We Need Global Cooperation to Halt Spread


Source: Democracy Now!

As the worldwide death toll from the coronavirus pandemic has topped 10,000, with over 250,000 confirmed cases of COVID-19, we speak with Stanford University’s global health expert Dr. Michele Barry, an infectious disease doctor. Italy has surpassed China in coronavirus deaths, and cases are rising in the Middle East, Africa and Latin America, as the governor of California has ordered all 40 million residents to shelter in place.

AMY GOODMAN: The worldwide death toll from the coronavirus pandemic has topped 10,000, with nearly a quarter of a million confirmed cases of COVID-19. Italy’s death toll has now surpassed China’s, where the outbreak was first reported, with over 3,400 deaths and more than 41,000 confirmed cases. In Iran, the Middle Eastern nation worst hit by coronavirus, the Health Ministry said the death toll has approached 1,300, with one person dying from it every 10 minutes and 50 becoming infected every hour. In Latin America, El Salvador, Nicaragua reported their first confirmed cases of coronavirus. South America has nearly a thousand confirmed infections, as Brazil, Chile and Peru all report hundreds of confirmed cases. Venezuela has announced a nationwide quarantine. In Africa, the number of confirmed cases has risen to 700, and the head of the World Health Organization had said Africa must, quote, “wake up to the coronavirus threat and prepare for the worst.”

In the United States, confirmed coronavirus cases have doubled over the past two days. New York has become the epicenter of the pandemic with more than 5,200 confirmed cases, the highest in the nation. In California, Governor Gavin Newsom on Thursday ordered all 40 million residents to remain at home, to shelter in place, effective immediately.

GOV. GAVIN NEWSOM: The virus will impact about 56% of us. You do the math in the state of California, that’s a particularly large number. That number, in and of itself, shouldn’t be overly alarming. The vast majority of us, the overwhelming majority of us, won’t have symptoms, will be perfectly fine.

AMY GOODMAN: With over 22 million people facing infection in California over the next eight weeks, Governor Newsom estimated the state’s hospital capacity has 20,000 fewer beds than will be needed at the peak of the pandemic.

For more, we go to California, where we’re joined by Dr. Michele Barry, director of the Center for Innovation in Global Health at Stanford University, incoming chair for the Consortium of Universities for Global Health. Dr. Barry is also the past president of the American Society of Tropical Medicine. She’s joining us from her home, as California is under a shelter-in-place order.

Dr. Barry, thank you so much for joining us. Before we start on the global picture, if you could just simply explain — people say “coronavirus,” people say ”COVID-19.” Explain where that term ”COVID-19” came from, what it means, and then the class of coronaviruses, what that means, as well.

DR. MICHELE BARRY: Well, good morning, and thank you. The name “coronavirus” comes from a series of viruses that are found in bats. There are about 1,300 species of bats. And at any one time, there are about six to eight coronaviruses that are circulating in bats. So, there are many different species of bats. There are only seven species that have been known to infect man so far, four of which we all know very well. They cause the common cold, and there are three that are more deadly: SARS1, SARS2 and MERS. The term “corona” comes from the halo that is seen around the virus, with the spikes that come out of the coronavirus when you look at it under electron microscopy.

AMY GOODMAN: And ”COVID-19” means?

DR. MICHELE BARRY: It’s a term that actually most people are — it’s a coronavirus disease, and it happened in the year ’19. Some people use the word “novel” in front of it, but it is synonymous for what is called SARS2, severe acute respiratory syndrome. And it’s the second such coronavirus that we’ve seen that causes severe acute respiratory disease.

AMY GOODMAN: So, let’s talk about where this pandemic is hitting hardest. In our headlines, we just talked about Italy surpassing China. Why don’t you take us, really, on a tour of the world. How has this happened? Why is Italy the epicenter, Europe itself the epicenter, and also Iran so hard hit at this point? How did this all unfold?

DR. MICHELE BARRY: Well, it’s an interesting story. And I’m going to step back and take a larger picture about it, because I’m very interested in one health and climate and planetary health. And I know we’re all obsessed about this virus, but I think we have to think about what some of the activities that have happened in this Anthropocene, where men have impacted the planet. We have changed the ecology of how we live with animals, so that if you look at most of the emerging viruses and the emerging diseases that have happened over the last hundred years, they’ve been what we call zoonoses. And zoonoses are spillover from animals.

This particular coronavirus was noted first in a seafood market in Hunan, and it has to do with the fact that there probably — even though this is a bat coronavirus, we do not know whether there’s an amplifier animal in SARS1, which also started in a seafood market in an area in China. It’s the intimate living with humans and animals and spillover. In SARS 1, it was probably a civet cat that was being sold. For a while, SARS2, this particular virus, was thought to be an amplifier with a pangolin, a highly trafficked animal. We know now that that’s probably not true, and we don’t know exactly how it actually began in the seafood market.

But I want to bring us back to this idea that we need to be doing better surveillance in our animals and doing a better job with our planet. The large Nipah virus epidemic had a lot to do with deforestation and movement of bats closer to other animals, and another novel virus emerged. So I want to bring people back to some of the larger issues, when we think about these emerging viruses that happen in the world.

AMY GOODMAN: And a connection to climate change, to the climate crisis?

DR. MICHELE BARRY: Yeah. Well, that is important. Climate change, deforestation and changing ecology is crucial for how we have animal and human ecology change. For instance, we saw the Zika outbreak happen several years ago in northeast Brazil. There’s been a lot of interesting discussion how deforestation may have played a role in that, and higher temperatures may have played a role in changing vectors, mosquito vectors in that role. Mosquitoes play no role in SARS, don’t worry. But it’s a very important question that I think, when this all quiets down — we’re sort of in the thick of this epidemic — I think we need to pay more attention to this concept of what I’m calling human and planetary health. We’re actually trying to build a new center for human and planetary health at Stanford. We’re working on a new postdoctoral fellowship for scientists to actually study this human ecology change.

AMY GOODMAN: We’re going to break, and then we want you to take us from Italy to China to Iran. We want to look at Africa, which you’ve called a “ticking time bomb,” and Latin America, Asia. Dr. Michele Barry, director of the Center for Innovation in Global Health at Stanford University, she’s an infectious disease doctor. Stay with us.

[break]

AMY GOODMAN: That’s quarantined Italian tenor Maurizio Marchini, passionately singing “Nessun dorma,” or “None Shall Sleep,” from his balcony in Florence, Italy, while the country is under lockdown from the coronavirus. This is Democracy Now!, democracynow.org, The War and Peace Report. I’m Amy Goodman. The worldwide death toll from the coronavirus pandemic has topped 10,000, with nearly a quarter of a million confirmed cases of COVID-19. Our guest is Dr. Michele Barry, Center for Innovation in Global Health at Stanford University. She’s an infectious disease doctor herself.

So, take us on a tour, but begin with — we just played this magnificent music of a quarantined opera singer singing out to his community. “Quarantine,” what does that word mean, Dr. Barry?

DR. MICHELE BARRY: So, that’s an interesting — I think there’s a lot of different understanding of what isolation and quarantine is. The word “quarantine” actually is an Italian word that comes from the word ”quaranta,” or “40” days. And those were the amount of days that a ship actually had to stay in port before being released into Venice when the Black Plague was occurring. So it actually comes from that word during the Black Death. When we think about quarantine and the difference between quarantine and isolation, isolation is when one has a sick person, and you isolate them, whereas quarantine is if you’ve had contact with a person, you need to stay at home and minimize contact, with family — well, with other people, other than your family, for 14 days.

AMY GOODMAN: So, let’s talk about Italy. Why is it the epicenter right now? Why has Italy become the epicenter? It surpassed China, and it has a link to China.

DR. MICHELE BARRY: I’m sorry? I didn’t —

AMY GOODMAN: It surpassed China, and it has a link to China. What is the connection? Why has it been hit so hard? And then, compare it to South Korea.

DR. MICHELE BARRY: Yeah. I think what South Korea — I can’t comment upon why Italy has been hit so hard. We can only speculate. And I don’t want to say anything, because I have a lot of Italian colleagues that are working incredibly hard to stave this epidemic. Most of us feel that they got behind the curve. And behind the curve is of — we really have no vaccine or effective treatment yet for this virus. What we do have is what we call nonpharmaceutical interventions. And that is basically quarantine and isolation and good transparent communication and testing, testing and surveillance.

And I think what South Korea and what Taiwan and what Singapore did that have made such a huge difference is that they did early testing, early surveillance. They quarantined people who had contacts, and isolated those that were sick. It’s clear, when you look at the Chinese numbers, and what Wuhan did was pretty amazing. They did very aggressive isolation and quarantine, whereas the Italians — and one can say it has to do with measures that are taken in not only a governmental — and you can argue about whether the Chinese were draconian, but they were very effective. You can talk about different kinds of cultures, how accepted it is to isolate yourself and wear masks. But whatever it was, Italy started behind the curve.

I think we, in California, we’re trying to be as aggressive as we can. We’re very early, particularly in my county, which was an early epicenter, Santa Clara County. And I have to give kudos to Sara Cody, who is our public health commissioner. She did early shelter in home. So I think these nonpharmaceutical interventions are really important.

And then — and this is more up your show — I think we need very strong central coordination. If you read a paper written by Jason Wang in JAMA, where he describes the early Taiwan approach, it was because there was strong central coordination. They had the ministers of labor, the ministers of education, the ministers of transportation all working together to give daily communication, and not misinformation, out there.

AMY GOODMAN: And is there a connection between particularly northern Italy and China, population movements, I mean, also, the whole supply chain, companies that are in China but serving populations in Italy, the United States, etc.?

DR. MICHELE BARRY: The amount of manpower that went into stopping the transmission in China was amazing. They sent 40,000 doctors to the Wuhan area. They had thousands of epidemiologists, so that teams of epidemiologists, with five to a team, would actually do contract tracing for one person. I don’t think Italy has that manpower. And we certainly know that they don’t have the manpower now with their doctors or nurses.

And many of us in the U.S. are very worried about overwhelming our hospital systems. I think you’ve heard a lot of discussion recently about flattening the curve. And what does that mean, flattening the curve? It doesn’t mean necessarily curing the disease. What it does is help not overwhelm our hospital system, which is what we’re all worried about. Already we’re worried about having enough nasal forensial swabs to do testing. I mean, we are way behind in our testing. If you look at South Korea, they did 5,000 tests per million people. We’re not even up to a hundred testing per million people.

AMY GOODMAN: How did that happen, Dr. Barry? How did this happen? The U.S. is supposed to be the leader in the world. Was this a combination of President Trump’s anti-science approach and his nationalist approach, xenophobic approach? I mean, didn’t the World Health Organization have a test that all of these countries have used, that the U.S. rejected, the CDC then put out its own, and it was flawed?

DR. MICHELE BARRY: I can’t comment on that, because I wasn’t involved in that decision. But certainly, it is really a travesty that we don’t have enough tests and that we’re not testing aggressively. It did not help to have a president that doesn’t believe in science — actually, early on, called this all a hoax. It really helps when a president believes in science and evidence-based science. So, yes, that is disturbing. But I can’t comment on what the machinations were. Our CDC is working very hard. Many of my colleagues are working around the clock trying to stave this off.

But one of the things about epidemics is it’s really important to have what I call shared global governance. And I don’t think in this world it’s great that we don’t have a stronger central governance of our world health. We have a World Health Organization that has a budget that is less than many of our hospitals in the United States. Even in the United States here, our par excellence group, the CDC, the Center for Disease Control, is not allowed to come into a state unless it’s invited by the state. We have a legacy of federalism, where the states are really the forefront of public health. And even within the state of California, our county has different recommendations than the next county over. So each of our counties are making decisions.

I think what is so amazingly powerful by some of the countries that have been able to contain this, like Singapore, Taiwan and China, has been central coordination. You may argue that some have been very draconian, but then, when you have a small little country like Taiwan, that abuts China and was able to do it with central command — and I actually visited the central command station in Taiwan about two years ago. It’s very impressive. They set that up.

Now, admittedly, those countries that have done very well, Amy — and people haven’t talked about this — they have had the experience of SARS1, so they were set up. For instance, there were fever clinics set up, where if people had fever, they were immediately transferred to these clinics. They had ability to build hospitals rapidly, which we have not had that ability. They were able to isolate sick people and not put them necessarily back into family units. If you look at the China data, most of the transmission drive was in family clusters, wasn’t necessarily in nursing homes or schools, which is where we usually think the drive for these clusters are. Actually, the majority of the clustering of illnesses were in the family. So isolating sick people becomes very key.

And we have a problem in this country with our homeless. I was talking to our county official, our public health official, and she is really working endlessly to try to buy up hotels, buy RVs, try to figure out how to isolate our homeless population.

AMY GOODMAN: To not get COVID-19.

DR. MICHELE BARRY: Yes, yes.

AMY GOODMAN: So, what happened in Iran?

DR. MICHELE BARRY: Oh, Iran. Iran was the perfect storm of — and let’s talk a little bit about that also, but it was the perfect storm of religion and politics and public health. And this had to do with the fact — because it’s kind of an interesting — why would you think Iran — and I don’t know — I have a slide with the curves, if that could come up, of how fast that curve went up. And you might wonder why it is that Iran sort of exploded. Well, it had to do with the fact that they have a very holy shrine in the town of Qom. And what happened, according to my Iranian colleagues that I’ve been talking to, is that there was a group of 700 Chinese pilgrims that were there from the Hubei province. And part of how one gives homage to this shrine is by kissing it or licking it. So you can imagine how that was a very easy way to immediately disseminate it. My understanding from my Iranian colleagues also, it’s been very hard to actually even barricade this shrine off currently, even in the midst of this epidemic. And we’ve seen how religion has also played a role in South Korea. The earliest cluster was in a church, where you have large gatherings of people. And even in New York City — and please correct me, but I’ve been following your epidemic, as well — that there’s been a real problem in the early Orthodox Jewish population, where that outbreak in the Hasidic population has occurred.

AMY GOODMAN: So —

DR. MICHELE BARRY: Yeah.

AMY GOODMAN: Right now it’s just exploding in Iran. And then I want you to talk about Africa, which you’ve called a “ticking time bomb.”

DR. MICHELE BARRY: Yeah. I think there are two ticking time bombs that I’m worried about — not only Africa, but India, because we haven’t heard a lot about India, and that’s, you know, over a billion people that are a very closely geographic space.

But the time bomb in Africa is really about healthcare capacity. I spent a lot of time working in sub-Saharan Africa, and we’re all extremely worried about it. We’re starting to see it take off in South Africa. The issue about why it’s a ticking bomb is, again, it has to do with surveillance and the lack of ability to test. The last numbers — and I may be a little outdated, because [inaudible] — we’re all — it’s like a firehose. We’re all watching these numbers. But the last numbers I looked at were that there were only 40 out of 54 countries that were able to do testing for COVID-19 or SARS

AMY GOODMAN: And in —

DR. MICHELE BARRY: — SARS2. And —

AMY GOODMAN: Go ahead.

DR. MICHELE BARRY: Amy, this is not the only coronavirus we’re going to see. Unless we pay attention — I’m really going to come down hard on this — on this concept of one health, keeping an eye on the intersection of our animals, our environment and our human health, are we going to get ahead of the ball for epidemics. Because this is not the big one. I mean, we think we’re living in the big one. The big one is really a pandemic flu, which is airborne and not droplet-borne.

AMY GOODMAN: And that — you talk about airborne, not droplet-borne — what does that mean? And is the coronavirus not only an issue of someone coughing or sneezing or getting droplets on another person, but this whole question of what does it mean to be aerosolized?

DR. MICHELE BARRY: So, yes, SARS2 can be aerosolized, if you are doing a procedure which vigorously causes massive aerosolization, like when you intubate somebody. This is why healthcare workers — and there were 4,000 healthcare workers in China that actually got infected. The lovely thing about infecting young people is that there’s a much smaller — even though it’s really important to think about the young people, the mortality rate in young people is much lower. But let’s go back to this question of aerosolizing. So, this has to do with the size of the droplets and how they’re actually suspended in air. The size of the droplets for SARS2, or COVID-19, are larger droplets, and they fall, and they fall way within six feet, which is why we have these six-foot distance that we’re asking people to stay away from, although healthcare workers are at much higher risk when they do aerosolizing procedures. And so we need to be careful about that. In SARS1, actually, one of the earliest disseminations was through fecal dissemination in the early residential building in Hong Kong, where there was a problem in the toilet. And we all know that SARS1 and 2 are —

AMY GOODMAN: And you’re talking about SARS2 is COVID-19?

DR. MICHELE BARRY: COVID-19 is SARS2, I’m sorry.

AMY GOODMAN: Is coronavirus.

DR. MICHELE BARRY: Yeah. See, most of us are using SARS1 and SARS2. But for this purpose, I’ll use COVID-19. COVID-19 is fecally excreted. But there have not been — first of all, diarrhea is not a major manifestation in that. But what I was talking about in the first of epidemic with SARS1, not COVID-19, there was fecal dissemination when there was a toilet that malfunctioned and aerosolized feces. So, yes, there is the potential of aerosolization, but it’s only with unique, unique procedures that that happens.

AMY GOODMAN: This is Democracy Now!, democracynow.org, The War and Peace Report. I’m Amy Goodman, as we bring you Part 2 of our interview with Dr. Michele Barry, infectious disease expert, tropical disease expert, global health expert from Stanford University. The worldwide death toll from the coronavirus pandemic has topped 10,000, with nearly a quarter of a million confirmed cases of COVID-19. Here in the U.S. at the White House, President Donald Trump sought to deflect criticism of his administration’s disastrous handling of the coronavirus crisis, lashing out at China, excoriating the media as “fake” and “corrupt news.” Confirmed coronavirus cases in the U.S. have doubled over the past two days. New York has become the epicenter of the pandemic with more than 5,200 confirmed cases, the highest in the nation — and, mind you, that number is going to massively increase because of the lack of access to testing. In California, Governor Gavin Newsom Thursday ordered all 40 million Californian residents to remain at home, to shelter in place, effective immediately.

Dr. Michele Barry has agreed to stay with us to do this Part 2 of our conversation. She’s the director of the Center for Innovation in Global Health at Stanford University, incoming chair for the Consortium of Universities for Global Health, also past president of the American Society of Tropical Medicine.

I want to start in the United States, Dr. Barry, and then go global. Can you talk about the response in this country?

DR. MICHELE BARRY: Yes, I can talk about the response. I wish it were much more aggressive. I think that we are at the beginning of a surge, and it’s absolutely terrifying. We’re all watching the beginning of this curve, and it eerily looks like Italy. I’m particularly worried about New York City, because we’re seeing that surge very quickly. And I’m particularly worried about the state that I’m living in. Our governor has taken a very strong stance by asking people to stay at home. The county which I’m in is actually in an order called “shelter at home.” I think we need to aggressively use nonpharmaceutical interventions — that’s what we’re calling it — because there are no great pharmaceuticals yet, and we can talk about that. But we need to use testing, testing, testing, isolation and quarantine. And unfortunately, our country has not up-ramped with testing. It’s really not understandable, from many of us from the professional side, that we’ve not been able to up-ramp our testing.

AMY GOODMAN: And explain why testing is so important, Dr. Barry.

DR. MICHELE BARRY: Because when you’re using nonpharmaceutical interventions, this concept of isolating the sick and quarantining contacts, you need to know who’s positive. And even now with the tests, they’re only running about 70, 75% sensitive. So we’re even missing a certain percentage of that, which means it’s even more crucial to know who’s positive and to isolate and quarantine, particularly for our elderly people, because it’s our elderly folks that have had the highest mortality. You know, there’s been these jokes about “boomer remover,” but this is really a “boomer remover” virus, because it’s the people over the age of 60 that are really dying with this disease and have the highest fatality.

AMY GOODMAN: You also have this little latest report — you know, it’s particularly looking at examples like in France and also, I believe, in Italy — that millennials are being hit, that I think in intensive care in France, there are more millennials in the intensive care units.

DR. MICHELE BARRY: That’s right. We are definitely seeing — and that becomes really important, because as I was driving in very early in the morning, we saw — we’re hearing about people in the U.S. going on spring break, millennials going on spring break. So, yes, millennials are not immune from it. When you look at the large numbers that have come out of China, Singapore, Italy, it’s really been the older group that have died from it, but millennials are getting sick. And certainly, we need to pay attention to that, even toddlers and young children. Even though they have the least manifestations of COVID, they have milder cases, there are still a small percentage that get hospitalized. And if it’s your baby and it’s your millennial, you do not want them getting ill. Unfortunately, it’s that age group that thinks they’re invincible and are going out there on spring break. I heard Miami and the Keys are having problems with spring breakers.

AMY GOODMAN: The Republican governor of Florida has refused to close all the beaches, to the shock of so many, while their senator, Rick Scott, is now in isolation.

DR. MICHELE BARRY: I think that’s putting your head in the sand, absolutely putting your head in the sand. No pun intended.

AMY GOODMAN: I wanted to turn to New York City Mayor Bill de Blasio, speaking this week.

MAYOR BILL DE BLASIO: We need 3 million N95 masks. We need 50 million surgical masks. We need 15,000 ventilators and 25 million each of the following items of personal protective equipment, which our healthcare workers and first responders would use depending on the situation: surgical gowns, coveralls, gloves, face masks. We need these in great numbers.

AMY GOODMAN: So, Michele Barry, around the country, healthcare workers are being told to reuse N95 air-filtering respirator masks amidst a critical shortage. President Trump says the federal government has ordered — I think he said 500 million of the masks, but Bloomberg News reports they could take up to 18 months to deliver. But, of course, two weeks ago, he said by the end of the week there would be a million tests administered, which was a complete lie. Can you talk about the role of the federal government and what you think needs to happen? You’ve been a longtime advocate for very important public health measures, that you’ve even brought to Congress.

DR. MICHELE BARRY: Yes. During the Ebola epidemic, I was — and even, actually, before that — I proposed a medical arm of the Peace Corps and an emergency medical contingency force for WHO. I actually put a bill through Senator Durbin to try to get a medical arm of the Peace Corps funded through Congress. Unfortunately, I failed.

It was also extremely disappointing that the Trump administration, early on, dismantled the pandemic preparedness team, although I heard he’s said he didn’t do that. But he did do that. He also, in his Trump bill, was trying to dismantle all of the hospital preparedness and has cut that aspect of CDC. All of that needs to be strengthened.

But I would argue we need to have a global health security force in the United States. And it’s not just the United States. I think we have to realize we cannot be xenophobic about viruses. Viruses do not know about borders. We are living in a globalized world now. We need to address these threats in a global — you know, a U.N. league of global preparedness against novel emerging viruses. I mean, this is an existential threat that threatens all of humanity, Homo sapiens.

AMY GOODMAN: You know, what’s very interesting is President Trump is now escalating the rhetoric against China, talking about the “Chinese virus,” and that’s picked up by his ally, Bolsonaro, the far-right president in Brazil, who also said the same thing as the infection rate is beginning to soar in Brazil. And the Chinese Embassy says, “You’re using the language of the United States.” But why this is significant is, at this point, what do we have to learn from China, as Trump slams China? Are you concerned that we won’t — he won’t be using the critical information that can come from China right now around the issue of containment?

DR. MICHELE BARRY: I think all of us — you know, I have no idea what goes through Trump’s ears, or between the ears. I know all of us are absolutely avidly reading everything that’s coming out of Chinese literature, and trying to figure out what they did right, what we can actually really institute in the United States to flatten this curve and contain it. When you look at a country like Singapore, they didn’t even stop their schools. By doing aggressive surveillance and aggressive quarantine and community solidarity policing, they didn’t even disrupt their life, so that it is really crucial to have good public health and good public health infrastructure. And maybe this is a wake-up call to the United States that we need to think about a public health infrastructure that starts at the top. I know people don’t want government, but the minute there’s an epidemic, the minute there’s a hurricane, all of a sudden government counts. And frankly, we were unprepared.

AMY GOODMAN: I mean, President Trump has attacked now the governors who are crying out for all sorts of aid. Now he is mobilizing two ships. I think they’re the Comfort and the Mercy. One will be in Seattle, one will be in New York. But, in fact, they’re under repairs, and apparently it might take weeks. And the governors are saying, “This is your role.” And the president says, “We’re not here to order things for you. We are not your clerk.” Talk about what you see an ideal system would look like in this country. And I also want to ask you if you think Medicare for All fits into this picture.

DR. MICHELE BARRY: Well, I definitely think Medicare for All fits into this picture, because if we’re not taking care of one sector of our population, you’re not going to be able to control viruses. Viruses don’t know which economic class, and it’s the most vulnerable populations that are going to have the hardest time containing this illness. They’re crowded. They’re vulnerable. I think we also — you know, I’m not an economist, and I know you had Joe Stiglitz, that talked about the economic ramifications. But it’s the most vulnerable populations that are going to be hit the hardest, and it spreads from them. So we need to take care of all of us. We need some community solidarity about taking care of this virus and other threats that occur. And, you know, it’s interesting. You could think about climate, you can think about air pollution, you can think about other issues that we’re going to need global governance about it. It can’t be done country by country by country.

AMY GOODMAN: The call by, I mean, some — you have Chesa Boudin, the new DA of San Francisco. You have the abolitionist groups around the country. We were just talking to mutual aid groups. The call to release people from jails and prisons. I mean, we’ve got the largest, proportionally, prison population in the world, not only prisons and jails, but also detention centers of immigrants.

DR. MICHELE BARRY: Yes, those are Petri dishes, if you know what I mean. They’re incubating. It’s interesting. You know, again, there’s social isolation in some of the prisons. But once it starts going through a population that’s eating together and can’t be kept six feet apart, it becomes a real problem. Yes, I think that is a problem. Again, I think we need a centralized approach. We need a centralized approach to prison health, a centralized approach to our public health infrastructures at the community level, as well as at the federal level.

AMY GOODMAN: You are an expert in global health, and I wanted to turn to South Africa’s president, who declared a state of disaster Sunday, implemented urgent measures to fight the coronavirus pandemic. This is 68-year-old great-grandmother Lucy Mayimela, who says the recommendation of self-isolation is impossible in her community.

LUCY MAYIMELA: [translated] If it’s my time to meet my creator, I will go. There’s nothing I can do, because they are saying there’s no cure for it. And I wouldn’t even know a person who has the cure. I stay in a shack. We share a communal toilet and a tap as a group. Those that have houses are in self-isolation, and I’m here. For me, it means I will die from hunger or corona. I don’t know, but only God knows.

AMY GOODMAN: So, what about what is happening in particular countries in Africa, why you’ve called it a “ticking time bomb,” Dr. Barry, and what you think needs to happen? Is it simply because the testing isn’t available, and, in fact, it is growing exponentially right now?

DR. MICHELE BARRY: I think it’s not just about testing. I think her poignant statement about the economic ramifications, the inability to have the food chain supply keep going and the inability to isolate is going to be devastating for this country — for this continent. The only, you know, maybe small hope is that it’s a young continent, so that hopefully the mortality won’t be as high as we’re seeing in Italy, where really the majority of the mortality is in the people 70 and above, and I think that’s also driving numbers in Italy. It’s an older population than we will see in Africa. So, in a way, it’s a demographic calculation. But that woman’s words really speak to me.

AMY GOODMAN: And then you have the fears growing from millions of refugees, for example, living in overcrowded and unsanitary camps around the world, including a million South Sudanese and Congolese refugees in Uganda.

DR. MICHELE BARRY: Absolutely impossible to isolate them by six feet. And again, a young population, but it is so devastating, what can happen. I just got back from the Tijuana border, because we were trying to help give care to the migrants that are aligning at that border. And I saw some of the living situations that they were living in. They’re not even in detention. They’re all living in large churches and tents, crowded together. So, once it hits there, it’s going to be a disaster.

AMY GOODMAN: And so, the U.S. policy along the border, you even had, up until this week, even in the midst of the orders to shelter in place, ICE moving in on immigrants to deport them. And now they’re saying they won’t deport immigrants who haven’t committed crimes. But in many, many cases, immigrants who’ve come over the border, by U.S. law, that is a crime, and so people don’t realize that’s the public threat Trump is talking about, simply coming into this country in desperation or seeking asylum.

DR. MICHELE BARRY: You know, I have to say, Amy, we need to pay — I totally agree with that. But I think what we need to do is concentrate on public health measures that actually mitigate this crisis. And I think we need to do it with an eye towards taking care of all our vulnerable populations, not just the rich. There’s been discussion in my part of the world, Silicon Valley, about who’s getting access to testing. Is there, you know, inequity in who can get testing? We’re trying very hard to set up drive-bys and not let that happen.

AMY GOODMAN: I wanted to ask you two specific issues. One is about ibuprofen, like Advil, this report that has come out that it could make you more vulnerable. Is that true? I don’t want to spread any rumors.

DR. MICHELE BARRY: No, I’ll be glad to, because I’ve been quoted in The New York Times about this. I read the literature on this. It’s basically one letter to The Lancet. It’s not a peer-reviewed. It’s not evidence-based. It’s not population-based. And so, I can’t believe that that got the legs that it had. I think what’s having legs now is chloroquine. And there’s been a rush on chloroquine. And I heard the manufacturers have — or hydroxy Plaquenil — hydroxychloroquine, which is also known as Plaquenil, and I heard there’s a rush on this now in most of the pharmacies. Again —

AMY GOODMAN: Well, of course, this isn’t puzzling, because President Trump took to the podium — he used the White House podium yesterday, standing in front of Dr. Hahn, the FDA commissioner, and said that chloroquine could be a — you know, it’s not a vaccine — it could be a cure. Immediately, Hahn steps forward, after Trump steps back, and starts to raise questions about this. But explain why — what it is, this anti-malarial drug, and what they are talking about.

DR. MICHELE BARRY: Yeah. So, this is my area, because I’m a tropical disease doctor, and I have a lot of experience with chloroquine. Yes, it was a cheap drug. It basically is a drug that, in theory, could potentially mitigate. The Chinese used it because of that theory. It changes — it can alter how COVID-2 attaches to the cell. Now, this is all in vitro studies. The Chinese used it. There was not a good randomized trial that showed it had a benefit. There is a trial from a French group, and again, small numbers, like six to nine patients. This has not been used in a randomized control trial. It was malpractice for Trump to say that this is a treatment for the disease. I think it’s — there are randomized control trials that are now being set up in the United States. People should try to get on those trials. But I do not think that this is a cure for the disease. Hopefully, we can prove it, we can prove it could be prophylactic. I don’t know. That is how we use it for malaria, as a prophylactic drug. But again, that whole cycle for malaria parasites is completely different than SARS, and you cannot — COVID-19. And you cannot jump to that conclusion. And it was very premature of him to say that. And that’s why you’re seeing a run on the market.

AMY GOODMAN: Can people relapse from COVID-19? And also talk about people who have recovered, the idea of using their antibodies as part of a serum that will help other people.

DR. MICHELE BARRY: Again, used by the Chinese. I think what would also be very helpful — we don’t yet have it in this country, which is also something I don’t quite understand why this hasn’t been ramped up more — is sero — blood testing — I don’t want to use a technical word — blood testing of whether you are building antibodies after the infection. So we don’t know the level of immunity of people after they’ve recovered. We don’t know if they can be reinfected, although looking at what happened in China, it doesn’t look as if there’s going to be reinfection. There have been one or two cases, one in Japan. There have been a couple of cases where they have shown reinfection, but we don’t know whether it was true reinfection, relapse or viral particles that the tests were picking up and not infectious. But looking at how the epidemic has been curbed in China, it looks like you won’t be able to get reinfected.

Now, sorry, that first question that you asked me, I sort of went off, on reinfection. What was —

AMY GOODMAN: Serum.

DR. MICHELE BARRY: Oh, serum. So, yes, pooled immunoglobulin, or antibodies, have been used in China. Again, they’re in the midst of an epidemic and did not do this in a randomized control trial. And I don’t — I’m sure that’s being set up in the U.S. That, I don’t know about. I know about the trials of remdesevir and chloroquine, the two treatments that are being used. And actually there are many other drugs. There’s a race to find the drug that’s the best drug.

AMY GOODMAN: And what would it look like if there was a kind of Manhattan Project set up in this country? You talked about the importance of the federal government being deeply involved, setting up a medical Peace Corps. Talk about the issue of the military. I mean, people in this country see the military fighting foreign wars. But when the enemy is at home, it’s a virus. How can you see the population in this country being mobilized in the most effective way? And then, how people — back to that basic question — can protect themselves the most, in the United States and around the world?

DR. MICHELE BARRY: Amy, I think you said it: This is a war. And we should be using — instead of using our military to go out there and, I don’t know, invade other countries, we should be using our military to help our workforce. I am really worried about our workforce being overwhelmed. I’m worried about behavioral fatigue, with quarantine and isolation. I’m worried about social services and mental illness for the folks that are quarantined and alone. This is a war, that we should be using our federal government to mobilize forces so that our medical system is not overwhelmed. And to separate it out by state by state and governor by governor, I just think, is a false approach.

AMY GOODMAN: And then, how people can protect themselves at home, in their communities? For you, it’s old hat. But give us the rules, from hand washing to a standard question people are asking, is “Can I go outside?” I mean, not even if there are other people there, but to go outside to walk in the fresh air. Could they be contaminated in some other way? Or should people just shelter at home, especially in cities, where, you know, you have to walk to a place, a public park or whatever?

DR. MICHELE BARRY: So, I think for people over the age of 60, you should shelter at home as much as you can. I think when one goes outside — and I think you should go outside, because we need exercise; there is something about your mental health that you need to consider — just make sure that you keep social distancing. That is what’s really, really important to think about. Again, it’s not an aerosolized virus. When you’re at home, or when you’re at all touching — be very careful when you’re outside touching doorknobs, touching elevator buttons. In SARS1, not COVID-19, but very related, one of the epidemics occurred in an elevator, touching buttons. Again, that’s something in New York City that you guys are going to have to think about. Make sure that you do not touch with your hands, or if you touch with your hands, don’t get crazy about not having sanitizer. Soap and water. You know, the going thing in California is to sing “Happy Birthday” to yourself twice. That gives you the 20 seconds of washing and lathering.

AMY GOODMAN: Final words, Dr. Michele Barry, as you head from your office back home, you, in California, are sheltering in place. All 40 million people in California have been told by the governor, Governor Newsom, to shelter in place. Your final thoughts?

DR. MICHELE BARRY: My final thoughts is, we’re all in this together. We need to work together as a society for civil society and public good. I think we have to remember it’s not about a snow day or a couple snow days. It’s not about a sprint. It’s really a marathon. This is going to take months. And we need to all work together as a team.

AMY GOODMAN: Do you see shelter in place going, ultimately, on for months, people isolating at home for months, society, schools, work not going on at the workplaces for months?

DR. MICHELE BARRY: Well, if you look at Wuhan, which had a very effective way of stopping the epidemic, it took them about two-and-a-half months, so — and that was — and they put in measures that I don’t think we as a country can put in. So, if you look at that — and again, I think we started this show off with my saying we need to learn from our colleagues overseas, what to do right and what’s not the right way to approach this epidemic. I think we need to take our governors, our public health commissioners seriously, when they say shelter at home.

AMY GOODMAN: And finally, where can people go for the most accurate information?

DR. MICHELE BARRY: Yeah. So, I still would strongly suggest — it depends upon what you want. If you’re in a business or want to figure out how to deal with your employees, OSHA has a very good website set up. But still, for regular folks who want to hear about what the guidelines are, CDC.gov has lots of very well-written advice for you to take. You know, I even go to CDC.gov for the — I definitely go to CDC.gov for the interim guidelines. And they’re changing constantly, so continue to check in on them on a daily basis.

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