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[As of the morning February 27,2020,
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there were at least 82,000 confirmed
cases worldwide of the coronavirus
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and 2,810 deaths from it.
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TED invited Dr. David Heymann to share
the latest findings about the outbreak.]
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[What happens if you get infected
with the coronavirus?]
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This looks like a very mild disease,
like a common cold,
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in the majority of people.
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There are certain people who get infected
and have very serious illness;
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among them are health workers.
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It's a very serious infection in them,
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as they get a higher dose
than normal people,
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and at the same time,
they have no immunity.
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So in the general population,
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it's likely that the dose of virus
that you receive when you are infected
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is much less than the dose
that a health worker would receive,
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health workers having
more serious infections.
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So your infection
would be less serious, hopefully.
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So that leaves the elderly
and those with comorbidities
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to really be the ones
that we have to make sure
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are taken care of in hospitals.
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[Who are the people who should be
most concerned about this?]
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Well, the most concerned are people
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who are, first of all,
in developing countries,
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and who don't have access
to good medical care,
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and may not have access
at all to a hospital,
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should an epidemic occur in their country.
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Those people would be at great risk,
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especially the elderly.
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Elderly in all populations are at risk,
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but especially those
who can't get to oxygen.
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In industrialized countries,
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it's the very elderly
who have comorbidities,
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who have diabetes,
who have other diseases,
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who are at risk.
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The general population
doesn't appear to be at great risk.
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[What preexisting medical conditions
put people at higher risk?]
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First of all,
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pulmonary disease existing
as a comorbidity is also important.
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In general, the elderly
are at greater risk,
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especially those over 70,
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because their immune systems
are not as effective
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as they might have once been,
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and they are more
susceptible to infections.
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In addition, in some instances in China,
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there's been a coinfection with influenza
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and at the same time,
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there have been some
bacterial superinfections
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on the pneumonias that are occurring.
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[Where can we find
up-to-date information?]
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The Center for Disease Control
in Atlanta keeps track,
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and has updates on a regular
basis on its website.
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Also, the World Health
Organization in Geneva,
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which is coordinating many
of the activities
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going on internationally,
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also has a website with daily updates.
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It's our responsibility
to get that information as individuals,
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so we understand
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and can make sure that we can
contribute in our own way
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to prevention of major spread.
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[You led the global response
to the SARS outbreak in 2003.
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How does this outbreak compare?]
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That's the same problem
with all new infections.
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This is an infection
that's coming to humans
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who have never been exposed
to this virus before.
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They don't have any antibody protection,
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and it's not clear whether
their immune system
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can handle this virus or not.
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This is a virus that usually finds itself
in bats or in other animals,
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and all of a sudden, it's in humans.
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And humans just don't have
experience with this virus.
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But gradually,
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we are beginning to learn a lot,
as we did with SARS.
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And you know, there are certainly
a larger number of deaths
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than there were with SARS.
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But when you divide that by a denominator
of persons who are infected,
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there are many, many more persons infected
than there were with SARS.
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The case fatality ratio,
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that is the ratio of deaths
to the numbers of cases in SARS,
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was about 10 percent.
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With the current coronavirus, COVID-19,
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it is two percent or probably less.
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So it's a much less virulent virus,
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but it's still a virus
that causes mortality,
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and that's what we don't want
entering human populations.
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[Have we responded adequately
at border crossings, such as airports?]
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It's clearly understood
that airports or any land borders
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cannot prevent a disease from entering.
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People in the incubation period
can cross that border,
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can enter countries,
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and can then infect others
when they become sick.
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So borders are not a means of preventing
infections from entering a country
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by checking temperatures.
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Borders are important because
you can provide to people arriving
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from areas that might be at risk
of having had infection,
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provide them with an understanding,
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either a printed understanding
or a verbal understanding,
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of what the signs and symptoms are
of this infection,
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and what they should do
if they feel that they might be infected.
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[What's the time line for a vaccine?]
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Vaccines are under development right now,
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there's a lot of research going on.
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That research requires first
that the vaccine be developed,
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then that it be studied for safety
and effectiveness in animals,
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who are challenged with the virus
after they are vaccinated,
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and then it must go into human studies.
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The animal studies have not yet begun,
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but will soon begin for certain vaccines.
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And it's thought
that by the end of the year,
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or early next year,
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there may be some candidate vaccines
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that can then be studied for licensing
by regulatory agencies.
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So we're talking about at least a year
until there's vaccine available
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that can be used in many populations.
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[What questions about the outbreak
are still unanswered?]
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It's clear we know how it transmits,
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we don't know how easily
it transmits in humans,
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in communities or in unenclosed areas.
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We know, for example,
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that in the enclosed area
of a cruise ship, it spread very easily.
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We need to better understand
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how it will spread once it gets
into more open areas
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where people are exposed
to people who might be sick.
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[What about the global response
could be improved?]
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A major problem in the world today
is that we look at outbreaks
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in developing countries
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as something that we need to go and stop.
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So when there's an outbreak of Ebola,
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we think, "How can we go
and stop this outbreak in the country."
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We don't think about
"How can we help that country
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strengthen its capacity
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so that it can detect
and respond to infections."
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So we haven't invested enough
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in helping countries develop
their core capacity in public health.
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What we've done is invested
in many mechanisms globally
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which can provide support
to other countries
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to go and help stop outbreaks.
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But we want to see a world
where every country
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can do its best to stop its own outbreaks.
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[Will we see more emerging
disease outbreaks in the future?]
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Today, there are over
seven billion people.
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And when those people come into the world,
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they demand more food,
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they demand a whole series of things,
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and they live closer together.
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In fact, we're in an urban world,
where people live in urban areas.
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And at the same time,
we're growing more animals,
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and those animals are contributing
food to humans as well.
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So what we see
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is that that animal-human interface
is becoming closer and closer together.
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And this intensive agriculture of animals,
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and this intensive increase
in human populations
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living together on the same planet
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is really a melting pot
where outbreaks can occur and do occur.
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We will eventually have
more and more of these outbreaks.
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So an emerging infection today
is just a warning
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of what will happen in the future.
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We have to make sure
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that that technical
collaboration in the world
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is there to work together
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to make sure that we can understand
these outbreaks when they occur,
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and rapidly provide the information
necessary to control them.
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[Is the worst behind us?]
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I can't predict with accuracy.
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So all I can say
is that we must all be prepared
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for the worst-case scenario.
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And at the same time,
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learn how we can protect ourselves
and protect others
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should we become a part of that epidemic.
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