Bill Gates did a one hour TED talk, focused on COVID-19, on Wednesday, March 25, 2020.
Then on Thursday, he did a Q&A with Anderson Cooper.
Then, on Friday, Joe Biden did a virtual townhall on CNN, and he endorsed everything that Gates had said
Here are the key thoughts from the TED talk, reinforced by Gates the next day’s Q&A.:
- A factor with respiratory viruses is that you are walking around with it for days before you feel debilitated. For example, with Ebola, you are flat on your back when you become contagious. Major reason for why its contagion spreads so quickly.
- China shut down everything in Wuhan on January 23rd. This dramatically reduced infection rates. South Korea did not totally shut things down, but they did universal testing (random sampling included) which enabled them to have the data, to identify what was happening, to isolate where they had hot spots, and bring things under control.
- China is actually getting back to work, after about ten weeks.
- Gates says if you can cut down the number of people getting infected, for example, from 1% to .4%, infections will rapidly shrink. This is what isolation in China did.
- US lost a month, between late January and late February. The history books will need to tell us why. But it seems to have taken the Federal Government a very long time to get organized. Consequently, some of the options that might have been available to the US are not available. Unlike South Korea, the US is already past the point where it can control the virus without a comprehensive shutdown. “ US did not act fast enough.”
- Gates predicted all of this in a 2015 TED talk where he essentially said either spend billions now to prepare or you will spend $4-$5 trillion knocking it down. Amazingly prescient. Relative to therapeutics and vaccines, apparently there is a lot you can do to develop features that are common to all of the coronaviruses such that when the virus hits you need only develop the components that are unique to that particular strain of virus. But these underlying components were never developed. Money dried up. Gates believes that because of this disaster it is likely that all of this will be developed and we will be much more prepared for the next one, be it three years from now or much further into the future.
- Isolation, Testing and Contact Tracing. You isolate to stop the spread. You test in order to collect data that helps you understand what is happening. Based on that data, you contact infected people and get them into isolation. The data shows: infections going up, stable, down; infections present here, but not there; given the data, you can start to go back to work here, under these conditions, but not there. In short, these three are inextricably connected. One without the other is not sufficient. The US would get a very bad score on this right now. US has still not created the testing capacity. US is still not testing the right people. Gates says: you test health care workers first, people highly symptomatic next. And way down the list, you test people because they want to be tested. No such controls exist in US right now. “Not organized or prioritized.”
- Yes, isolation is a disaster for the economy. But, argues Gates, the sooner you fully isolate, the sooner you can bring your economy back. He believes the entire US should be on lockdown and that the approach currently being taken – States determine their model, perhaps even counties inside states have different models – WILL NOT WORK! Gates puts the isolation period at 6-10 weeks.
- Gates says that testing should be able to ramp up into the millions for two reasons. First, just last week, The Gates Foundation got the FDA to approve the more simple swabbing technique, that the patient can do, at a medical facility, by only investigating the front of the nose. (They have already pledged $100 million to this current battle.) This takes minutes. It is proven to be as equally effective as the other technique. The second part of the test is the processing in what is called at PCR machine. PCR machines have been around for a long time and Gates says they are plentiful. My take: even as incompetent as US Federal Government has been led, there should be increasing amounts of test data becoming available.
- He was asked about herd immunity. He said that about 50% of the population has to be exposed to the virus for this to be meaningful. In that case, he says 3-4% would get infected, and a great number of people would die. In the US., it would be in the millions. Gates is not a fan of herd immunity.
- He said, even if a Government decided to reopen its economy and send people back to work, people will not do so if they think it will lead to their infecting their families or themselves. To put people back to work requires a strategy that can be sold to the public as having acceptable risk levels.
- Gates believes the data show that in China and South Korea the problem was not caused by people who are asymptomatic. This is important because when people go back to work there may be lots of folks who are asymptomatic in the workforce.
- Gates said that respiratory viruses are generally seasonal. Testing will actually tell you if this is occurring. This is good for the Northern Hemisphere as it warms up; but bad for the south, such as South America, as it cools down.
- When asked, hey, if you were President, what are the top two or three things you would do?
- Must maintain isolation for probably another six weeks, everywhere.
- Must be talking about testing all of the time, and reporting on it every week.
- Within twenty days you’ll see dramatic results.
- Science is on our side.
- The economic impacts will be dramatically bad. But, economies can recover. Human life cannot.
- We’re likely to be out of this in 6-10 weeks – but not for sure.
- He believes that the rich countries of the world will be where China is by summer. But, he believes this will be much worse for less developed countries. One reason: impossible to do social isolation because of poverty and high density living, for example, in slums. The hope for developing countries is in accelerating the development of a vaccine. There is a huge amount going on in this area but Gates is not forecasting a time period for general availability any faster than Dr. Fauci, meaning a year at best, and probably a year and a half.
- Vaccines and therapeutics? Apparently, they are different. A therapeutic might be extracting COVID-19 anti-bodies from a previously ill person, creating some kind of a compound, and injecting them into a sick patient. Such a therapeutic might alleviate the need for ventilators, which are likely to be in permanent short supply. Gates says such therapeutics are complex and are difficult to scale. But, if available, a therapeutic drug is one means of treating people who already have the disease. He says there are probably 20 different candidates being tested. I got the sense that therapeutics might be available before vaccines, maybe way before. But, this was only my sense of things. The goal of therapeutics is to reduce respiratory distress and thus alleviate the need for huge numbers of ventilators.
- Benton note: a word on ventilators and respirators. (Overly simplified, respirators are for health care works, including masks, but also a lot of other stuff. Ventilators are for patients.) One case: Medtronic PB 980. This is Medtronic’s biggest seller in this category. It can price out between $32,000 and $48,000. Medtronic has confirmed that they have licensed (my word) Tesla to start manufacturing this machine at a solar plant in upstate New York. Musk has confirmed. No calendar date when the first product might be available. (My pacemaker is made by Medtronic. They are first rate.) In addition, Ford Motor Company is working with both GE and 3M, GE on ventilators and 3m on all forms of respirators. General Motors is working with Vantec, more a manufacturer of component parts for thermal technologies, I think. These conversations seem to be real and promise to expand supply, starting in about 30 days, especially of the respirator family to protect health care workers. Ventilators are manufactured by maybe a dozen companies around the world, maybe more. I am sure that prices for some are much lower than Medtronic.
Bill Gates, Writing in the Washington Post, March 31, 2020 (edited)
The choices we and our leaders make now will have an enormous impact on how soon case numbers start to go down, how long the economy remains shut down and how many Americans will have to bury a loved one because of covid-19.
It’s become clear to me that we must take three steps.
First, we need a consistent nationwide approach to shutting down.
The country’s leaders need to be clear: Shutdown anywhere means shutdown everywhere. Until the case numbers start to go down across America — which could take 10 weeks or more — no one can continue business as usual or relax the shutdown. Any confusion about this point will only extend the economic pain, raise the odds that the virus will return, and cause more deaths.
Second, the federal government needs to step up on testing. Far more tests should be made available. We should also aggregate the results so we can quickly identify potential volunteers for clinical trials and know with confidence when it’s time to return to normal. There are good examples to follow: New York state recently expanded its capacity to up to more than 20,000 tests per day.
Even so, demand for tests will probably exceed the supply for some time, and right now, there’s little rhyme or reason to who gets the few that are available. As a result, we don’t have a good handle on how many cases there are or where the virus is likely headed next, and it will be hard to know if it rebounds later. And because of the backlog of samples, it can take seven days for results to arrive when we need them within 24 hours.
This is why the country needs clear priorities for who is tested. First on the list should be people in essential roles such as health-care workers and first responders, followed by highly symptomatic people who are most at risk of becoming seriously ill and those who are likely to have been exposed.
The same goes for masks and ventilators. Forcing 50 governors to compete for lifesaving equipment — and hospitals to pay exorbitant prices for it — only makes matters worse.
Finally, we need a data-based approach to developing treatments and a vaccine. Scientists are working full speed on both; in the meantime, leaders can help by not stoking rumors or panic buying. Long before the drug hydroxychloroquine was approved as an emergency treatment for covid-19, people started hoarding it, making it hard to find for lupus patients who need it to survive.
We should stick with the process that works: Run rapid trials involving various candidates and inform the public when the results are in. Once we have a safe and effective treatment, we’ll need to ensure that the first doses go to the people who need them most.
To bring the disease to an end, we’ll need a safe and effective vaccine. If we do everything right, we could have one in less than 18 months — about the fastest a vaccine has ever been developed. But creating a vaccine is only half the battle. To protect Americans and people around the world, we’ll need to manufacture billions of doses. (Without a vaccine, developing countries are at even greater risk than wealthy ones, because it’s even harder for them to do physical distancing and shutdowns.)
We can start now by building the facilities where these vaccines will be made. Because many of the top candidates are made using unique equipment, we’ll have to build facilities for each of them, knowing that some won’t get used. Private companies can’t take that kind of risk, but the federal government can. It’s a great sign that the administration made deals this week with at least two companies to prepare for vaccine manufacturing. I hope more deals will follow.
