WEBVTT - This is How We End It 0:00:04.920 --> 0:00:10.840 Welcome to Prognosis. I'm Laura Carlson. It's state since coronavirus 0:00:10.920 --> 0:00:15.160 was declared a global pandemic on today's show. With COVID 0:00:15.240 --> 0:00:19.560 nineteen crippling much of the world, there's intense uncertainty about 0:00:19.560 --> 0:00:23.360 what's next for global societies. In the United States, it's 0:00:23.360 --> 0:00:26.880 hard to envision when the economy and our lives will 0:00:26.920 --> 0:00:30.560 get back to normal. But it turns out there is 0:00:30.600 --> 0:00:32.720 a plan to beat the virus and to get the 0:00:32.720 --> 0:00:36.680 country back to work. The question is whether the government 0:00:36.680 --> 0:00:47.720 will follow it. But first, here's what happened today. New 0:00:47.800 --> 0:00:51.920 York Governor Andrew Cuomo said COVID nineteen deaths seem to 0:00:51.920 --> 0:00:55.520 be hitting a plateau. The state has become the epicenter 0:00:55.720 --> 0:00:59.080 of the u S outbreak. Cuomo says measures to lock 0:00:59.160 --> 0:01:01.720 down the state have started to work, but that the 0:01:01.800 --> 0:01:05.440 challenge is to maintain social distancing. For two days in 0:01:05.480 --> 0:01:07.640 a row, the death toll has been about the same 0:01:08.520 --> 0:01:12.440 for over a week, they had been increasing daily. If 0:01:12.480 --> 0:01:16.039 we are plateauing, we are plateauing at a very high level, 0:01:16.319 --> 0:01:19.960 and this tremendous stress on the healthcare system. There are 0:01:20.000 --> 0:01:24.560 also more signs that the crisis may be easing In Europe, Italy, France, 0:01:24.680 --> 0:01:28.759 Germany and Spain all reported lower numbers of new cases, 0:01:29.160 --> 0:01:32.280 and the Netherlands had the smallest increase in deaths in 0:01:32.319 --> 0:01:38.160 a week. Austria took the first steps towards restarting its economy. However, 0:01:38.440 --> 0:01:42.160 the news on Monday wasn't all positive. UK Prime Minister 0:01:42.240 --> 0:01:46.560 Boris Johnson, who had previously tested positive for coronavirus, was 0:01:46.640 --> 0:01:50.080 taken to a London hospital over the weekend. On Monday, 0:01:50.400 --> 0:01:53.640 Johnson was moved to an intensive care unit after his 0:01:53.720 --> 0:01:58.760 condition worsened. From the economic perspective, there's little doubt we're 0:01:58.760 --> 0:02:02.120 in for a deep recession. That's according to Jamie Diamond, 0:02:02.360 --> 0:02:05.280 CEO of j P Morgan Chase, who said in his 0:02:05.400 --> 0:02:08.720 annual letter to shareholders that the economic downturn we have 0:02:08.800 --> 0:02:12.360 in store will mirror the meltdown after the two thousand 0:02:12.400 --> 0:02:18.800 eight financial crisis. Finally, imports of an unapproved drug touted 0:02:18.840 --> 0:02:23.160 by President Donald Trump have just taken a major hit. India, 0:02:23.400 --> 0:02:26.200 which makes roughly half the supply of the malaria drug 0:02:26.400 --> 0:02:30.760 hydroxy chloroquin, banned its exports Monday to ensure enough supply 0:02:30.840 --> 0:02:34.679 for domestic use. The president had called the drug a 0:02:34.800 --> 0:02:38.640 game changer in treating coronavirus, even though there's no conclusive 0:02:38.680 --> 0:02:42.040 scientific evidence that it can treat the infection caused by 0:02:42.040 --> 0:02:45.720 the novel coronavirus. The drug also hasn't been approved to 0:02:45.760 --> 0:02:48.760 treat COVID nineteen by the U S Food and Drug Administration. 0:02:49.520 --> 0:03:00.800 Trump's endorsement had caused global stockpiling of the medication. Now 0:03:00.840 --> 0:03:07.200 for today's main story, former f d A Commissioner Scott 0:03:07.200 --> 0:03:10.760 Gottlieb is concerned that the unfolding crisis in New York City, 0:03:11.240 --> 0:03:14.760 the epicenter of the coronavirus in America, could be replicated 0:03:14.880 --> 0:03:18.800 in other cities across the country. Gottlieb, a physician and 0:03:18.919 --> 0:03:22.320 informal adviser to the Trump administration, has been sounding the 0:03:22.400 --> 0:03:25.560 alarm on the US federal government's need to prepare for 0:03:25.600 --> 0:03:29.919 a domestic outbreak of the novel coronavirus since late January. 0:03:30.440 --> 0:03:33.680 He told Bloomberg's Anna Edney that although the pandemic will 0:03:33.720 --> 0:03:36.560 get worse before it gets better, he has a plan 0:03:36.720 --> 0:03:41.280 to help prevent further spread of the disease. Gottlieb starts 0:03:41.280 --> 0:03:43.720 out by talking about what he thinks of the White 0:03:43.720 --> 0:03:47.120 House response to coronavirus and what they could have done 0:03:47.160 --> 0:03:50.160 differently earlier this year when there were just a few 0:03:50.240 --> 0:03:54.800 known cases in the country. Well, look, I think that 0:03:54.800 --> 0:03:57.360 there's going to be a lot of time to UM 0:03:57.560 --> 0:04:00.160 look back with. People are gonna be writing books about 0:04:00.240 --> 0:04:02.560 this episode for the next hundred years. This is really 0:04:02.560 --> 0:04:06.960 a historic period of time. I think they've been worried 0:04:06.960 --> 0:04:09.920 about this as as long as I've been engaged with them, 0:04:09.920 --> 0:04:13.880 in the conversations that I've been talking to them about this. UM. 0:04:13.960 --> 0:04:16.640 They started to take action in January. You know, the 0:04:16.680 --> 0:04:19.880 stuff that I thought they should do in January, and 0:04:20.080 --> 0:04:22.880 I thought they should do in February. I wrote about 0:04:22.960 --> 0:04:25.479 January and February, so you know, I was on the 0:04:25.520 --> 0:04:29.200 record talking about things that I thought should have gotten 0:04:29.240 --> 0:04:33.719 done with respect to the screening, the diagnostic screening. I'm 0:04:33.720 --> 0:04:36.200 talking a lot now about things I'd like to see 0:04:36.480 --> 0:04:39.960 with respect to a more deliver strategy with with respect 0:04:40.000 --> 0:04:48.000 to the development of therapeutics and drugs. And it's hard 0:04:48.040 --> 0:04:51.720 for me to know everything that went on on the inside. Um. 0:04:51.760 --> 0:04:54.440 You know, I'm sure that they struggled with trying to 0:04:54.480 --> 0:04:57.640 get more testing capacity out sooner, but the bottom line 0:04:57.720 --> 0:05:00.600 is that we were. We were dependent upon epide neological 0:05:00.720 --> 0:05:06.080 surveillance data into February that was imprecise, so you know, 0:05:06.120 --> 0:05:09.760 there was the the um possibility that you could have 0:05:09.839 --> 0:05:12.719 hundreds of cases and probably low thousands, and you wouldn't 0:05:12.760 --> 0:05:17.160 necessarily detect it, And at epidemiological surveillance data was backward looking. 0:05:17.200 --> 0:05:20.279 You would depend upon looking at admissions to the hospitals 0:05:20.360 --> 0:05:22.080 or the e d S, people who showed up for 0:05:22.200 --> 0:05:25.080 respiratory illness, people who showed up with influenza like illness 0:05:25.120 --> 0:05:27.800 but tested negative for flu. That was always a week 0:05:27.839 --> 0:05:29.840 old because that data gets reported at the end of 0:05:29.880 --> 0:05:33.400 every week. So if you did have a outbreak in 0:05:33.480 --> 0:05:38.120 this country that was sufficiently small, you weren't going to 0:05:38.480 --> 0:05:41.080 detect it in a timely fashion. And that's what happened 0:05:41.080 --> 0:05:43.039 in Seattle, and it's probably what happened in New York 0:05:43.080 --> 0:05:45.600 as well now looking back at the data. So when 0:05:45.600 --> 0:05:47.279 you look at the data New York and you look 0:05:47.279 --> 0:05:49.880 in early March, you start to see a signal in 0:05:49.880 --> 0:05:54.120 the influenza like illness surveillance system that people were presenting 0:05:54.200 --> 0:05:57.720 with influenza like symptoms at a time when flu rates 0:05:57.720 --> 0:06:00.600 were going back to baseline. That was probably an indication 0:06:00.640 --> 0:06:04.760 that coronavirus was circulating. Probably had an introduction of coronavirus 0:06:04.839 --> 0:06:07.559 at some point in early January. I think he dated 0:06:07.600 --> 0:06:11.039 it to like January twelve or thereabouts. And that cluster 0:06:11.600 --> 0:06:13.880 that was a single spark that that lit a fire, 0:06:14.440 --> 0:06:17.440 and it grew and it kept growing, and when it 0:06:17.480 --> 0:06:20.920 reached hundreds of cases, suddenly it started to throw off 0:06:20.960 --> 0:06:23.760 other sparks. And you saw the events in the nursing home. 0:06:23.880 --> 0:06:27.599 You saw that young gentlemen present with flu like symptoms 0:06:27.600 --> 0:06:30.360 who got diagnosed with coronavirus, and so it became apparent 0:06:30.440 --> 0:06:33.159 that there was an outbreak in Seattle. What happened in 0:06:33.160 --> 0:06:35.800 New York by comparison, and we won't know this, We 0:06:35.880 --> 0:06:38.599 might never know this, but this is sort of conjecture, 0:06:39.240 --> 0:06:42.120 is New York wasn't a single introduction that lit a fire. 0:06:42.200 --> 0:06:46.000 New York was maybe dozens of introductions, dozens of sparks 0:06:46.000 --> 0:06:48.760 that each lit their own fires, and they all grew, 0:06:49.200 --> 0:06:51.480 and they were all small clusters, and then they all 0:06:51.520 --> 0:06:53.440 became apparent at the same time, so that by the 0:06:53.480 --> 0:06:55.400 time you discovered there was spread in New York, there 0:06:55.440 --> 0:06:58.919 wasn't one large cluster expanding. There were dozens of small 0:06:58.960 --> 0:07:01.480 clusters all expanding, and at that point it was too 0:07:01.560 --> 0:07:04.560 late to do much to mitigate the risk short of 0:07:04.600 --> 0:07:07.760 the population type mitigation. And I worry that that's what 0:07:07.800 --> 0:07:11.240 other cities are going to experience now, that other cities 0:07:11.240 --> 0:07:13.600 aren't going to be one or two or half a 0:07:13.640 --> 0:07:17.120 dozen introductions that lead to clusters that are expanding, but 0:07:17.160 --> 0:07:20.360 they're gonna be many introductions, and maybe even more than 0:07:20.360 --> 0:07:23.440 New York, because while New York was probably seated from 0:07:23.440 --> 0:07:25.800 people coming over from Italy and maybe China and other 0:07:25.840 --> 0:07:28.760 parts of the world, UM, Florida was seated from New 0:07:28.800 --> 0:07:31.760 York and Seattle, and you know, Chicago was seated from 0:07:31.760 --> 0:07:36.280 New York and Seattle and Massachusetts and southern California and 0:07:36.320 --> 0:07:38.680 northern California. So the other cities that are going to 0:07:38.760 --> 0:07:43.520 experience this epidemic later weren't seated from foreign travelers. They 0:07:43.560 --> 0:07:46.240 was seated by domestic travelers. And the magnitude of the 0:07:46.280 --> 0:07:49.440 seating that could have gone on from domestic travel as 0:07:49.440 --> 0:08:04.800 opposed to foreign travel was probably far greater. Certainly, the 0:08:04.880 --> 0:08:08.720 DC metro area looks very concerning, Miami looks very concerning, 0:08:08.920 --> 0:08:13.080 UM New Orleans looks very concerning. Some of the states. 0:08:13.160 --> 0:08:15.320 Some of the city is in the northeast look concerning 0:08:15.320 --> 0:08:19.560 as well, Philadelphia, Detroit, Boston. But those states did implement 0:08:19.600 --> 0:08:22.680 mitigation steps much earlier, and more aggressive mitigation steps, so 0:08:22.720 --> 0:08:26.240 you hope you're going to see the the the benefits 0:08:26.240 --> 0:08:28.480 of that coming through pretty soon. But in the states 0:08:28.520 --> 0:08:31.200 that didn't implement those mitigation steps early and have the 0:08:31.280 --> 0:08:34.000 same level of spread and the same level of positivity, 0:08:34.160 --> 0:08:37.200 meaning people who get tested are positive at a very 0:08:37.280 --> 0:08:40.280 high rate and are under screening, I think you worry 0:08:40.320 --> 0:08:44.280 a lot about those UM those areas, and the Southeast 0:08:44.320 --> 0:08:48.679 in particular, I think is is particularly suspect they're under testing. 0:08:49.320 --> 0:08:52.719 They have rapid growth in cases UM, and when they 0:08:52.760 --> 0:09:00.800 do test, they're getting back a lot of positives. They 0:09:00.800 --> 0:09:03.600 had an opportunity to implement mitigation steps and really avert 0:09:03.679 --> 0:09:05.920 a bad outcome in those cities and didn't didn't take 0:09:05.920 --> 0:09:08.680 that opportunity. And some of them may get lucky and 0:09:09.160 --> 0:09:13.080 escape UM significant outbreaks and epidemics, but some of them 0:09:13.080 --> 0:09:15.920 may not. And I think by and large, whether or 0:09:15.960 --> 0:09:19.680 not we reach some of the grim statistics that were 0:09:19.720 --> 0:09:22.760 in Tony Fauci's model, where he was estimated that there 0:09:22.760 --> 0:09:25.199 could be two d thousand deaths and more. I think 0:09:25.200 --> 0:09:27.200 it's not going to turn on what happens in New York. 0:09:27.240 --> 0:09:28.880 I think we have a pretty good handle of what 0:09:28.960 --> 0:09:30.640 New York is gonna look like and when New York 0:09:30.679 --> 0:09:33.520 is going to turn the corner and the overall morbidity 0:09:33.559 --> 0:09:36.720 and mortality that the city is gonna experience. As tragic 0:09:36.760 --> 0:09:38.640 as it is, I think we kind of understand where 0:09:38.640 --> 0:09:41.520 the backstop is there, where the end is. At this point, 0:09:41.760 --> 0:09:43.640 I think it's gonna turn on what happens in Texas 0:09:43.720 --> 0:09:48.840 and what happens in Florida. Populous states, Georgia, populated states 0:09:48.960 --> 0:09:51.560 that were slow to implement mitigation steps could have been 0:09:51.600 --> 0:09:55.160 heavily seated, and they have very large epidemics. And Florida 0:09:55.200 --> 0:09:57.559 has the potential to eclipse New York in terms of 0:09:57.880 --> 0:10:01.320 the morbidity it sustains from this virus, given the demographics 0:10:01.320 --> 0:10:02.880 of the state, given the kind of growth that we're 0:10:02.920 --> 0:10:06.160 seeing right now, If they end up having very large epidemics, 0:10:06.200 --> 0:10:08.000 I think that's going to drive towards some of the 0:10:08.040 --> 0:10:11.560 more grim statistics that Tony Faucci and others were putting forward. 0:10:11.559 --> 0:10:23.200 In some of those models, I think what we need 0:10:23.240 --> 0:10:26.920 to appreciate, is, you know, absent a technology here, absent 0:10:27.000 --> 0:10:30.120 a drug therapeutic or or a number of drugs that 0:10:30.240 --> 0:10:32.360 really starts to make a very big difference in the 0:10:32.400 --> 0:10:34.719 morbidity and mortality of this. And I think we can 0:10:34.760 --> 0:10:36.880 get that. I think I think we should be focused 0:10:36.960 --> 0:10:39.600 much more on the development of the therapeutic than we are, 0:10:39.640 --> 0:10:41.680 and I think we should have a very very deliberate 0:10:41.679 --> 0:10:43.760 industrial policy towards that. I think we should have sort 0:10:43.760 --> 0:10:46.640 of a Manhattan style project. We seem to be focused 0:10:46.640 --> 0:10:48.840 on the vaccine and have sort of an industrial approach 0:10:48.880 --> 0:10:51.000 to the vaccine when you see the government working very 0:10:51.040 --> 0:10:53.400 closely with vaccine developers, and we don't have the same 0:10:53.400 --> 0:10:56.000 approach on a drug. And I find that odd because 0:10:56.040 --> 0:10:58.120 the drug is really the near term opportunity and and 0:10:58.120 --> 0:10:59.920 and the therapeutic is the only thing that's going to 0:11:00.040 --> 0:11:02.280 make a difference in the fall and prevent this from 0:11:02.280 --> 0:11:05.320 being something that really changes the way we live going 0:11:05.360 --> 0:11:09.040 forward until we get to a vaccine, but absent the therapeutic, 0:11:09.840 --> 0:11:13.679 I think April late April, early May, the epidemics running 0:11:13.679 --> 0:11:17.360 its course nationally. May as a transition month. June, we 0:11:17.440 --> 0:11:20.320 start to lift some of these restrictions, and I hope 0:11:20.600 --> 0:11:23.240 that in July and August the virus sort of collapses. 0:11:23.480 --> 0:11:25.120 That's kind of what happened if you remember back in 0:11:25.160 --> 0:11:28.240 two thousand and nine with the swine flow. The swine 0:11:28.240 --> 0:11:31.120 flow continued to circulate into June, which was very unusual 0:11:31.160 --> 0:11:34.000 for flow. Flus don't usually propagate a summer. But it 0:11:34.040 --> 0:11:36.480 was so novel. People had no cross community to it. 0:11:36.640 --> 0:11:39.000 They were susceptible to it that it continued to spread 0:11:39.000 --> 0:11:41.240 into June, and then in July and August it just 0:11:41.280 --> 0:11:43.320 sort of collapsed. It. It just went away, and then 0:11:43.320 --> 0:11:46.000 it was back in September. If you remember, summer camps 0:11:46.000 --> 0:11:47.720 were canceled, but some of them had it. There were 0:11:47.760 --> 0:11:49.960 some outbreaks and some summer camps and they would close, 0:11:50.360 --> 0:11:53.959 but it by and large um really dissipated in July 0:11:54.000 --> 0:12:02.720 and August in this sort of hot summer months. Some 0:12:02.800 --> 0:12:04.640 things will never get back to normal. I don't think 0:12:04.679 --> 0:12:07.320 we'll be shaking hands as much anymore. I think you 0:12:07.400 --> 0:12:11.080 might see masks become more accepted in our culture the 0:12:11.120 --> 0:12:13.319 way they are in some some Asian cultures. I think 0:12:13.320 --> 0:12:15.920 the idea of crowding ten thousand people into a ballroom 0:12:15.960 --> 0:12:18.439 for a conference might go away. You might have small 0:12:18.480 --> 0:12:21.160 conferences that you live stream. Things are going to change. 0:12:21.200 --> 0:12:24.400 You might see ultra violet light in walkways and airports 0:12:24.600 --> 0:12:28.520 because it kills viruses. You're gonna see airlines advertised deep cleanings, 0:12:28.520 --> 0:12:30.480 and Uber is going to talk about how they clean 0:12:30.559 --> 0:12:42.080 cars in between passengers. You're gonna see things differently. That 0:12:42.240 --> 0:12:45.880 was former FDH chair Scott Gottlie talking about what the 0:12:45.920 --> 0:12:50.760 future is for this pandemic and for us. That's it 0:12:50.840 --> 0:12:54.280 for the Prognosis Daily Edition. For more on the coronavirus 0:12:54.280 --> 0:12:56.720 crisis from a hundred and twenty bureaus around the world, 0:12:57.200 --> 0:13:02.000 visit Bloomberg dot com slash coronavius IRUs. If you appreciate 0:13:02.000 --> 0:13:04.560 the podcast, please take a moment to rate us and 0:13:04.640 --> 0:13:08.040 leave us a review on Apple Podcasts or Spotify to 0:13:08.120 --> 0:13:12.480 help more listeners find our global reporting. The Prognosis Daily 0:13:12.600 --> 0:13:15.719 Edition is hosted by me Laura Carlson. The show is 0:13:15.760 --> 0:13:20.640 produced by me tophor Foreheaz, Jordan Gaspore and Magnus Hendrickson. 0:13:21.320 --> 0:13:26.200 Additional reporting by Anna Edney. Original music by Leo Sidrian. 0:13:26.880 --> 0:13:31.520 Our editors are Francesca Levi and Rick Shine Francesca Levi 0:13:31.920 --> 0:13:35.160 is Bloomberg's head of podcasts. Thanks for listening.