70% Of Americans Want Officials To Prioritize Public Health Over Restarting Economy

Posted on April 24, 2020 by henrykotula • Posted in 2020 Election Issues, Clinical Testing, Contact Tracing, Coronavirus, Crisis, Crisis Management, Economic Crisis, Economy, Health Policy, Infection Control, Infectious Virus, Mortality, Pandemic, Partisanship, Public Health, Public Safety, Social Distancing • Leave a comment

https://www.forbes.com/sites/arielshapiro/2020/04/23/70-of-americans-want-officials-to-prioritize-public-health-over-restarting-economy-trump-kemp/?utm_source=newsletter&utm_medium=email&utm_campaign=news&utm_campaign=news&cdlcid=#74a9d5ce68d3

A wide majority of Americans are not ready to resume public life, according to a poll released Thursday by CBS News and YouGov, as governors in Georgia, Tennessee and South Carolina plan to allow stay-at-home orders to expire next week.

KEY FACTS

Only 30% of people surveyed said the government’s priority should be restarting the economy; 70% said the focus should be on slowing the virus through social distancing measures.

The polling shows a partisan divide—while 91% of Democrats and 69% of Independents favor focusing on public health, 52% of Republicans say the economy should take precedence.

29% of those polled said they would feel comfortable eating at a restaurant; Georgia Governor Brian Kemp will allow certain businesses, including restaurants, to open on April 27, 2020.

A minority of respondents said they would be comfortable going to work right now (44%) and even fewer said they would attend a large entertainment or sports event (13%), but the social isolation is taking its toll—54% said they would be willing to visit their friends.

KEY BACKGROUND

Protests against stay-at-home orders have cropped up around the country in states like California and Michigan, initially with President Donald Trump’s support. Although the movement is vocal, its support is limited. Less than a quarter of the poll’s respondents said they support the protests, and only 7% think that Trump should encourage them. The president is starting to change his tune, criticizing Georgia Governor Kemp’s plan to reopen businesses at the White House briefing on Wednesday.

WHAT TO WATCH FOR

Florida Governor Ron DeSantis said he is coordinating with neighboring governors on how to proceed, but has not yet announced whether he will extend the state’s stay-at-home order or let it expire. Florida has had more than 28,000 cases of COVID-19, more than any other southern state. A Quinnipiac poll released Wednesday shows that Florida residents’ opinions on reopening the economy reflect those of the country: Only 22% said that the state should loosen social distancing rules at the end of the month. As a first step, DeSantis allowed localities to reopen their beaches last week, and some, notably those in Jacksonville, were crowded.

Governor Cuomo, Bloomberg Announce Unprecedented New York COVID-19 Coronavirus Contact Tracing Program

Posted on April 24, 2020 by henrykotula • Posted in 2020 Election Issues, Clinical Testing, Contact Tracing, Coronavirus, Crisis, Crisis Management, Economic Crisis, Economy, Health Policy, Infection Control, Infectious Virus, Mortality, Pandemic, Public Health, Public Safety, Quarantine, Social Distancing, Vaccination, Vaccine • Leave a comment

https://www.forbes.com/sites/brucelee/2020/04/23/governor-cuomo-bloomberg-announce-unprecedented-new-york-covid-19-coronavirus-contact-tracing-program/?utm_source=newsletter&utm_medium=email&utm_campaign=career&cid=5d2c97df953109375e4d8b68#129e09243cd1

New York is not going to let the COVID-19 coronavirus spread without a trace. Make that multiple traces. In fact, make that many, many, many traces.

New York State Governor Andrew Cuomo and former New York City Mayor Mike Bloomberg announced the launch of a massive contact tracing program in an effort to better contain the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). How massive? How about larger-than-any-contact-tracing-effort-that’s-been-attempted-before-in-the-U.S. massive?

It is a sign of the times that Cuomo had to include a slide that said: “But we can’t be stupid.” After all, there are other people out there pushing to re-open businesses without at the same time providing a specific plan on how exactly to stop the virus when social distancing measures are relaxed.

Bloomberg Philanthropies, which was founded by Bloomberg, will contribute $10.5 million as well as technical support and assistance to the program. The Johns Hopkins Bloomberg School of Public Health will develop an online training program and certification process for those doing the contact tracing. Vital Strategies, via its Resolve to Save Lives initiative, will advise and assist the New York State Health Department staff in developing protocols and processes to help the whole contact tracing process.

Speaking of vital strategies, “test-trace-isolate” is quite a vital strategy to try to contain the COVID-19 coronavirus so that social distancing measures can be relaxed and things can re-open, at least to some degree. Contact tracing is the “trace” part of that strategy. I’ve described previously for Forbes how to do contact tracing. When you’ve identified a person (an index case) infected with the SARS-Cov2 via testing, contact tracing is determining and locating every person that index case may have had contact with that was close enough to transmit the virus. This way you can isolate or quarantine all of those contacts as quickly as possible so that they can’t spread the virus any further. Essentially testing, tracing, and isolating or quarantining aims to contain the virus, to box it in, to give it no people to spread to, to surround it by nothing but toilet paper, fluffy pillows, Netflix videos, and whatever else people have in their houses and apartments.

Without a vaccine or specific treatment versus the SARS-Cov2, the virus could have spread much more widely without social distancing measures in place, because supplements, gargling salt water, Medieval chants or whatever bogus prevention measures have been offered weren’t going to stop the virus. Premature re-opening could send all of those efforts down the metaphorical toilet bowl. “While we start our work to re-open our economy we must ensure we are doing it in a way that does no harm and does not undo all of the work and sacrifice it has taken to get here,” said Cuomo in statement. “One of the most critical pieces of getting to a new normal is to ramp up testing, but states have a second big task – to put together an army of people to trace each person who tested positive, find out who they contacted and then isolate those people.”

Think about it. If you re-open places and relax social distancing measures, it could take only a small number of people spreading the virus to then cause another surge in COVID-19 cases. Therefore, a good contact tracing program needs to be in place to catch potentially infectious people quickly. Implementing large scale and coordinated contact tracing programs has been one way that Germany, Singapore and South Korea have been able to better control the COVID-19 coronavirus and its impact than the U.S. and U.K. have.

“We’re all eager to begin loosening restrictions on our daily lives and our economy,” said Bloomberg in a statement. “But in order to do that as safely as possible, we first have to put in place systems to identify people who may have been exposed to the virus and support them as they isolate.”

Putting appropriate systems in place before making a decision? Hear that sound? It’s the sound of science walking back into the ongoing “re-open America” conversation and saying, “what the heck have you been doing to the house while I’ve been away.” Deciding to re-open anything without first putting proper systems in place to monitor and contain the virus would be like going to a dinner party when you aren’t wearing any clothes. It would leave you quite exposed and basically put your butt on the line.

Although the program is launching immediately, it will take some time to recruit and train hundreds or perhaps thousands of tracers. Potential recruits will come from a variety of places such as the State Department of Health, various state agencies, the State University of New York (SUNY), and the City University of New York (CUNY). Henning indicated that the timeline for getting things in place will be in the order of “a number of weeks.”

This program will coordinate with contact tracing efforts in New Jersey and Connecticut. After all, this virus doesn’t respect borders or need an E-ZPass to spread to neighboring states. As Henning noted, “New York state has already been talking extensively with New Jersey and other states.”

If you live outside this tri-state area, try to pay attention to what’s going on here. After all, contact tracing will have to occur in other parts of the country as well. Otherwise, the virus can keep circulating in different parts of the country, which means that it could at any time readily spread to the rest of the U.S. After all, the virus is like a very bad house guest. It doesn’t respect boundaries. And it is unlikely to just disappear without a trace.

The High Stakes of Low Scientific Standards

Posted on April 24, 2020 by henrykotula • Posted in 2020 Election Issues, Communication, Coronavirus, Crisis, Crisis Management, False Hope, Health Policy, Hydroxychloroquine, Infection Control, Infectious Virus, Misinformation, Mislead, Misleading, Pandemic, Public Health, Public Safety, Scientists, Social Distancing, Wishful Thinking • Leave a comment

https://www.axios.com/coronavirus-pandemic-science-problems-e6e619b8-c1a8-4e06-97d9-c328d4d0400e.html

In the midst of this pandemic, science is suffering from low standards for some research, a new study argues.

The big picture: Science — which is slow, methodical and redundant — isn’t necessarily made for the immediacy and acute public interest brought on by a health crisis.

Scientists rely on peer review and back and forth exchange that leads to a more polished final study. But a health crisis like the current pandemic, or the Ebola outbreak, creates a sense of urgency that can be antithetical to the scientific process.

What’s happening: A new study out today in the journal Science warns many of the clinical trials and studies first published about treatments and other issues involving the current pandemic were designed poorly or had other issues that affected their outcomes.

Studies that have yet to go through peer-review — like a recent, flawed study of the use of hydroxychloroquine to treat coronavirus — have found their way into news stories thanks to pre-print services, leading to problematic reporting and real-time peer review through Twitter.
More than 18 clinical trials testing hydroxychloroquine to treat the novel coronavirus have enrolled more than 75,000 patients in North America.
“This massive commitment concentrates resources on nearly identical clinical hypotheses, creates competition for recruitment, and neglects opportunities to test other clinical hypotheses,” the study says.
Early, flawed work has potentially increased the risk that later results may have gotten false positives and more media attention than they deserved, the new study says.

Yes, but: While the pandemic is exacerbating these problems with misinformation and lax research standards, it isn’t the cause of them.

“Some of the problems that we’re seeing right now are actually not that exceptional compared to the problems that we have under normal conditions as well, just that maybe they’re a little bit more amplified and have a little more visibility,” Jonathan Kimmelman, director of the Biomedical Ethics Unit at McGill University and one of the authors of the new paper, told Axios.
These kinds of issues cropped up during previous health crises, and while the authors of the new study argue that some of those problems around information sharing and standards of research have improved, there’s still a long way to go.

What’s next: Many of these issues around varying standards of research and communication could be remedied through better communication among researchers and the agencies funding their work.

Instead of having a number of fragmented studies competing for resources and looking for effective treatments, the researchers say it would make more sense to bring them under one umbrella, allowing them to coordinate.
“You could reduce variation, and you might get answers more quickly,” Alex John London, the director of the Center for Ethics and Policy at Carnegie Mellon and one of the authors of the new study, told Axios.
The authors are also calling on clinicians to resist performing their own small studies, instead opting to join up with larger trials.
They also say agencies need to help build those larger studies and avoid making statements to the public about unvalidated treatments that may or may not work, instead opting to elevate larger studies in their various stages to the public.

The South is vulnerable to a coronavirus nightmare

Posted on April 24, 2020 by henrykotula • Posted in 2020 Election Issues, Clinical Testing, Coronavirus, Crisis, Crisis Management, Health Policy, Infection Control, Infectious Virus, Mortality, Pandemic, Partisanship, Personal Protective Equipment (PPE), Public Health, Public Safety, Quarantine, Social Distancing, Vulnerable Populations • Leave a comment

https://www.axios.com/newsletters/axios-vitals-d53939d5-90fb-4aef-a87d-30cf2b0ceebf.html?utm_source=newsletter&utm_medium=email&utm_campaign=newsletter_axiosvitals&stream=top

COVID-19 vulnerability index, by county

The South is at risk of being devastated by the coronavirus.

Why it matters: Southern states tend to have at-risk populations and weak health care systems — and they’re the ones moving fastest to loosen social distancing rules. That puts them at risk for the worst-case coronavirus scenarios.

The big picture: To stop the spread of the coronavirus, there are really only two options: stringent social distancing, or stringent public health measures.

Driving the news: Several southern states including Georgia, Tennessee and South Carolina have recently announced that they’re starting to back off of social distancing.

Our national testing capacity is still nowhere near where experts say it needs to be, and only some communities have announced efforts to build up contact tracing.

Between the lines: The Surgo Foundation created a coronavirus community vulnerability index that takes into account factors like socioeconomic status, minority status, housing type, epidemiologic factors and health care system factors.

The bottom line: The South is already worse off in almost every way, partially due to policy choices made in these states. Its comparatively unhealthy population is vulnerable to more serious illness, and looser social distancing will enable the virus’ spread.

US hits grim milestone: 50,000 coronavirus deaths

Posted on April 24, 2020 by henrykotula • Posted in 2020 Election Issues, Centers for Disease Control & Prevention (CDC), Clinical Testing, Coronavirus, Crisis, Crisis Management, Economic Crisis, Economy, Food and Drug Administration (FDA), Health Policy, Infection Control, Infectious Virus, Mortality, Pandemic, Public Health, Public Safety, Quarantine, Social Distancing • Leave a comment

US hits grim milestone: 50,000 coronavirus deaths

More than 50,000 people in the United States have died of the COVID-19 disease, a grim milestone in a global pandemic that shows few signs of slowing even as pressure mounts to reopen parts of the U.S. economy.

The death toll is 16 times greater than the number of Americans who died in the 9/11 terrorist attacks and about one-and-a-half times larger than the number of U.S. soldiers who died in the Korean War. At the current pace, the number of coronavirus deaths is likely to surpass the number of Americans who died in the Vietnam War by the middle of next week.

The true number of deaths is likely higher than official figures. Coroners in California this week reclassified the death of a woman in Santa Clara on Feb. 6 as a coronavirus victim, the first known death from the disease in the United States and one that occurred three weeks before what had previously been thought to be the first known death.

About 900,000 people in the United States have tested positive for the virus that causes the disease, according to the most recent figures. That number has doubled in the past two weeks, climbing by 25,000 or more cases per day.

The richest nation in the world now accounts for about one-third of the planet’s 2.7 million cases.

The number of U.S. deaths has increased at a rate of about 2,000 per day in recent weeks as scientists race to understand the new pathogen and health systems in hard-hit areas like New York, Boston, New Orleans and Detroit struggle under the strain placed on hospitals and frontline health care workers.

More than a quarter of a million New Yorkers have tested positive for the virus, as have more than 100,000 residents of New Jersey. There are at least 35,000 cases in California, Illinois, Massachusetts, Michigan and Pennsylvania, and at least 20,000 cases in Connecticut, Florida, Georgia, Louisiana and Texas.

Though the virus was first detected in China, where the authoritarian government locked down entire cities in January, the United States is now home to the largest number of known cases in the world. The number of cases on American soil is nearly four times as high as the second-worst hit country, Spain, and higher than the total case counts in Spain, Italy, France, Germany and the United Kingdom combined, according to data compiled by Johns Hopkins University.

America’s disastrously slow response has stumbled over a number of hurdles other countries cleared easily. President Trump and his administration routinely claimed the virus was under control — he claimed the coronavirus would have “a very good ending for us” on Jan. 30, the same day the World Health Organization declared the virus a public health emergency of international concern.

Scientists now believe the virus began circulating in the United States in early to mid-January, a period when the country had little capacity to test its residents. An early test created by the Centers for Disease Control and Prevention and sent to public health laboratories across the country turned out to have a fatal flaw, setting back crucial testing capacity that could have uncovered the extent of the virus’s spread even as other countries deployed their own tests.

Companies that could have filled that backlog were also slow to develop their own diagnostic tests, and several ran into roadblocks at the Food and Drug Administration, which did not move to approve tests on an emergency basis until late February.

The United States only seemed to begin to take the threat of the outbreak seriously in early March. Almost two weeks later, the first state — California — announced stay-at-home orders.

As a consequence, the slow response has meant the United States has not bent its case curve downward as fast as other nations. The hardest-hit European nations have all seen daily case and death counts bending downward; the United States has, at best, reached a daunting plateau. And though countries like Italy, Spain and France have suffered more deaths per capita, their trajectories are down, while figures in the United States trend up.

There is still no known medicinal treatment for those suffering from COVID-19. And while dozens of laboratories across the globe race to develop a vaccine, experts warn that a finished product will not be available on a mass scale for more than a year — a schedule that would mark the fastest such development in human history. Until those vaccines are ready and widely available, the virus will remain in control.

Left leaderless at the federal level, state governments responded to the mounting crisis in their own ways. A bipartisan roster of governors in New York, California, Washington, Massachusetts, Maryland, Ohio and elsewhere have won praise for quick, decisive action and informative briefings that stand in stark contrast to Trump’s daily appearances at White House press conferences.

California Gov. Gavin Newsom‘s (D) order was followed by most other states, though eight states have yet to require residents to avoid nonessential activities. Even as some states took unprecedented steps to lock down their economies, banning residents from beaches and public parks and shuttering non-essential businesses, others were slow to act.

There is now mounting evidence that dozens of coronavirus cases are tied to an April election in Wisconsin, and to packed beaches during Spring Break in Florida the previous month. At least one man who attended what was dubbed a coronavirus party in Kentucky came down with the disease. Several pastors who defied recommendations against holding church services have died.

Now, as a few hundred protesters in several states demand a reopened economy, some governors are beginning to loosen restrictions. Georgia Gov. Brian Kemp (R) will allow some businesses to begin opening on Friday, even as the number of COVID-19 cases jumped to 21,883 on Thursday. Nearly 900 Georgians, about 4 percent of confirmed cases, have died.

Some nonessential businesses will begin opening in the coming days in Alaska, Indiana, Tennessee and Texas. Beaches have reopened in parts of Florida and South Carolina, even as public health officials have warned of the consequences of reopening too quickly.

“We have to proceed in a very careful, measured way,” Anthony Fauci, head of the National Institute of Allergy and Infectious Diseases, said at a White House press briefing Wednesday. “The one way not to reopen the economy is to have a rebound that we can’t take care of.”

But there remain signs of strain even within the highest ranks of government. Fauci contradicted Trump’s claim Wednesday that the virus would not return in the fall.

“We will have coronavirus in the fall. I am convinced of that because of the degree of transmissibility that it has, the global nature,” Fauci said.

Fauci did not appear at the White House briefing Thursday, when Trump said he did not agree with the nation’s leading infectious disease expert that the country’s testing capacity had risen to the level required to stamp out the virus.

“No, I don’t agree with him on that. No, I think we’re doing a great job in testing. I don’t agree. If he said that, I don’t agree with him,” Trump said.

The Health 202: States are ending their coronavirus lockdowns earlier than health roadmaps recommend

Posted on April 23, 2020 by henrykotula • Posted in 2020 Election Issues, Centers for Disease Control & Prevention (CDC), Clinical Testing, Coronavirus, Crisis, Crisis Management, Dept of Health and Human Services (HHS), Economic Crisis, Economy, Emergency Preparedness, False Hope, Health Policy, Infection Control, Infectious Virus, Mistake, Pandemic, Public Health, Public Safety, Social Distancing, Ventilators, Wishful Thinking • Leave a comment

https://www.washingtonpost.com/news/powerpost/paloma/the-health-202/2020/04/23/the-health-202-states-are-ending-their-coronavirus-lockdowns-earlier-than-health-roadmaps-recommend/5ea09b5988e0fa34528d6eb8/?utm_campaign=wp_the_health_202&utm_medium=email&utm_source=newsletter&wpisrc=nl_health202

Over a nearly three-week span in March, most state governors across the nation locked down their states because of the novel coronavirus.

Gradually opening things up will take even longer — and probably will vary considerably from state to state.

Governors are feeling pressure from two sides. Many troubling questions about the coronavirus remain unanswered, such as how to get more Americans tested and whether the United States even has enough capacity to track and isolate virus cases. At the same time, they’re feeling immense pressure to restart economic activity, with tens of millions of Americans out of work and the country stuck in a deepening economic crater.

As governors weigh when and how to reopen public gathering spots, there are several road maps they could look to.

Yesterday the National Governors Association released a 10-point guide for states. The first point is to make coronavirus testing broadly available. It urges states to improve surveillance to detect outbreaks, ensure hospitals are equipped to respond to surges and create a plan to reopen in stages.

The plan also warns states against opening prematurely.

“Opening without the tools in place to rapidly identify and stop the spread of the virus … could send states back into crisis mode, push health systems past capacity and force states back into strict social distancing measures,” it says.

Then there’s guidance from the Trump administration, which says states should first see a decrease in confirmed coronavirus cases over a 14-day period. That guidance is in line with what public health experts have recommended — although Trump has also frequently suggested he’d like to see states open sooner.

So far, governors vary widely in how they’re approaching the issue.

Some, like Trump, are chomping at the bit. Georgia Gov. Brian Kemp (R) is allowing businesses including gyms and barber shops to reopen on Friday. Colorado Gov. Jared Polis (D) has said some businesses may reopen on Monday, and retailers can have a limited number of in-store shoppers starting May 1.

Other governors are much more cautious. Virginia Gov. Ralph Northam (D), for example, has issued a stay-at-home order in effect until June 10. California Gov. Gavin Newsom (D) declined yesterday to name a date for easing restrictions, saying the state hasn’t reached its six goals before reopening the economy.

Newsom, however, did indicate progress has been made with his detailed playbook for reopening the state. After a phone conversation with Trump, the governor said the two had agreed to significantly ramp up testing across California, with hundreds of thousands of new swabs on the way and 86 new testing sites opening.

But virtually every governor is working on plans, some in coordination with other governors, on how to shape the post-quarantine world.

Here are the states opening things up first:

Georgia: Certain businesses may open on Friday; theaters and restaurants can reopen on Monday. Bars, nightclubs and music venues will remain closed; schools have been closed through the end of the school year.

Kemp explained his decision to reopen tanning salons, barber shops, massage parlors and bowling alleys, saying on Monday: “I see the terrible impact of covid-19 on public health as well as the pocketbook.” Kemp said he will urge businesses to take precautions, such as screening for fevers, spacing workstations apart and having workers wear gloves and masks “if appropriate,” my Washington Post colleagues William Wan, Carolyn Y. Johnson and Joel Achenbach report.

“Georgia, according to some models, is one of the last states that should be reopening,” they write. “The state has had more than 830 covid-19 deaths. It has tested fewer than 1 percent of its residents — low compared with other states and the national rate. And the limited amount of testing so far shows a high rate of positives, at 23 percent.”

Trump blasted Kemp’s decision during his briefing last night, saying it violates his administration’s phase 1 guidelines for when to reopen.

Colorado: Polis is allowing the state’s stay-at-home order to expire Sunday, after which the state will gradually reopen businesses. Starting May 4, nonessential offices may have 50 percent of their workforce at the site, although large workplaces will be advised to conduct symptom and temperature checks.

Polis has warned the restrictions won’t all be lifted at the same time.

“The virus will be with us,” he said earlier this month. “We have to find a sustainable way that will be adapted in real time to how we live with it.”

South Carolina: Gov. Henry McMaster (R) said Monday he was allowing nonessential businesses such as department stores and retailers to open, followed by beaches on Tuesday.

But businesses must follow three rules for operating: They must limit the number of customers in the store; require patrons to be six feet apart; and follow sanitation guidelines from the Centers for Disease Control and Prevention.

“I urge everyone to remember we are still in a very serious situation,” McMaster said at a news conference. “We know that this disease, this virus, spreads easily, and we know it is deadly. So we must be sure that we continue to be strict and disciplined with our social discipline and taking care not to infect others.”

Tennessee: Gov. Bill Lee (R) said he plans to allow some businesses to reopen once his “safer-at-home” order expires in one week. But the state’s biggest cities will make their own reopening determinations. Lee has appointed a 30-member economic recovery group to create a plan.

Lee, along with Kemp and McMaster, have met with the governors of Mississippi, Alabama and Florida to consider how to reopen their economies in a coordinated way in the country’s southeast region. The number of new cases and deaths in Florida has leveled off somewhat — something the state’s governor, Ron DeSantis (R), has been pointing to as he urges a speedy reopening in his state.

Ahh, oof and ouch

AHH: CDC Director Robert Redfield confirmed comments he made to our colleague Lena H. Sun after Trump claimed he’d been “misquoted.”

Director of the Centers for Disease Control and Prevention Robert Redfield said April 22 that his statement on covid-19 in the fall is “accurately quoted.” (The Washington Post)

The president took issue with the portrayal of comments from Redfield following an interview with our Post colleague Lena H. Sun. In that interview, Redfield warned that a second wave of the coronavirus could be worse than the current one.

“There’s a possibility that the assault of the virus on our nation next winter will actually be even more difficult than the one we just went through,” Redfield told Lena. He added: “We’re going to have the flu epidemic and the coronavirus epidemic at the same time.”

The president again repeated the claim at his daily White House coronavirus task force briefing – this time, with Redfield standing awkwardly next to him.

Redfield then said this: “I’m accurately quoted in The Washington Post.”

But Redfield also sought to “soften his words as the president glowered next to him,” Lena, Ashley Parker, Josh Dawsey and Yasmeen Abutaleb write.

“The remarkable spectacle provided another illustration of the president’s tenuous relationship with his own administration’s scientific and public health experts, where the unofficial message from the Oval Office is an unmistakable warning: Those who challenge the president’s erratic and often inaccurate coronavirus views will be punished — or made to atone,” they write.

Ahh, oof and ouch

AHH: CDC Director Robert Redfield confirmed comments he made to our colleague Lena H. Sun after Trump claimed he’d been “misquoted.”

It’s apparent “Trump is again bristling at a health official offering too dire a scenario,” our colleague Aaron Blake writes. He points out that Trump was set off a previous time when another top CDC official warned in February that the spread of the coronavirus was inevitable.

OOF: The former head of the U.S. agency pursuing a coronavirus vaccine says he was ousted for opposing efforts to promote hydroxychloroquine, a drug Trump has insistently touted as a weapon against the virus despite a lack of scientific proof.

Rick Bright, previously the director of the Biomedical Advanced Research and Development Authority, said he was dismissed and pushed into a narrower role after he called for strictly vetting supposed treatments like anti-malarials repeatedly embraced publicly by the president.

“I believe this transfer was in response to my insistence that the government invest the billions of dollars allocated by Congress to address the Covid-19 pandemic into safe and scientifically vetted solutions, and not in drugs, vaccines and other technologies that lack scientific merit,” Bright said in a statement, according to the New York Times’s Michael D. Shear and Maggie Haberman.

He added: “I am speaking out because to combat this deadly virus, science — not politics or cronyism — has to lead the way.”

The president was asked about Bright during last night’s briefing and whether the official was pushed out.

“Maybe he was and maybe he wasn’t. I don’t know who he is,” Trump responded.

OUCH: There were early missteps by Health and Human Services Secretary Alex Azar that bogged down the government’s response to the virus.

In late January, days after the first coronavirus case was confirmed in the United States, Azar told Trump in a meeting the coronavirus spread was “under control,” the Wall Street Journal’s Rebecca Ballhaus and Stephanie Armour report. Azar also told the president more than a million diagnostic tests would be available in weeks and that it was the “fastest we’ve ever created a test.”

These promises didn’t pan out.

“Six weeks after that Jan. 29 meeting, the federal government declared a national emergency and issued guidelines that effectively closed down the country,” Rebecca and Stephanie write. “Mr. Azar, who had been at the center of the decision-making from the outset, was eventually sidelined.”

There were numerous factors that slowed the administration’s initial coronavirus response, but “interviews with more than two dozen administration officials and others involved in the government’s coronavirus effort show that Mr. Azar waited for weeks to brief the president on the threat, oversold his agency’s progress in the early days and didn’t coordinate effectively across the health-care divisions under his purview,” they report.

Earlier this year, Azar tapped an aide to lead HHS’s day-to-day coronavirus response who had joined the agency after running a dog-breeding business for six years.

The aide, Brian Harrison, was derisively called “the dog breeder” by some within the White House, Reuters’s Aram Roston and Marisa Taylor report.

“Azar’s optimistic public pronouncement and choice of an inexperienced manager are emblematic of his agency’s oft-troubled response to the crisis,” they add. “… Harrison, 37, was an unusual choice, with no formal education in public health, management, or medicine and with only limited experience in the fields. In 2006, he joined HHS in a one-year stint as a ‘Confidential Assistant’ to Azar, who was then deputy secretary. He also had posts working for Vice President Dick Cheney, the Department of Defense and a Washington public relations company.”

There’s much we don’t know about the coronavirus

Scientists say a mysterious blood-clotting complication may be causing a number of the coronavirus-related deaths.

Doctors are learning that covid-19, once believed to be a straightforward respiratory virus, is much more frightening. Since the earlier waves of coronavirus cases, doctors have learned that the disease attacks not just lungs but kidneys, the heart, intestines, liver and the brain. Autopsies also have shown that some coronavirus patients lungs were filled with hundreds of microclots, our Post colleague Ariana Eunjung Cha reports.

“The problem we are having is that while we understand that there is a clot, we don’t yet understand why there is a clot,” said Lewis Kaplan, a University of Pennsylvania physician and head of the Society of Critical Care Medicine. “We don’t know. And therefore, we are scared.”

“In hindsight, there were hints blood problems had been an issue in China and Italy as well, but it was more of a footnote in studies and on information-sharing calls that had focused on the disease’s destruction of the lungs,” Ariana writes.

New data provide troubling statistics about coronavirus patients on ventilators.

A study found 88 percent of 320 coronavirus patients on ventilators in New York state’s largest health system died.

It’s an uptick from pre-pandemic figures. “That compares with the roughly 80 percent of patients who died on ventilators before the pandemic, according to previous studies — and with the roughly 50 percent death rate some critical care doctors had optimistically hoped when the first cases were diagnosed,” Ariana reports.

The research, published in the journal JAMA, also notes many of the hospitalized had other conditions.

“The paper also found that of those who died, 57 percent had hypertension, 41 percent were obese and 34 percent had diabetes, which is consistent with risk factors listed by the Centers for Disease for Control and Prevention,” she adds. “Noticeably absent from the top of the list was asthma. As doctors and researchers have learned more about covid-19, the less it seems that asthma plays a dominant role in outcomes.”

The economic fallout

If there’s a recovery from the current economic downswing this year, it could be temporary, economists warn.

There’s a growing chance of a second economic downturn if there’s another surge of the coronavirus or if there’s an increase in bankruptcies and defaults, our Post colleague Heather Long reports.

Instead of a V-shaped recovery, economists say, it is increasingly likely that the recovery will be W-shaped, in which there are improvements before another downturn later this year or in the following year. That possibility is “in part because creating a vaccine is likely to take at least a year and millions of Americans and businesses are piling up debt without an easy ability to repay it,” Heather writes.

“It could be triggered by reopening the economy too quickly and seeing a second spike in deaths from covid-19, the disease the coronavirus causes,” she adds. “… This could cause many businesses, which were barely hanging on, to close again. Many Americans could become even more afraid to venture out until a vaccine is found.”

“Pretending the world will return to normal in three months or six months is just wrong,” said Diane Swonk, chief economist at Grant Thornton, told The Post. “The economy went into an ice age overnight. We’re in a deep freeze. As the economy thaws, we’ll see the damage done as well. Flooding will occur.”

https://www.nga.org/wp-content/uploads/2020/04/NGA-Report.pdf?utm_campaign=wp_the_health_202&utm_medium=email&utm_source=newsletter&wpisrc=nl_health202

Here are the innovations we need to reopen the economy

Posted on April 23, 2020 by henrykotula • Posted in 2020 Election Issues, Clinical Testing, Contact Tracing, Coronavirus, Crisis, Crisis Management, Economic Crisis, Economy, Health Policy, Healthcare Providers, Hydroxychloroquine, Infection Control, Infectious Virus, Pandemic, Personal Protective Equipment (PPE), Public Health, Public Safety, Social Distancing, Vaccination, Vaccine • Leave a comment

https://www.washingtonpost.com/opinions/2020/04/23/bill-gates-here-are-innovations-we-need-reopen-economy/?arc404=true

Bill Gates is a co-chair of the Bill & Melinda Gates Foundation. This article is adapted from his blog post “Pandemic I: the First Modern Pandemic,” available at gatesnotes.com.

It’s entirely understandable that the national conversation has turned to a single question: “When can we get back to normal?” The shutdown has caused immeasurable pain in jobs lost, people isolated and worsening inequity. People are ready to get going again.

Unfortunately, although we have the will, we don’t have the way — not yet. Before the United States and other countries can return to business and life as usual, we will need some innovative new tools that help us detect, treat and prevent covid-19.

It begins with testing. We can’t defeat an enemy if we don’t know where it is. To reopen the economy, we need to be testing enough people that we can quickly detect emerging hotspots and intervene early. We don’t want to wait until the hospitals start to fill up and more people die.

Innovation can help us get the numbers up. The current coronavirus tests require that health-care workers perform nasal swabs, which means they have to change their protective gear before every test. But our foundation supported research showing that having patients do the swab themselves produces results that are just as accurate. This self-swab approach is faster and safer, since regulators should be able to approve swabbing at home or in other locations rather than having people risk additional contact.

Another diagnostic test under development would work much like an at-home pregnancy test. You would swab your nose, but instead of sending it into a processing center, you’d put it in a liquid and then pour that liquid onto a strip of paper, which would change color if the virus was present. This test may be available in a few months.

We need one other advance in testing, but it’s social, not technical: consistent standards about who can get tested. If the country doesn’t test the right people — essential workers, people who are symptomatic and those who have been in contact with someone who tested positive — then we’re wasting a precious resource and potentially missing big reserves of the virus. Asymptomatic people who aren’t in one of those three groups should not be tested until there are enough for everyone else.

The second area where we need innovation is contact tracing. Once someone tests positive, public-health officials need to know who else that person might have infected.

For now, the United States can follow Germany’s example: interview everyone who tests positive and use a database to make sure someone follows up with all their contacts. This approach is far from perfect, because it relies on the infected person to report their contacts accurately and requires a lot of staff to follow up with everyone in person. But it would be an improvement over the sporadic way that contact tracing is being done across the United States now.

An even better solution would be the broad, voluntary adoption of digital tools. For example, there are apps that will help you remember where you have been; if you ever test positive, you can review the history or choose to share it with whoever comes to interview you about your contacts. And some people have proposed allowing phones to detect other phones that are near them by using Bluetooth and emitting sounds that humans can’t hear. If someone tested positive, their phone would send a message to the other phones, and their owners could get tested. If most people chose to install this kind of application, it would probably help some.

Naturally, anyone who tests positive will immediately want to know about treatment options. Yet, right now, there is no treatment for covid-19. Hydroxychloroquine, which works by changing the way the human body reacts to a virus, has received a lot of attention. Our foundation is funding a clinical trial that will give an indication whether it works on covid-19 by the end of May, and it appears the benefits will be modest at best.

But several more-promising candidates are on the horizon. One involves drawing blood from patients who have recovered from covid-19, making sure it is free of the coronavirus and other infections, and giving the plasma (and the antibodies it contains) to sick people. Several major companies are working together to see whether this succeeds.

Another type of drug candidate involves identifying the antibodies that are most effective against the novel coronavirus, and then manufacturing them in a lab. If this works, it is not yet clear how many doses could be produced; it depends on how much antibody material is needed per dose. In 2021, manufacturers may be able to make as few as 100,000 treatments or many millions.

If, a year from now, people are going to big public events — such as games or concerts in a stadium — it will be because researchers have discovered an extremely effective treatment that makes everyone feel safe to go out again. Unfortunately, based on the evidence I’ve seen, they’ll likely find a good treatment, but not one that virtually guarantees you’ll recover.

That’s why we need to invest in a fourth area of innovation: making a vaccine. Every additional month that it takes to produce a vaccine is a month in which the economy cannot completely return to normal.

The new approach I’m most excited about is known as an RNA vaccine. (The first covid-19 vaccine to start human trials is an RNA vaccine.) Unlike a flu shot, which contains fragments of the influenza virus so your immune system can learn to attack them, an RNA vaccine gives your body the genetic code needed to produce viral fragments on its own. When the immune system sees these fragments, it learns how to attack them. An RNA vaccine essentially turns your body into its own vaccine manufacturing unit.

There are at least five other efforts that look promising. But because no one knows which approach will work, a number of them need to be funded so they can all advance at full speed simultaneously.

Even before there’s a safe, effective vaccine, governments need to work out how to distribute it. The countries that provide the funding, the countries where the trials are run, and the ones that are hardest-hit will all have a good case that they should receive priority. Ideally, there would be global agreement about who should get the vaccine first, but given how many competing interests there are, this is unlikely to happen. Whoever solves this problem equitably will have made a major breakthrough.

World War II was the defining moment of my parents’ generation. Similarly, the coronavirus pandemic — the first in a century — will define this era. But there is one big difference between a world war and a pandemic: All of humanity can work together to learn about the disease and develop the capacity to fight it. With the right tools in hand, and smart implementation, we will eventually be able to declare an end to this pandemic — and turn our attention to how to prevent and contain the next one.

A mysterious blood-clotting complication is killing coronavirus patients

Posted on April 22, 2020 by henrykotula • Posted in Blood Clots, Centers for Disease Control & Prevention (CDC), Coronavirus, Health System, Infection Control, Infectious Virus, Intensive Care (ICU), Mortality, Pandemic, Physician, Preexisting Conditions, Social Distancing, Uncertainty • Leave a comment

https://www.washingtonpost.com/health/2020/04/22/coronavirus-blood-clots/?utm_campaign=wp_news_alert_revere_trending_now&utm_medium=email&utm_source=alert&wpisrc=al_trending_now__alert-hse–alert-national&wpmk=1

Once thought a relatively straightforward respiratory virus, covid-19 is proving to be much more frightening.

Craig Coopersmith was up early that morning as usual and typed his daily inquiry into his phone. “Good morning, Team Covid,” he wrote, asking for updates from the ICU team leaders working across 10 hospitals in the Emory University health system in Atlanta.

One doctor replied that one of his patients had a strange blood problem. Despite receiving anticoagulants, the patient was still developing clots in various parts of his body. A second said she’d seen something similar. And a third. Soon, every person on the text chat had reported the same thing.

“That’s when we knew we had a huge problem,” said Coopersmith, a critical-care surgeon. As he checked with his counterparts at other medical centers, he became increasingly alarmed: “It was in as many as 20, 30 or 40 percent of their patients.”

One month ago, as the country went into lockdown to prepare for the first wave of coronavirus cases, many doctors felt confident that they knew what they were dealing with. Based on early reports, covid-19 appeared to be a standard variety respiratory virus, albeit a very contagious and lethal one with no vaccine and no treatment. But they’ve since become increasingly convinced that covid-19 attacks not only the lungs, but also the kidneys, heart, intestines, liver and brain.

And many are also reporting bizarre, unsettling cases that don’t seem to follow the textbooks they’ve trained on. They describe patients with startlingly low oxygen levels — so low that they would normally be unconscious or near death — talking and swiping on their phones. Asymptomatic pregnant women suddenly in cardiac arrest. Patients who by all conventional measures seem to have mild disease deteriorating within minutes and dying at home.

With no clear patterns in terms of age or chronic conditions, some scientists now hypothesize that at least some of these abnormalities may be explained by severe changes in patients’ blood.

The concern is so acute that some doctors groups have raised the controversial possibility of giving preventive blood thinners to everyone with covid-19 — even those well enough to endure their illness at home.

Blood clots, in which the red liquid turns gel-like, appear to be the opposite of what occurs in Ebola, Dengue, Lassa and other hemorrhagic fevers that lead to uncontrolled bleeding. But they are actually part of the same phenomenon — and can have similarly devastating consequences.

Autopsies have shown that some people’s lungs are filled with hundreds of microclots. Errant blood clots of a larger size can break off and travel to the brain or heart, causing a stroke or a heart attack. On Saturday, Broadway actor Nick Cordero, 41, had his right leg amputated after being infected with the novel coronavirus and suffering from clots that blocked blood from getting to his toes.

Lewis Kaplan, a University of Pennsylvania physician and head of the American Society of Critical Care Medicine, said that every year, doctors treat a large variety of people with clotting complications, from those with cancer to victims of severe trauma, “and they don’t clot like this.”

“The problem we are having is that while we understand that there is a clot, we don’t yet understand why there is a clot,” Kaplan said. “We don’t know. And therefore, we are scared.”

‘It crept up on us’

The first sign that something was going haywire was in legs, which were turning blue and swelling. Even patients on blood thinners in the ICU were developing clots in them — which is not unusual in one or two patients in one unit, but is for so many at the same time. Next came the clogging of the dialysis machines, which filter impurities in blood when kidneys are failing, and were getting jammed up several times a day.

“There was a universal understanding that this was different,” Coopersmith said.

Then came the autopsies. When they opened up some deceased patients’ lungs, they expected to find evidence of pneumonia and damage to the tiny air sacs that exchange oxygen and carbon dioxide between the lungs and the bloodstream. Instead, they found tiny clots all over.

Zoom meetings were convened in some of the largest medical centers nationwide. Tufts. Yale-New Haven. The University of Pennsylvania. Brigham and Women’s. Columbia-Presbyterian. Theories were shared. Treatments debated.

And although there was no consensus on the biology of why this was happening and what could be done about it, many came to believe the clots might be responsible for a significant share of U.S. coronavirus deaths — possibly helping to explain why so many people are dying at home.

In hindsight, there were hints that blood problems had been an issue in China and Italy as well, but it was more of a footnote in studies and on information-sharing calls that focused on the disease’s effects on lungs.

“It crept up on us. We weren’t hearing a tremendous amount about this internationally,” said Greg Piazza, a cardiovascular specialist at Brigham and Women’s who has begun a study of bleeding complications of covid-19.

Helen W. Boucher, an infectious-disease specialist at Tufts Medical Center, said there’s no reason to think anything is different about the virus in the United States. More likely, she said, the problem was more obvious to American doctors because of the unique demographics of U.S. patients, including large percentages with heart disease and obesity that make them more vulnerable to the ravages of blood clots. She also noted small but important differences in the monitoring and treatment of patients in ICUs in this country that would make clots easier to detect.

“Part of this is by virtue of the fact that we have such incredible intensive care facilities,” she said.

A leading cause of death

The body’s circulatory or cardiovascular system is often described as a network of one-way streets that connect the heart to other organs. Blood is the transport system, responsible for moving nutrients to the cells and waste away from them. A common cold or a cut on the finger can lead to changes that help repair the damage, but when the body undergoes a more significant trauma, the blood can overreact, leading to an imbalance that can cause excessive clots or bleeding — and sometimes both.

Scientists call this “hemostatic derangement.” In math, a derangement is a permutation in which no element is in its original position.

Harlan Krumholz, a cardiac specialist at the Yale-New Haven Hospital Center, said no one knows whether blood complications are a result of a direct assault on blood vessels, or a hyperactive inflammatory response to the virus by the patient’s immune system.

“One of the theories is that once the body is so engaged in a fight against an invader, the body starts consuming the clotting factors, which can result in either blood clots or bleeding. In Ebola, the balance was more toward bleeding. In covid-19, it’s more blood clots,” he said.

A Dutch study published April 10 in the journal Thrombosis Research provided more evidence that the issue is widespread, finding that among 184 covid-19 patients in an intensive care unit, 38 percent had blood that clotted abnormally. The researchers called it “a conservative estimation” because many of the patients were still hospitalized and at risk of further complications.

Early data from China on a sample of 183 patients showed that more than 70 percent of patients who died of covid-19 had small clots develop throughout their bloodstream.

Although acute respiratory distress syndrome (ARDS) still appears to be the leading cause of death in covid-19 patients, blood complications are not far behind, said Behnood Bikdeli, a fourth-year fellow at Columbia University Irving Medical Center, who helped anchor a paper about the blood clots in the Journal of The American College of Cardiology.

“My guess is it’s one of the top three causes of demise and deterioration in covid-19 patients,” he said.

That recognition is prompting many hospitals to change the way they think about the disease and manage it. When the novel coronavirus first hit, the Centers for Disease Control and Prevention and others put people with asthma at the top of their lists of those who might be the most vulnerable. But recently, European researchers writing in the journal Lancet noted that it was “striking” how underrepresented asthma patients had been. Earlier this month, when New York state released data about the top chronic health problems of those who died of covid-19, asthma was not among them. Instead, they were almost all cardiovascular conditions.

Some medical centers recently have begun giving all hospitalized covid-19 patients small doses of blood thinners as preventive measures, and many are adjusting doses upward for the most seriously ill. The challenge is that the more you give, the greater the danger of upsetting the balance in the other direction and having the patient bleed out.

Another big mystery the doctors hope the blood issue will shed light on is why some maternity patients are collapsing during or after giving birth.

A paper published in the American Journal of Obstetrics & Gynecology MFM in late March detailed how two women with no prior symptoms of covid-19 ended up in intensive care. The first was a 38-year-old patient of New York-Presbyterian/Columbia University Irving Medical Center in Manhattan who spiked a fever of 101.3 while undergoing a C-section delivery and began bleeding profusely. The second woman, 33, also underwent a C-section. But the next day, she developed a cough that progressed to respiratory distress. Her heart started beating irregularly and her blood pressure jumped to as high as 200/90.

Several physician-researchers said that the relationship between covid-19, clotting and pregnant women is “an area of interest.” Women in childbirth have always experienced clotting and bleeding complications because of the involvement of the blood-rich placenta, but it’s possible that covid-19 may be triggering additional cases by making some women’s bodies “lose balance.”

“There’s lots of speculation,” Krumholz said. “That’s one of the frustrating things about this virus. We’re in a lot of darkness still.”

Sign of the Week

Posted on April 21, 2020 by henrykotula • Posted in Core Values, Coronavirus, Infection Control, Infectious Virus, Mortality, Pandemic, Public Health, Public Safety, Social Distancing, Values • Leave a comment

Melinda Gates: This is not a once-in-a-century pandemic.

Posted on April 21, 2020 by henrykotula • Posted in 2020 Election Issues, Centers for Disease Control & Prevention (CDC), Clinical Research Funding, Clinical Testing, Clinical Trial Recruitment, Clinical Trials, Communication, Coronavirus, Crisis, Crisis Management, Emergency Preparedness, Food and Drug Administration (FDA), Health Policy, Herd Immunity, Infection Control, Infectious Virus, Intensive Care (ICU), Leadership, Leadership Cares, Leadership Trust, Mortality, National Strategy, Pandemic, Personal Protective Equipment (PPE), Public Health, Public Safety, Quarantine, Social Distancing, Vaccination, Vaccine • Leave a comment

https://www.businessinsider.com/melinda-gates-coronavirus-interview-vaccine-timeline-2020-4?linkId=87026774

‘We will absolutely have more of these.’ The billionaire philanthropist predicts a timeline for going back to normal.

Business Insider spoke with Melinda Gates about COVID-19, the prospect and timeline of making an effective vaccine, and how the world will be permanently changed by the coronavirus.
Gates said it would likely take about 18 months for a vaccine to become widely available, and that it should first go to healthcare workers to help them keep others safe.
She said this pandemic was not a once-in-a-century situation, like the Spanish flu. Because the world is now a global community, we’re likely to see other pandemics in our lifetimes, Gates said.
Even after things get back to normal, “our psyches are going to permanently changed … I hope we change to realize that we’re a global community.”

Melinda Gates is the cochair of the Bill & Melinda Gates Foundation, which has donated more than $45 billion to tackle some of the world’s toughest problems, including vaccination research and combating pandemics, from coronavirus to Ebola.

Gates and her husband have long been concerned about a pandemic and have warned that we need to be more prepared at a global level.

In a wide-ranging interview with Gates on Thursday afternoon, she gave her thoughts on the coronavirus pandemic, the inequality of it all, and how the world can go back to semi-normal. The highlights:

The world needs a vaccine delivered at mass scale to go back to “normal.” A realistic timeline is about 18 months, the same time it took to create an Ebola vaccine.
It is possible we won’t be able to find an effective vaccine for coronavirus, although Gates thinks that is highly unlikely.
The idea of herd immunity solving coronavirus is far-fetched. Gates said that would require more than half the population to get coronavirus (which isn’t anywhere close to happening) and a lot of death along the way.
To effectively roll out a vaccine, Gates believes you need to first give it to health workers, then to high-risk groups, then distribute it equitably to different countries and communities. The vaccine also has to cost very little with a fund to cover it for everyone. What the US is doing right now, pitting states against each other for supplies and allowing wealthy individuals to access tests first, would be disastrous for a vaccine rollout.
To prepare for the second wave of coronavirus this fall, or even a next pandemic, we need mass testing from the get-go, voluntary data sharing from people so that we can trace who has been tested and where they have been, and vaccine stockpiles so that you can distribute those as soon as you see signs of an outbreak.
Gates said there would “absolutely” be more pandemics in our lifetime. Coronavirus is not a once-in-a-century occurrence like the Spanish flu.
If you want to help vulnerable, poor communities survive coronavirus, Gates recommends giving to the WHO COVID Solidarity Fund, United Way, or America’s Food Fund.

We need a vaccine to be widely distributed before the world will start to feel normal again. Gates says we won’t get that for at least 18 months.

Alyson Shontell: How is it going in the Gates household?

Melinda Gates: Like all other families, it’s been a complete change of life for all of us. But we are also incredibly privileged, and we know that, and our kids know that. But yes, life has changed drastically. The kids are studying online. Bill and I are doing all of our meetings via video teleconference. I’m a terrible cook, so I’m heating things up a lot more, and everybody’s trying to pitch in to do what needs to get done in terms of things around the house.

And the other thing I would just say is every night, we’ve had this tradition for a long time of saying grace before meals. And what that looks like is that we all go around and say something we’re thankful for. Pretty much every night what comes up from the kids and us is we’re thankful for our health and for the fact that we’re not going hungry and the fact that we can still do our work and the kids can still learn. It’s kind of amazing.

Shontell: We heard Dr. Fauci say earlier this week that things probably won’t return to normal until we have a vaccine. What do you think is a realistic timeline for a wide distribution of a vaccine? Is anything faster than 18 months really safe?

Gates: I think it’s likely 18 months. Just from everything we know from working with our partners for many, many years on vaccines, you have to test the compounds. Then, you have to go into preclinical trials, then full-scale trials. And even though I’m sure the FDA will fast-track some of these vaccine trials like they did with Ebola, still by the time you get it through the trials safety- and efficacy-wise, then you have to manufacture the vaccine and manufacture at scale. I think it really is 18 months.

The good news that I’m seeing on that front, though, is so many scientists are coming forward, and I’m seeing CEOs come forward and say, “I have this platform we can use.” Pharmaceutical companies are coming together already to say, “How do we build up the manufacturing capacity so it’s there when we get a vaccine and we can basically just run it through the manufacturing process?” I’m seeing lots of good things come forward, but it’s a process that needs to run its full course, because you don’t want to put something in someone’s body that is harmful.

Shontell: Right. It seems like, in addition to creating something we’ve never had before, you do really have to do these human tests in a way that’s safe so that you’re not creating a vaccine that maybe cures coronavirus but gives you something else.

Gates: I’d add also that we need to know who it’s safe to give the vaccine to and in what dosages. We know COVID-19 is affecting people who are particularly vulnerable health-wise if they have diabetes, or a heart condition, or they have asthma. You have to make sure that, safety-wise, you’re not giving somebody a vaccine that’s going to affect their heart. So yeah, there are lots of issues there that have to be tested.

It’s possible we won’t be able to create a coronavirus vaccine, although Gates thinks that’s highly unlikely. Also, herd immunity is not the solution.

Shontell: If at the end of this 18-month period, or however long it is, we do feel like we’ve got a vaccine, what do you think that vaccine will actually look like? Is it possible that we actually won’t be able to create a vaccine at all? Could that be one scenario?

Gates: Well, it’s possible. We have to look at how far science has come even in the last five years. And the number of compounds we have, there’s something like 14,000 compounds that we, with our partners alone, have. And there are many, many, many others testing compounds that we’re looking at to see, “Is this promising?” Could that one be promising? And we have high throughput screening now of compounds. I really think we’re going to find a vaccine.

We found a vaccine for Ebola, right? And we did that in about an 18-month time frame, and that was hard. When I see the scientific community all coming together the way they are around the globe and sharing data and sharing information, we’re going to get a vaccine.

Shontell: OK, so you’d say that it’s a high likelihood.

Gates: High likelihood.

Shontell: That’s very, very good to know.

Gates: The other thing to think about is, in the meantime, there’s another whole strand of work going on, which is the therapeutics accelerator. Through the accelerator, we’re trying to find medicines so that if you get COVID-19, hopefully we can boost your immune system or tamp down the effect of the disease on you. So again, hopefully, we’ll come up with some medicines that will also help so people don’t get as sick as they’re getting and landing in the ICU, which is what’s truly tragic.

Shontell: Is there anything to this idea of herd immunity? Could we be closer than we think on that, or is that far-fetched thinking?

Gates: That’s still very far-fetched today. You don’t get herd immunity until you have a huge percent of your population that has had the disease. We know that from all the diseases in the past that humans have had. So no, we’re still a long way from herd immunity. And you can’t count on that because a lot of people are going to die in the meantime if you let the experiment run and you just let the disease run its course in communities. Sure, we could get herd immunity and we will get so much death. That’s why it’s so important to remind people the only tools we have today are physical distancing, handwashing, and wearing masks in public. We have to go with what we know works.

How to distribute a coronavirus vaccine to the masses: 1. Make it cheap and buy it for everyone. 2. Give it to healthcare workers. 3. Give it to the highest-risk people. 4. Come up with an equitable way for everyone else to get it (the US is screwing that up right now).

Shontell: Once we have a vaccine, what do you think is the best way to distribute it to the masses? Who should get it first? How would we do it on such a big scale?

Gates: We have to make sure that the vaccine is very low priced and that there’s a fund for buying it for everyone, whether you’re in a low-, middle-, or a high-income country. And that’s doable. We’ve done that with the Vaccine Alliance that exists today. That’s been in existence since 1990, so we know how to do that piece.

But we also have to distribute very carefully. The very first people that need to get this vaccine are healthcare workers, because if you can keep them safe, they can help keep others safe. Then you need to distribute it to the people who are the very most vulnerable. That is, they have underlying health conditions, some of the ones that we’ve talked about before. And from there, you then make it distributed completely equitably across society.

And even the United States is going to have to really work at that. COVID-19 is exposing all the inequities we have in our healthcare system. And so we need to look at, OK, does Mississippi get this vaccine at the same time California gets it and New York gets it? We can’t do this game that we’re playing right now where you have 50 different states competing for resources for masks and PPE, that makes zero sense. You need a national strategy that will equitably distribute this vaccine and we first look at the vulnerable populations.

Shontell: To touch on that point, as you mentioned, there are so many inequalities coming to light with this pandemic, from who has been able to get initial testing on to how it’s affecting different genders in different ways, to more African Americans in the US dying of this than other races. When you think about it, social distancing, stocking up on food, and handwashing are all privileges that some of the poorest communities don’t have.

You’ve done a lot of work on equality efforts, and you’ve said it’s the best way to fix everything in society is to level the playing field. How do we start leveling the playing field so the next time it’s better for everybody? How do we help the people who are in the poorest, most vulnerable communities right now?

Gates: We have to start by remembering that COVID-19 anywhere is COVID-19 everywhere. And if we keep that front and center in our minds, then we will start to think really deeply about these most vulnerable populations.

The thing that keeps me up at night — because I’ve traveled to Africa so many times and been in so many townships and slums — is if you are a person living in those conditions, you can’t begin to handwashing or social distance. In those situations, we need to start with food. People need to be able to feed themselves. And then if they feel like they have COVID symptoms, then they don’t have to go out of the house looking for food.

When I think forward about how we would do this, right now, we have to focus on the pandemic today right in front of us. We have to take the tools we have and try and distribute them as equitably as we possibly can. That means a national response that is thought out and strategic. So you start there.

When you plan for the future, you start to plan it out the way we did for other diseases that came into the world. You would create a vaccine stockpile. We’ve actually been quite involved with that for cholera, which we don’t get much in the United States anymore, but you get in a lot of places in the developing world or in refugee camps. And when there’s a stockpile of vaccine, then when you see an outbreak or a vulnerable population get it, it’s already basically paid for and you ship the vaccines out.

We have to have not a national stockpile of vaccines but an international stockpile of vaccines for something like COVID. We can predict some of these types of disease outbreaks; we just haven’t been planning it. We plan for things like an earthquake or a fire. We need to plan for disease. We are a global community. People travel. We’ve just learned that New York mostly got infected from people coming back from Europe. We have to plan for these things as a global community in the future.

How to be ready for the 2nd wave to hit this fall: Are you ready to give up your personal data and get tracked?

Shontell: Clearly, we were caught flat-footed and unprepared here in the US especially. There’s talk of a second wave of coronavirus potentially hitting in the fall. What are the things we need to do to plan for it? What has to be done by the end of the summer to put us all in a much better shape for it? And then I’m curious what we need to have in place to prevent something like this moving forward, if that’s even possible.

Gates: In terms of what we need to do to prepare ourselves this fall, first of all, all the way through this, we need to listen to the medical experts and the science experts. They know what’s real. We need to do the disease modeling to see where the outbreaks are going. We need to plan resources appropriately and share them in the United States with all the states in an equitable way.

And then we need to do massive testing. We have to have testing at wide scale so that you can get a test and you can know if you’re positive. And if you’re positive, then you self-isolate. Unless you get further disease, you then get telemedicine. You figure out if you need to go to the health system. And you have different tiers of the health system, places people can go for oxygen versus people who go to the ICU.

We can do that, kind of. You can do that triage of people if you have a test. To be frank, we also need to be able to share all that testing data so that eventually the US would be a place like South Korea, where I can literally prove on my phone “I took a test this morning — I’m COVID-free” or “Guess what? I had COVID before and I tested for antibodies in my system. I can be out in society working maybe now.” You could literally have a code on your phone that says, “Tested this morning” or “See? I have a COVID antibody.”

And so we can start to see who can be in society versus who needs to self-isolate. But without testing and contact tracing and some way of being able to prove to one another we’re safe, you can’t plan for a full eventual reopening of society. We need to do get that up and running at scale at a national level.

Preparing for the next epidemic is a whole different conversation. You’d have tests available from the get-go. You would have fought through the civil-liberties issues of people sharing their health information willingly or not willingly. Am I willing to share my health data so that you know if I got it?

Early on, people with COVID had symptoms we didn’t know to track. If we had known that from the get-go because they were able to share their information into a national database voluntarily, we would have known to tell people, “Look for these symptoms. Self-isolate just in case you have it.” We have to be able to start thinking through those types of systems as a country so that we’re prepared for whatever comes next.

Whose job is it to solve a pandemic, the elite’s or the government’s?

Shontell: Yes to all of that. Edelman put out on their annual Trust Barometer in January. They found that trust in media is really low right now. Trust in the government is really low too. But trust in business leaders is the highest group, and people seem to put the most faith in business leaders to solve some of society’s biggest problems.

You and Bill have done a tremendous amount with the foundation. You’re seeing Mark Zuckerberg giving a ton of money toward this. Sheryl Sandberg is doing the same. Jack Dorsey just pledged a big chunk of net worth to help fight COVID. Lots of people are stepping up. Bezos as well.

Is it the responsibility of business leaders to do this versus the government? Is this something we should come to expect? How do you kind of view the responsibility of the people who are in positions of the most privilege as we tackle something as wide-scale is this?

Gates: What I’m seeing is people stepping up. I sometimes wish people could see the number of emails we’re receiving daily at the foundation, not just Bill and me, but our scientists and our head of global health. We’re seeing CEOs come forward. We’re seeing philanthropists come forward. We’re seeing people who have knowledge and data saying, “Should we look at this? What should we do?” I am seeing the best of humanity come out right now in some of these leaders who are stepping forward and doing the right thing.

“Is this the responsibility of business?” was your question. It’s the responsibility of all of us. Business won’t be able to solve this. There’s no way business or philanthropy can solve this alone. It takes the government. It’s government who puts out huge amounts of money into our healthcare system to take care of everybody, to take care of the most vulnerable. It’s philanthropy and business and nonprofits coming together with government to have a national response. That is the only way we’re going to be able to care for all Americans.

But what I see is amazing scientists like Dr. Fauci stepping up and giving all the right messages. Those are the people we should be listening to, and I am seeing so many people come together behind the scenes to try and do the right thing. While the vulnerable is what keeps me up at night, one of the things that keeps me encouraged when I wake up in the morning is seeing so many people doing the right thing.

This is not just a once-in-a-century pandemic. ‘We are absolutely going to have more of these.’

Shontell: Is this a once-in-a-century pandemic like the Spanish flu, or do we need to expect to face more pandemics like this moving forward?

Gates: This is not a once-in-a-century pandemic. We are absolutely going to have more of these. This thing is highly infectious, COVID-19. But it is not nearly as infectious as measles. And we dealt with measles in the world. We know how to deal with measles. We’re going to see more, so we need to plan for them. And we haven’t planned for them as a global community.

Shontell: Why do you think we’ll see more pandemics?

Gates: We’ll see more because of all kinds of reasons, but mainly because we’re a global community and we travel and we spread disease.

Alyson: To end on a positive note, we are going to get through this, right? It will be hard, but we will get through this. I’m curious from your estimation: What timeline are we looking at for life to feel normal again? Or are we in a new normal, and are there things that we should expect to be permanently changed?

No one really knows when things will feel normal again. But be prepared for some permanent changes, including to your psyche.

Gates: I definitely think there are going to be things that are permanently changed. Our psyches are going to be permanently changed. We are learning some things about how to do more meetings online. We’re learning how to take care of each other online. People are reaching out to the elderly in their homes and doing video calls and sending emails or dropping a meal off. What’s going to change is our psyche, and I hope we change to realize that we’re a global community.

To the question of when does society reopen in what we think of as our normal form, nobody really knows the answer to that. It really is when we get a vaccine at scale.

Will we get, over time, probably some partial reopenings of society where you can do certain smaller group things or be out walking with one friend or two friends? I think we will start to see some partial reopenings.

We have to follow the data, though, of how is that working in Wuhan right now? How did it work in South Korea? How does it work in Germany? The places that are kind of ahead of us on both their response and when they got the disease? And then, we’ll start to be able to see, OK, where can we open up pockets of society over time? For right now, we need to be physically distant from one another.

Shontell: If the average person wants to give to help a vulnerable person or community, what’s the best way to do that other than social distancing? Is there some cause to give to or something that’s most helpful?

Gates: Yes. You could go globally. You could go to the WHO COVID Solidarity Fund. Locally, you could go to United Way. America’s Food Fund is another place you can go. I would give also to local domestic-violence organizations. We see domestic violence on the rise for many, many people, particularly women. Any of those would be amazing places to go and to give, even if you only give $10 — $10 or $100, it all makes a difference.

Shontell: I’m leaving this conversation very hopeful. Thank you for all efforts you and Bill and the foundation are doing in helping fight this. You were early to realizing the problems of pandemics, and we are grateful that you’re on it.

Gates: Thanks, Alyson. Be safe. Be well.

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KEY FACTS

KEY BACKGROUND

WHAT TO WATCH FOR

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COVID-19 vulnerability index, by county

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As governors weigh when and how to reopen public gathering spots, there are several road maps they could look to.

So far, governors vary widely in how they’re approaching the issue.

Here are the states opening things up first:

Ahh, oof and ouch

AHH: CDC Director Robert Redfield confirmed comments he made to our colleague Lena H. Sun after Trump claimed he’d been “misquoted.”

Redfield then said this: “I’m accurately quoted in The Washington Post.”

Ahh, oof and ouch

AHH: CDC Director Robert Redfield confirmed comments he made to our colleague Lena H. Sun after Trump claimed he’d been “misquoted.”

OOF: The former head of the U.S. agency pursuing a coronavirus vaccine says he was ousted for opposing efforts to promote hydroxychloroquine, a drug Trump has insistently touted as a weapon against the virus despite a lack of scientific proof.

OUCH: There were early missteps by Health and Human Services Secretary Alex Azar that bogged down the government’s response to the virus.

There’s much we don’t know about the coronavirus

Scientists say a mysterious blood-clotting complication may be causing a number of the coronavirus-related deaths.

New data provide troubling statistics about coronavirus patients on ventilators.

The economic fallout

If there’s a recovery from the current economic downswing this year, it could be temporary, economists warn.

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Once thought a relatively straightforward respiratory virus, covid-19 is proving to be much more frightening.

‘It crept up on us’

A leading cause of death

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‘We will absolutely have more of these.’ The billionaire philanthropist predicts a timeline for going back to normal.

We need a vaccine to be widely distributed before the world will start to feel normal again. Gates says we won’t get that for at least 18 months.

It’s possible we won’t be able to create a coronavirus vaccine, although Gates thinks that’s highly unlikely. Also, herd immunity is not the solution.

How to distribute a coronavirus vaccine to the masses: 1. Make it cheap and buy it for everyone. 2. Give it to healthcare workers. 3. Give it to the highest-risk people. 4. Come up with an equitable way for everyone else to get it (the US is screwing that up right now).

How to be ready for the 2nd wave to hit this fall: Are you ready to give up your personal data and get tracked?

Whose job is it to solve a pandemic, the elite’s or the government’s?

This is not just a once-in-a-century pandemic. ‘We are absolutely going to have more of these.’

No one really knows when things will feel normal again. But be prepared for some permanent changes, including to your psyche.

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