 How many people are infected with the coronavirus? What will it mean for our hospitals? And how many of us will die? Those are the questions that are at the front of everyone's mind. To get the best possible sense of things, I turn to reason science correspondent Ronald Bailey to discuss the constantly changing, often contradictory information coming from official channels. We are going through this almost daily change-up of what, you know, how many people of us are infected and how many people who are infected are going to die? What is the latest reading that you have on this? Well, in the United States, presumably, we're focusing on that. We'll start with that. Okay, we're talking basically on a Friday afternoon. It's around just shy of 90,000 Americans are diagnosed with having been infected with the coronavirus that causes COVID-19. The number of deaths is around 1,500 at this point. So that's where we're standing at currently. It continues to accelerate. It's going faster. And the question is, how much faster is it going to go and how high will it get before it turns around? Right. So can you answer any of those questions? What are the best guesses? Because, you know, we hear constantly changing ideas. You know, the CDC a while ago had a worst-case scenario that had something like 1.7 million Americans dying. In the worst-case scenario, we heard from Imperial College in London that it could be a couple of million people, et cetera. Break down the infection rate and the case fatality rate for us in ways that give us some clarity. Well, the truth is we don't know what the infection rate is. The only way we could know that is to know the number of people who are infected and all we know are the number of people who are diagnosed. So we can have the case fatality rate, which is the diagnosed cases versus the number of people who are dead. And that's 1.5%, which is terrible. But again, we don't really know if that is the way the whole epidemic is going to play out because we don't know how many people out there are undetected cases already who are either mild, asymptomatic, or whatever. And we really need to know that to figure out just how badly this epidemic is likely to evolve over time. At 1.5%, by the way, again, we can compare these rates between countries. Right now, that same case fatality rate using, again, diagnosed people and dead people in Italy is nearly 10%. That is 10% of the people who have been diagnosed have died with the disease. That's horrific. But again, even in Italy, we have no idea how many people have actually been infected. So we don't know if that rate is going to remain anywhere close to that. In fact, my suspicion is it won't at all remain as close to that. And that's partly because, I mean, obviously early on, especially in places where testing was limited, the worst cases are the only people who are being tested. And so they're more likely to die. That's correct. We talked a couple of weeks ago, I guess now, about coronavirus. And just to kind of update on some of those conversations, the case fatality rate or overall, once we know everybody who is infected and how many people die, we were talking around 1% of people who are infected die. Does that seem likely to hold up or does that seem high or low or there's just no way of telling? It's really hard to tell. I've been combing through the statistics all across the world, trying to figure that one out myself. And again, you have estimates, for example, by a researcher for whom I have great respect, John Ian Edis at Stanford University, who is a genius statistician, who has suggested we don't have enough data to even tell if it's going to be below the average for seasonal flu death rate, which would be amazing if true and would be absolutely wonderful when you get out of this lockdown. But he also admits it could be considerably higher than that. It could be up to one and a half to 2% of the population, which then would go back to those catastrophic rates that had been projected earlier by the models. He's saying that we have a tremendous range that we simply don't have enough data to decide on. I think his suspicion is that it's going to be at the lower end of that range. And so far, we don't know. Again, it isn't... The more people we test, the lower the range seems to go across the planet. But again, we haven't tested nearly enough people to figure out what the infection or if you will, the infection fatality rate is as opposed to the case fatality rate. Right. And in the end, I mean, it's the infection fatality rate that I think most people are concerned with, right? That's correct. What are the early discussions of coronavirus as mostly killing people who are 70 or older? Does that seem to be holding up? I mean, I've been reading stories about younger people dying from the disease and whatnot. What's the latest information you've seen on that? Basically, about 60% of the cases of people who've died, even in the United States, are 70 and older. So, yes, that continues to hold up. But of course, that's also true for things like seasonal flu. The majority of people who die of seasonal flu in the United States also are people in that age group. You have talked and written about, basically, there are about 2.4 million deaths a year in America, right? That's about right. Yeah. And so, you know, and I mean, this sounds grim, but on another level, we are in a complete lockdown as a country. I mean, we have really ground almost all activity to a halt that's considered non-essential. The economy is tanking, et cetera. At what level do we start to say, okay, this amount of death is a reason to shut everything down as opposed to this is something we can live with? What goes into those kinds of public health decisions? Well, that's the thing. You have to have the information on the likelihood of the numbers of people who are going to die. And again, if it's 100,000, I suspect it would be tragic. It would be terrible. But I think most people would go, no, we don't shut down the economy for that. It would be sort of like an especially bad flu season. And so we wouldn't shut down the economy for that. But then as you escalated up, if it's a half a million, well, maybe we do. Again, these are, this is why we have politicians or policymakers that are supposed to try to make these trade-offs for us in some sense or other if we're going to apply draconian public health measures. Which we're certainly doing, right? Which we certainly are doing. How, I guess, a couple of things. How confident are you that the lockdown model, which is now in place basically everywhere, is that going to contain things? You know, first off, like, do we know with any certainty or what are the kind of milestones that we look to to say, okay, this is working? Well, it did apparently work to the degree that we think that China is being honest about their statistics. It does apparently seem to have worked there. But it was quite draconian, as you know. The places where it's just in the West, where we've just now done it, it will take another week or so for us to know whether or not that's going to flatten the curve. And so that means the number of, is it the number of deaths? Is it the number of infections? It's both. It would be both. And all of this is hard to know because the testing is kind of like a moving target, right? We're testing many more people now. So the data we're getting is not directly comparable to even a week ago. Right. And it's not only testing. It's the people who, you know, the infection period is five to 14 days. So people may not know yet if they're going to get the disease and that would have to unfold over this period of time so that we have a better idea of how many people actually got infected prior to the lockdown. What are the, you know, what are the lessons that we can learn already from the way that the various government, whether it was local state or federal health agencies, responded to the early cases of this? What do we know went wrong? And what are we doing to correct that course? Well, from my particular point of view, and I've been somewhat obsessive about this, is the main problem was that there was complacency to it. There was not enough testing done. The states were actually following the directions of the Students for Disease Control and Prevention and basically only testing people who had traveled to China or back from China and people who had been associated with them. And this, by doing that, they missed the fact that the disease had already begun spreading throughout the country. And by missing that, we missed the opportunity for basically finding out who was infected, getting their contacts and telling everyone in that group to stay home. We might have been able to contain the epidemic a lot more than we have been able to do. So that's the main failure. I don't think that we can blame the state governments for that. They were following what they thought were federal guidelines. So I think it was a massive failure on the part of our federal public health officials. You know, you've written about this. The FDA now, which is in charge of drug testing and whatnot, has put a stop, a moratorium on at-home testing. What does that mean and why is that a bad thing? Well, at-home testing right now would be something that could be rolled out very fast. In fact, there were four companies that were planning to do that earlier this week. And they thought that they had reason to do that under the FDA's emergency use regulations. But then the FDA said, but no, you can't do that. They might be fraudulent. But the four companies that were doing this under no circumstances were fraudulent companies. They've already, our diagnostic companies, they know how to do this. The samples they were going to get from their customers were going to go to FDA approved labs for testing. And it seemed like a perfectly reasonable thing to do. And this would be one way to roll out and get a lot more data from the public about how broad this epidemic is at this point. All of these data would have been reported to public health authorities and we would have a much better idea if they'd allowed that to go forward. What goes into, you know, I can't ask you to like read the minds of bureaucrats or whatever, but why in this moment would they still be, you know, kind of sticking to ways that have already been kind of superseded by events? It's an extremely good question. The problem is that no bureaucrat ever wants to be told that they had approved something that turns out to harm somebody. And one of the concerns, and they should be concerned about this, there are a lot of quacks out there who are trying to offer cures for coronavirus, this, that, and the other thing, and that does need to be monitored and has to be stopped. And that's their role to do that. But these tests clearly do not fall in that category of fraudulent products that would be available to the public. And that should have been obvious. They know these companies. What countries so far or subunits within the United States do you think have done the best job of, you know, of kind of dealing with containing, you know, the coronavirus? I mean, we hear about South Korea, Taiwan, Singapore, you know, doing a good job of doing mass testing and locking people down and quarantining people who are infected. Countries like the Netherlands and Sweden seem to be allowing a kind of herd immunity, you know, way of dealing with this. Can you talk about what seems to be working or are there places in the United States that are doing a particularly good job? Well, let's divide it up. Let's look at what's going on briefly in the Netherlands and in Sweden. They haven't locked down their entire countries, though their entire countries, but they have begun to close down cafes, bars, that kind of thing and to prevent certain kind of gatherings anymore. The idea, there's a model inside the Netherlands where the epidemiologists there thought that the casualties, if you will, the deaths wouldn't be that great. And so the government is actually following that model and hoping that their statisticians are better than our statisticians. And we will see. The thing is that in the last week or so, the Netherlands rates for infections and for deaths is accelerating. So they may have made the wrong bet. Again, we won't know for another week or so. Sweden's rates are also accelerating as far as I can tell at this point as well. So they may be moving in the direction of a lockdown or not. Again, let 1,000 flowers bloom and we'll have better data. It may be tragic for the Netherlands or Sweden, or it may turn out we've knocked our economy into a dark, a black hole for no good reason. We'll find out. Can you talk about the Imperial College numbers? Because this, you know, and again, this is like after 9-11, we all became structural engineers, some within 48 hours. After 9-11, we all became financial sector analysts. And now, everybody's being asked to be kind of armchair epidemiologists. We heard from Imperial College of London, a study came out that was so influential and so terrifying, that England reversed course and went to lockdown rather than new herd immunity. Then, a couple days ago, apparently one of the main people behind that study said, look, we're going to be okay. Then he seems to have reversed course. What is going on there? And ultimately, what's the import for those of us trying to figure out what's going on? Well, what the Imperial College model did was basically said, assume the governments and people make no changes whatsoever in the face of the epidemic. This is how many people will die and this is how many ICU beds will need and the results were terrifying. But they made the untenable assumption that nobody was ever going to do anything about the thing other than get the disease and die. Well, all right, that's a nice baseline to have, but it is a good way to make policy. Well, then the next problem is is that the guy who's the head of it, a guy named Neil Ferguson, testified in front of a parliamentary committee. Well, thank goodness there's only going to be 20,000 people dying instead of 500,000 people dying in Britain now. And the reason was that because the lockdown is working. So what he basically did, as far as I can tell, is go back to his model and said, assume that the lockdown works perfectly. How well will we do? So again, it's another assumption. The lockdown is now working perfectly and therefore we will get rid of all those excess infections and deaths that we've been having before. Both of them, again, are speculation. We don't know. So at what point does, you know, and there seems to be a brewing kind of tension between epidemiologists or focusing on data as it becomes available and as it becomes better, more numerous and hence more representative and modeling. At what point do you put the numbers we have into a model and kind of figure out what's the likelihood that this is actually representing reality as opposed to, you know, so far it seems like everybody is being pulled by a model that is abstract and generally at the horrifying end of things. So how do we go forward from here in terms of modeling? Well, first of all, part of the reason that people are focusing on the horrifying is they say out of an abundance of caution the other truth of the matter is and you know this as well as I do that those people who are reporting on this those members of the fellow journalist will tend to focus on the high-end number because that's the one that catches people's attention. But the thing is the models are never going to tell us what the results are. What we really need to do is to roll out a massive amount of testing eventually everybody but that's another public policy thing but what we really need to do now is to do a fairly wide-scale random testing of the American population to find out just how many people are infected. If we have that bottom line then we can immediately, we don't need the model we can go and count the number of deaths and then figure out how terrifying it is or not terrifying it is. And so the main thing that we need to do from my point of view is go out and start doing testing as much as possible to get those data so we'll know what we're facing. Is it likely that there are going to be massive variation regionally throughout the country and so that what is working or what is necessary in New York City or the New York metro area is very different from Indianapolis from Dallas from Phoenix. There will be regional variations but for example you could do a city and have a good idea a very good idea of how bad it's going to be in New York which would then also be you could extrapolate that I presume that New Yorkers do not have weaker immune systems than the rest of Americans so you would be able to extrapolate that again to the infected fatality rate for any area so you could assume if Indianapolis met the same percentage of the population having the disease as New York does then you would end up with this many dead. It wouldn't be that hard to do. What is the going forward so if things went according to your lights we would have massive testing and either a lockdown or a kind of more freedom of movement based on what's happening with the infection rate and the death rate what about vaccines or how do we clear this in a way that we're not worrying about it every year or is that just, I mean is the coronavirus or something like it going to be an add on to the annual what is it like 10,000 to 60,000 annual flu deaths in a given year is this just, we're just going to be coming back to this every year. That's an extremely good question and I think the answer is probably it will be an add on you can't put it back in the box so on top of our flu vaccine every year we may get a coronavirus vaccine though this, the good news is this one doesn't seem to be mutating at all the same way that flu does so we probably may not need an annual version of it. So it's like it can actually be once we're immune to it basically it stops being a threat. It stops being a big threat right. Do we, you know why is it attacking older people because one of the things that is odd is the flu is kind of an equal opportunity killer right? No, no, no No, the flu actually kills older folks probably about the same percentage rate as the coronavirus does. The majority of flu deaths in the United States every year are people over age 65. And as far as it because unfortunately as we get older our immune systems become weaker over time they're less responsive. Do you, you know the one criticism that comes up now is that there is essentially no financial incentive for a pharmaceutical company to develop vaccines for things like this. Is that an apt criticism of the system and if so what are the ways to incentivize quick moving you know pharmaceutical interventions or other types of medical interventions into something like this? Right, well one of the things that you know right now they're trying, right now right now a lot of researchers are using a lot of the antivirals for example that were developed during the Ebola crisis that occurred and those once Ebola excuse me once Ebola was defeated these antivirals were put back on the shelf and nobody tested them anymore and what should have happened probably is to continue trying it on various possible theoretical if you will infections such as coronavirus. We know that coronavirus could transfer over to people because we had the SARS virus do that in the early part of the century and later on the MERS virus which was out of the Middle East so we know the coronavirus is always out there ready to come over for us and now finally what has gotten us. So there were actually companies that could have been testing their antivirals against these viruses all along had they been incentivized to do that. One of the ways you could do it as a prize let's say basically have companies identify threats and develop if you will vaccines and or antivirals or antibiotics to address them. That's also a problem by the way with antibiotics nowadays is that they're very little incentive for companies to develop those for if you will bacterial infections as well. So what we need to do is to figure out how to identify promising products and then incentivize companies to go forward with them. A prize of $100 million each might be interesting. That would be cheaper ultimately than we're looking at trillions of dollars in either direct payments or in fed money and things like that. Absolutely. What are the essential particularly from a libertarian perspective where what we're trying to do is to maintain limited government rule of law as much autonomy for individuals to make decisions about their lives. There's always some level of tension between public health and a kind of libertarian understanding of things but they're not mutually exclusive by any stretch. What are the essential lessons from a public health perspective do we need to learn and kind of insist on going forward that does as much as possible to think from reoccurring or happening on a regular basis and maintain kind of individual freedom to the greatest degree possible. There are two things I would like to say about that. One is that when you were having pandemics or epidemics that kind of thing they're occurring in essentially an open access commons and the problem with the commons is that we libertarians typically like to enclose commons if you would like people to stop polluting a river we give property rights to people who are by the river to stop polluting from doing that or to keep forests from being chopped down we give property rights to the foresters and that kind of thing but analogically speaking is that possible to do that if you will in a medical or health commons which is the world of bacteria and viruses we all live in and the answer is pretty hard to figure out how to do that. In a certain sense vaccination is that kind of way making people responsible if you will so they're not slinging their bacteria or their microbes at you but what to do in advance if you will to protect the commons from invasion from outside I think it's mostly going to come down to smart technological solutions. It's going to be basically figuring out surveillance which we're going to get better and better at I mean it was kind of astonishing that again trusting the Chinese they found out about the virus and within a month they had sequenced it and given it to the entire world and if we were back in the 1950s we still wouldn't know what has hit us yet so we've already made tremendous progress in that regard and we're going to make a lot more I think in the future so surveillance is key to that then we have to clear up the regulations so that people can start deploying things like the testing, the diagnostics much faster than we were able to do in the United States and then furthermore eventually I think that it will be possible to use computational strategies to figure out vaccines much more quickly than we do now and get them to market but that's a year in 10 years maybe do you is this something that you think we'll learn from as a society or as a government and use this to stop something that is truly catastrophic I mean I'm kind of presuming this is not going to kill half of us or anything like that but for the next big pandemic because were there lessons, it seems like there were lessons we should have learned from past experiences that we didn't bring us to here are we going to learn are we going to learn from this or are we going to be caught either fighting this thing again and again into the future or just get blindsided by something, whatever comes next it would be very hard for me to imagine and I hope this is not just optimism is that by having a multi-trillion dollar hit to our economy we won't decide that we're going to have to start taking more precautionary measures in the future for preventing exactly this kind of thing happening again I just can't imagine that we won't be able to figure out how to do that there will be a lot of of time and attention devoted to it and if it's not then well I don't know what to say is this a paradigm shift in terms of recognizing the interconnection of you know infection and of individuals in the way that we transmit it that you know that when you're talking about you know the basic mechanism here is a lot of testing and then quarantining of infected individuals until they're no longer a threat you know that is going to be the way that we do every aspect of our lives where we are quicker to submit to that kind of protocol and to squeeze things out so that we actually have you know in a weird way that we trade proactively a little bit of individual freedom or opt out in order to have a world where we're not going to be locked down every time there is some kind of scary disease out there no I think that's exactly right but again if we have a robust surveillance system for example and a tracking and tracing system that guards privacy which can be done you would be we would have been able to to if you will lock down a thousand people for 14 weeks 14 days and the epidemic wouldn't have existed I mean that's ideal but that could have been a paradigm that we can have in the future if we would be willing to do that I think that I you know I personally would not want to infect my neighbor with my microbes if if I you know if I can be told alright this is this is what you need to do to protect your neighbors right and this is also one of the distinctions I think you know early on that was worth drawing is that if I mean I assume if you're in a country like China an authoritarian regime and you know that people are getting sick and you know that the government like if you report to the government that you're sick you're done like you you're never heard from again or something like that in an open society where you can have some trust and confidence in the authorities and in rule of law you would be more than willing to sell for report in order to spare things but you know are we coming out of this you and I have talked about this in other contexts I've written a lot about it as well over the past 50 years you know the rates of trust and confidence in all institutions in America both public and private have just you know gone from up here you know through the floor you know is the way that the country or the you know the official apparatus responding is that going to build that kind of trust where people are more likely to offer up information or to be kind of like in a prisoner's dilemma where they're like fuck it I'm looking out for myself because I really don't trust the other people I I fear that it's going to be the case that this the way that it's been handled that this pandemic has been handled I don't think it's going to be building trust I think that it has been handled abysmally I hope that what comes out of this is that there will be groups who are who are incentivized both political groups but civil society groups who are incentivized to try to figure out how to build such trust in the future it's I I'm kind of horrified to see how badly it was handled in the United States and by the fact that it was handled so badly I'm afraid it will actually erode trust further okay well on that happy note we're going to leave this conversation Ron Bailey reasons long time science correspondent author most recently of the end of doom of all books Ron Bailey thanks for talking delighted to be with you and stay well this has been the reason interview with Nick Lesby thanks for listening please subscribe to this podcast another reason podcast at mcdonaldson.com podcast