Joe Rogan Experience #1566 - Nicholas Christakis

1. 0:00 – 15:00

   (instrumental music plays) Joe Rogan podcast,…

   1. NCNicholas Christakis0:02

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

   2. 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.

   3. NCNicholas Christakis0:21

      How did the sober October work for you?

   4. JRJoe Rogan0:22

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

   5. NCNicholas Christakis0:26

      It's interesting, you know.

   6. JRJoe Rogan0:27

      Very nice.

   7. 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.

   8. 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."

   9. NCNicholas Christakis0:57

      Yeah.

   10. 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.

   11. NCNicholas Christakis1:06

       (laughs)

   12. 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.

   13. 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-

   14. JRJoe Rogan1:49

       Yeah.

   15. 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.

   16. 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.

   17. NCNicholas Christakis2:34

       (laughs)

   18. 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-

   19. NCNicholas Christakis2:42

       (laughs)

   20. JRJoe Rogan2:42

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

   21. NCNicholas Christakis2:47

       (laughs)

   22. JRJoe Rogan2:47

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

   23. NCNicholas Christakis2:50

       (laughs)

   24. JRJoe Rogan2:51

       Do you ever use one of those? Bidet attachments?

   25. NCNicholas Christakis2:53

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

   26. JRJoe Rogan2:57

       Yeah.

   27. NCNicholas Christakis2:58

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

   28. JRJoe Rogan3:03

       You should get one.

   29. NCNicholas Christakis3:03

       Say that again?

   30. JRJoe Rogan3:04

       You should get one. You should get one. I'm telling you-
2. 15:00 – 30:00

   Yes. Wear a mask.…

   1. NCNicholas Christakis15:00

      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-

   2. JRJoe Rogan15:59

      Yes. Wear a mask.

   3. NCNicholas Christakis16:00

      ... wearing the mask.

   4. 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.

   5. NCNicholas Christakis16:31

      Yes.

   6. 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."

   7. NCNicholas Christakis16:43

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

   8. JRJoe Rogan16:45

      Yes.

   9. 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.

   10. JRJoe Rogan18:13

       J-

   11. NCNicholas Christakis18:13

       And ... Yeah?

   12. 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?

   13. 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.

   14. JRJoe Rogan18:44

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

   15. 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.

   16. JRJoe Rogan21:08

       Yeah.

   17. NCNicholas Christakis21:08

       Which is that-

   18. JRJoe Rogan21:09

       Which is probably good.

   19. NCNicholas Christakis21:10

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

   20. 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.

   21. 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.

   22. 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-

   23. NCNicholas Christakis23:05

       Yes.

   24. JRJoe Rogan23:05

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

   25. 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.

   26. JRJoe Rogan23:53

       Yes.

   27. 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-

   28. JRJoe Rogan24:25

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

   29. NCNicholas Christakis24:26

       I know.

   30. JRJoe Rogan24:27

       But-
3. 30:00 – 45:00

   Yes. Yes. …

   1. NCNicholas Christakis30:00

      sweep through cities in Italy and kill half the people.

   2. JRJoe Rogan30:03

      Yes. Yes.

   3. NCNicholas Christakis30:03

      Like, within a month, half are dead.

   4. JRJoe Rogan30:05

      Yeah.

   5. NCNicholas Christakis30:05

      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-

   6. JRJoe Rogan30:20

      Yep.

   7. NCNicholas Christakis30:20

      ... would die.

   8. JRJoe Rogan30:21

      Yeah. Yeah. Insane. Yeah.

   9. NCNicholas Christakis30:24

      I- yeah. And so, as you're ... Yeah.

   10. JRJoe Rogan30:26

       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.

   11. NCNicholas Christakis30:48

       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.

   12. JRJoe Rogan31:02

       Too late.

   13. NCNicholas Christakis31:03

       And so... Uh, too late, yes. (laughs)

   14. JRJoe Rogan31:05

       (laughs)

   15. NCNicholas Christakis31:05

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

   16. JRJoe Rogan31:11

       Yes.

   17. NCNicholas Christakis31:11

       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.

   18. JRJoe Rogan32:44

       Right.

   19. NCNicholas Christakis32:45

       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.

   20. 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.

   21. 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.

   22. JRJoe Rogan36:41

       Mm.

   23. 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?

   24. JRJoe Rogan36:51

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

   25. NCNicholas Christakis36:54

       Yes.

   26. 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.

   27. NCNicholas Christakis37:08

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

   28. JRJoe Rogan37:15

       Mm-hmm.

   29. 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.

   30. JRJoe Rogan38:13

       There's another-
4. 45:00 – 1:00:00

   Right, but this is…

   1. NCNicholas Christakis45:00

      about one percent. So there's a lot of little numbers I've thrown out at you, but-

   2. JRJoe Rogan45:03

      Right, but this is people-

   3. NCNicholas Christakis45:04

      But the gist is-

   4. JRJoe Rogan45:05

      ... with symptoms.

   5. 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.

   6. JRJoe Rogan45:18

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

   7. NCNicholas Christakis45:22

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

   8. JRJoe Rogan45:24

      Okay.

   9. NCNicholas Christakis45:24

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

   10. JRJoe Rogan45:29

       Right.

   11. 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.

   12. JRJoe Rogan45:40

       Okay.

   13. NCNicholas Christakis45:40

       But it's somewhere in there, 99-

   14. 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-

   15. NCNicholas Christakis45:45

       Yeah, okay.

   16. JRJoe Rogan45:45

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

   17. NCNicholas Christakis45:55

       Yeah, what that means is that-

   18. JRJoe Rogan45:56

       ... depending on who you ask.

   19. 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.

   20. JRJoe Rogan47:17

       I completely-

   21. NCNicholas Christakis47:17

       Does that make sense?

   22. 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-

   23. NCNicholas Christakis47:32

       That's not true.

   24. JRJoe Rogan47:33

       That's what I wanted to get out of you.

   25. NCNicholas Christakis47:34

       Yeah, yeah, yeah, that's not true. And-

   26. JRJoe Rogan47:35

       So people are saying... Yeah, go ahead.

   27. NCNicholas Christakis47:38

       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-

   28. JRJoe Rogan48:01

       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?

   29. NCNicholas Christakis48:24

       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-

   30. JRJoe Rogan48:35

       Yeah, I'm sorry.
5. 1:00:00 – 1:15:00

   So he- he faced…

   1. JRJoe Rogan1:00:00

      average person would receive if they got sick?

   2. 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-

   3. 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-

   4. NCNicholas Christakis1:00:45

      Yeah, it's a mystery. It sounds-

   5. JRJoe Rogan1:00:45

      ... health improvements, wouldn't significant-

   6. NCNicholas Christakis1:00:47

      It sounds-

   7. JRJoe Rogan1:00:47

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

   8. 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.

   9. JRJoe Rogan1:01:58

      So there-

   10. NCNicholas Christakis1:01:58

       And that is in fact what appears to have happened.

   11. JRJoe Rogan1:02:00

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

   12. 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.

   13. JRJoe Rogan1:03:40

       So this was an experimental treatment that they gave him?

   14. NCNicholas Christakis1:03:43

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

   15. JRJoe Rogan1:03:47

       Right. But the antibody-

   16. 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.

   17. JRJoe Rogan1:03:57

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

   18. NCNicholas Christakis1:04:02

       No, I wouldn't conclude that.

   19. JRJoe Rogan1:04:03

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

   20. 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-

   21. JRJoe Rogan1:04:15

       No, no, no.

   22. NCNicholas Christakis1:04:15

       ... know the answer to that.

   23. JRJoe Rogan1:04:15

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

   24. NCNicholas Christakis1:04:17

       Oh, yeah.

   25. JRJoe Rogan1:04:17

       ... the treatment, the overall treat-

   26. NCNicholas Christakis1:04:19

       Yep.

   27. 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.

   28. 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-

   29. JRJoe Rogan1:04:54

       You mean, just the s-

   30. NCNicholas Christakis1:04:54

       ... his steroids and- and that went away.
6. 1:15:00 – 1:18:26

   Oh, I'm looking forward…

   1. NCNicholas Christakis1:15:00

      (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.

   2. JRJoe Rogan1:15:17

      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.

   3. NCNicholas Christakis1:15:26

      Okay.

   4. JRJoe Rogan1:15:27

      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.

   5. NCNicholas Christakis1:17:06

      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.

   6. JRJoe Rogan1:17:44

      No, I don't-

   7. NCNicholas Christakis1:17:45

      That-

   8. JRJoe Rogan1:17:45

      I don't agree with that either.

   9. NCNicholas Christakis1:17:46

      Yeah.

   10. JRJoe Rogan1:17:46

       I think the economy would still be fucked.

   11. NCNicholas Christakis1:17:47

       Yes.

   12. JRJoe Rogan1:17:47

       But it would be less fucked. California is more fucked than Austin, Texas is.

   13. NCNicholas Christakis1:17:52

       All right.

   14. JRJoe Rogan1:17:52

       That's a fact.

   15. NCNicholas Christakis1:17:54

       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-

   16. JRJoe Rogan1:18:23

       That seems to be the message that we should get out.

Episode duration: 2:10:41