Brian Bremner, Executive Editor of Global Business for Bloomberg News discusses how the largest countries in the world have responded to the pandemic. With the US having more than 20% of the deaths worldwide, what are we doing wrong in containing COVID-19, and which countries are leading the way in doing it right?

TRANSCRIPT

Jeffrey Freedman: Hello, and welcome to the RP HealthCast by RooneyPartners. I am your host, Jeffrey Freedman. Fall is here in the Northern Hemisphere and public health concerns about a second wave of coronavirus cases are mounting. In this week’s episode, we are going to take a look at what is going on across the globe in terms of a potential second wave. In Europe, the UK, Spain and France, are now seeing spikes in coronavirus cases and Sweden’s early decision not to lockdown has resulted in a higher per capita rate of cases than all of their neighboring countries. It has been written that their government was seeking to reach herd immunity by not shutting the country down and therefore letting a majority of its population get infected. Speaking of herd immunity, President Trump has added Dr. Scott Atlas to the US coronavirus task force.

Dr. Atlas is an advocate of and is previously voice support on Fox News for a herd immunity approach here in the United States. That brings us to the three largest most impacted countries. Obviously, the US, Brazil and India. India is now the fastest growing pandemic epicenter in the world with over ninety thousand cases per day. Both the US and India have been reporting more than a thousand new deaths per day, and Brazil following with about eight hundred and fifty. The World Health Organization is recording new global cases at a rate of over three hundred thousand people per day. Nine months into this pandemic, what are we doing wrong in containing the virus, and which countries are leading the way in doing it right? What can we learn? So to help us address this, we are delighted to have with us Brian Bremner. Brian is the executive editor of Global Business for Bloomberg News. Brian oversees the global coverage of the coronavirus for Bloomberg, and this is actually Brian’s return to the RP HealthCast. Brian, it is so nice to have you back.

Brian Bremner: It is terrific to be back.

Jeffrey: Well, thank you for taking the time to help us understand what is working and what is not when it comes to the public policy response to the coronavirus. Last time you were on the podcast, you helped us understand the geopolitical challenges confronting a world seeking a cure to the pandemic. But today, we would like to take a spin across the globe with you to discuss the latest coronavirus hotspots and what is going on in these regions. Sounds good?

Brian: Sounds great.

Jeffrey: All right. Let us start in India, the world’s second most populous country with about one point four billion people, but they have been recording the world’s largest daily increases in coronavirus cases for almost a month now. They just passed Brazil for having the second largest number of cases in the world. Can you bring us up to date on what has been driving the coronavirus caseload in India and why is it so bad? What is the Modi government been doing to arrest the spread of the infection?

Brian: Well, you are quite right. I mean India has gone viral, I would say over the last month, and they are now kind of getting daily case growth. You know, very close to one hundred thousand per day, which is just absolutely astounding and that is kind of geometrical growth and it is conceivable, actually, that India could end up overtaking the US as the absolute epicenter of coronavirus sometime later this year. India is interesting and disturbing in a couple different senses. I mean, it is a huge, vast, vast country of seventy percent of the population actually live outside the major cities and what is really kind of happened in recent weeks is that the virus is really taking off in rural India, which is a huge public health challenge because these areas tend to be underserved by the healthcare system. It does not quite match what you would find in Mumbai or Delhi or Chennai, big major cities. It is another perplexing problem for the Modi government because of the economic hit that India has taken.

A lot of people do not realize this but in the April to June quarter, the economy actually contracted by nearly a fourth, nearly twenty-five percent, which is in relative terms, one of the biggest economic shocks that we have seen from the pandemic. Prime Minister Modi lifted the restrictions on the lockdown back in June, and there was like a bit of quiet and then the virus took off. India is facing the worst possible situation in that if it does nothing, the virus will just run riot across this fast subcontinent and unfortunately, make a lot of people ill and kill a lot of people, or you go back to a lockdown. But in India, a lockdown is really destructive because so many of the workers are living on subsistence wages. So you take that away from them, with very little government support, they go into extreme poverty. You could actually lose a lot of people to malnourishment or suicides or other kind of mental health issues that come from extreme poverty. That is the dilemma that the Modi government faces. Here we are in mid-September now.

Jeffrey: Yeah, I mean you talk about their economy. I mean, it is such a bifurcated economy. It would be between the haves and the have nots in India with so many people living in poverty and living together and on top of each other. So I mean, I cannot imagine testing has been that frequent or big in all parts, especially the rural parts of the area of the country. I mean do they have to wait like Sweden and try for herd immunity. I mean, is there any way to help it aside from that?

Brian: Well, herd immunity in India, it is hard to imagine what that would look like. It would be… I do not think there are anywhere near that level of infection rate. The destructive impact both economically in terms of public health would be really high if that is the strategy that they opt for. I mean, right now, they are kind of in a middling area where they are trying to take preventative measures where they can, but stop short of locking down the entire economy. The other thing about India that is interesting is kind of its global impact. I mean, obviously ,the people in rural India face unique challenges, but in Indian economy, that is really paralyzed by the virus has a spillover effect because you have a lot of companies – Facebook, Walmart, others – that view and are investing quite heavily in that market. The other thing about India that is interesting is that it is actually one of the major, if not the major vaccine production center. So when we eventually get to a vaccine, when we get approval on several of them, some of them may actually be produced by kind of contract manufacturers in India. So if the economy is in really grim shape and there is a public health crisis, on a massive scale, it is not just the Indians that are going to be coping with that that. In some sense, the rest of the world will be as well.

Jeffrey: Wow. That is a great point that I have not heard anybody bring up before. Thank you. Let us continue for a moment. Let us stay in the Southern Hemisphere and a country we mentioned with the third largest coronavirus count, Brazil. What has been the government’s response to the virus, and why does it continue to struggle to contain it? Has any of this changed since its president actually contracted the coronavirus?

Brian: Well, Brazil’s approach has been interesting as well. I mean the challenge that Brazil has is that you have got incredibly diverse urban and economic pockets throughout the country. In the major urban centers of Sao Paulo and Rio de Janeiro, you have got quite a population density characteristics that are wonderful for a virus, right? That has been a challenge. In the other parts of the less-developed parts of Brazil where the Amazon Rainforest cover is there you have got a very kind of developing healthcare system. Then you have a government led by Bolsonaro who is kind of a populist. He did not like resorting to any kind of lockdowns that would affect his political standing and deliver an economic hit to the country. He is a big fan of hydroxychloroquine, which is a treatment that it is very controversial because there is very little evidence that it actually helps COVID-19. He has been anti-mask. He fired a Health Minister who actually did call for more extreme containment strategies that might have made a difference and I do not believe they have actually replaced him. You have got Latin America’s biggest economy without a health minister in the middle of a global health crisis. It is not an ideal situation. Things seem to have plateaued a bit. You are not seeing the really extreme case growth that was happening in Brazil, like maybe two months ago. India’s problem is accelerating, so that is why India overtook Brazil not that long ago.

Jeffrey: Is there any rhyme or reason that it has declined a little bit in Brazil?

Brian: I do think people are kind of waking up to the threat. So there is probably a little bit more mask-wearing despite the political messaging. I think the treatments of COVID-19 were now kind of like eight, nine months into the crisis, healthcare providers have better strategies for dealing with people who become infected. That has probably helped as well. I do think social distancing is you are seeing more of that than you did three or four months ago in Brazil. Cumulatively, I think all those things have helped.

Jeffrey: Okay, so it is a little more education, a little more common sense and that certainly seems to be going a long way in Brazil. So that is good. Bolsonaro’s approach has been kind of somewhat similar to President Trump’s in a way in the beginning, back in the early part of the pandemic here. In the United States, we have only four percent of the world’s population, yet we have approximately twenty percent of its total coronavirus cases. We are, unfortunately, leading the world on that. If you could break that down for us a little bit. What are you seeing as a state of play here in the US now, especially as you are looking at it from the outside in, and with that, if you can also discuss both what role universities are playing and everybody going back to school and how our election year dynamics impacting the crisis?

Brian: Well, if you look at the US experience, we had those awful months, late March, April and May, where the pandemic was primarily focused on the northeast and New York got hit quite hard, of course. You saw fatality rates, two thousand people dying a day, and then things calm down a bit. The good news. is that some research has crusted and has plateau. Now, you are starting to see in pockets in the Midwest and the mountain states where the virus case growth is occurring and you mentioned the universities reopening and it is starting to look like a bit of a concern. A number of schools tried to open up, and then quickly had to go to online classes pretty fast, couple weeks in, because you are not getting a lot of compliance from young kids in their twenties who want to go out to bars or have fraternity parties and things like that. That is a concern, but I think the bigger concern is that the infectious disease professionals are all looking ahead to the late fall, when the weather cools off more people are inside and the projections are not terribly heartening. I mean, right now, the US is very close to hitting the two hundred thousand mark in fatalities. We are just days away from that happening.

Some of the more bearish forecasts are that we could actually double that and by the end of December have four hundred thousand people that we have lost if the worst case scenario happens. But these are pretty reputable people who are making these projections, critically the University of Washington, which has been one of the key modelers for their coronavirus taskforce that President Trump set up. These are pretty reputable people and I think the expectation is that things are going to kind of get bad again, unfortunately, as we get toward the end of the year. The election dynamics are front and center because the virus response has been so politicized and right now, the disconnect between President Trump and his scientific advisors is quite bewildering to behold. I mean we are getting very close to some Phase Three trial results in major vaccine programs, but President Trump seems to be insisting that the vaccine is going to be widely available by the end of this year. His top science advisors say they certainly hope that is the case but more realistically, you are probably looking at virus approval toward the end of this year, but it is going to be well into 2021 before a vaccine is widely available. So we are probably looking at living with this virus probably close to another year which I do not think has really sunk in on the public yet.

Jeffrey: That is helpful, but one thing that I know I am having questions about is I know there is probably about a hundred forty different vaccines under development right now. We have some elected officials, some healthcare officials that are saying we will have a vaccine ready as early as November, let us say. What does that mean? Does that mean that the first vaccine that is rushed through will be ready or is it that the best vaccine is going to be available? Are there going to be many vaccines available to everybody. What is going to be the state of play? Where do you think it all falls out? Is there just one that they have bought millions of that they are going to give to everybody, or different people going to get different things, or is it the first to market?

Brian: I think you are probably looking at a scenario where there will be several approved vaccines of varying efficacy and some of them might be double doses were you take one shot and then another month soon after you take another. We are getting very close to the end of the regulatory approval process to these Phase Three trials in which we have a large groups of human participants. Some of them are given a placebo. Some of them are giving the vaccine and you get a sense of the antibody reaction to it and how effective they are. There is a possibility that there might be emergency authorization where there is a slight shortcut. If they feel really confident about how Phase Three trials are going, they might cut it short and say, we are going to approve this one on an emergency basis.

So that is a possibility and that might speed up the process, but in terms of the vaccine coverage, I mean who is going to get it when, I think most experts assume that their first approved vaccines will go to public health worker. I mean the frontline healthcare workers and then high-risk groups, people with pre-existing conditions or older citizens, maybe above sixty-five years old that are at risk if they get the virus. if everything goes well, that might happen toward the end of this year or early 2021. But before the mass public has access to this, it is going to be a huge like a D-Day logistical challenge to really scale up and to get this from the factory into people’s arms. That is going to take into 2021, probably in the middle of 2021. So that is kind of the time frame. When can we get back to normal? Well, we cannot really get back to normal until a big chunk of the population has been immunized and that is as I said well into 2021.

Jeffrey: Got it. Okay. Thank you. Back to our tour of the world, of the globe if you will. A little closer to home for you, turning to the United Kingdom where you live in or based, the office of national statistics reports there were about forty thousand new cases of the virus in England during the first week in September. That is about eleven thousand more than the previous week or it was a thirty percent jump in the week. Also, the rise in the R number, the reproduction number, describes how many others each infected person passes the virus onto and that is one of the measures indicating the virus is spreading more widely in the UK. So if the R number is higher than 1 as it is now, the numbers infected are growing and with higher number indicates that cases are multiplying more quickly. With higher R numbers right now in the UK, what do you think the explanation is for the uptick, and do you this is indicative of Europe as a whole?

Brian: Well, I think in the UK, there are couple things going on. First of all, they fade out a lot of the lockdown measures that they had in the spring and early summer. So most of the restaurants now are back open. A lot of the pubs are. There certain restrictions on mass gatherings. The schools are back up. We are seeing the virus kind of rear its head again. The issue in the UK is kind of multi-faceted. I mean, a lot of people do not realize that a lot of the case growth is certainly in London, but also in the Midlands, around Birmingham, the second largest city. That area has been really hard hit as well. I think that third factor is the European travel season where British tourists were leaving the country and then coming back, and what we are seeing across Europe particularly in Spain and France are also flare-ups as well. So Europeans like they take their vacations very seriously and it looks like that is also fed into this a bit. So in Europe, depending on how you define it, the case growth is actually, if not neck and neck with what is happening in the US. Some days, it is actually exceeding the growth in the US. So unfortunately, Western Europe now is starting to emerge as a problem area again, and I think the World Health Organization basically said that recently that they are getting concerned about Europe again.

Jeffrey: So, you would think with common sense measures of staying home a little more, wearing mask, social distancing, we could probably get a handle on this, but everybody is getting a little stir crazy. So between vacationing and the nicer weather, people are just going out and forgetting.

Brian: Yeah, it has been a long battle. It is hard to sustain the intensity of… A lot of the virus dynamics really come down to individual decisions that people make everyday. If you get enough people behaving in a high-risk manner, this virus has proven itself as highly transmissible. It can be, as we know, it is an airborne virus. If you are in a room with a high viral load, you place yourself at risk of picking it up. The other thing, again, we have learned from the very beginning almost is a lot of people carry around the virus and do not show symptoms. There are like the this is stealthy quality to this pandemic.

Jeffrey: Yeah, and it is a great segue way. Let us talk about, starting from the very beginning, and let us circle back to Asia and China. China, the most populous country, also probably were the first instance and certainly, the first breakout of the virus started. Their government took a very strong decisive action and precautions and remedies to get the virus in check. Where does China stand now? Did they see a second spike? In being the world’s most populous country, they are not in the top three with us.

Brian: : No, they are not. One of the big ironies of this entire pandemic is that it all started in China, but China arguably has come closest to kind of vanquishing the coronavirus and definitely containing it. I mean if you go travel around Wuhan where it all started, you will see a city that existed pretty much before the pandemic. I mean, there are certain safety measures now. I mean hand dispensers. You probably see more people with masks, but everyday life, concerts, sporting events, going to the theater, going out to a restaurant, that is all happening in China right now. So what was it about the Chinese experience that is different from the rest of the world that is still struggling with it?

I think a lot has to do with the fact that the Chinese system is autocratic and fifty million people were quarantined regardless of whether they liked it or not, regardless of whether they wanted to participate in that or not. That does not happen in Western democracies, which depending on your viewpoint is a great thing in normal times, but when you are fighting this particular virus, the Chinese actually has had some advantages. I think that has been hard for the rest of the world to replicate. The other thing that I do not think is fully appreciated is the Chinese vaccine programs are pretty far along as well. I believe the Chinese are pretty confident that they will have a vaccine ready to go toward the end of this year and that they will put the full force of the state behind a massive rollout and the Chinese are pretty good about executing those kinds of public policy moves. It would be interesting to see if the Chinese also are the first ones to have a big part of their population fully immunized from the coronavirus. We will have a better idea of whether that happens by the end of the year.

Jeffrey: So it will certainly be telling in that regard. But let me ask you a question about you spoke where China the government said shut down, they shut down and they squashed it. Yeah, I guess our fear in the US is if you shut down, it is going to kill our economy. What happened to China’s economy when they shut down?

Brian: Well, they definitely took a hit. Their first and second quarter numbers were really depressed by this and they are definitely not growing. I mean the Chinese economy consistently has been growing at six percent, seven percent annualized rates and they are not going to come close to that this year, but they are not going into a severe recession like other parts of the world are. They were able to make their lockdown matter because they were able to sustain it long enough and then lift it very, very gradually and it seems like they did it long enough to make a difference. I mean, they definitely had flare-ups. There have been flare-ups in the Northeast and around Beijing, but they do a pretty good job of zeroing in on it, locking down selectively where they need to, and then doing contact tracing. They have got tons of people that they throw at these little outbursts and they have a track record of containing them relatively quickly.

Jeffrey: Thank you. Brian, traveling across the globe has been fantastic with you. Thank you. Thank you for your help and for sharing your knowledge as to what is going on. Next time we do it, I hope it will be in healthier times.

Brian: Yes, my pleasure. Thank you.

Jeffrey: Thank you.

Jeffrey: We hope you enjoyed this week’s podcast. If you have any questions comments, or future story suggestions, please reach out to us on social media. Thank you, and we hope you enjoyed the RP Health Cast.