 These are kind of structural issues around discrimination and racism. It makes people uncomfortable to talk about it and it's seen as being quite political, especially now with what's happening with the protests and the Black Lives movement. There obviously is a big problem. Welcome to World Versus Virus, a podcast from the World Economic Forum that aims to make sense of the COVID-19 outbreak. This week, racism. As Black Lives Matter protests put the issue at the top of the news agenda, we ask, why does COVID-19 hit ethnic minorities and people of colour harder? There's both intentional, deliberate racism, but there's also unconscious bias. And when you have groups of individuals who all kind of look the same and approach problems the same, they tend to hire people, mentor people, support studies that fit with their worldview. Debbie Sreedha, Professor of Global Public Health at the University of Edinburgh, tells us that far from showing us we're all in it together, the pandemic has exposed huge inequalities. Some people said it was the great equaliser, I think completely the opposite. It really put a mirror to societies to look at actually where we're underlying problems that were there under the surface and now actually need to be addressed. Subscribe to World Versus Virus on Apple, SoundCloud, Spotify, or wherever you get your podcasts. I'm Robin Pomeroy and this is World Versus Virus. The world watched in horror as George Floyd in African American died as a white policeman knelt on his neck. It sparked outrage and unrest not just in the US but around the world. The issue of racism runs deep. And we wanted to know if it might even in some way have contributed to the spread of COVID-19. It was one of the questions I put to Debbie Sreedha, Professor of Global Public Health at Edinburgh University. Professor Sreedha also told me why the as yet unknown long-term consequences of the virus for survivors could make COVID-19 in her words, our generation's polio, and why countries should not be looking to contain and manage the outbreak but to eradicate it. But on race, I asked her if we knew why black, Asian and other ethnic minority people in Europe and the US were more likely than others to catch and die from COVID-19. So I don't think there's an agreed universal explanation for this. I think there's several hypotheses that have been suggested based on studies. And so the few that seem most compelling to me are first that ethnic minorities are generally living in conditions. So they're housing conditions which are in poorer areas and more crowded areas. And so that exposes them to more risk daily. But I think the next thing we've seen is there are increasing studies looking at vitamin D and the role of vitamin D deficiency and people who are darker require more vitamin D and not getting it from sunlight, especially in northern countries. But the third, and I think this really gets to the heart of the issue, is that it does seem like in health workers, so BAME communities, black, Asian, ethnic minority communities, that health workers have been put onto perhaps longer shifts and to riskier positions, don't have as much access to PPE. These are kind of structural issues around discrimination and racism. And it makes people uncomfortable to talk about it and it's seen as being quite political, especially now with what's happening with the protests and the black lives movement. But I think we need to have these open discussions to actually get to the heart of what's happening because there obviously is a big problem and we need to figure out why that is. And think about how we practically can start to address it. We've reported on issues in the past at the World Economic Forum about how sometimes medical research is taken as its subject. A typical white male very often and it has not been tailored to a more diverse group of patients. Is there somewhere in medicine in general or healthcare some kind of underlying structural racism? There's both intentional, you could call like deliberate racism, but there's also unconscious bias. And when you have groups of individuals who all kind of look the same and approach problems the same, they tend to hire people, mentor people, support studies that fit with their worldview. It's just human to do that. And so what this reflects to me is first that we all need to reflect on our own biases and that we all sometimes may not even think that we're making a choice when we look at two CVs, that we look at two studies we want to support in terms of the validity of each that actually that reflects also our bias, that nobody's totally independent or somehow they're part of their social circumstances. And I think the other bit is about having diverse voices at the table and on grant panels, on ethics committees and policies. I mean, a clear example for that is the SAGE group, the Scientific Advisory Group on Emergencies in the UK where you do see a certain level of groupthink. There was a unanimous decision made not to suppress the outbreak completely. And that strikes me quite strange because these are really difficult debates and there was such scientific uncertainty you'd expect there to be a debate over that and perhaps a decision made in that direction but you'd say, okay, there was a dissenting voice so there were a few dissenting opinions or they couldn't reach a consensus so this is what you put forward. And that's my experience at least of sitting on panels is that you rarely reach a very clear consensus on something where there's a lot of uncertainty around which direction to go in. And so I think there are again points to having different worldviews and experiences and backgrounds and that's not only about ethnicity, it's also about gender, it's about class, it's about all the various bits that make people who they are and making sure that you have people who often disagree with you in the room. That's the best way to actually make good decisions and fund studies that actually reflect what is really needed. When we look back on all this in a year or two years or five years or a hundred years as we look back on the Spanish flu, will historians say there was racism in the way the world or certain countries responded to this pandemic? So I think what you've seen is the tide going out and revealing what was already there but we're seeing it more acutely. I don't think that COVID-19 has brought anything new that wasn't already here. There was already racism in the NHS. There was already racism within our countries and we just have to acknowledge that there's not a point when countries turn from being racist to not racist. It's a continuum, right? And it's an evolution and it's a process of changing minds. And so I think what we could say is COVID-19 has definitely acutely brought to the surface issues of race. Also, you know, inequality. There are deprived communities who are doing much worse off during this pandemic. Lockdown, some people said it was the great equalizer. I think completely the opposite. You saw people who suffered quite badly under lockdown. You saw people who enjoyed it a lot. And so I think probably the way I would see it is that it really put a mirror to societies to look at actually where we're underlying problems that were there under the surface and now actually need to be addressed. Do you have any predictions for the next six months? You talk about the second wave. What are the big risks? Colder weather, obviously. We all get the sniffles in winter. Is there anything else that you're worried about that could bring up a bigger second wave? Yeah, so maybe I'll start with saying what hopefully might happen. I think there is always this hope the virus might mutate to a milder form and turned out and change into something that's more like other common cold coronaviruses. So that could help us avoid a second wave. I think a second is if there's broader immunity among the population than we've previously seen. So could there be cross immunity from other viruses or from other colds that people might have had? That's a big open question. It wouldn't explain why we're seeing clusters of cases, but it might explain why kids are generally protected if they've been all exposed in schools or through their childhood to other viruses. And so those are two huge open questions and both of those could help shed light on a second wave. But absent those happening, yes, I'm very worried about a second wave because how viruses move is they try to go after any susceptible hosts, so people who have no previous immunity and this is what was so worrying about this virus when it emerged that there was no previous immunity in the population which means you'd get very high transmission. And so if we do trust the serology studies that have come out that were only 10% of the way through this in most countries, there's still a long way to go. And winter I think is harder not because of the way the virus transmits. It transmits perfectly fine in the summer in hot climates. We're seeing that in Brazil now. We're seeing that in the States and Florida. But people generally move indoors and their behavior changes which makes it easier to transmit. And plus you add on top flu and that only makes it harder to track who has coronavirus because of the issues around symptoms but it also means your health services are incredibly stretched. You have fewer beds and that means health services are more likely to be overwhelmed which means you probably need a lockdown at that point which is what we're all trying to avoid trying to keep the numbers low enough that you don't need to get into community transmission and get into another lockdown. So those are the things I guess that worry me and also the lack of learning and reflection. I think right now there is a feeling in England you know shops are open people have gone back to their life you know the government is talking about the virus in retreat the battle has been won that this is over. But a part of me worries looking at what's happening in other parts of the world because East Asia, China and South Korea they're constantly fighting this virus clusters keep emerging and they've been on top of this from the start it hasn't just gone away. In the States they lock down and they reopened quite quickly and you're seeing again rising cases coming up and discussions about a second lockdown already in the States. So I think what we have to do is look up at other countries and say what would put us in a different position to them. The only thing I think that would is possibly three things. The first is if people use face masks and change you know their behavior so that we're not having as much transmission. I think and the second could be that we have testing and tracing up and running and it is actually effective which is a big question since we haven't seen the data that actually it is proving effective that we're tracing contacts and getting them into isolation. And I think the third is possibly if the virus has spread farther throughout the UK in February and March than we had anticipated and that more people as we all think and everyone thinks they've had it at some point and that actually becomes true. But then of course the question raises that if you've had it and not produced antibodies because you had such a weak version would you be protected against the next time it comes around and that's the big million dollar question is around immunity. If you've had it will you get it again and if not in this year could it happen in two or three years. Now you have spoken about the as yet unknown long-term damage from COVID-19 even referring to it as possibly our generation's polio is there evidence already out there that it might cause serious problems in survivors that will last a long time? Well I think there's emerging evidence and these are in people who have been in different categories so you have people who are in ICU and then are released and who recover and it's clear that people who have been on ventilators or were very critically ill will face months of recovery including physio including possibly oxygen support then you have people who've been moderately ill who seem to come out and for weeks have fatigue who struggle with different parts of their body whether it's their heart or their lung capacity but you have this new emerging group of individuals who haven't yet been captured by health systems and we're seeing this in Sweden Netherlands and Britain through the creation of Facebook groups of people who possibly never were tested for COVID but think they've had it and are having weeks and weeks of fever of fatigue of pain and so I think there's going to be a lot of research taking place on these categories of individuals because we've learned about this virus that it actually can have effects four to five weeks after you're actually diagnosed with it or actually you've had it after you've had the acute infection Is any indication of what type of patient is most affected by that kind of thing? I think it's clear for hospitalization that there is certain risk factors we've already seen studies coming out regarding BMI that's body mass index you've also seen ethnicity and race people from black or ethnic minority backgrounds people from deprived areas as well potentially due to their living conditions and then those with you know comorbidities like previous heart conditions or asthma or cancer survivors so these are kind of categories of risk that have been for those who are admitted to hospital for those who are in the community it's not yet clear in the states they've given the term long haulers which is people who are generally age 30 to 50 usually healthy but somehow they're impaired physically after the virus I think this is from a tweet of yours my view is that we should eliminate coronavirus rather than live with it as a lurking threat and then you go on to talk about the one meter versus two meter debate about physical distancing that's happening in the UK right now you say that you call that a distraction from larger strategy you say the virus is too dangerous to leave unchecked get rid of it in school shops pubs can open normally is that strategy to eliminate it is it really feasible for Western Europe for the Americas North and South for Africa do you think it can actually be done well I think you know when the virus first emerged and we didn't know much about it there was obviously an idea that you could run it through populations that actually it might be the optimal situation given the costs of elimination the costs of control to society and to economies that you should just let it run through but I think what we've learned over the past few months is that's quite a dangerous strategy not only for the deaths it caused but also for the morbidity it causes and healthy adults and so then you've seen a move from what we call mitigation which is you let the virus go you try to treat everyone to suppression or control and this is the way that Western Europe has gone England currently in other countries and this is where Australia also started and I think what we've learned is this virus can set off clusters very quickly and tip into community transmission so our control is optimal in the sense that you can keep an eye on the virus you need to have robust testing in place tracing in place you cannot have large gatherings you cannot have weddings go ahead you can't have people sitting in pubs in close quarters because distancing is not possible you need schools reconfigured and so how we have to think about the new normal is quite significantly different to our life currently and there are costs associated with that there are major costs to keeping kids apart from each other in school especially young kids who need to interact and need to play in close contact with each other and so looking further afield we can now see that countries are starting to eliminate the virus just get rid of it New Zealand has done this that was their strategy from the start Australia looks to be following New Zealand Thailand, Vietnam, Taiwan countries in East Asia are just thinking that actually the least worst option with this virus is to eliminate it and have border control and that means you can have large rugby matches go ahead like New Zealand has done with spectators you can have weddings go ahead you can have kids back in school in a normal way you can have pubs open and restaurants open and so I think the succession with one meters or two meters kind of misses the larger point which is this is a virus that is here how are we going to manage it and what's your plan is your plan to let it run through what Sweden has attempted is the plan to keep controlling it but then you have to get the population to buy in what that actually means for their daily lives or are you going to try to eliminate it and how do you actually develop a game plan for that How long would it take if you're starting now we can't start back unfortunately from January or February but if you started now when do you imagine you might be able to have the rugby matches and the schools open again well yeah again usually we can't go back in time but I should say like in March I talked to Chinese colleagues and they said like look if you go after the strategy lockdown early and get on top of it you could probably be out the other side by mid-June and we're now on mid-June and now looking ahead I mean the goal at least in Scotland is we're looking ahead to schools opening on the 11th of August and thinking what can we do in the next six weeks to really drive numbers low it's really a strategic decision so if we have let's say running 20 to 30 confirmed cases we think in the community there's maybe 10 times that occurring do you say okay that's good enough we can reopen the economy and get on but you always have that threat or do you say we'll stay in lockdown a few more weeks and actually try to drive the numbers low enough that it becomes a negligible threat and that's the strategic decision I mean I see it always as short term pain for long term gain rather than the current position which feels like purgatory it's like a long drawn out suffering where the economy is obviously not going to ever recover if we don't have the virus you know completely controlled and people are wanting their normal lives back but are being told through a sense of very different rules about bubbles about who you can see and when you can see them it sounds like we need something to deal with that's better than these arrangements you're not talking about 18 months say you're talking about months and then weeks add it on and you see as how you go so it doesn't sound impossible no and especially for the UK because we don't have borders I can see a country like Germany struggling right and they've done a really great job controlling their virus but they share borders with nine other countries and so they're part of the European Union project and they can't obviously start closing their borders again you know their land borders against you know Austria and Switzerland when you have people moving across them every day I think the UK is in a different position islands and in general have done really well Faroe Islands, Iceland, Australia, New Zealand, Fiji I mean they're all these random islands across the world which we have done well for exactly that reason so no I mean the key message is it's not rocket science this virus needs a host to live in it needs to transmit to another host so if you give it nowhere to go by aggressively going after it making sure whoever has it is isolated then it'll burn itself out that's how we've had other outbreaks burn themselves out too Devi Sridhar is professor of global public health at Edinburgh University you can find all our coverage of COVID-19 at weforum.org and follow us on Facebook, Instagram, LinkedIn TikTok, YouTube and on Twitter using the handle at WEF thanks as always to Gareth Nolan for helping produce the podcast please subscribe to receive it every week just search World Versus Virus on Apple SoundCloud Spotify or if you get your podcast thanks for listening and goodbye