Corona Virus (COVID-19) discussion with Bill Gates

Hi everyone! Welcome to the Khan Academy daily homeroom. Sal Khan here — thanks for joining us. We have a pretty exciting show, I guess, today. For those of you all that this is the first time you're joining, the whole idea is in this time of school closures, we at Khan Academy are trying to make sure that you have the resources needed to keep learning, that you know how to use those resources, and that we have ways to stay connected in times of these closures.

That's why we're doing these webinars and these live streams. I do want to highlight, as I always do in these seminars and live streams, Khan Academy is a not-for-profit with the mission of providing a free, world-class education for anyone, anywhere. We were running in a little bit of a deficit even before this whole crisis struck, but now we're seeing our traffic is 3x of what it normally is. So any support is super valuable.

I want to give a special thanks to several corporations that have stepped up in the last few weeks in record time: Bank of America, followed by AT&T, Google.org, Novartis, and many of you have also helped donate to help close our gap. I encourage everyone, whether you're watching on YouTube, Facebook, or any other platform, to post questions on the message boards. We have team members who will surface questions, and I can ask Bill those questions over the course of our conversation.

So Bill, great to see you! Maybe a good place to start is how is the situation affecting you personally? How's the social distancing, and where are you spending most of your time?

Bill Gates: Well, I think everyone's lives are almost completely upended. You know, the normal things I do, talking about polio eradication, going into meetings at the foundation, traveling to meet with scientists — that's all gone. You know, when I wake up in the morning, I think, was this a nightmare or are we really in this almost different world where coronavirus is the top priority? We've got to get this thing under control. I'm doing lots of online meetings; I use Microsoft Teams for those things. I don't get to see many people beyond my family in person, so it's a huge adjustment. Yet, there’s so much to be done. It's not like I'm not busy.

Sal Khan: And where are you spending most of your time? Is it around the virus work?

Bill Gates: Yes, that’s… our foundation works on infectious diseases. We're the biggest funder of vaccine work. We understand how to make vaccines in volume. We do the disease modeling, and so the skill set we have, understanding the private sector, being able to work with governments, and knowing what regulatory things should be maintained for safety but which ones, because we've got to move so fast, should you go around… You know, and talking to leaders, discussing with Tony Fauci about how do we make sure the public is seeing this in the right way.

We explain why it takes so long for a vaccine, which is such a key thing to understand. Until we have that, we can open up a bit, but we won't go back completely to normal. We're orchestrating all of our partners around getting the testing right, getting the drugs right, and getting a vaccine, which will bring us to the end of this.

Sal Khan: Yeah, no, we're going to talk more about that. Actually, the first question I want to surface is from Facebook. Abid Sheikh writes, "Hello, since you predicted about a similar outbreak in the 2015 TED Talk, how did you react to the news about the COVID-19 pandemic?"

Bill Gates: He's referring to, famously, for anyone who doesn't know, I made a talk in 2015 that essentially was very prescient of the situation we're in now. I wrote a New England Journal of Medicine article that really went through the specific things like high-speed diagnostics and vaccine platforms that we needed to fund. This is certainly a case where being able to say “I told you so” is not at all gratifying because this is a horrific disaster. In my lifetime, whether it’s health or economics or just uncertainty for people, there’s nothing like this.

The goal there was to get governments to step up so that you could easily make a new RNA vaccine or you'd have the testing capacity very rapidly. I'm sure that because this is so widespread that next time we will have made those investments, but it's unfortunate that very little got done.

Our foundation, Wellcome Trust, and a few others did fund work along these lines, but not enough. So here we are.

Sal Khan: And give us a sense of where we are right now. We could talk a little bit about maybe what could have or should have happened, but where are we now? What’s your analysis? How bad is the situation in the U.S.? The rest of the world? How close are we to peak? How's it going to play out over the next few weeks or months?

Bill Gates: The concept of exponential growth is not that intuitive to people, but when you have this human-to-human transmissible respiratory virus, it creates exponential growth. Each case leads to say two or more cases. So if we hadn't changed our behavior, there's no doubt the majority of people would be infected and you’d get this huge overload of the medical system and literally millions of deaths.

The reaction — whenever you’re going to stop something that’s exponential — the sooner you act, the better, because then you can act in a way that you don’t overload your hospital systems, and you can treat the cases very, very well. Testing is key to know where the spread is and to inform people that they need to really isolate themselves.

The PCR test can actually see the virus before you’re symptomatic, before you would be transmitting to people. If we had the testing right prioritized, that would help with this. By the end of the month, with any luck, we’ll start to see the curve level off, and then in another month, the number of cases would come down. You could get to a point where, because you're targeting the testing and giving quick results, you do start to open up in a way like China has, where kids go to school, people go back to their jobs.

It’s not normal in that they don’t do sports events or big gatherings; that will wait until the vaccine. But we’d like, if things go well and the numbers will drive it, to see that ability to open up somewhat by ideally early summer.

Sal Khan: Are you all seeing evidence that the social distancing is working, that we are on track to peak in the next few weeks, and then maybe in a better state by the end of May?

Bill Gates: Well, China had in Hubei province over 80,000 cases. You know, that’s the model where they intervened in a very dramatic way. They enforced their quarantine very strongly, they did their contact tracing, they used testing; people would get testing results very quickly. It was the right people. They are now able to open up. South Korea had a reasonable number of cases, but they did the testing, did the tracing, and now they are in a situation where they’ve definitely bent the curve.

There are a few countries like Taiwan who did all the right things and never allowed the large numbers to develop. Unfortunately, for most countries, we can’t go back and change the fact we missed that early opportunity. Yet, there are communities where we are starting to see the numbers peak because of that social isolation. So that’s the first step — is that peak — but you don’t open up until they’re in an absolute way below like a factor of five from where they are today.

Sal Khan: Just from us, I don’t know from either an economic or scientific point of view, why do we see this disparity in testing or even the types of tests in the U.S. right now? Even if you’re lucky enough to get a test, it could still take several days to get a result while I’ve heard stories in Taiwan three months ago that you got your results before you left the airport.

Bill Gates: The very sensitive test is the polymerase chain reaction (PCR), where you make the primer specifically for this virus. It’s an amazing test, and there's a lot of machines out there in commercial labs, academic centers, and public health labs that we were slow to get all going. Even today, we're not completely taking advantage of that.

If you make sure you’re testing healthcare workers and don’t let the queue get very long, you’re testing contacts and people who test positive — that really guides individual behavior and broad behavior. In the U.S., we actually have more of those machines per capita than South Korea or anyone else, so it should be possible.

There isn’t a set of criteria, though, that stops somebody who’s not symptomatic from getting in the queue and testing themselves every day just because they’re worried, versus that healthcare worker. We do need to bring a sense of prioritization and not let these queues mean it takes too long to get the results back.

Sal Khan: Are you hopeful that’s going to change over the next couple of weeks?

Bill Gates: Yes. There's a lot of discussion about it. You know, the notion of okay, does the federal level really jump into that? Which agency has the right expertise to be able to do that? And so, I think that is likely to improve in the weeks ahead.

Sal Khan: And your prediction of hitting a peak in the country in a few weeks. One question I’ve been curious about is, you know, places like California. I know in Seattle and Washington we’ve been in some form of a stay-at-home policy, stay-in-place policy, lockdown policy for about three weeks now. And you know, the quarantine time is typically two weeks. Why aren’t we seeing the peak cases sooner? Why is it taking so much time?

Bill Gates: Well, there’s the lag of, you know, once you do the shutdown, you need to go, you know, at least maybe two infection periods before you’d really expect to see things going down.

Also, we weren’t doing enough testing, and now we’re seeing a higher percentage of what’s actually out there. But the actual numbers for California and Washington are very hopeful. The New York numbers continue to go up; we have cities with explosive growth, like Detroit and New Orleans. However, there are early signs that our changes have made a difference.

Our lockdown is not as extreme as those in China, but it should be enough in the places where there’s strong adherence to get to that peak. I’d say we’ll see, in some locales, in the next few weeks, we'll see that. For the country, at best, it would be the end of the month.

Sal Khan: What’s your sense of why New York has had such a tough situation? They’re in a lockdown situation now. Is it just the nature of the density of people, or is there something else going on there?

Bill Gates: Well, the international travel into New York is more than anywhere else, and the density is more than anywhere else. There’s some degree of bad luck when you’re dealing with exponentials; just a few cases here at the front of the exponential can drive a big separation between place A and place B.

You know, the governor there is stepping up and getting the modelers to help him understand what’s going on, enforcing their lockdown in a pretty serious way. Hopefully, the deaths are another lagging indicator because those are people who were infected 18 to 20 days earlier.

We really hope that New York peaks because they are near the breaking point for their medical system.

Sal Khan: And you know you’re one of the world’s experts, and you’ve worked with many of the world’s experts on things like vaccines. Obviously, there’s a lot of talk about a vaccine. I have a question here from Facebook. Siam Kumar asks, “How long will this vaccine take time to come to market?”

Bill Gates: Actually, I’ll add a second question to Siam’s question: how long and how effective will it be? I know the influenza vaccine is famously not 100% effective and it depends from year to year.

That is super important here. We only have one strain of the coronavirus, so we don’t have the same shifting we see in flu, so that makes it an easier target. The foundation works with the greatest funder of vaccine work. Of the 100 or so efforts out there, there are about four that use a new approach: DNA and RNA. They’re getting that going.

If that works, if it’s safe and efficacious, including in old people, which is super important here, those will be done first. Then we have four others that are more conventional techniques, but the risk of them not working is lower.

We’re funding the manufacturing capacity and the safety and efficacy of all eight of these at full speed because governments, in a few months, their money will really start to flow, but they’re a little bit slower, and they don’t really understand which of these organizations have which capabilities.

You saw Moderna, which is an RNA vaccine, actually going to phase one safety trials last month. They were the first to get to that milestone. We need to back all the eight leading candidates because some won’t be safe, some won’t be effective. We’re saying to people it’s likely about 18 months because of the scale issues.

In the best case, yes, things could be done before then; in the worst case, it would take longer. This is super important because until we have an applications vaccine that the entire world has had the benefit of, we will not go completely back to normal.

That is, large gatherings — even if we've kept the cases under control — schools are open, people are going back to their jobs. The risk-benefit ratio for large gatherings is not strong enough because you could get a super spreading and a bit of a rebound.

Getting that vaccine for the world is critical. The world doesn’t have a product creation standard from WHO about standards from Marmot Green, so we’re trying to step up and say, okay, let’s fix this for the entire world. Individual countries will try and get the supply allocated to them, but only by having seven billion doses do you really solve the problem.

Sal Khan: We have this question from Mile which Bergman on Facebook, which I think everyone is wondering about - just life until we have a vaccine. I'll add a little bit to it, which is, you know, this world you’re describing — even in a good scenario, we might be able to normalize in places in like the United States by June, but it’s not even full normalization. The vaccine’s 18 months away.

As we go back into the fall, it might pick back up with the seasonality. What are the economic implications? Because you talked about large gatherings, sporting events, concerts, but even I can imagine people’s behavior. Restaurants won’t normalize for a very long time.

How do you see this playing out economically?

Bill Gates: Well, this will be the biggest shrinkage of GDP in any of our lifetimes. There will be businesses like restaurants and tourism things that will be dramatically affected. Yes, the opening up — most jobs and school, like in China, should be able to resume in rich countries that do the right things by this summer.

By then, we ought to have an additional type of testing, which is a lateral flow rapid diagnostic test that is very quick. We ought to have large numbers of those, so that broadly we don’t have to triage quite as much in terms of that testing capacity.

There will be types of activities that people will be conservative about, even if the authorities, you know, if the model say that those risks are low — most people will take a while to get back into the "let’s go take a vacation, let's buy a new house" type mode.

The economy will be less vibrant in lots of sectors, so this idea of how much government help can there be does that eventually cause huge inflation? We are in uncharted territory in terms of how we minimize that. The economy will come back once you get that vaccine out there and people's mindsets return.

Eventually, the economy will be bigger than it was before we got into this, but the shrinkage we’re seeing in these few months is completely unprecedented. There are human lives behind that.

Sal Khan: There’s a ton of questions that have come through on various social media. From Facebook, Candy Westin Burkham, Facebook, Greg Roman — a lot of people are asking, Kimberly Bizac: Why aren’t we having just a really hardcore shelter in place nationwide? And I’ll add that question, maybe make it global.

How do people balance — I’ve heard the argument that the economic harm could cause a lot of deaths too. You could imagine in places like India; I’ve been monitoring some of the news there of folks who, with the shutdown, they have no livelihood and they don’t know how they’re going to get food.

That’s happening even in the U.S. So how do you weigh those tensions, and what do you see as the dynamics that’s keeping us from a really serious shutdown versus some of the more scattershot things that have been put in place?

Bill Gates: Well, whenever you do shutdowns, you always wish you did them a bit earlier. You know, we should do this nationwide because we're not going to partition the country into separate blocks. We need to get going on that. Your point about developing countries is a very important one because people live in slums where they’re close to each other. They have to get food every day.

In rich countries, we’ll be able to maintain food, electricity, sewage, and garbage through a several-month period. There will be incredible hardships, but there won’t be a shortage of food. We shouldn't see civil unrest coming out of this in the developing countries.

You’re just not going to reduce social contacts as much, so the likelihood that you can, you know, really bend that curve and get to a small number of cases may not be possible in developing countries. I'm very worried about the developing countries. Their health capacity is much less.

The total number of cases, say in Africa or India today, is not gigantic, but we are starting to see it grow. In the end, it looks likely there will be more damage, both in terms of deaths and economic damage, in developing countries than in the rich countries.

Sal Khan: There are a lot of questions that have come in on, hopefully not — I mean, it’s a very dystopian reality that we’re finding ourselves in. But what you've articulated is, in some ways, a hopeful scenario where we are able to shut down, we are able to surface in the summer. Do you see this flaring back up in the fall? And what do you think just life’s going to be like for the next 18 months? I guess it’s just going to be at this weird new normal.

Bill Gates: Well, the next two months, hopefully we get that cases down and have… We’re so good at that point of quick turnaround testing, contact tracing, testing that we have been. Some ongoing measures like no big public gatherings, spacing. Will masks be part of that? We don’t know.

We’re trying to do the experiments to see how much that reduces transmission. China is using that, but they’re also using temperature tests. We’ll see how effective that is. We don’t know how seasonal this virus is. If it is seasonal, then we'll start to see the benefit of that and reduce the force of infection in the northern hemisphere over the next few months.

Sadly, that would mean the southern hemisphere would be going into the strong season right now. The assumption is that it’s not very seasonal just because that’s kind of the worst-case assumption, and these measures can help us even if it’s not seasonal. If it is seasonal, as you say, our vigilance will relax a tiny bit in the summer, but it will have to go back up in the fall.

Sal Khan: And a question from Greg Roman on Facebook: How will humanity change as a result of this?

Bill Gates: Well, you know, I never lived through anything this dramatic. The Great Depression changed humanity. World War II changed humanity. You know, the 2008 recession to some degree changed things. This is much bigger than that 2008 thing or anything that I’ve ever experienced, and so it’s hard to predict.

There are simple things like will people take fewer business trips? Will people, you know, be afraid of foreign travel? I am concerned; will this drive us together within the country and across countries to solve a global problem like this or will it have a say, okay, we just need to hunker down and just, you know, isolate at various tribal or national type levels?

I see the cooperation of scientists globally, enabled by these digital connections, is phenomenal. You know, we did the genetics on this virus very quickly; that was very informative, and testing understanding in many countries got going very quickly.

We are very much in uncharted territory, and so the fact that I saw this as a risk doesn’t mean that I understand the broad, deep effects, many of which are sadly scary and potentially negative.

Sal Khan: And that kind of goes to this question. It's actually a more personal question from YouTube. Marconetto is saying, "Hello Sal and Bill. As a teen who's trying to make a difference, what are your tips on maintaining a focused environment, staying productive, and prioritized during this hectic and uncertain time?"

Bill Gates: I think it's a great time, mostly digitally, to talk to your friends. Understanding the stress and uncertainty it’s causing for them. Thank God the Internet looks to have the resilience that it’s a tool for us to constantly see what’s going on, to have these collaborations.

You know, the foundation meetings are always virtual, so I’m learning about the rooms that people have in their houses and their cats jumping up on their desk. It is a chance where you can learn a lot. Thank goodness that the online tools, Khan Academy, and the lead there, there are amazing materials.

How do you develop that discipline? What does your day look like when you’re not able to go out as much? This is — there’s some tough adjustment. Ideally, people would get a rhythm of okay, I’m online doing serious stuff. I’m watching videos to relax and entertain myself. I'm going to connect with some friends that I regularly connect with digitally.

I do think in the next couple of weeks, although there’ll be immense tension, we will fall into a pattern. There’s no reason that learning, at least for those who have access, shouldn’t go on or even to some degree intensify. The fact that some students don’t have access, even here in the United States, and some districts are, therefore, saying maybe they shouldn't do anything that is going to create disparities.

You and I have talked about this in the fall. How do we help get students who’ve lost the entire three months? How do we encourage them and really allow them to regain that material? I mean, losing three months of learning, you know, there’s a huge cost to that. It’s hard to put a dollar number on it, but no matter what grade you’re in, it’s a huge setback.

Sal Khan: And one last question maybe I’ll throw in too. You know, we talked about a likely scenario. I’m almost afraid to think about a worst-case scenario. You know, there’s possibilities. I mean, I am curious, do you think we might have shutdowns again in the fall type of scenario? But also, I’d love to finish up on: is there a silver lining to this? Is there something that you’re hopeful of that might come out of it? Some people say you should never waste a good crisis. How are you thinking about that?

Bill Gates: Well, part of the reason our foundation has been funding these new diagnostic tools and vaccine platforms is that they’re useful not just for the pandemic threat but also for diseases like tuberculosis, HIV, malaria that we've got, and so we’ve been funding these things for over a decade. They do look promising, both for coronavirus and those other things.

I will say that, you know, the thing that we didn’t act on five years ago when the danger was clear, this time governments will act on it. We will get the right tools in place, and the resources of society are dramatically less than what we spend, say, on the military to be prepared for that eventuality.

Hopefully, some families are drawn closer together. The idea of volunteering to help out people, giving philanthropically — you know, we’re all in this together, even on a global basis. This event will be something you think about for the rest of your life, how you responded to it as a defining thing.

I’m seeing many people rise to the occasion to help out others or to use their skills to try and bring this to an end.

Sal Khan: Oh, thank you so much! We could obviously talk for hours. I’m sure many people would love to hear — we could tell there’s just so much more that we could learn, especially about the virus. But thank you so much, Bill, for joining us. This was a real treat!

Bill Gates: Great to talk to you, Sal.

Sal Khan: Thank you, so thank you everyone for joining this live stream. I think we all learned a lot today. I hope that we can have future live streams where we can, as I’ve talked about in previous versions, talk about whether it’s the pandemic or how do we keep learning, how do we deal with kids at home who might have trouble staying focused.

Regardless, thanks for joining. As Bill just mentioned, the silver lining behind all of this is that this is a bit of a shared experience for all of humanity. As stressful as it is, the more that we can stay connected, I think the more it'll help all of us get through this. So, I will see you on Monday!