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The terms “ethics” and “morals” are often used interchangeably, but there are important differences between the two. Ethics require a group consensus of some form, whether formal or informal, whereas morals is for the individual to decide. Of course, one impacts the other, with a sort of chicken-and-egg effect, and both have an enormous impact on how we approach difficult subjects and navigate complex problems. TEDMED 2018 Speakers Adam Waytz, Rabiaa El Garani, Sherry Johnson, and Suchitra Krishnan-Sarin are each tackling moral and ethical dilemmas and sharing their wisdom from the Stage this November. Whether through research or lived experience, these Speakers will share stories of exploring, grappling with, and resolving health-related moral and ethical dilemmas on both individual and societal levels.

Adam Waytz, a psychologist and associate professor at Northwestern University’s Kellogg School of Management, is interested in uncovering what motivates a whistle-blower, or a person who decides to come forward to report someone else’s unethical behavior. Adam and his colleagues have conducted research to discover the psychological determinants of whistle-blowing in order to shed light on the factors that either encourage or discourage a potential whistle-blower to come forward. Their findings revealed that there are two basic moral values at odds when someone decides whether or not they will speak out about an offense: fairness and loyalty. People who prioritize fairness over loyalty tend to show a greater willingness to be a whistleblower, while those who prioritize loyalty show more hesitation to speak out. Through his work, Adam is lending new insight into how the guiding principles of ethics and morals can vary so much from person to person and contribute to drastically different decisions.

There are some issues around which morality and ethics are seemingly clear-cut. For instance, Sexual and Gender Based Violence (SGBV) is widely recognized as a serious crime and human rights violation. Unfortunately, SGBV is still a common occurrence in far too many places in the world. As an international investigator of SGBV and a member of the Justice Rapid Response-UN Women SGBV Justice Experts Roster, Rabiaa El Garani has traveled to places that are experiencing deep moral and ethical conflict surrounding SGBV—including Syria, Iraq, Lebanon, and the Central African Republic. In the JRR-UN Women documentary Evidence of Hope, a survivor who shared her traumatic experiences with Rabiaa underscored the importance of Rabiaa’s SGBV investigative work, saying “After I met [her] I realized that there are some people in the world that care about us.” Rabiaa’s work is bringing justice to survivors of SGBV, voicing their stories, and laying the groundwork for a new code of ethics in parts of the world where SGBV is often ignored or even accepted. 

While SGBV is considered a crime in every state across America, many people would be surprised to learn that child marriage is not. Sherry Johnson is a survivor of child marriage who was forced to marry her rapist at age 11, and by age 27, she was a mother of 9. Today, Sherry advocates for the fair treatment of children and fights for the abolishment of child marriage in the United States. After spending the past several years lobbying the Florida legislature on the issue of child marriage, Sherry recently achieved a major victory with the signing of SB 140 into law, which restricts marriage in the state to those who are at least 17 years old. However, the fight is far from over—almost all states still have some legal variation for children to marry.  

Another ethical debate that concerns America’s young people surrounds the practice of vaping, which is the inhaling and exhaling of aerosol (also referred to as vapor) through an e-cigarette or similar device. Vaping and e-cigarettes were initially considered to be a less harmful alternative to smoking tobacco cigarettes, however recent studies have shown their effects to be much more deleterious than originally thought. Furthermore, with advertising that appears to target youth, candy-like flavors like mango and fruit medley, and devices that pack an alarmingly high nicotine content, the vaping industry has become the subject of extensive ethical scrutiny in recent years. Suchitra Krishnan-Sarin is a biobehavioral scientist and a professor of psychiatry at the Yale University School of Medicine whose research focuses on the bio-behavioral understanding of vaping and substance use behaviors in young people. By digging deeper into teen vaping behavior, Suchitra is uncovering important information that can be used by policymakers as they look to regulate the e-cigarette industry in an effort to help keep children away from the highly addictive and harmful habit.

From health and wellbeing to human rights and policy, we look to ethics and morals to help bring clarity to our often chaotic world. Although the lines between right and wrong may seem clear to many, such as in the cases of child marriage, SGBV, and teen vaping, the fact is, these are not universal truths. Furthermore, given the individualized psychology behind how we establish our morals, we may never be able to see eye to eye on some things. We’re excited to continue exploring the complexities of ethics, morality, science, and behavior from the Stage this year and to gain a deeper understanding of these concepts from TEDMED 2018 Speakers Adam, Rabiaa, Sherry, and Suchitra. We hope to see you there!

The post How Ethics and Morals Bring Clarity to a Chaotic World appeared first on TEDMED Blog.

TEDMED Speaker Daniel Streicker provided some great insights about bats and pandemics in his 2018 Talk “What vaccinating vampire bats can teach us about pandemics” and TEDMED blog post. Learn about this Animal-Borne Disease Detective’s perspective on COVID-19 in our Q & A below.

TEDMED: What do we know about the origin of COVID-19? Which theories stand strong in your mind?

Daniel Streicker: We know that SARS-CoV-2 (the virus that causes COVID-19) most likely originated from a non-human animal, but exactly which animal and how it managed to make the jump to people largely remains a mystery. The virus genome is most closely related to viruses that are known to circulate in Old World bats in the family Rhinolophidae (horseshoe bats). That points to bats in this same group as the origin, but the viruses we know about aren’t a perfect genetic match to SARS-CoV-2. In fact, there are few decades worth of transmission separating the previously known viruses from the virus that is now circulating in humans. That gap could be filled by another bat virus that we don’t know about (there are likely many undiscovered coronaviruses in bats). Alternately, a historical bat virus might have jumped into and evolved in some ‘intermediate’ host prior to infecting humans. We don’t know exactly what triggered the shift to humans, but finding the animal source would provide viral clues. Researchers are now trying to use knowledge of the biology of the virus to work out candidate animals to survey.

TM: What should we be weary of to prevent another bat initiated outbreak?

DS: Like all animals, bats host diverse viruses, some of which are able to infect humans. Consequently the main thing we can do is limit the opportunities that viruses have to spread between species. In some cases, there are practical solutions like limiting the trafficking and consumption of wildlife or improving handling and animal housing standards. However, when there are indirect routes of infection between animals and people such as through the shared environment, through arthropod vectors (ticks, mosquitoes) or through domestic animals, prevention will be challenging without larger scale changes in human societies, such as changing farming practices, land use, and resource extraction practices. COVID-19 is not the first and it is not likely to be the last disease outbreak that originates from bats.

TM: Are there ways to take precautions against animal to human transmission for new diseases? Or is it inevitable?

DS: Unfortunately, some amount of animal to human transmission is inevitable. The positive side is that with each epidemic we gain new knowledge and technologies that let us respond faster. It also puts one more high-risk virus on our radar which might be prevented from re-emerging in the future. We can also do more now than ever before to prepare. The more we understand the routes through which animal viruses emerge, the more we can develop broad-acting precautionary measures to reduce the risk. For example, limiting human-wildlife interaction in high risk situations. However, we also have new tools that are allowing viruses to be discovered at unprecedented rates. More comprehensive knowledge of viral diversity can accelerate investigations into the origins of novel viruses that appear in humans. This cataloging of viruses is also a first step towards evaluating risk prior to emergence in humans, though we still need better ways to narrow the list of viruses that are worth preemptively investigating.

TM: Was there anyway for the world to anticipate this virus? What additional complications arise given that this is a novel virus?

DS: We couldn’t have predicted this exact virus, but given that the SARS outbreak of 2002-2003 was caused by a very similar virus (taxonomically the same species as the virus that causes COVID-19), it is really not a surprise. In the wake of SARS, a great deal of surveillance was undertaken to discover and characterize coronaviruses in wild animals, and numerous scientists provided persuasive evidence that these kinds of viruses were circulating in bats and posed a threat to human health. Why more effort was not put into developing vaccines and antivirals for humans is perplexing.

TM: Once we understand the source of COVID-19, and eventually develop a vaccine, should efforts be put into tracking and vaccinating the source animal – as you suggested for rabies in vampire bats?

DS: If this is a virus that is transmitted in nature by a wide variety of bat species, vaccination would be challenging. If emergence in humans turns out to be the consequence of a rare evolutionary change in an intermediate host, vaccinating that host could be practical. On the other hand, it could be that transmission in the intermediate host was short lived and it has now gone extinct from animals. In that case re-emergence would be relatively unlikely even without human intervention. The bottom line is that we need to know the steps that the virus took between bat and human to know where the most effective interventions should be targeted.

The post COVID-19 Q & A with Animal-Borne Disease Detective Daniel Streicker appeared first on TEDMED Blog.

2020 TEDMED Speaker Anupam B. Jena shares the power of creative observations in his Talk “The profound difference between seeing and looking“. In response to his Talk and his segment on TED Radio Hour, TEDMED spoke with Anupam about observing the changing world during COVID-19.

TEDMED: Given the rise of COVID-19, what questions that are “hidden in plain sight” have you been most intrigued by?

Anupam B. Jena: I’ve been intrigued by a few questions. In some respects, the COVID-19 pandemic is The Great Natural Experiment. Medical procedures, including screening tests for cancer, have been deferred. Can this inform as to how necessary those tests really were by studying the impact of those delays on patient outcomes? For some procedures, like cardiac bypass surgery in patients with severe heart disease, we’ll be able to better understand in a large-scale way what the impact of several month delays are on outcomes. The list is endless. I also wonder about the impact of forcing people to stay close together for longer periods of time than they do normally. There’s already evidence of domestic strain. It may also be the case that in families that have at least one smoking member, second hand smoke exposure (especially among kids) could rise. Remember, kids normally spend their days at school not all day at home. I mentioned in my NPR TED Radio Hour episode that I thought that outcomes of individuals with alcohol dependence might worsen because of the stress of pandemic and the lack of availability of resources like AA for those who use it.

TM: How do you balance correlations and coincidences? How do you differentiate the two if the observed event is a unique instance?

ABJ: My main approach, and that of economists, is only to take seriously those correlations that arise from individuals being exposed to an event for an essentially random reason. If we want to study the impact of the malaria drug hydroxychloroquine on COVID-19 outcomes – something that’s been in the news – what you quickly see is that patients who receive the drug tend to be different, on average, than those who do not. They are often sicker. A simple comparison may falsely lead you to conclude that the drug harms people. In the end, it may, but the right approach is to find people who were otherwise similar but by chance were exposed to the group. For example, patients who happened to be hospitalized after President Trump’s advocacy of the drug may be more likely to have been prescribed it. That might serve as a natural experiment because patients hospitalized before and after that first presidential announcement obviously were unaware that announcement was going to occur.

TM: How might the current pandemic inspire creative thinking and macro-level change to the US health system?

ABJ: The current pandemic has forced a lot of people who don’t think about health care issues to now put those issues front and center in their mind. Having talked a lot to people recently who are completely removed from health care, the ideas they come up with about testing, about the impacts of social distancing on their lives, etc., are fascinating. In many instances, what they are describing are the outcomes of this huge experiment but they just aren’t thinking about it in that way.

TM: Do you consider this pandemic a natural experiment?

ABJ: Yes and No. A natural experiment has to satisfy an important criteria – the impact of the event, in this case the pandemic, has to exact its effect on people’s lives in a single way, otherwise it becomes difficult to study. For example, suppose we find that the pandemic led people to not fill prescriptions for their essential medications and we wanted to use that transient disruption to study the ‘effect’ that medicines have on health outcomes in a real world setting. It is true that the medication disruption was caused by an unforeseen event, the pandemic. But if people’s health worsens, was it because of the lack of medication use or because of the stress and other changes to life induced by the pandemic. In that example, the natural experiment assumption fails.

TM: While everyone is looking at the health care system being overloaded, what are you seeing in the world of health?

ABJ: I am struck by the resilience of health care systems and health care professionals. In my own health care system, which is not alone, the organization is taking active steps to improve housing, social distancing measures, and testing in hard hit, historically underserved areas. That doesn’t help their ‘bottom line’ and as an economist who first thinks of the non-altruistic reasons that individuals and organizations do what they do, it highlights what we can do together when we have incredibly challenging problems to solve. At the end, the pandemic will take fewer lives than heart disease and cancer. It would if we were able to dedicate this amount of effort to reducing the burden of those diseases, the impacts to society would be large.

TM: Where do you anticipate seeing the most unexpected change in creative thinking?

ABJ: There has been a huge increase in interdisciplinary thinking around the pandemic. For example, economists are weighing in on issues that epidemiologists have studied for decades, in some cases offering new insights and in other cases re-discovering the wheel. A tangible area of interdisciplinary work is estimating the effectiveness of policies to stem the tide of the pandemic. At their core, these are statistical or econometric issues – what was the observed effect of a policy on disease spread, using state-to-state or county-to-county variation in the timing of policy implementation – not issues that are best addressed by mathematical epidemiologic models.

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By Neal Batra, principal and Kulleni Gebreyes, M.D., principal, Deloitte Consulting LLP

Last month, we led a discussion about the future of health at TEDMED 2020 in Boston (turns out this was the last in-person meeting any of us will attend for a while). We explained that we believe over the next 20 years, consumers—rather than clinicians or hospitals—will be at the heart of the US health system. These health consumers will likely be armed with data, tools, and guidance that allows them to make informed decisions about their health. 

We were just a few minutes into our talk when a physician in the audience began shaking her head in disagreement. She explained that she works with vulnerable populations and hasn’t seen any evidence of empowerment or consumer choice among her patients. Twenty years from now, she reasoned, they will still be making health decisions based on information from their doctors, family members, and friends. 

We weren’t surprised by the reaction. There is a long-held belief that increasing someone’s knowledge does not change their behavior. We see it a bit differently. The idea that the physician knows what is best for the patient may be an outdated concept. We believe that all people—regardless of economic status—will make the right health choices if barriers are removed and they are given the proper tools and guidance. Access to information through channels they trust could allow consumers to diagnose themselves with great accuracy and choose the most appropriate treatment options.

Can early intervention prevent disease?

Over the next 20 years, we expect early intervention will become a core component in maintaining health and wellness. We expect illnesses will be treated in the earliest stages, which can reduce overall spending on care. Maybe we can keep some people from developing a disease or reduce the amount of care needed. We often hear pushback on this idea. What about a diabetic patient? At some point, someone with Type 2 diabetes will need to meet with a doctor or visit a hospital, right? Not necessarily. We believe that early intervention could help encourage people to make lifestyle changes maybe years before they are diagnosed as pre-diabetic. Maybe through behavioral nudging, gamification, coaching, early interventions, and even financial incentives, a person on the path to diabetes avoids the disease altogether. We’re not saying no one will get type 2 diabetes in the future, but we do expect that intervention will take much earlier. 

We’ve all been hearing about the big changes on the health horizon for years. So why are things different now? We see four driving factors: 

An explosion of data: From connected medical devices to at-home genetic tests to the fitness tracker on your wrist, we are generating mountains of health data. 

Granularity of data: The health data we are generating goes beyond traditional health data (e.g., blood pressure, weight, cholesterol levels). We are beginning to gather more granular data such as cell-hydration levels, and we are getting closer to having access to these data in real-time. 

Interoperability: The value of data can be limited if we can’t connect it in a way that allows us to create insights into health and wellbeing. Our session participants agreed that we have a long way to go to solve interoperability, but no one seemed to think it was a challenge that couldn’t be solved. We believe we will reach a point where the myriad data streams we produce converge into a highly personalized picture of an individual’s health. 

Consumerism: Not long ago, most people showed up at the doctor’s office because they didn’t feel good and they wanted to know what was wrong. That line of sight may be changing as consumers gain access to deep and actionable information about their health. 

Sensors and real-time feedback could promote better health

Many of the stories we heard at TEDMED helped amplify our vision for a future of health that is shaped by consumers. One panelist described a future where ingestible sensors push the idea of behavioral-nudging to the next level. For example, diseases such as cirrhosis grow slowly, and it could take years for symptoms to develop. Now imagine something akin to a Fitbit for the liver—smaller than a grain of rice—that can detect the earliest stages of the disease. Real-time data from an ingestible sensor like this could nudge a person to avoid fatty foods, or to drink more water and less alcohol. Maybe early detection means the disease never develops. 

Will consumers disrupt the hospital business model?

Some of the people in our session were skeptical that the health sector was on the cusp of a monumental shift. After all, we’ve been talking about value-based care for years, but many hospitals and health systems remain mired in the fee-for-service world. The percentage of revenue from value-based care is still in the single digits for many hospitals, according to our recent survey of health plan and health system CEOs.  

In any industry, incumbents are rarely able to predict or respond quickly to disruption. And when the business model is working fine as it is, there is little incentive to change. The organizations that are able to disrupt industries tend to be those that discover new ways of doing business—rather than finding success within an existing framework. We expect that 20 years from now, companies in the health sector will operate under a consumer-focused business model. They can do well financially by helping consumers maintain their wellbeing (doing good). 

About Deloitte

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At TEDMED’s gathering in Boston, we had the opportunity to interview on stage the world’s top virologist, Peter Piot. In plain English, Peter provided solid scientific knowledge about COVID-19 and how to cope with it. Short answers, clear explanations.

Based on that live interview here is a written Q & A supporting the responses to 100 questions on COVID-19 with Peter Piot. We hope that you will find this additional content helpful and that you will share the video Q & A and this blog post with your friends and family.

1. TEDMED: Let’s start with the basics. What is a virus?

A virus is a very tiny particle of RNA or DNA genetic code protected by an outer protein wrapper.

2. TEDMED: How common are viruses?

Viruses are everywhere. It’s amazing to realize that if you add them all up, all the viruses in the world weigh more than all the living matter in the world — including all of the plants, animals and bacteria. 10% of the human genome is derived from virus DNA. The Earth truly is a “virus planet!”

3. TEDMED: Why is it so hard to stop a virus from spreading?

Because virus particles are so incredibly small, billions can float on tiny droplets in the air from just one cough.

4. TEDMED: Exactly how small is a virus?

Tiny. Even with a regular microscope, you can’t see a virus. 100 million viral particles of the novel coronavirus, can fit on a pinhead. That’s how incredibly small they are.

5. TEDMED: What do virus particles do?

Virus particles try to insert themselves into living cells in order to multiply, infect other cells and other hosts.

6. TEDMED: Why do viruses try to get into living cells?

It’s how viruses “reproduce.” Viruses act like parasites. They hijack living cells in order to force each cell to make more viruses. When a cell is hijacked, the virus sends out hundreds or thousands of copies of itself. It often kills the hijacked cell as a result.

7. TEDMED: What does it mean to be infected with the new coronavirus, which scientists have designated “SARS-CoV2”?

It means that SARS-CoV2 has started reproducing in your body.

8. TEDMED: What is the difference between SARS-CoV2 and COVID-19?

SARS-CoV2 is the virus; COVID-19 is the disease which that virus spreads.

9. TEDMED: Is it easy for a virus to get into a living cell?

This depends in the first place whether the cell has the right receptor for the particular virus, just as a key needs a specific keyhole to work. Most viruses are blocked by our immune system or because we don’t have the right receptors for the virus to enter the cell. Thus, 99% of them are harmless to humans.

10. TEDMED: How many kinds of viruses exist, and how many of them are harmful to humans?

Of the millions of types of viruses, only a few hundred are known to harm humans. New viruses emerge all the time. Most are harmless.

11. TEDMED: On average, how many particles of the virus does it take to infect you?

We really don’t know yet for SARS-CoV2. It usually takes very little.

12. TEDMED: What does it look like?

SARS-CoV2 looks like a tiny strand of spaghetti, wound up in a ball and packed inside a shell made of protein. The shell has spikes that stick out and make it look like the corona from the sun. This family of viruses all have a similar appearance; they all look like a corona.

13. TEDMED: How many different coronaviruses affect humans?

There are 7 coronaviruses that have human-to-human transmission. 4 generate a mild cold. But 3 of them can be deadly, including the viruses that cause SARS and MERS, and now the new coronavirus, SARS-CoV2.

14. TEDMED: Why is it called the “novel” coronavirus?

Novel just means it is new to humans, meaning that this specific virus is one that we’ve never seen before. Our immune system has been evolving for 2 million years. But since our bodies have never seen this virus before, there has been no opportunity for humans to develop immunity. That lack of immunity, combined with the virus’s ability to spread easily and its relative lethality, is why the arrival of SARS-CoV2 is so disturbing.

15. TEDMED: How often does a novel virus emerge that we need to care about?

It’s rare… but it happens. Examples include the viruses that cause diseases such as HIV, SARS, MERS and a few others. It will happen again. The emergence of a novel virus is a very big problem … if it can easily spread among people and if it is harmful.

16. TEDMED: How easily does the new virus spread?

SARS-CoV2 spreads fairly easily from person to person, through coughs and touch. It is a “respiratory transmitted” virus.

17. TEDMED: Is there any other way that the virus spreads?

Recent reports indicate that it may also spread via fecal and urine contamination, but that requires confirmation.

18. TEDMED: How is this new virus different from the earlier known coronaviruses that spread SARS or MERS?

SARS-CoV2 is different in 4 critical ways: First, many infected people have no symptoms for days, so they can unknowingly infect others, and we don’t know who to isolate. This is very worrisome because SARS-CoV2 is highly infectious. Second, 80% of the time, COVID-19 is a mild disease that feels like a minor cold or cough, so we don’t isolate ourselves, and infect others. Third, the symptoms are easily confused with the flu, so many people think they have the flu and don’t consider other possibilities. Fourth, and perhaps most importantly, the virus is very easy to spread from human-to-human because in the early stages it is concentrated in the upper throat. The throat is full of viral particles so when we cough or sneeze, billions of these particles can be expelled and transmitted to another person.

19. TEDMED: I thought the virus leads to pneumonia? How is the throat involved?

The disease often starts in the throat (which is why tests often take a swab from the throat) and then as it progresses it moves down to the lungs and becomes a lower respiratory infection.

20. TEDMED: I hear the word “asymptomatic” used a lot. What does it mean?

It simply means having no symptoms.

21. TEDMED: Are you saying that someone can be infected with the new virus and never show symptoms at all?

Unfortunately, yes. Many infected people do not show any symptoms for the first few days and then a mild cough or low fever shows up. This is the opposite of SARS, where you had clear symptoms for a few days but were only contagious when sick.

22. TEDMED: If you have no symptoms, can you still infect other people?

Unfortunately, yes. And that makes it much more difficult to slow the spread.

23. TEDMED: How likely is it that scientists will develop a vaccine to prevent people from getting infected?

It is reasonably likely, but there are no guarantees that we will even have a vaccine. Failure is possible. For example, we’ve been searching for an HIV vaccine for 35 years and we still don’t have one. I’m optimistic that we will develop a vaccine for SARS-CoV2, but we will have to extensively test it for efficacy and safety — which takes a lot of people and time.

24. TEDMED: Assuming that a vaccine for coronavirus is possible and further assuming that it will be discovered fairly quickly, how long before we have a vaccine that we can start to inject into millions of people?

We will have vaccine “candidates” in a month or two. But because of the need for extensive testing to prove it protects and is safe, it will be at least a year before we have a vaccine we can inject into people that is approved by a major regulatory agency. In fact, 18 to 24 months is more likely by the time we scale it up to millions of doses, and that is optimistic.

25. TEDMED: Why will it take so long to develop a vaccine if this is an emergency?

It’s not necessarily vaccine discovery that takes so long, but vaccine testing. Once a “candidate” vaccine exists in the lab, a series of clinical trials are needed, first on animals and then on successively larger groups of people.

26. TEDMED: Have we made progress already?

The good news is that only weeks after the discovery and isolation of SARS-CoV2, which occurred in early January of 2020, vaccine development started immediately. Funding has been allocated by many governments and many companies and scientists around the world are working on it with great urgency.

27. TEDMED: Are scientists in these countries cooperating, or are they competing with each other?

A bit of both, and that is not a bad thing. But international cooperation has generally been good. That’s encouraging.

28. TEDMED: Can’t we develop a vaccine faster?

Unfortunately, there are no shortcuts. The human body’s immune system is complex and unpredictable. Viral mutations may occur. Children are different from adults. Women may respond differently than men. We need to be sure that any vaccine is 100% safe for everyone who gets it. To accomplish that, we need to test drugs and vaccines at various doses on a wide range of healthy human volunteers under carefully measured conditions.

29. TEDMED: How deadly is the new virus?

Most scientists believe that it kills 1% to 2% of all the people who become infected. The WHO currently reports a higher figure of more than 3%, but that estimate is likely to come down as they figure out how to count many unreported or mild cases. Mortality is clearly higher in older people and those with underlying conditions.

30. TEDMED: Is the average death rate the figure to focus on?

Not really. You can drown in an “average” of 3 inches of water. A better way to understand the risks is recognizing that it can be deadly for certain groups of people and much less so for other groups — with a wide range of outcomes.

31. TEDMED: So what are the numbers and checkpoints to focus on?

80% of the time it’s a mild disease, but in 20% of cases it becomes more severe, with the worst cases reporting high fever or shortness of breath. As a result some people require hospitalization, and some will need intensive care to survive through a few critical days when their lungs are extensively infected.

32. TEDMED: Which groups of people are most at danger here?

First of all, older people like me: I’m 71. The older you are, the higher your risk. Also at greater risk are people with underlying diseases such as diabetes, chronic obstructive lung disease and pulmonary disease or cardiovascular disease or immune deficiencies.

33. TEDMED: How much danger do these high-risk groups face?

Their mortality rate can be as high as 10% or even 15%. And, your risk increases when you have more health conditions. The scientific data about all of this is regularly updated on the web.

34. TEDMED: So your risk increases significantly if you have other conditions, such as diabetes. Why?

Because your immune system reacts poorly to any infectious virus, but particularly to this one.

35. TEDMED: It seems that generally speaking, children and young people are only mildly affected, if at all. Is that true?

This is what it looks like, but as with so many other issues on COVID-19, this requires confirmation.

36. TEDMED: If true, why would SARS-CoV2 affect older people much more, but not younger people and children?

We actually don’t know. It’s going to be a while before we figure it out.

37. TEDMED: Anything else unusual?

You can infect other people even if you are totally asymptomatic and feeling fine. That’s unusual, though it can also happen with HIV infection.

38. TEDMED: We often hear COVID-19 compared to the seasonal flu. What’s the right way to frame this comparison? For example, are the seasonal flu and coronavirus equally dangerous?

The seasonal flu typically infects up to 30 million people a year in the U.S., and fewer than 1/10th of 1% of the infected group will die – but that is still a big number. Worldwide, in an average year, a total of 300,000 people die from seasonal flu. But, on an average basis, the new coronavirus is 10–20 times more deadly, and in contrast to influenza, we cannot protect ourselves through vaccination.

39. TEDMED: Does the new virus spread as easily as the flu?

The new virus appears to spread as easily as the flu.

40. TEDMED: Continuing with the comparison of flu and COVID-19, what about causes? Is the flu also caused by a virus?

Yes. Flu is caused by the influenza virus. But the influenza virus and coronavirus are very different. A flu shot doesn’t help you with the new coronavirus, but it greatly reduces your risk of flu. The common cold, for which there is no vaccine or cure, is often caused by another type of tiny virus called a rhinovirus, and occasionally another coronavirus.

41. TEDMED: How does the infection progress when the new coronavirus gets a foothold in your body?

It usually starts with a cough. Then a low fever. Then the low fever turns into a high fever and you get shortness of breath.

42. TEDMED: At what point is good medical care the difference between life and death?

It is usually when your fever is very high and your lungs are compromised so that you are short of breath or you need help to breathe.

43. TEDMED: How is the new virus different from a disease such as the measles, mumps or chicken pox?

SARS-CoV2 is currently far less infectious and dangerous but there is still a lot we don’t know about it. The other diseases are well understood.

44. TEDMED: If the new coronavirus is less dangerous than other viruses, why are many people so afraid of it?

Because new things that can kill us or cause us to be sick, make us very nervous. But accurate knowledge is the antidote to fear, so here in the U.S., I urge you to pay attention to CDC.gov. In other countries go your national health ministry or WHO websites.

45. TEDMED: How often should people check the CDC or WHO websites, or the website of their national health ministry?

We continuously update our knowledge as we learn more about the new virus, so these sites should be checked frequently.

46. TEDMED: Has mankind ever wiped out a virus completely?

Yes. Smallpox, which used to kill millions of people. And, we’re very close with polio thanks to the Gates Foundation and many governments around the world such as the U.S. Let’s not forget what a terrible plague that was in the world.

47. TEDMED: How does the new virus get to new places around the world?

By road, air and sea. Viruses travel by airplane nowadays. Some of the passengers may carry SARS-CoV2.

48. TEDMED: So, every international airport is a welcome mat for the new virus?

The reality is that SARS-CoV2 is already firmly present in most countries, including in the U.S., and far from any major international airport.

49. TEDMED: Since the epidemic began in China, do visitors from that country represent the biggest danger of importing coronavirus into the U.S.?

Since the new virus emerged in China in 2019, 20 million people have come into the U.S. from countries all over the world. The U.S. stopped most direct flights from China 4 weeks ago, but it did not prevent entry of the virus. Now cases of COVID-19 in China are often imported from other countries as the epidemic in China appears to be declining for the time being.

50. TEDMED: In other words, major airports are all you need to guarantee that any country will have the virus everywhere in less than 3 months.

Yes. I think you say in America, “The horse has left the barn.” This is not a reason to completely stop all travel.

51. TEDMED: Why might a country like Japan close its schools?

Other countries such as Italy and France are doing the same. It’s because scientists don’t know how much of the spread is accelerated by children who are carriers. Japan is trying very hard to slow the spread. Children generally pass along viruses quickly since they don’t wash their hands or practice much personal hygiene. They play a big role in how the flu spreads which is why many countries have been closing schools in affected areas.

52. TEDMED: If I get infected, are there drugs I can take to make the virus less severe, or make it go away entirely?

No drugs have yet been proven effective as a treatment or what doctors call a “therapy.” A lot of different drugs are being tested in clinical trials, so hopefully that will change for the better soon.

53. TEDMED: How likely are we to come up with new therapeutic drugs, and how soon?

I’m quite confident that probably in a matter of a couple of months, we are very likely to find “off-label” uses of current drugs that help treat an infected person. In other words, we’ll have a new use for existing drugs that were originally used against other viral infections such as HIV. It will take time and a lot of real tests to be sure though. New therapeutic drugs are being tested in clinical trials, particularly in China, but also elsewhere. It looks promising.

54. TEDMED: What about antibiotics? Everybody always turns to them in a crisis.

This is a new virus, not a bacteria. Antibiotics work against bacteria but they do not work against viruses. They may be helpful in hospital usage with secondary infections that are bacterial, but antibiotics have no effect at all on the new virus itself.

55. TEDMED: What about all kinds of new cures and therapies and treatments I’ve heard about on the Internet?

There are going to be endless false claims. Only when you read about it on multiple reliable websites, can you feel confident there is real science. But most of what you hear will be total rubbish, so be very careful, and don’t spread unconfirmed rumors.

56. TEDMED: How about masks? Are those blue surgical masks or an N95 facemask useful?

Masks have very limited value except in certain specific circumstances. For example, depending on the type of N95 mask, just under 50% of inbound virus particles will be filtered out, but they may reduce spread from airborne droplets.

57. TEDMED: What are the advantages of masks when used properly and who should wear masks?

The best masks, carefully fitted and worn properly, slow down the spread FROM sick people coughing. Meaning, the mask is not to protect you from other people; it is to protect other people from you. It is a courtesy to others to wear a mask when you get what you think is a cold, and you start coughing. Masks have an additional benefit: they make it less likely that you will touch your mouth, so it becomes less likely that if you have the virus on your hands, you will transfer it into your body. Masks provide benefits for healthcare workers. If you work in a health- care setting or in elder care, masks are mandatory.

58. TEDMED: Is there anything I can do to prevent from becoming infected in a global pandemic outbreak?

Washing hands frequently, not touching your face, coughing and sneezing in your elbow or a paper handkerchief, not shaking hands or hugging all reduce your risk. If you are sick, stay home and consult with a doctor over the phone to see what to do next, and wear a mask when seeing other people.

59. TEDMED: What does “mitigation” mean? I hear scientists using that word a lot.

Mitigation means slowing the spread of the virus, and attempting to limit its effects on public health services, public life and the economy. Until there’s a vaccine, what we can do is slow it down. That is really important.

I hear scientists using that word a lot. Mitigation means slowing the spread of the virus, and attempting to limit its effects on public health services, public life and the economy. Until there’s a vaccine, what we can do is slow it down. That is really important.

60. TEDMED: What other ways can we slow down the spread of the virus?

Good hygiene and common courtesy can slow down the spread. In addition, “social distancing” measures — such as working from home, not taking a plane, closing schools, and banning major gatherings — will help slow the spread of SARS-CoV2.

61. TEDMED: Do different viruses spread more easily than others?

Yes. Measles is the worst. You can get measles by walking into an empty room that an infected person left 2 hours earlier! That’s why we have measles outbreaks when vaccination rates go down. It’s a very tough disease. The common cold spreads fairly easily. HIV is much harder to spread, and yet we’ve had 32 million deaths.

62. TEDMED: What will it take to stop this virus?

Nobody really knows for sure, but China has shown that it is possible to stop the spread significantly. A vaccine may be necessary to fully eliminate SARS-CoV2.

63. TEDMED: How long will it take for the new virus to spread through a population the size of the United States?

Left to spread with normal measures of good hygiene, SARS-CoV2 appears to double its infected population about every week. That means it will go from 50 people who are infected to 1 million people infected in about 14 weeks. That’s the simple arithmetic of contagion. Of course, we can do things to slow it down.

64. TEDMED: How effective is good hygiene in slowing down the spread of coronavirus? Do the numbers of infected people decrease noticeably if people follow the guidelines?

The numbers change based on how careful people are, and even small changes are important to avoid stressing the healthcare system more than absolutely necessary.

65. TEDMED: Can a few thousand cases be hidden among our population? How would that be possible?

Every year, there are millions of flu cases. This year, some of these cases are actually COVID-19. In addition, many infected persons show no symptoms or very mild symptoms, so they are hiding in plain sight.

66. TEDMED: Exactly what does it mean to test positive?

It means that a sensitive test has detected that the virus is present in fluids from that person.

67. TEDMED: Should everyone be tested as quickly as possible?

Testing for COVID-19 should be much more widely available because we still don’t know enough about who is infected, and how the virus spreads in the community. We need far more testing to learn important data.

68. TEDMED: Why has South Korea set up a system of “drive-through” testing?

South Korea has drive-through testing because they are trying very hard to slow the outbreak by finding every infected person as fast as they can.

69. TEDMED: What is the main symptom that people should be on the lookout for?

Coughing is the #1 symptom.

70. TEDMED: Is fever a good way to identify infected people?

A high fever may be cause for concern and is worth getting medical attention. But screening for fever alone, at an airport or checkpoint for example, lets a lot of infected people pass.

71. TEDMED: What percentage of the people who tested positive in Chinese hospitals arrived without a fever?

About 30% of Chinese coronavirus patients had no fever when they arrived at the hospital.

72. TEDMED: Is the new virus likely to come back to a country again once it peaks and the number of new cases drops off?

SARS-CoV2 is likely to never leave us without the same effort that eliminated smallpox and has almost eliminated polio.

73. TEDMED: Meaning, the only way to beat the new coronavirus in the long term is global population-wide vaccinations?

We really don’t know. Population-based measures may work, but a vaccine may be necessary and is probably viable as long as the virus stays stable and does not mutate too much.

74. TEDMED: Might the new virus “burn out” like other viruses have seemed to do?

We don’t know, but it is unlikely. SARS-CoV2 is already too well established around the world. This is no longer just a Chinese issue; there are probably hundreds of thousands of people infected but not yet tested — not only in China but in close to 100 other countries. SARS-CoV2, like the influenza virus that causes the seasonal flu, will likely be with us for a long, long time.

75. TEDMED: Will the new virus come back in waves or cycles, and if so, when?

Again, we don’t know, but it is a very important question. Probably, although at this early stage, nothing is sure. The 1918 pandemic flu circled the world in 3 waves. The new virus may have a second wave in China with the reopening of schools and factories. But until we see what actually happens, we don’t know how SARS- CoV2 will behave.

76. TEDMED: If we get a “lucky” break or two in the coming months, what does being “lucky” look like?

Warm weather may slow down the spread, although we don’t have any evidence yet that this is the case. Singapore, which has 120 cases already, and has one of the best COVID-19 control programs in the world, is just 70 miles from the equator — so at least in that case, a warm climate has not stopped the virus from spreading. It’s possible that SARS-CoV2 could steadily mutate into a less dangerous form so that fewer people die from it, as happened before with the swine flu in 2009. But I wouldn’t count on it. Quickly finding an effective drug therapy or cocktail of drugs would be excellent news. That’s about it for luck.

77. TEDMED: Do people who are at high risk for COVID-19 have the same chance of dying everywhere?

Unfortunately, your risk of death depends a lot on where you are in the world. If you need and get cared for in a well-equipped modern hospital, which we hope is accessible to lots of people, the death rate will be far lower because of intensive care respirators and fewer secondary infections.

78. TEDMED: How do I know if I’m going to be in the mild group or the one that needs hospitalization?

You don’t know for sure, but being over 70 or having a chronic condition increases your risk of severe illness, and even death. We can only speak in terms of probabilities, because we don’t yet know enough about COVID-19.

79. TEDMED: Should I be worried that I’m going to get COVID-19? How worried are you, Peter?

If you’re not at high risk, I wouldn’t worry too much, but I would do everything I can to avoid becoming infected as you don’t know individual outcomes. Everyone is eventually going to be at risk for acquiring this infection in the next few years, just as no one avoids the common cold or the flu over time. So all of us should be ready to stay home at the first signs.

80. TEDMED: What do you mean everyone is going to be at risk for getting the virus?

I mean that all humans spend time with other humans, so we are all connected — and biology is relentless. However, I would take sensible precautions and, at the same time, not worry obsessively. That isn’t helpful.

81. TEDMED: If everyone is going to get the new virus, why try to avoid getting it?

If I get the virus immediately, then I can be done with it and move on. We want to slow down the infection, which means slow down the number of new cases and total cases, so our hospitals can handle the most affected patients without getting overwhelmed or turning away patients with other types of illnesses that require immediate attention.

82. TEDMED: It appears that after people recover from the new virus, they may still be contagious. Is that true?

We don’t know, although it appears that may be the case for a while after recovery. We are not totally sure. More research is needed.

83. TEDMED: Once you get the virus, are you then permanently immune to getting it again, like with measles or mumps?

Here again, we don’t know the answer to that important question yet.

84. TEDMED: Obviously, permanent immunity against COVID-19 would be important for individuals who came through one bout of the disease. Is such immunity also important for society as a whole? Why?

This question is extremely important for the vaccine development, because vaccines rely on the ability of our body to mount a protective immune response and on a stable virus. And obviously the number of people susceptible to becoming infected would gradually decrease over time.

85. TEDMED: Is the new virus seasonal, like the flu?

We haven’t gone long enough to see if there is a seasonal mutation to SARS-CoV2, or how the trillions of new virus particles change as they pass through millions of people.

86. TEDMED: So this virus can mutate by itself into new forms with new symptoms?

We don’t know at all. If it does, new vaccines may be necessary to prevent the mutated version of SARS-CoV2 from spreading.

87. TEDMED: If the virus naturally mutates, does that mean it could become more deadly, and on the other hand, it could also become less deadly?

Yes, either one is possible. It’s a new virus, so we have no idea what the mutations will do.

88. TEDMED: If coronavirus becomes a threat that doesn’t go away, what does that mean for myself and my family?

It means we will all learn to deal with it, and make sure we are all adopting safe behaviors. We should be particularly mindful of the needs of older family members.

89. TEDMED: I heard the virus can live for 9 days on a countertop. Is that true?

It’s probable that SARS-CoV2 can stay viable on some surfaces for quite a while, but we don’t know for how long.

90. TEDMED: The greatest pandemic of modern times was the 1918 flu pandemic right at the end of World War I. In that pandemic, influenza simply mutated — it was not a new virus. How does SARS-CoV2 compare to that mutation?

SARS-CoV2 is just as contagious as the 1918 influenza pandemic and appears to be nearly as lethal, but time will tell. Remember, back in 1918 there was no medical system anything like what we have in the developed world, and there were no antibiotics to treat bacterial pneumonia, which was a major cause of death.

91. TEDMED: Is there any chance that this is one giant false alarm and that we’re going to look back this summer and say “wow, we all panicked over nothing!”?

No. COVID-19 is already in well over 100 countries and it’s highly contagious. Virtually every day there are more and more cases, in more countries. This is not a drill. It is the real thing.

92. TEDMED: It’s hard to believe that suddenly a truly new virus that mankind has never seen can infect millions of people. When is the last time that happened?

SARS and MERS were new — but they did not reach scale. HIV was new to the world and has infected 70 million people — of whom 32 million have died from the HIV Pandemic.

93. TEDMED: HIV affects poor countries much more than wealthier ones. Will that likely be true for the new virus?

Yes, absolutely. Wealthy countries such as the U.S. are going to have much lower death rates because of better hydration, supplemental breathing equipment, proper handling of infections, and the like. This is potentially a giant problem for low-resource countries that have poor health systems. Many countries in Africa will face enormous risks. When it reaches the most resource-challenged countries of the world, it’s very likely to be catastrophic.

94. TEDMED: It sounds like the bottom line is that you are not terribly optimistic.

In general, I’m definitely an optimist but at the same time, there is a lot to be very uncomfortable and nervous about. I understand people have fears, especially if they are in one or more of the high-risk groups. But there is also good news, because we are already seeing progress in global cooperation, especially in science and medicine. We are seeing more transparency among governments. The number of cases in China is currently rapidly declining, but that could change. And, we are seeing very rapid development of therapeutics, for example.

95. TEDMED: You also said there is a lot to be concerned about. What are your biggest worries for the new virus?

Poorly managed, the spread of coronavirus can quickly overload any country’s healthcare system and block people who really need all kinds of medical access. Another worry is that overreaction and fear can cripple a country’s economy, which causes another kind of suffering. So, this is a very tough trade-off.

96. TEDMED: And, what should we be psychologically prepared for?

We should be psychologically prepared to hear about lots of “new” cases being reported in every city in the U.S. that begins testing, as well as an increasing number of deaths, particularly among the elderly. In reality they are often not “new” cases; they are existing cases that have become visible for the first time.

97. TEDMED: What things are you encouraged about?

1. Modern biology is moving at breakneck speed. 2. In addition to the public health community worldwide, including the World Health Organization, Government leaders at the highest levels are focusing on the threat. 3. We isolated the virus in days and sequenced it quickly. 4. I am confident we will soon have a treatment. 5. We are hopefully going to have a vaccine. 6. This is truly the age of modern communication. That can help us, as long as we debunk fake and dangerous news.

98. TEDMED: How ready is the U.S. for this?

The U.S. has had ample time for a head start to prepare for this pandemic, and so have other high-income countries. We all benefitted from China’s unprecedented mass quarantines that slowed down the spread. The U.S. will handle the serious cases correctly from the start by being more prepared.

99. TEDMED: Who are you most worried about?

It’s the low-resource countries that I am very worried about. Each death is a tragedy. When we say that on average, 1% to 2% of infected people will die from coronavirus, that is a lot. After all, 1% of a million is 10,000 people, and it is the elderly I am very worried about. But 98%-99% of people won’t die from this. The seasonal flu kills tens of thousands of Americans every year and you don’t panic — even if we actually should take flu far more seriously and make sure we are all vaccinated against it every year. Just as we have learned to live with seasonal flu, I think we will need to learn how to go about our lives in a normal fashion, despite the presence of COVID-19, until an effective vaccine becomes available.

100. TEDMED: Are there more pandemics in our future?

Definitely yes. This is part of our human condition and of living on a “virus planet.” It is a never-ending battle. We need to improve our preparedness. That means committing ourselves to seriously invest in pandemic preparedness and building a global fire brigade, long before the house catches on fire next time.

Peter, all of us at TEDMED thank you very much for your insights on this worldwide challenge. The better informed we all are, the better opportunities we will have to slow the spread of this — or any other — pandemic, and eventually either cure it or prevent it.

ABOUT PETER PIOT

Peter Piot, co-discoverer of the Ebola virus, is the Director of The London School of Hygiene & Tropical Medicine, renowned for its research, postgraduate studies and continuing education in public and global health.

Described by the Financial Times as “one of the world’s most famous ‘virus hunters,’” Professor Piot co-discovered the Ebola virus in Zaire in 1976. From 1995–2008, as the founding Executive Director of UNAIDS and Under Secretary-General of the United Nations, he made UNAIDS the chief advocate for worldwide action against AIDS. He also served as an Associate Director of WHO’s Global Programme on AIDS.

Professor Piot has held important posts at the Institute of Tropical Medicine, Antwerp, the Free University of Brussels, the University of Nairobi, the University of Washington, the Ford Foundation, and the Bill & Melinda Gates Foundation. He was the Director of the Institute for Global Health at Imperial College, London, and held the chair “Knowledge against poverty” at the College de France. A Fellow of the Academy of Medical Sciences, he was elected a foreign member of the National Academy of Medicine of the U.S. National Academy of Sciences. He is also a member of the Academy of Sciences Leopoldina of Germany, the Académie Nationale de Médecine of France, and of the Royal Academy of Medicine of his native Belgium, and a fellow of the Royal College of Physicians.

He has received numerous scientific and civic awards including an honorary doctorate from seven universities, the Canada Gairdner Global Health Award, and Robert Koch Gold medal, (2015). He was a 2014 TIME Person of the Year (The Ebola Fighters), and received the Prince Mahidol Award for Public Health. In 2013 he was the laureate of the Hideyo Noguchi Africa Prize for Medical Research. He received the Thomas Parran Award from ASTDA, the Nelson Mandela Award for Health and Human Rights in 2001, the Frank A Calderone Prize in Public Health in 2003, and the Prix International INSERM, Paris, RSTMH Manson Medal, and Bloomberg Hopkins Award. He was knighted as a Baron in 1995 in his native Belgium, and awarded an Honorary Knighthood KCMG in 2016, and the Grand Cordon of the Order of the Rising Sun of Japan (2018). He has published over 600 scientific articles and 17 books, including his memoir ‘No Time to Lose’ in 2012 (WW Norton), translated into French, Dutch, Japanese and Korean, and ‘AIDS between science and politics’ in 2015 (Columbia University Press).

The post Q&A with Peter Piot about COVID-19 appeared first on TEDMED Blog.

Talk In A Nutshell 

Beatie Wolfe brings the artful core of our humanity to life through music that highlights the depth of our human intention for storytelling and ceremony.

The Script

Opening Story

I’ve always loved the stories of albums, the tangibility of records and the ceremony of listening. From the time I started writing songs (age 8) and discovered my parents’ record collection, I saw records as musical books, with the artwork providing the perfect backdrop for the story, and I loved opening them up and entering into the world of the album. There was also a ritual to the occasion. I started imagining what my album could look like, what it could feel like, what worlds I could create. When it was time for my first album to be released, it was a very different era with the digital replacing the physical. So I thought about how to connect the two and that’s what my work became centred around. Reimagining the vinyl experience but for today.  

Statement Of Thesis: Music Is Core To Our Humanity

Why was this so important to me? Because music IS core to our humanity. We are a musical species more than anything else and music imprints on the brain deeper than any other human experience. 

I believe that there are three things that allow something to go deep, to stay with us and forever change us. These are: tangibility, storytelling and ceremony. 

Tangibility… as in a physical art form or space to explore… this could be a record jacket or the world’s quietest room… anything that grounds us in our present reality through a touchpoint. 

Storytelling in the broadest sense of the word, the ability for the artist or creator to tell a story through their work that can engage the imagination and transport us.

And lastly but perhaps most importantly… Ceremony, the space around and within the experience that allows us to go deep, to be fully immersed.

I believe that these three things set the stage for the music and allow it to imprint. Imprint so that every one of those experiences becomes a part of who we are and what we carry with us. This doesn’t just apply to music, it applies to anything, everything that helps to reconnect us with ourselves and one another. It’s these experiences that help to keep us alive inside. 

What Threatens These Musical Values Today?

Tangibility, storytelling and ceremony had always been part of the physical music listening experience and were just some of the things we lost when we moved to digital. 

The digital era created access, it presented solutions but it also created an idea that we could fast track a lot of what defined us as humans to begin with and without the true cost or value reflected in the process.

Music now floats around in its intangible sphere as part of the background noise along with everything else that sits there… news articles, notifications, calendar reminders, social media… everything occupying this same superficial stream of information that infiltrates our day-to-day lives, bombarding our sensory systems until we are numb, overloaded and fatigued. Music, and art, have become part of that constant background chatter and we have forgotten why they are so much more.

How Can We Rescue Music And Restore Our Humanity? Science 

There is a fine balance between what needs to be innovated and what needs to be preserved. So how do we reconcile the value of music and art in an industry that has decided that albums are obsolete and that singles need not be more than jingles, forgotten as easily as they are made? The opposite of imprinting. 

I found part of my answer in neurology. The great late Oliver Sacks studied the power of music extensively and grounded what a lot of us feel intuitively about music, in science. In Musicophilia, his book about music and the brain, he documents the impact of music for every neurological condition from Parkinson’s to Alzheimer’s, Autism to Schizophonia, showing how music is a remedy, a tonic, an orange juice for the ear. 

And I realised that there was no greater application of music than this healing application… using music to reconnect us with ourselves and one another when nothing else could.

A seed was planted in the back of my mind and when I found out that my grandmother had been diagnosed with dementia I decided to take my guitar with me the next time I visited her and play her my songs… because why not? 

Surprising Impact Of Live Performance For Patients With Dementia

Watching my grandmother transform from being confused and agitated to joyful and relaxed with just a song, moved me so deeply. I then decided to play for my father-in-law at his care home in Portugal and when the home director asked if I would play to everyone in the ward living with dementia and Alzheimer's, of course I agreed. Realising that no one in the home spoke English (except for my relative) and that my songs were unfamiliar to the residents, I expected a nice ambience at best. However watching people start to wake up, engage, clap along, even dance in their chairs, and become visibly reanimated from the music, just as Oliver had described, I realised that something important was happening. 

And then the director informed me it was the best he had seen the group in the 10 years he had been there.  

Something was crystalizing into view. What if music’s power was so strong, so interlinked with our own sense of self and wellbeing, that even without the memory component it could be a tonic, a remedy, a “way in”. What if it was the music and not the memory making the magic? In Musicophilia, Sacks had theorized that “music does not have to be familiar to exert its emotional pull” but he had not tested this. I had seen the tip of precisely this and wanted to see how much deeper it went.

Launch Of Research Project

Inspired by this insight, I began the Power of Music and Dementia research project with the Utley Foundation in 2014. The idea was to recreate what had occurred, naturally, in Portugal but this time with controls in place and the caregivers and doctors monitoring the residents. The intention was to show that even when memory was taken out of the equation the power of music prevailed.  

As part of this project, I went into care homes all across the UK and performed a set of my original songs while the residents were monitored both during the live performance and the weeks following as they listened to the same songs on headsets. 

The results were amazing. Both memory and communication were improved during the duration of the project and I saw some of the most powerful reactions to music I have ever seen. Reactions that imprinted on me forever.  

I watched David transform from a catatonic-like state to dancing. And Anne who had not spoken a word in 7 months; during the performance broke into song. Every one of these breakthroughs felt like the most vital link in the chain of our understanding about what moves us, what restores us, what makes us uniquely human. 

Global & Academic Recognition; Launch Of Charity

What began as a small research study in the UK was then recognized by leading academic and research institutions and was suddenly getting global attention. I found myself sitting with the top neurologists and brain experts as they picked my brain on the subject. And all because I asked a question, not as a doctor but as a musician. 

Today music for dementia is becoming a global movement. The charity, MusicForDementia2020, (established out of my project) is now actively working to get music in all care homes in the UK by the end of this year and I continue to work with them as an ambassador. 

Conclusion / Restatement Of Thesis: Core Power Of Music

So what did this teach me? It taught me to celebrate the experiences that keep us alive inside, that remind us of why we are here in the first place. At a time of more access than ever, how can we retain a sense of value? How can we choose to carve out deeper moments within the noise? How can we protect those endangered experiences that become our touchpoints, that shape our emotional sensibility, our identity, our wellbeing and create vast canyons and reserves in our very being?

We realise the importance of these choices when we realise the intrinsic value of music, and art, to us all as sentient beings.

When you have witnessed the power of music as medicine in this pure and concentrated way, which cannot be staged or fabricated. It either works or it doesn’t. When you see what music can do, even when language or memory are removed from the folds, see how the first few notes evokes a smile, a hand twitch, instantly, effortlessly and this builds and grows and it’s just them and the music... No tangible memories, no narrative, no point in time. Just them and the music, there and now. And the brain opens up like a flower, gently unfurling, presenting new pathways you never believed were there…

TEDMED Meetups, uniquely designed conversations, engage the entire TEDMED community to share their individual perspectives and voices to help improve humanity’s health. Read on to view some of the details of these captivating conversations taking place at TEDMED 2020.

Meetup 1 (Tuesday, March 3rd 8:00 am- 8:45 am)

Climate and Culture, A Health Equity Conversation Hosted by RWJF and facilitated by Malik Yakini, an RWJF Health Equity Expert Speakers: Cheryl Holder, Jyoti Sharma, and Thijs Biersteker Description: When we consider human health, we must consider climate health. Whether it is the impact the climate has on the social determinants of our health, the depletion of essential resources like water caused by a changing climate, or how we can harness art to better connect ourselves to our environment, each Speaker in this Meetup has a unique understanding of our connection to climate and its impact on our health. Facilitated by Malik Yakinin, a leader of the movement to bring great equity to the global food system, this Meetup will explore how climate shapes our culture and impacts our health.

The Good Life Hosted by the TEDMED Community and facilitated by Lucy Kalanithi, TEDMED EAB Member and TEDMED 2016 Speaker Speakers: Kevin Toolis and Louise Aronson Description: It’s one of the oldest philosophical questions: What is the good life? As we confront aging bodies and our own mortality, how do we embrace the beauty and dynamism of our lives in ways that enhance and expand our health and wellbeing? Hosted by former TEDMED Speaker and Stanford Medicine internist, Lucy Kalanithi, this Meetup will explore how reframing the stages of elderhood and embracing death as part of life can help us cultivate the good life.

The Future of Health Hosted by Deloitte and facilitated by Deloitte Leadership Speakers: Anupam B Jena, Michel Maharbiz, and Suchi Saria Description: Data is all around us, and within us. With progressive innovation comes new insights to advance health and medicine. This Meetup will explore how natural experiments can reveal important phenomena in our everyday lives, how tiny ultrasound activated implants can provide real-time information about our physiology, and how machine learning is saving lives in our medical system. Led by Deloitte, this Meetup allows us to wonder what the future of health will look like.

Compassionate Care Hosted by Astellas Oncology and facilitated by Shontelle Dodson, Senior Vice President for Health Systems at Astellas Speakers: Lisa Sanders and Shekinah Elmore Description: When faced with a difficult diagnosis or living with a serious illness, we must often manage a great deal of uncertainty. Whether it is helping to find a diagnosis or guiding us through the uncertainty of an unexpected health concern, health care providers and caregivers play an integral role in ensuring that patients can find fulfillment even in their most uncertain moments. Shontelle Dodson, a health systems leader at Astellas, will guide this discussion about the importance of infusing more compassion into care.

Meetup 2 (Tuesday, March 3rd 11:15 am- 12:00 pm)

A Culture of Health, A Health Equity Conversation Hosted by RWJF and facilitated by Aletha Maybank, an RWJF Health Equity Expert Speakers: Joseph Shin, Sandro Galea, and Wanda Irving Description: How do we create a culture of health in asylum settings and within systems teeming with racism? How do we create a culture that breeds love and not hate? How do we cultivate a culture of inclusivity and equity in healthcare? Aletha Maybank, the American Medical Association’s first Chief Health Equity Officer, will lead this conversation about bringing to light the darkest parts of our society in order to ensure that everyone has a fair and just opportunity to be as healthy as possible.

Personalizing Digital Health Hosted by Abbott and facilitated by Toni Nosbush, DVP of Global Product Development at Abbott Hive Innovators: Claire Novorol of Ada Health; Leah Sparks of Wildflower Health; and, Jon Bloom of Podimetrics Description: Today’s technology allows healthcare to be personalized like never before. In this Innovator Meetup, conversation will center around the trend in digital health that creates space for tailored health experiences. While these Innovators’ have varied focuses – ranging from family planning, to patient centered care coordination, and diabetic foot ulcers – the common thread is their focus on effective, reliable, and personalized care experiences. Guided by Toni Nosbush, a leader in global product development at Abbott, this Meetup will explore how better communication between doctor and patient, facilitated by personalized health tools, patients can receive tailored care to become and stay healthy.

New Age Diagnostics Hosted by the TEDMED Community and facilitated by Laura Indolfi, TEDMED 2016 Hive Innovator Hive Innovators: Andy Beck of PathAI; Gabe Kwong of Glympse Bio; Niamh O’Hara of Biotia; William Dunbar of Ontera Description: In this Hive Innovator Meetup, you will have the chance to learn about cutting edge life science innovation. With today’s scientific advancements, new diagnostic models have emerged to detect and intercept disease faster than ever. With AI powered pathology and diagnostics, a closer look at the epigenome, and miniaturized biological sensors, these Innovators are reimagining disease diagnostics. Their technology will shape a future in which illness can be identified accurately, quickly, and reliably every time. TEDMED 2016 Hive Innovator Laura Indolfi will lead this conversation about the possibilities of new age diagnostics.

New Models of Mental Health Care Hosted by the TEDMED Community and facilitated Pat Salber, TEDMED Community Member Hive Innovators: April Koh of Spring Health; Peter Hames of Big Health; TBD, Sana Health Description: Understanding mental health care has become an important theme of our time. With a steady rise in the prevalence of mental health conditions, we must leverage new tools and approaches to keep people healthy. In this Meetup, Innovators will discuss varying models of care that work to improve mental health. You will learn about medical devices, digital health products, and systems level tools that leverage new technology to improve mental health conditions like PTSD, sleep disorders, anxiety, depression, and more. Pat Salber, Editor-in-Chief of The Doctor Weighs In, will facilitate this Meetup about the potential of new models of mental health care to lead to personalized, tailored, and effective care we have not seen before.

Meetup 3 (Tuesday, March 3rd 1:00 pm – 1:45 pm)

A Just World Hosted by the TEDMED Community and facilitated by Pam Belluck, TEDMED EAB Member Speakers: Homer Venters, Laurie Hallmark, and Yasmin Hurd Description: From combating the opioid epidemic with nontraditional solutions, to transforming legal representation and advocacy for people with serious mental illness, to restoring health justice for incarcerated individuals, the Speakers in this Meetup are improving health for some of society’s most vulnerable populations. Pam Belluck, Pulitzer Prize winning science writer for The New York Times, will facilitate this discussion about what it means to create a fair and just world.

Health Techquity, A Health Equity Conversation Hosted by RWJF and facilitated by Margaret Laws, and RWJF Health Equity Expert Description: “Techquity” describes the use of technology to create a more equitable world. In this Meetup, Innovators will share how they are making healthcare more accessible and equitable by leveraging new age technology. From a medical device that empowers women to understand their cervical health, to a platform connecting vulnerable populations to social service providers, and an AI powered tool that makes radiology accessible to all people, these Innovators are using technology to fill major gaps in today’s healthcare system. Margaret Laws, an RWJF TEDMED 2020 Health Equity Expert and head of HopeLab, will facilitate this conversation about how ‘techquity’ can help health become more equitable, faster.

The Power of Medical Knowledge Hosted by the TEDMED Community and facilitated by Jeff Karp, TEDMED EAB Member; TEDMED 2014 Speaker Hive Innovators: Andrew Le of Buoy; Jane van Dis of Maven; Sunny Williams of Tiny Docs Description: Should medical knowledge be reserved for trained professionals, or can it lie with patients and communities? The Innovators in this Meetup will speak to the importance of empowering patients with medical knowledge that is accurate, reliable, and tailored to their unique needs. TEDMED 2014 Speaker Jeff Karp will lead this conversation examining how medical knowledge can be delivered in various forms–telemedicine, virtual communities, AI powered assistants, or even “caretoons” — all while serving the tailored needs women, children, underserved populations, or your average health consumer.

Mapping Human Health Hosted by the TEDMED Community and facilitated by Zen Chu, TEDMED Community Member Hive Innovators: Andy Blackwell of Eight Billion Minds; Katharine Grabek of Fauna Bio. Nancy Yu of RDMD; Ted Schenkelberg of Human Vaccines Project Description: With the rise of technology, we have the opportunity to capture health data like never before. In this Meetup, Innovators will demonstrate the ways in which data can be mapped, across conditions, to better understand, analyze, and reimagine human health. Zen Chu of MIT’s Hacking Medicine Initiative will lead this Meetups about mapping trends around mental health, immunity, rare diseases, or even animal genomics, and what it means for the future of data and human health.

Meetup 4 (Tuesday, March 3rd 4:15 pm – 5:00 pm)

Youth and Truth, A Health Equity Conversation Hosted by RWJF and facilitated by Kellan Baker, an RWJF Health Equity Expert Speakers: Anne Marie Albanno, Cheryl King, Francis X. Shen Description: Dealing with anxiety, mood disorders, developing brains, sexuality, and social pressures is just one aspect of the challenges that come with the transition from adolescence to young adulthood. How can we better understand the developing brain in order to ensure that all individuals receive access to the treatment and care they require? Facilitated by Kellan Baker, a leading researcher of how reshaping socioeconomic and political determinants of health can create greater health equity for transgender populations and other marginalized group, this Meetup will focus on how we as a society can best support our young adults.

Meaning Making and Memory Hosted by the TEDMED Community and facilitated by Kafui Dzirasa, TEDMED EAB Member and TEDMED 2017 Speaker Speakers: Anne Basting, Beatie Wolfe, Frederick Streeter Barrett Description: French philosopher, Rene Descartes’ famous words “I think, therefore I am” is a powerful statement about a sense of awareness within ourselves. In this Meetup, we explore our brain as a dynamic and complex organ by evaluating creative stimuli that lead to surprising reactions in patients with cognitive impairments and by understanding mind altering experiences that allow us to grow and to heal. Led by former TEDMED Speaker, Kafui Dzirasa, this Meetup challenges us to consider the meaning of life when memories fade.

The Social Side of Health Hosted by Humana and facilitated by William Shrank, Chief Medical and Corporate Affairs Officer at Humana Speakers: Cheryl Holder and Jonathan Gruber Description: Health, as we know, is more than just medical. Our health is impacted by economics, the healthcare system, the environment, and our social surroundings. Whether it’s understanding the impact of a changing climate on population health or structuring our health systems to make healthcare better and more accessible, how we think about the social side of healthcare matters. Humana’s Chief Medical and Corporate Affairs Officer, William Shrank, will guide this discussion.

Trust in Medicine Hosted by the U.S. Pharmacopeia (USP) and facilitated by USP’s CEO Ron Piervincenzi Speakers: Heidi Larson, Katherine Eban, and Ralph Nader Description: We all deserve medicines that we can trust, but globally, many lack access to high quality medicines and the health impacts can be detrimental. In this Meetup, hear from TEDMED Speakers who are examining the conditions in which low-cost generic medicine are made, are advocating for consumer rights to help ensure we have access to safe medicines, and are working to restore the public’s trust in the vaccines that help keep us safe. Facilitated by Ron Piervincenzi, the CEO of the U.S. Pharmacopeia, this conversation will dive into how leading thinkers and doers are working to build and maintain trust in medicine.

Meetup 5 (Wednesday, March 4th 8:00 am – 8:45 am)

Infectious Disease and Innovation Hosted by the TEDMED Community and facilitated by Celine Gounder, TEDMED EAB Member Speakers: Heidi Larson, Leor Weinberger, and Matt Hepburn Description: What does it take to fight disease and are we prepared for the next pandemic? Infectious disease specialist and TEDMED Editorial Advisory Board member Celine Gounder will lead this Meetup conversation examining the systems necessary to address pandemic threats – from global vaccine uptake to the development of novel therapies to deprive infectious disease.

Novel Approaches to Big Problems, A Health Equity Conversation Hosted by RWJF and facilitated by Aletha Maybank, an RWJF Health Equity Expert Speakers: Cheryl King, Francis X. Shen, and Thomas Abt Description: Big problems require big solutions. The speakers in this Meetup are developing and implementing big, novel solutions to some of society’s most serious issues. From curbing the rising rates of teen suicide, to fighting for justice in the legal system, to reducing urban violence, these individuals are committed to saving the lives of some of our most vulnerable populations. Aletha Maybank, the AMA’s Chief Health Equity Office, will guide the conversation and help us to understand how equity plays a key role in finding solutions to these issues.

A Vision for a Healthier Future Hosted by Geisinger and facilitated by Geisinger Leadership Speakers: Fred Moll, Gokul IUpadhyayula, and Suchi Saria Description: We live in a world where robotics, bioimaging, and machine learning are becoming increasingly common terms. This Meetup will explore the possibilities of constantly emerging technologies with capabilities to transform healthcare tools as we currently know them. Geisinger will lead this Meetup discussion about the role of technology in creating a healthier future.

Science and Storytelling Hosted by the TEDMED Community and facilitated by Nadja Oertelt, TEDMED EAB Member and TEDMED 2017 Hive Innovator Speakers: Amit Choudhary, Michel Maharbiz, Zuberoa Marcos Description: Whether it’s conveying the nuances and implications of a tool as powerful as CRISPR, understanding molecular and physiological states, or harnessing the power of storytelling in presenting scientific advances to keep the world moving forward, how we tell the story of science is integral to reaching and inspiring a broad audience and making the impact needed to shape a healthier humanity. Nadja Oertelt, TEDMED 2017 Hive Innovator and Co-Founder of Massive Science, facilitates this conversation about science and storytelling.

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