1/29/20 Conference Call

The Growing Threat of the Coronavirus

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from Member Conference Calls

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Public Health Threats and Pandemics

China

Thomas J. Bollyky and Yanzhong Huang discuss the latest in the growing threat of the coronavirus, including efforts in China to contain it, and how U.S. officials are responding to its spread. 

Thomas J. Bollyky

Senior Fellow for Global Health, Economics, and Development and Director of the Global Health Program

Yanzhong Huang

Senior Fellow for Global Health

Sheri L. Fink

Visiting Fellow, Harvard School of Public Health

FINK: Welcome to today’s Council on Foreign Relations conference call on the growing threats of the coronavirus with Thomas J. Bollyky and Yanzhong Huang.

I’m Sheri Fink. I’m a correspondent at the New York Times and an executive producer of the new Netflix documentary series Pandemic: How to Prevent an Outbreak, and I’ll be presiding over today’s discussion.

I’d like to remind the members that this conference call is on the record, and just as we are convening, just to give everybody a sense of the latest numbers, which I’m sure will be immediately out of date, but today China has reported that there have been six thousand confirmed cases of the novel coronavirus with at least 130 deaths. So, clearly, a growing situation.

Also just announced, the World Health Organization, which had thus far not called this a Public Health Emergency of International Concern, which is the designation under the International Health Regulations that were created after the SARS outbreak, they have just announced that they’re going to be reconvening that committee tomorrow and so we can expect some announcements there tomorrow.

So I also just want to give just a little background on our speakers today. So Thomas Bollyky is a senior fellow for global health, economics, and development at the Council on Foreign Relations. He also has—the paperback edition of his book on the history of infectious diseases control, called Plagues and the Paradox of Progress, was recently released. Very timely. And apparently it is, I’ve been told, on Bill Gates’ reading list.

And also Yanzhong Huang, who’s a senior fellow for global health at CFR. Also has a book that’s about to be published that’s very relevant called Toxic Politics: China’s Environmental Health Crisis and Its Challenges to State Power.

So let’s jump right in. There’s been a lot of questions about the World Health Organization and how this has been handled so far in terms of just at what point they would pull that—pull the trigger of the Public Health Emergency of International Concern, also known as PHEIC.

And so, Tom, do you want to take that?

BOLLYKY: Sure. So thanks, Sheri, for moderating this call and for all of you to be joining us today.

So the World Health Assembly or the—I’m sorry, the World Health Organization last week on January 22 and 23 convened its Emergency Committee to advise on whether or not Director General Tedros Ghebreyesus should issue a Public Health Emergency of International Concern, or a PHEIC or a PHEIC, depending on how you like to say that acronym. I think most people expected that to be issued last week. The criteria for it are threefold, that it’s an extraordinary event, that it constitute a public health risk that could spread to—internationally, and third, that it requires a coordinated international response.

For a number of people, those criteria might have met—been met last week but the committee itself was divided. They met twice on January 22 and 23 and couldn’t come to consensus on it. Apparently, the sticking point was whether or not we—there had been cases spreading to secondary contacts so meaning people that haven’t been in Wuhan itself but people who contracted it from somebody who did contract the virus from there.

We now have that in Germany, those—that secondary transmission in Germany and Japan and Taiwan. Vietnam now believes it has an incidence of this as well. So we’re starting to see that happening in other nations. So it would be surprising, particularly at this point, if the WHO—the Emergency Committee did not issue a recommendation in that regard.

FINK: And just tell us, very quickly, so what powers or what comes with that designation? So if we see this tomorrow, what follows from that? What is the importance of that designation?

BOLLYKY: Great. So the main thing it does, this designation does—and there have been five issued in the past. Since the revision of the International Health Regulations in 2005 there have been only five of these issued, two of them for Ebola—it enables the—it’s meant to heighten public health and political awareness of the need to double down on conducting surveillance, sharing information, cooperation, strengthening public health capacities.

It’s also meant to move governments towards following WHO’s recommendations on trade and travel measures because these can often hinder response activities, and that’s something we’ve started to already see. There are a variety of countries that have imposed restrictions on travel from China and over the last twenty-four hours there have been a series of airlines that have announced that they’re stopping travel to China as well.

FINK: Yeah, and actually, it’s so interesting because sometimes there’s this fear that that designation will—you know, that it feels punitive to countries. But in this case, Yanzhong, we see the country itself taking some very drastic and what many experts are calling unprecedented, and we don’t like to throw around that word, but the unprecedented step of closing off cities of just, you know, millions and millions of people.

And I’m just curious, is China one of the few countries that could pull something like this off? You know, how is it working? Tell us a little just because you have insight into both public health and, you know, Chinese governance. Tell us what you think of this measure and how it’s feeling inside China and what are the likelihoods that it could actually succeed in containing this outbreak.

HUANG: Yeah. Sure. Thank you, Sheri.

I think, well, you’re right. This is, indeed, unprecedented I think not only in PRC history but probably also in the history of modern public health and given that this quarantine is now affecting hundreds of millions of people in the country.

In fact, it’s not just Wuhan and the neighboring cities but I think the entire country now is being shut down, that the people are basically advised not to come out—you know, not to go to the crowded places. You know, they’re asked to stay at home. And the government expected these quarantine measures—(inaudible). In fact, when WHO Director General Tedros was in Beijing he praised the Chinese efforts to contain the spread of the virus and—not just indicated, stated he was very confident China is going to get the job done. And he—

FINK: Well, wait. I saw that was reported in the Chinese media, but the actual WHO sort of description of his remarks was a little less florid. (Laughter.) Do you have confirmation that he actually said that?

HUANG: Well, we don’t—we have to ask him himself, actually—(laughter)—whether that is true or not.

FINK: OK.

HUANG: But, anyway, the Chinese themselves, there seems to be—some leading scientists now indicating that the coming ten days will be crucial for that containment effort. They expect that the—if everything goes well, the cases will start to go down in ten days. You know, that is exactly the time that in Shanghai they announced the date of February 9 for people to come back to work.

FINK: Mmm hmm. I mean, it is pretty extraordinary and, of course, most of the experts that I’ve been interviewing are quite skeptical that it could work. But there are others just saying—even in a story we had the other day—Tom Frieden, who is a former director of our CDC, might be even on the call—just that it’s—you know, I mean, it’s a remarkably—you do stop transmission if you stop people moving and being exposed to each other. And in some ways it’s, like, a very—one official I spoke with had a—sort of, like, a selfless kind of very—that we should all be grateful to them for trying this.

 

 

But I was—also wonder just about the secondary costs and whether you can have more suffering and deaths from restricting movements and cutting off places. So we’ll have to see. And, of course, there’s that issue of trust and people following what officials tell them. And so I want to sort of get onto that because it seems like there’s a lot of panic going on, issues of, you know, some very racist things being said and I’m curious just if either of you want to address the—just kind of what the—that issue of trust, the issue of fear, and how that is going to impact everything from international relations and business to the human cost of this.

BOLLYKY: So I’ll start and then—and then allow Yanzhong to continue because he’s really been following the on-the-ground situation in China quite closely. But I will say a couple things. One, on the quarantine measures and creating travel restrictions, there’s not a lot of good research suggesting there are many circumstances where that works well.

Certainly, if there are isolated cases, you really—you might have the grounds for doing that. But, generally, what ends up happening is it leads people not to report their symptoms. It leads people to try to circumvent public health officials and government officials, and, as you said, Sheri, that trust is really important.

For instance, most of the—I think, actually, all of the cases in the United States that have been identified, if not most of them, have been instances where the individual themselves reported themselves to public health officials. So that’s a really crucial part of response. And if people are trying to circumvent that, that’s a problem, in general.

You also have, in terms of the trade and travel restrictions, not only can it be counterproductive in the immediate case for the same reasons, that people will try to circumvent the restrictions. It also creates a precedent that makes it really difficult to convince other countries to report in other instances.

So if the economic consequences are unnecessarily severe to reporting an outbreak, the whole reason in part that the architecture exists this way under the International Health Regulation is meant to be a tradeoff. It’s a tradeoff between transparency and early reporting in exchange for the international regime about—and requiring trade and travel restrictions to be science based and to get recommendations from the WHO on how they should be applied.

Arguably, by being slow to issue a PHEIC—a Public Health Emergency of International Concern—the WHO has fallen down a little bit in terms of getting ahead of those travel and trade restrictions because they have come in the last few days while everybody was waiting for that declaration to be made.

FINK: Well, exactly, and we see—you know, I see a lot in the business news today just about how many companies are just going ahead and taking steps themselves. So you have the private sector taking actions with or without these kinds of larger statements or recommendations from the World Health Organization.

Yanzhong, did you want to add to that question?

HUANG: Oh, sure. Yeah, I think it’s—(inaudible)—risk like this and people naturally will develop this exaggerated assessment on the risk posed by a novel virus, you know. A good example, during the SARS outbreak one leading scientist joked that your chances of going to get a car accident and die to go to the—a Chinese restaurant actually is much higher than the chances of getting infected by the SARS virus.

But, you know, it’s natural for people to, out of fear, uncertainty, they will turn to some what we consider irrational precautionary measures to minimize the chances of getting infected. But as Tom just said, you know, there is the fear, the—or hysteria, this irrational response associated with an outbreak like this probably could cause more damage than the virus itself.

FINK: I think that’s a very good point, and people’s risk assessment is, you know, famously, not rational and I just want to quote some statistics from the CDC last week that said between eight thousand two hundred and twenty thousand people have died so far in the U.S. alone from flu—from seasonal flu this season, and that is something we have a vaccine for. And so we become very blasé about certain risks.

Obviously, the efforts now are to contain a virus that could add to that horrific total. But you’re right, just the fear is often really out of proportion to risk and that can be very unfortunate.

Yanzhong, just to continue with you, so China had SARS emerge in 2003. Can you just tell us what are the capacities and what are we seeing this time in compared to that time in terms of the local public health infrastructure being able to recognize a new virus, being able to quickly get on top of it, you know, the sort of politics of—there was, obviously, you can give us the history with SARS—that there wasn’t a lot of transparency at first there. So how are we seeing things this time? How are you seeing things this time?

HUANG: OK. Well, just so let’s focus on those disease surveillance and response capacity. You know, we’re not going to talk about the potential cover up, which seems to be clear also in this case. During the SARS outbreak, it was very clear, right, that this capacity was not there including the capacity to quickly diagnose or recognize there’s something unusual happening. Remember that when the Chinese CDC—their chief scientist trying to find out what was going on, he actually attributed the origin to chlamydia as the bacteria before the Canadian scientist announced—(laughs)—it was caused by a coronavirus—you know, SARS.

FINK: This is with SARS you’re talking about, yeah.

HUANG: Yeah. And this time, you know, after that we know the Chinese government has invested tremendously on building its capacity, you know, in terms of disease surveillance, response. You know, if you go to any provincial CDC headquarters they will tell you probably that this building was—it was a brand new building, actually were built after the SARS outbreak. And the—WHO Director General Tedros, while in Beijing, also praised Beijing for its ability to sequence the genetic information of the virus in a very short period of time and also share with the international science community.

FINK: So we have—

HUANG: Mmm hmm.

FINK: So it sounds like you’re saying we have sort of more—you know, better scientific expertise and technical expertise but still some of the—

HUANG: Yeah.

FINK: —medical issues have gotten in the way, possibly.

HUANG: Yeah. You would think that this—that they have significantly improved that scientific capacity to diagnose, you know, the origin of the virus, you know, that—but now we just have more information suggested that the picture is probably much more complicated than we thought. In fact—

FINK: Got it.

HUANG: —we were told that before January 16 the local health authorities—the local CDC—the provincial CDC in Hubei Province was unable even to do the diagnosis—do the diagnose tests. They had to send the samples to China’s CDC to do the diagnoses. So after January 1, they sent seven hundred and sixty-three samples to China’s CDC. A leading Chinese scientist did the tests and he claimed they were all negative, and that was the result that was published—reported in a science magazine. And they didn’t realize there’s something terribly wrong until after January 8 when that case was first confirmed in Thailand.

FINK: So, in any case, just to summarize that, there were delays and we may be seeing some real—some real impacts from that. And before we go to questions from our members, Tom, just wanted to ask you, is there a possibility that this could just become sustained transmission, that it won’t be containable? And what’s being sought in terms of countermeasures—you know, diagnostics, medicines, vaccines? What’s happening on that front?

BOLLYKY: Great. Well, the good—the first answer is, yes, there is a real possibility that this could become a sustained spread of this disease, that we fail on our—the international community and the Chinese government fail on their attempts to control the current outbreak. As you know and perhaps many of those on the phone will know, there are lots of important pieces of information there—again, how easily it spreads to secondary and tertiary contacts, whether or not the disease is able to spread asymptomatically, how many deaths the disease caused, how many severe episodes of illness. All these things are going to be important for knowing how likely that sustained outbreak is going to occur, you know, in what populations. We can go on and on.

But let’s assume for the—or for the current case with the rapid growth of cases, and I’ve seen some modeling done that people think the real number of cases may be as high as forty-four thousand in China, that you may be looking at a circumstance where you have a sustained—a sustained epidemic both in China and in some of these other countries where we’re seeing secondary spread.

In those instances, it’s going to be very important to start working on a plan to mobilize a response and important on the—on the countermeasures side. The good news is with the early sharing, China’s CDC—for all the criticisms that have occurred of the Chinese government in general, China’s CDC and actually recently has a history of being fairly open in sharing genetic sequences and did so relatively early here.

That allowed for the development of the diagnostic. That’s great. The vaccine side is underway. Our National Institute of Allergy and Infectious Diseases is working on it along with CEPI, an NGO that is investing in development of vaccines.

What people on the phone should keep in mind, because there is a lot of optimism about that and I share that we have more of a global architecture in place, but, you know, realistically, we’re looking at three to four months before it enters phase one clinical trials—that’s just to determine the basic safety—and, you know, nine months to a year before we go to phase two and beyond.

Most vaccine candidates fail. It is very important that these public-funded efforts and philanthropically-funded efforts, working with private sector, develop as many candidates as they can and that’s already going underway. But people should be realistic both in terms of the time frame in which a vaccine might emerge and also the likelihood of success, and that’s leaving aside how is it distributed, how is it registered, who gets it and in which country and all those—

FINK: Who gets it first. (Laughter.) Yes.

BOLLYKY: Who gets it first. And all those questions are yet to come.

FINK: Well, thank you. And just in the interests of what the WHO leader did say, I just am tweeting at Dr. Tedros, which is the WHO’s—head of the WHO’s own Twitter account. He just tweeted within the last hour and he said, “I was struck by the determination of Chinese leadership and its people to end the new coronavirus outbreak. They are suffering the most. Their lives and economy are bearing the brunt of the outbreak as they make sacrifices to contain it. China needs the world’s solidarity and support.”

So at this time, I would like to invite members to join our conversation with their questions. A reminder that this call is on the record. Please limit yourself to one question and keep it concise to allow as many members as possible to speak.

OPERATOR: Thank you.

(Gives queuing instructions.)

And our first question will come from Lyric Hale.

Q: Yes. Hello. I’m calling in from Chicago, and I have a question about the rumors that are swirling around this virus, that, perhaps, there’s a bioengineered aspect to it—that it’s not completely natural, and if those rumors prove to be true that would be a game changer in terms of treatment, obviously. So I’d really appreciate any insight into that question.

Thank you.

HUANG: OK. Can I answer that question, Sheri?

FINK: Sure. If you’d like to, go ahead, and I can offer some insights, too. But go ahead.

HUANG: Yeah. I think there’s, essentially, two hypotheses here in terms of the origin of the virus. You know, one points to the animal origin and that it was believed that the bats and snakes were the carriers—the animal sources of the virus. But that is still not yet confirmed.

The second that—the second that just—Lyric just mentioned is that—point to a biosafety accident that likely occurred in the Biosafety 4 Lab in Wuhan. Remember that in 2015 they built China’s first and is currently still the only T4 lab that can handle the most dangerous pathogens, you know. So this hypothesis basically connected that to what is going on today and but that we don’t have any smoking gun evidence to support that. But you are right. Indeed, there are rumors, you know, now shared by this—in Chinese social media that points to this as a potential source.

FINK: I just want—yes, so I think we should just be clear with our members that at least in terms of the science that I’ve seen and, you know, this virus—we have the sequence of it. It’s very closely related to other previous coronaviruses that we know. There are animal populations that harbor these without getting sick and that’s how, typically, these viruses—when they jump into the human population it typically does come from animals.

So I think we just need to be very careful. We’re seeing a lot of, like, rumors and conspiracy theories. But thus far, at least I haven’t seen any, you know, reputable scientists promoting that idea and I’m not sure, Tom, what your sense of that is.

I’m not sure if we’ve lost Tom. OK. (Laughter.) I’m—

HUANG: Yeah. Yes. Sheri, may I just add to that? There was (a symmetry ?) of a similar biosafety accident. There was one after SARS outbreak. There was one Anhui Province, a leakage of the SARS virus causing infection of several people in that province, indeed.

BOLLYKY: I would still argue that Sheri’s—I favor the simpler explanation. There’s a history of zoonosis involving coronaviruses jumping from an animal population to a human population. There’s a history of that occurring in China. Whether it’s this particular wet market or something else around the animal trade, it seems far more likely than the exotic explanation. That said, we’ll see in the emerging days what comes out.

Q: Yeah. Yeah, thank you for dealing with that rumor. I think it’s important to do that. Thank you.

FINK: Thank you for getting it—for asking the question. That appears to be on a lot of people’s minds.

The next member, please.

OPERATOR: Thank you. Our next question comes from Grace Gu.

Q: Hi. Thanks for the panel.

So my question is about the readiness of the U.S. to face such a disaster of this scale that’s affecting, you know, hundreds of thousands. You know, so what are the lessons learned from how China has been dealing with the crisis and can you comment on the U.S. capacity?

Thank you.

BOLLYKY: So I’ll start and then Yanzhong and Sheri can weigh in as well.

But so the U.S. capacity has improved. I have enormous confidence, first, in—so start with the CDC, which would provide the technical assistance and the surveillance and the contact tracing in terms of both the—well, of the domestic response and also that assistance internationally. I have a great deal of confidence in the expertise and capacity of that agency.

I, similarly, have a lot of confidence in the capacity of NIH ID, led by Tony Fauci, who has been leading that agency for—since 1984 and is remarkable. So we have, particularly at the agency level, a good capacity. There’s been investments in our—more investment in hospitals in terms of our capacity to handle something like this. There’s a limited number where that remains the case but we have a better capacity, certainly, than we did around SARS and even around Ebola in terms of the number of hospitals that might be able to confront this.

I think in terms of the screening processes, which has recently been extended to twenty airports, I think that’s a prudent measure. As was pointed out in the briefing done yesterday by Health and Human Services by, I believe, Tony Fauci, mentioned in those contexts it’s often not the—what the screening itself identifies but conveying to people what they should look out for, what the symptoms might be, who they should call. That tends to be very useful. So good news on that side.

I do have concern on the coordination interagency wise, I have some concern on politicking in an election year, and I had a concern about funding. Just briefly on each of those things.

On the coordination on the interagency wise, we’ve seen a shift in how global health is managed at the National Security Council, which would ordinarily oversee the interagency process in this case. There used to be five people in the National Security Council working on global health overseen by a senior official—a senior director.

That has all changed. There is only—there’s two people directly working on that at the director level. They report into someone who covers a wide range of activities. Current reports are that this response is being coordinated by the deputy national security adviser, Matt Pottinger. People think highly of him but he has a lot on his plate. So I worry a little bit about coordination because responding to a(n) epidemic or outbreak really does take a variety of agency inputs and coordination.

Funding wise, we’ve cut our funding on the global health security and that agenda from 1.3 billion (dollars) in 2015 down to 400 million (dollars) now. So there has been a cut. There’s an emergency fund to tap, which has already been tapped. Secretary—HHS Secretary Azar said yesterday that funding won’t be an issue and I think that’s probably true. The question is how quickly it comes and how quickly we’re able to mobilize that, if it has to be appropriated by Congress or drawn from other sources.

The last issue I would be concerned with is politicking in an election year. Senator Tom Cotton has issued a letter already that came out today or this—yesterday or this morning calling for travel bans to China and, you know, I worry a little bit about this issue being politicized. Those of you who will remember amidst the West Africa outbreak of Ebola in 2013 and 2015, one of those came during a mid-year election and it was certainly politicized, including by Donald Trump, now President Trump, who called for bans to all those countries. So I worry about where we’re going on that front.

FINK: Thanks. And do you guys want to tell—just I think this member might and many members may be wondering what is—for the U.S. what is a good source of information on—you know, I think it’s important because the bottom line with a pandemic or an outbreak is that it’s on all of us, right, to protect ourselves, to protect our families and communities. What are some good sources of information that people can turn to to get the most up-to-date recommendations on how to protect—how to protect ourselves and our communities?

BOLLYKY: Great. So CDC has a situation summary on the 2019 novel coronavirus. They’ve been tracking the spread and development of the virus as well as updating online. They have good advice on what people should do and how concerned they should be, and I would really urge people to start there.

FINK: OK. So the CDC website, and it comes right up if you Google CDC coronavirus.

Next member question, please.

OPERATOR: Thank you. Our next question comes from Arch Ursdeh (ph).

(No response.)

OPERATOR: Arch, your line is unmuted. You may need to unmute your phone line to ask your question.

(No response.)

FINK: OK. Let’s go to the next member.

OPERATOR: Our next question comes from Keith Richburg.

Q: Hi. Can you hear me?

FINK: Yes.

HUANG: Yes.

BOLLYKY: Yes. Great.

Q: Hi. Keith Richburg from Hong Kong—the University of Hong Kong. So we’re kind of right in the epicenter, I guess, or next to it.

Just a question, because we’ve been getting kind of different views from China and international experts on when we might see this peak and when we might see it start tapering off. From China, one of the doctors there looking at it said we could be seeing the peak of it in a week or so or by early February and it should start tapering off. Some of the international experts are saying they don’t expect to see it peak until sometime around April or May. So those are pretty divergent viewpoints. I’m just wondering what the—what the modeling or based on previous epidemics would suggest to you.

HUANG: I could take—well, maybe Tom could weigh in later. Just—I think the rationale for the Chinese scientists to predict that the virus will peak in February because the quarantine measures—draconian quarantine measures were implemented on January 23 and the incubation time for the virus is up to fourteen days and usually, like, seven to ten days.

So they expected that by, like, February 9 also, you know, that we—if that quarantine measure is going to take effect we’re going to see that it’s going to interrupt the transmission chain. So you’re going to expect the cases, infections, will go down. You know, then you’re going to see the tapering off of the outbreak. And, indeed, from today if you look at the confirmed cases, the number actually already is—actually we are seeing less than yesterday’s cases. So that might be a good sign that those quarantine measures are—potentially, are taking effect.

FINK: We have also heard some reports that they—that there are some shortages in the diagnostics. So we have to take that into account. But, hopefully, that bears out.

BOLLYKY: Yeah. I mean, I think the real answer is and the answer anybody should give is we don’t know. You know, the—even on the incubation period side, the New England Journal of Medicine just put out a report on—coming from Vietnam that the cluster of cases they’ve seen suggest a three-day incubation period. There’s just—it may be closer to what my colleague has put out, too. It’s just we really don’t know.

We don’t have a good sense of, again, how easily it’s spread. There’s still debates about asymptomatic spread, which, you know, may not be, as Dr. Fauci pointed out yesterday, the main driver for the expansion of the epidemic. But it is—certainly, does have an effect on how we pursue control measures. You know, the reality is that we don’t know. I’ve heard reports that it may peak in ten days, reports that it’ll go for longer. I think it really depends on what assumptions you’re baking into that analysis and that’s something we’ll know more about in a week. But we—ideally, but we don’t yet.

FINK: And another thing that’s not quite clear yet that maybe we’re seeing is just the proportion of cases that are severe versus the proportion that are—that are mild, and do we have a good sense of that yet? I’ve heard it may take a couple weeks to really know that.

BOLLYKY: Not at all. So we don’t know the numerator or the denominator on that issue. We don’t know how many people for sure, you know, have developed more serious consequences from this particular illness. We certainly don’t know the denominator, meaning how many people have it in general. So we’re a ways away from getting a sense. I mean, based on the reported cases and the reported deaths, it looks like a case fatality rate, meaning how many—how many fatalities per overall number of cases of 3 percent. But, I mean, again, this is really based on very early reporting on the number of cases we know and we’ll know more—

FINK: Right. And we typically get—see the more severe cases earliest. So it could be expected to change.

BOLLYKY: Absolutely.

HUANG: May I jump in? Actually, in terms of—we know that this is a very highly transmissible virus. But from what I learned from those doctors who actually treated those patients, it seems to suggest that the virus is not as virulent as SARS. So that also may suggest a much lower the case—(inaudible)—you know, than the SARS.

FINK: You mean not as severe, not as—

HUANG: Right.

FINK: —that the—OK. Mmm hmm. That would be good if that—if that bears up. (Laughter.)

Next member question, please.

OPERATOR: Thank you. Our next question comes from Ellis Wang (sp).

Q: Yeah. I have a question, because I hear one of the speakers say, you know, the lockdown in China might not be effective. So what would you do otherwise if there weren’t a lockdown in effect?

BOLLYKY: So I think—and, again, I’ll let my colleague speak as well on this. I think the big issue was transparency to start with in terms of the information that was emerging—how many cases, how severe they were, good public health advice of measures that can legitimately help control the spread, encouraging people to report.

I mean, what generally works is, again, as Sheri mentioned at the outset, is trust and, you know, in this environment, China, after SARS, there’s, you know, some sense that—in terms of restrictions surrounding information was a little more permissive of criticism of local officials and that maybe that would tackle problems like these and they would emerge up to the national level and people would know—would know more. It doesn’t seem to have worked in this case.

So, you know, we—I think the reality is what you want is people to self-report and then to be able to trace their contacts. And, again, anything where if people don’t know what’s going on, they don’t know what they should be doing to counteract the potential spread of the disease, they don’t know necessarily how to identify what they have, you have that mistrust, you have that secrecy, you have people avoiding the government, is not generally a recipe for controlling an outbreak.

HUANG: Yeah. I agree with Tom that the actual quarantine measures are not the silver bullet to fighting the virus, you know, that when we look at the SARS outbreak, for example, the cases started to drop even before those large-scale quarantine measures were in place. You know, so not to mention that those quarantine measures are also associated with fear, panic—all those irrational moves that could cause a lot of damage to not just the public health but also the economy.

BOLLYKY: Yeah. And to tie into that, I mean, most of both the health and economic consequences of these outbreaks, 1918 aside, are generally from aversion behavior—people avoiding the ordinary economic activities they would do—shopping, flying, other activities—people avoiding health care facilities. This is—you know, the number of deaths that we have recently seen from outbreaks are relatively low. It’s generally—but, you know, in the SARS (confluences ?) you’re talking about eight hundred deaths but $30 billion of damage and that was, largely, from the aversion behavior. So that comes to how people respond when they—when they don’t know what’s going on.

What I will say in defense of quarantine at this point and sort of in a similar line—along the lines of airport screening, it does make people very conscious of what they’re doing, and from that standpoint, keeping it in the forefront of people’s mind the need to be very careful, avoid crowds, to be aware that the outbreak is happening is something which can have benefits even if the, you know, lack of broader trust doesn’t. But what it does in this circumstance is it creates a time period like we saw in this case where the outbreak can take hold and spread to other countries and develop significant numbers because, again, you have that lack of information and trust.

FINK: I just want to trail off one point and just for those who aren’t, you know, medical experts or public health experts—members who might be on the call—it’s not magic in terms of, you know, preventing yourself from getting sick. There’s simple things you can do and they’re the kinds of things that we learn about when trying to protect ourselves from flu. You know, it’s things like wash your hands. Don’t touch your nose and your mouth if you’ve touched a doorknob. You know, stay a certain distance from somebody who’s sneezing and coughing. So, again, the CDC website is really good for that and we can all do those things. Those other things that are helpful in an outbreak like this and that can protect ourselves.

Next question.

OPERATOR: Thank you. Our next question comes from Peter Court (sp).

Q: (Off mic)—additional piece of it, which is it seems as though the—there is a little bit of a tradeoff between isolation and transparency. If you cut—isolate people a lot you’re going to discourage transparency but if you don’t isolate people at all, then you’re going to get more spread. So is there anything more you can say about that balancing act?

FINK: Who’d like to take that?

BOLLYKY: Well, I can start. Unfortunately I’ll be largely echoing what I said before, but I do think it’s—the main thing is to maintain trust and self-reporting. Because that’s by far—by far and away the best way to get a handle on the traces. It’s not magic how people control these outbreaks. It’s shoe-leather public health. Identifying cases, isolating those cases, tracing their contacts, surveilling and maintaining that surveillance over their contacts. You know, these are the kinds of things that at the end of the day snuff out outbreaks. And to do that, you have to have information coming.

There is an amount of isolation there in terms of cases. You know, you do want to avoid people from going to crowds. And I thought it was appropriate on the Chinese government side around the spring festival to have restrictions on crowds and broad-spread travel around the country on those issues. I think there are reasonable things you can do. It does seem—you know, it’s—I agree with Dr. Tedros, we need to be supportive of the Chinese government. So I don’t mean to pile on, I really don’t, on this. But it does seem that the balance, particularly in the early days of this outbreak, were not gotten right.

FINK: OK. Next question, please.

OPERATOR: Thank you. Our next question comes from Tom McDonald.

Q: Hi. Tom McDonald. Partner of Vorys, Sater and former U.S. Ambassador to Zimbabwe.

Mine may seem like a very sort of simple, elementary comment, but you know, these, you know, public marketplaces. And I even saw this in Zimbabwe, you know, where Chinese are active in African commercially. But selling, you know, porcupines and different kinds of cats. And people in—even in Zim complained about dogs turning up dead or missing. You know, what is the—if the trend—if the origin of this—and I’m not a doctor at all. We dealt with HIV/AIDS a lot in Zim when I was there. So the question really is, what about these market—public marketplaces that at least in the daily press is where this has been attributed, originated with, you know, very exotic-type animals? And I’ve traveled extensively in China as an international lawyer. So will diets change? Will the government at some point restrict what kinds of animals can be sold in these marketplaces that are incubators for disease? I don’t know.

FINK: Thank you for the question. I think a lot of people wonder about that. Go ahead.

YANZHONG: Yeah. I think, indeed, the first forty-five cases identified by the Chinese were connected to that single wet market Wuhan. So now they’re—

FINK: It was actually—they later learned that that was actually corrected in the Lancet by the Chinese researchers just very recently, that not all of them were—I think it was two-thirds.

YANZHONG: Right. They were—yeah. Yeah. And it was—

FINK: And I should also say, Yanzhong, I just read a study that also suggests that it was a single introduction into a human. So another was researchers do this really cool science where they can sequence every single sample that is coming in that’s provided to them, and they can actually look for tiny little changes in the virus and trace it back. So they believe it was just a single animal—presumably animal to human transmission. That’s new data that I was just looking at in my reporting. So please go ahead.

YANZHONG: Thank you for sharing that update. Initially it was connected to that wet market. And now they’ve—the Chinese agree that this is a not-good habit of eating the wide animals, you know, the large animals. And the government has imposed a ban on this—on those animals, not just in Wuhan, but in the entire country. We hope that they are going to actually extend the ban to be permanent. But again, the issue is how to enforce that ban. You know, we have the history by the United States, when you banned alcohol, why, people made it in their house—in their own houses. So this is going to pose a challenge to the Chinese government of how to effectively enforce the ban. You know, they did that actually after SARS outbreak. It didn’t work out.

FINK: I just want to add something from my experience reporting in West Africa during the Ebola outbreak. And it was a big focus early on, where the possibility that it had—that Ebola had come from wildlife into humans through perhaps a bat, and that handling wild animals was a big culprit, and there was a lot of, you know, effort—public health posters and things like that. And then there was a shift, and the understanding is that it was likely that, again, just like here, one introduction from a wild animal to humans. And there are so many ways that we are going into—you know, human expansion is going into areas that used to be wild.

So I think, you know, we have to also remember—and this was said in West Africa—that this is a source of protein and nutrition for a lot of people. So there needs to be some thought into the balance of banning markets versus maybe just better practices around them. I’m not expert, but I do remember that being a big part of the conversation, that sort of everybody focuses on these markets and it turns out that the vast, vast majority of cases are coming through human-to-human transmission at some point. But obviously you do want to be monitoring wildlife, and limiting that chance of that leap from the, you know, animal kingdom to the human animal kingdom.

BOLLYKY: Yeah, and I’d just add to that. I mean, I agree with both of those statements. And I—in terms of what my colleague said about the banning of the wildlife trade, you know, I think particularly after SARS—which, you know, appears to have originated in bats—(inaudible)—potentially more broadly—people have been talking about these wet markets for some time, and it is a public health concern. That said, one thing I do want to caution—because there’s been a lot of really ugly comments, particularly online, apparently at airports, you know, stemming from notions that, you know, eating of wildlife like this or dogs is widespread, and therefore people won’t sit next to people on planes, and other really ugly stuff.

And, you know, we have to balance the very legitimate question that’s given around public health oversight of wet markets and how they can stop outbreaks to, you know, some of this stuff that’s going online about taking—which in some cases can be, you know, pretty offensive notions about populations, and leading to, again, the kind of environment that leads to mistrust. Again, very legitimate question. Not a criticism of the question. Criticism of the activity going on online that people are taking from those kinds of issues. Just wanted to emphasize that.

FINK: That’s really well said. Thank you.

Next question, please.

OPERATOR: Thank you. Our next question comes from Julie Chan (sp). Ms. Chan (sp), your line is open. You may need to unmute on your end to ask your question.

(Pause.)

Our next question comes from Emily Webber (sp).

Q: Hi. So I just had a question kind of in the same vein as previously asked.

But I think there was a Wall Street Journal article recently about worries about the coronavirus getting to Africa and possible some less-developed countries that maybe don’t have the same strong protocols in place as some of the more developed countries that have noticed it so far and tried to contain the outbreak. How concerned should the United States be? And is there other things the international community should be doing to kind of help countries that don’t have as strong a protocols to deal with this? And are there any particular countries of concern that you’re worried about at this point?

BOLLYKY: So I’ll start and then turn it over to the other two. I have a real concern about this. There are already prospective cases. I don’t know if we have a confirmed one case. There’s been one that’s been suspected for a while. So my colleague will correct me if I missed the news on Côte d'Ivoire and whether or not that case was ever confirmed. There’s suspected cases in other countries as well. We have today our first case in UAE. So we are starting to see other regions get involved.

The concern on the sub-Saharan African nations in particular in this context is, you know, twofold. One, you have the control concerns, which is if you have an outbreak of a disease that is significantly more contagious than Ebola, in this instance, you know, that the control might be quite difficult to maintain in health systems that aren’t—don’t have the same level of funding or have the same level of development. You also have concerns on the treatment side, that you’ll see—you know, the case fatality rate from Ebola is significantly lower outside of the region. You know, the 2013-2015 outbreak one out of eight cases that were experienced outside of West Africa resulted in a fatality. The original case fatality rate there started at 70 (percent). I think it dropped down to 40 (percent), but still was significantly higher. So there is that concern too.

If you also see a spread to countries where you have a more limited basis to control, you also may see a much larger number of cases. And that also makes it harder for the kind of containment measures that the U.S. and other countries are putting in place. Right now we’re screening flights from China at twenty airports. You know, if you see a sustained spread in a broader range of countries, this becomes harder and harder to do. So I really share your concern.

What could we do differently? Well, we just cut our budget to global health security. You know, nobody expected it to maintain at the heights of 2015 or 2016 of $1.3 billion in terms of the response to the Ebola outbreak. But it really, again, has dropped down to pre-Ebola outbreak levels, maybe even a little bit less. African CDC has, you know, already taken measures to start to prepare and to coordinate an international response. But it’s unfortunate that, you know, this is a very predictable event. I hope we don’t end up having to relearn the lessons that we learned from Ebola again in this context.

FINK: And do you want to—

YANZHONG: Yeah, I think that—yeah. Yeah. I think the risk is there, as Tom just elaborated, that in 2003 we had similar concerns, given the lack of surge capacity on the continent, people’s vulnerability to the disease. You know, but unfortunately the—(inaudible)—mostly like failed the continent. You know, maybe it has something to do with the warmer temperature there. And in this case, people are saying that the virus in Wuhan is indeed vulnerable to high temperatures. But given these increasing economic linkage between China and Africa, you know, that—I think this context now has changed.

FINK: So we have one minute left. I would just welcome our two wonderful talents here. And thank you—well, I’ll start by thanking you both. Tom Bollyky, the senior fellow for global health at Council on Foreign Relations, and Yanzhong Huang, also senior fellow for global health. Would you both like to just make any last points that we haven’t gotten to today?

BOLLYKY: The only thing I would say is I’d echo Sheri’s point first. Thank you all for coming. Again, this is worth tracking, worth ensuring our government has a productive response. Get your flu shot. There are many more things in your personal life you should be concerned about as opposed to this outbreak.

YANZHONG: OK. Yeah, I think it’s still too early, still too—if we talk about it, I believe that the participants who are interested and asking about the potential impact of the outbreak on the economy—I think it’s still too early to quantify the potential impact. Just still much and we still need to know—the case fatality rate, you know, for example, of the virus. But if you look at SARS, you know, this shaved off one percentage point of China’s GDP. So there’s a report from S&P suggesting that the spending on services, such as tourism, fell by 10 percent. Overall GDP growth fell by about 1.2 percentage points in China.

FINK: Wow. Well, a big story, and many, many different angles to it. So thanks, everybody, for joining us today. And this will conclude our teleconference call.

(END)