Public Health Threats and Pandemics
Thomas J. Bollyky, senior fellow for global health, economics, and development, and director of the Global Health Program at CFR, discusses COVID-19 and covering public health with series host Carla Anne Robbins, adjunct senior fellow at CFR and former deputy editorial page editor at the New York Times. This call is part of CFR’s Local Journalists conference call series.
Learn more about CFR’s Local Journalists Initiative.
Senior Fellow for Global Health, Economics, and Development, and Director of the Global Health Program at the Council on Foreign Relations
FASKIANOS: Good afternoon and welcome to the Council on Foreign Relations Local Journalists inaugural Conference Call Series. Today we will be talking about reporting on COVID-19 and public health. I’m Irina Faskianos, vice president for the National Program and Outreach here at CFR. As you know, CFR’s an independent and non-partisan organization and think tank focusing on U.S. foreign policy. This call is part of CFR’s Local Journalist Initiative, created to help you connect global to local issues that you cover in your community. Our programming puts you in touch with CFR’s resources, expertise on international issues, and provides a forum for sharing best practices.
We know that many of you on the call are working tirelessly to keep the public informed about the COVID-19 pandemic. Thank you for that. Thank you for taking the time to be with us. The call is on the record. The audio and transcript will be posted on our website after the fact, at CFR.org/localjournalists. We shared full bios for our host, Carla Anne Robbins, and speaker Tom Bollyky prior to the call. Carla Anne Robbins is an adjunct senior fellow at CFR. She is faculty director of the Master of International Affairs Program and clinical professor of national security studies at Baruch College’s Marxe School of Public and International Affairs. And as many of you know, Carla was deputy editor of page editor—editorial page editor at the New York Times, and chief diplomatic correspondent at the Wall Street Journal.
Tom Bollyky is CFR’s senior fellow for global health, economics and development, and director of the Global Health Program. He is also an adjunct professor of law at Georgetown University. He is the author of the book, Plagues and the Paradox of Progress: Why the World is Getting Healthier in Worrisome Ways. The book was included on Bill Gates’ booklist. He is also the founder and managing editor of Think Global Health, an online magazine that examines the ways health shapes economies, societies, everyday lives around the world. This site offers terrific resources on COVID-19 and other topics. So I commend it to you for your reporting. You can go to ThinkGlobalHealth.org. You can also access it from CFR.org.
So welcome to both of you, Carla and Tom. Thank you for kicking off this series. And I’m going to now turn it over to you, Carla, to take it from here.
ROBBINS: Thank you so much, Irina. And, Tom, thanks so much for doing this. And thank you all for everyone who’s on the call. I just can’t imagine what your lives must be like right now in the field, and the challenge both to your physical security and how overwhelming the twenty-four-hour news cycle must be these days. So thank you for doing that work. It’s extraordinary for our colleagues out there, and extraordinary for those of us who are reading it. So thank you.
So, Tom, let’s start—just to give all of you who have called in just a sense, Tom and I are going to talk for about fifteen minutes and then we’re going to throw it open to your questions. So, Tom, let’s start. Can you just give us a very quick sense of what issues do you think deserve the most attention and coverage right now both domestically and globally about the course of the pandemic?
BOLLYKY: Great. First of all, thank you both, Carla and Irina, for convening this call and moderating it. And thanks to all the journalists on the phone. It has been a flood of information out there, but it’s so important, the work that you’re doing especially now to give accurate, evidence-based information to people to sort through what’s happening and what’s coming. So I commend you for that, and I’m very pleased to be part of the call today to help however I can.
The story I think that people must—the eyes of the nation—let’s put it this way. The eyes of the nation, rightly, are on what’s happening with COVID-19 here in the United States. But we mustn’t lose sight of what’s happening in this pandemic abroad. That’s because it’s become clear that no country is going to escape this pandemic. There are cases and—reported cases in at least 175 countries, at least 140 countries and territories have reported deaths. We are all on the same epidemic curve together on this. Most of the modeling that we’re using, and some of you have been following the model put out by our good friends and collaborators on that Think Global Health website, the Institute for Health Metrics and Evaluation. All that is based on what happened abroad with this outbreak. And particularly on that model in what happened in Wuhan.
So both as journalists but also in terms of policymakers in the broader public in surmounting this terrible outbreak we have to learn from those that are ahead of us on that epidemic curve, I would draw out three quick lessons from what we’re seeing. The first is one that will be more familiar, but important to emphasize, that if allowed to spread this virus has fearsome consequences. The cases do spread asymptomatically. Some governors are catching onto this just in the last couple days, but it’s been clear for a while. They increase exponentially. And the demand on the health care system lags by about three weeks, which is roughly how long it takes for a person to get critically ill.
Italy at the start of a month ago, on March 2, had just under 170 cases and only thirty-four deaths. They’re now reporting 1,400 deaths and nearly 115,000 confirmed cases. That’s a case fatality rate numbers, deaths over all cases, that approaches 10 percent. And that reflects their elderly population, but also a completely overwhelmed health system. Italy’s population, of course, is less than one-fifth size of the U.S. But our cases are increasing at a similar pace and our death rate is actually a little bit higher in terms of how, at this juncture, the pandemic, how our cases are increasing. Overall, Western Europe has twice as many cases as the U.S., and seven times as many coronavirus deaths. But here too, our death rate is increasing faster, at this stage.
The other point, second point I want to draw from the lessons abroad, is that we are in this for the long haul. Given the fact that no one has preexisting immunity to this virus, it will—and there are no currently effective treatments or an effective vaccine, that means when countries let up on control measures, transmission will inevitably—cases will inevitably reoccur, and there’s a risk of transmission. So even countries or territories that successfully dealt with this are starting to see research into as students return and expatriates have retuned.
So Hong Kong has now confirmed over eight hundred cases. Singapore, which is rightly everyone’s gold standard in terms of national response, just surpassed a thousand cases. Japan, which had looked pretty good early on, its cases—reported cases have doubled in the past week. So until at least 50-60 percent of the U.S. population becomes immune or we have an effective vaccine or treatment, we are going to be living with this. We are going to have that risk. And it’s important for viewers and readers to understand that.
The last bit I want to emphasize, or third lesson, is the U.S. is not alone in terms of not having a—its reported cases not being entirely in line, likely, with what the situation is. The fact is that we’re catching up now to get a better sense of what has been going on for some time in terms of community transmission in the U.S. That’s true elsewhere as well, internationally. And we can see these kinds of risk occurring otherwise.
Some of you may have seen the estimates just coming out of Baghdad alone by local health officials that they may already have as many as nine thousand cases just in that city. And that’s far from what they’re actually reporting. Japan has only done 6 percent of the testing that Singapore and South Korea has done on a per capita basis. So they really don’t have a great sense on what’s increasing there. And then of course in the news has been China, and whether it’s been accurately reporting. So we are not the only country to be having these issues. And the consequences are starting to—you know, particularly in places like the Middle East or in Japan—starting to accrue.
Let me stop there and let more questions come.
ROBBINS: So—well. (Laughs.) That’s depressing and terrifying. So this notion of a second wave, even in places like the gold standard. But we had had some hope that the Chinese, as draconian as their approach was, seemed to have a handle on it. Now we’re seeing reports that the intelligence community reported to the White House that the Chinese were faking their numbers, which is a different thing from not having accurate numbers. One would not be surprised if the Chinese would have—for political reasons. They have a long history of not accurately reporting what’s going on inside the country. Is there any sense that the Chinese actually got a handle on it, and there are continuing lessons to be learned from them? Or has no one really gotten a handle on it?
BOLLYKY: Well, “handle,” again, will be relative. What you’re trying to do—and I’ll start there, and then I’ll back into the China question. What one is trying really to do in this case is to reduce the number of new cases to the point that you are able to employ the strategies that have been behind 100 percent of the successes we’ve seen, which is aggressive testing, isolating the sick, tracing their contacts, monitoring the people they come into contact with, and quarantine.
That’s effectively what Singapore and other nations have done. What you’re trying to do, in terms of suppressing cases, is to get back ahead of this virus so that you can deploy that strategy. So nobody will have fully a handle on it. You just want to get back in front of this so that you can try to keep your response ahead of the virus, which is what you’re trying to do. When you don’t know what’s going on, it increases exponentially and silently until you start to see it hit your health system. And that’s too late.
On the China side, this week there were reports from the intelligence—or, reports that the intelligence community had concluded that China underreported its cases and deaths. The U.S. officials haven’t detailed the contents of that report, but it was mentioned by Dr. Deborah Birx, who’s the coordinator for the COVID response, who suggested that this may be in part why the U.S. was slow to respond, was faulty data reporting to China. There was also a report in Radio Free Asia that suggested that looking at volumes of traffic in crematoriums that there may be as many as forty-six thousand total deaths, based on an estimated volume of forty-six thousand cremations occurring there.
Now, again, forty-six thousand—let’s start with the last one. Forty-six thousand deaths would be—that would be total deaths, not all coming from COVID-19, of course, that happened in the Wuhan area. You have to remember that China actually is reporting a higher case fatality rate than a number of other settings. So if you project out, let’s say, at 4 percent of where they would have to be, you would have to have a significantly larger number of cases. And it’s hard to imagine them hiding that many cases based on the reporting going on.
I will say the World Health Organization has been on record that they found—or, their estimates when they did their in-site visit, again, with somewhat of a broader delegation was that they believed the Chinese numbers were accurate. I wouldn’t be surprised if they’re underreported. I don’t think they are several standard deviations underreported in terms of something where they’re hiding as many as, you know, close to—close to several hundred thousand more cases than they actually reported. I just think that is unlikely.
I will say on the U.S. response, it is true that China suppressed information domestically and internationally on human-to-human transmission. But that was ultimately reported on January 20. So January 20, of course, was quite some time ago. The U.S. received its first case sometime after. In terms of this being a SARS-like virus that was spreading to human-to-human transmission, we have had that information for quite some time. Of course, a number of other countries, Singapore—or, South Korea received its first case the same day as the United States and responded a lot more aggressively. So it’s a little hard to give credence that whatever slowness there was in the U.S. response is purely a matter of China having suppressed information, because it does seem other countries were able to respond more aggressively.
ROBBINS: So if Singapore is the gold standard internationally, are there any communities inside the U.S. that are doing, say, within reason, a better job? Any states? Any cities? Any particular communities we should be looking at see what they’re doing better than others?
BOLLYKY: So I think really what it’ll come down to, and this information is still emerging, is no community was able to do what Singapore did, because that was rely on them being able to aggressively test. And we didn’t have—states and localities didn’t have that option. As has been—as has been heavily reported—and I’m not going to go through the blow-by-blow of why the U.S. didn’t have tests, although I can if there are questions on the phone—but the short of it is that states didn’t have the ability to aggressively test earlier because of challenges that emerged both within the FDA and the CDC in terms of getting tests out there and authorizing other entities to make it.
So nobody is doing that. What I think some states have been more aggressive on is social distancing measures. So a number of states have been early on that. There are some indications, whether you look at unusual surges of influenza-like symptoms, which there are sites that track that, the New York Times today just posted a report—a beautiful visualization of traffic based on cellphone data, people moving around and where that was occurring. So you can get some indications on what regions have been better about adopting social distancing policies. So that’s one element.
The other thing that we will see, but isn’t entirely clear yet, is what states and localities have been most effective in terms of increasing the surge capacity of their health care systems, procuring personal protective equipment, of course, ventilator supplies, the other elements they need for testing. States that did a better are also adopting policies to protect health workers. We’ll get a better sense of that, but I don’t think we have it yet. Those are the two elements where I think states will have had an opportunity to shine. But it won’t be in the same way that South Korea and Singapore did.
ROBBINS: So finally, before I turn it over to, can you just look forward a little bit? What stories should reporters be looking for, especially in their communities, in the coming week or so, to see where this is going?
BOLLYKY: So yeah. So I think, frankly, in all models the coming week or so is going to be—or, two or three weeks, is going to be quite grim in the U.S. And I suspect that is, you know, frankly going to dominate reporting given that likelihood. So I, from that standpoint, will acknowledge that. I do think, again, we should be looking to what’s happening in Asia now, because I do think it’s indicative of what’s coming thereafter, and people need to start being prepared for this, and to understand what this is going to look like. And then obviously Western Europe is just a couple weeks ahead of us. So the stories are going to matter.
Last, for those that do report on more foreign policy or national security issues, the combination of the aggressive measures countries are having to take for social distancing, places that have a history of instability, political or social, and unmet needs in response to this pandemic are going to cause some challenges, whether that’s in Latin America, or the Middle East, or parts of sub-Saharan Africa, or North Africa. There are some countries I really worry about in that case. And I think that’s also, from an international perspective, a story that is both relevant to the United States and underreported. But I appreciate in the next couple weeks for local reporters, sadly, it’s going to be—it’s going to be grim period.
ROBBINS: So let’s—I will follow up with one thing. But I was thinking about this list you gave us of measuring the effectiveness of government, and, you know, state governments, and what social distancing measures they’ve enacted looking at, you know, the documenting of the effectiveness of tracking unusual surges of influenza traffic, what states and localities are doing for increasing their surge capacity, PPEs, ventilators.
Can we adopt those same metrics for private businesses as well? I mean, there are businesses that are still working, because they are considered essential, whether it’s Amazon warehouses, whether it’s food delivery, whether it’s hospitals. There’s still quite a few grocery stores, there’s still quite a few businesses where people are going to work. And we don’t see as much coverage of the private sector. What sort of metrics should we be using to assess how well the private sector is doing in meeting the challenge of the coronavirus? And the private sector in our local communities?
BOLLYKY: Yeah. So there’s—that’s such a great question. There are two points I’d like to make there. The first is for essential businesses where it was made clear by states, and quite early, in terms of which businesses were designated as essential, how are they protecting their workers? There’s been a little reporting about Amazon in this regard. But there—I don’t think we’ve seen a lot of reporting about what we’re seeing in terms of infection rates at grocery stores or the many other essential businesses that you mention. So that’s the first issue.
The second issue is a more complicated one, which is of course the production of supplies. So far the presidential has foregone exercising his authorities under the Defense Production Act. So to some degree, it’s a little unfair to hold those suppliers to account, because it’s not—they’re not—unlike essential businesses which have been required to take this role, it’s more of a voluntary perspective. But getting a sense of how that more voluntary approach has worked in terms of providing the U.S. the supplies that it needs, whether it’s of ventilators or personal protective equipment, I think is going to be important, and is going to be an issue moving forward.
I think in terms of as we move into the political system, there will be, of course, debates about how we tested, risk communication. But one of the other big issues moving forward is going to be tracking what the consequences are in terms of how we’ve mobilized supplies of the various services and goods that we need to respond to this pandemic.
ROBBINS: Great. Thank you so much. So, Brandon, can we turn it over to the journalists who’ve called in?
OPERATOR: Yes, ma’am. At this time we will open the floor for questions.
First question will come from Antonio Fins with the Palm Beach Post. Please go ahead.
Q: Thanks for taking the question.
Can you speak to—you know, here in Florida we have—in addition to the public health challenges of having enough supplies and equipment, there’s also this other flipside which is the tension with trying not to shut down the state, the state economy too much, you know, not making the public health emergency the top priority, you know, trying to balance the economic tension with keeping businesses open. You know, to that extent we’ve got two cruise ships off our coast loaded up with people because we didn’t tell the cruises to stop sailing until just three weeks ago. So I wondered if you could comment too, that that seems to be another component of trying to address the public health emergency, is this other—is the economy.
BOLLYKY: Yeah. So I think it is. It’s an issue that we’ve focused on a lot at the Council in terms of our global health work. Frankly, both the theme of my book and this broader website is how health affects economies, societies, and everyday lives. And we’re seeing it, unfortunately, with this—with this pandemic. You know, I think at the end of the day our best economic policy at this point of course is our health response to this pandemic. If we don’t manage to get ahead of this virus we’ll just simply have a worse health outcome and a subsequent shutdown.
Unfortunately it is a scenario where it’s bad economic outcomes—good public health policies now, bad economic outcomes now, hopefully improvements later. And we can talk about that in a minute. Or, it is weak public health policies now and having to impose them later with worse economic outcomes. So if we don’t get this to peak and get ahead of this, we will—we will have a worse result. And I think we’re, you know, seeing that to some degree with how long this has gone in in some Western Europe nations.
Vis-à-vis the cruise ship, it is frankly a scandal that we did not shut down these cruise lines earlier. It is one of the very clear lessons that we had from the early days of this outbreak and epidemic, now pandemic, was the risk in cruise ships, because of how this virus was spreading, again, particular amongst unreported cases of asymptomatic cases, its ability to persist on some surfaces for a period of time. It is not an acceptable outcome to leave people on a ship under those circumstances. And it’s terrible that we’re in this now. And so it’s a scandal we didn’t shut down the cruise industry earlier, unfortunately.
Q: Thank you.
ROBBINS: Our next question—and can I ask you to re-mute yourself after you ask your question, because we’re getting a lot of extra noise. So thank you so much. So the next question, please, Brandon?
ROBBINS: So while we’re doing this, do you—have you seen any companies that are—that are doing an adequate job? I mean, we’re only seeing now the beginning of Amazon—starting by early next week they’re going to be taking the temperature of workers in Whole Food Markets, and they’re closing down, I think, one warehouse in Kentucky. Do you have any sense of the private sector, whether it’s because of industry groups or individual companies that are still working, that they have any sense of taking responsibility or getting any direction from government about how to deal with this? There’s some companies that are just huge numbers of people who are still working.
BOLLYKY: Right. So one thing that has been tracked and reported on is the application of sick leave, and what the conditions are for being able to exercise it in those circumstances, because the bill that emerged from Congress and signed by the president really excludes 80 percent of the U.S.’s workforce. It doesn’t apply to businesses under fifty and businesses over five hundred. So it has some real limits. There has been some tracking of large employers and whether they’re adopting the policies that can really enable their workers to stay home.
I do want to put a plug for one industry and actually one part also of the federal response that has worked well, which is the race to develop effective treatments and vaccines for this virus. It is the one element—or, a(n) element of the federal response that you can point to that kicked in immediately in terms of getting the genetic sequence from China of this virus. NIAID, that’s the Institute for Allergies and Infectious Diseases, working with partners internationally immediately started to pursue vaccines and fund research. There’s been, whether it’s Abbott, or Roche, or other companies that have done—started to really race to fill the gap that we’ve seen in what was produced federally around testing to try to catch up.
On the testing side, they’re late but that’s really their fault, in this instance. On the treatment and vaccine side, again, as I mentioned, this is—there’s no—this is going to keep coming. It’s going to keep coming in waves. Hopefully we’ll get ahead of it. We will become better on the surveillance side. We’ll become better on the testing side. And that will allow us to have more intermittent social distancing and targeting because we will know where the virus is, and able to track it from that perspective. But this will keep coming in waves until we—likely until we have an effective vaccine or an effective treatment that at least allows a greater number of people to survive this, so that we can over time safely develop immunity to this virus.
ROBBINS: So when the president spoke originally about reopening the country, you know, by Easter, or packing churches, and then backed off that, and then there seemed to be some sort of a plan that they were going to look at data around the country and see which communities might be able to go back to work. You know, I’m in New York. Obviously we’re not going to work for months. But how realistic is that? Or are these communities just not being tested, the ones where we’re seeing lower numbers? Are they just later to the—to manifest the illness? Or will we see more and more parts of the country being able to open up in a shorter period of time?
BOLLYKY: I think it will be some time. I do think we’ll get to a point where we will see a very local state-drive response. And to some degree, our system’s designed for that, where many of our public health powers really do rest with states and localities, not with the federal government. The federal government has its most power on the border. And we can talk a little bit about the role of travel restrictions and this too, because we’ve done some analysis of that question. But it is—we are going to see a more tailored response, but we’re in this case not going to see that until we get better surveillance and testing, so that we have a more accurate sense of where this is.
Until then, effectively this nationwide—or, not officially nationwide—practice of social distancing, because, again, it is being left state-to-state currently, is a byproduct of our limited surveillance and testing. We have to do this incredibly blunt measure because we have—we still don’t have a good sense of where this is. To give you a contrast, Singapore never closed its schools. They never had to. Despite the fact that they were the first country to experience community transmission of this virus—so, meaning the first country outside of China to have cases that weren’t just imported, that were confirmed to be spreading. They managed to get ahead of this, and they never had to shut their schools.
You know, there are, of course, localities in South Korea, in cities that are starting to go back to work. So until we can get to that point, and get ahead of this, we’re not going to be able to have that more targeted approach. But one hopes that with the sacrifice—the sacrifices that are being made now that we get the opportunity to do so sooner than later. But it certainly won’t be by Easter. You know, I think even the president has acknowledged, I think, that we’re looking at end of May/June. And it may be even a little bit longer.
ROBBINS: So if I were to look at a map right now, and if I, you know, were in a town or in a city in which there were only a very small number of cases, could I think to myself: Well, I’m really far ahead in the queue for reopening? Or is that because we don’t really know—the data just hasn’t penetrated most places?
BOLLYKY: We don’t know. We don’t know. We don’t know what the—what the case transmission has been. We don’t have testing enough. I will say, there are other things people are looking at to try to get an estimate of what’s happening. And one of them has been looking at rates of influenza-like illness—atypical rates of it and trying to use that to estimate where we’re likely to be seeing more cases. And I will tell you, unfortunately for the journalist who asked about Florida, Florida is red hot in that regard. But here are other communities where you’re seeing atypical rates of influenza. That doesn’t mean that they’re all COVID-19, but presumably some of those atypical rates are being driven by COVID-19.
ROBBINS: And those are rates that are reported by doctors to public health systems? These are not people who have been tested for the coronavirus? I mean, how do you find the rates, so that we can say that Florida is looking like a hotspot?
BOLLYKY: So I’m happy to share the link that is being used to do this. There is one that is being done with the combination of the set of smart thermometers and mobile applications. There are also, you know, this is—this is something that the CDC tracks in terms of influenza rates. But I’m happy to share the one that I referenced here in particular, which is done by a private company that does this off of mobile—the data, the U.S. weather, and other public health sources.
OPERATOR: The next question will be from Martin Levine with Nonprofit Quarterly. Please go ahead.
Q: Thank you. I’m wondering whether you have some observations about both the current impact and the future health of the nonprofit sector, which serves both here and I think internationally as a bulwark of social cohesion and support of those at greatest risk.
BOLLYKY: So it probably depends on the sector and the funding model, would be my guess. In terms of—and this is—I wouldn’t hold myself as an expert in terms of the nonprofit community in terms of its funding. But working through it logically it’s the best I can offer you on this, which is that to the degree that it’s driven by private donation, the fact that we are—we are heading for difficult economic times obviously will have an impact in terms of the nonprofit sector in that regard. And one may look at prior likely—or, prior recessions or economic downturns to guess what that impact might be.
I do think for those that focus on public health or global health, there’s going to be a significant increase both in public and philanthropic funding heading into those areas in response to what we’re seeing. You know, I’ve been working in public health and global health since the mid-’90s. I did the HIV response, I was a fellow at the New York City Department of Health, so a long time ago. Mostly you’re trying to get people’s attention about why these issues matter and why both domestic investment and international investment in these issues are important. That’s, at least for the short and medium term, not likely to be as much of a problem. The question, of course, will be trying to direct those investments to a productive use. And we’ll see how that works out.
OPERATOR: The next question will come from Sonia Azad with WFAA TV. Please go ahead with your question.
Q: Hi. Thank you so much for allowing us this time to chat.
First of all, and I think I may have come in a little, like, sort at the tail end of this, but I just wanted to get clarity. When you say that, you know, this will be coming in waves, and then say that we’ve got to get ahead of it, by getting ahead of it do you mean just treatment and vaccines? Because I think what I heard earlier was a resurgence in some Asian countries. And my second—so I just need a point of clarification about that. And then my question is about so many of us reporting from home. And I don’t know how this impacts print journalists, but for TV, you know, we’re kind of learning a whole new system. And I’m wondering if you have any thoughts around all these people reporting from home. Like, is it—is it actually more or less effective? I mean, we have people coming in with equipment into our personal space. And any thoughts that you have around that, maybe even something we can do better if, if there are any thoughts around reporting, and especially with technology, from home.
BOLLYKY: Great. So on the first question, thank you for giving me a chance to clarify that if it wasn’t clear. I appreciate it. So, yes. This pandemic will come in waves. Those waves, in this instance, will be driven by the fact that when you suppress the cases, you suppress them—ultimately suppress them down, this disease will be—because it’s already in 175 countries, we just surpassed a million cases globally, this disease is going to be endemic. What I mean by that term is it’s going to be a disease that is—or, a virus—at this point that is going to be in the background.
This will not go the way SARS went, where simply that virus effectively disappeared. It’s likely to continue to circulate. I think many people are hoping that we’ll see some kind of effective of warming weather on the virus, but there isn’t a lot of clear indications that that effect, if it does indeed exist, will be substantial. It’s spreading in the southern hemisphere and warmer places already. A lot of other coronaviruses, particularly MERS, were not temperature sensitive. So it doesn’t seem like weather will get away from it. What that means is that this virus exists globally, inevitably, with the world being connected as it is we are going to get cases—imported cases. Even if you were to manage to fully snuff out the outbreak in your own country, like you’re seeing in these Asian countries now people will come who have this infection. This is the reality of an interconnected world.
What’s important in those cases is that you are ahead of it. Not that we think we can stop imported cases from coming, because we can’t. It’s just not practical. What we can do is be able to identify them early, identify the people they’ve come into contact with, trace them, surveil them, quarantine them so it doesn’t spread to others. And that is what those East Asian countries are trying to do now. So I wouldn’t say they’re behind the virus. They’re responding to these imported cases the way one’s supposed to, with basic shoe-leather public health in response to imported cases. But the reality is, particularly for, like, a country like the U.S., but others, that there are going to be sparks thrown off by this pandemic, imported cases that arrive. The question is, are we able to control those until they—before the emerge as a wildfire of community transmission and cases? And that’s what we’re trying to be at the point of, so that we can get ahead of and prevent that from happening.
On the reporting side, sorry. On the reporting side, you know, I won’t give advice on how best to do media in terms of bringing equipment, other than obviously all the social distancing policies are going to apply to anybody bringing equipment into your home, and the distance you need to maintain, and the risks involved. And you—so it is important in that case. I will say, as someone who does a fair bit of TV around these issues, Skype has certainly helped a great deal. It wasn’t—it was not too long ago that studios were still requiring you to come in. So I do think that that helps. And I think it’s appropriate. It reflects the reality of the circumstances most Americans are in. So I would hardly hold myself out as somehow a bellwether for U.S. viewership in general, but I do I think there’s a level of appropriateness around that conveys the gravity that we’re in. I don’t know if that’s the answer you were looking for, but it’s the best I can offer on that point.
FASKIANOS: Carla, just—sorry—just, Carla, do you have any insight as a—as a—you know, given that you’ve been on the beat and whatnot. What would you say to that?
ROBBINS: Well, you know, I think that people are certainly understanding and much more, you know, forgiving of production values right now. I mean, I never—I’m a print reporter. But I mean, I think the challenge here is how do you go out and cover what’s happening in the community. And this is balancing public health reality, not just your own safety but also, you know, the safety of not transmitting. And that’s—you know, that’s a tension that exists for everyone in any work that we’re doing here. You know, reporters are essential workers right now. And when I was saying, how do you—how do you assess the performance of your local grocery store, you’re not going to be able to do that sitting at home. And but at the same time, you know, people take a risk here when they go out and do that. So there’s massive challenges here. I mean, you certainly can’t do everything sitting in your home. And so trying to figure out how to do it—how to do it the safest way is—you know, is a big part. And it makes everything, I assume, twice as hard.
OPERATOR: Thank you. The next question will come from Jim Morrill with the Charlotte Observer. Please go ahead.
Q: Oh, hi. Thanks for doing this.
Tom, you said we are in this for the long haul. Do you think it’s realistic to expect that these interventions, like state at home orders and social distancing, will be in effect this summer? Because we’re supposed to have fifty thousand people here in August for the Republican National Convention. Seems like a lot of people in a small place. So just wondered what you thought.
BOLLYKY: Great question. So by the long haul, I do want to clarify. What I mean is that this virus will not cease to be a threat really until we have an effective vaccine that, of course, is widely distributed. Widely enough distributed that it can have—it can grant herd immunity, enough people immune that you’re, again, a spark of a case where somebody gets it is not going to spread to many other people, and you have a wildfire of cases. So that’s what you’re trying to do. Until we’re at that point, this isn’t—this isn’t going to be likely to be over. I don’t want to foreclose the possibility that, you know, you may see something dramatic happening on some—well, actually, I mean, we’re—it really is going to be with us for a long haul. Let’s leave it at that.
In terms of what this means for large gatherings of people, whether it’s political rallies or conventions, this is going to be a big challenge. Hopefully we have better testing and point of care diagnostics by that point. There’s a large effort to try to do that. And maybe that ends up being part of it, or that we change how those events occur, which I think is a likelihood to try to keep monitoring and keep people—keep people safe in terms of the reoccurrence of this. But we’re certainly going to need much, much more aggressive testing and surveillance at a minimum to make political-style conventions happen in the way that they did. And I don’t think that’s going to change by August, that part. This will look different than previous conventions in that regard. That part’s a certainty.
OPERATOR: Thank you. The next question will come from Erin McGroarty with Fairbanks Daily News-Miner. Please go ahead with your question.
Q: Hi. Thanks so much for taking the time to chat with us today.
So I’m reporting from Alaska, where similar to California and a couple other states we suffer really bad wildfires during the summer. What is your impression on how this virus could impact large-scale public safety responses, like wildfire response or things like that?
BOLLYKY: Well, two issues I’d want to raise there. The first is to mention the obvious of course, which is that this is a respiratory disease. So lung health is going to be a really important factor on how people do when they contract this virus. So from that standpoint wildfires are going to be a contributing—a risk and potentially a contributing factor in the health outcomes that we see from this outbreak. So I want to emphasize that point. Secondly, of course, if it’s something that occurs while this, to some degree, is the same issue that we see around the political convention question. Even if you see a peak, if gathering people together in groups to fight a wildfire, this is going to be something that people have to worry about.
So this is going to be an issue with surveillance, and testing, and trying to deploy better point of—rapid point of care diagnostics as they’re developed to help enable those kinds of responses. But there are going to be activities—you know, maybe we can get away with a political convention not being held in the way that it’s been held in the past. And there are some options that perhaps you might see to do that in the way that we have gotten—we’ve done the unthinkable for Americans and fundamentally altered sports and how they’ve occurred. Maybe we can do that for politics. That’s not an option for police functions or firefighting functions, or other things where we really don’t have the opportunity to forego. So we will have to be careful in protecting those workers with personal protective equipment and testing and surveillance.
OPERATOR: Thank you for the question. The next question will come from Mica Soellner with Gannett Company.
Q: Hi, yeah. So I’m reporting in Wisconsin. And I’m wondering if there are any opportunities for any environmental coverage in regards to COVID-19. I’m thinking in terms of social distancing. People aren’t out as much. Or people are crowding, you know, like national and states parks. So I’m wondering, what are your thoughts on that?
BOLLYKY: So I think that it’s a good point. I think there’s going to be a fair amount of reporting in general about what the consequences of prolonged social distancing will be. So that’s all from the health perspective. And there’s mental health issues. There’s, of course, physical inactivity that we’re going to see. And it’s going to be to some degree compounded by our economic circumstances. So I think there’s a lot of reporting to do, and to be done in the future, on the consequences of prolonged social distancing in this regard.
In terms of the national park issues, there has been some reporting that you’ve seen, and I would not hold myself out as an expert on these issues but concerns in terms of park officials dealing with the increased—for a period of time—the increased number of people using national parks. I haven’t followed it closely enough. So I will apologize on this point in terms of which have shut down, and where. So I will not speculate in that regard.
ROBBINS: I will say that in New York the sky looks much clearer right now, because there are so many fewer cars out there.
BOLLYKY: Well, I will—just as a quick aside there—there is, I’m sure many of you saw, a study that was put out, or an analysis, I really should say, estimating—or, showing the reduction in pollution that occurred in China and whether or not its health consequences from that reduction—or health benefits of that reduction outweigh the toll of the virus itself. And you know, that seems quite speculative, and based on modeling we’ll see what happens. (Laughs.) But there is something to be—something there in terms of the broader impact we’re seeing from the activities we have to forego.
OPERATOR: Thank you. The next question will come from Daniel Munoz with NJBIZ. Please go ahead.
Q: Hi. Yes. Hello. Thanks for holding this for all of us. So I’m wondering if you could elaborate on the sort of the long and short-term economic impacts. I’ve been covering a lot of sort of economic health and quality of life. And I’m also interested in, say, the ability of federal, state, and local governments to continue to raise money if there’s no money to be taxed. So no income to be taxed. I’m just wondering if you could expand on that. And I’m in New Jersey, by the way.
BOLLYKY: Yeah, so I think—I’m sorry say the last question again, please?
Q: I’m saying I’m based in New Jersey, by the way.
BOLLYKY: Got it. So I will say, as a general matter, in past pandemics the long-term effects of—long-term economic effects have been more modest. In the SARS epidemic, again, many fewer deaths—many fewer infected, many fewer deaths, eight thousand cases, eight hundred deaths. It did affect nearly thirty countries and was estimated to have an economic toll of thirty billion (dollars). Those economic consequences lasted for about as long as the epidemic itself. And that’s because, you know, fundamentally underlying balance sheets and underlying assets and infrastructure were not affected. They just effectively went back to where you were.
The challenge, of course, you have on this side is both the supply and the demand crunch in terms of places not being able to make things or produce services, and other places not being able to consume them. And the employment consequences we’re already starting to see, not just in the United States. We’re really starting to see consequences in other places as well. Spain has also reported record numbers of unemployment, and you can go on.
In terms of—there’s no question the federal government and state response, to some degree, is going to be debt financed. That may vary by state depending on whether or not they have a balanced budget amendment, and what their abilities are to engage in that. And I will confess I don’t know with regard to New Jersey what it’s authorities are to do that. But you know, there obviously is going to be a decline in income tax both at the federal and at the state level. And we’re also going to be spending rather large sums of money to try to mitigate this. So the combination of the two are not going to be positive for balance sheets. Obviously New Jersey in terms of its effecting the New York area, a lot of it will depend on how effective we—the area is in terms of getting through its current peak as quickly as possible, so people can get back to work.
I will say, the estimate, again, that—from that same modeling, is that we are about a week away from the peak in New York and New Jersey. So this is coming sooner or later. Keep in mind, it’s a bell curve. So there are two sides to this. That doesn’t mean this is all over at this point. But New York and New Jersey and Connecticut, the tri-state area, seem to be a little further ahead of this in terms of experiencing it than other parts of the U.S.
OPERATOR: We have a question from Corinne Kennedy with the Commercial Appeal newspaper. Please go ahead.
Q: Hi. Thank you guys so much for taking the time to share your expertise.
So my question involves the statistical modeling predicting when the surge will come. I’m seeing a lot of that that models those for a national or state level. Do you know of any resources providing the kind of data modeling on the more localized level? And if not, what can we take for local areas—for me, I’m just in the Memphis metro area. Can we extrapolate things from those national or state models? Or do we really have to look somewhere else for localized data?
BOLLYKY: So in terms of the modeling, I have not seen localized modeling, although it may come from some of the same entities that are behind this modeling now. They do have some localized data. I think the issue again there is in part the data sources, whether or not they can get cases disaggregated to communities so they can make those estimates. So a lot of it, again, will depend on the underlying data.
So the short term I think is that we—states are going to have to—smaller communities, again, New York City is a little bit different in terms of its numbers, and all the data that they’re producing allows it to be more targeted in that case. Lots of communities will not have that level of data. And there you will have to, for the time being, in terms of these models, rely on the state data. You have a much better sense than I do for your own particular community how generalizable those state trends are in terms of hospital capacity and supply capacity are for your particular locality. Because they really—that is what this is tied to.
It’s projections of cases based on what they’ve seen in deaths in other areas, and what that means based on the heath care capacity. And those health care capacities are statewide. And you’ll have a better sense than most, which is what’s so valuable about what you all are doing about whether or not those statewide trends are representative of what you have in your own city or community.
Q: Thank you.
ROBBINS: Well, let’s see, we promised to get you all back to work at 5:00, and it’s 5:01. Tom, thank you so much for doing this. Irina, thank you so much for doing it. Thank you all for calling in. As Irina says, this is the inaugural of what we hope will be a series of conversations with CFR experts relating to the global and the local. And be safe out there. Thank you all for what you’re doing.
Irina, do you have anything you want to say?
FASKIANOS: I guess I’m just going to say you can follow Carla at @RobbinsCarla and Tom at @TomBollyky. We really are so excited to have you all on the call. Please email us if you have suggestions of how we can make this—you know, how we can iterate on this. And frequency as well, and time of day—if there is a better time of day to do it, when you might not be close to deadline. So we look forward to seeing your feedback by emailing us at [email protected]. So thank you all, and thank you Carla, and Tom. And stay well and stay safe.
ROBBINS: Thank you. Thanks so much.
BOLLYKY: Stay safe.