Speaker 1: Welcome to Prognosis. I'm Laura Carlson. It's state since coronavirus
Speaker 1: was declared a global pandemic on today's show. With COVID
Speaker 1: nineteen crippling much of the world, there's intense uncertainty about
Speaker 1: what's next for global societies. In the United States, it's
Speaker 1: hard to envision when the economy and our lives will
Speaker 1: get back to normal. But it turns out there is
Speaker 1: a plan to beat the virus and to get the
Speaker 1: country back to work. The question is whether the government
Speaker 1: will follow it. But first, here's what happened today. New
Speaker 1: York Governor Andrew Cuomo said COVID nineteen deaths seem to
Speaker 1: be hitting a plateau. The state has become the epicenter
Speaker 1: of the u S outbreak. Cuomo says measures to lock
Speaker 1: down the state have started to work, but that the
Speaker 1: challenge is to maintain social distancing. For two days in
Speaker 1: a row, the death toll has been about the same
Speaker 1: for over a week, they had been increasing daily. If
Speaker 1: we are plateauing, we are plateauing at a very high level,
Speaker 1: and this tremendous stress on the healthcare system. There are
Speaker 1: also more signs that the crisis may be easing In Europe, Italy, France,
Speaker 1: Germany and Spain all reported lower numbers of new cases,
Speaker 1: and the Netherlands had the smallest increase in deaths in
Speaker 1: a week. Austria took the first steps towards restarting its economy. However,
Speaker 1: the news on Monday wasn't all positive. UK Prime Minister
Speaker 1: Boris Johnson, who had previously tested positive for coronavirus, was
Speaker 1: taken to a London hospital over the weekend. On Monday,
Speaker 1: Johnson was moved to an intensive care unit after his
Speaker 1: condition worsened. From the economic perspective, there's little doubt we're
Speaker 1: in for a deep recession. That's according to Jamie Diamond,
Speaker 1: CEO of j P Morgan Chase, who said in his
Speaker 1: annual letter to shareholders that the economic downturn we have
Speaker 1: in store will mirror the meltdown after the two thousand
Speaker 1: eight financial crisis. Finally, imports of an unapproved drug touted
Speaker 1: by President Donald Trump have just taken a major hit. India,
Speaker 1: which makes roughly half the supply of the malaria drug
Speaker 1: hydroxy chloroquin, banned its exports Monday to ensure enough supply
Speaker 1: for domestic use. The president had called the drug a
Speaker 1: game changer in treating coronavirus, even though there's no conclusive
Speaker 1: scientific evidence that it can treat the infection caused by
Speaker 1: the novel coronavirus. The drug also hasn't been approved to
Speaker 1: treat COVID nineteen by the U S Food and Drug Administration.
Speaker 1: Trump's endorsement had caused global stockpiling of the medication. Now
Speaker 1: for today's main story, former f d A Commissioner Scott
Speaker 1: Gottlieb is concerned that the unfolding crisis in New York City,
Speaker 1: the epicenter of the coronavirus in America, could be replicated
Speaker 1: in other cities across the country. Gottlieb, a physician and
Speaker 1: informal adviser to the Trump administration, has been sounding the
Speaker 1: alarm on the US federal government's need to prepare for
Speaker 1: a domestic outbreak of the novel coronavirus since late January.
Speaker 1: He told Bloomberg's Anna Edney that although the pandemic will
Speaker 1: get worse before it gets better, he has a plan
Speaker 1: to help prevent further spread of the disease. Gottlieb starts
Speaker 1: out by talking about what he thinks of the White
Speaker 1: House response to coronavirus and what they could have done
Speaker 1: differently earlier this year when there were just a few
Speaker 1: known cases in the country. Well, look, I think that
Speaker 1: there's going to be a lot of time to UM
Speaker 1: look back with. People are gonna be writing books about
Speaker 1: this episode for the next hundred years. This is really
Speaker 1: a historic period of time. I think they've been worried
Speaker 1: about this as as long as I've been engaged with them,
Speaker 1: in the conversations that I've been talking to them about this. UM.
Speaker 1: They started to take action in January. You know, the
Speaker 1: stuff that I thought they should do in January, and
Speaker 1: I thought they should do in February. I wrote about
Speaker 1: January and February, so you know, I was on the
Speaker 1: record talking about things that I thought should have gotten
Speaker 1: done with respect to the screening, the diagnostic screening. I'm
Speaker 1: talking a lot now about things I'd like to see
Speaker 1: with respect to a more deliver strategy with with respect
Speaker 1: to the development of therapeutics and drugs. And it's hard
Speaker 1: for me to know everything that went on on the inside. Um.
Speaker 1: You know, I'm sure that they struggled with trying to
Speaker 1: get more testing capacity out sooner, but the bottom line
Speaker 1: is that we were. We were dependent upon epide neological
Speaker 1: surveillance data into February that was imprecise, so you know,
Speaker 1: there was the the um possibility that you could have
Speaker 1: hundreds of cases and probably low thousands, and you wouldn't
Speaker 1: necessarily detect it, And at epidemiological surveillance data was backward looking.
Speaker 1: You would depend upon looking at admissions to the hospitals
Speaker 1: or the e d S, people who showed up for
Speaker 1: respiratory illness, people who showed up with influenza like illness
Speaker 1: but tested negative for flu. That was always a week
Speaker 1: old because that data gets reported at the end of
Speaker 1: every week. So if you did have a outbreak in
Speaker 1: this country that was sufficiently small, you weren't going to
Speaker 1: detect it in a timely fashion. And that's what happened
Speaker 1: in Seattle, and it's probably what happened in New York
Speaker 1: as well now looking back at the data. So when
Speaker 1: you look at the data New York and you look
Speaker 1: in early March, you start to see a signal in
Speaker 1: the influenza like illness surveillance system that people were presenting
Speaker 1: with influenza like symptoms at a time when flu rates
Speaker 1: were going back to baseline. That was probably an indication
Speaker 1: that coronavirus was circulating. Probably had an introduction of coronavirus
Speaker 1: at some point in early January. I think he dated
Speaker 1: it to like January twelve or thereabouts. And that cluster
Speaker 1: that was a single spark that that lit a fire,
Speaker 1: and it grew and it kept growing, and when it
Speaker 1: reached hundreds of cases, suddenly it started to throw off
Speaker 1: other sparks. And you saw the events in the nursing home.
Speaker 1: You saw that young gentlemen present with flu like symptoms
Speaker 1: who got diagnosed with coronavirus, and so it became apparent
Speaker 1: that there was an outbreak in Seattle. What happened in
Speaker 1: New York by comparison, and we won't know this, We
Speaker 1: might never know this, but this is sort of conjecture,
Speaker 1: is New York wasn't a single introduction that lit a fire.
Speaker 1: New York was maybe dozens of introductions, dozens of sparks
Speaker 1: that each lit their own fires, and they all grew,
Speaker 1: and they were all small clusters, and then they all
Speaker 1: became apparent at the same time, so that by the
Speaker 1: time you discovered there was spread in New York, there
Speaker 1: wasn't one large cluster expanding. There were dozens of small
Speaker 1: clusters all expanding, and at that point it was too
Speaker 1: late to do much to mitigate the risk short of
Speaker 1: the population type mitigation. And I worry that that's what
Speaker 1: other cities are going to experience now, that other cities
Speaker 1: aren't going to be one or two or half a
Speaker 1: dozen introductions that lead to clusters that are expanding, but
Speaker 1: they're gonna be many introductions, and maybe even more than
Speaker 1: New York, because while New York was probably seated from
Speaker 1: people coming over from Italy and maybe China and other
Speaker 1: parts of the world, UM, Florida was seated from New
Speaker 1: York and Seattle, and you know, Chicago was seated from
Speaker 1: New York and Seattle and Massachusetts and southern California and
Speaker 1: northern California. So the other cities that are going to
Speaker 1: experience this epidemic later weren't seated from foreign travelers. They
Speaker 1: was seated by domestic travelers. And the magnitude of the
Speaker 1: seating that could have gone on from domestic travel as
Speaker 1: opposed to foreign travel was probably far greater. Certainly, the
Speaker 1: DC metro area looks very concerning, Miami looks very concerning,
Speaker 1: UM New Orleans looks very concerning. Some of the states.
Speaker 1: Some of the city is in the northeast look concerning
Speaker 1: as well, Philadelphia, Detroit, Boston. But those states did implement
Speaker 1: mitigation steps much earlier, and more aggressive mitigation steps, so
Speaker 1: you hope you're going to see the the the benefits
Speaker 1: of that coming through pretty soon. But in the states
Speaker 1: that didn't implement those mitigation steps early and have the
Speaker 1: same level of spread and the same level of positivity,
Speaker 1: meaning people who get tested are positive at a very
Speaker 1: high rate and are under screening, I think you worry
Speaker 1: a lot about those UM those areas, and the Southeast
Speaker 1: in particular, I think is is particularly suspect they're under testing.
Speaker 1: They have rapid growth in cases UM, and when they
Speaker 1: do test, they're getting back a lot of positives. They
Speaker 1: had an opportunity to implement mitigation steps and really avert
Speaker 1: a bad outcome in those cities and didn't didn't take
Speaker 1: that opportunity. And some of them may get lucky and
Speaker 1: escape UM significant outbreaks and epidemics, but some of them
Speaker 1: may not. And I think by and large, whether or
Speaker 1: not we reach some of the grim statistics that were
Speaker 1: in Tony Fauci's model, where he was estimated that there
Speaker 1: could be two d thousand deaths and more. I think
Speaker 1: it's not going to turn on what happens in New York.
Speaker 1: I think we have a pretty good handle of what
Speaker 1: New York is gonna look like and when New York
Speaker 1: is going to turn the corner and the overall morbidity
Speaker 1: and mortality that the city is gonna experience. As tragic
Speaker 1: as it is, I think we kind of understand where
Speaker 1: the backstop is there, where the end is. At this point,
Speaker 1: I think it's gonna turn on what happens in Texas
Speaker 1: and what happens in Florida. Populous states, Georgia, populated states
Speaker 1: that were slow to implement mitigation steps could have been
Speaker 1: heavily seated, and they have very large epidemics. And Florida
Speaker 1: has the potential to eclipse New York in terms of
Speaker 1: the morbidity it sustains from this virus, given the demographics
Speaker 1: of the state, given the kind of growth that we're
Speaker 1: seeing right now, If they end up having very large epidemics,
Speaker 1: I think that's going to drive towards some of the
Speaker 1: more grim statistics that Tony Faucci and others were putting forward.
Speaker 1: In some of those models, I think what we need
Speaker 1: to appreciate, is, you know, absent a technology here, absent
Speaker 1: a drug therapeutic or or a number of drugs that
Speaker 1: really starts to make a very big difference in the
Speaker 1: morbidity and mortality of this. And I think we can
Speaker 1: get that. I think I think we should be focused
Speaker 1: much more on the development of the therapeutic than we are,
Speaker 1: and I think we should have a very very deliberate
Speaker 1: industrial policy towards that. I think we should have sort
Speaker 1: of a Manhattan style project. We seem to be focused
Speaker 1: on the vaccine and have sort of an industrial approach
Speaker 1: to the vaccine when you see the government working very
Speaker 1: closely with vaccine developers, and we don't have the same
Speaker 1: approach on a drug. And I find that odd because
Speaker 1: the drug is really the near term opportunity and and
Speaker 1: and the therapeutic is the only thing that's going to
Speaker 1: make a difference in the fall and prevent this from
Speaker 1: being something that really changes the way we live going
Speaker 1: forward until we get to a vaccine, but absent the therapeutic,
Speaker 1: I think April late April, early May, the epidemics running
Speaker 1: its course nationally. May as a transition month. June, we
Speaker 1: start to lift some of these restrictions, and I hope
Speaker 1: that in July and August the virus sort of collapses.
Speaker 1: That's kind of what happened if you remember back in
Speaker 1: two thousand and nine with the swine flow. The swine
Speaker 1: flow continued to circulate into June, which was very unusual
Speaker 1: for flow. Flus don't usually propagate a summer. But it
Speaker 1: was so novel. People had no cross community to it.
Speaker 1: They were susceptible to it that it continued to spread
Speaker 1: into June, and then in July and August it just
Speaker 1: sort of collapsed. It. It just went away, and then
Speaker 1: it was back in September. If you remember, summer camps
Speaker 1: were canceled, but some of them had it. There were
Speaker 1: some outbreaks and some summer camps and they would close,
Speaker 1: but it by and large um really dissipated in July
Speaker 1: and August in this sort of hot summer months. Some
Speaker 1: things will never get back to normal. I don't think
Speaker 1: we'll be shaking hands as much anymore. I think you
Speaker 1: might see masks become more accepted in our culture the
Speaker 1: way they are in some some Asian cultures. I think
Speaker 1: the idea of crowding ten thousand people into a ballroom
Speaker 1: for a conference might go away. You might have small
Speaker 1: conferences that you live stream. Things are going to change.
Speaker 1: You might see ultra violet light in walkways and airports
Speaker 1: because it kills viruses. You're gonna see airlines advertised deep cleanings,
Speaker 1: and Uber is going to talk about how they clean
Speaker 1: cars in between passengers. You're gonna see things differently. That
Speaker 1: was former FDH chair Scott Gottlie talking about what the
Speaker 1: future is for this pandemic and for us. That's it
Speaker 1: for the Prognosis Daily Edition. For more on the coronavirus
Speaker 1: crisis from a hundred and twenty bureaus around the world,
Speaker 1: visit Bloomberg dot com slash coronavius IRUs. If you appreciate
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Speaker 1: Edition is hosted by me Laura Carlson. The show is
Speaker 1: produced by me tophor Foreheaz, Jordan Gaspore and Magnus Hendrickson.
Speaker 1: Additional reporting by Anna Edney. Original music by Leo Sidrian.
Speaker 1: Our editors are Francesca Levi and Rick Shine Francesca Levi
Speaker 1: is Bloomberg's head of podcasts. Thanks for listening.