A Look At The Spread Of Coronavirus
LULU GARCIA-NAVARRO, HOST:
Italy is locking down major cities in its north - Milan, Venice - risking its economy in a bid to contain the spread of the coronavirus there. Here in the United States, new cases are being reported across the country as evidence mounts the virus has been circulating here for weeks. President Trump spent yesterday in West Palm Beach at his golf resort.
In the show today, we will be looking at many aspects of this global health crisis. In a moment, we'll welcome a global health expert for an update. First, some voices from across the country.
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MARLEY RODRIGUEZ: I used to take the subway for everything. Like, I don't take the subway. I ride bikes, skateboard and stuff now. I don't like to have much contact or be, like, to close to people, you know, 'cause a lot of people yawn, sneeze and cough and never cover their mouth.
ERIC HADEN: Well, we are traveling to Europe for spring break, or we were planning to. So it's kind of like a lot of unknowns right now of, are there going to be travel complications? Are the places we want to go to going to be shut down?
CARL ISAACSON: I think with the deficit and - I think we're ready for a stock - big crash anyway, and this is the kind of thing that could accelerate it. And so we could have a real crisis worldwide - economic crisis. I'm more worried about that than my own personal health.
CROWN KENDRICKS: I got a 10-year-old son, so I don't let people cough around him or nothing like that. Just a lot of sanitizer, a lot of sanitizer right now - a lot of sanitizer. And I just - I'm just scared, you know what I'm saying?
COURTNEY MCQUAIN: I haven't adjusted any travel plans, but I was more aware of my surroundings when I flew recently. Try to practice good hand-washing habits, and eat healthy foods, and get plenty of rest, and drink plenty of fluids.
RODRIGUEZ: Clorox everything. I double-wipe. I don't have no company, and I'm just preparing because I know it's like - I'm just prepared for it, though.
GARCIA-NAVARRO: That was Marley Rodriguez (ph) from New York City, along with Eric Haden (ph), Carl Isaacson (ph) and Courtney McQuain (ph) from Boise, and Crown Kendricks (ph) from Phoenix. And I'm joined now in the studio by NPR's global health correspondent Nurith Aizenman. Good morning, Nurith.
NURITH AIZENMAN, BYLINE: Hi, Lulu.
GARCIA-NAVARRO: And on the line is Bruce Aylward, senior advisor to the director general of the World Health Organization. Dr. Aylward, thank you so much for joining us on WEEKEND EDITION SUNDAY.
BRUCE AYLWARD: Thank you for having me.
GARCIA-NAVARRO: And we should say, there is a brief delay on the line. Sir, we've watched this coronavirus emerge in China and move to South Korea, the U.S., Europe, Latin America. The WHO hasn't - the WHO has not called this a pandemic. Why not?
AYLWARD: Well, until very recently, what we've been seeing is many outbreaks in different parts of the world but not what you would call, let's say, a global outbreak like you tend to see with flu. And one of the important distinguishing features is as long as you have these discrete outbreaks, which has been the situation for quite some time, there's the opportunity to control them, to get on top of these and contain them and prevent...
GARCIA-NAVARRO: You still believe it can be contained?
AYLWARD: Absolutely. I mean, that's a big message that we saw in China and one of the big surprises.
GARCIA-NAVARRO: Let's talk about that visit to China. You led this fact-finding mission there, and you came away saying you were really heartened by what China was able to accomplish. You know, they went from 2,000 new cases a day to less than 100. But China took some really drastic measures. They locked down entire cities, most famously Wuhan, for weeks, in some cases going house to house checking people and requiring those with mild symptoms to leave their families and head to mass-quarantine centers, sacrificing their economy, possibly other forms of health care. Italy is now trying what seems to be some version of that. Is this what it takes?
AYLWARD: Well, what we saw in China - and first off, let's just take a step back. And the big surprise was this is a respiratory pathogen that many people were comparing to flu. And some aspects of it are similar, but some are quite different. For one thing, it kills a lot more people, No. 1. It's very serious. But most importantly, it turned out that you could actually contain it and reverse it.
And it wasn't the draconian measures that people think about. China has 31 provinces, thousands of cities, and it was only a few cities where they took those draconian measures. In the vast majority of them, they understood the disease, and they really went back to fundamentals of public health - case finding, rapid isolation of those and quarantine, if necessary, the contacts. And they've turned it around, and they've saved hundreds of thousands of cases and probably tens of thousands of deaths.
GARCIA-NAVARRO: But sort of based on your findings there, the WHO had been saying family clusters are one of the main ways this virus is spreading, rather than like the flu, where the virus passes from stranger to stranger. But is it possible that the reason the spread in China was largely limited to family clusters was because of the lockdown which you mentioned, because you're stuck at home with your family and not strangers? Because we're seeing something different here in the United States.
AYLWARD: Well, actually, I'm not sure. You're seeing clustering disease in adult populations, and it's just a function of how they cluster. And that's fundamentally different than flu where, as you know, you see just ripping disease through the very young population, which often brings it back to the adult population. But part of it may have been a function of the lockdown. But remember; it wasn't a lockdown everywhere. That's the wrong way to portray the way China approached this disease. And that's leading to some fundamental confusion and a failure to do the right things, which were rapid case finding and then trying to get the cases out of the houses so that you didn't have the secondary cases. It was quite different than the way it's being described.
GARCIA-NAVARRO: I just want to interject here because Wuhan is where the vast number of cases were.
AYLWARD: Wuhan is city in thousands.
GARCIA-NAVARRO: But Wuhan was where the real epicenter was, and that's where they did do the lockdown. I mean, what's the evidence that it was really the contact tracing and those other areas that turned this around as opposed to those lockdown measures?
AYLWARD: OK, you have to look at the data. You have to look at the data. We spent two weeks on the ground looking at the data. Every other province had hundreds if not thousands of cases, not unlike the situation you see in European countries or in the U.S. These are massive provinces with tens and even 100 million people in them, and they took a - they went after the cases. They looked for the contacts, and then they prevented mass gatherings of adult populations. These were their key measures. That's how they stopped it in the areas with over 1.3 billion people. So it's a mischaracterization to say Wuhan every single time you talk about China. That confuses people in the rest of the world.
GARCIA-NAVARRO: Is it possible, though, that China will see another large wave of cases, which then...
AYLWARD: Of course.
GARCIA-NAVARRO: ...Seeds another wave worldwide? What would prevent that?
AYLWARD: Of course, and that's what they're worried about. They recognize that - (laughter) I'm sorry I'm being a little - pushing a little bit on this. But...
GARCIA-NAVARRO: Push away.
AYLWARD: ...China knows that the majority of its population is naive, immunologically naive, meaning they don't have any protection against this disease. So they know it can come back. And as a result, when I talked to governors of provinces there, mayors of cities, and ask them, what are you doing now? They say, we're building beds for isolation, and we're buying ventilators to help take care of the very sick. And the interesting thing is the different mindset. You're seeing falling disease in these massive provinces in China, and they're building capacity. And then in Europe, you're seeing, we can't manage 100 cases. I mean, it's a completely different willingness to properly prepare.
GARCIA-NAVARRO: Properly prepare - I mean, are you saying that Europe and indeed maybe what we're seeing in the United States is a lack of preparation and a lack of capacity?
AYLWARD: You're seeing - you know, you are where you are. So that's in every country. The important thing is looking forward. But you know from this disease. You've seen its potential to spread for weeks. And you need plans to be able to isolate dozens if not hundreds of people, to be able to trace and support many, many contacts, the close contacts. And you have to be able to test. The key thing is speed here. So you have to have the speed.
GARCIA-NAVARRO: I want to interject about the testing. The U.S. government has been slow to get testing fully up and running due to this whole series of glitches, missed opportunities. Now there's concern that as a result, the U.S. has lost valuable time, that officials in the U.S. are only just starting to discover hotspots where the virus has been circulating actually for weeks. Based on what you've seen elsewhere, how difficult is it going to be to now recover from that?
AYLWARD: Well, it complicates your response. But, you know, I tend to take a - and I think most people in public health - a pragmatic approach to these things. You are where you are. And in the heat of a war like this against a threat like the coronavirus, it just doesn't help to point fingers. The important thing is, OK, get those tests deployed. Start testing those people. Find out where the virus is, and try and cut those chains of transmission. Even if you can't contain it, you can still slow it down and protect the vulnerable populations and limit the amount of damage that this disease can do. So you are where you are. And yes, it makes it more difficult because remember; one of the big challenges Italy has now is that they have thousands of people who are going to be in intensive care units and in their hospitals for weeks now as they clear the virus.
GARCIA-NAVARRO: Is Italy doing the right thing, and should something similar be done here in the United States if indeed it gets to that?
AYLWARD: Well, one of the challenges right now are the data because you really - and this is something in China they emphasize again and again and again because, in fact, when I went there, I spoke very much the way we started this conversation. Wow, we had to do these draconian measures. And they were always emphasizing no. We looked at the evidence, the epidemiology and the capacity of an area, and then we tailored and adapted the approach in every single area. It was not a one-size-fits-all.
And one of the challenges with Italy right now is just the amount of data. They're just running so fast to catch up with the cases it's difficult to understand what's driving the transmission because that's what you want to use to, you know, drive your strategy - what you cancel, what you suspend, et cetera. It should be driven by the way the virus is moving because remember; it's a virus. It has to move from people - person to person. And you want to look at where is it doing that most efficiently because that's - those are the key places to try and break it.
GARCIA-NAVARRO: That's Dr. Bruce Aylward, senior adviser to the director general of the World Health Organization. Dr. Aylward, thank you very much.
AYLWARD: My pleasure. Thank you.
GARCIA-NAVARRO: And also thank you to Nurith Aizenman, who is here in the studio with us. Thank you.
AIZENMAN: Glad to do it.
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