 Okay, we're back for a live, we're here on Think Tech, we're here on Energy in America on a given Wednesday with Lou Pudirisi. Hi Lou, thank you for coming and joining the show by remote from Washington, New York. Washington. Washington. Washington. Lockdown. It's a very locked down. Okay. Well, we have a very interesting discussion ahead of us, let me preface it by saying that, you know, this is Energy in America, we're talking about oil, gas markets, we're talking about energy markets and they're in the dumps as they were last week, I mean really in the dumps, and that's because there's no economic activity going on, not here, not anywhere really. And so, you know, the question becomes how do you generate and when do you generate economic activity so you, you know, you bring up the energy markets and that's a cycle up. The more economic activity, the more energy, the more energy, the more economics, you know, it works, it works as a cycle. So the problem is getting to reopening the economy. Donald Trump, you know, sort of fielded this idea, but let's do it now, now, now. And the medical community say, wait, wait, wait, what are you talking about? We haven't solved the public health problem. So we're kind of a dilemma. And part of this is, you know, how fearful are we? How fearful should we be? And Lou has looked into that, he's done some reading and analysis, and we want to talk about his conclusions about these things to see where we are vis-à-vis starting the economy again. And are we right? I mean, what kind of thought process should we be having at this moment in time? So Lou, tell us what you've been thinking and writing. So one of the things I think that as we, you know, the public interest and the public demand for opening up some of these state economies is starting to crisscross the country. Georgia's opened up, Texas has started to open up. There's a lot of people talking about the Swedish model. As you know, the Swedes never went into an extensive lockdown. They do have a, they have a better death rate than many countries in Europe, but they don't have an extremely low death rate. So this was actually in the discussion that the head epidemiologist and the retired epidemiologist said was that their deaths is related to nursing homes where they have foreign staff that were not well-trained and not following the instructions. Nevertheless, the Swedes are banning meetings greater than 50 people, advising the community to engage in some social distances, but they have not mandated any lockdown. All the bars, restaurants, social activities are up and running, except a sort of restriction on gatherings of very large groups. I'm going to like to talk about today. How do you explain it? Well, I think anything in Sweden is hard to explain. People follow instructions. You know, it's a kind of heterogeneous tribe. Everyone's well-educated, and I think- Could it be that they're culturally, they're more distant than, for example, people in Mediterranean, who are so emotionally- I think they're not too much hugging and kissing. Yeah, that's probably true. But I don't think that totally explains it because the, and so what I'd like to do is, so what's happening generally is the death rate is coming down, the number of cases are coming down, there's a bunch of models about when will we flatten the curve. And in fact, if you remember, the whole discussion was about flattening the curve, not driving it to zero. We are not going to drive it to zero. I don't know if we've discussed this in the past, but in the mid-1950s, there was an Asian flu outbreak in the U.S., about 160,000 people died, which would be well over 300,000 adjusted for population today. I remember as a young child, polio, my mother was just scared to death over polio, and we did get a vaccine when I was like seven years old or something, five or six. But I do remember, we didn't know about the transmission, but we didn't stop, we didn't turn the, we didn't stop the economy. So this is the first time we've done this. And I think that one of the things we're going to want to do when we come out. Well, wait, but to compare apples and apples, was polio, I don't remember. You know, I was there roughly the same time and Dr. Salk, and there was something about Lake George upstate New York, where all patients zero up there, as I remember. But the thing about polio is that it was not necessarily a social distancing issue. Well, it was something else. I don't remember what it was. It took us a while to figure out how it was transmitted. Yeah, I do think it was transmitted largely through fecal matter, but it could be transmitted from person to person. It probably was not as infectious. I didn't have such a high transmission rate as COVID-19, but it was pretty scary. Oh, yeah, for sure, because it had long-term effects on the patient. I mean, it might affect you your whole life. Yeah, and of course, if you go on the blogs now, look at the research papers, there's a lot of discussion now about lockdown, what works, what doesn't work. And there was recently a Lancet article, a series of articles of Lancet, the premier medical journal, one of the premier men that is doing a lot of survey work, which suggested that closing the schools probably have not resulted more than a 2% to 4% shift in the total number of cases. I do think this kind of stuff, we need to probe much more. And we need to think about this in a way that we can develop strategies when we come out of lockdown. I don't want to get into a big debate when we should come out of lockdown. I personally would have never put us in lockdown. I would have targeted this because of the nature from what we know, and what we know now gives me a lot more confidence that we can deal with this. Well, I asked you before, if you wanted to run for president, you told me no in certain terms. But let me say that he has screwed this up to a fairly well. He could have avoided the need for a lockdown. He could have avoided the whole thing if he acted promptly. So if I can pull up the data what different people said, I don't want to get, I'm not defending Trump. I'm not here to defend Trump. But I think he enters into the conversation. February 25th, Nancy Messoni, your director of the National Center for Immunization Respiratory Diseases, said that there was no need to do anything serious. You do nothing different than you're already doing. So I'm just saying that it's easy to blame Trump. I'm happy to blame him if it makes people feel better. But lots of fingerprints are on this thing, including the so-called experts, including Dr. Fauci, who in late February said he didn't think we had a serious problem. But let's put that aside. I mean, let's just take a look at where we are now and whether there's something by looking at the data that can tell us how we ought to feel, how we should feel about going back into the world, getting my hair cut or going to a gym or to a restaurant. So let's take a look at the first set of data in the first slide because one of the things I want our watchers and listeners out there to understand is that, yes, COVID-19 is quite serious, but there is something called the annual crude death rate. That is, all of us face a chance of dying from a whole bunch of causes. And as I say, when I say, we talked about this with a big group today via Zoom. And I said, well, we don't really need to discuss Bayesian statistics because everybody's been to Las Vegas. And I think this is what the Americans will understand. OK, can you take a moment and define Bayesian statistics? So Bayesian statistics is the study of probability theory, distribution of outcomes, and testing a set of prior assumptions against real sampling or observations, and adjusting those estimates after you make more observations. But put that aside. Let's just pretend that the bookmakers have done all the work for us. And let's start with this first slide because that's what I think people are going to need to understand. So this picture shows something called the crude annual death rate. And we look at three countries here, the US, I think Asia Pacific, and Europe. And as you can see, Asia Pacific in 1960 still had a very high crude death rate. And if you look at the 2017 data, right now we have about the crude death rate in the United States, which is the blue line, is about 8.5 per 1,000. So that means for all causes, for all causes, gun violence, cancer, heart disease. And if you go through that, you can see here, let's put that slide back up. I want to go for it. I want to sort of compare. So when we think about the probability of dying of COVID-19, we have to think about it as a marginal probability. In other words, we already have some chance of dying. So how much more risky is it when we leave our homes and go out into the community? And we can do some things. We can wash our hands. We can wear a mask. We can practice social distances. But we do have some data. So wait, wait. Before you go to the stove, I just want to add this. There's a factor, the dynamic factor. A lot of the things in the, what did you call it, the all causes, the raw death rate, crude death rate, they're statistical. And that is that they're not catching. They just happen. And whatever medical help they're going to get, it's all, we know. We know what it is. We know what the chances are for that particular problem. In the case of an epidemic, we don't know where it goes. We don't know really whether the failure of the social distancing or any other factor, we're ignorant right now, will make it just huge and cover the world, millions upon millions upon millions. And maybe a couple of them are you and me. That's the difference between the crude death rate and this. It's an epidemic. Well, let's take a look at the data. You keep putting my slide back up. Let's take a look at the data. Because I did some so-called worst case scenario. So I took the model. There's a whole bunch of models out there. People make estimates all the time. So I don't have to be the epidemiologist. I'm going to use their model. And what I did is I scaled up for New York. Right now, New York has a crude death rate of about 1,100 per million. I increased that to 2,000 per million, right? That's a pretty risk. That means that the probability of dying from COVID-19 is about 0.2%. The best part is Hawaii. Hawaii has about 14 deaths. I said, okay, let's scale up Hawaii to 50 deaths. The probability of dying from COVID-19 in Hawaii is 0.005%. You have shut down your entire economy. You don't even let people go to the beach for a probability of dying under my worst case scenario of 0.005%. Say I'm wrong. Say it's 200 and not 50. It's still going to be a very, very small number. And not only that, if we go to the next, and you can see for the US is much less than New York, Hawaii is much less than the US. But let's go to the second set of data, which I think is very interesting. One thing to think about COVID-19 is it attacks older cohorts, right? In other words, people like me. And so what I said is what is the walking around probability of dying for the geezer cohort, right? Which is me. And if you look at these different ones, 65 to 74, it's about 1.7 per thousand. And then by the time 85 plus, it gets to 150 per thousand. So your probability of dying is 15%. So the question is, if you look at the data, 70 to 80% of the COVID-19 deaths occur above the age of 65. They are highly concentrated. They are highly concentrated among people with so-called co-morbidities. 20 to 40% of the deaths in New Jersey and New York are in nursing homes. So the question is giving the catastrophic cost of locking down the economy. My suggestion is, and I think a lot of people are going this way is, let's put more resources into protecting the elderly, particularly those with co-morbidities. Let's ramp up the funding for PPE and protection for healthcare workers, treat that as an occupational health risk. And then build us a capacity to expand our hospitals if we need to do that. All of which we would have plenty money to do if we didn't shut down the whole economy. Because one of the capacities we're going to have to develop a vaccine, develop therapies is to be a rich country. We need resources to do that. If we are going to destroy the national economy or really make it difficult for us to raise the funds and have the productive and wealth capacity to fight this thing, we're going to have to go back to work. Who's we? Who's we? Everybody has to go back to work. But there has to be somebody leading the charge, no? Well, the final point is, is I think CDC could help everybody by publishing the risk data, which they haven't done so far. You can dig it out of their data sets, but they should publish the risk data. Because I believe for example, if you're 50 or younger and you had that risk data, chances are you're not going to worry that much. Yes, you don't want to take the COVID back to your grandmother or grandfather who has diabetes and heart disease and spread it to him. But that seems to be a more targeted way to deal with it. To isolate those individuals, to put protocols in place instead of, I mean, we are creating devastation across this national economy. We're going to have, I believe the first quarter of the year the national economy is going to contract between four and a half and 5%. In the second quarter, it could be well over 10 to 15%. We have no experience with this in the US. This is depression, we are playing with the depression. And we should not do it in a cavalier way. We should make sure we're getting the benefits from this. We've done the lockdown. Now we need to target the protections in a way that will actually yield something. I mean, the probability of dying below 50 is very, very small. Now? Now, but it's dynamic. Well, no, we have, well, wait a minute. We have data for six months starting back to China. It could go this way or that way. We don't know exactly how it's transmitted. We don't know how to fix it. Yes, you can get hit by a meter tomorrow. The Russians could engage it. Lots of small probability events can occur. I agree with you. Lots of them could occur. We don't stop living life because we face it. I'll tell you where I get stuck. I get stuck in the leadership. So somebody asked the administration, why don't you make masks under the Defense Production Act? No answer. The answer is let's open the economy. Somebody asked, why don't you make testing available like you said you would? No answer. Let's start the economy. It's a sequence thing. And I don't know what political arguments enter into it, but it's the wrong sequence. That's not going to fix the problem. My problem is the public needs to confront directly the risks. Have so I get, if more testing will help, gain confidence. By the way, opening the economy is not enough. If you're afraid to go to the restaurant or afraid to go to the store, so we need to publish certain protocols, I don't think we're having trouble getting masks now. We are. It's hard to get a mask. And furthermore, it's very hard to get a test. Now, these things are not easy. Remember, this is a nation that fought World War II, that had Rosie the Riveter, that built a B-124 bomber in a matter of hours. You can't make masks. It took some time to ramp up production. The testing rate is rising, and it's getting higher. I think we're over 5 million tests now. 5 and 1 half million. We've tested more than that. In a population of 330 million, we should have a normal test. And that's cumulative, Lou. That's not today or yesterday. It's cumulative. And that's when Pence went to the Mayo Clinic. He said, oh, I'm tested all the time. Are you tested every day, every minute? And how about the patient you're three feet away from? Is he tested every day, every minute? We're pretty sure he is sick. So why are you standing without a mask? I think the administration has a major problem in appreciating. Look, I'm happy to turn this into political discussion, if that's what you want. I'm not talking political. I'm talking about the sequence of events that you have to go through. I got it. The CDC screwed up the tests, not Trump, OK? They told him they wanted to go through a regulatory process. They told him they don't want to use commercial tests. They put their test out and it had a flaw, OK? So they did that. They need to own that. Now, the president is the president, so he's responsible for the CDC. I'm not looking to assign blame here. I'm merely saying that if you stop right now and you look at this data, these charts, and these conclusions, it's fine, except it's static and things change. Wait a minute, wait a minute. That's not what those charts show. I ramped that data up. I went with a worst-case scenario. Into the future? Yes, I looked at 2020. It's a worst-case scenario for 2020. I'm not using current data. I ramped the numbers up. But how could you do that if you assume we're going to go back to an economy? I'm going to reopen the economy. Nobody knows. But you can't do it. Of course, nobody knows. But you can look at the models and say, OK, let's take a reasonable high end of the model, under or not, and see what happens. At some point, you have to make a judgment. It's just like sending bomber pilots into Germany and saying, well, it's not really safe. So we're just going to wait. Of course, it's not safe. You had a 50% kill rate. But nobody said, oh, well, no, we can't do it. It's too risky. Think about it. Well, that takes us to the moral question, not the political one, but the moral question. How many lives are you willing to sacrifice to get a dollar of gross national product? Actually, I think the data suggests we already sacrifice 8,846 lives per 1,000 every year, automobile accidents, gun violence, suicide, cancer, heart disease. How much money are you willing to spend to drop that number down to 6,000 or to 5,000? Nobody, I mean, nobody, are you willing to drive your car 10 miles an hour? Because if you drove your car, I can drop 30,000 deaths tomorrow by just making everyone drive their car 10 miles an hour. Well, that takes us back to a political question because you can say to General Motors, you have a design flaw, and you know your calculation. That's going to cost 20,000 lives. Stop doing that and fix the design flaw. Cars are very safe. But I can make them really safe. You just drive 10 miles an hour. I can make them really safe. And the point is, nobody wants to drive 10 miles an hour. They're willing to accept the higher risk. And that's what's going on here. And you want me to make this risk zero. I can't make it zero. Should I accept the risk here? Should I accept the risk? Should I go outside? If I publish the data, then you can make that judgment. You think I would? Would you? I can't wait to go out. I looked at that risk. I'm in good health. I don't have diabetes. I don't have heart disease. And, uh. But was you really? I mean, because I think, you know, that's one of the questions that's come up. I watched my hand. Even if you say you guys can go out, no more lockdown. A lot of people are not going to go out. Even if you say you don't need a mask, they're going to wear a mask. Even if you say you can go within six feet, they're going to go, they're not going to go within six feet. That's fine. Publish the data and let people decide. The individuals that don't you think guidelines are useful here? Yeah, they're useful, but we should know. Are they working? I don't even know. Is a mask a good thing? I think it is probably. I wear gloves sometimes when I go to the store. Um, I wash my hands. I'm careful, but if someone said, look, they've opened up Hawaii and you can write out the rest of this thing for the next month, I'd be on the next United flight. Okay. I mean, I don't want, I'm tired of hanging around the house. And I believe I can protect myself. And I believe there would be a risk, but it's an acceptable risk. Well, but, but, but you don't really know. What I mean is we can have the second wave. Tell me why we wouldn't have a second wave. We are very likely to have a second wave, but it's not likely. The disease is not as lethal as everyone thought it would be. It's just not as lethal. In 1919, we had a second wave that was much worse than the first wave in 1918. We know the probability of adjusting the crew death rate for anybody below actually 65 is not even measurable. Even under a worst, worst case scenario, this is a geezer problem. Okay. And it should have a geezer solution. People are dying at all ages. You read some story about a young person dying. Do you want to do that? Or do you want to look at the data? That's the problem. You can read a story. Yes, it's five pages long and it's heartbreaking, but how many young people died of liver cancer last year? Thousands. How many people died of, people die all the time at different ages. But the data, the whole distribution of data is overwhelming. It's just overwhelming. Not just here, Korea, Japan, China, and particularly in the US. It's very targeted. I'm sure I wouldn't be surprised when this is over. Half the deaths are going to be attributed to people with very impaired systems who are over the age of 70. A high percentage of them are in nursing homes. I wouldn't be... How about the quality of dying? I mean, you can die this way. You can die that way. Here they can't even say farewell to their family. They can't have a funeral. They can't touch each other. They die alone. They die in pain. They die in agony. They die under a million drugs. And what do you want to do about that? What do you want to do about that? See, that question is... I don't think it's mechanical that's coming up with, well, X number of people will die and the chances are X number that you will die. This is a special kind of test. Let me just explain. We're all going to die. Some of us are going to have a horrible death, right? So the question is, how bad is this at the margin? How much worse is it? We're going to have to adapt and live with this thing. But we're also going to have to go back to work. So we should have a strategy that instead of takes everybody who was like largely invulnerable and everybody's invulnerable and treat them the same. We don't need to do that. Yes, it is contagious. Yes, there is a contagion risk. So we need to block off and try to do more for the most vulnerable and let everyone else go to work. As I told you that in May, that's next month, in fact, almost next month, we are going to start trials. We're going to start trials and we're going to have a chance of an early vaccine. Maybe a vaccine by the fall. Would you hold up? Absolutely not. You'd still open it up? Absolutely. You want to keep the economy shut down to the fall? Is that a policy recommendation you were making? I would keep it shut down until we know more, until we have masks, until we have PPE, until we have testing everywhere so we can know the dimensions. We haven't done these things and I think it's a sequence thing. I think it's easy to do. I have some masks. Do you want me to send you some? Do you have no masks? When the show is over, I'll give you my mailing address. Lou, we're out of time. I just love this conversation. It's not only with you and so many people and we have to have this conversation. I hope I'm not the first person to raise this issue with you. You're not the first person. But you raise it effectively and I really enjoy the work you do on it and the statistics and the conclusions. I really appreciate that. We'll have to continue it because it will continue to be attached to our economy and to us, to our energy. Please let us know when the good people of the Governor Y are going to let me return there, okay? Okay. We want you back. Aloha.