The Coronavirus: Keep Calm and Carry On

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Alyssa Hurst:

You're listening to RadioEd, a University of Denver podcast.

Lorne Fultonberg:

We're your hosts, Lorne Fultonberg,

Alyssa Hurst:

Alyssa Hurst

Nicole Militello:

And I'm Nicole Militello.
In today's episode we're talking about the new coronavirus. The mystery strain appeared back in December in China and has since spread to more than 40 countries across the globe, including the United States. So far we've see a scramble to contain the new coronavirus, economic fallout and a wave of xenophobia, but how concerned should we really be about this new virus? I sat down with professor Sandy Johnson, she's the director of the University of Denver's Global Health Affairs Program. We talked about everything from how countries are handling this outbreak to the race to find vaccinations and what she believes is the greatest risk we face in handling this outbreak. Thank you so much for being on the podcast.

Sandy Johnson:

I am so excited to be here.

Nicole Militello:

So let's start with what a coronavirus actually is because I was very fascinated to learn it can range from the common cold all the way to a much more serious illness like this current strain.

Sandy Johnson:

Yes, so coronavirus, you've probably read this in the news reports, they're named that way cause when we look at them under the microscope they look like a little crown. There are seven strains that we know of. Four of those strains are actually really quite mild. You had mentioned they're associated with the common cold. We do see that they are associated about one to 2% of the pneumonia cases in the United States, so it can be mild. They are associated with pneumonia. Now of course we have these three other strains, the first that really got global attention was SARS and that was about 2003. Little more than 800 cases ended up occurring worldwide that was a new strain of the coronavirus that we hadn't seen before and most importantly it behaved differently than the ones that we know of. It was associated with much more severe respiratory illness and what we saw was that it was impacting people that aren't our typical, vulnerable population. The other one that we have that we were concerned with is the Middle East Respiratory Syndrome, the MERS, so not SARS but MERS and 2014 was when we first saw that. It started in Saudi Arabia and we've seen clusters of that, that was scary because that is a very virulent disease. Case fatality rates with that are about 30%, but it doesn't seem to be as transmissible as other types of coronavirus and that hasn't really resulted in a pandemic. I think that people like you said, they don't realize that corona has been circulating in the U.S., we have four strains. It was interesting I was looking at Web M.D. last night they updated their site with new information and one of the doctors on the site said, "You know probably most of the people in the U.S. "have had a coronavirus and they didn't know it".

Nicole Militello:

Right. Yes, that's so interesting. So when a new coronavirus come onto the scene, how do we go from one person being diagnosed to suddenly it's a global outbreak?

Sandy Johnson:

It really depends upon the nature of the virus. How infective it is and how it's transmitted. So with the coronavirus that we're seeing right now the big issue is it's a respiratory virus, so that is the type that is most easy to spread from one person to another and I think that technology helps us and it hinders us. You know if this were 30 years ago, we wouldn't have the technology to be able to say this is a coronavirus, this has a different genetic strain than the other types of coronaviruses we're used to seeing. We'd probably look at this and say, " Oh, okay, we're having a weird flu", we wouldn't really be able to differentiate it. Technology helps us because it allows us to say, "OK, we're seeing something a little different, "let's do some testing on this". "Hey, it's a coronavirus." "Hey, let's do the genetic..." "Hey, this isn't what we've seen before." And when you see something new in public health that triggers an immediate response because we want to make sure we don't have kind of that dreaded mutant virus that's going to wipe out the world, you know the thing that Stephen King writes about in his horror novels, and just to be clear that is not what we're seeing. But we have the technology to start to follow these novel viruses to see how they spread. The more data we have the better off we're going to be, not just in understanding what's happening with the current virus, but potentially it's going to help us prepare for that really scary super flu that may never happen, but the more we understand how they spread the better we're able to develop our responses.

Nicole Militello:

OK, so what changes when the World Health Organization declares something a Global Health Emergency?

Sandy Johnson:

OK, so with the coronavirus a public health emergency of international concern is actually what the declaration is and that was something that's set up under the International Health Regulations that changed because of SARS, where it's a way to basically trigger a surge response. When the WHO declares a public health emergency of international concern, I don't know how else to say it other than PHEIC, it's basically telling the world we need to work on this together. A coordinated response is going to be best, those countries that have human and fiscal resources you need to harness those and you need to start sharing those with countries that don't have the fiscal or human resources that are going to be necessary and really it is about a surge response. We need to help each other and particularly we need to help countries or health systems prepare and help those that are weaker health systems. So if you think about what's happening with the coronavirus when this was declared we were still seeing really only cases in China, but the concern was this is highly infectious, this is something like a bad flu, we want different countries to heighten their surveillance first and foremost cause we want to see if this is all spreading from contacts that are coming from China, if we're starting to see this kind of appear from unknown sources. We want to see how then it's spreading through the countries and put everyone on alert for the fact that not only do we need heightened surveillance, we need to prepare our medical staff, we need to provide proper training for infection containment, we need to make sure we have appropriate protective gear. When the coronavirus appeared we didn't really know if we had any type of antivirals in our arsenal that would work against it. WHO wanted to get the research community to start focusing on this.

Nicole Militello:

OK, so it's really just making it a priority on the global stage?

Sandy Johnson:

Yeah, absolutely and trying to get different actors to work together.

Nicole Militello:

China has faced a lot of criticism for their transparency on this virus, what do you think about it?

Sandy Johnson:

I think China's actually done a very good job.

Nicole Militello:

OK.

Sandy Johnson:

And this is a huge debate in the public health community, we think that maybe the first cases in China were maybe late November, but we're not entirely sure. What we've seen reported from China was the first confirmed cases they had came in mid-December and China reported this at the end of December; they reported it to the WHO. I'm going to say that that's the appropriate thing because you don't want to have somebody come in that's sick and you immediately push the alarm button. You want to actually figure out are they sick with something we know about or are they sick with something random? Are they sick with kind of this new, mutant virus? If it's only one case, do you pull the international alarm and at least history suggests maybe that's going to cause more panic. So I would argue that China actually did due diligence, they did it quickly and they reported it to the international community quite rapidly. It's always easy I think to criticize, but when you are faced with the type of large, public health problem that China had you have to prioritize. One priority you're taking care of the patients. One priority you're communicating with your population. Another priority you're communicating appropriate information that's going to help other researchers around the world. I would argue that they've done that.

Nicole Militello:

What do you think about the job the United States has done?

Sandy Johnson:

I am a little mixed on it. In part because I think we haven't had great health messaging and I just say this: I think if you look at Singapore, at least some of the stuff that I've seen from South Korea, in terms of the public service announcements that have been out there, I think we're just starting to catch up with that. Personally, I've gone to the CDC website every day and I don't find their website particularly helpful. I just have to say we are adults. Let the country know what this is, be clear about what it can and can't do, and provide resources for people to feel a little bit more empowered in what they can do.

Nicole Militello:

I'm curious how big of a role you think a country's messaging plays into the success of containing an outbreak?

Sandy Johnson:

Huge. I think it's two things. I think it's the messaging and I think it's also the resources that are put forward. Michael Osterholm who is the head of a group at University of Minnesota that looks at infectious disease, he had an op-ed in the paper the other day and he referenced Singapore and the Singapore government I think I would agree has done a great job with the messaging and with making resources available. Singapore did this with SARS and when you go back to 2003 when we saw SARS spread and we saw cases show up in Singapore the Singapore government I think had a good campaign to educate people and knowledge is power and knowledge can help alleviate some of the fear, not all of that cause there's uncertainty. They told people what to do, they told them where the resources were. Singapore is also a very wealthy, small state. Singapore was able to put a lot of resources in to it and one of the things that the government had done was basically say self-quarantine, stay at home, we're closing marketplaces, but know that there's going to be price stabilization, there's going to be income support. Short answer the message is important, but the resources are also important.

Nicole Militello:

So North Korea claims to have no cases of the coronavirus. Talk to us about how handling an epidemic in a country like North Korea is different?

Sandy Johnson:

I'll just say, look at Iran. Iran is an authoritarian country, it is a country where there is a lot of government control of messaging, it is a country that does not have a very strong health system and it is a country that has areas that are pretty much disconnected from whatever health system exists there. Iran had no cases and then all of a sudden it had, I think I calculated it, it had a cluster of cases and that cluster of cases there were 14 deaths out of 60, so all of a sudden, oh Iran has no cases and then we have a 40, 50% death rate?

Nicole Militello:

Right.

Sandy Johnson:

OK, that means there's more than 60 cases there and that means it's been there for much longer. Whether it wasn't detected or whether it wasn't reported, it's hard to say, but the problem is when you have that type of secretive government and you have a poor health system, it's going to spread. It's going to spread even if you have a good health system. I have to say that, but it's going to appear much worse than it actually is. To go from zero to 14 dead in a week, that's scary. I think that that is the problem with North Korea. We have no idea how many cases are there given not just the border with China, but given the trade with China you know there are cases there. Does the country have the ability to detect the cases? Not likely, you know even in the U.S. in countries like this we're talking about the shortage of tests to basically confirm that this is the novel coronavirus. You know North Korea given what little we know of their health system, which is that it's not very good and they don't have particularly good surveillance and monitoring. Given that, there maybe cases and the government's like okay, it the flu or okay, looks like a cold that are actually coronavirus and you know the problem is we don't know how hot the area is.

Nicole Militello:

Right. There has been a big discussion about the economic impacts of the coronavirus, especially with it originating in China, the world's second largest economy, largest exporter of goods. Let's just talk about the fallout. I know this is a lot to unpack, so let's start with the impact on tourism and airlines. The International Air Transport Association estimates that the total global loss revenue due to the coronavirus could be almost $30 billion. What's kind of the fallout that we're seeing there?

Sandy Johnson:

So, I would say that the travel industry is the easiest industry to look at the impacts. The first things that we saw flights were being canceled to and from China. China in the first four weeks basically shutdown the tourism operators and said, "you cannot book package tours outside of China." We started to see a decreased demand for airlines. We also saw pushback from those who work in the airline industry saying, "We want to protect ourselves," so flights were cut. That's the start of it. You know, we're likely going to see more and more cuts in flights as corona spreads. You know, were already seeing reduced flights to and from Italy and now it's all over Europe. So we're gonna continue to see that. A number of airlines have posted I think fairly dramatic losses or expected losses because of the lack of demand, that's going to continue and we don't really know how bad it's going to be, but that's a direct impact. You think about tourism — we're starting to see the impact on hotels, not just because some of the hotels are going into lockdown, but again people aren't traveling, so the demand goes down. People aren't traveling or they can't travel because there are travel bans. You think about the service industry, that's dependent upon tourism, so that's going to play out in restaurants, that's going to play out in shops and there's going to be that multiplier effect through the community, which is not just going to impact income, but it's potentially going to impact employment. When you look at tourism different estimates say tourism is responsible for one in 10 jobs worldwide, so think of the number of people whose jobs are basically threatened. During this period of time how resilient are they? How able are they going to be to weather this? Do they have other employment opportunities? What happens? And that's gonna be both short and long-term that we're going to see that. I think for me the bigger concern is there are some countries that can certainly weather the storm. They have larger economies. I think China will ultimately be OK. Yes it's economy is gonna go down a little bit, but it has a large economy. It will be OK. Same thing with the U.S., not to dismiss what potentially can happen in the U.S. We're probably gonna see the economy shrink a little bit. You know Apple's already talked about reducing their projections, we'll survive that. What about these smaller countries? I was talking to a colleague of mine and he was talking about the impact with Kenyan Airlines. They had announced that they were expecting a loss of $80 million. That's huge. You think of some of these countries that are very heavily dependent on tourism that are much smaller. They're going to feel an impact and tourism is just one small strand.

Nicole Militello:

Right. So let's move on to trade. Do people need to worry if they did online shopping and they have an order coming from China? What are we seeing there?

Sandy Johnson:

OK, I think we're still figuring that out. What we're seeing is definitely supply chains are being interrupted and again that goes back to Apple saying our profits are going to be down because some of our parts are coming out of China. We're seeing a lot of conversation with global supply chain tied to essential medicines and tied to medical supplies. That's already been disrupted in part because those lovely little surgical masks that you get when you go to the doctor's office if you have a cold, many of the suppliers are in China. That's cut off. Not just the U.S., but many countries are actually dependent upon Chinese production for medicine. So many, like you have a computer in front of me and it's an Apple computer. You know parts in that computer are produced in China, so there's that potential for the supply chain interruption. We're seeing it with medical supplies, but also because there's a surge demand. The Chinese government is trying to reopen manufacturing plants. You know they're trying to make. It's not like the entire country is shutdown. I do have to say that. There are certain areas, particularly in Wuhan and around Wuhan that were very heavily impacted where I would say yes everything did shutdown, but the entire country didn't shutdown. We're seeing the government put in rules to try to basically introduce social distancing, to try to reduce the spread of the disease, but also keep manufacturing plants and other workplaces open. I think the interesting thing that we're seeing is looking at Korea and Korea is, yes we're going to cancel large events, but we are keeping our businesses open. We're dealing with, I think, a global community that understands how dependent we are upon each other and we want to take action to protect the health of people, but protecting the health of people sometimes means it's not about you getting a cold, it's not about you getting the flu, it's about making sure we have access to vital resources, we have food security. So I'm seeing efforts to try to mitigate the disruption to the global supply chain. What that's going to look like? I don't know. It is clearly going to impact trade, let me be clear on that. We know that's going to happen. Stock markets are all over the place and the supply chain... well go to the drugstore or go to the hardware store right now and try to get a mask.

Nicole Militello:

Right.

Sandy Johnson:

And what's interesting if you talk to the floor manager. I was talking to somebody in the store yesterday who's the floor manager and he was like, "Well, we haven't had these for four weeks because they're coming from China." So that's already been disrupted. I tend to think about the economic impact in terms of the direct impacts and then the indirect impacts and the direct impacts. I think of the airlines aren't running flights anymore, what are we spending on the response? What are we spending on our health teams? What are we spending on the medical supplies? What are the opportunity costs that are associated with that? For example, if you look at the U.S. we're still in the process of requisitioning funding for the corona response, but part of the pot of money that's been proposed by Congress was $500 million that was set aside for the Ebola response. That's part of a global health security strategy, so that money's not going to go there, but that doesn't mean Ebola's going away. So in my mind it's much easier to understand what are we spending on this, where is that money coming from? It's much more difficult to think about the indirect effects. The direct effect somebody is not at work, somebody is perhaps not earning income for several days while he or she is in quarantine. The indirect effect, that person now has less money, so they're not going to go spend their money outside.

Nicole Militello:

What kind of policy conversations have been on the global stage after a pandemic?

Sandy Johnson:

That's a good question. There is first and foremost, not just a lot of soul searching, there is very critical analysis of what the response was. The problem, of course at the global level you have the WHO, which is the technical expert for health response, you have the World Health Assembly which is made up of member states from the U.N., but then you have the national governments and even if there is consensus with WHO, even if there's consensus with kind of this global actor, that doesn't necessarily translate into national level policies. And I think one of the examples that we're seeing right now first after SARS then after the 2009 pandemic we had changes to the expectation, the roles that nation states are going to play if there's a large international health emergency. Some of the recommendations that came were you don't close borders, you don't cut off trade. OK, the global community has been saying that since 2003, they said it in 2009, they said it in 2014 to 2016 when closing borders and cutting off trade very severely impacting people in kind of the three countries that were experiencing the Ebola epidemic, but we're still doing that.

Nicole Militello:

Right, so have we really learned from the past enough do you think?

Sandy Johnson:

There are some things that I think the global community is doing better, but talking about global policy is incredibly complex because of state sovereignty and you know it takes one state to say, "No, I'm not going to do what you tell me to do” or “I'm not going to do what is recommended" to kind of start that domino effect and ultimately it's hard to argue against that because ultimately any national government is going to be responsible for protecting its citizens and what that means is going to be different from state to state.

Nicole Militello:

When we talk about a global outbreak, vaccinations are a really big part of that conversation and as of right now there is no vaccination for this new strain. Experts warn that a lifesaving vaccination could be years away. Can you talk a little bit about the race to find a vaccination during these situations?

Sandy Johnson:

So anytime we have a disease, you want tools to decrease the impact. A vaccine is going to prevent it, but there's also the potential for antivirals and antivirals are going to decrease the severity of it, decrease the duration of infectivity. So it's not all about vaccines, and I say this because in the U.S. we actually are seeing experimentation with an antiviral that scientists think will be useful in the current corona outbreak. We'll see what happens over the next few weeks, but 14 of the infected individuals from the Princess cruise ship are participating in this trial, so it's not all about vaccine. That's really important to know. You know if we can prevent a disease that is so much better then coming up with a treatment when somebody already has it. Technology for making vaccines is very complicated, even if you know what I'll call the secret formula and we don't have the secret formula for corona. And you know people were talking about a vaccine when SARS appeared. Different type of coronavirus, but we still don't have a vaccine for that.

Nicole Militello:

Right.

Sandy Johnson:

So we tend to see, oh my god there's an outbreak of something, we're going to put a lot of money into vaccine development and then as soon as the disease goes back down, those spikes go away, we forget about it. So right now if we came up today with the magic formula for a vaccine, we still have to test it, we have to make sure that it's safe and then we have to produce it and the production of vaccines is not easy. It might take three months for a batch of vaccines and a batch of vaccines is not going to cover seven billion people. This was something that we saw in the 2008-2009 influenza pandemic, we already knew how to make a vaccine for different influenza strains. We had to tinker with that so that it was responsive to the H1N1, but then it was three to six months to produce it and then when it was produced there wasn't enough to go around and so we had this panic over vaccine shortages. Of course my response is give the vaccines to the people that are most at risk. If we have them first and foremost get them to the healthcare workers because you want to keep them healthy and safe. Next, give them to the people in communities that have high rates of transmission. Here is a situation we don't have that magic recipe for the vaccine, we may or may not develop it and I think it's important that we keep researching it, but important message I think is we can still get through this even without a vaccine.

Nicole Militello:

A really important part of this conversation when we're talking about coronavirus is the xenophobia that we've seen come with it. What role does that play on the global stage when it comes to education, prevention, containing an outbreak.

Sandy Johnson:

Oh, it's huge and it's been an issue with every pandemic and I'll just start… I tell my students this. You know, we think of the 1918 influenza, we call it the Spanish Flu, it started in the U.S. The U.S. had better marketing. We had press controls and Spain didn't, but there's an incredible amount of stigma that goes with where a disease starts and of course this comes in to play. We've seen these lovely myths that China created this as a bio-weapon. No, no China didn't create this as a bio-weapon. The sad part is when people are afraid we look for something that's different about what we're afraid of. And, OK, this virus we first see it in China, it comes from China, well that's immediately a difference. We're from the U.S. They're from China. And it's human nature to fear and to blame. Now, we're rational beings and in theory we're enlightened beings, so we should be able to get over that, but going back to your question, we've seen this with every pandemic. I mean going back to 2019 the type A H1N1 — it was first discovered in Mexico and for a while it was called the Mexican Swine Flu. And what did we see? We saw the borders with Mexico close. We saw the messaging “Don't go to Mexico and this is just playing into some of the xenophobia that's already there. To me what's really scary is not just in the U.S., but in a number of countries around the world we are in a period of incredibly high levels of nationalism. This is going to play out with coronavirus and all of a sudden we have a reason to take action against the other and in my opinion we're seeing that with some of the policies already. When the U.S. said okay, we're not going to accept anyone into the U.S. who has been in China within the last 14 days. What does that mean? We're not accepting Chinese into the country. I mean how is that not racist, xenophobic. How is that not using the coronavirus as an excuse for fear mongering and for some of this kind of nationalism that we're seeing, but again it's not just in the U.S. The attacks that we saw in Germany, part of the motivation at least that came through in the news is you know foreigners fear of the coronavirus, so we're just protecting ourselves. It's an excuse.

Nicole Militello:

What is the greatest risk that we face right now in handling this outbreak?

Sandy Johnson:

Panicking. There have been so many wonderful interviews with medical personnel and they keep saying, "keep calm and carry on" and I think that that is so important. We are probably going to see coronavirus, again that beautiful thing that was on Web M.D. that said, "everyone's probably "already had a coronavirus", if we weren't calling this coronavirus, if this were just something that looked like the flu we wouldn't see the quarantines, we wouldn't see the borders closing. I mean we don't shut down the planes during flu season.

Nicole Militello:

Right.

Sandy Johnson:

But we're seeing this because we have a name, so don't panic. Don't panic. The good news is this is a case fatality rate that's not horrible. It's not to say getting sick isn't a problem and that's not to say if you think if everyone in the world were to be infected with this, seven billion people and 2% of them died from this that is horrible. Not everyone's gonna be infected.

Nicole Militello:

So keep calm and carry on.

Sandy Johnson:

Keep calm and carry on. And you know, coronavirus, we're learning so much from it and that's going to help us if and when something really, really scary comes along. But let's not be stupid.

Nicole Militello:

To learn more about the latest on the coronavirus or to hear more about Sandy Johnson's latest work visit our show notes at du.edu/radioed. Be sure to subscribe and check back for new episodes every other Tuesday. Alyssa Hurst is our executive producer and mixed the sound for this episode. James Swearingen arranged our theme. And Tamara Chapman is our managing editor. I'm Nicole Militello and this is RadioEd.