Zoonotic Diseases

Description of the video:

>> Well, welcome, everyone. We have a lot of folks on our webinar today. And so they're still in the process of joining. So we're gonna give everybody a few minutes and we'll get started kinda slowly here today. So this is the prepared for environmental change webinar series. We're very happy to have you join us.

And today's topic is very timely and that we're going to be discussing whether or not there's a connection or maybe it's more accurate for me to say how there is a connection between communicable diseases such as COVID-19 and environmental changes that are happening around the globe and even right here in Indiana.

So my name is Andrea Webster. I'm the implementation manager at the Environmental Resilience Institute at Indiana University. And before we get started officially, I wanna let you all know that you are all muted and that we are recording today's webinar. If you have questions throughout the webinar, we encourage you to put them in the chat box and then we'll get to them at the end.

But if you do have a clarifying question, if one of our presenters or one of us happens to use an acronym, that we forget to explain, please type them into the chat bar and then we'll try to get that answered for you right away. You can access that chat function by hovering your mouse over the Zoom window so where you're seeing my video now, there should be a little option, an icon that pops up that says chat.

And so you can click on that and then you can type your questions in there. We will be live tweeting today's webinar from our Twitter account which is @prepared4change with the four being the number, prepared number four change. And we encourage you to engage online and Retweet as desired.

And finally, I'm very pleased to introduce the director of the Environmental Resilience Institute, Janet McCabe, who's going to be our moderator today.
>> Thanks very much, Andrea, and welcome everybody to our monthly webinar. I'm particularly excited about this topic. We particularly wanted to make sure we were designing our webinar content to to be mindful of the fact that we're going through a pandemic now.

And so we have two incredibly experienced and talented people to speak to you today about different aspects of the connections and links between climate change, and the conditions that create climate change, and the impacts of climate change, and similarly for pandemics. I wanna just take a quick minute before we get started and talk about the institute for just a second.

If you're not familiar with it, the Environmental resilience Institute is a creation of IU's Grand Challenge Prepared for Environmental Change. We're an institute based at IU that works across the university and with many partners outside the university to try to help Indiana become more resilient in the face of the environmental and climate changes that we are seeing in our state.

One of our main focuses is local governments in Indiana and helping to provide them with data and tools and resources that will help them become more resilient. A number of the resources that we've developed and have available broadly at no charge for folks include the Hoosier Resilience Index, which is a tool for local governments to assess their own readiness for the vulnerabilities that they face with climate change.

This webinar series, our toolkit called the Environmental Resilience Institute toolkit, where you can find lots of information sorta soup to nuts about different environmental change issues that affect us here in Indiana. Many, many case studies from cities and towns around Indiana in the Midwest. It's really tailored towards the kinda communities we have here in Indiana.

Primarily small to midsize Midwestern cities. We support at the Grand Challenge in the institute, we support environmental journalism and communication about environmental and climate issues through our podcast in this climate, through the Indiana Environmental Reporter which is an online free news service, news stories produced about environmental issues.

At any entity in the state is free to use at no charge as long as you attribute them to the Indiana Environmental Reporter. We have some webinars coming up that I'm also really excited about, that when we talked to local communities often what they tell us is they need help in figuring out the economic impacts of climate change but also how to evaluate the economic pros and cons of different steps that they might take in order to become more resilient.

So we'll have some experts talking about that. And then just when we might be having some extreme heat, we will have a webinar about extreme heat and how that impacts public health and infrastructure here in Indiana and things that people can do about it. Always looking for ideas for webinar topics and interesting speakers that you think would be useful.

We do record these webinars and we archive all the past ones. So feel free to go to our website and see if there are topics that you are interested in. You can watch those. We have a couple of important partners and supporters in this work and wanna acknowledge them.

The Association of Indiana Counties and Accelerate Indiana Municipalities who've been our partners from the very beginning. And also the Indiana Public Health Association and Health by Design to really important organizations in Indiana that work on issues that affect local government and the space that intersects public health, quality of life, economic vitality and that sorta thing.

We've had many, many people register for today's webinar. These are some examples of the groups and organizations and people that wanted to sign up. So I'm not sure where we are with attendance right now, but very pleased to see that there was a lot of interest in this.

I am gonna quickly introduce both of our speakers and then I'm gonna hand it over to the first one, and then he's gonna hand it over to the second one. And you won't hear from me again until the end, unless there's some big crisis, which I'm assuming there won't be.

So first, we'll hear from Gabe Filippelli. Gabe has recently been named Chancellor's Professor of Earth Sciences and Director of the Center for Urban Health at Indiana University, Purdue University, Indianapolis, otherwise known as IUPUI. I've known Gabe for many years, have enjoyed working with him. His work includes research and comparative analysis of past climate change impacts on terrestrial and marine ecosystems with a particular focus on how these systems respond to rapid climate change as a way to look into how Earth and human systems will respond to current and future climate change.

That sounds like something that was written in order to get him that Chancellor's Professor title. What I know about Gabe is that he's extraordinarily competent and committed to working with directly with communities in Indianapolis and beyond. Looking at environmental issues that affect them, like lead poisoning, like water quality, like air quality.

But also just very expert on the science of climate change. And then we'll hear from Dr. Stephen Jay, who I also have known for many years. Steve is professor emeritus at the IU School of Medicine and at the Fairbanks School of Public Health. He is past founding Chair of the IU School of Medicine Department of Public Health.

He teaches, does research, service in the community and patient care. And he directed the IU School of Medicine program to establish the first health services administration, federally funded area Health Education Center in Indiana. Also just extremely committed to making a difference in our community. He's an internist and a pulmonary specialist.

Very, very expert in air pollution, climate change, infectious lung diseases, that's sort of topical right now, tobacco control, health and environmental policy and bioethics. And when I introduce Steve, I usually point out that he was the one that led the effort to have the IUPUI campus become smoke free.

So all of us breathers can thank him for that. So, thanks to both of you for being with us today, and I'm going to turn it over to Gabe.
>> I really appreciate the opportunity to present, and the very generous introduction. As I'm getting my screen up now.

I'm an environmental scientist who works a lot on health issues, right? This intersection between environment and health. And so the way that we have organized this meeting and Steve is I'm gonna be talking about some of the environmental factors that drive climate change and then enhance communicable disease, and then I'll pass it off.

Feel free if you have any questions email me, or I'm on Twitter as well. I'm not gonna be live tweeting this while presenting unfortunately, but nevertheless, I'll get on that shortly. I'm gonna be talking about a number of things but mostly how climate change and human activities have enhanced disease transfer between organisms and human beings.

So this is called zoonosis. And we're gonna look at climate change and potential for future outbreaks. And I'm gonna provide some highlight examples from our work here in Indiana, which that describes some of the issues that we actually have in our own backdoor. The bottom line though, is if it seems like things are getting worse, it's because they are in terms of climate change and pandemics.

They are linked inexplicably with along with our human practices, and they'll continue to do so unless we change. And these predictions have been around for a while, and unfortunately these predictions are coming true. But fortunately I'm going to provide toward the end the picture that we actually know how to change this.

We know how to how to deal with climate change. And we know how to improve local and global environments as well. So we've all probably quite familiar now with COVID-19, which is the disease that's manifested from the SAR-CoV-2 virus. That's just a cousin of the SARS virus that hit almost two decades ago, and it is a coronavirus, which is extremely common virus we have around.

This one for reasons that I'm sure Stephen will get into a little bit more in depth, this one is just particularly infectious. But we're familiar with all of these communicable diseases. And they all have sort of different flavours to them and different vectors. So that ranges from giardia which causes waterborne disease from bacterium, to Hanta virus which has a rat intermediary, to Lyme disease, and so forth with ticks.

And these diseases have been around since dinosaurs have been around to tell you the truth. I've been reading a great book on on the mosquito, and it describes how the dinosaurs were attacked by some of these diseases as well through mosquitoes. So, they've been around for quite a while.

Like I said, most of them have a middle partner in this exchange. And so some of those are what we consider natural partners. Certainly, we've had bats, mosquitoes and pangolins for quite a long time. So they've already always been present in our environment. Yes, we've had pigs chickens and mice for that long as well, but we've been in particularly with pigs and chickens, we certainly have been domesticating them quite a bit.

And it ends up that a lot of domestication of these livestock are what's putting us in very close proximity to these vectors. Now, a lot of these organisms are not sickened by what they're carrying. Certainly mosquito is not second at all to be carrying Zika, nor is a bat sickened by hat by breeding the virus, that's this Coronavirus.

but it's it takes a couple steps in this process to end up getting infected. So, why is it that we've seen a sharp increase over the past 100 years? And it's largely for two factors, climate change and what I call that the knock on effects of what we're doing, which are causing climate change, as well as human practices.

So the human practices and include how we're rearing livestock, how we're trading livestock, our encroachment on wild lands, and this speed of travel which allows an epidemic to become a pandemic. So I mentioned early on I'm gonna focus mainly on climate change and related activities, and turn the health stuff over to actually the health expert in the second half.

These environmental pressures all sort of come down to factors related to climate change. Climate change is does one thing and that's how we measure climate changes, is that it alters the distribution of temperature and precipitation. And a lot of our work with Environmental Resilience Institute is actually looking at those changes and beginning to forecast them into the future.

We already have ample evidence of that they've occurred in the past and they're continuing to occur to this present day. But the ramifications of both of these alteration of temperature and precipitation is it changes ecosystems. It causes some ecosystems to collapse entirely. We are seeing that play out in large deaths on coral reefs, but there's other ecosystems, terrestrial ecosystems which this occurs on as well.

But it also causes ecosystems to migrate as well as the species that are part of them. And this is migration, and I'll bring this up in local examples, this migration of tropical vectors to what we're in the past temperate environments like Indiana and others. One of the one of the main factors as well as in disease spread.

So generally expands the range of vectors. There's of course also deforestation, which contributes directly to climate change through carbon emissions directly from burning, as well as from soil loss. And there's biodiversity loss and environmental degradation, which is again a combination of climate change impacts as well as what we're doing to the environment.

In a nutshell, they all move what were previously endemic wild species in very close contact with humans. We saw how this played out with Ebola virus in Western Africa, where deforestation and movement of populations ended up biting up directly against mosquito borne pathogens. And then our own practices of how we dealt with, I'm sorry, Monkey borne pathogens, and then our own practices of how we handle that bushmeat then caused the problem to accelerate.

And in a nutshell is environmental pressures can is best I think captured in this fantastic quote rampant deforestation, uncontrolled expansion of agriculture and so forth have created this perfect storm for the spillover disease from a wildlife to people. And this was published by our very own IU's environmental resilience Institute's very own Edwardo Brondizio just last week.

And as I think it encapsulates these issues, very well, and I'd like to think that in a sense all roads lead to climate change, I know that's overgeneralizing but let's take a couple of examples of this. For example, we've all heard of rampant wildfires that occurred in Australia.

While these wildfires that are occurring in a lot of places, some of them are human triggered, a lot of it is because of changes in rainfall and temperature. And so these wildfires cause the movement of the species that were endemic to those forests toward human habitations, right? So in this case, there's a bat that's now fled that forest, and now is living in on a farm or near a farm that's raising pigs, and the pigs get infected and pass it on to the farmer.

Similarly, climate change can lead to extreme flooding, we've seen this in Southeast Asia quite a bit and even in our own state, and the flooding of course is a perfect breeding ground for mosquitoes. And those mosquitoes can bear these pathogens and transfer them into chickens for example, so this is the chicken example and then into people.

And finally there's deforestation and human practices, so deforestation again causes destruction of landscape which makes wild organisms come into contact with us. In this case it's via pangolin which is then sold and butchered in a market in China. So If we wanna think of these communicable diseases, they are not just born in China, born in Africa or wherever, actually many of them are born here in the US or Europe, there's many examples of that, and so this is the global phenomenon.

And, of course, it's made worse by the fact that we are a global society now and we travel pretty freely and rapidly. And so let's get into some of these epidemics. I just wanna leave it out on the table right now, there's absolutely no evidence that this virus leaked out of a Chinese research lab, but doesn't mean they didn't, but there's no evidence whatsoever.

On the other hand, there's lots of evidence that it is just a run of the mill, but particularly fierce virus that follows the same pattern as SARS, Ebola, MERS, Hantavirus and so forth, it basically came from the wild and into humans. So, why do I say that these problems will will continue to be with us?

Well, it's because climate change is gonna continue to be with us, climate change is driven largely by the emissions of carbon from our practices in the atmosphere where it acts as a greenhouse gas, and changes the distribution of temperature and precipitation. This is a measurement for Mauna Loa which is just our longest running observation station, basically all the carbon records look the same.

They've gone up and in fact, their increases is slightly exponential or is greater than linear, for example, my first breath I gave myself a favor, I marked myself at 1967. Okay, I'll stick with 67, that's a fine year, anyway I was actually 1964, my first breath was 320 parts per million carbon dioxide, my son's first breath was already up to about 365.

And my daughter's first breath was already up to about 382, so within from generation to generation, it went up by 35 parts per million, and even within one single generation, my oldest son to my youngest daughter, it went up substantially, and you can see it continues to the present.

We know what drives this, what drives this is carbon emissions and we know what would stop this trend from being exponential which is stopping emitting carbon. So it's pretty straightforward recipe really, we have seen that it's linked very strongly to global temperatures, there are some certain variations and temperatures, sometimes ocean stores extra heat, sometimes it stores less.

But regardless, it's no surprise that the hottest five years on record have been the last five years, and this is a trend that we've seen globally. What that effectively does, is it moves us to a different latitude, so it moves us toward a more tropical latitude effectively. So what I was mentioning that these vector borne diseases are these tropical ones are moving to temperate zones, it's probably more accurate to say that temperate zones are moving to the tropics.

And this is the projection that we have for this coming century under a couple different scenarios. So you could see that we've already experienced the weather is different here and it will continue to be so. One of the ramifications of this is combination of warmer winters and more flooding.

Warmer winters means that you don't kill off larvae, insect larvae, especially the viral larvae of mosquitoes and ticks, or you simply don't kill as many as you usually do. And more flooding is of course perfect breeding ground for mosquitoes. And so that combination allows expansion of vector borne diseases.

We could see that right here in our data from Indianapolis, where the number of ticks caught ticks, I'm sorry mosquitoes caught in mosquito traps by the Marion County Public Health Department increased fourfold in this timeframe was 400%. And that's again likely related to a lot more flooding, particularly spring flooding that we've had.

Similarly, Lyme Disease has expanded tremendously now, the incidence incidence of Lyme Disease doesn't always mean that there aren't cases that go undiagnosed, this is just diagnosed with Lyme disease. But the expansion of species in that bear the Lyme disease, so deer tick and other other dear is likely to be the main driver along with climate change of this trend from 1996 until 2014, this huge explosion in Lyme disease cases, again by about 400%.

And so these are both evidence that doesn't even require advanced modeling is actually just evidence that the environment's changed substantially. And it's these kinds of changes that can help contribute to the current pandemic as well as future ones. We are not powerless in this quest to try to slow the speed of climate change and pandemic spread and pandemic growth.

I had used that the carbon dioxide record or the greenhouse gas record in a couple slides ago. But you could see that there's number of trajectories that we can head toward depending on how much we control our future emissions. And it could be a trajectory that's more manageable like the blue trajectory on the bottom or one that's less manageable like the violet one.

Regardless, the future truly is in our hands. And I want you to leave with a couple kind of take homes that I've worked on quite a bit. You might have heard that carbon emissions have dropped tremendously, they're gonna drop 8% this year from COVID-19. We need them to drop about 7% a year to meet the Paris Climate Agreement targets.

Nevertheless, it's dropped 8%- in this year, but that's drop is from collapsing the entire global transport systems and in collapsing economic engines around the globe. So it's not putting up a solar panel or riding your bike to work one day a week. That's great, do all that stuff, but it's not going to solve this problem.

What I'm thinking might be a motivator is the fact that cities around the world are now able to see the mountains behind them. My colleagues, I was on a webinar last week, colleagues in Pakistan, they can see the Himalayas for the first time ever. And that smog is largely from vehicle emissions and the reduction of vehicle emissions cuz of shutdown.

I'm hoping that that clean air might be one of the global inspirations to actually change practices and expand our ability to de-electrify or I guess de-carbonize all of our electrical systems and transport systems. So before I pass it onto Steve, I'll just leave you with this. You would think that the public health response would be a well oiled machine by now but yet again, we'ved been blindsided.

This is by a book to the Stockholm Paradigm. All of these are links once this is online. You'd think that that was published last week. But no, that was a book that was published in 2019. So I don't know what Brooks, Hoberg, and Boeger would say about the situation now but clearly we've been blindsided again in a serious way.

So I'm going to now pass it over to Steve and I'm gonna be hanging on and happy to answer questions at the very end.
>> Can everybody see that?
>> We're not seeing your screen Steve.
>> How about now?
>> Nope.
>> All right, would you like for me to share that for you, Steve?

Looks like you figured it out.
>> There we go, there we go.
>> Sorry about that. Thank you very much for the privilege of interacting with two of my favorite people. Janet and Gabe Filippelli. And the Environmental Resilience Institute at IU, which is really a great step forward.

So let me start. By just emphasizing the link that Dr. Filippelli has already mentioned, but here's my list of a few of the sort of existential threats, if you will, that I see in addition to COVID and climate change, air pollution, loss of biodiversity. And another one you don't hear a lot about, but it's critically important, antimicrobial resistant infections.

The good news is is these are amenable to science based public health mitigation and adaptation strategies but our challenge today is the foundations of public health. The science, the rule of law and human rights and civil discourse are in troubled times undermined at this pivotal time when climate change and pandemics threatens societies and global health and wealth.

The evidence for the links between environmental change and communicable disease is robust. As Dr. Filippelli suggested, the attributable fraction of diseases caused by environmental factors can be measured and is very useful to inform public health interventions. At a local level in communities around the world, decreased quality of water, food, sanitation, increased rates of communicable diarrheal diseases as a result, air pollution, of course and climate change increase infectious diseases including COVID-19 pneumonia.

The catastrophic deforestation was mentioned by Dr. Filippelli and this is just one of many, many research papers that demonstrate how deforestation creates hot spots in this case for malaria and dengue from spread of anopheles and aedes mosquitoes. Now all of this, these links, should not be surprising. We have to go back to Hippocrates and I'm sure it was before him, but anyway in Airs Waters & Places, a famous treatise, he described the links between the human condition and environmental changes, in beautiful terms.

Evidence nowadays and today by the COVID-19 passing through bats and civets to humans frightening yet long predicted by philosophers and scientists. In essence, environmental degradation is a bridge for nasty viruses to pass from the wild niches to civilization. Potential environmental and public health effects of climate change were predicted long ago.

But in the 50s, a chap by the name of Keeling had measured atmospheric CO2 at Mauna Loa. Somebody has to do that as a grad student. Mauna Loa is not a bad place. But he measured increase in CO2 and parts per million 316 in 1958 to about 416 today.

But scientists in the 50s were predicting radical effects on climate and health by 2000. The power of science I guess to predict, they pretty much hit things on target at that time. Today, and I might add another mention that as a pulmonary fellow in Dallas back in 1970, we were measuring gases in the atmosphere and in patients and so on.

And we actually knew of Keeling's work and discussed the possibility of changing our patient standards to account for the small but measurable increases in CO2 at that time. So we've known a long time about these problems. Well, today as global CO2 and temperature increase, weather is as we know unpredictable, sea levels rise.

And we face unprecedented harms that are sort of described in this Cartoon and if you go clockwise, we see these are real threats and actual diseases and suffering that occur today as we speak all around the world. So this is not in the future, this is now. These are some of the problems.

Air pollution with asthma, COPD, even cause of lung cancer, vector borne infections, lyme disease, malaria and dengue, respiratory allergies, waterborne cholera and cryptosporidiosis. Environmental refugees with forced migration and civil conflict and a myriad of communicable diseases. Mental anguish, anxiety, despair, PTSD a significant problem today. Degraded water and food with starvation and diarrhea, heat stress and heart failure.

And finally injuries and fatalities from severe weather, that little child with his teddy bear at his feet sits in his home rubble a victim of Katrina. The good news after all that bad news, is that since 1970, 1972, the Clean Air and Water Acts and more recent rules, air pollution, water quality in Americans health have significantly improved.

Unfortunately, Harvard and Columbia law schools just reported pretty remarkable dismantling of nearly 100 environmental rules in the past three years. Primarily at EPA where rollback of about 27 of those rules will increase Americans risk of morbidity, mortality from respiratory disease. Ironic and tragic since, COVID-19 patients commonly present and die from a respiratory disease, pneumonia.

The net sum of climate change attributable diseases globally is very difficult to estimate. But the rough estimates have millions of diseases many, many deaths being cause around the world which cost to the world economy, estimated to be $8 trillion by 2050. And there's a troubling global mismatch between countries greenhouse gas emissions and their burden of harms.

Wealthy countries pollute, poorer countries suffer a global equity and justice challenge for humanity to address. Sea levels rise climate refugees appear around the world including the U.S Native Americans at the hilly is John Charles and the Mississippi Delta. And had Kivalina, Alaska, I believe Janet McCabe visited there at one time.

Climate refugees suffer a myriad of communicable diseases and are projected to be five to 10% of the global population by 2050 about 200 million people. A great challenge for public health and humanitarian organizations. These environmental changes increase the risks of communicable diseases whether epidemics or pandemics and we talked today of things going viral.

Indeed viruses may explode in an autoimmune population as shown here. One case, January 8, 500 January 23, 3.1 million April 28. America unfortunately leads the world and COVID-19 morbidity and mortality. This exponential growth is preventable. Public Health aim is to decrease contagiousness, the number of cases caused on average by an infected person, so called basic reproduction number.

The R number which is very useful for COVID 19 today is about two to four all of that stands needs more of a search, but it's in that range. Season veterans of epidemics know that to achieve and sustain an R of less than one requires first being prepared, testing, isolation, contact tracing.

Acting decisively using science based measures. Interestingly, Albert Bartlett, a famous lecture and 1969, a physicist by trade, said, quote, the greatest shortcoming of the human race is our inability to understand the exponential function, end quote. One lenders weather resistance to swift action in the US regarding climate change and COVID-19 stems, in part from this inability.

COVID-19 models forecast cumulative death and estimates vary with assumptions, most models are inaccurate. Some of them are very useful. That's a quote from somebody else and I think captures the problems of estimating things into the future with so many unknown variables. The difference shown here in this slide between strong contact reduction and weak contact reductions, about 50,000 deaths in the coming weeks, depending on our action to slow the spread.

These models are estimating direct morbidity and mortality of COVID-19, less is known about indirect impacts of COVID-19. But they're likely substantial. And include things like loss of routine care, like of medicines and technology, infection and death of front-line workers, persons not treated when hospitals are overwhelmed. Decrease in public health services during this time, quarantine related stress, domestic violence and suicide today particularly concerned.

Loss of jobs, health insurance,direct and indirect morbidity of COVID-19 disproportionately affects the poor. The racial, and ethnic minorities, the disabled and uninsured, and I think these pandemics and climate change are unmasking terrible concerns that we have for, as some people call the least among us. In this fifth month of the pandemic, the relative effectiveness of responses among countries has become apparent.

The U.S response compared to other countries has been slow, confused and driven more by policy than science unfortunately but two states deserve some credit. There are others but I'll pick on two California and Washington. They were prepared, organized, prompt and statewide science based decisions. Washington's COVID-19 death rate of 12 per 100,000 population in California is seven per 100,000 reflects some wise decision making.

New York lost some critical time early just a couple of weeks. But it makes all the difference with exponential change, but they lost a couple of weeks before showing excellence actually in catching up. But their death rate is 135 over 100,000 population. Both Washington and California are cautiously reopening business based on data driven process.

Keeping in R less than one isn't easy. Many states are reopening now without such rigorous data and we will see outbreaks, With no vaccine or safe effective drugs, we have to use traditional means which are effective the CDC guidelines in this case, hand washing, avoid touching the face, six feet physical distance, wearing masks, avoiding close contact with the sick, staying at home, cleaning surfaces, covering nose and mouth for sneeze and cough.

At a community or state level, key our surveillance, testing isolation, compulsive contact tracing, really keys to minimizing surges and return of business shutdowns, which are being experienced now in many parts of the world. National leadership to coordinate America's response to COVID-19 is needed. Many countries have excelled in their responses I pick just a few here South Korea, Germany, New Zealand, Taiwan, among others.

They share characteristics. They were well prepared based in part on their experience with SARS. They were organized, decisive, early targeted high per capita testing. They had excellent technology and data analytics support. And their national leaders for science based transparent, empathetic. They use general measures based on data to fit their needs, social distancing, masks and so on.

And a key I wanna stress is national health insurance, which we do not have in the United States. But it has been a critical factor a critical piece in the success of countries in dealing with this pandemic. COVID-19 reproduction rates among us states are shown here in the upper panel from April, and it just shows our numbers at one or greater in red.

That's not good. The goal is our values consistently less than one. In the bottom panel, Germany's aggressive control effort decreased, there are numbers from about four to less than one from January 28th to March 24th. Quality are a number of data are invaluable in planning, reopening of businesses.

Without such data frequently repeated and reported, decisions for opening will likely fail. A prominent public health expert at Hopkins Bloomberg School of Public Health recently urged the CDC to report and communicate transparently. The R number data to the public to increase public buy in an understanding of the actions being taken to slow the spread of COVID-19.

Just a brief word on Indiana we ranked 14th in the US with about 25,000 cases, 1500 deaths. Indiana unfortunately lacks public health infrastructure ranking 47 out of 50 states for state and federal funding for public health. And as with most other states, Indiana has a disproportionate representation of racial ethnic minorities among COVID-19 cases and deaths.

But overall, ISDH, local health departments, our universities and community hospitals are providing excellent care for patients and their family. In summary, climate change and COVID, along with other global public health threats I mentioned earlier, have laid bare humanity's challenges the issue may appear overwhelming. But with thoughtful, science based nonpartisan leadership, we will prevail.

1944 a B 24 Liberator plane rolled off the assembly line every hour four months at a time. Americans have risen to existential challenges. The good news is that science has informed our way forward. I've listed a few near term actions, sort of my biases, to consider. First, reestablish the Office of Pandemic Preparedness, which was discontinued in 2018.

Commit to the Paris Agreement and aggressively pursue decarbonizing our economy in the global economy. Create science-based transparent, credible public communications, so important during crises such as ours. Established national health insurance as I mentioned. Restore major funding cuts, which we've suffered over the last many years, actually, at CDC, NIH, NSF, our universities, R & D, and Public Health infrastructure.

A topic of great concern to the National Academies of Science. Create international collaboration and partnerships for tracking US global impacts of public health emergencies, we have to work internationally with our colleagues around the world. And establish adjust transition for workers adversely and disproportionately impacted by climate change and pandemics and just an added note, try to as soon as possible return to a bipartisan Congress.

The good news is we have a start on decarbonizing the environment. These data are from the World Bank and they list 57 major pricing initiatives in the world. Implemented or scheduled, we just need to fill the color on this map quickly. COVID-19 has reminded all of us to take care of ourselves, our families and friends and support those in harm's way.

The celebrations of our frontline heroes are moving and really capture the bright side of America, humanity. And finally, I think there's some great news maybe even increasing exponentially. The number of voices for change that we're hearing in this country and around the world. Evidence based advocacy is energizing youth Gratitude, Berg and others.

This is a once in a chance, lifetime to transform our thinking and actions hopefully bold, innovative and restorative.
>> Thank you Steve. That was great. Both of you thank you so much. We will we have a little bit of time for questions. So, thanks to those of you that have been putting questions in the chat box and Gabe has been responding to some of them.

One question, Steve, for you is, what are your thoughts on COVID-19 immunity after exposure? That's much in the news right now.
>> It is and I'm not an expert in that area, but we need a lot more research. It's based on studies with other viruses, you're exposed and you'll get an increase in IgM and then later IgG antibodies and that protect you from future events.

That has to be demonstrated, however, for this virus and it hasn't been as yet. So we're still a little bit uncertain. There's nothing that I know of that would prevent that from happening but we just need more data. There are some people donating plasma with antibodies, as we probably have read about which I think is definitely worth Trying and there are anecdotal cases to suggest that has done some people some good but again, much more research is needed.


>> I wanted to ask both of you, if you could comment on a couple of studies that have been reported on recently that show a correlation at least between high rates of COVID-19 and mortality, perhaps, and areas of excess air pollution.
>> Gabe, you wanna start?
>> I'll start and then of course let the pulmonologist actually maybe.


>> I know the air pollution part pretty well and I've been reading about this quite a bit because we've done our own work on the impact of COVID shutdown on air quality here in Indianapolis. We have seen about a 30 to 40% improvement over in air quality this year compared to last, again because of the near total shutdown of the entire system.

But nevertheless, it kinda shows a tight connection between our actions in a local environmental issue as well as in the global issue of climate change. What I've been when I've seen that those connections being made, which is that if you've been exposed to poor air for a long time, you are more susceptible to the more severe side of COVID-19 unfortunately.

So I've seen that and it's borne out a little bit in some evidence from Italy for example. But there's way too many compounding factors here for example, the people exposed to poor air in this country are typically also the ones of lower economic and health status. So whether that's because they have been exposed to bad air or whether it's simply because they are poor they don't have access to proper health care and they are not doing preventative work.

This could all tie in to it, but I guess the bottom line is there is not a tight enough connection yet because of those issues.
>> Yeah, what we have are a lot of data that go back for viral infections in general viral pneumonias example and studies that show pretty regularly that viruses go to the lungs and upset the ecosystem within the lungs.

And create lots of havoc from pneumonia to pulmonary edema interstitial what we call interstitial lung disease which is just a thickening of the lung. And so those data are pretty clear. Now, factoring out the variables that Doctor Filippelli has mentioned has been a tremendous challenge. But it has been done to the satisfaction of most now so that if you tease out all those variables that you got to factor in smoking and socioeconomic status etc.

It looks pretty clearly that air pollution per se particularly fine particles, but also oxides of nitrogen and sulfur cause increase in susceptibility. They change your immune status, the immunity of the lung and your immune status to make you more susceptible to respiratory infections. I think the example of that Gabe mentioned earlier of how the fact you can see the mountains clearly for the first time in the life span is so critically important in getting people's attention.

And the fact that short term air pollution, as Dr. Filippelli mentioned, has dropped dramatically in places like China and in the United States, and maybe these are the kinds of sort of symbolic things that will get people thinking about not returning after the COVID pandemic to business as usual and re polluting things.

Some of the experts have weighed in and said it's not gonna take long if that happens before we're right back to where we started.
>> Thanks, both of you. One of the questions that came through the chat box had to do with how we balance our emphasis on mitigation versus adaptation.

And we deal with that a lot in the Environmental Resilience Institute. So I wonder if either both of you could could speak to that.
>> I posted a brief reply to Chrissy. But yeah, we're too far past the point where we're not going to have to adapt. So mitigation and adaptation are going to have to be going on together.

I think the key here so the more emphasis you put on mitigation in rapid mitigation, the less chaotic and deadly will be the adaptive response we will need to this.
>> Yeah, I would agree I'm not a fan of dichotomies or even trichotomy. To say mitigation and adaptation, what about prevention?.

Let's prevent it. You actually have to do all these things together. It's a system. And so I would agree with with Dr. Filippelli's comments. We're way past the time when we could lean just on one factor, but we need to consider and continue to keep in our forefront the efforts to prevent climate change, to prevent these viral diseases.

And we're now at the point where obviously adaptation is crucial with a lot of good work going on around the world and in the United States in that regard. I think California was the first state to develop a statewide adaptation plan, or at least one of the first states, which was a long time ago.

So we've had some head start in trying to understand exactly what that means. Of course, it differs where you are in the country dramatically actually, in terms of how you organize things and structure things to best adapt to that.
>> I would just I would just add that we use the word resilience a lot at the Environmental Resilience Institute.

Because it's right there in our name. And I've been thinking a lot about how to explain that to people what really is resilience. Because I think some people come to it with the notion that resilience is being able to bounce back when something bad has happened to you, and to me that conveys two incorrect premises.

One is that we wanna just get back to wherever we were before as opposed to getting to a better state in the future. And the other is that you're just sort of waiting around for the bad thing to happen so that you have this opportunity to bounce. And when I talk about resilience, I really explained it as having three steps, the first of which is to reduce the likelihood that the bad thing will happen to begin with.

And that's if you're worried about your biggest employer in town leaving you don't just sit around and wait for them to leave, you work with them to make sure they're happy and wanna stay. So mitigation is step one, but you don't have to call it that if that is problematic for people.

And the second step is to make choices now that won't increase your risk of harm in the future. Which needs to be informed about where the floodplains are going to be and where the high heat hotspots are going to be. And make decisions now to keep people, fewer people from being at risk there and property and that sort of thing.

And then step three is prepare for the unavoidable which certainly that we need to do. So I didn't mean to hog the floor there, Andrea, you usually run these questions and I just completely hogged it. So why don't I turn it back to you to do this in a way that you know how to do so well.


>> Well, I mean, I think we're fine to continue on as is. I'm scrolling down to see what questions we haven't gotten to yet, but if anybody has a question they'd like to offer up verbally feel free to do so.
>> I'd be happy to receive emails myself.

I'm not much into the other social media stuff. I do text. But send me an email if I can provide literature data or what have you.
>> Yeah, several people have commented here that we're just running out of time and these solutions are so huge and it's so hard.

How do we keep it moving? Julia chatted, I hope for transformational behavior from humans around the world as a result of COVID-19.
>> Me too, me too, and if people on this webinar are interested or have ideas, I would encourage you to send an e-mail to Andrea, or me, or directly to Gabe or Steve.

But we can kind of collate it. And especially if people have ideas about how we can have these conversations here in Indiana. I do think that we have a incredible opportunity here on, unasked for with much suffering by many people. But if we don't learn lessons from this experience, then then shame on us.

And however people come to this, whatever moves them, let's use that approach with those different folks.
>> So one question that has come in and maybe we'll leave this as the last question. So if we were to become carbon neutral, what effect would methane emissions? All right, let's see.

What effect would the methane emissions have on us that we can't control?
>> I was just asked about an hour ago by my neighbor whether he should go vegetarian, I kid you not. And he had read something about methane and meat production and so on. So we had a brief chat.

And as you probably know, there would be a big difference if everybody in the world went vegetarian. Don't quote me to say that everybody should do that. But production of meat does lots of sort of bad things to the air, the environment. Methane's about 35 times more potent a greenhouse gas than CO2.

So it's a big issue.
>> And of course there are dependence on natural gas. And the exploitation natural gas makes that a little bit worse, natural gas is methane. And we found that it's significantly leaking from production fields even before turning on your stove or your furnace. And we've been actually looking at these methane sniffers.

So there's ways to actually see methane from outer space pretty clearly. And we've just had a new result out last week just shows the immense amount of methane coming off of the Permian Basin, oil and gas production facilities in western Texas. And that's just leaking out, just simply leaking out into the air.

It's not being used as a fuel source. So methane is huge.
>> And then permafrost melting all over the world.
>> So there are ways to reduce emissions, reduce that leakage from oil and gas development. And when I was at EPA we put out rules requiring that. And we're moving forward with that.

That's pretty much on hold under this current administration. But I think that's something that people will be looking at hard. The increased knowledge about the amount and impacts of methane from oil and gas development has really grown in the last ten years. When fracking started really opening up those fields.

Well, there's lots of questions coming through and some compliments, thank you very much. I think this has been an excellent webinar. It will be archived, that takes a couple of days, but feel free to share it with other people. I hope you will come to future webinars. So let me just let everybody get on to their next thing and practice good habits by ending roughly on time.

By thanking Dr. Steve J and Dr. Gabe Philappelli and Andrea, of course, for making all this run. And thanks to all of you for coming. And please stay safe and well and your families too.