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--:-- Sean Rameswaram: Support for Today Explained comes from Saks Fifth Avenue. Fall is here. Might be time to find some nice new pieces you can wear again and again.
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--:-- Sean Rameswaram: Twenty, twenty, twenty, twenty. Julia Ballou's your report on health at Vox.
--:-- Julia Ballou: And just about one year ago, I believe the 23rd of January 2020, we had you on the show and called the episode coronavirus. There was a new virus, and we spoke to you about it for the very first time.
--:-- Sean Rameswaram: Can you believe it's only been 12 months, Blues? Oh, my God, the longest 12 months of all of our lives.
--:-- Julia Ballou: And I was thinking, you know, since it's been a very long year, maybe it'd be a good time to take a stroll down pandemic lane with you and talk about how we did a year ago. Maybe what we've learned since, what we got wrong.
--:-- Sean Rameswaram: Are you game? I'm game. Let's take a virtual stroll. And it won't require masks. It's true.
--:-- Julia Ballou: At the time, January 2020, this virus, it was scary, but it also felt very far away.
--:-- Sean Rameswaram: So let's listen to a bit of what it sounded like in January of 2020. How many people has it killed so far? As of this morning, there are more than 600 cases and 17 people have died.
--:-- Julia Ballou: And how should we think about those numbers? How deadly is a virus if for every 600 infected, 17 die?
--:-- Sean Rameswaram: So it's way too early to figure out the case fatality, which is the number of deaths a virus causes among the number of people affected.
--:-- Julia Ballou: Because it's possible that there are thousands more people with this virus who don't have symptoms, who've never gone to the doctor, and therefore they're not counted as cases.
--:-- Sean Rameswaram: Now, over a year later, over 2 million people have died and over 400,000 of those deaths came from the United States.
--:-- Julia Ballou: Did you have any idea back then in January that it would look like this? No way, I did not.
--:-- Sean Rameswaram: And I think the funny part is, like, I wrote multiple pieces about how we were overdue for the next pandemic.
--:-- Julia Ballou: I even published a story after Trump came into power about why he was sort of setting up the U.S. to botch a pandemic response.
--:-- Sean Rameswaram: But I think at every turn over the last year, we underestimated the coronavirus.
--:-- Julia Ballou: And obviously that was true even then.
--:-- Sean Rameswaram: Let's talk about what the initial response to this was in China, which is what we were talking about back in January of last year.
--:-- Julia Ballou: What seemed like, you know, drastic, shocking measures the Chinese government had taken in Wuhan.
--:-- Sean Rameswaram: Let's play some of that. This morning, the Chinese city of Wuhan on lockdown. Flights canceled. Trains halted.
--:-- Julia Ballou: It's not just travel in and out of the city that's affected. It's everything within Wuhan as well.
--:-- Sean Rameswaram: Wuhan is in virtual lockdown. You're not allowed to enter any public space without a mask.
--:-- Julia Ballou: The city of 11 million people at the epicenter of a viral outbreak.
--:-- Sean Rameswaram: So that's more people than live in New York City, for example, or an entire country like Greece.
--:-- Julia Ballou: They just shut down travel within the city and travel out of the city.
--:-- Sean Rameswaram: And by this evening in China, they'd extended the travel restrictions to two other cities just east of Wuhan.
--:-- Julia Ballou: Huanggang and Euzhou, with a combined population of 8.5 million, are 70 kilometers away from Wuhan, where 11 million residents have been told to stay put.
--:-- Sean Rameswaram: So the response is escalating really fast as well.
--:-- Julia Ballou: And part of that is driven by the fact that China is now undergoing the biggest annual human migration for Chinese New Year on Saturday.
--:-- Sean Rameswaram: This crackdown might also suggest that they know more than they're telling us, that maybe the virus is even more transmissible than it seems right now.
--:-- Julia Ballou: Maybe it's in more places than we know. Maybe there are more cases.
--:-- Sean Rameswaram: But the public health people I talked to said that quarantining a city of 11 million and imposing trade restrictions on 20 million people in these three cities, that that's totally unprecedented.
--:-- Julia Ballou: It's funny to think about how drastic and shocking that seemed a year ago, because, of course, now it just sort of sounds like, well, they were being very effective in their shutdowns and from preventing this virus from spreading.
--:-- Sean Rameswaram: What did you think at the time about those restrictions, Belous?
--:-- Julia Ballou: Just that it was absolutely, yeah, unprecedented, shocking.
--:-- Sean Rameswaram: And everyone I spoke to said this was totally unique to China and that it would never fly in a Western democracy like countries in Europe or in the US.
--:-- Julia Ballou: There was also expert guidance saying like, don't shut your countries down, don't close your borders.
--:-- Sean Rameswaram: We had never seen this like total restriction on movement that not only happened in China but then happened in vast succession in countries around the world.
--:-- Julia Ballou: And yeah, so it's wholly unprecedented.
--:-- Sean Rameswaram: We still don't know what the impact is. There are still debates on the legality of these types of restrictions.
--:-- Julia Ballou: But I think we probably should have imagined these scenarios, even if they seemed totally unfathomable at the time.
--:-- Sean Rameswaram: One thing that sticks out to me hearing that was hearing that, you know, China is on the verge of its biggest annual migration for the Chinese New Year.
--:-- Julia Ballou: And, you know, it wasn't until we were hearing more about the cruise ships and international travelers who were coming into contact with people in China that it really set in that this thing is spreading and we are not prepared for it.
--:-- Sean Rameswaram: But really, it should have been obvious there, right, with the Chinese New Year, that of course, this is going to start spreading out of control.
--:-- Julia Ballou: I think like what, yeah, when we saw China shut down like that, that probably should have been a signal to the world that obviously they wouldn't do that if they didn't perceive this was a major threat.
--:-- Sean Rameswaram: But at the same time, we did have this precedent of previous viruses that ravaged China and that didn't have as much of an impact in other countries.
--:-- Julia Ballou: And one was the first coronavirus that went pandemic, SARS-1, in 2002-2004.
--:-- Sean Rameswaram: So it took off in China. Actually, it also took off a little bit in Canada, but it didn't have this effect, obviously, that we're seeing with the current pandemic.
--:-- Julia Ballou: And we also learned that this new coronavirus is quite different from the first SARS.
--:-- Sean Rameswaram: With the first SARS, people were contagious after they were quite symptomatic.
--:-- Julia Ballou: And with this one, we know that you're at peak contagion when you just start to experience symptoms if you experience them at all.
--:-- Sean Rameswaram: Again, yeah, we underestimated just how much of a perfect pandemic virus this was.
--:-- Julia Ballou: Let's talk about when we started to realize that this was something that was going to spread and that it was indeed spreading.
--:-- Sean Rameswaram: We talked about the cruise ships at length on our show, the Diamond Princess and the Westerdam.
--:-- Julia Ballou: One docked in Japan, the other in Cambodia.
--:-- Sean Rameswaram: This was a few weeks after our initial coronavirus with you that we talked about the cruise ships.
--:-- Julia Ballou: Let's hear some of that. Up until this point in the outbreak, a lot of the effort has been on containing the virus, stopping it from spreading on the cruise ships, quarantining people, keeping them from disembarking in other countries and spreading the virus there.
--:-- Sean Rameswaram: And now with what happened on the Westerdam and this American already testing positive, it feels like we're at a turning point.
--:-- Julia Ballou: With every passing day, we've been seeing more and more people test positive for the virus outside of China.
--:-- Sean Rameswaram: So the vast majority of the cases are still in China, but there's this mounting toll in countries around the world.
--:-- Julia Ballou: China has reported 70,635 cases of COVID-19 to WHO, including 1,772 deaths.
--:-- Sean Rameswaram: Outside China, WHO has received reports of 694 cases from 25 countries and three deaths.
--:-- Julia Ballou: And now with all these passengers just being let off these ships to travel back around the world, potentially carrying the virus with them, we're likely to see that toll outside of China mount even further.
--:-- Sean Rameswaram: It's this highly contagious respiratory virus, and it seems like it's doing a very good job of spreading among people.
--:-- Julia Ballou: And we might be at a point where containing it is impossible.
--:-- Sean Rameswaram: That was February 18th, 2020.
--:-- Julia Ballou: I remember speaking to you from underneath a blanket in California where I was on a work trip.
--:-- Sean Rameswaram: And I remember you saying that and thinking, okay, so this is just going to spread all around the country.
--:-- Julia Ballou: I didn't realize a month later I'd be living in lockdown with the rest of the country.
--:-- Sean Rameswaram: But it was the moment where I kind of realized this is maybe going to change the world.
--:-- Julia Ballou: Was that where your head was at too?
--:-- Sean Rameswaram: Yeah, I thought that the cruise ship seemed like this natural experiment where you could see just how contagious the virus was.
--:-- Julia Ballou: But at that point, we still didn't have a clear answer on the severity of the virus.
--:-- Sean Rameswaram: So what was definitely knocking around in my head was the swine flu pandemic, for example, of 2009, where it spread really quickly around the world.
--:-- Julia Ballou: There were these concerns about its deadliness.
--:-- Sean Rameswaram: The media definitely stroked fear and panic.
--:-- Julia Ballou: Schools closed. Flights were canceled.
--:-- Sean Rameswaram: And then it turned out that it wasn't very deadly.
--:-- Julia Ballou: And that caused this sort of mistrust in media and in politicians about hyping this threat and unnecessarily scaring people.
--:-- Sean Rameswaram: And I think at that time we taped the episode, I was still hearing from some of the world's best infectious disease experts, like even our very own Dr. Fauci, that this virus could be controlled and that maybe it would just burn itself out or it wouldn't be that big of a threat.
--:-- Julia Ballou: Just a week later, we spoke to you again in an episode titled Pandemic?
--:-- Sean Rameswaram: And this was when the virus was really starting to spread around the world.
--:-- Julia Ballou: And I think I asked you how scared I should be. How scared should we be, Blues?
--:-- Sean Rameswaram: Honestly, what scares me most right now is people's reaction to the virus and the fear and xenophobia and lockdowns and damage to the economy that this might cause than the virus itself.
--:-- Julia Ballou: Even as this spreads around the world, there's still a good chance it'll look more and more like the H1N1 swine flu pandemic, which was actually less deadly than seasonal flu and less and less like SARS.
--:-- Sean Rameswaram: Were we wrong about that one Beluz?
--:-- Julia Ballou: Yes, I think I was wrong. I thought at the time that travel restrictions would do more harm than good.
--:-- Sean Rameswaram: What we saw in previous outbreaks was that travel restrictions really punish countries.
--:-- Julia Ballou: They stop the flow of people and goods into countries where help was needed, like we saw in the West Africa Ebola outbreak in 2014-16, for example.
--:-- Sean Rameswaram: But now what we've seen is some of the biggest coronavirus success stories in the world, New Zealand, Australia, Vietnam, they've actually had some of the strictest travel restrictions.
--:-- Julia Ballou: So the thinking here has definitely changed and evolved, but yeah, we were wrong.
--:-- Sean Rameswaram: One is this failure to understand exponential growth.
--:-- Julia Ballou: It's so contagious that even if all these cases that we were talking about that had popped out outside of China didn't look like very big outbreaks, they soon would be because of how exponential growth works.
--:-- Sean Rameswaram: And then also there was this failure to actually gauge the situation because when a virus is that contagious and it can spread that broadly, you don't even need that many severe cases to overwhelm a health system.
--:-- Julia Ballou: And so even if it kills less than 1% of the people who get it, it's going to spread so far.
--:-- Sean Rameswaram: You can very quickly end up in a disaster like the kinds we've seen unfolding across the U.S. and in many other countries.
--:-- Julia Ballou: And then I think there was arrogance, like this failure to learn from other countries.
--:-- Sean Rameswaram: So I kept hearing, you know, the CDC in the U.S., we basically wrote the playbook for how to respond to epidemics.
--:-- Julia Ballou: And maybe this virus is out of control in Iran and maybe it's out of control in China and then maybe it's out of control in Italy.
--:-- Sean Rameswaram: But it won't be the same in the U.S.
--:-- Julia Ballou: And obviously that wasn't true.
--:-- Sean Rameswaram: And actually one of the things the pandemic revealed was like, you know, some of the lower resource countries have done much, much better than high income countries like the U.S. because of public health and political decision making.
--:-- Julia Ballou: The one last thing I will say another failure the positivity bias so kind of hoping that the best case scenario will play out rather than the worst case.
--:-- Sean Rameswaram: And I think I was guilty of that.
--:-- Julia Ballou: I know when we were talking I was like very heavily pregnant and yeah about to give birth to my first child.
--:-- Sean Rameswaram: And I was definitely hoping that I wouldn't be giving birth to him in this like deadly pandemic.
--:-- Julia Ballou: And that that wouldn't be the world he was entering.
--:-- Sean Rameswaram: And I think a lot of people had this type of thinking, like hoping for the best and not the worst.
--:-- Julia Ballou: Thank you.
--:-- [Theme music starts playing]
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--:-- Julia Ballou: Your home isn't just where you sleep. It's your community.
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--:-- Julia Ballou: You can hire top-rated pros, see price estimates, and read reviews all on the app.
--:-- Sean Rameswaram: Download today.
--:-- Julia Ballou: Today, today explain.
--:-- Sean Rameswaram: Okay, Blue, so we look back on the first few months of our coverage, and while we didn't get a ton of stuff wrong per se, It's clear like so much of the rest of the world, we were potentially underestimating the severity of this virus.
--:-- Julia Ballou: So I was hoping we could look ahead and provide people with an update on what the next few months and maybe even year of this pandemic might look like and try and get it right.
--:-- Sean Rameswaram: Let's be as sobering and realistic as possible.
--:-- Julia Ballou: We have vaccines now. How is it going?
--:-- Sean Rameswaram: So the vaccine rollout around the world is happening incredibly slowly.
--:-- Julia Ballou: The race to vaccinate hits a major setback. Promised doses not delivered.
--:-- Sean Rameswaram: Demand is far greater than the current supply.
--:-- Julia Ballou: At least a dozen states are now reporting vaccine supply shortages.
--:-- Sean Rameswaram: And California health officials are saying the state may not vaccinate all of its high-risk, high-priority seniors over 65 until June.
--:-- Julia Ballou: I think, yeah, we can imagine in the year ahead that there are at least two scenarios that could play out.
--:-- Sean Rameswaram: So one is countries do speed up the distribution process.
--:-- Julia Ballou: I feel confident that by summer we're going to be well on our way to heading toward herd immunity.
--:-- Sean Rameswaram: People start to get vaccinated in really high numbers.
--:-- Julia Ballou: And between them and the people who already have some immunity from prior infections we slow the spread of the virus
--:-- Sean Rameswaram: We also get into the warmer months in the northern hemisphere and people start to go outside and that also helps
--:-- Julia Ballou: So by maybe next autumn, winter, we're in much better shape.
--:-- Sean Rameswaram: Scenario two is we don't get our act together with the vaccine rollout.
--:-- Julia Ballou: Distribution continues to be painfully slow and that high-income countries continue to hoard the vaccine and delay access for the rest of the world.
--:-- Sean Rameswaram: Wealthy countries with just 14% of the world's population have bought more than half of the doses of leading vaccines.
--:-- Julia Ballou: And then at the same time, the virus is constantly evolving and we already have this evidence that there are mutations that might be really good at escaping vaccine protections.
--:-- Sean Rameswaram: One researcher in South Africa tells CBS News the strain is almost like a new pandemic and may require recalibrating the vaccines, much like is done with the annual flu shots.
--:-- Julia Ballou: In that scenario, even toward the end of this year, things aren't looking great.
--:-- Sean Rameswaram: And we're sort of in a similar place that we are right now.
--:-- Julia Ballou: I mean, everyone wants to get back to normal. But really what we're talking about when we talk about normal is getting to a place where we have herd immunity.
--:-- Sean Rameswaram: And we had Dr. Fauci on late last year, and he said he expects herd immunity to be something like 75, 85 percent of the population getting the vaccine.
--:-- Julia Ballou: Is that still the prevailing knowledge on herd immunity?
--:-- Sean Rameswaram: I think Dr. Fauci has actually been increasing his estimates for herd immunity.
--:-- Julia Ballou: And I think the most recent thing he's been saying is that it's something like 80 percent plus of Americans need to be vaccinated and others have estimated even higher numbers.
--:-- Sean Rameswaram: But I think we should probably be hopeful.
--:-- Julia Ballou: The basic point is that the vaccines are definitely going to help eventually, but it might not be this on off switch.
--:-- Sean Rameswaram: There'll probably be this period where we see a lot of people vaccinated in the U.S. and we can start to ease some of the measures but not fully lift our foot off the pedal.
--:-- Julia Ballou: But we still have a long way to go.
--:-- Sean Rameswaram: It's something like 6% of the U.S. population now that's had a vaccine.
--:-- Julia Ballou: And let's talk about these new variants of the disease.
--:-- Sean Rameswaram: I mean, do we know how the vaccine holds up against mutations?
--:-- Julia Ballou: Scientists around the world are racing to figure this out right now.
--:-- Sean Rameswaram: And what we know so far is mostly based on essentially studies in test tubes where they take blood samples from people who had a prior infection.
--:-- Julia Ballou: And then they challenge it with the new variant.
--:-- Sean Rameswaram: And then they see how whether the antibodies from that prior infection, how they respond to the new variant.
--:-- Julia Ballou: The studies on the variant that was discovered in the UK are suggesting that one's not a big concern for challenging these antibodies that we might have.
--:-- Sean Rameswaram: But the South Africa variant is emerging as a big concern.
--:-- Julia Ballou: We need to know what this means for people who have been vaccinated and that we don't know yet.
--:-- Sean Rameswaram: But yeah, the virologists I talked to in South Africa who are studying this are really concerned.
--:-- Julia Ballou: How easy will it be to adapt the vaccine to the mutations?
--:-- Sean Rameswaram: The two vaccines that are on the market are mRNA vaccines, and the companies behind those say that their technology is actually really well positioned to adapt the vaccines to new variants.
--:-- Julia Ballou: That's good news.
--:-- Sean Rameswaram: That is really good news.
--:-- Julia Ballou: I think that the concerning part, though, is that you just don't want to be in this catch-up position.
--:-- Sean Rameswaram: Okay, so let's just say that the vaccine does hold up against most of these mutations.
--:-- Julia Ballou: We get a lot better at vaccinations across the globe, not just in rich countries, but in poor ones.
--:-- Sean Rameswaram: And that the rich countries start doing a much better job of vaccinations than they have been thus far.
--:-- Julia Ballou: That means, though, eventually we get to start easing up, right? Be it later this year, be it early next year, sometime?
--:-- Sean Rameswaram: I think that's right, yeah.
--:-- Julia Ballou: Tell me this isn't forever, Baluz.
--:-- Sean Rameswaram: This isn't forever.
--:-- Julia Ballou: This is going to end, and we just need to hang in there for a little bit longer.
--:-- Sean Rameswaram: And maybe it's not going to end as soon as we would have hoped, but it's going to end.
--:-- Julia Ballou: Thank you.
--:-- Sean Rameswaram: You know, the positive thing we should say is like there's a new administration that for the first time has a national COVID strategy.
--:-- Julia Ballou: People are taking this seriously.
--:-- Sean Rameswaram: They're not denying that there's a real threat out there.
--:-- Julia Ballou: And so hopefully we're going to start seeing the fruits of that soon as well.
--:-- Sean Rameswaram: What do you think we'll be talking about a year from now when we have you on to talk about what we got right and wrong in this episode?
--:-- Julia Ballou: That's a hard one, but I think maybe we'll be wrong about the threat the mutations pose to the vaccines.
--:-- Sean Rameswaram: Maybe it'll turn out that they're not as great a threat.
--:-- Julia Ballou: Yeah, maybe the virus will continue to evolve in ways we can't even imagine.
--:-- Sean Rameswaram: We'll probably learn a lot more about how it affects our bodies and our health.
--:-- Julia Ballou: But one maybe hopeful place to end is that we know what to do now to fight this virus, and we now have an administration in place that isn't denying the threat it poses or the science of COVID-19.
--:-- Sean Rameswaram: We've seen other places where when leaders act decisively, when they have a plan in place and they execute it, they can successfully contain the virus.
--:-- Julia Ballou: We saw that in New Zealand, in Vietnam, you know, in other countries around the world.
--:-- Sean Rameswaram: And maybe we'll have that in the U.S. too and we'll be in a much better place than we can imagine a year from now.
--:-- Julia Ballou: Thank you.
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