'This is a war,' says doctor on COVID-19. 'We are at the beginning of a surge -- and it’s terrifying'
We continue our interview with Stanford University’s global health expert Dr. Michele Barry, an infectious disease doctor, with an in-depth look at the response in the United States to the coronavirus and how it compares to other countries, why she calls it a “ticking time bomb” for Africa, why testing is so important, whether it is safe to take ibuprofen, the race to find the best potential treatments, and much more.
This is a rush transcript. Copy may not be in its final form.
AMY GOODMAN: This is Democracy Now!, democracynow.org, The War and Peace Report. I’m Amy Goodman, as we bring you Part 2 of our interview with Dr. Michele Barry, infectious disease expert, tropical disease expert, global health expert from Stanford University. The worldwide death toll from the coronavirus pandemic has topped 10,000, with nearly a quarter of a million confirmed cases of COVID-19. Here in the U.S. at the White House, President Donald Trump sought to deflect criticism of his administration’s disastrous handling of the coronavirus crisis, lashing out at China, excoriating the media as “fake” and “corrupt news.” Confirmed coronavirus cases in the U.S. have doubled over the past two days. New York has become the epicenter of the pandemic with more than 5,200 confirmed cases, the highest in the nation — and, mind you, that number is going to massively increase because of the lack of access to testing. In California, Governor Gavin Newsom Thursday ordered all 40 million Californian residents to remain at home, to shelter in place, effective immediately.
Dr. Michele Barry has agreed to stay with us to do this Part 2 of our conversation. She’s the director of the Center for Innovation in Global Health at Stanford University, incoming chair for the Consortium of Universities for Global Health, also past president of the American Society of Tropical Medicine.
I want to start in the United States, Dr. Barry, and then go global. Can you talk about the response in this country?
DR. MICHELE BARRY: Yes, I can talk about the response. I wish it were much more aggressive. I think that we are at the beginning of a surge, and it’s absolutely terrifying. We’re all watching the beginning of this curve, and it eerily looks like Italy. I’m particularly worried about New York City, because we’re seeing that surge very quickly. And I’m particularly worried about the state that I’m living in. Our governor has taken a very strong stance by asking people to stay at home. The county which I’m in is actually in an order called “shelter at home.” I think we need to aggressively use nonpharmaceutical interventions — that’s what we’re calling it — because there are no great pharmaceuticals yet, and we can talk about that. But we need to use testing, testing, testing, isolation and quarantine. And unfortunately, our country has not up-ramped with testing. It’s really not understandable, from many of us from the professional side, that we’ve not been able to up-ramp our testing.
AMY GOODMAN: And explain why testing is so important, Dr. Barry.
DR. MICHELE BARRY: Because when you’re using nonpharmaceutical interventions, this concept of isolating the sick and quarantining contacts, you need to know who’s positive. And even now with the tests, they’re only running about 70, 75% sensitive. So we’re even missing a certain percentage of that, which means it’s even more crucial to know who’s positive and to isolate and quarantine, particularly for our elderly people, because it’s our elderly folks that have had the highest mortality. You know, there’s been these jokes about “boomer remover,” but this is really a “boomer remover” virus, because it’s the people over the age of 60 that are really dying with this disease and have the highest fatality.
AMY GOODMAN: You also have this little latest report — you know, it’s particularly looking at examples like in France and also, I believe, in Italy — that millennials are being hit, that I think in intensive care in France, there are more millennials in the intensive care units.
DR. MICHELE BARRY: That’s right. We are definitely seeing — and that becomes really important, because as I was driving in very early in the morning, we saw — we’re hearing about people in the U.S. going on spring break, millennials going on spring break. So, yes, millennials are not immune from it. When you look at the large numbers that have come out of China, Singapore, Italy, it’s really been the older group that have died from it, but millennials are getting sick. And certainly, we need to pay attention to that, even toddlers and young children. Even though they have the least manifestations of COVID, they have milder cases, there are still a small percentage that get hospitalized. And if it’s your baby and it’s your millennial, you do not want them getting ill. Unfortunately, it’s that age group that thinks they’re invincible and are going out there on spring break. I heard Miami and the Keys are having problems with spring breakers.
AMY GOODMAN: The Republican governor of Florida has refused to close all the beaches, to the shock of so many, while their senator, Rick Scott, is now in isolation.
DR. MICHELE BARRY: I think that’s putting your head in the sand, absolutely putting your head in the sand. No pun intended.
AMY GOODMAN: I wanted to turn to New York City Mayor Bill de Blasio, speaking this week.
MAYOR BILL DE BLASIO: We need 3 million N95 masks. We need 50 million surgical masks. We need 15,000 ventilators and 25 million each of the following items of personal protective equipment, which our healthcare workers and first responders would use depending on the situation: surgical gowns, coveralls, gloves, face masks. We need these in great numbers.
AMY GOODMAN: So, Michele Barry, around the country, healthcare workers are being told to reuse N95 air-filtering respirator masks amidst a critical shortage. President Trump says the federal government has ordered — I think he said 500 million of the masks, but Bloomberg News reports they could take up to 18 months to deliver. But, of course, two weeks ago, he said by the end of the week there would be a million tests administered, which was a complete lie. Can you talk about the role of the federal government and what you think needs to happen? You’ve been a longtime advocate for very important public health measures, that you’ve even brought to Congress.
DR. MICHELE BARRY: Yes. During the Ebola epidemic, I was — and even, actually, before that — I proposed a medical arm of the Peace Corps and an emergency medical contingency force for WHO. I actually put a bill through Senator Durbin to try to get a medical arm of the Peace Corps funded through Congress. Unfortunately, I failed.
It was also extremely disappointing that the Trump administration, early on, dismantled the pandemic preparedness team, although I heard he’s said he didn’t do that. But he did do that. He also, in his Trump bill, was trying to dismantle all of the hospital preparedness and has cut that aspect of CDC. All of that needs to be strengthened.
But I would argue we need to have a global health security force in the United States. And it’s not just the United States. I think we have to realize we cannot be xenophobic about viruses. Viruses do not know about borders. We are living in a globalized world now. We need to address these threats in a global — you know, a U.N. league of global preparedness against novel emerging viruses. I mean, this is an existential threat that threatens all of humanity, Homo sapiens.
AMY GOODMAN: You know, what’s very interesting is President Trump is now escalating the rhetoric against China, talking about the “Chinese virus,” and that’s picked up by his ally, Bolsonaro, the far-right president in Brazil, who also said the same thing as the infection rate is beginning to soar in Brazil. And the Chinese Embassy says, “You’re using the language of the United States.” But why this is significant is, at this point, what do we have to learn from China, as Trump slams China? Are you concerned that we won’t — he won’t be using the critical information that can come from China right now around the issue of containment?
DR. MICHELE BARRY: I think all of us — you know, I have no idea what goes through Trump’s ears, or between the ears. I know all of us are absolutely avidly reading everything that’s coming out of Chinese literature, and trying to figure out what they did right, what we can actually really institute in the United States to flatten this curve and contain it. When you look at a country like Singapore, they didn’t even stop their schools. By doing aggressive surveillance and aggressive quarantine and community solidarity policing, they didn’t even disrupt their life, so that it is really crucial to have good public health and good public health infrastructure. And maybe this is a wake-up call to the United States that we need to think about a public health infrastructure that starts at the top. I know people don’t want government, but the minute there’s an epidemic, the minute there’s a hurricane, all of a sudden government counts. And frankly, we were unprepared.
AMY GOODMAN: I mean, President Trump has attacked now the governors who are crying out for all sorts of aid. Now he is mobilizing two ships. I think they’re the Comfort and the Mercy. One will be in Seattle, one will be in New York. But, in fact, they’re under repairs, and apparently it might take weeks. And the governors are saying, “This is your role.” And the president says, “We’re not here to order things for you. We are not your clerk.” Talk about what you see an ideal system would look like in this country. And I also want to ask you if you think Medicare for All fits into this picture.
DR. MICHELE BARRY: Well, I definitely think Medicare for All fits into this picture, because if we’re not taking care of one sector of our population, you’re not going to be able to control viruses. Viruses don’t know which economic class, and it’s the most vulnerable populations that are going to have the hardest time containing this illness. They’re crowded. They’re vulnerable. I think we also — you know, I’m not an economist, and I know you had Joe Stiglitz, that talked about the economic ramifications. But it’s the most vulnerable populations that are going to be hit the hardest, and it spreads from them. So we need to take care of all of us. We need some community solidarity about taking care of this virus and other threats that occur. And, you know, it’s interesting. You could think about climate, you can think about air pollution, you can think about other issues that we’re going to need global governance about it. It can’t be done country by country by country.
AMY GOODMAN: The call by, I mean, some — you have Chesa Boudin, the new DA of San Francisco. You have the abolitionist groups around the country. We were just talking to mutual aid groups. The call to release people from jails and prisons. I mean, we’ve got the largest, proportionally, prison population in the world, not only prisons and jails, but also detention centers of immigrants.
DR. MICHELE BARRY: Yes, those are Petri dishes, if you know what I mean. They’re incubating. It’s interesting. You know, again, there’s social isolation in some of the prisons. But once it starts going through a population that’s eating together and can’t be kept six feet apart, it becomes a real problem. Yes, I think that is a problem. Again, I think we need a centralized approach. We need a centralized approach to prison health, a centralized approach to our public health infrastructures at the community level, as well as at the federal level.
AMY GOODMAN: You are an expert in global health, and I wanted to turn to South Africa’s president, who declared a state of disaster Sunday, implemented urgent measures to fight the coronavirus pandemic. This is 68-year-old great-grandmother Lucy Mayimela, who says the recommendation of self-isolation is impossible in her community.
LUCY MAYIMELA: [translated] If it’s my time to meet my creator, I will go. There’s nothing I can do, because they are saying there’s no cure for it. And I wouldn’t even know a person who has the cure. I stay in a shack. We share a communal toilet and a tap as a group. Those that have houses are in self-isolation, and I’m here. For me, it means I will die from hunger or corona. I don’t know, but only God knows.
AMY GOODMAN: So, what about what is happening in particular countries in Africa, why you’ve called it a “ticking time bomb,” Dr. Barry, and what you think needs to happen? Is it simply because the testing isn’t available, and, in fact, it is growing exponentially right now?
DR. MICHELE BARRY: I think it’s not just about testing. I think her poignant statement about the economic ramifications, the inability to have the food chain supply keep going and the inability to isolate is going to be devastating for this country — for this continent. The only, you know, maybe small hope is that it’s a young continent, so that hopefully the mortality won’t be as high as we’re seeing in Italy, where really the majority of the mortality is in the people 70 and above, and I think that’s also driving numbers in Italy. It’s an older population than we will see in Africa. So, in a way, it’s a demographic calculation. But that woman’s words really speak to me.
AMY GOODMAN: And then you have the fears growing from millions of refugees, for example, living in overcrowded and unsanitary camps around the world, including a million South Sudanese and Congolese refugees in Uganda.
DR. MICHELE BARRY: Absolutely impossible to isolate them by six feet. And again, a young population, but it is so devastating, what can happen. I just got back from the Tijuana border, because we were trying to help give care to the migrants that are aligning at that border. And I saw some of the living situations that they were living in. They’re not even in detention. They’re all living in large churches and tents, crowded together. So, once it hits there, it’s going to be a disaster.
AMY GOODMAN: And so, the U.S. policy along the border, you even had, up until this week, even in the midst of the orders to shelter in place, ICE moving in on immigrants to deport them. And now they’re saying they won’t deport immigrants who haven’t committed crimes. But in many, many cases, immigrants who’ve come over the border, by U.S. law, that is a crime, and so people don’t realize that’s the public threat Trump is talking about, simply coming into this country in desperation or seeking asylum.
DR. MICHELE BARRY: You know, I have to say, Amy, we need to pay — I totally agree with that. But I think what we need to do is concentrate on public health measures that actually mitigate this crisis. And I think we need to do it with an eye towards taking care of all our vulnerable populations, not just the rich. There’s been discussion in my part of the world, Silicon Valley, about who’s getting access to testing. Is there, you know, inequity in who can get testing? We’re trying very hard to set up drive-bys and not let that happen.
AMY GOODMAN: I wanted to ask you two specific issues. One is about ibuprofen, like Advil, this report that has come out that it could make you more vulnerable. Is that true? I don’t want to spread any rumors.
DR. MICHELE BARRY: No, I’ll be glad to, because I’ve been quoted in The New York Times about this. I read the literature on this. It’s basically one letter to The Lancet. It’s not a peer-reviewed. It’s not evidence-based. It’s not population-based. And so, I can’t believe that that got the legs that it had. I think what’s having legs now is chloroquine. And there’s been a rush on chloroquine. And I heard the manufacturers have — or hydroxy Plaquenil — hydroxychloroquine, which is also known as Plaquenil, and I heard there’s a rush on this now in most of the pharmacies. Again —
AMY GOODMAN: Well, of course, this isn’t puzzling, because President Trump took to the podium — he used the White House podium yesterday, standing in front of Dr. Hahn, the FDA commissioner, and said that chloroquine could be a — you know, it’s not a vaccine — it could be a cure. Immediately, Hahn steps forward, after Trump steps back, and starts to raise questions about this. But explain why — what it is, this anti-malarial drug, and what they are talking about.
DR. MICHELE BARRY: Yeah. So, this is my area, because I’m a tropical disease doctor, and I have a lot of experience with chloroquine. Yes, it was a cheap drug. It basically is a drug that, in theory, could potentially mitigate. The Chinese used it because of that theory. It changes — it can alter how COVID-2 attaches to the cell. Now, this is all in vitro studies. The Chinese used it. There was not a good randomized trial that showed it had a benefit. There is a trial from a French group, and again, small numbers, like six to nine patients. This has not been used in a randomized control trial. It was malpractice for Trump to say that this is a treatment for the disease. I think it’s — there are randomized control trials that are now being set up in the United States. People should try to get on those trials. But I do not think that this is a cure for the disease. Hopefully, we can prove it, we can prove it could be prophylactic. I don’t know. That is how we use it for malaria, as a prophylactic drug. But again, that whole cycle for malaria parasites is completely different than SARS, and you cannot — COVID-19. And you cannot jump to that conclusion. And it was very premature of him to say that. And that’s why you’re seeing a run on the market.
AMY GOODMAN: Can people relapse from COVID-19? And also talk about people who have recovered, the idea of using their antibodies as part of a serum that will help other people.
DR. MICHELE BARRY: Again, used by the Chinese. I think what would also be very helpful — we don’t yet have it in this country, which is also something I don’t quite understand why this hasn’t been ramped up more — is sero — blood testing — I don’t want to use a technical word — blood testing of whether you are building antibodies after the infection. So we don’t know the level of immunity of people after they’ve recovered. We don’t know if they can be reinfected, although looking at what happened in China, it doesn’t look as if there’s going to be reinfection. There have been one or two cases, one in Japan. There have been a couple of cases where they have shown reinfection, but we don’t know whether it was true reinfection, relapse or viral particles that the tests were picking up and not infectious. But looking at how the epidemic has been curbed in China, it looks like you won’t be able to get reinfected.
Now, sorry, that first question that you asked me, I sort of went off, on reinfection. What was —
AMY GOODMAN: Serum.
DR. MICHELE BARRY: Oh, serum. So, yes, pooled immunoglobulin, or antibodies, have been used in China. Again, they’re in the midst of an epidemic and did not do this in a randomized control trial. And I don’t — I’m sure that’s being set up in the U.S. That, I don’t know about. I know about the trials of remdesevir and chloroquine, the two treatments that are being used. And actually there are many other drugs. There’s a race to find the drug that’s the best drug.
AMY GOODMAN: And what would it look like if there was a kind of Manhattan Project set up in this country? You talked about the importance of the federal government being deeply involved, setting up a medical Peace Corps. Talk about the issue of the military. I mean, people in this country see the military fighting foreign wars. But when the enemy is at home, it’s a virus. How can you see the population in this country being mobilized in the most effective way? And then, how people — back to that basic question — can protect themselves the most, in the United States and around the world?
DR. MICHELE BARRY: Amy, I think you said it: This is a war. And we should be using — instead of using our military to go out there and, I don’t know, invade other countries, we should be using our military to help our workforce. I am really worried about our workforce being overwhelmed. I’m worried about behavioral fatigue, with quarantine and isolation. I’m worried about social services and mental illness for the folks that are quarantined and alone. This is a war, that we should be using our federal government to mobilize forces so that our medical system is not overwhelmed. And to separate it out by state by state and governor by governor, I just think, is a false approach.
AMY GOODMAN: And then, how people can protect themselves at home, in their communities? For you, it’s old hat. But give us the rules, from hand washing to a standard question people are asking, is “Can I go outside?” I mean, not even if there are other people there, but to go outside to walk in the fresh air. Could they be contaminated in some other way? Or should people just shelter at home, especially in cities, where, you know, you have to walk to a place, a public park or whatever?
DR. MICHELE BARRY: So, I think for people over the age of 60, you should shelter at home as much as you can. I think when one goes outside — and I think you should go outside, because we need exercise; there is something about your mental health that you need to consider — just make sure that you keep social distancing. That is what’s really, really important to think about. Again, it’s not an aerosolized virus. When you’re at home, or when you’re at all touching — be very careful when you’re outside touching doorknobs, touching elevator buttons. In SARS1, not COVID-19, but very related, one of the epidemics occurred in an elevator, touching buttons. Again, that’s something in New York City that you guys are going to have to think about. Make sure that you do not touch with your hands, or if you touch with your hands, don’t get crazy about not having sanitizer. Soap and water. You know, the going thing in California is to sing “Happy Birthday” to yourself twice. That gives you the 20 seconds of washing and lathering.
AMY GOODMAN: Final words, Dr. Michele Barry, as you head from your office back home, you, in California, are sheltering in place. All 40 million people in California have been told by the governor, Governor Newsom, to shelter in place. Your final thoughts?
DR. MICHELE BARRY: My final thoughts is, we’re all in this together. We need to work together as a society for civil society and public good. I think we have to remember it’s not about a snow day or a couple snow days. It’s not about a sprint. It’s really a marathon. This is going to take months. And we need to all work together as a team.
AMY GOODMAN: Do you see shelter in place going, ultimately, on for months, people isolating at home for months, society, schools, work not going on at the workplaces for months?
DR. MICHELE BARRY: Well, if you look at Wuhan, which had a very effective way of stopping the epidemic, it took them about two-and-a-half months, so — and that was — and they put in measures that I don’t think we as a country can put in. So, if you look at that — and again, I think we started this show off with my saying we need to learn from our colleagues overseas, what to do right and what’s not the right way to approach this epidemic. I think we need to take our governors, our public health commissioners seriously, when they say shelter at home.
AMY GOODMAN: And finally, where can people go for the most accurate information?
DR. MICHELE BARRY: Yeah. So, I still would strongly suggest — it depends upon what you want. If you’re in a business or want to figure out how to deal with your employees, OSHA has a very good website set up. But still, for regular folks who want to hear about what the guidelines are, CDC.gov has lots of very well-written advice for you to take. You know, I even go to CDC.gov for the — I definitely go to CDC.gov for the interim guidelines. And they’re changing constantly, so continue to check in on them on a daily basis.
AMY GOODMAN: Dr. Michele Barry, thank you so much for spending this time, director of the Center for Innovation in Global Health at Stanford University, incoming chair of the Consortium of Universities for Global Health. Dr. Barry is also past president of the American Society of Tropical Medicine. To see Part 1 of our discussion, you can go to democracynow.org. I’m Amy Goodman. Thank you so much.