Are we doing enough to prevent the spread of COVID-19?

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Joined by. Dr Ezekiel Emanuel former Obama. White House Health Policy Advisor. He's Vice Provost Global Initiatives University of Pennsylvania and Dr Peter Hotels Dean of the National School of Tropical Medicine at Baylor College of Medicine Doctor Manual. When we start with you. Where do you see us right now? Are we doing enough in terms of large scale social disruption and changes to slow the transmission of this epidemic? So first of all. I've been saying for several weeks now that it's going to get worse before it gets better. Parsley it's GonNa get worse because we have testing. That's just going to show us how prevalent the illness is. It's also getting worse because we know we have more community acquired infections as I mentioned to someone today. You know one week ago. We weren't even talking about new Rochelle and now new. Rochelle is a major topic in New York. And that's a lockdown and if we focus on new Rochelle without thinking about all the other places that this virus is maybe Washington. Dc maybe the suburbs of Baltimore. Who knows where the problem is? We need a more systematic less uneven response. That has to be pretty uniform. Because just 'cause we're seeing it new Rochelle doesn't mean Rochelle's the only place in New York that Scott and that response does have to include things like much more prevalent testing so we really have a handle on who's got it and who doesn't and a really good model is South Korea if you look at their trends you can see that. They're beginning to bend in South Korea. We also do need to inform people. We use the term social distancing like everyone knows what it means. It's not immediately obvious to people what that entails and how much you need to be separate from people explain to what should people know about but a large part of it. You people have come up with all these numbers no more than one hundred people to meet no more. The issue is density. How close are you to people? How easy is it for the droplets to spread? How much are you sort of packed in light sardines or not and that real? I mean that's a physical thing That is really important and I do think we probably need to educate people to minimize the. They're our contact and to stay home more. You can go out where there's no one else if you're going walking in the woods or something or going to a place where there are other people But I do think Restricting how we move around is going to be important I will note that not every but most of the Ivy League schools now for example colleges mine included. We're going online. The second half of the semester is all going to be online. Students aren't going to be in. Dormitories accepts students. That can go back to their home country and still complete the semester. So you are seeing a lot of action. But it's not concerted and that's what it's not systematic and that's what's bothering me Dr Hotels. We've been checking with you throughout the unfolding of the goal pandemic and I'm curious. Are we learning more about the virus itself about the basics about the transmission rate? Which seems to be maybe lower than at first. We thought the fatality rate the incubation period. Where is our knowledge right now about this so the transmission rate still seems to be? Pretty High Dr Fao. She mentioned. It's probably a significantly higher than the influenza as well as the mortality rate. But the you know just to echo and reinforce some of the things zeke Doctor Emmanuel was was saying we've learned a few things from a recent analysis. My colleague Mark Lipchitz sit at Harvard School of Public Health Chan School of Public Health together with a student a doctoral student. Ruan Lee didn't analysis of the Chinese cities in terms of how severe the epidemic is with the extreme example being Wuhan rare nine thousand people wound up in and severely ill with two thousand in the ICU versus city. Like Long Joe where there was only twenty a big difference right and it looked like it's primarily to do to how quickly you got on top of things after sustained community transmission started. So they let it go for six weeks. Before they implemented aggressive control and testing whereas in Guangzhou were the only at twenty cases one week. What's the lesson learned from the United States We're now about three weeks into this in terms of sustained community transmission. We had our first case of community transmission around the end of April so subtract a week before then. So we're getting to the point where because we're not doing adequate diagnostic testing and implementing those very important control measures. That seek pointed out. We're in a situation. Where we could risk being closer to Wuhan and Guangzhou and and we do we. We can't be there so now is a very critical period over the next couple of weeks where we have to be very aggressive about closing down major venues. We just this Houston. Today with the Rodeo was a tough decision but was the right decision that we're going to have to do this all over the country right now and the reason is this because if we miss that opportunity we then have. Our new problem becomes surge capacity hospitals. Where we're not gonNA have enough beds. We're not GONNA have enough into ventilators. We don't want to go in that direction. So now's now czar. Big Schnauzer going to be our last chance. We've already missed that in over the last few weeks. Can I reemphasize something? Peter says which is so in the entire United States. We have about eight hundred thousand hospital beds a little under eight hundred thousand hospital beds. In the entire United States we have under seventy thousand adult intensive care unit. Beds we have about sixty five thousand ventilators with the strategic supply. I've heard that it goes up slightly under one hundred thousand. That's our maximum capacity in the country at the moment if you imagine that even two percent of the population gets the corona virus and we have about six percent who are seriously. Ill GonNa need a respirator. We've exhausted all that supply. Just for those patients. Forget the heart attack patients. Forget the patients who need it for any other reason and I think what Peter said is exactly right we probably have missed two or three turns over the last few weeks where we could have gotten things down and just focusing on the hot spots. Seattle New Rochelle. I think is not. We need a much more systematic countrywide approach so that we don't overwhelm the healthcare system. Which already you know doesn't have that much search capacity in it. Dr Hotels Final Point to you for people that are watching this I. I've struggled with this for the last three weeks right. Communicating in a way that does not induce catastrophe or panic but also is clear eyed about the risks. And I do think it's worth just going back to the distinction between your individual risk you random American one of three hundred thirty million that you will get very sick and need to be hospitalized or may as life threatening illnesses that individual risk for any given random person is probably low in the grand scheme of things and this systemic risk to the society and to the healthcare system which is extremely high at this moment. Is that a fair way of phrasing. It yeah absolutely and also remember. It's it's all about communicating. What our top priorities are in. This is what I've been disappointed about. We've lost a lot of time because of a blanket statements that are not backed by data saying this is contained. This is this is the cold. This is the flu when in fact we know that there are specific groups that are at high risk including older older individuals those with underlying disabilities and our healthcare workers. And so what I've been looking for is at the White House. Press briefings to say. Look these are four. Bit Concerns Right. These are three or four populations That were concerned about This is a why we need to get on top of this very quickly. And here's what we're doing about it and and historically the American people have responded very well to this They understood this three. Bola Zeka as we say. This is not our first Rodeo so so we know how to respond and we just need that clear kind of concise messaging right now. All right. Just had one thing to Chris. Point which is we also do know the ass for any individual. The risk is low except we do know that there are certain people and Peter Emphasize of those who are over sixty or sixty five those who have chronic illness. They are at high risk and what we have done in. This country is aggregate them in nursing homes. Those are most vulnerable people people in nursing and we really have to social distance. There reduced the number of visitors. Probably two zero. Make sure that people are counting up and taking a donning protective equipment so that we don't have that Patriot play just explode with corona virus like it did in Seattle because almost every one of them is really on the verge just like the cruise ships. Good Point -portant point Zeki Manual. Dr Peter Hotels. Thank you

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