The Pandemic Lessons We Clearly Haven’t Learned

I remember thinking, as Covid ravaged the country in December 2020, that at least the holidays the next year would be better. There would be more vaccines, more treatments, more immunity. Instead, we got Omicron and a confusing new phase of the pandemic. What do you do with a variant that is both monstrously more infectious and somewhat milder? What do you say about another year when we didn’t have enough tests, enough ventilation or the best guidance on masks? And how do you handle the fracturing politics of a changing pandemic in an exhausted country? Zeynep Tufekci is a sociologist and New York Times Opinion columnist who does a better job than almost anyone at assessing the pandemic at a systems level. To solve a public-health crisis, it’s not enough to get the science right. There are also challenges with supply chains, infrastructure, research production, mass communication, political trust and institutional inertia. I’ve found Tufekci’s ability to balance the epidemiological data and the sociological realities uniquely helpful across the pandemic, and you can hear why in this conversation. We discuss how the Covid crisis has changed, as well as Tufekci’s sobering conclusion: that the virus, at this point, is feeding on our dysfunction. We look at what Omicron is and isn’t, where the Biden administration has succeeded and failed, the debate over closing schools, why so many Asian countries have so powerfully outperformed the West, how the role of vaccines has changed, what a pandemic-prepared society would actually look like, and what should be true of our pandemic policy in a year that isn’t now. Book recommendations: The Theory and Practice of Group Psychotherapy by Irvin D. Yalom and Molyn Leszcz Chaos by James Gleick The Dead Hand by David Hoffman Thoughts? Guest suggestions? Email us at [email protected]. You can find transcripts (posted midday) and more episodes of “The Ezra Klein Show” at nytimes.com/ezra-klein-podcast, and you can find Ezra on Twitter @ezraklein. Book recommendations from all our guests are listed at https://www.nytimes.com/article/ezra-klein-show-book-recs. “The Ezra Klein Show” is produced by Annie Galvin, Jeff Geld and Rogé Karma; fact-checking by Michelle Harris, Mary Marge Locker and Kate Sinclair; original music by Isaac Jones; mixing by Jeff Geld; audience strategy by Shannon Busta. Our executive producer is Irene Noguchi. Special thanks to Kristin Lin.

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:05Ezra Klein?

  I'm Ezra Klein, and this is the Ezra Klein Show.

• 0:20Ezra Klein?

  What makes the coronavirus crisis so maddening is that it changes constantly. It changes with each new variant. It changes as vaccines wane and boosters come on. It changes from year to year and month to month. It changes in the place you are in. It changes in the stage of life you are in. And it just changed again, profoundly so with Omicron. And I'm watching these changes in both my personal and professional life fracture our already pretty fractured dialogue further. Some see the new guidance and facts and behavior, for that matter, of the virus today as evidence of deception yesterday.

• 1:03Ezra Klein?

  Why don't the vaccines work the way I was told they did? And everyone, everywhere, is exhausted. I'm exhausted. We all are. But Omicron doesn't share our exhaustion. It's spry, ready to go, field fresh. And so we need a few things now. A clear understanding of what we're facing and how it's changed. A set of not just policies, but actually supplies that will help us cease being surprised and overwhelmed by new variants. We didn't get that in time this time, and that is partly on the Biden administration. And we're going to need a sense of grace with each other, which is, I think, harder and harder at this point to come by.

• 1:41Ezra Klein?

  One of the less talked about things a virus feeds on is our enmity, our anger. One of my first episodes of the show here at The Times featured Zeynep Tufekci. Zeynep is a sociologist and a writer who's been relentlessly living in the COVID future and has done a better job, in my view, balancing the epidemiology and the sociology of the crisis than anyone else. And by the way, you do need to balance those things. Since then, to my delight, she joined Times Opinion as a columnist. And so I asked her back for a conversation about what Omicron is and isn't, where our pandemic policy has succeeded and failed, and how to build the structures we need to live lives closer to the ones we want. As well as my email for guest suggestions,

• 2:25Ezra Klein?

  feedback, whatever, recommendations is ezra klein show at nytimes.com.

• 2:35Ezra Klein?

  Zeynep Tufekci, welcome to the show.

• 2:38Speaker 01

  Thank you for inviting me again.

• 2:39Ezra Klein?

  So we're well into the Omicron wave now. At this point, what do we know to be true? Or think with good evidence to be true? As to the difference between Delta and Omicron?

• 2:52Speaker 01

  Think of it like you're evaluating offense by the virus and you're also evaluating defense as a separate thing. At last tracking, I think there was seven, but I think an eighth one just got added. Lab studies with very consistent results, which is amazing because if they're all independent and coherent, you got a finding that this variant is very able to evade the antibodies from previous infection or vaccine, which we're going to get to in a second, but is less able to infect our lower lungs, which is associated with severity. So if everything else equal, right? Forget the immunity thing. You had identical twins with no immunity or triplets.

• 3:37Speaker 01

  This one would be less likely to get to your lower lungs, which makes you sicker. Now, that doesn't mean it doesn't make you sick. It just means it is less able to make you more sick compared to the other ones. So that's what I'm sure we know. And we have so much data now from other kind of, not just lab studies that this looks good. So you have, for example, even when people get hospitalized, you're getting fewer in the ICU. When people end up in the ICU, you're getting fewer ventilated. Does that mean it's nothing? No, of course not. Like, it just means it's less worse than the alternatives. Now, the second part of the question is, well, what about our immunity, right? What about our defenses? Now there, the picture, I think, is also very

• 4:22Speaker 01

  consistent in that the immune system is an amazing, complicated, wonderful thing. And it works in stages. What I've been comparing to bouncers at the sort of a club, and there is this wonderful metaphor of a castle. You have like this castle wall outside and it is defended by these antibodies. Now, the antibodies are right there, ready to go, stop any kind of person they don't like. And they have a list of people that they've been shown not to let in. But they're not very bright. They kind of get fooled very easily. So Superman comes, they're like, oh, you're Superman. We know you, you're on the no-go list, right? They kick you out.

• 5:05Speaker 01

  And then Clark Kent comes with the glasses and they're like, oh, you're a totally different person. And they let him in. They're kind of not very sharp at getting through the disguises. So those mutations in the spike kind of disguise it to the bouncer. So it gets in through the bouncer. That's what it means to have a breakthrough or a reinfection. But that is not everything that is in the immune system. And this is where the metaphor kind of breaks down because like no castle or club is going to have this. You have these things, memory B cells, T cells, which have an imprint, let's say, of these suspects. But unlike the antibodies, they can recognize the whole thing better. You just put on glasses, they're like, I know you.

• 5:49Speaker 01

  They're not fooled as easily. And they come in only after the wall has been breached. So when they come in and they go, I know you, you fool the antibodies, you cause a breakthrough, and then they get to work. And in most people, this is the process that we depend on to keep them out of the hospital, to keep the disease from getting worse. This is how vaccines work. This is like how immunity works in general. It does really do a great job, especially if you have, you know, a booster. It's just really good at that. But once again, it's not 100% good in the sense that some people will still,

• 6:31Speaker 01

  regardless of having this sort of protection, will get sicker. This is true for elderly, like even, you know, the regular common cold viruses like OC43, it can cause, you know, fatal outbreaks in nursing homes. So elderly people are always at risk from these kinds of things because the immune system ages and gets less robust. There's lots of immunocompromised people. They're also, their just immune system isn't working as well. This is the thing. And also sometimes you get unlucky. This is sort of this. Fact of life, um, nothing works perfectly, including the immune system. Okay, let me add one more thing is that it's incredibly contagious. Like the numbers we're seeing are amazing.

• 7:14Speaker 01

  And it's a combination that we're not hundred percent certain why this is the case. It's very good at replicating at the upper airways. But since it's able to get through the castle wall and just get in, you're seeing the spread very widely, especially in people who are not vaccinated or seeing a lot more issues. So in combination, you get a complex picture. So it's different. It's not like Delta. Delta was very contagious and it was more severe. Everything else equal, if you had two people and they were identical, otherwise you get or bunches of them. And you gave some of them Omicron and some of them Delta. The Delta people will get much, much sicker.

• 7:56Speaker 01

  And here's the thing, it is purely luck that this one is less severe. Because contrary to a popular belief, viruses don't evolve to be milder. We gain immunity to them for sure as we get exposed. But they just want to transmit. They don't care if you eventually die as long as they transmit through you. So the fact that we got a very contagious variant that happens to be milder. And I'm not saying it's great. I'm just saying it could have been much worse is pure luck, evolution luck. So that's what I think we know right now after six weeks, eight weeks, which is pretty amazing.

• 8:41Ezra Klein?

  Let me ask you about both the pessimistic way of looking at this and the optimistic version I've heard. But I'll start with the pessimistic one because you just brought it up, which is.

• 8:53Ezra Klein?

  We got lucky. And to say we got lucky is also to say we could get unlucky. We could have something as infectious as Omicron and more devastating in terms of its severity than Delta. But that brings up something you were you were saying at the beginning there, which is we now have a lot more past infection across, you know, the American and also the global population. We have a lot more vaccination across both populations. So is it really the case that we could just see something worse than anything we've seen, given all of that now pooled recognition of coronaviruses across the the global immune system? Or is it pretty plausible that in eight months, we're going to start hearing about a variant?

• 9:36Ezra Klein?

  It's like, great immune escape, great vaccination escape, and everybody is dead now.

• 9:40Speaker 01

  So let me just sort of step back and say, let's step out of the optimistic pessimistic thing. The way I like to think about it is like, what do we need to do to get ready? The vaccines have been incredible. Like, I don't think people realize who haven't been in this that most vaccine production doesn't like, most trials don't work. If you sort of go back and look at the 2020 state, and most a lot of people were like, this could take years. Just 50% efficacy was seen as this high bar. So they work really well. So we have this incredible tool. There's the other ones, so Odino virus vaccine, there's protein subunit vaccines.

• 10:22Speaker 01

  So there's a lot of like, things we could tweak in them that would give us more immunity. And the immune system, it's like an optimization problem. You have another feels like machine learning, you're trying to recognize something. And the more different angles you see, the better it gets. We should do two things. One, we should try to stop the virus from being able to explore the whole fitness landscape because, yeah, maybe not that likely, but if there's that like, one little corner that works, I don't want it to discover it, which means you vaccinate globally. That is the obvious step. And the second thing is, You want to up your own defenses. So it doesn't matter.

• 11:04Speaker 01

  Like even if it finds something, you want it to matter less. And you want to make it harder for the virus to find it by giving it less chances to evolve. So rather than the optimist versus pessimist, I'm kind of like, how am I going to prepare myself so that the better scenario is more likely? And also, if the scenario turns out to be worse, we are better prepared. And in both of those things, the answer is the same, which is lower transmission. And then it comes down to something like, will we need annual boosters? And I'm sorry, I have to say, like, if that's what it comes down to, that's the political problem now.

• 11:48Speaker 01

  If the only thing is like, will we need annual boosters? I know it's going to be a political thing and people will say blah, blah, blah, all of those things. But you know, for in the context of human history, like bring the smallest violin you can find. If that's the challenge, right? That is, so that I, I think that's the only remaining question is, will we need annual boosters if we do everything else from here till about next fall?

• 12:14Ezra Klein?

  I want to hold on the story you just told about vaccines. And I want to be the smallest violin for a minute because I'm having a lot of small violin conversations in my own life right now, which is the experience emotionally that I think a lot of people are undergoing on the vaccine over the past year is, got the vaccine, I was told it would prevent hospitalization, death and infection. And then it stopped doing that and I needed a booster. And then Omicron came and now it's infecting everybody, even people with the boosters. And you told me these were going to work. And now are you just telling me it's endless vaccines? It may or may not do what I thought they would do forever. Obviously, that is also a political problem.

• 12:58Ezra Klein?

  I mean, I'll read you a quote here from Ben Dominick, who's a conservative writer at the Transom, who, you know, wrote in his newsletter, right before our eyes, the media and the CDC are quietly admitting COVID truths after two years of lies. They are admitting that vaccination doesn't stop the spread. They are admitting that two COVID vaccine doses aren't enough, even if it did. So there is this political problem and it comes out of this emotional experience I think people are having, which is they were told the vaccines were a miracle and then what the vaccine could do for them began to change. So. How do you tell people to update their sense of that? Why should they not feel disappointed in the vaccines?

• 13:34Speaker 01

  Two things. On the one hand, I suspect I don't agree a lot with that person, but I actually am very, very sympathetic. Because I do think that the communication around this has been relatively poor. And it's not necessarily anybody's fault as much, right? There's some things I would like tweak and do better in retrospect, but like everybody's statements, my own, CDC's, everything. But part of the issue is we went into this with a very high baseline, where most of us in wealthy countries were heavily vaccinated, hopefully.

• 14:17Speaker 01

  And the very few who are not are very few. And they're protected by the rest of us who are heavily vaccinated, right? The few non-misless vaccinated people are protected by the fact that, oh yeah, you know, we are all vaccinated, so they don't really encounter it. So you had these very high health expectations that people had, which is great. But that's because we have existing vaccines, right? And existing sort of healthcare. And then we came into this essentially a shock. I used to teach 1918 flu in my college classes, in my introduction to sociology class, to try to explain what globalization means. And I would say, all right, you know, how many people know about the 1918 flu pandemic?

• 15:01Speaker 01

  And everybody would just look at me like, what are you talking about? And there'd be usually one person who said, yeah, my grandparent lost two siblings or something. There'd be some personal thing that had trickled down, maybe? So we got the pandemic, it was kind of a shock. And then we got vaccines fairly quickly, which again, wasn't appreciated because people don't understand, like that was not the expectation. It was just home run after home run. It's amazing, mind blowing. It is miraculous. And then we got the initial communication, which was true, that the vaccines were also holding down infections, which was absolutely true. It wasn't false.

• 15:42Speaker 01

  And then we had a couple of things happen. One of them is the antibodies, the bouncers, they do wane with other vaccines too, because it kind of happens. I mean, it's just the way it works. You can't have every type of bouncer wait at the door, at the castle. So it does naturally happen.

• 15:59Ezra Klein?

  They're dumb and forgetful.

• 16:01Speaker 01

  They're dumb, forgetful, and they only like work for one type of guy. So the one that recognizes Superman doesn't recognize Batman. So you can't hold the Superman and the Batman and the Hulk and the this recognizer at the door. Like you'd be, there's not enough space in your body. And then we got new variants because we did not vaccinate the world, right? If we had vaccinated the world more widely, the more you let it evolve, the more it's going to hit something eventually. So we got new variants, so it didn't really work. And then I think in addition, I think we reacted very late to Delta in the US. To kind of like this overreaction where we started saying things like the vaccines aren't working,

• 16:43Speaker 01

  which what you meant to say was they're not working as well as before. And the way they worked before was like incredible A plus hundred, five stars. And now it's like incredible A plus wonderful for most things. So even to this day, people will say stuff like, well, vaccines don't stop transmission. Of course they do, just not as well as before. They're still preventing even infections. It just isn't stopping everyone all the time and it's not working as well as before. So I think that kind of sort of disappointment, the psychological managing of the expectations has been.

• 17:26Speaker 01

  I, I think that's completely justified. What that disappointment people are saying is justified. But like, there's a reality to us versus pathogens. So the question is compared to last month, compared to two months ago, compared to last year, where is that curve going? And it has been nonstop better for a while. And that's again, because of vaccines and immunity and the switch from Delta to Omicron. That's the luck part. So when I look at it, I see progress and positive things and not enough. I would like to see a lot more. But if you're just going by the what we were told, what happened and this and that, it looks like a back and forth.

• 18:11Speaker 01

  It's not, but it looks like it. It feels like it. And of course, people are upset. I sympathize with, you know, not the substance of the claim, but I, I, I understand the subjective feeling of it. And I don't blame anybody for feeling like that.

• 18:26Ezra Klein?

  Well, that gets to the potentially sunnier interpretation of what we're going through right now, which is we got lucky in the respect that this super transmissible, super infectious variant is also somewhat more mild. And so eight weeks from now, we will have had a tremendous increase in the immunity conferred by past infection with a lot less of the death and disability that maybe Delta would have brought. And so there's going to be that much more protection across the globe, helping prevent hopefully other variants or at least their, their severity.

• 19:07Ezra Klein?

  I've heard some doctors posit this as a, as a more hopeful scenario, like Bob Walker at UCSF. Do you buy it?

• 19:16Speaker 01

  It's totally plausible. If you have like all the future worlds ahead of you, is this one potential one? Yeah, sure. But I go back to, well, we got lucky. And like, that is to me more worrisome almost than the virus itself. See what I'm saying? Like what I want to depend on is not counting on what the viral evolution will do. But I want to count on like a nimble effective response, no matter what it does. So is there, is the scenario that like by February, we have forty, fifty percent of the US infected with this variant, which is totally plausible.

• 19:57Speaker 01

  I think in a couple of months that will have forty, fifty percent test positive if they get test, which is part of the issue. And then will that confer like Omicron does confer good antibodies against Delta, which is great because Delta didn't confer good antibodies against Omicron from what I remember. So that's a great scenario. But again, that doesn't prepare you for. The what if, even if it's a low percent, like the last thing we want is to sort of count on the very plausible good scenario and then have some curveball come at us. And like, I mean, can you imagine one more curveball that we're not prepared for?

• 20:38Speaker 01

  The level of despair is already bad and hospitals can't deal with more of this. It's just like mild or not is not really the way you want to think about it for hospitals. So the, yeah, that's why I'm kind of wary of it plausible, yes, but so what?

• 20:57Ezra Klein?

  Let's start here with a bit of a retrospective. I don't think any of us believe that Omicron showed that we were where we had hoped we were. So what did the Biden administration do well on pandemic policy in its first year in office? And what did they do poorly?

• 21:12Speaker 01

  Let me evaluate them on their own because there's two ways to look at it. They did better than the previous administration, but that's a very low bar in many ways. So that's not really what we want to think about. But if you look at the Biden administration election promises, they didn't do many of the things they promised. They had these very good campaign promises on what they were going to do on things like rapid tests and masks and all of those things. We did not really get those done. Yes, they cannot control something like an Omicron coming up or not, but surely they had people telling them these are options because these were always options.

• 21:57Speaker 01

  And yes, it's true that they have been greatly hobbled by essentially public health undermining of every kind that comes from very high level media people in the conservative side and, you know, GOP legislatures and all of that. So they had all those things that are outside of their control. But, you know, once again, like I am not some professor outside of history giving marks to them. I just want to sort of look at what was under their control that they could have done better. And there's so much there that I think they left on the table that it is really disappointing because I think. Those are the parts that are even more important,

• 22:42Speaker 01

  given the essentially sabotage from some corners and the kind of problems we had in this country. I would have hoped they would have done things like lead in vaccinating the world, that we've done some stuff, but nowhere near what we could have and should have done.

• 23:03Ezra Klein?

  What could we and should we have done that we haven't?

• 23:06Speaker 01

  Scale up production of the, especially the mRNA vaccines, which have, again and again, have so much data that they are great. And a lot of the focus on that has revolved around their patents. Honestly, I don't care if we burn their patents on the biggest bonfire. Like, I have no interest in defending their patents. But even if both Pfizer and Moderna turned it all over, that wouldn't be enough. Because vaccine production is difficult. You need the vets, you need the nanolipids, you need the know-how, right? Even if we went to court and got some sort of, you know, waiver out of the WTO and just said, "All right, you've got to turn us the know-how." That wouldn't solve the problem.

• 23:50Speaker 01

  We should have been, in fact, globally, the moment we got the trial readout in like September, October, November of 2020, the first thing should have been, "These are amazing. What do we need to produce as fast as possible?" And the answer turns out to be, you need to essentially marshal infrastructure, even if they're owned by other companies. And I, again, I'm a pragmatist. I don't care if you pay them a trillion dollars at this point, because we're wasting so much, maybe not a trillion, but billions, because we're already spending that kind of thing. So there needed to be this global leadership to say, "All right, where is the spare capacity? How fast can we build more of it? How many people need to be trained? How do we do quality assurance?

• 24:34Speaker 01

  You know, what's the supply bottleneck? Is it the nanolipids? Is it this? Is it that?" Like, there needed to be this incredible sort of, like, World War II level upscaling of production. Especially of the mRNA vaccines, but the other ones too, because we have AstraZeneca, we have Novavax, never solved this production problem. It's great. The trial results are great. It's not anywhere because, you know, we should have stepped up and helped solve that. Just do it. And then we would have needed to have an equitable distribution of these things. For example, there's all these strategies where you could, for example, if you have a lot more supply of AstraZeneca, that could be your first shot and second shot, and you could have maybe a mRNA booster, which is, you get great results, it's more equitable,

• 25:19Speaker 01

  it fits your supply constraints. So these are things that require thinking globally. So there's a world in which we could have just gotten it all together and probably vaccinated everybody in the world by mid 2021 with at least one or two doses with boosters on the way, starting with the most vulnerable, and then we would not be talking about any of this. So that was step number one. We didn't do it. The second part is vaccine is like your personal protection. There's all these technologies you can use to lower transmission. So we know this is airborne. I'm still appalled that HEPA filters have never sold out. How can I still just buy as many as I want?

• 26:03Speaker 01

  Because we have research showing they do help lower transmission because they help filter the air for these viruses and other pathogens. You have, you know, better masks, N95s, K95s, KF94s, they are better at protecting the person. They are better at source control. And, I mean, it's what, 2022, and you can't even find which one's a counterfeit or non-counterfeit. I went to a doctor a couple of weeks ago for, um, I mean, I went to an office and everybody else was wearing surgical masks, except the medical doctor who was wearing double masks and just looked at mine and said, "Where'd you find a non-counterfeit N95? I don't know how to do this." I was like, "This is crazy."

• 26:47Speaker 01

  So ventilation, we have spent so much money on things like Plexiglas, which research shows probably makes things worse because it creates dead zones for ventilation and is expensive and is bad for schools because it blocks viewing. There's all these other technologies that do a much better job than

• 27:09Speaker 01

  Plexiglas, rapid tests, like people have been saying for years why it's not a magic bullet, but it's a great tool in your arsenal. Like, why can't we have many, many, many of them? And in fact, because of its nature, it's a great tool in your arsenal if people have tons of it and are testing frequently. That's how it works. It's a public health tool. We don't have them. So there's all these things that they did not do that I think were within their control.

• 27:41Ezra Klein?

  So one of the striking things that I've been looking back through their record myself is that this was all part of their plan, and they did appropriate through Congress a lot of money for it. So you go back to the American Rescue Plan, the very big first piece of legislation. And I'm running these numbers a little bit from memory, but as I remember it, it was something like 20 billion in there to scale up the vaccination program, 50 billion in there roughly to scale up testing, which I thought at the time was really interesting. They needed a bunch more money for testing than for vaccination, but they were going to build this national testing infrastructure and expand genomic testing and the whole thing. There's a huge amount of money in there for school retrofitting and for other

• 28:25Ezra Klein?

  kinds of institutions. My understanding was a lot of that was for ventilation and air filtration systems. But it is certainly not my sense that we have a capable national testing infrastructure right now. And that every classroom and every childcare center, which the Biden administration does say it is their priority to keep open, that every one of those rooms has state of the art, excellent air filtration. So one of my questions has been, where did that money go? Some of it is unspent still, I should say, but, but they got the money. Like, what, what, what happened to the, the implementation?

• 29:04Speaker 01

  That's an amazing question for somebody to track down. I don't know either. Like, I don't understand why we didn't just manufacture a lot more tests. Vaccination scaling up is hard. That would have really required leadership and even commandeering of infrastructure, which I think we could have done. I don't mean like take over the way we did in World War II, but I mean like pay some companies to cooperate to just sort of merge their resources. So that, but that we didn't do. We could have produced millions of millions of tests so that we had enough for everybody. We didn't really do. We still don't have the kind of early genomic surveillance that we need.

• 29:44Speaker 01

  It's gotten better. Like every time something like this happens, like a new variant comes. I have a bunch of countries whose data I look at. It's the United Kingdom, it's Singapore, it's Qatar, it's South Africa. So I get my understanding of these things first and foremost from other places. And then much later, some confirmatory looking stuff comes from the United States. Again, like I'm not putting all of this on just them because clearly the fractured nature of health infrastructure in this country is part of the problem. But that still doesn't excuse, in my view,

• 30:27Speaker 01

  how little we have made use of what we could have done, given our wealth. So there's a way in which we, as a country, are not able to execute things. I mean, I don't even understand politically why, forget all my science talk here, politically, why he wouldn't just come into office and then create these distribution centers or mailing centers, starting with, I don't know, start with the social security recipients, the elderly or people on disability, and just mail them some high-quality masks, some tests. Stay safe, Joe, card. You see what I'm saying? Like, this is the kind of stuff-

• 31:04Ezra Klein?

  No, totally. Every couple of years, there's a viral article about the Finland baby box, right? They give you this box and the baby, it can also be a crib, and it's a lot of stuff for the baby. We don't do any public provision of literal goods here.

• 31:16Speaker 01

  It's not like our politicians don't try to do this. It's just that Joe Biden did not do this. I would have wanted him to send these kits out. As a politician, right? I'm just sort of talking about, like, you can get into the argument on what's the best way to distribute or not. But if I were like a politician of that place, I'd be like, this is good politics. Why don't I just empower people and make them understand that I personally care about them, even if I can't solve every problem with the country, given the political situation? I will do what I can for you and your family. Seems like basic good politics. And instead, I was just reading today that one of the arguments against more rapid tests

• 32:01Speaker 01

  was that it would discourage people from getting vaccinated. And one of the arguments against sending more masks was like, what about the people not wearing masks? And I would like to say whoever is coming up with these scenarios is not making sense. The people who are not wearing masks aren't wearing masks. Distributing better masks to the people who want them doesn't make the other side of the problem worse by any means. The fact that some people aren't cooperating means that empowering and upping the protection of those people who are is even more important. And the idea that having more tests would discourage people from getting vaccinated does not make sense.

• 32:40Speaker 01

  I coined up Zennep's Law recently, and it is the idea that if you're thinking some second order effect, like, if you do this, counterintuitively, something will happen, is going to overwhelm the benefit of the first order effect?

• 32:57Speaker 01

  That's almost always false. Like, that was the idea that if you give people masks, they won't wash their hands. Or if you give people masks, they'll be more risky. Like, it's this idea of, like, too clever. What if better is worse? Well, you know what? Better is almost never worse. So just to put it plainly, if you distribute masks to people that are better, people will be better protected. If you give tests to people, they will have access to tests. Like, you don't need to come up with scenarios why you shouldn't do the right thing. I don't understand where people are getting these ideas about how humans behave.

• 33:53Ezra Klein?

  You said a moment ago that what we're seeing is this country can't execute. And I want to ask about that because it raises an interesting set of comparative questions. Oftentimes, I use as a comparator for our policy on a lot of issues, but particularly the pandemic, the UK. And the UK has been so much better on rapid testing than we've been. I mean, they really have handed those things out. And they've been better on a lot of other things. They, as you know, have a better data infrastructure. And my sense is masking is a bit better there. They're now more vaccinated than we are. A lot of the things we're talking about, not vaccination specifically, which has other qualities, but masking and air filtration and rapid testing

• 34:35Ezra Klein?

  are meant to reduce spread, are meant to reduce transmission. And the UK just has had an Omicron wave. We'll see where ours ends up. But as I'm speaking to you, their wave has still a higher peak than ours has yet because they were ahead of us. And so it didn't work there. And so better is better. And I agree with you, we should have done all these things. But would it have worked? Was control of this in our power?

• 35:01Speaker 01

  So UK is a very interesting case. It's a mishmash of terrible policies and amazing ones. They have so dragged their feet on airborne transmission. It took them forever and ever to concede the airborne transmission. And in fact, they have some of the highest death rates of healthcare workers because of that. Because their hospitals were not doing the right things properly in comparison. They have had policies like, we're going to support restaurants. We're going to give you vouchers, but you can't use them for takeout. You've got to go in right before the Delta wave. I don't know who thought about that one. They have really resisted vaccinating younger people.

• 35:42Speaker 01

  And it's fine to say young people usually are going to do much better. But of course, they're part of the transmission chain. I mean, some young people, one, they, they, they are part of the transmission chain. So they're not 100% great in all the ways. So they're not really a great example of that. But you are correct. They do do better on many other things. So now here's the thing about rapid tests. And I think this is one of the least understood aspects of it. The whole point of rapid tests would have been to absolutely flood the zone with massive frequent testing and incorporating it into a test to stay strategy. We're using them as an individual tool.

• 36:26Speaker 01

  And they do have value as an individual tool. Like I use them before I'm going to see anybody who might be more vulnerable, especially because I don't want to transmit inadvertently all of those things. But rapid tests in their core are a public health tool in the sense that if everybody does a lot of it frequently is how they're supposed to work. So we've taken something that is supposed to be, it's kind of like putting exhaust filters on cars, right? It is not meant to be only on your car. It is meant to be simultaneously on everybody's car to get clean air. So we never use that strategy. We never like use the frequent testing surveillance test to stay kind of thing.

• 37:09Speaker 01

  So what people are doing is they're purchasing it on their own and trying to kind of get through the Omicron wave as best they can. So if you want to look at someplace like South Korea, which had early outbreaks, right? It had terrible outbreaks early on. It had like these super spreader events. It never really shut down lockdown the way that people think about it, but they had the fairly sensible strategy of like trying to keep outbreaks from getting too big and getting out of control. And of course, they did, they faced the same problems we faced with like Delta wave, they got it, Omicron wave, they've got it. And they're

• 37:50Speaker 01

  doing so much better. Like if you put them on a plot with us, you can't even see them. They're like, you have to squint. The same with, say, Japan and other countries. And I'm not like, I'm on purpose not comparing it to places like China, which have done very draconian measures to keep it essentially zero, which I understand that is no longer on our thing. But there are all sorts of different places. So people keep arguing about UK or Sweden. Those are middling countries. They're not very interesting. You want to look at the ones that have Vietnam, Vietnam has literally, they didn't get vaccines enough. They are a poor country. They really, really struggled. They, the vaccine supply was a huge problem. And they're doing so much better than us because their public health response

• 38:34Speaker 01

  has been, I have to say, like, it's an authoritarian country. I'm not like really fond of everything they do. But they've been stellar with what little they have. While we are doing really badly with a lot of wealth.

• 38:48Ezra Klein?

  And at this point, what are Vietnam and South Korea and Japan doing that we're not doing? Because, I mean, to not get hit this hard by Omicron, given its infectiousness, there's really got to be something.

• 38:58Speaker 01

  Yeah, we're not, we're just a poorly vaccinated country. And a lot of the ones that are doing better are highly vaccinated. So that's big difference. Japan and South Korea recognize airborne transmission. They took precautions based on airborne mitigations, which makes a big difference. So instead of having useless Plexiglas, you have measures aimed at lowering airborne transmission. You have public health guidance for avoiding

• 39:28Speaker 01

  Close contact in crowded indoor places. You have all these things. A lot of malls will display their ventilation rates. Like you can see CO2 monitors, which are a proxy for how much fresh air is coming and going. So there's all these tools they used before the vaccines that kept the thing. They have much better, smarter contact tracing. Now, I do want to say one thing about the culture, which gets, I think, misunderstood. A lot of this has been attributed to they're more obedient or confirmist or this or that. And I would like to remind people that South Korea had major protests that ended up with a corrupt president in jail. And Hong Kong, where I've done research right before this, has been rocked by very, very

• 40:12Speaker 01

  strong protests and it was essentially crushed. The public, yes, obviously cooperated with things like vaccination, other things better. So that is part of the ability to execute. But their scientists were on top of this. I have no other way of saying it. They were on the ball. Their scientists on the wall. Their public health agencies were on the ball. And they had a more coherent response and they did much better than us overall by pretty much any measure you can look at. And also, I do want to say, like, people keep arguing the wrong countries. Everybody's still arguing over Sweden. It's now a highly vaccinated country. People keep pointing into Israel. It's not a highly vaccinated country. Like, people just have this first impression. They never check.

• 40:55Speaker 01

  A lot of Latin America right now is highly vaccinated, right? And you see other countries are, you know, doing very well in comparison to us. So there's something wrong.

• 41:07Ezra Klein?

  Let's talk about air filtration because of the things we've discussed, that is the one where I think there is the least public understanding. And I'll put myself here. I have the least understanding of what a really good step change in ventilation and filtration would look like. I think we know masks, people should be in N95s or K95s if you're paying attention. Vaccines, you want boosters. Testing, we want rapid tests. What would it look like to take? What we've learned on airborne transmission seriously and begin upgrading our infrastructure and ventilation practices. What have we seen in other countries that have worked? What could we do here?

• 41:46Speaker 01

  So this is a very interesting thing because most people have learned, as you say, the mask part, and I have no objection to it, but the way you think in public health or infection control is that that's like the last step. That is kind of like everything else has failed. Now you need a mask. The better way is not to need the mask as much. You may still wear it, but what you want it to be is like the last step that is as little necessary as possible. You want what they call sort of the infrastructure level controls, like there's sort of hierarchy of these things. Filtering and ventilation are those steps. So ventilation

• 42:30Speaker 01

  is essentially exchanging inside and outside air, like you move the air, which it's the easiest one. You know, you can just open the window a little bit and it will definitely help. The second ones, the filtration, this is the one that I think is baffling to me because it's the one in which we have an enormous amount of existing infrastructure and standards. The HEPA filter is a standard that is well established. It works, well tested, we know it. And you can literally go and click on HEPA filter on our store,

• 43:10Speaker 01

  MERV, which is the standard for air conditioners, like air conditioner filters, like when you change the air conditioner, that's, it's like the HEPA. It's the same thing. It's just called the MERV filters and they have gradations. For hospitals and other places, you have these other infrastructures like ceiling UV, which kills the viruses, the pathogens, but it's done in a way so that your skin's not exposed to it. So this is another thing lots of places could do. It's a professional thing. You're not gonna, you don't want to wing this because potentially dangerous, but you know, it's already in there. So we had everything we need. And like me, now you have Journalist PR pitches and I'm not a day goes by, I don't get some pitch for some gimmick.

• 43:54Speaker 01

  You know, some new mask that is seventeen thirteen zero H blah, blah, blah. And it will, I'm like, I thank you. And ninety five, I, I mean, I don't need your new potentially miraculous science. I, there's a very well functioning, heavily researched existing standard, or like you see these air filters with gimmicks and this and that. And some of the gimmicks are bad. Like you don't want that. You don't want that also. You don't want this. You just want a HEPA filter. I have so many examples, I'm collecting them now of schools being sold essentially snake oil. When all they need to do is try to figure out the ventilation and the HEPA filter. Now, there's also

• 44:37Speaker 01

  these boxes that people have rigged up. It's called a Corzy Rosenthal box. Is essentially like one of those sort of these box fans. And then you just put these cheap filters on it. The Murph standard filters, you just like take it, you put the fan, you put duct tape on it and they work. And schools could at a minimum, put those in there.

• 45:03Ezra Klein?

  Let's talk a bit about the schools. We're talking in a week where there's been a lot of conflict over this. There are teachers' unions fighting, being in the classroom. There's a lot of fissures, I would say, in the liberal coalition on this particular issue. And so I've been thinking about how to talk about it. And I wanted to try something out on you, which is to try to ask, what questions can you decompose the school question into? What are people struggling with when they struggle with the issue of, should our kids be in school? Should I have to be teaching in a school? To me, it looks like it's this set, but, but I want to see if you think these are, are right or wrong. It's, what is a danger COVID poses to children, which might be different for vaccinated and unvaccinated?

• 45:47Ezra Klein?

  What's the danger that school closure poses to children? What's the danger COVID poses to vaccinated teachers? How do we think about the people that average risk levels ignore? Be they immunocompromised teachers or those directly exposed to teachers or children who are high risk? And then have we done enough to our conversation about filtration and other things to make classrooms safe? Have we sort of fulfilled our end of the bargain collectively there? Does that seem like the right set of questions on the school issue to you? Or would you add or take away some?

• 46:20Speaker 01

  I would do the step back again because it's one of those things that if you haven't engendered trust in people that you know what you're doing, it almost doesn't matter what the answer is. See what I'm saying? Like if you haven't gotten people to feel safe, that you're in control and there's a plan. It's not right to criticize a teacher for not feeling safe because that's our failing that we haven't kind of gotten up the kind of infrastructure they need to be able to be in that classroom. Or criticize a parent for wondering on what will happen to their kid.

• 47:02Speaker 01

  But also can't criticize a parent who's terribly frustrated their kid is out of school because they're also right. You see what I'm saying? Like we've set up these impossible questions because of the way we failed. Even if I gave you an answer on what I think is the average kid's risk or something like that, like what does it matter? Like what has to happen is that that parents have to feel like there is a plan in place to keep my kid as safe as possible. And here are the steps and here's the science and it has to come from authorities they trust. So if you don't have that, what you get is this incredible finger pointing.

• 47:43Speaker 01

  Across those fissures you talk about, rather than thinking, wait, like, why are we debating this? Like, the point should be, how do we keep those schools open safely and take care of the children, take care of the teachers? Now, what I hear from teachers are things like, I don't even have access to tests. The students aren't tested regularly. And I have an immunocompromised parent I live with, or a spouse, like, how am I supposed to do this? And I, I mean, what am I, what am I supposed to say to that person, saying, like, you're probably okay? That doesn't seem very comforting. I mean, it's not even false, they're probably okay, but that's not how you can do policy. And I think it's even more for children, because

• 48:26Speaker 01

  there's a couple of things going on there. One of them is, of course, this has been lower risk to children. Like, this is just the way it is operated. But, I mean, how do you tell a parent, your kid is probably okay, and we're not doing what we need to do? I mean, you can, of course, drive without the seatbelt, and it's probably okay, too, right? True, most car rides don't end with rapid braking or accidents, so you're probably fine not wearing seatbelts either. But that's not how you can think about these things. So if you want to keep the schools open, instead of trying to, like, argue with teachers and parents, what you need to do is, put those tests in place. The rapid tests, the

• 49:08Speaker 01

  test to stay. And not just sort of randomly, like, you've got to flood the place and do them frequently. You've got to equip the teachers with, you know, the masks and the tests and all of that. You've got to put those HEPA filters or Corgi Rosenthal boxes that people make in the classrooms. You put, you know, some CO2 monitors, just to see how the, if you're using ventilation. And you then, I think, most people would feel much better. And then, if somebody said something that wasn't warranted by what we know, then you could say, well, you know what, I think you're underplaying or over-exaggerating. Like, if it came to, well, here's what we did, everything, and if somebody had an unreasonable

• 49:53Speaker 01

  confidence or fear, either way, then you could try to talk to them and say, look, here's what the statistics say. So I think a lot of the fissures are, it's like a symptom of our broader failure. And so it can't be resolved by answering those questions independently.

• 50:12Ezra Klein?

  I really agree with that, and I appreciate what you're saying on trust. This is something where I do think the technocratic, evidence-based mindset that I certainly include myself in, sometimes really fails as a communication mindset, because I see a lot of people who are upset that schools are closing. And I don't want schools to close. If you ask me where I think the weight of the evidence lies, I think they should stay open. But you're not gonna like hit somebody over the head with a chart and make them not feel afraid. And in a moment when a lot of both parents and teachers are afraid, to not then give them the tools to feel less afraid,

• 50:56Ezra Klein?

  you know, as you're saying, rapid testing and filtration, to say, we're doing everything we can, and I'm sorry, beyond that, there's just some risk here that we can't get rid of. But instead to say, you know, you're being ridiculous, or you're hurting children, it's not even that it's not true that closures would hurt children. It's just that, particularly in sort of liberal COVID conscious America, we've spent two years trying to get people to take this really, really seriously, and really be afraid of catching it and spreading it. And then to kind of all of a sudden, at a time of high waves, say, "Well, all the best to you. You know, hope it goes well in your classroom."

• 51:35Speaker 01

  Let me just sort of stop one thing. I think you can even hit people over the head with a chart, but you have to have a competent hand holding that chart. You see what I'm saying? You have to assure them that you created that chart.

• 51:51Ezra Klein?

  It's a chart in one hand, it's a rapid test in the other.

• 51:53Speaker 01

  Exactly. There is a very, very good pandemic preparation document that CDC had prepared before this, and a pandemic is a communication emergency. You have to be right, you have to be first, you have to be credible. So you have to be out there with the information, you have to be credible with the information, and you have to be right about it. And it could be, we don't know. This idea is not that you assure false comfort to people. You say, "All right, we got Omicron, it looks like antibody evading."

• 52:25Speaker 01

  Could probably cause breakthroughs. We don't know about severity. But here's what we need to do for the, you know, three different possibilities. That should have been your November 26th, November 27th press conference saying, this is coming. Here's what we know. Here's what we don't know. And here's the three things we're like putting in place. And if it turns out to be more severe, this is the plan. If it turns out to be this, here's like, you sort of put that in place. And once you have that trust and then you can tell people, okay, now this is the trade off we've decided. We think that we can operate these schools safely. And here's the plan we have for the kids who are immunocompromised or have immunocompromised family members or the kids like,

• 53:09Speaker 01

  here's the average plan, and this is why it's going to work best for your kid. And here's the subsection of kids and families that may require higher levels of protection for because of their own personal health situation. Here's how we're going to do that. I think that's how you get there.

• 53:28Ezra Klein?

  It's been really striking to me. So I have a three year old in preschool. And, you know, watching the people who work in the school have to act as risk officers and risk communication specialists and create a logistics chain for testing and masking and which ones. And you really see the complete breakdown of communication is one word for it, but clear guidance. There isn't just a simple checklist people can download for their institution. It's like, okay, do you have this CO2 level? Do you have these masks? Do you have these rapid tests? If you don't, here's how to get them. Here's our supply chain. Here's how to, here's how to hook into it.

• 54:13Ezra Klein?

  And once you've done that, you're done. And if you have this set of testing outcomes, here's what you do. And if you don't, then you stay open. And it doesn't seem to me it should need to be more than two pages, particularly if you can just click on the link for the supply chain. But instead, we are asking everybody to act individually as a small public health department. And it doesn't work. People aren't set up for that.

• 54:35Speaker 01

  I mean, not only people aren't set up for that, as we have seen, things change. So when you get a new variant like Omicron, it is not the same as Delta. Like if Delta was causing this many breakthroughs, like Omicron, the lengths to which we should go to suppress it are different than the lengths to which you would go for suppressing Omicron transmission. So people can't be like on their feet, reading all the papers, trying to follow the right people, trying to figure out CDC's confusing statements on rapid test this, rapid test that. Yes, but you can't find them anyway. Maybe they don't work for this, but maybe they work.

• 55:19Speaker 01

  This is just untenable. And I think that's the despair. So when I look at the school debate and I see all the harms of kids not going to school, it's terrible. But I look at it from the teacher's point of view and it's kind of hard not to sympathize with them because this is just such a mess. Like, how are they supposed to deal with this? I look at it from the parents who both want their kid to go to school and are very frustrated. And the parents were afraid for their kid. I kind of see where everybody's ended up where they are.

• 56:11Ezra Klein?

  We've talked here about the Biden administration as a singular entity, which is on one level true and on another level, false. The government is a bunch of different agencies and institutions and how they work together matters. And the CDC and FDA here are really quite key. And Biden can appoint their heads, but they also have a lot of independent dynamics of their own and processes and Biden can't just dictate what the FDA does. How do you grade the performance at this point of the CDC and FDA across the pandemic?

• 56:42Speaker 01

  So the FDA doesn't even have a permanent head at the moment, which I find it baffling. I know some of the political details of the process, this and that, and I honestly don't care. Whatever the problem was, we should have had a permanent head appointed very early on because there's a lot of things that need to happen with that kind of leadership that a politically accountable appointee can do, that the interim director, that's not the same thing. So step one. With the same problem, I think with the CDC, that they do have, of course, Dr. Walensky, who by all accounts, I know lots of people who know her and think very highly of her.

• 57:24Speaker 01

  But I don't think the CDC as an institution, such as sort of the broadened, has stepped up the way they could have in this year. They responded to Delta late. They did not update their guidance on masks. They could have done it on day one. Like, it was such a low thing. They could have just said, any mask is better than no mask. But if you want to up your protection, here's N95, Scan95, SKEF94, here's a link to get non-counterfied ones, and here's the sign. That's it, done, right? They could have stepped up and responded to the rapid test thing because the FDA has a different mandate. Like, it's supposed to evaluate clinical medical stuff, and rapid tests are a public health tool.

• 58:07Speaker 01

  They're in the CDC mandate. And they should have said, okay, FDA has approved these as medical devices like this, but this is how we use them for public health, which is a different thing. And they did not do that. So overall, I feel like I think neither of them is doing that well. I mean, to be honest, I, again, I mean, I really do know that there's an enormous number of people on staff there who are amazing. And I'm sure the leadership in both is great people, and that's not bad. But as a whole, if you look at both agencies and their performance, It's nowhere where it could have been despite the challenges that are outside their

• 58:51Speaker 01

  control. It's still not what they could have done with this landscape, in my view.

• 58:56Ezra Klein?

  Do you believe these agencies are not structurally built for emergencies, that they they work well in public health peacetime, but they're not for this kind of constant relentless, fast-moving situation? Or are these problems always there, but they don't simultaneously affect enough people, devices, treatments, et cetera, to rise up to the level of political concern?

• 59:20Speaker 01

  So I'm gonna say yes.

• 59:23Speaker 01

  Clearly, there is ongoing problems. Like, there's no question about it. When the pandemic hit, the CDC couldn't get functioning tests. We're still learning about it. Like, in February of 2020, we did not have tests that functioned, and FDA and CDC couldn't coordinate to get functioning tests, even though, you know, public health lab and universities had them. Like, they were able to build functioning tests, but they were prevented from using them, and the test that the CDC developed didn't work. And there was either contamination or reagent failure or whatever. Like, there was a bunch of still being investigated. So we flew blind in the most crucial period because these agencies couldn't work. So

• 1:00:05Speaker 01

  clearly, there was something going up to it, too. You have an enormous amount of revolving doors, especially FDA. People switch back and forth between the pharmaceutical industry and the agency a lot. Now, is there some role for people with industry experience? Of course. But a public health mindset is not necessarily that. They're asking the wrong question. You know, they're asking a table why it's not a chair, and you're like, we're gonna sit on it. That's what happened with rapid tests. So you've got to do two things, because I do really want to, because there's so many good people working in these places, like, and they're really working hard, and they're doing their best. So you want to

• 1:00:43Speaker 01

  provide whatever support we can to help them succeed without turning away from what's actually not working, that needs fixing. And in fact, I usually say this, like, criticism is an act of support and love, because you're saying you can do better. Sort of blind support is not. A vote of confidence. It's like low of expectation, like they should have been able to do better. We can appreciate how hard many are working with the best of intentions without losing sight of the fact that, no, it is not, we are not able to execute. It's not working. This is not how you do best pandemic management. And no, it is not completely and solely the fault of people

• 1:01:28Speaker 01

  who are irresponsibly and inexcusably sabotaging the effort. Those people are a problem, but they are not the only problem.

• 1:01:38Ezra Klein?

  One of the things that you've written about with the CDC and that I've been thinking about more is the way their guidance has often seemed to be reflecting considerations that they are not clearly stating. A bunch of problems with this early on in masking where they gave bad guidance on masking, but oftentimes in part because they're worried people buy all the masks. But they could have just said that a little bit clearer. More recently, they came out with guidance on isolation that struck many people as weird. You isolate for five days, come back without any testing. Then they had new guidance where it's like, well, if you have rapid test, test. And if you're positive, stay in. But if you, if you don't have rapid tests, don't worry about it. You made the point, maybe that they're dealing with the reality that there simply aren't enough rapid tests.

• 1:02:23Ezra Klein?

  I read that, as I'm saying, on some level, maybe we're not going to worry about case spread that much here. We're just going to accept that it would be better for this thing to spread through the country than for it to completely grind the economy and society to a halt with people isolating forever. But whatever it is, it strikes me that this kind of deep reading a lot of people are doing to try to figure out why guidance looks weird does bespeak a breakdown in communication authority. Once people don't think you're saying what you're saying, then it's, then it's pretty bad.

• 1:02:55Speaker 01

  Yeah, I will say it's more than communication authority. It is a way of trying to manage the public expectation and behavior in a way that is both illegitimate and worse, it won't work, it will backfire. I think there has been a lot of, you know, here's our considerations and here's how we're going to guide these things. And people can feel something's off because if your isolation guidance is, yeah, rapid test, we're going to use them in two weeks for tests to stay in school. But right now, we're not sure if they can measure infectiousness. By the way, the CDC head is the one that wrote the best paper on why they do. Yeah, that's not going to work. Like, you're just going to end up confusing people and losing the trust.

• 1:03:39Speaker 01

  So if the problem is we don't have enough of them and you want to preserve what you have, then you have to say, you know what? We screwed up. We don't have enough. That's not great. I understand why nobody wants to say we screwed up. But if you screwed up, it's visible. You're not saying it doesn't make it go away. So might as well say it. And then you can say, and we're going to deal with it by triage. We're going to put all the capacity we have to schools and hospitals and critical infrastructure because that's important. And in the meantime, and we're asking employers to not ask their symptomatic employees to confirm with a PCR test if they got a rapid test or just let them be like if they're symptomatic, just assume Omicron, let it be to preserve capacity.

• 1:04:23Speaker 01

  Like, there's ways of dealing with it that are both trust building and better for what you're trying to do that I wish they would do more of. Or if that's not the case, if there's some other reason, and if we're all misreading this, they need to really explain this. There's some reason why there's been this zigzag on what rapid tests are supposed to do and good for and not good for. That is some unpublished data or some other consideration, whatever it is, it needs to be right there on that press conference, explain to people in a convincing manner. Because what all you do is like, you know how we went to, we can't get mad at anybody in the school debate because I, I, how are they supposed to trust anything when it feels

• 1:05:08Speaker 01

  like you're being guided, right? Rather than informed and empowered.

• 1:05:14Speaker 01

  And I don't think it's a legitimate way to treat the public. It also doesn't work because it just backfires on you. And I say this with very like deep respect to their service as clinicians and medical doctors and all of those things.

• 1:05:28Ezra Klein?

  Let me end before we do books on this question, which is to simply set the levels for preparation, expectations for preparation. So what should be true in 10 months in our pandemic policy that is not true today? What if it were true, would you say, we did it, we used the time well, we prepared?

• 1:05:48Speaker 01

  So we should have updated vaccines and vaccinate the world because it's an incredible tool. I read a lot of history just out of interest and for work sometimes, but I just like reading history. And I'm so struck by how many people lose kids and young adults to all these things we don't ever think about anymore. We have vaccines, antibiotics, sanitation, all these things. So the vaccines is clearly the first thing. So we didn't really talk about it, but there's a couple of good antivirals and one or two not so good, in fact, potentially dangerous ones. So we should pick the good ones, the ones that work. Pfizer's one is

• 1:06:29Speaker 01

  good and it does work and it's very highly effective. And we should look into mass producing those and directing them equitably globally because it just can't be the case. Again, we just hoarded here because that's the second level, like because there are immunocompromised people and elderly people whose immune system is not going to work as well. They are going to need the therapeutics. Ideally, I want like, I don't know if it's technically possible, but I want like tests for other viral diseases too. I want a home flu test. I want a home RSV test. Like if we can do it for this, can we like, it would be great because usually we just let these things go, but they do damage. If you look at the respiratory disease

• 1:07:11Speaker 01

  burden outside of influenza before this, it's pretty high. Like there's all these other respiratory viruses that do damage. People argue over masks.

• 1:07:21Speaker 01

  And of course, you know, it's like if you don't need to wear a mask, that's much better. And the way to get to that is to reduce circulation and to do air filtering and ventilation. And this is sort of a big project because it's kind of like sanitation. There was a time in which you couldn't trust the water. When I grew up, we couldn't drink tap water. Like I grew up in Turkey and tap water wasn't considered safe. So we moved to a world in which most places it's supposed to be safe. So you want the air to be filtered the same way we filter water. And there's a big infrastructure project there because there's some trade offs. Because ventilation is great, but it's energy heavy if you're also using ACs or something like that.

• 1:08:05Speaker 01

  So you need to find these balances of how do you do this in an energy efficient way? And what do you do it and how do you measure it? So there's this huge, potentially amazing transformation for respiratory illnesses by recognizing that they are also almost certainly and quite likely airborne transmission. So you can kind of change your infrastructure around it to mitigate them in workplaces and schools, in places where people are together or restaurants. And then you will get, so like the benefits of doing all of that would be not just we would be better able to face whatever variant curve ball came. If the world was vaccinated, if people for whom vaccines didn't work as well

• 1:08:49Speaker 01

  had immediate access to functioning antivirals that were really effective. And maybe we could develop antivirals for other things too. And then we had airborne mitigation so that the burden from influenza and other diseases also fell. That's amazing. Like you're not just getting rid of the pandemic part. You're also preparing yourself for a much better future. And here's the part that always gets me. We are in such a wealthy moment in history. And our science and our technology is so advanced, relatively speaking, obviously, is that there is nothing but getting over our dysfunction that's holding us back. I mean, if you're in like 19th century and you're just puzzling over yellow fever,

• 1:09:33Speaker 01

  you don't even have germ theory and you don't understand mosquito vectors and it's hard, like it's really hard. I read those histories and I'm kind of going, it's the mosquito. I like, I want to give them clues, but they're like looking around and they like, of course it's hard. They can't do it. But right now we have everything in place. You literally have the sort of cake making thing. You just need to sort of stir it the right way. And it's our dysfunction that's holding us back. It's the global political dysfunction, our US specific dysfunction. It's our, it's the whole thing. And of course, every kind of obstacle is terrible, but that is just sort of stomach pain kind of

• 1:10:13Speaker 01

  level painful because we could do it. We have the tools and just need to kind of get our act together, which this is not, this is potentially hopeful.

• 1:10:24Ezra Klein?

  It is a potentially hopeful place to end. I completely agree. So finally, always our last question. What are three books you would recommend to the audience?

• 1:10:32Speaker 01

  One of the things that I really like reading about for people who want to see how hope and despair are intertwined is books by Irving Yalom, who is a psychotherapist, but has a lot, a lot of books about how facing the things that are your huge existential fears as humans, as species, right? The human condition. He has a sort of philosophy, and it's not just him, obviously, this is sort of deep in both Western and Eastern thoughts, is that facing those fears without like sweeping them under the rug is the way to both confront them and also

• 1:11:14Speaker 01

  Make the best of your life. He has these traditional textbooks, like the group psychotherapy process, which I read because I like textbooks. But he has also novels that are really good around this theme. People have been asking me a lot about like my interest in these kind of complex systems, that's the way they see this work. And I have to mention, like, there is a book that got me on this path, which a lot of people who have any sort of past as a geek or a current as a geek might have heard about, which is James Gleick's Chaos: Making a New Science. It is 1987, so a bunch of things have happened since in the field. So you can like follow up with new ones of it too.

• 1:11:54Speaker 01

  But it's kind of like is one of these early books that were just opened a lot of our minds into weight. Like, you know, this is the world doesn't work according to the simpler formula that you hope it works according to. It's like all these things interact in all sorts of ways. And it's a way of thinking about math and other things. So I really like that book. Um, oh yeah, you know what? I'm going to recommend something that is I read very recently. And I think it's important to read books like that. And this is the gonna feed into the despair part. It is called The Dead Hand, The Untold Story of the Cold War Arms Race and its Dangerous Legacy.

• 1:12:37Speaker 01

  It's a really harrowing story of how humans can lose the plot. We, as humans, USSR and United States and a lot of things, we set ourselves on like this incredibly dangerous path, both nuclear weapons and bioweapons and all those things. And we came close so many times to existential level threats that would do untold damage. And just kind of reading how people thought about it at the time, I'm just kind of looking and thinking, how did like men and women adults sit down around the table and say, all right, now let's develop this and do this and like not.

• 1:13:19Speaker 01

  So it's a sort of a strong reminder of how people can seem perfectly rational and logical and accomplished and high levels. And this is like, I'm not just holding one side or no, or they're like as a world, but then come up with plans to develop things that when you sort of look at it, you're like, I would they did what? So that will be the scary one.

• 1:13:45Ezra Klein?

  That one is a bit scary, but those are great. Zainab Tufekci, thank you very much.

• 1:13:49Speaker 01

  Thank you for inviting me in the conversation.

• 1:13:58Ezra Klein?

  That's the show. If you enjoyed it, there are a few ways you can help us out or shape the next episode. You can rate the podcast on whatever player you're listening on now, or send this episode to a friend, family member, if you didn't like it, an enemy who you think deserves it. Or you can tell us who you think we should have on the show next by emailing me at ezra klein show at NY Times. We really do get suggestions for guests we have on from the email. And though we can't respond to every message, we really do read every single one.

• 1:14:30Ezra Klein?

  The Ezra Klein Show is a production of The New York Times. It is produced by Roche Karma, Annie Galvin, and Jeff Geld. It is fact checked by Michelle Harris, Kate Sinclair, and Mary Marge Locker. Original music by Isaac Jones, mixing by Jeff Geld. Our executive producer is Ariya Noguchi. Special thanks to Shannon Busta and Kristen Lim.