Dickensian. That’s a term that rolled off epidemiologist Larry Brilliant’s tongue when I spoke to him in one more marathon interview this past weekend. He was not referring to the horrific descriptions of human suffering in the celebrated 19th century novelist’s works—though as we speak, the near-term picture he paints of our pandemic crisis does have images, of bodies stacked in refrigeration vans, that are, well, Dickensian. Instead, he is referencing the opening line of A Tale of Two Cities: “It was the best of times, it was the worst of times …”
This is the third interview I’ve done with the California expert on pandemics, who is CEO of Pandefense Advisory and was a consultant on the movie Contagion. Brilliant once helped eradicate smallpox, and also did a stint as the house doctor for the Grateful Dead. Our first talk, in March, was a welcome and well-informed stage-setter for the grim ride we faced, and was the second-most-read story in the history of WIRED. In our talk last summer, he analyzed our missteps and outlined what we needed to fight Covid-19. At the time, he and fellow epidemiologist Ian Lipkin were consulting with the Democratic National Committee on the protocols for a scaled-back national convention. (Suffice it to say that, unlike its political counterpart, the party had no superspreader events.) He is circumspect on whether he will be an adviser on protocols for a January inauguration.
With the horrific rise in Covid-19 cases and the election of a new president, I found myself seeking Brilliant’s views once more, and he did not disappoint, with a prediction of a hellish winter followed by a better year ahead. And if you are thinking of spending your 2020 Thanksgiving dinner the way an epidemiologist does, go Swanson instead of Butterball.
Steven Levy: How do you view what’s happening right now?
Larry Brilliant: I would have to answer that from two different vantage points. We are at the highest point that we have ever been in terms of cases. So from an epidemiological picture, it’s the worst it has ever been. I would say that we are at the peak, except we are rising dramatically. Tomorrow there’ll be a greater peak. This is Namche Bazaar. Everest is still ahead of us. The virus is doing exactly what we all expected. Every epidemiologist you see on CNN has warned us this will be the worst season. But we’ve had two things that have behaved differently than we expected, one better and one worse. That’s what makes this a Dickensian moment, the best of times and the worst of times.
OK, let’s start with the good things that were unexpected.
It’s not just the virus which has grown exponentially; science has grown exponentially. MIT has tracked 60,000 to 80,000 peer-reviewed publications on Covid since the beginning. That’s a huge number. And we have a vaccine that has come through a Phase 3 trial. We don’t know what the real data is until we unpack it. But my God, Pfizer’s vaccine is a circle-this-event in science. A new kind of vaccine—an mRNA vaccine—we have never had one in history. [Just after the interview, Moderna announced its mRNA vaccine has similar efficacy.] Science has proven we can develop a vaccine that not only creates neutralizing antibodies but prevents the disease. You can’t underestimate how important that is. Right on the heels of that, we have now got two good candidates for treatment—monoclonal antibodies, the Lilly one having received FDA approval, the Regeneron one shortly behind it. Right behind that we have almost 150 vaccine candidates and 150-plus candidates for treatment. And for the first time in history, in large part because of Bill Gates’ challenge, the vaccine has been produced at the same time as it was being developed. Huge amounts have been manufactured in anticipation of a positive, meaning a successful, vaccine. That is all absolutely incredible. And then one last thing. People have been saying for a long time to use antigen tests, but for the most part they have been worthless. Now they’re not going to be worthless anymore. We are on the eve of Crispr-based rapid tests, LAMP-based rapid tests, and improved antigen tests. I want to put all these things together—vaccines, increasing testing, increasing treatment.
So what is the unexpected bad news?
First the biological bad news. This virus creates a disease that is godawful. There are long-haul effects. Everybody who has gotten Covid is likely to have a preexisting condition in the sense of insurance, and we don’t know what that means yet in terms of our health care system. There will be people who will never return to who they were before. We still don’t understand the pathogenesis of this disease. And one really sad thing for me as an epidemiologist is we’ve now got rabbits and minks and cats and nonhuman primates who are able to get the disease, carry the disease, spread the disease, and in some cases spread it to humans. In other words, there may be animal reservoirs that make it theoretically impossible to eradicate this disease.
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But here’s really the worst thing. Back in March, every epidemiologist would have agreed that if we got a coronavirus spillover into humans, this is about what would have happened. But no one could have predicted such incompetence in the government of the United States of America. Nobody would have expected the manipulation of science for political aims. And, worse than all of that, ignoring the pandemic as if it didn’t exist. It’s frustrating to the docs working in emergency rooms and ICUs to watch patients die in front of their eyes and then have to go out and listen to the politicians. You have the governor of North Dakota saying that if you’re a nurse and tested positive for Covid [without symptoms] you have to go to work anyway. And what about Trump, who hasn’t even thought of a way to deal with the pain and sorrow?
He’s apparently being advised by a radiologist named Scott Atlas, who has spoken about pursuing a herd immunity strategy.
Atlas is, along with the whole Great Barrington group, holding up the white flag. [The “Great Barrington Declaration,” named after the Western Massachusetts home base of a conservative think tank, advocates “life as normal” for most of the population so the disease can take its course.] What kind of a craziness is that? They don’t understand what herd immunity is.
I am living near that town these days. And, by the way, people wear masks in Great Barrington.
I do think it’s wrong to say that Trump is being advised by an individual, as if there is a Svengali there. I think Trump is selecting someone who is saying something that he can latch onto as an excuse for shedding himself of the blame and the responsibility. But it’s not just Trump. This the age of pandemics and the rise of autocrats and nationalism and provincialism. It’s a terrible combination. Every year we are seeing one or two or three novel viruses jump from chimpanzees or bats or rodents or rats. With modern transportation, it’s just a few hours from a virus jumping from one animal to one human, to it being all over the world.
Let’s talk about the vaccines. As you mention, the Pfizer and Moderna vaccines are close to expedited approval. Can we trust them? Would you unreservedly say you would put your name on the list to get one of those?
Where’s the list? Of course I will.
Well, as you know, the list is up in the air, since the person in charge of the government beginning January 20 doesn’t have access to the plans that the current government has to distribute it.
In my dark days, I think that Trump is hanging on in order to get control of enough vaccines for his family. But seriously, the list is actually published. It’s from a committee of the National Academy called the Committee on Equitable Allocation of Vaccine. They put out a cadence of first responders first, high-risk individuals and nursing homes second, other high-risk individuals, all the way down so that everybody is on that list in some order.
Is that list the one that we’re actually going to use? Will the Biden administration adopt that?
If you have an ethical government, yes, I think that that will become the guideline. That’s how it’s done.
You participate in calls with the World Health Organization, which the president wants to abandon. What are they saying today about what’s happening?
Well, what they are saying after the election is “Welcome back, America, we’ve missed you.” They know that Biden is going to rejoin the WHO. But it’s not just the technical membership or even the money [that makes a difference]. It’s the camaraderie and the sharing of best practices.
With the rise in cases now, should we be having more lockdowns?
Ah, the lockdown question. No. If you eliminated the politics and if you were mindful of the economics, a decision could be made that was based on epidemiology or medicine rationally. But you can’t eliminate the politics or the economics, can you? One of the few things Trump says I like is that the treatment can’t be worse than the disease. He is saying that as an excuse, but there is an element of truth to that. Since I’m quoting people, let me quote the wonderful Tony Fauci, who said the cavalry is coming.
The cavalry might be coming, but they’re like a couple hundred miles away and we’re surrounded now. That didn’t help the people in the Alamo.
No, no. It’s three to six months away. So the question is, what do we do for three to six months? You ask yourself, where are these superspreader events, where are the clusters? You can’t see them because there’s so much disease, you can’t penetrate through that cloudy mist. But we do know in general that people standing at bars, romancing each other with no mask on and a glass of wine in their hands, are superspreader events about to happen. We do know the danger of small gatherings in homes around Thanksgiving time, when people let down their mask and let down their guard. So we could say that any face-to-face activity indoors that lasts more than 15 minutes, that that’s got to be postponed until the cavalry—the vaccines—actually arrives. But there’s a lot more things we can do now too. We now have protocols. You can have Hollywood productions go on and no disease transmitted on those production sites. We were able to have a Democratic convention that went on with no disease transmitted because people wore masks, they socially distanced, they closed every other stall in the bathrooms, they installed MERV-13 or 14 filters. So you don’t have to use a shotgun and close the whole economy, which you had to do back in March, April, and May. You can do a series of rifle shots, do more pinpoint closings and mandates. We need to arrive at a point where 85 or 90 percent of people are wearing face masks all the time. That’s the single most important thing that we can do, and they have to be the right face masks.
Are you in touch with the Biden transition team?
I am. There’s phenomenal people on his Covid committee. The task force is making plans, they are writing protocols about what are the air vents that you need, and the filtration systems, and what cadence of testing is best if you’re going to travel again. They’ve got little groups that are working on all those things. But they’ve only been in existence for about a week. Maybe they’ve had one or two or three Zoom calls, maybe in small committee groups. It’s just starting. But they’re not going to be like Trump’s task force, which was all show and no dough.
Do we need to do a deep cleaning of the White House?
Are you asking that since the White House was ground zero for a disease-ridden outbreak, does it have to have a deep clean? Well, it has to be made safe. Not just coming in with Clorox, it’s not a deep clean like that. But what are the air-filtration systems, are they adequate? How about the toilets, when you flush them do you create an aerosol? Still, most transmission occurs by droplets, human to human. The best thing you can do to make the White House safe is to remove the people who are spreading the disease.
Each time I’ve talked to you, you’ve been very frank about the seriousness of the crisis but optimistic we’ll get out of it. But how do we enter this holiday period, when the calvary is not here yet?
Every time you and I have talked, I’ve said it’s going to be years. And every time we talk, you hope that somehow it had changed to be months. It is going to be fewer years today than it was when the first 10 cases started. So I think there is more evidence that we will be OK than evidence that we won’t be OK. I’m worried about the bunny rabbits and the minks, of course, but I’m not worried that we won’t get a vaccine at all. I’m not worried that we won’t ever find a treatment. We never had a treatment for smallpox. This could have gone that way. We don't have a vaccine against HIV/AIDS. It could have gone that way. And we are getting rid of Trump! I wish I could say that’s not a political statement. When I get on CNN and I criticize Trump, I criticize him only in my lane. He has been terrible for this pandemic. And you need to have a leader who’s going to be good for the pandemic to make an epidemiologist happy.
So you are saying we should not be gathering to see our loved ones this season.
My recommendation is to have two Thanksgivings in 2021. Or make the entire year a year of Thanksgiving. And I mean it. We are going to have a Zoom Thanksgiving, we’re going to have a Zoom Christmas, a Zoom Hanukkah, a Zoom New Year’s. As of today, I’m even wavering if I can go out into the wilderness, which is what I’d love to be able to do for a week. Not because I’m worried about being in the wilderness, but you’ve got to get there.
The sad thing is that there’s a couple hundred thousand people who are alive now who are going to die from this before Thanksgiving 2021.
That is the saddest thing, but it’s not the only sad thing because millions of people who have it will have a shorter life expectancy in the long run, comorbidities, other diseases, other knock-on consequences of this long haul effect. I’m hard-pressed to find a disease that has done more damage than this one. It is already the second or third leading killer in the United States this year after only heart disease and cancer.
That is as dark as I’ve heard you speak.
It’s going to get worse before it gets better. I see a period of time when we’re going to see refrigerator trucks in front of hospitals and not have a place in the morgue for the bodies that are going to show up. Deaths lag cases by three to six weeks. If we are going to hit 160,000 cases a day and you’ve got a 2 percent death rate of cases, you’re looking at 3,000 deaths a day. And if we’re at 67,000 people in the hospital today and we are approaching capacity, where are you going to put the bodies? Where are you going to put patients? This is going to get worse. Thanksgiving is going to be an accelerator and Christmas is going to be an accelerator. And how are we going to feel as a nation when we go into the holiday season? People are going to feel really bad. So it’s hard for me to say to you that there is an optimistic side to this thing when I know the next couple of months are going to have really dark days. But we have cut several months—years—off the period of time that this virus will affect us, despite godawful governance. We do have the tools coming on board. It’s not Pollyanna. The cavalry really is coming.
Larry, I hope when the cavalry arrives we will be fully vaccinated and be able to have a drink together.
I actually think we will be able to do that. There will be pockets of the United States doing that in the early summer. Instead of next year in Jerusalem, let’s say next year in Barrington.
Make Barrington great again.
I love that. Get Barrington its reputation back.