WEBVTT 00:00:02.046 --> 00:00:04.426 A:middle >> Howard Bauchner: Hello and welcome to Conversations with Dr. Bauchner. 00:00:04.426 --> 00:00:06.466 A:middle It's Howard Bauchner, editor in chief of JAMA. 00:00:06.886 --> 00:00:07.836 A:middle What a pleasure. 00:00:07.836 --> 00:00:09.836 A:middle I am joined by Eric Topol today. 00:00:09.836 --> 00:00:10.636 A:middle Welcome, Eric. 00:00:11.466 --> 00:00:12.856 A:middle >> Eric Topol: Oh, great to be with you Howard. 00:00:13.046 --> 00:00:15.286 A:middle >> Howard Bauchner: So, I have to start. 00:00:15.286 --> 00:00:17.976 A:middle You have, I interview quite a few people, look a lot of titles. 00:00:17.976 --> 00:00:23.656 A:middle You have one of the best titles I've ever heard, the Gary and Mary West Endowed Chair 00:00:23.656 --> 00:00:27.836 A:middle of Innovative Medicine Scripps Research Executive VP, Scripps Research. 00:00:27.836 --> 00:00:30.726 A:middle How'd you get that title, Eric? 00:00:30.726 --> 00:00:36.036 A:middle >> Eric Topol: Well, the West family, they really wanted to support innovations 00:00:36.036 --> 00:00:42.816 A:middle in medicine, so back, soon after I came to San Diego in 2006/2007, 00:00:43.016 --> 00:00:45.246 A:middle I met them, and they set up this chair. 00:00:45.246 --> 00:00:47.916 A:middle And they've been incredibly supportive of our efforts. 00:00:48.786 --> 00:00:50.686 A:middle >> Howard Bauchner: Well, Eric, I think of you as a futurist. 00:00:50.686 --> 00:00:53.076 A:middle You've written a lot of incredible books. 00:00:53.256 --> 00:00:57.346 A:middle You're editor in chief of MetScape, so, we're kind of turning the tide on you. 00:00:57.346 --> 00:01:00.036 A:middle I'm interviewing you rather than you interviewing someone. 00:01:00.656 --> 00:01:05.556 A:middle And I already mentioned, Eric, I thought, unlike with the other people I've talked with, 00:01:05.556 --> 00:01:07.596 A:middle I'd like to look back a little bit. 00:01:08.096 --> 00:01:13.186 A:middle You know, late December, early January, we know that there's clearly an important virus, 00:01:13.186 --> 00:01:15.766 A:middle potential pandemic virus in China. 00:01:16.916 --> 00:01:21.066 A:middle What could we have done better, and how does 00:01:21.066 --> 00:01:23.516 A:middle that inform what we need to do now and in the future? 00:01:23.516 --> 00:01:27.126 A:middle So, what could we have done better, which wouldn't have been so monumental? 00:01:27.836 --> 00:01:28.226 A:middle >> Eric Topol: Right. 00:01:28.226 --> 00:01:32.046 A:middle Well, I think the most important thing that it's clearly 00:01:32.176 --> 00:01:35.766 A:middle where we were a negative outlier was about the testing capacity. 00:01:35.886 --> 00:01:39.556 A:middle So, if you look at many other countries that, not just South Korea, 00:01:39.556 --> 00:01:45.166 A:middle they started on the same day with the same first patient, January 21st, just over six months ago, 00:01:45.166 --> 00:01:46.956 A:middle but you look at many other countries 00:01:46.956 --> 00:01:51.946 A:middle that had the testing ready even before the first patient, like Iceland and other places. 00:01:51.946 --> 00:01:56.606 A:middle And we went two month without ability to do any significant testing. 00:01:56.606 --> 00:02:01.666 A:middle And so, during that time, we were having spread throughout the country, particularly, you know, 00:02:01.666 --> 00:02:05.236 A:middle in the New York/New Jersey area, but other places as well. 00:02:05.516 --> 00:02:06.926 A:middle And it was flying blind. 00:02:06.926 --> 00:02:13.806 A:middle So, that first phase was marked really by inability to find the spread, to track it, 00:02:13.806 --> 00:02:16.156 A:middle to see the people who are getting infected. 00:02:16.156 --> 00:02:17.166 A:middle And so, we were misled. 00:02:17.166 --> 00:02:19.176 A:middle You know, a lot of people that had pneumonia 00:02:19.296 --> 00:02:24.216 A:middle or other presentations, we couldn't even diagnosis them. 00:02:24.216 --> 00:02:28.396 A:middle So, that was, I think, the biggest singular problem, and as you know, Howard, 00:02:28.396 --> 00:02:31.876 A:middle that was tied to just the testing. 00:02:31.876 --> 00:02:37.026 A:middle The contamination and the tests and not understanding the scale of the issue. 00:02:37.026 --> 00:02:40.026 A:middle Somewhat, you know, just a denial. 00:02:40.026 --> 00:02:44.846 A:middle Now, other countries, interesting, when you talk to Carrie Stephenson and the people in Iceland, 00:02:45.106 --> 00:02:48.186 A:middle they say, well we learned how to do this, getting the testing ready 00:02:48.386 --> 00:02:52.256 A:middle and doing it even before the first patient at scale. 00:02:52.256 --> 00:02:55.776 A:middle We learned it from the U.S. So, anyway. 00:02:55.776 --> 00:02:58.766 A:middle We hopefully will have learned a big lesson on that one. 00:02:58.976 --> 00:03:03.986 A:middle >> Howard Bauchner: Yeah, you know, I said when you have a major medical error, in the hospital, 00:03:03.986 --> 00:03:05.956 A:middle it's when all the donut holes line up. 00:03:06.026 --> 00:03:10.286 A:middle And for us, that's exactly what happened with the testing, all the donut holes lined 00:03:10.286 --> 00:03:16.416 A:middle up from the CDC to the FDA to private industry, just didn't work. 00:03:16.746 --> 00:03:20.786 A:middle So, where do you think we are now, Eric, in the country? 00:03:21.886 --> 00:03:25.396 A:middle >> Eric Topol: Well, we're in a tough position because now we've gone through this surge 00:03:25.396 --> 00:03:29.876 A:middle that has actually made the first surge, the initial March 00:03:29.876 --> 00:03:32.106 A:middle and April, it makes that one look small. 00:03:32.966 --> 00:03:39.916 A:middle Yesterday, we had the highest hospitalizations yet in the pandemic in the U.S., 00:03:40.116 --> 00:03:44.066 A:middle just around 60,000, and there's no let up on that rise. 00:03:44.236 --> 00:03:48.306 A:middle In addition, you know, the deaths are starting to go up again. 00:03:48.306 --> 00:03:51.436 A:middle And so, we've had two days over 1000, and we haven't seen 00:03:51.436 --> 00:03:54.396 A:middle that since the end of May, eight weeks ago. 00:03:54.396 --> 00:04:01.476 A:middle So, all the metrics are looking bad because we haven't been able to achieve containment. 00:04:01.476 --> 00:04:07.516 A:middle And we have, instead of in the beginning of the pandemic, where we had places like New York 00:04:07.516 --> 00:04:13.136 A:middle and New Jersey, Louisiana, Detroit, we have now much more spread. 00:04:13.136 --> 00:04:21.316 A:middle And the problem we have is we went and reopened to basically promote this surge. 00:04:21.636 --> 00:04:25.526 A:middle The promotion at a time when we weren't ready. 00:04:25.736 --> 00:04:31.656 A:middle So, the guidelines suggest you get down to 10 million, 10 per million cases, 00:04:31.846 --> 00:04:36.936 A:middle and states were going, opening with 40, 50, 60 per million, 00:04:36.936 --> 00:04:39.716 A:middle and now they're at, you know, 400, 500 per million. 00:04:39.716 --> 00:04:45.496 A:middle So, instead of places like throughout Europe, the worst hit places, Belgium, Italy, France, 00:04:45.496 --> 00:04:51.126 A:middle Spain, that got down to close to 10 before they reopened, we just ignored that, 00:04:51.126 --> 00:04:53.316 A:middle and California was an example as well. 00:04:53.926 --> 00:05:00.676 A:middle But it's just not, it's a denial of the guidance, the guidelines, the evidence, 00:05:00.986 --> 00:05:02.546 A:middle and learning from other countries. 00:05:03.336 --> 00:05:08.476 A:middle >> Howard Bauchner: Do you think we finally have convinced at least a majority of people who live 00:05:08.476 --> 00:05:11.926 A:middle in the United States that they really need to mask? 00:05:11.926 --> 00:05:16.496 A:middle Do you think we've turned the corner on that important intervention? 00:05:17.176 --> 00:05:19.586 A:middle >> Eric Topol: You know, unfortunately, I wish that was the case, 00:05:19.586 --> 00:05:21.576 A:middle Howard, but it doesn't look that way. 00:05:21.576 --> 00:05:28.586 A:middle So, as of yesterday, of our 50 states, 22 still didn't have a mask mandate, 00:05:28.586 --> 00:05:33.256 A:middle and some of those were the worst in terms of a rise in case. 00:05:33.256 --> 00:05:39.796 A:middle Places like Florida, Arizona, Idaho, Tennessee, Alabama, Mississippi. 00:05:39.796 --> 00:05:46.006 A:middle So, we have a problem, not a buy-in in the importance of masks. 00:05:46.006 --> 00:05:48.556 A:middle And so, that is one part. 00:05:48.556 --> 00:05:53.466 A:middle The other thing is, places where there are mandates, there's no enforcement, of course, 00:05:53.466 --> 00:05:56.786 A:middle and so a lot of people just don't get it. 00:05:56.786 --> 00:06:04.996 A:middle Their nonuse of a mask is almost in defiance or liberty or, you know, whatever their reason, 00:06:05.226 --> 00:06:08.886 A:middle and they even question the evidence, which I think is quite powerful. 00:06:08.886 --> 00:06:14.216 A:middle So, we're not there yet on the mask, and that's really, unfortunately, because that would help. 00:06:14.216 --> 00:06:19.126 A:middle Interestingly, Howard, it's not just preventing infections but preventing the severity, 00:06:19.436 --> 00:06:23.926 A:middle just having a mask if you do get the virus, it looks like the load reduced quite a bit, 00:06:23.926 --> 00:06:27.336 A:middle and that's sparing what could be a much worse infection. 00:06:27.826 --> 00:06:29.786 A:middle >> Howard Bauchner: Yeah, I mean it does work in both ways 00:06:29.786 --> 00:06:35.116 A:middle if someone does have asymptomatic spread or is asymptomatic with disease, 00:06:35.236 --> 00:06:41.236 A:middle masking obviously prevents spread to others, but if you mask, you do help yourself. 00:06:41.336 --> 00:06:47.426 A:middle When I look back on journals, I think we could have all done things better. 00:06:47.626 --> 00:06:49.856 A:middle CDC, FDA, journals. 00:06:50.216 --> 00:06:55.536 A:middle You know, we and a couple other journals had published very early on, early February, 00:06:55.536 --> 00:07:00.946 A:middle about asymptomatic spread, and I don't think we did as good a job as saying what does that mean? 00:07:01.036 --> 00:07:03.926 A:middle You know, I think, you know, people hinted at it. 00:07:03.926 --> 00:07:07.796 A:middle There was concern about whether or not there were enough masks in the country. 00:07:07.796 --> 00:07:13.506 A:middle I do think journals could have been more instrumental in saying what does this mean. 00:07:13.776 --> 00:07:18.216 A:middle Particularly because around masking we're not talking about an expensive drug or a device. 00:07:18.216 --> 00:07:21.416 A:middle You're talking about something that virtually everyone can do, 00:07:21.706 --> 00:07:23.256 A:middle and they can create their own masks. 00:07:23.256 --> 00:07:26.306 A:middle So, I thought journals could have done a better job about that. 00:07:27.056 --> 00:07:30.026 A:middle >> Eric Topol: Yeah, and you really touched on, you know, something that's central here, 00:07:30.026 --> 00:07:35.266 A:middle because this is a unique virus where 30 to 40 percent of people 00:07:35.266 --> 00:07:41.796 A:middle who get the infection never know, they have no symptoms, and if they have some mild symptoms, 00:07:41.796 --> 00:07:44.836 A:middle they don't detect that it could be COVID-19. 00:07:44.836 --> 00:07:50.386 A:middle And so, it's a virus that has such a range of such high proportion of people 00:07:50.386 --> 00:07:56.036 A:middle without symptoms all the way to lethality, fortunately, in a much smaller percent. 00:07:56.036 --> 00:08:01.336 A:middle So, the problem is is that we don't have enough respect for the lack of symptoms. 00:08:01.656 --> 00:08:03.516 A:middle Each of us could be asymptomatic. 00:08:03.516 --> 00:08:06.996 A:middle No less the people that we, you know, come together with. 00:08:06.996 --> 00:08:12.186 A:middle So, this is that stealth mode of transmission that I think only 00:08:12.186 --> 00:08:18.966 A:middle in recent weeks has there been now acceptance about how high the proportion of people are. 00:08:19.216 --> 00:08:23.336 A:middle And you know, there's another problem is that the terminology, asymptomatic -- 00:08:23.336 --> 00:08:23.926 A:middle >> Howard Bauchner: Yeah, right, I know. 00:08:24.126 --> 00:08:25.786 A:middle >> Eric Topol: Paucisymptomatic. 00:08:25.786 --> 00:08:26.646 A:middle >> Howard Bauchner: Right, right 00:08:26.696 --> 00:08:28.006 A:middle >> Eric Topol: Which is mild -- you know, 00:08:28.006 --> 00:08:30.496 A:middle I think the Chinese had a really good term they published 00:08:30.496 --> 00:08:34.516 A:middle in Nature last week called the unascertained infections. 00:08:34.516 --> 00:08:36.176 A:middle Maybe that's the way to couch it. 00:08:36.176 --> 00:08:38.746 A:middle But, obviously, that's different than the presymptomatic. 00:08:38.746 --> 00:08:41.716 A:middle The presymptomatic people, obviously, they manifest. 00:08:41.716 --> 00:08:41.976 A:middle >> Howard Bauchner: Right. 00:08:41.976 --> 00:08:46.436 A:middle >> Eric Topol: But it's all those people that never know, and they're taking internal hits 00:08:46.436 --> 00:08:49.406 A:middle in their body, of course, by lung CT scans as you know. 00:08:49.406 --> 00:08:54.156 A:middle So, that has been a big challenge to get our arms around the pandemic, 00:08:54.156 --> 00:09:00.186 A:middle and a lot of those people that are going out to bars and, you know, all these other places 00:09:00.186 --> 00:09:05.776 A:middle to congregate, they are walking asymptomatic carriers, and they don't know it. 00:09:05.776 --> 00:09:09.336 A:middle >> Howard Bauchner: The language is interesting to me because I think it comes up all the time 00:09:09.336 --> 00:09:13.436 A:middle when we talk about how the virus spreads, by droplet or aerosolization. 00:09:13.436 --> 00:09:14.766 A:middle I think the same thing comes up. 00:09:14.766 --> 00:09:17.216 A:middle There's a struggle with the language. 00:09:17.886 --> 00:09:20.706 A:middle Eric, no one keeps up with the literature more than you do. 00:09:20.706 --> 00:09:23.936 A:middle You have a lot of contacts in industry. 00:09:23.936 --> 00:09:29.056 A:middle You know, I've spoken to Tony, Paul Offit, and others about vaccines. 00:09:29.056 --> 00:09:30.106 A:middle So, let's put them aside. 00:09:30.106 --> 00:09:31.246 A:middle There's been a few reports. 00:09:31.246 --> 00:09:32.626 A:middle I think there's more reports coming. 00:09:32.626 --> 00:09:35.046 A:middle Everyone knows that different companies are working on it, 00:09:35.046 --> 00:09:38.806 A:middle different types of vaccines, novel ones, old fashioned ones. 00:09:39.396 --> 00:09:43.926 A:middle But there's other modalities, convalescent titer, monoclonal antibodies. 00:09:43.926 --> 00:09:45.576 A:middle Could you talk a little bit about that, 00:09:45.576 --> 00:09:49.706 A:middle because a lot of people believe those approaches will be the bridge 00:09:49.706 --> 00:09:50.976 A:middle to a vaccine, particularly in the fall. 00:09:51.146 --> 00:09:51.213 A:middle >> Eric Topol: Yeah. 00:09:51.213 --> 00:09:57.266 A:middle Well, I think the monoclonal antibodies are, in terms of a therapy, 00:09:57.266 --> 00:09:59.906 A:middle the most exciting thing we've got on the horizon. 00:09:59.906 --> 00:10:05.556 A:middle And what's great about this is, you know, these are learning from nature. 00:10:05.556 --> 00:10:10.166 A:middle They are taking the antibodies, clones of antibodies from recovered patients 00:10:10.926 --> 00:10:15.346 A:middle and basically finding the key epitopes that account for neutralization. 00:10:15.676 --> 00:10:21.296 A:middle So, basically, each of us, when we get infected, develops some antibodies, 00:10:21.296 --> 00:10:23.716 A:middle but a lot of those antibodies aren't worth much. 00:10:24.136 --> 00:10:28.676 A:middle The ones that have potent neutralizing capacity are what we want 00:10:28.676 --> 00:10:32.016 A:middle to give at high quantities to people. 00:10:32.016 --> 00:10:37.026 A:middle And now, what's interesting, as there are many companies that are in clinical trial, 00:10:37.026 --> 00:10:42.156 A:middle most of them are going with one potent neutralizing monoclonal. 00:10:42.646 --> 00:10:47.446 A:middle One company, Regeneron, has published in science about their cocktail. 00:10:47.446 --> 00:10:53.546 A:middle That is, going for more than one epitope on the virus for their monoclonal. 00:10:53.546 --> 00:10:58.896 A:middle So, I think we're going to see, we already know that [inaudible]. 00:10:59.296 --> 00:11:02.566 A:middle If you give them one of these antibodies, you prevent the infection. 00:11:03.216 --> 00:11:05.286 A:middle That is, they don't manifest any disease. 00:11:05.286 --> 00:11:11.436 A:middle And if you give it to them when they have the condition, basically, it aborts the sickness. 00:11:12.326 --> 00:11:14.306 A:middle So, it's very potent. 00:11:14.576 --> 00:11:20.616 A:middle It doesn't invoke the concern so much about, you know, the antibody enhancement 00:11:20.616 --> 00:11:22.766 A:middle that we worry about with vaccines. 00:11:22.766 --> 00:11:25.226 A:middle The only issue about these are, well, there's a few. 00:11:25.226 --> 00:11:31.456 A:middle One is that in medicine, as you're well aware, the history isn't good 00:11:31.456 --> 00:11:33.446 A:middle for the expense of these monoclonals. 00:11:33.716 --> 00:11:36.486 A:middle They're very expensive, in cancer and many other. 00:11:36.656 --> 00:11:38.386 A:middle Rheumatology. 00:11:38.386 --> 00:11:39.076 A:middle >> Howard Bauchner: Right. 00:11:39.076 --> 00:11:42.836 A:middle >> Eric Topol: So, they're not like a cheap therapy like dexamethasone. 00:11:42.926 --> 00:11:47.686 A:middle Second is the production at scale, and in the one, if you could get it down to, you know, 00:11:47.686 --> 00:11:51.696 A:middle very low cost and availability, the biggest concern, of course, 00:11:51.696 --> 00:11:54.786 A:middle is that they're just a couple months' worth of protection. 00:11:55.186 --> 00:11:58.776 A:middle But, you know, when they are available, that will be transformative, 00:11:59.116 --> 00:12:04.396 A:middle while we wait for the vaccine, which is likely we will see multiple vaccines, you know, 00:12:04.396 --> 00:12:09.546 A:middle hopefully end of the year, beginning in next year, which is an accelerated pace the likes 00:12:09.546 --> 00:12:14.446 A:middle of which we've never seen So, I'm, I talked to Tony Fauci, you know, 00:12:14.446 --> 00:12:20.256 A:middle in our conversation last week, and he similarly is excited about the monoclonals because, 00:12:20.496 --> 00:12:24.186 A:middle you know, we don't, all we have right now is, you know, not great therapy. 00:12:24.186 --> 00:12:29.176 A:middle Dexamethasone, even though that trial recovery came out very positive for survival, 00:12:29.176 --> 00:12:32.026 A:middle a lot of us were using dexamethasone already. 00:12:32.786 --> 00:12:34.696 A:middle Remdesivir doesn't have the potency. 00:12:34.696 --> 00:12:39.026 A:middle And, you know, the interesting thing you probably have been seeing is 00:12:39.026 --> 00:12:41.856 A:middle that the interferon stuff is looking better. 00:12:41.856 --> 00:12:42.356 A:middle >> Howard Bauchner: Right. 00:12:42.356 --> 00:12:44.286 A:middle >> Eric Topol: And so, it's the opposite of dexamethasone. 00:12:44.286 --> 00:12:49.796 A:middle It looks like it works early, and we have a randomized trial that's small. 00:12:49.796 --> 00:12:53.896 A:middle And we haven't actually seen the data, just a press release, and we also have a large, 00:12:53.896 --> 00:12:56.536 A:middle multicentered study of over a couple hundred people. 00:12:56.536 --> 00:13:01.546 A:middle So, that looks encouraging, and you know, hopefully we'll have multiple therapies, 00:13:01.836 --> 00:13:05.646 A:middle but the monoclonals, I think, are going to play an important role. 00:13:06.116 --> 00:13:08.716 A:middle >> Howard Bauchner: The reason, from my standpoint 00:13:08.716 --> 00:13:12.846 A:middle that it could work is we know the high-risk group. 00:13:12.846 --> 00:13:19.986 A:middle I mean it's so clearly defined that, you know, if you're 65, 70, 75, particularly if you're 00:13:19.986 --> 00:13:23.376 A:middle in a nursing home, you know, or a healthcare worker, 00:13:23.376 --> 00:13:25.296 A:middle because we have to protect healthcare workers. 00:13:25.296 --> 00:13:26.946 A:middle So, we know the high-risk group. 00:13:26.946 --> 00:13:28.706 A:middle We've known it since January. 00:13:28.706 --> 00:13:32.306 A:middle So, for me, at least around monoclonal antibodies, 00:13:32.306 --> 00:13:35.436 A:middle we know who should be up first to get them. 00:13:35.436 --> 00:13:40.956 A:middle And I think in part, one of the success stories, and there's not many, of the last couple months, 00:13:41.036 --> 00:13:45.306 A:middle I think we're probably doing a better job protecting the frail elderly 00:13:45.306 --> 00:13:47.436 A:middle than we did in January, February, and March. 00:13:47.436 --> 00:13:50.996 A:middle I think that's in part why despite the number of cases, the number of deaths, 00:13:50.996 --> 00:13:52.886 A:middle that ratio is slightly different. 00:13:52.886 --> 00:13:57.256 A:middle Do you have a sense that we've at least learned that much over the last four or five months? 00:13:57.606 --> 00:14:01.856 A:middle >> Eric Topol: Yeah, you're bringing up a critical point because cases in March 00:14:01.856 --> 00:14:03.976 A:middle and April are different than cases now. 00:14:04.376 --> 00:14:07.106 A:middle Back then, you know, the threshold for getting a test, 00:14:07.586 --> 00:14:10.516 A:middle which were of limited availability was you had to be really sick. 00:14:10.516 --> 00:14:11.006 A:middle >> Howard Bauchner: Right. 00:14:11.006 --> 00:14:15.806 A:middle >> Eric Topol: And now, the states that are doing pretty well with testing, although still, 00:14:15.806 --> 00:14:21.636 A:middle albeit much lower than we'd like, but much more mild cases are being picked up. 00:14:21.636 --> 00:14:27.576 A:middle And, as you said, the young are out there, the younger people, but the older, 00:14:27.576 --> 00:14:30.346 A:middle vulnerable people are staying home by and large. 00:14:30.346 --> 00:14:34.926 A:middle So, the infections are definitely occurring at a younger age group, 00:14:35.276 --> 00:14:39.296 A:middle and their survival is enhanced just by that feature alone. 00:14:39.336 --> 00:14:46.956 A:middle So, the combination of the most vulnerable not being in the pool of being out there, 00:14:46.956 --> 00:14:53.506 A:middle to be exposed as much, the higher level of testing, more aggressive testing, 00:14:53.506 --> 00:14:57.536 A:middle gets us to that we won't hopefully see anything like that slope 00:14:57.536 --> 00:15:00.666 A:middle of fatality curves that we saw in March and April. 00:15:00.666 --> 00:15:04.846 A:middle But they are rising, the death rate is unquestionably increasing now, 00:15:04.846 --> 00:15:11.566 A:middle has been for the last couple weeks, and you know, this is something that we could avoid 00:15:11.836 --> 00:15:16.136 A:middle and still can avoid if we get much more aggressive about things like masks 00:15:16.136 --> 00:15:21.636 A:middle and distancing and if need be, even going back to a stay-at-home situation 00:15:21.636 --> 00:15:24.796 A:middle in places where things are really hot. 00:15:25.626 --> 00:15:29.996 A:middle >> Howard Bauchner: Now, Eric, people may not even know, you're a cardiologist by training, 00:15:29.996 --> 00:15:35.896 A:middle and you were a trialist, you still do trials, but you're really a preeminent trialist 00:15:35.896 --> 00:15:39.826 A:middle when you were in Cleveland before you moved to Scripps. 00:15:39.986 --> 00:15:44.766 A:middle There's lots of questions, but Eric, when you look at the disease, 00:15:44.766 --> 00:15:46.746 A:middle what strikes you about the disease? 00:15:46.746 --> 00:15:48.646 A:middle There's so many elements. 00:15:48.646 --> 00:15:54.366 A:middle I'm pained to say, I mean part, I mean as a journal editor who gets to read 00:15:54.366 --> 00:15:57.126 A:middle about so many different elements from that standpoint, 00:15:57.126 --> 00:15:58.926 A:middle it's scientifically very stimulating. 00:15:58.926 --> 00:16:04.696 A:middle But, you know, the proning that's taking place, the inflammatory cascade that s occurred. 00:16:04.946 --> 00:16:09.086 A:middle Now, just beginning to emerge are late complications, you know. 00:16:09.666 --> 00:16:12.976 A:middle Neurologic complications, hematologic complications, 00:16:12.976 --> 00:16:17.926 A:middle what strikes you when you consume all this literature about the disease itself? 00:16:18.176 --> 00:16:24.496 A:middle >> Eric Topol: Well, I think one of the most important things you're just getting to is 00:16:24.496 --> 00:16:27.326 A:middle that we consider this a respiratory virus. 00:16:28.036 --> 00:16:33.966 A:middle You know, had it entered through the nasal mucosa, attach to ACE2, and then somehow it got 00:16:33.966 --> 00:16:37.206 A:middle down to the lungs through aspiration, and that was kind of it. 00:16:37.206 --> 00:16:42.316 A:middle And, you know, the more we have learned about this virus, the more we know, 00:16:42.316 --> 00:16:46.526 A:middle it's so diffusely across the body, even things 00:16:46.526 --> 00:16:50.426 A:middle like the pancreatic islet cells to give new-onset diabetes. 00:16:50.426 --> 00:16:57.756 A:middle But, you know, the effects not just in promoting and endothelialitis and vascular effects 00:16:57.756 --> 00:17:02.076 A:middle with clotting and strokes and potential brain effects. 00:17:02.076 --> 00:17:06.536 A:middle And you know, there's hardly a major organ, kidney, heart, that isn't involved. 00:17:06.536 --> 00:17:09.686 A:middle So, you know, that has been, I think, 00:17:09.686 --> 00:17:13.726 A:middle very important because we were not geared up for that in the beginning. 00:17:14.146 --> 00:17:17.996 A:middle Now, we, as you know, Howard, we're into all this digital stuff -- 00:17:17.996 --> 00:17:19.196 A:middle >> Howard Bauchner: Yeah, right. 00:17:19.196 --> 00:17:19.406 A:middle >> Eric Topol: Yeah. 00:17:19.476 --> 00:17:24.546 A:middle So, we got into this, and you know, I've never been involved really with infectious disease 00:17:24.546 --> 00:17:30.366 A:middle to any extent, but what we got involved with, we published in January, I think, 00:17:30.366 --> 00:17:35.836 A:middle an important paper on about 50,000 people with a Fitbit that we can predict the flu. 00:17:36.176 --> 00:17:36.266 A:middle >> Howard Bauchner: Right. 00:17:36.486 --> 00:17:39.096 A:middle >> Eric Topol: And that was a precursor. 00:17:39.096 --> 00:17:44.986 A:middle So, as soon as we started seeing this pandemic get started, we said, hmm, that signal we had 00:17:44.986 --> 00:17:50.786 A:middle with the resting heart rate elevation for flu, and the surrogate for fatigue, 00:17:50.996 --> 00:17:55.926 A:middle which is that you are sleeping more and you're taking less steps. 00:17:56.856 --> 00:18:04.356 A:middle That triad was a remarkable signal for a flu, early signal for a flu. 00:18:04.356 --> 00:18:06.846 A:middle So, we said, well wait a minute, why don't we use that for COVID. 00:18:07.086 --> 00:18:11.876 A:middle So, back in March we already had launched a big study called Detect, 00:18:11.876 --> 00:18:16.096 A:middle and now we have 40,000 people in it that are giving their data constantly. 00:18:16.096 --> 00:18:20.386 A:middle And that's a very complementary strategy to test, test, test, 00:18:20.386 --> 00:18:24.216 A:middle which we can't do in 330 million people on a frequent basis. 00:18:24.216 --> 00:18:27.466 A:middle So, it gives continuous surveillance. 00:18:27.466 --> 00:18:34.586 A:middle It also, that same signal we've seen is very sharp for picking up COVID, 00:18:35.106 --> 00:18:37.006 A:middle correlating it with people who've had testing. 00:18:37.336 --> 00:18:39.756 A:middle So, we think we can achieve a digital surveillance 00:18:39.756 --> 00:18:43.976 A:middle for the country using what 100 million people have one of these, you know, wristbands, 00:18:43.976 --> 00:18:49.076 A:middle whether it's a smartwatch or a fitness band, and we think that can help, this pandemic is going 00:18:49.076 --> 00:18:54.366 A:middle to be with us for, you know, years, and if we use digital surveillance like they're using 00:18:54.366 --> 00:19:00.336 A:middle in Germany, which they adopted after our paper, then we could get much smarter 00:19:00.336 --> 00:19:04.646 A:middle about where the next outbreaks could be before they actually get significant. 00:19:05.076 --> 00:19:10.906 A:middle >> Howard Bauchner: Yeah, sadly there's been not much success in even cities that have invested 00:19:10.906 --> 00:19:15.486 A:middle in kind of testing, tracking, and tracing for a number of reasons. 00:19:15.686 --> 00:19:19.396 A:middle You know, the first is that you need really much more efficient testing than we have, 00:19:19.396 --> 00:19:25.206 A:middle and then secondly, the U.S., unlike many countries, doesn't turn over privacy data that's 00:19:25.206 --> 00:19:28.966 A:middle in one's phone, which is probably, is probably one 00:19:28.966 --> 00:19:31.526 A:middle of the most effective ways to test, track, and trace. 00:19:31.806 --> 00:19:35.046 A:middle And that's not very successful in the U.S. So, I know both Boston 00:19:35.046 --> 00:19:38.886 A:middle and New York City have really struggled around the test, track, and trace. 00:19:38.886 --> 00:19:42.376 A:middle So, it's interesting to see that there could be a different digital approach. 00:19:43.096 --> 00:19:47.306 A:middle Eric, there's been disagreements about what the fall may bring, obviously, 00:19:47.306 --> 00:19:51.916 A:middle the most complicated issue at the moment is schools. 00:19:51.916 --> 00:19:58.346 A:middle But do you have a sense of what may happen or should happen with schools and then, in general, 00:19:58.346 --> 00:19:59.976 A:middle what you think the fall will bring? 00:20:00.556 --> 00:20:06.476 A:middle I mean I interviewed Robert Redfield from the CDC, and you know, he said, he's concerned. 00:20:06.476 --> 00:20:08.256 A:middle It could be the worst fall around healthcare 00:20:08.256 --> 00:20:11.236 A:middle that the United States has seen in many, many decades. 00:20:11.336 --> 00:20:14.246 A:middle But my sense, so the question is around school and then 00:20:14.416 --> 00:20:16.646 A:middle in general what you think will happen in the fall? 00:20:17.206 --> 00:20:21.996 A:middle >> Eric Topol: Yeah, well, I think attacking the school issue first, 00:20:21.996 --> 00:20:25.106 A:middle since it's really paramount in our minds. 00:20:25.106 --> 00:20:28.926 A:middle You know, I think we're learning from the rest of the world what's going on in schools. 00:20:28.926 --> 00:20:35.596 A:middle If you're in a zone that has great suppression, very few cases, you can move forward, 00:20:35.596 --> 00:20:37.886 A:middle and there's been very good success stories. 00:20:38.196 --> 00:20:44.186 A:middle But, as you touched on, you got to have the tracing and isolation ready, test trace 00:20:44.186 --> 00:20:48.366 A:middle and isolation, so that in case you see something, you get all over it quickly. 00:20:48.366 --> 00:20:53.646 A:middle Now, what's interesting is that the model country for suppression, one of them, 00:20:53.646 --> 00:20:58.286 A:middle there's about 30 of them around the world, but one of them that's prominent is Israel. 00:20:58.356 --> 00:20:59.076 A:middle >> Howard Bauchner: Right. 00:20:59.076 --> 00:21:01.846 A:middle >> Eric Topol: And Israel had amazing success early. 00:21:02.266 --> 00:21:05.876 A:middle They got their cases almost down to none. 00:21:05.876 --> 00:21:07.656 A:middle And now they're experiencing -- 00:21:07.656 --> 00:21:08.006 A:middle >> Howard Bauchner: Yes. 00:21:08.006 --> 00:21:11.956 A:middle >> Eric Topol: Their longest outbreak, like the U.S. Now, if you look back at what happened, 00:21:11.956 --> 00:21:14.176 A:middle when they opened, they opened the schools. 00:21:14.546 --> 00:21:18.896 A:middle They've had major outbreaks, one of the biggest ones of any school outbreak yet, 00:21:18.896 --> 00:21:20.946 A:middle which was in Jerusalem in a high school. 00:21:20.946 --> 00:21:23.786 A:middle But they've had them also in day care centers. 00:21:24.276 --> 00:21:29.856 A:middle And so, here's a country that was the model, that like some other countries in Europe, 00:21:29.856 --> 00:21:33.106 A:middle which had really good suppression, but yet they've now had, 00:21:33.106 --> 00:21:34.766 A:middle you know, major school outbreaks. 00:21:34.766 --> 00:21:38.466 A:middle So, this tells us that we have to be very careful. 00:21:38.606 --> 00:21:43.056 A:middle And my surprise here, Howard, and this is something I just don't understand, 00:21:43.056 --> 00:21:47.826 A:middle is why don't we inject science into this and do this, let's say, in row risk zones. 00:21:47.826 --> 00:21:52.856 A:middle Like in New York area, in Connecticut, in New Jersey, whatever, Maine. 00:21:53.116 --> 00:21:58.256 A:middle Open the schools there's and have everything ready to, you know, do the contact tracing, 00:21:58.256 --> 00:22:01.806 A:middle do the genomics so you can see how the virus is transmitting, 00:22:01.806 --> 00:22:07.786 A:middle since we don't really know the frequency of child-to-adult, child-to-child transmission. 00:22:08.006 --> 00:22:10.436 A:middle Do that. Do that, you know, for a month. 00:22:10.686 --> 00:22:16.406 A:middle Get the data in low-risks zones so that we get a better handle on these missing pieces 00:22:16.406 --> 00:22:19.896 A:middle of information, so we can be smarter about opening schools 00:22:19.896 --> 00:22:22.786 A:middle in the areas of midzone activity. 00:22:22.786 --> 00:22:28.096 A:middle But we shouldn't even think about this mandate of opening schools in areas that are 00:22:28.096 --> 00:22:32.286 A:middle like Florida, Arizona, Texas, Georgia, and all the other -- it's crazy stuff. 00:22:32.546 --> 00:22:34.136 A:middle We know that's a recipe for trouble. 00:22:34.556 --> 00:22:39.666 A:middle So, even though children are less apt to get the infection and to transmit it, 00:22:39.666 --> 00:22:43.166 A:middle less doesn't mean zero, and there are plenty of cases. 00:22:43.326 --> 00:22:45.076 A:middle South Africa is another. 00:22:45.076 --> 00:22:46.996 A:middle South Africa is kind of like the U.S. now. 00:22:47.386 --> 00:22:49.076 A:middle It's on a steep rise of cases. 00:22:49.416 --> 00:22:52.206 A:middle When they opened the schools, it was horrible. 00:22:52.206 --> 00:22:54.856 A:middle They had so many outbreaks, they had to close down the schools. 00:22:54.936 --> 00:22:57.636 A:middle We don't want to have that happen in the United States. 00:22:58.176 --> 00:23:03.026 A:middle >> Howard Bauchner: Your comment about experimenting, it's just, we struggle so much 00:23:03.026 --> 00:23:07.086 A:middle in the middle of trying to take care of people and then the political fractionation 00:23:07.086 --> 00:23:09.866 A:middle in the U.S. doesn't help, but I had interviewed Paul Storm. 00:23:09.866 --> 00:23:16.046 A:middle Paul had said, the time to try to do some quasi-experimental data are now, 00:23:16.046 --> 00:23:18.276 A:middle and there was that really interesting report, 00:23:18.276 --> 00:23:20.546 A:middle I think it was out of Germany, where they opened a gym. 00:23:20.826 --> 00:23:26.156 A:middle They let 1800 people go, and they didn't let, and 1800 people could go to the gym. 00:23:26.156 --> 00:23:29.276 A:middle So, 1800 not, 1800 could. 00:23:29.506 --> 00:23:33.406 A:middle They followed them for a month, and they looked at the rate of disease at the end 00:23:33.406 --> 00:23:35.336 A:middle of the month, and it was pretty similar. 00:23:35.336 --> 00:23:39.616 A:middle So, the way in which they opened the gym, they then pronounced was safe. 00:23:39.616 --> 00:23:44.176 A:middle And Paul had mentioned exactly what you did, that over the summer, 00:23:44.176 --> 00:23:48.096 A:middle well I had interviewed him two months ago, that even then there were day care centers open. 00:23:48.316 --> 00:23:53.156 A:middle So, we really needed to learn from that experience so that it could inform what we do 00:23:53.516 --> 00:23:56.756 A:middle in the fall, and I don't think we've really taken advantage of that. 00:23:57.186 --> 00:24:01.756 A:middle >> Eric Topol: Yeah, we've got such an opportunity to get that model, science, 00:24:01.756 --> 00:24:08.766 A:middle evidence, and nail this down so that we don't put kids and teachers and bus drivers and staff 00:24:09.136 --> 00:24:15.796 A:middle and parents and grandparents all, you know, this is not an isolation of kids story. 00:24:15.796 --> 00:24:19.366 A:middle It's a matrix, it's a network that has to be understood, 00:24:19.366 --> 00:24:21.366 A:middle and we don't understand it yet enough. 00:24:21.366 --> 00:24:25.976 A:middle We just have variable lessons and indicators from other places. 00:24:26.196 --> 00:24:29.686 A:middle So, I hope we can do this in the right way. 00:24:29.686 --> 00:24:35.446 A:middle I'd love to see the schools open, obviously, but you know, not in a reckless way. 00:24:35.446 --> 00:24:39.266 A:middle You know, the other thing you're bringing up is the flu coming. 00:24:39.266 --> 00:24:40.556 A:middle >> Howard Bauchner: Yeah, right, the fall. 00:24:40.556 --> 00:24:41.086 A:middle Yeah. 00:24:41.086 --> 00:24:45.366 A:middle >> Eric Topol: And, you know, that adds another layer of complexity, 00:24:45.366 --> 00:24:47.406 A:middle as if we need another one right now, right. 00:24:47.686 --> 00:24:47.753 A:middle >> Howard Bauchner: Yeah. 00:24:47.796 --> 00:24:51.666 A:middle >> Eric Topol: But, the interesting thing here is not just about just coinfections 00:24:51.666 --> 00:24:58.116 A:middle and distinguishing flu versus COVID but also what's maybe going to help us. 00:24:58.196 --> 00:25:02.046 A:middle If we use masks, we're already seeing that the flu -- 00:25:02.046 --> 00:25:02.376 A:middle >> Howard Bauchner: Yes. 00:25:02.376 --> 00:25:06.916 A:middle >> Eric Topol: Is having a big dent in the spread of flu. 00:25:06.916 --> 00:25:13.656 A:middle So, the masks, if we get smarter about that and they become much more pervasive in use, 00:25:13.726 --> 00:25:18.906 A:middle that may help blunt the influenza that we would expect in the fall, late fall. 00:25:19.436 --> 00:25:22.566 A:middle >> Howard Bauchner: Yeah, you know, when you look at the summer months, you know, 00:25:22.566 --> 00:25:25.186 A:middle it begins to get cool in September, by October, November, 00:25:25.186 --> 00:25:28.656 A:middle people are generally inside in much of the United States. 00:25:30.286 --> 00:25:35.496 A:middle I really hope we can bring the 60,000 down to 5000 or 10,000 by late August 00:25:35.496 --> 00:25:38.686 A:middle so that then we're better prepared for September. 00:25:39.096 --> 00:25:42.216 A:middle We can think about which schools could open and which can open. 00:25:42.216 --> 00:25:47.586 A:middle But, you know, when flu arrives in October and November, if we're still at 50,000 cases, 00:25:47.586 --> 00:25:49.786 A:middle it will be a nightmare for the healthcare system. 00:25:50.156 --> 00:25:54.066 A:middle I really am uncertain how well we'll be prepared, and then obviously, 00:25:54.636 --> 00:25:59.216 A:middle trying to reach record highs for people being vaccinated 00:25:59.216 --> 00:26:01.026 A:middle against flu will be critical this year. 00:26:01.856 --> 00:26:03.126 A:middle >> Eric Topol: Absolutely. 00:26:03.126 --> 00:26:07.586 A:middle I mean, you know, and we've learned how weak that vaccine is relative. 00:26:07.586 --> 00:26:09.856 A:middle It's a rapidly evolving virus. 00:26:09.856 --> 00:26:14.626 A:middle Unlike, fortunately, SARS-CoV-2, which is a slowly evolving virus. 00:26:14.626 --> 00:26:17.646 A:middle If there's anything good about the virus, that's like the only thing, 00:26:17.806 --> 00:26:20.266 A:middle because the vaccine should hold over time. 00:26:20.626 --> 00:26:25.836 A:middle But now, we've got, we've go to get much more aggressive and serious in the places 00:26:25.836 --> 00:26:30.186 A:middle where this is heating up or has already overheated, and we're not doing it. 00:26:30.186 --> 00:26:32.446 A:middle And it's just amazing, because, you know, 00:26:32.446 --> 00:26:38.526 A:middle I tweeted about how maybe we should get a governor's brush up on exponential progression, 00:26:38.786 --> 00:26:42.236 A:middle because they don't seem to understand that when they do something more serious, 00:26:42.236 --> 00:26:44.296 A:middle they wait until it's gotten much worse. 00:26:44.296 --> 00:26:46.836 A:middle They don't watch the curves going up. 00:26:46.836 --> 00:26:50.686 A:middle And we have to learn that, you know, when you're already starting to see a signal 00:26:50.686 --> 00:26:53.646 A:middle of deterioration, it's already past the time. 00:26:53.646 --> 00:26:58.806 A:middle It's like, you know, if you're thirsty, that means you really are dehydrated right. 00:26:58.806 --> 00:27:01.546 A:middle And that's the same principle, but we don't get our governors, 00:27:01.546 --> 00:27:07.206 A:middle which are unfortunately responsible, because we don't have a nationally coordinated plan, 00:27:07.206 --> 00:27:10.556 A:middle they are being much too delayed in their action. 00:27:10.636 --> 00:27:13.356 A:middle >> Howard Bauchner: Yeah, it's got to be so difficult for mayors, 00:27:13.356 --> 00:27:15.716 A:middle governors, now school superintendents. 00:27:16.576 --> 00:27:19.986 A:middle I mean they have certain skills, but they're not public health positions. 00:27:19.986 --> 00:27:25.926 A:middle We don't have a very good public health system in the United States, and so, 00:27:25.926 --> 00:27:32.146 A:middle this obviously has shown all of the warts of our public health system and hopefully 00:27:32.146 --> 00:27:34.536 A:middle when we look back in three or four or five years, 00:27:34.536 --> 00:27:39.966 A:middle one of the changes will have been building up a reserve of public health knowledge 00:27:39.966 --> 00:27:46.386 A:middle and public health support systems in addition to the testing. 00:27:46.386 --> 00:27:52.186 A:middle Eric, I have to ask, you know, warp speed, I mean you know all the language. 00:27:52.186 --> 00:27:54.746 A:middle You follow it, you've done the interviews. 00:27:54.746 --> 00:27:58.896 A:middle A couple of traditional vaccines, you know. 00:27:58.896 --> 00:28:00.136 A:middle Heat killed. 00:28:01.056 --> 00:28:02.696 A:middle Then these new ones. 00:28:03.026 --> 00:28:09.546 A:middle Some of the reports have shown some concerns about adverse effects, but they're small. 00:28:09.546 --> 00:28:12.386 A:middle All of the studies have been small, phase one, phase two. 00:28:12.386 --> 00:28:16.566 A:middle The phase three studies, China, Europe, the U.S. are just beginning. 00:28:16.716 --> 00:28:17.626 A:middle >> Eric Topol: Right, right. 00:28:18.236 --> 00:28:23.496 A:middle >> Howard Bauchner: All right you optimistic, Eric, or restrained optimism? 00:28:23.496 --> 00:28:26.226 A:middle What's your level of optimism about the vaccines? 00:28:26.576 --> 00:28:30.776 A:middle >> Eric Topol: Well, you know, looking at the phase two data that just came out, you know, 00:28:30.896 --> 00:28:37.126 A:middle from some of these programs last week, you know, four of them, it looks encouraging. 00:28:37.126 --> 00:28:42.006 A:middle What I like seeing is that not only a great antibody response, 00:28:42.006 --> 00:28:44.676 A:middle neutralizing antibody, but also T-cell respond. 00:28:45.036 --> 00:28:51.706 A:middle So, some of the programs have given specific data on the T-cells, CD4, CD8, and you know, 00:28:51.706 --> 00:28:56.406 A:middle it's very encouraging that you're getting a response like SARS, 00:28:56.406 --> 00:29:02.286 A:middle the original SARS that we have now seen a lot of those people from 17 years ago studied well. 00:29:02.286 --> 00:29:08.526 A:middle So, you know, I think we're going to see good, if you will, artificial immunity, 00:29:08.526 --> 00:29:13.096 A:middle and I think our biggest problem, frankly, we'll have a choice of vaccines. 00:29:13.096 --> 00:29:16.436 A:middle Some of them will have, you know, differences in potency or durability, 00:29:16.436 --> 00:29:20.126 A:middle but our biggest problem probably is not going to be the vaccine, per se, 00:29:20.506 --> 00:29:22.956 A:middle but rather getting people to take the vaccine. 00:29:22.956 --> 00:29:28.156 A:middle If people can't even wear a mask, how are we going to see these people, you know, 00:29:28.156 --> 00:29:34.916 A:middle getting the vaccines, the antiscience problem, and the misinformation, 00:29:35.256 --> 00:29:38.036 A:middle disinformation out there is pretty profound. 00:29:38.036 --> 00:29:39.486 A:middle So, we're going to have to deal with that. 00:29:39.486 --> 00:29:43.996 A:middle We ought to start dealing with it now, because it's going to be hopefully a matter of months, 00:29:43.996 --> 00:29:47.896 A:middle or early next year, that we have a choice of some of these vaccines. 00:29:48.156 --> 00:29:52.896 A:middle >> Howard Bauchner: Staying with that topic, Eric, you know I'm a pediatrician, 00:29:52.896 --> 00:29:59.526 A:middle and so the notion, the anti-vax vacciners, and the vaccine hesitant families, 00:30:00.196 --> 00:30:04.746 A:middle and it's that group, that 20, 25, 30% of people 00:30:04.746 --> 00:30:05.976 A:middle who are vaccine hesitant, what do you say to them? 00:30:06.046 --> 00:30:13.456 A:middle >> Eric Topol: Yeah, well, we go to bring them along on the science and the social contract, 00:30:13.456 --> 00:30:16.856 A:middle and you know, this whole idea that, you know, we're all in this together 00:30:17.446 --> 00:30:22.716 A:middle and so that they understand that we can get there faster in terms of a normal back 00:30:22.716 --> 00:30:27.216 A:middle to pre-COVID life if we all get vaccinated. 00:30:27.216 --> 00:30:31.266 A:middle And, you know, I think that's something that's going to, it's an uphill battle, 00:30:31.266 --> 00:30:36.826 A:middle but it's not going to, the persuasion and the nudges, you know, they have to be done, 00:30:36.826 --> 00:30:41.256 A:middle this is where behavioral scientists really come into play, to do it right. 00:30:41.256 --> 00:30:46.246 A:middle And whether that's, you know, social media, TikTok, and all these things that, you know, 00:30:46.246 --> 00:30:52.836 A:middle have been used, anything we can do to start to dispel the Wakefield stuff 00:30:52.836 --> 00:30:57.376 A:middle and the growing anti-science sentiment that has occurred, which has been nurtured 00:30:57.376 --> 00:30:59.606 A:middle by our administration, unfortunately. 00:30:59.606 --> 00:31:04.706 A:middle And that's something that we can't ignore, that if we had an administration that was really 00:31:04.706 --> 00:31:09.666 A:middle into the science, that said from the get-go, masks are essential, that, you know, 00:31:09.666 --> 00:31:12.396 A:middle there's no risk and it has to be some benefit. 00:31:12.396 --> 00:31:12.796 A:middle >> Howard Bauchner: Right. 00:31:12.796 --> 00:31:17.146 A:middle >> Eric Topol: If we just had that, and again, with vaccines, we have a better chance 00:31:17.146 --> 00:31:19.756 A:middle of following the model, following the leader. 00:31:19.756 --> 00:31:23.936 A:middle And one other point I just want to get back to is not just our public health system, 00:31:23.936 --> 00:31:27.696 A:middle because you know this really well, it's the inequities in our health system, 00:31:28.096 --> 00:31:33.506 A:middle and we see this exaggerated toll among blacks, Latinos, Native Americans, 00:31:33.506 --> 00:31:35.716 A:middle and all these underrepresented minorities. 00:31:35.716 --> 00:31:41.986 A:middle And we got to, we're working on that too, and they've got to be getting vaccinated and treated 00:31:41.986 --> 00:31:44.016 A:middle and access to care and all that stuff. 00:31:44.016 --> 00:31:46.956 A:middle So, I hope we've learned a valuable lesson there as well. 00:31:47.226 --> 00:31:47.386 A:middle >> Howard Bauchner: Yeah. 00:31:47.386 --> 00:31:52.246 A:middle JAMA has published extensively on that very, very painful issue. 00:31:53.136 --> 00:31:58.346 A:middle Eric, so we just put a piece from ASIP yesterday, an opinion piece, you know, 00:31:58.346 --> 00:32:03.006 A:middle National Academy of Medicine, I know you're a member, has a committee on vaccines. 00:32:03.876 --> 00:32:08.786 A:middle I'm sure MedPAC is going to have a committee on vaccines, but they all make recommendations. 00:32:08.786 --> 00:32:10.026 A:middle None of them are definitive. 00:32:10.236 --> 00:32:14.446 A:middle Do you worry about political pressure on the FDA to approve a vaccine 00:32:14.446 --> 00:32:17.586 A:middle through emergency use authorization? 00:32:17.586 --> 00:32:22.056 A:middle That's come up, that there'll be some data in October, limited on safety, 00:32:22.056 --> 00:32:23.976 A:middle but because of the election in November, 00:32:23.976 --> 00:32:27.246 A:middle there'll be a lot of pressure on Steve Hahn and the FDA. 00:32:27.246 --> 00:32:28.976 A:middle I'm wondering how you think about that? 00:32:29.436 --> 00:32:31.996 A:middle >> Eric Topol: Yeah, I'm very worried about it, Howard, 00:32:31.996 --> 00:32:36.026 A:middle and the reason I'm worried is we already saw what happened with the hydroxychloroquine -- 00:32:36.026 --> 00:32:36.093 A:middle >> Howard Bauchner: Yeah. 00:32:36.416 --> 00:32:40.636 A:middle >> Eric Topol: Where the pressure from the administration to the FDA 00:32:40.636 --> 00:32:44.916 A:middle to give emergency use authorization without any compelling data, 00:32:45.306 --> 00:32:50.366 A:middle and obviously that has never been shown in any meaningful way to have any efficacy, 00:32:50.366 --> 00:32:52.496 A:middle and you know, also some questions of safety. 00:32:52.496 --> 00:32:56.126 A:middle So, if we see that replayed with the vaccine, that's even worse, 00:32:56.126 --> 00:33:00.116 A:middle because the threshold they're talking about is 50% efficacy, 00:33:00.456 --> 00:33:01.956 A:middle which is kind of like the flu vaccine. 00:33:01.956 --> 00:33:03.186 A:middle That's not very good. 00:33:03.276 --> 00:33:04.396 A:middle That's a low bar. 00:33:04.776 --> 00:33:10.296 A:middle And so, you know, the problem we're going to have, and you know this far better than I do, 00:33:10.296 --> 00:33:16.626 A:middle but when you go into scale vaccination, you're going to see things that you didn't see 00:33:16.626 --> 00:33:22.356 A:middle in any trials, and so you want to actually be very careful about letting the genie 00:33:22.356 --> 00:33:25.736 A:middle out of the bottle, if it is even genie, because we're going 00:33:25.736 --> 00:33:28.736 A:middle to see people that have untoward effects. 00:33:28.736 --> 00:33:32.746 A:middle It's unquestionable, the hope is that it's extremely rare. 00:33:32.746 --> 00:33:36.796 A:middle But, you know, this is why we need and FDA that's tougher on this 00:33:36.796 --> 00:33:40.316 A:middle and doesn't buckle to political machinations. 00:33:40.316 --> 00:33:44.546 A:middle And that's what we have right now, it seems, and you know, 00:33:44.666 --> 00:33:47.856 A:middle I hope that isn't what comes into play. 00:33:48.276 --> 00:33:52.066 A:middle >> Howard Bauchner: Yeah, as I said, there will be all of these advisory commits. 00:33:52.066 --> 00:33:53.986 A:middle Hopefully, they'll have access to the data. 00:33:54.356 --> 00:33:58.106 A:middle A lot of them are going to obviously focus on the important issue of cost and equity. 00:33:58.106 --> 00:34:00.886 A:middle Now, I do know the U.S. is spending a fortune on vaccines. 00:34:00.886 --> 00:34:05.516 A:middle Apparently, this new bill that they may settle on has more money for vaccines. 00:34:05.516 --> 00:34:08.866 A:middle So, hopefully since government is spending so much it will just be free 00:34:08.866 --> 00:34:11.186 A:middle for the country, but let's put that aside. 00:34:11.186 --> 00:34:14.976 A:middle >> Eric Topol: Yeah, that's the one thing I don't get is the billions and billions, 00:34:15.096 --> 00:34:19.566 A:middle tens of billions on vaccines, and nothing for rapid diagnostic tests, 00:34:19.566 --> 00:34:23.326 A:middle which are the most exciting potential of anything we've talked about. 00:34:23.326 --> 00:34:25.366 A:middle >> Howard Bauchner: So, I have to close. 00:34:25.366 --> 00:34:28.186 A:middle So, we've been on a while, and we could stay another half hour. 00:34:28.356 --> 00:34:33.116 A:middle Your life in the last four or five years is technology, the future. 00:34:33.366 --> 00:34:36.136 A:middle You really are so creative around that. 00:34:36.706 --> 00:34:42.996 A:middle So, is telemedicine here to stay, question one, because the transformation is extraordinary. 00:34:42.996 --> 00:34:46.686 A:middle We were limping along, and two weeks later, that's how we're delivering care. 00:34:46.686 --> 00:34:48.876 A:middle So, telemedicine, telehealth. 00:34:49.146 --> 00:34:51.606 A:middle And then there is a question, rapid tests at home. 00:34:51.606 --> 00:34:54.116 A:middle You know, you go to your drug store, you come home, 00:34:54.116 --> 00:34:56.336 A:middle and you know, it was like a pregnancy test. 00:34:56.556 --> 00:35:00.646 A:middle Where are we, so telemedicine, telehealth, is it here to stay? 00:35:00.986 --> 00:35:03.076 A:middle And then, a different approach to testing. 00:35:03.786 --> 00:35:07.726 A:middle >> Eric Topol: Yeah, well, I think the telemedicine has certainly got, 00:35:07.726 --> 00:35:13.686 A:middle its value has been absolutely embraced when you're trying to do physical distancing 00:35:13.686 --> 00:35:19.156 A:middle and delivering care, and somebody is not really ill, it's a winner. 00:35:19.156 --> 00:35:21.296 A:middle It isn't real medicine. 00:35:21.846 --> 00:35:24.026 A:middle You can't do the real physical exam. 00:35:24.116 --> 00:35:26.996 A:middle You can't be, the presence is different. 00:35:27.336 --> 00:35:31.986 A:middle But at least you're not wearing a mask, and you are not typing 00:35:31.986 --> 00:35:35.686 A:middle on a keyboard hopefully with your back to the patient. 00:35:35.686 --> 00:35:36.936 A:middle So, there's some tradeoffs. 00:35:37.306 --> 00:35:40.006 A:middle I think it's here to stay for many reason. 00:35:40.006 --> 00:35:42.696 A:middle I mean that's how, you know, largely I'm practicing now. 00:35:42.956 --> 00:35:49.956 A:middle The issue is that we're going to be in this pandemic for a stretch, and it's just increasing 00:35:49.956 --> 00:35:53.526 A:middle at rates like other exponential curves in the pandemic. 00:35:53.526 --> 00:35:59.116 A:middle And so, it's going to be used in the low-risk types of encounters, but why it's going 00:35:59.116 --> 00:36:02.726 A:middle to stay longer is we're going to get much better at data exchange. 00:36:02.726 --> 00:36:04.936 A:middle So, today, it's just a video chat. 00:36:04.936 --> 00:36:05.206 A:middle >> Howard Bauchner: Right. 00:36:05.206 --> 00:36:06.286 A:middle >> Eric Topol: Like what we're doing. 00:36:06.286 --> 00:36:11.406 A:middle But in the future, you'll have censure data and tests and all these other stuff 00:36:11.406 --> 00:36:13.186 A:middle that you can make it more objective. 00:36:13.186 --> 00:36:16.556 A:middle And you can do some of the physical exam during the encounter. 00:36:16.556 --> 00:36:20.246 A:middle So, I think we'll go to this telemedicine 2.0 00:36:20.246 --> 00:36:25.606 A:middle over the next couple years that'll even shore up its importance. 00:36:25.606 --> 00:36:33.146 A:middle It'll never substitute for physical visits, I mean the real deal, because that's medicine, 00:36:33.146 --> 00:36:37.856 A:middle and that's what we always want to use for anything that's important. 00:36:37.856 --> 00:36:41.926 A:middle Now, the other point that you got to is a rapid test. 00:36:41.926 --> 00:36:42.106 A:middle >> Howard Bauchner: Yeah. 00:36:42.106 --> 00:36:46.636 A:middle >> Eric Topol: This is really the most exciting thing, I think going on right now. 00:36:46.866 --> 00:36:52.346 A:middle There's over 16 companies that are now well into the assurance 00:36:52.346 --> 00:36:55.036 A:middle of sensitivity accuracy that's reasonable. 00:36:55.156 --> 00:37:01.846 A:middle Twenty minutes, 30 minutes, get the answer on a paper strip, like a pregnancy test. 00:37:01.846 --> 00:37:02.906 A:middle >> Howard Bauchner: Just like a pregnancy test. 00:37:02.906 --> 00:37:07.236 A:middle >> Eric Topol: Inexpensive, you know, even, you know, at Stanford, Manu Prakash got it 00:37:07.236 --> 00:37:11.656 A:middle down to a dollar a test, but, you know, five dollars, 10 dollars maximum. 00:37:11.656 --> 00:37:16.996 A:middle So, in a range that you could do at home quickly or, you know, at a place of work 00:37:16.996 --> 00:37:19.276 A:middle or wherever, and you get the answer. 00:37:19.436 --> 00:37:23.796 A:middle And that, I think, is what we should be investing heavily in, because the sooner we get 00:37:23.796 --> 00:37:30.896 A:middle that at scale and give those tests to people, rather than having to pay for it, 00:37:31.076 --> 00:37:35.026 A:middle that is something that is a ticket back to some semblance 00:37:35.026 --> 00:37:39.596 A:middle of where we were before we were hit with the pandemic. 00:37:39.596 --> 00:37:43.796 A:middle >> Howard Bauchner: Last question, and sticking with this theme, is that three months away, 00:37:43.796 --> 00:37:46.966 A:middle six months away, nine months away, and that's going to have to go through FDA approval. 00:37:46.966 --> 00:37:48.456 A:middle What's your sense of that, Eric? 00:37:48.866 --> 00:37:53.156 A:middle >> Eric Topol: Yeah, well, a couple of them already have EUA approval, which you know, 00:37:53.376 --> 00:38:00.446 A:middle Earns Use Approvals are given out like, you know, anybody can almost seemly get that. 00:38:00.446 --> 00:38:03.466 A:middle But so, I've spoken to several of these companies. 00:38:03.516 --> 00:38:10.616 A:middle Sherlock BioScience, Keidel [phonetic], and others, they're all talking about October 00:38:11.286 --> 00:38:15.096 A:middle to have these, they're making them now, you know, hundreds of thousands. 00:38:15.406 --> 00:38:20.056 A:middle We need millions, but we have a terrible predicament right now 00:38:20.056 --> 00:38:22.226 A:middle where we're, again, short on testing. 00:38:22.746 --> 00:38:25.836 A:middle And that's with a week or longer turnaround. 00:38:25.836 --> 00:38:26.026 A:middle >> Howard Bauchner: Yeah, no. 00:38:26.026 --> 00:38:26.596 A:middle It's terrible. 00:38:26.596 --> 00:38:27.656 A:middle >> Eric Topol: Which it's a farce. 00:38:27.866 --> 00:38:30.946 A:middle I mean if you don't get the results back in a matter of hours 00:38:30.946 --> 00:38:33.856 A:middle or a day, you know, what good is it? 00:38:33.856 --> 00:38:36.216 A:middle All the things that happen, you know in between. 00:38:36.216 --> 00:38:41.396 A:middle So, this is the only solution, and we just published the Rockefeller Foundation new report 00:38:41.396 --> 00:38:46.176 A:middle where we underscored the importance an the need for investment in this, but, you know, 00:38:46.176 --> 00:38:48.876 A:middle we have no response from the government. 00:38:48.876 --> 00:38:52.266 A:middle I do think, you know, yesterday Francis Collins and his group published 00:38:52.266 --> 00:39:01.256 A:middle about the NIH RADx rapid diagnosis initiative, which is like a shark tank of academic labs 00:39:01.256 --> 00:39:04.606 A:middle and companies and they're all competing for the support. 00:39:04.746 --> 00:39:05.996 A:middle That's helping things too. 00:39:05.996 --> 00:39:08.776 A:middle We've got to get there as quickly as possible, 00:39:09.046 --> 00:39:14.296 A:middle because then we could really know whatever we're doing is that each person is good for the day. 00:39:14.656 --> 00:39:17.486 A:middle That they don't have, they're not infectious, they're not transmissible. 00:39:17.626 --> 00:39:18.766 A:middle That's what we need to know. 00:39:18.826 --> 00:39:22.106 A:middle >> Howard Bauchner: No, it's entirely transformative for people to visit each other, 00:39:22.166 --> 00:39:26.816 A:middle to go back to -- I mean entirely transformative. 00:39:27.336 --> 00:39:34.096 A:middle And it is probably the best way we can get back to a semblance of working society. 00:39:34.756 --> 00:39:35.256 A:middle >> Eric Topol: Yes. 00:39:35.816 --> 00:39:38.966 A:middle >> Howard Bauchner: What a privilege to talk with Eric Topol. 00:39:39.496 --> 00:39:43.156 A:middle I've already mentioned that he's editor in chief of MetScape. 00:39:43.156 --> 00:39:48.896 A:middle So, it was nice for him to allow me to interview him since he usually does interviews. 00:39:49.246 --> 00:39:50.996 A:middle >> Eric Topol: I'm going to interview you next, yeah. 00:39:51.666 --> 00:39:55.186 A:middle >> Howard Bauchner: Eric is the Gary and Mary West Endowed Chair of Innovative Medicine, 00:39:55.186 --> 00:39:57.976 A:middle Scripps Research Executive VP, Scripps Research. 00:39:58.066 --> 00:40:02.486 A:middle I think of him now, I know he's trained as a cardiologist. 00:40:02.486 --> 00:40:07.086 A:middle He's done fabulous research in cardiology, but I really think of him as a kind of someone 00:40:07.086 --> 00:40:10.036 A:middle who loves technology and is a futurist. 00:40:10.036 --> 00:40:12.176 A:middle Eric, thanks so much for joining me today. 00:40:12.506 --> 00:40:13.406 A:middle >> Eric Topol: Oh, my pleasure. 00:40:13.406 --> 00:40:14.646 A:middle Thank you so much, Howard. 00:40:14.646 --> 00:40:15.636 A:middle >> Howard Bauchner: Please, stay healthy. 00:40:15.636 --> 00:40:17.556 A:middle >> Eric Topol: Yeah, you too. 00:40:17.636 --> 00:40:18.616 A:middle >> Howard Bauchner: All righty, take care. 00:40:18.616 --> 00:40:19.386 A:middle Bye Eric. 00:40:19.386 --> 00:40:19.646 A:middle >> Eric Topol: Thanks. 00:40:19.646 --> 00:40:19.936 A:middle Bye bye now.