#214 — A Conversation with Siddhartha Mukherjee

I am here with Siddhartha Mukherjee. Sid, thanks for joining me again on the podcast.

Thank you very much.

Thank you for having me.

So you've been here twice before.

We spoke about both of your fantastic tomes, the emperor of all maladies, which is really the definitive book on cancer in our lifetime.

Just an amazing book.

And also the gene, which was also amazing.

And so we've spoken about both of.

Those books at length on the podcast. I recommend anyone interested in those broader topics consult those previous conversations. But today I want to talk to you about the COVID pandemic in general and just get your kind of expert.

Eye view of what has been happening.

Here these long now, five months in the US that we've been dealing with this, I think, ineptly, by any objective criterion. Our ineptitude is fairly well established here. And I'll remind people who may not know it, you are a famous oncologist and also writer, but your background is in virology, so you actually have a.

Wheelhouse that is relevant to our current concerns.

So just to start off here, and.

We can go anywhere you want to.

Go, Sid, but what has been your experience watching this all play out, and watching in particular, watching the spread of.

Misinformation and just the way in which.

It'S been given top spin by political cynicism in many cases, and also just in the beginning, there was a fair amount of actually good faith uncertainty about the biology and epidemiology of COVID And so it really has been hard to draw the line at various points between a valid contrarian opinion and a dangerously irresponsible one.

And granted, that line is probably getting.

Clearer, but what's it been like for you these last five months watching this unfold?

So I think there are several threads.

In that conversation that I want to.

Break apart because they're quite different.

So I want to make a very clear distinction between the uncertainties of which there are many and the ineptitudes of which there are many. So we can talk about them separately because those are important, and there is gray zones in all those cases. So let's first talk about what went wrong and what could have not gone wrong in the United States and around the world. Well, before that, let's talk a little bit about why this particular virus, of.

All viruses, has the capacity to cause.

A pandemic, and the answer lies in the biology of the virus. There are two features or three features of the virus that make it particularly a pandemic causing virus.

That obviously is not true for many viruses.

One is that it's completely new.

We have never encountered it before, as.

Far as we know, and so therefore.

Humans are immunologically naive to the virus.

That's one.

The second thing, and now we're getting.

To really important things, is the fact.

That the virus has a high degree.

Of high capacity to spread. Virologists use one measure of this, a measure called r zero, which is a.

Measure of how many people, one person infects. And obviously, mathematically speaking, if that number is above one, then the infection will spread exponentially.

So some viruses have huge numbers. Measles is a very, very highly infectious virus.

SarS cove two sits actually in the higher range. It's hard to estimate exactly what that.

Number is because it varies depending on.

The population and the behavior of the.

Population, but it's got a high number. And the third feature, which is actually probably the one that we realized very.

Late and perhaps too late in the.

Game and is the most insidious feature.

Is that asymptomatic people, people with absolutely no symptoms, seem to be able to carry the virus and spread the virus. Now, that's a big distinction. That is not true, for instance, for.

Ebola or other very lethal viruses. When you have symptoms, you usually then become a transmitter.

But it's true for this virus. We might be familiar with other viruses, that it's true for HIV.

Also, it's true for HIV. You can have be completely asymptomatic, but.

Still transmit the virus. You can have virus in your blood.

And transmit the virus.

These viruses that have this capacity to.

Have asymptomatic transmission are particularly difficult because.

You cannot simply find people by symptoms alone.

You have to find them by testing.

And if you want to contain the.

Virus using public health strategies such as containment or quarantine or isolation, you have.

To essentially find them. You have to go and find them.

They will not find you because they.

Don'T know whether by you, I mean, a medical doctor or a medical system. And that's because they don't know if they're carriers, asymptomatic carriers, or they're really having the.

Have the virus. Yeah.

So that covers the territory of why.

This virus, of all viruses, has and had the capacity to start a global pandemic. So this brings us to the next piece of conversation, which is the conversation about ineptitudes. So very important to remember that the ineptitudes started right from day zero in Wuhan, China.

We should have known about this virus long before we actually did.

As a global community, several attempts to.

Buy chinese doctors in full good faith to communicate the urgency of what was going on in China were essentially blocked.

We think, or we now know to some extent.

And in fact, as you very well know, the ophthalmologist who sounded the alarm on the virus was essentially censored.

And unfortunately, as you also know, he.

Died of that viral infection.

We'll come back to that.

We'll come back to that in a second.

It's very important because that tells us something about the virus, I think.

So that's where the ineptitude started. I would say that's a global ineptitude.

That is also. I mean, people have conspiracy theories around it.

I don't know what to believe and.

What not to believe because the investigation has not really proceeded.

The chinese government has been extremely reluctant.

To share many crucial pieces of information around those first few days.

Are you referring to the speculation that this came from a lab as opposed to a wet market, or what conspiracy.

Are you thinking about?

So many.

So one is that I think we.

Still don't know the origin of the virus.

I think that there is an interview.

In science magazine from one of the.

Workers who cultivates coronavirus in the Wuhan coronavirus facility, and she's adamant that it.

Did not come from the lab. But the question is that incident has.

Not been fully investigated. I just don't know.

I don't think it was a bioterror weapon, for instance.

Nor do I think that it was.

An intentional infection of someone.

Right.

But I do think that we need to investigate and find out where the.

Virus came from and perhaps even track.

Back the very first index case, which.

Is usually possible if we have access.

To full, free information, which we do not at this point of time.

Just to linger there for a second.

Sid, does it actually matter? Within a very short period, we had.

The full sequence of the virus, and.

We are now dealing with the basics.

Of vaccine design and treatment design and epidemiology.

Does it really matter what the origin moment was?

It matters for future pandemics, and it.

Matters for future surveillance.

One of the things that we have to learn from this and never let it happen again. And doubtless there are hundreds of thousands of viruses, xenoviruses, that lurk in bats.

And other animals, particularly social animals.

I mean, one question is why bats.

Seem to carry so many viruses.

It's because they're very social, then they live in very dense populations, in environments. So it matters for the next pandemic because we cannot let this happen again.

But moving to the United States, the.

Ineptitudes, or I would say the glaring errors, began also very quickly and began from the start.

So one error that began from the start was that obviously the first response.

Here was, oh, it's going to go away.

It's not going to come. It's going to go away.

That's obviously now not been the case, but that was a completely misplaced response.

It was not going to go away.

The first index case was seen at.

The end of January in Seattle, and.