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  • Transcriber: Joseph Geni Reviewer: Camille Martínez

  • I want to lead here by talking a little bit about my credentials

  • to bring this up with you,

  • because, quite honestly,

  • you really, really should not listen to any old person with an opinion

  • about COVID-19.

  • (Laughter)

  • So I've been working in global health for about 20 years,

  • and my specific technical specialty is in health systems

  • and what happens when health systems experience severe shocks.

  • I've also worked in global health journalism;

  • I've written about global health and biosecurity

  • for newspapers and web outlets,

  • and I published a book a few years back

  • about the major global health threats facing us as a planet.

  • I have supported and led epidemiology efforts

  • that range from evaluating Ebola treatment centers

  • to looking at transmission of tuberculosis in health facilities

  • and doing avian influenza preparedness.

  • I have a master's degree in International Health.

  • I'm not a physician. I'm not a nurse.

  • My specialty isn't patient care or taking care of individual people.

  • My specialty is looking at populations and health systems,

  • what happens when diseases move on the large level.

  • If we're ranking sources of global health expertise

  • on a scale of one to 10,

  • one is some random person ranting on Facebook

  • and 10 is the World Health Organization,

  • I'd say you can probably put me at like a seven or an eight.

  • So keep that in mind as I talk to you.

  • I'll start with the basics here, because I think that's gotten lost

  • in some of the media noise around COVID-19.

  • So, COVID-19 is a coronavirus.

  • Coronaviruses are a specific subset of virus,

  • and they have some unique characteristics as viruses.

  • They use RNA instead of DNA as their genetic material,

  • and they're covered in spikes on the surface of the virus.

  • They use those spikes to invade cells.

  • Those spikes are the corona in coronavirus.

  • COVID-19 is known as a novel coronavirus

  • because, until December, we'd only heard of six coronaviruses.

  • COVID-19 is the seventh.

  • It's new to us.

  • It just had its gene sequencing,

  • it just got its name.

  • That's why it's novel.

  • If you remember SARS, Severe Acute Respiratory Syndrome,

  • or MERS,

  • Middle Eastern Respiratory Syndrome,

  • those were coronaviruses.

  • And they're both called respiratory syndromes,

  • because that's what coronaviruses do --

  • they go for your lungs.

  • They don't make you puke, they don't make you bleed from the eyeballs,

  • they don't make you hemorrhage.

  • They head for your lungs.

  • COVID-19 is no different.

  • It causes a range of respiratory symptoms

  • that go from stuff like a dry cough and a fever

  • all the way out to fatal viral pneumonia.

  • And that range of symptoms is one of the reasons

  • it's actually been so hard to track this outbreak.

  • Plenty of people get COVID-19 but so gently,

  • their symptoms are so mild, they don't even go to a health care provider.

  • They don't register in the system.

  • Children, in particular, have it very easy with COVID-19,

  • which is something we should all be grateful for.

  • Coronaviruses are zoonotic,

  • which means that they transmit from animals to people.

  • Some coronaviruses, like COVID-19, also transmit person to person.

  • The person-to-person ones travel faster and travel farther,

  • just like COVID-19.

  • Zoonotic illnesses are really hard to get rid of,

  • because they have an animal reservoir.

  • One example is avian influenza,

  • where we can abolish it in farmed animals, in turkeys, in ducks,

  • but it keeps coming back every year because it's brought to us by wild birds.

  • You don't hear a lot about it

  • because avian influenza doesn't transmit person-to-person,

  • but we have outbreaks in poultry farms every year all over the world.

  • COVID-19 most likely skipped from animals into people

  • at a wild animal market in Wuhan, China.

  • Now for the less basic parts.

  • This is not the last major outbreak we're ever going to see.

  • There's going to be more outbreaks, and there's going to be more epidemics.

  • That's not a maybe. That's a given.

  • And it's a result of the way that we, as human beings,

  • are interacting with our planet.

  • Human choices are driving us into a position

  • where we're going to see more outbreaks.

  • Part of that is about climate change

  • and the way a warming climate makes the world more hospitable

  • to viruses and bacteria.

  • But it's also about the way we're pushing into the last wild spaces on our planet.

  • When we burn and plow the Amazon rain forest

  • so that we can have cheap land for ranching,

  • when the last of the African bush gets converted to farms,

  • when wild animals in China are hunted to extinction,

  • human beings come into contact with wildlife populations

  • that they've never come into contact with before,

  • and those populations have new kinds of diseases:

  • bacteria, viruses, stuff we're not ready for.

  • Bats, in particular,

  • have a knack for hosting illnesses that can infect people,

  • but they're not the only animals that do it.

  • So as long as we keep making our remote places less remote,

  • the outbreaks are going to keep coming.

  • We can't stop the outbreaks with quarantine or travel restrictions.

  • That's everybody's first impulse:

  • "Let's stop the people from moving. Let's stop this outbreak from happening."

  • But the fact is, it's really hard to get a good quarantine in place.

  • It's really hard to set up travel restrictions.

  • Even the countries that have made serious investments in public health,

  • like the US and South Korea,

  • can't get that kind of restriction in place fast enough

  • to actually stop an outbreak instantly.

  • There's logistical reasons for that, and there's medical reasons.

  • If you look at COVID-19 right now,

  • it seems like it could have a period where you're infected and show no symptoms

  • that's as long as 24 days.

  • So people are walking around with this virus showing no signs.

  • They're not going to get quarantined. Nobody knows they need quarantining.

  • There's also some real costs to quarantine and to travel restrictions.

  • Humans are social animals,

  • and they resist when you try to hold them into place

  • and when you try to separate them.

  • We saw in the Ebola outbreak that as soon as you put a quarantine in place,

  • people start trying to evade it.

  • Individual patients, if they know there's a strict quarantine protocol,

  • may not go for health care,

  • because they're afraid of the medical system or they can't afford care

  • and they don't want to be separated from their family and friends.

  • Politicians, government officials,

  • when they know that they're going to get quarantined

  • if they talk about outbreaks and cases,

  • may conceal real information for fear of triggering a quarantine protocol.

  • And, of course, these kinds of evasions and dishonesty

  • are exactly what makes it so difficult to track a disease outbreak.

  • We can get better at quarantines and travel restrictions, and we should,

  • but they're not our only option, and they're not our best option

  • for dealing with these situations.

  • The real way for the long haul to make outbreaks less serious

  • is to build the global health system

  • to support core health care functions in every country in the world

  • so that all countries, even poor ones,

  • are able to rapidly identify and treat new infectious diseases as they emerge.

  • China's taken a lot of criticism for its response to COVID-19.

  • But the fact is, what if COVID-19 had emerged in Chad,

  • which has three and a half doctors for every hundred thousand people?

  • What if it had emerged in the Democratic Republic of the Congo,

  • which just released its last Ebola patient from treatment?

  • The truth is, countries like this don't have the resources

  • to respond to an infectious disease --

  • not to treat people and not to report on it fast enough

  • to help the rest of the world.

  • I led an evaluation of Ebola treatment centers in Sierra Leone,

  • and the fact is that local doctors in Sierra Leone

  • identified the Ebola crisis very quickly,

  • first as a dangerous, contagious hemorrhagic virus

  • and then as Ebola itself.

  • But, having identified it, they didn't have the resources to respond.

  • They didn't have enough doctors, they didn't have enough hospital beds

  • and they didn't have enough information about how to treat Ebola

  • or how to implement infection control.

  • Eleven doctors died in Sierra Leone of Ebola.

  • The country only had 120 when the crisis started.

  • By way of contrast,

  • Dallas Baylor Medical Center has more than a thousand physicians on staff.

  • These are the kinds of inequities that kill people.

  • First, they kill the poor people when the outbreaks start,

  • and then they kill people all over the world

  • when the outbreaks spread.

  • If we really want to slow down these outbreaks

  • and minimize their impact,

  • we need to make sure that every country in the world

  • has the capacity to identify new diseases,

  • treat them

  • and report about them so they can share information.

  • COVID-19 is going to be a huge burden on health systems.

  • COVID-19 has also revealed some real weaknesses

  • in our global health supply chains.

  • Just-in-time-ordering, lean systems are great when things are going well,

  • but in a time of crisis, what it means is we don't have any reserves.

  • If a hospital -- or a country --

  • runs out of face masks or personal protective equipment,

  • there's no big warehouse full of boxes that we can go to to get more.

  • You have to order more from the supplier,

  • you have to wait for them to produce it and you have to wait for them to ship it,

  • generally from China.

  • That's a time lag at a time when it's most important to move quickly.

  • If we'd been perfectly prepared for COVID-19,

  • China would have identified the outbreak faster.

  • They would have been ready to provide care to infected people

  • without having to build new buildings.

  • They would have shared honest information with citizens

  • so that we didn't see these crazy rumors spreading

  • on social media in China.

  • And they would have shared information with global health authorities

  • so that they could start reporting to national health systems

  • and getting ready for when the virus spread.

  • National health systems would then have been able to stockpile

  • the protective equipment they needed

  • and train health care providers on treatment and infection control.

  • We'd have science-based protocols for what to do when things happen,

  • like cruise ships have infected patients.

  • And we'd have real information going out to people everywhere,

  • so we wouldn't see embarrassing, shameful incidents of xenophobia,

  • like Asian-looking people getting attacked on the street in Philadelphia.

  • But even with all of that in place,

  • we would still have outbreaks.

  • The choices we're making about how we occupy this planet

  • make that inevitable.

  • As far as we have an expert consensus on COVID-19, it's this:

  • here in the US, and globally,

  • it's going to get worse before it gets better.

  • We're seeing cases of human transmission that aren't from returning travel,

  • that are just happening in the community,

  • and we're seeing people infected with COVID-19

  • when we don't even know where the infection came from.

  • Those are signs of an outbreak that's getting worse,

  • not an outbreak that's under control.

  • It's depressing, but it's not surprising.

  • Global health experts,

  • when they talk about the scenario of new viruses,

  • this is one of the scenarios that they look at.

  • We all hoped we'd get off easy,

  • but when experts talk about viral planning,

  • this is the kind of situation and the way they expect the virus to move.

  • I want to close here with some personal advice.

  • Wash your hands.

  • Wash your hands a lot.

  • I know you already wash your hands a lot because you're not disgusting,

  • but wash your hands even more.

  • Set up cues and routines in your life to get you to wash your hands.

  • Wash your hands every time you enter and leave a building.

  • Wash your hands when you go into a meeting and when you come out of a meeting.

  • Get rituals that are based around handwashing.

  • Sanitize your phone.

  • You touch that phone with your dirty, unwashed hands all the time.

  • I know you take it into the bathroom with you.

  • (Laughter)