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  • Transcriber: Ivana Korom Reviewer: Krystian Aparta

  • Helen Walters: So, Chris, who's up first?

  • Chris Anderson: Well, we have a man who's worried about pandemics

  • pretty much his whole life.

  • He played an absolutely key role, more than 40 years ago,

  • in helping the world get rid of the scourge of smallpox.

  • And in 2006,

  • he came to TED to warn the world

  • of the dire risk of a global pandemic,

  • and what we might do about it.

  • So please welcome here Dr. Larry Brilliant.

  • Larry, so good to see you.

  • Larry Brilliant: Thank you, nice to see you.

  • CA: Larry, in that talk,

  • you showed a video clip that was a simulation

  • of what a pandemic might look like.

  • I would like to play it -- this gave me chills.

  • Larry Brilliant (TED2006): Let me show you a simulation

  • of what a pandemic looks like,

  • so we know what we're talking about.

  • Let's assume, for example, that the first case occurs in South Asia.

  • It initially goes quite slowly,

  • you get two or three discrete locations.

  • Then there will be secondary outbreaks.

  • And the disease will spread from country to country so fast

  • that you won't know what hit you.

  • Within three weeks, it will be everywhere in the world.

  • Now if we had an undo button,

  • and we could go back

  • and isolate it and grab it when it first started,

  • if we could find it early and we had early detection

  • and early response,

  • and we could put each one of those viruses in jail,

  • that's the only way to deal with something like a pandemic.

  • CA: Larry, that phrase you mentioned there,

  • "early detection," "early response,"

  • that was a key theme of that talk,

  • you made us all repeat it several times.

  • Is that still the key to preventing a pandemic?

  • LB: Oh, surely.

  • You know, when you have a pandemic,

  • something moving at exponential speed,

  • if you miss the first two weeks, if you're late the first two weeks,

  • it's not the deaths and the illness from the first two weeks you lose,

  • it's the two weeks at the peak.

  • Those are prevented if you act early.

  • Early response is critical,

  • early detection is a condition precedent.

  • CA: And how would you grade the world

  • on its early detection, early response to COVID-19?

  • LB: Of course, you gave me this question earlier,

  • so I've been thinking a lot about it.

  • I think I would go through the countries,

  • and I've actually made a list.

  • I think the island republics of Taiwan, Iceland and certainly New Zealand

  • would get an A.

  • The island republic of the UK and the United States --

  • which is not an island, no matter how much we may think we are --

  • would get a failing grade.

  • I'd give a B to South Korea and to Germany.

  • And in between ...

  • So it's a very heterogeneous response, I think.

  • The world as a whole is faltering.

  • We shouldn't be proud of what's happening right now.

  • CA: I mean, we got the detection pretty early,

  • or at least some doctors in China got the detection pretty early.

  • LB: Earlier than the 2002 SARS, which took six months.

  • This took about six weeks.

  • And detection means not only finding it,

  • but knowing what it is.

  • So I would give us a pretty good score on that.

  • The transparency, the communication -- those are other issues.

  • CA: So what was the key mistake

  • that you think the countries you gave an F to made?

  • LB: I think fear,

  • political incompetence, interference,

  • not taking it seriously soon enough --

  • it's pretty human.

  • I think throughout history,

  • pretty much every pandemic is first viewed with denial and doubt.

  • But those countries that acted quickly,

  • and even those who started slow, like South Korea,

  • they could still make up for it, and they did really well.

  • We've had two months that we've lost.

  • We've given a virus that moves exponentially

  • a two-month head start.

  • That's not a good idea, Chris.

  • CA: No, indeed.

  • I mean, there's so much puzzling information still out there

  • about this virus.

  • What do you think the scientific consensus is going to likely end up being

  • on, like, the two key numbers

  • of its infectiousness and its fatality rate?

  • LB: So I think the kind of equation to keep in mind

  • is that the virus moves dependent on three major issues.

  • One is the R0,

  • the first number of secondary cases that there are when the virus emerges.

  • In this case,

  • people talk about it being 2.2, 2.4.

  • But a really important paper three weeks ago,

  • in the "Emerging Infectious Diseases" journal came out,

  • suggesting that looking back on the Wuhan data,

  • it's really 5.7.

  • So for argument's sake,

  • let's say that the virus is moving at exponential speed

  • and the exponent is somewhere between 2.2 and 5.7.

  • The other two factors that matter

  • are the incubation period or the generation time.

  • The longer that is,

  • the slower the pandemic appears to us.

  • When it's really short, like six days, it moves like lightning.

  • And then the last, and the most important --

  • and it's often overlooked --

  • is the density of susceptibles.

  • This is a novel virus,

  • so we want to know how many customers could it potentially have.

  • And as it's novel, that's eight billion of us.

  • The world is facing a virus

  • that looks at all of us like equally susceptible.

  • Doesn't matter our color, our race,

  • or how wealthy we are.

  • CA: I mean, none of the numbers that you've mentioned so far

  • are in themselves different from any other infections in recent years.

  • What is the combination that has made this so deadly?

  • LB: Well, it is exactly the combination

  • of the short incubation period and the high transmissibility.

  • But you know, everybody on this call has known somebody who has the disease.

  • Sadly, many have lost a loved one.

  • This is a terrible disease when it is serious.

  • And I get calls from doctors in emergency rooms

  • and treating people in ICUs all over the world,

  • and they all say the same thing:

  • "How do I choose who is going to live and who is going to die?

  • I have so few tools to deal with."

  • It's a terrifying disease,

  • to die alone with a ventilator in your lungs,

  • and it's a disease that affects all of our organs.

  • It's a respiratory disease --

  • perhaps misleading.

  • Makes you think of a flu.

  • But so many of the patients have blood in their urine

  • from kidney disease,

  • they have gastroenteritis,

  • they certainly have heart failure very often,

  • we know that it affects taste and smell, the olfactory nerves,

  • we know, of course, about the lung.

  • The question I have:

  • is there any organ that it does not affect?

  • And in that sense,

  • it reminds me all too much of smallpox.

  • CA: So we're in a mess.

  • What's the way forward from here?

  • LB: Well, the way forward is still the same.

  • Rapid detection,

  • rapid response.

  • Finding every case,

  • and then figuring out all the contacts.

  • We've got great new technology for contact tracing,

  • we've got amazing scientists working at the speed of light

  • to give us test kits and antivirals and vaccines.

  • We need to slow down,

  • the Buddhists say slow down time

  • so that you can put your heart, your soul, into that space.

  • We need to slow down the speed of this virus,

  • which is why we do social distancing.

  • Just to be clear --

  • flattening the curve, social distancing,

  • it doesn't change the absolute number of cases,

  • but it changes what could be a Mount Fuji-like peak

  • into a pulse,

  • and then we won't also lose people because of competition for hospital beds,

  • people who have heart attacks, need chemotherapy, difficult births,

  • can get into the hospital,

  • and we can use the scarce resources we have,

  • especially in the developing world,

  • to treat people.

  • So slow down,

  • slow down the speed of the epidemic,

  • and then in the troughs, in between waves,

  • jump on, double down, step on it,

  • and find every case,

  • trace every contact,

  • test every case,

  • and then only quarantine the ones who need to be quarantined,

  • and do that until we have a vaccine.

  • CA: So it sounds like we have to get past the stage of just mitigation,

  • where we're just trying to take a general shutdown,

  • to the point where we can start identifying individual cases again

  • and contact-trace for them

  • and treat them separately.

  • I mean, to do that,

  • that seems like it's going to take a step up of coordination,

  • ambition, organization, investment,

  • that we're not really seeing the signs of yet in some countries.

  • Can we do this, how can we do this?

  • LB: Oh, of course we can do this.

  • I mean, Taiwan did it so beautifully,

  • Iceland did it so beautifully, Germany,

  • all with different strategies,

  • South Korea.

  • It really requires competent governance,

  • a sense of seriousness,

  • and listening to the scientists, not the politicians following the virus.

  • Of course we can do this.

  • Let me remind everybody --

  • this is not the zombie apocalypse,

  • it's not a mass extinction event.

  • You know, 98, 99 percent of us are going to get out of this alive.

  • We need to deal with it the way we know we can,

  • and we need to be the best version of ourselves.

  • Both sitting at home

  • as well as in science, and certainly in leadership.

  • CA: And might there be even worse pathogens out there

  • in the future?

  • Like, can you picture or describe

  • an even worse combination of those numbers

  • that we should start to get ready for?

  • LB: Well, smallpox had an R0 of 3.5 to 4.5,

  • so that's probably about what I think this COVID will be.

  • But it killed a third of the people.

  • But we had a vaccine.

  • So those are the different sets that you have.

  • But what I'm mostly worried about,

  • and the reason that we made "Contagion"

  • and that was a fictional virus --

  • I repeat, for those of you watching,

  • that's fiction.

  • We created a virus that killed a lot more than this one did.

  • CA: You're talking about the movie "Contagion"

  • that's been trending on Netflix.

  • And you were an advisor for.

  • LB: Absolutely, that's right.

  • But we made that movie deliberately

  • to show what a real pandemic looked like,

  • but we did choose a pretty awful virus.

  • And the reason we showed it like that,

  • going from a bat to an apple,

  • to a pig, to a cook, to Gwyneth Paltrow,

  • was because that is in nature what we call spillover,

  • as zoonotic diseases,

  • diseases of animals, spill over to human beings.

  • And if I look backwards three decades

  • or forward three decades --

  • looking backward three decades, Ebola, SARS, Zika,

  • swine flu, bird flu, West Nile,