Responding to COVID-19

FASKIANOS: Good afternoon from New York, and welcome to the Council on Foreign Relations Religion and Foreign Policy Conference Call Series. I am Irina Faskianos, vice president for the National Program and Outreach here at CFR.

As a reminder, today’s call is on the record and the audio and transcript will be made available on our website, CFR.org, and on our iTunes podcast channel Religion and Foreign Policy.

We are pleased to have Thomas Bollyky with us today to talk about COVID-19. Thomas Bollyky is director of the Global Health Program and senior fellow for global health, economics, and development at the Council on Foreign Relations. He is also an adjunct professor of law at Georgetown University.

Tom Bollyky is the author of the book Plagues and the Paradox of Progress: Why the World is Getting Healthier in Worrisome Ways and the founder and managing editor of Think Global Health, an online magazine that examines the ways health shapes economies, societies, and everyday lives around the world. I commend the site to you all. You can access it from CFR.org or ThinkGlobalHealth.org. He has testified multiple times before the U.S. Senate, and served on expert committees. He has been a consultant to the Bill and Melinda Gates Foundation. And Bill Gates also put the book that I mentioned on his reading list. And in 2013, the World Economic Forum named Tom Bollyky as one of its global leaders under forty.

So, Tom, thanks very much for being with us today. I thought you could start us off updating us on what we are learning about COVID-19 internationally and here in the U.S., about its spread, and how religious communities can help slow down the spread.

BOLLYKY: Great. Thank you for that kind introduction, Irina.

Let me start by saying that I fully understand that the effective response to this pandemic of the novel coronavirus now known as COVID-19 very much depends on the actions and the vigilance of religious community leaders, both in terms of guiding the practices of those communities but also in terms of the guidance provided to the sick, the isolated, and the worried well. So thank you for all that you’re doing. I understand the importance of these communities. I myself am a regular attendee of religious services, too.

So it’s my great honor to speak with you. I will do my best to try to make this call a good use of your limited time. I’m going to walk through with just very briefly what’s happening on the international level and the shift of this pandemic to North America and the United States in particular. I’ll give you, second, a bit of a sense of what we’re learning about the severity and spread of this disease, which of course is a novel disease, a novel

reported cases are a substantial—overwhelmingly likely to be a substantial undercount. For countries that are starting to head into this pandemic, it virus. We’re still learning quite a bit all the time. And then I’m going to talk a bit at the end about the role of religious groups in terms of this outbreak and what the emerging guidance is around that. And then really look forward to questions and trying to be as helpful as I can however I can.

So let’s start with what we’ve learned in the last twenty or so days about this pandemic. To remind people, this disease outbreak was first notified to the World Health Organization on December 31 by the Chinese government. The U.S. experienced its first case on January 21. The World Health Organization declared it an international emergency on January 30. So all of this has started some time ago, but it’s really in the last twenty days that the pandemic has taken a dramatic turn.

Since February 24, 110 countries have reported their first COVID-19 cases. There are now more than 140 overall. The vast majority of those countries’ cases did not come from China; they came from other countries, like Italy and Iran. There are now nearly 190,000 reported cases of COVID-19 globally and 7,500 deaths. The appears to be doubling at a rate of every three days. So that’s exponential growth. At this point the epicenter of the pandemic is Europe, but North America and the United States in particular are not far behind.

The U.S. has at least 4,900 confirmed cases in forty-nine states and most territories, as well as Washington, D.C. There are at least eighty-nine deaths. In terms of the confirmed cases, no one, including the federal government, believes that to be the true number. It’s likely to be a substantial undercount of what exists, and we’ll find out more as testing becomes much more available this week.

To move to the second topic, in terms of what we’re learning around the severity and spread, most of what we’ve known about the severity of this disease and how it spreads, of course, originally came from China. China has had 81,000 COVID-19 cases. What we learned from China in broad terms is that 84 percent of the individuals who contracted the disease in China experienced mild symptoms. Roughly one out of seven had more severe outcomes like difficulty breathing and pneumonia. Five percent had what’s the equivalent to a critical condition, like major organ failure. And between 3 to 4 percent suffered fatalities.

The early data emerging from Italy, which now has the second-largest COVID-19 epidemic or outbreak, are, unfortunately, worse in terms of numbers. COVID-19 in Italy, between—roughly 10 percent—between 9 and 11 percent—consistently have required intensive care, so that’s substantially higher. All of Italy has 5,200 beds in intensive care units. At the rate that it’s increasing, it will quickly surpass—it would quickly surpass the level of support that exists in terms of intensive care units and ventilators and that type of equipment. I really think it’s the Italy example that spooked so many nations.

Other evidence that has emerged, really, over the last twenty-four hours is a paper in Science reported that in terms of the early experience cases that we have now are a bigger body of evidence. Eighty-six percent of those infections have gone undocumented; so that means largely asymptomatic, people not experiencing symptoms. But the people without symptoms were 55 percent, or more than half—or just half as much—half as contagious as those with documented infections. What that means, to put it in other words, is that it appears that asymptomatic people are spreading this disease, area greater contribution to the spread of this disease than we had realized. The authors of that paper argue that means that we need to see a radical increase in the identification and isolation of undocumented infections and a substantial increase in the social distancing policies because, again, it’s very hard to identify without testing those that have this condition.

There have been a handful of countries, as some of you may know, that have had success in reducing the spread and number of cases. They’ve done it with great speed and a focus on testing. So South Korea by the end of last week had tested 250,000 of its citizens. The adoption of aggressive social distancing policies early, such as banning public transport; gatherings of a larger size, public gatherings; the closing down of schools. And countries like Singapore, in Taiwan, and South Korea, even Vietnam, a whole range of countries that experienced this early have been successful.

At this point I think experts believe, in terms of the modeling, that there are multiple clusters in the U.S. So we may be a bit beyond that point in some regard, but we are as of this past week taking, obviously, as all of you know from personal experience, much more aggressive stances on social distancing. So we’re ramping up testing, and doing our best to catch up. And you know, clearly, to the degree that we can reduce the expansion of those clusters, it’s going to be really important moving forward.

The last point is on religious groups. In some countries they experienced, like any other gatherings of people, to the extent that religious communities have been involved in those gatherings there have been outbreaks amongst religious groups. In particular, Malaysia this week has had a spike of cases tied to a gathering of a missionary group in a mosque. South Korea, of course, had a large spread tied to a Christian group in that country, a small sect. Obviously, New Rochelle has had its experience around a synagogue. So it’s really across all faiths in terms of larger gatherings. At the same time, many religious leaders and groups have been at the forefront of adopting mitigation strategies around online services and providing support to their communities in ways that reduce the need to gather people in person.

The U.S. Centers of Disease Control released resources over the last week specifically for community and faith-based organizations. I commend them to all of you. And I’m happy to ask Irina to send the links to share that guidance.

In that guidance, that’s interim at this point, they urge religious and faith-based groups to establish ongoing communication with local public-health departments to get the most up-to-date, relevant information, to connect to communitywide planning practices. Of course, the White House put out guidance for communities that states that are experiencing community transmission of the virus to try to reduce gatherings of any more than ten or more people. So that’s going to include a lot of what occurs, of course, through community and faith-based groups in person.

Let me stop there. This is, obviously, a very high-level overview of all that’s been happening. And I’m happy to try to be as helpful as I can in any way that I can, and I look forward to your questions.

FASKIANOS: Thank you very much, Tom. Appreciate that overview.

And let’s open it now for questions. Again, we are on the record and I am anticipating that there will be a lot of questions, so please be brief in your question, and questions and no prolonged statements. So let’s turn it over to the group.

OPERATOR: Thank you. At this time we will open the floor for questions.

The first question will come from Homi Gandhi with FEZANA. Please go ahead.

GANDHI:: Great. Thank you very much. I appreciate your introduction to this particular topic.

You didn’t talk about Iran at all in this particular topic, because Iran is suffering from a large number of people. The statistics which are coming out are not very accurate. I know that they are suffering from this particular virus. They ask for United Nations help. (Inaudible)—wanted to help. But they are very proud people, not having political relationship. This becomes a very big problem. Zoroastrians, a very small community which has been affected in the Yazd area, and I don’t know how as an American I can help.

BOLLYKY: Great. Forgive me, so some of that was distorted. But I’ll try to respond to the extent that I made that out, and let me know if I’ve missed something.

There’s no question Iran is one of the epicenters, as I did mention briefly. Iran has been one of the outbreaks and a particular source of cases of spreading internationally. That’s, of course, indicative of probably what is a much larger than reported outbreak of this virus.

Right now Iran has close to 17,000 reported cases. Again, this is likely to be a substantial undercount. There has been an issue in general in terms of balancing the desire for religious services in the country. There has been more restrictions on public gatherings and shrines, as you probably know, and I know there’s been some social disruption around protests for those policies to reduce infection.

More broadly on your point about the need for international support for Iran, I think it’s quite evident that will need to be the case. The World Health Organization early put out a call for $637 million in terms of supporting low- and middle-income countries in preparing and responding to the COVID-19 epidemic/pandemic. That has been, unfortunately, not well-funded. That’s not specific to Iran; that’s true for everywhere. There does seem to be a broader response now among existing global health organizations and philanthropies and funders, but the scope of that is still emerging.

Then to tie into it in terms of the U.S. particular response around Iran and the role of politics in that context, the U.S. does seem to be seeking increasing funding in terms of its response to COVID-19. To date, most of that has focused on its domestic response. But there are talks about trying to ramp it up internationally in terms of what leaders can do to make sure that’s broad-based as possible and the importance of having it as broad-based as possible. I do, you know, urge you to speak to political representatives around that.

I do think it is quite clear in a pandemic of ap[n infectious disease of this nature we’re all only as safe as our weakest link. So whatever our political dynamics aside, it would be important to have this pandemic controlled everywhere and mitigated to that extent everywhere because otherwise we are really all at risk.

OPERATOR: Thank you. The next question will come from Tereska Lynam with University of Oxford. Please go ahead.

LYNAM: Hi. Just two quick questions.

Any guidance on where to get the best information of where we are and what we can do? I’m already seeing wild misinformation on social media saying China has solved the problem and we don’t need to worry anymore, and I think it’s important for religious leaders to have great information to give to their flocks.

And then, also, I’m already receiving calls from within my contemporaries, who are thought of as middle class, already suffering food scarcity and not being able to make their rent, and so they’re worried about becoming homeless. And wondering if you have any guidance on how religious leaders can help with that. Thank you.

BOLLYKY: Great. Thank you for both of those questions because they’re excellent.

On the first question, I can say that from the U.S. context—and we will circulate this afterwards—the CDC has put out specific guidance for religious and faith-based communities. CDC, of course, also has a broader website in terms of the activities or that they’re—personal policies that they’re advocating for individuals and for communities to reduce the spread even more broadly beyond that. We will circulate those links. I encourage people and leaders to use them. It is true there are, unfortunately, an enormous amount of misinformation out there, not just in terms of vis-à-vis the utility of what China itself has done, but also all sorts of unscrupulous people selling products on the basis of what’s happening in this epidemic so it is worse. Interrogating the source of information for anything that you receive, and certainly for our part we’ll circulate the best guidance we can from the CDC in that regard.

In terms of food scarcity and support services, this is going to be an important role for religious and faith-based communities as well in terms of providing services to their community members and beyond. Obviously, this needs to be done in a way that doesn’t contravene the priority on infection control. So, certainly people are delivering food to particularly the vulnerable elderly or people that have compromised immune systems or preexisting conditions that put them particularly at risk.

So in the Italy context, a significant number of those that have suffered severe outcomes and fatalities have not just been the elderly, but people with preexisting conditions around diabetes and heart disease and/or current or former smokers. So those people are particularly at risk. Residential care facilities are particularly at risk.In terms of individuals within communities, people have been delivering food. It is one way that people have been providing services and broader support. Obviously, that needs to be balanced with the need to maintain infection control.

Thank you for the question.

FASKIANOS: Thank you. Next question.

OPERATOR: Thank you. The next question will come from Mohammed Sahil with CIOGC. Please go ahead.

SAHIL: Thank you very much for this overview.

I’m a physician, a critical care specialist, but also running an organization called MediGlobal where we send medical missions to disaster regions to support the refugees and the displaced. So as far as you know, is there any plan to support the refugee communities, whether they’re Syrians in Turkey or Lebanon? We’re really worried about them because they were a target of hate speech in the past couple of years, and if there is any spreading of the COVID-19 among them then there may be a backlash with mass deportation. So that’s one question, if there is any plan to counteract that and have preventive measures for the refugees.

The second one is related to religious activities. CIOGC is the Council of Islamic Organizations of Greater Chicago. We suspended prayers in almost all mosques and we expect the same thing to continue through Ramadan, the fasting month, which comes about one month and a half from now. The problem with the suspension of prayer, that this will reduce the charity to religious organization. If you don’t have congregations and people coming to the churches and the mosque and the synagogue, people will be giving less, and that means that will be translated in less services to the community at need. So I don’t know what’s the solution, but that’s the question.

BOLLYKY: Great.

On the first question I share your deep worry. Right now in terms of the number of reported cases it’s been people—Turkey, which does host a significant number of Syrian refugees—obviously, not all, but a significant number—is only reporting forty-seven cases. Most people suspect that’s a gross undercount of the true burden that might exist in that country.

So as you undoubtedly know well, we have record numbers of displaced people worldwide. By the last count, if I’m recalling correctly, more than twenty-five million refugees as well. Providing health services both on the infectious-disease side and on the chronic side for these populations has already been a significant challenge, particularly for countries that—governments don’t necessarily spend a significant amount on health care anyway.

So the U.N. organizations that serve these communities from a health perspective have already been running over budget and demanding money—not demanding; asking, making pleas for money. That situation, obviously, is going to be compounded in this context.

I have not seen firm plans on what ultimately will be done in terms of these refugee populations, but I think you’re right. It’s inevitable that we are going to see spread, particularly in communities that are crowded together. This disease does seem to be spreading within households. That’s primarily the vehicle by which it does, and crowded settings. And it’s inevitable that’s going to happen in refugee circumstances, and it’s something that we need to have more of an international response to.

In terms of the issues around the reduction of in-person meetings and congregational services reducing charitable giving, it’s a real concern. This is not an area where I can profess to have expertise. I can simply say, my own church has increasingly moved towards online giving, to the extent that’s possible. Obviously, that’s not going to be available in every setting, in every community. But these are the types of divisions I imagine are useful, but perhaps other people on the phone might be willing to share their experience in this regard. It’s not something I can advise on, unfortunately.

FASKIANOS: Thank you. Next question.

OPERATOR: The next question will come from Emily Judd with Yale University. Please go ahead.

JUDD: Hi. I’m just wondering if you could speak a little about the economic impact that you foresee the pandemic having on the world in general. I’m wondering, once the outbreak stops, can you speak to how long the economy will take to recover?

BOLLYKY: I can tell you what we knew from past epidemics and tell you why that may not hold in this current case. I don’t think anybody can really accurately predict exactly what the scope of the economic fallout will be because it relies on several unknowns that I’ll get to as well.

So in the past I will say SARS was estimated to have—this is a coronavirus outbreak, some of you may know, in 2002-2003 of a different coronavirus called Severe Acute Respiratory Syndrome—infected around eight thousand, killed around eight hundred in roughly thirty countries worldwide. It was estimated to have caused $30 billion in economic losses, which at that time seemed like a lot but will be considerably less than what we see here. In the SARS episode, affected countries rebounded quite quickly because at the end of the day most of what had been driving those economic losses were aversion behavior, so people foregoing economic activities, people foregoing services—health services or otherwise. And when the aversion behavior—in order not to get sick. So foregoing those activities in order not to get sick. When people returned to engaging in those activities, you saw a relatively speedy economic rebound.

The challenge we have here is both on the supply and the demand side, where, of course, many of the more meaningful countries from a manufacturing standpoint are within the G-7, including China, the United States, Germany, France, and so forth. That group of countries represents around two-thirds of the world’s manufacturing. It’s still that those countries and economies largely have been shut down. They’re not coming online at the same time.

China is slowly returning to activity now, but many of its markets for its wares are now heading into the peak of this epidemic, and people don’t know how long that peak will last. The length of disruption and the extent of disruption, and how globally distributed it is really is going to have some lasting impacts, not just on trade, and travel, and tourism, and restaurants, and aircraft manufacturing, but more broadly in terms of this level of disruption of the whole economy shutting down for a period of time. All that is to say, we don’t know. In past epidemics economic activity returned relatively easily, but there is some reason to believe that may not be as easily the case in this circumstance.

FASKIANOS: Next question.

OPERATOR: The next question will come from Bruce Knotts with Unitarian Universalist Association. Please go ahead.

KNOTTS: Hi. Thank you very much for your presentation. That’s very informative.

Just to say something about our denomination, most of our workers have been told to work from home, and most of our congregations are doing virtual services. My question is regarding— here in the United States we think something like 30-40 percent of the people do not see this as a serious problem. And in some cases, certain religious people think that there are certain prayers, or potions, or whatever that will make them impervious to the disease. How do you combat the doubts, whether they’re secular or religious, and persuade people to take the right courses of action to protect themselves and their community? Thank you.

BOLLYKY: Great. So tthis is not an easy question. As some of you may know, it’s come up frequently around the issues on vaccination in general and how to convince people to follow scientific advice. It does seem to be that historically where a lot of vaccine hesitancy spreads is amongst cohesive communities and groups. Not all of that is religious, of course. A lot of it is also just simply social groups where people trust the other members of that group more than they trust outsiders. So that can be groups around, in some cases, wealthy schools, in some cases religious communities.

We’ve had mixed success in terms of providing science-based, dispassionate evidence into those circumstances, trying to determine how best to engage those communities. In many instances it’s really relied to some degree on state and local officials taking a firmer stance on compulsory policies around vaccination. That has ended up being important. But that’s a difficult line to get to. Obviously you have to balance civil liberties, and public health. And this is something that goes back many centuries on the vaccination issue, and it’s going to come into play here.

So unfortunately, we’re in a similar situation. I do take hope that we really do seem to be at a moment now where many world leaders and leaders domestically, both on the state and federal level, are increasingly singing from a similar song sheet as to what the threat is of this pandemic, and the measures that people need to take to combat it. So that is hopefully starting to move us in the same direction, but I share you concern about the misinformation being circulated online, particularly amongst social groups.

FASKIANOS: Tom, this is Irina, just a quick follow up on that. Do you feel that the governors’ and mayors’ response now is the right move, with the curfews we’re seeing happening across the country, closing of bars and restaurants except for takeout, gyms, et cetera?

BOLLYKY: I do. You know, I agree with Dr. Tony Fauci, who said yesterday that overreaction is really the right reaction given current circumstances. I think there’s more evidence and modeling that comes out that suggests that that’s indeed the case. And you may have seen in the news Imperial College coming out with models yesterday around projections and increases in the U.K. and U.S. that are really quite striking and worrisome, that in terms of the capacity of our health systems to handle, even under the best-case scenarios, the surges that we’re going to see.

It is important that we act, just like the countries that have had a more successful experience with this outbreak, quite quickly and quite aggressively to try in any way that we can to reduce the spread of this outbreak, because really based on current trends the projections are quite dire. And anything we can do to try to forestall those consequences and stretch this out, even if many of us get this infection in the long run, we cannot all get it at the same time. So trying to slow the spread, slow people’s rates of infection is going to be really important. So I find what states and mayors are doing entirely appropriate.

FASKIANOS: Thank you. Next question.

OPERATOR: The next question will come from Prema Rahman with Muslim Public Affairs Council. Please go ahead.

RAHMAN: Hi. Thank you for taking my question.

So my question is, I know that we are very much worried about running low on test kits. CDC is unable to produce enough test kits right now to cover for the number of cases that we’re seeing. And I know that earlier in January they had rejected the test kits from WHO. Now, since we are facing this shortage, is there still a possibility for us, like, say those who are working with government advocacy or government relations, can we still call on our government or CDC to turn to WHO to request those testing kits again?

BOLLYKY: Great. So it’s a great question. So there’s no question the United States has been slow on testing. Some of the reasons we know. Some of the reasons haven’t been publicized as of yet. Like as in all past outbreaks, CDC moved first in terms of producing a test. They produced it in real time, within twenty-four hours of receiving the genetic sequence from China. That is what they’ve done in past outbreaks, and in many cases the world has relied on the diagnostics produced by U.S. Centers for Disease Control and Prevention.

For reasons that aren’t entirely clear, the test did not work in this case. What happened then is state and local labs, and academic labs started requesting the ability to produce their own version. As a general matter, the U.S. Food and Drug Administration doesn’t oversee laboratory tests. They do in an emergency, in terms of licensing. Tunahe Food and Drug Administration, for a period of time, at least five days, did not grant emergency use authorization to these state and local labs or academic labs trying to produce their own tests. That changed on February 29.

Last week FDA granted emergency use authorization to Roche to produce, say, automated tests that can be done at greater volume. There has been more of that coming. I think most people project by the end of the week the availability of testing to be ubiquitous in the United States. I think the bigger concern on testing is whether or not we have a sufficient supply of reagents, meaning the material that reacts to the presence of the virus, to really make all these tests. The issue we have at this point though is, again, most people think in terms of the modeling that there are probably multiple clusters of outbreaks in the United States. And that the current number of cases of, again, roughly five thousand—it maybe is tenfold or more off.

We don’t know exactly where all those cases are. So testing is going to be important in terms of identifying some of that. But it is no longer, given the spread, a panacea. We really need to shore up our adherence to these social distancing policies. We really need to surge more safely in terms of our health care capacity. In health centers, that means ventilators. That means personal protective equipment. That means starting to, and this is happening, adapt the polices that can keep health workers safe. We’re starting to take measures to protect residential care facilities, to reduce any nonessential international with residential care facilities. All these things are happening now.

So testing will be an important part of this but given where we are in the projection of the outbreak, I don’t want to oversell it in terms of that. We’re really at a later stage, where we have to have all these other measures and moving on those inplace. But in term of the availability of the test, most people think by the end of the week it’ll be fairly ubiquitous at this point. In terms of the World Health Organization, I’m sorry, just to remember your point there, they have produced their own version of the test based on research done in Germany. A number of countries, like South Korea, had adopted it. That test worked, and that’s why those countries were able to roll out testing at a greater volume faster.

 FASKIANOS: Next question.

OPERATOR: The next question will come from Mohamed Magid with the ADAMS Center. Please go ahead.

MAGID: Yes, sir. I heard in the news that people are lining up in front of gun shops, buying guns. What aspect of security and unrest this might lead to if things become more complicated? That’s number one. Number two, what kind of communications strategy that faith community can be part of it to calm down the nation and to address the issue of mental health, because I do believe by people being confined in their home that long, issue of mental health, domestic violence, all this might increase.

BOLLYKY: I agree the federal government has asked for a fifteen-day period of social distancing policies. I think most people think twe will not be at the peak of this outbreak in fifteen days. So this may go on for some time. So the issue of mental health, and isolation, and loneliness is going to be important. And providing health services, to the extent we can, remotely to those populations is going to be really important. But frankly, this is a group in particular that’s going to play such an important role in that response to the communities that you serve. And that’s going to be incredibly important moving forward. And again, CDC guidance gets at some of this, and we’re happy to share it. But it’s a really valid concern because we do want to address those needs and, of course, ensure that they’re being addressed constructively.

FASKIANOS: Next question.

OPERATOR: The next question will come from Azhar Azeez with Islamic Society of North America. Please go ahead.

AZEEZ: Hi. Thank you so much for arranging this call and thank you so much for all your responses.

A quick comment before I ask my question. There is this National Muslim Taskforce that has been established with prominent national Muslim organizations and medical experts, organizations such as Islamic Medical Association of North America, American Muslim Health Professionals, Islamic Relief USA. All these wonderful organizations are taking the lead to educate the community and the masses. And I can very comfortably say at least 75 to 80 percent of Islamic Centers have been shut down, and they have substituted all therei congregational activity.

Having said that, I just want to ask you: There are a lot of people who are returning back from their vacations and overseas trips. And they are facing a lot of hardships at the airports. Sometimes there are long delays at the airports, which is exposing them to individuals who may have some sort of infection. So what are the steps that have been taken to address this issue at airports

BOLLYKY: So around the announcement last week—the days feel like months at this point—but last week the announcement of restrictions on travel from European nations, which subsequently will be extended to the United Kingdom as well. As you know, since it excluded there were U.S. citizens, there were quite a few people that tried to come home around the same time. There were media reports, that I’m sure you saw and that you’re referencing now as well, of long lines. The announcement was that they would increase the number of screeners at airports to handle that, because of course crowding people together in airports is not very good infection control either.

Other than the statement by the federal government that they would reduce the number of screeners—I unfortunately don’t have any further information about how that will actually manifest in practical policies beyond that announcement. But I’m happy to look into that and share anything, through Irina, that I can.

FASKIANOS: Thank you. Next question.

OPERATOR: The next question will come from Marina Bühler-Miko with St. Alban’s Church. Please go ahead.

BUHLER-MIKO: Yes. Hello. Good morning. I wanted to make a personal comment before I ask my question. I think I’m the only one on this call that actually has this virus. And I got it from the Episcopal community, which as you may know shut down the National Cathedral and its schools right away because one of the churches rectors had it. And I think I caught it from a gathering we had there a week ago Saturday. So as I start to get better, it hasn’t gone into my lungs. So I guess it’s mild, but I’m very, very tired. Anyway, I hope they start to tell us, those that are recovering, what we can do and whether they know whether it’s going to recur and whether we build up any immunity. I’m waiting to hear about that.

My other question refers to the part of the world that I’m very interested in. And all they do is talk about Russia and oil. I’m wondering what Russia and the former Soviet Union, what the data is coming out of there? And having worked there in business, I know how poor their health facilities are. So like the man from Iran and the people concerned about refugee populations, what’s happening in the former Soviet Union and the various republics there? So those are my two questions.

BOLLYKY: Great. Well, on the broader issue, I wish you a speedy and full recovery. As smooth of a convalescence as possible. So get well soon.

In terms of what the NIH stated yesterday or Dr. Fauci in particular, for people that are infected, those that do recover, what they’re looking for is really two negative tests within 24 hours to confirm that recovery. In terms of the emerging information—and, again, this is just reporting what’s emerging. It’s a novel virus. After an initial sense that the contrary might be true in terms of people having full recovering or whether they actually cleared the virus from their system, the best evidence that I’ve seen emerging so far is that it does seem that they do. So you should rely on CDC. The best scientific and medical evidence that I’ve seen emerging, it seems to be that the virus is cleared by those that have had it, but again you should check frequently with your physician and the CDC on that.

In terms of Russia, after reporting almost no cases the number of cases do seem to have been increasingly rapidly over the last couple days in Russia. As of this morning, and it may have shifted since then—Russia is now reporting close to one hundred cases, after reporting, again, virtually none just a short time ago. So the number of cases does seem to be increasing. I saw some reports, but frankly they emerged today and I haven’t read them—about what this might mean in terms of updating the constitution there, or political changes adopted in response. Again, those are just a headline I saw, so I don’t want to mislead that I’ve had a chance. As you can imagine, the news comes in an avalanche, and unfortunately other than the case counts of what’s going on in Russia I don’t have a clear sense, other than I know people are concerned about what this might do to the political situation there.

FASKIANOS: Thank you. Next question.

OPERATOR: The next question will come from Shaik Ubaid with the Muslim Peace Coalition. Please go ahead.

UBAID: Thank you for this information conference call and also from the speakers.

There are three points that are very important for the faith community. One is to be proactive. We have already suffered inaction by the Trump administration. We will be needing a lot more ICU beds and ventilators. So the faith community should put pressure on the government to do that. The other thing is the faith community should also be countering the conspiracy that China or Russia is behind it, or they say that U.S. was behind it, because the trust element has to be very important for people to maintain this social distancing, because this virus most likely will be with us for the next few months, at least.

And the third thing is, there should be some pressure on countries and organizations. For example, I was disappointed when the pope sort of pushed the churches in Rome to reopen, which was not the right thing to do in Italy. And also, the ruling party in India, its members are asking—with a huge population with such bad reporting coming from India—about using cow dung and cow urine as medications. So that will be impacting the whole world. So we have to be aware of this factor so that we are ahead of a mini crisis that will develop between this major crisis.

BOLLYKY: Great. I mean, I certainly think being ahead of this crisis is going to be important. Relying on public health authorities and the best available scientific evidence to shape the policies that are going on in religious, faith-based communities are going to be important. So in terms of the broad themes of what you mentioned, I think those are worthwhile themes for us to remember moving forward.

FASKIANOS: Thank you. Let’s see if we can get in one or two more questions.

OPERATOR: Thank you. The next question will come from Satpal Singh with New York University. Please go ahead.

SINGH: Hi. Thanks for taking my call.

And one may think that those people who are undocumented may not approach the health-care system, even if they have some symptoms of apprehensions of being deported. Similarly, people who don’t have health insurance, they may not come forward simply because they may need to have some expenses involved. So what would be the effect of that? That seems to be very concerning, because not only for their own health but also for the spread. So that’s one thing. And the second thing comes out of your mention of the Imperial College earlier. And I know that they recommended something like twelve weeks period of isolation for the elderly and the vulnerable. Has there been any further analysis on that? Thanks for taking the question.

BOLLYKY: So I’ll apologize on the second question. I don’t know, Irina, if you caught it all. I didn’t catch all of the second question. Would you like to repeat it, please? Or, at least the last part of it?

SINGH: OK. So basically that the study that came out of the Imperial College, that you mentioned, I think the British government based on that study recommended that the elderly and the vulnerable should isolate themselves for twelve weeks period. So I was wondering if there is any further analysis on that.

BOLLYKY: Great. So in terms of the length of time, I think most modeling that we’ve seen is twelve weeks is prudent. I think an optimistic scenario in the terms of the modeling that’s emerging is for the U.S. context at least, and perhaps for the U.K. as well, is mid-May or June as an optimistic scenario for looking at a peak. Again, this is going to be information that is still emerging, but in terms of the best modeling I’ve seen around that, that’s going to be important. And particularly for the elderly, to try and stay safe during a bad time, and supporting their need to do so is going to be important. So I think that’s sensible. And, as you know, in terms of the federal government, they really have announced a need to reduce any visits to residential care facilities, except those that are absolutely necessary. So that’s going to be important.

Irina, remind me the first question?

SINGH: Do people who may have serious symptoms but may not approach any health-care system without fear of being deported.

BOLLYKY: Yes, thank you. Great. It’s going to be incredibly important the undocumented, homeless populations, and so forth, be able to identify—or, we are able to identify within those communities people that have the virus and either need to be isolated or, in some circumstances, require medical treatment. There was an announcement made in terms of not enforcing, for those presenting for tests, immigration controls. But I will get you the formal policy because, again, something that’s reported on in the press. And I want to make sure I’m getting you a federal link before I tell you to advice your communities on something like that. So that’s another one that we will add to our list to circulate. But there had been a press announcement that a policy would be made around the undocumented and getting access to testing. But I will look for and circulate any federal link that we find. It’s important to make sure that you rely on that source.

FASKIANOS: Well, with that, I think we’ve come to the end of our time. And I know there are many more questions in queue. I apologize that we can’t get to you. But we will be standing up more calls on this topic. It’s going to be with us, unfortunately, for weeks, months to come. If you do have a pressing question, you can email [email protected], and we can see if we can get you a written answer to it. Tom Bollyky, thanks very much for being with us today. And we know—I know that you are getting in demand, and we appreciate your taking the time to be with us.

BOLLYKY: It’s my great honor. And I’m happy to be helpful. If people want to reach out to me either on Twitter or through CFR—see my profile on CFR, please do so. I want to be helpful to the extent we can. We are getting a lot of inquiries, but I’ll do my best to get to yours.

FASKIANOS: Right. And we can streamline those questions into one document for answers. I encourage you, again, to follow Tom Bollyky’s work on global health on Twitter at @TomBollyky, as well as go to GlobalHealth.org for more information about COVID-19. You know, you can also follow us on Twitter at @CFR_Religion for announcements about upcoming conference calls, et cetera. And as Tom said, we will circulate resources, trusted resources that you can refer to yourself and share with your communities. So in this time, let’s be kind to each other, try to stay well, and we will continue the conversation virtually. So thank you all.

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