 Buddy, this is Think Tech Hawaii on a given Monday morning and this is Jay Fidel and that's Ethan Allen. Welcome to the show. Ethan, nice to see you smile and face. I haven't seen you in a while. I am delighted that you're here. Well, I'm very glad to be back. Talk with you again, Jay. I'll always enjoy our conversations. The same here. Today is, we're calling it the changing face of COVID, which is actually kind of optimistic in its own way. So can you describe for us the changing face? And I already know the answer because I looked at a New York Times article. I don't know if I shared it with you about how, in fact, doctors and hospitals are getting more Akamai on how to deal with COVID. That doesn't solve the problem of having enough space for all the COVID people, but it does solve the death rate or at least it makes the death rate slightly lower. So tell us about it. Right. So it's really a nice case in a sense that we have learned how to deal with this virus much better than we used to. The fatality rate, even when you adjust for the fact that there's more younger people getting it fewer, less percentage of older people, the fatality rate for everyone basically is dropping. Doctors have learned a lot of things about this disease, about how to treat it, how to treat it rather aggressively. They can actually look now at people's, they can do blood tests and find that certain people have slightly different immune system functions with some of these very specific genetic markers predisposing to very severe cases. Those people, they get right on them, you know, give them the full glass treatment as soon as possible. And as such, they've dropped the fatality rate down, mortality rate down quite a bit. It is still a nasty disease. It still has a fatality rate probably 10 times that of the flu. But it's nowhere near what it was when we started. There are various treatments they know, doctors know now to look for things like low blood oxygen levels early. They know to give anti-coagulants because people get blood clots and screw up their kidneys and brains and various parts. So there's a whole slew of things. But the other thing that's changing right now is we are sweeping in this huge wave of COVID infections. And it shows every sign of continuing and sweeping up over the next few weeks. And yes, there's a real danger in some part of the country of just simply overwhelming medical facilities. Yeah. You know, every time I look at those charts, I take a deep breath. Those charts are straight up, they're logarithmic. And the top of those charts is way multiples of what the top of the previous peaks were. And you say to yourself, wow, at this rate, everybody in the country will be infected. Is it the weather? Or is it the asturgists and the motorcycle groups? Or is it both? I mean, why are those charts shooting up that way? Yeah, I think there are a variety of factors, but one is I heard it called COVID fatigue. People feel like, hey, we've been good. We've stayed at our homes, we've stayed away from crowds, we haven't seen our friends, we haven't seen our loved ones. We've done this for months and months and months and we're tired of it. And so to hell with it, we're just going to go out and have a good time here and go out to a bar or go out to a restaurant with a bunch of people or whatever. And I mean, you've got these, the cases in Hawaii here are going up, but it's not being brought in by tourists. It's virtually all community spread. There are family groups that suddenly bring together bigger family groups and suddenly it's spread again. People are just, they're sort of worn out with the constant mask wearing, social distancing, hand washing, and all the precautions that we just have to keep taking. Yeah, it's a temptation for sure. I know exactly what you mean in my own experience. You know, I'm tired of this stuff. I'm tired of being so careful. And I'm, you know, not that I'm taking more chances, but I'm being seduced into that possibility because I'm so tired of it. And I'm willing to spend more time, I think, with crowds of people. I went to Ala Moana over the weekend and I mean, I'm still cautious, but there are people, Ala Moana Center lined up for restaurants, you know, a foot apart, some of them without masks, but there are kids there, you know, a foot apart, maybe less. And you know that's an exposure. That's, that's the community spread I think you're talking about. The fatigue factor and people saying to hell with this, I'm not going to do this anymore. Right, you know, and that's a very hard thing to fight. We, our country is filled, you know, celebrates individualism. And so it's, my right as an individual, you know, not to wear a mask, my right to go out and, you know, bring my family of 10 and have a nice meal together. You know, people sort of think like this versus authoritarian countries where they can just say you will, everyone will stay home. And you know, if you're found out on the street, so have a good reason, you know, you're arrested or whatever. I mean, we can't control our population that tightly. And therefore we're getting, you know, we're getting bad spread. Well, you know, the couple of thoughts about that. So you see that logarithmic increase and you say, what is, what is that ultimately going to do to our society? Ultimately people, the social fabric is going to have to decide are they going to, are they going to be subject to all of the negatives. And we can talk about that of this logarithmic increase, or are we going to make some kind, take some kind of collective action? Because obviously with the pandemic, you need to take collective action. One person agreeing and the other person not agreeing doesn't solve the problem at all. The other thing that, you know, in the creation of democracy, such as it exists, in the creation of democracy where people are in a social fabric, a kind of agreement that they're going to abide by certain, you know, rules and everybody plays on the same page, you have to look back at Europe in the 14th century, you have to look back at the plague. You know, everybody was feeling very free and ignoring it, not worrying about it. And then they were seeing all their friends and neighbors die. And in the plague, the fatality rate was very high. And for 10 or 15 years, it just, there's a scourge all over Europe, all over Europe, you know, you watch the map and it was going from country to country. Anytime anybody crossed the border or worse, you had a ship went from one country to another, they'd infect the whole country and nobody knew what to do. They had no idea about fleas and rats and all that. They had no idea how it was being passed around. So after a while, I think, you know, Europe was a real mess, because it didn't end after the 10 or 15 years. It resurfaced every so often, once or twice a century, way up till the 19th century until people figured out what it was and how antibiotics could stop it. What I'm saying though- A basic sanitation could stop it. Yes, I could get that too. But what I'm saying is that to me, I believe that the European experience with plague was one of those elements that created the need for an egalitarian country that had a social fabric, that had a, you know, an agreement, a social agreement. And that was one of those factors that led to democracy as we achieved it in the late 18th century. Unfortunately, we forgot a lot of things about that social fabric. And now, this notion of liberty entitles me to spread a disease for all my friends and family, because that's liberty, man. That's constitutional liberty. They got it all wrong. And I suspect that this logarithmic increase is actually going to bring us back to where we were in appreciating how damaging it is to the social fabric if you take steps that are not safe. Right. I mean, there is an implied social contract that we all have. You don't just walk down the street and punch people out. That's not considered okay. Okay. This pandemic has basically layered some new rules into that contract, basically. And a lot of people, unfortunately, don't want to obey those rules. And you're right. I mean, if only, if and when enough people, I think, get, see the disease up close and again, impact them personally, will we really stop and realize, hey, this has got all the change is just nonsense. Everyone just has to wear a mask like whenever they're outside the next three weeks and their discussion. And it's going to take something fairly dramatic, apparently, because what we've done today certainly hasn't worked. Yeah, we have that. It is dramatic. However, your report, so to speak, that doctors have gotten better and healthcare workers have gotten better in dealing with COVID may encourage some people to be complacent. And that complacency is the enemy of the whole country actually. Sturges was a perfect example of complacency. These political rallies, another incredible example of complacency. And so you wonder about the report that you don't die as easily now. But I'd like to offer some wrinkles to that. One is that's going to depend on where you are in the country. It's going to depend on the competence of the doctors in a small town. They may not hear about these best practices and the fatality rate maybe just as high. I would say in the red middle of the country, that's probably the case. Their medicine isn't exactly what it would be in a big city hospital on either of the coasts. That's one thing. The other thing is healthcare workers are leaving the field. So the existing infrastructure of healthcare is actually shrinking, which means not only are there more people relying on the infrastructure that existed before, but the infrastructure that existed before is shrinking. Doctors are saying, I'm retiring. This is enough for me. Healthcare workers in general say, why do I have to do this? If I can find another way to put food on the table, I'll find another way. This is really the pits. I understand that. They're right. But this affects everyone, don't you think? Yeah, absolutely. And I don't think enough people appreciate too. Yeah. Well, some people will get it and this is not for no symptoms at all. Others will have just a mild food like illness. There are a fair number of people who will suffer lifelong damage. The kidneys will be trashed. Their lungs will be scarred. Their brains will be essentially impacted. They will in essence be neurologically impaired. All of these things are just awful. And of course, that's simply all of those are just going to add to the burden on the health care system. The exact percentages aren't well understood, but they're not trivial in terms of the people who have bad long-term effects. And again, that's just a vicious cycle. As you say, as the cases go up and people are more and more complacent about it, and the whole care system is shrinking, you can see all that can get to some perfect storm. Yeah. Well, people outside the country who have their own problems, some better or some worse, well, always better these days. It seems like we are the worst in the world. Those logarithmic increases are the worst in the world. The other thing I wanted to mention, though, is this. If I give you a health care system that is shrinking or at least the same, let's say the same, and I give you more people who are sick by logarithmic increases, then that means that the ordinary process of aging and getting sick from a myriad of other diseases, conditions, what have you, don't have any health care. They're being forced out. All the oxygen is being sucked up literally by COVID. So if I have a problem with my zorch, which in ordinary times, normal times, I could get that corrected anytime at a hospital, who knows, a zorch operation, special medicines for zorchitis. I'm making that up. Now I can't and I really don't want to because the hospital is all full of people who have infectious COVID. I really rather not go there. So what you have is people dying from other diseases. They would not otherwise die from because the truth is, I don't know if people, we're not infallible. We're not invulnerable. We do get old. When you stay at home and you have a limited life under COVID, you don't realize you're aging just the same way you'd be aging if you were out there doing your thing. And so as we age, we need medical care to stave off deaths. But if all the medical care is being usurped by COVID patients, you don't have medical care. So not only other people who have COVID dying, whatever rate it is, but the people who have other things would be dying for the lack of medical care. Right. And you see this, I mean, doctors are already noting a whole bunch of things like regular cancer screens. People just aren't showing up for the regular cancer screenings. You know, this may not affect every person immediately, but it's going to be some percentage of people are going to then miss being diagnosed with cancer in an early stage when it can be treated and are going to have cancer later stage. The numbers of excess deaths compared to last year every month are well, well above the numbers of COVID related deaths. So there are a whole bunch of people who are dying either from COVID that isn't correctly diagnosed and reported as such or essentially from other things they probably would have gotten treated, but they now won't get treated for various reasons. Yeah. So the numbers of deaths are really actually higher, considerably higher, quite possibly 50% to 100% higher than the numbers reported actually. Yeah. Again, this sort of side, this one-off effect. Yeah. Well, I mean, if you wanted to go, if your doctor told you to get a blood test, I guess it varies from institution to institution because he's following something. He's following some problem that you have been having for the past X years and you're supposed to get this blood test. Now you have to make an appointment. Just can't walk in. Right. And now you have to run the gauntlet of all these people around you on the hospital or the laboratory who may have it. Every time you leave your house, you're taking that risk. Every time you're in a group of people, there was something, where was it in Civil Beat recently about if you attend a group of five at Thanksgiving, you have X percentage of probability of catching it. If you have 10 people, you have double X or more probability of catching it. And if you want to do 50 people, you have, I remember the number, you have 19% probability of catching it at a gathering of 50 people. Right. So any group at all increases your probability. And I don't think people get that. That's not simple, but you've got to keep it in mind. Yeah. We have a couple of questions. Let's address them. Do you think more people are going to be lax about masks now that a promising vaccine has been discovered? I think it's an important question I was going to get to the vaccine. So there are two of them that came out within the past couple of days, really. One of them is this very interesting vaccine from Pfizer, 90% efficacious in partnership with the German company. I remember Trump was trying to make a deal with the German company. He was trying to buy away their scientists back at the beginning of this, and Angela Merkel said, no, you can't do that. It might be the same company, I'm not sure. So here we have this Pfizer and German company thing, 90%. And remarkably, this was announced right after the election. And they had the CEO of the company on, I think at age, the news hour, and they asked them, was this a timed release of your press conference? No, no, no, no, no. But the bottom line is that it would have been pretty good for Trump. Had this been publicized earlier. And then a couple of days after that, we have the new one from Montana, which is an American company. And I think in Massachusetts, in Boston or Cambridge, Massachusetts, it's probably connected with the schools up there by conglomeration of graduates. And they have a 94.5 efficacy just announced. And so these are optimistic things. These are encouraging. In neither case, is it going to be very quick, where they can actually deploy the virus. In both cases, it's a two shot deal. And although the army is apparently organizing distribution systems, I don't know if it's going to be that fast. So the question, to repeat the question, are more people going to be complacent about masks now that a promising vaccine, actually two of them have been announced? What do you think? Yeah, I mean, I think this plays right back into what we were talking about earlier. The complacency, the fatigue, it's like, oh, good, we'll get a vaccine next week. So now I don't have to worry anymore. There's going to be a whole bunch of people who think that. But the truth is, to run a good randomized controlled test on scale that we want to for these drugs is a huge time consuming process. They have rushed it already and are trying to do them as fast as they possibly can and have cut their time margins as thin as they can do them in order to get these things going. But realistically, you want to be testing literally tens of thousands of people and give them some significant amount of time for any bizarre effects to show up. There's not going to be the tens of millions of doses available for many months yet. So yeah, people should not be complacent. People should not relax, but they will, unfortunately. Yeah, well, it's still raging as an infection when you have that logarithmic curve going straight up and the rest of us. So some people, if the thing works 90% or 94.5, if it works, and by the way, it's good to have multiple choices like that. I would be much more concerned if there was only one. This way I can read up and make a choice, and I'm less likely to be concerned after I've made my choice. But I think there's going to be a delay, as you say. And even at best, in the next six months, only a certain limited percent of the population is going to get the vaccine, whichever one or both. And the rest of the population is going to be in the same place, talking about millions of people. And if they continue to be complacent, that's just going to be awful. It's still going to be raging. Because the other aspect is how quick is this really going to be? And how much acceptance? There are a lot of people that don't trust vaccines, I think, even more now than when we first saw this happen with measles. And they will say, no, don't you think? And so that takes it down a notch, that won't be generally accepted. Yeah, that was disturbing to me to see that in the various polls where they've asked people about vaccines and something approaching 50 percent of the population says they wouldn't do a vaccine, even when they were available. Vaccines have one of the most unassailable records of something that does huge good for the individuals, for their families, for their communities, for the public health at large, with really incredibly low risks to the individuals. It's a huge, a huge, long history. Multiple vaccines, got the multiple different types of diseases. All of them have worked remarkably well. And now we have people that just not trust them. We have record-breaking cases of measles. It's crazy. It's insane. The anti-vaxer movement, to my way of thinking, it's a public health menace. It is. And so one person feels that he'd really rather not, as far as he's concerned, measles or in this new Pfizer or Moderna vaccines would somehow have a risk for him. So he decides he doesn't want to take that risk. But he's putting everybody else in the community. It's not only one group of people, but concentric circles of people around him. The whole community is at risk because this one person refused to take the vaccine. They wouldn't let that happen in China, I'm telling you now. Right, right. No, I mean, we've already seen this and I'll be interested to see if if some lawsuits developer on this of states relax their laws made it easier and easier for parents to opt out of having their kids vaccinated, basically. Many states came, if you don't want kids to get vaccinated, if you can just sort of say it's against my principles or whatever. That's all you have to do. And now they've had these outbreaks of measles, there have been deaths. I'll be interested to see if there are lawsuits to come back against either the states for relaxing their laws or the parents for not getting their kids vaccinated. And I, you know, fine, you don't want to vaccinate your kids, don't send in public school. And on my mind, there's almost a one-to-one relationship there. I mean, unless you've got a very good medical reason that they can't take the vaccine. Religious police is nothing public health. Public health, you know, and Hawaii should be particularly concerned about public health because in the 19th century, we had every disease you could think of. It was brought by, you know, the explorers. It was brought by the people who arrived here in the 19th century and everybody got sick and hundreds of thousands of Native Hawaiians died because they had no immunity to it very quickly. And so people don't realize that if you don't do something for public health, a lot of people die. This goes back to what I was talking about at the start of our show about the bubonic plague in Europe in the 14th century. It took us what, 600 years to learn that you have got to take the science and use the science for the benefit of the entire population. And if you don't do that, you're going to have a pandemic like in 1918 or the 19th century, bubonic plague. So you've got to do it. And I think it's a failure of government, really, not to do it, not to require people to do all that can be done, not only for the benefit of that person, but the whole community. And my hats off to China for having really put the kibosh on COVID. They have done that. You've got to give them credit for that. Now, they were probably not very constitutional in their approach. Who needs human rights and civil rights? But the fact is they squashed the disease. Yeah, exactly. I mean, authoritarian governments can actually work in certain conditions. And that's one place, time and place where they have worked much better than our democracies. But it's, it's, you know, it is a problem. The plague killed off what estimates say about a third of the population of Europe. You know, that's, you know, with the logarithmic that could happen. Right. I mean, anyway, so there's a second question I want to ask you this. And this goes back to a discussion of the healthcare infrastructure. Is it safe to allow doctors to keep working, keep practicing when they have COVID, but they're asymptomatic, whether they know they have COVID or not. They're in a laboratory of COVID all day long, and they could be catching it. You know, what do we do about that? What do we do about doctors who are asymptomatic or and either intentionally or unintentionally are spreading it to patients? And what do you do as a patient? One of the things is we actually have a good tool that's developed for that now. We have the rapid COVID tests that are, that are measuring actually parts of the virus itself. So they aren't these original tests that came out, measured your body's immune response. And you get the virus in you, it takes a while to build up to start having your body kick into gear. And it may be a week or more before, maybe two weeks before your body actually throws a real immune system fight against it. And that will show up on those sorts of tests. Now they have tests that detect the presence of parts of the virus itself. So the moment the virus is in and starts to multiply, you can detect it, you can detect it within a day or two days, often of infection. These tests are reliable, they are fast, and they are cheap, and are being at the lab. This one is putting them out by the millions. If I were a doctor, I would be probably testing myself, you know, every day or every other day or something on that order. Just because, yes, there's, they're out there, they're in the laboratory, as you say, sort of a coded lab potentially. Those sorts of tests just need to be more widely used to save our healthcare infrastructure, save the first responders and frontline workers who may get exposed. So we do have that tool. There are also now better contact tracing tools coming online, or people are better able to track the people who you've been close to. There's a whole, of course, there's many controversies about those, but there are better technologies emerging from that, too. Now, and some people say that those technologies can't keep up with a logarithmic increase. So, you know, query how good are they as against an increase that keeps going up, up, up, up. And plus they need to be used by a huge percentage of the population to be effective, and nothing we haven't even begun to approach that kind of penetration online. But going back to the doctor issue, I just want to ask you one other thing is, you know, not all that masks have been politicized. This is one of the most irrational things that we have ever seen in this nation. And some doctors, you know, are, what do you want to call it, on the right side of the political spectrum. And they don't believe in masks. I'm not kidding you. This is a true fact. Even here in Hawaii, we remember 30% of the electorate in Hawaii voted for Trump a couple of weeks ago. They're quite remarkable. But some doctors voted for Trump and some doctors see masks as a political statement or not. So there you are in a doctor's office. I'm really interested in your thoughts about that. And the whole staff in the office is wearing masks because we live in a time of COVID. But the doctor, no. Say to the doctor, don't you think you should be wearing a mask? You've been seeing patients. You don't think who they are for where they've been. You have no way of knowing they haven't been tested as a threshold to come in here and get medical care. So how about you wearing a mask? Answer, I don't need a mask. Really? So what does the patient do when he finds that a doctor is making a political statement in the crucible of an examination room not wearing a mask? What do you do? For me, I'd turn around and leave as fast as I could. I would not use that doctor. I almost wouldn't care what my needs for a doctor were. That to me was very, very careless at the very best and at the worst. I mean, again, version of sort of malpractice, I think, but you're the attorney. Right. And we are all patients and we are all watching you because I guess what it tells you is that the health care system, which you need for things other than COVID, question even COVID, but for other than COVID, the health care system is embroiled in complexities that flow out of the political side of this. And you have to be watchful. The best person to examine your health and your risks is yourself. And you have to decide whether to go to Alamoana. You have to decide whether to go to a party at Thanksgiving. You have to decide whether to engage with a doctor who doesn't want to wear all those things fall back on you. Absolutely. And there is this. We're all ultimately responsible for our own well-being in that sense. But the fact that masks got politicized is, as you say, it's simply appalling, particularly now that it's being shown that they actually do good if they're aware. It's not just you're not spreading them. It actually turns out likely what they may well do is allow you to get low enough doses of virus that your immune system actually learns to deal with it more effectively. You can actually make yourself more resistant to it. Well, let me, in closing, Ethan, let me ask a completely unfair question. Okay. Given all that we've talked about, all the improvement in procedures and practices medical facilities around COVID, and of course, the spikes, and of course, the shrinking of the medical establishment, and of course, the advent of two promising candidates for vaccines, and people who may or may not take those vaccines, and when they will be available, and of course, the political end, what is your prediction here in these United States as to what's going to happen? What's going to happen around us that affects us, that exposes us or doesn't, to increase our risk or reduce our risk? What's going to happen here? Well, I don't, of course, no, but what I think may happen is some local areas right now, I would guess maybe somewhere sort of in the rural Midwest, Plains areas will get extremely high levels. The medical facilities infrastructure will essentially crash under the burden. They'll have out of control pandemics raging around. I would hope at that point, the rest of the country would then see this happening and would sort of realize that, yes, okay, hey, it's time to get very serious about this again and not be complacent. We hope again, particularly here in Hawaii, we are well set to do that, get ourselves organized, but we don't do a super good job of it. But yeah, no, I don't see a pretty outcome to this quite honestly. That means is we have to circle back, Ethan. We have to circle back and sort of connect the dots as time goes by and get a handle the best we can with further developments on all of these points. Thank you so much, Ethan. Ethan Allen, our scientists, to discuss anything and everything anytime in likable science. Yes, it's still likable science. Thank you so much, Ethan. Thank you, Dave. Fun is usual. All right, same. Aloha.