Bill Gates (@BillGates), founder of Microsoft and philanthropist, is no stranger to controversy. He is outspoken about things he cares about, including global health. A New York Times’ story notes, “In a 2015 speech, Bill Gates warned that the greatest risk to humanity was not nuclear war but an infectious virus that could threaten the lives of millions of people. That speech has resurfaced in recent weeks with 25 million new views on YouTube — but not in the way that Mr. Gates probably intended.”[1] The article goes on to note some fringe groups are pointing to video as evidence Gates wants to use the pandemic to wrest control of the global health system. Gates ignores the criticism and continues to push for decision-making based on the best science. His latest effort comes in the form an article he posted on GatesNotes.[2] He begins his article by observing, “The coronavirus pandemic pits all of humanity against the virus. The damage to health, wealth, and well-being has already been enormous. This is like a world war, except in this case, we’re all on the same side.” King Abdullah II of Jordan notes, “I cannot recall a time when every leader on the planet had the exact same item at the top of his or her agenda. This captures how truly surreal this moment in history is. But common concern does not necessarily translate into coordinated action.”[3]

The pandemic has demonstrated what has been referred to as the “butterfly effect.” In this case, instead of butterfly flapping its wings, stirring the air and, through a series of events, creating a storm, it looks like an infected animal in a marketplace touched a merchant who, through a series of events, created a pandemic. Like ripples in a pond, the pandemic has spread out to effect healthcare systems, supply chains, and financial markets. The current crisis has shown we must find a better way to confront future crises. King Abdullah put it this way: “Covid-19 is a threat that confronts every leader. But if we wish to defeat it, we must do what seems counterintuitive: Put politics and popularity aside. We must also do the exact opposite of what the doctor ordered: Come together and get to work. To face this single threat, we must have singular focus — the survival and well-being of human lives everywhere.”

Pandemics grow exponentially

The reason Bill Gates has consistently warned about pandemics is because they spread exponentially. He writes, “Exponential growth is not intuitive. If you say that 2 percent of the population is infected and this will double every eight days, most people won’t immediately figure out that in 40 days, the majority of the population will be infected.” Ethan Siegel (@StartsWithABang), a Ph.D. astrophysicist, observes, “In any biological system, if you put a living organism into an environment where it can thrive, with unlimited resources and no predators or competitors, it will always grow in the same fashion: exponentially.”[4] Siegel provides theoretical numbers to an unchecked spread of the coronavirus, “Let’s say you start with a population that has just one infected person on January 1st, and the number of infected people doubles every three days. … If the exponential nature of the infection transmission isn’t stemmed in any way, there will be 1024 infected people on January 31: about a thousand times as many as you began with. That’s a lot, but remember that this continues to double every three days as long as this growth remains exponential. On February 3, there will be twice as many: 2048 infected. On February 6, that rises to 4096. By the time you get to March 19, which is 78 days after the initial infection, some 67 million people will be infected.” If you want to know why healthcare officials were so insistent on social distancing, stemming the exponential spread of the virus is the reason. Gates adds, “It is reasonable for people to ask whether the behavior change was necessary. Overwhelmingly, the answer is yes.”

Siegel goes on to note, “This alarming thought of exponential growth infecting an enormous number of people in such a short time is not our likely fate with the COVID-19 coronavirus, for a few reasons. … The ‘exponential growth’ part can be stemmed, suppressed, or stopped entirely through a number of actions that we have the ability to take, both as individuals and as a collective society.” That’s what makes modeling pandemics so difficult. My colleague, Caleb Bastian, Chief Science and Technology Officer at Massive Dynamics™, writes, “Forecasting epidemics is not too dissimilar to forecasting hurricanes. Both are phenomena driven by non-linear differential equations with sensitive dependence on initial conditions. Being dynamic models, predictions are updated each day based on the new data.”[5]

We have much to learn

Many people are asking why we can’t deal with the rise of a new virus much quicker than we do. Gates explains there are a number of questions needing to be answered. For the novel coronavirus, they include:

• Is the disease seasonal or weather dependent?
• How many people who never get symptoms have enough of the virus to infect others?
• Why do young people have a lower risk of becoming seriously ill when they get infected?
• What symptoms indicate you should get tested?
• Which activities cause the most risk of infection?
• Who is most susceptible to the disease?

The best way to find answers to these questions is to get the world’s best scientific and medical minds to work together. Ngaire Woods (@NgaireWoods), Dean of Blavatnik School of Government at the University of Oxford, and Rajaie Batniji (@RBatniji), Co-founder of Collective Health, write, “Without rapid and effective global cooperation, the world may not exit this crisis safely at all. For now at least, heavy-handed nationalist responses predominate. Alongside curfews, lockdowns, and requisitioning, governments are closing borders and using wartime rhetoric to rally their populations. Global supply chains and trade are being disrupted not just by lockdowns, but also by wealthy countries’ competition for supplies. Soon, however, governments will need to restart the global economy. And that will require international cooperation in several key areas.”[6] In his article, Gates suggests a few of those areas.

The need for innovation and the return to normalcy

Gates writes, “During World War II, an amazing amount of innovation, including radar, reliable torpedoes, and code-breaking, helped end the war faster. This will be the same with the pandemic. I break the innovation into five categories: treatments, vaccines, testing, contact tracing, and policies for opening up. Without some advances in each of these areas, we cannot return to the business as usual or stop the virus.”

Treatments. Gates writes, “Every week, you will be reading about new treatment ideas that are being tried out, but most of them will fail. Still, I am optimistic that some of these treatments will meaningfully reduce the disease burden. … There is a class of drugs called antivirals, which keep the virus from functioning or reproducing. The drug industry has created amazing antivirals to help people with HIV, although it took decades to build up the large library of very effective triple drug therapies. For the novel coronavirus, the leading drug candidate in this category is Remdesivir from Gilead, which is in trials now. It was created for Ebola. If it proves to have benefits, then the manufacturing will have to be scaled up dramatically. … Another class of drugs works by changing how the human body reacts to the virus. Hydroxychloroquine is in this group. The foundation is funding a trial that will give an indication of whether it works on COVID-19 by the end of May. It appears the benefits will be modest at best.” The scariest thing about treatments is the number of false claims being made to separate scared people from their money. The U.S. Food and Drug Administration warns, “[People] might be tempted to buy or use questionable products that claim to help diagnose, treat, cure, and even prevent COVID-19. Because COVID-19 has never been seen in humans before, there are currently no vaccines to prevent or drugs to treat COVID-19 approved by the U.S. Food and Drug Administration (FDA).”[7]

Vaccines. “Vaccines have saved more lives than any other tool in history,” Gates writes. “Short of a miracle treatment, which we can’t count on, the only way to return the world to where it was before COVID-19 showed up is a highly effective vaccine that prevents the disease.” The first human vaccine tests have already started in the United Kingdom. Most officials, however, believe a widely-available vaccine is probably a year away. As Gates notes, “The issue of safety is obviously very important. Regulators are very stringent about safety, to avoid side effects and also to protect the reputation of vaccines broadly, since if one has significant problems, people will become more hesitant to take any vaccines.”

Testing. The importance of testing can’t be overstressed. Gates writes, “There has been a lot of focus on the number of tests being performed in each country. Some, like South Korea, did a great job of ramping up the testing capacity. But the number of tests alone doesn’t show whether they are being used effectively. You also have to make sure you are prioritizing the testing on the right people. … Testing becomes extremely important as a country considers opening up. You want to have so much testing going on that you see hot spots and are able to intervene by changing policy before the numbers get large.”

Contact tracing. One of the most controversial activities arising during the current pandemic has been contact tracing. Samantha Stein (@SteinSamantha), Chief Strategy Officer at QED-it, explains, “Naturally, any type of sweeping government-sanctioned surveillance program, however well-intentioned, raises serious questions: How is our sensitive data being used? Who has access to it? How vulnerable is our data to leaks and hacks? How could it be exploited by private companies in the future? And, of course, is there a way to mitigate the risk of privacy breaches? These are important questions that will most certainly resurface — even if we’re too preoccupied to think about them today — once panic ebbs and calm has been restored in the post-coronavirus era.”[8] Gates adds, “I think most countries will use the approach that Germany is using, which requires interviewing everyone who tests positive and using a database to make sure there is follow-up with all the contacts. … This approach relies on the infected person to report their contacts accurately, and also depends on the ability of the health authorities to follow up with everyone.”

Opening up. According to Gates, “Most developed countries will be moving into the second phase of the epidemic in the next two months. In one sense, it is easy to describe this next phase. It is semi-normal.” Semi-normal means activities involving large crowds are likely to be off the table for quite some time. Gates adds, “The basic principle should be to allow activities that have a large benefit to the economy or human welfare but pose a small risk of infection. … There are no easy answers to these questions. … Schools offer a big benefit and should be a priority. Large sporting and entertainment events probably will not make the cut for a long time; the economic benefit of the live audience doesn’t measure up to the risk of spreading the infection.”

Concluding thoughts

As is the case with most things, the pandemic is affecting the poor more dramatically than it is affecting those better off. Woods and Batniji conclude, “The faster and more effectively we act to contain the spread of the virus in the world’s poorest and most populous countries, the better we can protect everyone.” Gates adds, “The disease is disproportionately hurting poorer communities and racial minorities. Likewise, the economic impact of the shutdown is hitting low-income, minority workers the hardest. Policymakers will need to make sure that, as the country opens up, the recovery doesn’t make inequality even worse than it already is.” On the hand, Gates notes, “We are impressed with how the world is coming together to fight this fight.” The whole world is in this fight together and we will only emerge from the pandemic together. Like Gates, I salute everyone involved in the fight from healthcare workers to scientists, from morticians to manufacturers, from farmers to grocery workers. Gates concludes, “There are so many heroes to admire right now. … When the world eventually declares Pandemic I over, we will have all of them to thank for it.”

Footnotes
[1] Daisuke Wakabayashi, Davey Alba and Marc Tracy, “Bill Gates, at Odds With Trump on Virus, Becomes a Right-Wing Target,” The New York Times, 17 April 2020.
[2] Bill Gates, “The first modern pandemic,” GatesNotes, 23 April 2020.
[3] King Abdullah II, “It’s time to return to globalization. But this time let’s do it right.” The Washington Post, 28 April 2020.
[4] Ethan Siegel, “Why ‘Exponential Growth’ Is So Scary For The COVID-19 Coronavirus,” Forbes, 17 March 2020.
[5] Caleb Bastien, LinkedIn post, 30 March 2020.
[6] Ngaire Woods and Rajaie Batniji, “There’s only one option for a global coronavirus exit strategy,” World Economic Forum, 11 April 2020.
[7] Staff, “Beware of Fraudulent Coronavirus Tests, Vaccines and Treatments,” U.S. Food and Drug Administration.
[8] Samantha Stein, “How to restore data privacy after the coronavirus pandemic,” World Economic Forum, 31 March 2020.