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  • sat down was absolutely perfect that the timing could not have been better.

  • We'll tell everybody what to do, Michael.

  • Well, thank you.

  • I'm a for a black of a better term of medical detective.

  • I've spent my whole career tracking infectious diseases down, trying to stop him trying, understand where they come from so we can make sure they don't happen in the first place.

  • But most of all, trying to respond to situations just like this, just like this.

  • And, um, just out off the bat.

  • How serious is this?

  • Is this something that we need to be terrified of?

  • Or is this overblown, or how do you stand on this?

  • Well, first of all, you have to understand the timing of it in the sense that is just beginning.

  • And so, in terms of what hurt pain, suffering, death is a cow.

  • Happened so far is really just beginning.

  • This is gonna unfold for months to come yet, and that's I think what people don't quite yet understand.

  • Um, what we saw in China, I'm convinced, as are many of my colleagues.

  • As soon as they release all of these social distances is mandated stay in homes have left her home and weeks and weeks kind of thing when they go back to work there on planes, trains, subways, buses, crowded spaces, manufacturing plants, even China is going to come back again.

  • And so this really is acting like an influenza virus, something that transmits very, very easily through the air we now have dated to show that you're infectious before you even get sick and in some cases, quite highly infectious.

  • Just breathing is all that you need to D'oh.

  • So from this perspective, I can understand why people would say, Well, wait a minute.

  • Flu kills a lot more itself every year than this does.

  • And already we remind people that just beginning probably the best guest, what we have right now On what limited data we have to say.

  • This is gonna be at least 10 to 15 times worse than the worst seasonal flu.

  • Here we see 10 to 15 times worse in terms of fatalities.

  • Yeah, yeah, Just jealous.

  • In fact, I just brought some numbers.

  • We, uh, conservatively estimate that this could require 48 million hospitalizations.

  • 96 million cases actually occurring over 480,000 deaths that can occur over the next 3 to 7 ones with this situation.

  • So this is not one that to take lightly.

  • And I think that's what I can understand if you say we're going 10 deaths or $20 for 50 desk.

  • Just remember two weeks ago we were talking about almost no cases in the United States.

  • And now that we're testing for it and watching the spread as it's unfolding, those numbers going up astronomically.

  • Three weeks ago, Italy was just living life just fine.

  • Now they're literally in a virtual shutdown in the northern parts of Italy, and that's the challenge.

  • With an infectious disease like this, it could spread very quickly, and it also can affect people.

  • I think maybe to put this into modern terms, this is something we think of often when we think of, you know, pre antibiotic days, you know, the old time medicine.

  • We have an employee at our Center for Infectious Disease Research and Policy at the inverse Minnesota, and she has a dear friend who lives in Milan, Italy, and she works at a hospital there, and she texted us to this employee of ours last night, and this was an email that came out yesterday from one of their physicians in blood at the largest hospital there, he said, I just got a very disturbing message from a cardiologists at one of the Milan's largest hospitals.

  • They're deciding who they have to let die.

  • They aren't screening the staff anymore because they need all hands on deck.

  • And they have very small areas of the hospital dedicated to nine coded patients where they still screen doctors.

  • Everybody else is dedicated to covert patients, so even if they're positive, meaning that they're sick, they don't.

  • But they don't have a severe cough or fever than they have to work.

  • Hey says that that they're seeing an alarming number of cases in the 40 something change rage, and it's horrible cases.

  • So we need to stop thinking that this is only an old person's disease.

  • This is what I'm gonna unfold, not just in Wuhan.

  • It's unfolding in the line.

  • It's unfolding here in Seattle, and this is what's going to continue to Rolling Lee unfold throughout the world.

  • Yeah, where did this rumor come from?

  • That it's ah, old person's disease?

  • Is it just because the majority of people that have died from it so far have been older.

  • Yes, in fact, that's the primary risk factor for diners being old and then having certain underlying health problems.

  • For example, in China, uh, those men over the age of 70 who also smoked were 8 to 10% of them died.

  • 65% of older Chinese men smoke the, uh case fatality rate, or the percentage of people who die in women.

  • That same age group was only about 2%.

  • In that case, very few women smoke.

  • Now the challenge we have is that that's the Chinese data.

  • But there are Siri's of risk factors that we worry about that if they overlay on this disease, are gonna cause bad outcomes.

  • And we happen to be right at ground zero for one of the major ones here in this country.

  • That's obesity.

  • We know that obesity is just like smoking in terms of its ability to really cause severe life threatening disease.

  • And 45% of our population today, over the age of 45 in this country, are obese or civilian bees.

  • There's men and women.

  • So one of the concerns we have is we're going to Seymour of these, But I guess I would call very serious and life threatening cases occur in our country because of a different set of risk factors.

  • And we saw in China.

  • Now you mentioned that there's some sort of incubation period before people become sick.

  • There's still contagious.

  • What is this incubation period?

  • And how do we know about it when we calls something an incubation?

  • But we're talking about from the time you and I got exposed, meaning I was in a room breathing the air that somebody else who was infected, what the virus was expelling out.

  • I breathed it in How long?

  • From that time period till the time period that you get sick And what is that is that's we called incubation period.

  • So that's when case numbers conduct or triple in every so many days in this case is about four days so and we actually have data there from people who are exposed one time for one time only, and we know when they were exposed where they were exposed, how soon do they get sick afterwards.

  • So the chauffeur in the car where the individual was sick, showing symptoms than the chauffeur gets it four days later.

  • You know, they were there one time one time.

  • And if the chauffeur does not show any symptoms, he's still contagious.

  • You could you could also be contagious, too.

  • Or he and that's one of the things that's challenging here is you and I might get exposed to somebody who is totally asymptomatic.

  • No symptoms.

  • That virus would appear.

  • Well, that's not a very strong virus.

  • But in fact, when it infects us, it could kill us.

  • So we've seen cases of fatal disease that were exposed to people that had minor symptoms themselves.

  • Wow, this is what's unfolding here.

  • And this is where I think it's such an important.

  • And I said, why the timing is so important.

  • Because, you know, Joe, we really got to get information out to the public.

  • There is so much mystery from information right now, and, you know, we're gonna be this for a while.

  • This is not gonna happen overnight.

  • I worry.

  • I keep telling people we're handling this like it's a Corona blizzard, you know, two or three days romantic, normal.

  • This is a corona virus winter, and we're gonna have the next three months form or six months or more that are gonna be like this.

  • And you know, so far, this thing has been unfolding exactly as we predicted it.

  • We and our center put out a piece on January 20th and said, This is gonna spread worldwide time People said Dad, No, it's just China.

  • We put out a piece the first week of February, said This is gonna pop probably the last week of February 1st week of March, because what happens it has.

  • What's called a are not or a doubling time off of these every four days, so to increase is doubling every four days.

  • So if you go from 2 to 4 to 8 16 it takes awhile to build up.

  • But when you start going from 500 to 1000 to 6000 that's what we're seeing happening places like Italy.

  • We're beginning to see it in some ways.

  • Up in Seattle is what happened in China, and you know, when people are confronted with that, suddenly this more risk phenomenon that every talks about isn't so low anymore.

  • And that's we need to prepare people for now what can be done like what What can the average person do?

  • I see people walking around with masks on wearing gloves.

  • Is that nonsense?

  • Largely, Yeah.

  • First of all, we'll step back.

  • The primary mechanism for transmission is just the restaurant's just breathing.

  • In studies in Germany, which just have been published literally in the last 24 hours, they actually followed a group of people who had been exposed to somebody automobile manufacturing plant.

  • And then they had nine people that with this exposure, he said, if you have any symptoms will contact us, we want to follow.

  • Withnail agreed.

  • Well, they got infected.

  • And so in the very first hours, just feeling bad, sore throat.

  • They went in and sampled the throats there, their saliva, their nose for virus.

  • They did blood.

  • They did stool.

  • They did you earn.

  • And they found that at that very moment, when they first got sick, they had incredibly high levels of virus.

  • Sometimes 10,000 times out.

  • We saw with stars in their throats, meaning they were infectious at that point already, and they hadn't even had symptoms yet of really nature.

  • They were coughing you, and that's where we're concerned, because that's the kind of transmission.

  • I always have said, trying to stop influence virus transmission like try to stop the wind.

  • You know, we've never had anything successfully do that other than vaccine and we don't have a vaccine here.

  • So what's happening is that people in public spaces are getting infected.

  • And the way you need to address that is unfortunately, if you're older over 55 you have some underlying health problems which, unfortunately, what Americans do, we have obesity.

  • Then right now, you don't want to be in large public spaces trying to potentially get infected so you can take care of that part as far as what can Public health.

  • D'oh!

  • Why can't we talk about this?

  • We're not gonna have a vaccine anytime soon.

  • That's happy talk.

  • Um, what we you know, we can close schools.

  • One of the big challenges we have right now if we close schools, what we accomplished influenza virus.

  • When we close schools during outbreaks, because it turns out kids are get infected in school and they're like little virus reactors, you know, they come home and they transmitted to mom and Dad and brothers and sisters, and so we close school.

  • Sometimes it's Christmas breaks are always great for kind of putting the dampening effect on flu.

  • In this case, kids are not getting sick very often all which is one of the really good news features of this disease into China.

  • Only 2.1% of the cases were under 8 19 years of age.

  • Why is that?

  • You know, we don't completely know Andi.

  • I'm gonna come down a second because they're getting infected.

  • It turns out one study showed that they still get infected with the virus.

  • But they don't get sick.

  • And we have that happen.

  • There's a disease called infectious hepatitis, hepatitis A, where we have outbreaks and daycares.

  • And the way we know we have an outbreak is because it's transmitted through the stool.

  • Fecal Laurel is Mom and Dad, and the daycare providers all gets sick.

  • And the kids, those symptoms, we go in tests.

  • Kids are all positive.

  • So some diseases will manifest my primary When your adult, but not as a child.

  • This one appears to be the same.

  • So do we close schools or not?

  • If we're not really spreading the disease?

  • Because it turns out that if we close schools a recent study done showed that 38% of nurses today in this country who are working in the medical carrier have kids to school.

  • And if suddenly we're closed schools for two or three months, who's gonna take care of those kids?

  • 1/4 of the American population has no sick leave.

  • If we close schools, they don't get paid if they have to stay home.

  • So when you ask, what can we do?

  • We have to really be thoughtful about what we do.

  • Are we doing more harm than good bye closing schools, for example?

  • Even everybody will say, Well, we got to do everything we can.

  • Where do we just help people?

  • You know it's gonna be limiting your contact as much as you can, and that's really about what we can do and limiting the contact.

  • Is that really gonna help?

  • It does, because it's like putting rods and a reaction.

  • If you don't have as much close contact, you can not transmit as much if I'm if I'm sitting in a room with 100 people and we're kind of sharing air, the transmissions remarkable right here off the coast.

  • California, you've got your cruise ship.

  • Cruise ships are notorious for recirculating air inside the inner cabins.

  • We've had a number of outbreaks.

  • That's why they're having these outbreaks on cruise ships.

  • And then you leave them on there.

  • I think the cruelest human experience we've done in a long time with you, Mrs.

  • Leave him on these ships.

  • Get him off right away.

  • Should they get him all?

  • Absolutely.

  • We'll deal with them.

  • Well, they can put him in quarantine of some kind if they want to follow up on him.

  • But you're guaranteed they're all gonna keep getting infected day after day.

  • It seems like we're not really prepared for something like this.

  • Although the CDC has been telling us for a long time that we should be, you know, we are not prepared it all in the sense.

  • You know, I wrote the book Deadliest Enemies that was published in 2017.

  • Thank you.

  • Thank you.

  • Get it?

  • No.

  • And panic in a Chapter 13.

  • The title of the chapter was Cyrus and Murders.

  • A harbinger of things to come, you know, predicted this And then I wrote a chapter on there what a flu pandemic would look like if it emerged in China, and if you read it, it's exactly what's happened.

  • Supply chains went down.

  • China locked down the country.

  • It spread to other countries.

  • People pointed fingers and you know, it's It's the kind of thing where we hear it inherit boat.

  • Don't get prepared.

  • You know, Five years ago, I gave a talk at the Mayo Clinic.

  • First time I talked about this, I talked many times afterwards and I showed a slide of Puerto Rico picture was Puerto Rico.

  • And then I showed the map that I showed a picture of a building in Puerto Rico nondescript building.

  • And I said, This is our next big disaster.

  • Turns out that 85% of all the world's production of I V bags was sailing.

  • That we need desperately were made in these plants in Puerto Rico, and all we needed was 11 Category five hurricane to come through and take it out.

  • Maria came through a year and 1/2 ago, and the world went into a major crisis with shortage of I V bags.

  • Now that was so obvious that was gonna happen.

  • And yet we don't prepare.

  • That's so foolish.

  • I know.

  • I agree.

  • And that's what hopefully this is a wake up call.

  • The business community.

  • I hopefully will wake up.

  • You know, one of the other things we're doing right now, Joe, this is really one of the things that has me most concerned about.

  • This whole situation is our group has been studying for the last year and 1/2 with support from the Walton Family Foundation looking a critical drug shortages.

  • It turns out that we identified 100 and 53 drugs in this country that people need right now where they die.

  • I mean, it's on the crash card.

  • It's acute critical drugs, 100% of margin, Eric.

  • All of them basically are made offshore.

  • The United States and large part mermaid in China, in India.

  • And at this point, we have shortages.

  • Anyway, every day just before this crisis happened, Now these supply chains have gone down.

  • Our group is actively helping the United States government try to figure out you know where they get these drugs.

  • And I just think of this if I came to you and said the Defense Department was gonna outsource all his munitions production to China, you look at me and say, Come on.

  • You know what?

  • The U.

  • S.

  • Defense Department has no more access to these drugs and anybody else.

  • They're beholden to China for these drugs.

  • 690,000 Americans have end stage renal disease right now, most of their primary drugs coming from China.

  • And now with the shutdown and what's happening with this And this is what I talked about in the book, why I was so concerned?

  • Because we are at risk.

  • So even this situation is on.