archived recording Across the world, there are rising concerns of a potential coronavirus pandemic after a major jump in cases outside of China.

michael barbaro

From The New York Times, I’m Michael Barbaro. This is “The Daily.”

archived recording 30 countries and territories, nearly 80,000 cases.

michael barbaro

Today:

archived recording 1 South Korea, which has now 750 cases or more. archived recording 2 And in Iran, where there have been close to 100 cases and the death toll is 15.

michael barbaro

What began as a public health crisis in China is well on its way to becoming a pandemic.

archived recording 1 It’s still unclear how the virus made it into Italy. archived recording 2 Four new cases are here on a French territory. archived recording 3 Japan. archived recording 4 Canada. archived recording 5 Afghanistan. archived recording 6 Austria, Switzerland, and Croatia all confirming their first cases.

michael barbaro

Now.

archived recording And the C.D.C. in the last hour, warning Americans to prepare for the possibility of an outbreak.

michael barbaro

As officials warn of a coming outbreak in the US —

archived recording C.D.C.‘s Dr. Nancy Messonnier said it’s not a question of if the novel coronavirus will spread through the United States, but when.

michael barbaro

My colleague Donald G. McNeil Jr. on how bad the coronavirus might get.

archived recording 1 Outbreak could go any direction. archived recording 2 I do think that we are heading towards a pandemic.

michael barbaro

It’s Thursday, February 27. Donald, I have the sense that you have covered a lot of epidemics in your career. And if this isn’t too strange a question, how many epidemics have you covered?

donald g. mcneil jr.

SARS, MERS, bird flu, 2009 swine flu, Zika. Dengue and chikungunya didn’t really become epidemics. And also I’ve covered H.I.V., although that started long before my time as a health reporter. And seasonal flu. Have I forgotten anything? That’s enough, right?

michael barbaro

That seems like enough. That seems like a lot of epidemics.

donald g. mcneil jr.

Yeah, and this.

michael barbaro

And by “this,” you mean —

donald g. mcneil jr.

COVID-19, coronavirus infectious disease 2019.

michael barbaro

Well, that’s the reason we want to talk to you, Donald, is because you have this history and this experience when it comes to epidemics. And at this moment, there is a lot of news about this new virus, the coronavirus, but not a lot of understanding about it. So given your history, how do you rank this epidemic in terms of previous epidemics, in terms of — let me use some unscientific words here — bigness, scariness, awfulness?

donald g. mcneil jr.

I spend a lot of time thinking about whether I’m being too alarmist or whether I’m being not alarmist enough. And this is alarmist, but I think right now, it’s justified. This one reminds me of what I have read about the 1918 Spanish influenza. And the reason I say that is because, right now, the only measure we have for the death rate from this flu is a study that the Chinese did of the first 45,000 cases. And of those, 80 percent were mild. 20 percent were various degrees of seriousness, up to critical and on a respirator and in organ failure. And 2.3 percent died. Now, 2.5 percent mortality is about the mortality rate of the 1918 flu.

michael barbaro

Which was a very big deal.

donald g. mcneil jr.

It was a very big deal epidemic. Now, it’s not the Black Death. In the Black Death, a third of the world died. But in 1918, not everybody died, but everybody knew somebody who died. I mean, my oldest friend’s grandmother died. She was a young woman with two kids. She died. Another guy I talked to said, oh, yeah, my grandmother’s sister died in that one.

michael barbaro

I thought you were here to bring calm, Donald.

donald g. mcneil jr.

I’m trying to bring a sense that if things don’t change, a lot of us might die. If you have 300 relatively close friends and acquaintances, six of them would die in a 2.5 percent mortality situation.

michael barbaro

OK, you’re painting a pretty scary portrait here. What makes this virus something so lethal and fearsome? What is it specifically about this virus?

donald g. mcneil jr.

There are six kinds of coronaviruses we know about before. Two of them, SARS and MERS, kill a lot of people.

michael barbaro

Those are both coronaviruses.

donald g. mcneil jr.

Yeah. SARS kills about 10 percent of the people who get it. SARS is gone. MERS kills about 30 percent of people who get it.

michael barbaro

Wow. Those are high death rates.

donald g. mcneil jr.

Absolutely. But there are four other coronaviruses that cause about a quarter of all the common colds this year. And you’ve had all of them. I’ve had all of them. Everybody’s had all of them.

michael barbaro

So we’ve had coronaviruses and just maybe not called them coronaviruses.

donald g. mcneil jr.

Yes, you called them, “I had a cold.” There are many causes of the common cold, but some of the most popular ones are four different coronaviruses. This doesn’t give you a common cold. It attaches deep in your lungs. So you don’t get runny nose as much as you get fevers and cough. And then ultimately, if it keeps getting bad, you get pneumonia. And that’s what kills a lot of people.

michael barbaro

The final stage of this.

donald g. mcneil jr.

And it’s a viral pneumonia. So giving antibiotics does not help.

michael barbaro

So what you just said makes me think that in the grand scheme, this coronavirus is not as bad as a SARS or a MERS. So help me understand why, even though it’s seemingly statistically not as bad as those, it is something quite worrisome?

donald g. mcneil jr.

SARS and MERS, if you get them, are very likely to kill you. But you’re very unlikely to get them because they don’t transmit very easily. If you don’t hang around camels or emergency rooms in Saudi Arabia, you’re unlikely to get MERS. This coronavirus is very transmissible — not as transmissible as measles. About as transmissible as flu, maybe a little bit less. But it’s quite transmissible. We saw that on the Diamond Princess. Here you had a boat with three or four people who might have had the virus on it, then suddenly they were — what was it — 600 people who had the virus on it. That’s a transmissible virus.

michael barbaro

And why is it so transmissible? What is it about the virus? Do we know?

donald g. mcneil jr.

We don’t know. We know that it attaches to some receptors deep in the lung called the ACE-2 receptors, but then so do other viruses. We don’t know why this one jumps easily. Something in the genome does it, but we haven’t pinpointed that genetic change yet.

michael barbaro

So we don’t know why it’s so transmissible, but we do know that it’s passing from person to person quickly. So how exactly do you contract it? How does it transmit?

donald g. mcneil jr.

It’s transmitted mostly by coughing. And we think it’s transmitted by fomites, which is to say touching surfaces. So if you’re in this room and you’ve got it, you’ve coughed all over this table. And I come in later and I don’t know you were here. And I, you know, I’ve got my hands on the table, and then I pick up my finger and I put it in my eye or my nose. I might get it. And that’s scary. Now there’s a whole question of is it got aerosol transmission, which means it drifts through the air and might go through the ventilation system into another room. That might be part of it. And there might also be some fecal transmission. But those are unimportant. The main thing is coughing and surfaces.

michael barbaro

That’s how it gets transmitted.

donald g. mcneil jr.

We’re still in the early days of knowing about this virus, but that’s the prevailing theory, that those are the number one and two drivers.

michael barbaro

My sense is that when it comes to infections, this is not a virus that discriminates. That young people get it. Middle-aged people get it. Old people get it. But do we have a sense of who is most likely to contract this coronavirus?

donald g. mcneil jr.

Yeah.

michael barbaro

It sounds like because it’s so transmissible, almost everybody might be able to get it.

donald g. mcneil jr.

Oddly enough, children are very unlikely to get this virus.

michael barbaro

Huh. Why is that?

donald g. mcneil jr.

Well, nobody knows. The theory I’ve seen that makes sense is that kids have enormous numbers of these mild coronaviruses, because that’s the typical cold virus. Kids are the ones who get colds. You go to kindergarten, you come back with a cold. So they may have some immunity from having somewhat similar but mild viruses circulating in the child population. Whereas all of us who had those viruses as kids, our immunity to those has waned. And now we have a new coronavirus.

michael barbaro

Our immune system is just not as prepared.

donald g. mcneil jr.

Yeah, we’re susceptible to it. The people who are getting sick and hospitalized is basically people from 30 on up. Most of the people in the hospitals are between 30 and 79, the Chinese said. Now, the people who die is basically the older you are, the more likely you are to die. So far, the large numbers of deaths have been elderly Chinese men. That’s because the virus has been in China. But there’s also a phenomenon in China that something like 50 to 80 percent of all men smoke, and only 2 to 3 percent of all women smoke. And once you’re a smoker and you’re over 50, your lungs are kind of half shot, you know? You’ve got emphysema or C.O.P.D., maybe a mild case. But if you get a dangerous lung infection on top of that, you’re much less likely to recover. Also once you’re over 65, you have an immune system that starts weakening slowly, so you’re less able to bounce back from that kind of thing. So we see the death rates are like people in their 80s and then people in their 70s and then people in their 60s. But we’ve seen people in their 30s die from this. We’ve seen some of the doctors, you know, including the famous doctor Li Wenliang, who tried to raise the alarm. He was 33 or 34, and he died.

michael barbaro

And how do you explain that?

donald g. mcneil jr.

He might have been unlucky, and he might have gotten a big blast of virus from a lot of patients. Even with viruses, the dose, to some extent, makes the poison. If you get a big load of virus in one blast, your body’s overwhelmed more quickly by it. And that may have happened to him.

michael barbaro

You’ve been talking about this death rate of around 2 or 2.5 percent from this coronavirus. And you mentioned earlier that that is a lot like the Spanish flu of 1918. For those of us who didn’t live in the early twentieth century, can you put this into a more modern context? How does this compare with the annual flu? How does this compare with something maybe a little more knowable for us?

donald g. mcneil jr.

OK, this is not like the annual flu. The annual flu, in a bad year, has a death rate of around 0.1 percent. So we’re talking about 20 times as bad.

michael barbaro

That’s very meaningful.

donald g. mcneil jr.

When people were going around saying, oh, not to worry about this. You should get a flu shot because the flu is a bigger threat. Yes. At this moment, the flu is a bigger threat, definitely, in the United States. But don’t think you have nothing to worry about. One thing that might happen is it might not get here in a big wave until the fall. That happened in 1918. There was a spring wave that was scary, and then the virus mostly disappeared in the summer, because a lot of viruses don’t like hot weather. But then when it came back in the fall and winter, that was the real killer wave. And that’s when a lot of people died. But we conventionally say that if the 1918 flu came back today, it wouldn’t be as deadly.

michael barbaro

Because it’s not 1918.

donald g. mcneil jr.

Because in 1918, we didn’t have antibiotics, and a lot of people died of secondary bacterial pneumonias. We didn’t have mechanical ventilators to put people on. We didn’t have the steroids that cuts down on lung inflammation. We have a lot of things in modern medical care that we didn’t have then. But what’s disturbing about what you see happening in China is that a lot of people are going into hospitals and they are getting antibiotics, and they are getting Tamiflu, and they are getting antivirals, and they are getting steroids, and they are getting put on ventilators. And they still die. And that’s unexpected, and it’s quite spooky.

[music]

michael barbaro

We’ll be right back.

archived recording 1 Back now with scientists around the world working day and night to contain the coronavirus. archived recording 2 Chinese now sharing information with the World Health Organization in the hope that it will lead to treatments for the coronavirus, but — archived recording 3 There has been an effort to secure funding with Congress, some $2.5 billion used for vaccine development, treatment, as well as — archived recording 4 Top health authorities have played down the rising hopes about a vaccine, as well as a treatment for the coronavirus.

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michael barbaro

Donald, I want to move into diagnosis and treatment. Right now — correct me if I’m wrong — there is no treatment.

donald g. mcneil jr.

Correct. Right now, there is no treatment. I mean, there’s treatment in that you hospitalize somebody. You put them on oxygen. Then you give them antibiotics so they don’t get a secondary bacterial pneumonia or things like that. But there’s nothing that actually cures this virus.

michael barbaro

Or prevents it.

donald g. mcneil jr.

Correct. Nothing that prevents this virus.

michael barbaro

So what are the most promising possibilities out there to do either of those things? And what’s the timeframe we’re looking at to do that?

donald g. mcneil jr.

There are several anti-viral drugs that are being tested. Some have been used against H.I.V. Some have been tried against Ebola and didn’t work. There’s an anti-malaria drug they’re trying as ways of stopping this. They’re doing tests on them in China now. And we may know the results of that trial within the next two or three weeks.

michael barbaro

So far, then, none of the experimental treatments for this are known to work.

donald g. mcneil jr.

They’re still in the testing phase.

michael barbaro

Got it. Do we know anything?

donald g. mcneil jr.

Frankly, I think if there was something that was a miracle drug, it would have leaked right now. They — ethically, if it was a miracle, they’d have to stop the trial early and just give everybody that drug.

michael barbaro

OK, what about a vaccine, something that would prevent this virus?

donald g. mcneil jr.

A vaccine is going to take pretty close to a year to produce.

michael barbaro

A year.

donald g. mcneil jr.

A year.

michael barbaro

That’s a really long time.

donald g. mcneil jr.

Yeah, so we’re not — if this virus arrives here, we will not have a vaccine. And the reason is, you have to do the safety and efficacy trials. And those have to be done in animals, and then they have to be done in people. And first you have to do them in a small number of people, and then you do them in a large number of people. Because when you don’t do that, you may find — and this has happened — that the vaccine makes the problem worse.

michael barbaro

What do you mean?

donald g. mcneil jr.

Well, there have been vaccines that have caused horrible side effects in the past. And there also have been vaccines that actually make you more susceptible to the disease. There was a dengue vaccine that appeared to make children more susceptible to dengue. There was an H.I.V. vaccine trial that had to be stopped because it made people more likely to catch H.I.V.

michael barbaro

OK, so during this year when a vaccine would be under development, but not yet available, paint a portrait of what is likely to happen. Now I know, based on my many years as a Times reporter, science and health reporters here do not like to speculate. But I am going to, with your permission, ask you to speculate a little bit about what that year looks like, the worst-case scenario and the best-case scenario.

donald g. mcneil jr.

I don’t know what’s going to happen. But keep in mind, the 1918 flu was really the 1918-1919 flu. It started in the spring, faded in the summer, came back like a monster in the fall. That would be a worst-case kind of scenario. That we don’t have a vaccine yet by the fall, and the disease hits us hard then.

michael barbaro

In that scenario, could almost every person in the country who is not a child get the virus?

donald g. mcneil jr.

Some big chunk of the country — 30, 40, 50 percent — are likely to get a new virus when it blows through. And if you don’t get it in the first wave, you might get it in the second wave.

michael barbaro

And 2 percent lethality rate of 50 percent of the country. I don’t want to do that math. It’s really, really awful.

donald g. mcneil jr.

It’s a lot of people. It means, you know, you don’t die. 80 percent of people have mild cases. But you know somebody who dies.

michael barbaro

That’s pretty horrible.

donald g. mcneil jr.

Yeah. Right now, it’s a smaller threat than the flu for us in the United States right now, but it could be a lot worse. And take that threat seriously. And that’s what the C.D.C. is saying, too. Prepare. It’s not just prepare as in stock up on food and buy masks. It’s more like, mentally prepare yourself for what would happen if you and all of your friends had to stay home for a month, or not be able to ride the subways, or supermarkets ran low on food. Or, you know, your medicine — your insulin or your H.I.V. meds or your heart meds or whatever it is you take — wasn’t available because the supply lines from China have been cut off. So we’ve got to mentally prepare ourselves for something like that.

michael barbaro

OK. Now, the best-case scenario.

donald g. mcneil jr.

The best-case scenario is one of these drugs works, and basically everybody gets sick next year, but everybody who is hospitalized gets a drug that keeps them from dying and keeps them from going into deep, deep, deep respiratory distress. And we have the equivalent of a bad flu season. And then everybody says, oh, the media, they blew it out of proportion again. You know, it’s all ridiculous. And, you know, I get blamed. So, too bad. It’s happened before.

michael barbaro

So at this point, American health officials are saying it’s just a matter of time — and they’re not saying how much time — before this virus reaches the U.S. in a pretty meaningful way and starts to spread. So how prepared is this country?

donald g. mcneil jr.

Not prepared enough. And it’s hard to know exactly how prepared we need to be.

michael barbaro

Why do you say not enough?

donald g. mcneil jr.

Well, in any bad flu season, hospitals put people on all their ventilators. We have a National Strategic Stockpile, which has a lot of stuff in it — masks, gowns, gloves, drugs, even some ventilators. But you can’t stockpile enough ventilators to put — a ventilator is like a cost of a car. It’s $25,000 to $50,000. Hospitals can’t go out and order an extra hundred of those. And if they did order an extra hundred of those —

michael barbaro

It would take awhile.

donald g. mcneil jr.

It would take awhile. And also you need at least three people to staff that ventilator with the patient on it around the clock. And that’s a lot of trained respiratory technicians and things. So if we get hit with a gigantic epidemic of a lot of people with pneumonia needing to be on breathing machines, we’re not prepared for that.

michael barbaro

What about preparations beyond ventilators?

donald g. mcneil jr.

What happened in China, with the shutdown of Wuhan and Hubei province during Tet, during New Year, was the equivalent of shutting down Chicago and most of that surrounding part of the Midwest at Christmas time and telling people, you are now going to stay in Chicago. You can’t leave. You can’t see your families. All the flights are canceled. All the trains are canceled. All the highways are closed. You’re going to stay in there. And you’re locked in with a deadly disease. We can do it.

michael barbaro

Would we do that?

donald g. mcneil jr.

We can do it, but we’re not used to being controlled from the top down the way people have been in China. So I don’t know what’s going to happen in the United States. We’re not mentally prepared to fight a sort of people’s war against an epidemic, which is what happened in China.

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michael barbaro

Before I let you go, I feel like I have to ask you, given your experience covering these kinds of epidemics, what kind of preparations are you personally making?

donald g. mcneil jr.

I have food in the basement anyway. I always have about a month’s worth of food in the basement, because that’s the kind of person I am. I’ll probably order some more of my heart — you know, blood pressure medicine, you know, so that I have another 90-day supply. I shouldn’t stockpile masks. I’m against it. I did go out and buy a box of 10 masks back in January. I feel a little ashamed I did that, because really those masks are more important on health care workers than they are on me. Otherwise, I’m not sure there’s much you can do. You know, I take some comfort in the fact that 80 percent of the people have a mild disease, and that might be me and everybody I love, too. We might all get lucky. But not everybody we know is going to get lucky if this turns into something like 1918.

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michael barbaro

Well thank you, Donald.

donald g. mcneil jr.

You’re welcome.

michael barbaro

On Wednesday, U.S. health officials reported the first American infected with the coronavirus who had not traveled to countries in which the disease was circulating. Such an infection may represent a case of community transmission, which would be a turning point for the virus in the U.S.

[music]

archived recording (donald trump) I have just received another briefing from a great group of talented people on the virus that is going around to various parts of the world. We —

michael barbaro

On Wednesday night, President Trump addressed the nation about the virus from the White House, heralding his administration’s handling of the situation so far, describing the risk to Americans as low and appointing his Vice President, Mike Pence, to oversee the response effort.

archived recording (donald trump) We — we’re ready to adapt, and we’re ready to do whatever we have to as the disease spreads, if it spreads.

michael barbaro

Asked whether the U.S. would undertake the kind of sweeping measures used to contain the virus in China, the president said that nothing was off the table.

archived recording Mr. President, have you been presented any plans that would involve quarantining cities like we saw in China? And what would have to happen for you to take a step? archived recording (donald trump) We do have plans of a much — on a much larger scale, should we need that. We’re working with states. We’re working with virtually every state. And we do have plans on a larger scale if we need it. We don’t think we’re going to need it, but, you know, you always have to be prepared.

michael barbaro

As of Wednesday, more new cases of infection were reported outside of China than inside of it. The total number of cases has now surpassed 80,000, and nearly 3,000 have died.

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We’ll be right back. Here’s what else you need to know today.

archived recording [CROWD SHOUTING]

michael barbaro

At least 25 people have died in some of India’s worst Hindu-Muslim violence in years.

archived recording [CROWD SHOUTING]

michael barbaro

The violence began with a speech from a local Hindu official calling for the forceful removal of Muslims, who were protesting India’s new citizenship law, which is widely seen as discriminating against Muslims. Within hours of that speech, violence had broken out, much of it directed at Muslims. The latest case of what many inside and outside of India see as the rising danger of Hindu nationalism.

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