Ron Klain served as the chief of staff to vice presidents Al Gore and Joe Biden. In 2014, President Barack Obama tapped him to lead the administration’s response to the Ebola outbreak in West Africa. He successfully oversaw a hellishly complex effort preparing domestically for an outbreak and surging health resources onto another continent to contain the disease.

But Klain is quick to say that the coronavirus is a harder challenge even than Ebola. The economy is in free fall. Entire cities have been told to shelter in place. And there’s no telling how long any of this will last. In this conversation on The Ezra Klein Show, Klain answers my questions about the disease and how to respond to it, as well as questions many of you submitted.

We discuss how to change the virus’s reproduction and fatality rates, the economic policy necessary to make social distancing possible, what the Trump administration needed to do earlier (and what they still can do now), the strengths and weaknesses of America’s particular health care system in responding to a pandemic like this one, what Joe Biden is like in a crisis, and much more.

I’ve been covering the coronavirus nonstop, and this is one of the clearest, most useful conversations I’ve had. If you’re feeling overwhelmed, the clarity of Klain’s analysis will help.

Here’s are excerpts from our conversation. You can listen to the whole discussion on The Ezra Klein Show.

Ezra Klein

So I want to start by saying we are talking on Tuesday, March 17. At this point in time, where are we compared to where we need to be to get the coronavirus under control?

Ron Klain

We’re in very bad shape, and we’re going to start to see the consequences of that in the next few days. Until this point in time, we’ve had a lot of people saying, “It’s coming.” And I think we are now very near the point where “it’s here.”

I think the place where we’re gonna see this most immediately is in our hospitals and our medical facilities. We’re already hearing reports of doctors and nurses starting to get sick in larger numbers from treating patients. That means capacity will go down as patient loads go up. We’re hearing from major hospitals that they’re starting to fill up. Their emergency rooms are starting to fill up their ICUs. That’s only going to continue to get worse here in the next few days. And this conflation of an increase in patients and a lowering of capacity is where I think this will really hit kind of an inflection point.

That comes on top of two other problems that we’re behind on. The first is the testing problem, which has been covered a lot. And then the equipment problem. There are already reports of hospitals out of masks and personal protective gear. This equipment crush is going to be the other thing that starts to get a lot of attention here in the next few days.

Ezra Klein

I think the natural way to think about coronavirus is to think forward from how many people get the virus. But my sense in talking to epidemiologists is they’re actually working backward from health system capacity. The question is not how many people get the virus, but how many people get it compared to how many we can treat at any given moment. This is the idea behind “flatten the curve”: If the same number of people get the virus, but it is spread out over a much longer period of time, you don’t overwhelm the health care system and case fatality rate goes way down. Can you talk about that health system capacity dimension?

Ron Klain

If you think about health care economics, it makes no sense to build hospitals or intensive care units and have them just sitting empty all the time. So we run a hospital system that’s very much at capacity. Therefore, it doesn’t take a whole lot of extra demand to overwhelm that system. When there’s a horrible car crash of 50, 60 people, hospitals can get overwhelmed.

So something like this where you’re literally having thousands of extra patients in a city showing up in emergency rooms is going to overwhelm the system very quickly. And again, it comes at a time when the capacity of systems drops. Epidemics hit health care workers first and hardest. They get exposed, they get sick, and we have put them in quarantine so they don’t infect others. So we’re in this ironic place where the number of available health care workers we have is dropping just as the need rises.

And then the big thing, obviously, is how many hospital beds do we have? How many ICU beds do we have? How many ventilators do we have? These things are very, very hard to flex up quickly and effectively. And they really are the reasons why all the graphs on the internet of flattening the curve are so important. That’s what’s driving this whole thing.

Ezra Klein

I think there are two numbers that people have begun to hear about with the virus: reproduction rate (R0) and the case fatality rate (CFR). Currently, the reproduction rate has been something like 2.5 [each infected person transmits the disease to 2.5 people on average]. The case fatality rate has been about 1 percentage point [around 1 percent of those who are infected end up dying as a result]. These numbers come off as scientific properties of the disease, but they relate to social behavior. Can you talk a bit about how these numbers can vary?

Ron Klain

Let’s focus for a second on the case fatality rate. CFR is the classic story of averaging the height of, like, your 6-year-old and Kareem Abdul-Jabbar [the former NBA star who stands at 7-foot-2]. The numerical average there is not really telling of the average height in the room. What we’re seeing with this virus is that very few people under 40 have perished from it, even relatively few people under 50 have perished from it. But when you get the upper end of the spectrum — people who are 65, 70, 80, and with a couple of complicated health conditions — it’s extremely high. For them, the CFR is something like 20 percent. So when we say it’s 1 percent overall, we’re averaging a lot of zeros with a few 20s.

So it’s not like we’re all walking around with a random 1 percent chance of getting struck by lightning bolt here. We know that there are a bunch of people who, if they get it, will die in a very high percentage — 20 percent is very high. That gives us a lot of focus on who we need to do the most to protect: seniors. And it’s also a reminder to those of us who are younger and healthier that the risk here is not so much ourselves, but that we become carriers and agents of the virus. That understanding helps create a social mindset about how to approach behaviors like social distancing and self-quarantining.

The same applies to this question of R0. The rate of spread of the [virus] obviously depends on how many people we have contact with. And we can bring that number down significantly by all the different kinds of social mitigation measures that have been discussed. So I think these things are descriptors that tell us what’s happening, but we can change them.

Ezra Klein

There’s been a rhetoric around social distancing which is all about moral shaming. I saw tweets going around saying that all you have to do is stay at home and watch Netflix. So how hard is it really to be a hero? But for a lot of people, they’re going to lose wages. They’re going to lose jobs. This will change the course of their lives in traumatic ways. So we need to be able to sacrifice for each other — not just for the people who may get sick because they’re vulnerable, but also for the people might be really hurt by social distancing.

Ron Klain

It’s important to remember that for every person who is working at home, there are 10 or 20 people who make it possible for you to work at home by not working at home. The people who are running the electrical power plant and the water plant and the wifi and the cable and the heat, and the people who are staffing the grocery stores and the drugstores and the gas stations. We’re in a situation where for some of us to be safe, others of us are going to go out and continue to do their jobs.

And those people are not just the obvious people — the doctors and the nurses who we should pin medals on when this is all over. It’s the people who are creating the electricity that allow me to speak into this microphone and you to record it. Those people we don’t often think of as heroes in our society, but they are all out there doing their jobs and taking some risk on that.

Because those people have to do what they have to do, those of us who can do our jobs from home really need to socially isolate. Even if we’re contributing only a little bit to the spread of this, we’re really adding needlessly to a spread when other people really have no choice but to put themselves at risk. We need to think about this as a social project, as something we’re doing for each other.

Ezra Klein

I want to talk a little bit about that last point. The thing I hear more often and see more often is a sense that “I’m young and healthy and I only see people who are young and healthy, so I’m not much of a contagion risk.”

Adam Kucharski, the mathematical epidemiologist, has a very simple calculation on this point. He calculates that if each Covid-19 case leads to 2.5 more infections over five days, then a single case leads to 244 more cases over the course of a month. But if social distancing measures cut that number in half to 1.25 new infections for every case, that’s only four new cases over the course of a month.

This kind of exponential math is really unintuitive. This isn’t about you or even the people directly around you. It is also about the chain you start. If you infect somebody and they have connections, you kick off in that chain that could be very deadly. It’s hard to imagine because in our normal life it doesn’t feel like our actions reverberate that far. But the math of contagion is very different than the math of our normal sociality.

Ron Klain

No question about it. We saw this with Ebola in West Africa when I was the Ebola response coordinator. You’d find hundreds of people dead in a particular community, and when you’d trace where these horrible chains of transmissions came from, it would always come back some person on a scooter who came into contact with some person in this completely other community and passed on them who passed on to someone else and so on.

One of the complicating thing here is this disease has a relatively long incubation period compared to others. So the effects we’re seeing today, we’re seeing today are from people who were exposed 14 days ago. So just stop right now when you’re listening to this and think, what was I doing 14 days ago? That interaction you had 14 days ago is spreading the disease right now, right here. And what you’re doing now is going to affect disease where it is 14 days from now.

One challenge about these social behaviors is we’re asking people to make radical changes and we’re nearly not going to see the results of those changes for two weeks. I think that disconnect is going to make implementing all this a little bit harder.

Ezra Klein

One of the things that I think makes social distancing quite difficult is we do not have a country marked by a high level of social solidarity in our social policy. We are the only industrialized nation not to have guaranteed paid sick leave. The only industrialized nation that does not have guaranteed universal health care. This list goes on and on. So when we ask people to social distance or we mandate that they shelter in place, we are asking them to make very big economic sacrifices.

When it comes to this outbreak, solidarity doesn’t just go from the healthy to the sick. It also goes from the rich to the poor. Social distancing isn’t gonna just be a week or two weeks — it could be a year or 18 months. So we’re going to have to enter a sort of wartime economy approach where we make these public health measures economically possible for people. And that requires a very radical thinking of what we owe each other economically.

Ron Klain

I think that’s right. To date, a lot of the focus, understandably, has been on the very short term: Everyone has to go home for work from two weeks, Congress will provide a payroll tax credit for employers who are paying the leave, and so on. But these actions are treating this like it is an extended snowstorm — like after three weeks it’ll all be over and life will go back to normal. That seems very unlikely.

No matter how successful these social mitigation measures are, this is going to be with us for in the medium term — for at least six to eight weeks. And then we’re going to face relapses. I think the challenge is that the virus is more patient than people are. So the pressure to let these measures up will be intense. And every time we do, we’ll see a reintroduction of the virus and then we’ll be back at it again.

This is going to have a persistent drag on the economy for a while. And, as you say, our economy is not well-suited to be shut down for long periods of time. Where it’s hitting first is individuals and families who have to pay their mortgage and pay their rent and pay their bills — that needs to be addressed now. But we’re also going gonna need something much more comprehensive and much more long term. I think this is going to be with us for a while.

You can listen to the full episode by subscribing to The Ezra Klein Show on Apple Podcasts, Spotify, Stitcher, or wherever you get your podcasts.