WEBVTT - COVID-19 Chapter 8: Disparities 0:00:01.240 --> 0:00:04.200 I am a public defender. I practice in a small 0:00:04.280 --> 0:00:06.120 area of a state that is not one of the 0:00:06.120 --> 0:00:09.520 epicenters for the coronavirus. There are parts of my state 0:00:09.600 --> 0:00:12.000 that have been hit hard, and there have been cases 0:00:12.000 --> 0:00:14.640 in and around my area. A great deal of my 0:00:14.680 --> 0:00:19.840 time and energy has been devoted to my currently incarcerated clients. Often, 0:00:19.920 --> 0:00:22.720 when I see articles on social media about coronavirus in 0:00:22.800 --> 0:00:25.520 jails and prisons, there are a lot of comments along 0:00:25.560 --> 0:00:28.400 the lines of well, it's their own fault for being there. 0:00:29.080 --> 0:00:32.839 This frustrates me a lot. First, not everyone who is 0:00:32.920 --> 0:00:35.800 locked up has been convicted of something. Many of my 0:00:35.880 --> 0:00:39.479 clients are locked up because they could not make bail. Also, 0:00:39.880 --> 0:00:43.960 minor crimes should not carry a death sentence. When courts 0:00:44.000 --> 0:00:46.880 went to restricted schedules in mid March, my office started 0:00:46.880 --> 0:00:50.520 filing motions for bond for clients whose cases had been continued. 0:00:51.240 --> 0:00:53.920 One of my colleagues contacted the local jail to find 0:00:53.960 --> 0:00:57.560 out information on male inmates' abilities to social distance and 0:00:57.640 --> 0:01:01.400 maintain hygiene. Female inmates are housed elsewhere and we did 0:01:01.400 --> 0:01:05.959 not receive information on their situation. We found out one 0:01:06.360 --> 0:01:09.800 showers and toilets are shared with one shower for sixteen 0:01:09.840 --> 0:01:14.640 to seventeen inmates. Two clothing is washed twice per week, 0:01:14.920 --> 0:01:18.040 linens are washed once per week, and blankets are washed monthly. 0:01:19.040 --> 0:01:22.000 Three two or three inmates sleep on the floor of 0:01:22.000 --> 0:01:26.520 a pod designed for fourteen. Four There is no access 0:01:26.640 --> 0:01:31.479 to hand sanitizer. Five there are limited supplies of soap, 0:01:31.680 --> 0:01:36.040 toilet paper, and tissues. And six there is not enough 0:01:36.040 --> 0:01:39.560 physical space to allow inmates to maintain three foot separation, 0:01:40.000 --> 0:01:44.240 as was the recommendation at the time the judge hearing 0:01:44.280 --> 0:01:47.640 our motions was and at the time of writing this 0:01:47.920 --> 0:01:51.360 still is of the opinion that inmates are safer in 0:01:51.440 --> 0:01:54.520 jail than out on the streets. Of the approximately twenty 0:01:54.560 --> 0:01:57.200 bond hearings we did the first day, two or three 0:01:57.280 --> 0:02:01.480 were granted. For our next round of motions, my colleague 0:02:01.480 --> 0:02:03.960 went to court with an article from a national newspaper 0:02:04.000 --> 0:02:07.840 and a PowerPoint presentation, both written by an epidemiologist who 0:02:07.880 --> 0:02:11.600 studies disease in jails and prisons, as evidence that one 0:02:11.600 --> 0:02:14.720 case in a jail or prison would spread like wildfire 0:02:14.880 --> 0:02:19.200 throughout the inmates and correction staff. But since there wasn't 0:02:19.200 --> 0:02:22.320 a peer reviewed study and the epidemiologist was not physically 0:02:22.400 --> 0:02:25.400 in court to present her research. The judge would not 0:02:25.480 --> 0:02:29.240 let my colleague admit the article or PowerPoint. The lack 0:02:29.280 --> 0:02:32.920 of scientific consensus is a roadblock. We keep running into 0:02:33.560 --> 0:02:37.600 news reports say studies show various underlying conditions cause greater risk, 0:02:38.160 --> 0:02:41.280 but we have no way to present that evidence as evidence, 0:02:41.840 --> 0:02:45.280 so the judge does not consider it when making determinations. 0:02:46.320 --> 0:02:48.560 We have tried to proffer what we have read in 0:02:48.639 --> 0:02:51.720 news reports, but the prosecutor objects and the court does 0:02:51.760 --> 0:02:56.480 not accept our attempts. In all, the jail population has 0:02:56.520 --> 0:03:00.720 been reduced about fifteen percent, which is not bad, but 0:03:00.880 --> 0:03:03.360 it does not fix the hygiene issues or the fact 0:03:03.440 --> 0:03:08.000 that inmates cannot physically maintain the now recommended six foot distance. 0:03:09.120 --> 0:03:12.280 I do not know how many inmates are immunocompromised, nor 0:03:12.400 --> 0:03:14.880 how many have other health issues which would put them 0:03:14.880 --> 0:03:17.919 at greater risk if they were infected. I do know 0:03:18.000 --> 0:03:21.639 there are inmates in those situations. I represent some of them. 0:03:22.200 --> 0:03:24.480 I do not know what measures the jail is taking 0:03:24.520 --> 0:03:27.680 to screen inmates who may be showing symptoms. The local 0:03:27.720 --> 0:03:32.160 hospital is small and already has coronavirus patients. I get 0:03:32.240 --> 0:03:35.800 multiple calls a day from incarcerated clients asking if they 0:03:35.800 --> 0:03:38.880 can have a bond hearing or a furlough motion. Some 0:03:39.120 --> 0:03:42.800 I can file, most are not eligible. Many of my 0:03:42.880 --> 0:03:45.320 clients have read in the paper about inmates and other 0:03:45.440 --> 0:03:49.280 jails getting out, which is true. But my clients are 0:03:49.280 --> 0:03:52.000 not in those other jails. They are where they are 0:03:52.200 --> 0:03:55.080 with judges who still believe they are safer locked up. 0:03:56.000 --> 0:03:58.560 A few jails in my state have now had outbreaks. 0:03:59.080 --> 0:04:01.400 So far we have I've not had a positive case 0:04:01.440 --> 0:04:04.280 in our jail, but I believe it is only a 0:04:04.280 --> 0:04:04.960 matter of time. 0:04:07.280 --> 0:04:09.960 I am a daughter to two Mexican parents who migrated 0:04:10.000 --> 0:04:12.520 to the US when they were very young. Before the 0:04:12.560 --> 0:04:15.600 pandemic began, I was working in the ophthalmology department, a 0:04:15.760 --> 0:04:19.159 large network of clinics in the California Central Coast. My 0:04:19.240 --> 0:04:21.920 life was pretty ordinary. I got to work at about 0:04:21.920 --> 0:04:24.719 seven thirty am, got a coffee at the cafe across 0:04:24.760 --> 0:04:27.600 the way, worked eight to nine hours, then headed home. 0:04:28.080 --> 0:04:30.320 On the weekends, I did a lot of hiking with friends, 0:04:30.440 --> 0:04:33.720 walking downtown, or going to cafes to read or hang out. 0:04:34.640 --> 0:04:37.200 Just before the start of the pandemic, I had accepted 0:04:37.240 --> 0:04:41.080 the admission offer into the PhD program began making plans 0:04:41.120 --> 0:04:43.839 to move and in the process of starting a research 0:04:43.880 --> 0:04:48.240 position at the institution in May. Unfortunately, all of those 0:04:48.279 --> 0:04:50.800 plans have been put on hold due to COVID nineteen. 0:04:51.800 --> 0:04:55.000 I am passionate about public health and had been volunteering 0:04:55.000 --> 0:04:58.120 at my county's public health department, so I heard about 0:04:58.120 --> 0:05:01.480 the novel coronavirus shortly after the first incident was reported 0:05:01.520 --> 0:05:04.799 to the WHO. I began to worry about my parents 0:05:04.880 --> 0:05:07.200 when I saw that patients who seemed to be impacted 0:05:07.320 --> 0:05:12.040 most severely and also dying were older people with underlying conditions. 0:05:12.720 --> 0:05:15.440 My mom is a breast cancer survivor and also has 0:05:15.440 --> 0:05:18.920 an underlying heart condition, and my dad just recently fell 0:05:18.920 --> 0:05:23.080 sick from pesticide exposure. I am constantly telling my parents 0:05:23.080 --> 0:05:26.719 to be careful, wash their hands, etc. But it's difficult 0:05:26.760 --> 0:05:29.680 when you can't be there and they're struggling both financially 0:05:29.760 --> 0:05:33.360 and health wise. Add on their undocumented status and it 0:05:33.440 --> 0:05:38.120 really amplifies the fear when you're undocumented. Moving through society 0:05:38.279 --> 0:05:41.479 undetected feels like the key to survival, and a lot 0:05:41.520 --> 0:05:44.880 of times, seeking professional medical attention feels like a risk 0:05:45.000 --> 0:05:48.159 too big to take. At the start of the pandemic, 0:05:48.200 --> 0:05:51.120 I felt hopeful because I trust our leaders in scientific 0:05:51.160 --> 0:05:54.159 research spaces as well as our medical and health care staff. 0:05:54.680 --> 0:05:57.000 But I quickly came to realize how much impact the 0:05:57.040 --> 0:06:00.560 administrative and political side of things has on science ability 0:06:00.640 --> 0:06:03.880 to save lives. Aside from my worry stemming from the 0:06:03.960 --> 0:06:06.960 lack of leadership coming from people in positions of power, 0:06:07.520 --> 0:06:09.880 I was also just really stressing out about the fact 0:06:09.920 --> 0:06:12.360 that most people I knew or was connected to via 0:06:12.440 --> 0:06:15.920 social media had no idea how to get reliable information. 0:06:16.760 --> 0:06:19.680 Another big stressor is money, but I think there are 0:06:19.680 --> 0:06:21.680 a lot of people stressing out about that right now, 0:06:23.200 --> 0:06:25.520 Like a lot of people, I don't have an income now, 0:06:25.760 --> 0:06:28.000 but I still have rent and bills to pay. I 0:06:28.040 --> 0:06:31.240 also regularly help my parents financially, but I can't do 0:06:31.320 --> 0:06:34.360 that now either. I think the message that I want 0:06:34.360 --> 0:06:37.720 to drive home the hardest is number one. There are 0:06:37.760 --> 0:06:41.000 populations in the country who have been victims of exploitation, 0:06:41.600 --> 0:06:45.320 who have dedicated their lives to becoming true Americans, who 0:06:45.400 --> 0:06:49.000 have selflessly given their labor and their bodies to prove 0:06:49.120 --> 0:06:52.680 that they can be and are productive members of this 0:06:52.880 --> 0:06:56.760 national community, who will, unfortunately not be granted access to 0:06:56.839 --> 0:06:59.919 aid during this pandemic, and these are decisions that have 0:07:00.080 --> 0:07:02.960 been purposely made by the people who have been elected 0:07:03.000 --> 0:07:06.599 to lead. Not only is this a humanitarian crisis in 0:07:06.640 --> 0:07:09.680 our country, but it also costs a lot more money 0:07:09.880 --> 0:07:13.280 to disenfranchise communities and limit their access to health care 0:07:13.600 --> 0:07:16.240 than to grant them the tools and services they need 0:07:16.400 --> 0:07:20.160 to stay healthy. Number two, there are a lot of 0:07:20.240 --> 0:07:22.880 health care providers and staff who are putting their lives 0:07:22.920 --> 0:07:25.520 on the line for our communities, and they are also 0:07:25.600 --> 0:07:29.280 probably experiencing some level of oppression. They really need the 0:07:29.280 --> 0:07:32.080 support of their community. They need to feel that their 0:07:32.080 --> 0:07:34.920 community is behind them, backing them up when they are 0:07:34.920 --> 0:07:39.080 expressing concerns regarding their safety and working conditions. It is 0:07:39.120 --> 0:07:42.200 pretty obvious now that the fight against this pandemic will 0:07:42.200 --> 0:07:44.160 have to be led by the people on the ground 0:07:44.240 --> 0:07:48.120 who hold no administrative power but care enough about preserving 0:07:48.200 --> 0:07:51.240 human life to take on the fight. But those of 0:07:51.320 --> 0:07:53.600 us who will be stepping up to make homemade masks, 0:07:53.840 --> 0:07:57.240 organized donation drives, and offer free meals and services must 0:07:57.320 --> 0:08:00.560 remember to make an intentional effort to consider and include 0:08:00.600 --> 0:08:02.840 the most marginalized folks in our communities. 0:08:48.120 --> 0:08:48.400 Wow. 0:08:49.440 --> 0:08:53.079 Wow, those were excellent first hand accounts. 0:08:53.840 --> 0:08:57.240 Thank you so much for writing in Yes. 0:08:57.520 --> 0:09:00.760 Yes, So those are two first had account that people 0:09:00.840 --> 0:09:03.800 sent to us when we were asking people to fill 0:09:03.840 --> 0:09:06.959 out the form, and we really really appreciate you taking 0:09:07.000 --> 0:09:09.440 the time to write that out and share your story 0:09:09.480 --> 0:09:12.320 with us. I think it's very interesting and important to 0:09:12.320 --> 0:09:13.720 hear all these different perspectives. 0:09:14.320 --> 0:09:18.360 Yeah, thank you so much. Man. Also so well written, 0:09:18.640 --> 0:09:19.319 so well. 0:09:19.120 --> 0:09:21.439 Written, I know it's amazing. 0:09:23.840 --> 0:09:27.120 Hi, I'm erin Welsh and I'm erin Olman Updike. 0:09:27.720 --> 0:09:32.439 Welcome to another episode, the eighth episode in our series 0:09:32.440 --> 0:09:35.599 on COVID nineteen, which we're calling Anatomy of a Pandemic. 0:09:36.440 --> 0:09:39.920 This week, we're talking about the disproportionate impact this pandemic 0:09:40.000 --> 0:09:43.160 is likely to have on populations that are already vulnerable 0:09:43.480 --> 0:09:46.400 and what we're currently doing to try to minimize that impact. 0:09:47.320 --> 0:09:49.760 But before we get into that, we have a few 0:09:49.760 --> 0:09:54.199 pieces of business to get into. First Off, first hand accounts, 0:09:54.400 --> 0:09:57.400 which you just heard two of. We're going to keep 0:09:57.440 --> 0:09:59.520 doing these episodes, and that means we're going to need 0:09:59.559 --> 0:10:02.439 more first hand accounts from you. If you're willing to 0:10:02.480 --> 0:10:05.120 share how this pandemic has impacted you, and you're okay 0:10:05.160 --> 0:10:07.480 with us featuring your story as a first hand account 0:10:07.480 --> 0:10:10.320 on upcoming episodes. We're asking for you to go to 0:10:10.400 --> 0:10:12.600 this podcast will Kill You dot com and click on 0:10:12.720 --> 0:10:15.800 COVID nineteen firsthand to fill out the form there and 0:10:15.840 --> 0:10:16.680 we can get back to you. 0:10:17.520 --> 0:10:21.800 Second alcohol free episodes on our website, we have made 0:10:21.840 --> 0:10:24.599 a special playlist that has our episodes with the quarantini 0:10:24.679 --> 0:10:28.079 talk edited out. We're providing these for anyone who, for 0:10:28.120 --> 0:10:32.040 whatever reason doesn't want to hear us talking about alcohol. 0:10:32.760 --> 0:10:36.000 Don't worry our normal episodes we'll still have quarantinies and 0:10:36.080 --> 0:10:37.680 you'd actually have to go out of your way to 0:10:37.720 --> 0:10:39.120 listen to the alcohol free ones. 0:10:41.559 --> 0:10:46.600 Lastly, business wise, if you've listened before, you probably know 0:10:46.679 --> 0:10:49.440 that we have a good Reads list, which Aaron Welsh 0:10:49.800 --> 0:10:50.680 pretty much curate. 0:10:53.200 --> 0:10:53.439 I'm not. 0:10:53.800 --> 0:10:55.960 It's also the good user contributions. 0:10:56.320 --> 0:10:58.640 That's true, it's a great list. It's a really good list. 0:10:59.040 --> 0:11:02.520 But now we also have an affiliate page on bookshop 0:11:02.559 --> 0:11:05.920 dot org, which is an amazing online bookstore that works 0:11:05.920 --> 0:11:09.679 with independent bookstores to support them financially. So you can 0:11:09.679 --> 0:11:12.240 find that link on our website, along with links to 0:11:12.320 --> 0:11:15.200 books on bookshop dot org in our reference section for 0:11:15.240 --> 0:11:16.040 each episode. 0:11:17.000 --> 0:11:19.360 Yeah, we really love the idea of bookshop dot org 0:11:19.400 --> 0:11:21.760 and a listener, the listener who sent that to us, 0:11:21.840 --> 0:11:25.120 thank you very much. So on bookshop we have a 0:11:25.120 --> 0:11:28.079 few different lists, so I'm thinking now maybe to separate 0:11:28.120 --> 0:11:31.760 them into nonfiction fiction and memoirs. But in any case, 0:11:31.800 --> 0:11:33.760 you can find all of the books that we have 0:11:34.120 --> 0:11:36.520 read in our episodes there, and then we'll also throw 0:11:36.559 --> 0:11:39.120 in some more that we have read and liked or 0:11:39.120 --> 0:11:43.400 that other listeners have recommended. And then I also want 0:11:43.440 --> 0:11:46.880 to just give a little friendly reminder that even though 0:11:47.000 --> 0:11:50.440 public libraries are closed, if you have a library card 0:11:50.600 --> 0:11:55.040 and an appropriate device, you can still check out ebooks. 0:11:55.080 --> 0:11:57.800 You can still check out audiobooks, you can still check 0:11:57.800 --> 0:12:02.280 out magazines, and there are also a ton of other 0:12:02.440 --> 0:12:07.800 amazing resources on libraries online, so you should check out 0:12:07.800 --> 0:12:09.240 your local library website. 0:12:10.080 --> 0:12:14.000 Awesome, all right, Well is. 0:12:13.960 --> 0:12:15.280 It h What time is it? 0:12:15.320 --> 0:12:15.560 Aaron? 0:12:16.240 --> 0:12:20.800 I believe it's quarantiny time. I believe you are right 0:12:22.240 --> 0:12:23.320 checking my watch. 0:12:23.480 --> 0:12:27.680 Now there we go, so quarantiney eight. 0:12:28.520 --> 0:12:29.600 Quarantini number eight. 0:12:30.280 --> 0:12:36.199 Quarantin E eight has bourbon, apple, brandy, grenadine, and lemon juice. 0:12:36.600 --> 0:12:40.440 Yum, it's pretty good. That sounds good. I don't have 0:12:40.520 --> 0:12:43.080 those ingredients, so I haven't tried that one yet. But 0:12:44.320 --> 0:12:45.559 sounds tasty. 0:12:45.679 --> 0:12:48.880 It's it's not bad, I can I can vouch for 0:12:48.960 --> 0:12:50.560 its decentness. 0:12:51.120 --> 0:12:55.080 Decentness just what everyone wants. 0:12:55.080 --> 0:12:58.120 Better than decent. I think it's tasty, but you know, 0:12:58.160 --> 0:13:01.880 people have different tastes, so anyway, true, so true? Yeah, okay, 0:13:01.960 --> 0:13:05.560 all right, So moving on. So we got some emails 0:13:05.559 --> 0:13:08.080 from listeners asking us to clear up a few things 0:13:08.080 --> 0:13:11.559 about COVID nineteen from our previous episodes, So we're gonna 0:13:11.600 --> 0:13:14.479 do that real quick before we dive into the interview. 0:13:15.559 --> 0:13:18.200 The first is about herd immunity. So in one of 0:13:18.200 --> 0:13:21.640 our COVID nineteen episodes, we said something like herd immunity 0:13:21.679 --> 0:13:25.880 as a strategy is a terrible strategy, which in retrospect 0:13:26.120 --> 0:13:29.200 may have been a bit confusing because we usually talk 0:13:29.240 --> 0:13:33.000 about the importance of maintaining herd immunity in preventing outbreaks. 0:13:33.520 --> 0:13:38.959 So why would herd immunity be a bad strategy? Well, first, 0:13:39.000 --> 0:13:41.920 let's just go over the definition of hurd immunity. Herd 0:13:41.920 --> 0:13:46.200 immunity is simply that if there's a large proportion of 0:13:46.240 --> 0:13:49.720 people who are immune to a particular pathogen. Outbreaks of 0:13:49.760 --> 0:13:52.840 that pathogen are less likely to happen because the chain 0:13:52.880 --> 0:13:56.640 of transmission can't be maintained. It's the way that we 0:13:56.800 --> 0:14:00.160 achieve herd immunity that makes it a good or bad strategy. 0:14:00.480 --> 0:14:03.760 So you can achieve her immunity by either vaccinating people 0:14:04.160 --> 0:14:08.320 or through actual infection with a pathogen. Right now, we 0:14:08.559 --> 0:14:12.240 don't have a vaccine for the virus that causes COVID nineteen, 0:14:12.440 --> 0:14:15.600 So the only way to achieve herd immunity for that 0:14:15.720 --> 0:14:19.920 would be through having everyone get infected. But if we 0:14:19.920 --> 0:14:22.800 were to do that, an unbelievable number of people would 0:14:22.840 --> 0:14:27.240 become severely ill or die. Our hospitals would be overburdened 0:14:27.800 --> 0:14:30.880 even more than they currently are. And so that is 0:14:30.960 --> 0:14:34.480 why herd immunity for COVID nineteen at this point is 0:14:34.480 --> 0:14:37.000 a bad strategy. It's sort of just the way you 0:14:37.040 --> 0:14:37.920 get hurt immunity. 0:14:38.120 --> 0:14:42.400 Does that make sense, Yes, excellent explanation, Aaron, thank you, 0:14:42.720 --> 0:14:45.600 Thank you. Okay. The second thing that people have written 0:14:45.600 --> 0:14:48.720 in about is about are not and this idea that 0:14:48.760 --> 0:14:51.120 we've talked about of bringing down the ar not of 0:14:51.160 --> 0:14:55.720 SARS COVID two. So usually on this podcast when we 0:14:55.760 --> 0:14:58.680 talk about the are not of a pathogen. We describe 0:14:58.720 --> 0:15:02.920 it as kind of an unchangeding inherent characteristic of that pathogen. 0:15:03.200 --> 0:15:05.800 For example, we've said that the are not of measles 0:15:05.840 --> 0:15:08.600 is between twelve or eighteen, or the are not of 0:15:08.640 --> 0:15:11.640 smallpox is between three and a half and six. So 0:15:12.000 --> 0:15:15.280 when we talk about bringing it down, bringing the are 0:15:15.320 --> 0:15:17.360 not down, how can we even do that? 0:15:17.840 --> 0:15:18.640 How is that a thing? 0:15:19.840 --> 0:15:23.200 It has to do with how the are not is calculated. 0:15:23.920 --> 0:15:27.360 These numbers, and again the are not is the reproductive 0:15:28.080 --> 0:15:32.240 value of a pathogen. These numbers are estimates that are 0:15:32.320 --> 0:15:37.360 based off of a particular kind of idealized scenario in 0:15:37.400 --> 0:15:42.800 which one single infected person goes into a community of 0:15:43.160 --> 0:15:47.520 fully susceptible individuals where no one else that they're around 0:15:47.640 --> 0:15:51.680 has immunity to that pathogen. The number of people infected 0:15:51.960 --> 0:15:55.520 from that one person in that community would be the 0:15:55.600 --> 0:15:58.320 are not value that would be the basic are not. 0:15:59.720 --> 0:16:03.840 The effective are not depends on how many people in 0:16:03.880 --> 0:16:08.160 that community are immune, or on how much people change 0:16:08.200 --> 0:16:12.360 their behavior to actually decrease their exposure, So both of 0:16:12.400 --> 0:16:16.560 these numbers are context dependent. The basic are not of 0:16:16.640 --> 0:16:20.320 measles is twelve to eighteen, but the effective are not 0:16:20.440 --> 0:16:23.840 in a community that has high rates of protection against measles, 0:16:23.880 --> 0:16:27.400 for example, high rates of vaccination is much much lower 0:16:27.560 --> 0:16:30.720 because there aren't enough susceptible people in that community to 0:16:30.760 --> 0:16:36.000 actually sustain that chain of transmission. So in the absence 0:16:36.000 --> 0:16:39.640 of an effective vaccine such as we're living right now 0:16:39.680 --> 0:16:43.200 with COVID nineteen, we can still drive down the ar 0:16:43.360 --> 0:16:46.520 not by breaking the chain of transmission through changes in 0:16:46.560 --> 0:16:50.960 our behavior, which brings us to a very important discussion 0:16:51.320 --> 0:16:54.320 in this interview today. 0:16:54.480 --> 0:16:58.440 Yes, if you have listened to the podcast before, you 0:16:58.560 --> 0:17:00.800 know that our sign off is wash your hands, you 0:17:00.840 --> 0:17:05.520 fil the animals, And throughout this pandemic, hand washing has 0:17:05.600 --> 0:17:08.600 been hammered over and over again as a good way 0:17:08.680 --> 0:17:11.200 to reduce your chances of getting infected with the virus 0:17:11.320 --> 0:17:13.720 and passing it along to others, and it is a 0:17:13.760 --> 0:17:18.600 really good way to prevent that from happening. But what 0:17:18.760 --> 0:17:22.480 if you don't have clean water or soap, What if 0:17:22.520 --> 0:17:25.080 you're not able to shelter in place because you're fleeing 0:17:25.119 --> 0:17:28.680 from a war, or what if you can't practice social 0:17:28.800 --> 0:17:31.679 or physical distancing because you live in a slum or 0:17:31.720 --> 0:17:32.560 refugee camp. 0:17:33.400 --> 0:17:36.520 These are the questions that doctor Jonathan Whittall, who is 0:17:36.560 --> 0:17:41.000 the director of Analysis at Medisan San Frontier aka MSF 0:17:41.240 --> 0:17:45.320 aka Doctors Without Borders, brought up in his amazing article 0:17:45.560 --> 0:17:49.600 titled Vulnerable Communities are Bracing for impact of COVID nineteen. 0:17:50.240 --> 0:17:52.720 We brought him onto the podcast to talk about how 0:17:52.760 --> 0:17:56.240 this pandemic is likely to impact populations that are already 0:17:56.320 --> 0:17:59.920 vulnerable or whose health and safety is constantly under threat, 0:18:00.320 --> 0:18:02.560 and to discuss what we can learn from working in 0:18:02.640 --> 0:18:05.240 past public health crises with limited resources. 0:18:06.240 --> 0:18:39.840 You'll hear from him right after this break. 0:18:40.720 --> 0:18:43.440 My name is Jonathan Whittell. I'm the director of the 0:18:43.480 --> 0:18:48.520 Analysis department for Doctors Without Borders, so I work on 0:18:48.760 --> 0:18:55.359 global issues related to FoST migration, conflict, and humanitarianism, health 0:18:55.359 --> 0:18:59.520 policy issues. We have a team of people that are 0:18:59.720 --> 0:19:04.280 our digging into each of these broad thematics to try 0:19:04.320 --> 0:19:06.640 and help our projects and our teams that are working 0:19:06.640 --> 0:19:09.720 in the field understand the environment that they're trying to navigate. 0:19:10.280 --> 0:19:13.520 At the moment, I'm talking to you from Beirut in 0:19:14.000 --> 0:19:17.240 the Middle East, and what I'm working on at the 0:19:17.240 --> 0:19:20.920 moment is one hundred and ninety percent COVID nineteen. 0:19:23.400 --> 0:19:25.960 Yeah, Yeah, So what kind of projects are you working 0:19:26.040 --> 0:19:28.880 on there or what specifically are you doing in Beirut. 0:19:29.560 --> 0:19:32.560 So what we're doing, well, i'll talk more broadly than 0:19:33.600 --> 0:19:37.040 on Lebanon, but what we're doing on COVID nineteen. So 0:19:37.320 --> 0:19:39.440 doctors with our board is just for listeners to have 0:19:39.480 --> 0:19:42.359 a bit of background. I'm sure many of them know 0:19:42.480 --> 0:19:45.400 what we do. But we're an emergency medical organization, so 0:19:46.520 --> 0:19:50.920 our goals are saving lives, alleviating suffering, responding to emergencies. 0:19:50.960 --> 0:19:54.840 We work in seventeen countries around the world. We respond 0:19:54.840 --> 0:19:58.560 to epidemics, so this is not something new for us 0:19:58.560 --> 0:20:03.120 in the sense that it's we do work on epidemic response, 0:20:03.880 --> 0:20:07.760 but we also respond to neglect, people that are excluded 0:20:07.800 --> 0:20:13.200 from access to healthcare, and the impact of conflicts, disasters, 0:20:13.440 --> 0:20:18.000 et cetera. So with COVID we've been we've been responding 0:20:18.040 --> 0:20:23.160 since the beginning when it started in China, and the epicenter, 0:20:23.320 --> 0:20:26.479 as you know, has now shifted to to to Europe 0:20:26.520 --> 0:20:30.840 and North America. And what's what's interesting is that for 0:20:30.880 --> 0:20:35.280 the first time in MSF's history, we are conducting a 0:20:35.359 --> 0:20:41.119 major medical emergency response in Europe. So the crisis, the 0:20:42.680 --> 0:20:47.640 emergency has overwhelmed the health system in Europe and there 0:20:47.720 --> 0:20:51.119 was a need for MSF to to respond to this emergency. 0:20:51.520 --> 0:20:55.119 So we're now working in Italy, Spain, Belgium, France, a 0:20:55.200 --> 0:21:01.040 few other countries in Europe. And this kind of epidemic 0:21:01.880 --> 0:21:05.639 it requires work on multiple different levels, from community levels 0:21:05.720 --> 0:21:09.400 right up to hospital care and very sophisticated hospital care. 0:21:10.000 --> 0:21:12.600 But what we've seen in Europe is that it's the 0:21:12.600 --> 0:21:17.520 health system as a very individually based model, so focuses 0:21:17.600 --> 0:21:21.280 very much on the individual and it's very hospital focused. 0:21:21.320 --> 0:21:23.800 So for example, if you have cancer, you would want 0:21:23.840 --> 0:21:28.280 to be in Europe to receive treatment if you're facing 0:21:28.320 --> 0:21:31.680 a pandemic. It's something that Europe hasn't dealt with for 0:21:32.000 --> 0:21:34.920 one hundred years. But at the same time, Europe is 0:21:34.960 --> 0:21:37.159 not going to stay and North America is not going 0:21:37.200 --> 0:21:41.280 to stay the center of this epidemic for long, and 0:21:41.359 --> 0:21:44.280 we're extremely worried about about what's going to come next, 0:21:44.840 --> 0:21:49.600 where we start to see the virus entering into lower 0:21:49.600 --> 0:21:54.000 resourced countries where the kind of next wave of this 0:21:54.080 --> 0:21:57.240 pandemic will will hit and then we will face different 0:21:57.240 --> 0:22:02.600 dilemmas and difficulties more linked to the already week week 0:22:02.880 --> 0:22:06.720 and overstretched health system. So, yeah, grappling with all of 0:22:06.760 --> 0:22:10.000 these issues from our emergency response as it stands today 0:22:10.080 --> 0:22:13.560 to preparing for when the next wave hits are what 0:22:13.600 --> 0:22:15.240 we're really focused on at the moment. 0:22:16.160 --> 0:22:16.720 Gotcha. 0:22:16.800 --> 0:22:17.119 Yeah. 0:22:17.800 --> 0:22:22.240 So the COVID nineteen pandemic for so many people is unprecedented, 0:22:22.400 --> 0:22:25.840 but there are also many other populations that have experienced 0:22:26.080 --> 0:22:30.560 these devastating outbreaks or epidemics or other just more continuous 0:22:30.600 --> 0:22:33.479 threats to their health and safety as you mentioned. And 0:22:33.640 --> 0:22:36.199 can you talk about what you're seeing in terms of 0:22:36.200 --> 0:22:40.159 the differences between this COVID nineteen pandemic and other public 0:22:40.160 --> 0:22:44.000 health emergency situations such as call our outbreaks and refugee 0:22:44.000 --> 0:22:47.360 camps for example, or Ebola epidemics. 0:22:48.000 --> 0:22:52.480 Yeah, So the biggest difference is scale. This is happening 0:22:52.640 --> 0:22:58.119 everywhere at once, So I think every health organization and 0:22:58.160 --> 0:23:01.560 every ministry of health is going to be pushed to 0:23:01.680 --> 0:23:03.760 its limits and beyond and what we're going to need 0:23:03.800 --> 0:23:07.760 as a kind of global global solidarity. And I think 0:23:08.280 --> 0:23:12.359 with COVID nineteen, the outcomes for the severely ill is 0:23:12.400 --> 0:23:15.880 extremely concerning for us, which is why it's so important 0:23:15.920 --> 0:23:20.679 to break the train of chain of transmission and to 0:23:20.760 --> 0:23:23.679 lower the number of critically ill. So in this sense, 0:23:24.160 --> 0:23:27.240 the community component is quite similar to what we see 0:23:27.280 --> 0:23:29.840 in other epidemics. We can't wait for patients to reach 0:23:29.880 --> 0:23:33.240 the hospital to tackle the pandemic. We need to work 0:23:33.280 --> 0:23:36.159 at a community level. It's a critical part of the 0:23:36.160 --> 0:23:39.080 overall response, and that's very similar to the kind of 0:23:39.080 --> 0:23:43.040 work that we do and for example in Ibola. The 0:23:43.080 --> 0:23:47.440 problem with COVID nineteen is that the measures that people 0:23:47.480 --> 0:23:50.920 need to take to protect themselves are hard or even 0:23:50.960 --> 0:23:55.200 impossible in some places, distance from taking distance, social distance, 0:23:56.200 --> 0:24:02.119 isolating the elderly, the medically vulnerable, hand wash and the 0:24:02.240 --> 0:24:05.919 disease is also transmitting when people are mildly sick or 0:24:05.960 --> 0:24:10.520 even not symptomatic at all, which makes the management of 0:24:11.040 --> 0:24:14.960 tracing contacts or if one person that is sick has 0:24:15.000 --> 0:24:17.560 contact with another person, we call it contact tracing and 0:24:17.600 --> 0:24:21.520 we try to follow the potential spread of the disease. 0:24:21.560 --> 0:24:25.840 This is very difficult in COVID in COVID nineteen, So 0:24:26.040 --> 0:24:29.520 usually in an epidemic situation for doctors without borders, if 0:24:29.560 --> 0:24:33.040 it was happening in one specific location, we would deploy 0:24:33.119 --> 0:24:36.359 the full scale of our emergency response and supplies and 0:24:36.359 --> 0:24:40.040 we would set up large scale response in a specific 0:24:40.119 --> 0:24:45.120 location that identifies people that are sick, traces who they've 0:24:45.119 --> 0:24:48.920 been in contact with, educates the community about the virus 0:24:49.160 --> 0:24:52.399