INSUBCONTINENT EXCLUSIVE:
Bill Gates, newly free from his role on the Microsoft board, has taken to Reddit to answer the community questions about the pandemic, the
government response, and what the world can do to be better prepared
Always candid but never cynical, Gates gives some heartening but realistic advice.
Worth noting at the outset is that Gates and the
Foundation have been warning about and preparing for an epidemic of this type for years
His 2015 TED talk in particular is extremely prescient, and he wrote a detailed article (PDF) around then for the New England Journal of
Medicine detailing the lessons we should learn from the Ebola outbreak
The Foundation also participated in the creation of the Center for Epidemic Preparedness Innovations in 2017
(A recent simulation with Johns Hopkins that has been getting attention for its eerie parallels to the present situation is not in fact a
prediction or good comparison.)
You can read all his responses (and the thousands of questions and comments) at the AMA, of course, but the
most interesting ones have been lightly edited and condensed below.
Q: What do you think about the current state of testing nationwide?
&The testing in the US is not organized yet…Things are a bit confused on this right now.&
Gates: The testing in the US is
In the next few weeks I hope the government fixes this by having a website you can go to to find out about home testing and kiosks
Things are a bit confused on this right now
In Seattle the U of W is providing thousands of tests per day but no one is connected to a national tracking system.
Whenever there is a
positive test it should be seen to understand where the disease is and whether we need to strengthen the social distancing
South Korea did a great job on this including digital contact tracing.
We need to democratize and scale the testing system by having a CDC
website that people go to and enter their situation
Priority situations should get tested within 24 hours
This is very possible since many countries have done it
Health care workers for example should have priority
Elderly people should have priority
We will be able to catch up on the testing demand within a few weeks of getting the system in place
Without the system we don''t know what is missing & swabs, reagents etc.
Q: What about this Imperial College study suggesting 1-4 million
Americans will die with current approaches, but total shutdown would limit deaths to a few thousand?
Fortunately it appears the parameters
used in that model were too negative
The experience in China is the most critical data we have
They did their &shut down& and were able to reduce the number of cases
They are testing widely so they see rebounds immediately and so far there have not been a lot
They avoided widespread infection
The Imperial model does not match this experience
Models are only as good as the assumptions put into them
People are working on models that match what we are seeing more closely and they will become a key tool
A group called Institute for Disease Modeling that I fund is one of the groups working with others on this.
One tool that is helping us is
looking at the genetics of the virus to understand the tree of infection.
Q: Can the 18 month estimate for a vaccine be shortened?
&My retiring from public boards was not related to the epidemic.&
Gates: This is a great question
There are over 6 different efforts going on to make a vaccine
Some use a new approach called RNA which is unproven
We will have to build lots of manufacturing for the different approaches knowing that some of them will not work
We will need literally billions of vaccines to protect the world
Vaccines require testing to make sure they are safe and effective
Some vaccines like the flu don''t for the elderly.
The first vaccines we get will go to health care workers and critical workers
This could happen before 18 months if everything goes well but we and Fauci and others are being careful not to promise this when we are not
The work is going at full speed.
Q: (Deleted, but regarding Gates stepping down from the Microsoft board)
Gates: My retiring from public
boards was not related to the epidemic but it does reinforce my decision to focus on the work of the Foundation including it work to help
with the epidemic.
Bill Gates leaves Microsoft board
Q: (In response to a deleted comment)
Gates: We should not call this the Chinese
virus.
&We should not call this the Chinese virus.&
Q: What about a timeline for effective treatment?
Gates: A therapeutic
could be available well before a vaccine
Ideally this would reduce the number of people who need intensive care including respirators
The Foundation has organized a Therapeutics Accelerator to look at all the most promising ideas and bring all the capabilities of industry
So I am hopeful something will come out of this
It could be an anti-viral or antibodies or something else.
One idea that is being explored is using the blood (plasma) from people who are
This may have antibodies to protect people
If it works it would be the fastest way to protect health care workers and patients who have severe disease.
Q: &Thoughts on
chloroquine/hydroxychloroquine?
Gates: There are a lot of therapeutic drugs being examined
This is one of many but it is not proven
If it works we will need to make sure the finite supplies are held for the patients who need it most
We have a study going on to figure this out
We also have a screening effort to look at all the ideas for Therapeutics because the number being proposed is very large and only the most
promising should be tried in patients
China was testing some things but now they have so few cases that that testing needs to move to other locations.
Q: Can you help with
ventilator production?
Gates: There are a lot of efforts to do this
If we do social distancing (&shut down&) properly then the surge of cases won''t be as overwhelming
Our Foundation expertise is in diagnostics, therapeutics and vaccines so we are not involved in the ventilator efforts but it could make a
contribution to have more especially as the disease gets into developing countries including Africa.
Q: What do you think of efforts to
slow the spread?
&I worry about all the economic damage, but even worse will be how this will affect the developing countries who
cannot do the social distancing the same way as rich countries, and whose hospital capacity is much lower.&
Gates: The only model
that is known to work is a serious social distancing effort (&shut down&)
If you don''t do this then the disease will spread to a high percentage of the population and your hospitals will be overloaded with cases
So this should be avoided despite the problems caused by the &shut down&
If a country doesn''t control its cases then other countries will prevent anyone going into or coming out of that country.
We are going
into lockdown but as usual in retrospect we should have done it sooner
The sooner it is done the easier it is to get the cases down to small numbers.
The current phase has a lot of the cases in rich countries
With the right actions including the testing and social distancing within 2-3 months the rich countries should have avoided high levels of
I worry about all the economic damage, but even worse will be how this will affect the developing countries who cannot do the social
distancing the same way as rich countries, and whose hospital capacity is much lower.
Some people like health care workers will be doing
heroic work and we need to support them
We do need to stay calm even though this is an unprecedented situation.
&People like health care workers will be doing heroic work
and we need to support them.&
Q: What about a national &shelter in place& policy?
Gates: Most people can shelter in their home but
for people who that doesn''t work for there should be a place for them to go
We are working on seeing if we can send test kits to people at home so they don''t have to go out and so the tests get to the people who are
The US still is not organized on testing.
I think people in the US will be able to largely isolate for 2-3 months
If they can access testing including a home test kit then they will understand who is infected
I keep saying how important the testing piece is.
Q: What can educators and parents do for students, especially kids from low income
families?
Gates: It is a huge problem that schools will likely be shut down for the next few months
There are a lot of online resources from people like Khan Academy and Scholastic
Comcast and other internet connectivity providers are doing special programs to help with access
Microsoft and others are working on getting machines out but the supply chain is quite constrained
Unfortunately low-income students will be hurt more by the situation than others so we need to help any way we can.
Lawmakers look to
bridge ‘homework gap& with subsidized Wi-Fi hotspots for students
Q: How should we determine which businesses should stay
open?
Gates: The question of which businesses should keep going is tricky
Certainly food supply and the health system
We still need water, electricity and the internet
Supply chains for critical things need to be maintained
Countries are still figuring out what to keep running.
Eventually we will have some digital certificates to show who has recovered or been
tested recently, or when we have a vaccine, who has received it.
Q: Will there be multiple waves or &rebounds& after the first?
Eventually we will have some digital certificates to show who has recovered or been tested recently, or when we have a vaccine, who
has received it.
Gates: It depends on how you deal with people coming in from other countries and how strong the testing effort was
So far in China the amount of rebound being seen is very low
They are controlling people coming into the country very tightly
Hong Kong, Taiwan and Singapore have all done a good job on this
If we do it right the rebounds should be fairly small in numbers.
There are many models to look at what will happen
That article is based on a set of assumptions derived from Influenza and it doesn''t match what has happened in China or even South Korea
So we need to be humble about what we know but it does appear that social distancing with testing can get the cases down to low levels.
In
China less than .01% of the population was infected because of the measures they took
Most rich countries should be able to achieve a low level of infections
Some developing countries will not be able to do that.
Q: How is the Foundation helping, and how can we help?
Our foundation is working with
all the groups who make diagnostics, therapeutics and vaccines to make sure the right efforts are prioritized
We want to make sure all countries get access to these tools
We donated $100M in February for a variety of things and we will be doing more
One priority is to make sure that there is enough manufacturing capacity for therapeutics and vaccines
We have other efforts like our education group working to make sure the online resources for students are as helpful as they can be.
We
don''t yet have all the tools we need to fight COVID-19
This is an important step toward having treatments, while we also explore vaccines and diagnostics
Thanks to @wellcometrust and @mastercard for launching this effort with us
https://t.co/M8AJ3083zK
mdash; Bill Gates (@BillGates) March 10, 2020
There will be lots of opportunity to give to social service
organizations including food banks and I am sure people will be generous about this
Once we know who tests positive we can figure out how to support them so they can stay isolated and still get the food and medicine they
need.
Q: How can we be better prepared for the next pandemic?
We need to have the ability to scale up diagnostics, drugs and
The technologies exist to do this well if the right investments are made.
Gates: The TED talk I did in 2015 talked about this
We need to have the ability to scale up diagnostics, drugs and vaccines very rapidly
The technologies exist to do this well if the right investments are made
Countries can work together on this
We did create CEPI = Coalition for Epidemic Preparedness Innovation which did some work on vaccines but that needs to be funded at higher
level to have the standby manufacturing capacity for the world.
I think that after this is under control that Governments and others will
invest heavily in being ready for the next one
This will take global cooperation particularly to help the developing countries who will be hurt the most
A good example is the need to test therapeutics wherever the disease is to help the whole world
The Virus doesn''t respect national boundaries.
Q(?): I can''t believe Bill Gates just answered my question! (And general thanks.)
Gates:
Its nice to hear something positive in this time of great uncertainty
I hope the Reddit community can spread the word about social distancing
Digital tools like this can help us stay in touch even though we are physically isolated.
