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--:-- Sean Rameswaram: Subject to credit approval, AppleCard is issued by Goldman Sachs Bank USA, Salt Lake City Branch. Terms and more at AppleCard.com. Julia Blue, senior health correspondent at Vox. When we spoke a week ago, we had hundreds of people sick on one cruise ship off the coast of Japan and potentially a bunch of sick people who had just been let off another cruise ship in Cambodia. You said it might have been the tipping point for what's now being called COVID-19, was it?
--:-- Julia Blue: Unfortunately, yes. So we've seen the battlefront against this virus go completely global in the last week. And if you remember, when we first started to talk about this coronavirus, it was really heavily concentrated on China. And most of the countermeasures against the outbreak there were focused on people coming from China or within China itself. And what's different now is that the number of people being diagnosed with the virus outside of China has been surging and the rate of new infections in China seems to be going down. So as of today, there are more than 81,000 cases of COVID-19 in 40 countries and territories. And that list includes countries as far and wide as Bahrain, Afghanistan, Switzerland, Brazil, even my home turf here in Austria. As of yesterday, they found cases here.
--:-- Julia Blue: And there are particularly worrisome outbreaks happening in Italy, Iran, and South Korea right now, because basically overnight in these three countries, they went from only zero or a few cases to more than 1,000 cases in South Korea. And so that's why on Tuesday, the Centers for Disease Control and Prevention in the U.S. warned Americans to brace themselves for more spread of the virus in America. Do we know how it got to so many other countries? Was it that one cruise ship that let its passengers disembark in Cambodia? Or is this just more of like a natural spread of this virus?
--:-- Julia Blue: I think it's the latter. What's worrisome now is that a lot of the cases can't be traced back to any particular place. They seem to be occurring locally, what epidemiologists call community spread in different countries. Is this a pandemic yet? Is that word being used officially? That's what it looks like. So a pandemic means a new infectious pathogen is spreading in multiple regions of the world. And no health body has used the P word yet. But a bunch of the public health and infectious disease experts I've been talking to are saying we're either on the brink of a pandemic or it's already happening.
--:-- Julia Blue: And what that means is that containing the virus, so fully halting its spread, may no longer be possible. And countries are going to start shifting their strategies from focusing on containment, so using things like travel restrictions and whatnot, to mitigation, meaning doing things that will minimize the harm that local outbreaks can have. So that's things like preparing to take care of thousands of sick people, figuring out how to protect the most vulnerable populations, making sure hospitals are ready, all of those types of measures.
--:-- Julia Blue: Who gets to decide whether this is called a pandemic or not? Traditionally, it's the WHO who would declare an outbreak a pandemic, but a spokesperson there told me they no longer use this formal definition. And that's because of lessons learned during, do you remember the swine flu pandemic in 2009? Sure. Yeah, so they used the P word then, and the disease turned out not to be very deadly. And they were accused of inciting fear and causing all kinds of disruption to the global economy. So it's unclear whether they're going to make a formal pandemic declaration.
--:-- Julia Blue: But several global health organizations are now working out an official definition of a COVID-19 pandemic. And in the meantime, we're probably going to start to hear the word used informally more and more. Does this mean that a lot more people are going to die? Saying a disease has gone pandemic doesn't say anything about its severity. So it means that large swaths of the world are now exposed to this new pathogen, and we're going to see it spreading more broadly. But it doesn't mean a lot of people are going to die. And we still don't know how deadly this virus is.
--:-- Julia Blue: So in China, the case fatality rate has been hovering around 2%. And outside China it looks like less than 1% according to the WHO. And as countries start to look for more cases, especially cases that aren't linked back to China, they'll probably identify more people with mild and asymptomatic disease and that death rate is going to continue to drop hopefully. You mentioned that there's major outbreaks in South Korea, Iran, and Italy. Can we walk through what's going on in each of those countries and how they're trying to contain COVID-19?
--:-- Julia Blue: Yeah, let's do that. So South Korea is home to the largest outbreak outside of China right now. They went from around 30 cases last week to more than 1,200 as of Tuesday. And many of the cases there have been traced back to members who are part of a religious group and then their family members and contacts. And on the weekend, the country's president put South Korea on its highest alert over the outbreak. So thousands of community centers and daycare facilities have closed. The government is restricting outdoor rallies. They're asking churchgoers to stay home or gather online.
--:-- Julia Blue: And one important thing is that South Korea is a liberal democracy so they haven't been taking the same kinds of measures as China in terms of completely locking cities down. Instead, they've been advising people who have respiratory symptoms to stay home and self-isolate. So there are reports that at the outbreak's epicenter, shopping malls, restaurants, and cafes are basically empty right now because of fear of the virus.
--:-- Julia Blue: Iran is less of a liberal democracy. How is this going there? So this is the biggest outbreak in the Middle East. And it became clear that Iran had a big problem when travelers with the virus started to turn up in other countries. And now they have the most deaths outside of China at the moment, which suggests that many of the cases there haven't even been identified yet. And I should say, as of today, they have 139 cases. And disease modelers have estimated that there are thousands and thousands more because of the fact that they've already exported cases to so many countries.
--:-- Julia Blue: So schools and universities across the country are being closed. Cinemas and restaurants are shutting down. We're also seeing countries in the region close their borders to Iran and cancel flights. So that includes Turkey, Armenia, Pakistan, and Afghanistan. One worrisome thing there is that there have been reports and concerns that they aren't accurately reporting cases. So yeah, we'll see what happens there in the coming days and weeks.
--:-- Julia Blue: And what about this third major outbreak in Italy? Italy now has the biggest outbreak in Europe with 322 cases. And it seems to have started in a town called Codogno, which is just south of Milan in Italy's Lombardy province. And since then, people have been diagnosed with the virus in other parts of Italy, but more importantly, cases are also turning up around the world that are linked back to Italy, suggesting the outbreak there might be much bigger.
--:-- Julia Blue: So people with the virus have turned up in Austria, Brazil, the Canary Islands, and they've all been linked back to Italy. On the Canary Islands off the eastern coast of Africa, more than a thousand tourists are trapped in a hotel because an Italian guest came down with the virus. And Italy has taken measures that are closer to China than to South Korea. So they've imposed pretty severe quarantines to stop the virus. And cities in this northern region have been put on lockdown. So people are barred from entering or leaving the affected areas.
--:-- Julia Blue: They've also canceled sporting events and cultural events. Museums have shut down. Venice's famous Carnival, which happens every year at this time of year, has ended early because of the outbreak. So yeah, things are not looking so good in Italy and they're definitely taking a more severe approach to stop the outbreak.
--:-- Sean Rameswaram: How's the rest of the world bracing for impact here? The rest of the world should be bracing. So that was the message from the WHO on Tuesday. They said the rest of the world has to be prepared for outbreaks showing up within their borders yesterday basically like we need to be preparing as soon as possible and this is not the time to focus on what word we use that will not prevent a single infection today or save a single life today this is a time for all countries communities families and individuals to focus on preparing
--:-- Julia Blue: We must focus on containment while doing everything we can to prepare for a potential pandemic. Again, the CDC came out with a similarly kind of bleak message saying, you know, we have to brace ourselves for spread and disruption in the U.S. to people's daily lives. We expect we will see community spread in this country. It's not so much a question of if this will happen anymore, but rather more a question of exactly when this will happen and how many people in this country will have severe illness.
--:-- Sean Rameswaram: People have long predicted that a pandemic would completely disrupt the global economy, and we're already seeing that happen. So we're seeing markets tumble this week over concerns about the virus. Companies from Guinness to Apple and Danone are warning that this outbreak is going to affect their bottom line. Yeah, there's concerns about pharmaceutical supply chains and auto parts supply chains linked back to China. And this is just really the beginning.
--:-- Sean Rameswaram: Who's most at risk here? Is it elderly people? Is it people who are already sick? Is it babies? Is it middle-aged people? Who is it? Yeah, if we're talking about individuals, this disease seems to be particularly hard on the elderly. So in the data we have from China, we've seen the risk of death increase with every decade after the age of 50. And they're also finding that people with underlying health conditions are at a greater risk. So these are the vulnerable populations that countries really need to be thinking about how to protect.
--:-- 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. 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: After the break, what a major COVID-19 outbreak might look like in the United States? Support for today's show comes from Adio. What is Adio? Adio is an AI-native customer relationship management system built specifically for the next era of companies. They say it's extremely powerful, adapts to your unique data structures and scales with any business model. According to Adio, Adio takes less than a minute to set up, And within seconds, you will have your email and calendars synced. You'll see all your relationships in a fully-fledged platform, they say, all enriched with that actionable data.
--:-- Sean Rameswaram: And they say you can build AI-powered automations and use its research agent to tackle some of your most complex processes to seize so that you can focus on what matters, building your company. You can join industry leaders such as Flatfile, Replicate, Modal, and so much more. You can go to atio slash todayexplained to get 15 off your first year That attio slash today explained
--:-- Sean Rameswaram: Not all journalism is the same. Take The Guardian. Our coverage has something unique. Fierce independence. Nobody owns us or tells us what we can and can't say. So we're free to report the whole picture. We connect what's happening in Washington to the rest of the globe. expose corruption wherever we find it, and give fresh perspective on everything from wellness and soccer to culture, the climate, and more. Read, watch, and listen to The Guardian for free at theguardian.com.
--:-- Sean Rameswaram: Brian Resnick, you've been writing for Vox about what a coronavirus outbreak in the United States would look like. Let's start with how many cases of this COVID-19 we have in the country at this point. So the numbers are small so far. So it was roughly like around 14 or, you know, it's like a dozen or so people in the United States who have this disease. And then there's another 40 or so people who have contracted this disease from outside the United States and now they're in the United States. But we now know that this is likely to get worse.
--:-- Sean Rameswaram: Yeah, this week the CDC really stepped up his messaging on this topic saying that it's a when now, not an if, to see community spread within the United States. How prepared is Donald Trump to deal with something like this? So I have three things in mind when you ask that question. One is, well, there used to be this White House office in charge of pandemic prevention and response under Obama, which Trump eliminated. So there's not a White House office specifically about coordinating this.
--:-- Sean Rameswaram: Two is I spoke to Ron Klain, who was Obama's Ebola czar. So he was a person. There's a lot of branches of the federal government that could potentially respond to an outbreak. And Ron Klain was like this one person who kind of coordinated the response in the federal government. Trump could appoint someone like him to do that for this. Three is kind of a worry. Because one and two weren't worries? Yeah, yeah. Three is more like thinking about how Trump has acted in the past when the advice of his scientific organizations contradict the messaging he might want to put out.
--:-- Sean Rameswaram: So I'm thinking about Sharpiegate. Sharpiegate? Like a marker? Yeah, yeah, yeah. Remember in September, there was this hurricane forecast for a hurricane that was looking like it was going to hit Florida or it was, like, coming up the East Coast. And Trump had tweeted that Alabama was in the forecast range. And that was never true. The forecast never included Alabama. Remember the last two days how we got into a disagreement with the National Weather Service where he tweeted the storm was going to hit Alabama and they said, what? No.
--:-- Sean Rameswaram: I do remember this. We'll take a closer look at Trump's outdated map from last Thursday morning. He, in like this little press gathering, showed the press the map that had the hurricane forecast. And then it looked like there was like a sharpie drawing to make the hurricane forecast encompass Alabama. He gave the storm a boob job. I tell you, a couple of high hard ones. And it was like this classic Trump moment where, you know, what was he trying to do there? Just like prove he was like right all along? Like he actually took a map from one of his scientific organizations, NOAA, which is the National Oceanic and Atmospheric Administration, and altered it.
--:-- Sean Rameswaram: Like altered the science, altered, you know, and places like NOAA or the CDC, Centers for Disease Control and Prevention, exist to help the public. Like, they need to have the public's trust and not have their science undermined. And, you know, already we're seeing reports I saw in The Washington Post that Trump is furious that the coronavirus is impacting the stock market. And, you know, I'm kind of starting to get a little nervous that Trump's messaging on this might start to contradict the CDC.
--:-- Sean Rameswaram: You know, when he asks, is Trump prepared? Like, is he prepared to confront the truth of a virus that doesn't care about international boundaries, that doesn't care about state lines, that doesn't care about stock markets or the economy or his reelection prospects? Like, is he prepared to confront a virus? Well, what might the administration's actual response look like? So the federal government does play a really important role in the response to an outbreak.
--:-- Sean Rameswaram: The biggest one is just having the CDC, which is the world's premier scientific disease expert investigations. Like, they provide such a critical role in defining what a case of a virus is, sending out test kits to make sure, like, if somebody comes into a hospital or a doctor's office who think they have this virus, they can get confirmed and then protect their family members. So that function in the government is going to continue, and they're going to provide that critical information to make sure we can get a handle on this outbreak.
--:-- Sean Rameswaram: And also, what the Trump administration can do, they can appoint a czar or somebody who oversees the federal government's response to the pandemic. The federal government also maintains a strategic stockpile of medical supplies like respirators. So in the case of emergency, when hospitals and local authorities get overwhelmed, like there are stockpiles of equipment that can help save lives and that can be deployed. So the federal government can help and hopefully it will be mindful of these things and act.
--:-- Sean Rameswaram: But something that I was kind of surprised to learn in talking to a lot of experts was that the power of public health really doesn't rest with the federal government. But really the power of public health and to enforce public health rests with the states. The states. Yeah. Like per the 10th Amendment of the Constitution, any power not explicitly given to the federal government is given to the states and public health is one of them.
--:-- Sean Rameswaram: So does that mean that we're going to see a patchwork of responses in the United States that Texas is going to respond one way and Alabama might respond differently? Absolutely. Yeah. So like it's generally a state power to issue quarantines. You know, the CDC might advise that communities do something called social distancing, which is basically avoid mass gatherings of people. So local governments could cancel concerts. They can cancel sports events. You know, and it can even go even more local than like a city or state government.
--:-- Sean Rameswaram: Like any school board can cancel a school. And it's also worth noting, like, each state has different laws on the books on these things. So it could get a little chaotic in that I was reading this recent review of the laws among all the states. And, you know, some states don't provide good protections for civil liberties. They don't provide like the right to a council for a quarantine. Not all states like provide protections for like if you quarantined and you can go to work. Not all of them provide protections for you to keep your job.
--:-- Sean Rameswaram: And, you know, quarantine and these social distancing measures should be thought of, like, as a type of jury duty, like a civic responsibility to make sure, like, infection doesn't spread. But unfortunately, you know, because of this patchwork, it could play out, like, kind of unfairly for some people. What are the chances that we see something like what China has in Wuhan, where they shut down, quarantine an entire city? Could that happen in the United States? Might Austin get quarantined or even New York City? I'm told no. I'm told that is extremely unlikely.
--:-- Sean Rameswaram: And that's something China can do because it has this authoritarian top-down rule. But we have this federalized system where each city and state is going to be making decisions for his own community. And I'm told that has pros and cons. A pro is that it is flexible. So like New York City, which dealt with typhoid Mary, they dealt with polio, they've dealt with it. They've seen everything. They can just start on a response and they don't need permission from the federal government. They are the experts there in New York City and they have the power to enact a public health response.
--:-- Sean Rameswaram: The con is that New York City might do a great job in responding to a virus, but New Jersey or Connecticut or any other state that borders it might do less of a good job. And viruses don't really care about state lines, so they can cross them and, you know, continue to spread. What are we likely to see here then? Yeah, so like the CDC was pretty clear on this, that you should be prepared for things like your child's daycare being closed or for schools being closed or for you to have to telework.
--:-- Sean Rameswaram: So be prepared to not be allowed to go to places where a lot of people congregate. Congregate, be prepared for potential concerts to be canceled, for sporting events to be canceled. The CDC was pretty clear about, you know, if you have a kid, go call their school and ask them, what is their plan for an outbreak? The idea is to think about the contingencies now. If you basically are forced to stay in your home for longer than you'd like, how does that impact your life? And you should start thinking through that.
--:-- Sean Rameswaram: There are also, like, just general pandemic precautions that the CDC emphasizes, like, always, which is, you know, cover your coughs and wash your hands. And if you are feeling sick, just stay home. Like, don't interact with people. Interacting with people is how viruses spread. Thankfully, Vox has a generous remote work policy. Yeah. I at least want one day off if there's a pandemic. Like, it's a little, like, just give me, like, one okay thing if a horrible thing is going to happen.
--:-- Sean Rameswaram: Brian Resnick, always a pleasure. Thanks, Sean. Brian Resnick is a senior reporter here at Vox. He mostly covers science from the office, though he sometimes has been known to work remotely. I'm Sean Ramasvuram. It's Today Explained. The rest of the team includes Bridget McCarthy, Afim Shapiro, Jillian Weinberger, Amina Al-Sadi, Halima Shah, and Noam Hassenfeld, who makes music too.
--:-- Sean Rameswaram: Cecilia Lay checks our facts, and I can't forget the mysterious Breakmaster Cylinder. The first time I ever collaborated with Breakmaster was five years ago. I was hosting a podcast called Sideshow at Studio 360, and I was throwing this big event at WNYC to honor my favorite NPR newscaster, Lakshmi Singh. I had started a meme in her honor to talk about diversity in public radio. I called it the Lakshmeme. You can check it out on the gram. I'm at Ramas firm.
--:-- Sean Rameswaram: Breakmaster Cylinder made some music for the dance party at the end of the show. Anyway, today is NPR's 50th birthday. A historic moment unfolded just moments ago. So many members of our team are connected to NPR, worked there, interned there, started at a member station, met their husband there, you name it. Our show probably wouldn't even exist were it not for public radio.
--:-- Sean Rameswaram: So as a little tribute, I thought I'd play the song Breakmaster made for my live event five years ago. If you love it, you can find it on Bandcamp. That's a website. Go there and search for the NPR drop. You can even support Breakmaster Cylinder's work and buy the song there. And you should always, always, always support your member station. Happy birthday, boo. From NPR News in Washington, I'm Lakshmi Singh. Thank you.
--:-- Sean Rameswaram: The track just sounds so hot. I'm writing my own stuff, sitting in front of the computer, and then pulling up all the wires. It has a sound to it. That sounds pretty nice. Apparently you have a tremendous impact. A tremendous impact. A tremendous impact. A tremendous impact. A tremendous impact. A tremendous impact. A tremendous impact. Now the White House turns its attention to finding someone to let the bass kick. Bass kick People you know, me and then they found me high since 20 years ago. Blasphemous, but it sounds nice.
