 We're very excited that Rear Admiral Susan Blumenthal has agreed to have a conversation about the present crisis. She's a senior fellow in the America's Health Policy Program and a former U.S. Assistant Surgeon General serving in the administrations of four U.S. presidents in various roles. I'm Peter Bergen. I run the Global Studies Program at New America. And so I'm going to turn it over to Rear Admiral Blumenthal to make some opening remarks and then we're going to have a discussion and also I'll be looking for your questions in the chat and the Q&A functions. Well thanks so much Peter for having me today and for the opportunity to talk about this pandemic that is devastating the health and economy not only of our country but of countries around the world. In America over 71,000 people have died as of today in the world, 258,000 have perished. More people have lost their lives in the United States than in any other nation. In fact we represent 25% of deaths worldwide. But it's not another country that's attacking us. We're at war with an invisible enemy COVID-19 and you know for many of us in the public health field this is the Pearl Harbor of public health as our nation was woefully unprepared for this assault on the well-being of Americans. Years of neglect and underfunding of America's public health infrastructure had left our nation extremely vulnerable to an infectious disease threat. Alarmingly despite major scientific advances in the 21st century the major weapons in our country's toolbox for battling this coronavirus outbreak when it emerged were similar to those used in 1918 to combat the Spanish flu pandemic. They were proven public health practices such as social distancing and good hygiene. And you know I was looking at a television appearance that I had done right after the H1N1 flu outbreak and talking about social distancing and proven public health practices having been in the government after the anthrax attacks SARS and H1N1 that we are still using these practices. Now more than ever our country's response requires mobilization of all agencies of government in collaboration with the private sector working with other countries in a coordinated battle to save lives. So you know we know everyone is at risk and every state in the nation had declared COVID-19 as a disaster. The disease has overwhelmed our health system which currently has less than a million staffed hospital beds. The disease is also disproportionately affecting people of color who experience many other health disparities in our country including higher death rates from some illnesses, racism as well as less access to health care. Furthermore people of color are more likely to be essential workers and have lower incomes with an inability to social distance at their jobs or stay home for weeks. And also we've seen an interesting sex difference in the disease. We found that while women and men experience the disease at similar rates that men have twice the death rate as women do and we can talk about that more later. The disease's current mortality rate is almost 6% in America and the original projections were that as many as 100,000 to 240,000 people in our country could lose their lives. To put these numbers in perspective consider the US service members deaths from two previous four. In Vietnam there were 58,000 deaths and the Korean War 34,000 deaths. So this means that if this death, the original projected death toll rate from COVID-19 in America could be double the number of lives lost during these two major wars combined. And as we all know the economic toll of this disease has been staggering. On March 16th the stock market fell 13% with the Dow losing 3,000 points. It's largest one-day drop in history. More than 30 million Americans have lost their jobs. It's projected that we could see the highest rate since the Great Depression. But this World War III is not being fought against foreign countries as we all know. It's being fought in our homes and our workplaces and hospitals. And in response to state and local mandates 95% of Americans are hunkering down in their homes. Although a great concern is that by May 10th as many as 43 states have plans to partially or completely reopen their businesses. This has scientists and public health officials extremely alarmed because we worry that with this opening there will be a boost in infections and deaths. We still have a very short supply of face masks, hand sanitizers, ventilators, hospitals across the country are running dangerously low on supplies like masks, disinfectants. It puts both health care workers and patients at risk. This would be like sending soldiers into war without helmets and armor. But there is much that we can do to fight back, to effectively mitigate and manage the impact of this disease and to prevent death from it's continuing impact. As I mentioned we have these proven public health practices like social distancing and good hygiene but thankfully they are now being combined with the technological and scientific advances of the 21st century. Because we are in a revolution of scientific advance and these now have to be combined with proven public health practices. Senators have called on the president to enact the defense production act of 1950 which would have granted him authority to repurpose manufacturing plants for mass production of crucial medical supplies. While the president did enact this law he hasn't fully implemented it by directing clothing, car and cosmetics manufacturers among other businesses to produce these crucial medical resources including personal protection equipment, diagnostic and antibody tests at massive scale as well as ventilators to save American lives. So while some private companies have valiantly stepped up to this challenge and car companies the president did ask them to make ventilators the need is still very great and more industries must be marshaled for this purpose. Additionally novel methods for testing, vaccine and treatment production are at last being developed into Polaroid. The United States has the technological expertise to lead a revolution in scientific discovery to fight this public health crisis and our universities and biotech industries among the very best in the world are now at this forefront of this battle. A new generation of molecular biology techniques and high throughput platforms are being mobilized for large scale testing. In this national emergency the FDA lifted regulations on production of these tests and gave emergency approval for four of them. As a result many tests for example antibody tests have been put on the market without however adequate evaluation and now there's going to be backtracking to asking the FDA to reevaluate many of these tests to make sure that they are safe and effective because these diagnostic tests these antibody tests will be used to help decide whether people should go back to work and they need to be accurate. We also need accurate home tests for detecting disease as well as documenting recovery if America's communities are going to recover from this viral assault. Contact tracing using armies of trained professionals and volunteers as well as technology is needed. This is an essential component for opening up America. Contact tracing is the bread and butter of public health. It's been used for monitoring sexually transmitted diseases TB and other illnesses but now we have to do it in a different way. We can't knock on people's doors. We're going to have to conduct it on the phone through texting, apps and other technology are being proposed but they do present privacy concerns and this needs to be worked out with this kind of new model. Medications that are being used to treat other diseases as we know are now being evaluated in clinical trials for their safety and effectiveness as coronavirus therapies and new drugs must be developed as well. As data about the clinical course of the disease is collected, we must ensure that this data is analyzed for sex and racial ethnic differences. These are important variables that have been overlooked for all too long so that interventions and policies can be enacted to meet the needs of the diverse populations affected by the pandemic. Let me just give you an example. I was involved in the response to HIV AIDS from the very beginning of its emergence that was thought to be a disease that affected only gay men. Women were not considered to be really affected by the virus. Flash forward 35 years. It's a public health oversight. We're now 52% of cases worldwide are among women from a population that was thought not to be affected at the beginning of the virus. Furthermore, since this is now the third major coronavirus threat over the past 20 years, following SARS and MERS that has negatively impacted the health and economies of countries around the world, we need a vaccine that can prevent transmission of a new coronavirus epidemic that may occur in the future. Legislation has been introduced for scientists to develop a universal coronavirus vaccine that could protect us from this deadly enemy in the future while we are searching to develop a vaccine for this particular one and deploy it fast as a major tool to prevent further spread of COVID-19. The creation of a national vaccine production center in the U.S. would also be an important investment. We've learned that 80% of drugs that we take in America are manufactured overseas generally in China or India, the ingredients. We really need to look at our supply chain models for that, for masks, for other products that are essential to us in a pandemic. Moreover, new information technologies and social media are being innovatively harnessed to share information, track disease spread in real time, provide telehealth services, and finally after years, two decades of trying to implement telehealth in America finally we're seeing waivers for the use of these services and reimbursement for them. And also information technology can facilitate professional training and research collaborations on COVID-19 across communities and countries. You know our nation's health is linked to our economy and again you know that last month the Congress passed a $2 trillion economic stabilization bill, the CARES Act, there needs to be a Marshall Plan in these bills to help our hospitals and healthcare facilities, but it requires additional funding and as you know the Congress passed a measure last week to provide billions of dollars to provide people with paid sick leave and to ensure free coronavirus testing and treatment and a 484 billion relief package with additional funds for small businesses, hospitals, and additional testing. Finally as the father of medicine Hippocrates once said, prevention is preferable to cure. We have to invest in building permanent pandemic preparedness infrastructure in resilient health systems in America and around the world. We urgently need a national and global plan that coordinates key components of the response between our governments and private sector. We must continue support for the World Health Organization that serves as an important international role bringing together countries and sharing best practices. The lessons learned from this devastating disease outbreak in America and worldwide must be institutionalized for the future. The establishment of a permanent office in the National Security Council in the White House with the appointment of a pandemic and bio threat coordinator is needed who would work with all of our government agencies, other nations, and the private sector to ensure that our response infrastructure remains resilient and ready to address the next infectious disease pandemic that will invariably occur. Additionally, we need to expand existing federal workforce programs such as AmeriCorps and FEMA Corps and have our Peace Corps be reassigned to, for example, work in contact tracing in order to assist vulnerable Americans, including the food insecure, our seniors and the homeless during this outbreak would be important and again is being proposed. The National Health Response Corps of medical providers, engineers, computer scientists, construction workers, and other professionals working alongside our country's active duty and reserve uniform services should be established. And the uniform public health service of which I was a member for 20 years is creating a reserve corps whose members would also bring their skills to fighting the pandemic. Such programs reflect America's strong history of national service by mobilizing our people as a cornerstone of a whole of government and societal response to addressing the COVID-19 pandemic and future threats to our nation's public health and safety. And lastly, a commission needs to be established, as was done after 9-11, to review the problems in our national response to this pandemic. The elements that were successful, what went wrong, and how to accelerate modern testing, treatment, and vaccine production, including the policies that must be put in place for the future. And I'm pleased that such a commission has been proposed by Congress. I just want to remind everyone on the line, and thank you all for being here to learn more about this pandemic, throughout history, infectious diseases have killed more people than wars. So we must remain vigilant against them. We need a 21st century response and prevention paradigm that combines the most cutting edge technologies for surveillance, testing, treatment, and vaccine production with proven public health practices. And each one of us must fight this war working together so that someday COVID-19 will be a disease found only in the history books. And with that, thank you, Peter, and New America, for the opportunity to speak with the audience today. Thank you, Dr. Blumenthal, for the very stimulating set of opening remarks. You said something pretty striking, which is this was the Pearl Harbor of public health. And then towards the end of your presentation, you suggested, obviously, that we need a commission. You know, Pearl Harbor, during World War II, there were multiple inquiries into Pearl Harbor. And Admiral Kimmel was sort of forced to retire early. You know, in our present kind of highly politicized environment, I mean, obviously the 9-11 commission is a model that Hadley Hamilton and Thomas Keane, who are widely regarded as, you know, impartial and non-partisan and serious people with a lot of government experience. I mean, can you imagine a commission coming out of the present Congress that would have, you know, would, that people would coalesce around, particularly early on in this pandemic? Well, do you see this as something that comes later? Or what, how should this be constructed? And when should it come? Well, I think it needs to, I think we need to be looking at the lessons now. But I think the commission should come as the pandemic, you know, is waning. I think it can't be politicized. It has to be as objective as possible to really look at what went wrong and to see what the lessons are and how for the future we can accelerate our marriage between public health and, and technology. Because, you know, this is a new century and we didn't have these tools in at the beginning of the last century. And so the fact that these are the mainstays of our response today is very troubling. You know, I think whether Peter, it's foreign policy or, or it's, it's health will spend anything once a person has developed cancer or a heart attack. But we spend so little in prevention and preparedness. And I think this has to be a lesson. You know, even, even before the pandemic, 70% of deaths are due to chronic illnesses. We spend only 3 to 5% of our nation's health care budget three until recently are 3.5 trillion dollar health care budget on prevention. And yet 70% of disease is preventable. So I hope that one of the lessons learned from, from this pandemic for this generation is that we need to institutionalize these lessons and we need to invest in pandemic preparedness. It will help us not only for the next pandemic, which will invariably occur to be prepared and resilient and have a crew of trained personnel who are in reserve, but who can reactivate quickly and have a roadmap of actions that must be taken to rapidly respond and technology that's in place, you know, that can, and what, you know, if you think about just from the first SARS epidemic, it took six months to map the genome of the SARS virus then, and it took three weeks to map it this time for, for COVID-19. So we've already seen an acceleration, but, but I think there are many more lessons to be learned. And so we can't be premature in, in mapping them. Well, one technology that shows a lot of promise is CRISPR technology. And it seems that using CRISPR technology, there might be a pretty cheap and fast test fairly rapidly available. Is that something you know much about? Well, I've, you know, I've read that, you know, CRISPR, you know, could be put in place for this. I mean, I think there's, there's so many technologies out there that we can examine, but we're in a rush here against time. So I'm, I'm confident that there will be technologies that will help us, whether it was the high throughput platforms that are taking our testing capacity, you know, way up. We've, you know, there were many mistakes that were made in terms of the CDC test, not being able to bring it to scale, not realizing that there were contaminants in the reagents, you know, to, you know, having our, our academic centers and private labs get involved. But again, there needs to be more of a coordinated response. We've found that the states and localities are competing against each other for resources. There should be a federal roadmap and a way of distribution resources. It shouldn't be a competition. It should be a, we're all in this together. And here are our needs. Here's a plan. And here's how we're going to distribute the resources. Is that the role of CDC, or are they being kind of absent here? Well, it's, I mean, this is a great institution, but mistakes have been made. I mean, the role is really, and again, you know, what happened was a defunding of these agencies. I mean, before the pandemic hit, CDC was slated by the administration to have a large cut in its funding. The Public Health Service Commission core, which is our nation's first responders, I was a member of that service for 20 years. It was slated for a 30 to 40% cut in personnel. So there was a, you know, what we need is, as I mentioned in my opening remarks, we need in the National Security Council, and there was one in the past, a global health security coordinator, somebody whose job it is to think about these issues every day. Remember that in an interconnected world, the spread of an infectious disease is just a jet plane away. And people forget that 41 new diseases, new infectious diseases, has emerged since 1968 alone. I mean, there's AIDS, one of the largest pandemics to hit a generation. Ebola, H1N1 flu, Lyme's disease, you know, MERS, I mean, all of these diseases, Hantavirus, three new diseases emerge almost every year. So if we need someone who is thinking about them, working with our agencies like CDC, the NIH, FEMA, to, you know, to have an all-of-government response. Remember that CDC is one of several agencies within the Department of Health and Human Services, which is one of the agencies in the President's Cabinet. To deal with a pandemic, you need an all-of-government response, health in all policies. As we've seen the infectious disease just affect our health, it affects our military, it affects our housing policy, it affects food and our food systems and our federal food assistance programs with rising numbers of food insecure individuals in America. So we need an all-of-government response, and that's why we need someone in the White House that is, whose job it is, is to map these kinds of outbreaks and to help mobilize government when they see a signal that something, you know, is happening somewhere in the world. If you did the thought experiment where the U.S. government responded to this perfectly and there was this White House coordinator that was let go in 2017, 2018, I mean, how would this look? Let's say the government had got everything right. Well, I mean, I think, you know, again, it's hard to predict or to see, you know, what might have been, but I think, you know, the intelligence was saying to the White House that something is happening in China, a very serious outbreak. And I know, you know, from what I've read again, that, you know, alerts were sent to the president and to the administration in early January, let's say to the administration. And, but, you know, we're not acted upon again, it's hard to envision something like this. Each generation has to relearn the lessons of the past, sadly, but, you know, we've seen books written on it, we've seen movies made of it, and, you know, history that tells us what happens. I mean, this is not unlike the 1918 pandemic flu that killed 50 to 100 million people worldwide, where the warnings were not taken seriously. And actually it was the second wave, because people went out, the second wave that killed more people than the first wave. So let us... How did that 1918 pandemic sort of peter out? I mean, what was the set of circumstances that let it sort of expire? Well, I think, again, people followed the public health practices, and eventually you got some herd immunity, you know, in the sense that you have 60% of people who've been exposed, 60 to 70%. So, you know, it takes its course. But... Why is that 60 to 70% number so important? I mean, why is it not 80% or 90%? You know, it's... Because first of all, for this pandemic, we think that maybe about 15% of people have, you know, moderate disease, and about 5% have very, very serious illness, and 5% are, we think, you know, die from the illness. This mortality rate keeps changing. But so I think, you know, this is... And if you look at Sweden, they are taking this herd immunity approach. They have not closed their society. And they, you know, they believe that this will be a way... It's kind of an experiment, but this will be a way of engendering this kind of herd immunity. You know, Peter, you had asked me about the public health service and its history. I don't know if that's of interest to you, but, you know, it's a service that's over 200 years old. And it was put in place because of the Merchant Marine Service, where, again, as we find ourselves now, infectious diseases, we had the Merchant Marine who would come and go. They were essential to our economy. And a service was, well, Marine hospitals were established. And then a service was established that would be on duty 24-7 to monitor these Merchant Marine as they came back and forth to our country to make sure that they weren't sick, either bringing diseases into the country or that diseases would go out. And that then got transformed into the public health service. And this is a group of 6,500 trained professionals on duty 24-7. They're one of seven uniformed services in our country, standing side by side with the Army, the Air Force, NOAA, the Marines. They wear the Navy uniform and are our nation's first responders for health. And while they serve across the agencies of the Department of Health and Human Services, they also can be assigned to the Environmental Protection Agency, Department of Defense and to other countries, you know, to report back on emergencies that are occurring. Because again, you know, health is essential to our nation's economy. 18% of our GDP is healthcare and health. So that's why we have a service led by the Surgeon General and the Assistant Secretary for Health that can respond to these emergencies and to other disease threats by conducting research, surveillance, and service delivery to our nation's most vulnerable. A question we have from Nick Ters of Time Magazine. If there was one piece of advice, concrete advice that you could offer to President Trump, what would it be? Well, I think it would be preparedness and transparency. I think people crave trusted information. It's something we learned from the anthrax attacks across our nation, that you need a person. And that's why, you know, for example, Dr. Fauci has taken on such, my colleague from the AIDS epidemic, you know, is taking on such an important role. And Dr. Birx, who again, I've also worked with in the AIDS response, that you need trusted physicians that you get the truth from in terms of what's happening, how many cases, what's the path forward, should we open, because otherwise you're going to engender fear. And fear, you know, breeds confusion. We get mixed messages. And there's not a consistency in the response. So I think that's very important. And also, you know, there were rumors that the White House Task Force was going to be disbanded. I've read today that that's not going to happen. But it's very important to have this ball of government response. Each agency of government is important. I would also say, so I'd say, you know, trusted communication and all of government response and also working with our international partners. We have to continue support for the World Health Organization. We can't solve this problem alone. If we're going to get back to a new normal, we're all interconnected, we're all interdependent as nations in the world. How does this end? Well, I think it's a new normal. I think we have to scale up testing dramatically. We have to do the contact tracing to identify at a massive scale. We have to identify those people who may have been infected, help isolate them. And then, you know, we need to begin to scale as we find certain criteria are met. Then we begin opening up America again. But it's based on phases and it's based on trust. And, you know, it's based on the disease starting to go on a downward trend as more and more people, you know, have experienced symptoms and then we see, you know, a flattening of the curve and then a decline in the disease. We don't yet know whether there will be a second wave. It's most likely that there will be. But again, we don't know a lot about this virus. For example, you know, we've not seen a coronavirus behave like this where there's clotting that occurs. So we've seen clotting in the lungs, strokes in otherwise what seemed to be normal people. Again, causing clots. This is a very different mechanism than a coronavirus has done before. We're not really sure of its natural history. I mean, in terms of having so many people who are asymptomatic and other people who present with range of symptoms, you know, who is going to be affected and why does it look differently? So as we learn more about the natural history of the disease, it will better prepare us. And as we have a vaccine, I mean, this is ultimately vaccines with the landmark public health accomplishment of the 1900s, early 1900s, with the smallpox vaccine, the diphtheria vaccine. I mean, that is truly the way you end a disease is with a vaccine. But in the meantime, think about HIV AIDS. When we began working in this disease, you know, 30 years ago, my work was to develop behavioral, you know, requests for applications for research, because we didn't have drugs, lifesaving drugs. We didn't have prevention tools. So fast forward, we now have drugs for HIV AIDS, where people can lead a normal life expectancy. And we have other drugs, pre-exposure prophylaxis, PrEP, that if you're a high-risk person and you're negative, you may never get the disease. If you take this disease as, I mean, if you take this medication as directed, we still don't have a vaccine for HIV AIDS. So I think we can develop medications that will treat the disease. I think we can, hopefully, I mean, the Holy Grail is a vaccine. And there are many vaccine trials now underway. They've moved at the most rapid pace. I mean, usually, a vaccine takes eight to 10 years. The fastest was measles that took four years. We've got vaccines for coronavirus now in clinical trials. So and, for example, the one in London, my understanding is that they're preparing, you know, millions of vials before the disease, before the vaccine has even been approved. There are new ways of making vaccines. It used to be you had to wait nine months to grow the vaccine, like the flu vaccine on an egg. We're using new methods now with mRNA, DNA, and other mechanisms for vaccine production and, you know, accelerating the time to produce them. So you know, we need to be hopeful that we will have medications. We will have a vaccine, you know, sooner than ever before. But in the meantime, we have to continue with the proven public health practices, the social distancing, the good hygiene, and the contact tracing and the isolating people until we have these other tools which technology and science should hopefully produce in the not too distant future. Again, it's IV from Dysivir, but it's, you know, produced so far in the one trial that was released, 37% reduction in death rate. But again, there are trials underway with placebo, which is the true, you know, control clinical trial that should, you know, give us much more information in the next month or two. Are you personally hopeful? That is the alternative. We must be hopeful. And that means, though, that we're all in this together. You know, we can't solve public health problems alone. We each have a responsibility to do our part with these proven public health practices, wearing a mask when we go outside, you know, doing the things that we can do to protect others and ourselves. This is a societal responsibility. And just like, you know, World War II, where everybody felt they had a role to play, you know, individuals, businesses, we stood together, united. And now we have to be united even though we're apart. And then in terms of technology and science, yes, I mean, I believe that we will have these tools that will help us move faster towards recovery. But what I worry about is that people will move too quickly to put these proven public health practices aside, to move into social settings that we could see another spike in virus outbreak in the not too distant future if we disregard this advice from our scientists and our public health officials. You mentioned the sort of fifth of the U.S. economy that is the healthcare sector. And we have a sector, and we have a question kind of really about, you know, the effect that COVID-19 has had on the whole other aspect of the healthcare system. People not wanting to go to hospitals often for, you know, even if they have some pretty serious health problems. How do you kind of manage that? Well, I think we're starting to see a bit of a window, an opening here. At first, our hospitals were overwhelmed. They continue to be in crisis mode, but they're starting to see an opening where people can come in now potentially for elective surgeries. They're hit very badly. I mean, these are, you know, our national treasures, our nation's hospitals. They're essential to the health of our society and our economy. Many of them were getting hit very badly. For example, in my state of Massachusetts, we have great hospitals. Many of them, their income is in part based on foreign travelers coming, you know, and who could not come anymore. Elective surgeries had to be canceled. Outpatient visits had to be canceled. So, but I think that we're going to start to see an opening of this. Our cancer hospitals, for example, our premier cancer hospitals are being hurt because they couldn't, you know, take the kinds of cases that they were able to do. But I think we're going to start to see a window of opening here where elective surgeries can be performed again and cancer patients can be seen again. And again, when the public advice comes from, you know, our federal government that we can, you know, go back for elective surgery, we, you know, or outpatient visits, then we should heed that advice. What I'm concerned about is pitting our states against our federal government in terms of advice. And I think that we need, Americans need a clear and coherent and trusted message so that they can follow that guidance. And in terms of, you know, going to the hospital, going to outpatient clinics, going back to work, all of this needs to be a consistent, trusted message. What do you say to those who say that the shutdown is worse than the virus? I say that, you know, it's, they both are impacted because as a great poet from Massachusetts, Ralph Waldo Emerson said, the first wealth is health. You know, our businesses can't function if people are dying and sick and contagious. This is a very contagious illness. So we first have to make sure that the health of our nation is stabilized. And then we can slowly send people back to work. But I don't think we're there yet. We need massive testing. We need massive contact tracing with isolation of those who are infected as we move back to work. You mentioned some of the other coronavirus and you were, you know, you were part of the response to the SARS epidemic. What, I mean, why was SARS and MERS ultimately not that big a deal? I mean, obviously, they were a big deal if you contracted them. They had very high lethality. But why did they not evolve into something like what we're discussing now? Because I think they were, they were identified early and the contact tracing occurred and people were isolated. And then for other biological reasons of the virus, they did not, they, they did not spread. People, they have a very high death rate, but they did not spread because, again, these proven public health practices were put in place. Is that because the country, I mean, South Korea, Taiwan, Singapore, Hong Kong, they all seem to have got on top of this relatively, is it because they had the SARS experience? Is it because they're, what, what, and obviously Singapore has sort of fallen back a little bit now because of the migrant labor dormitory issue. But what reflect a little bit on what some of the countries like New Zealand or Australia, what do they get right? Well, I think, again, they had been sensitized, you know, to, you know, to this public health problem, how it had, you know, kind of crushed the economies of, you know, the, the places that where it had gone. For example, you know, Hong Kong and Toronto. But, you know, it was, it was stamped out, I think, SARS because, you know, of a strong and swift response and probably some good luck too. So, you know, I think that Australia moved very rapidly to control it and have seen, you know, a very positive response. To it. I think one of the things that we need to do moving forward is really to look at these lessons, you know, in terms of what goes right and what goes wrong. And, you know, the strategy was pretty simple with SARS. If sick people can be stopped from infecting healthy people, the disease will eventually die off. But it's, it's harder now because of the sheer number of cases that we've seen, you know, by the end of SARS, 8000 people had been infected. Already, you know, a million people have been infected. So it's, it's a much bigger challenge than SARS. Well, that raises a question about international travel. I mean, I think you've probably seen the reports about New Zealand and Australia having some kind of agreement between themselves about internal travel because both of them have had a pretty successful, you know, kind of counter coronavirus campaign. But, I mean, when do you think it's likely that, you know, international travelers would be coming to the United States or leaving the United States? Is that three months from now, six months from now, a year from now, or who knows? I don't think we know yet because we're still looking at the model. You know, obviously, everyone wants us to go back, you know, to, you know, to the way it was, right? But I think we still don't know enough about the natural history of this disease, this particular one, in order to have that kind of prediction. You know, I think, again, for, for, you know, we're learning that, for example, this COVID-19, you know, probably was here much earlier than we ever knew. You think about 40,000 people coming into China, coming from China into America every day. That was a lot of people coming in before we said it was, you know, before the borders were closed. So, I think, you know, we still have a lot more to learn and a lot more modeling to do before that decision can be made. Kind of a related question from Ken Mayer called, which is, the French have discovered SARS, the coronavirus was present in France in early December. Does that change anything about the way we think about the origin of the virus in China or just suggest that it was in China even earlier than we may have assumed at this point? Well, I think there was a lack of transparency about it. It was probably in China. I mean, many diseases originate, again, these are called zoonotic diseases where animals and humans live in close proximity and they go from animals to humans. They jump. So, for example, the flu every year generally comes from China. And so I think it probably was there and then people were going from China to Europe, right? And then from Europe into America. So, you know, there will be scientists spending a lot of time, you know, mapping the genomes, comparing them, seeing if there's any mutation to, again, better understand what the pathway was for this virus infecting so many people around the world. You mentioned earlier the fact that minorities and other disadvantaged populations are African-Americans are disproportionately affected. This is a question from an audience member. What can hospitals or health care centers, how can they better reach these populations where they are? Is there an approach that can be kind of institutionalized post-COVID-19? Well, I think, again, sadly, these facts reflect shameful disparities that have existed in our country for all too long. You know, African-Americans have higher maternal mortality rates, higher death rates from heart disease, from stroke, from some forms of cancer. And again, we haven't necessarily targeted our messages to them. We haven't, you know, there's lower access to health care. There's racism in the society. So, I think, again, we need to target education campaigns to the most vulnerable in our society, and we have to find ways to get, you know, health care access to them. And, you know, again, whether it's mobile testing, whether it's, you know, testing in easy-to-go places, whether it's, again, expansion of Medicaid, which not all states did, and it's been very hard to get accomplished with the current administration. But I think that, again, the coronavirus has shown another shameful spotlight on these inequities. And there are a number of waivers that are going into place through Medicare. Hopefully, we'll see more expansion of Medicaid services, telehealth services, because, again, it's hard to get the child care and the transportation to go see a doctor if we can use telehealth in the meantime, which is something that, when I worked with the military, two decades ago, telehealth was something that was used on the battlefield. And, but it was impossible to get the approvals for, because of the Federal Trade Commission, you know, where is a doctor licensed? They're licensed in their state. So is the patient coming to you, if they're in another state, or are you going to them? These were trade issues. But in an emergency, we find that there are other ways of practicing medicine or of working, for example, with telework. But, again, we have such a high percentage of the minority community are in essential jobs where, you know, they can't stay home. They, you know, can't, you know, keep food for two weeks. They're on the front lines and heroes need help. And we have to find a way going forward to make sure that our minority communities have the access to healthcare that they deserve. And then in terms of, you know, the, this interesting issue related to why are women and men disproportionately affected. This was a focus of my work was to look at sex differences in disease. Why are men, you know, dying at twice the rate? And what could we learn from women in terms of, say, some biological factor, genetic factor, that could be of help to men? And we know that, you know, hormonal and immune factors that begin with the fact that women have two X chromosomes and a man has an X and a Y, may be playing a role. There were studies of mice where they remove the ovaries of the mice in the SARS, previous SARS epidemic, and blocked estrogen receptors. And they found that the female mice died at the same rate. But we also may think it's a genetic factor. And so again, research is now starting to look at this issue. But we also have to look at the socioeconomic factors because again, women are more on the front line of the response to the coronavirus epidemic. And we're seeing a rise in domestic violence as a result of people being homebound. And so there are so many different biological, social, and economic factors that play into the way a disease manifests, spreads, and is mitigated. A question from Aaron Goldzimmer. Seems like the only way we can reopen is widespread testing, tracing, isolation. Yet, while I hear about technological advances in testing, I don't hear about actual plans and timelines to making this happen. Is this happening and we're just not hearing about it? Or is the U.S. never going to get its act together while other countries eventually do? Well, I think the U.S. is starting to get its act together. Again, my state of Massachusetts, California, other states are really ramping up now the testing and contact tracing. In Massachusetts, there's a partnership with partners in health that was started by Paul Farmer. It was used in developing nations where community health workers went out and tested and did the contact tracing. It was an enormously successful model that we're now trying to bring to the United States to get a dual dividend from our investment in global health. But there will need to be now technology embedded into this. So I'm hopeful Johns Hopkins University through the Bloomberg Foundation is working with New York and New Jersey to develop a model there. But again, my point is that we should have had these models in place before this outbreak occurred. We're in the 21st century after all. We have the technology. We have the scientific revolution. We have to be thinking ahead. Prevention is preferable to cure. As I mentioned, 40 new diseases since 1968. We, you know, those in the public health field, this is our public health nightmare that an outbreak would occur. We modeled it, we practiced it, we'd written about it, but these books were on the shelf. Funding had been cut. The coordinator had been fired or moved to another place. It was not seen as a priority. And so I think the bottom line here is let's make it a priority now and in the years ahead. Let's make the investments that we need to do. Let's advance the technologies and keep them advanced because what's an advanced technology today 10 years from now may not be so advanced anymore. So we have to keep technological advances focused on these public health problems. Remember, diseases kill more people than wars and we have to be prepared to fight them. Well, I think that's probably a good place to leave it. We want to really thank you very much, Dr. Bueingthul, for your really interesting and useful and helpful and important observations. And I do have one more question from Nick Ters of Time magazine. He talked about the need for transparency and rely on expert for messaging. Can you talk about the perils of confusing and dangerous messages from government officials like using powerful light inside the body or ingesting disinfectants? Well, again, I think that these are very dangerous messages. We need to be hearing from our trusted physicians about what works and what doesn't. You know, I think that, again, research into light, you know, because light can be disinfected but the light has to be high up on the ceiling or the distance it's not meant for humans. So we need, again, what we learn from anthrax attacks. We need a trusted public health official communicating with the people about what works and what to expect. And that's the way forward. And I just want to mention an initiative that I've been working with. One of my goals has been, and projects I've been working on is to really bring public health and technology together because that's the only way we're going to have a 21st century paradigm. And then the coronavirus hit. So working with MIT, we've started a social media campaign called Beat the Virus, beatthevirus.org to get out those proven public health messages to amplify them. And then to develop a public health communications campaign where a network where local communities can get the information that they need in the trusted way. As well as at a national scale. So again, I would say that trust facts beat the virus. You know, facts are what we need today for the confidence that we can open up America and the world again and return to a new normal. Remembering lessons of the past, but marrying them with the science and technology of today and the future to keep our public health system resilient for the inevitable challenges that will come and to have a healthier, more prosperous future in the years ahead. Thank you very much, Dr. Blumenthal and all the participants on this call would like to thank you as well. Thank you. Thank you. Thank you for the opportunity.