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Podcast: Preparing for the Pandemic: 'The Window Is Closing'

Podcast: Preparing for the Pandemic: 'The Window Is Closing'

TRANSCRIPT: Preparing for the Pandemic: 'The Window Is Closing'

Laurie Garrett:

I'm sorry America, but our spending on public health has been decreasing for decades and it's woeful, and no, we don't have the best public health system in the world.

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 today the biggest crisis since the financial meltdown, and a Pulitzer Prize-winning science journalist to help us get through it. I have Laurie Garrett, author of "The Coming Plague and Betrayal of Trust: The Collapse of Global Public Health." Sounds intense, let's get to it.

Laurie Garrett, Pulitzer Prize-winning author of "The Coming Plague," expert of all of the things that we are dealing with right now. Really good to be with you.

Laurie Garrett:

Thank you, Ian.

Ian Bremmer:

So, the first thing I should mention is that we are sitting more than six feet away from each other, right. Should we even be doing this right now? Is it okay? Is it safe? I mean, I think people would like to know.

Laurie Garrett:

Well, I think there's lot of good questions to ask about whether or not it's safe for you to leave your home or wherever it is you're hunkered down right now. It's just very, very important you do everything possible to minimize the proximity to other people, so that if you can move about and never get more than five or six feet from another person, you're okay.

Ian Bremmer:

There are a lot of things we still don't know about this virus, because it's new and so fast spreading. Tell our viewers what the key things are that we know and the key things are that we still really don't know.

Laurie Garrett:

Well, we know more about the virus in genetic terms than we've ever known about a microbe this quickly in the history of humanity. We have identified completely genetically sequenced dozens of strains of it from all over the world. We can actually map which strain came first and then it sired these strains, and sired those strains and which strain went from Wuhan to-

Ian Bremmer:

Washington State.

Laurie Garrett:

Tehran to this place, and so on and so forth. I mean, we've never been this far ahead on that part of the story before. We also know a great deal clinically, and we know it because the Chinese figured it out through trial and error with a lot of people dying, and we know exactly how this virus kills people.

We understand that very well, and it's a terrible, terrible disease. You're essentially drowning. The immune response against this very foreign thing to which no human being has previously been exposed means that your immune system says, "Whoa, I don't know what the heck this is. I don't have any memory of seeing this before, so I don't have specific neutralizing antibodies, I don't have a laser target to take out this enemy, so we're going to go all out nuclear war."

We know all this. We know a great deal about the various stages clinically. I mean, the American doctors are just seeing it for the first time, so when I say we, I'm saying globally-

Ian Bremmer:

The global community, of course.

Laurie Garrett:

The sort of global health community, but there are still a huge number of gaps in our knowledge that are fundamental to policy choices being made right now, and those gaps basically boil down to two giant problems, we don't have enough testing anywhere. Where testing has been done well, such as in South Korea, we have some reasonable idea of how likely it is that one person infects one, two, three or four more people, and we have a bit of an idea of who's more susceptible to infection than another person, but we're not really, really sure.

Ian Bremmer:

So, we don't know if you can actually get this again if you've already been infected, given that lack of data.

Laurie Garrett:

There's a huge problem there, because what we're seeing in China is there are people who go into intensive care, go into rigorous treatment, seem to clear the virus. They have two tests done to determine if they have virus in their body before they're released, and then three, four weeks they're back and they're terribly sick all over again.

So, there's two possible explanations for that. One is that the test was very bad, it didn't get down to a dilute level of virus. So let's say it could detect the presence of the RNA of virus at the level of say 300 particles per microliter, but you had one particle per microliter, so you're way below the test level. Then once you got back to life and started being rigorous and vigorous again, the virus surged. That's one explanation.

The other is that you never really had a powerful immune response to begin with, that you had this sort of scorched earth fire all weapons at once response, which actually is what makes people so sick when they suffer with the disease, but you didn't have that laser beam targeted smart bomb that just went right in and recognized the virus and got it.

Ian Bremmer:

There is an enormous difference in the reported mortality of this virus from South Korea testing vastly more much lower percentage of the population that has died from it well under 1%, as opposed to in Italy where we're talking over 5%.

Laurie Garrett:

Some places eight.

Ian Bremmer:

Right, Iran for example. Obviously testing regime is a big part of this, but also there's a question of what kind of population. There's pollution in the atmosphere, there's how old you are, there's density. Given all of your expertise, where do you think mortality, once we get testing truly up and running in this country, where do you think we probably are heading on that question?

Laurie Garrett:

Well, Ian, I think actually it's going to vary dramatically across the country. We have a very patchwork system in the United States, and I think if you'll allow me, I need to step back for a moment and explain how we got to this mess. Most of the public health systems arose by dictate from the ruler. In Europe, for example, it would be the kings, this and that, the queens, yada, ya. So, the rules and regulations of public health came from the top down.

The United States was 100% the reverse. Everything arose from the bottom up-

Ian Bremmer:

Grassroots up, everything's different. Everything's different.

Laurie Garrett:

And it's different wherever you go. You cross state lines, you have a completely different public health system. The rules and regulations are all different. Inside of some states, you cross county lines and there's differences. So, the first thing that will be very different is the nature of the power structure within public health in a given state.

The second thing is some states have essentially opted out of Obamacare. They've made the ceiling, or the basement if you will, for qualifying for Medicaid so low that you have to be in dire poverty to get into Medicaid. So, they have a huge percentage of their population that's working class and lower middle class that doesn't have health insurance and doesn't have access to their system.

Ian Bremmer:

So are you saying that it is feasible, even likely that in some parts of the United States you will see Lombardi style mortality rates from this disease?

Laurie Garrett:

Yeah, I think that will be so in certain parts of the country, and then in other parts of the country it'll be quite the reverse. I mean, I think if you're right now in San Francisco where they are pulling out all the stops as we speak, they've literally shut the city down. They've told everybody-

Ian Bremmer:

Stay in your homes.

Laurie Garrett:

Yeah. It's possible that they will keep their mortality rate relatively low, that they will be successful in holding it below 2%. But then you may get to some other locations, I don't want to name one, because I don't want to be accused of smearing a population, but there are certainly places where you have large concentrations of elderly who have moved there for retirement, where you have many of them living in co-housing facilities or in gated communities where elderly see elderly all day long, and where their caretakers may be underpaid and in some cases be immigrant labor. Those are dynamics that call for some really strong intervention from government or you're going to have a disaster there.

Ian Bremmer:

We're not going to change what has happened over the last several months leading up to this. Going forward, what are the two, three things you would like to see immediately at a national level, if they need to be at a national level, that would make you feel more comfortable about the trajectory going forward?

Laurie Garrett:

Well, I'll tell you the one I've been screaming for for more than a month already in the United States. We have in the United States through our Centers for Disease Control, a network of so-called sentinel surveillance hospitals. These hospitals are used to do routine surveillance, such as is there methicillin resistance in staphylococcus aureus in hospital populations in America? So, what I want is a targeted hospital surveillance that goes to every single intensive care unit in every one of the sentinel hospitals in America and-

Ian Bremmer:

How many are we talking about?

Laurie Garrett:

Oh, I think we're talking about roughly 1,000 hospitals across America.

Ian Bremmer:

So something we can do, yeah.

Laurie Garrett:

So, it's doable if we had a test, and to specifically test all pneumonia patients of unknown etiology. So that means you know they don't have bacterial infection causing their pneumonia, and you're sure it's not flu, so that leaves everything else, but definitely viral. Test and find out how many people do we already have unbeknownst to us, untested, sitting in hospital wards carrying this virus and potentially exposing all the hospital workers and other patients.

We should have done that a month ago, and I think we would've saved a lot of lives if we had done it a month ago. We would've known which hospitals in what parts of the country already had silent undiagnosed COVID-19 cases, but hospitals are the number one place where they're going to be found.

The second would've been a surveillance to just figure out a random sample of senior citizen homes that are assisted living centers for people that actually do require some medical attention already for whatever underlying problem they have. Again-

Ian Bremmer:

The most vulnerable population in the country.

Laurie Garrett:

The most vulnerable.

Ian Bremmer:

Yes.

Laurie Garrett:

The most vulnerable, and just go in there and test them by the thousands and find out how many are already infected.

Ian Bremmer:

One another thing we don't seem to know is why so many people can have this disease and not display any symptoms, including most particularly children. Do we know anything about that?

Laurie Garrett:

Yeah, we know more than we did a couple weeks ago and every day we're learning more, but of course it's important for people to understand that we're in a live science experiment, but now we actually are getting more data to show that there have been children very seriously sick and a few have died in China, and it's not an utterly benign experience for children.

More importantly, children may be vectors. In other words, they're able to get infected and to pass it on to others, but feel no particular ill effects, and therefore actually be, worst case scenario, running amuck very vigorous as kids are. So that when you're the mayor of New York trying to make a decision, do I close the schools? You think, "Well, a lot of those parents will probably leave the kids with nana while they go to work." Well, are those kids vectors passing their virus to their older grandparents?

Ian Bremmer:

So, that leaves me to ask some recommendations you would have for just the average viewer of this show, because I mean, you've heard from Dr. Fauci, now we all have, this is going to get worse before it gets better, not only in this country, but probably across most of the entire world.

What are some things that we need to make sure, other than wash your hands and avoid large gatherings? For those that are already doing that, but this is changing every day, what are some things that you would say?

Laurie Garrett:

On the personal side, I think your days are counting down. I would say you have two or three days to make some very tough decisions as a household, and you're going to be stuck with what you decide now. Those decisions include where do you want to hunker down for eight weeks? Are there elder relatives or sickly friends or anyone who's-

Ian Bremmer:

You say eight weeks, because you think that is the most likely or that's the absolute minimum?

Laurie Garrett:

Oh, I think you have to have that framework in mind. Eight weeks is long enough of a framework that you realize this is a major disruption of my life.

Ian Bremmer:

I understand, okay.

Laurie Garrett:

Right? So for example, I know of friends that have moved to Florida, relocated to Florida, because they have elderly retired parents there and they want to take care of them. So they've picked up their whole life, gotten in cars, driven to Florida, and they're going to camp out there looking after their elder parents for the next eight, 10, 12 weeks, however long it is.

I know of people who abandoned business trips and hasten their way back to their home cities in the United States realizing this. Some are abandoning the cities and going out to country homes, some are making the reverse decision. Point is you have to decide now, because in a matter of days airports will be shut down, trains will be shut down. They will start shutting down highways, you will find it difficult to get gasoline and you will be stuck wherever you have placed yourself.

I would say if you haven't made a choice and decided I'm ready and I've got what I need, medicines and something to keep the kids occupied and so on, then you're going to be in an unfortunate situation. You won't have a lot of options to move around. That's number one.

On the larger level, what I think we need to really consider now is how volunteer workforce can be utilized. Very few communities in the United States really have any clue how to do this. It's so long since the World War II generation where this was just automatic. Everybody was part of the United Way or the Red Cross or their local charitable organization. They had a community chest and a City of Commerce Association, and the Elks Club and all that stuff that meant they knew how to mobilize a group and everybody go off and take care of this problem.

Ian Bremmer:

Society is much more atomized now, though much more connected through virtual space. One could argue that's going to make it a lot easier for people to stay in contact with those that need.

Laurie Garrett:

Contact is one thing, but if it comes down to something like we need to get 20 people from this location to a care center and we need volunteers who have a vehicle with gasoline, somebody has to be in charge, somebody is telling you how to do it, what's safe, what's not safe. This is organization, you can't just do this virtually. If you get to really concrete things like handing out food, taking care of homeless folks, taking care of the neediest in your community, this is people power not virtual power.

The problem is that all of our big civic organizations have aged out. You look at your local Red Cross and it's likely to have an average volunteer age of somewhere north of 70 years. They're in high risk, they really shouldn't be the ones that are out there making sure that everybody has bottled water if something happens to our water supply, because we have sick-outs amongst our water employees, our water department employees. You can go through a whole list of scenarios of things that are likely to start falling apart, that we just assume somehow without thinking about it someone else is taking care of.

Ian Bremmer:

I mean, we've also got a country that's now taking this a hell of a lot more seriously than it was even a few days ago, and your expectations for what you just recommended people to do is that that's going to become even more the case over the next literally few days. Does the fact that we had that 10-day window on Italy, how much is that going to really give us an opportunity to avoid this Contagion style outcome?

Laurie Garrett:

I'm afraid that most people have barely paid attention to what's going on in Italy, and if they've seen something on the evening news or however they osmotically absorb information off their internet services, and they've sort of noticed, "Gee, Rome is shut down, I wonder what's going on there?" They've sort of noticed that bodies are stacking up, because they can't do funerals and the crematoria are backed up, and they've sort of paid attention to people dying in their homes, and they've kind of started to realize there's something really dreadful happening there. I think even then, very few have processed that as a warning for us.

Americans are exceptionalists. We always think that we're going to be different from other countries, we're going to be better. I'm sorry America, but our spending on public health has been decreasing for decades and it's woeful, and no, we don't have the best public health system in the world. You better pay attention to what's going on in Italy, because we're just lagging about nine to 10 days behind Italy.

Ian Bremmer:

Now, you were one of the experts advising the movie Contagion, which I watched again a couple weeks ago. Bats were actually part of it.

Laurie Garrett:

Bats were part of it, and it was loosely based on Nipah, which is a bat virus that kills mostly children in Southeast Asia via a palm tree route. Long story. Anyway, so we thought, "Okay, let's go with that route." But we were very concerned with all the aspects of portraying how society falls apart in an epidemic, what actions really make a difference.

Yes, the heroism of public health workers and their travails, that they're paid practically nothing and you expect them to risk their life. But what we had never imagined was an American government that would utterly ignore the problem for weeks, and then have a series of policies that just seem to change with every single press conference and every single statement before Congress, to such a degree that it is an absolutely confusing set of guidelines set out to the rest of the nation, and nobody knows what our federal response really is. We had not imagined that.

Ian Bremmer:

So, there is opportunity for a Contagion 2. We'll make it a geopolitical thriller and we'll truly scare people.

Laurie Garrett:

Well, then it would be a horror movie, not a thriller.

Ian Bremmer:

Laurie Garrett, thank you very much.

Laurie Garrett:

Thank you, Ian.

Ian Bremmer:

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

Subscribe to the GZERO World Podcast on Apple Podcasts, Spotify, Stitcher, or your preferred podcast platform, to receive new episodes as soon as they're published.
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