0:00:00.993,0:00:04.596
I want to lead here by talking[br]a little bit about my credentials

0:00:04.620,0:00:06.230
to bring this up with you,

0:00:06.254,0:00:08.471
because, quite honestly,

0:00:08.495,0:00:12.963
you really, really should not listen[br]to any old person with an opinion

0:00:12.987,0:00:14.578
about COVID-19.

0:00:14.602,0:00:16.231
(Laughter)

0:00:16.255,0:00:20.260
So I've been working in global health[br]for about 20 years,

0:00:20.284,0:00:24.798
and my specific technical specialty[br]is in health systems

0:00:24.822,0:00:28.700
and what happens when health systems[br]experience severe shocks.

0:00:28.724,0:00:31.193
I've also worked[br]in global health journalism;

0:00:31.217,0:00:34.928
I've written about[br]global health and biosecurity

0:00:34.952,0:00:38.064
for newspapers and web outlets,

0:00:38.088,0:00:40.243
and I published a book a few years back

0:00:40.267,0:00:43.693
about the major global health threats[br]facing us as a planet.

0:00:44.281,0:00:48.047
I have supported and led[br]epidemiology efforts

0:00:48.071,0:00:51.939
that range from evaluating[br]Ebola treatment centers

0:00:51.963,0:00:56.092
to looking at transmission[br]of tuberculosis in health facilities

0:00:56.116,0:00:58.872
and doing avian influenza preparedness.

0:00:59.397,0:01:02.486
I have a Master's Degree[br]in International Health.

0:01:02.940,0:01:05.048
I'm not a physician. I'm not a nurse.

0:01:05.072,0:01:09.345
My specialty isn't patient care[br]or taking care of individual people.

0:01:09.369,0:01:13.050
My specialty is looking at populations[br]and health systems,

0:01:13.074,0:01:16.135
what happens when diseases[br]move on the large level.

0:01:17.288,0:01:20.946
If we're ranking sources[br]of global health expertise

0:01:20.970,0:01:23.549
on a scale of one to 10,

0:01:23.573,0:01:27.196
one is some random person[br]ranting on Facebook

0:01:27.220,0:01:31.075
and 10 is the World Health Organization,

0:01:31.099,0:01:34.823
I'd say you can probably put me[br]at like a seven or an eight.

0:01:34.847,0:01:37.386
So keep that in mind as I talk to you.

0:01:38.931,0:01:42.116
I'll start with the basics here,[br]because I think that's gotten lost

0:01:42.140,0:01:45.557
in some of the media[br]noise around COVID-19.

0:01:46.281,0:01:50.251
So, COVID-19 is a coronavirus.

0:01:50.275,0:01:54.228
Coronaviruses are[br]a specific subset of virus,

0:01:54.252,0:01:57.663
and they have some unique[br]characteristics as viruses.

0:01:57.687,0:02:01.426
They use RNA instead of DNA[br]as their genetic material,

0:02:01.450,0:02:04.573
and they're covered in spikes[br]on the surface of the virus.

0:02:04.597,0:02:07.484
They use those spikes to invade cells.

0:02:07.508,0:02:11.010
Those spikes are the corona[br]in coronavirus.

0:02:12.364,0:02:16.035
COVID-19 is known as a novel coronavirus

0:02:16.059,0:02:20.173
because, until December,[br]we'd only heard of six coronaviruses.

0:02:20.197,0:02:22.113
COVID-19 is the seventh.

0:02:22.137,0:02:23.297
It's new to us.

0:02:23.321,0:02:24.912
It just had its gene sequencing,

0:02:24.936,0:02:26.131
it just got its name.

0:02:26.155,0:02:27.487
That's why it's novel.

0:02:28.215,0:02:32.428
If you remember SARS,[br]Severe Acute Respiratory Syndrome,

0:02:32.452,0:02:33.623
or MERS,

0:02:33.647,0:02:35.575
Middle Eastern Respiratory Syndrome,

0:02:35.599,0:02:37.638
those were coronaviruses.

0:02:37.662,0:02:40.779
And they're both called[br]respiratory syndromes

0:02:40.803,0:02:43.692
because that's what coronaviruses do --

0:02:43.716,0:02:45.514
they go for your lungs.

0:02:45.538,0:02:48.882
They don't make you puke, they don't[br]make you bleed from the eyeballs,

0:02:48.906,0:02:50.390
they don't make you hemorrhage.

0:02:50.414,0:02:51.698
They head for your lungs.

0:02:52.595,0:02:54.694
COVID-19 is no different.

0:02:55.193,0:02:58.517
It causes a range of respiratory symptoms

0:02:58.541,0:03:01.714
that go from stuff like[br]a dry cough and a fever

0:03:01.738,0:03:05.386
all the way out to fatal viral pneumonia.

0:03:05.410,0:03:08.699
And that range of symptoms[br]is one of the reasons

0:03:08.723,0:03:12.070
it's actually been so hard[br]to track this outbreak.

0:03:12.094,0:03:17.190
Plenty of people get[br]COVID-19 but so gently,

0:03:17.214,0:03:21.173
their symptoms are so mild, they don't[br]even go to a health care provider.

0:03:21.197,0:03:23.095
They don't register in the system.

0:03:23.119,0:03:26.879
Children, in particular, have it[br]very easy with COVID-19,

0:03:26.903,0:03:29.300
which is something[br]we should all be grateful for.

0:03:31.570,0:03:33.934
Coronaviruses are zoonotic,

0:03:33.958,0:03:37.218
which means that they transmit[br]from animals to people.

0:03:37.242,0:03:41.872
Some coronaviruses, like COVID-19,[br]also transmit person to person.

0:03:42.589,0:03:45.956
The person-to-person ones[br]travel faster and travel farther,

0:03:45.980,0:03:47.605
just liked COVID-19.

0:03:48.079,0:03:51.415
Zoonotic illnesses[br]are really hard to get rid of,

0:03:51.439,0:03:53.690
because they have an animal reservoir.

0:03:54.229,0:03:57.251
One example is avian influenza,

0:03:57.275,0:04:02.376
where we can abolish it[br]in farmed animals, in turkeys, in ducks,

0:04:02.400,0:04:06.623
but it keeps coming back every year[br]because it's brought to us by wild birds.

0:04:06.647,0:04:08.062
You don't hear a lot about it

0:04:08.086,0:04:10.896
because avian influenza[br]doesn't transmit person-to-person,

0:04:10.920,0:04:15.235
but we have outbreaks in poultry farms[br]every year all over the world.

0:04:16.506,0:04:20.735
COVID-19 most likely skipped[br]from animals into people

0:04:20.759,0:04:23.316
at a wild animal market in Wuhan, China.

0:04:24.987,0:04:27.115
Now for the less basic parts.

0:04:28.034,0:04:31.727
This is not the last major outbreak[br]we're ever going to see.

0:04:32.106,0:04:36.371
There's going to be more outbreaks,[br]and there's going to be more epidemics.

0:04:36.395,0:04:39.225
That's not a maybe. That's a given.

0:04:39.672,0:04:42.861
And it's a result of the way[br]that we, as human beings,

0:04:42.885,0:04:44.770
are interacting with our planet.

0:04:45.225,0:04:48.273
Human choices are driving us[br]into a position

0:04:48.297,0:04:50.920
where we're going to see more outbreaks.

0:04:51.539,0:04:53.301
Part of that is about climate change

0:04:53.325,0:04:56.275
and the way a warming climate[br]makes the world more hospitable

0:04:56.299,0:04:57.850
to viruses and bacteria.

0:04:58.287,0:05:04.328
But it's also about the way we're pushing[br]into the last wild spaces on our planet.

0:05:04.916,0:05:07.879
When we burn and plow[br]the Amazon rain forest

0:05:07.903,0:05:10.454
so that we can have[br]cheap land for ranching,

0:05:10.478,0:05:14.475
when the last of the African bush[br]gets converted to farms,

0:05:14.499,0:05:19.301
when wild animals in China[br]are hunted to extinction,

0:05:19.325,0:05:22.461
human beings come into contact[br]with wildlife populations

0:05:22.485,0:05:25.278
that they've never come[br]into contact with before,

0:05:25.302,0:05:28.290
and those populations[br]have new kinds of diseases:

0:05:28.314,0:05:31.685
bacteria, viruses,[br]stuff we're not ready for.

0:05:32.612,0:05:34.085
Bats, in particular,

0:05:34.109,0:05:37.378
have a knack for hosting illnesses[br]that can infect people,

0:05:37.402,0:05:39.589
but they're not[br]the only animals that do it.

0:05:40.610,0:05:45.250
So as long as we keep making[br]our remote places less remote,

0:05:45.274,0:05:47.238
the outbreaks are going to keep coming.

0:05:49.093,0:05:53.737
We can't stop the outbreaks[br]with quarantine or travel restrictions.

0:05:53.761,0:05:55.673
That's everybody's first impulse:

0:05:55.697,0:05:59.567
"Let's stop the people from moving.[br]Let's stop this outbreak from happening."

0:05:59.591,0:06:05.076
But the fact is, it's really hard[br]to get a good quarantine in place.

0:06:05.100,0:06:08.176
It's really hard[br]to set up travel restrictions.

0:06:08.200,0:06:11.848
Even the countries that have made[br]serious investments in public health

0:06:11.872,0:06:13.568
like the US and South Korea

0:06:13.592,0:06:16.281
can't get that kind of restriction[br]in place fast enough

0:06:16.305,0:06:18.588
to actually stop an outbreak instantly.

0:06:19.123,0:06:22.643
There's logistical reasons for that,[br]and there's medical reasons.

0:06:22.667,0:06:25.502
If you look at COVID-19 right now,

0:06:25.526,0:06:29.550
it seems like it could have a period[br]where you're infected and show no symptoms

0:06:29.574,0:06:31.668
that's as long as 24 days.

0:06:32.460,0:06:36.376
So people are walking around[br]with this virus showing no signs.

0:06:36.400,0:06:40.274
They're not going to get quarantined.[br]Nobody knows they need quarantining.

0:06:43.090,0:06:47.181
There's also some real costs to quarantine[br]and to travel restrictions.

0:06:47.940,0:06:49.679
Humans are social animals,

0:06:49.703,0:06:52.507
and they resist when you try[br]to hold them into place

0:06:52.531,0:06:54.217
and when you try to separate them.

0:06:54.727,0:07:00.695
We saw in the Ebola outbreak that as soon[br]as you put a quarantine in place,

0:07:00.719,0:07:03.126
people start trying to evade it.

0:07:03.150,0:07:07.202
Individual patients, if they know[br]there's a strict quarantine protocol,

0:07:07.226,0:07:09.354
may not go for health care,

0:07:09.378,0:07:12.823
because they're afraid of the medical[br]system or they can't afford care

0:07:12.847,0:07:16.134
and they don't want to be separated[br]from their family and friends.

0:07:16.158,0:07:18.074
Politicians, government officials,

0:07:18.098,0:07:20.561
when they know that they're[br]going to get quarantined

0:07:20.585,0:07:22.448
if they talk about outbreaks and cases,

0:07:22.472,0:07:26.903
may conceal real information for fear[br]of triggering a quarantine protocol.

0:07:27.522,0:07:31.271
And, of course, these kinds[br]of evasions and dishonesty

0:07:31.295,0:07:34.956
are exactly what makes it so difficult[br]to track a disease outbreak.

0:07:37.101,0:07:41.236
We can get better at quarantines[br]and travel restrictions, and we should,

0:07:41.260,0:07:44.356
but they're not our only option,[br]and they're not our best option

0:07:44.380,0:07:46.241
for dealing with these situations.

0:07:47.320,0:07:51.792
The real way for the long haul[br]to make outbreaks less serious

0:07:51.816,0:07:54.589
is to build the global health system

0:07:54.613,0:07:59.816
to support core health care functions[br]in every country in the world

0:07:59.840,0:08:02.284
so that all countries, even poor ones,

0:08:02.308,0:08:07.272
are able to rapidly identify and treat[br]new infectious diseases as they emerge.

0:08:08.375,0:08:13.064
China's taken a lot of criticism[br]for its response to COVID-19.

0:08:13.088,0:08:17.481
But the fact is, what if COVID-19[br]had emerged in Chad,

0:08:17.505,0:08:21.041
which has three and a half doctors[br]for every hundred thousand people?

0:08:21.999,0:08:25.000
What if it had emerged[br]in the Democratic Republic of the Congo,

0:08:25.024,0:08:29.169
which just released its last[br]Ebola patient from treatment?

0:08:29.193,0:08:32.170
The truth is, countries like this[br]don't have the resources

0:08:32.194,0:08:34.356
to respond to an infectious disease --

0:08:34.380,0:08:37.085
not to treat people[br]and not to report on it fast enough

0:08:37.109,0:08:38.773
to help the rest of the world.

0:08:40.878,0:08:45.795
I led an evaluation of Ebola[br]treatment centers in Sierra Leone,

0:08:45.819,0:08:48.922
and the fact is that[br]local doctors in Sierra Leone

0:08:48.946,0:08:51.917
identified the Ebola crisis very quickly,

0:08:51.941,0:08:54.897
first as a dangerous[br]contagious hemorrhagic virus

0:08:54.921,0:08:57.399
and then as Ebola itself.

0:08:57.423,0:09:01.555
But, having identified it,[br]they didn't have the resources to respond.

0:09:01.579,0:09:04.949
They didn't have enough doctors,[br]they didn't have enough hospital beds,

0:09:04.973,0:09:08.024
and they didn't have enough information[br]about how to treat Ebola

0:09:08.048,0:09:09.923
or how to implement infection control.

0:09:11.075,0:09:15.802
Eleven doctors died[br]in Sierra Leone of Ebola.

0:09:15.826,0:09:19.185
The country only had 120[br]when the crisis started.

0:09:19.885,0:09:21.353
By way of contrast,

0:09:21.377,0:09:25.446
Dallas Baylor Medical Center has[br]more than a thousand physicians on staff.

0:09:26.615,0:09:29.073
These are the kinds[br]of inequities that kill people.

0:09:29.451,0:09:32.196
First, they kill the poor people[br]when the outbreaks start,

0:09:32.220,0:09:34.668
and then they kill people[br]all over the world

0:09:34.692,0:09:36.238
when the outbreaks spread.

0:09:36.963,0:09:39.238
If we really want to slow down[br]these outbreaks

0:09:39.262,0:09:40.870
and minimize their impact,

0:09:40.894,0:09:43.985
we need to make sure[br]that every country in the world

0:09:44.009,0:09:46.873
has the capacity to identify new diseases,

0:09:46.897,0:09:48.155
treat them

0:09:48.179,0:09:50.860
and report about them so[br]they can share information.

0:09:52.445,0:09:55.936
COVID-19 is going to be[br]a huge burden on health systems.

0:09:56.517,0:09:59.990
COVID-19 has also revealed[br]some real weaknesses

0:10:00.014,0:10:01.811
in our global health supply chains.

0:10:02.399,0:10:07.133
Just-in-time-ordering, lean systems[br]are great when things are going well,

0:10:07.157,0:10:11.193
but in a time of crisis, what it means is[br]we don't have any reserves.

0:10:11.217,0:10:13.579
If a hospital -- or a country --

0:10:13.603,0:10:17.494
runs out of face masks[br]or personal protective equipment,

0:10:17.518,0:10:21.258
there's no big warehouse full of boxes[br]that we can go to to get more.

0:10:21.282,0:10:23.236
You have to order more from the supplier,

0:10:23.260,0:10:27.171
you have to wait for them to produce it,[br]and you have to wait for them to ship it,

0:10:27.195,0:10:28.357
generally, from China.

0:10:28.381,0:10:32.615
That's a time lag at a time[br]when it's most important to move quickly.

0:10:33.391,0:10:37.410
If we'd been perfectly[br]prepared for COVID-19,

0:10:37.434,0:10:40.961
China would have identified[br]the outbreak faster.

0:10:40.985,0:10:44.539
They would have been ready[br]to provide care to infected people

0:10:44.563,0:10:47.103
without having to build new buildings.

0:10:47.127,0:10:50.364
They would have shared[br]honest information with citizens

0:10:50.388,0:10:52.797
so that we didn't see these[br]crazy rumors spreading

0:10:52.821,0:10:54.798
on social media in China.

0:10:54.822,0:10:58.172
And they would have shared information[br]with global health authorities

0:10:58.196,0:11:01.097
so that they could start reporting[br]to national health systems

0:11:01.121,0:11:03.238
and getting ready[br]for when the virus spread.

0:11:03.959,0:11:07.055
National health systems would then[br]have been able to stockpile

0:11:07.079,0:11:08.856
the protective equipment they needed

0:11:08.880,0:11:12.669
and train health care providers[br]on treatment and infection control.

0:11:13.192,0:11:17.326
We'd have science-based protocols[br]for what to do when things happen,

0:11:17.350,0:11:19.377
like cruise ships have infected patients.

0:11:19.983,0:11:24.286
And we'd have real information[br]going out to people everywhere,

0:11:24.310,0:11:28.351
so we wouldn't see embarrassing,[br]shameful incidents of xenophobia,

0:11:28.375,0:11:32.694
like Asian-looking people getting attacked[br]on the street in Philadelphia.

0:11:33.403,0:11:35.187
But even with all of that in place,

0:11:35.211,0:11:37.673
we would still have outbreaks.

0:11:38.939,0:11:41.667
The choices we're making about[br]how we occupy this planet

0:11:41.691,0:11:42.996
make that inevitable.

0:11:44.003,0:11:48.308
As far as we have an expert consensus[br]on COVID-19, it's this:

0:11:49.006,0:11:51.292
here in the US, and globally,

0:11:51.316,0:11:53.749
it's going to get worse[br]before it gets better.

0:11:54.489,0:11:58.931
We're seeing cases of human transmission[br]that aren't from returning travel,

0:11:58.955,0:12:01.053
that are just happening in the community,

0:12:01.077,0:12:03.296
and we're seeing people[br]infected with COVID-19

0:12:03.320,0:12:06.508
when we don't even know[br]where the infection came from.

0:12:06.532,0:12:09.255
Those are signs of an outbreak[br]that's getting worse,

0:12:09.279,0:12:11.519
not an outbreak that's under control.

0:12:14.298,0:12:17.365
It's depressing, but it's not surprising.

0:12:18.150,0:12:19.362
Global health experts,

0:12:19.386,0:12:22.331
when they talk about[br]the scenario of new viruses,

0:12:22.355,0:12:24.953
this is one of the scenarios[br]that they look at.

0:12:24.977,0:12:27.549
We all hoped we'd get off easy,

0:12:27.573,0:12:30.958
but when experts[br]talk about viral planning,

0:12:30.982,0:12:34.850
this is the kind of situation and the way[br]they expect the virus to move.

0:12:36.727,0:12:39.508
I want to close here[br]with some personal advice.

0:12:40.524,0:12:41.836
Wash your hands.

0:12:42.442,0:12:44.838
Wash your hands a lot.

0:12:44.862,0:12:48.215
I know you already wash your hands a lot[br]because you're not disgusting,

0:12:48.239,0:12:50.445
but wash your hands even more.

0:12:50.469,0:12:54.422
Set up cues and routines in your life[br]to get you to wash your hands.

0:12:54.446,0:12:57.414
Wash your hands every time[br]you enter and leave a building.

0:12:57.438,0:13:01.142
Wash your hands when you go into a meeting[br]and when you come out of a meeting.

0:13:01.166,0:13:03.454
Get rituals that are based[br]around handwashing.

0:13:04.160,0:13:06.014
Sanitize your phone.

0:13:06.038,0:13:09.819
You touch that phone with your dirty,[br]unwashed hands all the time.

0:13:09.843,0:13:12.271
I know you take it[br]into the bathroom with you.

0:13:12.295,0:13:14.446
(Laughter)

0:13:15.264,0:13:20.314
So sanitize your phone and consider[br]not using it as often in public.

0:13:20.338,0:13:23.459
Maybe TikTok and Instagram[br]can be home things only.

0:13:24.550,0:13:25.857
Don't touch your face.

0:13:26.888,0:13:28.538
Don't rub your eyes.

0:13:28.562,0:13:30.014
Don't bite your fingernails.

0:13:30.038,0:13:32.210
Don't wipe your nose[br]on the back of your hand.

0:13:32.234,0:13:34.311
I mean, don't do that anyway[br]because, gross.

0:13:34.335,0:13:36.090
(Laughter)

0:13:36.114,0:13:37.669
Don't wear a face mask.

0:13:38.158,0:13:41.473
Face masks are for sick people[br]and health care providers.

0:13:41.497,0:13:45.409
If you're sick, your face mask[br]holds in all your coughing and sneezing

0:13:45.433,0:13:47.590
and protects the people around you,

0:13:47.614,0:13:49.433
and if you're a health care provider,

0:13:49.457,0:13:52.068
your face mask is one tool[br]in a set of tools

0:13:52.092,0:13:53.925
called personal protective equipment

0:13:53.949,0:13:56.810
that you're trained to use[br]so that you can give patient care

0:13:56.834,0:13:58.438
and not get sick yourself.

0:13:58.462,0:14:01.472
If you're a regular healthy person[br]wearing a face mask,

0:14:01.496,0:14:03.727
it's just making your face sweaty.

0:14:03.751,0:14:04.893
(Laughter)

0:14:04.917,0:14:07.314
Leave the face masks in stores

0:14:07.338,0:14:10.077
for the doctors and the nurses[br]and the sick people.

0:14:11.195,0:14:13.686
If you think you have[br]symptoms of COVID-19,

0:14:13.710,0:14:16.202
stay home, call your doctor for advice.

0:14:17.143,0:14:22.571
If you're diagnosed with COVID-19,[br]remember it's generally very mild.

0:14:22.595,0:14:24.056
And if you're a smoker,

0:14:24.080,0:14:26.948
right now is the best[br]possible time to quit smoking.

0:14:27.679,0:14:29.028
I mean, if you're a smoker,

0:14:29.052,0:14:32.469
right now is always the best[br]possible time to quit smoking,

0:14:32.493,0:14:35.359
but if you're a smoker[br]and you're worried about COVID-19,

0:14:35.383,0:14:39.133
I guarantee that quitting[br]is absolutely the best thing you can do

0:14:39.157,0:14:42.853
to protect yourself[br]from the worst impacts of COVID-19.

0:14:44.846,0:14:47.345
COVID-19 is scary stuff,

0:14:47.369,0:14:51.548
at a time when pretty much all of our news[br]feels like scary stuff.

0:14:52.099,0:14:57.093
And there's a lot of bad-but-appealing[br]options for dealing with it:

0:14:57.117,0:15:02.405
panic, xenophobia,[br]agoraphobia, authoritarianism,

0:15:02.429,0:15:07.243
oversimplified lies that make us think[br]that hate and fury and loneliness

0:15:07.267,0:15:09.420
are the solution to outbreaks.

0:15:09.444,0:15:10.658
But they're not.

0:15:10.682,0:15:12.784
They just make us less prepared.

0:15:13.356,0:15:17.566
There's also a boring[br]but useful set of options

0:15:17.590,0:15:20.302
that we can use in response to outbreaks,

0:15:20.326,0:15:23.724
things like improving health care[br]here and everywhere;

0:15:23.748,0:15:26.943
investing in health infrastructure[br]and disease surveillance

0:15:26.967,0:15:29.302
so that we know[br]when the new diseases come;

0:15:29.326,0:15:32.268
building health systems[br]all over the world;

0:15:32.292,0:15:36.863
looking at strengthening our supply chains[br]so they're ready for emergencies

0:15:36.887,0:15:39.015
and better education,

0:15:39.039,0:15:43.524
so we're capable of talking about disease[br]outbreaks and the mathematics of risk

0:15:43.548,0:15:45.845
without just blind panic.

0:15:46.790,0:15:48.917
We need to be guided by equity here,

0:15:48.941,0:15:51.257
because in this situation, like so many,

0:15:51.281,0:15:54.514
equity is actually[br]in our own self-interest.

0:15:55.727,0:15:58.429
So thank you so much[br]for listening to me today,

0:15:58.453,0:16:00.350
and can I be the first one to tell you:

0:16:00.374,0:16:02.540
wash your hands[br]when you leave the theater.

0:16:02.564,0:16:04.873
(Applause)