 Hey, Amesh, how are you? Good. Running around, thanks for doing this. I really don't know how busy you are. Sure. So let me quickly give kind of your bio. So tell me again, how you pronounce your family name? Adulja. So Amesh Adulja is an MD. He's a senior scholar at John Hopkins University Center for Health Security. He is focused on emerging infectious disease, pandemic preparedness, and biosecurity. I mean, you can read his bio at the centerforhealthsecurity.org. Just put Amesh Adulja on the internet and you'll get a ton of stuff. He comments on issues related to infectious disease on Fox and many other news outlets. He publishes quite a bit and works at the major hospitals. Was a is, I guess, is still affiliated with the medical school at the University of Pittsburgh. Yes, the School of Medicine. And actually, I'm not going to read the whole bio, but it's extensive. So I cannot think of anybody in a better position to talk about what's going on with the coronavirus than Amesh. So thanks again for joining us. Sure. So maybe let's start at the beginning. How did, where did this virus come from? And kind of how was it discovered? So this virus appeared in late December and it started in a cluster of patients that had been to a seafood market in Wuhan. And they had unexplained pneumonia and they were tested for the usual suspects and everything came negative. And because of the history of SARS, which we can get into, they're very aggressive in China with trying to explain undefined pneumonia. And what they found was a novel coronavirus. And coronaviruses are viruses that we've known for quite a long time. They're four of them that circulate and cause the common cold. And then there are two that are really severe, SARS and MERS. And they found a novel coronavirus and that set off a lot of alarm bells because people thought, could this be the next SARS? And based on the experience that China had with SARS in 2003, where they covered up cases, where there was an outbreak that kind of went undetected and really surprised the world and then spread around the world and caused 8,000 cases and 800 deaths and led to tens of billions of dollars at economic losses. They China got very aggressive and really started to clamp down on this outbreak and be very aggressive with their measures there. And now we've seen cases that have appeared in other countries. We've seen travel bans initiated. But one thing that's important to remember is that coronaviruses cause a spectrum of illness. And when you start an outbreak, you're going to find the most severe cases first. And now we're coming to learn that there are a lot more mildly symptomatic cases, even asymptomatic cases, people who are infected with no symptoms. And this is behaving. Whoops. We lost you. Put the virus in a lot of cars. Okay, so we lost you a little bit. You know, maybe I don't know if you have a, how your internet connection is there, but we kind of, we lost you for a second. So let's go back. Let's talk a little bit about SARS. Because, so do we know where the virus came from? Let's start with that. Is it animal transmitted? Was it from seafood? I mean, there are a lot of conspiracy theories out there. I'm sure you're probably familiar with them. There's one that they stole it from a, the Chinese stole the virus from Canada. There's one that it's comes from a lab in Wuhan province that does biological warfare. So, you know, say a little bit about where, what we know about where the virus comes from and where this class of viruses come from and how it appears in humans. So all the coronavirus is circulated in bats. That's the home for these coronaviruses. And what can happen is bats can spill that virus into other animals. So that happened during SARS when it spilled into civet cats, which then were consumed in that start of the outbreak. So we know that this came from an animal. We don't know which animal, but ultimately came from bats. And that's where this virus originated, but then it had the capacity to spread in between humans. So right now it's not being spread because of animal to human. It's all human to human right now. So it's become less important from a public health standpoint to understand which animal it came from, but more of a, it's a very logical curiosity trying to understand where it came from. And now this is spreading efficiently from human to human. And it's no surprise that it came from bats in an animal because that's what coronaviruses do. That's what happened with SARS and Middle East respiratory syndrome as well, went from bats to camels. And that's also causing an outbreak in the Arabian Peninsula currently. So what happened with SARS? So I mean, I vaguely remember there was a lot of panic. There was a lot of stress. As you said, the Chinese tried to cover it up. And then I think once people discovered that there was a lot of panic about it. How dangerous was SARS? And then how was it brought under control in the end? So SARS infected about 8,000 people in several different countries, mostly in Asia and then in Canada. It killed about 800 people. So it had about a 10% case fatality rate. There were a handful of cases in the United States in the single digits. But what was significant about SARS was this is the first time we saw coronavirus do this. And it got people very nervous about what coronaviruses could do. And it was really the actions that governments took in terms of travel restrictions, trade bans that actually magnified the impact of this virus. Because they say, you know, tens of billions of dollars of losses and airports are barren and empty. And it was really a virus that only killed 800 people. And after SARS, that's when this whole WHO governance type of thing came about with the international health regulations because they were so worried about countries taking the wrong actions in response to an outbreak, including travel bans and economic restrictions that it would make the outbreak much worse. And that's why the WHO has come out against travel bans. But SARS was really a human factor outbreak. It was a, and it spread mostly because people first the animal exposure and then it relied on healthcare workers where there wasn't proper infection control in certain hospitals. And then this phenomenon called super spreaders. People who were kind of like typhoid Mary types who spread it more disproportionately to people. And that's how SARS spread. And once we understood how to treat it in the hospital safely and we understood this idea that there are certain people that are super spreaders, we were able to control it pretty quickly and it basically went away after people stopped consuming that animal. And it's basically vanished from the earth for the most part. So why do you say the travel bans made it worse? I mean, clearly they would make it worse economically, but did they not help to contain it geographically? No, because if you have a respiratory virus that can be spread from person to person, it's going to have a spectrum of illness. There are gonna be people that have mild illness, some people are going to be incubating this virus and the travel bans are not going to capture those people and what it's going to end up doing is diverting the resources of public health authorities to dealing with travel screening, travel ban monitoring those people rather than actually fortifying your healthcare system in order to get ready for these types of outbreaks occurring in your country. It also makes it much harder to get resources into those countries because now you've made it logistically very difficult to get into the outbreak zone. And then it creates stigmatization and then it causes more economic losses to that country which makes it even harder for that to fight. So it's very, there are not really any good criteria for when a travel ban actually works and it's basically been a debunk type of thing. But every, and we have this conversation with every outbreak Ebola, H1N1, Zika, all of these things and all the public health and infectious disease authorities all say this has all been disproven long, long ago but every time politicians jump to it because it's the easiest thing for them to do to satisfy people who think this is them doing something so they're going to be tough and it ends up backfiring usually. So is, so tell us a little bit about, you know the danger of this coronavirus. How deadly is it? Who's actually dying from it? You know, I've heard that pretty much only old people are actually dying or young people I guess people with challenged immune systems that it's not as deadly as maybe some are claiming. And how easily is it transmitted? So the severity was a big question and that's what drove all the panic because we didn't know. We're hearing about the sickest cases first and as we learn more we're seeing that this case fatality rate is dropping. Now, if you look at the, if you try to do the raw calculation based on Chinese numbers that are being released by their health department, you get about a 2% but that doesn't account for the fact that they're not testing people who aren't needing hospitalization. So there is a big denominator that we're missing and all the cases outside of China none of them have been fatal. All the cases in the United States are mild. So I do think you're going to see this case fatality rate drop much lower than 1% and this is going to be basically clustered in those who are elderly, those who have other medical conditions. And I think we'll get, it's gonna be a burden for hospitals and healthcare systems to deal with the cases because they're gonna get inundated with a lot of cases coming in just like we do in flu season. But I don't think this is going to be a very, it's gonna probably be a, qualify as a pandemic but it's not going to be a very severe pandemic because the fatality rate is much less than what we're seeing now. And we'll get a picture of that in more time. I do think that it is transmitting efficiently from human to human. We are seeing some cases, we have one case of human to human transmission in the United States from a wife to a husband. And we have seen in other European countries, this has occurred a pretty interesting case in Germany where a traveler infected several people kind of in a business setting. So it does seem to be transmitting more efficiently than SARS did. And you have to, yeah, this actually makes sense because coronaviruses are very prolific. They cause one quarter of our common cold. So that virus is adapted in many cases to human transmission. So it sounds like there's nothing really overly scary here that people, I mean, I read somewhere people die of regular flu numbers far greater than what is happening with the coronavirus. And yet people are panicking. Is there any politicians in particular? Is there any justification? In the very beginning stages before we knew what was going on, I do think that that quick scrutiny of what was going on and really putting resources forward made sense. I think as we get further out, there's gonna be a time where we have to say, we're gonna have to stop this containment type of issue and just be mitigating the consequences that we're gonna have, this is gonna come to many countries in the world and we're gonna have cases. And some of them are gonna be severe, but most of them are gonna be mild and we're gonna have to deal with it. And I think it's important that we get healthcare systems ready for that. We start thinking about vaccine development, antiviral development, because that's all important to do regardless of what's going on. But I do think that there was an appropriate reaction because it was a novel coronavirus in the history of SARS and the history of MERS, but now I think we have to begin to think about where this is gonna fit in terms of risk stratification and how we kind of wind down some of the emergency stuff that's going on. Do you think China overreacted? Not in the beginning, I don't think they overreacted because I think that anytime you have a novel coronavirus, you have to set the alarm bells off because of SARS and MERS. I do think that they're quarantining a 50 million people, that was never warranted. And that actually probably made it worse because they announced that they were gonna do it and five million people left before they did that, which actually is a way to spread it around. And I think it's the Chinese government has these levels of bureaucracy and everybody trying to not be blamed for something bad happens. So their bias is to take a strong action versus a not strong action based on what happened in SARS and based on the fact that their head of state has been calling this a major priority and that they were gonna put people on the wall of shame if they did anything wrong. So that really set the incentives the wrong way to do this with armed guards at train stations and really made it worse, I think, with shortages, for example, that have occurred in Wuhan. Somebody's up to us asking, would it be fatal in developed countries where more can be spent to prevent, identify cases quickly and treat victims? I mean, how many fatalities do you really expect in kind of more developed countries? I think it will be a very minimal. We'll be much less than 1% of cases. Okay. And I think you'll probably get that even in China once we actually figure out the denominator. Is there an issue with kind of China's live animal food markets that makes them kind of the source of many of these viruses and is there anything the Chinese government should or could do about that? So many of our infectious diseases jump from animals in the closer contact you have with animals and more of them, the more likely this is to happen. So we definitely know that live markets are a source of many sources of viruses that could actually come into humans. Many of them don't have the capacity to do that, but that's a place where you can see this interaction or what we call viral chatter between humans and... Whoops, you lost you there again. Long. Amish. Yeah. Yep. Sorry guys, he's obviously got a... Okay, try that again. So live markets are definitely a place where animals and humans interact. And in those places are where viruses can find opportunities to jump into humans. And it is something that we've always tracked and looked at and wondered as a big place for emerging infectious diseases to appear. The Chinese government has been scrutinizing them. They closed them down. They have cleaned them out, trying to increase the better practices there. But I think it's something that's really culturally that they are very interested in keeping because they want fresh food. They like to go to the market and have the animal slaughter there. So it's a very hard thing to change. We learned this in Ebola. It's very hard to change cultural more. And even if they know that there's this risk, but that's why China has always been on the top of lists for places where pandemic viruses can emerge because of the live markets. Yeah, I don't know if I ever told you the story of... The story of going to a restaurant in Guilin, China. This is probably 2004, 2005. And my wife and I are in Guilin, China, which is a tourist area, but a tourist area mostly for Chinese. So there are very few American tourists and so they don't speak much English or at all. We're going to a restaurant. Of course, there are no menus in English. There are no knives and forks. And so we're trying to communicate what we want to eat. And finally, I think I drew a fish on the tablecloth and they figured, okay, fish, fish is good. So she literally says, okay, come with me and go, what? She takes me outside the restaurant. And outside the restaurant, there's this niche by the pavement. And in the niche, there's a big aquarium with fish. And next to the aquarium fish, there's a cage with rabbits and the thing with totals and all kinds of animals laid out there, live animals just there. And she takes a net, she puts it into the aquarium. She says, this fish. And I pick a fish and then she flings it over her shoulder, slams it into the pavement, kills the fish right there on the pavement. And then somebody from the kitchen comes out and takes it back and cooks it. And I go back to the table and my wife says, I'm so glad you didn't pick the rabbit. Because who knows how they would have killed it right there. But yeah, I mean, part of it is poor countries and much of China is still very poor. They can't refrigerate and they can't keep things fresh. They still serve live animals and live fish and they have these live markets primarily because of the cost of refrigeration. And that's- And also there's stories about the Walmart equivalents there that are not getting customers. They don't get customers to buy food there. They all, people prefer fresh food. Yeah, I mean, wouldn't we all if it was safe? I mean, I think fresh food is probably marginally better in terms of taste, but far less convenient, obviously. So what happened? What makes, let's say the Spanish flu, these real pandemics where thousands of people die or tens of thousands of people die, what makes those possible? How, to what extent are we at risk of something like that of a real pandemic that affects all of our lives, that kind of like the horror movies that we see all the time, kind of the catastrophe? And how much of it is kind of overblown and a media's tendency towards, portraying the negative and towards kind of raising hysteria levels? The media's always going to portray things worse than they actually are, but we do have face pandemic risks that are kind of unique in 2020 versus even 1918. We have an interconnected world and before viruses and bacteria traveled at the speed of a steamliner, now they travel at the speed of a jet. So they can get from one side of the world to the other side of the world very quickly. We also have multiple mega cities all over the world where there is crowding, poor conditions, maybe minimal sanitation in certain areas that allow the opportunity for viruses to spread in big cities. And people are worried about this coronavirus spreading in mega cities in Africa and how that would be. So those two factors do make us at higher risk for pandemics, but we do also have a better healthcare system. We've discovered lots of things about medicine. We have sophisticated ICUs. We've got antibiotics, antivirals, vaccine development. So there's kind of competing factors with pandemic risk, but I do think when you're on a planet that's dominated by microorganisms, it's only a matter of time before another pandemic to happen. And the Spanish flu was probably the worst that we've had in history with probably a hundred million people killed. And that was because it was a novel virus. It was a novel flu virus. And it happened at the time. Whoops, we lost you there again. You had lots of people going all over the world. Yeah, I don't know why that's happened. Yeah, it happened again. Am I there? Last I heard it was a novel virus. Yeah, so 1918 was a novel virus that really took advantage of the fact that there were massive troop movements going on after the end of World War I. And we had no antivirals, no antibiotics for secondary bacterial infection. We didn't even know flu was caused by a virus at that time. But that is really the paradigm pandemic that we worry about happening. And there are flu viruses that are very scary. Actually in China, bird flu viruses that people think about could be the next type of 1918 if they develop the ability to transmit between humans efficiently. And so if you live in a developed country like the United States, to what extent should people be worried? I mean, clearly if you live in Africa, if you live in parts of Asia, I mean, where the facilities, the medicines, that just the people's, you know, the hygiene, everything else is limited. You know, hundreds of millions of people could die. But do you think people in the developed world is it a real concern? I do think that any kind of pandemic could be disruptive to any country in the world. The deaths are definitely going to be clustered in places that are resource poor. But I do think any, even a mild pandemic would be a hit to the United States in terms of disrupting life, causing hospitals to really be inundated with patients. Hospitals mostly run at almost capacity now. And even a bad flu season can put people in the parking lot getting treated. So I do think there's not much redundancy and resiliency in some of our healthcare systems even in the United States. I think that we have to be alert to pandemics. I think it should be thought of as a risk that we have to face and prepare for and think about. I don't think that that means that everybody should be storing soup cans in their basement and waiting for the army get into occur. But I do think at least from a public health preparedness standpoint and infectious disease preparedness that it's an important thing that experts actually devote time to thinking about and preparing for in case they do happen. And somebody in the super chat asked, do new viruses tend to come from particular regions of Earth? Have any major viruses originated from the West in recent history? Well, the 2009 H1N1 pandemic originated from Mexico, which totally changed the whole paradigm. Everybody thought the new flu pandemic virus would come from China, but it came from Mexico. So they can come from different places. It's not necessarily that it's only one part. There are certain hotspots in the world, but any virus can emerge anywhere. And it's important that we don't be completely geographically restricted because we can be surprised and like we were with 2009 H1N1. And you said there's a virus now in the Middle East, something about camels? Yeah, Middle East Respiratory Center, which is another novel coronavirus discovered in 2012 in Saudi Arabia and in Jordan. This is spreads from bats to camels to humans, but it hasn't been able to spread efficiently between humans. We've got some healthcare associated clusters and some family clusters, but it's not spreading in the community. It has a 35% mortality rate. So it's very different than this coronavirus, but it's one to keep an eye on because it is still accruing cases even now as we speak in the Arabian Peninsula. So you think the travel bans that the Trump administration is imposed are ill-advised and wrong and just much more focused on kind of showing that we're doing something rather than actually being effective. What should the United States government in this case be doing? What is the role of government in situations like this? I think it's to think about how this impacts national security and to worry about contagion spread and how this might disrupt civil society. Right now we have government systems to help healthcare facilities prepare for these types of emergencies when they rise to the level of national security. And what we're seeing is the government trying to get our healthcare facilities ready. They, in our current system, the government has a big role in drug development and vaccine development. So they're already ramping all of that stuff up. They're putting resources into our health departments that can help with monitoring people and communicating to the public about what to do. I mean, a lot of these things are a result of what the government has done in pandemics for quite some time. And I think that when you talk about the quarantines that they're doing, for example, in California, they don't really seem warranted. I think it's also, the one thing that is important is when travelers come in to actually tell them about this risk in case they get sick afterwards. I don't think you need to isolate, you don't need to quarantine them or do anything to them but just they need to know who to call so that they don't contaminate other people if they walk into the emergency department. Those types of activities, I think, are the best things to do. I think the travel ban will unlikely impact this virus. I think that it's likely already spreading in many countries with mild cases that just are being mixed in with flu cases and they're not being recognized and we'll only learn that in retrospect. So it's going to actually take away from other resources that are more important. Okay, so one last question. What are kind of the symptoms? If somebody does have the virus, what are kind of symptoms that should alert somebody to go see a doctor or to look into it more? So this is the hard part because the symptoms are identical to the flu or the common cold. So you're going to get a cough, fever, chills, sore throat. You may be short of breath and I think once you're short of breath, I think that's shorter breath than coughing is something that you might want to see a doctor for and alert them that you've been to places where this is but remember we're still in the middle of flu season so you're still more likely as an American to have the influenza than you are to have this coronavirus. So it's important to keep that risk perspective and not think that you just jump to that novel coronavirus and not think that you have influenza. Okay, Jennifer has one more question. As people get cleaner and eat better in different parts of the world, I guess, does this make for better resistance to any new virus? It does. I think that nutrition plays a big role. That's why we see large deaths from diarrheal illness or measles in Africa and less so in the developed world. So it definitely nutrition is important for your immune system to be at its peak. And then Abtenes, what do you think of the mobile game, Plague Inc. It claims to accurately simulate pandemics. I don't know if you know anything about that. I don't know that one specifically. I played a couple when I played the game pandemic. It's a board game, but I think they're fun. I don't know that they, I don't know how accurate they are, but I think they're fun. Okay, great. Thanks, Amesh. It's always great to talk to you because you bring a level of objectivity to these things that is rare in our culture. So I appreciate it. Thanks for the work you're doing to just generally to calm people down and to bring some rationality and objectivity, I guess to the whole world of infectious diseases. So really appreciate it. Thanks for having me. Sure. 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