In 2015, in a TED talk, Bill Gates warned that the world was not ready to deal with a global respiratory pandemic. He got the insight, he says in a blog post, based on the experience of his Bill & Melinda Gates foundation in working with governments and private companies to tackle epidemics like Ebola, SARS, Zika.

Discussing the Ebola virus that killed over 10,000 in Africa, he told the TED audience that “As awful as this epidemic has been, the next one could be much worse. The world is simply not prepared to deal with a disease—an especially virulent flu, for example—that infects large numbers of people very quickly. Of all the things that could kill 10 million people or more, by far the most likely is an epidemic.” The talk has gotten over 60 million views, including on the TED site and on YouTube.  (https://www.ted.com/talks/bill_gates_the_next_outbreak_we_re_not_ready?language=en.)

Why infections and deaths in India will likely be high

Since the coronavirus erupted in China in January, Gates, 64, has provided useful insights. “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,” he writes today on his blog Gates Notes.

In the blog, he gives an update on the science of the pandemic and what needs to be done to curb it. “So far, developing countries like India and Nigeria account for a small portion of the reported global infections,” he writes. “With luck, some factors that we don’t understand yet, like how weather might affect the virus’s spread, will prevent large-scale infection in these countries.”

However, he cautions that the disease dynamics will likely be the same as in other countries. In less developed economies it will be harder to make the behavior changes that reduce the the virus's reproduction rate. Gates notes that, “If you live in an urban slum and do informal work to earn enough to feed your family every day, you won’t find it easy to avoid contact with other people.” The health systems in countries like India and Nigeria have far less capacity. He says, “Tragically, it is possible that the total deaths in developing countries will be far higher than in developed countries.”

While Gates works on philanthropy, Nadella runs Microsoft

The Gates foundation will spend $250 million to tackle Covid-19. Funds will support the development of diagnostics, therapeutics, and vaccines, as well as partners in Africa and South Asia to scale the detection, treatment, and isolation efforts.  “We have a responsibility to meet this global crisis with global solidarity,” Gates said. (https://www.gatesfoundation.org/Media-Center/Press-Releases/2020/04/Gates-Foundation-Expands-Commitment-to-COVID-19-Response-Calls-for-International-Collaboration)

In 2008, at age 52, Gates retired as chief executive of Microsoft to devote full attention to the Bill & Melinda Gates Foundation. On March 13, Gates resigned from the board of both Microsoft and Berkshire Hathaway “to dedicate more time to philanthropic priorities” he wrote in a post on LinkedIn..

Gates added that “I will continue to be engaged with Satya and the technical leadership to help shape the vision and achieve the company’s ambitious goals.” He was referring to Satya Nadella*, who took over as chief executive of Microsoft in 2014. Nadella joined the company in 1992. He grew up in Hyderabad, got a bachelor’s degree in electrical engineering from Mangalore University (Manipal Institute of Technology) in 1988, a master’s degree in computer science from the University of Wisconsin, Milwaukee and a master’s degree in business administration from the University of Chicago. He is married and has three children. (https://news.microsoft.com/exec/satya-nadella/.)

Gates reportedly continues to own about $18 billion of Microsoft stock. Through the years, Gates has sold the stock and reduced his ownership in the company, enabling him to amass much of his net worth of $102 billion, as estimated by Forbes.

Difficult to ignore the dead bodies and go shopping

So far, the Gates foundation has spent over $55 billion to tackle health, education, development and climate change problems around the world. It has about $47 billion in assets, funded by Gates and his friend Warren Buffett, chief executive of Berkshire Hathaway. (https://www.gatesfoundation.org/who-we-are/general-information/foundation-factsheet ) While its head office is in Seattle, the foundation has about 1,500 employees including in Delhi, Beijing, Abuja, Addis Ababa and Johanessburg.

On March 24, 11 days after resigning from Microsoft’s board, in another TED talk Gates said the United States missed its chance to avoid mandated shutdowns. “We did not act fast enough to have an ability to avoid the shutdown…It’s January when everybody should’ve been on notice,” Gates said. (https://www.ted.com/talks/bill_gates_how_we_must_respond_to_the_coronavirus_pandemic.) The Covid-19 virus was first discovered in December in China.

While self isolation will be “disastrous” for the economy, he said, “there really is no middle ground.” He suggested a shutdown of six to 10 weeks. “It’s very tough to say to people, ‘Hey keep going to restaurants, go buy new houses, ignore that pile of bodies over in the corner, we want you to keep spending because there’s some politician that thinks GDP growth is what counts,’” Gates said. 

A hot summer may not help

Several Indian officials and commentators say that Covid-19 will have less of an impact in the country since it will wither away in the summer heat. Gates says that such complacency is unwarranted. While almost all respiratory viruses, including COVID-19, are seasonal, “we see the novel coronavirus spreading in Australia and other places in the Southern hemisphere,” during their summer season. So, he says, “we already know the virus is not as seasonal as influenza is.”

Data from the U.S. and Europe show that the coronavirus is mainly impacting those above 65 in age. For instance in New York City, which has a severe outbreak, a third of those over 75 years of age, who were infected by the virus, have died. This compares to less than 1% of deaths among those under 44. Also, the rate of infection and hospitalization is far lower among the young. (https://www1.nyc.gov/site/doh/covid/covid-19-data.page)

Young but at risk

Several commentators in India forecast that the impact of the pandemic will be low in India since about half of the population is under 25 years of age and nearly two thirds below 35. Gates says that demography based inferences “is a complicated subject because even if young people don’t get sick as often, they might still spread the disease to others…we do know that many people with the virus don’t report symptoms, and some portion of those might end up transmitting it.”

Further, data from the U.S., Italy, Spain and China, show that the rate of mortality is very high among those infected with Covid-19, who have heart, diabetes and other diseases. As Gates points out, while the populations in India and Nigeria “are disproportionately young -which would tend to mean fewer deaths from COVID-19 - this advantage is almost certainly offset by the fact that many low-income people’s immune systems are weakened by conditions like malnutrition or HIV.” Also, even prior to the spread of the coronavirus, he adds, that a child in a poor country was “20 times more likely to die before the age of five than one in a rich country…The diseases include HIV, malaria, tuberculosis, polio, and pneumonia.”

Lack of good sanitation will fuel spread

India lacks good sanitation, as described in a story by Mohd Imran Khan and Anu Abraham.

(https://www.globalindiantimes.com/globalindiantimes/2020/4/4/why-social-distancing-is-not-helping-stop-the-spread-of-the-coronavirus-in-india) This means that countries like India face a greater risk since “there may be spread from fecal contamination since people who are infected shed the virus,” Gates writes on his blog.

The Gates foundation is spending $100 million to tackle the coronavirus, in addition to its annual philanthropic spending of about $5 billion. To tackle Covid-19 and restart economies, Gates says, there has to be innovation in 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,” he blogs. 

“More than 100 groups are doing work on treatments and another 100 on vaccines,” says Gates. “We are funding a subset of these but tracking all of them closely…to see not only (their) chance of working but also the odds that it can be scaled up to help the entire world…However, it isn’t clear how countries will come together to coordinate the funding. Some could go directly to the private sector but demand that their citizens get priority,” he adds.

Here are BIll Gates views on treatments, vaccines, testing and re-opening.

Most treatment trials will fail

“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. Some will be easier to deliver in rich countries than developing countries, and some will take time to scale. A number of these could be available by the summer or fall.”

“One potential treatment that doesn’t fit the normal definition of a drug involves collecting blood from patients who have recovered from COVID-19, making sure it’s free of the coronavirus and other infections, and giving the plasma to people who are sick. The lead times for manufacturing are about seven months in the best case.”

Vaccines at least 18 months away

“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,” Gates writes. “Vaccines have saved more lives than any other tool in history. Smallpox, which used to kill millions of people every year, was eradicated with a vaccine. New vaccines have played a key role in reducing childhood deaths from 10 million per year in 2000 to fewer than 5 million per year today.”

“Unfortunately, the typical development time for a vaccine against a new disease is over five years…Many of the vaccine approaches will fail because they won’t generate a strong enough immune response to provide protection. Scientists will get a sense of this within three months of testing a given vaccine in humans by looking at the antibody generation. Of particular interest is whether the vaccine will protect older people, whose immune systems don’t respond as well to vaccines.”

“I am often asked when large-scale vaccination will start. Like American’s top public health officials, I say that it is likely to be 18 months, even though it could be as short as nine months or closer to two years.”

Testing can work only if there is isolation

“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. For example, health care workers should be able to get an immediate indication of whether they are infected so they know whether to keep working. People without symptoms should not be tested until we have enough tests for everyone with symptoms. Additionally, the results from the test should come back in less than 24 hours so you quickly know whether to continue isolating yourself and quarantining the people who live with you.

“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. You don’t want to wait until the hospitals start to fill up and the number of deaths goes up.

“Even if there is adequate and good testing, it is important that a government provide a place for an infected person to isolate themselves, if they can’t do it at their home.” This is important in India, given the density of the population and most sharing a room with at least one other person.

Microsoft opens up in China

“One example of gradual reopening is Microsoft China, which has roughly 6,200 employees. So far about half are now coming in to work. They are continuing to provide support to employees who want to work at home. They insist people with symptoms stay home. They require masks and provide hand sanitizer and do more intensive cleaning. Even at work, they apply distancing rules and only allow travel for exceptional reasons. China has been conservative about opening up and has so far avoided any significant rebound.

“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. But as you dig into the details and look across the economy, the picture quickly gets complicated. It is not as simple as saying “you can do X, but not Y.” The modern economy is far too complex and interconnected for that.

“For example, restaurants can keep diners six feet apart, but will they have a working supply chain for their ingredients? Will they be profitable with this reduced capacity? The manufacturing industry will need to change factories to keep workers farther apart. Most factories will be able to adapt to new rules without a large productivity loss. But how do the people employed in these restaurants and factories get to work? Are they taking a bus or train? What about the suppliers who provide and ship parts to the factory? And when should companies start insisting their employees show up at work?”

For the full version of Bill Gates blog: https://www.gatesnotes.com/Health/Pandemic-Innovation

*Bill Gates, right, and Satya Nadella are shown in the photo.

Photo courtesy The Bill and Melinda Gates Foundation.

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