Coronavirus Is Our Future | Alanna Shaikh | TEDxSMU

Global health expert Alanna Shaikh talks about the current status of the 2019 nCov coronavirus outbreak and what this can teach us about the epidemics yet to come.

Alanna Shaikh is a global health consultant and executive coach who specializes in individual, organizational and systemic resilience. She holds a bachelor’s degree from Georgetown University and a master’s degree in public health from Boston University. She has lived in seven countries and it the author of What’s Killing Us: A Practical Guide to Understanding Our Biggest Global Health Problems. Recent article publications include an article on global health security in Britain’s Daily Telegraph newspaper and an essay in the Annual Review of Comparative and International Education. She blogs on coaching and personal resilience at www.thisworldneedsbrave.com.

The CDC now recommends always wearing a mask in public.

This talk was given at a TEDx event using the TED conference format but independently organized by a local community. Learn more at https://www.ted.com/tedx

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Transcript

Transcriber: Theresa Ranft
Reviewer: Peter van de VenI want to lead hereby talking a little bit about
my credentials to bring this up with you,because, quite honestly,
you really, really should not listento any old person
with an opinion about COVID-19.(Laughter)So, I've been working
in global health for about 20 years,and my specific technical specialty
is in health systemsand what happens when health systems
experience severe shocks.I've also worked
in global-health journalism.I've written about
global health and biosecurityfor newspapers and web outlets,and I published a book a few years backabout the major global health threats
facing us as a planet.I have supported and led
epidemiology effortsthat range from evaluating
Ebola treatment centersto looking at transmission
of tuberculosis in health facilitiesand doing avian influenza preparedness.I have a master's degree
in International Health.I'm not physician. I'm not a nurse.My specialty isn't patient care
or taking care of individual people.My specialty is looking at populations
and health systems -what happens when diseases
move on the large level.If we're ranking sources
of global-health expertiseon a scale of 1 to 10 -1 is some random person
ranting on Facebook,and 10 is the World Health Organization -I'd say you can probably
put me at like a 7 or an 8.So, keep that in mind as I talk to you.I'll start with the basics herebecause I think that's gotten lostin some of the media noise
around COVID-19.So, COVID-19 is a coronavirus,and coronaviruses
are a specific subset of virus,and they have some
unique characteristics as viruses.They use RNA instead of DNA
as their genetic material,and they're covered in spikes
on the surface of the virus,and they use those spikes to invade cells.Those spikes are the corona
in coronavirus.COVID-19 is known as a novel coronavirusbecause, until December,
we'd only heard of six coronaviruses.COVID-19 is the seventh.It's new to us,it just had its gene sequencing,
it just got its name -that's why it's novel.If you remember SARS –
severe acute respiratory syndrome -or MERS – Middle East
respiratory syndrome,those were coronaviruses,and they're both called
respiratory syndromesbecause that's what coronaviruses do.They go for your lungs.Don't make you puke,they don't make you bleed
from the eyeballs,they don't make you hemorrhage,
they head for your lungs.COVID-19 is no different.It causes a range of respiratory symptomsthat go from stuff
like a dry cough and a feverall the way out to fatal viral pneumonia.And that range of symptoms
is one of the reasonsit's actually been so hard
to track this outbreak.Plenty of people get COVID-19,but so gently, their symptoms are so mildthat they don't even go
to a health care provider.They don't register in the system.Children, in particular,
have it very easy with COVID-19,which is something
we should all be grateful for.Coronaviruses are zoonotic,which means that they transmit
from animals to people.Some coronaviruses, like COVID-19,
also transmit person to person.The person-to-person ones
travel faster and travel farther,just like COVID-19.Zoonotic illnesses
are really hard to get rid ofbecause they have an animal reservoir.One example is avian influenza,where we can abolish it
in farmed animals,in turkeys, in ducks,but it keeps coming back every year
because it's brought to us by wild birds.You don't hear a lot about itbecause avian influenza
doesn't transmit person to person,but we have outbreaks in poultry farms
every year all over the world.COVID-19 most likely skipped
from animals into peopleat a wild animal market in Wuhan, China.Now for the less basic parts.This is not the last major outbreak
we're ever going to see.There's going to be more outbreaks,
and there's going to be more epidemics.That's not a maybe; that's a given.And it's a result of the way
that we, as human beings,are interacting with our planet.Human choices are driving us
into a positionwhere we're going to see more outbreaks.Part of that is about climate change
and the way a warming climatemakes the world more hospitable
to viruses and bacteria.But it's also about the way we're pushing
into the last wild spaces on our planet.When we burn and plow
the Amazon rain forestso that we can have
cheap land for ranching,when the last of the African bush
gets converted into farms,when wild animals in China
are hunted to extinction,human beings come into contact
with wildlife populationsthat they've never come
into contact with before,and those populations
have new kinds of diseases:bacteria, viruses –
stuff we're not ready for.Bats, in particular,
have a knack for hosting illnessesthat can infect people.But they're not
the only animals that do it.So as long as we keep making
our remote places less remote,the outbreaks are going to keep coming.We can't stop the outbreaks
with quarantine or travel restrictions.That's everybody's first impulse:Let's stop the people from moving,
let's stop this outbreak from happening.But the fact is it's really hard to get
a good quarantine in place.It's really hard
to set up travel restrictions.Even the countries that have made
serious investments in public health,like the US and South Korea,can't get that kind of restriction
in place fast enoughto actually stop an outbreak instantly.There's logistical reasons for that,
and there's medical reasons.If you look at COVID-19,right now, it's seems
like it could have a periodwhere you're infected
and show no symptomsthat's as long as 24 days.So people are walking around
with this virusshowing no signs.They're not going to get quarantined.Nobody knows they need quarantining.There's also some real costs
to quarantine and to travel restrictions.Humans are social animals,and they resist when you try
to hold them into placeand when you try to separate them.We saw in the Ebola outbreakthat as soon as you put
a quarantine in place,people start trying to evade it.Individual patients, if they know
there's a strict quarantine protocol,may not go for health carebecause they're afraid
of the medical system,or they can't afford care,and they don't want to be separated
from their family and friends.Politicians, government officials,when they know they're going
to get quarantined,if they talk about outbreaks and cases,may conceal real informationfor fear of triggering
a quarantine protocol.And, of course, these kinds
of evasions and dishonestyare exactly what makes it so difficult
to track a disease outbreak.We can get better at quarantines
and travel restrictions,and we should.But they're not our only option,and they're not our best option
for dealing with these situations.The real way for the long haul
to make outbreaks less seriousis to build the global health systemto support core health-care functions
in every country in the worldso that all countries, even poor ones,are able to rapidly identify and treat
new infectious diseases as they emerge.China's taken a lot of criticism
for its response to COVID-19.But the fact is, What if COVID-19
had emerged in Chad,which has 3.5 doctors
for every 100,000 people?What if it had emerged
in the Democratic Republic of Congo,which just released its last
Ebola patient from treatment?The truth is countries like this
don't have the resourcesto respond to an infectious disease,not to treat peopleand not to report on it fast enough
to help the rest of the world.I led an evaluation of Ebola
treatment centers in Sierra Leone.And the fact isthat local doctors in Sierra Leone
identified the Ebola crisis very quickly.First as a dangerous,
contagious hemorrhagic virus,and then as Ebola itself.But having identified it,
they didn't have the resources to respond.They didn't have enough doctors
or hospital beds,and they didn't have enough information
about how to treat Ebolaor how to implement infection control.Eleven doctors died
in Sierra Leone of Ebola.The country only had 120
when the crisis started.By way of contrast,Dallas Baylor Medical Center
has more than 1,000 physicians on staff.These are the kinds
of inequities that kill people.First, they kill the poor people
when the outbreaks start,and then they kill people
all over the worldwhen the outbreaks spread.If we really want
to slow down these outbreaksand minimize their impact,we need to make sure
that every country in the worldhas the capacity to identify
new diseases, treat them,and report about them
so they can share information.COVID-19 is going to be
a huge burden on health systems.I'm not going to talk
about death rates in this talkbecause, frankly, nobody can agree
on the COVID-19 death rates right now.But one number we can agree onis that about 20% of people
infected with COVID-19are going to need hospitalization.Our US medical system
can just barely cope with that.But what's going to happen in Mexico?COVID-19 has also revealed
some real weaknessesin our global health supply chains.Just-in-time ordering LEAN systems
are great when things are going well,but in a time of crisis, what it means
is we don't have any reserves.If a hospital or a country
runs out of face masksor personal protective equipment,there's no big warehouse full of boxes
that we can go to get more.You have to order more from the supplier,
wait for them to produce it,and you have to wait for them to ship it,
generally, from China.That's a time lag at a time
when it's most important to move quickly.If we'd been perfectly
prepared for COVID-19,China would have identified
the outbreak faster.They would have been ready
to provide care to infected peoplewithout having to build new buildings.They would have shared
honest information with citizensso that we didn't see these crazy rumors
spreading on social media in China.And they would have shared information
with global health authoritiesso that they could start reporting
to national health systemsand getting ready
for when the virus spread.National health systems
would then have been ableto stockpile the protective
equipment they neededand train health care providers
on treatment and infection control.We'd have science-based protocols
for what to do when things happen,like cruise ships have infected patients.And we'd have real information
going out to people everywhere,so we wouldn't see embarrassing,
shameful incidents as xenophobia,like Asian-looking people getting attacked
on the street in Philadelphia.But even with all that in place,
we would still have outbreaks.The choices we're making
about how we occupy this planetmake that inevitable.As far as we have an expert consensus
on COVID-19, it's this:here in the US and globally,it's going to get worse
before it gets better.We're seeing cases of human transmissionthat aren't from returning travel,that are just happening
in the community.And we're seeing people
infected with COVID-19when we don't even know
where the infection came from.Those are signs of an outbreak
that's getting worse,not an outbreak that's under control.It's depressing, but it's not surprising.Global health experts, when they talk
about the scenario of new viruses,this is one of the scenarios
that they look at.We all hoped we'd get off easy.But when experts talk
about viral planning,this is the kind of situation and the way
they expect the virus to move.I want to close here
with some personal advice.Wash your hands!Wash your hands a lot!I know you already wash your hands a lot
because you're not disgusting.But wash your hands even more.Set up cues and routines in your life
to get you to wash your hands.Wash your hands every time
you enter and leave a building.Wash your hands when you go in
and come out of a meeting.Get rituals there
based around handwashing.Sanitize your phone.You touch that phone with your dirty,
unwashed hands all the time.I know you take it
into the bathroom with you.(Laughter)So, sanitize your phoneand consider not using it
as often in public.Maybe TikTok and Instagram
could be home things only?Don't touch your face.Don't rub your eyes.Don't bite your fingernails.Don't wipe your nose
on the back of your hand.I mean, don't do that anyway
because it's gross.(Laughter)Don't wear a face mask.Face masks are for sick people
and health care providers.If you're sick, your face mask holds in
all your coughing and sneezingand protects the people around you.And if you're a health care provider,your face mask is one toolin a set of tools called
personal protective equipment,that you're trained to use
so you can give patient careand not get sick yourself.If you're a regular, healthy person
wearing a face mask,it's just making your face sweaty.(Laughter)Leave the face masks in storesfor the doctors and the nurses
and the sick people.If you think you have
symptoms of COVID-19,stay home, call your doctor for advice.If you're diagnosed with COVID-19,remember, it's generally very mild.And if you're a smoker,right now is the best
possible time to quit smoking.I mean, if you're a smoker,right now is always the best
possible time to quit smoking.But if you're a smoker
and you're worried about COVID-19,I guarantee that quitting
is absolutely the best thing you can doto protect yourself
from the worst impacts of COVID-19.COVID-19 is scary stuffat a time when pretty much
all of our news feels like scary stuff.And there's a lot of bad
but appealing options for dealing with it:panic, xenophobia,
agoraphobia, authoritarianism,oversimplified lies that make us thinkthat hate and fury and loneliness
are the solution to outbreaks.But they're not,
they just make us less prepared.There's also a boring
but useful set of optionsthat we can use in response to outbreaks,things like improving health care,
here and everywhere;investing in health infrastructure
and disease surveillanceso that we know
when the new diseases come;building health systems
all over the world;looking at strengthening our supply chainsso they're ready for emergencies;and better education, so we're capable
of talking about disease outbreaksand the mathematics of riskwithout just blind panic.We need to be guided by equity herebecause in this situation, like so many,equity is actually
in our own self-interest.So, thank you so much
for listening to me today,and can I be the first one to tell you:wash your hands
when you leave the theater.(Applause)

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