Modern Wisdom - #149 - Dr Eric Feigl-Ding - Just How Bad Is COVID-19?

Episode Date: March 9, 2020

Dr Eric Feigl-Ding is an Epidemiologist at the Harvard Chan School of Public Health and Senior Fellow at the Federation of American Scientists. The Coronavirus outbreak has been the biggest news story of 2020. For every story claiming it's an oncoming apocalypse, there's another saying it's just the flu. Today we get to hear from one of the world's most central voices on Covid-19. Expect to learn, whether Covid-19 could have been bioengineered, how the virus is transmitted, strategies to protect yourself, the dangers if exposed, what the actual mortality rate looks like, whether containment is a viable strategy, and much more... Extra Stuff: Follow Dr Feigl-Ding on Twitter - https://twitter.com/DrEricDing Check out Stat News - https://www.statnews.com/ Take a break from alcohol and upgrade your life - https://6monthssober.com/podcast Check out everything I recommend from books to products - https://www.amazon.co.uk/shop/modernwisdom - Get in touch. Join the discussion with me and other like minded listeners in the episode comments on the MW YouTube Channel or message me... Instagram: https://www.instagram.com/chriswillx Twitter: https://www.twitter.com/chriswillx YouTube: https://www.youtube.com/ModernWisdomPodcast Email: https://www.chriswillx.com/contact Learn more about your ad choices. Visit megaphone.fm/adchoices

Hello friends, welcome back to Modern Wisdom. You may be noticing a slight change in the audio quality today and that is because I'm recording on my brand new mic setup. Jason Calacanis gave me a bit of shit about what I was recording on a few weeks ago so I thought, fuck it, why not spend some of those hard earned YouTube ad revenue dollars on a brand new setup. So here it is. Increasingly, here from some of the listeners that they use the show to fall asleep on a night time, I'm not sure how much of a compliment it is to hear that people use the show to fall asleep. I'm hoping that it's the dulcet,ultry soft tones that are actually sending them to sleep from me and the guest rather than the content itself. But time will tell, and with this brand-new

lovely warm mic, if you hear it fall asleep, then maybe this will happen even quicker now. Anyway, onto today's guest. Dr Eric Feigelding is an epidemiologist at Harvard and he is an advisor to the World Health Organization. So, as you can imagine at the moment, he is in the thick of it, dealing with the COVID-19 coronavirus outbreak. And very fortunately, I managed to get him in between recording for BBC Iran and ABC news interviews. I managed to get him for a full hour, sit him down and ask him everything that I wanted to know about the outbreak from where it's come from, what the dangers are, what we can expect moving forward, signs that you could be infected without having to get tested.

Prevention is containment going to work, quarantining strategies, everything. So hopefully this will clear up some of the questions you have about the current situation, although it's not conclusive, it does give us the information, which is the best that we can ask for at the moment. Please welcome the wise and wonderful Dr Eric Feigelding. Oh yeah, PS, if you are new here, don't forget to hit the subscribe button, you will receive one episode every Monday and every Thursday with the world's most fascinating humans delivered directly to your listening device of choice. If we're about to face a global pandemic, you might backed up so you can listen to it while you're under quarantine.

This must feel like a war zone for you at the moment. Yeah, this epidemic, it's been raging. I think the world woke up to it somewhere in late January, but it's gotten really, really bad since. When we just when we think it couldn't get worse, it's gotten worse. Just yesterday, the total mortality, the total number of deaths outside of China actually exceeded the daily deaths inside of China. Like the curves of cross, so now the epidemic is actually worse outside of China. And it's not stopping. Well, I'm glad that I've got hold of yourself so that you can try and give us some signal to cut through the noise that everyone has been seeing online. I recently saw Shane Parish is doing the same thing. He's got some coronavirus experts on. And the most common

question that people are asking is to do with trying to work out where the bullshit ends and the information begins, right? So before we get started, who are you? Why should we listen to you? Who are you? Why should we listen to you? Yeah, so I'm a public health scientist. I've been a faculty at Harvard for many years and Actually, I resigned my faculty run for Congress, but that's a different story but I really enjoy science communication and Public policy and advocacy and especially raising a lot this. My doctor was in epidemiology, so the science of epidemics. And although I did other chronic disease epidemics not infectious

disease epi, it's still in my wheelhouse. And I think sometimes in the world, you know, getting a message out there is something that many scientists are not good at. They know so much in their technical area that translating it for the world and making the masses listen is something that's not usually taught. And so it's something I really enjoy. And especially for this pandemic now, I think waking people up and waking them up early before the tsunami hits is something we have to do in public health and we have to do way better. So this is why I'm tweeting nonstop about this COVID-19 and trying to make everyone listen.

I get it. Yeah, it's interesting that some of the people that are the best qualified to tell us the technicalities and the specifics about what's happening, perhaps aren't the best qualified to tell us the technicalities and the specifics about what's happening, perhaps aren't the best qualified to communicate that out, right? And that's that I get what you mean when you say about that. So, okay, let's start. What is coronavirus and what's COVID-19? Is that the same thing? No, coronavirus is a family of viruses. It's like when someone who drives a certain brand of car, but they have different makes and models. Coronavirus is one family. And you know, the common cold, there's a few coronaviruses that common cold, but there's all the common cold that's other viruses. SARS is a coronavirus,

MERS, which is Middle Eastern respiratory disease a couple years ago, also coronavirus. which is Middle Eastern respiratory disease a couple years ago also coronavirus and It's it's one of those viruses has these spiky, you know aura around it's corona So it looks like it has a corona around the virus particle on the microscope But it's an RNA virus, but it's not a it's not a Retro virus like Like HIV is HIV is an RNA virus that has to convert to DNA, live in your DNA, merge in your DNA, and then replicate this RNA. It directly replicates its virus particles after an invades.

Okay. Yeah, and so this is a virus that made a jump from animals, probably a bat or some other animal to humans. And there's a lot of genetic evidence showcasing that. There's no evidence that showcases or supports that it's a bioengineer, bio weapon whatsoever. Because the more you go, you can do, there's these detective clues that you can see within the DNA, within the original, the RNA genome that suggests it was evolutionary driven,

not as opposed to some human kind of insertion. So that's the first myth busting there that this is created by the Chinese government to drive the price of gold or something like that. Yeah, yeah. There's absolutely no evidence whatsoever. And there were some studies that, you know, put out that idea in an unpublished preprint manner. I even tweeted about it because I thought, oh, it's published, but it was retracted. And once it was retracted, I deleted as well. And that's all the thing. There's a lot of, so there's bad websites,

but there's also these pre-publication websites that are not reliable because they're not peer reviewed, and anyone can publish onto them. And information is tricky. And I think people need a filter and putting debunking articles right after someone posts it, I think it's really key in this day and age. So yeah, it's not bioengineering by a weapon. Well, if there is, there is no evidence to date about that. But at the point right now is look, it's clearly a virus that's jumped from animals of humans.

That's pretty clear. And we right now are just trying to focus on solving it. We can discuss and debate how it jumped later, but I think right now that's not the most important thing as part of the epidemic. Got you. So, are the different strains? Are we talking about one thing, COVID-19? So strains, you know, strangers like, is it? There are different kind of branching, but all that branching evidence has shown that

the all branched pretty recently in sometime in November. So it was one single event that has since spawned all these different small variations. So there are like a variation here and there, like for example, the variation in Washington State is different from this variation that was in Iran. But we know that one in British Columbia that was tested from the woman who flew from Iran came from Iran, came from Wuhan. While the Singapore and Japanese and Korean ones came from a different branching. And so using that kind of evidence, we can actually, instead of asking where did you fly, you can actually look at the virus genome to see where did this version come from like British Columbia

Vancouver is very close to Seattle, right? You think that maybe the Seattle version of Washington State version is the same one no They come from different locations because of air travel so you can actually You know use detective work in its genome to see where originally came from, as opposed to just asking where we do travel. I guess it's useful, right? It allows you to see the footsteps of where this has been. Okay, so we know that about the different strains. What are the biggest misinterpretations so far that you've seen? Besides those conspiracy theories, I think the misinterpretation, it's just a flu.

That's actually someone, actually, early on, a lot of public health officials and policy makers just said it's just a flu. It's not just a flu because, hey, everyone has partial immunity to various strains of the flu. No one has immunity to the coronavirus. There's novel coronavirus, COVID-19. So this novel coronavirus, the virus is called SARS-CoV-2. The disease is called COVID-19.

The virus causes disease, COVID-19. Its analogy is HIV causing AIDS right? HIV is the virus, AIDS is disease. So but you know people just called COVID-19. So this this virus I think the main you know misconception first of all is that it's just the flu is very's very dangerous because we have, A, we have vaccines for the flu. Each year, we may pick the wrong strains to put into the vaccine, but it's still at least partially effective, right? Anywhere from 50 to 80% effective against most of the strains. We don't have a vaccine whatsoever, and we don't have background immunity from you previously having the flu for previously this virus.

And secondly, the flu has a mortality of 0.1%. This one has a mortality of a full one to 3%. That is 10x to 3x higher. 10x to 30x higher. So they're not in the same order of magnitude mortality. Granted, there could be some places like Singapore with super high wealthy healthcare that could actually, you know, the mortality could drop below 1%. But on average, you know, WHO said it's 3.4% so far. And that's pretty scary personally.

So again, it's not on the same scale flu. We don't have vaccine, We don't have countermeasures So it's not the flu and that annoys me to know and when people say it's just the flu and also the final the other thing is the transmission the transmission reproductive number Which means the R not forOT for every infected person, that person will infect for the flu 1.3 more people. For this virus, it's 2 to 4 additional people. If you think about it, you know, that is one of the fastest exponential rises you can potentially find.

Now granted, there are things like measles that have higher R knots in the teens But yes, what we have a 99% effective vaccine against the measles all you have to do is take it So we again for something with no vaccine whatsoever. This is a very high R knot and has a doubling time around one week Which is is a pretty fast doubling time for in terms of transmission epidemic. So, altogether, it's not the flu. In terms of other misinformation, some people say that men get sicker or more than women. I would say it's partly true.

Men get infected at the same rate as women, but it could be and but men seem to have a slightly higher mortality But that's from a study in China in which men like 70% of men in China smoke and so if you smoke Obviously this thing is gonna kill you faster So is it because that that it hurts men more is it because men also smoke more? We haven't figured that out. So I don't know if it's and there's no genetic variation I think you know You know right now people are coming down in Europe and

People are dying in in Washington state in the US and they're not Asian whatsoever. So I don't think there's any racial Explanation of why you know there's any racial explanation of why. There's no racial differences there. Yeah, and the other mysterious thing that we actually is actually true is children don't seem to get sick from this. Well, they get infected and they get maybe a mild sniffle,

but almost all children who are infected have very mild to almost no symptoms. Which is in turn, it wakes good, but very strange, but it's well established. Oh, and the finally, the main differential between this virus and SARS and the flu is, this SARS-CoV-2 COVID-19 is transmittable while it's asymptomatic. SARS, we were able to stop in nine months without any vaccine whatsoever. This one, and that's not going to be able to happen because, you know, say you take a plane, right? You're healthy, healthy.

Get off the plane. Two days later, you get sick. Develop your symptoms. Well, with SARS and many later you get sick, develop your symptoms. Well with SARS and many other viruses, well, it's okay. You only got sick two days after, we're not worried about everyone else that you traveled with. But for this one, it's tricky because you can actually shed viruses even when before you have the symptoms. And so that is very tricky and very difficult for a containment of the epidemic because how an epidemic works

is that how containment quarantine works is that you find a case, you contact trace, and you quarantine them. And hopefully you quarantine enough, but based on a seven day kind of thing, there's a lot of asymptomatic transmission that could have happened. So again, altogether, this virus is, it's a mean little sucker. In certain ways, you know, SARS and MERS, which have much higher mortality, SARS is 10% mortality, MERS at like 50%, but 30%, and Ebola has 50%. A virus that kills more and kills faster

is actually easier to control than a virus that kills slower, kills less, and spreads asymptomatically. So again, all these reasons, why is just so difficult? Got you. I want to loop back around to a few of the things you brought up there But one of them is the current mortality rate, which you've said between one and three percent. I've Heard and read some stuff talking about the fact that that is the numerator that we've got on the top But the denominator on the bottom due to some testing

questions may be different. And if that numerator on the bottom turns out to be significantly higher than we've thought, because the reported cases in some places, yeah, the reported cases in some cases are people that are symptomatic or symptomatic. And the people that died from it, are the people that died from it from the people who had symptoms,

whereas it could be people who died from it versus people who were just infected, and that number could be much higher. Could you take us through that? Yeah, so very good question. And epidemiologists have thought of that. There's two different things. There's a tug of war happening.

What you're talking about is underdiagnosis. Basically, mild people or asymptomatic people, they're just not tested and therefore they don't show up in the denominator of total cases. And this underdiagnosis was a problem for China for a while. And there's, it's still a problem in almost every country other than Korea. Korea is doing 15,000 tests a day drive-through style. What? There are countries... Korea's got drive-through tests. Drive-through tests and doing 15,000 tests a day. Holy shit!

It's insane. Korea's... You need a country that is like systematically, you know, well managed enough centrally, and you have the wealth and you have the capacity for the scientific labs to do. The United States came and do that. United States can probably, you know,

across all its labs do only like 9,000. And that's across the entire United States right now at the moment. Hopefully we can do more, but our capacity is not even close to Korea. So my point is underdiagnosis. By the way, Chinese numbers are different than other numbers because if you test positive and you don't have symptoms, China does not put you on the confirmed case count. Everywhere else, if you're a test positive, regardless of symptoms, you're a case count.

So there's underdiagnosis, which if the number at the bottom of this case of mortality ratio is larger, then a case of mortality will drop in percentage, right? But there's another competing thing, and that is the mortality lag. So this disease is a long ass sucker. Mild cases are about 80% 80% mild to moderate and the duration of mild cases is 2 weeks, which is by the way pretty long because most people who have a flu just get over in a week but

severe cases which is 20% severe and critical 20% is about three to six weeks long. And the critical people who are basically need hospitalization in ICU, they have a 28-day mortality of 50% in China. And China, by the way, has a lot of ventilators. They can manufacture a lot of ventilators, and they have staff ICU staff nurses. But the issue is the three to six weeks, it means you have a lot of cases, once you're diagnosed, say someone's diagnosed during Valentine's Day after kissing, terrible Valentine's Day. But their outcome does not resolve to a death or recovery for at least six weeks or three to six weeks.

You see, there's a lag. From the day that you have to think of the cohort, you can't think of it of mortality as simple back of the Natcan calculation of death over cases. You have to look at it from a cohort perspective. And the problem is a lot of most countries, China still have the people who have not recovered. And in Korea, I would still say like 80% of the cases are neither deaths nor recovered and released. You've healed yourself, you don't have a virus, you're over it.

Most two-thirds of them or three-fourths have not been death or recover, which means they're still part of this. I'm still sick. I'm still have symptoms or I'm still testing positive. I'm not clear from my body. And that actually causes two problems. One, the lag, meaning this numerator is not finished, right? It's not fit, this cohort, this Valentine's Day cohort, if everyone who got out of Valentine's, will not be finished until end of March, early April. So we cannot finish calculating the case fatality then. If we just keep testing, testing more,

we're just adding more people to the denominator, but who have not finished the entire disease course. So there's a tug of war. Under diagnosis would drag the CFR down, but the mortality lag of incomplete resolution of most of the cases, because they haven't hit the end. Yeah, this case fatality is only finalized when everyone is either dead or fully recovered. And that has not happened for most cases yet. So, hence, they balance out to around one to three percent, depending on the model.

And the other key implication of the disease being three to six weeks in 20% of people, which is a lot. One in five people who have a three to six week disease course is hospital beds will be completely swamped. Like the United States, terrible. Like Korea has a really high for a capital number of hospital beds, really high.

Korea is like top five. Like 2,000 people do not have beds. You know, this is why China built a hospital in 10 days, right? And Korea, you know, does not have enough beds and most countries do not have enough beds. And it's just gonna jam up the healthcare system. It's terrible in that sense. That seems pretty ugly.

Why do you tell us what the virus does? What does it do? I heard it's bad for people that smoke and it's something to do with COPD. What is it? It's a pneumonia. It causes a viral pneumonia. So it will give you a fever at first. You'll have coughing, it's

common, and then you have, you know, you feel like you have fluids in your lungs, you have total breathing, and then an over time, an infection can set in further of your lungs. And not sure if it creates lung scarring. There's China did one lung transplant on someone with COVID-19, but it's unclear. You only need that if you have permanent lung scarring. And most pneumonia doesn't do that, but if the pneumonia is bad enough, you have problems getting oxygen. And that's why people are on ventilator, respirator machines, because they need oxygen. And if it just causes, it should really, really bad pneumonia,

people just are oftentimes dying for lack of oxygen. That's the truth. So we've said that children somehow appear to be fairly low in terms of symptomatic. Who are the people that are at the highest risk? So I'm going to give you two answers. In terms of the death, elderly definitely have the highest death. 65 plus.

The curve goes up like this. It's not like a step, it's not a step function. It's not a point. It's a curve. Yeah. Yeah. It curves up and it curves up starting around age 50 and then you know, definitely above 65 it becomes a high risk. Like in nursing home in Washington state, there's been six deaths already in a nursing home of frail elderly people.

It's really bad and just one week. But in terms of the other thing is just because you don't die, actually, you know, it's tricky. In terms of healthcare system, I hate to say it. Someone who dies quickly actually is cheaper for the healthcare system and for insurance. Someone who's sick for six months or for six weeks, that's actually really, really bad, right? Because it jams up, hospital beds, ICU services, et cetera.

And so I think you can't just look at that. And in terms of ICU, there was a one study that said, a lot of young people were actually stuck in ICU as well for this. It's, you know, in terms of the earliest reports in China, there's just as many people under the age of 60 as over the age of 60 in ICU, presumably on the ventilator machine. This is a really serious issue because people being sick for a long time is actually a really, really taxing thing on the healthcare system. And I think the other thing is,

there's also many young Chinese doctors have died. There's a 29 year old, 29 year old, 34 year old, 42 year old. Like that's four doctors, like basically 40 or under. It's very troubling. So, and the other thing is just because you are part of the 80% who have a mild and moderate case, you're still spreading it.

You're not most likely those people who are not tested are the 80% but they're spreading it and young people, you know, old people stay home and watch TV or play checkers or something. Young people are out and about going to work, bartending, waitressing, going to movies, sports games, you know, going to restaurants. They're the ones spreading around and so in certain ways you know their morbidity may be less but they actually add to the total number of people infected. So these infectious 80% mild is actually much harder to control. Because, again, even if 20% or just 20% is sick, these 80% keep spreading and amplifying the total denominator for people

who can come down with something really serious. That's why I don't think it's just because it's mild for you, it doesn't make this virus any better for the general population. I understand, yeah. So we touched on it there and you mentioned it earlier on. I really want to try and get some definitive ideas about when your infectious period begins, how long the onset is likely to take before you are either symptomatic or an unsymptomatic, and then when you could re-release yourself into the world. Yeah, good question. So this is actually a project that I'm working on because right now, based on the early studies, and we don't have incubation times for everyone, incubation

is defined. The moment you got infected to the moment, you develop symptoms. And sometimes you can't, you don't know when someone first got infected. So not every case has this information. For the limited numbers we have, it says anywhere between five to seven days. But that means that's just the mean. Half of them are longer than that. And right now, all the quarantine rules are basically quarantine someone who was exposed for 14 days. You're traveling, entering the country, quarantine for 14 days. The question is, is, you know, there's a normal distribution, right? And if the mean is at five to seven days, the question is,

are you sure that by extending it to 14 days quarantine, you've captured the entire tail? Because what if this tail centered on five to seven has a very, very long tail? And let's just say 10% of the people exceed 14 days incubation. So that which means, oh, I'm perfectly healthy for 14 days. I'm going to be a release on the 15th day. They could still develop it if they have a long incubation time on the 18th or 20th day. And then you've, because the quarantine time is supposedly, if you pass this quarantine time and you haven't gotten sick, we can release

you into the wild, right? You don't have disease, go have fun again. But the question is, I don't know if it's long enough. And there's some studies of showing someone with 21 days or 25 days or something like that. Now I don't know if they're misreported, but it's concerning because is 14 days fully capturing 99.9% of all people. Because if you just let one person out, now one person can have a super spreading event. You know, a lot of applications.

What's that mean? I've heard that term used before, super spreading and super spread is. What is that? Yeah, so on average, one person, I told you that are not one person affects two to four, right? A super spreader is some unusual circumstance. There's one person is spreading to tons of people, like five to ten to twenty people. Like a super spreading event is like a sick bartender who serves everyone at a party.

Yeah, yeah, yeah. And then that person does not just transmit to the average of two to four, you know, three, but it's in spreading to like a whole party and from there, you know, it gets loose. And so that's a super spreading event and the person who does it is a super spreader. So it's got, it's nothing to do with someone's particular physiology or the strain of the virus that they've got. It's more to do with lifestyle and the way that they interact. Unusual circumstance. Got you. Got you. So there was another super spreading event years ago in the SARS first SARS epidemic in which there was a toilet system in a Hong Kong building and the toilet system was outgassing septic gas

and which held the virus particle and we went to ventilation system and went into the whole infective whole building. Holy fuck, that is a bad thing that happened. I hate to say there's a study that basically, now it's not of this new virus, it's too new, of the old SARS virus, someone did a study and they realized that obviously you can spread it from a droplet sneeze, right?

Or talking at dinner time to someone. But apparently it's also in the fecal matter, which means, in the did a study of flatulence, is the virus particle in the flatulence. And the flatulence, you know, it can go pretty far. Now, I wouldn't say this on camera on TV, but we're a podcast. So, we can say whatever you want, Eric. Let's start to debate about whether or not we can fart our way to a pandemic Yes, it is I will send you the link it is there's a someone did a study they should win

You know the Nobel for this, but um They they actually show that the the virus particle can actually travel quite far If you if you leave a very long trail of art. So now it's not for this current virus but it's for the old Zara's virus. It's a sister coronavirus. How likely is it that it's going to be it's going to have the same capability? Yeah, I think it's likely because issue in Hong Kong last month as well. And someone who was living, someone who's self-quarantine at home, but someone was living like several floors beneath them,

got infected. And they found that it was also something related to septic gas. Got you. So we've spoken about the fact that it's to do with, at least mostly droplets. I've heard it's something to do with like, it's not airborne, but like waterborne. What does this mean? How do I get it? It just means like a lot of these droplets when you sneeze like up to

It actually goes pretty far It doesn't have to be fully airborne airborne now. There's some argument that it could that be airborne I think the jury is still out. So what's the difference between Abon, Abon and Morta droplets? Well, water droplets will eventually settle, right? Airborne means like it will stay in the air and it will float in the air like a balloon, right? Well, obviously it's a tiny particle, but it's staying in the air.

But you know, a droplet means these tiny things like when he sneezes or when you speak, it comes out of your mouth, but over time it will settle down. So it's like semi Flying in the air for a short distance and so we're sure about that now fully airborne It's hard to say there's some study that says yes some study that says no, but. But I think the main thing is close contact. Close contact. And I think the close contact issue, we've seen it. Also, we think a lot of the, for example,

the ship, the Diamond Prince Princess ship, it was a Petri dish, literally, to grow. And a lot of people, one in four, one in five to one in four people on that ship has tested positive, which is insane. You know, that ship has three thousand seven hundred people and one in four one in five people has tested positive. And the reason we think of that is because a lot of people who are in the inner cabins, besides the food sharing, you know, public,

but people who are in our cabins, they don't have like a window. And so their ventilation system now, is it, is it like droplet travel through the system? Okay. So we, let's say that we're with someone we're talking to, then we've got that concern. What about if I touch my mouth and I've got it and then I put my hand on a door knob or something, how long can it live on a door knob? Yeah, it can live a week. A week. Yeah, a week. That's a long time. Yeah, it's up to a week. It depends on certain things like temperature and humidity. It degrades faster in warmer and more humid air.

But at the same time, you know, we're like Singapore happened, epidemic is Singapore 70, 75 degrees. You know, that's like 20, 25 degrees Celsius. And so that still happened. But the things were mostly indoor people. that still happened. But the things we're mostly indoor people. Singapore epidemic happened. The super spreading event was at a grand high hotel Singapore. And that hotel, you know, hotels, it doesn't really matter with the outside climate is right. If you had an indoor conference center or

indoor gym and you get it, it doesn't matter what it is outside. So, you know, I think that one of the misinformation actually is about, oh, it's gonna all go away when the summer comes, it's gonna be too hot. Except we are indoor workplace kind of people and there's something called the Southern hemisphere, the Earth, and then it'll just go to Africa and Australia and Indonesia when it's wintertime in the summer time of the North and the winter time in South. So I don't think that it's going to go away in the summer

arguments. It might slow down a little, but it could easily come back in the fall. Got you. That's that's the tricky part. The virus seems as the survivor basically. Can containment work or are we just past that still? Containment, you know, a lot of people say WHO still trying to be optimistic the containment can work, but I think I But I think we have to move from containment

to mitigation. How do you do that? What's the difference? Mitigation is just reducing the number of people who are exposed., you test as much as you can, but in terms of actually stopping the virus, you just you mitigate its impact and you mitigate its spread. But containment just means preventing the community transmission event, right? Someone is someone travels from say Iran lands at the airport and then we detect that they're sick and we quarantine them, then that is contained, right? But if they can't come back, go send Infector kids, goes a daycare child care, goes to a party, infects everyone, and they all go home

And they all test positive, and they all don't know necessarily where they had gotten it. It's not contained anymore. It's community transmission. And community transmission is way more dangerous than a travel related thing because it means they picked it up randomly in the community of an unknown source that we can't necessarily trace anymore. Got you. Okay. you can't necessarily trace anymore. Got you. Okay, so when does it get to the point where we need to just buy all of the rice in Costco

and not leave our house? I think depending on which country you are, we're already there. I mean, is that realistic? Do I need to do that? Like, you know, I don't think there's any cases in Newcastle where I am, like, should I be worried about going anywhere? No, I said, depending on where you are. Yeah, yeah, yeah.

I don't think you came there. I think Italy is there. Italy's having a bad time at the moment. Italy is so bad. Italy really is bad. Seattle right now is having a really bad one. Seattle area, you know, area, Amazon has many buildings, but one of their buildings that does Amazon

fresh, Amazon Prime now, it's called the Amazon Brazil building. It holds like over 2,000 workers in this huge building. Someone's as a positive on February 25th, and they have to send the notice to everyone. Like, and the epidemic is so bad widespread in Washington that I think they may have to shut down schools soon. They might have to cancel all public events.

Like some places you have to put these moratoriums on on public gatherings and I think some places like Italy is just canceled schools today for at at least two weeks maybe longer. Yeah. Nationwide. I think Washington State may have to do that as well. Dubai, Dubai already has. Yeah. No, but I think this is this is where, you know, mitigation comes in because you're not containing it anymore. You know, it's there. We just have to, you know, lock down people. anymore. You know it's there. We just have to, you know, lock down people. And it does work, social distance, until we have the vaccine, which will take a year to 18 months, a year for lucky. And hopefully, the vaccine is high enough, like a 60, 70% effective vaccine might not be enough to stop this virus.

Remember, for every infected person, it may infect two to four additional people. So, you need to get the R below one. And so, with that, you know, something that has a R of three, you need like, we said, you know, 70% higher, just to bring it below one. You know, you need a very high efficacy, you need 85, 90, 95% efficacy, and not every vaccine has the perfect efficacy like that. So, and then that is only a year and a half.

There are existing antiviral drugs that could work. There were testing, there's some older HIV and hepatitis C drugs were currently testing. The drug does exist, it's been phase one tested, but we have to phase two test whether it works with this virus. Again, that might take six to nine months. We couldn't get early results depending on how good it is in late April at the earliest. So we'll have to see. I get you. Okay. How can I tell if I've got COVID-19 without going to hospital where I am, might, hospitals might already be over capacity or whatever? How do I know?

whatever. How do I know? Because the symptoms are very non-specific at first, fever, coughing, pneumonia. But there's many things that caused that, right? So you need to get tested at the same time, you know, testing capacity is very limited. So again, what you could, if someone has something, it could be the flu. It really could, or it could be another endemic common cold coronavirus that's not nearly so bad. You can't really tell until you're totally tested. You could get a CT, and

it will tell you a CT will pick up a really bad pneumonia in your lungs, but That's more of an approximation again. It's not for certain in who bay anyone who tests a positive for CT pneumonia They assume you have it because that's because you're in Wuhan, right that person But most you have to go Okay That that seems like it's not as easy as it could be or should be, I suppose. Let's talk about the origin just for a second. I want to get back to how people that are listening can potentially protect themselves

and then potentially some public policy implications as well. But there's been some talk. I've seen quite a bit of stuff about. We need to find the origin. Patient zero is important. Is finding patient zero important? The person that it jumped from animals to humans? At this point, it's not the most important thing at all. Patient zero would give you a source initially, but at this point for all the treatments and containment and public health measures, it's a low importance. So people keep asking, was it the seafood market or not?

I would say that it might not be the seafood market only because the new and the general paper actually found that the first two people infected in early December had no seafood market contact. It was only the next wave that had seafood market contact in late December. So it could have been that someone introduced it to the seafood market and seafood market was like this super spreading event, right? So, you know, but whether it was introduced to C for Market or it was a gem-made, it's jumped from the animal to humans, add to C for Market, it doesn't really make that much of a difference. I don't think.

You know, the only people who really care are the bioweapon conspiracy theories. Yeah, yeah, yeah, yeah. So it's a move point. We know that there's tons of, you know, there's a study in which people study about how many coronaviruses are in bats. Oh my God, there's like dozens and dozens that we've never even known about. And so then they tested the blood

of all these people, these indigenous people and local rural tribes are exposed to these bats. And they found, oh my god, these people actually have a lot of coronavirus that never been identified before. They just been mild and we've ignored it because it's not bad. But this one is actually a really bad one because it selected itself for, you know,

over time, the most, the survival of the fittest in terms of viral evolution. So this, we have now viral evolution selected one of the most infectious, severe viruses. And it is perfectly natural and possible and plausible that happened by itself. Got you. Have we had any indication that this virus could mutate and is that a concern? Does it matter and what does it mean? Yeah.

So it can mutate. RNA viruses mutate more than DNA viruses. That's like a general rule. Because RNA system is always a little funky because DNA has two helixes, right? And so you make an error, the other helix realizes the error and something fixes it right away. The RNA is a single strand, so it doesn't have this correction mechanism, but the coronavirus is a big enough RNA that

actually has a special endonucleus within it that actually can fix errors along the way. So it doesn't mutate as fast as the flu. The flu has a very funky mutation system that tries to always reshuffle itself and creates some brand new strains every year that causes vaccines have always have to play a whack-a-mole catch up. But hopefully we can have one vaccine that will work for this. So, you know, we have different variations, small variations. And they found that the actual mutation rate is one mutation, one that approximately, one, um, um, um, um, amino acid, um, immunotation every, um, two weeks. So that's how they figured out that's

approximate rate. And so you can figure out how, how it diverges, uh, you know, you know, the detective slew thing, um, of the virus genome I told you about earlier. But it's not, we're not going to get multiple strains, and it could mutate by at the same time. It could, most mutations are just junk mutations. It could potentially select for a very hyper-survival one, but generally you need a very high number of infections for that. And right now overseas, there's still not enough of that. I don't think the mutation is our current worry. I think we will be able to find one vaccine that will work for it for a long time. It's so it's not like the flu in that sense.

Got you. Right. What are some of the things that the people who are listening can do to protect themselves? What's the 80 20 on that? I would stop shaking hands to with people, no friends. We've hired them this bump, elbow bump. Sorry for putting in here, but I saw a relative transmission rate graph, which I'm going to presume that you've seen. And it's like, uh, the elbow bump was best then followed by the fist bump. And then there was like the slow fist bump. I'm like, who's doing a slow fist bump like you're from Save By The Bell in the 1990s or something? Yeah. I think that's just one measure.

I think the other key things are, you know, just don't touch your face. By the way, really embarrassing. A Washington state, there was a press conference about the epidemic. And as she was fumbling through her papers, she would say, everyone, wash your hands, don't touch your face. She was flipping her paper like her fingers to get through the picture. say everyone wash your hands, don't touch your face. She was flipping her paper, and licking her fingers to get through the bits. Middle of the press conference,

telling people don't touch their face. It was terrible. What is it? It's not face palm, is it? It's like face, you don't wanna face palm, that's a problem. Oh, yeah, I know. Anyway, it's common internet meme right now,

but it's just so terrible. But I think, you know,, it's common internet meme right now, but it's just so terrible But I think you know avoid touching elevator buttons just avoid touching door knobs I know that is really hard, but door knobs are not disinfected often Don't touch things in public You have to kind of be a little germaphob until this thing is over, you know and Public transit is the other thing. Like, I see like this,

you know, the city leaders are always saying public transit is fine, but public transit is also one of the confined space, limited ventilation. You know what I'm talking about. And it doesn't have an unlike the airplane. I airplane at least, it takes in new air every three or five minutes. So the air in the cabins being replaced, every three or five minutes.

So in certain ways, the airplane is pretty good. Unless you get unlucky and sit in someone next to a cough, the airplane is actually pretty good in terms of replacing the air. But that's not true on a bus or a train. I don't know if they use super high small micron hepa filters that can filter out virus particles because not every air filter does. I think the other key thing is people ask, do travel. I think the other key thing is people ask, do travel. I say, look, at some point, once the pandemic becomes really real, and it's like in 89 votes,

what's really real, man? As in the epidemic is literally everywhere. 80, let's just say, if I was in the United States, it's an 80% of all the states, you know, I'm going to say, it's probably everywhere, and staying here is no better than getting on a plane and going there. Granted, you know, airport is a place to exchange, but I don't think you should stop your life. And people ask me how anxious I am. My, my, my scale, one to ten, I'm a six.

I'm worried, but I'm not anxious because I'm anxious about things that is something I can control that I'm not doing, right? Like testing. I'm anxious that we're not getting enough testing. But am I anxious for the inevitable and inevitable? Because the CDC wants CDC vaccine immunology head says report to Congress this virus is in that evidence. It will be in every single state. In that sense, I am not anxious because it's like just brace yourself. Come what may, right? So I have that kind of

stoic mentality. obviously not everyone does. But you know, protect yourself as much as you can. As for masks, surgical masks are pretty useless. And N95 masks do not filter out everything. But N95 masks are better. But at the same time, if you wear a beard, it's totally useless wearing some N95 mask by the way. And the most meaningful seal of the whole seal. A ramble. And again, the surgical mask, the mask, what they mostly do is it catches your

spray from your mouth. When you're talking to someone, hey, how's it going? I have a great idea and you're spraying, you know, even if you're someone who's very careful, everyone sprays just a livers when they talk. At dinner time, it's natural. Math, but it does not actually protect you from inhaling the virus if it's in a droplet, tiny droplet in the air. Does that make sense? So sometimes people have a false sense of security when they wear a mask. It's not.

It's actually protect others, not to protect yourself necessarily. Okay. That's not good at all. I thought I could just stick a mask on and I'd be okay. So it turns out that that's not very good. So what about helping and I might find masks are partially effective. We are partially, but they're also now in the highest demand No, yes getting hold of you seen. I just got told before this by one of my friends that alcohol handwashed prices

Some companies charging like 10 x 100, what it should be. Yeah. Yeah. No, there's a lot of price-catching, although there's actually like to do it yourself, like home hand sanitizer that you can make out of, I suppose, a purple alcohol yourself. So, that's cool. That's pretty cool.

You've just people to be able to search on the internet and find out how to make it. How to make your own hand sanitizer. It's probably shelf-life stability, probably not as good, but you just make some aloe vera gel. And this alcohol and you can it's good enough. Cool. That's a really good tip. I like that. What about ensuring that I am as robust as I can be. I shall be uping my vitamin D, D3, should I be, you know? Yeah, some people say take your vitamin C, vitamin D, vitamin D is good for general immunity,

vitamin C can maybe shorten a cold, a short, a small amount, but we don't have evidence. I'm a scientist. I'm an epidemiologist. I also do clinical trials. Unless you have causal evidence, I'm the jury's still out in my sense. I don't have in doing it, but there's also no indication that it's gonna move in here.

Don't go panic buying on these things without evidence. That's my general thing. Don't go panic buying. Also, by the way, panic buying is more of a semaphormic social phenomenon. If you see someone panic buying at the store, you're going to panic buy. But if you see someone just buying one or two, you're just going to buy one or two, right? It's the panic buying is, you see other panicking and people panicking and then you panicking. And then that's how stampede's happen. That's how people die and stampede, right?

Because oftentimes it's other people running and so all of a sudden you have to run to, or else you're going to be trampled. So it's society is a funnily little place. Oh, man, it is. These weird shaven apes walking around with a brain that really doesn't work right for the environment it's in.

I got a couple more questions. First off, we've spoken, it's been, in the nicest way possible, Eric, you haven't told me what I wanted to hear. But I'm glad that you've told us what you know. What would be an indication, two part question. First part, what would be an indication that things are getting worse? The indication that it's getting worse is if you start, if the epidemic is unchecked even in a high-income country, like Germany, Sweden, Finland, Denmark. What does unchecked mean?

Like community transmission, like really fast community transmission in those kind of places, I would really start to worry. Because those places have some of the best healthcare systems. And the other signal is in Korea, if the mortality, you know how I talk about the cohort, you say your Valentine's Day, infected person, by the end of March, if the mortality is still pretty high, then I'm gonna still be pretty worried about

It because if the mortality is like above 1% even in Korea That's that's pretty bad in my sense. Okay, what would be an indication that things are getting better? The community transmission is stopping. And I want to see, you know, high number of tests, and then high number tests, the proportion infected, steadily declining, assuming the same constant number of tests. That would be a good signal, because the more you test, or at a high test volume, you're not finding more. That means potentially the epidemic is winding down. I just want to say that the test is not perfect. The test has a accuracy about 50% or less, which means not that there's

false positives. If you test a positive, it's most likely a pretty much clear, it's positive. There's a lot of false negatives. And the false negatives is not an issue when you're first diagnosing a case as much. You know, early on, it's really important to catch every case, but at least catching a case, catching at least 50% of cases is better than catching none, right? The problem of this high number of false negatives is that when you, it's time to release people from either quarantine or from the hospital, their fever is gone, their symptoms are resolved. And right now, oftentimes, you need two consecutive, a one full day apart negative tests, two consecutive negative tests. But the problem is,

you can easily have, you know, 50% times 50%. You could have a 25% chance just by pure luck that you get negative tests, right? And that worries me because it seems now out there spreading it around, thinking that fine. And because there's many examples, someone tested negative seven times, released tested positive a week or two days. That's an actual example. Oh my god, there's like five or six examples in China, in Japan. This happens so many times. Just look, right now they call it reinfection. It's this, it's, I don't think it's reinfection. Mistyagnosis.

It's just you were released on based on negative tests that are, that are faulty. Got you. And then, um, and then over time, um, you know, say you get sleep to private one night and, uh, you had a stressful day and then over time, um, you know, I'll say you get sleep deprived one night and Oh, you had a stressful day and then your your immune system drops a little bit and then the virus flares back up. Um, but you, but you never shed it. Like this happens all the time.

Like for example, HIV, um, HIV tests, sometimes they say, oh, the drug was so effective. It is below the limit of the detection. We can't detect the virus, but we know it's still there. So this kind of thing happens all the time. Like, you could be low, low, low, low, and then tests will give you a negative, but the test might not be sensitive enough to the super low. And two negative tests to release you,

you still have it, still shedding test positive later, but during that time you may have infected someone. That actually worries me the most. I would love to see a test with both high sensitivity and high specificity. Sensitivity means all the true cases, how many do you find? You want to find 99% of them.

High specificity means all the people who don't have it, how many percent that you correct, like one minus the false positive. So false positive is 1%, the specificity is 99%. You want the specificity, you have a test to have high sensitivity and high specificity. And oftentimes the problem with the US testing delay was the kit, there's three parts of the kit. The first two was the filing the virus. The third was a negative control. The negative control had a whole bunch of other miscellaneous viruses. And the test kit was supposed to test positive just for the COVID-19, the SARS-CoV-2 virus,

but negative for the negative control. But it somehow cross-reacted and the test kept testing positive for even for the ones the sample that does not have it, because somehow the test is picking up other viruses as well. And that's why the testing when the US was delayed two weeks. But this testing problem, we need to get a better test. But this 50% Acure one, and 50% based on Chinese Academy of Science analysis, is currently the best we have. But hopefully we can find there also a more rapid one.

Because right now, the lab, the PCR, that you need a PCR machine. So it takes at least 12 hours to, you know, by the time you send it to a lab, you get it back. And it's pretty labor intensive. If we have like an A1C, like a glucose strip or a cholesterol, you know, you basically imprint, stick it in the little strip and it tells you or something rapid under an hour. That would be really great.

There are people working on it, but it still has to go through some approval. But, um, and then I want to see how accurate it is. I can only imagine some of them. I mean, you're one of them. You're one of the people that's in the midst of this particular situation. But I can only imagine how chaotic some of the guys working at vaccine laboratories,

working at the testing laboratories, working at the testing laboratories, you know, working at the control set. And then take it one step up from there. What about the doctors, the nurses that are working? It's like every healthcare professional on the planet just got turned up to 11, right? Yeah, yeah. It is really stressful with healthcare professionals. And also first responders, like firefighters and police

who first respond to someone who falls ill and needs 911 or emergency ambulance. And unless you know that this person that has a respiratory illness who could be a potential case, they're not wearing any protection. And the scary part is, look, the quarantine Japanese quarantine officer boarded the Princess Diamond ship,

the one that was quarantined off of Yokohama. He boarded with mask with protective gear, did inspection, got off the ship, tested positive. Another firefighter in Japan transporting these patients, as they were evacuating, he was wearing protective gear, and he's transporting, tested, tested positive. And so it's really trouble. Like right now, in one county in next to Seattle, Washington, 25 firefighters have been quarantined, which is a full quarter of their entire

firefighting workforce out of commission for 15 days. And now half of them have developed flu-like symptoms. All from just transporting, you know, there's one patient. This virus is so infectious. It is just, you cough in the sneeze and it goes everywhere and that's what's such a worrying little little sucker. I want to wrap back up and just give everyone what they should take away from this. Apart from obviously all the information and thank you so much for giving us your time. I know that you must be crazy, busy around Turkish TV and Iranian BBC and ABC and all this stuff. The things that people can do, what should they do? Give us the principles they should take away.

Don't panic by slow-by. Your stock up, probably like two weeks worth of food and water, in case of future panic by. But remember, you're trying to prepare. So power preparing is slow by Avoid touching people and avoid touching your hands watch, you know, just generally going to restaurants be very careful Don't touch anything basically. That's not purely, you know static clean I Would avoid

social things I would avoid social things. I would avoid concerts, sports, sports events, parties with poor ventilation, maybe outdoor party, maybe, but I just, knowing and seeing how infectious it has been on so many different situations, avoiding these kind of things that all costs. Public transport. Yeah, and public transport be very careful. Be very careful. If someone coughs next to you, move out of the way. But at the same time, don't be racist that, you know,

someone just because they look like they're from China. At this point, looking like someone from China is not an indicator of someone having a virus anymore. Honestly. You know, in that sense, you know, avoid Italians, but that doesn't make sense either. I get you. I think, I think just social distancing is the most important thing. I hate to say it. Until we have these drugs or a vaccine, social distancing is the most important thing. I hate to say it. Until we have these drugs or a vaccine, social distancing is really the best measure. And again, this bumps and elbow bumps or something like that, just boy touching people.

And even at dinner, if you're having face to face conversation, stand as far as the way as you can. And, you know, at restaurants people are very careful. When you're going out to dinner and you're talking, you're saliva will naturally go into someone else's food across the table. So, and if you're going to do a podcast, do it over Skype like this. Yeah. Although we're going to have these virtual reality kind of like holograms. And then, you know, it's going to feel real because then you can. If you can, if you can infect me with COVID-19 through a hologram,

then technology's gone too far. Hey, I haven't infectious personality. Isn't that? I get it. Eric, man, let's say thank you so much. You are right in the midst of it at the moment. People want to follow you for updates and stuff. Where should they go? Yeah, follow my Twitter. I have a Facebook as well, but right now I'm just purely on Twitter Twitter for those updates at at doctor eric thing dr eric your i c then ding d i n g at doctor eric thing fantastic either any other other than your twitter feed obviously are there any news outlets or websites or whatever that you think are giving accurate updates where

people could follow those as well. I think stat news is really good one. Stat news is like a health care newspaper there and they have pretty good updates. Obviously WHO has updates but WHO their recommendations are much more optimistic. If you want more realistic in certain ways or more predictively ambitious, I would say, you know, I think following Twitter COVID-19 hashtag, it's a really good hash because it's something that everyone's using for this epidemic on Twitter. You know, as I try to source everything that's indirectly sourceable from a journalist or a newspaper.

So I'm trying to stick to the facts, but I'm giving the real realistic things that the health department people don't necessarily want to say aloud. So I think certainly certainly in the environment that we're in at the moment, it makes a lot of sense to err on the side of prudence rather than optimism with something like this, right? Look, Eric, man, thank you. Thank you so much for the time.

I hope, in the nicest way possible, I hope that we don't need to do another episode about this. I hope so. Next time, if we speak again, we can just be talking about, you know, some at cool. Isn't that isn't that virus? Isn't that virus that all gives us like really, really good skin? Isn't that like such a such a wonderful pandemic for us all to have? As opposed to, you know, how much how much food you have left next time we we are or in our

bunkers. Well, I do know I do know where you are. are. If I need to contact you and let us say, if so, man, I'm glad that I've got a hold of someone who understands what's going on. I'm sure that a lot of the people that are listening do as well. Thank you so much. Let's chat again, hopefully in a couple of weeks or months. I get it.