MetroFocus: October 28, 2020

Encore: November 13, 2020

MASTER VIRUS HUNTER “DEEPLY CONCERNED” ABOUT COVID’S COURSE IN NYC

With new cases of COVID arising across the tri-state, fears of a second wave may be rooted in scientific fact. But will the infection be mutated and more dangerous or severe? Tonight, Dr. Ian Lipkin, the preeminent epidemiologist at Columbia University who consulted on the movie Contagion and is known as the “master virus hunter,” shares his concerns about COVID’s trajectory in New York City.

 

TRANSCRIPT

> THIS IS 'METROFOCUS' WITH RAFAEL PI ROMAN, JACK FORD, AND JENNA FLANAGAN.

'METROFOCUS' IS MADE POSSIBLE BY SUE AND EDGAR WACHENHEIM III, SYLVIA A. AND SIMON B. POYTA PROGRAMMING ENDOWMENT TO FIGHT ANTI-SEMITISM.

BERNARD AND DENISE SCHWARTZ, BARBARA HOPE ZUCKERBERG.

AND BY JANET PRINDLE SEIDLER, JODY AND JOHN ARNHOLD, CHERYL AND PHILIP MILSTEIN FAMILY, JUDY AND JOSH WESTON, DR. ROBERT C. AND TINA SOHN FOUNDATION.

> GOOD EVENING AND WELCOME TO 'METROFOCUS.'

I AM JACK FORD.

WITH CORONAVIRUS CASES SURGING ONCE AGAIN AND FEARS OF YET ANOTHER WAVE SEEMING MORE AND MORE REAL EACH AND EVERY DAY, THE WORK CONTINUES TO DEVELOP NOT JUST A VACCINE BUT EFFECTIVE TREATMENTS AND BETTER TESTING AS WELL.

FOR MONTHS NOW DOCTORS AND SCIENTISTS FROM OUR AREA HAVE TAKEN PART IN A GLOBAL EFFORT TO COMBAT THE PANDEMIC AND TO SAVE LIVES.

ONE OF THE DOCTORS LEADING THE FIGHT HERE LOCALLY IS DR. IAN LIFKIN.

THE COLUMBIA UNIVERSITY PROFESSOR OF EPIDEMIOLOGY WHO HAS SPENT DECADES TRACKING INFECTIOUS DISEASES, RESEARCH THAT HAS EARNED HIM THE UNOFFICIAL TITLE MASTER VIRUS HUNTER.

SO WHERE DOES THIS EXPERT THINK WE ARE HEADED IN THE COMING MONTHS?

WHAT'S THE TRAJECTORY OF THIS VIRUS?

WHAT PROGRESS IS HE SEEING WITH REGARD TO THERAPEUTICS AND TESTING AND WHAT ABOUT THAT ELUSIVE POTENTIAL VACCINE?

JUST SOME OF THE QUESTIONS WE'LL EXPLORE TONIGHT WITH DR. LIFKIN WHO SERVES AS DIRECTOR OF THE CENTER FOR INFECTION AND IMMUNITY AT COLUMBIA'S MAMEN SCHOOL OF PUBLIC HEALTH.

DOCTOR, THANKS SO MUCH FOR JOINING US TODAY.

GOOD TO BE WITH YOU, JACK.

LET ME START OFF WITH THIS NOTION OF ANOTHER WAVE.

WE'VE SEEN JUST RECENTLY AS MANY AS 1,000 NEW HOSPITALIZATIONS IN NEW YORK CITY.

NEW JERSEY SEEING A SIMILAR SPIKE.

AND WE'RE SEEING SIMILAR NUMBERS ACROSS THE COUNTRY.

MEDICALLY SPEAKING, IS IT AN ACCURATE CHARACTERIZATION TO SAY WE'RE LOOKING AT YET ANOTHER WAVE OF THIS VIRUS?

PEOPLE MAY ARGUE ABOUT THE USE OF THE TERM.

I DON'T FIND IT MATTERS VERY MUCH PRACTICALLY.

THE QUESTION REALLY IS HAVE WE CONQUERED THIS VIRUS OR NOT?

AND THE ANSWER OF COURSE IS THAT WE HAVEN'T.

SO TO REALLY CALL IT A SECOND WAVE YOU WOULD UNEQUIVOCALLY REQUIRE SOMETHING LIKE CLOSING THE VIRUS DOWN COMPLETELY, HAVING IT COME BACK IN.

OR ALTERNATIVELY YOU'D HAVE A NEW TYPE OF VIRUS, SOME SORT OF VARIATION ON THE VIRUS THAT WOULD EMERGE THAT WOULD ALSO LOOK COMPLETELY DIFFERENT.

I WOULD ARGUE THAT THE VIRUS HAD NEVER REALLY GONE AWAY.

SO WHILE THERE WAS A LITTLE BIT -- THERE WAS A DIP AND IT'S COMING BACK, PRACTICALLY YOU CAN CALL IT A SECOND WAVE.

SOME PEOPLE WOULD NOT LIKE THAT CHARACTERIZATION.

I DON'T THINK IT MAKES ANY DIFFERENCE.

WHAT IS IMPORTANT IS TO REALIZE THAT WE DON'T HAVE IT UNDER CONTROL AND THERE'S A HIGH RISK THAT WE WILL HAVE A VERY BLEAK WINTER UNLESS WE DO SO.

WHEN WE'RE LOOKING AT WHY WE'RE SEEING, AS YOU SAID, THOSE SORT OF DIPS AND THOSE INCREASES HERE, OBVIOUSLY WE'VE SEEN ALL SORTS OF THEORIES OFFERED UP AS TO WHY WE'RE SEEING THAT.

WHAT'S THE BEST MEDICAL ESTIMATE THAT YOU CAN MAKE OR ASSESSMENT THAT YOU CAN MAKE AS TO WHY WE ARE SEEING THESE FLUCTUATION OF NUMBERS INCLUDING AND MOST DRAMATICALLY THE INCREASES WE'RE SEEING NOW?

ALL OF THIS IS ANTHROPOGENIC.

WE DO THIS TO OURSELVES.

PEOPLE WHO REFUSE TO WEAR MASKS.

PEOPLE WHO DO NOT PHYSICALLY DISTANCE.

INDIVIDUALS WHO TRY TO AVOID TRACK TRACING.

ALL THE THINGS THAT WE NEED TO DO TO KEEP TRACK AND CONTROL OF THIS VIRUS UNTIL WE HAVE A VACCINE.

THIS IS WHY WE'RE SEEING THESE NEW WAVES.

SO YOU ARE SEEING THESE INCURSIONS INTO OUR COMMUNITY IN AREAS WHERE PEOPLE AREN'T FOLLOWING THE RULES.

AND FRANKLY, THIS IS A PROBLEM OF LEADERSHIP.

IT'S NOT JUST STATE LEADERSHIP AND CITY LEADERSHIP.

IT'S ALSO LEADERSHIP IN SMALLER GROUPS THROUGHOUT THE COUNTRY.

SCHOOLTEACHERS, MINISTERS, CULTURAL HEROES, OTHERS.

WE'RE TRYING TO ENGAGE ALL OF THEM IN THIS FIGHT AGAINST THE VIRUS.

I DON'T WANT TO MAKE THIS A POLITICAL DISCUSSION, BUT IT DOES GET ME TO A TOPIC.

WHEN WE SAW THE PRESIDENT'S CHIEF OF STAFF, MARK MEADOWS, COME OUT AND SAY THAT WE'RE NOT GOING TO BE ABLE TO CONTROL THIS VIRUS.

AND I'M WONDERING FROM YOUR PERSPECTIVE, IS THAT AN ACCURATE DESCRIPTION OF WHAT WE SHOULD BE TRYING TO DO OR IS IT INDEED POSSIBLE FOR US TO SOME EXTENT TO ACTUALLY CONTROL THIS VIRUS?

I THINK WE CAN CONTROL THIS VIRUS.

IF EVERYONE PHYSICALLY DISTANCED, IF EVERYONE WORE MASKS, IF WE AVOID THESE GATH GATHERINGS, YOU KNOW, OF LARGE NUMBERS OF PEOPLE, THEN WE WOULD HAVE A VERY DIFFERENT SITUATION THAN WE DO NOW.

I THINK THE DIRECTOR OF NIAID, ANTHONY FAUCI, MADE THIS POINT MONTHS AGO AND IT IS STILL VALID.

YOU CAN CONTROL THIS VIRUS WITH NON-PHARMACOLOGICAL INTERVENTIONS LIKE MASKS, HAND WASHING, PHYSICAL DISTANCING AND IMPROVEMENTS IN VENTILATION.

NOW, THERE ARE A NUMBER OF RISK FACTORS THAT HAVE BEEN IDENTIFIED THAT ARE ENVIRONMENTAL THAT WE CAN ADDRESS TO.

SO IF YOU HAVE A CLOSED RESTAURANT, FOR EXAMPLE, OR A BAR.

BARS ARE PARTICULARLY DELETERIOUS IN TERMS OF CONTROLLING THE OUTBREAK.

PEOPLE ARE TALKING VERY LOUDLY ABOVE MUSIC.

THEY BECOME DISINHIBITED BECAUSE THEY HAVE ALCOHOL.

AND THEY GET CLOSER.

AND THE OPPORTUNITIES FOR SPREAD ARE DRAMATICALLY INCREASED.

AS WE MOVE IN TO WINTER MONTHS AND MORE PEOPLE ARE CONGREGATING INDOORS, THERE IS A VERY REAL RISK THAT THIS IS GOING TO BE A PROBLEM.

NOW, WHAT WE'VE NOT TALKED ABOUT AT ALL YET IS TESTING.

AND --

LET ME -- I'M GOING TO GET TO THAT IN ONE SECOND.

I THINK I WANT TO FOCUS ON IT.

BUT AN INTERESTING POINT WHEN YOU TALK ABOUT BARS AND RESTAURANTS, AS A SCIENTIST WHO HAS DEVOTED HIS LIFE TO RESEARCH IN THESE AREAS ARE YOU AT ALL COMFORTABLE RIGHT NOW GOING OUT TO A RESTAURANT, EITHER AN OUTDOOR FACILITY OR AN INDOOR SPACED FACILITY?

SO I DO GO OUT TO EAT.

MORE THAN SOME PEOPLE WOULD THINK IS PRUDENT.

BUT I GO TO PLACES THAT ARE OPEN.

AND BY THAT I DON'T MEAN PLACES THAT ARE ESSENTIALLY TENTS.

WHICH ARE BASICALLY JUST MOVING THE INDOORS OUT OF DOORS BUT IT'S THE SAME EFFECT.

I GO TO PLACES THAT ARE WELL VENTILATED.

I WEAR THE MASK EXCEPT WHEN I'M EATING.

AND I MAKE CERTAIN THAT PEOPLE THERE FOLLOW THE VARIOUS SORTS OF PRECAUTIONS THAT I THINK ARE ESSENTIAL TO MINIMIZE THE SPREAD OF THIS INFECTIOUS AGENT.

WE SHOULD NOTE THAT YOU HAD EXPERIENCED YOUR OWN BOUT WITH THIS VIRUS.

I DID.

WHAT DID YOU LEARN FROM THAT EXPERIENCE PERSONALLY THAT YOU'RE ABLE TO CARRY INTO YOUR RESEARCH?

SO JACK, I WAS IN CHINA IN JANUARY AND I CAME BACK THE FIRST WEEK OF FEBRUARY.

WHEN I LEFT CHINA, EVERYONE WAS WEARING A MASK.

THE MAJORITY OF THE BUSINESSES WERE CLOSED.

AND THERE WAS NO QUESTION BUT THE PEOPLE TOOK THIS VERY, VERY SERIOUSLY.

WHEN WE FLEW BACK TO THE U.S., WE WERE WEARING MASKS.

WHEN WE GOT OFF THE JETWAY, PEOPLE WERE WEARING MASKS.

AND THE PEOPLE WHO WERE RETURNING FROM CHINA, WHICH THERE WERE VERY FEW AT THAT POINT, THIS WAS THE LAST UNITED FLIGHT INTO NEWARK OUT OF BEIJING, WE WERE TAKEN INTO A ROOM AND WE WERE INTERVIEWED.

INTERESTINGLY, THERE WERE PEOPLE COMING FROM ITALY AND FROM EUROPE, WHERE THERE WAS A LARGE OUTBREAK ONGOING, AND THEY WEREN'T ISOLATED AT ALL.

AND IRONICALLY, I BECAME INFECTED IN MARCH IN NEW YORK, WELL AFTER I'D RETURNED.

SO I HAD MY TWO WEEKS OF ISOLATION AFTER COMING BACK FROM CHINA.

AND THEN I WAS ACTUALLY IN A -- DOING AN INTERVIEW ON A NETWORK THAT SHALL BE NAMELESS BECAUSE I DON'T WANT TO GET INTO LEGAL DIFFICULTIES.

AND ONE OF THE SOUND PEOPLE CAME UP BEHIND ME AND PLUGGED AN EARPHONE IN.

RIGHT?

AND FIVE DAYS LATER WE WERE OFF TO THE RACES.

AND IN BETWEEN THE TIME I'D BEEN AND THE TIME I BECAME ILL I WAS CONTACTED BY THE NETWORK AND SAID OH, BY THE WAY, ONE OF OUR SOUND ENGINEERS HAS TESTED POSITIVE.

SO WHAT DID I LEARN?

NUMBER ONE, IT'S A VERY STRANGE DISEASE.

YOU HAVE -- YOU KNOW, I HAVE AS AN AFTERMATH OF THIS VERY WEIRD SUPERFICIAL PAIN JUST ABOVE MY LEFT KNEE.

AND IF I TOUCH IT I GET A SORT OF A JOLT.

A VERY SHARP PAIN.

IT'S VERY WEIRD.

MY EXERCISE TOLERANCE IS NOT WHAT IT WAS.

THIS IS THE FIRST TIME I'VE EVER HAD A RESPIRATORY SYNDROME THAT PRESENTED WAKING ME UP FROM SLEEP WITH A SPLITTING HEADACHE.

YOU KNOW, SO IT'S -- AND THERE ARE PEOPLE WHO HAVE MUCH, MUCH WORSE DISEASE, OBVIOUSLY.

SO THE MOST DIFFICULT PART OF THIS WAS THAT MY PHYSICIANS RECOMMENDED BECAUSE AT THE TIME WE DIDN'T KNOW ANY BETTER THAT I TAKE HYDROXYCHLOROQUINE.

AND I'VE NOT BEEN ABLE TO LIVE THAT ONE DOWN.

PEOPLE SAY YOU SHOULD HAVE KNOWN BETTER.

I THINK THE ANSWER IS THAT EVEN THE EXPERTS AT THAT POINT CERTAINLY, WE DIDN'T KNOW ENOUGH TO KNOW BETTER.

LET ME GET TO SOME OF THE ISSUES.

YOU MENTIONED TESTING.

I WANT TO TALK ABOUT TESTING.

I WANT TO TALK ABOUT THERAPEUTICS.

AND I OBVIOUSLY WANT TO TALK ABOUT THE VACCINE.

BUT LET'S START WITH TESTING.

WHAT ARE YOU SEEING IN TERMS OF YOUR RESEARCH AND THE WORK YOU ALL ARE DOING ABOUT IMPROVING, AND WHAT DO WE NEED TO IMPROVE IN TERMS OF TESTING?

SO THERE ARE SEVERAL ASPECTS TO EMPHASIZE WITH RESPECT TO TESTING.

FIRST, OF COURSE, YOU KNOW, THE PROBLEM THAT WE HAD WITH THE INITIAL TEST THAT WAS RELEASED FROM THE CENTERS FOR DISEASE CONTROL UNDER DURESS BECAUSE THEY HAD TO GET SOMETHING OUT QUICKLY AND THERE WAS A PROBLEM WITH SOME OF THE WAYS IN WHICH THE ASSAY WAS DEVELOPED.

HAS UNDERCUT I THINK THE CONFIDENCE OF THE AMERICAN PEOPLE IN THE FEDERAL GOVERNMENT AND SPECIFICALLY THE CDC, WHICH I THINK IS UNFORTUNATE BECAUSE ERRORS HAPPEN.

THEY CORRECTED IT.

AND I THINK WE NEED TO MOVE ON.

WHAT WE'VE LEARNED WITH THIS VIRUS AS OPPOSED TO MOST VIRUSES WE STUDY IS THAT THE VAST MAJORITY OF PEOPLE WHO TRANSMIT THIS VIRUS ARE ASYMPTOMATIC OR HAVE ONLY MILD DISEASE AND DON'T REALIZE THEY'RE INFECTED AT THE TIME THEY TRANSMIT.

SO WHAT THIS MEANS IS YOU CAN'T JUST DO TEMPERATURE CHECKS AND SAY THIS PERSON HAS NO FEVER, THEREFORE THIS PERSON CAN ENTER THIS AUDITORIUM, THIS CONCERT, WHATEVER THE CASE MIGHT BE.

THIS MOVIE THEATER.

THIS RESTAURANT.

WE HAVE TO CONTINUOUSLY TEST.

THE GENERAL COMMUNITY LOOKING FOR PEOPLE WHO ARE ASYMPTOMATIC.

CARRIERS OF THIS INFECTIOUS DISEASE WHO ARE CAPABLE OF TRANSMITTING IT TO OTHER PEOPLE.

AND THE EVIDENCE SUGGESTS THAT YOU ARE MOST LIKELY TO BE INFECTIOUS JUST PRIOR TO THE ONSET OF DISEASE IF YOU'RE GOING TO HAVE DISEASE AT ALL.

SO THAT'S AN EXTRAORDINARY CHALLENGE RIGHT THERE.

HOW DO WE DO THAT?

HOW DO WE SET UP THE NECESSARY NETWORK, IF YOU WILL, THE EXTENSIVE NETWORK, IF YOU WILL, TO DO THIS?

DO WE LITERALLY HAVE A TESTING SITE ON EVERY CORNER?

OR ARE THERE TESTING BEING DONE THAT YOU MENTIONED, SOMEONE WALKS INTO A THEATER ARE THERE TESTS?

INTO A RESTAURANT, ARE THERE TESTS?

IS THAT REALISTIC?

WELL, AS YOU SAY, LOGISTICALLY IT'S VERY CHALLENGING.

AT COLUMBIA UNIVERSITY WE HAVE GATEWAY TESTING.

BEFORE ANYBODY CAN RETURN TO THE UNIVERSITY, UNDERGRADUATE STUDENTS, STAFF MEMBER, FACULTY.

AND THEN WE TEST A RANDOM SAMPLE ON A WEEKLY BASIS OF 10% OF OUR TOTAL POPULATION.

NOW, YOU CAN DO THIS IN SCHOOLS.

YOU CAN DO THIS IN WORKPLACES.

THE QUESTION WOULD BE HOW WOULD YOU DO THIS WITH A CITIZEN WHO IS NOT PART OF SUCH A NETWORK?

AND THAT'S SOMETHING THAT THE CITY IS TRYING TO SORT OUT AND SOMETHING I THINK WILL BE ESSENTIAL.

PEOPLE ARE ALSO TRYING TO MONITOR SEWAGE.

RIGHT?

WASTEWATER.

WITH THE IDEA BEING THAT IF YOU HAVE A VERY SENSITIVE TEST YOU CAN GEOGRAPHICALLY LOCALIZE WHERE THERE MIGHT BE INFECTION.

THIS IS SOMETHING THAT WE'VE NEVER REALLY DONE BEFORE FOR A RESPIRATORY TRACT DISEASE.

BUT IT'S A WAY IN WHICH WE CAN CONDUCT SURVEILLANCE AND THEN NARROW DOWN AS TO WHERE SOMETHING MIGHT BE OCCURRING.

THE TESTS REALLY FALL INTO SEVERAL DIFFERENT CATEGORIES.

WE HAVE MOLECULAR TESTS THAT ARE VERY SENSITIVE.

THESE ARE THE PCR-BASED TESTS.

THE PROBLEM WITH THOSE IS THAT IT TAKES A LONG TIME TO DO THEM.

AT LEAST SIX TO EIGHT HOURS.

BECAUSE YOU HAVE TO COLLECT A SPECIMEN.

PEOPLE ARGUE ABOUT WHETHER IT SHOULD BE SALIVA OR A SWAB FROM THE THROAT OR A SWAB FROM THE ANTERIOR NOSE, OR WHATEVER.

OR THE NAZ O'FA RINGIAL SWAB WHICH PEOPLE DESCRIBE AS VERY INVASIVE.

I DON'T REALLY FIND IT SO.

BUT YOU CAN PROBABLY GET BY WITH SALIVA OR AN ANTERIOR NARY SWAB.

NEITHER OF THOSE ARE PARTICULARLY INVASIVE.

THEN YOU HAVE TOEX TRACT THE GENETIC MATERIAL AND THEN YOU HAVE TO TRY TO AMPLIFY IT BILLIONS AND BILLIONS OF TIMES UNTIL YOU FIND EITHER EVIDENCE OF THE VIRUS THERE OR IT'S NOT.

NOW, THERE WILL BE, IF YOU TAKE SOMETHING OUT TO THE EXTREME IN TERMS OF THE NUMBER OF DIFFERENT PROCEDURES THAT YOU TAKE THROUGH.

IT'S CALLED CYCLES ON PCR.

YOU MAY FIND FALSE POSITIVES.

YOU MAY ALSO HAVE FALSE NEGATIVES.

AND PEOPLE ARGUE ABOUT WHICH IS MORE DAMAGING.

SO WHEN WE WERE RUNNING THE DEMOCRATIC NATIONAL CONVENTION SCREENING PROCESSES, WE TESTED EVERYONE IN WILMINGTON, DELAWARE, MILWAUKEE, AND L.A.

EVERY SINGLE DAY.

WE TESTED THEM BEFORE THEY TRAVELED.

WE WERE ABLE TO FIND SEVEN PEOPLE WHO WOULD HAVE COME INTO THE CONVENTION, WHO WOULD HAVE CREATED THE OPPORTUNITY FOR A SUPERSPREADER EVENT.

BUT BECAUSE WE CAPTURED THEM, IF YOU WILL, PRIOR TO THEIR ENTERING THE BUBBLE, WE OBVIATED ANY RISK.

SO WE DIDN'T HAVE ANY TRANSMISSION WHATSOEVER.

BUT THAT WAS A MAJOR INVESTMENT IN TESTING.

NOW, IN A CITY THE SIZE OF NEW YORK THE QUESTION WOULD BE HOW MANY PEOPLE DO YOU NEED TO TEST ON A DAILY BASIS?

AND I WOULD SAY IT'S PROBABLY -- EVERY WEEK PROBABLY 10% OF THE POPULATION.

SO THIS IS HUNDREDS OF THOUSANDS OF TESTS THAT YOU HAVE TO DO ON A DAILY BASIS.

LET ME JUMP IN BECAUSE I THINK THAT SOUNDS DAUNTING BECAUSE IT PROBABLY IS DAUNTING.

IT DOESN'T MEAN IT'S IMPOSSIBLE.

BUT JACK, YOU'RE TALKING ABOUT AN INFECTIOUS DISEASE, RIGHT?

THAT HAS DECIMATED US ECONOMICALLY.

AND CULTURALLY.

SO IF WE WERE TO SPEND, RIGHT?

$100 MILLION A YEAR TESTING.

AND WE WERE KNOWN AS THE SAFEST PLACE TO DO BUSINESS --

COMPARED TO OUR LOSSES THAT'S LITERALLY A DROP IN THE BUCKET.

EVEN BEFORE YOU TALK ABOUT THE IMPACT ON HUMAN LIFE, RIGHT?

SO MORBIDITY AND MORTALITY DROPS.

ECONOMIC LOSSES DROP.

EVERYBODY'S MORE COMFORTABLE.

YOU CAN MAKE A VERY STRONG ARGUMENT FOR THIS.

LET'S SAY IT'S A BILLION DOLLARS.

IT'S STILL A DEAL.

IF YOU'RE LOOKING SIMPLY AT DOLLARS AND CENTS, EVEN THOUGH YOU MIGHT SAY IT'S DAUNTING, IT STILL MAKES SENSE IF YOU WILL.

LET ME JUST TELL YOU, I WANT TO MAKE THE POINT TO YOUR AUDIENCE THAT THIS IS REALLY FEASIBLE.

SO THERE ARE ROBOTS THAT YOU CAN USE THAT ARE CAPABLE OF DOING THESE KINDS OF EXTRACTIONS ON A MASSIVE SCALE SO THAT YOU CAN ACHIEVE THESE KINDS OF THINGS.

BUT THAT MEANS THAT YOU HAVE TO MAKE THE INVESTMENT.

AND THAT'S AGAIN THE WHOLE ISSUE OF LEADERSHIP.

LEADERSHIP NEEDS TO SAY YOU KNOW, WE'VE GOT TO DO THIS.

PERIOD.

WE HAVE THE WAY.

WE NEED TO HAVE THE WILL.

YES.

LET ME JUMP IN.

JUST A REMINDER TALKING WITH DR.

IAN LIPKIN FROM COLUMBIA UNIVERSITY, ONE OF THE PREEMINENT INFECTIOUS DISEASE EXPERTS IN THE WORLD, ABOUT WHERE WE ARE WITH THIS VIRUS.

LET ME JUMP TO THE VACCINE TIMELINE BECAUSE FOLKS ARE SO UNDERSTANDABLY FOCUSED ON THE NOTION OF VACCINE.

FROM YOUR PERSPECTIVE, HOW CLOSE DO YOU THINK WE ARE FOR HAVING A SAFE AND EFFECTIVE AND WIDELY AVAILABLE VACCINE?

SO THOSE ARE THREE DIFFERENT QUESTIONS.

RIGHT.

AND I HAVE TO UNPACK THEM IF I'M GOING TO TRY TO ANSWER.

SO WE HAVE ALL SORTS OF VACCINES THAT ARE AT VARIOUS STAGES OF VALIDATION.

I WON'T EVEN SAY IN DEVELOPMENT BECAUSE THEY'RE PROBABLY ALL PRETTY MUCH DEVELOPED.

THEY'VE BEEN TESTED IN A VARIETY OF WAYS.

WE HAVE A LOT OF SAFETY DATA IN THE SHORT TERM FOR VAST MAJORITY OF THEM.

AND BY THAT I MEAN ANYBODY WHO'S GOING TO GET ILL WITHIN THE FIRST MONTH, SMALL NUMBERS OF PEOPLE WHO'VE BEEN TESTED, WE'RE VERY CONFIDENT IN THAT ASPECT.

THE EFFICACY OF THE VACCINES IS WHAT WE DON'T UNDERSTAND YET VERY WELL.

BECAUSE WHAT WE HAVE TO DO IS MAKE A DECISION TO GO ONE OF TWO WAYS.

EITHER WE'RE GOING TO DO THIS WITH A ONE DAY SOONER APPROACH, WHICH IS A GROUP THAT HAS SELECTED VOLUNTEERS WHO ARE GOING TO AGREE TO BE VACCINATED WITH ANY OF A DIFFERENT NUMBER OF VACCINES AND THEN DELIBERATELY CHALLENGE WITH INFECTIOUS VIRUS TO SEE WHETHER OR NOT THEY'RE PROTECTED OR NOT.

AND THERE YOU COMPARE A PLACEBO, WHICH IS SOMETHING WHICH IS INERT, VERSUS THE VACCINE.

IF YOU DON'T GO THAT ROUTE WITH THE DELIBERATE VOLUNTEER APPROACH, THEN YOU HAVE TO GO SOMEPLACE WHERE THERE'S A LOT OF DISEASE AND YOU HAVE TO MAKE A DECISION YOU'RE GOING TO VACCINATE THIS GROUP BUT NOT THAT GROUP AND YOU'RE GOING TO COMPARE THOSE TWO GROUPS TO SEE WHO IS PROTECTED OR IS NOT.

AND THE BAR THAT'S BEEN SET THERE IS A 50% PROTECTION RATE FOR THOSE PEOPLE WHO RECEIVE THE VACCINE.

NOW, I WOULD HOPE THAT THE PROTECTION RATE WOULD BE BETTER THAN 50%. AND I THINK IT WILL BE FOR THE VACCINES THAT ARE SELECTED TO GO FORWARD.

THAT'S SOMETHING THAT I THINK WE CAN DO IF WE'RE WILLING TO DO VACCINE TRIALS WHERE THERE'S VERY ACTIVE INFECTION.

THE THIRD THING, THOUGH, IS THE ISSUE OF SAFETY IN THE LONGER TERM.

WHEN YOU START VACCINATING TENS OF THOUSANDS OF PEOPLE, THERE ARE GOING TO BE PEOPLE IN THAT MIX, PARTICULARLY IF YOU'RE LOOKING AT THE WHOLE RANGE OF AGE GROUPS, SEX DIFFERENCES, RACIAL DIFFERENCES.

SOMEONE IS GOING TO HAVE SOME ADVERSE EVENT DURING THE COURSE OF THAT VACCINE OBSERVATION PERIOD.

IT MAY HAVE NOTHING WHATSOEVER TO DO WITH THE VACCINE.

BUT ANYONE WHO BECOMES ILL, DEVELOPS, HAS A HEART ATTACK, HAS A STROKE, SHOWS FIRST SIGNS OF MULTIPLE SCLEROSIS OR PARKINSON'S DISEASE, DOESN'T MATTER WHAT IT IS, TRANSVERSE MYELITIS, WHICH IS THIS M.S.-LIKE DISEASE, YOU NEED TO BE CERTAIN THEY DIDN'T GET THAT BECAUSE THEY GOT THE VACCINE.

AND SOMETIMES THESE SEQUELLAE MAY BE ONLY APPARENT SEVERAL MONTHS OUT.

WE CAN'T WAIT SEVERAL MONTHS OUT.

THERE'S BEEN A CONSEQUENCE A DECISION THAT PEOPLE ARE GOING TO WAIT TWO MONTHS TO SEE WHETHER OR NOT THERE'S ANY SORT OF ADVERSE OUTCOME.

NOW, YOU'VE GOT MANY VACCINE CANDIDATES OUT THERE, AND SO PERIODICALLY YOU'LL FIND THERE'S A HALT IN A VACCINE TRIAL WHERE PEOPLE DECIDE, WAIT A SECOND, LET'S TAKE A STEP BACK, ASK WHETHER OR NOT THERE'S AN ADVERSE REACTION.

ALL OF THOSE THINGS ARE GOING ON EVEN AS WE SPEAK.

NOW, WILL THERE BE A VACCINE THAT IS PROVEN, THAT IS VALIDATED, THAT IS SHOWN TO BE SAFE BETWEEN NOW AND NOVEMBER 3rd?

ABSOLUTELY NOT.

ARE WE GOING TO HAVE ONE BY DECEMBER 1st?

PROBABLY NOT.

BY THE END OF DECEMBER I WOULD SAY WE PROBABLY WILL HAVE A PRETTY GOOD IDEA AS TO WHO CAN BE VACCINATED.

WE'RE NOT GOING TO HAVE ENOUGH VACCINE FOR EVERYONE AT THAT TIME POINT.

BUT ULTIMATELY I THINK WE'LL HAVE TWO TO FOUR VACCINES IN THE UNITED STATES THAT WILL BE VALIDATED AS BEING EFFECTIVE AND WILL BE SAFE.

NOW, SOME MAY BE PERCEIVED AS BEING MORE EFFECTIVE THAN OTHERS.

AND PEOPLE ARE GOING TO WANT THIS ONE OR THAT ONE --

LET ME ASK YOU THAT.

HOW WILL YOU KNOW?

AS A -- LET'S CALL IT A CONSUMER.

AND I DON'T MEAN TO TRIVIALIZE WHAT'S GOING ON HERE BY USING THAT TERM.

BUT LET'S SAY I'M OUT THERE AND I'M IN A CATEGORY, I'M OLDER, I'M IN A CATEGORY THAT'S SORT OF HIGHER UP IN TERMS OF GETTING ACCESS TO IT.

AND I SEE THERE ARE THREE OR FOUR OF THEM OUT THERE.

IF I'M GOING TO BUY A NEW CAR, I CAN TEST DRIVE IT AND SEE WHICH OF THE THREE OR FOUR MODELS I'M INTERESTED IN.

HOW DO I AS A PRIVATE CITIZEN WITHOUT ANY REAL MEDICAL EXPERTISE MAKE THE DECISION WHICH ONE OF THOSE IS BEST FOR ME?

WELL, THIS IS GOING TO BE A PROBLEM, JACK, BECAUSE I DON'T THINK THERE'S GOING TO BE ENOUGH OF ALL OF THEM SO THAT YOU CAN SAY I WANT THIS ONE OR THAT ONE.

OR THE OTHER ONE.

THAT WOULD BE IDEAL.

BUT I DON'T KNOW THAT WE'RE GOING TO HAVE THAT MUCH OPTION.

YOU'RE GOING TO HAVE TO MAKE A CHOICE.

I WOULD HOPE THEY WOULD ALL BE SIMILAR IN EFFICACY, BUT WE DON'T YET KNOW THAT.

WHAT WE DO KNOW IS THE FIRST PEOPLE WHO RECEIVE THE VACCINE ARE THOSE WHO WE FEEL TO BE AT HIGHEST RISK BECAUSE THEY'RE FIRST RESPONDERS, THEY'RE THE ONES MOST LIKELY TO COME INTO CONTACT WITH THE VIRUS.

THEN WE'RE GOING TO COME TO TRY TO PROTECT THOSE INDIVIDUALS WHO ARE FELT TO BE AT HIGHER RISK WHO MAY NOT BE NECESSARILY FIRST RESPONDERS BUT THEY'RE PEOPLE WE WOULD VERY MUCH WANT TO PROTECT.

BEAR IN MIND THAT EVERY TIME WE VACCINATE ANYONE THE OVERALL RISK FOR THE ENTIRE GROUP DROPS BECAUSE YOU'RE MOVING TOWARD THIS CONCEPT OF HERD IMMUNITY.

BY HERD IMMUNITY I MAEAN THERE ARE A NUMBER OF PEOPLE WHO ARE IMMUNE TO SOMETHING AND THE VIRUS IS ON THIS SIDE AND IT HITS SOMEBODY WHO'S IMMUNE AND IT STOPS DEAD IN ITS TRACKS.

IT CAN'T PROPAGATE FURTHER.

NOW, IT TAKES A LONG TIME TO GET TO HERD IMMUNITY.

WE ESTIMATE SOMEWHERE BETWEEN 60% AND 80% OF THE POPULATION WILL HAVE TO BE IMMUNE BEFORE OTHER PEOPLE WILL BE PROTECTED BY THIS BUFFER, THIS RING AROUND THEM.

WE DON'T KNOW, BY THE WAY, DESPITE WHAT PEOPLE ARE TALKING ABOUT IN WASHINGTON AND THE WHITE HOUSE OR THIS GROUP, THIS GREAT BARRINGTON DECLARATION, THAT NATURAL INFECTION ALWAYS LEADS TO SUSTAINED SUBSTANTIVE SUBSTANTIAL IMMUNITY.

WE HOPE IT DOES.

AND AS ONE WHO WAS INFECTED I'D LIKE TO BELIEVE THAT THAT'S THE CASE.

BUT I AM PERFECTLY HAPPY TO RECEIVE THE VACCINE AGAIN IF I CAN GET IT.

LET ME ASK YOU -- AND I'VE GOT JUST ABOUT A MINUTE AND A HALF AND I KNOW IT'S NOT A LOT OF TIME TO ANSWER THIS QUESTION.

BUT CAN YOU TOUCH BRIEFLY ON THE NOTION OF THERAPEUTICS?

WHERE ARE WE IN TERMS OF DEVELOPING SOMETHING THAT SAYS ALL RIGHT, HERE'S THE VACCINE BUT IF YOU DO GET IT HERE'S HOW WE CAN TREAT YOU.

SO THERAPISTICS ARE NOT AS WELL DEVELOPED.

PEOPLE HAVE BEEN TRYING TO REPURPOSE DRUGS THAT HAVE BEEN SHOWN TO BE VALUABLE IN OTHER CONTEXTS.

AND THE RATIONALE THERE IS YOU ALREADY HAVE THE SAFETY DATA.

RIGHT?

YOU CAN CIRCUMVENT THE STEPS YOU NEED TO PROVE THAT THE DRUG IS USEFUL.

THAT IT'S SAFE.

UTILITY'S A SEPARATE ONE.

THE ONLY ONE THAT'S REALLY BEEN APPROVED HAS BEEN REMDESIVIR.

FROM THE VANTAGE POINT OF AN ANTI-VIRAL.

BUT IT HAS ONLY MODEST EFFECT.

AND THE W.H.O. DOESN'T THINK HAS MUCH EFFECT AT ALL.

THE OTHER DRUG, WHICH HAS PROVEN TO BE VERY EFFECTIVE, IS IN PEOPLE WHO HAVE AN EXAGGERATED IMMUNE RESPONSE.

STEROIDS, DETECTION AMETH ZONE IS VERY HELPFUL.

BUT THERE ARE A WHOLE HOST OF THINGS THAT HAVE BEEN SHOWN NOT TO BE HELPFUL AND IT'S IMPORTANT TO KNOW WHAT THOSE ARE.

WE'VE EXCLUDED THEM.

YOU KNOW SOME DON'T WORK.

THESE MIGHT WORK.

LET'S SEE WHERE THEY GO.

DR. IAN LIPKIN, AGAIN, THIS HAS BEEN EXTRAORDINARILY HELPFUL.

YOU ARE A MAGNIFICENT TEACHER IN ADDITION TO A GREAT RESEARCHER.

AND MY HOPE IS THERE'S A LOT MORE I WANTED TO TALK ABOUT, MY HOPE IS WE CAN GET YOU BACK SOON AND CONTINUE THIS CONVERSATION.

THANKS SO MUCH FOR JOINING US AND OUR THANKS TO YOU AND YOUR COLLEAGUES FOR THE GREAT WORK YOU'RE DOING.

YOU STAY WELL NOW.

THANKS, JACK.

'METROFOCUS' IS MADE POSSIBLE BY SUE AND EDGAR WACHENHEIM III, SYLVIA A. AND SIMON B. POYTA PROGRAMMING ENDOWMENT TO FIGHT ANTI-SEMITISM, BERNARD AND DENISE SCHWARTZ, BARBARA HOPE ZUCKERBERG, AND BY JANET PRINDLE SEIDLER, JODY AND JOHN ARNHOLD, CHERYL AND PHILIP MILSTEIN FAMILY, JUDY AND JOSH WESTON, DR. ROBERT C. AND TINA SOHN FOUNDATION.

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