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ALTIF transcripts: Covid’s long tail

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Covid’s long tail

Most people think it’s all over. But with new variants raging, are we too sanguine about dismissing the risks from Covid. Neil and Jonathan talk to Deborah Birx, who ran the Coronavirus Taskforce in Donald Trump’s White House, about dealing with “the Donald”, where we are with the virus, and how we can avoid contracting a nasty case of economic long Covid.

Presented by Jonathan Ford and Neil Collins.

With Deborah Birx.

Produced and edited by Nick Hilton for Podot.

Sponsored by Briefcase.News

Jonathan Ford 00:06
Hello and welcome to a long time in finance with Jonathan Ford and Neil Collins, in partnership with briefcase dot news, the service that brings intelligent curation and analysis to your media monitoring. Walk around London these days and you’d be hard pressed to see anyone wearing a mask. COVID restrictions are pretty much a memory, the only reminder being all those rows about illicit parties at number 10 Downing Street that recently helped to force Boris Johnson from office. But should we all be taking it quite so easy. COVID certainly hasn’t gone away. And as I speak a new variant Omicron ba.5 is rampaging around the globe. At present in the UK, Around 30,000 people a week, are contracting COVID. Although far fewer being hospitalised the general view may be that the virus is fading away like Spanish flu did in the 1920s. And that most of us are pretty much immune, at least to serious disease. But is that the correct assumption? And is it really the time to be chucking out all those old tests and bits of PPE? We’re joined today by Deborah Birx, an American Public Health Expert and former holder of one of the least enviable jobs in epidemiology, White House Coronavirus, Task Force coordinator under Donald Trump. And she’s just published a book, ‘silent invasion’ about her experiences. Welcome, Debbie.

Deborah Birx 01:31
Thank you, happy to be with you.

Jonathan Ford 01:33
We want to talk to you a bit about where we are with COVID, and its long-term economic effects. But we have to start by talking a bit about your time in the White House, and what it was like working for Donald Trump. I mean, he was famous for his frivolous bullish approach to the virus, including the famous suggestion that people should inject themselves with bleach. But was it easy to work with him? And do you think he got the message in the end?

Deborah Birx 01:56
Well, it was the reason I came back obviously, I had worked for decades overseas on major pandemics, HIV, TB, and malaria, zika, ebola, and we had actually battled those pandemics quite successfully by using data and using it in real-time. And I think what you missed in my introduction is my title-included response. And so it wasn’t just about looking at data, it was about responding to that data. And I think, January and February, the United States was way off track. Didn’t prepare, wasn’t proactive, believed the virus could be contained offshore. But I could see that that wasn’t going to happen. So I did come to the White House with a list of things that needed to be done immediately. And I have to say, throughout March and early April, I really felt like the White House and the Trump administration was finally taking the pandemic seriously. We did the 15 days to slow the spread, much like Europe. We did the 30 days to slow the spread, although we never locked it down like Europe did in any way, our mobility dropped to about 60%. But yours dropped by 80 or 90%. And so Americans never took it quite as seriously as our European colleagues. But then, additional, and as you can see from the election piece, people come to the President with ideas and he does latch on to some of those. And I think by early April, he was very much latching on to the Scott Atlas, and several of those cancer epidemiologists from Oxford, Harvard, UCLA, and Stanford who just believed that the virus would be minor and not…

Jonathan Ford 03:46
Is this herd immunity, we’re talking about

Deborah Birx 03:48
They wouldn’t call it that. But that was what their intent was.

Jonathan Ford 03:52
You describe in your book several meetings with Trump and basically looked to me from reading it, that it was pretty difficult to get through if he had an alternative idea. But do you think he was ultimately prepared to be led by the science?

Deborah Birx 04:06
Well, clearly not in the end? Clearly not. And I’m just really grateful that Vice President Pence and the task force and all the members of the task force were willing to be led by the science and data. So by the middle of April, we had the President saying one thing, and the task force doing the opposite.

Neil Collins 04:28
Was he similar in private to the public persona that you saw, and the extraordinary comment about injecting bleach and his sort of inability to string a sentence together, you must have spoken to him a lot when the cameras were not rolling. How different was he?

Deborah Birx 04:48
There was one Donald Trump and you have seen Him in His whole evidence.

Jonathan Ford 04:54
In all his glory. But let’s, let’s turn to where we are with COVID now Because many people do have this idea that it’s a bit like sort of Spanish flu after World War One, which had sort of three waves and then subsided. And we don’t really even know it existed now, there’s no real trace of it. But is that really the right way to look at COVID? Or should we be thinking of it in a different way?

Deborah Birx 05:17
So here’s my, my problem has been from the beginning, comparing this to flu, because it gives people a sense that we understand this virus. And of course, we had experienced flu through the centuries. And so Spanish flu was particularly deadly and deadly to young people that had never seen that flu before. But older people had some pre existing immunity to that particular strain. And so it killed primarily young people. And then once the young people developed good immunity, that prevented them from having reinfection, then it did drift away, and we got a new variant. The trouble with this particular virus is it is made to continuously escape both immune pressure either from prior infection or vaccination, or eventually, it will be focused on also evading our antivirals. And Spanish flu didn’t have these long term consequences. And I think, what always worried me about the people who said just let everyone get infected, they’re not going to get seriously ill. It was clear to me from the beginning that we didn’t know all the complications from this virus. And when you lose taste and smell, that’s unusual. And that’s a neurologic event. So it implied that the virus was doing more than an ordinary Coronavirus or an ordinary flu. And I think we have to separate both the acute infection from the chronic infection and the chronic outcomes that many people are experiencing.

Jonathan Ford 06:58
And what sort of immunity do we get from the current generation of viruses, or vaccines? Is it something that could at some point confer the sort of lifetime immunity that you get from say, polio vaccines? and the like? Or are we, are we always going to be in a cat and mouse game with this thing?

Deborah Birx 07:17
So there’s no evidence, and we’re in our seventh surge right now in the United States, our swell of the spring is now moving into what I was very concerned about three months ago, has moved into a full surge across our southern states, our rate of new hospitalizations in those over 70 is now 80% of what it was last summer during the Delta surge for new admissions. And so what I see in the evidence is if you look at someplace like South Africa, or the UK that has done quite a good job in sequencing the viruses and testing, it was evident that reinfection was going to occur every four to six months based on the South African data and the development of variants. And that’s what this RNA virus is doing. So I would say right now, if in the game of COVID, pandemic, I give the virus seven, and us three, so we’re still losing, because we’re not…. and that’s why I wanted to talk about the response in my title, we’re still not responding proactively to this virus in what we have learned over the last two and a half years.

Neil Collins 08:33
And what should we be doing that we’re not doing?

Deborah Birx 08:37
Well, I think the UK actually did respond proactively through 2021. So although you reduced restrictions, you were rapidly expanding testing. And so although we were testing at the same population rate, all through 2020, you continue to expand testing and making it available for free. And through the delta wave and the Omicron wave, the summer of 2021, and the winter of 2021, you had 60% less fatalities than we did. And I think you were able to communicate effectively to the population. And that’s how you control pandemics, effective communication to the population so that they know what their risks are. They know what the risks to their family members are. And they take those precautions and their internal mitigation to actually stop the spread of the virus to those who will have the most rocky outcome.

Jonathan Ford 09:34
Okay, but central to what you’re saying is we need to test?

Deborah Birx 09:39
You need to make testing available so that before people see their 65 year old with metastatic cancer or they see their person post cardiovascular surgery, or they see their elderly 80 and 85 and 90 year old grandparents and parents, to know that they’re not carrying the virus to them.

Jonathan Ford 09:59
But in Britain As far as testing is concerned, although you’re absolutely right, we continued with our test and trace and free testing equipment all of last year, since the beginning of April, Britain has stopped handing out tests lateral flow tests to people for free. Is that a mistake, do you think?

Deborah Birx 10:16
You have to make testing available to everyone, there will be some people who can’t afford tests. And you probably know who those are in Britain, we should actually be shipping tests to those households, so that they have them. And if you don’t want to make them free for everyone, they should be made free for those who need them the most. And we know who those are, those are individuals over 65. I’m sure in Britain, you know, everybody over 65 have significant health risks.

Jonathan Ford 10:47
I’m looking at one now.

Neil Collins 10:49
I’ve no comment to make on this.

Deborah Birx 10:51
Ship tests to their household with information that says, you know, before you see your grandchildren, they should test or if there’s a surge in your area, and these surges are very confined. So I mean, we’re talking about eight weeks of people testing, and then there’s a lull and during the lull, we should be looking at all the data to see who was hospitalised and who died in that last surge, and then put into play and practice the response that will prevent that with the next (inaudible). That’s how you end pandemics you treat every hospitalisation and death as a failure of your programming. And then you fix that programming during the lulls.

Neil Collins 11:35
My sort of central question which I’d like your views on is on lockdown. I remember vividly the row that followed Sweden’s decision not to lock down, listening to the experts, they’re saying, in the end, it probably wouldn’t make a great deal of difference in terms of the spread of the disease. And I wonder what your views were on what we could describe in shorthand as the Swedish model here.

Deborah Birx 12:04
So the Swedish model is very interesting, because if you look at their mobility, those at greatest risk markedly decrease their social mobility, they effectively communicated, who is at greatest risk, and those individuals and the people around those individuals protected them. So I think it’s a misnomer to say that Sweden did nothing. But on the general piece of lockdowns. The only time you do that is if you’ve gotten yourself into a crisis, and obviously, all high income countries just about got themselves into a crisis and got themselves behind. None of us took those early January and February signals seriously enough to be proactive enough to prevent that deadly original surge. And when you have no tools, and it’s an unknown virus, you have that kind of drastic response, because you have to protect the hospitals so that you can save as many lives. No time after that April, did the United States really go to that kind of federal-wide lockdown. And indeed, as we got more and more tools, and understood how to confront the virus, and we finally got testing up and running, and enough PPE to protect our health care workers, and early, early treatment with remdesivir, then you can back off your mitigation and move to much more of a personal mitigation approach, which is really what the United States has done since April of 2020. But that requires consistent clear communication of what you need to do at the population level. And that’s what still often missing in the United States, we over-committed on vaccines, implying that they were more than what they are. They’re great! But they don’t prevent infection. And so people who got vaccinated, they basically early on told them they could do whatever they wanted. And that was not true.

Neil Collins 14:09
Do you think that we in this country have grasped this if they can you think they haven’t in America?

Deborah Birx 14:15
Well, I think if you look at your delta and omicron deaths, of which you really were quite open, compared to where you were in 2020, you had 60% fewer fatalities corrected for population in the UK than the US. And that tells me that you more effectively communicated to your population about what they needed to do to protect their vulnerable family members.

Jonathan Ford 14:41
Can we flip back to the present for a second and think about the economics really of COVID as it goes forward? Because I mean, a lot of people will say, we got through lockdown, we got through all the nightmare stuff in 2020. As long as we don’t have to lock down again or do anything terrible, this is a sort of something we can live with it, it will not be good for some people who are vulnerable and older, but they’re probably not as economically productive. So, therefore, economically it won’t have much impact. But do you think? Do you think that’s… I know that sounds rather Darwinian.

Neil Collins 15:20
It’s bad news for us geriatrics, that’s for sure

Jonathan Ford 15:22
I always try to sugar the pill for Neil but I forgot just now. But what do you think the economic impact of the sort of COVID we now have, this sort of long tail if you like what you’ve described as the sort of AIDS impact of COVID. It’s something that is there.

Deborah Birx 15:37
So there’s two pieces; one, long COVID can be devastating to the economy, if we have 50 million or 80 million people with long COVID. Secondly, as opposed to maybe the UK, our individuals over 50 and 60, who may be particularly vulnerable, still, to severe disease, actually provide a lot of the childcare across this country – we have very poor access to childcare. It’s very unaffordable. And I will tell you in most neighbourhoods, and certainly even in our household, we’re supporting the ability of 30 and 40 somethings to be able to work. And so it’s much more complicated than who is actually getting sick from COVID. Because it’s the long COVID issues, the late onset cardiovascular and diabetic and brain findings. And then there’s the fact that in the United States, a lot of 60s and 70-year-olds are providing child care support, so the rest of Americans can go to work. And so it’s not so clear cut in the US now, that all said, we have all the tools that we need to protect everybody. But the thing is, we’re not implementing them in a way that can ensure that everyone’s protected.

Neil Collins 16:58
So in terms of the policy responses, just making sure people get yet another job is not sufficient, you’re saying there’s something rather more disturbing and long-term there that we don’t understand, and that we’re not really paying attention.

Deborah Birx 17:18
Correct. And let’s be very clear; the current vaccines do not have long-term protection in the majority of the individuals against infection. And that means that you’re still susceptible, potentially, to long COVID. And you’re still potentially susceptible to these cardiovascular and diabetic and brain findings that we don’t understand. What I’m advocating for is just clarity and communication to the public. Make sure that they understand what all their risks are, because people are smart and will do the right thing.

Neil Collins 17:56
I watched your presentation to the committee, despite the glacial pace of it, I found quite a lot, quite a lot got out. Do you think that that sort of hearing is helpful? Does it make any difference?

Deborah Birx 18:15
Only if it changes our actions, and right now, we are still not effective in responding to COVID in rural America, and people are dying at higher rates in rural America. And that is a reflection of their long-term lack of access to health care in general, instead of the United States, we like to say it’s because of how they voted. This is not because of how they voted, it’s because of the structural issues related to access.

Neil Collins 18:45
That’s very interesting idea, that your chance of getting COVID depended on how you voted, which is quite an interesting concept, I must say. I mean, is this just a question that the government are not prepared to spend the money, because it seems to me that you can make a very powerful case for saying, as you might put it, prevention is better than cure.

Deborah Birx 19:08
You know, it is not about more money. It’s how that money is spent. You know, there are things that are good. And then there are things that are great. And we should invest in those things that are great and needed community by community. I remember with HIV in the US, we sent money equally by population across the United States, yet there were areas that really never had a risk for HIV. And so finally, it took us 20 years to invest where it was a problem, the right amount of funds. And so I’m telling you, we know where the problem really is right now, and how we need to invest in our rural areas to really ensure that they can do better with vaccination, but critically, access to treatment and access to testing.

Jonathan Ford 19:56
Okay, so to summarise, we basically should be testing or be making tests available, educating people in what they should do to avoid getting the disease and targeting assistance at where it’s most likely or most likely to be prevalent.

Deborah Birx 20:09
And treating every hospitalisation and death as a failure of programme.

Jonathan Ford 20:13
No, I agree with that. I just wanted to come to something which I noticed you quoted in the Daily Mail newspaper here in Britain, about the origins of COVID. And this sort of argument that it has come out of a laboratory in Wuhan, which was initially poo-pooed, I think, by the scientific community, a lot of it, but it’s now taken rather more seriously, do you think this was a lab experiment that went wrong and the Chinese covered it up?

Deborah Birx 20:40
You know, what I said was, I don’t know. But what I do know is these things could have happened. They’ve happened with other viral diseases. You can imagine unintentionally, someone who was working with Coronavirus in the laboratory. And now we know that young people can have asymptomatic infection, could have become infected unknowingly, and could have taken the virus out of the lab unknowingly. Either it was coming out of an animal model early on and much earlier than we projected, which allowed it to adapt to humans over October and November and then explode into this pandemic, and Wuhan in December and January, or it could have come from a laboratory or multiple sources. Let’s just all as high income countries decide that it could have happened, and put into the policies and practices to do everything to prevent it from happening in the future. You know, we had to learn this with HIV. We did have people who got infected in the laboratory, and that was a tragedy. But we put systems and we put responses in place to keep that from happening in the future. Let’s plan that either could happen and could have happened and let’s put in precautions now to make sure that doesn’t happen in the future.

Neil Collins 22:03
Be careful, you may get the job of doing it if you’re not careful.

Jonathan Ford 22:09
In the next Trump presidency.

Neil Collins 22:16
That was a long time in finance with Jonathan Ford and Neil Collins, editing and production by Nick Hilton. And our sponsorship partner is briefcase dot news. Join us again next week.

Jonathan Ford 22:42
Sorry about this, Deborah. Neil’s phone’s just gone off,

Neil Collins 22:45
It rings at least twice a day.

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