What You Need to Know About COVID-19 With Dr. Saad Omer of the Yale Institute for Global Health

Dr. Saad Omer

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Moderator : Welcome to Conversations on Health Care with Mark Masselli and
Margaret Flinter, a show where we speak to the top thought leaders
in health innovation, health policy, care delivery, global health, and
the great minds who are shaping the hea lthcare of the future.

This week Mark and Margaret speak with Dr. Saad Omer, Director of
the Yale Institute for Global Health and internationally renowned
epidemiologist. He talks about the Covid - 19 epidemic, what
government , health institutions, univ ersities and individuals need to
do to stay safe and how global researchers are rapidly working
towards a vaccine a s the disease begins to spread.

Lori Robertson also checks in, the Managing Editor of F act C heck.org,
and looks at misstatements spoken about health policy in the public
domain, separating the fake from the facts . We end with a bright idea
t hat's improving health and well being in everyday lives.

If you have comments, please e - mail us at [email protected] m or find
us on Facebook, Twitter, or wherever you listen to podcast. You can
also hear us by asking Alexa to play the program Conversations on
Health Care .

Now stay tuned for our interview with Dr. Saad Omer on the Covid - 19
outbreak here on Conversation s on Health Care.

Mark Masselli: We're speaking today with Dr. Saad Omer , Director of the Yale
Institute for Global Health, Associate Dean for Global Health
Research, and Professor of Medicine and Infectious Disease at the
Yale School of Medicine. A renown ed epidemiologist , Dr. Omer is the
Susan Dwight Bliss professor of epidemiology and microbial diseases
at the Yale School of Public Health. Dr. Omer, welcome to
Conversations on Health Care .

Dr. Saad Omer: Thanks. It's my pleasure.

Mark Masselli: Dr. Omer , I think it's fair to say that the whole world is watching this
outbreak of Coronavirus and you know it continu es to spread beyond
its origins. It emerged in Wuhan, China. It's really grown to epic
concern. You specialize in research and study of global in fectious
disease. So c ould you give us a quick description of this new strain of
Corona virus, Covid - 19 and its properties, how it spreads and maybe
just help us put this in context with other viruses and flus, SARS or
MERS things that people might remember having gone through .

Dr. Saad Omer: This is an emerging virus. So there are things that we are getting
familiar with. We know a lot more about this virus now than we knew

Dr. Saad Omer

a week ago or two weeks ago or three weeks ago, but still our
knowledge about this v irus and this outbreak is getting updated very
frequently. But we do know that the virus is more infectious than
influenza. It's a respiratory virus . The mode of spread is through
respiratory droplets. The evidence about that being airborne,
meaning the pa rticle size being so small that it hangs out in the air is
non e to very, very limited, at this time. And we also know that it’s not
as infectious as, let's say like measles, which is if a person who has the
virus enters a totally susceptible population, me asles infects
approximately 12 to 15 individuals, this one is 2.2 to 2.6 as an
average, but this is certainly more than influenza. There's another
parameter that we pay atten tion to, which is the mortality, how many
actually die of it. In China, in central China, it’s less than 2%. But the
early impression is that outside that intensive region of outbreak the
mortal ity rate is a little bit lower.

Margaret Flinter: But Dr. Omer , I think you've just provided invaluable information and
there's still so much we don't know as you said about Covid - 19,
because it's the first time it's appeared in humans. When people don't
have all the information they like it just puts them on edge. In this
case, I think we're seeing whole government s put on edge. So you
recently h osted a forum at the Yale Institute on Global Health and you
strongly urge d that a global protocol needs to be put in place if we're
going to not just help prevent the spread of the infection, but help
preve nt the spread of misinformation. Maybe tell us a little more
about how the World Health Organization decides to shift
classification from epidemic to pandemic in outbreaks like this.

Dr. Saad Omer: What I was alluding to is actually ongoing efforts, for example by the
World Health Organization, putting i n place common protocols for
evaluating potential interventions for countries and even
communities to adapt in terms of prevention, etc. But in this country,
we are actually very fortunate to have a very robust technical agency
in the form of the CDC, that was very quick to act providing these
resources etc . that people can adapt and adopt more broadly
preventing it in the communities and hospitals etc. Early 2000s there
was an outbreak of SARS since then we've had a pandemic influen za .
We have looked at ME RS and more recently Ebola.

So what happens is WHO says, o kay, this is an outbreak that we
should pay attention to and at some point they convene a group of
expert , a relatively small group of experts from all around the world
and essentially sa y, is this emergency a public health emergency of
international concern? Is there potential for it to impact multiple
countries? After that there is an epidemiological and scientific
classification issues, whether it's a pandemic meaning ongoing
transmission, multip le generations of transmission in multiple
countries spanning the globe . A big distinction WHO makes is the

Dr. Saad Omer

public health emergency of international concern which they have
declared this outbreak.

Mark Masselli: Just thinking about the trajectory of this o utbreak. Your colleague, Dr.
Albert Ko said the epidemic is still in this exponential phase. How
should the public be educated about preparing themselves for this
pathogen as it continues to spread and what's the best messaging for
the public at large ?

Dr. Saad Omer: A few things. Today if you ask me, is there a high individual risk of
catching this virus in the U . S .? The individual risk is very low in terms
of the probability of you getting it now, but I'm not downplaying the
concerns people have and the g eneral public is concerned about what
could come in the future. Could that happen here? There's some
uncertainty involved with that but these concerns are not unfounded.
How we translate those concerns into action matters. We can have
fear based paralysis that we enhance the potential impact of this
outbreak by impacting our operations. So the best thing you could do
is to live your life the wa y you are, but take precautions.

We are not powerless in the face of this outbreak. Yes, vaccines are
needed and s o there are things in the pipeline for that but it'll take a
little bit of time. Yes, treatment is needed, etc. You can do a few
things now that work for all respiratory viruses that are useful here.
First of all, our best available and the most low cost t ool is proper
hand washing. So everything is there to do proper hand washing etc.
yes the re are hand sanitizer that help but you don't have to have
those to be able to do that. So there are ways of doing that. Work
with your kids . Work with your family and especially the elderly
because they seem to be at a higher risk. If all families do that, you
cumulatively decrease the risk of an outbreak getting to your family or
your workplace.

The other important thing is self isola tion i f you have symptoms, if
thi s outbreak comes here and one way of doing that is now we can
work on Zoom or Skype or teleconferencing, etc. Don't be a hero,
because that could impact your whole sort of work environment or
school etc. And then with s chools it's a little bit tricky. The schools
should be rational about these things, letting kids know that it's okay
to stay home. When the nurse sends out an e - mail and says it's okay
to stay at home but the school doesn't put in place a remote
broadcasting mechanism to those who stay at hom e and t he teachers
still penalize them. When people are at home they’re not spreadin g it
around into the community.

The other things you could do even now is to get your flu shot and
here's the reason why. So flu shot doesn't biologically protect you
agai nst Coronavirus . What it does is initially when you have the
symptoms, you don't have a lab test so the symptoms overlap. You

Dr. Saad Omer

then go to the healthcare system, a lot of people come together and
that's an opport unity for infection to transmit, and jam up th e system
by being there. If you have a flu shot you decrease the likelihood of
actually going there and so you help with a pandemic response. Flu
shots are really good, but they're not perfect, but they're specifically
helpful a gainst severe outcomes . You are leaving these things open ,
the healthcare facilities are more able to care for folks who, God
forbid, are affected by the Corona virus outbreak.

In terms of our responses look societies go through pandemics, that's
not new and they come out on the othe r side either proud of their
response or a little bit sheepish about what they did. And I want to
make sure that we all recognize that the way we act and carry
ourselves by not discriminating against specific communities, we don't
want to have a History Ch annel documentary 20 years from now that
makes us feel ashamed of our response that I was there and I didn't
do anything about it. I urge people to have active compassion for
folks , for example who have contacts with populations where this
early epidemic e merged. But you know, as I often said, this is not a
Wuhan virus , it is not a scientific name. It's a virus that transmitted
i nitially from there , the influenza pandemic started on this side of the
globe and was initially ide ntified in North America would have been
an incredible insult to injury if the world started antagonizing folks
from North America, Mexico, the U . S . , etc.

So as we respond to this, as we face the prospect of this outbreak,
potentially becoming larger with the uncertainty of impact on
m ortality etc . , we should be responding as folks who pay attention to
the evidence and also we are compassionate, actively compassionate
in how we behave.

Margaret Flinter: Well, Dr. Omer while we're on that subject, it's a good time to send
out a global sh out out I think of respect and solidarity for the
healthcare workers particularly in Wuhan , the city that's bigger than
the population. I think who are from everything that I read just
heroically working around the clock in difficult circumstances because
of the huge volume of patients that they're trying to take care of. And
I wonder for all the preparation that we've done for all the planning
for bioterrorism and disasters that American Healthcare Organizations
and Hospitals are prepare d for, how well w ou ld any of us do
confronted with something of this magnitude and so I wonder if you'd
like to speak to the protocols to train , to equip , to protect the
healthcare workforce that we so vitally need in times of an epidemic
or p andemic.

Dr. Saad Omer: Actually , there are many heroes in this outbreak. But amongst them
at the front of that hall of fame , if you will, of people who went
beyond themselves are health care workers, specifically those who

Dr. Saad Omer

are in Mainland China combating this outbreak. Remember when
the se kinds of outbreaks happen, they have an impact on the whole
health system. So folks who are coming in with heart attacks there is a
basic frequency of that or those who are caring for those as primary
care physicians and nurses etc. Coming back to the U . S . , yes , we have
a lot of muscle memory in this country now of hospital preparedness,
their existing protocols that I know are being updated , and we at Yale
are fortunate that the WHO collaborating center for hospital
preparedness is actually two floors u p for me, and there is a lot of
work that has gone on to hospital preparedness.

Having a plan doesn't mean that everything will go smoothly but we
do know or at least institutions at the central level are better
prepared. Obviously, these kinds of trainin gs go up and down based
on the emergency du jour we haven't had a large outbreak of a
respiratory illness since the pandemic influenza that was
approximately 9 to 10 years ago. Having said that, we talk a lot about
central federal level agencies, but the f rontline of this response is
hospitals , health care providers , but also local and state healthcare
departments , and for the past several years we have seen this boom
and bust cycle where their baseline funding has been cut just
devastated and we should be a strong public health system at all
levels because CDC is a technical agency that doesn't have presence in
all parts of the country , and that's the job of those who a re embedded
in the communities.

Once this thing dies down we should all be advocates for sustained
increased funding for these entities because if we don't do that, we
pay for it when you don't do long term planning, but that increases
our vulnerabilit y as a population as a country.

Mark Masselli: We're speaking today with Dr. Saad Omer, Dire ctor of the Yale
Institute for Global Health, Associate Dean for Global Health Research
and Professor of Medicine in the infectious disease. There's a lot of
second guessing I think going on about the Chinese and about their
response, but they've now quara ntined entire regions to prevent the
spread of virus and you're just seeing other countries the whole issue
of the cruise ships , we're seeing these travel bans , flight restrictions .
I'm wondering if you could tell us why you're so concerned about
what the fallout might be from government’s overreacting.

Dr. Saad Omer: Yeah. So t here are certain things we know. We know we have
experience in terms of planning, we meaning the global health
community in terms of preparedness, etc. Overall, one way to deal
with emerging situation is to close the gap between assimilating new
information and actual decision making, empowering public health
agencies, with decision making, the CDC director, the NI A H Director or
the National Institute for Allergy and Infectious Diseas e director, so

Dr. Saad Omer

soon after the first case was introduced in the U . S. I published an op -
ed in the New York Times to say, look, yes, we are a democracy. Well,
one could argue having the political leadership lead this is well within
their purview, but it may n ot be prudent when there is an emergent
outbreak . So I advocated for empowering the agency leads,
fortunately those who lead these entities are mainstream scientists or
public health professionals. For example, quarantine decisions should
be based on evide nce. So that kind of framework is the best practice.

Margaret Flinter: Dr. Omer, talk about the coordination that we're reading about
between the scientific and the academic research communities. I
know Yale has had a longstanding research partnership with scientists
in China for many years , so your team at the Yale Institute for Global
Health is actively involved in the current response there. Maybe talk
to us a little bit about how these global partnerships between
scientific and academic institutions rea lly help to accelerate the
research and the decision making and provide more information to
entities like the World Health Organization and CDC.

Dr. Saad Omer: This is when you really see the benefits of a globally engaged
university that if you have longs tanding relations hips you do two
things. If you have former students for example going back or you
have current fellows, etc . then when the data come out there's a little
bit of a lag in terms of analyzing and you get those insights not just a
little bit e arly but with some nuance , and outbreaks tend to be and
should be all hands on deck kind of situations. I strongly believe the
way universities can uniquely play a role in countering some of these
threats is by being agile and being at the forefront of res earch and
evidence synthesis , having contacts and longstanding relationships
with academic peers not only help us contribute but also the other
part of this equation is that that helps us prepare and translate that
knowledg e for domestic policy as well.

Ma rk Masselli: But I think what every one of our listeners is waiting to hear from you
about what are you talking to your colleagues about in terms of the
potential for a vaccine and give our listeners an overview.

Dr. Saad Omer: So the good news is that we as a scientific communit y, I work on
vaccines, we as a scientific community have shortened the interval for
biological development of vaccine candidates and by a lot. So
compared to SARS etc. and some of the other stuff due to evolution in
our ability to r ecognize the various genetic variants etc. and how to
leverage that that has shorten ed the biological cycle. The second
thing is there has been an explosion of these biotech and academic
entities that are at the forefront of some of these newer technologie s.
The last accounting and the last tabulation I saw which was a couple
of days ago that there are 37 approximately vaccination programs.
These are programs meaning people say that they have candidates or

Dr. Saad Omer

they're close to a candidate then they will evalua t e humans and not
all of them sort of bear fruit but this is, the bigger the pipeline the
more likely it is that you get a few cand i dates that are really suitable.

Out of those there's only one candidate from the conventional big
pharma or large vaccine ma nufacturer , and so because of that
ecosystem we have made advances on the biological side of it. But
there's still, in order to ensure both efficacy and safety in humans
there's a process of going through these trials doing early phase trial
and late phase trials, etc. So the current time horizon looks like at
least a year before we have something close to even early licensure
etc. But it can change as things emerge etc . and so on and so forth.

Margaret Flinter: We’ve been speaking today with Dr. Saad Omer, the Director of the
Yale Institute for Global Health. You can learn more about his
important work by going to www.yigh.edu or follow him on Twitter at
SaadOmer 3 . Dr. Om er , thank you so much for sharing your insights
a nd your expertise during this time of a rapidly unfolding story and for
joining us today on Conversations on Health C are .

Dr. Saad Omer: Than k you. It is indeed a privilege.

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Mark Masselli: At Conversations on Health Care we want our audience to be truly in
the know when it comes to the facts about healthcare reform and
policy. Lori Robertson is an award winning journalist and Managing
Editor of FactCheck.org, a nonpartisan, nonprofit consumer advocate
for voters that aim to reduce the level of decep tion in U.S. politics.
Lori, what have you got for us this week?

Lori Robertson: At the South Carolina Democratic presidential debate, several
candidates disagreed with Senator Bernie Sanders over whether he
had explained how he would pay for Medicare for All . Sanders cited a
recent study led by a Yale researcher that found Medicare for all
would lower total national health spending. That study published in
the Lancet in February was led by a professor who said she was an
informal unpaid adviser to Sanders ’ senate office for his 2019
Medicare for All Act . But other researchers have found the plan would
increase total health spending.

Sanders estimates that based on the study, he would only need to
increase government spending by $17.5 trillion over 10 years to cover
the cost of his proposal. But Medicare for All lacks many details
leaving researchers to make various assumptions. Sanders was wrong
to say that “ Every study out there conservative or progressive says
Medicare for All will save money ”. The Urban Institute for One
estimated a Medicare for All plan would increase national health
spending by $ 720 billion in 2020. Federal government spending would

Dr. Saad Omer

increase by $34 trillion over 10 years. One reason the Yale and Urban
Institute estimates are so far apar t is the assumption on what the
government would pay healthcare providers under Medicare for All .

The Yale study assumed hospitals would be paid at Medicare rates
which are lower than private insurance payment rates. But the Urban
Institute assumed the ho spital rate would be 115% of Medicare rates ,
and it notes that even that may be politically challenging. If hospitals
were paid 140% of Medicare rates, the Urban Institute said that
would raise national health spending by $ 95 1 billion in 2020. That's
my fa ct check for this week. I'm Lori Robertson, Managing Editor of
FactCheck.org.

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Margaret Flinter: F act C heck.org is committed to factual accuracy from the country 's
major political players and i s a project of the Annenberg Public Policy
Center at the University of Pennsylvania. If you have a fact that you'd
like checked, e - mail us at chcradio.com . We'll have FactCheck.org’s
Lori Robertson check it out for you here on Conversations on Health
Care.

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Margare t Flinter : Each week Conversation s highlights a bright idea about how to make
wellness a part of our communities and everyday lives. When Wichita
Kansas nurse practitioner Michael Wawrzewski learned of the harsh
and often fatal conditions that expectant mo thers endure in Sub
Saharan Africa , all because they live too far from a medical clinic,
believing that every human being should have access to quality health
care . He came up with a solution , Clinic In A Can transforming
shipping containers into fully equ ipped mobile clinics and operating
rooms that can be shipped anywhere in the world.

Michael Wawrzewski : When you walk in the inside you will believe or think that you're
inside your doctor's office or inside at the clinical environment for
which maybe you' re in an emergency room or an ICU unit.

Margaret Flinter: Wawrzewski learned from his early iterations that gas powered
generators can be problematic in low resource areas and switch ed all
of his portable clinics to solar power.

Michael Wawrzewski: There i s no part of the world that does not have sunlight and so solar
power has become the cornerstone so that now every piece of
equipment including the air conditioners we can run it off of 500
watts of electricity, which means six solar panels on the top and eight
batteries is enough to run a clinic for 18 hours .

Margaret Flinter: Clinics In A Can have been delivered to war torn Sudan to earthquake
ravaged Haiti and more recently to Santa Rosa, California, an area

Dr. Saad Omer

decimated by the wildfires that also destroyed the main community
health center there. Santa Rosa Community Health Center CEO Naomi
Fuchs says that the portable clinic provided a lifeline for her patien ts
in the wake of the disaster.

Naomi Fuchs : These are converted shipping containers that arrive ful ly e quipped as
a medical exam room.

Margaret Flinter: The clinics are designed to support workflow and to become a
permanent fixture in low resource areas serving as long ter m primary
care centers as well.

Michael Wawrzewski: A containerized clinic is some thin g that's a turn key. We equip it with
the best equipment and we ship it as a completed project that once
on the ground within 20 to 30 minutes or so is ready to be used.

Margaret Flinter: Clinic In A Can clinic a professionally outfitted shipping contai ner fully
equipped with medical and surgical equipment ready for deployment
anywhere in the world where disaster strikes providing quality state
of the art medical facilities in a low resource area. Now that's a bright
idea.

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Mark Masselli: You've b een listening to Conversations on Health Care. I'm Mark
Masselli.

Margaret Flinter: And I'm Margaret Flinter.

Mark Masselli: Peace and Health.

Margaret Flinter: Conversations on Health Care is recorded at WESU at Wesleyan
University, streaming live at www.chcradio.com , iTunes, or wherever
you listen to podcasts. If you have comments, please e - mail us at
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