Pushkin from Pushkin Industries. This is Deep Background, the show where we explored the stories behind the stories in the news. I'm Noah Feldman, and right now the only story that anyone is talking about is coronavirus. In order to make sense of coronavirus, we decided to speak to Sidhart Mukherjee, who is probably the foremost interpreter in my generation of the meaning of disease and how it affects our daily lives. You probably know his book The Emperor of All Maladies of Biography of Cancer, which one the twenty eleven Pulitzer Prize for General Nonfiction. You may also know his twenty seventeen book The Gene and Intimate History. Sidhart is a voice of reason, logic, and thoughtfulness, and he's the person I wanted to hear from at exactly this moment of panic. So Sid, maybe we can start by a my just asking you, how have you been thinking medically, statistically, personally, or otherwise about the coronavirus epidemic as it gradually rolls itself out. Well, so there are several questions in that, because there's that I've been thinking different medically, personally and statistically. But let me just tell you a very broad through landscape view. Right now, we're in a moment of some degree of confusion. There are, like any epidemic, or like any virus, coronavirus has some absolutes. In other words, there's some absolute things about the virus that are determined by its biology and by the interaction of that biology with the host. There's a real number which predicts how many people you infect if you you know what the so called are not value is and what the case fatality rate is, etc. And we need to know those very much in order to understand how to develop an effective strategy against it, whether it be quarantine or you know, medicines or whatever it might be. The problem is that those numbers are included by random chance events and by underreporting of the actual virus. So what do I mean that by that? If you look at the map of the spread, there are, as you know, eighty thousand odd cases in China, there are one thousand od cases in Japan. There are x thousand odd cases you know, in neighboring countries. But then there are some obviously some peculiar anomalies. There's this big case load in the Italy of all places in northern Italy and Lombardy and other places. Why did all of a sudden it skip all of Europe and become this major infection in northern Italy. It's not as if you know Han and you know Venus our major criss crossing destinations for each other. I mean, there is tourism of course between Italy and China. But something bizarre happened there, something that we can we cannot simply explain. So we are in a situation where we have to get we have to provide two kinds of explanations. One kind of explanation is as what I call are the viral absolutes, the epidemiological absolutes, and the statistical absolutes. What is the actual number of cases that is being detected or found? And then there are these things that, you know, how do we explain it that places that shouldn't seem to have any connection are suddenly epicenters of the worst parts of the epidemic. And that's what's that's what's very confusing about it at the moment. So from what you've said, the problem is that although there are absolutes, we definitely don't know them now and we may not know them until very very late in this process. They are there somewhere, but we can't get at them. The best way to get at them is is to let time is a little bit more time pass, And I'm not talking about a lot of time. I'm talking about, you know, a process of weeks, maybe a couple of weeks, three weeks, etc. And then also to in the meantime to separate the wheat from the shaft, so to separate out the things that are including these absolutes such as random movements and underreporting, and find out what the real numbers are, so that we get some sense in a given population what these epidemological absolutes are. What is the actual case fatality rate? So if you look, for instance, in the United States, there have been five hundred odd cases and twenty two deaths, that would put the case fatality rate at four percent, give or take. If you look at another place in parts of Europe, there've been a thousand cases and three deaths, which would put it a full magnitude less than the United States. But there is there is an actual number. There's a number to be had, or even a range of numbers to be had, of what the actual case fatality rate is and the decision of the severity of the epidemic will depend on that actual case fatality rate. There is an actual number, an absolute truth as to the number of people you are likely to infect under normal circumstances in it through going through a normal day. So it will take a few days, perhaps weeks, before some of these clouds clear and we begin to get actual, real estimates of what those numbers are. We're getting there. We have a sense of what it is, I think with COVID nineteen, but it's not all there yet and we're slowly getting there. So first point then for listeners, I think, is that this number, which we're all going to have to become very familiar with, the R zero or are not as you called it, which is the number that tells us for a person who's infected and is exposed to others, how many people will become infected, is going to become clearer in the relatively near future. And of course it might depend on the genetics of a population. That's a very important point, which is to figure out whether there's some populations that are particularly susceptible, whereas some populations are particularly non susceptible. We just don't know that yet. But again, these numbers will become clear. Once they do become clearer, what will the next step really be, Because then we leave the realm of absolutes and we enter the realm of social policy response. First of all, if it turns out that the number of people that you can infect while you're an asymptomatic carrier of the virus is large, then it makes most sense to impose quarantining and rather draconian quarantining in areas that are very severely affected, as China has done. As China has done. That's correct. So if both those things are true, if you're an asymptomatic carrier and you can infect a large number of people, then quarantining and other sort of I would say broadly prophylactic measures. Work Number two is to identify the susceptible population, like who is the most susceptible population to the exposure. Remember in the early days of the HIV epidemic in the United States, those numbers came about quite slowly, but eventually wor figure out there was a susceptible population men who had sex with men, and there was a susceptible population of hemophiliacs who are receiving blood transfusions. Of course, internationally, now that's no longer true. The vast number of people infectively HIV are no longer those two populations. It's now become a completely different disease. But when you identify susceptible populations where you have a high level of transmission of risk, then you can make social policy measures which are not as blunt as the ones that are are made without those so they can be much more targeted. You target the people at risk, and you try to figure out how to move about life in business and economy without imposing the kind of very draconian quarantining efforts that we've seen in places like China. So let's try to see if even under these conditions of uncertainty, you can't guide our listeners through some kind of rational behavior. I'm not saying rational behavior once we know the numbers, but rational behavior right now under conditions of uncertainty. So let's take a really simple example. You know, I planned a month ago to bring my kids on a spring break trip to New Orleans, so it's domestic travel their kids. Very few kids have gotten this. If they have gotten it, they haven't haven't had very bad symptoms. But of course New Orleans is a tourist destination. There are lots of people there. If you click on the Louisiana State Board of Health, they say there are no reported cases in Louisiana. Now you look at the CDC website, it doesn't tell you not to engage in any domestic travel. And yet, on the other hand, you know universities are in the process as we speak, of telling everybody that they're going to run their classes remotely, even in places with very few cases of the disease reported. How irrational is it or how rational is it to say, you know, we've planned this trip, we're going to go. We're not in any great risk factor. Airplane travel is not inherently more dangerous than getting on public transportation. There's a question of particular in dissociety. There's a question of personal liability versus I would say institutional liability. So, and they're different. When you're taking your children to travel with you to New Orleans, I agree with you that the risk is small children, as you very well know, don't seem to get the severe variant of the disease. In fact, i'd be more worried about you than your children. But you're taking that on as a personal liability. Institutions, as you know, especially in this climate, political climate, and social climate, don't want to take institutional liabilities. It's a difference between personal liability and institutional liability that we're talking about. I would say the likelihood that a Stanford student will get a severe variant of COVID nineteen is extremely low. The closure of the university and conversion of into remote classes is not the biggest deal, and so in that risk benefit analysis, the institution chose to diminish their institutional liability by saying, look, you know, we have the infrastructure already to do this, and so we'll go ahead. This is in great contrast too. For instance, the New York school system. As you very well know, the New York school system is not just a school system, but it's a social network, and it's a social network that provides meals, often to under privileged and kids from very poor back grounds. If they were to stay at home, they would mean that their parents would need to take time off work, and you know, the economic costs would be staggering. So it's closing down a school system where there is no simple infrastructure for remote schooling anyway. Plus the actual school provides a safe haven for millions of kids. The question of institutional liability is completely different. So in your particular case, I think that's a personal liability that you're taking with pretty minimal risk. And then that, by the way, that might not only be about any potential downside for a mere my kids. It might be about we don't want to become carriers. And the reality is that the more people circulating, the more difficult it becomes to restrain the spread of the virus. And so it might be as a publicly interested matter, you know, one arguably ought to stay home, right, And again the question really becomes a question of looking very dispassionately at risk versus benefit. So remember that if you look through as anyone might, you can it's all accessible. There are recommendations now for virtually every country where you could travel too, in terms of completely rest travel, restrict unnecessary travel, or be free to travel. It would be helpful to have that for the United States as well, in terms of potentially every city or state that you're traveling to, because the hotspot areas are known. So in other words, someone like you should be able to without multiple clicks, go to Louisiana, go to New Orleans, figure out what the case numbers are today, and figure out what the actual risk is, and make a personal decision whether to take on that risk, whatever it might be. Can I ask a policy question that follows from that? So one interesting thing to me is that no government website has said the following, we advise you not to engage in unnecessary travel, even to places where there are no reported cases. That has not been said on any government website. And yet my guess is that many physicians would say, well, this is common sense, don't engage in unnecessary travel, even to an unaffected place. I mean, my university sent around guidelines saying if it's university business, no unnecessary travel on university business anywhere within the domestic United States. So what I'm wondering is, as a physician, do you have the sense that there is some gap between what rational medical professionals would at this point recommend and what government agencies are recommending, maybe potentially for political reasons, you know. In other words, I I don't have the faith that I would like to have that the CDC hasn't advised me not to travel domestically because it's safe to do so, as opposed to the CDC hasn't recommended that I not traveled domestley because they're worried that the President will get angry at them because he'll say there's down the economy. Well, I think the CDC is being quite rational and careful here. I don't think. I'm not sure, but I don't think that the reason that the CDC has not issued a blanket statement against travel is that it's it's it's trying to appease the president. I just think the CDC is trying to be reasonable about shutting down, you know, things that make the normal business and the normal lives of Americans livable under these circumstances. Said, one of your superpowers is not only to be a top and scientist, but also to be able to explain to us the cultural meanings of our interaction with scientific reality. When you wear that hat, your interpreter of maladies had, how do you think about what we're going through at the moment. Well, I think that in some ways this reads like a modern version of Cameos. The plague. The first set of decisions that were made in Wuhan which we now know and understand a little bit better, were made out of fear and were actually extraordinarily erroneous decisions, which in turn points to the idea that given the globalization of the world, given the nature of travel, given the nature of the interactions between people, you know, this isn't this isn't a China only problem. It soon becomes a world problem. China's suffering grave economic consequences of this now, and it will continue to suffer grave economic consequences. But those grave economic consequences were themselves the consequences of a political regime which is fundamentally unable to be free with information. So the first thing it highlights, I think in the cultural realm is that information moves at light speed around the world today, and that's a good thing in the case of an epidemic. The suppression of information, a paternalistic attitude towards a grave disease is a terrible decision to make, And in some ways, there's a kind of reckoning that's going on within China, as many people have noted, there's a reckoning that's going on whether this can continue or not, I mean, can this statewide a suppression of facts we still don't know actually what's true and what's not true. The Chinese are now telling us that they're quarantining has been extraordinarily successful, etc. Strong Men presidents who believe in confining people are very likely to believe this kind of rhetoric. Oh, you know, just throw everyone into, you know, behind blue doors and it'll all be fine. So I think what it's revealed, I think is the is how vulnerable the world is to political regimes that have really become outdated, and how quickly information can move, how restricting that information can have grave consequences for the country itself. What if it turns out, though, that, notwithstanding China's restriction on information, and notwithstanding the fact that we of course can't trust what the government is saying about data, that the rather draconian response that they did worked really well. I mean, I can imagine, you know, this is just one of the possible states of the world, but I can imagine an outcome where it actually turns out that the draconian response was very effective, and that the less draconian responses that may be undertaken by more liberal countries like the United States turn out not to contain the disease as well, absolutely, and which is again why you know a kind of help from the the CDC would be is coming and is most appreciated. I should also say that the way to do this, it's really threading a needle, and threading a needle very carefully. This is going on right now in Italy, as you very well know. I mean, the Italians are famously suspicious of their political system. They enjoy an enormous number of liberties and freedoms, and you know their police cars parked along the major highways of in northern Italy making sure that people don't move. You can't imagine the conflict between those two cultures. Giving up the people who have enjoyed historical and continue to enjoy an enormous amount of personal freedoms, forcing them not to move, not to congregate in the square, or to go to their local bar for casual drink is obviously extraordinarily disruptive. So I think we'll have to thread a very fine needle in terms of identifying hotspots, identifying the vulnerable populations, and giving reasonable advice which takes the cost and benefit risk appropriately. And it has to be done on a case by case basis. It can't be done on a blanket basis. Yet, Now, if it turns out that the you know, there's more mutations coming more, you know, if it turns out that you can get reinfected by the virus, which we don't know yet. It's unlikely, but we don't know yet, then of course all bets are off. I wanted to ask you actually about that, about the genetic side of it, wearing your geneticis had. What do you think are Maybe it's impossible to say, but the probabilities of evolution happening rather quickly in the middle of the outbreak in such a way that we get not only the question of people getting reinfected, but also potentially just different strains of COVID nineteen, you know, COVID twenty or twenty one making their way into the population. Well, it depends on what the counter pressure are, as it were, because evolution happens through various mechanisms with these viruses, with these families of viruses, and usually the sort of the big evolutionary change, as it were, which is the assortment of the segments of RNA, have already happened. Most of these viruses come from other populations, other animals and so therefore usually have not developed strategies to evade the immune system and remain or become chronic in humans. In terms of new epidemics. It was an exception with HIV, but aside from that, most of these viruses usually once you get immunity to it, you get immunity to it and you don't get reinfected. We think that that's the case given what's happened. Otherwise you you know, WUHAN would still be flaring. So based on all the information that we have, if it's true information, we have a center of the epidemic where there was a wave of deaths unfortunately, but then it stopped brewing. It's not flaring still. So to some extent, the best information that we have so far is that the virus, of course it will mutate, but that immunity does develop to it, and that immunity is protective. That's very good news for future vaccines. A vaccine is not coming tomorrow, but that's very good news for a future vaccine because of course you need community. Is there anything that you think we're missing from the public discourse around COVID nineteen right now, Well, one thing that's missing is you know, look getting a vaccine will take a long time because vaccines are complicated to make. They're complicated a test. They have to be tested on populations to be produced at a very high standard. What's missing is why and why not for the people who are actually falling sick. Why or why not? We don't have either antibodies or in others biological or small molecules that are directed against the viral enzymes. We know them. The genome has been sequenced, we know what the what the vulnerabilities are, and I know that there's several facilities that are screening for small molecules as well as biologics that will help. These are not vaccines, right, so these are injected biologics that will enact, hopefully inactivate the virus. So an update from the CDC on that process, those kinds of ideas from the nation's highest authority in terms of the management of illness would be a helpful thing to have, because talking emptily about a vaccine which could really be months away, is not not going to help right now. If we could say to it to you that you know, if you get really, really sick, Here's where we are in terms of medicine development for this, and there's no better country in the world, I think, than the United States in developing medicines. Then I think there will be less uncertainty and a panic around what's happening next in terms of medical development against the virus. Last question for you, who said, where are you telling your kids? Well, so, I mean we've been following every day what the CDC has been recommending. I mean, thankfully, as I said, children are not the worst affected. We have not been doing anything except saying to them, try to in New York City, where now there are several cases, we've been telling them, try to avoid public places which are not you know, where there's where it's not necessary to go, wash your hands frequently, as frequently as possible. And if you know someone who's sick, or obviously if you have symptoms yourself, let us know at the earliest. I mean, nothing more, nothing less than that. I also led with my kids with the don't worry, you're going to be fine. Kids don't seem to be getting this, and that an amazingly calming effect on them. So I appreciate that part of the advice as well as the rest of it. Thank you so much for a really calm and rational account of an ongoing breaking story that continues to have scary parts, but that, as you say, canna, ultimately be managed by getting to the absolute truths that are out there and then using logic and reason and risk benefit analysis to try to get us to a manageable outcome and perhaps even to some potential treatments for the worst affected. Thank you very much for your time, my pleasure. Thank you so much. We'll be back with this week's playback in just a moment now for our playback. I want to tell you Gorezuch. I want to tell you Kavanaugh, you have released earl Wind and you will pay the price. That's Democratic Senator Charles Schumer last week, speaking in a slightly unhinged tone, if you ask me, in front of the Supreme Court at an abortion rights rally while an oral argument was going on about an important abortion rights case. Since then, Schumer received intense criticism from President Trump, but maybe more significantly from Chief Justice John Roberts and a number of Republican senators, and he apologized, kind of saying I shouldn't have used the words I did. Here's why this whole moment in the news is actually a pretty big deal. Ever since Donald Trump became president, and in fact even before that when he was running for office, Donald Trump has made the federal judiciary one of his central targets. He has a specific goal in mind to undercut and undermine public trust in the judiciary, and he has a very Trumpian way of doing it. He singles out individual judges, often by name. He says that they're illegitimate, He points to who appointed them and says that that will determine what they're going to do when they're in office, and ultimately he hints that he would like to be able to push them around. What Schumer was doing was borrowing a page from the Trumpian rhetoric a threat. Each time someone outside of the Trump administration does that, it tends to suggest the Trump's approach is perfectly fine. It tends not only to further undercut the judiciary, it also tends to suggest that we should all move to a world where it's completely normal and fine to threaten and attack judges. And there's one more problem with what Schumer's doing. It's pretty much guaranteed to backfire. In the case that was going on in the Supreme Court when Schumer was outside making his threats. The primary issue before the justices was whether the Court would follow its precedent that would actually lead to the striking down of a Louisiana anti abortion law, or whether the justices would deviate from a relatively recently created precedent and go a different way. In that debate, Chief Justice John Roberts is the absolutely all important swing vote. He in fact did not vote for the decision on which the precedent would be based in this case, so we know that he didn't agree with that case. But what he was thinking about, and this was very clear in the oral argument, was precisely whether to follow that precedent even if he didn't like it, even though that would send the public message that the Court was not following precedent. There's probably no more pressing issue in front of the Supreme Court right at this juncture than how much precedent should matter. Roberts is the swing vote. By attacking other justices, Schumer guaranteed that Roberts would have to come out against him, and in the process of doing so, Roberts would find that he did not want to signal to the world that he was listening to Schumer. Schumer very possibly caused Liberals Roberts's own vote in this case. In other words, Schumer was really playing with fire. His words at the margin might be a decisive factor in pushing John Roberts to the conservative side in a case where his comments and oral arguments suggest he was at least toying with the possibility of sticking with the Liberals on a precedent theory. We don't know how this case will come out, and we don't know how the other important cases involving president will come out. We do know that in this moment, John Roberts must be thinking about nothing but the question of precedent all day, every day. In that environment, it is remarkably unwise for the Senate minority leader to contribute to an environment where Democrats are threatening the courts in just the way that Donald Trump is the correct narrative for Democrats and indeed for anyone who wants to protect the independence of the judiciary and precedent, and the value of the rule of law is that the courts should be allowed to do their job and should be treated respectfully in the process. Chumer wasn't just wrong on the merits, he was dangerously wrong in the real world. Deep Background is brought to you by Pushkin Industries. Our producer is Lydia gene Kott, with studio recording by Joseph Fridman and mastering by Jason Gambrell and Jason Rostkowski. Our showrunner is Sophie mckibbon. Our theme music is composed by Luis Gera special thanks to the Pushkin Brass, Malcolm Godwell, Jacob Weissberg, and Mia Lobel. I'm Noah Feldman. I also write a column for Bloomberg Opinion, which you can find at Bloomberg dot com Backslash Feldman. To discover Bloomberg's original slate of podcasts, go to Bloomberg dot com Backslash Podcasts. You can follow me on Twitter at Noah R. Feldman. This is Deep Background.

Pushkin from Pushkin Industries. This is Deep Background, the show where we explored the stories behind the stories in the news. I'm Noah Feldman, and right now the only story that anyone is talking about is coronavirus. In order to make sense of coronavirus, we decided to speak to Sidhart Mukherjee, who is probably the foremost interpreter in my generation of the meaning of disease and how it affects our daily lives. You probably know his book The Emperor of All Maladies of Biography of Cancer, which one the twenty eleven Pulitzer Prize for General Nonfiction. You may also know his twenty seventeen book The Gene and Intimate History. Sidhart is a voice of reason, logic, and thoughtfulness, and he's the person I wanted to hear from at exactly this moment of panic. So Sid, maybe we can start by a my just asking you, how have you been thinking medically, statistically, personally, or otherwise about the coronavirus epidemic as it gradually rolls itself out. Well, so there are several questions in that, because there's that I've been thinking different medically, personally and statistically. But let me just tell you a very broad through landscape view. Right now, we're in a moment of some degree of confusion. There are, like any epidemic, or like any virus, coronavirus has some absolutes. In other words, there's some absolute things about the virus that are determined by its biology and by the interaction of that biology with the host. There's a real number which predicts how many people you infect if you you know what the so called are not value is and what the case fatality rate is, etc. And we need to know those very much in order to understand how to develop an effective strategy against it, whether it be quarantine or you know, medicines or whatever it might be. The problem is that those numbers are included by random chance events and by underreporting of the actual virus. So what do I mean that by that? If you look at the map of the spread, there are, as you know, eighty thousand odd cases in China, there are one thousand od cases in Japan. There are x thousand odd cases you know, in neighboring countries. But then there are some obviously some peculiar anomalies. There's this big case load in the Italy of all places in northern Italy and Lombardy and other places. Why did all of a sudden it skip all of Europe and become this major infection in northern Italy. It's not as if you know Han and you know Venus our major criss crossing destinations for each other. I mean, there is tourism of course between Italy and China. But something bizarre happened there, something that we can we cannot simply explain. So we are in a situation where we have to get we have to provide two kinds of explanations. One kind of explanation is as what I call are the viral absolutes, the epidemiological absolutes, and the statistical absolutes. What is the actual number of cases that is being detected or found? And then there are these things that, you know, how do we explain it that places that shouldn't seem to have any connection are suddenly epicenters of the worst parts of the epidemic. And that's what's that's what's very confusing about it at the moment. So from what you've said, the problem is that although there are absolutes, we definitely don't know them now and we may not know them until very very late in this process. They are there somewhere, but we can't get at them. The best way to get at them is is to let time is a little bit more time pass, And I'm not talking about a lot of time. I'm talking about, you know, a process of weeks, maybe a couple of weeks, three weeks, etc. And then also to in the meantime to separate the wheat from the shaft, so to separate out the things that are including these absolutes such as random movements and underreporting, and find out what the real numbers are, so that we get some sense in a given population what these epidemological absolutes are. What is the actual case fatality rate? So if you look, for instance, in the United States, there have been five hundred odd cases and twenty two deaths, that would put the case fatality rate at four percent, give or take. If you look at another place in parts of Europe, there've been a thousand cases and three deaths, which would put it a full magnitude less than the United States. But there is there is an actual number. There's a number to be had, or even a range of numbers to be had, of what the actual case fatality rate is and the decision of the severity of the epidemic will depend on that actual case fatality rate. There is an actual number, an absolute truth as to the number of people you are likely to infect under normal circumstances in it through going through a normal day. So it will take a few days, perhaps weeks, before some of these clouds clear and we begin to get actual, real estimates of what those numbers are. We're getting there. We have a sense of what it is, I think with COVID nineteen, but it's not all there yet and we're slowly getting there. So first point then for listeners, I think, is that this number, which we're all going to have to become very familiar with, the R zero or are not as you called it, which is the number that tells us for a person who's infected and is exposed to others, how many people will become infected, is going to become clearer in the relatively near future. And of course it might depend on the genetics of a population. That's a very important point, which is to figure out whether there's some populations that are particularly susceptible, whereas some populations are particularly non susceptible. We just don't know that yet. But again, these numbers will become clear. Once they do become clearer, what will the next step really be, Because then we leave the realm of absolutes and we enter the realm of social policy response. First of all, if it turns out that the number of people that you can infect while you're an asymptomatic carrier of the virus is large, then it makes most sense to impose quarantining and rather draconian quarantining in areas that are very severely affected, as China has done. As China has done. That's correct. So if both those things are true, if you're an asymptomatic carrier and you can infect a large number of people, then quarantining and other sort of I would say broadly prophylactic measures. Work Number two is to identify the susceptible population, like who is the most susceptible population to the exposure. Remember in the early days of the HIV epidemic in the United States, those numbers came about quite slowly, but eventually wor figure out there was a susceptible population men who had sex with men, and there was a susceptible population of hemophiliacs who are receiving blood transfusions. Of course, internationally, now that's no longer true. The vast number of people infectively HIV are no longer those two populations. It's now become a completely different disease. But when you identify susceptible populations where you have a high level of transmission of risk, then you can make social policy measures which are not as blunt as the ones that are are made without those so they can be much more targeted. You target the people at risk, and you try to figure out how to move about life in business and economy without imposing the kind of very draconian quarantining efforts that we've seen in places like China. So let's try to see if even under these conditions of uncertainty, you can't guide our listeners through some kind of rational behavior. I'm not saying rational behavior once we know the numbers, but rational behavior right now under conditions of uncertainty. So let's take a really simple example. You know, I planned a month ago to bring my kids on a spring break trip to New Orleans, so it's domestic travel their kids. Very few kids have gotten this. If they have gotten it, they haven't haven't had very bad symptoms. But of course New Orleans is a tourist destination. There are lots of people there. If you click on the Louisiana State Board of Health, they say there are no reported cases in Louisiana. Now you look at the CDC website, it doesn't tell you not to engage in any domestic travel. And yet, on the other hand, you know universities are in the process as we speak, of telling everybody that they're going to run their classes remotely, even in places with very few cases of the disease reported. How irrational is it or how rational is it to say, you know, we've planned this trip, we're going to go. We're not in any great risk factor. Airplane travel is not inherently more dangerous than getting on public transportation. There's a question of particular in dissociety. There's a question of personal liability versus I would say institutional liability. So, and they're different. When you're taking your children to travel with you to New Orleans, I agree with you that the risk is small children, as you very well know, don't seem to get the severe variant of the disease. In fact, i'd be more worried about you than your children. But you're taking that on as a personal liability. Institutions, as you know, especially in this climate, political climate, and social climate, don't want to take institutional liabilities. It's a difference between personal liability and institutional liability that we're talking about. I would say the likelihood that a Stanford student will get a severe variant of COVID nineteen is extremely low. The closure of the university and conversion of into remote classes is not the biggest deal, and so in that risk benefit analysis, the institution chose to diminish their institutional liability by saying, look, you know, we have the infrastructure already to do this, and so we'll go ahead. This is in great contrast too. For instance, the New York school system. As you very well know, the New York school system is not just a school system, but it's a social network, and it's a social network that provides meals, often to under privileged and kids from very poor back grounds. If they were to stay at home, they would mean that their parents would need to take time off work, and you know, the economic costs would be staggering. So it's closing down a school system where there is no simple infrastructure for remote schooling anyway. Plus the actual school provides a safe haven for millions of kids. The question of institutional liability is completely different. So in your particular case, I think that's a personal liability that you're taking with pretty minimal risk. And then that, by the way, that might not only be about any potential downside for a mere my kids. It might be about we don't want to become carriers. And the reality is that the more people circulating, the more difficult it becomes to restrain the spread of the virus. And so it might be as a publicly interested matter, you know, one arguably ought to stay home, right, And again the question really becomes a question of looking very dispassionately at risk versus benefit. So remember that if you look through as anyone might, you can it's all accessible. There are recommendations now for virtually every country where you could travel too, in terms of completely rest travel, restrict unnecessary travel, or be free to travel. It would be helpful to have that for the United States as well, in terms of potentially every city or state that you're traveling to, because the hotspot areas are known. So in other words, someone like you should be able to without multiple clicks, go to Louisiana, go to New Orleans, figure out what the case numbers are today, and figure out what the actual risk is, and make a personal decision whether to take on that risk, whatever it might be. Can I ask a policy question that follows from that? So one interesting thing to me is that no government website has said the following, we advise you not to engage in unnecessary travel, even to places where there are no reported cases. That has not been said on any government website. And yet my guess is that many physicians would say, well, this is common sense, don't engage in unnecessary travel, even to an unaffected place. I mean, my university sent around guidelines saying if it's university business, no unnecessary travel on university business anywhere within the domestic United States. So what I'm wondering is, as a physician, do you have the sense that there is some gap between what rational medical professionals would at this point recommend and what government agencies are recommending, maybe potentially for political reasons, you know. In other words, I I don't have the faith that I would like to have that the CDC hasn't advised me not to travel domestically because it's safe to do so, as opposed to the CDC hasn't recommended that I not traveled domestley because they're worried that the President will get angry at them because he'll say there's down the economy. Well, I think the CDC is being quite rational and careful here. I don't think. I'm not sure, but I don't think that the reason that the CDC has not issued a blanket statement against travel is that it's it's it's trying to appease the president. I just think the CDC is trying to be reasonable about shutting down, you know, things that make the normal business and the normal lives of Americans livable under these circumstances. Said, one of your superpowers is not only to be a top and scientist, but also to be able to explain to us the cultural meanings of our interaction with scientific reality. When you wear that hat, your interpreter of maladies had, how do you think about what we're going through at the moment. Well, I think that in some ways this reads like a modern version of Cameos. The plague. The first set of decisions that were made in Wuhan which we now know and understand a little bit better, were made out of fear and were actually extraordinarily erroneous decisions, which in turn points to the idea that given the globalization of the world, given the nature of travel, given the nature of the interactions between people, you know, this isn't this isn't a China only problem. It soon becomes a world problem. China's suffering grave economic consequences of this now, and it will continue to suffer grave economic consequences. But those grave economic consequences were themselves the consequences of a political regime which is fundamentally unable to be free with information. So the first thing it highlights, I think in the cultural realm is that information moves at light speed around the world today, and that's a good thing in the case of an epidemic. The suppression of information, a paternalistic attitude towards a grave disease is a terrible decision to make, And in some ways, there's a kind of reckoning that's going on within China, as many people have noted, there's a reckoning that's going on whether this can continue or not, I mean, can this statewide a suppression of facts we still don't know actually what's true and what's not true. The Chinese are now telling us that they're quarantining has been extraordinarily successful, etc. Strong Men presidents who believe in confining people are very likely to believe this kind of rhetoric. Oh, you know, just throw everyone into, you know, behind blue doors and it'll all be fine. So I think what it's revealed, I think is the is how vulnerable the world is to political regimes that have really become outdated, and how quickly information can move, how restricting that information can have grave consequences for the country itself. What if it turns out, though, that, notwithstanding China's restriction on information, and notwithstanding the fact that we of course can't trust what the government is saying about data, that the rather draconian response that they did worked really well. I mean, I can imagine, you know, this is just one of the possible states of the world, but I can imagine an outcome where it actually turns out that the draconian response was very effective, and that the less draconian responses that may be undertaken by more liberal countries like the United States turn out not to contain the disease as well, absolutely, and which is again why you know a kind of help from the the CDC would be is coming and is most appreciated. I should also say that the way to do this, it's really threading a needle, and threading a needle very carefully. This is going on right now in Italy, as you very well know. I mean, the Italians are famously suspicious of their political system. They enjoy an enormous number of liberties and freedoms, and you know their police cars parked along the major highways of in northern Italy making sure that people don't move. You can't imagine the conflict between those two cultures. Giving up the people who have enjoyed historical and continue to enjoy an enormous amount of personal freedoms, forcing them not to move, not to congregate in the square, or to go to their local bar for casual drink is obviously extraordinarily disruptive. So I think we'll have to thread a very fine needle in terms of identifying hotspots, identifying the vulnerable populations, and giving reasonable advice which takes the cost and benefit risk appropriately. And it has to be done on a case by case basis. It can't be done on a blanket basis. Yet, Now, if it turns out that the you know, there's more mutations coming more, you know, if it turns out that you can get reinfected by the virus, which we don't know yet. It's unlikely, but we don't know yet, then of course all bets are off. I wanted to ask you actually about that, about the genetic side of it, wearing your geneticis had. What do you think are Maybe it's impossible to say, but the probabilities of evolution happening rather quickly in the middle of the outbreak in such a way that we get not only the question of people getting reinfected, but also potentially just different strains of COVID nineteen, you know, COVID twenty or twenty one making their way into the population. Well, it depends on what the counter pressure are, as it were, because evolution happens through various mechanisms with these viruses, with these families of viruses, and usually the sort of the big evolutionary change, as it were, which is the assortment of the segments of RNA, have already happened. Most of these viruses come from other populations, other animals and so therefore usually have not developed strategies to evade the immune system and remain or become chronic in humans. In terms of new epidemics. It was an exception with HIV, but aside from that, most of these viruses usually once you get immunity to it, you get immunity to it and you don't get reinfected. We think that that's the case given what's happened. Otherwise you you know, WUHAN would still be flaring. So based on all the information that we have, if it's true information, we have a center of the epidemic where there was a wave of deaths unfortunately, but then it stopped brewing. It's not flaring still. So to some extent, the best information that we have so far is that the virus, of course it will mutate, but that immunity does develop to it, and that immunity is protective. That's very good news for future vaccines. A vaccine is not coming tomorrow, but that's very good news for a future vaccine because of course you need community. Is there anything that you think we're missing from the public discourse around COVID nineteen right now, Well, one thing that's missing is you know, look getting a vaccine will take a long time because vaccines are complicated to make. They're complicated a test. They have to be tested on populations to be produced at a very high standard. What's missing is why and why not for the people who are actually falling sick. Why or why not? We don't have either antibodies or in others biological or small molecules that are directed against the viral enzymes. We know them. The genome has been sequenced, we know what the what the vulnerabilities are, and I know that there's several facilities that are screening for small molecules as well as biologics that will help. These are not vaccines, right, so these are injected biologics that will enact, hopefully inactivate the virus. So an update from the CDC on that process, those kinds of ideas from the nation's highest authority in terms of the management of illness would be a helpful thing to have, because talking emptily about a vaccine which could really be months away, is not not going to help right now. If we could say to it to you that you know, if you get really, really sick, Here's where we are in terms of medicine development for this, and there's no better country in the world, I think, than the United States in developing medicines. Then I think there will be less uncertainty and a panic around what's happening next in terms of medical development against the virus. Last question for you, who said, where are you telling your kids? Well, so, I mean we've been following every day what the CDC has been recommending. I mean, thankfully, as I said, children are not the worst affected. We have not been doing anything except saying to them, try to in New York City, where now there are several cases, we've been telling them, try to avoid public places which are not you know, where there's where it's not necessary to go, wash your hands frequently, as frequently as possible. And if you know someone who's sick, or obviously if you have symptoms yourself, let us know at the earliest. I mean, nothing more, nothing less than that. I also led with my kids with the don't worry, you're going to be fine. Kids don't seem to be getting this, and that an amazingly calming effect on them. So I appreciate that part of the advice as well as the rest of it. Thank you so much for a really calm and rational account of an ongoing breaking story that continues to have scary parts, but that, as you say, canna, ultimately be managed by getting to the absolute truths that are out there and then using logic and reason and risk benefit analysis to try to get us to a manageable outcome and perhaps even to some potential treatments for the worst affected. Thank you very much for your time, my pleasure. Thank you so much. We'll be back with this week's playback in just a moment now for our playback. I want to tell you Gorezuch. I want to tell you Kavanaugh, you have released earl Wind and you will pay the price. That's Democratic Senator Charles Schumer last week, speaking in a slightly unhinged tone, if you ask me, in front of the Supreme Court at an abortion rights rally while an oral argument was going on about an important abortion rights case. Since then, Schumer received intense criticism from President Trump, but maybe more significantly from Chief Justice John Roberts and a number of Republican senators, and he apologized, kind of saying I shouldn't have used the words I did. Here's why this whole moment in the news is actually a pretty big deal. Ever since Donald Trump became president, and in fact even before that when he was running for office, Donald Trump has made the federal judiciary one of his central targets. He has a specific goal in mind to undercut and undermine public trust in the judiciary, and he has a very Trumpian way of doing it. He singles out individual judges, often by name. He says that they're illegitimate, He points to who appointed them and says that that will determine what they're going to do when they're in office, and ultimately he hints that he would like to be able to push them around. What Schumer was doing was borrowing a page from the Trumpian rhetoric a threat. Each time someone outside of the Trump administration does that, it tends to suggest the Trump's approach is perfectly fine. It tends not only to further undercut the judiciary, it also tends to suggest that we should all move to a world where it's completely normal and fine to threaten and attack judges. And there's one more problem with what Schumer's doing. It's pretty much guaranteed to backfire. In the case that was going on in the Supreme Court when Schumer was outside making his threats. The primary issue before the justices was whether the Court would follow its precedent that would actually lead to the striking down of a Louisiana anti abortion law, or whether the justices would deviate from a relatively recently created precedent and go a different way. In that debate, Chief Justice John Roberts is the absolutely all important swing vote. He in fact did not vote for the decision on which the precedent would be based in this case, so we know that he didn't agree with that case. But what he was thinking about, and this was very clear in the oral argument, was precisely whether to follow that precedent even if he didn't like it, even though that would send the public message that the Court was not following precedent. There's probably no more pressing issue in front of the Supreme Court right at this juncture than how much precedent should matter. Roberts is the swing vote. By attacking other justices, Schumer guaranteed that Roberts would have to come out against him, and in the process of doing so, Roberts would find that he did not want to signal to the world that he was listening to Schumer. Schumer very possibly caused Liberals Roberts's own vote in this case. In other words, Schumer was really playing with fire. His words at the margin might be a decisive factor in pushing John Roberts to the conservative side in a case where his comments and oral arguments suggest he was at least toying with the possibility of sticking with the Liberals on a precedent theory. We don't know how this case will come out, and we don't know how the other important cases involving president will come out. We do know that in this moment, John Roberts must be thinking about nothing but the question of precedent all day, every day. In that environment, it is remarkably unwise for the Senate minority leader to contribute to an environment where Democrats are threatening the courts in just the way that Donald Trump is the correct narrative for Democrats and indeed for anyone who wants to protect the independence of the judiciary and precedent, and the value of the rule of law is that the courts should be allowed to do their job and should be treated respectfully in the process. Chumer wasn't just wrong on the merits, he was dangerously wrong in the real world. Deep Background is brought to you by Pushkin Industries. Our producer is Lydia gene Kott, with studio recording by Joseph Fridman and mastering by Jason Gambrell and Jason Rostkowski. Our showrunner is Sophie mckibbon. Our theme music is composed by Luis Gera special thanks to the Pushkin Brass, Malcolm Godwell, Jacob Weissberg, and Mia Lobel. I'm Noah Feldman. I also write a column for Bloomberg Opinion, which you can find at Bloomberg dot com Backslash Feldman. To discover Bloomberg's original slate of podcasts, go to Bloomberg dot com Backslash Podcasts. You can follow me on Twitter at Noah R. Feldman. This is Deep Background.