Balaji Srinivasan: Coronavirus Will Shape This Decade Like 9/11 Shaped the 2000s

How should the US Government and the rest of us respond to the coronavirus, which has just been declared a global pandemic by the World Health Organization? Balaji Srinivasan, who was on the short list to head up Donald Trump's Food and Drug Administration, has some strong opinions. He's a former venture capitalist at Andreessen Horowitz, and he's a serial entrepreneur with a PhD in electrical engineering. The genetic testing company he co founded counsel helped change the way millions of people prepare for parenthood and is crippled. Cryptocurrency startup Earn.com was acquired by Coinbase, where he served as chief technology officer. In a prescient, lively and constantly updated Twitter feed, Sirnavasan has been way ahead of the curve in noting the coronavirus's spread and potential to cause a global public health crisis and a massive economic and social disruption to life as we know it. Balaji, thanks for talking. Hello. Let's get right to it. You were really early in sounding the alarm about coronavirus. How did you hear about it and why were you on top of it? And what does that say about Silicon Valley versus journalists on the East Coast? Sure.

So I've been following the coronavirus out of my peripheral vision as kind of one of many stories until I saw the lockdown on January 23, and that was unprecedented. It was an unthinkable signal. The Chinese government, it's completely focused on economic development. So to quarantine millions of people, which would soon become hundreds of millions of people, that made me pay attention to what was going on. And so I began talking to many friends of mine, Chinese engineers, entrepreneurs, angels and the like. And the qualitative picture that I got from this was hair raising, right? You know, we're talking videos and photos of people being blockaded in their apartments, dying on the street. Even one of a man throwing himself off a bridge because he couldn't get into the hospital. He didn't want to bring the virus home to the family. I didn't know what to believe from this. Some of it could be fake, but on their hand, those images would seem fairly difficult to fake even with today's technology. And they seem to match the general circumstances. So even if some of them are true, these were sort of sci fi movie level events happening in China, Right? And if I was too skeptical, I would remind myself that there was an officially acknowledged scale of the lockdown, which was unprecedented. That was a independent reference point of ground truth that one could anchor on.

Right.

Right Now, I also have a background in bioinformatics molecular diagnostics, genomics and so on. So even though maybe a lot of people know me for crypto and venture capital, actually I did many years as a founder of a genomic testing company prior to getting into crypto and angel and venture. And I was an academic for many years. So the third thing I did is I dug into the literature and read all these sort of dispassionate medical reports and you know, these, these kinds of articles in the New England Journal of Medicine or the Lancet, they're written in a style which is almost like the opposite of clickbait. So like, you know, the first, the first U.S. case study written up in the nejam said something like, you know, 35 year old patient with no pre existing conditions contracted bilateral pneumonia by day 10. We pursued compassionate use. And in English that means a healthy 35 year old man was brought to death's door and we need an experimental drug to save his life. Right now, I mean, zero insult whatsoever towards the folks writing these articles that accepted style. When you translate them, it's eyebrow raising. You know, basically, you know, here's a healthy 35 year old about to die and it took 10 days and a team and an experimental drug to save him. And that was like the first case in the usa, right? And that's a contagious disease. So you know, you start mapping that to not just one person but, but to 10 people or 100 people or 1,000 people, that starts to get very expensive in all senses of the term in terms of suffering and in terms of medical resources and so on. So the combination of A, China's official state action, B, unofficial social media reports from people in China, and C, articles in biomedical journals, that's what made me triangulate on this early as something of potentially critical importance.

So what were journalists missing? And actually for that matter, what were American health officials? Because the New York Times ran a story this morning about how Seattle, there were a couple people in Seattle who said, look, there's something really big going on here. And then they couldn't really get traction within their own health organizations. But what were journalists and health officials missing?

So I want to say first some professional journalists really got this right and I've got a piece coming on, let's call it corporate journalism versus citizen journalism. And not all corporate journalism is bad. For example, journalists at Kaijing in China, they published really impressive stories in the face of state censorship. And you know, the New York Times, their China reporters, you know, like Amy Quinn and Paul Moser, they did Pretty impressive work. There's people on the ground in China who risk consequences from both the government and the virus to get the story out. So I want to kind of level set that right. But I'd say tech journalists completely failed on the most important story of the year so far, if not the decade. This could be to the 2020s what 911 was to the 2000s or the financial crisis to the 2010s. Kind of the starting gun that kicks off.

So you're telling me we're in a new decade and it's already kind of in the shitter?

I'm not saying in the shitter, but certainly this is going to be an event that colors this decade. The number of consequences, obviously, politically, but for technology, for biotech, for all kinds of things, for immigration policy. So just focusing for a second just on the tech angle, tech journalists completely failed on this. It's not just that infamous Recode article Talking about how VCs were for.

Pretty.

Much every intelligent politician in the world is doing, or the buzzfeed article saying, don't worry about coronavirus, worry about the flu. It was the tone of these journalists and all their tweets and whatnot, talking about the terrified, racist, xenophobic bubble boy VCs who were scared to death of this total non issue of virus. Right. And that's all a matter of public record. And of course, this non issue turned out to be very much an issue. And they weren't simply getting the story wrong, but they were actively attempting to shame and silence the people getting the story right. And some of them, you know, later insincerely apologized. Others wrote, you know, columns about how they got the story wrong in a slightly more insincere way. And then once Trump started adopting their early talking points about how the virus was just the flu, several of them have reversed themselves and pretended, you know, they'd been taking it seriously all along, you know, they were, they were against the virus, you know, before they were for it or against.

Right.

But as a group, I think tech journalists completely just unforgettably failed on the virus crisis in a way I know people, at least within tech will never forget.

What explains that are tech journalists. And, you know, and we're going to get to the kind of libertarian intersection.

Sure.

Are they, are they always skeptical about, you know, the great big thing, or is it particular? I mean, because in a way, tech journalists seem to be suckers for certain types of stories and then they reject others. What, what would, what would make them more prone to rejecting this story?

No, I mean like in general, I think it's not that they're skeptical of big things. They're, they're credulous of big things that are negative, you know, against tech companies and they are skeptical of things that are positive.

Right.

And the reason for it, I think it really boils down to the fact that, you know, another word for a lot of these journalists is they're employees of a media corporation. And those media corporations are direct competitors of tech corporations and their direct competitors certainly monetarily on the back end in terms of advertisers and what have you, but even more importantly on the front end in terms of influence. Right. You know, in many different ways people seek information on Google, they talk to each other on Facebook and WhatsApp, they post on Twitter in many, many different ways. That undermines kind of information monopoly. And you know, the counterargument you'll often get is, oh, there's an advertising versus editorial wall in journalism. Tech people don't understand this. And of course, you know, that actually exists within tech companies as well. You know, Google has a wall between search engine engineers and advertising engineers. That wall at least existed for many years. But really it is true that journalists aren't thinking day to day ad sales, but they are hyper conscious of the fact that the industry is generally declining, that fellow journalists have gotten laid off, and that these callow tech people seem to be all making millions of dollars. Of course they focus on the successes, but not the failures. So I think certainly part of it is the fact that many of these tech journalists frequently lack technical backgrounds. I mean there's this amusing thing where folks were like, oh, ha ha, all these VCs commenting on the coronavirus. And you know, I had to cock my head because many VCs have biotech backgrounds. That's like if not half of VC, it's a very large chunk of VC founders fund, y Combinator, Asics and Z all have large biotech funds. And biotech in the broad sense meaning biomedicine, not simply predominant DNA. And then of course there's lots of specialist biotech funds. But tech journalists, they lack technical backgrounds. They often, you know, they can't code, they don't know drugs, diagnostics, therapeutics, but they comment. And so certainly part of it is a lack of technical background. I think another part of it is, you know, as you may be aware, many of these tech journalists, they actually grew up rich, they went to private school, they have trust funds or inherited wealth and they're motivated by a bizarre Sort of animus against the nouveau riche tech people. And one way of parsing it is really old money versus new money. And, you know, there's a guy, Antonio Garcia Martinez, who tweeted about this, you know, recently, and a bunch of journalists yelled at him. And then many of them volunteered. One of them volunteered that she had gone to a $90,000 a year private school before anybody else.

So reel that back for a second, though, and how does that map onto missing the coronavirus story?

Great question. Is basically the combination of A, technical ignorance and B class hostility curled into a cocktail where they didn't know what they didn't know about the virus, but they did know that they hated these tech interlopers, and that's what drove the coverage.

Okay, so discuss how is coronavirus different than the flu? One of the early stories was, and I think there's a plausibility factor that this is a type of flu, might be a little bit worse. But let's not lose our shit over this.

Yeah. So let me give a qualitative answer and then a quantitative answer. So on December 1, Wuhan was a normal. Okay? It had its problems, but it was a normal city. Okay. Less than 60 days later, seven hospitals in Wuhan were filled. According to Kaijin, the sick were being sent home to die. China instituted the largest quarantine in recorded history, and basically wartime measures were instituted. Now, that is not a bad flu season. That is something that is on a completely different level. And you have to think, okay, well, the Chinese government, the Chinese people, there's many criticisms one can give of them, but they're serious people. These are not folks who are known for doing anything like this. They're so focused on economic growth. So that right there is a pretty unfavorable signal. And then I tweeted that. And now later, Iran and Italy have both had very similar kinds of scenarios. So this virus seems to be overwhelming hospital systems, flooding them with folks with respiratory failure, crashing hospital systems. So that itself is something which is qualitative. Now, the quantitative is when people are comparing this to the flu, they're comparing a constant to a variable. The flu is a known quantity. It's roughly steady state. We know within bounds how many people it's going to infect. A bad flu season does not crash a hospital. Right. Whereas this is something which is wildly contagious, has at least on the order of 10x the lethality rate. It has a far higher hospitalization rate than the flu. And, you know, a better way of calling it would be like an aggressive viral pneumonia. Right, because people know the word pneumonia and they know pneumonia is actually serious. Right.

So what is, what is your best guess of, you know, the lethality of this? What is it going to be? You know, are we going to have a 1% kind of death rate out of infection overall compared to a tenth of a percent for the flu or. Okay, does it make sense to talk about it in these terms yet?

All right, so. Good question. Let me, let me say a few things. First is the, the so called case fatality rate, which is the percentage of folks who die from the disease diagnosed with it. It varies a lot between countries. Italy is now reporting like 8%. Okay, now why are, why is it so high? Well, Italy, it seems like it's really just killing folks who are 70 or 80 plus. These are also obviously human beings. There are elders, our parents, our grandparents or what have you. So it's just like just extremely dangerous there. Also extremely dangerous in the US that nursing home, you know, they reported something like, you know, last I saw, it's like 26 people out of 120 died. A normal month it's an acute care home, but in normal month they said three to seven die. So if you have 26 die, that's the excess of like, you know, 20, 25 deaths. Right, 20, 23 deaths. So, so, but the, the broader point is, let's even say the case fatality rate is 2%. There's, there's a few reasons why that is not low. First of all, if 2% of America died or if 60% of America got it and then 2% of those died, that is millions of people. That is like a thousand X9, 11. Right. So that alone 2% is a very high number in that sense. There's completely excess, unanticipated deaths out of nowhere. Number two is lots of people, you know, again, who stats you know, have been reported. These will vary a lot. But who's reporting something on the ear of 20% have serious conditions requiring hospitalization, 20% getting hospitalized. Not all of those people are going to bounce back. Okay. For example, there's a radiology paper that I cited where prominent radiologists, or let's say credible people at ucla, USC are basically observing, look, SARS and mers, there's permanent lung damage there. For a substantial fraction of the folks affected by that, it's not necessarily the case. You get COVID 19 and you just jump out of bed and you're all set. If you don't die, there's a continuum. Anything serious enough to put 20% of people in the hospital is going to cause permanent damage to people, probably at least to some people. Like, think about polio. Right. It didn't kill everybody, but it did paralyze some people. So that's the second thing is, you know, so first is 2% is actually still pretty high death rate. Second is other folks are going to be permanently injured. And third is quantity really matters. You know, if you had a 2% case fatality rate and this thing was not that contagious, it only infected a thousand people.

Yeah.

Okay. It would not be something that requires the attention of every government in the world. But scale matters. You have something that has the potential, in the absence of dramatic intervention, to scale to millions and then maybe billions of people just to show that that's possible. Remember the swine flu from 2009?

Yeah.

So there's a technique called serosurveys where you actually go and take blood out of somebody's arm. It's not a mathematical model, you know, so there was a paper which went and looked at a bunch of people who've done sero surveys in different countries, looked for antibodies against H1N1, and they found that about 10 to 20% of people in like a dozen countries had antibodies to H1N1.

Right.

So that's a reproducible molecular assay. It's not, that's not a mathematical model. What that meant is 10 to 20% of people in the world had gotten swine flu. Now, if you have something like COVID 19, which is potentially as contagious as swine flu, so it can get to that scale of 700 million or 1.4 billion people, but is far more lethal. That's an extremely dangerous thing. So that's why basically, you know, three reasons that, you know, the fatality rate is actually pretty high. Number one, 2% is actually pretty high. Number two, there's potential for long term illness calls, people are getting hospitalized. Number three, the scale is massive. So the sheer number of people flooding into emergency rooms and so on will crash hospital systems. And that, by the way, has second order consequences. You crash the hospital and then what happens? Nobody wants to come into the hospital. Why? Because you don't want to get COVID 19. Right. So all other routine care goes down. Right. You, you had an appendix and you need to get that removed. That goes down. You, you just want to get a checkup. Can't do that. You want to deliver, deliver a baby, all that stuff. So it has second order effects on mortality and so on. The population. Go ahead.

Okay, so you're making the case that this is a serious issue that really needs mass attention at different levels. Out of the countries so far that you've mentioned, and a couple that we haven't, there's China, there is Iran and Italy have been hardest hit by most accounts. It's obviously in the US and we're going to be seeing numbers doubling and the doubling cube going up. South Korea has talked about having effectively contained it, it seems, or at least according to some of the reports coming out of there, what countries are doing well in dealing with this and what countries are something that we really need to avoid.

So it looks like in this kind of first round that Asian countries, so you know, I wasn't sure what to make of China's posted decline, you know, like a week or so ago, but now that South Korea, Taiwan and looks like Singapore, Malaysia potentially are getting this under control, it looks like it is possible to halt the spread through China, like measures of lockdown, quarantine and so.

On and so forth. Right, okay. And by that, and so on and so forth, let's. Including kind of enforced social distancing which seems to come up again and again of just having, not only having people stay out of the workplace, stay out of big meeting places, but then, you know, not getting too close to each other when they're walking around the street.

That's right. That's right. And, and I think the other countries that I think have done reasonably well, so Estonia, you know, not a surprise competent country. Israel I think has done a pretty good job so far. Right. And generally the countries that you know, like, you know, Israel, Singapore, Estonia, these are, these are smart countries with serious people. Right, right. I haven't, I haven't looked at Dubai's numbers, but I wouldn't be surprised if they're doing reasonable.

So they're also, they're smart countries with serious people, et cetera. They're also a lot of them are either very authoritarian or much more authoritarian than the U.S. including a country like Israel, which for a variety of national security reasons people there put up with a much more invasive day to day presence of the state. You're a libertarian, I mean, you're one of the kind of libertarian visionaries for this horrible decade that has just been started. How do you feel about that kind of stuff? You know, you're, I don't believe you to be an anarchist or anything. I'm certainly not. But you know, how do we know that this is the time where you say, okay, you know, what we do have to cede extra control to the state for a certain period of time? Or is this just the beginning of a lockdown that really never gets relieved?

So I want to, in a very polite way, contest the premise. I wouldn't actually.

You don't have to be polite, by the way, either.

No, no, no. What I mean is I understand why you. You thought of that premise, but I would actually not call myself a libertarian. And I think I've actually been consistent about that over the years. I'm sympathetic to certain libertarian concepts and ideas, but, you know, here's, here's my mental model and I tweeted about this or what have you. I think the ideal is a competent centralized government, which you can effectively sign the social contract with the terms of service by immigrating there. So you immigrate to Israel, you immigrate to Singapore, and by immigrating there, you're effectively just like, you know, you sign up for Facebook, you sign up for Google. There's, there's terms of service, and if you don't like them, you at least have the back button. You can leave and you don't. You're not mandated to it. Now that's not completely ideal because there's Facebook pixels, Google pixels that will track you across website. There's non idealities there. But let's say at a high level you can make that analogy, right? If you enter the society, you're kind of signing this contract. If not, you're not. So a competent centralized government, you know, for example, like, you know, I personally would prefer not to own a firearm. I personally prefer a government that controls crime to an extent that I can actually trust in that government to protect my family and property and what have you. And I think Singapore is like that, you know. Now with that said, if the best is a competent centralized government, the worst is a malicious centralized government like the ussr, you know, like, like Cuba or North Korea or what have you. And then, you know, not quite as bad as that, but certainly quite bad is an incompetent centralized government as distinct from actively malicious. And of course there's, there's gradations of that. Okay, yeah, absolutely. But like, let's say where the US is right now, right? You know, at city, state and federal levels, we have not seen phenomenal leadership on the coronavirus crisis. And in fact, we haven't seen phenomenal leadership in quite a while. You can argue that, you know, the peak of the USA was roughly bracketed by 1933 and 1968, you know, so 1933, Hoover Dam, 1945, Manhattan Project, 1968, Apollo. That was a period of peak centralization when US government actually got a lot of the technical talent and was able to build and ship big things. And before and after that period, you actually have the technical talent. And I'm not saying technical talent is everything, but it's a lot. You know, you had the technical talent, you know, before that era, the quote, robber barons and you know, captains of industry who are building railroads and aviation, the Wright brothers, all those kinds of people. Then afterwards you have all the tech CEOs and investors and hedge fund folks to, you know, to some extent and whatnot. So what's my point? My point is, while the best is a competent centralized government and the worst is a malicious government, and the second worst by a big jump, but still bad, is an incompetent centralized government, in between a competent and an incompetent centralized government is the decentralized response.

So what are the best elements of the decentralized response and how much of that is coming from non governmental agencies and how important are the. Yeah, talk a little bit about that.

Yeah, so when I say the decentralized response. So certainly very specifically it's things like the Gates foundation working with welcome and MasterCard to go and welcome Trust. Actually it is a government funded organization in part, but the Gates foundation putting up money to fund at home tests because the state is failing. Right. But it's not just decentralized medicine, it is decentralized media because like, for example, at least a big chunk of the centralized media failed here. You know, tech journalism failed. And I call it centralized, by the way, in the sense that's culturally centralized. Even though it's 10 or 20 different outlets, they all work at each other's kind of things. They're all in the same social network. Right. So you have decentralized medicine, decentralized media. This virus crisis is going to become a financial crisis, if it isn't already. A ton of money is going to be printed. So you're going to need decentralized finance. Brings us back to crypto. You need decentralized preparation because your city or state is probably going to say nothing to see here until suddenly the tsunami descends upon it. Right. And that's what I mean by the decentralized response is while I prefer a Singapore or Israel or an Estonia, which is actually capable of taking care of these things, essentially as a service provider, I pay that government and they take care of stuff for me in the same way that I don't have to think about, I don't know, my Dropbox.

Right.

I pay Dropbox. If that is not the case, then I still want to be able to do it myself. And that's where the decentralized response comes in. Does that make sense?

Yeah, I think so. And in this model, the blurring of private and public or private and public is kind of blurred in a lot of ways, right?

Yeah. I mean like one thing I think a lot about is the reason that I support you can make a high level difference between let's say principled and pragmatic libertarian leaning people. Right. The principled libertarians are against something on a matter of principle. Right. That is to say, even if, let's take quarantine as actually a good example, they are for exit because to them the rights to individual are paramount. Even if it's actually worse for society and the individual. And I don't mean worse in a theoretical way, I mean worse in it like die of a contagious virus kind of way. Right. A pragmatic libertarian though is basically someone who's like, okay, here's utility function of some kind and you know, we should support the policies that maximize that utility. For example, Singapore in general has fairly free markets. They're fairly pro free to trade, but they don't hesitate to kind of step in and put a thumb on the scale if necessary. Just for example, they actually did put price controls on top of masks and they issued a bunch of free masks to deal with this crisis. And I very much, at least personally, I put myself in that second camp of the pragmatic because the goal is human flourishing and that doesn't mean being rigidly ideological in my view.

Right. Do you think with something like putting price controls on, it could be breather masks, it could be hand sanitizer, it could be any number of things. Does that actually work in America? I mean on a level of pragmatics.

So I mean the thing about it is, let's say there's kind of three levels of doing something, right? Let's take price controls. Level one is like the really dumb oh, let's put price controls because we hate these corporations, they're trying to chip people and so on. Level two is the smart version, which is actually if you impose price controls it's going to cause shortages and that's going to be a problem because these manufacturers in a time of huge demand won't have the capital to go and purchase more. Level three is for the maintenance of social stability. In a panicky time, we will do something like impose price controls, but also otherwise subsidize manufacturers on the back end to go and purchase more masks.

So talk.

Does that make sense?

Yeah, no, I, when I say I understand, I don't necessarily agree, but I'm interested in kind of fleshing out this, you know, this picture of how government and other parts of society work in a crisis situation. A bunch of you mentioned before, second, second and third order health effects and kind of things that will show up down the line a bit right now, Donald, the Trump administration and Congress, I think you alluded to it before, we're going to see some kind of massive stimulus project here in order to hopefully quiet the markets or to make people think that everything's not going down the drain. What are the types of stimulus projects? If you think they should be there should be. What are the types of things that you think would work and what do you think are going to be counterproductive?

So let me say that basically.

You.

Know, to extend, I think it was a Rothbardianism, you know, you said like war is the health of the state. Right, right.

I think it's actually Randolph Bourne, but.

Yeah, okay, fine, fine. That he got it from. Yeah, yeah, okay. So, you know, like crisis is the health of the state. And in many ways I think, you know, you can kind of slot in pandemic as being an even more severe version of many of the debates we've had on terrorism over the last 20 years. And then, you know, then, then crime goes to like a, like less version each of those, as you go up the scale from crime to terrorism to pandemic, you start giving government powers to constrain law abiding people, you know, in ways, you know, that, that normally you wouldn't agree with. Right. Because the threat goes so high. Right. Like a pandemic, you're talking about basically putting 11 million people in jail without any probable cause, you know, or at least house arrest. Right. So, you know, the tricky part about this here's, I'm not saying I have all the, you know, ethical answers or what have you, but in, in late January, I was wrestling with this because frankly, while I thought, you know, I'd certainly known, you know, pandemic was a possibility, you know, this is kind of we're in like sci fi territory at this point. You know, this is something which I would have considered. Have you described the current scenario to me back in November, I would have said, look, you know what, yes, that's a challenge to the theory of exit as prime, but why don't we cross the bridge when we come to it? Right now that bridge has been crossed. So we have to come to what are the philosophical issues at play? Right. So here's a few things I would say. First is, you know, Ben Gurion had a really good mental framework before Israel became independent. There's a time when, you know, there was a White paper that British had issued that he disagreed with and it essentially opposed, you know, the independence of Israel and what have you. But at the same time, they were allied with the British to fight the Nazis. So he had one liner where he said, we shall fight the White Paper as if there is no war. We shall fight the war as if there's no white paper. Okay, Meaning that while they would argue vociferously against the White Paper, they wouldn't undermine the British in their fight against the Nazis.

Nazis.

And while they would ally with the British against the Nazis, they would not give up their aspirations for independence at some point. Right. Makes sense. He recognized that these two goals were, in a sense, in combat, successfully achieved because they defeated Nazis and they got it right. You know, like, over time. It took a few years, but it worked. Right. So that's kind of how I think about this. You know, from the utilitarian standpoint. There's no point in freedom if you're dead in the sense of, I understand, live free or die, but, and I agree with it in many ways, but die. I'm not sure I have a pithy one liner on it, but, you know, like just randomly dying from a virus that you could prevent for some sacrifice of freedom for a little bit of time does not seem to me to be a good trade off from a utilitarian standpoint. Right.

One of, you know, one of the other kind of questions about a lot of this stuff is, you know, Robert Higgs, the economic historian who wrote a book called Crisis and Leviathan, talks about how, you know, and it's very much in the ballpark that we're talking about here that the state looks at a crisis, it asserts certain types of power, it flexes out when the crisis has passed. You know, the power doesn't go away, it stays some part of it or all of it. So how do you guard against that? Because we have been seeing, you know, whether in terms of economics, whether in terms of certainly surveillance and certain types of national security things for all of this 21st century, a flex by government. How do whatever is coming down the line, how do we make sure that the government gives back most of the power that it Builds up in itself.

So this is actually, I think I tweeted something like this. I feel that I got it right. I mean, we'll see. But I think I got it right early on because it reminded me a lot of the post 911 period. So what I tweeted on February 3rd was, you know, like, sometimes the solution creates the next problem. My rough forecast of the future, the coronavirus results in quarantines, nationalism, centralization, and this may actually work to stop the spread. But once under control, states will not stop, cede their powers. So we decentralize, Right? And so my answer is, I'm not sure you can work within the system to take away powers once they've been granted. I also don't think that you should undermine, you know, like quarantines that, you know, could, you know, go and spread a deadly virus to lots of people because then you're just screwing everybody, right? However, to reconcile those two incompatible things, just like Ben Gurion and the white paper and war, I think the answer is we make the hard choice to work with the quarantines and so on in the present day, sacrifice some freedom in order to quell the virus. Then we work on decentralized technologies like decentralized medicine and other kinds of things to enable people to prepare in the future more easily, especially if they're in regions where the government is incompetent.

Let's get to that. What the decentralization will look like in a second, because that I'm actually more interested in because the crisis is upon us and things are going to happen. But when we talk about quarantines, can we be more specific? New Rochelle, New York, Governor Andrew Cuomo here in the state of New York has created a containment area of about a mile square, a mile radius in whatever diameter in New Rochelle, New York. It doesn't mean that people aren't allowed to leave their house. It doesn't mean that they can't go to grocery stores, et cetera. But the National Guard is there to bring food to people who can't get out otherwise, to clean up stuff, et cetera. When we're talking about quarantines in America, what are we talking about? And what's an acceptable quarantine, you know, currently or. And how does that change?

So the containment zone is basically like, okay, on a 1 to 10 scale. I give it like a, I guess 2. Because at least it's directionally in the zone of okay, we need to do something to contain this thing, right? However, there's many Problems with it first is it's pre announced by two days. So it's like, you know, like that's exactly what happened with Wuhan. All these people fled. It happened in Italy, all these people fled.

But it's also, that's understandable too, right? And particularly an authoritarian regime. People in Wuhan knew what was coming and they're like, I'm getting the fuck out of here. Because if I, if I present to the government, you know, I don't, I don't know if I'll ever come back.

And you know, it is something where like this is, it is essentially, here's one way of thinking about it. This is like a wartime scenario in the sense of, you know, if you talk about like the anarchist minarchist division, right, okay, the state has legitimate powers in terms of crime and punishment and war, right? And if you think about this, it's kind of like the world is being invaded by a virus, right? Not by the Germans or the Russians or what have you, by a virus. And that virus non compliant with regulations, it has no budget, it's completely decentralized. Its objective is to kill you and to spread, you know, like it's committing murder all the time, right? And, and so in those cases, like, you know, if you're fighting a war, you unfortunately like somebody has to make greatest good for the greatest number of decisions does, you know, and there's something, sometimes those are zero sum decisions. One person does have a downside in order for others to have an upside or vice versa. Right. And in the case of Wuhan, for example, I absolutely understand why somebody from there wanted to flee. It was in their interest if they weren't sick to get outside this quarantine zone, which they might get sicker, you know, even if they were help. On the other hand, you also understand why the people outside do not want people from Wuhan to flee because they didn't want that, you know, sickness come to them. So that unfortunately is just a diagonally disaligned kind of thing, right? The win for one is lost for the other and vice versa. There's no obvious win win there other than maybe some compensation for people in the quarantine zone, which is what Iceland is doing by the way, like paid quarantine. Right. And that might be a smart thing to do, by the way. You know, you give some social credit, some payback. It's not fully compensatory, but maybe partially so. You know, the thing is descending on us so quickly that people haven't thought through things like that. But you know, one thing also to preempt, by the way, some people will quote that, you know, quote, like those who give up some freedom for a little security deserve neither on their hand. That's also, I don't think it's pragmatic in the sense of, you know, the, the counter argument. Another American quote is, you know, freedom isn't free, right? Meaning that some sacrifice is required. And you know that. I think that is also true. You know, it doesn't, you don't, you don't build a society without some things like that. Let's come back to your original point, though. So you're talking about how should we think about mandatory quarantines, right? And I think, you know, and especially let's take the New Rochelle example, I think America is managing to do things in the worst way.

Oh, really?

Okay, here's why. Because the containment zone is not a quarantine. It gets people to flee. It's pre announced. It is. So if you're doing it, you do it, you know, like actually quarantine in place and you stop people from leaving. It's not an optional thing. If you, if you announce it, then people think, oh, it might become mandatory. Let me get out before that happens. And you actually accelerate the distribution of the virus. It's like bursting spores, you know, push them out. Right. So that's actually like the worst of the three options. Don't do it. Do it or pre announce it and then do it. That third one is actually one that spreads the most.

So what I mean, are you, Would you recommend or how do you recommend? And, and it's interesting to talk to somebody who is, you know, seriously, you know, in line to be the FDA commissioner where, you know, and we can talk about, you know, the way in which the FDA and the CDC and whatnot are either doing well or bad. But like, would you go to, you know, where would you say, okay, we're having a mandatory quarantine? Or is it everywhere in the country? I mean, the Lombardy region of Italy, you know, the industrial powerhouse of Italy is under a form of quarantine. I mean, are we telling people not. Yeah, okay, so do we say nobody's leaving the country, nobody's coming in, or if they're coming in, they have to be, you know, quarantine for a couple weeks before they're allowed to go to their final destination?

I mean, I think that's probably what's going to happen because basically something that was a preventable thing, we've had a cascading failure where basically we're flying blind. Thanks to the CDC's case definitions, thanks to the FDA CDRH division, impeding emergency use authorizations for all these labs and bottlenecking testing during a critical period in February. Thanks to all of that, basically everybody was and still is in some ways, in a sense of kind of complacency. They thought, you know, oh, it's being contained. You know, Trump's been tweeting, oh, it's only so many cases. Actually, it's probably more like 10,000 plus cases, you know. And the reason I get that estimate is when Trevor Bedford profit UW got finally, he was able to get some sequence data out of these viruses, two viral strains. Given the estimate that in Washington alone there's large, there's likely an outbreak of size 570. That was like a week ago, right? So, you know, almost certainly there's like 10, 10,000 plus in the US and we're gonna, we're gonna find all. And so what I think is gonna happen is we've traded the de facto decision by the FDA and cdc, but FDA in particular to not approve diagnostics has meant that our indicator is going to be deaths, right? And hospitalizations. We're going to only take this seriously once we basically disabled our early warning system. And so we're only going to take it seriously when just a bunch of people start piling up in emergency rooms, which is happening, by the way, in Washington and California.

When will we know that? When will we know that the infection has peaked?

We'll know that it's peaked when we have massive diagnostic capability. And I'm talking like hundreds of thousands or millions of tests a day because an infectious disease, right, so testing somebody once is not sufficient. You may need to retest them multiple times. So we need an absolutely massive diagnostics effort, number one. And because, you know, the thing is, it's not how many cases you have, it's how many cases you have and how many tests you ran to determine that. If you didn't run a lot of tests, then you're like, you know, the person looking for the quarter under the lamppost, right? So we'll only know it's peaked if we have massive diagnostic testing capability. We're tracking new cases per day really rigorously across the country. And then we're seeing that peak come down like what happened in Asia.

And you don't see in. I mean, it's kind of fascinating to talk to a kind of prophet of decentralization. And we're effectively doing a decentralized Response in the US because different states, different localities are doing all sorts of things. The federal government is largely. I mean, it's only getting its act together now. The private sector, the nonprofit sector is doing stuff. But you, I mean, basically that, you know, that's a big mistake for this particular situation.

Yeah. I mean, the decentralized response is better than nothing, but it is significantly worse than a competent, centralized government.

Yeah.

And one way of thinking about it is if you bucket this into the national security category, you know, this is. That's, that's, you know, minarchist would agree. This would fall into security. It's something that's like an invasion of the country by a virus. Right. And, you know, so what I think is going to happen, or let's say what I think is possible. Okay. Just given what's happened in other places, given what's happening in New York, I think it's possible that blue cities get quarantined by red troops. Okay.

That should end well. Right.

You know, that's. That. That's what we're on track for, unfortunately. I hope we avoid it.

So this is the full Omega man scenario, right. Of I was, you know, the 1971 Charlton Heston movie where a. Some kind of chemical bomb wreaks mayhem and turns turns people into hippies, Actually albino hippies.

Okay.

And Charlton Heston is one of the last regular people left. But your people are put under lockdown. It's martial law. You can be shot if you are seen wandering around the streets after a certain period.

Point.

I mean, that's essentially what you think is the response that is necessary.

The issue is, I don't think that America is capable of properly calibrating a response. Okay. So it's either apathy or it's going to be this incredible bureaucratic overreaction, which is going to be essentially an internal tsa.

Yeah. Let's talk a little bit about the ways in which the coronavirus is forcing us or may force us to rethink things, or if we're smart about it, will actually come up with new ways of doing things. You talked recently in a tweet about how tsa, you know, I mean, you're saying we're going to be going through an internal TSA for the entire country. You talked about how actually the way TSA screens things now is exactly the wrong way to do things. Can you expand a little bit about that?

Yeah, so. Well, first of all, it's not hygienic. So they are basically padding people down that I don't know if you've seen these. The. Of course you've seen them. But at airports, the checkpoints where you've got the conveyor belts, these buckets that you put stuff in, they're filthy because people put their shoes in them. It's awful, right?

Yeah.

And so it's literally just.

It's a salad bowl. Yeah. To mix together to make sure, like, if you didn't have something, you know, if you, if you come in clean by the end of the. When you're picking up your shoes, you're dirty as hell.

That's exactly right. And I mean, especially coming out of sfo, like, you know, SFO streets are not the. Yeah.

I flew out of there like two days ago or a week ago. So thank you.

But for the reminder. So what I think you could replace that with, you know, especially given that these three TSA agents have come up, you know, positive for the coronavirus and probably patting people down at Santa's. I think you just abolished. I mean, in an intelligent country, in a competent country, if you felt that you still had to screen for things. Okay. Because, yeah, it is possible someone gets a gun or a knife on a plane. I probably, as a consumer, want some form of screening for that, given that terrorism is a real thing. Do Amazon today. Josh Wolf of madocob tweeted about it. It's basically like non invasive scanning. They'll just detect whether or not you have the guns or whatever. I mean, the imaging is there for that. And then no agents, no one touches you or whatever. And you can even use thermal cameras and potentially other kinds of sensing to determine does someone have a fever or what have you. That's what they're doing in China now. Like, will the US Actually do that? I'm skeptical. Maybe. Maybe in, like, smart regions, but I don't know.

Can we talk about other areas? You have talked over the years about kind of decentralization of things like the workplace and whatnot, or the workforce. Are there ways in which. And I don't want to be as ridiculous as kind of making lemons out of a pandemic virus or something like that, but people are being told, okay, if you can work from home, disperse yourselves kind of reliably. How are you. What are some of the positive ways that we can take this moment to think about redoing certain kinds of social, economic, political organization that we take for granted that probably is not particularly efficient or useful for this point in time? Anyway?

That's a good question. So I think one analogy would sort of Be In World War II, women went to work, and then after. And they went to work as a wartime measure. But afterwards it was a new normal. Right. And women were now in the workforce and it was just a different, different thing. Right, yeah. And by analogy, I think, you know, one of my friends said something like 2020 is the year the future historians will write the Internet actually began.

Right.

Or like this century actually began because we're basically in a chaotic way. We're doing like a tweet about this, like a digital Dunkirk evacuation. Right. Retreat to the cloud to escape the lightning offensive of the virus, you know, so you're just kind of like retreating to the cloud. And the thing about that is we're turning the cloud into, like the primary place we are conducting work and other kinds of things. Because a whole new argument for using, you know, Internet technology, that argument is hygiene. Right. The remote argument for hygiene. I mean, that shifts something that is happening already into something that is the default way to do it. Like by default, for example, you want touchless faucets, right? By default you want remote capable jobs. By default, you want autonomous taxis and so on and so forth, because it's more hygienic. And this stuff is already happening. But that adds like 20 or 30 points of population support for it. So it's going to accelerate a ton of things like that. That is a silver lining for.

Yeah, I love the idea of a digital Dunkirk. I think that really gets at a lot of what's going on and also what might actually be truly useful and kind of pathbreaking going forward. Can you talk a bit about the. Is there a generational element to all of this? I mean, and there is clearly, in the sense that if you're over 70, you are much more likely to die. You know, the baby boom generation and I guess the last remnant of the quiet, the silent generation, I mean, they're being pushed off the stage. This seems to, in a weird way, be kind of accelerating that in terms of kind of cultural, economic, political power. We're almost certainly witnessing. I would like to believe that we're witnessing the last presidential election where it's all about, you know, various people who are close to 80 years old. But is there a generational thing going? Or how does the generational split, which seems to be growing significantly in America, you know, on a daily basis, how is that influencing or intersecting with the coronavirus?

Well, so it's certainly. I mean, one thing that's definitely the case is all of these politicians are in the maximum danger area for the coronavirus. And yet they are still shaking hands, they're still at rallies and whatnot. It's actually mind blowing to me. You know, I don't even understand it so well.

And they can't not do it, right? Because if they don't do it then they look weak and that they're about to die. If they do do it, you know, they might get infected and actually die.

So I guess so. But I mean, like, you know, tough to be that.

Yeah, there's.

There's certainly, I think, a way to phrase this in terms of leadership and maybe you start holding digital rallies and do periscopes and stuff like that. You know, you can actually. It's actually easier to hold a larger crowd. Guess what? You know, they can all just connect live. You don't need a venue. You can, you can just hold it every single day. A massive rally with a million people. Right. So I think what's going to happen is things that were previously fully offline, like rallies, conferences, K through 12 education, healthcare, stuff that sort of resisted the Internet, were all forced into digital conferences, you know, online education, telemedicine, all of those kinds of things. Areas of, you know, like, for example, remote legislation that's going to come. Right. All these areas that are previously proved resistant to the Internet are now just getting uprooted from the ground and pulled into the cloud and people are going to be forced to operate that way for a while. And you know, that has some salutary. I mean, in the short term that's chaotic. It's going to cause a lot of dislocation and so on. It does have salutary long term benefits because we basically learn how to modernize certain areas that are proved resistance to that over the years.

All right, I think we're going to leave it there. That's a good note to end on. We've been talking with Balaji Sirnavasan about the coronavirus and how do we get past a, you know, how do we live in a borderless world with a borderless virus?

So, yep, I think the borders will come back with this and. But we'll board us on the Internet. All right.

I hope so. Thanks very much. Take care.