Testing, Contact Tracing, Quarantines and Physical Distancing: Tomas Pueyo on What U.S. and Others Must Do to Beat

Tomas Pueyo

[ Music ]

Female : 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 and the great minds
who are shaping the health care of the future. This week Mark and
Margaret speak with Tomas P uey o, Silicon Valley startup
entrepreneur, engineer and writer whose recent in - depth articles in
the online publication M edium have garnered worldwide attention
more than 60 million view . He 's applying his engineering and data
analytics acumen combining disparate information about COVID - 19 to
pull it all together for a published guide on how nations ,
governments , health systems and ind i vidual should be responding to
this pandemic .

Lori Robertson also che cks in , Managing Editor of FactCheck.org ,
always separating the fake from the facts . W e end with a bright idea
that’s improving health and well - being in everyday lives. If you have
comments please email us at chcradi [email protected] or find us on
Facebook , Twitter , or wherever you listen to p odcast . You can hear us
by asking Alexa to play the program Conversations on Health Care .
Now stay tuned for our interview with Tomas P uey o here on
Conversations on Health Care.

Mark M asselli : We're speaking today with Tomas P uey o , Vice President for Growth at
Course Hero an online reference source for students , a n engineer and
entrepreneur with an MBA from Stanford. He's played a significant role in a number of other Silicon Valley sta rtups, including Zynga and the online investment platform

SigFig . He has recently gained
worldwide attention for his in - depth analysis of the global health data
around COVID - 19.

Margaret Flinter: Tomas is a published author and a public speaker on the neur oscience
of storytelling, and he's recently become a very important thought influencer on coronavirus with a series of well received articles
published in the online site Medium . Tomas, welcome to
Conversations on Health Care.

Tomas Pueyo: Thanks for havin g me.

Mark Masselli : Tomas , a n engineer , data analyst and self - described storyteller . You
saw a lot of disparate infor mation emerging around COVID - 19 . You
took really a deep dive into the global data around COVID - 19,
including each country's different appr oach. You wrote the first piece,
I think early in March , Coronavirus: Why You Must Act Now and much
of what you predicted and laid out has happened. I'm wondering what
actions should have been taken in those early days of the pandemic and so necessary for us to get ahead of the pandemic?

Tomas Pueyo

Tomas Pueyo: Yeah, much time has passed. I think it's important to go back to the
th
mindset that the world had around that time . March 10 China was
already close to being out , the daily cases in Hubei had been going
down su bstantially. At that point, it was South Korea, Iran and Italy,
that we're exploding . Each one of them had thousands of cases and
nearly all other countries just had a few dozen. What people thought
was, well, you know I only have a few dozen cases, this d oesn’t
matter . That was the mindset of most people . I f you see something
happening in China, and then the exact same thing happens in three
other countries a few weeks later, and you see the same beginning in
every country . T hen you can just predict what's going to happen very
easily .
th
I think on March 10 Italy had already locked down , s o it's not like it
was only a Chinese thing , and you c ould see all these other countries
going through the exact same thing . You took Spain and France, for
example, one mor e -- nearly one more week to make decisions. It
took the UK , I think , two or three more weeks to do that. Then in case
of the US i t was just at the state level, it never happened at the
federal level . I think that's where the mistake happens, and then
hist ory repeats itself . Assuming that it is not going to happen to you is
a mistake.

Margaret Flinter: Tomas, we a re watching the predictions that you made play out in
real time in our nation's hospitals in particular in our cities and
increasingly rural areas , which are being overwhelmed. Your follow up
article, The Hammer and the Dance explores what has to be done
now that we are living in the midst of a pandemic . T he hammer, the
strict shut down of schools, businesses, most of society has bought us
time. Sti ll 50,000 people are dead, millions are sick. Talk with us about
why this hammer phase is a harsh, but a really necessary approach
right now ?

Tomas Pueyo: Y ou see a country like South Korea, like they had an outbreak, but
they knew exactly what they needed to do because they had
something similar happened to them five years ago with MER S . They
had the right laws, they had the right public education , and so t hey
didn't even need countrywide lock downs. They just did what they
knew what to do , and t he results was very positive. Most of the
countries did not have th is experience. Most of the countries were
completely overwhelmed. Their healthcare system completely
overwhelmed. It meant also that they didn't know exactly what to do
to control this. That's what t he hammer is. It's realizing that you have
a massive outbreak , you need to stop it . That buys you time to
understand the virus , to understand how to handle it, and to take all
the measures to control it . Controlling the epidemic, and
understanding what to do to prepare for the dance are the reason
why you need to be very aggressive for a few weeks early on with a

Tomas Pueyo

hammer to buy yourself time.

Mark Masselli : Tomas, a lot of people are really eager to reopen the economy, which
you refer to, I think, is the dan ce part of the equation . We haven't
even hit peak outbreak in many parts of the country and yet people
are marching in the streets. You say there are some clear strategies
that would help facilitate opening things up again, but that we have to
be patient i f we we ’ re to do this without initiating another wave of
outbreaks . I’m wondering based on your data analytics of countries
that have done it right , what must we do here in the United States,
especially without a viable treatment or vaccine? How do we cont inue
to sort of minimize the risk to human life while preserving the
economy as well?

Tomas Pueyo: Yeah, there are some people in some places going on the street and
many, many more staying home. Now, obviously, you don't see them
because they're staying h ome. Tens or hundreds of millions of people
who are staying home are the very vast majority. It makes sense that
people are angry, because this is very hard. So many millions of
people lost their jobs, some businesses are going to be have to close
and in m any cases, unfortunately, it was also an avoidable situation if
we had taken the right measures at the right time. I t makes sense that
people are angry , but it's also true that most people understand what
to do . What do we do to move forward as fast as pos sible? The issue
with the measures that you're mentioning that some states want to
relax is that you haven't changed anything. I am a bit concerned about
some of these me asure relaxations that happen in different places .

To your point now, what can we do i nstead? T he hammer is this very
b r unt force that you apply , a scalpel enables you to be much more
precise on exactly what you need to do. It is a combination of testing,
con ta ct tracing, isolations and quarantine. First, you need to test
everybody , because if you don't test , you don't know who is infected.
If you don't know who is infected, you cannot isolate them to prevent
them from being infectious . Then you also want to see all the contacts
that they 've had over the last couple of weeks, so that you can isolate
them . Y ou test them to see if they’re positive, if they’re positive, you
isolate them, and if not you ask them to stay at home for a couple of
weeks, so that they can’t transmit the virus to anybody else. If you do
this, you can isolate only a few people and enable everybody else to
go back to work , but those are not easy things to do. We all know that
our testing is not the right level. We know that our contact tracing is
basically non existent. We need to set up these things.

The question is not we've already been in lock down , a re we ready
yet? But rather, what measures are we taking? W hen are these
measures going to be ready for us to dance? I mentioned fo u r, there's
a few more, for example, everybody should be wearing masks even

Tomas Pueyo

homemade masks make a huge difference. It is a no brainer just
everybody should be doing this . Then there's the obvious things of
hygiene, physical distance, and public education , a ll of these things
are pretty cheap to do, and we should be doing them all.

Margaret Flint er: I want to talk about the group of people that are just paying such an
incredibly high price, and that's our frontline healthcare workers.
They're in our hospitals, they're in our clinics, because we didn't
flatten the curve early on weren't as prepared as we should have
been. We have a system that's overwhelmed and people just don't
have the basics of what they need to fully protect themselves. We
hear about g overnors bidding against each other to get the essential
protective equipment that they need . W hat's the best way to go
forward based on your analysis to make sure that across the country
our health systems are supported, and healthcare workers have what
they need to be protected while they c arry out their life saving work?

Tomas Pueyo: Thankfully, we're in a place where these people self lessly go and fight
th is day in and day out, which by the way I think is heroic, but also
put ting stark contrast with the sacrifices that we ask everybody else
to do, and some are not willing to make. They are dying for all of us .
The obvious one is our personal protective equipment. You want
them to have their masks and their screens, f or the face , and their
gowns, and we just don't have that -- enough of that st ill , s o that's
crazy , so that’s t he first thing that we need to keep doing. A lot of the
production of these things was happening in China, they are price
gouging now. T here is homegrown desire to build these things, but
then nobody's controlling and coordinating it .

I know a bunch of manufacturing plants that say, I can recycle into
building masks, but I don't know the designs that I should be using . I
know there's demand, but nobody's contacted me , s o how do I do it? I
think that's one of the key roles is the want of coordination that the
federal level should have had, and unfortunately hasn't happened. I
think obviously, ventilators everybody talks about them , ICU beds.
Another one of the keys that we will need over the next few weeks is
understanding better the virus and the illness and how they work ,
becaus e we know that a big chunk of the issue is due to the virus, but
another issue is due to the immune response to the virus . F or
example, ventilators might not be helping for the immunity r esponse,
understanding the details there first, obviously, to do the proper
treatment, but also then to understand what are the assets that we
need to deliver those proper treatments.

Mark Masselli : We're speaking today with Tomas Pueyo , engineer, data analyst,
entrepreneur, author and writer w hose collections articles on C OVID -
19 published in the online site Medium have been widely acclaimed.
Tens of millions of people have viewed them. Tomas, one of the

Tomas Pueyo

articles in your coronavirus series really caught my attention in the
piece out of many one . You do an in - depth analysis of why a cohesive
public health approach is so much more effective than this piecemeal
approaches received right now . For example, we've all read where
Georgia, Florida are reopening , i n that piece I think you do a great job
of laying out some very specifi c reasons why a unified strategy across
the country will not only save lives, but serve the economy as well. I'm
wondering if you could illuminate more of yo ur thinking on .

Tomas Pueyo: Yeah, the places that are impacted first are always going to be the
on es that are most connected to the world because they are the ones
importing the cases, and then the ones that have the more density
because then the transmission rate is going to be higher . That's
because in this country, urban areas tend to be more Democr at s, and
rural areas tend to vote more Republican, that meant that democratic
areas were impacted first . Then it might be perceived as a more of a
party line kind of issue . B ut the problem is when you look at
historically, how these kinds of illnesses spre ads, then they end up
spreading everywhere.

Early on, it was perceived as a partisan issue because of this reason,
but it wasn't . The reason why you need to coordinate , you don't want
different states to be bidding against each other for these kinds of
ass ets. In fact, you want to allocate these assets to the right basis and
you want one single buyer so that they have all the force of their
purchasing power. The other one is obviously know ledge , right,
b ecause y ou have the CDC at the federal level, you don' t have the
CDCs at the state level. T he epide miological experience and the ability
to research everything that needs to be done , i t makes sense to
centralize that .

Whenever you have an impact at the economic level, you will have
some parts of the economy t hat are wors t hit than others . You want
as high level as possible to go and spread the pain. For example,
Florida's economy relies very heavily on tourism. Tourism is very
affected by the coronavirus . If Florida has to make a decision between
health and ec onomy and their economic impact is going to be so
much higher than in other states, they will have a different
conclusion . That is probably the right conclusion for Florida, which
might not be the right conclusion for the rest of the country . That is
why y ou need a higher level coordination. Federal government saying
you know Florida for the good of all the states, you need to shut
down, but you are going to incur more cost , so we need to
compensate you for that.

Margaret Flinter: Well , Tomas , and in the co ming months, we will as a nation, I hope , be
on the downside of the COVID - 19 outbreak curve , but we are clearly
going to be left with an enormous hit to the economy, to our

Tomas Pueyo

healthcare system, maybe to our just national sense of well - being .
You've talked ab out we need to get back to a new normal and
learning a new way to dance . As a dance aficionado , I really
appreciate your quote from Martha Graham that dance i s discovery,
discovery , discovery . We're going to have to discover a lot of new
dance steps , but w hat are they ? How do you envision this rebuilding
of the country after the worst of this is behind us? What are these
projections look like in terms of getting back to this new normal and
how peop le learn the steps to get there?

Tomas Pueyo: T here's a very short term , there is a medium term and there's long
term . S hort term is the next few weeks, then is -- the medium term is
the dense period , and t hen the long term is once we're out of this,
and each one of them has their own challenges . Right now, the sho rt
term, the challenge is figuring out which measures we're going to bet
on. I mentioned a few of them very quickly summarizing, testing,
con ta ct tracing , isolations, quarantines, masks, public hygiene, public
education, and physical distancing. There's al so probably a couple
more that we need. One of them is some travel restrictions , t he other
one is limits on social gathering si de .

If we can do an amazing job locally, but then you import cases from
abroad, then you have a problem . This is exactly what hap pened in
Singapore. They're doing a great, great job locally and t hen import ed
cases from workers , and then they had an outbreak . I think that we
might need to do is also limits on social gatherings , because if you
have, for example, a very big fair that l asts three, four days with 5000
people, the likelihood that one of these people or a few of these
people come and inf e ct all these other networks that are available in
that place is very high . Then y ou can have a huge super spreader
event like this, like t he one that happened in South Korea, where just
a woman went to a church twice, created 5000 cases . That's the
medium term . How do we l ive with these measures ? The new normal
m ight be, now you have a mask on you all the time.

Now, if you're in a meeting, y ou should not have 10 people in a small
room, but maybe it's two or three people and you're sitting in a way
that you don't face each other. T here's a lot of these small things day -
to - day that are going to change . Then there's a question of after that ,
rig ht, a fter there's a vaccine , after there are treatments, how we can
tackle this . I think there's a lot of questions that we will need to ask .
M any of the systems in the United States were not well equipped to
respond to these crises , but the government is just a tool and is just a
tool for coordination . If you face a situation like this one where you
need co ordination , y ou need the government in this case to provide a
solution.

The fact that my wife, for example , was in isolation because three

Tomas Pueyo

weeks ago, sh e might have had the coronavirus and she turned out to
be negative, but it cost us over $2,000. If it ’ s going to cost us through
the current healthcare system $2,000 per person to be tested for the
coronavirus, nobody's going to get tested . If nobody gets tested, we
can’t control the epidemic. Y ou need an intervention of the
healthcare level to prevent these type of epidemics from happening
again . This is the type of conversations we're going to have for the
long term.

Mark Masselli : W e were fortunate to ha ve Dr. F uci on our radio show , I think , early in
March, but I think there were only -- whatever it was , 15 cases were
out there . B ut he has talked since then about the second wave of
COVID - 19 outbreaks once the society opens up again. W e're still
learning more about the capacity the virus has spread . Y our latest
installment, in this really great lexicon of work that you are doing
entitled T he Basic Dance Steps Everybody Can Follow . You really sort
of lay out for the public the role, the important role they could do . I t's
just really the fundamentals of blocking and tackling, if you will, of
wearing mask , hand hygiene, simple behaviors, s o really I think we
have to retrain our mind about how we do a dance with somebody,
right, maybe a little more distant danc e . Tell us how that public plays,
perhaps the most vital role?

Tomas Pueyo: Yeah, my interpretation of it is based on what he understands and
what's happening in the US , it is likely that we will be suffering
another one . Many o ther countries will probably not . It really
depend s on us . We've seen that governments in different levels are
taking the right decisions, but not all. Citizens have a role to play ,
businesses have a role to play in. B locking and tackling I think is
important to understand the scienc e that we know today of the virus .
What we thought a few weeks ago is that it was just transmitted
through droplets. You speak or like you cough rather and y ou made a
few droplets that fall o n the ground within six feet , and so y ou're
good as long as you'r e not cough ed in the face. We've learned since
that that's not the case. It’s only the coughs but it might be you
speaking. It might be you just singing , like a choir in Washington State.
60 people , 45 got sick in the church, the mega church in South Korea .
These people are singing a lot still .

We also know now that you can emit when you cough , for example, a
cloud of droplets that stays in the air for longer and goes farther away
for a couple of meters . One of the fascinating study in the Chinese city
of G uangzhou , three families sitting in three different tables at a
restaurant, and just one person in one of the tables ended up
spreading the virus to seven or eight people in three different tables .
That tells you some of the patterns of the spread. It happ ens
exceptionally when there's a lot of talking, singing, contact close to
each other in confined environments for a long period of time . This is

Tomas Pueyo

what you need to avoid .

The things that don't look like they are infecting too much, are for
example, walking outside. O nce you understand that, you start
understanding some of the things that you can do to prevent these
from happening. For example, why are masks so important? Because
half of the transmissions are pre - symptomatic, which means that
people don't hav e symptoms yet, but they're sick, they're already
transmitting the virus. If you have a mask, all these droplets are going
to stay in the mask. Everybody should be wearing these masks . First ,
because it prevents others from being infected. It a lso obviousl y,
because it protects you from being infected too , but you shouldn't be
sitting in a meeting with five people in the same room talking for an
hour, because that's a recipe for disaster. N ow you start
understanding what are some of these measures that you can take .

Margaret Flinter: We've been speaking today with Tomas Pueyo , engineer, startup
entrepreneur, author of a series of powerful articles on the
coronavirus , published in the online site Medium , you can find them
and we encourage you to read them thr ough his pages on Facebook,
LinkedIn and on Twitter @ t omas p ueyo . Please also follow his work on
Medium . Tomas, we want to thank you for sharing your really
remarkable skill for clear communication and taking complex data,
turning it into digestible stories , and giving us a guidebook for
navigating this pandemic w hat we need to do , w hat we need to avoid
doing . Thank you so much for joining us today.

Tomas Pueyo: Thank you so much for having me. I think what you're doing is
extremely important. Spreading this message is the single most
important thing and the most impactful thing that we can do for the
health and the economy of this country. T hank you very much.

[Music]

Mark Masselli: At Conversations on Health Care, we want our audience to be truly in
the kno w when it comes to the facts about health care 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 deception in US poli tics. Lori,
what have you got for us this week?

Lori Robertson: Online posts have claimed to reveal various cures for the novel
coronavirus. Some are benign like eating boiled garlic, while others
are potentially dangerous like drinking chlorine dioxide an d industrial
bleach , n either will cure the virus. One rumor claims that boiled garlic
can c ure the virus. Another says that loading up on vitamin C will do
the trick. Yet another w ould have people essentially drink bleach.
None of these “ cures ” will treat the virus. As for the dangerous idea of
drinking bleach, chlorine dioxide kits are sold online under various

Tomas Pueyo

names, miracle mineral solution , miracle mineral supplement, but
there are most often referred to as MMS . These ki t s typically include a
bottle of sodium chloride and a bottle of an activator such as citric
acid. When the two chemicals are mixed together, they make chlorine
dioxide . B ut MMS hucksters sell the chemical solution as a cure for
cancer, AIDS, autism and now the novel coronavirus.

One popu lar conspiracy theorist wrote on Twitter “ no known cure for
coronavirus. They say, well, it sure sounds like c hlorine d ioxide could
wipe it out. ” He directed his 116,000 followers to a website called
TV ’ s C orner which posted a banner at the top of its site telling
customers it was experiencing a high volume of orders. Chlorine
d ioxide is used as a disinfectant in municipal water treatment , but the
Environmental Protection Agency has set a maximum allowed level of
0.8 milligrams per liter. The FDA has warned against using MMS since
2010 and reiterated in a statement to F act C heck.org that “ T he FDA
recommends consumers do not ingest these products . ” That's my fact
check for this week. I'm Lori Robertson, Managing Editor of
FactCheck.org.

Margaret Flinter: F act C heck.org is committed to factual accuracy from the country's
major political players and is 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 www.chcradio.com . We'll have
FactCheck.org’s Lori Robertson check it out for you here on
Conversations on Health Care.

[ Music ]

Margaret Flinter: Each week Conversation s highlights a bright idea about how to make
wellness a part of our comm unities and everyday lives.

Mark Masselli : When Jennifer Staple - Clark was a sophomore at Yale , an internship at
the ophthalmology office turned out to be a life transforming experience. She realized that many of the patients who had limited access to medic al care were coming into the office with serious eye
conditions that had gone past the point of reversing, leading to unnecessary blindness. What she launched from her dorm room was a local initiative to improve access to preventative eye care to the needi est population in her local community.

Within two years, she took her organization Unite for Sight
worldwide, and has since turned it into one of t he leading providers of
global eye care in hundreds of communities around the world. Unite
for Sight brings s ocial entrepreneurs , public health experts, local eye
surgeons and volunteers together to bring eye care into some of the
most underserved areas of the world . T hey use each country's existing
pool of ophthalmologist and eye surgeons to treat their local pa tients.
They also train community health workers in each area they serve,

Tomas Pueyo

thus removing traditional barriers to eye care experienced by many in
extreme poverty.

The community health workers provide education and transportation
to get doctors to the patient 's communities and patients to the
hospital if surgery is ind icated. S ince its inception, Unite for Sight has
served 1.4 million patients worldwide and restored eyesight to
roughly 55,000 people restoring not only their sight, but their dignity
and ability to be productive members of their communities as well .
Using global health delivery models and improving the quality of life
by offering basic preventative eye care to those who had previously
gone without , now that's a bright idea.

[Music]

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

Margaret Flinter: And I'm Margaret Flinter.

Mark Masselli: Peace and Health.

Female : Conversations on Health Care is recorded at WESU at Wesleyan
University, streaming live at www.chcradio.com , iTunes, or wherever
you listen to p odcasts . If you have comments, please email us at
[email protected] , or find us on Facebook or Twitter. We love
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