Speaker 1: My name is Colleen Kraft, so I wear a number
Speaker 1: of hats at Emory. I just took a new job
Speaker 1: right before this started, and so I think a lot
Speaker 1: of what I'm coping with has to do with my
Speaker 1: own sort of perfectionism and self criticism. I started out
Speaker 1: doing more on the preparedness planning aspect, which was very administrative,
Speaker 1: and that's also my new role at Emory, and so
Speaker 1: that was nice, a nice thing for me to walk
Speaker 1: into because I was already kind of going into the
Speaker 1: executive leadership group of our hospital, so it was kind
Speaker 1: of nice to be sort of also a subject matter expert.
Speaker 1: But what's happened as patients have started to arrive, you know,
Speaker 1: and be diagnosed in our community, is that I've realized
Speaker 1: that my role has dramatically changed into being sort of
Speaker 1: the helping with the clinical laboratory. Because remember that's one of.
Speaker 2: The hats I wear is in diagnostic testing.
Speaker 1: So I'm both a clinician that sees patients, but I
Speaker 1: also work in our clinical lab, which I love doing
Speaker 1: both of those things. And so I this morning, for instance,
Speaker 1: spent three hours prioritizing four hundred samples into ninety two
Speaker 1: and working with people to data analyze that. You might say,
Speaker 1: why would an MD do that? That makes no sense. However,
Speaker 1: we have a full staff of people that need to
Speaker 1: be doing the rest of the work for the hospital,
Speaker 1: and so what you're seeing is people are being kind
Speaker 1: of it's like, we need to establish the process before
Speaker 1: we have to hand it off, right, because there's a
Speaker 1: lot of ups and downs.
Speaker 2: There's a lot of things coming at us.
Speaker 1: Like I just explained, just feeling like everybody's need something
Speaker 1: from me, Like I cannot leave my phone for five
Speaker 1: minutes without it blowing up with text messages or calls
Speaker 1: or emails. It's it's insane. You don't like, there's no
Speaker 1: way to feel disconnected. And so my role has changed
Speaker 1: from being sort of, you know, thoughtful, trying to be organized, planning,
Speaker 1: you know, inner rejecting, to being like physically sorting through
Speaker 1: with you know, a number of supervisors from three different laboratories,
Speaker 1: how we're going to prioritize our testing because I want
Speaker 1: to make sure that we're doing, you know, the best
Speaker 1: thing for our patients and our employees, and also communicating
Speaker 1: outward because of course, no one's ever happy with the
Speaker 1: turnaround time, especially with the media about testing kits. I
Speaker 1: think it's also encouraged the demand that we have to
Speaker 1: have this diagnosis today when I'm like, well, we've just
Speaker 1: discovered is like two and a half months ago everybody.
Speaker 1: So I think that, you know, that's what a leader.
Speaker 2: I think is supposed to do.
Speaker 1: I'm not sure I'm being a leader, but I think
Speaker 1: that that's what you're supposed to do, which is jump in,
Speaker 1: be helpful, try to create a process because you can
Speaker 1: see all the aspects of the process, and then keep
Speaker 1: doing iterations for the process so you can hand it off.
Speaker 2: I think that's what I'm supposed to be doing.
Speaker 1: But again, I think some of my stresses I'm not
Speaker 1: sure what I'm i supposed to be doing because I'm
Speaker 1: there's so much to do. Right am I supposed to
Speaker 1: draft this email? I'm supposed to talk to this I'm
Speaker 1: also on our Governor's task force, which has happened since
Speaker 1: we talked, and that's been an incredible opportunity.
Speaker 2: So today I sorted.
Speaker 1: Samples for three hours, and then I worked with some
Speaker 1: data analysts about how we can get these I've been
Speaker 1: creating a manual spreadsheet how I mean this is all
Speaker 1: very boring, and then I worked with people to pull
Speaker 1: this data so I don't have to pull it, and
Speaker 1: then you know, just helping with the process, and then
Speaker 1: being in a zillion jillian meetings like while I'm doing
Speaker 1: this a lot of times because there's just so many
Speaker 1: executive meetings that I have to be in, so it's
Speaker 1: been quite crazy. And then I'm today, I'm carrying the pager,
Speaker 1: so the er has been calling me all day about
Speaker 1: whether or not to admit where we're cohorting our patients.
Speaker 1: So if there's this suspicion that they have COVID, we'll
Speaker 1: put them on a couple of wards, not all all
Speaker 1: over the hospital. So we're the gatekeepers for deciding if
Speaker 1: those people get to cohort.
Speaker 2: So it's like being pulled in a million directions. And
Speaker 2: I am truly exhausted working fifteen hours a day at
Speaker 2: the hospital. So whereas my kids get to stay.
Speaker 1: At home and I would love to be at home
Speaker 1: with them, I am spending even more time at work.
Speaker 1: So that's sort of also probably what you hear my
Speaker 1: voice is the strain of exhaustion, but yeah, we'll get
Speaker 1: through it.
Speaker 3: So that might have been a familiar voice for you.
Speaker 3: That was doctor Colleen Kraft who spoke on our Clinical Disease,
Speaker 3: a minisode of this Anatomy of a Pandemic series, and
Speaker 3: she was also on our first coronavirus episode back in February.
Speaker 4: Hi, I'm erin Welsh and I'm erin Olman Updyke.
Speaker 3: And this is this podcast will Kill You.
Speaker 4: Welcome to the third installment of our Anatomy of a
Speaker 4: Pandemic series. They're not minisodes.
Speaker 3: What have we covered so far? Erin well a lot.
Speaker 3: We've talked about the virus itself, SARS Kobe two, and
Speaker 3: then we talked about the disease that it causes, COVID
Speaker 3: nineteen and so now the next question is we're in
Speaker 3: a pandemic? What do we do about it? We're here
Speaker 3: in this situation, living through what we have known was
Speaker 3: possible since at least nineteen eighteen, but this has never
Speaker 3: happened on this scale since. So what do we actually
Speaker 3: do about it? How do we try and control it?
Speaker 3: And so, yeah, that's what we're going to talk about today.
Speaker 4: But first, of course, it's Quarantiny time.
Speaker 3: What are we drinking now?
Speaker 4: This time we're drinking Quarantini number three gin some delicious
Speaker 4: rosemary simple syrup. You could use dried rosemary to make
Speaker 4: simple syrup out of and some lemon juice.
Speaker 3: YEP, it's pretty delicious, actually, very refreshing.
Speaker 4: Very refreshing. And I do want to address yet again
Speaker 4: that we don't recommend drinking all these quarantinies in one day.
Speaker 4: If you're binge listening to these episodes, please don't binge drink.
Speaker 3: But if you want to drink along with us and
Speaker 3: you don't feel like drinking alcohol or don't want to
Speaker 3: drink alcohol, we also have placey burrita recipes that we
Speaker 3: will post for all of our quarantine recipes, and you
Speaker 3: can find those on our website This podcast will Kill
Speaker 3: You dot com, and we'll also tweet Insta, Facebook these recipes.
Speaker 4: You could definitely binge drink the plasy burritas because they
Speaker 4: don't usually have that much sugar in them. Yeah, they're
Speaker 4: quite good.
Speaker 3: Yeah, and maybe even hydrating. Yeah. Okay, So what should
Speaker 3: we know before we dive into this episode.
Speaker 4: So when we recorded our first coronavirus episode back in
Speaker 4: early February, it was still or at least we thought
Speaker 4: at that point that it was still fairly well contained
Speaker 4: at least, China had instituted pretty strict policies to try
Speaker 4: and control the epidemic there, and while cases were appearing
Speaker 4: across the globe at that point, we were mostly, we
Speaker 4: thought able to identify these cases and use what's called
Speaker 4: contact tracing to try and pinpoint where that person became
Speaker 4: infected and who they came in contact with who they
Speaker 4: could have potentially exposed, so that we could try and
Speaker 4: stem the infection that way.
Speaker 3: So early on in an outbreak, this contact tracing is
Speaker 3: a super valuable tool that helps public health professionals identify
Speaker 3: and isolate cases and then identify and quarantine healthy people
Speaker 3: who have been exposed in an attempt to try and
Speaker 3: squash the infection before it really spreads in a population.
Speaker 3: But that, of course was then, and this of course
Speaker 3: is now. It sure is so.
Speaker 4: Now it's clear that community transmission, meaning transmission from person
Speaker 4: to person, not only in close family settings or not
Speaker 4: only travel related cases, but transmission kind of freely in
Speaker 4: and among communities, is happening across the globe at this point,
Speaker 4: which is why the World Health Organization has declared this
Speaker 4: a pandemic. So now the question is what do we
Speaker 4: do about this? Because, as you may have heard from
Speaker 4: chapters one and two, this is a disease that in
Speaker 4: some cases can be really severe, and we are at
Speaker 4: risk of overflowing our hospitals, or in some parts of
Speaker 4: the world, hospitals are already over capacity, which means that
Speaker 4: people could be dying not just from disease, but also
Speaker 4: from lack of access to supportive care.
Speaker 3: So you've probably heard a lot of talk about social
Speaker 3: distancing and how to flatten the curve. But what do
Speaker 3: these two things mean and why are they important? Okay,
Speaker 3: so social distancing is literally exactly what it sounds like.
Speaker 3: It's putting a greater distance between you and other humans.
Speaker 3: And in our February Coronavirus episode, doctor Marshall Lyon actually
Speaker 3: mentioned it, which is like, yeah, we knew, kind.
Speaker 4: Of like we knew this is a strategy, especially for
Speaker 4: yeah illness strategy.
Speaker 3: Yeah, why does this work? Why does social distancing work? Well,
Speaker 3: since we're dealing with a virus that is transmitted from
Speaker 3: respiratory droplets, so from your saliva by literally just coming
Speaker 3: into contact with other people's saliva directly or stuff that
Speaker 3: their saliva may have touched, like doorknobs or grocery cart handles,
Speaker 3: or even just their filthy hands or whatever. If you
Speaker 3: don't come into contact with these things, then you can
Speaker 3: prevent yourself from getting infected. Now this works on the
Speaker 3: flip side. If you are sick, by not going out
Speaker 3: to the club, to the party, into work, into school,
Speaker 3: then you aren't spreading your saliva, which contains a bunch
Speaker 3: of virus all over the world for other people to
Speaker 3: come in contact with. And we also recognize that staying
Speaker 3: at home may not be an option for everyone, and
Speaker 3: that's what makes it even more important that if you
Speaker 3: do have the privilege to stay at home, if you
Speaker 3: do have that ability, then you need to do so.
Speaker 3: It is a social responsibility aspect at this point.
Speaker 4: Absolutely. And remember that we've learned that this is a
Speaker 4: virus that might not even make you feel all that sick,
Speaker 4: but it could still make those around you super sick.
Speaker 4: So by practicing social distancing, we're protecting our ourselves and
Speaker 4: those around us who might be more vulnerable to severe infection.
Speaker 4: We really can't stress enough that this is what we
Speaker 4: should all be doing to be good citizens, friends, neighbors, humans.
Speaker 4: The other thing is washing your hands, washing your hands,
Speaker 4: washing your hands.
Speaker 3: Okay, what about masks, So masks can be effective if
Speaker 3: you are sick, in like helping to prevent the spread
Speaker 3: of droplets when you cough. I saw a really interesting
Speaker 3: jiff of or gif. I don't want to anger anyone
Speaker 3: out there. That's the last thing we need right now.
Speaker 3: I've just been revealed as a jiff sayer, not a
Speaker 3: gift sayer. And it had examples of what it looked
Speaker 3: like when you cough directly into the air when you
Speaker 3: breathe normally, how much your respiratory droplets are traveling, and
Speaker 3: you can see it directly when you cough into your
Speaker 3: hand versus your elbow versus into a mask, like a
Speaker 3: dust mask, versus into an N ninety five mask versus
Speaker 3: into it.
Speaker 4: It's really really could we find that and post that
Speaker 4: because I'd love to see that. Yeah, credit man, reddit man.
Speaker 3: Okay, but if you're sick, you shouldn't be out coughing
Speaker 3: on people anyways, especially not right now when no one
Speaker 3: should be out and about unless you have to be.
Speaker 3: And so if you do have to be, wearing a
Speaker 3: mask can be a great way to prevent the spread
Speaker 3: of those respiratory droplets. But if you are not sick.
Speaker 3: Masks don't really do much to prevent you from getting
Speaker 3: sick because A you have to touch your face to
Speaker 3: put on the masks, and you're probably going to be
Speaker 3: adjusting them frequently. B. They don't cover your eyes, which
Speaker 3: the virus can go into your mucus membrane, and so's
Speaker 3: you know, one of the roots of entry. See, some
Speaker 3: of the ones that you buy over the counter are
Speaker 3: too large a poor size to actually prevent viral entry anyways,
Speaker 3: And at this point, hospitals and clinics are running out
Speaker 3: of masks, so everyone buying them up is not helping
Speaker 3: anyone at this point. I mean, if wearing a mask
Speaker 3: helps keep people six feet away from you, if that's
Speaker 3: the idea behind them, which I feel like in other
Speaker 3: scenarios it might be that could work, but right now,
Speaker 3: in this pandemic, it's not super helpful.
Speaker 4: Yeah, Okay, what about this notion of flattening the curve.
Speaker 4: I feel like we've talked about on this podcast before,
Speaker 4: what an epidemic curve tends to look like. Right, So
Speaker 4: most of you at this point have probably seen one
Speaker 4: drawn out, especially if you've been looking at all the
Speaker 4: case numbers of COVID nineteen plotted out on a graph.
Speaker 4: But basically, in all epidemics, the number of cases tends
Speaker 4: to increase exponentially at first, so it's a pretty sharp
Speaker 4: line up at first, and then eventually it reaches some
Speaker 4: kind of peak, and then it will begin to dip
Speaker 4: back down slowly, so it kind of looks like an
Speaker 4: upside down you. That's what a normal epidemic curve looks like.
Speaker 4: So flattening the curve literally means trying to slow down
Speaker 4: that upstroke of that upside down you so that the
Speaker 4: rate of infection is slower. What this does is it
Speaker 4: makes it so that the peak, the top point of
Speaker 4: that curve is pushed down. So this could mean potentially
Speaker 4: a prolonged over time course of that epidemic, but the
Speaker 4: rate of infections is slower, which means that a hospitals
Speaker 4: don't get overrun with super sick people all at once.
Speaker 4: And we've said so many times already that this is
Speaker 4: a real major concern in the case of COVID nineteen,
Speaker 4: and it also means that we have more time to
Speaker 4: test and develop both treatments and hopefully a vaccine. So
Speaker 4: flattening the curve is something that can be really useful
Speaker 4: in trying to lessen the overall impact that an epidemic has.
Speaker 4: So you might have heard a bit about this notion
Speaker 4: of herd immunity as a strategy. This is a terrible strategy.
Speaker 3: Fits a terrible strategy.
Speaker 4: It's a terrible an What it is is an unethical
Speaker 4: strategy because it is not a strategy. It's basically saying
Speaker 4: we're not going to do anything. We're going to let
Speaker 4: anyone everyone get infected, and eventually everyone will get infected
Speaker 4: and they'll either die from the infection or they'll become
Speaker 4: resistant because they've developed immunity to that infection. That's not
Speaker 4: an ethical public health strategy to prevent deaths from this disease.
Speaker 4: It's not it's not a strategy, but that is essentially
Speaker 4: what would happen if you were to not do anything
Speaker 4: to try and control this outbreak. Okay, does that make sense? Yeah,
Speaker 4: Because herd immunity is essentially the idea that once enough
Speaker 4: people in a population have been exposed, either through infection
Speaker 4: or through vaccination, then eventually there are so few susceptible
Speaker 4: people left in that population that the pathogen can't spread anymore.
Speaker 4: But that the results of that is a lot of
Speaker 4: people dying.
Speaker 3: Yep. So yes, okay. So this episode, we were fortunate
Speaker 3: enough to interview doctor Critika Kupali, an expert on global
Speaker 3: health security and pandemic preparedness. We asked her all of
Speaker 3: your questions about outbreak control and whether the efforts that
Speaker 3: we are making at national and international scales are going
Speaker 3: to work. We hear from her right after this break.
Speaker 5: I named Kritika Kapali. I'm an infectious to the physician
Speaker 5: I didn't. I training it on University in Atlanta and
Speaker 5: my background is on emerging infection, operate response, pan panic preparedness,
Speaker 5: and global health security. I was the Michael vector for
Speaker 5: a Bowler treatment unit in West Africa during the twenty
Speaker 5: fourteen outbreak, and after that got involved with health system
Speaker 5: strengthening and preparedness responses for emerging infections and currently I'm
Speaker 5: the vice chair of the Infectious Disease Society of America
Speaker 5: Global Health Committee and in that role have been also
Speaker 5: spearheading efforts to develop a global Health Security working group
Speaker 5: focused on the training of frontline workers on the response
Speaker 5: for emerging infections and also just developing best practices for
Speaker 5: treatment of these types.
Speaker 2: Of infections.
Speaker 5: We were doing this actually last year. If that gives
Speaker 5: you an idea of what we were thinking about, Thank
Speaker 5: you so much.
Speaker 3: Well, we're very excited to have your expertise on this podcast.
Speaker 3: Let's start off by asking basically, you know, we know
Speaker 3: that at this point, community transmission in a lot of
Speaker 3: the US is pretty well established. So what can be
Speaker 3: done now to slow that down?
Speaker 5: Yeah, that's a really great question. So we definitely know
Speaker 5: that community transmission is happening. As of today, we know
Speaker 5: that there are seven three hundred and twenty four cases
Speaker 5: in the US and over one hundred deaths, and so
Speaker 5: we just expect those numbers to go up as testing
Speaker 5: capacity increases. And we're really at that point where we
Speaker 5: need to.
Speaker 6: Do things to mitigate transmission. So there are substantial interventions
Speaker 6: that need to be implemented based on the urgency of
Speaker 6: protecting our healthcare systems and also protecting our vole populations.
Speaker 5: So the plans that have an instituted locally, you know,
Speaker 5: may vary place to place, and they're restricting gatherings. The
Speaker 5: White House, the CBC announced this plan for fifteen days
Speaker 5: to stop the coronavirus, where they you know, restricted gatherings
Speaker 5: to less than ten people, encourage working from home or teleworking,
Speaker 5: arranging for distance learning. And you know, there are many
Speaker 5: short term closures occurring all over the country right now,
Speaker 5: and in some places, some of those restrictions are even
Speaker 5: more stringent. You know, where I am in California, we
Speaker 5: have a order to shelter in place, which means really
Speaker 5: just you cannot leave your place unless you need to
Speaker 5: leave for essentral reasons.
Speaker 3: Yeah, I mean, this is this sort of seems like
Speaker 3: in some ways, looking at what's happening in Italy and
Speaker 3: trying to see parallels in other parts of the world,
Speaker 3: especially in the US, it seems like, you know, we're
Speaker 3: a bit behind the curve in terms of implementing some
Speaker 3: of these social distancing or self isolation of practices. And
Speaker 3: I think it's it's challenging too because in states where
Speaker 3: perhaps the case number is currently low, that doesn't mean
Speaker 3: it'll remain low, and I think there's maybe a less vigilance,
Speaker 3: and so I think it seems essential to really practice
Speaker 3: this social social distancing and self isolation everywhere. Is that
Speaker 3: is that sort of what you're thinking is as well?
Speaker 5: Yeah, absolutely right. I think you know, there's certain places
Speaker 5: that have been hit hard, and there are areas that
Speaker 5: you know, quite frankly, I would have thought would have
Speaker 5: been hit hard by something like this. There area, major
Speaker 5: metropolitan area, so areas on the West coast, New York, Washington,
Speaker 5: d C. All those areas are areas that in essence
Speaker 5: you would consider being places at high risk. However, just
Speaker 5: because those areas have been hard hit doesn't mean mean
Speaker 5: that other parts of the country are not at risk
Speaker 5: and they don't need to implement these measures as well,
Speaker 5: because really all it takes is, you know, one person
Speaker 5: and they can spread it to the next person and
Speaker 5: then to the next person, and that's how it propagates.
Speaker 5: And so that's why these measures have been implemented at
Speaker 5: this point in time. Mm hmm.
Speaker 3: You know a lot of different countries, including the US,
Speaker 3: have implemented travel bands or have closed borders. How effective
Speaker 3: is that at this point in time in terms of
Speaker 3: slowing down the disease.
Speaker 5: Yeah, so I think that's a really wonderful question. And
Speaker 5: so I think if you look at you know, what
Speaker 5: modelers do, and you know, we talk about this, you know,
Speaker 5: how effect their travel bands and you know, do they
Speaker 5: prevent infection. You know, overarchingly, the data will show that
Speaker 5: travel bands don't prevent infections. You know, the big lockdown
Speaker 5: that China has back in January that was not necessarily
Speaker 5: to prevent infections from spreading. We could have predicted that,
Speaker 5: you know, this infection was going to spread to the
Speaker 5: rest of the world. But what it has is it
Speaker 5: flows infections right and especially at this point in time,
Speaker 5: we know that the cat is out of the bag,
Speaker 5: so to say, everywhere. But I think one of the
Speaker 5: things that has happened that the travel ban is you
Speaker 5: know what it does is it tries to ease up
Speaker 5: the load on the healthcare system. So by preventing other
Speaker 5: people from coming into the country that may be sick,
Speaker 5: that potentially could be decreasing the load of positive patients
Speaker 5: coming into the country that could have a burd into
Speaker 5: your own healthcare system.
Speaker 3: Mm hmm, gotcha. So these control measures, so closing borders,
Speaker 3: closing school canceling large public meetings, uh, strongly suggesting self isolation,
Speaker 3: or even doing the shelter in place, How can we
Speaker 3: tell whether these strategies are actually working.
Speaker 5: Yeah, So, you know, one way we're going to be
Speaker 5: able to tell that these strategies are working. Is by
Speaker 5: doing what doctor Chadras, the Director General of who said yesterday,
Speaker 5: we need a test, test, test, and the more we
Speaker 5: test and we more we have an idea of what's
Speaker 5: going on in our community, that will give us a
Speaker 5: better idea of what we are doing is working. So
Speaker 5: if we test and we get a better idea of
Speaker 5: what's going on in the community, with time, if these
Speaker 5: measures are working, and hopefully they will, a number of
Speaker 5: positive tests will go down like we have seen in China,
Speaker 5: like we were seeing in South Korea. And that's an
Speaker 5: important thing to do because obviously the point putting these
Speaker 5: measures in place is to see if we can get
Speaker 5: control of what's going on.
Speaker 3: And so you know, based on that and based on
Speaker 3: this test test tests, I mean there's there is a
Speaker 3: lag time where it seems to be a lag time
Speaker 3: between getting as many people tested and then getting the results,
Speaker 3: and you know, there's it's going to take a little
Speaker 3: bit of time. So how soon do you think we'll
Speaker 3: be able to see whether these things are having in effect?
Speaker 5: So I think it's going to be a while, and
Speaker 5: I think people really need to be prepared to be
Speaker 5: inconvenienced for a while you know, there is a model
Speaker 5: and paper that came out of Imperial College earlier this
Speaker 5: week suggesting that we could be in this for the
Speaker 5: rest of the year into next year. And I don't
Speaker 5: think that's an unreasonable thought process, because we need to
Speaker 5: get an idea of the number of cases going on,
Speaker 5: then we need to make sure that we're getting numbers,
Speaker 5: you know, under control. And then once we have a
Speaker 5: better idea of what's going on, getting the numbers under control,
Speaker 5: we really need to think about, Okay, well, how are
Speaker 5: we going to move forward to make sure we don't just,
Speaker 5: you know, all of a sudden, listen all these public
Speaker 5: health measures and then we're back at score one again.
Speaker 5: So I really think that people need to understand that
Speaker 5: this is going to be going on for a while,
Speaker 5: and not just a couple of weeks or a couple
Speaker 5: of months. I think this is something that we need
Speaker 5: to plan for.
Speaker 3: So a lot of comparisons have been made between this epidemic,
Speaker 3: this pandemic and the seasonal flu, and some people, especially
Speaker 3: earlier on in the pandemic, people asked, you know, why
Speaker 3: are we taking such measures to control this if the
Speaker 3: flu is just as deadly, or if the flu is
Speaker 3: so deadly as well.
Speaker 5: Yeah, I think that's a great question. It's one that
Speaker 5: I've been asked a couple of times, and so I think,
Speaker 5: first off, people need to understand that this is not influenza.
Speaker 5: I think the only appropriate comparison to influenza with COVID
Speaker 5: nineteen is that the measures we used to prevent both
Speaker 5: dizzy ESEs are the same, so hands washing, covering your
Speaker 5: respiratory secretions, and if you're six, stay at home. And
Speaker 5: the other appropriate comparison is that they both cause respiratory
Speaker 5: viral illnesses. Beyond that, I think that the comparisons really
Speaker 5: are not appropriate comparisons. You know, first off, that are
Speaker 5: not for flu is about one. So what that means
Speaker 5: is if I have influenza, on average, the number of
Speaker 5: people I'm going to infect is about one person, whereas
Speaker 5: currently the estimates of the are not for COVID nineteen
Speaker 5: is about two to two point five, So that means
Speaker 5: if I'm infected, on average, I'm going to infect two
Speaker 5: to two and a half people. Additionally, the fatality rate
Speaker 5: for influenza is about point and zero five two point
Speaker 5: one percent versus for COVID nineteen. It's estimated to be
Speaker 5: higher at three point four percent. The other thing about
Speaker 5: influenza versus COVID nineteen is the hospitalization rate for influenza
Speaker 5: is about two percent versus the COVID nineteen has been
Speaker 5: shown to be about nineteen percent, and so that is
Speaker 5: a huge difference in the burden that it has on
Speaker 5: our healthcare system. And studies are showing that people who
Speaker 5: are getting admitted for COVID nineteen can be admitted anywhere
Speaker 5: and require hospitalization anywhere from two to six weeks. So
Speaker 5: once people get admitted, they may require prolonged hospitalization. Again
Speaker 5: to taking that burden onto our healthcare system for a
Speaker 5: long time, and as that accumulates, that will become a problem.
Speaker 5: And then the final point I want to make is
Speaker 5: for influenza, we have a vaccine, we have therapeutics, and
Speaker 5: for COVID nineteen, this is a brand new infection that's
Speaker 5: never been circulating in our population. No one's been exposed
Speaker 5: to it before, so we're not quite sure, you know,
Speaker 5: how people are going to respond. We're still learning about
Speaker 5: the transmission dynamics, we're still learning about the clinical course
Speaker 5: of the disease, and we don't have any therapeutics, and
Speaker 5: we don't have a vaccine. So I think people really
Speaker 5: need to start thinking about COVID nineteen as being different.
Speaker 5: It's not the flu. We need to start making the
Speaker 5: comparisons to INFORMZA.
Speaker 3: Those are all excellent points, really well stated. So you know,
Speaker 3: your a lot of your expertise is in pandemic preparedness,
Speaker 3: and so one of the things we wanted to ask
Speaker 3: you was how well you feel the US was prepared
Speaker 3: for an epidemics such as COVID nineteen.
Speaker 5: Yeah, that's you know, that's a hard question.
Speaker 6: You know.
Speaker 5: I think it's always easy to play Monday morning quarterback,
Speaker 5: so to speak, when something happened and you can say, oh,
Speaker 5: well I should have done this, I should have done that,
Speaker 5: and I should have done this.
Speaker 1: Right.
Speaker 5: I think those of us who work in the fields
Speaker 5: have always been concerned that disease like this, what we
Speaker 5: call quote disease X, the unknown disease, was going to emerge.
Speaker 5: And I think that we've always been talking about the
Speaker 5: need to be prepared, and you know, when something like
Speaker 5: this happened, it demonstrates the weaknesses and our preparedness system.
Speaker 5: Do I think that we are more prepared than we
Speaker 5: were back in two thousand and nine during H one
Speaker 5: N one in twenty fourteen during a bullet Yes, do
Speaker 5: I think that we have a further way to go? Yes?
Speaker 5: I think that, you know, when all of a sudden done,
Speaker 5: this outbreak is going to change how we as the
Speaker 5: United States, how we as a global community think about
Speaker 5: tandemic preparedness, and how we think about infectious diseases, because
Speaker 5: which has shown us a lot of things that we
Speaker 5: can do better on.
Speaker 3: Yeah, I've had many conversations talking about how it's really
Speaker 3: challenging for epidemiologists and people who work in you know,
Speaker 3: global health security. It's sort of like you can there's
Speaker 3: only you can either be overprepared or underprepared because everything
Speaker 3: that's going to be evaluated in hindsight and it's going
Speaker 3: to be, oh, you should have done this, you should
Speaker 3: have done that, or oh you it was it wasn't
Speaker 3: necessary to do this and do that. So it's a
Speaker 3: it's sort of there's no winning in this in this
Speaker 3: game sometimes, is what it feels like.
Speaker 5: Yeah, absolutely, Well, it's kind of like being an infectious
Speaker 5: disease doctor, right, so we are the service we bring
Speaker 5: is really valuable. They've done tons of studies showing that
Speaker 5: the value of an infectious disease doctor is great. When
Speaker 5: we take care of patients with various infections, patients do better, right,
Speaker 5: But that doesn't translate into the quote unquote dollars that
Speaker 5: the hospital system see, so they don't necessarily want to
Speaker 5: invest in assets. Almost same analogy here when you're talking
Speaker 5: about preparedness, right, if we're underprepared, then we see all
Speaker 5: the things that happen, right, But if we're over prepared,
Speaker 5: then nobody actually sees what happens. So then if you
Speaker 5: almost have to justify your existence of the things you're doing.
Speaker 3: Mm hmmm, yeah, exactly. So you know so far using
Speaker 3: that hindsight playing the Monday morning quarterback, what are some
Speaker 3: of the important lessons that we learned so far in
Speaker 3: this epidemic, even though it continues to progress, And how
Speaker 3: do you think we can apply that to maybe helping
Speaker 3: us stop the spread of this current pandemic or in
Speaker 3: our preparedness for future pandemics.
Speaker 5: Yeah, I think that's a another really good question. So
Speaker 5: I think one of the things we really need to
Speaker 5: think about is how we develop local and statewide preparedness plans.
Speaker 5: There needs to be coordination between public and private partnerships
Speaker 5: public and private hospital systems. I think that we need
Speaker 5: to have improved communication systems in this day and age
Speaker 5: of electronic communication, how we can better communicate with all
Speaker 5: the different teams that are involved. I think we need
Speaker 5: to have enhanced surveillance systems. We should have been leveraging
Speaker 5: our surveillance systems probably earlier on during this outbreak to
Speaker 5: get a better idea of what was going on with
Speaker 5: this outbreak. I think we need to invest in research
Speaker 5: and development, not just therapeutics and vaccines, but also really
Speaker 5: understanding what the best practices are during an outbreak for
Speaker 5: trying to contain the spread of outbreaks. And we need
Speaker 5: to think about how to stockpile the appropriate medications ppe masks.
Speaker 5: We do have a national stockpile, but I think we
Speaker 5: need to think about how to have regional stockpiles. I
Speaker 5: think we need to think about how we can ramp
Speaker 5: up production of important things that we might need during
Speaker 5: an outbreak. I also think that probably one of the
Speaker 5: most important things is thinking about how long term to
Speaker 5: invest in our healthcare responders, infectious disease physicians, people who
Speaker 5: work in public health. We are a workforce that is understaffed.
Speaker 5: We are a workforce that is the dire need of
Speaker 5: people to go into our workforce, and part of the
Speaker 5: reason people don't go into our workforce is we are
Speaker 5: one of the least all compensated workforces. And so I
Speaker 5: think that's one thing that needs to be thought of
Speaker 5: and needs to be addressed, because obviously there's going to
Speaker 5: be a need for this. This is a need, and
Speaker 5: we need to think about how to sustain our workforce.
Speaker 3: Excellent, Yeah, I think those are really great points. Yet again,
Speaker 3: and so for a lot of this interview, we've kind
Speaker 3: of focused on what's being done in the US at
Speaker 3: a national scale. But you know, what I've seen pop
Speaker 3: up in the news here and there, but doesn't seem
Speaker 3: like there's been enough attention drawn to it. Perhaps is
Speaker 3: the risk of this disease spreading and essentially exploding in
Speaker 3: some countries that may not have the resources to combat
Speaker 3: it the way that a lot of European and North
Speaker 3: American countries do. Can you speak to that at all
Speaker 3: and what kind of risks we're seeing there.
Speaker 5: Yeah, I think that is an absolutely important point. And
Speaker 5: if you go back to when this was declared a
Speaker 5: public health Emergency of International Concern by the WHO. That
Speaker 5: was one of the main points that they made in
Speaker 5: making that declaration at the time, is their concern was
Speaker 5: how this could affect countries that don't have very strong
Speaker 5: health care infrastructures and our resource limited and they really
Speaker 5: wanted to emphasize how important it is that we helped
Speaker 5: try and support those systems. And you know, I always say,
Speaker 5: especially in global health, that we are all as strong
Speaker 5: as our weakest link, and so wherever that country may be,
Speaker 5: we need to help make sure that globally, our healthcare
Speaker 5: systems are strong, our surveillance systems are strong, and we
Speaker 5: have the workforce that is trained to help respond to
Speaker 5: these types of problems. I think if anything that this
Speaker 5: outbreak is shown us is it's very easy for infections
Speaker 5: to spread from country to country. So we need to
Speaker 5: invest in these things globally.
Speaker 3: Absolutely so. In our first episode on coronaviruses, we asked
Speaker 3: each of our experts, you know, what about this disease
Speaker 3: concerns you and what about the response or how we
Speaker 3: have dealt with it so far? Is maybe a you know,
Speaker 3: inspiring or cause for optimism, something about you know, something
Speaker 3: that's a little bit of a silver lining in a way.
Speaker 5: Sure, So I'm going to adjust the first part first.
Speaker 5: So I think the thing that concerns me is what
Speaker 5: we're seeing happening now, which was what I was concerned
Speaker 5: about back in January, that this was going to spread globally,
Speaker 5: that this was going to have a huge effect on
Speaker 5: the healthcare of people worldwide, it was going to affect
Speaker 5: the global economy, and it was going to have long
Speaker 5: lasting repercussions, and I still worry about that. I think
Speaker 5: the other thing I worry about is that it's going
Speaker 5: to have a long term effect on our first responders,
Speaker 5: having been on the front lines of prior epidemics, and
Speaker 5: the mental and emotional toll that it takes when you're
Speaker 5: taking care of this many patients that are this sick
Speaker 5: all the time who end up passing away, has a
Speaker 5: toll on you. And I feel particularly right now for
Speaker 5: the people in China, the people in Italy that are
Speaker 5: seeing this on a mass scale. And so I think
Speaker 5: that's something that hasn't been talked about that we need
Speaker 5: to talk about, and not just the healthcare providers, but
Speaker 5: also the patients. When you ask me what about this,
Speaker 5: reassure me I think it's really been how the scientific
Speaker 5: community has come together. I've been hearing and seeing so
Speaker 5: many stories of people coming together to do for the
Speaker 5: greater good of our community and our patients. And I
Speaker 5: think the stories I hear have just been really wonderful
Speaker 5: and really warmed my heart. People at institutions putting aside
Speaker 5: their own research to try and help get lab testing
Speaker 5: op to capacity, you know, physicians of course, working over
Speaker 5: time to help take care of patients to help try
Speaker 5: and decrease that burden. Some of my colleagues that one institution,
Speaker 5: their division chief is over seventy five and was supposed
Speaker 5: to be on service this week, and they didn't want
Speaker 5: him to be on service with COVID nineteen circulating, so
Speaker 5: they came up with a plan to take over his
Speaker 5: clinical service for him. So I think seeing you know,
Speaker 5: colleagues stepping up everywhere to help take care of each
Speaker 5: other has been really amazing.
Speaker 3: Yeah, that is that is incredible. It's always so inspiring
Speaker 3: to hear these stories of healthcare workers sort of you know,
Speaker 3: who are on the front lines and as you mentioned,
Speaker 3: completely emotionally and physically drained. And I do I agree
Speaker 3: it's not something I've heard talked a lot about yet
Speaker 3: during this current pandemic, and so you know, just a
Speaker 3: moment of appreciation for everyone who's out there fighting this fight.
Speaker 5: Yeah right, No, I think right, that's the message we
Speaker 5: try and get out, right, Like over the weekend, hearing
Speaker 5: from a couple of friends, right, Like, I'm working my
Speaker 5: tail off and then I drive home and I see
Speaker 5: like this bar pack full with people. It's like, why
Speaker 5: am I doing this when you know these people don't
Speaker 5: seem to have any regard or you know, And I
Speaker 5: think it's really trying to make everybody in the world
Speaker 5: understand at this point that you can have a role
Speaker 5: and shifting what's going on, and you are important in
Speaker 5: helping to shift what's going on. It's not just the
Speaker 5: frontline provider, it's not just the support staff. Everybody needs
Speaker 5: to play a role in this. And I think when
Speaker 5: we can empower everybody, that makes such a difference in
Speaker 5: this situation, because all it takes is a couple of
Speaker 5: people or a group of people that will make this
Speaker 5: disease hard to get under control.
Speaker 3: Yeah, I think it is. It is a matter of
Speaker 3: social responsibility, and it is frustrating, you know, to have
Speaker 3: you know. I think I saw an advertisement for a
Speaker 3: bar in Chicago that was like, oh, you know, the
Speaker 3: parade is canceled, but we're still open coming, and it's like,
Speaker 3: how where's the Yeah, what are you doing? Like that's
Speaker 3: completely undermining all of these public health efforts and it's
Speaker 3: sort of being Yeah, it's just like complete disregard for
Speaker 3: all of the hard work that people are doing to
Speaker 3: try to slow down or stop this pandemic.
Speaker 5: Right, absolutely, So one of the things I talked a
Speaker 5: lot about with some of my colleagues is, you know,
Speaker 5: they've done this messaging right, if you're older, you're at risk.
Speaker 5: You're older, you're at risk, which is absolutely appropriate. But
Speaker 5: what younger people don't hear is that they can get it.
Speaker 5: And absolutely young people are getting it. Absolutely young people
Speaker 5: are having adverse events from it. And that's one part
Speaker 5: of it. And then the second part of it is also,
Speaker 5: you know, you can get it and have mild symptoms,
Speaker 5: and then you can be the person that transmits it
Speaker 5: to your grandparents, to your parents, to your other loved ones.
Speaker 5: And how horrible would you feel if that's what happens, right,
Speaker 5: You don't want to be that person, I guess you know,
Speaker 5: especially for someone like myself who has worked in Africa,
Speaker 5: has worked in India. But I think especially having been
Speaker 5: in Africa during vi abola outbreak and like seeing what
Speaker 5: happened with my own eyes, the destruction of the devastation.
Speaker 5: But it's just like here, we're so lucky we have
Speaker 5: when we tell people to stay at home. For most people,
Speaker 5: not everybody. There is of a whole other set of
Speaker 5: issues and people who are disenfranchised and have you know,
Speaker 5: other socioeconomic issues, and we hope we trying to work
Speaker 5: through those to try and get those people safe. But
Speaker 5: if all I'm telling you do is stay at home,
Speaker 5: that's the heart, that heart of the thing to.
Speaker 3: Do right for the people, as you mentioned, who can
Speaker 3: stay at home, who can afford to stay at home,
Speaker 3: you know, the cost of staying at home versus the
Speaker 3: cost of going out and potentially getting infected or you know,
Speaker 3: getting infected and then passing that on to somebody else,
Speaker 3: like those cost you can't even compare those. It's I
Speaker 3: think it's very hard to get that message across, particularly
Speaker 3: when as you as you mentioned it, we've been delayed
Speaker 3: on the response of like, oh, well, you know, young
Speaker 3: people you're you're fine, you're safe from it, and it's like, well,
Speaker 3: you know that you may be at lower risk. However,
Speaker 3: that does not mean that you do not have a
Speaker 3: social responsibility to slow down the spread of this disease.
Speaker 3: So it's it's a hard it's a hard message for
Speaker 3: people to I think, to hear because it's like, wait
Speaker 3: a second, how does this work. So hopefully, you know,
Speaker 3: as this message gets louder and louder, and as we
Speaker 3: understand more about the transmission, this will be something that
Speaker 3: you know will be taken seriously at in all locations
Speaker 3: among all people.
Speaker 5: Well, and the other it's just very quick thing to
Speaker 5: add on to this, right, is that this is information
Speaker 5: based off the Chinese data. Right, we're starting hopefully to
Speaker 5: get information from Europe and other places. And I think
Speaker 5: the point that I guess, the overall point I'm trying
Speaker 5: to make is, you know, we have information in one group,
Speaker 5: one ethnicity of people. And this goes back to your
Speaker 5: idea of your question about why we it's important to
Speaker 5: have you know, information globally on this, right, we know
Speaker 5: that we look at things like race, ethnicity, gender when
Speaker 5: it comes to diseases. So you know, I think it's
Speaker 5: important to get inflammation that's coming out of Europe, getting
Speaker 5: me out of South Korea, coming out of Australia, other countries,
Speaker 5: and what the patient populations look like there, because it
Speaker 5: could be different, And I think that's a really important
Speaker 5: thing people need to keep in mind too.
Speaker 4: That was awesome. I wish that I got to sit
Speaker 4: down on that interview erin I'm bummed to have missed it.
Speaker 5: Well.
Speaker 3: I'm sure that there'll be more opportunities as this continues.
Speaker 4: But we learned a lot, I think from listening to
Speaker 4: that interview.
Speaker 3: So did.
Speaker 4: The first thing that we learned is that some parts
Speaker 4: of the world and some parts of the US have
Speaker 4: already been hit harder than other parts so far. But
Speaker 4: that doesn't mean that any one place is immune to
Speaker 4: the spread of this infection. We've said it before, but
Speaker 4: it bears repeating. Viruses know no borders, So the precautions
Speaker 4: that have been put in place in some areas really
Speaker 4: need to be enacted across the board in order to
Speaker 4: have a big effect. I actually saw a great map
Speaker 4: today that we'll link to that estimated the latest possible
Speaker 4: time that every state needs to implement these measures like
Speaker 4: shelter in place in order to reduce the overall board
Speaker 4: and actually flatten the curve.
Speaker 3: Was it like yesterday, last week for a.
Speaker 4: Lot of states, Yeah, it is like last week or
Speaker 4: the week before, but even in states where there aren't
Speaker 4: a lot of cases, now it's like this week or
Speaker 4: next week.
Speaker 3: Essentially. Yeah, that's I feel like, being completely immersed in
Speaker 3: all of this. That's the one thing that keeps coming
Speaker 3: out is that these things we need to have already done,
Speaker 3: and if we haven't done them yet, we need to
Speaker 3: do them now. That plus social distancing. If you can
Speaker 3: afford to stay at home, stay at home. It is
Speaker 3: your social responsibility.
Speaker 4: I think that's my fifth point, Aaron, Oh.
Speaker 3: Sorry, okay, okay. Well the second point is that big
Speaker 3: large measures like travel bands and so on, they don't
Speaker 3: necessarily make it so that infection isn't going to happen,
Speaker 3: and they don't fully prevent the spread, but they can
Speaker 3: help to slow the spread of infection. So it's a
Speaker 3: more nuanced discussion, I think than a black and white picture. However,
Speaker 3: and this one is super important. This is not an
Speaker 3: excuse for racism. No, there has been and there continues
Speaker 3: to be, way way, way too much racism going around.
Speaker 3: This is not a Chinese virus. This is a global
Speaker 3: phenomenon that could have originated literally anywhere, and now it's
Speaker 3: everywhere and anyone and everyone. No matter what you look
Speaker 3: like or sound like, no matter your gender, religion, skin color,
Speaker 3: or anything else. Anyone can be infected, and anyone could
Speaker 3: pass this virus onto others. That's how viruses work. There
Speaker 3: are rules for naming that a who has put into
Speaker 3: place since twenty fifteen, a whole crew of experts with
Speaker 3: probably over one hundred or at least decades of years
Speaker 3: of experience and a way more nuanced understanding of naming
Speaker 3: rules and the social impact or stigmatizing impact that certain
Speaker 3: names can have on diseases. This wasn't just a random
Speaker 3: decision made. This was a very carefully thought out list
Speaker 3: of rules for why we name diseases the way we
Speaker 3: name them now.
Speaker 4: Major number three. Another important thing we learned. This is
Speaker 4: not the flu. I mean, we knew that, especially if
Speaker 4: you listened to chapter two, But this has been some
Speaker 4: people still saying this in the media, some people in
Speaker 4: the US. So the infection that SARS CoV two can
Speaker 4: cause the disease we know of as COVID nineteen, so
Speaker 4: far as we can tell, has a higher case fatality rate,
Speaker 4: even in the best case scenarios that we've seen so far.
Speaker 4: It also has a much higher hospitalization rate. And we've
Speaker 4: talked so many times that a large part of the
Speaker 4: need to flatten the curve is to reduce the strain
Speaker 4: on our healthcare systems, because if people can't get in
Speaker 4: to seek medical care, if they get really ill, or
Speaker 4: if people can't go to the hospital for any other
Speaker 4: reasons because the hospitals are full of COVID nineteen patients,
Speaker 4: then this this becomes even more controllable and tragic. And
Speaker 4: unlike influenza, we don't have any immunity to this virus whatsoever.
Speaker 4: If you have ever gotten the flu or ever gotten
Speaker 4: your flu shot, which of course all of our listeners
Speaker 4: are up to date on their flu shots, then you
Speaker 4: have the potential at least some ability to fight off
Speaker 4: a new influenza infection. You have some kind of immunity,
Speaker 4: But with this we've got nothing.
Speaker 3: Number four on our list of things that we can
Speaker 3: take away from this conversation is that we currently are
Speaker 3: and have been for a long time, under resourced for
Speaker 3: an outbreak like this, and this outbreak in particular even
Speaker 3: here in the US, and this has direct implications on
Speaker 3: just how bad an outbreak gets. So we need to
Speaker 3: continue to invest in communication, coordination and surveillance efforts, not
Speaker 3: only early on in outbreaks, but all all the time,
Speaker 3: so that we can pick up on outbreaks early enough
Speaker 3: in the process to really be able to prevent these
Speaker 3: kinds of events in the future. Emergency preparedness, global health security,
Speaker 3: but on national and international scales. It's something that we
Speaker 3: need to invest more in. And this is something that
Speaker 3: we talked about even in that very first coronavirus episode
Speaker 3: back in early February. This is something that epidemiologists and
Speaker 3: people who work in international health have been saying for
Speaker 3: years and years and years. We need more funding because,
Speaker 3: especially in countries that may not have the resources to
Speaker 3: do the surveillance that is necessary to detect novel or
Speaker 3: emerging pathogens. Like I think, as doctor Capoli says, our
Speaker 3: international public health is only as strong as the weakest link,
Speaker 3: and we all need to strengthen that because otherwise we
Speaker 3: have something that is going to spill over time and time. Again,
Speaker 3: as I said in the first coronavirus episode. This is
Speaker 3: not a new pattern. This is not something that has
Speaker 3: a unique event. This is something that has happened before
Speaker 3: and very much has the potential to happen again, but
Speaker 3: with a different virus that once again we are unprepared
Speaker 3: and unable to detect, or test or treat.
Speaker 4: Exactly the last thing. Number five, and I think the
Speaker 4: most important takeaway points from probably any of our episodes.
Speaker 4: We've said it before. We all have a social responsibility
Speaker 4: at this point to do what we can to help
Speaker 4: prevent the spread of this infection. This isn't someone else's problem.
Speaker 4: This is all of our problems, and we all have
Speaker 4: the ability to help in some capacity. Staying home that's helping,
Speaker 4: because the thing is not everyone can stay home. Our
Speaker 4: healthcare workers are on the front lines, not only going
Speaker 4: into work every day, but literally putting their bodies in
Speaker 4: between this infection and the rest of the world. And
Speaker 4: it's not only healthcare workers. Lots of people have to
Speaker 4: keep going to work in order for us all to
Speaker 4: be able to survive. Right people who work at grocery stores,
Speaker 4: emergency services, public transit, food production. These people have to
Speaker 4: be out and going to work, and the other thing
Speaker 4: is that for so many people, staying home means they're
Speaker 4: not making any money. So for people who live not
Speaker 4: just paycheck to paycheck, but shift to shift, and that's
Speaker 4: a lot of people. For them to stay at home
Speaker 4: and lose out on paychecks because everything is closed and
Speaker 4: they can't go back to work, this has a massive
Speaker 4: impact on people's lives and livelihoods. Staying home for a
Speaker 4: lot of people means they're at risk of losing or
Speaker 4: in many cases have already lost their jobs and maybe
Speaker 4: even their health insurance. And in this country, in the
Speaker 4: US especially, this pandemic I think is really exposing the
Speaker 4: massive holes in our social safety net.
Speaker 3: I mean, do we even have a social safety net?
Speaker 2: Yeah?
Speaker 4: I mean do we really like? It's it's really atrocious.
Speaker 4: And the longer this outbreak last, the larger this impact
Speaker 4: is going to be. So the best thing that we
Speaker 4: can try and do is to just stay home and
Speaker 4: help stop the spread.
Speaker 3: Of this virus. Well put thank you sources.
Speaker 4: Sources.
Speaker 3: So we just have one here, and this is the
Speaker 3: one that we referenced in the interview with doctor Capoli,
Speaker 3: and this is by Ferguson at All Report nine. So
Speaker 3: this is that famous or notorious. I guess Imperial College
Speaker 3: of London report that came out last week that talked
Speaker 3: about the various strategies for controlling the spread of this
Speaker 3: virus and the various outcomes depending on which strategy we use,
Speaker 3: whether no control, mitigation or suppression.
Speaker 4: Also, we'll also put a link on our website to
Speaker 4: that map that I mentioned as well. It's pretty cool interct.
Speaker 3: And if we can find the jiff of that. And
Speaker 3: then there's a really cool jiff gif of the lightning
Speaker 3: the curve illustration. I saw it. It's really good kind
Speaker 3: of I don't know if you've seen that rolling around
Speaker 3: on Twitter.
Speaker 4: Well, my favorite one is the cattening the curve.
Speaker 3: Oh my god, Yeah, I've seen that one too. I
Speaker 3: was like, what did you miss speak?
Speaker 4: No, I didn't ask me the curve anyways.
Speaker 3: Anyways, Okay, thank you again so very much to doctor Capouli.
Speaker 3: We really appreciate you taking the time to chat with us.
Speaker 4: Yeah, thank you so much. And thank you to Bloodmobile
Speaker 4: for providing the music for this episode in all of
Speaker 4: our episodes.
Speaker 3: And thank you to you listeners who have stuck with
Speaker 3: us through episode three of this Anatomy of a pandemic.
Speaker 3: You've got more coming strap in Okay, Well, until next time,
Speaker 3: wash your hands.
Speaker 7: You filled the animals.
Speaker 4: H u h