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3 月 26 日晚,微软联合创始人比尔·盖茨在美国有线电视新闻网(CNN)表示,“这就是一场噩梦,我没想到我们的应对是如此的缓慢和混乱。”他强调,全美必须有效停摆至少 6-10 周。同时,他喊话道,整个国家都需要像在中国发生这些感染的地区那样做。
值得一提的是,34分钟采访中,盖茨6次提到中国,并一再强调美国需要借鉴并严格遵循中国曾经实施的封锁措施。
盖茨说,经历过非典的国家在这次防控中做得最好,在感染人数很少的情况下就作出了反应。中国采取了非常严格的隔离封锁措施,比美国做的最好的州还要严格。在付出了巨大代价后,现在中国的商店开门了,而世界其他地方的商店却关门了。
盖茨认为,中国和韩国的例子证明,严厉的封锁措施能够避免大比例人口感染。他遗憾地表示:“但凡美国有一丁点像那些做得最好的国家,我们现在的情况都会好一些。”
1、中国经验值得借鉴
值得一提的是,长达34分钟的采访,比尔·盖茨6次提到中国,并一再强调美国需要借鉴并严格遵循中国曾经实施的封锁措施。
比尔·盖茨:这次我们发现,经历过SARS的国家在这一次传染病防控中做得最好,他们在感染人数很少的情况下就作出了反应。
比尔·盖茨:好消息是中国采取了隔离封锁措施,非常严格,在封锁措施实施了六周之后,他们的措施仍然很严格,比美国做的最好的州还要严格。在经过六周这个周期后,他们目前已经逐渐重新开放了,总体感染人数已经变得非常非常小了。这是非常好的消息。人们以此为范例,看中国的数据,看韩国的数据,他们实现了很好的控制。
比尔·盖茨:中国在付出了巨大的代价之后,现在中国的商店开门了,而世界其他地方的商店却关门了。
比尔·盖茨:全美都需要采取中国部分地区曾实施的封锁措施。
比尔·盖茨:严厉的封锁措施是能够避免大比例人口感染的。中国和韩国的例子已经告诉我们这个事实了。
中国疫情防控经验确实被很多国家借鉴。对于当今处于疫情中心的美国来说尤为重要。盖茨遗憾地表示,“但凡美国有一丁点儿像那些在这方面做得最好的国家,我们现在的情况都会好一些。”但当下他应当感到欣慰的是:在27日中美两国领导人通话中,中方明确表示愿继续毫无保留同美方分享信息和经验,提供力所能及的支持。
2、检测一直都是核心问题
盖茨认为目前美国的新冠疫情检测非常混乱,政府未能有效承担公共卫生的责任。这也被认为是美国错失防疫最佳时机的重要因素之一。
比尔·盖茨:说起新冠检测,(美国)现在是很多公司决定谁能够接受测试、谁不能。这非常混乱。公共卫生应该是政府的责任,而非私人机构。在美国,一些人没有任何症状但有条件每天做测试,而一些医护人员却没有途径测试。
比尔·盖茨:可能是由于检测的问题,很多地方其实有很多病例。
比尔·盖茨:比如纽约已经采取了措施,能够避免医疗系统的过载。全美都应该采取和纽约一样的行动。并不是说单纯地不让人在州与州之间流动,而是说要搞清楚到底有多少人感染,除了封锁,还需要有相应的检验能力,尽早为检测出阳性的人诊治,才能阻断进一步传播。
比尔·盖茨:检测至关重要,是绘制疫情趋势曲线的数据来源,这些都是非常重要的信号,提醒我们隔离措施做得是否到位,或是我们何时可以减少措施。所以检测一直都需要,非常核心。
盖茨还提到,未来6到9个月的时间,可能会研发出一种新型检测试纸,灵敏度较好的话在家就可以测试,通过试纸的变化直接出结果。
不过远水解不了近渴,现在的美国仍需快马加鞭地提升检测能力,确保病人被及时收治隔离。
3、全美封锁刻不容缓
当主持人问道,美国有的州县只有两三百病例,也需要封锁吗?盖茨认为,目前全美都需要。
比尔·盖茨:即使只有100个病例,如果不进行封锁,每天的感染人数将会增长33%,100例到1000例到10000例,如果不去阻止的话,增长的速度会很快。越早阻断越早封锁,疫情就更容易到达峰值。
比尔·盖茨:目前已经有部分地区已经封锁了,病例数量仍在增长,也许还需要一个月的时间才能到达峰值。虽然一些州显示只有一两百例,但人们会到处流动。所以基本上,全美都需要采取类似中国部分地区实施的封锁措施。
比尔·盖茨:我们现在进入了困难时期,如果我们采取了正确的措施,我们只需要坚持6到10周,但必须全国统一步调,大幅提高检测数量,优先进行检测,来确保我们一次封锁隔离就能解决问题。这样我们就可以在死亡人数升高前解决医疗上的问题。我们肯定会遇到经济的问题,因此才要速战速决。各州县之间各自为政是行不通的,不严格执行封锁隔离的地区感染人数会指数级增长。
在描述冠状病毒时,盖茨说,由于这是呼吸道系统的人传人流行病,可谓“噩梦般的场景”,但也无需恐慌,只要采取有效措施,就可以有效控制。他多次提到美国的反应和很多国家相比混乱、缓慢,因此当下封锁行动刻不容缓。
4、认清现实 复活节前没法恢复商业
采访中,主持人不止一次问比尔·盖茨:针对4月美国就能够恢复商业的说法,很多卫生领域专家说不太可能,但他们不懂经济,民众不买账。您既了解经济,又懂公共卫生,您的建议呢?
盖茨非常坚定地说,4月中旬恢复“完全不现实”。
比尔·盖茨:回到工作岗位并不是首要考虑的问题。这种封锁确实很痛苦,但很难说一周之后就可以去剧院了。因为你有可能会被感染或者感染别人。我怀疑即使你告诉大家他们应该买房子、买车、去餐厅,大家可能也不想去做。人们想要保护身边所有的人,保护父母。
从主持人的提问中可以看出,美国民众对长时间的封锁、居家隔离是有怨言和怀疑的。对此,盖茨说,美国的峰值远未到来,现在的封锁是为了拯救上百万人的生命,封锁执行得越彻底,生产生活恢复得就越迅速!他认为这么做,6到10周就有可能把疫情控制住。
5、不要慌张,努力改变自己的行为
在节目的最后,盖茨说了一段话送给处于疫情中的人们:
现在是充满挑战的时刻,我们都在为生命的改变作出巨大努力,这些都是我们未曾预料过的。
人们现在努力待在家中并减少必要的联系,这很了不起。
人们在学习如何通过可视设备进行授课和接受教育,还为慈善机构和社区捐款,帮助那些无家可归、食不果腹的人们,这很了不起。
我相信(感染病例)数字终会下降。会有一个时间点,可能10周,也可能更早,我们的生活终会回归正轨。
确实,这是一段很长的时间,但如果做得不好,很可能意味着这个时间还会更长,甚至会重来一次。
虽然一些变化看起来有些可怕,但不要慌张。我们必须集中精力做好,改变自己的行为,防患于未然。
目前美国疫情十万火急。据美国约翰斯·霍普金斯大学发布的实时统计数据显示,截至北京时间3月31日中午12点之前,全美共报告新冠肺炎确诊病例超过16万+例,确诊数居全球首位,死亡超3000+例。
不得不承认,美国政府因前期决策失误错过了防疫的最佳时间。时不我待,希望美国能够抓住全球合作抗疫的第二个窗口期,立即行动起来,尽快控制住疫情。
CNN专访比尔盖茨对话稿
COOPER: Bill, in that TED Talk, you pointed out that we invest a lot in being ready for a war or nuclear deterrence, but you said, quote, "We've invested very little in a system to stop an epidemic. We're not ready for the next epidemic."


Just big picture, before we get into details, how do you see the coronavirus, where we're at right now in the United States, compared to other pandemics the world has faced? I mean, what's the good news, what's the bad news?


GATES: Well, this is a terrible pandemic. Because it's spread human to human in a respiratory way, you can infect somebody when you're still fairly healthy. And there are many things, like Ebola, that aren't like that. You're flat on your back before you become significantly infectious.

BILL GATES, CO-CHAIR, BILL & MELINDA GATES FOUNDATION: So this is kind of a nightmare scenario that in 2015 I gave a (INAUDIBLE) lecture, I wrote an article in the New England Journal of Medicine and talked about how we needed to invest in new platforms so that we could quickly make diagnostics, make drugs, and make vaccines to stop an epidemic before it got to large numbers.


ANDERSON COOPER, CNN HOST: I know you did some of that investment, but was -- were all the things you called for or hoped would be done, were those done?


GATES: Basically almost none of them. A few countries, our foundation, and Wellcome Trust did fund a vaccine effort called the Coalition for Epidemic Preparedness and Innovation. And that -- and some of that work is being used to make the vaccine so it'll be the first to be ready for coronavirus.


But in terms of the testing, the antiviral drugs, not much happened. You know, people -- when you don't know that a problem will come around, sometimes people prepare like we prepare for war with war games and putting lots of money into that, but sadly we've gone long enough without a disease here in the United States that even though we had Ebola and Zika and SARS, not much happened.


The countries that really were affected by SARS actually are the ones that have done the best in this epidemic because they acted when the number of cases were still very, very small.


DR. SANJAY GUPTA, CNN CHIEF MEDICAL CORRESPONDENT: So, Bill, when you give a talk like you did in 2015, and then you see what's happening now, I mean, could you have foreseen the rest of this, the sort of response, the lack of infrastructure, the lack of resources, no apparent strategy really out of the gate? Has that part of it surprised you given that, I mean, you were sounding the alarm five years ago?


GATES: Well, one of the things I called for is in that the same way we do war games on a regular basis and we say, OK, we're not ready to deal with surprises, I called for us to do germ games and look at, OK, who would talk to the private sector? Who would make sure that testing capacity was raised? Who would make sure that the right people are being tested, you know, not somebody without symptoms getting tested daily, rather, you know, medical personnel who have symptoms who really need to know?


And so I wouldn't have predicted exactly how slow and how somewhat chaotic the response has been. But if we had done those simulations, we would have seen some of those flaws in the system and, you know, behaved a little bit like the countries that have done the best on this one.


COOPER: It's important to remember that COVID-19 was only first found in humans a little over three months ago. It certainly feels like a lot longer than that given what we're going through. What stage do you think the pandemic is in right now in the United States and globally? And I guess, you know, what people at home want to know is how close are we to a peak here in the U.S.?


GATES: Well, the good news is that China did their shutdown, and they did it in a very serious way. And after a six-week period of a shutdown that's more extreme than even the best states in the United States are likely to do, they were able to start opening up again. And the total number of cases there is very, very small. So that's very good news.


And as people are developing models, they look at that Chinese data. They look at how the South Korean numbers have gotten under of control. So we're entering into a tough period that if we do it right we'll only have to do it once for six to 10 weeks. But we have to do it -- it has to be the whole country. We have to raise the level of testing and the prioritization of that testing quite dramatically in order to make sure we go through one shutdown, so that we take the medical problem and really stop it before there's a large number of deaths.


We do then get an economic problem, which is why you want to minimize the amount of time. And having states go with different things or thinking you can do it county by county, that will not work. The cases will be exponentially growing anywhere you don't have a serious shutdown.


COOPER: So even in -- because folks look -- people who want sort of county by county or say, you know, let's get back online faster say, well, look, in some states there's less than 200 cases. In many states there's less than 200 cases right now. You're saying even in those states the same kind of shutdown needs to occur?


GATES: Well, let's say you have 100 cases, and let's say you don't do a shutdown.


[21:05:01]


Then it grows 33 percent per day. So you take 100, you get 1,000, you get 10,000. It's exponential growth if you're not stopping it. The sooner you engage in the shutdown, the easier it is to get to that peak. We have not peaked.


You know, the parts of the country that are in shutdown by the -- in late April we should start to see the numbers peak there. They'll still be too high to open up, so you'll probably have to go another month to really get those numbers down. But any part of the country that has cases, and truthfully because of our problems with testing because we're not prioritizing testing the right way, a lot of those places actually do have cases.


But even if they have the hundred, that will grow and people do cross county boundaries. And so basically the whole country needs to do what was done in the part of China where they had these infections.


GUPTA: Yes, and it's worth pointing out, again, that states that had just a few cases last week have, you know, over 1,000 or sometimes 2,000 cases this week, to your point, Bill.


The other thing I'm curious about, you know, we keep hearing that the virus is going to dictate the timeline. Dr. Fauci has said that. When you look at this virus, we've got three-and-a-half months' worth of data now, 150 countries. If you apply all the analytics that Microsoft -- all the analytics that we can possibly apply to this, is how this is going to sort of progress and end knowable? I mean, can you give a clear answer depending on what sort of, you know, mitigation measures we have in place?


GATES: It's very likely that rich countries who uniformly throughout their country do a serious shutdown, that they will be able to avoid a high percentage of their population getting infected. That's what the exemplars, like some of the work in China and South Korea are telling us.


Now as you get to poorer countries, the difficulty of doing the isolation, where you live close by in slums, where you have to go out every day to get your food, it is going to be much, much tougher. And so, you know, by summer I think the rich countries that have been competently led on this will not have to go back into shutdown. And, you know, from the disease point of view, they'll avoid very large numbers of deaths.


And so in that phase we still will have a challenge with the developing countries.


COOPER: One of things that Dr. Fauci actually said in our last hour, which really concerned me, and I was asking him about the states that -- you know, I think there's more than a dozen or so that have a -- just 100 or 200 reported cases, he was saying how it's critical that -- you know, that those states, that they have testing there, that they test, and that contact -- do contact-tracing of all those who are known to be infected to really right now when the numbers are still low track it all.


And then I asked him -- he was using a lot of sort of future verbs about things needing to happen or plans. It didn't sound like --I asked him if it was actually happening now. He said it needs to happen a lot more. From what you're saying it has got to be happening right now because if there's not that contact-tracing in places where it seems like it hasn't really hit, we're going to see it hit.


GATES: That's right. I mean, we wish that we shut down even sooner in places like New York. Then you would have not had the medical overload that is such a huge challenge for them. Unless you're going to partition the country, the whole country has to be in this together. And we're not -- you know, I don't see us making people not cross county lines or something like that.


So it really is how many cases are in the country, and have we adopted in terms of testing -- testing prioritization and contact-tracing the right things. But the good news is we're seeing that countries that pay that price, which is a gigantic price, then the percentage of Chinese that are infected is like 0.01 percent. And so now, you know, stores are open there and closed in the rest of the world.


You know, that's -- I'm not sure you call it good news, but I totally agree with what Dr. Fauci said. He has been a very positive voice about the numbers driving this. And those numbers are very uncertain because of the -- still the disorganization of the testing capacity and where it's directed.


GUPTA: You know, it strikes me that -- I mean, you know the world of public health very well and you know the world of the economy very well, financial world very well.


[21:10:05]


They seem to be pitted against each other. And I don't normally know much about the financial world at all, but I think there's this idea, Bill, that maybe you can be a little incremental here, right?


Yes, we need to listen to the public health guidance and all that, but can we be a little incremental, start getting some things back to work, you know, so that we don't, you know, really devastate the economy that much? How do you respond to that?


GATES: Until we get the number of cases in the country down to small numbers where we can be doing testing and isolation against those small numbers, we need to make this our top priority. And it is super painful to drive this very high degree of social isolation I call shutdown.


The middle course really isn't there because it's hard to say, oh, go back to the theater for a week, you know, maybe or maybe not you'll be infected or infecting people. You know, until we get the certainty we've hit these low numbers, you know, I doubt even if you told people that they should be buying new houses and cars and, you know, hanging out in restaurants, I doubt they're going to want to do that.


You know, people want to protect older people. They want to protect their parents. And so the sooner, you know, we take this medicine, which is tough medicine, the sooner we'll be out of it and not have to go back into it again.


(CROSSTALK)


GUPTA: I'm sorry, just really quickly, when you say low numbers, I mean, are you talking about actual numbers or are you talking about spread? Because this is a virus that can spread to two or three people. That's a lot. I mean, if it spreads below -- to just below one person, is that what you're talking about or are you talking about actual numbers?


GATES: Well, the absolute numbers better be pretty low because you're going to have to have the testing capacity to take the remaining positives, see them early, and so you're not getting that exponential spread. And that's why looking at the other countries who acted sooner, and in some cases did not have to shut down to a full degree, that's where the lessons are.


You know, they can show us, OK, what was the medical history? So you see if asymptomatic are spreading. But, yes, the absolute numbers are going to have to be fairly low, and we'll have some degree of caution. We won't open up completely overnight and, you know, because we don't want quite the full exponentiation even off of the small base that we'll get ourselves to.


COOPER: And I don't want to be political in any way, but just in terms of for folks who are out there, you know, and looking forward, I always think it's better to know just factually what's coming down the pike than -- you know, than it's good to have hopes and aspirations, but it's good to also to know what's actually coming down the pike.


For people who are believing or imagining that, you know, in middle of April or early April people will be able to gather together in churches for, you know, Easter celebrations or, you know, go back to work in a regular way, it's sounding like you're saying that that's not -- you don't believe that's realistic.


GATES: No, it's not realistic. The numbers are still going up. That only happens after the numbers have peaked and are going down a lot and getting down to an absolute level. You know, there are some good things happening. The work on a vaccine, although that probably will take 18 months, that's going full speed ahead. Our foundation is funding that. We're looking at getting vaccines to everyone in the world. So in the long run that is the key thing.


We had a really positive result that people were wondering, did you have to have the medical person swab you in this way that they stuck it deep in your nose? We were able to prove, which -- on Monday the FDA made official that if you do a self-test where you don't have to have the medical worker with personal protection equipment, that self- test is as accurate as the one where the medical worker gives it.


So that means that by self-swabbing we'll be able to get a lot more tests done and only be limited by the PCR back-end capacity. So there's -- you know, there's good news coming. One of the therapeutics -- although none of them are proven out, but there are quite a few. We have a thing -- a foundation created called the Therapeutics Accelerator to really look at thousands of compounds and make sure we focus the human trials on the ones that have the most promise.


So, you know, innovation, which -- some of which we could have done in advance. But innovation really is happening. But, you know, when you look at those numbers, the U.S., you know, now with the most cases, you know, there is no state that has gotten to the point where their numbers are flat and are going down. And the testing capacity means we're quite blind to a lot of these cases right now. [21:15:17]


So, it can be done, but we're not -- you know, the light is not at the end of the tunnel in terms of a mid-April reopening.


COOPER: Can I just ask, on a personal basis, for your family, I assume you guys are self-isolating.


How is -- what is your life like now, compared to what it was? And how long do you think you are going to have to, as a family, live like you're living?


GATES: Well, there's some uncertainty about this.


But my view has been that through May, unfortunately, the schools will not -- are not likely to come back for this year, this school year. And that's about the range, late May, early June, that we will probably have to be like this.


You know, I'm learning how to do digital meetings. I happen to use a thing called Teams from Microsoft. But it's a very different lifestyle.


And it's very jarring. We're in a -- it's a scary time. Every morning, you get up, you see that number has increased. So, you know, learning to cope is -- you know, we're completely in unchartered territory.


But the scientists that our foundation gets to fund and work with, they are doing a great job. And the health workers are doing heroic work.


So, I do see it coming to an end. And if we do it properly, we will only be shut down in the U.S. for that one period of time.


COOPER: I don't know if you saw Sanjay Gupta's tutorial on how to wash your hands, but, to me, it was a revelation that you have to, like, clean your thumbs separately.


That, I was unaware of.


(LAUGHTER)


COOPER: You probably knew this, Bill.


GATES: I will have to go back and study that.


(LAUGHTER)


COOPER: OK.


GUPTA: Not separately. But you do have to make sure you get your thumbs, for sure.


Let -- a few years ago, Bill, we talked -- I don't know if you remember -- talked about pandemic flu at that point and vaccines, and how quickly a vaccine could be deployed at that point, and if you did it months faster, you could save a lot of lives in a pandemic flu situation.


With this, you know, Dr. Fauci, I think, has been very clear that this is year, 18 months, whatever, that it will take before people could actually get this vaccine.


Are there -- are there -- and I know that he's right about that. But I'm just wondering, from a technological standpoint, are there ways to speed this up using genetically modified virus or anything to expedite the process?


GATES: Well, for the next pandemic, we should be able to make diagnostics very quickly, like hundreds of millions within two months.


We should be able to scale up antiviral drugs from a much bigger library within like six months. And by being ready with this RNA platform, we should be able to make vaccines in more like a year than a year-and-a-half.


And so we can. And I think governments this time probably will pay attention to making those investments for the next one.


You know, the -- one of the biggest open questions is the therapeutics. Can we very quickly find an antiviral drug that really means the number of people who have to go on the respirator is much lower and cuts down that death rate quite a bit?


It's tough enough in the U.S. with the -- we put a lot of money into our health system. If you think about this as you get to India, Nigeria, and the even poorer countries in Africa, just imagine what the overload is going to look like there.


And yet they won't be able to do the -- that isolation. And so, you know, we -- we -- as we have gotten the disease down with the low infection rate, we will have to be not letting people go to those countries or come from those countries hardly at all.


It'll be very strict in terms of how that testing is done. So, the sooner we solve this on a global basis, the sooner we can go back to the kind of world economy that actually was in very good shape before this came along.


GUPTA: And just to be clear, you think that there will be lessons learned and applied for the next pandemic?


It seems, sometimes, unless something is smacking us in the face, Bill, that people just don't pay attention, even when it comes to their own individual health, let alone public health.


GATES: Well, talk about being smacked in the face.


What's going on here is mind-blowing. Never in my lifetime has -- have we had to change our behavior and have this drastic effect on the economy in order to save lives.


[21:20:02] And, you know, there are people who wish we didn't have to do that. I -- that is fully understandable. This is some very tough medicine. But it's better to take the economic problem, where the economy can come back, than to allow it to spread throughout the country and take millions of deaths as the price that we have to pay here.


And so, yes, I think this is a smack on the head. You know, this will cost trillions of dollars. They just passed a $2 trillion relief bill, and now they're talking about more.


The kind of research to be ready for the next pandemic is a tens-of- billions number. So it'll look almost trivial compared to the price we're paying now. And that price would have been a lot lower if the world was more prepared.


COOPER: There -- a lot of people don't understand why a vaccine can't be developed sooner. The biggest reason for that is simply science, which I something we can't necessarily change.


But you're saying that it could down the road get to a place where it would take a year, not a year-and-a-half. Is that after spending the tens of billions you're talking about?


GATES: Yes, the -- you know, companies like Moderna, CureVac, Inovio, our foundation has been funding them to build vaccines in a somewhat different way.


It's an RNA platform that is very versatile, so the amount you have to change is very small. And you can build up your manufacturing, so that it is available. No matter what pathogen comes along, that manufacturing capacity is there, and certain elements of how you go through regulatory approval.


Because you're only changing one small piece, you would have had many of these RNA vaccines approved. People understand the safety profiles. So that would mean that, in the future, yes, that timeline is less.


Because you want things to be safe, and, you know, vaccines actually can, in weird cases, do an enhancement of the disease, you really need to test for that.


And so I don't think we will get much below a year. You know, we will challenge very smart people to work on that. But there -- the trade- off involved there is about the -- how confident are you that, when you're going out and giving this, that there's no side effects?


COOPER: I do just want to follow up on something you said, that it -- and I think it's important to point out that, as bad as this is, this could be worse, in terms of a virus -- you have talked about the potential of a pandemic that wipes out, you know, huge percentages of countries' populations, and that is entirely possible.


So, for anybody who doesn't think that this is reason enough to prepare for the next one, there -- something coming down the pike could be much worse, correct?


GATES: That's right.


You will see in the -- a lot of people try to show that viruses, their infectivity and how much they kill, the case fatality rate, those are separate things. And so smallpox is a very bad case, because it's very infective and it kills like 30 percent.


Here, fortunately, although there's still some uncertainty, you know, the case fatality rate is something like 1 percent. If you have a medical system that's able to take care of the severe cases, about 1 percent of those who are infected die.


And, yes, it could be worse. This is very, very bad, but still not the worst-case.


GUPTA: I have got a question sort of about how you see the role of the public sector vs. the private sector when it comes to something like this, a pandemic, you know, a global issue like this.


You know, you were talking about the testing. And there was a press conference at the White House where they had people from these various private diagnostic testing organizations and other consumer-facing organizations that were private.


You know, with something like this, is -- how does that collaboration happen? I mean, is there -- should the roles and the responsibilities be more equally, you know, divided, or at least described?


GATES: Well, the responsibility to take care of the health of the public, that's a governmental responsibility.


And so, in the case of testing, those companies aren't in a position to decide who should be tested and who shouldn't be tested. Those are societal priorities.


So, right now, it's fairly chaotic. I said somebody can get a test every day without symptoms, and a medical worker in another location doesn't have access to the test.


So, the values we have as a society are understanding the disease dynamics. And the very finite capacity of the way we're doing the tests now, which is the PCR machines, that is up to the government to get involved with.


[21:25:02]


In this case, state leaders have had to step in and take some responsibility there. But, you know, it's kind of unfortunate that we don't have a digital system that is ranking for the finite capacity we have exactly which ones should be taken care of there.


And maybe we will get that fixed or not. Maybe that'll strangely have to be at the state level.


But the government is in the role here. And it has to design the system. And then the private sector companies, you know, who own those machines, run those machines, they will step up. They will work super hard.


The clarity, though, has to come from the federal government.


GUPTA: You talk about vaccines and anticipating a pandemic like this.


If you go even one step further back, Bill, and say -- I read an article that said that this virus was actually found in bats sometime ago. It was a virus of concern for people who were looking for this, because it was a coronavirus, and there was a concern it could jump from animals to humans.


Do you think that this could have been prevented even earlier on from making that jump?


GATES: Well, having these markets where you have, you know, bats in a cage and pangolins and things like that, it's fairly clear the less we have of those, that somewhat reduces the chance.


But it won't reduce it to zero. And so you really do need the preparedness system there. And there are so many coronaviruses in animals, it would not have been possible to say, OK, this is the one to be afraid of.


We don't understand enough about that, how it transforms to cross the species barrier. There are literally millions of viruses out in animals. The number that cross over, like the flu does, is not very large.


But that's not very easy to predict. There are people who have looked at that, maybe someday. But that's outside of our ability. And so we have to have the tools, when it does cross over, to see, wow, if you're seeing human-to-human transmission, particularly respiratory transmission, then the world has to go on red alert.


And parts of the world went on red alert in January, and parts did not.


COOPER: You have talked tonight a number of times -- you have referenced the importance of testing.


And I just kind of want to circle back to that, because we're hearing from a number of, you know, public leaders that they seem to be de- emphasizing it, saying, look, we're not going to test the whole country.


And there's now guidelines that, if you have symptoms, you probably don't even need to get tested. As long as you're not really bad sick, you can just -- or very sick, you can stay at home, and, if things get worse, then contact a hospital or your doctor.


Can you just talk about the role testing has moving forward? I mean, obviously, we know the problems with the test that existed. We know all that, but, just moving forward, how important it is to keep testing.


And do you want to -- just to get data, is it you just test the people who have symptoms? Do you test people who have no symptoms whatsoever to kind of get some sort of a baseline?


GATES: Yes, for surveillance, you probably do want to go out and almost randomly pick people, even asymptomatic, to see if you're missing something there.


And our foundation, with partners in the Seattle area, actually has that going on. We took a flu study that we were doing before and repurposed it. Actually, that flu study was the first to see community spread of coronavirus in the U.S. and should have been a red flag when that was seen.


In any case, the testing is very key. The only reason we talk about what you do if you can't get a test is that demand will exceed supply, even as we get organized with more capacity and we're doing the prioritization, that not everyone will be able to be tested.


I mean, people are so concerned now that, if you really could test everybody, you know, that would be nice. But we don't have, you know, 300 million tests available, even if we're doing the right things.


Testing is how you know what's going on. That's where you see those red dots. That is the indicator that will tell you we're not doing enough of a shutdown, or, actually, now we can start to back off.


So, testing has to keep going up. Testing is very, very central. But we won't be able to get a test to everybody who just wants that peace of mind, unfortunately.


Eventually, we may have a strip test that tests for the virus, not for serology. But if it has the right sensitivity, we could have a scale- up there.


But, unfortunately, that's probably you know 6 to 9 months before we'll have that type of that home test.


[21:30:00]


COOPER: I know we got to let you go. Just finally, for - you know there's a lot of folks out there tonight watching or going to be watching this online or whenever tomorrow. What's your message to them? People are scared, people are worried, they've lost their jobs, they're -- they don't know how long they're going to be in their homes. What do you -- what's your message?


GATES: Well, this is a very challenging time. And we're all having to make huge changes to our lives that we never would have expected. People are rising to the challenge, you know, figuring out how to be at their home and reduce their contacts. That's really fantastic. People are figuring out how to volunteer, in many cases through virtual connections, tutoring and mentoring. People are giving money to philanthropies in the local areas that are stepping up to find where people may not have shelter or food and that's really fantastic.


You know, I'm an optimist. We'll be driven by the numbers, but I -- from what we've seen in other countries, if we do this well, and nationwide, these numbers will start to come down. And so there'll be a point, you know, hopefully in -- in 10 weeks or less, where we can start going back to normal.


That's a long time, though. I mean, it's a wild amount of time, and there will be this temptation to let off. Unfortunately, that will just mean that it -- it lasts longer or that we have to go back and do that again. So, you know, there's no need to panic, even though the change is a bit scary.


GUPTA: If I could just ask one more thing, because I think you're so -- your voice is so important here. But there's a lot of people who are watching right now who have not been affected by this, and they're feeling fine, they don't know anybody who's contracted the coronavirus. How do you best convey risk in a situation like this?


GATES: Well, if we do the shutdown properly, the percentage of people who get infected will actually be very low. That's the idea, is to not get up to like 1 percent, which, you know, then is 4 percent, 16 percent, 64 percent, if you keep letting it exponentiate that way. So you have to stop well short of that 1 percent.


You know, the damage, there will be a lot of economic damage. Somebody who owns a restaurant, somebody who's now -- their job is not there. That, you know, we'll have to be creative on this new ground how we do things like relief packages to help out and minimize a lot of that pain.


But the medical risk, if we do this thing well, the chance that you're going to get coronavirus and die of it is not super high. There are other diseases that will still be killing more people during this timeframe, if things are done well. We're really focused on this, because we need to be to change the behavior to nip it in the bud at modest percentages of the population.


COOPER: Well, Bill, thank you very much for being with us tonight. And thank you for the work that you and Melinda do all the time. Thank you so much. Really appreciate it.


GATES: Thank you. Great.


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