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Iranian Infectious Disease Specialist on How the U.S. Should Address the Coronavirus Pandemic

Web ExclusiveMarch 02, 2020
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As the number of confirmed coronavirus infections continues to grow worldwide, cases have now been confirmed in at least 65 countries, with the death toll surpassing 3,000. The first two fatalities on U.S. soil were reported over the weekend in Washington state, and there are now at least 89 cases in the U.S., with New York, Oregon, Rhode Island and Florida reporting new infections. President Trump meanwhile is claiming that criticism of his handling of the outbreak is part of a Democratic “hoax.” We look at how the U.S. has and should respond, in Part 2 of our interview with Dr. Kamiar Alaei, Iranian global health policy expert, co-founder and co-president of the Institute for International Health and Education, and a visiting professor at the University of Oxford.

This is a rush transcript. Copy may not be in its final form.

AMY GOODMAN: This is Democracy Now!, democracynow.org, The War and Peace Report. I’m Amy Goodman. The number of confirmed coronavirus infections continues to grow worldwide. Cases have now been confirmed in at least 65 countries, with the death toll surpassing 3,000. The first two fatalities on U.S. soil were reported over the weekend in Washington state. Both deaths were at the EvergreenHealth hospital in Kirkland, and both men were residents of the same nursing home. A genetic analysis shows the virus was likely circulating undetected over the last six weeks in Washington state, potentially infecting hundreds of people. There are now about 90 cases in the U.S., that we know of, with New York, Oregon, Rhode Island and Florida reporting new infections. But we don’t really know, because the U.S. is hardly testing people. Where in South Korea they’ve tested something like 35,000 people, in the United States maybe 500. President Trump meanwhile is claiming criticism of his handling of the outbreak is a Democratic “hoax.”

We’re going to turn right now to Dr. Kamiar Alaei, co-founder and co-president of the Institute for International Health and Education. He’s in the capital of New York, in Albany. In Part 1 of our conversation, we talked about Iran, your home country, which now looks like it’s the epicenter of coronavirus in the Middle East. But, Doctor, since you deal with infectious diseases, I wanted to ask you generally about the significance of this outbreak, what is being called by many a pandemic, and what people can do to protect themselves.

DR. KAMIAR ALAEI: So, it’s a very important question, because if you look at the trend of the outbreak, it’s expanding. And there are a lot of countries that they underestimated the reality, and you see over the past weeks they are facing the major challenge. That includes in the U.S. and some of the countries in Europe. Definitely, I think people have the main road to protect themselves by washing their hands at least for 20 seconds by soap, and at the same time to reduce direct communications outside the home, because the issue is all 81% of people who got infected, they have very mild symptoms, so that’s the reason they go to their works, and they can infect others. And each person who gets infected may infect three to four people. And that’s the reason that it’s getting exposed to a lot of people.

AMY GOODMAN: On Friday, Michael Ryan, the health emergencies program executive for the World Health Organization, said the World Health Organization’s attempt to send epidemiologists, clinicians and prevention and control professionals to Iran had been delayed. I want to turn to that clip.

DR. MICHAEL RYAN: Yes, we are sending a team. In fact, the team would be there by now, but there are severe issues with getting flights and access to Iran right now. And we thank the governments of UAE and other governments who are facilitating the process of not only getting teams, but getting medical supplies and other important items.

AMY GOODMAN: So, your country, Iran, is at the epicenter of the coronavirus in the Middle East. Of course, China has been the most hard hit, and after that, South Korea. But can you respond to what this representative of the World Health Organization said?

DR. KAMIAR ALAEI: Yeah. It’s very important because they expected to go and visit Iran. But my understanding is that Iran may want to delay for a few days to make to the real number, because, as you know, for several weeks they underreported the cases. And just over past 24 hours, they reported 500 new cases. So they wanted to match some of those numbers, because they have to be very clear and transparent with World Health Organization. So, I guess, by this way, they wanted to match the real numbers before the WHO representatives visit Iran.

AMY GOODMAN: And why do you think they’re doing what they’re doing in Iran, Dr. Alaei?

DR. KAMIAR ALAEI: Because this is what they’re supposed to do. This is the main mandate of the minister of health, based on this outbreak, to have a very proactive case finding, to find new cases. So, if you look in the number of unofficial cases, at least 10 times greater than the number of official cases. So, by this way, the government over the past three days, they tried to change the strategy to be more proactive, and yesterday they announced that they wanted to engage 300,000 volunteers to be proactive, to go to the homes and knock the doors and find infected cases. So, by this way, they wanted to show that they are doing some things. But still, I am not very positive they can do things, because there’s a lot of political decision-makers that influence those health policy approaches, so by this way it’s a very challenging and a little controversy between policy makers, what’s the right thing to do.

AMY GOODMAN: I wanted to ask you about this Time magazine report that said, talking about Iran, “Medical workers … said that their equipment is badly outdated, a situation made worse by the U.S. sanctions on the Iranian economy. Although the U.S. administration says 'humanitarian and medical needs' are exempt from sanctions, few European companies dare to do business in Iran in fear of potential retribution from the United States. Moreover, sanctions on Iranian banks make it highly complicated to carry out transactions with Europe.” So, if you can talk about the effects of these sanctions? And a lesson to the United States as they try to isolate Iran, they might well simply be hurting themselves and the world community.

DR. KAMIAR ALAEI: That’s a very great, you know, point, because definitely sanction has significant impact. And we heard that last Thursday they wanted to remove some of those sanctions. But there are a lot of companies, they hesitate, you know, to help Iran. But I think this is a right moment, while the president of the United States mentioned that they wanted to support Iranians, you know, population. So, this is a time to show in reality, because who is the most affected population are, you know, Iranian people. So, by this way, I think they can share a clear message, not only U.S., but also Europe, that they try to help people who are getting infected, or they are at risk for coronavirus. And this is the case if you — back in George W. Bush, in 2003, that he initiated PEPFAR, you know, because he believed that if we don’t control HIV in Africa, we may get infected, as well. You know, sooner or later, this will be the case. Now we have a global — you know, getting to global pandemic. So I think this is a moment for the U.S. officials to be more transparent and to show the Iranian people that they are there to help them and be more proactive.

AMY GOODMAN: Are you concerned about the man President Trump has put in charge of dealing with the coronavirus? And that is the vice president, Vice President Pence. In naming him, President Trump talked about the Indiana model around health. Now, what that model was, was when Pence was governor of Indiana, he refused to allow a needle exchange program. You’re an expert in HIV/AIDS, and this is exactly what happened. There was an outbreak of HIV/AIDS because needle exchange was not allowed in Indiana. Vice President Pence, at the time governor, said he would go home and pray on it. People were putting enormous pressure on him to allow the needle exchange, as a result of this outbreak from his policies, and ultimately he relented.

DR. KAMIAR ALAEI: So, I think there’s a little difference between coronavirus and you know, needle exchange programs, because, as you know, a needle exchange program was targeting injection drug users, but the coronavirus infecting everyone. I think the policy should be different, definitely different. And there is no excuse not to have more proactive approach. And I heard there are a lot of experts that are very concerned about the — recently, a report that they may be over 1,500 infected cases in the state of Washington. So I think the U.S. should be more proactive, to have more its case finding among those who may be affected or infected. So, this is, I think, a very important time to show how U.S. wants to approach this, the outbreak. Definitely it’s a very good sign that the vice president serves as the leader of this, you know, the team, but at the same time, to what extent they are implementing those policies is the main question.

AMY GOODMAN: So, let’s talk about how many cases we think there are in the United States, because we’re saying these enormous numbers in places like South Korea, something like 30 — well, enormous number of cases. But there have also been 35,000 tests. Why haven’t there been these tests done? I think in the United States there have been maybe 500 tests. What has been the problem? But even when you do have a test — they’re saying now they’re going to be sending out thousands of test kits around the country — what can people do? I mean, there isn’t a vaccine for the coronavirus.

DR. KAMIAR ALAEI: So, definitely, I think case finding is very important point to help to identify those who are infected in the early stages, but it should be very, you know, a reasonable approach. You can’t test everyone. But definitely the number of cases which was tested in the U.S. is not enough, and definitely they have to increase the number of cases. But they should be very targeted. You can’t, you know, test anyone. But definitely those states like state of Washington, that they are the most affected states, they should be more screening, you know, to identify those who may have been traveling over the past at least two or three weeks. But you saw there’s new cases that they had no previous experience of traveling to China or had the exposure to the person who was traveling. That shows that now the trend is changing from the history of traveling, which was one of the main indicators for a person who comes to medical facilities, to be more proactive to other potential factors that the person may get infected.

AMY GOODMAN: And then, can you explain the issue of lethality, mortality, and how it compares to the flu? Apparently, the flu is something like 0.1% mortality and the coronavirus 2% mortality, many times more. But how is it expressed in people? What do they feel? What’s the difference between the flu and this in terms of symptoms?

DR. KAMIAR ALAEI: So, definitely there are some similarities between flu and coronavirus. But flu, they have more, you know, pain in the muscles; with a coronavirus, usually they don’t have. And I saw there are some in the media, they wanted to say, “Oh, flu is more important than coronavirus.” But as you know, flu, it may take during the five days that they infect others while they’re infected, but for coronavirus it may take up to 15 days. That means that it is three times greater, the chance of infecting others. And at the same time, those who have coronavirus, even before they get symptomatic, they may infect others. So, in the long run, coronavirus may kill more people than flu, if we are not very careful to manage the outbreak.

AMY GOODMAN: And the symptoms of coronavirus?

DR. KAMIAR ALAEI: Yeah, so definitely people have, you know, headache. They have fever. Fever is very — but not like the previous family members like SARS or MERS, that 90% they had fevers. They have cough, and definitely they have dyspnea. That dyspnea shows that the lower respiratory system got affected. And as you know, people over age of 60, or they have a chronic condition like diabetes or high blood pressure, they’re at greater risk. You know, if you are at the age of over 70, 8% maybe has a mortality rate. And if you’re at the age of 80, that chance may increase to 15%. So, it means that if you’re at the — you know, over age of 60, you have to be more careful.

AMY GOODMAN: And the flu and the coronavirus comparison when it comes to children and infants? Is the flu more lethal for children than the coronavirus?

DR. KAMIAR ALAEI: Yes, that’s very interesting, that even children, they get infected, but you don’t see a lot of mortality among children and new babies. And as you know, coronavirus is a new mutation of the virus, so we don’t know a lot about them. But as you see, most of those who get infected, they are over age of 10. So that shows maybe, you know, the immune system in the new babies is not into the level that have additional damage to the body.

AMY GOODMAN: And you’re in the capital of New York. What is New York doing right now? And do you think they’re doing enough?

DR. KAMIAR ALAEI: So, definitely, we heard yesterday, you know, the Governor Cuomo announce that the first case of coronavirus was detected from one of the person who had a visit in Iran, that she came back to the U.S. That shows that the coronavirus is entering to New York. And that shows that they — definitely, they have used a lot approaches to be more proactive, but definitely they need to be more proactive at this stage, that now it’s entering to their country, especially to New York, which is very overcrowded, especially Manhattan.

AMY GOODMAN: And so, what should people in New York do, do you think?

DR. KAMIAR ALAEI: So, definitely, because the main route of transmission is through, you know, flights, definitely they should have more screening for the new entry passengers when they come to the U.S., regardless if they — so, traditionally they say if they come from China or Southeast Asia. No, they should come from anywhere. They should have the kind of checking their temperature, have some quick screen of questions, if they have history of traveling in those affected countries. So, by this way, they may have a more proactive approach to screen those who make it, you know, infected. And as you know, for two weeks, they may have no symptoms. So, may they encourage some of those that they are very suspicious to stay at home for two weeks.

AMY GOODMAN: And what do you think of the policy of shutting down borders, and President Trump just announcing no one can come out of Iran into the United States right now? He didn’t — they are not saying this for even China, which is harder hit, and South Korea.

DR. KAMIAR ALAEI: This is similar to a few weeks ago. We had the case in China that there are a lot of border countries. They shut down the borders. But the World Health Organization recommended that may increase the number of new cases, because people they decide to use indirect destination to enter to their final destination. So, I understand why the President Trump, he decided to shut down the border. But it’s very challenging, because people may go to Canada or may go to Mexico and comes from there by, you know, other borders. So it’s very challenging. But if they come with the habit and the transparency, so it will be a very targeted approach. OK, if you come from China or from Iran, so they do medical examination, they do testing. And if they get infected, they can early, you know, detect them.

AMY GOODMAN: Do you think the shutting down of borders is a bad idea?

DR. KAMIAR ALAEI: So, it’s not a bad idea, but it’s not the only approach, because it depends of the country. you know? Definitely, I understand, you know, Iran is this — after China, is the second country which is approaching this outbreak. But at the same time, we shouldn’t just focus on shutting down the borders for some certain countries and underestimate other ways that the virus may enter to the country.

AMY GOODMAN: And finally, this issue of going to the hospital or to the doctor when you’re feeling sick, or being at home, if you can explain what you think is the best approach? I mean, you had, for example, the cruise ship, where it looks like a thousand people may have been infected. Perhaps it went through the ventilation system. Aren’t hospitals the sickest places?

DR. KAMIAR ALAEI: So, definitely, I think it depends of the country or the state that the persons feel like symptoms. If it is very an outbreak of the — for example, if I’m in the state of Washington, I may use different approach than New York, because in New York there are very, very few cases. So, definitely a person feeling kind of those symptoms and has a history of traveling, especially in the Southeast Asia, should go to the doctor. But if they are in the state with a higher rates like state of Washington, maybe they ended up staying at home, if they don’t — if they are less than 60 years old, and they don’t have severe symptoms. So it’s better off that they stay at home, because, by this way, so it will be — you know, in two weeks, the disease will be gone, and they don’t get additional exposure when they go to the hospital. And at the same time, they don’t infect others, because the point is that maybe a person get infected with mild symptoms, but that person may infect others that they are over age of 60 and put their life in danger.

AMY GOODMAN: Dr. Kamiar Alaei, co-founder and co-president of the Institute for International Health and Education, visiting professor at University of Oxford, expert on HIV/AIDS, drug policy and international health and human rights. To see Part 1 of our discussion, go to democracynow.org. I’m Amy Goodman. Thanks so much for joining us.

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