YING HUA: So good afternoon. The name is Ying Hua. I'm an Associate Professor in Design and Environmental Analysis in Human Ecology, and I'm Director of Cornell China Center. Welcome to the roundtable of the coronavirus.
I think in the past month or so, many of us are closely following the news about this outbreak of respiratory illness caused by a new coronavirus first detected in Wuhan, and then quickly spread, and now still spreading and influencing a lot of regions. And according to US CDC, right now, about 30 countries and regions have confirmed cases. And for China, the official data shows there are already more than 40,000 confirmed cases, and more than 1,000 people died of infection.
And I think this feels even closer to the many international community, Chinese faculty, researchers, students, staff, including myself, as we are very deeply concerned for the health and welfare of our family members and friends in the affected regions.
And so I think we have a lot of questions. We're craving for knowledge and information. And then we want to know what we can do. So that is the reason we-- the China and Asia-Pacific Studies program, Cornell China Center, and the Migrations, the Global Grand Challenge Initiative-- we got together and put together this panel of, we think, subject experts from many disciplines on campus to have this discussion looking at it from many different angles, from a scientific angle and also from the social, historical, political perspectives.
And so we're also live streaming this event and also doing a recording for people who express interest, but cannot be here or listen to the discussion at this time. And so without further ado, let me first invite Professor Wendy Wolford, the Vice Provost for International Affairs, to say a few words on her campus-to-global perspective.
WENDY WOLFORD: Good afternoon. It's wonderful to see everybody here. I'm sorry that we're gathering under these circumstances, but it's nice to have an opportunity to get to discuss this epidemic together. I'm so grateful to Allen Carlson and to Xu Xin with the China Asia-Pacific studies program for organizing the event. So grateful to Ying Hua and Nina Chaopricha and the Cornell China Center for coordinating.
On behalf of the Global Grand Challenge, the university's Global Grand Challenge and Migrations, I want to say that we're really pleased to be able to participate and that all of the conditions around this epidemic really do highlight the need to unpack the flow of people and plants and animal microbes across the planet, but also how those affect our economy, politics, and public health understanding. So thank you to all of the organizers. Thank you so much to all of the speakers. This is incredibly helpful.
What we're hoping that this panel does is to separate the panic from the pandemic. Can we really understand what are the facts, although those are complicated and difficult to pull apart? Can we situate those in broader histories of politics and particular sorts of US, perhaps, China relations?
I said that the initiative is one that fits really squarely within the Migrations theme. But it's interesting to think about how this is important to understand not only the flows and how these people and microbes, plants, animals are incredibly mobile, but also how they're eminently rooted in place.
So the epidemic, the virus started somewhere. And it's also understood, at least here in the United States, through a very long history of relations between China and the US, between Asians and Americans, between the citizens of this country and particular notions of illness and health or purity, so being able to understand how it is that we, as a particular university, as a particular community, as a particular country respond to the virus and to concerns about the virus require this incredibly multidisciplinary and very talented set of panelists.
It's very clear that the epidemic, the coronavirus, is rapidly spreading and changing. It's unknown. We need to understand it. It's a very real virus. But I would also say that it brings with it the potential for discrimination on multiple levels and that that sort of potential for anti-Asian discrimination is also a very real virus, and one that didn't start in a food market in Wuhan, but can be dated many decades, even centuries earlier, depending on how you think about the original origins.
I want to put out there the question of when a person right now, when people, whether on this campus or outside, look at an Asian person and worry about contagion and disease, if that's something that's happening, how much of that is due to the first definition of virus, the disease, and how much of that is due to the second virus, which is a kind of discrimination that may thread its way through our understanding of its effects. These are the things that I hope that this very interdisciplinary panel will begin to unpack, where it is that we're coming from, how a disease is both something that is microbial, a virus, but also very much in our own understanding of sickness and of particular populations.
I've been really impressed over the last couple of weeks at how well and generously our community here has responded to this concern and how much the university has attempted to really find all of the people who might be impacted and work with him to try to address their situations. But there are always concerns that individuals have. And I hope that there will be a way of continuing to strengthen the positive aspects of our community in these times. So thank you very much.
YING HUA: Thank you, Wendy. I also want to mention today a representative from Cornell Health is also with us just in case later, in the Q&A session, there are questions about the preparedness of Cornell and the Cornell community. So now, let me introduce the panelists and invite my colleagues to the front of the room. So today, we're very happy to have Professor Gary Whittaker. He's Professor of Virology, Department of Microbiology and Immunology at the school. He is Section Chief of Infectious Disease Epidemiology and DGS of the Cornell Master of Public Health Program and a leading global expert on coronavirus in different [INAUDIBLE].
And the second panelist I want to introduce is actually Nathaniel. He's not here. He's from Weill Medical, so he's in New York City. And Nathaniel Hupert, Weill Cornell Associate Professor of Health Care Policy and Research and of Medicine, Co-Directory of the Cornell Institute for Disease and Disaster Preparedness. Hi, Nathaniel. Is he muted?
I'm going to continue to introduce our panelists. And next is Dr. Jeremy Wallace. He is Associate Professor of Government on Chinese Politics. And Dr. Derek Chang, Associate Professor of History, Former Director of the Asian-American Studies Program, he will share with us his perspectives from the angle of Asian and American historical experience.
And Gen Meredith, she's Associate Director of Cornell Master of Public Health Program, Lecturer in Population Medicine and Diagnostic Science at that school. She's a leader of large programs to build the public health workforce capacity around the world, particularly for infectious disease civilians and our response.
And at last, I'm going to introduce our moderator, professor Allen Carlson. He's Associate Professor of Government and Director of the China Asia-Pacific Studies, CAPS, program. So I'll hand it to Allen to moderate the rest of the [INAUDIBLE].
ALLEN CARLSON: Thank you. So we're going to give each of the panelists somewhere between six to eight minutes. I think as moderator, I'm also the timekeeper. So I will work to keep you guys on time. I'll just also preface things very briefly with a couple of autobiographical comments.
30 years ago at this time, I went off with the school for international training on a Tibetan studies program. While I was in Tibet, I contracted some sort of gastrointestinal disease. I lost over 50 pounds. My fighting weight back in the day was about 200 pounds. When I came back from Asia, I was under 150. My parents cried when I got off the airplane.
I bring it up because whatever I had contracted interested the CDC, at least briefly. They had me send the sample in and then never got back to me.
I didn't have what they were looking for. Hopefully, today, we have at least some information for you all about this rapidly evolving story. Wendy's framing it as both a question of epidemiology, of a virus itself, but then also related to the spread of information, the viral spread of information. The last time the world was facing a similar type of epidemic, qua pandemic, was 2002, 2003 with SARS, which was basically a pre-social media event. It's not like the internet didn't exist then, but we didn't all have feeds constantly telling us what was going on and being able to post.
And then, over the last two weeks, I, in conjunction with excellent people around the university, made one of the hardest decisions I've made as a faculty member here at Cornell, which was to suspend our operations in Beijing this semester, changing the plans of seven students who were all set to go. As I was doing that, I realized that I both had information but didn't have a lot of information either. I think that's where the world stands right now.
And actually, from looking around, it seems that this is kind of the first event of its type. And Cornell is uniquely positioned to host such an event in terms of the interdisciplinary experience that we have. So I don't have much else to add. I'm as looking forward to hearing what people have to say as the rest of you. So I'll hand things over. I don't know if we have an order. Gary, did you--
GARY WHITTAKER: Yeah. [INAUDIBLE]
Good afternoon, everyone. So I have my little cheat sheet here. And I'm going to start by the first question about the virus, what is it? And I'll preface that by giving a little history. So it is coronavirus number seven, human coronavirus number seven. The first two or three of those have been there for a long time and not caused much in the way of problem.
And then in 2003, when SARS coronavirus came along, that was coronavirus number four, probably. And then that generated a lot of attention. But then SARS was eliminated by public health response, and everybody kind of went back to business and somewhat forgot about it. There was a lot of activity for a while. It disappeared.
And then in 2012, 2013, another coronavirus came up, which is the MERS coronavirus, Middle East Respiratory Syndrome, which is still here. It's actually not gone away. It's a very unusual trickling kind of outbreak. And it's, in this case, though camels. SARS was through palm civets in the live animal markets in parts of China. MERS is through camels.
That gives a clue as to where these viruses are coming from. They're all coming from wildlife reservoirs. And generally, the source of many of the viruses is bats, so bats that transmit to various animal species that then come into contact with humans. And then that's the pattern that's been happening for a long time.
And then when we go to coronavirus number five, which is probably what's called NL63, which is another human coronavirus. And that was linked to a transfer actually about the Middle Ages, like 14th century probably is when that happened. That's become well established.
Then we come to 2019, 2020, where we have a new coronavirus, which if you're not aware, now has a real name, which is COVID-19, which I'm actually not very happy about. It sounds kind of surreptitious. I don't know what the word is. COVID-19 is its name as of, I think, today.
And then the link to an animal market is there, Wuhan. And we also have another fugitive species, which is the pangolin, which again, today has been announced as-- which is basically a spiny [INAUDIBLE] traditional Chinese medicine, and is a very widely traded animal for wildlife reservoir.
So that's the latest news. We have a name for a virus, and we have at least a theoretical intermediator, though that really still does need to be proven. It's very, very early days. So that's still the message. It's still early days in terms of really figuring out what this virus is.
How is it different from the flu? That's another question. The flu is another virus of concern [INAUDIBLE]. And I would say it's different in certain aspects, one of which is the adaptability of this virus in particular is very, very adaptable as a virus. Influenza is adaptable too.
But as far as adaptability goes, I would say coronavirus is like influenza, in terms of the ability of these viruses to change species and change [INAUDIBLE] and change tissues, and adapt and recombine and come out as new viruses. So they're really, in my mind, a big priority of trying to understand how these things work in nature.
And I think moving down to things about approaches and how to fight the outbreak, so I think I'll start from a medical perspective. And I think a vaccine is not going to cure this virus. We're not anywhere near a coronavirus vaccine that's effective in any animal or in any human.
So that's a really long way away. I could be proven wrong. And in some ways, I hope I am. But I think I'm predicting that's a long way away, at least a year, if not more before we get a vaccine that is effective.
And we do have to be careful, because there are some viruses where vaccines can make things worse. And coronaviruses are documented to be one of those examples. So we have to be very careful with the vaccine. We can't just rush something out, which could cause a problem. I think that will be a really bad thing to do. So we need to be careful about rushing out anything new.
Therapeutics have come up. And I think there are some possibilities there. There's some antiretroviral drugs being tested. I'm not convinced that that's really a rational strategy. Both the viruses do have proteases, but they're quite different proteases. So again, I'm not sure that's a good strategy.
There are other drugs. Remdesivir is closer to being an actual drug. And I think that's certainly something to be focused on right now. There's some good data on that as a potential drug. So I think remdesivir is my most likely candidate to come out with these rapid clinical trials and so forth.
And I want to mention testing. We're in a period where we can do very rapid testing, very effective testing. And information's been shared to make that testing available. It's just a case of capacity right now.
And in the US, it's only run by the CDC. So they're backed up, and it's taking time. But that's been distributed to state labs, and I think there's definitely progress there. So we should be able to test a lot more rapidly and get these answers.
Quarantine becomes an issue now. We're dealing with quarantine, and we've got people in quarantine for a long period of time at a very large scale. The scale of the quarantine here is completely unprecedented. So the ability to test and accurately manage that quarantine is critical at this point.
So I think there's good progress there. And I think it's [INAUDIBLE] the first time to do this scale of quarantine with good, accurate testing to really manage that whole process. And do I have time?
ALLEN CARLSON: One minute.
GARY WHITTAKER: So I'll mention a couple of numbers. Epidemiologists like to talk about R0, which is the reproduction number. It's not always that useful, but it's about four, which means that for every one person infected, they'll transmit the virus to four other people. That's way less than a lot of viruses, like measles, which is 12 or 18, but it's more than influenza. It's more than MERS. It's about the same as SARS.
And there's also the serial interval, which is the time between successive chains. And that's relatively long, which is, in a way, a challenge because the timeline to manage gets extended, but it actually does allow intervention. So there's pros and cons of that.
And I think I'll end, as I'm out of time, with a virus that I think has been forgotten about. And I want to talk about animals for a second. A lot of animals get coronavirus. So in the veterinary world, they've been very important for many, many years. Pigs have a big repertoire of coronaviruses, just like we do. And the most recent pig virus is called SADS, which is Severe Acute Diarrhea Syndrome in pigs.
And it was actually a very highly SARS-like virus that emerged in China about three years ago and really didn't get a lot of attention [INAUDIBLE]. There's an example of what could happen in humans, which really happened in pigs. And [INAUDIBLE] more about animal species and try to understand what's going on with humans [INAUDIBLE].
ALLEN CARLSON: So we'll go then to Nathaniel, who's-- are you there? Here you go.
NATHANIEL HUPERT: I'm here. I don't know if you can hear me or see me. Hello?
We can hear you [INAUDIBLE].
SPEAKER 1: Can you hear us?
NATHANIEL HUPERT: Can you see me? Yes. I can hear you just fine.
SPEAKER 1: You're good to go.
GARY WHITTAKER: That's great. [INAUDIBLE] moderating the event.
NATHANIEL HUPERT: Good. Well, thanks.
GARY WHITTAKER: We'd love to hear from you. Do you have about six to eight minutes?
NATHANIEL HUPERT: I couldn't quite hear that. But the question that I have is, should I turn off my video to get better audio? Use the microphone.
SPEAKER 1: We're not seeing anybody.
NATHANIEL HUPERT: I'm going to shut off my video for a second.
SPEAKER 1: So I think it's fine just as it is in the audio.
NATHANIEL HUPERT: [INAUDIBLE] So we'll just proceed just like this. So hi, folks. Sorry I couldn't make it there. I've actually-- I've got some back-to-back rotations at New York Presbyterians Cornell-affiliated Lower Manhattan hospital, which is just caddy corner to Chinatown. So this is all very, very [INAUDIBLE] and interesting down here in New York City.
Let's see. There. I have some good news and bad news. And you just let me know if I should be trying my video, OK? I'm at [INAUDIBLE]. The good news, obviously, is that there are no cases in New York state. That's the local good news. New York state and New York City just had a very nice conference call at 1 o'clock today reviewing this, and I'll get back to what was mentioned on that call in just a second.
There is also, I think, some potentially good news coming out of the international front of this, which is that as those of you who've been peeking at the World Health Organization dashboard web page, Mike, the day-to-day numbers suggest that there's been a decrease in new cases over the last four or five [INAUDIBLE], which raises the tantalizing question of whether containment strategies that are mainly taking place in China in large scale terms might be working.
There's also good news, but again, this has [INAUDIBLE] here on the local front, which is that New York state's distributed health officers, taken as a whole, have about 2,000 people currently in New York state who are under voluntary home isolation. And this is mainly because they arrived from China on planes and were asked to do this, and they complied.
So this is, I think, a very promising piece of information, because it's a lot of people [INAUDIBLE]. Everyone seems to be carrying out this request pretty effectively. There is also some bad news in addition to the fact of this entire outbreak occurring. That includes some very new data. This is a non-peer-reviewed but web-published large review of over 1,000 cases.
The lead author is Zhong Nanshan, who is a very well-known epidemiologist and pulmonologist in China, who did work on SARS. And this paper suggests that there is actually the potential for extremely fast human to human transmission, with a median incubation period of about three days, which is faster than people had thought.
The other bad part of that [INAUDIBLE] in this paper is that the incubation period can stretch as long as 24 days. And that makes for trouble-- I think isolation and quarantine. Other bad news about this outbreak so far-- as was mentioned, there's no distributed testing. In fact, [INAUDIBLE] were planning to get some testing kits from CDC this week. I'm not sure if that's really occurred. New York state certainly has not yet.
There's a big [INAUDIBLE] diagnostic testing. In addition, in the absence of any definitive laboratory test, there was a lot of interest over the last couple days in using things like CT scans of people's lungs to try to find infection. [INAUDIBLE] really going to work in probably about half the cases. So things like looking for flu, looking for lung phlegm, are not going to be sensitive enough to find all the cases, which is really the goal when you're trying to isolate people.
And so it's not great. We've also had cases-- for example, today's case in San Diego-- of people who actually are infected testing negative when they have the CDC's, [? quote, ?] "standard" test, and then testing positive. So this is going to make for trouble when the tests aren't perfect.
The unknowns about what's going on include both unknowns about this outbreak and unknowns about future outbreak. And then unknowns about the more general future when outbreaks like this become more prevalent, as most experts in this field believe they will. [INAUDIBLE] this outbreak, it's been said today by a very prominent Hong Kong epidemiologist that this can infect 60 [INAUDIBLE].
On the other hand, other epidemiologists, and, in fact, almost all of the mathematical modelers who've been on the CDC's modeling calls this [INAUDIBLE] starting several weeks ago, and are really ramping up right now, say it's far too early to make any predictions about how this is going to spread.
So some of the very simplistic modeling papers have already hit the academic press, but they're fairly well discounted by those who are in charge of the response, because as we saw with Ebola and other outbreaks, typically, they use overly simplistic modeling setups and make grand projections about what the toll is going to be.
Nevertheless, [INAUDIBLE] pandemic influenza that did, in fact, lead to many tens of millions of deaths with [INAUDIBLE] [? 2% ?] fatality rate, which is, according to the numbers, something like what earlier versions of the numbers coming out of China look like. Everyone's a little bit nervous about how these numbers are going to play out. The general sense is that the case fatality rate for this is actually much lower because of undetected cases increasing the [? denominator. ?]
Even if we contain this completely, the question is, what's going [INAUDIBLE] when this coronavirus rears its head the next time? Because it's certainly not going to evaporate from the earth. And then the larger questions of, how should this country and other countries prepare for outbreaks like this?
One of the things I've heard from colleagues within government is that there's a real need not for, necessarily, more emphasis on the epidemiology, but emphasis on fields like economics, government, and others that are represented here at the table to weigh in on the impact of not just the disease itself, but also the possibilities, for example, of repeated testing and isolation of large numbers of individuals across the globe, including those involved, for example, in manufacturing, supply chains, critical infrastructure.
This has the potential to become a disruptive new way of life that we haven't quite gotten a sense of, but also haven't invested enough time to think about seriously, especially in terms of how those predictions might influence current investment [INAUDIBLE] money, time, et cetera in better preventive strategies on the ground. So that's where I'll end for now.
SPEAKER 1: [INAUDIBLE]. It was actually quite clear throughout, and I appreciate you reaching out to us this way. OK, Gen, do you mind going next?
GEN MEREDITH: I thought I was going to get to go last. Hi, everyone. It's a real pleasure to be here. My background is in applied boots on the ground public health, and for 12 years before coming to Cornell, I worked to build up the workforce capacity of public health workers in the US and then in developing countries around the world. So part of what I'll talk about today is some of the opportunities I see from this.
One of the first prompt questions that we had is, should we be concerned? My answer is, I don't know yet. I am probably, like many of you, really fascinated to see what is unfolding and to see the confluence of policy and science playing out in real time.
I came to public health in the era of HIV, and I was just reminding myself of the history of HIV as I was preparing for today. And it took us about two years with HIV to really understand how the disease was transmitting from one person to another and what the virus was and what it meant to be able to prevent.
It took us many more years to be able to find effective treatment. So the fact that we're six to eight, maybe a little bit longer, weeks into the COVID-19 outbreak and that we're able to already be seeing diagnostics coming to market-- or not even to market-- being shared free of cost, that we're seeing test mechanisms be distributed by lead scientists, and that we're seeing, almost day to day, more information coming out about how the disease could potentially be transmitted from one person to another, what potentially the root causes were, what the vectors were, and what we can do to prevent this.
So the fact that there's a lot of information out there I think is good, and the fact that the information is changing means that there's really smart people trying to figure out what we can do. So coming back to this question of, should we be concerned, I think we should be concerned if we are going to be complacent.
As Gary said, we've seen repeated outbreaks. As Nathaniel said, we've seen repeated outbreaks. And so we can-- we, the collective we-- can see this outbreak. And we can wait for it to hopefully abate, and then we can just go back to business as usual. And then I think something will come back more-- with more force.
What I'm hoping is that we can look at some of the root causes of this and look back to some of the things with MERS, with SARS, with other, with Ebola, with HIV, and try to understand, what is it that we as humans are doing in our interactions with our natural environment and with the animals that are a part of this environment?
So you know, there's a lot that we can say about cultural practices of different countries. There's a lot that we can say about income inequality in other countries, which drive us to behave in ways that are culturally appropriate and/or in order to find food by specific means.
So what I will say next-- I don't mean this at all in a critique-- but wet markets is something that has been pulled back to or associated potentially with COVID-19. Now wet markets are something that are very important in the Chinese culture, from what I understand. There's also bushmeat trades where people who might not have other economic means are going out to try to find natural resources that they can either consume themselves or that they can sell for profit.
Now what that means is that we are interacting with our environment, with our natural environment in different ways. When you bring animals of different species together in close proximity, when you have them in cages, when you have that mixing with humans, when you have that mixing with lots of people in close proximity and with hot temperatures, viruses can start to change, and viruses can cross from one species to another.
So that's one thing that we can be thinking about is, how are we, as humans, interacting with animals and interacting with our environment? And how can we maintain our cultural practices, yet also think about ways to potentially prevent other diseases?
On the flip side of that, I like to think about the systems that support public health. So public health is built on the premise of being able to detect disease, being able to prevent disease, and being able to respond to disease. Gary and Nathaniel talked a little bit about the detection processes. Detection of something new is really, really hard. And we have scientists that are working hard on this. CDC has developed testing. They're now getting this out.
But there's going to be some faults in that at first. There's going to be some best practices or best ideas, and it's going to take a few iterations, probably, to get a test that's really, really good and a test that's available to everyone. Unless we can test, we actually can't detect. So I think it was Nathaniel or Allen that talked about we're not sure actually how many cases are out there, because we can't yet effectively test everywhere.
In order for us to prevent, we also have to understand what the mechanisms are of transmission. So I think what we're seeing with the WHO, and what CDC is talking about is keeping hand hygiene, if you're sick, covering your mouth, to have three feet or six feet of space between people who are ill.
There's also some guidance coming out from WHO that's talking about food safety as well, to make sure that your meat and your eggs are very well cooked. And if you're handling raw meat or organ meat, to do so in such a way that you're protecting yourself and not cross-contaminating food.
So these are best guesses at this point. But you still need to wait and see what actually is causing disease to spread from one to another. We are just understanding that there can be person to person contact. Hong Kong-- there's a question right now if there's maybe transmission that's happening through water. We don't know. We won't know until this hypothesis can be further tested.
So I guess all of that to say is, I don't know if we should be concerned, but I hope that we can use this as a call to action, a call to action to invest more in thinking about how we're investing or interacting with our environment, a call to action to have more or continued investment in diagnostics not once a crisis happens, but diagnostic in anticipation of what might come.
Investment in surveillance systems, meaning that there's opportunities for people to be able to document when they see something that is abnormal and to have somebody be able to say, oh, there's a few cases that seem abnormal. Let's go investigate and try to figure out what's going on.
And also, to be able to find systems where suspected cases that are then connected to national laboratories for confirmatory tests, that there's clear opportunities to be able to have the data cycle back. And so people who know if they potentially-- people who may have been at risk are able to truly understand if they have been at-- if they have been exposed and if they are infected or not. I'll stop there.
SPEAKER 1: [INAUDIBLE]
SPEAKER 2: Well, thank you. I want to extend my thanks to the Cornell China Center and to the China and Asia-Pacific Studies program, the Migrations Global Grand Challenge initiative, but particularly to Allen for inviting me to be part of this panel.
I have a couple of students who are in the room. They know that I've never kept to a timeline, so I've written down my remarks, so it's not-- I mention that so that you just don't think I'm the model minority writing everything down and trying to appease people.
So this is a really interesting forum. I've not ever been part of a panel with medical and health experts, with public health experts, and so I'm really pleased to be a part of it. What I feel like I need to say at the beginning is to be explicit about my area of expertise or, rather, to be explicit about what my area of expertise is not.
I'm not a medical doctor. I'm not an epidemiologist. I'm not a scientific researcher, nor am I a public health specialist. In fact, I'm a historian. I'm a historian of race and racism in America. I'm interested, briefly put, in how differential social relations of power manifest themselves in complex ideological, cultural, and material arrangements that we call race. That's where I come to this from.
As a scholar of American racism, I'm particularly interested in this moment of the coronavirus. I think it provides me a lot of opportunities to think deeply about the relationship between xenophobia and race and disease, but it also, I think, to be quite frank, is a moment of concern not just as an historian, but as someone who occupies a marked racial [INAUDIBLE]. Every time we have a kind of moment like SARS or like coronavirus, I hunker down a little bit.
And in fact, the news is kind of filled these days with anecdotal reports that the Chinese, or more broadly, anti-Asian or anti-immigrant incidents in the US over the last few-- over the last few months. And mostly, these are moments of interpersonal discrimination or xenophobia or racism, although as I'll suggest, I hope there is, perhaps, the possibility of sort of broader institutional arrangements of discrimination that we need to be aware of.
So what I want to do today is talk a little bit about the deeper historical antecedents in these moments of interpersonal discrimination and the possibility of institutional forms of discrimination. Themes of contagion danger or disease and dirt have long been attached to people, to bodies deemed foreign or alien in America. Immigrants have long been associated with public health risks. One of the first public health inspection sites was in colonial Philadelphia, and it was meant to sort of vet or process German immigrants.
Historically, though, the idea of immigration or immigrants as public health risks has been especially applied to people from Asia and, more particularly, to people from China. There's a deep history of this representation. Whether grounded in observation or cutting edge for the moment-- or temporary moment-- scientific knowledge, or fantasy, not only were Chinese thought of to be culturally and racially inferior, but they were believed to have brought with them, either as carriers or through less than modern sanitary or domestic habits, dangerous diseases that require the restriction, containment, and exclusion.
But we might think back to the 1870s, [INAUDIBLE] of the 19th century, especially we might think back the to the 1870s in San Francisco, which was one of the population centers of the Chinese in America, when the city's Chinatown, with its foul and disgusting vapors, as one official put it, was thought to be the primary source of atmospheric pollution in the city. And as one other official put it, a laboratory infection.
So notice here that there's not an association with disease, poverty, or material conditions with particular bodies. So it was in 1875 and 1876, when in the midst of a smallpox epidemic in San Francisco, the city health officer ordered every house in Chinatown to be thoroughly fumigated. When the epidemic persisted, the health officer explained-- and these are his words-- "I unhesitatingly declare my belief that the cause is the presence in our midst of 30,000, as a class, of unscrupulous, lying, and treacherous Chinamen, who have disregarded our sanitary laws, concealed, and are concealing their cases of smallpox."
1900, in the midst of an outbreak of bubonic plague in San Francisco, scientific, medical, and public health officials disagree about how best to diagnose and treat the disease. Anti-immigrant politicians step into this space and deposit their explanations. Mayor James D. Phelan, who would later become a US senator on the back of his anti-Chinese politics, labeled the city's Chinese residents, quote, "a constant risk to the public health." He undertook a campaign [INAUDIBLE] and segregation.
Between 1910 and 1940, at the Angel Island immigration stations in San Francisco Bay, thousands of Chinese were detained, incarcerated, interrogated, and medically-- and I should say also invasively-- examined. Examinations for hookworm and trachoma in addition to those for contagious diseases were used as a reason not just for detention, but for exclusion and deportation.
These were procedures not undertaken with immigrants at Angel Island from Mexico or from Europe. They were foc-- or from Japan, for that matter. They were focused on the Chinese. So why does this all matter?
I bring up this history, these things that happened 100, 150 years ago, because I think we're in a political moment that seems awfully familiar. Back then, as now, some political and economic elites were seeking to mobilize a politics of exclusion, racism, and xenophobia. And the association of Chinese with disease became an all too convenient rationale not just for everyday acts of discrimination, but for larger scale state-sponsored immigration restriction and political marginalization.
Then, as now, immigrant knowledge of the scapegoating the deep suspicion about the motives of the state, resulting in a skeptical reception for scientific and medical and public health policy information. Then, as now, there was an erosion of immigrant trust in the institutions of civil society, which has deep consequences.
The longer history of America's anti-Chinese, anti-Asian racism-- its relationship at certain political and economic moments to xenophobia-- means that the threat of a disease associated not just with a geographic place, with particular foreign or alien bodies isn't restricted to medical or public health dangers. Rather, the so-called Wuhan coronavirus and the policy and state responses to it must also attend to, I think, the discriminatory possibilities engendered by the outbreak. Thank you.
SPEAKER 3: I just want to structure my remarks in kind of three buckets-- first, about information, second about borders, and third about economies and policy. So as was said, there's a lot that we don't know about this outbreak, about this epidemic-- different words, so we want to talk about it.
A lot of that lack of knowledge is natural. This is something that, in the end, it's about a novel situation. And so it is something new. It is something that is natural that we do not know about it. We have a lot to learn, but we are learning quickly but not completely.
But second, that there is a lack of information, and we don't know things, in part, for manmade reasons. And that lack of knowledge in the information environment in which it was generated is part of the political, but also the health story of this situation. So we know that-- we believe that we know that the outbreak originated in Wuhan and Hubei, China.
That is the source. We believe that we have information about the actual kind of-- the actual transmission from animal to human, but we don't have a lot of details about the early cases, because we don't know necessarily. People may have been asymptomatic. There might have been a lot of basic things that we don't know.
More troublingly, we don't know a lot of information. A lot of information was not shared with the public inside of China during early moments of the outbreak that could have been shared, that was shared inside of scientific communities, but was not shared with the public in ways that, perhaps, encouraged or allowed the spread of the virus to reach the scale that it has.
And there is blame inside of the Chinese political system about who is to blame for this lack of information being released. Is it local government officials were unwilling to talk about problems in their localities, or were these local officials relying on central guidance to not release this information that they were told to be tight-lipped, especially under a system that has increasingly become centralized under the current leadership of Xi Jinping in China?
So this kind of-- and this happens inside of a broader context of a society that has problems of public trust with censorship and information controls as manipulation of data, all of these things that release and decrease public trust, and so make concerns about when you have a crisis even harder to believe in to follow through on. So there's a lot more that we could say about information, things that we know and don't know.
But to move on to borders, this is a global issue, and this is-- dozens of countries have had cases. And a lot more are concerned and have suspected cases, but the vast majority of the cases are taking place inside of two buckets-- first, inside of Hubei province inside of China. Of the 40,000 or 42,000, 43,000 confirmed cases, 75% of them are taking place inside of one province in China. And inside of that province, not only 75% of cases, but 96% of the people that have died from this virus are from this disease have died in Hubei. Inside of that, most in Wuhan itself.
Similarly, at the level of the national border, China has reported 98% of the confirmed cases. And all but one or two, depending on your beliefs about the status of Hong Kong, the deaths associated with the virus. Of the 1,018 deaths, 1,016 are mainland China, one in Hong Kong, one in the Philippines.
So these are-- there is still clear significance of borders in this story. And this is-- despite the fact that this happened, the emergence of the virus was at the exact time of the Lunar New Year when you had the world's largest annual migration of humans with 3 billion trips estimated around the country. Wuhan itself is a transportation hub, and so in some ways, this was ideal for spreading lots of people around the country.
Economically, on the other hand, this is a moment when, in some ways, it makes sense that things are shut down. So the fact that these factories are naturally shut down around Lunar New Year and in China, and so the fact that you've had a calm period with lots of economic-- without lots of-- with lots of lost economic activity is relatively natural.
Yes, this has been a very long Lunar New Year. For any of you who have a family cooped up in houses together, it may be very, very long. But it is-- but it is not-- it's not unprecedented the idea that you would have kind of people staying in their homes for long periods of time at this moment.
What is quite interesting on the economic and political sphere here is the extent to which these are-- this kind of end of the holiday is going to be allowed to take place. How are factories going to be reopened or restarted? Are people going to return to normal economic life, or are they going to stay retreated in their homes?
Are migrant workers going to go back to the cities and factories in which they had been residing and working, or are they going to decide that because they lack health insurance or are concerned about their access to health facilities in their locales, are they not going to do so?
There are real concerns about the extent to which this is a pandemic that is going to be extremely dangerous. The death rates that you see in Hubei are substantially greater than you see in the rest of China, let alone in the rest of the world. And so is it the case that we are simply missing information about low level symptomatic cases in Hubei, and so the death rates are actually quite low? Or is this what you see when you see kind of an overwhelmed health system?
There are a lot of questions that we have, and I think that Chinese inside of the country are concerned about and thinking about when they're making their choices about kind of return to work and return to normal, quote unquote, life. The last thing I'll say or last thing on economics is to say that a lot of predictions about the extent to which this virus and disease will affect the local-- that is the Chinese and the global economy-- are based on the estimates based on SARS, which was described as having-- affecting 2% GDP growth for a quarter in China, but really not much in annual terms as activity kind of shifted around inside of the year.
But with COVID-2019 already affecting five times as many people and killing 125% in the middle of this outbreak, it doesn't-- it seems to me that seems like a lower bound of where we are going, and that's in a world where China is a much greater share of global economy and the global growth than it was during the SARS crisis.
The last thing I'll say is about symbols and politics. So about the information story, early on in the discussion, it was not just information was not being shared, but there was actually kind of like penalization of some doctors who tried to put information out about the virus and the outbreak. Eight doctors were reprimanded and perhaps detained.
One of those, Li Wenliang, the 34-year-old doctor, subsequently died last Thursday. And his death and descriptions of it became-- went viral, to use a term, on the Chinese internet and globally, I would argue. And it's become a symbol of outrage for popular frustrations about the way that the Chinese government has dealt with the information about this crisis, as well as the crisis itself.
So this is-- to bring to the-- to bring to the scale of this, this is a global scale. We're talking 43,000 people across borders. These are individuals in the end that are being affected, and that can have symbolic importance beyond themselves. So with that, I'll turn to regular discussion.
SPEAKER 1: We're going to quickly turn it over to questions from the audience. But first, I'm going to just direct a question to the panel as well. And anyone who's out there on the webinar, you won't be able to ask questions. We don't have a vehicle for that, but you can still enjoy the conversation.
My comment to the panel is this is that it strikes me that, clearly, while there's a great deal that's unknown, this is a public health crisis of great magnitude. And I'm curious the degree to which you all think that it may be possible or necessary to bring together area studies expertise, and [INAUDIBLE] as we kind of work to develop the most effective way to limit the spread of the disease and limit the suffering, which is caused by it.
Because I think that these aren't two communities that oftentimes speak together, and yet even just on Gen's presentation and Derek's, you can see the kind of not quite orthogonal, but rather different perspectives on a singular issue. And not that there's then animosity between the two sides, but that there's a huge degree or a huge potential for misunderstanding and missed opportunities.
My sense is that those of us who are from China, who've worked with China for long periods of time have, I think, a great deal to contribute to understanding the context for this particular outbreak. At the same time, as Derek said-- and I'll go even further-- I'm a bit of a hypochondriac, so I'm like the opposite of a doctor. I think I freak out about every little tiny thing.
But so I'm not good for medical advice. But I think I can speak to some of the things, for example, that Jeremy brought up about the nature of the Chinese political systems. So just a minute or two from each about kind of that point of intersection and the degree that maybe it could be utilized and furthered, and what forms that might take place.
SPEAKER 4: If you could please use the mic so that [INAUDIBLE].
SPEAKER 2: So that's a good question. I'm stalling now. It seems to me as though, in sort of reading around this in parts, in preparation for today, what actually struck me was the politicization of particular kinds of state functions.
So it's the degree-- it's not that the public health workers are somehow necessarily-- it's not just the sort of cultural or even racial kind of linkers that people have on at any particular given historical moment. What's sort of a broader issue to me seems to be about the trust that both people who are subject to things like quarantine or restriction, things like that, the trust that they have in state ownership.
And to me, hearing Jeremy talking about trust in China of the government or the state, I'm thinking a little bit about a particular political moment and the role of the Department of Health and Human Services under the current administration makes me wonder about whether it might be useful to bring together, particularly maybe not so much historians, which is useful, but certainly, political scientists and policy experts with-- into that public health world.
GEN MEREDITH: My answer is yes. So I think the question was, is it possible and necessary to bring together experts? There's at least one student of public health in the audience, and the student will recognize that we talk about this all the time that public health problems are complex, that there are not simple answers, and the only way that we'll get to a place of being able to first understand and then address complex problems is by pulling together interdisciplinary teams that can represent all these different perspectives.
And I would argue that we should have historians at the table, because learning from the lessons and the mistakes we made in the past to help us move forward in a stronger way. I pulled something from the CDC's website, so the Centers for Disease Control is our leading public health agency in this country. And it has quite a strong reputation around the world. And CDC has been offering help to go and understand a little bit more about the COVID-19 epidemic.
But something from their website that they talk about specifically is this importance of training an interdisciplinary team, including disease detectives, laboratory scientists, veterinarians, and health care infection prevention experts, who are equipped to identify, track, and contain disease outbreaks in both human and animals before they spread.
And I would add to that, further on in some of their materials, they talk about the importance of communication. They talk about the importance of emergency response teams that are able to act in that organizing core so that there is clarity of communication, that there is culturally appropriate interventions.
A great example-- I'm sure some of you remember some of the pictures from Ebola, that the response team went in in such a way that it caused so much fear that people who were potentially fearing their own health didn't want to go to a clinic, because they knew that they would get locked behind a gate, and they wouldn't be able to see their family anymore.
So I think that's where some of these cultural norms and communication practices and clarity and confidence and trust, I think, comes in, because in order for us to get ahead of an epidemic, we have to have trust in the systems. And to know that if we feel something or if we see something and we say something, we're not going to get reprimanded for it.
SPEAKER 1: I think, too, as both of us being students of Chinese politics and realizing that maybe, as such, we know how little we know about Xi's administration, but it would seem of crucial importance then, as we're thinking about either multilateral response or something else, to take into consideration [INAUDIBLE].
SPEAKER 3: So I think it has always been the case that the internal politics of leaders of countries, especially when they are non-electorally promoted, is hard. It's a black box of authoritarianism. People use that expression. I think under Xi Jinping, Chinese politics become much more so-- has become much harder to suss out, to understand from the outside. It seems like from the inside as well.
And so those-- those types of dynamics are very hard. So Xi Jinping himself kind of disappeared from the public stage for a number of days before having a reappearance in the past two or three days. And like, how do we read that situation? These types of kind of in the absence of good information rumors spread. And when you have a potential crisis like this or an actual crisis like this, it is dangerous. Such rumors can be quite dangerous.
I think the other-- one of the problems from the beginning that we didn't really discuss much was the other side. Are we spreading too much concern? Are we spreading fear beyond the actual health risks that we are talking about? And so it is important to put the scale of that global flu kills tens of thousands of Americans, even more globally, every year.
And so on orders of magnitude greater than what we've seen under this coronavirus, and so there is-- and so at some level, that's why the case fatality rate, the CFR that was mentioned earlier, getting that right lets us know-- we don't shut down our economy because of seasonal flu.
And so if this is the risk level is about the risk of seasonal flu, then you presumably will not shut down our economy for this COVID-19 either. If, on the other hand, the risk is greater, akin to what it is like in Hubei right now, then we should, because that's a level of 2%. That's the Spanish flu pandemic. And so that's-- which killed tens of millions more than World War I.
And so this type of-- this is why the information and this is why you imagine people are scared at the beginning, because this level of information-- and there are credible estimates from different scholars as we pointed out at the very beginning, that some of them put us at levels that are extremely concerning. And some of them put it at levels that are much more normal, even if that is still quite dangerous.
So that's why learning from across different types of teams, different types of information environments, I think, is really important.
SPEAKER 1: Nathaniel, are you still there?
NATHANIEL HUPERT: I am. And in fact, I'm [INAUDIBLE] to get on [INAUDIBLE].
SPEAKER 1: [INAUDIBLE]. I can see you. [INAUDIBLE]. Would you like to chime in on this issue before I turn to the rest of the audience?
NATHANIEL HUPERT: Absolutely, and very briefly. I mean, you just mentioned [INAUDIBLE] tradition in China. I think that we also have to think about features of the current administration here. [INAUDIBLE] the recent decrease in budget at CDC for things like zoonotic diseases. That's diseases that come into [INAUDIBLE] animals, and all of the rest of the pretty dramatic cuts that have been made for global surveillance program. [INAUDIBLE] this is now an uphill battle being fought by public health.
And what's fascinating about what I've been hearing [INAUDIBLE]-- so a little bit more background on me. I've been advising the CDC and also the office of the Assistant Secretary for Preparedness and Response intermittently over the last month. Now everything that I've said so far only represents my personal views and not any official view of the US government.
Frankly, from any of my colleagues, who are veterans of not just the 2014 Ebola outbreak, but also the 2009 pandemic flu, [INAUDIBLE] outbreaks. I've been hearing that they are desperate for us on the outside, for the academic world, for the finance world, and others to help them imagine what the world will look like, for example, if we have to do large-scale isolation on the levels that we're seeing, perhaps not in Wuhan, but in [INAUDIBLE] around China, I mean, that would be so disruptive to the fabric of society. And this gets back to something that Dr. Navarro [INAUDIBLE] point-person on flu said to my research group at Cornell about 15 years ago. We came to him with a model [INAUDIBLE] antiviral use in pandemic, and he was very polite, but essentially dismissed us by saying, I'm not interested in how many people are going to die. I want to know if society will survive.
And so I think we're not-- clearly not at that level yet. And with this outbreak, it's really important for those in the outside of public health to remember that even though public health has many tools and many really smart people working on these things with fancy [INAUDIBLE], they really need the rest of the picture. Not just to figure out what the impact will be, but especially right now, [INAUDIBLE] to help motivate those who control the levers of action, and especially the money, to make the [? argument ?] that this is really important to catch early.
SPEAKER 1: Thank you, Nathaniel. You're also now on the big screen in front of us, just so you're aware.
NATHANIEL HUPERT: OK.
SPEAKER 1: We'll then-- actually, whoever has a question, just raise your hand, and we'll pass the microphone around [INAUDIBLE] for any one specific number. I know a couple of people had to leave to go to other commitments already. If you have questions about Chinese politics, I'm probably the best person to answer those. OK. If you want to just introduce yourself briefly, that would be great.
ISAAC: I'm Isaac. I'm a CAP student here at Cornell. I was actually just wondering, for everyone in general, for CDC and the global public health as it is now, are there any foreseeable issues with the current American administration not properly funding the CDC or politics interfering heavily with the CDC so that it could interfere with the proper eradication of this disease and the curing thereof?
SPEAKER 1: Well, Nathaniel, you just kind of opened the door to that important question. You would say yes. There are some--
NATHANIEL HUPERT: OK, can you still hear me?
SPEAKER 1: Yes.
NATHANIEL HUPERT: What I would say is that we haven't-- really, we haven't [INAUDIBLE] the global habit of spending a lot of money or a lot of things after we're [INAUDIBLE] something bad going on. The example during Ebola was building many hundreds of hospital beds in West Africa, unclear whether more than about 25 of them were ever used. That's from news reports after the fact.
So here, so the question, which I think is a very good one-- you know, as I mentioned, public health is a little bit more on its [INAUDIBLE] had been over the prior decade. And that is because of very clear policy decision and [INAUDIBLE] with, then, money.
As I mentioned briefly at the very beginning, there is a pretty good consensus that this is not going to [INAUDIBLE] this time. These are going to be happening as the human population on this planet continue to encroach upon the natural world, as was mentioned. And also, as the human population continues to grow and grow [INAUDIBLE], especially in urban environments, not particularly healthy for the humans.
So it's a really hard [? argument ?] to make, how to convince those who have the ability to organize [INAUDIBLE] and other aspects of society so that these types of events can be contained. I will say that the response, as was mentioned before, to this outbreak has been lightning-fast on the public health side compared to other outbreaks in the past.
The question is, how much can we sustain? 2,000 people in voluntary home isolation in New York state is one thing. We have [INAUDIBLE] the Cornell hospitals in New York City-- Cornell and Columbia Hospitals, part of New York Presbyterian-- have been running at surge level two and three, 94 and [INAUDIBLE]. Ask any engineer and [INAUDIBLE] will know that that is not a healthy capacity level. And this is with literally zero [INAUDIBLE] how health care is going in these days.
And then you add something like [INAUDIBLE] this break. The question is, how badly will it break? And can we do something to prevent that from happening?
SPEAKER 1: Thank you, Gary. I'd just add that on the Chinese side, I think there are still lots of questions regarding the degree of transparency and level of cooperation, both bilateral and multilateral. And I'd add as well that there are clear incentives on the part of people in both countries to further particular narratives about that level of operation.
So on the one hand, it's quite clear that from early, early on that the sequence of this virus was shared, and to bounce around the world working on figuring out what exactly [INAUDIBLE]. But now there's some reports that maybe they're not particularly-- is not particularly receptive to the WHO, particularly the CDC, in terms of giving access to especially the epicenter of the viral outbreak. Again, I think that the main thing is we're working with so many unknowns right now.
And then it feels-- we feel it on a much more visceral level because there are unknowns that then aren't taking place 10,000 miles away. I mean, they are. But we also have all of these feeds at the same time giving us information. And those feeds are not generally very well vetted. And so the degree to which there is that misinformation and conspiracy theories, which are all over the places to begin with, I think it complicates by an order of magnitude the public health response [INAUDIBLE].
I think one of the things that's not getting quite enough attention is the [? rate ?] [? at ?] [? which ?] this is-- the first virus-- or first epidemic of its kind in an [? era ?] of global social media. And the distorting and perverse effects [INAUDIBLE]-- some positive, in terms of the [INAUDIBLE] of information. You can quite literally now-- in any-- most Chinese cities-- certainly in Beijing-- know exactly on what street someone has been reported in real time, when someone is found and carrying the virus. That's unbelievable, right?
On the other hand, there's been this story about biochemical weapons. [INAUDIBLE] as responsible for that. And a number of other stories I won't even discuss because even discussing them gives them some credence. I shouldn't even have said the last one because it's completely [INAUDIBLE], and shown to be not credible. But anyhow, can we take another question? [INAUDIBLE]?
SPEAKER 5: Hello, everyone. I'm [? Xing ?] [? Li, ?] and I'm from anthropology department. And I'm also from China. My hometown called [INAUDIBLE], actually. I think, except [INAUDIBLE], has the kind of highest number of like, [? contagious ?] cases in my hometown. So I'm quite concerned. And actually, I'm checking my family like, everyday. And of course, they are isolated, and the whole city is locked down right now.
And I can feel like, strongly. Like, it's not worried about-- it's concerned about information. Like, what kind of information is useful for them. And they even asked to me like, OK, well, what kind of information do you have now? You know, because I'm outside China.
And I wonder if I have kind of different information from theirs. So I'm wondering like, from the perspective of public health management operation, like, how is the current information with these down by Chinese government? And what else information, or what kind of information is important for like, China's people, like, my family right now in those like, areas with such high [? contagious ?] spread. Thank you very much.
GEN MEREDITH: That's a really good question and a really tough question in that I don't know what the answer is yet. I'll share some information with you. But I just-- I appreciate the stress and the concern that you have. And I'm sure your family really appreciates that you're here [INAUDIBLE].
As I mentioned earlier, I think the virus is still so new that we're not actually sure what in its totality can transmit the virus from one person to another. The best information now-- and I pulled this down from Centers for Disease Control in the US and from the World Health Organization-- is to consider this almost like you would any kind of flu or influenza virus. So making sure that you have space between people that are showing any kind--
--any kind of symptoms, including runny nose including coughing, including sneezing, to wash your hands all the time, to not touch your face, to cook food well, and to, if you're handling food that is raw, to make sure that you're washing hands after and not having it contaminate. So that's the best information that is available right now.
Some of the things that are unclear still is if I'm not showing symptoms, if I might still be able to transmit the virus. We just don't know the answer to that yet. And so that's where I think some extra concern comes in, because if I'm sitting here beside somebody who's not sick, I might feel that that's OK. But we might not know if there actually is the possibility of infection.
So I guess the best advice that I can give-- and I'd ask Nathaniel to also jump in-- is to advise your parents to keep space from other people where possible, to wash their hands, to try not to touch their face, and probably to make sure that they have enough food and enough water to be able to keep themselves safe and comfortable in their homes. [INAUDIBLE] to keep in touch with you.
SPEAKER 1: Nathaniel, do you want to add something?
NATHANIEL HUPERT: So yeah. I'll comment. I feel for you. I'm sorry that your friend [INAUDIBLE].
I would note that you're an anthropology student, I believe, and that there have been calls in the [INAUDIBLE]. I've been trying to stress this to my colleagues in the last week that one of the things that is needed now, as was needed in the 2014 [INAUDIBLE], is something like an emergency anthropology field investigation unit. Because we don't know why this is so bad in Wuhan. We don't know what the actual practices that are transmitting this. [INAUDIBLE]
We, the public health community, discovered that one of the critical transmission moments was during funeral practices. And [INAUDIBLE] been very highly predictive. Incorporated changes in funeral practices at specific times that were effected by very clearly appropriate and sensitive and informed interventions in the communities that were most affected. I think [INAUDIBLE] previously about, not only the history of anti-Chinese racism in the US, but also the history of essentially the lack of attention to culture in a positive way in public health really hindered [INAUDIBLE] going to, I'm sure, figure out how to beat this simply by looking at numbers in an Excel spreadsheet.
We're going to figure out what's going on [INAUDIBLE] only when we really understand how things are moving on the ground. And that's where anthropology really comes in. Other questions?
SPEAKER 6: Hello. My name is Jay [? Xing. ?] I'm a government and CAP student. And I wanted to just ask about a portion of Professor Chang's [INAUDIBLE] roundtable.
So we see online that we have [INAUDIBLE] racists and discriminatory dialogue, whether it's [INAUDIBLE] about them, or they're actually being said on multiple forums. So I guess what I want to ask is do you see that being the norm, even after we manage the corona virus, not even with just within the US, but globally. So, much like the post 9/11 era, where we see self of self-inflicted wound where we have discriminatory policies against Muslims and just people with brown skin, you see that kind of society we're going to live in, and how does that happen? Is it just-- is it a number of cases that have to be reported where people somehow go through discriminatory rhetoric where, like-- how-- what is the mechanism that happens?
DEREK CHANG: Can I just ask you to-- just a point of clarification. What are you asking-- so after-- if this particular sort of epidemic is contained or whatever, you're asking what happens afterwards?
SPEAKER 6: So would you-- would you think that that kind of dialogue and that kind of vision of-- that kind of perspective of immigrants, particularly Asian immigrants being [INAUDIBLE] and having that virus, do you see that [INAUDIBLE]?
DEREK CHANG: So, as an historian, one of the things that I've noticed is you know, I don't think it's consistent, right-- that there's certain tropes and themes and ideas and frameworks that are mobilized from time to time, right? And we can look at economic downturns. We can look at moments of global or international rivalry. We can look at particular moments where the conditions become more ripe with the mobilization of these tropes.
As I said, the notion of immigrants or when people-- aliens being affiliated with or associated with or being actual carriers of disease being a danger, right-- that's an old, old idea. That's not consistent over time. It goes away at certain moments, and then resurfaces at other moments.
So I think we really have to be attentive to those other factors, right? Economic factors, the sort of political national factors, the international, global factors, right? When is China considered a rival to the US? What does that have to do-- how does that sort of effect degree to which Americans perceive Chinese bodies in a particular way? Does that answer--
SPEAKER 6: Yes.
VICTORIA: Thank you all. My name is Victoria. I'm a also a [? CAPS-Comm ?] major. So my question is also related to transparency and information. But two days ago, the Chinese government has led an operation to launch a map that pinpoints exposed cases with great specificity, naming communities and streets.
And there have been private efforts to pinpoint patients, disclosing their names and IDs and so on and so forth. I know is a time where we need information, but to what degree, to what extent is this sort of exposure effective and necessary? Or is it paranoia and is it excessive [INAUDIBLE]?
SPEAKER 1: Do we actually need to know that? Or is there something else going on, whether it's at the grassroots level, or at the level of the student [INAUDIBLE]? Clearly-- again, to go back to this, we have so much disinformation and [INAUDIBLE] out there.
One of the things, as consumers-- as [? exceedingly ?] [? extreme ?] interests [INAUDIBLE] of this news, it is quite worthwhile to look at the source, and to have some sense of what interests may be behind them. I had a conversation last week with one student [INAUDIBLE].
The potential of somehow trying to corner the mask market in South Korea in order to profiteer off of that. And the degree, then, to which, if you were a mask producer, it might not be a bad thing to have everyone panicked about the degree to which [INAUDIBLE]. And I think that-- mostly, that was just made up, the discussion. But that kind of the idea of looking at the source and looking critically at the source, I think is of particular importance.
And in this case, I think we're both seeing the official movement of the Chinese state to identify. But then also, clearly, Chinese netizens are [INAUDIBLE] kind of weaponizing that public data and bringing in the private realm. And this is something that we see, again and again taking place in social media. So then the question to people who have medical expertise, is there any medical rationale for that [INAUDIBLE] or revealing of [INAUDIBLE].
GEN MEREDITH: Nathaniel, I'll start, and then you can jump in. From a public perspective, I would say absolutely not. In my experience, and as I'm sitting here really reflecting on your question, I think your is actually not what we want in a public health response, because as I mentioned before, it pushes people inside their door, and they become scared to say I feel sick.
From a public health intervention perspective-- so from people who are doing outbreak investigations-- that level of specificity is incredibly valuable. In the US, that is very confidential information. There is a disease detective that would know that one case. That disease detective would go and do an interview or an intervention with that individual to understand who else may have been exposed so they can get that person into treatment, but also to understand what activities have you done over the last 6, 8, 10, 12, 14 days to be able to make better understanding of what is driving this infection.
So from a public health practitioner standpoint, that level of specificity is fantastic. That would allow for a very strong investigation and potentially response. I can't see any value of making that information public.
NATHANIEL HUPERT: Just very briefly, I would [INAUDIBLE] objects in the history of public health was a map from London identifying a particular pump handle as the source of a cholera outbreak. But that translated into the present situation, I think, has lots of scientists working on this now have pretty much ruled out the idea that this [INAUDIBLE] cluster of infections from an animal source. The more likely hypothesis is that this was being transmitted [INAUDIBLE] market that is now famous, and then caused the number of infections through, again, human to human [INAUDIBLE]. And that sort of prevalence in the community, it [INAUDIBLE]. Certainly, in this country, we would never allow that to happen because of patient privacy laws.
SPEAKER 1: So we were [INAUDIBLE].
NATHANIEL HUPERT: [INAUDIBLE] Oh, sorry. I'll shut up.
SPEAKER 1: Nathaniel, the audio was also breaking up a little bit. I apologize. We were to go till 5:30. Maybe we could do a quick round if there a few questions. Just briefly state your question, and then we'll go through the panel, quickly trying to hit on some of the answers to those questions, if there are any questions. So it will go 1, 2, 3 [INAUDIBLE], Austin, 4. All right? Yep.
JOHANN: Thank you. My name's Johann. I'm an undergraduate student in the College of Arts and Science. And my question is, as we all know, the naming of the virus, and a lot of things associated with [INAUDIBLE] and anti-immigrant rhetoric. And my question is, has CDC confirmed that a novel coronavirus is a pandemic instead of an epidemic? Because I noticed some of the panelists are interchangeably using the words. And I just checked the CDC's website. They have a very clear definition of what is pandemic and what is epidemic.
And I'm just wondering, also, is there an available guideline somewhere that can be used by officials, maybe universities and government, that can appropriately, or correctly, calling or referring to the viruses so that we will avoid future unnecessary fears among people? Thank you.
JESSICA: Hi, there. My name is Jessica and I've been interested in public health a long time. And my question has to look at the history and really, the health communications. And I can't help but think of the HIV/AIDS pandemic, and how in particular in this country and elsewhere in the world, men who have sex with men were disproportionately targeted. And then there was a lot of advocacy around that. And so when I think of-- I guess, those bodies in some ways can hide. But are there things to be learned from the discrimination practices that were against people who have HIV, and then the communication strategies that we use to address those in the context of today's epidemic or pandemic?
KRISTEN GRACE: I'm Kristen Grace. I'm in the Office of Global Learning, and I work with students who are going to Asia. And we have students in Singapore right now, which does not have a high number of cases at the moment. But the country has raised their level of alert from yellow to orange, which-- and they've instituted a number of measures, such as requiring temperature checks twice a day and not having large gatherings, et cetera.
And it's easy to read that in a reassuring way, while they're really taking a lot of precaution and very helpful, it's also easy to read that in a very disturbing way. And if you need to report your temperature to people, things like that. And so I'm just curious what your read is of a public health response, and how much that's a model, how much that isn't? So I'm just curious.
SPEAKER 6: I'm also a CAPS major, and I know we talked about the silencing of a few doctors back in December who [? fought ?] [? about ?] concerns of a potential virus that could have led to, I guess, the expansive spread that it's led to today. So I was just wondering if there have been other potential virus outbreaks, whether it be in the US or other countries around the world, where the silencing didn't occur and it was able to be contained because of the lack of the social censorship that [INAUDIBLE] countries don't have.
SPEAKER 1: So you have one minute for each of those.
DEREK CHANG: I feel like [INAUDIBLE] respond to, at some level, [INAUDIBLE]. But I want to comment a little bit about the HIV/AIDS of-- Paris were lessons learned. And I think it's actually really interesting. I mean, my understanding of-- not from a public health perspective, but from a social and political historian, that in part, the politicization of AIDS-- HIV/AIDS-- is a kind of disease that was about a particular set of sexual practices. Politics of that affected public health response because the state was response.
What was what I was hoping to say in my remarks was that I'm vaguely concerned or very thoroughly concerned about the ways in which a particular kind of politicized response to coronavirus might see the disease or responses to the disease not being-- or the virus not being handled by health professionals, but perhaps by the Department of Homeland Security or by immigration officials, right? The way in which that bleeds over into politics is my concern. And I think the HIV/AIDS pandemic actually provides a really nice example of that, kind of object lesson.
SPEAKER 1: [INAUDIBLE]. Nathaniel, why don't you go and then we'll--
NATHANIEL HUPERT: Yeah. I have one very interesting, I believe, public [INAUDIBLE] is that the travel restrictions that were instituted in this country were not done on the basis of [AUDIO OUT]. Oh, sorry. I was just going to say that the travel restrictions that were instituted were not done on the basis of science coming out of the CDC.
OK, I will. Sorry. There we go.
I was just going to say that the [AUDIO OUT] of the federal government were done independent of scientific input from the CDC. And I think that the interesting fact that-- and of course, these came after multiple travel restrictions against various countries over the past several years that had nothing to do with explicitly with concern about invasive infectious diseases, but certainly implicitly, as [? we've ?] discussed, partakes of that language of fear and contagion. And so we're [INAUDIBLE] against this virus in a very fraught type of environment where the motives for various public health [INAUDIBLE] need to be fully understood.
SPEAKER 1: Thank you, Nathaniel. Gen, last word?
GEN MEREDITH: Last word. I'll come to the silencing question. And I've been sitting here trying to think of it. The [? investment ?] that comes to mind is actually foreign outbreaks in the US. [INAUDIBLE].
So the question comes to silencing, and where there isn't a silencing of information, do we have the ability to better contain things more quickly? And so, food-borne outbreaks is something that comes to mind. And the US has invested heavily in developing systems here to be able to look at and investigate and assure food security from production, all the way to when we're consuming it.
And when there are reports of an outbreak, there actually is quite a strong infrastructure that comes in place to be able to trace back where potential foods have come from, and to limit the number of people who are affected. The way that that works effectively is that there are strong data systems that are connected between states. And so CDC can, for example, manage data reports coming in from states, and see that there's a cluster that's emerging.
In this case, there's actually some interesting things where people do use social media to report that they're sick. And yet, it's maybe bad for the industry, for the restaurants that are being affected. And yet it is helpful for people working in health departments to be able to see where people are complaining of similar symptoms. So I guess my answer is I think information can be very helpful. But I think it comes back to also trust and communication and being-- when information is shared, that it's used appropriately and effectively, in a comprehensive way to try to get ahead of it.
That being said, I think that this must have been incredibly scary for public health leaders, for physicians, community members to see this disease emerge, because at first, I hazard a guess that people thought it was the flu. And then probably some head scratching started to happen to say, this actually doesn't seem normal. And so then the question start. Well, what could this possibly be?
And so I imagine that there must have been a tight balance about how soon we talk about this publicly, because we don't want to have people freak out until we actually know a little bit more information. But at what point do we have to make sure that people have information? I don't know that there's the right algorithm, if you will, of what that right time is.
SPEAKER 1: So first, and finally I'd just like to thank all the panelists. This was a very informative [INAUDIBLE]. Also, the [INAUDIBLE] as well. So thank you for coming.
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A diverse panel of Cornell experts discussed uncertainties surrounding the coronavirus outbreak at an event on the Ithaca campus, Feb. 11, 2020.