Michael Levitt is Professor of computer science and structural biology at Stanford Medical School and winner of the 2013 Nobel Prize in chemistry. He has been a close observer of the pandemic and the response from the outset through its movement to Europe, the U.K., and the U.S.. On May 2, 2020, speaking to the Unherd podcast and YouTube channel, he offered some compelling thoughts and observations, and a striking conclusion.
Below is a transcript of the parts I found most relevant.
Q: So you noticed that the curve was less of an exponential curve than we might have feared, in those early days?
A: In some ways there was never any exponential growth from the minute I looked at it, there were never any two days that had exactly the same growth rate — and they were getting slow…of course you could have non exponential growth where every single day they’re getting more than exponential — but the growth was always sub-exponential. So that’s the first step.
Q: [In the UK] we talk endlessly about the R-rate — the reproduction rate — and apparently that began very high, maybe as high as 3, and … [we’ve now] got it down below 1 in the UK. Intuitively, if there’s a high reproduction rate, you should see that exponential curve just going up and up.
A: Well no, wait, okay. The R-0, which is very popular, is in some ways a faulty number. Let me explain why. The rate of growth doesn’t depend on R-0. It depends on R-0 and the time you are infectious. So if you are twice as long infectious and have half the R-0 you’ll get exactly the same growth rate. This is sort of intuitive, but it’s not explained, and therefore it seems to me that I would say at the present time R-0 became important because of a lot of movies — it was very popular — talked about R-0.
Epidemiologists talk about R-0 but, looking at all the mathematics, you have to specify the time infectious at the same time to have any meaning. The other problem is that R-0 decreases — we don’t know why R-0 decreases. It could be social distancing, it could be prior immunity, it could be hidden cases.
Q: You’ve been observing the shapes of these curves and how the R-0 number tends to come down and the curve tends to flatten in some kind of natural way regardless of intervention. Is that what you are observing?
A: We don’t know. I think the big test is going to be Sweden. Sweden is practicing a level of social distancing that is keeping children in schools, keeping people at work. They are obviously having more deaths in countries like Israel or Austria that are practicing very very strict social distancing but I think it is not a crazy policy. The reason I felt that social distancing was unimportant is practicing very very strict social distancing, but I think it is not a crazy policy.
The reason I felt that social distancing was unimportant is that I had two examples in China to start with and then we had the additional examples. The first one was South Korea (yeah), and Iran, and Italy. The beginning of all the epidemics showing a slowing down, and it was very hard for me to believe that those three countries could practice social-distancing as well as China. China was amazing, especially outside Hubei, in that they had no additional outbreaks. People left Hubei, they were very carefully tracked, had to wear face masks all the time, had to take their temperatures all the time, and there were no further outbreaks.
So this did not happen in either in South Korea or in Italy or in Iran. Now, two months later something else suggests that social distancing might not be important, and that is that the total number of deaths we’re seeing in New York City, in parts of England, in parts of France, in northern Italy — all seem to stop at about the same direction of the population so are they all practicing equally good social distancing? I don’t think so.
The problem I think is outbreaks occurring in different regions. I think social distancing that stops people moving from London to Manchester is probably a really good idea. My feeling is that in London, and in New York City, all the people who got infected, all got infected before anybody noticed. There’s no way that the infection grew so quickly in New York City without the infection spreading very quickly. So one of the key things is to stop people, who know that they’re sick, from infecting the others. Here again, China has three very, very important advantages that are not high-tech that don’t involve security tracking of telephones.
What they involve is, number one, the tradition in China for years, of wearing a face mask when you’re sick. As soon as the coronavirus started everybody wore a face mask. It doesn’t have to be a hygienic face mask it just has to be a face covering to stop you spraying saliva, micro droplets of saliva on somebody you talk to. The second thing in China is that because they were so scared of the SARS epidemic in most airports, stations where you pay tolls et cetera, there are thermometers. Infrared thermometers that that measure your temperature. So having your temperature measured at every single store entrance — either with a handheld thermometer or with something mounted on the wall — is something completely standard in China. And the third thing is that almost all payments in China are made not using a credit card, so in some senses it is very much easier there to practice social distancing. Of course, in addition they know where people are.
Q: What’s your view of the lockdown policy that so many European countries and states in America have introduced?
A: I think it is a huge mistake. I think we need smart lockdowns. If we were to do this again, we would probably insist on face masks, hand sanitizers, and some kind of payment that did not involve touching right from the very beginning. This would slow down new outbreaks and I think that for example they found as I understand, that children, even if they’re infected, never infect adults, so why do we not have children at school? Why do we not have people working? England, France, Italy, Sweden, Belgium, Holland, are all reaching levels of saturation that are going to be very, very close to herd immunity — So that’s a good thing. I think the policy of herd immunity is the right policy. I think Britain was on exactly the right track — before they were fed wrong numbers and they made a huge mistake.
I see the standout winners as Germany and Sweden. They didn’t practice too much lock down, they got enough people sick to get some herd immunity. The standout losers are countries like Austria, Australia, Israel that actually had very very strict lockdowns but didn’t have many cases. So they have damaged their economies, caused massive social damage, damaged the educational year of their children, but not obtained any herd immunity.
I think in many ways the European countries are fine. They didn’t need to have lockdown but they have all reached a high enough level of infection not to have to worry about further future attacks of coronavirus. The United States seems to be heading that way, they’re certainly that way in New York City but they still have a long way to go
Q: What you’re saying is that, you believe success — as we are currently measuring it which is as few cases as possible and as small a spread of the virus as possible — is actually failure?
A:I think if you really control your epidemic, for example, California, it’s now had lockdowns for six weeks, and wants another four weeks,they have so far less than a hundred deaths, that means they don’t have more (let’s say a hundred thousand) in people, that is not enough to give them significant herd immunity. They didn’t need to do all that lock down.
The lockdown is particularly hurtful in countries that don’t have good social infrastructure, countries like the United States and Israel. Many, many people have been really really hurt — especially young people. You know I think that everybody panicked — they were fed incorrect numbers by epidemiologists and you know this I think led to led to a situation.
There is no doubt in my mind that when we come to look back on this, the damage done by lockdowns will exceed any saving of lives by a huge factor. One very easy way to see this is, and again I am getting into a sensitive territory here, but economists have a very simple way of looking at death. They don’t count people. They come to the conclusion that if you’re 20 and you die that’s a greater loss than if you’re 85 and you die. It’s a hard issue, but in some ways are we valuing the potential future life of the 20 year old? Are we valuing the loss of more senior persons by what’s called daily disability-adjusted life years. Basically if somebody is in their 80s, has Alzheimer’s disease, and then dies from pneumonia (perhaps due to corona) that is less of a loss than if a 15 year old is riding his motorcycle bike and gets run over. This is an important way of looking at death.
It’s also you know, right now, the number of excess deaths is around 130,000 up to yesterday, [May 1st]. This is for all of Europe, for a population of around 330 million people. So an excess of 100,000 for this whole year, is actually not that much. In some of the worst flu epidemics we get to those kinds of numbers — sometimes it’s a bit more, sometimes a little bit less.
Now, I’m not saying flu is like coronavirus, I’m just simply saying that the burden of death of flu is like coronavirus. Especially when we correct for the fact that people who die from coronavirus are older on average than people who died from flu. Flu kills young people, it kills two or three times more people under 65 than does coronavirus. If we put those facts into the situation we find that the burden of death from coronavirus and Phillip Shaw will, in Europe, where we have good numbers in less than that of a very flu.
Another factor which has not been considered are all the cancer patients who aren’t being treated, or all the heart cardiology patients who aren’t being treated. I’ve got estimates of tens of thousands of people who are basically going to be dying because of lack of that treatment — and generally again the age group who die of cancer are younger than the age group who die of coronavirus.
There’s one very easy way to sort of summarize coronavirus. I put an article in the medium by the pretty famous British statistician Sir David Spiegelhalter of Cambridge [University] and he had said that the numbers coming from Ferguson suggested that we had to lose about one year of people. It turns out that I immediately wrote an article in the same medium and replied to him, saying that in fact the answer was actually one month, not one year. So basically my feeling is, and it’s being supported by the numbers, is that the amount of excess death you need to reach saturation, I’m not going to call it herd immunity, where the virus by itself stops, is on the order of four weeks of excess. Now to give you some idea in the European area where there is good monitoring, by a website called EuroMoMo, run out of Denmark, which covers about 300 million people. Every week in Europe in that area there’s around 50,000 natural deaths. So in four weeks there will be about 200,000 extra deaths in that year — and it looks like coronavirus in Europe where it’s no doubt that it’s the most severely hit area in the world — we’ll probably reach around 200,000 or 4 weeks worth.
Q: So what happens if what you’re saying is there’s a sort of statistical observation which is around four weeks of excess death and then the pandemic seems to peter out, or begin to flatten out. What does that mean policy-wise for these European countries then?
A: If we could protect the old people perfectly, then the death rates would be very, very low. So for example in Europe there were about 140,000 excess deaths in the last nine weeks. The number of those excess deaths who are younger than 65 is about 10%. So basically 13,000 of 130,000 deaths are actually under 65 years old and if we had simply been able to protect elderly people then the death rate would have been much much less. But the key thing is to have as much infection for as little possible death and also do whatever you can to keep the hospitals full but not overflowing. It’s a difficult calculation and the trouble is that in Sweden there’s no political concerns.
The trouble is is that in Israel and I know as well in the United States, everything is political and therefore nobody could say something like this. They would say, “Ah, but you are not valuing death — the thing that should have been done is for the media to stress to people that everyday somebody dies. These people are essentially in the same age band, and they die from Corona and other comorbidities, other diseases.