COVID-19 Update From China
Hello, and welcome to this author interview. This is Howard Bachner editor-in-chief, of, JAMA as. Many of you know listen, to these podcasts before. I've been fortunate, to interview. Dr.. Tony Fauci director. Of. The National, Institute, of Allergy. And, Infectious Diseases. And today I'm, interviewing son, uwu who. Is the chief, epidemiologist. At the China Centers, for Disease Control, welcome, son you. Thank. You, thank. You so much for. Joining me I think our. Listeners are really quite anxious to hear from you. But before we start personally. On, behalf. Of JAMA the United States and I think most of the world I. Hope. You and your colleagues, in China are, are doing, well I know it's been an extraordinarily, difficult, time, the last. Few. Months and I'm quite sure you're working virtually, every day very long hour so I I wish you and your colleagues, the best, could. You tell our listeners on you. Were. You trained and what you currently do. Okay. My, name's in you from the China CDC, I was. Trained in the University. Of California. At Los Angeles with the PhD, degree in. 1995. After. Coming back to China, so. I primarily, work on, hiv/aids. Also. When the. Imaging. In fact stated it is coming I also join, the fight for this epidemic, for, example, in the 2003, so. I joined the. Entire. Epidemic. For SAS, all. This coronavirus. So I join in the, middle. Who, January. So, my, role it's try, to collecting. Data. The. Individual, cases and. Try. To use. Epidemiology. And an Isis, look a to the, pattern, and the, trend of the academic, try, to interpret. The. Result, and, it's evil, guidance what's the most important. To. Address. The, you well. I think the United States and, other countries have, a great deal to learn from what's been going on in China so I'll I'll ask a, number of questions but, before we get to. The questions, on you can. You tell me as, of today. Which, is. February. 13th. And for, me it's 8:30 in the morning for, you it's it's. 10:30, or 11 p.m. at night February, 13. What, are the number of cases that are currently, now. Been reported, in China and the number of deaths the number of cases outside of China is actually quite small but what are the number of cases in China. We. Collect, data every day by, the me, tonight, so we download, the data from our national. Reporting, system, we do an, Isis, Anniston leaders report to, the National, Health, Commission. So now I have, they're available at. My hand upon has ever, returned. 220. So. That. There. Was the two desert two days ago there. By, the. Kirby, returns we. Have totally, reported. 42,000. 38. Confirmed, cases. Reported. 1066. Teen dad, and. Also. We, have 20. 1675. Suspected. Cases. As. You, know because. I know you participated. In a number of discussions. Some. Some. Interesting discussion. Has occurred about the definition. That. The. CDC. In China is using so. You just indicated there's, about. 43,000. Cases, but. Then you also just, indicated, that there's approximately. 21,000. Other. Designations. What what is the 21,000. Suspected. Cases so, that amazed, there. Has not been diagnosed. As a conformity, test yet and are. Those individuals, who, have symptoms and don't have symptoms and have had diagnostic. Testing, or those individuals, who have had diagnostic. Testing, but have not developed, any symptoms, which or is it both. Most. Of, this is suspected, cases if, you have the, clinical, symptoms, but, I do not have the. Laboratory. Tested. Yet because, the capacity. To provide. Timely. Laboratory. Test it. Insufficient. Particularly, in, Hubei, Wuhan, so. We, try to support. Capacity. In. Hebei. Province so. Central. Common defender many health workers, including level, technician. To Hebei and Wuhan, try. To address, that issue so, there so. I do appreciate it just the capacity, to do massive. Or a large number of diagnostic, testing, is just limited as it would be in any country. Right. Right. Can. Can. You say a bit about I, mean.
You're A trained, epidemiologist. You've done remarkable. Work can. You can. You tell me what your sense is of, the epidemic, in China over the last week, or two weeks do you have a sense of what you think is occurring. So. If we look at the epidemic, we have two, important. Indicators. So, for each individual. Cases they, do have. Two. Dates one. Its onset. Of symptoms, one. It's the data of reporting. So. The public, the, only knows how, many people, being, reported, and also. The government, announced. It's the number of people being reported, so. What do we do so. For each individual. We, have the epidemiological. Investigation. Try to understand. What. Onset. Of the illness, so, we use that data to. Reconstruct. The. Epidemic, occur, that's. On that the. The epidemic, curve picker, in, January. 23rd. To, 26. But for most, people. In the general public, you cannot see that only. We. Ananassa. Data can, present. That that way, no. Epidemic. Now it's actually, green down so. That is because, we have a very. Strict. Control. Measure so. It's also how, no. Go ahead you finish your sentence I apologize, once your finisher whatever because that we also have that non green. Festival. People stay at home that. Isolated. Or, reduce, the people movement. After. That, a long. Holiday people, come into work so the, future, direction, of epidemic. Still, uncertain. Yet so we prepare. Possible. Upcoming. Epidemic. But. It sounds like your, sense from looking at data on a daily basis. And the. Investigations. That you've been able to do is. That actually. The. Epidemic. Is improving. Not getting worse is that is that I want to make sure I understand, what you just said. That's. Correct that's, correct so, you have a too broad a. Carton. Of epidemic, one it's in Hebei, and Wuhan City that. Epidemic. Is a different, from, the, rest of the. Country. Okay, yeah so, outside. The Hubei, is mainly. Originated. From Hebei then. We, do have, secondary. Transmission. Most. Are clustered. At a family. Does, another spreaded to the community, so. The epidemic, green Dumbo's, that's. The on the onset, of illness, and also based, on the reporting, of days. However. In. Hubei, and the Wuhan the. Epidemic. Is still, very, complicated. Yet because the number of people infected, are. Huge. So. The. Medical. Treatment, and diagnosis, of the capacity. Cannot. Absolve, you, know, recent days you can see you know a large. Number of reported. Cases continue. To increase also, not, stable, so that makes the interpretation. Very. Difficult, for people outside. Do. You have a sense you, know if you just look at the numbers, you know it's 43,000. Or so and a thousand, deaths that gives you a case fatality rate, of two to three percent but. Some people have projected, that it's actually much lower because there's likely many other people who are infected, who. Haven't either come for medical attention or aren't. Yet defined as having been infected, do, you have a sense of what you think the case fatality rate, actually. Is. Right. Now the castle Canada uh, as. You, just said about two. Percent. If, the universe. Over. Estimated. Because we, do. Have a symptomatic, cases. Also if. We compare, the. Mortality, in. Cooper. Wuhan, and. Outside. Will be behind so, in, other, provinces, the, mortality, it's, about one percent. Right. And if I'm not mistaken in, Hubei. There's about thirty two thousand, cases and there's about ten thousand cases and the rest of China is that accurate I think those are the numbers I looked up this morning. You. Know cool day the kind of for about ninety, percent about, little cases in China it's 90% in okay okay so the so, about 10%, of the. 42,000. Cases or about 500, cases are outside, of Liu Bei so the majority as you said ninety percent, are in who may, there's. Been a seven, seventy. Seventy, percent so 70% of the 42,000 is about thirty thousand so there'd be about 10,000, cases outside. And, you said the case fatality rate outside, of that area is lower. Yeah. Now. There's been some discussion, about asymptomatic. Communication. Of the disease and defining. An asymptomatic, state, is quite complicated, part. Of it is in the case series of JAMA published. People, had unusual, symptoms diarrhea, for example, or GI, upset, which isn't usually associated, with respiratory, pathogens so. I think defining, an asymptomatic, state, is not easy is it what's. Your sense about asymptomatic. Communication. Of the disease or spread, of the disease do, you think it's real or it's still uncertain, I. Think. Understanding. About the, spectrum through. Coronavirus. To, still. Continue. To increase. So, in the earliest stage we. Do. Not have believed that we. Were asymptomatic, cases, however, with. More people being tested, we do observe, such. A number of people.
The. Tested. PCR. Positive by, the way you know. Any. Symptoms, so the most common symptoms, we. Observe, it's, a favor. Cry. Cough and the fatigue also, some have diarrhea, so. For the asymptomatic, cases, they. Have no dis symptoms, at all, however. We do not know which is really the. Virus. Career, or, is in the early stage they, may, with. The time moving. They will develop, informatica. Cases, or, diagnose. Of the cases so it so, we still needed to observe, a, symptomatic. A cases for a certain period period. Over time, now. Studies, ongoing yeah. Now the, other issue. That's come up and we're about to publish or research letter in the next day or so today's, Thursday I think we're publishing it tomorrow about a case, series in infants. Children. Under. The age of 1 there had been initial reports that it seemed as though infants, and children were being spared, but I don't think that's the case do you, in. The data that you get can you look at the age spectrum of those people the, the 42, odd thousand, is, can. You can. You see disease. And infants, and young children. Yeah. We do we have. Very very small. In the early stage because the, exposure, is, in, the. Foot. Market, for the photo market many. Ad out there, so if we look at age distribution. Majority. Younger, a doubt so. Let. Me look at this figure. For. People. Ages searching. She, 79. That account, for 90%. 90%. Of total cases, there. Were the. Children a. Limited. Number because there you. Can suppose you the opportunity. To be suppose these are small so. There are many after. After. The, virus, spread, after. Outside. Of Hebei then, the more kids are the four children will, report. It now is, there anything emerging. Yet on treatment, most of the case series when we publish, that have been in other journals, have really been symptomatic for, those particularly, those older adults with comorbid. Conditions, who are quite ill it's, mostly been symptomatic you. Know people have tried some. Antiviral. Some antimicrobial. Agents. Corticosteroids. Have been reported, to be used. Some. HIV, drugs is anything emerging, around treatment, or is it too early or, it still. Too. Uncertain, to really be definitive, about treatment, other than than. Supportive. Care. Right. Now it's a more supportive. Of a care and, doctors. Try every. Effort include. For, example one. Of medicine treat HIV, called, a Creepo and they'll, be used in, the, pitting themselves feel. Good, so. One. Doctor. He, suffers. The corona virus, because he is doctor, and he, knows the. Critical. Can be effective, for the MERS then, he, took the medicine then, he. Shared. His experience. Right now in the China we, do have the clinical trial to. Test the one of a medicine you're. Not in the market yet he - uh whatever, the boy chiliad. Yes. Everywhere out. Of the man okay, it's. A little medicine has, not been marketed, yet but it's very effective. At best on the literal. And that's. Being tested in a in, a clinical, trial, yeah. Hi. Uh Julie. Ida. Provide. 800. Dosage. Dosage. For, the clinical trial attire are already, ongoing. For, about a week now, and is it for individuals, who are, quite. Ill in the intensive, care unit or is it general. Population, who's eligible to be in the trial. If. In the hospitalized, hospitalized. Patients. Right and that. Correct is there a control. Group or a placebo group. I'm. Not directly. Involved. My understanding, it's a, weakening. Of a trial so, it. Follows. The. Requirement. For the Clio I think it's they have controlled I'm not sure if they have that principle, but, it's, a do, you have a competitive, group now. Your. Clinical, epidemiologist. You have an enormous, amount of experience looking, at epidemics, now pandemics. What, have been the surprises. For you about this. It's. A very hard. To. Predict, to four days because, in, the early stage we, saw that it's a very severe, a new, epidemic and.
If, We look at severity. Then. The. Mortality is, not. As high, as far. You, know however. It's. A very contentious, so. From, a hoob a spread. Into the rest of China only takes about a. Few, weeks. So. The. Spreading of virus, well quickly. They'll. Have understanding, of the chronal virus still. Another. Who. Answer. The question, needed, to scientifica. Study to, answer. That you, know some people have suggested it's behaving more like certain, strains of flu that have occurred in the past rather, than. Coronavirus. With. SARS or Merv's it's been interesting there's been a bit of discussion about that I. Think. You could located, a transmission, pattern, it looks, like. Flu. However. The clinical. Symptoms. Are, different, some. Of cases, look like soon. To be recovered. However like, just one day or two days people. Died. Yeah. So it's to go. Ahead the. Pathetic, survivor, is still, a mystery. Now. Obviously. Though, there's a great deal of interest about. How. Coronavirus. Moved. Through. Different, populations, from animals, to human. Beings, is, there any additional information, that's emerge about. What. The origins, of this, particular, corona. Virus may have been. We. Do not have answers yet. Biologists. To try to find. The answer there, are is, clearly, the, epidemic, originates. The from the one, of a seafood. Wholesale. Market, there. Are some what, animal, so, data data market we do not know exactly. Which. Animal, or which originally to come from. Now. Obviously the, vast. Majority of cases have, been in in, China. Far. Less around. The world and, that. That's, despite, a, remarkable. Amount of travel, between, China, and the rest of the world when. It is likely that that, people were infected so I I've. Been impressed, with what the public health communities, and, infectious. Disease individuals, have done in countries, around the world including, the United States because it really, has. Not spread substantially.
Out Outside, the US except, obviously for, that ship. In Japan. What. What do you think you would want to say to, your. Other. Epidemiologists. And clinicians, around the world about how they should think about, the. Infection what. Advice would you give us I. Think. If. We look at a posture, for few weeks, Chinese. Government takes from the action particularly. Living. The people move. In out of hoo-ha, latitude. Slow down and reduce, the epidemic, and, reduce. The transmission when, the Hebei to the rest of the country, and also. Reduce. The spreading, from. China. To. The rest of the world however. It's still some, cases, reported. From the liberal countries, so the epidemic, it's, without, a border, so, early, detection is. Very important. The surveillance, program. A very, sensitive, surveillance to. Detect, the. Initial. Cases and, also, immediately. Have the, isolation. Control measures it's very important, that she. Reduce. The scare after, epidemic. Well. I know, obviously. Great. Deal of information crosses. My desk as, as as well as I read extensively about, this every morning and throughout the day and I think you're well aware there's been concerns. Raised about whether, quarantines, are effective, or not effective and, I'll let other people, weigh. In on that ultimately, with, respect, to. This epidemic, and pandemic but. It's. It's certainly an interesting question, and I know, your. Your government has been really quite aggressive, about trying to really. Constrain. The. The virus to a limited, number of areas. Can, you tell, me what it's like I mean the numbers that we here in the United States and around the world are, markable, that. China. Has, constrained. The, travel, of over 50 million people that is a remarkable. Number how, has China been able to do that I. Think. Because. Of epidemic. Said alert, to the public, and also we. Do have lessons. And then in, the 2003. For. A massage out of the break and. We. Understand. Isolation. Quarantine, it's the most effective. Letters. To control, this epidemic if. We look a to the. Academic. Outside, of obey so. As not, as the Tecla the measurement. And the, the, epidemic, is mainly. Contained. A, family. Or, custard. In the family so. We look at all the cases outside, of, de, provinces, so. Colossal. Cases. Family, cost cases, account. Of whole eighty-three, percent, that. Means people. Because. Who, spring festival they, go. We. Tend to home from obey the. Providers. To home is only transmitted. Reason home not, beyond. Of the home not, due, to the community, so. That means. Identify. Close, contact, and, the quarantine or isolates, them it's, a good strategy to, prevent. The epidemic, from the family, cluster.
To, The community. To, two questions have come in over social media and. I'll. Read them to you or, paraphrase. And first. Yet you, mentioned, the the clinical. Trial that's ongoing. Have, you had much contact with the different groups that have been trying to develop a vaccine and, do you have any information, about vaccine, development, ders you. Know dr. fowey had mentioned that he he thought in the best best, of all worlds we could get a vaccine, into, phase one trials, in three to six months other people have closer to a year do you have a sense about vaccines. I. Do. Not know exactly how, nice pick to my knowledge a feel, group, of scientists. Are doing. Vaccine. Research. So. Optimistically. You. May take, about. At. Least a few. More months. So China. In I, think in the 2009. When. The flu, coming. It only took took. About six months to have, the vaccine ready for, vaccination. So. Optimistically. It may take about, at. Least half. A year to get a vaccine ready right, well I'm I'm, guardedly, optimistic that. The. Epidemic and pandemic will, be, really. Much. Quieter, in the next few months and that ultimately we may decide we don't need the vaccine. Diagnosis. And immunocompromised individuals. Is, difficult, because they may, not respond, to the PCR, do you have a sense of, diagnosis. And individuals, who are immunocompromised, I, assume it would start with you know what symptoms they have and, and do they have a good. Story for exposure, to someone who was diagnosed, but do you have, any advice about diagnosis. And individuals, who are immunocompromised. We. Do not have, understanding. About this issue yet, so. Because. Epidemic, justice, got a few weeks so the, studies too uncommon with another fully understand. So, immunologist. And biologists. They may have. A study in, this area. Another. Question that's come up in, social media I'll. Read, it to you and it it's. Again, about the the, numbers that we talked about earlier. That. You had mentioned about forty. Forty two thousand cases seventy. Percent or in who Bay and. Then another twenty, one thousand where there's uncertainty, but. The the comment. Was an almost fifty percent increase, in cases as, of. Yesterday or today and who Bay province, reports, fourteen, thousand, eight hundred and forty new cases, is this simply catching up and they put that in quotes as is catching, up as more, testing, is done can you comment, on that that. Is, that member also.
Try. To me as well because there. Are, previously. You have accumulated, cases. Waiting for. Diagnosis. And. Because. The. Capacity. To provide. Timely, laboratory. Confirmed, cases, it's, very, difficult, then. The clinician. Suggested. Because in, Hebei. Because, they use, the clinical. Diagnosis. The cases, okay. And, do, you have enough do, you have enough diagnostic. Tests, now the. CDC just sent quite quite a few out and unfortunately. There was a report. That came across my desk very quickly that they had to recall some for different reasons but. Does. China have enough diagnostic, tests at this point are you still behind and having sufficient, amounts. Of tests to make diagnosis. Now. We do have sufficient. Establish, that, was take a test, however. That. Did, require certain. Laboratory capacity and, also need. And. Technician. To perform, the, tests and. I. Think, the world, watched. With amazement as, China. Constructed. Two hospitals, in the period of two weeks I think most. Of the world just watched with amazement it, was remarkable. Are, is. It your sense now that there's sufficient clinical. Facilities. To care for individuals who, need to be hospitalized. Or are seriously. Ill or, as China's still struggling with this. New. Number of individuals, who were so ill. So. China. Try the best that she. Make. A, treatment. Available, for people with after there's a corona virus, and that she knew how to get abused just less, than 10 days and, also. The. New code Mukul has a Charlotte is mobilized. And other, facilities. As the, temporary. Healthcare. Setting, for, my, treatment. For a patient, right. Now I have the condition is going to, improve. Uh. This, is Howard Bachner editor-in-chief, of. JAMA. And. I've. Had a remarkable, guest this morning son, uwu who. Is, the. Chief epidemiologist. For China CDC, he's, an adjunct professor, of epidemiology. At. UCLA, and the director, of the division of HIV, prevention, at. The China CDC, or obviously. As, you can tell from this conversation for, the last three. Months he's certainly been working on the, corona, virus epidemic and, pandemic, so. On you I I can't, thank you enough for joining me today I know it's really quite late I'm sure you've been working incredibly, long hours, so. I do want to thank you and I really. Can't emphasize enough that on, behalf of JAMA the. United. States I assume the world that we we. Wish you and your colleagues, well and caring, for these. Individuals. I have. Been impressed with what. I've seen in read about. The capacity for, China to respond, to this epidemic. So. Again thank you so much for joining me today and please stay, healthy. Thank. You my pleasure I. Think. We're done son you but they need us to stay on. You.