Bill Gates says pandemic could get 'worse than I would have expected' - and calls for leadership


Tech leaders typically use their TED talks to sketch out an optimistic vision of the future, but today Bill Gates used his to warn about a rough autumn ahead due to the continuing coronavirus pandemic.

"There's good progress … but nothing that would fundamentally alter the fact that this fall in the United States could be quite bad, and that's worse than I would have predicted a month ago," he told moderator Chris Anderson during a live-streamed TED2020 Q&A.

Although Gates didn't mention President Donald Trump by name, he faulted a lack of American leadership for making things worse.

"We need leadership in terms of admitting that we've still got a huge problem here, and not turning that into almost a political thing," he said. "You know, 'Isn't it brilliant, what we did?' No, it's not brilliant. … We need a leader who keeps us up to date, is realistic, and shows us the right behavior as well as driving the innovation track."

Although the bulk of Gates' career was spent turning Microsoft into a tech juggernaut (and turning himself into the world's second-richest individual), he and his wife, Melinda, have focused on global health issues for the past two decades. In recent years, he's been raising the alarm about the potential for a global viral outbreak - most famously during an earlier TED talk in 2015.

Now he comments on the pandemic's progress almost weekly from his Seattle-area home base via video links with media outlets ranging from TED to CNN to Comedy Central's "The Daily Show."

Many of the comments during his Q&A with Anderson revisited past themes, but came against the backdrop of a rise in confirmed COVID-19 cases reported in states such as Arizona, California, Texas and even Washington. "The virus has gotten into a lot of cities that it hadn't been in before in a significant way," Gates noted.

He worried that the U.S. death toll from COVID-19 could rebound from its current average rate of 500 to 600 deaths per day to the levels seen in April - that is, in excess of 2,000 per day.

Previously: Gates Foundation CEO on COVID vaccines and the pandemic's potential silver linings

Two worrisome factors have to do with a resurgence in mobility that is facilitating transmission of the virus, and a reluctance on the part of many people to wear face coverings when they're out in public.

Gates said the experts were wrong in the early days of the outbreak when they discouraged people from wearing masks, partly out of concern that there wouldn't be enough medical-grade masks available for health care workers. "It's a mistake, but it's not a conspiracy," he said. "It's something that we now know more [about]. Even now, our error bars on the benefit of masks are higher than we'd like to admit, but it's a significant benefit."

On the topic of mobility and the reopenings of businesses, Gates said "there are some things we shouldn't have opened up as fast."

"Opening the bars up as quickly as they did - you know, is that critical for mental health?" Gates asked.

In contrast, there's a serious benefit vs. risk tradeoff when it comes to reopening schools. "Probably the benefit is there," Gates said. "Now that means you can get surprised. The cases could show up, and then you'd have to change that, which is not easy."

Gates said epidemiologists at the University of Washington's Institute for Health Metrics and Evaluation found that infection rates in May and June were not as bad as their computer models had projected, leading them to conclude the coronavirus that causes COVID-19 was somewhat affected by seasonal weather - as is the case for cold and flu viruses. That might be good news for the Northern Hemisphere's summer, but it's also why Gates is less optimistic about autumn.

The silver lining is that "we will have some additional tools for the fall," Gates said. Studies have already shown that drugs such as remdesivir and dexamethasone can improve a patient's prospects, and more treatments may be found by October.

"We should start to have monoclonal antibodies, which is the single therapeutic that I'm most excited about," Gates said.

But Gates said it's unlikely that any vaccines will become widely available before the end of the year. The three farthest-along vaccines are being tested by Moderna (with the help of an initial Seattle-based clinical trial), Johnson & Johnson and a team including AstraZeneca and the University of Oxford. Other prospects are moving ahead as well.

Gates suggested taking a cross-company approach to produce the best vaccines to emerge from clinical trials. "Then you're using the manufacturing plants of many companies to get maximum scale of the best choice," he said.

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