Welcome to Prognosis. I'm Laura Carlson. It's state since coronavirus was declared a global pandemic on today's show. With COVID nineteen crippling much of the world, there's intense uncertainty about what's next for global societies. In the United States, it's hard to envision when the economy and our lives will get back to normal. But it turns out there is a plan to beat the virus and to get the country back to work. The question is whether the government
will follow it. But first, here's what happened today. New York Governor Andrew Cuomo said COVID nineteen deaths seem to be hitting a plateau. The state has become the epicenter of the u S outbreak. Cuomo says measures to lock down the state have started to work, but that the challenge is to maintain social distancing. For two days in a row, the death toll has been about the same for over a week, they had been increasing daily. If we are plateauing, we are plateauing at a very high level,
and this tremendous stress on the healthcare system. There are also more signs that the crisis may be easing In Europe, Italy, France, Germany and Spain all reported lower numbers of new cases, and the Netherlands had the smallest increase in deaths in a week. Austria took the first steps towards restarting its economy. However, the news on Monday wasn't all positive. UK Prime Minister Boris Johnson, who had previously tested positive for coronavirus, was
taken to a London hospital over the weekend. On Monday, Johnson was moved to an intensive care unit after his condition worsened. From the economic perspective, there's little doubt we're in for a deep recession. That's according to Jamie Diamond, CEO of j P Morgan Chase, who said in his annual letter to shareholders that the economic downturn we have in store will mirror the meltdown after the two thousand eight financial crisis. Finally, imports of an unapproved drug touted
by President Donald Trump have just taken a major hit. India, which makes roughly half the supply of the malaria drug hydroxy chloroquin, banned its exports Monday to ensure enough supply for domestic use. The president had called the drug a game changer in treating coronavirus, even though there's no conclusive scientific evidence that it can treat the infection caused by the novel coronavirus. The drug also hasn't been approved to treat COVID nineteen by the U S Food and Drug Administration.
Trump's endorsement had caused global stockpiling of the medication. Now for today's main story, former f d A Commissioner Scott Gottlieb is concerned that the unfolding crisis in New York City, the epicenter of the coronavirus in America, could be replicated
in other cities across the country. Gottlieb, a physician and informal adviser to the Trump administration, has been sounding the alarm on the US federal government's need to prepare for a domestic outbreak of the novel coronavirus since late January. He told Bloomberg's Anna Edney that although the pandemic will get worse before it gets better, he has a plan
to help prevent further spread of the disease. Gottlieb starts out by talking about what he thinks of the White House response to coronavirus and what they could have done differently earlier this year when there were just a few known cases in the country. Well, look, I think that there's going to be a lot of time to UM look back with. People are gonna be writing books about this episode for the next hundred years. This is really
a historic period of time. I think they've been worried about this as as long as I've been engaged with them, in the conversations that I've been talking to them about this. UM. They started to take action in January. You know, the stuff that I thought they should do in January, and I thought they should do in February. I wrote about January and February, so you know, I was on the record talking about things that I thought should have gotten
done with respect to the screening, the diagnostic screening. I'm talking a lot now about things I'd like to see with respect to a more deliver strategy with with respect to the development of therapeutics and drugs. And it's hard for me to know everything that went on on the inside. Um. You know, I'm sure that they struggled with trying to get more testing capacity out sooner, but the bottom line
is that we were. We were dependent upon epide neological surveillance data into February that was imprecise, so you know, there was the the um possibility that you could have hundreds of cases and probably low thousands, and you wouldn't necessarily detect it, And at epidemiological surveillance data was backward looking. You would depend upon looking at admissions to the hospitals or the e d S, people who showed up for respiratory illness, people who showed up with influenza like illness
but tested negative for flu. That was always a week old because that data gets reported at the end of every week. So if you did have a outbreak in this country that was sufficiently small, you weren't going to detect it in a timely fashion. And that's what happened in Seattle, and it's probably what happened in New York
as well now looking back at the data. So when you look at the data New York and you look in early March, you start to see a signal in the influenza like illness surveillance system that people were presenting with influenza like symptoms at a time when flu rates were going back to baseline. That was probably an indication that coronavirus was circulating. Probably had an introduction of coronavirus at some point in early January. I think he dated
it to like January twelve or thereabouts. And that cluster that was a single spark that that lit a fire, and it grew and it kept growing, and when it reached hundreds of cases, suddenly it started to throw off other sparks. And you saw the events in the nursing home. You saw that young gentlemen present with flu like symptoms who got diagnosed with coronavirus, and so it became apparent
that there was an outbreak in Seattle. What happened in New York by comparison, and we won't know this, We might never know this, but this is sort of conjecture, is New York wasn't a single introduction that lit a fire. New York was maybe dozens of introductions, dozens of sparks that each lit their own fires, and they all grew, and they were all small clusters, and then they all became apparent at the same time, so that by the time you discovered there was spread in New York, there
wasn't one large cluster expanding. There were dozens of small clusters all expanding, and at that point it was too late to do much to mitigate the risk short of
the population type mitigation. And I worry that that's what other cities are going to experience now, that other cities aren't going to be one or two or half a dozen introductions that lead to clusters that are expanding, but they're gonna be many introductions, and maybe even more than New York, because while New York was probably seated from people coming over from Italy and maybe China and other parts of the world, UM, Florida was seated from New
York and Seattle, and you know, Chicago was seated from New York and Seattle and Massachusetts and southern California and northern California. So the other cities that are going to experience this epidemic later weren't seated from foreign travelers. They was seated by domestic travelers. And the magnitude of the seating that could have gone on from domestic travel as
opposed to foreign travel was probably far greater. Certainly, the DC metro area looks very concerning, Miami looks very concerning, UM New Orleans looks very concerning. Some of the states. Some of the city is in the northeast look concerning as well, Philadelphia, Detroit, Boston. But those states did implement mitigation steps much earlier, and more aggressive mitigation steps, so you hope you're going to see the the the benefits
of that coming through pretty soon. But in the states that didn't implement those mitigation steps early and have the same level of spread and the same level of positivity, meaning people who get tested are positive at a very high rate and are under screening, I think you worry a lot about those UM those areas, and the Southeast in particular, I think is is particularly suspect they're under testing. They have rapid growth in cases UM, and when they
do test, they're getting back a lot of positives. They had an opportunity to implement mitigation steps and really avert a bad outcome in those cities and didn't didn't take that opportunity. And some of them may get lucky and escape UM significant outbreaks and epidemics, but some of them may not. And I think by and large, whether or not we reach some of the grim statistics that were in Tony Fauci's model, where he was estimated that there
could be two d thousand deaths and more. I think it's not going to turn on what happens in New York. I think we have a pretty good handle of what New York is gonna look like and when New York is going to turn the corner and the overall morbidity and mortality that the city is gonna experience. As tragic as it is, I think we kind of understand where the backstop is there, where the end is. At this point, I think it's gonna turn on what happens in Texas
and what happens in Florida. Populous states, Georgia, populated states that were slow to implement mitigation steps could have been
heavily seated, and they have very large epidemics. And Florida has the potential to eclipse New York in terms of the morbidity it sustains from this virus, given the demographics of the state, given the kind of growth that we're seeing right now, If they end up having very large epidemics, I think that's going to drive towards some of the more grim statistics that Tony Faucci and others were putting forward.
In some of those models, I think what we need to appreciate, is, you know, absent a technology here, absent a drug therapeutic or or a number of drugs that really starts to make a very big difference in the morbidity and mortality of this. And I think we can get that. I think I think we should be focused much more on the development of the therapeutic than we are, and I think we should have a very very deliberate industrial policy towards that. I think we should have sort
of a Manhattan style project. We seem to be focused on the vaccine and have sort of an industrial approach to the vaccine when you see the government working very closely with vaccine developers, and we don't have the same
approach on a drug. And I find that odd because the drug is really the near term opportunity and and and the therapeutic is the only thing that's going to make a difference in the fall and prevent this from being something that really changes the way we live going forward until we get to a vaccine, but absent the therapeutic, I think April late April, early May, the epidemics running
its course nationally. May as a transition month. June, we start to lift some of these restrictions, and I hope that in July and August the virus sort of collapses. That's kind of what happened if you remember back in two thousand and nine with the swine flow. The swine flow continued to circulate into June, which was very unusual for flow. Flus don't usually propagate a summer. But it was so novel. People had no cross community to it.
They were susceptible to it that it continued to spread into June, and then in July and August it just sort of collapsed. It. It just went away, and then it was back in September. If you remember, summer camps were canceled, but some of them had it. There were some outbreaks and some summer camps and they would close, but it by and large um really dissipated in July and August in this sort of hot summer months. Some things will never get back to normal. I don't think
we'll be shaking hands as much anymore. I think you might see masks become more accepted in our culture the way they are in some some Asian cultures. I think the idea of crowding ten thousand people into a ballroom for a conference might go away. You might have small conferences that you live stream. Things are going to change. You might see ultra violet light in walkways and airports
because it kills viruses. You're gonna see airlines advertised deep cleanings, and Uber is going to talk about how they clean cars in between passengers. You're gonna see things differently. That was former FDH chair Scott Gottlie talking about what the future is for this pandemic and for us. That's it for the Prognosis Daily Edition. For more on the coronavirus crisis from a hundred and twenty bureaus around the world,
visit Bloomberg dot com slash coronavius IRUs. If you appreciate the podcast, please take a moment to rate us and leave us a review on Apple Podcasts or Spotify to help more listeners find our global reporting. The Prognosis Daily Edition is hosted by me Laura Carlson. The show is produced by me tophor Foreheaz, Jordan Gaspore and Magnus Hendrickson. Additional reporting by Anna Edney. Original music by Leo Sidrian. Our editors are Francesca Levi and Rick Shine Francesca Levi
is Bloomberg's head of podcasts. Thanks for listening.