What we do (and don't) know about the coronavirus
TED invited Dr. David Heymann to share the latest findings about the outbreak.]
00:22
[What happens if you get infected with the coronavirus?]
00:25
This looks like a very mild disease, like a common cold, in the majority of people. There are certain people who get infected and have very serious illness; among them are health workers. It's a very serious infection in them, as they get a higher dose than normal people, and at the same time, they have no immunity. So in the general population, it's likely that the dose of virus that you receive when you are infected is much less than the dose that a health worker would receive, health workers having more serious infections. So your infection would be less serious, hopefully. So that leaves the elderly and those with comorbidities to really be the ones that we have to make sure are taken care of in hospitals.
01:07
[Who are the people who should be most concerned about this?]
01:12
Well, the most concerned are people who are, first of all, in developing countries and who don't have access to good medical care and may not have access at all to a hospital, should an epidemic occur in their country. Those people would be at great risk, especially the elderly. Elderly in all populations are at risk, but especially those who can't get to oxygen. In industrialized countries, it's the very elderly who have comorbidities, who have diabetes, who have other diseases, who are at risk. The general population doesn't appear to be at great risk.
01:45
[What pre-existing medical conditions put people at higher risk?]
01:50
First of all, pulmonary disease existing as a comorbidity is also important. In general, the elderly are at greater risk, especially those over 70, because their immune systems are not as effective as they might have once been, and they are more susceptible to infections. In addition, in some instances in China, there's been a coinfection with influenza and at the same time, there have been some bacterial superinfections on the pneumonias that are occurring.
02:19
[Where can we find up-to-date information?]
02:22
The Center for Disease Control in Atlanta keeps track and has updates on a regular basis on its website. Also, the World Health Organization in Geneva, which is coordinating many of the activities going on internationally, also has a website with daily updates. It's our responsibility to get that information as individuals, so we understand and can make sure that we can contribute in our own way to prevention of major spread.
02:48
[You led the global response to the SARS outbreak in 2003. How does this outbreak compare?]
02:52
That's the same problem with all new infections. This is an infection that's coming to humans who have never been exposed to this virus before. They don't have any antibody protection, and it's not clear whether their immune system can handle this virus or not. This is a virus that usually finds itself in bats or in other animals, and all of a sudden, it's in humans. And humans just don't have experience with this virus. But gradually, we are beginning to learn a lot, as we did with SARS. And you know, there are certainly a larger number of deaths than there were with SARS. But when you divide that by a denominator of persons who are infected, there are many, many more persons infected than there were with SARS. The case fatality ratio, that is the ratio of deaths to the numbers of cases in SARS, was about 10 percent. With the current coronavirus, COVID-19, it is two percent or probably less. So it's a much less virulent virus, but it's still a virus that causes mortality, and that's what we don't want entering human populations.
03:56
[Have we responded adequately at border crossings, such as airports?]
04:00
It's clearly understood that airports or any land borders cannot prevent a disease from entering. People in the incubation period can cross that border, can enter countries and can then infect others when they become sick. So borders are not a means of preventing infections from entering a country by checking temperatures. Borders are important because you can provide to people arriving from areas that might be at risk of having had infection, provide them with an understanding, either a printed understanding or a verbal understanding, of what the signs and symptoms are of this infection, and what they should do if they feel that they might be infected.
04:41
[What's the timeline for a vaccine?]
04:44
Vaccines are under development right now, there's a lot of research going on. That research requires first that the vaccine be developed, then that it be studied for safety and effectiveness in animals, who are challenged with the virus after they are vaccinated, and then it must go into human studies. The animal studies have not yet begun, but will soon begin for certain vaccines. And it's thought that by the end of the year, or early next year, there may be some candidate vaccines that can then be studied for licensing by regulatory agencies. So we're talking about at least a year until there's vaccine available that can be used in many populations.
05:25
[What questions about the outbreak are still unanswered?]
05:29
It's clear we know how it transmits, we don't know how easily it transmits in humans, in communities or in unenclosed areas. We know, for example, that in the enclosed area of a cruise ship, it spread very easily. We need to better understand how it will spread once it gets into more open areas where people are exposed to people who might be sick.
05:52
[What about the global response could be improved?]
05:56
A major problem in the world today is that we look at outbreaks in developing countries as something that we need to go and stop. So when there's an outbreak of Ebola, we think "How can we go and stop this outbreak in the country?" We don't think about "How can we help that country strengthen its capacity, so that it can detect and respond to infections?" So we haven't invested enough in helping countries develop their core capacity in public health. What we've done is invested in many mechanisms globally, which can provide support to other countries to go and help stop outbreaks. But we want to see a world where every country can do its best to stop its own outbreaks.
06:38
[Will we see more emerging disease outbreaks in the future?]
06:41
Today, there are over seven billion people. And when those people come into the world, they demand more food, they demand a whole series of things and they live closer together. In fact, we're an urban world, where people live in urban areas. And at the same time, we're growing more animals, and those animals are contributing food to humans as well. So what we see is that that animal-human interface is becoming closer and closer together. And this intensive agriculture of animals and this intensive increase in human populations living together on the same planet is really a melting pot where outbreaks can occur and do occur. We will eventually have more and more of these outbreaks. So an emerging infection today is just a warning of what will happen in the future. We have to make sure that that technical collaboration in the world is there to work together to make sure that we can understand these outbreaks when they occur and rapidly provide the information necessary to control them.
07:44
[Is the worst behind us?]
07:46
I can't predict with accuracy. So all I can say is that we must all be prepared for the worst-case scenario. And at the same time, learn how we can protect ourselves and protect others should we become a part of that epidemic.
08:00
[To learn more, visit: Centers for Disease Control and Prevention World Health Organization]
TED에서 현 상황의 최신 정보를 얻고자 데이빗 헤이만 박사를 초청했습니다.
[코로나 바이러스에 감염되면 어떻게 될까요?]
00:25
대부분은 감기처럼 가벼운 병으로 보입니다.
00:30
감염되면 심각한 증세를 보이는 사람도 있습니다. 보건 의료원들이 그렇습니다. 그들에게는 심각한 감염입니다. 일반인보다 훨씬 많이 노출되지만 그에 대한 면역력은 없으니까요. 일반인들은 감염되었을 때 받아들이는 바이러스 양이 보건 의료인들이 받는 양보다 훨씬 적지만 보건 의료인들은 심각한 감염을 겪게 됩니다. 따라서 여러분의 감염 위험은 덜 심각할 것으로 생각됩니다. 노인과 만성 질환이 있는 사람들만 병원에서 치료받아야 할 대상이 될 것입니다. [가장 걱정되는 사람들은 누구인가요?]
01:12
가장 걱정되는 사람들은
01:15
우선 개발도상국에 있는 사람들로 양질의 의료 서비스를 받지 못하고 병원도 전혀 갈 수 없는 사람들입니다. 나라에 전염병이 퍼져도 말이죠. 그런 사람들 중에도 특히 노인들이 엄청나게 위험합니다. 전체 인구 중에서 노령층이 위험합니다. 산소 치료를 받을 수 없는 상황이거나, 선진국의 경우에는 만성 질환이 있는 노인들, 당뇨병 같은 질병이 있는 노인들이 위험합니다. 보통 사람들은 크게 위험해 보이진 않습니다. [어떤 기저질환이 더욱 위험한가요?]
01:50
무엇보다도
01:51
만성 폐 질환이 있다면 주목해야 합니다. 보통 70세 이상의 노인들이 훨씬 위험합니다. 면역계가 이전보다 기능을 못하기 때문이고 감염에 보다 취약하기 때문입니다. 게다가 중국의 어떤 경우엔 인플루엔자에 동시 감염되어 폐렴이 발병한 상태에서 세균에 중복감염된 사례도 있습니다. [어디서 최신 정보를 구할 수 있을까요?]
02:22
애틀란타의 질병관리본부에서 추적해서
02:25
홈페이지에 주기적으로 업데이트 합니다. 제네바의 WHO에서도 국제적으로 벌어지는 활동과 공조해서 매일 홈페이지에 업데이트 하고 있습니다. 그런 정보를 찾아봐야 할 책임이 우리 개개인에게 있습니다. 그 정보를 이해하고 각자의 방식으로 도움을 줘야 합니다. 큰 확산을 방지하기 위해서 말이죠. [박사님은 2003년 SARS 발생 당시 글로벌 대응팀을 지휘하셨죠.
02:50
이번 발생과 어떻게 비교해 보십니까?] 모든 새로운 감염은 동일한 문제입니다.
02:54
이전에 이런 바이러스에 노출된 적이 없는 사람들에게 생긴 감염입니다. 보호 항체가 없기 때문에 면역계가 이 바이러스를 감당할지 확실하지 않습니다. 보통은 박쥐나 다른 동물에서 발견되는 바이러스인데 갑자기 사람에서 발견된 겁니다. 사람은 이 바이러스에 걸린 경험이 없죠. 하지만 SARS와 마찬가지로 점차 알아가고 있습니다. SARS 보다는 확실히 사망자 수가 더 많습니다. 하지만 감염자수를 기준으로 보면 SARS보다는 훨씬 더 많은 감염자가 있죠. 치사율을 보면 SARS의 사망률은 약 10%였습니다. 현재 코로나19의 경우는 2% 혹은 그 이하입니다. 그러니 덜 치명적인 바이러스지만 사망을 유발하는 바이러스이기 때문에 사람에게 유입되길 원치 않는 것입니다. [공항과 같은 국경지역에 대한 대응이 적절한가요?]
04:00
확실한 건 공항이나 국경지역을 통한
04:04
질병의 유입을 막지는 못한다는 겁니다. 잠복기에 있는 사람들이 국경을 넘어 입국하고 이후에 발병했을 때 전염시킬 수 있습니다. 따라서 국경에서 체온을 확인하는 것으로 감염 유입을 막을 수는 없습니다. 국경이 중요한 이유는 감염 위험 지역에서 온 사람들에게 정보를 줄 수 있기 때문입니다. 어떤 것이 감염의 징후와 증상인지 문서나 설명으로 알려주고 감염됐다고 느끼면 어떻게 할지도 알려주는 겁니다. [백신의 상황은 어떻습니까?]
04:44
백신은 현재 개발 중에 있습니다. 많은 연구가 진행되고 있어요.
04:49
연구를 위해서는 먼저 백신이 개발되어야 하고 동물실험을 통해 안전성과 실효성이 확인되어야 합니다. 동물에 백신을 주사한 뒤에 바이러스에 감염시키는 것이죠. 그후에 사람에 대한 임상실험이 진행됩니다. 동물 실험은 아직 시작하지 않았지만 몇 가지 백신으로 곧 시작할 겁니다. 연말이나 내년 초에 실험이 시작되면 몇 가지 후보군 백신에 대해서 정부기관의 허가를 받기 위한 연구가 진행될 거라 예상합니다. 그러니까 대규모로 백신이 사용되려면 적어도 1년은 있어야 한다는 것이죠. [이 상황에서 아직 모르는 것은 무엇입니까?]
05:29
어떻게 전염되는지는 확실히 알지만
05:31
지역이나 공개된 곳에서 사람 간에 얼마나 쉽게 전염되는지는 모릅니다. 크루즈 선박 같은 폐쇄된 장소에서는 쉽게 퍼진다는 걸 알고 있지만 우리가 알아내야 할 것은 보다 개방된 공간에 있는 사람들이 유증상자에게서 전염되는 양상입니다. [글로벌 대응의 개선점은 무엇일까요?]
05:56
현재 중요한 문제는 개발도상국에서 발생되는 것을
06:01
우리가 개입해서 막아야 한다는 것입니다. 에볼라가 발생했을 때 "어떻게 이 발생에 개입해서 멈출 수 있을까?" 하고 생각하지 "어떻게 도와야 이 나라가 역량을 갖춰서 감염을 진단하고 대응할 수 있을까" 하고 생각지 않습니다. 그런 면에서의 투자가 불충분했기에 개발도상국들이 공중 보건의 핵심 역량을 갖도록 돕지 못했습니다. 지금까지는 국제적인 체계에 투자해서 전염병 발생에 개입하여 억제하도록 도움을 제공했습니다. 하지만 저희는 모든 국가가 스스로 발병을 억제할 수 있게 되길 바랍니다. [앞으로 다른 전염병이 발생할까요?]
06:42
오늘날 70억이 넘는 인구가 있습니다.
06:44
세계 인구가 늘어나면서 더 많은 식량과 여러 물자가 필요하고 더 밀집되어 살고 있습니다. 사실 우리는 도시화된 세계의 도시인들인 셈이죠. 그리고 동시에 가축도 기르고 있고 그 가축이 식량이 되고 있습니다. 그렇다 보니 확실히 인간과 동물간 접촉이 점점 밀접해지고 있습니다. 이런 집약적인 축산업과 지구상의 인구가 급증하고 있는 상황이 전염병이 일어날 수 밖에 없는 온상과도 같습니다. 이런 발병은 점점 더 많이 생길 겁니다. 현재 발생하는 전염병은 앞으로 일어날 일의 경고일 뿐입니다. 우리가 해야 할 일은 세계적인 기술 협력을 통해서 전염병이 발생했을 때 상황을 파악하고 통제할 수 있도록 신속하게 정보를 제공할 수 있어야 합니다. [앞으로 최악의 상황이 남아 있습니까?
07:46
정확히 예측할 순 없습니다.
07:48
제가 말씀드릴 수 있는 건 모두가 최악의 상황에 대비해야 한다는 겁니다. 그와 동시에 전염병 상황에서 우리와 다른 사람을 지킬 방법을 알아 두어야 합니다. [자세한 내용은 질병관리본부와 WHO 홈페이지에서 살펴보십시오.]
How can we control the coronavirus pandemic?
00:12
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.
00:26
(Laughter)
00:28
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.
01:50
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.
02:40
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.
03:04
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.
03:43
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.
04:36
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.
05:16
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.
06:01
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.
06:55
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.
07:59
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.
08:52
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.
09:38
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.
10:04
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.
10:45
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.
11:56
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.
12:26
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.
12:48
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.
13:16
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.
13:24
(Laughter)
13:27
So sanitize your phone and consider not using it as often in public. Maybe TikTok and Instagram can be home things only.
13:36
Don't touch your face. Don't rub your eyes. Don't bite your fingernails. Don't wipe your nose on the back of your hand. I mean, don't do that anyway because, gross.
13:46
(Laughter)
13:48
Don't wear a face mask. Face masks are for sick people and health care providers. If you're sick, your face mask holds in all your coughing and sneezing and protects the people around you. And if you're a health care provider, your face mask is one tool in a set of tools called personal protective equipment that you're trained to use so that you can give patient care and not get sick yourself. If you're a regular healthy person wearing a face mask, it's just making your face sweaty.
14:15
(Laughter)
14:16
Leave the face masks in stores for the doctors and the nurses and the sick people.
14:23
If you think you have symptoms of COVID-19, stay home, call your doctor for advice. If you're diagnosed with COVID-19, remember it's generally very mild. And if you're a smoker, right now is the best possible time to quit smoking. I mean, if you're a smoker, right now is always the best possible time to quit smoking, but if you're a smoker and you're worried about COVID-19, I guarantee that quitting is absolutely the best thing you can do to protect yourself from the worst impacts of COVID-19.
14:56
COVID-19 is scary stuff, at a time when pretty much all of our news feels like scary stuff. And there's a lot of bad but appealing options for dealing with it: panic, xenophobia, agoraphobia, authoritarianism, oversimplified lies that make us think that hate and fury and loneliness are the solution to outbreaks. But they're not. They just make us less prepared.
15:25
There's also a boring but useful set of options that we can use in response to outbreaks, things like improving health care here and everywhere; investing in health infrastructure and disease surveillance so that we know when the new diseases come; building health systems all over the world; looking at strengthening our supply chains so they're ready for emergencies; and better education, so we're capable of talking about disease outbreaks and the mathematics of risk without just blind panic.
15:58
We need to be guided by equity here, because in this situation, like so many, equity is actually in our own self-interest.
16:07
So thank you so much for listening to me today, and can I be the first one to tell you: wash your hands when you leave the theater.
16:14
(Applause)
How we'll fight the next deadly virus
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.
00:26
(Laughter)
00:28
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.
01:50
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.
02:40
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.
03:04
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.
03:43
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.
04:36
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.
05:16
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.
06:01
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.
06:55
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.
07:59
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.
08:52
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.
09:38
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.
10:04
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.
10:45
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.
11:56
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.
12:26
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.
12:48
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.
13:16
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.
13:24
(Laughter)
13:27
So sanitize your phone and consider not using it as often in public. Maybe TikTok and Instagram can be home things only.
13:36
Don't touch your face. Don't rub your eyes. Don't bite your fingernails. Don't wipe your nose on the back of your hand. I mean, don't do that anyway because, gross.
13:46
(Laughter)
13:48
Don't wear a face mask. Face masks are for sick people and health care providers. If you're sick, your face mask holds in all your coughing and sneezing and protects the people around you. And if you're a health care provider, your face mask is one tool in a set of tools called personal protective equipment that you're trained to use so that you can give patient care and not get sick yourself. If you're a regular healthy person wearing a face mask, it's just making your face sweaty.
14:15
(Laughter)
14:16
Leave the face masks in stores for the doctors and the nurses and the sick people.
14:23
If you think you have symptoms of COVID-19, stay home, call your doctor for advice. If you're diagnosed with COVID-19, remember it's generally very mild. And if you're a smoker, right now is the best possible time to quit smoking. I mean, if you're a smoker, right now is always the best possible time to quit smoking, but if you're a smoker and you're worried about COVID-19, I guarantee that quitting is absolutely the best thing you can do to protect yourself from the worst impacts of COVID-19.
14:56
COVID-19 is scary stuff, at a time when pretty much all of our news feels like scary stuff. And there's a lot of bad but appealing options for dealing with it: panic, xenophobia, agoraphobia, authoritarianism, oversimplified lies that make us think that hate and fury and loneliness are the solution to outbreaks. But they're not. They just make us less prepared.
15:25
There's also a boring but useful set of options that we can use in response to outbreaks, things like improving health care here and everywhere; investing in health infrastructure and disease surveillance so that we know when the new diseases come; building health systems all over the world; looking at strengthening our supply chains so they're ready for emergencies; and better education, so we're capable of talking about disease outbreaks and the mathematics of risk without just blind panic.
15:58
We need to be guided by equity here, because in this situation, like so many, equity is actually in our own self-interest.
16:07
So thank you so much for listening to me today, and can I be the first one to tell you: wash your hands when you leave the theater.
16:14
(Applause)
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