Pandemic expert: The US can't claim to be surprised by coronavirus

I want to know what scares you most about coronavirus. The current coronavirus pandemic is worse than many that we have anticipated in the past. It is causing a greater deal of death and disruption in many places around the world. So this is going to end up being a truly historic, historically bad event. What specifically about this new coronavirus makes it so scary and so different? Well first of all, it's the fatality rate associated with it. We don't know precisely yet what the fatality rate will be in the US. But if we look to the best examples of other countries that have been affected so far, it looks to be about one half, 1% which sounds like a small number But as 100 times greater than that of seasonal flu, and greater than several of the flu pandemics we've had in the past and in countries where they not been able to control the spread of the virus to slow the spread down Now, fatality rates have been many times higher than that. When did you first realize that this was going to be so serious? Well, some time mid to late January it started to become obvious that this was something that was unprecedented. In our lifetimes, I think really, you know, at the very beginning of January when we first started hear about cases of undiagnosed pneumonia in Mohan and we thought maybe this would be like SARS. Maybe this would be like the outbreaks of different forms of bird flu that have happened in China. Once this really got going in mid January and the Chinese officials cracked down on it so hard that really got our attention, we thought This must be much worse than than his apparent right now. And then because the Chinese, at least after the middle of January were being pretty transparent about their numbers, we can see that number of cases was Doubling in incredibly rapid rate. Why is Corona virus different to other epidemics and pandemics we've seen in the past? There's obviously still a lot we don't know. But it's clear from what people are saying is that it's really different. Yes, well, It's different in that it's just as contagious as influenza but many times more lethal than influenza. So annually somewhere around 10 to 15% Of the world's population becomes infected with influenza. We think because this is a totally new disease that has never been experienced by humans before, the number of people who will be infected will be much greater than that. Probably many times greater than that. And in even if the case fatality rate the number of people who are sick and who end up dying, is on the low end, of half a percent that would mean millions and millions of deaths. And so the early information we heard about influenza kills more people every year. Was that was that misinformation or was that just early information that was perhaps misguided? It was both. Yeah, initially, it was Just a lack of understanding of what was going on. And then later on, it was an attempt to calm people by giving them untrue information. So obviously you're an expert in public health But I wonder if you can talk about the specifics of the virus. So where a super virus like SARS CIV 2 comes from, and what's the science behind how a mutant strain like this appears. So this virus came from bats. Bats Carry lots of different viruses and without causing any illness in the bats. Their immune systems are adapted to these viruses. So many of these emerging diseases have a natural host in bats. In some parts of the world, Where there are open-air markets, and markets that trade in live animals, so-called wet markets. There's a greater risk of viruses that exist in the wild getting into the human population. And that's what happened with this virus. It's very similar to the SARS virus of 2003, which also came from bats. The SARS virus came through an intermediary host, that is, several kinds of animals, particularly civets. That were sold live or freshly killed in the markets. They ended up infecting people working in the markets or people working at restaurants. And will butcher the animals in the restaurants. And once introduced into humans. Initially, these, these viruses don't cause extreme disease because they're not well adapted to humans, and they don't spread even more importantly, they don't spread from person to person because they're not adapted to human physiology. But once they're in humans, once there have been enough infections in human, the viruses adapt to the human host, and then they become transmissible, person to person. And that's what we saw happen in China sometime around late November or the beginning of December. Kept available on both of our websites for groceries and hot and cold family style meals to go. Go go on the website, give us your basic information as well as credit card. Decide what kind of groceries sundries. You might need. Well, it's a combination of the virus itself and the way that it attaches to the respiratory tract of people. But even more importantly, it's it's the fact that No human has any immunity to this virus, you've never experienced this virus nerves. And so unlike the flu, where we all have partial immunity to flu, we have no immunity to, to this virus. And could you go into a little bit of detail you mentioned the way it attaches to the respiratory tract. I know. I've done some basic research. It's sort of this. The coronavirus gets its name from that crown shape, or the way it kind of spikes in. Could you give us kind of a layman's breakdown of what actually happens when the virus enters the body, and kind of comes in contact with human cells? So the coronavirus is covered by many many spike proteins. These are little tree like out patches for on the on the virus surface and these these attach To a specific receptor that exists in the human respiratory tract in our lungs, our breathing tubes and in the lungs themselves. And when the virus attaches to ourselves, the virus. Creates an opening in our cell walls and the genetic material of the virus is injected into ourselves where it takes over the mechanism, the mechanics of ourselves to produce more virus, and then the cell Explodes essentially and speed out now thousands of times more virus that go on in a chain reaction going from cell to cell with ever increasing numbers of virus. Ever increasing numbers of damaged cells. And so the lungs become damaged by the virus. They could become damaged by our body's attempt to fight the virus and our lungs becoming inflamed. They swell and fill with fluid and, in severe cases, end up killing people. Because they their lungs fail. So last year when we spoke, I actually asked you whether we'd be caught off guard by some sort of mutant bad influenza. I still remember that line. You also mentioned the, the [UNKNOWN] simulations that you've done and we talked about the worst virus you could imagine. Is this new Coronavirus, is this as bad as it gets? Is this as terrible as you could imagine? No, unfortunately, I can imagine things that are worse than this. In our event to one exercise that we did. Last October and the event in the clay eggs exercise that we did the prior year. In both cases we used to fictitious viruses that were many times more lethal than in the covid 19 virus. In terms of viruses that would appear just out of the wild and that aren't sort of created in simulations, I guess in terms what everyday people are seeing. They might have a memory of SARS, they may have a memory of MERS. Is this up there with the worst we've seen in terms of just a virus that has caught us off guard? You know, it's hard to know with any precision how this will play out, and it won't play out the same in every community. It will be different in different locations at different times. But I think what they experienced in China, what they're experiencing now in northern Italy is very much like The great influenza pandemic in 1918, which is the worst pandemic that we know anything about in any detail. That killed somewhere between 50 and 100 million people around the world. And so from where you stand now, How bad will it get? We don't know. We don't know how bad it will get. It depends on, to a large extent, on whether or not we are successful in slowing down the spread of the virus. Which is what we are doing now. It's why we're all working from home and maintaining social distance. It's why we've closed gatherings and closed schools. And all these other completely unprecedented and dramatic steps. The reason for this, almost the total reason for this is to protect the healthcare system. What we saw in will Han and what we're seeing in northern Italy is collapse of the healthcare system. As a result, death rates have soared. And even people who don't have this disease but people with heart attacks and strokes and traumatic injuries from car accidents, can't get care because the hospitals are completely overwhelmed. That's why we're doing these things that we need to try. Okay, prevent. And if we can do that, then this will just be really bad. If we can't successfully do that, then this will be catastrophic. I wonder whether you could we've heard the phrase flattening the curve, and I've had a lot of people asking me what it means or sort of talking about it. I wonder whether you could just do a really quick rundown of. How that social distancing relates to this phrase flattening the curve and kind of what it does, because I'd like to sort of mention that if we could. So we often talk about or often use the phrase flattening the curve. And by that we're talking, we mean, we're talking about the epidemic curve. That is A curve that describes the number of cases per day throughout the course of an epidemic. So it'll be roughly a bell-shaped curve. And what we're concerned about is the height of that curve. That is the number of people who are sick and in hospitals on all at the same time. It's much better to have an epidemic that lasts longer, but it is not as high so that there We may have the disease with us for a longer period of time, but not so many people all sick at the same time. In that scenario where we could spread it out where we can flatten the curve, our hospitals will be able to maintain functioning and we'll be able to have life saving measures, life saving resources. For people who need it. I don't want you to be a dooms dayer but you know we've seen responses around the world that some countries have been quick, some countries have been too slow to act and we've seen the repurcussions of that. I guess to stop that, That how bad could it get if we don't act? What is the worst case scenario here? I don't know what the worst case scenario is. What we've seen in Will [UNKNOWN] China what we've seen in Italy are death rates that are higher than what was experienced in the US during the great pandemic of 1918, the worst pandemic, we know of. [SOUND] Now that hasn't been the case everywhere. It wasn't the case in China outside of Wuhan. It wasn't the case in other countries that were able to get a jump on this very early and vigorously implement social distancing. It's really a matter of countries being surprised by the epidemic. So obviously, China was surprised that you know, no one knew this virus existed, so naturally they were surprised by the virus. Italy was surprised. They didn't see it coming. We in the US can't claim to be surprised. We have seen this coming for months now. And hopefully the measures that we are taking now we'll make us more like, Other countries in Asia like Singapore, or South Korea, or Taiwan in Japan that enable to slow the spread of the virus down and keep their health system functioning. Do you think countries that have been later in the sort of the outbreak Around the world, some of those kind of more secondary countries. The US, you mentioned Australia and from there, do you think some of these countries have been too slow to act considering the warning that we had? Yes, I think generally speaking Around the world, many countries have been too slow, that I think many national leaders have not been able to really get their heads around what their public health officials and epidemiologists have been telling them since mid January. This is unlike anything we've seen before. And there is no way to completely stop this. It can't be contained. It can only be slowed down, but slowing it down is central and requires an unprecedented level of action. And many people said that the Chinese were overreacting to what was happening Wuhan back in in late January. It's now clear that they weren't overreacting. And it you know that they have implemented things that we could not do in this country or in many countries because of the way their society is organized, but they understood eventually, you know, after several weeks. The magnitude of what they were dealing with. How concerned are you about the role that social media and technology can play in the spread of information? Is this a sort of a new world order in the 21st century pandemic? Yes, I think that social media is It's very powerful and very much a double edged sword. So we are able to communicate in ways that were unimaginable before. So I can now look and have real time information about what's happening in countries all over the world We couldn't have imagined that before. I can see tweets from people in China and Italy. Videos posted on YouTube from medical colleagues in Italy. That have been incredibly valuable and so helpful in terms of our getting prepared. But of course, on the other on the other hand, we are also seeing a fair amount of misinformation. We are seeing people trying to peddle. Fake cures. We're seeing people who are doubting the science. We are seeing officials who are trying to manipulate the public for political reasons. So It's very much a double edged sword. And hopefully that we can hopefully the good from it will outweigh the bad. Let's talk about possible good news and solutions. Do you- I mean, I guess there's a few ways we could attack this but. Let's start with when we're caught off guard like this and it's a new virus that our bodies have no immunity to. What's the timeline to a vaccine and the timeline to a treatment? So the timeline to a treatment is likely much shorter than the timeline to a vaccine. For, both we have to prove that we first have to develop a call candidate, countermeasure or drug or vaccine. Something that in the laboratory looks like it might be effective. Tested in animals to show that at least in animals, it's effective. The next step is we have to prove that it's safe in people which involves putting. Initially a small number of people then eventually a large number of people to have them. To administer the drug or vaccine to them. Because last thing I want to do is give somebody something that's not safe. That doesn't harm them, or that does harm them. We don't want to give them something that harms them. And then we have to prove that it's effective. So we have to, we have to give it to people who are sick, and also give it to people who are not sick so that we can see the difference. This all takes a lot of time. It takes many, many months to do this. And then if we can show that it's both safe and effective Then we have to manufacture it o a global scale. We have to manufacture enough of this for 7 billion people. We have never done this before. So I think most experts have predicted that it would take 12 to 18 months before a vaccine. That is a very rosy estimate. We've never done that before for anything other than influenza because we were already set up to do it for influenza. So this should be Incredibly fast, and it's quite likely it'll take longer than that. But for treatments it's it's not nearly as hard. We don't need to do testing on the same massive scale. And so it's likely that we will have treatments in much less time, perhaps in three to six months, we'll have treatments. There are already trials going on with several candidate drugs that show some promise. And so I think that Perhaps by the end of the summer beginning of the fall, we will start to see some treatments become available. And these won't prevent of, for the most part, these wouldn't prevent infection but they would hopefully reduce the Severity of disease for those who are critically ill. Considering the timeline of treatments, vaccines, how long could this pandemic last? Well, as long as people don't have immunity, this virus will continue to spread. So how long will depend to some extent on what we do if we're really successful in slowing down the spread of this virus in order to protect the healthcare system, we'll have this virus for a longer period of time than if we just let it Run wild and burn through the global population as fast as it wants to do. But it is certain that this virus will be with us for a long time, probably to some extent, for the forseeable future. What we think is likely to happen is, there'll be a series of waves of this disease. Hopefully future waves are not are not as bad as this first waves. And then it'll be a recurring cycle of of waves of this Until there is either a vaccine or until most people have been infected. And once most people are immune either through a vaccine or through infection, then the virus will slow way down, but it probably will never go away. That will become more like flu or more like the other childhood diseases that we have. The only people that will get this infection, we hope in the future will be children who have a mild illness. So like. Like mumps, or measels, or chicken pox, or the other several childhood illnesses, if I were to guess, I would guess that's what will happen with COVID-19, that it will always be with us. Not a major problem, something for which we have a vaccine, and would probably become just another vaccine that kids get. And, but I will also add, but also like flu, or these other diseases, it will continue to be a disease that's dangerous too The elderly or the infirm. And so for people who are at home now or in self isolation, practicing social distancing, is this world that we're living in right now, do you think this will continue weeks? Months? And how likely is it that we'll get kind of an all clear? I don't expect to get an all clear all at once. I think what we're seeing in Asia right now is a very careful and gradual relaxing of measures. Carefully looking to see if there's evidence of a an increase in the number of Of cases. So I think that's probably what we'll see in the rest of the world. I think that the measures that have been implemented now will last for probably months. Whether that's two months or Four months or six months? I don't know. I think probably it'll be a matter of, on the order of a couple months. I think then as the epidemic wave passes in each state I think there'll be a gradual relaxing of these measures. We have to keep in mind that as these measures are relaxed, it is likely there'll be subsequent waves. And they may have to be re imposed again. I don't believe for a minute that measures Last a couple weeks will do any good. They will not protect healthcare system. So I don't expect that to be I don't expect that to happen. I think right now when leaders are talking about Two weeks of any one of these measures, is there just trying to buy some time? I don't think any of them believe that there'll be only two weeks. Let's talk about possible solutions. I'm interested to know, I guess, first of all on a broad level, and I don't know whether you have specific examples, but How is technology helping us find solutions here? Whether it's helping us in tracking cases or helping us in developing treatments? How is technology helping? Okay, technology has really revolutionized our response to this through communications through as we've talked about, through Been able to communicate around the world in real-time. It's enabling us to do social distancing, well, like we are doing right now. I'm working as effectively from my home as I did from my office. We are conducting this interview at a distance These are things that we could not have done, in the past. Technology is revolutionizing the way in which we can make drugs and vaccines to do it much faster than we could ever do it before. So even though it will certainly be at least A year or two before we have a vaccine. This would be the first time we've ever had a vaccine for an emerging infectious disease in the past, because in the past, it took so much longer so I think technology has been a has been and will continue to be a great boon to this response. But it's not going to make the disease go away. Are you seeing any treatments or new I guess New approaches or solutions that excite you, I've seen been doing some reading on CRISPR being used to help kinda track the virus or new technologies in diagnosis. Are you seeing any technologies that excite you? Well, I'm not The technology guru. So several of my my colleagues are much more current on all the technologies that are coming to play in both diagnostics and and in therapeutics. But one of the things that I find, particularly two things, I'll say On the on the diagnostic side. Our ability to to do very complicated diagnostic testing in a box essentially that Easter require a full laboratory. can now be done, essentially, in a box the size of a large printer or a laser printer. That is incredibly exciting, and these are fully automated machines that they can be deployed. In a hospital without having to have a fully trained laboratory technician to do the test. That is very exciting and although, I don't think it's gonna happen right away for this virus, they're also Essentially chips were a drop of fluid can be put on a on a little chip and get an answer. Very quickly the so called point of care diagnostics. That has also been revolutionary for some diseases. Not yet for COVID 19 but but maybe down the road On the therapeutic side, I'm very excited about the role of monoclonal antibodies. So basically these are created by introducing the virus into an animal. And then drawing off the, the serum, the blood from that animal and isolating the antibodies that are produced. These can then be grown on massive scales in essentially what what amounts to giant fermenters and And then these can be injected into people that provide instantaneous at a temporary immunity. And so this is a technology that's really grown in the last decade or two. And it could eventually be a game changer, it's much faster to do this than it is to make a traditional vaccine. Although, this doesn't entirely replace traditional vaccines. What are the things that you and I can do? Is there anything we can do? Or is this just the new normal until this has run its course I think everybody has a critical role to play. We all have to bend together to do the social distancing. To adhere to these really difficult public health interventions that are changing our lives so dramatically. We have to do this for the good of our neighbours, and our family members, and our communities. If we don't, if we don't each and everyone of us adhere to these requests from public health, We will see what what has been seen in in Italy and in China. A catastrophe that, that most people have trouble imagining.Are you personally you work in this field you've worked in this field for years. Are you scared? Yes. I'm scared. I think one would have to be clueless not to be scared right now. The risk to each of us is real. The the risk to Someone who's young and healthy is really quite small. And this is an idea that sometimes people have trouble understanding. So a young, healthy person, their risk of serious illness or death Is very small. The risks to someone who is over 60 goes up very rapidly. And people with some underlined health conditions are also at significant risk. And there are an awful a lot of people in our country who have underlying health conditions. So people with diabetes, people with with coronary heart disease, people with kidney disease, people who are undergoing cancer treatment People with arthritis who are on steroids, people with asthma and almost any underlying chronic lung condition. We're talking about millions and millions of people in United States who are at higher risk. Then the average healthy person and so if you're over 60 and you have health conditions, underlying health problems, then your risk is very substantial. And it's pretty scary.