My name is Colleen Kraft, so I wear a number of hats at Emory. I just took a new job right before this started, and so I think a lot of what I'm coping with has to do with my
own sort of perfectionism and self criticism. I started out doing more on the preparedness planning aspect, which was very administrative, and that's also my new role at Emory, and so that was nice, a nice thing for me to walk into because I was already kind of going into the executive leadership group of our hospital, so it was kind of nice to be sort of also a subject matter expert.
But what's happened as patients have started to arrive, you know, and be diagnosed in our community, is that I've realized that my role has dramatically changed into being sort of the helping with the clinical laboratory. Because remember that's one of.
The hats I wear is in diagnostic testing.
So I'm both a clinician that sees patients, but I also work in our clinical lab, which I love doing both of those things. And so I this morning, for instance, spent three hours prioritizing four hundred samples into ninety two and working with people to data analyze that. You might say,
why would an MD do that? That makes no sense. However, we have a full staff of people that need to be doing the rest of the work for the hospital, and so what you're seeing is people are being kind of it's like, we need to establish the process before we have to hand it off, right, because there's a lot of ups and downs.
There's a lot of things coming at us.
Like I just explained, just feeling like everybody's need something from me, Like I cannot leave my phone for five minutes without it blowing up with text messages or calls or emails. It's it's insane. You don't like, there's no
way to feel disconnected. And so my role has changed from being sort of, you know, thoughtful, trying to be organized, planning, you know, inner rejecting, to being like physically sorting through with you know, a number of supervisors from three different laboratories, how we're going to prioritize our testing because I want to make sure that we're doing, you know, the best thing for our patients and our employees, and also communicating outward because of course, no one's ever happy with the
turnaround time, especially with the media about testing kits. I think it's also encouraged the demand that we have to have this diagnosis today when I'm like, well, we've just discovered is like two and a half months ago everybody. So I think that, you know, that's what a leader.
I think is supposed to do.
I'm not sure I'm being a leader, but I think that that's what you're supposed to do, which is jump in, be helpful, try to create a process because you can see all the aspects of the process, and then keep doing iterations for the process so you can hand it off.
I think that's what I'm supposed to be doing.
But again, I think some of my stresses I'm not sure what I'm i supposed to be doing because I'm there's so much to do. Right am I supposed to draft this email? I'm supposed to talk to this I'm also on our Governor's task force, which has happened since we talked, and that's been an incredible opportunity.
So today I sorted.
Samples for three hours, and then I worked with some data analysts about how we can get these I've been creating a manual spreadsheet how I mean this is all very boring, and then I worked with people to pull this data so I don't have to pull it, and then you know, just helping with the process, and then being in a zillion jillian meetings like while I'm doing this a lot of times because there's just so many executive meetings that I have to be in, so it's
been quite crazy. And then I'm today, I'm carrying the pager, so the er has been calling me all day about whether or not to admit where we're cohorting our patients. So if there's this suspicion that they have COVID, we'll put them on a couple of wards, not all all over the hospital. So we're the gatekeepers for deciding if those people get to cohort.
So it's like being pulled in a million directions. And I am truly exhausted working fifteen hours a day at the hospital. So whereas my kids get to stay.
At home and I would love to be at home with them, I am spending even more time at work. So that's sort of also probably what you hear my voice is the strain of exhaustion, but yeah, we'll get through it.
So that might have been a familiar voice for you. That was doctor Colleen Kraft who spoke on our Clinical Disease, a minisode of this Anatomy of a Pandemic series, and she was also on our first coronavirus episode back in February.
Hi, I'm erin Welsh and I'm erin Olman Updyke.
And this is this podcast will Kill You.
Welcome to the third installment of our Anatomy of a Pandemic series. They're not minisodes.
What have we covered so far? Erin well a lot. We've talked about the virus itself, SARS Kobe two, and then we talked about the disease that it causes, COVID nineteen and so now the next question is we're in a pandemic? What do we do about it? We're here in this situation, living through what we have known was possible since at least nineteen eighteen, but this has never happened on this scale since. So what do we actually do about it? How do we try and control it?
And so, yeah, that's what we're going to talk about today.
But first, of course, it's Quarantiny time.
What are we drinking now?
This time we're drinking Quarantini number three gin some delicious rosemary simple syrup. You could use dried rosemary to make simple syrup out of and some lemon juice.
YEP, it's pretty delicious, actually, very refreshing.
Very refreshing. And I do want to address yet again that we don't recommend drinking all these quarantinies in one day. If you're binge listening to these episodes, please don't binge drink.
But if you want to drink along with us and you don't feel like drinking alcohol or don't want to drink alcohol, we also have placey burrita recipes that we will post for all of our quarantine recipes, and you can find those on our website This podcast will Kill You dot com, and we'll also tweet Insta, Facebook these recipes.
You could definitely binge drink the plasy burritas because they don't usually have that much sugar in them. Yeah, they're quite good.
Yeah, and maybe even hydrating. Yeah. Okay, So what should we know before we dive into this episode.
So when we recorded our first coronavirus episode back in early February, it was still or at least we thought at that point that it was still fairly well contained at least, China had instituted pretty strict policies to try and control the epidemic there, and while cases were appearing across the globe at that point, we were mostly, we thought able to identify these cases and use what's called contact tracing to try and pinpoint where that person became
infected and who they came in contact with who they could have potentially exposed, so that we could try and stem the infection that way.
So early on in an outbreak, this contact tracing is a super valuable tool that helps public health professionals identify and isolate cases and then identify and quarantine healthy people who have been exposed in an attempt to try and squash the infection before it really spreads in a population. But that, of course was then, and this of course is now. It sure is so.
Now it's clear that community transmission, meaning transmission from person to person, not only in close family settings or not only travel related cases, but transmission kind of freely in and among communities, is happening across the globe at this point, which is why the World Health Organization has declared this a pandemic. So now the question is what do we
do about this? Because, as you may have heard from chapters one and two, this is a disease that in some cases can be really severe, and we are at risk of overflowing our hospitals, or in some parts of the world, hospitals are already over capacity, which means that people could be dying not just from disease, but also from lack of access to supportive care.
So you've probably heard a lot of talk about social distancing and how to flatten the curve. But what do these two things mean and why are they important? Okay, so social distancing is literally exactly what it sounds like. It's putting a greater distance between you and other humans. And in our February Coronavirus episode, doctor Marshall Lyon actually mentioned it, which is like, yeah, we knew, kind.
Of like we knew this is a strategy, especially for yeah illness strategy.
Yeah, why does this work? Why does social distancing work? Well, since we're dealing with a virus that is transmitted from respiratory droplets, so from your saliva by literally just coming into contact with other people's saliva directly or stuff that their saliva may have touched, like doorknobs or grocery cart handles, or even just their filthy hands or whatever. If you don't come into contact with these things, then you can prevent yourself from getting infected. Now this works on the
flip side. If you are sick, by not going out to the club, to the party, into work, into school, then you aren't spreading your saliva, which contains a bunch of virus all over the world for other people to come in contact with. And we also recognize that staying at home may not be an option for everyone, and that's what makes it even more important that if you do have the privilege to stay at home, if you do have that ability, then you need to do so.
It is a social responsibility aspect at this point.
Absolutely. And remember that we've learned that this is a virus that might not even make you feel all that sick, but it could still make those around you super sick. So by practicing social distancing, we're protecting our ourselves and those around us who might be more vulnerable to severe infection. We really can't stress enough that this is what we should all be doing to be good citizens, friends, neighbors, humans.
The other thing is washing your hands, washing your hands, washing your hands.
Okay, what about masks, So masks can be effective if you are sick, in like helping to prevent the spread of droplets when you cough. I saw a really interesting jiff of or gif. I don't want to anger anyone out there. That's the last thing we need right now. I've just been revealed as a jiff sayer, not a
gift sayer. And it had examples of what it looked like when you cough directly into the air when you breathe normally, how much your respiratory droplets are traveling, and you can see it directly when you cough into your hand versus your elbow versus into a mask, like a dust mask, versus into an N ninety five mask versus into it.
It's really really could we find that and post that because I'd love to see that. Yeah, credit man, reddit man.
Okay, but if you're sick, you shouldn't be out coughing on people anyways, especially not right now when no one should be out and about unless you have to be. And so if you do have to be, wearing a mask can be a great way to prevent the spread of those respiratory droplets. But if you are not sick. Masks don't really do much to prevent you from getting sick because A you have to touch your face to put on the masks, and you're probably going to be
adjusting them frequently. B. They don't cover your eyes, which the virus can go into your mucus membrane, and so's you know, one of the roots of entry. See, some of the ones that you buy over the counter are too large a poor size to actually prevent viral entry anyways, And at this point, hospitals and clinics are running out of masks, so everyone buying them up is not helping
anyone at this point. I mean, if wearing a mask helps keep people six feet away from you, if that's the idea behind them, which I feel like in other scenarios it might be that could work, but right now, in this pandemic, it's not super helpful.
Yeah, Okay, what about this notion of flattening the curve. I feel like we've talked about on this podcast before, what an epidemic curve tends to look like. Right, So most of you at this point have probably seen one drawn out, especially if you've been looking at all the case numbers of COVID nineteen plotted out on a graph.
But basically, in all epidemics, the number of cases tends to increase exponentially at first, so it's a pretty sharp line up at first, and then eventually it reaches some kind of peak, and then it will begin to dip back down slowly, so it kind of looks like an upside down you. That's what a normal epidemic curve looks like. So flattening the curve literally means trying to slow down that upstroke of that upside down you so that the
rate of infection is slower. What this does is it makes it so that the peak, the top point of that curve is pushed down. So this could mean potentially a prolonged over time course of that epidemic, but the rate of infections is slower, which means that a hospitals don't get overrun with super sick people all at once. And we've said so many times already that this is a real major concern in the case of COVID nineteen, and it also means that we have more time to
test and develop both treatments and hopefully a vaccine. So flattening the curve is something that can be really useful in trying to lessen the overall impact that an epidemic has. So you might have heard a bit about this notion of herd immunity as a strategy. This is a terrible strategy.
Fits a terrible strategy.
It's a terrible an What it is is an unethical strategy because it is not a strategy. It's basically saying we're not going to do anything. We're going to let anyone everyone get infected, and eventually everyone will get infected and they'll either die from the infection or they'll become resistant because they've developed immunity to that infection. That's not an ethical public health strategy to prevent deaths from this disease.
It's not it's not a strategy, but that is essentially what would happen if you were to not do anything to try and control this outbreak. Okay, does that make sense? Yeah, Because herd immunity is essentially the idea that once enough people in a population have been exposed, either through infection or through vaccination, then eventually there are so few susceptible people left in that population that the pathogen can't spread anymore. But that the results of that is a lot of people dying.
Yep. So yes, okay. So this episode, we were fortunate enough to interview doctor Critika Kupali, an expert on global health security and pandemic preparedness. We asked her all of your questions about outbreak control and whether the efforts that we are making at national and international scales are going to work. We hear from her right after this break.
I named Kritika Kapali. I'm an infectious to the physician I didn't. I training it on University in Atlanta and my background is on emerging infection, operate response, pan panic preparedness,
and global health security. I was the Michael vector for a Bowler treatment unit in West Africa during the twenty fourteen outbreak, and after that got involved with health system strengthening and preparedness responses for emerging infections and currently I'm the vice chair of the Infectious Disease Society of America Global Health Committee and in that role have been also spearheading efforts to develop a global Health Security working group
focused on the training of frontline workers on the response for emerging infections and also just developing best practices for treatment of these types.
Of infections.
We were doing this actually last year. If that gives you an idea of what we were thinking about, Thank you so much.
Well, we're very excited to have your expertise on this podcast. Let's start off by asking basically, you know, we know that at this point, community transmission in a lot of the US is pretty well established. So what can be done now to slow that down?
Yeah, that's a really great question. So we definitely know that community transmission is happening. As of today, we know that there are seven three hundred and twenty four cases in the US and over one hundred deaths, and so we just expect those numbers to go up as testing capacity increases. And we're really at that point where we need to.
Do things to mitigate transmission. So there are substantial interventions that need to be implemented based on the urgency of protecting our healthcare systems and also protecting our vole populations.
So the plans that have an instituted locally, you know, may vary place to place, and they're restricting gatherings. The White House, the CBC announced this plan for fifteen days to stop the coronavirus, where they you know, restricted gatherings to less than ten people, encourage working from home or teleworking, arranging for distance learning. And you know, there are many short term closures occurring all over the country right now, and in some places, some of those restrictions are even
more stringent. You know, where I am in California, we have a order to shelter in place, which means really just you cannot leave your place unless you need to leave for essentral reasons.
Yeah, I mean, this is this sort of seems like in some ways, looking at what's happening in Italy and trying to see parallels in other parts of the world, especially in the US, it seems like, you know, we're a bit behind the curve in terms of implementing some
of these social distancing or self isolation of practices. And I think it's it's challenging too because in states where perhaps the case number is currently low, that doesn't mean it'll remain low, and I think there's maybe a less vigilance, and so I think it seems essential to really practice this social social distancing and self isolation everywhere. Is that is that sort of what you're thinking is as well?
Yeah, absolutely right. I think you know, there's certain places that have been hit hard, and there are areas that you know, quite frankly, I would have thought would have been hit hard by something like this. There area, major metropolitan area, so areas on the West coast, New York, Washington, d C. All those areas are areas that in essence
you would consider being places at high risk. However, just because those areas have been hard hit doesn't mean mean that other parts of the country are not at risk and they don't need to implement these measures as well, because really all it takes is, you know, one person and they can spread it to the next person and then to the next person, and that's how it propagates. And so that's why these measures have been implemented at this point in time. Mm hmm.
You know a lot of different countries, including the US, have implemented travel bands or have closed borders. How effective is that at this point in time in terms of slowing down the disease.
Yeah, so I think that's a really wonderful question. And so I think if you look at you know, what modelers do, and you know, we talk about this, you know, how effect their travel bands and you know, do they prevent infection. You know, overarchingly, the data will show that travel bands don't prevent infections. You know, the big lockdown that China has back in January that was not necessarily
to prevent infections from spreading. We could have predicted that, you know, this infection was going to spread to the rest of the world. But what it has is it flows infections right and especially at this point in time, we know that the cat is out of the bag, so to say, everywhere. But I think one of the things that has happened that the travel ban is you know what it does is it tries to ease up
the load on the healthcare system. So by preventing other people from coming into the country that may be sick, that potentially could be decreasing the load of positive patients coming into the country that could have a burd into your own healthcare system.
Mm hmm, gotcha. So these control measures, so closing borders, closing school canceling large public meetings, uh, strongly suggesting self isolation, or even doing the shelter in place, How can we tell whether these strategies are actually working.
Yeah, So, you know, one way we're going to be able to tell that these strategies are working. Is by doing what doctor Chadras, the Director General of who said yesterday, we need a test, test, test, and the more we test and we more we have an idea of what's going on in our community, that will give us a
better idea of what we are doing is working. So if we test and we get a better idea of what's going on in the community, with time, if these measures are working, and hopefully they will, a number of positive tests will go down like we have seen in China, like we were seeing in South Korea. And that's an important thing to do because obviously the point putting these measures in place is to see if we can get control of what's going on.
And so you know, based on that and based on this test test tests, I mean there's there is a lag time where it seems to be a lag time between getting as many people tested and then getting the results, and you know, there's it's going to take a little bit of time. So how soon do you think we'll be able to see whether these things are having in effect?
So I think it's going to be a while, and I think people really need to be prepared to be inconvenienced for a while you know, there is a model and paper that came out of Imperial College earlier this week suggesting that we could be in this for the rest of the year into next year. And I don't think that's an unreasonable thought process, because we need to get an idea of the number of cases going on, then we need to make sure that we're getting numbers,
you know, under control. And then once we have a better idea of what's going on, getting the numbers under control, we really need to think about, Okay, well, how are we going to move forward to make sure we don't just, you know, all of a sudden, listen all these public health measures and then we're back at score one again. So I really think that people need to understand that this is going to be going on for a while, and not just a couple of weeks or a couple
of months. I think this is something that we need to plan for.
So a lot of comparisons have been made between this epidemic, this pandemic and the seasonal flu, and some people, especially earlier on in the pandemic, people asked, you know, why are we taking such measures to control this if the flu is just as deadly, or if the flu is so deadly as well.
Yeah, I think that's a great question. It's one that I've been asked a couple of times, and so I think, first off, people need to understand that this is not influenza. I think the only appropriate comparison to influenza with COVID nineteen is that the measures we used to prevent both dizzy ESEs are the same, so hands washing, covering your respiratory secretions, and if you're six, stay at home. And the other appropriate comparison is that they both cause respiratory
viral illnesses. Beyond that, I think that the comparisons really are not appropriate comparisons. You know, first off, that are not for flu is about one. So what that means is if I have influenza, on average, the number of people I'm going to infect is about one person, whereas currently the estimates of the are not for COVID nineteen is about two to two point five, So that means if I'm infected, on average, I'm going to infect two
to two and a half people. Additionally, the fatality rate for influenza is about point and zero five two point one percent versus for COVID nineteen. It's estimated to be higher at three point four percent. The other thing about influenza versus COVID nineteen is the hospitalization rate for influenza is about two percent versus the COVID nineteen has been shown to be about nineteen percent, and so that is a huge difference in the burden that it has on
our healthcare system. And studies are showing that people who are getting admitted for COVID nineteen can be admitted anywhere and require hospitalization anywhere from two to six weeks. So once people get admitted, they may require prolonged hospitalization. Again to taking that burden onto our healthcare system for a long time, and as that accumulates, that will become a problem.
And then the final point I want to make is for influenza, we have a vaccine, we have therapeutics, and for COVID nineteen, this is a brand new infection that's never been circulating in our population. No one's been exposed to it before, so we're not quite sure, you know, how people are going to respond. We're still learning about the transmission dynamics, we're still learning about the clinical course of the disease, and we don't have any therapeutics, and
we don't have a vaccine. So I think people really need to start thinking about COVID nineteen as being different. It's not the flu. We need to start making the comparisons to INFORMZA.
Those are all excellent points, really well stated. So you know, your a lot of your expertise is in pandemic preparedness, and so one of the things we wanted to ask you was how well you feel the US was prepared for an epidemics such as COVID nineteen.
Yeah, that's you know, that's a hard question.
You know.
I think it's always easy to play Monday morning quarterback, so to speak, when something happened and you can say, oh, well I should have done this, I should have done that, and I should have done this.
Right.
I think those of us who work in the fields have always been concerned that disease like this, what we call quote disease X, the unknown disease, was going to emerge. And I think that we've always been talking about the need to be prepared, and you know, when something like this happened, it demonstrates the weaknesses and our preparedness system. Do I think that we are more prepared than we were back in two thousand and nine during H one N one in twenty fourteen during a bullet Yes, do
I think that we have a further way to go? Yes? I think that, you know, when all of a sudden done, this outbreak is going to change how we as the United States, how we as a global community think about tandemic preparedness, and how we think about infectious diseases, because which has shown us a lot of things that we can do better on.
Yeah, I've had many conversations talking about how it's really challenging for epidemiologists and people who work in you know, global health security. It's sort of like you can there's only you can either be overprepared or underprepared because everything that's going to be evaluated in hindsight and it's going to be, oh, you should have done this, you should have done that, or oh you it was it wasn't
necessary to do this and do that. So it's a it's sort of there's no winning in this in this game sometimes, is what it feels like.
Yeah, absolutely, Well, it's kind of like being an infectious disease doctor, right, so we are the service we bring is really valuable. They've done tons of studies showing that the value of an infectious disease doctor is great. When we take care of patients with various infections, patients do better, right, But that doesn't translate into the quote unquote dollars that the hospital system see, so they don't necessarily want to
invest in assets. Almost same analogy here when you're talking about preparedness, right, if we're underprepared, then we see all the things that happen, right, But if we're over prepared, then nobody actually sees what happens. So then if you almost have to justify your existence of the things you're doing.
Mm hmmm, yeah, exactly. So you know so far using that hindsight playing the Monday morning quarterback, what are some of the important lessons that we learned so far in this epidemic, even though it continues to progress, And how do you think we can apply that to maybe helping us stop the spread of this current pandemic or in our preparedness for future pandemics.
Yeah, I think that's a another really good question. So I think one of the things we really need to think about is how we develop local and statewide preparedness plans. There needs to be coordination between public and private partnerships public and private hospital systems. I think that we need to have improved communication systems in this day and age of electronic communication, how we can better communicate with all the different teams that are involved. I think we need
to have enhanced surveillance systems. We should have been leveraging our surveillance systems probably earlier on during this outbreak to get a better idea of what was going on with this outbreak. I think we need to invest in research and development, not just therapeutics and vaccines, but also really understanding what the best practices are during an outbreak for trying to contain the spread of outbreaks. And we need to think about how to stockpile the appropriate medications ppe masks.
We do have a national stockpile, but I think we need to think about how to have regional stockpiles. I think we need to think about how we can ramp up production of important things that we might need during an outbreak. I also think that probably one of the most important things is thinking about how long term to invest in our healthcare responders, infectious disease physicians, people who work in public health. We are a workforce that is understaffed.
We are a workforce that is the dire need of people to go into our workforce, and part of the reason people don't go into our workforce is we are one of the least all compensated workforces. And so I think that's one thing that needs to be thought of and needs to be addressed, because obviously there's going to be a need for this. This is a need, and we need to think about how to sustain our workforce.
Excellent, Yeah, I think those are really great points. Yet again, and so for a lot of this interview, we've kind of focused on what's being done in the US at a national scale. But you know, what I've seen pop up in the news here and there, but doesn't seem like there's been enough attention drawn to it. Perhaps is the risk of this disease spreading and essentially exploding in some countries that may not have the resources to combat it the way that a lot of European and North
American countries do. Can you speak to that at all and what kind of risks we're seeing there.
Yeah, I think that is an absolutely important point. And if you go back to when this was declared a public health Emergency of International Concern by the WHO. That was one of the main points that they made in making that declaration at the time, is their concern was how this could affect countries that don't have very strong health care infrastructures and our resource limited and they really wanted to emphasize how important it is that we helped
try and support those systems. And you know, I always say, especially in global health, that we are all as strong as our weakest link, and so wherever that country may be, we need to help make sure that globally, our healthcare systems are strong, our surveillance systems are strong, and we have the workforce that is trained to help respond to these types of problems. I think if anything that this outbreak is shown us is it's very easy for infections
to spread from country to country. So we need to invest in these things globally.
Absolutely so. In our first episode on coronaviruses, we asked each of our experts, you know, what about this disease concerns you and what about the response or how we have dealt with it so far? Is maybe a you know, inspiring or cause for optimism, something about you know, something that's a little bit of a silver lining in a way.
Sure, So I'm going to adjust the first part first. So I think the thing that concerns me is what we're seeing happening now, which was what I was concerned about back in January, that this was going to spread globally, that this was going to have a huge effect on the healthcare of people worldwide, it was going to affect the global economy, and it was going to have long
lasting repercussions, and I still worry about that. I think the other thing I worry about is that it's going to have a long term effect on our first responders, having been on the front lines of prior epidemics, and the mental and emotional toll that it takes when you're taking care of this many patients that are this sick all the time who end up passing away, has a toll on you. And I feel particularly right now for the people in China, the people in Italy that are
seeing this on a mass scale. And so I think that's something that hasn't been talked about that we need to talk about, and not just the healthcare providers, but also the patients. When you ask me what about this, reassure me I think it's really been how the scientific community has come together. I've been hearing and seeing so many stories of people coming together to do for the greater good of our community and our patients. And I think the stories I hear have just been really wonderful
and really warmed my heart. People at institutions putting aside their own research to try and help get lab testing op to capacity, you know, physicians of course, working over time to help take care of patients to help try and decrease that burden. Some of my colleagues that one institution, their division chief is over seventy five and was supposed to be on service this week, and they didn't want him to be on service with COVID nineteen circulating, so they came up with a plan to take over his
clinical service for him. So I think seeing you know, colleagues stepping up everywhere to help take care of each other has been really amazing.
Yeah, that is that is incredible. It's always so inspiring to hear these stories of healthcare workers sort of you know, who are on the front lines and as you mentioned, completely emotionally and physically drained. And I do I agree it's not something I've heard talked a lot about yet during this current pandemic, and so you know, just a moment of appreciation for everyone who's out there fighting this fight.
Yeah right, No, I think right, that's the message we try and get out, right, Like over the weekend, hearing from a couple of friends, right, Like, I'm working my tail off and then I drive home and I see
like this bar pack full with people. It's like, why am I doing this when you know these people don't seem to have any regard or you know, And I think it's really trying to make everybody in the world understand at this point that you can have a role and shifting what's going on, and you are important in helping to shift what's going on. It's not just the frontline provider, it's not just the support staff. Everybody needs
to play a role in this. And I think when we can empower everybody, that makes such a difference in this situation, because all it takes is a couple of people or a group of people that will make this disease hard to get under control.
Yeah, I think it is. It is a matter of social responsibility, and it is frustrating, you know, to have you know. I think I saw an advertisement for a bar in Chicago that was like, oh, you know, the parade is canceled, but we're still open coming, and it's like,
how where's the Yeah, what are you doing? Like that's completely undermining all of these public health efforts and it's sort of being Yeah, it's just like complete disregard for all of the hard work that people are doing to try to slow down or stop this pandemic.
Right, absolutely, So one of the things I talked a lot about with some of my colleagues is, you know, they've done this messaging right, if you're older, you're at risk. You're older, you're at risk, which is absolutely appropriate. But what younger people don't hear is that they can get it. And absolutely young people are getting it. Absolutely young people are having adverse events from it. And that's one part
of it. And then the second part of it is also, you know, you can get it and have mild symptoms, and then you can be the person that transmits it to your grandparents, to your parents, to your other loved ones. And how horrible would you feel if that's what happens, right, You don't want to be that person, I guess you know, especially for someone like myself who has worked in Africa,
has worked in India. But I think especially having been in Africa during vi abola outbreak and like seeing what happened with my own eyes, the destruction of the devastation. But it's just like here, we're so lucky we have when we tell people to stay at home. For most people, not everybody. There is of a whole other set of issues and people who are disenfranchised and have you know, other socioeconomic issues, and we hope we trying to work
through those to try and get those people safe. But if all I'm telling you do is stay at home, that's the heart, that heart of the thing to.
Do right for the people, as you mentioned, who can stay at home, who can afford to stay at home, you know, the cost of staying at home versus the cost of going out and potentially getting infected or you know, getting infected and then passing that on to somebody else,
like those cost you can't even compare those. It's I think it's very hard to get that message across, particularly when as you as you mentioned it, we've been delayed on the response of like, oh, well, you know, young people you're you're fine, you're safe from it, and it's like, well, you know that you may be at lower risk. However, that does not mean that you do not have a social responsibility to slow down the spread of this disease.
So it's it's a hard it's a hard message for people to I think, to hear because it's like, wait a second, how does this work. So hopefully, you know, as this message gets louder and louder, and as we understand more about the transmission, this will be something that you know will be taken seriously at in all locations among all people.
Well, and the other it's just very quick thing to add on to this, right, is that this is information based off the Chinese data. Right, we're starting hopefully to get information from Europe and other places. And I think the point that I guess, the overall point I'm trying to make is, you know, we have information in one group,
one ethnicity of people. And this goes back to your idea of your question about why we it's important to have you know, information globally on this, right, we know that we look at things like race, ethnicity, gender when
it comes to diseases. So you know, I think it's important to get inflammation that's coming out of Europe, getting me out of South Korea, coming out of Australia, other countries, and what the patient populations look like there, because it could be different, And I think that's a really important thing people need to keep in mind too.
That was awesome. I wish that I got to sit down on that interview erin I'm bummed to have missed it.
Well.
I'm sure that there'll be more opportunities as this continues.
But we learned a lot, I think from listening to that interview.
So did.
The first thing that we learned is that some parts of the world and some parts of the US have already been hit harder than other parts so far. But that doesn't mean that any one place is immune to the spread of this infection. We've said it before, but it bears repeating. Viruses know no borders, So the precautions that have been put in place in some areas really need to be enacted across the board in order to
have a big effect. I actually saw a great map today that we'll link to that estimated the latest possible time that every state needs to implement these measures like shelter in place in order to reduce the overall board and actually flatten the curve.
Was it like yesterday, last week for a.
Lot of states, Yeah, it is like last week or the week before, but even in states where there aren't a lot of cases, now it's like this week or next week.
Essentially. Yeah, that's I feel like, being completely immersed in all of this. That's the one thing that keeps coming out is that these things we need to have already done, and if we haven't done them yet, we need to do them now. That plus social distancing. If you can afford to stay at home, stay at home. It is your social responsibility.
I think that's my fifth point, Aaron, Oh.
Sorry, okay, okay. Well the second point is that big large measures like travel bands and so on, they don't necessarily make it so that infection isn't going to happen, and they don't fully prevent the spread, but they can help to slow the spread of infection. So it's a more nuanced discussion, I think than a black and white picture. However, and this one is super important. This is not an excuse for racism. No, there has been and there continues to be, way way, way too much racism going around.
This is not a Chinese virus. This is a global phenomenon that could have originated literally anywhere, and now it's everywhere and anyone and everyone. No matter what you look like or sound like, no matter your gender, religion, skin color, or anything else. Anyone can be infected, and anyone could
pass this virus onto others. That's how viruses work. There are rules for naming that a who has put into place since twenty fifteen, a whole crew of experts with probably over one hundred or at least decades of years of experience and a way more nuanced understanding of naming rules and the social impact or stigmatizing impact that certain names can have on diseases. This wasn't just a random
decision made. This was a very carefully thought out list of rules for why we name diseases the way we name them now.
Major number three. Another important thing we learned. This is not the flu. I mean, we knew that, especially if you listened to chapter two, But this has been some people still saying this in the media, some people in the US. So the infection that SARS CoV two can cause the disease we know of as COVID nineteen, so far as we can tell, has a higher case fatality rate, even in the best case scenarios that we've seen so far.
It also has a much higher hospitalization rate. And we've talked so many times that a large part of the need to flatten the curve is to reduce the strain on our healthcare systems, because if people can't get in to seek medical care, if they get really ill, or if people can't go to the hospital for any other reasons because the hospitals are full of COVID nineteen patients,
then this this becomes even more controllable and tragic. And unlike influenza, we don't have any immunity to this virus whatsoever. If you have ever gotten the flu or ever gotten your flu shot, which of course all of our listeners are up to date on their flu shots, then you have the potential at least some ability to fight off a new influenza infection. You have some kind of immunity, But with this we've got nothing.
Number four on our list of things that we can take away from this conversation is that we currently are and have been for a long time, under resourced for an outbreak like this, and this outbreak in particular even here in the US, and this has direct implications on
just how bad an outbreak gets. So we need to continue to invest in communication, coordination and surveillance efforts, not only early on in outbreaks, but all all the time, so that we can pick up on outbreaks early enough in the process to really be able to prevent these kinds of events in the future. Emergency preparedness, global health security, but on national and international scales. It's something that we
need to invest more in. And this is something that we talked about even in that very first coronavirus episode back in early February. This is something that epidemiologists and people who work in international health have been saying for years and years and years. We need more funding because, especially in countries that may not have the resources to do the surveillance that is necessary to detect novel or
emerging pathogens. Like I think, as doctor Capoli says, our international public health is only as strong as the weakest link, and we all need to strengthen that because otherwise we have something that is going to spill over time and time. Again, as I said in the first coronavirus episode. This is not a new pattern. This is not something that has
a unique event. This is something that has happened before and very much has the potential to happen again, but with a different virus that once again we are unprepared and unable to detect, or test or treat.
Exactly the last thing. Number five, and I think the most important takeaway points from probably any of our episodes. We've said it before. We all have a social responsibility at this point to do what we can to help prevent the spread of this infection. This isn't someone else's problem. This is all of our problems, and we all have the ability to help in some capacity. Staying home that's helping,
because the thing is not everyone can stay home. Our healthcare workers are on the front lines, not only going into work every day, but literally putting their bodies in between this infection and the rest of the world. And it's not only healthcare workers. Lots of people have to keep going to work in order for us all to be able to survive. Right people who work at grocery stores,
emergency services, public transit, food production. These people have to be out and going to work, and the other thing is that for so many people, staying home means they're not making any money. So for people who live not just paycheck to paycheck, but shift to shift, and that's a lot of people. For them to stay at home and lose out on paychecks because everything is closed and they can't go back to work, this has a massive
impact on people's lives and livelihoods. Staying home for a lot of people means they're at risk of losing or in many cases have already lost their jobs and maybe even their health insurance. And in this country, in the US especially, this pandemic I think is really exposing the massive holes in our social safety net.
I mean, do we even have a social safety net?
Yeah?
I mean do we really like? It's it's really atrocious. And the longer this outbreak last, the larger this impact is going to be. So the best thing that we can try and do is to just stay home and help stop the spread.
Of this virus. Well put thank you sources.
Sources.
So we just have one here, and this is the one that we referenced in the interview with doctor Capoli, and this is by Ferguson at All Report nine. So this is that famous or notorious. I guess Imperial College of London report that came out last week that talked about the various strategies for controlling the spread of this virus and the various outcomes depending on which strategy we use, whether no control, mitigation or suppression.
Also, we'll also put a link on our website to that map that I mentioned as well. It's pretty cool interct.
And if we can find the jiff of that. And then there's a really cool jiff gif of the lightning the curve illustration. I saw it. It's really good kind of I don't know if you've seen that rolling around on Twitter.
Well, my favorite one is the cattening the curve.
Oh my god, Yeah, I've seen that one too. I was like, what did you miss speak?
No, I didn't ask me the curve anyways.
Anyways, Okay, thank you again so very much to doctor Capouli. We really appreciate you taking the time to chat with us.
Yeah, thank you so much. And thank you to Bloodmobile for providing the music for this episode in all of our episodes.
And thank you to you listeners who have stuck with us through episode three of this Anatomy of a pandemic. You've got more coming strap in Okay, Well, until next time, wash your hands.
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