So I'm Katie Berson. I live in Japan with my husband and two daughters, Louisa and Zuzu. They're five and three. And we had heard about the coronavirus, which is what we were calling it at that point, maybe just a few weeks before we were scheduled to go on our cruise. The cruise was leaving out of Yokohama coming back to Yokohama. It was really ideal because we didn't have to fly anywhere,
which we thought would be safer. But you know, my mom, who is actually a manager at a hospital laboratory, was all up in arms. She's like, please see if you can cancel. I'm really worried about it. And we were like, oh, mom, it's fine, and so, you know, we we actually had to meet with the Preventive Medicine Officer BECA because we're in the service, prior to leaving, just to make sure our vaccinations were up to date, and we were, you know, aware of what the risks were, it didn't really come
into play. We met with her two weeks prior than the week prior to our departure, and it wasn't a concern. It was just wash your hands, you know, like, don't be stupid. So my husband and my daughters decided not to get off the ship in Hong Kong because we didn't want to risk it with the girls. We didn't really know what we were dealing with, but I went ahead. I wore that was our second stop on the cruise, so we're like five days into the cruise. I carried
my hand sanitizer. We exercised what we thought was you know, extreme caution, which at this point now we actually know what extreme caution is. But anyway, I came directly back onto the boat, got in a shower, washed the clothes. You know, we were trying to be as careful as we could. I didn't say hello to the girls. They were in their kid camp for the day until I had like thoroughly dejermed. But then, you know, we carried on.
We didn't have any other real concerns or red flags with the virus until we got to Okinelwa, which was our last stop of the cruise, and they said that, you know, the Japanese Ministry of Health is exercising caution and needs to scan each individual passenger prior to them deboarding. So we were delayed somewhere between three and five hours getting off the boat, because they were scanning everyone, and so we thought, man, you know, I guess things are
ramping up. It must be, you know, more of a concern. But we still didn't think, or we didn't know, and I don't think anyone did know what it really was, like an animal that we were dealing with until two days later when we arrived in Yokohama. And Aaron's this part was like so surreal. We're sitting there at our last dinner and the white stuff must have known what was up. They must have been briefs because they didn't miss a beat. They can continued serving, they didn't pause
to listen. There wasn't a reaction. But the captain came on and he spoken English first, and of course the dining room is primarily English passengers Japanese passengers, so he spoke in English first. He explained that there was a passenger who had boarded at Yokohama, stayed on only until Hong Kong and then deboarded because he wasn't feeling well and Hong Kong was his home and he had tested positive for the coronavirus, and so you know, my husband
and I just kind of look at each other. We don't want to react because we don't want to alarm the kids, so and also we didn't really know what that meant for us. So we sat and we listened. And then because we knew what was being said, once the announcement was being made in Japanese, it was really kind of eerie because I'm looking at the Japanese passengers as they're receiving this information, and I could see the colors draining from their face like they were right, you know,
and it was very somber in the dining room. We finished our meals and and we went back to our room and we had to call, you know, a couple of people that my husband worked with and say, you know, here's the situation, and we passed. You know, we were ready to get off the boat the next morning at seven in the morning. And of course seven o'clock rolls around, there's no announcements. Eight o'clock rolls around, there's no announcements.
Nine o'clock rolls around. The ship is being quarantined for full fourteen days, and so we just, you know, we took it as that, you know, it looks like we're going to be here for a while. We explained to our girls there are bad germs. We don't think we have any, but we have to keep them away. We're going to be washing our hands. You may not leave the room. And every day was different as far as
the information that we received. Obviously, the ship was in reaction mode, so we didn't receive our meals that first day until like three o'clock in the afternoon, which is really hard with kids, but we never blame them. There was never any anger. It was just everybody's trying to do their best to keep this thing contained. Really, the staff and crew on the ship really rallied to keep the kids entertained. I mean, gosh, they ate so many kids meals and they had so many toys delivered. You know,
we just exercised extreme caution and it paid off. We all came off healthy and well. And then we went straight from the boat to another fourteen day quarantine. Because we live on a military base, people look at me and they're like, God, you've been through something, and it must have been so hard. But really, like truly, I got to wake up with my babies snuggled next to me every day. I didn't have to cook. Like I
didn't have to cook, I didn't have to clean. All we had to do was play and be together and hope for the best, you know, like you just control what you can. And as a military family, I have never in my entire marriage or since my kids have been born, had six weeks of my husband all to myself. And really the outcome of it it was kind of just this like beautiful moment in humanity, Like so many people cared. I mean, I was hearing from people that I haven't spoken to in probably twenty years. And it
wasn't just like a little message on Facebook. It was like this like in depth message, like I'm praying for you. You know, we can send you things, what do you need? It was just really beautiful. People were delivering breakfast, lunch, and dinner as if I couldn't cook, Like they wanted to do nice things. They wanted to reach out and help, and it just made me feel like so loved and
so supported. And I think that would be like a really great takeaway from this tragedy is you know, like when we can work together and support each other, it's a beautiful thing. And we should also value our older generations.
So you just heard from Katie Berson, who we were so excited to connect with and talk about her experience on the Diamond Princess. She was on the Diamond Princess, y'all. Yeah, like that's about it. Yeah, famous, So thank you so much, Katie.
Also, I just Katie what an incredible human. She had the most positive outlook I have ever heard from someone who went through something like that and really helped me try and see silver linings in things as well. So I just really appreciated getting to speak with her too.
Absolutely.
Hi, I'm Aaron Welsh and I'm Aaron Alman Updike.
And this is this podcast will Kill You. Hello, Welcome to chapter four of our Anatomy of a Pandemic series on COVID nineteen. So far, we've discussed the biology of the virus, how the disease progresses, and the control strategies that we're using to slow its transmission, and in this episode we dive into the epidemiological characteristics of this pandemic.
We brought back the amazing doctor Carlos del Rio, who chatted with us in our first coronavirus episode back in February about the importance of investing in global health. You might remember his excellent Dolly Parton quote to.
Go along with that, I sure do so.
In this minisode, we ask him all about the ar not of the virus, that reproductive rate of the virus, and how to bring it down, what flattening the curve means, and why we see different case fatality rates in different regions of the world, and the absolute necessity of acting now to help slow the spread of this disease. But before we get into that, we have some business to take care of. It's quarantiny time.
What are we drinking for this one?
A pickle Martini? Is that?
Yeah?
That's the one, A pickle martini.
Quarantini four, our first ever martini.
No boobo bavida.
Oh well, you're right, that was so long ago. Does it ease steel trap? Aaron steel cap? Do you know how difficult it is to like think of I'll be like, oh, this is a great recipe, and then then I have just through all of the old ones.
Oh, if you also didn't know, we have a great resource of all of our quarantinis on our website.
But yes, you can click the quarantini tab.
And all of our plusy burrita is the non alcoholic version, which we'll post the recipe for this pickle pickled jalapeno martini.
Yeah, you could also just use a pickle if you don't have pickled klopenias. I didn't have a pickle, so I had to use pickled hellipenions desperate times, you know, desperate times. I wasn't going to go to the store for a jar of pickles.
No, of course, not. Shelter in placed Aaron Shelter.
Okay.
Before diving into the interview, we also wanted to talk a bit about the disease ecology since that's kind of our forte of spillover events in general, and then go through a timeline of events to give us an idea of the spread of this virus. This timeline is it's intense. It's intense, but it really gives us a good picture of what exponential growth really looks like and.
How fast a disease like this can spread across the entire world.
Math Man who knew?
Who knew? Mathematicians that's who, model or statisticians, good point epidemologists. Any Ways, Anyways, the ecology of COVID nineteen and its emergence, it deserves a more nuanced discussion. Then I'm going to give it here because we want to get to the meat of this episode quickly, right, but we wanted to touch on a few things. As has been reported in peer reviewed articles as well as from experts on these episodes, this virus likely emerged from a bat, which is also
where stars originated from bats. The COVID nineteen virus was probably passed to another host before infecting humans. This sequence of events a virus spread from bats to other animal species, and then to humans. It's not unprecedented. In fact, this has happened in many other disease outbreaks. And it does not mean in bold underline, it does not mean that killing bats or destroying their habitat will prevent spillover events.
So don't get your pitchforks out and start to try to kill all the bats.
No, we're not blaming bats quote unquote blame.
This is how ecology works. It's just it doesn't mean that bats are malicious or that we should kill the bats. In fact, doing those things like culling bat populations or destroying their habitat that has been shown to actually lead to an increase in disease outbreaks from bats. And spillover
events from bats. So bat conservation and the preservation of habitats is actually one of the most important ways that we can reduce over events and funding back conservation, especially in regions that may not have the resources to do so. That is crucial in this fight against emerging infectious diseases.
Also, bats provide really important ecosystem services. They're pollinators, they're seed dispersers, they eat insects ones that annoy us, for example, and they're also one of the most amazing and fascinating groups of animals on this planet. This is our personal opinion and the role that some bat species play in some spillover events from wildlife to humans cannot and should
not be ignored. This is a multifaceted problem. Ignoring it prevents a complete understanding of the ecology of these events and how they happen, and it can ultimately be more damaging to back conservation. If we want to prevent spillover we need the complete picture. If you would like to read more about the ecology of bat virus spillover events, there are a couple of great papers by doctor RAINA. Plowwright Boop Boop. She's awesome and we'll link to those
on our website. We're also going to put up a paper that discusses a lot of the ecosystem services that bats provide. That's by koons at All on our website as well. Cool Cool, don't hate the bats.
Don't hate the bats.
But also don't ignore the role that they play in these spillover events.
Right, Okay, Now onto the timeline. It's a big one. Let's start at the beginning.
It's like eight pages of timeline.
I know, but you know, we're just going to work through it. But I will say that you know, this is not even a complete timeline, Like, we cut a lot of this out. And so what I have one of the great resources I have found is and so this is where we got all of this timeline information basically is from Al Jazeera. They have they're continually updating a timeline about COVID nineteen across the entire globe, and so if you want really detailed information, that's the place to go.
Awesome, Okay, So.
Chinese officials are still looking for the patient zero quote unquote of COVID nineteen, but it's possible that they will never be identified. But what is clear is that the disease had been spreading for a while before it was recognized as a novel infection and one of concern. So what might be the earliest case of COVID nineteen was traced to November seventeenth, twenty nineteen, in a fifty five
year old person, but that hasn't been confirmed. If it is, though, that predates the wet market where the first apparent cluster of COVID nineteen emerged, so community transmission might have been going on for a while before it was recognized, or it could have been amplified at that wet market, But the market may not have necessarily been the site of the spillover event, which I.
Feel like kind of makes sense to me in some cases, because I know early on they were trying to identify, like what animal at the wet market, and we couldn't really find a good one.
So if it was.
A person at the market who just happened to be there infected that ended up causing sort of this spread, that kind of makes sense.
Hmm.
Yeah.
And honestly, a delay in recognizing a novel disease, especially a respiratory infection whose symptoms can pretty easily be mistaken for diseases caused by a number of other respiratory viruses. It's not that unusual. It might take a while before you realize a that there is an unusual number of pneumonia cases outside of the norm, and b that these cases are caused by a new virus that you haven't
seen before. So by late December, there were several cases of unusual pneumonia caused by an unknown virus in Wuhan, and Chinese health officials notified the WHO of this on December thirty five.
First YEP. The next day, January first, the wet market where this first cluster I mentioned was apparent. The Huanan seafood wholesale market was shut down. At this point, there were more than forty people infected.
On January seventh, officials announced they had identified a new virus. According to the World Health Organization, the novel virus at that time was named twenty nineteen n CoV and was identified as belonging to the coronavirus family.
January ninth, the first death from the virus occurs in China.
January thirteenth, the World Health Organization reported a case in Thailand, the first outside China, and a woman who had arrived there from Wuhan.
January sixteenth, Japan reports a confirmed case again from someone who had visited Wuhan.
Between January seventeenth and January twentieth. The US, Nepal, France, Australia, Malaysia, Singapore, South Korea, Vietnam, and Taiwan all confirmed cases of this novel coronavirus.
I mean that's a matter of weeks, yep okay. January twenty second, the death toll in China jumped to seventeen with more than five hundred and fifty infections. Airports in Europe and Asia increased screenings of passengers traveling from China. Wow.
Five hundred and fifty by January twenty second.
I know, I keep getting chills when I read this timeline me two.
January twenty third, Wuhan was placed under effective quarantine. At this point, the WHO said there was no evidence of the virus spreading between humans outside of China, and the outbreak did not yet constitute a public emergency of international health concern.
January twenty six, new cases were confirmed in the US, Taiwan, Thailand, Japan, and South Korea.
January twenty seventh, the death toll in China rose to one hundred and six, with one hundred in Hubei Province. Another four thousand, five hundred and fifteen people in China were reported to be infected. There were two thousand, seven hundred confirmed cases in Hubei Province, up from fourteen hundred twenty three the day before.
It's like a doubling, essentially m HM. On January thirtieth, the WHO declared COVID nineteen a global emergency, as the death toll in China jumped to one hundred and seventy with seven thousand, seven hundred and eleven cases reported. On this same date, India and the Philippines confirmed their first cases of the virus, with one infected patient in each country.
January thirty first. The next day, the number of confirmed cases in China jumped to nine thousand, eight hundred nine. Russia, Spain, Sweden, and the UK all confirmed their first cases of the virus, and.
On February second, the first death outside China was reported in the Philippines.
On February sixth, the death toll in mainland China rose to at least five hundred sixty three, with more than twenty eight thousand cases confirmed Meanwhile, authorities in Malaysia reported the country's first known human to human transmission, and the number of people reported infected in Europe.
Reached thirty thirty thirty thirty February sixth. On February seventh, Lee Wen Lang, a doctor who was among the first to sound the alarm over the coronavirus, died, and Hong Kong introduced prison sentences for anyone breaching quarantine rules.
On February ninth, the death toll in China surpassed that of the two thousand and two two thousand and three SARS epidemic, with eight hundred eleven deaths recorded and thirty seven thousand, one hundred ninety eight infections. It's worth noting the SARS epidemic infected around eight thousand people.
Yes On February eleventh, the WHO announced that the new coronavirus would be called nineteen.
As of February twelfth, one hundred and seventy five people were infected on board the Diamond Princess cruise ship.
February fourteenth, Egypt became the first country in Africa to report a case, and France reported Europe's first death from the virus.
As of February seventeenth, there were one thousand, seven hundred seventy deaths reported in mainland China and seventy thousand, five hundred forty eight cases. Japan also confirmed ninety nine new cases of the virus on board the quarantined Diamond Princess cruise ship.
February eighteenth saw China's daily infection figures drop below two thousand for the first time since January, with the country's Health Commission reporting seventy two thousand, four hundred and thirty six infections on the mainland and one thousand, eight hundred and sixty eight deaths.
On February nineteenth, Iran reported two deaths from the coronavirus hours after confirming its first cases.
February twentieth, South Korea report or it's its first death from the coronavirus.
February twenty second, South Korea saw its largest spike in a single day, with two hundred and twenty nine new cases of the virus. On that same day, Italy reported its first two deaths, while Iran confirmed a fifth death among ten new infections. A sixth death was later confirmed, though it wasn't clear whether this case was included in the country's twenty eight confirmed cases.
February twenty six, the global death toll neared twenty eight hundred, with a total of around eighty thousand confirmed cases reported globally. On the same day, Norway, Romania, Greece, Georgia, Pakistan, North Macedonia and Brazil all detected their first cases of the coronavirus.
On February twenty seventh, Estonia, Denmark, Northern Ireland and the Netherlands reported their first coronavirus cases. The number of infections globally passed eighty two thousand, including more than two thousand, eight hundred deaths.
On March third, Italy announced the death toll in the country reached seventy seven, equalling the total deaths in Iran, which stood at seventy seven.
On March seventh, the coronavirus had killed nearly thirty five hundred people and infected another one hundred and two thousand people across more than ninety countries.
On March tenth, both Iran and Italy recorded their highest death tolls in a single day. A total of fifty four people died in Iran over a twenty four hour period, while in Italy one hundred and sixty eight new fatalities were recorded from the coronavirus. On the same day, Lebanon and Morocco reported their first deaths from the virus, while Democratic Republic of the Congo, Panama, and Mongolia confirmed their first cases of infection.
On March eleventh, World Health Organization declared the coronavirus outbreak a pandemic as Turkey Ivory Coast, Honduras and Bolivia confirmed their first cases. In Cutter, infections jumped drastically from twenty four to two hundred sixty two in a single day.
On March sixteenth, New York City's bars, theaters, and cinemas are closed down as the number of cases continued to rise in the US.
On March nineteenth, Italy overtook China as the country with the most coronavirus related deaths, registering three thousand, four hundred five deaths compared to three thousand, two hundred forty five in China. The death toll in Spain soared by two hundred and nine to a total of seven hundred sixty seven fatalities from the previous day. A roughly twenty five percent increase in infections was recorded in Spain, taking the country's total to seventeen thousand, one hundred forty seven.
On March twentieth, which is just a couple of days ago. Coronavirus related deaths surged past ten thousand globally, which is more than the number of people infected with STARS during the entire course of the epidemic. The number of cases in jerman Many rose by two thousand, nine hundred and fifty eight overnight to a total of thirteen thousand, nine hundred and fifty seven. Spain meanwhile had a death toll of one thousand and two on the same day. Though
March twentieth. In China, however, no new domestic cases were reported for a second consecutive day.
That's a big deal. On March twenty first. Europe remains the epicenter of the coronavirus, with Italy reporting six hundred and twenty seven new fatalities, its biggest daily increase, bringing the total number of deaths to four thousand, thirty two amid forty seven thousand, twenty one cases. Spain is the second worst hit country in Europe, with more than twenty one thousand infections and at least one thousand.
Deaths on March twenty second, which is the day that we're recording this episode, the global death toll rose above thirteen thousand, while infection counts surpassed three hundred and eleven thousand. So right now it is eleven four one Central time, US Central time, and there are three hundred and eighteen thousand, two hundred and nine confirmed cases and the globe and thirteen thousand, six hundred and sixty four deaths ninety four thousand,
seven hundred total recovered. Wow, it's a very chilling timeline.
That is a very chilling timeline that was really helpful I think to go through though, Yeah, because even if you didn't catch every single number and every single date, I think it's very clear from going through that that this is a rising and spreading very rapidly exponentially exponentially, and b that we're still in that exponential growth right now today, March twenty second.
So how do we slow that down? Well, to answer that question and to talk about the characteristics of this disease, we brought back doctor Carlos del Rio, so let's let him take it away right after this break.
So my name is Carlos del Rio. I'm an intense least decician and a public health also expert, And I'm a professor of medicine and Global health here at Emory University, where I'm also the executive Associate Dean of EMRI at Grady.
So at this point in the epidemic, we've seen a lot more about how the virus has spread in different places and in different populations. Do we have a better sense of what the r not is for the virus?
Well, you know, I think we're beginning to know better what again we should define what are not is? You though, people are probably now hearing this term and a term that was a sort of a epidemology lingo is now becoming like household dinner conversation term. But you know, I've been talking to I've been talking to ceo so companies and others who now now call me. And I had a COEO of a company today call me, what do you think about the are not?
You know? Today?
So it's interesting to see that are not has become sort of a lingo that we all talk about. But basically what this means is is a reproductive number. Right, It's the number of infections that of virus causes. So one first infected person leads to other people being infected. And there are diseases like measles, for example, that may have an are not out fifteen, So one infection leads to fifteen, and if an are not is below one, then the disease dies.
It disappears.
So so mers has typically had an are not below one,
so we rarely see epidemic. We have not seen an epidemic from merce, but this disease has a are not about two and a half to three, which means that somewhere between two and a half and three individuals getting effect that after a person has been infected, and that's what causes what we call an exponential growth in this epidemic because and I try to explain this to people in simple terms, if you have one infected person, that person impacts let's say two and a half person, So
let's go with the lower limit. So that means that after five days you're going to have two and a half infected persons. So now you have that person plus two and a half, but then in thirty days you're going to have four hundred.
And six infected people.
That's what we call exponential growth.
Can you talk a little bit about the progression of the epidemic in China and in some other places where the disease seems to be slowing down in those places, is there a risk of a second wave of infections?
You know, I think there's always a risk. So let's suppose we can decrease I told you, you know, one to two and a half to four hundred at the other thirty days. If you can decrease exposure, you can decrease transmission by fifty percent, So you can bring the are not from two and a half to let's say one point two one point two five. Now at the end of five days, you'll have one point five infected
people instead of two point five. And at the end of thirty days, you'll have fifteen infected people instead.
Of four hundred. Now, if you can bring that are not below one.
Now at the end of five days, you'll have let's say zero point seven of a person infected, so not even one. And then at the end of thirty days you'll have maybe two people infected. So you will probably still see some cases. But as long as you can really decrease exposure, and that happens by two mechanisms Number one, Initially China has done it by by social distancing, right, by quarantining, by isolating people, by really going to a
national shutdown. But something that's going to happen eventually. As you get more people infected, you essentially have a you know, a herd immunity, and there's not enough people to infect out there, so a number of transmissions also goes down. So I suspect there will be little clusters here and there, but I don't think there's going to be a huge wave again, assuming that there's immunity to this virus.
And so kind of along those lines that you mentioned about trying to decrease that are not overall. Can you talk us through what the stages of an epidemic are and what it means to try and flatten that epidemic curve. How do we know when that actually happens.
Well, we know when that actually happens. I mean, this is a complicated phenomenon, but you know, the epidemic starts, it starts growing. It's really when you get that a reflection point where the number when cases are not growing by a factor of one, when you get two cases growing by a factor of only one, then you start seeing that that planning of the curve. Then you start seeing but that by that point it's a little too late.
And I think about it like a plane taken off. Right.
Initially you were seeing you know, ten, twenty, fifteen, forty one hundred cases. You know, the plane was just still running down the runway very quickly. Then the those goes up, and then you know, we start seeing in the US one hundred cases and now we're, you know, whatever a number of cases. We're up to where like sixteen or eighteen thousand, right, So now the plane's at eighteen thousand feet.
At some point in time, you're going to see it get to thirty thousand, and it's going to start leveling off.
So, just like a plane, you get to a point.
Where you have enough people infected out there and you have enough transmission, then the number of susceptibles is going down. So I don't like to talk about phases of an epidemic because there's really no pass. The natural history of an epidemic is to continue until you infect it or or you cause all susceptibles to be either infected or death. Right, But what you want to be sure is that you prevent that. And what we need to do is do everything we can to shut down that are not to decrease,
the are not to below one. If we can bring the are not below one, we all control transmission.
Right and so that needs people to stay at home and practice social distancing and so on. But I'd like to revisit something you mentioned in talking about how the epidemic has progressed in China and so one of the things that you talked about was herd immunity, which would require that this infection with this virus leads to immunity. Is that something that we have seen do. Are people who are infected with this virus and then they recover, are they immune and resistant to future infections?
There's been a lot of talk of whether you can reinfect it or not. I think from what I can tell that people going to develop community and are going to not get infected. So I think immunity is going to help us going forward.
Gotcha, I guess, like, what is the relative effect that social distancing has had versus herd immunity has had?
You know, it's really hard to tease that apart, but I will tell you that if they hadn't done what they've done, the massive shutdown that they did, I think social distancing player probably may played a huge role there. And the reason I say that is because if they had not done this, I think the numbers would have been staggerantly higher. And you know, just I look at it today, you know, I mean I was just in
shock today when I saw that. You know, China as of today has about eighty thousand cases with three thousand and two hundred of deaths, really has half the number of cases forty thousand cases, but has more death than anywhere else. Italy has not surpassed China and death, but I think China really emphasized the social distancing and that's why their number of deaths compared to the number of cases is so much lower. It's four percent versus Italy, which is eight percent, right right.
Right, And I think that's one of the things that this outbreak has revealed, particularly here or looking at the US, is that, you know, we have to slow the spread of disease. People need to stay at home, they need
to practice social distancing. But I feel like, at least anecdotally, this message and also from what I've seen on Twitter and on some other news reports, I feel like this message doesn't seem to have properly sunk in, especially in areas that may not be currently experiencing the same number of confirmed positive cases as other regions, or in populations that have been said to be at lower risk. So how can we convince people just how important it is to stay home when they can.
Well, you know, again, it's in your hands to become infected or not right. If you become infected, you will then lead to other infections. So the best thing that, I mean, the best vaccine we have for this is to not get infected, because if you don't get infected, then other people won't get infected. And if other people don't get infected, then you'll stop the channel transmission. And that, to me is what we need to do right now.
So I mean the term planning the curve, or the way I explain it is by saying, look, if I'm at the hospital and three hundred people coming sick today, I can't take care of them. But if three hundred people come in sick over a month and take care of them, it's easy. It's easier, right, So we want to spread out the number of cases. But more importantly, for the general individual, it's in your.
Hands to prevent transmission.
If you don't get infected, you're not going to pass it to others, And if you don't pass it to others, you're cutting down that transmission chain. So cutting down that transmission chain is something that we all have the ability to do. Yeah.
Absolutely, Yeah.
And so I have another question for you actually about in looking at the differences in fatality rates between like in China versus in Italy, how do you feel like that compares to something like South Korea where they tested very large numbers of people and the death rate there was as low as I think, like less than two percent.
Is that because of better identification of cases in your opinion, or because of better social distancing and treatment methods or what do you think some of those differences are.
I think that two things up, and I think that you know, every countrys had a little different and there's some issues Italy. Clearly, if you look at who got infected in Italy, clearly Italy had a much older population, and I think that clearly was playing a role. If you look at the distribution of Italy versus South Korea. In South Korea almost thirty percent of their cases were between the ages of twenty and twenty nine and almost twenty percent between the ages of fifty and fifty nine
in Italy. In the country, I would say almost forty percent of cases we're between the ages of seventy and above. So you have a very different distribution of cases in a population. You will also have very different distribution of comorbidities in a population.
So it's not simple. We're learning very clearly.
That mortalities are very different in different populations, right right, and that to me is is very important because our populations look very different.
Yeah, you know, recently, earlier this week, there was that report that came out from the Imperial College of London that had these, you know, variety of modeling predictions based on you know, no control strategies, mitigation strategies, suppression strategies. But all of the numbers were fairly alarming. And so can we make any guesses at this point to what we might see in terms of numbers infected or just how long the outbreak will last? Like what is the end game on this?
Well, the endgame is to stop it.
And uh, I worry that you know here in the United States, we don't have we have we have several problems. Number one, we don't have wohan. We have multiple wu hunts. We have a wool hunt in Washington State, we have a wool hunt in New York State. We have a Woohan now happening in the South. So we have multiple wuhants. And I think that to me is one issue that you know, we don't have one wuhan. And the other thing we have our public health is is the sameralized
not centralized. Right in China, the central government can say do this and it will happen. Here in the US, the federal government doesn't have that authority. The federal government makes recommendations, and then after the federal government's recommendations, then the states really public health is run up state and local health department level. So you have states saying, oh, you know, California saying we're going to shut down the state, and state of Florida saying, oh, you know, we're okay,
you know, we don't want to. Yesterday, I was hearing the governor being interviewed and saying, you know, we don't really don't want to impinge in individual liberties. And the college students want to be parting.
Out there is their right.
So you have a very different approach. And if you put in the middle of this the economy, and there's no doubt that epidemics have huge economic consequences. I mean, the epidemics hurt business, and epidemics hurt consumption, and epidemics court has heard a lot of things that we've seed already, what the stock market has done, and what you know is going to happen to small.
Business and to other businesses.
So so I can see a politician being reluctant to take the top measures that are needed. And that's when you say, we need an independent body that can help and make those recommendations. But unfortunately we don't have such independent body in this country. It's all based on you know, it's all based on political decisions, and unfortunately it's.
Not going well.
I mean, I think you and I will agree that the response in the US has been haphazard at best.
Yeah.
In one of the things that I think a lot of people are wondering is that at the beginning, we were looking at this as a matter of weeks and as the epidemic. As the pandemic has progressed, it seems like now we're looking at this on the scale of months.
I think the more you delay the response, the more the time is right. And I think that's something that people need to understand that as you take more time, more time takes you, you know, basically, it becomes harder to do the right things.
Yeah, I mean, that's what it seems like, is that even in places that have been relatively low impact by the virus, it seems like not even the tip of the iceberg, but the tip of the tip of the iceberg, where we don't even know the extent of the community transmission that's going on. And so you know, we see these actions like shelter in place that have been happening in California and in parts of New York and maybe
going into effect elsewhere. But is that, like, should that be happening now in places that haven't seen the number of cases that those states have seen.
The answer is yes.
When somebody says to me, oh, we only have twenty cases, we got live under control, I said, if you only knew right by the time you have twenty cases, you're already you know, twenty cases too late. So I would emphasize and say over and over, no, you cannot do that.
I mean, that is a mistake that everybody has made and I don't want to get political or anything, but you know, you know, I look at different Trump quotes through the epidemic, right, and his first press conference about this was we got in February twenty eighth, we sart fourteen cases. We got this under control. Next week there's gonna be no cases, and now we have a national emergency. You know, so you get distracted and this comes back to hunt you, right, m.
Hm, yeah. Absolutely.
There's been a lot of talk about this virus potentially becoming another seasonal influenza type virus. What do you think about is that something that we think is likely at this point that this is now so well established that this is going to be kind of a recurrent seasonal thing.
You know, I can't. I can't. I don't. It's possible.
I'm going to I think at this point in time, it's speculative to say that I don't want to worry about the future. I want to worry about the president and the president we have the house is burning, right, We have a fire in the house. And I almost sound here like somebody's asking me, well, you know, once you rebuild a house, you think it'll be another fire.
Again. I said, let's put this.
Fire out again first, you know, let's worry about that later. So let's take care of the current problem. And the current problem is let's stop this, and then we'll figure out about the rest. You know, there's a lot of really good work happening in vaccines and other things. So depends whether we have a vaccine.
That's I think there's the answer.
Yeah, yeah, absolutely. You know, I think one of the things in particular that I'm still trying to get a grasp on the entire timeline or an understanding of it, is the testing and the controversy around the testing. Can you walk us through a little bit of that and why there were why it was slow at the beginning, what's going on now? Just sort of a brief on the testing aspect.
Well, I think in a testing aspect, we have we have three things.
You know.
Number one, we have pant on you virus and the virus sequences were put on the internet and the CDC developed a test.
And then of course this is not you know, people came on talking about a kit. This is not a kit.
You know, this is not a something that you go to a store and you buy, right, This is something that they developed.
This was a home group. You know, this is best I can describe it. This was a laboratory developed test. They did it in house, and of.
Course because of a laboratory developed tests, and they had some challenges, and during those challenges because of some regulations that existed, you know, unfortunately, when the president activated or said this national emergency, that's activated a ferioce of rules that blocked others from developing a test at this point in time. At that point in time, so most people were not developing I said, some people a weren't developing tests,
but others were not. So there was a lot of I would say things that I would describe between bureaucracy, unfortunate mistakes, and just dealing.
With something new that prevented us from.
Developing what I would have been a robust test. And then now a lot of tests are being developed and companies are getting involved. But also, you know, initially CDC started getting tests out to health departments. And we know, you and I know that health departments are there to do public health, but not to do clinical care. But if clinical patients were coming, then all of a sudden, the health departments are supposed to be providing clinical testing, right,
which is not what they're designed to do. So now I think things are a little better because now you have companies out there working and doing and all this stuff, and that makes a huge difference. And I think we're seeing, you know, the FDA is approving tests less than right, so I think they're going to be more testing, and I think we need a lot more testing, and as you've seen, the US.
Is way behind.
The problem is is that we would like to offer the test to more people, but we still have our point that we need to ration our testing. And we're in a situation right now in this country that we've never been before. We are rationing testing, we're rationing ppe. So I tell people, now, you know what it feels to be in a developing country, right because we're rationing things and that's something that we don't necessarily feel comfortable doing.
But that's the reality, right is we are in a rationing environment and rationing is very hard.
Yeah, absolutely so at this point, I know, I know some of this it kind of varies state to state or even maybe county to county as well, but are there general recommendations At what point a person if they suspect that they're infected, should go and try and get tested, even in spite of these shortages.
If you have symptoms, if you are things you have the disease, you need to go to your doctor or you need to call your doctor and then you'll be told whether you need to be tested or not. But I want people to know is that if you're asymptomatic and just I don't want to worry it, well, to go get tested right now because their reality is just going to overwhelm the system and is going to take care of tests that we need for people who actually need it right now.
So you've touched a bit already on that we're kind of learning as we go with this whole pandemic. But what do you think that this outbreak so far has taught us how to prepare for what we're experiencing right now? How can we do better kind of moving forward?
I think right now it's really hard to know. But when we're done with this, I think we have to sit down and do the do the post boarded right, We need to do the let's go over this and find out where where were the mistakes, you know, and what got us in the trouble we're in because we should have never been in this kind of trouble. And
you know, I would start with one thing. I think we have underinvested in public health for years, right, and many administration, not just the current but I started with Obama have really underinvested in public health. And you know, CDC has I think over seven hundred vacancies. And now because we are underinvested in public health for years now, we're having spent billions and in taking care of the problem. If we had invested in public health to begin with
and had the surveillance equipment and other things. And I'll tell you an example of underinvestment. The state health departments are having trouble scaling up testing the way they should. Why because they don't have enough machines, they don't have enough personnel because they've we're underinvesting. So I would I would really want to see people rethink public health and whether we we have to put our priorities there. If we don't invest in public health, then we are going
to be having another pandemic. And you know, and I think about you know, two thousand and nine we have pandemic influence and now we have this ten years later, So let's let's rethink this so we don't have the pandemic of twenty twenty nine.
Yeah. Absolutely. So I'll end with asking you a question that I asked in our first episode on coronaviruses, and I asked, what about this disease concerns you? And what about the response or how the epidemic has been handled so far? Is there anything about that that is cause for optimism.
What concerns me.
The most about this disease right now is a transmission in healthcare settings because I tell people are healthcare workers, doctors, nurses, you know, advanced practice providers, et cetera, you know, a rest story, therapists, you name it are in the front lines. They're finding this virus in the battlefield, and we have been unable to give them all the necessary personal protection
of equipment. So there's not enough personal partecular equipment, and therefore we are they begin to battle without enough protection, and that to me, we're doing the best we can, but we're still not where we would like to meet. And you know, we're having meetings to talk about, well, you know, how do we how do we use PP more appropriately? I mean, if we had enough VP, I would feel so much comfortable, so so not having enough material to provide our our doctors, our nurses, our healthcare
workers the necessary protections. That that worries me a lot, because I think we're going to see a lot of infections among healthcare workers in this country and that is bad and that is something that this should be unacceptable and we need to make a big cry about that. But number two is I also worry that people are not taking it seriously and that people are still you know, partying, And I saw the videos of the college kids in the beach and Florida saying, Oh, this is no big deal.
And what gives me hope is is science. And I think, you know what I've seen come together, how science, how industry, how the community is coming together, gives me hope because where I come from, where my research has been, with my work has been, which is an HIV.
That's what's the solution.
We are where we are in HIV because the community, the scientists, industry, and governments came together and got us where we are. To me, it's unimaginable to see where we are. I could have never predicted that it will be where we are in HIV and it's because because of that that coalition that made us better and made us stronger. So I have hope that between science community and everybody coming together will be in a better place.
Doctor del Rio, he said we could call him Carlos, but it just feels wrong.
Carlos, thank you so much. We really appreciate I mean, all of the people that we have talked to. I know we keep saying this, but all of the people that we've talked to took time, precious time out of their incredibly busy schedules to talk with us and to help spread some factual information about this disease. And for that, we thank you so so much.
Yeah, really, thank you so much. So what have we learned?
What have we learned? I think one of the things Number one that we've learned is that there does appear to be immunity to this virus, and that this immunity could substantially contribute to what slows this pandemic. So, even though we have talked about the horrible concept of using herd immunity as a strategy, it could be what happens naturally as people do get infected, especially since we're seeing
this exponential growth. Now that might be what helped to contribute to the decline of cases in China, But more importantly is the social distancing measures, and we'll talk about that as well.
Absolutely. Number two, an important thing that we learned from this episode is that we have to consider characteristics of this disease and this epidemic in the context of the places that are being affected. So we're seeing different infection rates and different case fatality rates in different regions, in part because the populations that are affected in those regions are different, and we don't at this point necessarily know exactly what all those differences are that are driving the
differences in case fasevitality and in infection rates. That's something that we might only be able to recognize in retrospect once we make it through the other side of this outbreak. And I think that's really important because you know, there's been a lot of talk about, well, the case metality rate is this in Italy versus this in South Korea, And we don't fully understand exactly what those differences mean in this context.
Yet, right and how much they're going to change as we test more people, as the number of cases grow, as our knowledge about this disease grows exactly.
Yeah.
Number three, we have underinvested in global health security and in international public health and pandemic preparedness on national scales, international scales, regional scales, local scales, state scales, whatever, every single scale, on every single conceivable scale, for years and years and years. This lack of investment in global health security and pandemic preparedness, it is coming back now to
haunt us. And so the amount of money that you know, speaking for the US, the amount of money that we have saved by cutting programs such as the CDC and pandemic preparedness initiatives, that number is infinitesimly small compared to the bill that this is going to lead to. And that's just the economic bill. The psychological impacts, the social impacts.
I mean, this is going to have repercussions for every aspect of our lives, and I think it is going to fundamentally change the way that we live, the way that we work, the way that we communicate, and the way that we think about our own health and safety.
Say it, Aaron. Number four, We learned from this interview, but there were a lot of different factors that contributed to the slow rollout of tests that we've seen in the U. We are doing better now, for sure. There's a lot of different private labs and private hospitals and public hospitals that are developing their own tests, and people are working really hard to try and roll out more
and more tests. But that delay has really prevented us from getting the precious knowledge that could have helped to slow this disease. And I think you can't really underestimate just how important that was. Like, this is a thing we've kind of botched, and like doctor Kraft mentioned in one of our episodes, it's not like we could have made this overnight, right, but it was kind of months of not not ramping up production on something like this to be able to start rolling out these tests well.
And now we're running into further issues of running out of protective equipment, of running out of swabs to actually run these tests, Like we have a lot of issues in the actual supply chain of tests for this virus.
Absolutely, you know, And I think that if we want a silver lining this, then this is hopefully something that we can take and learn from. We've talked about this before in in terms of epidemiologists either always being viewed as over prepared or underprepared, or overreactive or underreactive, and it's a huge challenge. It is zero point five. I think this is a really important one, and this is something that we have hammered on in other episodes in
this series so far. We can bring down the r not of this virus through control measures and personal decisions, our individual actions. Each one of us has the power to help slow the spread of this disease. We really need to take this seriously. So there was a really.
Great modeling study that looked at the data from Wuhan like retrospectively after the fact, and they suggested from this that the restrictions that were implemented and people actually by people actually changing their behaviors, they were able to decrease the art not in that infection from around two point four to one point four. So they cut it by one hundred percent, which is massive, massively important.
Yeah, it can be done. It can be done. It has been shown to be done. So let's do it. Let's do it.
Let's do it.
So okay sources.
Yeah, So that paper that I just mentioned, that was a paper by Lee at All in Science published in Science on March sixteenth, entitled Substantial Undocumented Infection facilitates the rapid dissemination of novel coronavirus.
And then there's those papers that we mention earlier by plow Right at All and Coton's at All. We'll post those papers on our website.
And for more details on the timeline as well as for updates on it that we'll post the link to that Al Jazeera article as well.
Yeah, it's awesome. Thank you again so much to Carlos. We really appreciate it. We do.
And thank you to Bloodmobile for providing the music for this episode in all of our episodes.
And thank you to you listeners for sticking through one more episode of this. There's more coming your way until next time.
Wash your hands, you filthy animals, um