March 24, 2020

COVID-19

#100 – Sam Harris, Ph.D.: COVID-19—Comprehending the crisis and managing our emotions

"This has been a period of time unlike any other in our lifetimes. . . there's really no analogy." — Sam Harris

Read Time 8 minutes

In this episode, Sam Harris, neuroscientist, author, and host of the Making Sense Podcast, joins Peter to discuss this unprecedented coronavirus (COVID-19) crisis. The discussion includes the important distinction between COVID-19 and influenza, the impact on the economy, the dire situation in New York, and the challenge of creating a safe and effective vaccine. Additionally, Sam brings insights from his extensive meditation practice to help those struggling with stress, anxiety, and fear in this extraordinary situation.

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We discuss:

  • A time unlike any other—why many people don’t seem to fully grasp the magnitude of this situation [2:00];
  • Why comparing COVID-19 to influenza is a bad analogy [10:45];
  • The impact on the economy of measures like shelter-in-place—Is the “cure” worse than the disease? [16:45];
  • Why are some places, like New York, getting hit so much worse? [24:45];
  • The trickle down effect of an overrun healthcare system on non-COVID related health issues [34:45];
  • How to calm our minds and manage our emotions during this craziness [38:00];
  • Talking to kids about this situation without burdening them with undue stress [50:15];
  • Insights from meditation practice—Recognize and unhook yourself from a heightened emotional state [52:00];
  • How to make the most of a situation where you let your emotions get the best of you [59:15];
  • What are some potential positive things that Sam hopes could be learned from this crisis and applied to the future? [1:09:30];
  • The unfortunate politics being layered on top of this crisis [1:15:30];
  • The challenge of creating a safe and effective vaccine for COVID-19 [1:20:00]; and
  • More.

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Show Notes

A time unlike any other—why many people don’t seem to fully grasp the magnitude of this situation [2:00]

“This has been a period of time unlike any other in our lifetimes. . . there’s really no analogy.”

  • Between SARS, MERS, and now COVID-19, these coronavirus are not something that will just go away
  • It seems like we should have known something like this could happen, yet as a society we are so fundamentally surprised
  • 2015 TED Talk by Bill Gates: The next outbreak? We’re not ready
  • Sam’s worried that after we come out of this, we will eventually fall back asleep on it until it blindsides us again

People are having a tough time grasping the magnitude of the situation

  • Sam has spent a lot of time trying to convince smart people to take this seriously
  • But there really is no good analogy to this situation
  • It’s just been very interesting to see the layers of denial and obfuscation present themselves and to have to kind of punch through them. . . .it’s just psychologically, it’s very interesting to watch.

The challenge of communicating this crisis to the public

  • Peter says the communication has been too binary — e.g., people saying we “know” this or that will happen
  • A better way to communicate things that would less alienating to the people who are naturally skeptical would be to use confidence intervals — e.g., “we’re 90-95% sure that this or that will happen”

 

Why comparing COVID-19 to influenza is a bad analogy [10:45]

  • Many people have been outwardly comparing this to the seasonal flu to sort of downplay the crisis
  • But Sam and Peter say this is not a good analogy
  • Nobody is discounting the severity of influenza
  • However, influenza comes in a very predictable wave and the infection and mortality is spread out over the course of a year
  • But CV is still in exponential growth in new cases and there’s no evidence yet that we are on the back side of that curve where that has stabilized
  • And we don’t yet know what the absolute potential for mortality from coronavirus really is because it’s still in its infancy
  • If we could somehow “freeze” the new cases in their tracks, this CV situation would indeed look way less harmful compared to the flu
  • So the point is… what steps can we take to freeze this thing from spreading?

 

The impact on the economy of measures like shelter-in-place—Is the “cure” worse than the disease? [16:45]

  • It’s hard to say what we could do differently to protect the economy without a vaccine
  • There are many people that are really worried about how the “lock down” or “shelter in place” strategy might crush the economy and lead to a depression
  • Sam says many of the policymakers are also concerned but may not be expressing it properly
  • At the same time, nobody is saying there’s nothing to worry about from an economic standpoint
  • Sam is concerned that people aren’t fully grasping the importance of stamping down the spread of this virus
  • Sam also acknowledges that even after just one week, the “shelter in place” order is beginning to unwind as people grow more restless 
  • And this fact makes it pretty clear that the idea that sheltering for weeks, much less months, is a farfetched idea

Why haven’t we been able to communicate this idea of shelter in place to eradicate this virus? 

How long would it take?

  • It will be very hard to enforce “stay at home” in a free society like the US
  • But Sam doesn’t feel like this idea that it will take a few weeks and we could nearly eradicate the virus hasn’t been communicated properly
  • Peter says it would likely take about 4 weeks of total lockdown to burn this thing out

 

Why are some places, like New York, getting hit so much worse? [24:45]

See this video by Peter that explains why NY is in a dire situation and why we can’t think of Italy or the US as a whole:

  • It’s important to understand that even within Italy, the statistics are drastically different among areas (Milan vs. Rome vs. Sicily)
  • New York is looking to be in a much more dire situation compared to other cities in the US
  • Even with the most conservative estimates, Peter says it’s unlikely that NY will not get overwhelmed with ICU cases
  • Why? 
    • NY got a bad head start (i.e., they pumped the brakes too late)
    • They live in close quarters
    • Lots of public transit 

“We think that there needs to be a really important strategy of mitigation in New York and that every other city like Miami, like San Francisco, like Los Angeles and like Seattle who are next in the cross hairs, needs to be pushing the brakes a little harder.”

 

The trickle down effect of an overrun healthcare system on non-COVID related health issues [34:45]

  • When the healthcare system gets overwhelmed, other health issues people have may also go untreated potentially leading to death
  • In Peter’s practice, there are patients needing blood work done but won’t get it for some indefinite period
  • Less drastic things like root canals and other more minor procedures will be affected as well
  • Tip: Be careful not to get injured because you won’t want to have to go to an urgent care for treatment and risk getting and spreading CV

 

How to calm our minds and manage our emotions during this craziness [38:00]

-Many people are experiencing elevated stress, anxiety, and fear at this moment

-How does Sam handle this?

“If you understand the mechanics of your own mental suffering, if you understand how anxiety arises from the first person side. . . just actually able to witness it as a matter of experience, moment to moment, that allows you to get off the ride whenever you can remember to.”

-Sam says it starts with being able to recognize your thoughts and emotions and suffering

  • The recognition is a skill that needs to be learned
  • Then it needs to be practiced
  • Overtime you become more skilled
  • It’s not that you can stop negative feelings from arising…
  • …It’s that you can drastically shorten the amount of time it takes to untether yourself from them

“You want to feel fear when it’s appropriate and useful to feel it and you want to be able to release it the moment there is no point to it.”

 

Talking to kids about this situation without burdening them with undue stress [50:15]

Sam practices honesty as a core ethic in his home

  • But just because you are not lying to your kids, it doesn’t mean you have to tell them everything
  • If his daughter, for example, were to ask a question for which the answer will cause her to be anxious…
  • …”I’ll basically just acknowledge in that moment that there’s a door that’s locked that she’s trying to open, but there’s no point in opening it. I’ll tell her what she needs to know there. And that’s not the same thing as saying, ‘Oh, there’s nothing to worry about’ or giving her some dishonest answer.”

“It’s a stronger foundation for a relationship . . . because she knows now that when I say something is not worth worrying about. . .she knows I’m not bullshitting her.”

 

Insights from meditation practice—Recognize and unhook yourself from a heightened emotional state [52:00]

  • Sam says that he isn’t immune to getting emotional or angry or letting emotions get a hold of him
  • The difference is… 
  • Through mindfulness practice, Sam has the ability to “put on the brakes and get off the ride” quickly

Waking Up App

 

How to make the most of a situation where you let your emotions get the best of you [59:15]

  • Peter recently shared on social media an embarrassing moment where he lost his temper on his kids and felt subsequent shame about it
  • Sam points out that you can turn moments where you screw up into a positive
  • That feeling of shame could serve an important purpose
  • For example, that feeling of shame might compel you to give a sincere apology
  • That apology could then show your kids that it’s okay to sometimes lose control of your emotions as long as you recognize when it happens and try to improve it

 

What are some potential positive things that Sam hopes could be learned from this crisis and applied to the future? [1:09:30]

  • Sam is hopeful that this crisis might help separate out the experts from the rest who might be just making stuff up
  • He hopes that the anti-vaccine community will recognize the importance of vaccinations and perhaps slow the anti-vax movement
  • He’s hopeful that people will start to place more value in the scientific community who are invaluable in moments like the present
  • Sam hopes that people (especially those with extreme libertarian views) will recognize the essential role of government 
  • Peter adds that he hopes people will see that a public-private partnership is essential
  • Peter also says he’s optimistic that in the future, cities will take on some more of  the risk stratification and planning such that they aren’t waiting on the federal government or the CDC
  • Overall, Sam is hopeful that we’ve learned many lessons from the many things that have gone wrong in this crisis so that WHEN it happens again, we are more prepared

 

The unfortunate politics being layered on top of this crisis [1:15:30]

  • Sam says that the political layering has distorted everything
  • Sam uses the example of the controversy around the term “Chinese virus”
  • Sam says many are caught up in criticizing the president for using this term
  • And the president is surely using the term to bait his opponents into getting caught up in it
  • But the reality is that this virus did originate in China
  • And it was born of bizarre and unacceptable cultural practices of eating bats
  • And the Chinese authoritarian government did conceal the gravity of this outbreak and failed to give the world adequate warning
  • However, Democrats might be right to be worried about how Chinese people might be treated because most of them have nothing to do with this and are equally horrified by the practice of eating bats

“You can hold these truths in buffer simultaneously and not be deranged by it, but we don’t have a politics, or a journalistic community, frankly, that is showing much aptitude for that.”

 

The challenge of creating a safe and effective vaccine for COVID-19 [1:20:00]

  • This is harder to vaccinate that things like polio, measles, or smallpox 
  • The coronaviruses behave a bit more like RSV viruses which, to create enough immunity, you have to create a larger exposure
  • And the risk of the vaccine is higher—anytime you vaccinate somebody there’s a risk that they get sick from the vaccine
  • The perfect vaccine would be the vaccine for which you have no risk from the vaccine and you get perfect immunity…
  • …But the reality if you may never get there
  • In discussions with virologists, Peter says “we have to sort of caveat our optimism around how long it will take to make a vaccine for this and how safe it will be.
  • This mirrors the type of virus for which vaccines have historically not been a great alternative because of the risk reward trade off.” says Peter
  • This brings up the important point that we have to be able to discuss this stuff openly and not get bogged down in unreasonable positions
§
Sam Harris, Ph.D.

Sam Harris is the author of five New York Times bestsellers and the host of the Waking Up Podcast. His books include The End of FaithLetter to a Christian NationThe Moral LandscapeFree WillLyingWaking Up, and Islam and the Future of Tolerance (with Maajid Nawaz). The End of Faith won the 2005 PEN Award for Nonfiction. His writing and public lectures cover a wide range of topics—neuroscience, moral philosophy, religion, meditation practice, human violence, rationality—but generally focus on how a growing understanding of ourselves and the world is changing our sense of how we should live. Harris’s work has been published in more than 20 languages and has been discussed in The New York TimesTimeScientific AmericanNatureRolling Stone, and many other journals. He has written for The New York TimesThe Los Angeles TimesThe EconomistThe Times (London)The Boston GlobeThe AtlanticNatureThe Annals of Neurology, and elsewhere. Sam Harris received a degree in philosophy from Stanford University and a Ph.D. in neuroscience from UCLA. For more, see his publications and lectures. [samharris.org]

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  1. Re: Sam says…..
    “But the reality is that this virus did originate in China
    And it was born of bizarre and unacceptable cultural practices of eating bats”
    I was of the opinion that this was just one speculation as to the origin of this virus. There’s equal speculation as to the original of the Italian outbreak, and some question that it’s somewhat different to the Chinese version(s).
    I would speculate that the source may be an evolved version of the common poultry coronavirus, due to homologous vaccination of poultry against Infection Bronchial Virus (IBV), dangerous to animals and humans as predicted in this Italian scientific study:
    https://veterinaryresearch.biomedcentral.com/articles/10.1186/s13567-019-0713-4

  2. I read that the reason Milan had such a head start on Covid-19 is because there were a lot of clothing manufacturers from the Wuhan area involved in the Milan fashion industry. The virus got there early before anybody had any idea that keeping people from Wuhan out of the country was a good idea.

  3. Peter,
    Can’t thank you enough for all the data you share on your multiple COVID-19 podcasts!! Invaluable!
    Noreenf LEadbetter RN MN

  4. Dr, Attia, this is your worst podcast I listened to. I don’t see how is Sam Harris qualified to comment on many of the topics you discussed.

  5. Peter-
    Thank you for your conversation with Sam and the talk over the unsavory treatment of animals in china. To that, I posted the following on social media. Curious as to know what others think of this topic.

    When we are over the Corona virus crisis, let’s keep in mind that:
    Despite the rumors, we (Homo sapiens,) are not the center of the universe, nor are we the boss of all other species.

    Every living organism including bacteria and even viruses (not independent lives), are here thanks to an incredibly sophisticated interplay of biochemical and metabolic processes. A dazzlingly purposeful circuitry of events to enable survival and reproduction. They are no less amazing than we are.

    Our universe and our earth, with its creatures and non-living participants, took billions of years to reach this point. The interplay of all things comprises a fragile ecosystem with limited plasticity. Push it too far and it will fight back to resume balance.

    Living organisms have a niche, a habitat and a purpose on earth. They get to live their lives, the way they know how, and so do we. It is not our business, nor our right to take them away from their habitats, kill, abuse and torture to meet our purposes, for just and unjust reasons.

    We are not given a carte blanche to capture animals, drain away their bile, cut away their scales, skin, tusk; kill, pillage, imprison and abuse. It is unnecessary, it is ugly, it is cruel, and yes, it can backfire and cost trillions in wealth and endless mortality and morbidity.

  6. Peter and Sam at one time. A real treat in a difficult world!! Thanks for everything to you both. Very much appreciated.
    Greetings from Australia.

  7. Sam Harris has got his sums completely wrong in relation to Covid related deaths in Milan. A 0.2 mortality rate would result in more than 11,000 deaths. At the present moment, Italy’s entire death rate is around 7,000. There is enough misinformation out there already without public commentators pulling alarmist and irresponsible figures out of thin air. More than ever, journalists and commentators need to check their facts!

  8. I like Peter Attia but this podcast makes things even more confusing.

    In this podcast they say, “At the same time, nobody is saying there’s nothing to worry about from an economic standpoint.”

    Yes they are. Many leaders around the world by simply saying that, “things will be difficult but we can all pull through,” is a way of dismissing the harsh reality for millions of what a prolonged lockdown really is to the everyday person who is worried about paying rent, feeding their family, who is mentally in a delicate place etc…

    “Sam says many of the policymakers are also concerned but may not be expressing it properly” [Economic hardship]

    Doesn’t seem like it. Doesn’t seem like they are concerned about anything except looking like they are doing something positive in this crisis. They are not even expressing their concern for Covis-19 properly.

    On top of that governments fail to prepare for this and then put all the onus and guilt on its citizens to fix this.

    Then Sam (and others) wonder why people aren’t taking this seriously. We’re looking up at those responsible and in charge and feel their disconnect and incompetence.

    Nobody is willing to have tough conversations. It’s all “do as we say.”

    Trust is earned.

    • Regarding increasing bed capacity: I’m not sure how many beds they contain, but the USNS Comfort is headed to New York to field non-COVID patients, and likewise the USNS Mercy is docking at LA.

      While building more ventilators is a good thing, we need to GREATLY expand testing and intervene earlier (going upstream to treat earlier, so fewer people end up needing ventilators in the first place). In the US our positivity rate of those tested is over 50% which means we are still cherry-picking the sickest people to get tested. (In most countries the rate of positives is 1-8% of those tested). My German in-laws report that Germany’s secret to their strikingly few fatalities is the fact that they do very widespread testing. They catch cases early and get them started on treatment right away, so few cases become critical. I wonder if COVID+ patients with mild symptoms could be treated with chloroquine or hydroxychloroquine at home, to reduce the strain on hospitals and their staff.

      • For several weeks there’s been a lot of CoV information-sharing between physicians internationally, and non-peer reviewed “field reports” from the front lines of battle have been appearing in medical journals. Many drugs, with already-established safety profiles, are being repurposed, including those that are off-patent. As CoV spreads upstate from NYC, one physician serving a Hassidic community outside New York has combined two similar protocols, reported out of South Korea and France respectively, and he is claiming to have zero deaths and zero intubations so far among the 699+ patients he’s treated (699 as of Sat. 3/28). He granted Rudy Giuliani an interview; he seems to be quite a humble fellow, and extremely patient with Giuliani’s many detailed layperson’s questions!
        https://www.youtube.com/watch?v=1TJdjhd_XG8
        He is now swamped with patients as you can imagine, but other physicians are following suit with this very highly scalable protocol (it is claimed to cost twenty [20] dollars).
        In a separate interview Sat. 3/28 Giuliani stated,”I can’t tell you how many doctors appreciated [Trump’s] pointing out this drug [during a press conference] because they said it freed them . . .”.

  9. From the Show Notes, “Peter says it would likely take about 4 weeks of total lockdown to burn this thing out.”

    And this is just one of the reasons why people have a hard time following the quarantine orders from authorities.

    Who’s right? What’s going on? First it’s just a couple of weeks, then a few more. Then they are saying that we should be prepared to do this for many months. Now Peter is saying we can burn this out in 4 weeks. And, experts just finished reporting yesterday that we should be prepared for the 2nd wave and that this virus is not going away?

    Meanwhile, the livelihood, both psychological and financial, of millions is on the line and we are supposed to have confidence in what we are being told.

    I’m not arguing one side or the other. I’m saying that if you want people to suffer for a common good, you better be on your “A” game in terms of knowing what you are doing, and communicating that effectively. I believe that most people don’t have confidence in what the authorities are doing/saying, and they have plenty reason to doubt them. Again, not saying who’s right, just that the ball is being dropped by those in charge repeatedly.

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