Freelancer Seminar Series: What can we expect from Coronavirus?

How the Coronavirus (Covid-19) pandemic is unfolding, what we can expect in the days ahead and what governments must do now to contain the spread
Mar 31, 2020 • 31 minute read
Adam Smith @HomebrandAdam
Technical Co-pilot
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An in-depth look at how the pandemic is unfolding

Every week at Freelancer.com in our global town hall we run talks on globally significant topics.
 
This week we had Michael Liedtke, Product Manager of the API who has a Masters in Public Health, specialising in Epidemiology, which is the the branch of medicine which deals with the incidence, distribution, and possible control of diseases and other factors relating to health, detail in length the factors around the Coronavirus outbreak. 
 
We deem this talk so significant that we think it is the canonical reference to the global outbreak and decided to make it public so that the world can be educated. Introducing the Freelancer Seminar Series: Insights on the Pandemic.
 
 
 
Freelancer recently sent a Global Coronavirus (nCov-19) Survey to 40 million users on what governments are doing — and should be doing — to stop Coronavirus. We surveyed on the topics of business, health, behavior, access and government response. See the full 100 page report here
 
For a transcript of the video and links to the resources mentioned, read below.

 

Resources

 

Transcript:

Today is Friday March 27th 2020. Today I'm going to be sharing with you insights on the pandemic as part of the Freelancer Seminar Series.

My name is Michael Liedtke. I have a Masters in Public Health. I studied Epidemiology at grad school. That was my major. Today I'm the product manager of the Freelancer API, but I have experience working in the Australian healthcare system and the Tanzanian healthcare system.

In any case let's get to it.

So today I'm going to just give you a brief introduction on what's going on, I'm gonna go through the state of the pandemic, the data and where to find it, what it all means. I'm gonna share with you a really great tool. It's an epidemic calculator that gives you insight into how epidemics and pandemics progress and what you can do about them.

Next, I'm going to move on to "The Hammer and the Dance." Now, this was a piece of analysis that's been gone viral itself. Really interesting ideas and concepts in this. A couple of problems with it but, we'll go through that get, to help you get your head around it.

Then I'm gonna take a look at the kind of government response, what governments can do, what businesses can do and what people as individuals can do, and finally we'll wrap up with kind of looking into the future and how this all is gonna play out.

So first off, I think it's pretty evident to anyone watching this today that this is a world historic event. You know, it's basically a denial-of-service attack on healthcare systems and economies.

Think of cloud computing. There's all sorts of investment made in the last decade or two on being able to scale up to handle millions if not billions of customers in the cloud. Now this sort of technology can't really be applied to healthcare systems today, and that's why part of the reason why we're facing such trouble. So how we respond in the coming weeks and months is really going to determine how we come out of this, and in the course of the next decade.

This is a really important point in time and we really need to adjust to this. The adjustment period's very important. Being in denial about what's happening and how we respond, it makes the problem, you know, can make the problem orders of magnitude worse. So it's really important that we're on top of things, we move fast, we make decisive actions and and we move forward.

The other thing I'll point out is that that, in addition to washing our hands and being hygienic, in this day and age through this pandemic, we really need to be careful about the facts and the data going around. Now, I'm not perfect in this regard. Of all the things, I know only a portion of them are true. It's just difficult figuring out which portion is, so we need to be careful about the data we consume. A lot of misconceptions, misinformation floating around. We also have to be careful about what we share, and that we're not compounding the problem by sharing things that are not true.

So let's jump into the state of that pandemic. I'm just gonna go through some online data sources now, I'm just going to start with the the CDC in the US. They have a whole section of their site now dedicated to Covid-19. This is a good resource for anyone who wants to get some knowledge about how they should deal with this, whether they're a worker in the healthcare system or just a citizen. Very useful information here also some morbidity and mortality statistics and other sorts of guidance. So I'll give that to you to peruse.

The other thing at the CDC, they have a weekly report. The Morbidity and Mortality Weekly. There's a section on the novel coronavirus as well, so you can take a look at that.

Moving on now, this site is the Corona Clock, and someone created this because his mom wasn't really getting the message, didn't realize the severity of the situation, and that we really need to pay attention to the recommendations we're receiving from our local governments, on self isolation and quarantine and making sure that we're not spreading this virus around. So this just counts down the time to the next death, next infection and next recovery.

Now, this data is being pulled, I think, hourly or every several hours from some of the John Hopkins data or something. It's not perfect, but gives you a sense of kind of the urgency that we face today.

The next thing I'm going to pull up is just the John Hopkins data. They've mapped out all of the cases and deaths and so forth across the world, so you can kind of drill into the different countries and cities and so forth. And again, this is pulled from multiple sources. It's not the the necessarily 100% accurate, but it's pretty much the most accurate data we have in one place today.

Another resource which is really useful is the Worldometer data. Now, to take you through some different countries here, this is as of today, Friday the 27th of March 2020, we're up to over half a million cases, 24,000 deaths and 123,000 recovered.

Now, it's useful to understand that these numbers are what's been reported. Obviously, there's a lot other people out in the population who haven't been tested, had an asymptomatic case or subclinical case, and it hasn't really bubbled up into the purview of the healthcare systems monitoring all this. However, of those serious enough to appear on the radar of various healthcare systems and these surveillance networks, we see that 5% of active cases — these are people today who actively have this virus — are serious or critical, and that's a very high number and very concerning as we see this this grow.

Another very concerning number is the closed cases. So, again, I think people on the radar in the system, we see 16% of closed cases have resulted in death, so that's a pretty stark figure as well. We can see the the massive growth here.

Now I'm just going to switch to the logarithmic views here. We can see that there's the slope here has been increasing. Now this is this is kind of interesting. So on a logarithmic scale, if you have a straight line that means that it's an exponential growth, and the fact that the slope is steeper means that the time between doubling is decreasing so this this is accelerating.

Now eventually epidemics, pandemics, they burn out, so there'll be an inflection point on that and then it will taper off, and you'll have like a logistic curve. In any case, we see that the growth has been accelerating. If you've been following this from the early days, the fact that it's going up by such large numbers — you know, 30,000–40,000 cases a day and even more — is very, very confronting.

So now down to the countries. Today is the the first day where the US has topped China. You know that started in China, kind of topped out at 80,000 cases.

Now again, these are what's been reported. We don't know how much of this information is true, but just based on this, it kind of gives you a sense for how different countries are coping with with these things.

Now a few weeks ago, these new cases per day were in the tens and maybe into the hundreds. If you've been following this you'll notice that these have gone from hundreds to thousands and now into the five figures with the US here.

Italy has topped out [and] so far they're still seeing six, seven hundred cases a day, deaths a day. Also troubling here there's still a lot of active cases, so some of these cases that are active remain in the hospital for a very, very long time. Over a month. So that's very concerning. 

I'll also point out the total cases per million population. These a month ago were 50, 60, 70, maybe 100, 200. And now they are up into 1,300 cases, and Italy, 136 cases per million of population. So these numbers have been just growing and growing and growing and becoming more and more concerning.

Now taking a look at Australia here. I know we have an audience in Australia, so again we're kind of early on in the curve here, but we should expect to be seeing numbers like up here at some point unless we really take drastic action to tamp down on these issues.

Again, taking a look at Australia, the cases per million population, 120. Deaths per million population, 0.5. So in terms of potential and, you know, like you know these numbers from Italy and so forth, they haven't topped out yet. But we have a long way to go if we continue on the trend without taking action.

Now I know action has has started and you know but it's important that that continues and that on all levels, not just the government plans, but that people respond to this on an individual basis.

I will also say that these numbers are largely due to how much you test. We really need to test, test, test for all this stuff. Look at Switzerland. [Switzerland] has been doing a lot of testing, but they've also had kind of been slow to respond in terms of how they've cracked down on group gatherings and so forth. So, yes, a lot of, lot of problems here.

Jumping into the Australian details here, we can see this curve heading upward, and again, we have this exponential growth here, linear from 100 to 1,000, so the time to get from 100 to 1,000 is gonna be the same from 1,000 to 10,000, and then again from 10,000 to 100,000. And we see this across a lot of countries.

Freelancer also has an office in the Philippines, so we see they're a little bit earlier in all of this. The curve is a little bit different here. Maybe they're they're having some results from their social isolation policies, but we can see kind of similar concerns.

Canada as well, similar type curves and exponential growth. And the US, of course, now leading the boards. Obviously, New York City has is deeply problematic just with the density and all the public transportation and so forth, that's been spilling over to New Jersey. It had been Washington and California leading the way, but with New York coming online with this New Jersey spillover, all of this stuff is just going to grow and grow.

So let's just see where we are here. So that's kind of some of places you can get data if you want to look at this day-to-day useful information. I'll just point out one thing about this as well: So if you imagine that — I think we know at this point more or less that the the course from infection to a death for a person who ends up succumbing to this is about 20 days — now in in 20 days if you find out that there's one death in your neighborhood, what that means is that that person was infected 20 days ago. It also means that if there's a 1% case fatality rate, that means that there were a hundred people walking around your neighborhood infected by the time that one death showed up.

So one of the big problems with this particular pandemic is that it's not obvious that people need to self-isolate. If you get the flu and you're sick within a day, you're at home within a day and you are not spreading it around. However, if you get this and you're walking around for five days, before I even notice if anything's wrong, well that's part of the reason why this spreads so easily. So just because some people are trying to time when they start wearing masks or time when they start staying home, well, if you're doing that, you're doing it too late.

So it's important that we we keep that in mind when we're figuring out which policies to have, we really need to be kind of looking backwards so we can look forward to what happens.

Next thing I'm gonna look at here is an Epidemic Calculator. Now this this is actually a super useful thing. I wish I had this in school. It really illustrates kind of what happens during an outbreak.

Now, this is based on the SIR model, which is the Susceptible Infectious Recovered model. It's actually much more complicated than that. In this case we have susceptible population, then exposed, infectious, recovered. That's this model. Then we have some other things here. We have hospitalized and fatalities. But the idea with this is that you can take a look at the data over time, so the number of days is on the x-axis and the y-axis is the number of cases, and then the colors show you which stage of the disease each are in. It also calls out the peak hospitalizations based on the given data.

So we can play around with these inputs. So I've got a 7 million sized population here, initial number of infections is 99.

So, R-naught is the reproductive factor. So it's basically, given one case, how many more cases does it lead to? So if one person, if R-naught is one they yield one more case, and that person yields one more case. So basically the total number infected any given time stays the same. It's always one. It's one, and then one, then one and one. If it's two, well you get one leads to two and two leads to four, and you've got that exponential growth.

So the key thing when modeling an epidemic and designing policy around it is trying to figure out how to reduce that R-naught value below one, and so we have the concept of an R-naught budge. Like, what tools do we have to reduce that R-naught? You know, closing schools is one tool, closing restaurants is another, and each of these has an economic cost, so we can basically design our society, when dealing with this pandemic in a way that maximizes the results without entirely killing your economy.

Now, all these things we can play around with. These are sliders here, so I'm going to just show you briefly what happens when we take the R-naught up. So, again, starting there's 99 people out of a population of 7 million. If we start moving R-naught up again, and also this, this is decreasing, so right from the start we're basically peak hospitalizations, around a 45 and peaked at 39 for the given mortality and transmission and so forth. But it just, it kind of falls away the whole way.

Now, with R-naught above that, we see it actually climbs, because we got that exponential growth. But we also have, over time, people recovering, so that means there's fewer people susceptible, and so that's where you get a peak and then a drop.

So you can play around with this and you can model out, you know, everything in your population. We also see here, so I just bumped the R-naught up to nearly four, and we get this big peak here, peak hospitalizations 800,000. So that's massive. So you can you can see the impact R-naught has on things is absolutely huge, and that means that we all as citizens have to do our part to keep that down.

In any case I highly recommend playing around this tool. You can play around with the sliders, see how it all works. There's a bunch of epidemiology resources and stuff, but um that's that's a super cool tool. 

Alright, so the next thing after this is "The Hammer and the Dance." Now this is an analysis that was published on Medium that's gone viral, and it's a super useful look at kind of how to game out this challenge we're all facing. So this is worth taking a close look at. I recommend you read the whole thing, but I’m just going to highlight a few things.

So first off, the hammer and the dance, what is this? So given this pandemic, if we do nothing we're in a heap of trouble, everything will just balloon out, our hospital systems will be overrun and the impact on people and society will be massive, there'll be a huge number of deaths, huge amount of disability, there's a lot of lot of issues here.

So, mitigation. This has also been thrown around. Well, why don't we try to flatten the curve? Let's mitigate this by a shelter at home, and try not to go out too much. We'll close the nightclubs but we'll keep the restaurants open. Well it turns out that that's nearly as bad as as doing nothing.

So the idea of the hammer is to just shut everything down, so massive decisive action, get everyone to stay at home, everything's closed, hammer on this to put a lid on it, so then we can deal with it, buys us time to deal with it. And the dance is what we do after that. So that's the basic concept, and if we do this we can just spend a few weeks with the hammer. If we don't, if we end up in mitigation, we're gonna have wave after wave after wave of trying to deal with this like, it’s getting out of control, let's try to flatten the curve. But if we don't do it properly it's just gonna kind of bubble up again.

So that's what faces us. And, again, we see this massive growth. This is where it started, and you can see the exponential growth here, so this is just kind of covering the history of everything, different countries have reacted in different ways.

I will point out that, you know, Hubei province, they shut down at 1,000 cases. So Australia's already at 3,00, the US is at 85,000. Do we have perfect shutdown in Australia at the moment? I don't believe so. I think the last week there's been a lot of strides in that direction. And the US? Complete patchwork. No real federal shutdown. So the US is in a lot of trouble, and I'll get get to that in a bit later on the part on government.

So using that tool I showed you earlier, this analysis has looked at the situation in the US. They've made a bunch of assumptions down here, so population and so on and so forth, and based on those assumptions they've produced this outcome of 10 million dead. So pretty stark stuff.

The other piece to understand here is, given the infections, this is how many people we're going to have in the hospital, and this is how many people we're going to have in ICU. This red line here is is how much hospital capacity is available. Very, very small amount compared to the demand. And again, if we had Amazon Web Services or Microsoft Azure or Google Cloud platform, we could go ahead and we could scale up our healthcare system to deal with the peaks and demand, but we don't, so we have this situation where we're about to be overrun, and that's why we need the hammer.

So this analysis was in response to a paper that came out of Imperial College two weeks ago. It actually might have been published earlier or distributed earlier. This particular "Hammer and Dance" came out a week ago, so this has been gaining traction. In any case, this Imperial College was looking at, alright, if we do nothing we're absolutely slammed, a lot of people die, but we get it over with because people will get some immunity from being infected, and kind of resolve itself. If we do mitigation measures — so closing schools and universities, make it a little better, so on and so forth — we can kind of flatten out these curves a bit.

So that sounds good, like we're cutting the problem in half or something. Problem with that is that with some of those measures, you get a second wave, or a third wave or so forth. So you're introducing economic pain, and that economic pain gets back again and it comes back again.

The other thing to think about is that, alright, the hospital system is already operating at, you know, peak capacity already. So hospitals are already dealing with strokes and heart attacks and, you know, car accidents, and all sorts of other things, right? So fighting the curve and getting these curves to extend out in time means that you have, in theory, more capacity over time to deal with Covid-19 infections. And, yes, in theory that's true. In reality, well you may just take care of your Covid-19 patients over a longer period of time, but then your hospital system still can't cope because it's already at the limit in terms of all the other things going on, so you get all these secondary casualties. So, flattening the curve is not a magic bullet, unless you can truly drop it down with suppression tactics. And again, mitigation versus suppression: mitigation is a half measure, suppression is a full measure. And only the full measure gets you to a point where you can truly reduce the overall number of people infected so that your hospital system isn't overrun in the same way in which you ultimately would with the mitigation measure.

Now this analysis also calls out this idea of kind of getting it over and done with and getting some measure of herd immunity, and the point it makes is that, well, we already know this is an RNA virus. RNA viruses mutate more fastly than DNA viruses, so you have different strains already appearing, so your herd immunity is going to run out at some point.

Now there's, there's a couple problems with that. So there's a difference between, the having different strains doesn't mean that the immunogenicity is compromised. So if you are infected and have an immune response and develop antibodies, those may work on multiple strains. We don't know that yet. So it is a risk, relying on herd immunity, but it is possible that these different strains don't matter so much in terms of the antibodies we do end up developing, whether that comes from an actual infection or from a future vaccine.

But moving down here, I think it's clear that the suppression strategy, which is what this is here, you know, it it goes from millions and millions which we saw earlier down to 40,000 infected and only 4,000 dead. So 10 million dead verus 4,000 dead. Again this is in the US based on the assumptions here. That is a huge difference, and so the difference is mitigation versus suppression. So this is clearly the superior strategy. It also fits in economically as the best way to handle it. And again this is pivoting off of what the Imperial College paper was saying, and this is basically a critique against that, that we need to be smart about how we how we go about these things.

So yeah suppression buys us, it reduces the overall number of people being infected because it delays the transmission right now, cuts off that exponential growth. It also buys us time to do other things, to look for, to deal with this on a local or regional level and to deal with it either with pharmaceutical interventions, down the road, if we find a drug that works or develop a drug that works, or a future vaccine. We can see suppression working in Hubei province. Number of cases, here I guess it was more than 1,000 when they did a full lockdown, and we can see that that they locked it down and then it eventually fell.

Now another key thing to understand here is that there's a delay in response with this stuff. So if you lock everyone down for three weeks and the numbers are still rising, it doesn't mean you did the wrong thing. It just means that it takes time for this these changes to show up in the numbers.

Anyway I'm gonna skip down here. Obviously there's a lot of research, massive amount of research going on right now, but let's move on to the dance.

So what do we do after we do the suppression? Well, then we have to deal with it through many different measures, so this is looking at, all right things that are cheap to do things or they're expensive to do. So closing all schools and churches and bars and mass gatherings, that's expensive. But this looks at different countries who did different things, and you can kind of see the outcomes. So, anyway, take a close look at that.

Anyway the key to the dance is keeping that R-naught below one, implementing proper testing and contact tracing and quarantine and isolation. These are traditional public health control measures and these work, but you have to implement them and you have to implement them widely. You can't do a half measure when doing this. And so there's a whole public education part of this that comes together. But you need to do all these things, and this gets us to our idea of an R-naught budget.

So this analysis cleverly put together this idea. They sorted by expense, so they used their R-naught budget on things that are expensive. So we can't close grocery stores. Merchant services, schools and universities, bars and restaurants, sports; this is what we should be using for our budget. 

And again, this is just kind of pulled out of thin air, this idea, but you know the way they've done this there's no hard numbers on how much each of these costs. There's some estimates, but we could do a whole bunch of things to make sure that we can keep this tamp down.

If you look at what China is doing, they are instituting very aggressive measures, also seen in Taiwan and in South Korea. You know, measuring people's temperatures as they exit a building or enter a building or enter a restaurant or if they go from one town to another. There's all sorts of infection control measures and other work that's done to make sure that people are in compliance. They've basically put a layer of enforcement, monitoring and enforcement, to make sure that people are in compliance with these restrictions, and that's how they're dealing with it.

The reality is, this is a very tricky thing with privacy and independence and so forth, but there's gonna have to be some sort of, you know, authorities working together with people to figure out a way to be responsible in terms of how to deal with this, both in the hammer phase but also and as this plays out over the next two years, how we deal with the dance phase of this.

So, we can keep society running, we can keep the economy going, we can keep things open, you know. Today and in Taiwan, the restaurants are open, the schools are open, people are out and about, but they're also wearing masks and they're also respecting the self quarantine. There's fines on, if you test positive and you self isolate, there are fines for breaking that isolation. There's a lot of things in place to make this work, and governments in the West, your Australia, your US, your European countries, we need to do those same things if we're going to work our way out of this in a reasonable way. And again, some estimates on the cost for all these control measures, to get that R-naught under one.

So that's the idea there. I think this is really a useful piece of information. Again, the critique on it has to do with some of the kind of ideas around herd immunity and, you know, a vaccine.

The other problem with vaccines, you know, it's not a magic bullet. There are vaccines in development, vaccines already developed very, very quickly, but these take time to test. Because of something called antibody dependent enhancement in the coronavirus, it basically can produce a situation where a secondary infection is a lot worse than the first one, so instead of providing a productive benefit you get the opposite. So things like dengue fever have this characteristic, and I think we saw some of that with SARS as well.

This is a big problem, because if you wanted to, alright, so we have developed a vaccine, we think it works in culture or whatever. I'm not a virologist, don't really know how that stuff works. But you can't just distribute to a billion people and all of a sudden billion people are 10 times more susceptible to death from Covid-19. So we really need to do the proper testing on any vaccine.

So a vaccine is not going to happen this year. We still don't have a vaccine for SARS and that was in 2003, so there's not a huge hope there. And if we do get one, you know, maybe it lasts for a year like influenza or maybe it's two or three years. If you look at the SARS virus, I think what they've observed back in 2003 and moving forward was that, an infection with it gave you anywhere from four months to 12 years of immunity. So let's say we kind of arrive somewhere in the middle there. Maybe three years, maybe five years of immunity. 

It'd still be great if we had a vaccine that dealt with that, and maybe with herd immunity we get something like that, but it's a long way to get to the point of 80% herd immunity for this. You know, different viruses, different diseases have different herd immunity numbers, and there's some math behind how that all works. But first we need to rely on the non-pharmaceutical interventions, then look at pharmaceuticals. I'll cover one of those in a bit and then and then look at a vaccine.

So, I mean, there's a massive effort on all fronts on all these things, but we have to keep in mind that there's not a magic bullet. Also vaccine update is problematic. A lot of susceptible people don't respond well to or don't build an immune response to vaccines, so that can be that can be a problem as well. So all things to think about as we move forward.

Alright let's go back to the slides. So, yes, we went through a bit on the Imperial College paper, the hammer and the dance, the R-naught budget. Remember, R-naught is a not a property of the virus but a property of the context in which it propagates, and we have to be mindful of secondary casualties.

You know, I was recently doing some research on the Ebola outbreak of 2014 to 2016 in West Africa, and from that you know there was 11,000 something people who died of Ebola during that outbreak. But research showed that about ten-and-a-half thousand people died from just not being able to use the hospital system because the hospital system was overrun. So we can't forget about that.

Alright what's up next? Oh, yeah, government response.

So this is kind of a commentary opinion on my, you know, observations for myself. You know, I'm not a government official. I don't know exactly what to do, but, you know, broadly speaking I can say that pain now is a lot better than a lot more pain later, and that's where the hammer and the dance fits in.

Countries that have patchy responses are in big trouble. We see this in the US. The response in the US has been largely bottom-up. They haven't had a coordinated response. A lot of reasons for this, but it's been a really, really bad response in the US from the start, and that means they're way behind the eight ball on building capacity for the healthcare systems, making PPE, making ventilators. You know, Ford and GM and Tesla are now making ventilators. You have distilleries making hand sanitizer. You have textile factories making masks. There is kind of this patchwork response.

But the government response is super concerning because we have some governors who, are like, "Let's shut everything down we're gonna take the hammer approach." You've got other governors that, I mean, the governor of Mississippi this week said, "Meh, we're not China. Let's just let this thing go." And so I hope you don't live in Mississippi, because it's gonna be a really bad situation there, very soon.

I think one thing that to keep in mind if we as we look at how different countries respond to this, it's revealing in many ways. It also kind of gives you some insight into the culture and how the culture responds.

I'll call out a couple countries here. South Korea largely has had a very good approach to this, but they, we have to recognize they live under a siege mentality. They have North Korea on their doorstep, the threat of war at all times, so the population has to invest their faith in the government, that the government will protect them. And so they have that mentality, and that becomes really an effective part of the response.

The US has a feeling of invincibility. They have these long-term geopolitical advantages of long coastlines and riverine systems and they have, you know, kind of a lot of a success with all the farmland, and they have a lot of natural advantages. But I think that leaves the US vulnerable in a situation like this, because they do think they're kind of invincible.

That said, the public health community in the US and around the world has been warning for decades about pandemics. This is nothing new. There are pandemics that come around every decade at least and go back millennia, so this is not something to be surprised about. There's been all sorts of preparation in the US, at all levels of government, all sorts of pandemic preparedness, disaster drilling. You have the National Guard, you have the Army Corps of Engineers, you have the Defense Protection Act, and theArmy logistics services. I forget the name for it. But all sorts of things in place.

The current administration in recent years has shut down a lot of that, at the very least mothballed certain things. The guy leading the pandemic preparedness office in the White House was let go in 2018, and that office was closed. I think we're seeing some of the results of that, and that is that the lack of a coordinated federal response, one that was decisive and early. Being decisive early is super important in this pandemic. That was lacking, and it's almost like going to war without your army. You spend all these years and decades building up capability, and then you don't use it when when the time comes around.

And I'll kind of pull out something I found which is quite interesting related to this, and that is this Global Health Security Index, and it basically ranks the countries about how prepared they are for various situations. And the leader on this board is the United States, and yet they've provided probably the worst response of any country to this so far.

So we'll see how it all plays out, but it's just a warning to government officials that you need to be decisive, you need to be early and you need to get your act together, because this is a big problem and it's not going to go away on its own.

I'll also pull this out as well. Transparency is critical in public health and epidemics. Laypeople become either effective force multipliers or stubborn walls. I think that is very true.

All right, looking at business. Now I'm not gonna comment too much on this. I will say it's a very challenging situation. The nature of many businesses puts them in a very vulnerable spot. Obviously hospitality, travel, tourism, all these things are very, very difficult situations. Some of these businesses won't survive.

It is important for governments, I mean, it's amazing to see all these kind of Republicans in the US advocating for UBI all of a sudden, so obviously something serious is going on, and that there's the government response to be had here. But also I think businesses need to recognize that how they respond to this will be remembered. If they treat their employees well, if they do their best to serve their customers, that will be remembered. So I just thought I'd call that out.

Personal choices as individuals. You know, these are the things we need to do right now. We need to sleep, we need to get sun. When you get your vitamin D, that's really important for the immune system. A lot of people are vitamin D deficient, and myself included. I'm taking a supplement now. Important thing to understand about supplements, you only need them if you're deficient in something. Extra supplement on top of your daily recommended allowance doesn't really do anything.

So, think of a construction site. Imagine you need materials to build your house on your construction site. Well if you have enough materials, you can build your house. If you don't have enough materials, you're not gonna be able to put up that wall or install that kitchen. So it's important that you have the things you need to build your house. However, having extra stuff, if you have way too much building materials on your building site, where you're not gonna be able to walk around you're not gonna be able to that kitchen to put it together, so those extra things in most cases don't help a lot.

So if you need vitamin C, vitamin D, these things are good to take. Excessive supplement use, don't worry about. Again, you know, if you have any concerns, talk to your doctor. I'm not a doctor, it's not medical advice.

Masks. A lot of misinformation about this. I think the the initial idea was, alright, let's save them for healthcare workers. Fair point. Healthcare workers do need these more than than anyone else.

However, the messaging was wrong around this. Instead of saying, "Yes, masks are effective, but keep in mind, save them for your healthcare workers," the message was masks aren't effective, which puzzled a lot of people. Like, "They're not effective? Then why are our healthcare workers using them? Why is the nurse and the doctor and the dentist wearing these things?"

Well, they actually do work. They're not 100%. The n95 mask is kind of the one you shoot for, but even just having a bandana is better than nothing, and that has to do with transmission.

There's a difference between droplet transmission and aerosol transmission. I'm not really sure what the line is here. I'm not sure if there's clear evidence that's suggests that this is purely a droplet transmission scenario, versus aerosol, but if you're wearing a mask and everyone around you is wearing a mask, well you're in a much better position, because at the very least the droplet transmission is not affecting you.

The other thing to understand is that there's a dose-response relationship here. So, the more dose you get, it sounds like for this particular disease, the worse your outcome is. So wearing a mask, even if it's not 100%, is a lot better than saying, "Well, it’s not 100%, so I just won’t bother."

Now I know there's a stigma with wearing masks. It sounds like the Czech Republic has been effective at getting celebrities to kind of tweet with themselves wearing masks and get rid of the stigma, and I think the celebrities should be doing this. Definitely in Australia, we should get famous people here to wear a mask and get people over this idea, that that this is a silly thing.

Now I know there's a lot been going around about hydroxychloroquine and some other drugs. There was an initial quote-unquote study out of France, but it had a sample size of 30, and it wasn't controlled, wasn't blind. There was a lot of problems with it. And there's  some follow-up studies that have basically shown no difference between treatment and control. There's been some research in looking at the cell response in a petri dish, and it looks like that is promising, but again that doesn't always translate into the human body.

Basically this is inconclusive at this time. Don't go out and get this stuff.

The other thing to consider is that a lot of anecdotal evidence, it's just a case of regression to the mean. Someone gets infected and they get better, and when they were infected they took something, so they assumed that, "Oh, what I took was what cured me," and it could be it had nothing to do with. It just your your body was fighting it, and and you ended up with a good outcome. So you should be careful about understanding kind of this research and that's one of the points of our parts of Epidemiology is studying diseases and interventions and pharmaceuticals, and figuring out what is effective and what is not.

So also we individually need to stay home, and we need to remember this is a collective action problem. It is incumbent upon the citizens to do what the local public health authorities are recommending and stay home.

So the future. You know, it's easy to take a clinical view at this. As an epidemiologist you kind of get used to thinking of these things as numbers, but behind all all the numbers are human stories. There's a lot of heroes, a lot of villains. Now, this is an opportunity. It's a chance to make the world a better place. I think it's been hugely educational. It has been to me personally, but I think to a lot of other people, this is a very educational opportunity.

We see very clearly now the the flaws in our society, the vulnerable places, the vulnerable people. We look at the prisons and the homeless populations, and these are places where it spreads very easily. And we see the economy not being able to cope and businesses closing and all sorts of problems. But it's a chance to kind of re-evaluate, take a step back, see what's happening and make the world a better place.

Also there's a risk that people take advantage of this. I mean I think it was a Netanyahu in Israel who postponed his own criminal trial because of this. So, you know there will be that. There will be people looking for more governmental powers, and trying to put in more surveillance and so forth.

So there's a definitely a balancing act with with all of this stuff, but you hope. Adversity tends to bring out the best in people, and there is hope to be had here, and people are stepping up. And it's inspiring to see all the people on the front lines, all the healthcare workers, all the paramedics and police and firemen and everyone working to keep their business open, to take care of their employees, to help each other out, to take care of your neighbor and help out in your community. There's a lot of ways you can get involved, so have a search around and talk to your community and see what you can do.

And I'll just point out a little thing that someone put together. A little Covid hacks thing. They're packing together some little projects to help out their communities, help out people who are infected, help out the businesses in their neighborhood, help out the hospital systems and the supply of PPE and so forth.

So there's a lot of good that's going to come out of this, and it will end at some point. But we have a few hard months and, probably realistically, you know, a year or two to really get a handle on this, and this pandemic will turn back into regional epidemics.

And there will be a time where certain parts of the world are still vulnerable other parts have handled it well. And that will mean changes for how we travel and how we get around and so forth. But it is important that we do our part now to make this all happen.

So I just wanted to say thank you to all my listeners and thanks for joining this Freelancer Seminar Series. If you have any questions for me, you can email me. My email is up here, and thank you very much and stay safe out there and have a wonderful day. Thank you very much.

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