WEBVTT - COVID-19 Chapter 3: Control 0:00:04.120 --> 0:00:06.480 My name is Colleen Kraft, so I wear a number 0:00:06.480 --> 0:00:08.600 of hats at Emory. I just took a new job 0:00:08.840 --> 0:00:11.480 right before this started, and so I think a lot 0:00:11.520 --> 0:00:14.160 of what I'm coping with has to do with my 0:00:14.200 --> 0:00:19.720 own sort of perfectionism and self criticism. I started out 0:00:19.720 --> 0:00:23.680 doing more on the preparedness planning aspect, which was very administrative, 0:00:23.680 --> 0:00:26.159 and that's also my new role at Emory, and so 0:00:26.320 --> 0:00:28.639 that was nice, a nice thing for me to walk 0:00:28.640 --> 0:00:31.920 into because I was already kind of going into the 0:00:32.120 --> 0:00:35.239 executive leadership group of our hospital, so it was kind 0:00:35.240 --> 0:00:37.640 of nice to be sort of also a subject matter expert. 0:00:38.920 --> 0:00:41.760 But what's happened as patients have started to arrive, you know, 0:00:41.800 --> 0:00:45.320 and be diagnosed in our community, is that I've realized 0:00:45.360 --> 0:00:49.320 that my role has dramatically changed into being sort of 0:00:49.360 --> 0:00:53.559 the helping with the clinical laboratory. Because remember that's one of. 0:00:53.560 --> 0:00:56.000 The hats I wear is in diagnostic testing. 0:00:56.200 --> 0:00:58.520 So I'm both a clinician that sees patients, but I 0:00:58.520 --> 0:01:01.040 also work in our clinical lab, which I love doing 0:01:01.120 --> 0:01:04.639 both of those things. And so I this morning, for instance, 0:01:04.680 --> 0:01:09.560 spent three hours prioritizing four hundred samples into ninety two 0:01:11.400 --> 0:01:14.479 and working with people to data analyze that. You might say, 0:01:14.560 --> 0:01:17.800 why would an MD do that? That makes no sense. However, 0:01:18.720 --> 0:01:20.920 we have a full staff of people that need to 0:01:20.920 --> 0:01:23.640 be doing the rest of the work for the hospital, 0:01:24.319 --> 0:01:26.560 and so what you're seeing is people are being kind 0:01:26.600 --> 0:01:29.560 of it's like, we need to establish the process before 0:01:29.600 --> 0:01:31.280 we have to hand it off, right, because there's a 0:01:31.280 --> 0:01:32.360 lot of ups and downs. 0:01:32.400 --> 0:01:34.320 There's a lot of things coming at us. 0:01:34.319 --> 0:01:38.120 Like I just explained, just feeling like everybody's need something 0:01:38.160 --> 0:01:41.679 from me, Like I cannot leave my phone for five 0:01:41.800 --> 0:01:45.000 minutes without it blowing up with text messages or calls 0:01:45.120 --> 0:01:49.920 or emails. It's it's insane. You don't like, there's no 0:01:50.000 --> 0:01:54.480 way to feel disconnected. And so my role has changed 0:01:54.480 --> 0:01:59.200 from being sort of, you know, thoughtful, trying to be organized, planning, 0:01:59.480 --> 0:02:04.559 you know, inner rejecting, to being like physically sorting through 0:02:05.640 --> 0:02:09.360 with you know, a number of supervisors from three different laboratories, 0:02:09.800 --> 0:02:12.040 how we're going to prioritize our testing because I want 0:02:12.040 --> 0:02:13.760 to make sure that we're doing, you know, the best 0:02:13.760 --> 0:02:17.639 thing for our patients and our employees, and also communicating 0:02:17.639 --> 0:02:19.840 outward because of course, no one's ever happy with the 0:02:19.880 --> 0:02:24.040 turnaround time, especially with the media about testing kits. I 0:02:24.040 --> 0:02:27.640 think it's also encouraged the demand that we have to 0:02:27.639 --> 0:02:29.840 have this diagnosis today when I'm like, well, we've just 0:02:29.880 --> 0:02:32.440 discovered is like two and a half months ago everybody. 0:02:34.040 --> 0:02:37.359 So I think that, you know, that's what a leader. 0:02:37.040 --> 0:02:38.280 I think is supposed to do. 0:02:38.680 --> 0:02:42.239 I'm not sure I'm being a leader, but I think 0:02:42.280 --> 0:02:44.320 that that's what you're supposed to do, which is jump in, 0:02:44.760 --> 0:02:48.480 be helpful, try to create a process because you can 0:02:48.520 --> 0:02:52.160 see all the aspects of the process, and then keep 0:02:52.280 --> 0:02:54.760 doing iterations for the process so you can hand it off. 0:02:55.400 --> 0:02:57.200 I think that's what I'm supposed to be doing. 0:02:57.320 --> 0:03:00.480 But again, I think some of my stresses I'm not 0:03:00.520 --> 0:03:03.200 sure what I'm i supposed to be doing because I'm 0:03:03.320 --> 0:03:05.760 there's so much to do. Right am I supposed to 0:03:05.840 --> 0:03:07.639 draft this email? I'm supposed to talk to this I'm 0:03:07.639 --> 0:03:10.680 also on our Governor's task force, which has happened since 0:03:10.680 --> 0:03:13.120 we talked, and that's been an incredible opportunity. 0:03:13.800 --> 0:03:15.639 So today I sorted. 0:03:15.360 --> 0:03:17.760 Samples for three hours, and then I worked with some 0:03:17.919 --> 0:03:20.880 data analysts about how we can get these I've been 0:03:20.880 --> 0:03:22.840 creating a manual spreadsheet how I mean this is all 0:03:22.960 --> 0:03:25.920 very boring, and then I worked with people to pull 0:03:25.960 --> 0:03:28.280 this data so I don't have to pull it, and 0:03:29.440 --> 0:03:32.400 then you know, just helping with the process, and then 0:03:32.440 --> 0:03:36.000 being in a zillion jillian meetings like while I'm doing 0:03:36.000 --> 0:03:38.800 this a lot of times because there's just so many 0:03:38.840 --> 0:03:42.080 executive meetings that I have to be in, so it's 0:03:42.120 --> 0:03:44.920 been quite crazy. And then I'm today, I'm carrying the pager, 0:03:45.320 --> 0:03:46.960 so the er has been calling me all day about 0:03:47.000 --> 0:03:50.120 whether or not to admit where we're cohorting our patients. 0:03:50.200 --> 0:03:53.400 So if there's this suspicion that they have COVID, we'll 0:03:53.400 --> 0:03:55.560 put them on a couple of wards, not all all 0:03:55.560 --> 0:03:59.160 over the hospital. So we're the gatekeepers for deciding if 0:03:59.160 --> 0:04:00.520 those people get to cohort. 0:04:01.480 --> 0:04:05.280 So it's like being pulled in a million directions. And 0:04:05.320 --> 0:04:10.720 I am truly exhausted working fifteen hours a day at 0:04:10.720 --> 0:04:13.720 the hospital. So whereas my kids get to stay. 0:04:13.520 --> 0:04:15.200 At home and I would love to be at home 0:04:15.200 --> 0:04:18.800 with them, I am spending even more time at work. 0:04:19.560 --> 0:04:22.120 So that's sort of also probably what you hear my 0:04:22.240 --> 0:04:27.039 voice is the strain of exhaustion, but yeah, we'll get 0:04:27.040 --> 0:04:27.400 through it. 0:05:11.400 --> 0:05:13.680 So that might have been a familiar voice for you. 0:05:13.760 --> 0:05:17.560 That was doctor Colleen Kraft who spoke on our Clinical Disease, 0:05:17.640 --> 0:05:22.000 a minisode of this Anatomy of a Pandemic series, and 0:05:22.040 --> 0:05:26.320 she was also on our first coronavirus episode back in February. 0:05:27.240 --> 0:05:30.440 Hi, I'm erin Welsh and I'm erin Olman Updyke. 0:05:30.600 --> 0:05:32.520 And this is this podcast will Kill You. 0:05:33.360 --> 0:05:36.760 Welcome to the third installment of our Anatomy of a 0:05:36.839 --> 0:05:40.880 Pandemic series. They're not minisodes. 0:05:41.279 --> 0:05:45.080 What have we covered so far? Erin well a lot. 0:05:46.240 --> 0:05:49.520 We've talked about the virus itself, SARS Kobe two, and 0:05:49.560 --> 0:05:51.920 then we talked about the disease that it causes, COVID 0:05:52.040 --> 0:05:55.719 nineteen and so now the next question is we're in 0:05:55.760 --> 0:05:59.320 a pandemic? What do we do about it? We're here 0:05:59.360 --> 0:06:01.919 in this situation, living through what we have known was 0:06:01.960 --> 0:06:06.000 possible since at least nineteen eighteen, but this has never 0:06:06.240 --> 0:06:10.240 happened on this scale since. So what do we actually 0:06:10.279 --> 0:06:12.520 do about it? How do we try and control it? 0:06:13.080 --> 0:06:16.200 And so, yeah, that's what we're going to talk about today. 0:06:17.440 --> 0:06:19.920 But first, of course, it's Quarantiny time. 0:06:22.480 --> 0:06:23.640 What are we drinking now? 0:06:24.480 --> 0:06:32.320 This time we're drinking Quarantini number three gin some delicious 0:06:32.400 --> 0:06:35.920 rosemary simple syrup. You could use dried rosemary to make 0:06:35.920 --> 0:06:39.280 simple syrup out of and some lemon juice. 0:06:39.480 --> 0:06:43.400 YEP, it's pretty delicious, actually, very refreshing. 0:06:43.200 --> 0:06:46.120 Very refreshing. And I do want to address yet again 0:06:46.200 --> 0:06:49.520 that we don't recommend drinking all these quarantinies in one day. 0:06:49.880 --> 0:06:53.760 If you're binge listening to these episodes, please don't binge drink. 0:06:54.400 --> 0:06:56.760 But if you want to drink along with us and 0:06:56.800 --> 0:06:58.760 you don't feel like drinking alcohol or don't want to 0:06:58.839 --> 0:07:03.080 drink alcohol, we also have placey burrita recipes that we 0:07:03.120 --> 0:07:06.400 will post for all of our quarantine recipes, and you 0:07:06.440 --> 0:07:08.800 can find those on our website This podcast will Kill 0:07:08.880 --> 0:07:13.840 You dot com, and we'll also tweet Insta, Facebook these recipes. 0:07:14.120 --> 0:07:16.680 You could definitely binge drink the plasy burritas because they 0:07:16.680 --> 0:07:19.640 don't usually have that much sugar in them. Yeah, they're 0:07:19.720 --> 0:07:20.440 quite good. 0:07:20.600 --> 0:07:27.560 Yeah, and maybe even hydrating. Yeah. Okay, So what should 0:07:27.600 --> 0:07:30.720 we know before we dive into this episode. 0:07:30.800 --> 0:07:33.800 So when we recorded our first coronavirus episode back in 0:07:33.880 --> 0:07:37.800 early February, it was still or at least we thought 0:07:37.800 --> 0:07:40.480 at that point that it was still fairly well contained 0:07:40.800 --> 0:07:44.520 at least, China had instituted pretty strict policies to try 0:07:44.560 --> 0:07:48.000 and control the epidemic there, and while cases were appearing 0:07:48.080 --> 0:07:51.680 across the globe at that point, we were mostly, we 0:07:51.760 --> 0:07:55.280 thought able to identify these cases and use what's called 0:07:55.400 --> 0:07:59.119 contact tracing to try and pinpoint where that person became 0:07:59.160 --> 0:08:02.160 infected and who they came in contact with who they 0:08:02.160 --> 0:08:04.440 could have potentially exposed, so that we could try and 0:08:04.480 --> 0:08:06.160 stem the infection that way. 0:08:07.200 --> 0:08:10.520 So early on in an outbreak, this contact tracing is 0:08:10.560 --> 0:08:14.360 a super valuable tool that helps public health professionals identify 0:08:14.400 --> 0:08:18.760 and isolate cases and then identify and quarantine healthy people 0:08:18.840 --> 0:08:22.120 who have been exposed in an attempt to try and 0:08:22.160 --> 0:08:25.120 squash the infection before it really spreads in a population. 0:08:26.120 --> 0:08:29.640 But that, of course was then, and this of course 0:08:30.000 --> 0:08:32.480 is now. It sure is so. 0:08:32.559 --> 0:08:36.559 Now it's clear that community transmission, meaning transmission from person 0:08:36.600 --> 0:08:39.880 to person, not only in close family settings or not 0:08:39.960 --> 0:08:44.160 only travel related cases, but transmission kind of freely in 0:08:44.200 --> 0:08:48.319 and among communities, is happening across the globe at this point, 0:08:48.679 --> 0:08:51.720 which is why the World Health Organization has declared this 0:08:51.840 --> 0:08:54.880 a pandemic. So now the question is what do we 0:08:54.960 --> 0:08:57.439 do about this? Because, as you may have heard from 0:08:57.480 --> 0:09:00.440 chapters one and two, this is a disease that in 0:09:00.480 --> 0:09:04.160 some cases can be really severe, and we are at 0:09:04.240 --> 0:09:07.040 risk of overflowing our hospitals, or in some parts of 0:09:07.080 --> 0:09:10.480 the world, hospitals are already over capacity, which means that 0:09:10.520 --> 0:09:13.160 people could be dying not just from disease, but also 0:09:13.160 --> 0:09:15.080 from lack of access to supportive care. 0:09:16.040 --> 0:09:19.080 So you've probably heard a lot of talk about social 0:09:19.080 --> 0:09:22.559 distancing and how to flatten the curve. But what do 0:09:22.600 --> 0:09:26.240 these two things mean and why are they important? Okay, 0:09:26.280 --> 0:09:29.640 so social distancing is literally exactly what it sounds like. 0:09:29.760 --> 0:09:32.760 It's putting a greater distance between you and other humans. 0:09:33.480 --> 0:09:37.960 And in our February Coronavirus episode, doctor Marshall Lyon actually 0:09:38.000 --> 0:09:41.240 mentioned it, which is like, yeah, we knew, kind. 0:09:41.080 --> 0:09:44.040 Of like we knew this is a strategy, especially for 0:09:44.160 --> 0:09:45.640 yeah illness strategy. 0:09:45.760 --> 0:09:51.280 Yeah, why does this work? Why does social distancing work? Well, 0:09:51.440 --> 0:09:53.800 since we're dealing with a virus that is transmitted from 0:09:53.880 --> 0:09:58.079 respiratory droplets, so from your saliva by literally just coming 0:09:58.120 --> 0:10:01.880 into contact with other people's saliva directly or stuff that 0:10:01.920 --> 0:10:05.559 their saliva may have touched, like doorknobs or grocery cart handles, 0:10:06.160 --> 0:10:09.000 or even just their filthy hands or whatever. If you 0:10:09.120 --> 0:10:11.839 don't come into contact with these things, then you can 0:10:11.880 --> 0:10:15.520 prevent yourself from getting infected. Now this works on the 0:10:15.520 --> 0:10:18.480 flip side. If you are sick, by not going out 0:10:18.720 --> 0:10:21.439 to the club, to the party, into work, into school, 0:10:21.840 --> 0:10:25.760 then you aren't spreading your saliva, which contains a bunch 0:10:25.760 --> 0:10:28.000 of virus all over the world for other people to 0:10:28.000 --> 0:10:31.559 come in contact with. And we also recognize that staying 0:10:31.600 --> 0:10:35.040 at home may not be an option for everyone, and 0:10:35.400 --> 0:10:38.640 that's what makes it even more important that if you 0:10:38.880 --> 0:10:41.320 do have the privilege to stay at home, if you 0:10:41.440 --> 0:10:43.960 do have that ability, then you need to do so. 0:10:44.000 --> 0:10:47.080 It is a social responsibility aspect at this point. 0:10:47.280 --> 0:10:50.720 Absolutely. And remember that we've learned that this is a 0:10:50.800 --> 0:10:53.760 virus that might not even make you feel all that sick, 0:10:54.160 --> 0:10:56.920 but it could still make those around you super sick. 0:10:57.240 --> 0:11:01.040 So by practicing social distancing, we're protecting our ourselves and 0:11:01.160 --> 0:11:04.240 those around us who might be more vulnerable to severe infection. 0:11:04.679 --> 0:11:06.560 We really can't stress enough that this is what we 0:11:06.600 --> 0:11:10.559 should all be doing to be good citizens, friends, neighbors, humans. 0:11:11.120 --> 0:11:14.760 The other thing is washing your hands, washing your hands, 0:11:15.080 --> 0:11:15.720 washing your hands. 0:11:16.920 --> 0:11:20.680 Okay, what about masks, So masks can be effective if 0:11:20.720 --> 0:11:23.600 you are sick, in like helping to prevent the spread 0:11:23.640 --> 0:11:26.200 of droplets when you cough. I saw a really interesting 0:11:26.520 --> 0:11:29.640 jiff of or gif. I don't want to anger anyone 0:11:29.640 --> 0:11:32.560 out there. That's the last thing we need right now. 0:11:32.920 --> 0:11:36.000 I've just been revealed as a jiff sayer, not a 0:11:36.040 --> 0:11:40.880 gift sayer. And it had examples of what it looked 0:11:40.960 --> 0:11:44.400 like when you cough directly into the air when you 0:11:44.400 --> 0:11:47.440 breathe normally, how much your respiratory droplets are traveling, and 0:11:47.480 --> 0:11:49.959 you can see it directly when you cough into your 0:11:49.960 --> 0:11:53.520 hand versus your elbow versus into a mask, like a 0:11:53.640 --> 0:11:56.520 dust mask, versus into an N ninety five mask versus 0:11:56.600 --> 0:11:56.839 into it. 0:11:57.040 --> 0:11:59.559 It's really really could we find that and post that 0:11:59.559 --> 0:12:03.640 because I'd love to see that. Yeah, credit man, reddit man. 0:12:04.800 --> 0:12:09.000 Okay, but if you're sick, you shouldn't be out coughing 0:12:09.040 --> 0:12:12.240 on people anyways, especially not right now when no one 0:12:12.240 --> 0:12:14.600 should be out and about unless you have to be. 0:12:15.000 --> 0:12:17.080 And so if you do have to be, wearing a 0:12:17.080 --> 0:12:19.840 mask can be a great way to prevent the spread 0:12:19.840 --> 0:12:23.920 of those respiratory droplets. But if you are not sick. 0:12:24.320 --> 0:12:27.320 Masks don't really do much to prevent you from getting 0:12:27.400 --> 0:12:31.680 sick because A you have to touch your face to 0:12:31.679 --> 0:12:34.000 put on the masks, and you're probably going to be 0:12:34.040 --> 0:12:38.560 adjusting them frequently. B. They don't cover your eyes, which 0:12:38.600 --> 0:12:40.760 the virus can go into your mucus membrane, and so's 0:12:41.120 --> 0:12:44.360 you know, one of the roots of entry. See, some 0:12:44.400 --> 0:12:46.480 of the ones that you buy over the counter are 0:12:46.559 --> 0:12:50.679 too large a poor size to actually prevent viral entry anyways, 0:12:51.360 --> 0:12:54.600 And at this point, hospitals and clinics are running out 0:12:54.640 --> 0:12:58.400 of masks, so everyone buying them up is not helping 0:12:58.520 --> 0:13:01.839 anyone at this point. I mean, if wearing a mask 0:13:02.000 --> 0:13:04.680 helps keep people six feet away from you, if that's 0:13:04.720 --> 0:13:07.720 the idea behind them, which I feel like in other 0:13:07.760 --> 0:13:10.760 scenarios it might be that could work, but right now, 0:13:10.800 --> 0:13:13.080 in this pandemic, it's not super helpful. 0:13:13.440 --> 0:13:16.960 Yeah, Okay, what about this notion of flattening the curve. 0:13:17.640 --> 0:13:21.160 I feel like we've talked about on this podcast before, 0:13:21.360 --> 0:13:24.840 what an epidemic curve tends to look like. Right, So 0:13:25.080 --> 0:13:27.199 most of you at this point have probably seen one 0:13:27.280 --> 0:13:29.320 drawn out, especially if you've been looking at all the 0:13:29.320 --> 0:13:31.880 case numbers of COVID nineteen plotted out on a graph. 0:13:32.200 --> 0:13:35.840 But basically, in all epidemics, the number of cases tends 0:13:35.840 --> 0:13:39.680 to increase exponentially at first, so it's a pretty sharp 0:13:39.760 --> 0:13:43.319 line up at first, and then eventually it reaches some 0:13:43.400 --> 0:13:46.120 kind of peak, and then it will begin to dip 0:13:46.200 --> 0:13:49.200 back down slowly, so it kind of looks like an 0:13:49.280 --> 0:13:52.360 upside down you. That's what a normal epidemic curve looks like. 0:13:52.920 --> 0:13:56.520 So flattening the curve literally means trying to slow down 0:13:56.600 --> 0:14:00.040 that upstroke of that upside down you so that the 0:14:00.120 --> 0:14:03.760 rate of infection is slower. What this does is it 0:14:03.800 --> 0:14:06.560 makes it so that the peak, the top point of 0:14:06.600 --> 0:14:10.959 that curve is pushed down. So this could mean potentially 0:14:11.080 --> 0:14:15.280 a prolonged over time course of that epidemic, but the 0:14:15.360 --> 0:14:20.520 rate of infections is slower, which means that a hospitals 0:14:20.600 --> 0:14:23.720 don't get overrun with super sick people all at once. 0:14:23.880 --> 0:14:26.400 And we've said so many times already that this is 0:14:26.440 --> 0:14:29.360 a real major concern in the case of COVID nineteen, 0:14:30.080 --> 0:14:32.400 and it also means that we have more time to 0:14:32.480 --> 0:14:36.600 test and develop both treatments and hopefully a vaccine. So 0:14:36.800 --> 0:14:39.480 flattening the curve is something that can be really useful 0:14:39.520 --> 0:14:43.720 in trying to lessen the overall impact that an epidemic has. 0:14:45.800 --> 0:14:48.480 So you might have heard a bit about this notion 0:14:48.560 --> 0:14:54.160 of herd immunity as a strategy. This is a terrible strategy. 0:14:53.920 --> 0:14:55.200 Fits a terrible strategy. 0:14:55.320 --> 0:14:58.760 It's a terrible an What it is is an unethical 0:14:58.800 --> 0:15:02.240 strategy because it is not a strategy. It's basically saying 0:15:02.240 --> 0:15:04.160 we're not going to do anything. We're going to let 0:15:04.200 --> 0:15:08.600 anyone everyone get infected, and eventually everyone will get infected 0:15:08.640 --> 0:15:12.560 and they'll either die from the infection or they'll become 0:15:12.600 --> 0:15:16.280 resistant because they've developed immunity to that infection. That's not 0:15:16.480 --> 0:15:22.320 an ethical public health strategy to prevent deaths from this disease. 0:15:22.560 --> 0:15:26.960 It's not it's not a strategy, but that is essentially 0:15:26.960 --> 0:15:30.000 what would happen if you were to not do anything 0:15:30.040 --> 0:15:34.840 to try and control this outbreak. Okay, does that make sense? Yeah, 0:15:35.280 --> 0:15:39.680 Because herd immunity is essentially the idea that once enough 0:15:39.760 --> 0:15:43.960 people in a population have been exposed, either through infection 0:15:44.280 --> 0:15:48.720 or through vaccination, then eventually there are so few susceptible 0:15:48.760 --> 0:15:54.160 people left in that population that the pathogen can't spread anymore. 0:15:56.040 --> 0:15:59.320 But that the results of that is a lot of 0:15:59.360 --> 0:16:00.120 people dying. 0:16:00.680 --> 0:16:05.760 Yep. So yes, okay. So this episode, we were fortunate 0:16:05.840 --> 0:16:09.840 enough to interview doctor Critika Kupali, an expert on global 0:16:09.840 --> 0:16:13.400 health security and pandemic preparedness. We asked her all of 0:16:13.440 --> 0:16:16.360 your questions about outbreak control and whether the efforts that 0:16:16.400 --> 0:16:20.280 we are making at national and international scales are going 0:16:20.320 --> 0:16:23.880 to work. We hear from her right after this break. 0:16:54.600 --> 0:16:57.400 I named Kritika Kapali. I'm an infectious to the physician 0:16:58.000 --> 0:17:02.360 I didn't. I training it on University in Atlanta and 0:17:02.880 --> 0:17:08.960 my background is on emerging infection, operate response, pan panic preparedness, 0:17:09.000 --> 0:17:13.679 and global health security. I was the Michael vector for 0:17:13.760 --> 0:17:16.480 a Bowler treatment unit in West Africa during the twenty 0:17:16.520 --> 0:17:20.720 fourteen outbreak, and after that got involved with health system 0:17:20.800 --> 0:17:29.680 strengthening and preparedness responses for emerging infections and currently I'm 0:17:29.720 --> 0:17:32.760 the vice chair of the Infectious Disease Society of America 0:17:32.840 --> 0:17:35.840 Global Health Committee and in that role have been also 0:17:36.119 --> 0:17:42.120 spearheading efforts to develop a global Health Security working group 0:17:42.520 --> 0:17:48.679 focused on the training of frontline workers on the response 0:17:49.040 --> 0:17:54.080 for emerging infections and also just developing best practices for 0:17:54.440 --> 0:17:56.120 treatment of these types. 0:17:56.119 --> 0:17:56.800 Of infections. 0:17:56.840 --> 0:18:00.480 We were doing this actually last year. If that gives 0:18:00.480 --> 0:18:03.080 you an idea of what we were thinking about, Thank 0:18:03.119 --> 0:18:03.720 you so much. 0:18:04.240 --> 0:18:07.919 Well, we're very excited to have your expertise on this podcast. 0:18:08.480 --> 0:18:12.320 Let's start off by asking basically, you know, we know 0:18:12.400 --> 0:18:16.080 that at this point, community transmission in a lot of 0:18:16.119 --> 0:18:19.840 the US is pretty well established. So what can be 0:18:19.920 --> 0:18:21.520 done now to slow that down? 0:18:22.160 --> 0:18:25.359 Yeah, that's a really great question. So we definitely know 0:18:25.440 --> 0:18:29.800 that community transmission is happening. As of today, we know 0:18:29.960 --> 0:18:34.159 that there are seven three hundred and twenty four cases 0:18:34.200 --> 0:18:38.520 in the US and over one hundred deaths, and so 0:18:39.520 --> 0:18:42.680 we just expect those numbers to go up as testing 0:18:42.800 --> 0:18:47.480 capacity increases. And we're really at that point where we 0:18:47.520 --> 0:18:47.800 need to. 0:18:47.800 --> 0:18:52.240 Do things to mitigate transmission. So there are substantial interventions 0:18:52.240 --> 0:18:55.919 that need to be implemented based on the urgency of 0:18:55.960 --> 0:19:01.240 protecting our healthcare systems and also protecting our vole populations. 0:19:01.600 --> 0:19:05.800 So the plans that have an instituted locally, you know, 0:19:05.880 --> 0:19:10.960 may vary place to place, and they're restricting gatherings. The 0:19:10.960 --> 0:19:16.760 White House, the CBC announced this plan for fifteen days 0:19:16.800 --> 0:19:21.119 to stop the coronavirus, where they you know, restricted gatherings 0:19:21.160 --> 0:19:25.720 to less than ten people, encourage working from home or teleworking, 0:19:26.240 --> 0:19:30.480 arranging for distance learning. And you know, there are many 0:19:30.960 --> 0:19:34.119 short term closures occurring all over the country right now, 0:19:34.560 --> 0:19:37.080 and in some places, some of those restrictions are even 0:19:37.720 --> 0:19:40.560 more stringent. You know, where I am in California, we 0:19:41.119 --> 0:19:45.240 have a order to shelter in place, which means really 0:19:45.280 --> 0:19:48.119 just you cannot leave your place unless you need to 0:19:48.200 --> 0:19:49.919 leave for essentral reasons. 0:19:50.760 --> 0:19:52.879 Yeah, I mean, this is this sort of seems like 0:19:53.040 --> 0:19:55.919 in some ways, looking at what's happening in Italy and 0:19:55.960 --> 0:19:58.520 trying to see parallels in other parts of the world, 0:19:58.640 --> 0:20:01.040 especially in the US, it seems like, you know, we're 0:20:01.080 --> 0:20:03.600 a bit behind the curve in terms of implementing some 0:20:03.640 --> 0:20:08.479 of these social distancing or self isolation of practices. And 0:20:08.520 --> 0:20:12.560 I think it's it's challenging too because in states where 0:20:12.800 --> 0:20:16.560 perhaps the case number is currently low, that doesn't mean 0:20:16.640 --> 0:20:20.320 it'll remain low, and I think there's maybe a less vigilance, 0:20:20.920 --> 0:20:24.560 and so I think it seems essential to really practice 0:20:24.600 --> 0:20:29.320 this social social distancing and self isolation everywhere. Is that 0:20:29.480 --> 0:20:31.600 is that sort of what you're thinking is as well? 0:20:32.440 --> 0:20:36.159 Yeah, absolutely right. I think you know, there's certain places 0:20:36.160 --> 0:20:39.480 that have been hit hard, and there are areas that 0:20:40.040 --> 0:20:41.800 you know, quite frankly, I would have thought would have 0:20:41.800 --> 0:20:43.960 been hit hard by something like this. There area, major 0:20:44.000 --> 0:20:49.440 metropolitan area, so areas on the West coast, New York, Washington, 0:20:49.520 --> 0:20:53.159 d C. All those areas are areas that in essence 0:20:53.160 --> 0:20:57.719 you would consider being places at high risk. However, just 0:20:57.760 --> 0:21:00.200 because those areas have been hard hit doesn't mean mean 0:21:00.280 --> 0:21:02.600 that other parts of the country are not at risk 0:21:03.000 --> 0:21:06.240 and they don't need to implement these measures as well, 0:21:06.280 --> 0:21:10.640 because really all it takes is, you know, one person 0:21:10.720 --> 0:21:12.720 and they can spread it to the next person and 0:21:12.800 --> 0:21:14.879 then to the next person, and that's how it propagates. 0:21:14.920 --> 0:21:18.880 And so that's why these measures have been implemented at 0:21:18.880 --> 0:21:20.840 this point in time. Mm hmm. 0:21:21.560 --> 0:21:24.080 You know a lot of different countries, including the US, 0:21:24.119 --> 0:21:30.159 have implemented travel bands or have closed borders. How effective 0:21:30.400 --> 0:21:33.199 is that at this point in time in terms of 0:21:33.200 --> 0:21:34.400 slowing down the disease. 0:21:34.920 --> 0:21:37.280 Yeah, so I think that's a really wonderful question. And 0:21:37.359 --> 0:21:40.400 so I think if you look at you know, what 0:21:40.840 --> 0:21:43.520 modelers do, and you know, we talk about this, you know, 0:21:43.560 --> 0:21:46.000 how effect their travel bands and you know, do they 0:21:46.000 --> 0:21:51.199 prevent infection. You know, overarchingly, the data will show that 0:21:51.240 --> 0:21:57.080 travel bands don't prevent infections. You know, the big lockdown 0:21:57.160 --> 0:22:01.359 that China has back in January that was not necessarily 0:22:01.400 --> 0:22:06.679 to prevent infections from spreading. We could have predicted that, 0:22:07.480 --> 0:22:09.879 you know, this infection was going to spread to the 0:22:09.920 --> 0:22:11.960 rest of the world. But what it has is it 0:22:12.240 --> 0:22:16.520 flows infections right and especially at this point in time, 0:22:16.600 --> 0:22:18.440 we know that the cat is out of the bag, 0:22:18.560 --> 0:22:21.639 so to say, everywhere. But I think one of the 0:22:21.680 --> 0:22:26.399 things that has happened that the travel ban is you 0:22:26.400 --> 0:22:29.760 know what it does is it tries to ease up 0:22:30.760 --> 0:22:35.960 the load on the healthcare system. So by preventing other 0:22:36.080 --> 0:22:38.680 people from coming into the country that may be sick, 0:22:39.040 --> 0:22:44.240 that potentially could be decreasing the load of positive patients 0:22:44.240 --> 0:22:48.200 coming into the country that could have a burd into 0:22:48.240 --> 0:22:50.560 your own healthcare system. 0:22:50.680 --> 0:22:55.280 Mm hmm, gotcha. So these control measures, so closing borders, 0:22:55.400 --> 0:23:01.480 closing school canceling large public meetings, uh, strongly suggesting self isolation, 0:23:01.800 --> 0:23:06.560 or even doing the shelter in place, How can we 0:23:06.640 --> 0:23:10.080 tell whether these strategies are actually working. 0:23:11.400 --> 0:23:13.560 Yeah, So, you know, one way we're going to be 0:23:13.560 --> 0:23:17.200 able to tell that these strategies are working. Is by 0:23:17.240 --> 0:23:22.200 doing what doctor Chadras, the Director General of who said yesterday, 0:23:22.440 --> 0:23:25.520 we need a test, test, test, and the more we 0:23:25.600 --> 0:23:27.800 test and we more we have an idea of what's 0:23:27.840 --> 0:23:30.399 going on in our community, that will give us a 0:23:30.440 --> 0:23:33.680 better idea of what we are doing is working. So 0:23:34.240 --> 0:23:37.200 if we test and we get a better idea of 0:23:37.200 --> 0:23:40.160 what's going on in the community, with time, if these 0:23:40.200 --> 0:23:44.080 measures are working, and hopefully they will, a number of 0:23:44.160 --> 0:23:47.320 positive tests will go down like we have seen in China, 0:23:48.040 --> 0:23:50.679 like we were seeing in South Korea. And that's an 0:23:50.720 --> 0:23:54.360 important thing to do because obviously the point putting these 0:23:54.359 --> 0:23:56.760 measures in place is to see if we can get 0:23:57.200 --> 0:23:58.879 control of what's going on. 0:24:00.040 --> 0:24:02.080 And so you know, based on that and based on 0:24:02.119 --> 0:24:03.879 this test test tests, I mean there's there is a 0:24:03.960 --> 0:24:05.680 lag time where it seems to be a lag time 0:24:05.680 --> 0:24:08.800 between getting as many people tested and then getting the results, 0:24:08.800 --> 0:24:11.080 and you know, there's it's going to take a little 0:24:11.080 --> 0:24:13.120 bit of time. So how soon do you think we'll 0:24:13.119 --> 0:24:16.560 be able to see whether these things are having in effect? 0:24:17.080 --> 0:24:19.000 So I think it's going to be a while, and 0:24:19.040 --> 0:24:22.840 I think people really need to be prepared to be 0:24:23.040 --> 0:24:27.520 inconvenienced for a while you know, there is a model 0:24:27.960 --> 0:24:30.960