WEBCAST WITH JOHNS HOPKINS EXPERTS



COVID-19WEBCAST WITH JOHNS HOPKINS?EXPERTSMarch 2, 2020 [MUSIC PLAYING] JOSH SHARFSTEIN: Welcome to this special broadcast from Johns Hopkins University. Thank you for joining us. I'm Joshua Sharfstein, Vice Dean of Public Health Practice and Community Engagement at the Johns Hopkins Bloomberg School of Public Health, and former Secretary of Maryland's Department of Health. We're here to talk about the outbreak of 2019 novel coronavirus, known as COVID 19, with three Johns Hopkins experts who have been at the forefront of response efforts. First, we will hear from a scientist who developed the International Index of Preparedness cited by President Trump. I'm going to ask her why this index was developed, what criteria were considered, and how well is the United States prepared for the novel coronavirus. Second, we'll talk to an expert studying misinformation and fraud about how you can protect yourself from coronavirus scams. Third, we'll talk to three experts about the breaking news from the west coast of the United States about the community spread of the novel coronavirus. We'll hear what to expect in the days and weeks ahead. Our goal today is to bring their knowledge directly to you. If you have questions, you can submit them via the webcast Q&A Module, and we'll have a chance to answer a few of those questions today. And we'll also have more chances to talk about coronavirus. We plan to do more of these webcasts. And we're launching a new podcast series called Public Health on Call with regular episodes on the coronavirus. You can get all of this content via the Bloomberg School website and YouTube channel. In the next few days, we expect this podcast to be available where you regularly get your podcasts. And with that, let me introduce our great panel. First, Jennifer Nuzzo. She is a senior scholar at the Johns Hopkins Center for Health Security here at the Johns Hopkins Bloomberg School of Public Health. Next, Dr. Tara Kirk Sell, also a senior scholar at the Johns Hopkins Center for Health Security. And then assistant professor Lauren Sauer is Director of Operations at the Johns Hopkins Office of Critical Event Preparedness and Response at the Johns Hopkins University School of Medicine. I'm going to start with you, Dr. Nuzzo. Recently, President Trump cited a Johns Hopkins study of international preparedness called the Global Health Security Index. I think this here was actually the study that the President cited. His exact words were, Johns Hopkins, highly respected, they did a study, comprehensive, the countries best and worst prepared for an epidemic, and the United States, we rank number one. So Dr. Nuzzo, what was your role in creating this index? JENNIFER NUZZO: Thanks. Well, the Global Health Security Index was the partnership of three organizations. The Johns Hopkins Center for Health Security, where I am, and The Nuclear Threat Initiative, an organization in Washington, DC, And the Economist Intelligence Unit, which is the research arm of The Economist magazine. Our three organizations work together. In terms of my role, I led the Hopkins team that worked on developing the index. We helped define the questions that went into it, oversaw the data collection, analyzed the data, and really extracted from it what the findings and recommendations are that we published in the report that you held up. JOSH SHARFSTEIN: How long did it take to collect all that information? JENNIFER NUZZO: Well, it was a three year project. Data collection was a shorter component of that. And we couldn't have done it without the Economist Intelligence Unit, which has analysts in essentially every country in the world. It's capable of collecting data in native languages and pull that information together in a culturally vetted way to make sure we're getting the right information. JOSH SHARFSTEIN: So take us inside this index a little bit. What does it measure? JENNIFER NUZZO: So we measure the health security capacities and readiness of 195 countries. We measure their readiness in six categories. I can actually show for you what those six categories are. The first three is looking at their abilities to prevent, detect, and respond to infectious disease threats. These are commonly measured areas that are part of other international benchmarking tools. But we added to those efforts three additional categories. Specifically, we looked at the strength of countries' health systems. We looked at the degree to which countries comply with international norms and their commitment to transparency. And then we looked at what their overall risk environment is. And these are the kind of national factors that can influence, first of all, whether diseases are likely to spread within countries, and also the degree to which countries are going and being able to marshal the resources that they have on paper. JOSH SHARFSTEIN: So each country got assessed according to how many different dimensions within these six categories? JENNIFER NUZZO: Yeah, there are 140 questions that we looked at. And these questions were crafted in such a way that when any analyst goes out to collect data, two analysts in different parts of the world looking for the exact same-- the answer to the exact same question will get the exact same answer. So that took a lot of effort to make sure that we phrased the questions properly. JOSH SHARFSTEIN: Got it. So let's see what you found. JENNIFER NUZZO: Yeah. So the fundamental finding of The Global Health Security Index is that no country is fully prepared for epidemic or pandemic threats. In fact, the scores, on average, were quite low. The average score among all countries was about a 40.2 out of 100, which means that there is a lot of work to be done. The President was right. The United States does score highest. But even the United States is not fully prepared, and there are a number of areas where additional work is needed. JOSH SHARFSTEIN: So I want to first start outside the United States, and I want to ask you some questions about the United States. We know that the virus, now, is on six continents. And it's in a number of the countries that are not in the top tier on your ranking. And what are your concerns? What's, generally speaking, lacking in those countries, and what are the biggest issues for the global spread of this disease? JENNIFER NUZZO: My biggest concern is actually a concern for all countries, which is the readiness of their health systems. There've been a lot of work in recent years trying to improve countries' public health capacities, strengthening laboratories, trying to strengthen surveillance. And I think there are a number of countries that you possibly wouldn't expect score higher on the list, just because they have made national commitments to do that. That said, very few countries have really given the attention to the health system that they need. Making sure they have enough doctors and nurses, making sure these doctors and nurses can see patients in a way that's safe, that they have the right personal protective equipment. And so across the board, we were really worried. Category four, that looked at the health system, was the lowest performing among all countries in the index. JOSH SHARFSTEIN: And as a result of that, if there are a lot of patients who are quite sick, then you can see really serious strains in many countries around the world. JENNIFER NUZZO: Yeah. We have seen time and time again, in outbreaks and situations, that health systems that are unprepared often serve as points that amplify transmission to the larger community. So it's not just important that we have the doctors and nurses there to save patients' lives. That's, of course, extraordinarily important. But we want to make sure that when patients do show up at these health facilities, that what happens there is safe, such that we don't inadvertently spread to the patients and the clinicians, but also the broader community. JOSH SHARFSTEIN: So let's talk about the United States, the strengths and weaknesses that you found when you did this survey and index for our country. JENNIFER NUZZO: There were some interesting places where the United States seems to have some work to do. I think probably the biggest worry of ours in looking at its scores was in terms of access to health care. We wanted to make sure that, in an infectious disease emergency, it's absolutely important that people, one, are able to physically get to and live near health facilities so that they can get there in time, so that they can be treated early. But then an added dimension to this is if fear of the cost of health care is a deterrent, then that could create a bad situation where people either remain at home, potentially, or in their communities, potentially, affecting others. Also, they may not seek care until late, where they're potentially putting others at risk who are going to care for them, because now it requires a lot of resources. So making sure people's fear of cost is not a barrier to seeking care when it's needed in an emergency. JOSH SHARFSTEIN: So our sort of disjointed health care system could have consequences for our response to this crisis? JENNIFER NUZZO: Absolutely. JOSH SHARFSTEIN: What can be done in the short term? I know that the purpose of the Global Health Index was to generate, in part, long term investments for some of these very serious underlying challenges. But now that we're where we are, what can be done in the short term? How much in these gaps can be made up? JENNIFER NUZZO: Well, one of the things that we're seeing the index being used for, it's very difficult to say from the index that, you know, a country that scores two points higher than another one will be that much better in the response to the coronavirus. That said, in benchmarking where countries may have weaknesses and gaps, we think that's really important for organizations and governments to think about, trying to make improvements now and to prioritize what actions they take so that they don't keep putting money into areas that may be stronger they think of redirecting. But also, I think in terms of, let's just take the broader health system. I think that's a place where governments and communities need to put their greatest focus now, making sure that health facilities have the personal protective equipment they're going to need, that the health workers have the training, that they have plans for how to deal with a surge of potentially critically ill patients so that an unready health facility doesn't put the rest of the community at risk. JOSH SHARFSTEIN: And where can people go to find out more about this index? JENNIFER NUZZO: We have a website. It's called the . JOSH SHARFSTEIN: Can we pull up the slide there? JENNIFER NUZZO: The report is there. yes. JOSH SHARFSTEIN: I think that one mentions it. JENNIFER NUZZO: The full report is there. You can download not only the report, but the data model that has all of our data sources. And we encourage other researchers to think about using these data for other projects. JOSH SHARFSTEIN: And, you know, your transparency is actually matched by one of your question survey, right? Like, the part of preparedness for, I understand, for the team, is assessing whether countries are being forthright about epidemics. JENNIFER NUZZO: Yeah. Many of the questions asked about the availability of public information regarding certain capacities or capabilities, we thought it was really important to do that. Because if you're living in a country and you don't know that a plan exists, it's questionable whether that plan is going to work. And also, we need to be able to-- this is a great example, COVID 19 is a great example of an international crisis. When an international crisis happens, countries around the world need to be able to understand, when cases are reported somewhere, what strengths that country has to be able to continue to report cases and to respond so that they can calibrate their response plans appropriately. JOSH SHARFSTEIN: Well, it seems like this is going to be a great resource during this difficult time that we're in now. Thank you. I want to turn next to Dr. Sell. Dr. Sell, you have studied misinformation and scams for a while. Can you tell us a little bit about your background on that topic? TARA KIRK SELL: Yes. So the research that I recently did was on Ebola, the misinformation during the Ebola outbreak, and what was happening on Twitter and in social media. And so we did a study where we looked at all these Ebola-related tweets, and we found that 10% of them had misinformation or half true information. We also saw that there was a really strong relationship between misinformation and politics, or discord-inducing tweets. And we also-- another thing we also saw was that there are really strong rumor trends. And so we saw a lot of rumors about government conspiracies in our data set. JOSH SHARFSTEIN: And now, on the novel coronavirus, there's some rumors about government conspiracies. Can you talk about what you're seeing as you're looking out at the current landscape of information? TARA KIRK SELL: Right. So yeah, we have here-- you know, we have an example of that coronavirus might have originated in a lab linked to China's biowarfare program. That's misinformation. The interesting thing about this misinformation is that if you go to a different country, it blames a different country. So this is a coordinated effort to sow discord and division when we need it the most, when we need to have cooperation the most. JOSH SHARFSTEIN: And what else, when you look out on the various different websites, social media channels, what do you see that is concerning? TARA KIRK SELL: Yes. So we also see a number of fake cures when we look at misinformation about coronavirus. There's fake cures, and then there are also different efforts to blame different populations. Here we have some examples of some cures out there that aren't going to work. We also see an effort for people to try to buy and stockpile masks, which aren't effective to protect yourself. JOSH SHARFSTEIN: And so, you know, if somebody is selling something online that isn't going to work, you know, what's the harm in that? What kind of problems can you see? TARA KIRK SELL: Well, there are a number of things that can be harmful about that. People can go waste their money, and people can think they're protected when they're not protected, and take risky actions that they shouldn't be taking. And sometimes, these actual-- so cures actually will harm people themselves. JOSH SHARFSTEIN: And, to date, there's no approved treatment for that novel coronavirus? TARA KIRK SELL: Right. So anything you see that says it cures coronavirus is false. JOSH SHARFSTEIN: Got it. Now, how, in this sea of misinformation, do good sources of truth get out? TARA KIRK SELL: Yeah, so people are working on trying to promote different sort of true sources of information and also push back against misinformation. We see on Facebook, they're trying to push people to go towards official sources, the same with YouTube. The WHO is promoting or providing some myth busting. Other public health authorities are trying to do the same. We see that the FDA has pushed back against a rumor that there's a risk of COVID 19 from taking drugs that are made in China. So I think there are a lot of efforts out there to combat this misinformation. But I think the thing that is most important is that people need to be thoughtful about what they're reading on the internet, and consider, is this true or not and not just take it as automatic. JOSH SHARFSTEIN: I want to zoom in on one issue, which is masks. Because the Surgeon General had to jump on Twitter and dispel some myths and say like, please don't stockpile masks at home. They're really needed for health care professionals. And yet you showed a site which is saying, this will protect you from coronavirus. You know, what should people know about masks? TARA KIRK SELL: So masks are not effective on-- if it's a surgical mask, it's not going to be protective against coronavirus, right? Because the air can get in from the side. So buying a lot of masks and stockpiling them just prevents professionals from being able to have access to them when they need them for other things. Or if you're trying to stockpile an N95 mask, these are resources that we need at hospitals for people who are actually dealing with coronavirus cases. And so it's not good to take them out of the marketplace so that no one else has access to them. JOSH SHARFSTEIN: Hopefully his message will get across. Great. Now I understand that if people want to hear more from you, you're going to be on Capitol Hill later this week? TARA KIRK SELL: Right. So I have some congressional testimony about this issue, about misinformation on Thursday at 9:00. JOSH SHARFSTEIN: Great, and good luck with that testimony. TARA KIRK SELL: Thank you. JOSH SHARFSTEIN: OK, now let's go to our third topic, the news of the day. Community transmission of COVID 19, the novel coronavirus on the west coast, including a couple of deaths now reported. Let's bring into the discussion Assistant Professor Lauren Sauer. I want to start with a basic question. Until now, the approach has been, if there is a case, we're going to aim for containment. The person may be isolated. Other people who are exposed may be asked to sort of self quarantine, stay away from other people until they know they haven't gotten it. Go home, if it's a health care provider, you know, if you've taken care of a patient, wait at home for 14 days. But as there becomes more community transmission, can that be sustained, and what has to change? LAUREN SAUER: Yeah, it's a great question. I think that, as we move from just thinking about containment to thinking more about our mitigation strategies and our health system preparedness strategies, knowing that we will see communities transmission and we will see cases, a model that we've used previously and continues to work here is this identify, isolate, and inform. So even if you're moving beyond the idea of containment, you still want to identify these people, whether it's in the community or the health system, isolate them so that there's no further spread to impact the community even further, and to protect health care workers and the rest of the people in the hospital, and then inform your infection prevention groups, your public health workers. Use the reporting mechanisms that have been set in place. And that's really helpful for reducing the burden of disease in a community and protecting vulnerable populations during the time where we know we're seeing communities spread anyway, and we're not going to stop every single case that we come across. JOSH SHARFSTEIN: And thank you for that great explanation. And that's related to your day job. Maybe could you explain what you do? LAUREN SAUER: Sure. I'm the Director of Operations for the Johns Hopkins Office of Critical Event Preparedness and Response. And it's a preparedness and response entity at Hopkins that looks to really streamline the approach to preparedness and response across all Johns Hopkins Communities. So ensuring that the health system is protected and responding, ensuring the university is protected and responding, protecting our faculty, our staff, our students, and our entire broader community at Johns Hopkins. We are a global community, and so it's all the more important to have a consistent and collaborative message around preparedness and response. JOSH SHARFSTEIN: And partly what your message here is, is that, even when containment strategy, that starts to fade away, the substitution for that is not panic. LAUREN SAUER: Absolutely. The substitution is never panic. JOSH SHARFSTEIN: Yeah. The substitution for that is isolate and inform. LAUREN SAUER: Yeah. Identify, isolate, and inform is a model that we use in the health system, but works in the community, works in community health centers, it works in long term care facilities, and really can help protect vulnerable populations within our community. JOSH SHARFSTEIN: I'm going to follow up with a question about long term care facilities, because in Washington state, that's where they're seeing an outbreak. And it's obviously a very vulnerable population. What should be going on at long term care facilities, and how should this current situation change their practice? LAUREN SAUER: Yeah. One of the challenges with long term care facilities is that you have a population that is somewhat unhealthy and is potentially more vulnerable to diseases like COVID 19. So what you want to see happening in long term care facilities is posting signs at entrances, encouraging hand hygiene, encouraging that visitors stay home and don't visit when they're ill, isolating the patients in the facilities who may be ill, even if they're mildly ill. These things that work so well for us during flu season, or that we encourage people to do in flu season, will also help in this situation. And one key thing, I think, that all long term care facilities can do, and actually that any of our health facilities in general should be doing, is encouraging their health care workers to stay home when they are ill or use a mask whenever they develop any sort of symptoms, which is another reason why protecting the masks supply is so important. JOSH SHARFSTEIN: Great. I'm going to go back to you, Dr. Nuzzo, and ask you about social distancing measures, which are what is sort of the official name for things like closing schools, telling people not to go to the movies, canceling concerts, things like that. There's a little bit of an understanding that like, when there's community transmission, now it's time to flip a whole bunch of switches. How do you think about those sorts of measures? Do they work? Is it time to start? You know, as you think about where we are right now. JENNIFER NUZZO: Right. So this is something I think we're going to be hearing a lot more about, particularly as states continue to report cases and we continue to find, as we are ramping up our surveillance. And that's clearly what's happening now, is that we're expanding surveillance for this virus. So we're testing more people than we did before, which means that we're going to see more cases, and that we believe that we're now gaining a window into what may have been happening in the communities. So as we discover the presence of the virus and evidence that there's been local transmission, we need to think about how we may try to reduce the impact of the virus on our communities. And one of the approaches is, in absense-- since we don't have vaccines or drugs targeted at this virus, to think about trying to increase the distance between people. It stands to reason that, if you're sick and you reduce the number of people you come in contact with, that there's less of a chance that you can transmit it to others. So many of the measures considered, like closing schools and possibly closing public gatherings, those are all things that are trying to increase distance between people. The evidence for these measures are not as strong as we would like it to be. They have been used in the past largely around influenza. This disease has some similarities, but it's not fully similar to flu. And so I think as states, in particular here in the US and other countries, are thinking about using these measures, it's critical that they examine the evidence that the measures will work. And, in thinking about using them, also consider what the potential risks are. JOSH SHARFSTEIN: What do you mean by potential risks? JENNIFER NUZZO: And there are risks, right? So while a measure may sound great on paper in terms of reducing transmission, say you close schools for an extended period of time, maybe that makes people more likely to stay at home. Maybe it doesn't. If people, then, re congregate elsewhere, we need to think about whether we're going to achieve the benefits that we'd hope. But critically, if we implement measures that make it harder for people to say, get to work, make it harder for the health care worker to show up, because now schools are closed and they no longer have child care to depend on, then we could find ourselves in a situation where the measures themselves may cause more harm than the virus itself. JOSH SHARFSTEIN: So it sounds like this is not going to be a one size fits all. JENNIFER NUZZO: Absolutely not. JOSH SHARFSTEIN: And it'll be a dynamic situation depending on the nature of the outbreak in different parts of the country. JENNIFER NUZZO: Absolutely. And you'll probably hear a continual revision of planning and an reassessment of the information. So I think that's an important point for the public to consider. They may think, as soon as they hear about cases, we should close schools. We should close everything. But we really need to take a very thoughtful and nuanced approach to this, because we don't want to make it such that the people who keep the lights on and the water flowing and the grocery stores stocked can't get to jobs and keep our societies functioning. JOSH SHARFSTEIN: And similarly, if you start in one place and you try something different, that doesn't necessarily mean-- JENNIFER NUZZO: Absolutely. JOSH SHARFSTEIN: --that people don't know what they're doing. They're just working their way through a set of options to see what's going to have the biggest impact. JENNIFER NUZZO: Absolutely. This is an uncertain situation, and it's important to collect information the best we have and use new information as it becomes available and continually reassess and revise approaches as new information surfaces. JOSH SHARFSTEIN: Great. Now, Dr. Sell, you have shown a few slides about things that people shouldn't do. Go running out and spend all this money on cures that aren't cures at all. What are a few things that people should be doing? TARA KIRK SELL: Right. Well, the first thing that people really need to do is think about doing a better job washing their hands, having respiratory etiquette, coughing into your elbow. Think through, hey, how am I going to practice making sure that I do this in my everyday life. And then also think, OK, if one of my family members is mildly ill, hospitals are taking care of the most sick patients, how do I care for a loved one at home? How do I make sure that I have the time and availability in my work to do that? And then finally, think about some things that you may need to have ahead of time. You might want to think about making sure you have enough of your prescription medications so that, if it's inconvenient to go to the store or if you don't want to stand in line with people who might be sick, you have your prescription medications. But overall, I think the most important thing that people need to do is think about how we can work together through this and not panic. JOSH SHARFSTEIN: Great. So we have time for a few questions from our audience, which I'll look at. One here is about testing. The question is, is there enough testing? And how should we think about testing? I think that that's been a big issue, since there was some trouble with the initial tests, and now we're kind of catching up. Who should get tested, and for what purpose? Dr. Nuzzo? JENNIFER NUZZO: Right. So we are catching up, and testing is going to be greatly expanded over the coming weeks, which is welcome news. Because I think it's important for us to gain an insight into what's happening in our communities. My guess is that the priority will be first for hospitalized patients, trying to understand what they may be infected with, particularly for those patients who are severely ill and don't have influenza or other respiratory viruses. It will be important so that clinicians can know how to treat that patient, and also so that they don't put themselves in harm's way. But I think once we get to the point where we have a little bit more capacity in the system, it will be important to possibly do broader testing so that we can understand better where the virus is, and to include in our testing efforts, mildly ill patients so that we can understand how much virus is in the community, how long has it been here, how quickly is it moving. There are a lot of fundamental questions that we need to answer, for which additional diagnostic testing would be helpful. TARA KIRK SELL: But, you know, one thing that's really important about the testing that people need to understand is that, as testing expands, we will see a number of new cases, and that those new cases may expand sort of very quickly as our testing capacity expands. JOSH SHARFSTEIN: They were always there. TARA KIRK SELL: But they were always there. It's not that we're having this explosion in our country. It's that we're finding the cases that are there. JENNIFER NUZZO: And I think on a point another that we should stress, because we've seen this in, let's say, the 2009 pandemic, is that as people hear about testing becoming available, they may just be concerned, do I have the virus, even though they're not ill. I think we would be in a very bad situation if people went to an ER, for instance, an emergency room, to get tested when they're not ill. Right. JOSH SHARFSTEIN: Just to get tested, they could wind up getting sick. JENNIFER NUZZO: They could wind up getting sick. That reduces the resources that are available in the ER to treat people who are sick. And, you know, we don't routinely test people who don't have any symptoms. So that would be an important thing that they shouldn't just try to go out and get the tests out of curiosity. JOSH SHARFSTEIN: Well, thank you. And I certainly appreciate the fact that you all are now 24/7 on the novel coronavirus. And I guess a question that has come in is, how does the work that Johns Hopkins University does, and you all do, different from the work of the public health department or CDC? LAUREN SAUER: So I think it is in support of the work of public health departments and CDC. We are a university and an entity that seeks to build evidence to improve public health practice. I mean, I think, even though we're all academicians, we are also public health practitioners. And it is so important to use that evidence space to inform what places like the CDC and state and local health departments do. When we make policy and procedures at Johns Hopkins that are based on the work of the CDC or the work of state and local health departments, it is focused around supporting our community. So it may be nuanced. It may be slightly different than the language that's used in CDC or health department guidelines, but is always taking into consideration the work that they have done, and are doing, and continue to do to support the broader community, and then focusing on Johns Hopkins. JOSH SHARFSTEIN: And I know from my own experience as a public health official, the team here was just an incredible source of support and expertise for all kinds of unique and different questions. And I think what's great now is that we'll be able to share some of that knowledge with the public. So thank you to a great panel for a candid discussion of the COVID 19 outbreak. As I noted at the top of the broadcast, this webcast is just one of the many ways Johns Hopkins University experts are sharing their knowledge on this global public health challenge. Please be sure to follow Johns Hopkins and Bloomberg School channels to get all of your latest information and stay up to date with the expert knowledge you need. If you have questions to address in the future on programs like this or on our new podcast, please email publichealthquestion@jhu.edu, publichealthquestion@jhu.edu. Thank you very much for joining us. [MUSIC PLAYING] ................
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