Germany, United States, South Korea discussed on The Editors
What have South Korea and Germany gotten right on the krona virus? Have we overreacted? And what will normality or semi-normality? Look like we'll discuss all this and more on a special edition of the editors with Scott Gottlieb the former FDA commissioner now with the American Enterprise Institute. You're listening to a national view podcasts. You listen to this. Podcast VIEW DOT com. Or what have you? But it'd be easier for you and better for us if you made us part of your feet at any of the streaming services out there from spot fight. I tunes feel like what you hear. Please give us a glowing five star review on I tunes. If you don't like what you hear here forget. I said anything so Scott. Thanks so much for making time. And congratulations on all your really valuable work on this. I thought we do this. Conversation and three buckets. I I'd ask about some things. I'm just curious about mostly involving the various Responses from countries around the world and how China handled this second. Go into some of the critiques. From the right about how we've handled this and especially The argument that we've overreacted and three get into your work with your colleagues about how we responsibly. Open up again. So let's just dive right in and let me ask you this. If this virus had merged in one thousand nine hundred seventeen and nineteen eighteen and let's subtract world one pretend world war one didn't happen all the crowding and things of that nature But just have the same medical and scientific knowledge and conditions of that era. Would this virus have looked like I think given the profile? This virus is likely it would have been far more deadly than the Spanish flu. If you look at Look in comparison to Spanish flu viruses have bears some similarities in that the people who seem to be hardest hit by virus are people who are middle aged relative to normal seasonal fluid Spanish flu was that the young people will by and large spared. Old people were spared to But there were a lot of older people around nineteen eighteen and they would disperse differently demographically but the people who are hardest hit by the spent the middle aged people and it was often stories talking. About how the Spanish flu left kids orphan to be raised by their grandparents and what was happening with the Spanish flu was people were dying of. We think was an overwhelming inflammatory response. Immune reaction to the fluid south the fluids so novel that revved up people's immune systems and that that immune response actually destroyed people's lung tissue this seems to be very similar this is a lower airway disease affecting lower areas of lung and the people who are getting into trouble and getting what we call acute respiratory distress syndrome in the air type picture in the ICU. Ending up with prolonged innovations. What's happening? They're having an overwhelming immune response. They're developing what squad sidelined storm. It's basically a release of immune cells and those immune cells are attacking their own tissue and damaging their lungs. That's very Spanish flu like and if you look at the sort of overlay of deaths from Spanish flu verses intimations in ICU admissions from covert nineteen. There's unmistakable trend in terms of how the ages trend with the exception at for covert nineteen. There's a very large spike. When you get over the age of seventy five eighty and that we don't we can't full explain that other than to say that nineteen the warrant a lot of eighty euros now. There are is possible that the small number eight year olds who lived in nineteen eighteen. Maybe we're dispersed in the countryside outside the cities with Spanish flu hit and so they just didn't come into proximity with the Spanish flu. Maybe they would selected for because a you know were were had more ability to the pathogens unclear that's never been explained. But what is clear is that there's unmistakable trend as you move through the age bands of people died from the Spanish flu versus people who are admitted to the ICU. For Covert nineteen reason. Why that's I think relevant observation is at. I think it's reasonable to surmise. That anyone who soup who gets admitted to belonged Icu stay with covert nineteen ends up getting into bait ends up getting prolonged critical care. That's probably someone who would have died from the Spanish flu. And if you do accept that assumption or at least some amount of that suction if you say well. Some large proportion of people who are surviving covert nineteen or even surviving but ending up with prolonged Into Beijing in critical stays in critical care would have died from Spanish flu than Spanish Nineteen not only looks like Spanish flu in terms of distribution across the age range but looks far more fearsome. So let's talk about some of the responses around the world and the different outcomes so I remember one of your Bank tweets at the beginning of this. What four or five weeks ago is that? We've missed the opportunity to be on a South Korean curve because of the the initial testing debacle. But I just wonder that that South Korean example just how applicable it would have been in this country Involved such robust contact tracing in tracking people on their phones and things that even if we've been stronger out of the gate on testing would seem hard to do in this country. What would you think of that operation while the tracking on the phones? Were sort of a sideshow thing. I think a lot of people clinging to that to find reason to be skeptical of sort of traditional public health case Baynes tracking. We would never do that in this country Track people and see where they go and see if they come into contact with coke now is sort of a sideshow thing that South Korea did They did do contact tracing overall though they identified their cases efficiently. They had very broad diagnostic capabilities so they tested a lot of people identified those cases and they did do traditional contact tracing where they interview people who are positive found at all. The people were in touch with you. Know ask those people if they were sick required some selfies late. Who may be had signs of symptoms coca until they got back? Positive tests may be for people who are in closer contact they were were also requiring people self isolate until tests came back proving that they were negative so they did. They did that. Those are the traditional tools of public health. We do that here all the time. There's a measles outbreak outbreak of multi-drug-resistant tuberculosis. We do those cards it tools. We also did that at the outset of covert nineteen in fact. We did more than that. We forcibly required people to quarantine on military bases when they're identified as having covered nineteen or or exposed to nineteen. We're even more aggressive in some ways. The challenge was that there ended up being so many cases in the. Us quickly overwhelmed our capacity to do that to do contact tracing and what we call case based interventions if we want to prevent another outbreak in the future or large epidemic. We're GONNA have to rely on these tools. We really don't have a choice. I mean you can either let this circulate. You could do three things they just let it circulate and then you're GonNa have an extreme amount of morbidity death and disease hostels be overwhelming to build more hospitals people probably as large subset of people are going to be afraid to go out. You can do what we're doing now. population-based base mitigation. But it's it's untenable to do this again to me we. We can't go through this again as a country or you can do those case based interventions very aggressively and try to find people who have the disease test very aggressively and when you find people ask them to self isolate for a period of time that they're infectious in five people. They might have been in contact with either treat them. Hopefully we'll have a drug that will be a prophylaxis you'll be all treat them or s themself isolate for the duration that they may have the disease. We're those are the only three options I mean. Is that really a good middle option with any of those strategies so we'll circle back on on. Xm obviously hits on your on your thinking about how we open back up the German example in Europe. It it does seem to be the the genuine exception in Europe. Lots of confirmed cases. Probably write a product of of lots of testing But then many fewer deaths than in places like Italy Spain the UK which lease at the outset. I haven't checked down in on a slightly ahead to do with apparently young people being disproportionately in fact infected but what accounts for Germany looking different than the rest of Europe. We don't know exactly. There's a number of things about Germany. That are a lot different first of all as you said. They case fatality relative cases. They turned over as far lower than us. Certainly but lower than other parts of the world is well. It's probably a function of a number of things. One day are diagnosing more than mild and moderate nascent cases in the community so there Denominator Looks Different Than Ours. Relative to the numerator. Many people are hospitalized. How many people Ultimately come to the infection they have many more mild and mater cases underneath that here in the US were by and large just diagnosing. People were presenting to the hospital. I would say on the whole. Were probably doing a worse. Job Than China did At diagnosing all our cases in several other criticism of China date not being believable. Our data's probably off by me even further because we have less community-based testing in Chinese at this point you can you can sort of surmise. Just by the fact that we don't have community based testing sites that up And certainly less than South Korean Singapore Hong Kong where they had a lot of community based testing site. Set up the other thing. Is that when you look? At a comparison of the percent of deaths blessed in sixty five years old versus percents deaths over the age of eighty At your in Germany. It's it's four point. Nine percent of all their deaths from covert are less than the age of sixty five Sixty one percent or by the age of eighty give you some other examples in elite nine percent of all their deaths. Covert deaths are less than the age of sixty five Netherlands is five point one percent in Portugal. Four point five percent in Spain is four point. Six percent in Sweden four point eight percent switch learns three percent so pretty consistently around five percent. Say of all those countries of the deaths overall about five percent or less than the age of sixty five of all their debts in the US by comparison Louisiana. It's twenty three percent Michigan Detroit's twenty one percent In New York City. It's twenty nine point nine percent so startling as that's under underlying health conditions we don't know Is the short answer. The long answer is there seems to be a correlation With a poverty and death if if you overlay the map of where the death star in those cities in the United States there Areas of extreme poverty. And so you can surmise that. It's socioeconomic factors like crowding in in housing with people can't socially distance probably co Morbid illness because his higher incidences of Diabetes Smoking related illness in those communities so is probably multifactorial but like a lot of other infectious diseases. Mrs True Infectious they often become diseases of poverty in disproportionally affect people of lower socioeconomic groups for a whole variety of reasons. Another reason is that in a lot of people lower income people who can't can't miss work but there were also they work in jobs where they come into contact people think about someone on checkout line. Grocery store That person's coming into contact with a lot of people on a daily basis increasing debt. Paternity that they get sick so moving here to the US. what your view has been the the difference or parent difference now comes in. California in New York. San Francisco is initial hotspot and the New York Times Article Day or two ago along piece on. Why New York was was late and both Cuomo's got. I've gotten a lot of praise and de Blasio not so much Both both were late to this compared to California. But you look at the timeline. And it doesn't seem like an enormous difference. I think you know the the lockdown California's started a couple of days earlier than that in New York. Wh- what accounts.