>> Hello, and welcome to this author interview.
Once again, this is Howard Bauchner, editor-in-chief
of JAMA, and this is Conversations with Dr.
Bauchner, and I'm here with Frank Snowden.
Welcome, Frank.
>> Oh, thank you very much. I'm delighted
to be here.
>> Frank joins us from Italy, and we will
get into that in a second. Frank is the Andrew
Downey Orrick professor of history and professor
and chair -- was the chair of the history
of science and medicine department at Yale,
and he joins us because of a remarkable book,
which I've learned is sold out on Amazon,
which was published just recently entitled
Epidemics and Society. I assume when this
book was published in the fall, you did not
anticipate what would happen around the world
in January, Frank.
>> You're absolutely right, and it took me
completely by surprise, and although, like
many people, I imagined that there would be
some sort of pandemic challenge -- people
have been predicting that a long time -- but
I had no idea that this would happen now,
at all.
>> Yeah, it's an amazing coincidence. It's
Epidemics and Society: From the Black Death
to the Present, and we'll go through details
of the book and then how it compares to COVID-19.
But Frank, could you tell people what it's
like in -- why are you in Italy?
>> Right.
>> And why are you in Italy, and then what's
it like? Been -- you've been in Rome since
the end of January. So why are you in Italy,
and then what's it been like in Rome for the
last two months?
>> Yeah. I'm in Italy for -- originally for
a different purpose, which was that I wanted
to make use of the newly opened papers -- the
Vatican just opened the papers to scholars
-- of Pope Pius the 12th, and I was very interested
in his papers with regard to the Holocaust
and then to the Cold War just after the Second
World War, but my whole plans were upended
by the coronavirus outbreak, and I've stayed
on, and I've devoted myself to coronavirus,
really, either as research, and that is to
keep up to date with it as best I can, and
to think and talk with my head together by
thinking and talking with various people in
the hope that maybe something -- in a small
way, something that I've learned in 40 years
of thinking about infectious diseases could
be useful. And so I've been doing hours of
interviews every day for the last month, and
I've found that to be -- really seems to me
an important, I guess, therapeutic when you're
in lockdown to feel that you're maybe doing
something useful, and also to talk with people
all around the world gives you a sense of
not being enclosed so much. So but most importantly,
it's a sense of maybe to provide some sort
of context for people who haven't an experience
in this field and would want some sort of
idea of how this could be happening to the
world. So I've been putting my head together
with people trying to think about that and
discuss it. So that's what I'm doing now.
>> We'll get into, you know, how the information
in the book relates to coronavirus pandemic,
but what's it like in Italy now?
>> The situation now is that the lockdown
is more severe than in most countries in the
industrial world, and that is to say that
you aren't allowed to go outside for any purpose
except to purchase food and medications, and
there's nowhere else you could go to purchase
anything because that's about all that's open.
And to do that, you have to do two things:
one, stay within a radius of a few hundred
yards of your home, and you have to carry
with you a document stating while you're outside
-- why you're outside and where you're going
so that if the police stop you and it happens
that where you are doesn't correspond with
what you said you were doing and where you
were going, you can be very heavily fined.
So you can't visit anyone. You can't meet
anyone outside. You're supposed to be six
feet apart at all times from any other human
being, and people are -- they're clearly very
concerned. One humorous side was the observation
of the local newspaper, Il Messaggero in Rome,
The Messenger, and it said this is -- thinking
of compliance with these very strict orders,
it said this is the first time in three millennia
that the people of Rome have ever been obedient.
[Laughter] In any case, I have a sense then,
even from my brief outings, that there is
a real seriousness of purpose, and that is
encouraging and I think corresponds to the
fact that the Italian epidemic -- it looks
as though -- let us keep our fingers crossed
-- the state is beginning to get a handle
on it and the numbers are beginning -- the
incidence seems to be slowing down, which
is very, very happy thought.
>> I spoke to Mauricio Ciccone, who I interviewed
a live stream from Lombardi about three weeks
ago, and I think he --
>> I saw that.
>> Yeah. He, with a few other people, single-handedly
made the United States pay attention and stay
away, because it was this really impassioned
conversation from someone who's world-renowned
and respected saying you have no idea what's
coming, and I think it really made people
in the United States, intensivists really
understand that whatever they thought was
coming they were ill-prepared for, and I've
listed him on my short list of heroes. But
I spoke to him this morning, and he actually
indicated that he thought, at least in Lombardia,
there was greater capacity to deal with the
events on a day-to-day basis than there had
been in the past.
>> Precisely. The hospitals are not overwhelmed
in the way that they were even a week ago,
and this I think is really good news and much
to be celebrated.
>> So you write the book, you publish it in
the fall, and now you're living through a
pandemic. It's an extraordinary circumstance,
convenience of events. What has struck you
about this pandemic vis-à-vis what you've
written about in the book?
>> I suppose this pandemic is more like the
Spanish influenza than any other event that
I can think of this kind, and one is struck
by the ease with which it has spread through
the world, in part because of many circumstances
-- the kind of world we've built -- but also,
I'm very struck by the lack of preparedness.
It seems as though the world was totally unprepared
for this in ways that are difficult to comprehend
since ever since 1997, with the avian flu
outbreak, there has been a surge of epidemiologists
and virologists saying that another pandemic
challenge is an inevitable part of our future.
And one can see this in 2005 and '06, just
after SARS, that the US Congress passes and
establishes a national pandemic preparedness
plan, and the World Health Organization does
the same, the 50 states do that, and then
there are also preparedness plans by major
companies, and yet -- I guess it's human nature
-- soon afterwards, there's a feast and famine
element, and these plans were sort of put
away, even though Anthony Fauci in 2005 said
to the US Congress that if you're living in
the Caribbean, you would expect -- a meteorologist
could tell you that the coming of a hurricane
was inevitable. They couldn't tell you when
and how powerful it would be, but it was inevitable,
and virologists now can tell you that another
-- this is 2005 -- epidemic was coming, and
it was inevitable. You didn't know how powerful
or when it would strike, but it was inevitable,
and that seems a very dire situation that
people or governments all around the world
should have taken very seriously, and yet
there seemed not to be when ebola struck out
-- struck the world once again, the world
wasn't ready -- taken by surprise -- and just
afterwards, in 2018, as you know, the World
Health Organization appointed a commission
to look at global preparedness and appointed
the former Prime Minister of Norway to lead
this investigation, and they produced a very
report under the title, in 2019, "A World
At Risk," and so it is amazing to see, and
this is not -- I'm not pointing a finger at
any one country. It seems to be pretty -- a
global circumstance. As we know, in the United
States, health system budgets were slashed,
and in Italy as well. Just because I'm here,
I say that, and it's an important set case
at the moment that the budgets were slashed.
There was no movement to build surge capacity
within the hospital system. And so I suppose
this lack of taking science seriously is what
disturbs me most about the onset of this,
because it seems to me that around the world,
there is a great deal of skepticism about
science, that in this country -- Italy, that
is to say -- the Five Star movement has, really,
contempt for science. We can see -- and this
isn't a partisan matter, because under President
Bush, there was a lot of preparedness efforts
to deal with diseases, and that seems to be
different under the present administration,
which is not -- is -- when the World Health
Organization said this is something that should
be called COVID-19, there were so many who
said, well, no, we're not going to call it
that. We're going to call it the Chinese virus
or the Wuhan virus, and not -- in addition
to being stigmatizing, it's also saying to
the scientists of the world we're not really
going to take your concern seriously. It's
rather like climate science, and we're going
to contest that as well. So this is something
that deeply worries me, and it seems to me
that this confirms Bruce Aylward's comment
when he was asked when he came back up from
his mission for the WHO to China a few weeks
ago, and we said, "What do we really need
to do to prepare?" and he said the first thing
we need to do or nothing else will work is
to change our hearts and minds, that is, a
new mindset is necessary.
>> Right. Just to remind people, Bruce leads
the WHO international efforts around many
different issues, and particularly focused
now on coronavirus pandemic. Just one comment
on something you said. I think people have
come to know and -- know the wisdom of Tony
Fauci. He's done many live streams with us.
He wrote our first viewpoint on the subject.
He called me up and said, Howard, I think
I should write something about this. I think
this is going to be a struggle for the US
and the world, and he was prescient in that
comment.
>> Okay.
>> I want to go back to something that comes
up all of the time, and I think you are probably
as knowledgeable about this as anyone else.
Could you talk a little bit for a few minutes
about the Spanish flu? People talk about it
all the time or allude to it but don't really
then fill in the blanks. Could you give us
a kind of history lesson, a short history
lesson, about the Spanish flu?
>> Well, I'll do my best. The Spanish influenza
-- there's still debate about where and how
it started. The three candidates really are
that it came from China or that it started
in Kansas or that it started in France at
the British military and hospital base at
Étaples, and so those are three different
candidates. What they have in common is something
that's terribly part of the world we're living
in now: that it had in part to do with our
relationship with the animal world and zoonoses
-- that is, animal diseases spilling over
to human beings -- and all three of those
putative origins envisage precisely that happening,
which reflects new relationships. As we become
such a numerous and economically powerful
species, our relationships with animal habitat
and with wild animals have taken on different
forms, and many more contacts are taking place.
So that's something that really needs to be
considered -- our relationship with wildlife
now -- because Ebola started that way, and
the coronavirus also started that way. So
that's a major issue now. And then it was
spread quickly. From Étaples, it spread like
wildfire with the British soldiers perhaps
being demobilized for health reasons and the
ones who survived their ordeal in France and
in the United States. Of course, the movement
of troops to the Western Front spread the
disease, and it was entirely, of course, a
disease that was completely unknown. I believe
Rupert Blue, the US surgeon general at the
time, said that Florentine doctors understood
the bubonic plague in the 15th century just
as well as physicians understood the Spanish
influenza in 1918. So it came in three waves,
the third being the really extraordinary wave
of 1918, late 1918, November, and then into
the new year, and it's caused a total mortality
-- it's extraordinary to think of, but the
estimates have been going up from -- constantly,
and now most people think it caused a minimum
of 50 million deaths and perhaps as many as
a hundred million, which is to say many times
more than the First World War itself. It's
interesting to see that an important factor
in it, though, was, ironically, not just the
war, but also the peace, because when the
soldiers returned home, they brought the disease
--
>> Yeah. Yeah.
>> -- back with them and spread it like wildfire
in the United States. For example, to take
one example, but as you can imagine, the -- when
soldiers returned, there would be parties
to celebrate and welcome them back there,
and there would be parades, and those spread
the disease. There was a terrible parade in
Philadelphia where hundreds of thousands of
people began to be ill very soon afterwards.
Some of the -- other places in major cities
took a lot of measures that look like today
-- the masking, social distancing, the making
sure that major events where people congregate
were canceled. Church services no longer took
place. Those sorts of things were very important
parts. The way of fighting it was not a million
miles away from the way -- the conception
of how deal with the coronavirus. So that's
interesting. One of the other striking features
of it, though, is that it was largely -- it's
even -- there's a famous book called the -- America's
Forgotten Pandemic, which is to say how in
the world could it be that a disease that
caused perhaps 100 million deaths would not
have lasting long-term memory seared into
our institutions and to our economy and so
forth, and yet it was quickly forgotten, partly
because it was overshadowed by the war and
peacemaking afterwards, partly because it
didn't besiege communities in the way that,
say, bubonic plague does or coronavirus, also,
but was something that swept through, left
devastation in its trail, but in just a few
weeks was gone. And it's striking that if
you look at Britain, there is exactly -- there
are so many monuments to remember the First
World War and the bravery of the soldiers.
There's exactly one monument to remember the
heroes of the Spanish influenza, the doctors
and nurses who put their lives on the line
to care for patients and colleagues in this
epidemic. It was something we see today -- that
there is a horrendous mortality --
>> Yeah.
>> -- among caregivers was a prominent feature,
and I'm hoping this one -- people ask me,
well, what would my sense of what might happen
in this coronavirus, and I say, well, one
thing I do hope -- in the arts that at least
we will memorialize and remember the people
in the coronavirus who are the real heroes
of the epidemic -- doctors, nurses, orderlies,
and also, I would add a group people don't
think of so much, but the shopkeepers and
attendants who are keeping us going and alive
during this epidemic. Dealing with the public
is not a safe position to be in at this time.
>> Now when I -- I was listening to NPR on
the way in, and they were talking about grocery
deliveries, which have largely been maintained
in the United States, and every time I go
shopping, which is in the mornings, because
I qualify for the senior time period, --
>> Yes.
>> -- I thank people for working.
>> Yeah.
>> I mean, you know, we don't have the capacity
to deliver food to 300 million people in the
United States. People are going out shopping,
and those supply lines, even though people
have run out of some numbers of items, has
not been that prominent. People largely have
been able to get what they need. Now you did
talk -- you talk about some of the elements
from 1918 that we use today: social distancing,
you know, some forms of quarantine. You know,
it's so painful in the United States because
of the dramatic delay in testing that we really
used -- needed to use 100-year -- essentially
100-year-old approaches because we couldn't
identify who was sick and who wasn't with
the coronavirus. But the other thing you mentioned,
and you touched on it and then moved on, but
I want to go back to it, because it's an issue
that's emerging now in the United States:
this notion of waves. You talked about it.
>> Yeah.
>> So even though it's the Spanish flu of
1918, it didn't end in 1918. Could you talk
a little more about this -- these waves?
>> Yes. The -- what seems to have happened
is that the early waves in 1918, the first
in the spring, was rather by comparison benign
and seems not to have been a major, major
cause of mortality, but the speculation now
seems pretty clear that it probably -- that
the virus mutated between the spring and the
autumn, and then it was this autumn catastrophe
of November that coincided largely with the
end of the war that was the cataclysm that
-- and it's -- a feature of it that's pronounced
is the curve of the mortality. That is to
say that it seemed a very unnatural event
because it didn't affect the very young and
it didn't effect --
>> Right.
>> -- the very -- the elderly in the population,
but there was this great W-shaped curve, nodding
U, that spiked in the middle with young people
and the soldiers, of course, but not only
soldiers, but young people in the prime of
life, the bread earners of families, and 600,000
and more Americans died in the war, but the
Spanish influenza killed many more Americans
than the war did, just as most other countries
experienced exactly the same. So this was
extraordinary mortality and morbidity, and
yet there is the sense that somehow it didn't
affect the world in the way that this coronavirus
seems to be having a more lasting effect,
despite -- we don't know what its mortality
and morbidity will be. I shudder to think,
but clearly it's going to have major, major
long-term effects on our economic relationships,
on the economy, on the relationship between
the industrialized country and emerging markets
and international supply links. All sorts
of things are going to be influenced by this
coronavirus. Political outcomes of major proportions
will probably also be in the offing. And so
it's interesting to start to think about why
some of these pandemics have left a huge footprint
and others seem not to, and it's not simply
a matter of counting the dead or the people
who have been afflicted, because even Asiatic
cholera, which had a small mortality, was
the most feared disease pandemic of the 19th
century, and it left a huge impact on the
sanitary movement. Our sewers, our [inaudible],
our drink -- safe drinking water, housing
regulations, paved roads, all kinds of -- the
germ theory of disease all partly emerged
out of this major cataclysm that was much
smaller than the Spanish influenza. And so
it's interesting to try to tease out why that
these pandemics are not just interchangeable
causes of death, but each one is experienced
by society in a very different way that needs
to be looked at on its own.
>> Well, I'm hoping, obviously, and we'll
come back to this that the legacy of this
pandemic is preparedness, but --
>> That's what I'm hoping.
>> -- that is perhaps the best of what could
come out of this, because we will face it
again, and if it's not in my lifetime or your
lifetime, it will be in our children's lifetime.
It is --
[ Inaudible Speaker ]
-- inevitable, just as a hurricane was. I
was struck by your comment, and this came
up in my live stream with Nicholas Christakis,
about who died in the Spanish flu versus now.
We really know that largely children under
20 are being spared, which is not typical
for flu at all in the US.
>> Right.
>> That doesn't mean there won't be some deaths
in that age range, but they are largely being
not only spared, they are generally been quite
healthy, and then obviously older individuals
with comorbid conditions have, in every data
set, emerged as those at the highest risk,
with very high case fatality rates for people
who need hospital care, and it's the one point
I want to make repeatedly. We don't have good
denominator data. We don't know the true case
fatality rate. The case fatality rates that
are being produced are really case fatality
rates of people who seek care. They're not
people -- not everyone who is infected. We
simply don't have denominator data.
>> Exactly.
>> And so I think we should be careful in
-- when we talk about 10% case fatality rate,
what it truly means.
>> Yes.
>> But you commented on Spanish flu that it
was this middle-age group. It wasn't the very
young or the very old. Are the data good enough
to know that that was really the group that
were affected, and were there not enough old
people then to know if it would have impacted
old people?
>> Well, it seems that the data under -- under
that, there's a consensus on that, and there
are fairly robust data, so I think we can
take that as pretty much an established truth
about this pandemic, and then the -- I suppose
the immediate question was, "How could this
be?" and it seems as though there are a number
of the strongest immune systems, a sort of
autoimmune reaction that led to a cytokine
storm.
>> Yeah.
>> And therefore are their lungs fill with
blood and they drown to death on their -- and
suffocate is the way that young people in
the prime of life often experienced this horrible
disease, and the discussions of autopsy are
extraordinary into what the findings were
in people's -- young people's lung, which
is consistent with that. There's also probably,
of course, the good epidemiological reasons
and that it was the young people who were
brought together on transport ships and in
military camps and at the Étaples, so the
war is part of the reason that it affected
young people so much. There may also be an
immunological fact that perhaps there was
a crossover immunity that older people had
experienced. There was a terrible calamity
in the 1890s, and perhaps the older people
who had lived through that had a crossover
immunity that the -- and the younger people
simply didn't have that protection. That,
I think, is another factor.
>> Frank, there's a really interesting question,
and it hasn't come up in any of my discussions
across my desk despite many -- reading many,
many submissions. Are there lessons from other
epidemics? Not the Spanish flu epidemic, but
are there lessons from other epidemics, or
is that the first modern epidemic where we
have better data historically or where people
see -- saw it as there were some modern approaches
that we understood, but are there lessons
from other epidemics that may inform what
we should do now?
>> I think absolutely there are. One, the
psyche of human beings, which is stigmatization
and the way that drives epidemics forward,
and one can see this from the time of the
Black Death was a time of extraordinary violence
when, for example, there were anti-Semitic
pogroms at Strasbourg. The -- there was a
population of 12,000 Jews. They were all rounded
up and taken to the Jewish cemetery and offered
the option of either conversion or being killed
on the spot. Half of them refused conversion,
and they were burned alive in the Jewish cemetery.
The flagellant movement -- these people who
went on these processions, whipping themselves
-- but they also directed their feelings outward,
and they also turned on other people, and
there was a great deal of violence that followed
in the wake of that movement. You can read
in some of the literature -- the first Italian
novel by Alessandro Manzoni, called The Betrothed,
shows in the city of Milan in 1630, when Milan
was at war with Spain, that Spaniards were
found who were totally innocent -- they weren't
soldiers. They weren't spies. They just happened
to be in the wrong place at the wrong time.
They were rounded, up tortured, and they confessed
under torture. Then their bodies were broken
on the wheel and they were burned alive because
they were accused of spreading this disease
by poison and poisoning the wells and so on.
So one sees this. One also -- it's part clearly
of, coming more close to our own times, HIV/AIDS,
where there was a great deal of blame casting
at the homosexual population, and in between,
Asiatic cholera created lots of waves of xenophobia.
You can see, for example, cartoons and journals
of the period of immigrants arriving with
on the bowsprit of a ship -- with death there
on the bowsprit and soldiers and vigilantes
coming to the beaches to turn away immigrants
from the United States. There is then this
-- tuberculosis had not as much of that, but
it was the case that people began, particularly,
paradoxically -- when people understood more,
there was -- with the germ theory of disease,
when it was determined that tuberculosis wasn't
a hereditary disease, as it had been thought
before, but was something that was a germ,
a disease, as they thought at the time, of
filth, and the working classes were -- held
that. Then there was a lot of social tension
on a class basis. Also, in a place like New
York, on an ethnic basis, because it was the
immigrant groups, the ethnic groups that were
more likely to be dangerous in that respect.
So there was stigma and not, and now I'm afraid
with the coronavirus, we don't really seem
to have learned that lesson, and it seems
strange, in that it's also simply a matter
of thinking logically, as the World Health
Organization has been, about stigma -- that
stigma simply isn't prudent, because what
happens then is that the people with the disease
don't come forward, don't see physicians,
and therefore it's a major driver of the disease.
That was seen definitely through the course
of the HIV/AIDS epidemic in the United States.
The stigma actually made the disease much
worse. So it's counterproductive in that sort
of way, and it's ethically reprehensible,
but nonetheless, we see once again this stigma
against Asian people, as if there was something
in someone -- in an Asian person's DNA that
made them terribly dangerous, and so Chinatowns
around the world emptied out, and in the United
States, which is particularly -- one doesn't
like to stir this demon, because we have such
a history in our own country of the Chinese
Exclusion Act, and during the Second World
War, the internment camps for Japanese-Americans.
You'd think that we would be, in a sense,
inoculated against that particular form of
ethnic prejudice, but we don't seem to be,
and there are these awful stories of assaults
on even Chinese schoolchildren in the United
States. And this isn't true only, of course,
in the United States. The -- one finds in
Italy, where I am at the moment, that there
are sort of right-wing populist groups that
-- the same sorts of people in Italy who in
Britain might have been Brexiteers and in
Italy have a different sort of political orientation,
but they have said that -- this is a point
without any evidence at all -- that this was
a disease of immigration, and we must close
borders and we must hunt for the case -- the
index case of this disease, and that person
will be guilty, and we can blame them, and
clearly it was an immigrant and Le Pen's -- is
making that same sort of -- there's upsurge
of a sort of violent nationalism and xenophobia
and nativism in lots of respect. So that's
a very worrying trend and one that -- as Dr.
Tedros, the director-general of the World
Health Organization has been saying, there's
this horrible misinformation epidemic that
accompanying this pandemic, and the information
epidemic is driving the biological pandemic
forward, and therefore it's really dangerous,
and one must be extremely careful not -- to
not accept the statements that it's a Chinese
virus or that it's due to immigrants in Italy
or the same in France and so on. So I think
that's another lesson of this, and hopefully
when you're having your good hope that after
this is over that preparedness would be -- go
into effect, a sustained preparedness -- I
would add that -- no longer the feast and
famine, but something that was sustained part
of our lives, that this -- part of that would
be the -- an intense campaign of education
to teach the perils of bigotry on ethnic lines
and scapegoating was -- when in fact, in times
of disease, patients from -- that -- who contract
contagious diseases are guilty of nothing
more than being at the wrong place at the
wrong time. So I'm hoping that that will be
something that people really understand in
our country and around the world. So that
would be -- changing our hearts and minds
in that respect, too, would be a wonderful
thing to have happen.
>> Yeah. I do think preparedness has worked.
I'm always hesitant to think of Taiwan and
Singapore as the best examples. They're very
small countries. But Korea is a much larger
country and generally has done quite well.
They had learned quite a bit from SARS and,
you know, they were up with very aggressive
testing, case-finding, tracking, and quarantine
very, very quickly -- something the US tragically,
tragically was not able to do.
>> Yeah.
>> Many other countries weren't able to do
it, but that --
>> Italy is one of them, too.
>> That was -- without doubt, the great tragedy
is the waste of six, eight, or ten weeks because
of just an extraordinary number of failures
in the US.
[ Inaudible Speaker ]
The last question, Frank. It's become much
more of a topic. Much discussed in the US
is the wearing of masks. You know, JAMA had
published an article -- I looked at it early
this morning -- six weeks ago that there was
asymptomatic spread, so I'm surprised that
a number of leading societies and authorities
are saying, "Well, there's asymptomatic spread.
Maybe we should be more conscious about wearing
masks in public." Certainly many health systems
are now asking all employees to wear masks.
Not every health system, but many. Obviously
we need more masks for this to be the case,
although there's many homegrown versions.
What's going on with wearing masks for the
public in Italy?
>> Right. Initially, the word that was put
out was that it was kind of a service to the
health care community not to wear masks because
there simply weren't enough. The supply was
so restricted that it should be -- they should
be reserved for those who need them most was
what we were told initially, and so I for
one didn't buy a mask for that very reason,
and then soon after, the advice changed, and
--
>> Oh, it did change.
>> But initially, it was that, but people
didn't seem -- they weren't compliant with
this, because you could see that there weren't
-- when finally the idea was that you should
buy them, there weren't any masks to be had.
There was not a run on toilet paper here.
There was a run on masks and gloves, and I
went to the pharmacist and asked for gloves
and masks, and they laughed at me. You know,
you won't find one anywhere in Rome. Well,
that didn't turn out to be true in the end
-- you'll be glad to know I have both masks
and gloves now -- but that did take a couple
of weeks to happen.
>> And are more people wearing masks in public
than in the past?
>> Oh, oh, absolutely.
>> They are.
>> There's -- when you go out on the streets,
I would say, at least in the neighborhood
where I live, 80% of the people and more are
wearing masks, and people grumble a little
bit if you're in the line at the supermarket
and you're not --
>> Yeah.
>> -- wearing --
>> This is Howard Bauchner, editor-in-chief
of JAMA. What a pleasure to talk with Frank
Snowden, the Andrew Downey Orrick professor
emeritus of history and history of medicine
at Yale. We've been talking both about his
book, his experience, his current time in
Italy. This has been Conversations with Dr.
Bauchner. I want to remind our listeners on
Monday, there will be a live stream with Preeti
Milani. We'll go through her update article
that will be published either tomorrow or
on Monday. It will be all clinical -- less
history, all clinical current events. But
Frank, I really want to thank you for joining
me today, and I really want to make sure you
stay healthy.
>> Thank you so much, and you do the same,
and it's been a great pleasure.
>> And I look forward to your book on coronavirus
epidemic/pandemic.
>> Oh, well, thank you very much. I do, too.
[Laughter]
>> All right-y. Bye-bye, everybody.
>> Yeah.
>> Thanks, Frank.
>> Goodbye.
