The Gates Foundation WeChat public account released Bill Gates’s signed article “Gates Answered 31 Questions About New Corona Pneumonia“.
Bill Gates said that he recently had a question and answer on new coronary pneumonia (COVID-19) in the “Ask Me Anything” section of Reddit. This article is these questions and his answers (slightly adjusted).
1. What worries you most about the current epidemic crisis? What gives you the greatest hope?
At present, many rich countries are also suffering from epidemics. If reasonable measures are taken, including detection and “Social Distancing,” which I call “Shut down,” then these countries should be able to avoid mass infections within 2 to 3 months. I worry about all the economic losses caused by the epidemic, and what is worse, how this will affect developing countries, they cannot be isolated like rich countries, and their medical conditions are much worse.
2. Can you briefly talk about how most Americans should help others during this crisis?
The key is to take the “retreat” measures I mentioned just now in your community, so the infection rate will drop sharply and get our lives back on track as soon as possible. Healthcare workers are heroic and we need to support their work. Even if this is an unprecedented situation, we need to remain calm at all times.
3. Can the 18-month vaccine development cycle be shortened? How much can it be shortened?
This is a great question. There are currently more than 6 vaccine research and development methods underway. Someone is adopting a new method called RNA. We will do a lot of development for different methods because we know that some methods will fail. We will need billions of doses of vaccines to protect the world. The vaccine needs to be tested to ensure it is safe and effective. Some vaccines, such as the flu vaccine, are not suitable for older people.
The first batch of vaccines we receive will be provided to healthcare workers and staff in key positions. If all goes well, maybe 18 months, but we and Anthony Fauci (Dr. Anthony Fauci, American infectious disease expert) and others need to be careful not to make commitments in uncertain situations. Work on vaccine development is proceeding at full speed.
4. I would also like to ask about the progress of effective therapies.
Effective treatments should appear earlier than vaccines. Ideally, this will reduce the number of intensive care cases that require measures such as a ventilator. The Gates Foundation has organized a “Therapeutics Accelerator” project to discover the most promising therapies and pool the capabilities of the entire industry. I look forward to the emergence of promising solutions, which may be antiviral drugs, antibodies or other treatments.
One option that is currently being explored is the use of blood (plasma) in cured cases, in which antibodies may be protective. If it does work, it will be the fastest way to protect health care workers and critically ill patients.
5. As an educator, what can I do for my students? Especially low-income students who cannot get technical support during this time. I’ve tried sending them comforting emails (and pictures of cats), but I still worry about the long-term impact of the outbreak on education and student health.
Schools are likely to close in the next few months, which is really a big deal. But what impresses me is that many teachers use creative distance learning methods (if you are such a teacher, thank you for this work). But I know that not everyone is qualified for distance learning. There are also many high-quality educational resources online, such as Khan Academy, CommonLit, Graphical Mathematics, Zearn, and Scholastic. Comcast and other networked vendors are implementing special programs to help people access these online resources. Microsoft and others are working hard to provide the hardware, but the supply chain is under pressure. Unfortunately, low-income students are more affected in this situation, and we need to help them as much as possible.
6. How would you rate China’s response to the outbreak? If you rate from 1 to 10, how many points would you give China?
After January 23, China realized the seriousness of the epidemic and then implemented strong quarantine measures with remarkable results. Of course, isolation has made it difficult for everyone, but it did prevent the spread of the epidemic. Other countries will do different things, but the combination of detection and isolation is clearly effective. Until we get the vaccine, we can only do so.
7. No matter how long this pandemic lasts, what do you think are the first steps we should take as a global village after its end, and how can we better cope with the next pandemic?
I talked about this in a TED talk in 2015. We need the ability to scale up diagnostics, medicines, and vaccines quickly. With the right investment, existing technology can do just that. Countries can work together in this regard. We have created the CEPI (Coalition for Epidemic Preparedness Innovation). It has done some work on vaccines, but it needs more funding to enable the world to have the capacity to mass-produce at any time.
8. You and other experts have warned about such incidents, why are most governments in the world not prepared?
No one can predict the chance of a new virus emerging. But we know that flu or other respiratory viruses will definitely happen at some time, and the world lacks special funding for this issue. The Gates Foundation, Wellcome, and governments such as Norway, Japan, Germany, and the United Kingdom have co-funded the creation of CEPI, but compared to actual demand, this is still a fortune. We will prepare for possible fires and wars, and now we must prepare for equally serious epidemics. The good news is that our biological tools, including new approaches to diagnosis, treatment, and vaccine development, give us the ability to build a robust response system to a naturally-occurring epidemic.
9. I live in Seattle like you and I feel our tests have not increased. We also have fewer confirmed cases than other states. What do you think is the cause? Measures to maintain social distance or not enough tests?
Virus testing in the United States has not been organized. In the next few weeks, I hope the government can set up a website to solve this problem, and you can learn about the information related to the outbreak such as home testing on the website. The current testing effort is a bit confusing. In Seattle, the University of Washington can perform thousands of tests every day, but these tests are not connected to the national tracking system.
Whenever a positive case is found, a report should be made to track where the case appears and decide whether to strengthen isolation. South Korea has done a good job in this regard, and it has established a digital tracking system.
10. I read the report of the Imperial College of Technology’s New Coronary Pneumonia COVID-19 Response Team and the analysis under different conditions. Basically, if no action is taken, 4 million Americans will die from new coronary pneumonia; through mitigation strategies, namely, “social distance” and “flattening the curve”, 1.1 to 2 million Americans will die from new coronary pneumonia; However, the report also pointed out that if a strong “repression strategy”, that is, a “full blockade for 18 months”, only a few thousand deaths would occur. Do you agree with these numbers? If so, why not implement a “shelter in place” policy across the country immediately?
Thankfully, the model parameters used in this study appear to be too negative. China’s experience is the most critical data we can get. They have implemented effective blockades and reduced confirmed cases. They performed extensive tests, so they immediately saw a sharp rise in confirmed cases, but so far, the number of new cases has been very small, and China has successfully avoided large-scale infections. The model used by the Imperial College of Technology does not fit China’s situation. The quality of a model depends on the assumptions in it. Someone is working on a model that is more in line with what we see, and this will be a key tool. One of the organizations I funded called the Institute for Disease Modeling is working in this area.
11. The new coronavirus detection standard seems to be more beneficial to the rich and famous, which is very unfair. Those who are being tested are professional athletes and even people who have no symptoms at all. I’m not talking about health workers or people who hold important positions, but people such as actors, athletes. On the other hand, the guidance from the Kaiser Health Foundation in Washington is that you must have a fever to 101.5 degrees Fahrenheit (38.6 degrees Celsius) and have severe breathing difficulties or a severe cough to perform the test, and even then, the test results are required Wait 5 days or more.
Why do rich people and celebrities get special treatment even for projects that should be managed by the government, such as New coronavirus detection? Should there be a large number of tests left for so-called “important people”? Everyone else has been told that they need to pay attention to the public interest and avoid putting too high demands on the medical system, but it is not hypocritical that rich and famous people can get what they want when they need it.
We need to expand and “democratize” the detection system through the CDC’s website. People can log in to the website and enter their own situation. Priority should be detected within 24 hours. This is likely to happen, as many countries are already doing this. For example, health care workers and the elderly should enjoy this priority. We will be able to meet testing requirements within a few weeks of the system being in place. Without such a system, we would not know exactly what was missing-whether it was a swab or a reagent.
12. What do you think of the Dutch strategy to fight the epidemic? They will not “retreat” completely, but will try to control the spread of the epidemic to achieve “herd immunity”.
The only effective model currently is known is to strictly maintain social distance (retreat). If this is not done, the proportion of infected people will be high and hospitals will be overloaded. Therefore, although “retreat” can cause some problems, strict measures should also be taken. If one country cannot control it, other countries will prevent anyone from entering or leaving the country. I think the Netherlands will eventually take control measures that other countries are taking.
13. How would you rate chloroquine/hydroxychloroquine?
Many therapeutic drugs are being tested, one of which is chloroquine or hydroxychloroquine, but the effect has not been proven. If it works, we need to provide a limited supply to those who need it most. We are researching this, and we are also screening and searching for other effective drugs, because the number of candidate drugs is very large, and only the most promising drugs should be tested on patients. Some tests have been done in China, but they have fewer and fewer cases, so they need to be tested elsewhere.
14. What kind of help can your foundation provide for outbreak prevention and control? Donate money or make products for healthcare workers?
The Gates Foundation is working with all organizations involved in diagnostics, treatment, and vaccines to ensure that the right initiatives are prioritized. We want to ensure that all countries have access to effective tools. We donated $ 100 million for a series of work in response to the epidemic in February, and we will do more. One of the priorities is to ensure that we have sufficient capacity for the production of therapeutic drugs and vaccines. We have also done a few other things, such as our education project team is working hard to ensure that online resources for students are as helpful as possible.
15. Can you help produce a ventilator?
Much work is already underway in this regard. If we effectively maintain social distance (retreat), the number of cases will not surge. Our foundation specializes in diagnosis, treatment, and vaccines, so we currently have no work-related to interventional ventilators. But if the epidemic spreads to developing countries and regions such as Africa, the foundation can also contribute in this regard.
16. Should “shelter in place” policies be implemented nationwide?
Most people can take refuge at home, but for those who can’t, they should be provided with shelter. We are investigating whether we can send virus test kits to people who stay at home so they don’t have to go out and those who need priority can test at home. The United States still has not organized effective detection measures.
17. While maintaining social distance, what adjustments must we make to the way businesses operate to sustain the economy?
Which companies should stay in business is a tricky question. The food supply and sanitation system should, of course, function normally. We also need hydropower and networks, and the supply chain for these critical supplies needs to be maintained. Countries are exploring this.
Ultimately, we will use an electronic health certificate that shows who is recovering or who has recently been tested, or who has been vaccinated when we have a vaccine.
18. When will all this end?
To keep the epidemic to a minimum, we need vaccines. If reasonable measures are taken, many rich countries (including the United States) can keep the number of cases low, but it will be difficult for developing countries to stop the spread of the disease, so vaccines are essential. Once we have a mass-produced vaccine, organizations like Gavi (The Global Alliance for Vaccines and Immunisation) that help developing countries to procure vaccines will play a key role.
19. How long will this situation last?
This will vary from country to country. Cases in China have fallen to a low point, and their testing and “retreat” measures have been very effective. If a country is well-tested and can “retreat” within 6 to 10 weeks, then they should also see a significant reduction in cases and be able to reopen.
20. Will the epidemic “rebound” if the “retreat” ends?
It depends on how you respond to the immigration crowd and how well you test. So far, the rebound of China’s epidemic has been very low. They have implemented very strict border controls. Hong Kong, China, Taiwan, Singapore have done very well on this point. If we can do it well, there should be relatively few cases of rebound.
21. How many confirmed cases are expected in a month? Three months? What about six months? What do you think will happen after China lifts the blockade? Will the second wave of outbreaks occur?
China has reported a few cases of rebounds. South Korea is also moving in a positive direction. If confirmed cases are self-isolated, the rate of transmission will be very slow. The sooner you know the infection, the sooner you can isolate it.
22. Can you estimate how many people in the world will be infected?
This will vary from country to country. Taiwan, Hong Kong, and Singapore have responded quickly, with very few cases. The proportion of infections in mainland China will also remain at a very low level (less than 0.01%), and Thailand is another good case. Unfortunately, isolation is much more difficult for poor countries. People live densely and need to work continuously to get food, so countries with widespread virus transmission may occur.
23. Given the economic impact of these quarantine measures, will your foundation work in addition to direct medical intervention? For example, increased investment in “food banks”, political support for bills to provide workers with income and sick leave, and so on.
Our foundation focuses on these areas of expertise: diagnostics, treatment, and vaccines. I believe that everyone has a lot of opportunities to donate to these social service organizations, including food banks, etc. People will generously donate to this. Once someone is diagnosed, we can find ways to help them and get the food and medicine they need while maintaining isolation.
24. I have a friend who is a doctor of the National Health Service (NHS). Since yesterday, he has been working without a mask because he has run out of masks. I want to ask who has taken up all the masks?
I deeply regret this news. This also explains why people need to maintain social distance to minimize the number of cases, and why we need to get national testing networks and databases up and running as quickly as possible.
25. The New York Times has just published a report saying that according to a leaked government document, the outbreak will last for 18 months and will be repeated many times. How would you rate this?
There are many models available for prediction. That article was based on a set of hypotheses derived from flu models that were not in line with the situation in China or even Korea, so we need to be humble about what we know. It now appears that maintaining social distance and effective testing can reduce cases to lower levels.
26. But when the quarantine is lifted, will the epidemic rebound? The total number of people cured is still a very small number compared to the total number of people who may still be infected.
Our goal is to keep infections to a small percentage. Under strong measures, less than 0.01% of China’s population is infected. And most rich countries should be able to keep infection rates low. Some developing countries will not be able to do this.
27. Do you believe news from China?
China is doing a lot of testing, and South Korea is doing a good job of testing. When China’s epidemic was very severe in January this year, their news was quite public. The good news is that they now have very few cases of infection. The United States needs to organize inspection systems so that we can see the trends.
28. What measures should I take to reduce my contact with my grandparents when they deliver living items?
Washing your hands is the key and keep your distance. If you are feverish or coughing yourself, let others do the work for you.
29. Why hasn’t the United States “retreat”?
We are about to go into retreat. But in retrospect, we should do it earlier. The sooner this is done, the easier it will be to keep the number of cases low.
30. In your opinion, will the economy recover after the epidemic is over?
It will eventually. The impact of “retreat” on the economy will be huge, but if done well (including the testing link I have mentioned all the time), then we will eventually get back on track.
31. What do you think is the long-term strategy for the pandemic? Will this war make us fully prepared for the next epidemic?
I think that after all this is under control, governments and other organizations will invest heavily to prepare for the next crisis. Global cooperation is particularly important for helping the most affected developing countries. A good example is that no matter where the disease occurs, treatments need to be tested to help the world. Because the virus knows no borders.