- Thank you everyone
for coming out today.
Welcome to the Latham and Watkins forum,
and thank you to the Reiss
Center on Law and Security
for sponsoring this event.
I am Lisa Monaco.
I am distinguished senior fellow
at the Reiss Center on Law and Security,
and a professor here at the law school.
Special welcome to some of my students
that I see in the in the audience.
Thanks for coming out,
for what I think is a
really important event
and one NYU
and the law school,
and the Reiss Center is uniquely situated
to host.
I'm going to introduce
our panelists in a second,
and you will be blown away as I was
by the breadth of the
experience and expertise
that we've got on the stage this afternoon
and notably that is
really reflects
interdisciplinary expertise.
Right.
We've got lawyers, we've got doctors,
we've got journalists.
So it's really an impressive array
and I think something that NYU
the law school, Reiss Center is really,
really proud to be able to bring to you.
So without further ado,
I want to introduce our panelist.
We're gonna have a
discussion this afternoon
on the Coronavirus, legal
issues, policy issues,
international law, and
governance questions,
and I'm really looking
forward to the discussion.
So let me begin by
introducing our panelists.
I am going to start at the far end.
We have Laurie Garrett,
who is here with us.
She's a former senior fellow
at the council up for global health,
at the Council on Foreign
Relations, here in New York.
She is a Pulitzer Prize
winning science journalist.
The best-selling author of
books very relevant to
this discussion today.
The coming plague,
Newly emerging diseases
in a world out of balance,
was I think her first book,
if I'm right about that?
- Yes
- And betrayal of trust
the collapse of global public health.
I would note these titles,
more than 10 years old, maybe, almost?
But yet,
still incredibly relevant on point,
and obviously quite prescient.
Laurie has been at the forefront
for years of
some of the
most vexing global
public health challenges,
and sounding the alarm on
the danger of emerging infectious disease.
She's been recognized in journalism,
academia and the public health community,
and she was gonna bring today
I think a rare perspective
as this a science journalist,
and as I said
somebody's been on the front lines
of very significant worldwide epidemics,
from SARS, to MRS, Ebola, and HIV.
Next to Laurie is Dr. Alexandra Phelan.
She's a member of
the Center for Global
Health science and security,
and an instructor in
the Department of
Microbiology and immunology
at Georgetown in Washington DC,
and a professor in global and public
health law and ethics at
Georgetown Law Center.
We won't hold it against you
that it's a different
Law School Alexandra.
Dr. Phelan works on
legal and policy issues
related to infectious diseases.
With a particular focus
on emerging and re-emerging
infectious disease, outbreaks,
and international law.
She as I've
as you could tell from her appointment,
she's got degrees in both
biomedical science, and law,
and focuses on global governance
of infectious diseases.
Next to Dr. Phelan, is Dr. Shitong Qiao,
who is visiting us here at
the law school this semester
from the university of Hong Kong.
Where as an assistant professor of law
at the University of Hong Kong,
He's an expert on property and urban law,
with a focus on comparative law in China,
Dr. Qiao
graduated from Wuhan University
which will become very relevant
in our discussion this afternoon.
Is also a graduate of Peking University,
and Yale University,
where he received an LLM.
Again, not holding it against you.
(laughing)
He has practiced in the courts in Wuhan,
and clerked in the Hubei
Province High People's Court.
So we
are we are bringing you
a real on the ground perspective.
And finally directly next
to me. Dr. Howard Zucker.
Dr. Zucker is the commissioner of health
for the state of New York.
That means he is the
state's chief physician.
He leads initiatives
in throughout the state
to combat such important issues.
as the opioids crisis,
to strengthen environmental health,
and the AIDS epidemic in New York.
He has been many years
at the New York State
Department of Health,
and has has helped establish a network
of hospitals equipped to treat Ebola.
Something that we cross paths on
when I served as
the president homeland security adviser
during the Ebola
epidemic in 2014
and 2015
and has implemented
programs in New York to treat
the threat of Zika
and spearheaded
issues like combating antimicrobial
resistance and measles.
He oversees the entire public health,
and healthcare workforce here
in public health care
facilities in New York.
He is a has received his MD
from George Washington
School of Medicine in DC
and a JD
and an LLM
from two other New York law schools.
[Laughter]
- Fordham, Columbia.
And has bio security law at Georgetown.
They note to the Dean
that we need to
up our global public
health expertise here.
He has a public policy background
as well as serving as
a White House Fellow,
and for then
Secretary of Health and Human
Services, Tommy Thompson
He rose to become a
Deputy Assistant Secretary of Health,
in the Department of
Health and Human Services,
overseeing the medical reserve core.
That's today a Medical Reserve Core
that's run by the US Surgeon General,
and he's worked in pandemic preparedness
from SARS to anthrax.
He's recognized internationally
for his work to advance global health.
Including serving as an
assistant director-general
at the World Health Organization.
So, we'll get into that
experience as well.
So, I did not overstate the expertise
that we are bringing
you here this afternoon.
I really want to thank
all the panelists for being here.
So, let's get right into it.
I want to start with
a little bit of a kind of state of play,
if I could and I'm gonna go
to Laurie Garrett and to
you Dr. Zucker on this.
We have all been kind of bombarded,
almost daily with
the kind of running count
and maps about the spread
of the Coronavirus.
Let me start with you Laurie,
and ask you just to give
folks a level set, right.
What is the scale and scope,
and how should we be thinking about it
today as we sit here,
and then I'll go to you Dr. Zucker on
what's the, what's the
situation here in New York,
and how should we be thinking about that?
- Thank you.
I want to say two quick things
before I answer your question.
First of all,
to the chair of our panel,
thank you for your service
in the Obama administration,
for the tremendous
pandemic preparedness
infrastructure you created.
All of which the Trump
administration destroyed in 2018.
So, we find ourselves without
Lisa's masterful system of preparedness
infrastructure in place in America today
as we face the possibility of
Covid-19 reaching our shores.
Thank you everything you did.
And two,
(clapping)
Yeah.
I also see quite a number of
Asian students in the audience
and I want to say to all of you,
I regret from the bottom of my heart,
whatever racial assaults
you have heard, or seen.
Any mistreatment you have undergone.
It's unconscionable,
there is no basis in it
and you you deserve the support
of everybody in this room
and of all American citizens.
So, to answer your question,
unfortunately now I'm gonna bash China,
and when I say that Chinese in China,
I'm talking about Xi Jinping,
the Chinese Communist Party
and the leadership of the
People's Republic of China.
We are in a very difficult situation
as a global community right
now, for two chief reasons.
One is that
clearly the government of Xi Jinping
has been lying about this
epidemic from the very beginning.
From the earliest stages
in December before anybody
was outside of China
was aware there was this new disease
but when physicians and
public health people in Wuhan
knew there's a new pneumonia.
There's something killing people.
It's dangerous, it's terrible.
And as I documented in detail
in a recent article in foreign policy,
so I won't go through it you
can look it up if you want,
but at every step of the way
since publicly finally acknowledging
the existence of this epidemic.
The Chinese government
has created a narrative
and said this is the
narrative of the moment,
and then made the data fit the narrative.
When that narrative failed,
go narrative number two
and make the data fit
narrative number two.
That fails go to narrative number three.
What are these narratives?
Oh, we have an outbreak
it's a hundred percent
about the fish market.
Nobody's got it.
There's no risk to anybody else.
It's all in this fish market.
There's no such thing as
a Coronavirus in fish.
So we knew right away
it wasn't a fish market,
but you go from there and expand
and you realize from the very beginning
at traced already
to early December
there were cases
spreading utterly independent of the
wild animal market.
So there was already human-human
transmission in Wuhan,
that had nothing to do
with that narrative.
Then it was we've shut the market down,
so now the epidemic will magically stop
and we will now report
there's only 30 cases.
There's only 32 cases.
There's only and for two weeks
the numbers never even hit fifty.
One day they actually went backwards.
Oh, we've made a mistake.
It's fewer cases than we said yesterday.
They were all lies.
They were fabricated numbers, whole cloth.
One of the things that
flies conveniently did,
was create a perfect ratio of deaths
to suppose of active confirmed cases.
So that you had a fatality rate that
was exactly what they wanted two percent.
Then and when it was clear
that there was florid spread
well beyond the animal market
the first person who spoke up about it
was Li Wenlaing
and his speaking up about it
of course got him in deep trouble.
You've all heard of him,
the physician who has
sadly died of Covid-19.
Wen Li, Li Wenlaing
actually just sent a chat message
to a physician chatroom.
It wasn't on all of Weibo or something.
It was actually a fairly
confined messaging,
but because of it he and
seven other physicians
were forced to come
before the secret police,
sign a statement saying we are liars,
we are rumor mongers,
we made this up, it's not true,
and he had said the key thing
that brought the attention of
the state down hard on him,
he referred to it as being quote
something like SARS.
And of course the SARS
virus outbreak in 2003
was covered up by the Chinese government
under Chong Yuen.
In a transition to Hu Jintao,
and had a dramatic impact
on the status of China
and how the outside world saw them.
So I don't want to take up too much time
going through everything that has happened
since they finally publicly
on New Year's Eve announced
that there was this epidemic
and then a series of steps thereafter.
I just want to put a
couple things on the table
and then tell you where we are
I think at this moment.
One is we now know Xi Jinping addressed
top party officials on January 7th,
saying he was taking
control of the epidemic,
For the head of state, of the
largest nation in the world,
the second biggest economy of the world,
with a whole lot on its plate
that has nothing to do with a new virus,
to actually say I am
taking control of this,
means he knew a lot,
was worse than what was publicly told.
He knew this was a much
more dire situation
than on January 7th was a
matter of public record.
That's number one.
Number two,
we have had two major episodes
where suddenly the alleged count,
the number of infected,
the number of dead,
has skyrocketed in one day.
So you've had a baseline,
baseline, baseline, then
(increase wheeze)
then baseline, baseline, baseline,
(increase wheeze)
In both those occasions
they came the day after
a major pronouncement from Xi Jinping.
In one case it was when he sent out a
message through the party
infrastructure saying
there shall be no more cover up,
anybody who lies about this
or obstructs the unfolding epidemic,
response will be shamed for eternity,
You know in Communist Party jargon,
that's pretty bad.
So the next day boom, all of a sudden,
there's all these numbers reported.
Now that was January 19 20.
The second big one came more recently,
February 12th,
when all of a sudden
it was announced that
they were gonna count
the numbers differently
in Wuhan, and Hubei.
Not anywhere else in China.
They're still using the
same old counting system
classifying cases the same old way
but in this one region
the numbers will be counted differently,
and that resulted in a huge jump.
14 thousand plus cases reported
additionally in one day.
Since then,
the numbers have supposedly
been slowing down.
Now since then the deaths have
supposedly been slowing down
and it has been a matter of party
rhetoric repeated many times over,
over the last 10-12 days.
That the epidemic has reached it peak
and it will come down towards zero,
sometime in March.
And this is based on CDC data.
Some of which was first published
only about 24 hours ago.
Maybe 28 hours ago.
I lose track of time
because I try to be on China time
and America time at the same time
and so you could imagine
I'm not getting much sleep these days, but
and this was a big paper,
the first big paper to
come out of China CDC.
There, that,
they have a Centers for
Disease Control, as do we.
and this paper looks at
more than 70 thousand cases
and concludes that indeed the
new onset of infection rate
has been going down.
So that what we're allegedly seeing now,
according to this study,
is the catch-up time on incubation.
Now the incubation period on this disease
turns out to be very long,
and one of the things we're finding
as we look outside of China
things like the cruise ships
where people are getting affected
and some of the outbreaks
in Singapore and Hong Kong,
is that this incubation time
which were initially told
and assured by Wuhan
authorities was three days.
Then we were told and assured
by CDC China was 14 days.
We now know is out as
far as 24 maybe 25 days.
What this means is
that if what we're doing is
waiting for catch-up time
on long incubating cases
but not new infections
oh we can't be rest assured
until the end of February.
Now do I believe any of this?
I was in the SARS epidemic
in China throughout
and in Hong Kong,
and in the two years following
I spent a lot of time
investigating on the ground,
the SARS responses in Vietnam,
in Singapore, in Thailand,
and back in the mainland,
and in Hong Kong.
So I have a really good
idea of how the state,
how Beijing responded to SARS
and from by a maybe January 5th or 6th
it was obvious to me
that they had decided
to use the SARS playbook
in responding to Covid-19.
What was the SARS playbook?
It was, oops, we screwed up,
we covered up for too long,
we allowed the virus to
get all over the country,
we have no choice but to
go to mass quarantines,
roadblocks, temperature and fever checks
all over the whole nation.
You know on any given day in Beijing
I would have my temperature
taken 12 to 15 times,
every time you go in and out of a doorway
of any building,
and pulled over by police
to have it taken as you
drive down the streets.
and then anyone with a fever,
regardless of the cause of fever
because there was no test to confirm SARS.
You would be quarantined
and they built those instant hospitals
that we've had much ado about
with the current outbreak,
and you would be stored
away in an instant hospital,
until you went two weeks without a fever.
end of story, and it worked,
but it worked for SARS
because the infectious stage of SARS
actually was coincident with fever stage.
So they actually were capturing everybody
who was potentially infectious.
We now know with this virus
you can have no symptoms at all
and be contagious to another person.
So without a way to test who's infected
and who's not,
the quarantine policy is almost
definitely going to fail,
The second problem is
that the screening test
they'd have developed,
which is, for those of you
science nerds in the group,
it's the RTPCR takes,
you know, if you have an illumia
or a high-throughput device to screen on,
it's about a four-hour test.
If you lack the high
speed it's a little longer
but at any rate,
you can get a one-day
turnaround, on yes, no,
you're infected.
Turns out to have a 50%
false negative rate.
Oops.
So, then the third thing is
a lot of people who really are symptomatic
and in fact are in intensive
care unit with pneumonia
test negative.
We don't know why.
They certainly have plenty
of virus in their body
but it comes up negative on the test.
So the big change that recently was made
was to add them in based on symptoms
into the case count number.
Bottom line, I think that
they've made a series of blunders,
and I'm happy to dissect them further
in the Q and A time, if you're interested.
That have absolutely both undercut
the capacity to control the disease
and also undercut all
global and National trust.
There's no reason if
you're in Wuhan today,
for you to trust the Beijing government
or frankly most of Wuhan authorities.
And in eroding the trust nationally,
they've played the WHO
and I'm gonna let Howard talk about WHO
but they played WHO like a fiddle,
and unfortunately WHO
is limited by the fact,
that it by charter,
has to deal with nation-states,
not with individuals,
not with the masses within the state.
So if the nation state chooses to lie
WHO transmits lies
and so my bottom line is,
no I don't trust any of the numbers.
No I don't believe that
it's only 75 thousand people
infected to date.
I think it's probably quite
substantially more than that and
I'm deeply concerned that
you basically now have
about a hundred million people in China,
who are not in their homes,
jobs, and schools at the moment.
They took, they left, and fled.
They fled Wuhan.
They fled any place they thought
there might be a quarantine.
They took advantage of the lunar holiday
to go to home villages and various parts
and they've not returned.
Most factories are still not
operating or are operating
at very low level.
Most schools are still not open
and this is the whole
nation I'm talking about.
When these people are now
under a lot of pressure
from Xi Jinping to get
the economy rolling again.
China's hurting.
This is very, very, very,
economically painful.
Some so they want everybody
to come back to school,
and factories, and I think
we'll see a second resurgence.
- So you put a lot on the table Laurie,
that I want to get into
on the response front.
I want to hear from Howard first,
on you the numbers issue, right.
I mean Laurie, I'm gonna put on the table,
the outline that we've seen
in some of the reporting here,
has been
75 thousand global infections,
and Laurie gave us some
some food for thought
and how we should trust that number
and a death toll within China,
only of about two thousand
but obviously some cases in, you know,
at least two dozen
countries external to China.
So how should we think about that
and then what is the
situation here in New York?
I think you, like me, feel that
we the first casualty in a crisis is
reason in facts.
So let's get back to facts and perspective
and hear your view on both.
- Sure, So New York, as New York State,
with an international City, New York City.
Every time our antennas are usually up,
whenever we hear of something,
whether it's a infectious disease,
or any of the problems
that can occur on an international stage.
So when this happened
we were already thinking
how is this going to impact us,
particularly with John F Kennedy Airport,
and the travel that we have.
Immediately we'd spoke
with the Port Authority,
which is run
by the governor
and we sat down I had a conversation
about flights coming in.
at that time there about
15 thousand flights
that were coming in to,
15 thousand people that were coming into
the United States and
many that came into JFK,
along with SFO San Francisco,
and LAX and elsewhere.
Those number of individuals
now is down to about 800 to 12,
800 to 13 hundred, according
to the CDC yesterday.
So it's a dramatic drop,
but for New York,
what we've had so far
is we've had
persons under investigation
looking at individuals
where there is concern.
Whether they had traveled from a Wuhan
and they had fever
or if there was an issue of concern
and there were 25 people of that
that fall into that category between
both the city
city as well as the rest of the state
and all those tests have come back
negative so far
or come back negative.
So far we've had zero individuals
in the state of New York.
We continue to monitor those
who come into the state
for who are from either
the Wuhan area or the
or elsewhere in China
and we have about over 400 individuals
outside of New York City,
and there are thousands of
individuals within the city
that we have been
that have been monitored as a result
of our concern to be sure that
there isn't in any risk of infection.
These are some of the
challenges that were obviously,
we're faced with as we as
we move forward with any of the
infectious diseases of this nature
and we are used to this in the past.
I would like to put it in some perspective
because a lot of times people get very
nervous and very anxious about things
and like I said we
haven't had a case here,
but last week we had probably in
the well I give you that some,
the final number for the
entire season so far,
we've had over a hundred thousand
individuals in the state of
New York who have had the flu.
We've had unfortunately
thousands of deaths
and we've had
we've had unfortunately
three pediatric deaths
in the state from flu
and in the country there
are millions of individuals
who have had the flu this season.
and unfortunately you know
thousands who have died
and if you look globally even more so.
So I think that it's
important to keep things
in some perspective when we're
dealing with these things
but to always remain vigilant
and pushing forward on things.
- Thanks, for that Howard,
because I do think that
type of perspective
is very very important.
I know Governor Cuomo recently said
that the common flu remains
a far greater threat
to New Yorkers
and so it is,
it's important to keep
that in perspective,
even as we delve further into many of
the very important issues
that Laurie put on the table
and that we'll talk about
for the rest of the panel.
I want to
kind of zoom out now
and talk about the responses.
Right, both it from China,
from the international
public health community
and then obviously here
in the United States,
and let's start of course with China,
Laurie put some issues here
on the table for us, but
as I mentioned at the outset,
we are really fortunate to have somebody
in professor Qiao,
who has spent some time in Wuhan.
It's probably fair to say
that many, many Americans
had never heard of Wuhan
before the Coronavirus
story started to hit.
Can you give us a little bit
of a sense of the place?
How should we think about the city?
You know, for folks who are
not familiar with that location
and you know, kind of the
anything you have heard
or know to be the case
with the kind of
on-the-ground response there.
- Sure, but firstly I have
spent four years in Wuhan.
I did my undergraduate study.
And in the past month,
I've been really talking to
well, my parents in Hubei.
So about far away from Wuhan
and my two cousins in Wuhan.
While I was at Massey,
he was working in a hospital.
So I'm,
what I'm seeing right now, I think,
I actually admire Laurie for,
many of the very insightful comments,
as I agree with many points you have made.
I think most important well actually
we are going to be on same page,
is that I think the current period,
like what's going on right now,
I think it could be a
recent, riskiest period,
because the thing that
people having in their house
following demands you know
people are becoming impatient
and the government has
is under this pressure
to getting people back to work.
That's why I have been warning
my parents in the past month
in the past week basically,
you know people who are
alert don't go outside
because it's a time
like people think, okay
you know, maybe it's under control, right?
People actually, I indeed,
I'm talking to people higher
and also in other part of Hubei.
People are indeed becoming
actually a bit more optimistic
because the government
now is actually in action.
So I think, that's something
actually I fully agree with
but a certain thing
because I have been trying to understand
what really happened.
Mostly from in inside
of perspective, right.
I would say we can really divide
what happened in January
into two periods.
So from like, I will say
like, the end of December
to January the six,
obviously the local authorities
didn't actually acts that badly, right.
So actually on December
30th and December 31st,
they already knew there
was a bigger problem
and physicians and nurses got infected.
They already, actually
I think December 31st,
there had already been like
a gene test by researchers.
We know it was like 80% similar to SARS
and the local the Public
Health Authority in Wuhan
already reported to the National CDC
in Beijing on December 30
and our December 31st the National figures
they already sent an
experts to Wuhan, right.
And from January 1st to January 6th
the local Public Health Authority in Wuhan
they already issued internal
documents about this thing.
So basically, warning the
hospitals to take actions.
And also they had already started to
issuing public notice to the public.
Well, we don't know why
the numbers are good or bad
but they already started issuing notice.
So let us say it's not that bad
and also on January the 3rd
the Chinese Government already
started sharing information
with the United States, with the WHO
and also with like Hong Kong government
and you know my other governments.
So that's why the Hong Kong government
acted on January the 4th,
had already initiated a so-called
second a class emergency response.
So obliviously from
like the end of December
to January 6th,
it was okay at all feels like perfect
but what was missing here and
the two weeks you have there
January 6th to January 18th.
- [Laurie] Yeah.
- The other words the two meetings
of the Wuhan City government
and the Hubei City government,
the Hubei provincial government.
That was the most important
public or political event right.
Of the provincial and the city governments
and it
looks like somebody, you know
suddenly pressed the pause button, right.
Everything stopped.
And the Hubei Public Health Authority
stop the publicizing any information
or when they did this, they
said there was no new cases.
So I think, of those as the two weeks
we have really missed.
So from my perspective, I mean
I think there are two problems
from a inside perspective.
Why is it really the flow our information?
Okay?
The other is the principal agent problem,
that was to say
that according to recent a report
published by Prime
Minister Li Keqiang, right.
The official, right,
had already gave instructions
on January the 7th
but then why did local government
wait until January the 20th
to take a serious, serious action?
So for me, because of all my expertise,
in addition to property law,
which had nothing to do with this event,
is that your local government law
So that I have always been interested in
understanding the incentives, right.
The behavior patterns of local governments
and how the interact plays
the central government.
I think that's a key here.
Let's just say when the local governments
don't have Marshall
Authority, or autonomy,
how to basically get everything done
by sending the information to Beijing
and are waiting for the commands,
the orders from Beijing.
That's like the big whole waste of time.
I think that's something
inherent in the institution.
That's something when you to keep in mind
and if in the future for responding to
such a public health crisis.
So that's I guess, I'm using up my time.
- [Lori] No, No, No.
- But here.
- Can you give us,
I want to stay with you for a second
and then also go to Dr. Phelan on this.
Give the audience a sense,
is there a legal framework
that is being conducted here,
that's being operated under,
is it extra legal how,
how should we think about
these levels and how they're working.
- Sure, I think there are two things.
The first is as a legal level
as Dr. Alexandra will say,
we have at least two laws
one a law of emergency or the
law of emergent incidence.
Right.
That's one law.
The other is the law
of infectious disease.
So this two law,
two law is actually there
are like many others,
but they actually define.
For example, you know,
after water situations
you know, you have the obligation
to report to the provincial
and also the central governments
and who has the obligation
and the responsibility to disclose
the information to the
public and water conditions.
You can initiate the emergency
the emergent responses.
So that's the law,
which I think are very important
and there are also
problems with such laws.
The other part is a political
part, to the defector part.
Is really about the relationship between
the central government
and local government
because of many of our experts here
like Professor Jericho knows,
why of all secrets to China's
I will say relative success
in the party from the 1978 to 2008.
The economic success is a so
called the fact of federalism.
Dare to say the central government
gave the certain degree of autonomy
in managing its economy,
in managing the urban affairs, right.
So local officials, so
they are also motivated
to a certain degree to
you know to do their job.
As good, you know, they can
but they're kind of the
defect of federalism
or decentralization has been
somehow reversed in the past decade,
because of this
this effort from the central
to centralized power.
I mean there is a rationale
for centralization.
I can give you one day lecture about that,
but this centralization
does have the problem of
what I have been talking about the
information flow right.
Everything goes to Beijing.
You can understand,
it's going to be very difficult
to govern New York City or
New York state from DC, right.
It's going to be much more time consuming.
And you all do that right now.
- [Lori] For the record Dr.
Zucker did not comment on that.
(laughing)
- And a second to say that,
well, assuming that leadership
had given the instructions
on January the 7th, right?
Assuming the instructions
are serious enough
and clearly that the
principal-agent problem,
the local official clearly
didn't take instructions
seriously enough right.
Otherwise the problem
could have been solved,
and instead the local officials
they are very busy with their
most important other events,
The two meetings.
Right?
So I will just conclude
away that last word,
the local officials they
are struggling with,
I mean there's three things right now.
Right?
- [Laurie] Well many of
them have been fired.
- Yeah, many have been fired
but the three things
the first one development,
economic development.
Right.
A second thing is the social stability
and the third thing is loyalty.
As I call development,
stability, and loyalty.
It's a very tricky balance to
to maintain
and the past decade, almost a decade,
centralization, I think,
may have made this,
have made local official
job even more difficult
and what I'm seeing really the last thing,
if you talk to officials in Wuhan,
even the talk.
I mean the parties in Wuhan,
who had to be removed
and also governor Hubei,
who had been removed.
They wouldn't really feel very, just it's
it's just bad luck.
They have said, it's a typical playbook
they did nothing unusual.
- [Lauri} yeah
- Right
but again I think it's
a institutional problem
we should really reflect a pond.
- So Dr. Phelan let me get you in here
I mean we've heard and
we've seen reporting
about the restrictions that
have been put in place.
Laurie talked about her own
experience through SARS.
We had the report in the
New York Times yesterday,
I think it was about at
least the half of the
Chinese population under
some form of restrictions.
We've got reporting of the annual meeting
of the National People's Congress.
That may be delayed
it's a huge, huge event.
What's yours perspective on these measures
and the number of the issues
that Laurie put on the table
and the framework that
Dr. Qiao has put on the
put on the table as well?
- Yeah.
Thank you very much Lisa.
I think I've agreed very much
with a lot of the points
that Dr. Qiao made,
in particular with regards
to the relationship of information sharing
and the structural
impediments of a bureaucracy.
So rather than necessarily
active conspiracy.
there is also just simply the
the structural impediments
of a very slow-moving democracy
and how that that flows,
and I think there are some
interesting parallels.
That when we do talk about the
United States legal system,
I like the term de facto
federalism, that you use
because I think for the law students
and the lawyers in the room
there's a lot of interesting issues about
who has a duty to act for public health,
who has the authority under
law to act for public health,
and what are the limitations
on the exercise of that authority,
that parallel quite nicely
between the U.S federal system
and this de facto
federalism or centralization
that we see in the Chinese scenario.
So if we're looking now,
at the these limitations
that last question,
which goes to vert of the question asked
about the way in which quarantines
and control and control measures
are being implemented in China.
You know, I think,
there has been, what I consider
a relatively unfortunate praise
for some of the mechanism and measures
that have been taken in China.
I think that the starting point
is at public health powers
are there to protect the public health
and they really derive from police powers
in all in governments
all around the world.
These are quiet can be
quite coercive powers
and you know these are powers that in
in effect constrain individuals liberties
on balance for the protection
of the public's health.
Now the right to health is a human right
and so you say the right to movement
and the right to life and
these individual liberties,
and we are in this process of
always balancing these rights
and ensuring that they are protected.
So a cordon sanitarian,
which is exactly it's
exactly what we saw in Wuhan.
It wasn't a quarantine.
What it was was essentially
cordoning off an entire city
so that people couldn't come in and out,
is a fairly arbitrary
and highly restrictive
and constrictive measure.
That isn't appropriately tailored
to achieve a public health outcome.
Right, because what it's actually doing
it's not assessing the risk to individuals
or the risk to spread.
It's essentially trying to trap
and contain something in one place,
at the essentially the sacrifice
of all the individuals
who are in that area.
That is not only morally reprehensible
but there are also legitimate issues
of whether that actually is not just good
for public health for the people in Wuhan,
the public health of people in China,
for public health of
people around the world,
because what we have seen
in particularly the international
response to these measures
is a shifting of norms,
some really important norms
about what we accessory
intervention for public health.
So I'm just going to say
why this is actually quite
bad for public health
beyond just the very
real human rights issues
that emerge from these sorts of responses.
Public health is reliant
upon public trust.
When a government engages
in measures that cause fear,
or uncertainty and aren't
appropriately tailored
and do restrict liberties,
you undermine public trust
and public health needs
people feeling comfortable
to go to doctors, go
to health care centers,
engage with officials and tell them
about their travel history,
or potential symptoms,
So that you can then
accurately screen them,
and test them and isolate
them if they're unwell,
and actually provide them with treatment.
You know, that is what
a good public health
response looks like, right.
When you put people in position
where they feel that they're
going to be locked up
but they're not going
to have access to food
or water or they're
going to lose their job
or they're not going to see their family,
they're it's indefinite
and perhaps they won't have
access to vitally needed medications.
You know that's when
you see people starting
to avoid public health authorities
and what that means is that's
when you get transmission in the community
because people are sick and
they're avoiding authorities
and they're actually coming into
contact with other individuals.
So Public Health tries
to avoid these measures
and so one of the the core sort of tenants
that we have and a test that is reflected
in international law under
the International Health Regulations
which are leading law for
international infectious disease.
Also within the US Constitution
and the way it's interpreted
in terms of limitations under
under looking at the the fifth amendment
and also the 14th amendment
and how they apply to quarantines
here in the United States
and around the world and
international human rights law,
is the least restrictive mission necessary
to achieve a public health outcome.
Mass quarantines are
always highly restrictive
they are not the least restrictive measure
needed to obtain the public health outcome
and come with a range of consequences.
I'll just leave one last sort of statistic
on this particular point,
UN Aids, executive director of UN Aids
today has come out and made clear that
there are a significant number
of individuals in China,
who are HIV positive
who do not have access
to their medications,
are in at risk of running
out of their HIV medications.
That is just one small example
of the logistical impacts
and the supply chain impacts
and the human rights impacts,
the human rights health impacts,
that overly burdensome measures can have
and there are going to be
thousands of those sorts
of examples of other
chronic diseases people,
with who are going to be
dying of secondary reasons
as a result of these
purported public health
but really authoritarianism measures.
- Let me ask you.
Thank you very much for that
and also for planting what
I suspect are there's some
good fodder for a law school note or two
from your your lay down there.
Dr. Zucker let me go to
you on this last point
that Dr. Phelan has made in terms of
the role of the international community,
UN Aids reference that she
made, as we said at the outset,
you are former official from
the World Health Organization
you just give you know a short description
of what that is, what its role is,
and the controversy we've had with
the regard to the Coronavirus,
in terms of their pronouncement
about a public health emergency.
- So I mean the WHO is an
interesting organization.
I will start by saying
so I start by saying
there are many very talented
individuals over there.
Mike Ryan is running these operations
is a really talented
individual and working hard
but it's also it's
in its own way it's a
political organization as well
as Laurie mentioned
it's made up of Member States
and the way it operates
is in a system which I think
in a lot of ways needs to
be updated and changed,
we move in a much faster pace today
than in the the way
the structure is set up
and it's
the power that it has
is limited in many ways,
it runs the International
Health Regulations.
There's a handful of things
that the WHO can actually do
and to push forward.
The biggest strength it has
its convening power
and it's pressure to put other
to make nations sort of do certain things
because they will in some ways
be shamed if they don't
and so I think that
comes to play in many ways,
but there is a lot of
pressure put upon them
and is an organization, as Laurie said
that in some ways
has the pressure of politics
that comes into play.
If they issue a public health
emergency international concern
there are some implications
that come from that.
There's also money that,
you know and a lot of ways,
money will go out to some
countries for support
if there's an emergency
but in a lot of ways that
the strength it has is
it's convenient power
and its ability to sort of in some ways
make people realize that if
the WHO said this is problem,
than the rest of the
world is gonna turn around
and say why are you not
acting responsibly when that happens.
- So they
came under a lot of criticism
in during the Ebola epidemic,
for waiting months
for declaring a public health emergency
of international concern.
Here there were signs that they were
moving slowly, not as slowly.
What's your perspective on that?
- So I agree and the end
so then the question is why?
You know, what what happened is this
you know, I'm not there,
and so all I can think of is
like sort of I'm sure there was much
quite a debate going on about
when to issue something of this nature
is this something which is of concern
and again it goes back a little bit
as we were talking about
before this meeting convened
about risk and it's not
just risk individual risk
but sometimes you know those
who are in positions of authority
may look at this as how
they will weigh risk
and sometimes there are other influencing
there are other factors that
may influence that decision.
So I can't speak the
necessarily to exactly
what happened in that room
as those discussions were taking place
but you know, as Laurie actually I think,
was listening to that.
I wasn't listening to the debate
but I'm sure it was a
challenging discussion of.
- Oh my god.
I think, you know, as if
anybody's looking for a subject
to write, you know legal brief on,
if Alex doesn't beat you to it.
It has
we have a problem.
we set up a system in 1948 that we call
the World Health Organization.
We set up the international
health regulations in 2005
that were meant to
sort of modernize the
legal framework of WHO,
specifically for
outbreaks, epidemics, etc.
Ultimately it's about
a bunch of incredibly
overpaid people in Geneva
with tax-free, tax-free incomes.
Making decisions, thinking
about poor countries.
Along comes the two biggest,
you know mega outbreaks of out time.
Actually the three biggest
of our modern period
since passage of the
International Health Regulations,
have occurred in the
United States and China
and so the two wealthiest
economies on the planet,
the two most arguably most
powerful nations on the planet.
One was 2009.
H1 N1 in case you're scratching
your head saying America,
and the other two,
were SARS in 2003.
The various bird flu outbreaks since,
and now Covid-19 in China.
WHO shows deference to
the big and powerful,
and acts quite differently
to the countries that are less powerful,
less economically advantaged,
and what was going on in the conversation
in the fyke decision process
boiled down to this,
I, Dr. Ted Rose, director-general WHO,
have met with Xi Jinping,
he's an honorable man,
and he is very deeply
concerned about this problem,
and they are taking radical
measures all over the nation,
and they are doing the right thing,
and they will bring this under control
and we must show solidarity
and support to the Chinese
people and government.
And meanwhile what we're
gonna all fall back on as our
way to wiggle out of this one,
why aren't we declaring an emergency
is we'll wait until we
see secondary transmission
outside of China in another place.
Where people are getting it
independently from China.
So then you have the cruise ships
and it's like, uh-oh, we better get moving
and then you have secondary
transmission in Hong Kong
and secondary transmission in Singapore
and it starts to be
- So the pressure became
- A little crazy.
- To great
- To great and they just
finally had to do it.
if I may, I wanted to make
a couple quick comments
off the very smart things
that some folks here said.
- Let's do that quickly,
because then I want to
get to the US response
because I have to imagine
people are gonna have views on that.
- Well first of all,
anything I say about China, you know,
I have to show deference to
the political genius on all matters China,
sitting right here in the front row.
So Jerry, I apologize for my ignorance,
but there is no event more
important in China for the leader
than a well-greased, well-oiled
National People's Party Congress.
It must function perfectly,
everybody must ratify, blah, blah, blah,
and of you've never seen pictures of it
just Google you'll see.
I mean it's, you know, ten thousand people
in all in neat little rows
with the giant star of the nation.
Well imagine now take what google picture
and now imagine
everybody's wearing a mask.
Oops.
That's not going to workout.
So there's a tremendous amount of pressure
to bring this under
control before late March
and the Congress
and there's already talk about having to
postpone the Congress
or cancel it.
- [Lisa] Yeah
- And so this is really serious.
What I think we are seeing now unfolding
that has the goes to what you
were talking about with trust,
this epidemic has been securitized.
A lot of people who have disappeared,
supposedly to quarantine,
have been journalists,
Chinese journalists.
Have been people who
posted videos on Weibo
that show brutal arrests,
not by people in PPEs
but taking advantage of the epidemic.
Beating the crap out of
people on the streets.
Some of you may have seen
people rounded up in downtown Beijing
and stuffed into little tin boxes
and you hear them screaming
bloody murder from these boxes
and nobody's wearing masks and so on.
So this is not the quarantine,
it's they're using quarantine response
to round up dissidents.
We've even seen videos of lines of men
cowering, covering their heads
and police going down and
beating them with steel batons
commanding them to sing
the national anthem
before they go to quarantine.
And so, I think that
that if anything you've been kind to them.
This is at one point the bureau chief
for the New York Times in Beijing,
when it was announced
that Li Wenlaing had died,
it was an unparalleled
outpouring of grief and rage
on all Chinese social media.
Usually people know you
can't express these things,
you'll get in big trouble.
Right but people were so overwhelmed
and it poured out and in real-time
the New York Times was
monitoring accounts being pulled
(shoot)
and you can see them right in
front of you getting censored
and the individuals account
permanently blocked,
and it was
very the way the state responded
to the death of Li Wenlaing.
Everybody who goes to see
Li Wenliang's small memorial
in front of the hotel
is being photographed.
Every all their identity
and history is being noted.
You know if you dare to show
honor to this hero of the epidemic.
When Zhong Nanshan who
was the sort of hero
of the SARS epidemic in that
he was the first physician in Guangzhou
to identify there's a new
disease in my hospital
and to speak up about it.
He sort of has been
brought out of retirement
as a new figure in this epidemic
and he broke down in
tears sobbing on camera
talking about the death of Li Wenlaing
and this I think you know
anybody in China to see this
was just a huge political event.
I, you know until the journalists
that have been dragged off,
who have been told they
went to quarantine,
are heard from again.
We have to assume that
what has effectively happened
and I would love to hear
your comments on this
but that what has effectively happen
is that the ongoing security state
has now thoroughly integrated
with the securitized epidemic response
and both are being used
for political purposes
and I would just remind you that
in November, the Chinese government
started a national campaign
that involved these posters
that look like Marvel
Comics superhero drawings
and they depicted like a
bad guy in a Marvel comic
wearing a mask and the poster said
be a patriot never wear a mask,
exclamation point and the reason
because they've developed
the world's largest
artificial Intelligence facial
recognition security state
and if you're wearing your mask
the AI can't pick up who you are
and therefore monitor all your movements.
So you know, don't wear a mask.
Now, six weeks after they
launched that campaign,
they have to make it a
law to not wear a mask
and you are seeing people
rounded up on the streets
for failure to wear a mask.
- So to really it's a very vivid image
and I've seen some of that also
and in some of the news reporting.
We've talked a lot about
the Chinese measures,
of course, the Chinese
aren't the only ones
who have had quarantine.
I'd love to hear from you, Dr Phelan
on some of the steps that
in this country we've taken.
Folks I know, we've been
riveted by the cruise ship story
but a few weeks ago, the first,
I think I'm correct on this
but dr. Zucker will correct me,
the first
really large-scale
quarantine since the flu,
since the 1918 flu
pandemic was done,
right here in the United
States in California.
Have I gotten that right Dr. Zucker?
- Yep.
- So Dr. Plelan the issues you brought up
about Public Health and Trust
give us your perspective
on some of those steps
and then I'd love to hear
also from you Dr. Zucker
on you know you have
to advise the governor,
How does one think about these issues?
- The steps here in the United?
- Yeah.
- So I mean Public Health powers
are rather broad.
They need to be.
They need to be flexible,
to be able to adjust
to emerging infectious
diseases or health threats
that we may not may not be aware of
and there's this point
about the largest federal quarantine
since you know, Spanish flus is important
because most of the time
public health powers are
exercised by the states
or delegated from the state
down to local authorities
such as here in New York City
and the reason being is that states
have their police powers reserved
under the Tenth Amendment
of the Constitution and the federal powers
for public health are rather specific.
So they are defined by the
limits of the Commerce Clause.
So where an infectious disease
essentially can impact international
interstate trade or Commerce
or from a foreign, from
some outside of the country
into the United States
and so as a result the CDC's powers
under the Public Health Service Act
really narrowly defined
for when there is that
risk of interstate spread
or spread from outside the country
into the country.
The CDC's rules for how they
respond to infectious disease,
outbreaks, like this outbreak,
were revised in 2017.
There are some really
interesting political timing,
it was all around inauguration
and for many many years
the CDC has been trying
to update these laws
in response to the revision
of the international health regulations.
Those international laws
and under the rule the CDC can essentially
isolate or quarantine or treat,
someone who they reasonably
reasonably believe has been infected
by a specified communicable disease
and those specified communicable diseases
have to be in an executive order.
Interestingly there hasn't
been an executive order
for the Coronavirus
and the reason is probably because
it's likely captured by
the definition of SARS.
So a severe acute respiratory
syndrome, broadly.
What that means is that the
CDC can impose quarantines
and treatments and measures
and we have seen these federal quarantines
which are rather unique and new to see
federal quarantines of
individuals who are coming,
who've traveled in the last
14 days to Hubei province,
who are US citizens, residents,
or you know don't,
fall within the range of exceptions,
that are set out by the federal government
and can be put in these quarantines.
I don't believe those are necessarily
appropriately tailored measures.
There has been numerous
people coming into the country
subject to previous CDC guidance,
who were able to engage
in home quarantine,
and self monitoring, and much
less restrictive measures,
and well before these other
quarantines were imposed.
and there are a lot of challenges
with implementing these sorts of measures
in terms of actually being
accurate travel histories
People traveling on different passports,
you know, because people
can we duel citizens.
So you know, these seem to
be a little bit more theater
and a bit more,
and more restrictive than necessary.
I think when we look at something like
a reasonable belief of
someone being infected from a
Supreme Court precedent point of view.
That point of view, really you know,
we require the Supreme Court says
that we need clear and convincing evidence
if you are going to be
compulsory confining someone
and that is a much higher
standard than reasonable belief.
We haven't seen that necessarily tested
in this sort of outbreak
and you know what that would mean
with the current Supreme Court
because you know we look at how they say
different travel bans
have been interpreted
by the Supreme Court
and whether we would
see a similar division
along those lines based on the government
having a you know
a relatively legitimate interest
in protecting public health
even if these measures do not appear
to be appropriately
tailored before their name.
- So Dr. Zucker, I want to leave
a few minutes for questions
but obviously we're nowhere near
needing any kind of quarantine,
let's be very very clear about that
but just as somebody
who advises the Govern
and who would be the one
to be making these calls,
how do you think about it?
- Sure.
So, first I was just say
for the law students in the audience,
you'd always wonder in class
how Gibbons B Ogden from
the early eighteen hundreds
and Jacobson versus Massachusetts right,
- [Lisa] Oh wow, that was
impressive pulling that out
- The early nineteen hundreds.
These things that we studied in school,
and you say is this gonna be relevant?
Yeah, it actually is.
They do come back to
to surface in life.
So the I am,
the way we when you make these decisions
you really do have to sort of weigh
the public health and
the public safety issue.
These are these are tough
decisions to make them
and we're the best thing we can do
is always to continue to monitor.
You don't want to overreact to situation
as I just mentioned about flu
and as the governance
spoken about, you know,
constantly about the risk of flu
and versus the the risk of Coronavirus
but the best way to do this
is just to keep a very close eye
on everything that's going on.
Any case that, any person won't say case
because we haven't had a case
but any person you're concerned about,
you monitor, you try to track,
try to figure out what is going on.
Keep a close eye and we've had
and this is very labor-intensive
even I should say like intensive.
Is anytime someone of concern
you really do have to go back
and try to figure out all the epidemiology
that's involved here and to move forward.
I will draw from the example
of the measles outbreak
because that is a great example where
and this was only within the past year,
we just finished dealing
with us in October
and we had a
real challenge there.
We were working with the community
and how far and how much can you push
and what do you need to do
and what can you do to make sure kids
who are at risk or potentially infect
are not in school
and so this is where you decide
okay, how much,
what do you need to do it
and to make sure that
the public remains safe
and it is a balancing act
and I can't give a specific answer
because every case is
a little bit different.
That was one scenario,
this is another scenario
and so you need to keep it in perspective
and also it is dependent
upon different regions.
I mean it's a little
bit a different issue.
For example the measles issue
was specific to a certain
number of counties
but it could have spread.
It could have spread more.
Fortunately the state has a
very high immunization rate
except for these small pockets,
but we
the way you advise anyone
you know, a governor, or others
is to sort of be sure that
your remaining very vigilant
on top of the issue on a regular basis.
- Great.
We've got a minute or two for questions.
I know we have a hard stop at two
because people have to go to class.
Professor Cohen.
Let's get you up.
- [Cohen] Is there a mic?
- Yeah, there's a mic coming to you.
- This is a great panel and I congratulate
the organizers and participants.
- Thank you.
- Let's talk in conclusion
about what are the
implications of this experience
for governance of China
because however important
these medical problems are,
they will pass.
- Yeah.
- But the Chinese government,
the Communist Party of China,
Xi Jinping is going to remain.
So what I want to know from our
extremely good speakers,
is what do you see about
the implications of this?
Is there likely a result
of this experience
to be more freedom of speech in China,
less government manipulation of the media?
Would you have greater freedom
of information in China?
Are we likely to have more
civil society NGOs rules
than have been allowed, so far?
Will the police be less
arbitrary and coercive
as a result of their highly
publicized depredations?
What are we likely to see
with respect to
federalism, centralization,
more centralism or less?
- So I'm gonna ask our panelists to give
and I'm gonna I'm gonna
use the power of the chair.
I'm gonna be positively
President Xi like here.
- Okay.
- And say lightning round.
More open,
less open.
- It's already less open.
They're gonna crackdown like crazy
and they
and you will note in all Chinese data,
Taiwan, Hong Kong, and Macau
are listed as Chinese mainland data.
- [Lisa] Dr. Phelan?
- So I've lived in China on
and off over the last 20 years
and phrase I've said since
the beginning of this outbreak
is that 2003 is not 2020.
SARS is not what we're gonna see now.
2016 is not 2020.
The open China, the
positive ideas at that time
that we had four or five years ago,
before Xi Jinping came into power,
is not all we're gonna see now.
I think the changes that all
enable Xi Jinping endure this
occurred in the last three years.
Particularly civil society,
information sharing.
I think that it's more likely to get more
this I don't think this will rock him
in the way that some people
would thought it would.
- [Lisa] Dr Qiao.
- I think we have to take
a long-term perspective.
I think in the long run
we have to believe in
the power of the society
and the power of the people.
And the government, whatever it is,
have to live with the more
you know, mobilize and
more powerful society,
and people to govern.
- [Lisa] Dr. Zucker, you're happy too,
I'm happy to have you weigh in on this,
or for you to give a
public health announcement
for everyone to get the flu vaccine.
- I would give the public
health announcement
that everyone should get their flu vaccine
because even though the numbers
you know, this is everything's well,
it's just February you still
should get your flu vaccine.
Our numbers still go up.
Last week was our second
highest number of flu cases
that we've had in decades.
You know a per week.
For one a week period.
- I think that type of perspective
is a very good note to end on.
Please join me in thanking
our wonderful panelist.
(clapping)
