Akashma Online News

SEPTEMBER 14TH, 2020

Dr Jay Bhattacharya is one of the doctors who pushed

Dr. Jay Bhattacharya is a Stanford physician and economist and co-author of several seroprevalence studies on COVID-19.
In this must-watch interview, we talk about EVERYTHING, including the true infection fatality rate, comparisons to influenza, drama around his Santa Clara antibody trial, reinfections, vaccine development, economic and social impacts, why we MUST reopen schools NOW, the horrors of censorship of scientists and opposing dialog, how Stanford is contributing to the problem of stifling dissenting opinions, Dr. Scott Atlas and his advisory role to the president, empathy vs. compassion with regards to COVID, and MUCH MORE.
This is a must-listen interview with a really smart and thoughtful scientist who has been too-often maligned and mischaracterized by the media.

Transcript Below!


[Dr. Z] Hey, everyone Dr. Z, welcome to The ZDoggMD Show. Today I have a special guest look, I moved back to the Bay Area, so I could talk to smart people at places like UCSF and Stanford and in the Bay area. And I was all excited and then COVID hit and it was Zoom, Zoom, Zoom, and I hate Zoom. So today I have someone I’ve been wanting to talk to since this pandemic started, Dr. Jay Bhattacharya is a Stanford Professor of Medicine and he has training and specialty in economics. Actually tell me Jay, who are you man?
[Dr. Jay] Well, okay.
[Dr. Z] Not in a metaphysical sense.
[Dr. Jay] Exactly, so I am a Professor of Medicine as you said at Stanford university, I’ve been at Stanford on the faculty for about 20 years. I’ve an MD and a PhD in Economics. And I studied health policy and health economics. I’ve been working on infectious disease, economics and epidemiology for 20 some years now.
[Dr. Z] So the reason I wanted to have you on the show was what you just said. You have the MD Stanford training and PhD in economics, which means you can see in a way that many frontline healthcare people, including public health people, aren’t able to see the bigger picture. Now you came to prominence during the pandemic as one of the coauthors of the Stanford Seroprevalence Study, which raised all kinds of interesting. I mean, tell me about that experience because I was talking about your piece early on saying, hey, if this is true, the actual infection fatality rate of this disease is actually much lower than we thought it’s still higher than flu, but it’s not as high as they’ve been saying in China. What was that experience like?
[Dr. Jay] I mean, that was incredible. Just an amazing, in some ways, dispiriting, but also exciting experience. Let me kind of go back just a little bit?
[Dr. Z] Absolutely.
[Dr. Jay] So what got me into it was I had done some work during the H1N1 Flu epidemic in 2009.
[Dr. Z] I remember that one.
[Dr. Jay] I mean, it was a big deal at the time, right? But luckily it didn’t turn out to be as bad as COVID, but especially at the beginning, people were really, really panicked over the high fatality rates that were the case fatality rates that were coming up out of all around the world.
[Dr. Z] I remember I was a practicing hospitalist at Stanford and everybody was like, we’re all going to die. It was a kind of a catastrophization.
[Dr. Jay] Yeah, it’s actually an in the early days, there was good reason. There were these case fatality rates that looked like Ebola. It just did look terrible. In the months that followed what happened was people did zero prevalence studies and found that there were many times more cases of infections than there had been cases in H1N1 and the infection fatality rate, which turned out to be about a hundred times less than the initial case fatality rates in the H1N1 case.
[Dr. Z] So let me reiterate that for people who don’t understand some of the terminology. So case fatality rate is when someone is actually tested for disease, presents to care and is diagnosed with the disease, and then how many people die out of that group.
[Dr. Jay] Correct.
[Dr. Z] Infection fatality rate is, well, of all the infections that exist, including ones that we weren’t able to openly diagnose. What’s the rate of fatality in that group. And it was 100X different in H1N1.
[Dr. Jay] In H1N1 that’s right.
[Dr. Z] And so this got you interested then when COVID came around, I imagine.
[Dr. Jay] It looked like a repeat to me, right? So looked like the people were finding enormously high case fatality rates. I think World Health Organization said 3.4%. There was a piece published in JAMA in February Journal of American Medical Association, that said 2.2%. And these are terrible numbers.
[Dr. Z] These are horrifying numbers. These are the kind of numbers that would cause you to lock down the entire planet instantly, because you’re gonna lose that percentage of your population if everybody gets infected.
[Dr. Jay] Millions and millions of people dead, right if that’s the number in the United States alone.
[Dr. Z] Alone.
[Dr. Jay] If the numbers are right. But that was what happened at H1N1. And I said okay, well, do we really know how many people actually have it? And at the same time we’re worried about how much testing resources we had. Remember there was a shortage of tests. So we’re just holding onto the test to look at people who actually have serious disease, which is what you ought to do from a clinical perspective. But then from an epidemiologic perspective, can you extrapolate that to say, okay the population at large 3% of us are all gonna die if we get it. And we don’t have the answer to that. So that’s what led to the Stanford Seroprevalence Study.
[Dr. Z] Yeah.
[Dr. Jay] And the other share problem studies I’ve worked on. So it was this hypothesis. Like how many people actually have it? How deadly actually is it?
[Dr. Z] And so how did you do this study? Because there was a ton of controversy around the methods and the actual sensitivity specificity of the assay that you use and all that.
[Dr. Jay] Yeah, so that was a lot of confusion around that. So we wanted to do a study that could be done very, very quickly, put it in the field very, very quickly. At the time of the study the FDA had approved for use some, the lateral flow assays, they looked like pregnancy tests, like little pregnancy kits. The one we used had pretty good error properties. You know every medical test has errors. I mean, there’s just not a, and you can’t avoid that. That’s just the nature of, we don’t have a tri-corder that can automatically tell me exactly what’s wrong with you, right? We need to look at the numbers and interpret them. At the time the FDA had approved for use these little lateral assayed tests, including the one we use, for sale but they hadn’t approved them for general use in the population. We could use them for research purposes, but not for clinical purposes. So we use one of those, the reason it was very simple. There are two kinds of tests to do antibody testing, there’s these ELISA tests, which are pretty accurate and then these lateral flow assay tests. For the ELISA’s, you have to draw venous blood. It’s really hard in the middle of a pandemic to go out and find, you know, can I draw venous blood from you? A big vial of it, or I can just do a little finger stick. The nice thing about epidemiologic work is that you can correct for the errors, which is what we did. Actually I’ve run three Seroprevalence Studies, one in Santa Clara County, one in LA County, and one in with Major League Baseball.
[Dr. Z] Did you get to meet a lot of baseball players?
[Dr. Jay] I got to meet a lot of, not baseball players, I mean it was surreal, I got to be in a meeting with all the owners. It was just–
[Dr. Z] Oh, wow, that’s nice.
[Dr. Jay] It was fantastic. I had to contain myself when I met the Yankee’s owner, but, you know, that’s another thing. So I ran three different studies and the interesting thing about the studies was we use very different methods to try to disseminate them. So the Santa Clara Study was the first one. It was a big study, 2000 some people in the Bay area in Santa Clara County.
[Dr. Z] Right.
[Dr. Jay] We wrote the study very quickly and we released it through an open science process,
[Dr. Z] Like a pre print,
[Dr. Jay] A pre print, right, exactly. So now the traditional path involves sending it to a journal. The journal then sends it to three anonymous reviewers. No one will hear it about it, except me. And that’s how I spend my life dealing with this three anonymous reviews, all of them always hate me.
[Dr. Z] So you’re not used to the whole planet hating you at once.
[Dr. Jay] Yeah, that was interesting. So we sent it and I got 10,000 peer reviews in one day.
[Dr. Z] Oh my gosh.
[Dr. Jay] And it was kind of interesting, exciting. I learned a lot. So we made, what I would characterize a relatively minor error in standard error calculation, which we corrected within a week.
[Dr. Z] Right.
[Dr. Jay] And the number that we got was absolutely stunning. What we found was that the disease was 50 times more prevalent than people thought based on just the case number. So people thought in Santa Clara County, there were a 1000 cases as of April 3rd, I think it was. But in fact based on the study, you could tell 50,000 people had, had some antibody evidence of it the same time.
[Dr. Z] Right, which would correspond to an infection fatality rate at that time of what?
[Dr. Jay] About two in 1,000.
[Dr. Z] two in a 1,000
[Dr. Jay] So that means out of the 1,000 people who got the infection, 998 survived.
[Dr. Z] So 0.2%.
[Dr. Jay] 0.2%.
[Dr. Z] So double what we think the mortality is for flu.
[Dr. Jay] Well I am not 100% sure I know what the flu mortality, I know the evidence, it’s unclear in flu no one’s done the same kind of infection fatality rate numbers that they’ve done with for COVID that they’ve dealt with the flu.
[Dr. Z] So in many ways we’re comparing apples to oranges when we’re comparing flu–
[Dr. Jay] So let’s come back to that flu comparison. ‘Cause it is interesting and important, but I think the key thing is how much would you change your life’ for two in a 1,000 risk? And there’s a couple other things we learned. So one is that if you’re older, it’s much higher. It’s probably much worse than the flu actually.
[Dr. Z] Yeah.
[Dr. Jay] For older
[Dr. Z] Order of magnitude.
[Dr. Jay] So if you’re over 70 versus if you’re let’s say you’re under 15 or under 10. It’s on the order of a 1000 to one difference in mortality probability. So the flu is much more deadly if you’re older, if you’re over let’s say 65 or 70. And if you’re under–
[Dr. Z] The flu or COVID we are talking about?
[Dr. Jay] I’m sorry COVID I apologize. It’s COVID is much more deadly if you’re over 65 or 70, and if you’re under say 40, the flu is worse. That’s what seroprevalence studies shows.
[Dr. Z] And that was the sense that I was getting early on too. And seroprevalence study was supporting that. And you said something which we’re gonna get back to. I think that’s a theme of this, how much would you change your life for a two in a 1000 chance, right?
[Dr. Jay] Yeah and I think that age difference is important. The absolute number is also important well, let’s get back to that theme.
[Dr. Z] Yeah, absolute versus relative risk, yeah.
[Dr. Jay] So the interesting thing about that, so we released the LA County Study. It was immediately accepted in JAMA and published.
[Dr. Z] Just instant.
[Dr. Jay] It’s the same number
[Dr. Z] Peer reviewed.
[Dr. Jay] Peer reviewed, yeah. I’ve never had such an easy time with a review it was a very strange. Whereas the Santa Clara Study, it exploded Twitter. I’m not on Twitter myself.
[Dr. Z] Thank God for you.
[Dr. Jay] It was actually probably good for my sanity.
[Dr. Z] It really is.
[Dr. Jay] And everyone on earth was paying attention to it all at once, one study, right.
[Dr. Z] Right, pre print.
[Dr. Jay] And everyone was convinced that I was absolutely wrong.
[Dr. Z] Yeah.
[Dr. Jay] 100% wrong because people had fixed in their mind, New York City where the death rate was higher. Actually we know from seroprevalence studies that it was higher, the actual infection fatality rate was higher in New York City. So now since then 50 some studies from around the world have been done. And there’s a consistent theme that the infection fatality rates somewhere between two and three in 1,000, just like what we found in Santa Clara, just like what we found in LA County and the places that have higher density where you think did worse, you know, Bergamot, New York City, they did worse. Their infection fatality rate is worse five in a 1,000, six in a 1,000 in some Spain, maybe 10 in a 1,000.
[Dr. Z] So, okay, there’s a lot here. And again, this gets me fired up because I’ve been talking about this myself, why would an infection fatality rate be different in say New York versus at Santa Clara? Walk me through that.
[Dr. Jay] Yeah, sure so we think about infection fatality rate as if it were just a–
[Dr. Z] Static.
[Dr. Jay] Well, as if it’s the virus itself, it’s a feature of the virus. Here’s the virus. Here’s the infection fatality rate. That’s wrong thinking. It’s a function of the virus obviously, the biology of the virus, but also the host and also of the healthcare system taking care of the patient.
[Dr. Z] Do they survive or do they get care
[Dr. Jay] All three of those things matter a ton.
[Dr. Z] Ah.
[Dr. Jay] So for instance, if you look at the case fatality rate for this disease, just case fatality forget about infection fatality, right? This is the number of people who have the disease who actually died from it. It’s declined very sharply since March and April.
[Dr. Z] Sure has, cases up deaths down.
[Dr. Jay] Has the virus changed? Maybe a little, I mean, there’s some mutation, but not enough to think that it’s had any appreciable change. What it is, is a few things. One is the set of people that are getting infected are less vulnerable to it. They tend to be younger. And so they just don’t die at higher rates from it. The second we were better at managing it, better treating it.
[Dr. Z] Right, dexamethasone.
[Dr. Jay] Exactly.
[Dr. Z] Not intubating everyone.
[Dr. Jay] Not killing people with ventilators right. I mean that would seem like a really good idea.
[Dr. Z] Yeah which by the way, wasn’t clear in the beginning at all. So not to disparage people who are intubating everyone, but we just didn’t know.
[Dr. Jay] Yeah, I know, look, I have a lot of sympathy and people were really brave going in when we didn’t have the numbers. I honor that, absolutely. But it is absolutely the case, we’ve learned a lot about how to treat the disease and we’re much better at managing than we once were. I think that kind of news ought to get out more. That seems like an important fact, our understanding of disease shouldn’t be frozen in Amber, in March.
[Dr. Z] No, so you’re preaching to the choir because I just did a video on this, on the cases up deaths down. I actually think that there is a lot of catastrophization and misunderstanding, and there’s been a polarity that I’ve not seen in science ever. And the thing is folks like you, this is the thing I criticized your trial as well, but also put it out there and said, hey, this is what’s going on. This is the critique, et cetera.
[Dr. Jay] Well, science, that’s how it works.
[Dr. Z] That’s what you do in science.
[Dr. Jay] I mean, I didn’t mind the science. Of course we talk, we look at the data, we try to interpret it. That’s the fun part of science.
[Dr. Z] But the vitriol and the censorship too, like Ioannidis is your partner in that one of the most respected scientists actually has done papers and papers and papers on how we get science wrong with our own biases, right. Was accused of severe bias and censored.
[Dr. Jay] Yeah, it was absolutely shocking. So, like Buzzfeed attacked my family, Buzzfeed.
[Dr. Z] Can I say, so anytime I see anything in Buzzfeed, if it isn’t 10 reasons celebrities have done something that make you go, what I’m shook! I don’t listen to it because it’s so clearly biased.
[Dr. Jay] Yeah, it was really kind of
[Dr. Z] Buzzfeed attacked your family?
[Dr. Jay] Yeah they said my wife was involved in like she volunteered, my daughter actually volunteered as a, it was lot of community involvement with the feeling around the study in Santa Clara was a lot of volunteers a lot of people, it was a really good feeling. And my wife was super excited about the study. She’s an oncologist. She wrote a email and to her friends, encouraging them to sign up and somebody leaked the email, which had some information that was not quite right. And then Buzzfeed made her international news.
[Dr. Z] Oh my God.
[Dr. Jay] That’s the hardest part of this. It was just getting my family involved with it in a way that I didn’t expect.
[Dr. Z] What’s the agenda for that, that you’re somehow minimizing the pandemic and gonna cost lives, is that right?
[Dr. Jay] I think so, that’s part of it. The same Buzzfeed author then wrote an accusation that somehow, because people gave money, including like, I guess a JetBlue executive
[Dr. Z] Right, I saw that.
[Dr. Jay] To Stanford
[Dr. Jay] Right, right 5,000 bucks.
[Dr. Jay] 5,000,
[Dr. Jay] So 5,000 which is a rounding error on the cost of a trial.
Well, in this case, the study was we ran a really cheap, it was less than a $100,000 for the study.
[Dr. Z] Nice.
[Dr. Jay] But they give the money to Stanford and somehow I’m gonna change the results for the, it’s just ridiculous.
[Dr. Z] You know what, Jay, when you’re in big JetBlue’s pocket anything goes bro
[Dr. Jay] It was really kind of him to give money for the study was like, I’m grateful.
[Dr. Z] And that’s fine that he had his own agenda, which was probably, hey, yeah.
[Dr. Jay] Everyone has an agenda
[Dr. Z] Everyone has an agenda.
[Dr. Jay] So my agenda was to learn what that number was. I think we now know it.
[Dr. Z] So your feeling now is that somewhere between 0.2 and 0.3% infection fatality rates.
[Dr. Jay] That’s the median around the world
[Dr. Z] Median, around the world, It may be higher in places like a New York.
[Dr. Jay] [Dr. Jay] Yeah.
[Dr. Z] Why was it higher in New York, do you think?
[Dr. Jay] I think there’s lots of reasons. I think potential one is I think the set of people that were infected in New York were older. And the institutions where they are infected was less capable of dealing with it in the early days of the epidemic. So there’s something to this and the fact that it was older people in nursing home settings that weren’t sort of equipped to manage it. I think that played a big role in why it was higher in New York. The other thing is I think there’s a, and this is a theory I’ve seen, I think, I mean, there’s something to it, when viral load is higher, when you’re exposed to it multiple times over and over again, you just get a worse outcome.
[Dr. Z] So I talked about this with Monica Gandhi yesterday on the show UCSF ID doc, and her theory of viral inoculum correlating to severity.
[Dr. Jay] I saw that.
[Dr. Z] Yeah, yeah and she actually posited the same exact thing in, it’s a theory like it’s was hypothesis in New York was that people are in the built environment or on top of each other, especially minority communities, which were hardest hit. And so, as a result, if you’re out in Queens or somewhere, and you’re just living in this multifamily home, told to stay indoors, right. What are you doing? You get a high viral inoculum. And again, it’s a hypothesis, but it’s interesting because that would affect your infection fatality ratio if that is a component of how severely ill you get.
[Dr. Jay] Correct and that is what explains why nosocomial spreads like hospital’s spread it’s so important.
[Dr. Z] Exactly. We talked Dr. Li, the guy, the ophthalmologist in Wuhan who first sort of broke this news and he died and he was 33 and the thought was, he’s an ophthalmologist. So he’s seeing patients this close to their face, getting viral inoculum right in the face. And now we’ve learned a lot from that. that’s why we N95 and face shield in the hospital and paper and all that. If we can yeah. So do you think the infection fatality ratio, if you just looked at one community, like say Latinos, Latinas, would you think it’d be higher there from what we’re seeing?
[Dr. Jay] From what I’ve seen, I think that minorities are harder hit with this epidemic. That’s absolutely true. So black communities, Latino communities are been harder, especially in California, Latino communities make up the bulk of the–
[Dr. Z] Disease yeah, 45% yeah.
[Dr. Jay] It’s incredible, I don’t think the infection fatality rates,
[Dr. Z] Sorry 60%, 60% of cases in California
[Dr. Jay] But I don’t think that the infection fatality rate is much higher conditional on getting it. It’s just they’re more likely to get it.
[Dr. Z] I see.
[Dr. Jay] It may be a little higher. I mean, you know, it’s hard to.
[Dr. Z] See because is there preexisting disease more in that community, chronic disease, diabetes, hypertension disease.
[Dr. Jay] Yeah, that’s the question. So if you have these underlying conditions, of course, you’re more likely to die from, if you’re older you’re more likely to die from it, things like that we know for a fact. Once you control for that, if you’re Hispanic, are you more likely to die? My guess is probably not.
[Dr. Z] Interesting.
[Dr. Jay] It’s mostly those preexisting conditions and the fact that you’re more likely get it in the first place.
[Dr. Z] Now, one counter proposal I might say as well, if viral inoculum does matter, if that hypothesis is true and Hispanic families are more likely to congregate together under one roof, you might see actually a higher infection fatality rate in that.
[Dr. Jay] It could be yeah. There’s a study that was done in Mumbai, in the Dharavi Slums in Mumbai.
[Dr. Z] Yes, I saw that, explain it.
[Dr. Jay] First, the, the prevalence was enormous. I mean, I think it was like–
[Dr. Z] It was 80%, 60 or 80.
[Dr. Jay] I actually talked to some of those study authors, the studies who ran the thing. Essentially the idea they have is that the lockdown put people, this is a slum where like 10 people live in the same house and there’s police walking around, making sure that if you walk out of the house, you’re gonna be arrested. So they put 10 people in the house, they probably spread the disease with the lockdown, enormous viral load. You can see with the 80% antibody number right.
[Dr. Z] Right
[Dr. Jay] But the infection fatality rate was really low.
[Dr. Z] Minuscule.
[Dr. Jay] Yeah.
[Dr. Z] Like I think it might be an under reporting to some degree, but like 200, 300 deaths out of all these.
[Dr. Jay] Yeah it was really, really low. So part of that is they don’t have the diabetes, they don’t have the obesity, they don’t have those kinds of predisposing conditions.
[Dr. Z] ‘Cause they’re thin.
[Dr. Jay] And they’re younger.
[Dr. Z] They’re younger.
[Dr. Jay] So, I think we’re still learning and at least I’m still learning quite a lot about this disease.
[Dr. Z] Well, and you know the other thought that I had, and again, this is just pure mental masturbation is the idea that that group may be exposed to so many pathogens on a daily basis, including Corona Viruses, et cetera, that they have some innate T-cell immunity or mucosal immune something that we don’t have.
[Dr. Jay] Yeah, I think there’s some evidence of that even in the United States right.
[Dr. Z] Yeah, exactly.
[Dr. Jay] I saw this really interesting study where it looked at, it was a small study so I don’t know if it generalizes it will hold up when it’s done larger, but people who have young kids, you know if you have young kids, I have three kids and when they were little I had colds all the time. People with young kids are less likely to die from it.
[Dr. Z] And that really tells you something like, I remember I had a severe cold actually just in January before it was really widely prevalent and I never had antibody testing or anything. So I don’t know if it was COVID, but I doubt it. No one else in the family was sick. I caught it from a friend who was in Las Vegas. And I wonder whether getting those really jazzes your T-cell immunity kind of like getting a BCG vaccination or something like that.
[Dr. Jay] There seems to be increasing evidence that T cell mediated immunity does matter quite a bit.
[Dr. Z] But even talking about that people are like, “stop minimizing the catastrophe.”
[Dr. Jay] I don’t understand this, like this is not politics to me. This is a really important epidemiologic phenomenon that we absolutely have to get our hands around. We need the best science possible. I don’t understand the politicization of you’re on team apocalypse or you’re on team doom, right, team–
[Dr. Z] Team denial.
[Dr. Jay] Yeah, exactly.
[Dr. Z] I liked that team apocalypse versus team denial go! That’s really what it is. And we say that we don’t understand it, but we do understand it’s an election year all that, but as scientists, we don’t condone it is what we’re trying to say. You got sucked into it, right? Because by definition now you’re on team denial because you did science that doesn’t support the press’ narrative of X, Y, and Z.
[Dr. Jay] Yeah, what I was taught in public health circles, we actually give people the right information, the true information. We don’t unduly stoke panic just in order to get the result we want, which is essentially you’re gonna comply with this order or that order. We don’t do that. We tell people, okay, here are the risks. We have to trust people to react to that appropriately. Not many times, they won’t some but many times they will, but on net if you wanna maintain trust in the public health community, the absolute first thing we have to do is tell them the absolute truth about what we know and we don’t know.
[Dr. Z] So what you’ve nailed here again, is something I talked with Vinay Prasad on the show about which is authenticity. We suck at it in medicine, we prevaricate, we think we don’t trust the public to do the right thing. We are paternalistic to a fault. So when Monica was on the show yesterday, she said, you know, I’m an HIV researcher. I believe in harm reduction. How dare us preach at people wear mask you dummy, you stupid person. And do you wanna kill grandmothers? And this and this and this, that’s not the way to communicate public health. You communicate the uncertainty, but you communicate what we know and her whole thing as well, if mass reduce inoculum, and it’s a low risk intervention, then maybe you guys should do that. But it’s your decision. I don’t wanna mandate it. And if we get 80% compliance according to our data, maybe that’s a tipping point, but you know, again, it’s a hypothesis.
[Dr. Jay] I’d amend that a little bit. I agree with that actually, but the only thing I’d amend is it’s related to the harm you really, really are seeing. So if we really are seeing it’s a 3% mortality disease, yeah then I’m okay with more aggressive. But if on the other hand we’re really uncertain about that 3%, which we were. If we really don’t know, we should tell people, look, it’s looking like 3% we don’t know, let’s see, here’s what we’re doing to try to figure it out. We should just be honest about what we don’t know. I think to me has been the most shocking thing that the public health people and doctors have dawn this mantle of absolute knowledge in a place where I’ve read a lot of this literature there’s a lot I don’t know even though I’ve been reading the literature scientifically. So we just don’t know. We should say that. Why is it bad to say that when we just don’t know.
[Dr. Z] You know, and what it does there’s a side effect of that, that we’re seeing now, which is when doctors and public health officials say, “don’t wear a mask.” and then yeah in the next breath, “wear a mask of any kind. “I don’t care “if it’s just the lace panties over your face wear that” we look like idiots. And on top of that, the public then, which isn’t as dumb as they’re portrayed by the intellectual elite, goes, “now wait a minute.”
[Dr. Jay] And they should.
[Dr. Z] And they should. And then what happens is, and you see it in the comments to my own videos, right? If I do a video kind of leaning in one direction, a billion people comment the other direction. If I lean in, in that other direction, a billion people comment, the public is trying to find truth.
[Dr. Jay] Right.
[Dr. Z] And it’s tough.
[Dr. Jay] I mean, you know, that’s okay. We’re having a conversation, there’s stuff I’m learning from you. I hope there’s some stuff you’re learning from me. And basically that’s what science is. It’s a conversation that leads to more data that leads to more conversation. That’s what it is.
[Dr. Z] So what you just said is absolutely reasonable and rational and Buzzfeed attacks your family.
[Dr. Jay] Yeah, so, I mean, that was tough, I have to say. That was probably the hardest parts of the whole work on this was just feeling like I’ve dragged my family into something. There’s one thing to go after me. It’s another thing. Like, but in any case, let’s leave me aside. So we put this paper out, we find this number 0.2 to 0.3, and then a whole series of studies started coming out from around the world to find the same number. Many of them published, the peer reviewed literature I think now has established it.
[Dr. Z] So let me ask you a question though. So what, two to three times a flu is still catastrophic, man. Well, how do you respond to that?
[Dr. Jay] I’d amend that, there’s also no vaccine.
[Dr. Z] Right no vaccine and we didn’t have treatments.
[Dr. Jay] Absolutely it is worse than the flu for those reasons.
[Dr. Z] Thank you ’cause I think that the denial, I think a lot of people perceive a denial. This comparison with flu is very charged and the truth is–
[Dr. Jay] It’s worse than the flu. And I think for older people, it is absolutely we should treat it like it’s much worse than the flu, because it is worse than the flu. So for instance, nursing homes, right? So I just looked at a paper that said that nursing homes often share staff workers. So like one staff worker works in nursing A may also works in nursing on B. We should be using our testing resources to make sure that when shared staff workers move back and forth, they don’t bring the virus back and forth with them across these nursing homes. That seems like a completely reasonable outcome of the fact that older people are much more vulnerable, especially people with comorbid conditions.
[Dr. Z] And you’ve been a big advocate of protecting vulnerable groups.
[Dr. Jay] That’s the whole point of this is to learn who really should we be using our relatively limited resources to protect. And when we raise alarm, who should we be doing it for. There’s cost to raising alarm, right? So like, if I panic you, you may take actions. That’s the whole point of the raising the panic and the alarm. But those actions will have very little effect or much less effect on the spread than the costs that you pay and the society pays for those acts.
[Dr. Z] And the problem with those costs are they’re often in tangibles, like I have had fans, who’ve become fans of my show since we started the COVID adventure. And the reason they became fans is they have generalized anxiety disorder, or they have some level of anxiety. They have been jumping out of their skin, watching the press catastrophize about this in generating the fear that I think was the medical establishment was complicit with because they are seeing it on the front lines in a very biased way. Oh my God, my ICU is full of people who are dying, including some young people. And therefore anything we can do to get the public to behave is gonna be important, right. And then what ends up happening is these poor individuals who have a tendency to anxiety are losing their minds. So they tell me, I watch your show because you seem rational and you have opposing viewpoints, and you’re not just saying we’re all gonna die. And I think why should I be the one who’s doing that?
[Dr. Jay] Well, you have a good audience.
[Dr. Z] I think that ought to be the general.
[Dr. Jay] I agree with that. I don’t really understand it, but it seems like people want, especially the press seems to want to create this panic. So every time there’s a study that comes out, that a child has died, which has happened absolutely for this disease. You’re gonna get this panic headline from the press. Now, one of the things I’ve learned from the seroprevalence studies, again from around the world now, not just mine, is that there’s a very wide range of clinical presentations from this disease. It ranges from, somewhere between 30 to 40% of the people that get it have no symptoms whatsoever. They can’t remember. They have the antibodies, but they have no symptoms that they can remember from it maybe even a larger part have relatively mild symptoms. It’s like a cold. And a small fraction have this horrible viral pneumonia that kills them. We focus all our attention on the viral pneumonia and none on the fact that 998 people are gonna recover from it.
[Dr. Z] Yeah, that’s a feel good hit of the summer, right there. Like that’s a positive story and they’re going to develop immunity and this whole panic about, well, no, we’re never immune. That’s another press thing.
[Dr. Jay] Yeah.
[Dr. Z] It’s insane
[Dr. Jay] It’s like no other virus does that, right.
[Dr. Z] Exactly well, what do we all, and the related piece to that, like you said, one story about a child.
[Dr. Jay] HIV, I guess
[Dr. Z] MISC, HIV I guess, strep throat. You can’t have a vaccine.
[Dr. Jay] So actually it’s a legitimate scientific question, but one we now have an answer to. You do develop immunity, this virus.
[Dr. Z] And the thing is because we have now millions of cases and we can look and there’s been like, I think two documented cases of actual re-infection.
[Dr. Jay] Yeah.
[Dr. Jay] One was like, it was totally mild. The other was more severe. And so you could think in a population there’s variants, right.
[Dr. Z] But two out of millions right? So, and as you said, the first case, that was the reinfection, it looked like the guy was protected.
[Dr. Jay] Mild, which is what you would expect, even with a cold, like, you get a cold one year, you may get it again the next year, but it’s gonna be minor.
[Dr. Jay] Yeah, if you have the same virus, even if the antibodies fade, you may have T-cells or other mechanisms immunity that make it so that, it’s not that you won’t get sick, but you’ll get sick much less and it won’t create severe illness.
[Dr. Z] Now, one thing that’s gonna come up, and this comes up a lot again, in the catastrophization camp, but what about the long haulers and the terrible damage to the lungs and the cardiac damage and the brain damage and all the other things.
[Dr. Jay] You know, those happened with influenza.
[Dr. Z] Exactly, right.
[Dr. Jay] So my son, my young son, 13 year old now a couple years ago, got the flu and he’d had the flu vaccine and he still got the flu.
[Dr. Z] Which happens.
[Dr. Jay] Yeah, it happens I mean it was fine. Like, it was a little worse than I thought it would when you normally would get, and he was getting better and he woke up one morning and he couldn’t walk.
[Dr. Z] Oh my gosh.
[Dr. Jay] I was going through all the panic things when you go through medical school, you always have to.
[Dr. Z] Like Guillain-Barre.
[Dr. Jay] That’s exactly
[Dr. Z] Transverse myelitis.
[Dr. Jay] And I’m like, Oh God. So it turned out it was benign myositis. Thank God and within a week he was walking again. Flu has all kinds of strange side effects. It has neurologic side effects. It can have cardiac side effects. We put these in context, right? These are things that happen. Absolutely can happen. but we have a lot of information about how frequent they are. Are they likely? How long lasting they are? If it was Guillain-Barre would have been terrible, but if it’s benign myositis it’d last week and he’s okay.
[Dr. Z] So that’s funny because my daughter had a viral syndrome when she was three and couldn’t walk and again benign myositis. But again, you go through the panic, but the point being these things happen with viral infection, this is a new viral infection that we don’t have a vaccine for. That is novel to the degree that it’s novel. Although we seem to have some innate immunity from cross-reactivity to Corona Virus, and yet we are spinning it as if the world is ending. And the thing is that would be fine if we thought it was actually going to cause less harm to spin it that way than not, but it’s actually causing a lot of harm in terms of the response. So whether it’s suicide rate going up, substance abuse, economic catastrophe, mortgaging our children’s future, creating intergenerational divides now.
[Dr. Jay] Yeah, I was hoping we get to talk about that. ‘Cause that’s something I think has been vastly underemphasized and it’s breaking my heart. So let’s talk about suicide. The CDC released a report, I think in July that it was a report where they ask about suicidal ideation. Like how many suicidal thoughts, have you have you had any serious suicidal thoughts. One in four 18 to 24 year olds, one in four 18 to 24 year olds in June had serious thoughts of suicide.
[Dr. Z] You know, so my assistant is in her early twenties and she only just recently told me during the early lockdown stuff, we didn’t have her in our house. And, kind of kept her on a, not a furlough we were paying her, but she isolated. Now this is a hyper social person in the prime of her life who is now told, don’t leave your house sit there with your dog. And she told me now that it was so awful for her, you know?
[Dr. Jay] Yeah, for a disease for her 20 early twenties, probably one in 10,000 death rate. We’re basically imposing asking young people who are meant to live in community. Not me I was a hermit, but everyone,
[Dr. Z] Me too, I really enjoy this.
[Dr. Jay] But we’re not meant to live alone in our house hold up, it’s going to have consequences. It’s gonna have severe negative consequences, psychologically, and we are already seeing it. That is just the beginning of the cost of the lockdown. Worldwide, they’re reports of hundreds, of millions, of additional people starving as a result because you said you’re talking about economics. So one of the themes I’ve heard argued against me when I make this point is, well, look, you’re talking about the lockdowns and there’s some economic costs, but what are they relative to the lives we save. But it’s not lives on one side the economy on the other. The economy is really important to the lives of the people who are in the midst of it. And hundreds of millions of people around the world that are on the edge of economic disaster. And you push them over you, you destroy the world economy. It’s not just dollars. It’s hundreds of millions of people starving. And that’s what the UN has said. Then you go, and it’s fine.
[Dr. Z] I said this, like in the first month of this pandemic, I said, you guys seem to have this false dichotomy between economy and lives. Blood is treasure it’s there it’s a transitive property. When you start having unemployment, the suicide rate goes up in the world when you shut the economy down, people starved to death. And this idea, and I’m gonna rant for one second and you may or may not agree with me. I feel like my own tribe of people, the healthcare professionals, have held the rest of our country hostage with their catastrophizing around this, which was done with good intent. These are good smart people. And they’re right. We’ve had deaths and terrible outcomes, but they fail to see the bigger picture. And Monica Gandhi on the show yesterday said, as doctors it’s our responsibility to see this.
[Dr. Jay] Our job is to show people that picture, I’d say even more than just, I mean, I call us the Zoomocracy and I mean it. So like, I’m fine I can be on Zoom and I’m not going to lose my well, maybe who knows the Sanford could keep me.
[Dr. Z] We gotta talk about that.
[Dr. Jay] But I think I’m fine, right? So like, why should I care about, well, my job is to tell people what’s happening in the rest of the world, I think. There’s this program called Gavi, which is a program for vaccinations International Program for Vaccinations. They’ve halted their operations because of the lockdown.
[Dr. Z] So polio comes back, measles comes back. measles never gone, measles is still here.
[Dr. Jay] Yeah we’re gonna see research we may even see resurgence in polio in the United States because people stopped taking their kids for the OPV vaccine.
[Dr. Z] Yeah absolutely cancer screening, their mental–
[Dr. Jay] So we’ve had good news from cancer for the past few years. We’ve actually had decreases in cancer related mortality for the first time in my memory anyways, for three or four years in a row that will reverse, we’re gonna start seeing later stage breast cancers, later stage prostate cancers, people stopped getting screening. People actually even stopped getting treatment for cancer, active cancer. During the epidemic.
[Dr. Z] Yeah I’ve seen that. HIV, patients are losing their viral suppression. Monica was talking about that because they’re not coming in.
[Dr. Jay] Tuberculosis millions of extra tuberculosis cases ’cause you have tuberculosis, you have to treat over a long period of time with regular antibiotics. People come in around the world because they’re–
[Dr. Z] Directly observed therapy, all this other stuff.
[Dr. Jay] Exactly and that stopped were gonna see a resurgence of tuberculosis deaths.
[Dr. Z] Well, so let me ask a question because this is very gloomy stuff. Like, honestly, when you said earlier, you were heartbroken. This is what keeps me up at night because you know here we have this platform we can get to see, like you said, we’re part of the Zoomocracy. Like we can do this, we can get this information out, but it doesn’t sink in. And what it does is, I worry that it even contributes more to this polarization because there are camps that get so emotional about the damage we’ve done from our response and camps that gets so emotional from The United States’ perceived failure relative to other countries in terms of mortality per million.
[Dr. Jay] I’m heartbroken at both. I mean, I think we in public health need to balance COVID is not the only threat to public health. We need to understand that there’s all kinds of public health problems.
[Dr. Z] So what do you think you would say The United States should do? And then I wanna talk about Sweden and Europe and Asia too, but what do you think the United States should do? So here’s the problem, all this disaster from our response and then the danger of the virus, which is worse for the elders and people with comorbidities. And it’s blessed than we thought initially. And we have a little better treatment now. So what do you think?
[Dr. Jay] If I had to characterize the American response. It’s exactly backwards.
[Dr. Z] Yes.
[Dr. Jay] We have quarantined the healthy and we’ve exposed the vulnerable to the disease.
[Dr. Z] That’s it and Monica said yesterday.
[Dr. Jay] Flip that around.
[Dr. Z] Monica said yesterday, we were exactly backwards as well. We’ve favored the rich people who can survive this, the Zoomocracy like you and I, and we’ve punished the poor. So we’ve actually told them, stay inside, lose your jobs, get $1,200 a month.
[Dr. Jay] Yeah, or you go out and expose yourself, deliver the groceries to
[Dr. Z] Essential worker.
[Dr. Jay] Yeah, I don’t understand it. I could understand three in a 100 deaths.
[Dr. Z] Different story
[Dr. Jay] You imagine it, but even there you’d wanna focus response and figure out who really is
[Dr. Z] In that 3%.
[Dr. Jay] Right, exactly and there may be people who are less vulnerable. You tailor your strategy around the numbers you’re seeing, but we haven’t done that yet. We’ve gone the opposite route since in many ways, I think New York is an absolute disaster, New York, I mean, the highest death rates in the world happened in the Northeast early map of the United States.
[Dr. Z] Yeah and multiple reasons for that probably that will become clear also more in retrospect and our retrospectoscope is is gonna be highly, highly indicting. I think of a lot of behavior that we had early on.
[Dr. Jay] Yeah, can we return to, you were asking me earlier about like the scientific discussion around this.
[Dr. Z] Yeah, I would love to,
[Dr. Jay] So I’ve been really concerned about censorship in science around this epidemic.
[Dr. Z] As have I.
[Dr. Jay] Yeah and so like you mentioned, John Ioannidis is one of the foremost physicians in the world, researchers in the world studying. I had the honor to be able to work with him. He did an interview early on in the epidemic that was suppressed by YouTube.
[Dr. Z] How do you suppress John Ioannidis?
[Dr. Jay] I don’t know, I don’t understand it. My view of science is that it’s a conversation. We have to have the ability to express views that are not popular or else we can’t have a science. We can’t have science.
[Dr. Z] I mean.
[Dr. Jay] So the idea is that somehow if somebody is expressing a view that is contrary to somebody’s interpretation of some public health organization, World Health Organization or whatever, it’s ipso facto dangerous to say those views, that is a form of population control. That’s what it is, right.
[Dr. Z] It really is, yeah.
[Dr. Jay] It’s fine if you know, with 100% scientific certainty, that some fact–
[Dr. Z] Is wrong.
[Dr. Jay] Yes.
[Dr. Z] Yeah, like vaccines cause autism, right?
[Dr. Jay] So what’s the your response. You say, look, the vaccines don’t cause autism, right? That’s the right response.
[Dr. Z] That’s right.
[Dr. Jay] And here’s the evidence.
[Dr. Z] That’s right.
[Dr. Jay] If you have a situation of a new virus where the science is emerging rapidly and we’re learning new things, I’ve changed my mind about 15 things about this virus as I’ve read new papers
[Dr. Z] Me too.
[Dr. Jay] over the course, how could you not?
[Dr. Z] Yeah but you know what, read the comments in my videos. You flip-flopped on this five times.
[Dr. Jay] Got me with this new evidence coming up right.
[Dr. Z] Yeah.
[Dr. Jay] So in that context, scientific censorship is criminal.
[Dr. Z] Yeah. I agree.
[Dr. Jay] And so I think, and