What the US can do to bolster its pandemic resilience

Update: This episode has ended. 

In the first episode of Radio Corona, Gideon Lichfield, the editor-in-chief of MIT Technology Review, hosted a Q&A with Jamie Heywood, a health-care entrepreneur, the cofounder of PatientsLikeMe, and a former CDC advisor. They discussed the coronavirus, fragility, and resilience. You can read the transcript below.

Recorded on March 18, 2020.

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Gideon: I am very, very happy today to have with me Jamie Haywood. Jamie is a healthcare entrepreneur who built the world's first biotechnology nonprofit to work on research into ALS or Lou Gehrig's disease, which his younger brother suffered from and unfortunately passed away from. He also co-founded patients like me, which is a platform that lets people take control of their own healthcare data while also making it available to researchers. I'll ask him a little bit about some of those things, but Jamie, it's great to have you here. Thank you for joining us.

Jamie: It's a pleasure to be here - trying times or interesting times.

Gideon: Very, very interesting indeed. So, I am going to ask James a few questions and if you have questions for him or for me, you can drop them into the chat. And we'll be reading those and picking them out and feeding them to Jamie as we go. So Jamie let's start with you. We brought you in here because you were interviewed by our biomedicine reporter Antonio Regalado for a story about a month ago in which he described how you were preparing for the pandemic or for an event like this. Can you talk a little bit about why you were preparing and did you see something coming or were you just always in a state of readiness?

Jamie: You know this concept of preparing or how one manages disruptions in society, I really became aware of it when I worked with the CDC as part of the bio surveillance advisory committee for President Bush. And we were tasked, about 40 of us, with identifying threats to the nation that were biological in nature, putting them in the context of other events like asteroids or other traumatic events that could hurt the world's population, et cetera. And then figuring out how we build infrastructure and prepare for those events, both in terms of rapid response and then communication networks, all of those things. And at that time, I learned a few things that made me uncomfortable. And unfortunately, I think if you go back and read the predictions from our group, that's almost a decade ago now, they all have sort of come true, which is that the hospital systems have very little excess capacity. We're not really equipped to develop rapid responses or vaccines. There isn't coordination.

Gideon: Sorry, you were briefly muted for some reason.

Jamie: I don't know why that's going in and out. Let's try it now. Is it okay now?

Gideon: Yes.

Jamie: Sorry. So I guess I learned about how things that could go wrong would break things that we count on. And then you also learn about how little food there is functionally in the pipeline. And if you flash forward 10 years and we’re in the Amazon Walmart era with the transition from local retail to global retail to on-time distribution. One of the consequences of that is the entire world's supply chain has gotten shorter. I remember reading this great article, when you go buy a piece of clothing at a store, another one is made the next day to replace it and then it goes through their supply chain. So the advantage of that is we have an incredibly efficient world, very little waste, things costs less. The disadvantage of that is when something goes wrong - in workforce communications, energy credit, whatever - there isn't a lot of capacity in the system to absorb the hit. And so my family has always tried to thoughtfully think about "what would happen if things didn't exist, whether you lost energy or whether you lost the food supply or credit or money or you know, and - my partner is a clinician. What would you do without the medical system? I think I said in the article or at another time- I do not have the assumption that when I need it, the ER will be there for my children. I don't operate under that assumption because I think that it is an assumption born by a stable state that is not how the history of the world teaches us we'll live in. Now you're muted.

Gideon: I'm muting myself. So I mean you obviously are in a position I think to take some measures to prepare and to have resources on hand that maybe not everybody does. One question I think and hear as I'm getting some questions from the new audiences, first of all, do you think it's a case of making our supply chains more resilient and if so, what needs to happen for that? Or is it really, do you think it's more on people to be prepared? And what does preparation look like for the average person who can't afford to create their own mini-clinic at home or something like that?

Jamie: Well I think there are roles for people, there are roles for communities, there are roles for states, there are roles for federal governments. I don't know why it keeps switching off to mute. It's interesting, I'm not doing it. Anyway, there's roles for world governments in that. And what I would say is in general, we should put more investment into anticipating things that could go wrong. And you could see the value of that. I mean just looking at, literally a third of the stock market value has been wiped out by one event that had we invested less than 0.1% of the world's resources or 1% of the world's resources in anticipating, and maybe there's 10 or 20 events that could do that - so let's call it a 2-3% investment globally. We could have rolled this out. It's just not that overwhelming in an anticipated fashion. We knew it was coming. You know, the CDC knew it was coming. Everyone knew it was coming. It was designed. We didn't know it was going to be this virus, but we knew this would happen and we didn't prep for it so now we're suffering the consequence.

Gideon: How worried do you think we should be about food shortages for instance? You know, for me, I think for a lot of people, this became a lot realer last week when we started going to the supermarkets and seeing the shelves emptying out. And the retail chains are saying, no, don't worry, we've got this. Do you think we should be worried, especially if social distancing measures continue for weeks or months on end?

Jamie: Well look, my view is that this is going to get a lot worse over the next weeks. I think you can sort of roughly say we're three weeks behind Italy, give or take, and we're in that range plus or minus. And it's pretty rough over there. I also think the point you made about the supply chains, they can handle this, assuming that the workforce has continued to show up and the financial infrastructures to move capital around continue to operate well, which I think is going to take some thoughtful work on the part of the government. I wish I was a little more hopeful about the thoughtfulness of that, but I mean I think that if governments intervene in the markets thoughtfully and if people are rational in the balance of profiteering versus sort of being fair and good citizens. I think we can, I think we can withstand this. I don't think we're in this scenario that we're likely to run out of food, but this was not a particularly bad scenario in terms of a modeling. So I will also say the portion of society that does anticipate, because we didn't really buy anything for this event. We were largely prepared. I mean they create resilience for everyone else. There's sort of a little bit of a poopoo or, you know, "isn't that silly" to that community. I think that when something goes wrong, that community is buffering the consequences of this and helpful. You're, you're muted again

Gideon: Thank you. I keep muting myself because I don't want my HVAC to fill with the noise. Somebody asked me to follow up with you on one of the questions. It's like you said, the CDC knew this was going to happen, even if it's not this particular virus. Can you tell us a bit more? What do you think they knew and what was the shape of the inaction on their part? Or the failure to prepare in this case?

Jamie: I certainly don't want to blame the CDC, I mean the people. Well, I'll be political for a moment here. It has been profoundly frustrating for me to watch the level of criticism that lands on, you know, what we call the bureaucracy. Because the people that I knew at the CDC were really honorable, professional people that were really thoughtfully trying to make sure all of our children were safe. I find the same is true of the people in the military and the other parts of the government. So I think that there's a denigration of government employees that is just appalling given what they make. And they are our lifeline, our safety line. And so, there's a little bit of a component where we as citizens can't sit here and say, "oh, you know, they're terrible. They're terrible. Cut their pay, cut their salaries, cut their budgets. Oh by the way, save us now please with nothing." So I think at some level the CDC was stripped of its resources and not just by the current administration, but like consistently denied the resources to prepare. I think we consistently overestimate military threats and consistently underestimate environmental and biological threats. And so we should do far more to be resilient with that context, which is collaborative with the world as opposed to destructive. But what did we know? We knew that and were tracking dozens and dozens of potential pathogenic viruses that are on the verge of crossing species. There are people that understand how changes to them could really make them become weapons or backward vectors that are really dangerous. They're modeled, all of these scenarios are modeled. In fact, there are, there were sort of "war games" that are run when you run the vectors. And so when this came out in China, I would say any one of them start. There I go again. Anyone of the thousand experts that are sort of familiar in that space, just looked at the projections and said, "this is going to go pandemic and it's not stoppable and we should start acting." And that was two months ago. So we knew that was gonna happen 10 years ago and it's happened a year ago. We knew it was happening two months ago and we did not really anticipate or prepare ourselves to receive the blow.

Gideon: Okay. So if you've just joined us, I’m talking to a biotech entrepreneur, Jamie Haywood, and if you have questions you can drop them into the chat box. If you hover over your zoom screen, you'll see a little chat button at the bottom. Click on that and you can drop the questions that you want us to ask into the chat panel. So let me continue a little bit on the thread you were just talking about. What would it, so as you said, the CDC was, and other agencies, are tracking dozens of viruses that could cross over to humans. We know that there are different variables that can make a virus more or less dangerous as level of contagiousness, how long it stays incubated and so on. So we know that something like coronavirus or worse could come along at any time. What would it look like to have a system, both the national and the global level, that is sufficiently prepared for those kinds of viruses that when they come along it can move quickly to a) contain them and b) start working on treatments, vaccinations and so on?

Jamie: I think, well unpacking this really involves unpacking a lot of the relationship between sort of market driven capitalism and rational government. So if you look at the healthcare system, the investment in M.S. drugs, I think I'm gonna roughly guess is-

Gideon: Multiple sclerosis

Jamie: global investment in pandemic preparedness, just full-stop.

Gideon: Sorry say that again. How many times?

Jamie: MS drugs. If you look at the MS drug market, it's in the tens of billions a year. And if you look at the sort of really direct preparedness for this kind of work, it's just not close to that. So I'm not - I mean, my brother died of ALS, so I clearly care about treating disease, but I think that we have created a system where the bulk of the best minds are not working in balance between what the market tells them will make money on and what the society needs. And so I think there's a need to be realignment between sort of public health and public health objectives, which would include all the other things like clean water and access to better food and all of these objectives that are part of these medical systems. So I would hope that we use this for a moment to say, where should we spend our dollars to make ourselves healthy? Right? And to me, resilience is health. The next sort of set of things. And I think this is a little bit more of a structural, societal level. We are an increasingly specialized society and we increasingly teach people that they can't operate outside their specialties. And we sort of isolate the guilds. And I think that underestimates the flexibility of human beings. It tends to create people that have learned helplessness that they can't solve their own problems. There are societies like the Swiss or others where it's not sort of culturally ingrained in that way. And I think that we could engineer our schools and our training and the way we relate as a group into more resilience, learned ability to repair things, ability to grow things, ability to manage crises. These were given an example of how they do that. And in Switzerland, well they just have more basic training and they sort of have a sense that the citizens are all supposed to come to the aid of the country. It's sort of ingrained in the culture. Ha we have a guest on the show from Switzerland saying hi. I mean I think that they have this sort of concept, sort of community commons bunkers. It's sort of a little bit of a gun culture, but their guns are collected in a community context. And so I think that there are models like that and I'll do a simple observation. If you ask the question, “what percentage of homeowners could fix some set of items in their house 50 years ago versus today?”, I think the number is far lower. And that is an example of resilience failure because you are requiring a specialist to come in and sell something. And it's the same whether it's in food development, whatever it is. So specialization is efficient but not resilient. And I think that's, again, a structural question and I think it's also not good for people. I think that a lot of innovation comes.

Gideon: We seem to have lost Jamie briefly from the call. Uh, let's see. Sorry. He is back. We lost you for a minute. So about specialization.

Jamie: I'm an engineer in biotech. I mean that crossover between fields is where the innovation comes from. So I think that we've over-engineered specialization in our society. And the last part is I think big business is not very resilient. I think that smaller organizations are better and they're better for humans. They're better for society, they're better for communities. They're better for adaptability, not better for efficiency. Walmart will always crush small businesses as will Amazon. But we have engineered our society to be biased to big business in the way we look at-

Gideon: Sorry about these technical problems. But yeah-

Jamie: We biased our society against small business in the way it's operationalized, taxed, everything. And now these small effects like the frog and the boiling water produced a not very resilient society and that we should be thoughtful and fix it.

Gideon: Right. Some people are curious about the preparations that you have in your own home and what  you think are the basic preparations that an average person would need to do to make themselves in the household more resilient? Do you want to talk about that a bit?

Jamie: Yeah, I mean, some of it's just basic. We have food and capacity to make water. We have medicines that would be necessary in either a trauma or, to manage pneumonias or different kinds of antibiotics and that kind of thing. We have, let's call it, portable lightweight medical equipment, pulse ox, the stuff that essentially short of a ventilator, the measurement equivalent of an ICU- you know, EKG and all of the components. Again, we have a clinician in the house, so we know how to use this, but I also view myself as not caring for just my family, but my brothers and my parents. I don't view myself as just responsible for myself, but for the community. And last, I'm an engineer, so like to being prepared to fix things that don't work, being prepared to operate without power for an extended period, batteries, all that stuff. And that's all just part of our household and has been for a long time.

Gideon: What sorts of muscles do you think the government, the federal government in particular, has that it is not flexing yet? And also, do you think that different levels of preparedness among the states could be a problem if you have some states that have a much stronger response than others? Right now San Francisco has put just about everybody basically on lockdown, but some of the states are being very relaxed, for instance.

Jamie: Well, there's two parts of that question. I mean, one is how well do states prepare for emergencies? I think Massachusetts having been through a few things, you know, the bombings and stuff, we are more recently reviewed in our preparedness so I think that we're probably among the better of the states. We're also a wealthy state, which helps. The second part of that question is what's the strategy? This is what's depressing to me is that the information necessary to build the correct models, like how many people are really infected, how many of you have been really affected? How many people been exposed? What's the lethality? Who does it kill? You know, I'm part of a group that it's monitoring all this sort of frontline reports on this. And it's just depressing because those numbers have profound implications for what happens. And I think the current idea that slowing the progression of the virus in society through flattening the curve is the right one. But I think we really don't have much insight into what's going to make that effective or not, short of the sort of Chinese, very draconian but effective method versus what has been feasible or realistic in the United States. Maybe we should also reexamine that and again, trust our government more. Which I think we can do better.

Gideon: I wrote something yesterday that seemed to get a lot of responses where I talked about how I felt like people are not yet realizing that this is not a thing that you, we can try to shut everybody inside for a few weeks or a couple of months and then it's over. It will take at least until the vaccine is developed, we could be seeing, and this is the Imperial college study that was released on Monday, we could be seeing social distancing measures enforced for a couple of months at a time, over a period of a year and a half before we find the vaccine. And part of the reason is that if you want to keep the healthcare system going without total collapse, you need to keep the number of infections low. And if you keep the number of infections low, you don't develop herd immunity across the whole population very quickly. And so we have to get used to the idea that this is going to be on your normal for awhile. What do you think of that scenario?

Jamie: Yeah, I think what you wrote was very thoughtful and I encourage everyone to read it. The variables in that- so what I am hopeful about is that we have treatments in our arsenal or emerging arsenal that will modulate how the virus either replicates in the body or creates resistance to the cytokine storm or the thing that kills you in the end, the progressive part of the illness. I don't think we should be counting on vaccines anytime in the near future. This is just going to take awhile though. You know, again, miracles happen, but viruses are hard to build vaccines for. So I just don't think it's gonna be that simple or we should not count on it being that simple. I've been talking to a lot of friends trying to analyze the market and what to do next, which in hindsight I wished I had thought about cause that wasn't part of my list of preparations, but its sort of obvious what would happen. I think that what is complicated about what's going to happen here is it's going to get really- the probable outcome

Gideon: Sorry. There we go again.

Jamie: That's pretty ugly for the next, over the next few weeks, you know, let's call it three to two to five weeks, two to three, three to four weeks kind of range. I'm guessing most of us will know someone that knows someone they love get really badly affected, so it will feel very real. But what we don't know is to what degree immunity emerges and for how long, like for the flu immunity only seems to last seven years and then you can get a sort of give a different version. We don't know whether this is seasonal at all, there’s some evidence of that, but there's a bunch of unknowns and so those questions will look at whether this ends up being sort of the baseline sitting in the background, a one and done, you know, a flu with a different name. So the positive is I think we're going to learn how to get a better, we may or may not be able to create the vaccines, but we should not fool ourselves into how effective the flu vaccine is. It's still a rough disease, right? And then for the markets, I think what I'm struggling with is I do believe this is going to stimulate real demand. But I don't think that the bulk of the market has internalized that, as you wrote, society will shift permanently. I think there's going to be fundamental changes in the way people think and act and do that will affect the market- some in good ways, some in bad ways, and it's gonna be a rough adjustment and very rapid. I mean, I looked at the numbers today. I think it was 12,000 unemployment applications today. It was 8,000 on Friday. I think those were the number of Monday and Friday. I've heard in the last bad recession it was 5,000 a week. So we could be looking at some pretty rough economic times and I'm hopeful that people are thoughtful about how to manage that at the government level. It may take some intervention.

Gideon: Do you think we shouldn't be about this virus mutating, splitting into new strains, getting potentially even more lethal?

Jamie: There isn't a lot of reason for viruses to get more lethal. In fact, what all viruses want to do is make more of themselves. I mean, they don't even want that.

Gideon: That's just like us in that way.

Jamie: Well, yeah, but the viruses that make more of themselves, you know, make more of themselves. So it's just self perpetuating. And I think that at some level being more lethal makes that worse. There are a lot of viruses in our body that we aren’t even aware of that are replicating and propagating because they've just figured out how to balance. So in general, I mean, these are very general statements, but I think in general diseases tend to get less lethal. But they could go to a higher penetration rate. Sorry. My family's model is that we have assumed for the last two months that we will all get this. And that's the preparation. I think ultimately you want to get it later because I think we're going to better tools, but I'm not that worried about it getting worse. But I also think, by the way, we should not be under the illusion that something much worse could not come along. I mean, if you look at what's happening in the permafrost, you look at global warming and its impact on ecosystems, I mean, in my mind I'm anxious about smallpox returning. If we're getting live wolves, I’m sorry, recently dead wolves with blood out of them out of the Ice Age and on a regular basis, which we are, and mammoths or other kinds of things. This is a scary time to not be prepared for severely disruptive. I think if you've got the right group of people together and it's pretty obvious who they are, we could invest a little money as the world in being prepared to manage that in a way that’s much less painful.

Gideon: Someone was asking, someone from the finance industry is asking, and this may be related to what you were just saying, is there a collaborative effort from the financial and corporate side that can be done now to help by time until the vaccine is developed? Um, I don't know what exactly he’s asking, but what ideas can we talk about in our communities to help spearhead a new mentality?

Jamie: So speaking as a guy that owns a biotech company, or started on, I own part of it. I am disappointed in our scientific biological infrastructure today in that it seems more focused on who owns what and the potential profits and then how it can have impact in the best way. And I'm disappointed in medicine today. I think that it would be- you could imagine a world where the purpose was to serve reducing human suffering well, and people that did that well earned a reasonable profit. I think what we have is the purpose is to earn a profit and human life improvement is a secondary element in that. So I think that makes collaboration quite hard. In fact, I don't believe that, and this is an entrepreneur that started four companies and a nonprofit, in capitalism as being able to be altruistic at times of challenge to the commons. And I think it needs to be more balanced in our society to overweight and to counterbalance that. And I think the universities, frankly, are really not playing their role to the degree they should and they've become more machine. I'm being critical here, but this is a resilience gap that I don't see working as well as it should. The people that I see really working to do that are independent actors, not people attached institutions so much.

Gideon: Quite a lot of the questions we're getting in the chat are from people who kind of want to know some basic stuff like how the virus spreads, is it true that it can be spread by leaf blowers, you know, throwing this stuff through the air. It strikes me that there’s actually a lot that we don't know rather yet about how the virus spreads. For instance, we don't yet know a lot about how easy it is to catch it from let's say a pole in a subway train. Do you feel like we will know a lot more about that soon and will that effect on the policy choices that we make?

Jamie: So I don't want to, this is not particularly my area of expertise, but I have sort of two general thoughts about this. One is, we are overly obsessed with the idea of what it takes to catch it. So the exposure to the one thing that would hurt us, cause I don't think it works that way. It's much more complicated. You have to be vulnerable. There's a whole bunch of stuff that goes into that and much less into, Hey, did you get a good night's sleep last night? Because, if you didn't get a good sleep last night, you're more likely to be infected and unable to manage it. Right. So the curb of your immune response, these things are much more important. So I think about resilience as a human personal thing too. Did you eat well? One of my physicians like telling everyone “just stop drinking”. Like alcohol knocks your immune system down and you don't want to have four drinks last night and go out and get the virus the next day. You're ill prepared, you're giving it a chance to take itself on you. So, you know, sleep, sunlight, eating well, exercising safely and healthfully, these are things that create resilience in you. The second thing, you know, it's more- I think the answers we don't know and anyone that tells you they know the answer to any of these questions is extrapolating from false optimal data. So the data from the flu is that if you put people playing poker and they're wearing masks and eye goggles and gloves, they still get the flu. So there's something subtle about how viruses infect us that we don't understand. And as I just touched my face, I think the strategy is to create resilience in oneself. Follow the rules for social distancing in the right way and be prepared to be sick. Well, which means that you are taking care of yourself.

Gideon: And how do you think we're going to adapt as a society to having social distancing for long periods of time of possibly a year or more? Do you think that we're going to find ways - I mean, there are some proposals I've seen circulating that say let's just really isolate the people who are more vulnerable and have lighter restrictions and everybody else. Do you think we're going to get to that kind of thing?

Jamie: Well, the thing that I'm struggling with in these questions is I want to know what the next step is. So if we shut down commerce, if we shut down building everything, when do we restart it? The purpose of life is to live, not to sit in a padded room isolated, right? So the purpose of life is to live. And so I think that there is going to have to be some reassessing and I don't think it's about Corona, but reassessing of what matters and what risks and balances we take to do that. And it's interesting to do a walk around our neighborhood and you see everyone out in the sun and distance from each other, but they're walking in and seeing it. One of the hopeful things I think is, is that we're a very stressed, overly driven, manipulated species by our 24-7 sort of stimulation culture, a little bit of reset. It says, what do we really care about and how do we choose that? It sounds good to me cause I don't think what we were doing was healthy for us as individuals, society, communities, the country. World. So I'm kind of happy about that. I love the narratives about nature. Waking up. Yeah. I mean, I think that's true. I think that optimistic take as a good long term one, the short term problem of course, is that like, it's going to be really wrenching for people. Some of them have a lot of insecurity. Well, if you look at- So I'm doing some home construction right now and if you look at the very great people that are working in my house there, they're living paycheck to paycheck. They have families, they have houses. If you just take the average American wage of 50,000 a year. If their economics are shut off, even this sort of thousand dollar check proposed, I mean, they don't have really budgets to cut. They don't have much excess. Right. So one of my real concerns is we live in a society where the capital holders have kept the bulk of our population at the edge of sufficiency to keep them working all the time. And when you give it a hiccup, I mean we would have to get every one of those families, $500 a week to keep them from going under. And I don't know how long we can do that. So I think there's going to have to be a realignment of capital in our society back to the people that are living and away from the people that are holding the assets to make that work.

Gideon: I don't know if I lost you here. You're back. You're back.

Jamie: I'm back. Okay.

Gideon: We're going to wrap up in a second. So I'm going to ask you two final questions. One is, do you have any post webinar homework for the people on the call? Are there any books? So loads of movies or anything that you would suggest for firsthand coping?

Jamie: You know, let's take this as a blessing and we are forced to break our routines. So let's be observant about that and ask ourselves the question, what in our routines, the bar or seeing an unhealthy friend or seeing a healthy friend, caring for someone else versus trying to reach some goal that isn't going to get you what you want. Let's be intentional and think about what we want our children's communities to be like, take these weeks and come out of it with the intention to build that community for ourselves, to make something that is great with this technology. You know, in terms of the homework for the virus, I would say that again, the best thing you can do is sleep, hydrate, eat well, get sunlight, be well, so intentional health for yourself and your family is the solution. That's the best solution. There's no second to that. And then, let's pay attention to what we learn is working from the places that are succeeding in flattening the curve and apply them intentionally to our own society the best way.

Gideon: Great. Well, I was going to ask you what other final message you had for people, but that sounded like a pretty good one.

Jamie: It's been a pleasure and I appreciate Technology Review's leadership and these questions. It's been really thoughtful to keep reading it.

Gideon: Thank you, Jamie. So if you're on the call, please, thank you for tuning in. Remember, we've got a newsletter you can sign up on our site technologyreview.com and we hope to see you in the next webinar or the next edition of [inaudible]. If you sign up to the newsletter, you'll get notifications of when the next episodes are. Thank you very much and thank you, Jamie. Bye. Bye.