Public Health Perspectives

COVID-19 Series: Global Health

May 19, 2020 Melanie Flores, MSW Season 1 Episode 3
Public Health Perspectives
COVID-19 Series: Global Health
Show Notes Transcript

During these uncertain times, people across the world are facing numerous challenges. The COVID-19 pandemic has shown no border and is affecting us all in every sector of life. Join four experts in the fields of public health, medicine, economics, and history as they discuss the ramifications of COVID-19 across disciplines.

This session will focus on the cultural, medical, and economic considerations of the COVID-19 pandemic, as well as the public health response.

To see the live presentations of this COVID-19 Series, go to www.makinghealthhappen.org.

Guest Speakers Include:

Mehmet Tosun, Ph.D., Professor of Economics, Barbara Smith Campbell Distinguished Professor of Nevada Tax Policy, Director of International Programs
Dr. Tosun is the Barbara Smith Campbell Distinguished Professor at the University of Nevada, Reno (UNR). He is also a Professor of Economics and the Director of International Programs in the College of Business. He is a research fellow at the Institute of Labor Economics (IZA), an affiliate research fellow at the Oxford Institute of Population Ageing, a research fellow at the Economic Research Forum (ERF) for Arab Countries, Iran and Turkey, and a fellow at the Global Labor Organization (GLO). He is an Associate Editor of Socio-Economic Planning Sciences. He is on the journal editorial board of Migration Letters and the journal program committee of Przeglad Organizacji (Organization Review) in Poland. He also serves on the board of the Reno Philharmonic Association and the Ozmen Institute for Global Studies at UNR.

Trudy Larson, M.D., Dean of Community Health Sciences
Trudy Larson, M.D., is the Dean of the School of Community Health Sciences at the University of Nevada, Reno. She was appointed following an impressive 27 year career at the University of Nevada, Reno School of Medicine where she served as a professor, former chair of the Department of Pediatrics, and also served as an associate dean.

As a pediatric infectious disease specialist, she has spent her career focusing on HIV/AIDS and immunizations and has contributed to both fields in research, education and service. She is one of the founders and is the former Medical Director of the HOPES clinic providing medical services to those with HIV/AIDS. In her capacity as co-Medical Director for the AIDS Education and Training Center at the University, member of the Northern Nevada Immunization Coalition and medical consultant to the Washoe County District Health Department, she has taken the lead in speaking to professional audiences and the general public on topics such as AIDS, vaccination, disease outbreaks, bioterrorism, sex education, just to name a few.

Cheryl Hug-English, M.D.
Cheryl Hug-English, M.D., MPH, is the Medical Director of the Student Health Center at the University of Nevada, Reno. She formerly served as interim dean of the University of Nevada School of Medicine. A 1982 graduate of the medical school who went on to earn a master's in public health from UCLA, Hug-English most recently served as a clinical faculty member in the Department of Family Medicine and medical director of the University of Nevada, Reno's Student Health Center.

Hug-English is a past president of the Nevada State Board of Medical Examiners and was named the School of Medicine's Alumnus of the Year in 2008. Her prior posts with the school include chair of admissions, assistant and associate dean of admissions and student affairs, and member of the Integrated Clinical Services Board. She has served on several committees, including the Student Development Committee. Hug-English is also a past president of the School of Medicine's Alumni Association.

Hugh Shapiro, PhD, Associate Teaching Professor
Hugh Shapiro is a professor of Asian history at the University of Nevada, Reno. As a Smithso

Intro to Public Health Perspectives Podcast

Okay, good morning. Everyone. We're going to get started with our Series today. Welcome all of you on behalf of the University of Nevada Reno the Osmond Institute of Global Studies and the Nevada Public Health Training Center within the school of Community Health Sciences. Today. We are going to continue our covid-19 series the topic of today is global health challenges where we will address the coronavirus pandemic during these uncertain times.

People across the world are facing numerous challenges covid-19 pandemic has shown no border and is affecting us all and every sector of Life today. We will join for experts in the fields of Public Health Medicine economics and history as they discuss the ramifications of covid-19 across disciplines. This session will focus on the cultural medical economic and public health considerations of covid-19 pandemic as well.

As the public health response. My name is Gerald Dermot. I am the director of the Nevada Public Health Training Center at the University of Nevada Reno. And I'm just going to share a few housekeeping items before we get started. First of all, all participants will be in listen-only mode throughout the session.

Next please use the question chat box at the question comes up throughout the session. Please use the question chat box and we will address the question after the presentations. Finally. This session is being recorded and will be available on both the making Health happen website as well as on the Osmond Institute for Global Studies website with that being said, let's get started.

First of all, I want to introduce and give the stage to my colleague. Dr. Burch Boogaloo as and then go on he will give some brief remarks as the Director of the Aspen Institute Global Studies Birch.

My name is dr. Burch Barbara glue director of The Osmond Institute for Global Studies at the University of Nevada Reno. I hope you and your family are safe and healthy during these challenging times and I would like to welcome you to this important and timely webinar on behalf of the husband Institute for Global Studies. I'd like to thank Gerald.

For inviting us to collaborate with this Center in hosting this event as part of the covid-19 webinar series. Thank you Gerald. We have an impressive cast of experts and Specialists from the University who will be addressing various aspects of the coronavirus pandemic to inform us on its origin spread and impact throughout the world providing historical Medical.

Genomic and epidemiological perspectives, I would now like to turn to Gerald who will be serving as moderator of the webinar to tell you a bit about today's speakers Gerald.

Thank you very much.

We're going to start with our first Speaker today upper speaker will address the history of covid-19. We have dr. Hugh Shapiro. He's an associate professor of History. Dr. Shapiro is an associate professor of East Asian history at the University of Nevada, Reno. Shapiro has enjoyed visiting appointments at Princeton University at universities in China, Japan and Taiwan and at The Institute for advanced study in Princeton.

Is archival and fieldwork in East Asia regards the history of medicine disease and the body in a comparative context.

his recent work appears in volumes published by Harvard University press Shapiro's other research and teaching interests include sino-russian Central Asian relations and the history of decolonization Revolution and Authority authoritarianism as the Smithsonian Journeys expert. He has lectured in 20 countries in Eurasia.

He received the linking price for history of Chinese science and one the University's highest teaching award Shapiro earned his ba from Stanford University and his PhD From Harvard University is an Affiliated faculty of the Osmond Institute for Global Studies. I will now turn it over to dr. Shapiro.

Thank you very much for that generous introduction. And also I too.

I'd also like to thank the organizers of this event. I'm very honored to be here.

I want to speak very briefly about the influence of The current and recent epidemics on a phenomenon known as medicine such as a new in very profound political and cultural power in China. The Chinese word is Wang.

Yo since citizens of the net this is becoming the last under 20 years has become a new force in Chinese society and currently there are upwards of 800 million netizens. It's a new type of power and it's pretty much rooted in this and recent epidemics.

So actually today is a very very significant day.

This is a great great example of the new the new power of the internet in the relevance of netizens to everything going on in China just today if you'll see in the lower right hand corner of the screen English translation of a text called Wuhan diary dispatches from a quarantine City by very respected very prominent writer in Chinese name Fang Kang who before the epidemic chemical is already very respected and widely published authors. Also a close family friend. She lives in Wuhan was in the city at the lockdown and has kept a daily diary of of the quarantine. It's a very candid and uh, now I'm polish sometimes but very very straightforward account which has attracted the attention of the authorities and another subtitle might be the conscience of aloha.

Gives from the get-go Fang Fang raises question of accountability of who in the Wuhan Administration was responsible for suppressing news of the outbreak at the at the beginning now the just a very quick note about the nature of the suppression. In fact was a city and provincial decision. It was there. This was mid-December.

There is several very prominent annual meetings were We're coming up in the the city authorities. Simply didn't want competing narratives to interview interfere with these very triumphant events. Of course, the larger uncertainties in this type of system also exacerbated the hesitation people in the city the administrators in the city weren't quite sure what to do before the higher-ups had made their position had made their position clear.

But once once the story broke and once the authorities decided to take action lockdown was very Swift and part of the the swiftness and intensity of the reaction has to do with Wu Hans extremely Central position in China's national infrastructure. It's a it's an incredibly important city historically you can say a lot about that but for the moment, let me just emphasize that the majority of north-south Railway traffic runs.

Through Wuhan as does all of the East-West River traffic it being on the youngs the river and keep in mind the youngs the river is home to 400 million people. So there are there are five six seven provinces that flow through Wuhan. So once the idea of a lifetime lifetime, I'm scooting lockdown came to the fore it was done with an incredible intensity. I can't emphasize the the the centrality of who hunts position in the National National.

Infrastructure, and as I was saying f****** counters, it was extremely candid. She didn't only call for accountability. She also told the you know, the ups and downs of the confusions the daily by system like this d'études of the lockdown and it as I said it drew attention of authorities. This is one very interesting phenomenon of the internet in China.

It's very much a cat and mouse because the netizens and one on one hand are extremely resourceful. They're very skilled users of the internet. What are the other hand the authorities also have a lot of impressive it people there upwards of perhaps two million internet police whose job it is to monitor the monitor the internet and so Fang Fang would would was not publishing hard copy. Everything is online. She's using WeChat and also a Chinese version of Twitter and she would put up a posting.

And her followers the netizens would take screenshots would take screenshots of a just like this these before the essentials could take them down and another technique to circumvent censorship would be to change the domain.

She's gone through several dozen domains and so on but and if this is what you would see if you hadn't been quick enough to read it or take a screenshot which essentially says it's something you don't see all that often, but I would say maybe about 10 percent of the post this Exactly says unable to view content because it violates regulations. There are other ways the authorities used to censor the instrument. The internet one is character assassination one of the characters assignation.

Which very effectively uses paid paid netizens paid negative reviewers to to flood the relevant sites with very hostile and negative negative evaluations and this particular posting the title of the story is if you see here is Fang saying she never imagined when for one diary would appear in the west the three news of it.

They're being a translation that she would be labeled a traitor that she is so she's she's being excoriated in the internet. As I said, this is one one one form of censorship is to destroy someone's reputation.

And as I saying both sides are very resourceful, there are Myriad techniques for subverting internet censorship. I'll just very briefly say mention a few one is to misspell words. So you say there's certain phrase which is blacked out you can misspell it or use an abbreviated form. Another is a homonyms Chinese is the language of homonyms. So homonyms have played very largely and circumventing the internet algorithms the sensor censorship.

Another is to play around with numbers. For example say they're certain dates that are forbidden on the internet such as January 1st. You can write January 1st. The Internet won't permit it. But if you want to say January 1st, you might write say December 30 seconds. So you put up December 30 seconds, if people think oh January 1st, and so of course in the internet police will black out December 30 seconds. So this is a minute by minute sometimes second by second back and forth phenomenon.

now the Prudence of epidemics is huge in the rise of the of the netizens. You look back at 2003. That's the key. Let me try and go to this terrific website by a statistician names Hans rosling's called gapminder. I highly recommend every oh check it out. So this is showing what you're looking at here are the percentage of the country on the internet. That's what this access is. And here's this time. So I'm going to click it's basically starts in 1990 watch 1990.

Get to 2000 2003 to 2012 run it one more time to South to 2003. It goes from linear to exponential. So the question is what happened in 2003.

And what happened was with sharks SARS was?

Incredibly horrible and a huge disaster. And at first the government suppress the news they suppress the news of the outbreak and so people started going online people realize that you could actually find out a lot of information about the medical and social issues of Cyrus online. And so this is really this is really one of the internet takes off as a shadow source of information and communication in Chinese Society.

The other the other way that the internet took off in 2003, which is just as pertinent is that people like like people today social distancing people want to stay at home people want to stay at home to avoid contagion? So they started shopping online this this truly led to a paradigm shift this truly led to a paradigm shift if you have the rise of e-commerce, and I can't I can't emphasize enough how enormous e-commerce is in China Jack ma household name in the United States his Alibaba company.

Top 10 in the world this massive companies like JD.com. They they pushed Amazon. They pushed Amazon to have same day or next day delivery it all began after 2003 consumers in China became intensely fastidious. If you couldn't give her the same afternoon people wouldn't want it. And this is an enduring phenomenon today. You have 800 million active online users. And the other interesting thing about the internet in China is it's not computer-based.

44:17

It's China is now post computer its cell phone and here's a shot. You see in many cities if for pedestrians have two lanes one lane is is for people who are not talking on their cellphones definitely industry people talk on their cell phones. And so the it's a post computer society in which people the chief interface is the cell phone. Now the other the thing which is quite remarkable.

44:42

Is that the netizens actually can push back they can be heard in you can see the different ways. I'm I'm going to share a video that one of my friends shot in Wuhan and it's a very upbeat thing. This is this is early early February.

44:58

It's about second week of the lockdown what people using the internet they organized a flash mob a flash mob at midnight when everyone would come out and say this Joe John Jay you means Matane tough means go for it. Will Han. So the the early lockdown meme was Wuhan Jiao Wu Han hanging tough here. Listen up.

45:49

but it also as the as the quarantine war on and is people gain more information the tone of the social media postings actually became quite quite hostile through to the authorities and quite quite angry and people were saying there hadn't been this type of anger in the Chinese internet actually since since the events of 1989 intend to men and this this Heroes of the pandemic this popped up and social media a few days ago is the translation of a piece run by Fortune Magazine earlier this week and it lists the 25 top heroes of covid-19 of people people sacrificing for to help cure and treat and so on and as you see number one, we see number three is Jack ma number one is is dr. Lee got early when Liang he dr.

46:47

Lee he is the excuse me. He's the ophthalmologist who first identified covid-19 in December. He was the one who was brought in by the police in Wuhan and essentially silenced enforced to do a self criticism.

47:01

He's he subsequently died of the He died of covid-19.

47:10

And he's become a martyr. Listen to this. This is another this is another meeting and their excuse me.

47:24

It's people are expressing their incredible sorrow.

47:33

and their rage With her shouting what people are shouting their morning? Dr. Lee their morning, dr. Lee and it's just an outpouring of grief.

47:56

So this this phenomenon of using of netizens using the internet to express themselves to express their rage clearly if they post something online. It's not Anonymous.

48:08

It's not Anonymous, but this type of event is anonymous and it reminds me of other nonviolent protests my colleagues and Latin American history will know more about this than I do in the mid eighties in Chile and then in Uruguay in the in the air of the dictatorships, there's a phenomenon that people would In home and they would they would they would somehow break the silence and it allowed people to protest without retribution their turn off the lights at home again at agreed-upon time and take pots and pans and smash them smash the pots and pans and they make an incredible cacophony was very generalized is very Anonymous.

48:45

It was very not a very Anonymous is actually fairly fairly effective in one level the pots and pans protest again is become a meme picked up in a very different idiom in Iceland and recently in late April and Italy business owners came out in the streets and were protesting the situation with with pots and pans. It also reminds me of something in the late the late Soviet Union the the nonviolent protest in the baltics the singing Revolution, but I won't say much about that now however to conclude to conclude that was a month ago when people are expressing their raids on the internet.

49:22

There's a completely different tone now the total social media it went from criticizing the Words response in China to covid-19 situation to criticize in the US and it's the new emerging Cold War as some people are saying it this the earthquake that some of you will have felt this morning at 4 a.m. I felt it. This is been imported very prominently in China now a 6.5 earthquake in the United States is not big news try to has much bigger earthquakes, but it's an example of how media in China is emphasizing negative things going on in the United.

49:56

It's to to distract from problems at home. But also sort of the feed to feed this this idea that the United States has problems that China's actually handling handling things. Well, let me just say let me just say this the idea of United States and China disengaging across the board, especially in STEM related research. I think this would be a scientific disaster.

50:21

There's no question the the the Giants of scientific research in the world are trying to do Two states and to solve any of the global problems from climate change to covid-19. They need they need to cooperate Wuhan is opening up. These are Health stations. You have a on your phone you have an app which can be scanned. One of my former graduate is Michael is working in New Holland. This is his thing we used to with his permission and you've heard of the goal of testing the entire population of Wuhan which is going on now this photograph is from yesterday, and and I'll stop there. I think I've gone over my time. Thank you very much.

50:55

Thank you. Dr. Shapiro. Thank you very much.

51:04

Next we have. Dr. Cheryl hug English. She is the director of the Student Health Center. She's the medical director of the Student Health Center at the University of Nevada Reno. She formerly served as associate dean of Admissions and student affairs and interim dean of the University of Nevada School of Medicine an alumnus of the university and a 1982 graduate of the University of Nevada Reno school of medicine.

51:32

She also a painter master's degree in Public health and epidemiology from the University of California Los Angeles. She currently sits on the board of directors for the American college Health Association and is a member of the national acha covid-19 task force, which recently released guidelines for the reopening of college campuses in the covid-19 era.

51:55

doctor hug English We can hear you now. Okay, I'm I think my slides just went away though. We can see your slide. You can see them. Okay good.

52:16

So I thought that it would be good for us just for a few minutes to spend a little time in our covid-19 time capsule and I think that so much has been learned in the last few months that it's important to kind of take a few minutes to look back.

52:49

So let's look at the beginning and back in December of 2019. None of us in the United States had ever heard of covid-19. It probably seems like years ago, but really it was just a few months ago in late December. We started getting and getting reports of the first cases were reported from Wuhan China and in January 21st, 2020 we had identified.

53:19

Add our first case in the United States by February 6th. We had our first death in the United States and by February 26th. We had our first identified case of community spread that was not associated with travel by March 13th. A National Emergency was declared and by March 17th, and nation was asked to stay home and we had cases in all 50 states.

53:50

By March 26th, the United States had the highest number of cases in the world.

53:56

And by April 2nd, the global number of cases topped A Million by yesterday, May 14th, the global cases topped over four and a half million and the cases in the United States are over 1.4 million with over eighty six thousand deaths. So I think we can safely say this virus has taken the world our nation by storm in a very rapid and very powerful way.

54:25

It remains a very fluid situation lots of unexpected suspected twists and turns with this virus. Sometimes it feels like we're paddling Upstream. Sometimes it feels quite frankly like we're going overboard and the path has not been smoothly laid out. It's very unpredictable.

54:45

But I think it's also really critical to remember that we have traveled a long way and we have learned a great deal in in just a few short months.

54:56

So what do we now know for months later? We've learned a lot about the characteristics of covid-19. And I know that dr. Larson is going to spend some time with more specifics about this but we've learned a great deal about what this virus does how it is transmitted. We've certainly learned about how infectious it is with every person infected about two-and-a-half others of the potential to be infected.

55:24

We've also learned that a great proportion of cases are asymptomatic up to 25 some say even up to fifty percent may be asymptomatic. We've also learned that the symptom profile of this virus continues to change and that certain groups are more vulnerable to this virus those over 65 and those with other predisposing medical conditions.

55:52

And we have certainly learned the importance of community transmission.

55:58

All that is important to say because our community response all of the difficult choices that each of you have made as individuals as families our school system our businesses have mattered.

56:15

The collective changes that we all have have done and they have not been easy. I'm staying home for Nevada social distancing wearing masks or facial coverings have all allowed as time for our Healthcare System to be prepared so that we're not overwhelmed that we have enough facilities that we have enough supplies and Personnel to handle this virus.

56:45

So On behalf of me personally. I want to thank you to individual for all of the things that you have done to help mitigate the spread of this virus.

56:55

We've also learned a lot about how to identify this virus. We've learned a lot about how to test for this virus and we have viral testing which often you hear the term PCR, which this type of testing is really looking for active infection where the viral particles themselves and we more recently have seen the explosion of antibody test. These tests has for an immune response to the virus meaning exposure.

57:25

The virus unfortunately few of these tests have actually been validated and we don't currently know whether this means immunity to the virus. It may mean exposure and these tests may have a role in helping us determine prevalence that this virus but we don't yet know if we really can use them to determine whether someone is immune to this infection.

57:50

We also have identified who should be tested. We've been able to expand that based on increased availability of testing which was initially a problem and we've been able to contact Trace individuals who have been infected and the potential people who have been exposed. So lots of progress. It really involves boxing this virus in we need to get our boxing gloves on with this virus.

58:19

We need to Broadly, we need to isolate those who have active infection. We need to find the contacts for those people who've been infected and we need to quarantine those in essence boxing the virus in.

58:36

So where do we go from here? I think it's safe to say this virus is going to be with us for a while and it's also safe to say that as individuals and as communities we need to be able to live our lives.

58:52

And so as we begin to reopen our communities, it is indeed like a big puzzle and all of the pieces are very difficult sometimes to find the match. I think Tom frieden who was the former director of the CDC said it best when he said it really isn't about the date. It's about the data and our decisions really do need to be scientifically and data-driven and I think under the leadership of our governor.

59:21

The governor's this alack. We have a very good phased-in approach for how to begin to open our communities in the state of Nevada.

59:31

We're doing it with gray problem solving and patients. We need to adapt to new ways of doing things and I think all of you have done a fantastic job of learning some of those skills over the last two months. We need to find ways to coexist with this virus in a safe and strategic way.

59:52

We also need to do it with resilience and optimism and with respect and Synergy for our own personal health and for our communities health Working at UNR campuses and universities are like their own many communities or sometimes big cities.

1:00:13

And so the discussions that are occurring on a community level are also occurring on our college campuses throughout the country and at UNR we are certainly engaged in these conversations on things like how classroom teaching will be promoted and and occurring How we bring our researchers back how we bring our residence hall students back. Our dining facilities athletic events how we provide medical care incorporating telemedicine as well as in-person visits how we test for our campus and certainly an important piece is looking out for the mental health and well-being of our faculty our staff and our students and also providing training on covid-19.

1:01:03

Well-being is a huge part of this. I think all of us to a degree have experienced some sense of isolation. We are connected beings and this has been difficult.

1:01:14

There's been some increase in some in anxiety and depression and we have used we have stayed open on our campus at the Student Health Center and I and our Medical School clinics providing telemedicine service for patients as well as some limited in person visits we've Also been able to provide telepsychiatry visits and counseling visits from our Counseling Center and the Student Health Center support groups are important going forward and things like virtual game nights virtual nutritional counseling and fitness classes are important as well. I want to emphasize the importance of fun because fun itself is healing and we need not we need to remember to incorporate a sense of fun throughout this difficult time.

1:02:04

So there is still a lot of questions. Well, there's viruses mutate. Will there be another surge do antibodies confer immunity? If so for how long what's the best treatment and will there be a vaccine and when will that happen?

1:02:21

I am certain that Looking Backward in our time capsule of what we've accomplished over the last few months that in the coming months many of these questions will be answered. So I'll leave you with this final thought we will get through this together with creativity with Innovation with new knowledge and research. Thank you so much.

1:02:45

Thank you, Doctor hugging glitch.

1:02:49

Next we're going to switch gears a little bit and talk about the economic impact. Our next presenter is dr. Mehmet II assume doctors too soon is the Barbara Smith Campbell distinguished professor at the University of Nevada Reno. He's also a professor of economics and the director of international programs in the College of Business.

1:03:11

He's a research fellow at The Institute of labor economics an affiliate research fellow at the Oxford Institute of population ageing a research fellow at the economic research forum for Arab countries, Iran, and turkey and a fellow at the global labor organization to use an associate editor a socio economic planning Sciences. He is on the journal editorial board of migration letters and the journal program committee.

1:03:42

As the Prejudice clad organizational organizational review and Poland he serves on the board of the Reno Philharmonic Association and the Iseman Institute for Global Studies at the University of Nevada Reno. It is my pleasure to introduce dr. Too soon.

1:04:06

Okay. Talk to you soon. You now the presenter. Ok, just all right.

1:04:15

Okay, can everybody see this? Yes, I guess okay. We're all good to go. So, you know, of course, I got to start by thanking the organizers, you know Gerald, you know, and on uh, so they've been working on this very hard and you know a great job with this with this webinar a great turnout. And of course my thanks to the director of the urban Institute for Global Studies.

1:04:45

- Barbara Lou and I'm probably the only one that can say this name perfect like this, you know, so and you basically see me as the person wearing a jacket and tie. So I must be the one that is really going to be bearing the really bad news. And because I'm going to talk about economics, but but maybe at least like the least I can do is to show you some start by chopping.

1:05:15

You some pictures and this is actually a picture of London and this is from one of our international business programs because we have a great program in London that of course is not on hold obvious for obvious reasons. And so you also see on the left hand side of the screen this nice very nice Bridge, which is in Istanbul Turkey and we have very close connections is the College of Business in Istanbul with Coach University.

1:05:45

The end, you know, like I always say like we're in the business of Building Bridges. Well, literally, right. So you're looking at a bridge that connects two continents Asia and Europe. So what a great way to kind of like do International collaborations.

1:06:01

So again, you know for obvious reasons, we got to be a little bit patient about the things we do, but but at least I want to I want to start with that lighter note, but the my topic is economic impacts and There will be some not so good news, I guess. So the things that I want to do.

1:06:21

So rough outline is like a really I want to accomplish three things here in this very short period of time so I will talk about economic impacts in the US and globally talk about the current picture talk a little bit about the future policy response by the government and then if I have enough time, so I have actually some interesting to talk about regarding In the future challenges moving forward as well. So the impacts so Harvard Professor Kenneth rogoff wrote an article and use this term. So I'm just borrowing that that's why I put it in quotation mark, you know, he likened depend emic to it Alien Invasion, right? So it's like the science fiction movies.

1:07:07

So it is very sudden the alien start invading Earth and then we are basically unprepared even like the more developed Nations like the United States the superpowers and you know, like they're they're basically are at a loss right so they don't know exactly what to do how to respond and and bit of a chaotic environment.

1:07:33

So maybe it is not as bad as like that so that may be a little bit of an exaggeration but it's sort of like feels like that to a lot of people well including me I guess so And of course with the covid-19 people are like have been an especially more. So now like talking about the session, right? So the great lockdown so we like to attach the the word grade to a lot of things Great Depression the Great Recession in 2008.

1:08:03

And then this is called the Great lockdown and then the of course following recession, which is referred to as the covid-19 recession and It is not just us. Obviously it is globally us has impacted of course pretty badly. But it is this is a global thing and I will say that in kind of a commonality to you know, pretty much all recessions are these external shocks?

1:08:33

And when you're recording this we got to say things about demand and Supply so demand and Supply shocks on the demand side incomes fall consumers feel pretty bad about Obviously people lose their jobs consumption suffers. There's that impact of the current e non travel the tourism sector, you know is usually impacted first and a lot, right? So those are what we associate with the demand side and then Supply shock, of course, the the firm's on the production software their business closures and there are these really complex supply chain nowadays, especially globally, right? So you have corporations with thousands of supporters.

1:09:15

Pliers right so like Toyota companies, I understand has as you know, more than thousand, maybe two thousand different suppliers and it is like crazy and and you know, the supply shock is also there because the pandemic disrupts the the production side the supply chain quite a bit and then of course the financial truck usually takes the form of liquid in the crisis, right?

1:09:39

So people need cash the businesses need cash to survive and you know, the So I'm gonna land money anymore because it is a tricky situation, right? So they want to hold on to the cash that they have and maybe they don't have enough and they are of course worried that they won't be able to get it back. So there's this reluctance and of course usually there's also something about the oil the Earth like an actor nothing. Just wanted to let you know. I'm sorry. It's like you're not progressing. I just wanted to let you know in case you're going through slides.

1:10:15

Okay, I am going through slides. So which one are you seeing right now? Because they're progressing in mind.

1:10:22

We only see your intro slide after the outline already seeing the one that says economic impacts. No.

1:10:33

Okay, so how about now? Yes.

1:10:39

Perfect. Okay, maybe I'll just do it without putting into the slide show. So with the oil shock, of course, it is little bit different. So like a lot of times the oil shock is like that spike in the price as well as it's just all positive The Experience, right? So this collapse in the oil crisis and even like as you probably heard that it went into this negative territory for a little bit and then went back up but it is still a little over $20.

1:11:08

At Barrel right now. So this demand shock lack of demand out there and then of course this excess supply of oil led to a significant decrease in the prices, but I let me hit you with my best shot here, especially regarding the unemployment rate. So if you look at this graph, you basically see the point about like how this may be a little bit different type of recession you're talking about, right?

1:11:38

So the most recent, you know unemployment rate that was announced by the Bureau of Labor Statistics 14.7% And a lot of people think that it is probably higher than that in terms of the unemployment insurance claims. That number is actually higher and it is probably going to get higher but even with that 14.7% that is the highest rate that we've seen since the Great Depression and how high was that in the during the Great Depression.

1:12:07

It was as high as about So, you know are we going to go to that level maybe right so likely at this point, but again the unemployment rate that big spike in unemployment rate in just one month. Pretty much is is pretty amazing. Now some other numbers so economic indicators.

1:12:31

You know 4.8 percent decline in the GDP in the quarter 15.4% in industrial production. I mentioned unemployment rate which you know, basically translates into more than 20 million people losing jobs and 36 million unemployment insurance claims out there, you know, just a little bit about Nevada, you know, if you go with the insured unemployment rate it is at this point as of May 2nd.

1:13:01

And which is the highest in State history so far and we expect that to continue. So nobody's like he's really badly as well. So and then the big drop in the retail sales and the price indices are falling which means that we are not experiencing inflation, obviously because the opposite and then on the monetary and fiscal indicators insurance rates are pretty much at zero big drop in federal receipts deficit in one month.

1:13:31

Only is more than 700 billion dollars and then the public debt is rising to a hundred percent of GDP. So looking pretty bad forecast a bit about the future. So I'm this is obviously not an exhaustive this but like, you know looking at some of the forecast out there come from Sports 7.2 percent decrease in GDP the nonpartisan CBO Congressional budget office 5.6% 2020, but then Rebound in 2021 with a 2.8 percent, you know.

1:14:01

again, very high deficit and debt levels, you know projected to be going to a hundred percent or even more and the IMF is actually also telling us like a big drop in the GDP like unprecedented level of decrease but a rebound in 2021 and again the fiscal balances public debt being at, you know, historical levels few things about the global so this Is the map that shows that in 2020 the real GDP growth is expect to be. Well, it's in red pretty much all around except for a few places like China and India and some places in sub-Saharan Africa. So a big dip a bigger dick than the Great Recession in the real GDP and on the rebound and kind of a summary of that with the growth projections now, I will of course say that take the one the numbers for 2221.

1:15:01

Or a bit of grain of salt, right? So these are based on the assumptions that the economy is going to start growing again like a rebound starting especially in the second half of 2020 or like towards the end of 2020 and problem didn't factor into this the possible second or third way kind of similar situations with the fiscal balances u.s. Leading everybody else with the fiscal deficit as you see here.

1:15:32

and then with the dead level I want to basically point out that while we see many many more countries reaching that psychological Benchmark level of hundred percent of GDP, like for the public debt that is being held and you see like a worldwide almost a 16% job in one year from 2019 to 2020 from 69 to 85% now because fellow you have any policy responses Federal government state and local governments federal government has monetary and fiscal policy at the the disposal. You know, the FED Reserve is going to continue with the low interest rate policy expanding liquidity as much as possible fiscal policy. We had the cares act.

1:16:19

This is sorek stimulus package more than 2 trillion dollars that provides a lot of funds to individuals and businesses and state and local governments now the And local government responses is fragmented in the u.s. Because of the decentralization that we have the fiscal federalism that we had. So and there also, you know bounded by the balanced budget requirements, right? So they are hands are tied. They have rainy day funds but well, this is not just a regular reindeer talking about this is the storm it hurricane force winds and it's a tsunami all mixed together. So it is like pretty bad.

1:16:58

So rainy day funds will not be enough so But so far the economic policy response by the federal government has been pretty quick. So there are actually some good things to say about that and both monetary and fiscal policy of the Federal Reserve Bank, Peter myself are averted a financial crisis. And then the the fiscal stimulus was actually done pretty quickly, but there's still a lot of business in the public health system, obviously and the state and local governments are in pretty bad shape regarding budgets.

1:17:27

They need help more fiscal stimulus may be needed and we need it better coordination between governments. So so with my students be looked at this relationship between the covid-19 that's rates and the decentralization of the Garment and well, you know, this is not a very strong correlation, but it is still a positive correlation. Whereas normally people expect that it will be negative. Right?

1:17:53

So decentralization bringing garment to the you know to the people at the local level is supposed to be a good thing, but But something is wrong regarding the federal government state and local government coordination. So that better coordination is needed here finally. So I'm going to end with this slide so I have few other things, but I think I'm running out of time but future challenges right high debt levels. Are we looking at a debt crisis moving forward? Possibly?

1:18:25

We're definitely going to experience more taxation the future but you know, there is a lot of fiscal capacity in a other countries and low tolerance, right? So a lot of anti-government anti-tax feeling, you know, especially in countries like us Rising inequality after the pandemic that there's actually evidence that this happens, you know quite a bit and this is a varying Trend because there's usually a larger impact on those less skilled workers and there are lower remittances to help out, you know, poor individuals in developing countries. So that's probably going to lead to Rising inequality.

1:19:01

Conflicts fragile stays Refugee crisis. We already have that and you know, it's probably going to get worse after the pandemic and there's a lot of anti-globalization sentiments. I don't know if anybody saw the cover of The Economist magazine this week's Economist magazine that's actually featured as like always the is the globalization dead. I hope not because the believe in globalization globalization helps, you know, bringing countries together people together in different.

1:19:31

some parts of the world international cooperation collaboration, but of course, there's a very and we need more International cooperation climate change it is there there has been temporarily because of the pandemic because of the loss of activity but maybe as a smart policy this is a good time to think about a carbon tax, which will address the first challenge that I mentioned with the debt and Taxation, but but also a carbon tax that will help with the climate change and Last two things Automation and displaced workers that's already part of the discussion. I'll do you going to have a lot of displaced workers because of the recession and you know, is it going to get worse aging of the population? Right? So this crisis is especially hitting the elderly people that need a lot of Health Care. So there is a big impact on the Health Care System, but there's also a big impact on the fiscal side the government budgets. So that is not going away. That's a major Trend this demographic.

1:20:31

Terrific, you know transformation that you're experiencing with the Aging of the populations and that is going to be in the background at that will be there for for us like once the pandemic is over as well. Thank you.

1:20:46

Thank you. Dr. Johnson.

1:20:50

So next we have dr. Trudy Larson Beckett Rudy Larson is the dean of the school of Community Health Sciences at the University of Nevada Reno. He was appointed following an impressive 27 year career at the University of Nevada School of Medicine where she served as a professor former chair of the Department of Pediatrics and also served as associate Dean as a pediatric infectious disease specialist.

1:21:15

She has spent her career focusing on HIV/AIDS and It's and has contributed to both fields and research education and service. He is one of the founders and is the former medical director of the hopes Clinic providing Medical Services to those with HIV and AIDS and her capacity as Co medical director for the AIDS Education and Training Center at the University member of the Northern Nevada immunization Coalition and medical consultant to the washer County District Health Department.

1:21:44

Just taken the lead to speaking to professional audiences and the general public on topics such as Chas AIDS vaccination disease outbreaks bioterrorism sex education and more with based. I would like to introduce. Dr. Trudy Larson to be our next presenter.

1:22:05

All right.

1:22:07

Sure.

1:22:15

All right, and hoping that my screen showed up, maybe it didn't note and then went away you did. Let me see what I can do here.

1:22:26

orbit Okay now I can't see it.

1:22:30

There we go it So what I'd like to do is finish up today by sort of bringing this all together and highlighting the fact that what we're experiencing is experiencing is really about a virus. And so this is a picture of the coronavirus coronavirus has have been a part of both human and animal life for a very long time. We know about coronavirus has most of the time because it causes the common cold.

1:23:08

However, as an RNA virus it is has the capacity to mutate into mutate rapidly and this is essentially what has happened to other times with the coronavirus. It caused SARS in the early 2000s. And then it was responsible for MERS and is now responsible for what we term covid-19 the disease associated with this SARS covid to virus and how did it come about because of the rapid mutation?

1:23:38

Haitian rates and the fact that this exists in both humans and animals, you know allows for rapid changes and as it mutates one of these viruses some point changes from inhabiting any animal and is then mutated to be able to infect a human we call this zoonotic infections and that's undoubtedly how this particular virus got started in a Wu had Market where animals and humans Resided with their viruses sharing their genomes and so it was a new virus and importantly that meant that no one in the world was immune to this virus yet setting up the perfect stage for a pandemic this set of symptoms actually represents almost fifty six thousand cases from China and identified very early on.

1:24:38

that fever was one of the most prominent symptoms now, this is important because as we talked about are mitigating strategies and and reopening mantri temperature's going to be one of the important ideas that will help identify potentially infected folks before they're allowed to mingle for example, so we have fever cough we know about that the most scary part of covid disease obviously is shortness of breath and this is because the lungs are in Infected and become become the cause of pneumonia that's very much an interstitial pneumonia. We did resulting in low oxygen saturations, which causes a really significant symptoms and is the major reason that people are actually hospitalized. Now, these are where people have symptoms as we know anywhere from 25 to 60 percent depends on the series that you look at of people are actually asymptomatic.

1:25:38

Have no symptoms, which means they're infected and they're infectious and that is an incredibly important common concern as we look to try to mitigate the consequences of this infection. So with the worldwide spread, it's been very interesting really like this map.

1:25:59

This comes out of Johns Hopkins and you can see where this was a very very slow, but Insidious increased an On you can see the the rise starting in Italy. That's the one of the orange ones and so all the country sort of simultaneously began to experience the symptoms of covid but clearly the US who really was significantly impacted with a very rapid rise in the number of cases fairly rapidly, but this is worldwide. It is seen in every country.

1:26:38

Entry we've heard a lot of the stories about Italy and we've heard a lot of the stories about Spain being particularly hard-hit and then the source from Germany where they were not and the and the big difference among these countries most likely is the fact that they took different efforts to mitigate risk. So when you think about covid-19 and you think about what we need to do to intervene to stop the spread of this infection, I want you to remember this picture. This is a backlit.

1:27:08

Sure of a sneeze and I want you to see all those particles that are projected way out many feet and also can see what the bigger droplets dropping 2 grams. So this really explains where this virus goes now if it was just if we were just to look at normal breathing. This would be a much much smaller Cloud, but there's still a big cloud with droplets those droplets contain infectious virus, and so it's very clear.

1:27:38

that if we want to impact transmission, we have to stop the spread of these droplets and that means not only through the air but we also have to stop it where these droplets land which is why you hear a lot about sanitizing surfaces because that's a very predominant way for the transmission of these infections where you actually see that your hands that drop on the droplets come and watch do your eyes your nose that's How these get transmitted so if we want to stop the transmission of infection, we have to stop this large cloud of virus from being projected out in from hitting surfaces. One of the things that was mentioned by dr. Hon English is the ability of this virus to infect and infectiousness is measured by what we call are not and so that's what how you pronounce this.

1:28:36

So how do you impact are not and you have to understand that viruses have their own intrinsic are not how much how infectious truly are. They just to give you a comparison measles is one of our most infectious viruses. It's are not is 14 to 17 depending upon the susceptibility of the population. The are not for Coronavirus is 2.5. So if we look at this how we impact are not in normal behavior, no interventions in five days a single.

1:29:08

And will infect 2.5 people and as you can see over time each generation growing by three days this results in 406 people being infected from this just this one person. However, if you begin to impact the are not by increasing social distancing and other mechanisms, like using masks, let's say 50% less contact will result in half the number of people in five.

1:29:38

Days and a substantial decrease in the number of people in 30 days and if we even do a better job which many of the lockdowns have done with extremely less contact then you actually sort of diminish the spread to almost zero and that's really what we're looking to do is impact the transmissibility and the infections of this virus by all of our activities. You've heard a lot about flattening the curve.

1:30:05

I thought I'd show you a nice representation here because What social distancing also does by interrupting those transmissions and slowing essentially the rate of climb we move from the red cone which is without protective measures to the blue cone, which really substantially shows a decrease and I want you to look at that dotted line because that has been our key fixture here is that we cannot overwhelm the healthcare system.

1:30:36

And so that's what our all of our efforts have been doing staying at home using social distancing not going to work. It has made a significant difference in our ability to keep up with this infection with those who are seriously ill and so the key has been to keep us under that Healthcare System capacity Healthcare citizens system capacity was very much overwhelmed in New York City here in Nevada. We have been far luckier. We actually did flattening the Curve.

1:31:08

So what I'd like to show you is this is our Nevada data if you are interested in following this with the data, which I suggest you do there is a wonderful website called Nevada Health Resources and every day the graphs are updated that show the number of cases the number of hospitalizations percentage of hospitalizations and in a couple of other figures which are critical, so I just wanted to show you the graph on the left is are flattening of the Curve.

1:31:38

So we had a continual increase to the end of March into the middle of May and begin to stabilize and otherwise, in other words it begin to flatten at about a hundred and fifty cases per day and then later on in the month of April began to decline slightly and we've been very much flat for many many weeks.

1:32:00

Now, the one on the right is a little bit more Dynamic and what this shows you is the percent of testing that is positive the blue Is of our percent of testing the green line is what the who reference recommends for reopening and so this is one of the critical features we've been following in Nevada to see if it was appropriate for us to reopen and so you can see here by May 10th. We were approaching that 10% which is 10% of tests that are being done are positive and that's an important figure because we're testing a lot more people now three to four thousand people a day.

1:32:38

And our cases are slightly going up but their percentage is going down which really is an indication of the circulation of this virus in our communities. Well, let's look at the key components of reopening. These are the five categories that is in the governor's plan for reopening number one is declining hospitalizations and the percent positive of those who are tested.

1:33:03

This happened for two weeks last week is when it had two, Worth of data that showed this was happening which was the impetus for Phase 1 at that time hospital hospital capacity was adequate for both total beds. And for ICU beds was plenty of room just in case we also increase testing substantially by the addition of another number of testing sites and a number of testing Labs so that there is no ability to test all symptomatic persons, which is a another key factor reopening adequate Public Health Workforce.

1:33:38

Force and this is to do the work. I'm just going to talk about in a minute that has not quite really wanted to be but certainly it's on its way and the other key feature is adequate personal protective equipment for all agencies.

1:33:52

Not just the ones you like think about like hospitals or nursing homes, but also our emergency responders prisons and places where people congregate where there's a very high probability of outbreaks and it's the outbreak situation that will increase our Were substantially so those are very it's a very critical feature of reopening. So, how do we look forward? So we're currently in Phase One the there is a plan for phase two and four phase 3, but through all of these there is a common feature because we have to stop transmission always remember that picture of where all this virus is going. So we need to include social distancing including masks and that means that are 6 feet apart.

1:34:38

Art face coverings primarily when we're in in closed spaces because that's where the greatest risk. Is that as you saw from that sneeze. It goes out quite a way so that six feet becomes very important for mitigating spread. Not only do we need to do our social distancing but we also have to do the classic public health issues of identifying cases.

1:35:00

That's your testing being able to isolate those cases effectively that we can contact trace and contact tracing is a Interesting skill whereby the case is questioned about all the people they were in contact with since they weren't symptomatic and before they were symptomatic or even those that were done a week before they were tested positive if they had no symptoms and that their contacts then can be tested and quarantined until they either become infectious and weighed out their isolation or they don't become infectious and what that does is effectively interrupt that transition.

1:35:38

Mission Cycle and that is the critical piece that we're going to need to do to get this fires under control as we begin to reopen which is a very critical event.

1:35:49

We do need to get back to our social interaction to our economic interactions, but I think we need to be honest about this we're going to have to do all of these activities and it's how we have a vaccine that is really the only way that we are going to have some semblance of comfort with our Interact on a little my Colin normal level so I watched the encourage you to become comfortable or as comfortable as you can be with our new normal because this normal is what we're going to be doing until we have a vaccine and so when is that going to happen?

1:36:26

I've never seen so many International Pharma companies really interested in doing international studies in collaborating on clinical trials and for any vaccine that needs to get Flipped it has to go through steps the biggest step being clinical trials that not only show that it's effective but that it's safe because that is our critical feature of vaccines that they must be safe. And so as we look forward, I think we need to show patience. We need to be respectful.

1:36:58

We need to help everyone understand why masks and social distancing are so critical for us to be able to move forward and not only On our University and we can hardly wait for that to happen. But really that we can then support our economy again, so thank you for letting me speak and I and I hope that you have a little sense of optimism that there isn't going to be an end of this. Thank you.

1:37:28

Thank you. Dr. Larson at this time. We are now nine minutes over our lot of time for this very engaging webinar series at this time. We will be taking the questions individually to the panelists since we are over our time and hoping that they can answer those questions and then we'll be posting the answers to those questions along with the recorded video within the week.

1:37:55

And so I would like to thank All of you for joining our weekly covid-19 webinar series. I'd like to remind everyone that the series are ongoing for an additional eight weeks. It's every Friday from 10 a.m. To 11 a.m. Pacific Standard time. Our topic next week is working with the lgbtqia population and consideration for covid-19.

1:38:20

So thank you all of you for attending and if the panelists could stay on the line and we can get some thinking of answers that we would appreciate it.

1:38:46

Okay, everyone. Thank you so much a great job to all of the panelists. I don't know. I know some of you have to go but if you are available just to answer the questions in your category. We still have this recording on so we will be splicing the questions for each panelist and making that video available for those that cannot stay. But thank you all for an engaging webinar at its highest point. We had about 280.

1:39:16

People currently on the line that went up and down throughout the webinar. So thank you for spending the time with us. And we do have a few questions. The first one is a question for everyone and it says the economic as well as the social cost of lockdown are very high as economists.

1:39:38

We are always looking at the opportunity because many people are concerned that these costs of elect down might be too high and so so they would like to hear the opinion of the panelists on this issue, but anyone like to start I just I needed you so you're still muted. Yep. Can you you're all right. Yeah, I guess maybe I should start because it's sounds like an economics question and and you know, maybe it is one of my students or former students, you know talking about opportunity cost and everything. Obviously, that's that's true. Right. So like, you know, there's a high opportunity cost. But you know, my answer to the question will be the following.

1:40:28

Almost all of their sessions before right? So like the big difference about this one is that it is attached to this phonetic in all these other recessions. We basically have seen, you know, like life still continuing and with the government policies eventually the economy coming back, you know with this one, right?

1:40:50

So you are looking at something different because unfortunately the effect Act of the economy opening up could be you know, like the more like, you know, the pandemic basic the continuing and getting burst in the future as well. So there's there's that risk so we just don't know because we don't have the data yet. I say it hasn't happened yet. But but there's that's a big risk and then you can argue that and I'll basically respond by using another economics term negative externalities.

1:41:28

From such an event like, you know opening up the economy and and leading to further spread of the virus, you know could be actually devastating so there could be a much greater cost as social cost social and economic costs attached to that spread of the virus. The negative externality is getting worse because of that, right? So but you know, like it's absolutely true that there's a very high opportunity cause of you.

1:41:58

No business closures and stay at home owners.

1:42:04

So can I respond to that as well? So I as I look at this like this is the first time we've ever lived through a pandemic and so I am not sure we actually do know the answers and I do think that to a certain extent we are this is a trial-and-error possibility. And so I think it's some point we have to look at it. Like what is the ultimate outcome?

1:42:27

Because we I don't think we're gonna be able to do have everything come out the way we want and so I think one of the outcomes is Deployment another death, so we really don't want a lot of deaths and we particularly don't want a lot of deaths in our working folks and the folks who really keep our society going in our economy going and so it deaths is really the outcome that you're looking for. Then we would still be under lockdown and we would be under lockdown for a long time. And so I think trying to balance that is do we have the fortitude because this is a circle of behavioral issue. Do we have the fortitude?

1:43:03

Ali Implement social distancing and wearing of masks consistently so that we can open the economy because that will be the key because we can economy can get going if people can get going and people can get going if they know how to do this social distancing and the masks and so we have an answer for how to roll out safely. I think I've seen some that casino plans their remarkable they're going to do temperatures employees.

1:43:32

They're going to Look, they have a lot of safeguards that they're looking at because that's their livelihood and I think as we have to give her purse ourselves permission that that we may not always get it right at this is the first time we've been through it. And so I think the Ingenuity that is coming out because our we haven't done this before there's a lot of really interesting issues that are not issues. I would say interesting new Concepts that we're going to be doing in the foreseeable future Telehealth.

1:44:03

With has never been popular it's working. It's beautiful that's going to be happening for us in the University. We've never used so much remote teaching. It's when you can be done and it's going to be successful all these people who are working at home finding out that their that they can do a great job and they don't have to go into the office. I think we can really look at how we can be industrious and we can still be safeguarded until we get that vaccine. So even though I know there's been a huge hit and we've never been this way before.

1:44:33

Really never been this way before and we haven't had to do both of these things at the same time. And I think it's a very reasoned and a reasonable approach but this takes personal responsibility to a very very high level.

1:44:50

Thank you. Dr. Scrub you have anything?

1:44:56

No, no. No, I blend very fascinated by my colleagues response is thank you and I don't have any comment or pick. The next question is actually for you to just Bureau question was can you tell us anything about Communications between Chinese and US health professionals during the pandemic?

1:45:16

So I'm so my understanding. The question is from overseas from health workers in China. Yes. No, they're actually they're actually has been a lot of sharing of clinical data between between professionals. I think on this topic. Dr. Larson would probably be able to speak more accurately, but the answer is yes that is going on but I would actually like to ask my colleague. Dr. Larson of you're probably seeing this in real time.

1:45:41

I have to say the number of papers that have come out. So they're all a peer-reviewed journals. There can be extraordinarily fast. I am excited. I'm very impressed. So there's a lot of sharing clinical data some of the nuances of the clinical presentations now have been shared the whole idea of asymptomatic shedding and you know, that that was shared early on and allowed us a chance to really, you know, incorporate that I think in our responses here in the US.

1:46:09

And all around the world. I think the boundaries are much less absolute between professionals who need to share that information.

1:46:23

And birch as the Director of the oven Institute for Global Studies, you can jump in on any of these questions as well. Next question is also for dr. Shapiro. How do you assess the level of misinformation about covid-19 and mainstream media?

1:46:43

So globally it's quite profound. And again, I love to hear my colleagues on this. This was I think this is actually a big concern because conspiracy theories are ubiquitous there in the environment is part of the internet, I think for covid-19. They're actually very they're dangerous medically, but they're also dangerous socially because you do have episodes of violence against people being perceived of coming from a certain country of which conspiracy theories have have tarnish.

1:47:12

So I think Frankly, I think this is the problem and I think serious problem with with real consequences. Not only with negative medical outcomes, but also people being being assaulted. So, I think it's a very serious problem. Thank you.

1:47:30

anyone else Okay, next looking at the world both covid-19. What will the cultural economic and political relationship between China and the US?

1:47:48

He wants to take that I listen. I just wanted to say generally if you look at you as trying to relation say for the last fifty or a hundred years. It's it's a pendulum. It really is. It goes It goes from hot to cold and it's getting cold now, but I'm confident things will normalize. There's so much shared interest not just economically and in stem research, but also culturally the United States and China have so much in common. I see I think we're in for a bumpy.

1:48:18

Hash now, but I see things improving in the medium term. That's my optimistic feeling.

1:48:25

And then I think this for dr. Larson, can you speak to any of the new information about the risk to Children showing up at the they have to recover from or never show symptoms of covid-19 - yeah. This is a really interesting observation. It's not real common thankfully but it's sort of similar to what we would call Kawasaki disease and Kawasaki disease disease has been a disease has been very well known for a long time without a costly like we didn't quite know.

1:48:55

I wish that was very much thought to be a post a post infectious immune response and caused a lot of the damage and this is probably similar to that that it's actually not the virus itself. But the response to the virus causing the problem, that's also true for some of the younger folks that get covid. They have a very healthy immune system. And so they get what they call cytokine storms. They can probably read about cytokine storm and what that is.

1:49:21

It's just the entire immune system just turning on really rapidly and with lots of of chemicals that are can be somewhat damaging and causing a lot of organ damage. It was the fundamental way that Spanish Flu actually cause death in young people was this activated immune system.

1:49:39

So it's not unheard of it's I think a scary component that we really have to pay attention to because the kids don't tend to die from this but they're very very seriously ill and that's and that's a real damaging kind of thing for children to have to go through Excellent. Thank you. I think this question is for dr. To assume countries across the world try to deal with the pandemic by themselves. There's very little International cooperation and coordination the world could probably never seen a bailout package the size of which is now being in place in the US and unprecedented three trillion US Dollars developing a new normality for the world should be done together on the global level. Do you think this is possible?

1:50:22

Yeah, so but but is it is not just so the US the stimulus the fit especially the fiscal stimulus in the US but also the monetary stimulus it's basically on President, right? So like, you know historic like injection of cash and and like an other type of help coming from the federal government, but you know, you also have big disco Simmons programs.

1:50:51

Japan from China from you know multitude of European countries. So a lot of countries and you know, of course even like countries with a lot of problem with that they're basically saying that while you cannot go cheap on this one we have to basically, you know, put the big garment in there to address this.

1:51:12

So I think that's basically the thing that is needed right now and even like more fiscal stimulus than what We have right now. So this needs to continue for a little bit and you know in reference to also the Great Recession that as you know, like especially for some states like us the recovery period was like, you know, really long, right? So things didn't really go back to normal economically in Nevada for a long time.

1:51:39

So one reason people say is you know, because there was like a fiscal stimulus that was not very large nothing compared to what we have right now when they ship the supports Of the was scaled back to early. Well, you know, this is a point where we need to just like keep it up and and and we basically expect the same thing from rest of the world.

1:52:07

And dr. Shapiro and what are the key unique features of the concept of netizens which culture language and social norms are currently dominating.

1:52:19

You know, that's a great question and you make me I think we should teach a class together on that that topics very topic the phenomena of the netizens. I can't be underestimated. How significant it is for China's ongoing Transformations. I'll just give one example five years ago is in China during the one of the annual party congresses and new laws come down and they lock him down saying that people shouldn't run yellow lights.

1:52:50

And people in China or obey the law. So people started stopping yellow lights know if you of course are you stopped at a yellow light in Nevada? You would be rear-ended the same thing was happening in many cities. Same thing was happening in Chinese cities. And so people went online by the hundred million and said this law is endangering us. We are law-abiding people were obeying the law but it's putting us in Danger get rid of this LA and within one month. This was really shocking. I wouldn't if I had heard this say at a conference or read a paper on this I wouldn't have believed it, but I was there.

1:53:19

Are I witnessed it within a month the central government reversed its law which I think for the history of the 20th century. I don't I haven't seen that happen, but it's specifically because of the critical mass of opinions that can be expressed on the Internet by netizens. So this is just one of a million examples the the role of medicines in shaping public policy and foreign policy and domestic economic spending its profound.

1:53:47

So I would keep your eye on the Wasn't thank you for that. Great question.

1:53:54

Going to try to wrap up with a few more questions. What about the uncertainty factors in testing for both the virus and antibodies they stated apparently some of the most prominent buyers testing the u.s. 25 percent rate of false negatives.

1:54:09

What about the fact that they only had partial or no symptoms for the first five to eight days of the disease so much of the disease transmission takes place in visibly not only to the general population, but also, To the public health system. So how do we communicate this uncertainty to the general population which expects certainty from the experts? You know, what this is a fundamental issue in medical communication because in medicine we know nothing is absolute.

1:54:42

You can't say always and never you know, and so we learn how to deal with ambiguity and be reasonable about you know processions, so I this is fundamental to the whole issue of science being that because science is about ambiguity and dealing with so I think what we need to sort of we have to put things into context. So first of all, testing our PCR tests are pretty accurate probably 90 to 92 percent. So that's not too many, you know, false positives or false negatives.

1:55:19

That's a pretty good the Abbot test that they Talked about they have an ID, which is the rapid test in one in a one small series turned out to be almost 50% inactive inaccurate and another series maybe not so that that was one of the the test that was fast-tracked through the FDA through their emergency utilization process. So I think what so what we tried to do is get everything out of stress we could as we did that empirically we did again to find out that it wasn't as good as it should have been because it did not go through the rigor.

1:55:52

Of the studies that would have normally been, you know needed to approve those tests. So we're sort of having to deal with okay, the FDA has a process for a purpose which is the writing to make sure that they only like license the best the best test and we sort of limited because this is an emergency. So now we have to go back track, you know, try to redo these and I think that's really hard when you have to do that publicly. Like why did you approve in the first place?

1:56:18

Well, it was an emergency rule, you know, so the point is it's not Safe to the person accepted May diagnose them incorrectly. But now we have to really go back say okay, which tests are the best tests the antibody tests. The one we're using in Nevada now is very accurate and so we're pretty comfortable with that but not all Labs have the accuracy of our of our state public health lab and they're doing it only for population studies, which is the recommendation. We're not using an antibody test for any other reason than to say this person has been exposed or infected.

1:56:52

And that's all we know about them. We don't know what else that that says, but at least it allows us to my population to understand who's been infected who's not particularly for those who are not symptomatic and that's why when you have uncertain about the symptoms you have asymptomatic. So like this the only way to do this is is being like every day. I am going to wear my mask and every day I am going to socially distance because I don't know if I'm infectious. I don't know if they're infections.

1:57:22

I So that's the only way we can do this to really make it work and I want people to who are who are really worried about the economy.

1:57:31

Like we all are to say if I want our economy to get going I have to do this and I have to be aware that it is what is necessary to break that Interruption of transmission so that so that we can really keep our Healthcare System able to keep up we're going to be slowly but surely Lee getting more and more people immune as this happens at least for those who already had it for this first go-around, but we're going to have this it's not going to leave us this virus is going to be circulating for the foreseeable future. So I just it really is a totally different totally different mindset that I always remind myself.

1:58:11

I don't have all the answers because this is the first time I've ever lived through a pandemic and so, you know, you everybody has to give themselves a break because this is our best guess we're going to try to do what we know we know and how This this works these contact contact tracing isolation masks. We know it works. So it's the best we can do for now until we have maybe more elegant and less invasive means but it's hard. I think that is the only absolute we actually know right now.

1:58:40

Absolutely, and I'm just going to leave it with this last question for all the panelists. We are still have 90 people on the line and we're still getting questions and probably have about 50 more question. So I'm going to be happy to send them out to you via email some of them and poker them out to you and hopefully we can post them to the website but it seems like this event very well attended and a Hot Topic. So just in closing out, what do you see as the most impactful thing that we can do?

1:59:10

Internationally as well as within our state.

1:59:13

And so we can talk start with dr. Tolson. Okay. Yeah. Thanks. That's a good question and I will actually started one of the things that I mentioned at the my last slide about the future challenges and I mentioned that the the cover of The Economist magazine, right? So, you know, like I think the one really terrible thing will be that the nation's the country start.

1:59:43

Using their economies their borders and economies to each other. So kind of like, you know closing up, you know, we lived through those times in the in the past and like sometimes those things led to Wars and more suspicion between garments and and countries. So, you know, we need to make sure that especially internationally we need to be definitely to continue on International cooperation.

2:00:13

We should Not give up on that. So this these found Amex is like epidemics and pandemics, you know, they even likely happen in the future. So I actually I will argue just the opposite.

2:00:25

We probably need to have better cooperation and coordination between countries and governments and and also like, you know, for more locally, I will say that I really see major major weaknesses for state are especially for States like us and And it is the driven by some of the you know, the rules and regulations out there and the type of federalism that we have in the u.s. I think and you know, the federal government also needs to work better with state governments and and also the local governments. So in a way the Federal Reserve Bank had to basically step up and they used to be the the lender of Last Resort to just private Banks.

2:01:12

But now their lender of Last Resort to everybody including, you know state government, so it is really interesting times.

2:01:20

Thank you. Thank you. Thank you screw over to you.

2:01:24

I Just I just want to say I agree with my colleagues great comments. I just want to edit. We really are in this together and I would say resist blame resist the impulse to search for a source look for Solutions and actively with dr. Larson said respect. I think we respect our neighbors, but also our neighbors and the International Community, so that's that's my comment night. Thank you.

2:01:51

Trach dr. Larson. So I was going to just mention that virus is really don't care where you're from what your politics are beta it doesn't care. It doesn't matter. And so I think we need to remember that because I was going to say the same thing about blame because we cannot blame. This is a virus that there's no bleeding in viruses.

2:02:11

They just do what they do and they do it naturally and it doesn't matter where the virus mutates and becomes able to infect humans and can From all over the world. And so we just need to be humble about this and recognize that there is no one to blame and we have to be very respectful of the who their International surveillance. This is early warning. We that is absolutely critical that we maintain support of the who because they have Labs all over the world that are able to you know, Mom.

2:02:51

Sure, and they share their knowledge and it's really about human health. Not any nationality. It's really about human health. And I think that's going to be fundamental as we go forward. I believe that the search for a vaccine will be very International. I think it requires all these brilliant scientists sharing their information and really honing. You know, what it is is what's the key protein here that we can develop an effective.

2:03:21

Response to that's going to provide protection that hats that us that's going to be in the next year.

2:03:28

So thank you for your time. I want to turn it over to our director of the Osmonds due to Global Studies that close us out. I think we had a really good conversation. Thank you all for taking the time to talk to all of us. I will be sending additional questions. You can answer some of those and hopefully it won't be too overwhelming for you. I think these conversations are important with over 400 registrants and upwards of almost 300 people on the call and a hundred still hanging on I think.

2:03:56

This is the first of many conversations that we need to continue to have so Birch.

2:04:05

Yeah.

2:04:09

This you guys have been doing this on a weekly basis and The Institute is very grateful for taking part in it, and I hope in the future. We will do more of this in collaboration with your Center and our Institute. Thanks again for a great webinar. Absolutely. Thank you for everyone that joined as a reminder.

2:04:32

We have these weekly every Friday 10:00 to 11:00 Pacific Standard time, and we look forward to posting the L and posting some of the answers to your questions, so thank you for joining today and thank you to all of our panelists. Thank you. Thank you co can respond Gerald. Have a good weekend everyone.

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