(SINGING) When you walk in the room, do you have sway?
I’m Kara Swisher, and you’re listening to “Sway.” We’ve all been living through Omicron. In my house, it’s been hell, with half of my family testing positive around the holidays. I can’t say how it started. The blame game here seems pointless, although we did take to calling half of us “Covidiens” and the other half “No-vids.”
All of a sudden, the “No-vids” were running a sick ward comprised of me, my toddler, and my son Louie, who, thank God, is an excellent chef. Besides my immediate family, my brother got it. My sister-in-law got it. My nephew got it. I think my mother, who was with them, got it. But she couldn’t find a test, like a lot of people, and she declared that she did not have it.
While all of us have become makeshift scientists and doctors, testing ourselves, none of us really know what we’re doing in this weird, new world. The other day, I was pinching that tiny dropper in my rapid test kit and thought, there’s a reason I didn’t go into STEM. And I know I’m not the only one who’s completely perplexed, so I wanted to make sense of our crazy world with a couple of experts. And no, not my toddler nurse daughter or my son, the chef.
My guests today have both helped guide the public throughout the pandemic. Ashish Jha is a physician and the dean of the Brown University School of Public Health. And Emily Oster is an economist at Brown, who has collected data on how schools are responding to Covid. Both have gotten heat for their hot takes — in particular, their advocacy for keeping schools open. So we’ll talk about that and a lot more.
Welcome to “Sway.”
So that was my Covid rant, in general. So I’d love to know how you two have been doing. Emily?
You know, hanging in. I think this has been a very emotionally taxing time for a lot of people, because, particularly in the period before Christmas, I think it felt, to a lot of people, a little bit like some kind of return to March 2020. And of course, it wasn’t. But it was hard not to feel that way with things closing and the, sort of, number of cases.
I think the other piece that’s been hard for a lot of people, and to some extent, for me, is, we spent a very long time really trying very hard not to get Covid. And then all of a sudden, the public-health messaging, particularly coming from the top, switched a little bit from what seemed like, we’re pursuing a zero Covid, to, well, of course you’re going to get it. But let’s try not to go to the hospital.
And it’s not that I think that that isn’t necessarily the right message to end on, but I think that that shift was quite hard for a lot of people. And particularly, you know, I speak to a lot of parents of kids under five. And I think, for that group, they felt really left behind. They felt really abandoned. This sort of rhetoric of, everything is fine if you’re vaccinated, and if you’re unvaccinated, it’s a winter of death — that’s really felt very hard for people with one-year-olds. So there’s a lot of pieces of that, I would say, I feel tired.
Yeah, I mean, here we are almost two years in. And my mental model when this pandemic began — and I said this pretty openly — was, I saw this — the acute phase of this pandemic is lasting about 18 months. And thought, by the time we got into the summer to fall of 2021 that we’d be in much better shape. That looked like it was going to happen.
And then a bunch of things went, I think, a little awry. A lot fewer people got vaccinated than I think many of us expected. Delta, followed by Omicron have been real challenges. And so there’s also this just exhaustion of, you know, I thought we were going to be done with this thing by now.
And so what’s been interesting listening to Emily is, the public-health messaging is changing. But we expect it to change, because the pandemic changes, and the population changes. And one of the problems has been that people kind of expect a consistency of, why is this message different than what you were giving a year ago? And it’s because the world has changed. And that has been a challenge, I think, for a lot of folks, and conveying that the message a year from now will look different from today’s. And that’s OK, too.
Well, I know, except they don’t prepare you for it.
Yeah, I think, for me, that’s the piece of it that is hard as — I think it’s absolutely right that we expected the public-health messaging to change. And you and I expected the public-health messaging to change early on, and none of that was surprising. But I think when we deliver those messages, they are frequently being delivered in absolutes. And then the absolute is changing the next day. So nobody wear a mask. Everybody wear a mask.
And with many of those things, we’ve seen that kind of back and forth. And if you dug into it, you would understand why the circumstances have changed. But because the messaging seems to focus on, do X or do Y, and not — right now, we think we should do X. But we’re collecting more information, and here’s the nuance. And without that messaging, it’s hard for people to see why you’ve changed your mind.
So the Times recently reported how the C.D.C. had to issue recommendations based on what was previously considered insufficient evidence. Dr. Jha, how do you think the balance between issuing updated guidance and waiting for the science to be borne out is — because that’s another, sort of, confusing part of it.
Yeah, it’s always a balancing act, right? Because you need to provide guidance when people can use it. So imagine that in the middle of this surge, with hospitals depleted of staff, C.D.C. said, hey, we have no guidance whatsoever on isolation. We’ll get back to you in six months — that would be malpractice. That’s not acceptable.
And by the way, we deal with this all the time in clinical practice. There are lots of times I have to make a decision on a patient, but I just don’t have very good data. So I go with the best data I have. There are a couple of things that are a really important part of that. One is to communicate the uncertainty, to say, we don’t have great data, but this is the best evidence we have right now. This is what we’re recommending, and we’re going to gather more data. And by the way, when we do, we may come back to you and change our recommendation. I think most Americans would understand that just fine.
Let me just push back because I’ve had several major health events. I had a stroke, for example, and I had some low white blood cells, et cetera. And at one point, I said to the doctors — because they didn’t understand what was happening. I said, can you just say, I don’t know? Because I would feel so much better if you would just say, I don’t know. And they couldn’t do it. And my brother is a doctor. And they tried to give me all these words. And it was really an interesting thing. And I think a lot of people, when science is under siege — which it is, by malevolent people, I think — the “I don’t know” part is problematic for people.
I don’t know how you feel, as a doctor, in that way.
Yeah, one of the problems — and I would argue this has been a problem in the entire pandemic — has been the fear of, how will my words be misinterpreted, or what will people do — almost thinking about the second-order effects of things. What I mean by that is, when we didn’t have enough masks, we told people not to wear masks because we were worried that there was going to be a run. Like no, just level with people. People should wear masks, but we don’t have enough. So therefore —
And the C.D.C., I think, made the same mistake recently with using a negative test to end isolation. What they should have said is, if you can get access to tests, and they’re negative, you can end isolation safely. But we don’t have enough tests right now, and so here’s plan B. I think people are more than sophisticated enough to handle that. But we always worry that people will misinterpret, they’ll panic. And that’s not how this stuff works.
One last point that we often also believe — that if we say, I don’t know, that that creates open grounds for misinformation. I actually don’t think that’s true at all. I actually think that being unnecessarily certain, I think not providing any information at all — those are the grounds for misinformation is to come in and— but I think being open and honest is actually a pretty strong tool against misinformation.
I talk a lot about Facebook and medical misinformation. Facebook is just the biggest place. It’s all over the place. How do you deal with that when all this information is flowing over these systems, and much of it is inaccurate?
To me, this is the biggest challenge, at this point in the pandemic. And you could argue that if we did not have this level of misinformation, we would have managed Omicron very, very differently. Imagine a world where 90 percent of adults were vaccinated and boosted, and most of the kids were vaccinated. Omicron wave would have washed over us. The hospitals would have been fine. We would have largely been able to go on with little to no major impact.
This is the challenge of our time. I see this as a complex scientific problem. How does misinformation get created? How does it spread? Why do some things stick and others don’t? And we really have to apply that lens, understand it, and then come up with tools to counter it. And if we do, I think we’re going to be in better shape. But this is the work of many months and many years ahead.
So Emily, the changing guidance can lead to distrust in institutions, like the C.D.C. as well. It feels like it’s leaving us on our own then. We’re testing and quarantining at our individual discretion. Meanwhile, anti-vaxxers are feeling validated, not that I agree with them, obviously. But when people are taking medical advice from Dr. Google, Twitter, word of mouth, whatever, talk a little bit about the information desert that occurs.
Yeah, I think that we have, almost from the beginning, left people a little bit in the space of trying to have them make their own individual decisions. And the number of people who sort of reach out, like, oh, I’m going to build a calculator. Let me figure out — like, I’m going to multiply this by this, and I’m going to try to get this uncertain number about mortality. We don’t have these numbers, never mind that we don’t really know how to multiply them. And so some of the pieces of data that we would most like to be able to make either policy or individual decisions has simply been missing.
And so we’re at a point now where it might be useful to understand a bit more about the hospitalization data. And we don’t have the data infrastructure to collect that, because we didn’t build it. And I think that there’s this continual failure of data collection in ways that would be helpful for decision-making for all kind of actors.
So Dr. Jha, when you’re thinking about this idea of Dr. Google — and I make a joke about it, but Dr. Google drives my brother crazy, you know what I mean? The idea of, everyone can google everything. Do you think you’ve lost your job to Dr. Google in that way? And that’s actually a good source of information compared to some of the other information people are getting.
Joe Rogan? You’ve lost your job to Joe Rogan, Ashish?
How do you think about this moment that’s heralded as a recognition of public-health expertise? It’s also been a boon for medical misinformation.
Yeah, so first of all, I actually think the democratization of information, the much greater availability of information is a good thing. I’ve always felt that, as a clinician. I have patients walk in and say, I googled my condition, and here’s — I use those as opportunities to talk. It’s very different in a clinical encounter, because I have time, and I have a trusted relationship. I think what this has meant is, because information is ubiquitous, now it’s about judgment. It’s about, who do you trust to sift through all of that? And there are two sets of things that have happened in this. One is, there are people who are like, I’m not going to trust any of the experts. Why should I listen to Tony Fauci, even though he’s been working on this issue for 40 years? I’m going to do my own research on Google. That’s fine, but that’s pretty dangerous stuff. There’s a high likelihood you can end up with a lot of wrong answers that are going to be harmful to you.
The second part is that it has given rise to a bunch of what I think of as quasi experts, people with good titles who should know better but who have used this moment to step in and say, hey, I’m a professor at Harvard. And sure, you’re a professor at Harvard, but you’re speaking a lot of nonsense. You don’t have any expertise in this topic, because expertise is specific. And that is almost impossible for people outside of the academic or non-academic medicine, public-health world to sort out.
You’re talking about professors versus a Joe Rogan, who —
Yeah, I’m talking about, a virologist is not an epidemiologist. And then there are people — and again, I take someone like a Marty Makary, who’s at Hopkins, who has said some smart things. And he’s a smart guy. But he is not afraid to go way beyond his area of expertise. And he has never been held back by being wrong.
And so he says stuff and pronounces — like, he had this pronouncement that we were going to hit herd immunity in April of 2021. Turned out, not so much. But he’s a professor at Hopkins. And so if you’re a normal American — and there’s a guy at Hopkins, one of the leading institutions, seems really smart. He is really smart. How do you deal with that? That’s the challenge, is, people are struggling to figure out who are the real experts and who’s just making it up.
So how do you, as a doctor, deal with that? Because I’m trying to think of what the doctor that Joe Rogan had — Robert Malone.
Oh, god. Yeah.
Oh, god. Oh, go ahead. Go each — start with you, Emily. Oh, god.
So I listened to some of that. What you get, which I think is very resonant with what Ashish is saying, is actually very difficult to really parse, you know, what — this is a person with a lot of credentials, or sounds like a lot of credentials, and went to school for a long time, maybe had some role in this, who is saying things which, on their face, most people have no ability to refute or not refute. And so I think that that just makes it very hard to evaluate expertise and to think about expertise.
I will say, I think there’s a weird flip side, which maybe I feel more than others, which is, a lot of the criticism that I get in the public sphere is, you’re not an expert. You’re an economist. I’m not a virologist. I’m not an epidemiologist. My expertise in some of these things around schools is being the person who collected the data on that and knowing something about the context and knowing something about how data works and so on. But I am not an epidemiologist.
And so I feel, a little bit, this kind of like, well, I think a reasonable person could say, why would I listen to you? And many people do say that. And so I hope that — for some people, they think, OK, here’s a kind of expertise this person is bringing to the table. And I think Ashish sometimes thinks that I bring expertise to the table. Not always.
But how do you separate that out?
Dr. Jha, you said, oh god.
Yeah, so credentials matter, right? It’s not like, oh, credentials don’t matter at all. And with all due respect, if Emily started talking about, like, CD8 versus CD4 T cells and why she thinks that the third boost really changes the mix, I’d be like, Emily, I’m not sure this is what I want to hear from you. But I do want to hear about that from someone like Akiko Iwasaki, who’s at Yale, who’s a superb immunologist.
And I’ll talk about Emily specifically because she has gotten a lot of criticism for, quote unquote, not being an expert. And what I think of her expertise is, she brings data, and she brings really thoughtful analysis to that data. And you can disagree with Emily Oster. But in my mind, you can’t disagree unless you’re bringing better data.
The challenge with someone like a Robert Malone is, it is very hard to understand, unless you have expertise, why he is so wrong. And most people don’t have that and can’t develop it and don’t have the time and energy to parse all of that. And that’s the difficulty of the moment we’re in.
So Emily, one of the things we talked about when you were answering some questions from my column was the idea of everybody being an amateur risk analyst with cherry-picked data, sometime. And we’re all really bad at it. Can you talk a little bit about that? That idea of, if this, then this. If I do this, then this.
Yeah, I think that there are a lot of reasons why we are not great with risk analysis. For me, the one that always comes up the most is just, how do we understand probabilities? So evaluating your risk and how to make decisions under uncertainty requires an understanding of sort of, how big is some probability? How does this risk compare to other risks?
And when we group small probabilities together, how do you differentiate between 1 and 80 million and 1 and 100? Those are both small probabilities, and they are very different, many orders of magnitude different. But you have no way to understand that, as a person. It seems small, but it isn’t zero.
So that means that when we try to think about what’s the right choice to make in a world in which there’s a small probability that my kid would get sick or a small probability of Covid or something, when we try to evaluate those risks, we need to use tools that allow us to put them in other contexts, because otherwise, all we can come up with is really, well, this is small, but it’s not zero.
So they’re using bad math, is what you’re saying, essentially.
They’re using bad math. It’s a very understandable bad math.
And then you get a situation where people think they’re over Covid. Everybody’s like, it’s done.
Right, they want to move everything into the zero, right? They want to say, you know what? I’ve just decided it’s over, so it’s actually zero, right? And so it’s sort of like, I’m comfortable with, this is the most important thing. And it’s a high risk that I should be thinking about all the time, and I’m comfortable with zero. And that’s probably also bad. I mean, that is also problematic.
OK, speaking of that, Dr. Jha, we could have mitigated some of this chaos right now in December. You mapped out a six to eight-week national plan with these steps. One, folks get vaxxed and boosted. Two, make rapid tests widely available. Three, limit indoor gatherings but keep schools open. Sounds like a good idea. We did parts of that, right? We did some of that.
Yeah, and part of it was that we just didn’t have the rapid tests available, partly because, just being very frank, I think the administration dropped the ball on this. And then they were caught flat-footed. But I think what Emily describes is exactly right, which is, much of the country wants to live in either zero or one, right?
And there’s a chunk of people who still think this is the only issue we should be thinking about. It’s all Covid all the time. And so any time I want to pivot to saying, like, Covid is a real problem, but it is one problem of many things we need to be thinking about. Kids missing school is also a really big problem — people do not want to discuss any of that. And then they immediately trot out, but 850,000 Americans have died, which is true and horrible.
On the other hand, you have a group of people who just — as Emily said, they’re in the zero column. They’re ready to move on. Covid is in the rearview mirror. And the problem is, you need something in between. And you need something where we can live with Covid, even now. And once the surge is over, even easier and better. But at the same time, we’ve still got to do certain things a little bit differently for a while longer. And that’s not a lockdown, but that’s also not being done with Covid.
So one of the things — Emily, you were talking about people living in these numbers they shouldn’t be living in — is, testing is not as accurate. Although, that’s maybe just because everybody is testing now that we suddenly realize this. There was a Washington Post article talking about this, where people thought they were negative, but then they were positive. And apparently, positive is positive, no matter what, for these rapid at-home tests.
It’s like pregnancy.
Yeah, right. Exactly.
But when you think about this idea of rapid at-home testing not feeling reliable, what does that do, from people’s risk-assessment point of view? Then they can’t even trust this.
Yeah. I mean, so I feel very strongly about the use of rapid tests and that this is a very important part of how we think about safety and all of those pieces. I will say that I think one of the things we need to make sure we are aware of, particularly in the Omicron case, is to pay attention to symptoms, also. And I think we’re going to have to accept that in Omicron, we are definitely seeing cases in which symptoms are showing up a day before a positive test. So I sort of simultaneously think it is extremely good technology and also one where we should — if you are very sick, and you have a negative rapid test, you still shouldn’t be doing stuff.
Yeah, you think you’re free. You think it’s like a “get out of jail free” card.
Exactly. It’s not a “get out of jail free” card.
Yeah. Other countries, the Brits, have been giving out free tests since April 2021, and people are actually reporting their results. So shouldn’t we be doing that? I was thinking that, I was doing. Like, the ones that were positive with my wife and our newborn, I didn’t report. I didn’t report our negative tests. Shouldn’t we be doing that? It could be, are we Americans? We just don’t do that, or that it’s not built into the system?
It would be really helpful. The problem — and I’ve talked about this with a lot of states, and I’ve talked about this with folks at the White House. The challenge is, how do you authenticate? You can actually report using QR codes that are built into tests. So it’s not impossible to do, by any stretch of the imagination.
It’s difficult. And there are two sets of things going on. One is, all of the concerns about authentication, and can we really be confident that this is real? That comes up. I think, ultimately — and maybe I’m wrong on this — but I think, ultimately, that’s a distraction. I think we can fix that part of things. We can make sure. And I don’t know that a lot of people are going to be sending in fake results. Maybe.
But the second part is, it’s hard. The state governments have lousy, lousy I.T. systems. They’re cutting-edge 1990s. And so they’re trying to figure out, how do they even accept this information? And given that everybody in states right now is just completely swamped with where we are with Omicron, no one wants to try to figure out how to solve this.
Spain is moving to treating this as an endemic, more like the flu. Instead of mass-testing the population, they plan to use case-sampling methods, similar to what is used to track flu cases. Is that what we should do? Is that better when you’re — because you’re not getting any of this data on rapid testing at home, or practically none.
Well, so first of all, I don’t think we’re anywhere near endemic at this point, just because, I mean again, it’s hard to call it endemic when we have about 800,000 Americans getting infected every day. That is not an endemic disease. And obviously, the horrible death rates— but I think we’re shifting. I’ve thought of this variant as the transition variant that gets us to think about this virus differently.
So we do need to, I think, do population-level surveillance. I think waste water is a great way to do it. The other way is what U.K. does, which is, it sends out swabs to a random subset of the population and just asks people to swab themselves and send it back. And it tests. And we could do that with some degree of reliability and figure out how to make that happen. We haven’t done that kind of stuff.
Actually, one of the biggest problems in this entire pandemic is, almost all the decisions we make are based on data from other countries. And we’re like, oh, Israel. Here’s data from Israel. Here’s data from the U.K., South Africa. And I’m like, how about data from America? How about we use American data? Again, I’m delighted to use data from Israel. Don’t get me wrong. But the idea that we never could build a data infrastructure to let us make decisions about America, we’re always —
And we invented the internet. How do you like that? No, I’m teasing.
This is ridiculous.
Let’s talk about the national economy, which is suffering. There’s not enough workers, because they’re all sick, essentially. So flights is one place where people are seeing it very clearly — flights canceled. Restaurants, schools closing. There are also hidden costs, like people skipping work to wait in line for tests. So Ashish, when you’re talking about the idea of testing and the costs of this, is there a better way to do this, from a medical point of view, or not? Because I feel like I’m living at the P.C.R. testing service with my kids. Every week, you need a — you can’t go to school. You can’t go to school without it.
Yeah, so at this point, I really do believe that the rapid antigen tests should be our primary strategy for testing. But even rapid antigen tests are, right now, really not affordable for a lot of Americans, you know, because the value of rapid antigen tests is that you should be able to use them on a regular basis. And if they cost, like, $10 a test, that’s going to get pretty expensive —
Yes, it does. Yeah.
— pretty quickly for a vast majority of Americans. First of all, it shouldn’t cost $10, because the actual cost of putting these things together is very, very low.
I sat there. I was like, cents is what I feel.
And I’m not an economist. I don’t play one on T.V. But my sense is that something is going wrong with the market there.
We call that a markup. That’s a high markup.
Yeah, and the only way you get away with it, from my understanding, is if you don’t have enough competition. And this is where the F.D.A., in the United States, has really failed us, because they really restricted who could get into the antigen-testing market. And that’s getting better. The administration is finally pushing the F.D.A. to start allowing more of these tests in. But the point is that these tests should be super easy to get. I’d like to get to a point where it’s about $1 a test.
All right. Well, let’s then move on to schools, because you’ve both advocated for keeping them open during Omicron. Can each of you give your pitch as to why — Emily, why don’t you start, because this is something you did which caused a lot of controversy around you, for example.
You know, a lot of us agree that it made sense to close schools in March of 2020 when there was a lot of uncertainty. By the time we got to the fall of 2020, I think it was fairly clear that it was possible to have schools, at least in some places, open safely. And certainly by the time we got to the winter of 2021, we had seen a large amount of data showing that schools were simply not a source of significant spread. And I think that’s continued to be true. It’s continued to be the case that schools are not generally areas of superspreading. And a lot of kids may show up at school with Covid, but math class is not where we’re getting it.
I think, at the same time, the other piece of this is simply that we have realized how costly it was to have schools closed, that on the one hand, there’s, OK, this is a safe environment. And the other hand, there’s, boy, this has been really damaging for a lot of kids. It’s been damaging for their learning. It’s been damaging for mental health. It’s had a lot of other negative consequences.
So I agree. And actually, I think, on the issue of schools, I think Emily has been more right than I have been. It has been amazing to me that this issue keeps popping up and that during the Omicron wave, there has been — there have been schools that have been closed, that have not opened. There is no reason for it.
And when people say, well, aren’t you downplaying infections? The key point here is, what’s the alternative? Not just the alternative in terms of the impact on kids, which has been very large. But do we really think that if we close schools and go to remote learning, that everybody is going to lock themselves down at home?
Or, what’s actually going to happen is, sure, for those six hours, kids will do remote learning, to the extent that you can do remote learning. But then they’re going to go hang out with friends. They’re going to hang out with family. That’s where people are. And the spread will continue. So there is no evidence, in my mind, that if we go remote right now, that we’re going to slow spread. But there is very good evidence that we’re going to cause a lot of harm.
So Emily, you have said transmission risk is negligible. We’re seeing some data that contradicts this. In Illinois, over 40 percent of potential exposure were traced to schools. Are those outliers?
So I think there’s a little bit of a question here about what you mean by exposure versus spread. So the thing you’re describing is, they collect a set of data in Illinois, in particular, where they ask people who — I think it’s something like, you have a positive test. Where might you have been exposed, or where did you have some exposure? Of course, that’s not, for sure, I knew I got it there, but that’s the set of places that I was exposed. And so it’s not necessarily how we’d want to do contact tracing for schools. And in fact, when we have done more contact tracing, just not seeing a lot of spread in schools. Whether it’s a little more true or a little less true in Omicron, I think, is hard to say.
But I think Ashish’s point is, well-taken — I was thinking about this the other day when I was listening to The Daily, and they were talking about the school closures in Chicago. And they were interviewing people about, what are you doing this week when your kid is not in school? And somebody said, well, our kids couldn’t be in school, so seven or eight other families called up, and my wife stays at home with our kids, so we’ve got all their seven kids at home at our house hanging out.
It feels like Covid soup.
That’s worse for exposure. And then even the view that, look, how can we reopen schools? So many people have Covid because they were out of school over the holiday break. There’s a little bit of a tension there in that discussion.
So one of the things Ashish said — you had a Twitter thread about how schools can MacGyver their way to a safe-enough classroom with inexpensive portable air filters and good masking. A lot of schools are cash-strapped. They don’t have books.
Yeah. No, I appreciate this. And to me, this was a real issue in the fall of 2020. There were poor school districts that needed financial help. The American Rescue Plan puts in literally tens of billions of dollars for ventilation upgrades for testing. So money is really not the problem. And it’s pretty inexpensive. Masks are pretty cheap. Obviously, higher-quality masks can be expensive for some families. And we should make that cheaper, or free, actually.
Air filters — yeah, you can put together — a Corsi-Rosenthal box costs about $50. And a couple of them in a classroom would have a tremendous impact on ventilation in that classroom, even if you did nothing else. Again, not trivial. I don’t want to say, well, everybody should be able to afford $100 for a classroom. But probably, given that there are tens of billions of dollars out there for this, probably everybody should be able to afford $100.
And one last point on this is, we have to have some level of accountability. The American Rescue Plan was passed, what, in March of ‘21 or something? We’re 10 months later. Why can’t we assume and expect that our district leaders or school leaders will take the billions of dollars that Congress has given them for something and do something with that?
How do you both look at these sickouts that teachers are doing? And now I know a lot of people are complaining about the Chicago sickouts. There was one in Washington D.C. How do you look at those, with teachers saying it’s still not safe enough? Who’s to blame here?
Look, I just came off of two weeks of clinical service in the hospital. I saw a lot of Covid patients. I had a patient I was seeing sometime last weekend. Right in the middle of me examining him, he had a coughing fit and coughed in my face, like, nonstop for a while. I did not freak out. And I don’t think I was exposed, because I was wearing a high-quality mask, and I’m boosted.
That is available to every teacher in Chicago. So there’s a little bit of, like, what are we talking about? What exactly is the risk if you wear a high-quality mask and you’re boosted? I’m sorry, but that risk of getting infected is somewhere very close to zero. It’s not zero, but it’s very, very close to zero.
All right. Emily, you’ve pointed out the mental-health impacts of staying at home, also, and the important reason for keeping schools open. How do you calculate the long-term impact of missing things like prom or graduation? My son missed both. He’s a very lucky kid. But at the same time, it’s clearly going to have an impact. How do you calculate that impact?
There are some things that we can imagine calculating, numbers-wise. So things like, OK, this is the amount of school kids miss. This is the learning loss. This is the increased dropout rates. And it’s much harder to quantify some of these emotional losses. And I think we hear a lot about the idea that kids are resilient. Kids are resilient, but not infinitely. And it doesn’t mean that those are not losses.
And I think, as parents have had the moments in which something happened, and our kids miss something that they really wanted — and yeah, is it the end of the world that your kid misses the play? Well, no, it’s not the end of the world, but it’s sad. And I think we will need to wait to find out the long-term impacts of some of those —
Some of those things.
— things, which is hard.
I’ll tell you. The moment was when they threw the diploma through the car window at us. I just was like — you know?
It’s a low.
The drive-by birthday parties. I could have done without the drive-by birthday parties.
Yeah, yeah, yeah. So what would change your mind about keeping schools open, each of you? What would make you push for closures?
It is hard to imagine. Certainly, I can imagine a variant where our vaccines just provide zero protection against significant illness. That would make me start thinking about, can we really do this? Obviously, the biggest reason why schools may have a hard time staying open is if there’s just so many people out sick that you can’t actually physically run the place. But I actually struggle with what it would take to close schools, at this point.
I think a variant that was causing high rates of serious illness in kids.
Yeah, that’s true.
One of the things that’s been true throughout is that the disease has not — the kids have been at lower risk. If we ended up with something that had a profile that was more like a very serious flu where kids are a higher-risk group, then I think — I would not advocate the long-term closures. But could I see a form of rolling closures? I can imagine. There’s nothing about the way the pandemic or the variants have gone thus far that would suggest that that’s a direction that we’re headed. But I think that’s what it would take for me. It would have to be something where the trade-off was about the kids. And I think that’s the key for me. All of the trade-offs we’ve made so far have put kids last and been like, OK, that group is not that important. What are we doing about the other groups? It is only if we found, actually, that is the group that is getting seriously ill, that I would — I might think we should change.
OK, we just have a few more questions. Vaccine mandates aren’t likely to fly in school, especially with the Supreme Court ruling on employee mandates. But how do you talk to parents who are scared to give their kids the vaccine? I literally just ran them to CVS the minute — like I did. I don’t care what Joe Rogan says, we’re going for it. We’re not strong, immune people, the Swishers.
I don’t work out as much as you, Joe, but there you have it. Anyway, how do you get those vax rates up? And should they make it mandated, vaccine required? They do at our school for sports, for example.
I think a lot of school districts are looking at this vaccine as part of the broader portfolio of vaccines that we mandate. And so I would like to see this treated in very much the same way. I’ve also been an advocate of giving parents a little bit of time to get used to the idea and feel more comfortable. But I can imagine, starting next school year — so one that starts in September of 2022 — that we’re going to see a lot of school districts mandate vaccines. I think that’s fine. I think that’s great.
Normalize it, in other words.
And normalize it. The only way this is a special vaccine is, we’ve given it to more people and studied it more closely than maybe any other vaccine.
When you’re thinking about kids under five, for example — I have a daughter who’s two, and I have a newborn who did get Covid — how worried should parents be? That’s the one thing we think about all the time about any decision we make. And sometimes I think we overworry. Sometimes I am not worried enough kind of thing. And right now, in my family, it’s like, protect the golden child. That’s our joking name for her that Scott Galloway gave her. But when your kid is under five, what is the outlook, in that regard?
The risk in that age group is very low. The risk of serious illness is very low. I think it’s lower than for many other things that you’re probably not thinking about every day, like hand-foot, you know, like RSV.
Yes, we got that. We got that.
Right? You got that, too. Yeah, that’s a bad one.
And so I think that there’s a normal — sometimes when I talk to people about this, I say, we should think about this as a bad flu season or where you want to be taking some normal precautions with your kid. And maybe there are some things you want to avoid. But in terms of who is higher risk in your house, you’re higher risk than your golden child.
Even vaccinated and boosted.
Even vaccinated and boosted, yeah.
Yeah, so first of all, I do think vaccines for kids under five is coming very soon. So I’m hoping that that is going to —
I definitely hope that.
I think it is going to provide a lot of relief. But I agree with Emily that the issue with risk in kids is tricky because one of the things that people have used is, oh, it’s lower risk for kids than adults. Well, almost everything is lower risk for kids than adults. That’s actually not that interesting of a comparison in my mind. The question I ask is, what is my kid’s risk of complications of Covid compared to other risks that my kids have, right? And then what can I do to minimize it? But even in using that lens, for kids under five, their risk is reasonably low. And so what I have been advising friends and colleagues who’ve got kids under five is, again, the most important thing you can do is make sure that the people who are above five around them are vaccinated, because that’s probably the single biggest thing.
But beyond that, I think being cautious and thoughtful is right. But I don’t think that you need to lock yourself down. And there are definitely families who are like, I have a kid under five, and we’re not going anywhere until this kid is vaccinated. I think that’s unnecessary because there is a real cost to that. And the cost of getting infected with Covid, for a four-year-old, is relatively low, even compared to other risks that that four-year-old faces.
So if you could wave a magic wand and get the government to do one thing to handle Omicron, what would it be?
There are several. But if you ask me to pick one, I think, in the short run, it would be to have more therapeutics available, because look, obviously, I’d love to have more people vaccinated. I’d love to have more testing available. But those things, people have been working on. The challenge is, there’s still going to be some number of high-risk people who are going to get infected and get sick. And some of them are going to die. And the best way to prevent the really bad outcomes from more infections is to have more therapeutics available. I think that’s the last missing piece of getting this pandemic really under control.
This is something Governor Ron DeSantis has been doing quite a bit. He’s opening antibody centers. How would you make those widely available? And do you think that’s a critical part of it, at this point, is, let’s —
— treat rather than stop?
Well, so it’s a bit of both, right? Let me put it this way. Low-cost things that can reduce infection numbers, I think we should do, because there’s no reason to let the infection rip through society and then only treat the high-risk people. I think that’s a bad strategy. So prevention still is a really important thing.
The second part, obviously, is if you get people vaccinated, the number of people who are going to have bad outcomes dramatically gets lower. And then you use therapeutics as the cleanup. There will be breakthrough infections. There will be people who are chronically ill or people who are immunocompromised for whom the vaccines won’t work. And then you use therapeutics as that third piece.
So one of my critiques of Governor DeSantis has been, he’s done not enough, I think, on slowing spread. I don’t think he’s been as strong on vaccines, and then said, but the therapeutics will bail us out. The problem with that is that there aren’t — we’re not going to have millions of people getting therapeutic infusions every day. That’s not a good strategy.
It’s expensive. It has all sorts of complex problems. So we need better long-term strategies. But that doesn’t mean therapeutics are not really important. They are, as that kind of cleanup.
So last question for each of you. Ashish, are you worried about a new variant emerging that is more dangerous?
I’m confident we’re going to have more variants. And I don’t know whether they’ll be more dangerous or less. One of the misinformation pieces out there is this idea that viruses always evolve to become less virulent. That’s just nonsense. That’s not true. Sometimes they do. Sometimes they don’t. We don’t know what the future variants will hold.
What I am very confident of is, every single variant that nature has thrown at us, the tools that we have now can counter them. And so what we need to do, at this moment, as we come out of the Omicron surge, is start building up our stockpiles, make sure we have tons of tests, make sure we have plenty of masks, make sure that we’re working on better and higher-quality vaccines that may be pan-coronavirus vaccines, stockpile therapeutics.
If we do all of that, then pretty much whatever nature throws at us, we’re going to be able to manage it. We’re going to be able to get through it. We’re going to be able to protect vulnerable people. We’ll be able to protect our economy and our society. And again, there’s always the complete curveball, but I’m largely not worried about it. But I’m also not of the opinion that we’re done. We’re not done. But we now have all the tools to manage this moving forward.
What are the numbers you think are most important? What are you looking at? What are you spending time focused on?
When I get up, I look at the hospitalization numbers and something about the ratio between those things, because I think that the big societal threat, at the moment, is overwhelming of hospitals. The basic numbers, whether people are there for flu or “flurona” or Covid or Covid and they broke their leg or whatever it is — that’s part of the burden. So in that sense, I think the overall hospital numbers matter a lot.
Are the most important thing right now.
I just want to be clear. “Flurona” is just flu and coronavirus at the same time. That’s not a different disease.
OK, thank you for making that up. And then —
Yes. I didn’t make it up.
No, I know that. No, I got that. Other than Covid, what’s the scariest thing coming for us, from a health point of view?
No, I think rebuilding the health system. It is really tattered at this moment. Two years of a pretty brutal pandemic, you have a lot of physicians and nurses who really are burnt out and just don’t want to continue anymore. And so figuring out how to rebuild the workforce, figuring out how to restructure our health-care system so we can manage these things, managing an endemic — there’s a lot of work to do. And what I’m worried about is, people are going to say, OK, good. Covid is over, or Covid is under control. We’re ready to move on. We’re not ready to move on. We’ve got a lot of work to do.
“Sway” is a production of New York Times Opinion. It’s produced by Nayeema Raza, Blakeney Schick, Daphne Chen, Caitlin O’Keefe, Wyatt Orme, and Kristin Lin; edited by Nayeema Raza with original music by Isaac Jones, mixing by Sonia Herrero and Carole Sabouraud, and fact-checking by Andrea López-Cruzado. Special thanks to Shannon Busta, Kristin Lin and Kristina Samulewski
Irene Noguchi is the executive producer of New York Times Opinion Audio, which, by the way, also produces another podcast called “The Ezra Klein Show,” hosted by none other than Ezra. He has a great conversation out with Times columnist Zeynep Tufekci. Go check it out.
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