Speaker 1: So I'm Katie Berson. I live in Japan with my
Speaker 1: husband and two daughters, Louisa and Zuzu. They're five and three.
Speaker 1: And we had heard about the coronavirus, which is what
Speaker 1: we were calling it at that point, maybe just a
Speaker 1: few weeks before we were scheduled to go on our cruise.
Speaker 1: The cruise was leaving out of Yokohama coming back to Yokohama.
Speaker 1: It was really ideal because we didn't have to fly anywhere,
Speaker 1: which we thought would be safer. But you know, my mom,
Speaker 1: who is actually a manager at a hospital laboratory, was
Speaker 1: all up in arms. She's like, please see if you
Speaker 1: can cancel. I'm really worried about it. And we were like, oh, mom,
Speaker 1: it's fine, and so, you know, we we actually had
Speaker 1: to meet with the Preventive Medicine Officer BECA because we're
Speaker 1: in the service, prior to leaving, just to make sure
Speaker 1: our vaccinations were up to date, and we were, you know,
Speaker 1: aware of what the risks were, it didn't really come
Speaker 1: into play. We met with her two weeks prior than
Speaker 1: the week prior to our departure, and it wasn't a concern.
Speaker 1: It was just wash your hands, you know, like, don't
Speaker 1: be stupid. So my husband and my daughters decided not
Speaker 1: to get off the ship in Hong Kong because we
Speaker 1: didn't want to risk it with the girls. We didn't
Speaker 1: really know what we were dealing with, but I went ahead.
Speaker 1: I wore that was our second stop on the cruise,
Speaker 1: so we're like five days into the cruise. I carried
Speaker 1: my hand sanitizer. We exercised what we thought was you know,
Speaker 1: extreme caution, which at this point now we actually know
Speaker 1: what extreme caution is. But anyway, I came directly back
Speaker 1: onto the boat, got in a shower, washed the clothes.
Speaker 1: You know, we were trying to be as careful as
Speaker 1: we could. I didn't say hello to the girls. They
Speaker 1: were in their kid camp for the day until I
Speaker 1: had like thoroughly dejermed. But then, you know, we carried on.
Speaker 1: We didn't have any other real concerns or red flags
Speaker 1: with the virus until we got to Okinelwa, which was
Speaker 1: our last stop of the cruise, and they said that,
Speaker 1: you know, the Japanese Ministry of Health is exercising caution
Speaker 1: and needs to scan each individual passenger prior to them deboarding.
Speaker 1: So we were delayed somewhere between three and five hours
Speaker 1: getting off the boat, because they were scanning everyone, and
Speaker 1: so we thought, man, you know, I guess things are
Speaker 1: ramping up. It must be, you know, more of a concern.
Speaker 1: But we still didn't think, or we didn't know, and
Speaker 1: I don't think anyone did know what it really was,
Speaker 1: like an animal that we were dealing with until two
Speaker 1: days later when we arrived in Yokohama. And Aaron's this
Speaker 1: part was like so surreal. We're sitting there at our
Speaker 1: last dinner and the white stuff must have known what
Speaker 1: was up. They must have been briefs because they didn't
Speaker 1: miss a beat. They can continued serving, they didn't pause
Speaker 1: to listen. There wasn't a reaction. But the captain came
Speaker 1: on and he spoken English first, and of course the
Speaker 1: dining room is primarily English passengers Japanese passengers, so he
Speaker 1: spoke in English first. He explained that there was a
Speaker 1: passenger who had boarded at Yokohama, stayed on only until
Speaker 1: Hong Kong and then deboarded because he wasn't feeling well
Speaker 1: and Hong Kong was his home and he had tested
Speaker 1: positive for the coronavirus, and so you know, my husband
Speaker 1: and I just kind of look at each other. We
Speaker 1: don't want to react because we don't want to alarm
Speaker 1: the kids, so and also we didn't really know what
Speaker 1: that meant for us. So we sat and we listened.
Speaker 1: And then because we knew what was being said, once
Speaker 1: the announcement was being made in Japanese, it was really
Speaker 1: kind of eerie because I'm looking at the Japanese passengers
Speaker 1: as they're receiving this information, and I could see the
Speaker 1: colors draining from their face like they were right, you know,
Speaker 1: and it was very somber in the dining room. We
Speaker 1: finished our meals and and we went back to our
Speaker 1: room and we had to call, you know, a couple
Speaker 1: of people that my husband worked with and say, you know,
Speaker 1: here's the situation, and we passed. You know, we were
Speaker 1: ready to get off the boat the next morning at
Speaker 1: seven in the morning. And of course seven o'clock rolls around,
Speaker 1: there's no announcements. Eight o'clock rolls around, there's no announcements.
Speaker 1: Nine o'clock rolls around. The ship is being quarantined for
Speaker 1: full fourteen days, and so we just, you know, we
Speaker 1: took it as that, you know, it looks like we're
Speaker 1: going to be here for a while. We explained to
Speaker 1: our girls there are bad germs. We don't think we
Speaker 1: have any, but we have to keep them away. We're
Speaker 1: going to be washing our hands. You may not leave
Speaker 1: the room. And every day was different as far as
Speaker 1: the information that we received. Obviously, the ship was in
Speaker 1: reaction mode, so we didn't receive our meals that first
Speaker 1: day until like three o'clock in the afternoon, which is
Speaker 1: really hard with kids, but we never blame them. There
Speaker 1: was never any anger. It was just everybody's trying to
Speaker 1: do their best to keep this thing contained. Really, the
Speaker 1: staff and crew on the ship really rallied to keep
Speaker 1: the kids entertained. I mean, gosh, they ate so many
Speaker 1: kids meals and they had so many toys delivered. You know,
Speaker 1: we just exercised extreme caution and it paid off. We
Speaker 1: all came off healthy and well. And then we went
Speaker 1: straight from the boat to another fourteen day quarantine. Because
Speaker 1: we live on a military base, people look at me
Speaker 1: and they're like, God, you've been through something, and it
Speaker 1: must have been so hard. But really, like truly, I
Speaker 1: got to wake up with my babies snuggled next to
Speaker 1: me every day. I didn't have to cook. Like I
Speaker 1: didn't have to cook, I didn't have to clean. All
Speaker 1: we had to do was play and be together and
Speaker 1: hope for the best, you know, like you just control
Speaker 1: what you can. And as a military family, I have
Speaker 1: never in my entire marriage or since my kids have
Speaker 1: been born, had six weeks of my husband all to myself.
Speaker 1: And really the outcome of it it was kind of
Speaker 1: just this like beautiful moment in humanity, Like so many
Speaker 1: people cared. I mean, I was hearing from people that
Speaker 1: I haven't spoken to in probably twenty years. And it
Speaker 1: wasn't just like a little message on Facebook. It was
Speaker 1: like this like in depth message, like I'm praying for
Speaker 1: you. You know, we can send you things, what do you need?
Speaker 1: It was just really beautiful. People were delivering breakfast, lunch,
Speaker 1: and dinner as if I couldn't cook, Like they wanted
Speaker 1: to do nice things. They wanted to reach out and help,
Speaker 1: and it just made me feel like so loved and
Speaker 1: so supported. And I think that would be like a
Speaker 1: really great takeaway from this tragedy is you know, like
Speaker 1: when we can work together and support each other, it's
Speaker 1: a beautiful thing. And we should also value our older generations.
Speaker 2: So you just heard from Katie Berson, who we were
Speaker 2: so excited to connect with and talk about her experience
Speaker 2: on the Diamond Princess. She was on the Diamond Princess, y'all. Yeah,
Speaker 2: like that's about it. Yeah, famous, So thank you so much, Katie.
Speaker 3: Also, I just Katie what an incredible human. She had
Speaker 3: the most positive outlook I have ever heard from someone
Speaker 3: who went through something like that and really helped me
Speaker 3: try and see silver linings in things as well. So
Speaker 3: I just really appreciated getting to speak with her too.
Speaker 2: Absolutely.
Speaker 3: Hi, I'm Aaron Welsh and I'm Aaron Alman Updike.
Speaker 2: And this is this podcast will Kill You. Hello, Welcome
Speaker 2: to chapter four of our Anatomy of a Pandemic series
Speaker 2: on COVID nineteen. So far, we've discussed the biology of
Speaker 2: the virus, how the disease progresses, and the control strategies
Speaker 2: that we're using to slow its transmission, and in this
Speaker 2: episode we dive into the epidemiological characteristics of this pandemic.
Speaker 3: We brought back the amazing doctor Carlos del Rio, who
Speaker 3: chatted with us in our first coronavirus episode back in
Speaker 3: February about the importance of investing in global health. You
Speaker 3: might remember his excellent Dolly Parton quote to.
Speaker 2: Go along with that, I sure do so.
Speaker 3: In this minisode, we ask him all about the ar
Speaker 3: not of the virus, that reproductive rate of the virus,
Speaker 3: and how to bring it down, what flattening the curve means,
Speaker 3: and why we see different case fatality rates in different
Speaker 3: regions of the world, and the absolute necessity of acting
Speaker 3: now to help slow the spread of this disease. But
Speaker 3: before we get into that, we have some business to
Speaker 3: take care of. It's quarantiny time.
Speaker 2: What are we drinking for this one?
Speaker 3: A pickle Martini? Is that?
Speaker 2: Yeah?
Speaker 3: That's the one, A pickle martini.
Speaker 2: Quarantini four, our first ever martini.
Speaker 3: No boobo bavida.
Speaker 2: Oh well, you're right, that was so long ago. Does
Speaker 2: it ease steel trap? Aaron steel cap? Do you know
Speaker 2: how difficult it is to like think of I'll be like, oh,
Speaker 2: this is a great recipe, and then then I have
Speaker 2: just through all of the old ones.
Speaker 3: Oh, if you also didn't know, we have a great
Speaker 3: resource of all of our quarantinis on our website.
Speaker 2: But yes, you can click the quarantini tab.
Speaker 3: And all of our plusy burrita is the non alcoholic version,
Speaker 3: which we'll post the recipe for this pickle pickled jalapeno martini.
Speaker 2: Yeah, you could also just use a pickle if you
Speaker 2: don't have pickled klopenias. I didn't have a pickle, so
Speaker 2: I had to use pickled hellipenions desperate times, you know,
Speaker 2: desperate times. I wasn't going to go to the store
Speaker 2: for a jar of pickles.
Speaker 3: No, of course, not. Shelter in placed Aaron Shelter.
Speaker 2: Okay.
Speaker 3: Before diving into the interview, we also wanted to talk
Speaker 3: a bit about the disease ecology since that's kind of
Speaker 3: our forte of spillover events in general, and then go
Speaker 3: through a timeline of events to give us an idea
Speaker 3: of the spread of this virus. This timeline is it's intense.
Speaker 3: It's intense, but it really gives us a good picture
Speaker 3: of what exponential growth really looks like and.
Speaker 2: How fast a disease like this can spread across the
Speaker 2: entire world.
Speaker 3: Math Man who knew?
Speaker 2: Who knew? Mathematicians that's who, model or statisticians, good point epidemologists.
Speaker 2: Any Ways, Anyways, the ecology of COVID nineteen and its emergence,
Speaker 2: it deserves a more nuanced discussion. Then I'm going to
Speaker 2: give it here because we want to get to the
Speaker 2: meat of this episode quickly, right, but we wanted to
Speaker 2: touch on a few things. As has been reported in
Speaker 2: peer reviewed articles as well as from experts on these episodes,
Speaker 2: this virus likely emerged from a bat, which is also
Speaker 2: where stars originated from bats. The COVID nineteen virus was
Speaker 2: probably passed to another host before infecting humans. This sequence
Speaker 2: of events a virus spread from bats to other animal species,
Speaker 2: and then to humans. It's not unprecedented. In fact, this
Speaker 2: has happened in many other disease outbreaks. And it does
Speaker 2: not mean in bold underline, it does not mean that
Speaker 2: killing bats or destroying their habitat will prevent spillover events.
Speaker 2: So don't get your pitchforks out and start to try
Speaker 2: to kill all the bats.
Speaker 3: No, we're not blaming bats quote unquote blame.
Speaker 2: This is how ecology works. It's just it doesn't mean
Speaker 2: that bats are malicious or that we should kill the bats.
Speaker 2: In fact, doing those things like culling bat populations or
Speaker 2: destroying their habitat that has been shown to actually lead
Speaker 2: to an increase in disease outbreaks from bats. And spillover
Speaker 2: events from bats. So bat conservation and the preservation of
Speaker 2: habitats is actually one of the most important ways that
Speaker 2: we can reduce over events and funding back conservation, especially
Speaker 2: in regions that may not have the resources to do so.
Speaker 2: That is crucial in this fight against emerging infectious diseases.
Speaker 3: Also, bats provide really important ecosystem services. They're pollinators, they're
Speaker 3: seed dispersers, they eat insects ones that annoy us, for example,
Speaker 3: and they're also one of the most amazing and fascinating
Speaker 3: groups of animals on this planet. This is our personal
Speaker 3: opinion and the role that some bat species play in
Speaker 3: some spillover events from wildlife to humans cannot and should
Speaker 3: not be ignored. This is a multifaceted problem. Ignoring it
Speaker 3: prevents a complete understanding of the ecology of these events
Speaker 3: and how they happen, and it can ultimately be more
Speaker 3: damaging to back conservation. If we want to prevent spillover
Speaker 3: we need the complete picture. If you would like to
Speaker 3: read more about the ecology of bat virus spillover events,
Speaker 3: there are a couple of great papers by doctor RAINA.
Speaker 3: Plowwright Boop Boop. She's awesome and we'll link to those
Speaker 3: on our website. We're also going to put up a
Speaker 3: paper that discusses a lot of the ecosystem services that
Speaker 3: bats provide. That's by koons at All on our website
Speaker 3: as well. Cool Cool, don't hate the bats.
Speaker 2: Don't hate the bats.
Speaker 3: But also don't ignore the role that they play in
Speaker 3: these spillover events.
Speaker 2: Right, Okay, Now onto the timeline. It's a big one.
Speaker 2: Let's start at the beginning.
Speaker 3: It's like eight pages of timeline.
Speaker 2: I know, but you know, we're just going to work
Speaker 2: through it. But I will say that you know, this
Speaker 2: is not even a complete timeline, Like, we cut a
Speaker 2: lot of this out. And so what I have one
Speaker 2: of the great resources I have found is and so
Speaker 2: this is where we got all of this timeline information
Speaker 2: basically is from Al Jazeera. They have they're continually updating
Speaker 2: a timeline about COVID nineteen across the entire globe, and
Speaker 2: so if you want really detailed information, that's the place
Speaker 2: to go.
Speaker 3: Awesome, Okay, So.
Speaker 2: Chinese officials are still looking for the patient zero quote
Speaker 2: unquote of COVID nineteen, but it's possible that they will
Speaker 2: never be identified. But what is clear is that the
Speaker 2: disease had been spreading for a while before it was
Speaker 2: recognized as a novel infection and one of concern. So
Speaker 2: what might be the earliest case of COVID nineteen was
Speaker 2: traced to November seventeenth, twenty nineteen, in a fifty five
Speaker 2: year old person, but that hasn't been confirmed. If it is, though,
Speaker 2: that predates the wet market where the first apparent cluster
Speaker 2: of COVID nineteen emerged, so community transmission might have been
Speaker 2: going on for a while before it was recognized, or
Speaker 2: it could have been amplified at that wet market, But
Speaker 2: the market may not have necessarily been the site of
Speaker 2: the spillover event, which I.
Speaker 3: Feel like kind of makes sense to me in some cases,
Speaker 3: because I know early on they were trying to identify,
Speaker 3: like what animal at the wet market, and we couldn't
Speaker 3: really find a good one.
Speaker 2: So if it was.
Speaker 3: A person at the market who just happened to be
Speaker 3: there infected that ended up causing sort of this spread,
Speaker 3: that kind of makes sense.
Speaker 4: Hmm.
Speaker 2: Yeah.
Speaker 3: And honestly, a delay in recognizing a novel disease, especially
Speaker 3: a respiratory infection whose symptoms can pretty easily be mistaken
Speaker 3: for diseases caused by a number of other respiratory viruses.
Speaker 3: It's not that unusual. It might take a while before
Speaker 3: you realize a that there is an unusual number of
Speaker 3: pneumonia cases outside of the norm, and b that these
Speaker 3: cases are caused by a new virus that you haven't
Speaker 3: seen before. So by late December, there were several cases
Speaker 3: of unusual pneumonia caused by an unknown virus in Wuhan,
Speaker 3: and Chinese health officials notified the WHO of this on
Speaker 3: December thirty five.
Speaker 2: First YEP. The next day, January first, the wet market
Speaker 2: where this first cluster I mentioned was apparent. The Huanan
Speaker 2: seafood wholesale market was shut down. At this point, there
Speaker 2: were more than forty people infected.
Speaker 3: On January seventh, officials announced they had identified a new virus.
Speaker 3: According to the World Health Organization, the novel virus at
Speaker 3: that time was named twenty nineteen n CoV and was
Speaker 3: identified as belonging to the coronavirus family.
Speaker 2: January ninth, the first death from the virus occurs in China.
Speaker 3: January thirteenth, the World Health Organization reported a case in Thailand,
Speaker 3: the first outside China, and a woman who had arrived
Speaker 3: there from Wuhan.
Speaker 2: January sixteenth, Japan reports a confirmed case again from someone
Speaker 2: who had visited Wuhan.
Speaker 3: Between January seventeenth and January twentieth. The US, Nepal, France, Australia, Malaysia, Singapore,
Speaker 3: South Korea, Vietnam, and Taiwan all confirmed cases of this
Speaker 3: novel coronavirus.
Speaker 2: I mean that's a matter of weeks, yep okay. January
Speaker 2: twenty second, the death toll in China jumped to seventeen
Speaker 2: with more than five hundred and fifty infections. Airports in
Speaker 2: Europe and Asia increased screenings of passengers traveling from China. Wow.
Speaker 3: Five hundred and fifty by January twenty second.
Speaker 2: I know, I keep getting chills when I read this
Speaker 2: timeline me two.
Speaker 3: January twenty third, Wuhan was placed under effective quarantine. At
Speaker 3: this point, the WHO said there was no evidence of
Speaker 3: the virus spreading between humans outside of China, and the
Speaker 3: outbreak did not yet constitute a public emergency of international
Speaker 3: health concern.
Speaker 2: January twenty six, new cases were confirmed in the US, Taiwan, Thailand, Japan,
Speaker 2: and South Korea.
Speaker 3: January twenty seventh, the death toll in China rose to
Speaker 3: one hundred and six, with one hundred in Hubei Province.
Speaker 3: Another four thousand, five hundred and fifteen people in China
Speaker 3: were reported to be infected. There were two thousand, seven
Speaker 3: hundred confirmed cases in Hubei Province, up from fourteen hundred
Speaker 3: twenty three the day before.
Speaker 2: It's like a doubling, essentially m HM. On January thirtieth,
Speaker 2: the WHO declared COVID nineteen a global emergency, as the
Speaker 2: death toll in China jumped to one hundred and seventy
Speaker 2: with seven thousand, seven hundred and eleven cases reported. On
Speaker 2: this same date, India and the Philippines confirmed their first
Speaker 2: cases of the virus, with one infected patient in each country.
Speaker 3: January thirty first. The next day, the number of confirmed
Speaker 3: cases in China jumped to nine thousand, eight hundred nine. Russia, Spain, Sweden,
Speaker 3: and the UK all confirmed their first cases of the virus, and.
Speaker 2: On February second, the first death outside China was reported
Speaker 2: in the Philippines.
Speaker 3: On February sixth, the death toll in mainland China rose
Speaker 3: to at least five hundred sixty three, with more than
Speaker 3: twenty eight thousand cases confirmed Meanwhile, authorities in Malaysia reported
Speaker 3: the country's first known human to human transmission, and the
Speaker 3: number of people reported infected in Europe.
Speaker 2: Reached thirty thirty thirty thirty February sixth. On February seventh,
Speaker 2: Lee Wen Lang, a doctor who was among the first
Speaker 2: to sound the alarm over the coronavirus, died, and Hong
Speaker 2: Kong introduced prison sentences for anyone breaching quarantine rules.
Speaker 3: On February ninth, the death toll in China surpassed that
Speaker 3: of the two thousand and two two thousand and three
Speaker 3: SARS epidemic, with eight hundred eleven deaths recorded and thirty
Speaker 3: seven thousand, one hundred ninety eight infections. It's worth noting
Speaker 3: the SARS epidemic infected around eight thousand people.
Speaker 2: Yes On February eleventh, the WHO announced that the new
Speaker 2: coronavirus would be called nineteen.
Speaker 3: As of February twelfth, one hundred and seventy five people
Speaker 3: were infected on board the Diamond Princess cruise ship.
Speaker 2: February fourteenth, Egypt became the first country in Africa to
Speaker 2: report a case, and France reported Europe's first death from
Speaker 2: the virus.
Speaker 3: As of February seventeenth, there were one thousand, seven hundred
Speaker 3: seventy deaths reported in mainland China and seventy thousand, five
Speaker 3: hundred forty eight cases. Japan also confirmed ninety nine new
Speaker 3: cases of the virus on board the quarantined Diamond Princess
Speaker 3: cruise ship.
Speaker 2: February eighteenth saw China's daily infection figures drop below two
Speaker 2: thousand for the first time since January, with the country's
Speaker 2: Health Commission reporting seventy two thousand, four hundred and thirty
Speaker 2: six infections on the mainland and one thousand, eight hundred
Speaker 2: and sixty eight deaths.
Speaker 3: On February nineteenth, Iran reported two deaths from the coronavirus
Speaker 3: hours after confirming its first cases.
Speaker 2: February twentieth, South Korea report or it's its first death
Speaker 2: from the coronavirus.
Speaker 3: February twenty second, South Korea saw its largest spike in
Speaker 3: a single day, with two hundred and twenty nine new
Speaker 3: cases of the virus. On that same day, Italy reported
Speaker 3: its first two deaths, while Iran confirmed a fifth death
Speaker 3: among ten new infections. A sixth death was later confirmed,
Speaker 3: though it wasn't clear whether this case was included in
Speaker 3: the country's twenty eight confirmed cases.
Speaker 2: February twenty six, the global death toll neared twenty eight hundred,
Speaker 2: with a total of around eighty thousand confirmed cases reported globally.
Speaker 2: On the same day, Norway, Romania, Greece, Georgia, Pakistan, North
Speaker 2: Macedonia and Brazil all detected their first cases of the coronavirus.
Speaker 3: On February twenty seventh, Estonia, Denmark, Northern Ireland and the
Speaker 3: Netherlands reported their first coronavirus cases. The number of infections
Speaker 3: globally passed eighty two thousand, including more than two thousand,
Speaker 3: eight hundred deaths.
Speaker 2: On March third, Italy announced the death toll in the
Speaker 2: country reached seventy seven, equalling the total deaths in Iran,
Speaker 2: which stood at seventy seven.
Speaker 3: On March seventh, the coronavirus had killed nearly thirty five
Speaker 3: hundred people and infected another one hundred and two thousand
Speaker 3: people across more than ninety countries.
Speaker 2: On March tenth, both Iran and Italy recorded their highest
Speaker 2: death tolls in a single day. A total of fifty
Speaker 2: four people died in Iran over a twenty four hour period,
Speaker 2: while in Italy one hundred and sixty eight new fatalities
Speaker 2: were recorded from the coronavirus. On the same day, Lebanon
Speaker 2: and Morocco reported their first deaths from the virus, while
Speaker 2: Democratic Republic of the Congo, Panama, and Mongolia confirmed their
Speaker 2: first cases of infection.
Speaker 3: On March eleventh, World Health Organization declared the coronavirus outbreak
Speaker 3: a pandemic as Turkey Ivory Coast, Honduras and Bolivia confirmed
Speaker 3: their first cases. In Cutter, infections jumped drastically from twenty
Speaker 3: four to two hundred sixty two in a single day.
Speaker 2: On March sixteenth, New York City's bars, theaters, and cinemas
Speaker 2: are closed down as the number of cases continued to
Speaker 2: rise in the US.
Speaker 3: On March nineteenth, Italy overtook China as the country with
Speaker 3: the most coronavirus related deaths, registering three thousand, four hundred
Speaker 3: five deaths compared to three thousand, two hundred forty five
Speaker 3: in China. The death toll in Spain soared by two
Speaker 3: hundred and nine to a total of seven hundred sixty
Speaker 3: seven fatalities from the previous day. A roughly twenty five
Speaker 3: percent increase in infections was recorded in Spain, taking the
Speaker 3: country's total to seventeen thousand, one hundred forty seven.
Speaker 2: On March twentieth, which is just a couple of days ago.
Speaker 2: Coronavirus related deaths surged past ten thousand globally, which is
Speaker 2: more than the number of people infected with STARS during
Speaker 2: the entire course of the epidemic. The number of cases
Speaker 2: in jerman Many rose by two thousand, nine hundred and
Speaker 2: fifty eight overnight to a total of thirteen thousand, nine
Speaker 2: hundred and fifty seven. Spain meanwhile had a death toll
Speaker 2: of one thousand and two on the same day. Though
Speaker 2: March twentieth. In China, however, no new domestic cases were
Speaker 2: reported for a second consecutive day.
Speaker 3: That's a big deal. On March twenty first. Europe remains
Speaker 3: the epicenter of the coronavirus, with Italy reporting six hundred
Speaker 3: and twenty seven new fatalities, its biggest daily increase, bringing
Speaker 3: the total number of deaths to four thousand, thirty two
Speaker 3: amid forty seven thousand, twenty one cases. Spain is the
Speaker 3: second worst hit country in Europe, with more than twenty
Speaker 3: one thousand infections and at least one thousand.
Speaker 2: Deaths on March twenty second, which is the day that
Speaker 2: we're recording this episode, the global death toll rose above
Speaker 2: thirteen thousand, while infection counts surpassed three hundred and eleven thousand.
Speaker 2: So right now it is eleven four one Central time,
Speaker 2: US Central time, and there are three hundred and eighteen thousand,
Speaker 2: two hundred and nine confirmed cases and the globe and
Speaker 2: thirteen thousand, six hundred and sixty four deaths ninety four thousand,
Speaker 2: seven hundred total recovered. Wow, it's a very chilling timeline.
Speaker 3: That is a very chilling timeline that was really helpful
Speaker 3: I think to go through though, Yeah, because even if
Speaker 3: you didn't catch every single number and every single date,
Speaker 3: I think it's very clear from going through that that
Speaker 3: this is a rising and spreading very rapidly exponentially exponentially,
Speaker 3: and b that we're still in that exponential growth right
Speaker 3: now today, March twenty second.
Speaker 2: So how do we slow that down? Well, to answer
Speaker 2: that question and to talk about the characteristics of this disease,
Speaker 2: we brought back doctor Carlos del Rio, so let's let
Speaker 2: him take it away right after this break.
Speaker 4: So my name is Carlos del Rio. I'm an intense
Speaker 4: least decician and a public health also expert, And I'm
Speaker 4: a professor of medicine and Global health here at Emory University,
Speaker 4: where I'm also the executive Associate Dean of EMRI at Grady.
Speaker 2: So at this point in the epidemic, we've seen a
Speaker 2: lot more about how the virus has spread in different
Speaker 2: places and in different populations. Do we have a better
Speaker 2: sense of what the r not is for the virus?
Speaker 4: Well, you know, I think we're beginning to know better
Speaker 4: what again we should define what are not is? You though,
Speaker 4: people are probably now hearing this term and a term
Speaker 4: that was a sort of a epidemology lingo is now
Speaker 4: becoming like household dinner conversation term. But you know, I've
Speaker 4: been talking to I've been talking to ceo so companies
Speaker 4: and others who now now call me. And I had
Speaker 4: a COEO of a company today call me, what do
Speaker 4: you think about the are not?
Speaker 5: You know? Today?
Speaker 4: So it's interesting to see that are not has become
Speaker 4: sort of a lingo that we all talk about. But
Speaker 4: basically what this means is is a reproductive number. Right,
Speaker 4: It's the number of infections that of virus causes. So
Speaker 4: one first infected person leads to other people being infected.
Speaker 4: And there are diseases like measles, for example, that may
Speaker 4: have an are not out fifteen, So one infection leads
Speaker 4: to fifteen, and if an are not is below one,
Speaker 4: then the disease dies.
Speaker 5: It disappears.
Speaker 4: So so mers has typically had an are not below one,
Speaker 4: so we rarely see epidemic. We have not seen an
Speaker 4: epidemic from merce, but this disease has a are not
Speaker 4: about two and a half to three, which means that
Speaker 4: somewhere between two and a half and three individuals getting
Speaker 4: effect that after a person has been infected, and that's
Speaker 4: what causes what we call an exponential growth in this
Speaker 4: epidemic because and I try to explain this to people
Speaker 4: in simple terms, if you have one infected person, that
Speaker 4: person impacts let's say two and a half person, So
Speaker 4: let's go with the lower limit. So that means that
Speaker 4: after five days you're going to have two and a
Speaker 4: half infected persons. So now you have that person plus
Speaker 4: two and a half, but then in thirty days you're
Speaker 4: going to have four hundred.
Speaker 5: And six infected people.
Speaker 4: That's what we call exponential growth.
Speaker 2: Can you talk a little bit about the progression of
Speaker 2: the epidemic in China and in some other places where
Speaker 2: the disease seems to be slowing down in those places,
Speaker 2: is there a risk of a second wave of infections?
Speaker 4: You know, I think there's always a risk. So let's
Speaker 4: suppose we can decrease I told you, you know, one
Speaker 4: to two and a half to four hundred at the
Speaker 4: other thirty days. If you can decrease exposure, you can
Speaker 4: decrease transmission by fifty percent, So you can bring the
Speaker 4: are not from two and a half to let's say
Speaker 4: one point two one point two five. Now at the
Speaker 4: end of five days, you'll have one point five infected
Speaker 4: people instead of two point five. And at the end
Speaker 4: of thirty days, you'll have fifteen infected people instead.
Speaker 5: Of four hundred. Now, if you can bring that are
Speaker 5: not below one.
Speaker 4: Now at the end of five days, you'll have let's
Speaker 4: say zero point seven of a person infected, so not
Speaker 4: even one. And then at the end of thirty days
Speaker 4: you'll have maybe two people infected. So you will probably
Speaker 4: still see some cases. But as long as you can
Speaker 4: really decrease exposure, and that happens by two mechanisms Number one,
Speaker 4: Initially China has done it by by social distancing, right,
Speaker 4: by quarantining, by isolating people, by really going to a
Speaker 4: national shutdown. But something that's going to happen eventually. As
Speaker 4: you get more people infected, you essentially have a you know,
Speaker 4: a herd immunity, and there's not enough people to infect
Speaker 4: out there, so a number of transmissions also goes down.
Speaker 4: So I suspect there will be little clusters here and there,
Speaker 4: but I don't think there's going to be a huge
Speaker 4: wave again, assuming that there's immunity to this virus.
Speaker 3: And so kind of along those lines that you mentioned
Speaker 3: about trying to decrease that are not overall. Can you
Speaker 3: talk us through what the stages of an epidemic are
Speaker 3: and what it means to try and flatten that epidemic curve.
Speaker 3: How do we know when that actually happens.
Speaker 4: Well, we know when that actually happens. I mean, this
Speaker 4: is a complicated phenomenon, but you know, the epidemic starts,
Speaker 4: it starts growing. It's really when you get that a
Speaker 4: reflection point where the number when cases are not growing
Speaker 4: by a factor of one, when you get two cases
Speaker 4: growing by a factor of only one, then you start
Speaker 4: seeing that that planning of the curve. Then you start
Speaker 4: seeing but that by that point it's a little too late.
Speaker 5: And I think about it like a plane taken off. Right.
Speaker 4: Initially you were seeing you know, ten, twenty, fifteen, forty
Speaker 4: one hundred cases. You know, the plane was just still
Speaker 4: running down the runway very quickly. Then the those goes up,
Speaker 4: and then you know, we start seeing in the US
Speaker 4: one hundred cases and now we're, you know, whatever a
Speaker 4: number of cases. We're up to where like sixteen or
Speaker 4: eighteen thousand, right, So now the plane's at eighteen thousand feet.
Speaker 4: At some point in time, you're going to see it
Speaker 4: get to thirty thousand, and it's going to start leveling off.
Speaker 5: So, just like a plane, you get to a point.
Speaker 4: Where you have enough people infected out there and you
Speaker 4: have enough transmission, then the number of susceptibles is going down.
Speaker 4: So I don't like to talk about phases of an
Speaker 4: epidemic because there's really no pass. The natural history of
Speaker 4: an epidemic is to continue until you infect it or
Speaker 4: or you cause all susceptibles to be either infected or death. Right,
Speaker 4: But what you want to be sure is that you
Speaker 4: prevent that. And what we need to do is do
Speaker 4: everything we can to shut down that are not to decrease,
Speaker 4: the are not to below one. If we can bring
Speaker 4: the are not below one, we all control transmission.
Speaker 2: Right and so that needs people to stay at home
Speaker 2: and practice social distancing and so on. But I'd like
Speaker 2: to revisit something you mentioned in talking about how the
Speaker 2: epidemic has progressed in China and so one of the
Speaker 2: things that you talked about was herd immunity, which would
Speaker 2: require that this infection with this virus leads to immunity.
Speaker 2: Is that something that we have seen do. Are people
Speaker 2: who are infected with this virus and then they recover,
Speaker 2: are they immune and resistant to future infections?
Speaker 4: There's been a lot of talk of whether you can
Speaker 4: reinfect it or not. I think from what I can
Speaker 4: tell that people going to develop community and are going
Speaker 4: to not get infected. So I think immunity is going
Speaker 4: to help us going forward.
Speaker 2: Gotcha, I guess, like, what is the relative effect that
Speaker 2: social distancing has had versus herd immunity has had?
Speaker 4: You know, it's really hard to tease that apart, but
Speaker 4: I will tell you that if they hadn't done what
Speaker 4: they've done, the massive shutdown that they did, I think
Speaker 4: social distancing player probably may played a huge role there.
Speaker 4: And the reason I say that is because if they
Speaker 4: had not done this, I think the numbers would have
Speaker 4: been staggerantly higher. And you know, just I look at
Speaker 4: it today, you know, I mean I was just in
Speaker 4: shock today when I saw that. You know, China as
Speaker 4: of today has about eighty thousand cases with three thousand
Speaker 4: and two hundred of deaths, really has half the number
Speaker 4: of cases forty thousand cases, but has more death than
Speaker 4: anywhere else. Italy has not surpassed China and death, but
Speaker 4: I think China really emphasized the social distancing and that's
Speaker 4: why their number of deaths compared to the number of
Speaker 4: cases is so much lower. It's four percent versus Italy,
Speaker 4: which is eight percent, right right.
Speaker 2: Right, And I think that's one of the things that
Speaker 2: this outbreak has revealed, particularly here or looking at the US,
Speaker 2: is that, you know, we have to slow the spread
Speaker 2: of disease. People need to stay at home, they need
Speaker 2: to practice social distancing. But I feel like, at least anecdotally,
Speaker 2: this message and also from what I've seen on Twitter
Speaker 2: and on some other news reports, I feel like this
Speaker 2: message doesn't seem to have properly sunk in, especially in
Speaker 2: areas that may not be currently experiencing the same number
Speaker 2: of confirmed positive cases as other regions, or in populations
Speaker 2: that have been said to be at lower risk. So
Speaker 2: how can we convince people just how important it is
Speaker 2: to stay home when they can.
Speaker 4: Well, you know, again, it's in your hands to become
Speaker 4: infected or not right. If you become infected, you will
Speaker 4: then lead to other infections. So the best thing that,
Speaker 4: I mean, the best vaccine we have for this is
Speaker 4: to not get infected, because if you don't get infected,
Speaker 4: then other people won't get infected. And if other people
Speaker 4: don't get infected, then you'll stop the channel transmission. And that,
Speaker 4: to me is what we need to do right now.
Speaker 4: So I mean the term planning the curve, or the
Speaker 4: way I explain it is by saying, look, if I'm
Speaker 4: at the hospital and three hundred people coming sick today,
Speaker 4: I can't take care of them. But if three hundred
Speaker 4: people come in sick over a month and take care
Speaker 4: of them, it's easy. It's easier, right, So we want
Speaker 4: to spread out the number of cases. But more importantly,
Speaker 4: for the general individual, it's in your.
Speaker 5: Hands to prevent transmission.
Speaker 4: If you don't get infected, you're not going to pass
Speaker 4: it to others, And if you don't pass it to others,
Speaker 4: you're cutting down that transmission chain. So cutting down that
Speaker 4: transmission chain is something that we all have the ability
Speaker 4: to do. Yeah.
Speaker 2: Absolutely, Yeah.
Speaker 3: And so I have another question for you actually about
Speaker 3: in looking at the differences in fatality rates between like
Speaker 3: in China versus in Italy, how do you feel like
Speaker 3: that compares to something like South Korea where they tested
Speaker 3: very large numbers of people and the death rate there
Speaker 3: was as low as I think, like less than two percent.
Speaker 3: Is that because of better identification of cases in your opinion,
Speaker 3: or because of better social distancing and treatment methods or
Speaker 3: what do you think some of those differences are.
Speaker 4: I think that two things up, and I think that
Speaker 4: you know, every countrys had a little different and there's
Speaker 4: some issues Italy. Clearly, if you look at who got
Speaker 4: infected in Italy, clearly Italy had a much older population,
Speaker 4: and I think that clearly was playing a role. If
Speaker 4: you look at the distribution of Italy versus South Korea.
Speaker 4: In South Korea almost thirty percent of their cases were
Speaker 4: between the ages of twenty and twenty nine and almost
Speaker 4: twenty percent between the ages of fifty and fifty nine
Speaker 4: in Italy. In the country, I would say almost forty
Speaker 4: percent of cases we're between the ages of seventy and above.
Speaker 4: So you have a very different distribution of cases in
Speaker 4: a population. You will also have very different distribution of
Speaker 4: comorbidities in a population.
Speaker 5: So it's not simple. We're learning very clearly.
Speaker 4: That mortalities are very different in different populations, right right,
Speaker 4: and that to me is is very important because our
Speaker 4: populations look very different.
Speaker 2: Yeah, you know, recently, earlier this week, there was that
Speaker 2: report that came out from the Imperial College of London
Speaker 2: that had these, you know, variety of modeling predictions based
Speaker 2: on you know, no control strategies, mitigation strategies, suppression strategies.
Speaker 2: But all of the numbers were fairly alarming. And so
Speaker 2: can we make any guesses at this point to what
Speaker 2: we might see in terms of numbers infected or just
Speaker 2: how long the outbreak will last? Like what is the
Speaker 2: end game on this?
Speaker 5: Well, the endgame is to stop it.
Speaker 4: And uh, I worry that you know here in the
Speaker 4: United States, we don't have we have we have several problems.
Speaker 4: Number one, we don't have wohan. We have multiple wu hunts.
Speaker 4: We have a wool hunt in Washington State, we have
Speaker 4: a wool hunt in New York State. We have a
Speaker 4: Woohan now happening in the South. So we have multiple wuhants.
Speaker 4: And I think that to me is one issue that
Speaker 4: you know, we don't have one wuhan. And the other
Speaker 4: thing we have our public health is is the sameralized
Speaker 4: not centralized. Right in China, the central government can say
Speaker 4: do this and it will happen. Here in the US,
Speaker 4: the federal government doesn't have that authority. The federal government
Speaker 4: makes recommendations, and then after the federal government's recommendations, then
Speaker 4: the states really public health is run up state and
Speaker 4: local health department level. So you have states saying, oh,
Speaker 4: you know, California saying we're going to shut down the state,
Speaker 4: and state of Florida saying, oh, you know, we're okay,
Speaker 4: you know, we don't want to. Yesterday, I was hearing
Speaker 4: the governor being interviewed and saying, you know, we don't
Speaker 4: really don't want to impinge in individual liberties. And the
Speaker 4: college students want to be parting.
Speaker 5: Out there is their right.
Speaker 4: So you have a very different approach. And if you
Speaker 4: put in the middle of this the economy, and there's
Speaker 4: no doubt that epidemics have huge economic consequences. I mean,
Speaker 4: the epidemics hurt business, and epidemics hurt consumption, and epidemics
Speaker 4: court has heard a lot of things that we've seed already,
Speaker 4: what the stock market has done, and what you know
Speaker 4: is going to happen to small.
Speaker 5: Business and to other businesses.
Speaker 4: So so I can see a politician being reluctant to
Speaker 4: take the top measures that are needed. And that's when
Speaker 4: you say, we need an independent body that can help
Speaker 4: and make those recommendations. But unfortunately we don't have such
Speaker 4: independent body in this country. It's all based on you know,
Speaker 4: it's all based on political decisions, and unfortunately it's.
Speaker 5: Not going well.
Speaker 4: I mean, I think you and I will agree that
Speaker 4: the response in the US has been haphazard at best.
Speaker 1: Yeah.
Speaker 2: In one of the things that I think a lot
Speaker 2: of people are wondering is that at the beginning, we
Speaker 2: were looking at this as a matter of weeks and
Speaker 2: as the epidemic. As the pandemic has progressed, it seems
Speaker 2: like now we're looking at this on the scale of months.
Speaker 4: I think the more you delay the response, the more
Speaker 4: the time is right. And I think that's something that
Speaker 4: people need to understand that as you take more time,
Speaker 4: more time takes you, you know, basically, it becomes harder
Speaker 4: to do the right things.
Speaker 2: Yeah, I mean, that's what it seems like, is that
Speaker 2: even in places that have been relatively low impact by
Speaker 2: the virus, it seems like not even the tip of
Speaker 2: the iceberg, but the tip of the tip of the iceberg,
Speaker 2: where we don't even know the extent of the community
Speaker 2: transmission that's going on. And so you know, we see
Speaker 2: these actions like shelter in place that have been happening
Speaker 2: in California and in parts of New York and maybe
Speaker 2: going into effect elsewhere. But is that, like, should that
Speaker 2: be happening now in places that haven't seen the number
Speaker 2: of cases that those states have seen.
Speaker 5: The answer is yes.
Speaker 4: When somebody says to me, oh, we only have twenty cases,
Speaker 4: we got live under control, I said, if you only
Speaker 4: knew right by the time you have twenty cases, you're
Speaker 4: already you know, twenty cases too late. So I would
Speaker 4: emphasize and say over and over, no, you cannot do that.
Speaker 4: I mean, that is a mistake that everybody has made
Speaker 4: and I don't want to get political or anything, but
Speaker 4: you know, you know, I look at different Trump quotes
Speaker 4: through the epidemic, right, and his first press conference about
Speaker 4: this was we got in February twenty eighth, we sart
Speaker 4: fourteen cases. We got this under control. Next week there's
Speaker 4: gonna be no cases, and now we have a national emergency.
Speaker 4: You know, so you get distracted and this comes back
Speaker 4: to hunt you, right, m.
Speaker 2: Hm, yeah. Absolutely.
Speaker 3: There's been a lot of talk about this virus potentially
Speaker 3: becoming another seasonal influenza type virus. What do you think
Speaker 3: about is that something that we think is likely at
Speaker 3: this point that this is now so well established that
Speaker 3: this is going to be kind of a recurrent seasonal thing.
Speaker 5: You know, I can't. I can't. I don't. It's possible.
Speaker 4: I'm going to I think at this point in time,
Speaker 4: it's speculative to say that I don't want to worry
Speaker 4: about the future. I want to worry about the president
Speaker 4: and the president we have the house is burning, right,
Speaker 4: We have a fire in the house. And I almost
Speaker 4: sound here like somebody's asking me, well, you know, once
Speaker 4: you rebuild a house, you think it'll be another fire.
Speaker 5: Again. I said, let's put this.
Speaker 4: Fire out again first, you know, let's worry about that later.
Speaker 4: So let's take care of the current problem. And the
Speaker 4: current problem is let's stop this, and then we'll figure
Speaker 4: out about the rest. You know, there's a lot of
Speaker 4: really good work happening in vaccines and other things. So
Speaker 4: depends whether we have a vaccine.
Speaker 5: That's I think there's the answer.
Speaker 2: Yeah, yeah, absolutely. You know, I think one of the
Speaker 2: things in particular that I'm still trying to get a
Speaker 2: grasp on the entire timeline or an understanding of it,
Speaker 2: is the testing and the controversy around the testing. Can
Speaker 2: you walk us through a little bit of that and
Speaker 2: why there were why it was slow at the beginning,
Speaker 2: what's going on now? Just sort of a brief on
Speaker 2: the testing aspect.
Speaker 4: Well, I think in a testing aspect, we have we
Speaker 4: have three things.
Speaker 1: You know.
Speaker 4: Number one, we have pant on you virus and the
Speaker 4: virus sequences were put on the internet and the CDC
Speaker 4: developed a test.
Speaker 5: And then of course this is not you know, people
Speaker 5: came on talking about a kit. This is not a kit.
Speaker 4: You know, this is not a something that you go
Speaker 4: to a store and you buy, right, This is something
Speaker 4: that they developed.
Speaker 5: This was a home group. You know, this is best
Speaker 5: I can describe it. This was a laboratory developed test.
Speaker 5: They did it in house, and of.
Speaker 4: Course because of a laboratory developed tests, and they had
Speaker 4: some challenges, and during those challenges because of some regulations
Speaker 4: that existed, you know, unfortunately, when the president activated or
Speaker 4: said this national emergency, that's activated a ferioce of rules
Speaker 4: that blocked others from developing a test at this point
Speaker 4: in time. At that point in time, so most people
Speaker 4: were not developing I said, some people a weren't developing tests,
Speaker 4: but others were not. So there was a lot of
Speaker 4: I would say things that I would describe between bureaucracy,
Speaker 4: unfortunate mistakes, and just dealing.
Speaker 5: With something new that prevented us from.
Speaker 4: Developing what I would have been a robust test. And
Speaker 4: then now a lot of tests are being developed and
Speaker 4: companies are getting involved. But also, you know, initially CDC
Speaker 4: started getting tests out to health departments. And we know,
Speaker 4: you and I know that health departments are there to
Speaker 4: do public health, but not to do clinical care. But
Speaker 4: if clinical patients were coming, then all of a sudden,
Speaker 4: the health departments are supposed to be providing clinical testing, right,
Speaker 4: which is not what they're designed to do. So now
Speaker 4: I think things are a little better because now you
Speaker 4: have companies out there working and doing and all this stuff,
Speaker 4: and that makes a huge difference. And I think we're seeing,
Speaker 4: you know, the FDA is approving tests less than right,
Speaker 4: so I think they're going to be more testing, and
Speaker 4: I think we need a lot more testing, and as
Speaker 4: you've seen, the US.
Speaker 5: Is way behind.
Speaker 4: The problem is is that we would like to offer
Speaker 4: the test to more people, but we still have our
Speaker 4: point that we need to ration our testing. And we're
Speaker 4: in a situation right now in this country that we've
Speaker 4: never been before. We are rationing testing, we're rationing ppe.
Speaker 4: So I tell people, now, you know what it feels
Speaker 4: to be in a developing country, right because we're rationing
Speaker 4: things and that's something that we don't necessarily feel comfortable doing.
Speaker 4: But that's the reality, right is we are in a
Speaker 4: rationing environment and rationing is very hard.
Speaker 3: Yeah, absolutely so at this point, I know, I know
Speaker 3: some of this it kind of varies state to state
Speaker 3: or even maybe county to county as well, but are
Speaker 3: there general recommendations At what point a person if they
Speaker 3: suspect that they're infected, should go and try and get tested,
Speaker 3: even in spite of these shortages.
Speaker 4: If you have symptoms, if you are things you have
Speaker 4: the disease, you need to go to your doctor or
Speaker 4: you need to call your doctor and then you'll be
Speaker 4: told whether you need to be tested or not. But
Speaker 4: I want people to know is that if you're asymptomatic
Speaker 4: and just I don't want to worry it, well, to
Speaker 4: go get tested right now because their reality is just
Speaker 4: going to overwhelm the system and is going to take
Speaker 4: care of tests that we need for people who actually
Speaker 4: need it right now.
Speaker 3: So you've touched a bit already on that we're kind
Speaker 3: of learning as we go with this whole pandemic. But
Speaker 3: what do you think that this outbreak so far has
Speaker 3: taught us how to prepare for what we're experiencing right now?
Speaker 3: How can we do better kind of moving forward?
Speaker 4: I think right now it's really hard to know. But
Speaker 4: when we're done with this, I think we have to
Speaker 4: sit down and do the do the post boarded right,
Speaker 4: We need to do the let's go over this and
Speaker 4: find out where where were the mistakes, you know, and
Speaker 4: what got us in the trouble we're in because we
Speaker 4: should have never been in this kind of trouble. And
Speaker 4: you know, I would start with one thing. I think
Speaker 4: we have underinvested in public health for years, right, and
Speaker 4: many administration, not just the current but I started with
Speaker 4: Obama have really underinvested in public health. And you know,
Speaker 4: CDC has I think over seven hundred vacancies. And now
Speaker 4: because we are underinvested in public health for years now,
Speaker 4: we're having spent billions and in taking care of the problem.
Speaker 4: If we had invested in public health to begin with
Speaker 4: and had the surveillance equipment and other things. And I'll
Speaker 4: tell you an example of underinvestment. The state health departments
Speaker 4: are having trouble scaling up testing the way they should.
Speaker 4: Why because they don't have enough machines, they don't have
Speaker 4: enough personnel because they've we're underinvesting. So I would I
Speaker 4: would really want to see people rethink public health and
Speaker 4: whether we we have to put our priorities there. If
Speaker 4: we don't invest in public health, then we are going
Speaker 4: to be having another pandemic. And you know, and I
Speaker 4: think about you know, two thousand and nine we have
Speaker 4: pandemic influence and now we have this ten years later,
Speaker 4: So let's let's rethink this so we don't have the
Speaker 4: pandemic of twenty twenty nine.
Speaker 2: Yeah. Absolutely. So I'll end with asking you a question
Speaker 2: that I asked in our first episode on coronaviruses, and
Speaker 2: I asked, what about this disease concerns you? And what
Speaker 2: about the response or how the epidemic has been handled
Speaker 2: so far? Is there anything about that that is cause
Speaker 2: for optimism.
Speaker 5: What concerns me.
Speaker 4: The most about this disease right now is a transmission
Speaker 4: in healthcare settings because I tell people are healthcare workers, doctors, nurses,
Speaker 4: you know, advanced practice providers, et cetera, you know, a
Speaker 4: rest story, therapists, you name it are in the front lines.
Speaker 4: They're finding this virus in the battlefield, and we have
Speaker 4: been unable to give them all the necessary personal protection
Speaker 4: of equipment. So there's not enough personal partecular equipment, and
Speaker 4: therefore we are they begin to battle without enough protection,
Speaker 4: and that to me, we're doing the best we can,
Speaker 4: but we're still not where we would like to meet.
Speaker 4: And you know, we're having meetings to talk about, well,
Speaker 4: you know, how do we how do we use PP
Speaker 4: more appropriately? I mean, if we had enough VP, I
Speaker 4: would feel so much comfortable, so so not having enough
Speaker 4: material to provide our our doctors, our nurses, our healthcare
Speaker 4: workers the necessary protections. That that worries me a lot,
Speaker 4: because I think we're going to see a lot of
Speaker 4: infections among healthcare workers in this country and that is
Speaker 4: bad and that is something that this should be unacceptable
Speaker 4: and we need to make a big cry about that.
Speaker 4: But number two is I also worry that people are
Speaker 4: not taking it seriously and that people are still you know, partying,
Speaker 4: And I saw the videos of the college kids in
Speaker 4: the beach and Florida saying, Oh, this is no big deal.
Speaker 4: And what gives me hope is is science. And I think,
Speaker 4: you know what I've seen come together, how science, how industry,
Speaker 4: how the community is coming together, gives me hope because
Speaker 4: where I come from, where my research has been, with
Speaker 4: my work has been, which is an HIV.
Speaker 5: That's what's the solution.
Speaker 4: We are where we are in HIV because the community,
Speaker 4: the scientists, industry, and governments came together and got us
Speaker 4: where we are. To me, it's unimaginable to see where
Speaker 4: we are. I could have never predicted that it will
Speaker 4: be where we are in HIV and it's because because
Speaker 4: of that that coalition that made us better and made
Speaker 4: us stronger. So I have hope that between science community
Speaker 4: and everybody coming together will be in a better place.
Speaker 3: Doctor del Rio, he said we could call him Carlos,
Speaker 3: but it just feels wrong.
Speaker 2: Carlos, thank you so much. We really appreciate I mean,
Speaker 2: all of the people that we have talked to. I
Speaker 2: know we keep saying this, but all of the people
Speaker 2: that we've talked to took time, precious time out of
Speaker 2: their incredibly busy schedules to talk with us and to
Speaker 2: help spread some factual information about this disease. And for that,
Speaker 2: we thank you so so much.
Speaker 3: Yeah, really, thank you so much. So what have we learned?
Speaker 2: What have we learned? I think one of the things
Speaker 2: Number one that we've learned is that there does appear
Speaker 2: to be immunity to this virus, and that this immunity
Speaker 2: could substantially contribute to what slows this pandemic. So, even
Speaker 2: though we have talked about the horrible concept of using
Speaker 2: herd immunity as a strategy, it could be what happens
Speaker 2: naturally as people do get infected, especially since we're seeing
Speaker 2: this exponential growth. Now that might be what helped to
Speaker 2: contribute to the decline of cases in China, But more
Speaker 2: importantly is the social distancing measures, and we'll talk about
Speaker 2: that as well.
Speaker 3: Absolutely. Number two, an important thing that we learned from
Speaker 3: this episode is that we have to consider characteristics of
Speaker 3: this disease and this epidemic in the context of the
Speaker 3: places that are being affected. So we're seeing different infection
Speaker 3: rates and different case fatality rates in different regions, in
Speaker 3: part because the populations that are affected in those regions
Speaker 3: are different, and we don't at this point necessarily know
Speaker 3: exactly what all those differences are that are driving the
Speaker 3: differences in case fasevitality and in infection rates. That's something
Speaker 3: that we might only be able to recognize in retrospect
Speaker 3: once we make it through the other side of this outbreak.
Speaker 3: And I think that's really important because you know, there's
Speaker 3: been a lot of talk about, well, the case metality
Speaker 3: rate is this in Italy versus this in South Korea,
Speaker 3: And we don't fully understand exactly what those differences mean
Speaker 3: in this context.
Speaker 2: Yet, right and how much they're going to change as
Speaker 2: we test more people, as the number of cases grow,
Speaker 2: as our knowledge about this disease grows exactly.
Speaker 4: Yeah.
Speaker 2: Number three, we have underinvested in global health security and
Speaker 2: in international public health and pandemic preparedness on national scales,
Speaker 2: international scales, regional scales, local scales, state scales, whatever, every
Speaker 2: single scale, on every single conceivable scale, for years and
Speaker 2: years and years. This lack of investment in global health
Speaker 2: security and pandemic preparedness, it is coming back now to
Speaker 2: haunt us. And so the amount of money that you know,
Speaker 2: speaking for the US, the amount of money that we
Speaker 2: have saved by cutting programs such as the CDC and
Speaker 2: pandemic preparedness initiatives, that number is infinitesimly small compared to
Speaker 2: the bill that this is going to lead to. And
Speaker 2: that's just the economic bill. The psychological impacts, the social impacts.
Speaker 2: I mean, this is going to have repercussions for every
Speaker 2: aspect of our lives, and I think it is going
Speaker 2: to fundamentally change the way that we live, the way
Speaker 2: that we work, the way that we communicate, and the
Speaker 2: way that we think about our own health and safety.
Speaker 3: Say it, Aaron. Number four, We learned from this interview,
Speaker 3: but there were a lot of different factors that contributed
Speaker 3: to the slow rollout of tests that we've seen in
Speaker 3: the U. We are doing better now, for sure. There's
Speaker 3: a lot of different private labs and private hospitals and
Speaker 3: public hospitals that are developing their own tests, and people
Speaker 3: are working really hard to try and roll out more
Speaker 3: and more tests. But that delay has really prevented us
Speaker 3: from getting the precious knowledge that could have helped to
Speaker 3: slow this disease. And I think you can't really underestimate
Speaker 3: just how important that was. Like, this is a thing
Speaker 3: we've kind of botched, and like doctor Kraft mentioned in
Speaker 3: one of our episodes, it's not like we could have
Speaker 3: made this overnight, right, but it was kind of months
Speaker 3: of not not ramping up production on something like this
Speaker 3: to be able to start rolling out these tests well.
Speaker 3: And now we're running into further issues of running out
Speaker 3: of protective equipment, of running out of swabs to actually
Speaker 3: run these tests, Like we have a lot of issues
Speaker 3: in the actual supply chain of tests for this virus.
Speaker 2: Absolutely, you know, And I think that if we want
Speaker 2: a silver lining this, then this is hopefully something that
Speaker 2: we can take and learn from. We've talked about this
Speaker 2: before in in terms of epidemiologists either always being viewed
Speaker 2: as over prepared or underprepared, or overreactive or underreactive, and
Speaker 2: it's a huge challenge. It is zero point five. I
Speaker 2: think this is a really important one, and this is
Speaker 2: something that we have hammered on in other episodes in
Speaker 2: this series so far. We can bring down the r
Speaker 2: not of this virus through control measures and personal decisions,
Speaker 2: our individual actions. Each one of us has the power
Speaker 2: to help slow the spread of this disease. We really
Speaker 2: need to take this seriously. So there was a really.
Speaker 3: Great modeling study that looked at the data from Wuhan
Speaker 3: like retrospectively after the fact, and they suggested from this
Speaker 3: that the restrictions that were implemented and people actually by
Speaker 3: people actually changing their behaviors, they were able to decrease
Speaker 3: the art not in that infection from around two point
Speaker 3: four to one point four. So they cut it by
Speaker 3: one hundred percent, which is massive, massively important.
Speaker 2: Yeah, it can be done. It can be done. It
Speaker 2: has been shown to be done. So let's do it.
Speaker 2: Let's do it.
Speaker 3: Let's do it.
Speaker 2: So okay sources.
Speaker 3: Yeah, So that paper that I just mentioned, that was
Speaker 3: a paper by Lee at All in Science published in
Speaker 3: Science on March sixteenth, entitled Substantial Undocumented Infection facilitates the
Speaker 3: rapid dissemination of novel coronavirus.
Speaker 2: And then there's those papers that we mention earlier by
Speaker 2: plow Right at All and Coton's at All. We'll post
Speaker 2: those papers on our website.
Speaker 3: And for more details on the timeline as well as
Speaker 3: for updates on it that we'll post the link to
Speaker 3: that Al Jazeera article as well.
Speaker 2: Yeah, it's awesome. Thank you again so much to Carlos.
Speaker 2: We really appreciate it. We do.
Speaker 3: And thank you to Bloodmobile for providing the music for
Speaker 3: this episode in all of our episodes.
Speaker 2: And thank you to you listeners for sticking through one
Speaker 2: more episode of this. There's more coming your way until
Speaker 2: next time.
Speaker 3: Wash your hands, you filthy animals, um