 Hello, I'm Philip Cohen, your professor of the social problems class. You may remember me. I've been missing you. I hope you're all doing well. It's been a month since I first opened up the class to discuss the status of the coronavirus. The then emerging epidemic. So I thought what I would do today is give you an update on that. Describe where we are, how we got here, and where we're going briefly. And then after that we'll have a chance to discuss and get your reactions. So I'm going to go ahead and share my screen and show you some slides. I'm going to share with the. Okay, later I'll get the audio. Okay. So coronavirus COVID-19 here we are April 3rd. I'm recording this in the afternoon of April 3rd. And here we go. Pandemic update. I'm going to talk about our pandemic, a little bit about the global trajectory, and then the US trajectory, how we got here and a little bit about where we're going. I'm not an expert on pandemics, not an expert on global public health. I am a social scientist, so I can understand a lot of things that I read, I read a lot of news and some scientific research on this. And I am a teacher, so I'm trying to do my best to explain where we are. What is a pandemic? A pandemic is from the Greek, with and meeting all and demos meeting people. So pandemic is a worldwide disease and we use it to mean a worldwide new disease. So the World Health Organization, which is our international body for dealing with things like pandemics, declared this current crisis of pandemic on March 11, a worldwide spread of a new disease that was after was observed spreading around the world. This pandemic is a coronavirus pandemic. A coronavirus is a group of diseases that affect humans and other species, both. So we're usually concerned with coronaviruses that affect people, some of them are quite minor, some common colds, some of them are quite serious. The novel coronavirus, the one we're dealing with now called novel coronavirus 2019 was discovered in Wuhan, China, late last year in 2019. We now call the disease that this virus calls COVID-19, coronavirus disease 19. So that's the disease epidemic we're dealing with now. On the screen you have some links that will take you to some introductory materials. This particular epidemic is very bad and there are some reasons why this one is bad, like any novel disease, I think, definitely like this one. We have no immunity to it, so no human that encounters this disease as far as we know is immune to it. Second, it's highly contagious. I'll talk a little bit about how it spreads. We don't know exactly how it spreads, but it definitely is very efficient at spreading from one person to another, so it's spreading rapidly. One key problem with that in that rapid spread is that we have transmission from people who are asymptomatic. There are some people who don't appear to be sick, who don't feel sick, who nevertheless have the virus and transmitted to others. For example, by wiping their nose and touching a doorknob, etc. So we're not exactly sure how that's working, but there definitely are some people who are not symptomatic, so you can't stop this by just avoiding people who are sick who have fever or coughing and sneezing or so on. And then the last element about why this is so bad is because it has relatively high mortality. The vast majority of people who get this virus survive, most of them have mild symptoms, and yet compared to other pandemic diseases, the mortality rate is pretty high. So the mortality rate is higher than with the seasonal flu that we experience, higher than with many other diseases that we have. We don't know exactly what the mortality rate is. It depends on how much medical care you get and the state of a lot of other things, but it's maybe somewhere around 1% of people who get this disease were not exactly sure. So because of these factors, it's been spreading rapidly with bad consequences. The graph I'm showing you here shows you the number of new cases confirmed by testing every day in the country since February. And we're up to, as of yesterday sometime, probably a million confirmed cases, that is people who've had a test or presumed by their doctors to have the disease, have a confirmed case reported out to the global reporting system. This graph you're looking at shows exponential increase. It increases more and more and more all the time. For example, yesterday there were 80,000 new cases reported. So that's pandemic exponential spread. Here's a map of where it is spread around the world. You can see that it's quite global. It's not uniformly around the world though. Having started in China, it first spread to countries where people travel to and from China, which are Europe and the United States. There was a big outbreak in Iran from a cluster of people who apparently came from China, but it is now spreading around the world. A lot of countries don't have a very rigorous testing program yet. So we don't know, for example, how many people really have it in Kenya or Zambia or some of these other countries that show a few number of cases now, but it is basically everywhere in the world. So how does it spread? Well, coronavirus is in general usually spread through droplets that is some coughs or sneezes or wipes their mouth or nose and then touches something that somebody else touches and then they touch their mouth or nose or eyes. That's why they came up with this recommendation of staying six feet away from people because normally if you cough or sneeze the droplets go less than six feet. However, in the case of this coronavirus COVID-19, it is spread by asymptomatic people so people are not coughing and sneezing noticeably. And there is new evidence that is getting stronger that there may also be aerosolized droplets, which are tiny, tiny droplets, not just the kind of come flying out of your mouth, but maybe just come out from breathing and may linger in the air. In some cases of people who are catching it, even though they don't seem to be exchanging any actual liquid droplets. So the recommendations we have had are be to stay six feet away from people, wash your hands all the time, especially before eating and touching your face. And we're working up to new recommendations to wear a cloth mask to protect yourself and especially protect others from what you may be expelling from your body even if you don't yet have symptoms. This is April 3, we're soon going to have recommendations probably that we wear masks when we're interacting with other people. Okay, so now we're going to talk about how we got here in the United States, starting with a few things that the Trump and the Trump administration did wrong before this ever even started that contributed to the problems that we're having now. Number one, a general orientation against effective government, against government at all, involved cutting the Centers for Disease Control, which is our main public health disease outbreak agency. This budget is from this graph is from the CVC's website showing their budget in 2018 and 2019 falling from a little under 8 billion to just a little over 7 billion. And then the proposed budget before all this happened was lower yet only about six and a half billion dollars. So a general cut less attention, less money to the public health infrastructure in the country. Specifically, there was an office dedicated to pandemic research and interventions in the National Security Council in the White House. That was eliminated in a reorganization of the White House and part of a downsizing of the National Security Council. This was from a report that came out last fall before all this happened. It remains unclear who would be in charge at the White House in the case of a grave pandemic threat or cross border biological crisis. Before all this happened, experts like these from the Center for Strategic and International Studies were worrying and we've been worried about this for a long time. How would we respond and it appeared as of last fall already that our response, our capacity to respond was being diminished by cuts and reorganization in the Trump administration. And then very specifically, and this is this was shocking to a lot of people in 2019 last year there was a very elaborate exercise scenario to to sort of game out what the federal government would do in the event of a global pandemic. They used a novel influenza as the example but it's very similar in the case of a novel coronavirus. And they discovered in the case in this in this gaming out in this simulation that they ran a number of ways that we were not prepared and they had recommendations and it was all ignored. So the Trump administration did not follow the recommendations for the advice and instead Trump has taken to saying publicly nobody knew there would be a pandemic or epidemic of this proportion nobody has ever seen anything like this before. That's a total lie. We all knew that this could happen that this was that there was a strong risk of this, and that we were not well enough prepared. We should have been preparing more. We all knew that Trump didn't know that because he doesn't know a lot, but we but people who paid attention already knew this. And then there's the happy talk. Trump's messaging to the public has has been was very much at the beginning that this was totally under control that this was not a big deal for us. And later, as he has come to acknowledge that it actually is a big deal, he continues to falsely claim that it is totally under control. And to the point where as of now he is saying, even if one or 200,000 Americans die, it will be a total victory because we've both handled it so well. And a little bit of some clips of him in the happy talk scenario here. I've always known this is a this is a real this is a pandemic. I felt it was a pandemic long before it was called a pandemic. We have a totally under control. It's one person coming in from China and we have it under control. It's going to be just fine. And we think we have it very well under control. We have very little problem in this country at this moment, five. And those people are all recuperating successfully, but we're working very closely with China and other countries. And we think it's going to have a very good ending for us so that I can assure you. Now, the virus that we're talking about having to do, you know, a lot of people think that goes away in April with the heat as the heat comes in. Typically that will go away in April. We're in great shape. We have 12 cases, 11 cases, and many of them are in good shape now. We have it very much under control in this country. And again, when you have 15 people and the 15 within a couple of days is going to be down to close to zero. That's a pretty good job we've done. I think every aspect of our society should be prepared. I don't think it's going to come to that, especially with the fact that we're going down, not up. We're going very substantially down, not up. It's going to disappear one day. It's like a miracle it will disappear. And I've gotten to know these professionals. They're incredible. And everything is under control. I mean, they're very, very cool. They've done it. And they've done it well. Everything's really under control. And we're prepared and we're doing a great job with it. And it will go away. Just stay calm. It will go away. Okay, so obviously that was all not true. It was not under control. It was not going very substantially down. It was not going down to zero. It was not going away in April. None of that was true. And that, that miss messaging, which was, he just does to make himself feel better, make himself feel like he's doing a good job. So other people think he's doing a good job. That sent a very bad signal to the public that was not that serious. In addition, there were specific policy and practice failures as this unfolded in the United States. The key failure may have been the failure to have an adequate testing regime. So we did not know how many people had the virus or we could not figure out how many people had the virus. And the way you stop an epidemic like this, if you get to it early is you find whenever you find a person who has it, you immediately quarantine that person. And then you find all the people they've interacted with as much as possible. That's called contact tracing and you quarantine those people. So by isolating the people who have it and the people they've been exposed to, then you can keep it from spreading. That's the general, that the first line approach to an epidemic like this. We did not have a good test in this country to do that. The first test rolled out by the CDC didn't really work. We didn't adopt the World Health Organization test, which was out there, which would have possibly allowed us to do more testing faster. So as a result of the disease spread, I'm faster than we could keep track of it. And very early on, it was clear that we had community spread. It was spreading from person to person. And when we found a sick person, we couldn't even tell where they had gotten it. So it got out. Okay. And then we failed to contain that. So we didn't stop the movement of people around the country from areas that were affected to areas that weren't. We didn't stop the movement of people around town and around the institutions, the schools and nursing homes and shopping malls and all the places that people go in the areas where there was disease spreading. And so it got out and spread further. Then we did not have and we still don't have a uniform system of advising or directing or enforcing people to stay in place to stop moving around to stop organ to stop assembling in groups to stop going to church and theaters and shopping and so on. So we have most places now have either regulations or strong guidelines to do that, but still not everywhere. And it definitely was way too slow coming. So the disease spread again that way. And then specifically as far as Trump and the federal government, there's been a real failure in the production and management of the vital equipment and supplies and people that we need to fight this. So the personal protective equipment you may have heard about the PPE. That is all the stuff that medical workers need to safely deal with people have this fire so it's gowns and booties and masks and gloves and all that and so we don't have enough of that has to be changed very regularly. And then, crucially, the ventilators when you have a very serious case of this. It's a respiratory illness it becomes. It gets seriously affects lung capacity the lungs. And then the worst case, the patient ends up on a ventilator they need to have a breathing machine. The federal government had a stockpile of them. It wasn't enough. Some of them didn't work. They weren't distributed properly. They have left way too much to the market to the companies that produce these things. Instead of using the authority of the federal government to seize control of that process and direct the production and distribution of those resources to the places that we need them so they've left it to the market and has not worked. Especially in New York but increasingly in other places, we don't have enough equipment and supplies and people to deal with the outbreaks that we have. So just to show you a little bit of some numbers on this trajectory. I hope my picture of myself is not in your way here. This is a form of graph you may have seen a way of interpreting the outbreak. I've just shown you a few countries, including the United States. The way this graph works is along the bottom on the x-axis is the number of days since each since the country got to their 10th death since they recorded their 10th death. And then the y-axis as it rises is doubling 1632 6428 256 each click going up is a doubling of the number of deaths. So a straight diagonal line here is exponential growth. It's doubling, doubling, doubling, double. Okay, so South Korea was an early case and you can see their slope. So by the time they got out to the end here about 37 days from their 10th death, they're somewhere in between 128 and 256 deaths. So that's like a pretty mild slope. Then on the other hand there is Spain with a pretty steep slope. They're only on 24 days after the 10th death, and they already are up around 10,000 deaths. Okay, and there's Italy, France, and I put Brazil and Canada on there as examples of countries that have relatively recent outbreaks. Only 13 or 14 days after their 10th death, and you can see their trajectory kind of following this course, this exponential course up. And then you look at the United States on here. And the disturbing thing about the USA trend is that our slope is different from the others. It is steep. So we are going up that exponential slope at a steeper rate than the other countries. The thing about the United States is it's a huge country, and we actually have multiple outbreaks in different parts of the country. So in a way, the United States is more like Europe, where there's a bunch of different outbreaks around the country. So here I now I just add some states to that same figure, you can see New York, which is following the path of Spain, that's our worst state. You can see Washington, which actually was a very early return that to be our best state, at least so far in the long run, they're all the way out to 29 days, and still less than 256 deaths. But then we have these rising new states Michigan, New Jersey, Louisiana, which are following a pretty dangerous course. And so what I'm showing you here is around the country we have a number of different outbreaks, each has their own dynamics, this pattern of exponential growth is is pretty bad and very serious and why the United States overall is showing this bad curve. Now, a straight line going up on this is very bad at any angle if it's straight, it means it's growing exponentially. What you want is this kind of curve. So what you see with Spain and Italy, they're starting to curve. If the numbers are accurate, there's some, you know, fuzziness on that for sure. But the idea is, you want to get out of that exponential growth and start looking more like South Korea where there's not adding more and more cases of more and more deaths over time. Okay, I didn't put China on here China's a kind of a special case, and it would kind of break the graph so China's not shown on here. So on that, on that logic, what a lot of what we're trying to do with our public health measures and you may have heard this phrase is called flattening the curve want to flatten the curve. We want to slow down the rate at which new people get infections. The red distribution here shows what would happen if we just let the virus spread and didn't do anything about it. Lots and lots of cases will pile up very early. And at a certain point, we would have more cases than we're able to handle with our health care system. Something like what's happening in New York where they don't have enough hospital beds and ventilators and doctors and nurses and so on. And so they're unable to give everybody the best care. So the idea of the social distancing that you hear about and closing schools and closing restaurants and bars and all that is to just slow down the rate of spread so that when people do get sick. They're not going to a packed hospital. Essentially, they're going to a hospital that is that is able to take care of them. So there are ambulances and doctors and nurses and beds and ventilators, and we can manage the disease much better if we're not also overcrowded. So that's the logic of flattening the curve. And even if we can't prevent it, even if we don't have a vaccine, which I'll talk about in a minute. We can still reduce the total damage by reducing the rate at which people become infected. That's called flattening the curve. Okay, now back to our US states graph here just four states and it shows us that the trajectory is different. New York is the worst up over 2000 deaths in a relatively short period of time. And Washington is the best which with under 256 deaths in that relatively long time 29 days. And then we see sort of Michigan and California in between. And when you start to look at what's happened in all these different states. We see there were different practices. Washington actually because they had that first outbreak that was, it was scary and terrible but it was apparently relatively confined to a nursing home at the beginning. They relatively early had a pattern of social distancing closing things and sheltering place isolation everybody try to stay separate and close things down as much as possible. That has produced good results that their their slope is not as steep California close to that also pretty good. On the other hand New York Michigan worse not enough was done early on, and they have more of an explosive outbreak. So this is sort of the logic behind this practice the social distancing, the flattening the curve type of practices where we try to really just cut down the rate of transmission and we can. We can do that if we do it before it's too late and most of the country don't have these really bad outbreaks yet we still have a chance to improve that slope a lot and increase our chances of being able to fight this at least in the hospitals. Okay, so what's going to happen next. Well, the people who are already infected are going to get sick. The people who are showing up at the hospital now probably been infected 10 days two weeks or longer. So it takes, you know, maybe six, eight days for any symptoms and then maybe five, five, seven days after that for the symptoms to get bad enough to go to a hospital. So the people showing up at the hospital now are like back when we first closed schools almost. So that's going to happen we're going to have some people getting sick. We also have the epidemic spreading. We're not doing enough to stop it, you can still get your car and drive from New York to Missouri if you want to. And nobody's going to stop you from doing that you can get on a plane or train and so we're not, we're not stopping the spread so the spread is going on. So many thousands of people are going to die in America and that's pretty inevitable at this point we've had a few thousand deaths already. There's just curves there's nothing going to break that slope at the moment we're going to have thousands of people die. How many we don't know many. Okay, we can still with our public response, determine how fast this gets how bad it gets over the next period of months so that's really remains to be seen. And how many people die who get infected is not just a biological fact Oh, X percent died, it has to do with. Do we diagnose them take them to the hospital do they have the resources and staff to take care of them. So, we don't know how many people are going to die, or even if we knew how many people are going to get infected. That depends on when and where they get infected and what is our capacity to respond. There's a lot of variables. A lot of variables left you can see the picture here's the Javits Center in New York City, where they've erected a large temporary building and you can see a lot of these around the country and convention centers and so on. When is this going to be over. What's going to happen now you're, you're if hopefully you're watching this sitting at home, or in your apartment somewhere and wondering how long it's going to happen well, we don't exactly know. But we are pretty sure some things, even if we stop it basically now in the absence of a vaccine. So remember, no one is immune to this if it's out there, it kind of has the capacity to still spread. If we tamp down the numbers a lot, we may be able to come out of our homes, but then there may still be waves of outbreaks somebody gets it, it spreads a little and we kind of have to shut things down again in a particular area. So, as soon as there are a few enough cases if we have the testing and tracing capability, if there are a few enough cases we could let us all out of our homes, and practice reasonable social distancing, and then when somebody gets sick, immediately isolate them trace the people they've had contact with and isolate them and so we could be able to keep it manageable. So let's get the epidemic down now. So that's the first goal. Unfortunately, it's also spreading around the world and in some places it's going to spread a lot, and they won't have the capacity to stop it and so I think even if we get it under control here, much more than it is now, we will have travel restrictions for quite a bit longer, and we won't either won't allow people to come from other countries or if they do come will require them to be quarantined and so on. So this global travel restriction, at least from the US perspective is going to last for a while. Eventually, we need treatments and a vaccine. They're working on that now obviously we don't know how long it's going to take. There's a best case scenario sort of for a vaccine which is something like 18 months, but it has to be developed. It has to be tested to make sure it's effective and safe, and then it has to actually be produced and distributed around the world and billions of doses it's going to be very difficult to do. So we're not expecting that very soon. Treatments will improve at the moment we don't have a treatment for it. We have, we take care of people who have the illness, and they have to fight it with their own immune systems but they're also working on treatment medications which may, which may help. So where does that leave you, the common student or viewer of this. That's not my expertise. I don't know. I care about you. I want you to be well and do the right thing, but I'm not the person who's going to give you the best personal advice. So that said, here's a couple of notes. Please follow the real public health advice. I real I mean, don't listen to the president. Don't listen to the politicians in his orbit. Listen to your governor, your local public health officials, the Centers for Disease Control, follow their advice if they stay stay home. Stay home. If they say, wear a mask, wear a mask, follow the advice is not just about you it's about who you might be affecting. Take care of yourselves. That includes mentally and physically. Obviously, it's a huge challenge. I'm not minimizing that at all. Look out for yourselves and each other, reach out, communicate, even if at a physical distance, don't let them become a total social distance. Take care of yourselves and each other. You may find ways to help. I'm not a key resource on that. There may be things you can do online, things you can do with your money, things you can do with your time that will help people to cope with this crisis and helping can be empowering and make you feel better about what is obviously a very bad global situation. And then this is going to go on for a while. You have a future ahead of you. The world is going to be a very different place after this. So what is that future going to be like and what is going to be your role in it? Think about who you want to be in the future. And try to think about that as imagining yourself in the world after this is over and who do you want that person to be and what do you want that role to be. So that's just a general encouragement to think positively and think about this in the long run. You know, we've got over humanity has gotten over a lot of bad things in the past, and we will probably get through this also. So thanks for listening.