Placeholder Image

字幕列表 影片播放

  • Transcriber: Theresa Ranft Reviewer: Peter van de Ven

  • 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 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 1 to 10 -

  • 1 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 7 or an 8.

  • 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,

  • and 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,

  • and 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 East respiratory syndrome,

  • those were coronaviruses,

  • and they're both called respiratory syndromes

  • because that's what coronaviruses do.

  • They go for your lungs.

  • 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

  • that 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 like 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 into 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's 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 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 3.5 doctors for every 100,000 people?

  • What if it had emerged in the Democratic Republic of 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 or 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 1,000 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.

  • I'm not going to talk about death rates in this talk

  • because, frankly, nobody can agree on the COVID-19 death rates right now.

  • But one number we can agree on

  • is that about 20% of people infected with COVID-19

  • are going to need hospitalization.

  • Our US medical system can just barely cope with that.

  • But what's going to happen in Mexico?

  • 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 get more.

  • You have to order more from the supplier, 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 as xenophobia,

  • like Asian-looking people getting attacked on the street in Philadelphia.

  • But even with all 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</