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The pandemic can be stopped. We already know how, explain two of the world’s top public health doctors in this episode on lessons from the pandemic. The solution involves truly understanding how the disease was stopped in the early countries that confronted it. “We’re going back and relearning a lot of the lessons from China,” said Dr. Bruce Aylward, who led the World Health Organization’s mission to China and is working to share those findings in Italy and other countries. Dr. Aylward says leader’s in the West were slow to listen to the lessons. “We are all human at a certain level and we tend to cherry pick that part of the information, which we find most reassuring,” he observed. Dr. David Nabarro, WHO Director-General’s Special Envoy on COVID-19, said that quick action will contain the virus. “If when a case arrives, you prevaricate, you’re half-hearted, you pretend it’s not real and you wait perhaps two, three, four weeks before you start to implement measures of any kind,” he warned, “what happens is that it basically doubles in scale every two to three days.”

Following the lead of Drs. Nabarro and Aylward, Co hosts Edie Lush and Claudia Romo Edelman share their plan to offer regular episodes of the podcast that detail success in attacking the pandemic and share them widely while the lessons can make a difference.

Featured guests

Dr. David Nabarro

David Nabarro is the Co-Director of the Imperial College Institute of Global Health Innovation at the Imperial College London and supports systems leadership for sustainable development through his Switzerland based social enterprise 4SD. From March 2020, David is appointed Special Envoy of WHO Director General on COVID-19. He secured his medical qualification in 1974 and has worked in over 50 countries – in communities and hospitals, governments, civil society, universities, and in United Nations (UN) programs.  David worked for the British government in the 1990s as head of Health and Population and director for Human Development in the UK Department for International Development. From 1999 to 2017 he held leadership roles in the UN system on disease outbreaks and health issues, food insecurity and nutrition, climate change and sustainable development. In October 2018, David received the World Food Prize together with Lawrence Haddad for their leadership in raising the profile and building coalitions for action for better nutrition across the Sustainable Development Goals.

Dr. Bruce Aylward

Dr Bruce Aylward is the Senior Advisor to the Director General, World Health Organization (WHO). Since September 2017, Dr Aylward has been serving as Senior Advisor to the WHO Director General and Director of the WHO Transformation. In this capacity he leads the team that is responsible for the design, coordination and implementation of a comprehensive reform of the organization, across its 7 Major Offices, 3 levels and more than 145 country offices, to deliver its new strategic plan and the health-related Sustainable Development Goals (SDGs). From August 2016 through August 2017, Dr Aylward worked with the United Nations Office for the Coordination of Humanitarian Affairs (OCHA), initially leading the inter-agency process that resulted in the first-ever system-wide activation procedures for major infectious disease emergencies, then establishing and leading OCHA’s Change Management Unit. In that role he took forward the recommendations of a wide-ranging functional review of OCHA to optimize its role, functions, structure and processes for the challenges of the 21st century. 

Special thank you to:

Transcript

Dr. David Nabarro (00:02):

If when a case arrives, you prevaricate, you’re halfhearted, you pretend it’s not real and you wait perhaps two, three, four weeks before you start to implement measures of any kind that are serious. What happens is that it basically doubles in scale every two to three days.

Dr. Bruce Aylward (00:26):

I don’t think the listening has kept up with the learning. I think there’s been an incredible speed of learning, incredible dissemination of lessons. And the other thing of course was it was landing on, not deaf ears, but ears that wanted to hear a different story. They wanted to hear it was going to be okay that this was like flu. This is like seasonal flu and it’s not. And it never was. We knew that from day one.

Dr. David Nabarro (00:47):

If we can turn up the volume now, particularly with self-discipline by people and really good quality public health and that will show up in a period of misery that if we can’t turn up the volume, if we can’t do it as a responsible society then the misery will go on a lot longer, it’s all in our hands.

Claudia Romo Edelman (01:14):

Welcome to the Global GoalsCast.

Edie Lush (01:16):

The podcast that explores how we can change the world. In this episode lessons from the pandemic.

Claudia Romo Edelman (01:22):

We can stop this virus. That is the first and most important lesson, but only if we quickly act on what China, Italy, and other places have already learned.

Edie Lush (01:37):

We will hear from two of the most important public health doctors in the world who tell us the challenge right now is not about science or medicine.

Claudia Romo Edelman (01:46):

It is about communications and listening and cooperating. It is about turning up the volume.

Edie Lush (01:54):

and we are going to turn up the volume right now. I am Edie Lush.

Claudia Romo Edelman (01:58):

and I am Claudia Romo Edelman.

Edie Lush (02:04):

Claudia, it’s only three months since the world first encountered a new Corona virus and the frightening illness that it brings called Covid-19. One of the scariest things about this virus is the explosive way that it spreads.

Dr. Tedros Adhanom (02:18):

The pandemic is accelerating. It took 67 days from the first reported case to reach the first 100,000 cases, 11 days for the second hundred thousand cases and just four days for the third 100,000 cases.

Claudia Romo Edelman (02:46):

And by the way, only three days to reach 400,000 cases. That was the head of the World Health Organization, Dr Tedros, he is from Ethiopia and he has been handed a big job getting the world to act together to stop these Corona virus

Edie Lush (03:04):

Like billions of people all around the world, we here at Global GoalsCast, have had our lives and our plans turned inside out. I’ve been staying at home sheltering in place with my family here in London

Claudia Romo Edelman (03:16):

and I am working here from home in New York City where officials are fearful that the spread of the Covid-19 will soon overwhelm medical services. So we wanted to do something useful in this podcast.

Edie Lush (03:30):

and I know that so many people feel the same way.

Claudia Romo Edelman (03:33):

So like most of you, we are adopting. This is the first of a series of episodes in which by doing what we do at Global GoalsCast, we hope to be some value in this crisis.

Edie Lush (03:45):

That’s right. We always look for the solutions we ask who is succeeding, who are the champions, making things better. And then we share that with you. And it turns out that is badly needed right now because it turns out the virus is spreading faster than the world’s ability to understand and act on what we already know about how to stop it.

Claudia Romo Edelman (04:09):

So this episode is about what we already have learned in one place and how can we adopt it in other places while there is still time.

Edie Lush (04:20):

So to sum up those lessons, our editor Mike Oreskes and I sought out two of the world’s leading public health figures. The first is Dr. David Navarro. Claudia, you and I know him really well.

Claudia Romo Edelman (04:32):

He is not only part of the advisers of the Global GoalsCast from day one and my former boss, but he’s the right guy for these jobs. The special advisor for the World Health Organization and corona virus. He’s the one who worked in Ebola and SARS and others. So I’m super pleased to have Dr. David Navarro on the show.

Dr. David Nabarro (04:56):

Just to give you a perception of where I think the world is right now. Yeah. This, this pandemic actually advances as a, a number of small outbreaks that then grow quickly into large outbreaks and then become explosive. The truth is that actually it doesn’t have to go on advancing exponentially. It can be contained and we’ve got really good evidence now from China, from South Korea and from Singapore and it doesn’t have to double in scale every two or three days. And if you respond early, as soon as you’ve got a case that’s been discovered or an early chain of transmission by isolating the person who’s got the disease and then by finding the contacts the person has had following up those contacts, quarantining them. And if you do that rigorously backed up by testing, you have a really well-disciplined public health workforce supported by communities that know what they’ve got to do. This can be contained. And I think that’s probably what’s happening in Japan where they’re going about life normally. But if when a case arrives, you prevaricate you’re halfhearted, you pretend it’s not real and you wait perhaps two, three, four weeks before you start to implement measures of any kind, that are serious, what happens is that it basically doubles in scale every two to three days. And so after two or three weeks you have an absolutely massive number of cases and your hospitals get overloaded and in the end, in order to deal with that, you have to implement these draconian lockdowns that totally damage your economy. Make a lot of people poor, make people super upset and don’t necessarily, unless you’re able to do an app study, massive effort, don’t necessarily push it back. But if you can do the massive effort as it’s happening now in Italy, sooner or later you push it back. But if you act on day one, two or three, you really have so much less of a response and you have so much less damage to the fabric of society than if you act on day 21 now, this was a life lesson available to us in mid-February from China, beautifully written up by the team that went to China from all over the world. And I remember at that time putting the word round, but I wasn’t anyone. Of course, Ted Ross, from WHO, did it saying, come on, do it quick and you can get on top of it. That’s slow, underplay it or whatever you do, you will get really badly damaged. And so the big damage is in Italy now, in Spain now, in France now, it’s coming into other places. Germany had been very clever and doing a good response. There would probably be not too bad. They have really, really pulled the stops out. What I do say is that just look at the experiences, the places that have done it well and those of you who are in New York or in California or in Seattle, yours who come in about two and a half weeks, I mean it may come in quicker because I get stories now that emergency rooms are filling up. Let me know if people are not doing testing, which they’re not in very much in the U S and in Europe, we have to accept that the global figures are a massive underestimate. We have to accept that the national figures are an underestimate. So what we go on crudely, it’s how many friends we know who are stuck at with high fever and cough and also what we’re hearing from health workers who are working in emergency rooms of hospitals. As it gradually builds up and as we’ve seen in Italy, you know the undertakers can’t do their work and a whole load of other things are going on as it gradually gets worse. Then

Edie Lush (09:20):

as that phone you hear suggest Dr. Navarro is spending his days talking to colleagues all around the world. He is very worried where the pandemic will go if it isn’t curtailed now.

Dr. David Nabarro (09:32):

That is basically my big message for everybody and why am I saying it because two reasons. One is even when you’ve got a big outbreak happening like Italy is having or like Spain is having, you can still beat it back and you’ve got to, because if you don’t it would just go on and on and on and get worse and worse and worse because it’ll take some time before you really infect all the people in your population who are susceptible. So you have to go and pushing it back is just that you need massive force and locked down on its own isn’t enough. You have to keep the good public health work going and you can’t give up on that. But the second reason why I’m saying it is that in all countries what’s happening in Milan or what’s happening in Seattle right now would be very damaging. You see, you’ve got so many people who are just barely scraping by on cash income and the first sectors that will go in any nation are the sectors that employ a lot of casual labor like hospitality and travel and even construction, which is being hit over again. So the economic and societal consequences for poor countries are going to be much, much greater to than they are in rich countries or in countries that have got capacity in society, for social protection like Singapore, like South Korea, like China. And so I really want very, very quickly to get the message out the poor countries when they get the first case or two instead of waiting and saying it’s not that bad, really and follow any example of some European or North American nations who’ve been a little slow. They’ve got to be really, really rapid, rigorous and robust from the beginning and bring their people with them and say, if you want to avoid the kind of mess that we’re seeing in Europe, we have to be really focused from the beginning. I’m seeing signs of this. I talk to a great colleague called Sam Bassow in Mali and they’re getting ready themselves really organized. We know there are cases in South Africa, we were talking last night, with colleagues from the African Union Development Agency how have got a base in Pretoria and they are getting very organized. So I want to just really make this point. The poor countries have a chance of not being really put into a most dramatic impoverishment. It means crash, upgrade of public health capacity, possibly bringing in medical students and others to support community public health workers. It means informing the population of their partners in the response. It means working on the economic and societal implications from the start so as to prepare social protection for the people who are most vulnerable. It also means the whole of government recognizing that one of the things we’re seeing in Africa at the moment is rising food prices already. And so we’ve gotta be prepared for increases in hunger and possibly civil disturbance. Riots and prisons have been happening in France and in Italy and they’re likely to happen in other parts of the world as well as prison visits are stopped. And there’s in some cases, prison staff go on strike or have to stop during their work because they’re quarantined. Perhaps the most important message I’d like to get out is this. We’ve seen that a period of miss coordination between provincial and federal health authorities led to a bit of uncertainty as to what to do and that’s been admitted and mistakes have been identified and have been, situations being rectified. We see in Europe different countries are doing different things, shutting their borders arbitrarily and all that sort of stuff. Every day lost and getting global solidarity is a massive impact. Every three days lost we have got double the size of the problem to deal with. So what are governments doing, why aren’t they just saying we will use all the coordination mechanisms at our disposal to deal with this as a common enemy as was done for bird flu in 2005 as we’ve done for the H1N1 pandemic in 2009 as was done for Ebola after a bit. And so I, I just find myself wondering whether the failure of multilateral behavior that we are seeing now in 2020 is going to prove to be a complete undoing because this is not going to stop where it is now, who knows? We might be 5% of the way in.

Mike Oreskes (15:01):

David, could I take you back for a second to February 24th I’m very interested in your judgment about what didn’t happen at that moment. Why didn’t those findings get fully out? I don’t know whether this was that they didn’t get communicated or that, so then why didn’t they reach people? Why didn’t they sink

Dr. David Nabarro (15:26):

I have hypotheses but a serious leader would realize that electability depends on good leadership, but quite a lot of the leaders we have at the moment, they find it hard to lead and hard to take the tough decisions that are needed to lead on behalf of your people. And they have looked at what Xi Jinping did and they managed to find folk with it and not recognize what he did which was suburb and also, what the South Korean leadership have done. What the Singaporean leadership had done and of course the reason why they moved quickly is they had SARS in 2002 so it didn’t really need an awful lot of explanation. They knew how much hardship they faced as a result of being, halfhearted on SARS for some months, but that still doesn’t excuse really the leadership of European and North American nations just doesn’t excuse them. And I think that it’s more a wish to try to make light of it or wish to try to imply that somehow everybody was wrong or wished to try to brace their way through it. The cost of those two or three weeks I think are gonna prove to be extraordinary in lost years of development and destruction of the financial system, in widespread unemployment in the 30% of industry of the GDP, it is made up of sectors that involve contact with people or travel or tourism. That’s Goldman Sachs figures from yesterday. I’m pleading with people everywhere just to even now to hear the lessons because they’re in front of our eyes. It will be an absolute total miracle if there’s not a massive outbreaks in the United States. Right. With huge impact on the lives of poorer Americans. What we will end up happening is that Europe and North America will turn out to be the amplifiers, something that increases poverty but which is actually harder for the poor countries to take. So Europe, North America with all their financial stimuli and all that stuff. Who bluster their way through, but there’ll be no financial stimuli and no safety nets, but people in urban slumbs in Indian sub continent or in Africa. I hope I’m wrong.

Edie Lush (18:19):

I asked Dr. Navarro about developments here in the United Kingdom

Dr. David Nabarro (18:25):

Well I think the UK is getting better. Kind of just work on community involvement, taking it super seriously. It’s a responsibility of everyone. Make sure your health workers can get to work, treat them like royalty or like you in America, treat the military, don’t give up. And then I’ve got a whole series of things that I’m offering on the struggle. Because of the delay in Britain there’ll be a lot of small businesses that are going to go under. A lot of people feeling very angry and uh, we just got to try to help people actually realize that if we can turn up the volume now, particularly with self-discipline by people and really good quality public health and that will shorten the period of misery that if we can’t turn up the volume or if we can’t do it as a responsible society then the misery will go on a lot longer, all in our hands.

Claudia Romo Edelman (19:33):

Turn up the volume, says Dr. David Navarro and that is what he has been doing all his life. Being able to turn up the volume and make sure that people actually massively act. Dr. David Navarro has been a friend of this Global GoalsCast since the day we started. For more he sent us to one of the world’s most experienced voices on infectious diseases and that is Dr. Bruce Aylward. When the World Health Organization needed someone to go to China in February to understand what was happening. They sent Dr Aylward to lead the mission. That report released in late February warned that the world was not prepared to combat this new virus. And sadly the message did not get through. Edie and Mike spoke to Bruce Aylward from the WHO office in Geneva.

Edie Lush (20:32):

Can I ask why you think the world wasn’t ready? Why they didn’t listen?

Dr. Bruce Aylward (20:38):

I think there were a combination of factors. One was this was a new disease which the West didn’t really understand, it didn’t trust all of the information that it was hearing. And you know, we are all human at a certain level and we tend to cherry pick that part of the information which we find most reassuring. Okay. This is happening in the winter, but it’s going to be spring for us and we’ll be out of flu season so it won’t be so bad. Oh, uh, the mortality rate was really bad in Wuhan, but the rest of the China, it was really low so it would be really low here. Oh, this is actually more like flu than it is like SARS. So the mortality rate will be really low. So there was a lot of cherry picking of those aspects of, uh, of the disease that were at least unsettling to us. Um, rather than really preparing. I think we’re going back and relearning a lot of the lessons from China. And in fact with the work I’ve been doing with Italy is some of it from a distance. A lot of it has been really sharing those lessons. So, you know, the, the first and probably most important lesson from China was that in the absence of a vaccine and in the absence of a drug that works against this disease, you could actually use fundamental public health measures around finding cases very rapidly isolating those cases, quarantining their contacts, and slow down what is a respiratory pathogen. And for those of us who grew up in the world of infectious disease control, one of the almost ingoing assumptions is a respiratory pathogen is almost impossible to stop without a vaccine. And so the first big lesson out of China was this is not flu. This is not the pathogens you’re used to. This is one that you can actually stop with these core public health measures. Super, super important lessons. That was a single, but you know, we’re not going into this war on armed. That was really the big lesson. People look at China, they talk about the shutdowns and the lockdowns and the rest of it. Those were enablers. Those were not the tools that turned the tide and stopped the, uh, the, the outbreak in China. So that was the first big lesson. But the second really big lesson out of China was that to get an edge on this virus though, you have to move very, very fast. Speed is everything. Because this is a respiratory pathogen at the end of the day. So you’ve got to be able to move very, very quickly to get in front of it. The virus can increase exponentially, which means you have to think exponentially, not incrementally to get in front of it and to achieve speed. What China and that really brought us to that, you know, third lesson was it realized that the medical community, yes we’ll deal with the consequences of this outbreak. You know taking care of the sick, et cetera, but it is going to be the population that will really have to stop the outbreak and that population is going to do it by washing their hands, by covering their mouths, by understanding the symptoms, by rapidly getting tested, having a very high index. So the population was primed, accountable, active in a way that simply extraordinary. The next big piece that they learned was that again, in terms of getting the speed you need your people, right? Don’t, don’t, don’t wait for the people to get to the medical system and then look at them, you know, get them involved even earlier. But the next piece was to achieve that speed. You need to take full advantage of technology and China, I think few people in the West really realized how technologically enabled China is.

Edie Lush (24:07):

That technological enablement. When I’ve looked at what, how China was able to deal with it. And also Singapore as well, seems to have been so key because it was enabled you to track who you were with, who, if you were infected, who you might have come into contact with through a tube journey or an Uber journey.

Dr. Bruce Aylward (24:32):

The importance of technology played out, I’d say in three big ways. One way was it helped to run the response itself. Yes. People’s cell phones in some places. I understand, I didn’t actually see it, but they actually had a little indicator on it that would go from green to yellow to red depending on where they actually were and the probability that they were at a high risk zone for actually being exposed to the, uh, to the disease. And that would affect then quarantine decisions and all sorts of stuff. But there was a whole bunch of technology that just helped make it possible to run a fast response on this scale involving hundreds and hundreds of thousands of, of people that eventually basically all of society there. But, um, so that was one part to help enable to respond and. And a neat example of that, for example, um, one day I was in Chengdu, which is the capital of Sichuan province. That’s where all the pandas are. So, and the reason we had gone there was this is a massive state which has both urban areas as well as rural areas. And we want to know like, okay great, maybe the cities you’re taking care of. What about these rural populations? And the governor is really interesting. In the meeting I was having with the governor, he said, well we were rolling out 5G at the same time this thing hit. And a big plan was to enable Chengdu, the capital first. And we decided no, we would roll out in the rural areas first so that we could establish centers of excellence that could be completely enabled and in real time work with the peripheral areas to provide them the best possible guidance, the best possible support, both to help and manage their disease, but to help keep patients alive as well. And people alive and everything they talked about always came back to keeping people alive and saving lives. But that was one sector. And then in the schools everybody keeps saying, well they closed all the schools in China. Actually the schools, the buildings closed learning went online and, and, and just the, the whole, the whole, uh, I kept hearing this from lots of mothers that I met actually about how their kids were in schooling, frankly. And then when it came to all the support services, the remember people, the city of Wuhan for example, locked down 15 million people living in their apartments or their apartment compound for over a month and a half. Those people have to eat. Those people have all these other services have to work all done online. Well not the eating part of course, but at least the ordering of the food and the return of it. So technology, you know, because it was such a technology, really advanced society and literate society, it could very rapidly move online and you know, that physical distancing did not become a barrier to its ability to, to implement the strategies that had to.

Edie Lush (27:16):

My entire family is now online learning. All my kids are online learning. I will say they’re not a huge fan of it. In fact, my, the youngest says, online learning is boring. So no huge fans here. But, let’s move on to Italy and tell me what are the lessons that you’ve seen come out of there?

Dr. Bruce Aylward (27:38):

First big lesson is just make sure you can run a safe system. The second big learning out of Italy, and I think that they, um, you know, they, they did well in this regard is they recognize that this disease does not increase linearly. It increases exponentially. So we have to think in big leaps in terms of our measures to get ahead of a virus like this. You can’t sort of, um, pussyfoot around it. And what they did was they, you know, they saw, they went from, you know, uh, individuals and dozens of cases one day to hundreds the next and boom, they locked down huge areas that were affected because they just realized, we, we, we’ve, we’ve got to get, take these extraordinary measures to try and take the heat out of this so we can get the other measures in place. So I think that was, you know, another, uh, um, a major, uh, learning out of, out of, um, out of Italy was what was that. And then related to that of course was just the whole, uh, speed and risk of the international spread. You know, I, I remember, um, way back when we were looking at H1N1, that was the last big pandemic of flu, uh, about 10 years ago and it didn’t cause a lot of deaths, but it spread very rapidly. In China, it took 123 days for that or something like that. 130 days to infect every province. This disease took 23 days and I don’t think it actually transmits as well as flu. You know, we’re just in a much more interconnected world. The consequences of which for controlling a disease like this are huge.

Mike Oreskes (29:11):

Can I intervene with a question? It’s very striking listening to you, Bruce, the, the feeling or the picture you paint of the virus moving faster than the things we learn about it and want to share with each other. Is that a fair way to describe it?

Dr. Bruce Aylward (29:29):

Yeah, I, I think, you know, this virus does move with the incredible speed. Um, what, what I think is, is truly extraordinary is the speed with which we’ve learned about this virus. Remember, this is a brand new virus, emerged 10, 12 weeks ago. And, you know, in terms of our, our knowledge of it, and during that time when it first emerged and people keep asking me about what happened in Wuhan and I say, look, they had a new virus causing a new disease in a new place with a, which required new approaches in terms of trying to control it. We didn’t understand any of those things. We didn’t even understand how to diagnose it. And in that time and, and, and here, credit has got to go just to the ingenuity and skill of Chinese scientists. I mean, they sequenced this thing within days. Um, they had primers and, and a test, you know, a few days later, they made all of that publicly available as fast as they generated it. And, um, and then, you know, they learned how to actually control it. And I think that, you know, the, and then if you look in the scientific literature, they just share that information incredibly, you know, quickly, this is what this disease does, this is how we’re trying to control it and this is the impact it’s having. Um, so I, I think actually, um, the learnings have moved very, very quickly. I don’t think the listening has kept up with the learning. Um, so I, I think there’s been an incredible speed of learning, incredible dissemination of lessons, but the listening and application of it and you know, how much of that is because of who was actually doing the talking. And the other thing of course was it was landing on not deaf ears, but ears that wanted to hear a different story. They wanted to hear. It was going to be okay that this was like flu. This is like seasonal flu. And it’s not an, it never was. We knew that from day one.

Mike Oreskes (31:13):

How do we address that problem. The extent to which the problem here is really a communications problem as much as it is a scientific or medical one.

Dr. Bruce Aylward (31:21):

It’s a leadership problem. Um, uh, to, to tell you the truth, uh, because I think, and, and it’s a little bit of a mindset, but when faced, uh, and I remember in the early days of this, I remember a friend of mine from New York, uh, was back and forth to me. The, I hadn’t heard from him in some years. Um, which is one of the great things about the work I do. I regularly hear from people I haven’t heard from for years. People I really liked. Uh, anyway, he wrote, he was in the business of looking at, um, at, at, at, uh, at advising businesses on investments and things like that. And, and, you know, where the world was going. And I, you know, and he said, look, when I compare this to, um, uh, flu, flu kills this many more people in the US et cetera, et cetera, et cetera. And I said, you’re comparing a disease that we’ve known for a decades and decades for which we have vaccines for which we know, you know, the genetics of it, how we evolved with the disease that we’ve known for at that point 4 weeks, you’ve got to respect the uncertainties, um, with this. And when you respect those, you air on the side of no regrets. This may be a very serious disease. This may spread very, very rapidly. We have got to be prepared. It may overwhelm our healthcare system. Um, and, and I, I think, uh, you know, I think it’s a very human need to try and think the opposite. But um, you know, for those who work in crisis management and this is how we think, it’s not being pessimists, it’s, it’s being, you know, optimistic about what can be done. But it can only a, you can only be optimistic if you really envisage how serious this can be.

Edie Lush (33:08):

It’s a very different experience listening to you talk about Covid-19 than it is to listening to politicians. I’m here in the UK and I personally, I’ve been waiting for something to get more serious for the reaction to get more serious. And it wasn’t until last night that it looked like Boris Johnson had finally gotten some coaching in terms of how to actually talk about this. I don’t expect you to, to give me an overt critique of, of politicians, but how do you get people to listen to experts? Cause that’s really what this is about.

Dr. Bruce Aylward (33:40):

Well I’m actually very, very sympathetic to the challenge that politicians face here because they need to put in place, as we talked about earlier, kind of exponential measures for, for you know, for, for a very, very, uh, what people would think is small levels of disease. And that’s a very, very hard thing to communicate to. The politicians often get this many, the ones I’ve talked to, they got that right at the very beginning. But what they realized was once I put those things in place, the clock starts ticking. And I, in terms of how long I’m going to be able to do that in terms of how much disease I can prevent and how many lives I can save. I’m willing to take a bit of a hit and do this later because I think that’s going to save more lives and ultimately more of our society and economy as well. So I think what I’ve seen is most politicians acutely actually aware of, of, of, of these things and, and trying to find that balance because they know that they’ve got to bring that whole population with them, especially when it comes to the kind of measures isolating yourself for 14 days for a disease you may or may not have. Um, this is, these are tough and, um, you know, armies operate in very different ways when you know they’re, they’re, they’re drilling versus when they’re looking at the whites of the eyes of the enemy, so to speak. And so it’s really when the diseases is upon you that you can march all your troops in a different way. And I think, you know, explicitly or implicitly or intuitively that’s in the minds of many of the politicians who have to respond and manage. It’s a tough job. They have a tough job right now.

Edie Lush (35:20):

There’s discussion now around unifying efforts and taking collective action. And do you see that happening and how important do you think that is?

Dr. Bruce Aylward (35:32):

I think it’s super important because we’re dealing with a brand new disease that we’ve not seen before, first of all. So if we look at the whole area of understanding this disease and generating new knowledge, the faster you can pull information and results, whether from on the natural history of disease, disease, you know, that means what it looks like in different populations, how it affects the young, the old et cetera, um, to how drugs work in terms of trying to, to, to uh, counteract it. You know, the more you can pool together experience from multiple countries, the faster you’re going to get to your answer. And that’s why WHO for example, launched this thing called The Solidarity Trial, which it’s as simple as trial design in the world. But what it allows is multiple countries around the world to um, uh, what’s where to enroll patients very, very quickly and get to an answer in two weeks that might normally take two years. I mean, there’s extraordinarily clever people putting together ideas about how to get countries to collaborate together in, in, and get it, get answers in, in ways we hadn’t envisaged before. So that, that, that’s exciting, you know, in terms of generating new knowledge. But then as we look also just in terms of responding to the disease, the ventilators, the mass, the PPEs, there’s actually an awful lot of that in the world, but most of it is in the wrong places. So to get it to the right places and into the hands of the right people requires a tremendous amount of both international collaboration, but collaboration also within countries and in China. If I just divert for a second, you know, one of the most beautiful things I saw and I saw so many, you know, just absolutely beautiful things at the individual level and the way, the way I was going to say ordinary people. But there’s nothing ordinary about these people. So for example, when we went to Wuhan, the most difficult thing was getting physically getting there because the flights there is no flights, the roads are closed, there’s no trains, et cetera. But what they arranged was a special bullet train that we were able to take that that got us there. When we got there and we got off, it was, you know, the most haunting experience in some way, an eerie experience because we pulled into this hyper modern, gigantic, beautiful train station. And we got out of this ultra modern bullet train into a city of skyscrapers that was silent with this empty a, a train station where our footsteps echoed through the night there is, as we got off the train, then I heard people behind me and I thought, well, hang on, what’s going on? I thought no one could get off of in Wuhan. And I turned around, there’s another group. And I asked, I said, so who are these people? Who are you? And went to say hello to them. And it was a group of volunteer medical, uh, folks from Wandong, the city we had just left who had come to Wuhan to help and you know, just this incredible solidarity. They said, look, we’ve got the outbreak under control in, in Guandong. We learned a lot about how to manage this disease. So we volunteered to come and we’re going to run one of the wards here in Wuhan. And I think few people outside realize just the 40,000 medical workers from around China went into Wuhan with all their own PPE, not to use their other PPE as well as protective equipment to help manage this response. But, and every one of them I talked to were so proud of what they were doing. Cause I mentioned this to someone who said, Oh yeah, they probably had to do that. Are you kidding? These people volunteered. This was like incredible, incredible humans, right? And it was all about saving lives and doing their part.

Edie Lush (39:17):

So I wonder is it too early to talk about recovery? Is it too soon to be doing that?

Dr. Bruce Aylward (39:21):

Is never too early to think about recovery. And in fact in any crisis, and you will find that, you know the pros at this, they go into this thinking about how they’re going to come out of it because it will often affect your measures and what you’re doing in real time. So for example, if you want to be able to lift the major restrictions you’ve put in place on people’s movements or the shutdowns you put in place in terms of businesses, et cetera, you have to think, what do I have to do to be able to do that safely? Well, you need to be able to test every suspect case so you know where this thing is. You need to be able to rapidly isolate anybody however sick or not they are so that they don’t infect anyone else and slow this thing down. You don’t reinfect all these things you’re opening. And then you need to be able to properly quarantine people. So if you’re not thinking about that, because it’s going to take you weeks to put that in place, if you don’t have it. You know it took China, you know, weeks to build all these capacities. And so thinking about recovery is useful in that it forces you to think, gosh, how do I lift these restrictions? How do I do that safely? What do I have to put in place? And then all of a sudden you start thinking, okay, if I want to lift these restrictions in three weeks, I better work backwards to how fast I got to have enough testing capacity in my country, enough ventilators and beds, enough, uh, to manage any surge that accompanies that um, uh, as as well. I met a number of the governors and mayors in China, and remember these are mayors of cities of 25 million people and 15 million people and governors of a province of 150 million people. I mean, they have massive responsibility and they’re managing huge, huge resources. And so I would say to them like, well, congratulations. You’re, you know, you’re bringing cases down. Um, you must feel good about that and what next? And every one of them said to me, we’re building more hospital beds and we’re buying more ventilators. And I said, excuse me, but your cases are coming down. And they said, look, we do not know where virus came from. We don’t think it’s going to go to zero. We don’t have a vaccine. So we are worried that we get it down and then it’s going to surge again. We’ll get more cases or whatever. But we cannot afford to stop our economy again. We cannot afford to close our hospitals and make them Covid hospitals. We cannot afford to stop all the things that are so important to us as a society. So what we’re going to do is make sure we have the capacity to manage this thing at scale if we have to without closing businesses. And, and the other measures we’ve had to take. So, you know, here, here were these, um, and it’s so counterintuitive and, and it was so funny because here were these governors and mayors expending tremendous resources to buy ventilators, build hospital beds, et cetera, for a disease that was disappearing in front of them due to their extraordinary work. But then as I came back to the West and talked about it and told the story, people were saying, yes, but we have a more resilient health system. Yes, but we have this or that, whatever. And you know, here we are, uh, four weeks later with overflowing intensive care units, not enough ventilators. Um, you know, healthcare workers getting infected cause they don’t have masks and gowns. We’re pairing a terrible, terrible price, um, for this. And it may well not have been any different. Um, you know, one of the things I always tell the people who work with me, they go, oh gosh, that must really frustrate you and, and I know and you fight wars forward, um, you, you, we are where we are today. We move forward. Um, and you know, at the end of all this, you go back, you learn the lessons and you try and do it better next time. But, uh, the finger pointing, the, looking at the mistakes, it doesn’t really help fight this one forward. There’s a lot of lives to be saved out there. A lot of disease can be prevented

Mike Oreskes (43:21):

In that spirit of, of forward. If you were gonna summarize the lessons of communication and leadership that you’ve come to based on all of your experience and particularly the last couple of months, what would you do? What would you say?

Dr. Bruce Aylward (43:35):

First of all, tell people straight up what you’re dealing with. Um, don’t soft pedal anything. You can always dial it back. But tell him straight up, people are adults. Um, people will take responsibility, they will do the right thing, but they have to know what they’re dealing with. And one of the biggest challenges we faced in this was that people thought, were confused whether or not this was a severe disease, number one. Number two, tell them what they can do to take, to help themselves. I heard again and again, people saying, you know, almost weeping sometimes on interviews saying they felt so helpless. And I thought, my goodness, that’s a huge, a communication failure because no one more than you as an individual controls whether or not you get Covid, no one rather than, than you as an individual controls whether or not your family gets it and the probability of adverse outcomes. You have huge control of the potential outcomes here. And then the third thing is how you engage them in a meaningful way in the response itself. Um, and, and, and give them, you know, the time horizons as well over which these actions are gonna play out and then what they can do to, you know, for the broader effort. And we’re seeing extraordinary civil action in terms of helping, uh, manage this disease. You know, when I was leaving my, uh, apartment building this morning here in Switzerland, it was a little sign from Veronique on the seventh floor who was saying, um, you know, for any of you who may be housebound for any reason or, or, or a bit sick or just too tired to do it, um, I’m very happy to do your shopping for them. And then pasted right below that was, hi, we are Amy and Suzanne from the fourth floor. We can help when Veronique runs out of energy or shopping bags or whatever. But it’s just fantastic to see what people will do. All they need is to understand how they help. So that’s another such big piece of the communications.

Claudia Romo Edelman (45:41):

Wow, that was amazing. So much information and so packed with hope at the same time with fear. But you see when you’re Dr. Navarro, and fortunately for me, I have worked with him over time. I know that what he’s mapping out in his mind is what he wants to see, his global mobilization. And he wants to see how do I mobilize every government so that they can implement measures at the federal, and at the local level. How do I see private sector mobilizing, how do I see individuals mobilizing and in order to mobilize all of them are the instruments that we need. How do we need communication? And the one thing that I heard again and again is turn up the volume. And in these turn of the volume that he mentioned a number of times, it’s the role of actually organizations like ours Edie, to be talking about how serious it is and how important it is. I don’t want to have anyone having the illusion that this is up to individuals. Actually not. This is up to governments to take the measurements and the policies that allow individuals to understand clearly what they should and should not do. Individuals of course have to develop a sense of global solidarity and personal responsibility, but this is absolutely not about us. This is about governments getting their act together, understanding what their role is and having private sector CEOs launching measurements for their employees. This is a top down, bottom up issue,

Edie Lush (47:11):

So of course leaders matter. I thought it was really encouraging that in India, prime minister Modi locked down the country even though there were only 500 confirmed cases and one of the clips that we didn’t play from Bruce Aylward in fact was how important he said journalists and podcasts like ours were in terms of getting out the serious messages, the real news and avoiding anything that is not true.

Claudia Romo Edelman (47:42):

Two things I think I take from here, which is one, how important it is the last point that you mentioned Edie with Bruce, which is collective action and the importance of actually being unified and in that sense a world human. With our Hispanic arm, what we’re trying to do is get every Hispanic to have a platform, a clearing house for information and action. Hispanics, 60 million people in the States are most affected by Covid, in particularly small businesses, entrepreneurs, independent workers with restaurants that are closing, the hotels that are sucking people are affecting directly this community. So what we started doing is shifting the energy, the resources, the infrastructure and the networks that we had for the Hispanic start campaign, which was for perception change of Hispanics and mobilize it and move it to create something which is Hispanic Stars but in action. So we’re launching as a fact today the Hispanic recovery plan, which is a clearing house for information and action with the aim to communicate, organize and mobilize, to have weekly calls in which we bring experts to be able to talk and give an update of what’s happening, but also to mobilize everyone to create a sort of like a marketplace for people that need and people that want to give because experience of Bruce, seeing his, his building, someone saying, I’ll do the shopping for you. We have to provide a platform, a digital platform for people to do that all the time. When people lost the job and they can no longer have a studio to give a yoga lesson or someone who was working in a kitchen doesn’t have a space. You need to be able to have almost like a Craigslist to see who can help me. I can give yoga lessons online. Who wants to hire me? Because this is a time in which solidarity matters and having a recovery plan matters even more. And in that sense, the second point is that We Are All Human got called by the United Nations to help on the response of Corona virus 19, particularly on this area of communication and turning up the volume and what they said, what they need the most is to have a narrative on three phases. The first one is health. So we need to make sure that we are talking about the emergency and flattening the core number two about global solidarity suppression. Trying to make sure that people understand that we belong to the same human family. And if there’s one thing that is positive about Covid 19 is that it’s humanizing everybody so that we understand that it doesn’t matter what political party we have or not, it can touch you. Businesses can get you and it can affect us all the same way. So we’re starting to realize how important it is to be with our family and how important it is to be nice to each other. So the second point that the United Nations is willing to do is a global solidarity. And the third one, which has not been spelled out yet will be recovery. I’m pretty sure I need that sense, Edie, your Global GoalsCast should be an arm to be talking about these three steps that we have so that we can ask humanity, go back to our feet being more solidarity with each other while we heal.

Edie Lush (51:01):

One of the things I heard very strongly from Dr. Navarro and that he’s reiterated since speaking to us in his online narratives, which I usually suggest you go and read, is the effect on poorer groups of people and poorer countries as well. And I’m really interested in what’s happening in Mexico, Claudia.

Claudia Romo Edelman (51:19):

I mean like I was telling you about the Hispanics and Hispanics, you know like from the 60 million people, there’s a huge majority, 70% are Mexican. So our connection between Hispanics and Mexico is huge. And Hispanics in America have already understood, have already felt the impact, have already seen someone getting sick, have really lost their jobs, are in a state of panic. And that’s why having something like a Hispanic recovery plan moves people from fear to action. But it is absolutely devastating for someone like me, Mexican, Hispanic, leaving the state, seeing Mexico and seeing how the president just over the weekend said that Mexicans, you know, stronger than a virus that we should hold each other very tight and hug each other the Mexican way and then just going to have dinners and just yesterday the governor of Puebla for God’s sake, he said that Corona virus, hits only rich people Suggesting that Mexico one is not rich, two that is going to be invisible or invincible and those kinds of things are so dangerous. That’s why I was saying it all starts with the leadership in this case.

Edie Lush (52:31):

I,n rich countries, poor people are the most economically vulnerable. So it’s fine to tell everyone to stay home. But hospitals in New York nurses are reporting that some of their patients are telling them they can’t afford to stay home. People that do gig work like driving for Uber and for Lyft. In the UK, there’s been an announcement that we will see workers be able to get 80% of their salaries paid up to a certain amount, but there’s still been no announcement for the self employed and so when I was on my run this morning I did still see a lot of people going out to work and they did not look like key workers in terms of hospital workers to me.

Claudia Romo Edelman (53:08):

That’s where it is super important and I did work like Dr. Navarro in a couple of pandemics, SARS and Ebola and they have the same curve all the time. The question is how kind of curve do we want to use for the recovery of ours so we can be at the shape, which means you go down fast but then equally you have a plan and then you recover fast. So it goes down fast. You go up fast. Are we going to allow these to have a U-shape which is low down, so you go down and you stay low for longer and then you go up, you know like, and then you go up in the other way. Well we cannot allow this to happen is to be an L-shape where you go with down and then you stay low for long. What I am thinking that what what the part of our recovery that is so important is because most people’s mindset from one place which is a static and fearful to having a plan to having looking forward, that’s why doing this thing about getting Hispanics to have a plan , a recovery plan is mobilizing all the resources that we know of so that people can apply for credits and apply for loans because resources are getting put, at least in this country in America, there’s more than $18 billion available for people that have small businesses and being an entrepreneur. Also for those people that have lost their jobs and they cannot afford to stop working, there are resources that you put them together in a collective action, it’s much easier to deal with as a situation that if you do that in isolation and fear. And so that’s the play in which I think that the most vulnerable are for sure the people that you’re mentioning, if you will, in the gig economy, in the shared economy and working in the service industry.

Edie Lush (54:57):

And I think it’s important to talk about the, the lessons that we’ve learned, which we heard in this episode. Asia actually has done better. There’s a tendency to dismiss the lessons from China. Authoritarian Eastern culture must be different, but Navarro said, and I think what you’re saying too, is that they have experience of SARS. They understood the danger. They also have incredible technology to track people and an acceptance from the population that tracking is necessary to help combat that. And I think we’re seeing the effects of that.

Claudia Romo Edelman (55:29):

And so for all our listeners, we do want to give you the encouragement of the power that you have to make sure that you take this seriously, that you stay home, that you’ve washed your hands, that you have that sense of authority over your colleagues, over your peers. But that you also have a sense of solidarity for those people that cannot stop working or that cannot actually get a job anymore. So this is a time for us to be agents of change and to have solidarity for each other and here are the Global GoalsCast we will continue reporting on this virus and we will continue reporting on what the world has done, what are the lessons learned and the best practices are. And in the meantime the power is with you.

Edie Lush (56:14):

If you want to support our efforts in doing that, do let us know. All right, so Claudia, stay safe. Wash your hands and see you soon. Thanks for listening everyone.

Claudia Romo Edelman (56:31):

Thank you so much!

Edie Lush (56:32):

Like, subscribe via iTunes or wherever you get your podcasts and of course follow us on social media at Global GoalsCast.

Claudia Romo Edelman (56:40):

If you live in America and want to be involved and support the Hispanic effort, go to Hispanicstar.org See you next time.

Global GoalsCast (56:52):

Global GoalsCast was hosted by Edie Lush and Claudia Romo Edelman. We are editorial guru by Mike Oreskes, editing and sound production by Simon James. Our operations director is Michelle Cooprider and our interns, Brittany Segarra and Taryn Rennie. Music in this episode was courtesy of Universal Production Music, one of the world’s leading production music companies, creating and licensing music for film, television, advertising, broadcast, and other media, including podcasts. Original music by Neil Hale, Angelica Garcia, Simon James, Katie Krohn, and Andrew Phillips. Thanks to CBS news, digital.