COVID-19: How it spreads, how to test for it, and economic impact

Verge editor-in-chief Nilay Patel talks with Verge health reporter Nicole Wetsman and Verge deputy editor Liz Lopatto about the health concerns of the coronavirus outbreak as well as its economic effect in the United States. Learn more about your ad choices. Visit podcastchoices.com/adchoices

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:00Speaker 00

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• 0:31Nilay Patel?

  Hey, everybody. It's Sinead from The Vergecast. On this week's interview episode, Verge Health reporter Nicole Wetsman joins me along with Verge Deputy Editor Liz Lopatto to talk about the coronavirus. Nicole has been covering it very closely from the health angle, tracking its spread, the response of our authorities, how to test for it, how to treat it. And Liz has been paying a lot of attention to the impact on the supply chain, all of the various economic impacts from that, and all of the events that are being canceled. This was a very eye-opening conversation that really helped me organize the swirl of thoughts I've had as I've been keeping up with the virus news. Check it out. It's Liz Lopatto and Nicole Wetsman on The Vergecast.

• 1:10Nilay Patel?

  Nicole Wetsman, welcome to The Vergecast.

• 1:11Speaker 02

  Thanks for having me.

• 1:12Nilay Patel?

  And Liz Lopatto, welcome as well. Hey. Liz is like a veteran of many Elon-themed episodes of the show. But Nicole, this is your first one.

• 1:20Speaker 02

  Excited to be here.

• 1:21Nilay Patel?

  You are our new health reporter at The Verge.

• 1:22Speaker 02

  Yes.

• 1:23Nilay Patel?

  And this is your moment.

• 1:25Speaker 02

  Yeah.

• 1:26Nilay Patel?

  It's not a great-

• 1:26Speaker 02

  Thrown in the deep end.

• 1:27Nilay Patel?

  It's not a great moment, but here it is. There is a coronavirus outbreak in the world at this point. And I wanted to bring you both on. Liz, you used to be our science editor once upon a time. You're now our deputy editor. You've been spending a lot of time thinking about sort of the worldwide impact of the virus. And obviously, Nicole, you're covering the virus itself. So, the day we're recording this, minutes ago, Mashable pulled out of South by Southwest, MWC was canceled. We're seeing just these huge effects of the virus. And I wanted to just sort of talk about it from the start. So, Nicole, tell us, what is the coronavirus?

• 2:03Speaker 02

  Sure. So, the coronavirus is a novel virus. This is something that we haven't ever seen before. So, this is something completely new that emerged in China, researchers believe, probably sometime in December. So, a coronavirus is actually the category of viruses. There are lots of coronaviruses. Some of them are- Circulate regularly in the US right now and they cause, you know, pretty much the common colds. They're very mild. We really don't pay much attention to them. But we've also had two other novel coronaviruses emerge and cause outbreaks, sort of similar to the one that we're seeing now, and that was SARS and MERS. Both of those are also coronaviruses. So this is a new one. And the naming is still a little bit up in the air. But the virus

• 2:48Speaker 02

  itself, right now, we're calling it SARS-CoV-2. So that's the virus itself that we're dealing with, and it causes an illness that we're calling COVID-19. Naming conventions around viruses and new diseases are kind of complicated, and the name of the virus itself could change. People are kind of debating that. But that's sort of where we are now.

• 3:08Speaker 03

  Nicole, I just wanted to point to something that I hear you saying a lot, that the virus is new. And that's important because we're just not used to dealing with a virus. Our immune system has no response to it now. Is that right?

• 3:20Speaker 02

  Yeah, so this is something that the human population has never been exposed to before. If you think about, like, during colonial times, when someone came to a new continent and introduced a virus that the population just had no immunity to because they'd never seen it before, it has a bigger effect than it might be if this was something that was more broadly circulating normally, and that people might have a little bit more kind of innate immunity and protection against.

• 3:46Nilay Patel?

  So the virus starts in China. It spreads fast out of China. How do you track that? How do you say, oh, my gosh, it's a new virus? And then how do you track how it's spreading?

• 3:56Speaker 02

  So that involves a lot of really kind of old-school epidemiology, kind of gumshoe work, detective work. So Chinese public health officials figured out that they had a problem actually really, really quickly. After SARS in 2002, China built up its public health infrastructure in a really huge way. So they had systems in place that were able to detect that they had something new that had never been seen before. And we're able to try and start containing the spread pretty early. It was sort of unprecedented, is what experts have been saying, who I've been speaking with over the past month. And the procedures then are pretty much, you find a sick person, you figure out everyone

• 4:38Speaker 02

  that they've been in contact with, and you trace then all of these contacts, because this is a virus that spreads through close contact. So it's a respiratory virus, it spreads through droplets. So it's the sort of thing that someone sneezes or coughs, the little tiny saliva snot particles hold the virus, and then if that gets into another person's nose or mouth or eyes, they can then become infected. So we're really just trying to figure out how the virus was passed from person to person to person and track its spread that way.

• 5:09Speaker 03

  We're always a little bit behind, right? Because there is this period where you might be infected, but you don't have any symptoms yet, so you don't know you're sick.

• 5:15Speaker 02

  Right, and it's even harder, because with this virus, there's evidence that you can be passing it on to other people before you even show symptoms. So the way that we're functioning, we're working is sort of by looking at a snapshot of the past. And we're always going to be a little bit behind, and that's why moving fast is so important, because we're always lagging.

• 5:36Nilay Patel?

  So what are the symptoms? What are you looking for?

• 5:39Speaker 02

  The symptoms sort of appear to be a bit like the flu. The most common symptoms that are being reported are a fever and a dry cough, and then other sorts of flu-y things can come into play as well. For around 80 to 85% of people, the symptoms are pretty mild. And that's another reason it's been so hard to stop the spread, because people might not even know that they're sick, or even really register that they could have a problem. But for about 15-ish% of people, this is all based on reports coming out of China, because they have the largest number of cases, they're best equipped to give us those percentages, just as a sidebar. It can be pretty severe, and these people develop pneumonia, and they have to be hospitalized and have to be on oxygen.

• 6:20Speaker 02

  It's critical, critical medical term for really, really bad, in probably around 5% of people. And we're still trying to figure out how many people will go on to die from this, although estimates are putting it around 2% or 3% probably.

• 6:36Speaker 03

  Just for our listeners, what's a dry cough versus a wet cough?

• 6:42Speaker 02

  So, I'm not a doctor, but-

• 6:45Nilay Patel?

  But today-

• 6:46Speaker 02

  Today, I'm a medical professional. Graduated from med school. A wet cough would, or a dry cough would be something that's not like a phlegmy cough.

• 6:57Speaker 03

  Yeah, you're not bringing up mucus.

• 6:58Speaker 02

  You're not bringing up mucus, it's in your chest, it's like the type of cough that is like maybe a little rattly and can come with like shortness of breath and things like that.

• 7:07Nilay Patel?

  So, how much more fatal is it than the flu? I mean, because really you're describing, this is a virus that's similar to a virus that causes a cold. It's more deadly because it's new, it's novel, but obviously, some people are getting it and just getting better. It seems like mostly older people are the ones who are experiencing it in a fatal way. Where does all the fear come from? Is it just that it's more fatal?

• 7:28Speaker 02

  The fear comes into play because this is something that's new. Like, we just have never seen it before, and so we don't know- We have some idea of how it spreads, we have some idea of how it affects the body, but we know so, so, so little about it, because this is something that's only been around since December. So, that's really scary for doctors, it's really scary for public health officials, because we just don't know what the effects of it could be. People compare it to the flu, but it's kind of hard to make that comparison, because the flu is something that we know super, super well. We're really experienced with dealing with the flu, we can predict its seasonality, it's something that we can handle and prepare for. This is something that just emerged kind of out of the blue, and we were not prepared for, and don't know very much about. The flu tends to have a seasonal fatality rate-

• 8:13Speaker 02

  This can vary depending on the severity of flu season of about 0.1%. The projections right now are putting the fatality rate for this at about 2% or 3%. Again, with the caveat that- That is something we are not going to know for sure for a long time. So it is looking more dangerous than the flu. The other concern comes because it is flu season and so our hospitals are already full of flu patients. And if we add another illness on top of that, that's causing people to become very sick and need to be hospitalized and put on supplemental oxygen, that is adding another layer of crowding on top of already full hospitals who are prepared for flu season, were ready to deal with the patients they would see then. But this is just more.

• 8:57Nilay Patel?

  Yeah, and it sounds like that fatality rate is orders of magnitude larger.

• 9:01Speaker 02

  It appears to be at this point, yes.

• 9:04Nilay Patel?

  So how do you test for this? Because this is one of the big controversies right now, is the United States was not necessarily prepared to test for it, there are other tests available, our CDC wanted to test. Like, what does a test mean?

• 9:15Speaker 02

  So the test that people, the type of test that people are using to try and find people who have this virus is basically looking for little bits of the virus in their bodies, so, or in their respiratory samples. So they have little, we know what the genome of the virus is, we know what the genetic sequence is, and then we take little bits of that and we kind of look for it in the saliva samples that we're testing. The CDC wanted to make their own test, they were able to do that fairly quickly and able to start testing in the centralized CDC lab. But when it came time to start trying to distribute their own test to other labs around

• 9:57Speaker 02

  the country, we ran into problems because they were testing, they were looking at three little snippets of the virus's DNA, and the test for one of the little snippets apparently was not working for most labs. So the CDC ended up scrapping that one and we're testing with two. This is very wonky.

• 10:17Nilay Patel?

  This is what we're here for. If there's one show that we want to be this wonky on, it's this one.

• 10:21Speaker 02

  Great. So that then presented an issue because it was taking a long time for

• 10:28Speaker 02

  Test results to come back, state labs were not able to test close by to where patients were. We had a really low number of people tested in the US as compared with other countries. And the thing about a virus like this is that, and the predictions for how it was spreading are that there were probably cases here, and just because we didn't see them, doesn't mean they weren't there. It just means we weren't testing for them and being able to identify them. So, that is a huge problem when you're trying to prevent an outbreak, because you cannot identify and isolate people who you don't know have the virus. So, it looks like testing capacity is ramping up. State labs are getting permission to develop their own tests from the FDA. It's also a little bit complicated

• 11:11Speaker 02

  because the CDC is in charge of developing the initial diagnostic, right? But the FDA is in charge of approving and shipping out, or and kind of getting commercial tests ready to go. So, it involves both of those agencies. A lot of the heat's falling on, falling on the CDC for this, which their test was not working properly, great. But the FDA is also, has a lot of responsibility here in terms of getting tests approved and kind of out into the world.

• 11:39Speaker 03

  And arguably, that delay in testing has already had consequences in Washington. Is that right?

• 11:46Speaker 02

  Yes. So, we're seeing a pretty significant outbreak at a nursing home in Washington State. Washington State had the first case of the illness reported. First of all, that was someone related to travel. But, we're starting to see instances of community spread. So, that's people cropping up who test positive for the disease, who don't have any connection with anyone who we know had it. So, it means that it was spreading undetected through the community. And in Washington State, we had an outbreak at a nursing home. There've been a couple of deaths associated with that nursing home where the outbreak is occurring. And just today, it was reported that someone who died last week in a hospital in Seattle

• 12:27Speaker 02

  was found to have died from this new virus, and we just hadn't detected it. And that was a patient who Was living in the nursing home where the outbreak is occurring. So it seems that this has been spreading in Washington and in the Seattle area for probably a couple of weeks now. And because we didn't have the testing infrastructure, we weren't able to find it. And that's also because the CDC's recommendations for who should be tested have been changing and haven't been very broad. So for a long time, only people who had traveled to regions where we knew the virus was were recommended for testing for this new virus. And that was expanded a little bit, but it's still, in order to be tested, according to

• 13:12Speaker 02

  the CDC, you should have either traveled to one of those places, had contact with someone who we know has the virus, or have a severe viral pneumonia that requires that you be hospitalized.

• 13:24Nilay Patel?

  That seems like a one thing is not like the other situation.

• 13:28Speaker 02

  Yeah, so the severe pneumonia that requires that you be hospitalized is trying to catch people who maybe had community exposure and so have developed a severe form of the illness and they didn't test positive for other viruses that could have caused their sickness. The problem with that is, as we said at the beginning, around 80% of people don't have severe symptoms that require that they be hospitalized. So if we're only recommending that people who are hospitalized be tested, we're probably missing a lot of people who are walking around with what looks like maybe a mild cold, which is bad.

• 14:05Nilay Patel?

  I have a mild cold right now. I have to tell you, I'm living in terror. It's gonna be fine. I'm pretty sure it's not the virus. I can't help but look at this through a product lens, like that's who I am. It seems like developing a test, manufacturing a test, making sure the test works, those are just like classic product problems, right? Are they rate limiting who gets the test because they don't have enough tests or the tests aren't accurate?

• 14:28Speaker 02

  They might be. It's very po- I mean, we have a limited number of tests right now, like the states, even though the testing capacity is ramping up.

• 14:35Nilay Patel?

  How do you manufacture a test?

• 14:37Speaker 02

  Well, these are, so these are what's called a PCR test, reverse transcriptase PCR test, which is a kind of chemical reaction that looks for a little bit of DNA in a sample. So that's the sort of thing that, like a PCR is something that labs run all the time. It's just a matter of commercializing and automating the tests so that they can be run more easily, basically.

• 15:00Nilay Patel?

  Yeah.

• 15:01Speaker 03

  And also characterizing the false positive and false negative, right?

• 15:04Speaker 02

  Sure.

• 15:05Speaker 03

  Because that's, that's an important part of any kind of test, no matter how you're running it. You just need to know how often it's going to be inaccurate.

• 15:11Nilay Patel?

  Yeah.

• 15:12Speaker 02

  Right.

• 15:12Nilay Patel?

  I just feel like there's a part here where particularly maybe for the Veritas audience, like what we have is a measurement problem, like at a very direct level, like we just don't have the data to know what's going on. And part of that is that the product that would generate that data is bad or missing.

• 15:28Speaker 02

  Yeah.

• 15:29Nilay Patel?

  And that just seems bonkers to me, because there's like clearly a lot of demand for this product right now. It doesn't seem like we can make it, but other countries are testing at scale.

• 15:40Speaker 02

  Sure, yeah. And, and that has been a huge amount of the criticism put on Health and Human Services, the CDC and FDA, because other countries are testing thousands and thousands of people. And the CDC's answer has, for the past couple of weeks, sort of been, we have a limited case criteria based on what we think the risk is and who we think is at risk. That's been a little bit of sort of the party line on why our testing has been lower than other places, because flight restrictions and travel restrictions went into place so early. It's looking like that is just not an acceptable answer anymore because we have seen community spread in a number of states. And it's obvious that those restrictions did not stop the virus as much as maybe we thought that they did,

• 16:24Speaker 02

  or we'd have liked to think that we did.

• 16:26Nilay Patel?

  Yeah, so there's just a part of this that we haven't really talked about yet, which is like a political leadership aspect to this whole situation. Liz, I'm just gonna have, I'm gonna take Nicole out of the hot seat for that question, because I know you have a lot of thoughts about this. It seems like we're not aggressively responding to this virus at the time.

• 16:43Speaker 03

  Not as aggressively as you might like. And I will say, one of the things that's disappointed me is how focused Donald Trump and his administration have been on the economic effects, rather than on the human health effects. And that's stupid for two reasons. Reason one is that obviously, human life is valuable. I, I can't believe I'm saying that out loud, but it's true.

• 17:03Nilay Patel?

  We're getting some anger tweets today.

• 17:06Speaker 03

  But two, if you want to reassure the business community, what you say is something like the following. We will do whatever it takes to curb the spread of the virus. We are testing very aggressively. We are trying to find out through surveillance testing how many people in the population might have mild cases or might be sick. And we will spend as much money as it takes to make sure that this is under control. We are not concerned about the markets right now. What we want to do is just get a handle on this and make sure that we can treat it as best we can. Because, paradoxically, saying that is the thing that actually does reassure the markets.

• 17:41Nilay Patel?

  Right, because you're controlling the problem and not the symptom that you're worried about, which is the markets falling.

• 17:46Speaker 03

  That's exactly right. And right now, I'm seeing a lot of response to the symptom and not the cause. And so, you know, there's been confusing information that's been released throughout the frankly incoherent press conferences that President Trump has held on this disease, which I personally do not find reassuring. I can only speak for myself. But I would feel a lot better if I were being communicated with by people who were, for instance, epidemiologists, or virologists, or other kinds of area experts, rather than, you know, career politicians. And the fact that Vice President Pence is the person who is leading this fills me with

• 18:27Speaker 03

  a great sense of foreboding, because one of the things that he is known for, as in his time as the governor of Indiana, is making an HIV outbreak worse.

• 18:38Nilay Patel?

  Nicole, you wrote that story for us. How did he do that?

• 18:41Speaker 02

  Pence decided that he did not want to allow the rollout of needle exchanges, which are, you know, evidence-based strategies to reduce the risk of kind of needle-transmitted diseases like HIV in drug users. And Pence decided he didn't like that. And so, he kind of dragged his feet and delayed the introduction of those very evidence-based policies, which allowed HIV to spread through the community more than it would have were those policies implemented much earlier.

• 19:11Nilay Patel?

  So, there's definitely an interplay here. I wanted to get that specific out, because there's an interplay here between what the doctors and scientists are saying to do based on the evidence they have and the data that they have. They're maybe hamstrung in how much data they actually have. Based on the testing problem. And then there's the what are we going to do now that it's here moment that we seem to be in.

• 19:33Speaker 02

  Right.

• 19:33Nilay Patel?

  Right, it's definitely here, it's definitely spreading, it's, I think there was another case announced in New York today. We're recording this, by the way, we keep saying today and this week and last week, we're recording this exactly one week before you're hearing it, so.

• 19:45Speaker 02

  A lot's gonna change.

• 19:46Nilay Patel?

  Something else is gonna happen by the time you're listening to this. But there was another case in New York, we see cases are spreading, it seems like in Washington in particular, Washington State, there's been many, many more cases.

• 19:56Speaker 02

  We have several here in the Bay as well.

• 19:58Nilay Patel?

  Is that going to sort of break the political logjam? Is that, do you see that Pat Nichols just made a horrible face at me? What, what do you, what is going on there?

• 20:07Speaker 02

  Well, we hope so. Um, you look, there's a lot of cases that are being reported, cases are going to continue to be reported because we have just ramped up testing so that we can find them, like they're already there. We're just turning on the lights, basically. And hopefully, as that starts to happen, you'll see more aggressive action, what that action looks like, whether it's effective, remains to be seen. We're under a public health state of emergency right now, which is declared by the Department of Health and Human Services. Florida and California are currently in statewide states of emergency, there are states of emergencies at various county levels across the country.

• 20:47Speaker 02

  That means that officials have a menu of kind of powers that they can draw on to try and act more quickly and aggressively. What actions will be taken, like that kind of remains to be seen. I think the thing that I'm looking for next, and what I think should happen in response to the increasing number of cases here, is that the CDC should change their criteria for testing to include not just people who are hospitalized, because a lot of people who have this disease do not need to be hospitalized. And we also need to have more ongoing kind of background surveillance, so we do regular flu surveillance in the country where public health, state public health labs, look at

• 21:29Speaker 02

  samples taken for various reasons from people and just kind of check to see, you know, what viruses are here, what flu is circulating. That often happens by like batching samples together, because you're not diagnosing a person, you're just looking to see if there's a virus in the community population. We need to be doing that for this new coronavirus, so we can see what levels it's at in the country.

• 21:51Speaker 02

  And we just need more data on that front. So hopefully, when now, we're going to see more urgency around those decisions. It is concerning, from a leadership perspective, to hear reports of the nation's leading infectious disease official, Anthony Fauci, not being able to present at certain meetings or give certain interviews, because he's very good at communicating to the public about emergencies and about risk. That's like something that he's very well-known for. And so, when something like this is happening, what you want to do is put someone who people trust, who is good at this, and who has good information in front of the camera, and say, tell people what's going on.

• 22:34Speaker 02

  It's very confusing when you have different messages coming from politicians, coming from the CDC, coming from HHS, which is what we've been seeing over the past couple of weeks. It's not reassuring.

• 22:43Speaker 03

  And also, to speak to Fauci specifically, like, he's outlasted a number of presidents. It's not like he's some partisan hack, you know? Like, this guy has been in his job for decades. He's really good at it. And like, I've talked to him, I think you have too, Nicole, like, he's around, we know him. And it's one of the reasons, I think, that people are feeling really skittish, is that this trusted figure, who has been around forever and has handled most of our infectious diseases, is, in some ways, it seems, being prevented from talking to the public.

• 23:16Speaker 02

  And trust is really important in situations like this. I wrote a story a couple of weeks ago about, you know, why, in public health emergencies, trust is kind of the most important resource that officials have, because if there isn't trust in these institutions, people aren't going to follow their instructions. And when people don't follow instructions during an outbreak like this, people die. Ebola is a very different disease than COVID-19, but during the Ebola outbreaks in West Africa, lack of trust in public officials delivering health information meant that people kept sick relatives in their home, where disease could spread, and that made the outbreak worse and harder to control. It turns out that the CDC, as of right now, or has, you know, in the past couple of years,

• 24:01Speaker 02

  tends to have a higher level of trust from the American public than Other institutions like the presidency or Congress. So hopefully that remains in place. But it's important that people trust the officials who are giving them instructions about when to go to the doctor, whether or not they should get masks, what they should be doing to prepare themselves for for potential disease in their community.

• 24:24Nilay Patel?

  It's a no on the masks and it's like a yes on the extended.

• 24:27Speaker 02

  Hard no, hard no on the masks.

• 24:29Nilay Patel?

  Yeah.

• 24:30Speaker 02

  Yeah.

• 24:31Nilay Patel?

  But a yes on the extended hand washing.

• 24:32Speaker 02

  Yes, on extended hand washing, 20 seconds or longer if you're feeling fun.

• 24:37Nilay Patel?

  I will say that just the cultural aspect of the songs you should sing, washing your hands is just one of those like emergent hilarious behaviors enabled by social media. Landslide, the chorus of Landslide is 20 seconds long. I'm just letting you know.

• 24:52Speaker 02

  I've been singing the chorus of Africa.

• 24:54Nilay Patel?

  See, it's perfect.

• 24:55Speaker 02

  That's what I've been doing.

• 24:57Nilay Patel?

  I have a small child, so it's definitely just happy birthday in our house. It's perfect. Happy birthday twice, by the way. Last big zoom out question. We've had Bill Gates on the show. Bill Gates likes to talk about pandemics. It's his, it's his thing. Well, I guess two questions. One, does this meet that criteria? I mean, I know there's like a technical one and then there's like the scary one where you get to make movies about it. And then we'll answer that question first. Does this meet either one of those criteria?

• 25:23Speaker 02

  So some people would say yes, some people would say no. I mean, there isn't really a definition of pandemic, which is the hard part. The World Health Organization has said that they are not ready to declare a pandemic because the word is associated with a lot of fear and people sort of freak out when they hear you say it. That's why they were reluctant for a long time to say that we were in a public health emergency of international concern, which is like the other thing that they declare. And, you know, we can sort of think of a pandemic as something.

• 25:53Nilay Patel?

  Wait, those are the only two steps on the scale? There's nothing, public health emergency of international concern and pandemic?

• 26:00Speaker 02

  And then, well, there's epidemics and then there's pandemics.

• 26:03Nilay Patel?

  I'm just saying, you need a little bit more gradation on that scale, perhaps.

• 26:07Speaker 02

  Yeah. Well, those are, so those are World Health Organization terms. They, you know, tend to be a little more conservative with doling stuff like that out. But you know, if we think about a pandemic as an outbreak of an illness that's affecting lots of places around the world and spreading and causing death, you know, that's sort of what we're seeing right now. I mean, that doesn't mean it's time to freak out. There's still, you know, it doesn't mean that this is going to cause the end of the human race. We're not in a situation like that. In China, the number of cases reported per day appear to be going down, which seems to indicate that they've got what looks like a little bit more of a handle on, on things. And that wasn't just necessarily because of the like

• 26:51Speaker 02

  hugely stringent quarantines they instituted. There were also, you know, more social distancing measures and the Chinese government changed some rules around how many prescriptions you could get at a time so people could stay home and testing and costs for things like healthcare. And it appears that some of the things that they were doing was working. It remains to be seen how well some of those things can or should be implemented in other countries, but it's not unstoppable. It's just a matter of mustering the resources, political will and expertise to, to do that, even if it is a pandemic.

• 27:28Nilay Patel?

  Is this, so this was the second part of my question. Is this the sort of thing where you can just throw money at it to go away? Like if Bill Gates or Mike Bloomberg was like, you know what, this, this idea I have is bad. I'm gonna spend the billions over here. Could he just fix it tomorrow?

• 27:41Speaker 02

  It would help, I would say. I mean,

• 27:44Nilay Patel?

  Maybe money always helps.

• 27:45Speaker 02

  Money helps. Because what we have to do, I mean, the, the work of stopping a public health emergency and stopping a disease outbreak is low tech, actually. It's, we need to figure out who's sick. We need to figure out who they've been in touch with, and we need to figure out if those people are sick. And that work takes a lot of manpower. And we need resources like a test that is working really well to, to do that work well. And we also need people who are sick to tell their doctor that they are sick and stay home rather than going to work because they don't have Sick leave at their job. And we need the tests to be available to people so that they don't feel scared that they're going to have an enormous medical bill if they go to the hospital and say, I

• 28:28Speaker 02

  don't want to put people in my community at risk. So in that sense, money, money matters a lot, but it's slow, methodical epidemiological work. And it's the same public health tools that we use for other things on a large scale, and they have to happen quickly. But we know how to do stuff like this. It's just a matter of doing it.

• 28:48Speaker 03

  Nicole, I want to return to something you said earlier. You mentioned social distancing. For anybody in our audience who might not know what that is, can you sort of give them a sense of what that is? Because that might be something that they can practice themselves if they're feeling worried about this.

• 29:01Speaker 02

  Sure. Social distancing is basically just means staying away from other people at sort of a fundamental level. Social distancing recommendations or practices might include canceling large gatherings, canceling school for a period of time, asking people to work from home. Because this disease spreads by close contacts, so people that you're really in close touch with for, you know, some amount of time, we don't really know for sure. If you're not around other people, you minimize your chance of getting the disease, but you also minimize your chance of spreading the disease. So if you're someone who has a mild case or is asymptomatic, staying away from like a nursing home, for example, minimizes the chance that you would be a carrier for a

• 29:43Speaker 02

  disease into a group of people who are particularly vulnerable to it. So we've seen some of those measures put in place. A school in New York closed because a parent of one of the students was diagnosed with the virus. There have been a lot of event cancellations, as we know, over the past couple of weeks. And that's what the CDC calls a non-pharmaceutical intervention, non-pharmaceutical intervention. So it's not a drug, but it's something that can help slow the spread of an illness.

• 30:12Nilay Patel?

  Okay. So we're going to take a break. That's a great transition to what I want to talk to Liz about, which is the sort of cultural and economic impact here. So we'll be right back. We'll talk about that.

• 30:26Speaker 04

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• 30:57Nilay Patel?

  Okay, we're back. Elizabeth.

• 30:59Speaker 03

  Yeah.

• 31:00Nilay Patel?

  Welcome back to the show. What do Elon do this week? That's usually what we're here for. Has he solved it yet?

• 31:05Speaker 03

  No.

• 31:06Nilay Patel?

  But no, you have been tracking sort of the other side of the virus spread, which is the trail of economic destruction in its wake. It seems like a lot of things have been canceled due to social distancing. People don't want to fly. And then underneath that all is, I think, the thing that's really freaking out the markets, which is the supply chain disruptions that we're seeing around the world. Walk me through that part of it.

• 31:30Speaker 03

  Okay, well, as longtime listeners know, I am the chaos correspondent, so here I am. If you think about where your laptop comes from, you might be aware that many hardware companies are heavily dependent on China. There is one company in particular that is specifically dependent on China, and it is Apple. Steve Jobs specifically hired Tim Cook to fix Apple's supply chain, which was at the time broken. And if you read stories from this period, like there's a 2008 article in Fortune Magazine where, you know, they write that Cook closed factories and warehouses around the world and established specific relationships with contract manufacturers.

• 32:12Speaker 03

  He thought that inventory was, quote, fundamentally evil. And so he basically reduced the amount of time that inventory was sitting on the shelf. Because if you think about tech, much like with the fashion industry, the longer you hold on to something, the less valuable it becomes, because there's so much quick product turnover. So basically, what Tim Cook did was he streamlined all of this by doing...

• 32:34Speaker 03

  Integrating something called just-in-time manufacturing. And to be clear, this is not just Apple. Just-in-time manufacturing is something that's pretty common in the car world as well. And the idea is that nothing sits on the shelf for very long. You don't have much of an inventory, that you're getting things supplied to you as you need them. And this actually is like, logistically quite difficult and a fairly complicated thing. So, you know, that's, that's great for, for profits because you aren't, you know, losing money while stuff sits. But it is a problem in terms of resiliency. So if something happens in, let's say, China where your supply chain is, you potentially are looking at shortages.

• 33:18Speaker 03

  And that's part of the problem here. There are a couple of problems if you think about the supply chain. Problem one is that most companies like Apple, they don't have visibility all the way into the supply chain, right? Like, they know who's sending stuff to them, but they don't necessarily know where those companies are buying their raw materials from. And I've been talking to some supply chain analytics experts, which are-

• 33:43Nilay Patel?

  The rowdiest bunch, yeah.

• 33:46Speaker 03

  And, you know, they're saying things that are, to me, a little bit alarming. So, the supply chain is being disrupted in several places because of these illnesses. Raw materials are stacking up, they're tied up in inventory, nothing is happening with them because they don't have the people to do things with them. And then, all the way down the chain, things are being slowed down because of that, beyond the fact that there are also problems for manufacturing products like phones and laptops that require a lot of human labor. And that human labor has not been totally available. So you've seen Apple cutting its forecast-

• 34:23Nilay Patel?

  They were among the first to do it. I mean, we've seen, since then, Microsoft and others have done it too, but Apple was like, among the first companies to say, "This is gonna affect us."

• 34:32Speaker 03

  Yeah. I think Apple is probably among the most severely affected. Specifically because its supply chain is so dependent on China. But there's like a lot of other things. And I'm just going to read you my favorites from this Bloomberg story because it's like watches, it's board games, it's masks, it's some medications, it's auto parts, it's garments, it's, most hilariously to me personally, lobsters.

• 35:01Nilay Patel?

  Oh yeah, of course.

• 35:02Speaker 03

  Like, there's just a lot of things that are being touched. And because this is all pretty diffuse, it can be really difficult to get a handle on what exactly is going to happen. And I think if you know anything about the markets, you know that they don't like it when there's uncertainty. And so that seems to be leading to a lot of discomfort among people who are interested in economics and in stocks specifically.

• 35:27Nilay Patel?

  And so is the, is the problem that they just don't know what's going to happen in the supply chain? Or is it, we don't know when it's going to start up again? Or is, oh my gosh, just in time manufacturing has the fatal flaws here, the whole world has to change?

• 35:41Speaker 03

  Honestly, I think it's a little bit of all three. So there have always been people who have pushed for resiliency in supply chains. So that means that like, maybe you have like, an operation in China, and maybe you have an operation in South Korea, and maybe you have an operation in, like, I don't, I don't know, someplace else.

• 35:58Nilay Patel?

  The United States, I think, is one that comes up frequently in this conversation.

• 36:01Speaker 03

  Sure, the US, why not? That would be novel. But like, let's say that you, you have all of these different places. Like, it's a little less efficient, that's definitely true. But it also means that if something goes wrong in any one of those places, you're not stuck. And the upside to this is that, you know, if your competitors were all relying on that one place, but you weren't, when they're experiencing shortages, your goods are still available, and so more people will buy your goods during those sort of disruption events.

• 36:29Nilay Patel?

  So a story you told me was about red paint after the tsunami at Fukushima. That's the one that has stuck with me the most. Tell the people that story.

• 36:37Speaker 03

  I have heard this story like three times now from different supply chain analysts. So you may remember several years ago, there was this nuclear event in Japan, in Fukushima. And so like a lot of stuff got closed down. And again, not everybody has knows what's going on in the supply chain. And this was like an ugly surprise because carbon makers ran out of red paint. And what had happened was that the sparkly part of red paint was made in exactly one place. And that one place had been affected by the Fukushima nuclear disaster. So it wasn't making any more sparkles. And that was the end of red paint for a while.

• 37:15Nilay Patel?

  And that's just one of those like butterfly effect situations, right? Like you just don't, you can't possibly foresee that.

• 37:23Speaker 03

  It's nearly impossible to foresee this kind of thing. And that's, I think, part of the reason that you're seeing people freaking out is that we actually don't know what's going to happen. We don't necessarily know where the shortages are going to be. We don't know how severe they will be. And that kind of uncertainty is a kind of uncertainty that people don't like.

• 37:43Nilay Patel?

  The way I've been thinking about it is regardless of the sort of political noise about nationalism, like we live in a hyper globalized world, right? Like the biggest companies in the world paid only the slightest attention to the fact that countries exist in many, in many ways. This virus is sort of similar. It's, it's obviously just crossing borders as it will. And it's sort of like highlighting the routes the globalization has taken. It's highlighting where the supply chains are. It's disrupting those things. Beyond just the market impact, Liz, is that having sort of the cultural impact that you would expect from that moment? Are people paying more attention to it? Or is it just, oh, man, we're not going to be able to get phones. Apple's, Apple's stock has went down.

• 38:24Speaker 03

  I actually don't know that. People are thinking about it that seriously. I do see some folks in the money world who are thinking about it this way. But I don't know that the average person is. I don't know that the average person really thinks about where their iPhone comes from at all. But the other thing that I will say is that what is specifically interesting about this outbreak is where it started. Wuhan is a major manufacturing center. I think it's got something like 500 auto parts manufacturers around it and in it. And it ships to the entire world. So, you know, if you're thinking about how diseases are transmitted, it's pretty much by people. And so you have a lot of people who are there to, for instance, oversee manufacturing.

• 39:08Speaker 03

  You have people who are interacting all the time with people from other countries. And that makes it much, much easier to spread around the world.

• 39:17Nilay Patel?

  Yeah, the stat that also came to mind was, I think, United Airlines got in trouble last year because they put, like, one of their banners at one of their events leaked. And it was like, "Thank you, Apple, for being like 8% of our total revenue, because Apple just buys 50 seats a day back and forth from China." And I just don't think the normal person in Apple Store considers just the fact that Apple sends 50 people to China there and back every single day. And that's just on one carrier, and they have contracts with many other carriers as well. It's not part of their brand, it's not part of their image, but it is the mechanism by which they make the products. And once you shut that down, I think that has to have some huge effect on not only just the products and how good they are, but the company itself.

• 40:00Nilay Patel?

  Like, all those people are just sitting around now. They have nothing to do. Like, they're not, they're obviously not making new stuff. They're not refining the old stuff. They're not doing any work. What does it mean for companies of this scale to sort of hit pause?

• 40:14Speaker 03

  Great question. I don't know that we know. I think that there is probably, for some of these companies, there's a certain amount of inventory. Because if you think about shipping stuff from China, that takes a while, right? So, and specifically when it comes to cars, car seats are usually made very, very close to where the final car is assembled. And so in that assembly plant, you might have two hours. Worth of car seats on hand at any given time because there's just a truck going back and forth bringing car seats because that's how close they are. But if you're thinking about components that are coming from China, you know that that's going to take longer. Particularly if you're shipping them, that's a while. So maybe you're shipping more of them. There are some things still on the shelf.

• 40:53Speaker 03

  This also occurred around the Lunar New Year, which is a period when all work stops in China. So maybe there was a stockpile around that. But I don't think we have a good idea of what this means. I don't know what happens here and like. One possibility is that more companies start thinking seriously about resiliency in their supply chain. And one possibility is that as soon as this passes, everybody goes and goes right back to doing the thing they were doing before.

• 41:21Nilay Patel?

  Yeah, that kind of brings me to the the next thing that is happening. Because, you know, we all fix the supply chain. That is a decade long project, right? I mean, Apple has flirted with building phones in India. It's mostly the older ones. They're not ready to build their flagships there. Samsung has diversified a little bit, but they build phones actually quite differently than Apple like. This is a long process to completely diversify, particularly out of China. So that's like the the medium to long term. The short term is we're all just not going to parties anymore. Right? We're we're canceling MWC. We've GDC got canceled the game developers conference.

• 42:02Speaker 03

  I O got canceled while we were doing this.

• 42:04Nilay Patel?

  So Google I O is canceled. Facebook conference was canceled. The smaller Google conference, Cloud Next was canceled. I think we are, by the time you listen to this, we might know if South by Southwest is canceled.

• 42:15Speaker 03

  I think it's increasingly likely.

• 42:16Nilay Patel?

  It it feels that way, but you know, like, that's like a huge like South by Southwest, a huge hit to like the economy of Austin.

• 42:24Speaker 03

  Yep.

• 42:25Nilay Patel?

  Like, a lot of Austin, Texas is built around, you know, three extremely decadent weeks that occur. What are those ripple effects like? Are they trackable? Are they meaningful?

• 42:36Speaker 03

  I think they're meaningful. I think they're hard to track because, again, they're going to be diffuse. But let's imagine you're a local restaurant and you rely on South by to give you maybe the most lucrative month of the year. And that doesn't happen. Maybe that makes it a little harder to pay your rent for the rest of the year. And then, so if you fold because you can't pay your rent, that potentially is a problem for your landlord. Because, you know, rent is important if you're a landlord and also real estate people tend to be pretty heavily leveraged in order to purchase products, so they need to pay back money on their own debt. And if they can't do that, that's a default, which is a problem for the banks because then they're holding bad debt. And if you remember 2008,

• 43:18Speaker 03

  and you may remember that bad debt can be real troublesome.

• 43:22Nilay Patel?

  Yeah, I'm sorry. I'm only now reacting to the fact that I O is canceled while we were talking.

• 43:29Nilay Patel?

  So it just hit. I was like, wait, what? I, Google I O is in May.

• 43:33Speaker 03

  Uh huh.

• 43:33Nilay Patel?

  It's in, it's in the middle of May. That's a long time away. Is that realistic? Is that, I, I, I open that to both of you. Is, is looking all the way out to the middle of May and saying we're canceling this a realistic thing to do?

• 43:47Speaker 03

  Yes, at least in my opinion.

• 43:49Nilay Patel?

  Both of you said yes.

• 43:50Speaker 03

  Yeah. Okay, so Nicole is gonna probably have some more details about, about this than I do, but I can sort of give you my spin, which is, we're at the very beginning of this. We still don't know how broadly the virus is circulating. We still don't really know where it's circulating. We haven't done the sort of surveillance testing that would give us a handle or a picture at least of what's going on. We don't know what's happening. And so personally, I have just been viewing every conference this year as subject to cancellation because we don't know what's going on and there's a possibility it's worse than we know.

• 44:27Speaker 02

  And the Olympics might be canceled, so we're looking at a lot of really enormous global world events that are kind of hanging in the balance as we try to figure out what's going on and how bad it is.

• 44:39Nilay Patel?

  And this is all just to stop people from commingling from different?

• 44:42Speaker 02

  Yeah, this is like what we call social distance, what we call social distancing.

• 44:45Nilay Patel?

  That's what you were saying before.

• 44:46Speaker 02

  Yeah.

• 44:46Nilay Patel?

  But like, once it's in every country, do you have to maintain social distancing?

• 44:50Speaker 03

  You want to slow the spreads so that you aren't, everybody isn't getting sick at once and overwhelming in an emergency room. So like, one of the mistakes that was made during the 1918 flu pandemic was that there was this

• 45:03Speaker 03

  This parade in Philadelphia of soldiers that were coming back. And there had been a couple of cases of the flu. And the town didn't want to cancel the parade because they were worried that might undermine public confidence. So there was this parade. And then a lot of people got sick immediately afterwards and overwhelmed the medical system.

• 45:24Speaker 02

  So we're looking to do what's called flattening the curve. Epidemiologists talk about the epicurve of a disease. So it's like how the cases increase and then how they decrease. We want to flatten that out so that we don't have a spike in the number of people getting sick at one time. Because if we have 1,000 people who are sick and, you know, 15% of those people need to be hospitalized, that's a lot of people that need to be hospitalized at one time and need a hospital bed. So by flattening that out, we kind of reduce strain and we add slack to the system, which lets us get people better before the next person gets sick. And that also buys us time to do things like making sure that the treatments that we're

• 46:08Speaker 02

  testing actually work. And, you know, vaccine development is a long, long ways away, but time, every day matters in terms of kind of trying to figure out how to stop the spread of this.

• 46:19Nilay Patel?

  So are these cancellations, are they happening because of those reasons and authorities are saying, "Stop it, we're in control, we want to flatten this curve"? Is it a bunch of just big companies saying, "Oh, we can save some money in the budget this year"? Or is it some combination of people trying to do the right thing and these commands? How does that interaction work?

• 46:38Speaker 02

  It's a really complicated kind of interplay. I mean, people are really bad at perceiving risk in general. Like, humans are really bad at telling how risky it is to do a certain thing. Like, people are more afraid of flying than they are of driving in a car. You're more likely to die in a car crash than a plane crash. Like, things like that. Risk perception is really hard. But in a situation like this, people organizing these conferences are probably doing a combination of public health advice.

• 47:05Speaker 02

  What would it mean if something did happen at the event? And what are the exposures in that respect? Like, kind of, risk mitigation and management? In the event that there was an outbreak at their event? And, you know, economic considerations, political considerations? So it's going to be a combination of factors going into those decisions.

• 47:23Speaker 03

  I will say, at least from my point of view, watching the way that I've seen the national authorities responding to this, I think we all owe our local health authorities a debt of gratitude, because a lot of the responses that we're seeing are coming from them. Whereas the sort of message from Donald Trump and Mike Pence has been, you know, all business as usual. Here's a basis, here's a, here's a 50 basis points rate cut. Like, maybe we'll do tax cuts. And like, the response that, that leads people to potentially, like, cancel these events, even though, like, probably they've already sunk money into them that they can't get back,

• 48:03Speaker 03

  is maybe somebody who's a little more local saying, hey, this is really not a good idea right now.

• 48:09Nilay Patel?

  Yeah. You know, it's funny that, that sort of White House response of, oh, pressure the Fed into cutting rates, or we'll do a tax cut. It's completely at odds with what Nicole's been talking about, which is, most of the work here is fairly old-fashioned. It's not old-fashioned, but like, it is not the highest tech work. It's not a bunch of scientists in a room together concocting a solution. It's a bunch of scientists out in the field doing stuff. And that just takes time and money and effort and, like, patience. Whereas a rate cut or a tax cut sort of takes that element of it completely for granted. Right? Like, this is, this stuff is going to happen. So we'll just cut rates so we can even things out while that happens all by itself? Seems like a real mismatch of priorities.

• 48:53Speaker 03

  Yeah, I think that's, I think that's true. I think it's trying to shore up people's confidence. And I think it's a mistake to try to shore up people's confidence by saying, hey, the economy's going to be OK. Like, the thing that people are really worried about are, you know, the supply chain stuff, rightly so, and the health stuff, also rightly so. And so, like, maybe you can't necessarily affect the supply chain stuff, because that is happening in China. But perhaps you can do something about the health stuff, for instance, by authorizing a bunch of money to make sure that there are Testing, there's like testing available for anybody who wants to or needs to get tested and that they don't have to pay for it themselves. Or creating a fund for people who don't have paid sick leave but can't afford not to go

• 49:37Speaker 03

  to work so that you can pay somebody to stay home when they're sick so that they can still make their rent. Or any of a variety of other things. Like, it's not like economic solutions are bad solutions. It's just that that partic- those two particular economic solutions, I think, don't speak to the actual root of the problem.

• 49:54Speaker 02

  Another, you know, problem with the messaging mismatch is that it's just bad risk communication, emergency communication practice to say that everything is fine and gonna be okay when you don't know that that's the case because if the other shoe drops, then that makes it worse. You know, you know, prepare for the worst, hope for the best, sort of conversations are better practices in a situation like this where you say, you know, this is, could be bad and you should get ready for it, we're gonna do everything we can. That's not the messaging that's coming out of the White House administration right now.

• 50:25Nilay Patel?

  We seem to do a more responsible job of communicating and stuff with like, snowstorms in New York City, right? Like, every year, twice a year, they're like, "It's gonna snow, really bad state," and then everyone's like, "It didn't snow." And I'm like, "Yes, we keep listening to you."

• 50:38Speaker 02

  You were ready.

• 50:39Nilay Patel?

  So I usually end these conversations by asking, "What's gonna happen next?"

• 50:44Speaker 02

  No idea.

• 50:45Nilay Patel?

  Just confused faces all around.

• 50:47Speaker 03

  Well, I mean, we do have a couple ideas, right? That we're gonna see the case counts go up.

• 50:53Speaker 02

  Right.

• 50:54Speaker 03

  Like, that's gonna happen because there's more testing. So, if you do see the case counts going up a lot in the next week or so, don't panic. That is to be expected, that's because we've changed the testing criteria, that's all that's happening there. It's, you know, we're just trying to get a handle on what's going on. So that's gonna happen. But beyond that, it's a lot of question marks, right? Like, maybe some more things will be canceled. Maybe there will be some shortages. For instance, there's already a drug shortage, though the FDA won't say specifically which drug. That may happen more broadly elsewhere, specifically for things like laptops and phones, and maybe also for cars. But beyond that, it's hard to predict.

• 51:37Speaker 02

  We might also see things like schools closed and... Life disrupted in that way more broadly if things continue to spread in certain communities. So, you know, we're expecting disruption of some kind. It kind of remains to be seen exactly what form and how bad that disruption will be. But this is going to do stuff to day to day life.

• 51:59Nilay Patel?

  Yeah. Is this the rest of the year, do you think?

• 52:02Speaker 02

  I don't know.

• 52:02Nilay Patel?

  Five years?

• 52:04Speaker 02

  I don't know. I mean, Nicole wrote a great story where she's pointed out that there are a number of possible outcomes here. And one possible outcome is that this coronavirus sticks around and becomes a seasonal infection like the flu. And if that happens, we'll adjust to it and it won't seem as scary anymore because we're just used to it. And we'll also know more about it, probably have treatments and hopefully have a vaccine at some point if it becomes just like a regularly circulating virus. I mean, that's bad because then we have another circulating respiratory virus that causes more people to have to go to the hospital. But over time, you know, cognitively, we adjust to having something around. That's what happened after HIV AIDS emerged. It,

• 52:48Speaker 02

  you know, caused not the same but similar types of panic and response and research efforts. And now we sort of have adjusted to this being another disease that we have around. So that could happen here. And, you know, when something becomes, starts circulating through the population, you know, you develop more innate exposures and immunities and it becomes less intense. So like, that's one outcome. Another outcome could be that we are able to contain it. It's not looking super, super likely, just because it spreads really subtly. But, you know, it's still a possibility. Experts still say it's not out of the realm quite yet. And it could just circle the globe for a little while. I mean, that's another-

• 53:32Nilay Patel?

  Look, it's new. It's got its walking shoes on.

• 53:35Speaker 02

  Exactly.

• 53:36Nilay Patel?

  It's on the road.

• 53:37Speaker 02

  Yeah, on spring break.

• 53:40Speaker 03

  You know what I keep thinking about? There's a saying, "May you live in interesting times," and it's considered a curse.

• 53:47Nilay Patel?

  Yeah.

• 53:48Speaker 03

  Well, kids, the times are interesting.

• 53:50Nilay Patel?

  It definitely, it definitely seems that way. Well, I am very happy that I have the Verge Science Team. I have Nicole, Liz overseeing the whole thing, paying attention to where our car paint comes from. It's deeply important to me. Is black paint affected? Because that's really the only one.

• 54:07Speaker 03

  You just want to know if you can have a murdered-out Mustang.

• 54:09Nilay Patel?

  That's all I want in this world. Keep, keep an eye on Nicole's work at The Verge. The whole Verge Science Team, we're paying a lot of attention to it. Liz has promised me a story about the supply chain impacts.

• 54:22Speaker 03

  I can't believe I'm being publicly shamed.

• 54:24Nilay Patel?

  I do it to Dieter on the other show every week, so.

• 54:27Speaker 03

  All right. Well, so here's the deal, is that I have been trying to track down what's going on with the supply chain. But unfortunately, there's been so much breaking news around the coronavirus, I haven't had a chance to write it. If everybody would just chill out for a day or two, so I can sit down and write my story, that would be great.

• 54:43Nilay Patel?

  All right. When it is out, we'll let you know. Thank you both for taking the time with me. I know you're both very busy. I actually, I've had a swirl of information, and it's been very helpful in organizing it. All right. That's it. Thank you both.

• 54:56Speaker 03

  Thanks. Thank you.

• 54:58Nilay Patel?

  All right. My thanks to Liz Lopatto, Nicole Wetsman on The Vergecast. You can check out all of Nicole's reporting on the coronavirus on the site, theverge.com. Liz, she's going to write that supply chain story. She's going to be mad at me that I said this here, but she's going to do it. It's going to be great. I do it to Dieter every week, I'm doing it to Liz this week. We'll be back later this week with a chat show. We'll be back next Tuesday with the interview show. Keep it going. You can tweet at me, I'm at Reckless. I love hearing your feedback. Love hearing who you want me to talk to next and what you want us to cover next. Get at me, I'll be listening for it. Talk to you soon.