Friday, November 13, 2020

Out of the Crisis #22: Ron Klain on pandemic response and preparedness, entrepreneurship, and rebuilding trust in institutions

Earlier this week, Ron Klain was named President-Elect Biden's chief of staff. The two have worked together for the last 30 years, and Ron also served as Biden's chief of staff during the Obama administration. He was the White House Ebola Response Coordinator in 2014 and 2015, when the Obama administration set up a pandemic prevention office and created a playbook for managing future outbreaks. It included everything from preparing the health care system to testing, treatments, and the acceleration of vaccine development.
 
As 2020 began, most Americans thought the coronavirus--if we thought of it at all--was something that was going to be a problem in China only. Ron delivered the opposite message loud and clear. In a January 22nd op-ed in the Washington Post written with Nicole Lurie, he told us,"We are past the if question and squarely facing the how-bad-will-it-be phase of the response." 

Not only that, but he made it plain that the idea no one could have foreseen the pandemic was nonsense. His work on the pandemic playbook gave him an intimate understanding of the situation and the ways in which the response to it had already been bungled. Upon coming into office, the Trump administration had disbanded the pandemic prevention office and shelved the playbook, which is a good deal of the reason we find ourselves in the situation we're in today with the virus.

This conversation was recorded before the announcement of Ron's new position in the incoming Biden administration. At the time, he was advising the campaign while also serving as Executive Vice President and General Counsel at Revolution, a DC-based VC firm created to fund startups led by diverse founders all over the country. 
 
We talked about the need for joint public-private efforts to rebuild the country, the role of startups in the recovery, whether a different administration would have handled the virus differently, working with Biden, the advice he got from Dr. Anthony Fauci, and many other things.
 

You can listen to our discussion on Apple, Google, or wherever you like to get podcasts.



 




A full transcript is beneath the show resources below.
 

Highlights from the show:

Ron introduces himself and discusses his quarantine (2:32)
Disparities in how the pandemic has impacted people (4:01)
Ron's background and how it affected his initial awareness of the virus (6:12)
How the Obama administration's Ebola efforts led to pandemic preparedness  (6:51)
Why pandemic preparedness plans were dismantled (9:49)
Ron's attraction to and path through public service (13:02)
Could a different administration have handled coronavirus the way Ebola was handled? (16:17)
What a proper response would have looked like (18:55)
The problems that stem from not believing science holds the answers (20:15)
The problem with the "no recriminations" approach (24:04)
What concerns Ron the most, months into the pandemic (27:37)
Why testing is essential for containing the virus (28:19)
How better health strategy is also better economic strategy (31:07) 
Dr. Fauci's advice about fear and honesty (32:38)
What the pandemic has revealed about our civic fabric and the institutions that govern American life (35:03)
The polarized response to the virus (38:16)
What bipartisan politics and policy actually are (41:28)
What Ron thinks we have to do to regain trust in our institutions (43:47)
The steps we should be taking now to build a more resilient, equitable, society for the long-term (46:07)
The prospects for a coordinated response to everything from hunger to education to unemployment (50:52)
Building pilot programs with philanthropic, state and local money to demonstrate their scalability (56:32) 
The necessary dialogue between government and the private sector (58:48)
How Ron sees the role of startups and entrepreneurship in the recovery (1:00:43)
What it's been like to work with Vice President Joe Biden on the Recovery Act other initiatives, and his presidential campaign (1:03:31)
Doing debate prep with Biden (1:06:12)
The lessons from the 2008-2009 financial crisis and response (1:07:09)
What we need to get out of the crisis (1:09:54)
 

Show-related resources:

"I ran the White House pandemic office. Trump closed it." Beth Cameron, Washington Post, 3/13/2020
Charlie Brown, Lucy, and the football ("A Charlie Brown Thanksgiving")

Transcript for Out of the Crisis #22: Ron Klain

Eric Ries: This is Out of the Crisis. I'm Eric Ries. Would you believe me if I told you this whole thing was avoidable? I'm talking about the pandemic but also the ripple effects we are all experiencing: economic distress, social displacement, increasing inequality in schooling, in health care, and so much more. Is there a way we could've avoided or at least softened the damage? One trope I am really tired of hearing is that we are living through an unprecedented situation. Who could've seen this coming? The media, our leaders, people on social media keep mentioning this idea, as if we've never seen anything like this before. But this kind of pandemic is not actually unprecedented. Pandemics have happened before. Scientists have been warning about this exact scenario for many years. In fact, a coronavirus caused a shutdown as recently as 2005. This is not ancient history.

We need to stop pretending that we didn't know what to do. We could've chosen to know what to do. We could have learned from what worked in the past. There is a world of research and experts who have seen these situations before, know the common mistakes that societies make, and have developed a playbook for avoiding these kinds of disasters. We had the opportunity to act, and our leaders chose not to. We have to come to terms with the fact that this was a choice, as heartbreaking as it is to do so.

Ron Klain may know more about the leadership side of pandemic response than almost anyone in the U.S. He was named President Obama's Ebola czar in 2014 and led a coordinated response to that disease, resulting in only 18 cases and 2 deaths in this country. On top of that, he has dedicated his life to public service. He has been the Chief of Staff to two different vice presidents and has long been an advocate of science-based policy. Ron saw this coming. He wrote about this pandemic in January and laid out a plan we could have used to avoid the crisis. In our conversation, I ask Ron point blank if the outcome we are living through was inevitable, or could we have avoided this catastrophe? You're not going to like his answer. Here's my conversation with Ron Klain.

Ron Klain: I'm Ron Klain. I'm currently Executive Vice President at Revolution, a Washington-based investment firm. Previously, I've served in both the Clinton and the Obama administrations, including as White House Ebola Response Coordinator under President Obama.

Eric Ries: Ron, thank you so much for taking the time to have this conversation.

Ron Klain: Thanks for having me.

Eric Ries: Before we get into it, how are you doing? It's hard to focus on leading when you're not taking care of yourself. How are you? How's the quarantine been for you and your family?

Ron Klain: Well, we've been very lucky. No one in our immediate family's gotten sick, and of course that's the most important thing. I think it's a challenge, right? I mean, I feel very, very fortunate on the one hand. I'm working from home. I'm able to do my work from home effectively, and all the technology, everything works. But I do think, look, it's hard to be isolated from friends. It's hard. I haven't seen my mom the entire time we've been quarantined and socially isolated. So I think we're going through a lot of the same things that everyone else is going through, a lot more fortunate than the vast majority of the people. But I think even for those of us who have nice homes and the technology to work from home and the opportunity to work from home, there are challenges, as well.

Eric Ries: It's interesting to be going through something that so many others are at the same time. One the one hand, this has been a bonding moment for many of us, having a similar experience, and yet, in another way, this emphasizes the incredible inequity in our society. Some of us have been able to weather the storm relatively easily, have the right setup and other forms of support. And so many don't. I really keep thinking every day about those who don't have that luxury and how hard this must be for them.

Ron Klain: Yeah. Look, there's no question. From the start of this, what I've said is people say we're in lockdown, we're in stay-at-home, all these things. That's not true. Even from the most rigorous period of this, millions and millions and millions of people had to go to work every day so that millions others could work more safely from home. And that includes the people who generate the electricity that makes this conversation possible and the internet that works and makes this conversation possible, as well as, obviously, the people who we see more up front, obviously the health-care workers but also the people who are delivering things to our homes and putting the things in the boxes that get delivered to our homes and making the things to get put in the boxes to get delivered to our homes and so on, so forth. So this has been an incredibly uneven pandemic in terms of its impact on people. That's obvious. That's clear from the data that's coming out, a great disparate impact of people of color, particularly African Americans and Latinos, but also disparate based on class, disparate based on employment, disparate based on all kinds of other circumstance in terms of whether or not you've been able to be more safe or be less safe. And that's, I think, one of the real sterling and most pervasive features of what we're going through.

Eric Ries: For those who don't know you, would you share a little bit about your background? I want to make sure people understand why your voice carries so much weight in this moment. And I also thought I would just start with a quote from something that you wrote, if you don't mind, because I couldn't believe that this was written on January 22nd of this year, at a time when I think it's safe to say that most of us thought coronavirus, if we'd even heard of it, was something that was going to be a problem over there. We've been dealing, for months now, with people who've been saying that no one could've known or no one could've foreseen or all this nonsense. It says, and here I quote, "We are past the if question and squarely facing the how-bad-will-it-be phase of the response." That was on January 22nd. Talk a little bit about how the pandemic first came on to your radar. How did you know this was going to be such a severe problem at a time when most of the rest of us were in denial?

Ron Klain: Well, we need to roll the clock back to before this pandemic, to the fact that in 2014 and 2015, I served as the White House Ebola Response Coordinator. And of course my principal job during that period of time was to coordinate that whole of government response that President Obama marshaled towards fighting Ebola, mostly over in West Africa, but also getting our country ready for the occasional case we were going to see, preparing our health-care system, preparing the testing, preparing the various treatments we were going to need, and of course helping to accelerate development of a vaccine.

We did all that, and in the course of doing that, I got very interested in and connected with people who have been focused on this question of pandemic preparedness and wound up then spending parts of the next five years working on this issue. I think that, "Nobody saw it coming is about as wrong as you could get." In fact, what's been widely circulated on the internet the past few months is a speech that President Obama gave in the middle of the Ebola response at NIH in December of 2014, which my team helped write, where he said, in December of 2014, "Hey, Ebola is a dangerous, horrible disease, but it's hard to spread. It's a wake-up call that someday soon," and he said then, "maybe five years from now, maybe 10 years from now," but five years later, December 2019. He said, "Maybe someday soon we're going to see a flu-like virus that spreads easily, that is deadly. We need to start to get ready for it."

So, during the Obama administration, we did things to help get ready for it, even after we fought Ebola. We created a pandemic response playbook that we wrote in 2015, in 2016. We set up a bunch of global surveillance systems like one called PREDICT that was supposed to find these diseases early on. We worked with the Chinese government to put U.S. experts inside the Chinese disease-response agency. So there were a lot of indications that something like this was going to happen, and a lot of steps were taken to prepare for it to happen. And when the first signs of this virus emerged in China in the public in December of 2019, I think it was pretty clear that this was exactly the kind of threat we'd been preparing for, exactly the kind of threat that we thought we would see here.

Now, look, early on, I think, as I said in that piece in January, it was hard to know how bad it would be. It was hard to know how quickly it would spread, how widely it would spread. And indeed, one reason why it was hard to know was part of the outcome depended on our response to it. When people say, "Well, who could've foreseen this," well, part of, I think, is we couldn’t have foreseen exactly how bad it's been because it was hard to foresee that our government would bungle this as badly as it did. So I think the bottom line, Eric, I think is people in the field knew that something like this was coming. They put in place measures to try to prevent the worst-case scenario, and yet our government has bungled and stumbled into the kind of disaster that we're seeing now.

Eric Ries: It's been almost criminally negligent. We don't have the language or concepts for this kind of disaster. No one would have ever thought to write them down as a crime before because doing them was seen as inconceivable. To me, the big tell more so than the stuff that has happened since the lockdown began is that many of the pandemic preparedness actions and structures that you talked about that were put in place while you were there were dismantled before the pandemic. Why?

Ron Klain: Yeah. It's interesting. Why on earth? So, look, I think that one thing we said at the end of the Ebola response was that we should never have to have one of these specialized disease responses again. And I said, "Let's set up, inside the White House, a permanent office on pandemic preparedness and response, of experts who can help prepare for what is inevitable and bring together all the different disciplines you need to monitor the risk, assess the risk, quickly respond to the risk, quickly run the response." So President Obama set up that office after I departed, put someone named Beth Cameron in charge of that office, a real global health expert. With the change of administrations, Donald Trump kept the office for the first year and put Admiral Tim Ziemer, who was a veteran of the Bush administration's work on AIDS in Africa in charge of the office, and I think continued to do a good job.

And then, in 2018, John Bolton took over as National Security Advisor, and Bolton had a very traditional view of security. His view was that the idea of a disease arising in a developing part of the world and spreading here... His view was that those kinds of threats, those were development problems. Those were problems for social workers and aid workers, that diseases would spread in poor countries, and we'd need to send relief over there. His view was, that wasn't a national security threat. That was kind of a do-gooder problem. We should have a bunch of do-gooders go over and do that stuff. So he said, "Look, what we're going to do is we're going to shut down this office that Obama created. We're going to keep a few people to keep an eye out for terrorists because Bolton was very focused on the idea that terrorists might bring diseases to this country, but not that tourists would bring diseases to this country.

In fact, what we've learned painfully over these ensuing six months is that it really didn't matter if COVID came here as a bio-weapon or merely because a bunch of people on tours from China and from Europe brought it here. We're all suffering a big price, and it has a big national security impact. So I think the answer to your question is a very traditional and out-of-date view about national security led people to view these threats, these what they called soft threats, not hard threats, as not real problems. It's the same reason why some people in the national security community, particularly ultra-conservatives, don't view climate change as a national security threat. It's an environment problem. It's a problem for the environmental people, but it's not really a security threat. Global health issues were seen the same way by Bolton and his allies, and as a result, the pandemic-prevention office at the White House was shut down, and the team was disbanded.

Eric Ries: Talk a little bit about how you first got into public service and into government. How does one eventually become the Ebola czar. It sounds like a career.

Ron Klain: It's not a career path. No, no, no, no.

Eric Ries: Talk about why you felt called to do that and just how your path through public service has led to this moment.

Ron Klain: I'm a lawyer by training, and I served in the Clinton administration in the White House Counsel's office and ultimately as Chief of Staff to Vice President Gore, and worked on Capitol Hill both before and after that in both the House and the Senate. So I had experience on the Hill. I had experience in the White House. At the end of the 2008 election, Vice President Biden asked me to be his Chief of Staff, and I spent the first two years of the Obama administration as Vice President Biden's Chief of Staff and also as overseeing the team that implemented the recovery act, the big economic recovery package that President Obama got passed in 2009. And implementing that package involved coordinating the work of 14 government agencies, spending $900 billion in two years.

Eric Ries: Which used to be seen as a lot of money.
 
Ron Klain: It used to be a lot of money. At the time, it was the most money the government ever spent on something like that. We got it out the door on time. We did it with a minimum of waste. It was seen as one of the most efficient, transparent government programs in history. And I think it was that experience that led President Obama to come back and take over the Ebola response. His view at the time, in the fall of 2014, was that he had excellent medical experts, he had excellent scientific experts, but that the government wasn't really executing fast enough, that the agencies weren't working together, the throughput of the system wasn't as fast as it needed to be. So he had the view that, based on my experience in implementing the recovery act, he would bring me in to oversee this vast Ebola response that he had commissioned.

We ultimately put 10,000 people on the ground in West Africa to fight the disease there. We got 100 hospitals and health-care facilities in the U.S. ready to receive potential patients, to test potential patients, to screen and isolate potential patients. We treated about 18 people in the U.S. with Ebola. Two people died. One person who was misdiagnosed initially in Dallas who passed away. And then we had a U.S. doctor who was fighting the disease in West Africa who got misdiagnosed there. And by the time we got him back to the U.S. to be treated, he was just too ill to be saved.

So we successfully treated 16 of 18 patients, and I think we put together the right kind of response in terms of testing people who needed to be tested, screening people who were coming from West Africa to the United States, tracing their interactions with others in America, and protecting the country from a potential outbreak here. Even while, obviously, the vast majority of our efforts were about fighting the disease in West Africa and containing it there, the best way to keep people throughout the continent of Africa safe and ultimately other parts of the world safe was to try to contain and fight the disease in the three countries where it was raging in 2014.

Eric Ries: Oh, man. I vividly remember the cable news histrionics and the fear-mongering and the way that we in the public received the story about the Ebola outbreak. I mean, given that some of those same players are still on the air now, we understand how many of those arguments were really, truly in bad faith. I guess one of the big questions that is lurking in the pandemic response is: was that outcome available for COVID-19 for the U.S.? If things had been handled differently, could we have had a similar deescalation? It's almost like a fantasy now that the experts could have been criticized for exaggerating and fear-mongering. That's a fantasy outcome. Is that something that we could've had? Was that possible, given the facts on the ground?

Ron Klain: I think we were always going to see many more cases of COVID in the U.S. than we ever saw of Ebola. I think that the disease is spread so much more easily. So I don't think we could've had the same kind of outcome. I do think we could've had a much, much, much, much better outcome if we had handled this properly. So, if you look at countries like Korea, for example, which had thousands of cases but many fewer deaths, not just two like we had with Ebola but several hundred, but nonetheless got the disease under control in relatively short order and didn't suffer anything like what we're talking about here in the U.S., 130,000-plus deaths already and continuing to mount at 500 more a day.
 
So nothing about the extent that we've seen was inevitable. I do this, though, that certainly some epidemic here or some outbreak and some spread here and fatalities here were inevitable. I mean, I think that... Could you have had an outcome that was more like H1N1 in 2009, 2010, where over the course of a little more than a year, about 13,000 people died, so about 1,000 a month? Right now, we're still at 500 a day on COVID. I think something like that was much more possible than what we've seen. So this was... I've said from the start we did a great job on Ebola. This was harder problem, and it was always going to be more difficult, but we sure have botched it up. I don't think there's any question about that, too.

Eric Ries: In a previous conversation, we had an epidemiologist, Dr. Robert Schooley from UCSD, and he talked a little bit about, from the medical and scientific perspective, what a proper response would've looked like and what could have prevented more than 100,000 deaths. I wanted to ask you the same question but from the point of view of leadership. What are the attributes that were needed to make this work? What I think has been so interesting in these conversations is the ways in which the pandemic reveals as much as it causes problems. It's revealed all these other epidemics of inequality, of short-term thinking, and a real failure to take leadership seriously.

Ron Klain: Yeah.

Eric Ries: I wonder if you could talk about, in a hypothetical universe where the president had called you after he saw your op-ed on January 22nd and said, "Ron, what do we do?"

Ron Klain: Yeah, sure.

Eric Ries: What would a proper response have looked like?

Ron Klain: Well, so first of all, I think the pandemic both reveals and causes. I think both things are true. And I think, look, the first thing I would've said was... And I said that in the piece and that you read from, Eric, and in the other pieces I wrote in January. I wrote a number of pieces in January, early February. I testified. I testified at the first hearing Congress had on coronavirus on February 5th. So, to me, it starts with putting science first. People always think that's odd coming from me as a non-scientist, but when President Obama brought me in to run the Ebola response, his first directive to me was, "There are the scientists over there. They're going to make all the strategic decisions. Your job as a policy person is to figure out what government policies will take that science and turn it into action and implement their scientific and medical directives through this complicated government we have of federal government and state government and local government and private health-care systems and public systems and so on and so forth."

That's where policy people are needed, but the key strategy of the response has to come from science and medicine. And I think the number one problem we've had in the U.S. is the continued effort to either silence, quash, bend, ignore the scientific and medical advice when it came because it was inconvenient or unpleasant or whatever or because we have, also, this cultural trope for some political movements in our country that, like, "Science is bad," or, "Science is elitist," or, "Silence is liberal," or any of these crazy-

Eric Ries: But they've had a lot of practice on climate change.

Ron Klain: Practice on climate change and all kinds of things.

Eric Ries: Tobacco, I remember the fight over tobacco.

Ron Klain: Tobacco, all these things, right. So I think that's where you have to start. You have to start with the idea that: where are the answers going to come from? They're going to come from science. That's the first thing. The second thing I would've said is, "You have only two choices with an epidemic. You over-respond or you under-respond. This isn't like a business problem where you can do just in time, just enough inventory, just the right way. You are either going to wind up with too many test kits or too few, but never the right amount. You are going to wind up with too many hospital beds or too few, but never the right amount because epidemics are unpredictable, because there's uncertainty. So, to quash these things, you have to overdo it. You have to just imagine the worst-case scenario, deploy against the worst-case scenario, and then, if you succeed, you're going to have overspent, over-deployed, over whatever. And people will criticize you for it, but what they're criticizing you for actually is the success of your response."

And here, I think there was an effort early on to just do just enough. Maybe we won't need so many tests. Why should we spend all this money and do all these things to make all these tests? Maybe we won't need that many hospital beds. Maybe we won't need that much PPE. Let's just see. Let's just see. Let's just see. Right? And the problem is we got behind on all these critical things. We got behind on tests. We got behind on beds. We got behind on PPE. We got behind on critical equipment. We got behind on critical chemicals and reagents and things like that. And once you're behind, catching up is super, super hard. It's an exponential problem. And it's not just that. Also, because you're behind, it keeps getting worse. And so you get further and further behind.

So, if, in fact, we had woken up in late December, early January and ordered millions of testing kits and begun to test people early and appreciate it early on, just how widespread the virus was, we would've then surged contact tracing and identified who has the disease and where is it, and who are they having contact with, and isolated chains of transmission. And we would've surged protective gear to the people on the front lines so they wouldn't be spreading it or getting the disease. And so front-line workers who were doing the deliveries and the groceries and all those things wouldn't be getting it and dying and spreading the disease and all these things that are happening.

If we had done all that, Eric, in January, in February, we'd be having a conversation. Some people would be saying, "Oh, my god. You spent $1 billion on buying gloves that were never used. What an overreaction," and so on and so forth. But I'll tell you what. We would've saved a lot of lives, and the money we spent on things we didn't need would be dwarfed in comparison to the economic losses we're suffering because we didn't do that. So I think those are really the key pieces that were missing here: a lack of science, a lack of real intensity and effort on the response.

Eric Ries: I was involved tangentially in a number of the relief efforts early on, especially around PPE and education and hunger. So I had indirect contact with the government at various levels and got to see more than I ever wanted to see, believe me, but I'm sure quite minor compared to what you've seen in your career. I just got a little bit of a taste of the dereliction of duty that has happened here. One of the things that really struck me among advocates, though, especially early on, was that there really was a no-recriminations policy. Almost everyone I talked to said, "Look. Look forward. Don't look back. The fact that mistakes were made... We'll obviously need to have a truth and reconciliation commission at the end of this. But right now, we need to focus on getting the right thing done, and that means working across the aisle. That means working with people who made mistakes. Everything is forgiven if people will make the right decision now."

I think that was really admirable, and it took a tremendous amount of forbearance on the part of these advocates and the folks working in the field. But one of the really maligned consequences of that is that the public is not really properly informed about what was happening as it was happening, even though we who were working on the problem had this idea that we understood that this had been incompetently handled or maliciously handled in some cases. We all nonetheless had this collective delusion that this was going to be a short-term problem. We said, "In a few weeks, when people finally do wake up to the reality of it and start addressing it properly, then we could deal with everything else later." Now later has come, and it seems to me like the collective delusion is still operative. We're still not taking the problem, even right now at this very moment, seriously enough. Talk a little bit about what worries you the most at this point, what our response is now as we enter summer with cases spiking again.

Ron Klain: Yeah. It's an interesting point. I certainly agree with the idea that early on, a no-recriminations approach was the right approach, but I think that became kind of a no-accountability approach, which bled into the wrong approach. So I would go, and I would speak up publicly, and I would say, "We don't have this testing problem fixed." And people would say to me, "Well, don't point fingers." And I would be like, "Okay, but we don't have this testing problem fixed." I'm not saying we didn't have it fixed in January, though we didn't, and I'm not saying we didn't have it fixed in March, though we didn't. But it's April. We still don't have it fixed. And I think it was fair for the advocates, the people who had this view, to assume a very reasonable thing, which was that the Trump administration would wake up and start to do stuff. So, leave aside how angry we should be about their failures on testing in January and February, there's a sense that by March they were going to get it together. They were going to do it. We could worry-

Eric Ries: You're going to laugh at this, but I had two or three weeks of my life where I was told every single day that someone had it on good authority that tomorrow FEMA was going to make the mass order of PPE, and therefore we could all stand down. I actually heard that every single day for like 20 days in a row. I felt like the people that I was hearing it from sincerely believed it. It was like Lucy and the football over and over and over.

Ron Klain: It is Lucy and the football. So I think that's a real thing that happened here, which was just a reasonable disbelief by reasonable people that things wouldn't reasonably change, and they didn't. So what concerns me as we sit here today is that none of these things are still done. And I'll tell you, what concerns me the most, I suppose, is a certain kind of defeatism. I saw someone who I really admire and respect, I'm not going to name him, but who's a real progressive leader, tweet today, "Well, it's too late for testing and tracing now. It's gotten out of control. We've lost control of it. We need to figure out what to do now," so on and so forth. Look, it's not too late for any of these strategies. The countries in Europe, if you look at what happened in Europe... I mean, I mentioned Korea early, which got on top of this early and did a good job of not letting it get out of control.

But look at what happened in Europe. They did not do a good job of getting on top of it early. It did get out of control there. They did suffer losses of life, but they never gave up on getting in the game. And ultimately, in March or certainly by early April, they had robust testing regimes. They had robust contact-tracing regimes because I think, in our country, we're a little focused on this testing thing, as we should be. We don't talk about contact tracing enough. Testing makes tracing possible. Tracing extinguishes threads of transmission.

Eric Ries: I will put a link to testandtrace.com in the show notes. It's the definitive resource. This is very important.

Ron Klain: I appreciate that, yes. So Europe not only tested. They traced, and as a result, yes, way too many lives were lost. Yes, it was too late, but they now have the epidemic down to... not wiped out, but down to a far, far, far, far lower level than we have in the U.S. The other day, the entire continent of Europe, 450 million people had fewer new cases than the state of Arizona, which has about 7 million people in that. So the point is the basics here remain the basics. I worry that we're just at a place... We know that, as a political strategy, the Trump White House is selling, "Hey, you know what? Nothing you can really do about it, just going to have to learn to live with it. This is just one of these background risks we have in society. Just everyone go on with their day." That is them. What I worry is that the people who are fighting this start to give up or start to think, "Well, I guess there's nothing we can do," and we just throw up our hands. There is still something we can do. We can test. We can trace. We can provide PPE for people, people in the healthcare system and also the people we're sending back to work.

I mean, I saw an event at the White House yesterday, I think it was, on how all the K-12 kids should go back to school, and they should all go back to school. Well, okay, that's a plausible position, but only if you're going to mask and face-guard the teachers and glove them and protect them. And if the White House's position is, by the way, "Teachers, you know what? You have to go to the five-and-dime store to buy your own chalk because we don't give you school supplies. And now, by the way, teachers, you're going to have to figure out how to get your own masks, how to get your own gloves. You're just kind of on your own," that's not a strategy. So I do think a concerted federal effort on testing, on tracing, on equipment, on clearer guidance on what should open and when it should open and how it should open safely... I think all those things would obviously save lives.

I think, ironically, Eric, the other thing about it is better health strategy here would also be better economic strategy. The president set up this thing where he says basically, "You know what, a bunch of scaredy-cat liberals want to see us focus on health. I'm saying we need jobs. Let's reopen as quickly as possible. Let's reopen without standards. Let's reopen willy-nilly. Let's reopen without protection for workers and customers. Just open." Not only is that approach going to cost lives... That's pretty obvious to people, I think, but that approach is going to wind up hurting the economy even worse because we know what's going to happen, which is... America's a consumer-driven economy. We don't make people shop. There's no law that says, "You must go out to eat." There's no law that says, "You must go into the dress shop and buy a new dress. People consume when they think it's safe and smart to consume. And when they see their government throwing up their hands and doing nothing to make it safer, they're not going to consume. So you see all the data starting to come in now that restaurant usage is actually going down, not up, in these early-open states. Bricks-and-mortar retail are going down, not up. Why? Because consumers don't feel safe. I think that's the economic flaw in the president's thinking.

One last thing on this point, when President Obama hired me to be the Ebola Response Coordinator, I obviously knew very little about diseases and response and these kinds of things. I knew how to coordinate government policy but didn't know about the substance. So, of course, the very first phone call I made was to Dr. Tony Fauci. And we talked at great length about a lot of the current issues and the things where he wanted my help in terms of getting the government to do better and whatnot. And I asked him, "Give me just some general advice, Tony. Give me some way to think about this." What he said was fear was a really important thing to think about. He talked about the early days of HIV/AIDS where Dr. Fauci was one of the real leaders from the start trying to fight this horrible disease.

And he said that people had all kinds of fear about getting HIV/AIDS in all kinds of ways, and that fear really impacted certain kinds of businesses, certain neighborhoods, so on, so forth. And he said, "Look, the thing about fear is the worst way to deal with it is to tell people they're being stupid or to deny it or to tell people you have absolutely nothing to worry about because when you say you have absolutely nothing to worry about, people think you're lying because they have something to worry about. So the most important thing is just to be honest with people, to tell people honestly what's riskier and less risky, how they can be safer, how they can manage risk in their lives."

Eric Ries: Which we didn't do with masks, for example.

Ron Klain: Like we didn't do with masks. His point was, if you're honest about what makes people afraid and tell people the truth, that is the best way to manage the social and political consequences of fear. And I've thought about that countless times over the course of this COVID epidemic. You see Dr. Fauci staying true to that advice repeatedly in public, when he's allowed to speak publicly by the Trump administration, telling people how things are, what's working, what's not working, so on and so forth. And I think the American public is incredibly generous in their willingness to accept that not everything is going to go right, as long as you're trying to make it go better. Instead, Trump stands up there and goes, "Nothing to worry about, nothing to see here, nothing to be afraid of. It's a hoax, whatever." That just makes people's fears worse, and I think, in the long run, that obviously has big health care consequences. It also has big economic consequences because people just aren't fooled. They know what's going on, and unless they believe their government's really addressing it, they're not going to respond economically, as well.

Eric Ries: I really appreciate you saying that the pandemic both causes problems and reveals problems. I think that's really right on. If you think big picture now, what are some of the things that have struck you? What do you think the pandemic has revealed about our civic fabric, about the institutions that govern American life compared to, for example, what we've seen in other countries or compared to the image we had of ourselves pre-crisis.

Ron Klain: Yeah. I think three things. I don't think any of these things were unknown before the crisis. It's not that we didn't know these three things, but I think the nature and extent of them have really come into sharp relief. The first is the disparities we have in this country by race. We've just seen a huge disparate impact of this epidemic on people of color, particularly Black people and Latinos. I think that disparate impact, again, not a surprise to anyone who's looked at any other public health issue in this country. That's always true, but I think it's just really come home in a really powerful moment.

Of course, it also overlaps with the murder of George Floyd and the Black Lives Matter protests and whatnot. It's obviously a coincidence that George Floyd got killed in the middle of this. It's not a coincidence, though, that the reaction to the murder of George Floyd is infused with this sense of a life-or-death moment for people of color in this country around COVID. It's just a lot of things that have always been there but really heightened and dramatized by this epidemic. So that's one thing that it's revealed.

I think the second thing it's revealed is this great disparity in our economy, and not just between rich and poor, which we always knew was there, but between the kind of work that people can do at home and the kind of work that requires people being out in the world and working that way. Obviously, I worked for a long time for Vice President Biden. I'm a big supporter of his. I'm working on his campaign, and he's got a TV ad now where he says, "The delivery workers, the grocery store workers, the warehouse workers, we've got a new name for them. We call them essential workers. We praise them, but we have to do more. We have to pay them." And it's not like they weren't essential before. It's not like people were out there hunting and gathering their own food before. We were beneficiaries of the convenience of either getting it delivered to your house or, before COVID, the convenience of walking into a grocery store and seeing a billion choices all perfectly stocked on the shelves when you wanted it, where you wanted it, and all these things.

Eric Ries: Never mind the people that actually grew it.

Ron Klain: Never mind the people who grew it and the people who picked it and the people who then got it from the farm to the processing wherever, and all these steps in this whole process. So this all existed kind of behind the scenes. Now I think the fact that these men and women who do this work are the least paid in our country, very often, are the ones who've been at risk of getting the disease, I think it's really driven that home.

Then I think the third thing that, again, we all knew was just how polarized we are as a country around some basic things. One thing that's been different about America and other countries has been the fact that this has been kind of a polarized response in our country, the idea that we have people... Every day, you go on social media. You see some video of some person yelling at some other person about mask-wearing, and people with these crazy conspiracy theories that, even though their doctors have been wearing masks for like 100 years, that they're going to die from CO2 poisoning because they wear a mask or whatever, that polarization, which, again, everyone who's followed this knew existed before. I think people had maybe this optimistic hope that in a moment of national crisis, you might be able to set that polarization aside, that when really life and death stakes turned on it, people would set it aside. But I think people know that that is true now, and we're seeing the grave, grave consequences of that in a really painful way.

Eric Ries: It's so interesting going back to your experience with Ebola because it's not like polarization was low at that time.

Ron Klain: No.

Eric Ries: And people made an attempt to polarize that issue politically, of course, and yet you had leadership who was willing to put that aside and do what was in the interests of the nation. Is it right to call this polarization, or is there something else here? How do we make sense of the fact that there's an asymmetrical nature to this?

Ron Klain: Yeah, it's a really smart point, Eric, and having said my little polarization speech, I will also say I give the opposite speech at times. Ezra Klein had a great piece out in Vox last week along these lines, which is that it's kind of partly polarization, and a lot of it's just Trumpification. I mean, what's interesting about the mask thing is that, while there are differences among Democrats and Republicans on masks and Democrats are more likely to Republicans to wear masks and feel more likely there should be mandatory mask rules than Republicans, it's also fair to note that, in fact, a majority of Republicans do wear masks. A majority do think there should be mandatory mask laws. The big difference here isn't really a classically polarized difference but a difference between maybe 80% of the country, members of both parties who say, "This is what we should... and 20% that's holding out.

So I think it's important not to conflate this fact that we do have 20 or 25% of the country that's following Trump, to not conflate that with broad, just general polarization like, "Oh, we have different views on tax policy. We have different views on... This is something where... One reason why Trump is unpopular right now is he is pursuing a view of this that is a distinctly minority view. So I do think it's a fair caution to be careful about how even I use phrases like polarization and to be a little more precise in how we see this moment. There is no question that we are divided, but the division is more like an 80/20 division, not like a 55/45 division.

Eric Ries: It really reminds me, and you were there so I'm really curious to hear your perspective of it... It reminds me of the early days of the Obama administration in 2009. The president had run on a desire to bring reconciliation and bipartisanship back to Washington. I remember reading his book and the way he said, "We're going to incorporate ideas from both sides." The political opposition at that time had a conscious strategy that if they opposed something, then it couldn't be bipartisan by definition, and therefore he couldn't be a success by that metric that he, himself, had laid out as a marker. I remember feeling frustrated at the time that the press went along with that, rather than saying, "Wait a minute. Shouldn't the test of whether something is bipartisan be not whether politicians of different parties sign on because that's easy to game? But shouldn't it be based on the polling data, based on the evidence we have?" There are policies that command a bipartisan majority across the whole nation.

I think it's meritorious, and we should give politicians credit when they do something that is bipartisan. But even if they have bad-faith opposition that decides to oppose it even though, just a minute ago, they had been for it, and if we had made that choice as a society then to view issues through that lens, wouldn't we be reaping the dividends of that right now?

Ron Klain: Well, hard to know, but I think it's a very good point. And what I'll say here is this actually goes one step further because let's give some credit here. Mitch McConnell wears a mask in public, publicly says people should wear masks. Kevin McCarthy, the Republican Leader of the House, wears a mask in public, says people should wear masks. So, particularly on this mask issue, this isn't like 2009 and Republicans versus Democrats and so on and so forth. You even have many elected Republican leaders joining Democrats saying, "This is what we need to do," so on and so forth. And really, Trump and his most core identifiers are really out there on their own on this. They're really the outliers. That's, I think, what's so striking here, which is that even Trump's more traditional political allies like McConnell, like McCarthy, others, aren't willing to walk down the plank with him on this mask thing.

Eric Ries: Funny that they would draw the line there.

Ron Klain: Yeah. Well, thank goodness.

Eric Ries: Thank goodness. That's right. They're probably saving lives right now.

Ron Klain: Absolutely.

Eric Ries: What do you think we have to do to regain trust in our institutions? I mean, it's a catch-22. Right now, some of the very people that are actively damaging these institutions are on TV saying, "See? This is proof that you can never trust institutions. You can never trust elites to run them because we ourselves screwed it up." And you know for sure that many of them are going to be on cable news next year saying that exact same thing, probably on January 22nd. What do we do about that?

Ron Klain: Yeah, I think it's a hard problem. Look, I think, in the end, the government and its leaders need to do the right things and hope that people see that they’re the right things, hope that they see the results, hope that they follow along. There's often an answer to that, and then there's a political answer to that. The problem with that is that politics exists in real time, and it takes a while for reality to be proven. So I think about health care reform as a good example of this, which is that 2009, 2010, President Obama, Vice President Biden, Democrats in the House and the Senate put a lot of capital and energy into passing the Affordable Care Act and providing health care to tens of millions of Americans and protecting people from pre-existing conditions and protecting young people that could stay on their parents' program, policies and whatnot.

Eric Ries: It helped a lot of entrepreneurs, by the way...

Ron Klain: Helped a lot of entrepreneurs.

Eric Ries: ... because so many founders cannot get health insurance.

Ron Klain: Yeah, a lot of ways to really... positive for, obviously, health care, but also positive for the economy in all kinds of ways, and paid a huge political price for that in 2010 because the benefits weren't really baked in by that stage in time, and the costs were very apparent. Now, 10 years later, President Trump's effort to roll all that back is a political liability for him. And 10 years later, the people who made those decisions in 2009, 2010 are the political winners from having been on that side. But in real time, it was a big political problem. So I think that's unfortunately the nature of our political life right now. I don't know what will change it. I just know that this is the most important thing. President Obama always believed, and I agree with this, that the most important thing you can do is just do the right thing. I do think progressives need to do a better job of explaining to people why they're doing the right thing and explain to people what they've done and try to do a little better job in the realtime of winning the political battles over these things. But you got to do the right thing and then try and tell the story on that.

Eric Ries: Let's talk a little bit about the long term. What are the steps we should be taking right now to build a more resilient, more fair, equitable, just society on the other side?

Ron Klain: I think clearly we need to act on all three of the most obvious crises and a fourth lingering crisis. So we need a meaningful economic policy and economic policy changes. And that means creating jobs for people who have suffered permanent job losses as a result of this. There are going to be millions of people who have lost their jobs for good as a result of this. We need to create jobs for them. We need to raise incomes, both the minimum wage and other things that raise people's incomes. We need to help families cope not only through this crisis, but to be better off after this crisis is over. There's a whole series of economic measures that need to be taken. Obviously, health care reform is part of that.

Secondly, we need to really still address this COVID crisis. President Trump keeps saying, "It's going to go away. It's going to go away like a miracle. It's just going to disappear," whatever the formulation of the day is. It changes, but it's some version of that almost every day. We're going to need a lot of government action to do that. We are going to need to vastly ramp up testing and tracing and get to a place where we get this under control until we have a vaccine that's widespread and widely administered and whatnot. So that's the second thing.

We have a racism crisis still in this country, and we need to address that. We need to address that with criminal justice reform policies. We need to address it with policies that address all forms of systemic racism and housing and employment and the ability to start a business and to grow a business and all these things. Then we have the climate crisis, which has kind of slid off the front page because of those other three crises, and that's the nature of the climate crisis, unfortunately, which is it's always not on the front page because other things take its place in terms of the day-to-day news. But I think it's really important that we address it.

COVID is a really interesting metaphor for the climate crisis, or a comparison or whatever part of speech you want to use to describe this, which is that there's a crisis that people ignored early on, kind of thought it would go away. Trump even used the word hoax to describe it, like he's used for the climate crisis. Scientists were disparaged. People who issued warnings were considered to be negative Nancies or whatever you want to call them, and so on and so forth, alarmists. And then, all of a sudden, it was here. And we're seeing the death toll and the devastation, the economic consequences.

Eric Ries: Well, to your point about the defeatism.

Ron Klain: And the defeatism: "Nothing we can do about it."

Eric Ries: Nothing we can do about it now that it's so bad because we didn't act before. Therefore, we don't need to act now.

Ron Klain: Act now... Again, I think climate's a more slow-moving version of COVID but, in some ways, even more drastic and dramatic. So we need to really address that, also, as a country and as part of a global community.

Eric Ries: So, to me, the comparison point that keeps coming up from history is the WPA and the effort to put the unemployed back to work doing socially useful things. The need for that scale of investment keeps coming up in these conversations again and again and again, just the really obvious stuff. We have idle factories right now in this country, and we can't import enough PPE. How is it not the most obvious thing in the world that we need to have a mass effort to retool, re-skill, retrain, insource production of essential items? And, although it's masks and gowns right this minute, the production of melt-blown polypropylene, in the future we'll need to be manufacturing new items. So we need to have a WPA for manufacturing.

But shouldn't there also be a 21st-century digital WPA? We have millions of working families who can't work and send their kids to school. So we need to have a mass of investment in online education and tutoring. Well, good news. There's millions of people who are out of work. There's college students who can't go to school. There's retirees. There's knowledge workers of every kind who are not as busy as they used to be. Those people could all be online tutors for kids. We could be investing in mastery learning and supplemental education, closing the digital divide in education, making sure we don't have a lost year for students if we can't reopen schools. We could be doing that for every working family in the country.

It's so obvious in hunger. We have restaurants closing and going out of business. We have farmers plowing over crops at a time of unprecedented hunger. How is it not the most obvious thing in the world that the government should be funneling money to those private enterprises to keep them open, keep those people employed, getting the macroeconomic boost of that, and using that to feed the hungry. I feel like we're tackling many of these symptoms individually. There's plenty of nonprofits and people advocating for their one issue. But what do you think the prospects are for us to zoom out and say, "Okay, hold on. This is a massive societal-wide disruption with second, third, fourth-order effects that are all of a similar form"? Do you think we could do that coordinated response like our grandparents had to?

Ron Klain: Yeah, I certainly hope we're going to see that. As I mentioned before, I support and am working with Vice President Biden. He's got a big speech coming up where he's going to lay out his economic plan he calls Build Back Better that really addresses a lot of what you're talking about, Eric, that addresses the need to retool our supply chain, first and foremost, to start there, to insource the production of a lot of these key goods that you're talking about and the other things we're going to need down the road: medicines, treatments, therapeutics, ultimately vaccines, things like that. We should be insourcing as much of that as possible to create more security and speed in our supply chain and create more jobs, right? We need to really ramp up the production of all the PPE you're talking about.

The president has a tool, the Defense Production Act, that he could use, that Governor Abbott wouldn't have to send the National Guard to make masks. We could send workers, people whose job it is to make stuff, and they get paid, and we get the stuff we need. President Trump's been unwilling to use that authority for some reason. Vice President Biden says he will as president. But I think we also need to think bigger, as you're saying, which is... One idea the vice president's had specifically is to create a contact-tracing core of 100,000 people to take a lot of those young people who are out of work, who can't get jobs and let them do something really important, which is to help them run down this disease, learn skills in public health and community health and may wind up being great careers for them. Once this is all over, we could redeploy them to fight opioids and other great public health crises we have. These aren't just one-time things.

Then we also need to really ramp up our caring economy. We need to really increase the number of people you were talking about, providing care for the children, for the elderly, doing the kinds of teaching you're talking about, doing all kinds of online opportunities you're talking about. I think one thing that's been a weakness, aside from all the other weakness, but one other thing that's been a weakness has been a perspective that this COVID crisis is a short-term thing, that it's like a really bad blizzard, that, "Oh, if we wait a couple days, it goes away." We plow up the streets. We all go back to our normal lives by Thursday, by Friday, by next week, so on and so forth. And I think that's led us to ignore these larger solutions that will take longer to ramp up. I mean, the WPA is a really interesting metaphor, everyone loves the WPA. It's a really interesting story. It took two and a half years before it started to employ people in significant numbers. I mean, this was not a short-term answer to the Great Depression. It was a long-term to the Great Depression.

I think, here, while certainly I hope we get COVID under control way before two and a half years, and I do think we could stand up some of these larger things much more quickly than the WPA was stood up in the 1930s because we have a lot of tools... We have a lot of advantages over the 1930s, no question about it. But I do think, look, it'll take longer to do some of these bigger things you're talking about. But I think, sadly, the effects of this disease are going to be with us for a long time. And as we talked about earlier, Eric, the effects of some of the underlying social problems the disease has laid bare are definitely going to be with us for a long time. So I think a bigger solution to this around insourcing, around manufacturing, around dealing with the climate crisis by creating jobs and building a cleaner energy economy and around really beefing up our caring economy, these things will pay benefits for the COVID response. There's no question about it, but long-run benefits for our country, too.

Eric Ries: I want to run an idea by you.

Ron Klain: Please.

Eric Ries: Because one of the themes in these conversations has been to inspire people to take action. I've been in dialogue with a lot of philanthropists and nonprofit leaders and, frankly, tech leaders who have not historically had a lot of interest in philanthropy who are getting in the fight right now, some of them for the first time. But this defeatism and sense of despair that has been so much a part of the messaging around the crisis has created a lot of confusion. What good could it do? What can I do?

I helped start this hunger-related nonprofit, and we're just trying to turn philanthropic dollars into food at the most efficient rate possible, feed as many people as possible. And I was talking to a philanthropist about it, and he was like, "What's the point? The government should be doing this, and they're not. So what if you fed an extra 100,000 people?" He was very dismissive about it. And of course, I was like, "Tell that to the 100,000 people who wouldn't have had a chance to eat." Yet I also understand his point. So I feel like what we're missing is a bigger vision of: what can people do to lay this groundwork? So I want to run an idea by you. Just tell me if you think I'm out to lunch here, no pun intended.

If there's going to be a delay before the government really is going to take this seriously and make the investments that are needed, hopefully... It's an election year now, but there'll be a new Congress soon. And so hopefully it could be early in the new year. If there's a possibility that it could happen then, don't we have an urgent need for shovel-ready projects? I know that would be a phrase near and dear to your heart because I remember how important it was in 2009. We didn't have enough shovel-ready projects, and that inhibited our macroeconomic response.

Should we be building pilot programs right now using philanthropic money, state and local money, whatever resources we can get our hands on to demonstrate their scalability, especially given that we have digital technology our grandparents didn't have? I feel like in the next six months, we could have 20, 50, 100 pilots in these different areas at relatively modest cost that would show that there is a way to spend this kind of money responsibly and effectively, the kind of money that's going to be needed to reverse the depression once it's available. So say a little bit about what you'd like to see the private sector, the NGOs, the tech community... What should we be doing now to prepare for this moment of shovel-ready action?

Ron Klain: Yeah, I think it's a great point, Eric, and I think that these philanthropic efforts are both meaningful in and of themselves... You feed one person, that's one less person that's hungry, let alone 10,000 people or 100,000 people. I mean, that's meaningful change. But also, as you say, they're really important for what they can teach an incoming administration about the way things can be done. And I'll use a very concrete example on this, which is my... I'm very proud to call him a friend, José Andrés at World Central Kitchen, who not only is feeding a ton of people in all kinds of parts of the country and the world in response to COVID...

Eric Ries: Millions the last time I checked.

Ron Klain: Millions, millions of people. If you go back to what he did in Puerto Rico after the hurricane, if you go back to what he did in Haiti and other places, what he did is exactly what you're saying, which is he found ways to feed people so effectively, so efficiently that they are now the standards that the government increasingly uses when it responds to a humanitarian crisis. I mean, his philanthropy both saved a lot of lives and innovated about creative ways to use existing kitchens and existing resources, how to feed people efficiently, how to get them hot meals, not just some prepackaged thing that had been sitting in a warehouse for nine years, that now FEMA uses some of his techniques when they respond. So I think this needs to be a dialogue.

I mean, I think that one thing that frustrates me as someone who's been in venture capital, in the private sector world is sometimes business people have a view that they have all the answers, and the government's filled with stupid people. And then sometimes government has a view that it has all the answers, and these business people are all wrong. The fact is there's smart people in both sectors, and there's stupid people in both sectors. And there are good approaches in both sectors, and there are bad approaches in both sectors. And if government's working well, it's learning from private models. It's hopefully also then regulating and providing direction to private players, and hopefully you get the best of both.

I mean, I think the COVID response is the illustration of the worst of both in the sense that the government did a really shitty job. Then, in the middle of it, Jared came along and said, "These government people are horrible. I'm going to bring in a bunch of private people. And instead of using my government tools, we're going to build a completely separate task force that uses only private-sector solutions to solve COVID." And that completely failed. We were going to have testing in every single big-box store parking lot. We have them in less than 1% of the parking lots right now. The people who were making the test chemicals didn't know if they were supposed to ship them to Jared's testing centers or government testing centers. It was just a complete mess.

Instead, we really need a whole-of-society response to this. We need a unified response where government is leading, it's working with private-sector models, it's drawing the best of all worlds, and it's willing to use the tools at its disposal. So we'll use the Defense Production Act. It's willing to use the authorities it has to leverage the resources we have as a country to help solve these problems. So I definitely think, I definitely hope that philanthropic leaders, business leaders will develop solutions in the months ahead, and those solutions will be leverageable by government and certainly learnable by government, and hopefully will lead to better policy in the future.

Eric Ries: We haven't really had a chance to talk about your work with startups, but your day job is actually at Revolution, started by our mutual friend, Steve Case. Do you want to talk a little bit about the role you see for startups to play in this recovery? I think something that's not super well understood on the policy side is that net new job creation fundamentally comes from entrepreneurship. And when people hear the word startup, they think San Francisco or Silicon Valley, and they have a very stereotypical image in their mind. But actually, entrepreneurship is critical to the growth of the economy all across our country.

Ron Klain: Yeah. I mean, I think entrepreneurship plays a critical role in creating jobs, not just in San Francisco, not just in New York, not just in Boston, the big venture and startup hubs in our country, but throughout the country. One thing we do at Revolution is we believe there are great startups all over America. We back them all over America. We backed hundreds of startups outside of Silicon Valley, outside of New York, outside of Boston, in every part of the country, and also diverse founders. There are many great women founders, people of color, founders of color that we've been able to back outside these three big hubs. So I think that, as we go to tackle this COVID crisis, we're going to find that startups are a key part of it. They're a part of innovating and developing responses to it. They're a part of building back the economy better after this has all gotten under control, part of really creating the kind of resilient economy of the future that is less impacted by things like that. So I think there's a lot of reasons to really focus on startups.

Our policy, the government policy thus far hasn't been that focused on that. The government policy's really been focused a lot of money to big businesses like airlines and things like that and then a good amount of money to traditional small businesses: pizza parlors and restaurants and dry cleaners and things like that. They're vital, and they definitely need to stay open. Of course they should've been included, and of course they need help. We really haven't thought much about, hey, what's it going to take to really get the kinds of startups you need coming out of this crisis to help provide solutions to the crisis and to really create the real job growth we're going to need? Because, look, one thing we know is going to happen is the economy on the other side is going to be different than the economy that went in.

Probably, there's just going to be less brick-and-mortar shopping. If you've ordered stuff online for six months, maybe you don't go back to the store in month seven, maybe less in-restaurant dining, just a lot of habits, less viewing of movies in movie theaters. There's displacement in the economy. We're going to have to fill that gap with a bunch of new jobs, and startups are a big part of creating those new jobs.

Eric Ries: I feel like I'd be remiss if I didn't ask you at least one political question while you're here.

Ron Klain: Fire away.

Eric Ries: Because compared to all of our guests, you must be the one closest to Vice President Joe Biden, who is one of two people who is overwhelmingly likely to be our next president. Will you talk a little bit about what it's been like to work with him? You talked a lot, especially the work on the Recovery Act and the work that you did with him out of the spotlight. Then what's it been like watching him ascend to the center of international attention and helping with the campaign?

Ron Klain: Yeah. So I first went to work for Joe Biden 30 years ago. I started working for him in the 1980s and had the pleasure of working on his Senate staff, worked on the judiciary committee staff in the 1990s. So he's been a mentor and a friend for a very, very long time. The thing I always tell people about Joe Biden is what you see is what you get. He is a very down-to-earth, very nice person, a giant heart, compassionate, decent person. And I think that the presidency and presidential campaigns don't change you. They reveal you. We've seen over the past three years the kind of person Donald Trump is, and I think we've seen, over the course of this campaign, the kind of person Joe Biden is, someone who always has that moment to talk to people, tries to reach out to people, really worries about the consequences of things on people.

I think that great presidential campaigns are the combination of a great candidate and the right moment. While I think Joe Biden would've been a great president for this country at any time, I think he's especially the president we need at this time to restore just some sense of decency and honor to the presidency, to try to show some compassion and understanding and to explain to people that experience in government is a good thing. Government's a hard thing to run. You need to know what you're doing. Just his background, his success in getting bills passed and working with Congress, getting things done, I think are the kinds of things we need. He's got the right values and the right experience.

It's funny. If you showed up tomorrow morning in New York and said, "I've got an idea. I want to build the most complicated skyscraper ever, but I've never worked on a job site or a building before," people would laugh you out of the room. And yet, Donald Trump showed up and said, "I've got an idea. I want to run the most complicated enterprise we have in America, government. I know nothing about it other than that I hate it." And we're seeing the consequences of that. I mean, we're seeing the bill on that has come due in a really powerful way. I think Joe Biden's experience, Joe Biden's character, Joe Biden's kindness and compassion, I think those are the things we really need in the Oval Office right now.

Eric Ries: I've got to ask this because, although people may not know it, you've been in charge of debate prep, I think, for every Democratic nominee since Al Gore, right?

Ron Klain: Yes, exactly.

Eric Ries: How on earth do you do debate prep under these circumstances? I got to know, what on earth do you do? How do you do it?

Ron Klain: Well, I think we'll see when we get there in terms of... I'm not going to lay out our strategy here on the podcast. But, look, I think it's really important for Joe Biden to be Joe Biden in these debates and to tell it like it is and to stand up for himself and to make it clear he's not going to take any gruff from President Trump. But he's not going to be Donald Trump. He's not going to be rude and mean and whatever. I think he's going to stand tough and be tough but be a tough Joe Biden, not a Donald Trump imitator. That's for sure.

Eric Ries: One last question on the politics, if you don't mind.

Ron Klain: Sure.

Eric Ries: What are the lessons that you hope the vice president and everyone who works in his incoming administration, if it comes to pass... What are the lessons from 2009 that you want them to learn? Because it seems to me like so much of the world we live in now was shaped by the consequential choices that were made by the president and others in responding to the last financial crisis. Obviously a lot of things went well, but I'm sure you would be the first to admit there were some things that we couldn't have foreseen and didn't go as well as you would've liked. Well, we're living in that world now and, to me, one of the major appeals of Joe Biden as a candidate is that he was there. He was in the room where it happened, so to speak, when those choices were made. So what are the lessons you hope he's taken away from how things unfolded over the past 10 years?

Ron Klain: Well, look, I think that... I want to start with the fact that he's very proud of his role in making those things happen. I think that the policy solutions weren't perfect, but I think America's a lot better off because of the Recovery Act. I think America's a lot better off because of the Affordable Care Act. I think America's a lot better off because of Dodd-Frank. I think that it's important to understand that every day in the White House is precious, and every day in a crisis is critical. And it's really important to muster the largest possible response you can as quickly as possible to address as much as possible. And the vice president, if he becomes president, is going to have a very, very full plate of dealing with all of the things we've talked about in this conversation, Eric. And I think he's just going to have to throw everything he has at it and fight like hell to try to get as much of this done as quickly as he can. I think if he can get bipartisan support for that, that's great. If he can't, he has to do it, anyway, and he has to understand that time is of the essence.

I know there are critics of the 2009, 2010 record, but I'm really proud of my experience, and I know Joe Biden's really proud of his experience in it. I think a lot of Americans were helped. You can't let the perfect be the enemy of the good, and you can't wish for things that you can't have. I hope that, if he becomes president, he's able to deliver on the same scope and nature of changes. I hope, obviously, they're going to go farther on health care, they're going to go farther on jobs, they're going to go farther on climate change, they're going to go farther on race, father on immigration. At least, that's what he's going to try to do. He's running on a bold agenda in all these areas, and then just getting done as much as he can. That's definitely the goal.

Eric Ries: Ron, I really want to thank you for taking the time to do this. I feel like there are 100 more questions I want to ask you. You have had a front-row seat to so many of the important episodes in American history, certainly in my lifetime. So I really appreciate your perspective and especially appreciate the work that you're doing now to help us build the new normal that we all want to see. I want to ask you one last question.

Ron Klain: Please.

Eric Ries: Simply, how do we get out of the crisis?

Ron Klain: We need leadership to get out of the crisis. Look, obviously, I'm biased. I think part of this is getting Joe Biden elected president. But I think what we're seeing is two big things. The talent, the resilience, the determination of the American people is really impressive, but without the right leadership, you can't really fight something like this pandemic and all the consequences it's inflicted and all the problems it's revealed. So I think, in the end, we need better leadership in Washington to fight this crisis.

Eric Ries: Ron Klain, this was a pleasure. Thank you so much.

Ron Klain: Eric, thank you so much.

Eric Ries: This has been Out of the Crisis. I'm Eric Ries. Out of the Crisis is produced by Ben Ehrlich, edited by Zach McNeese and Sean Maguire; music composed and performed by Cody Martin; hosting by Breaker. For more information on ways to get involved, visit helpwithcovid.com.

If you or someone you know is leading an effort to make a difference, please tell me about it. I'm @ericries on Twitter. Thanks for listening. Please rate and subscribe wherever you like to listen.
 


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Wednesday, September 2, 2020

Out of the Crisis #21: Tomas Pueyo on the hammer and the dance, political polarization, and how the pandemic will affect the way we live and work

In mid-March, as the coronavirus was sweeping through Asia and Europe, Tomas Pueyo published a piece on Medium titled "The Hammer and the Dance: What the Next 18 Months Can Look Like if Leaders Buy Us Time." One of a series he wrote after starting to analyze pandemic data in mid-February, the piece was shared by millions in multiple languages. It turned him instantly from an education technology expert--his day job is as VP of Growth at Course Hero--into a leading voice for how to move forward.

For many people, "The Hammer and the Dance" was their first introduction to the epidemiology of how to defeat a pandemic. It lays out, in clear and concise terms, a two-part strategy: first the hammer to flatten the curve as fast as possible. And then, once that curve is low enough, governments can dance, testing and tracking cases until the virus is eradicated or we develop a working vaccine.

Had we been able to apply this strategy simultaneously nationwide, the U.S. would be in a very different place than we are today. Instead, as Tomas told me, "every state was forced to behave like a country, but it was not equipped to behave like a country. Many had no idea how to deal with a pandemic. They didn't have experience buying bulk from the government things like masks or ventilators." The effects of that approach are ongoing and will be long-term. "If you can't even control the virus during the hammer period, it is unlikely that you can control it during the dance," he explained. "The benefit of the hammer and the dance is lower, and also the cost is higher."

Now, six months in, the virus looks different in every part of the country and the world. But one thing holds true everywhere: "Normal will never come back. The world that existed is not coming back."

Tomas and I talked about how political polarization has affected virus response, the best ways to approach the dance, strategies for countries that can't apply the hammer and the dance method, and why it's not possible to approach other catastrophes, like climate change, in the same way he's analyzed the coronavirus.


You can listen to our discussion on Apple, Google, or wherever you like to get podcasts.



 



A full transcript is beneath the show resources below.
 

Highlights from the Show:

  • Tomas introduces himself and discusses his quarantine set up and experiences so far (2:22)
  • Readership for "The Hammer and the Dance" (5:10)
  • How Tomas came to write it, and his other writing (7:22)
  • How he decided which data to look at as the virus spread and what it told him (9:56)
  • What Tomas was doing at the time he began his coronavirus research and why he took it public (14:18)
  • His first Medium article, "Why You Must Act Now" (16:44)
  • The argument it made for the seriousness of what was coming (18:18)
  • Understanding which virus management strategy would work (20:00)
  • The early debates about how to handle the coming threat (21:32)
  • Tomas's call to action and how it felt to have it read and shared by millions (22:44)
  • "The Hammer and the Dance" (25:33)
  • How countries who applied the hammer brought the virus under control (29:18)
  • Moving forward into the dance (30:32)
  • The ways to unpack and read the data (32:21)
  • Herd immunity vs. hammer and dance (35:19)
  • Denying that the economy is made up of people (36:51)
  • The importance of incorporating new information with speed (38:20)
  • Avoiding mental pitfalls and confirmation bias (41:31)
  • Tomas talks about what he got wrong (45:29)
  • Key points in how the virus travels and how to say safe (48:43)
  • The politicization of the virus and the advice surrounding it (49:56)
  • Patterns in effective vs. ineffective government management of the virus (50:56)
  • On forcing states to behave like countries (52:40)
  • His assessment of the state of California (54:13)
  • On "Out of Many, One", Tomas's article on political polarization in the US (57:11)
  • What Tomas is working on as he looks at the next phase of the virus (1:03:02)
  • Strategies for countries that can't do the hammer and the dance effectively (1:05:10)
  • What Tomas wants to see both for the world and himself once this pandemic passes (1:09:17)
  • How he thinks the pandemic will affect urban living, education, and work (1:14:32)

Show-related resources:


Transcript for Out of the Crisis #21: Tomas Pueyo

Eric Ries: This is Out of the Crisis. I'm Eric Ries. You remember The Hammer and the Dance? If you're one of 50 million people who read that article, you probably do, but who wrote it? For the past few years, there has been a trend of decreased trust in our public institutions. This shouldn't really come as a surprise. We have been busy chipping away at the foundations of our simple society.

Getting clear, unbiased reports has been challenging, even for simple problems. So how are we supposed to get information out in the middle of a pandemic? How do we cut through the news in the disinformation campaign? Some of you may remember a series of articles that made the rounds in the early days. The most famous was titled The Hammer and the Dance, and for many people it was their first introduction to the epidemiology of how to defeat a pandemic.

These articles laid out in clear and concise terms the available strategies that would allow governments to deal with the spread of coronavirus. The article advocated for a hammer at first to flatten the curve as fast as possible. And then, once that curve was low enough, governments could dance, testing and tracking cases until the virus was eradicated or we developed a working vaccine.

These articles had an outsized impact on the public's understanding of what needed to be done and I think helped speed the adoption of shelter-in-place orders. And even though at least in the United States we never quite made it to the dance, tens of millions of people read them, and it shaped their understanding. It helped them to come to grips with what was happening and hold their leaders accountable for action and inaction.

So when a fractured world where the media is as politicized as it has ever been, who managed to get this message out? His name is Tomas Pueyo. He was not a famous author. He wasn't a media star. He worked at an education startup here in Silicon Valley. So how did he do what so many others struggled to accomplish? Here's my conversation with Tomas Pueyo.

Tomas Pueyo: Hi, I'm Tomas Pueyo. I wrote a few articles around the coronavirus that got viewed by over 60 million people, and that pushed me from really not a person very well known in the coronavirus world to appearing on the news and in different newspapers. Before that, my day job is VP of growth at an online education company called Course Hero.

Eric Ries: Thank you for coming on. Thanks for making time.

Tomas Pueyo: Thank you.

Eric Ries: This has been a pretty stressful time for all of us. Let's start with how are you doing. How long have you been in quarantine? You saw this coming, so you must have a pretty extreme quarantine setup. Just tell us about how you're doing. How's your family? How are you hanging in there?

Tomas Pueyo: Yeah, I started figuring out it was going to happen around the middle of February, and I was waiting for the cases to really start appearing in Silicon Valley. When the first case appeared in Santa Clara, I pushed really hard for my company, for myself to work remotely as much as we could. So even before the shelter-in-place was announced, my company announced remote work.

And so, by now, we've been out, or we haven't been going out for more than two months. Both my wife and I work full-time. We haven't had the schools for the kids. We haven't had a nanny at home, and we have three kids below four years old, which has been quite trying for us and to juggle two jobs at the same time while also kids without help. And that's especially true since besides my day job, I had then to work on the coronavirus for a couple of months.

That was around six, seven hours a day. As a result, I didn't sleep for a couple of months, and my wife had to work two times as hard helping at home, but thankfully even with all of that, I'm in a better position than many other people who have suffered during this crisis in terms of people who have lost their jobs, but I can't complain in spite everything.

Eric Ries: I appreciate you saying that, and we should certainly reserve a moment to say thank you to all of the spouses and supportive partners that have made possible so much of this relief work that we have been talking about in this series of conversations. I'm in the same boat as you, not getting as much sleep as I would like, but cognizant of how much better we have it than so many who are struggling right now.

Tomas Pueyo: Yeah, absolutely.

Eric Ries: I had to do the math, and it's dangerous to do the math live, but I had to look up on Wikipedia the number of English-speaking internet users, which is about 1.1 billion.

Tomas Pueyo: Yeah.

Eric Ries: So if I'm getting it right, 60 million people is something like 5% of the possible audience of people who are on the internet and speak English.

Tomas Pueyo: That's funny, so a couple of things. Actually, the article was translated. The articles were translated to over 40 languages each.

Eric Ries: Oh my goodness.

Tomas Pueyo: Yeah, I'm counting some of these other languages, and it's not always easy because I control, for example, the Spanish and French versions of the article. And each one of these was seen by more than a million people. Whereas, for example, I don't control the German one, which a newspaper published, but when I check in with them, more than two million people had read it. So really it is not just the English-speaking, but since you're talking about addressable market, I had a thought about it.

And really the addressable market is not just the people, English-speaking, connected to internet, but rather I would say whoever is willing to spend half an hour reading an article about the coronavirus. I think that addressable market is probably, maybe, in the tens of millions, maybe hundreds but definitely not in the billions. So I think the most interesting aspect of this article is how just mind-blowing that distribution is.

I was talking with a journalist that told me that, "When I read your very successful article, it gets seen by two million people at most," but having 20 times that is just ridiculous. It's crazy.

Eric Ries: It's a remarkable thing, and I hope you have taken a few moments to appreciate the scope of it. We've had the chance to work together a little bit in crisis. And when I've been trying to recruit folks to help you with things, I don't have to say anything except for, "You remember that article, The Hammer and the Dance?", and everybody's heard of it. Everyone remembers reading it.

It was a seminal moment for so many of us, and it's remarkable to me. I think you're right. Among the audience of people who are educated, who are interested in data, willing to read a lengthy and in-depth article about the coronavirus, it has unbelievable mind-share and it was such an important part for a lot of us of crystallizing our understanding of what was to come. Tell us, just walk us through the story of how you came to write that article and how you even had the imagination that you should be the kind of person who should become almost the spokesperson for the crisis response.

Tomas Pueyo: Yeah, it's funny, because you mention The Hammer and the Dance. It actually was the second piece, but I think that is the testament of the craziness and the blurriness of all these events that have occurred over the last two or three months. So I think it's good to take stock of what has happened. Around the middle of February, I caught from Twitter from people like Paul Graham who had been tweeting about this coronavirus epidemic for some time, I identified the problem and I started looking at a little bit of data and posting it on Facebook.

Eric Ries: To be clear, you were not a published author or a scientist. This is not your background to be writing these things.

Tomas Pueyo: I am a public author but about a completely different topic. I have a book about storytelling structure, and I'm also not at all professional at storytelling. It's just one thing that I do that I take complex problems, and I go deep in understanding them and trying to solve them, and then trying to communicate about that problem. So the same thing really happened with the coronavirus.

I had no idea about the coronavirus. I just started looking at the data and trying to understand, make sense, of what was happening based on the data. And initially that was just on Facebook for my friends, but very, very quickly because the world was not aware of what was going on and all of the data was public, you could make your own decisions, reach your own conclusions based on that data.

And I think through February, one of the things that was obvious is that that had become a pandemic. By the end of February, the virus was in over 60 countries, and many of them had thousands of cases. And if you remember, Wuhan closed the entire region of actually Hubei when they only had less than 500 cases. So you knew by the end of February that this was a pandemic and that it was going to be catastrophic.

Eric Ries: Well, you knew. You knew actually. Look, first of all, in these conversations, the number of times that the story begins on Twitter is remarkable. So first of all, what a testament to social media and its power to reach-

Tomas Pueyo: Huge.

Eric Ries: But a lot of us were on Twitter in February, and a lot of us were looking at headlines and follow Paul Graham. So you went deeper than the average person. First of all, what was the data you were looking at, and how did you even decide what data was good and what was bad, what was legitimate, what was worthy of analysis? How did you figure that out?

Tomas Pueyo: Yeah, that's fascinating. One of my jobs in the past was consulting measures and acquisitions. And in that when you do that, within weeks you need to get very, very deep, become an expert in a new discipline without any previous background in it. And you need to look at the data very critically, because the other side of the merger or acquisition is actually trying to frame all the information in a way that is beneficial to that side and against your side.

So you learn to really look at the data and also in tech, you also know this, it's very, very hard to figure out the truth from the information you get, the signal from the noise. And in fact, The Lean Startup is very much that. It's focused on how to learn as fast as possible with as little cost as possible. I think for me, the first course was Worldometers in that it was a day-to-day report on the cases.

And one of the first things that you saw is that you had daily cases being exported from Italy, especially from Italy but also from Iran but especially from Italy, to all the corners of the Earth. So you're starting to see that, and you realize one healthcare system or two healthcare systems may be able to respond to a crisis successfully, meaning maybe South Korea and China, but once you have 60 countries that have cases, the odds that at least one of them fails in the containment is huge.

So that's the first hypothesis there. There's many, many data points there that are imperfect, but you can start triangulating from them. One of the key points was China is lying on this data. Well, if they were lying, they did an amazing job, because if you looked at all the ratios, such as deaths over cases and things like that, all of them were pretty reasonable and consistent.

If you only have one data point though or one data source, like China, that's not very reliable, but as soon as you start having South Korea and Iran and Italy, now you have four sources from different countries, different organizations. And if you see that these ratios are converging in the same direction, now your confidence is dramatically higher. So really, a lot of what I did was that.

It was looking around the world, where do we already have the data, comparing these ratios and reaching a conclusion. One of the key examples is the case fatality rate, right? At the beginning, still today but at the beginning even more, people said, "This is like the flu." Okay, let's look at the flu. The case fatality rate, the number of people who died, divided by the people who officially have the flu in the US, we can look that up. It's around 0.13%.

If you then looked at different areas in the world, at the time in South Korea, it was 0.6%. In safe areas of China that didn't get overwhelmed, it was 0.9%. And in Hubei, it was 5%, right? And you can actually see these numbers converge in different directions, and you can make extrapolations on what is going to be the range. So I think that, by the way, is one of the key, key highlights of that is in order to predict something in a chaotic world, you can't jump straight into models, into theoretical models.

You can only model something theoretically, if you really deeply understand the mechanism that underpins it, because a model is a simplification. And you don't know what to simplify and how to simplify it, unless you've really understood it, but something like the coronavirus crisis is a very complex one with a lot of different reactions that governments or populations can have. So you can't really jump into models.

So I really didn't rely a lot on models. I relied mostly on what happened in other countries. What did China do? What did South Korea do? What did Taiwan do? And then, based on that real-life experience, extrapolating what will happen in other countries.

Eric Ries: Explain a little bit about what you were doing at that time, because you're an amateur sleuth. You're pulling data from public sources. You have a day job here in Silicon Valley at an education technology company. So just talk a little bit about the reality of your life at that time as you were starting to post on Facebook and get a sense of the dawning... You had this dawning realization that this was going to be bad in the US.

Why did you decide or why did you feel an obligation to do more than just look at the data and share it with friends? What drove you to take this next step and go public, if you will, with the data?

Tomas Pueyo: Initially, it was again just on Facebook, and that was still going public because my Facebook is open. And the level of reactions that I had to that content is about anything else that I've ever shared. Not every one of my friends, but lots of my friends every day when I posted something engaged in debate, thanked me for the analysis. And so, that kept me going, and that became actually more and more urgent and important as days passed, because on one side the fact that this was a pandemic was becoming more and more obvious.

And the people in my environment and my group of friends were realizing that, because they were following the data, but people outside of that were not. My family didn't believe me at the beginning. My company was cautious about this. They were not moving forward very quickly towards remote work. And so, I was seeing this reluctance to take this extremely seriously everywhere around us, even in Silicon Valley, right?

A few companies ordered a work-from-home early on, but most of them didn't and people were waiting for the politicians to take decisions, right? For example, Santa Clara had a community-spread case early in March. If something like that happens, you want to close everything, because it's a community spread. It means that you just don't know what's happening.

Eric Ries: That's right.

Tomas Pueyo: But people were not, yeah. And so, I first started focusing on the Bay Area. Okay, at what point should you close your office? I explained it to Washington State, because that was ground zero of the United States at the time until it was New York. And then, what happened is all of that analysis was convincing my friends in Silicon Valley but not outside of it. So a friend of mine said, "Hey, I'm here in Paris. I understand what you're saying. People outside of Silicon Valley don't understand this, and you put together an analysis that is relevant for Paris, too. So I can share with my CEO friends, and they can close their offices."

And I just took all my analysis and put it in one place, and that was my first Medium article is the Why You Must Act Now article that got 40 million views, but I really didn't think about it. My previous most successful article ever had 250,000 views, so I thought it could get up to that maybe but not that much more than that. The fact that it exploded to 40 million was completely a huge surprise.

The goal of that article was to wake up a lot of people and to have so many people around the world really realize this is a big deal. The problem is once people realized that, they didn't know exactly what to do about it. And one of the first things that different countries were thinking is, "Hey, maybe we should just let this thing run, this herd immunity concept, this mitigation idea of maybe-"

Eric Ries: It feels like a lifetime ago, late February, early March, as least for me. And I think it's easy for us to lose sight of the fact that these prescriptions were very controversial, and the public was very confused in those early days of the pandemic. So walk us through the argument and what the data was showing at the time of that first article.

Tomas Pueyo: Yeah, and I love what you say around the mindset that people had, right? The mindset that most people had was, "We've seen this in the past. It happened with SARS. It happened with MERS. It happened with the swine flu. It happened with the avian flu. It happened so many times, and then nothing happens. This is the same." And so, people were feeling very safe that this was not going to happen to them.

They saw it happening in China, but then it stopped. And then, they were seeing it happening in Italy, but it's just Italy. It's not me. So really, people were not realizing that this is going to come to you, too. That's the mindset that people had, and the mindset is that, "Oh, there's not that many people dying. The flu is something that's pretty bad too," and that we shouldn't be concerned.

And so, I think that's what this first article of Why You Must Act Now really, really achieved at drilling this idea that this is really bad. And if you don't act right now, you're going to have bodies piling up in your country, the way that it was happening in Iran which was digging, the way that it happened in Hubei where the fatality rate was around 5%. So I think at that point, in fact I've started looking into this and you actually can see the mobility in different Western countries dramatically go down after March 10th.

And it might completely be a coincidence, but that's right around the time when people really realize, "Oh my God, this is bad." Now the fact that it's bad doesn't mean that we know how to react. At the time, the story that was most well known was the story of China, and China is basically a dictatorship. So the number one argument in Western countries was, "Well, this is bad, but it's not extremely bad. And then, you have China and we're a democracy. So we cannot just contain this."

Eric Ries: Yeah, and the presumption with whatever China did was bad.

Tomas Pueyo: Exactly.

Eric Ries: We're not going to copy what they did.

Tomas Pueyo: Exactly, exactly. And so, thankfully we have in that corner of the world a few countries that are very strong democracies who did a very good job, and Taiwan is a good example but South Korea is the best, because not only were they able to control the virus, but they were able to actually control a full outbreak without a hammer.

Eric Ries: Was that clear to you, even at that point, that their strategies were going to be effective? I'm trying to put the chronology together in my own head, and I'm realizing I can hardly remember what happened when.

Tomas Pueyo: Yeah. So for sure by then, which is March 18th, we knew that South Korea had controlled it. And actually, I'm looking at the data right now in my first article, and we knew it. I just did not call it out very specifically in the analysis. I'm just confirming right now. No, I did, yeah, yeah. So I did.

Eric Ries: But in that first article, the case was really that Western countries need to take this seriously and take urgent action.

Tomas Pueyo: Yes.

Eric Ries: That was the message. I don't know how other people are feeling about this, but it's hard for me even to remember that there was a time when that was controversial and that was a case that needed to be made now that we've gotten used to this pandemic, but before the NBA shut down, before we had those first confirmed cases of community spread, before... I can't remember which it were that tested positive in the early days, it seemed like a problem from over there. And I think we were all in a very severe form of denial about it.

Tomas Pueyo: Yeah, and I think those small data points that you share are the ones that help us go back in time, right? So for example, I don't know if you remember, but there was a massive debate on whether South by Southwest should happen or not.

Eric Ries: Right, isn't that wild?

Tomas Pueyo: Right. And so, so many people were angry about this, and so that's one. And then, the second one was Tom Hanks I think was the first famous person to--

Eric Ries: Yeah, that's right. That was the celebrity I was thinking of.

Tomas Pueyo: And just the fact that we thought this was a debate, I think highlights how we're thinking about it, yeah, at the time and how misinformed we were.

Eric Ries: How did it feel? How did you actually get the news that your article had traveled so widely and had been read by so many millions of people? What was it like being in the eye of that storm?

Tomas Pueyo: So the first is I pushed the article very, very, very hard and I've never done that in my life. Obviously, I release products at my job. I write articles, but usually I limit myself to making a post maybe on Facebook and that's it. This one was different, because I did realize how misinformed the public was, and I also knew that it was all coming from the right side for me.

I was not trying to make money out of this, and it was all about the message. So it's the first time in my life that I pushed this to all my networks as hard as I could, and I was also very aggressive on the viral mechanics that I plugged into it. Why You Must Act Now is a call to action. At the end of that article, I use a couple of sentences that say something like, "Sharing this document or this article is one of the few times in your life where you can actually save lives by sharing an article. If you agree with it, you should share it," or something like that.

That's a very, very strong call to action to put at the end of an article, and I knew that would dramatically increase the virality. The only reason why I added it is because I felt very, very strongly that, indeed, that message needed to be told. In fact, I have not used that again in my latest articles, because I didn't think the message was as urgent and needed to be as widespread, but I was very, very conscious on pushing it.

Even then, I didn't know it would be so successful. And so, what happened is the day after when I woke up, my phone would be buzzing every three or four seconds with Twitter notifications, with Facebook notifications. And it was literally three or four seconds for two or three days in a row, and then I started receiving messages from friends who were saying, "My father sent this to me. My group of friends from Russia sent this to me. I've received this from three different sources."

That really creates this image of, wow, this is really going widespread. And then, obviously I have the statistics from Medium.com, which lets you know how many people have viewed your article, and I could see it. Oh, I wake up and it's 10 million people. Three hours later, it's 11 million people. It's all very virtual. It's in the numbers, but that's really, really, really absurdly crazy.

Eric Ries: Tell us about The Hammer and the Dance.

Tomas Pueyo: When I published Why You Must Act Now, that was a Tuesday. And by the weekend, a few countries had already started taking measures. The debate after that, that's around the 15th, March 15th was really, "Okay, what should we do? Should we actually close the country, or should we do something different?" And one of the key debates there was led by the UK. The UK had a very strong team of epidemiologists from Imperial College.

Neil Ferguson is a famous one from them, and one of the main debates was around herd immunity. In fact, I went on TV the Friday around March 13th or something like that with one of these epidemiologists, John Edmunds, and his recommendation was basically, "We should not do anything too aggressive right now. We should wait a little bit, little by little increase our measures."

And it wasn't clear whether they wanted to just flatten the curve, whether they want to completely contain the virus, whether they were going for herd immunity. It wasn't really clear. And for me, it was crystal clear that if you waited a single day, the crisis would be dramatic. The other thing that I knew that maybe they didn't know is because of my job in product and in marketing, and my experience in storytelling, I have a sense of what you can tell people to influence their behavior.

And I knew that if you were very, very clear and you told the story well, people would listen and people would stay home, which is not what the team of epidemiologists and clinicians in the UK were thinking. So you had this very dangerous trend of maybe a lot of countries are not going to take the measures that they need to take. And so, I spent the following few days putting all the information together on why I thought you absolutely need to be very aggressive early on.

It's a deep analysis of what do you do if... What happens if you don't do anything? What happens if you just do enough to mitigate the virus so that your healthcare system doesn't get overburdened, and what happens if you actually go much more aggressive and you really contain this? Then, you crush the virus, and then you start handling the virus after that. By that time, not only did we know what China had done and we knew that China had controlled the virus, but we also knew that South Korea had done it too, and they had done it within three weeks.

So we knew we had at least two examples of the fact that we can do this, and we can do it also like South Korea, which is a democracy. I think the last thing that people didn't know is just how to think about this. What measures should I take, and how should I think about each one of them? And I think the key additional factor that I added to the conversation is, like nearly all decisions in life, this is a cost-benefit analysis.

Just look at your measures in terms of cost-benefit. Your benefit is the reduction in the transmission rate. The cost is the economic cost, and just try to optimize these things. Right now, you don't know what you're doing. So just completely lock down the entire country, and now you buy yourself time to figure out what to do properly. What are the optimal cost-benefit measures to start dancing, to start opening up the country, in a way that the virus is not widespread anymore?

Eric Ries: But what has worked well? What approaches are working and what hasn't?

Tomas Pueyo: Yeah, it's still early and we don't know all the details, but what we see is a lot of countries apply the hammer and the dance, mostly the hammer first. And now, we're starting to dance, and nearly all of the countries in the Western world that applied a heavy hammer have been able to control the epidemic within a matter of weeks, between seven and 12 weeks.

Eric Ries: And the hammer is the lockdown, the shelter-in-place-order strategy.

Tomas Pueyo: That's right, very aggressive, exactly, part of you don't know what's going on. You have a virus that's widespread. You don't know where it is. So you just shut down the country. You make people stay home while the caseload goes down, and you buy yourself time to figure out what to do. So you have countries like Australia, New Zealand, Estonia, Lithuania, Latvia, Iceland, Ireland, Spain, France, Italy, Germany, Norway, Denmark, Finland and many, many more.

All these are countries that have applied a hammer and really got the caseload to a level where they can start thinking, "Okay, it's time to start reopening the country." And then, many of these countries realized what they needed to do to move forward into the dance, this phase where you don't need these aggressive measures anymore. You can replace them with intelligent and much cheaper measures but still contain the virus.

For example, instead of locking everybody out, you might be able to identify who is infected and who might be infected, and and you only isolate those people, right? So that's one of the core measures to control the virus. So many countries were able to figure that out and start playing with it, and as a result started opening the economies.

And you have most of Eastern Europe, for example, that has been able to start reopening the economy without severe outbreaks. Countries like Spain have started opening up again. Many of these countries have ordered masks, for example.

Eric Ries: As you got into all this data, what's been the most interesting, surprising or shocking? You've unpacked it all.

Tomas Pueyo: One of the most fascinating debates has been the people that still push for the herd immunity case, and I think it's a very interesting and fascinating conversation to have. It highlights the only country that has really decided to very officially form a strategy that doesn't lock the economy down, that's Sweden. Sweden decided, "You know what? This is not as bad as we think, and we cannot contain this virus. So let's just keep it open and try to limit the number of deaths."

So that is really a debate that is anchored in data, even if unfortunately Sweden didn't make that data explicit, but really the debate that you're making here is, A, doing a lockdown is not better for the health, because regardless this is going to become endemic anyways and everybody's going to catch this. And, B, it's not as bad as we think and then, C, also locking the economy is very bad for the economy.

These are three statements that you can look at data to decide whether that's true or not. For example, in the argument of you cannot contain this, well, I think empirically that you can look at countries like China, Taiwan, Vietnam or South Korea who have been able to contain this. So when you're making that statement that you cannot contain this, I think there are examples, empirical examples, where you could if the burden of proof is on your side and Sweden didn't say anything about this.

The second argument was, "I don't think many people will die from this." And the argument there was the case fatality rate, the number of people who die divided by the official number of cases, is high but the true number of death is going to be low. The infected fatality rate, so the deaths over the truly infected, not just the official cases is going to be very low and is going to be similar to the flu.

That statement is another one that's based on data. You can go into the detail of the data, if you read whether that's true or not. And you can see for case fatality rate for the official death, you can see that the flu is 15 to 20 worse. And because the flu is such a low-fatality illness, there's no numbers on the infected fatality rate. There's no number on the true number of deaths [crosstalk 00:34:11]-

Eric Ries: We don't know what to compare it to.

Tomas Pueyo: Exactly, we don't know who to compare it to, right? So there's two things that you can do there. One of them is let's look at the studies on infected fatality rate as they come in, and the Santa Clara one was a famous one, which was suggesting that the infected fatality rate was very low, 0.1%, that it was very flawed and there was a lot of problems with bias. And the people were assembled and false negatives and things like that.

So you want to look at all the data from across the world and pick the best examples. And so, for example, one of the best ones is the Diamond Princess cruise, because it's nearly a perfect test. You have 1,500 people locked in one place, and you let these run loose. And what happens? Well, it happens that the lowest threshold there of deaths was around 0.7, 0.8% infected fatality rate, and that was the very lowest possible but you know now you have a lower bound of a fair amount of deaths.

And that's how you pick a little bit of the data to figure out what's true and what not, and then the same thing happened with the economy. One of the bets there that Sweden is making is doing a lockdown is too bad for the economy. And so, the question you can ask yourself is, okay, how can I look at data in the real world to figure out whether that's true or not? There's not a lot of data about this, but the one data point that we could look at is what happened in the 1918 pandemic and what we saw there.

Eric Ries: Which has been well-studied in the intervening years.

Tomas Pueyo: Exactly, and the US has been amazing at studying it. It was a big continent where there was enough different cities that were distant enough that you could isolate the epidemic in each one of these cities, but all of them in the same country so we have proper data about it. And you would assume that the cities that have higher mortality because they had weaker measures are the ones who'd have a better economy one year later.

Eric Ries: If it was true that lockdowns were harmful to the economy.

Tomas Pueyo: Exactly, but what you found is the opposite. The cities that were the hardest in the lockdown for the longest period of time were the ones who had a better economy one year later. And so, out of all the data that exists in the world, very little supports one case or the other of herd immunity versus hammer and the dance, but the one data point that we had was that hammer and the dance was actually better, not only for the health but for the economy.

Eric Ries: Well, and this is the thing that has been hard for me as a bystander, as an observer of all these debates. One of my old Lean Startup sayings is that metrics are people too, and it came up in my conversation with Brian Chesky, too. It's a very common confusion people have when you reduce people to numbers, like in the economy. You have this idea that, well, if we protect the numbers by sacrificing the people, then that will somehow work, forgetting that an economy is made up of people.

And if the people are dead, that's not actually very good, very healthy for the economy, not least of which as many of the people are educated and will refuse to transact economically, even if you do reopen. So it seems like there's been this mass denial in certain countries, in certain states, driven it seems like by political leadership that somehow we can avoid these hard decisions, and it will somehow work out.

What's it been like to be on the other side of that? I was going to call it an abyss. I don't even know what to call it. How do you even begin to make the case against such a bad idea?

Tomas Pueyo: It's funny, because you remind me a lot of the conversation around two decades ago when Daniel Kahneman wrote Thinking, Fast and Slow making people realize that, well, maybe economics is all behavioral economics. And so, if everybody is homo economicus, then you're never going to figure out the truth of the economics. So yes, I agree with you that you need to understand the psychology of humans to really understand what's happening.

And for me, I think the number one mental pitfall here is the speed of incorporating new information. The same thing happened with the entire crisis. People did not incorporate the new information that was coming, that was telling them, "Hey, this is something serious, and the world is going to change." And I think that's very natural. You know this, because you've shaped products too, where your intuition as a human is going to be very frequently wrong, and you cannot assume that what you think is going to be the right product that you put in the market is going to be what people want.

In fact, you have to eliminate your preconceived opinions, and you need to listen to the data and incorporate that data in shaping products. That experience that is so humbling about the fact that you know nothing about the world is not an experience that most people have. For most people, they're allowed to have confirmation bias in their daily lives, because the world doesn't change fast enough to prove them wrong.

They can keep their same stories about how the world works, and that keeps them safe and it takes them a long way. Here, you have a situation where that's not valid, where the world as you knew is gone forever and that is a very hard mental jump for people. Whenever they say, "Reopen the economy," what people mean is, "I want to go back to where we were." That's why they're saying, "We don't want to close the economy."

What they mean is, "Okay, this thing is going to pass and we're going to suffer, but then then that way we can have back the economy that we had," but that's not true, because now you have this new element that completely changes the world. The world will never go back to normal. And you need to understand, okay, what are the ramifications of this new virus coming? And the key ramification is people are going to be scared as hell to go out.

Some people will want to do it, but many won't. And those who don't want to go out because they don't want to infect themselves, because they don't want to infect their partner who has diabetes, because they don't want to infect their grandparents who's 90 years old in a residence. These people are not going to go out for months or even years, and that's going to be depressing the economy much more than if you do a short-term aggressive hammer, and you contain the economic downturn to a few weeks. And then, after that, you can open up the economy.

Eric Ries: I've been really shocked how many people I know educated, wealthy, privileged who have convinced themselves that they're an exception to the rule. So they nominally support the lockdown. They think it's a good idea to act aggressively, but they have to be able to go out and just do this one thing, or there's a party that they want to go to. And they'll find a way to make it social distance and the motivated reasoning that is driving that behavior, I wonder are we seeing that in the data on a societal level? We're not really taking this, even now, as seriously as we need to.

Tomas Pueyo: I love that one, because that's the typical conversation that you're going to have about others is, other people are always going to have these biases, but I'm a pure person. For me, what that means is I actually watch myself constantly to be sure that I don't fall into these pitfalls. And for me, one of the key ones has been avoiding the human tendency, again for confirmation bias and proving that it was right. So if you go very publicly saying, "The hammer and the dance is the right way to go-"

Eric Ries: You're committed to that.

Tomas Pueyo: That's right. And how do you look if suddenly it turns out that it was wrong, and you are the person who caused the trillion-dollar impact on the world economy, right? And so, that is actually a mental pitfall, and I have caught myself trying to do that, looking for data that would confirm my bias. And so, as soon as I did that, I established what are the numbers that would convince me that, indeed, that was the wrong strategy.

And so, the number that I put myself is on the infection fatality rate, you would want that to be close to the flu, so maybe 0.1%. If only 0.1% of people die, then that's good. The other argument that you could use-

Eric Ries: And multiple countries, you were looking at if their fatality rate had converged on that number. You would have said, "My hypothesis was falsifiable."

Tomas Pueyo: Yeah, exactly, exactly, right? And it doesn't mean that the decision was wrong at the time based on available data, but at least this is a factor that says, "My conclusion is now different, because my data is different." That's one. Another one is the ability to isolate old people, and one of the variants of herd immunity, which I think is a very valued one, is let everybody catch this except for old people and people with comorbidities.

And those people, you're going to isolate for a month or years until we find a treatment and vaccine. The problem that I see with this is, A, in countries like the United States, there's 45% of the population that is either of old age or has a comorbidity like obesity or heart conditions, right? So you can't isolate 45% of the population. Even if your country's healthy, like Sweden, can you actually isolate old people in residences for two or three years?

And the answer, their belief was, yes, you can, but then more than 50% of the deaths in Sweden have been people in residences. So far, you cannot do this. It's a bit like communism. It sounds really, really cool, great idea, but in practice it's really impossible to isolate so many people for so long, but that would be a falsifiable claim. You could prove that people can be isolated successfully.

And then, the last one is the economy, right? You can actually prove whether a hammer and the dance or herd immunity strategy are more reasonable, and you can prove that in retrospect, in a year or two when we have all the data. In the meantime, you want to look at all the leading indicators that you can find. And the best one that I think you can find is the markets. The markets predict whether, or try to predict, how the economy's going to fare.

And what you see is that in Sweden, right now the main index is actually equal or worse than the main index in other Scandinavian countries. So the markets don't believe that Sweden is going to fair economically better than other Scandinavian countries, but these three are data points that actually can end up being different, and as a result prove that my strategy ends up not being the right one. And if that's the case, then you want to shift your conclusion despite your confirmation bias that's going to try to support it.

Eric Ries: Tell us about something you got wrong.

Tomas Pueyo: So many things. One of them was a suggestion that the speed of viral mutation was going to or could be very fast. There's a lot of actual early indicators that the virus is mutating, right? It's an RNA virus versus a DNA virus, which tend to mutate very fast. The RNA are faster than DNA, and it's also in the family of influenza viruses. And as we know, influenza mutates fast enough that within one to two years, you catch a new one and you're not immune against it.

So the hypothesis there was if you go for herd immunity, maybe in a few months or a year or two, it was worth it because you don't catch this again. That was very well-stated as a hypothesis, a fear, but it turns out that the level of mutation is not as fast as we feared. So it is likely if you catch this, you will be immune for some period of time. We still don't know whether it's one year, two years, five years, but at least it looks like it's safer than we feared at the beginning.

And there's many, many more things like that. I think another one was for masks, right? There's been a lot of conversations around masks. Are They Good, Are They Bad is an amazing paper by Jeremy Howard and all the co-authors.

Eric Ries: It was Zeynep too, co-authored-

Tomas Pueyo: Yes, that's right.

Eric Ries: Going to their op-ed and to the paper.

Tomas Pueyo: Amazing paper looking at a dozen of those other papers, gathering all the evidence around is a homemade mask better than the alternative. So that was a very sturdy article, but then there's always some potential areas where these can be flawed. And one of them can be, well, if the masks are not properly put and as a result, people are not very well protected, but that makes them feel safe and they go out, then maybe that's actually counterproductive.

And so, there's always these debates, and I think these debates are crucial because it helps us reach better conclusions. I think in the case of masks, just to be clear for your audience, they're absolutely great and we should absolutely be wearing them, especially to protect others because we never know when you're sick. So we need to prevent others from catching this, but these debates keep happening all over the place about all the data points, and it's very important that they do.

Eric Ries: What's your advice for people who are having trouble wading through all this disinformation so that they know what's safe for them to do, what's right for them to do, for them and their family?

Tomas Pueyo: Yeah, I think you're actually touching on two very different points. One of them is just an individual person's ability to see through this, and then there's the other issue of political polarization actually that I think we should touch on. On the individual side, the interest in coronavirus has subdued compared to what happened a couple of months ago, and people are tired of reading all this information.

And the key takeaway is this. The virus spreads mostly when you are in a confined environment with a lot of other people singing, touching and talking to each other for a long period of time. If you avoid all of these factors, you are probably safe. So for example, being at home with your family, that's a confined environment when you speak with a lot of different people, with your family members for a long period of time.

So that is very highly likely to create infections. A meeting is very bad. You are talking for a long period of time with other people. A music concert is very bad. A choir is very bad. Conversely, if you are walking outdoors with friends and you're talking to the wind, and you're two meters apart, that is not problematic. So understanding these rules of thumb is very important.

Obviously, also masks and hygiene is a crucial thing. If you only do these things, that is a way that you can protect you, or yourself and your family members and your loved ones. And you don't even need the government to help you there. I think the other topic is on polarization and the fact that in this country, more than in any other country that I've seen, you have a different opinion on what to do about the coronavirus that is based on the party that you're in.

I don't have a solution, but I think it is very difficult to only rely on people there, because if the leaders consistently share a message, usually people who follow those leaders are going to follow that message, because the herd mentality and the us versus them is such a strong psychological factor that you will listen to whatever your leader says. And so, there, I think we can obviously appeal to people's reason through science, but I also think that for a big chunk of population, this will not be possible, if the leaders are not also brought in.

Eric Ries: What are the patterns you've noticed in terms of which governments, both nationally and at the state level, have been effective in their response, and which ones have not been?

Tomas Pueyo: Yeah, one of the things that I love is comparing the US with Europe, because in both cases you have a lower sovereign level and then a high sovereign level, the states and the federal government in the US, and the countries and the European Union in Europe. Interestingly, the default sovereign level in the US is the federal government, whereas in Europe it's the countries.

And so, usually in every other country in the world, what you see is the higher sovereign level is the one that take ownership of the problem and tries to solve it. And it makes a lot of sense, because in a pandemic like this one where you need to make a lot of decisions really, really fast, you need central coordination. Otherwise, you end up having, for example, what we saw in the US is states fighting against each other, competing against each other, for ventilators and masks and things like that, but you want the high level to make the decisions.

In the US, that was the federal government, but the federal government relinquished power. In Europe, the default of sovereign level is the countries. So even if it would have been better for the European Union to do it, that was not the default. The countries did it, and that worked because each country was equipped to do it. They had epidemiological centers. They had plans to this.

Yeah, so that probably worked. Because they're sovereign, they can close the borders with each other. The problem that happened in the United States is that every state was forced to behave like a country, but it was not equipped to behave like a country. Many didn't have equivalence of the CDC. Many had no idea how to deal with a pandemic like this one. They didn't have experience buying bulk from the government things like masks or ventilators, because they're states.

They're not used to the mental concept that, "Oh, I can close my borders." Even today, many states have been able to do that. Hawaii and Alaska defacto have closed borders. Everybody that comes in needs to have a two-week quarantine, and it's enforced but most other American states haven't done it. Many have a two-week quarantine encouraged, but not enforced. And so, that's a problem, because you have a state, for example, like, I don't know, Idaho which is doing really, really, really well.

And maybe there's people from Georgia who are traveling to Idaho, and they are seeding the coronavirus in the community. And you definitely don't want to do that, if you've done a good job at controlling the virus. And so, I think the main struggle has been that one in the US. The higher sovereign level has relinquished its power.

States have been left to fend for themselves, and they don't have the mindset or the experience to do it. So they've had to learn as fast as they could. And given that, I think they've done a reasonable job, not all of them but many.

Eric Ries: Give us your assessment of how we're doing here in California.

Tomas Pueyo: Yeah, I think we forget now, but it is incredible how fast politicians were at taking measures. The one that should be called out the most is probably London Breed. She was relatively newly elected, and she took a massive stance of calling the emergency before there was a single case in San Francisco and before any other-

Eric Ries: We're very grateful to her for that.

Tomas Pueyo: Yeah, yeah. And before I think most or any big leader in the country did it, and now it looks obvious, but at the time that was a huge political bet that you're making. If it turns out that it's not a big deal, then you don't look like an intelligent leader. So very, very big kudos for her. And then, Gavin Newsom very, very quickly also reacted to this. I think a couple days after I published Why You Must Act Now, the measures were starting to be taken in California.

There's a couple of interesting things that happened. First, the population was already reducing its mobility before there were official measures. So I think the population there helped. The fact that, for example, in Silicon Valley so many people are informed helped a lot, and we have to remember that this is especially bad in urban areas, right? So the fact that the Bay Area, one of the two or three big urban areas in California, was already staying home before the shelter-in-home order, I think that was good.

The same thing I think happened in LA. I think with the measures, they were regressive and relatively early, and I think that was good. One of the problems I think is that it was a one-size-fits-all, and I think that's problematic because you have, for example, areas in Central Valley where people depend mostly from the work that they do outdoors and where you have communities without a single case, and they had to follow the same order as the people in big cities like San Francisco where many people can work from home anyways.

And so, they're not as impacted. So I think that one-size-fits-all was a bit problematic. It's understandable, given that it's very hard to make very intelligent decisions without a lot of data and without a lot of time to think about it, but that was a bit harsh. And I think all in all, the state is making reasonable decisions on how to open, in what order, and more importantly under what conditions, for example, right?

The cases need to be at X level, and they must be going down and you need enough testing, and that means X numbers of tests, and you also need enough contact tracing. So all these conditions I think are exactly the way you'd want to be ending the epidemic.

Eric Ries: Do you want to talk a little bit about your political article, the U.S. divided and all that?

Tomas Pueyo: I'm happy to do that.

Eric Ries: One of your more recent articles has been about the political polarization in the US and about the need for us, as a country, to pull together. That's a pretty brave topic to address so openly. Not everyone who has been involved in the corona response has been willing to address the politics of the situation. Why did you feel compelled to write that? And recap your argument for those who haven't seen it.

Tomas Pueyo: Yeah, I think it's interesting. It's actually connected indirectly to the question that I get a lot, which is, "What you did for coronavirus is amazing. Can we do that for climate change?" So I'll talk a little bit about that, and then I'll go back to your question. And my answer to that is no. You cannot do the same thing for climate change. The reason is because there's a few factors that make the coronavirus very unique.

One is it affects the entire world. That's like the climate change. And two, the consequences are dire like the climate change. In fact, the consequences of climate change are much worse than the ones for coronavirus, but the two factors that make the coronavirus different is one of them, this is light speed. Within days, the entire situation happens. So the urgency is dramatically higher than it's in the decades.

And then, the last factor is nobody knows about this. There's no stance on this. And so, as a result, everybody is open to learn as much as possible. These four factors, you only have two in climate change, and the other two you don't. Climate change, it's in the decades, and also you have a lot of people who have already found their opinion, and then you have confirmation bias leaking in.

Many people already have a conclusion, and they're feeding the data to the conclusion. In the U.S., what I saw after the hammer and the dance is that most countries were taking the right decisions, but the U.S. wasn't yet. And we had this key window in March and early-April where nobody, either at the federal level or the state level on the democratic side or the republican side, had a very definitive position about it.

You already had Republicans on the republican side leaning towards more openness to the economy, and the democratic side more towards the health and lives. That was not a crisp delineation. My goal there was trying to make this a data-driven nonpartisan argument, and the reason why I thought that was not only desirable but more currently achievable is because Republicans actually have the most to lose by this, by the coronavirus.

The default response of a Republican usually is going to be more freedom, less intervention from the government, but also they default to the economy's really, really important. So one of the things that I wanted to highlight is this is bad for... If you let this go and you don't control it, it's going to be really, really bad for the economy, not only for health but also for the economy.

So if you really care about the economy, you should control this. The second argument that I wanted to make is one around how self-serving fighting the coronavirus could be. I realized that Republicans had not yet realized how bad the coronavirus could be for their constituents. Republicans are in general older, and they are in general also less healthy than Democrats, not because of who they are but rather the fact they're people in more rural areas and to also be older and also have more comorbidities.

And so, I wanted to highlight the fact that, well, it's going to be worse for you, Republicans, if you don't control this. You're going to have more people dying, both because they're older and they have comorbidities. And the impact in the elections could actually be dramatic. For example, just straight deaths for Pennsylvania could account for 30% of the gap between Trump and Hillary in 2016, right?

So 30% of the elect rate that pushed Trump in Pennsylvania, which was a swing state, could die directly from the coronavirus, right? I think that's huge, and then the last thing I would try to do there is just explaining the early polarization to a very reasonable fact, which is the fact that urban areas are both more connected and dance than rural areas. They also tend to be more democratic.

If you're more urban and more connected, you also will have more coronavirus cases earlier on. We saw that in New York, for example, very connected to Italy and a lot of cases very early on. So there was a correlation, but not a causation between the fact that you will be hit early by the virus and being Democrat. That did not mean that as a rural state you would not be hit, because what we see in all pandemics is that they take a longer time to reach rural areas.

And when they do, they hit hard. And so, for all of these reasons, the economic reason, the self-serving reason and the fact that this was not as much ideological difference but a more rural-urban difference, I thought we had this narrow window of time where we could write an article to influence politics at the national level in the US. I tried, but I think if I succeeded, it was more at the state level but definitely not in all states and definitely not at the federal level.

Eric Ries: What's the data showing right now? What are you working on these days to look forward towards the next phase of the pandemic?

Tomas Pueyo: I'm working on three different things. One of them is finalizing the dance. What are the recommendations for dancing properly? And one example of this is you have many states and many plans that recommend a number of contract-tracers based on the population of the state, right? For example, I need, I don't know, 10 contract-tracers per 100,000 inhabitants, which makes no sense, because if you have two states that have a million inhabitants and one of them has 10,000 cases, and the other one has none, should both of these have the same number of contact-tracers?

No, and so being clever what are the different metrics that you want to follow and what are the different goals that you should achieve, I think that's the most urgent thing, given that so many states and countries are moving into the dance without being properly prepared. That's the first one. The second one is updating the debate around herd immunity versus hammer and the dance.

And I think it's a very important one, because we're not in this for a few months. We're in this for maybe years. And so, it's always going to be tempting to say, "We give up and we're just going for the herd immunity." That's in fact what we're seeing in many states in the United States, whether Georgia, for example, or Florida, admit or not.

Eric Ries: Been really painful to watch.

Tomas Pueyo: Yeah, it's painful to watch, but that's the de facto strategy that they're following. They are basically saying, "You know what? I didn't control this. I don't want to go through the problem of controlling this, and so I'm just going to open up the states." And the result is going to be bigger outbreaks, bigger maximum number of cases, collapsed healthcare systems, a lot of deaths.

This is a constant debate, and I think it needs to be updated all the time based on available data. So I'll be looking at that. The last one is the hammer and the dance only is relevant if you can do the hammer, and you can do the dance. It is not the case for many countries. For example, both Peru and India have had a pretty dramatic hammer applied, but in both cases, the number of coronavirus cases has been going up during the hammer.

So if you can't even control the virus during the hammer period, it is unlikely that you can control it during the dance. And also, not only the benefit of the hammer and the dance is lower, but also the cost is higher, because fewer people can work from home. More people depend on a daily income to eat. And so, you can't assume that what's valid for Western countries is valid also for developing countries.

And so, I'm looking into what are the right strategies for them. In fact, it is depressing. I talk with people in Kenya, in Peru, in Mexico and in Bangladesh, and it is just so hard. They are in this bind where it sounds like they're forced to go for herd immunity, but they don't want to. In fact, you do need to look at the details, because the details matter. And you look at an example like Kenya, for example.

Kenya did not brush the curve, but in fact they've been pretty stable at a quite low number of cases, but the economic toll has been very, very heavy, right? So they're wondering, "Okay, did we succeed or did we not, and should we open or should we not?", with interesting facts such as, for example, Kenya has experience with Ebola contact-tracing. And so, they can use that to reduce the epidemic in the dance and moving to the dance faster than Western countries can.

You also have natural AB tests there where, for example, Rwanda, Burundi have been pretty good at also applying a hammer and having very few cases. Whereas, Tanzania, which is another neighbor of Kenya, did not apply hammer and very few people hear about this, because the official data does not show deaths and cases and all that thing, all that stuff, but anecdotal evidence shows a collapsed healthcare system and people dying on the streets.

And so, this is an interesting situation where you have a completely different set of data points that you need to process with a completely different cost-benefit for you to know what is the right solution. And the stakes are huge, because here we're talking about Kenya and Tanzania and all these countries, but what about India, 1.2 billion people? If they get it wrong and they go for herd immunity, what happens with 1.2 billion people, coronavirus running wild?

Is that then containable into only India, or the entire world gets affected? I think these are some of the very hard decisions that we need to make, and it's a bit unfortunate that we are still in a world where there's 200 sovereign countries, and there's only very few overarching organizations that help, because if the World Health Organization, for example, had been better organized, not as politicized and had had more power, there's a world where the coordination across countries could have been substantially better.

And we could have taken the right measures. For example, if it turns out that the right thing for the entire world is for India to contain the virus, but India cannot afford to contain the virus, there's an argument to be made for Western countries to fund India to contain the virus, but you just cannot even conceive that, because we don't have an organism that is multinational that can have that level of coordination and transfers of wealth.

And so, I think that is one of the things that I want to see happening and I believe are going to be happening over the next few decades, the same way as in the past, for example, you have the IMF or the World Bank that have emerged as stronger multinational organizations that do influence decisions across the world. There might be a World Health Organization or another type of organization that might emerge for health, for pandemics, for health in general and hopefully for other types of disciplines in the world.

Eric Ries: What do you hope this is going to mean for you? Do you think when the crisis passes, you're going to go back to the life you had before?

Tomas Pueyo: I've been very, very, very careful to separate these two things. One of the things that drives me the most in life is to generate love with my friends, with my family, with society in general. And the way to generate love in society is to have as big an impact as possible. And so, thanks to this, I've had more impact than I could ever dream of having. So I'm just pushing that as much as possible, and I've been very careful to keep that very separated from my personal gain, because I did not want to have misaligned incentives.

If something was right for the world and for the impact, and that was bad for me, I did not want that to influence my decision-making. So I really separated these two things, and I'm pushing as much as possible the message as much as I can. My goal was as I push this, the world is going to catch up, and I will have very little to contribute anymore. And so, I can start thinking of, okay, what does this mean for you, and what can I do about it?

And so, I think we're right at that phase right now. So right now, I'm thinking, okay, is there something that I can do that aligns with what I want to do in the long term? Thankfully, one of the things that I always wanted to do in the long term was what I've done for the coronavirus, taking big problems, understanding them, breaking them down, finding solutions and communicating about them.

And so, that's what I'm exploring right now. Can I use what happened with the coronavirus to replicate this? So I have some thoughts. I had a few offers for books, something that's interesting. I work with a group of volunteers that is super, super strong and super energetic, and they want to go into the direction of building a philanthropy to pursue these goals.

And I'm in general just talking with people like you and with other people who have experience in having a career around content and ideas that they have. So if you or anybody in your audience has ideas on how to push that, I think that's definitely something I want to explore.

Eric Ries: Where do we go from here? How do we get out of the crisis?

Tomas Pueyo: The fear that I have when I hear that question is that there's an undertone. There's an underlying question, which is when do we go back to normal, and I know that's not what you mean but that is how many people are going to interpret that question. And so, I think it is very important to state that normal the way you conceive it, which is how people might conceive it, which is going back to how the world was in the past.

That normal will never come back. The world that existed is not coming back. And so, there's two different terms here. There's the two short-medium terms, and there's the long term. And the divide between them is the discovery of a vaccine or a treatment. Short-medium term is before that, and long term is after that. So in the short to medium short, what's going to happen?

Each country will be making different decisions on how to handle the coronavirus. Some of them are going to be successful at the hammer and the dance, which means that in a matter of weeks, they will be back in the world where things are relatively like they used to be. They will be able to go out and do most of the activities that they used to, not all of them. For example, business fairs might be very problematic for a long time.

For example, traveling internationally for tourism might be very problematic for a long amount of time, but broadly if you use a mask, if you use physical distancing, if you're careful and if there's not a lot of cases in the community, we will be able to do most of what we used to. There's going to be outbreaks. For example, there was another outbreak last week in South Korea based on a guy who went to a few clubs one evening.

France reopened schools a week ago, and 70 of them have already closed out of tens of thousands. So very few, but they've already closed. So that's going to be the new normal, being careful for months, working from home as much as we can, hoping that outbreaks don't happen in your area. And if they do, then potentially having a small local hammer applied. The long term I think is the most interesting one, because the world will change.

We will all have had a common experience for months, for years, that will have changed our habits. And that's the hardest thing to change for humans, habits, but if the entire world suddenly changes their habits and adapts new habits, that is going to have a long-lasting impact. There is an obvious way where that's going to be true, which is the ability to work from home.

As you know, companies like Twitter have decided to be full-remote from now on. Companies like Facebook have decided that people are not going to come back until September or some until 2021. More remote work will mean also less business travel, and it will also mean a change in the real estate industry, because suddenly the benefit of living in cities is lower. Whereas, the cost is the same.

And so, I do think unlike in other crises, there will be an exodus to outside of big cities. I don't think it's going to be dramatic. I don't think 20% of the population's going to leave San Francisco, but it might be enough to actually tilt the real estate industry. And then, there's more industries that are going to be impacted, and it's harder for others to know exactly what it's going to be, but you can explore what it's going to be like.

And I think for me, one of the ones that is top of mind is universities and colleges. My job at Course Hero is focused on helping students study, especially college level. And universities right now are in a bind, because colleges that have a campus, what they do is quite bad for the spread of the virus. You have a bunch of adults that are co-mingling in parties, in dorms, in classrooms.

It's different networks mixing with each other and talking a lot. They're touching each other. And so, all of that is really, really bad for the spread of the virus. So campuses are a bit dangerous right now, but there was already a fight between campus schools and online schools happening, online schools growing. You have something like Lambda School, right? Yeah, that's very, very important and a very interesting trend.

And traditional schools who defend the campus experience is unparalleled. If that's true, then very few people are going to sign up in September, because why would you sign up if you cannot go to college, to campus? If that's false, then it's also bad for campus colleges, because it means that their education is not much better than online education. I think something is going to-

Eric Ries: Have it both ways.

Tomas Pueyo: Yes, exactly. And so, I think that's a very, very difficult situation, and we'll be talking with university presidents and educators to figure this one out, but that's what I'm close to. And I'm sure there are dozens of other industries that are going to be like this.

Eric Ries: Certainly. Tomas, I want to thank you for taking time. I know this has been a incredibly busy whirlwind experience for you, and I don't know how you have time to eat or sleep with the volunteers, the incredible output and the research and just the depth of care that goes into each of the articles that you publish.

Tomas Pueyo: Thank you, Eric. In fact, I want to say one of the biggest positive surprises of all of this has been actually meeting people like you, where I obviously had heard your name working in Silicon Valley. And so, thanks to this, I've been in contact with people like you. And one of the things I discovered is how careful and how thoughtful and caring you are, and people like you are, in not only everything you do and you say, but also in just making the world a better place.

And I'm really not saying that for pandering. You really were super supportive early on with me and just reaching out to say, "Hey, how can I help? No strings attached, just how can I help?" And that level of generosity, I had not been frequently exposed to, and it definitely was true for you and for people like you. So thank you for that.

Eric Ries: Oh, well, thank you for saying so. That's incredibly kind and I want to make it super clear the debt still runs the other way. You've done so much for so much of us. So we're all standing by to help, and I hope that many of the people who are listening to this will take inspiration from your example and get in the fight, think about how they could use their unique skills and background to be of service at this time. If folks want to get involved with what you're doing or get in touch with you, what's the best way?

Tomas Pueyo: The best is actually both Facebook and Twitter. My Twitter is @tomaspueyo, T-O-M-A-S P-U-E-Y-O. And I tend to listen to both DMs and engagements in my tweets. On Facebook, I have actually a pretty, pretty intense community and I post nearly everything I'm going to publish later on, on Facebook.

And I found that debate to be more intelligent and thoughtful actually than on Twitter. On Twitter, you get a lot of random people who want to score points. Whereas, in Facebook, because you have this personal relationship, people are much more thoughtful.

Eric Ries: Awesome. Well, we will put links to both things and to a few of your articles for those who want to learn more and get more involved.

Tomas Pueyo: Awesome.

Eric Ries: Thanks so much for your time.

Tomas Pueyo: Thank you.

Eric Ries: This has been Out of the Crisis. I'm Eric Ries. Out of the Crisis is produced Ben Ehrlich, edited by Jacob Tender and Sean McGuire. Music composed and performed by Cody Martin. Hosting by Breaker. For more information on the COVID-19 crisis and ways you can help, visit helpwithcovid.com. If you are working on a project related to the pandemic, please reach out to me on Twitter. I'm @E-R-I-C R-I-E-S. Thanks for listening.






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