What Has COVID19 Taught Us

so

today i’m really going to engage in a

conversation with you

rather than present slides and go over

data as you’ve heard

we’re going to try to focus on what’s

been positive that’s come out of this

past year it’s been

transformative for all of us

not just because of kovic but because of

racial division economic

division the trump administration

recognition of climate change which i

think is

probably even more important than what

we’re going to be talking about today

with respect to viruses a truly

extraordinary time to be

in your early 20s because you’re gonna

have to develop

the solutions for all of these problems

that the generations before you have

created and for that i apologize

but i hope you take it as a challenge

and you rise to it

what is a virus um i don’t know how many

of you are

pre-med or biology majors

but i think it’s worth thinking about

the term virus

what it implies so viruses are

intracellular parasites

and they require the machinery of the

cell to reproduce themselves

to disseminate to become infectious and

they evolve to become more fit and to

adapt to specific hosts

the term virus and going viral has

changed obviously

with the introduction of social media in

the 1980s the concept of going viral

arose within the advertising industry

as a way of getting your product to

market

and now of course people market all

sorts of ideas

and with the growth of ai what we’re

finding

is that one can really distribute an

enormous amount of

not only useful information but

misinformation

and this is going to be an extraordinary

problem for us

all sorting what’s real from what’s not

you saw the implications this had for us

in terms of the take over the capital

the way people move around from various

kinds of demonstrations

and i first became aware of this

particular issue

in 1999 when i went to a department of

defense meeting

that was held in an island off the coast

of virginia

there was an animal virologist that’s

what i am a plant virologist

and a computer virologist and in 1999

there weren’t many people thinking about

computer viruses

in retrospect that was very you know an

innocent period but this was something

that the

military realized was going to be

extremely important

i think you’ve seen the ways in which

this has grown

now we can use what we’ve learned

about containing

sars cov2 and other viruses and thinking

about the ways in which

we control misinformation and from those

who are interested

in electrical engineering and algorithms

and such

this is a wonderful opportunity i think

to have a huge impact

so i wanted to get that point about

viruses across before we start talking

about

infectious diseases now i didn’t start

out my career

wanting to work on infectious diseases i

wanted to make films when i was in

height

in college in high school i wound up

going to medical school

during my second residency in

san francisco in the early 80s hiv aids

emerged

this was really the first zoonosis

that drew our attention to the

challenges that we were going to have

with viruses coming out of areas that

had formerly been

fairly secluded we presume that virus

came from some place in central africa

based on similarities in sequence to

other viruses

and probably through bush meat hunting

consumption of wild animals

and i think you could make the argument

that if everyone became a vegetarian

we wouldn’t have any more of these

wildlife diseases

and we’d solve a lot of problems with

climate change not that i’m suggesting

that

but it’s just an interesting thing to

ponder

now it took two years from the time that

we realized

that the disease aids it was then called

gay related immunodeficiency disorder

was due to an infectious agent

and that was really because there was a

child

who’d received multiple blood

transfusions during infancy so there’s

no

possibility of any sort of sexual

transmission and that child became ill

from a blood product

people then began looking for this

specific virus

that would be implicated in that

disorder

a french group ultimately identified it

but it took two years from the

recognition of the presence of that

virus

in patients with this disorder to its

recognition as the cause of disease

and there was an enormous amount of

fighting between

a group at the national events cancer

institute in the united states

and the pastor institute in paris

fighting over credit for the discovery

the intellectual property and the money

associated

with that discovery

during that time period hundreds of

thousands of people were exposed became

infected

and probably millions of people died as

a result

now if we fast forward to present day

and think about intellectual property

around

vaccines associated with covid19 we see

the same sorts of issues we need to find

some way to ensure that everyone

has access to these vaccines we can talk

during the q

a about the differences between the

vaccines

but the major point is still there is

that is

until everyone is safe no one is safe

in 2002 2003 there was an outbreak of

sars a related coronavirus in china

that virus belong began began as best we

know in guangdong province

in a city called guan niquanjo where

there are a lot of wildlife

markets and people consume a lot of

these

very very expensive expensive exotic

animals

killed thousands of people not nearly as

bad as what we’ve seen

with sargo v2 but it illustrated the

fact

that respiratory viruses the ones we are

most concerned about

can spread very very rapidly the last

such example that we have in recorded

history

is in 1918. when a new influenza virus

emerged

that resulted in damage and death and so

forth

over a period of two years perhaps

one percent of the world’s population

died

now that’s not going to happen here with

sarge kovi 2

because we have technologies at this

point that allow us

to detect the virus to isolate to

develop vaccines all of which will be

important

but it illustrates what i’m trying to

tell you about respiratory viruses

and that is to say that these are the

ones that concern us the most

because you don’t have to have the

intimate contact in order to transmit

the virus

and there are some people who we define

as super spreaders who obviously have

very very high loads of virus

that they spread either by talking

loudly or coughing or some other sort of

way in which

the virus is transmitted that results

in infection of a large number of people

now we’ve seen the catastrophe of

leadership

in this country and the fact that we

didn’t have

adequate testing we didn’t have

sufficient supplies

of personal protective equipment

but i will say that the vaccine effort

was extraordinary

typically when we have

a an effort to build a new vaccine it

takes five to ten years

the first sequence of this virus were

released

at the beginning of the second week of

january

so here we are

a point now where we probably immunized

10 to 15 percent of the u.s population

i didn’t check the data today but we

anticipate

that by the end of the summer everyone

who wants to be vaccinated will have

been vaccinated

and we believe that by september

of 2021 90 of the population will be

vaccinated

so right now our challenges are still

focused around

production of these vaccines though we

have

though we are on track as i say to

produce everything that we’re going to

need

at least in the united states and some

of the logistic challenges with delivery

of these vaccines

now the reason we’ve been so successful

is that we’ve changed our whole approach

to making vaccines

so we started really if you go back

several hundred years

where people did this method by which

they would simply take

a skin lesion from somebody scrape it

and then introduce it to another

individual because there had been

observations serendipitous

observations that this led to protection

edward jenner discovered for example

that

girls who were you know adolescents who

were

milk maids as they were called did not

get smallpox

and he extrapolated from that finding

to try to find ways in which he could

look at things that were on

their hands that were associated with

this particular protection from

infection

and to transfer that to other people and

in the first

years of the of the revolutionary war

george washington for example varulated

his troops

there have been enormous losses

amongst native peoples in the americas

and elsewhere as a result of the

introduction

of infectious diseases so infectious

diseases are extraordinarily powerful

and the vaccines that we’ve developed

for addressing them

allow us to prevent them from spreading

now i don’t know that we’re going to get

everyone to take these vaccines one of

the things that we’re trying to do

is to produce videos

that persuade people that vaccines are

safe

since 1990 the late 1990s i’ve been

struggling with

someone named andrew wakefield who keeps

pushing

this notion that vaccines cause autism

despite the fact there’s no evidence

that that’s the case

and there’s been resistance to polio

vaccination

because people have been concerned about

the possibility that this might

lead to sterility or other kinds of

problems

people in the united states now

including um fairly

some prominent people whose names i

won’t mention

um have been suggesting

that this particular vaccine the ones

the ones that we’re selling the ones

we’re using now

like the pfizer vaccine

and the moderna vaccine are actually

um they actually contain some sort of

small nanobots

that travel through your body and record

your thoughts

i mean these kinds of absurd things that

are actually being

voiced by people and believed by people

just like the qnon

concept of you know you go into this

pizza parlor and you’re going to find

these abused kids

you know behind some closet

so we have to deal when i started

talking with you about misinformation

these are some of the things we need to

address

there were some videos that came out

from our former presidents with the

exception of trump

and the first ladies where they

encouraged

people to get vaccinated um

and we’ve had a number of sort of

celebrity efforts to build

trust in vaccines and to provide

information

about physical distancing and so forth

but i don’t think that’s as persuasive

as seeing somebody who looks like you

whoever you are a broad range

a whole color palette people who are

black

and brown and red and yellow and white

old young male female so forth

these are the kinds of projects that i’m

now doing

and i hope that you will see them soon

because we did those with scott burns

the screenwriter

from contagion we made them about two

months ago

originally they were designed to roll up

your sleeves in new york

but now it’s going to be roll up your

sleeves america and i think what you’ll

see is

you know a wide range of people as i say

will be more persuasive

in encouraging people to take vaccines

so as eager as you may be to take

vaccines

and i would bet that almost everybody on

this call

is eager to have a vaccine there

are something like 25 to 30 percent of

the population

who do not want to be vaccinated as

extraordinary as that may seem to you

my wife is going to walk in through the

front door

catherine i’m on this zoom ted thing so

this is life right life during the

pandemic

anyway so um so as

eager as we all are to get vaccinated

there will be people as i say who do not

want to be vaccinated

and we need to find some way to reach

out to them and make this happen

now i don’t even know where to start

with the last administration because

there were several

sorts of things that came up they were

really quite extraordinary

we take hydroxychloroquine

this was a drug that was promoted

without

evidence base i was infected

in march and my infectious disease

physicians

put me on hydroxychloroquine

and i’ve had difficulty living that down

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we don’t have a lot of drugs as yet

there’s some

question as to whether or not

convalescent plasma is valuable or not

the one thing that we know is absolutely

important

is barrier protection and when we first

began

thinking about covid and transmission

we didn’t know the incubation period we

didn’t know how long people would shed

virus

we didn’t know what

to do to detect the virus what

diagnostic tests would be most useful

and we certainly didn’t know what

therapeutics might be useful

so when you go back and do it

post-mortem

on our performance during this

particular

pandemic it’s going to be extraordinary

to see what worked and what didn’t so

what are the lessons that we did have

that were positive the first i would say

is that we need to be better prepared

personal protective equipment whether it

be masks or gloves

or ventilators or air purification

systems of any types like merv 13

filters

that you put inside your furniture air

conditioners

these are going to be useful whatever

the agent

and we should not have been in a

situation where we didn’t have a

sufficient supply

when i was in china at the end of

january

in 2020

and the first week of february the

chinese government was

buying as much as they could find

on the open market and we

were just caught flat-footed

despite the fact that many of these

types of gear were actually produced in

the united states

similarly when the decision was made to

start

producing diagnostic tests

we didn’t use the appropriate controls

in manufacture

so when you do this method called pcr

you have to have a negative control

the negative control is contaminated

there’s no way to know

whether or not what you find and call

positive signal

is actually positive and that was an

assay that was built by our cdc

the food and drug administration was in

such a hurry

to approve drugs diagnostics and other

treatments

that they released things prematurely

which undercut the confidence

of the american people in what it is we

were doing

then we had natural experiments that

were done

in other parts of the world that were

amazing so if you look at

scandinavia the norwegians and the danes

said

we’re going to try to contain this

infectious disease

by isolating people and by forcing them

to wear masks

the swedes in contrast said we’re going

to go for broke

and plan to hit herd immunity as rapidly

as we can and come back to normal

and their death rate was four to tenfold

higher

than in norway and in denmark so we

clearly learned an enormous amount

by looking at what other people were

doing

now what is the future of this virus

and the pandemic so here’s the good news

although this virus will almost

certainly be with us

from this point forward we will have

immunity to it

because we will be continuously

vaccinating

improving the vaccines we provide and

learning more about drugs

that can be helpful in treating disease

number two the collaboration that we’ve

seen

internationally and nationally has been

nothing

short of extraordinary people are

working across

borders and finding ways in which they

can be helpful

to one another we need to continue in

this way

now one of the things that we need to do

is to ensure

that there is capacity to detect

infectious agents anywhere in the world

right now

there this is really restricted to the

developed world by that i mean north

america

and europe australia probably south

africa

but once you start moving into rural

areas

or you move into south america or south

asia

we don’t have these capacities

so the wealthier nations of the world

need to provide

the tools that are required to detect

and respond to infectious agents

intellectual property is another

potential compound that we need to

address

intellectual property cannot prevent us

from

making vaccines and drugs available at

low cost

to the developing world not only is it

unethical

it’s also foolish from the vantage point

of self-interest

because until this virus is contained

it is going to continue to evolve and it

become a bigger and bigger threat to us

all

so as you are in a position

in the next say 15 20 years to lead

which is what i hope you all will do

please think about not only what’s

happening

in the united states but what is

happening globally

the america first policy

sounds good to some people but it

doesn’t really work

people have to be equal and unless they

are we’re not going to make progress

the world is not going to be a safe

place just like pollution

doesn’t respect borders neither do

infectious agents

now i think in terms of formal

points that i wanted to make we’re

probably there

i mean i could i could have shown you a

lot of slides but i was told not to do

that

so i’ll close with one last thing on

climate change

which as bill gates has said is a much

thornier issue

than addressing the pandemic

climate change we think of in terms of

rising seas famine

all sorts of other issues it has an

impact on infectious diseases too

with droughts followed by periods of

flooding

you get an increase in rodent

populations

insect populations these animals carry

diseases that are threats to humans

as we see food insecurity more people

resort to eating bush meat and as they

consume bush meat

agents that were formally restricted to

wild animals

begin to move into people

in addition deforestation

leads to these animals moving in closer

proximity

to humans so for example

lyme disease which was formally seen

only really in a very small area in the

eastern seaboard

has now moved across the new into the

midwest

and into the west mosquito-borne

diseases

like dengue and malaria which we had

never seen

in north america has now begun to move

into texas and to florida and as we see

increasing temperatures

you’re going to start seeing more and

more of these infectious diseases

emerging

in the midwest as well

so