The Kaiser Foundation's Josh Michaud explains what the US is — and should be — doing to fight coronavirus.
Josh Michaud, (@joshmich) Associate Director, Global Health Policy, The Kaiser Foundation
Matthew Yglesias (@mattyglesias), Senior correspondent, Vox
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hello. Welcome to another episode of the weeds on the box media podcast network, I'm Matthew, Glacius in my guest today, Josh MACHO is the associate director of global health policy at the Kaiser Family Foundation. He is knowledgeable about many things, global and health related. But specifically, we wanted to talk today about corona Virus and the Covid nineteen disease that it causes, because I don't know it's a lot of our minds this week. I said. Thank you so much yeah. It's a pleasure to be here thanks. So I want to
to start not quite in that at the beginning of the story, but sort of in that, in the middle and in January I remember I was on vacation
was aware that there was a big infectious disease outbreak problem in China.
And I know it was a big deal. I mean I wasn't like downplaying it, but it was a problem that was in China and the United States was doing some stuff restrictions on travel of foreign nationals. Who'd been there to try to stop it from coming here.
And then I guess it worked for a while that there was a period of time and it went on for it for awhile, to the extent that I sort of kind of tuning out dislike chinese corner virus stories and then stop work and went liquid.
What happened there yeah well, what you're seeing is. I think
the world and with the U S case as well, is that countries are trying to catch up to where the virus is, and we saw this initially from the start,
with the chinese cases, because they didn't realize something serious was happening until it had already become a major epidemic
and then what you saw was
bull from that original epidemic, starting to cede epidemics elsewhere and the travel restrictions that were put in place, at least at the. U S were a little.
Behind the ball. Actually, there's people had already arrived by the time, those written in place and then, as the epidemic expanded, you had additional people come from additional locations that weren't covered by these bans, seeding likely transmission chains in the U S,
elsewhere. So that means we're just behind the ball at all times. It seems with this with this epidemic and there's a time delay. So you
had this massive epidemic in China, which garnered rightfully a lot of attention. But it's me
that had been smouldering there from for a while, and the worry is in the concern is that these seeds
and other other countries means that just just a matter
time before we see widespread transmission wherever there are there change now it takes a while to build up. So you know it's not something that happens all at once. It takes a while to build up. You have that sort of explanation.
Dual growth over time, and you start off with a few cases. Then, all of a sudden you ve got dozens to hundreds of cases, and we see that a story read me. I repeat itself over multiple countries now, Anne and part of the problem. Here I mean it's good that in many cases the illnesses mile right, that's that's better yet and if everybody was seriously sake, but it's also its.
Unlike in a disaster movie where everybody is, is dying and one consequence of that is that it's hard to actually know whose say grade cause. It's not it's like super unusual for a person to have
cough or a fever. No, absolutely not, and what you see at first in any epidemic like there's some something new is that you will, you will see the most
severe cases first and those were the ones that were caught in China, people had serious pneumonia people had respiratory failure, people who are dying,
from this disease and then,
you start to realize that's just the tip of the iceberg that there's a lot of other people out there who have a milder version of this illness and then it's difficult
especially when you're in a situation when you have an overwhelming number of serious cases to find out the extent of the rest of that iceberg and the rest of the world has learned from
experience that China's gone through realising that, yes, we have this virus, which causes mostly in eighty percent of cases, are or that mild to moderate variety.
And we need to be looking for those. But up until now.
And especially in the United States. We haven't been looking for those we ve had such a restricted, a protocol
for how we screen for this and look for cases here in the United States that
coming now to realise it with mists quite a number of cases because of that waited so something that
I keep seeing here I mean I know, a lot of people are just not great with statistics. It seems to go against human kind of intuition in a lot of ways, and I felt like I saw the president on television several times expressing that where he would be saying well, this is like the flu and I actually get what he means is just that the typical Covent nineteen
case and the typical flew case are pretty similar like. If you look at them, the median expected outcome you get sick, but not that say right, you don't I stay home for a couple days, leave feel better. So that is the same. But then there is a difference in the distribution of the outcomes that makes us a much more serious
kind of problem. That's right, so symptom wise, there's a lot of overlap. Sure, and in fact, when we're survey
For this, and you don't have a test you looking for influenza like illness, that's the term right.
So you know what I'm fever cough and perhaps some him some long issues, and that's a good starting point for thinking about this and its true, like you said that there
Presentation in here and influence is also mostly mile about where this new virus separates itself from
influenza is that this is brand new
and that nobody in the human race has pre existing immunity to this virus, which is different from info
and we don't know how that will play out over time. So you know
have seasonal influenza, which circulates every year,
quite a bit of illness and a large number of deaths, in fact, in the United States, this past season we're thinking, maybe fifteen, sixteen thousand death cause. But this is particularly
influenza season. So it's hard to compare
air when we're just learning about this new virus- and it's only
starting out on his trajectory. It may eventually become a circulating respiratory illnesses just like influenza,
is just like we have a number of other carogne viruses which cause human disease which circulating cause common cold. So, as you point out, one of the major concerns is that this might be more serious, are more deadly or cause more severe.
Then seasonal flu. I think we're still learning more about that, but the early index.
Are that there is reason to worry that this is some multiple level higher in terms of serious hospitalization
In death then irregular seasonal flu and that's true, even though most people have mild symptoms. The minutes I hear
You getting your car and you just go drive, but no seatbelt you'll probably be fun. Yes. Yes, it sucks still not a good idea if it can both be a serious problem and not like for the typical person that kind of risk wanting you use beat you there's just that the novelty right that, when it comes to infectious diseases new, is that there are a lot of instances in Cuba
history, when previously isolated populations, get exposed to a new disease and its is much worse than sort of previously weighed- and that's that's essentially what we, but we see here that add that that a virus that nobody gets
how we have and that that can be alarming, even if there's nothing like inherently terrible right. Yes,
And we see this again and again, in fact, even with within influenza, we
pandemic. Strains of influenza, which emerge to which humans don't have
unity or very little immunity and the same situation plays out where it rapidly spreads across the world. Because
There is no existing community, and we last saw this in two thousand and nine, with the h one n one pandemic, which emerged from North America and within you know, just months it had spread across the world.
Same thing we're talking about here. The immune system is set up in such a way that you have defenses against viruses that you've had experience within the past or been exposed to some.
New european system is not least that
is readily available to to fight off with existing antibodies that that presents a problem. So let's thoughts come back to the to the testing right. So we know we were doing these border control measures and China is doing stuff domestically.
Hong Kong. Other surrounding countries are doing things and one thing that I'd heard from a people is well. You know, even if this isn't foolproof, you can buy time. You don't need a foolproof containment to be making a difference, but by time for four weeks
right. I mean this is, would spin so surprising to me about the that. The testing thing is that we knew that this problem was happening and in China there ve been questions about the stock market and it seems like we didn't. It seems, like nothing, really happen:
That interim yeah well, you you would wish that more would have happened, given the time that China has bought with its extreme measures of
quarantining you know and and and restrict
the movements on seven hundred million people there and
DE, as you said, the border measures which are put in place in many locations.
Here in the. U S do have some impact there, not hermetically sealing off any country, as we clearly have learned, but they have
diminished. The number of new cases that arrive in this country are the countries which is you know, a commendable effort
and having that extra time means you
be doing something with it and there has been
I'm stumbles on the? U S! Side! In that respect, as you point you, the testing
issue is a real mystery. Why we would
taken so long in order to scale up testing in this country. I know that there is
technical issues there there was probably some management issues and some coordination issues between the
de I and II and the CDC and and and the broader government in making sure that test worked, and there is restrictive screening protocol in
which meant that the demand wasn't high, but if you didn't have the tests than you couldn't expand the protocol, so you had the sort of back and forth attention between those two two issues but
expanding screening we know now would have been. A very good idea is clearly. We have hidden cases in the United States and, as we now start to expand screening, we're gonna be finding those people
and we had found them earlier, we would might have
able to intervene and transmission chains and prevent further spread. That's the whole point. Speed is of the essence yeah this. This screening
protocol it seemed like a real, isn't. Illegal must get like a conceptual mistake when
but one thing you do in medicine. Sometimes is somebody sick like their seriously say they come to the doktor and you're gonna? Do some tests to see why,
they're sick, so that then you can give them the appropriate treatment, because you know if it's a bacteria and antibiotics
you got to know what's going on on and that's totally totally part of medicine all time
I'm, but what we really want to do with colonel virus is not home in on what's causing the pneumonia and the sickest patient
We want to find people with mild symptoms and stop them from
spreading a very dangerous,
illness around more vulnerable populations, but it seems
had just ruled out testing, be both miles and that's right end
the World Health Organization after it had visited China and saw what happened there.
Lee said that all countries should take note of
happening here and really do what you can to contain this virus as soon as you see it in your country and an essential
part of that is being able to identify who has it, regardless of how severe the disease is and trace all the context of that person to identify it yet other cases. Clearly, some countries have been slow.
To realize this or implement it, and the United States is a prime example of that, so who's done it well. Singapore Singapore has a history of dealing with infected,
These outbreaks, Sars hit Singapore hard and they ve built up a system
where they have a very pro active public health response to outbreaks. Like this, Singapore has a lot of traffic from China. They had an epidemic
make of this particular vires early on and put in
incredible measures rapidly in place, and I dont know if the final count now stands at Singapore, but I think we are under a hundred cases could have a lot worse, so they actually did the work of trying to find every single case and test them. So they wrapped up their testing and surveillance rapidly
then identify people put them into quarantine if they weren't chilling symptoms are dig, might have that later developed the disease and also implemented social
sensing closures at the border when necessary, all at a quick pace and it's really paid off
They? Basically, when I mean I was just a small country-
but they went everywhere right. They didn't.
Say, okay, well,
like this one guy was sick and now we're gonna eat. I won't take take our him, they they went very aggressively room, say
okay, probably there's a bunch of sick people somewhere and we've got to go, find them that's right and in part, because it's a small country, but also
Singapore very there's, some dark side, well, their governance there, but it's very organized. They have their shit together in a lot of ways and they know where everybody is, and they know how to find you and they have good public services and
think that, along with other things, they impose strong restrictions or fines on people who don't follow quarantine orders. There is a massive monetary panel
for someone who was found to not be following
recommended quarantine order. Something like that, but I mean even in small sections, the United States, like we know, there's been a substantial outbreak in the Seattle AIR right, but they are not. I mean that Gingham Singapore Small, but see
was smaller and they are not like.
Running around tat the house testing everybody though there like we know there is an outbreak there, there's some tracing of the cases Billig. We shall really have no idea what's going on and in greater Seattle. No, no! It is a black box right now in its it's kind of frightening thing about, but, as I said, we did their slow too
catch up to where the virus is, and I think now testing will expand in Seattle area as well as other locations and the public
Authorities are doing what they can to track those cases, but you know there's been analyses looking at the genomes of the virus in that region and compare
them to viruses that were, there were found in the West Coast six weeks ago,
The similarities are such that either the the logical
now that we ve had transmission going on there for six weeks, which hasn't been detected,
and so now we're starting to see that tip of the iceberg show up with these deaths.
The numbers of cases being identified increasing rapidly? You had the people, the first response
in Seattle, who went into the nursing home where we ve seen the death theirs it
a dozen or more of them who have been identified as being positive for this. So clearly, there is
mission going on and again we're just behind the ball there it it's hard to catch up at this point right. So let me take up
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but eventually you will see people progress to the point of death and that's part of the problem is there's a delay in terms of the transmission someone gets infected. It takes. It can take five to six days for symptoms to show up and then take can take. You know
two weeks, three weeks until they develop those severe symptoms. So you know
talking about a month, maybe after the actual infection,
that you have the end result either recovery or death, and so when we start seeing deaths, we can trace back and say
it is a lot more going on here than than we had known and
People are not worried about it because of this, not realizing that their. There are some implications for twenty percent of the population
and were only just now, starting to see case numbers rise to the point where we start to see that in large numbers and most of you just eat M doing your head or calculate on your phone like a basic x men for growth exercise rang. If something doubles every week I could quite a few weeks and you still have almost no
that's right- you know very few people, it's not a big deal and then next thing you know you know. You're in real kind of disaster zone
and one issue here I mean I think they definitely on China- is that if a hospital gets too
This is a serious pneumonia like that's fine, their professional, but there's also up like a breaking point.
That right that the healthcare system does not have necessarily like surge capacity- that's right right.
There's a normal expected amount of sick people in a winter.
And you can go a little bit above that and they say- was busy winter, but if you double Ed triple ed than but what are you gonna do like that? They don't have the respirators that none of the equipment- and we were not there-
air at all, but in a ran it seems like they are,
yeah and ITALY to write their in in lombardy or that that area, which is highly affected by this virus, that you know they're having a real hard time finding places to put in seriously ill patient and the same thing.
Might be seen in a lot of other countries, including the United States, and as you said, we,
normally operating at or near capacity in these emergency rooms and- and I see use in places where
you would need a how's seriously ill patients with covered and
there is little wiggle room Tony found, the other thing. Twenty percent of people might need to be hospitalized if they become infected with, and if we have several hundred cases.
Maybe that's manageable. If we start talking about thousands of cases in a particular location, then that quickly becomes difficult to manage
we're, seeing that evidence in IRAN and in and in ITALY and other, please read so it said that the size of the denominator makes a big difference because there's a certain nobody wants to go to the hospital right. But you know, if you have to: u have to if they contribute, they judge well, and that's ok, but if it gets to the point where the hospitals can't treat people who need possible,
Asian you're looking at a different, that's different degree of of problems in the extreme, and what you would have is is it is. It is a war on China situation where they,
became overwhelmed and such to the point that they had to build two entire new massive thousand dead horse
In in order to handle and all of the patients that needed intensive care, intensive care that
no. If we would see that anywhere else, but is an indication that you can click quickly, things in quickly get out of hand right. So what should we do like? We're were behind the curve. Hear me even saying a few times, and I feel like the attitude from the federal government is that they don't want to do anything to drastic, because it would be alarming and economically disruptive, but is that right I mean: should we be ramping up in and doing things that would inconvenience the daily lives of.
Normal people, but possibly slow the spread of illness. Yes, so I think that you're getting different messages from the federal government, so we have one message coming through saying everything
gonna be fine, don't worry about this and it will pass- and you know- but if you listen in part the words of the EAST Sea DC, there actually saying and have said that there could be significant disruptions and they support the use of these disruptive measures it in order to address this. This is how the Democrats
and sort of the smart approach to this would be know what the transmission levels are in any given location at any given time and they're going to be different across different location. So there's no
aid for a national lockdown. There is need for perhaps region, specifically evens NEO counties, specific responses to the knowledge that
this disease is is circulating in a given area. So right now authorities in seattle-
in that area might consider strongly implementing some kind of social, dense, distancing measures, closing schools telling people
work from home and that kind of thing in order to mitigate the impact of this and also hopefully prevent some of the sum of the disease and transmitting at and also give the public health authorities time to do this case. Investigation work,
without getting overwhelmed and also preventing. As we said, the hospitals becoming overwhelm too from patients flattened out that epidemic curve with these measures. But it's not one size fits all. It's gonna be targeted layer depending on the circumstances. In a given location rights or the finding of of the car. I did a piece I stole somebody's graphic from somewhere about the basic idea here. Is that like, if you can just slow it down, even if the same number of people over some infinite time horizon get sick, you can avoid those hospitalization surge stride so that every I mean I guess the basic point of that is that it's good to avoid fatalism. You don't want to say well it's out there there's nothing. We can do so. It doesn't matter and actual makes quite a big difference. Just up the pace.
That events unfold but but tell him what would outlook would look like. You said that social justice, and so say you know, can county decides way like this? This is bad. We ve gotta, we gotta make sure our hospitals gaunt, don't get overwhelmed ab. We need like. We don't have the testing protocols up yet like we got a lot things down lower that look like you said, damn close clothings
Yeah you know our model, for this is: is influenza pandemics and during the last
once a pandemic to them
nine. There was some closing of the schools because
children, known carriers and transmitters of ahead of the of the influenza virus. You know
and here, the the science is still out on us clear that children can get in fact,
maybe at a lower rate than adults and the other thing about children. Is there not seriously affected by the disease, which is good news, but closing
this. Might be a prudent measure when you're thinking about trying to flatten that curve and to draw out that epidemic curve so that you don't have that overburdened system gets cause. They're, like I mean I've, gotta preschooler like a notorious cesspool, it s shot. It's it's really hard to get kids to follow like strict handwashing.
So don't don't touch that kind of Catherine of Gaul talking and sneezing, not covering that kind of stuff. You like we hire best but like kid, kids are grows, so, even so with flew, there's also work with with influenza. There's your concern that the health risks to control Dron are actually quite high, but that's not the case here, but still they could be spreading at around right. It's it's
the vector yeah, and this is a measure that had been taken elsewhere now. Japan is closed, schools and South Korea's close schools and- and now I just heard that
has closed all schools, so
This is something that other places are taking as a,
measure and I think, would be recommended when you're seeing no community transmission is one way to reduce that and then how about like big events spread. That seems, like the other thing, that
that happens. The large groups, like maybe, let's, sir, let's not go to minor. They then have basketball team in Seattle anymore,
but, like concerts I mean I was yesterday. I was at a conference with salespeople, and you know I mean it was good like it was a good event, but like what happens to the conference is you've got a whole bunch of people in a room and everybody's shaking him by his hand, a thing good to see you and it's
It seems not ideal, absolutely yeah, no there's a serious consideration to restricting very large groups from getting together and recent times
do that to you know. The rules are in in France that no long, no more no groups larger than five thousand people can get together in Switzerland. I think it's no
of larger than one thousand people can get together and can't you
we ve seen meetings scientific meetings in that I am aware of, and probably lots of, business meetings and other things being cancelled because of this,
the World Bank just canceled its spring meeting
here in the in the in the Washington DC region,
We don't have the virus here, at least as far as we know, so the the
that is another prudent measure in, and you know it in
Seattle or ever seeing transmission
would be another thing for authorities consider seriously and if so, where, so, let me Cosette to things like one is people can voluntarily cancel events which it seems like we're. Seeing some of you know- and I know everybody our age- our department set out a thing and they were like
you know, let's chill, on international travel for a little bit, but also like in France. The government has like shut things down and no place in the United States is
that currently right, not as far as I know, they're all voluntary measures, as you said, so it's not government
David at this point and the world
around that it's not like the federal government. Only
extremely unusual circumstances, is the federal government gonna be imposing restrictions on people gathering, shire or enforcing federal quarantines?
That is highly unlikely. I would say by right: I mean in the: U S constitutional system, you wouldn't do that, then the CDC doesn't have that
authority, but also normally the federal government does player informal, coordinating role and in all kinds of things right I mean that the government could be recommending that states or cities curb public gathering and they're. Not yes, that that's true, they could be. They ve raised the issue as something which potentially could happen in it.
Accommodations could becoming in the future, but we haven't seen any actual real hard recommendations come down from
federal government to say you know, can county. We think you should be doing this or
place that has over into a dozen cases might think about doing school. Closing
in stopping large events? I think that certainly could
and would be the role for the CDC to play. But everything comes
implementation of the state and local level is that those decision makers that are making an that's such a heterogeneity, Edward and genius, a sort of approach across the different states in local areas that that hard to say what will happen. You know one thing driving this obviously like it would be super annoying tat schools shut down and that nobody wants to have. You know, like movie theatres, closed or whether you know it's, it's a pain in the ass, and so how much you think about that as a preventive measure has something to do with how you see them the risks sort of unfolding- and this is where I to me at least that the message from the top seems very unclear, because during the sort of border
troll era it seemed like we were being told that this was a very serious problem and that's why they were doing all these border controls because it results from possible. Somebody could get off the plane from Thailand and beat SEC ran like coffin. You and then you get so great him in, but but it's fine
So ok we're doing these extraordinary restrictions, presumably because this is a big deal and then once it failed. Now it's like suddenly not a big deal,
and it it leaves me fucking, very puzzled as to what what's going on exactly. I don't know it. You know
There are people in the government taking this European do think it's a big deal, so I would say that the feeling that
not a big deal, is limited to a certain group and that sir, but what kind of group to have that, while the people want to frame this as something that
is not going to seriously affect the economy or not seriously erect people's health here and you may
There's some rationale behind not inducing panic, but that's the tricky thing is to find the right balance in public communication between.
In informing people about the real risks watch you know and what you don't know and then inciting
sort of an overreaction or panic. If you say that something it is true,
four situation, then there can be understandable reasons that people would react and, with its irrational, so
I do think before taking it seriously, and I do feel that a serious problem, but sometimes that message gets mixed with other similar bear down. Remember where we were speaking of is the public health agencies of the? U S, government. I think you don't. Even in the drum era his his people at FDA are pretty well regarded. There's a lot of professionals said at CDC,
it at an age at things like that in any seems like you here, or at least heard until a kind of change and protocol a lot of concern from those quarters, and then you have an economic policy sort of political pointy is who seemed to be really really worried about the stark and trying to not alarm people and that there's at a clash of some kind in terms of what are you trying to say ride like if you, if you want to get people to wash their hands more, you, Sir, got a spook mellow but rent, but if you could try to get people to like not sell their stocks, yet it now
spoke them desert like that's it. You have a president for at some level right it decide what actually important here. Yes in that's the mixed message problem that you face and yeah, I think that's the right diagnosis that you ve made there that you have different incentives across different
decision making groups, and so you do need someone to have a clear message from the top that this is the most important thing and we haven't necessarily seen that, and so do I mean, do you think you know what what's your your view on this?
are normal people, you know decision, makers and state mogul levels. Are they under reacting? Still at this point I mean do: do people need to be a little more on a more afraid, I'm an obviously nobody wants to pat brain, but you know there's like do you take measures that are inconvenient that are annoying, but they can save people's lives like do do we need to be ramping up here?
think we probably do and that we probably are- and I think, there's going to be a marked difference going forward if we start to see more transmission other locations that there will be more of a preparation
and we we were a a bit off guard with the situation in the Seattle region. I think, and the authorities
there have done what they can, but I would like to see other regions that see cases take a more proactive stance. I started to think we're starting to
that we've had cases in the New York
region. Now we ve had cases in Florida and while we're not to the point,
doing social distancing and those locations. There does seem to be your strong push to to address this. With policy that is in a remarkably different from what came in the past, so I'm thinking of Governor Cuomo, saying that he expects people not to worry about.
Costs of being tested for the corona virus or the care involved in it and ordering sort of state entities to cover the cost of those things, which is an important consideration,
Of course, and is marked difference from taking tackling other health issues. Ok, let's put together
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Calm, slash, weeds and joined the over one million people who have taken charge of their mental health with the help of an experienced better help professional. Don't we see this, you know spreading globally are all different kinds of other countries, and I think we have in so far seeing a lot of clear evidence of outbreaks in the developing world, and is that because they don't have that testing infrastructure? Or is it just good news like what? What what do you think this is going on there?
the answer is a little bit of a mystery part of it is the testing and just like the United States, there hasn't been a scale of testing to the extent that we would like to have seen as fast as we would have seen in order to get a good picture of what's happening,
so I'm thinking of a country like Indonesia, which
as a lot of traffic from China, and there was people earlier
making predictions that Indonesia would be a prime location for an outbreak, yet
Only recently did Indonesia even report, its first confirmed cases,
and Indonesia has not taken aggressive measures in terms of testing. So in that particular example, you have,
What I would say is a black box about. What's going on there is there wide Tran transmit?
in Indonesia. Nobody knows because we're not looking or not shine, a light on that and that same scenario could be repeating itself across a lot of different for developing countries,
and the other. The World Health Organization is working with countries, the Gates Foundation and Welcome trust in
the World Bank or providing support to get testing
surveillance capabilities out too,
the developing world, but it takes time and
I think there is more
has been going on in countries that we don't know about. We seen that here
of course, in the U S and slightly happening elsewhere as well, but the Youtube
to a very important consideration. Not
I do not know, what's going on, but the impacts in those countries, because they are
even more limited than we are in terms of their healthcare capacity and the ability to do the contact me.
In all the work that needs to be done in the public health side, the impacts there could be even more significant gaming. That's something I've been I've been thinking about, is you know the sort of speculation and talk and math about while, what's case, vitality, wait the out of this illness? But, of course it somewhat like a pure biological fat
right. People get treatment when they're, sick and the quality and availability of the treatment is itself an important variable. So when you talk about South Korea, you talk about Japan. These are high income. Countries, with with pretty strong strong
social capital, creative and, presumably at a good amount of capacity to take care of people who are ill
Indonesia, India, Nigeria, Central America. You know these are places, have don't have a lot of sophisticated medical equipment? They don't have a of cases. Just like governments that are well trusted by everybody, the ability to enforce orders, things like that and it seems like you could be talking about something that is much more much more serious in some parts of the world
then it would be in South Korea yeah. No, I think that's absolutely right and you need to be concerned about that. I know people are worried about that. One prime example of that juxtaposition is within
in itself because the initial outbreak occurred in one area and New Bay Province, and there you saw a very high relatively case, fatality rate,
and that had to do a lot with the availability of healthcare resources to treat people with
Where does that's where the sort of two percent number come yet invite
was higher even then, then than two percent
I don't remember the exact number, but you might have been in the three point: seven at least in an early stage in that epidemic. There compare that with the other provinces, where you had large numbers of cases yet at a much lower case. Fatality rate is
as one. They were for warned that this was gonna happen in a ramp up their ability to to work on and and and pay attention these severe cases- and I you know they were able to control the disease to extend flattened that curve, meaning they could accommodate all the severe case. So you can see a similar thing playing out and malaria, whereas we have
I could pass it it to deal with the severe outcomes and areas we don't have that and the consequences could be dire if, if the health care infrastructures not there to treat these, but there is also the the possibility, at least that I am an maybe
the circulates is internet. Rumours but the warmer whether will prevent the spread of illness, and that could be a positive factor for Raffer Guy Indonesia. Places like that low low income countries tend to be hotter near you, certainly something to two to pay attention to end its potentially could impact the ease of transmission. This virus, I think
There is reasons to believe it will and there's little reason to believe it won't. If we know that respiratory viruses do Influenza excetera at don't like hot and humid conditions and are killed by sunlight, and so
There is that biological angle that they just do better in cold dry conditions,
but on the other hand, people don't have any
previous immunity to this particular virus, as we ve talked about already,
That means that everyone is susceptible and there is a greater likelihood of transmission, even more so than seasonal influenza. I
you don't want. Intuitively right is like people are familiar with cold and flew season, and that happens when its call to people not get the flu in the tropics where there is
winter. Oh, no people do get the flu in the tropics shore, but
there's no marked Sir
personality, as as you would see, in the northern and southern latitudes,
so you have flew, circulating more or less than a year round basis, and you don't have these massive peaks of flu during a flu season. Necessarily
it would be wrong to infer from, like my lived experience of the seasonality of the flu in a temperate area that, like the flu, can't go where it's hot. That's,
What's going on that's right, yeah, the flu viruses and another respiratory viruses, don't necessarily do well in hot and humid. They do,
ass. Well in hot and humid environments, they transmit more
in dry and cold environments, but that doesn't mean they don't trends,
at all, in those hot and human environments you're, even with this corona virus, we ve, seen. Of course, transmission
in a place like Singapore, where you have ninety degree days in hot and humid Hong Kong is not exactly frigid, and so it's not that it can't transmit, which is a concern there is.
And I believe that the threat of transition in the northern hemisphere could be affected. But to what extent we don't know when a spring
rolls round in summer rules or and we're not to write an end. So one of the things with with with normal Saddam's seasonal flu is that lots of people have acquired immunity. So when the virulence slows down a kind of goes away for for a little while, but we're talking now, if, if you know this is the beginning of March tried, so if a month from now there many a much larger base of infected people and nobody has an acquired immunity or very few people, do the fact that the spread may slow a little bit is not really a game changer, because the the base rate is going up so much that's right, gather, there's so many susceptible people there who
become infected that, even if transmission is diminished somewhat, it doesn't completely halt the transmission wearing. This is all speculation. Of course, we don't know exactly how the virus will react.
Different environmental conditions. We have that everyone's. Yet, but Billy just eat it. Doesn't it doesn't see
like the analogy to seasonal flu, even if it holds up doesnt mean that in our case, with a new virus that you would expect us to just go away and right bring you, wouldn't you wouldn't translate,
blue experience directly to our experience with this. I think that would be. That would not be the proper way to try to look at this rate, even if the biology is somehow similar of the of the virus it yet itself right. So then that's! My question is like how does this end policy wise, because we're seeing China, it seems like has gotten forgotten ahead of things eventually, and they would like to restart their economy for understandable reasons, but if they do that
given this is gonna explode. Again, that's the worry and if care is not taken in the way that regular life's starts up again, then that
certainly as a possibility, but from what we ve heard from
W Joe expert team, which has travelled to China and from chinese sources, is that their taking that very seriously and that means
slowly and with great care. Taking steps
towards resuming normal life, and so they have in place a sort of Exquisites surveillance systems, tracking people's moves and identifying cases, and
have taken every measure that one can think of in order to know where the diseases and, if its spreading, so if they
able to see that in particular location that there's,
evidence or no evidence of transmission, then,
Maybe they can lead up a little bit, but they keep those surveillance systems in place in order to see any increase and therefore put in a more specify or Morse targeted efforts such as the contact tracing work and finding those cases early and intervening quickly. So this is built on an essentially building out that the infrastructure for surveillance, firm for conduct, tracing for social distancing for quarantines and continuing to every relaxing at but continuing tat, have it and perhaps selectively, reimbursed
yeah so that so you sort of the the very stringent transportation and people being in lockdown in their houses. Allow people to roam the streets
more than once a week or whatever it is, and and then you you see
how that goes, and then and then you allow larger gatherings to get the other or factories to start new work.
Again. People congregating in larger groups see how that goes, and you don't see a flare up. Then you can continue that process of getting everything running, but it's all predicated, as you say, on being able to maintain those
violence in case finding systems and doing it and intervene an honour and a rapid basis, and so you you're not doing it for an entire population of a city anymore. You doing for much more selective group and talked much more targeted way. Therefore, reducing the risk that it can explode out into a bigger epic. That's a weed! That's all like stuff: we don't! We don't have that we're not when I doing large
I don't know any country other than maybe Singapore and a few other countries where it something like this could be put in place. Yet it's sort of unique to China at a wise
Korea is the other sort of really big. The biggest outbreak right. That that has happened here and they're going to have to at least try to get to that. That kind of a point, but is there hope for us in the United States? Or is it semi inevitable that we will
we will can end up where, where China was, I dont know there. There are different scenarios, which I could vision and a worst case scenario would be the China scenario, and I don't know, if that's very likely, because
on China had to face this brand. New threat was the first place it had two faces. Brenda threatened was completely caught off guard
there is no country in the world which is not aware of this threat and not taking steps. So you know that would differentiate us from that scenario that worst case scenario, but
as it stands, you know we have epidemiologists out there saying that we should be looking at this circulating
in anywhere between twenty and sixty percent of the adult population. By the time that it makes this way around the world, so
You know if you start to do it, the mental math in your head as to what that implies in terms of hospitals, Asians and in terms of deaths and wanting to to highlight which we haven't yet. Is that we're not talking about deaths across all age groups? This is something that highly concentrated in terms of its severity and death in old,
it is particularly those over the age of sixty. So I don't think I want anybody to be worried about the entire population. That two percent of the populations and Rita is very important to consider those who have pre existing conditions or an elderly as being particularly at risk for this, but anyway, that that would be that the worst case,
scenario what I think it did to the boy you are just raising saying. I think we should be clear on is that you know to the extent that that you, the hypothetical prime age, Pike S, listener without serious.
health health problems listening any kind of measures were talking about. You know, washing your hands complying with social justice
was it really about? You were right, I mean it's about it's something you do for the sake of other people who are more vulnerable than if
there's millions of us running around coughing on each other spread his virus around a lot of people like mostly old people, people, otherwise vulnerable respiratory conditions are going to die. That's right, I do you know, like most people are in this area, where we have a responsibility as like other members,
society too sure yeah, you, you protect others who might be more vulnerable from getting this virus, and also you contribute to that mitigation aspect. Where you're you don't have a whole lot of cases occurring at the same time. So even though adults
younger than sixty have very low chance of dying from this virus that, as far as we know, there can
some people who would need to be hospitalized or seen by medical professional them? To the extent we can reduce that number rat? You have contributed to the the public good, as as as in terms of the limited resources we haven't healthcare system to address this bank, that that's like the line between panic, gang and being responsible, as that, it's not in it
Like you necessary, not you you! The listener. Mozilla need to be in terror about yourself and your family, but that, like as as a society, there is a concern that we will have over Whelmd hospitals that we will have infections of a lot of elderly people that we will have an inability to treat that twenty percent of people who might need more help, and so whatever you can do to reduce, spread like that that it
It's helping other people, it's not just about like housing. Are you that's right in these measures are evidence based in and shown to be effect
another epidemic. I mean this is hand washing, sounds so pedestrian. But
When it comes down to it, we should all be washing our hands. This much all the time
especially during flew season, but it does affect the rate of transmission,
and if everyone is doing it,
you know transmission goes down and that's the reason why it's recommended is the number one thing and, as you say these
rational- and you know not panic and do
measures. These are. These are ways to contribute to the the f
be proactive was as an individual as a household as a community to reducing the effect of this.
Everyone has a role to play, and I am so but before let you go, I usually I liked ass people have what what? What didn't we talk about here white, but should have asked you about that. You you think people need to know well enough. I think a lot of people have their hopes pinned on a vaccine
for this virus and where were hearings, different stories about how long it's gonna take for a vaccine to be available. I think that's it. That's that's! That's a topic which requires some additional
caution. We're not going to see a vaccine for at least a year and a half probably
be longer, and I understand how people think they can know in advance
well long. It would take to wake anew the well the the actual science behind making. The vaccine is probably not that difficult compared to other things, so that the problem is that process of testing its effectiveness it safety over time. You have to go through the regulatory process, and that takes time. So you have phase one trials where your chest
to see if this thing is safe, that you can actually give it the people, then you go through larger trial to see that it actually protect people from this and then very large trials. In order to see that a protection
and that there is no adverse outcomes in law.
Population after all
and then those take time, money, effort that can be built at a year, long process and so it through in a heroic,
but we can get through this process and about a year and if all the science falls into place. That's how you can
have a base scenario away and then making room for things which don't go the way which replant or we would
and mean that you could add a few months
But wanting to know is that the even if you do have an effective candidates- and I certainly do hope we dwell- and I expect we will- that that's just the first dose, and so you have to start thinking about,
how quickly production can ramp up in order to make enough doses? If this is still an issued circulating around in a year and a half that we want to protect themselves against organised decide, you know who gets the
Those that are first rolling off the production line, and, typically you think about
people who are on the front lines of healthcare workers- and
people who are susceptible to severe disease. Those are the people who want a popular. He want to focus on first with with a vaccine, so I mean that's something we have experience with wide from from pandemic flues, where it takes some time to get it wrapped up in a new they. They say you know, people who are vulnerable and and healthcare workers jelly go, go first opportunity.
Mr Lange reinventing the wheel moroccan allocation question. No, no we're not, but it is contentious as it were. As you can imagine and weave you know, we had these plans in place. We saw them getting me, be put
operation during the two thousand and eight when in when pandemic. But of course, in that case we received the vaccine after we, the worst had passed
It were, and also after we realise that it wasn't the most severe pandemic that we could have had that they so the demand for them
Scenes fell away, just as they were coming online other tasks. That gives a. I think, some people who have the impression that there is a kind of you now that buddy me I'll just to cry Wolf, and they were member this, I very hyped flew about ten years ago and the international.
Be that big of a deal again early on in an epidemic, as we saw with this particular coronavirus epidemic, is that your early cases are the severe cases, and so you
tend to overestimate we're just going on a number of cases in the numbers of deaths early in an epidemic you're not overestimate the severity of this?
because basically you get a denominator just to people who were so sick that they went to the hot, exactly yeah, that's right! So the same thing
happen with two thousand. I need one and we have first. It appears
We didn't know how big that denominator was just
we don't know having the denominator for the crown of ours overtime
and we were able to find that out and therefore come to the realisation that it wasn't. You know
like the nineteen eighteen flu, which had a maybe two to three percent mortality rate overall, much
more closely aligned with so does the irregular seasonal flu of less than one point one percent, and so
it wasn't. Amount of crying Wolf is matter of uncovered
the truth over time, and only studies and experience can give us that and so are. The hope is that over time we will find out what the krona virus that we actually have. Many more
than cases do we do. But in order to do that kind of research, we need a different approach and that is to start testing lots of people doing blood tests to test to see if they have been exposed to the virus. Can you can test for antibodies, specific for the virus and then
where you can get in a much more a much clearer picture of the true denominator. You got what you wanted, you essentially like, but random sampling yeah for that right into instead of Danish having me what you think are sick. Yes right, you just wanted just grab some different people, desert icy and see like cats. Who knows like. I had a comb three weeks ago,
Maybe maybe I was an hour rang, wouldn't know until until we tested everybody and you'd have to test entire population, but tat sort of a sudden, a well representative sample. It's like Paul are yet around here, and so you, you do the Sir Sir Ology test for evidence of prior infection, and then you get this denominator, and yet we do that for flew at which, as you know why
how these estimates about the case fatality for flew about? We haven't yet done that to a great skill in krona viruses. You know we had you have to make the test and they have to prove it works. There are places that are starting to do. Then the debate shows pushing
and this research agenda and it really will shed a little light on on how a pervasive the the infection is and how severe it is. Once you have that picture we, so we should look for that research to come out of foreign countries pretty soon right, because
where you had the epidemic earlier on this way, you can look up, take a constructive look back. We haven't yet had, at least as far as we know that many cases and ordered when I look back ass, exact, ok, fantastic. I thank you so much. I just Michel from the Kaiser Family Foundation is really great, really informative, thanks, as always at it to Oliver listeners back there. Thanks to add generic held our producer and weeds piggy back on Saturday.
Transcript generated on 2021-05-20.