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
[Music]
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