Special Episode: Scott Gottlieb, MD [206]


What have South Korea and Germany gotten right on the krona virus? Have we overreacted? And what will normality or semi-normality? Look like we'll discuss all this and more on a special edition of the editors with Scott Gottlieb the former FDA commissioner now with the American Enterprise Institute. You're listening to a national view podcasts. You listen to this. Podcast VIEW DOT com. Or what have you? But it'd be easier for you and better for us if you made us part of your feet at any of the streaming services out there from spot fight. I tunes feel like what you hear. Please give us a glowing five star review on I tunes. If you don't like what you hear here forget. I said anything so Scott. Thanks so much for making time. And congratulations on all your really valuable work on this. I thought we do this. Conversation and three buckets. I I'd ask about some things. I'm just curious about mostly involving the various Responses from countries around the world and how China handled this second. Go into some of the critiques. From the right about how we've handled this and especially The argument that we've overreacted and three get into your work with your colleagues about how we responsibly. Open up again. So let's just dive right in and let me ask you this. If this virus had merged in one thousand nine hundred seventeen and nineteen eighteen and let's subtract world one pretend world war one didn't happen all the crowding and things of that nature But just have the same medical and scientific knowledge and conditions of that era. Would this virus have looked like I think given the profile? This virus is likely it would have been far more deadly than the Spanish flu. If you look at Look in comparison to Spanish flu viruses have bears some similarities in that the people who seem to be hardest hit by virus are people who are middle aged relative to normal seasonal fluid Spanish flu was that the young people will by and large spared. Old people were spared to But there were a lot of older people around nineteen eighteen and they would disperse differently demographically but the people who are hardest hit by the spent the middle aged people and it was often stories talking. About how the Spanish flu left kids orphan to be raised by their grandparents and what was happening with the Spanish flu was people were dying of. We think was an overwhelming inflammatory response. Immune reaction to the fluid south the fluids so novel that revved up people's immune systems and that that immune response actually destroyed people's lung tissue this seems to be very similar this is a lower airway disease affecting lower areas of lung and the people who are getting into trouble and getting what we call acute respiratory distress syndrome in the air type picture in the ICU. Ending up with prolonged innovations. What's happening? They're having an overwhelming immune response. They're developing what squad sidelined storm. It's basically a release of immune cells and those immune cells are attacking their own tissue and damaging their lungs. That's very Spanish flu like and if you look at the sort of overlay of deaths from Spanish flu verses intimations in ICU admissions from covert nineteen. There's unmistakable trend in terms of how the ages trend with the exception at for covert nineteen. There's a very large spike. When you get over the age of seventy five eighty and that we don't we can't full explain that other than to say that nineteen the warrant a lot of eighty euros now. There are is possible that the small number eight year olds who lived in nineteen eighteen. Maybe we're dispersed in the countryside outside the cities with Spanish flu hit and so they just didn't come into proximity with the Spanish flu. Maybe they would selected for because a you know were were had more ability to the pathogens unclear that's never been explained. But what is clear is that there's unmistakable trend as you move through the age bands of people died from the Spanish flu versus people who are admitted to the ICU. For Covert nineteen reason. Why that's I think relevant observation is at. I think it's reasonable to surmise. That anyone who soup who gets admitted to belonged Icu stay with covert nineteen ends up getting into bait ends up getting prolonged critical care. That's probably someone who would have died from the Spanish flu. And if you do accept that assumption or at least some amount of that suction if you say well. Some large proportion of people who are surviving covert nineteen or even surviving but ending up with prolonged Into Beijing in critical stays in critical care would have died from Spanish flu than Spanish Nineteen not only looks like Spanish flu in terms of distribution across the age range but looks far more fearsome. So let's talk about some of the responses around the world and the different outcomes so I remember one of your Bank tweets at the beginning of this. What four or five weeks ago is that? We've missed the opportunity to be on a South Korean curve because of the the initial testing debacle. But I just wonder that that South Korean example just how applicable it would have been in this country Involved such robust contact tracing in tracking people on their phones and things that even if we've been stronger out of the gate on testing would seem hard to do in this country. What would you think of that operation while the tracking on the phones? Were sort of a sideshow thing. I think a lot of people clinging to that to find reason to be skeptical of sort of traditional public health case Baynes tracking. We would never do that in this country Track people and see where they go and see if they come into contact with coke now is sort of a sideshow thing that South Korea did They did do contact tracing overall though they identified their cases efficiently. They had very broad diagnostic capabilities so they tested a lot of people identified those cases and they did do traditional contact tracing where they interview people who are positive found at all. The people were in touch with you. Know ask those people if they were sick required some selfies late. Who may be had signs of symptoms coca until they got back? Positive tests may be for people who are in closer contact they were were also requiring people self isolate until tests came back proving that they were negative so they did. They did that. Those are the traditional tools of public health. We do that here all the time. There's a measles outbreak outbreak of multi-drug-resistant tuberculosis. We do those cards it tools. We also did that at the outset of covert nineteen in fact. We did more than that. We forcibly required people to quarantine on military bases when they're identified as having covered nineteen or or exposed to nineteen. We're even more aggressive in some ways. The challenge was that there ended up being so many cases in the. Us quickly overwhelmed our capacity to do that to do contact tracing and what we call case based interventions if we want to prevent another outbreak in the future or large epidemic. We're GONNA have to rely on these tools. We really don't have a choice. I mean you can either let this circulate. You could do three things they just let it circulate and then you're GonNa have an extreme amount of morbidity death and disease hostels be overwhelming to build more hospitals people probably as large subset of people are going to be afraid to go out. You can do what we're doing now. population-based base mitigation. But it's it's untenable to do this again to me we. We can't go through this again as a country or you can do those case based interventions very aggressively and try to find people who have the disease test very aggressively and when you find people ask them to self isolate for a period of time that they're infectious in five people. They might have been in contact with either treat them. Hopefully we'll have a drug that will be a prophylaxis you'll be all treat them or s themself isolate for the duration that they may have the disease. We're those are the only three options I mean. Is that really a good middle option with any of those strategies so we'll circle back on on. Xm obviously hits on your on your thinking about how we open back up the German example in Europe. It it does seem to be the the genuine exception in Europe. Lots of confirmed cases. Probably write a product of of lots of testing But then many fewer deaths than in places like Italy Spain the UK which lease at the outset. I haven't checked down in on a slightly ahead to do with apparently young people being disproportionately in fact infected but what accounts for Germany looking different than the rest of Europe. We don't know exactly. There's a number of things about Germany. That are a lot different first of all as you said. They case fatality relative cases. They turned over as far lower than us. Certainly but lower than other parts of the world is well. It's probably a function of a number of things. One day are diagnosing more than mild and moderate nascent cases in the community so there Denominator Looks Different Than Ours. Relative to the numerator. Many people are hospitalized. How many people Ultimately come to the infection they have many more mild and mater cases underneath that here in the US were by and large just diagnosing. People were presenting to the hospital. I would say on the whole. Were probably doing a worse. Job Than China did At diagnosing all our cases in several other criticism of China date not being believable. Our data's probably off by me even further because we have less community-based testing in Chinese at this point you can you can sort of surmise. Just by the fact that we don't have community based testing sites that up And certainly less than South Korean Singapore Hong Kong where they had a lot of community based testing site. Set up the other thing. Is that when you look? At a comparison of the percent of deaths blessed in sixty five years old versus percents deaths over the age of eighty At your in Germany. It's it's four point. Nine percent of all their deaths from covert are less than the age of sixty five Sixty one percent or by the age of eighty give you some other examples in elite nine percent of all their deaths. Covert deaths are less than the age of sixty five Netherlands is five point one percent in Portugal. Four point five percent in Spain is four point. Six percent in Sweden four point eight percent switch learns three percent so pretty consistently around five percent. Say of all those countries of the deaths overall about five percent or less than the age of sixty five of all their debts in the US by comparison Louisiana. It's twenty three percent Michigan Detroit's twenty one percent In New York City. It's twenty nine point nine percent so startling as that's under underlying health conditions we don't know Is the short answer. The long answer is there seems to be a correlation With a poverty and death if if you overlay the map of where the death star in those cities in the United States there Areas of extreme poverty. And so you can surmise that. It's socioeconomic factors like crowding in in housing with people can't socially distance probably co Morbid illness because his higher incidences of Diabetes Smoking related illness in those communities so is probably multifactorial but like a lot of other infectious diseases. Mrs True Infectious they often become diseases of poverty in disproportionally affect people of lower socioeconomic groups for a whole variety of reasons. Another reason is that in a lot of people lower income people who can't can't miss work but there were also they work in jobs where they come into contact people think about someone on checkout line. Grocery store That person's coming into contact with a lot of people on a daily basis increasing debt. Paternity that they get sick so moving here to the US. what your view has been the the difference or parent difference now comes in. California in New York. San Francisco is initial hotspot and the New York Times Article Day or two ago along piece on. Why New York was was late and both Cuomo's got. I've gotten a lot of praise and de Blasio not so much Both both were late to this compared to California. But you look at the timeline. And it doesn't seem like an enormous difference. I think you know the the lockdown California's started a couple of days earlier than that in New York. Wh- what accounts for the disparity between this those two places in your view. Well they were late. They'll probably about a week behind California in terms of the actions that they took and a certain things that they didn't do that. Enclose subway system to blase was very reluctant to close the school system. I think relative to the country though they took pretty aggressive action When they did Sampson's go really lead on on the stay at home order anything when they did that. People were shocked by that people. Who weren't really cognizant of what was coming and in. New York did a number of days later not I think about four five days later. Maybe they announced Day or two later. I think what happened in New York. Probably if you look at Seattle Seattle's probably a better example. Seattle had a a large outbreak very clearly early. The first city really to be identified as having a large outbreak. They they were Very resistant to take any kind of medication steps. And we're getting a lot of criticism Fort They didn't close businesses. They didn't shut their transit. Date didn't require state homeowners And that was well before when we knew that there was even a community spreads. Cisco but what happened in Seattle probably and we know this now from Asia looking at the sequences of the strains in different people is Seattle. Probably had a single introduction sometime before the The travel restrictions will put in place from a traveler from China. 'cause you can sequence strain in now see where it's from any sequence strange of the other people and see where it's from. It's it seems to be the same strain. One large cluster eighty five percent of the infection. Seattle seems to be from one large cluster in the rest. Are you know travelers from Europe and elsewhere? So when that cluster hit? Let's say a thousand cases or fifteen hundred cases and it was expanding a star to throw off sparks. Sparks lit fires became visible the nursing. Home the young man who had the flu flu like symptoms and ended up being cost-wise all those early cases where sparks thrown off from that initial fire would probably happen in New York. Is New York? Some point in February didn't have a single introduction that ended up being a spark that litter flame it ended up it had probably dozens and dozens of simultaneous introductions. All the same time that all became sparks that lit separate fires and when all those fires hit five hundred cases six hundred cases then it became self evident across the entire city. By that time it was so heavily seated there was so many clusters expanding that it was too late. We don't know this for sure. But we're GONNA know this eventually by looking sequencing data that these probably our separate clusters. Seattle probably caught a break. In a way in that there they had one expanding cluster of managed to see that one expanding cluster they took interventions too late but they interventions early enough to deal with one large cluster versus other cities in the mid multiple clusters. Right so last thing on on this portion of our conversation you mentioned China. So what is your view? Obviously China's coming in with the for Getting beaten around the head and shoulders by a lot of folks especially folks on the right If China had been more honest and more transparent at the outset how much of a difference would have made In the spread of this disease or is just the nature of this disease That that was bounded to get out. Get loose around the world. One way or the other Look very critical of China's behavior in this before it became fashionable to criticize China's behavior analysis was over a period of time when everyone was bending over backwards to laud China seem to forget. That actually happened both. Us and international officials were saying congratulatory things about China's behavior. You think waking the president even president trump what was going on In the HELL secretary others. I think what was going on in the beginning was China is not being forthcoming with information. That could have helped us prepare so just a the most visible example is. They didn't make the virus available to anyone so in order to develop a diagnostic test. You need what's called a positive control you need. You need the virus itself. You could try to synthesize it. But that's never as good you want to live virus. China would give it to anyone they held onto it. They pub sure they publish the sequenced strain. But they didn't make the live virus available. The United States eventually got the live virus but they got two weeks later than they otherwise could have that delayed development of diagnostics I think the bigger the bigger infraction here and the one that's going to be judged against their their role in humanity and what they did to the world because his viruses changed the course of history. This has altered the world. This is not going away. This is GonNa permanently change how we live until we get to a vaccine. I mean the the gravity of what does virus is going to mean. Society for the next two years cannot be overstated. My view and this is a consequence of something that came out of China. And it's not just an accident. I mean they set up the conditions to create this risk. They knew they. They knew they had the conditions to create this kind of risk with these markets in the way they handled live animals. But but even more worrisome than that is you could make now a reasonable argument looking at just the little that we know that had China been more aggressive sometime in November and certainly in December in terms of trying to contain the spread of this Taking the kinds of aggressive steps that ultimately took in January in December and been more forthcoming with what was going on because they would have had to be forthcoming. 'cause it would've been very visible that they had a An issue of concern then they might have been able to fully contain this this this potentially if they would have locked down that city or or quarantine people when they knew they had a very unusual flu. Circular pneumonia circulating. I couldn't figure out what it was. And that was in December. That wasn't in January when they when they revealed to the World January twentieth at Fourteen Health. Care workers were infected and in fact the spread human-to-human. Now you look at the studies at the Chinese are putting out there. Putting out their own studies of clusters that they were monitoring that go all the way back into December. So they were. They were concerned about this monitoring clusters in December. They would have instituted steps then had been more forthcoming about what was happening then. this might have been an an entirely avoidable world event. I think people are going to be looking at that closely for years and years to come. And the and the basic impetus there likely was just the inclination of any government especially a dictatorship of that nature to not admit it has a problem. It's kind of the Noble Syndrome while it could be. It could be many things but I think in in this sort of broad buckets of how these things usually in fall one of two things either. They didn't recognize what was going on. They didn't know what they didn't know or they knew it and they thought that they could contain it with you know secret stance and this wasn't gonNA become problem. That's the best. That's the best of all worlds. You contained no one knows you had that hard to believe it i. I don't accept the the idea that they knew it was going to get this bad. And they Let spread I mean I think I think they either were very worried about it. A weren't worried enough but they certainly weren't forthcoming about it. They certainly weren't sharing information about it. If we had known all along what was happening and been alerted to it earlier we probably would have implemented some measures that we did. I mean the Travel restrictions at the president implemented. Did help keep this virus out? The Europeans unfortunately didn't do that in Europe became heavily seated. We actually became seated from Europe from China. Right right I had. They had been more forthcoming. The Europeans might have made some different decisions to. But if you think about the the sequence of this really wasn't until January twentieth I remember the date I remember the document. The China put out information at fourteen health. Care workers were infected. That was the first hard evidence that there was human-to-human transmission By that point China had no net for at least three weeks maybe for their own studies now and probably earlier than that. Because I don't know what their intelligence says I'm just looking at the clinical data. They're putting out and they put out. Clinical Data Studies in literature. That show that they. They had research in late December early January where they were following families to look at whether or not one person would infect the other family members and in fact. They had proven that they do so. That's evidence that the human human transmission in an agent make that available and they made that available early and made the full scope of the infections are underway available early. We might have taken different steps. Every country might have taken different steps so everything was delayed because of the China obvious Gatien so less than China. we'll get to some of the criticisms from the right of what we've been doing. So do you have any Rough guests of of how many people really died there did At all believe that three thousand is close to the real number tar detail. I mean I. I doubt that the China's The China's statistics are off by some order of magnitude You know it says. Seemed like they undercounted. Deaths early in the course of their epidemic but It does I do believe that China got control of the epidemic rule with measures that they took the reality is gonNA end up. The reality is we'RE GONNA end up under counting cases and probably unto counting deaths here as well. I think what's happening around the world in the setting of these epidemics is the systems of becoming overwhelmed. And it's hard to keep up with data. Okay so let. Let's talk about some other Chris of what we've done. I think very implicit late answered this one. But I'll put it to you anyway there One critique is look these public health experts. They're going to want to squeeze every last a case of this disease without considering the cost of the measures necessary to do that and president trump has made a mistake. He's he's fallen in with these white lab coat types who have Convinced him to undertake these lockdowns. That are as as trump is occasionally set himself Worse than the disease the The cost of what we're doing. This population base mitigation is enormous. We're going to be measuring these costs for many many years. Is Things happening? Now that we're not even aware of women not going for Prenatal Care. People not presenting with With strokes and heart attacks and scientists symptoms of cancer. We're GONNA get diagnosed late. Nasa come to just the direct public health costs it. Drinking increased. People are having issues staying at home and fighting with spouses So the implications of this just the direct public health implications are enormous. And it probably measurable. And we're GONNA be seeing seeing that for many many years to come the alternative. Is You have a pathogen ends. Probably you know this pathogen. At this point I think it's not debatable. I think people who try to debate the sort of violence and features of this pathogen. Just it's not credible disappoint. The pathogen is highly contagious. It infects eighty percent of the people get mild and moderate disease. Probably ten to twenty percent or Ason dramatic about ten to fifteen percent ended up with severe pneumonia. Ten percent requiring hospitalization may be a little bit more five percent ended up in critical care and one percent end up succumbing to that's been fairly consistent in every country and even if we're under counting a proportion of people Because they're so asymmetric and just not getting captured those people typically don't count anyway. They're not part of what we call a case fatality rate. The part of what? We call the infection tally rate but setting that aside even under counting proportion does nowhere. That does not literature says. It's a large portion. It might be ten percent might be twenty percent And the reality is you see it. Now see the consequences of it. It's probably the case that about five percent Probably less of. Us population has been exposed to corona virus. When you talk to the mild lawyers who were very good in consistently right. They say anywhere from one to five percent of the. Us population has been exposed to corona virus. Except that is three percent and that's the same learn Europe and Europe's actually testing. They're popular population Percent has been exposed and they're coming out the same thing three to five percent. This hasn't affected everyone. She had three to five percent of the US population being exposed at this point. Look what's happening. Look at all the desk. Look at all the the hospitalizations I mean the New York City health system has been overrun. It's been consumed by this Louisiana New Orleans same thing Detroit. Same thing Miami same so if we let this virus just spread and we don't do any of this we're going to have to accept a couple of things number one. The hospital systems are gonNA be over on. There will be no healthcare. We can be all covert 'cause we're not gonNA be able to build a whole bunch of new hospitals. Get a whole bunch of Later so prepared to time. You just won't be able to get healthcare. Everything will be covert and and even more or more doctors. The snap of. We're not going to get any of that. You know or or the or you won't be you won't be willing to go into a hospital. I mean who's going to go into a hospital for knee replacement right now right. So that's the first thing you have to accept. You have to accept that there's going to be a lot of death from covert nineteen Lot more deaths than what they're currently is and I think you also have to accept that. A percentage of the population and not a trivial percentage aren't GonNa go to work anyway. I mean you're going to have people who vacation don't go to restaurants. Don't go to theaters. Don't go on cruises Disneyland and do everything. They can to work from home and not. Everyone's going to have that luxury. It's going to be divided by socio-economic lines it's going to be wealthier. People who are able to Selfies late voluntarily and other people who can't but but that's the reality. So you're not gonNA have a fully functional society the idea that you can just have this circulating and we should go back to our normal lives and Just Grin and bear it if we try that. I don't think there's going to be anything normal about our lives. And so what's what's the consequence you know we'll see what happens now. Is We lift these restrictions? And I think there's going to be a lot of pressure to lift these in May and into June. And we're not gonNA have all the tools in place to do that is going to be a lot of risk. Hopefully this summer's enough of a backstop that we could take that risk cannot ignite another epidemic or large outbreaks. But come the fall. This is GonNa be back again and I think people just need to understand that in eighteen hundreds when smallpox circulated it. It had a real impact on society. You know even in the fifties I guess and when Polio circulated that had a real impact on society. In the summers pools were closed camps. Were closed. There's been historical periods where there was a fearsome pathogen circulating and it changed the way people live. This is one of those pathogens. This is a once in a century. Pathogen this is going to change the way we live and is that does not an easy solution here until we get to a vaccine Technology is a solution here but until we get there this is going to alter our life. And it's just a question of what kind of trade offs were willing to make so we'll get into those tradeoffs a little bit more and one second one out throw unless conservative critique at your cheek from the right which is that these models were desperately flawed at at the best people in the press were repeating the upper bound estimates without the necessary caveats which was scaremongering and even As of a week ago the the number you know that the the top echelons of our our government was presenting in president trump and and duct faculty and the rest of them of hundred thousand deaths. has proven to be Or a looks to be inflated so we are scared into the by these models into these takings radical measures. Well look I I was on record when I put out estimates that upwards of two hundred fifty thousand deaths saying that I thought it would be far less than that under a hundred thousand so I thought that the models were a little aggressive On the way out I think they're probably a little bit Under counting on the way down but But I think the models probably are more in line with what we're going see at this point you know. Remember a couple of things. Modeling isn't like forecasts into whether you don't make a forecast in walk away and see if comes true your models going to affect your behavior you're gonNa make a model and you're GonNa do things that's going to affect the outcome so it's dynamic. I think that the The one of the drivers in this New York so New York is getting better control of their outbreak than I think. They're original models. Estimated New York was driving a lot of cases but where I think the models are probably flawed now or potentially off is when you look at the big states in the sun belt in southeast. I think that there's more risks and I've been saying this consistently so we'll see if it's right but I think there's more risk in Texas Georgia probably Florida and I've been saying Louisiana Louisiana actually is worsening under the models. It's the only state that looks worse under the new update of the model the old update. But I think there's still more risk Georgia and Texas. I hope that's wrong. And the reason I say that is just because they're still not diagnosing a lot of their cases. They're big states. They relate to put in place steps for Mitigation Hospitalizations relative. To the total number cases. They're diagnosing which suggests that they're under diagnosed cases. Florida we know is going to be pretty bad. But even under the model Florida's showed a lot of improvement but setting aside those four states. It's very clear that across the country. The latest updates those models and the one that people look at which the IHS model which is the model that the White House looking very closely at the latest updates show improvement and that's really good news because it shows that you know our our actions are having effect and delayed the closer we get to the depth of summer. I do think that the warm weather is going to be a backstop of sorts. We don't know how much but it's GonNa be a backstop of sorts against Against continued spread so July and August should be months that it's harder for this virus spread it will spread but probably not with the same efficiency. So let's talk about how we responsibly. Open backup. You've done a lot of thinking about this and work on this with your with your colleagues. So a key. Tentpole here is just massive testing. That's really a K. What you what you really want to be doing is turning over The positive cases you want to find a positive cases and not just not just the people who are presented to the healthcare system with signs and symptoms of cove nineteen but the people who are asymptomatic mildly symptomatic. Find them ask them the selfies late. Then that opens up a whole nother question is had. He asked them to self isolate in a way that people respect but are comfortable with but setting aside that piece of the debate. You WanNa you WANNA basically find an isolate. The disease what we're doing now is where isolating tire populations. Because we don't have the capacity to just isolate people who have the disease what you WanNa do is just isolate. The people have the disease and do it early enough so that they haven't spread it widely the way to do that is to have diagnostic testing everywhere. Like the idea idea that I've put out there as maybe everyone who presents the healthcare system regardless of what is four? She gets swapped You Walk in. You know the doctor puts the stethoscope on your chest and he swabbed for virus. They take your pulse and they swab your current affairs. That's not an absurd vision and it's not something we would do. The next decade is probably not something we'd even do for the next two years but it might be something we do for the next six months until we get through one cycle of this until we get through this epidemic and get through the next fall and winter and understand if this is going to become seasonal. It's GONNA WANNA come back again because if this if this becomes epidemic again fall a we have large outbreaks in some ways. All bets are off the idea that this is just GonNa just GonNa let people get this in. It's going to circulate and it is what it is. Life with. Corona virus circulating at a high level in the population is not going to be a life any more attractive than what we're living right now because people even even people might not enforce to self isolate because the critics of one out and we've made a decision that would just GonNa Grin and bear it. Most people are GONNA self isolate. Who can and you're going to be. Even greater socioeconomic divides between people who get sick and people who don't and the hospital system will be unfunded dysfunctional. You won't you will not go get healthcare right. So yeah I think it's been pretty compelling people pointed out that A lot of lockdowns are happening for the lockdowns. You know people are going to restaurants less people are on the subways less even before the the official declarations came down exactly because people are afraid. So you say Dr. Putting a stethoscope on you and testing is not absurd vision. I haven't absurd vision for Scott as absurd vision of the likes. Lehman come up with Regardless of of the various difficulties probably drives people. Like you crazy. Who Know what they're talking about. But my absurd vision. Is You mail a test. Everyone in the country and how themselves administer I assume that's As a practical matter completely a ridiculous but what would be the obstacles to massive testing? Is it Is it manufacturing them or or getting the structure in place to administer them and and get the results or why? Why can't we just do this relatively easily? It's not absurd vision. I mean that's that would be a component of a broad health monitoring system so if you thought of a multi-layered health monitoring system what you'd want is very widespread access. The point of CARE TESTS DOCTORS OFFICES. I think businesses should get the game. I think business should think about. How do we make testing available to employees at the point of employment? So people can get tested very easily. We have to de stigmatize testing. We have we have to have people want to get tested And you want to do what's called Sentinel surveillance which has basically test representative sample of the population so you can capture all those mild in dramatic people in. That might be something where you mail. People attest and let them swallow themselves as send it back. In fact they're doing that in Seattle. Seattle has assembled surveillance program where they've enrolled a whole bunch of people and they just randomly test them over the course of the year to see if they might be Infectious in 'cause they're mild people particularly young people who are the ones who are more likely to get mildly symptomatic illness. So it's not. It's not an absurd vision at all. I think one of the things we we have to struggle with is when you you want people to want to get tested but but when people end up having the disease you also want to be able to tell them they have to stay at home. You're not going to lock them up. You're not going to put them in a hotel. You're not gonNA rip math from their family. But you're going to stay at home and you're GonNa want to enforce that. You go on to make sure they stay home with either public health worker or I you know I propose to much and maybe you use cellphones and you just say you have to stay home and we. We're GONNA track you cell phone cell phone better not leave your home or we're going to text you every day and say are you home just to verify just to remind people just simple technology and people the reaction was? Oh How could we have? We tell people they have to stay home. Or How could we monitor them to make sure the state and that is well? Look what we're doing now. We're telling the whole population Eddie home. So but the problem with that with what I'm proposing and what I'm proposing is exactly what we've done all through time. And in fact what what the administration did at the outset of this but the challenge with it is that if you are too onerous if you if you tell people to stay home they don't want to then they're not going to Go get diagnosed. And they're not going to raise your hand. Say you know what I think. Have Corona virus somehow need to provide something? That's an offsetting incentive for people to get diagnosed in one would be a truck if there was a treatment available. Then everyone would wanna get diagnosed. So that's why why the treatment become so important even if it's even if it's a treatment solely partially successful it's a big incentive for people to want to test diagnose even if they know they're going to have to end up staying at home for week if they can get access to treatment that mitigates the risk of having met outcome that's going to be enough to induce right. Want to raise their hand so And I I know we're been selfish with your time here but just a couple of things really quickly treatment. So what what are we doing there anything else? We need to be doing differently. Obviously in a lot of smart people working on this Twenty four hours a day. We're making progress. I mean I think that there's a subset of drugs I think of it this way. What's the drugs that we can have available by the fall that can help mitigate the impact or the likelihood of another epidemic or large outbreaks? 'cause I think vaccines years away. I think a base case. We have to assume vaccines two years away. Get it sooner that as a possibility but we can't. We can't make predictions on on the idea that we're gonNA have vaccine within six months or a year because that's very very aggressive when it would be historic to get a vaccine that quickly against the novel pathogen based Novel Vaccine Pathway. So just let's assume it's a couple of years away. GonNa need medicine again. Need Good Diagnostics in the interim to manage this when you look at the medicines that could be available by the fall that could be produced at scale a scale. That's enough to provide a benefit to the general population and that may have a treatment effect. That's impactful enough to actually make a difference not cure not something that you know suppresses. The disease but but a treatment effect that can mitigate the worst outcomes in a subset of patients. That list of drugs isn't a hundred and it's not fifty it's probably between four and six maybe seven I count six so I think what we need to be doing is taking six drugs and having a very deliberate strategy at how to pull them through development to turn over the car on whether or not they work and whether or not they're safe and effective and can be widely distributed typically from a regulatory standpoint. What you do is you kind of. Sit Back and wait and you wait for the application that come in evaluated You know there's a sort of separation between the regulatory authorities in the product developers for reasons that make sense in an almost circumstance and this circumstance. I think the government needs to behave differently almost as a consultant with more more of Industrial Policy. Approach to how we develop. These drugs with a clear is towards trying to facilitate Speed with the development program. You still want to get the data to make a good judgment about whether these products are working because the worst thing would be to say. A product works in a dozen. That's no good that's GonNa Cause more harm than good but you want to find out if they're working as quickly as possible. I think that it's going to take a level of collaboration and involvement by the regulators that we haven't historically done and I'll close here. It's also gonNA take the regulator standing up and saying that that's what they're doing. We're we're looking out. We think these five drugs are the ones that are likely to work and be available in time for the fall and the falls critical time period. And we're going to you know pay special attention to these these five jobs and that's what we're doing and if you disagree with. Us think that the wrong drugs or you think there's another drug that we left off the list. Let us know. We'll consider it but in our judgments these five drugs you have to be very deliberate transparent about what you're doing and why so concluding questions Scott. How optimistic are you that? When September October November rolls around we've put regime in place that stops Another epidemic on the scale of what seen the last month or so but allows a condo return to normalcy. I'm very worried about the fall. I think that someone needs to own the strategy for how to get the different pieces. In place to mitigate risk in fault have really clear strategy around that. I think we're losing time in terms of the things that need to happen with respect to both getting place diagnostic screening. The capacity do good public health inventions and accelerate the development of drug. All this going on a lot of it's being led by private industry not being pulled together necessarily at least yet as sort of comprehensive vision strategy So I'm worried that we're losing time. It's April we still have a window of opportunity but these days really count. You know it's not. It's not a different amount of time that we have to get in place. The tools we need by August to mitigate the risk in September grey sky will just been fantastically helpful. Thanks so much for your time. That's it for us. You've been listening to a national. You podcast any rebroadcast. Re transmission or account of this game without the express written permission of National Review magazine. Strictly prohibited this podcast had been produced by the incomparable Sarah Shitty. Who makes us sound better than we deserve? Thanks everyone for listening. We are the editors and stay safe

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