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I want to lead here by talking a little
bit about my credentials to bring this
up with you because quite honestly you
really really should not listen to any
old person with an opinion about kovat
19 so I've been working in global health
for about 20 years and my specific
technical specialty is in health systems
and what happens when Health Systems
experience severe shocks I've also
worked in global health journalism I've
written about global health and
biosecurity for newspapers and web
outlets and I published a book a few
years back about the major global health
threats facing us as a planet I have
supported and led epidemiology efforts
that range from evaluating Ebola
treatment centers to looking at
transmission of tuberculosis at health
facilities and doing avian influenza
preparedness I have a master's degree in
international health I'm not a physician
I'm not a nurse my specialty isn't
patient care or taking care of
individual people my specialty is
looking at populations and health
systems what happens when diseases move
on the large level if we're ranking
sources of global health expertise on a
scale of one to ten one is some random
person ranting on Facebook and 10 is the
World Health Organization I'd say you
can probably put me at like a seven or
an eight so keep that in mind as I talk
to you I'll start with the basics here
because I think that's gotten lost in
some of the media noise around kovat 19
so Kovan 19 is a corona virus and corona
viruses are a specific subset of virus
and they have some unique characteristic
as viruses they use RNA instead of DNA
as their genetic material and they're
covered in spikes on the surface of the
virus and they use those spikes to
invade cells those spikes are the corona
in corona virus kovat 19 is known as a
novel coronavirus
because until december we'd only heard
of six corona viruses kovin 19 is the
seventh it's new to us it just had its
gene sequencing it just got its name
that's why it's a novel if you remember
SARS severe acute respiratory syndrome
or MERS Middle Eastern respiratory
syndrome
those were corona viruses and they're
both called respiratory syndrome because
that's what caverna viruses do they go
for your lungs they don't make you puke
they don't make you bleed from the
eyeballs they don't make you hemorrhage
they head for your lungs kovat 19 is no
different it causes a range of
respiratory symptoms that go from stuff
like a dry cough and a fever all the way
out to fatal viral pneumonia and that
range of symptoms is one of the reasons
it's actually been so hard to track this
outbreak plenty of people get Kovan 19
but so gently their symptoms are so mild
that they don't even go to a healthcare
provider they don't register in the
system children in particular have it
very easy with kovat 19 which is
something we should all be grateful for
corona viruses are zoonotic which means
that they transmit from animals to
people some corona viruses like kovat 19
also transmit person to person
the person-to-person ones travel faster
and travel farther
just like kovat 19z notic illnesses are
really hard to get rid of because they
have an animal reservoir one example is
avian influenza where we can abolish it
in farmed animals in turkeys in ducks
but it keeps coming back every year
because it's brought to us by wild birds
you don't hear a lot about it because
even influenza doesn't transmit
person-to-person but we have outbreaks
in poultry farms every year all over the
world
Kovan 19 most likely skipped from
animals into people at a wild animal
market
han china now for the less basic parts
this is not the last major outbreak
we're ever gonna see there's going to be
more outbreaks and there's going to be
more epidemics that's not a maybe that's
a given and it's a result of the way
that we as human beings are interacting
with our planet human choices are
driving us into a position where we're
going to see more outbreaks part of that
is what climate change and the way in
warming climate makes the world more
hospitable to viruses and bacteria but
it's also about the way we're pushing
into the last wild spaces on our planet
when we burn and plow the Amazon
rainforest so that we can have cheap
land for ranching when the last of the
African bush gets converted to farms
when wild animals in China are hunted to
extinction human beings come into
contact with wildlife populations that
they've never come into contact with
before and those populations have new
kinds of diseases bacteria viruses stuff
we're not ready for bats in particular
have a knack for hosting illnesses that
can infect people but they're not the
only animals that do it so as long as we
keep keep making our remote places less
remote the outbreaks are going to keep
coming we can't stop the outbreaks with
quarantine or travel restrictions that's
everybody's first impulse let's stop the
people from moving let's stop this
outbreak from happening but the fact is
it's really hard to get a good at
quarantine in place it's really hard to
set up travel restrictions even the
countries that have made serious
investments in public health like the
u.s. and South Korea can't get that kind
of restriction in place fast enough to
actually stop an outbreak instantly
there's logistical reasons for that and
there's medical reasons if you look at
kovat 19 right now it seems like it
could have a period where you're
infected and show no symptoms that's as
long as 24 days so people are walking
around with this virus showing no sign
they're not gonna get quarantined nobody
knows they need quarantine a there's
also some real costs to quarantine and
two travel restrictions humans are
social animals and they resist when you
try to hold them into place and when you
try to separate them we saw in the Ebola
outbreak that as soon as you put a
quarantine in place people start trying
to evade it individual patients if they
know there's a strict quarantine
protocol may not go for health care
because they're afraid of the medical
system or they can't afford care and
they don't want to be separated from
their family and friends politicians
government officials when they know that
they're going to get quarantined if they
talk about outbreaks in cases may
conceal real information for fear of
triggering a quarantine protocol and of
course these kinds of evasions and
dishonesty are exactly what it makes it
so difficult to track a disease outbreak
we can get better at quarantines and
travel restrictions and we should but
they're not our only option and they're
not our best option for dealing with
these situations the real way for the
long haul to make outbreaks less serious
is to build the global health system to
support core healthcare functions in
every country in the world so that all
countries even poor ones are able to
rapidly identify and treat new
infectious diseases as they emerge
China's taken a lot of criticism for its
response to Kovan 19 but the fact is
what if kovat 19 had emerged in Chad
which has three and a half doctors for
every hundred thousand people what if it
had emerged in the Democratic Republic
of Congo which just released its last
Ebola patient from treatment
the truth is countries like this don't
have the resources to respond to an
infectious disease not to treat people
and not to report on it fast enough to
help the rest of the world I led an
evaluation of Ebola treatment centers in
Sierra Leone and the fact is the local
doctors in Sierra Leone ident
the Ebola crisis very quickly first is a
dangerous contagious hemorrhagic virus
and then as a bola itself but having
identified it they didn't have the
resources to respond they didn't have
enough doctors they didn't have enough
hospital beds and they didn't have
enough information about how to treat
Ebola or how to implement infection
control 11 doctors died in Sierra Leone
of Ebola the country only had 120 when
the crisis started by way of contrast
Dallas Baylor Medical Center has more
than a thousand physicians on staff
these are the kinds of inequities that
kill people first they kill the poor
people when the outbreaks start and then
they kill people all over the world when
the outbreaks spread if we really want
to slow down these outbreaks and
minimize their impact we need to make
sure that every country in the world has
the capacity to identify new diseases
treat them and report about them so they
can share information Kove in nineteen
is going to be a huge burden on health
systems I'm not going to talk about
death rates in this talk because frankly
nobody can agree on the Cova 19 death
rates right now but one number we can
agree on is that about 20% of people
infected with kovat 19 are going to need
hospitalization our US medical system
can just barely cope with that but
what's gonna happen in Mexico Kovan 19
has also revealed some real weaknesses
in our global health supply chains just
in time or during lean systems are great
when things are going well but in a time
of crisis what it means is we don't have
any reserves if a hospital or a country
runs out of face masks or personal
protective equipment there's no big
warehouse full of boxes that we can go
to to get more you have to order more
from the supplier you have to wait for
them to produce it and you have to wait
for them to ship it generally from China
that's a time lag at a time when it's
most important to move quickly if we'd
been perfectly prepared for Cova 19
China would have identified the outbreak
fast
they would have been ready to provide
care to infected people without having
to build new buildings they would have
shared honest information with citizens
so that we didn't see these crazy rumors
spreading on social media in China and
they would have shared information with
global health authorities so that they
could start reporting to national health
systems and getting ready for when the
virus spread national health systems
would then who'd be enabled to stockpile
the protective equipment they needed and
trained healthcare providers on
treatment and infection control
we'd have science-based protocols for
what to do when things happen like
cruise ships have infected patients and
we'd have real information going out to
people everywhere so we wouldn't see
embarrassing shameful incidents of
xenophobia like Asian looking people
getting attract attacked on the street
in Philadelphia but even with all that
in place we would still have outbreaks
the choices were making about how we
occupy this planet make that inevitable
as far as we have an expert consensus on
kovat 19 it's this here in the US and
globally it's going to get worse before
it gets better
we're seeing cases of human transmission
that aren't firm returning travel that
are just happening in the community and
we're seeing people infected with kovat
19 when we don't even know where the
infection came from those are signs of
an outbreak that's getting worse not an
outbreak that's under control it's
depressing but it's not surprising
global health experts when they talk
about the scenario of new viruses this
is one of the scenarios that they look
at we all hoped we'd get off easy but
when experts talk about viral planning
this is the kind of situation and the
way they expect the virus to move I
wanted to close here with some personal
advice wash your hands wash your hands a
lot I know you already wash your hands a
lot because you're not disgusting but
wash your hands even more set up cues
and routines in your life to get you to
wash your hands wash your hands every
time you enter and leave a building wash
your hands when you go into a meeting
and when you come out of a meeting get
rituals they are based around
hand-washing sanitize your phone you
touch that phone with your dirty
unwashed hands all the time I know you
take it into the bathroom with you
so sanitize your phone and consider not
using it as often in public maybe tick
tock and Instagram could be home things
only don't touch your face don't rub
your eyes don't bite your fingernails
don't wipe your nose in the back of your
hand
I mean don't do that anyway because
gross don't worry face masks face masks
are for sick people and health care
providers if you're sick your face mask
holds in all your coughing and sneezing
and protects the people around you and
if you're a health care provider your
face mask is one tool in a set of tools
called personal protective equipment
that you're trained to use so that you
can give patient care and not get sick
yourself if you're a regular healthy
person wearing a face mask it's just
making your face sweaty leave the face
masks in stores for the doctors and the
nurses and the sick people if you think
you have symptoms of Kovan 19 stay home
call your doctor for advice if you're
diagnosed with kovat 19 remember it's
generally very mild and if you're a
smoker right now it's the best possible
time to quit smoking I mean if you're a
smoker right now is always the best
possible time to quit smoking but if
you're a smoker and you're worried about
kovat 19 I guarantee that quitting is
absolutely the best thing you can do to
protect yourself from the worst impacts
of kovat 19 Kovan 19 is scary stuff at a
time when pretty much all of our news
feels like scary stuff and there's a lot
of bad but appealing options for dealing
with it panic xenophobia Agra phobia
authoritarianism oversimplified lies
that make us think that hate and fury
and lonely
are the solution to outbreaks but
they're not they just make us less
prepared there's also a boring but
useful set of options that we can use in
response to outbreaks things like
improving health care here and
everywhere investing in health
infrastructure and disease surveillance
so that we know when the new diseases
come building health systems all over
the world looking at strengthening our
supply chain so they're ready for
emergencies and better education so
we're capable of talking about disease
outbreaks and the mathematics of risk
without just blind panic we need to be
guided by equity here because in this
situation like so many equity is
actually in our own self-interest so
thank you so much for listening me today
and can I be the first one to tell you
wash your hands when you leave the
theater
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