--:-- Sean Rameswaram: It's Thursday, April 16th, 2020. Happy birthday, Dad. I'm Sean Rameswaram, and this is your coronavirus update from Today Explained. Let's spin the globe. We'll start with the biggest planet on Earth, Facebook. The company today said it has removed hundreds of thousands of posts featuring conspiracy theories and medical misinformation about COVID-19. People who interacted with the bad stuff are going to get notifications and links to good stuff from the World Health Organization. Check your sources, people.
--:-- Sean Rameswaram: Japan's Prime Minister Shinzo Abe declared a nationwide state of emergency today, extending one that was already in place in the country's major cities. COVID-19 is spreading there, but the country has not imposed lockdowns like we've seen elsewhere. Despite sharing a border with China, Vietnam has fewer than 300 COVID-19 cases and zero reported deaths. According to NPR, that's because of early quarantining, aggressive contact tracing, and some serious consequences from a one-party communist state.
--:-- Sean Rameswaram: Russia's postponing a big military parade, even though Vladimir Putin really, really didn't want to. He's now saying the risks are just too high. Infections continue to rise there. The United Kingdom is extending its lockdown by at least three weeks. The British government thinks the country is nearing its COVID-19 peak. And back in the United States, we got new jobs numbers today. 5.2 million people filed for unemployment last week, bringing the total over the last month to about 22 million.
--:-- Sean Rameswaram: The Washington Post is reporting that millions of Americans who were expecting stimulus checks via direct deposit on Wednesday didn't get them due to a glitch in the IRS payment matrix. The Post says a number of parents didn't get their $500 checks for dependents as well. The IRS and Treasury Departments say they are working on it. The president is scheduled to speak about reopening the country later today.
--:-- Sean Rameswaram: That's all while the governors of several states on the East Coast are extending lockdowns until mid-May. Much more on what it will take to properly and safely reopen the country in today's show. And before we get to the show, you've probably heard that New Yorkers applaud their essential workers from their windows and doorsteps and stoops every night at 7.
--:-- Sean Rameswaram: Tonight, a group called Peace of Heart Choir wants to dial it up a notch. Here's the idea. After a clap and a cheer, everyone does their best Sinatra and belts out New York, New York at the top of their lungs. You can sing along to the song Tonight at 7 via WKCR889, WBAI 99.5, or join in from just about anywhere on the planet at the New York Sings Along event page on, where else? Facebook.
--:-- Sean Rameswaram: The greatest city in the whole world. Start spreading the news. I'm leaving today. I want to be a part of it New York, New York These vagabond shoes They are longing to stray Right through the very heart of it New York, New York I want to wake up, Manny In a city that doesn't sleep.
--:-- Sean Rameswaram: Support for Today Explained comes from BetterHelp. Let me tell you a true story. Last weekend, I got an email from a listener who wanted to discuss their problems with me. And I said, look, I don't think that this is about me personally. At least I hope it's not. Why don't you try BetterHelp.com slash Explained. Absolute truth.
--:-- Sean Rameswaram: As the largest online therapy provider in the world, BetterHelp can provide access to mental health professionals with a diverse variety of expertise. Find the one with BetterHelp. The one is not me, guys. Our listeners get 10% off their first month at BetterHelp.com. That's BetterHelp.com.
--:-- Sean Rameswaram: The only thing President Trump really wants to talk about is when and how the country opens back up. One day, he's got all the power to do it. The next day, he's going to cooperate with governors. The deadline keeps getting punted. What's clear is he doesn't really have a plan to fight this coronavirus.
--:-- Sean Rameswaram: But Zeke Emanuel does. He's an oncologist, a bioethicist, and was a health policy advisor in the Obama administration. The first thing I asked him was, is the country even ready to open back up?
--:-- Zeke Emanuel: No, it's not ready on two accounts. First of all, we have too many new cases still of COVID-19. While we've probably bent the curve, we're still high up. And you can't even think about reopening the country until you've come down the back end of that curve. That'll take another four to six weeks. It's a bell-shaped curve for your audience. So what goes up has to come down in exactly the same arc.
--:-- Zeke Emanuel: So that's part one. And part two is we need a kind of infrastructure that allows us to move from mitigation, that is reduce the number of new cases and deal with the cases we have, to containment. When a new case pops up, isolate them, find the other people they've been involved with and try to limit the spread of the virus.
--:-- Sean Rameswaram: So what we really need to do is to take the time we have now and get that infrastructure ready, and there's no evidence we're doing that. What we know is that testing is something like 150,000 people per day, which is a slight improvement from a few weeks ago when it was 100,000 or so a day.
--:-- Zeke Emanuel: So we've gone from doing not remotely enough to slightly more than that. We need to change substantially the who we test, not just the numbers. When I tell you how we change the who, you'll see that the numbers have to go up substantially.
--:-- Zeke Emanuel: So right now we're testing people. The top categories are all people who we suspect have COVID-19 because of symptoms. Healthcare workers, frontline healthcare workers because of symptoms. New patients because of symptoms. People over 65 because of symptoms. People with comorbidities like hypertension or heart disease or diabetes because of symptoms.
--:-- Zeke Emanuel: That is we using the test to treat people. Really important but bad if what you want to do is open the economy and limit the spread of the virus. If you want to limit the spread, you have to do a different form of testing and testing different people.
--:-- Zeke Emanuel: You have to focus in on testing frontline workers who are actually interacting with a lot of people, everyone in the hospital, grocery workers, you know, frontline responders, policemen, firemen, people who are going to go back into the office, people who are going to work in restaurants.
--:-- Zeke Emanuel: Those are the people who need to be tested because you got to clamp down if any one of them is positive because they're interacting with, if not hundreds of other people, certainly scores of other people. Then when you say, all right, if I got to do all these frontline workers and grocery workers and restaurant workers, how many of them are there?
--:-- Zeke Emanuel: And let's say I want to test them every week to be, you know, reasonable. Three to four million frontline health care workers who have contact with patients every day. Three million grocery workers. You know, you're already at seven million people. That's a million tests a day per week.
--:-- Sean Rameswaram: And you haven't even talked about the policemen, the firemen, the people going back into their office. Is it your sense that we're never going to get there, that the president doesn't see that as a priority?
--:-- Zeke Emanuel: I don't quite, you know, people have been asking me this question, And I just can't figure out what the dilemma is. Is it an FDA dilemma? Is it now that LabCorp and Quest just have run out of reagents? They haven't done it. I just don't know what the limit is.
--:-- Zeke Emanuel: But there's clearly a big limit out there. I also think that the federal government, you know, there is some way in which it's abdicated its lead and responsibility in coordinating the national effort. And I do think that we need more careful, where are all the resources? Are we putting them in the right places?
--:-- Sean Rameswaram: Let's bring on more testing capacity. And that needs to happen. What's your sense of the supply of personal protective equipment at this point? I mean, you're talking about a massive ramping up of testing that we still haven't reached.
--:-- Zeke Emanuel: It depends what you mean by have it. One of the habits is, are you changing your N95 mask between patients? The answer to that is clearly no. People have been given an N95 mask and, you know, this is your mask for the year kind of thing.
--:-- Zeke Emanuel: Well, that that is not a good practice. I watched a CBS reporter in a news segment go into a New York hospital and he was interviewing a nurse. And she was telling the reporter, I'd like a mask like yours. I'd like all of us to have masks like yours and these white suits like you have.
--:-- Zeke Emanuel: Look at your hazmat suit. Look at what I'm wearing. And the reporter says, what is that? It looks like a garbage bag. Yeah, it is a garbage bag. I'm wearing a trash bag. We have on garbage bags and you have on very fancy stuff.
--:-- Sean Rameswaram: Yeah. Are you talking about just the states like South Dakota, North Dakota, Nebraska that haven't made formal shelter in place policies? Are you talking about cities and states that have them in place, too?
--:-- Zeke Emanuel: Cities and states were late to put them in place. You're still on the exponential growth curve, maybe delayed a few days than what you would have done with no shelter in place. But you didn't do shelter in place in time.
--:-- Zeke Emanuel: You know, that was clearly the case in New Orleans where they let Mardi Gras happen. They, you know, then got on the exponential curve. Parts of Florida, you're going to see a lot more. So, you know, it's going to pop up around the country.
--:-- Sean Rameswaram: Is the United States particularly disadvantaged here because of how much autonomy the president has given the states in this situation? I mean, Italy was late to implement social distancing, but once they did, they really clamped down. Obviously, we're not doing that.
--:-- Zeke Emanuel: Will that affect the entire country's ability to proceed? People travel. And if you don't clamp down everywhere and have a national shelter in place policy and have a president who's trying to persuade every governor and giving governors cover to do it, that's how you get a national policy.
--:-- Zeke Emanuel: And if you don't have a national policy and someone from, you know, South Dakota who happens to be positive but asymptomatic goes to someplace that doesn't have a high level, interacts with a lot of people, you could have another explosion in those places. And that's how it's happened.
--:-- Sean Rameswaram: People who were in China came back or people who were in Europe and got it in Europe came back and, you know, just a few people spread it around. And all public health people think, all right, we relax the physical distancing. We allow non-essential businesses to open. People go back to work.
--:-- Sean Rameswaram: We even allow some large crowds like religious services. And you will definitely have a recrudescence of the disease. If we can't get our testing ramped up, we're never going to get to contact tracing. And contact tracing is the next step. That's after the break on Today Explained.
--:-- Sean Rameswaram: Support for Today Explained comes from Built Rewards. These days, it seems like everybody has a rewards program. You swipe your card and you get one cent on the hundred dollars. But with your rent, frequently, you just pay month after month. You never get anything from it other than that roof over your head. Not anymore, says Built Rewards.
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--:-- Sean Rameswaram: Support for this show comes from Macy's. It's almost fall, and that means it's time to cycle your wardrobe to the cold setting. Because while everyone loves a breezy summer outfit, let's be real. Layering is even more fun. That's why Macy's Fall Fashion Guide has everything you need to piece together the perfect look for you.
--:-- Sean Rameswaram: It's your one-stop shop for fall's latest trends and must-haves, curated by their experts. Add a statement shoe to your collection, like the calf-hair loafers from Steve Madden. Or tap into your romantic side with flowy dresses from Cece and sheer pieces from INC.
--:-- Sean Rameswaram: You can even throw in some textural layers for contrast, like a faux fur bomber jacket from Karl Lagerfeld Paris. Whether your old favorite sweater or coat is on its last threads, or you're just craving a new vibe to switch things up, Macy's has got you covered this season.
--:-- Sean Rameswaram: Find the perfect layering pieces for you by exploring the Macy's Fall Fashion Style Guide. Shop in-store or online at macy's.com.
--:-- Sean Rameswaram: All right, so my understanding is that if we can't really get the social distancing piece figured out and the testing piece figured out, we're never going to get to the place where we can properly implement contact tracing, figuring out who's come into contact with people who have COVID-19.
--:-- Zeke Emanuel: No, no. Contact tracing depends upon being able to identify COVID-positive people and then look at their contacts rapidly. That's where technology really needs to come in and then get those people tested. That is the nature of the game.
--:-- Sean Rameswaram: And in this situation, because the virus travels so fast, You really need to have technology augment basically old-style gumshoe contact tracing.
--:-- Zeke Emanuel: Okay, so if we get the extended nationwide shutdown we need and testing on the massive scale we need and the PPE our essential workers need, none of which we have yet, how do you then trace contact?
--:-- Zeke Emanuel: You need technology to help us identify people who are connectors, who interact with a lot of people and have come close to a lot of people. That technology is, you know, Facebook and Google already have it, and they can probably give you a list of everyone you've come in close contact with.
--:-- Sean Rameswaram: And this is the thing that Google and Apple say they're going to collaborate on too? Yes, because you'll have it on the Android, you have it on the iPhone, but you don't need an app, they already know.
--:-- Zeke Emanuel: And then you need to have a list for everyone who's positive, be able to detect that list and probably send out a message that says, you've come in contact with someone who's COVID positive. That doesn't mean you're COVID positive, but you need a test.
--:-- Zeke Emanuel: You know, that's not rocket science. That's something the Google and Facebook engineers could probably do over a weekend if they really wanted to. And that is very, very important. But of course, none of us trust Google and Facebook with our data and we'd be very suspicious.
--:-- Sean Rameswaram: So we need some an independent, public, trusted organization to do it, to guarantee us it's not going to be commercialized. They're not going to keep the data on us. They're going to erase it so that our individual privacy is protected.
--:-- Zeke Emanuel: So a whole nother host of problems here. Even if we get to the point where we have the infrastructure, we have the third party, there's a good chance that Americans still won't want to volunteer their information to the government, to Google, to Facebook voluntarily, right?
--:-- Zeke Emanuel: Right. Trust is a big issue here. And, you know, there's probably half the population doesn't trust the government and half the population doesn't trust the tech companies. And so, you know, you have to find some other group that, you know, a three-way collaboration where one group that controls the data is some group that the public will trust.
--:-- Sean Rameswaram: And rumor has it the president's going to seriously speak about contact tracing for the first time later today. I'm guessing it's because he's, what, just been preoccupied with trying to reopen the country?
--:-- Zeke Emanuel: And maybe it's just that the attention has been on the testing issue, both the viral testing and now the serology testing that everyone seems to be focused on the antibody testing. Both are important, but they're not the only thing that they enable the contact tracing.
--:-- Sean Rameswaram: They enable isolation. But, you know, remember, the real threat here, the real threat to opening are the asymptomatic infected people. Yeah. Because they're the people unwittingly just go and spread it around.
--:-- Zeke Emanuel: And any one of us could be that person. And we need to basically focus in on that person and make sure that they isolate themselves for at least 14 days. Which we can't do without dramatically ramping up testing.
--:-- Sean Rameswaram: Correct. Which we show no signs of doing right now. Correct. And by the way, the third leg of the stool is to protect the particularly susceptible. Those who are older, those with serious comorbidities that we know give you a predilection towards getting the disease, vascular problems, diabetes, obesity, heart disease, asthma.
--:-- Zeke Emanuel: Does this keep you up at night? Well, you know, you got me on a day when I'm not particularly depressed. Last week, I was particularly depressed the whole week because of this, because I couldn't see a way out.
--:-- Sean Rameswaram: I do think we have the capacity to ramp up testing. I think the pressure will grow to ramp, change the guidelines under which we're operating, have the CDC change those guidelines. I think there are ways or solutions to the testing problem.
--:-- Zeke Emanuel: Is someone going to have to drag the president kicking and screaming? And if so, who is that someone? Is it Fauci? Is it Birx? Is it Newsom, Cuomo? Who is it?
--:-- Sean Rameswaram: Inslee? If I were a betting man, it's probably going to be the business community.
--:-- Zeke Emanuel: Here's what you have to do if we're going to open up. He's got all these business guys he's talking to. I think they're mostly guys. So I think if they say, listen, I'd be happy to get my people back, but I need you to do something to make that a more viable and safe, by the way, process for me.
--:-- Sean Rameswaram: That may be the dance that we end up having. And if that doesn't happen, can you just remind us in your estimation what this looks like? Is it a second wave? Do we even get out of the first wave?
--:-- Zeke Emanuel: Yes, we'll get out of the first wave because we're sort of sheltering in place. And it looks like the president has backed away from the May 1st opening. It'll be sometime in May or June 1st, something like that.
--:-- Sean Rameswaram: The numbers will have come down substantially. Then we're going to, you know, we're not going to be prepared. We're going to relax the physical distancing guidelines and rules. People are going to go out and you're going to have a second resurgence, probably sometime mid end of July early August kind of thing
--:-- Zeke Emanuel: That will depend heavily on how much risk people are taking I think in the last couple of weeks I heard more hesitation Like, you know, 41 people who were grocery store clerks died. Maybe there's something to this, and I don't want to rush out and be the first person out there going to a restaurant, sitting at a table.
--:-- Sean Rameswaram: You know, if the American public is hesitant and not assured that the safety precautions in, they might actually be very slow to restart the economy. And so I think we don't know how fast that resurgence might take place.
--:-- Zeke Emanuel: But if we don't have the proper regime to actually test, contact, trace, I can see Americans being hesitant. I've seen enough 27-year-olds who aren't supposed to get sick from this thing die. Maybe I'll be a little more cautious. We'll see.
--:-- Sean Rameswaram: Have you had an opportunity to speak with the president since this pandemic became, you know, a crisis?
--:-- Zeke Emanuel: I'd prefer not to answer that question. The answer is I have spoken to him, but not in the last four weeks.
--:-- Sean Rameswaram: Huh. What did you guys talk about?
--:-- Zeke Emanuel: COVID-19. Various proposals to intervene.
--:-- Sean Rameswaram: Did you feel like you convinced him in any particular regard?
--:-- Zeke Emanuel: I don't want to go into the details.
--:-- Sean Rameswaram: If you could talk to him today, considering everything you just told me about how far behind we are on testing still, how far behind we are on PPE still, what would you say?
--:-- Zeke Emanuel: Well, I completely agree with him that we need to reopen the economy. It's really important for all the Americans who lost their job. It's important to everyone. And try to explain why I think the testing has to go up and contact tracing and how you might do that.
--:-- Sean Rameswaram: And make a big impassioned plea that, you know, the only way you're going to convince Americans to do these things is if they have the assurity that they can be tested and the health care system will be there for them.
--:-- Zeke Emanuel: Did you ever think you'd see a pandemic like this in your lifetime in this country?
--:-- Sean Rameswaram: I was of two minds. So I began teaching at the University of Pennsylvania, and I used to teach a course called Rationing and Resource Allocation, where the rationing part was all about pandemic planning and how you would distribute all these goods like a vaccine, an ICU bed and ventilators.
--:-- Sean Rameswaram: And so I've been thinking about this and my students have been learning about this. And there's a line in that course in my slides that I show all the influenza pandemics in the 20th century, 1918, 1957, 1968. And I had a line that I would say, you know, we're overdue for a pandemic in this country. We've gone 50 years without one of these. We're going to have one.
--:-- Sean Rameswaram: And, you know, we had a near miss in 2009 with H1N1. I'm worried. So I'd always been thinking about it and always knew that there is a remote possibility. But if we have this remote possibility, the consequences are huge.
--:-- Sean Rameswaram: But I also was like, you know, like everyone else, it's a low probability event, huge consequences, but low probability. And I think as human beings, we're kind of crappy at planning for low probability, high impact events.
--:-- Sean Rameswaram: And I think we need to be better at that. It's like insurance. I don't buy insurance for a high probability event. I buy my insurance for a low probability event, but high impact. Yeah. We need to think about these kind of planning things like insurance.
--:-- Sean Rameswaram: So I've been thinking about this for 15 years. Did I actually think I'd live through this and have a role in it? No. Hmm. But I mean, this pandemic has made so painfully obvious so many dysfunctions in the United States from our social safety net to government preparedness to, you know, gross inequities.
--:-- Sean Rameswaram: It feels like an opportunity to maybe hit reset on so many things we're doing poorly or just not doing at all. Do you think we will?
--:-- Zeke Emanuel: There are three or four things that this pandemic has really made clear. I think first, it's made all of us insecure. The uncertainty, the insecurity is just palpable to everyone constantly.
--:-- Sean Rameswaram: The second thing is we're social beings and social life is critical to all of us. Not being able to be in the same studio with you doing this over the phone. It's like, I want to be with people. Having a Zoom, you know, happy hour is not a happy hour, right?
--:-- Zeke Emanuel: And I think people are really feeling hungry for that. And the third thing is we're all limited in our experience. Yes, I can be in my house and I can go out for the same effing walk over and over again. And not being able to have new experiences is degrading substantially people's happiness.
--:-- Sean Rameswaram: So I think the first part of your question is critical. It's security people want. So I do think we're going to have a reset. And I think we're going to have a reset around security. Our government, our country has to give us some security.
--:-- Sean Rameswaram: What does that security look like? Clearly, health insurance. Clearly, family leave. Clearly, unemployment insurance, whether you're in the gig economy or not.
--:-- Zeke Emanuel: Similarly, on social life, when this thing is over, you can forget virtual reality. What we want is reality. We want people. We want to rub shoulders with real other people.
--:-- Sean Rameswaram: Thanks so much, Steve. Take care, man.
--:-- Sean Rameswaram: I just want you to know that I miss you and I love you. Can't wait for this shit show to be over so that I can touch people, drink with people, and have the best life ever.
--:-- Sean Rameswaram: Zeke Emanuel is Vice Provost of Global Initiatives at University of Pennsylvania. He's also got a new podcast, Making the Call. It's Zeke and another bioethicist answering big questions about COVID-19. Go subscribe for more Zeke wherever you're listening to this. Again, it's making the call. I'm Sean Rameswaram for him. This one's Today Explained. Thank you.
