Why COVID-19 is hitting us now -- and how to prepare for the next outbreak

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 COVID-19.

(Laughter)

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 in 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 10,

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 COVID-19.

So, COVID-19 is a coronavirus.

Coronaviruses are
a specific subset of virus,

and they have some unique
characteristics as viruses.

They use RNA instead of DNA
as their genetic material,

and they're covered in spikes
on the surface of the virus.

They use those spikes to invade cells.

Those spikes are the corona
in coronavirus.

COVID-19 is known as a novel coronavirus

because, until December,
we'd only heard of six coronaviruses.

COVID-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 novel.

If you remember SARS,
Severe Acute Respiratory Syndrome,

or MERS,

Middle Eastern Respiratory Syndrome,

those were coronaviruses.

And they're both called
respiratory syndromes

because that's what coronaviruses 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.

COVID-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
COVID-19 but so gently,

their symptoms are so mild, they don't
even go to a health care provider.

They don't register in the system.

Children, in particular, have it
very easy with COVID-19,

which is something
we should all be grateful for.

Coronaviruses are zoonotic,

which means that they transmit
from animals to people.

Some coronaviruses, like COVID-19,
also transmit person to person.

The person-to-person ones
travel faster and travel farther,

just liked COVID-19.

Zoonotic 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 avian influenza
doesn't transmit person-to-person,

but we have outbreaks in poultry farms
every year all over the world.

COVID-19 most likely skipped
from animals into people

at a wild animal market in Wuhan, China.

Now for the less basic parts.

This is not the last major outbreak
we're ever going to 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 about climate change

and the way a 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 rain forest

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 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 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 US 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 COVID-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 signs.

They're not going to get quarantined.
Nobody knows they need quarantining.

There's also some real costs to quarantine
and to 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 and cases,

may conceal real information for fear
of triggering a quarantine protocol.

And, of course, these kinds
of evasions and dishonesty

are exactly what 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 health care 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 COVID-19.

But the fact is, what if COVID-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 the 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 that
local doctors in Sierra Leone

identified the Ebola crisis very quickly,

first as a dangerous
contagious hemorrhagic virus

and then as Ebola 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.

Eleven 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.

COVID-19 is going to be
a huge burden on health systems.

COVID-19 has also revealed
some real weaknesses

in our global health supply chains.

Just-in-time-ordering, 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 COVID-19,

China would have identified
the outbreak faster.

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
have been able to stockpile

the protective equipment they needed

and train health care 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 attacked
on the street in Philadelphia.

But even with all of that in place,

we would still have outbreaks.

The choices we're making about
how we occupy this planet

make that inevitable.

As far as we have an expert consensus
on COVID-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 from returning travel,

that are just happening in the community,

and we're seeing people
infected with COVID-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 want 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 that are based
around handwashing.

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.

(Laughter)

So sanitize your phone and consider
not using it as often in public.

Maybe TikTok and Instagram
can be home things only.

Don't touch your face.

Don't rub your eyes.

Don't bite your fingernails.

Don't wipe your nose
on the back of your hand.

I mean, don't do that anyway
because, gross.

(Laughter)

Don't wear a face mask.

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.

(Laughter)

Leave the face masks in stores

for the doctors and the nurses
and the sick people.

If you think you have
symptoms of COVID-19,

stay home, call your doctor for advice.

If you're diagnosed with COVID-19,
remember it's generally very mild.

And if you're a smoker,

right now is 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 COVID-19,

I guarantee that quitting
is absolutely the best thing you can do

to protect yourself
from the worst impacts of COVID-19.

COVID-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,
agoraphobia, authoritarianism,

oversimplified lies that make us think
that hate and fury and loneliness

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 chains
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 to me today,

and can I be the first one to tell you:

wash your hands
when you leave the theater.

(Applause)