Podcast No. 66: Dr. Nicholas Christakis, Yale Coronavirus Expert

My guest this week is Dr. Nicholas Christakis, Sterling Professor of Social and Natural Science at Yale University.

Nicholas has become one of the leading experts on coronavirus in the country. He’s been following the disease since it exploded in China and has outlined steps our society needs to take to battle this pandemic. Dr. Christakis is a physician and sociologist focusing on human social networks and human behavior. He has devoted much of his research to evaluating how social networks can predict epidemics and has given a TED Talk on that very subject. Nicholas was also a frontline doctor during the HIV crisis in the 1990’s, and is a member of our scientific advisory board.

Nicholas Christakis Coronavirus Podcast Show Notes:

3:03 - Nicholas’ Background. Dr. Christakis is a physician and sociologist who researches human social networks and human behavior. He is the director of Yale’s Human Nature Laboratory and was an inaugural member of the WHOOP scientific advisory board. 6:38 - China’s Response to Coronavirus. “I was paying attention to what the Chinese were doing and it was dawning on me that they were using what I ultimately called a social nuclear weapon. They weren’t just doing this for fun. They were fighting a viral enemy, and that viral enemy was sufficiently powerful in their judgment that they needed to put a billion people under house arrest, basically, for 2 months. So I began to pay much more serious attention in February to this pathogen and it was clear to me that it was going to be pandemic.” 8:49 - Defining Coronavirus. “Coronavirus is a class of viruses. It’s a ribovirus. It’s an RNA virus. This virus is similar to the SARS CoV-1 from 17 years ago. ... There are other coronaviruses that circulate in our population. For example, the common cold is caused by a wide variety of viruses and a few of those viruses are coronaviruses. There are dozens or maybe even a couple hundred viruses that can cause the common cold which is incidentally one of the reasons it's so hard to ‘cure’ the common cold. It’s not one condition, it’s many conditions.” 11:33 - How It Started. Nicholas explains why this pandemic may have started in bats and why it’s spreading so quickly in humans. “We are all immunologically naive. This virus is new to us. That’s one of the reasons it’s spreading so fast. There’s no natural immunity to this pathogen in our species.” 12:18 - Effective Reproductive Rates of Illnesses. “Measles is like 18. Measles is highly contagious. Ebola is about 2, let’s say. So each Ebola case might make another. [Coronavirus] is about 3.8, which is large.” 13:53 - An Endemic Outcome. “What the Chinese have done and what we are attempting to do is they have stopped the spread of the pathogen, they have not eradicated the pathogen. This disease is going to come back. This disease is going to become what’s known as endemic in human populations, like the flu. It’s going to become like the flu. It’s deadlier than the flu and as time goes by it’s possible and it’s often typical that pathogens mutate to be less deadly.” 14:47 - Mortality Rates. “I think the case fatality rate of [SARS] was 10% and this pathogen is let’s say between half a percent and 1%, we don’t know yet. Just to benchmark you, the common flu is about 0.1%, one in a thousand people with the flu die. We think 5 to 10 times as many will die with [coronavirus].” 17:13 - When Coronavirus Started in the United States. “We know now from genetic studies that the pathogen was already in the United States by the middle of January ... we should’ve been preparing ourselves. We should’ve been preparing the public for the battle. We should’ve been preparing the public to understand the difficult tradeoffs between lives lost and economic consequences. ... We should’ve been buying ventilators. We should’ve been getting our factories to manufacture personal protective equipment.” 18:33 - Korea’s Rapid Response. “They moved immediately to detecting cases and engaging in home-bound quarantine. People weren’t put in prison, they said ‘Okay, you’re sick, go home.’ And contract tracing. This was incredibly effective. If you look at the charts ... they’re at a very gradual slope and they’re able to cope. We did not do that.” 19:49 - Why Italy Became Overwhelmed. Nicholas details how a virus “super-spreader,” an older population, and high prevalence of multi-generational households led to the collapse of Northern Italy. 23:05 - The Risk Healthcare Workers Are Assuming. “Expecting doctors and nurses and other healthcare personnel to take some risk, it comes with the territory. It’s like being a cop or a firefighter. I think that’s reasonable and I think most healthcare workers see it as a calling and will assume those risks happily. But that’s completely different than sending them into battle without equipment. That’s ridiculous. It’s like sending a firefighter in to fight a fire with no hose and no uniform and no axe. This is craziness, and that’s the problem we’re facing now. I’m very worried.” 25:08 - Best-Case Scenario. “I think at best, at very best, we escape with a few million Americans infected and 35,000 deaths. At best.” 26:11 - Worst-Case Scenario. “In most pandemics, about 40% of the population gets infected ... so if we say 40% of Americans get infected, that is 120 million Americans or something. Let’s say on the conservative side that 0.3% of Americans die from that ... that’s 360,000 deaths. That’s a top-3 killer in our society. It’s catastrophic, that many deaths. And it could be worse, maybe 60% of Americans get infected and maybe the case fatality rate is higher. It could be better. We don’t know and this is one of the frustrating things to try to communicate to the public that we cannot know for sure what is likely to happen. There’s a range of outcomes. What I can tell you is we need to take this seriously. This is not a drill.” 28:08 - A Sobering Forecast. Will and Nicholas discuss the findings of a recent Imperial College London report that changed the way the United Kingdom is responding to the pandemic. 32:33 - Testing. Nicholas details the testing shortage the United States has faced and continues to face and calls for a major investment in serology testing to determine who is immune to COVID-19. “We need to ramp up production and we need to get the best tests we can.” 36:55 - A Coronavirus Vaccine? Nicholas says he is “optimistic” about a vaccine, but does not expect one to be ready for the next 12 to 18 months. 37:30 - The Second Wave. “I think we may get a little relief, as is typical of pandemics like this, in the summer. ... But then what’s going to happen, as is typical, is the schools will reopen in September and people will go back to work and then we’ll have a second wave. In 1918, the second wave was 4 times as deadly as the first wave. I don’t think this is going to happen in this case, I think this will be more like the [1957 flu] pandemic, but we’re very, very likely to have a second wave. Incidentally, I’m very concerned it’s going to interfere with our election.” 39:48 - Dr. Christakis’ Lecture on Coronavirus. Nicholas gave a lecture to Yale students on the pandemic before spring break. You can watch it here. 40:17 - Waze for the Flu. Nicholas is developing an app that would monitor the spread of disease using phone data and social networks. He gave a TED Talk on the subject called How Social Networks Predict Epidemics. 46:59 - How Widespread is COVID-19 in the US? “The doubling time of this epidemic is about 6 days without social distancing. There’s probably already half a million Americans [with coronavirus], and next week there will be a million Americans. This is the thing about epidemic growth and exponential growth that people don’t understand. For a very long time nothing is happening, nothing is happening, nothing is happening, and then all of a sudden a lot happens.” 49:30 - Impact on the Younger Population. “Young people don’t die,” Nicholas says of the numbers from across the globe. “But they absolutely can get the disease and they can spread it, and furthermore they can actually get quite sick. There are now reports of fit, healthy people that are felled by condition. Maybe they survive because they get excellent medical care, but if we can no longer provide that medical care because our ICUs are full maybe young people will start to die.” 50:30 - Compassion in a Time of Coronavirus. Nicholas’ op-ed in The Washington Post lays out how we can band together to fight COVID-19. 55:14 - Failing to Trust Experts. “We’ve had a deterioration in the intellectual fabric of our society in the last 20 years. We’ve become as a society less capable of grasping the relevance of expertise. People think that it’s elitist to be an expert, which is ridiculous. When you need your car repaired you want an expert mechanic and when you need surgery you want an expert surgeon. The whole point of an economy is that different people specialize in different things. There are people who are experts in whatever it is that you’re interested in and I think it’s proper to pay them deference.” Connect with Nicholas on Twitter @NAChristakis Check out his book Blueprint: The Evolutionary Origins of a Good Society 58:34 - Your Questions. Will answers your most frequently asked WHOOP questions this week.