Brian Lehrer: Brian Lehrer on WNYC, and now we turn to look at some dramatic trends in the COVID-19 pandemic around the world that could offer lessons for here. In Israel, a second national lockdown has begun as that country is the first developed nation to shut down non-essential businesses again, to stem occurrence spike. What happened and what can we learn?

In Madrid-Spain, nearly a million residents, in certain working-class neighborhoods mostly, are now forced to stay in their districts for the next two weeks, according to Agence France-Presse. That's also a reversal after opening back up. What can we learn from Madrid?

In India, a nation of 1.4 billion people, they've had more than 5 million cases and 88,900 deaths. According to the World Health Organization, there are now more new daily cases than in any other country, which was not true at first in India. How did it start spreading more quickly there, and are there lessons for others from that?

We'll also ask the Centers for Disease Control, coronavirus aerosols question, which has implications for how everybody lives. Joining me now to discuss all of this is Ramanan Laxminarayan, economist, epidemiologist, and founder and director of the Center for Disease Dynamics, Economics, and Policy.

Thank you so much for coming on. Welcome to WNYC.

Dr. Ramanan Laxminarayan: Thanks for having me, Brian.

Brian: Can I ask you first about the CDC flip-flop? Have you been following that? On Friday, they warned everybody officially that not just the big droplets, but the little aerosols can linger in a room over some period of time after people have been talking or singing or breathing there, and then yesterday they took that down. What's the real science, and what do you see as the politics, if you have an opinion about that?

Dr. Ramanan: Well, it was extremely confusing but not inconsistent with the way public messaging has been happening on COVID in the United States. The community that deals with this, the environmental engineering folks, people who study how droplets are formed or how long these aerosols stay in the air, have been saying for a while that it's not just droplets. It probably is likely that these particles aerosolize, and they stay around particularly in indoor spaces where there's also the potential to infect a lot of people all at one go. We know that also from the early transmission events of COVID, which happened in restaurants or one ski resort in Austria, which resulted in most of the COVID cases initially in that country, but this is the way it happens.

Now, CDC has always stayed away from this. It was surprising and welcome to acknowledge that they would say something probably even stronger than what WHO says. WHO says, we're not going to rule out the aerosol transmission, and we think that we need to study this more. CDC went from saying, well, this is not an issue, to saying, this is really one of the ways in which it's going to be a common mode of transmission, and then of course, as everyone knows, on Monday, they just backtrack completely and took that guidance down. Who knows what's going on inside? It obviously has implications for opening up restaurants if we go with the line that aerosolization is happening, and that's a mode of transmission, but it probably runs counter to a narrative that it's safe to open up the economy, which seems to be what the administration is pushing.

Brian: What are the implications for personal behavior? If people are confused, and people are uncertain, and people want to be safe, if they assume that the more aggressive interpretation of the science is accurate, and they want to just live their lives assuming that the aerosols can give them Coronavirus, what does that mean people should do in terms of individual decisions?

Dr. Ramanan: I don't think it's very different from what we had before, which is avoid indoor spaces with lots of other people, and definitely avoid being in those spaces without a mask. That goes without saying. In general, indoor spaces, whether they be restaurants, places of worship, classrooms, a lot of people in one space puts a person at risk for either transmitting the disease or receiving one.

This is now in the public mind. I think people get this now, and this is what we need to stay with. It does have implications for opening up of schools and colleges, and certainly having people in close proximity, even in outside settings, like stadiums, where there are football games. Broadly, I would say just don't get together in places, if you can keep the distance going. Preferably gather outside with that distance, but definitely don't have large gatherings indoors.

Brian: My guest, if you're just joining us, is Ramanan Laxminarayan. He's an economist, epidemiologist, and founder and director of the think tank, the Center for Disease Dynamics, Economics, and Policy in Washington. Now we're going to dart around the world to certain countries that have dramatic developments in their COVID-19 epidemics or part of the pandemic. We're going to talk about India first, and I want to invite listeners with ties to India to call in now, what are the particular challenges in India as you see them? What are you hearing from people back home or back there, whatever your relationship to India is? Is the government helping? Call us in to us 646-435-7280.

After that, we'll go to Israel and Spain, which are having second wave lockdowns in more industrially developed countries, and see if there are warnings for us about how we should reopen or not.

Tell us about India. Some listeners may remember that early on, India preemptively locked down for three months. Can you take us back to that first lockdown and the immediate impact on the virus that it had?

Dr. Ramanan: Sure. India got a first few cases from people evacuated from Wuhan in early February, but really the cases substantially started growing only in early March, which as people will remember, was later than when there were outbreaks in the United States. By March 24th, when the first major lockdown was announced, and this was a lockdown which literally applied to every corner of the country, no one was exempt, no institution was exempt, the trains, which have never stopped running since they were introduced in the pre-colonial days, the train system was completely shut down. It was described as the harshest lockdown of the world, and that came at a time when India had about 500 reported cases and fewer than 10 deaths. This was March 24th, midnight, the lockdown was announced with four hours' notice.

People had no opportunity to prepare. There were migrants who couldn't get home, people who were stuck in someplace or the other, and the advice was shelter in place, which is a little hard to do if you happen to be in a place that's other than where your normal place of living would be. It was tightly enforced because it was recognized that India was at particular risk for COVID, being a large country. India is about four times the size of the US in terms of population, but in an area which is just about a third of the size of the US, so it's about 12 times more dense in terms of population than the United States.

The disease would have just ripped through a country with less than ideal public health systems, and would have resulted in significant casualties and overrunning of hospitals. People were watching what was going on in Spain, Italy, France, the UK, and also in New York back then, and the call was India really can't afford it. That lockdown ended up going on for three months, although with progressive easing, but not a huge amount of easing, but we're now in a situation where the lockdown has been easy to some extent, but even today, the trains don't run in India. Most flights are empty. There are very few flights that run. It's actually not that easy to get around, and there are periodical local shutdowns. A local jurisdiction might just say, wait, just for the next three days, we're going to shut down everything. We're going to have a local lockdown.

India has not really fully emerged from that lockdown, which was imposed on March 24th, and it's now over six months later, and it has been devastating for the economy, but as you noted, the cases keep climbing, but that was never a surprise. India is a large country, and this was always going to happen.

Brian: Let's take a phone call. Nathan in Westchester, you're on WNYC. Hi, Nathan.

Nathan: Hey, Brian. Excited to be on your show. Long-time listener.

Brian: Thank you for calling.

Nathan: I maintain pretty close ties with India. I have all my family in India. I visit often. My sister is a doctor. I hear about this pandemic a lot from her. One thing that we have noticed, that lot of people who contract this disease, they die pretty quickly. From the time they start feeling sick, four or five days later, they are gone. This creates a huge shock for the family. A very little time to react to the situation.

Brian: Since your sister is a doctor, has she conveyed any impression to you about whether that's different from in the United States, because they don't have the means to treat people in the same way, like our guest was indicating before, or anything like that?

Nathan: The rate of mortality actually is much lower in India, that's why I hear. That masses are contracting, but not a whole lot of people are dying compared to the numbers that contracted. The strange thing is that people who die, they die pretty quickly after they contract this disease. This is a big difference that she mentioned most of the times.

Brian: Nathan, thank you so much for your call. I appreciate it.

I'm going to go right to another caller, Gary on Long Island. You're on WNYC. Thank you for calling in.

Gary: Hi, Brian. Long-time listener. I love your show. Thank you for having me on.

Brian: So good to have you.

Gary: Thank you. I born and brought up in India, New Delhi, and I have two sisters still living there. One of my sister, my older sister, they lost their businesses because economy is so bad, because health care system is bad in India, and government is not doing anything for the people. In America, when you're sick, you have emergency, you go to the hospital, they treat you, then they bill you for that. In India, if you don't have a money in your pocket, you can't even enter the hospital. Is that bad in India.

I heard stories every single day from my sister, my friends out there. If their relative or somebody gets sick, if you don't have the money in your pocket, you cannot go to the hospital.

Brian: That's on the devastating health side. You also told our screener you wanted to say something about your sister losing her job and the economic situation?

Gary: My sister lost-- They used to have these two great businesses in India. They used to sell bikes, motorcycle in India, and they have this service station and everything. They lost their employees, because they cannot pay them anymore. Nobody's buying bikes anymore, and they lost their businesses, and government is not helping at all. They promised them a lot of stuff, the money, the loans, and a lot of stuff, the food situation and everything, but nothing happened.

Same thing like America, the government is lying to people, the same thing happening in India.

Brian: Gary, thank you for your call, depressing as it is. Dr. Laxminarayan, do you want to react to either of those two callers? They put so much on the table.

Dr. Ramanan: There is a perception that mortality rates are lower in India, which is entirely consistent with the fact that the Indian population is much younger than most other countries. 65% of the population is under the age of 35. Very different from Europe, for sure, and even younger than the United States. That does reduce mortality rates.

The caller is also correct, that we do see deaths very early. It's unclear whether it's because people are showing up for testing late, and therefore it appears that they're dying soon after being tested positive, or it's truly something that's different. We don't really know the answer to that. That said, we have to remember that India has one of the lowest testing rates of the world of any large country. Only countries like Pakistan and Bangladesh test much lower than even India.

We have an incomplete picture on the epidemic, and we probably won't know very much about the mortality rate until well after. Because a lot of people who are dying of COVID today, are not counted as COVID deaths, and that's a problem.

In response to the second caller, I feel really badly. I see that all the time. In fact, I was in New Delhi just four days ago, and it's heartbreaking. The small businesses are all going out of business, there's a lot of unemployment and job loss. This was an economy that was anyway shrinking-- Oh, not shrinking, but it was growing at a slower rate even prior to the pandemic, but now things are going to get a whole lot worse.

Brian: Give me a thought on agriculture, because the World Bank estimates that more than 40% of people in India work in agriculture. We know the stories in this country about meatpacking plants in the agricultural sector being one of the locations for a super spreading. Were they, like in the United States, allowed to work through the lockdown, and have there been epidemiological implications?

Dr. Ramanan: They have been allowed to work through the lockdown. Farmers have been allowed to work through the lockdown, so that was the one exception that was made. However, unlike the United States, the processed food industry in India is much smaller. Most of the food is sold fresh, the direct grains, the direct vegetables or meat to people. You didn't really have the need for these operations, which had a whole lot of people in small spaces and transmitting the disease.

That said, there's a whole other set of things that are happening now, which are agricultural reforms happening right in the middle of the pandemic right now. The government is taking advantage of the pandemic, to put in place some measures to reform the agricultural system. The intent is to make the system more efficient, but there's been a significant amount of pushback from farmers who would probably argue that those reforms are probably less ideal and not well-timed.

COVID itself has not been the main challenge for farmers, and that's a good thing, because India's agriculture depends a lot in the monsoon, the rains, which happen in July and August. The monsoon was good this year, and agriculture is really the only bright spot in an otherwise dismal economic picture.

Brian: We have a few minutes left with Dr. Ramanan Laxminarayan, who is founder and director of the Center for Disease Dynamics, Economics and Policy, a think tank in Washington, as we talk about Coronavirus in a few other countries and implications for here. I want to move on to Israel, the first developed country to impose a second lockdown four months since its first. What do experts think contributed to the second wave getting so bad?

Dr. Ramanan: Well, Israel did a good job containing the outbreak the first time around. They were early in lockdown in February. It came off in May. Schools reopened progressively. The one problem was that the surveillance infrastructure, to test people, and then also to do contact tracing if there were cases, that was just never established at a level that is needed to support an opening up, and Israel's paying the price. It now has a huge number of cases, I think they've moved beyond 2,500 cases a day, which is large for a country of just 9 million people. Therefore, they are imposing another lockdown right in the middle of the high holy holidays. Rosh Hashanah was obviously earlier this week, and then Yom Kippur coming up. They really wanted to make sure that they had it back under control. It's just a lesson for all other countries, this virus is not going away, and if you take off control measures, it will come back.

Brian: I've heard theories that one of the reasons that it got out of control to the degree that it has in Israel, is the relatively large orthodox population, which is more inclined to want to gather in synagogues in person than other groups, but also that they reopen public schools on a widespread basis, and that that reignited the epidemic. That, of course, would be relevant to New York and other places in the United States.

Do you have good enough information on either of those things to draw a conclusion?

Dr. Ramanan: I've heard a lot more about the schools, but the part about the orthodox use is also-- This has been the story both in New York as well as in Israel, even in earlier parts of the epidemic. You're absolutely right. New York is a microcosm, in that sense, of that structure. There are strong implications for what's happened in Israel for what could happen in New York as well. I don't know if New York schools have opened up yet. I know they keep pushing them back every week, but it is something to be concerned about.

It does lead to another question, Brian, which is how much kids transmit. There is a narrative that kids are not necessarily major carriers of the disease. There's lack of consensus here.

In large scale studies that have been now carried out in India, for instance, and one good thing about some states in India is that the contact tracing has been exceptionally good, that we're finding that there's a lot of transmission of COVID among children, because kids tend not to maintain physical distance, and they transmit very effectively to each other. You can't expect kids in schools to stay away from each other and socially distance. I think people who say that just don't remember having been a child themselves. It's hard to expect schools to reopen, but kids will not transmit to each other. I think that's wishful thinking, and I think we should anticipate that the reopening of schools in New York will have a similar effect, and mainly to the need for another shutdown as we're seeing in Israel.

Brian: On the economic side of this, in both Israel and India, I'm seeing their economies contracted 29% and 24% respectively, so a lot, during their lockdowns. Putting on your economist hat, or wearing that one next to your epidemiologist hat, what did these large short contractions mean long term for economies, if anything? Because that's the tension. You shut down to protect people from the virus, and it causes incredible economic pain. You reopen, it reignites the virus, but then you also worry about businesses going out of business permanently, and individuals not being able to recover for a long, long time their finances.

Dr. Ramanan: That's absolutely true. Brian, the thing that stays after lockdowns is just fear. I don't know the situation in Israel intimately, but I'll tell you in India, people are just fearful of going out. Even if there is no lockdown, people are fearful of going out to a shop. Fear is probably the worst thing for any economy, because it does a lot of things that we just don't absolutely need. Economies don't run on essentials, economies run on things that people want to have, not just on needs, because needs can be satisfied just through food and some basic requirements. You see that a lot in India, which is that people are fearful of opening up shops. People are fearful of, as the previous caller said, buying bikes or motorcycles or whatever else it is because these are optional purchases. Those have an effect that outlast the lockdown by many months, maybe even years.

It is worrying. In India, I don't see the economy coming back to life for a few years. It's not something which you just turn the switch back on and then people are able to open their shutters and start manufacturing and have people line up to buy and get bank loans and do all of that stuff. Destroying that cycle of economic activity has long-term consequences, and I would imagine that's true for every country in the world. I think we're going to see this pain for quite some time to come lasting years, and it's not a matter of months.

Brian: Finally, just very briefly, Madrid, the way I've seen it reported, is that certain working class neighborhoods described that way will be forced into a two week lockdown, which will confine residents to their districts. Why certain neighborhoods and not the whole city, in the case of Madrid?

Dr. Ramanan: I actually am not familiar with the situation in Madrid. I'll tell you that straight upfront. I will say that Spain was one of the places where the health system was least capable of dealing with the outbreaks the previous time around. From the health perspective and the mental health care perspective, I think they are less willing to take a chance that other countries might be willing to. Spain, as you know, just like Italy, is an older country in terms of population, and so much larger population's at risk. If I were in charge there, I would certainly be risk averse in the way that they're being.

Brian: Dr. Ramanan Laxminarayan, economist, epidemiologist and founder and director of the Center for Disease Dynamics, Economics and Policy. Thank you so much for coming on and for all this information.

Dr. Ramanan: Thanks for having me.

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