A Geneticist Who Predicted 500,000 COVID Deaths in February Explains What Happens Next

Vance Crowe [00:00:01] As the crow flies on the Vance Crow Podcast. Alright, RA Kahn, welcome to the podcast.

Razib Khan [00:00:09] Great to be here.

Vance Crowe [00:00:10] So, I actually don't know you very well, but I have followed you on Twitter for many years. You are a geneticist that I know at one point was gonna be involved, a reporter for the New York Times, and then all kinds of social stuff blew up around you. But I know that you are highly respected among people that I know well, Kate Crosby, Jesse Hoff, have all said, Hey, he's a Twitter feed worth watching. But when I watch your Twitter feed, I see somebody that is saying things like, we are not doing nearly enough to stop coronavirus. And these are some things that people should be aware of. So you are way, way far away from other people that I know as far as the measures that you're willing to go to. So first, gimme a little bit of a background on who are you and what are you doing, and then let's talk about your perspective on Coronavirus as it stands on April 2nd, 2020 or April 3rd. What day is today? April 2nd.

Razib Khan [00:01:00] It's the second. Yeah, it's after, after April Fools. That's how I, that's how I time it. So in terms of who I am, what I do, I basically work in the genomic space, mostly in humans doing ancestry and inference and other things. I consult for people. I, I run a podcast with Spencer Wells of late Ursil, national Geographic called The Insight on, you know, human genetics and its intersection with history. You know, I'm basically an evolution human genetics guy. Probably my, you know, my domain spans medical to a lot of like population genetic stuff. So that's what kind my bread and butter in my day-today is. I do take an interest in other things. So in January my wife and I were paying a lot of attention to what was going on in Wuhan. And you know, I've done a little bit of modeling work with R Knots and epidemiology just in graduate school. So I knew what the, the framework was, I knew what the parameters were and I, I remember saying at the time in January 20th, but you know, like this rnot is too high. It's gonna decline. It's gonna decline. Like we have evidence from sars, we have evidence from mers, we have evidence from H one N one and it was

Vance Crowe [00:01:59] Rnot. So tell me what that is.

Razib Khan [00:02:01] The rnot is basically just like the rate of reproduction. So you know, rnot A two, you got two people you infect as an infected person, rnot of 0.50. You're only gonna like have a 50% chance of infecting someone. So you want rnot to get below one. So that basically means that the infection is decreasing in the population. An rnot of above one means it's increasing. You don't want that. Right. And you can decline, you can decrease the rnot in various ways, you know, depending on what you do. But basically it wasn't declining. And so, you know, my question is, was China special? All I came to the conclusion the first week of February. It wasn't, there wasn't some special parameter and we had to be really worried. And so in early February, you know, myself and some of other, my other friends online, mostly in private channels 'cause we didn't wanna seem crazy, you know, were starting to get extremely worried. And so, you know, that's when the Costco run started. You know, we just started doing a lot of research and a lot of reading and I did some back of the envelope I calculated in the middle of February 500,000 excess fatalities is reasonable in the United States. And so that's where I was, people started asking me what I thought and basically I said freak out. You know, by February it's been interesting because I feel like the world has kind of come to where I was and a lot of the people that are where I was had totally different interests and focuses and preoccupations in February.

Razib Khan [00:03:39] So it's a little interesting going from being the crazy guy till the world is crazy. That's, you know, how I

Vance Crowe [00:03:45] Feeling. And so when you talk about you were making Costco runs, like how secure were you making yourself? How, how much were you thinking, Hey, I need to buffer myself away from other people as you watch this coming as a slow motion tidal wave?

Razib Khan [00:03:59] I mean, we didn't assume there was any community spread where we are initially. So we weren't like super worried about masking or anything like that. But basically, you know, months more than months and we got like a year's worth of toilet paper in the shed, you know, so it mostly, I I was hoping that there wasn't gonna be social collapse or anything like that, like looking at the mortalities and you know, China was able to prevent that, although they used certain means and certain methods. But basically we just wanted to be able to do the social distancing and the self quarantining immediately. And we started doing that in early March.

Vance Crowe [00:04:34] Yeah, in my family we did that as well. I had been traveling and my friend Kate was telling me all the time, Hey, if you're on a plane you should be wearing a mask. And I remember thinking like, I, that would be too embarrassing. I would never do that. And now knowing what I know now, I, I can't even imagine that way of thinking ever again. But we started getting food and thinking about how are we gonna be able to distance well before other people were. And it was a weird experience because like you had said, you don't wanna be the crazy person. But at the same time as Nasem Taleb says it, it pays to panic early. So you don't wanna be the one that panics last. You wanna be the one that panics early and the payoff for panicking early means you have extra food and you're, you're better prepared. And the downside of not panicking early means you're not prepared.

Razib Khan [00:05:21] Yeah, exactly. Just gives you a buffer. It gives you a slack against, you know, just tail risk. All the things that are happening in the world right now with the volatility kind of anticipated that this is not out of the ordinary of what the back of the envelope calculations. And you know, people are talking about a lot of these mathematical models and epidemiology and all this stuff. But I mean, my personal experience just going through this right now as a human being is the original just like basic simple models using like, you know, what percentage infected, what percentage fatality. I mean they come close enough to giving the general flavor and sense of what's really happening. What was really important for me was the empirical evidence. So, you know, I was keeping track pretty intensely what was going on in China at the end of January. And I was very hopeful that there was something special about Hube and that I came to the conclusion there wasn't.

Vance Crowe [00:06:11] So you talked about how China used some measures that maybe be questionable and you know, what do you think China did and and when you watch their leveling off is, tell me more about that.

Razib Khan [00:06:26] Yeah, well so I mean they, there are not went from, you know, two to four in that range down to 0.3, which, you know, a lot of people will say that's overkill. So that means they really crushed it, at least by what they reported. And I think that there is some issue with their data. I totally agree with that, although I think we can get some insights out of it. Alright. But really what they did is, you know, one they quarantined hube, then they quarantined, you know, they quarantined Wuhan, which is the city of 11 million. They put people in their houses, they refused to let them go. They quarantined apartment complexes. They had all sorts of levels of granularity of lockdown all across the region. They also locked down, you know, like big cities, pretty much the whole nation to, to some extent from what I recall, although that started later and it ended later or ended earlier. Right. So Wuhan I think is gonna be, it's officially supposed to be, I think out of quarantine and always on April 8th. I don't know if that's gonna end up happening 'cause they're, they're getting stressed out again. But that's what they did. I mean, you know, there were stories which I think are probably correct 'cause there were multiple sources of people basically locked into their house by the authorities. 'cause they just didn't want them to go out. You know, whole families were just like sealed in there and, you know, a lot of tragedy happened. So, you know, adults can die, but children generally do not. So there were cases where, you know, there's a three-year-old leftover and then, you know,

Vance Crowe [00:07:55] I, you know, and, and we think about this like being abhorrent and, but I watch what's going on with the cruise ships. So I used to actually work as a decade end on a much smaller cruise ships than the ones that are not, that are stuck out at sea. And you'll put on, on the one hand, be like, what idiot got on a cruise in the last two weeks to put themselves in this position? And yet they're still stuck, not able to come into port. And you know, you have to have a country that accepts you. It is no small thing to come into a dock. And if a if a city doesn't want you, you can't go there. And yet we're leaving people on those things to die. Yeah. What do you think about that? Because I, from what I understand, when we bring cruise ships in, that is a huge viral load that you're letting into an individual city. What's, what's the trade off damage there?

Razib Khan [00:08:40] Well, I mean, look, I mean, ultimate here, ultimate goal here is to save lives. So, you know, you're not really doing that if you're letting people die on the vine there. I think one thing we need to maybe think about are these open air, you know, just tents where they would, you know, or like these big, you know, stadiums, there's places you can put people, keep them somewhat distant from each other. This is not, this is not from what we can know, a disease that's as contagious as measles. And so it should be okay if you can put them in a separate facility or in a tent somewhere. I mean, that's what they did in China. So I think that there are ways to accommodate, I just think we need to be creative and open to them,

Vance Crowe [00:09:24] You know. So what, what is your assessment of how the US is doing so far with their stay at home orders and the quarantines? How, how do you think they're doing? How would you assess it?

Razib Khan [00:09:34] Well, I mean there's, there's some cell phone data and I'm sure some of your people out there read in the New York Times or not. Yeah, it looks like the southeast, the South in particular has been a little bit tardy and late on the west coast, it's been extremely well, as good as it gets. We're we're still not perfect, obviously. So the r not in Washington state, it's 1.4, so that means it's still spreading but much slower than say in New York where New York City where they delayed it. And so times of the essence, you know, a day here, a week here, it makes a huge difference. So it looks like once people start seeing people die around them, they start complying. Right? And so in Washington State, we had the issue with Kirkland nurse, current nursing home, and a bunch of people died. And I think that put the fear of God in people and there's been really high compliance from what I've heard from my friends in that state and also with the data show. So I think we're doing okay. I'd give us like a c plus right now. I think we started late now. Like here's the issue, which multiple friends and I have talked about. If we started doing really draconian measures in early February, we probably would've prevented the pandemic in the United States. But then people would ask why you did that when nothing happened? Yeah.

Vance Crowe [00:10:47] And then you, you have a whole new problem, which is that people don't believe. It's just like if you evacuate for every hurricane, eventually people stop paying attention to them. Yeah.

Razib Khan [00:10:55] So I, so I don't know if we could have done anything different. I do think I'm not very happy with, I'm not happy with how long it took Trump and a certain element of, of conservative media to go beyond the idea that it's just the flu. Because it's just, even if you accept that the mortality rate is the same, the morbidity is way worse, right? So you're in the hospital for a month, there could be lifetime consequences. It even with if you, if you equalize a mortality somehow, which like is unlikely, it's like at least 10 to 30 times more fatal probably. You know, it's not like the flu. So I think that there was a miscommunication, some misinformation there that's caused a problem. And until it reaches your community, a lot of people, it's not real for them. I understand. You know, I kept track of social media pretty intensely in January and China. I saw what happened there. And then in Iran it was a little spotty, but the exact same thing happened when it happened in Iran around like February, like 20th or so. I think that's when I realized, you know what, like there's just no chance that there's some special thing they eat in China or some special, you know, Iran has nothing to do with China, you know, aside from being an economic satellite. Right. And so that's why it, there was an outbreak and the exact same thing was happening in Iran that happened to China. And honestly the exact same thing is happening to New York City.

Vance Crowe [00:12:16] And if I recall from, I think it was your interview with Spencer Wells talking about Iran had even closed their borders to China before they had a reported case and a traitor snuck into China and then back out. And one person caused un unimaginable damage to Iran. Yeah,

Razib Khan [00:12:33] Well, I mean, if you have a super spreader for some reason, and we're still like totally unclear about the, the influence of viral load and like individual differences. But you know, there are cases, I think in the Korean case, one woman spread it to like dozens of people at a buffet, you know, so I say R not is like, you know, take two nor the average person is spreading it to two. But there are these exceptional cases and once you have those, like then all bets are off, right? So this is, this is all over the world and you know, there's some East Asian nations like Taiwan that have done a really good job, con constraining it, but it's everywhere now. So we are beyond the stage of can it be contained in China or Iran or wherever it's here, how do we deal with it?

Vance Crowe [00:13:18] I saw the horrifying video of people living in Ecuador and I've spent some time in Central America and Ecuador is a poor place, but it's not any more dramatically poor than say the, the slums of Panama or Nicaragua or even even Costa Rica. And I see what's going on in those places. And I mean that's, those are people living at the base layer. They are, they are so afraid that they're dragging the bodies out into the streets and burning them or leaving them wherever they find them. I mean, it, it's bad.

Razib Khan [00:13:48] Yeah. Yeah. I mean we don't even know, I mean just because the resources, the attention, the focus is gonna be on Europe. We don't even know what's happening in some parts of the world. We'll find out later. The media will go later. I mean, honestly, if you're a reporter, would you wanna go into some of these places? No. And would you think you would even be able to get back out? You know, so there there's gonna be some issues with that.

Vance Crowe [00:14:10] And so taking all of this in, into, into account, I see you talking about like, hey, we may need to limit interstate travel and on on Twitter. To me that is a, a threat to the m to to the republic, right? That when you stop free travel between states, you're doing something we have not done, even during the Civil War, people were allowed to travel between states. So tell me what makes you think this is the right measure for society, that we should be considering this? 'cause to me that is a very scary thing.

Razib Khan [00:14:48] Yeah, I mean I think one thing which I said explicitly was I think we even need to get more granular. Granular, it might need to be cities as far as threat to the republic. I think, you know, it might be unconstitutional. It depends. You ultimately, I gotta be honest, I think, you know, maybe legislation is needed, something like that to test whether it is constitutional or not. I understand the role of federal government, interstate, interstate travel, but empirically, like I have a bunch of preprints here that, you know, your listeners and viewers could, could pay, could see there. So

Vance Crowe [00:15:18] Preprint is, is data that has not been necessarily backed, backed up and validated. It's the, it's the first time it's going out. It's saying, Hey scientists, take a look at this. See if you can find some flaws in it. And you've got access to early data that people would come back and say, Hey, we made a mistake. We understand. That's why we put it out to you. So it's not necessarily validated, but it is an indicator.

Razib Khan [00:15:38] Yeah. And there's, there's a fair number of evidence from Australia, from India, other places people believe that these quarantines on the national level are delaying the spread, delaying or decreasing the spread. Like Taiwan has an extremely intense system of vetting and quarantining with other countries, right? And so initially the experts were saying, quarantines don't work. You know, just like with face masks, there's some political reasons that they were doing this in my opinion. But there is a fair amount of evidence that quarantines work. I mean that's what they did in China. Basically you contain and then you decrease local RO rather than focusing on the whole population. Because imagine trying to put out all of these different fires all over the place, right? So if we do social distancing in three fourths of the country, but not in one fourth of the country, it's gonna spread again back to three fourths of the country, right? And so in terms of cutting down travel, I think that's a way where you could put the fire out and not let it rekindle if everywhere doesn't do it equally. Right now New York City is really outta control and there's quite a bit of evidence that people are literally fleeing like refugees. Yeah,

Vance Crowe [00:16:42] I mean I think you've got a real problem with a state like Florida, right? Because people left New York and then they went to Florida and you have a state that said, hey, we are going to, we're gonna allow people to have their civil liberties. We're gonna let them gather. But now what are you going to do when you have a geriatric population and people start getting sick there? You're not gonna wanna see Florida license plates in Illinois, right? That's gonna be a scary thing. And people are not gonna be offering hotel rooms when they ask you for your license to, to check you into your room. You have to wonder if that hotel will accept somebody from Florida and, and it could get ugly.

Razib Khan [00:17:14] Yeah. I mean, so if you do it ad hoc like that, it will get ugly. I think that the government needs to step in and have some, I mean that, that's what happened in China too. You know, hube accents were persona non grata for a while. There were some serious issues. So, you know, people are scared, people are dying. There's gonna be a lot of crazy stuff that's gonna happen. So, you know, I think we have enough evidence from various cases that local quarantines do work in giving us time and in giving us just a way to control the spread in a rational way. Excuse me. So I'm just proposing this as a pragmatic solution. Now, as far as like a danger to the republic, I do think it is a danger to the republic. I do think a pandemic is a danger to the republic. Like historically pandemics have taken down societies. They haven't killed most people. Even the black death didn't kill a majority of people, but it has taken down the social order. So it is a danger. So I think that doing this is a threat to our constitutional order, but the alternative is more of a threat in my opinion.

Vance Crowe [00:18:21] So I think that that's a thing that's hard for people, including myself. To really wrap your head around. So St. Louis, Missouri, we have a few thousand cases, maybe 1700 cases. And I, I, I don't wanna, I don't wanna minimize death 'cause it's a real thing, but it's not been the deaths, you know, we aren't hearing the sirens running constantly here. It's hard to imagine that it's real when you see that there are nurses that aren't going into work right now. 'cause they've got plenty of time. The ICUs aren't filled up. You know, I had an ICU nurse on yesterday on the podcast. He said, I haven't seen a coronavirus patient. So it's very difficult to say, yes, I agree that we should eliminate people's liberty to go to church. We should knock down their ability to travel state to state. When, when, when you're not seeing it around here. So what would, what would be the case that you would make for how people could see something that would make them understand what you understand?

Razib Khan [00:19:19] Well, I mean, we do have social media. We do have video. I mean, it is true that on the West coast, the ICU for example, the ICUs have not gotten overwhelmed. We were scared that they did. It's been a kind of a best case scenario. And I honestly think partly it's just the way people reacted really early. You know, Washington state was the American, like, you know, early case supposedly. I think with hindsight we know that that's not true at all. It's just we had earlier awareness 'cause of that nursing home.

Vance Crowe [00:19:46] Right? Right.

Razib Khan [00:19:47] And so, you know, go on social media, look at what's happening in New York. Like I have friends in New York who had it. I know of people you know, you know, I know people who died. Okay. I mean, you know, I like, I know people who know people like, you know, one of my friends texted me, her parents' neighbor was doing their lawn on Saturday. He was feeling bad. And on Monday he died.

Vance Crowe [00:20:08] Wow.

Razib Khan [00:20:09] So, I mean, that's one case. I can give you others, you know, I don't wanna get into the details, but you know, just get out there and just reach out and ask like, we have all this technology, we have all this social media. You can see what's happening. You know, you don't need to trust the authorities, trust other people, their experiences. People in New York were very complacent until it came and now it's there and like it might hit Detroit next. I think one thing people need to understand is that there might be heterogeneity, there might be differences in different areas based on other variables. Like what if it's low density? What if it's really warm? You know, like all of these things together

Vance Crowe [00:20:44] Can have effect. Effect. Yeah. Identity transport seems to be a really, a really tough one, right? Because you have all, all these people packed in, you've gotta ride the subway or you're riding lots and lots of buses and that seems to be high spread. And then you look at a place like Louisiana where it seems like you've got a, a combination of really pretty poor people in high density party situations along with many comorbidities. I think when Louisiana, when the full weight of what is going on down in Baton Rouge spills over, that's when you'll start seeing people really see the, the, the horseman of the apocalypse on the yeah. This thing,

Razib Khan [00:21:21] I mean, it'll be multi-regional and even if it never affects western Kansas. To give a concrete example, I've been to western Kansas, like, I'm just like, how is it gonna spread there? You know? But we're one big country, we're one big common market. If New York City's on its knees, that's not good for the Midwest. You know, if, if the port facilities aren't working because everyone is sick at these big cosmopolitan ports, that's not good for exports, right? Just like brass tacks, we are a single economy. I think one of the social consequences might be like, frankly less free trade, less movement of people and more of a focus on like, you know, internal connections and robustness, you know, being more anti-fragile.

Vance Crowe [00:22:02] So is there a, a liberty that you don't think should be given up? Is there a line that you would say we should not cross in order to be able to, to stop this pandemic? Or is it stop the pandemic at all costs?

Razib Khan [00:22:16] I mean, obviously if it's at all costs, then you lose the whole point of stopping the pandemic, right? So obviously there are limits. I would not, you know, like search and seizure. There are certain things, you know, your home is your castle, you know, but I do think it's pragmatic and we need to seriously consider it. I'm not a lawyer, you know?

Vance Crowe [00:22:35] Yeah. I mean, I think even beyond the legal ramifications, I think everybody can have an intuitive sense of like, where does this go if we, if we cross this line?

Razib Khan [00:22:45] Yeah. I, but I think, I think this is a, this is an emergency situation. So in ancient Rome, they had a republic, but they would've appoint a dictator for a a finite term, right? Emergency powers happen even in democratic Republican situations because there are emergencies. This is an emergency. If you don't think it's an emergency, obviously you're gonna oppose it. But if you think it's an emergency, I think it is on the table. I some of,

Vance Crowe [00:23:08] I think one of, one of the things that has surprised, you know, I'm, I'm from Midwestern stock, I've lived all over, but I, you know, my core people are from the Midwest and many, many of them have said it really only took three weeks of being afraid for everybody to give over their, their rights. And I've been really surprised by the, the left right divide here. And maybe I shouldn't have been, but I have been surprised that there are people that are 100% convinced all liberty should go away. And then other people saying like, Hey, we may have to lose some people in order to keep our economy going because there are other consequences that matter. I I keep trying to find people like you to help me met this out because I genuinely don't know the answer to it. I, I don't wanna live in a, in a society where civil liberties are gone. And I am, I am very afraid of rule by mob or rule by dictatorship because once you give these freedoms up, the government find sees that it's much easier to control your population if you have these rules in there. So I, but I don't wanna be Yeah, so crazy libertarian.

Razib Khan [00:24:11] Yeah, I mean, it, it's, it's, it's difficult when we have to make some difficult choices. You know, I do think I dislike the conformity. I dislike the conformity in February and I just like the conformity now where everybody's on board, all the people that are, you know, talking about, oh, coronavirus this, we need to like stop the spread. They were, were just asleep at the wheel in February, you know, like they started paying attention maybe the first week of March and I stopped seeing less cr being less crazy. So I think contrarian views are always, always necessary and acceptable because it needs, it keeps you in check. My friend Heather McDonald wrote something really early on about the importance of the economy. And you know, Heather and I are friends. Like, you know, we've met, we've had dinner, like we had lunch, you know, when I'm in New York. So I appreciate her viewpoint. I disagree with it. But I think, you know, at some limit there is the point that the economy, I mean, look, if we have an eight, so, you know, I have friends in academia, a lot of them, and you know, some, some postdoc was saying, well, we should do an 18 month lockdown. And I'm just like, wait, that's crazy. And my friend's like, yeah, this postdoc doesn't understand where his salary comes from. Like, we'll starve, okay, you know, at some level you have to maintain the productivity of the economy and produce. So, you know, we need to set limits, we need to set boundaries. And,

Vance Crowe [00:25:25] And I mean, at, at its core, that's one of the challenges. The people that have time to be on social media right now are not the ones showing up to fix water pipes draining into people's houses or electrical outlets that are not working. You know, all kinds of other problems. And so you do have this mentality that the only people you hear talking are the people that are not actually essential.

Razib Khan [00:25:45] Yeah, yeah. I mean, people who are, you know, knowledge economy type people, you know what I'm saying? And so yeah, there's, there's that bias there. I do think what's happening in New York, so, you know, like there's all this theory, there's all this exponential growth. Like we all know that, right? Okay. We've seen that. I just think the, the evidence of Northern Italy, of New York City, okay, it doesn't, it's not happening everywhere to the same extent. But it could, and when it happens, it's really bad. Now it's not black death bad. It might not even be Spanish flu bad because we just have so much, so much more in terms of like, you know, the miracle of medicine in innovation, right? But it's pretty bad when you know, you, you're 80 and your chance of dying is, is 10% at that moment. You know, now people are saying like, oh, well they're dying of other things, blah, blah, blah. Okay, these are people that would've lived many years. You know, there are people who are 40 who are dying, like 20 to 40% are under the age of 65 that are dying in places like Italy. And, you know, yeah, their risk is lower, but maybe they have a precondition they don't know about, you know, and they would've lived 20 or 30 years. So it's not just people at death's door, you know, I think the evidence is there, you know, there's a lot of theoretical models and those are interesting, but let's look at the evidence. So, you know, when I was talking about travel bans and stuff like that, I mean, there's evidence in Australia, there's evidence in India, there are nations that did it, and there are nations that didn't. And you know, it, it does delay the spread and it gives you time. And so time allows us to innovate, like it allows us to get better treatments, eventually a vaccine, you know?

Razib Khan [00:27:18] And then there's like social adaptation. Like one of the most interesting things about this is stuff like masks and social distancing, not doing handshakes. There are all sorts of things that we are finding out that we can do to mitigate the spread of this pandemic that doesn't require fancy biomedical technology.

Vance Crowe [00:27:35] Yeah. Our, our children never know a world where it's uncomfortable or weird to wear masks. Like that is going to happen. It it you every airport in America, you know, I even have photos of the last trip I took up to Alberta and I I said the whole time, all the way there and all the way back I did, I saw five people wearing masks, which maybe I could have counted five before this had happened. I guarantee if you're in an airport now, there's probably only five people that aren't wearing masks at this point.

Razib Khan [00:28:05] Yeah, no. That it's, that's a, that's and that's an easy social change. There's gonna be probably harder ones about like the way you run businesses with conferences and other things like that, that are gonna require a lot of adaptation and that change your, in your routine. How are concerts gonna work? I mean sports, there's all sorts of things in our culture that are gonna be examined. And I think some of them are gonna be okay. Like this pandemic will pass at some point. Hopefully we'll make it through it. I mean, I think we will, but there's some things that, you know, I think people are just gonna, it's not worth it.

Vance Crowe [00:28:33] So when you think about this becoming in, in multiple waves, right? So maybe we get this kind of contained and then it comes back, or you have another pandemic that comes. What is the trigger to make everybody say this is when we go into total lockdown, or Hey, we were able to handle SARS before this happened and we didn't, we didn't shut down the entire economy. What's the dividing line between those?

Razib Khan [00:28:58] I, I would say the dividing line is your health capacity. You know, the issue is like if you don't have a a health system that can handle someone, they're just gonna die. Some people are just dying in their houses. People in France are just dying in their houses. This is well known. Multiple people in Italy and France that I know have told me this, and it's reported in the press, they just don't bother to take people anymore. And there's just issues with these dead bodies and houses. You know, people, you know, the, they don't, they can't take 'em to the mortuary right now because it's overwhelmed. So, you know, when you have that threat, then you need to move.

Vance Crowe [00:29:32] And I, so this kind of something that's going on right now. I've heard in Nova Scotia and in Montana when people test positive, they say, okay, we're gonna send you home and we're gonna have a nurse come visit you twice a day and check on your vital signs because we don't want you in the hospital. What do you, what do you think of these measures? This a good idea, this is a bad idea. Is it preserve our healthcare services? Or what do you think?

Razib Khan [00:29:57] I think it's a good idea because the hospitals are also vectors of contagion. I mean, you people are gonna, hospitals 'cause they have no other option. So they're, you know, if you can keep people apart, keep people at home, you have the capacity to do it.

Vance Crowe [00:30:09] Yeah. That was one of the things is we were making preparations. I was trying to see what is the largest amount of stitches or something like that, that I could handle to not have to go to the emergency room. Because we were trying to think of like, you really want to avoid needing medical care probably for the next two months. So you gotta think about should I actually cut this board or should I wait until I'm not in danger? Should I get up on this ladder? 'cause if I fall, the, the compounding problems that can go on with this are way bigger than they've ever been before.

Razib Khan [00:30:40] Exactly. Exactly. That's what I always tell people. I was like, just like, don't go to the hospital. Like, just figure out ways to, to not be risky. I mean, even if you're gonna go outside, maybe you shouldn't ride a bike. Maybe you should go for a walk. Oh yeah.

Vance Crowe [00:30:51] That's all off the table. We don't, we are not riding bikes in this house. I mean, it'd be great 'cause there's not that many cars, but there is no chance because one tiny mistake that could have been fixed very easily in an ER now becomes a, a major issue.

Razib Khan [00:31:04] Yep. They don't have the capacity. And you could catch it. I mean, that's a serious issue.

Vance Crowe [00:31:08] So let's change subjects for just a little bit. The, the economy. You see $2 trillion get added to the economy. Are you worried about inflation? Hyperinflation. Deflation?

Razib Khan [00:31:20] Yeah. You have to be. You have to be, I mean, I think, I'm not an economist, don't play one on tv, but I do have to say we had a supply shock with China and now China's coming back online, but they're seeing a huge demand shock. So the economy in the west is shut down. It's shutting down all over the place. My family's from Bangladesh and their, like, their clients are not paying anymore for the textual exports. Like Europe is just, they're not paying for, you know, stuff that they produced. And so there's gonna be a lot of hardship due to the economic effect all across the world in the United States as well. You know, and so that's the reality. And we're gonna have to like face it straight on,

Vance Crowe [00:31:59] You know, people are, it was, it was interesting 'cause in my family we're now drinking probably double the milk that we ever drank before. So I was thinking, hey, the dairy industry's doing great, but I've got a buddy Dwayne Fay, he is a, he's a dairy farmer up in Washington state. And he said, people don't realize 60% of all the dairy or some crazy number like that is, is eaten in restaurants. It's those little pats of butter that come out with your rolls. It's the, it's the extra cheese that that or cream that gets thrown into your stuff. So they're dumping right now, tens of fou, I don't know that Dwayne is, but dairy farmers all over the United States are dumping huge amounts of milk. And you can't just turn that off. Those cows need to eat. They're gonna produce milk and you can't just turn that off. You turn that off, it means kill the cows and then you can't turn it back on. So

Razib Khan [00:32:42] Yeah. Yeah.

Vance Crowe [00:32:43] These kinds of of shocks to our system are, are concerning for for sure.

Razib Khan [00:32:49] They're, they're, they're, and you know, and, and I understand like we can't like do a, I don't think it's feasible to do a, a national three month lockdown. So one of the, one of the ideas, and I think biology of Assan talked about it and it's been promoted in, you know, various publication, green zones and red Zones. And so you have this idea of, you know, there's hot zones, areas where the infection is at a high frequency and areas where it's not, there's no reason that the area where it's not shouldn't be producing economically and you know, producing and consuming and regular life is going on as much as it can. Again, this goes back to what I'm saying about quarantines and preventing travel that would allow for it. You wouldn't have to worry if you're in western Kansas that something is gonna come from Dallas if there's controls about what's happening. And even if there's controls, like truckers can come in and out. Healthcare people can come in and out. Essential people can come in and out. I'm just saying that like if you live in a city with a high infection rate, maybe you shouldn't be taking weekend jaunts in small towns around, you know, the suburban core. I mean, this is the kind of thing that I'm talking about. Yeah,

Vance Crowe [00:33:53] I mean I think, so I have always advocated for the Federalist system where cities are actually the very, very core of, of your democracy. And that you allow cities to have far more agency over what they do as, as more federal money came in and we tied everybody together and we said, Hey, we have to treat San Francisco the same as St. Louis, the same as Detroit. They're not the same. And I'm there, if there was one thing that could come out of this that would be great, it would be that you allow these economic mega regions to be able to, to govern themselves.

Razib Khan [00:34:28] Yeah. So there has to be a little bit more independence in some ways. I think, you know, our, just in time economy, you know, these extreme efficiencies, which have been great. They've reduced the prices on everything. I think we need to revisit some of that because it doesn't look like it's really robust to shocks in, you know, supply lines need to be more redundant. They need to be more flexible, they need to have more buffer. I mean, this is common sense, right? Like, I mean, after what we've experienced, the

Vance Crowe [00:34:55] The biggest thing that I, I hope people's eyes are open to is right now if you wanted to get beef, it's not that there aren't cows there, it's, and it's not even that there aren't enough butchers to be able to cut these animals up and be able to deliver 'em. It's that the USDA has to inspect these things. There are only so many that were set up and are legally allowed to do it. And so you have supply over here, demand over here, but there's all this red tape. And if we were able to cut that out, we live in a world that does not need to be regulated. Like we're the 1940s, but we are regulated in that way. Yeah. People are still treating the meat industry like it's the jungle and frankly it's keeping people from having a more resilient system with a lot more local supply.

Razib Khan [00:35:38] Sure. Well, I mean, I think, you know, in the world we lived in Precor Coronavirus, we had, we left, we left a lot of efficiencies on the table as well. Just because we could, because we had, you know, we thought we had slack in the system. We, you know, all pandemics infectious diseases. That's like a 19th century thing. Well it's not. So we need to worry about that now. But, you know, there could be other ways we can compensate. So maybe we have, we have less free trade, you know, we have more redundancy in the system. But we could look at regulation and we can make it more rational and more efficient. 'cause we have to, you know, maybe we have to now it's like there's pressure to do certain things that there weren't before. I mean, we know this really explicitly when it comes to drugs and the FDA right now, right? Know that,

Vance Crowe [00:36:20] Say more about this.

Razib Khan [00:36:21] Well, just like, you know, like some of the issues relating to the testing of coronavirus had to do with problems between the FDA and HHS and just coordinating who gets approval to do what. And are hospitals allowed to do these tests because, you know, they haven't been checked and vetted and you know, we're talking where, like a world where like days matter, you know, and

Vance Crowe [00:36:45] Yeah, I mean, I, I, the, the argument, I mean, in the past it was like, well, we need the government to be here and you can't just try medications willy-nilly. And now you've got people that are like, Hey, if we don't try something, these people will perish. And, and the, and the, i I know this is going on in biotech crops, right? Like the amount of years it takes to get a biotech crop to market is absurd. But they put it in there because they had political pressure and they didn't have an existential pressure. And existential pressure has a way of burning off access regulation.

Razib Khan [00:37:17] Well, I mean, so, you know, university of Washington and the Pacific Northwest, I mean they, they did some tests that they weren't officially allowed to do. They, they couldn't, they couldn't stop. They couldn't, they couldn't take it anymore. They were just like, people are gonna die. So they did some tests, right? The federal government, you know, obviously they're not gonna go after them. You know, they sometimes there's the law or the rule and there's the right thing, and sometimes you have to do the right thing, which I think you're seeing. And I think that might serve as a precedent of like, well, maybe we need to change the rule, you know? And so that could be a positive impact of this frankly, disastrous event that we're going through right now. Like looking at the unemployment, looking at what's happening to the economy. You know, there was a story about how actually, like I was talking to a friend of mine who lives in Mumbai in India, and he said one of the weirdest things is the sky. It's blue, no blue, no pollution. He has never, he's lived in the, he's lived there for 20 years. He's never seen a blue sky in Mumbai. It's always hazy.

Vance Crowe [00:38:15] Wow.

Razib Khan [00:38:16] Yeah. And it's blue now. So there's all these weird things that we're seeing and like, you know, it's great to see a blue sky, but it also says like nothing is happening. And in India, there, there are people who are like, you know, we talk about food security and other things in the United States, but look, I mean, it's nothing compared to a third world country. There are people who literally, like, they don't have enough food to make it to the next day unless they work. And so there's some serious existential like life and death decisions being made. I will say, you know, I don't think this is gonna go on in this extreme way for more than a month. I think there will be unwinding and loosening in various ways because there have to be, you know, this isn't, it's not lives at all costs because ultimately we know that if the economy is shut down long enough, other lives will be lost. Right. We know that. Okay. You know, if you, if you're not making machines in hospitals, other people will start dying. And right now elective surgeries are postponed in this country, but at some point people with cancer and heart disease are going to need to be treated.

Vance Crowe [00:39:24] Oh yeah. My mother is going through cancer treatments right now, and I I I, I was very much like, Hey, maybe we should stop the radiation and take a pause. And they're like, maybe you should. But also maybe the, the disease clears up and now you've got such a backlog for getting in to do radiation that you've now gone to the end of the line. Like there are all kinds of other things. So actually this brings me a good change question. What do you think of the social ramifications? How concerned are you about, about people that are unemployed, things like unrest, suicide, things like that?

Razib Khan [00:40:00] I mean, it's gonna be horrible. It will be horrible in the near term. I don't know if we're gonna have a depression. How you wanna define that? I hope we don't, I hope it's a v-shaped economic turnaround. I hope we know enough from the depression as well as our, you know, public health. We can just rationally make the better decisions based on, you know, what we know rather than what history has taught us of how we've reacted. I do think the 20th century is over in the year 2020. Like I feel like, you know, I feel like a lot of 20th century stuff is going around in our culture that dates back to a different time in a different era. And I think that that's,

Vance Crowe [00:40:42] That's super interesting. What do you mean that that's a fascinating concept?

Razib Khan [00:40:46] Well, I mean, you know, like if you're conservative, you know, taxes, regulation, the Reagan era, there's still kind of a halo of the Cold War and like, you know how we won that if you're liberal, it's the civil rights of the civil rights of the 1960s, the 1970s, you know, the achievements that have been made of like giving, you know, marginalized groups, you know, you know, rights and liberty and dignity and all this stuff. But I I, I think people just have been doing the same thing, same thing for decades because that's all they know, you know, for Republicans it's like cut taxes for Democrats, it's like give rights to, you know, ever more marginalized smaller groups frankly, you know. But you know, we have a world where we're not gonna be the number one economy in 10 years, probably a world war can't.

Vance Crowe [00:41:34] Whoa. You are the only dude that's ever said that to me.

Razib Khan [00:41:38] Yeah, I mean if you just, if you look at the nominal, the nominal GDP just aggregate not per capita, you know, you know when the last time the US wasn't number 1 18 80.

Vance Crowe [00:41:50] Wow.

Razib Khan [00:41:51] And you know, what was number one then? China.

Vance Crowe [00:41:54] Oh wow.

Razib Khan [00:41:56] Yeah. History's a circle bro. Anyway, so it's weird. But, so I think, I think probably, unless we have some major innovation, if we have some major innovation and productivity gains that can change, obviously. But we haven't, I feel like, you know, and I love it, I love the internet, but we need, we need stuff. We need stuff, we need material innovation, not just information innovation, right. To really have our economy grow that fast. So I think in the next 10 years, you know, yeah, we'll probably be number two just 'cause of population, you know, we're gonna have like 350 million people trying to have like 1.35 billion, you know, and so they'll eventually probably surpass us. We need to deal with the psychology of that. I thought that was gonna be our big psychological shock. But I think our big psychological shock is our state capacity response issues with this. Because everyone I think will know people that are gone at the end of this year because of C 19.

Vance Crowe [00:42:48] Wow.

Razib Khan [00:42:48] You know, I think everyone will, I mean, not like your, not your parents necessarily, but you know, maybe an aunt, maybe a second cousin, maybe your best friend's brother. You know, that's, you know, if you're talking like fatalities of like hundreds of thousands, that's gonna touch everyone.

Vance Crowe [00:43:07] I, I mean the reason I started doing this special Corona series was because I think the, the Overton window is kicked wide open right now, and things that would've been unthinkable or radical just a few days ago are now on the table. And it's amazing to me even that, that we started this conversation and I really thought I was going to push back a lot harder on your interstate idea, but frankly, I'd rather have some zones that are red zones and green zones than I would the entire nation being shut down. So I, I can, I can see the logic there and it's, I I think that that's, each man and woman are gonna have to go through their own psychological journey here because I was living in the 20th century, just like you're describing. And, and, and while I thought of myself as a modern person, I, I think you're absolutely right. Like there is going to be a huge push to get kids into physical jobs, into jobs where they would be essential. Right now I think there are a lot of parents probably sitting at home saying, what can I, my kid do so that they're, they're never in this position like I am right now. And I think that's gonna change the nature, probably the cha hopefully it will change the nature of colleges and universities and what they're focused on. I think

Razib Khan [00:44:18] This is, this is, this is the shock that academia was always assuming would happen. And it's, this is the exogenous shock, right? So now that equilibrium is gonna change. So if you think about it, it's like, I think a lot of equilibriums in a lot of just economic and cultural activities are gonna change

Vance Crowe [00:44:35] You. What do you think the, the, is there a curve ball coming with the next stimulus package after this 2 trillion, you think it's something big, like they're going to absolve student loans of all the debt? Like are they gonna do big things like that?

Razib Khan [00:44:49] I doubt it's gonna be student loans. It's not enough people. Not enough people have huge student loans that's too small of a, that's too small ball. I don't, I don't have any idea what's gonna happen. I mean, at some point we are gonna like run out of the capacity to print money though, right? So Yeah,

Vance Crowe [00:45:01] But that's The thing that I think is so interesting about this is they're not printing a single dollar. They're not printing, they're just adding numbers into spreadsheets. And it's, it's why I think like paradoxically, while they're putting all this money out there, hard cash, actual dollar bills are worth more because they aren't printing more of them. Yeah. But I, you have to keep the liquidity of the credit system because if credit cards suddenly freeze Amazon comes to a halt, suddenly Instacart suddenly stops. And so I think that right now the system is, while you have to have delivery services no matter what credit cards stay running.

Razib Khan [00:45:40] Yeah, yeah. I mean, so I think that that's true. I I think part one of the problems with the economy is no one person obviously has it all in their mind. So there's parts that everyone doesn't see and we're just kind of hoping, and it's worked so far and that's the, the be beauty and genius of the free market. But, you know, one of the issues that I do want to emphasize is, you know, our culture, we've had these culture wars and people are arguing with other people and they're doing social status games. A virus doesn't care about the cultural war. A virus doesn't care about our society. A virus doesn't care about economic efficiencies. A virus is a, a natural event. It's an act of God and it's taking, it's, this happened to our paleolithic ancestors. There's no difference. And I think that is, that is what is blowing people's mind because all of these social status games that we got good at and we thought were the big deal virus doesn't care. You know?

Vance Crowe [00:46:35] Yeah. I, and I think I see that. So I did a podcast late last night with the cattle rancher from Oklahoma, and he basically said, when he looks around at society, he thinks they're still kind of in this enchanted sleep where they're like, Hey, we're on kind of a long snow day and I can go outside and I'm, I'm still making jokes about how much ice cream I can eat and how much wine I'm buying. But that in reality, the nature of the society that they were in is completely changing. And, and now is a good time to be waking up to the idea of like, well, what will this look like and where will I fit? Because my, my place in the hierarchy is not, is not assured for better or for worse. I think there's gonna be people that do really, really well and how to this, but the system itself is gonna shake up the, the snow globe has already been shaken and who knows where that snow lands.

Razib Khan [00:47:23] Yeah. And like in the United States, we have a big internal economy that's gonna be positive, but imagine like Netherlands, which is based on exports and what's happening to the EU where like nobody trusts anybody else. It's all back to the nation state, you know? So this whole globalized era of the late 20th century, I think in some ways it's gonna be over because we understand that we can't just rely on China because if China shuts down, we're hosed. Right? So there's gonna be more redundancy, there's gonna be more bilateral

Vance Crowe [00:47:51] Hyper nationalism.

Razib Khan [00:47:53] There could be that, but I mean, we'll see, I, I mean, yeah, the issue is like, it's gonna be different than I think in the past. And I, I think we need to like think about what it, I mean, for example, like Hungary is obviously, Orban is now basically a, you know, he has fiat to do whatever he wants to in Hungary, Victor Orgon Orban. But they've been, they've been getting really, really good with, with China, apparently Xi called all the European leaders in the last couple of weeks for bilateral, you know, so the, you know, it's, it's as they say, like the arsonist like burned down your house and now they're, they're helping out, you know, you know, what do you need? What do you need? I can help you. So this is, this is where we're at right now. You know, we're, we're a little bit on our knees, a little bit off our game, and China's just stepping in and, you know, you know, we're here to help. We're the middle kingdom. That's what, that's what they're doing right now, you know,

Vance Crowe [00:48:45] So, Zeb, I'm, I've got one more question for you, but before I get to it, if people wanted to follow you on social media or your podcast, which is excellent, I, I, I found your conversation with Spencer to be one of the best ones I've heard since I started just, just this morning. How can people listen to more of what you're doing?

Razib Khan [00:49:03] Yeah, just go to Zi Kahan on Twitter. R-A-Z-I-B-K-H-A-N. And for the podcast it's the insight and you can find it on, you know, apple everywhere. Just the insight with Spencer Wells and Zi Kahan. And so that's, that's the best way to find me.

Vance Crowe [00:49:17] I, I absolutely loved it. All right, so the question I'm asking everybody on here, April 2nd, 2020, what will the world look like in two weeks?

Razib Khan [00:49:30] I think the world will look similar, but we're gonna start planning seriously about what we're gonna turn back on and what we're gonna turn, keep off, what is gonna be part of the long emergency. This, we are in a, we are in an emergency, there's a short term emergency and there's gonna be some things that are gonna be part of the long emergency of like, okay, that's never gonna change. You know, like perhaps we will have things like everyone who gets on a plane has to wear a mask, you know, that's the long emergency. It's just, people don't even question it. It's like not smoking on a plane, right? There's gonna be other things where I think life will, you know, small towns, downtowns will start reopening. People will keep their social distance not be as touchy, but life will be the same, you know? And we're gonna start to get a sense of the outlines of what'll be the same and what will never be the same.

Vance Crowe [00:50:18] Very, very interesting. All right, man, I so appreciate you coming on and doing this, and this has been great. Maybe, maybe we'll have you on in a couple weeks and see how things are going as well.

Razib Khan [00:50:28] Hopefully it'll be good news.

Vance Crowe [00:50:29] Yeah, that'd be great. Hopefully

Razib Khan [00:50:30] It'll be good news. We're bending the curve. I'm, I'm a little bit more optimistic, I do wanna say than I was two or three weeks ago. Partly 'cause we've acted, right? So if we didn't act, it would've spread way more than it has. We've acted. We are bending the curve, I think in the middle of April. We will see the worst of it and you know, after that it'll get better. It's just right now is not very good and we just need to like bite the bullet and do it, in my opinion.

Vance Crowe [00:51:00] Amen. All right man, well thank you so much for being on here. I really appreciate it.

Razib Khan [00:51:04] That was great. Vance. Ah.