How South Korea prevented a coronavirus disaster—and why the battle isn’t over

How South Korea prevented a coronavirus disaster—and why the ...

The nation beat back COVID-19 with more than its large number of tests. Can it maintain this success?

The COVID-19 testing center at H Plus Yangji Hospital in southern Seoul doesn’t look like much from the outside. Resembling a mobile home, the temporary building sits in a parking lot near a loading ramp, propped up on one end by a wooden plank. Its walls are wrapped in red and white, and billboard-like signage proclaims that the hospital was named one of the 100 best in the Republic of Korea.

But inside is a gleaming bank of four booths with transparent plastic walls; rubber gloves embedded through them in a manner similar to a high-grade biosafety lab. When a person walks into a booth, they consult over an intercom with a doctor who remains outside. The doctor can swab their nose and throat using the gloves without ever coming into contact with the patient. The booths maintain negative air pressure, which sucks in any virus-carrying airborne droplets. After the test, a staff member in protective gear disinfects the booth, scrubbing the walls with a squeegee.

Hundreds of similar “walk-in” testing booths located all over the country have been one of the pillars of South Korea’s highly successful strategy to contain COVID-19, helping officials roll out rapid and extensive diagnostic testing.

The nation of 51 million people has also taken a big data approach to contact tracing, using credit card history and location data from cell phone carriers to retrace the movements of infected people. Surveys show most Korean citizens are OK with sacrificing digital privacy to stop an outbreak. At the same time, authorities have pushed an intense—but mostly voluntary—social distancing campaign, leaving most bars, restaurants, and movie theaters free to operate.

The viral scourge is far from over in South Korea—a recent outbreak connected to several nightclubs was reported with 102 cases as of May 12. Despite this, the country’s response could serve as a model for the rest of the world, but achieving this level of speedy success in the face of a pandemic was not easy.

Lessons from the past

A major factor shaping South Korea’s response was its ability to apply lessons learned during previous outbreaks, especially the country’s MERS coronavirus outbreak in 2015, which resulted in 186 cases and 38 deaths.

In the immediate aftermath, South Korea’s legislature created the legal foundation for a comprehensive strategy for contact tracing—whereby anyone who has interacted with an infected person is traced and placed in quarantine. Amendments explicitly authorized health authorities to request patients’ transaction history from credit card companies and location data from cell phone carriers—and to release the reconstructed movements in the form of anonymous “travel logs” so people could learn the times and places where they might have been exposed.

A huge push with contact tracing and testing managed to corral an early rise in cases that threatened to spiral out of control—hundreds were reported each day, peaking at 909 cases on February 29 with most associated with a religious sect in the city of Daegu. The strategy also managed to snuff out several subsequent coronavirus clusters at churches, computer gaming cafes, and a call center. By April 15, South Korea safely held a national election, in which 29 million people participated. Voters wore masks and gloves; polling centers took everyone’s temperature and separated anyone with a fever. No cases have been traced to the election.

While people in other countries may consider Korea’s data collection a violation of patient privacy, the measures have broad support from the South Korean public. In a March 4 poll led by the Seoul National University Graduate School of Public Health, 78 percent of 1,000 respondents agreed that human rights protections should be eased to strengthen virus containment efforts. Experience with past outbreaks also meant people were quick to stay at home and wear masks in public even before the government began issuing formal guidelines.

Crucially, South Korea had built up its diagnostic testing capabilities after the 2015 MERS outbreak. Unlike the U.S., which relied on testing kits developed by its Centers for Disease Control and Prevention (CDC) in Atlanta, South Korea enlisted the private sector. At a meeting in late January, officials urged local biotech companies to develop testing kits. Within a month, the nation was running more than 10,000 tests daily.

A recent boom in South Korea’s biotech scene, long predating the pandemic, helped with the ramp-up, says Thomas Shin, the CEO of TCM Biosciences, a company in Pangyo, south of Seoul. “During the last five years, there were many new bioscience companies,” says Shin. TCM was one of the companies that heeded the government’s call to develop kits, and it received approval from the country’s Ministry of Food and Drug Safety in April.

Shin says the decision wasn’t necessarily an easy one from a business perspective—new diseases are difficult to forecast, and if they’re snuffed out quickly, it can be hard to recoup the costs of initial development. But with South Korea’s close connections to the outbreak’s epicenter in China, Shin says TCM could see a similar situation developing rapidly on the home front—and projected a business opportunity in the global market. So far, the company has shipped kits worth roughly $2.6 million.

On April 30, the nation reported just four cases, all of them travelers arriving from abroad, marking the first day with zero local infections in two and a half months. As case numbers have continued to fall, the government has cautiously relaxed its guidelines, while signaling a shift to “everyday quarantine” measures, such as wearing masks and temperature checks at schools.

People’s attitudes have also relaxed, leading some officials to worry about complacency and a second wave of infections. The nightclub outbreak may heighten those fears, but the government has already responded aggressively, tracing and testing thousands of people in a matter of days.

Last mile is the toughest

Though testing companies were quick to respond to the demand, rolling out the kits presented difficulties. Through February, demand for tests was still outpacing supply, and there were only enough kits to distribute to a select number of hospitals.

Furthermore, hospitals struggled to administer the tests to potentially contagious patients safely and quickly—testing areas needed to be sanitized after each patient, long queues meant the virus could spread while people waited in line, and health workers were running low on protective gear. At Yangji Hospital, this also led to exhausted staff, says hospital director Sang Il Kim.

“Even when we did have kits, the waiting times were just too long for everybody to get tested, so they would have to go to other hospitals,” adds Yoona Chung, a doctor in the hospital’s surgery department.

According to Yangji’s data, the hospital was conducting roughly 10 tests a day by late February—but many more were being turned away due to the wait. Other hospitals in Korea started experimenting with drive-through testing centers, where patients could get tested without leaving their cars. But Yangji Hospital is near a subway station in a crowded neighborhood in southern Seoul; for many of its patients, cars aren’t an option.

So, Kim devised the walk-in booths, which went into pilot operation on March 10. Within days, the number of tests administered in a day had tripled. By the end of the month, the hospital could handle more than 90 patients a day. Hospitals elsewhere in Korea and around the world quickly adopted their own variations on the concept. A hospital in Busan had a similar idea independently but others have had help from Kim.

At Massachusetts General Hospital in Boston, hospital leadership saw news reports on Yangji’s booths and asked an in-house team to create a version, hoping to better protect their health workers and conserve precious protective gear. A bit of Googling and two phone calls later, hospital staff connected her with Kim via email.

“I remember it was 10 p.m., we’re all frustrated, up all night, trying to figure out how to make this work,” says Nour Al-Sultan, a business strategy analyst at the MGH Springboard Studio, the team of researchers and designers tasked with reverse engineering the booths. “I go to bed, and I wake up the next morning, and Dr. Kim is the one who answers all of my questions.”

MGH has now installed about eight booths at three hospitals in the Boston region. According to preliminary data, they’ve reduced the need for protective gowns, which are in short supply, by 96 percent, saving more than 500 gowns a week. The MGH team is now working with colleagues in Uganda to help them develop their own versions of the booths.

“The fact that he took the time to provide me with such generous insights is just a testament to this spirit of global collaboration against the pandemic,” Al-Sultan says.





How the CFO enables the board’s success—during COVID-19 and beyond

How the CFO can guide the board through crises and transformations ...

Two board experts explain how in times of crisis or transformation, the CFO can serve as a rock in the boardroom, a critical arbiter of difficult decisions, and a scout for the future.

Critical business decisions cannot be made unless management teams and boards of directors are on the same page. Transparency, fair and balanced dialogue, and well-structured processes for gaining agreement on strategic plans—these dynamics must be present in every boardroom, in good times and, especially, in bad.

The CFO plays an important role in ensuring that they are.

In crises, such as the global spread of the novel coronavirus, the CFO is best-positioned to provide the most relevant and up-to-date facts and figures, which can help boards find clarity amid chaos. In corporate transformations, the pragmatic, data-focused finance leader is the only one who can prompt the board to actively consider all the short- and long-term consequences of proposed strategy decisions.

Barbara Kux and Rick Haythornthwaite, longtime board directors for multiple global organizations, shared these and other board-related insights with McKinsey senior partner Vivian Hunt in a conversation that spanned two occasions: a gathering of CFOs in London some months ago and, more recently, follow-up phone conversations about the COVID-19 pandemic.

These interviews, which have been condensed and edited here, explained the importance of finance leaders in serving both as scouts for the future and as trusted translators of critical market information.

Shaping the COVID-19 crisis response and recovery

Rick Haythornthwaite: The board’s most important functions in the wake of COVID-19 are threefold: one is making sure that employees are being treated decently and that the company is taking all the precautions it can. Second is obtaining an objective, insightful understanding of the business and trends. And third is anticipating and preparing for recovery. The key in all three areas is having high-quality data to inform the board’s decisions and to share with employees. Of course, getting data from a market in freefall is never easy. This is where you need CFOs to be absolutely on top of their game.

The board needs to know what is really happening to the top line, what short-term measures can be taken to preserve and boost cash, and all the actions you have to take during the early stage of such events to buy time. But the board must also have a handle on long-term issues.1 And now that we’re months into this crisis, people are starting to draw lessons from previous ones and bringing some historical data into board discussions. The CFO can use these data to construct hard-edge scenarios that prompt good conversations in the boardroom.

Barbara Kux: An important difference in the role of CFOs today, as compared with their role during the financial crisis in 2008, is that they need to simultaneously manage both short-term responsiveness and future recovery. The CFO must keep the ship floating through rough waters—safeguarding employees’ health, securing liquidity, monitoring cash flow and payment terms, ensuring the functioning of the supply chain, assessing effects on P&L and the balance sheet, reviewing customers’ and suppliers’ situations, and initiating cost-reduction programs. That is all very challenging indeed. But then the CFO must also serve as the ship’s scout—watching for key trends that are emerging or that have accelerated as a result of COVID-19, such as digitization and changes in consumer behavior.

The balance between opportunity and risk is being altered substantially for most companies. The CEO could be tempted to profit from immediate demands—“let’s make ventilators, let’s make disinfectants.” The CFO’s job, by contrast, is to point out the differences between quick-to-market options and long-term post-COVID-19 options. These post-COVID-19 options can be an important factor in motivating and engaging employees during these challenging times.

It is also important for the CFO to present the board with reports and pre-reads that paint the entire picture in an objective way, including potential scenarios for the future. That is the only way boards and senior management can take thoughtful and well-founded decisions—first for the recovery and then for a sustainable future for all stakeholders. The word “crisis” has two meanings, one being “danger” and the other being “chance.” Today’s CFO must consider both.

The word ‘crisis’ has two meanings, one being ‘danger’ and the other being ‘chance.’ Today’s CFO must consider both.

Shaping the general transformation agenda

Barbara Kux: Outside of crisis periods, studies by INSEAD and McKinsey show, boards spend more than two-thirds of their time on “housekeeping”—financial reporting, compliance, environment, health and safety issues, regulatory issues, and the like. Only about 20 percent is spent on strategy. It is very important for boards to get out of this “compliance cage,” as I call it, and really focus on sustainable value creation. I’m thinking of the board of a leading oil and gas company that did just that. It recognized the importance of sustainable business development early on. The company gained first-mover advantages by diversifying toward a green business, including investing in solar and battery technologies.

At the end of the day, the board is ultimately responsible for the strategy, and the CFO is best-positioned to support strategy discussions. The finance leader can serve as a neutral party among the members of the C-suite, synthesizing their transformation ideas, supplementing them with comprehensive quantitative and qualitative data, and then working with the CEO to bring it all back to the board. This is even more important today to respond to COVID-19–related challenges early on.

Rick Haythornthwaite: The biggest challenge for any CEO, CFO, or other senior leader is to institutionalize new ideas without sucking the life out of them. Each C-suite leader plays a different but important role in this regard. The CFO needs to give transformation initiatives structure and rigor, while the CEO is probably better suited to take on the motivational aspects—for instance, the context for change and definitions of success. The whole team creates the strategy map—the markets and products affected, changes in pricing, the execution plan. But the CFO needs to ensure that the financial and operational underpinnings are there. Even if they are not visible to every single part of the organization, the board can see them through the CFO.

‘Scouting for the future’

Barbara Kux: To serve as an effective scout, the CFO should establish nonfinancial KPIs, like net promoter and employee-engagement scores, that are critical for the future health and performance of the organization. CFOs should review the strategy process to see that risks and opportunities are being well-assessed. And they can raise the political antennae of the board—accessing global think tanks, for instance, to understand what’s going on in Washington, China, and other important regions or in the medical community. The CEO often is not the most long-term–focused person in the organization; we know this because our financial markets are still very much short-term oriented. The board has to be long-term oriented. The CFO, therefore, must maintain a good balance of both. That might mean introducing a lean-transformation program with a focus on short-term results while, at the same time, contributing to the definition and implementation of a sustainable strategy for the company to emerge strong from the COVID-19 pandemic.

Rick Haythornthwaite: Boards need CEOs who can handle multiple truths, who can be expansive in thinking, and who can live comfortably in the future and bring the company along for the ride. The CFO also needs to be a protagonist in the boardroom, but from a different base: you can’t move to the future until you are anchored in the present. The CFO provides that anchor. Having a balance between future and present, between CEO and CFO, is important. The board wants to feel that there is strategic momentum—but also that the company is not just heading off on a journey of delusion.

Daring to dissent

Barbara Kux: It is important for the CEO and CFO to get on well, but their relationship should not be too close. It is better for the CFO to be objective, even if that sometimes leads to constructive conflicts. At times the CEO defaults to presenting only the positive in the boardroom, which makes it harder for the CFO to play back a more objective story. But that is very much the role of CFOs. They need to raise those early warnings. As a board director, I feel better if the CFO sometimes states, “by the way, we are losing market share here.” It takes a great deal of self-assurance for the CFO to come into the boardroom and say something like that. An independent-minded CFO will always be transparent with the board. A good CEO will always strive to establish an open relationship with the CFO. It is important for the board to motivate this constructive behavior from both executives so it can truly understand what is going well or not so well.

An independent-minded CFO will always be transparent with the board. A good CEO will always strive to establish an open relationship with the CFO.

Leading constructive dialogues

Rick Haythornthwaite: The senior-management team should not be delivering full solutions to the board at the outset; there should be a period of questions and discussion. The boardroom should be the place for CFOs and boards to engage in the cut and thrust of examination and exploration, with thoughtful planning and framing of dialogues to ensure that decision making is of the highest possible quality.

I’ll give you an example. CFOs used to be able to put traditional capital cases in front of the board about things like investments in plant and equipment, and there was typically a well-grooved dialogue. The kinds of actions they are talking about have changed, though. Think about companies’ investments in platform technologies, which can involve large sums being paid for targets with very low EBITDA—the idea being that value will ultimately come from the combination of entities rather than from a singular target.

Boards may be unfamiliar with such investment cases, so rather than jumping into quick, instinctive type-one decisions forced by the imposition of inappropriate and probably unnecessary time constraints, they will need an education. The board must take time to understand what, in practice, the acquisition of a platform would look like—how it might be scaled under new ownership, how that scaling would affect the bottom line, any risks involved, and so on. This is fundamentally a type-two decision, requiring time and deliberation. The CFO has an important role to play in making sure that this process happens, that it plays out over several board sessions rather than being squeezed into one meeting, and that conversations are grounded in hard numbers.

In the wake of COVID-19, of course, these dialogues may need to happen virtually; the quality of the conversation will still be good, as people are becoming accustomed to virtual meetings.2 They are fine for certain pro-forma tasks, where the issues are well-understood and processes are well-established. But when you’re trying to bring in new voices and new ideas, that’s when you need to be together in the same room.

Growing into the role of change agent

Barbara Kux: The role of the CFO is so much more expansive than it was even five years ago, including additional responsibility for cyber and digital transformations and for IT initiatives. To get your arms around the role and grow in it, take a step back and look at the company objectively. “What other roles could I play in the company, and how does that overlap with what I am doing now?” “Which initiatives would make the most impact in the company, and how could I realize quick wins in those areas?” Maybe it’s a focus on digital or compliance or export control or political intelligence. The CFO’s professional response to COVID-19 crisis management could be a springboard for future development. Whatever it is, I would identify it and just start. Take any kind of training you can get; read as many business publications as you can. Train yourself in how to deal with activist investors. Step by step, your hat will become bigger.

Rick Haythornthwaite: Whether you are talking about COVID-19 or digital disruption or any other impact on the business, please remember that the board still wants to sleep at night, and when the details are lost, the board will be much less forgiving of CFOs than of CEOs. Don’t forget that part of it. Particularly in this challenging economic environment, it is very important. Chairs and boards? We like to sleep soundly at night.




The White House said it was following health experts’ advice. Then we learned it isn’t approving a key CDC document.

Diseases & Conditions | CDC

White House press secretary Kayleigh McEnany made a point at the start of Wednesday’s news briefing to emphasize that President Trump is following health experts’ advice as we enter what Trump has labeled the “next stage” of the coronavirus response — reopening the economy.

“As you are well aware, President Trump has consistently sided with the experts and always prioritized the health and safety of the American people,” McEnany said.

Several hours later, we got another example of the White House resisting what those health experts are advising.

The Associated Press reported around midnight that the White House had shelved planned guidelines from the Centers for Disease Control and Prevention. The document, which was due nearly a week ago, was aimed at providing local authorities with step-by-step guidance on how to reopen:

The 17-page report by a Centers for Disease Control and Prevention team, titled “Guidance for Implementing the Opening Up America Again Framework,” was researched and written to help faith leaders, business owners, educators and state and local officials as they begin to reopen.
It was supposed to be published last Friday, but agency scientists were told the guidance “would never see the light of day,” according to a CDC official. The official was not authorized to talk to reporters and spoke to The Associated Press on the condition of anonymity.

A coronavirus task force official told The Washington Post that the document has not been completely shelved but was in the process of being revised because it was “overly specific.” The official also indicated that it was felt the document was too broad, as “guidance in rural Tennessee shouldn’t be the same guidance for urban New York City.”

The denial, though, reinforces that the White House is reluctant to submit to the CDC’s more detailed prescriptions for reopening the economy. And it’s difficult to divorce the delay in this document’s publication from Trump’s anxiety to reopen the economy — and the tension that has created with past guidelines.

The administration in mid-April issued phased advice on when areas should start to reopen places such as restaurants and other nonessential businesses. But many states have moved forward with certain elements of reopening without actually satisfying those guidelines. Most notably, they have begun to reopen without meeting the Phase One guideline that they should see a decrease in confirmed coronavirus cases over a 14-day period.

As The Post’s Philip Bump reported, some states that have pushed forward with reopening have also seen an increase in cases — which would prevent them from satisfying the requirement for moving into Phase Two. That requirement is that the decline should continue for another 14 days after Phase One begins.

Issuing a detailed document would seemingly complicate further reopenings, because it would again restrict what states and local authorities are supposed to do.

The Washington Post’s Lena H. Sun and Josh Dawsey previewed what the document was set to look like last week. And they also obtained a draft of the document. The new guidelines were to go beyond the initial ones in prescribing specific actions that could be taken in each phase of the reopening. Advocates for reopening have worried that strict guidance could make it difficult for businesses, churches, child-care centers and other facilities to actually function.

Trump, who has long signaled a desire to begin reopening that economy sooner rather than later, has doubled down on that rhetoric in recent days. Despite a steady national death rate that approached previous highs on Tuesday and Wednesday, and even though cases continue to increase outside the major U.S. hotbed of New York City, Trump on Tuesday signaled that we are entering the “next stage” of reopening the economy.

“Thanks to the profound commitment of our citizens, we’ve flattened the curve, and countless American lives have been saved,” Trump said. “Our country is now in the next stage of the battle: a very safe phased and gradual reopening. So, reopening of our country — who would have ever thought we were going to be saying that? A reopening. Reopening.”

Trump has been resistant to the advice of the health officials around him, from the early days of the outbreak when he continuously downplayed the severity of the situation. On several occasions, this tension has boiled over.

We’re also hearing from those officials less and less. The CDC long ago ceased holding briefings on the coronavirus outbreak, and the White House coronavirus task force briefings, which often featured health experts Anthony S. Fauci and Deborah Birx, have now been halted in favor of less-frequent and less-coronavirus-focused briefings from McEnany. Fauci has also been prevented from testifying to the Democratic-controlled House, although he is still slated to testify in the GOP-controlled Senate and has continued doing some interviews. The cumulative effect is that these health experts aren’t on the record as much as the effort to reopen the economy begins in earnest.

In the place of those public comments, the CDC guidelines were to provide firm and detailed advice from those officials for the new stage. But for reasons that seem pretty conspicuous, we still don’t have them.




The world came together for a virtual vaccine summit. The U.S. was conspicuously absent.

The world comes together for a virtual vaccine summit. The U.S. is ...

World leaders came together in a virtual summit Monday to pledge billions of dollars to quickly develop vaccines and drugs to fight the coronavirus.

Missing from the roster was the Trump administration, which declined to participate but highlighted from Washington what one official called its “whole-of-America” efforts in the United States and its generosity to global health efforts.

The online conference, led by European Commission President Ursula von der Leyen and a half-dozen countries, was set to raise $8.2 billion from governments, philanthropies and the private sector to fund research and mass-produce drugs, vaccines and testing kits to combat the virus, which has killed more than 250,000 people worldwide.

With the money came soaring rhetoric about international solidarity and a good bit of boasting about each country’s efforts and achievements, live and prerecorded, by Germany’s Angela Merkel, France’s Emmanuel Macron, Britain’s Boris Johnson, Japan’s Shinzo Abe — alongside Israel’s Benjamin Netanyahu and Turkey’s Recep Tayyip Erdogan.

“The more we pull together and share our expertise, the faster our scientists will succeed,” said Johnson, who was so stricken by the virus that he thought he might never leave the intensive care unit alive last month. “The race to discover the vaccine to defeat this virus is not a competition between countries but the most urgent shared endeavor of our lifetimes.”

A senior Trump administration official said Monday the United States “welcomes” the efforts of the conference participants. He did not explain why the United States did not join them.

“Many of the organizations and programs this pledging conference seeks to support already receive very significant funding and support from the U.S. government and private sector,” said the official, who spoke on the condition of anonymity under White House rules for briefing reporters.

Public health officials and researchers expressed surprise.

“It’s the first time that I can think of where you have had a major international pledging conference for a global crisis of this kind of importance, and the U.S. is just absent,” said Jeremy Konyndyk, who worked on the Ebola response in the Obama administration.

Given that no one knows which vaccines will succeed, he said, it’s crucial to back multiple efforts working in parallel.

“Against that kind of uncertainty we should be trying to position ourselves to be supporting — and potentially benefiting from — all of them,” said Konyndyk, a senior policy fellow at the Center for Global Development. “And instead we seem to be just focused on trying to win the race, in the hopes we happen to get one of the successful ones.”

Conference participants expressed a need for unity.

“We can’t just have the wealthiest countries have a vaccine and not share it with the world,” Canadian Prime Minister Justin Trudeau said.

“Let us in the international community unite to overcome this crisis,” Abe said.

Russia and India also did not participate. Chinese premier Li Keqiang was replaced at the last minute by Zhang Ming, Beijing’s ambassador to the European Union.

The U.S. official said the United States “is the single largest health and humanitarian donor in world. And the American people have continued that legacy of generosity in the global fight against covid-19.”

“And we would welcome additional high-quality, transparent contributions from others,” he said.

Asked three more times to explain why the United States did not attend, the official said he already had given an answer.

The U.S. government has provided $775 million in emergency health, humanitarian, economic and development aid for governments, international organizations and charities fighting the pandemic. The official said the United States is in the process of giving about twice that amount in additional funding.

There was one major American player at the virtual summit: the Bill and Melinda Gates Foundation, which promised to spend $125 million in the fight.

“This virus doesn’t care what nationality you are,” Melinda Gates told the gathering. As long as the virus is somewhere, she said, it’s everywhere.

Scientists are working around-the-clock to find a cure or treatment for the coronavirus. The World Health Organization says eight vaccines have entered human trials and another 94 are in development.

But finding an effective vaccine is only part of the challenge. When it’s discovered, infectious disease experts are predicting a scramble for limited doses, because there won’t be enough to vaccinate everyone on Day One. And deploying it could be difficult, particularly in countries that lack robust medical infrastructure.

Those that have begun human trials include a research project at Oxford University in England, which hopes to have its vaccine ready in the fall. The university started human trials on April 23. “In normal times,” British Health Secretary Matt Hancock said, “reaching this stage would take years.”

Other scientists are sprinting to create antiviral drugs or repurposing existing drugs such as remdesivir, which U.S. infectious diseases chief Anthony S. Fauci said he expected would be the new “standard of care.”

Other approaches now in trial include treatments such as convalescent plasma, which involves taking blood plasma from people who have recovered from covid-19 to patients who are fighting the virus, in the hope that the antibody-rich fluid will give the infected a helping hand.

Conference participants expressed hope that by working together, the world will find solutions more quickly — and they can then be dispersed to all countries, not only the wealthy, or those that developed vaccines first.

Many of the leaders stressed their support for the WHO. President Trump announced last month he was cutting off U.S. funding for the WHO because he said it had sided too closely with China, where the coronavirus arose. Trump says Chinese leaders underplayed the threat and hid crucial facts.

Public health analysts have shared some of those criticisms but have also criticized Trump for cutting off funding.

Peter Jay Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine, said the United States has always been the primary funder of new products for global health. The country invested $1.8 billion in neglected diseases in 2018, according to Policy Cures Research, more than two-thirds of the worldwide total.

Hotez said the United States shoulders the burden of investing in global health technologies, while countries such as China do not step up.

“More than one mechanism for supporting global health technologies — that may not be such as a bad thing,” he said. “If it was all under one umbrella, you risk that some strong-willed opinions would carry the day and you might not fund the best technology.”

Hotez is working on a coronavirus vaccine that uses an existing, low-cost technology, previously used for the hepatitis B vaccine, precisely because he is worried about equitable distribution of the vaccine.

“I’m not very confident that some of the cutting-edge technologies going into clinical trials, which have never led to a licensed vaccine before, are going to filter down to low- and middle-income countries anytime soon,” Hotez said. “I’m really worried.”





The Inside Story Of How The Bay Area Got Ahead Of The COVID-19 Crisis

The Inside Story Of How The Bay Area Got Ahead Of The COVID-19 Crisis

The Inside Story Of How The Bay Area Got Ahead Of The COVID-19 ...

Sunday was supposed to be a rare day off for Dr. Tomás Aragón after weeks of working around-the-clock.

Instead, the San Francisco public health officer was jolted awake by an urgent 7:39 a.m. text message from his boss.

“Can you set up a call with San Mateo and Santa Clara health officers this a.m., so we can discuss us all getting on the same page this week with aggressive actions, thanks,” said the message from Dr. Grant Colfax, director of San Francisco’s Department of Public Health.

“Will do, getting up now,” Aragón responded.

It was March 15, two days before St. Patrick’s Day, a heavy partying holiday and nightmare scenario for public health officials.

The novel coronavirus was spreading stealthily across the San Francisco Bay Area and public health officials were alarmed by the explosion of deaths in Italy and elsewhere around the globe. Silicon Valley would be next, case counts indicated.

Until then, they had primarily focused on banning mass gatherings. But they knew more had to be done — and wanted to present a united front.

Within a few hours of the text, Bay Area public health leaders jumped on a series of calls to debate options, including the most dramatic — a lockdown order that would shutter businesses, isolate families and force millions of residents to stay home.

They decided they had no choice. And they were able to move swiftly because they had a secret weapon: a decades-long alliance seeded in the early days of the AIDS epidemic that shields them from political blowback when they need to make difficult decisions.

Together, they would issue the nation’s first stay-at-home order, likely saving thousands of lives and charting the course for much of the country. Three days later, Gov. Gavin Newsom followed with his own order for California. New York came next, as have dozens of states since.

“This was one exhausting and difficult day for all of us,” Aragón later wrote in his journal. “We all wish we did not have to do this.”

Now, officials nationwide are weighing how to lift isolation orders as the rate of COVID-19 transmission slows — and protests against the orders mount. The Bay Area is again poised to lead, but with a warning: All of this could be for naught if it isn’t done right.

The coalition of county public health officers didn’t set out to lock down the Bay Area that fateful Sunday morning in mid-March. But as they discussed the exponential increase in Santa Clara County cases, where the hospitals were becoming overwhelmed by infected patients falling ever sicker, what they needed to do “started to crystalize,” said Dr. Sara Cody, the county’s public health officer.

“It felt huge to me,” she recalled, “because I knew how disruptive it would be.”

Elsewhere in the region, diagnosed cases were sparse. But decades of experience had shown the health officers that while they represent different jurisdictions, they are one region when it comes to infectious diseases. “We knew that it would be a matter of time before that was our experience,” said Dr. Matt Willis, Marin County’s public health officer, who contracted COVID-19 days later.

Cody told her colleagues that Italy was under siege, and her county was just two weeks away from a similar fate. If she could have locked down sooner, she told them, she would have.

“That was compelling,” said Dr. Lisa Hernandez, the public health officer for the city of Berkeley, which had not yet recorded any cases of community transmission. “We knew there was going to be St. Patrick’s Day parades and celebrations, so the timing was critical.”

Dr. Scott Morrow, California’s longest-serving public health officer, who heads operations in San Mateo County, said he also felt the urgency. “We thought, ‘Yes, the clock is ticking,’” he recalled.

County health officers in California have immense power to act independently in the interest of public health, including the authority to issue legally binding directives. They don’t need permission from the governor or mayors or county supervisors to act.

Even for this group, though, with all its collective strength, telling millions of Californians to shelter in place seemed risky at first. But the health officers involved had grown to trust one another, even if they don’t always see eye to eye.

For instance, they currently disagree on whether to require residents to wear face coverings. Some counties, including San Francisco and Marin, are requiring them in public, while others, like Santa Clara, are not.

On the first Sunday morning call, Aragón floated the idea of developing a coordinated recommendation that Bay Area residents stay at home. By the next confab, Cody, Santa Clara County’s health official, made the case that for social distancing to work, it had to be an order.

“Sara Cody was the courageous leader!” Aragón later wrote in his journal.

So forceful a move can be unpopular, but evidence shows it can also be the most effective, in the absence of treatment or a vaccine. “Here’s the rub on these methods — they only work if you do it really early,” said Dr. Howard Markel, a medical historian at the University of Michigan and an expert on the 1918 flu pandemic.

“When you do a quarantine, you stop the commerce, you stop the flow of money,” he said. “But on the other side of that are those whose lives are saved.”

This isn’t the group’s first pandemic. The alliance, formally called the Association of Bay Area Health Officials, was born in 1985 in the early days of the AIDS epidemic.

Dr. David Werdegar, who became health officer for San Francisco that year, was analyzing AIDS data for surrounding counties and asked their health officers to join him for dinner at Jack’s, an old bordello-turned-political hangout in the city that has since shuttered.

Most of the infectious disease research was happening in San Francisco at the time, but HIV was spreading, and one city couldn’t fight it alone.

“It was important that we share all the information we had,” said Werdegar, now in his 80s and retired.

Dr. Robert Melton, a former Monterey County health officer, said that working for nearly two decades with Bay Area public health giants taught him tremendous lessons. “Camaraderie is important in maintaining the energy to be able to focus on the common good, through good and bad,” he said.

That close-knit relationship among the 13 health officers — representing counties stretching across a large swath of Northern California from Napa to Monterey — continues to this day. Collectively, their public health actions touch about 8.5 million people.

They meet monthly and communicate regularly on Slack, a messaging app. Their diverse backgrounds and expertise, especially in an era of funding cuts, provide a deep well of public health knowledge from which to draw. Together, the group has joined forces to combat youth vaping, air pollution and measles outbreaks.

And they have also tackled various influenza scares, which is why they had an emergency response blueprint at the ready when cases of what would later be called COVID-19 first cropped up in Wuhan, China.

“We spent a couple years as a region thinking about pandemic planning, and that really helped us come a long way thinking about these policies for COVID-19,” said Dr. Erica Pan, the interim health officer for Alameda County.

So when they jumped on the call that Sunday, they were already in mid-conversation about how to respond. They brought their lawyers and, working into the predawn hours, translated their lockdown plan into legalese, one that would be enforceable with fines and misdemeanor charges.

They would make prime-time announcements across the region the next day, alongside elected officials. “This is not the moment for half-measures,” said San Jose Mayor Sam Liccardo. “History won’t forgive us for waiting an hour more.”

At first, the stay-at-home order applied just to the “Big Seven” counties surrounding the San Francisco Bay, whose officers peeled off from the larger group to issue it first. They shared their model ordinance with the others, who quickly followed.

Dr. Gail Newel, an OB-GYN and Santa Cruz County’s health officer, is not an infectious disease expert. She has relied heavily on the group’s expertise throughout her career, and especially now.

“It’s this incredible bank of knowledge and wisdom and experience that’s freely shared among the members,” she said. “And the whole Bay Area benefits by that shared knowledge bank.”

Roughly one month after they made the unprecedented decision to close the local economy, the risk seems to have paid off. It will be years before researchers have fully analyzed its impact, but officials across the Bay Area are cautiously optimistic. Others haven’t been so lucky.

Though there are important differences between the two regions, New York City, which issued a stay-at-home order four days after the Bay Area, saw its hospitals completely overwhelmed and had recorded more than 14,600 deaths as of Monday.

By comparison, the counties represented by the alliance have documented more than 215 deaths and hospitals haven’t been overtaken by a surge. In fact, hospitals brought online specifically to accommodate an overflow of patients are sitting largely empty.

Even within California, communities that waited to issue lockdown orders have emerged as COVID-19 hot spots, including Los Angeles, where Mayor Eric Garcetti followed suit three days after the Bay Area.

Internally, some of the Bay Area health officials have wondered if they made the right call. But “anytime I have any doubt, I just read another news report from New York or Detroit or New Orleans,” said Dr. Chris Farnitano, Contra Costa County’s health officer.

And the close-knit band is already undertaking its next task: reopening the economy without causing another spike in cases.

Before the orders are lifted, the officials say there must be rapid, widespread testing across the population. They want to hire disease investigators by the hundreds, if not the thousands, to trace the virus and quarantine those who have been infected. And until there is a vaccine, they may ask people to wear masks in public and continue social distancing, even in bars, restaurants and schools when they reopen.

“I was concerned that we might get a lot of resistance and it might get interpreted as alarmist and overreach,” said Marin County’s Willis. “Time has shown that it was really a vital step to take when we took it.”





Trump reportedly squandered 3 crucial weeks to mitigate the coronavirus outbreak after a CDC official’s blunt warnings spooked the stock market

Dow closes with decline of 950 points as coronavirus continues to ...

  • President Donald Trump’s administration wasted three key weeks between February and March that could have been spent enacting mitigatory measures against COVID-19, The New York Times reported on Saturday.
  • By the end of February, top officials knew that time was running out to stem the virus spread, and wanted to present Trump with a plan to enact aggressive social distancing and stay-at-home measures.
  • But on February 26, a top CDC official issued stark warnings about the virus’ spread right before the stock market plummeted, which angered Trump for being, in his view, too alarmist. 
  • The Times reported that the entire episode killed off the efforts to persuade Trump to take aggressive, action to mitigate the virus’ spread. In the end, Trump didn’t issue stay-at-home guidance until March 16. 

President Donald Trump’s administration stalled three key weeks in February that could have been spent enacting mitigatory measures against COVID-19 after Trump was angered by a public health official issuing a dire warning about the virus, The New York Times reported on Saturday.

On Saturday,The Times published a lengthy investigation of all the instances Trump brushed aside warnings of the severity of the coronavirus crisis, failed to act, and was delayed by significant infighting and mixed messages from the White House over what action to take and when. 

The Times wrote: “These final days of February, perhaps more than any other moment during his tenure in the White House, illustrated Mr. Trump’s inability or unwillingness to absorb warnings coming at him.”

The Times conducted dozens of interviews with current and former officials and obtained 80 pages of emails from a number of public health experts both within and outside of the federal government who sounded the alarm about the severity of the crisis on an email chain they called “Red Dawn.”

One of the members of the email group, Health & Human Service disaster preparedness official Dr. Robert Kadlec, became particularly concerned about how rapidly the virus could spread when Dr. Eva Lee, a Georgia Tech researcher, shared a study with the group about a 20-year-old woman in China who spread the virus to five of her family members despite showing no symptoms.

“Eva is this true?! If so we have a huge [hole] on our screening and quarantine effort,” he replied on February 23. 

At that point, researchers and top officials in the federal government determined that since it was way too late to try to keep the virus out of the United States, the best course of action was to introduce mitigatory, non-pharmaceutical interventions (NPIs) like social distancing and prohibiting large gatherings.

As officials sounded the alarm that they didn’t have any time to waste before enacting aggressive measures to contain the virus, top public health officials including Dr. Robert Kadlec concluded that it was time to present Trump with a plan to curb the virus called “Four Steps to Mitigation.”

The plan, according to The Times, included canceling large gatherings, concerts, and sporting events, closing down schools, and both governments and private businesses alike ordering employees to work from home and stay at home as much as possible, in addition to quarantine and isolating the sick.

But their entire plan was derailed by a series of events that ended up delaying the White House’s response by several weeks, wasting precious time in the process.

Trump was on a state visit to India when Dr. Kadlec and other experts wanted to present him with the plan, so they decided to wait until he came back.

But less than a day later, Dr. Nancy Messonnier, the director of the National Center for Immunization and Respiratory Diseases at the CDC, publicly sounded the alarm about the severity of the coronavirus outbreak in a February 26 press conference, warning that the outbreak would soon become a pandemic.

“It’s not so much a question of if this will happen anymore but rather more a question of exactly when this will happen and how many people in this country will have severe illness,” Messonnier said, bluntly warning that community transmission of the virus would be inevitable.

The Times reported that Trump spent the plane ride stewing in anger both over Messonnier’s comments and the resulting plummet of the stock market they caused, calling Secretary of Health & Human Services Alex Azar “raging that Dr. Messonnier had scared people unnecessarily,” The Times said. 

The Times reported that the entire episode effectively killed off any efforts to persuade Trump to take aggressive, decisive action to mitigate the virus’ spread and led to Azar being sidelined, writing, ” With Mr. Pence and his staff in charge, the focus was clear: no more alarmist messages.” 

In the end, Dr. Kadlec’s team never made their presentation. Trump did not issue nationwide social distancing and stay-at-home guidelines until March 16, three weeks after Messonnier warned that the US had limited time to mitigate community transmission of the virus, and several weeks after top experts started calling for US officials to implement such measures.

In those nearly three weeks between February 26 and March 16, the number of confirmed COVID-19 cases rose from just 15 to 4,226, The Times said. As of April 12, there are over half a million confirmed cases in the United States with over 21,000 deaths.