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Zachary I can tell me he has a question for you. Can you bear a question from Zach? I would love a question from Zack Zack. You're doing a great job on the podcast. Thank you. I love the facts you come up with thanks. I love the research you're doing I love that. You're not trying to come off as anything other than 18 year old boy. I like that. You don't you don't try to like dress it up and go like I've got some kind of the announcer voice you don't do that. Just sound like a
A kind of a board 18 year old suffering his dad. Go ahead. Yeah. Who's who do you think is the funniest u.s. Senator now
the funniest.
Wow, welcome to the bubble. This is Andy. Slavitt. We have a great show for you today. My Koster home is our guest if you're wondering why you're listening to clips of Zack and old shows. It's because we work.
In this forum as his last show. So let's hear a few more before we start the show. Hey, I want to do shooting my son Zack. Hey Zach, how are you man?
Are you in the graphic for the bubble?
Yeah kind of the bathroom. That's you. Okay good to meet you in person or virtually but to see her face. His cartoon face pretty good is really good Governor. This is Zach. I was just wondering what's your advice?
Two Governors who are just now facing their peaks in the near future.
Thanks for the question Zack. I appreciate it. I love to know what your plans are for the fall. Maybe your dad can tell me at some
point Senator Sanders. I just wondering how do you think that Democratic party can unify for the upcoming election and the next several months given that there were some turnout issues with the previous election that may have cost the party the election.
Well Zach, I think what we are trying to do and that's a very good question and thank you for your interest in politics and I urge you to get your friends classmates involved as well. We have
our will there be Sports version today with Adam schefter this senior NFL analyst for ESPN. How do you like my sports voice? Pretty good, like your son's like your podcast voice to me. Oh just the same as trying to throw on I was trying to
Throw in like in ESPN's hoarse voice didn't little bit. Okay, good good. I think the thing that we don't talk enough about on the show is just how there are some different points of view out. There is a lot of sameness of thinking around this coronavirus in the response. And so I think we got to do a better job of getting more diverse opinions out there. Yeah. I've seen a lot of people
just looking for confirmation bias about
whether or not we should reopen finding something that says we should find you something.
We shouldn't and picking the one that fits what they want to say so we could we could have other opinions. Why are these antibody test important but the antibody test is especially important going with what they just figured out because it could show not only how far spread the diseases but also who can be immune potentially based on this and you think it's important that we figure out who is immune
Une for what reason? Is it important? Because what the time for the over your food? Yeah Evan, here we go. Okay. I have more questions for Zach but he literally has food in the oven that he wants to attend to which is I think what happens when you mix business and home pleasure. Go ahead. Go get your go get you on 28 and salmon salmon, you healthy kid, right you're getting to meet some interesting people Zack, but I think knowing how you are Larry brilliant. One of the people that I think it's
Going to be one of the North Stars for you as you think about your career and your life and your contribution
and you don't have to follow any of those North Stars. You find your own kiddo. Thank you.
It's a bit of a Melancholy episode because last episode was Zak's last episode at least for now as he gets prepared for school. And so I wanted to instead of my normal introduction and of course instead of having Zachary.
Rita fact just talk a little bit about Zach and a little bit of a dedication and I don't actually know Zach forget to listen to this now, but I hope you do someday. Maybe you'll listen long after I'm gone with your kids or your grandkids. So here goes I've got ten things to say to you first. This was your idea this podcast. Thank you for thinking about it. It's been great fun.
Second I learned so much from you and I do learn so much from you all the time Dad's don't say that enough, but I really enjoyed how much I got to learn from you presenting your facts.
Third thanks for sharing with this audience who you are. I know you don't love doing that necessarily maybe not be easy for any 18 year olds, but I think people loved it fourth. I love being your dad and your brothers dad mom, and I wouldn't we would trade everything else we had for that five. I watched you grow on the show. I hope you had fun.
Doing it help you'll look back on and be proud of it six sometimes when we were doing the show. I would just look over at you and feel very proud.
Seven there were times on the show as we were setting up as we were recording where I talked to you more sharply without tenderness in my voice as we were working. I hope you don't take that as a sign of what adulthood should mean adulthood should mean every bit of love and nurturing and caring that you've experienced in your life on the good days.
I never hate I will miss you on the show number nine. Thank you. Thank you for being you contributed excited for the next steps in your life. I know it's not an easy time, but I hope you get to be 18 and what it feels like to be a teen. I know being on this show may have had its moments, but it's no substitute for being a kid. So go be a college kid, even if it happens to be from our basement for some time and
We'll make that work and the number 10 come back anytime. You just say the word you can have your old spot back. Even if we have the best co-host in the world. There's only one you and we'll kick him
out for you.
Okay onto the show really happy to have my Koster home here on the show today. Mike is a friend. He is the director of something called Sid wrap, which is the center for infectious disease and research and policy. It really is as much fun as all that at the University of Minnesota. He is like the guy of pandemics. He's written about pandemics before it happened he is
Been calling this he is advised president. He is someone who has an incredibly touching voice on this podcast. I think this episode you'll find to be very much like the Larry brilliant episode and there are some really great and interesting parts of this interview and I learned a lot. So let's chat with Mike.
Professor hey, hey there. How are you doing today? I'm good. Good to see you.
How you doing, man? I've no idea. What year is it? It's a it's March.
Thanks. I wish it were oh boy. Do I wish it? Were are we doing better or
worse than you thought would be doing in March. I
think we're doing differently than I thought we'd do in March.
So what did you picture? I can't say that
it's worse.
Are better but I I've been surprised by how it's
unfolded with been your biggest surprises
the partisan nature of which are just about everything we deal with divides down into ideology as opposed to Public Health practice in the implementation of that. I think that's really been unfortunate. It didn't start that way though.
Right? I mean at the beginning it felt like I know it's going back to March and April it felt like people were
Heavily together trying to figure out what's going on.
Yeah, well, you know even back then I felt something that wasn't as partisan but it was nonetheless preconceived notions, you know, I published an email on January 20th saying that there's those was going to be a pandemic. It's we've published it's on our website. In fact, one of the more I think wonderful things that our group was able to contribute. I actually met with leadership with 3m on January 20th, and
In doing that I shared with them what we had concluded the next day. They fired up every in 95 manufacturing machine. They had in the world and ran 24/7 long before the US government ever got a hold of them and ask for more.
I didn't know that. Yeah bye weeks
and so but during that time period from January 20th and I wrote an op-ed piece on February 20th and New York Times saying come on. Let's get on with it. This is O going to be a pandemic and we need to be preparing that.
Way and you know where I got a lot of resistance was a lot of the Public Health Community really it all there was people saying here goes Mike again, you know, he's just scaring the hell out of everybody needlessly, you know bad news Mike and you know, no matter how we try to lay out the data people didn't want to believe it. And you know, remember we still had our US Government largely saying that this everything was okay we had who saying is okay.
It's not like you'd said that every day of your life. I mean you said it was coming.
You said we need to be prepared for it, but it's not like it sounds like you were raising these alarms I should but I should stop and confess one thing. This is really for the audience's benefit people who hear me talk and they think I have Smart most of the stuff I get I get from my gosh troll from the start of this thing and not just not just Mike. There's a few other people that you had a chance to meet in the show, but I'd say my primarily is one of those people that when I'm confused or want to understand something, you know, you've been the guy that that explains it to me. So if we were agreeing
If you hear things from Mike that sound like think you've heard before it's not because my stopping me it's actually cuz I copied my kid. He's getting now you finally hearing the
source. Well, you know, I think that we've thought a lot about this. I mean, you know, I come back to it and I'm not trying to promote here but you know in the book I wrote that was published in 2017 deadliest enemies chapter 13 is on coronavirus in the title was SARS MERS a harbinger of things to come and chapter 19 was on what?
Influenza pandemic would look like originated out of China and it's almost unfolded exactly as this coronavirus pandemic. So we thought a lot about this, you know, we thought about it beforehand.
And did you kind of tabletop it's did wrap like how it would go and did you kind of you know, red team kind of scenarios. We you that detailed.
Yes, and in fact right after 9/11, we were asked by the US government to develop a whole series of table tops that we
Did for the government on bioterrorism but then also at melded into influenza and of course what everyone was really preparing for was an influenza pandemic which obviously didn't happen. It's not what we see here, but there are a tremendous number of similarities. And so we have done a lot of work on influenza pandemic preparedness and how that might look we've done a number of different table tops, you know policy discussions on what to do how to consider it.
And there are some differences than this happening here, but I don't whole how society would be impacted was exactly what we had predicted. Did you think when when you wrote
that in January that we still had a chance to contain it like happened in South Korea? What did you feel like know we were going to be on the for sure. I have Community spread
on January 20th. I really felt that it was gone. It was it was like the fire that got away. I did believe that.
I know would probably do as well as anybody contain it because they could take the direct Kony and measures to really bring it to a halt when they could keep people in their homes for 12 weeks or more what I wasn't sure is how much transmission had occurred in China because you may recall this whole thing unfold right at the time of the Lunar New Year and Wuhan which most people don't realize is the Transportation Hub for all of China all the major fast trains between Beijing Shanghai and Hong Kong go through on all the major airports there.
Kind of like the O'Hara for the us where the right in the center of the country. And so we were concerned about how much movement would actually occur within China. But we also knew that there would be a lot of case activity outside of China because of that and so a week after I wrote the January 20th memo. I did another one in which I said, you know, it's probably going to take four to six weeks before the rest of the world sees this because there will be one or two and then four and six and eight and 10
Uses and nobody will pick it up. And by the time we do pick it up, it will largely be in heavily populated areas around the world and it'll flash quickly because then the, you know the numbers when they started the big ones start to double and so that's exactly what we saw in New York. We saw in Lombardy, you know, we saw in other cities around the world
and now you get to here is that can me talk paid for by someone
else.
You know Zack we don't get to talk enough about on the show Sports the suspension of the NBA was really what sent shock waves through not just the World of Sports but through the whole country. It's back now. I know you're watching a lot of the games but things are different, you know Basketball Hall of Fame photographer. Andrew Bernstein has his new show where he sits down with a lot of the biggest names in sports to discuss the historic return to
Season what it takes to get back in the court. It's called Legends of sport restarting the clock. It's a new podcast. It's presented by the LA Times. You can subscribe to it wherever you get your podcasts.
Here in the bubble. We know there's some off-the-wall covid-19 advice for how not to get sick out there stuff, like washing your hands with essential oils. I love essential oils, but I stick with science when it comes to pandemics. That's why I love you, baby for your science. Okay in the bubble is stairs. You're going to hear Lana and me talking about living guard face masks on the show a lot because first we all know that masks really do help curb the spread of covid-19.
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how quickly did you know, there was going to be asymptomatic spread because one of the things that others missed and a lot of political leaders didn't understand for a long long time, but even I will tell you that I don't
know if you know this my Cube probably do but the CDC was used the first bottle they used was an influenza model for spread. And so the reason they kept coming up with answers that this is not going to be so bad is because they kept using an influenza model which of course, you know, people are sick and they stay home because they know they're
sick. Yeah. Well, you know, it's interesting because I had the good fortune or you might say the the unfortunate situation to have worked on both SARS. And myrrh.
First in 2003 when Cyrus hit I was still splitting my time between the secretary's office at HHS and at the University and so I was involved with the 2003 SARS and outbreak response and we realized at that time that the individuals were really not a very infectious tilde five or six of their illness which allowed us then to once we got rid of the animal Reservoir out of the markets if we could just basically isolate these cases soon.
Enough, we can stop transmission fluid which then happen. Well, the repeat of that happened in 2012 with MERS and I haven't been very involved with that. I was a sort of as an advisor the royal family of Abu Dhabi and have spent time in the Middle East working on this issue. I was in Samsung Medical Center in 2015, when that outbreak occurred from someone bringing back the virus from the Arabian Peninsula, and they're the same thing happened this case. It was animal Reservoir was Campbell.
If we never got rid of and weren't going to and so people keep getting pinged with this virus over there, but we understood that humans didn't become highly infectious again till they five or six so initially I too thought that were the case. I just assumed well, this is going to like you sounds like coronavirus Chinese will clean this up quickly. They'll figure out that who is infected. They'll get them isolated and by January 10th, it was very clear to us because we've been following this since December that that wasn't the case that there was
clearly asymptomatic or at least very mildly ill symptomatic Transmission in the community that was not occurring just in the hospital, right? So that's how we knew that on January 20th when I made the statement, which I published that that this was going to be a pandemic because this now did involve exactly what you just said asymptomatic transmission or at least mild the ill people transmitting which we hadn't seen in the same way with MERS and SARS and it truly distinguished it from the
when we were having dinner.
That night at the University of Minnesota annual dinner that I came as a speaker we sat together, which was a fun night that was back in December. I believe we following what was going on even then
that was actually just before this happened. Yes. It wasn't December and it was a fun night. You gave a great talk that night. You gave a really great talk that night. So and I enjoyed I love so much talking to your wife. That was what was even more fun. Had. I only known yeah, it was really happening at that time. I mean it was happened in Wuhan at the very night. We were there too.
Gather we just nobody knew it yet, really
and by the way, if people don't listen to Mike's podcast, which will have a link for thank you have to listen to it. It's a great I advise people to have two or three sources of information and you know the criteria by which I advise people is pick people who will say what they know and what they don't know what will state their biases and will will adapt their views and as things move along and I think Mike you're somebody that I think if people aren't dumb
I'm following you should and you're also willing to I think infer things and be can be clear about what you're referring and what you know, but you're willing to kind of help people understand applications before there's am you run of the first people that was talking about aerosol ization. And I people were talking about surfaces and I remember running into you and you're like Andy don't worry about the surfaces. It's not the surfaces,
but you know, what you didn't do though. You didn't allow me to get my disclosure tonight and that disclosures. I know less about this disease tonight that I did six weeks ago because the more I learned about
Unless I know
oh, well, that's funny because that's the kind of where I was going to go Mike which is which is let's just stick it kind of quick recap of what do we know and what don't we know like if there's if there's three columns what's the stuff? We were absolutely positive about that. We really understand. What are we really understand about this virus?
I think we have a pretty good handle on the fact that the transmission with this virus is primarily swapping are with someone else number two. Is that Ruiz for reasons? We still don't
and there's kind of a modified SARS MERS impact impact of this disease in the sense that there is a super shedding kind of environment where it's the right person in the right environment meaning larger indoor are often where you see lots of transmission and it's been stated and I think the numbers are probably very close to that that 20% of the patients or cases account for 80% of the transmission and you know, it's amazing when you see some of these
These outbreaks that occur and very distinct things like a one wedding or one funeral or one evening at a bar and it's remarkable the kind of transmission you see with that. So I think that's we do
know if that's something about the individual or is that something about the type of location purely just the type of location or is it
both? I think it's both in other words indoor air. No cell phone do it. You know, we have a lot of households where people would say what has to be droplet because only 15 or 18 percent of all the household.
Let's get infected. It's not that infectious and the right they're actually right but then you have those where somebody can transmit 280 of 92 people that were in that room that night and they're shedding virus that is just remarkable and we don't understand why you know, we've been looking at things called sticky mucus and so forth. Is there a way that in when we breathe and when the comes out that would actually enhance the amount of virus and I think we're learning a lot about aerosols aerosols being
In these very tiny be be like drops as opposed to the big bowling ball, like drops and while they contain much much less virus. There's so much more of it that if you inhale that and that's what floats so I think that to we now have a much better handle on than we did before.
So if we could identify these super spreaders we could like make them wear like orange t-shirts or something,
you know better yet. I those are the ones I'd love to put in isolation, you know for themselves and for others if we could isolate them.
We did, you know MERS and SARS patients, you know, you could stop transmission. This is where this whole issue about R naught. Nrt, and all these things that people cite all the time about what the risk of transmission is. Remember someone who might be highly infectious for measles was an example get them into a room with negative air pressure and the right filters and they should transmit to nobody so it's always a combination of the individual and how infectious they are. But it's also the environment they're in and that's what I think.
We often miss with this disease is the combination thereof.
So we're trying to control for the environmental piece. Yeah, we're trying to you know, at least identify that there are certain places bars Church choirs old buildings places poor ventilation, etcetera. I think most people understand that I have that message and they understand that if they're in a setting like that, they're better off wearing a mask and so forth. But how are we on the people themselves? It's saying, you know, and he's got the virus Mike's got the virus then one may have a little more.
Dubs in the other but one of them's a super spreader and the other ones not how close are we to being able to figure that
out? We're not you know, we've got a long ways to go. But what's interesting. Let me just point out on the environment issue because I think this is another important point, you know, right after the protests occurred. In fact why they were going on I was interviewed a lot and people would say, oh boy. This is just going to blow this thing up. And I said, you know, I don't know if it is and the reason for that is outdoor air the virus dissipates quickly. It's not even sunlight.
Because remember most of the protests occurred at night and I said be careful don't jump to that conclusion in lo and behold sure enough. It didn't turn out to be a major enhancing Factor at all and transmission at the same time. I warned everybody ostriches and says Sturgis is going to be a heck of a problem already. So wait a minute, you're not consistent here and that's outdoor. And I said no. No, I've never been to Sturgis, but I've heard a lot of Stories the number of indoor bars the number of tattoo parlors and number of all the
Places that people go to and they're indoors and so it's not the writing of the bike. It's not basically walking down the street nearly as much as it is being indoors and that's the distinguishing feature between sturgeon the protest they weren't indoors during the protest they are at Sturgis and now we're beginning to see we just had a big boost in new cases in Minnesota today and we're just at the beginning it's going to be big it's going to be a big number of cases.
Yeah from Sturgis. So it sounds like we understand much better.
Better about how the virus spreads and we don't quite understand who those people are. So there's not a lot we can do is science scientists looking at that are epidemiologist looking at that question. Do they do you think there will be an answer to that question because God I would be
helpful. I don't think so. I think you know, maybe our animal models will get us closer to that. I mean the answer to this is going to be a vaccine that would ultimately make sure none of us got infected with it in a meaningful way, but I think the question
Asking is a really important because this is not the last coronavirus. It's going to happen. So, you know, we're going to see more so I think that it is a really important question that we need to answer but I don't know how to do it right now. And even the people who are doing the animal studies where they're actually, you know, intentionally infecting macaque monkeys using different routes of and so forth trying to understand why certain ones get much higher there's infectiousness. By the way, you see the same thing in the animal models if you infect a group of monkeys, I'm number of them.
M will get sick mildly sick not that much virus production and there will be a couple of them all same age same gender. They'll just have sky-high virus levels coming out of them and they're not any sicker than the people who are the are the animals that don't have much we don't understand why
interesting. All right, let's evaluate how we're doing on the science. So I think there's there's probably a few different areas of science that are important to us here at one is clearly mentioned vaccine and how we're doing on the on the path are the
Getting in a very topical conversation. This week is around therapies. And the third well go back to because it's a bit of a different category which which you and I love to talk about which is testing could uh, put that in a different bucket. If you go back again to say January 20th when you wrote that paper how impressed should we be? How do you feel about how we've done from a scientific standpoint? Where can we do better? Where's the most promise?
I think first of all, I'm the vaccine. So let me just take that one because I want to contrast the therapy. I think it's been remarkable.
It's been done so far, you know, not just in the United States, but in Europe and of course, we have the Russian and Chinese vaccines if we don't understand yet very well. It has been nothing short of a game-changer kind of approach that I give everyone credit for that the problem with with it is however that we want this vaccine yesterday and even to do it correctly, you know, I liken this to the Iowa farmer that decides you don't want to take the end of the summer officers going to plant twice as many
Acres in April so we can harvest in July as opposed to September doesn't work that way. You know, there you go. That's it. So, I think the bottom line message is on the vaccines. We still have a lot of work to do before we will be satisfied. We have an effective vaccine now on the therapy side. We haven't done it like that. I mean the Brits have done a much better job organizing and moving out the kind of clinical trials that have given us meaningful data. That's the challenge. I mean the the
the paper that just came out. In fact, I just happen to have it here. This is published today. You mind if I read you the summary of the random severe study that everybody you know was so high on that was the one got the emergency use authorization for
this is really really really tough to get these days. Yeah. What is its humor humor for the
crowd it is but let me just read you the conclusions. Okay, because this was what got all the news how important this was among patients with moderate covid-19 those
Nice to attend a course or atoms of are did not have a statistical significant difference in clinical status compared with standard cared 11 days after initiation of treatment patients randomized to a five-day course over dims of are had a statistically significant difference in clinical status compared to a standard care, but the difference was of Uncertain clinical importance. This is the the main study. What is this telling you? So the fact that we don't even know more about that than we do just with that.
I think we underpowered and we didn't really appreciate the challenges of wanting to save someone's life which injury clinician wants to do. So, we're going to throw everything at them we have but then it eliminates the ability to really study it in a systematic manner to make sure we don't have bias. We don't have all kinds of selection issues that come into play and so the same thing is true right now with with the whole issue of plasma therapy, you know, the data just are really unclear. So I think we
We've not done so well in the therapy side. We need to change
that right and there's only so many patients Go, I mean there's a lot of people been infected but you can't have a patient in every single trial. And so we put these people in these trials for these very marginal drugs and these marginal drugs which by the way, they can be prescribed off-label. Anyway meanwhile in England, we've got these clinical trials going on with actual patients. So the fact that FDA gets spends all this
Ford in energy around this it goes back to your first point. I mean, it looks political and feeling are a one of the most disappointing things for me who's you know that I don't know if you feel you reflect on this you served it government various times as well is just our institutions which are supposed to be protected from politics and we're supposed to see the clearest views of the best information we have at the time whether it's the FDA or the CDC the wh W chose another story.
But none of them have really covered themselves in glory fine. People make mistakes is a complex novel virus, but the political interference has been really disturbing to me.
It's on President. And I think one of the challenge we're going to have here is we already have a public that skeptical of Science and you know, we've already heard of these surveys which I'm not sure how much Credence I put in them that people wouldn't take a vaccine for covid-19. I think if you're in the middle of a house on fire event and you
A license to prove vaccine that public health is saying take it they probably would but I think right now my very worst thought could be is that if we have an adequately research vaccine, we haven't done the data analysis because we don't have the data to analyze relative to Effectiveness and safety and public health leaders stood up and said this is not no we can't do this right now. That would create such a
Confusion in the public such a backlash that I worry desperately about that. We can't have that happen because we not only jeopardize this vaccine. I think we jeopardize vaccines across the board for which we're fighting desperately right now to get the American public to understand why they're so important
right this sort of a knowledge of the collective good which is something that seems more foreign to us in this country than I would have S disappointing but this idea that you know that we all have to value and benefit in it.
Trust in the FDA is an asset. We can't squander for the very reason you described and it's quite possible that we could have a very valid vaccine candidate that there ends up being very low trust in and that would be as you said it really unfortunate situation because of the great work that science would have done it. So that has got to be re-established somehow
it does and you know, and I think it's very clear. I believe this is true about public health in general if we had an effective and safe.
Vaccine right now, we would celebrate its approval in its use and it would have no partisan issues. I'm more than happy to have what some called an October surprise if the data are there to support it. So this isn't about you know, trying to inject politics into this at all. We just have to have the science that backs up our data if we're wrong and this is not a safe vaccine. It doesn't work, you know will pay for that for generations to come look at we're still
He knows you so well know from 1976 and Swine Flu of Guillain-Barre syndrome. I mean, there are still people who remember that and say well I won't I don't trust the government. Right?
Well, so the White House called me before the kind of laser plasma announcement and asked if I would publicly support it and I said the following I said the tell you what if the president doesn't overstate the value if the data is presented clearly and cleanly if the FDA scientists can speak clearly about the
Ins it's not overstated then I'll analyze added I'll support it if I agree with that, but that's not what happened. And I told him specifically I said if if on the other hand the president uses this in a way where the value is overstated, it's going to be a big mistake and I said it's a mistake that I think all of us are going to pay for in my view that seems like it's what's happened.
Yeah, I think you know let the science just be the science if we could carve out one area right now. We all want to be successful there shouldn't be
One who wants to be successful in one who doesn't we want to do whatever we can to reduce the pain and suffering the death and economic disruption that this virus is causing. I would celebrate right now any finding from this Administration or any other government of the world if the data were there to validate the findings and the safety was clear and compelling boy. What a great day to celebrate. Absolutely.
Absolutely. I mean the only thing that can catch up to
Invisibly spreading viruses is science, right? Yep, and now for something we like to call advertising.
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I want to make sure that we clarify for the people listening when you say vaccine what exactly it is you mean because I think people have in their minds when they hear vaccine. Sometimes they think oh MMR vaccine one little dose and I'm good for life. And it's 97 percent other people might have in their mind and influenza vaccine. I've got to get it annually and it you know, it's got an even chance of working. But if it works it's going to save a lot of lives and even that
Good incrementally, which it people expect when they hear the word vaccine.
Well, I think you raise a really good point an important point. We need to help Define the future now for the public so that they don't appear to be surprised by whatever information comes out. I think you've seen that kind of telegraphing already from people like Tony Fouch and others who have been saying, you know, this vaccine may only be 50 or 60% effective, but that's a heck of a lot better than 0 and so, you know don't expect this to be perfect. But it
it doesn't have to be perfect to still have a big impact. I think the challenge we have right now is twofold one is in terms of who is protected even 50 or 60 percent are protected. If it's primarily the same people who have mild disease younger healthier people then the vaccines going to have less impact than if we can find a way to protect those who are at higher risk of serious outcomes people are older and as you know from influenza vaccines, that's a challenge influenza.
Things tend to work better on those who tend to typically do better once they get infected. But unless still the impact is substantial or getting your flu shot. I think that's going to be the same situation here is we have that the second situation though is one that came to light today, which we knew was coming is, you know, we've been concerned for some time that with both stars and MERS we have evidence of waning immunity. This isn't like even an influenza virus like a pandemic strain you
Do develop immunity the probably last many many many years for that specific strain, but this morning it was reported that the first case of well-documented second infection occurred. This was an individual from Hong Kong who had been infected last March at the time was identified the virus isolate obtained culture positive. And then he recovered he was on a trip to Europe came back to Hong Kong months later and coming.
Through customs. He was tested found positive. They actually culture them again. They got another virus out. It was a different one than the first one so it wasn't a chronic infection and it was the same strain that we saw in Europe. So bring he did bring it home with him that clearly pointed to the fact that at one point. He had been infected likely develop some immunity and then it waned that's not a surprise. We actually should expect to see that and more. So we're trying to figure out is how does that fit in then to how?
I won't be vaccinated if we get infected and we lose our immunity if we get infected a second time will be a milder illness surely could be possible. And so this is an area that we still have a lot of work to do but it's not going to be like as you pointed out an MMR or you know under childhood immunization that may have a long long longevity in terms of protection. This one likely is going to have a much shorter term protection level and require booster doses if anything you
must get
Uncle Mike about how many armchair epidemiologists exist in the world now, I mean, there are people that are positive about things that no expert had I know even has an opinion about relative to herd immunity can be achieved at thirty percent level and it's it's leveling, you know levels off because of this cross immunization from T cells and these are people who haven't heard the word. No, no offense, then they haven't heard the word T Cell before a week ago and I see
I'm just being a little bit silly because we're naturally clutching at straws here. We want to know more we want more certainty. It makes us all feel better. But I also think that that what this show is about and yours is people can handle the truth better than they can handle being the upside down to being disappointed and it's good to know what we know and what we don't know. So if we're going to take stock in what we know about immunity and herd immunity levels start with herd immunity levels do feel good is any possibility that the virus slows down at?
30% is New York just as at risk today at 25 percent as it was before put us putting aside how long it lasts for a second. Yeah.
This is a really important question and thank you for asking because I think it is one that really deserves a conversation. And again, I'll just say that I'll take you as far as my knowledge will let me go and when I hit the edge of the cliff, I'll tell you okay, if you want to keep going that your that's your deal. Okay number one, is is this how everyone?
Understands what herd immunity is we're talking about. It's really just a statistical probability in the sense of if I'm infectious with a certain virus. There's a level of infectiousness that comes with each one. Now. I've already talked about the fact that with covid-19. We kind of have a different approach where some people may be highly infectious and others not it's kind of like saying your heads in the freezer your feet are in the oven and average your Dipper do this, right, you know kind of thing, but let's just take the people who are of a certain level infectiousness.
And that so if I'm out there how many people in the community have to have protection already much like a rod in a virus reaction. Meaning that there are a control rod. So if suddenly I'm in front of three people or four people in three out of the four are already protected, I can almost transmitted to one and once you get that below one person for person infected then the number of cases start to go down so herd immunity isn't even about transmission stops. It's just
Just that that's when the speed at which is occurring begins to slow down. The theory had been well, you know, maybe people have already had these coronavirus infections and that they have some residual T-cell functionality a cetera and and you know, I am not a Corona virus virologist, but I hang around a bunch that have taught me a lot and you know, they've been a little skeptical about yeah, would that happen because with Mars MERS and SARS, we actually saw waning immunity over time with
Those infections so I like in it this way, you know, I've been studying certain populations that have had unique opportunity for us to understand how infectious the in these are and what happens look at the prison population. Look at San Quentin San Quentin went from nobody infected to a fairly quickly over 60% infected and then it slowed down but it kept transmitting till it was over 80% infected. I can go through populations like that where there was no evidence of residual.
Unity that somehow protected, you know after it hit 20 or 30% we're a very high percentage of the people all get infected which says if there was some kind of earlier herd immunity that wouldn't have happened
right? And so I think the worst formula in the world is to try to do math on a podcast. But but if you try taking out your phone and multiplying one point two times one point two times one point two times one point to venture the numbers get pretty big if you'd use 1.7 the numbers again.
Really big but if you use a number less than 1 like a saying is that if you use .7 or 0.5 those numbers those things really go down. Yep exactly. When you you have written you wrote a piece recently with head of the Federal Reserve here where you talked about the fact that we can sort of simulate that effect and I putting words in your mouth a little bit, but by taking a bunch of different actions, even before we have a vaccine
Scene because as you said if we don't share each other's are the virus has no place to go or fewer places to go. So you want to talk a little bit about what you said in that paper. Sure.
Well, you know, I think that part of it is what is the best of the bad Alternatives, you know, if nothing's working and right now we're in a bad situation. I'm I'll make a projection here tonight. I hope I'm wrong, but you know when we saw case
Numbers increased to 32 thousand new cases a day in March and April and to can April 12. You know, New York was on fire. We thought oh my God, this can't get any worse than this and then, you know kind of flatten the curve things started to improve and we got down to about 22,000 cases a day by Memorial Day and at that point we were done, you know for pandemic fatigue set in everybody kind of said, okay task force went home. Yep, exactly and then and then look what happened.
Bye-bye. The you know towards the end of July we were up at 65,000 cases a day. And we thought boy 32,000 cases a day doesn't sound so bad does it well now we're down we're going to get into the 40's maybe occasionally high 50s for a few weeks and then all the university and can college campus cases are going to explode they're starting to now we're going to see more transmission spill over into the community and we're going to go right back up again. So it's almost like we've had this peak come down a little bit.
And level another Peak higher than the first come down a little bit level and I think we're on this climb. Now. The reason I bring this all up is because our best guess is and it's more than a guess. We actually have data that while there are some spots in the United States. Particularly New York City some places in Florida, Arizona where we have higher levels, but on a whole only about eight to ten percent of the u.s. Population has been infected by this virus so far, which is still a lot when you think about you know, 30 million people have been
An infected that's a lot but we got a lot left to go. So for us to get to herd immunity thing. We're just talking about fifty to seventy percent and we're at 8 to 10% Now. The question is well, how are we going to get there? Well, you can get there through natural disease, which would just keep occurring until you get there or you're going to get there by a vaccine and hope again, you have some durable immunity. So what we wrote about was what is the lesser of two evils and we've learned from around the world you can
This thing down and you can drive the case numbers to such a low level imagine it like a forest fire. Whereas after, you know containing 60% of you go home and say well we're done how fast it comes right back. But if you only have The Embers left to brush fires, then you know, the County Fire Department can handle that. They don't need the big National Crews to come in. And so what we're saying is if we could drive it down then we can keep it down like New York is done. I mean New York to me.
Is an amazing comment about this issue. We all know that New York has not come back to its full self. It's not it's not the same city. It was but you know what they're now in their 13th week of flatness. They've had days where they haven't had any deaths at all. And I think that that's an example of what can be done. Now. What we proposed was you need to lock down and selected areas not all across the board you for example, you don't need to lock again down in New York. Okay, but you do need to lock down and some hot spots.
Minnesota right now is one that I'm really concerned about. But what you do is you pay for it. You don't leave anybody behind and and Neil who is a brilliant brilliant leader, you know, the Federal Reserve is looked at our savings we've gone from eight percent savings to 20% savings from this Panda. I mean, we could Finance supporting individuals left out of work small businesses city and state governments by just the savings that we have and we could pay ourselves a dollars back.
Back and supposed to some foreign country and we hold people whole, you know, it's where people are hurting that they've been financially hard to hit is what's wrong. So I think that's the point that we've rages get it down in the modeling that the Federal Reserve Bank has says look at we're going to bleed a lot more we're going to spend a lot more money between now and the time of vaccine might get here. Let's say if it is early next year then we're going to do if we do a lockdown for four to six weeks in selected areas.
Get the case numbers down and then hold them down through testing and tracing and the kind of approaches we can do with these other countries are doing and I worry that you know, we didn't learn the lessons of these other countries and I also worry that unfortunately the other countries of the world learn too much from us because they then in some cases just let up completely like Germany France places like that. We're now we're seeing the increases again. You know, how do they do like New York to just keep the foot on the brake enough to hold?
Hold it down, but not to smother the community. You've been pretty judicious.
You are the first person to explain to me that asking everybody to sacrifice all the same time in a very large country. Like this is a colossal mistake and unnecessary and it's really seems to me that the logical extension what you saying is it's the big events both personal and family events Arenas churches bars, and you can be
Order this
time. I mean, I think in April you threw everything at it now, maybe you could say look there's a lot of stuff we
can continue to do and
they're just maybe there's a don't list. There's a be careful list and there's a new list.
You're absolutely right and here's an example. You know, I really miss going out to eat and just enjoying time in a bar, you know, I miss that but at the same time right here in our state just this summer we've had over 47 bar Associated outbreaks that have occurred and
And we have had almost 50 other event-related outbreaks just like you talked about. Okay, and that is really helping to feel drive this whole situation. The same thing is going to happen with colleges universities. You know, I don't care what you do testing, you know, and tell people not to you know, we have colleges it tested everybody when they first got there and they've already had outbreaks because all it takes is one person that was tested at the wrong time or multiple people and it started from there.
Now that doesn't mean testing is important but you're right. What we want to do is minimize the big outbreaks and to hold those down and accept the fact that we're going to have cases. I would never tell anyone that there's a single college campus in this country is not going to cases they are but we don't want the big outbreaks
on testing which again, I'm no expert in but it seems to me that if you wanted to do something like open schools. You have a very specific strategy for testing for
School, so I spent time with the NBA and you may have as well and with Steve Kerr on the podcast last week talking about the bubble. The number one thing that they say about testing isn't the accuracy level. It isn't anything else. It's actually the Cadence. Yeah, because the test is good as a point in time. And so getting a test it's easy to do and cheap is actually more important to getting a test. That's two or three points more accurate than another one but take six or seven days and costs $150. Yeah,
but you know
The challenge that we have today is not even as much the test. The current test availability is important. We're now seeing in a number of the college campuses and this is something we knew already up to 50% of the students refused to do any contact tracing refused to give any names refused to get tested themselves. We have a number of people in this country. We do not believe that this pandemic exist. It's a hoax they will not get tested and followed up and when you start adding these all up
Up, you get a pretty sizable number pretty soon of those that refuse to participate
the question I get asked very frequently is what we learn our lessons from this virus and my answer is it depends if this ends up going down like the crack epidemic or the opioid epidemic, you know, the crack epidemic happened to other people and our policy response was cold and it was we didn't buy it didn't feel like that. It's a we criminalize the whole thing with opioids if I like it happened to all of
Us and well, I don't think we've done a great job, you know, we talked about it differently people think about it differently for right now. I think there's a lot of the country that still looks at this like the crack epidemic and the more it happens to older people prison populations, you know Farm labor communities meat packing plants and the more that younger people kind of get it but they're just carriers the more that deepens my sense that this red blue thing could be more pervasive than we'd like it to be,
you know, I
Why I think you're well first off, you're absolutely right, but I think one of the things that may also start to influence us we're beginning to see this long-haul phenomena these people who are initially ill but mildly ill but at two and three months are still really quite ill in the sense of very fatigued as a chronic fatigue leg syndrome, and this is actually a current fairly High incidence among young healthy adults that begins to leave them roll mark because they just can't get out of bed. They can't go to work.
Set for a cetera and now they're not at risk of dying in an intensive care unit. But their quality of life is really substandard. If that message can get out that you know, this is something you don't want to get not just because you're not going to be an intensive care unit. But look what the potential is here for you over the months ahead and we don't know where this is going to go yet because many of these people are still sick months later
kitchen here now though Mike your fear mongering again, right? I mean, I wrote it I put a tweet out about long haulers because I interviewed a bunch.
Each of them and I got a whole response now, he's moving the needle this is just about people dying that day and he's moving in the oven.
You know, what it is. You know, this is this is just about telling the truth. It's about you know, we didn't know about this three months ago and now it's learning and sharing what we know and long haulers are absolutely a very real and legitimate piece of this. And so I mean when you put things out like that you're right on the mark.
Yeah. Yeah. Well you think strong you I mean you are you are the
Then your time are 24 by 7. I know you're doing a great service to all of us. One of the principal people who is not being willing to knocked off message and weak like today, you know, if you want to ask yourself are there still people out there who will not be knocked off message and say what they believe and say what's right, you're listening to one of the very best in Mike.
Well, thank you. You're very very kind. And as Ben Franklin once said we must hang together we shall hang separately. So I like hanging with you.
Yeah, let's hang it. Let's hang it.
Thanks, Andy.
I really hope you like that conversation with Mike as you noticed. We substituted Mike in it because I'd want to get him on the show for a long time. We still have a couple of great ones coming up. We're going to talk about toolkit episode about getting back to school coming up on Monday and Wednesday. We very very very likely have for you Mike Birbiglia. The reason I say very very very likely is because there is so much news happening.
All the time that we are pulling other pieces together. We have a toolkit episode coming up the following week on Long haulers. You heard Mike and I talk about what those are people who are really sick for quite a long time with covid-19. Anyway, I should let you go. Thanks for sticking with me
over now.
Thanks for listening to in the bubble. Hope you write us.
Highly we reproduction of lemon out of media Chrissy peas is our producer Ivan. Korea have is their editor Jessica Cordova Kramer and Stephanie whittles wax executive produced the show and run our lives. My son Zack slavit is my cool co-host and on-site producer. Our theme was composed by Dan Malad and Oliver Hill with additional music by Ivan Korea. If you can find out more about our show on social media at lemon out of media and you can find me at 8:00.
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Law enforcement in America is under scrutiny. Now more than ever. It just isn't working changing. It means navigating through a web of policies Paper Trails and personas. That's far more complicated than it may seem actor JL is is determined to demystify this for us all with the untold story policing his series with lemon out of media and campaign zero each week J speaks with policy experts academics.
Data scientist organizers and City officials they cast a light on the inner workings of policing you rarely see from contracts to unions to community activism by separating truth from fiction. Jay discovers. The concrete steps. We can take to actually reduce police violence across the United States. We actually had a hole in the bubble episode on this topic with DeRay McKesson. Check it out and now I'll just power listen to The Untold Story policing.
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