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#27 – COVID-19 Worst Case Scenarios, Infection Fatality vs. Case Fatality Rates, Antibody Testing, and the Asian Response with Dr. Spencer Wells

More COVID-19 discussion. Dr. Spencer Wells returns to the show to discuss the dropping COVID-19 infection fatality rate, possible economic forecasts and the outlook for a vaccine. This is not an episode for the faint of heart!

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This Episode Covers:

  • When will COVID-19 “end”? [6:45];
  • Is COVID-19 an infodemic? [10:00];
  • COVID-19 waves and what to expect [16:50];
  • Understanding case fatality rate (CFR) [23:30];
  • The possibility of bank failures [30:00];
  • The rise of Asia [35:00];
  • How to avoid further catastrophe [40:00]


Dr. Spencer: But the CFR in Mississippi and Louisiana and Tennessee and West Virginia is gonna be way higher than that, way higher, because of preexisting conditions. I mean, the hardest hit places in America are gonna be the poor places. That’s the reason the African American populations are being hit at three to four times the rate of other ethnic groups in America, you know. It’s access to healthcare. It’s obesity. It’s Type II diabetes. It’s all sorts of preexisting conditions.

John: Welcome to the Gene Food Podcast. I’m your host, John O’Connor. Hey everybody. Today, we have Doctor Spencer Wells back on the show. He came on a couple episodes ago and did the Looking into the Coronavirus Crystal Ball episode. Spencer is a PhD in Biology from Harvard. He is credited with being the catalyst for the consumer genomics testing industry through his work at National Geographic. He’s written books. He’s hosted television shows through National Geographic, where he was an explorer in residence for a number of years. His nickname is Indiana Genes, very well known, very well respected population geneticist. We had a popular episode with him the last time he came on.

Today, I am recording this introduction after having spoken to Spencer from Indonesia. He is a good friend of mine from the time that we were in Austin. And we get into a whole host of different topics. One of the things that I wanted to talk with Spencer about are these antibody studies which are coming out, which I think of as being a positive piece of science and a piece of research because they’re showing that the infection rate for COVID-19 may be actually far greater than the case count that we see on television. I ask him whether the prevalence and the spread of COVID-19 in communities like Santa Clara County, Los Angeles, New York city, and Miami, and the fatality rate dropping as a result is cause for optimism, or if we still need to be concerned about COVID-19.

We talk about where the disease spreads, indoors versus outdoors scenarios, if and when we’ll ever be able to get back to normal, the cases of India and more humid tropical hot nations, and some of the biomarkers that are associated with very problematic cases of COVID-19. I will tell you that Spencer is somebody who we love because he’s authentic, he’s not pulling any punches, he’s candid, he’s gonna tell you what he thinks. This is a very, very open conversation about the state of both the illness itself and the science surrounding testing, but also what the economic impacts are likely to be or could be. We’re both business owners. He owns a music venue in Austin. And I’m still digesting it as I record this introduction. It’s a very, very, very, very, very, very, very, very intense conversation. And for those of you who are tuning into this podcast for our normal nutrition insights, I will tell you that it gets a little bit political and some of his predictions are rather dire.

So if you’re looking for something that’s a little lighter and maybe good news on Coronavirus, if there is such a thing, this may not be the episode for you. But if you’re looking for somebody who is a very thoughtful and very brilliant scientist giving his take on where he sees things going, you’re gonna get a lot out of this episode. Without further ado, here is Doctor Spencer Wells coming on the Gene Food Podcast for round number two.

So we got Spencer Wells back here. Last episode was a really popular one. What I’m hoping to get from you today, Spencer, is permission to be a little bit more optimistic about the actual severity of COVID-19. I don’t know if you’re gonna give me that, but I’m hoping that you will. I just think people are too negative about COVID-19 right now, based on some of the antibody studies that are coming out of Santa Clara, LA, New York City. How bad should we think of this right now?

Dr. Spencer: Well, so… Okay. The antibody studies, I’m glad that the U.S. has finally gotten those online. I’m glad that they’re being widely deployed, and that we’re getting some of the numbers in. It’s preliminary data. But at the moment, you know, this is something I’ve said all along. There are a huge number of people that are asymptomatic who’ve been infected with this. And so, it’s both good and bad. It’s good from the perspective you’re thinking of, which is if there’s so many people who’ve been infected and so few people who died in comparison, that drives down the mortality rate. So that’s good. But on the other hand, a huge number of asymptomatic people creates a reservoir to reinfect new people. And so, you know, this is the issue I’ve been talking about for, you know, a month now.

The only way to reopen intelligently is to create risk pools. And unfortunately, risk pools in America drive out probably two thirds of the population. You know, we know that the greatest risk factor for hospitalization in the New York infections was obesity, you know. And America is the most obese nation on Earth. So, it’s projected to hit nearly 50% obesity rate in 2020. So everybody over 60, I would say, everybody with a BMI greater than 30, needs to stay isolated. And that’s still a huge number of Americans. And then, the people below 60 with a BMI below 30, we need to be testing them for genetic factors because we know that healthy triathletes in their 20s can also crash and die within a few days.

And so, there’s certainly genetic factors that contribute to the heterogeneity in outcomes. But yeah, I mean, it’s positive in some ways and negative in some ways.

John: We see the Miami study in particular that came out. And I don’t know how great of a study it was. I know these antibody tests have problems. And when you look at it, states like Florida that everybody predicts were gonna have these huge, terrible outbreaks of COVID-19, the actual fatality rate based on these antibody studies is like 0.1%. What do we do with that?

Dr. Spencer: Yeah.

John: What do we do with that?

Dr. Spencer: Well, remember that mortality is always a lagging indicator. And so, you know, people who are infected now are not gonna die now. They’re gonna die in three weeks. And this has not been going on that long. And this is the point I’ve been trying to make to America for weeks now, is that this is not gonna be over by Easter. This is not gonna be over by the end of April. This is not gonna be over by the end of fucking August. This is something that I think is gonna go on well into 2021, if we’re lucky. And if we don’t do a good job, it’s gonna go on into 2022 or possibly even 2023, because multiple waves… We’re seeing this in Asia now. So, the Asian countries dealt with it so well at the beginning. And they cut off that first wave and flattened the curve. And they started to release people back out. And the second wave pops up. And remember that the second wave in the 1918 flu pandemic was much more fatal than the first one.

John: Yeah. I just think you could have two things being true at the same time. This is my sort of perspective on this right now. One, you could have this being around for 2021, 2022. I think there’s a good chance that this is around in 2030. But maybe…

Dr. Spencer: Oh yeah. Listen, I think… So, the WHO… This is probably the most important thing that I tweeted in the last 24 hours. And, you know, I try and stay on top of the news so, you know, I think I have a pretty clear sense of the big stories coming out. The WHO said that we should not be creating immunity passports because we now know that people can be reinfected. It’s just like the seasonal flu, you know. This is another thing I’ve been saying. It’s like there’s no simple vaccine to this. And so, you know, people are gonna be reinfected by different strains. It’s a huge genome, as we’ve talked about. It’s 30KB of RNA genome. And it has all of the issues that go along with having an RNA genome rather than a DNA genome in terms of replication errors.

The amount of variability in the antigens is enormous. I mean, if we have a billion people infected by the end of the summer, which I think we will, you know, the level of variability is such that, you know, some of the strains will be almost unrecognizable from the original strain that broke out in Wuhan in November.

John: Now this is something that you kind of can’t say on Twitter. You and I are chatting as friends so I’m gonna say it here as part of this interview. What if you were to plot the rise of flu cases…? And I’m not saying this is the flu. I’m not saying this is the flu. I’m not, not, not saying. This is clearly [crosstalk 00:09:13]

Dr. Spencer: No. The flu is a good proxy. I mean, we all have to draw comparisons in this. And flu is a good proxy.

John: So if you were to just… The problem I have is we’re gonna get into the social impact. But it’s like you get on Twitter, you see the graphs going up. And they’re troubling. I mean, they’re very troubling. There are cases [crosstalk 00:09:28]

Dr. Spencer: The U.S. hasn’t flattened at all. And yet, they’re reopening.

John: But what if you [crosstalk 00:09:32]

Dr. Spencer: It’s utterly insane. And we’ll talk about that when we talk about the social stuff. But anyway.

John: We’re gonna get into that. My whole thing is I wonder what the social and economic impact would be if you started really aggressively testing for flu. Nobody’s testing for flu. This guy, Doctor Ioannidis at Stanford, made this point like two months ago. He was pilloried on Twitter for this. But he’s saying, “Look. You don’t test for flu. You don’t know how many people actually have flu. You don’t actually track who’s dying from flu. You don’t have good data. So it could be that the flu rate, the infection fatality rate of flu is actually a little bit higher than what people say.” What would happen to the psyche of the public if you were showing this constant rise of flu every year? So, I guess the question for you is, how much of this is pandemic and how much of this is infodemic, if any?

Dr. Spencer: I think it’s a combination. I mean, listen John, you and I have talked about this offline. And I tweeted something about this yesterday. I’m like, in the simulations people at the WHO and the CDC were running, and, you know, this is why it’s not a black swan event because everybody knew it was coming, but would you ever have guessed that a virus with a 1% fatality rate could utterly bring down the hugest economy in the history of the world in less than three months?

John: No.

Dr. Spencer: I mean, that’s the issue. And this is why I’m much more concerned about the social effects. But no. I mean, this remains a very, very dangerous virus for some people, not for everybody. But the problem is we don’t know. Who are the people who are most likely to have their insides reamed out? I mean, the way this infects and destroys your body, and the long term effects even if you survive after being on a freaking respirator, you know, your lungs are damaged for years, possibly for the rest of your life. It infects your brain. There’s evidence that it infects your testicles if you’re male. And it may affect fertility, all sorts of things. Like, this is not the seasonal flu. It’s not.

John: It’s definitely not. I mean, you can see it in the number of people that are dying every day in New York. It’s clearly hitting some people in a different way than others. We talked about obesity, hypertension, diabetes. There’s studies out of Wuhan that people that have higher C reactive protein are more likely to be…to succumb to the virus.

Dr. Spencer: Well, CRP is a sign of inflammation, as you know, you know. If you have preexisting inflammation for whatever reason, then of course you’re gonna react negatively to any infection.

John: Right. But then the… So the thing is, is we can just state it for the record, and just everybody can agree, not the flu, far more deadly. You need protocols in place. It’s not to say that these protocols that have been taken are in some way an error. Clearly, they were needed. Especially when you have unknowns, you need to err on the side of caution. But we have a situation now where, you know, the beaches in California are closed. And yet, Scott Gottlieb is tweeting out studies from Wuhan that show, “Look. You’re not gonna get this outside. You’re just not.” So, what’s the…

Dr. Spencer: And that’s the reason the wet tropics, like I’m living in now in Indonesia, I think we’re gonna come out of this pretty well, honestly. You know, are we gonna have cases in slums where people are packed in and they’re all breathing the same air? It’s stuff that we’ve talked about before. Of course we will. And the same thing in India. But, you know, if anything, India is the anomaly that shows us the most about how this is transmitted, because… I said there were two anomalies a couple of weeks ago, Sweden and India. Sweden’s now no longer an anomaly. Sweden is like England, you know. It’s basically like a fucking raging pandemic because they decided not to lock down. India is still an anomaly.

I mean, this is a country of 1.3 billion people. And it has had tracked infections for a month now. And they haven’t exploded. Indonesia has had infections for over a month now. And they haven’t exploded. And, you know, in part, that’s because of the lock-downs and people are wearing masks and everything else. But in part, you know, it’s this same point I’ve made before which is that, you know, if you’re outside, you’re 18 times less likely to transmit the virus to someone than if you’re in some sort of air conditioned office space, sitting next to them at a cubicle. And so, I think the poor tropical world, oddly enough, are better prepared for this, not through any planning that they’ve done, but simply the nature of their existence. People don’t live in high tech air conditioned apartment units. They don’t go to work in closely crammed office cubicle spaces the way you do in Atlanta and Houston and, you know, Washington, DC.

And so, you know, some people in the U.S. are talking about, “Oh. Well maybe summer will save us.” No. Summer in America means everybody’s crammed into these cool, dry spaces, which promote the spread of the virus. So if anything, the next wave is gonna come in the summer in America.

John: Due to the air conditioning issue?

Dr. Spencer: Yeah, absolutely. I mean, if people opened their windows and worked outside, they’d be safe. If they wore masks everywhere when they left their homes, and they kept their windows open all the time, and they maintained, you know, 6 to 12 feet between themselves and another person wearing a mask, there would be no transmission. And that’s what’s happening in Indonesia. America is not gonna do that. We’re addicted to air conditioning. And so is Singapore. And that’s the reason why Singapore is now the hot spot in Southeast Asia. Everybody said, “Oh. Indonesia’s gonna be the craziest spot.” No fucking way. Singapore is the scariest place in the entire region now. And that’s the most advanced country, with the highest usage of air conditioning. Everybody hangs out in hotels, offices, and shopping malls.

John: So the message is, if you’re gonna do something do it outside. But I think the message should also be to the people that are creating policy, that if you’re gonna be out…that activities that are outside should be encouraged and not shut down. So let me, before we get into the social impact, read this tweet today from…I can’t… Balaji Srinivasan, Nate Silver replied. He says, Look. “This virus may end the late 20th century way of life. Large physical gatherings of strangers will be viewed with concern from here on out.” This means that political rallies, concerts, events, restaurants, dense cities, they’re all going to end. You know, it’s like it’s over.

And that’s what you get on Twitter all the time. Well, Nate Silver replies. And he goes, y’all can do whatever you want but I’m going to a F-load of concerts, baseball games, restaurants, etc., as soon as this is over. I love Nate Silver.

Dr. Spencer: What’s over? What does over mean? And this is a question I feel like policymakers are not addressing intelligently. You know, how do you define over with something that is now endemic? This virus is like the flu now. And it’s gonna come back in waves, in the future, every season. We hope it’s seasonal because we want to be able to get out and live our lives when it’s not infecting everybody. But it’s got, you know, a low mortality rate as coronaviruses go. We’ve talked about this before. SARS is 10 times higher. And MERS is 30 times higher and much scarier. This is not Ebola. But it’s higher than seasonal flu. And so, you know, we can only hope that it becomes seasonal. And we can only hope that we have a series of amiable vaccines in the way that we do for seasonal influenza. But what does over mean in that situation? Like it’s never gonna be over. It’s a question of society adapting to it.

John: Yeah. I think you could say, viewing Nate’s comment in its most favorable light, that over means lock-downs are over. It’s more of a known quantity. We have these serology studies which show that the infection fatality rate is not nearly as high as maybe was reported in the press at the beginning of this. And so, there’s a little more of a comfort. And so, do you wanna go to the Ohio State Michigan game outside? Yeah. I would go to the Ohio State Michigan game outside.

Dr. Spencer: So, the point I made on… I did an interview with Vance Crowe, the second one I did with him, on his podcast on YouTube about a week ago. And, you know, I said that the only way we’re gonna be able to get out of lock-down is we have to create these risk pools, as I mentioned before. And honestly, I feel like anyone over the age of 60 is probably on lock-down for the duration because the mortality rate goes up so drastically after age 60 that it’s not worth taking a risk. This is not the seasonal flu if you’re over 60. This is more like fucking SARS or Ebola, especially if you’re like over 70 or over 80. Like, no. And again, there are so many asymptomatic carriers who can infect you that, you know, if you’re a 77 year old who’s in otherwise decent health, who decides to go to the grocery store, and someone coughs near you, some 20-year-old who’s asymptomatic, you’ll die. You know? There’s a very good chance that you’ll die. And that’s a risk that…

It’s a kind of existential risk that I don’t think anyone is used to living with. You know, as you get older, of course you realize that death is certain. And we all have to come to terms with that. And there’s religion and philosophy, and writing, and all sorts of things that people use to deal with that impending doom. But this is something that…you know, it’s like you do all the stuff you’re supposed to do in your life. You exercise. You eat healthily. You, you know, don’t smoke. You go to bed and get plenty of sleep early, and all this other stuff. And this just rears up out of nowhere, unexpectedly, and it can kill you. And so, that’s a very different world. And that’s a world that I think we are gonna have to live with moving forward, indefinitely, until there’s a series of vaccines. And, you know, I tweeted something today about I think this is the solution.

And it’s a very complicated mathematical model about how, you know, multiple doses of flu vaccines tend to reduce the, you know, morbidity of the flu and the antigenic variation, and everything else. And I won’t get into it in detail, but there’s no short term fix is what I’m saying. Like there’s no single vaccine that’s gonna appear magically this fall that’s gonna protect everybody.

John: But do you see…do you think we could have something that can do a flu shot, where you take it in for, I don’t know, 70% of people, it makes the flu less severe…

Dr. Spencer: So I… If you have… Do you have show notes for this?

John: I’m gonna add show notes to the…yeah, to the website page.

Dr. Spencer: Yeah. So, I’ll give you the link to that paper. It’s actually very interesting because it’s almost the opposite of what I would have predicted, that vaccines would drive viral evolution away from an antibody response. But in fact, what they do is they tend to reduce the antigenic variation and the morbidity associated with the flu infections. But it’s something that only happens after a series, like annual flu vaccines for two decades. And so, you know, this is something where, if we want to get to the point where everybody can go out of the house, there are gonna have to be mass vaccinations, forced mass vaccinations. I’m not talking like, you know, “You get to take the vaccine at CVS if you want it.”

This is like hold a gun to people’s heads and everybody lines up like they did for polio in the 1950s, like they do in, you know, West Africa for, you know, a lot of these horrible viruses that appear in Africa. Everybody gets a series of vaccines over the course of several years. And that is the only way to, I think, get out of this in a way that allows people over 65 to ever come out of their homes again.

John: Wow. Okay. And so, in light of all this…

Dr. Spencer: Just to lighten things up for you there.

John: Yeah, just to lighten. It’s only 8:30 a.m. here. I haven’t even finished my coffee. But no, it’s all good. No, it’s freaking crazy is what this is. It’s absolutely insane. I just…I’m clinging to more…I’m clinging to these serology studies and the prevalence of the spread because I think that it’s the most optimistic line in the news that’s out there, which is that it’s spreading far wider than we thought. Even if everything you said is true, it would be nice to have some recognition on television that the case counts that they constantly list, and the case fatality rate that’s based on that case count, is actually totally inaccurate. And it’s putting even…

Dr. Spencer: It’s not totally inaccurate. Listen John, I mean, everybody who studies epidemiology and virology knows that when you have a new zoonotic outbreak, when you have… So, this is akin to small pox being introduced into the Americas in the year 1492. Okay? And so, you’ve got an immunologically naive population, i.e. the entire population of the world in this case. But in that case, it was the entire population of the Western Hemisphere. And they have a novel virus for which they have no natural immunity that’s been built up. They haven’t had that, what I was just talking about, trying to create artificially with a series of vaccines in the course of many years, they haven’t built that up in their population yet.

And so, CFR is the only thing you can measure at the beginning, because you’ve got like…you can test for the bug and you see how many people are dying. And so, that’s the only statistic you have. But everybody who studies epidemiology knows that CFR is an overestimate of mortality rate. And so, we always knew that that initial 2% to 3% would come down. And it’s, you know, 1%-ish, maybe it’s less than that. Maybe it’s 0.7% or 0.5%. Remember though that that depends very much on your access to healthcare. So, your mortality rate in Ecuador is way higher than it is in Germany. And that has nothing to do with the nature of the bug that’s infecting you. That has everything to do with your access to healthcare. So, you know, mortality rates depend on a lot of things. CFR is our actual measurable statistics.

John: I cling to that because dummies like me, we see the case fatality rate getting reported on CNN. When I hear… Being in nutrition, it’s funny for me to see epidemiology now being lionized because epidemiology is something that gets completely shit on all the time in nutrition conversations because of food frequency questions.

Dr. Spencer: Of course it does.

John: But…

Dr. Spencer: The whole correlation-causation thing. I mean, the gold standard for any study of any disease is a longitudinal study, as you know.

John: For sure.

Dr. Spencer: But those take so much time and they’re so expensive that literally only a handful of them have ever been run, you know. So, yeah, you know this.

John: Right. But the reason I cling to this…so I cling to this as a layperson because when I see these headlines I think, “Oh my god. The World Health Organization is saying that this has a 3.5% fatality rate.” And it scares the crap out of me.

Dr. Spencer: It depends on the country you live in.

John: Right. But then…

Dr. Spencer: It’s like we just discussed.

John: Contextually…

Dr. Spencer: It does, it does in some places. You know, it probably will be close to 3% in Indonesia. It’s probably 3% or more in Ecuador. But it’s under 1% in Germany. You know, it depends on your access to all of those things that we use to treat and detect this, and to help people survive it.

John: And where does it end up in the U.S., do you think, the overall fatality rate?

Dr. Spencer: Overall? I am very [inaudible 00:26:10] about the prospects in the U.S., not because I think the coasts are gonna be hit hard. I think the CFR in California and Oregon and Washington and New York and, you know, DC, will be 1%-ish. But the CFR in Mississippi and Louisiana and Tennessee and West Virginia is gonna be way higher than that, way higher, because of preexisting conditions. I mean, the hardest hit places in America are gonna be the poor places. That’s the reason African American populations are being hit, you know, at three to four times the rate of, you know, other ethnic groups in America. You know, it’s access to healthcare. It’s obesity. It’s Type II diabetes. It’s all sorts of preexisting conditions. And so, the CFR in America’s gonna be much higher than it is in places like Germany. I guarantee it. Overall, as a country, it’s gonna be much higher.

John: And important for listeners who are, you know, tuning in and not kind of up on these acronyms, IFR is different from CFR. Infection Fatality Rate is the total number of people that are infected and die. And then, the CFR are really the sickest people that, as Spencer is saying, require hospitalization and have the most acute cases. So, let’s…

Dr. Spencer: And I just wanna reiterate what I’ve said to you, what I’ve said in other forums as well, the U.S. has 4.2% of the world’s population. And it currently…and this has been stable for 2 or 3 weeks now, it currently has one third of the confirmed cases, 4.2% versus 33%. That’s a sign that something is not going well. You know, the fact that that number has been…that ratio has been stable for this long, it’s a sign that things are not being done properly in the U.S. And this is why I’m negative about, you know, the outcomes in the U.S.

John: Wow. Yeah, it is quite a quagmire. But let’s… So, aside from the actual case fatality rate, infection fatality rate, all these kind of issues that are well traveled, you have a lot to say on the economic and social impacts, which you could argue, regardless of whether you’re a little rosier on that outlook or a little more negative, that ship has already sailed out of the dock, economically, because of these measures that have been taken already. So, how do you see this unfolding economically? I’m guessing not good.

Dr. Spencer: What do you know about the fractional reserve rules for banks?

John: Very little, very little.

Dr. Spencer: So, fractional reserve is set by the federal government. It’s set by national governments. It’s basically the percentage of cash that banks have to keep on hand to deal with their outstanding balances. And historically, since 2008, since the crisis, it’s been like 10%, 15%. When there’s times of crisis, the Fed will urge banks to increase that. But, you know, it’s relatively low because banks see outstanding loans as income streams. And so, you want to encourage them to get money out into the economy. At the end of March, as a response to how serious this is economically, the Fed set that rate to 0%.

And so, banks don’t have to have any cash on hand. And this is the first month, right now, in April, since this pandemic really hit in America and the economy closed down, and the unemployment rate went to 17%, which it’s at right now, that people’s credit card bills are due, and that they have to pay rent, and that landlords have to use that rent to pay off their mortgages. What all of this means is that banks are going to fail. There’s not enough money to prevent that from happening. They will lock up withdrawals and people won’t be able to take their money out. And there will be runs on banks as a result, by June or July. It’s a certainty. Anybody who knows history knows how this plays out. I’ve read this book so many times. It’s going to happen.

And Americans are totally unprepared for that kind of event. It’s going to be the scariest economic disaster that’s ever happened in the history of the United States. So, that’s how I feel about how things are going economically.

John: Oh my god. And so… Ugh, god. And how…

Dr. Spencer: And we haven’t even gotten into government debt, the fact that the deficit is now not only the highest on record, but literally at a point where I can’t honestly see how anyone coming out of this. I mean, so imagine this. Look at the history of the Great Depression. Unemployment peaked in mid 20% range, 25%, 27%, so different estimates, but say 25% starting around 1930. It peaked in the early ’30s. It did not drop back to 1920s levels until World War II. World War II is what basically brought the U.S. out of the Great Depression. I certainly hope that the U.S. is not gonna have another World War II. But the point is that digging yourself out from under an unemployment rate which is estimated, from this depression because it is a depression that we’re in now, it’s estimated that it’s gonna be 30% to 35%, so much higher than the Great Depression of the 1930s. Digging out from that will take decades, just to get unemployment back to the level where it’s sustainable, 5% let’s say. You know, not what it is today. It’s historically low before we came into this pandemic. But even to get it back to like a sustainable kind of 4% to 5% level.

And we haven’t even started dealing with some of the bailout costs that are being incurred. So the trillions of dollars, not only in the first one, the second PPP, the third one that will be passed next month, the fourth one that will be passed in June, the fifth one that will be passed in July, the bigger one that will be passed in August when people really realize how deep this is. The deficit is so high, I honestly don’t know that America is ever going to be able to dig out from under this, you know.

I see this as literally an epoch shifting event. This is when America ceases to be a global economic superpower and Europe as well. Europe is being hit just as hard. And they’ve got all their internal divisions and Brexit and everything else they’ve been dealing with before they ever came into this. This is where the geopolitical and economic center of gravity in the world shifts back toward Asia. And so, this is the end of Western Hemisphere hegemony in the world. It’s the end of Europe and America running the show. That’s how serious this is.

John: Wow.

Dr. Spencer: Yeah, forever. Forever. America’s never going to come back from this, in my opinion.

John: So let me ask you this, two things that I think of when I hear this very upsetting prediction that you’ve just made, which we all need to take very seriously. One, we’ve talked about it in past interviews. We talked at the beginning of the show. Asia is struggling from this just as much from an outsiders’ perspective as is the United States. And there’s been some things that have happened policy wise. I mentioned my girlfriend’s Japanese. We keep up on the news out of Japan. And Japan has used part of their stimulus to encourage companies to take their factories out of China. So you would think that a movement like that… I saw you tweeted out something, I retweeted a tweet that you published yesterday about that exact phenomenon.

Does your model…how does your model account for the future of manufacturing inside of China in light of this? And then also, does the model that says that this is going to be a…

Dr. Spencer: China… People…people In America, it’s so funny, like if you haven’t spent any time in places like China… If you’re an American who buys an iPhone, you see China as a cheap factory. China has a huge growing middle class, as does India, as does Indonesia. Remember Indonesia has the fourth largest population in the world, after the U.S. It’s got 280 million people. The IMF before this happened projected the Indonesian economy was going to be the fourth largest in the world, after China, India, the U.S., replacing Japan, replacing every European country. There’s a growing middle class in Asia that is so dynamic and so excited about consumption. It’s not the low cost manufacturer anymore. I mean, honestly John, if I were projecting out, if I had a bricks and mortar business and I were trying to decide where to stick a factory in five years, I’d put it in Mississippi. That’s the new third world.

John: Oh god. What would you do if you had a nutrigenomics startup that was all eCommerce? Where would you put that in the next five years?

Dr. Spencer: Virtual businesses are good. Virtual businesses are good. No. But I mean, I’m just looking at the Hopkins, you know, list of countries by number of confirmed cases. U.S., Spain, Italy, France, Germany, United Kingdom, Turkey, Iran, you know, you have to go all the way down before you get to the first Asian country. China is after Iran. And we all know that China has baked the numbers. But still, they’re not baked to the extent that, you know, they’ve gone from 83,909 to 939,249 confirmed cases in the U.S. They’re not that different. So, you know, Asia is doing much better in this whole thing than Europe and America.

John: And is that because of their ability to implement a police state and essentially surveillance?

Dr. Spencer: I wouldn’t call it a police state. I would call it, you know, social consciousness. What I see in Asia, having spent much of my life living, working, traveling, in Asia, and now living here for two months and for the foreseeable future, people are willing to forego some personal liberties when it benefits society in a way that the U.S. isn’t. There are no protests at governors’ houses here in Indonesia saying “Let us out of the lock-down.” And the lock-down’s much more intense here than it is in the U.S. You can’t come or go from any region. You can’t take a boat. There are no planes flying. It’s locked down. You can still get on a fucking plane and go from Los Angeles to New York if you want in the U.S. And yet, people in Michigan and other places in America, Austin, Texas, you know, a place we both lived, they’re marching on these state capitols and demanding to be let out of this lock-down. That insistence on personal liberty is the reason why, when you go down this list of afflicted countries, they’re the ones hardest hit.

John: What is a scenario where this isn’t as bad for America? Can you think of…I’m just playing devil’s advocate, what could we do to not go into ruinous, terrible, apocalyptic decline as result of the coronavirus?

Dr. Spencer: You could have a President who tells people to inject bleach into their bodies resign. That would be a big start. You could get rid of everybody who’s currently in charge of the public health effort. I mean, Azar aside, like the “Wall Street Journal” ran this story this morning about how he’s gonna be ousted, but you know he’s the fall guy. But that’s stupid. It’s just chaotic leadership. It’s utter insanity because the damage has already been done, you know. Azar should have been ousted three years ago. He shouldn’t have been the fucking head of HHS. And he’s only gonna be replaced with someone who’s equally as bad, because we know that the administration’s decision making throughout this process has been utterly crazy, just literally viewing it from the outside, you’re like, “How does someone come up with some of these things they say?” There’s, you know…

So, what could save America? Ousting the current administration, literally, a revolution, people out in the streets getting rid of this government and installing a government that actually pays attention to science and reason because the only thing that will get anyone out of this is paying attention to numbers, science, statistics, and epidemiology. In my opinion, somebody like Cuomo with Fauci should be president and vice president, not fucking Trump. So the only way out of this is to have somebody in charge who is kind of like, you know, the Prime Minister of New Zealand. And I think she is the world leader who’s done the best job of, you know, explaining to people exactly what it means to lock down, what people need to do, what the science is telling us, and how they get out of this. And if you don’t have somebody like that as your leader, you’re in trouble.

John: So the New Zealand thing is fascinating. I hear that on Twitter all the time. I mean, there’s more sheep in New Zealand than there are people. I’m not saying that the Prime Minister of New Zealand is not doing a great job with the lock-down. Frankly, I’m not educated on what her policy initiatives have been, or how she’s been educating the public. But it seems as though on an island nation like that, where there are so few people, it becomes a little bit easier to get a handle on this thing because of the fact that it spreads…

Dr. Spencer: Absolutely.

John: …it spreads in close contact. When we had the text exchange to get this next follow up episode going, I invited you to come on the podcast and said I was feeling more optimistic about COVID-19. And I invited you to come on to crush my naivety, which you’re doing an excellent job of doing. But I would…I just come back to this issue of, again, maybe naively, and this is I, I know we’re gonna close out the show here, I come back to this issue of people are all sharing their N=1. My friend Michele and my friend Jason, they’re married, dear friends of mine. Michele gets it. She lives in Hoboken. She gets sick, very sick, she recovers. My friend Jason, he gets it, nothing. He’s not the healthiest dude. He’s the guy that’s at the bar to… To Jason, if you’re listening, I love you. You’re a healthy guy, but you party. He had no symptoms whatsoever.

And then, this drum beat of these serology studies… You said Cuomo. Cuomo’s huge on the antibody studies. That’s a big thing that he’s pushing because he wants to know…

Dr. Spencer: Sure.

John: The article I sent you last night, if this keeps coming back that 20% of the city already has it, and the overall infection fatality rate is at a half a percent, man, I just don’t…as the layperson, again, as the dummy, in my mind looking at this as a non-epidemiologist, I just don’t see how that lines up with the sustained great depression. So I want to give you the last word. And just, again, just crush my last remnant of optimism here, just get rid of it.

Dr. Spencer: Okay. Let me unload on you.

John: All right. Do it.

Dr. Spencer: There’s gonna be no vaccine for this that is perfectly effective. There may be a series of vaccines over the course of a decade or more that will help to mitigate its impact. People who’ve been infected with it will get reinfected in the same way that if you’ve had a cold, you can catch a cold again. If you’ve had the flu, you can catch the flu again. There’s no herd immunity. That’s a myth. People are making that up. People on the right are making that up to justify opening things up again. And so, America is what, six weeks into this? Imagine this for six years because that’s how long it’s gonna go on if we keep opening things up.

If that doesn’t crush your hope, nothing will because the economy is cratering right now, six weeks in. Imagine six years of this. We will be beating rocks together trying to make a fire.

John: Six years of lock-down for sure… I guess my thinking is that if we realize that there are, like you said, genetically aged demographics, preexisting conditions, and we have a way of getting people on different protocols…

Dr. Spencer: But again, America is the fattest country on Earth. You know this. I mean, you study nutrigenomics. I mean, a nearly 50% obesity rate, if that’s the greatest risk factor according to the New York infection data, in addition to the fact that everyone over 65, and we’ve got a huge baby boomer population that’s entering retirement right now, you know, so what, two thirds, three quarters, of America can’t go out? What’s that gonna do to the economy? I don’t see any easy way out of this. There is no hopeful scenario for America.

John: Wow. Wow. Okay. Well, I mean, I know we’re kind of running out of time here. The Doctor, Spencer Wells, is still maintaining his sort of doomsday, but very educated and informed and reasonable position on COVID-19. I think I’m gonna go make another pot of coffee and maybe just go into my bed, [inaudible 00:45:08] crawl into the fetal position, and just give myself a good cry for, you know, for 10 minutes or 15 minutes, and then maybe just try to run for extended mileage, just to try to build some semblance of endorphins and happiness back into my brain. But it’s crazy man. It’s crazy time, crazy time.

Dr. Spencer: Totally crazy. I’ve never seen anything or anticipated anything like it. And I, again, I, you know, I don’t think America is really…because it’s early days and because Americans are so good at coming back from things like this, I think nobody’s taking it as seriously as they really should be. And that’s what worries me. It’s what I’ve called on Twitter many times arrogant complacency, because it’s like we’ve always been the winners. We’ve always been the ones on top. We’ve always been the ones who, you know, fought off the Nazis and, you know, built the strongest economy in the history of the world. This is different. This is so different.

John: We’re gonna have to watch it and see what happens. I hope that it’s not quite as bad. But, you know [crosstalk 00:46:19]

Dr. Spencer: I hope so too, because it’s not good for the world if what I’m sketching out is true. I hope it’s…I hope I’m wrong.

John: And time will tell. But we appreciate your perspective and your expertise. Thank you for joining the show again. And we look forward to seeing you on future episodes, and I look forward to seeing you and Holly in person, in Indonesia, once it’s safe to travel once again.

Dr. Spencer: Thanks John.

John: The Gene Food Podcast is our attempt to synthesize the latest developments in the fields of genetics, nutrition, and medicine and offer you practical tips and stories you can use in your own unique health journey. If you enjoyed this podcast, you can find more information online at

John O'Connor

John O'Connor is the founder of Gene Food, a nutrigenomic startup helping people all over the world personalize nutrition. John is the host of the Gene Food Podcast and a health coach trained at Duke's Integrative Medicine Program. Read his full bio here.

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