Front Burner - U.S. scrambles to contain COVID-19, and it's a problem for everyone

Episode Date: March 6, 2020

COVID-19 deaths in the U.S. have reached double digits. As efforts to contain the coronavirus in the U.S. continue, certain factors make it even more difficult. First, there's a shortage of test kits. Then there's the question of cost for patients. We look at the U.S. public health response with Laurie Garrett, a Pulitzer Prize-winning science journalist who built her career studying pandemics.

In the Dragon's Den, a simple pitch can lead to a life-changing connection. Watch new episodes of Dragon's Den free on CBC Gem. Brought to you in part by National Angel Capital Organization, empowering Canada's entrepreneurs through angel investment and industry connections. This is a CBC Podcast. Hello, I'm Jamie Poisson. The efforts to contain COVID-19 continue around the world. Iran has halted Friday prayers in all provincial capitals. In South Korea, officials are struggling to contain a growing epidemic.

They now outpace China when it comes to new cases. India and Italy are closing schools. And in the United States, as cases grow in California, New York and Washington state, there's been a lot of criticism about the public health response there. As this outbreak develops, it's becoming clear how COVID-19 is treated in one part of the world has a real impact on what happens in other parts of the world. As soon as you see community spread in the United States, it pretty much guarantees we have community spread here in Canada. We may just not know it yet. On Thursday, there were over 30 cases in Canada, though no deaths at the time that we recorded this podcast. Today, I'm talking to Lori Garrett from New York. She's a Pulitzer Prize-winning science journalist who has spent

much of her career studying pandemics. This is Frontburner. Hi, Lori. Thank you so much for taking the time to speak with me. I know you are just swamped right now. Well, thank you for your interest. So we're reaching you in New York City. And as of Thursday afternoon, there are 13 cases over there, over 50 in California, I believe, 39 and counting in Washington state. in Washington state. And those are a few of the hotspots in the US. And can you paint me a bit more of a picture of what the situation is like in the United States right now? Well, some of this is going to be, oh, we heard this before for Canadians, but here we go. You know, you have universal access to healthcare in Canada, we do not in the United States. So we have millions of people for whom the burden of being tested and then treated for potential COVID-19 infection is odious,

so potentially financially difficult that they will resist getting treatment, they will resist care. So first problem we have is a huge segment of our population that is likely to dodge anything. And then if they have care, we'll be completely terrified about the cost and what it means for their family and their income. Can you give me a sense of the costs here? So let's say I present with COVID-19 like symptoms in the United States, And I want to go to the hospital to get a test done to see if I have it. Like, what am I talking about here? Well, that gets to our second big problem in America, which is we don't have a standardized, totally available test kit. So unlike other advanced industrial societies, our country really dragged its feet, did not take advantage of the many weeks in which

China, in its own way, fought off its virus and tried to buy us time for the rest of the world. Instead of taking advantage of that time to develop a fabulous test kit, highly accurate, sensitive, good specificity, all of the above, no contamination, and then put it into commercial production so that everybody all over the country would have test kits. Well, none of that was done. The coronavirus, that's a new thing that a lot of people are talking about. Hopefully it won't be as bad as some people think it could be. So we're racing to catch up. As a result, there's two ways to get tested right now. One is using your local health department, and they're using slow-to-be-distributed,

originally contaminated Centers for Disease Control-made government test kits. And according to the CDC, if you have one of those tests, it's free. However, there's a limited supply of those. And of course, they're skewed towards distribution in areas where there's already known cases, so that they can do investigations in the field to track people down. The second possibility is that the FDA, our Food and Drug Administration, just a few days ago gave the green light for biotech companies to roll out their potential test kits and for states to certify the reliability of those kits themselves without waiting for FDA approval, and then you put them into use. So those, we assume, will cost money. We've not seen any real

good price tags yet, so not sure how much that will be. And then you get to treatment. And of course, depending on how sick you get, how long you're hospitalized, and what kind of care is provided to you, that could run the gamut from a few hundred dollars to tens of thousands, if not hundreds of thousands of dollars to individuals. People without health insurance. Even with health insurance, your deductibles could amount to a considerable burden. I want to try to sum up some of the issues here. I want to try to sum up some of the issues here.

First, there's a shortage of test kits. Then there's also the problem of how well the early U.S. CDC kits worked. And on top of all of that, there is also the cost of getting health care more widely. Is that fair? That's a fair rendition. I would say that then the real problem is, in the United States, we have no idea how extensive this virus may be, how many people and in what locations are infected, because we're really only beginning to aggressively roll out testing now. So we know that the case that was identified as the first case in Kirkland County in Washington State, just below, just a few miles below British Columbia, that first set of cases traces as a viral strain, figured out according to its genomic sequence, to a strain that left Fujian, China around January 10th to 12th. That implies that that

virus has been in circulation in that part of the state of Washington for six weeks, maybe seven. And that means inevitably, I mean, the first person that was identified had no known contacts with anyone either who had traveled in China. In other words, it started seemingly out of the blue. What that means is that there's been virus in circulation. People have acquired it. It's a community transmission center. In the Dragon's Den, a simple pitch can lead to a life-changing connection. Watch new episodes of Dragon's Den free on CBC Gem.

Brought to you in part by National Angel Capital Organization. Empowering Canada's entrepreneurs through angel investment and industry connections. I know the United States has issues with its healthcare system, but it does seem surprising to hear how disorganized this response is. Yes. Why? I think we're all surprised and distressed by how disorganized, by how Keystone cops-like it is, gang that can't shoot right, and whatever other cliche you want to use. That's the situation we're in right now in the U.S., and there's a number of reasons. The disintegration of our public health

capacity under the Trump administration. All of this had been anticipated by the Obama administration and before that by the George W. Bush administration. A lot of it was hastened by the anthrax mailings that occurred immediately following the attacks on the World Trade Center in 2001. A Florida man has contracted a very rare and potentially deadly form of anthrax. Now to the home front and those concerns over anthrax in Florida. In Nevada. To New Jersey tonight. Good morning. President Bush tries reassuring the nation after anthrax is found at a facility that handles mail going to the White House. And our recognition that we didn't have the capacity to quickly tell where the anthrax had gone, what buildings were contaminated, what people were infected,

this sparked a huge research effort and a recognition of the need to have a better toolkit. It made the Centers for Disease Control take the outbreak question far more seriously. As you move forward, the next big landmark moment is 2009 with swine flu, H1N1. We're monitoring the emerging cases of swine flu in the United States. The Department of Health and Human Services has declared a public health emergency as a precautionary tool to ensure that we have the resources we need at our disposal to respond. And the recognition, it had all started and gone unnoticed in the American Midwest pork industry

and spread from swine in that industry to individual workers, and that there had even been cases in the United States that nobody had noticed in California and Texas before it really exploded in Mexico. As it went around the world, everybody realized, oh, we don't instantly have vaccines. Oh, we don't have an institution or a pharmaceutical industry that's prepared to meet government needs, push everything else aside, and go full bore on making effective vaccine sufficient supply for the world doesn't exist. It warned the whole world, we're not ready. Right. Then along comes 2014, Ebola in West Africa, and we saw the WHO utterly fail. The vice president of Samaritan's Purse, Ken Isaacs.

The international response to the disease has been a failure. While Dr. Peter Piotz was one of the first people to discover the Ebola virus, he agrees that the WHO acted too slowly. Five months, a thousand deaths before WHO issued a statement and saying that this was a public health emergency. It forced a complete soul-searching and reconstruction internally of the World Health Organization and of its regional offices, all promising, this will never happen again, we're getting ready, we understand, we goofed. Right. And did they learn anything?

again, we're getting ready, we understand, we goofed. Right. And did they learn anything? Well, you know, WHO is a better institution today than it was then. But what wasn't learned was that you get what you pay for. If you don't finance global health interventions, if you don't pay for health security preparedness, for stockpiles of supplies, for everything that's necessary for an effective response, and you try to run on a shoestring, you get what you pay for. And in the case of WHO, there's been no significant budget increase for WHO when you adjust for real dollar value since the 1980s. Wow. And judging from what you've been saying during this conversation,

1980s. Wow. And judging from what you've been saying during this conversation, in the United States, there seems to be less money. Well, then you go to this, the US specific piece of this. So in 2014, when Ebola burst out, I think the whole Obama administration was shocked by the poor quality of the international response to come to the aid of Liberia, Guinea, and Sierra Leone. And so he ordered a massive scale-up, committed a billion dollars just right on the spot, and really revved up all of government response, and then realized that there were agencies tripping over one another. And so he created the position of a Ebola czar. He was set inside the White House with the duty of basically, as we say in America,

herd all those kittens around. And did those efforts help lay the groundwork to fight coronavirus now? Well, the problem is then from that, there was a all of agencies review and the creation of a whole new kind of infrastructure to deal with what was termed health security. And that involved everything from the National Security Council attached to the White House all the way down to local health departments with training and clear jurisdictional commands, a beefing up of the global health budget at our CDC. And in 2018, the Trump administration erased all of that. Okay. And is it fair for me to say that the disorganization that we're seeing around the public health response in the U.S. to COVID-19 is directly related to that? response in the U.S. to COVID-19 is directly related to that. It's absolutely directly related to that. And this whole failure of the CDC test kits appears to be related to like a 23% reduction in funding for the laboratory skill set of CDC. So they had, you know, a handful of people working

around the clock exhausted with inadequate supplies and so on to do the job. What did these kind of failures mean for a country like Canada, which borders the United States? You mentioned B.C., right? It's right beside Washington state right now, which borders the United States? You mentioned BC, right? It's right beside Washington State right now, which has a big outbreak. What we see is several things. First of all, let me take care of the hubris smug factor first. Don't be smug. Pay attention to excessive hubris there in Canada. Because after all, in 2003, when SARS emerged in the world, Toronto had the hardest time getting rid of SARS of almost any place on earth. Yes. And three times declared they had been successful and they weren't. And I know that these community level cases were really what turned

SARS here from bad to worse. Yes. And that's a really important point for everybody in public health to be taking into consideration and addressing honestly right now. And point two, when you look to yourself, and you think about what's going on in the United States of America is messaging. I'm sitting here talking to you on Thursday. This morning, my president of the United States referred to the disease as being caused by the corona flu and stated repeatedly that, quote, just like the flu, most people get a really mild case and they can continue to go to work and they can continue to go to school. A lot of people will have this and it's very mild. to go to work and they can continue to go to school. A lot of people will have this and it's very mild. You never hear about those people. So you can't put them down in the category of the

overall population in terms of this corona flu or virus. So you just can't do that. So essentially, he undermined everything that had been messaged by public health leaders in the hard hit communities by saying, you know, don't tell everybody to quarantine. And so there he is saying that. And meanwhile, the governor. Right. The governor of California has declared a state of emergency. A state of emergency. So we have total contradiction in messaging. Pardon me, under the circumstances to advance a proclamation of a state of emergency in the state of California. This is not... And I think this will simply continue. And one of the things we see as a direct result of that is boomerangs of extreme in the stock market. Have you seen any messaging

from leaders that you found impressive or that you think is the right kind of messaging? You have no further to look than to the leader of Singapore. Today, I want to speak to you directly to explain where we are and what may lie ahead. him. And the way he handled this in a country that already had gone through SARS and taken significant losses in SARS in its health care worker labor force, he sat down for sort of the equivalent of a fireside chat. He went through every single aspect of the virus that his public health people had advised him. He was very accurate. And he told the nation, this is what we will do. This is what won't work. The real test is to our social cohesion and psychological resilience.

Fear and anxiety are natural human reactions. We all want to protect ourselves and our families from what is still a new and unknown disease. But fear can do more harm than the virus itself. It can make us panic or do things which make matters worse, like circulating rumours online, hoarding face masks or food, or blaming particular groups for the outbreak. Here's the amount of money I'm increasing in the budget for health.

Here's who should go see a doctor. Here's who should stay home. It was so clear. Everybody in Singapore knew this is how it's going to work. Everybody knew what phone number to call as a single national number to report whether or not they thought they had symptoms and so on. And guess what? There's one country in the world that has managed to contain

an initial outbreak of this new disease, Singapore. Let us stay united and resolute in this new coronavirus outbreak. Take sensible precautions, help one another, stay calm and carry on with our lives. I wonder if you have any advice for the Canadian government or Canadians, what they should be looking for right now, the kind of actions that they should be taking. Well, I say this to every country that's got a few, what seems to be a handful of cases scattered about. No real outbreak discernible at this moment. Take advantage of this window of opportunity to do two things. One, make sure you have scale-up capacity for test kits and make two kinds of test kits. One that is for

actual medical diagnosis and one that is for surveillance use by public health. And then the second thing you should do right now is have those surveillance kits put to use, go across the country to your intensive care units and run tests on every single pneumonia patient that is not influenza and not bacterial. So you're looking at all the pneumonia of unknown etiology, as we say in medicine, and test them and make sure you don't have some hidden coronavirus cases in the mix. Okay. Lori Garrett, thank you so much. Thank you. After we recorded this conversation with Lori, BC health officials announced that there are eight new cases of COVID-19 in the province.

One of them is a resident of Seattle who's in the province visiting family. Dr. Bonnie Henry says this is of concern and that she'll be working with Washington state health officials to figure out where the exposure occurred. All right, that's all for this week. FrontBurner comes to you from CBC News and CBC Podcasts. The show is produced by Mark Apollonio, Imogen Burchard, Elaine Chao, Shannon Higgins, and Derek Vanderwyk.

Our sound design this week came from Billy Heaton, Matt Cameron, and Mandy Sham. Our music is by Joseph Shabison of Boombox Sound. The executive producer of FrontBurner is Nick McCabe-Locos. I'm Jamie Poisson. Thank you so much for listening and talk to you all on Monday. For more CBC Podcasts, go to cbc.ca slash podcasts.