Q&A with public health expert Nicholas Christakis

Nicholas A. Christakis is the Sterling Professor of Social and Natural Science at Yale University and a well-known public health expert. He is also the Co-Director of the Yale Institute for Network Science and the director of the Institute’s Human Nature Lab.

After a public Zoom conversation on the COVID-19 pandemic with McCormick Professor of Jurisprudence Robert P. George, hosted by the James Madison Program in American Ideals and Institutions, Christakis spoke with The Daily Princetonian about how states and countries have responded to COVID-19 and where the current U.S. response falls short.

This interview has been condensed and lightly edited for clarity.

The Daily Princetonian: What are your thoughts and assessment on the state-level responses within the United States?

Nicholas Christakis: The lack of federal coordination has clearly harmed us. At the state level, we could have prepared as well. It’s very difficult for governors to take action because, often, there’s not a lot of political will to do it. It requires tremendous leadership; you have to tell people that there’s a lurking threat, that we cannot see it, that we are at the flat part of the exponential curve but if we wait until the curve deflects, it’ll be too late. Governors eventually started to act, but they did it in different ways at different times.

One of the more interesting contrasts in the nation is between Kentucky and Tennessee. Kentucky took stronger action earlier in the course of the epidemic. Tennessee is really exploding in terms of its cases while Kentucky is not. There’s plenty of ways that government at multiple levels has not been as prepared as it should be, and we can clearly do better.

DP: You mentioned the variations between the measures taken by different states. How big of a difference can be made by differences in terms of speed and the kind of response taken? How little does it take to make a big difference?

NC: Some interventions have a bigger effect than others. For example, closing borders generally doesn’t have much of an effect. The reason is that, by the time you are aware of the threat and are starting to close your borders, it’s already too late since the pathogen has already crossed the border and into your terrain, though there may be some exceptions such as island nations or particularly isolated places. The idea that we are going to start closing borders within the United States is preposterous; it’s not going to stop the flow of the pathogen.

But other measures, like closing schools by a week or two weeks early, can make a big difference in an epidemic. I think we can even see some suggestive evidence of that in the United States now. I think New York City would not be as bad as it is right now if the schools had been closed earlier.

There’s reactive school closure, which is closing a school when you’ve experienced an outbreak in the school, and there’s proactive school closure, which happens even when you haven’t seen an outbreak in the school yet. If you are prepared for a reactive school closure, you’ve got to ask yourself: why not close the schools now and get the benefit of closing it two weeks earlier?

DP: The U.S. is now the epicenter of the coronavirus in terms of confirmed positive cases. However, there are other countries, like India and Brazil, that are still earlier in their stages of the pandemic. Prime Minister Narendra Modi of India shut down the entire country while President Jair Bolsonaro of Brazil is taking a very opposite mentality by downplaying the danger posed by the virus. Where do you think these two countries will stand a month from now, and what is your assessment of their responses?

NC: I think they are both going to be in serious trouble for different reasons, and I am very worried about what’s going to happen in the southern hemisphere. The virus is going to move south in the summer months, as is typical of respiratory pandemics, which move from hemisphere to hemisphere. I think we are going to have serious outbreaks in both of those countries for a variety of reasons.

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DP: Can you talk about some of those reasons?

NC: Each of these countries has different strengths and weaknesses it brings to the problem. I think the strategy of Brazil to take it on the chin is not going to work necessarily unless it’s prepared to tolerate a great number of deaths, which it might be. In India, I think even if they start reducing the number of coronavirus deaths, I am reading that there are huge numbers of people that are literally starving out because they have no wages, so it’s not an easy problem in either of those countries.

DP: Now, another phrase that has been thrown around very frequently is the strategy of “test and trace.” Supposedly, it’ll allow us to track down the individuals who are positive cases and to allow the rest of the population to return to the economy. How far are we away from being able to achieve “test and trace”?

NC: Months. We are months away from being able to do the South Korean system. Our public is not prepared for that. We don’t have the testing facilities. We don’t have tests. We don’t have the personnel to do the tracing.

So, we would need public buy in. We would need public health personnel and equipment. We need computer systems and tests. We would need a lot of infrastructure to do that, and it’ll take a lot of time to set that up. But I think people will suddenly be willing to do that if that’s what allows the economy to get back on track.

DP: When it comes to medical personnel, if we really do have a shortage or even a very severe shortage of personnel in this country, how can we make up for that problem?

NC: ICU nurses, historically, can physically manage two seriously ill patients at a time. You can stretch that out a little bit. You can shift some of the duty to other personnel like respiratory therapists; medical schools are rushing to graduate students so that they can become interns, but we are limited.

I think the bottleneck is going to be the personnel that can take care of people on ventilators. There’s no way around it. I don’t know if it’ll be possible to get enough humans that can operate this equipment fast enough. I’m imagining some hospitals are probably doing crash training programs as well. So, you know, that is going to be a challenge.

China contained the epidemic in Wuhan by busing in health care workers from around the nation. Whole teams of medical workers were transported into Wuhan. It’d be as if you took all the doctors and nurses from a Philadelphia hospital, built a hospital in New York City, and just moved them there. That’s the kind of thing China did. I don’t see that happening in the United States.

DP: What do you think is the currently the most harmful misinformation being spread about the coronavirus, either online or otherwise?

NC: I think the most harmful intellectual posture is a kind of American exceptionalism or complacency that says we can have our cake and eat it, too — that suggests we don’t have to make any sacrifices to fight this pathogen. I don’t know what makes us think we are so special. The ultimate outcome of this is that it will become endemic.