Published on Dec 08, 2020

Video Transcript

[MUSIC PLAYING] JOHN WHYTE: Welcome, everyone. You're watching Coronavirus in Context. I'm Dr. John Whyte, chief medical officer at WebMD. We're all tired of the coronavirus, tired of staying in, tired of wearing masks. Yet, cases are still going up. Deaths are going up. Hospitalizations are at an all-time high. And some people are suggesting the way that we solve this is not just vaccines, because that's going to take a while. We need to do a lockdown.

And one of those proponents is Dr. Yaneer Bar-Yam, who's an MIT trained scientist, an expert in quantitative analysis of pandemics. Dr. Bar-Yam thanks for joining me.

YANEER BAR-YAM: Thank you for having me.

JOHN WHYTE: Now, you talk about the way that we can crush COVID is by treating it like a house fire. And you've got to put the fire out all at once. And that requires a lockdown, in your analysis. So tell me the rationale behind it.

YANEER BAR-YAM: So it's actually-- starts with just understanding the transmission, right. We all know this by now. It transmits when somebody breathes out and someone else breathes in. And the point is that the virus dies if it doesn't transmit. So we just have to stop it from transmitting. And the way we do that is by making sure that we're not near other people. It's that simple.

And the lockdown, what people call a lockdown, is just the idea that we're just going to go all-out. And it turns out that the advantage of doing this is that it goes away very fast. It actually only takes about four to six weeks for even a very large outbreak to get down to very, very small numbers if we do it all-out.

And so why would we want to live with this for six months, three months, six months. We've been living with it for a long time already. So if you're tired of it, the solution should be to get rid of it. If there wasn't a way to do that, then, well, there isn't a way to do that. But it turns out that there is. And it's been shown in multiple countries. And the analysis shows it. The experience shows it. So that's really what we want to do. We want to get rid of it.

JOHN WHYTE: Now, you mentioned that it's been shown in multiple countries. Let's take New Zealand. That's an example that you've often--

YANEER BAR-YAM: Absolutely.

JOHN WHYTE: --described where they had a lockdown, a true lockdown, where really one family member was designated to go out. And they really defined essential workers. Had no cases in over 100 days. But then they started to have a few outbreaks as well. So it didn't completely eradicate the virus, is that right?

YANEER BAR-YAM: That's right, but it turns out that that's where the idea of the fire really shows up. Just because you can't get rid of all possible future fires doesn't mean you don't put out a fire. If there's a new fire, what you do is you attack it quickly. You get rid of it. And then it only is a small fire in a localized place for a short amount of time. That's the way you fight fires, because you don't want to live in a burning building. If there's a new fire that shows up, you just get rid of it at that time.

And this idea, somehow, was confusing to people. Because people said, hey, why should we put out this huge fire if there's going to be another fire in the future. But when you think about it in terms of fires, it makes it really clear that it's still the right thing to do to get rid of the fire.

JOHN WHYTE: People that say, you know what? Lockdowns have been tried. And they haven't worked. Several countries have tried then. Is your argument that they haven't done them right?

YANEER BAR-YAM: This is one of the problems with the word lockdown. Everyone thinks a lockdown is a lockdown is a lockdown.

JOHN WHYTE: Give me a better word.

YANEER BAR-YAM: It turns out that the word lockdown was originally used not even to mean the stay-at-home orders, or the social distancing, or the masks. It was originally used to mean stopping transportation. You didn't want people to go from the place that had the disease to other places that didn't have the disease, so you would transmit it from community to community and start more fires. You just don't want to move it from place to place. So you want to stop it where it is.

And in order to do that, what you do is you create firebreaks. You prevent travel from one place to another. And there are various ways to do that. You can do it voluntarily. You can do it with enforcement. You can do it with fines, all kinds of things.

One of the most important problems is that we didn't say, hey, we're going to do this, and we're going to get it right. And you have to know that if you do it right, the number of cases drops really rapidly. So you can actually get-- if you do it well, you can get down by 100-fold in just a month.

The first thing that we do need is that people will buy in. It doesn't have to be everybody. There are always crazies. And remember that the press is often really good at focusing on the crazy-- you know, the--

JOHN WHYTE: But it has to be-- let's be fair. It has to be most people, or it doesn't work.

YANEER BAR-YAM: It does have to be most people. And in fact, it probably has to be maybe 80% of people in order to do it well. But the point is the following. You have to give people a reason to do it. And the most important reason to do it is that after a month, after five or six weeks, you can go back to normal. And that's super important.

And the other thing, which really helps, is to set it up in the best way. And this is the best way anyway, because we talked about the limitations on travel-- is you set it up community by community. The communities that do it well, they go back to normal. The communities that don't do well, they take longer.

JOHN WHYTE: Do we have to combine it with an incentive package? Because the argument could be-- I'm giving you the arguments. You know this. Businesses can't survive for a five-week lockdown right now. They just can't. Small businesses will not be around.

YANEER BAR-YAM: So here is the thing. It always becomes harder the longer you wait. If we had done five, six weeks, how many businesses would have been in trouble if we--

JOHN WHYTE: In March, right.

YANEER BAR-YAM: --did it half a year ago. So the point is the following. It is harder now. And so what you want to do is you want to support people who are vulnerable, people with financial needs, all kinds of other things.

JOHN WHYTE: You say we're limping along instead of being decisive. Is that a fair characterization, we're kind of limping along?

YANEER BAR-YAM: That's right. I mean, the point is that when you're fighting a fight like this-- I mean, imagine you're fighting a fire. And you fight a fire and say, OK, I got it down a little bit.

JOHN WHYTE: I know, you say-- it's a great analogy.

YANEER BAR-YAM: Yeah. Or you say, hey, it's all right. There's just this little fire left in the den. It'll be all right. And you walk away.

JOHN WHYTE: So why isn't there a will to do it? How do we get to that point?

YANEER BAR-YAM: And the answer is people really have to understand. And part of that is the communication. There's just a lot of miscommunication.

JOHN WHYTE: Do you feel there is a political appetite to do a lockdown? People say, that's a sledgehammer approach. We need a scalpel.

YANEER BAR-YAM: There is no scalpel. If there was some other way to do this that made everyone feel comfortable, and they're all OK with what you're doing, and so on, so on, you think people wouldn't have found it already? Don't forget that this was also done in Australia. Australia's COVID-free. And Australia's a big country with lots of states. And there was one state, Victoria, that had an outbreak. And they got rid of it even though other states were free of the disease during that time.

JOHN WHYTE: Does testing play a role in this? Do we-- some people argue it's not lockdowns that we need to do, but we need to test people every few days for two weeks. Other people [INAUDIBLE].

YANEER BAR-YAM: So here is the idea. When you're in a fight, you have legs and arms and so on, and hopefully a head on your shoulders.

JOHN WHYTE: Hopefully.

YANEER BAR-YAM: And so if you have an incredible left hook, you use your left hook. So if we had massive testing that we could do today and do it every day and so on and so on, that would be the left hook. But the point is the following. We have all of these things. You don't want to tie your legs together. So you want to use all of the tools that you have, because this is a tough fight.

Another thing that we really have to focus on, which we didn't do almost at all, or very well, is that we didn't isolate people well. If you leave people in their homes, you infect a lot of family members and a lot of housemates. What they do is they have people go to hotels or the dorms. But in New York, they had the fanciest hotels set up places for people to go who had cases.

And the other thing is that you get if you go to a place, you get supported isolation, which means people are going to take care of you. And in particular, if you have COVID, you want to make sure that if you turn worse in your case, you immediately get care.

JOHN WHYTE: What if we gave financial incentives for people to--

YANEER BAR-YAM: And that's OK. But the point is the following. It really is mostly about making sure people understand that the huge incentive is that we get out of this.

JOHN WHYTE: What about people that say, Dr. Bar-Yam, vaccination is around the corner. So we don't need to do this lockdown.

YANEER BAR-YAM: You figure out how many people will die at 2,000 deaths per day over six months. And when we go dial back to individual consequences and people say, hey, I don't care. I'm going to take the risk. I don't mind. One of the things that people don't know about is they don't know a lot about long COVID, what are called long haulers, people that get-- and this is affecting young people, healthy people, athletes, all ages. And what it means is there's heart damage. There's brain damage. There's lung damage. And for some people, maybe it's important that there's-- also looks like there's damage to male fertility. And the point is--

JOHN WHYTE: You're really trying to reach people. You're grabbing at anything to encourage people.

YANEER BAR-YAM: Hey, and again-- I'm sorry. The consequences of this disease are scary. If you're not paying attention, then you don't know it. So all I'm trying to do-- and again, my role in this context is not to say this or that or anything, but to communicate about what are the consequences of people's actions. That's something that I take very seriously.

If people are going to trust you, if anybody is going to trust you, it's because you tell them straight what is going on. And the biggest challenge that we've had is that many of the people that we want to trust have not been telling us what is really happening.

And indeed, what is really happening is that we have a terrible disease. The disease grows rapidly. And the most important third statement is that we can stop it. And all we have to do is to make a decision. We have to make a decision that we care about getting back to normal and that we care about the people we love. And that that's what we want to do. We want to--

JOHN WHYTE: What about the fact that people say, they care, they just disagree with your strategy. So that doesn't mean that they don't accept your strategy, they don't care. They have a different philosophy.

YANEER BAR-YAM: Here's the thing. The strategy in terms of the consequences is obvious. It's been shown mathematically. That's my specialty. It's been shown in the real world by many different countries, small and large, rich and poor, island and mainland. The main thing is it also doesn't have to be everybody.

And what's happened over and over again is that the polls have shown that a vast majority of people want more restrictions. So this whole idea that there is all of these massive numbers of people that don't want to do this, it's not supported by the information we have.

JOHN WHYTE: Well, you have given us a lot to think about. And certainly, we need to take another look at this concept of a multi-week lockdown. And really to your point, use every tool that we have, which are limited, in terms of crushing COVID-19.

Dr. Yaneer Bar-Yam, I want to thank you for taking the time today.

YANEER BAR-YAM: Thank you.

JOHN WHYTE: And I want to thank our viewers for watching. If you have more questions about lockdown, other questions about COVID, send them our way. You can send it to [email protected], as well as on social at Dr. John Whyte in WebMD, as well as Medscape. Thanks for watching.