#191 — Early Thoughts on a Pandemic

This is Sam Harris.

Okay, this is my second podcast on.

Coronavirus, and it is very consciously a follow up to the one I just dropped with Nicholas Christakis. I've done this with Dr. Amish Adalja, who's an infectious disease specialist affiliated with Johns Hopkins University. As many of you know, that Johns Hopkins website has become a resource for more or less everyone on the spread of coronavirus. And Amish has a background in infectious.

Disease, and he's helped develop us government.

Guidelines for the treatment of plague and botulism and anthrax.

He has edited the journal Health Security.

A volume on global catastrophic biological risks.

He's a contributing author to the Handbook.

Of bioterrorism and Disaster Medicine. So the spread of an emerging pandemic is very much in his wheelhouse, as you'll hear. He sounds less concerned than I do, and the reasons for that become explicit at two points. So I just want to flag that here so that you have an emotional barometer to the conversation. The first is that his estimate for the case fatality rate for coronavirus worst case puts it at 0.6%, which is six times worse than influenza, but quite a bit better than the worst case.

Scenarios being talked about elsewhere.

He definitely thinks that this is going to be considerably lower than 1% fatality. So, if true, that's obviously good news.

Six times worse than the flu would.

Still be quite terrible when you run the numbers. But it doesn't put this virus at.

3% or 2% or even one and.

A half percent, which is a very common figure one sees at the moment. So I don't know how accurate an estimate that will prove to be, but that is one reason why he sounds more hopeful than I have been. But there are two other reasons that.

Don'T become explicit until the end of.

Our conversation, and I want to preview them here so you have the appropriate frame coming in. The first is that Amish is a.

Man who spends a lot of time thinking about the worst case scenario.

And the worst case scenario is something like a bird flu that mutates and becomes highly infectious among people and has.

Something like a 60% mortality rate.

He is thinking about species annihilating plagues that we know are possible. Right. And that we need to prepare for. So, in light of that possibility, what.

We'Re experiencing now, even the worst case.

Scenario, is very much a dress rehearsal for something much, much worse that could yet happen. So that's worth understanding. But the other piece here, which, again, we talk about only at the end is that his primary concern now is not to sow panic. Right.

And my primary concern has been to.

Spread not panic, but heightened concern, because I'm encountering people who think that this is no big deal, right. I'm encountering them disproportionately on the right side of the aisle politically. But I've seen people with real reputations and considerable reach tell their fans that this is just like the flu, and.

6000 people die every year of diabetes.

And we don't freak out about it. They're not even making contact with the dynamics of this thing that is unfolding in front of us. So where you come down on the need to mollify people's fears or amplify.

Their concerns here, I guess, is a matter of judgment.

And Amish and I are running in different circles and have calibrated that rather differently. So please know that going in, I.

See a society that still doesn't want.

To close its schools. I know people who are still going to concerts. I have people who seem surprised that I expect that their spring break plans are going to change. I know people who don't seem to understand why conferences are getting canceled. And there's a pervasive sense, again, especially on the right side of the political spectrum, that the media is exaggerating the problem here, very likely for political and monetary gain. And my concern is to break through that bubble.

And you'll hear in a few places.

Where I attempt to do that without fully understanding Amish's concern. Not to sow panic, but we come to a full understanding by the end anyway. I hope you find this useful.

Undoubtedly, this will not be the last.

Conversation on this topic I have. Amish has agreed to come back anytime there's new information that he thinks people should know. And I will do my best to make myself useful during what I am confident will be a challenging time for all of us. And now I bring you Amish Adalja.

I am here with Dr. Amesh Adalja.

Amish, thanks for joining me.

Thanks for having me.

So this is the second podcast I.

Have done on coronavirus in 48 hours, and I really want to cover this.

Topic completely insofar as we understand it at the moment.

And you really seem to be the right person to speak with here. Give us your background and why you have any expertise on this topic. Sure.

So I'm an infectious disease critical care.

And emergency medicine physician that has focused my.

I focus my whole entire career basically, on emerging infectious disease pandemic preparedness, how infectious diseases, and national security intersect.

And that's basically where I've kind of niched myself. And when these types of outbreaks occur, it often is something that I've been.

Thinking about long before the outbreak occurred.

And that's sort of why the media.

Sometimes turns to me during these incidents.

And I try to understand them, dissect.

Them, predict what's going to happen, and.

Even do this when there's not an outbreak.

And you're affiliated with Johns Hopkins?

Correct. Right.

So I'm part of a think tank at Johns Hopkins called the Johns Hopkins.

Center for Health Security, which is a.

Think tank devoted to infectious disease emergencies and was founded back in 1997 by.

The man who eradicated smallpox from the earth, DA Henderson.

And it was initially founded in response.

To bioterrorism, but has now really expanded.

To think about all infectious disease emergencies.

And we have a multidisciplinary team of epidemiologists, physicians, people with mphs, lots of.

Different types of people, infectious disease modelers. And we try to really keep on top of these issues and kind of.

Be the leading voice on them.

And you do seem to be the leading voice because the Johns Hopkins dashboard seems to be the dashboard that everyone.

Is using to track the spread of this disease.

Yeah, that was something that people put together rapidly.

It's not in our specific center.

That's actually, I think, from one of the engineering schools that's put that together. But it's been really useful, and it's.

Been refreshing to see the world using Johns Hopkins talent to help understand what's going on.

Okay, so it's March 10, the day we're recording this. I think we'll probably release this on the 11th.

And at the moment, there are around.

118,000 confirmed cases and a little over 4000 deaths. And I know we have a denominator.

Problem still, so we don't actually know how many people have been infected.

So it still requires some guesswork to estimate the case fatality rate. But what is your best estimate at this point?

So, the best estimate, I think, is.

Derived mostly from the south korean data, where there's been extensive testing, the most.

Per capita testing that's been done in.

Any country, where they actually have drive.

Through testing centers there you're seeing the.

Case fatality rate at 0.6.

So that's now become my upper bound.

I do still think that there is probably a severity bias there because it still takes some effort to want to go get tested.

So we're still not fully getting capture.

Of everybody that might have very mild or minimal symptoms that people don't even barely notice. So I think 0.6 is the upper.

Bound, and I think the lower bound is going to be somewhere, I would.

Say a little bit above seasonal flu, which is 0.1%. So it's somewhere in there, but it's.

Still a lot of fluctuation and still a lot of uncertainty.

Okay.

So that is actually quite a bit.

More sanguine than anything I had heard up until now.

I recorded my previous podcast 48 hours.

Ago, and there you have, I think it was the Lancet reporting 1.2% to.

1.6% or somewhere in there. I mean, something like half the rate.

Of the most dire predictions of around 3%.

So you're reasonably confident that 0.6% is the upper bound, which now we're talking.

About six times more lethal than the seasonal flu.

0.6 seems to be the best way to look at this. When you think about the fact that we've had major testing constraints in many.

Countries, and South Korea has been very.

Aggressive at testing, and that's where they're seeing their number.

So I think that that's the easiest parameter to try to put into this.

Big world of unknown about this. And I definitely think the 1% 3% numbers are way off because of the severity bias.

It's important to remember that seasonal flu is 0.1%, so it's still a magnitude higher.

And it will be difficult, more difficult in dealing with the seasonal flu to.

Deal with this virus.

I want to talk about the comparison.

With flu with respect to both severity