Doctor and economist Joel M. Zinberg joins Brian Anderson to discuss the “tripledemic” of Covid, flu and RSV, the relationship of public health and epidemiology to real-world evidence, and the Covid situation in China.

Audio Transcript

Brian Anderson: Welcome back to the 10 Blocks podcast. This is Brian Anderson, the editor of City Journal. Joining me on today's show is a frequent guest, Joel Zinberg. He's the Director of Public Health and American Well-Being Initiative at the Paragon Health Institute. He is a senior fellow with the Competitive Enterprise Institute, and he's an associate clinical professor of surgery at the Mount Sinai Icahn School of Medicine. Earlier, he had been the senior economist and general counsel at the White House Council of Economic Advisors—this was from 2017 to 2019. He has been a key contributor for City Journal throughout the Covid-19 pandemic, and he continues to cover public health, medicine, and economics for us today. So Joel, thanks very much for joining us again.

Joel Zinberg: Oh, my pleasure.

Brian Anderson: So I'd like to start off with the new word that's coming at us from every source, the so-called tripledemic, which refers to the circulation, which is going on right now of three diseases: Covid, the flu, and the common respiratory virus RSV. Listeners may have noticed a familiar course from the public-health bureaucracy and the mainstream press imploring us again to wear masks and take extreme precautions before seeing family, and some have even called for the reimposition of mask mandates. So, as you wrote for City Journal in a recent piece, in your view, it’s safe to ignore this kind of tripledemic hype. So what prompted this new round of hysteria, as you describe it, and why has it been so overstated?

Joel Zinberg: Well, I think what's happened is that you, first of all, you've had a situation where for the previous few seasons you had an artificially low level of respiratory syncytial virus, the RSV that you referred to, and you've also had an artificially low level of flu, so influenza, so that when we returned to sort of more normal levels, it suddenly seemed like we were at a very high spot. Secondly, you had a situation with RSV and with the flu where the season seemed to start a little earlier than normal. So for example, the flu normally runs from October to April. You were starting to get relatively high values a little bit earlier than normal, and it led people to think, oh, this is going to be a problem. You're going to have all three diseases—RSV, influenza, and Covid—occurring at once.

Except the problem for that narrative is that they're not really surging simultaneously. You've had RSV peak basically mid-November. It's been steadily down since that time, and it's at levels that are below where we were in previous seasons, normal RSV seasons, for this illness. You had flu starting a bit earlier than a normal, and it seemed to be a pretty severe season. But it seems also to be abating, and we're not at a point where we are necessarily going to be anything out of the ordinary. So for example, the latest figures are showing about 20 million cases thus far—hospitalizations of 210,000, deaths of about 13,000. But to put that in context, a normal season has about nine to 41 million cases, and a normal season has about 240,000 to 710,000 hospitalizations. So 210 doesn't seem that out of the ordinary, and 13,000 deaths falls well within the 12,000 to 52,000 we've seen over these previous 10 normal seasons.

So it may turn out to be a severe total season, but it doesn't look that way at the moment, and we're about almost halfway through that. We're necessarily going to exceed what we've seen in prior years. And of course, thrown into the mix here is COVID, which we've never had before. But the fact of the matter is that even with the newer variants—and here I'm referring to Omicron variants, and the latest and greatest is XBB1.5. You're getting a lot of cases, but you're not getting tremendous amounts—at least relative to earlier periods of the Covid pandemic—of hospitalizations or deaths. So you have a situation where we've had peaks in the summer of cases, hospitalizations, and deaths, but since that time, you haven't seen huge increases. Hospitalizations have been rising a little bit lately, but as I said, relatively speaking, they're low compared to some of the surges we've had in the past. All these things could change, but we're not seeing the simultaneous surge, and the hype is just not warranted.

Brian Anderson: I'd mentioned mask mandates, they've not been brought back around the country, but there are a few exceptions. We've seen the reinstatement of mask mandates in public schools in Philadelphia and Camden, New Jersey so far. And as you wrote in your article, the fact that prominent academics and officials were calling for mandates suggests that the public-health apparatus really hasn't learned certain lessons from the Covid pandemic. Few of its representatives seem to have considered the importance of cost-benefit analysis before they start recommending these kinds of intrusive restrictions, much less reckon with what is now a very significant decline in trust that Americans have in the public-health field. So do you, just to put on your predictive hat for a minute, do you think we'll see mandates return in a widespread way, either now or during a future pandemic, perhaps? What is it going to take for the public-health world to really think in a more effective cost-benefit way?

Joel Zinberg: Well, the problem from the start has been, as you point out, they have not been thinking in an effective cost-benefit way. And it was known really both before the pandemic and from early on in the pandemic, that mask were not terribly effective in stopping the transmission of Covid. And there was a study by the highly regarded Cochrane Library before the pandemic, that found that medical and surgical mask-wearing made little difference to the outcome of influenza-like diseases. And even early in the pandemic, there were starting to be randomized control trials, both of the effectiveness of masking for Covid and for non-Covid respiratory diseases. And again, basically very few studies showed any kind of benefit at all. So this is all based on sort of observational studies that had methodological problems as opposed to the randomized clinical control trials, which are the gold standard.

And what we've seen is from countries like Sweden, which one, never closed their schools, and two, didn't impose mask mandates that you didn't get any benefit from, particularly in the school setting. And again, early on we knew that children are not terribly vulnerable to this disease. I mean, the number of deaths for children has been less than a few tenths of a percent of the total deaths of Covid, so that it's a minuscule amount. And they were never particularly at risk. And most of the studies indicated that teachers were far more likely to get Covid out of school from other adults than they were in school from their students. So this has been pretty clear for some time, but as to your question, will we see calls for the reposition of mask mandates? I think if we get a real surge in Covid, you may start getting some of those calls.

And particularly because unfortunately in many of the major cities, including where we are, New York City, teachers unions are extremely powerful. And from the start of the pandemic and all the way through, they have been very vocal in calls to mask everyone, to close down schools, to do everything possible to protect teachers—or at least in their view, protect teachers—even if their view is misguided with little or no concern for their students. And the accumulating evidence indicates that things like mask mandates and school closures have real deleterious effects on the students, interfering with their educational and psychosocial development. Kids who have hearing impairment, and even kids without hearing impairment, are having difficulty understanding what's being said to them.

And when you look at the educational losses that resulted from the pandemic, they're really staggering in terms of numbers of years of both math-reading scores and English-reading scores. And these will reverberate for years to come. Unless action is taken to ameliorate the problem and let them catch up, these kids are going to suffer severe economic consequences going forward, tens of thousands of dollars in lost earnings for them and in decreased production for the economy.

Brian Anderson: Yeah, in this context, I don't know if you saw this last week, the New Yorker published a story from Emma Green about the people's CDC, which is this group of academics, doctors, and activists who argue for an indefinite, permanent set of restrictions to counteract Covid. And this group charges that CDC statistics are in fact downplaying the severity of the spread of Covid and its long-term effects. So to give a sense of this, from my perspective, disconnection from reality, they recently posted a guide to safe gatherings, which maintains that any event whatsoever should be held outside with universal high-quality masking. So everybody outside, everybody wearing masks. Yet this seems extreme to me.

I walk around New York now and people are basically acting pretty normally, and I'm not seeing a huge amount of mask-wearing. Yet, this group does seem to reflect the views of many people in the public-health field. So it's received funding from various health-focused philanthropies. There has been praise for it from at least some epidemiologists at universities. So I just wonder, to what extent does this to my mind extreme sensibility reflect the disposition of the public-health field at large?

Joel Zinberg: Well, look, it's contrary to almost all the evidence. And we've seen, as I mentioned before, Sweden, which was vilified for not closing down like the rest of Europe and for keeping schools open and allowing people to continue to carry on normal lives with some restrictions, but really lax compared to everywhere else in the world. Sweden has done better in its health outcomes, or at least no worse than most of the EU. So that's one situation. We have a lot of evidence from this country, if you compare the 50 states and the District of Columbia, the states that imposed really severe lockdown measures compared to states that do not have better health outcomes. And I'll point out that there's some articles getting published over and over again by the same authors saying that the U.S. has done worse, and they don't adjust for age distributions.

And then they talk about different states. And again, they don't adjust for different states’ age distributions. And so there are critical flaws in their writings and in their thinking, because we've known since very early on in the pandemic that the mortality rates are exponentially higher for the elderly, and they're higher for people with underlying medical conditions. So it's just ridiculous to publish these things. Yet you see some presumably reputable journals like JAMA that are publishing these articles. And obviously as you're pointing out, you have some folks in the public-health community and if you want to live in a box, like a Diver Dan outfit, perhaps I'm dating myself by making that reference, but I'm referring to someone putting on a deep-sea diving outfit with a bell and an air hose to the surface. Yes, you can keep yourself from getting all sorts of diseases, but that's not the way anyone wants to live.

And it's really counterproductive because it interferes with normal social interactions. It interferes with economic activities. What we needed to do in this setting was to focus on protecting the folks who are most vulnerable in that we, again, we've known from the start, the elderly and people with underlying medical problems, they formed the vast majority of the people who've been hospitalized and who have died from Covid. And by the way, it's a similar scenario with the flu. Those—the elderly and the people with underlying problems—are the folks who get sickest from the flu. So we should be focusing on protecting those folks who are vulnerable and not isolating everyone in society. It just cannot be done. It should not be done. And I think all you need to do is look at China to see what happens when you try to do something like that.

The reality is, economists have known for a very long time that people respond to risk without government mandates. And that's what happened with Covid. Both here and in other countries in the world, when rates of Covid were high, people took mitigating measures on their own. They didn't go out as much. They avoided crowded indoor areas. They sometimes began masking on their own, particularly if they were vulnerable. And when rates of Covid go down, people relax, and they don't engage in those activities. And there's no reason to think that going forward you won't have that kind of reaction without the sort of blunderbuss and slow-moving government responses.

Brian Anderson: Well, a final question would address China, which you've just mentioned. So let's look at that briefly. That's the other big Covid story. Now, the ruling Communist Party has seemingly dismantled almost overnight it's draconian zero-Covid policy after, I think, seeing pretty significant public pushback in the country, reading the alarming economic signs of the effects of zero COVID. So what's gone out have been Covid checkpoints, testing requirements, mandatory quarantines, surveillance teams, the whole thing seems to have been dismantled. Yet it is true that Chinese citizens, and this is especially true among seniors, the most vulnerable, have lower rates of vaccination than we do broadly in the West.

And the Chinese vaccines don't seem to be as effective in the country, which has, as at least up until this point, rejected the use of Western vaccines, at least the mRNA shots from Pfizer and Moderna. So accordingly, there's been a lot of speculation that a huge wave of infections and deaths is going to hit China. We're certainly hearing all about a lot of infections, it's just hard to get reliable information out of that country as you no doubt would agree. But I'm wondering what your assessment is trying to see this from afar right now.

Joel Zinberg: Look, the problem with China has been from the start getting reliable information, and at the outset of the pandemic, the World Health Organization was complaining that they weren't getting accurate information. And a little bit later, it seemed like they tried to cozy up to the Chinese to get more reliable information and maybe get some more information on the origins of Covid. But that hasn't been terribly successful. Right from the start, the Chinese withheld information on this disease that was spreading in China. It took weeks for it to get out to the U.S. and to the rest of the world. They've stonewalled on investigations into whether or not Covid originated in the Wuhan laboratory. And anyone who believed the figures on China's Covid cases, hospitalizations, and deaths was foolish, because they were trying to project a certain persona, I guess, to the rest of the world that they were better than the Western countries at combating disease, and that their approach was better and they just were not going to share bad news.

And I think it eventually became intolerable for the Chinese people. I mean, they were in a situation where anyone who was tested positive for Covid was going to be confined for weeks in a hospital. And anyone who's even exposed to COVID in the most casual way would be quarantined. So if nothing else, there was a tremendous incentive among the Chinese people to under-report illnesses and to try to fly beneath the radar. So even if China had been completely honest in reporting its statistics, they were probably skewed, because the Chinese people were trying to dodge these very heavy lockdown-type measures. And there's no doubt you're going to see a lot of cases now because you don't have a big reservoir of natural immunity built up from people being infected. Although, as I say, we don't really know how many people were infected, and you don't have a high percentage of the population that was vaccinated.

Mostly that's the Chinese government. They were not pushing vaccinations, they didn't the way we did here, even though the vaccine effort here was vilified. In fact, the vaccine effort here was pretty good. And I think the Chinese people were being led to believe you don't need the vaccine because we have our zero Covid policies, and that's protecting you. So now you have a situation with no natural immunity or vaccine, or very low levels of immunity, and you have Omicron variants, which are highly transmissible, circulating through the country. So there have been estimates that as much as 250, 300 million people have been infected in the month of December alone, yet the Chinese government's holding forth that only a few dozen people have died, which is just completely unbelievable. So, I think what we're going to see is a wave of Covid, you are going to see a lot of hospitalizations, although the hospital capacity in China is far less than the hospital capacity per capita that we have here in the U.S.

And by the way, I would point out vis-à-vis the tripledemic discussion we were having before, even though there's all this hysteria here, we are still at the point where we have about 19 to 20 percent of our hospital- and ICU-bed capacity available. That's not to going to be the case in China. They have a much lower capacity to start with, and they will fill those beds very quickly. And we'll probably never really know how many people are hospitalized and how many people have died. But there are certainly anecdotal reports of morgues and crematoria being filled up with bodies.

Brian Anderson: Well, all very, very useful information. Joel, always great to have you on. Don't forget to check out Joel Zinberg's work on the City Journal website. He's been covering the pandemic since its beginning for us. That's at We’ll link to his author page in the description, so you can find all of that material. You can also find City Journal on Twitter @cityjournal, and on Instagram @cityjournal_mi. As usual, if you like what you've heard on today's podcast, please give us a ratings on iTunes. Joel Zinberg, always great to talk with you.

Joel Zinberg: Thanks for having me, appreciate it.

Photo by Michael Nagle/Xinhua via Getty Images

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