 Hi, I'm Jay Fidel. This is ThinkDeck, and the program we're going to do now is East West Center Insights. It's actually a program of the East West Center. This is the first iteration of it. And my co-host for this program is Karina Lyons. She's VP at the East West Center. Hi, Karina. Hi, Jay. Aloha. Thanks for having us here today. Yeah. Well, I think it's very important because going forward, you're going to be the host. So we're sort of introducing the program today. But they would rather look at you than me anyway. I know that. Yeah. So congratulations on setting it up, Karina. Thanks, Jay. And yeah, I'm looking forward to this dummy run. So why don't you host today, and I'll take my lead from you. Okay. All right. But let's have all your questions. Let's make it hot for Tim. Tim Brown is our guest today, and he is a UH professor, and he is going to talk about the global effect, the global process of coronavirus, which is very important. We talk about it, not dissimilar from a program he gave under the auspices of the East West Center only a few days ago. Welcome to the show, Tim. Nice to be here, Jay. So let me start this off by saying that I think the media in this country have focused inward, as the White House has, into international issues and arguments about who's in charge, about whether the job that the White House has done over the past couple of months is adequate about what the truth is and what it isn't. And these are kind of international issues that we have all seen on network television, cable television. But what we have not focused on nearly enough, in my opinion, is the relationship of what is going on in the pandemic here in this country and other countries and how it spreads, the nature of the contagion from one to the other. And I was hoping that we would talk about the global aspects and process of the pandemic with a view to looking at the contagion, look at the effects, and look at the steps down the road we will have to cope with. So can you give us some thoughts on that, Tim? Well, I think it's worth noting, first of all, that the United States represents only about one-quarter of the total detected coronavirus infections. In reality, it may be higher than that because our testing has been so inadequate compared to a lot of other countries. I think the global nature of this pandemic is clear. The importance of WHO, I think, in responding is another thing that we need to pay close attention to. And I believe that as this pandemic plays out, with the United States basically being in the number one position right now, we have a lot of lessons to learn from countries overseas. Yeah, countries overseas are in different programs. One small thing comes to mind. In Europe, they keep the staff, the employees on the payroll, even though there's no business happening in the given small or medium-large-sized businesses. In the U.S., there's no such rule, and so often they're being separated from their business with the problem of having to recreate the business later. So it's a different orientation, a different way of looking at the recovery, looking at the way the business decline is happening. But what about the notion of the contagion? We have hotspots hither and yon. We have people flying from one country or not to another and taking the virus with them. I'm reminded of the story of Ebola and Lagos. Lagos is a city of 10 million or more, and Ebola got into Lagos. It was a terrifying moment because Lagos is a global hub in Africa. And the concern about the epidemiologists involved was that it would spread to the world from Lagos. Luckily, they caught it. Luckily, it didn't happen. But in this case, it is spreading to the world, and there are many global hubs. Can you talk about the epidemiology of that and how the hotspots work and how the virus and the mutations of the virus are reaching every corner of the globe? Yeah, let me go into that. But first, I want to point out that there's a major difference between this virus and Ebola. Ebola is an even more contagious virus, but only through contact with bodily fluids and direct contact. And it also has a much higher fatality rate than this virus. It will kill 80 to 90 percent of people, at least in African settings where the healthcare is not as good. The fatality rate has been lower in the United States, for example, in the returned cases here. But because of that, it's very difficult for Ebola to spread very far. It usually in the past has burned out in villages. It never actually got to the large cities in Africa. So in fact, the outbreak we had a couple of years ago was a major change in terms of Ebola epidemiology and that it did spread to several large cities in a number of African countries. And that made it that much more difficult to contain because there were so many people that basically were at risk under those settings. This virus, on the other hand, has a lower fatality rate, probably only about one percent on average. We don't have the exact number now. We do know that it varies by age. Those who are in the older age groups may have a fatality rate as high as 10 percent. Those in the younger groups have a somewhat lower fatality rate, but it's still non-zero. It's also more contagious than Ebola. It basically can be transmitted, like most respiratory illnesses, basically through coughs, through seizes, through touching surfaces and then putting your hands to your eyes or your mouth or your nose. And that basically makes it a more viable virus in terms of the types of global travel that we have today. And while this started in Wuhan, and the exact origins are still under debate and under question, it very quickly spread from there basically through global travel. I mean, as people pointed out, even once Trump had imposed the alleged China lockdown in January, there are still 40,000 people from China who still came into this country over the next month. So we still had massive introductions of the virus throughout the United States. Interestingly though, it's in New York, it's not the viruses that came from China that have driven the epidemics, it's the viruses that came from Europe. And the molecular epidemiology studies have shown that. So fundamentally, travel with a virus that's very easily spread through respiratory means gives this incredible reach throughout the world. Now, some people are saying that, well, if we lock down travel, we basically could contain this virus. And while right now that is clearly one of the steps we're calling for, studies have actually been done, which have looked at this. And what they found was that the travel lockdown that they did in Wuhan, basically only probably delayed the epidemic by three to five days. On a global scale, the international lockdowns, which did occur, depending on, you know, different countries ban travelers from other countries. And the mix of countries just vary depending on kind of political desire as well as what was going on epidemiologically. But those bans basically probably did slow the more rapid introduction of the virus into many countries. But once it gets in there, the entire population is fertile ground. It's important to remember this is called a novel coronavirus because we've never seen this one in humans before. And so we have no immunity to it, we have no resistance to it. And therefore, it's doing the same thing that basically happened in the Pacific in the past, where you introduced viruses where people had no immunity whatsoever. And basically we saw massive impacts on the populations. Now, the thing we're lucky about is the fatality is comparatively low. But we've already seen what, even with that low fatality rate, what can happen in the hospitals of New York, the hospitals of Italy. And basically it can very quickly overwhelm our healthcare systems even today. So basically travel contributed to it, but it didn't stop it. Karina? Yeah, Tim mentioned the Pacific and I'm really glad that he did that because we're here in Hawaii, and of course that's based right here in the Pacific. And some of your viewers may not know, Tim has been one of the experts has been informing and advising the state of Hawaii here. And yesterday, Tim, correct me if I'm wrong, I'm losing track of the days actually. I think it's yesterday, it was Tuesday today, Tuesday today. So yesterday, Tim, on Monday, Tim testified in front of the House Select Committee here in Hawaii on the COVID virus. And he tabled a study, right? I read your paper, Tim. When we talk about coming in hot for Tim, I think I should probably say at the outset that I'm actually Tim's boss. Tim is a senior fellow at the East West Center, so don't feel like this is a performance evaluation, Tim. This is totally just innocent questioning about your testimony to the state, I'm actually said. But bring it back to your paper. You said that there were three special circumstances about Hawaii that made a corona control plan, a coronavirus control plan possible. And the three circumstances were, and you might have to remind me, the geographic location, the relatively small size of the population, and the small number of governments here in Hawaii, we have four counties and one state government. And that's really similar to the Pacific, as you said earlier. So I was wondering whether you think your work on the corona control plan, whether that would be applicable to the small island nations in the Pacific here in our region? Well, I think that absolutely the types of things we're talking about here in Hawaii are relevant throughout the Pacific. I think they're also relevant in large island nations like New Zealand, which in fact has a very good control plan in place at this point, and which is probably the one country that's on its way toward elimination right now. And I think actually has a very reasonable chance of eliminating coronavirus within its borders, although the lesson we've learned from Hong Kong, Singapore, Taiwan is that even once you get it down to very low levels, you still have to guard then against reintroduction from other places. And I think that, you know, the interesting thing is that actually travelers from the United States are considered to be one of the highest profile groups right now in much of Asia, because of the relatively uncontrolled spread of the virus in this country. So I do think that, yes, the lessons here are probably relevant to a lot of other countries and could definitely be applied throughout the Pacific. But we're still learning here, we're far from settled on a final plan and we don't really know exactly how things are going to play out over the near future. We're still trying to get our own house in order in terms of testing and tracing, in terms of basically doing a better job, deciding when we can reopen and how we can reopen. I think all of those are open questions right now. Just as you are. Yeah, are we testing and learning in other countries too? But that's a question, by the way, came in on the on our Facebook page. And this is not directly relevant close. By his refusal to participate in global response to the pandemic, has Donald Trump increased the number of cases and fatalities around the world? Want to try that? Let me start first. I will say by his failure basically to react as a true chief executive should in the United States, he has already failed the United States and produced thousands of additional deaths, if not tens of thousands of additional deaths. And to this day, his response remains inadequate. He has not helped to mobilize testing resources. He has not helped to mobilize the personal protective equipment that's so effective and so needed in healthcare settings and for the public around the country. And he basically has failed to show any leadership, basically deferring to the governors, which is a good thing because frankly, they've got much more rational approaches to this than he has had. In terms of global leadership, there is no global leadership in this pandemic. And I trace a large part of that vacuum to the United States, which normally would have played that role. And in fact, all he is doing at this point is basically attacking the WHO, threatening to pull their funding today. And this is not helping matters. WHO is absolutely essential to the global response at this point in time. And the US pulling out funding now would actually throw fire or throw gasoline onto the fire and make the situation even worse, potentially on a global scale. So yes, I do believe that Trump is contributing to increased infections both in the United States and around the world with his lack of response. What about other institutions? What about institutions like the East West Center nonprofit, you know, concerned with the Pacific region and beyond? What can, what is the East West Center doing, Karina, or could it do in order to deal with and help some of these less developed countries in responding to the coronavirus? Well, in the first instance, we're lending out Dr. Tim Brown, so that when he is sharing his actual device, of course, right there. And in all seriousness, you know, part of the issue in Pacific nations is that there is access to quality health care is severely limited. And so experts like Tim, who are epidemiologists with years of experience are, you know, it's a few and far between. And so part of what we're doing is asking Tim these sorts of questions, you know, when people put out a really useful practical plans that policymakers can draw on. And then we have to do that next step of analysis. Is this applicable in other places? I mean, I've gone on record saying at least in the Pacific, I think the best bet is the elimination plan in the first instance. So that's step one of Tim's coronavirus control plan that he published with Sumner. And, you know, if we get beyond that, things get much, much harder because there isn't the infrastructure. So, you know, institutions like the East West Center, like the crop agencies, the Council of Regional Organizations of the Pacific, they all come together to coordinate and try to access and leverage resources, including expertise just like Tim. Well, that goes to a question I was going to ask Tim. That is this. You use the word learning. We both use the word learning. And so here we have a situation where the, you know, US has not learned very well. I'm sorry. The coordination, for example, the testing and isolation, those things, you know, could chart out pretty well and tracking. Those things all should be involved in a non-therapeutic and non-vaccine approach to the response. So I would imagine that the other developing countries, in fact, all the countries in the world have had, you know, similar problems. And we haven't shown any leadership on that. But could they learn anything from us? Is there anything we can do to expose our lessons so far as they are to this world? And is the developing world of any value to us to learn from them how these things interact? And for example, you don't have a lot of healthcare infrastructure in many places. You don't have masks. You don't have arrangements. India comes to mind as an exception, where you can, you know, order a shutdown and all this. But can the lessons go both ways here? Can we teach them? And can we learn from them in what they're doing or not doing now? Well, on the teaching front, I'm a little more challenged here because frankly, I think that, yes, they can learn from responses in places like California. I think Gavin Newsom has actually done a very good job as governor there. You know, San Francisco was one of the first places in the United States to impose lockdowns. Washington State is another fine example of a very good response after the initial outbreaks in nursing homes there. We also have examples of complete failures. I mean, we're still seeing ongoing transmission among church groups in some of the Midwest states. And this is really ridiculous at this point, given what we know about the virus right now. That we're still getting opposition to shutting down church services at this point in time as a potential vector for coronavirus transmission. And I think that so we have good examples, we have bad examples in this country. I think for this country, there are some excellent examples overseas of, I would say, actually smaller nations, Singapore, Hong Kong, Taiwan, that have actually done a very good job of containing this. They're still struggling and they're going to continue to struggle, as will any country at this point. But they are doing an excellent job, I think, of containing this and keeping it under control. There are steps forward and steps backward. Singapore was doing extremely well. But in the last week, they basically have had to go back to imposing lockdown constraints because of the growth of coronavirus among migrant workers in large dormitories. And that has produced more than half of the infections in Singapore at this point. So it's an evolving situation in every country. Taiwan has done the best job, I would say. Taiwan and New Zealand probably have done the best job of containing this at this point. And we're seeing relatively little in the way of new infections. They both really impose travel screening and restrictions very early on, quarantine requirements on incoming travelers. And I think those were extremely valuable and helping them to keep the epidemic under control. And then they have all had very good testing and contact tracing setups. I mean, one of the researchers in Singapore was pointing out that to get an idea of the level of testing they're doing in Singapore, only about 1% of the tests they do are coming back positive. In the United States, the last time I heard that number, it was on the order of 20% of our tests are coming back positive. So we're testing nowhere near at the level that Singapore is in terms of actually virus and picking it up. So our testing infrastructure is still far too inadequate basically to even be talking about opening a country up again. Just a lot of lessons that could go both ways. I think they can learn from the states here that have done a good job. I will hope that Hawaii will be in that class before too long if we can get our testing and tracing situation in order. And we can learn a lot from good responses that have been done overseas. I was going to ask you about trade and cooperation. But there's a question here. Let me address this and then we can get on to other things. This question on Facebook is, has China been acting in good faith in providing the virus genome, the PPE, and other help and supplies to the US and other countries? Or should we still be suspicious of them? China is a mixed bag. I think there's very little question that they were not open and transparent in the early phases of this outbreak. It was exactly the same way in the SARS. I do think they kind of got their act together though and did become much better about that in the last couple of months. And part of that is a response to the Chinese populace, which was not happy with the initial response to SARS anyway. The public in China was not happy at all with the way the government dealt with that epidemic. And so I think that helped to push the government to get more open. In terms of PPEs, I think they are still our major supplier of PPEs. They have continued to supply despite their economy basically, at least in some provinces, basically shutting down to a great extent. So I don't know that I'm necessarily critical of them in that regard. I think that the challenges we face are supply chain challenges that are tied not just to China, but the fact that so many of our supply chains are dependent upon things that come out of China. And once those commodities basically cease to flow, we lose our own capacity basically, for example, to develop some drugs, to provide PPE and so on. And we really do need to be thinking again at a national level of how do we build our own capacity so that the next time this type of epidemic happens and there will be a next time. I think it's important to remember the population of the world is growing very rapidly. We're over 7.7 billion people now. That's much larger than it was in 1918 when the flu spread around the world. And so I think that we basically need to be prepared for this to happen again. Remember how fast this one spread? I mean literally in four or five days it was everywhere around the world. Yeah, amazing. And with modern travel that's to be expected. Karina, you had something. Yeah, I'm still just a little chilled by Tim's last comments. But I was interested in countries that don't have access to adequate testing in some states in America that don't necessarily have access to adequate testing. Or are not doing the testing for what degrees and what can they do, Tim? I hate to say it but at this point to a great extent it's every man for himself. I mean every country really just like the states in the United States have pretty much had to take responsibility for setting up their own testing infrastructure for trying to obtain their own PPEs very often at loggerheads with the federal government that is actually trying to take the resources that they have located. I mean there's a rather almost hilarious story yesterday of 29 million pieces of PPE that basically the state of California had located and it turned out to be a fraud. But the reason they found it was a fraud was the federal government was basically about to steal those resources from California to add them to its own stockpile. And so we literally have the states at loggerheads basically with the national government here. And I think that if there's one lesson out of that it's that we need a coordinated response both at the national level and the local level. And I think at this point every country needs to be doing what it can to try to locate resources. Again I'm going to go back to what Jay was asking earlier. I think the loss of U.S. leadership at the international level is a major loss because I do believe in the past we would have been part of a coordinated international response that would have been looking out for developing countries and to help those countries that basically don't have those resources right now. But instead I think because of the disunity that has existed at the international level in recent years it literally has become every country watching out for itself every country competing with every other country for resources and it's a no-win game for anybody. Everybody ends up worse off because of that the prices get driven up. There are winners the people basically who are driving the prices up and are basically you know making a fortune off this thing. But in general the people of the world are the losers of this game. You know in this in this country we've seen this kind of reverse federalism where the president has abdicated although he claims to have all powerful control he has in fact abdicated and and some states have gotten together they've made compact agreements between governors in a number of states in order to sort of step into the void and that's admirable and that's kind of an organic evolution you know necessity breeds invention. But I'm wondering if the same thing could happen internationally. If some countries got together with other countries for the lack of leadership by the U.S. and form you know groups self-help groups groups to be the leaders or elevate one country to be the leader and and and thus have some leadership on the field. A. is that happening. Is there any indication that that's happening. Could it happen. And if so who are the countries that would aspire to being in that leadership group or being the leader country. I think it could happen. I think the reason we haven't seen it very much is this virus hit so hard and so fast that nobody was prepared for it and everybody is so busy responding right now they don't have time to think about coordinating and getting their act together. And I do think that for example trade agencies like ASEAN in Southeast Asia basically could play a major role in terms of trying to obtain PPE for some of their member states and for other countries that are having challenges. China has actually stepped up and become a net donor of PPEs to many poorer countries even to the United States they've actually donated both test kits and PPE to the United States. So I do think that you know they're filling a little bit of the void that was left by the United States lack of leadership but nothing near what the United States would have done traditionally in a situation like this. Yeah. So I do think amazing where we are right now we're all too busy responding really to get our act together and really worry about coordination and I would agree with you I mean one of the problems we've got in the United States is the government the governors are pretty much in the situation where they have to rebuild the federal government which is what they're trying to do at this point. And in fact my partner has basically said that one of the things governors ought to do is they ought to just get get together all 50 of them and go as one to the PPE manufacturers and the others and say hey we're fixing the price and you're going to deliver this or else which is what the federal government should have been able to do. Everything is changing everything around the world is changing and certainly that part of American federalism is changing. So Carina we're just about out of time and as my co-host I would like to offer you the opportunity to summarize and take the big points out of the discussion by Tim Brown and create a takeaway for people who are watching. Thanks Jay. Well it's going to be really difficult because Tim really pulled his punches you know he's pretty shy about saying what he thinks so it's going to be tough. Tim and I go away and go away back. Yeah look Tim you know what I learned here today but also from the work that you have done with Subna iron COVID in particular but also your other work on infectious diseases that we didn't get a chance to touch on today for many of you who don't know Tim has been a world-class expert leading the response to HIV AIDS and I think he's really highlighted the importance of a coordinated and cohesive policy response to this because planning is critical and there's still a chance and amongst all of your realism Tim I got it I heard the optimism for the future there's still a chance if we knuckle down and plan now and you know listen to experts such as yourself look at some of the research and the modeling and the planning that's being suggested and then more importantly coordinate around a plan that makes sense I think that there's a chance to if not eliminate then actually hashtag flatten the curve. So thanks for showing up today Tim and thank you so much for the work that you've been doing at the center for the state of Hawaii and right across the globe over the span of your 30 35-year career is that right Tim? Something like that. Yeah flat again let's just say 10. Well thank you Korean Alliance thank you Tim Brown thank you both and I must say that you know the reference to Seminole Croy is very important because at the end of the day we're going to have to rebuild the economies we will come up with a vaccine someday and at that point we're going to have to fix the world economy and this is ultimately going to be an economic question isn't it? Anyway thank you very much Tim thank you for all the work you do and you know this is really remarkable that we have this kind of talent at the university at the East West Center and that we can actually provide value beyond our shores. Thank you so much Karina thank you Tim aloha you guys and wash your hands.