 Well, some of what we begin with is throat clearing anyway, so I will get us started Hi everybody, I'm Jonathan Zittran. I teach law and computer science and with my intrepid co-host Dr. Margaret Bordeaux We have been convening on Zoom irregularly and fitfully since April or so to take stock of what's going on with the global coronavirus pandemic how we might assess it, how we might improve our lot collectively within it, and whether there are aspects to it that despite, of course, massive public interest in it and corresponding coverage of it, we might uncover so that we might think a little bit more deeply and fulsomely about what's going on, and to that end we're really pleased to have two guests with us today who have been thinking on the big picture, one of whom will have to leave actually halfway through our broadcast and the first, I guess we should just introduce them right now as a matter of fact The first is Jennifer Prahruger, a professor of health equity economics and policy at the University of Pennsylvania, who studies the relationship between political structure and global health outcomes and inequalities and also Professor Rivka Weinberg, professor of philosophy at Scripps College specializing in procreative ethics, bioethics, ethical questions surrounding birth, death, and perhaps many things in between So again, thank you both for joining us today and before we throw it to you, I should throw it to Margaret And also alert our watchers that the chat room is not enabled But the Q&A function is so we'll keep an eye on that and if you happen to be watching this not through zoom webinars but on our corresponding YouTube and I think we also maybe it's just YouTube if you're on facebook live I don't know what you're doing here, but if you're also watching there feel free to tweet at vkc harvard Berkman Klein center harvard any questions you might have while we go Um before we jump in Margaret, maybe I should just tee up for you the question I ask every time Which is where do we stand since we last gathered? What's the slope of the curve of this thing? Um, uh, and if you have one word to open to describe how you're feeling about things, what would that word be? Yeah Not the one word Jonathan. I already told you and warned you that I Feel like whenever we start with these, um things. I'm I'm overly gloomy. Um And always feel a little bit. Um I feel a little bit at sea, you know when when talking about it I actually am gonna I'm gonna do something I almost never do Just throw it back to you and actually I Yes, um because I actually am very curious to know what uh word You would use where do you perceive us to be with respect to this epidemic? Just I just want to say the word that you would choose with respect to the epidemic As it just is a matter of disease control, you know, how What would be the word that you would describe how much control do we have over the epidemic? And I and I'll I'll I'll say why I'm doing this in a second this painful exercise, but I'm I'm curious I'm curious to know what your impression is Well, I'll buy jennifer and riftka a moments of extra time to think about it and offer my own word, which I think is going to be lulled l u l l e d That if this were any form of narrative By now we would have been on to the next act and there would have been narrative progress and uh enough with all these precautions things feel more normal just because They narratively should well, of course the virus doesn't particularly follow that convention And that lulls us perhaps into a sense of complacency that goes very much to the apex of the american political system in thinking about How to handle this and something that requires sustained attention and resources and Even medium and long term planning Even to this day maybe still is not yet getting it. So that's my word is lulled Okay I didn't mean to put my our guests on the spot. I guess I I I can also just just stop there and return to you guys later for your word but The reason the reason that I that I wanted to do that was because I think that that is True that a lot of people feel You know, everything is abnormal, but it's been so abnormal for so long and the viral rates are You know, they feel like that they should be you know lower Uh, when in fact, you know in in two-thirds of the country the number of cases is increasing In massachusetts the number of cases is increasing. We just had our highest Day of new cases that since march Um, you know this past week Um, so I would say in in general in terms of the sort of epidemic trend in terms of new cases You know, the word I would use is is accommodated To summarize kind of where we are we're at we are not in a good place We still are having about 700 to a thousand deaths a day in this country We still have a very weak public health response And we do not have Really, we haven't distributed our our public health goods in a way that reflects any form of of equity or of justice And we are still asking people to to take on enormous enormous risks And kids are out of school the economic damage is is still ongoing. So You know, I think it's it's it's uh, you know, again I hate the hate the word because I'm always so bleak here at the beginning But the the thing that I think is charged on to the The front page and to the top of everyone's mind here is again the national leadership on Of this epidemic response or the lack thereof and not even just the lack thereof But really the the act of undermining of of efforts to contain The epidemic and the the issue that you know, I really want to wrestle with all of you today About is the the issue that we've sort of been like trying to keep in our peripheral vision I feel like as a public health community And and that issue is is the malignant nature of the of the federal leadership It's not just ignoring the crisis or even denying the crisis. It's undermining efforts to To to contain it And undermining the institutions and the trust in the institutions of our public institutions That would give us the tools that we need to to contain it And so this is a very vexing political moment It's certainly not something that I learned about how to handle in medical school It's really not something that Took center stage in my In my when I was a student of public health But it was something that took center stage When I worked in different countries around the world experiencing health crises or or conflict And where you had to contend and think very carefully about how to contend with political leadership As you were trying to implement A public health program And and so I I thought it would be really helpful frankly to me To talk with our our two guests today About this issue, you know, how should our public health leaders uh Take into account And cope with or address The political leadership of the country Um, and I I think both of our guests have sort of thoughts about this coming from Different traditions and different frameworks. Um, but the first person I would Wanted to turn to is professor ruger Who uh, have we done introductions? Properly Okay, uh, so so dr Ruger is a professor of health equity at university of pennsylvania and has written a series of articles that I have found very profound about the relationship between political configurations political context and And responses to health either emergencies or health issues um, and I I find some of the features of these things that she has described In some of the dynamics that she's described in particularly in authoritarian countries to be You know familiar all of a sudden uh, and uh keeping me up at night as I I wonder if those are truly the dynamics that are playing out In this country with respect to handling coven. So, um, Professor ruger, I just turned it over to you to say Maybe you can describe a little bit about what you've seen and in studying The responses to health crises in authoritarian countries and governments Well, thank you margaret and jonathan and rivka and and all the participants. Um, this is a terrific venue I think it's a wonderful focus That you all are Bringing to the conversation I want to focus on four characteristics That we've been looking at In the health equity and policy lab as we look at the difference in responses to this, um Pandemic around the world and of course the Epidemic in the united states And of course as you are saying Margaret our work we do couch in a justice framework and so We're interested in these characteristics of number one governing for the common good You know, what does that look like? Um when when countries nations are Focused on the good for everyone That's the first thing the second thing is a sense of shared responsibility Um and one that's in particularly focused on scientifically grounded systems So we have a shared sense of responsibility for a scientifically grounded approach the third is rational and compassionate and transparent communication And that's the really the interaction between Government and the leadership, whether it be International national or within a country and the people who are in the process of trying to help combat the epidemic and pandemic themselves And the fourth is ethical leadership and trust and this is sort of a set of characteristics that We're we're looking at in terms of trying to understand what separates Um more effective responses from those that are less effective. And what what are the measures of that? A number of cases, but particularly death rates and mortality rates And also whether or not the vulnerable vulnerable groups or certain groups of the population are protected In ways that we would we would expect Under a system of justice and effectuating justice and health and do you uh find yourself Revisiting anything from the paper, which for all of the factors you just enumerated explains by having a more responsive democratic I know it's a loaded word, but democratic regime is likely to lead to better outcomes Is there anything? counter-intuitive About the pandemic of 2020 when we see regimes that are anything but democratic Able to quite promptly tell people all right, you all are quarantining here We don't care what you think and uh, we're going to use You know, you better have a a green card on your phone that lets you into the store And if you can't show it you're not coming. I mean the sorts of things that only an authoritarian regime can do um Is that How does that complicate if at all You are for factors about long-term sustainable public health Yeah, no, that's a great question. Um, I would like to uh differentiate between using authority and authoritarianism Um, and I think it gets to your question because for sure Countries are using and national governments are using their powers of authority Um, and some would argue restricting people's liberties in ways that in this country and and some other places people would find extremely uncomfortable And problematic And in violation of these liberties However, there are countries that are using these authoritarian or authority authority like standards that have worked with their populations to let's see Convince I don't think is the right word To educate to understand collaboratively That it's in everyone's interest To for example in technology have an app Or some sort of a digitized or some sort of an electronic way of tracking this virus Who has it who doesn't have it? um, and and and restricting access to certain areas Of our spaces accordingly in order to save lives um in order to save people from illness and sickness And so the question is how do governments do that? um, and are they doing it effectively and we are seeing that that's happening pretty effectively in many countries I mean you look at south korea and taiwan and even you know countries like even european countries um, even asian countries south, you know in like new zealand i'm thinking of you know There is a great degree of restriction and the use of authority quarantines is another way that we use our authority um, but in those cases the secret sauce is that there is a um Understanding on the part of the population that this is and these are necessary Um efforts. There's also recognition that they may be temporary So, you know, they may not last forever that this is something that we might move on from after this epidemic in a country and pandemic globally Subsides and so there's a temporal aspect to it also And I think that that's also critical as to this particular disease Yeah, and you know what you've described is sort of the positive attributes of a country that in the in a government structure that can Cope with the health crisis, you know, I think your negative examples are also, you know, very instructive to me And you know laying out some of the case studies of china and their experience with sars one their experience With hiv and their experience with the even you know with the famine You know looking at really what kind went wrong And in those in that political context, I wonder if you could just say a couple words about kind of what what didn't What were the features of the authoritarian? You know culture and government that prevented them from being able to address those those health crises Yeah, thanks marvitt for asking that question Um, I'm really glad you did because I think one thing we want, you know, look We're still gathering more information, right about the origins of this virus and and Where it came from and all these things but current state of knowledge is that it came From china and and within that authoritarian regime There were efforts Made That were less transparent and forthcoming Than they might otherwise have been Both in understanding what we all know from global preparedness that One of the major sources of new viruses Is going to be The transfer from the animal to the human population and so This is something that is not new We know this we understand this we have many many reports In the global governance global health governance system and so recognizing and employing that to One's own advantage, but also to the global community's advantage is something that is a critical part of an open and transparent dialogue That looks for solutions And does not try to cover up or explain or Otherwise fail to address the heart of a problem. That's number one number two is The slowness in the response and this is why we're having So we have now a global geopolitical problem Right, uh, this sort of this sort of tension between the us and china The backdrop to the who and what it didn't didn't do in the entire un system and all these things, but You know, essentially we are talking about whether or not information Right is is shared independently And as you know in one of my other articles, I've argued for a much more independent International Organization, I believe we should have a global health organization That is global in the sense for all people as opposed to international for nations interests to be advanced Um, and so this is another area where Whether you want to call it authoritarian or not a characteristic Of not sharing information and information not being transparent and independently verifiable Is highly problematic And this is what the openness and the transparency the impartiality and the independence gets us And that's what we want because ultimately these are scientific prob. I believe these are scientific issues And they're issues of justice fantastic, um Uh Yeah, you know one of the surprising things uh that you wrote that struck me so So relevant in this sort of current moment You know is when you were writing about the uh the famine and china and the great leap forward That one of the lack of transparency was really a sort of an internal issue where the government kind of fooled itself Because you know, uh folks at the local level government officials Were scared to pass on um information to uh the higher ups at higher political levels About how badly they were doing at the local level and so they were projecting up, you know, these these, uh numbers that Had enough food and they had enough They were producing enough and so the higher ups then said, okay Well, we don't need to import anything and and we need to export more, you know So, you know, the famine was ongoing and they were Shipping food out and not taking food in and it was a sort of internal problem of transparency, which I think was really Interesting to me because you know as I think about what's happening now Um, I think some of those the reluctance to give bad news uh to higher ups Is is really a dynamic that that that we're seeing here um, and I you know, I can point to A couple of examples some of the cdc leadership when early on when they came out and said hey, this is going to be bad, you know Being really punished and and and called out by leadership, you know, don't say that that's you know unfair Most of the lack of testing that that we are experiencing still Um is you know, really you can draw a line between it and uh the fears of Of leadership, uh, and the and the president in particular of not wanting more testing and continually saying You know, don't don't allow for more testing. Um, and and you know A question whether they really leaned on the FDA to not approve new methods of testing in a timely way Um, and I think that that's the thing that starts to really check some boxes between what you you know describe happening In uh, you know, of course, you know, you focused on china. It just as it happens Um, you know with sarah's one and the famine in terms of case studies of of what happens with the health of crisis humanitarian crisis in a authoritarian setting, um, but but many of those Many of those features of response, you know, are eerily familiar all of a sudden So, you know, not passing information up to the to uh higher ups in the government Not giving the public the information that the public needs for two reasons To to both take on and start behaving in a way to protect their own selves wearing a mask Etc. Uh, but also, uh, the the information that they need in order to sort of send a demand signal from the field saying, hey We're struggling over here. We need more resources You know without without really understanding where things are spreading. Uh, how severe it is Um, how worried they should be Uh, you know, it's very hard to send that demand signal. Um, and you know, I'm seeing that, um, you know I think we are also seeing, uh, that sort of any, um Uh, the the science as you're saying, uh to to be able to understand and make policy and formulate a collective response That is compassionate. That is just, um, you know that that uh, we're seeing very specific things play out where That is being undermined and you know, there's been I was counting up in preparation for those three episodes where The FDA, you know, issued an emergency youth Authorization for medications that had very scant evidence behind them In terms of efficacy at and did so, you know at the at the request and under the pressure of Uh, the white house administration, um, you know, so so I think this starts to add up, you know To a picture a very very alarming picture quite frankly, um, you know of of One where we are, you know, I don't know when when you call some um, uh administration of You know a totalitarian state. I don't know when thresholds are reached, but we do see these behaviors playing out I I just wonder, I mean, is that what you're seeing, uh, professor Ruecker and then I'll turn to you, uh, professor Weinberg Yeah, thank you mark, right and um, you know, as you know I have to to go to another panel panel in a few minutes, so I will chime in here and and and thank you again for including me in this conversation I think it's highly problematic that we are coupling science and politics, uh, in the response to this epidemic in this country and frankly globally internationally, uh, the pandemic in the way that has been Done and it's problematic because it's a scientific problem that requires a scientific solution And that's social scientific It's basic science and we we really need to try to understand how to prevent And control and treat, uh, uh the transmission of this this disease. I mean that that's what it's about and We do need reliable and valid information to do that and and and scientific entities Need the space to do that. That is what they are authorized to do. That is what they are expected to do um, and they are, uh separate for a reason and so, uh, the politicization um, is highly problematic and, um, it frankly is hindering the response to the to the pandemic and the epidemic and in countries where you see A scientifically grounded approach with honest and and true information to the best of their knowledge at the time Um, and by the way using prior information from other experiences You know country, I don't I don't believe you had to have dealt with Mercer SARS to be have been effective You know the u.s. Was ranked very highly in our global health security initiative ranking whether their capabilities were in place for the u.s To have been responded effectively to this And it hasn't been an optimal response And you're hitting on one of the reasons why we need to make sure that the scientists can do their job and that we're basing our decisions on science So thank you so much for joining us. I know you have to hop off but to sort of turn to to you Rivka So, you know, I think we all in general agreement that some very alarming things are happening here with respect to Are not only not like I said, it's not just a passive issue Um, you know where a government is not taking it seriously and ignoring it. It's you know, the act of undermining and the in the act of Undermining our our collective ability to respond um, and and doing so in in such a way where the result is Is death and disproportionate death for My, you know, traditionally marginalized communities in this country So I guess, you know, I read your your op ed back in in january about mass atrocity prevention and what sort of our general posture as a as a community and country should be With respect to To, you know, moral crimes and and the mass atrocity. I don't know whether you can sort of chime in and just tell me kind of You know, does this reach the level of of of of that kind of kind of event or Well, not yet but I think that I think it's more It's not as uh, there's a lot of problems coming from the administration About mostly about denying the fact but there's also not really a Science does not dictate anything. It just tells us the facts Right, it tells us what's happening. It doesn't tell us what to do about it And we have not really discussed it and framed it. So one side is screaming We have to open up where on the other side is like science science science. That's not really a conversation. That's not really Uh, that's not really the topic science just tells you the fact. What should we do about these facts? We should be discussing What our approach to risk is what should uh, what is the best way to go forward? Which would be which would actually bring more people On board because as it is each side feels like the other side is ignoring them once, you know So the democrats are saying you're ignoring all the people who died And the republicans are saying you're ignoring all the people who are at a school Who are out of work who and so the The facts Have not been addressed the way I would like to see this addressed is how should we manage this risk? I don't see that so the easiest thing to do would be to have a national policy of masks That would be nice. We don't have that. So what we have to me is like We have the worst of all the worlds We have an economy that's I mean kids are out of school for a very long time. That is a very high cost that we're not really discussing that much Um People are out of work. People are dying. There's no public. We don't have a public health system That's another problem. So when we talk about public health, we don't have a system Not everyone has health care. Not everyone even has access to running water. Not everyone has a mask so When I see the approach, it's uh, extremely chaotic extremely and I don't and I don't But the approach I would like to see what I think is uh, makes the most sense in terms of What should we do about these facts is how should we approach this risk? What should we do to contain it? What should we do to mitigate it? Uh, that's the way I think it should be approached because that takes into account all the moving parts Science doesn't tell you anything about what to do. It tells you what the facts are then you have to decide what to do As you say that might not be totally within science's purview because there's values and value judgments to make and balance Um, but of course even there there might be a rigorous and transparent way to do that sort of thing if you were Within the u.s federal government right now possibly as a public health official And wanting to broach those topics and looking for the traditional connections between the technocratic layer and the political layer Precisely to meet those questions of what's your risk tolerance? What's our strategy here? And if you credit margaret's account that it's been some combination of either you send that question up the pole and nothing comes back Or what does come back is an inconsistent non rigorous possibly even outright politicized in the sense of Values that have stated openly would not be values most people would subscribe to for handling this dot dot dot What what should you do? I mean you've written about Complicity in its many forms and if you thought it was wrong how do you in the public health context balance between You resign and leave your post to whoever doesn't have your standards to take on the work Or you end up complicit With what's happening. I'm curious how you think about that. So I think that you don't lie One of the things that it makes it a little bit easier is that people who work for the cdc Are not directly fired by the president and work for the president and the same goes for the nih So there's some independence and I think that people should First of all always tell the truth. And so if if there's a if the administration says you have to change the guidelines You should say these are the guidelines that the administration dictated. So I I don't find the Uh, there's a lot of problems, but it's not so moral quandary ish to me because it's not like if you leave your post Somebody worse is going to take over first of all that doesn't mean you shouldn't leave your post I'm going to come back to that in a moment, but Here there are people who probably will not be fired Um, and they should they should explicitly tell the truth always tell the truth Always, you know say what the risks are, you know, you know, the the malaria drugs are not proven Now they're proven not to work always just, you know, the vaccine is this you know It's probably a year away things like that always say the actual truth and if you get fired you get fired There's a famous example um, uh, ronard williams writes about this where he talks about Uh, uh, should you do something wrong to prevent somebody else from doing something worse? he gives this hypothetical case of Uh, a chemist in england during world war two or so any world will do And he says this person doesn't believe in chemical warfare And they're out of work and they need a job should they take the job doing Research for chemical warfare and just not do their best. So they'll slow it down a little I mean, they have to do the job otherwise that they're fired But if they don't do it somebody else will be enthusiastic and really do a great job I don't think they should do it. I don't think you should do the bad thing so that somebody else doesn't do the worst thing That involves predicting the future that you don't know it allows somebody else to make you do a bad thing And it's just in general. I think the wrong approach I think the right approach to doing the right thing is to do the right thing not to do the wrong thing Because somebody else might do the worst thing and I think it's the same case here You work for the cdc You work even if you work in the minister in the administration you do the right thing You don't do the wrong thing so that somebody else doesn't do a worst thing And so you don't tell a half lie so that somebody else doesn't tell a whole lie So what I see one of the problems that has happened in the united states I mean, like I say the biggest problem is that the president would like to pretend This is a pr problem doesn't seem to care much about the reality of how people suffer because of it So that's the biggest problem. But then we also have Lying throughout that has had a lot of bad effects for I mean For the most part the cdc. I think has told the truth Fauci has told the truth um But in the beginning when they said something like uh, don't buy a mask because it's not going to help you Obviously that was a lie if it's not going to help you why is it going to help a doctor? Of course, that wasn't true That was a big mistake because then when they came back around and said hey everybody wear a mask people like well In the beginning you said not to wear a mask and your hypothesis there is not that they the science was uncertain And then it settled it was that They felt that if they told people masks worked there'd be a mask shortage for the people who needed the most so they told A fib in order not to have a run on masks Is that Just a mistake Just because and I Fauci admitted as much actually he said we didn't want to run on masks The science wasn't unclear if it was unclear. Why would the doctors be wearing masks? Of course, they were protective How protective they were was not known but that was a very that was an example I think of a a lie. It's not a fib. It's flat out false intended to deceive. So it was a lie told for a good purpose That is a bad idea But I guess maybe it's the scale of the lie that makes it a fib No, uh, it's a it's an it's a it's an intentionally false thing done to deceive people even for a good reason That is not the way to be moral And it usually doesn't work out. Look how it backfired here and then but but that would that's From what I see about let's say Fauci or the NIH most of the time. They've been pretty Honest that was a mistake in the beginning, but it has backfired quite spectacularly now in terms of not Of how many people don't want to wear a mask when if everybody wore a mask so many more Activities could be allowed. So I've got to ask you in the spirit of bernard williams There's been some intimation That the information flow to the president has been modulated in order to produce certain decisions or results for quote the greater good Uh, how would you relate that to the chemical warfare making facility? Is that something that you owe the truth to the public? Do you owe the truth to the principal if you think that the Principal will do something quite bad with it. That's much more complicated because Part of the truth is this social contract and the trust you trust the person to do something good with the truth You know truth is important for trust when you have somebody who has the the wrong intentions in the presidency Which is what I think we have I don't think I think the president does not care that much about most people And so The contract is broken and I don't know that he's owed the truth. So then you have more of a Pragmatic question of is it better to lie to the president? I don't know that that's true either I don't think that gosh I mean it really does implicate everything you were saying before because it's having to predict the future and all the Contingencies and the greater good and all of that while basically making yourself the deep state No, I I think that the difference here is is the lie wrong in the first place when somebody is untruthful all the time Then your bond your obligation of truth to them is weakened Morally because they're sort of out of the contract and they're not doing what they're supposed to do But I also didn't inform them that they're out of the contract because if you do then obviously I don't think lying to the president is a good idea either Right. I don't think so. I don't think it's gonna help anything. I think everybody should flat out tell the truth I think deba berks standing nearby Complicitly not saying anything is a mistake and if she would get fired she should get fired. I think she's doing the wrong thing So to go back to your original question, whether you can lie to a liar is more morally complicated Then or whether you can lie to a murderer is more morally complicated than whether you should generally lie You shouldn't lie But in this case it is not more complicated because I don't think lying to trump is the good idea either Lying to the president is also not a good idea. It's it's very rarely a good idea even practically to lie and morally almost never so I think we're in a you know, very problematic public health situation and political situation, but I think some of the moral problems are not that Hard to solve should you lie? No Well, I was just gonna say, you know so I um Well, I don't know. This is a little risk on my part. I guess but I uh What what you're saying in some ways really chimes with some of the research that I've been trying to now frantically look up about the personality disorders Actually in treatment of personality disorders and you know, there's been a there's been a very robust, you know Conversation, I think many of us have heard about amongst the psychiatric community You know the folks that do uh work with people with personality disorders and violence Uh people with very violent behavior, you know, been like, oh, this is a very dangerous situation We think, you know, the the president has a personality disorder Um And you know folks coming back being like you shouldn't diagnose the president You know, that's not your place. Think about the ramifications of that Uh, you know, which I think is which I have a lot of time for as well But one of the things that was interesting uh in the sort of research around therapy for personality disorders Especially a sort of narcissistic or in violent personality disorders is It's also the rule of thumb you learn on your first day on the psychiatric boards in medical school Never play to somebody's delusion if somebody is has a delusional disorder, which is different than a personality disorder But but in both cases don't play into the delusion don't pretend that you're you know, say, okay, this person has a delusion that they are a um The cia is after them. Don't you know, do something like say, oh, I'm part of the cia and we're not after you You know something, you know, kind of crazy Don't do that because it really will you know reinforce the delusion and in the case of personality disorders The technique is really called limit setting uh, where you where you um, you know, essentially Fence them off anytime they say, you know a lie or something. That's a half truth or imply something You know, you you immediately, you know step forward to to say no, that's untrue You know and and just you know very much fencing them in as a therapeutic measure Um, and so it's interesting that you say that because it came to mind when I was watching some of these press conferences as you know, trump is getting off the helicopter taking off his mask and You know going into the white house exposing people to millions of viral particles potentially You know that that for me That is the those are the cases and those are the moments that I think public health people and leaders need to train on You know, how to intervene in that moment how to how to intervene when you're standing behind the president And they're saying something untruthful and very harmful um, and I I think that's a that's a very tough that's a very tough kind of uh Thing to figure out to play out, you know, uh, we're so I don't know. Anyway, so it chimes with what you're saying. I've never lie It's morally difficult. I think it can that's right. It can be personally difficult because it takes some kind of courage Um, it doesn't take the highest degree of courage. Nobody's gonna kill you. You know, you're not gonna be tortured We're not in that kind of a regime. So it just takes a certain kind of personal courage to uh, uh, tell the truth um But it is not morally complicated, but I'm still following Margaret's uh, don't feed the delusion if you have a boss Who seems to only care for example about the red states Would pointing out that a particular strategy that happens to be good for everybody Pointing out. Oh, this is really good for the red states. This is gonna help you with your whatever it is It isn't really in if you are the advisor. You might not think that's a noble motive. Is it okay to play? to that Yes, because that's true And there's nothing Saying that there's nothing wrong with acknowledging that but I also think that there is more than one level of problems here Because we have a problem at the federal level and that is the biggest problem Where we don't have a mask mandate where we have a complete we have no policy Which is complete chaos and has let the pandemic get to this point where there's a lot of wishful thinking But we also don't have state policies that are going to engender cooperation amongst the population Because when you tell people like we told them in the beginning Flat stay home and flatten the curve So people did that and they still couldn't go back to work Don't overwhelm the hospitals. So we didn't and they still can't go back to school You have places where I live in california where they're talking now still Opening bars where you can't wear a mask where people are drunk Which is the best way to spread the disease before they're talking about opening the schools for children So you're not going to get co-op. It's not You can't get people to cooperate when your policies don't make sense. That's why they're not cooperating Absolutely, and there's there are multiple layers of of and of which jonathan has Suffered through my ranting about in this very forum From lack of a national strategy to malignant leadership to a very poorly functioning public health system very poorly funded to really uh, I think I agree that the the um The loss of the plot if you will over. What is our goal? in terms of this this uh, this point in the epidemic right flat in the curve actually worked because people You know had a very clear goal. They could see that curve, you know over the weeks flat Um, and I think that you know, there is a controversy in in the public health community What is the goal that we should strive for now? um, it shouldn't be you know elimination And people say no that's too aggressive and the knock on consequences are hard So I I think the the the the issue around what you ask people But what one thing I would sort of push back on a little bit is around this issue of cooperation because Because the truth is the american public has cooperated dramatically. I mean many meant like I think the last count was 75% of the public wears a mask um, you know, it's it's actually been sort of shocking to me uh that um, you know, how much uh folks have have dug in and really taken on uh Following the advice as they as they understand it. There's a tremendous amount of of uh churn and you know things in the headlines, etc Even things like contact tracing and not calling people back from contact. That's just not what we're seeing in massachusetts I mean we see people pick up the phone for contact tracers by and large Um overwhelmingly so so I think that we do have a lot of public trust. I think that uh, and I think that's a good thing I think that the question I would sort of wrestle with here is this issue around how do we deal with you know, Given that given that we have all of these other problems You know how what are there techniques that we can use right now to To bring people together around a common set of goals and a common set of facts Um, and I'm not sure how to orchestrate that I think you could if you if there was a little I don't see clarity I see that You know the national strategy is certainly sorry. I don't know how to get this to stop The national strategy is not a strategy and is full Mistruths and is awful and has created a lot of problems But the state strategies are also problematic again What is the goal when you told people to flatten the curve? They could they could people agreed with it? Participated and succeeded and they got no reward for it There was nothing nothing. Yes the hospitals were not overwhelmed That is But everyday life has been crushed Um, and so what I see is I I want to hear more about risk. I want people to talk more about What are we doing for young people? We've asked so much of them so many there's no colleges are wreck Internships are gone Jobs are gone their student loans are still there young kids their lives are being you know, their whole development is being warped And we keep saying to them do this for your grandmother. That's not how people work What are we giving back to them? Where's the social contract? Where's the gi bill for all the young people who are supposed to hide now when their risk is very low Yeah I definitely think that they're not reopening schools as you know Enormous enormous enormous issue as I'm sitting here with my four kids banging at the door and I do have a lot of I would say that the way I would kind of characterize the problem is we have lost our ability to prioritize as a community And there's not really that sense of conversation Or really what our priorities based on shared values and that's the conversation that I wish I was being led I think it could be led at the state level potentially I don't know that it is But I think it's also because the state is just States are struggling with trying to negotiate and contend with The national leadership and whether the national resources are going to be available to them So, you know, we come to testing issues for example, you know, we we would we would probably Reprioritize who should be tested and who should have access to testing the state doesn't want to get involved in that necessarily because They're not sure the testing resources are going to be there for them to actually act on the priorities that people make is my sense I don't know. I blame the states a little more than you do. Of course nationals. I blame blame everybody The the the national strategy doesn't exist and is and is contrary to fact and is Malevolent actually doesn't care about people, but the states haven't done what you said I haven't said this is what we value. Here's how we're going to aim at what we value Here's how we're going to prioritize what we value. Here's how we're going to manage this risk There's been no coherent strategies. It's better to have one at the federal level But it doesn't excuse that there isn't one at the state level either so With the particular example in mind just from recent headlines around the apparent white house rejection of the FDA's guidelines for vaccine approval The story goes with the hope of being able to announce approval of one prior to the election to affect the incumbents electoral fortunes I'm wondering how your template of Ideally we'd have self-interest all around So produces a mutuality in a pandemic but speak to self-interest Would it be incumbent say on a pharmaceutical company? In a fit of public spiritedness not to put up a vaccine for distribution and possibly massive windfall profits to themselves and their shareholders Or is it like hey, it's the government's job to set the rules of the game And if the ultimate rules are submit your vaccine and we'll stamp it. Yes Pfizer is kind of obligated to or at least allowed to to pursue that No, they're not because the moral rules are always the rules. So those are the rules of the game morality is the rule of the game So morality sets the rules. Can you set? Can you release a vaccine that is not to the american standard? just because you have a Incompetent and uncaring president that lets you of course you can't what do you mean the rules of the game The rules of the game are the moral rules. Those are the rules. So again What we have here is not I don't find them. We have a lot of problems here About people not complying with morality and also people being massively incompetent and impractical at all levels But I don't find this still more a dilemma ish. It's not like oh, what should we do? Should we law? I know you shouldn't should you release a vaccine when it's not ready? Of course not just because somebody lets you when is that an excuse? I mean, it's kind of along the lines of I paid exactly to the penny The tax I owed and no more Even though in a just world I would be paying more taxes kind of thing now. Maybe I don't agree with that analogy Because paying your taxes your moral obligation is to pay what you owe Releasing the vaccine your moral obligation is to only release it when it has met the standards it's supposed to meet So Independent of what the government sets as the standards The standard. Yes, the standard is the moral standard and certainly not a standard that was altered For reasons that have nothing to do with the stand for the for why the standards are what they are Different because taxes are you know much more political agreements so you can agree to one thing you agree to something else Uh a standard of safety for a vaccine is not supposed to be a political agreement And at that point then it's not a self-interest story. It really is a story of being regarding of others and the community Possibly at some sacrifice or foregone opportunity for oneself Yeah, the same way you're not supposed to steal from people or sell them things that don't work And so let's say the government says today you can do price gouging or you know today you can sell poison It's still wrong to do that The game are the moral rules the government doesn't set moral rules. They only set political rules. That's different Do you have any time for you know, our patients with the head of the FDA doing You know, because I can kind of imagine right the conversation in his head. This is uh secretary han who's like, okay, you know, the the government says, you know, trump says, hey, you know We think plasma this thing of you know Of convalescent plasma is going to be really good for people And there's like a glimmer of evidence that maybe could be useful. It's been useful in other things. It's really not unusual to try And you know, he he ends up authorizing, you know, a Use of issuing an EU a emergency youth authorization for convalescent plasma Has a big press conference with trump, you know, saying this is awesome We are making huge strides post the evidence that he used to To approve that which was a subgroup of a subgroup of a subgroup analysis um, you know, definitely weak T in terms of what we would usually use as evidence for issuing a EU a And puts it on the website that analysis and says under the heading I wrote it down Another achievement in administration's fight against pandemic on the FDA website So that's why this okay. Well, okay I mean, you know with uh with convalescent plasma did turn out that the effect wasn't very big and You know, we're still kind of studying it. Maybe maybe, you know, it was other things like, um Uh from desivir, you know, it does look like it has a place. You know later They also did the same kind of thing. Um, you know, how much of that is kind of going along to get along how much of that is You know is I mean, I think if I have said anything it's that don't go along to get along Don't do it never do it never Never do a slightly bad thing because you think it's going to lead to a greater good that is that is You know, there's two ways. Well, there's a few ways But there's more than two ways But one of the two central Moral theories are sort of principle based or outcomes based I go for principle based because you never know what the outcome is and when you let the ends justify the means You do a lot of terrible things and you don't know what the ends are So I say you go for the means that's sort of the content approach the principle based approach You do the right thing and what happens happens because it's always what happens happens So at least you'll know I did like all that the jim comey approach I don't agree that it was Jim comey's approach. I think he had a lot of because he did not He there were rules in place that are not just the rules of the game But that were morally true as well not to affect an election which he did I think he was self aggrandizing he fooled himself and he presented it as I'm doing the right thing But I don't think that was accurate in his case But if it was that he would not have been doing the wrong thing, but I think I don't think that's true And there are more there there will be cases where Things look terrible no matter what you do or you do something and it leads to a terrible result And that's really unfortunate, but in these kinds of cases I really think and I think for the most part the medical community has done a pretty good job this of pushing back against the laws All the leaks you get out of the cdc who's leaking that stuff or the leaks you get out of the nih about This is against the rules and this bypassed this process Somebody doing the right moral thing is leaking that to the press It would be even more right if they put their name in front of it in their face too We have maybe a minute left anything we've missed that you'd want to bring to the table on this range of topics Uh, I don't think we've missed anything Um, I would go back to the beginning where you asked if there's one word that I feel about the pandemic in the united states I'm going to say two which is over it people feel over it. I see this I live in a neighborhood where there's um, a lot of very right-wing people and very left-wing people And I see a lot of agreement of like exhaustion. We keep doing what we're supposed to do and nothing's getting better. We keep, you know, uh You know, the kids are home. They're socially isolated They're they're suffering a lot. You know, I have a kids too and I I really see it's really terrible There's nothing you can do as a parent to really mitigate the effects of not being around other children Which is a normal human development? Uh, and so And we don't see the vaccine We don't see things getting back to normal people are unemployed, you know, and we don't see reasoned policies We see they keep talking about restaurants and boards Which should be the last thing on the list instead of schools Which would be the first thing on the list and I think people are exhausted because we have been ineffective Our policies have been ineffective Well, it calls to mind Something I think it was Julia Yafi tweeted the other day an old russian kind of proverb that says what feels like things are really bad But in fact, they're average because this year is better than last year and next year Sorry, this year is worse than last year and next year will be worse than this year. So we're really Whereas my father liked to say you ask a guy with his head in the freezer and his feet in the fire How are you when he says on average? I'm doing okay It could be a lot worse, but we can also it could be a lot better And it could be a lot better starting tomorrow. None of these policies are set in stone They could all be we could get better at this every day But I don't see Right I don't see it happening at the state level either. I don't see it happening at any level of government Yeah, no, I mean, I think we're in violent agreement there. Um, and I would say that But I do want to note I I always start on a note of pessimism, but I try to end on a note of optimism usually after I get the the The expression from Jay-Z and I'm gonna do that again Which is that yes, you're right that actually public health works Okay, if we do the three things that we do them well the contact tracing the mask wearing and the environmental Modification and ventilation and air purification. We actually can't control this and we can get kids back in school and these things are possible and And so I think part of the over it frustration is that we're just not getting on on it We're not doing the work that needs to get done So that's the whole thing though I think part of the frustration is when we make progress we don't open up the things that are most consistent with our Care and values Yes, I agree with you Um, I absolutely agree with you. Um, and I you know, I think that we are you know It's like been pushing a huge boulder up an enormous mountain and you strain and strain and strain and you don't seem to get anywhere Um, and I think that's a huge problem But I do think that that is also As you know a situation by choice and I do think that things will change For the worse or for the better. We'll see I'm optimistic. It'll be for the better Well, uh, especially against, uh, I guess it's hard not to just call it the sophistry of There were some folks on television saying that the fact that the president Caught it shows you that none of these measures work. So we might as well Exactly, but um, you point out The opposite the public the public action has been overwhelmingly Yeah, you know, yes for it So there is a uh, a path forward. There is a way to get it, right? Maybe we'll be in the churchillian zone of we'll follow that path after we try all the others and uh, we'll we'll keep cycling through but, uh, Because thank you so much for joining us and for your clarity And determination and all of your work that's gone into trying to keep people focused on uh, their ethical valence and their responsibilities and uh, the courage maybe That's called for tough moments to um, to be true to it So thank you very much. I really appreciate that you you know, you're having me here and I think these kind, you know the this these kinds of um, uh, events Are really and discussions are really important. Um And it would be really good if more people would talk about the problem in this way Well on that optimistic spirit and hopeful spirit Uh, thank you again. Thank you all for tuning in and uh, we will catch you In a future session check in on how things are going And uh, over to you margaret for any final benediction Uh, well, I I think the path is the path may be hard, but it is clear. So let's get on it All right Uh, and this wraps yet another covid state of play. We'll catch you uh, again In a matter of a few weeks where uh, as margaret's put it so artfully like the end of a newsweek article The future is uncertain, but one thing is clear if things don't get better. They could certainly get a lot first Until then Thank you