogan 59:39 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.

Nicholas Christakis 59:53 Yeah.

Joe Rogan 59:53 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?

Nicholas Christakis 1:00:02 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-

Joe Rogan 1:00:34 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-

Nicholas Christakis 1:00:45 Yeah, it's a mystery. It sounds-

Joe Rogan 1:00:45 ... health improvements, wouldn't significant-

Nicholas Christakis 1:00:47 It sounds-

Joe Rogan 1:00:47 ... health improvements sig- signify that your body's recovering better?

Nicholas Christakis 1:00:52 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.

Joe Rogan 1:01:58 So there-

Nicholas Christakis 1:01:58 And that is in fact what appears to have happened.

Joe Rogan 1:02:00 And this was a study you said that was in England?

Nicholas Christakis 1:02:04 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.

Joe Rogan 1:03:40 So this was an experimental treatment that they gave him?

Nicholas Christakis 1:03:43 Yes. They gave him not the dexamethasone. That was a well-documented treatment.

Joe Rogan 1:03:47 Right. But the antibody-

Nicholas Christakis 1:03:48 But the antibody cocktail was apparently, the CEO of the company, of Regeneron, was his golfing buddy or something. I'm not exactly sure.

Joe Rogan 1:03:57 So whatever it was, it seemed to be very effective. And- and then immediately-

Nicholas Christakis 1:04:02 No, I wouldn't conclude that.

Joe Rogan 1:04:03 ... he went on a wild tweet storm. It seemed like he had a lot of energy.

Nicholas Christakis 1:04:07 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-

Joe Rogan 1:04:15 No, no, no.

Nicholas Christakis 1:04:15 ... know the answer to that.

Joe Rogan 1:04:15 I didn't- I didn't mean that. I meant-

Nicholas Christakis 1:04:17 Oh, yeah.

Joe Rogan 1:04:17 ... the treatment, the overall treat-

Nicholas Christakis 1:04:19 Yep.

Joe Rogan 1:04:19 ... 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.

Nicholas Christakis 1:04:32 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-

Joe Rogan 1:04:54 You mean, just the s-

Nicholas Christakis 1:04:54 ... his steroids and- and that went away.

Joe Rogan 1:04:57 You mean, just from the Twitter feed?

Nicholas Christakis 1:04:59 Yeah. I mean, if you look...

Joe Rogan 1:05:00 But- but isn't that how he always is?

Nicholas Christakis 1:05:03 Well, I'm not an expert on Donald Trump's tweets, but if you just looked at some of the things (laughs) , you're right, maybe- maybe- maybe- maybe he was always that way. But if you look at, if you look at, um, some of the things he did, like I think the- the little, having the Secret Service drive him around the hospital was a bit, you know, was a bit manic, you know. That was like a very irresponsible thing to do. It exposed people to risk. It put his own health at risk. I mean, you and I, if you and I were in the hospital with COVID and we told our- our doctors, "You know, I just want to go for a drive around the block right now. Let me out of the hospital." I mean, they would- they would say, "No." You know, uh, that would not be an okay thing to do. Um-

Joe Rogan 1:05:41 He wanted to wave to people, right?

Nicholas Christakis 1:05:43 Yes.

Joe Rogan 1:05:43 Yeah, hilarious.

Nicholas Christakis 1:05:45 Yes. I mean, I think, um, I think one of the things, and I make this argument in Apollo's Arrow, one of the things that's very interesting to me about- about plagues, earlier you talked about how plagues were one of the four horsemen of the apocalypse, is that, um, that the- that- that lies and denial are like the squire of the horsemen. They like follow right behind.

Joe Rogan 1:06:11 Mm-hmm.

Nicholas Christakis 1:06:12 And- and- and in a way you would even say that lies and denial, since they've occurred for thousands of years, whenever there's an ou- outbreak, people have always developed superstitions, they've wanted to deny what's happening, there's been a lot of lying, there's been a lot of snake oil salesmen. You know, there- there's just a lot of mendacity that a- that follows the germ. So the germ is spreading through social connections and bullshit is spreading through social connections. And I think that we saw this even in the president where he was, you know, frankly misrepresenting what was happening. We now know that he was told that it was gonna be a pandemic in December, but was saying, "Oh, it's just a flu. Nothing's gonna happen. Nothing's gonna happen." He- he was lying.... and uh, and his whole hydroxy, uh, chloroquine story. There was no evidence that this drug would work but, you know, he was like a snake oil salesman selling it. And you could even make the argument that, that it is the perfection of our democracy, it's the fact that we have a democratic system that allows us, the popular will to be reflected in the leaders that we elect, so that if the people wish to be lied to, they will elect a liar. They will e-

Joe Rogan 1:07:19 Can I pause, can I pause you for a second there?

Nicholas Christakis 1:07:22 Uh-

Joe Rogan 1:07:22 There was a lot of people that did believe that hydroxychloroquine, at the time, had some positive benefits, including my doctor, who is not-

Nicholas Christakis 1:07:29 No, there's no ev- there's-

Joe Rogan 1:07:30 ... not a Donald Trump supporter. This was early-

Nicholas Christakis 1:07:32 No, no-

Joe Rogan 1:07:33 No evidence at all?

Nicholas Christakis 1:07:35 There was some suggestion that based on in vitro studies that the drug might work. It wasn't crazy to consider (laughs) that it would work. I mean, it wasn't a crazy idea to say, "Maybe this drug works." But there was no clinical evidence that it worked, there was no randomized control trials that showed it worked and-

Joe Rogan 1:07:50 Right. But isn't that also because there was no time for any randomized control trials, because this was-

Nicholas Christakis 1:07:55 Yes.

Joe Rogan 1:07:55 ... the initial stages of the d- the pandemic?

Nicholas Christakis 1:07:57 Yeah. So, so I'm not saying that it wasn't crazy to think that it might work.

Joe Rogan 1:08:01 He- I-

Nicholas Christakis 1:08:01 But to say that it does work is a different statement.

Joe Rogan 1:08:04 I agree with you wholeheartedly that his, uh, endorsing of it as being some sort of a miracle cure was irresponsible.

Nicholas Christakis 1:08:11 Yes.

Joe Rogan 1:08:12 And, and but that's also kind of what he does, right? Like, when he was, uh, sitting next to, I'm sorry, what is her name? Uh, Birx? What, what was her name?

Nicholas Christakis 1:08:22 Yes.

Joe Rogan 1:08:22 Yeah.

Nicholas Christakis 1:08:22 Yes.

Joe Rogan 1:08:23 And he was saying, uh-

Nicholas Christakis 1:08:24 Ricks, I think.

Joe Rogan 1:08:24 ... maybe we can, yeah, maybe we can, uh, in, use, uh, some sort of a internal disinfectant on people and all that cra- He's, he's riffing. He likes to ha- You know, he's the guy that likes to have the answers when he's giving these speeches.

Nicholas Christakis 1:08:38 Yeah.

Joe Rogan 1:08:39 And he likes people to pay attention. And I think in that response-

Nicholas Christakis 1:08:43 Yeah, but the joke-

Joe Rogan 1:08:43 ... he's, it's, that's, that's how he usually is as a human being. He gets to be 70 years old, now all of a sudden he's the President of the United States and he's doing this, now it becomes a problem.

Nicholas Christakis 1:08:54 Yeah, so this is what I would like to say. So, I, I, I, a- and I said it up by saying, you know, it's a, it's a reflection of the perfection of our democracy that we are able to get the public will, and if, uh, reflected in our leaders. And if the public will is to, as I said, have someone who tells you only good news and doesn't tell you bad news, we're gonna get that. But I don't think that lets the leaders off the hook. And actually, before I explain that, let me just go back and say it's also true that many other leaders in other European nations, like in Italy or in England, also flubbed this. So, it's not the case that only Trump singularly botched the response. Now, there were leaders in South Korea, in New Zealand, even in Greece, you know, who did a, had a successful response. But my point is, we're the United States of America. I expect more of us. We have the CDC. We're the richest nation on Earth. We, you know, we, we, we have, uh, uh, uh, scientists and doctors. We have this, we spend 17.7% of our GDP on healthcare. The, we have the National Security Agency. (laughs) We have everything you would need to do better, and I expect more from us. So, I, I absolutely do fault him for, for flubbing this. But I also think the American people need to take some responsibility and need to sort of man up, uh, you know, and, and recognize that the world has changed, there's some serious stuff that's going on, and we have to do better in how we confront, um, this threat. We can't be like children, pretending that it's not there, or, or fantasizing that it'll just miraculously go away. That's not a mature response. And we have, unfortunately, a, a long road ahead. Uh, and ag- uh, you know, we are not at the beginning of the end of this pandemic. We are just at the end of the beginning. A- and just to set the stage a little bit, here's what I think is gonna happen. So, it's great that the vaccine has been invented, and we'll have several of them. But as we've discussed, there are gonna be some problems and challenges in, in manufacturing it and distributing it and persuading large numbers of people to get it and so on. And that's gonna take time, let's say a year. So, let's say the vaccine is approved in a couple of months, the beginning of 2021. I think we're gonna spend all of 2021 doing all that other stuff, distributing the vaccine and so on. Meanwhile, the virus is still spreading. And right now, probably about 12% of Americans have been infected with the virus. In the end, for various calculations and reasons, probably about 50% need to be infected. The final attack rate probably needs to be about 50% before we reach this threshold known as herd immunity. So, we're about a quarter of the way there, let's say. So, the virus is gonna keep spreading, and while we're doing all that other stuff. So, either way, I think we get to 2022 before we've reached herd immunity, either naturally, because the virus has finally attacked that many people, or artificially, because we immunize that many people. So, at that point, just to be clear, the virus isn't gone. It's still in our world, it's still circulating, but its epidemic thrust, its epidemic capacity now has been neutered, and we have, the virus will be so-called endemic when we reach the herd immunity threshold, either by vaccines or naturally. That's 2022, let's say. But that's just then we've overcome the biological and epidemiological impact of the virus. And until that time, we're gonna be wearing masks, they're gonna be intermittent school closures, we're gonna have to have physical distancing, there's gonna be prob- gathering bans, you know, hospitals will be full periodically. Uh, this is, you know, gonna be the world we're in for the next year or so. And then we'll get to the point where we have herd immunity, one way or the other. But then, you see, we have to recover from the psychological, social, and, um, economic shock...You know, f- let's not forget, tens of millions of Americans are out of work. Many small businesses have gone out of business. Uh, we have a, sort of a reshaping of our economy in all kinds of radical ways, and it's going to take a while for that to unwind. Also, a lot of people are going to be disabled by this condition. So far, we've been talking about death. Probably five times as many people will be disabled, will have some form of long-term disability: renal, cardiac, neurological, or pulmonary. Uh, so if we have a, let's say, half a million Americans, for sure half a million Americans will die of this condition. Maybe as many as a million. It's going to, in the end, by the time the pandemic is over, it's going to be a number in that range. Whatever that number is, about five times as many will be disabled. So, let's say half a million Americans die, we're going to have two and a half million Americans with some form of disability. We're going to have to cope with that as well. So, if you look at the history of epidemic disease, it's going to take a, a year or two to recover from that. So I think it's 2024 before we really begin to enter the post-pandemic period, when life will return app- you know, approximately to normal with, with some persistent changes in, in our society. And I'll say one more thing and then I'll shut up. If you look at the history of previous pandemics, what typically happens is, um, is during the time of the germ hitting the society, people get more religious. They, uh, become more abstemious. They save money. They withdraw from other, from social contact. Uh, they avoid risks. Risk aversion increases, risk-taking declines. All of these things happen. And then w- when the, when finally the epidemic is over, all of those things reverse. Uh, people relentlessly seek out social interactions, uh, you know, uh, sporting events and nightclubs and restaurants and political rallies. Uh, people be... their sexual licentiousness goes up. Uh, spending, people start spending money. Uh, risk-taking comes back. One, one person, uh, Neil Ferguson, actually, who kindly reviewed the book in, uh, the Times Literary Supplement, when he read this description, he goes, you know, "Here's hoping," (laughs) you know, "that, that this is what it'll be like." So I think come 2024 or 22- late 2023, that period, we're going to have like the Roaring '20s again, uh, when our society is going to really be unleashed from, from the shock that we, we are experiencing.

Joe Rogan 1:15:17 Oh, I'm looking forward to that. Um, one thing I got to urge you is please, we- you're- every time you get excited and slap your table, we get a loud bang out of your microphone.

Nicholas Christakis 1:15:26 Okay.

Joe Rogan 1:15:27 Sorry. Um, w- we talked about the economic issue. You briefly just touched on it. W- what do you think can be done to mitigate the economic impact, and what, what states do you think are doing it right versus what states do you think are doing it wrong? It seems to me that one of the big problems that people are having with this pandemic is, all of a sudden, governors and mayors have these powers that they never had before, and they don't seem to totally make sense. Like, they're allowing people to have mass protests, and they're actually encourage them, encouraging them, but they're not allowing people to go to the gym. They're allowing people to do things like go to Walmart or go to Target, but they don't want them going to restaurants. California's particularly restrictive, and just today entered into, um, they went back to Phase Purple, whatever the fuck that means, where they're, they're shutting everything down. And this is right after the governor got caught going to a restaurant with a bunch of other people, doing things that he specifically told people not to do. Um, this is a problem that people have with the power that government has now assumed. And the real concern that many people have, myself included, is that we're never going to see them give that up. Is that the power that they have now to tell people to stay home, don't work, shut down schools, shut down gyms, shut down restaurants, that they're not going to let that go. People enjoy using power, and especially if they have a legitimate, a legitimate good cause for it, like we do here in the pandemic.

Nicholas Christakis 1:17:06 So, I share your concerns, and I understand what you're saying, and there are many components to what you just said. First of all, I, I want people to understand that even during the bubonic plague in England, when the government wasn't ordering restaurants to close, the economy still collapsed. So we have to draw a distinction between what the germ is doing to us and our economy, and what it would have done regardless of what government did, versus what we are doing to ourselves in order to fight the virus. So I don't want people to think that, oh, if the government was doing nothing, our economy would be going great.

Joe Rogan 1:17:44 No, I don't-

Nicholas Christakis 1:17:45 That-

Joe Rogan 1:17:45 I don't agree with that either.

Nicholas Christakis 1:17:46 Yeah.

Joe Rogan 1:17:46 I think the economy would still be fucked.

Nicholas Christakis 1:17:47 Yes.

Joe Rogan 1:17:47 But it would be less fucked. California is more fucked than Austin, Texas is.

Nicholas Christakis 1:17:52 All right.

Joe Rogan 1:17:52 That's a fact.

Nicholas Christakis 1:17:54 All right. Well, I believe you on that. I, I don't know the precise- I mean, what's happening in Austin versus... I don't know. But I don't think that the economy would necessarily be less fucked if you, um, if it, if, if the government took no action. In fact, the, the, the, the principle, the ideal principle at least, is that by the government acting, we can protect the economy. So for example, if the government were able to effectively force people to wear masks, and if everyone wore masks, we actually could maybe have a functioning economy. So-

Joe Rogan 1:18:23 That seems to be the message that we should get