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  • Hello and welcome to everyone joining us from around the globe.

  • Thank you for being part of Day two of our special series.

  • Ted connects This week we're bringing you interviews from some of the world's greatest minds.

  • Offer tools for us to navigate through and thrive in these really uncertain times.

  • I'm Whitney Pennington Rogers, Ted's current affairs curator, and I'll be one of your host for today's event.

  • Yesterday we kicked off this series with an interview from acclaimed psychologist Susan David, who offered us some tips on how to really be our best cells in these trying times.

  • And we're gonna switch gears a little bit today from thinking about our own personal mental health to the state of our global public health systems.

  • Thank you.

  • Um, I guess we have a pretty exciting guest.

  • Thio introduce on the other side of the country.

  • Let's bring in Bill Gates.

  • Well, they say the the better known people are, the less you have to ensure them.

  • So it's great to have you here.

  • How are you doing?

  • Well, I think this is a unprecedented, really disconcerting time for everyone with things being shut down, not knowing exactly how long it's going to last worrying about the health of all the people we care about.

  • Um, you know, I'm lucky that I get to connect up with videoconferencing using teams a lot.

  • So the foundation ists stepping up.

  • And there's a lot of great people trying to, uh, help with this crisis.

  • But it's it's scary for everyone.

  • You basically stuck at home life like many of us watching.

  • Yeah, almost all my meetings air, uh, using teams.

  • Now I'm getting used to that.

  • Uh, you know, I've gone days without seem, seen any work co workers.

  • Let's start here.

  • Bill of five years ago, you stood on the ted stage.

  • Andi, you gave this this chilling warning that the world was in danger at some point off a major pandemic.

  • People watching that talk now, you know, the hair stands up in the back of their neck.

  • It is.

  • It is exactly what we're living through.

  • What happened?

  • It Did people listen to that warning at all?

  • Basically, No, um, you know, I was hopeful that with the, um Zika on Ebola and SARS and murders, they all reminded us that particularly in a world where people move around so much you can get a huge devastation.

  • And so the talk was to say, Hey, we're not ready for the next pandemic.

  • But in fact, there's advances in science that if we put resource is against them, we can be ready.

  • Sadly, very little was done.

  • There were some things.

  • The Coalition for Epidemic Preparedness Innovation.

  • Ah, C E p.

  • I was funded by our foundation Welcome trust in a number of governments, um, to do some of the platform vaccine work, but the in the area of diagnostics, antibodies, antivirals, basically doing the disease games that I talked about, where we'd simulate, uh, what needed to be done.

  • We hardly did anything.

  • And and so now here we have a respiratory virus that is sadly fulfilling.

  • Ah, some of the more negative predictions I made.

  • I mean, last month you said that this might be the big one.

  • You wrote that this this could be the sort of once in a century pandemic that people had been fearing.

  • Is that how you think of it?

  • Still, Well, it's awful to say this, but we could have a respiratory virus whose case fatality rate was even higher if this was something like smallpox, you know, that kills 30% of people.

  • So this is horrific.

  • Uh, but you know, in fact, most people even who get the cova disease are able to survive.

  • So in that it's quite infectious, way more infectious than MERS or stars were It's not as fatal a CZ.

  • They were, uh, and yet the disruption were seen in order to knock it down is is really completely unprecedented.

  • So this is a you know, it's going global.

  • Uh, that was its respiratory.

  • That was the great fear.

  • Um, how many people end up dying?

  • Hopefully, if we do the right things, it won't be a gigantic number.

  • So it's, you know, we we should end up not having a 1918 flu situation.

  • We should be able to do a lot better than that.

  • And that's that's because of actions that we would take.

  • I mean, left without the right actions.

  • The prospects are pretty, pretty deadly.

  • And if we if we knew what we knew in 1919 thing could take out many tech tens of millions of people around the world because, like you said, is the key thing here.

  • That It's got this sort of strange combination off being certainly more dangerous than flu not as dangerous as something like Ebola or size, but more interesting, then flew by a factor.

  • But but but infectious?

  • Andi, also infectious before symptoms have started is that part of why it's it's been really hard to respond to, right?

  • So Ebola, you're actually flat on your back before your very infectious So you're not, uh, at church or in a bus or at a store with most respiratory viruses like the flu and co vid.

  • Uh, at first you only feel a little bit of a fever and a little bit sick.

  • And so there's the possibility you're going about your normal activities and infecting other people.

  • And so, you know, human, human transmissible respiratory viruses that in the early stage aren't, um, stopping you from doing things?

  • That's kind of a worst case.

  • And that's where you know, I did a flu simulation in the 2015 talk and showed how quickly it spread versus 1918 people move around.

  • Ah, lot born now then they used to, and so that works against us.

  • Now the medical system that steps up to pre people is also far, far better.

  • But it was when was it clear to you that unless we acted this, this could be a really deadly pandemic?

  • Well, in January, it was discussed that there was human human transmission taking place.

  • And so, you know, the alarm bells, uh, were ringing, uh, that this fits the very scary pattern that it will be very difficult to contain.

  • And in in on January 23rd China did their equivalent of the shutdown did it in a fairly extreme form.

  • The very good news is that they were able to reduce the infection rates dramatically because of those actions.

  • But it's it's January where everybody should have been unnoticed.

  • Uh, let's get her out together with testing.

  • Let's get going on therapeutics and vaccines.

  • We've got to get organized because we have this novel respiratory virus whose infectiousness and fatality put it in that super scary range.

  • And so what did happen is that such a mystery to me about the sort of the last month of preparation?

  • Certainly.

  • I mean, in many countries and sitting in the US where we are, will you on the phone to people during early February late January early February, saying, You know, guys, you know what's going on?

  • This is a really big deal.

  • What are we doing?

  • What was happening behind the scenes during that period?

  • Well, you'd like to have government money show up for the key activities.

  • We put out 100 million.

  • We created the Therapeutics accelerator.

  • There's the period between when we realized it was transmitting and now where we should have done more.

  • I think the most important thing to discuss today is that in the area of testing, we're still not, uh, creating that capacity and applying it to the people most in need.

  • And so we have health workers who are symptomatic who can't get a test on so they don't know should they go in and not go in.

  • And yet we have lots of tests being given to.

  • People are symptomatic, and so they're testing thing to me.

  • It's got to be organized.

  • It's got to be prioritized.

  • That is super, super urgent.

  • The second thing is the isolation, that various parts just focusing on the US Some parts are doing that in a fairly strong way.

  • And other parts Not yet.

  • And you know it's very hard to do.

  • It's tough on people.

  • It's disastrous for the economy.

  • Uh, but the sooner you do it in a in a top way, the sooner you can undo it on and go back to normal.

  • I said, Well, come to the isolation part in in a minute, but it's just sticking with the testing thing.

  • I'm just so confused as to why, with more than a month's notice, I mean, there are so many smart epidemiologists in the in the US, for example, you plug numbers about infectiousness and fatality into any simulation, and you see that if you don't do anything, millions of people will die and there's a month.

  • So what's your explanation for?

  • What do you think happened here is toe?

  • Why just know there was almost no test.

  • A month later, there was no viable test in the U.

  • S.

  • Was this just government complexity?

  • Too many chefs in the kitchen.

  • What on earth happened here?

  • Well, we certainly didn't take advantage of the month of February.

  • The good news is that the actual process the PCR, um, machines, we have a lot of the United States, and so there's models like South Korea who took advantage of February, built up the testing capacity and they were able to contact race and their infections have gone down even without the type of shutdown.

  • That because we're late, we're having to do one thing that is good news just this week is that people had thought to do this test, that you have to have a nurse or doctor shove a swab way up all the way to the back of your throat, which hurts a lot.

  • But also, you're gonna cough and potentially spread the disease to that health care workers.

  • So they have to have protective equipment and change that.

  • What?

  • We sent data to the FDA this weekend showing that just a individual by themselves lobbing up to the tip of their nose uh, they're able.

  • The accuracy of that test is essentially the same as having a health care worker do it.

  • That helps a lot.

  • We still have to do other things, But that means that you don't have to change protective equipment.

  • You just hand the patient.

  • That's mob.

  • They do it, put it in the test tube.

  • And if the capacities right within 24 hours.

  • You should get that result back.

  • So how do you see that playing out there?

  • Are there people going to massively scale?

  • There's those tests and how well, how ordinary citizens be able to get hold off them it.

  • Does it still have to be actually prescribed by a doctor at some point?

  • Or at some point, will you be ableto just order them off Amazon or something?

  • And, well, pretty ironic today because the government hasn't stepped in to make sure that the testing capacities both increased and it's used for the right cases.

  • There will be a website, and if the federal government doesn't do it, a lot of local governments will have to do it that you go to you give your situation, including her symptoms.

  • You're told, you know, based on your work and your symptoms, are you a priority?

  • If so, you're told where they're kiosks you could go to and you'll do the South swab and just hand it over.

  • Or eventually we'll send the kits to you at home and then you'll send it back and hear that result.

  • Maybe six months from now, you'll actually be able to do you have a strip where you perform the test in the home, but for now, they sending it back for the PCR processing.

  • We can have massive capacity there, and that's how you know the testing is everything, because that's how you know whether you mean to doom or shut down, or you're starting to get to the point where you can relieve it.

  • Some people are trying to argue now that almost like testing should be dark back because you know the cat is out of the bag.

  • Testing is bringing people together and risking infection.

  • You know, forget that.

  • Let's just focus on treatment and on isolate on isolation strategies you disagree with that testing is still absolutely essential and needs to be swell.

  • The two go together are testing at very high volume and the isolation piece if you're If you're a medical worker, you want to stay and do your job.

  • If you're making sure the electricity water food is still available, you want to do your job.

  • And so testing is what indicates to you.

  • Do you need to go into isolation and make sure you're not the source of spread And so you know, testing is is the key thing.

  • Uh, you know, South Korea did that in this massive way that, uh, everybody should learn from.

  • And so that that is paired with the isolation peace.

  • Our goal here is to get to the point where a very small percentage of the population is infected.

  • You know, China on Lee 0.0.1 percent of the population was infected.

  • If you let it.

  • If you don't do these things, you're gonna get the majority of people infected.

  • And that huge overload of the medical system Whitney has some questions from our audience.

  • Whitney.

  • Some of the questions that we're seeing are about how our tech giants and leaders can play a role in isolating this and containing this on this virus.

  • You know, the tech companies are very involved in making sure that some work can go on.

  • You know, people can stay in touch, you know, they can help with some of the disease modeling.

  • They can help with the visibility of the numbers.

  • It's actually very impressive.

  • You know, You get up there and you can see you know those numbers.

  • Actually, they're sad numbers, but, uh, everybody's able to monitor this thing back in 1918.

  • They didn't have this type of visibility on an ability to share best practices.

  • But for a lot of people, the isolation is the key thing.

  • I mean, Bill, one of the riddles about this isolation strategy is how long, how long has to last, right?

  • Like a lot of people are concerned that the price off victory by isolating everyone is that you crashed the economy and that you know what?

  • We have to be basically at home, not doing regular jobs for 36 months, maybe maybe all year.

  • So much so that there's now this big debate in the U.

  • S.

  • And other countries about this may just be the wrong strategy that we can't crash the economy that badly.

  • We should only isolate for another couple weeks and then let people back.

  • And if that means you know, a lot of other people get sick and we eventually build up heard humanity.

  • That may be the right the right way to go.

  • What's your thought on this?

  • What is the theme isolation strategy that eventually leads to us getting back to normal?

  • Andi, it's very tough to say to people Hey, keep going to restaurants, you know, go buy new houses, ignored that pile of bodies over in the corner.

  • Just, you know, we want you to keep spending because there's some, uh, maybe a politician who thinks GDP growth.

  • This is what really counts.

  • It's very hard to tell people when there's an epidemic spreading that threatens, particularly their parents, are elderly people that they know that they should go about things knowing that their activity is spreading this disease.

  • I don't know of any rich countries that have chosen to use that approach.

  • It is true if you did that approach over a period of several years on, not people would be infected.

  • You'd have what's called herd immunity.

  • They heard immunities meaningless until you, in fact, over half the population.

  • And so you can take you'll overload your medical systems.

  • Here, case fatality rate, instead of being 1% will be like 34%.

  • And so you know the idea.

  • It's very irresponsible for somebody to suggest we can have the best of both worlds.

  • What we need is the extreme Shutdown Thio, so that in 6 to 10 weeks, if things go well, then you can start opening back up says they're just putting the math together.

  • From what you just said, Bill, to get to herd immunity, you needed more than half the people in the country to basically get the bug.

  • So in the case of the US, for example, that 150 million people thereabouts you said that there could be the fatality rate in that scenario, you're talking about 4 to 5 million people in that in that potential fatalities.

  • I mean, it's like like it.

  • That's just a horrifying scenario that no one should be contemplating even 1% of their population getting sick.

  • They will treat whoever goes for this, ignore the disease strategy.

  • They will treat them as a price state.

  • So no, none of their people go in and none of your people will will go into that.

  • And so briefly a few countries in Europe that hadn't really looked at this hard considered okay, should be we be the ones who kind of go about business as usual.

  • It is tempting because if you got there early, South Korea did not have to do the extreme shutdown because they did such a good job on testing and you know, that's why it's testing a name to me, that the government's not allocating the testing to, uh, to where it's needed.

  • Um, you know, and maybe that will have to happen at the state level, because it's it's not having at the federal level.

  • But there is.

  • There is no middle course on this thing.

  • It is sad that the shutdown will be harder for poor countries than it is for richer countries.

  • So let's come into that in a minute.

  • But just the one exception, I've had the case made for his Japan that Japan has not contained it quite in the same way that South Korea did, but has allowed people to work.

  • It's tried to make extreme measures for protecting the most elderly population, but they tried to sort of.

  • They tried to find a middle scenario, haven't they?

  • Well, if you act when you have, you know, hundreds of cases, uh, you may be able to contain it by doing great testing and great contact tracing and restricting foreigners coming in without as much damage to our economy.

  • The U.

  • S.

  • Has passed this opportunity to control without shut down so that the worst case of what was happening in, uh, Wuhan in the beginning or in northern Italy.

  • Uh, you know, the last few weeks that we avoid that, but we we did not have fast enough to have ah, uh, ability to avoid the shot down.

  • But then what I don't understand in the case of the US, for example, is that if if even if we're successful in bending the curve and reducing the number of new cases from a period of extreme shut down as it were, no immunity has been built up, let's say that there's still no vaccine.

  • Surely, when you lift restrictions and people start going back to work, the whole thing just blows up again.

  • The experience that were seen in China and in South Korea is that there are not.