<p>In this episode, infectious disease and pandemic preparedness expert, Amesh Adalja, M.D., puts the current pandemic into context against previous coronaviruses as well as past influenza pandemics. Amesh also provides his interpretation of the evolving metrics which have contributed to big variations in modeling predictions, whether this will be a seasonally recurring virus, and perhaps most importantly—how we can be better prepared for the inevitable future novel virus. Finally, Amesh explains where he sees positive trends which give him reasons for optimism.</p> <p><span style="color: #201f1e;">We discuss:</span><span style="color: #333333;"><br /></span></p> <ul> <li><span style="color: #201f1e;">Amesh's background in infectious disease [2:40];</span><span style="color: #333333;"><br /></span></li> <li><span style="color: #201f1e;">When did the virus actually reach the US? And when did Amesh realize it would pose a real threat to the US? [4:00];</span><span style="color: #333333;"><br /></span></li> <li><span style="color: #201f1e;">Comparing and contrasting COVID-19 to previous pandemics like the Asian flu of 1958 and the Spanish flu of 1918 [8:00];</span><span style="color: #333333;"><br /></span></li> <li><span style="color: #201f1e;">Will COVID-19 be a recurring seasonal virus every year? [14:00];</span><span style="color: #333333;"><br /></span></li> <li><span style="color: #201f1e;">Will a future vaccine be specific to this COVID-19 or will it also cover previous coronaviruses as well? [15:15];</span><span style="color: #333333;"><br /></span></li> <li><span style="color: #201f1e;">What does Amesh think might be the true case fatality rate of SARS-CoV-2? [16:15];</span><span style="color: #333333;"><br /></span></li> <li><span style="color: #201f1e;">Why did early models over predict infections and deaths by order of millions? [18:30];</span><span style="color: #333333;"><br /></span></li> <li><span style="color: #201f1e;">Role of government—How does Amesh view the role of local versus central government in dealing with a future pandemic? [21:50];</span><span style="color: #333333;"><br /></span></li> <li><span style="color: #201f1e;">What went wrong with testing and how could we have utilized it more effectively? [25:15];</span><span style="color: #333333;"><br /></span></li> <li><span style="color: #201f1e;">Future pandemic preparedness—why Amesh is cautiously optimistic [27:30];</span><span style="color: #333333;"><br /></span></li> <li><span style="color: #201f1e;">Should there be different policies and restrictions for places like New York City compared to less populated and less affected places across the US? [30:15];</span><span style="color: #333333;"><br /></span></li> <li><span style="color: #201f1e;">Why mass gatherings might be disproportionately driving the spread of the virus [32:30];</span><span style="color: #333333;"><br /></span></li> <li><span style="color: #201f1e;">Learning from HKU1, a lesser-known novel coronavirus from 2005 [34:00];</span><span style="color: #333333;"><br /></span></li> <li><span style="color: #201f1e;">Thoughts on Sweden's herd immunity approach [36:10];</span><span style="color: #333333;"><br /></span></li> <li><span style="color: #201f1e;">The efficacy of masks being worn in public and what role they will play as restrictions are slowly lifted [37:20];</span><span style="color: #333333;"><br /></span></li> <li><span style="color: #201f1e;">What are some positive trends and signs of optimism? [39:15]; and</span><span style="color: #333333;"><br /></span></li> <li><span style="color: #201f1e;">More.</span></li> </ul> <p><span style="color: #201f1e;">Learn more: <a href="https://peterattiamd.com/">https://peterattiamd.com/</a><br /> <br /> Show notes page for this episode: <a href="https://peterattiamd.com/ameshadalja">https://peterattiamd.com/ameshadalja</a><br /> <br /> Subscribe to receive exclusive subscriber-only content: <a href="https://peterattiamd.com/subscribe/">https://peterattiamd.com/subscribe/</a><br /> <br /> Sign up to receive Peter's email newsletter: <a href="https://peterattiamd.com/newsletter/">https://peterattiamd.com/newsletter/</a><br /> <br /> Connect with Peter on <a href="http://Facebook.com/PeterAttiaMD"><u>Faceboo</u></a><u>k</u> | <a href="http://Twitter.com/PeterAttiaMD"><u>Twitter</u></a> | <a href="http://Instagram.com/PeterAttiaMD"><u>Instagram</u></a>.<br /></span></p>
Actionable Insights
1. Sustain Pandemic Preparedness Funding
Advocate for sustained funding and prioritization of pandemic preparedness, viewing it as a perpetual national security concern rather than a reactive measure, to avoid the cycle of reactive funding followed by neglect.
2. Demand Preparedness from Policymakers
Demand that policymakers prioritize pandemic preparedness as a platform issue when voting and asking about future plans, remembering the economic and personal disruption caused by outbreaks.
3. Prioritize Local Public Health
Adequately resource and empower local health departments, as they are best positioned to manage outbreaks due to their intimate knowledge of their communities, capacities, and gaps.
4. Improve Diagnostic Testing & Tracing
Enhance diagnostic testing, case finding, and contact tracing capabilities to effectively contain future outbreaks, as current resilience to infections was overestimated.
5. Test Mild Cases for Containment
Test mild cases of infectious diseases, not just severe ones, because mild cases can be highly contagious and contribute significantly to unabated spread.
6. Streamline Diagnostic Test Availability
Streamline bureaucratic processes and emergency use authorizations to ensure rapid and widespread availability of diagnostic tests during a public health emergency, avoiding delays seen previously.
7. Broaden Testing Criteria
Broaden testing criteria for respiratory viruses beyond severe symptoms or specific travel history to catch early and varied introductions of a pathogen, preventing widespread undetected spread.
8. Critically Evaluate Scientific Models
Critically evaluate scientific models by understanding their underlying assumptions, as small differences can lead to big changes in outcomes. Use models as tools to be revised with real data, rather than as absolute truths.
9. Implement Locally Managed Response
Implement a public health response that is locally managed but federally coordinated, leveraging local knowledge and capacities while providing national guidance and setting the tone.
10. Tailor Policy to Local Conditions
Tailor public health policies and restrictions to local conditions, considering factors like transmission rates, population immunity, hospital capacity, and diagnostic testing availability, rather than a one-size-fits-all approach.
11. Avoid Mass Gatherings Pre-Vaccine
Avoid mass gatherings until a vaccine is available, as they disproportionately drive disease spread by bringing people from wide geographic areas into close, interactive contact, potentially putting a town over the edge.
12. Understand Mass Gathering Risk Factors
Be aware that activities involving shouting, screaming, eating, and drinking in dense social settings significantly increase the risk of virus transmission at mass gatherings.
13. Prepare for Widespread Transmission
Prepare for a respiratory virus to be everywhere once efficient human-to-human transmission is confirmed, especially if it has had a head start in spreading undetected.
14. Anticipate Seasonal Virus Recurrence
Anticipate that novel coronaviruses may become seasonal, circulating annually like other common cold coronaviruses, and prepare for successive waves.
15. Learn from Other Regions’ Experiences
Learn from the experiences of other regions that have faced outbreaks to better gauge local testing and hospital capacity responses, adapting strategies based on their successes and challenges.
16. Cocoon High-Risk Groups
Implement strategies to protect (cocoon) high-risk individuals, such as the elderly and those with underlying medical conditions, from infection, though acknowledging it is challenging.
17. Reopen Elective Services Judiciously
Consider reopening elective surgeries and clinics in areas not inundated by an outbreak, as delaying these services can lead to other significant health consequences not captured by pandemic models.
18. Broaden Essential Business Definition
Broaden the definition of “essential” or “life-sustaining” businesses during shutdowns to mitigate economic impact and other societal costs, looking beyond current restrictive lists.
19. Evaluate Safe School Reopening
Evaluate the safe reopening of schools based on local conditions, acknowledging that widespread school closures were controversial and not universally supported by experts.
20. Mask Use for Sick Individuals
If you are sick with respiratory symptoms such as a cough, fever, sneezing, or sore throat, wear a mask when in public to prevent spreading illness to others.
21. Avoid Mask-Induced Complacency
Be mindful that wearing masks should not lead to complacency in other protective behaviors like hand washing and social distancing, and ensure proper mask handling to avoid contamination.
22. Caution with Homemade Masks
Exercise caution regarding the effectiveness of homemade masks for asymptomatic individuals, as their ability to prevent spread is uncertain and they may not effectively block coughs and sneezes.
23. Improve Diagnostic Curiosity
Improve diagnostic curiosity and testing for respiratory viruses to better understand their prevalence and prevent surreptitious spread, as many go undiagnosed due to “biological dark matter.”
24. Interpret CFR with Nuance
When interpreting case fatality rates (CFR), remember they are average numbers and individual risk varies significantly by age and other factors, so not every person carries the same risk.
25. Invest in Pan-Coronavirus Vaccine
Invest in research for a pan-coronavirus vaccine, as coronaviruses tend to be more stable than influenza, potentially offering cross-protection against multiple current and future threats.
26. Conduct Retrospective Sample Analysis
Conduct retrospective studies by looking at bank samples to understand how prevalent a virus was before it was widely recognized, helping to map its early spread.
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