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CHRISTIANE AMANPOUR: Nicholas Christakis is a physician, sociologist and author who has an important message for all of us. Even in trying times, he says humans cannot escape their innate instinct for good, a case he makes in his latest book, “Blueprint: The Evolutionary Origins of a Good Society.” He talks to our Hari Sreenivasan about this latest theory, the importance of social distancing and why it does actually work.
HARI SREENIVASAN: Nicholas Christakis, thanks so much for joining us. You have got an M.D. and an MPH from Harvard. You have got a Ph.D. in sociology. What are the different data points that you are looking for during this pandemic?
NICHOLAS CHRISTAKIS, “BLUEPRINT: THE EVOLUTIONARY ORIGINS OF A GOOD SOCIETY”: Well, we’re monitoring a number of things, or I should say many scientists are making monitoring many things. We’re monitoring the number of cases that are occurring in different locations around the world. We’re monitoring whether those cases occur near in time to other people to whom most people are connected, because, of course, a virus spreads through social network ties. We’re monitoring when those cases are occurring. And then we’re using mathematical models to try to project what’s happening with the epidemic. What’s the trajectory? Where is it striking? How fast is it striking? What’s likely to happen soon?
SREENIVASAN: There’s also a historical dimension to this, in the idea that this isn’t the first time we have had this. Given that you have studied this closely for a decade or more, what does history teach us? And where are we in terms of how these pandemics stack up?
CHRISTAKIS: Well, I have been studying social networks for about 15 or 20 years. Pandemics, I am a little bit familiar with from my background, but, beginning in around January, I began to turn my attention very deliberately and directly to present pandemic that we have been facing. First of all, pandemics are not a novel thing. They occur. Every 10 years or so, we are struck with a pandemic. Most viewers will remember the SARS pandemic, the H1N1 pandemic, the MERS pandemic. Pandemics come, but usually — or, typically, they peter out. But once in a while, they’re very dramatic. I think this pandemic is most similar to the 1957 pandemic that swept the world and that afflicted the United States. It was a different type of virus back than this virus, but there are a number of similarities in the pace of spread, in the transmissibility of the virus, in the lethality of the virus. And if you imagine a little graph where you plot how transmissible is the virus, and how deadly is the virus, and you put all the pandemics on that plot, this virus that we’re facing right now would seem closest to the 1957 pandemic, which was a leading killer in the United States. We estimate that the 1957 pandemic killed about 110,000 people. The population in the United States back then was about half what it is today. So that number of people dead was — made the virus about half as deadly as cancer was back then. So this is a serious once every half-century event that we are facing, I and many other people believe.
SREENIVASAN: What makes this particular virus so dangerous? Because people look at the numbers and they say, you know what? This isn’t killing as many people as SARS did. It is killing more people than flu. So what’s that Goldilocks zone, and why is that a threat?
CHRISTAKIS: You have hit on it, Hari. If the germ is too deadly, for example, if it’s like Ebola, which kills well over half, probably 80 or 90 percent of the people that get it, the disease burns out, because it kills its victims before they can transmit it. SARS was a little bit too deadly to spread so much, nowhere near as deadly as Ebola, but about 10 percent of the people that got SARS died from it, and that contributed to extinguishing the epidemic. The flu kills about 0.1 percent of the people. The usual seasonal flu that we get or the class of germs that cause the flu kill about 1.1 percent of the people that get it. This condition, SARS-CoV-2, we think probably kills five to 10, maybe a bit more, times as many people. We think it’s roughly five to 10 times as deadly as the flu. So it’s more deadly, which makes it more serious, but not too deadly, certainly not as deadly as Ebola, but not even as deadly as the prior SARS pandemic from 2003 from years ago. So, that’s one of the things, one of the parameters, the so-called case fatality rate, or a similar quantity known as the infection fatality rate, the fraction of people that are infected that die. It has — this germ has a property which puts it sort of in the middle range, which makes it a bit more of a challenge to confront. And that’s coupled with the fact that it has like middling transmissibility as well.
It’s not too hard and it’s not too easy to transmit. And that makes it a really powerful enemy.
SREENIVASAN: So, will the physical distancing, the social distancing, that we’re talking about work? Because there also seem to be other costs here, when kidney dialysis centers start to scale back, cancer treatments get postponed.
CHRISTAKIS: You’re framing the question in terms of the total health benefits and health costs. And that’s a bit easier for me to discuss than when we have to trade off the health benefits vs. the social disruption and the economic costs, because, basically, we have crashed our economy. So, speaking just narrowly about the health benefits and costs, the health benefits might be that we greatly reduce the number of people who die. I think that at least 35,000 Americans are going to die of this condition. If that happens, that would be about as deadly as motor vehicle accidents. We in this country are very concerned about motor vehicle accidents. We spend billions and billions of dollars dividing our highways, mandating car safety. We are upset when people die. We read in the newspaper about car crashes. Car crashes are a leading killer. If I told you that you could wave a magic wand and make car accidents go away as a cause of death, we’d all — we’d be delighted. Well, what’s happened now is a magic wand has been waved, and we have added a killer that’s as bad as motor vehicle accidents, at best. And the estimates get worse from there. And what we’re trying to do now, therefore, is two things. We’re trying, if we can, to lower the total number of deaths. And there’s debate about whether the total number can be lowered. But what we’re trying to do is reduce the percussive impact of this epidemic wave. We’re trying to flatten the curve. So let’s say, for the sake of argument, that 100,000 Americans are going to die of this condition in the next year. What we’d like to avoid is these 100,000 dying in the next month. We don’t want to overwhelm our health care system by all of those people arriving at once. And so what we want to do is, we want to employ social distancing, we want to break the paths by which the germs spread through us from person to person to person, to flatten the curve. That means, instead of all of the cases happening now, we distribute those cases in time, so that the 100,000 deaths, let’s say, occur over 12 months. There are several benefits of that. First, on any given day, we have fewer cases. So, that means that our supply chain and our health care systems can work to take care of those patients and not overrun our ICUs. Second, we postpone some of the cases out into the future. Maybe, by then, we will have invented a vaccine. As you said, however, there are many health costs to that. We might be increasing social isolation. We might be causing people to lose their jobs, and now they commit suicide because they’re sad or because they’re economically deprived. We might be contributing — interfering with people getting ordinary health care for renal dialysis, like you said, or other conditions. So, just from a public health point of view, if you adopt a policy-maker’s perspective, you try to weigh all these costs and benefits and say, what’s best for our society in terms of lives saved? What should we do?
SREENIVASAN: I remember a newscast where I was talking about the head of China talking about how grave this was. This was probably early, mid-January. Frame for us, what are the sort of opportunity costs here? How much does a day, a week, a month matter in a response to something like this?
CHRISTAKIS: I and other people who have some expertise in this area who have been paying attention have been very concerned about this since January. And one way that I can invite you to think about what — why we should be concerned is that, beginning on January the 25th, approximately, the nation of China, which has an authoritarian government and a collectivist sort of culture, and therefore was able to do these things, basically passed rules and regulations that compelled 930 million people to stay in their homes since then. So nearly a billion people have been homebound for almost two months in order to confront this epidemic. And that should have given us some idea as to the kind of force that is required to confront this virus that is attacking us. So we should have paid attention, in my view, immediately, just like you’re suggesting, like in January. Certainly, by the end of January, by early February, it was very clear that this was a serious pandemic. And one of the sad ironies here is that, to my eye, our country did not adequately prepare and take advantage of the hard-fought weeks that the Chinese bought for us, because we have had six weeks or more when we could have been stockpiling equipment, preparing — preparing the public to engage in the kind of social distancing. The market would have gone down, but it might have not been so abrupt, if we had slowly prepared people for the severity of what we were confronting.
SREENIVASAN: Nicholas, I wanted to ask you, one of the things that your book “Blueprint: The Evolutionary Origins of a Good Society” talks about is that we are geared toward collectively doing good. Is that something that would work even in the context of a pandemic, thinking about community vs. just about oneself?
CHRISTAKIS: Yes, that’s a good question. One of the things — evolution has shaped us to be a social species. It’s shaped us to assemble in groups, to befriend each other, to hug and touch each other. And it’s those properties that evolution has shaped us with that the virus is exploiting. It’s using those natural instincts of ours to kill us, basically. But evolution has also equipped us with other forces that the virus has not taken away. For example, we have evolved to be a cooperative species, to work together. So, even now that we’re that we’re supposed to be engaged in physical distancing, we must and we can band together. We work together to confront this enemy. And, in addition, evolution has done something else for us, which is unbelievable. We are one of the very few species that teaches each other things. Many listeners will take this for granted, but, actually, it’s extremely rare in the animal kingdom. And I have investigated and studied how and why it is that we human beings come together precisely so as to learn from each other. So we can learn from past pandemics. We can learn from the Chinese. We can learn from the Koreans. We can learn from the Italians. We can take all that knowledge. We can learn from our own scientists who’ve been studying this stuff. We can learn from our neighbors. And we can take all that learning and spread it among ourselves and use that capacity that we evolved to have to work together to fight the germ.
SREENIVASAN: In addition to societies, you also study how ideas spread. And it seems that we’re in kind of a perfect storm for an opportunity for misinformation to spread right now. We don’t have a tremendous amount of trust in government. We have these filter bubbles that we live in where we can choose to — well, whatever reality that we like, right? So, how do we get a handle on that in a time when we don’t have — we’re not taking advantage, as you say, of the information that we should be putting out?
CHRISTAKIS: Yes, I think that’s a very important point. There are a number of ways in which our intellectual fabric in this nation has frayed in the last 10 or 20 years. We have less of a respect for science than we used to. We have less of a respect for expertise than we used to. We see expertise as kind of an elitist thing. And so we don’t take it seriously. We have lost the capacity for nuance. We see things as polarized. It’s either this or it’s that. We’re not willing or able to tolerate that there’s a range of outcomes. We’re not entirely sure what’s going to happen. We have difficulty compromising when we see opposing viewpoints, and which will be necessary in this case, because there will be trade-offs. There aren’t going to be perfect solutions. So all of these things that have happened in the intellectual fabric of our country in the last 10 or 20 years will make it more difficult for us. And you mentioned the issue of echo chambers. Many people think that the truth is subjective, that you can just make up the truth. That’s not true. The truth is the truth. There is an objective reality out there. I can’t wish the virus away. It’s there, and we may be imperfectly able to see it. Scientists may not be 100 percent sure about what’s going on, or there may be some confusing points, but the virus is there. And so somehow we have to acknowledge or get out of this sort of idea that, well, what the people around me are saying must be true, or the truth doesn’t matter, or you can invent anything you want. No, we have to accept the fact that we have to use the scientific method to confront the virus and accept that there’s an objective reality that we have to work together to confront.
SREENIVASAN: We have had some good news recently, that China has slowed the rates of new infection down to almost zero. But, at the same time, as we watch what’s happening to the Italian health care system, it doesn’t even look like it’s peaked yet. Why the differences?
CHRISTAKIS: Well, first of all, what the Chinese have succeeded in doing is in stopping the spread of the virus. They haven’t eradicated the virus. So the disease will come back to China. And, in fact, it will come back to all of us. This pandemic is going to is very likely to come in waves. So, right now, unfortunately, we’re just confronting the first wave. There will be another wave, probably, probably in October or November, which will again sweep the Earth. So this is the debate that’s happening right now. But, well, how long do we need to engage in social distancing? So, what the Chinese have done is, they have succeeded in stopping transmission by locking down their public, their population, and reducing social mixing. The Italians also started doing that, but late, and so they are beginning to see a flattening of their curve. They’re beginning to see a decline in the number of new cases. But there’s always a lag. So, for example, the United States right now, even if we locked down as much as the Chinese — and we’re not doing that — we would only stop the epidemic at where it is today, which we don’t know where it is and won’t know until another three weeks. So, three weeks from now, we would know, did we succeed today in stopping transmission?
SREENIVASAN: Well, what do you think of the long- and the short-term effects after we come out of this? Are we going to continue social distancing in a different way?
CHRISTAKIS: No. No, what’s going to happen is, eventually, the disease is going to become endemic. So on endemic disease is a disease like the common cold that’s just among us. It’s not epidemic. There’s not more of it than usual. It’s just the usual amount. So, eventually, what’s happened now is something very unusual, which is that a new pathogen has been added to our species that’s just going to circulate, we think, forever in our species. But what will happen is, is, we will develop immunity. We will develop herd immunity. Large numbers of us will have been exposed at mild conditions, we will be immune to the condition. If we’re re-exposed, we won’t get sick. We also won’t be able to transmit it because we’re immune. There’s a big debate about how long the immunity will last at the individual level. But at the collective level, eventually, we will develop immunity. And this disease will just be, like, added to the list of influenza us or influenza-like illnesses that afflict us. But it’s going to take some time. And what we’re trying to do now is slow the pressure of the wave. It’s basically like we’re trying to build breakers offshore, so that this big wave that’s coming, we slow it down, we lower its peak, we spread it out, so it doesn’t strike us with the same force. But it will strike us overall. All that water’s going to come to shore.
SREENIVASAN: Nicholas Christakis, thanks so much for joining us.
CHRISTAKIS: Thank you so much for having me.
About This Episode EXPAND
Prestigious religious scholar Karen Armstrong discusses the importance of faith and spirituality in difficult times. Journalist Mike Chinoy compares and contrasts government approaches to COVID-19 in Asia. Sociologist Nicholas A. Christakis explains the importance of social distancing and why it works.LEARN MORE