How much do things around you need to change before you start changing your behavior?
Dr. Peter Sandman has made a career out of analyzing people’s “adjustment reaction” process. And it turns out, people are wired differently.
Some watch the world intently, looking for early indicators of change and reacting swiftly to them. Others prefer not to get distracted by the “small stuff” and only pay attention once change is forced on them.
Neither approach is inherently right or wrong, but the difference often sets us up for conflict and confrontation when big risks are involved. Those who argue for swift, extreme action are resisted by the side not convinced change is necessary — as the covid-19 pandemic has clearly revealed. Families have been divided and long-term friendships ended as the “Masks for everyone!” and “It’s just the flu, bro!” camps have gone to war.
Dr. Sandman is a top world expert on risk communication. In today’s podcast, he explains the fundamentals for mobilizing people when risk is involved and why the US has done such a poor job of it so far with the pandemic:
When you did your adjustment reaction show, I received a lot of emails from people saying “Thank you for explaining the adjustment reaction. Either I felt like I was being an idiot — or my family thought so, my friends thought so, my colleagues thought so — and this helped me understand what I was doing. This was something I could show them to explain that this is reasonable.”
I think it’s important to understand that the adjustment reaction is a normal, healthy reaction even if the crisis fizzles. I mean it’s not just that you’re guessing right. If you have an adjustment reaction and you become hypervigilant and you take precautions, you’re in a better position to notice what happens. So if the crisis gets worse, you’re in a better position to notice it and you’re ready to respond. If the crisis fizzles, you’re in a better position to notice that and stand down. So it’s not only useful when you turn out right; it’s also useful when you turn out wrong.
As for the US, we’re going to get there later than a lot of other cultures because we’re as polarized as we’ve ever been and more than any country I’m aware of. That gets in the way. Our leaders and our public health officials have done a crappy job of communication. At every step they’ve done a crappy job of precaution advocacy early on. They’re dong a crappy job of crisis communication in places where things are bad. They’re doing a crappy job of outrage management when people are saying “How dare you destroy my economy?!” or “How dare you manage this pandemic so badly?!”. It’s stunning to me that the CDC has yet to apologize for having messed up testing. It’s stunning that the public health profession has yet to apologize for having messed up masks. There are three key paradigms — precaution advocacy, crisis communication, outrage management — we’re 0 for 3 in doing any of them well.
Click the play button below to listen to Chris’ interview with Peter Sandman (60m:53s).
Chris Martenson: Hello, everyone. And welcome to this Peak Prosperity podcast. I'm your host, Dr. Chris Martenson. And really got a very, very special program for you today. Out of the entire coronavirus series that I've done I've been giving you the science giving you the data, such as it is and it's changing and it's been wonderful to be able to assemble the data as clearly as I can. But I feel, honestly, that one of the most important episodes I did was talking about something called the adjustment reaction.
Now, there's a lot of data that comes with something like a pandemic and infectious diseases and we're talking about crazy things like r naughts and transmissibility and how long things live on surfaces and mutations and all of that.
In truth, the most important thing is how you react to it and how you respond. And there's a range of ways that we respond. And there's nothing better or worse, good or bad about this--but we need to be aware of and I think an openness towards the idea that each of us is going to emotionally react in a different way to this. And some people are going to react faster and adjust faster and some slower. Again, nothing right or wrong about any of that but it is part of the human landscape. And to the extent that our authorities, our national managers, I sometimes call them instead of leaders depending on the job they are doing--to the extent that they are aware or unaware of that process really helps shape and define how effective they are going to be at being a manager versus a leader, a true leader of something as contentious, as belief altering, as a pandemic.
So we are very fortunate today to have one of the world experts on risk communication. In fact, somebody who defined the field of risk communication and the term with us today to help talk us through and walk us through what risk communication looks like--the adjustment reaction, all of that. Today we have with us, Dr. Peter Sandman. And he is the author of that piece on adjustment reactions that I liberally pulled from and used and linked back to because it is just such important work.
Dr. Sandman here is -- he is a creator of this phrase which is risk equals hazard plus outrage. It is a formula for risk communication. He's a pre-eminent expert as I mentioned and consultant on that and crisis communication. We will learn about the difference between those two pieces there. Author of numerous articles and writings on risk communication. He has got a great website at PeterSandman.com. And we are really honored to have him here with us, today.
Academic for much of his career he started as an environmental communicator around three mile island. He was a journalist then and that morphed into figuring out and learning how to become a risk communicator. He has been working on all sides of the issue. He was a consultant for a long time working CEOs, companies about risk communication. He has been retired, unretired. Today, he is out of retirement again. And, he has been heavily involved in infectious diseases including the H5N1 outbreak that sort of didn't materialize, but a lot of lessons learned. Dr. Sandman, welcome to the program today.
Peter Sandman: Thank you.
Chris Martenson: So, let's start here. Just give people a quick overview of your background and how it is that you came to be involved in risk communications. That's just a great story. Anything I didn't cover there.
Peter Sandman: Well, way back when I was a doctoral student I got interested in environmental communication and did my doctoral dissertation on [an] aspect of that. And then, when I started my academic career, you know, like any other academic I cannibalized my dissertation and became an expert on environmental communication. And that remained my field, actually, until shortly after Three Mile Island. I was heavily involved in Three Mile Island and then not managing the accident but covering the coverage of the accident. And covering the flacking, the PR about the accident.
In the aftermath of the accident I got interested you know, my focus in environmental communication had been basically how do you scare people? How do you get people to take environmental risk seriously enough? But Three Mile Island had other problems you know, they've had the problem of how do you keep people from overreacting? How do you reassure people if the risk isn't as serious as they think it is? And then, a third paradigm, when the risk is serious and people rightly think it's serious how do you guide them through it? So, I broadened my focus from environmental communication to risk communication and helped invent that field in the --by the mid 1980's risk communication was beginning to become a field and I was beginning to become identified with that.
Chris Martenson: Peter, I'm wondering if there is a parallel here between our careers in a sense. So, I deviated from my life in order to begin articulating to people a view of the world that talked about the risks and the various predicaments we face and all of that. So, when I started I thought I was in the business of sharing information with people and I did that. And overtime, took me a couple of years cause I'm a quick learner eventually--I figured out that I wasn't in the business of sharing information. I was in the business of challenging belief systems. Totally different place to be and it's an emotional territory. It's not a logical territory. It's not about the data. But it's about how the data is presented -- is that something you discovered as well that it was your field as maybe less about the structure of the data and more about the delivery of the data?
Peter Sandman: I mean that’s fundamental. Not just to risk communication, Chris, but to understand actually all communication. I think people have or many people have at the back of their minds a sort of a rational model of how communication works. That this information and the information influences your attitudes and the attitudes influence your behavior. And there is no question that that sometimes happens. But more often than not, it happens in the other direction. There is behavior and you build your attitudes around your behaviors to make sense of your behaviors. And then you go out information seeking, looking for information that supports the attitude behavior complex that you have evolved. And then you become very resistant to information that might tell you you're wrong. It might tell you your attitudes are wrong but even worse, might tell you your behavior is wrong. So, you know, we are all, if you will still thinkers when we get information that conflicts with what we already know, or I'm sorry with what we are already doing what we already believe. I will say well, that's fine. But I still think and we go back to our prior attitudes, our prior information set and above all, our prior behavior. That's key to risk communication but it's not a creation of risk communication; it's key to communication itself.
Chris Martenson: Right. So with that as a--a cornerstone of that and by the way, the people listening to this are all familiar with the backfire effect and we have studied that and I told people that in my own communication arc I had to take a big tour through behavioral economics, standard psychology, understanding how we are wired, ultimately understanding the cortex versus the lymphatic system. There was this whole field of study I never thought I was going to get involved in. Cause I was just trying to tell people how oil fields deplete and things like that. Right? So it was a lot of --
But now, we are in a really serious situation here and COVID comes along. So, if you could, Peter, in your own words what happens when something like COVID comes along? You got a culture. It's operating the way it operates. It has got a whole sort of a trajectory to it. COVID comes along and crashes into that. What is that process really about for people in terms of data versus emotions? What is happening?
Peter Sandman: Let me approach that through the backdoor, if I can, Chris. And talk a little bit about the basics of risk communication and where a crisis like COVID fits in. And the core understanding of risk communication is the extremely low correlation between whether a risk is dangerous or how dangerous it is and how upsetting it is. And for those of your listeners that like numbers that correlation is about .2. You can square a correlation to get the percentage of variance accounted for. A glorious 4% of the variants or here it is without numbers. The risks that upset people and the risks that kill people or hurt people are completely different.
Now, I'm not saying if the risk is upsetting that in itself proves safe. That would be a negative correlation. What we’ve got is a correlation that is essentially very close to zero. So, all four corners of the matrix or field. So for convenience you know, in the 1980's I renamed how dangerous it is hazard and how upsetting it is, outrage. So what I am saying is the correlation between hazard and outrage is this very low .2 correlation. So that gives you you know, if you look at the four corners of that matrix if that is--if the situation is high hazard, low outrage it is dangerous but not upsetting, then the risk communication task is what I call precaution advocacy. Essentially, watch out, this could kill you, do something. And so precaution advocacy is probably you know, the oldest kind of risk communication is the first kind of risk communication we do with our children. You know, telling them to watch out, take care, don't do dangerous things.
In the opposite corner we have the risks that are high outrage, low hazard. They are not terribly dangerous but they are very upsetting. And there the paradigm has calmed down. The message isn't “calm down” because calm down isn't an effective message. Especially if it is “calm down you hysterical idiot.” Calm down doesn't calm people down. But the paradigm is “calm down.” Then you have the high--
Chris Martenson: What are some examples in there?
Peter Sandman: I'm sorry?
Chris Martenson: What are some examples in the low risk, high outrage category?
Peter Sandman: In the low hazard.
Chris Martenson: Low hazard. Yeah. Sorry.
Peter Sandman: You have the typical super fund site for example. You know, it's a hazardous waste site. It is scary. Some hazardous waste sites are very dangerous. If it is a properly managed site it is probably not very dangerous. Living a couple of miles away from a hazardous waste site is not very likely to be a serious hazard but it's not likely to be quite as serious outrage. You know, Ebola in the U.S. was high outrage, low hazard. Ebola in West Africa and then later on in the Congo was high hazard and high outrage but in the U.S. where it was never likely to be a severe outbreak it was low hazard. But for many people it was still high outrage.
Chris Martenson: Thanks for that. Yeah.
Peter Sandman: So, the third corner is crisis communication. High hazard and high outrage. And the fourth corner is not interesting, right? Low hazard, low outrage. You know, there is no risk communication to be done. What would you do? Congratulations on your apathy. You are absolutely right. This absolutely is not dangerous. So, I never found a way to earn a living in that corner. But I did earn my living in the other three corners, doing precaution advocacy when people were insufficiently upset and outrage management when people are excessively upset and crisis communication when people are rightly upset. You know, those are the three paradigms of risk communication.
Now, when you get a crisis, you know, in the early stages of the crisis you know, the experts are going to notice that it's serious. The public is not yet going to notice that it's serious and your paradigm is precaution advocacy. You are trying to warn people. And you know, we obviously did a horrible job of COVID 19 precaution advocacy. The experts who were trying to warn people failed. Part of the problem is a lot of experts were afraid that if they warned people--you didn't know whether COVID 19 was going to be severe or not, long after you knew it was going to be a pandemic you didn't know if it was going to be a very bad pandemic.
You had, some people will remember the H1N1 pandemic. It was a genuine pandemic and it was milder than seasonal flu. So, it was a pandemic that saved lives which was kind of a paradox. So, the experts didn't know if it was going to be severe so they were a little reluctant to warn people. The logical thing to say to people about something that might be really awful but might fizzle is to tell them it might be really awful but it might fizzle and get them to take appropriate precautions and if it fizzles you're glad in the same way you buy insurance. Not in the hope your house will burn down, but in case it does.
So - but I think the experts were afraid to warn partly because they had warned about H5N1 and it didn't happen. And they’d warned that H1N1 had happened but it was mild and they were feeling like we don't want to be accused of alarmism again. So, they did a horrible job of precautionary advocacy. They barely tried. This is where the adjustment reaction begins to come in because in the early phases of the crisis people start to notice that this might get bad and while lots of people are still complacent, lots of people are under reacting, a lot of the experts are under reacting and they are over reassuring and government officials are saying don't worry about it--it's not a big deal. We will worry for you. We are watching it, just in case it gets serious but you know, you don't have to worry.
But some people began to go through an adjustment reaction. That is, you know, they overreacted or they reacted prematurely. And you had the famous toilet paper you know, the run on toilet papers and other kinds of signs of adjustment reaction. That is an adjustment reaction is not only normal, it's healthy. It prepares you for a crisis. The people who had adjustment reactions to COVID 19 were the ones that got to say later on to the majority that was complacent, I told you so because they turned out right.
Chris Martenson: Yeah, adjustment reaction is something an individual would experience, I think, not just for COVID for any big sort of--what is the right term for this? It is not even necessarily risk but something that is really going to impinge and change the direction of things. But especially for something that is a risk. It is a risk to health, life, limb, financial risk, could be all sorts of things, right? Doesn't have to be this is life or death, right?
Peter Sandman: Doesn't have to be life or death. Doesn't have to be a health or safety risk. You know, but it is something new in your environment that looks like it might represent a major, negative change. And you personalize it--it may be already happening someplace else. It is already happening in Wuhan. It is already happening in Milan but it is not yet happening here in Arizona. But you personalize it. You think it's happening. You take precautions prematurely. You become hypervigilant and then if the crisis materializes you are better prepared and if the crisis fizzles you are, you know, you come out of your adjustment reaction and you you know, you shrug it off and you say well, I guess I have a year's supply of toilet paper.
Chris Martenson: Yeah, so let's--I want to step through these you wrote here at your site on the adjustment reaction when someone first learns about a new and potentially serious risk the natural healthy, useful reaction is an over reaction and it begins with a pause. In terms of COVID 19, what does the pause mean? What is an example of it?
Peter Sandman: You pause your other activities. I mean, there is a sort of a law of conservation of outrage. You can only be upset about a certain number of things. You only have as much upsetness in your system as you have. So you know, if you are going to start taking COVID 19 seriously, you have to pause some other things. You have to worry less about other things to make room in your worry budget to worry more about COVID 19. So, that is what that pause is all about.
Chris Martenson: Okay. The law of conservation of outrage. So, the pause so there is an observational period, a stepping back, a conservation of resources, as it were in this case--emotional or mental resources. And then, you say your next step maybe you become hyper vigilant. What does that look like?
Peter Sandman: You want to know if this is as bad as it looks like it might be. So you pay more attention to news than you did. You know, your Google searching pattern changes. You know, depending on what the crisis is the signals might be different. So for COVID 19 in the early days it had something associated with China, so you might have avoided Chinese restaurants. You might have avoided going to Chinatown. You certainly would look harder, you would worry more about someone sneezing in your vicinity because you know, you picked up the idea that COVID 19 has something to do with sneezing even though there isn't any COVID 19 in your town yet, sneezing becomes something you noticed more than you would have noticed a few weeks ago.
Chris Martenson: Great. And then in personalizing the risk you mentioned that before what does it mean to personalize in this case?
Peter Sandman: But you are likely to imagine that it is getting you. For example, if you sneeze you know, I mean normally I sneeze and what do I do? I blow my nose and forget about it. But if I sneeze when I read about COVID 19, then I'm worried that it might be coming to the U.S. As you know, obviously, that turned out to be a perfectly reasonable thing to worry about. But early on if I sneezed you know, that might scare me in a way that represents a personalization of the risk.
Chris Martenson: Great. And I think you take extra precautions is the last step. I think that makes a lot of sense here. And we are seeing a bifurcation of that in the United States where a lot of people are wearing masks and other people are saying “no, I'm not wearing masks.” And from where I stand, the wearing of masks is the most logical, easy things to understand because it is not so much as protecting me from you, it's protecting you from me and all of that and it is part of being part of a tribe.
But so a lot of people took these extra precautions. I know people who haven't even stepped out of their home basically, in a couple of months now. Other people aren't taking precautions at all. They want to get on a cruise line, they want to go to the beach, they don't want to wear masks, all of that. Would you suggest then that this simply reflects the degree to which people are in different places on the adjustment reaction?
Peter Sandman: Well, no. We are past the adjustment reaction at this point. I mean yeah, the adjustment reaction is an early precrisis, an early crisis phenomena. What we have--what we have got now well, it's complicated. There are probably still some people who are complacent about COVID 19, especially young people who have learned that they are not all that vulnerable and maybe they lack empathy for their elders, maybe they don't have much contact with their elders. So, there is COVID 19 complacency. There is COVID 19 denial which looks like complacency but actually, it's opposite. That is if you are really freaking out and then you are at risk of panicking, you trip an emotional circuit breaker and you go into denial instead. And, you know, denial is a zebra. Complacency is a horse. In general, when people act like they don't care they don’t care. But there are times and COVID 19 is likely to be one of them when some people care so much they can't bear it. They are so upset they can't bear it.
So there is COVID 19 denial. Denial is why panic is rare. It is very hard to find any examples of COVID 19 panic precisely because denial is available if you are at risk of panicking. You can flip that circuit breaker and go into denial instead. And, you know, and then there is perfectly normal, rational, desirable, COVID 19 fear where you are appropriately worried and if you are my age you are more worried than if you are my grandchildren's age and you are -- you know, you are taking rational precautions but you are not necessarily taking them entirely rationally. You are upset so you are in crisis. You are in a high hazard, high outrage environment where fear is the appropriate response.
Chris Martenson: To back it out a tiny bit. And I do want to get through the steps--first, to reiterate this point one of the most important points we can make--this is completely normal, completely natural. Not only should it be expected it should be encouraged that people go through an adjustment reaction, correct?
Peter Sandman: Yes. Early on in the crisis or in a precrisis stage officials tend to imagine that the public is panicking. They tend to interpret the adjustment reaction as a panic. And they go into what I have sometimes called panic panic. They feel panicky about their misperception that the public is panicking. And so, they do a variety of things that are harmful to the adjustment reaction. They over reassure. They appear overconfident, you know, they say I know what I'm doing. I'm sure I'm an expert here. They express contempt for the adjustment reaction. You are being hysterical, you are being a fool and all of those things are undesirable. What you want to do is guide people through the adjustment reaction. Help them take wise precautions rather than unwise precautions. Help them take precautions that are forward looking. I mean, if the adjustment reaction is premature, which it usually is--then we want them to take precautions that will stand them in good stead when the crisis reaches them rather than precautions that are excessive now.
And you know, let me sort of stop for a minute. If I had to say one thing the United States did wrong about COVID 19 and it's hard to pick one thing because we did many things wrong--if I had to pick one, it was locking down most of the country prematurely. It was, you know, it was an unwise adjustment reaction. You know, now when New York City locked down, that was probably sensible. New York City should have--should have taken precautions earlier. The virus got out of control in New York City. The hospitals were at great risk of being overwhelmed and indeed, some of the hospitals became overwhelmed and a lockdown made sense. You threw everything you could at the virus.
But most of the country didn't look like New York City, at all. And we will take Arizona because Arizona is starting to look like New York City now. And I heard someone on television yesterday say you know, Arizona came out of lockdown too soon. And I would say Arizona went into lockdown too soon. It went into lockdown too soon when it had very little virus and very little transmission and what it should have been doing is taking much more modest precautions that did much less harm to its economy and monitor the situation and you know, it might or might not have needed to go into lockdown about now. But it exhausted its capacity for lockdown way before anything like that was happening.
Chris Martenson: Yeah, you have a lockdown budget. There is only so long you can keep people in lockdown, right and in the economy and all of that you have to time that very carefully. But to me, the authorities needed to have clear, consistent communication all the way through. They should have been saying the same things and it should have been all 50 states having sort of the same message that what should have been a national, coordinated here is how we are going to respond to this thing. And, in fact, you know what is frustrating to me, Peter? I can read documents that talk about how to do this that were written 20 years ago that looked perfectly valid. Like you dust them off, the WHO has a perfectly beautiful pandemic document. Looks like it was created about 20 years ago.
Peter Sandman: I helped write some of those documents. I share your sense of frustration about that. What you said is true but it might be misleading. Yes, there should be national messaging. But there shouldn't be a national response because if the--the you know, pandemics have, you know, sweeped through places. The United States is a big place. And, you know, if you ask the question what is the average temperature in the United States right now you would very quickly decide because it is cold in some places--did we just lose volume?
Chris Martenson: We did for just a second but it's perfectly fine. We can make it work.
Peter Sandman: I got a message. All right, I'll back up. You know, if you ask the question--what is the national temperature in the United States right now you would very quickly decide that is a dumb question. It's cold in some places, hot in other places. Temperature is not a national phenomenon. All the pandemic plans I ever worked on talked about targeted, layered, local responses. You know, so yes, there should have been national messaging. But the national messaging should have emphasized local responses and it was a horrible mistake for most of the country to respond the same way New York City responded.
Chris Martenson: I'm with you on that. I hope I wasn't implying or misleading that we needed a national response. But we needed national messaging. And one example, face masks. Very simple logic and we had all these national U-turns on the whole thing with the surgeon general coming out and saying oh gosh, you know, people shouldn't wear masks and later saying, we should wear masks. And one embarrassing moment, he even took a t-shirt and folded it up and showed how to fashion a facemask out of a t-shirt months after private citizens had figured out how to fold blue shop towels into sewing patterns. We had a whole cottage industry of people making things far more elegant than the surgeon general, who has got far more resources at his disposal to figure that out. I thought that was an embarrassing moment nationally when you can't even organize around something as simple as face masks. But that message should have been clear and consistent.
Later we had Fauci coming out and saying, what I knew all along and everybody I think sort of knew which was actually, we were kind of fibbing to the public because we wanted the masks for the healthcare workers but we didn't want to just say that outright. So that was an example to me of mismessaging, burning capital on that and then having to undo that and now they can't undo that and that is why we see this facemask problem right now. The messaging was just a train wreck from beginning to end.
Peter Sandman: Yeah. Messaging about masks - they weren't mostly mistaken, they were mostly dishonest. You know, they knew that masks were helpful. They knew that masks were helpful not primarily as personal protective equipment not primarily to protect you from incoming virus but as source control--to prevent--protect others from outgoing virus. So, that they knew all of that. And they thought they despaired of convincing people of that. They were afraid that if they said yeah, masks are useful mostly to protect other people from you and you know, we would be really grateful if you would use cloth masks, and informal masks and nonmedical masks. They thought that was too you know, the good masks--the best masks particularly the N95 masks for healthcare workers. They thought that was too complicated a message. So, they did what they always do which is faced with a choice between a truth that they thought was bad for public health or a lie that they thought was good for public health they prioritized public health over integrity, and they always do.
Public health people, I mean, they try to tell the truth when they can. But they put a much higher priority on saving your life than on telling you the truth. They think those point in opposite directions, they lie to you and then they wonder why you don't trust them.
Chris Martenson: Very well said. Before we move on to where we go from here with this whole story--I just want to wrap up the idea of an adjustment reaction. Probably one of the most of all the emails I got and all the comments that were listed under the YouTube video around the adjustment reaction, this was the one that evoked the most of people feeling relief, profound relief. These people typically who are following my stuff go through a much more rapid automatic adjustment reaction than the people around them and this creates a lot of tension in their lives because they feel like something is wrong with them or is there something wrong with all these other people and to them it's all clear and they have already gone through the little arc and the other people are somewhere way back on the arc. So, not understanding this automatic, natural response and that we all go through it at different paces can be very frustrating but boy the relief that comes when you see it that way and go oh I just went through mine faster and now I have the opportunity if not the responsibility to help others navigate their own. So, it's an opportunity rather than a deficit in this case. I'd just love your reaction to that.
Peter Sandman: I got the same experience you had when you did your adjustment reaction show. I had a lot of emails from people saying, thank you for explaining the adjustment reaction. Either I felt like I was being an idiot and this helped me understand what I was doing or my family thought so, my friends thought so, my colleagues thought so. This was something I could show them to explain that this is reasonable.
I think it's important to understand that the adjustment reaction is a normal, healthy reaction even if the crisis fizzles. I mean, it's not just that you're guessing right. You know, the--if you have an adjustment reaction and you become hypervigilant and you take precautions you are in a better position to notice what happens. So, if the crisis gets worse you are in a better position to notice it and you are ready to respond. If the crisis fizzles, you are in a better position to notice that and stand down. So it's -- it is not only useful when you turn out right. It is also useful when you turn out wrong.
Chris Martenson: Yeah, and wrong is something - I don't like to be as binary as that because I think what people are doing are playing the probabilities. So, one of the things that is often trotted out is oh, all those people who put together bomb shelters around the Cuban missile crisis hahaha, look at all that wasted effort. In fact, the probabilities were heavily weighted towards that being a very legit, very serious crisis and in fact, 20 years later we got the memoirs from JFK's chief of staff saying we were this close, right?
Peter Sandman: Very close.
Chris Martenson: Very close. So, in fact, those people were behaving I think, very prudently. People who were reacting. They were reading the tea leaves correctly. It’s not only okay, it's wonderful that it didn't go that way. But it doesn't mean that it was wrong or that their reactions were out of alignment with the actual risk that was contained in that period of time, the hard that was there, right?
Peter Sandman: Any well run organization and any well run individual is looking at risk in terms of magnitude and probability. And if the magnitude is super high and the probability--and if the probability is also super low you shrug it off, right? Yes. An asteroid crash could kill me tonight but I'm not going to take asteroid precautions. But you know, if the magnitude is super high and the probability starts rising from very low to low and now it's looking like it's moderate you know? By the time the probability is moderate and the magnitude is super high if you have a brain you are taking precautions. And you are not taking those precautions because you think the probability is extremely high. You are taking those precautions because moderate probability is high enough when the magnitude is very high.
Chris Martenson: Great. So, here we are. It is June 29th. We are more than six months into this and before earlier I think you said with COVID, we're not done with it. It's not done with us. Where do you stand on COVID at this point? Does it fizzle from here? Where are we at? Is this just something we are going to have to learn to live with and readjust our sense of risk just like my grandparents had to live with the idea that an abscessed tooth could be the end of you? Is that just something we live with now or is this--where are we, do you think, in this whole story?
Peter Sandman: Well, viruses keep spreading until one of two things happens--you know, either the virus runs out of susceptible people, okay? Doesn't have to run out entirely. It runs out enough that it is not finding enough susceptible people; what is called the reproduction number which I think you covered in earlier podcasts is below one. So, somebody who is infected doesn't come into close contact with somebody who is vulnerable and you know, and the virus dies. That is one way. It runs out of vulnerable people. And that can happen either because they have all caught it already or because a lot of us have been vaccinated.
The other way it ends is a miracle. It loses strength all by itself or it, you know, it just passes it you know, it passes in waves and then it leaves and it doesn't come back for a number of years and during those years you haven't got a lot of virus. Until one of those two things happens; until the virus goes away all by itself or most people are you know, at least 70% or so are no longer vulnerable it is going to keep spreading.
In New York City, where I live, they think about 20 or 25% of the population has already been infected. That's not nearly enough to have herd immunity so we are very low now, but you know, we are very low out of some combination of it went away and we took a lot of precautions. As we take fewer precautions we are going to have more cases because we still have a lot of vulnerable people. You know, so yeah--you know, as Michaele Olsterholm who is probably my favorite epidemiologist says, we are in the second inning of a nine inning pandemic. And you know, it is you know, it is possible that we will get a really effective vaccine, really quickly. And by the end of the year most people will have been vaccinated and will have herd immunity that way. It is possible. It is likelier than it has ever been. But it has always been extremely unlikely. So it is not extremely unlikely but you shouldn't be betting on it.
You know, so you know, maybe we are going to get a really effective vaccine. If we don't get a really effective vaccine or until we get a really effective vaccine we are going to live with this thing. And what we need is a balance where we are taking the virus seriously but not obsessing over it and we're resurrecting as much of our economy and as much of our way of life as we can. You know, the metaphor that's often used is dancing. We are dancing with the virus. We are keeping the number of cases low enough that our hospitals aren't overwhelmed. We are taking special precautions with people who are especially vulnerable you know, the elderly--the people with comorbidities of various sorts. We are doing everything we can to protect them. And you know, little by little more and more people are getting infected. We are hoping they stay immune after getting better for at least a few years. And we're learning to live with it.
That's the best case scenario is we get a wonderful vaccine. The second best case scenario is we learn to live with it. So far, we are doing a crappy job of learning to live with it. But you know, it's only the second inning we may still learn to live with it. The United States is, as you know, is way behind a lot of other countries. Europe seems to be doing a better job than we are. Most of Asia seems to be doing a better job than we are. But I mean, they are not immune yet either. They have got plenty of vulnerable people so they are in the second inning too. And the, you know, we are going to have to wait to see how the game ends.
Chris Martenson: Yeah. And on that point, you know, I've always said there is obviously a balance here and you gotta keep your economy functioning. If that crashes you are going to have probably a worse public health outcome than COVID can even think of ever delivering, right? But at the same time you still got a very serious thing going on with COVID and I am in the camp of saying buy as much time as you can while not crashing your economy and you got to balance those things out. I think China has done really a very good job and of course they are authoritarian and we can have lots of critiques over how they might have done it from a civil rights, human rights standpoint and all of that.
But I featured this one video from this gentleman who is a Brit. He is operating a factory in China. This was a month ago and they have this six point plan for every factory you have to follow these things and if you all do these and that's that and you include it everybody is wearing a mask, obviously, and they are disinfecting the facility twice a day and on and on. But they got on with it. They developed a cogent response. They said, here is what we are going to do. If anybody shows up to your factory the first thing we are going to do is scan them on the way in and before that. Anybody that has a fever boom, they go into a room. They are evaluated. They are assessed and something happens, right? So, I saw that. And then, you see the way in New Zealand has their response and Thailand has theirs and Hong Kong has theirs. It turns out there are a lot of ways you can manage this. We're not quite there yet in this country. What would be required to get us there do you think if it's possible?
Peter Sandman: Bear in mind that you are talking to a communication expert about epidemiology. You know, so I mean I'm going to give you second hand information because this is not my field. But they kind of know what is required and they even have sort of figured out that some things that democracies are bad at you know you don't get to put on the list because you are not going to be able to do it well and you have to find a democratic way of dancing with the virus that may be different from the way China dances with the virus.
You know, the two main things you do is you protect your most vulnerable people and you protect your hospitals. Cause if hospitals are overwhelmed, then people are dying that didn't have to die and they're not just dying of COVID. They are dying of strokes and car crashes because the hospital can't cope with them. You keep your hospitals from being overwhelmed and you protect your most vulnerable people. And other than those two, you know, you kind of prioritize the economy over preventing infection.
The one that's most complicated is identifying infected people and tracing their contacts and quarantining their contacts. That's easier to do in authoritarian countries than it is in democracies and it's easier to do with something that you know, with a virus that is symptomatic before it's infectious. The nice thing about SARS, I worked on SARS. The nice thing about SARS is by the time it was infectious you were sick as a dog in nearly all the cases. There were exceptions. But nearly every case by the time you were infectious you were sick as a dog. So, the only people or the vast majority of people who caught SARS were healthcare givers. Either they were family members taking care of a sick person at home, or they were healthcare workers in hospitals.
And you know, nobody went to work with SARS. Nobody rode on the subway with SARS. The thing about COVID 19 is you are infectious for several days when you feel fine and in a large number of cases you're infectious the entire time and you feel fine and you never get sick. You just, you know, you are just like typhoid Mary except we have millions of typhoid Marys infecting other people without feeling crappy.
So, that makes contact tracing harder and less effective. And I think there is a real debate right now among experts and I don't get to participate in that debate because I'm not an expert on that. I am a patient guy. The experts are really divided on whether it is worth even trying to do contact tracing and quarantining of contacts. You know, because of the nature of democracy and the nature of this virus. The things they know were worth doing are the things you hear all the time, right? You wash your hands a lot. You stay six feet away from people as much as you can. You wear a mask, especially when you are not six feet away. You keep outdoors more than indoors and above all, you protect your hospitals and you protect your vulnerable people. And other people get infected. And some of them die but not many of them. And that's how you dance with the virus.
Chris Martenson: And on that last point about the statistics of this and not many people die. My own difficulty--my PhD is in Pathology so maybe I overfocus on the disease aspect of this. But certainly, I have the training there. So, for me, the statistics look good until I start reading these things about how people who are largely asymptomatic had a mild cough and now they find out that they've got potentially, they don't know, this is the uncertainty, but potentially lifelong lung impairment because of the fibrotic scarring that happens. And now we are finding out there are neurological deficits in some people not many but there it is. And there is this Kawasaki-like disease in children. We don't know about this particular virus but it's crazy its affinity for the Ace 2 receptor but it's the CD147 receptor which means it is a white blood cell issue. Also seems to go into neural tissue. It's crazy what we don't know about this. 38 kilobits of information and it is just astonishing the complexity that comes out of that.
So for me, managing it from my level of awareness around this is, I just don't know what is going to show up in this thing in a year or what we are going to find out about it five months from now. And like you say, it could magically fizzle or we might discover this is something that has a second infection that is associated with it because some people, for whatever reason, don't have a humoral response that's long lasting. We have a cellular way of fighting it off with immunity but it doesn’t last it comes back. We don't know. So, it's that uncertainty that keeps me just a little bit paralyzed, Peter, in terms of saying it comes out of this - I don't want it. Right? And that's all I know for sure at this point at my age and given what I know. I'd rather not get it. Your point is that you know, if we only have two ways it runs out of victims or miraculously goes away and the only way it runs out of victims is we get the vaccine which is a more likely than it was--but still, let's be honest not terribly likely to come out any time real soon because of the nature of complexity of developing vaccines. Or it runs out of victims because we have herd immunity which means, I got it. I don't want it.
I feel like I'm pretty normal in that regard. I think a lot of people are juggling that sort of level of uncertainty and coming to the same conclusion which to me, is automatically economy shattering and changing is people like me saying I'm not going to take a flight. I'm not going on a cruise. I'm not going to Vegas to handle poker chips any time soon, right? Until that uncertainty lifts. Does that feel like a--where am I in the adjustment reaction process?
Peter Sandman: Yeah, well I mean all data say that you are--you got a lot of company. A very high percentage of the public and you know, they did a wonderful survey of epidemiologists. A very high percentage of epidemiologists are nowhere near ready to live normal life. They are nowhere near ready to live, you know, what -- you know, what we are starting to think of as the new normal. You know, we can't get into the new normal as long as we are all going to stay holed up in our homes. And it--there are, I mean, it's paradoxical. There are people who are insistent on getting out. There are people who have no choice but to get out. And then, there are people and they tend to be, you know, wealthier and more professional and they tend to be white who have the luxury of, you know, I have been in my apartment with very rare ventures outside my apartment for three and a half months. You know, I got here from overseas in the middle of March. And I've been since the middle of March I have been out about twice and up to the roof a few times. That's it.
But I have a good apartment and I have a beautiful view. And I have a sweetheart, who I adore. And I have a good internet and I couldn't have done it without all of those, you know? And I don't have to earn a living cause I did that already. You know, so I'm living on retirement. So, there are people who have to go out. There are people who want to go out and then there are a whole lot of people like you and me who don't have to and don't want to. And as long as that continues to be the case, I think the economy is going to have an enormously difficult time recovering cause you know, we've got you know, we've got too much of the money. And we're not going out and spending it.
I don't have a solution to that but I know one piece of the solution to that is to be candid about the uncertainty. And you know, if you tell me I'm an idiot not to go out I dig in my heels and I'm less likely to go out. You tell me, of course I am afraid to go out. Of course, I'm worried about what they don't know about this virus yet. Of course, I'm wondering even if they get a vaccine, even if they give me the vaccine, even if they tell me I've got, you know, good antibodies and you know, my T cells are strong and I'm good to go, I'm still not sure I want to sit in a restaurant. I'm still not sure I want to go to the, as you said, the casino and handle poker chips.
If you validate people's fears, they are better able to decide to overcome those fears. That doesn't guarantee that they will overcome those fears. They might just decide that, you know, they are going to hang onto those fears. But when you tell people their fears are stupid the likelihood that they will overcome them goes down.
So in so far as we want the economy to recover, we have to validate the fears of people who are reluctant to go back into the economy. And for heaven's sake, we have to validate the fearlessness of those who are willing to go back into the economy; and one of the it seems to me one of the stupidest things we do is tell young, healthy people fine tell them to where a mask when they are near people like me, by all means. Tell them to spend a lot of time outdoors, not indoors. Tell them to keep six feet distance. Tell them to wash their hands. But don't tell them to stay indoors. They are the ones who are willing to go out and spend money and earn money. And they're the ones who can most safely go out and earn money and you know, we ought to be. I mean, I want to make them heroes. We ought to certainly encourage them to do what they want to do.
Chris Martenson: Oh, absolutely. You know, for me and this is--I think this is realistic--I have the sense that if I got on a 747 and there were 230 other passengers, I know that at least a couple of them would not be wearing masks or have them pulled down, tucked down under their nose or feeling like they should be free to cough or sneeze into the open air and I'm out of there. Like that’s it. Until we have we talk about eight forms of capital people can build. And one you can't actually build, you can just live in, is cultural capital. Culture is a very slow changing thing. So, I feel great about where I live in Western Massachusetts right now, when I go out, 99% of people are wearing masks. Usually, it's just some old guy that refuses. But otherwise, it's, I feel the coverage is sufficient and I feel safe. There are other places where that would be almost inverted and I wouldn't feel very good in those particular places and that's the local culture, right? And there's not much I can do if I lived in a place where 99% of the people decided they didn't want to wear masks except choose not to engage with them.
To me, that's the main inhibitor in this whole thing is getting people into those normal things you said which is reasonable distancing, reasonable amount of handwashing and also public sanitation of public surfaces--door knobs, railings, escalator, banners, things like that. And mask wearing--if we have those things in place I feel like we can get back to this much more rapidly, relative. Cause I am going to be that person who doesn't have the luxury of choosing to go out or not to go out. And if I do go out and I see that it's not safe cause I still don't want this thing. I'm pretty sure I would still like to avoid it if possible. Who knows, maybe I already got exposed and I was asymptomatic all the way through. Who knows. But to the extent I believe I haven't gotten it yet, I would very much like to maintain that track record. And to me, so that is why talking with you and this subject communication is the most important thing that we can get right in this story. And unfortunately, I would give my country, the United States low marks on that consistent communication about the uncertainties, about the risks and about the things we should be doing which were just those simple things--the distancing, the sanitation and the mask wearing. Your thoughts?
Peter Sandman: Yeah, I mean I think we are going to get there. We are going to get there later than a lot of other cultures because you know, we are as polarized as we have ever been and we are as polarized as any country I'm aware of. And that gets in the way. And, you know, our, both of, our officials and our public health officials have done a crappy job of communication. At every step they have done a crappy job of precaution advocacy early on. They did a crappy job of crisis communication in places where it was bad and they are doing a crappy job of crisis communication now in places where it is bad. They are doing a crappy job of outrage management when people are saying how dare you destroy my economy or how, you know, I mean how dare you manage this pandemic so badly. It is stunning to me that the CDC has yet to apologize for having messed up testing. It's stunning that the public health profession has yet to apologize for having messed up masks. We are doing a crap--you have three paradigms -- precaution advocacy, crisis communication, outrage management. We're zero for three in doing any of them well.
And, you know, so we're going to be one of the last ones to figure out how to do it. But you know, we'll figure out how to do it. I have very little doubt that, you know, we will be if we don't get a good vaccine a year from now we will be dancing with the virus. And you know, we'll be doing the things that make sense and, you know, we will pretty much all be on the same page. There will always be the 5% of the population that won't go along. But you know, we can live without that 5%. We are going to get there. We are just going to be one of the last ones to get there because we have done everything badly.
Chris Martenson: Well, that was a perfect summary and we're going to end right there. Dr. Peter Sandman, thank you so much for your time, today. Please, if you could, where would people go to read about this wonderful work that you've done and find awesome articles on this topic?
Peter Sandman: Well, my website is www.psandman.com that's P-S-A-N-D-M-A-N dot com. And when you get there, you will find it's divided into four main categories--crisis communication precaution advocacy, outrage management, and infectious diseases which overlays the other three but has become a special interest of mine. If you are particularly interested in COVID 19, there is a COVID 19 section of the infectious diseases index, which now, at the moment has 23 items in it and it is growing.
Chris Martenson: Fantastic. Well, Dr. Peter Sandman, we will direct people to PSandman.com. Thank you so much for your time today. Thank you for your work in the world. It's valuable and really necessary and needed. So, thank you.
Peter Sandman: Thank you.