I amthechairofourDepartmentofGlobalHealthhereoftheUniversityofWashingtonandthecodirectoroftheUniversityofWashington's MettaCenteronPandemicDiseasePreparednessandGlobalHealthSecurity.
I thinktheotherpieceofgoodnewsisthatcurrentlytherearestillrelativelyfewcaseshereintheUnitedStates, andtheriskofbecominginfectedremainslowhereintheUnitedStates.
Preparednessandresponseeffortshavebeenprettystrongtodate, andWashington, ahhasactuallynotonlybeenthehometothefirst U.
S case, butahhasbecome a nationalleaderaspartofthisresponse.
I alsowanttoextendmythanksbothtothemedicineoraswellaseveryonewhoishereinpersonandthosewhowerestreamingonline.
I alsowantedtofollowuponsomethingthatJudymentionedyouand I thinkbackasaninfectiousdiseasephysicianwhen I cameheretouniversityWashington, myfellowshipandwhathastranspiredsincethenwe'vehadSARS.
In 2003 wehad 2009 h one n onepandemicinfluenza.
Wehadmurdersin 2012.
WehadEbolain 2014.
Andalthoughthatmaynothavehadthesamepandemicpotentialfrom a resourceintensityandpreparedthis, itreallycausedahlotofustospend a lotofenergyandwellspentenergybecausemuchofwhatwedidinpreparationfrom 2014 hascarriedfortoourpreparationherefornow, thenovelCoronavirusin 2019.
Andso I suspectabsolutely, we'regoingtoseemoreandmoreofthesepotentialemergingpathogens.
When I lookatthelineuptonight, itreallystrikesmehowfortunatewearetoliveintheNorthwest.
I alsothinkwe'reveryfortunatewhenyoulookattheUniversityofWashingtonandthebreathofouractivities, bothlocallyandresponseregionallyandthenglobally.
A CEhasbeenmentionedhereaswell.
From a schoolofmedicinestandpoint, wehavewonderfulclinicalcareandincoordinationwithpublichealth, greatepidemiology, alongwithalltheotherhealthscienceschoolswithintheUniversityofWashington.
Andtheeducationisalsoveryimportanttomeas I reflectononeparticularindividualwhoiswithustoday.
Dr.
JorgeDiaz, whoisourguestfromProvidence.
EverettGeorgewasinfectiousdiseasefellowwithusmanyyearsagoandfrommystandpoint, oneofthosefellowsthat I verymuchregretthatweweren't abletokeepwithinoursystem, butalsostrikesmetheimportanceofourroleineducatingthenextgenerationofphysiciansandtheleadersandpartnersthatwehavewithinthecommunityastheydidanexceptionaljobincaringforthefirstpatientwhowasseeninthe U.
Um, sothefirstpanelwillbemoderatedbyPeterRabinowitz, whoiscodirectorofour U W Medicinetres I saidBefore, andprofessorofGlobalhealth, environmentalandOccupationalHealthSciencesandFamilyMedicine.
Healsodirectsthe U W.
Centerforonehealth, onehealthresearch.
Thesecond, um, actually, doyouwant a wavesopeopleknowwhoyouare?
Um, so I'm gonnaRavennalaidsomethecodirectorofthemedicineorforpandemicdiseasepreparedness, and I'm gonnamoderatethisfirstsession.
Thegoalis, asJudysaidofthefirstsessionistoreallysetthestagewithsomelatestinformationaboutthecovein 19 infectionandthevirusthatcausesitandhowthatactswhenyou'reactuallytakingcareof a patientwithitandhowyouarealsohowitisactinginpopulationsasopposedtojust a singlepatient.
So I'm gonnaintroducethepanelthat's goingtobetalkingaboutthistotalkaboutthethevirusitselfandcoronavirusesingeneral.
Um, DrJeffGottliebisaninfectiousdiseasephysicianprofessorofmedicineatUW, andhe's alsotheinterimchairofthe U DoubleAdvisoryCommitteeonCommunicableDisease, whichisreallyleadingtheresponsetoCovein 19 acrossthe U.
AndKathyLoFiisthestatehealthofficerandchiefscienceofficerforWashingtonstate, andsheadvisesthegovernorandthesecretaryofhealthon a widerangeofhealthissues, andherparticularinterestisininfectiousdiseaseoutbreaksandtheircontrol, andshewillspeakaboutpopulations.
Andbefore I askthemsomequestions, I justwantedtotalkaboutoneotheraspectofthissituationthatJudyalludedto, whichisthatwehaveseeninthelastseveraldecadesmoreandmoreofthese, whatwecallemerginginfectiousdiseases, diseasewe'vereallyneverseenbeforeordiseasesthatwemaybeknewaboutbefore, betteractingintotallydifferentwaysandtheseemerginginfectiousdiseases.
Whenyouaddthemallupandthere's beenmergedandSARSandEbolaandWestNileandavianinfluenzaandeachone n onewhenyouaddthemallup, actually, about 2/3 ofthemendupbeingdiseasesthatcomefromanimals.
Andhopefullywe'lllearnthatlessonaswelearntheotherlessonsthatweneedtolearnabouthowtorespondto a problemlikethisbuthopefullybeabletopreventthenextoneaswell.
So I'm gonnaturnnowtoourpanelandaskedJefftoreallykindofjustdescribewhatisthis?
Um, somyjob, I hope, istojustgiveyousomeinformationaboutCoronavirusesingeneral.
Andwhat's newaboutthisparticularnovelCoronavirusthatemerged a coupleofmonthsago.
Um, asmanyofyoumayknow, Coronavirusis a largefamilyofourown.
A envelopedvirusesthatcirculateinanimalsprimarily, butalsowhenhumans.
There's fourhumancoronavirusesthathavebeenwithusfor a longtime.
Thatcausedthecommoncoldandmaybe 5 to 20 or 30% ofcoldseveryyearinyouoryourkidsoryourfamilymembersareduetothesehumanCoronavirusescirculatingbecauserelativelymilddiseasethey'reubiquitousontheplanet.
Thosenumbersareveryrough, andwe'restilllearning a lotabouthowthisvirusspreadsandwhatit's pandemicpotentialistypicaldiseasefeatures, which I thinkGeorgewilltalkaboutmorebecausehehasobviouslyfirstandpersonalexperiencebutfevers, respiratorysymptoms, pneumoniainseverecases, causingacuterespiratorydistresssyndromeandrequiringintensivecare, ventilatorsupport.
Um, thosesymptomsarerelativelynotspecificforviraldiseases, andwe'restilllearning a lotaboutthespecificsofhowthisvirusiscausespathogenesisandhoweasilyitspreads.
Butclearly, basedonwhatweknowsofar, itisspreadingperson a personrelativelyseeminglyeasily, atleastinChina, right?
So, um, thelargeportionsofworkthatwedidactuallyhappenedbeforethepatientarrived.
WhentheEbolaoutbreakhappenedinAfricain 2014 15 ourhospitalbegansortofbecomingreadyforitbysettingup a systemwherewecouldacceptpatientswithEbolathatrequiredmonthlytrainingstomakesurethatourstaffwasreadytomakesurethatourpartnersinthecommunitywe'rereadytotransferthepatientfromonelocationtoanothertosetupourunitinourhospitalrapidlyandsafelywithourfacilities, folks s o.
AndsowhenwegotthecallfromtheCDCthatwehad a positivepatientthefirstthingthatwentthroughmymindinouraffectionprofession, mannersMindwasOK.
Doweopenourunitornot?
Andwethoughtthatsincewehadrecentlydonetrainingonthisactually a fulldrill a fewweeksearlierthatweknewthatwecouldgetallourprotocolsandproceduresinplaceanddoitreliably, uh, sothatwewouldbeabletosafelyexceptthispatient's we'vesaid, openourunit.
Uh, andoncewe'vemadethedecision, thenwestartedgoingthrough a checklist.
That's reallywhatwasonmymindtomakesurethatwehadallthepiecesinplace, allthenursingstaff, thatwasthatis a volunteerstaff, youknow, comein, haveallthefacilitiesfolkscomeinandbuildthewallsthatwewerebuildingtoewalloffourunittotesttheairairflowintheroomandtomakesureweallhadonlysupplysincerityforthepatient.
Wealsohadtocommunicatewiththe E.
M s folkstomakesurethatwecouldsafelytransportthepatientfromhishometoourunitin a waythatwouldn't causepanicinourhospital.
Sowehadthemcomethroughsome, uh, loadingdockdoorsandtransportedthrough a partofthehospital.
Andthiswas a littlebitchallengingbecauseitwas a newdisease, a czYou, asyoumentioned, youknow, weweretryingtofigureoutOkay, Well, howisthediseasespread?
Um, Jeffandhisgroupatpublichavebeenindispensable, helpingcoordinatecampusAh, uh, campuscoordinationofthesefourcases, and I thinkwelearned a lotabouthowtoum, withthesefournegativestudentshad a hadlearntthatwe'vealsolookedattravelasyoucanimaginewithsuch a bigcampus, wehavelotsoffaculty, studentsandstafftravellingtotheaffectedareasandChinaandlearningabouttheirtravelplanstocomeback.
Asyouprobablyheard, ifyou're a memberofthecampuscommunitythattheuniversityput a travelbanfor U DubtravelrelatedbusinesstoChinauntilthisdissipates, um, andtryingtofigureoutwhoinourcampuscommunitymightbecomingbackonandmightbeatriskintryingtomakesuretheyaretracked, stayingathomeandnotpotentiallyspreading a virustotherestofthecommunity.
Um, andsothat's taken a lotofpartnersbothinuppercampusinyou, dumbmedicineandourpublichealthcolleagues.
Wewanttoleavetimeforquestions, but I justwantedbriefly.
And, Kathy, couldyoujustsortofgive a snapshotofwheretheWherethehealthdepartmentisrightnowonwhatyou'reexpectinginthenearfutureintermsofeverythinggoingoninpublichealth?
Um, but, uh, butreally, from a clinicalpointofview, therewouldbemanagedthesamewayandpresentverytypicallythesamewaytheme.
Theonlything I wouldaddisthatitappearsthatwithCovein 19 theprogressionsortofseverediseaseandpneumoniahappensabout 10 daysaftertheonsetofsymptoms, whichis a littledifferentfrommurdersandstars.
Differenthowit's justmoredelayedlower.
Andthenthere's a questionaboutviralsheddinginourpatient.
Sothere's threetargets, bytheway, Umandso, youknow, I wouldthinkthatthreetargetswouldmakeit a prettygoodtest, butyeah, like, I don't know, wedon't reallyhave a panelforseaofpositivesandnegativesthatweknowforsurethatCDCcantest.
I mean, itwasapprovedtotestindividualswith a higherlikelihoodofhavingcoronavirus, which, whicharepeoplewhohavesomeepidemiologiclinkessentiallytoeitherChinaor a confirmedcase.
So I justsaid, ifyoustarttestingpeopleinthegeneralpopulationhas a verylowpretestprobabilityofhavingCorona, thenyou'regonnalikelySeymourfalsepositives, evenfor a veryspecifictest.
Umgreat.
Um, anythingelsethispanelwanted?
Didyouabsolutelywantedtosaywe'regonnahavemoretimeattheendoffor a questionandanswer.
But I dowanttoleavetimefortheotherpanelstotakeplaceandyou'llhave a chancetoaskquestionsaftereachofthepanelsaswell.
Allright, front, Jeffthere.
Yeah.
Soasourpanelsettles, I thought I justintroducedmyself.
SoasJudymentionedearliermynameisDavidPiggott.
I'm anassistantprofessorhereinthenewlyfoundeddepartment, HealthMetricsSciencesand I contributetotheuniversity's MettaCenterforPandemicPreparedness.
Sothepreviouspanelgaveus a lotofvirusnames, thingslikeZikaand a bolathatpreviouslywererarediseasesoffin a farflungcountrythatarenowbecomingmorecommon, beingpresentedinthenewson a routinebasisandactually a partofdaytoday, conversationswillregularlyonDDEum, globalitgloballywearetryingtobetterprepare.
We'vegot a lotoforganizationswhonowhaveitastheirexplicitmandatestothinkaboutglobalhealthsecurity.
Haverelativelyspeaking a verygoodhealthcaresysteminfrastructure, weweretherewasrecently a globalhealthSecurityIndexstudyinthe U.
S.
Rankedatthetopwithrespecttobeingabletomanage a largescalepandemic, Thatdoesn't meanwewoulddoiteasilyordoitespeciallywellbyourownstandards.
Butwe'reatthetopoftheglobalscaleandinWashingtonstateranksconsistentlyatthetopof U.
S stateswithrespecttoemergencypreparedness.
Andwe'rein a veryfortunatecountywherewehaveahah, robusthealthdepartmentwithwatchofexpertsthataretrainedhereattheuniversity.
And, um, wehaveverygood, longstandingrelationshipswithourhealthcarecommunity, whichis a veryfundamentalpartofemerginginfectiousdiseaseresponse.
So, forexample, 20 yearsago, um, I started a groupcalledItwasatthattimecalledtheOutbreakResponseWorkgroup, wherehebroughttogethercountyhospitalexecutiveswithourpublichealthteamtotalkaboutthingslikebioterrorism, emerginginfectiousdiseases.
Weknowaboutthemeaslesoutbreaklastyear, and a lotofthosepeopleendupinhealthcarefacilitiesandfacilitiesneedtobepreparedforpatientswithflupatientswithmeasles, patientswithmumpsandotherinfectiousdiseaseson a regularbasis.
Atthesametime, wedon't tendtohave a CZJeffsortofpointedoutsurgecapacity.
We'renotbuiltinhealthcaresystemstoexpandoutandallof a suddenacceptpeoplewithnovelinfectiousdiseases.
AsGeorgepointedout, I thinkreally, the 2014 WestAfricanEbolaoutbreakwasobviously a hugelydevastatingepidemicforthepeoplewhowereinWestAfrica, whohadtodealwiththatlostlovedonesandcoworkersandsoforth.