Podcast: COVID-19 and The Dark Winter to Come: Insights From Dr. Ashish Jha

TRANSCRIPT: COVID-19 and The Dark Winter to Come: Insights From Dr. Ashish Jha

Dr. Ashish Jha:

I think there's no doubt in my mind when I have poured over the data that an average person who got infected and got sick enough to be hospitalized, let's say in March in New York, that person probably has a 30% to 50% lower likelihood of dying today. That's amazing.

Ian Bremmer:

Hello and welcome to the GZERO World Podcast. Here you'll find extended versions of the interviews from my show on public television. I'm Ian Bremmer, and while the US presidential election will have obvious and enormous consequences over the years to come, one thing won't be changing any time soon. The Coronavirus Pandemic is here with us for a while. And with flu season and winter barreling towards us, my guest today says, the battle is far from over. I'm talking to pandemic response expert and Dean of Brown University School of Public Health, Dr. Ashish Jha. Let's get to it.

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Ian Bremmer:

Dr. Ashish Jha, he is Dean of the Brown University School of Public Health. It's wonderful to have you on GZERO, sir.

Dr. Ashish Jha:

Thank you for having me on.

Ian Bremmer:

I want to start where I left things off in my monologue on this idea of pandemic fatigue. Right now we're seeing an average of about 85,000 to 90,000 daily cases in the United States, and as Dr. Fauci said last weekend, the stars are all aligned in the wrong places as it gets colder and we head into winter. How much of what we're seeing right now is literally people just getting tired of the virus.

Dr. Ashish Jha:

So I think it's two or three things. Certainly one of them is people getting tired of the virus. It's been a long haul, nine, 10 months of this stuff. And I think that's definitely a part of it. I think another part of it is the sheer amount of misinformation that people are dealing with. Lots and lots of misinformation about how serious the virus is, how it's spread. And the last thing is I don't feel like we in public health have done a good enough job of helping people understand risk. One of the things that leads to fatigue is if you feel like you can't do anything at all safely, then you end up sort of throwing up your hand and saying, "Well, I don't care. I'm going to do all of it." But of course, lots of things are safe, some things are less so, and we've got to do a better job of helping people understand so they can make better choices.

Ian Bremmer:

So speaking of that, I mean it's very easy to imagine everyone should wear a mask all the time if they're in public, everyone should be socially distant. But if you are a young, healthy person and you're not living with people who have preexisting conditions or are 70 plus, talk a little bit about what you think is a reasonable way to live your life.

Dr. Ashish Jha:

Yeah, so the problem is imagine you're a 25-year-old, you're a healthy person, you're not living with your parents, you may be living by yourself or with other 20 year olds or 20 something year olds. The problem becomes that if you just say, "All right, the pandemic is not going to affect me, I'm just going to not worry about it." First of all, there's a good chance if you get infected, it's true, you're likely to do okay. But you have a period of time of five to 10 days of infectiousness, of which several days you're not even aware that you have any symptoms, during which time you can spread it to somebody in the grocery store. You can spread it to somebody who then can spread it to an older person. So it's hard even for a 25-year old who may not be at high risk to remember that they're not on an island and that what they do will end up affecting everybody else.

Now, that doesn't mean they need to be in lockdown. So when they go outside and they're hanging out with friends outside, that's fine. That's pretty safe. If you're going to go inside and spend time with people really do have to wear that mask. And if everybody else does it, there's a lot of things we can do socially, but unfortunately in the middle of the pandemic, we can't act like life is normal even if you're a perfectly healthy 25-year-old.

Ian Bremmer:

So then, I mean, being here in New York City, let me give you a for instance. I mean, right now you have restaurants across the city that have 25% occupancy inside. It is going to get colder and when you are eating, you are not wearing a mask, you have no idea who these other people are. Are you saying that no one should actually be doing that? Is that an unacceptable level of epidemiological risk from your perspective?

Dr. Ashish Jha:

In New York City where the level of infection is still relatively low at 25% indoor dining, it's probably not super high risk. Depends a little bit on who you're having dinner with and also depends a lot on what the restaurant's doing to try to mitigate in terms of ventilation. Can they open windows? Now, I know it's getting colder, but you can crank up the heat and make sure there's a reasonable amount of ventilation. That stuff helps a lot to actually make indoor dining safe.

Bars are pretty much a disaster. The problem with bars is they involve alcohol, and when people drink, they stop being careful and they start getting close and they start speaking more loudly. And so there's a bunch of reasons why I don't see any way to justify having bars open during this pandemic. But 25% indoor dining in a place that doesn't have a large outbreak with reasonable ventilation, yeah, that's pretty safe.

Ian Bremmer:

Now Ashish, you've been very critical publicly of the United States government not handling this coronavirus well. I want to ask you, I'm looking right now at the European Union, and I am seeing not only overall levels but also per capita levels of cases and of deaths significantly higher than here in the United States. Explain that to me.

Dr. Ashish Jha:

So this is one where, I'll be honest with you, I got it wrong. I really thought the Europeans had learned their lesson from that first wave and they would never let themselves be subject to another large wave of infections. And what Europe did do ... and again, Europe is not a country, there's a lot of variation across countries in Europe, but broadly speaking, they got hit by a lot of infections and hospitalizations and deaths in April and May, and March, April, May. They locked down pretty aggressively and the summer was pretty mellow. They did well during the summer with very few cases.

What happened was in early to mid-August, cases started rising because the virus hasn't gone away, the pandemic is with us. And my assumption was that the European governments would look at those and say that they would act the way East Asian countries have done or New Zealand and Australia have done. Which is they would react, they would stop certain types of activities, they would keep the virus under control. In fact, that's not what has happened. Places like UK, France, Spain essentially acted like the pandemic was over. And through mid-August, through early to mid-October, you just saw this constant increases in cases. And by mid-October it was very clear that Europe was having another wave of infections.

There is a part of me that has to go back and say, what assumptions did I make about the European governments? And again, we're talking about places like UK, France, Spain. Germany on average has been better though they're seeing a big increase as well.

Ian Bremmer:

And the death rates are a lot lower in Germany, that's right.

Dr. Ashish Jha:

And Germany's just done better. But that's again, good governance and good leadership. But it is a reminder that America is not unique in its inability to manage this virus.

Ian Bremmer:

If you look at France, the United Kingdom for example, right now, Spain, do you actually say, you know what, their governments have actually done no better, maybe even worse, than the Trump administration?

Dr. Ashish Jha:

Yeah, it's a good question. They did have a better summer than us, at least there's that. Although, America's a funny country, right? Because in many ways there are parts of the United States that look just like Europe in the sense that they had a pretty good summer, certainly in New England, parts of the Midwest. But I think you can make a compelling case that the United Kingdom has not done meaningfully better than the United States. That France and Spain have not done overall meaningfully better. So while the Trump administration, certainly on a global scale, has done a pretty abysmal job, there are other high income countries with well-functioning societies that are pretty competitive with the United States for mismanagement of the virus.

Ian Bremmer:

I know that we're getting better at treatment. I know that more people understand what the symptoms are, testing continues to increase though not the levels we'd like. As all of that happens, how much do you think right now mortality rates legitimately are going down as a consequence of that?

Dr. Ashish Jha:

I think they are. I think there's no doubt in my mind and I have poured over the data that an average person who got infected and got sick enough to be hospitalized, let's say in March in New York, that person probably has a 30% to 50% lower likelihood of dying today. That's amazing. I mean, no disease do we-

Ian Bremmer:

That's amazing.

In less than a year

Dr. Ashish Jha:

In say eight months, nine months, we've reduced mortality by 30% to 50%. How have we done this? A little bit through therapies, remdesivir, maybe convalescent plasma, probably not. Dexamethasone, a steroid, I think really the evidence is very good that it's clearly helpful for more advanced disease. But also I think doctors and nurses have just gotten better at figuring out how to take care of people with this disease. Whom to put on a ventilator, whom not to. How to avoid putting somebody on a ventilator. Just a lot of stuff because we had no experience with this disease, and so we were making a bunch of reasonable guesses based on similar diseases like this. And we've learned how to take care of this specific virus itself.

Ian Bremmer:

Do you have any sense on whether or not you think it is likely that over the next six-nine months we will have continued progress in mortality?

Dr. Ashish Jha:

So there's at least one more therapy that I remain pretty optimistic about, and that's monoclonal antibodies. The kind that the President got when he was sick, Governor Chris Christie got when he was infected. Again, the data on this is still very much in the works. What I'm most worried about with monoclonal antibodies is that back in April, May, many of us who were optimistic about this were begging the government to make a large investment in production saying even if it turns out not to be useful, it'll have wasted maybe some hundreds of millions or maybe a couple of billion dollars. But if it turns out to be useful, American people will want millions of doses of this. That hasn't happened. So if these therapies turn out to be useful, we just won't have much of it around. And that'll be frustrating to people who could benefit from it.

And then there is probably another 30 to 50 drugs that are being tried out. Most of them won't work, but if one or two of them do, that could make a big difference. So I remain optimistic that a year from now this disease will be even more treatable than it is today.

Ian Bremmer:

Okay. So that's good news on the mortality rate front. What about in terms of extended implications of people that get this disease, the so-called long COVID. How much do we know about that? And also, do we see improvements, similar improvements, in being able to reduce the likelihood that you're going to have very lasting, deteriorating effects as a consequence?

Dr. Ashish Jha:

Yeah. So long term consequences of this disease are really worth thinking about and they come in two flavors. And part of the issue here is everybody thinks you either die or you survive. But when you look at survivors, obviously you have a chunk of people who do really well, essentially go back to baseline. But there are two groups of people that I think about in terms of people with longer term consequences. One is people who were really pretty severely injured during that initial hospitalization or that initial illness. I have a colleague who's in his mid-forties, a physician, used to run marathons and he got COVID in April. He can barely walk down the block without getting short of breath. He has very profound lung damage. Will he recover a year or two years from that? We just don't know. We don't know how much of his pulmonary function will recover. So you have those kinds of people and they may represent 5%, 10% of people who get infected, maybe let's say closer to 5%.

Ian Bremmer:

5% of all people that get infected. In other words, we're talking asymptomatic everything.

Dr. Ashish Jha:

Yeah, I think so. I mean, part of it is it depends on how many people get hospitalized, but most people who get hospitalized when they come out, end up with some level of disability. It may very well be that six months later many of them will have recovered a lot of their function. We just don't know. But again, some of the series from China, from other places, suggests that 60%, 70% of people who've been hospitalized, six months later are still suffering significant consequences. So it could be, let's say 5% of potentially everybody.

The second group, which is I think a much smaller group, are people who continue to have active symptoms, fevers and other things, one, two, three, even five months out. Obviously we don't know what's going to happen to any of these people because we just don't have that long set of experiences. Again, those are relatively infrequent, but we've got to watch them. And I don't know that we're getting any better at either predicting who's going to have it or doing anything to help those people yet. We don't have enough experience with those types.

Ian Bremmer:

Now we got to get to the vaccine issue. You've said publicly that you don't think a vaccine brings this pandemic to an end. Is that because you're thinking about the first vaccines that we get that are likely to have only limited effectiveness? How much of that is about just inability to get enough people to actually take it? Give us a little bit of the Dr. Jha 101 for COVID vaccines.

Dr. Ashish Jha:

Yeah, all right. So I expect that this year, 2020, before the end of this calendar year, we're going to have a couple of vaccines authorized. I mean if we're lucky it might be three or four, but somewhere in the, let's say, two to four vaccines range. We'll start giving them out to people in early January, February. I expect the vaccines, if we're lucky, they will be 70% or 80% effective. And if we're really lucky, 50% to 60% of Americans will eventually end up getting vaccinated by May or June. And if you think about that, that's not how you bring a pandemic to a complete close. Next July, August won't look like the July, August of 2019, but it will look meaningfully better than July, August of 2020. So I don't want to understate the value of vaccines. I think it's going to be incredibly valuable. A vaccine that's 80% effective, that 60% of Americans take, that will have a profound effect on the level of virus in the community, will make a really big difference in lots of our lives. The pandemic won't be gone. The virus won't be gone.

Ian Bremmer:

When a vaccine is made publicly available by the US, from your perspective, if you have access to that vaccine, should you take that vaccine immediately?

Dr. Ashish Jha:

Yeah. So my plan is first of all to look at the scientific data. If the scientific data shows it to be effective and reasonably safe, then whenever I am eligible, there will be kind of an eligibility period of different people will be, whenever I am eligible, I will go get it. And I think that's what people should do. Again, this will depend a lot on the data, so I hate making recommendations until the science is clear, but if the scientific process continues with the same level of rigor and carefulness that has been done so far, I'm not going to hesitate getting a vaccine. I'm not going to hesitate having my elderly parents get vaccinated. And as long as there's some data on kids, I'm going to not hesitate getting my children vaccinated.

Ian Bremmer:

Is FDA approval sufficient for the average person that isn't Dr. Jha to say, "Yeah, this is fine."

Dr. Ashish Jha:

There is some great scientists at the FDA and they generally make these decisions. And if we let them make the decision and don't have political appointees overruling them, then yeah. Then I think FDA approval is good enough. The problem in the last couple of months is you've seen meddling from the White House where they just start getting involved in the FDA, political appointees, start really getting involved, and that I think undermines the confidence, as long as that doesn't happen.

Ian Bremmer:

So there has been some erosion in your view at this point?

Dr. Ashish Jha:

No doubt about it. I think there's been a lot of erosion. I think a lot of Americans are really hesitant and have lost a lot of faith in both FDA and CDC. I think it's going to be very important to restore that faith because not everybody needs to be able to or can necessarily go through and evaluate all the data themselves. We've got great scientists who are supposed to do that, that's what we pay them for. We should let them do it, and we should really let them voice their assessment as opposed to letting political leaders decide what the right answer is.

Ian Bremmer:

So if you've gotten this vaccine, and let's say it is 70% effective, after you've gotten it, how should this change your behavior?

Dr. Ashish Jha:

Yeah, so I alone, if I'm the only one who has it and in the rest of the community the virus levels are really high, it probably won't do too much. But once you get a broad range of people who have been vaccinated, then what you'll see is two things. You'll see, first of all, levels of virus in the community go way, way down. I think that'll make a huge difference. And second, I will feel more comfortable. So if I'm living outside of Boston as I am, and let's say majority of people have gotten vaccinated by next summer, I'll feel much more comfortable going to a restaurant and sitting in a restaurant that's maybe 50% or 75% at capacity. Both because a level of virus will be low, and obviously also because I will have a certain degree of protection that will also make me feel comfortable.

Ian Bremmer:

But I mean, once you've gotten vaccinated, 70% protection, that's not making you feel, I mean, that doesn't mean 30%, you're still much less likely to die if you're in the 30%. It does not mean that.

Dr. Ashish Jha:

No, and we don't know, by the way. There's a lot we don't understand about this yet. Obviously we don't understand a lot about the vaccine because the vaccine is still being studied. But for instance, what we know with a flu vaccine is that even in years where it only offers 10% or 20% protection, if you get the vaccine and then get the flu, you're much less likely to die. So even if it's not offering you full protection, it often offers a little bit of collateral protection. You may still get infected, but you won't get as sick. This is stuff we're going to have to sort out, and we're going to have a lot more information about this, I would say over the next two, three months.

I do think it'll change my behavior. I think there'll be some high-risk things. I don't think I'm going to go to a movie theater anytime in the next year without wearing a mask and without being a place where everybody's wearing a mask. And then of course, my hope is that by next summer or next fall or early 2022, we get the second, third generation vaccines that could be 95% effective, in which case it will have a profound effect on behavior and how we're dealing with the virus.

Ian Bremmer:

So tell me, how has this changed you? I mean, as a doctor living through this pandemic, how are you different today than you were before this hit?

Dr. Ashish Jha:

How am I different? Well, first of all, like most other Americans, I'm feeling a little exhausted and wiped out by all of this. I have to say, it has changed some of my views on certain things. I really thought ... I didn't see this virus and the response to it becoming as politicized as it has. I always sort of felt like on issues of medicine and even public health, depending on the kind of to issue we're talking about, I mean, obviously certain things like reproductive health have been very politicized over the years, but something like a deadly virus that's causing a global pandemic struck me as a pretty bipartisan issue. And so I think, been a surprise to me, and it has forced me to avoid getting into partisan battles and try to stay on the science. It's not always easy.

And of course, the other part that's been unusual is the amount of personal vitriol that I often feel like I'm taking from people who've decided I'm part of the deep state trying to destroy America. Again, these are unusual times for everybody and I think living through those experiences certainly has made me think about public health and our society a bit differently.

Ian Bremmer:

If there's one thing that we could do differently going forward as the United States, as the US government, in terms of a more effective response to this coronavirus, it would be what? What's your top recommendation?

Dr. Ashish Jha:

I mean, the single biggest overriding thing is just take the virus seriously. Stop ignoring it. Every time it starts increasing, act. And literally, you could act by enforcing a national mask mandate. That would be great. Really ramping up testing, that'd be great. Making some smart policies about not having indoor gatherings of a certain type. That would be helpful. It almost doesn't matter. I mean, any of those, or a combination of all of those would be really helpful. The hardest thing, the worst thing that we've done, is consistently underestimate the importance of this virus, the seriousness of it, and that's what keeps getting us into trouble.

Ian Bremmer:

Dr. Ashish Jha, thank you so much for joining me. You made the country smarter, and we really appreciate it.

Dr. Ashish Jha:

Thank you for having me. I really enjoyed it.

Ian Bremmer:

That's it for today's edition of the GZERO World Podcast. Like what you've heard? Come check us out at gzeromedia.com and sign up for our newsletter, Signal.

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The GZERO World Podcast is brought to you by our founding sponsor, First Republic. First Republic, a private bank and wealth management company, places clients needs first, by providing responsive, relevant, and customized solutions. Visit firstrepublic.com to learn more. The GZERO World Podcast is also brought to you by Lennar, America's largest and most innovative home builder and the number one destination for foreign residential real estate investment in the US. Learn more at www.lennargzero.com. That's L-E-N-N-A-R-G-Z-E-R-O.com.

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