Transcriber: Eunice Tan Reviewer: Tanya Cushman
David Troy: Hello, I'm David Troy, host and co-curator of TEDxMidAtlantic.
This video is part of a series we're creating
using videoconference technology
during the coronavirus crisis.
I'm joined today by Dr. Leana Wen.
Dr. Wen is an emergency physician
and public health professor at George Washington University.
Previously, she served as Baltimore's health commissioner.
She's a former TEDxMidAtlantic speaker also.
Welcome, Leana.
Leana Wen: I'm happy to be with you, Dave, during these challenging times.
DT: Absolutely.
So, this coronavirus - it's here among us.
And I think we all are sort of yearning
for things to return to some form of "normal,"
but that's maybe not so easy.
What kind of process are we looking at
to learn to live with this virus over the next year or so?
LW: Mm-hmm.
I mean, you're right that it is a very difficult time
and, actually, one that I don't know that we could have imagined
even weeks ago, much less months ago.
I mean, when we first saw the images of what was happening out of China,
and then when it became closer and closer to us,
I think we began to see that this could impact us.
But until it hit the US -
and so quickly and in such a visceral way -
I don't think we processed what this really means.
And I think for a lot of us,
we're experiencing this in deeply personal ways.
Certainly the individuals who have loved ones who have become ill
or who have developed symptoms and are concerned about being ill
or who have been exposed to COVID-19, the new virus, themselves -
they're going through pain and suffering
that would be unimaginable not so long ago.
But I actually think for all of us,
we're all called upon to make sacrifices
in a way that, again, we might not have imagined
and could not have imagined.
I mean, the idea of schools being canceled,
of businesses being shuttered,
and us not having gatherings.
Even something as basic as not being able to shake hands
or not being able to see relatives -
it's just a very different time.
And I think it's a time
that calls upon all of us to have a type of collective selflessness
because for the first time -
I think for a lot of us -
we're seeing just how interconnected all of our fates are.
I mean, we are in an interconnected world,
but in this case,
my health is also instrumental to your health.
My being healthy and keeping my family healthy
is also what's going to prevent this disease
from being transmitted in the community.
And we know that coronavirus
is not something that only affects those who are medically vulnerable
and the elderly.
We know that it's something that could affect each of us.
And so while it affects each of us,
it's also our collective responsibility
to stop the transmission of the virus from person to person.
And I think it just calls upon us to make peace with those sacrifices
and to understand too
that if other people are making much greater sacrifices than we are,
then we have an obligation to do our part.
And if we don't,
the selfishness of one person or ten people
could have a profound impact on the rest of society.
So I think, you know, we always talk about social distancing in these times,
but in a way, the social closeness and the interconnectedness of all of us
is even more clear than it normally is.
DT: Absolutely.
And, you know, I think, in terms of timelines,
Dr. Fauci has said that, you know,
we don't get to make the timeline; the virus makes the timeline.
And, you know, I think that we've been looking at this
as kind of an event right now
where we're having to very suddenly adapt to all of these kinds of changes.
But I think that one of the things that we probably need to get used to
is that this is something that will be with us in various ways
for a very long time.
And, you know, we may need to go through multiple waves of lockdowns
and other kinds of behavior modifications that, you know, will change our society.
Can you give some sense of sort of what the process is
for how we might, for example,
start to open restaurants and go back to workplaces?
LW: Well, at the time that we're speaking right now,
we're pretty far from being able to loosen the restrictions that are being placed.
And that's in part because of the work that we're doing
and the work that we have not done too.
So you were talking about this being a process,
and I think that's a very good way of framing it -
that there is a process.
And also then, as you were saying, quoting Dr. Fauci,
that the virus is what dictates the timeline.
But it's not just the virus.
Yes, the virus does dictate the timeline
because it's a disease and it's a new disease.
We don't know exactly how this disease exactly operates.
We don't know whether we're going to see a temporal variation -
the seasonal variation depending on temperature.
But we also are not powerless against this virus either.
There are very specific interventions that we can do
that will change the trajectory of the disease spread.
And so when we look at what's happened in other countries,
we know that if social distancing measures
were applied aggressively and early and consistently,
that that would flatten the peak
and reduce the peak rate of transmission and the total number of cases too.
But if those social distancing measures were spread out over time,
and especially if they're implemented too late,
then you see a much higher peak.
You see higher numbers of people who are infected,
you see a longer term of infection,
and, unfortunately, you see more people dying
because our hospitals will become out of capacity.
If all these ill patients come in all at the same time,
then we just don't have the resources to treat people,
and, unfortunately, people will die because we have to ration care.
And so what needs to happen
is that we have to very urgently stabilize our healthcare system
because that is going to be the reason for mortality -
and actually a reason for mortality
that we just cannot forgive ourselves for
if we have to ration care not only to those patients with coronavirus
but also to other patients,
because healthcare continues to happen.
People are still going to be coming in with heart attacks and strokes
and diabetes complications and other things that need hospital care.
And if they cannot get care, then they will also suffer as a result.
So we have to stabilize the healthcare system first.
Second is we have to get mass testing
because otherwise we don't know the true spread of coronavirus
in our communities.
And that's really important -
we need data and science to guide our decision-making.
And only after we're seeing number three,
which is the effects of our social distancing measures -
only after we're seeing
the peak of the number of cases begin to decline consistently,
then we can start potentially rolling back these social restrictions.
And ideally, we have the data at that point
to roll them back one community, one region at a time
or several regions at a time
but not all at the same time.
And I get concerned, though, that because we've been late,
because we have not consistently applied social distancing across the board,
because we don't have widespread testing,
because we haven't had the focus on strengthening our healthcare system
that we need -
as a result of being late,
I'm afraid that that's actually going to cost us more time.
And I think - it just reminds me of something that my mentor
and, I know, someone that you love and admire dearly -
also a TEDxMidAtlantic speaker -
Congressman Elijah Cummings,
used to say - that the cost of doing nothing isn't nothing.
that the cost of doing nothing isn't nothing.
DT: Right.
LW: That there is a cost of inaction.
And, unfortunately, we are seeing that cost now.
When we don't pay attention to public health, to prevention,
when we don't act quickly enough,
we see that actually there will be a lot more pain and suffering and lives lost.
But we need to look forward.
We can't just navigate from where we wish we were;
we need to navigate from where we are.
And we need to do everything we can,
and that means continuing to make these sacrifices
that will seem very difficult.
But at the end of the day, they are what are lifesaving.
DT: Absolutely.
And in terms of testing, I mean, I think that's been cited repeatedly,
and certainly, you just mentioned it
as a prerequisite for, you know, trying to get things back on track.
I understand that there's a couple of different kinds of testing
that are potentially available.
Can you talk about, you know, kind of what are the constraints on testing
and what are the different kinds that we may need
in order to get back to work?
LW: So there has been some excellent reporting done
about the missteps in testing
and why it is that the US is so far behind other countries
when it comes to having widespread testing capacity.
I think, in general, it has to do with lack of anticipation.
Because even after tests were actually being produced and distributed,
then we found out that the swab that's used to actually get the test,
that that was in short supply.
And then we found out that the reagent used to process these tests
were in short supply.
And so it's one thing after the other.
And then there was the problem with personal protective equipment -
that if nurses and doctors and healthcare workers
don't have the equipment to actually collect tests in a safe manner,
then you can't do the tests either.
And so I think that's been one trend along the way -
that so much of the process of combating COVID-19
has been looking at what's already happened
instead of anticipating what we need going forward,
which is something that I hope that will be changed.
But looking forward to testing -
the things that we do need and are on the horizon -
one is point-of-care testing.
You can't have people wait five, six days for a test result.
That's not practical in a clinical setting,
and it doesn't make sense for public health measurement
to look at something from a week ago.
You need point-of-care testing,
meaning testing that's done at the bedside,
available within the hour.
And there are now tests that are being developed to this extent
that are really important.
The second thing is you need to look at
not only the test for whether somebody has an acute infection now;
ideally, we also get to the serology test, looking at antibodies,
because there are people who may have had coronavirus
and may have had no symptoms or mild symptoms
or because of lack of testing, never got tested.
It would be good to find out
if there are people out there in the community
who have immunity already to coronavirus,
because that would certainly change how they interact with society.
And they might be the first ones to be able to return to work
or, you can imagine, if they were frontline healthcare workers,
it gives them a level of protection as well.
And then the third thing about testing is you need it to be widespread.
Everyone who has symptoms should get tested.
Everyone who has exposure should be tested.
And beyond that, we need surveillance testing
so that we understand
is it that 50% of the people who are walking around
actually have coronavirus and are spreading it
and just don't know it?
Or are we talking about 1% or 0.1%?
That level of surveillance and understanding
is also critical to public health,
to guide public health measures moving forward.
DT: Sure, that makes a lot of sense.
At the moment, we don't have very good visibility into the spread,
and, you know, I think that puts a lot of future decisions into uncertainty.
In terms of more final kinds of resolutions to this -
you know, I think that there's a lot of work being done
on both treatments and on vaccines.
My understanding is that, you know,
most vaccines probably would be like at least a year
but probably more like 18 to 24 months out on the horizon.
Can you give a sense of, you know, what we might expect in terms of vaccines?
LW: Sure.
So COVID-19, as you know, is a new disease,
which means that nobody has immunity to it naturally
because it hasn't been around.
There also is no vaccine and no proven treatment as of yet
because of how new it is.
Treatments could be developed a lot sooner
because there are existing medications that are antivirals
or have other properties that are promising,
and there are already clinical trials underway
with multiple of these potential treatments.
But, ideally, what we need to get to is what you said, Dave,
which is getting to a vaccine
that will prevent us, as much as possible,
from contracting COVID-19 in the first place.
And the development of that vaccine
and being able to roll that out worldwide -
that will be the real game changer.
That's when we can all go back to as much as life as normal
as we knew it before.
Now, developing a vaccine for a novel disease is very challenging.
It has to go through multiple phases.
They have to demonstrate safety and efficacy.
And, importantly, it's not just about developing the vaccine -
it's also about making enough.
Because when we think about vaccine,
we think about the moment at which the vaccine gets to people,
not just the moment at which it gets approved
by the Food and Drug Administration.
And so you're right that the timeline -
I think the most ambitious timeline is 12 months;
a more realistic is 18 months;
and it may take even longer.
And I think that kind of timeline
underscores why these other preventive measures
and really drastic measures that we're taking
when it comes to social distancing
are so important.
Because if we don't implement these measures, then we're looking at -
some models show -
40 to 60% of the American population contracting coronavirus.
And if there's a death rate of 1 to 3%,
that's millions of Americans who could die in the next year.
We have an opportunity to change that and reduce the number of deaths.
But without a vaccine,
those types of social distancing measures
are our best bet
and what each of us has to do.
DT: No, absolutely. I think that's very good advice.
And in terms of, you know, what kind of advice would you maybe pass on
to people that are watching this at home,
you know, as we enter into this period of living with this virus,
this process of starting to manage it,
and then, ultimately, try to bring it under control?
If there was one piece of advice
that you could give to people watching this,
as a public health professional,
what might it be?
LW: The one piece of advice -
well, maybe I can give several pieces of advice, if I can?
DT: Sure. Yeah, absolutely.
LW: Maybe three pieces of advice.
The first is that there are tangible things that we can do
in order to reduce our own risk.
And, very specifically, one thing that I think everyone has come to know
in the last several weeks to months
is the importance of hand and face hygiene,
which I hope is something we'll keep up
even long after coronavirus is under control.
I hope we'll keep on these types of good personal hygiene practices -
washing hands for at least 20 seconds with soap and water,
using hand sanitizer if that's not available,
stop touching our face or touch our face less.
I think those are good practices, regardless,
and are things that we should continue to keep in mind.
The second is around social distancing.
You know, there's a social media campaign
that a number of healthcare workers have launched
that really breaks my heart every time I see it.
And that's healthcare workers -
doctors, nurses, pharmacists, respiratory therapists,
everyone who works in this -
holding up signs that say,
"I stayed at work for you.
Please stay at home for me."
And sometimes we think about
"What good am I doing just sitting on the couch, watching Netflix?"
It doesn't feel like we're contributing to the greater societal good.
But I want people to know
that that is the single most important thing that you can do
to reduce the rate of transmission of COVID-19.
This new coronavirus is spread person-to-person,
and if we are able to stop that transmission in its tracks,
we're stopping the virus in its tracks.
And the single most important thing you can do
is actually to stay at home and watch Netflix, if you will,
and to physically distance yourself,
understanding how challenging that is.
I mean, I'm about to give birth
at the moment that we're speaking,
actually - now.
DT: We caught you at the last possible moment, I think.
LW: That's right.
And I mean, right after having the baby,
I won't be able to have any visitors.
I won't have any family over, any friends over.
And it's a big change for me,
as it is for a lot of people,
to go through this period of physical distancing.
But that is what I need to do,
that is what we need to do,
and that's the single most important thing in order to save lives.
And I'll just add one more thing, the third thing,
that, I think for all of us,
is that we know we're facing this period of uncertainty.
And a lot of people, everyone has given up a lot -
some people more than others -
but everybody is going through a lot.
And I think the last thing that I'll leave people with
is that this is our opportunity
to face this uncertainty with solidarity
and recognize the cooperation and collaboration that we all need,
and that to tolerate that uncertainty is also a level of sacrifice too,
and that we should be granting each other grace
and recognizing each other's humanity
even more than we ever have.
DT: That's beautiful.
We're so pleased to be able to have you here today -
I know you've got a lot going on.
And, you know, we all wish you the best,
you know, as you head off to give birth and bring another life into this world.
You know, it's such a challenging time,
but again, thank you so much for sharing your wisdom with us today,
and I think that this will help people understand, you know,
what it's going to be like to actually live through this together.
So, thanks again.
LW: Thank you, Dave.