How will COVID-19 change our society? What can we learn about societal resilience from studying previous pandemics? What are some of the challenges of influencing human behavior, especially in a society that values individual rights over communal responsibilities?
Sinai and Synapses’ new weekly interview series “Sacred Science” (hosted at Jewish Live) talked with Nicholas A. Christakis, MD, PhD, MPH. He is a sociologist and physician who conducts research in the areas of social networks and biosocial science. He directs the Human Nature Lab at Yale University. He’s the author of several books, including Blueprint: The Evolutionary Origins of a Good Society, Connected: The Surprising Power of Our Social Networks and How They Shape Our Lives, and most recently, Apollo’s Arrow: The Profound and Enduring Impact of Coronavirus on the Way We Live.
Next week, December 15th at 2 pm Eastern, we will speaking with Dr. Jeremy England, author of the new book Every Life Is On Fire: How Thermodynamics Explains the Origins of Living Things.
Okay, welcome everybody, to our first launch of Sinai and Synapses project “Sacred Science: Gleaning Wisdom from Science and Religion.” I’m Rabbi Geoff Mitelman, and I’m the founding director of Sinai and Synapses, which bridges the worlds of religion and science. And in our mind, the biggest questions that we’re facing in this world, like climate change, or political psychology, or questions of our own human origins, or how we respond to COVID-19, they’re not purely scientific questions, they’re not purely religious questions, they’re human questions. And we need as much wisdom as we can to help us understand and address them. And so this conversation, this weekly conversation that we are launching today on Jewish Live on Sacred Science is hosted to be able to think about these kinds of questions with some of the biggest, most interesting, most thoughtful people in this world right now.
And I’m thrilled to be sitting today with Dr. Nicholas A. Christakis, who has several letters after his name. He’s an MD, he’s a PhD, he’s an MPH, he’s a sociologist, and a physician who conducts research in the areas of social networks and biosocial science. He directs the Human Nature Lab at Yale University. He’s the author of several books, including: Blueprint: The Evolutionary Origins of a Good Society; Connected: The Surprising Power of Our Social Networks and How They Shape Our Lives; and most relevant for us today, his newest book, Apollo’s Arrow: The Profound and Enduring Impact of Coronavirus on the Way We Live, which I’m amazed was able to be created and written in just a few months here. So, Nicholas, thank you for being here with us this afternoon. And Nicholas, you’re unmuted, there we are.
Nicholas Christakis: Yeah, I couldn’t unmute myself. So I just said, thank you for having me. I’m glad to be here. And I actually recognize a couple of names that popped up, which makes me feel at home.
Geoff Mitelman: I’m glad. We’re thrilled to be able to be talking about some of these really, really interesting questions. And I think the first one that I think is important for those of us who are listening, there are definitely people here who identify as being religious, there are certainly some religious leaders. Many people here I think would identify as relatively politically liberal, and will tend to say that when we’re thinking about how are we going to act in response to COVID-19? A phrase that comes up a lot is, “well, we’re going to follow the science, we’re going to follow the science” and they’re going to keep their gatherings either totally virtual or very, very small to try to save lives and protect people here. But even if we say, “I’m going to follow the science,” most of us are laypeople when it comes to scientific knowledge and public health recommendations change, sometimes rapidly, some of the recommendations have been mainly due to political interests, so how do we distinguish among, you know, things that are accurate information, are going to be accurate for a long time, information that was accurate at the time but has since changed, information that’s well-intentioned but is misinformed, and things that are just outright deception? How do we distinguish among all of those?
Nicholas Christakis: Well, I mean, you’re opening with a difficult question of epistemology. I can’t believe that’s like, the first topic is how do we know the truth? Here’s one thing I can say and not only do how do we know the truth, but who do we know is a truth-teller? On the former question, in some ways, a bit easier from my perspective, setting aside sort of divine inspiration. I think science is the best tool that we as human beings have created that allows us to approach the objective reality of the world, you know, it has a set of self-correcting rules, a set of principles, a set of norms, that tend towards finding the truth. Now, it’s not infallible. Scientists, you know, of course, can be wrong and often are wrong, but they’re dedicated to the pursuit of truth and in principle, they follow the classic rules like you know, we do more experiments and we must reject an idea if it doesn’t comport with the reality. You know, the whole heuristic that reality is a cruel mistress, you know, you can have whatever fantastic, you can imagine that masks don’t help prevent COVID but the virus will set you straight, you know, if you are mistaken in your perception.
A more difficult question is how do you single out who is most likely to be a good scientist or a good truth-teller? And I think here it can be very helpful if you are selective in who you listen to and look for certain traits. One, of course, is the ability to present the evidence for your belief, right. So if you make a claim that this or that is true or false with respect to Coronavirus, you should be able to explain why you have that belief, what is your evidence for that, and you should be able to bound your uncertainty right you should be able to say, you know I here’s how certain I am about this. Here’s why I believe this thing, here’s the evidence against it, here’s the evidence for it. And you should be willing, if, as you suggested, to revise your beliefs, I think that enhances our credibility, not decreases it, a scientist that gets up and says, I used to think this for these reasons, but now there’s additional evidence, so I have revised my opinion. That should increase that person’s credibility, not decrease it, in fact. And so even though it is true that even in this pandemic, some scientists have misstepped, about certain topics, like the utility of masks, which incidentally, most scientists did not get that wrong, right from the very beginning. Or the ongoing debates we have about how risky is it to keep schools open? You know, what is and is not known about not only the transmission among children, but the utility of closing schools and how it works, and what do we know from previous examples, all of these ongoing debates. You know, I think that listeners who are interested in “who do I trust?” should be looking for people who are willing to follow some of those descriptors that I mentioned a moment ago.
Geoff Mitelman: And I think what’s interesting and what’s challenging is that there are some pieces, particularly in the religious world, where there is a social reality that is not necessarily an objective reality. That, you know, light in the Hanukiah is going to create wonderful pieces, right? That it’s a social reality – ritual is a social reality there, versus COVID-19, which is a physical reality. And, you know, one of the interesting things that happens with pandemics is that it’s not just the science of the virus, but “How is it communicated through people and through interactions in the social world that we’re living in?” It’s not just, “I’m living in an isolated piece, but how I’m acting impacts other people as well.”
Nicholas Christakis: Yeah, I mean, you’ve almost given the perfect description of what people call a complex system, right, that has biological, social, and physical components. The physical components, for example, being drugs or physical objects that also play a role in the transmission of the virus. And, of course, I talk a lot about that in Apollo’s Arrow, how epidemics, intrinsically, are social phenomena. It’s not just about the virus, it’s about how human beings interact with each other. What actions they take. the virus has its own agenda. But you know, we are not without agency, either. We have our agenda, which is to survive and to outsmart the virus. And, you know, we affect what happens to the pandemic, we’re not just passive recipients of it.
I should say, just incidentally – and I don’t mean this in a blasphemous sense – there’s no God-given reason that this virus only kills about 1% of the people that it infects. You know, right now, 10 months into the pandemic, we know how deadly this virus is. The so-called infection fatality rate, the fraction of people who are infected with the virus who die, is between 0.5 and 0.8%. If you get symptoms – about half the people don’t even get symptoms – if you get symptoms, you got to double those numbers. So about 1 to 1.6% of infected people die. And of course, most listeners know that varies with age. So if you’re younger than 20, you know, maybe 1 in 3,000 to 1 in 10,000 of those people will die. And then around your 50s, it becomes around 1 to 2%. And by your 70s and 80s, it’s like 20 or 25% of the people who are infected will die. So it’s actually quite a serious virus; we should take it seriously.
And as a tangent on a tangent – if you’re young and listening to this, just because as a parent, I’m really relieved that my children in their 20s, if they were to get this, wouldn’t die. But death is not a problem for the young at all. In other words, young people don’t have a material risk of dying anyway. So actually getting the virus materially increases your risk. If you’re in your 20s, you should be taking this seriously. But anyway, so the virus we now know a lot about the infectiousness of the virus. Now I lost my train of thought, now you had asked me about, what was your question? Remind me for a second.
Geoff Mitelman: Now I’m so immersed in this, the social reality versus the medical reality.
Nicholas Christakis: All right. So the virus has this intrinsic lethality, you know, now we know “this is how the virus kills us.” And I should also say that this intrinsic lethality, we’re lucky it’s only 1%. The virus could have been much more deadly, it could have killed 10% or more of people. You know, some of the medieval plagues were devastating. The people thought the world was ending, they were being annihilated, you know, 50% of the people in a city would die within a few months. The smallpox epidemics that killed Native Americans, 95% of the people would die, right? So we don’t have that, but what this means is that there is some role of agency. We have an opportunity to do something about this virus, precisely because it is not quite as deadly as it could have been. So we’re lucky, in fact, that we can act.
Geoff Mitelman: And I think what’s interesting, though, there’s also a downside to that. I mean, look, we would rather have many fewer people die, better to have more people alive than dead. But one of the challenges of COVID-19 and seeing this, particularly if people who are spreading a lot of misinformation. But one of the challenges is that when we’re thinking about our agency, I think we’re naturally, as human beings, we’re focused on what’s immediate, and local, and personal, and concrete. And COVID-19 sometimes feels like it’s abstract, and distant, and “other people.” There was an article, I think, in the New York Times, just recently, saying that maybe one of the reasons people are not taking it as seriously is because it feels so potentially far away and abstract, because we’re not seeing “What does it actually look like to be intubated,” or “What does it look like in the hospital?” I think for some people here, they have a very intimate sense of that if they’re in the medical field, or if they’re a clergyperson who’s been working with friends and family members who have died of COVID-19. But it’s really, really hard for us to take action on something when it feels completely very far away. And we’re so isolated right now that we’re not even seeing other people.
Nicholas Christakis: Yes, that’s exactly right. And I’ve been making that argument for quite a while. And that argument has at least three components. The first argument, which you mentioned, was the fact that we’re not in touch with these deaths, we don’t see them. And it’s quite likely that, even if at least half a million Americans are going to die of this condition – maybe as many as a million before the epidemic is over – even in that range, even if a million Americans die, and this might be this half a million, all these numbers will happen regardless of the vaccine ,given the pace of the epidemic in our society right now. Even if that many Americans die, they’re probably only 10 people who will know each of the decedents intimately. And maybe 100 people who might know of them, let’s say, you know, personally. So that’s still 100 million Americans, a million Americans die. That’s one out of 300. 100 million Americans know someone who died. So that’s, you know, only one-third of Americans. Most Americans on the other side of this epidemic will neither have died, nor even know anyone who’s died. And so it’s very easy, as you’re suggesting, to think this is a problem of “it’s other people.” First point, which is wrong, of course. The second point we already also mentioned, which is the fact that this virus only kills about 1% of people is one of this fiendish qualities.
If the virus had killed more people, or killed them more consistently – I’ll get to that in a moment, if the virus had a higher lethality rate – we would actually be taking it more seriously. I believe, you know, if it was bubonic plague, or if it was even like the virus in the movie Contagion, which also began in bats and killed about 30%. Its so-called infection fatality rate, IFR for COVID is about 1% we said or 0.5% or 0.8%. For the fictitious virus in the movie Contagion, it was 30% of the people got it died. [If it were] something like that, very bad virus, we would be taking it more seriously.
But there’s a third element, which is really sneaky of this virus, which is its protean manifestations. Let me give you just a little example for the listeners to see this point. Okay, imagine two different worlds. And I’m going to ask the listeners to pick in a moment, they may not be able to express themselves to me, but I’m going to ask them to think, okay, here’s an exercise. There are two different worlds, okay? World A, there are 1000 people, 10 of them get seriously ill from a virus, and one of those people dies. So one out of 10 people die, that’s a 10% lethality rate. That’s World A, okay. In World B, there are 1000 people, 100 people get sick from the virus, 90 of them get a mild illness and then they recover, 10 of them get a serious illness, just like in World A, and one of them dies, just like in World A. All right, that’s World B. Now here, we would compute that 1 out of 100 people who got sick or 1% of the people who got infected died, you understand, so in World A, 10% of the people got sick died, in World B, 1% of the people who got sick died. In which world would you rather be?
Geoff Mitelman: Right? You’d want the one where fewer people get sick, you would think. You would hope that you would want one where people are healthier.
Nicholas Christakis: Yes, you would want to be in World A, right. There’s no sense in which it’s superior to be in World B. In World B, one out of 1000 people dies, 10 out of 1000 gets seriously ill, and 90 out of 1000 also gets sick. But the problem is that World B is the world we’re in. It’s confusing because many of the people get the virus [and] nothing happens to them. They either don’t have symptoms, or they have a common cold. And that makes the virus seem less lethal, because the denominator you’re using is the fraction of people who got infected, rather than the fraction of people who died, let’s say. It’s this variety of manifestations, this protean expression of the virus, in addition to its intrinsic lethality, that is causing some of the confusion and making it harder for people to take it seriously.
Geoff Mitelman: That leads to a nice question. And I also want to say to people, if there are questions, you can type them in the chat and we’ll respond in a little bit here. But one of the things that I think is interesting is the question of messaging, and how do you share these kinds of messages? And there’s both the message that is being said and the message that’s being heard, because that’s not always the same thing, right? You’ve got to have clear public messaging, but you’ve also got to have messaging that people will actually act on. And I think one of the things that can come up is religious leaders tend to be people who are trusted. They have a relationship, they have a megaphone in this kind of way. Some of the people who are preaching religious liberty are being totally counterproductive in saying, “We’re going to get everybody in for Christmas, and let’s get everybody singing, because we’re not going to be afraid.” And that’s horrible. And there’s also the possibility – I think there are a lot of people who tend to use the framing of shame, of “How dare you act in this kind of way,” that I think can feel good morally, but it ultimately can be very counterproductive and ineffective, because that’s not a good behavior change.
So what are some of the ways in which whether you’re a religious leader, if you’re somebody who has some influence, what would be good messaging, given all the confusion of this?
Nicholas Christakis: So back in March, I wrote this piece in The Washington Post about compassion and Coronavirus, or something. I don’t remember the title right now, it was back in March. And it was before I wrote the book, and in fact, was writing it. One of the ideas that prompted me to want to write the book – I was consulted as a result of that piece by the Archdiocese of New Hampshire. And they said to me, they came to me and they said, “Look, you know, we want to keep our churches open. We need our soup kitchens, we need our Alcoholics Anonymous, in our basement, we have a pastoral duty, we want our priest out visiting sick people. We are struggling with this, you know, what should we do?”
And I said, “I understand the part of your tradition that suggests that is the brave and the right thing to do, that that is the moral thing to do. But actually, there’s another part of your tradition, which privileges life, and which, and actually that the brave and moral thing to do is to close your churches, that is being community-minded. If you really care about life or death in your community, not just about your own flock, but the larger community and society of which you are a part, I would argue you have the duty to move your services to Zoom.” Now, if you’re a priest, or a rabbi or a new mom, and you have to go to the bedside or perform a ritual, then, you know, we should have provided PPE, we should have made provisions for that as well.
And as I write in the book, I mean, I thought the fact that so many people were dying alone, like the Orthodox Jewish community in New York, where they said the holy prayers, they were said by the phone, put at the bedside – you know, for me, this was anathema, and actually unnecessary. I mean, I understand why, if you have no PPE, if your hospital is full, you can’t provide, you don’t want additional people to come into your hospital that would bring more infections. Or if they’re not infected, you don’t want them to come into the hospital and become infected, and you don’t have the staffing or the PPE to stop that. I can understand some of those motivations. But at the same time, as a hospice doctor – and I was a hospice doctor for many years – to me, the collapse of our health care system to the point where so many Americans were dying alone – and [how] we had to resort to these expedients of having sort of last rites and different traditions phoned in, you know, it was just outrageous to me, and I think with some planning would have been avoided. So my point is that I think that there are parts of the tradition which I think can be dispensed with, in the favor of other parts of the tradition, in a time of plague. But there’s still some parts I think, which can be honored.
Geoff Mitelman: And I think what’s challenging is that we tend to deal with an “either/or,” right? Our minds tend to do this, and our society now is very much “us versus them.” And you talk about this in the book, too, of how we create an us-versus-them piece.
Nicholas Christakis: That’s typical of all plagues, right? And in fact, it was one of the origins of anti-Semitism in the Medieval period, right. Although not just anti-Semitism, I mean, there was that case of those hapless Spaniards, right, who were drawn and quartered and blamed by the Italians, or whatever it was. But anyway, go on. I’m sorry. Yes, us-versus-them.
Geoff Mitelman: Us-versus -hem in all sorts of different ways. When I think what we need to be thinking about more sort of trade-offs and scales, and how do we make these kinds of decisions? And I remember – I live in suburban New York, I live actually right near New Rochelle – when I was living as the pandemic was happening, a phrase that kept coming up was “The infinite value of human life.” And that’s a phrase that comes up in a lot of religious contexts, of “Every life has infinite value.”
And the problem was that we say life has infinite value, because usually the things that we need to keep someone alive, they don’t have to be rationed, right? There’s not only X number of beds, and we’ve got to figure out who’s going to live and who’s going to die. But we had to make all of these different trade-offs of different questions of people’s mental health, questions of their livelihood. And I think, you know, I’m seeing in a lot of conversations now, of very much “I’m trying to do the right thing,” and people can either be guilty about not doing enough, or can be blaming other people for not doing enough. What are some ways to be a bit more shades of gray?
Nicholas Christakis: Well, I mean, there’s at least two aspects to what you’re saying. One is the whole thinning out of our intellectual lives in this country in multiple ways. One of which is a lack of appreciation for science – you could talk about science education – at every level. The polarization, the political polarization, the kind of us-versus-them idea you mentioned, which is there’s this bifurcation, where we think it’s us-versus-them for many things. And most important, I think, the loss of nuance in our society, the lack of capacity to see things in shades of gray, which I think, as an adult, we need to be adult about the world, right, that most things are complex, and they’re shades of gray. And that applies even to one’s posture.
I think when it comes to people who hold beliefs that are, from my point of view, nonsense, which are, in fact nonsensical, and also, from my point of view, nonsensical with respect to how to manage the epidemic. And I think that listening to what people are saying, even if they tell you, you know, just today, for example, I heard a story of people, they were high school educated, working-class – a young man who read on the internet that the vaccines should be avoided because the government was going to be injecting microchips into us. These people were not mentally ill, they were not stupid. They just had, you know, adopted this belief system, which was wrong – there are no microchips in the vaccines that are going to be injected into people. But how to take them seriously, right? Like, shaming them, as you said, is not going to work. Demeaning them is not going to work. You have to somehow join them. And not only is that the humane thing to do, but it’s also the savvy thing to do from a public health point of view.
And this is why, incidentally, one of the missed opportunities in our country – we haven’t talked about this yet, but you know, I’m ashamed as a nation of how poorly we have done managing the pandemic. I mean, it’s preposterous. A lot of the blame, I think, does rightly fall at the White House. Now, it is true that other wealthy democracies also screwed up, you know, England and Italy, you know, for example, but other countries did well, you know, not just sort of island nations like Taiwan and New Zealand, which is, of course, a wealthy westernized democracy, New Zealand, but it’s an island. Okay, so good. But you know, even Greece did well, you know, or Germany, for example. And so it is the case that we did poorly, plus from my point of view we’re the United States, you know, we should have done better than we’ve done.
So we’ve done really badly on every axis of testing, PPE, but one of the most important ways we’ve done badly, and we continue to do badly – and I hope that with the new administration, this will change – is public messaging. How do we rally the nation? We’re a plural democracy with people from all walks of life, with different beliefs with different levels of understanding, different religions, different politics, different ideology, different ethno-racial background, different everything, you know, that’s the United States right. How do we rally the nation and use the bully pulpit effectively for public health messaging? And I think one of the themes that could have been adopted, and I’m beginning to see President Biden adopting, is calling people to sacrifice, right, saying, “You know, we are Americans, we’re facing a threat. It’s a virus that’s invading us. It’s not an army, but it is a threat, it’s going to be a challenge, we have to come together as a people to fight this thing. It will require sacrifices of different sorts from different people. From some it just will require money, you know, more taxes. Others, like healthcare workers will have to risk their lives in caring for us. Still others will have to wear masks, which are inconvenient, or make them feel silly, you know, everybody is going to have to do something to work together.” So I think that kind of framing, I think, in my experience, tends to work in the United States. But you’ll notice that as far as I can tell, that’s not, in fact, been adopted, certainly not on a national level.
Geoff Mitelman: And I think part of the challenge, and this is where the thing about the Supreme Court case that came in with Cuomo, that the Supreme Court recently overturned…
Nicholas Christakis: Yeah, on certain grounds, yes. Here’s the challenge – some of you may know, I’m a strong First Amendment defender – so I think it’s absolutely essential that any rules be even-handedly applied, right, you can’t single out religious institutions. So if you say that, you know, “No gathering larger than 10 people is allowed,” that applies to the Orthodox weddings, that applies to the Walmart, that applies to the protests, that just has to apply uniformly. We cannot pick based on the content. But here’s the problem that I face in this as a public health expert. It is entirely possible that certain kinds of activities, the useful feature, or the relevant feature, might not just be the size of the gathering, but the actual activity. So if, in fact, in religious services, take place indoors, involve singing, involve higher density of people’s bodies, for example, or [are of] longer duration. You see, there may be other pertinent features, which might call for the state to actually single out religious institutions. And there of course, in the United States, we would have a serious problem, right? And we know, just to be clear, that religious gatherings, whether it’s singing or churches, or weddings, have been repeatedly sites of super spreading events in the way that grocery stores, for example, have not been. So if the state were to want to restrict them on public health grounds, I would want them to do that ,even at the same time as I don’t think we should single out religious institutions.
Geoff Mitelman: I think that’s exactly right. And I think that’s what’s been, I think, particularly challenging in the American etho,s is that America is very much grounded on a perspective of private individual rights. And religion, at least I know, Judaism to an extent, but other religions as well.
And can orient to being about public communal responsibility. That’s a harder sell sometimes in the American landscape to be able to say, you’re connected with other people, and you have a responsibility. And you’ve got to get by, and it’s hard.
Nicholas Christakis: Yes. And yet Americans also have these traditions. I mean, this is, as you say, not just the attention within religions, but even within our history, you know, you have de Tocqueville describes us as a nation of joiners, right. Americans, famously, joined clubs, we’re not the Swiss, you know (although even the Swiss, actually, if you think about the Swiss, they have other ways of expressing a common identity). So I think this sort of rugged individualism in the United States, and “Don’t tread on me,” runs parallel with, you know, we’re a nation of joiners. And I think this is again, where messaging is so important, because there are parts of our ideology in our history that you can appeal to, that equip us to cope with this in a way you could even think that these traditions, as we were discussing before we started, you know, these traditions, including Judaism, record, not just in the Talmud, which records you know, both the successful and the weak argument, which I think is an extraordinary feature of the Talmud and incidentally, as we were talking about tends to be a more scientific appreciation of the world. Less doctrinaire, right? Okay, we think this is the truth, but here are the falsities that we’re also keeping in mind, our eye on, but I also think that these properties of subtlety of thought about the world are crucially important when you’re dealing with a kind of complex threat like the virus. Actually, I lost my train of thought there for a moment, but I think I said what I wanted to say.
Geoff Mitelman: Well, there was a question that came up, which was that there are a lot of people who are not hearing or integrating evidence which would motivate people to take it more seriously. And I think there are two different pieces of that. And one is, we came to this, at the beginning, of “Where do we find the evidence?” And sometimes it’s a “Can I believe it? versus “Must I believe it,” right. That where we look, the information that we get is very curated right now. But there’s also the question of “Evidence doesn’t always motivate people.” And think that’s some of that question, of “How do we motivate people?” You talk a lot about this. And I think in Connected, which was one of your books that I read about 10 years ago, of people being able to mirror each other, they look at their leaders, they look at their peers. What are the ways in which social networks can be leveraged to be taking this more seriously and acting more effectively and more healthfully?
Nicholas Christakis: Well, first of all, there’s that saying, you know, “You can’t reason a person out of a position they haven’t been reasoned into,” right? Like, you’re forming your beliefs based on emotions, let’s say – which, I’m not critical of emotions, I think emotions are an extraordinary feature of our humanity. But they’re not necessarily… sometimes they can be a terrific guide to action, actually. You know, fear, for example, can be quite wise at times. But I think that when it comes to things like a pandemic, I think we need to use reason. And I think that we should be reasoned into and out of our positions. But you’re also right that networks are incredibly important vehicles for the transmission of everything from feelings to germs to ideas.
And I did an experiment years ago with a man by the name of Sam Arbesman, and another man by the name of David Rand. Yes, exactly, on a network contagion of altruistic behavior. And, you know, we showed that when you’re kind to someone else, it’s not just redounded to you, or redounded to that other person, but that person learns to be kind, and then treats still others with greater kindness. And so anyway, so I think – What’s the take home from that again?I’m sort of meandering, this is like a dinner table conversation, not like a lecture, so I lose my train of thought pretty easily. But I think that the point I would make about that is the recognition that if we are able, as citizens, as leaders, if we, to the extent we have leadership roles, whether you’re a rabbi or a person that leads some group of some kind, we are able to cultivate in others, desirable changes in behavior. Thankfully, those changes will ripple out and have bigger benefits than just the direct effects. And that’s one of the insights from Connected that you alluded to.
Geoff Mitelman: And, you know, there was a question that came up. And it links to something that I’ve been grappling with, because I’ve got a five-year-old and that question, his line now, is that Google knows everything, except when the Coronavirus is going to end. And he’ll ask “When is the Coronavirus going to end?” And what I think he means “To what extent is when is life going to be back to ‘normal?'” I think a lot of us are looking at this, and at least in the Northern Hemisphere in the Northeast, we’re about to get into a deep winter, that’s going to be even harder, because we’re not going to be able to be outside. So having a sense of what’s likely to happen is a helpful piece. And you’re talking about this a lot towards the end of Apollo’s Arrow, of what’s likely to happen sort of in the next six months, what the world is going to look like in the next 18 months and what’s likely to happen in sort of 2024. And we’d just love to hear a little bit about your seeing of the future, of what this world is going to look like.
Nicholas Christakis: Just to set the stage for that, let me introduce another piece of sort of technical information about a virus. Earlier we talked about the lethality and [how] other infectious diseases have a number of fundamental properties. But one of them is the lethality. And there are several others, but one of those others is the infectivity of the pathogen. How infectious is it? This is known as the R0, the R sub-zero. So this is the basic reproduction number. When you have an infected case of the virus in a non-immune host that’s interacting normally, how many additional cases do you get? And for this virus, it’s about three. So for each case of Coronavirus in a non-immune host population of humans interacting normally, each case causes three new cases. Now of course, if we were to change our behavior, which we do, for instance, by physical distancing from each other, what we’re doing is we’re stopping that. But we’re not modifying the intrinsic infectiousness of the pathogen. This R0 is a property of the pathogen. Now if you take that number, and you use a certain mathematical formula…
Actually, before I talk about that, let me then do a digression – and I’m not going to lose my train of thought this time. There’s something known as “herd immunity.” And herd immunity is the idea that a population can be immune to a pathogen or not prone to epidemics, even though not every individual within it is immune. For example, let’s consider measles. Let’s say you vaccinate 96% of the population for measles. If one of the 4% of non-immune people gets the measles, you don’t get an outbreak because they can’t give it to anyone else. They’re surrounded by people who are immune, okay. And that percentage that 96 percentage is the so-called herd immunity threshold.
Now, measles is the most infectious disease known. And you should have the intuition that the threshold of people that need to be immune varies according to how infectious the disease is. And the calculation for that uses the R0, you go (R0 – 1)/R0 is the herd immunity threshold, and for Coronavirus, 3-1 is 2, divided by 3 is 2/3. The herd immunity threshold is 66 – let’s say 67%. Now, it turns out that’s a simplification that has – I won’t go into the details, but it makes something known as the well-mixed assumption. When you take some network science into effect, it turns out that the proportion that actually needs to be immune is lower than that, let’s say 45%, maybe 50%.
So let’s say, for the sake of argument, that if 50% of Americans were to become exposed to this virus and acquire immunity naturally, we would have reached the herd immunity threshold and the virus’s epidemic potential would have now stopped. It doesn’t mean the virus has disappeared, the virus is still among us, can still kill us, but its epidemic force has been stopped. So that’s our target. Right now, about 13% of Americans have probably been exposed naturally, the number’s rising rapidly, probably by half a percent or a percent every two weeks, that number is going up right now, given that we’re in the second wave, and given how poorly our nation is behaving. But that means we’re about a quarter of the way to herd immunity. Okay, now, if we just let the virus keep going, it’ll probably take another year or so to reach the herd immunity threshold naturally.
Alternatively, we have now invented a vaccine. And the vaccine, thank goodness we’ve invented, but now must be manufactured. We need tens or hundreds of millions of doses distributed, which is not easy for various reasons. And then we have to persuade the public to accept it, at least 50%. So my thinking is, and that’ll all take time. Okay, we’re going to get to the end of 2021. So I think it’s going to be 2022, the beginning of 2022, before we have the epidemiological and biological force of the pandemic in the rearview mirror behind us, either because we’ve reached herd immunity artificially because of vaccination, or we’ve reached herd immunity naturally, because while we’re doing all this stuff for the vaccine, the virus is still spreading, right, and infecting people. So either way, 2022 demarcates a milestone for this pandemic.
So that is the immediate period. From the time the virus came to us back into late 2019, to early 2022 is the immediate pandemic period. Then I think we’re going to enter what I call the Intermediate Period, because the country is not going to suddenly return to normal. We have 30 million Americans out of work, countless businesses have been shuttered. We’ve had great movements of people like in times of all plagues. People have fled cities and moved to rural areas. Some of them will relocate, going back. We’ve got the psychological damage to our children whose schools have been closed, and the social changes. So all of that’s going to take time if you look at historical epidemics. So I think that gets us to the end of 2023, let’s say the beginning of 2024, before we begin to have redressed a lot of the social, psychological, and economic impacts, and also incidentally clinical, because one thing we need to also realize is that – we don’t know this for sure – but probably about five times as many people will be disabled by this condition as are killed by it. So if we have half a million Americans dead, that means 2.5 million with some kind of non-trivial disability. And that’s a huge amount of disability in our society, and that is going to take our attention to after we get the acute shock behind us.
But then in 2024, we’re going to enter what I think is the post-pandemic period, which I think in some ways could be like the roaring 20s again, after the 1918 influenza pandemic – and I’m almost done. Usually what happens in times of plague is people get more religious. I mean, this has been observed for thousands of years, they get more abstemious, they stop spending money, they get risk-averse, they adopt a whole set of behaviors like that. And then when the plague is behind them, they do the reverse. Religion now declines again, people spend liberally, you might get sexual licentiousness, people relentlessly seek out opportunities for social interaction. They’ve been, you know, they’ve been stuck at home fearing a deadly pathogen for years. Now, all of a sudden, they go to bars and nightclubs and political rallies and musical events and churches and synagogues again, and all of that stuff returns and then there’s an efflorescence of the arts and so on. So I think, I think that is what we’re going to experience as a society. As we enter the post-pandemic period, now, one last thing, there will be persistent changes in our society, even then. Okay, and so your five-year-old, you know, there will be changes that young person will experience in the world they grow up in, partly as a result of this pandemic.
Geoff Mitelman: And I think what’s interesting, and what’s helpful with your book, too, is that you look at the history of plagues because we are so focused, particularly now with social media and the advances of technology of “2020 is the worst year, and oh my God, this is going to happen. When is this going to happen right now?” But [with] plagues, it’s an 18 month, two-year, five-year period. We talked about the Black Death, we talked about over several years, or the 1918-1919 influenza pandemic. It’s not just, you know, the March of 2020, it’s going to be a longer period, it’s hard for us to realize that right now. Because the virus is the virus, and that’s going to impact us here. And some of it’s going to be very slow shifts.
Nicholas Christakis: Yes, that’s exactly right. And I also think that, you know, for example, no expert that I know was remotely surprised that we’re having the second wave. Every respiratory pandemic comes in waves. We’re going to have a third wave too in a year, by the way. If the vaccines have been rolled out substantially, the amplitude of the wave will be reduced significantly. But this coming summer, we’ll have a decent summer, and then they’ll come, winter cases will go up again, right. And this will be the reverberating echo of the pandemic.
We are extraordinarily lucky that if you think about human beings since time immemorial, there are so many listeners right now are probably hearing this and thinking, “This is incredibly annoying, this way we have to live. And it’s so alien and unnatural that we’re in our homes, we can’t go out, we can’t go to worship, and we can’t go shopping, and we can’t travel, and this is outrageous and so alien.” But the thing is, plagues are not new to our species. They’re just new to us. We think that this is so weird, but it’s not. Plagues, they’re in the Bible. They’re in Homer, you know, the Iliad, Apollo’s Arrow opens with a plague. So this is an old and familiar enemy that we are facing. And so I think it’s very important for people to understand that, and that in a way, we are so lucky, because our time in the crucible happens to be at a time when human beings in real-time can invent a vaccine. This has never before happened. It’s unbelievable, just unbelievable that we have vaccines 10 months into the epidemic. And usually these vaccines, typically in the past, only in the last 100 years or so or 50 years, have we even been able to do such things. Typically [they] have arrived long the threat of the pathogen is behind us. So, you know, we are lucky we have this tool at our disposal.
Geoff Mitelman: And that’s I mean, that’s – you talk about this with plagues coming up in the Bible, it comes up in the Talmud, that, you know, for many of us, when we’ve studied texts or things like that, it’s “Oh, it’s a metaphor,” because it because we haven’t actually had to deal with…
Nicholas Christakis: It’s old wisdom that is being given to you right now!
Geoff Mitelman: Right. And I think, what’s been different is that the role that religion in reality…
Nicholas Christakis: You wish it was a metaphor! Right, exactly, “Oh, this is a metaphor! God didn’t really mean that we would actually die, right?” No, you are actually going to die! You know, it’s bad!
Geoff Mitelman: And I think that’s because for so many centuries, the question of God and question of power, we didn’t have the level of agency that we have as human beings that you had to make sense of it. It’s a lot of Yuval Harari and Steven Pinker’s work also, “What does this all Mean?” with a capital M, because we didn’t have the ability to shift and change. We had to deal with plagues since agriculture has started. And now all of a sudden, we’ve got these technologies and can be talking with, you know, in the Black Death, people didn’t know what was happening in Egypt or in Persia or in the Americas or anything like that. And now we can see what’s happening in Italy and all over the world, and that’s a different world that we’re living in here.
Nicholas Christakis: Yes, yes, it is. I mean, you’re right that we can have contemporaneous appreciation for what’s happening elsewhere around the world. And that is also different. Although even in 1890, in the so-called Russian flu (which I actually think was probably another Coronavirus pandemic, I think people wrongly think it was influenza), there was news that spread, I mean, people were aware of what was happening. But I think that these oral traditions and these written traditions actually were intended to transmit warnings and information about how to act and how to think about, you know, plagues.
So – I tell the story in the book, it’s one of my favorite stories, about these tsunami stones in Japan. So you know, there was a tsunami in 1600 or so, approximately, in Japan. And the waves, the tsunami, was so big that the waves came 10 miles inland. And of course, they wiped everything out, like everything completely out. And the Japanese villagers that lived at the edge of the wave put up stone markers, and they said, “Do not build villages below this line.” And when there was another tsunami 400 years later, in Japan, during the Fukushima disaster, the villages that were spared were the villages that were built just above the stone.
You know, this is a way of transmitting [ideas]. Or an even better story related to tsunamis is the Andaman islanders who had an oral tradition. This is a digression on a digression, but I’ll tell you the story because it’s so interesting to me, when the same tsunami struck, in Phuket in Thailand. There were many people on the beach, and there was a little Australian girl. All of a sudden, the tide started going out very rapidly at the wrong moment, there were all these people on the beach, and the water just disappeared. And you could walk out into the beach, and you could explore the sea bottom, and you could see the fish and the crabs and the seaweed. It was very interesting. And people were wandering in to look at all this stuff. And a little ten-year-old girl in Australia had had a lesson, which she had learned that in her classroom, that when this happened, it meant that a tsunami was coming. Because this, of course, was the trough in front of the wave, right, the water was drawing back. And then the huge, you know, wave was coming.
And I talked to my wife when I read this story, because I know a good amount of physics. If I had been on that beach, I would have recognized that this was a very unusual event that the water was drawing back. But I don’t know that I would have realized it was a tsunami, which was outside of my experience as a person. I don’t know if I would have put two and two together. But if I had heard the little girl, I would have instantly [thought]: “Oh my God, I know that is really bad. We need to get inland immediately, right?” Like, I would have been able if triggered by that little thing, I would have known what to do. So the Andaman islanders, in the same Indian Ocean, had an oral tradition, which they passed down, which was that if you see the sea suddenly recede, and you’ve never seen anything like this before, go to this temple – made of stone inland on a hilltop, by coincidence – go to this temple and pray. That was their oral tradition. And all of them survived. They’re like stone-age people, they all survived that tsunami. Whereas in India, on the Indian coast, with modern technology, with buoys offshore, with all of this stuff, thousands of people lost their lives. So there is a sense in which our transmission of information, whether it’s across space, like in a given moment or across time, when it comes to oral traditions or written traditions, is a way of warning our descendants about the dangers posed by this age-old threat.
Geoff Mitelman: And being able to know – I’m thinking about text that we’ve been reading, questions of liturgy and on the High Holy Days of talking about there’s a Martyrology. And there’s a whole piece of “who shall live and who shall die” and a lot of Jewish liturgy was written 1000 years ago, 500 years ago, and texts get interpreted and get built on. And you’re trying to do almost like a palimpsest of trying to see like, what’s underneath this here because society has changed, but human nature hasn’t over you know, over that long.
Nicholas Christakis: I’m in your camp on that. Human nature has not changed for thousands of years, actually, just to pick up a little thread of what you said. You mentioned offhandedly – and listeners may not appreciate this – it’s very likely that plagues came to us because of the agricultural revolution, that actually the way our ancestors lived prior to the Pleistocene did not involve these types of [diseases]. Our groups were too small, we did not have the kind of contact with – certainly not, they weren’t domesticated – animals. Most of the human pathogens like measles, and tuberculosis, and diphtheria, and all of these pathogens, actually originally came to us from animals we domesticated. And the pathogens that afflict us are the domesticated descendants of the pathogens that afflicted the non-domesticated animal ancestors that we domesticated.
And then we also needed large aggregations. There’s an idea that I talked about in the book, which is a subtle and interesting idea, which has to do with so-called minimum community size for a pathogen to move from an animal to us, and then circulate among us. There have to be enough of us in the group, otherwise, it runs out of runway, it has to be able to move in a circle through the population. So when you get, you know, beginning with the great empires of the past, you get domesticated animals living in close proximity to large aggregations of people, that’s when you begin to get plagues. Prior to that, probably they didn’t exist, these types of large-scale things.
Geoff Mitelman: And that’s, you know, that leads to there are a couple people who brought this up here – and you mentioned this also, which is so much of what makes us human and the connectedness and the socialness of things that are very deep in human nature of ritual and song and handshakes and hugs and ritual, are so integrated into who we are, and yet also are the vectors of this invisible virus. What’s been so hard, is how are we changing human nature, to combat what we want to be able to do, which is to save human lives? And it’s very challenging to be able to make this trade-off.
Nicholas Christakis: Well, that’s exactly right. I mean, one of the deep ironies here is that this pathogen is exploiting our deepest humanity. I mean, we have all these wonderful qualities. We, unlike other animals, we’re social. Many animals are social, we live in aggregations. But we also make social networks, we have friendships. Other animals do not have friendships, you know, they don’t form long-term, non-reproductive unions with other members of their species. We are cooperative animals; we make sacrifices for people who are not genetically related to us, which is also very rare in the animal kingdom. We do all of these – we love our mates, you know, we form sentimental attachments to the people we’re having sex with, which is again uncommon in the animal kingdom. So although birds have monogamy, this is all in my book Blueprint: The Evolutionary Origins of a Good Society, which is another whole topic.
But anyway, the point is, we have evolved to have a particular kind of sociality, and to teach each other things, you know, like we transmit information, like we were discussing earlier, and you could make the argument that in a very real way, the spread of germs is the price we pay for the spread of ideas. That the virus exploits our social nature and our interest in working together and transmitting information and coming near each other in order to transmit knowledge and share knowledge. It exploits those… and to hug and touch each other and all this stuff, it exploits those tendencies to spread. But equally paradoxically, it’s the case that those are the tools we’re going to use to fight the virus, right? It is the spread of ideas that will result in us being able to repel the spread of the virus. It’s the working together, ironically, to live apart, and all of those things that we’re doing that will ultimately be the things we need to do to fight this, you know, this biological enemy that we’re facing.
Geoff Mitelman: That’s exactly right. And I want to thank you for taking the time here this afternoon. Because it’s been a hard however many… I’ve lost how many months, it’s been eight months. And it’s going to be a slog for a little bit. But, as for those of us who are celebrating Hanukkah, or celebrating Christmas, or celebrating Kwanzaa, one of the wonderful things is that we’re entering into this very, very dark time, but we have the ability to be able to create a little bit of light and create a little bit of hope. And that’s the human agency that comes from our connectedness. And the very things that are making life so difficult right now are also the things that will be able to help us overcome them and to be able to connect more.
Nicholas Christakis: I think that’s exactly right.
Geoff Mitelman: And so, I highly recommend Nicholas’s book Apollo’s Arrow, I just finished reading it. And it’s thought-provoking and it’s a very wide sweep of what the history of pandemics are, have been, and what’s happened from March, I guess, to you wrote about until July, probably…
Nicholas Christakis: Most of the things that have happened. You know, I had to send the book to the publisher in July, and then I had a little final crack at it in August before it went to the printer. But nothing unexpected has happened so far.
Geoff Mitelman: I also recommend that people follow you on Twitter at @NAChristakis, because there’s great thoughtful reflections and ideas, so please follow him. And for those of you who are here for our launch of Sacred Science, we thank you for taking the time.
Next week, we are going to be talking with Dr. Jeremy England, who is an ordained Orthodox rabbi and is also a physicist and is the author of the new book, Every Life Is on Fire: How Thermodynamics Explains the Origins of Living Things. He’s done some fantastic work about the origin of life, and was an MIT trained physicist, and explores some of the interplay of science and religion. Over the next few weeks we’re going to be talking with everybody from rabbis – Rabbi Rachel Gurevitz, and Rabbi Rachel Jackson – but also people like Michael Shermer, Steven Pinker is going to be o,n Professor Tania Lombroso. We’ve got some wonderful guests over the next few weeks. And Nicholas, we’re thrilled to have you as the launch of this project. So thank you so much for taking the time.
Nicholas Christakis: Thank you very much for having me.