19 Episode results for "Scott Gottlieb"

Scott Gottlieb on the future of pandemics and public health after COVID-19

The Munk Debates

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Scott Gottlieb on the future of pandemics and public health after COVID-19

"Welcome to the munk debates podcast every episode we normally provide you with a civil insubstantial debate on the big issues of the day but our world as we know it has changed and so has our format for the next few weeks. We're bringing you a special series. Called the monk dialogues we invite the sharpest minds and brightest thinkers for one on one conversations live on facebook to reflect on what our world will look like after the covid nineteen pandemic. These dialogues provide you the listener with original insights into the pandemics impact on everything from our shared values to the economy to international affairs. This week we bring you former commissioner for the Food and Drug Administration Dr Scott Gottlieb in conversation with rudyard griffiths. This isn't edited version of the live event. Recorded Thursday may twenty first tie. I'm Richard Griffiths. The host of the monk dialogues and welcome to our program this evening on. Tonight's edition of the Bunk Dialogues. Where the opportunity to speak with one of America's leading commentators and analysts on Covid Nineteen. He is the former. Us Commissioner of the Food and Drug Administration. He's a board member of Pfizer the drug maker. He's a member of the group known as the American Enterprise Institute where he's a resident fellow and he's a contributor at C. N. B. C. Ladies and Gentlemen please welcome to the monkey dialogues. Scott Gottlieb be here. We'll Scott as we discuss. The purpose of these dialogues is really to get all of us thinking about the impact of Covid nineteen on our society on how we're going to work how we're GonNa live the future of just about everything and to do that. By stretching our minds into the future thinking about what are the repercussions what are the effects of this pandemic? Not Tomorrow or next week but in the months and years to come and again thank you for being on the show. I think you're uniquely suited to help us in that intellectual journey so let's begin by asking you. There was one thing that you were Gonna. Kinda pull out of the last two or so months of our experienced this pandemic one lesson that you would think that we need to really dial into and dig into when it comes to understanding. The future of these pandemics going forward. What would that one thing that one lesson be for having me here tonight? I think we felt. We will much better prepared for this kind of risk and we ended up being. We had spent years doing pandemic planning mostly for influenza. We were worried about a bird. Flu Not really started here in the United States. Back in two thousand and three two thousand and four in earnest. We started significant. Planning exercises for the risk of a pandemic influenza and we built out an infrastructure for testing for surveillance for diagnostic capabilities for stockpiling certain equipment. That we felt we would need sending over pandemic and I think what we learned in. This tragedy is far less well prepared than we thought we would now. This was a corona virus. It wasn't influenza. But a lot of the things that we didn't anticipation of the risk of pandemic flu should have been applicable here and we should have been better prepared and the one thing I think ended up being a challenge here and surprise a lot of was the lack of diagnostic capability the inability to get diagnostic testing in place. Quickly the underfunding of public health labs and the public health infrastructure and just generally being able to deploy a diagnostic quickly to do surveillance that we would be able to detect spread before it got too late before you had too much spread that you're at the point that you really have an epidemic underway which is in fact what happened in the US. We were dependent upon syndrome. Rick surveillance data feeds of like how many people were visiting emergency rooms in that kind of information because we didn't have the ability really to test people until we got into late February early March Scott. We'd historian Neil Ferguson. On when I asked him Macau will historians write about this moment. His feeling was that the focus would be far more on the response than the the virus itself and the initial outbreak. What do you kind pull away again as the key insight or lesson from our response in particular these shutdowns hindsight is always twenty twenty and we never want to second guess people who have to make very difficult decisions in real time but will we look back on this and wonder did we do. The right thing did react appropriately to the risk that we faced. I think we had no choice but to do what we did here. In the United States at least the scope of the epidemic that was underway in cities like New York in New Orleans and Chicago in Detroit without the kinds of population base mitigations. This shutdowns the stay at home or is that we implemented the health system would have been overrun and we talk a lot about the public health implications of the shutdown and there will be significant public health implications of the shutdown we see vaccination rates way down. People missing cancer screening. We see people skipping. Chemotherapy visits and so there's GonNa be lots of implications public health implications on the back end of this that we're going to be analyzing for a long time. But the reality was that there was no public health system so long as cova was spreading epidemic in major cities in New York City. Affectively became a couvert only healthcare system. You couldn't get healthcare in New York City hospitals for the most part unless you had an emergency or cove illness network literally hospitals that were made cove only including one that I used to practice that in in elmhurst Queens. We simply had to break the epidemic. And I think what we didn't know at the time. This was becoming epidemic in no cities that I just mentioned now. In hindsight there were parts of the country that will largely untouched by this where the risk was much lower. Where wasn't spreading? We didn't know that at the time. We didn't have good surveillance in place so we couldn't really adjust mitigation to just focus on those places that will hot spots where the greatest risk was and try to ring fence the infection in those regions. We didn't have the testing to do it. We didn't have the preparation to do it. And so I think one of the things that will be debated was was there a strategy where you could have targeted the areas where the spread was the greatest and let other parts of the country. Relax a little We did that to some degree. Not every state and not. Every city implemented the same measures in the federal government left it largely up to states governors to make decisions about mitigation for that reason because different regions experiences very differently but generally there was effectively. A national shut down for a period of time and not every part of the country face the same risk but I think. In retrospect we had to do what we did because on one hand we didn't know who is at risk and there were a lot of cities at significant risk and we simply had to break the epidemic to get to a point where we can now focus on you know people who are infected with the disease and move towards what we call case based interventions trying to focus on containing the infection by identifying individuals. Who are infected gave diagnosed early. Hopefully getting them isolated so that you can limit spread with this pandemic Scott. An and once in the future over the next couple of months Into the next year. What is the public health? Objective visit to eradicate covert nineteen. Is it to manage. Simply the rate of transmission so that healthcare system can continue to function and provide a breadth and depth of services that we expect. What is the goal that were trying to manage towards the questions? That came in tonight for you. I I think there's a sense of confusion amongst the public right now about what they're hearing in terms of the messages coming out of different public health authorities at different levels is a radicalization realistic or is it. Really about a policy of containment well. I don't think eradication realistic. I think what our goal should be to try to limit spread as much as possible taking reasonable steps that allow for economic activity and other public health functions to go on but prevent the risk of another epidemic and prevent the risk of spread. That's uncontrolled in a way that we lose control of the infection tried to protect vulnerable populations meaning getting getting testing resources into address communities at risk worksites. Not everyone's equally vulnerable to this near groups that are uniquely vulnerable to this because of the way they work people who can't naturally social distance at work or people who live more crowded. Housing circumstances are lack access to testing in healthcare. In the first instance. So we need to make sure. We get testing resources into those three days. But we're not gonNA build a radically this. I think this is going to become an endemic illness. Meaning illness just continues to circulate. I think we'll eventually set into a more seasonal pattern as other grown viruses do their seven circulating corona viruses. They're all seasonal infection most of them. 'cause a common cold sometimes people get more significant pneumonia from them but mostly they circulate in in the late winter and this might end up being like the fluid might end up being something that we get vaccinated for in an annual basis and it causes a certain amount death and disease. But we're able to mitigate it with steps into wintertime in terms of improved hygiene and making sure we get vaccinated and eventually we'll hopefully up therapeutic sport and we're trying to do now is by time to get to that point win. Technology can help us more fully vanquishes when we have a vaccine when we have affected therapeutics. And so we're going to need to be vigilant from here until that point and hopefully that will come sooner than later. I know we're going to talk about that a little bit. But we're probably not going to have that at least available for mass use in the fall. I don't think vaccine. For distribution to general population is really a twenty twenty event. I think as a twenty twenty one event and so we're going to need to get one more cycle with covert. We're GONNA need to get through a fall to winter season with covert when this is GonNa be colliding with flu. And when the risks of epidemics spread again gunning increase. And we're going to need to be vigilant so we're going to need to do a lot of things to try to contain the risk of respiratory illnesses. More generally heading into the fall and winter. I don't WanNa put you on the spot. Scott to make a prediction you're much more sophisticated analysts than that. So let's talk about risk. How concerned are you about the risk of the second wave this autumn and the potential scale there of that way? But I mean we're all looking back at the charts of the one thousand nine hundred thousand nine hundred nineteen pandemic where really it was the second wave that was significant killer in that influenza outbreak. Is THAT INEVITABLE WITH COVA. That the the second wave going to be bigger. It seems like a lot of states are opening a lot of provinces here in Canada varying degrees of controls in place limited testing in some areas limited contact. Tracing does all of that look to you. Like a bit of a recipe for a heightened risk for a large second wave but I think that will be spread in the fall and winter. What what constitutes a second way will the second instance this be bigger than the I will become epidemic. I think we have better tools heading into the fall. In terms of better screening. Technology will have more therapeutics. Hopefully we'll have additional drugs coming online in fall. Better TESTING. Better surveillance better awareness. Not going to be caught off guard this time and so hopefully we can prevent that. But we're also going to be heading into a fall and winter season when this is GonNa be colliding with flew into the circumstances for wider transmission or greater. We'RE GONNA be heading into the months when this pathogens going to be most efficient in terms of spread and it's going to clog the flu that's going to confound our billion diagnosis quickly so this is a real challenge. I mean I think we face risk when you look at the data globally and you look at the exposure to cove right now. You Look at France. Spain and Sweden Zero prevalence studies studies looking antibodies. And people which identifies whether they've been exposed to it runs about five percent. You look at cities like Milan. Barcelona Paris percents seven percent of those cities have been exposed to covert either a symptomatic in or they developed covert the disease Paris. In Wuhan seroprevalence studies were ten percent here in the United States. You look at places that were largely unaffected like Boise Idaho. One point eight percent but even in cities that were affected to a greater degree Boston ten percent Los Angeles may be ten percent. New York City's high at twenty percent New York state around twelve percent but the point being that around the world countries and even cities with epidemics only a small percentage of the population habits. Where a long way from her immunity and so there's a lot of people who are still vulnerable to this. I think by the end of the epidemic here in the US when you get into June maybe a third of New York will have been exposed to this. That's getting to levels where you're going to have some reduction in the rate of future transmission because you have a large portion of the population that's now been exposed but that's the outlier most cities most countries. It's only a small percentage of the population so we have a very fertile ground for covert heading into the fall and winter in terms of population. That's been largely unexposed to this. Because mitigation was successful able to contain the epidemic before it got out of control to even a greater degree and cause more death and disease. Okay Scott this is an important point for me to underline with you if I'm understanding you correctly because there's been a lot of discussion about again trying to think about the months to come the year to come and and people feeling some that herd immunity could be an effective strategy in other words that we allow the virus to spread. We shelter the people most at risk but our best protection about the virus is to get to a level of antibodies in the population. I don't know sixty seventy eighty percent. Whatever it is to effectively neutralize the effects of cove. It and it's infectiousness. Am I hearing you correctly that you do not feel that that is a valid public health strategy? I don't think it's a valid public health strategy for a variety of reasons. The one I don't I don't think you can just help. People who are older or co Morbid conditions have medical conditions and put them in higher risks. That they've got stay at an everyone else can go out and when you start adding up the number of people who have conditions put them at a higher risk of a bad outcome here diabetes heart disease lung disease. People who have autoimmune diseases are immunosuppressant drugs it ends up being a very high percentage population people over the age of sixty five. You're getting into pretty big numbers when you look at the data you know forty five. Didn't fare so well with us. When you look at hospitalizations in your calf hospitalizations were under the age of fifty five so there are a lot of young people now realizes more people under the age of fifty five and over but there there were a lot of young people younger people middle aged people. Getting into trouble with this This disease as well and look at the level of death and disease that we sustained with a relatively small percentage of the population being affected. So even if you if you believe the date New York for example and you believe twenty percent of New Yorkers been infected so about one point seven million people have either had covert or been infected with us. At the time that we did that study there were about seventeen thousand diagnosed cases. Seventeen thousand deaths. Excuse me that's infection fatality rate one percent which means the case. Taliban rate is much higher because people who are infected at least thirty or forty percent of them don't develop symptoms. The the case fatality rate is how many people who developed the disease succumb to it. So it's always going to be higher for diseases where you have a lot of asymmetric spread. That's a high rate of death for a disease. And that's in a setting where we were social distancing people who were vulnerable were staying home and we were still having infection rates at that level. So I think we're going to have to be willing to sustain a lot of death If we want to just let this course of population you look at Sweden people talk about Sweden adopting some element of that strategy. And I don't think Sweden really adopted that strategy. I mean people are social distancing. There they just let some of their restaurants and other things open but people aren't really going out all that much in Sweden. They have the highest tally per capita in Europe. Right now there's a long way from her immunity and and it's really just Stockholm. Other parts of Sweden. The exposure is very low. It's really just stockham. We see higher exposure levels. The seroprevalence study that was published recently showed about seven percent in Stockholm. That's again a long way from her media. I know some people have said it might highest twenty percent based on some other studies but even bat is approaching heard immunity level so I think that that strategy we do want to sort of go down that route and I don't think we do. We're going to have to sustain even more depth than than we have Scott Three quick questions. I've got my mind before I take audience questions number one for you as a parent of young kids. There's a lot of us out. There are schools coming back in the fall. Do you put a high chance of that. A high likelihood that children will be back in school and will they be back in school in large numbers. Will it be staggered? Will it be limited availability? What's your take on the kindergarten to grade twelve educational system for this autumn? I think they'll be an attempt to open the school this fall. I think we'll we'll hopefully if you sort of believe. My optimistic scenario will becoming office summer whim. We'll see cases. Continue to go down. There will be a seasonal effect. Here I think that the schools good implement measures to identify classrooms to try to have students only congregating smaller groups. You won't let one go out for recess and and mixed together you'll keep people within groups so you can do better contact tracing within the school in isolation if you do have cases. I think a lot of schools are GONNA look to implement testing in the school. I think you might see attempts to densify classrooms by going to maybe four days a week in classroom in one day week Taylor learning or doing some tele classes inside the school keeping people separated on computers. So I think there's things schools I know they're thinking about those things now. The districts have resources to do that. Not Every district does but I think they'll be an attempt to open. It is going to become question of what happens in the fall. I mean hopefully this scenario in the fall is we have really good screening place where able to detect cases early get people diagnosed. Get people isolated. They'll be communities that have outbreaks there. There might even be cities where there's a small epidemics or states will have to close things selectively some school districts to close down for a period of a couple of weeks as infections move through certain communities. But you don't see a a simultaneous national shutdown as seen now but I don't think we get through the fall winter without having to grapple with us in some fashion without seeing some schools closed. That's kind of like the h one n one season as well where you saw. There wasn't a simultaneous shutdown. The entire school system nationally here in the US in two thousand nine but you saw a school district shutdown as local epidemics arose in local communities. This mind you is more contagious than h one. N One final question before we bring in the audience here and that's to talk a little bit about what's happening closer to this moment right now. Which is we are seeing states like Texas. We've had recently here in the province of Ontario. An uptick in cases. You know the geographies you know the region's it some some areas. Maybe because they had very few infections have been the curve at a state level province level but there seemed to be other larger jurisdictions like Texas like Ontario where we're having real challenges right now in bringing this virus under control in terms of bending the curve down and yet right now this last week and going forward we're starting to open up. How do you think that's going to play out? Scott I mean do you think again. The seasonal effect will wash over or mask the the result that just populations are GonNa be mixing more and people are going to be within the parameters of transmission of what is as you said a very infectious virus. I think we're GONNA see a slow burn. I don't think we'll getting rid of this virus. I think we're GONNA consume continued spread. Hopefully level that's manageable. Hopefully people continue to practice. Good things in your individual lives that can greatly reduce rescue beverages The collective action. Everyone just going out a little last washing hands. A little more wearing masks cleaning shared services things like that once you distribute that kind of activity on on a population wide basis that has a big impact on the epidemiology spread. And I think people are going to have that vigilance. I worry more about the fall when people may become off relatively quiet in summer. And they kind of lose some of that They let their guard down a little bit. But we're gonNA see continued spread. Hopefully this summer does present the backstop in that Kinda Offset some of the increased bradberry. Look in the United States. You've seen if you look over the last three weeks you saw for the first two weeks hospitalizations coming down hospitalizations really the most objective measure the epidemic. Because you'RE GONNA see cases go up because we're testing more. We're going to be turning over more cases but you still hospitalizations. Come down for two straight weeks in the last week at best nationally. Seen SORT OF FLAT. Now but probably. You're seeing a little bit of uptake when you look at the seven day rolling average on hospitalization. So we're seeing cases bounce off little bit in the hospitalization data here in the US as we reopen now. That should surprise nobody. I mean we expected that as we ended these mitigation steps. We were going to have some bounce in cases. And that's why most of the plans warfare staged reopening not to do it all at once a dimmer as opposed to off switch. But we're going to have to watch that closely. You may have the slow what you're doing or even pull back some of the things you've done if you see. The cases bounced up too much. Look at states like Alabama right now. We are seeing uptick in cases and in cities. You're seeing the hospital. Start to fill back up there some states. And there's some cities here where there's some worrisome signs it's not nationally certainly but there are certainly some states and cities. Georgia's well. You've seen an uptick in hospitalizations in the last about week okay. That's a really good points hospitalizations that we need to be looking at understand what's happening in terms of the future trajectory and course of this virus. Scott I'm going to start bringing in some questions. And the first is from Nando. She's asking during covid. Nineteen and future pandemics governments public health officials and citizens deal with anti vaxxers and people who are against contact tracing of individuals. I guess people have privacy concerns. So what's your feeling there? Scott maybe just to elaborate on that question a is this kind of wake up call for the Anti vaxxers. I mean it wasn't increasingly powerful movement. Unfortunately I'll take side on this. I'm in favor of vaccinations. What's your feeling? How are you concerned? Maybe that in terms of people actually using a vaccine that they may not and as a result the burn. The spread goes on longer than necessary. I'm very concerned about this move. You look a vaccination rates generally people. There's there's vaccines that are highly effective in very safe. And and we don't see vaccination rates at the levels that they should be HP vaccinations around fifty one percent array of people gain the second vaccination from jacuzzis about fifty six percent only about half. The population gets vaccinated for the flu each year. The shingles vaccine which is effective only about thirty percent of people third of eligible people. That so we don't see people taking advantage of vaccines and we see far too much. You know spread of infectious disease in far too much disease and deaths from from these diseases that could be managed much better if vaccination rates were higher. I worry about in this context for sure. You know there are a group of people who are against vaccines call their safety into question there as a minority small minority but a vocal minority and spread a lot of fear. I believe that's misguided and misinformed about vaccines generally we saw that here in the US with the measles mumps rubella vaccine where people pulled away from Using vaccine we saw outbreaks of measles as a consequence of that and so I think we need to do everything we can to try to inspire confidence in a new covert vaccine and that means making sure that they're put through appropriate clinical trials that we don't short circuit that process at all in an effort to try to get vaccines to the market more quickly. We need to make sure we have. Robust data says and can demonstrate with a high degree of certainty to safety and benefits of these vaccines. So that when people when reasonable people look at the data sets they can have confidence in them and we can get as many people vaccinated as possible is going to be novel Vaccines Novel Platform that. We're developing vaccines are and. I think that that's going to lend itself to People. Being able to raise doubts and questions that could make people skeptical in way that can have adverse public health impact if people don't get affected vaccines is that part of your thinking. Scott about why maybe twenty twenty one before we have a vaccine for mass adoption because simply we need to do this right and to Russia vaccine out in the fall could have some unintended consequences. Which is a lot of people suspicious about the vaccine suspicious as to whether it's been as rigorously tested other vaccines in the past. That's exactly right. I think we need to put these proper. Clinical trials knows going to be ten thousand thirty thousand patient. Clinical trials large scale trials in in settings where there are outbreaks spread. I think we can use the vaccine experimentally in the fall in settings of outbreaks and try to ring fence the outbreaks using it therapeutically in wave to work but you're also using the context of a rigorous clinical study collecting data. So it's stole experimental vaccine. But you just deploying it in settings where. It could achieve a therapeutic purpose. In fact it's effective so you couldn't deploy vaccine as a tool but. I don't think that we're going to be at a point where we're going to have those data sets available to licensed vaccine for mass inauguration to think that you're going to have those large data sets available in time for this fall to license it to approve the vaccine for general use. I think that that's very aggressive and probably not real realistic. Even if we get in trials enrolled into summer you're not going to know with the spread is do not going to know where to those trials. You really almost have to wait until you have the outbreaks to enroll the trials if we start enrolling trials in July and August in Dallas and the outbreak ends up being in Little Rock. Arkansas enrolling ten thousand people in Dallas might not have been the right decision. You'RE LISTENING TO THE MONK. Dialogues a special edition of the. Munk debates podcast where we invite big thinkers to reflect on what our world will look like after covid nineteen this week former. Fda Commissioner Scott Gottlieb on the future of pandemics public health and their effects on the economy. Let's go to another audience question. I'll read it out for you. And we can go from there. And president trump is threatened to withdraw the United States from the WHO the World Health Organization is your position so Scott. What's your view on the? Who there's been a pretty strong debate about whether they were as neutral as they should have been vis-a-vis China and whether they were a slow off the bat here to declare global pandemic and touring the five alarm bell. That states around the world needed to get a headstart on preparations to try to reduce the effects of covid nineteen. I think the WHO here was far less effective than it could have been and should have been. I think it was less effective in the setting of the Ebola outbreak in western Africa than it could have been should have been and demonstrated the shortcomings of the W. H. O. I think they were too late to really speak with a clear voice about what was going on. In China this the scope the risks to press China to make more information available. So I I think it's an organization where we have to do a lot of evaluation on how to make sure this doesn't happen again and make sure we have more functional World Health Body but I don't agree with you be defunding it and this is a wrong time to weaken you. Organization still further especially with the risk that covert is going to become now in the Southern Hemisphere. Allow those nations lack access to public health infrastructure? Neighbor rely more on the. Who you'd think about parts of Africa? Parts of South America and so weakening the WHO setting when this could become epidemic in southern hemisphere. This isn't the time to do it. I think we need to reexamine. Who after this public health emergency passes and do the best? We can right now to press them to do a better job in a setting of the current epidemic. But I think a lot of this should be done after this epidemics past try to really reform that organization. Thanks got a great questions from the audience. So let's let's keep going here on this monk dialogue with Scott Gottlieb the former commissioner of the Food and Drug Administration a board member of Pfizer the drug maker and someone who's really distinguished himself as one of the most astute and thoughtful commentators and analysts on the covid nineteen pandemic so this question. Scott is from Sheldon this week to companies announced results with respect to preliminary testing Vaccine do these milestones mean. The chances of developing a vaccine have gone up or just that testing can continue and Scott. It's interesting maybe we can talk a little bit about one of your other hats the aware which is an analyst on CNBC. We've seen some very big market reactions to the Gilead Therapeutic. And now the Madonna vaccine a very preliminary study. I guess or test that they conducted in both instances very small samples. You could say that these are not even the first inning. It's maybe the first batter at bat in the first inning yet. This huge reaction response that. Do you think the two things are commensurate? Should we be as optimistic about talk about Madonna result past week? Well look I think it's encouraging I. I wouldn't necessarily say that we should be tremendously optimistic about any one of these vaccines but I think that what we see now is a number of early sets released about different vaccines that demonstrates that it should be possible to develop a vaccine against coronavirus. I think that's the real takeaway here we've now seen a number of different vaccine constructs some very novel constructs in case in return in. Marta contract which we haven't used before develop a licensed vaccine visors taking the same approach. We've seen a number of these constructs be able to in both animal models as well as now people induce the production of antibodies that should provide some level of protective immunity. And so that is statement. We couldn't make six weeks ago or two months ago. And so that's why. I think we should be more encouraged with respect to the Madeira data in particular. It's early. It was only forty five patients in all forty five. The data shows that the different vaccines that they use have three different doses of two hundred and fifty gram doses hundred microgram dose and twenty five granddaughters but in all three doses they able to generate the production of antibodies and people were what we call binding antibodies me. They bound the virus. What we don't know is where they neutralizing antibodies. Did they bind the virus and destroy the virus testing for neutralizing? Antibodies takes longer. Because you have to expose the antibodies to the virus in a special lab. It'd be a cell three lab a secure lab because this is now a special pathogen needs to be dealt with carefully. They only looked for the first eight patients on whether or not the vaccine was generating neutralizing antibodies. In fact it was in those eight patients and so I think a lot of people assumed well if it worked in the first eight patients. It's probably likely to work. In some proportion of the next thirty seven we don't know all neutralizing antibodies same. We don't know what level of protection is going to afford but we infer that. Oh probably afford some level of protection these these vaccines any of them probably aren't going to provide protection like we think of smallpox vaccine or measles vaccine where you're vaccinated and you can't get infected. Would this is probably GonNa be more like the flu vaccine? You can get infected. But it's going to reduce the severity of the infection and limit your ability to get Cova the disease. What about Scott. Are you concerned that the DNA sequences that were using now for a lot of this vaccine research is going on right now or primarily those that came out of the initial clusters on in Europe and viruses do mutate? Is there a risk here that we create a a series of vaccines that are based on kind of Kovin? One point zero and we move onto Cova two point zero and three point zero and four point. It's unlikely in a short period of time. So all mutate this virus mutating just because it's mutating doesn't mean that it's getting more dangerous or less dangerous more contagious less than pages. Or that's going to obviate technology. So we've looked at a lot of sequencing data now with this vaccine eylau this work comes lavish Trevor Bedford in the Hutch in Washington State. And what we see is the viruses undergoing drift but the part of the viruses genetic material that codes for the protein on its surface. That is the target of our vaccines particularly this spike protein. Which is the protein. The virus uses to invade ourselves the genetic material that codes that spike protein isn't undergoing as much change and it changes at. Its undergoing aren't changing that spike protein in a way that it should evade our antibodies to it and so it's undergoing drift and so we have a vaccine we might want to reformulate the vaccine every two or three years to get it more precise to what the current composition of spike protein is. But it's unlikely to be the case that we see such rapid mutations in the engines the things on the surface of the coat of the vaccine we target without antibodies that we do with the flu vaccine or with influenza. Where in a single season influenza? Sometimes we've seen undergoes so so many significant mutation so many significant changes obviates the vaccine for that season that that vaccines no longer effective. We're unlikely to see interest seasonal mutations happened so rapidly that this would operate a vaccine. But I think it's probably the case that when we do hopefully get a safe and effective vaccine. We're GONNA WANNA reformulate it on some semi regular basis to get it more precisely aligned with what the current predominance sequences for the parts that code for the region. The vaccines is targeting fascinating stuff. Scott do we know one hundred percent that this virus was not genetically engineered in a lab. I think we feel pretty confident that this virus wasn't manipulated and certainly wasn't like a bio weapon that was deliberately released and engineered and released to Epidemic causing an outbreak. I think there are still some question is we know there was a lab will Han. That was a high security lab. We know they were doing. Experiments with Corona viruses have been isolated from bats other species. We also know that lab didn't have good procedures and well before this well before this episode. You can go back two years ago. There was articles in science magazine. Some of the leading academic journals calling into question the safety procedures in that lab saying that they didn't have good controls in place the special pathogens and calling into question whether they should have been allowed to handle the pathogens. They were handling so I think there's some doubt in people's minds is. Could this have been an accident? Could it have been a lab accident? Where patient zero if you will wasn't someone who came into contact with an animal in sort of inadvertent way but someone who was doing an experiment and accidentally infected themselves maybe became as symptomatic didn't know they had the infection went out and became patient zero and spread it. We might never have an answer to that question. We're going to have to look at the store strain to some of the original infections to really get a sense of that and have much more information about what was going on in that lab and look at some of the strange that they were working with and we might never get that information. I mean it doesn't seem like China's making a lot of that available so I think liveliest theories in doubts gonNA persist maybe perpetuity. But when you sort of hear about people saying well Clinton's have been elaborate could have been something deliver. I think most reasonable people are saying. It's not something that was deliberate net someone releases deliberately by could have been a lab accident and I don't know that we can fully discharge that possibility. It's less likely I mean I think we think it's the less likely scenario may be far less likely scenario. But I don't think we can fully discharge it. Then I guess. Part of this dialogue is thinking about the future. How do we get controls internationally? In place to ensure that countries that maybe are not at the standard of candidates the United States in terms of lab infrastructure lab technology. Don't advertently or inadvertently release another virus. I mean are you optimistic that we have the international consensus to do that? Well no I'm not. I mean this isn't the only lab where has been questions raised in the scientific community out procedures in certain labs. There's been questions about labs in the United States where there were concerns that they didn't have proper procedures in place so we need strong international bodies to overseeing this we have them the World Health Organization. I think that they're not functioning as stringently or aggressively. They could be or should be and we allow certain countries to hold certain special pathogens. Who probably need to reexamine that and make sure that there is a better set of universal procedures in place for ensuring lab safety for the labs that are going to handle. The most dangerous pathogens now is going to be a lot of people who don't want to use this episode as he sort of rallying cry for that. Because there's a lot of people still pushing back on the notion that this could ever have been lab mistake. Miss had to have just been sort of a natural occurrence that this virus jump species went from a bad or another animal into humans. Probably that's the case. But you know. I think we're never going to fully discharge that doubt and I think we should reexamine Lab Safety more generally. It's an important call to be making. Okay let's get some more questions. This has been a great discussion digging in a lot of issues. That were certainly top of mind for me and for you. The Viewing Audience Mark. Warren is asking. How important is a national testing strategy for the United States? And why is it so hard for us to mobilize strategy and Scott can ask the same thing here in Canada? The scaling up of testing has been a persistent challenge. And I would say baby doubly so the scaling up of any large scale contact tracing system whereas Scott you know this better than most you look at countries like Taiwan South Korea China. Frankly they seem light years ahead on on both fronts. I think the reality is that allow these tasks gut are going to be largely. Left to states is certain things. The federal government can do to support these activities. But they're going to be largely left to states. Some states are doing a better job than others at getting in places infrastructure. I think getting into the fall least in the United States. The challenge isn't necessarily going to be on the back end the platforms running tests. Which was a challenge. This go around. We just didn't have enough labs in PC are based machines to run the tests. Scale that up. We've gotten a scaled up dramatically now running about four hundred thousand tests a day but initially running about ten thousand test a week and so has been scaled up dramatically in a very short period of time. But we got our lead start. I think that capacity is gonNA continue to grow. And we're when we get into the fall we're going to have the capacity to do one of these. Federal officials said ten million tests a week. That's probably right. It might even be more than that. Because we're going to have next generation sequencing we're GONNA have continued to scale piece based platforms. We're going to build massive screening with next generation sequencing. We're GonNa have many more pointed care. Diagnostic tests approved including Antigen based tests or literally. Squabble sticks that you can use in a doctor's office we'll have millions of those in the market and so they'll be ubiquitous availability of testing in the marketplace. I think the challenge isn't going to be the back end running. The test is going to be the front end. Who's collecting the test? And I think we're likely situation where a lot of people don't want to do. Covert testing because if you turn over positive case then you're going have to shut down your office if your provider or if you're doing testing at a certain segment pharmacy. People won't WanNa go into that pharmacy baking. Kobe patients might be coming in to get tested. And so you're GONNA have a lot of places a Saito. We don't do covert testing if you think you have it. Go to this special test site. And that's GonNa Limit Access When you call your physician in the fall and you say I think I have the flu. I feel like I have the flu. They're not going to say come in test you Kobe Influenza. They'RE GONNA say go to this special testing site if that's what ends up happening. And we end up. Sorta getting testing to special sites in. It's not really ubiquitous MMA community. That's going to greatly limit our ability to do mildly symptomatic nascent testing Is Kinda WANNA be swabbing? Everyone everyone who shows up at the doctor's office anything? Suggestive should be getting tested. In the fall I worry that's not going to happen. That's what we need to be thinking about how to get testing in a ubiquitous fashion into the community where everyone's conducting these tests. Scott his anyone talking just simply about swabbing anyone that goes into a GP. I mean regardless of whether you got flu symptoms or not you get tested and you just do that for the benefit of your family. Your Co workers and others. It takes a stigma away from it and it just becomes part of our regular checkup for the autumn and into the New Year. Look I've been advocating that. I don't think it's unreasonable idea. We WanNA basically get we call it sentinel surveillance system place where we're doing sort of routine screening of the general population trying to catch a symptomatic spread. And so how do you do that one way to do? It is to do a random sample the population and get them. And that's really hard because you have to find at random sample get tested them convinced him to get tested the other way to do it is just you screen such a large population but even if it's a selected population at ends up affectively being a random sample because you're screening so many people and one way to do that is exactly said if you go into your. Gp'S OFFICE THREE POINT. Eight million encounters with the primary care system every week in the United States. If you go in for a sore throat you get grown of our swab going for your annual physical. You get coronavirus swab. Go in for a sprained ankle. You get coronavirus swab. If we just sorta swab everyone for coronavirus shirts a selected population that's coming into the doctor's office but ending up doing so many tests routine basis that it ends up effectively being the statistical equivalent of a random sample or representative sample. And so I think what you're saying makes perfect sense but what I worry about is we don't get in place procedures now. We say if you're a physician's office and you do all this you you clean your office every night. You don't have a waiting room. Move patients directly into examining rooms. You make sure your staff is washing has between patients and maybe they're wearing masks. Whatever the procedures are but if you do all this and you diagnosed a covert patient your office. It's okay you don't need to do anything special. Maybe you clean the room. We need to get. In place. Universal precautions that allow doctors pharmacists others to diagnose covert patients in routine settings without having to go through extraordinary hoops every time they do. If we don't they're not going to do the tests they refer patients away and we're never gonNA get to what you're talking about. Yeah no it's important not to build those deterrence into the system. Okay lots of good questions. Here let's get some more end when this from Terry Scotch. He's asking if a vaccine is developed for ceus shortage if so we'll distribution be staggered so those who are most vulnerable get at first or will some nation and groups benefit. I at the expense of others. It's a big challenge Scott. I'm sure it's one that you and your fellow board members at Pfizer. Think a lot about there are the ethics. I think we all get. That is the aspiration. But what's the reality? Scott say say China develops the first working vaccine and China might develop the first working vaccine Chinese using older technology to develop vaccines are using for the most part of the vaccines and furthest along three are inactivated viral virus vaccines which is an old approach probably is going to confer less immunity but could be much faster route to market an easier to scale and so they might developed. The first vaccine might not provide as as robust immunity of some of the vaccine using new technologies. That Western countries are trying to develop but it could be quicker. I think ultimately the reality is. We need more than one manufacturer more than one large manufactured be successful here because we only have one manufacturer being successful getting press finish line. We're going to be severely supply constrained not just within the United States but globally not just globally but even within a country. We're not gonNA have enough and I think that the backstage a likely to be licensed for high risk populations I. I think you're likely to see some as not really rationing. You're likely to see the vaccine targeted to high risk individuals who can drive more of the benefits of the vaccine so you might not vaccinate people under the age of thirty or under the age of twenty. Those kinds of decisions are likely to be made as far as nations are concerned if you look back in two thousand and nine with h one n one we had a situation where countries that were manufacturing their vaccine supply outside of their country including the United States in other nations. Those nations held onto the supply until they satisfied their local needs. And we did the same thing. In one instance where we held onto another country supply their h one n one vaccine and that was with a flu that while virulent while dangerous was far less virulent than corona virus. And you saw that National Behavior Sandoz first vaccines that. Come off the lines. It's not gonNA be a billion doses day one it's going to have this supplies gonNA ramp and initially. You're going to be supply constrained you're going to have to make allocation decisions about it and I think countries are gonNA behave the way they have historically which is make sure. I have enough for at least a portion of my population. I'm most worried about before I try to make more equitable distribution of it. I'm not passing judgment. I'm not advocating it. I think it's just reality. What's going to happen? And I'm basing that on historical precedent thousand which I was involved in policy then and I was watching that behavior very closely and I think we were all surprised by Scott just to build on that I. You're painting a picture here. Lot of listening to you would agree. It makes it makes sense. Countries will take care of their own populations. I but what does that mean for the virus? Globally I mean we're seeing countries like Nigeria now. Having large scale outbreaks in Lagos Brazil is increasingly racked by this virus. If we have a vaccine in two thousand twenty one how much longer until we have a level of radicalization globally that allows us to do something pretty essential both for our domestic economies in the international economy? Which is to restart the movement of people in planes across borders and press rewind back to January twenty twenty when we had international air. Travel is all of that. Like Twenty Twenty. Two twenty twenty three beyond. How do you see that playing out? I think we'll have enough for a global supply. So of the companies that are working on a working on manufacturing at scales that could provide for something akin to global supply. Bigger challenge is going to be getting into a lot of markets. I think that initially what you would do. If you have a limited supplies you're GONNA make it available to your population but you also try to get it into regions of the world where there's epidemic spread and depending on what season you're in when where the virus is spreading could be spreading in different parts of the world. You're going to try to make sure that you get it into those regions. I if you do have a limited supply but how long did it take us to get global eradication of smallpox and polio? Vaccines have been around. Long Time. He's on global radicalization polio. So getting vaccine is not just a matter of the supply getting scenes into markets. Where you don't have good infrastructure good public health. Infrastructure is a very big challenge. Let's squeeze some more questions than comes from Jean Scotch. She's asking. What is the best advice? You can give the general population on how to live in deal with this in the coming months. Great Question Jean. At the beginning of this interview Scott you talked about you know some simple things wearing a mask washing your hands keeping surfaces clean. I mean some of this just practical in terms of reducing your risk or. There's some other things that maybe people aren't doing that. You're seeing people not doing that. That you would recommend look. I think he just gets down to try to decrease your personal risk. Limit your social network a little bit. Go out a little less go shopping. Let's be vigilant about trying to social distance where you can wash your hands. Use Hand sanitizer. I recommend people using masks. We know that diminishes the risk of spread so people can have to make personal decisions about how much they're willing to sacrifice how much willing to inconvenience themselves to try to reduce their personal risk. But I think it's GonNa come down to that all of us taking collective action to individually reducing a personal risk. There was data coming out of a university here but like everyone makes one less trip to the grocery store every week so instead of shopping twice you shop ones that could reduce spread ordering things more said a going out to stores all of that practice on a mass scale. That's still social distancing. And that's going to help mitigate risk and so everyone should think about their lives how they can reduce your never gonNa be free once you start going out and about so you're just sort of layering on things that reduce risk as much as possible. What about bars and restaurants Scott? How DO PEOPLE GAUGE THAT RISKED? Us recommend that they try to look at the number of infections in their county or their city and try to gauge that way or is it better as you say just to make a decision for the months to come that maybe those types of social activities are not going to be at the top of your list. I think for people social activities won't be at the top of the list is something that's GonNa come back near the later. The thing I miss the most is going out to dinner the thing. I'm probably going to do less going out to dinner when you do it. In your local community you have a better sense of what their risk is in your local communities posted traveling to a community. Don't really know so. I think people are gonNA stay. Local things outside are safer than things inside so you know. Dining out is safer than dining an enclosed space and in fact in my state Connecticut. They're reopening restaurants but you have to have table service outside so they're changing local ordinances to facilitate that. No there's ways to do things that are higher risk but do at a lower risk smark. Okay why come into the top. They our let's squeeze one last question in four Scott from Joseph Scott. He's asking can the covid. Nineteen virus be weaponized using something like crisper technology to target specific population. And if so can this be prevented I guess maybe to extrapolate from that Scott. Just a bigger question here. We talked about the risk possibility that this may have been an engineered virus accidentally released from a lab. We don't know we may never know but are you concerned. Just generally about technologies like crisper. That are really allowing people at low text play with. Mother Nature in ways that could be extremely harmful for the rest of civilization. Is this a new threat on par with nuclear weapons or other big global threats like climate change that we understand well and there's a lot of consensus towards doing something about them but we don't really understand the risk of man-made intervention into the world of viruses? But just a backup a minute. I don't think that this was a virus that was engineered in accidentally from lab. I think that there's a possibility that this was a virus. That was in some labs or his lab in Wuhan's library. I was accidentally released. If it was engineered. In any way or changed we would have probably been able to detect that in the in the sequence but remember these labs what they do. Is they go out and collect viruses from nature and then they just hold onto them and to the virus that was in nature just now and it's been a lab. That's the potential risk that you if you don't have good controls lab that you can slip up infect yourself if you're working with it you know to your point. Yeah absolutely the the technology for engineering any pathogen and weapon izing. It is more ubiquitous. Crisper one technology. There's a lot of other technologies that are synthetic biology a lot of other technologies. That are more ubiquitous. Now that doesn't take a tremendous degree of sophistication that anyone who has a PhD. In access to an academic lab can probably mess around with so. Yep It's going to be a growing risk going forward that it's easier to weaponize pathogens and what you're gonNA worry about going forward but I worry most about a rogue state. I worry about rogue individual I worry about someone just an individual sort of very good sophistication and diabolical intent. That could become someone who ends up engineering something on their own and then ends up spreading it because visit more ubiquitous and that's much much harder to control a really important message for all of us to reflect on Scott. You've been very generous with your time. And as usual you've shared with us again as I said some hard one insights from your time as Michener of the FDA in the United States a board member of Pfizer educated medical doctor. Scott really appreciate all the analysis and sophistication that you've brought to our dialogue this evening. Thanks mad me coming up next week. Conversation NOT TO BE MISSED WITH DAVID BROOKS OF THE NEW York Times former monk debater. We had him here on the main stage in Toronto. Last autumn for muck debate on capitalism he is our guest on Thursday may twenty eighth at eight PM Eastern. We're going to talk to David about the impact of Covid nineteen on US POLITICS. There's a big election underway in the US. Come this November and also a topic that David is quite good which is the impact of covid on our collective values and let me conclude by thanking all the partners that make this dialogue possible. The Peter Melanie Munk Foundation and their sister foundation the orientation that underwrite as with the munk debates all of the time effort energy and cost associated with producing these events. Thank you for being part of this program you. Let's all of US dialogue together to figure out the future of the world after covid nineteen. Good night I'm readier Griffis. The Munk debates are produced by antica productions and supported by the monk. Foundation rudyard Griffiths Ricky Girl wits and Debbie Pacheco are the producers the president of Antica productions is Stuart Cox. Be sure to download and subscribe wherever you get your podcast and if you like us feel free to give us a five star rating. Thanks again for listening.

Commissioner Scott Gottlieb United States influenza Epidemic Food and Drug Administration New York City Pfizer flu vaccine Sweden federal government China Texas China Richard Griffiths pandemic influenza facebook Europe C. N. B. C. Ladies and Gentlem
Scott Gottlieb on how, and when, to end social distancing

The Ezra Klein Show

00:00 sec | 7 months ago

Scott Gottlieb on how, and when, to end social distancing

"World History permanently altered by this episode. I don't think you can have an episode of this magnitude and not have implications that are going to be potentially quite profound that. We don't fully understand yet. Hello welcome to the show on the box media podcast network. The big question right now is what comes. After social distance there is no national plan. We are in appeared of enormous sacrifice economically socially personally. And there's no national for using that time. Well people are doing things. States are doing things. Cities are doing things. But there's not actually been articulated strategy for what comes next so. I think it's really important to look at the people who are trying to articulate those strategies and tried to get a realistic understanding of. What is the path here? Like what even if we do all this right. What is right? Look like one of the people trying to figure that out is Scott Gottlieb. He is the former. Fda Commissioner is Donald Trump's first FDA commissioner and he was a very rare trump appointee and then he won quite a lot of plaudits from people on both the left and the right after working in the trump administration went back to the American Enterprise Institute a Conservative leaning. Think tank where. He's really been one of the key voices on. Cronin bars particularly on the right part of the people on the right. But some real expertise here trying to get this taken seriously trying to think about it and systematic way and he's one of the lead author on a plan now for reopening the economy. So we talked about that plan here talk about sort of the coin of ours response in general and one thing that I think is worth keeping in mind and go to. Vox and we'll put this in the show notes. You can see a big piece. I've written on the various plans to reopen the economy. And the way they're actually kind of scary beal here that here too. There's not a snapback to normalcy here. We're not imagining. Even if everything goes well that in two months or three months or four months or back to something. We will recognize economically socially as normal. That's particularly true for more vulnerable populations which is part of. I think it's so important that we're actually talking about these plans interrogating them and trying to understand what they mean for us and are they the path we want to take as always email is as reclined show at Fox. Dot Com as clan show at. Vox Dot Com. Here's Scott Gottlieb Scott Gottlieb. Welcome to the PODCAST. Thanks for having me. I wanted to start here in. Twenty nineteen the Global Health Security Index gave the US the world's highest score high score in the world on pandemic readiness so in terms of our capabilities. We were ahead of countries like Germany and South Korea Singapore Taiwan and when the pandemic head. It doesn't seem like we were able to fully maximize at. What do you think is responsible for that gap between our capabilities and our response meal for years we we were preparing for pandemic And we were focused mostly on flu and so there was some things that were different about a corona virus. Where some of the planning that we had undertaken I think wasn't as applicable for example we envisioned the ability to scale of vaccines against the pandemic flu strain in ways that we couldn't do in the setting of a corona virus but I think in many respects the kind of planning that we didn't name preparations that we thought we had warrant as robust as what we believed near the most visible example of that stockpile. We had been stockpiling equipment in anticipation of a potential pandemic for years. But clearly we didn't have enough ventilators. We didn't have enough personal protective equipment for frontline. Healthcare workers in Masks. And the other thing is we never thought to stockpile things like testing equipment or reagents that would be used to try to roll out very broad diagnostic testing capabilities. And so there were certain things that despite all the planning that we had done over a very long period of time and I was there back in two thousand and five when a lot of this began when there is real focus on pandemic planning in anticipation of the risk of bird. Flu a lot of that planning either eroded over the years or more lightly wasn't robust enough to deal with something that was this novel on this scale. This really is a once in a generation pathogen and in many ways I think it evades some of the planning that. We didn't some of the anticipation that we had. What is the ways evades out? Because we call the once in a generation pathogen. I think it's worth talking about how that's true We've been reporting on this advice for for some months and when I go back and look at those early stories even epidemiologists we were talking too often. Didn't see how this is going to get that men often. We didn't see how this get. Even Dr Farsi. was downplaying some of the threat desolate as early. February so in the public health community among people who understand infectious diseases. What got missed originally. And what do we need to learn from those misses for next time? I think in some ways this pathogen occupies that sort of sweet spot between being virulent enough being deadly enough that it can cause of death and disease being severe enough and also being contagious enough that it can reach around the world a lot of pathogens that we've seen in recent years SARS and mirrors were very deadly but they weren't very transmissible laden they didn't transmit human-to-human inefficient ways and also they were so deadly that they incapacitated their hosts and they made themselves self evident. If you had SARS outbreak in your city you knew how to SARS outbreak this pathogen because of the asymmetric spread because of the large number of people that become only mildly. Symptomatic has the potential to spread very efficiently. And in fact is very contagious. And so we know. A lot of people get infected from any one individual but is still stolis cohort of people that sizable enough that developed severe disease and could succumb to it that it can cause an extreme amount of morbidity and mortality and really incapacitate a healthcare system and cause mass casualties and so in many respects. I think it was that pathogen that we long feared that occupied that that perfect middle ground between transmissibility ease of transmission and violence The ability to cause a lot of death and disease so before we get into your report about how to begin reopening the country. I want to set some expectations here. Many of us are living under lockdown. Right now we remember what normalcy is like. And I think the expectation from any of us is at when lockdown ends normalcy is. What returns. Are we going back to normal anytime soon? Does the status quo snap back into place? I don't think there's going to be a binary point in time when we just returned to what we were doing. I think world history permanently altered by this episode. I don't think you can have an episode of this magnitude and not have implications that are going to be potentially quite profound that we don't fully understand yet including public health implications. There's going to be public health implications for these these severe lockdowns as going to be people who didn't get prenatal care didn't didn't seek healthcare and ended up having a medical sequentially for that. But I think also as long as this pathogen circulating in the background and we don't have a vaccine for it we don't have very effective therapeutics and I don't think we're going to have those things by the fall and we may not have them this year. This is going to alter the way we live and do business You know some of it's going to be subtle you'll see businesses advertising deep cleanings In between you know Uber Rides airplanes. People aren't gonNA shake hands as much anymore. I think wearing masks in public is gonNA come more fashionable in western societies. He might see airports using alter violet light and shared. Walkways things like that so some of it will be subtle and some of it will get dividends for in the form of maybe less than flu. Seasons are just you know reduce transmission of of illnesses. Generally some of. It's going to be more profound. I think the marginal customer for a stadium or a concert or a cruise ship. I don't think they're coming back Soon I think people are going to be more circumspect about travel particularly international travel businesses are going to be more circumspect about bringing together large groups of people. So you're GONNA see a change in a way. We live in the way we do. Business in the question is can we get back to our normal economic activity or are normal level of economic activity with with that kind of sort of profound pervasive change? In a way we we operate and it may be hard. I talked about an eighty percents economy if this continues to circulate in a fallen you have outbreaks because in the US the consumer you know really drives the economy in China if you look what happened in China. The manufacturing sector bounced back but the Chinese consumers still hasn't returned. If you see what people doing in China they're going to work and then going home if we have a situation where business bounces back but consumers sit. Sit Out or they're reluctant to re-engage in the same way that they were engaging economy before where a very consumer led economy and I think that's GonNa be a pervasive drag. Your plan divides the coming months into four phases. And then it establishes triggers for states to move from one phase into the next to just start into it. Can you give me a high level overview of those four face? Well let me tell you what Phase one is the phase. We're in right now. The population base mitigation We WanNA WE WANNA move into phase. Two which is starting to reopen America. What we tried to do with the report was create really identifiable milestones and in Thai policy. Decisions around those milestones. And we did that because we want to give people something to shoot at. We wanted to give very sort of clear identifiable objectives. So people can debate whether those right or wrong. I think you know we had laid out sort of broad broad objectives that it was hard to put granular details around and metrics around. I don't think it would have been as useful so one of the one of the very clear milestones that we identify as we say fourteen days after you have a sustained reduction in new cases you can start to reopen. The economy can start to lift. Stay at home. Orders and allow certain businesses to go back to work and sort of a staggered fashion while still implementing certain Certain restrictions and commensurate with that. You also need to have the capacity to treat. Everyone's you need to make healthcare systems rebounded and has sufficient capacity and you also need the capacity to test everyone so you need to have the ability to do point of care testing in the community and really test everyone who may present with symptoms of Corona virus which we don't have the capacity right now so those were the three milestones that we identified it when you would make a decision to reopen the economy. So I want to go into a part of phase one here because I think people understand the part of phase one they have to do social distancing staying at home but something you talk about in phase one is that we need to increase testing capacity. And we need to enter. The health system has the capacity to save. We treat a cove in nineteen patients and others. Who Need Care? I mean this is when when you talk about that flattening the curve. This is what people raising the line or raising the bar right. Raising the amount of testing and healthcare. We can actually offer. Are we doing enough on that right now? In states like California and New York and Washington and others that are in. Intense lockdown is the huge sacrifice being made by the people locking down sacrificing income and wages and social life. Is that being matched by a true mobilization on the health. Care supply side. We're doing a lot to increase testing capacity. But we're GONNA hit an upper limit back up getting from one hundred thousand tests to a million tests is going to be easier A lot easier than getting from a million tests who one point five million tests and the reason I say that is because what we did up until this date is we took platforms that existed. Labs that were out there. Labcorp inquest academic labs and we got them in the game. We stood them up so now they're vast platforms are available for Corona virus testing. And that's why we've been able to increase testing. We're probably by the end of this week at a million tests the week in terms of capacity. Next week we'll build on that but getting to the point where you have to three million tests capacity per week which is probably where you need to be initially as you do this transition. That's going to be very hard because we've tapped out the available platforms and now would depend upon creating new platforms and new supply chains to fuel those platforms. And that's GonNa be very hard. We're GONNA hit an upper limit and we're probably approaching that right now in terms of what the spare capacity is in the country. And now it's going to be a question of how fast can Abbott and be and other companies build new testing platforms. And how fast CAN LABCORP QUEST? Scale up new labs that didn't exist before and that's a harder. That's a harder exercise. And so where do we need to be as we do this transition you know one benchmark would be to say basically everyone who presents to a primary care doctor for whatever reason should get swabbed for Corona virus? That wouldn't be an absurd objective if you want to really widespread screens that you can capture not just symptomatic people but a symptomatic people at least initially for a period of time just swab. Everyone just like a child goes into a pediatrician's office if their ear hurts they get strep test. If their nose is running they get a strep test of their throat hurts if they disrupt testing of their lethargic in school they get a strep test. You can think of Corona virus at least initially same way. You WanNa swab very liberal and report the results so that you can detect small outbreaks. Do those case based interventions isolate individual people who were infectious rather than? Try to do what? We're doing now isolate entire populations. So will we get there? I don't think we're going to get there by May. I think that we're still going to be under testing relative to what is the optimal public health standpoint. I think we have the ability to get there by September but we need to be doing a lot of things right now really investing in that Congress is going to need to ultimately act. I I WANNA get very wonky in technical in the testing question here because I've been looking at every one of the plans people released for how to get the economy back up and running your plan. The Center for American Progress Plan the Harvard Safra Center plan. Paul rumors plan for mass testing the economist. And what I see and there are two things I wanna come back later to. It based contact tracing but but but here on testing is massive scaled up testing. You talk about a couple of million a week. Some of those plans talk about a couple of million a day. Roamers plan talks about twenty two million a day and so a huge question in all this seems to me to be. What are the constraints on? How rapidly we can build up testing. What what what. Don't we have that we need to have? Is there a resource material? Constrain is just getting bodies out there like what keeps us from going to five million tests a day in two months. Why why is that? A is that an unrealistic goal. And if so what makes it unrealistic while the resource constraint that we're going to bump up against right now so what? We did up until now as I mentioned was sort of get labs that were there into the game. We stood him up. We got them working on krona virus tests. Now we're going to be at a constraint in terms of not having available platforms. We're GONNA have to build more machines to actually run to test if we want to get to the levels. You're talking about in some cases we'd have to build more of those little toaster size boxes at. Abbott makes that. They put in doctor's offices of these for flu. Swabbing strep testing and now using corona virus testing so building. That hardware takes time. Deploying hardware takes time especially into places where it's not currently deployed and in the other limiting factor is the testing supply chain. It's not the the machines that we might not be able to build. We're not gonNA have enough reagents. We're not gonNA have enough plastic tips to pipette samples from one. Well to another. We're not gonNA have enough plastic cartridges to put the samples and we're actually running short of swabs to To Swab People's noses it's all the low margin commodity products in the testing supply. Chain that we're now having problems obtaining and it it's lesson learned that if you look at any complicated supply chain. I learned this from when I was at FDA. If you think about where the vulnerable vulnerability as in your supply chain where the weak points are where things go shortage. It's never the high margin product because a high margin product has a good manufacturer WHO's invested manufacturing. Who has invested in continuity of business decisions to make sure they never go down because they're selling an expensive machine. They're selling a high margin product. It's always the commodity prog the low margin products because that's always a manufacturer that's probably offshore. It's probably one or two manufacturers. It's been consolidated manufacturing because it's low margin the business and They can't scale up because they've underinvested in manufacturing for many years and so if you're making pipette tips you know you don't have a lot of residual manufacturing capacity you don't have a state of the art plant necessarily and so hard to scale it up. That's the weak link in the supply chain. That's why I said at the outset thinking about stockpiling these things. We never envisioned being in shortage of of swabs for nasal swabs or reagents in fact. That's what's happening now. And this is something where if we invoked and aggressively mobilized against the Defense Production Act. We could do more. I mean I'm obviously not a manufacturing expert but the folks who make cue tips potentially could be mobilized into making swabs apple. Could help make the little toaster things? I don't know what you need to do to get region. I recognize what I'm saying is going to sound very crude. But is this a situation where resources exist and they need to be directed and mobilized through some kind of central planning or? Is this something where even if you put into play that level of aggressive direction you still couldn't invent the agent that you need to make this work. Yeah I don't know how much you can Just create new manufacturing some of these commodity products because sometimes there's materials that go into them as starting materials knows in fact are the weak link in a supply chain so even if you had extra manufacturing so for example within ninety five masks you can build a plan to make masks but the actual ingredient that the product that goes into making those masks manufactured outside the US would be hard to scale new manufacturing for that. And that's what's in shortage right now. So some of the starting green is now in a way that comes into play with the with the testing supply chain with respect to the the point of care tests. I think we're GONNA need that made by companies like Abbott and be back Dickinson. Those are a little bit different that those companies control their entire supply chain end to end so they they don't just make the high margin product. They make everything that's used in the performance that test. They make their own Swabs their own pipette tips their own cartridges. And they make the toaster sized box. So that's a supply chain that could be scaled a little more easily because they control it so I think that we're going to build a scale capacity and that's why I think some of the swing capacity now and some of the necessary capacity is going to be those poincare tests right now. The only one that's approved is actually to cepheids gene expert which isn't a true poincare test. Net is not really in doctor's offices as usually in community hospitals and maybe large medical practices but the Abbot is a truly point of care tests. Eighteen thousand doctors offices beady makes a similar machine that they use for flu testing as well. Anything STREP throat testing also. They're not approved yet but I would suspect that they're going to be on the market within the next month or so That's GonNa make a big difference too and in trying to scale those systems having those companies make more whether or not you took over facility and tried to convert it to making those boxes. I'm not sure that's going to be more efficient than just Having those companies ramp up their own manufacturing which is in fact what they're doing so I want to talk about the other side of what? He called the comprehensive covered. Nineteen surveillance system so on the one hand. You have the widespread and rapid testing. We've talked a bit about what we need there. And what the difficulties are there. But then there's what you call the National Sentinel surveillance system and this is a way you can track the background rate of infection. It's a way you can do contact tracing. There's a lot of discussion about whether or not you not based contact tracing where people download an APP which seems to be happening at least to some degree in Taiwan. This seems to mean to be another one of these things. Get it scale. It really helps but on the other hand the idea that every American is going to download an APP that lets the government or some company or someone trace who they've been near and who touched to end You know they have to scan a qr code when they walk into a building. That's a very big cultural shift to end. It goes quiet again. Some of Where we were where we tend to be in this country and we're not operating in a moment of high political trust or high trusted corporations. So can you talk a bit about what that might look like? And what you think the obstacles to getting there might be Lon- think we're GONNA get to that that kind of An APP I don't think that we would accept that in an in the United States. I think there'd be a lot of privacy concerns. I don't think we should be doing that. And so the idea of having some kind of APP that word Geo Track people and tell you when you've been in contact with someone or or report when you've been in contact with someone who had grown virus as a way to do contact tracing I don't think we should be doing that. They're they're they're experimenting with things like that. In some countries it South Korea had something similar to that I think technology could be very helpful though and where we have to have a very robust debate is when it comes to case based interventions and self-isolation. So if we if we have the system we need and we have very robust screening in the community and we end up identifying people when they have mild disease into matic disease for the period of time that they're infectious. What do we do? What do we ask them to do? We can ask them to voluntarily selfies late or we can enforce that self-isolation And the question is are we gonna go towards enforcing the self-isolation now? In fact we've already done that with corona virus with the early cases we quarantine people and we enforce self-isolation when he actually quarantine some individuals on military bases with a multi drug resistant to Berkeley closys or measles. We oftentimes require self-isolation. And we enforced we enforce with public health officials. Sometimes we enforce it with police and so in this setting. Are we going to do that? I think we should. I think we should be asking people to self isolate enforcing it. But are we going to be using tools to enforce that self-isolation as opposed to public health workers to make it more efficient so basically text messaging people every day saying are you home that would be at least invasive or requiring them to download nap in tracking their phone to make sure? They haven't physically separated from their phone. Obviously it could go out and leave their phone home but these layers of layers of protection. You can do it with video chat things like that to make sure people are adhering to a self isolation. We have to have that debate because even that level of case based interventions seems to Make some people concerned and I think of. We're not GONNA be at a point where we can ask people to self isolate and do something to help. Supervise that to make sure that they actually had here. We're going to have to then accept that we're going to have larger outbreaks than we might otherwise having is going to be hard to control this infection because simply asking for voluntary compliance with self-isolation may not be enough. Now the flip side of this though is that you don't want to impose restrictions that alienate individuals or Make people concerned about their privacy. Because if you do then what's going to happen? Is You're going to discourage people from going out and getting tested and self identifying when they have grown a virus and that's the last thing you want you want people to be encouraged to get tested and identified and diagnosed with Corona virus. We need to balance whatever we impose against not discouraging people from actually getting tested and where that line is. That's a debate we need to have. We haven't had it yet when people are identified as being positive with krona virus. What do we ask them to do? Ultimately this decision's GonNa be up to mayors and governors but I think that the way this has been debated in in sort of the public discourse people go right to the sort of South Korea style apps where they tracked every movement. And you don't recognize that technology that fulfills a purpose. That's far away from that level of surveillance and intrusiveness which I don't think we should ever get to but that does implement some kind of requirement individuals to take responsibility when they're infectious to not go into contact with strangers other people the public at large. We'll talk a bit then about when you say we need to massively scale contact tracing. What does that look like? It's it's a lot of things but but at a basic level it's what states like Massachusetts doing right now with our hiring one thousand public health workers do contact tracing so that when they turn over positive cases when they identify people with infection they'll interview them they'll Talk about who they might have been in contact with. They'll trace down those individuals. They'll ask them if they have signs or symptoms of Corona virus. They may ask them to get tested. Some of them they may ask to self isolate for period of time depending on the level of exposure and a likely that could have could be infected or at least fight slate until they get back a negative test. That's the traditional sort of bread and butter boots underground work of public health. We don't have the capacity right now. We've underinvested in our public health infrastructure for years. We don't have the capacity to do that at scale so very quickly if there was a large outbreak in a city will overwhelm the capacity of any cities public health infrastructure. To do that at scale talking about if you have more than like thousands of cases. You're going to overwhelm the system for shore. So we need to build that out recognizing that we're probably going to need more capacity because this is a virus that we're we're going to have to contend with some reasonably size up outbreaks. Now you can use technology as I mentioned with respect to the case based interventions into self-isolation to augment. Some of that. But you can't use it you can't use technology to augment all of it ultimately you need people doing this work. This episode is brought to you by. Us Salar there's never been a better time to switch to US cellular. Because now when you do you'll get fifty percent off your choice of selects new smartphones. That's amazing phones. Lake the Samsung Galaxy S. ten ee or the Google Pixel for a great choice on a great phone. Now that's fair. Us Cellular Choose Fair. Terms apply check. Us Cellular Dot Com for details. Hey It's Cara Swisher you may know me as the only person who looks cool wearing sunglasses indoors but in my spare time. I host a podcast called Rico decode every week. We talked about power. Change THE PEOPLE. You need to know around tech. 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So if there's a sustained reduction in cases for at least four days in state the hospitals can save we treat all patients requiring hospitalization state is able to test people with covert nineteen symptoms and the State is able to conduct active monitoring of confirmed case in their contacts. You can go to reopening state by state and tell me what you think will reopen when we go state by state. Because I don't think you mean that you can have an NBA game Again so if you if you manage to get to phase two what kind of economy re looking at. What is what is opened. And what can we not still do? Yeah I think it's going to be we're going to be entering this in. May We're going to be starting to make these decisions in Maine through June. I think it's going to be a gradual reintroduction of activity. Oh probably lift the stay at home. Order is but you'll tell people if you go out you have to wear a mask for a period of time. You'll allow certain businesses to go back to work. I but you'll tell businesses that they have to put certain restrictions in place to try to reduce the number of people who congregate together so reduce the risk. That that you can spread infection in the workplace. Basically maintain some social distancing a workplace. They'll be increased local ordinances on food handler's temperature tax checks on food handler's tables have to be spaced apart. You can have more than seventy five percent you fire of your fire capacity and certain businesses limited number of people that can be endorsed things like that to just try to reduce human the human interaction as much as possible while having a functioning economy allowing people to re engage in normal activity and you'll slowly introduced that what's GonNa be introduced. It's going to be places where a lot of people crowd indoors for purely entertainment purposes so bars venues concerts Clubs things like that probably going to be the last to open up now against this backdrop. We're going to be entering summer when people preferentially WanNa be outside anyway so you try to do whatever you can to move as much of that activity into outside venues rather than indoor venues where. There's slightly less risk of transmission. It's really crowding people together inside. That creates the biggest risk for transmission. I think we're talking here about some of the population did not all of it in phase two even in a phase three. That doesn't have a vaccine. My mother is in her seventies and has the lung damage. My father is in his seventies. And he's immuno-compromised. Do they get to go out? What kind of normalcy returns for them if any or are they in a position of essentially self-isolation until there is a vaccine. Well there's a difference between what is the government require you to do. What are they asked you to do? And what are you choose to do? I think that there might be sort of guidance. That people who who have certain conditions are in a vulnerable position with respect to this virus for longer periods of time. Try to avoid going out and I. It might not be enforced. Not going to be pulling people's licenses industry and checking your age and where you going to make sure you out for legitimate purposes but there might be some strong recommendations as certain individuals delay their reintroduction. If you will but I think the bigger question is what are people choose to do? And I think that there's going to be large groups of people that choose to do things very differently so long as this virus is continuing to circulate even at low levels But certainly so long as we continuously outbreaks in American international cities. Which I think we're GONNA see through the fall in the winter if we don't have a really strong significant technological solution to this in the form of a drug. That is really a game changer. Which I suspect. We're not GONNA HAVE THIS SEASON. We're not GONNA have this fall in winters can take a little longer to get that and I think people who are older vulnerable are GonNa make decisions to limit their activity. And that's why I talk about the eighty percent economy. I think there are certain things that people don't do and certain things don't come back. I mean just talking to my own parents You know they're talking that way about trying to be a little bit more circumspect about what they do heading into the fall. I know a lot of people that are canceling vacations or making different decisions about the fall in anticipation that is probably GONNA be so. Still some furtive risk from this. We don't remember really. I mean very few of US alive. They lived through a time when they were polio outbreaks. In the summer. But when you talk to your parents or people who lived through that they talk about summer camps being closed pools being closed. Kids didn't go out. We know if you look back at the history of smallpox Diptheria when when infectious diseases were became epidemic cities at change city life. Things closed people in do things. We've never lived through period like that with a highly infectious disease doubt transmitted through you know. Normal interactions or could be transmitted on a surface on a subway a city. That was deadly enough to invoke realistic fear and this is deadly enough to invoke realistic fear. When you have a pathogen like this circling it's going to impact city life particularly in urban centers. That's been the history of pathogens like this. We just haven't had to deal with one and when those when they came along we were able to vanquish them with technology. Now we're going to be able to vanquish this with technology. I'm very confident that the questions the timeframe I wanna hold though on the what you just said here and try to face. It's emotional cost a little bit more frontally What you're saying that for people who are especially vulnerable and that is a lot of people. A lot of older people a lot of people with Some kind of pre existing compromised immune system. This is going to be a rough year. It's going to be a year where you don't get to have normal even other people. Maybe you're getting a lot closer to that or at least don't get to have it safely and I don't know that I don't know that any of us are totally prepared for that right. I mean it's only April if people are gonNA have to be following this through the fall even as even as the people they love starting to go out in a way that makes him more of a danger to them right. I think about this myself. That if social distancing is lifted because San Francisco I live for California where I live has managed to make face to in a way it becomes more dangerous for me to then go see my parents because I've been in contact with more people. Maybe I've been going back to work or I've been whatever it might be. And in a in a perverse way as the rest of the country becomes less isolated again. The people who bear the brunt of this in terms of their vulnerability might become yet more isolated because the folks were being so careful before and so posed lower risk to them pose a higher risk now particularly in these in these urban areas. Mesh is going to be a very tough way for people to live or am I missing some part of it no. I think that I think that there's going to be more trepidation about what we do that. The things that really tip that balances if again technology but also a very aggressive surveillance system if you have a surveillance system plays in surveillance is probably the wrong word if you have a health monitoring system in a testing regime. We you know that you're testing so many people on a daily basis for Um Corona virus that you're likely to surface now break when his only hundreds of cases and before becomes thousands and thousands of cases. I think if you can demonstrate that to people that's going to inspire a lot of confidence people feel fairly comfortable to go to go out again because you're living in a city like New York of nine million people and you're testing regime is going to is as sensitive enough to pick up outbreaks of five hundred people. Your absolute risk of actually contracting. It's fairly low. You know you're in a city of nine million people. What's the likelihood that you're gonNA come into contact with the four hundred who have corona virus and then come into contact with them in a way that you can actually get the virus pretty low but if you don't have that in place and you're walking around and you recognize that your risk be quite high and nobody knows it? That's an uncomfortable position so February twentieth in New York City and I can look at my calendar right now and see what I was doing in New York City. That does days. We were at a lot of risk of corona virus. We just didn't know it. And so if that's the situation in perpetuity that's GonNa that's GONNA create a lot of fear and uncertainty. Anything people are going to be more reluctant to go out now. That said we should be able to get to those sort of state that I described where we have very broad screening and place where people can go and get tested very easily. Where we're doing what you what you referred to sentinel surveillance which is basically testing a representative sample of people to try to capture a symptomatic mildly symptomatic spread before small outbreaks. Become big outbreaks. We can do all that but it takes a lot of planning. It's GonNa require the you know the administration working together with Congress and some of it has to be done legislation. Some of it can be done through regulatory changes but we really need to have sort of a comprehensive plan. That'S THE SECOND REPORT. We put out this week where we tried to outline in a very long report. What are the detailed steps that you need to implement to try to get to a very broad testing regime and a health monitoring regime And so we try to outline what what we think needs to happen there as well as same authors on both papers you mentioned a couple of minutes ago the questions vaccine's or therapeutics a phase. Three which is a much more. Normal phase of life works off of that. So I know you've talked a bit about the best. We need to make on on medications. Just let's start here. Why don't you give me your survey of where you think we are? And what you think is plausible in terms of therapeutics. Say by the end of the year so by the end of the year. We're not going to have a vaccine. I think base case we need to figure that a vaccine may be two years away and hopefully we can get it sooner than that but I think we need to work off of UH assumption that we're not GonNa get it sooner than that so we're going to have to live with corona virus for a couple years and we have need other technology if you look at what could be available by the fall. It's really a small subset of drugs. I would be focusing attention and resources on that small subset and really trying to work aggressively with those manufacturers to try to pull those products through the development process and turn over the data cards that you're GONNA need to turn over to determine whether or not they're safe and effective whether or not they're going to have an impact on this disease and so what others drugs. One is room desks here from Gilead. Which many people probably heard about? It's an antiviral drug. It inhibits viral replication. It's pretty far along. There's data available right now. That suggests that it's active Lot of doctors are using it. They believe that is active. Is probably going to be more effective. If used earlier in the course of the disease rather than late the other the other products are the therapeutic antibody so this four companies making these veer biotechnology regeneration Amgen lily. These are basically biotech manufactured. Antibodies the same kind of antibody. Your body would produce if it's exposed to the and that antibody your body would use that antibody to fight the virus if you're exposed again. There's two ways to get those antibodies. One is to take them off. Someone who's been infected in other ways to actually manufacture it at scale using the tools of biotechnology and that's in fact what these companies are trying to do. That's an attractive product for a number of reasons I welcome. It uses a treatment early in disease. It's probably less effective later and disease because they have to have a lot of virus on board. It's hard to give enough. Antibodies to mop it all up but it could also be used as a prophylaxis as a bridge to vaccine. Will you might be able to give a monthly injection or bi monthly injection and basically vaccinate people be able to give them something that would prevent them from getting infections. So you can use that in your frontline healthcare workers you can use it in. Tsa agents food handlers. Who are coming into contact with a lot of people in a more likely get infected and then spread the infection. You can use it in context close contact so when someone's sick identify who they're in contact with and you give them the injection right away to prevent them from getting sick so that could be a very attractive drug. The combination could be very effective if you can have both of those by the fall a treatment to help people who are infected and show up in the emergency room and in an antibody that can help prevent infection and those who are exposed. That's a pretty potent combination now. The the biggest obstacle in addition to doing the trials to figure out if they work if they're safe and effective is going to be manufacturing them as scale. That's something we can solve for right now. We should be working on how we're going to make investments to help these companies scale manufacturing and get to you know large commercial scale manufacturing in time for the fall so that of the one of them does work. We're able to turn on his big quickly and produce not hundreds of thousands of doses but millions of doses a month. That's the kind of position to be in. There was money set aside in a recent Senate bill that cares acted Senate and house bill. The president signed that actually set aside upwards of ten billion dollars to do just this but that needs to be implemented the companies need to be aware of it and pursue those opportunities. You need the agencies working to stand that up that all has to happen. It's not hasn't happened yet but you know we have time to do that. But that's the kind of thing I think. We should be focused on right now. You talk also in phase three about sir logical surveys determined population immunity. I've seen conflicting reports on whether people who've got encourage virus our immune and I recognize. There is some here that we simply don't know. But what is your best? Guess on that if we had that sir logical would it even matter because people are actually immune or would it not matter much because a substantial portion could get reinfected while I think both of those things? I think that there is immunity here. People who are infected most developed a robust antibody responses a highly immune genyk virus. Your Body sees it as foreign and develops a lot of antibodies. That's important is getting people. Sick as the revved up immune response the virus and so you develop. Antibodies that immunity probably last six months to a year. The antibodies decline. You might have some residual immunity might have some what we call you. Know Sell based immunity Where where if you're really challenged with the virus in two or three years you might get sick again But you the illness you'd get the second time. When be as severe there is a cohort people about a third based on some very early data that we're getting out of China now. A state came out this week. That suggests that a percentage of people maybe up to thirty percent don't really develop a robust antibody response. We don't know why it tends to be younger people as that can potentially partially explain is pure speculation but explain maybe why younger people also don't seem to get sick from this virus. Maybe they're not mounting a very vigorous immune responses so that they the inflammatory response from the immune system is in something that is happening in them. And that's why they're not having the same bad outcomes that Middle aged people and older people who do mount a very vigorous meeting response develop antibodies. Do pure speculation. We don't know it's one study and we need to figure it out but the bigger issue also is that once we do this serological. Testing logical testing is important. It's important understand where the virus has been. Who's been exposed? It could be important for decisions. About return to work in certain professions where there's going to be high exposure right like police officers or emt workers or or or doctors and nurses but by and large what we're going to find his at a very small percentage of the population has actually been exposed to this virus. If you talk to the models and the experts United States they say anywhere from one to five percent of people probably have been exposed virus already if you look at the data coming out of Europe. They're already using serology. It's again in sort of five percent range when you look across Europe. Some some countries higher like Italy but most of the countries are in a five percent range. So the idea that. There's thirty or forty percents. Population has had this virus. In that Colbert illness. You had in January or February in you know what it was probably was corona virus. I think that's GONNA turn out not to be the case it's going to be a small percentage of the population. Certainly in the single digits that have any level of antibodies from either being asymmetrical mildly symptomatic or having it knowing they had it. And it's not going to be enough to create Herd immunity enough people who have immunity that this can no longer spread. It's also not going to be enough to have this pool of people turn just returned to work one of the things that worries me going forward is it has been hard enough to get states into phase one and to try to do phase one well not every state is air even as we speak and then you move into phase two. I think there's going to be a lot of relief but something that is planned for in your proposal but there were also seeing in other places like Singapore which had a very effective response but now had to go back into lockdown. Where you can't have people over and they're they're going back into a very intense freeze is that you might have to bounce back and forth between phase one in phase two for a while and the political difficulty of getting people to accept that once they have lifted it the political difficulty of going backwards going all the way up to the president. Who really wants to out of phase one as quickly as possible and is not going to be excited in an election year. About reestablishing it. It seems that the obstacles to being able to dance back and forth are very high. But if we don't we could end up back in a very very difficult situation given what you just said about the absence of likely herd immunity. I'm curious given your proposal. Talks about this. Possibly go back how you think about the obstacles to doing so. I think there will be political obstacles. Not just at a national level but our local levels well but ultimately these decisions are going to be made by mayors and governors. And even that's going to be a hard decision because you wanna be the city that shuts down activity while the rest of the country's humming and it's going to be in the best interests of every other part of the country that you do that but it's not going to be in your best interest if you look at the history of this outbreak in this epidemic. Seattle should've taken more aggressive steps earlier. Now it ended up that the The epidemic in Seattle wasn't as large as we thought might be because Seattle was a single large cluster that was expanding as opposed to multiple introductions with multiple clusters. So in some way. We dodged the worst outcome there. But they were very slow to take aggressive steps. They kept activity humming along far longer than they should have. And that would have the first city to really start to shut down economic activity and you saw reluctant to do it. So I think it's going to be a challenge when you have outbreaks in cities at what point do cities you know. Pull the trigger and start to shut down economic activity and start to impose some of the population base mitigation not just to prevent spreading their cities but also prevents spread more. Broadly in the United States. It's going to be in the country's interest that when there are outbreaks local officials take aggressive actions. It's not gonNA always be that a parent to local officials that they should step aggressively forward if they think that there might be things that they can do that are more limited so this is going to be hard just not not just at a national level national decision-making where having the decisions aren't going to get made but I'm more worried about local decision making and people being reluctant to take steps that could serve the national interest well but may be served their local interests not quite as well Scott Gottlieb. Thank you for doing. Thank you very much for being on the PODCAST. Thanks for having me. Thank you to Scott Gottlieb for being here. If you want to learn more about the plans I have two quick recommendations for you. I mentioned at the top is peace over which is not just about the I plan but also center for American. Progress is plan. The Harvard Suffer Center ethics Plan or proposal and Paul Romer Nobel Prize winning economist. His plan You can find the show notes or box The headline is. I've read the plans reopen economy. They're scary. They are scary and Party. When you begin thinking about the mass surveillance or mass testing regimes. They are beginning to consider. Maybe we need them The future may be scary here and then also on the weeds this week. Matt Iglesias and I dive into plans. And try to think through some their assumptions More deeply you can download that. Replicate your podcasts. As always thank you to Karma for researching Jeffey gelded for producing. Vox Media Putz production.

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41:30 min | 1 year ago

The Scott Gottlieb era is (almost) over

"It's very hard. I'm away from my family in the weekend. It's very hard so hard as part of the job is is the fact that I'm away from my family, and even when I'm home on weekends, you know, spending one whole day working. So I don't think I'm balancing it. Very well. I'm Dan diamond this is Paul shack. And that was FDA Commissioner Scott guy lead appearing on this podcast, just four months ago at the time the Commissioner said that missing his family was the hardest part of his job in this week. That's the reason he gave for leaving FDA. It's one of the most notable departures for the Trump administration and given God leaves influence high profile all the policies, he pushed the people he hired. We wanted to spend some time looking into all the new questions your raises for the Trump administration. I you'll hear from my colleagues Sarah Carlin Smith, a farmer reporter and Adam Cancun who kind of covers it all as we talk about the politics around Commissioner Ghalib's departure, then after the break I sat down with Sarah over mall. Also, a farmer reporter and Halina bottom Miller, our senior food and agriculture reporter to discuss the policy implications and. God lead a legacy at FDA reminder that Commissioner and Gottlieb appeared on this podcast twice. I'll include links to those episodes for you to listen at your convenience. And now, let's get to it with Sarah Carlin Smith and Adam Cancun, Sarah Carlin Smith, welcome to politico. Boss, jack. Thanks, San Adam Cancun. Welcome back to politico balls check to hey, dance could veer by my count. There have been three agency altering departures attic during the Trump administration. HHS secretary Tom Price left in September twenty seventeen because of the charter plane scandal CDC director, Brenda FitzGerald, left in January twenty eighteen after her stock portfolio scandal where it turned out she owned tobacco, stocks and other things and kept having to recuse as a result. And now Scott Gottlieb is leaving just two months after he memorably posted a meme of Mark Twain, and the quote, the reports of my death have been greatly exaggerated. Sarah, you cover FDA so closely. Why is he FDA Commissioner leaving really so FDA Commissioner Scott Gottlieb says he only planned on ever being in this job about two years for just about at this. Mark his family lives in Connecticut, which is close to DC, but you know, it's on a daily commutable distance. And he just taken too much like a toll on his personal life and his family, and it's time for him to move on that being said that this is DC we've heard a lot of people use that line before. And it's been a cover up for something else. So I'm spending time with my family, and it's rain for doing anything but spending time with the family, right? But so far, I think there's nobody has any credible explanation to counter what Scott Gottlieb is saying nobody can say anything that com- confirms. He's not telling the truth, but people are still wondering, you know, did he have some kind of dispute with? With HHS or the Trump administration. Was there some tension going on with congress? Is there another reason that may be sent him running now besides just wanting to spend more time with his family? I think what's especially striking is that in Washington when someone is leaving. There is always going to be scrutiny. There will be rumors flying and in a normal administration. The explanation that I'm leaving because I'm burned out or spending time with family, even that might be more accepted than in the Trump administration where we've seen departures usually out of chaos or scandal. Is there any whiff of scandal that any of us have heard about with Gottlieb? I don't know that there's been any whiff of scandal in the in the Trump era way of it. So, you know, things that are potentially illegal or or that have been unethical. He hasn't asked for a mattress from the Trump hotel. No. And what's interesting, and I think what's really baffling in particular about this resignation. Is that? You know, Scott Gottlieb is one of the most respected. I guess Trump officials from you know, if you talked to either Republicans or Democrats, they'll say about the same thing, and he's largely been, you know, among the least controversial. So the idea that, you know, you have Gottlieb leaving now seemingly abruptly with very little notice raises a lot of questions, and you know, everybody wants to spend more time with their family. I'm sure that's a contributing factor. But it's it's very hard to buy that that is the sole factor. Here's a headline from Bloomberg quote, Donald Trump just lost his most popular bureaucrat, so Gottlieb's popularity and success was was seen across the administration. Let's go back to what some of those contributing factors might be or at least some of the fights that Commissioner in God Leib got into Sarajevo looted to perhaps tension with the hill where the broader administration what what are some of those flash points would have they been so galleys been aggressive and probably almost every area that f. DA can get its hands on. So he's been really proactive and tobacco e cigarettes. And that's probably one of the most controversial areas and FDA Commissioner can strongly regulate and particularly among Republicans. He's also been really big on nutrition policy, contributing or continuing a lot of Obama era policies that weren't always popular with Republicans at the same time. I think he's done things to balance, you know, both sides to peace, both sides, Republicans and Democrats, so maybe on the side of appeasing. The right a bit more. He's done things to try and speed up. Drug approvals created new fast pathways for gene therapy, really made some big changes to the medical device approval process. So that's where a lot of his popularity comes in just a question of whether some of those issues like tobacco have sort of bubbled up enough that they created some kind of tension for him. Can I should say the three of us have spent? So much time since his announcement that he was leaving trying to figure out exactly what those tensions were two of us. Have talked to Gottlieb directly. We've talked to people close to him as well. When you say that tobacco has been a flashpoint for him what specifically has happened with tobacco recently. So Ghalib's been trying to do things one is lower the amount of nicotine in cigarettes. The other big thing is kind of to ban flavors and a lot of tobacco products. Particularly menthol that's been a big key area of controversy. Senator Burs the hill. Republican is not a big fan of that. And then the third thing is e cigarettes to more tightly regulate that and kind of keep it out of the hands of kids of those policies. I think the e cigarette thing gets the most bipartisan buying and public support, particularly if it's targeted just a kids, but he starting to push it a little bit with some of his allies as you get further into other policies, and the tobacco issue has been. Seen by some as a third rail Gottlieb had a meeting at the White House just last week talking about tobacco and other other other issues in the smoking area. I I know I have heard folks who may not have any evidence suggests that there's pressures either from vaping from tobacco caused some of the tension for God leaves departure is there any truth to that. As far as we've been able to report. I mean, I I would think that if if there is truth to it and certainly possible it's not in the traditional Trump administration away where the president gets fed up with somebody or somebody in his inner circle, or you know, that person loses the confidence of of the employee's under him. That's generally kind of what we've seen in the past kind of creating the momentum for somebody to go here. If there's an issue it's in that middle area, you know, it's with Owen be officials with people in HHS. It's that kind of mid-level area that doesn't touch Trump that doesn't touch the, you know, employees where there would be. A problem. Golly is very vehemently on the record denying that. There's any tension in the administration White House over the tobacco products. He's saying that meeting his meetings went fine at a very public event. Do Senator Richard Burr from North Carolina, very recently called golly. About on the floor of congress criticizing him, first Abaco policy. And I mean, he's one Senator perhaps one Senator more powerful than others and tobacco. But like what I was going to say it's Gottlieb Ray publicly said today that before he leaves he was going to finish a lot of his tobacco agenda. So that will be probably interesting and key moment to watch. Right. If he can finish it if the White House in adjust gave him approval to check that box that probably does send a strong message that there wasn't a huge disagreement there and just to jump off on that real real quick. You know, everybody looks at at Richard Burton from North Carolina as. Mainly because he's been the most vocal about this. But I think one thing that I can say with confidence is at Richard Burr is not the Republican Senator that has the ear of the president. You know, there are several senators who talked regularly with Trump who talked regularly with his inner circle Richard Burr is not the guy who's going to go up to the west wing and get somebody fired. Now, Richard Burr has been part of the Senator cadre that has pushed intelligence investigations with Virginia. Senator warner. Yes. And as much as of a conservative s yes, he is not been among the president's staunchest defenders, I guess I should say. And so you may be contributing factor. But I think, you know, Gottlieb's most likely to be believed when he says, look, this was not, you know, the fact that this was not the single factor. That said, I think that there is a case for, you know, it'd being contributing can you being part of maybe a broader, you know, a broader decision where look he's he's on the exits. It's coming up on. Two years everybody that I've talked to and and let me know if you've heard differently, but everybody I've talked to said they only assumed he had four to six months left in the administration. Anyway, the question is what for me what happened over the last seventy two hours that made him decide. This is the day that I'm going to resign. When that's the thing that I don't think that we were clear on yet. And I think what's tough is none of the three of us were in the room. Again, we have talked to people who have been in the room we've talked to gallium directly. And this is the challenge of being a Washington reporter, sometimes the folks that you talk to we'll have incentive to tell you the story that you that that they want you to hear I I want to go back to Gottlieb's track record again thought of very highly by the president publicly embraced by the healthcare industry. And yet there were few flash points recently, the shutdown the federal shutdown really weighed on FDA which had to make constant moves to figure out how it was going to be continuing with rations. There were staff. Some senior staff that Gottlieb wanted to install that. He couldn't interestingly the deputy, Amy Abernathy who just joined the administration could have been onboard even sooner and had more of an overlap if there had not been a shutdown. So I know that that was was attention point. And when you think about the negative stories for the Trump administration during the shutdown that the story about FDA, not doing food inspections, and how massively viral that went the story not not the impact from the lack of inspections as far as we can tell. But but Dow became a flash point for people who opposed to the administration and Trump for shutting down the government one. Interesting thing about Gottlieb. A long ball before the shutdown is he's always been fairly independent. He I don't think he's ever felt like he's had to pander to the White House line. So they've definitely been key instances where he's taken viewpoint that probably isn't a hundred percent where the White House would want to go and in the shutdown the language he was using on social media, very publicly was sending a message that the shutdown was creating problems for the FDA. This was not ideal and politically for the White House. It's a little bit complicated. Right. Have your day Commissioner saying of this whole government shutdown is a terrible idea in the White House is kind of directing it and saying this needs to happen. So we can get our other priorities accomplished. And that's another area. I think people are wondering about like or some of those building tensions something that kind of just lead someone to split. And I I want to take that forward. So Commissioner regard Leib had the power the authority. The skill set where he could go out and set a message around FDA he could push his priorities Adam as he departs success in a month. What does this mean for strategy for the political power structure there and for FDA moving forward at least one political yet? It leaves a lot up in the air. If you think about, you know, some of the priorities that we've we've talked about already especially on on tobacco vaping mental. You know, these are things that only Gottlieb was going to push. These are his his major priorities. And and the main question, I think in in talking with people around the agency and on the hill is there's a major question of I whether those priorities will continue to go forward. And Secondly, you know, who's shepherding those there's still no news on who's going to be acting. Whether the administration wants to nominate somebody to be FDA Commissioner permanently. There's questions around, you know, who even you know could qualify for that job or be up for that job relatively quickly. And on the other hand, you're looking at again, a shift where you have one of the three major agency heads leaving so Gottlieb's leaving that leaves Seema Verma the head of CMS an Alex as are, obviously the the HHS secretary who are now kind of the two senior people there. And I I think it's interesting. It's something we've discussed here is that. There have always been these rumors around, you know, we'll see him Verma leave at some point. When will she leave? It's it's it's ironic number one that that she's still here. And according to the people that I've talked to has no plans to leave anytime soon whatsoever, which I find pretty credible. And Secondly, she in particular seems to be gaining a lot more influence in a lot more power over the last few months, and the reason for that is a few fold anything that the Trump administration wants to accomplish in his next couple of years most likely going to have to be regulation there. Not going to get much by for top Trump priorities from House Democrats. And then Secondly, if you look at the people who have come in and who have left Mark short is now in the White House, a key Seema Verma ally. Andrew Bromberg who often clashed with Seema Verma is now gone replaced by Joe Rogan DPC domestic policy the domestic politics, which is this key policy center in the White House. Exactly. And these are the people who are are essentially setting the agenda health policy was in addition to as our, and that's not to say that as has lost any influence, but those two have worked well together. And if you're looking for, you know, any kind of focus shifting I I would I would say look at what firm has wanted to do look at what as has wanted to do. That's where the focus is. Now. I two thought it was really interesting that Seema Verma who has been at war with advocates in her field who have said that the policies administrator Verma has advanced are harming Medicaid could harm Medicare the the head of. Backpack. The advisory council warned Seema Verma recently. There was an exchange of some unusual letters between her in that panel. So I to pointed out at the interesting parallel that administrator Verma who has been rumored to leave what four serious times in the past two years. We've heard of her departure she is going to outlast Scott Gottlieb. And I pointed that out on Twitter and administrator Verma tweeted or whoever Manser account that that was not notable. She said what's actually notables the work Commissioner and Gaul even I have done to lower drug prices and drive innovation our healthcare system and straighter. Straighter for that Gottlieb in Burma got along very well. And we're working on things, you know, in in the drug pricing realm. I think is worth pointing out is to my understanding, Scott, leaps tenure at the FDA is actually pretty typical in terms of the amount of time and FDA Commissioner usually spends the job there've been a few exceptions where we had people overstay two two and a half years. But that's another thing to think about just that these are hard jobs, whether you're family lives locally or not oftentimes people take big pay cuts to come into these jobs. So there's also just reason to think this is sort of typical of big jobs in DC that people often don't spend a whole presidency in them. And maybe that's part of it. You could argue that God leap has been the most typical appointee in some ways he didn't attract negative headlines. He was closely working with his industry, and now perhaps his departure will follow somewhat of a typical path. I one last question here, which is about what this means for congress and its relationship with chick shos Ademir up on the hill. Allot does God leaves departure change that dynamic? This is this is a question. I was posing to a few people today if anything it it seems to hurt any kind of relationship between health agency and the administration and House Democrats. So you have to remember first of all House Democrats have the power to investigate, you know, the various parts of the Trump administration, and they've they've vowed to do so aggressively, but in talking with, you know, people who work on the healthcare side, they've said, look, we know we can talk. We've always known we can work with and talk with Scott Gottlieb can do the same with as are. But to a lesser extent losing godly means there is a major loss of a go-between between Democrats and the administration, and the first thing that does is it it kind of leaves a vacuum there. Right. So if you're a House Democrat and say, I want to talk about drug pricing. I wanna talk about. FDA stuff. Now, who do you go to to try and figure out a bipartisan way forward? And then Secondly on the investigation side. This kind of re removes you potential person that that, you know, Democrats could say, well, maybe we'll will back off a little bit on the investigation because we wanna make sure that we can preserve our relationship with God. Leap to this point. I asked a democrat today, you know, who's a natural point person. What does this mean for the investigations who do you work within and they wouldn't say much, but they did they did joke. You know, what you don't think we can we can work with Seema Verma. And it's and the context being look if there's anybody that they have not felt like they've been able to get along with it is Seema Verma and men to a lesser extent. As our and losing Gottlieb means there's there's no kind of buffer there anymore. Scott Gottlieb is personal ball. He has a personality. That's a track did people to him on all sides of the aisle all parts of industry, and he's a really really skilled communicator, most FDA commissioners have not been so public and so great at that. And that's going to be a huge loss for FDA. It wants to move its mission forward and clearly as Adams saying it could have broader ramifications for all of HHS because he filled such an important role where he could get buy in from two competing political parties. And I would also argue that if you look at the areas of compromise that are available in the health sphere. It is almost always almost completely in the in the FDA realm on things around ObamaCare, you're not going to get much compromise on things around, Medicaid and Medicaid work requirements. No compromise there. But when you're talking about, you know, drugs getting generics to market faster. Those are areas that that we've seen some kind of bipartisan progress. So that's another main question that we'll have to kind of see how his answered going forward is you know, who picks up that mantle and how does that relationship develop? And we will see how your stories evolve going forward how congress is working with FDA and how FDA evolves, Adam, Sarah, thanks so much for joining the podcast. Thanks to then fun. Hey, it's Dan diamond. And if you like learning about the politics and policies around HHS, you don't have to wait for pulse. Check just sign up for a free subscription of our newsletter. Politico pulse. Good a politico dot com slash politico. Pulse. You'll get the newsletter at ten AM or pro subscribers. Get it at six AM. If you're interested in either good, politico dot com slash politico. Pulse. For more information and to sign up and now back to our conversation. About Scott Gottlieb with my colleagues Sarah over ball and Alina bottom Miller eve, which. Now, I'm joined by two other colleagues first Halina bottom Miller, Yvette our senior food and agriculture reporter. Hello, Helene, Halina high and Sarah over mall for farmer reporter back yet again, and your your names, it's like the pronunciation Olympics. So we just talked about the politics of Scott. Leaps departure. I wanted to spend the next fifteen or twenty minutes talking about the policies that he put into place at FDA when you were thinking about all the different initiatives that he pushed white is the signature one that stands out, Sarah you cover pharma. Lena, you're here because it's the food and Drug administration you cover food and nutrition. Why don't we start the with the drug issues? And and what what grabs you sir about his legacy and the signature initiative there were so many different things both for drugs and devices. But I think if you had to sum them all up, it'd be about modernizing the space, whether it was issuing guidance that would acknowledge the way that technology. And cyber security threats played a role or is you've got instant made the drug trial process. More efficient and easy to incorporate real world real world data into it that wasn't happening under the Obama administration. I think one of the things that was significant about what Gottlieb was doing under. The Trump administration was was really the way that he incorporated or was trying to incorporate real world data because that has really just in the past few years become a more significant player in the drug space as far as medical devices. He really was adapting to the time in the scrutiny that has been placed on devices and some of the safety concerns that have come out lately is their device a drug that that Gottlieb shepherded through that historically was not able to make it through FDA. I don't know about not able to make it. But he led the agency when some drugs came to market that are really first of their kind regenerative medicine so cart T therapies cell Therapy's. And the first gene therapy was. Approved under his leadership, and he published framework for how more of those therapies can be developed and come to market. So he's definitely was leading FDA during a very very exciting time for science and drugs. You know, what was the signature initiative on the food nutrition side? So I think the two things looking back will will Mark Gottlieb's legacy is implementing two major Obama nutrition policies. The I would be keeping the update to nutrition facts labels, which was something very important to former first lady Michelle Obama, and there was a bit of controversy during the Obama administration when they mandated that those updated labels would have to include added sugars disclosure, so actually a lot of consumers now are seeing those labels. They've been slowly rolled out. And certainly when this administration came to power there was an opportunity to. Delay that further to scrap it to redo it. There could have been all manner of disruptions to that policy. But he decided to keep it on track. And my understanding as someone who only dabbles in the food and nutrition news is that industry was very opposed. They were. Yeah. That really felt that the added sugars label in particular wasn't backed by science was, you know, a bridge too far. So there was that. And then also menu labeling. So when you see calories being posted on those menus of chain restaurants, and this has been implemented nationwide. It's was actually something buried in ObamaCare that or the Affordable Care Act that everyone kind of forgot about took years to implement and that finally took effect last spring and the Commissioner took a lot of heat for pushing that policy to the finish line. Even though there were parts of particularly retail and pizza chains that were very opposed to that. And those are two I think very visible markers of of legacy that that we're gonna see for a long time. So I- cheated a little on this question because I asked Commissioner and Gottlieb directly today. When what do you think is your legacy at FDA if you had to pick one thing and that was hard because he can. Yes. But he said he was proud of changing the culture on. Opioids certainly golly has been out stressing things that in the past FDA might have done to contribute to the opioid epidemic and walking back from that. He said there's a different way of thinking around opiates. But if I had my druthers, I actually think that I should probably not have used the word brothers. But if I had my pick of a legacy that that he is memorable on that. He is so different. It's how he shaved media strategy for FDA. I can't remember a time that any health agency got this much positive press. A lot of that goes back to him. He could teach a masterclass, and they're there to tactics that I thought he was particularly good at one was knowing how to spread nuggets between all the different publications. So there would be a New York Times story on say opioids or modern healthcare on some story that would be relevant to that readership and that not only ensures positive coverage. But it really forces us like kids chasing a soccer ball to do. Those follows. Stories those match stories even his resignation news all three of us know when when that news dropped we spent the next number of hours trying to confirm it and then have to follow that story. And then I think the second thing that he was really good at was understanding that the more accessible a government official is usually the the better the coverages, but the stories will be smarter. If I can call Commissioner Gottlieb directly and get his comment. That's usually better than having something work through telephone. And Secondly, the more they're talking and responding and appearing at speeches and making their calendars public, the less time all of us have to snoop around and try to figure out what's going on behind the scenes, and I speak from experience here. When officials wall themselves off that sometimes can lead to the most investigative stories because there's nothing else to write about. In terms of his opioid legacy. How do you think? Sarah, the Gottlieb era will be remembered. Well, first of all completely agree on his accessibility. I think it was most noted even during the shutdown when he was talking almost daily about how they were working and providing morale to furloughed employee's. But yes on opioids that's really interesting because Lena, and I were actually just speaking with him earlier and went underlined actually how we're super three of us have talked to the FDA Commissioner in the past twenty four hours. Did that ever happen in your old days covering FDA? Absolutely. Not it used to be really hard to get even statements basic questions answered on certain topics, and that has completely changed completely changed hundred hundred eighty degrees. Right. Absolutely. And I think one of the reasons I mean, he always has been accessible, but one of the reasons he really wanted to talk today was just just the things that are still going according to plan, and he did specifically bring up his opioid plan an assurance that all of this. This really sweeping proposal that they have to reform opioid reviews. An oversight and safety issues is still going to be on track for two thousand nineteen goals, including requiring blister packs vote for opioids and post marketing studies to see addiction risks. He will really did want to stress that is absolutely still in implementation. Even when he's not there, and I want to add one thing to the to the media strategy because I think the other noticeable thing that maybe the members of the public aren't as. Is aware of is just how many statements Commissioner? Golly put out, and you know, just on on everything. I mean every day multiple statements every week just, you know, you could go back, and look your inbox flooded, very unusual in some of these statements. I think he mentioned the opioid statement was forty five hundred words this long, yes, willing, so you had to read the whole thing, you know, sometimes there were little nuggets buried in there and just that level of communication totally different than any other FDA. I've covered what's an initiative, maybe an overlooked one that Ghali oversaw. He was remarkably busy. I mean, the reason they're sending all those statements to our inboxes was it felt like FDA was announcing something new all the time. Halina was was there one that thinking back was particularly interesting or different that he pursued one of the things early that I found really interesting is the Commissioner said that FDA had found money to do a consumer education campaign ran nutrition. It wasn't a ton of money. I think it was going to be a few more. Dollars. But this was kind of unique. I mean, even when they rolled out the first nutrition facts label in the mid nineties. There wasn't a budget to market that it was really reliant on free media. That's not traditionally been something FDA does. So it was a kind of novel approach the fact that that was a priority. And that it was a nugget that he would share with the media. It was something he was looking at that was part of a broader nutrition strategy that he laid out last year that didn't get a ton of attention because attrition policy tends to not be this like major mainstream issue, but was really novel. And I think surprised a lot of people almond milk and milk strategy. Did did win a lot of attention. And we don't let Allman doesn't lactate that is the the the you can buy t-shirts now with that that certainly was one of his most probably has most viral moment, it got an onion article. Yeah. It was on the late show. Someone used to in their wedding vows. When when the onion is parodying, people aren't sure whether it's true or false. And on that note, we don't know what's going to happen on that issue because that got a lot of attention, you know, in popular culture, but dairy producers really want FDA to crack down on use of the term almond milk, and soy milk, and you know, cash cashew cheese. So that's a big question. That is an unfinished and unfinished item, Utah Republican Mike Lee recently made the statement that that a lot of this is unnecessary. Someone like me who goes in buys almond milk or coconut milk. We we don't need the milk part is irrelevant. The reason we're buying these things is because it's not dairy milk, and that is widely known. So that this is a controversy that didn't need to exist. Well, the dairy industry would argue that you're not getting as much calcium and vitamin d from your cashew, Melker, whatever. So maybe consumers are confused. This is something that's going to be hotly debated. And it's definitely an unfinished piece of business. Speaking of unfinished business as we sit here. Twenty four hours. Or so after ABS news broke that he was leaving. Do we know who's going to lead the agency? No. And we talked a bit about this on on our last panel. But I'm curious Selena, you've tracked FDA for a long time. Is there even a shortlist for who the person is going to be running FDA after he departs? So normally we would look to deputy Commissioner role, Amy Abernathy. I think I'm saying her name right is a new deputy Commissioner our principal deputy Commissioner, but she hasn't been at the agency very long and neither has another deputy Commissioner. I'm more familiar with Frank Jaanus who works on food policy and response that's a new title. And neither of them have been at the agency. I don't think long enough to qualify to be acting Commissioner. And so we're not sure we asked the still current Commissioner about this today, and we did not get a response. So it is an unknown something that I think a lot of reporters in Washington are going to be bugging them about. I'd I'd love to see the internal trials of who wants to be the neck. FDA commissioner. They me running is there is there any expectation that any policies are going to drop in the next few weeks that will serve as Gottlieb's kind of farewell at FDA some signature effort is trying to get over the hump, sir. Carlin. Smith is on the first panel did mention something about tobacco, right? Yes. So that is definitely one of his biggest priorities. He has a plan to significantly curb e cigarette sales specifically in convenience stores that he already essentially unveiled in November. But he presented last week at the White House that plan he has assured us he is very confident in his words. He said he's very confident that that is going to go through very soon. He has every intention of finishing that up while he's here what he won't be able to finalise in his last month is broader tobacco reform, so specifically banning menthol cigarettes and all flavors in cigars, which are both proposals. That are in the draft form right now, and that he's very passionate about. But he just doesn't have the time to make them go through. He went speaking with us earlier was very aware. How controversial those are. And said, you know, he doesn't know what's going to happen in the next few months or with the next Commissioner, but he thinks that he's laid the groundwork for those to survive so on on the food side. I mentioned, you know, dairy labeling. This is an open question. We don't know what's going to happen with this consumer education plan or really the broader nutrition strategy that they've laid out part of what they wanna do. There is updates some archaic food labelling standards, and you know, one of the commissioners points on this is that if you updated some of these old regulations, you could spur more innovation in the food sector that might help combat diet related disease and help people encourage them to eat healthier. There's also this question of whether or not the FDA will keep working on sodium reduction targets that are voluntary for the food industry. But are quite controversial. They were first proposed under the Obama administration. And he has said that you know, that they going to continue working on. On them. But it remains a question under a different Commissioner. Will there be kind of the political cover to do something? That's more controversial down the line. And I I want to take it to my last question, which is on this legacy of what comes after Scott Gottlieb. Did he permanently changed the agency? Or is it going to snap back could Donald Trump pick someone from Silicon Valley who has a very different view and FDA which was one of the prevailing theories a couple years ago that that Peter Thiel acolyte, the the venture capitalists who supported Trump and his campaign wanted to put someone in who didn't believe in regulating drugs and devices, so could FDA go back to the FDA that we are so familiar with or or is there a legacy here that some of these things are just built so deep now after two years, they're not going to get shaken why the ways it might snap back on the communication side. Who knows but on drugs you as a good point about regulation. I don't think that anybody on either side of the aisle. Saw what Gottlieb was doing? The plans that he put in place even the in finished ones as necessarily controversial. They were really more aware of and adapting to current realities in the drug space and and things like speeding up clinical trials or making the data from it more accessible to other people. I don't really see someone even someone from silicone valley or even especially so in from Silicon Valley trying to rewrite that legacy. And so I think especially in the drug and device space that is safe tobacco is a big open question. And then there's other open questions that Helene, and I have worked on together like cannabis knol, and what the future is for that. Because he just started on that project guts CBD. Oils that are now circulating as like pain relievers and other things that are largely unregulated. Yes. And the FDA last year late last year told congress that it's technically has the authority to regulate those drugs, but that leaves all these dietary supplements that Halina would know more about with her space kind of in limbo or even putting it in beverages. These questions about you know, the last farm Bill Leeb legalized hemp and one of the most lucrative things. You can make hemp CBD. And can you add that to foods and supplements right now shampoo got a pinch for that a pet food is the thing also. So that's a whole wild west area where they're going to have to draw up some some ground rules for figuring out how that's all going to work without I guess infringing on the pharma side, which I've gotten a little bit of a crash course on recently. I think on the food side, what will be interesting less so on whether or not certain controversial policies can advance is whether or not the next Commissioner is even interested in food and talking about food policy as. Much as golly was because that was really what surprise people a lot of times most times FDA commissioners, come from us more medical background, which makes sense considering their portfolio of issues, it's a really broad portfolio. And if you do not have a medical background or. It's usually Trump might go outside that that path concerning. Yeah, I talked to someone today. And they were like, you know, the doctors who get there are always surprised at how interesting food issues are right. Because it's not it tends to not be their wheelhouse. When we look at who's going to be on the shortlist. I'll certainly look all of them up. But I can almost guarantee you none of them. We'll have a record. And we didn't expect Gottlieb to be as vocal on food. Is he has been one legacy point that I'm I'm curious to see if it persists is. How Scott Gottlieb who a few years ago would have been seen as a non-starter for this kind of ministration job by Democrats at least because of his financial entanglements. They quickly ran and embraced him. When some of the less traditional candidates from Silicon Valley were being put forward and Gottlieb dot confirmed. And then was quickly in embraced by Democrats who liked to style his strategy and the policies who's putting forward. Peter zog. The former Obama budget official was on this podcast few months ago, saying that the success of doc. Golly. And also HHS secretary as our has given him cause to rethink whether there should be more people coming from industry into government, historically, that has not been a democratic the the Democrats haven't really put forward industry, folks. They look more for researchers academics career government types. Not people were coming off Wall Street to run big healthcare organizations. So I'm curious to see if if this is just an artifact of the Trump administration, or if Democrats will have a new broader approach to who they think should fill these kind of regulatory rules. It's an interesting that's an interesting observation, but I've got Lebed did have a fairly lengthy track record at FDA. So I think going in and out of the think tank rolled FDA industry, the venture capital world, probably gave him a broader view sort of the wider landscape that is a little bit different than someone who would, you know, come straight out of the private sector. But I don't know that even if you've got someone. Random out of industry that they're going to have that aggressive communication strategy. I think to your point earlier that is probably going to be a unique characteristic of this tenure, I think we should underline. It Scott Gottlieb was one of a kind. We are. We are not expecting another FDA Commissioner with his set of skills as calms approach his initiative. He also very notably was one of the only if not the only FDA Commissioner talk directly about drug pricing, which of course, is a pet project of President Trump. And so I think back to that industry point he did really strike a balance on trying to protect the incentives that would keep industry, you know, engaged in developing new and life saving technologies, but also is not afraid to talk very directly about what they needed to do into shame them when they were doing things that you kept generic or cheaper medicines away from people, and he was able to blend because he was a former chick show sufficient during the George W Bush administration. He was able to blend the regulatory background with the industry knowledge. And then say look guys I've been in your shoes. I get it. But this is why we need to move where Trump wants us to go. Well, I guess we will see who inherits those very big shoes of Scott collie Polina, Sarah. Thanks so much for joining the podcast. Thanks. Thanks. That's it for pulse. Check this week. My thanks to all my colleagues, sir over m- all star Carlin Smith, we bottom Miller eve, Adam Cancun. And of course, Michaela Rodriguez produced the show, if you like political pulse. Check, you can find it on your favorite podcast app. Please rate and review us. They're confined me at Di diamond politico dot com by Email, and you can find a new episode of politico pulse. Check in your podcast player next week.

Commissioner Scott Gottlieb FDA FDA Commissioner Sarah Carlin Smith HHS President Trump congress White House Adam Cancun Commissioner Ghalib Obama reporter Senator Richard Burr administrator Verma Scott Gottlieb House Democrats secretary Commissioner Scott guy
FDA Commissioner Scott Gottlieb

POLITICO's Pulse Check

50:08 min | 3 years ago

FDA Commissioner Scott Gottlieb

"The bottom line is that if we are creating a whole pool of kids addicted to nicotine through e cigarettes some proportion than we're gonna become long-term uses of combustible tobacco that otherwise might never have initiate tobacco and all the great gains that we've made in his country, reducing smoking rates. And you saw the data that came out today showing smoking rates continue to come down and also stigmatizing smoking among young people. So that we're reducing the pool of future smokers all of that will be reversed or lost. If we can address the youth use of cigarettes. I'm Dan diamond this pulse. Check and that was FDA. Commissioner Scott Gottlieb vowing to crack down on e cigarette. Sales to young Americans. I just sat down with the FDA Commissioner, right? As news was breaking about the FDA's plan to widely banned sales a flavored e cigarettes in an effort to curb teen. Use now Commissioner Gottlieb couldn't comment on news reports, but he did detail with the agency is thinking what he's called an epidemic ahead of a formal announcement next week, but someone who can break down the latest news and t- up white. You're about to hear from Commissioner Gottlieb is my colleague, sir overhaul who's been covering the e cigarette beat get to both of those conversations in a moment. But first reminder, if you like pulse check, if you like being able to hear us put questions directly to Commissioner leave and other top officials. You can help us by keeping the podcast going every rating review on itunes. It's help. And please send suggestions to you. Can find me a D diamond politico dot com by Email and check the show notes for time cues an additional information about the topics we discuss in with that. Here's my conversation with Sarah over m- all politico health reporter. Sarah. How are you? Good big day. It was widely expected that the FDA was going to issue. Some moves to crack down on his cigarette sales. But what is actually going to happen? When news reports have suggested is that the ban is going to be fairly widespread. And where these cigarettes will be easy. Cigarettes will be sold. Did the cigarette makers see this coming? I think to a certain extent, they did especially the focus on flavored vapors and the teen appeal of them the FDA last week had released a summary of its conversations with e cig makers where banning flavored products had come up Altria also had preempted them about by about a week announcing that they would voluntarily pull their flavored is gets off the market. And so you could kind of see that as a bellwether another thing that Altria had announced last week was that they were going to back raising the age to buy all tobacco products to twenty one which even surprised if you other people in the tobacco market. It in each market. So you could see that even as something that they are potentially intimidating as well and just to to key in on that raising the age limit from eighteen around the country to twenty one is opposed by the tobacco industry. Historically. Right. Exactly. I don't smoke. I don't understand all the specifics here. Why would the FDA leave out menthol flavors in its pending actions? Well, so the the FDA has already banned flavored cigarettes, but they have left menthol cigarettes on the market. And that is something that Commissioner Gottlieb has talked about wanting to be visit. But in the meantime, they haven't done that. So the issue is if you ban menthol e cigarettes are you there for making traditional cigarettes more attractive again to smokers. Maybe some that have quit maybe some that are trying to quit. So it's about striking a balance they recognize that there's a really big problem in teen news, but they want to make sure that traditional smokers and people that have quit stick to ease. Which everyone agrees are healthier than traditional tobacco products. There's one ISA lobbyist who wants told me, you wouldn't give a recovering alcoholic whisky flavored drink so you don't want to just leave recovering smokers with just a tobacco flavored product. And these products the balance Gottlieb and others are trying to walk is to make them appealing enough for the recovering adult smokers, but not so cool that younger smokers want to switch on and in our earlier podcast with a top jewel executive Tevi. Troy, we talked about how cool some of these products, actually, look, and why that can be a difficult balance a strike because they need to be somewhat cool. But not so trendy is to get teenagers hooked on them too. FDA Commissioner Gottlieb has teased a formal announcement next week. You're a reporter here. What are you watching for? Well, I think that there is definitely going to be more in that announcement than the flavored products ban. Like, we said Altria has already sort of prompted with some things that they want to see. So maybe we will see something about age limits in next week's plan. Also, we have to remember that this is a very quick reaction to a very specific issue teen use. But like you said they want to strike a balance for adult smokers as well. They have pushed back actually formally regulating the industry until twenty twenty two. So they've got a few more years to outline what it can look like from this point onwards. How flavored products can come back to the market and how they are going to make sure that adult smokers continue switching I would note that on Thursday the same day that this announcement came out the CDC released figures. Saying that smoking is an all time low. I think that the FDA wants to make sure that that trend continues and they're going to be looking at e cigarettes as a part of that in the future. We'll we'll be looking at your coverage of the pending. He cigarette announcement next week and sir over multi queue for joining political pulse. Check making your debut, first time caller longtime listener, we're glad to have you. And now you'll hear my conversation with Commissioner godly by sat down with him for about an hour at each headquarters in Washington DC on Thursday, you'll hear we get to cigarettes pretty quickly in our talk. But also hit on topics like his leadership of FTA how he thinks about balancing science and politics in this administration opioid policies that he is leading and much much more. Remember to use the show notes to find time cues to locate parts of the conversation, and now here's Commissioner golly. In one of your last interviews with politico at our pro summit, you made the comment that quote, an almond doesn't lactate. This was part of your broader push to move away from terms like almond, milk, and soy milk. You made that point before. But it really blew up. Now that comment is a t shirt late night hosts mocked the idea and ran clips, by the way, the first person to seamlessly work the phrase and almond doesn't lactate into their wedding, vows and. Sends me a video gets. I don't know what t shirts. Were you surprised by that reaction? I was surprised by the reaction you go on Tomasson dot com, and you type in that phrase, and there's a lot of a lot of paraphernalia sold with with the phrasing dozen lactate, including mugs and t shirts. I'm glad that. I I've started a small business industry and help grow the economy with that phrase. But yeah, it caught me by surprise. There is a serious question though, here dairy farmers want to move away from terms like, cashew cheese, or soy milk FDA's trying to thread, the needle, well, you know, there is a regulatory obligation. If they see has with respect to our standards of identity, we have standards of identity that do articulate what food needs to constitute in order to be to have a certain phrases associated with it. So for example, what are you? What does it mean to be up how much tomatoes genie to have in order to have ketchup, and how many tomatoes do you need? I don't know. But, but you know, these these standards of identity have public health importance because people. Due impute certain nutritional content based on the nomenclature being used to describe a food product. And if a food products being described with the nomenclature, what people think they're getting a nutritional content that they're not that could have an adverse health impact. So in the case of milk. We know milk is fortified with calcium and vitamin d and has other nutritional value. If something is calling itself milk, and doesn't doesn't have those nutritional derivatives someone could substitute and their diet, not beginning that nutritional content and suffer adverse consequences than in fact, we've seen cases in the medical literature where parents, for example, that fed their children rice milk. There was some there was some public health implications of that some clinical equality, so one of the things we're asking is whether or not the use of the term milk needs to be be correlated with a certain nutritional value. So, you know, manufacturer might be able to meet those standards, for example, by fortifying the product there's going to be constitutional issues on whether or not we couldn't. Forbid a nut manufacturer from calling on beverage almond milk. Because if you look at the dictionary, the first term of milk relates to electing animal, the second term of of milk is something derived from a nut. So there is a speech issue here that said if we have data demonstrating that consumers think they're getting a nutritional value than a not by the use of the term milk. That's someplace where we might choose to enforce the existing standard of identity differently. And that's the kind of data. We're looking for. That's the process we're going to be going through in terms of evaluating whether or not we should change the way we enforce that existing Senate of identity your agency has been working with the department of agriculture on oversight of lab. Beast me lab lab grown meat. There's been somewhat of a public turf or here. Republicans wanted to give all the authority essentially to US DA. Yes, or no does the house flipping democrat. Make it easier to achieve dual oversight dual jurisdiction. We'll call. Cultured meat now. So lexicon has changed. But I think that I've been working very closely with USDA meeting with meeting with the deputy secretary the secretary we've had other discussions. I think we are very close to having a proposal on how the two agencies are going to work together, very closely insured jurisdiction here in a way that makes policy sense. And in a way, that's gonna make scientific sense in terms of the different processes involved in developing these products, and which agency has expertise in different areas of how these products are developed. So I feel very good that we're on. We're in the final stages of having a joint framework to agencies can work on together. And my hope is that if if we go out publicly, you know, with some some robust proposal on how we're going to approach this going forward that congress would give deference to the agencies to work out the fine print on how we would implement that. And if it requires legislation down the road to fully codify that if congress wants to come. In god. If I what we do, obviously. I'd welcome the input from congress. But I would hope that congress would give us the opportunity to work out these details. This is very new science. It's it's complex, and I think it's best work through by the agencies, and then we can be in a better position to inform congress if they want to legislate here. So I just to translate because they didn't hear yes, or no, you think congress, regardless of who controls what chamber should be deferential to the agency on something of this matter. Well, I think this is I think this is a very new area of technology. We're often in a position of having to to figure out how to regulate an industry after the fact the industry get started products route in commerce, and then we come in and try to regulate it after the fact this is an an example of where we're trying to lay out the regulatory parameters in advance of these products actually being available. So I think we have time to work this out what I'm saying is I think I'm going to be in a much better position to to inform congress on what I think a proper framework should look like and be an agreement with the secretary Bagley. Culture, go forward with a joint proposal to congress that then they can come in and make a judgment whether or not they agree with us. They wanted they want to legislate in a slightly different way. I think right now anyone who acts including congress on trying to legislate around. This is going to be acting in the absence of of a fuller understanding of what this process looks like because we're still developing it, you know, and if we if we the sort of experts in this will working through these issues are still trying to come up with what their framework looks like I think we have a better better opportunity to inform congress, you know, six months from now three months from now than we do do today. Attorney general Jeff Sessions has departed the Trump administration HHS secretary, Alex as our has been rumored as a possible replacement. I should say that his office has denied that he is interested. But you never know if secretary as ours tapped to be attorney general would you want to be secretary? Well, I'm not going to engage in hypotheticals on hypotheticals other than to tell you what. I told you before when you asked me this question about a year ago, which is I'm very happy and the job I'm in and I will say beyond that. I think I'm in the job that I'm best suited for. I mean, this is the place where I think I'm going to, you know, deliver the best work for the administration and for the public health. You referenced our conversation on this podcast about a year ago. I asked you at that time to give a headline for what you thought the agencies work was if you were picking the headlines as a as a newspaper editor you responded with more of an essay than a headline. But that's just a quibble if you were picking the headline for twenty eight teen with the you're almost over. What would that be for FDA? You know, the headlines ends up being issue specific, I think that we've done some pretty bold things and things that are going to have a pretty broad impact on public health in a couple of different areas. I think that work that we've done in in tobacco is notable, frankly. And I think it's going to have a meaningful impact in perpetuity. I think the things that we've done to try to shift the agency. Orientation to the opioid crisis and think differently about what roll is with respect to that crisis are going to have a lasting impact. I hope they will. And I think some of the work we've done to try to promote competition are also going to have lasting impact. I look at it from the from the standpoint, if you're asking me what I think of the most notable things that we've done I look at it from the standpoint where I feel that we have changed the agency's relationship to important issues and with the agencies now thinking differently about its mission with respect to those issues, and those are three areas with agencies now thinking differently with respect to those issues through the work that we you know, that we've done together that that I've done with the leadership of the centers. Is an essay. It's the headline and the first couple of paragraphs of historic. We'll give you credit for over achieving and delivering more than than the editor asked for. Let's let's go through those interns who tobacco and even beyond tobacco Easter 'grats. And what the FDA is is doing in that area. This is a real life problem in a way that say Medicare payment regulations might not be I get emails from readers who say I am. I am worried about my teenage son or daughter using jewels vaping and in school. I don't get that same level of urgency around like the discrete regulations that are happening. You've said that FDA has data showing that use of of ping devices among teenagers, isn't ethnic. What do you know? And when will we find out about it is going to be coming up very soon? We're going to announce action next week. The first stages of our action next week in terms of what we're going to do to try to address the epidemic of teen use of cigarettes. And I've already said the data shows a greater than seventy five percent increase in the use of cigarettes. Year-over-year from twenty seventeen to twenty eighteen among high school students and about a fifty percent increase in the use of cigarettes among middle school students in this comes from the national youth tobacco survey. This is early data from the national youth tobacco survey where we looked specifically at the east cigarette. Use based on concerning trends that we spotted you know, and and it's not just that uses gone up, but but regularly uses gone up. So typically in the past the argument was well kids are experimenting with these cigarettes. But they're not using it all the time. But the rate of use of regular use of cigarettes, which means using it twenty out of the last thirty days is also gone up. Thirty percent. I think the important thing to remember here. And why we're so concerned is this is not these are not kids who would have smoked cigarettes. But now they're using cigarettes. These are kids who would never have initiated on nicotine and had survey data shows that in fact, the companies owned data shows that they've told us that. And we also now have data that shows that kids who initiate on nicotine through e cigarettes. Proportion of them a gonna end up being smokers of combustible tobacco. So all the great game. Worship. What proportion you have to look at different studies. The rand study found reported on some Monday numbers national academies of medicine study reported numbers I own path study has reported numbers. So there's different studies that have reported different numbers with respect to what that proportion is. But the, but the bottom line is that if we are creating a whole pool of kids addicted to nicotine through e cigarettes some proportion than we're gonna become long-term uses of combustible tobacco that otherwise might never have initiated on tobacco and all the great gains that we've made in his country, reducing smoking rates. And you saw the data that came out today showing smoking rates continue to come down and also stigmatizing smoking among young people. So that we're reducing the pool of future smokers all of that will be reversed or lost. If we can address the youth use of cigarettes. I believe the steps that we're going to take gonna be robust. They're going to be an initial set of steps if we don't start to. See these trends come down. We'll take additional actions, but we're going to be stepping into this market. And I'll just say, I'll give one more minute. If I may, you know, we said less when we announced a comprehensive policy we saw an opportunity for these non combustible products to be away to migrate adult smokers off of combustible tobacco onto products that didn't pose all the same risks. And we put nicotine at the center of our regulatory efforts. And we we were accommodated to the east cigarettes insofar as we gave him extra time to come in with applications because we we wanted to we wanted to help promote this opportunity for adult currently addicted adult smokers, but we said then, and we said all along that it cannot come at the expense of addicting a whole generation of young people on nicotine threes cigarettes. And that's exactly what's happening. We warned the companies we told them that we wouldn't tolerate it. And we're not going to be tolerating. You mentioned the moves that your agency has made last year FDA decided to push the deadline for regulatory review of the e cigarette products to August twenty twenty two almost four years from now. So putting that in plano. English e cigarettes can hit the market without approval from FDA. Why did you make that decision? And or you re thinking that while it was e cigarettes that were on the market as of two thousand sixteen can continue to stay on the market until that date, if I hadn't changed that date, the applications would have been do about a month ago or two months ago, and there's the potential that these products would have had to come off the market a year from now. I still think we are trying to strike the right balance between trying to more rapidly migrate adult smokers off of combustible tobacco by regulating the nicotine levels in in combustible cigarettes to minimally a non indicative levels while still providing an opportunity for adults who want to get access to satisfy levels of nicotine to do through products that are less harmful. That means nicotine replacement therapy. The least harmful form of nicotine delivery, things like, you know, gums and patches that you might be able by a pharmacy without a prescription. And we've put out new policy to try to promote development of those products. But it also could mean things likely attrac- nicotine delivery systems like he cigarettes. And if you if we could switch every adult smoker who's currently addicted to combustible cigarettes onto cigarettes, we will dramatically reduce overall bidding mortality these e cigarettes are not risk free. They have risks associated with and we have to fully characterize them. But we know they're less risky than smoking combustible product. The what what happened in twenty eighteen in terms of the? The rapid rise in e cigarette. Use would have happened regardless. If I never changed the policy because nothing would have changed the applications would have been due in August. The products would have remained on the market for at least another year probably longer than that. So I don't think there was anything. We did by extending those deadlines at had the immediate impact. What we couldn't foresee was the dramatic rise in popularity among these e cigarettes among kids and particularly one brand of cigarettes among kids. That's what is driving this increase rate of us. But you know, I feel that we are going to be stepping in quickly enough with action to try to reverse these trends, I'm hopeful that we're going to be able to start to reverse these trends, not immediately. It's going to take time, but we're going to act forcefully. And what what we intend to do within the next week is just going to be a first step if we don't start to see aggressive action on the part of the sponsors themselves. And if we don't see our own action having an impact on these. Where we we're willing to step in with additional measures to try to reverse this. We cannot allow the rate of use that we're seeing among kids to continue, and we cannot allow fully now twenty percent of all American teams to be users or be cigarettes, which is is close to where we're going to be at when his data fully comes out. What are the additional measures that you could use? Well, I think the question I is what are we contemplating? That's the first question you should've asked me. And then and then the next question would have been what else are you considering? But I'm happy to ask those questions. If that will listen were information what what additional actions, are you contemplating? Well, where we have an issue of a problem with access and appeal these products to accede to kids and their too appealing to kids. So we're going to be taking some measures to limit accessibility of these products to kids looking in particular at sales of these products in retail establishments. You know, gas stations convenience stores where tobacco products are traditionally sold and considering taking the flavored. Products out of those establishments and making and making the flavored products only available in adult only establishment. So things like the ten thousand vaping stores in in the country were differentiating between cartridge based systems and open tank systems the open tank systems by and large used by adults. It's the cartridge based systems that are being used by the kids. And so we would we would look to differentiate between those two products. And we would also look to take action to, you know, limit a cocktail online sales unless the online sites are adhering to certain measures that restrict the ability of kids to be buying those products on online simplest being obviously age verification, perhaps adults signature on delivery. Like you do for wine when you order wine online right now, very small percentage of the cigarettes were actually sold online. Most of them are being sold in retail establishments of the convenience stores. And we think most of the places where the kids are getting access to these products are those those. Stablishment? It seems to me and this is a little bit of I'm surmising little bit. But it does seem that that convenience store clerks who understand it's not appropriate to sell a combustible tobacco product to two kids. There's there's less of you know, an inhibition about selling an e cigarette product kids, and so you see more sales. So we see establishments where we don't see violations on the combustible side. But we're seeing violations on e cigarette side. And so we have to look at that channel that channel is a place with these kids getting axes products and the flavors are one of the primary elements that are making these products attractive to kids the fruity flavors. You're talking about online sales being a small percentage here. Can you give a sense for how small yeah, I think you should talk to the individual manufacturers? But generally, and and we don't we don't necessarily collect data on that. I'm getting my information from the manufacturers. And I want to be careful not to reveal their confidential commercial confidential information. But generally, it's less than ten percent of their overall sales are coming through the online channel and for some of the. It's quite small. So most of the sales are in brick and mortar establishments. You've mentioned meeting with these manufacturers meetings are available on your public calendar. I'm curious if they have said anything in your meeting, specifically that have changed what you are going to do in terms of enforcement, and he positive ideas that they've contributed. I don't think that the com- the conversations have been helpful because they've informed me about things where we didn't have where maybe we didn't have full insight before they've they have come forward with with data that that has been helpful. For example, you know, some of the data that that kids who are initiating on e cigarettes aren't kids who would have initiated on combustible tobacco actually comes from some of the manufacturers. They they have some survey data they've discussed that with us. So I've I've gotten some additional helpful insights in terms of understanding the public health parameters of the problems. I think we have a good sense of what we're gonna do. I think that there's areas of agreement with some of the manufacturers about what would be most impactful. So there's elements of what we're gonna do that some of the manufacturers have, you know, said we think these are good ideas. Are we are we are going to voluntarily take steps that that comport with what the kinds of things are you talking about? So I've I've been pretty public about where we're looking to try to take action. So I don't think that there's been there's going to be a surprise with the manufacturer with respect to what we ultimately do. They've been constructive conversations. I can't I can't say that. It's informed. What we're going to do in so far as we heard a good idea now implementing it, I think it's I think it's validated that the kinds of things we're looking at also the kinds of considerations. They're making insofar as you know, they share some of these concerns I think that they recognize now I've been saying all year. But I think they recognize now that this is an existential threat to them because even if FDA were not take robust action, and we will take robust action. It's more than likely congress would step in here. So this is an. Essential threat to this business segment. They're not griping though, that you've sent mixed messages that that perhaps initially by cracking down on traditional tobacco and encouraging the shift to lure risk products like e cigarettes that now you've changed tuned too much by cracking down. But it's not miss it. It's not mixed messages. My message has been consistent all along. I see the cigarettes is not pretending to transition currently addicted adult smokers. I don't see it as not between two dick generation at young people nicotine, and I told him all along at the outset. And I said this at my very first speech when I announced our original policy vis cannot come at the expense of addicting, a whole generation of young people on nicotine. And I remember those words because I've much have said that dozens and dozens of time so this isn't a change in tune. I am still of the mind, and we are still the minded FDA that these products represent a potential opportunity for adult smokers. We don't want to foreclose this channel entirely. I don't wanna take action that's gonna shut the cigarette. Industry down. We see this is not between. But in order to close the on ramp for kids. We are going to have to narrow the off ramp for adults in order to make it much harder for kids to get access to these products. We are going to have to take action that will put some speed bumps in the way of adults as well. That's that's just the reality. There's no way to do this without also. So creating some measures that's gonna make it a little harder for adults to get access to all the products that they want, but quite frankly, I think most adult smokers, and I know most parents of teenagers are going to be willing to see us take action that makes that accommodation if it means closing down the level of youth use that we're seeing right now. So you've talked about manufacturers being helpful. But you've also taken pretty aggressive moves. You rated the office of jewel the dominant veep product. Why did you do that? If the company came to the table to discuss plants, well, look, they're two separate issues. We have an industry segment problem in terms of the east cigarettes being too appealing to accessible to kids, and we have company specific problems in terms of certain products being more widely used by children and jewel is one of the products that's being very widely used by children. And we want to understand why we have our own internal estimates onto proportion of sales of their products that are going to kids. It's very high. Hi, it's a high percentage of their overall sales that are going to kids, and we want to understand that we want to understand whether their marketing practices or aspects of that product that are making it more appealing to kids. And that was part of the information that we were trying to collect in those in those actions, you know, and I said that the companies have been helpful. They've been helpful in terms of answering questions and bringing information, I think to date, and I think they are starting to take measures that are going to address aspects of this problem, but up until recently, they have not been helpful. I don't think that they've recognized that this is an existential threat. I think they could've stepped into the market with more forceful action much earlier in the year. Are they are they starting to take actions right now, I believe they are you saw some actions recently, we believe some companies are going to take some additional voluntary action. So I think they recognize it. I think they know where serious I think they know we're deeply concerned. I hope they share those concerns and our public health mindedness. Guard. But, but this has been only recently that we've started to see a change in behavior and more vigorous action on the part of the manufacturers. And that's why you know, this isn't going to be something that I leave up to voluntary action. We're going to step in. We're going to put in place regulatory actions. That can be enforceable. That are vigorous. I'm not leaving this up to voluntary action on the part of sponsors Tevi. Troy who runs jewels government and policy affair shop was on this podcast ruler this year. I asked him a version of the question. I'm going to ask you you to our friends. You wrote articles together you worked in the Bush administration together. Now, you are regulating him at jewel. Do you think any differently about tabby, Troy, no, of course, not and I'm not regulating Tevi, Troy, I'm regulating jewel, and and you know, Tevi has been very Phidias about not having conversations with me about about these issues, you know, my interactions with jewel have been through the meetings that I've had with them the on the record. Would meetings that I've had with them. I would never second. Guess someone's decision to seek employment in a legal, you know, in a legal area of commerce in five years. You'll be able to write very interesting co bylined articles like, hey. Hey, less romantic, Mary, Madeline, James Carville. I I want to shift to other questions about the administration while we have time, and when would be held this administration views science there have been widespread concerns that the Trump administration has been too receptive to the antiabortion movement at just wrote a headline on politico pulse. Our newsletter about H E S. Making more moves to curb access to abortion for customers of the Affordable Care Act exchanges. There have been studies on teen pregnancy prevention that have been canceled. There's an agency wide review on fetal tissue research. And I've talked to officials political appointees career staffers who've said there's a there's a war at times between being pro-life and being pro science. Do you share those concerns, and if not do you understand why staff would have them? Well, I think with respect to the FBI look at the FDA, and I'm not I'm not following all the headlines that you are on all these other issues. I think with. Respect to the FDA. We've been very consistent and adherence to good science based decision making. I think my interactions with people in his administration have demonstrated not only an appreciation for the importance of that principle, but in a preoccupation for the unique mission of FDA. And I think impart why I've, you know, believed that I've been able to advance a robust policy agenda cross a lot of different areas that I believe is public health minded, advancing, you know, initiatives and programs that are gonna have a public health impact. Like what we've done on tobacco. Like what we've been able to do with respect to some of the changes made terms of how we regulate opioid drugs is because there's people in key positions of this administration, including secretaries are whoever deep understanding of FDA deep respect for its mission a deep respect for the science based decision making at the agency. And the secretary has been exceedingly supportive of the agency an exceedingly supportive of my Bill. To make independent decisions, you know, working with the professionals at at the FDA, and is one of the things I think I talked about the last time we spoke and one of the lessons. I learned when I work with Mark McClellan Moi's that it's very important that the the decision making and the ideas come out of the career staff FDA is not an agency where you can engage in top down policymaking where I can sit in my office with a Kabbalah people writing guidances and policy documents and try to impose it on on the, you know, the workings of the agency my job is to set out, you know, broad goals parameters public health goals that we're I think we should be investing our time try to get those resource, but the ideas in terms of how we're going to achieve them half to come from the professional staff, and it's my my job to work to make sure they get implemented. There was a recent survey by the union of concerned scientists that under the Trump administration many government science. Tests have been unhappy at places like EPA that is not the case FDA if anything happiness has been up under under your leadership one concern that some scientists have brought up to me is what the president has said at times about vaccines. You've been an unflagging champion Commissioner of the value vaccines. President Trump at times as questioned the Rafic ac- before being elected after being elected floated the idea of of vaccine safety commission. Have you ever spoken with the president about vaccines? I have not what would you tell him while I continue to speak privately about the things. I speak publicly. I don't think that my advice, privately is private and private is any different than my advice in public. I, you know, support support the role of vaccines. I think it's one of the greatest public health achievements of of humankind. Our ability to develop vaccines for vexing infectious diseases. I think that the, you know, the high vaccination rates that we've been able to achieve historically against pediatric diseases in particular have been one of the profound chievements of of modern. Medicine and to see those those gains reversed by fears that I don't think grounded in science and am talking particularly about some of the criticism around the MR vaccine would receive vaccination rates declining. And we see local communities putting in place ordinances allow people to choose not to vaccinate the kids on rationale that doesn't comport with science doesn't doesn't isn't directly related to health concerns. Those are all deeply concerning to me, and you know, out continue to be outspoken, and and trying to promote higher vaccination rates and trying to continue to support, you know, the safety of vaccines and regulatory process that overseas at one of, you know, one of the things that I think I can do to try to affect this debate is just to reassure people that we are aggressive in continuing to look at the safety net. See vaccines, and when we we learned something we make it known publicly, no products completely safe. There are side effects associated with vaccines. They're very rare. But there there are side effects. We need to speak honestly about that. Since we're talking about the president. I wanna talk about some of his other priorities that bring in your agency fighting the opioid crisis and this month. You teased a new approach to proving some opioid medications. Can you be more specific about the timeframe and the details of what that approach will declare? We're going to announce a public meeting very soon where where it's going to be sort of the first step towards trying to develop that framework and gather public input on what that would look like. And you know, this is a regulatory process takes time to unfold, you would have we we're gonna start it with a part fifteen hearing and put out a series of questions and open a dock and try to gather information. But the essence of it is that you know, we we've had criticism around the approval of selected opioids, and you've covered some of those criticisms, I think that underlying those criticisms isn't a question of whether this drug should have been approved of that drugs should have been approved. I think that what underlies those concerns our concerns from people who say in the throes of an opioid epidemic a massive opiates epidemic. Why do we need yet? Another opioid drug and is this drug going to be differentiated in some way that is going to provide additional public health benefits on top of all the available therapy. Or is it just another drug that could lead to addiction and abuse and misuse now setting that said supply doesn't create demand simply having more opioid drugs on the market isn't going to create more addiction. But if you have more opioid drugs on the market that have that a more likable or have more potential for abuse misuse that could drive more more addiction. But I think we have an obligation from public health standpoint to tackle the underlying question of should we have more opioid drugs. And if so what should the standard be and what I've proposed is asking the question of whether or not we should have a public health standard around the approval of new opioids where when we approve an opioid. We're looking at it against the overall therapeutic or Metareum and asking the question whether or not is differentiated providing some additional benefit over the existing drugs or whether or not it has a risk of. Being misused or abused a diverted because of the features that drug but looking at it in the context, not just that individual approval, which is generally how we look at drugs. Now, we look at an opioid drug against itself. But looking at it against all the other drugs within the category, and whether or not it's going to have a role in the overall therapeutic approach to the treatment of pain. That's a much different approach. That's a different standard Fowley would look at this. But I think congress has told us they want us to be thinking about opioid approval and controlled substances in a different way, the controlled substances act is the clearest expression from congress that they want. They want agencies to be thinking about the approval of these products differently. And we've got formation of that in a recently enacted opioid legislation with congress gave us a very specific set of authorities on how they want us thinking about opioid drug approvals that don't apply to any other therapy class. So I think we have an obligation to try to tackle this question. Head on. I don't wanna be having these debates in the context of this approval and that approval and people criticizing the individual drug approvals. What I wanna do is. Have an open honest debate about what I think is the underlying question is why another opioid drug in a setting of an addiction crisis shifting from opioids to drug pricing. It's been about four months since secretaries are recommended that you form a working group on drug importation industry groups have been resistant to this idea. Some Republicans have been critical like Orrin Hatch. Also seems like HHS hasn't been especially enthusiastic about this idea. Is that wrong? Well, I don't I'm not tracking all the criticism. You probably have a better handle on that in terms of what you hearing. Then then may we are we are moving forward with trying to look at a framework on how he would do this. Remember, this this applies to off patent off exclusivity drugs that are in that are so source drugs where they don't face competition where you have a price increase that creates an access dislocation that that forestalls access for certain patients. So we are looking for Justice summarize what you just said it's a very narrow. It's an it's a narrow. It's a narrow set of circumstances where? You have a drug that's off patent where there's something that happens in the market with respect to the price that makes it harder for patients who need the drug to get access to it. So there was a there is a bottom line public health concern in the setting of where we would employ this, and we are actively working through what that framework, look like how we would do it how we would make the legal certification to operationalize it on how we would apply a rationale to look at the drugs that we would seek to import in a very closed fashion. So we can ensure end to end the end to end integrity of the drug as it comes into the United States. This would not be free for all importation. This would be a closed system would be working with an intermediary to import the drug to make sure that we can secure the supply chain as the drug moves from a foreign market here. But look at the same time that I've done this. I've also put forward policies to try to create a global globally harmonized approval process for generic drugs to make it easier for generic drug companies to file what will hopefully eventually be a global applications. So if you're a European if you're a small European generic manufacturer, and you're manufacturing in in France, we wanna make it easy for you to follow the same application to US and bring that drug into the US market that I think will be hopefully in the long run a bigger opportunity to get more competition into this market than trying to do, you know, one off import Titian when these situations arise I want to prevent the situations where we have these sort of sole source drugs where you can have a speculator come in and take a big price increase and try to play. What I say what I call regulatory arbitrage hoping that they can sustain the price in the market long enough to return a profit before we can approve the next generic drug and bring in competition. So understanding that those are goals. I still don't think that there's been a lot of public information here, can you share who the members of the working group are for instance, who are working with the leadership of HHS. And you know, we're pretty far along. I think that we're we're pretty far along in mapping out. What the what the framework would look like, I can't give you a timeframe in terms of when we would, you know? Bounce a final framework when we might seek to import drug, but in terms of working through the the mechanics of how this would work what the legal issues are we've been spending a lot of time on this. You know, it seems like a long time to you from the date that we initially announced this two now, and I forget when we announced bobbly three or four months ago, but in July nineteen July, but in terms of government on top of your head. The. Terms of government policy making working through, you know, difficult issues. That's not a time. You know, these things do take time to put in place, and as a reason why they should take time because we're changing policy, and we want to be delivered about it. We need to be careful. I mean FDA is a is a complex agency with a complex statute. And there's a lot of implications. If we get something wrong in terms of the public health. Your time is precious. So I'd like to close this podcast with a lightning round of questions. Quick answers. If that's okay, I'll try to be as brief as I can be. It's a mandate. Secretary as ours said, I think he he's said this directly to reporters before that every time he talks to President Trump the president asks about drug pricing. Is there something that the president always brings up with you? You know, I I don't have as many opportunity to talk to the president. When I do it's usually about specific issues. And so the the the handful of opportunities that I've had time to be in the Oval Office and speak with the president's usually been the concepts and briefing among something very specific. What's the public health issue that you wish reporter like me spent more time writing about? That's a good question. I think nutrition I think that the stuff that we're doing on the food side of our house and with respect to trying to promote trying to reduce the burden of chronic disease through through better nutrition, sometimes gets shorter shrift. I think the the food policy has a profound impact on public health. You know, if we can have we can have small public health gains on an individual basis through our food policy. The the sort of distributed impact of that once you aggregate it over the entire population is enormous will here you go. Here's a nutrition question much of the nutrition work that you have pursued has been in line with what the Obama administration wanted to do in some ways, you even gone further with the consumer education. For instance, do you think a democratic house will give you more backup on the nutrition changes that you wanna see well, I haven't had any challenges implementing the policies that we've pursued. I mean, we we inherited a set of statute and and policies that would mid. Stream from the prior administration. We follow through a net. We felt that. There was strong public health rationale for the new nutrition facts label for menu labeling, and so we've continued to implement those policies and we've been able to fully implement those policies. I think now what I'm doing is looking at what is the next set of nutrition policies. You saw has put out nutrition plan our action plan about six months ago, and that encompassed a lot of the things that we want to do both individual policies as well as the medically where you're going to see more policies from us trying to use labelling trying to use information that we would make available to consumers as a way to help reduce the overall burden of chronic disease. So there's more that we want to do. But I can't say that. I've I feel that I've been impeded impede it in any way in terms of achieving what I wanna do on attrition agenda. Reporters like me spend, a lot of time focusing on you secretary as our administrator Verma who's the government health official that we should be giving more of the spotlight to well. When I think of when I. Think of FDA an an and I think about FDA a lot. I think that the the folks who really make things happen that are very important to the agency. Everyone is important to the agency and went you when you walk through the agency, and you look at division, directors and medical reviewers. They're the ones who are making things happen on day to day. But I think the center directors really are the senior experts there might chief scientists I I make sure that I meet with them each one individually every week and those interactions or where the policy gets done. Those are the hours that I enjoy the most every week of someone who said what's the best part of the job. It's meeting with the Senator actors they are experts in their field. And I think that's sometimes not fully recognized how impactful they are. So I should interview interview and investigate the Senator actors got it. Well, you kind of you them and speak to them nicely and ask them respectful questions. You don't need to investigate them. I always ask respectful. Nice questions. Here's a version of a question. I've heard asked of your female colleagues how do you balance being a working dad with the job of being FDA Commissioner, it's very hard. I'm away from my family during the weekend. It's very hard so hard as part of the job is is the fact that I'm away from my family, and even when I'm home on weekends. You know, I spent one whole day working. So I don't think I'm balancing very, well, did you balance it better in some way? Given the demands of this job. It's hard these twenty four seven jobs, and I think I think, unfortunately, that's the only way to do these jobs. Well, there's going to be a new planned community next door to FDA. I saw you with the groundbreaking. I watch video of you with Maryland governor, Larry HOGAN, could you buy a home in that next community that community will be fully erected? I think in sometime like twenty twenty five. So I'm not making long-term plans out that far. Last question when I sat down with CMS administrator Andy Slavic at the time in two thousand sixteen I think it was the first episode of this podcast. He made a comment like I need to do something on drug pricing. If I don't the next guy who comes in the next person who comes in. We'll say what the heck was slab thinking, what is the thing that you need to accomplish that if the next FDA Commissioner comes in and it hasn't been done. You will feel like the work was unfinished. Well, look, I feel good about what we're doing our job in the pro drug pricing debate is to try to bring more product competition to the market. I feel like we're doing that successfully. In terms of the reforms will make making the generic drug side. I think there is there is not as much recognition as the obstacles that branded companies face bringing follow on innovation to the market and some of these these drugs targeting on medical needs. We you see companies maintaining monopolies for longer periods of time and sometimes in perpetuity for drugs targeting unmet, medical needs, and that lack of competition against branded drugs is maintaining higher prices for long appear. As of time we have data demonstrating this. Now, I'm gonna be publishing a study that we did our own analysis showing that when we look at a cohort or drugs from the early two thousands to the current cohort of drugs over five or ten year period is taking much longer to get the second and third to market drug to the market now than it did ten years ago, and there's reasons for that. And I think there's things we can do to address it. But if that if that trend continues, and if you see venture capitalists and companies pulling out of the market, if they don't think that they can be first to market we're going to have significant challenges going forward, keeping these drugs affordable. The other thing that I'm going to be focused on in two thousand nineteen is looking at ways to try to improve the overall economics of generic drug development. I think that that industry is facing some pressures a lot of more commercial pressures that we can't affect. But I think some of them are regulatory. I think the multiple cycles of review are very costly to the industry. I think there's things we can do to make it less expensive and more efficient to file generic applications and get more generic companies into the space. See more competition, and we're going to be very focused on some of those reforms also making high value opportunities available to share companies that means you know, what we can do in biosimilars what we can do on drugs that have Rhames associated with them. What we can do in hard to formulate drugs to make it easier to genera size those drugs. Well, that's a lot of stuff to finish. No wonder you're working sixty's a week. Really could be working seven. But we will let you get back to your work. Commissioner Scott Gottlieb. Thank you for joining politico. Bolster thanks for having me. That's it for pulse. Check this week. My thanks to Commissioner, Scott Gottlieb and his team for making time and space for this interview. And my colleagues are over mall for making her long way to debut on politico. Pulse. Check as always thanks to producer Mikhail Rodriguez for touting her equipment. Enter time all over Washington DC on Thursday, confined pulse. Check on all of your favorite podcasts players. Can find me at Di diamond politico dot com, and you can find a new episode of pulse. Check coming to you very soon.

FDA nicotine FDA congress Commissioner Commissioner Scott Gottlieb secretary president reporter HHS politico editor United States Sarah Altria Dan diamond Altria Troy
Special Episode: Scott Gottlieb, MD [206]

The Editors

00:00 sec | 7 months ago

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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Exit interview: FDA Commissioner Scott Gottlieb

POLITICO's Pulse Check

30:04 min | 1 year ago

Exit interview: FDA Commissioner Scott Gottlieb

"I come before. You today humbled by the realization that the lives and futures are families like minor affected by the decisions made by FDA. Should you? Choose to confirm me, I'll make it my mission to fight for those families every single day and ensure that the FDA puts their interests first in everything we do. I'm Dan diamond this pulse. Check. And that was Scott Gottlieb testifying in April twenty seventeen about why he wanted to be FDA Commissioner two years later as godly prepares to leave the agency. How has the reality of running FDA compared to his early goals on Wednesday? I watched the Commissioner's office to ask him as part of a wide ranging conversation about his priorities legacy and unfinished business, you know, when you're at a think tank looking at things in the abstract is very different than when you're running regulatory agency, and you have public health obligations, you'll hear from God leave in a moment. But just reminder that if you like political pulse Jack new can help us by rating, reviewing the show on your favorite podcast app. Just search for politico Halse check, he should also check the show notes where we linked to stories previous episodes with Commissioner God lead and other items that we reference. During the conversation. And now, let's get to that conversation with Commissioner. Scott Gottlieb Commissioner Scott Gottlieb. Welcome back to politico. Pulse. Check. Thanks for having me. We weren't expecting you back. So soon the secret to cut the line is just to announce it your resigning it worked here. You are one of your colleagues. I was asking around trying to figure out what what to ask you today. One of your colleagues said I should ask if you don't love America anymore. If that's why you're leaving the FDA feel free to weigh in on that sometimes, you know, sometimes a pipe just a pipe. And you know, the reason I'm leaving the reason I gave this got really difficult commuting from Connecticut and being away from my family, basically for two straight years. So my kids on Saturday, but you know, it'd be home late Friday night. And I'd be back in Washington Sunday and mostly working all day Sunday. So two years of that with with three young kids got hard reporters. Like me, my colleague, Sara Carl Smith's are over m-. All others have been. Trying to figure out the reasons behind your departure. Do you understand why that has been such a source of curiosity? I don't understand why has been source of curiosity. You know, obviously, I love this job. And I'm very unhappy leave it I would have liked to have done for longer. And it was a difficult decision in the week after I resigned motionless. It was very difficult. I was thinking whole week. What did I do was this right decision? But you know, I've been in two years, and I worked this job one hundred and fifty percent, I think that that was largely apparent to people on the outside. This was really a twenty four seven job. I I didn't work from home Fridays. I was home late Friday night again, which spent part of Saturday with my kids. Go out my wife, Saturday night and Sunday be back at work two straight years that difficult. I think in retrospect had had I do it over again. I would have moved my family down here at the outset. But I didn't speaking on behalf of journalists. I think one reason it is such a source of curiosity is there. It could be a reason that you're leaving that could be of interest to the American people, for instance, if you push too hard on tobacco, and that was an issue or if the White House had a different vision for the FDA that would seem to be of interest to well on the tobacco. I understand the proximity of when I announced on that Tuesday versus there was reports that I had been at the White House that Friday a briefing on tobacco meeting. But the reality is, you know, there was always going to be something immediately before I resigned and something coming up immediately after I resigned as always things happening here every week. I think with respect to the tobacco issue in particular. I would hope we put that to rest with the announcement made last week where not only did weed Vance a policy that we intended to. But you know, we got strong support the secretary put out a statement. I had a White House fact sheet issued the White House press secretary re tweeted some of the statements Kellyanne Conway over the weekend re tweeted some of these statements with respect to that that announcement you had to chief-of-staff, Mick Mulvaney and had. Domestic policy council. Joe Rogan both affirming that there was going to be steps taken to address a youth the youth addiction to to nicotine in e cigarettes and additional tobacco relation coming. So I think the strong statements and the administration which we would have had regardless. But I would think that's strong. That's strong statement from the administration, in fact that we got that policy out in time for him that we that we intended to would would put those rumors to rest vaping has been a major subject of of your tenure. It has been something you've weighed in on quite a bit. I don't want to spend too much time on it. But the Washington Times a conservative paper has an editorial today Wednesday morning saying that your resignation quote comes at just the right time. And they specifically criticize you for pushing vaping regulations and suggest you became an quote avenging angel for the nanny state with the Scott Gottlieb of three years ago who worked for conservative thinktanks like a and argued against regulations from the FDA with that Scott Gottlieb have recognized the description of Commissioner Gottlieb or remember the. Golly of two years ago. Probably always a recipient of editor Oriels. I mean in the Washington Times that applauded me for pushing off the application deadlines on on the electric cigarette products to allow them time to come through an appropriate series of regulatory gates at the time that we propose to regulate nicotine and combustible cigarettes to render the minimally not addictive with vision that we would be able to more more rapidly migrate adult smokers off of traditional cigarettes onto modified risk products like e cigarettes, potentially which would pose far less health risks. That was the vision we embraced it that was out plan. But what changed our mind was when Mitch Zeller the head of the tobacco center came into my office on August thirty first twenty eighteen with data from the twenty eighteen nationality tobacco surveys showing epidemic use of e cigarettes. And they just want to jump in. Because you've you've said some of these things about the vaping strategy before. I am curious about is Scott. Golly. The regulator versus galley booze outside the FDA thinking that this agency was doing too much for exam. Apple response letters to drug companies when when drug companies would apply and have their approvals turned down. When you read you argued that those response letters should be public now that you're Commissioner those letters mean separate issue. I mean, I still I still would argue that there should be more transparency where we can have more transparency. I think the Scott Gottlieb who's running a regulatory agency needs to weigh how I allocate agency resources against public health considerations. And ask is trying to increase transparency around complete response is the best use of the public. They've finite public health resources. I have whether it's the lawyers or the people in cedar who would have to redact those letters. And that was the that was distrustful that we had internally. You know, when you're at a think tank looking at things in the abstract is very different than when you're running a regulatory agency, and you have public health obligations, and what what I had to make decisions against first and foremost, my public health applications, I don't have the luxury in these jobs of thinking about things in an abstract fashion. All the time you have set of obligations, and you need to carry out the mission of the agency, and I feel very comfortable that we made decisions against a good set of public health considerations. And did what was right through multiple settings and multiple tough decisions. So Scott leave on the outside looking in a wrong, Scott, golly. Bunny outside riding up as at the American Enterprise Institute, which were largely consistent with you know, my how I executed the mission on the inside. And I'm proud of proud of the eight hundred articles that I wrote on the outside. They only know that number because his Senate managed to pull them all during my confirmation process. But as you're very prolific colleagues to shame for your productivity. But you know, there's a lot of difficult practical considerations on the inside. That don't always just hue to a particular sort of regulatory ideal ideology, they have they important public health considerations. And things that this agency has to do to protect consumers that sometimes put us in places where we are. Yes. We are impacting competition. We are impacting the free flow of information all the things that as a conservative you want to you want to try to promote you try to there's sometimes a hard balancing against public health considerations. Speaking of communications tragedy from the day, you were confirmed to today FDA put out press announcements on virtually everything hand sanitizer, heart valves, milk cheese. Do you want to guess how many press announcements FDA put out under your tenure? I would suspect us a little more than one a day. It's exactly that it's four hundred eighty one. I think you've been in seat about four hundred and sixty five days not counting weekend or government holidays that's much faster than the Obama administration. Why was that a focus of your time? Here what was the strategy behind being? So proactive not just with press announcements. But you're doing interviews with me other folks, you're you're always available. What was the rationale? Why think that can -cations policy communications is a very important part of effective policymaking. I think that you know, it's not just that we have to explain what we're doing very clearly so people understand what the goals are of the agency. But I think in order to advance the policy it's very clear that people have a they accurate vision of what we're trying to achieve so we can get broad consensus. Brought by and and so that was the goal. I mean that was really the the thinking behind trying to be communicative trying to put out very clear statements around the rules. We put out the guidance we put out so people understood what what the vision was. And how the different things that we were doing fit into a broader public health vision. Why don't more Trump officials follow yearly? Well, I think there are agencies that do, you know, part of it is that it's a it's resource intensive in its time. Intensive I would spend my Sundays probably clearing between six and twelve documents and writing some of those documents writing so on my own speeches, you know, drafting statements. This was a extremely resource intensive endeavour not just for me. But but for the entire staff here, our office of media fares people in the senators who drafted some these statements, but I think, you know, looking back I think it didn't able us to advance things in a way that allowed them to be enduring you've kind of become known as the tobacco Commissioner, not only. Have there been all these actions? You just referenced this has been a major focus of press attention. I'm curious when we look back at your tenure at FDA. What do you think your major accomplishment was on medical devices? Well, look, I think with spectra medical devices. I think it's, you know, taking a fresh look at the five ten k approval process and looking to modernize that and reeducate how we. How we look at the product process. Trying to way I see the five ten K processes. It's very backward. Looking you know, people who are bringing new devices forward to try to try and find predicates to compare the devices to constantly looking back at old predicates? And I think we need to have a forward-looking process with people have the potential to create new predicates through the D-I-N-O-V-I-T-E process, which we try to create more efficiencies around creating going through the D-I-N-O-V-I-T-E process as well as reeducate some of the old predicates. And so we started down a path of creating a policy framework that could allow the agency to reeducate some of the existing predicates. I think that conceptually is a very important sort of policy advanced to step into I think more discreetly in terms of discrete policy reforms I would point to some of the things we did on digital health where we move towards a whole different paradigm of regulation moving towards a firm based approach. I think that that kind of frameworks going to going to be something that we can use an other other context of of. New technology. And then in terms of the unfinished business the stuff that we opened the door to. But but remains unfinished I would point to the legislation trying to look towards a modern framework for in vitro diagnostics, the IV C T legislation, which we obviously advanced substantive ta to the hill, and that will that will continue to move forward on Capitol Hill. I had a call today about it. With some members of congress have some meetings about it. That's one of the things I wanna take a little bit further before before I leave this giant in the two weeks. You have to have left. You just went through a number of different priorities. Both things that you're working on things that might have been finished. I wanna take those apart as as much as we can in our time getting back to device safety. There have been a lot of questions about device safety in your time here at FDA some driven by investigative journalism. Documentaries. Some your own statements to it does seem like there's a new development every week with device safety. What what does he need to do in the next few years specifically after you are gonna make sure that devices are safer? Well, I think I think. Vices are safe. And I think the process is very rigorous. A lot of the questions have surrounded a small subset of devices. Will we frankly have taken significant action when you look at Eastshore shore? We that product is effectively been taken off the market. We took a strong action against certain other women's health devices. You know, I think that the the device review process is rigorous overall. I think with the questions have been historically, and this is over a long period time is around five ten K process and people people from the outside looking in believing that devices should be regulated like drugs and everything should be a PM application devices should go through you know, randomize perspectively randomized placebo controlled trials. There's reason why we don't do that, you know devices. The device statute itself is a much more modern statute that allows us to adjust our level of regulatory touch to be commensurate with the risk of the device. Not every device proposes same kinds of risks page. And implantable device could be much more risky than, you know, at a device at just a tool in the hands of a physician being used to help assist them surgery. So the five ten K process allows us to regulate lower risk devices differently than we would regulate higher risk devices. I think if you look at what's happened over time and even the time period, I've been here the five ten case gotten much more complex, the the length of five ten case has grown significantly. There's much more clinical data and five ten K. So I think the process over time has gotten more rigorous, but the fundamental architecture of the device review process where we have this more titrate approach that allows us to adjust our level of regulatory touch to the perceived risk of the device with known risk the device, I think is fundamentally sound. But when you say, you know, devices device safety has been under assault over period time. I know this weren't your exact words. I those words I think which really being criticized is the the framework and people who who are arguing this is what I hear that, you know, certain devices shouldn't be going through a process like the five ten k. Process that's much longer debate. And I think fundamentally that process is very sound. The FDA's budget proposal does seek to left a provisionally approved devices. So essentially moving devices to market with less data. How do you reconcile that with this focus on device safe while the the the budget proposal builds in number things, and I think one of the most fundamental things in in what we didn't a budget. What we've done even administratively, and we've allocated more resources from my office to this function is trying to move towards a more active surveillance system when it comes to medical devices. And so this is another paradigm change in terms of how the agency looks at device safety where the the long term goal, and we got money in twenty twenty budget for this. We also got money in the twenty nineteen budget. So it's actually been appropriated as well. As some money, we've been we've Riach allocated internally to try to move towards a system where we use data derived from traffic health records to engage in more active surveillance of medical devices in the post market, we've never had that capability anywhere. Really in the agency. We have it a little bit in a central system when it comes to drugs, but mostly we use claims data to do retrospective analyses of safety questions, particularly on the drug side. We've never really been able to move towards more active surveillance system using HR date. I think the first place it we're gonna fundamentally be able to do that on a broad basis is going to be in the device space. And this is really the vision of what we've been trying to do with respect to with respect to device safety the goal in two thousand twenty budget proposal, we put voters to get ten million lives. EH our lives into a database. I would allow us to do active surveillance in the post market, you mentioned digital health at it seems difficult to regulate this field because in many cases to harm to patients might not be clear. I normally wear an apple watch. It took it off because it was interfering with the microphone that I'm speaking into. But that apple watch has engaged Bilton. And I think the worst thing that can happen as it gives me falls data about my heart rate that's different than say contaminated lettuce or a drug that's linked with. He shouldn't deaths. Do you worry about the the products getting ahead of the evidence when it comes to some of these very hyped digital health innovation? I think you're not when you say the worst thing that can happen is the watch can give you false data. That's the worst thing that can happen dot com report an outcome. That's not actually occurring. I think what what what you hear people expressing angst about more often, isn't what you just said. But, but but people worrying that the devices are going to be able to report data that might not have clinical significance. Make it would reporter, you know, proximal fibs, so an intermittent arrhythmia that might not be clinically significant. But you actually had the arrhythmia my view is that if device can otherwise report information that could be actionable could help inform you about your health could help prompt you to see a physician we as regulators should earn aside of trying to allow patients to have access to tools, otherwise inform them as long as it's informing them accurately. It's not up to us to decide whether or not that information is immediately actionable whether or not. The patients should should it shouldn't have access to it. That's the decision to be made by the patient by the provider. But if a tools as long as the tools, providing reliable information accurate information, if a if a patient wants an information, I think they should have access to it. And the other thing I would say also is that if you look at the history of digital tools, more broadly and lets about from digital health tools, but just digital tools. More broadly. The use cases have always evolved over time. In tools have been introduced with a with with us one use for them when one use case, but what we've seen is once they were available application, developers others came along and figured out other app. Other ways to use these tools once they got into the hands of consumers and once enough consumers had them that. There was a business case to be made think of the think of the camera in the back of your phone when that was I put it in the back of your phone. It was a camera now it's a sensor now shoes for all different kinds of functions. I think you're gonna see the same thing with digital health tools, which is once we are able to. Create a framework with these come onto the market for one specific use people are going to create applications that once the hardware is in the hands of consumers that are going to have much broader set of uses, and that's gonna create a create a whole new set of opportunities. But if we withhold these digital hell, tools, these these hardware platforms until all the use cases of worked out. I don't think you're ever going to see the investment in the kind of software that can unlock the full capabilities of these tools. I'm trying to use the time. I have with you to run down the list of priorities. A you yourself have established going back to your first speech to FDA in may of twenty seventeen in your opening remarks. You said quote, our greatest immediate challenge is the problem of opioid abuse. And yet a few months ago FDA approved Subbiah a synthetic opioid hundreds of times more powerful than morphine. Why approve this powerful new drug amid an opioid couple things with with the Suva. I mean, the headline is that it's one hundred times more powerful than morphine actually what to SUV. Is is it's a very small amount of a powerful of formulation of of an opioid. And the reason why you'd want to formulate something like that is because it's designed for sub will administration it's designed to allow the opioid to be put under the tongue and get in the blood very quickly. And if you took a a less potent opioid and designed it for that purpose, it would be a very large pill, and it would never be absorbed. And so the only way to create something that could get absorbed quickly into the blood through sub lingual administration would be to use something that was very potent. But it's actually an amount of opioid that's quivalent to fifteen milligrams of morphine, which isn't a trivial amount of morphine. But it's an amount of morphine NAT is commonly prescribed in emergency situations for someone who might need a bedside procedure, for example. And I've been in many situations as a physician, you know, where I've been bedside with a patient where I needed to do an emerging procedure you think of a place in a test tube where you couldn't get IV access. And so you couldn't administer intravenous. Pain sedate sedation in that setting and having a sub lingual administration that could provide enough analgesic in that setting could could could be life, saving the other thing to remember what the Suva is. You know, this was on. I talked about the time we did enter into you know, an arrangement with the Pentagon we committed to prioritize products that they felt were priority products for the battlefield and four frontline soldiers and their priority. Lists isn't thirty products. It's not fifty products. It's about ten and the movie was one of them. And we we worked out that arrangement as, you know, a compromise for an effort that was underway to try to strip FDA all authority to approve products that were intended for frontline show soldiers for the battlefield because we felt that it was important to have FDA review products intended, for the battlefield what we committed to do was give products that they prioritize which is a small list breakthrough like Thai. Touch within the agency. So there was a there was an imperative with respect to disprove that did factor into how the agency at least the process by which it was developed not by which was reviewed and non how we assess for specific. But certainly the process which was developed. I think the larger question though, it to SUV, and I said this at the time, and I'm going to be saying this again before I leave isn't the question of disprove per se. I think these questions come up with the respect to every time we approve a new opioid. That's you know, perceived as powerful which is and it's a fair question. Which is why is FDA proving another opioid your yet another opioid that has the potential to be diverted in abusing the setting of an opioid crisis. And that's a reasonable question. And it's a question of whether or not we should have a comparative superiority standard when it comes to the approval of new opiates. I think we need to address that question. I don't I don't like addressing the question litigating it in context of individual proves, I think it's a broad policy question that we ought to consider wholesale. And we are considering it and considering whether or not the agency needs. Different authorities when it comes to opioids to put in place, some kind of comparative superiority standard to say that if new opioids coming to the market that has the potential diversion abuse. Should it be differentiated in a way that is offering some advantage over the existing therapeutic or material? And I would I would argue that if we had such a standard to SUV, you would probably meet it because it is differentiated way can be used in clinical settings where other drugs aren't available. But we should we should ask the question, and a broader setting the last thing, I'll say, and you open the door to I'll just say it the issue of whether or not Subbiah is a drug that could be abused. It does have risks associated with it. It does have a risk of diversion and abused. But I think it's a risk that is gonna be significantly mitigated in terms of how this drug is administered where it's administered the risk really is a risk of diversion by healthcare professionals because it's drugs going to be administered in inpatient settings. It's going to be tightly controlled and pick systems. That's how it's going to be delivered in inside a healthcare. Setting. And so the risk. You worry about is will healthcare professionals try to divert it in no settings and abuse it and we've seen that that does happen happens much less. Now there's much tighter controls, but it does happen. But that's really the risk you talking about. I think the way this was portrayed. Somehow this drug is going to be available. You know, lock prescribed an outpatient settings by general practitioners, and it's going to become a street drug or a choice drug of abuse. You're talking about there's a risk of diversion and abuse here. But it's narrow this administration pushed the right to try Bill, which led patients, essentially, go around FDA to get on approved drugs is roundly opposed by cancer organizations, HHS curling conducting a review of its fetal tissue research scientific organizations. Don't like that either before he came into office. This president was allowed critic at times of vaccinations, you're seen as a champion of science. What would you say to the general public and to staff who are concerned about your departure in the feet of science administration? Why think? That this this agency has been very rigorous in terms of how we've approached public health issues. I think we have affirmed the importance of science based decision making. I don't see any departure from how this agency makes decisions, you know, when I would obviously quibble with your underlying sort of statement and assumption upfront, but which part all the parts, but just in terms of just in terms of looking at FDA, I'm very confident in the process that's underway here in and, you know, the the decision making process in FDA isn't just sort of consequence and the result of things that I did over the last two years. It's the consequence of what how this agency has gone about its work over decades. And I think this agency the rigor by which we make decisions the importance of the decisions we make the way they impact people's lives. I think that we we have really infirm d- over a long period of time the importance of science based decision making in regulation and policy thinking about. Who's taking over for you Ned sharp less head of the National Cancer Institute. Why pick him as your successor as far as I know. He's never worked in FDA. You had a track record here before you came back. He's only been in government about a year and a half. What did you see in Dr sharp us? Well, I didn't pick them. The secretary did secretary as secret that you favor him. Well, I I made no secret that that I think he's highly capable and very competent. I think he has a very good ethic to be running this agency. And so why why do I like net because I've worked with him because I think he's a deeply public health minded because I think he understands the mission of the agency he's done work with FDA. He plays basketball with FDA reviewers. And I think is underlying ethic and is underlying approach to public health issues is very consistent with with the way this agency thinks about its mission. We've talked about your priorities. What would you have started? If you had been here for say another year started more recently. That's interesting. It's an interesting question. I think that a lot of what we a lot of what we did really reflect the things that I came in thinking about the things I got generated during during the time that I was here. I think some of the things that I might have pushed on that. I was looking at doing were some things around food safety where we were looking at implementing brought in Frank Janas, the head of food safety at at WalMart. And we are looking at technology that will allow the agency think differently about how it does track and trace with respect to the food supply chain and produce in particular, those are things that will get underway that I haven't been long enough to to get started. There's a couple of other things like that that are in process. I want to leave some some of that work for you know, Dr shoplift make decision whether whether and how he takes him forward. The other thing that I I would have liked to pushed further along were the implementation of some of the authorities that we got under the support act where we got we worked on over very long time and got some substantially with Ari's with respect to dealing with yoga. Crisis. And I won't be here to see all goes through and get implemented. But I'm very confident they will be for example, the one that probably going to narrowly miss the opportunity to announce that was very important to me was requiring the immediately so points to be put in blister packs. I think that fundamentally changes how providers prescribe I are formulations of opioids like vicodin and Percocet requiring them to be in one or two day ballista backs. It's gonna push much more the prescribing towards one or two day dispensing as opposed to a bottle of thirty pills that will get out. That's certainly going to get out. But I worked very hard on out. And who would like to have been here to get through the finish line? Last question. You did two separate stints in George W Bush administration. You're right FDA. He left the government you came back. What are the odds? The you will come back to government serve Halley that to you at side. That's your your life your career. Look, I would love an opportunity to serve in the government. I don't know. I don't know whether that will come to fruition. I think every time I've stepped out of one of these jobs. I accept the fact that might be my last time in the government and that last time, I I left the role as deputy Commissioner I said to myself, this is the best job I'm gonna ever have. And I might never be back in the government. I needed to make a decision to do that for personal reasons. The time I was undergoing treatment for cancer. I've had that conversation with myself in my in my head this time again that I'm walking away from you know, a tremendous opportunity, perhaps the best job will ever have. And it may be my last job in the government. Well, we will see we will see you around. Hopefully, thank he's gonna Gottlieb. That's it for pulse. Check this week. My thanks to Doug Andreas. And of course, Commissioner Scott Gottlieb at FDA for time for the interview as well as Jenny meant and Sarah Carlin Smith at politico for making this conversation happen to if you like politico pulse. Check helpless by rating, reviewing the show on your favorite podcast app. If you have suggestions for future episodes. Find me I'm a diamond politico dot com by Email and you'll find a new episode of politico pulse. Check in your podcast player next week.

FDA Commissioner Scott Gottlieb Commissioner Washington Times Washington Apple nicotine America Connecticut Dan diamond opioid abuse Sara Carl Smith Jack secretary Joe Rogan American Enterprise Institute politico White House
Coronavirus: One-on-one with Scott Gottlieb

POLITICO's Pulse Check

00:00 sec | 7 months ago

Coronavirus: One-on-one with Scott Gottlieb

"Hello Paul Scheck listers. This is Dan Diamond and welcome to our special pulse. Check series on the corona virus outbreak. Today I'm talking with Scott Golly but the former head of the food and Drug Administration. Who's been one of the influential figures advising the trump administration on its corona virus response from the outside? Dr Gotlib began warning on the corona virus outbreak in January as the virus spread and one the rest of China before most Americans had even realized the potential threat now. He Dispenses Policy Prescriptions and commentary on twitter MTV while guiding officials behind the scenes. You'll hear our conversation in a moment but first the whole politico newsroom is engaged in our coverage of the corona virus could find that coverage are politico nightly newsletter as well as in the political pulse newsletter that author every morning with Adam Cameron. Now here's my conversation with Dr Scott. Golly so we had talked about doing this person. But you're not in DC. That's right MENA KEG it. Is that the new normal just waiting this out in Connecticut for the next few months while. I'm not sure I'm going to be here the whole time. I'm obviously trying to spend as much time at home in time with my family as well. I don't want to leave them if I can avoid it. But I'LL BE DOWN IN WASHINGTON I've been back and forth a little bit already meetings down in Washington and I think if there's something important that I need to be down there for I'll be heading down. Are you taking steps to protect yourself when you're traveling in the middle of this outbreak? Yeah the last time I flew was Two weeks ago And I was pretty careful. Last two board cleaned my seat You know didn't take anything from the flight attendant Which I think is a mode of transmission nine. You Know Simple. Things used a lot of pure. Al obviously is a lot of things you can do to mitigate your risk. I I believe that a lot. More transfer for this virus is probably through shared services and contaminate services. And that's not to say that there isn't a respiratory transmission. There is but My theory and I haven't been able to get anyone to say. I'm right or wrong on his A lot of colleges but if you perhaps compared this to flew in terms of the transmission of flu whereas flu might be more transmission from respiratory droplets. I suspect that there might be more. Transmission on a relative basis of corona virus through shared services and contaminate services. Otherwise it doesn't it's not easily explained how you can get situations like the conference you had an in in. Massachusetts where single infected individual at biogen conference was able to infect. I believe around seventy people It's not plausible. That a single individual would be in close enough proximity to seventy people at a single conference to transmit something through respiratory droplets in any sort of reasonable setting or reasonable interactions. And so that's certainly suggests that there was some surface got contaminated whether it was a utensil used to share it to to get food or something like that that became a source of the infection and in fact the emerging data shows that the viruses sticky at hangs around surfaces when there are images of the Chinese brain disinfectants in the streets I initially looked at that and Scott it a little bit. Admittedly I thought it was for show. I thought that they were doing that to send a message to the local population that they were taking every possible step now. In retrospect I think that the Chinese might have been onto something and then you might seem more Spraying disinfectants in In shared spaces here in the United States as well in cities like New York where the viruses become epidemic. I do think surfaces are form of transmission. And so I'll I'll pause here The upshot of that is what it means for consumers is that you know the whole idea of cleaning your hands not touching your face wiping down shared services. If you run a business organization I think that could have a big impact here. Debbie burkes on the White House task force certain General Durham Adams and others have also tried to hammer home that point of of shared surfaces. You mentioned New York City and as we speak there's a tragedy unfolding in the big apple. Corona virus cases are surging hospitals already or straining to manage the load. The video and stories are horrifying. I know you were warning. The New York City would be hard hit. Did you expect it? This soon in all Kendra expected it sooner. I was talking privately and a little bit publicly about elmhurst being very worried about her queens having practice there for a number of years and knowing the the population there It's that that's one of the public hospitals elmhurst Queens right and that that hospital has been very hard hit and what was perplexing me in in February. Was that there. I was talking to doctors in Elmhurst and there was no There was no reporting that there were cases showing up that could be consistent with corona virus because I thought that the the initial indication that we had spread in the United States would be a cluster of people showing up with an unexplained respiratory illness. Atypical Pneumonia Air Ds Type Picture Respiratory Distress Syndrome. It at a single hospital that it would take two or three people showing up at a single hospital and being on the critical care ward and in doctors would say this is. Something's going on. They would send off the samples to CDC and we would discover that corona virus circling. That's how I thought that this would unfold out the first stages this would unfold and I felt that elmhurst was very vulnerable city because of the flows of immigrants from areas that were affected particularly China so I thought that that city would be that area would be seated early and it. Wasn't you know it. I was checking with some of the physicians. I knew there and they weren't seeing that they weren't Explained that and now it's exploded and exploded very quickly And so what it suggests. There's different ways. You can postulate what what happened but what it suggests is that there were probably multiple seeds in the New York area that all were sparks that lit fires that burned simultaneously and they all exploded all at once into bonfires. As opposed to a single introduction that formed large cluster Because if you have this much spread right now If it was a single cluster. That was expanding you would have. You should've discovered that. Cluster at an earlier stage but if you had multiple clusters while expanding simultaneously and they all exploded at the same time that might explain the level of spread. You have right now without the sort of early indication that you would've thought would've materialized that stands in contrast to Seattle Seattle appears to be More of a single cluster. Now there's been multiple introductions based on the sequencing work that we've looked at the Trevor Bedford's done out of the Hutch. He's done outstanding work through this whole this whole crisis but the the vast majority of the cases in Seattle seemed to be related to a single cluster and so it was one introduction that then led to thousands of cases. And that's why Seattle you discovered earlier. Perhaps because you were discovering that that expanding cluster through off enough sparks into the hospital to be discoverable earlier as opposed to a lot of clusters all growing simultaneously until they all got big enough to throw off their individual sparks. You mentioned Trevor Bedford. That's scientist who did some of the tracking of the genome in Seattle and has posted that on on twitter. Right New York City. It's close to your heart studied. There you work there. You changed your twitter background to look like that famous. I love New York bumper sticker. How're you doing with this emotionally? I think I'm Grappling with the same things. Everyone else's looking at this This is an unfolding tragedy in New York. It's hard to watch. I know the people at Mount Sinai Well I know a lot of doctors at other parts of the city. I talked to them. in here what's happening and This is Like nothing any anybody's ever seen before who's practicing medicine. Who's alive today? And they're they're overwhelmed. They're overworked. They're personally scared for their own health and safety. They have to go home to families every night. You know that's hard it's it's scary And I think that they are. You know the emotional part of this is that they're grappling with a situation where they're very worried that they're not going to provide the level of care that they feel. They ought to be to everyone pretty soon. That they're gonNA have to make hard choices. And even if they're not making explicit choices that just not gonna be able to care for everyone in time from that people need care in order to both save lives and help ensure people have good outcomes here. I am does not an easy way to mitigate that because what you'd want to be doing right now is pouring massive resources into New York and supporting these hospitals in these doctors as what they didn't China very successfully they poured resources into the WHO Bay province and Wuhan literally bring thousands of doctors into that province to support the local healthcare infrastructure. We don't have that luxury. We don't have that luxury because we don't have the same top down control controls. China does but we also going to have multiple cities that get pressed even if we don't have epidemics of this portion of the parts of the United States and we may I'm hopeful we won't but we may we are still going to have enough parts of the United States. That are pressed. That is gonna be hard to pull resources out of other population centres. Pour THEM INTO NEW YORK Yes the best healthcare system I think in the country. But we're going to see it in about a week. Be maxed out and then after that. You'RE GONNA start to see people being put in the makeshift hospitals In Java's convention Elsewhere and if this continues the way the governor's modeling. Those are going to get maxed out soon too and I'll just close by saying you can't move people to Southern Connecticut Long Island New Jersey. The outlying hospitals are also going to be maxed out. This is really a an issue affecting the tri-state area. Not just not just New York City so the hospitals you might transfer to Are also going to be at the brink. I talked to doctors at Stanford Hospital where I used to practice medicine as well now built a second. Icu and the hospital. Pretty much maxed out right now in. It's still it's still early innings. Remember even this peaks even if the epidemic peaked in two weeks in New York City. Which is the optimistic. End of the governor's projections. You won't have a peak in hospitalizations till at least two to four weeks. After that in Bay province they implemented the lock down the number of cases Accruing each day in peak for another six weeks and then hospitalizations peak for another four weeks after that. Now that's that's a long time frame will probably be in a shorter timeframe but hospitalizations will peak Week weeks after the number of cases peak right because of the lack exactly again booth when people are infected and then when they need hospitalization and then when they're on the ventilators for weeks at a time Seattle got slammed. Now New York City is getting hit. Hard where are you watching doctor as the next cities that this could become a catastrophe? Well let me give you the optimistic vision. And then I'll give you the pessimistic vision. The optimistic vision is that right now. The case numbers are growing rapidly because of an artifact of testing that we have a backlog of testing the people who are being tested. And who are in that backlog right now. People who presented the hospital six more likely to be positive. So the positivity rates very high once we work off the backlog and start testing in the community the actual rate of growth will decline that New York City actually will peak in two weeks. Hospitalization rates seem to be slowing down And other cities acted quickly enough with their mitigation tactics to avert At an outcome on order of New York City and certainly San Francisco appears to have done that They appear to be on a better trajectory than other parts of the country and they acted early with the mitigation steps. That's the optimistic vision. That vision has this whole epidemic peaking sometime in May be mid April rather than late April. The more pessimistic view would be that New York peaks later This really does end up being a disaster in the city. I don't believe that's going to be the case. I think that is probably on the shorter end of the of the curve in terms of when L. peak the shorter end of those two to three weeks and then the longer end of it and allow those models. Don't Bake in the mitigation steps that we took in New York City while not very fast Act acted aggressively and a reasonable timeframe certainly relative to what China did but the pessimistic vision would have multiple cities in the United States seated simultaneously but behind New York. And there's fires now burning there that are going to become epidemic some of which will be on the same proportion as New York If you look at what's the data right now in China no no province had more than fifteen hundred cases outside the who province and as you know those provinces of big in the United States right. Now there's nine cities that have more than fifteen hundred cases to date and so the risk is that other cities become epidemic. The ones. I'm worried about. I'd be very worried about New Orleans. They were very slow to act in Louisiana. I'd be very worried about cities in Florida like Dade County. They were slow to act cases a building. There I'd be very worried about Texas where they've given authority to local officials to make decisions and we've seen slower decisions and not a lot of testing. It's it's a little bit odd that Texas only has the number of cases that it does so Dallas is building cases. I'd be worried about Dallas. I'd be worried about any city with a mass transit system where a lot of people use mass transit because of the shared services. So if that's your concern you have to worry about cities like Chicago and perhaps Boston both which earlier to act with tough mitigation steps but notwithstanding that they've cities similar to New York. So you have to worry about a city with a mass transit system because of what we've learned about the transmissibility of this unshared surfaces so those are the ones put top of my list. I'd also add Atlanta to that list. Atlanta looks very hot right now. DETROIT. You'd probably put on that list as well and You know parts of California Seattle out of the woods. I think Seattle might have caught a break. Notwithstanding the fact that they were slow to act and take tough measures they might have caught a break. Insofar as maybe this is just one large cluster rather than simultaneous clusters in California. Los Angeles looks very hot. But the local officials in the state officials there have been fairly aggressive and implemented. They mitigation steps earlier in the course of the epidemic relatives certainly to China and Italy. You just listed off a number of major American cities where the virus could hit hard and to your point in ways worse than in China. Just simple question yes or no in two weeks will the. Us have the worst corona virus outbreak in the world. I think I think by this Friday the. Us May have the worst current virus outbreak in the world in absolute terms on a per capita basis. I'm hoping we don't Eclipse Italy Italy. As I believe around seventy thousand cases right now I could be off on that and Population of around sixty million on a per capita basis in the United States. That would be in the hundreds of thousands of cases. I believe we'll get into the hundreds of thousands of cases here in the United States. Hopefully the low hundreds of thousands of cases. I don't believe we'll get into the millions but you know by this Friday. We could have one hundred thousand cases in the United States Or B B approaching that number. We'll have some days with some big totals coming up in the next next week Or Two as New York reaches its peak number of cases and then the question is what happens in other cities you started writing in tweeting about corona virus back in January and February. There's op-ed you did in the Wall Street Journal with Lou Borio Act. Now to prevent an American epidemic the date on that was January twenty eighth some trump appointees around that time told me that you were alarmist for attention that you didn't know what you were talking about. Unfortunately you did. What did you see back then that prompted at your flurry of warnings? Well I was talking to a lot of biologists from all around the world not just the United States but Some folks in Australia and other parts of the world Hong Kong that? We're very concerned about the The nature of this pathogen and I'd written a piece in the Washington Post early in the back of my first tweet on this there was January. Second it was just the nature of the pathogen that it appeared to be based on the early reports much more contagious than SARS. Less less deadly than SARS a lot. Less than Lehman SARS but much much more contagious than SARS. As though it had the features of a pathogen that as I said was saying at the time Sort of had that The perfect storm if you will had that perfect balance in terms of being lethal enough to be very very virulent very threatening but transmissible enough that it could race around the world We always knew that there'd be one day be a pathogen that occupies that middle space because a lot of Moore's and SARS were very lethal but not very contagious and other things. That are very contagious. Aren't very lethal. And so will you worry about as a pathogen that that fills that middle ground between being transmissible but being lethal and this seemed to be that perfect pathogen in terms of its its characteristics. And that's what worried me. The most the president has said that it was impossible to prepare for this. But you seem to be prepared. You were writing and warning on it. Why were you more aggressive than the White House on this? Well I wasn't more aggressive right. I was on the outside Ah pining on this as opposed to being inside being able to affect trade policy I was very worried about it. That's the bottom line and I think that there's going to be a lot of time spent for decades and decades. They'll be writing about this one hundred years to look back at. You know what we could have done and should have done the things that we could have done. It should have done in January and February wrote about in January and February. Now I'm focused on what we should be doing now to help both. Come down from this epidemic as well as prepare for the summer and the fall to make sure this doesn't happen again and there's a different toolbox that we need and some steps. We need to be taking right now to make sure that when this epidemic does reach its apex start decline. We can move towards away from population based mitigation towards more case based interventions where we intervene to target the disease itself rather than intervene at target entire population. And there's a toolbox that we're GONNA need a fall to prevent outbreaks from happening again and certainly prevent another epidemic and it doesn't include a vaccine because I think we need to. We need to figure out what life's GonNa be like for the next year or two without a vaccine because we're not gonNA have it and so that's what we need to be focused on right now we can prepare in March for May We didn't fully prepare January for March. That's hindsight You know what would we needed to do? There's some things we could have done clearly in January and February. That would put us in better shape than we are in right now but we'd into him. We need to work with the platform that we have. So if you're trying to plan ahead for the months to come power you spending your time. Are you on the phone? With policy makers scientists were you coordinating relief efforts. Like take me through your day. In this moment we're spending time talking to members of Capitol Hill On a bipartisan basis. And spending a lot of time trying to formulate Ideas in in a practical fashion that can be implemented into policies so not just not just position papers and white papers but actually trying to give specs on what could be in legislation. What could be policy some of this? I put on twitter. I tweeted out in installments. Some guidances I put should be issued to bring the academic labs and clinical labs into the testing game in February and some of it. I put into papers and got a pay coming out with mark. Mcclellan diagnostic testing and how to build out a sentinel surveillance dark mark. Mcclellan the former FDA COMMISSIONER. So when you tweet these guidances out. Do you think that that leads to train? Do know that people are looking at your your twitter feed and using that for policy. I hope people looking at it. I mean you know the the social media that putting out on my platform is getting. You know it's it's getting hit. It's getting re tweeted. And so I do. I do think it's getting circulating. People are seeing it how much I don't know But I get calls on it. I I get calls from people who are in a position to implement some of these measures asking me for more details. That's what I've spending a lotta time. Trying to provide. People might focus right now. Is I think we need a much different screening capacity in the fall? I think we'll have the tools to do that and we need to build it into some of the legislation. That's going to be coming out. We need a very robust sentinel surveillance system. We need to have appointed care diagnostic and very liberal testing in the doctor's offices and we need to have logical testing to look at the background rates of immunity in the population. That's going to inform policy making. It's also going to provide an early trip wire to identify spread in the United States. And when it happens in small clusters before becoming epidemic and that gives you the opportunity to use case based events where you go in you identify the individuals you quarantine them you quarantine their close contacts as opposed to having to put in place. The population base mitigation steps. That we're doing now. Which are blunt instruments? You do that when you've lost control of an epidemic. We don't want to lose control this. We can't afford to let this happen again. We can barely afford for. What's going on right? Now and the human carnage is going to be heart wrenching but this cannot happen again and so if we have another large outbreak pedantic in the fall if we can't get back to some semblance of normal life because this pathogen is circulating and people are fearful about going out going to work. This country is going to be in a difficult spot. We don't need to be there we can. We can have a toolbox that I think committee that but we absolutely need to be planning right now. What those tools are getting them in place. We have a head start. We have the time to do it. And it also is going to involve a therapeutic. I think that there's a real possibility that we can have an antiviral that can help treat. People who get infected. In high risk of a bad outcome might rescue them if they if they've already developed really severe symptoms but if you introduce an antiviral earlier in the course of disease like you use antivirals influ for someone who's at high risk of having a bad outcome that can help mitigate the potential for a bad outcome. I think we can. Couple that with a therapeutic antibody. Recombinant antibodies a number of companies working on this including regenerate who I work with when I was at FDA on developing that he bullet treatment that could be could be successful here in developing an antibody that could target the virus. And you can use that as a prophylaxis in your healthcare workers and people who nursing home patients. Chemotherapy patients people at high risk of of a bad outcome. You basically give them a monthly injection or maybe every month and injection of an antibody that's serves as prophylaxis to help them from getting infected in the first place and that's how the antibody drug that Regina undeveloped for Ebola works and it was successful. It was it was beneficial. It's been eclipsed by a vaccine but but it was a good bridge to vaccine and that's what you want here. You want an antibiotic therapy again by that. Could BE A Bridge to a vaccine will get a vaccine. We just aren't going to have it in time for the next cycle. You said you're spending your days. Talking to members of Congress talking to scientists planning ahead offering policy guidance on twitter my colleague Cerro Vermont. I wrote a story where we called you. The shadow corona virus's. Are you refuse to talk to us for that story? I've got you in front of a microphone. So let me ask you now. Is that a fair term. I don't think so I you know the people who are working. This problem in the White House are dealing with a much broader range of issues. Hey Hopping in here to say Dr. GOTTLIEB's recording dropped out so the remainder of our conversation is with a backup recording. I don't think so I you know the people who are working this problem in the White House are dealing with a much broader range of issues than I am Including all the logistical issues. Of How do you get a ninety five masks in ventilators into New York? And how do you make sure the supply chain doesn't break down? I mean my my Work is narrowly focused I'm trying to think about August. I'm trying to think about the fall. I'm trying to think about this summer. I'm trying to think about what happens. When the epidemic passes as there's a lot of good people focused on the immediate crisis. I'm trying to think a little bit about the future. About when this immediate crisis passes how do we transition away from these population base measures towards more case based interventions and then? How do we build a toolbox in the fall that prevents large outbreaks happening again? And makes this a livable pathogen? You know this this is GonNa be with us. This is a fearsome pathogen. This will probably spread to South America as they go into their winter. There does appear to be a seasonality to this and then it could come back again and we're going to have to contemplate travel restrictions and South American nations coming up this summer We're going to be contemplating all these things. But this could come back again in the fall and in the winter and become a seasonal pathogen until we can bank with vaccine and so the question becomes. How do we make sure that this could exist in the background? And we can have a normal life and life's never going to be perfectly the same. This has changed. This has altered the course of history and the world. This has changed American Life and global life. We're going to have more cleaning of shared services we're going to have restrictions on how many people crowded elevator. Uber's and airplanes are going to be advertising the deep cleaning. We're GONNA see more ultraviolet light in indoor settings we're GONNA see copper used on shared services. There's things that are going to change just like after nine eleven and I'm not meaning to compare this to nine eleven but after nine eleven there was security features. That never went away. We we didn't have. Tsa before nine eleven. We didn't take our shoes off in the airport. So certain things are going to stay with us. But with the right toolbox with the right Surveillance techniques and perhaps some therapeutics in our metareum. This can become a pathogen. That circulates that on a daily basis. People don't worry as much about they. They changed their habits. They used parral. They wash their hands more There's things that they do differently but you don't. You can get back to normal life with some additional vigilance and that and that's what we that's what we need to strive for. And I think that we're going to get there but we just need to be focused on that strategy. That's what I'm trying to think through given that there are so many threats. That's only to be tackled. Is it realistic that we would go back to work? In two weeks. Like president trump has signaled. He blinked America to do what happens if if the economy opens back up around Easter. Look I think what policy makers policy makers are are Trying to find is some identifiable measure progress that could be related to the American people in a way that people can create expectations around that. That's what that's what everyone wants to people on Capitol Hill. I believe that's what the president wants. I think we need that. I think we need a way to speak to the American people about what what progress is what will it look like when we're turning the corner and then what can we gradually reintroduce into our lives. I don't think anyone believes that. This is an on and off switch. I think people understand. This is going to be a gradual evolution. Certainly my conversations with people. I think that they understand that but I think what we need to give. The American people is something to measure progress by. And if you can't back into an approximate date about when things are going to start to transition you need to back into our Identifiable goal posts that people can see by turning on their TV so it needs to be something. You can't tell people Here's a model and you know we're GonNa know when the data you know gets to a point with model starts to change people don't know your model. You need to say well when we reached the apex and you see new cases declining or when you see hospitalizations falling off that means this and that means we can. We can probably start to think about this and so it needs to be something that people can measure themselves for themselves and say I'm trying to think that through as well what that looks like and what that gradual evolution is China did a very good job at this You know. In retrospect China did a lot of things right even though they got to a slow they got off to a slow start but they did a lot of things right after that There's GonNa be consequences for some of the things they did. Some of them were two Jacobean. But in terms of restarting their economy they gradually took their foot off the brake of population-based mitigation and gradually introduced case based interventions I in the outlying regions of of the WHO providence and then gradually and who province. I think we'll we'll have a similar situation here where we can gradually take take off some of the most onerous things in parts of the country. We broken transmission with a virus isn't circulating anymore or circling a low level and in substitute in other things to help. Make sure it doesn't flare up again and it's GonNa be a gradual evolution. So if if you think that this is GonNa peak sometime in mid to late April. Probably MORE LIKELY LATE. April but maybe mid April. If you believe the optimistic scenario so we'll be coming down the epidemic curve. This is a bell curve so the time to get to the peak. It's it's similar to the time to get down from the peak but as you're coming down that curve on the back end you can start contemplating some of these things and so we'll be coming down that curve. Hopefully in May and into June and hopefully transmission breaks off in June and July and August are relatively quiescent. And so as we're coming down at curving getting into the summer we can start to contemplate especially in parts of the country. We can have evidence that there isn't transmission taking place contemplating lifting some of these some of these population-based restrictions. That are in place right. Now you do need in order to do that. You do need to have good surveillance. You need to know where the viruses circulating where it isn't circulating so you need to get really good surveillance in place. I believe I believe. We'll have the be robust screening. We'll be able to screen hundreds of thousands of cases a day as we scale this up. The only limitation on very very robust screening on that magnitude isn't going to be the diagnostic capability of the labs. It's GONNA be literally the supply chain supporting the diagnostic capabilities. So things like the pipe pets and the cotton swabs agents all the low commodity components of testing other things that are probably going to put an upper limit. On how many tests we can do a day as As tragic as that sounds like it's hard to believe we're going to be limited and how many tests we can do day because we're not going to have a little plastic parts to put samples in last question you ran the FDA. Is it hard to be on the outside? Rather the inside for this crisis and is it possible you'd go back inside It's terribly hard to be on the outside And not supporting my former colleagues and doing and participating. The things that I know can can help improve the outcome and as far as the role. I'M GONNA play. We'll see I mean right now. You know I'm engaged wearing my policy at the American Enterprise Institute and talking to members of the administration and members of Congress helping to give them support. Give them ideas draft things where it's helpful? Put it out on twitter on on on white papers. Everything I'm saying on the inside I'm saying on the outside. So if you WanNa know what I'm telling policy makers if you follow me on twitter it's I'm basically saying the same things so I'm pretty I try to be pretty consistent students about making sure that I'm putting out publicly what I'm saying privately. That's one of the most effective twitter plugs I've ever heard Dr Godly. Well you get back to fighting the corona virus with your platforms. Thanks so much for joining politico pulse check. Thanks a lot thanks. I mean that's our show for today. My thanks Scott Gottlieb for taking time out of his packed schedule to join us at politico. Our producer is anti reese. Jenny comment is our senior producer. Irene Noguchi is our executive producer. You can find political pulse. Check my going to your favorite podcast APP. Searching for our title you can help us by leaving review rating on the show. That's a signal helps new listeners. Discover PULSE CHECK Tim. Thanks for listening. And we'll be back with you again next week

New York City United States China twitter epidemic New York Seattle food and Drug Administration politico White House scientist Scott Gottlieb WASHINGTON Massachusetts Scott Golly Elmhurst Dr Scott president FDA
White House NEC Director Larry Kudlow; Dr. Scott Gottlieb

Squawk Pod

00:00 sec | 4 months ago

White House NEC Director Larry Kudlow; Dr. Scott Gottlieb

"This CNBC podcast is sponsored by capital group home of American funds. Nearly Ninety years of experience helps you say I can partner with this firm to navigate times visit capital group DOT, com slash market volatility American Funds Distributors Inc... This is walk pod I'm CNBC producer Katie Kramer today on our podcast. The Corona. Virus Hits a grim milestone with the largest global uptick in new cases in a single day Dr Scott Gottlieb former FDA head on what it means in the US this week's going to really be a pivotal week for us to get a picture of where things are heading states like Florida and Arizona and Texas whether or not they're tipping over into exponential growth or not, and the president's top economic advisor. Larry cudlow on the White House response. There are some hot spots were on it. We know how to deal with this stuff now. There is no second wave continent. It's Monday June. Twenty second twenty twenty days are going to start getting shorter now, fortunately squad. Now. Good morning everybody welcome to swap walks here on CNBC. I'm becky. Quick along with Joe Kernan and Andrew Ross Sorkin and thank you very much, so for the reminder that the days start getting shorter from here literally side as you said that it's. A fleeting to think of that, should I use my old joke? Actually still only twenty four hours. People are sick of that probably wouldn't whenever you tell me as long as they. Say! Always say! Off. Dad Jokes on her father's Day I hope both of you had very good fathers day. We did I hope. I hope Matt did as well, and and Sorkin did as well I didn't see him again. All the. All the invites dating? We're waiting. We had the drinks ready. The s'mores ready the whole operation did I mess up your address? There was nothing at that location. It was like. It's hard to find on. Google admitted Google maps. They send you a little bit of a pasture. Awkward Awkward Direction. It was pastor so. Or it's the wrong address. That's saw like the like the phone numbers that I used to get new. Update now and some of the reopening. That's taking place in America New York City. Entry face to today that means at bars and restaurants can offer outdoor dining in stores can open for in-person retail hair, salons and barbershops Henry Open, but no nail salons massage parlours just yet. Playgrounds will reopen, but team sports are still prohibited. That's in a place where the numbers have gone down quite remarkably. Remarkably in Texas, though on the other end of this officials, suspending liquor licenses for twelve bars for violating cove, one thousand nine protocols is part of an undercover investigation by the state. Liquor Authority the first violation results a thirty day suspension, and a second fraction earns a sixty day suspension and prospects, maybe dimming for college football season this after some more reports of covert outbreaks among teams. On Friday was reported that twenty three Clemson. Football players tested positive for the virus over the weekend sports illustrated, said a large number of lsu football players have been placed in quarantine to try to slow the spread of the virus Kansas State suspending all football workouts for two weeks after fourteen athletes from various sports tested positive last week, there were positive tests from football players, the University of Texas also at the University of Houston, Alabama Auburn South Florida and West. Virginia there continued by the with questions about Major League Baseball. So I don't know where we are guys on all of this I felt like it was one step forward two sips back one step forward I i. don't know I. Don't know either about college in general still up in the notices. Of being made, I, don't know if you saw Harvard Harvard, put out a note. I think on might have been laid on Friday saying that they're going to. It's going to be online classes. No matter what next year in its entirety, however, they're gonna try to bring some percentage of of the students to campus, so you would effectively live on campus living in a dorm room, but all of your. You wouldn't go to a classroom you. All of your classes would be done. Effectively over zoom or some I don't think so I. Don't know I mean they talked about three possible scenarios one being what they call a very low density situation which they talked about being what looks like the school now, which is very density, a third of the students, maybe thirty or forty percent of the students coming back, and then all of the students coming back. They said that was probably unlikely. The scenarios and then the question is which students get to come back. Is it a lottery system by the students? There's GonNa be want to come back. Don't want to come back. It's very interesting to watch. All of this will have huge implications obviously on the economy you saw the latest on. We should have thought about this As people age, all of their organs become less effective. The immune system is like one big Oregon. So you try. You're dependent on your immune system to react to the vaccine to give you immunity, or if you have a really weak immune system by definition, even though you get the vaccine, you're depending on your own white blood, whatever you're depending on your own internal system to develop that immunity, and it's unclear whether the people most at risk because of their weakened immune system can actually. Respond to that. That's the way you might need a moose booster you. Kind of knew that though I guess. Bill Gates told us that. Scott Gottlieb told us that in the past. We're just not sure if it's going to work for pro for old people. Even even young people seem to be immune. Already. kind of I mean some of them. With a strong immune system. And the other issue we watch these states that are getting the higher number of cases all the time they are the states that are already open, and we can say hey in New York, and New Jersey cases of come significantly down. That's because we haven't been open. If we open up again back in the same position I think that remains to be seen to. The deaths are what they were a guess, but we're GonNa have come old concentrated. He's probably going to present the the more positive case. We'll see what he says. The Governor in Florida made a very interesting point, especially in terms of the numbers, the hotspot that you're seeing there. A lot of those people are younger and so again. This goes to the issue. You just mentioned Joe. The death rate has come down a large part that may be because younger people are getting it, and so it's not, it's not as. deathly you will as as as older people if you. Say. Affect parents latch their grandparents. Anybody else who might be vulnerable. That's you know. We're we're back where we started, we haven't. We haven't gotten rid of the virus. We've been living with it for a while, and we may have to figure out how to live with for some time to tell I looked at. A. Letter that allows me to you know if I get stopped, there's something on the way and it was march sixteenth. One at. Sixteen so it's been. It feels like allowed to be allowed to be going into work. Essential. Largest single, the increase in global coronavirus cases was recorded on Sunday according to the World Health Organization after more than one hundred, eighty, three thousand new cases were reported worldwide. The US continues to take the lead with more than thirty six thousand new cases on Sunday, and an additional thirty thousand cases, being reported on both Friday and Saturday, twenty three states showed an increasing trend in. In cases this past week California Texas and Florida are leading the way each with more than four thousand new cases on Sunday alone, officials are warning that some clusters of infections are apparent among younger people who may be crowding in groups new daily cases in the US appeared to be going down throughout May and into early. June but ticked up when some states started to reopen. There is still no. FDA approved drug to treat the corona virus and the National Institutes of Health said on Saturday it had halted a clinical trial of malaria drug hydroxy Clark went tree covid nineteen patients, saying it had no benefits. Here's Becky quick in his latest OP, ed former FDA Commissioner, Dr Scott Gottlieb discusses the British strategy of fighting this pandemic, and why the United States should follow its example. Joining us right now is Dr Scott Gottlieb. CNBC contributor and he serves on the boards of both alumina and Pfizer Dr Gottlieb. Thanks for being here. It's good to see you. Thanks. Let's talk about drop ed I up. What are the British doing differently than we are well the recovery trial, which was a trial that unearth the finding with decks and Beth zone star that was demonstrated to cut the risk of death by third in patients who were in debated with Kovin Bhai twenty percent and patients who were requiring oxygen. That was what we called practical clinical trials, so it's very large. It was still randomized trial where patients randomized to. To different treatments or just routine care, but it was a practical trial in so far as it wasn't collecting a lot of different variables about the patients, and so made it easy for doctors to run this kind of a trial in a crisis situation, doctors who are busy working at critical care units in the US, we've reached for more elaborate clinical trials, and that's made it harder to run and enroll these clinical trials, and it's made it harder for us to get results. We actually affirmatively decided not to participate in recovery trial and I think regulators. Public health authorities need to rethink. Trials and reach for these kinds of practical trials that are going to be easier to run these settings that we start getting answers about what works and what doesn't. We're going to be more dependent upon therapeutic innovation here in this country given the fact that we're going to continue to have a lot of infection, and so we're going to need things that try to reduce the death rate as a way to try to quell the impact of this this disease. Let's talk about a few of those things that we've been watching. Today is a reopening of face to New York. City meaning that people can get their haircut salons. Outdoor dining and drink service a lot of other things that are out there and I've been watching over the last several weeks. Where sometimes people in the northeast? Seem like they've. been thumping their chests a bit about how much better we're doing here than in some other places where we've been taking strict measures, we have seen a decline in the number of cases, other places have opened up and have seen. More cases coming on. Are we just waiting for this to happen to us? Because as we reopen up, it's inevitable that you are going to see an increase in cases, and maybe it puts us right back where we were, we'll see an increase in cases, but we're reopening much in backdrop. First of all cases are way down in the northeast New York new. New Jersey Connecticut cases are way down. I think the population here more aware of the risks that you more likely see compliance with masking people being mindful of their social interactions, and so we also have a lot of infection here New York probably thirty percent of the population has been infected New Jersey and Connecticut probably around ten percent of did seroprevalence studies. Maybe higher than that, and so there's been more infection here, so the transmission rates going to be a little bit less because of that, because now you have more people who have some level of immunity, so I wouldn't expect to see the big increases that they're seeing in the southeast and the South In here when we open remember Florida Tech Says Georgia. Alabama South Carolina. Arkansas Arizona all open against the backdrop of a Lotta spread their cases never really went down, and then they opened up, and so they were destined to have more infection as they open. Do you think that's why when you look at what we're hearing from? Some of the schools already some of the universities that have opened up for their football practices. It was Clemson Lsu Kansas state the University of Texas, the University of Alabama South Florida and West Virginia that have all seen cases. Spikes in the number of kids on those teams who have seen corona virus with a positive, or do you think it's just something that you're going to inevitably see when you have close contact sports for universities across the country, and then potentially high schools to? Your the sports are challenged for the colleges and the high schools I think the professional leagues can do a lot to create a bubble around the players and test them. And put in place measures to control what they do off the field as well. I think it's going to be much more difficult for colleges to do that. First of all to implement it testing, they don't have the resources to do it, but also to control behavior off the field, and so it's going to be much more difficult for them to restart college football than a restart professional football my view, I think they can restart professional football, but they have endless resources to try to work this problem. Get testing and place and try to put measures in place to reduce. Reduce the risk off the field as well, but I don't think it's a question that you're seeing the outbreaks in states where you already have outbreaks background rate of spread there. That's probably quite significant I think this is gonNA. Be a pivotal week for us to get a picture of where things are heading states like Florida and Arizona and Texas whether or not they're tipping over into exponential growth or not. The problem is with exponential growth. Everything looks sort of okay. Until all of a sudden it does, and the cases of building very quickly. Those states that sir down. And I think they'll continue to stay down in part because we're treating this better in part, because the outbreaks for now are among a younger cohort as old people do a much better job of protecting ourselves, but wh what will be the sign what would be the numbers of the statistics? We look at to decide whether this has gone exponential. Well I think if you're if you're seeing cases. Cases continue to build by five hundred to a thousand states like Florida. Texas ARIZONA ZINC cases bill by five hundred a day by the end of the week, where maybe six thousand cases in these states, maybe a little bit more in Florida Texas, California. Now that's that's GonNa. Be a curve Stein. Look like exponential growth a doubling time coming down to something. You know about a week or Or less right now. The W tons about ten days some of these places, so he's been coming down. They're having major outbreaks underway. There's no question about it, and they might be past the point that they can control this. Just with simple interventions like trying to get more people to wear masks and people be mindful their social interactions. They might have to start closing some establishments with people. People congregating indoors and they know the viruses spreading the problem is they don't know what those establishments are there guessing? It's the bars because a lot of young people are getting getting the illness, but I don't think they've traced it back to those locations effectively 'cause they don't have the tracking and tracing in place that other states including New York new. Jersey and Connecticut have as they reopen. Doctor Real quick. Given, it appears that the morbidity rate has come down and that's such a great sign. How should we think about these numbers? Relative to hospitalizations given the younger people that are that are that are getting this? What I mean, again it goes back to Becky was asking about the number. What numbers or data point should we looking at? Is this really at this point about hospitalizations is that? Is that the key to look at relative to total number, because obviously also, and it's become politicized, but obviously we're doing a lot more testing so I'm trying to I'm trying to think through. Where we should be looking well doing more testing, but the positive rates going up, so it's not just a function testing I think we are looking at hospitalizations, because the measure that the political classes looking at his resource utilization by the healthcare system and ask themselves do we have enough capacity to stay in these kinds of outbreaks, the problem with that is that the hospitalizations number one or a leading indicator and hospitalizations are going up, and all these states forty percent of hospitalizations, in Arizona now covert patients, but the other the other challenges that if we get a lot of infection, even if it's among the twenty to forty year old. Old Cohort, that's less likely to get is certainly less likely to come to the infection. If we have that much infection going on in the background eventually, it's GonNa seep into other communities you know people over the age of fifty aren't Gonna be able to keep themselves protected in perpetuity, so you know. What are you racing against erasing against all the twenty to forty year olds getting infected before it reaches the six year olds. Eventually, it's going to get into the older population. These places as the density of infection increases, which is what's happening right now. The dense infection does seem to be pretty hard and he's places right now. Among the younger population taxing Lee, thank you. It is great to see you. Next on squawk. pod Larry, cudlow, top economic advisor in the White House on both the economic and the pandemic recovery gets just you know hot spots. They send in CDC teams. We've got the testing procedures. We've got the diagnostics. We've got the PCP and so I. Really think it's a pretty good situation. This CNBC podcast is sponsored by capital group home of American funds. Nearly Ninety years of experience helps you say I can partner with this firm to navigate tough times visit capital group DOT com slash market volatility American Funds Distributors Inc... This pond from CNBC with Joe Kernan Becky and Andrew Ross Sorkin. Here's Joe. There were just posing the question about the coronavirus and what it means the stock market. I'm wondering when November fourth or whatever that day is. I wonder when when or if you are able to discern. Anything from the stock market based on the prospects of president, trump versus vice-president by at this point because we have, we have President Vice President Biden on the show. Guys and he said they won. Those tax cuts for corporations get get rescinded. I would repeal the two trillion dollars tax cut for the folks who making over a million bucks a year, because as demonstrated as demonstrated very little or no grow for. Corporation that the The the the corporate tax rate I moved back to what I had proposed and twenty eight percent, but we had proposed at twenty eight percent because I wanna make sure that we see that these corporations. That's not going to take them on. Maybe! That hasn't been. Maybe a lot of that hasn't been helpful to. The economy we had before corona virus, but maybe it was so I guess there's a lot of time left, but certain things that flipped certainly the polls, many of them are double digit now the national polls the battleground states don't look much better and the composite of the betting sites. Are. Has Not I. Mean it was like this. It's flipped its widening right now so I don't know. Do we see it depends on the composite of the Senate it depends on. Which controls into the? Questionable too so I. Don't know when we actually start. I mean we've got so much more going on. With Corona virus, especially in the middle of this, what looks like the very troubling spikes in certain states I don't know if we started thinking about. Moving onto. Electoral concerns at this point. I don't know you did see you did see the markets. Pick up when it looked like it was going to be Joe Biden instead of Bernie Sanders when? That was for the MARLINS. That's one of the worst case scenario for the markets was was taken off the. Table But. There'd be a difference good if you're gonNA raise taxes immediately and and get rid of the. Entire trump. tax cut I think the plan is not to get rid of the entirety of the corporate tax cut. His Tax Cut, have you? We'd be part of it, but not get rid of it completely. I thought he said he would just just reverse the entire bill he did he just talking about corporate corporate taxes would be not great either what? He'd go back. Go back and twenty eight or twenty nine, didn't he? SAW wouldn't go back to where you were talking about going back to twenty. He's talking about going back to twenty eight percent on the corporate tax rate I think the real tax rate that would be interesting to see what else can. We happens to the individual tax rate it actually most wealthy, not necessarily well. That's that would be on the table. He says he would do this immediately. I have my own. Questions about whether that would even be plausible. Given where the economy may or may not be at that point. We heard just a few minutes ago. Corona virus cases are surging and sponsor around the country aside from the obvious pub, public health implications that could spell renewed trouble for the US economy joining us right now to talk about the potential need for more economic stimulus out of Washington Larry. cudlow. He is White House national. Accounts Economic Council Director Larry. It's great to see. See You thank you for joining us today. And maybe we can just start with the number of coronavirus cases. We have seen more cases out there I know part of that's because we're doing more testing, but a higher percentage of those tests coming back have been coming back with more positive results in some places. To what do you think actually I think nationwide becky? The. positivity rate is still quite low well under ten percent. Now I do agree The numbers quoted to me by the health people. I'm not the expert they are. Over the weekend there thirty seven states that have virtually no problems. There are thirteen states that do have hotspots by the way part of that is a massive new testing. Run five hundred thousand tests. Per, day, so you're going to pick up some, but just interested. I was going through at this morning. Seventy hot spots that you talked about Arizona no question about it. Florida no question about it Nevada. North, Carolina Oregon Texas, but on the other hand, Becky just to balance it out I'm looking at this Colorado down thirty percents. Here the Washington DC METRO AREA DOWN THIRTY ONE ILLINOIS DOWN Thirty. Six Massachusetts Down Twenty seven Michigan. That's really something there. Dan Eighty percents. On case rates, so you know this. There are some hot spots were on it. We know how to deal with this stuff now. Come along way since last winter and There is no second wave coming. It's just you know hotspots. SEND CDC teams. We've got the testing procedures. We've got the diagnostics. We've got the PPI and so I. Really think it's a pretty good. Situation fatality rates. Incidentally, the Taliban rates continue to decline looking at the one day and seven day. Fatality rates less than one half of one percent Even while as you noted, cases have gone up in some places so all in all. I think it's pretty good situation, and of course reopening the economy is the key to economic growth, and we've had a whole bunch of green shoots that are showing recovery. Faster that a lot of people thought hey Larry. We spoke with Scott Gottlieb earlier today, the former head of the FDA and his his point is that in some of these states where you are seeing hotspots, it's a lot of the younger people, people ages, thirty and younger who are getting it at this point. The good news is a lot of them. Do not have the same sort of adverse reaction to some of these things the concerning point would be do they spread it to their parents to their grandparents to other people there around who who may have some underlying issues and I guess nobody wants to see the economy back down. We WanNA. Get out there. We want to make sure things can open up. Would you be in favor of targeted places? If you find out that it's linked to bars and it's thirty years younger who are spreading it. Would you be in favor of shutting down? Potentially some of the bars are slowing things down just so that things don't get out of hand. Where look again I'm not the public health expert I think that sort of thing is up to the individual states. The governors in some cases. The mayor's Gottlieb is dear friend and a brilliant guy. I'm sure he told you how important it is to maintain. Best Practices social distancing. Where applicable again it's voluntary, but we're applicable. face masks some kind of cloth, face mask and again get testing where possible I not going to advocate shining down any place just if if that's what the locals think is necessary, but again the costs of shutdown in economic terms and psychological turns in addiction terms. I mean. We've learned a lot since last February's so I'll leave that to the locals, but I sure hope not. I mean look. We're in a position now and again I want to get back to economic story. We're in a position now WE'RE GONNA come on much stronger in this recovery Then a lot of folks thought maybe than we thought here and you know there's been a whole bunch of green shoes on retail sales. unemployment new business applications on travel and Apple Mobility Indexes housing demand, strong auto demand the strong. This is great stuff. The employment was up three million in May. The early estimates are about three and a half million new jobs in June. That comes out July second just as a reference point. The Congressional Budget Office is suggesting twenty percent plus q three, perhaps Q. Four. If you get twenty percents, and you got a five percent in Q. One becky, that will get us back to the prior peak in the economy in twenty nineteen. That is wonderful news and the temporary layoffs and furloughs. Folks are going back to work so I think the rescue package was solid and I think the economic numbers are coming on great. We'll all hope and pray continues and look. Let's have best practices on safety guidelines. Any Larry wanted you to comment I wanted to account mine if you could on the president's comment. Over the weekend at that at that rally in Tulsa where he effectively said. that. He said to his people slow the testing down, please. His the bad pug. When you test of what you do testing to that extent, you're gonNA. Find more people you're gonNA, find more cases. So I said to my people slow the testing down, please. They test, they test. We had tested. People don't know what's going on. We got we got another one over here. There have been other members the administration that have suggested somehow that he was joking I saw it with my own eyes. You saw with your own eyes and also suggest to you that just a week ago. He said quote. If we stopped testing right now, we have very few cases. If any, so there's been a series of comments quotes that he has made that have not by the way been suggested to be jokes prior to this. Well as you look. I can't account for all that I felt he was tongue in cheek when he said I was not there I didn't see all of that rally in Tulsa I. Truly believe it's tongue-in-cheek in meetings that I've attended whenever this subject. Come Up. It comes up in connection with the economic rebound and. Testing and best practices have always been. His belief and he's listening to the Public Health people, Deborah burks, and so forth there giving them the right advice. I believe he's taken the right. Advise. I can't settle this I think it was tongue-in-cheek. You'll have to ask him I. Think The Cape Point though I really do think the key point is you've got a thirty seven states are in great shape. You've got thirteen states some odd where there are hospice as I. Mentioned, hotspots are mentioned. Becky I read down the list. You've got tremendous declines. Declines in positive rates from new cases in major major states. New York is opening right now. That's a huge chunk of GDP. People are gonNA. Come in or not, but they're going to be wearing. Face coverings if they need to. They'll be temperature testing if they need to. So I. Think we've learned a lot I think private industry private business is very sensitive to the needs of their workforce. They're doing everything they can to assure them and to take safety measures and I think the local. The local governors and mayors are going to have a piece of that, too. So and I'm not GonNa make much of it. sometimes there's a presidential sense of humor That works for some, but not for all. I can't convince you if you don't believe that but I can assure you that he is. He wants safety and security and economic growth, and that seems to be the trend line right now I think we're in pretty good shape. Certainly compared to where we were last winter, Larry we hear reports that the administration would like to see a two trillion dollar package that that is followed up for additional support and stimulus. Where would that money be focused? What what what needs to happen and there are a lot of questions because the six hundred dollars extra for unemployment that goes into people's paychecks will end at at the end of July at this point while we're planning on this. We're having pretty much constant policy meetings and I'm going to go into one. After we all talk and I I can't ten point a number. There's a pre decisional Shall we say rumors or this? And that nothing has been completely determined I will say as a generic matter. First of all after the July recess, there is likely highly likely to discuss in the House the Senate and and the administration some new plans for economic growth. Okay, there's probably I saw this thing in the journal today. There's almost certainly going to be a package. What's in the package Becky? I don't want to predict. We'll say this things. The president has talked about publicly. Okay. He talked about a payroll tax holiday for the workforce. He's talked about capital gains tax relief. If you buy something in the next six months, you'll be excluded from the capital. Gains for quite some time. There's a story about private equity in the. Today he wants to help out with some form of tax relief restaurants, entertainment athletic contests things of that sort. We want to help out the tourism business which has been hurt very badly. We also WANNA reward. People who are re employing. Going back to work. I think that's important. We're also concerned about protecting liability insurance in Kobe. Nineteen cases for small business and everybody there may be some targeted spending discussions going on between the three major bodies. All this is up in the air. Those are things the president, and said publicly so I'm happy to lay them to you know decisions have been made states and municipalities that may have been hit particularly hard by the pandemic. Should they additional funding? I wouldn't want to say at this point, but I'll say we're looking at everything. certainly anything related to Kobe. Deserve serious, serious attention with respect to some additional spending. We will see about that We will be looking at the whole panoply of options for the state. We've worked very well at the states, I think it's a remarkable achievement. President trump vice president pence has taken the lead on this constant discussions with governors I've been engaged. Many others in the White House had been engaged to help them out. Wherever possible a lot of this of course is the right equipment that right machinery the PP stuff the. The masks. The delivery of tests don't forget. We are making pretty good progress here. with respect to vaccine, development and therapeutic development, which I think is terribly important, especially therapies that might help out during the summer months so i. want you know I don't WanNa get too specific. We are looking at a whole bunch, a whole panoply across the board of possible assistance plans. You know I'll say this, Beca. You Know Me I. Fully supported the Cares Act I. I think the PCP program. The payroll protection program probably saved as much as fifty five million jobs. I think you saw in the May. Numbers temporary layoffs and furloughs going back to work by three million I think a lot more of that's coming I. Think in general. The rescue package was extraordinary led by the president tremendous bipartisan votes in both the House and the Senate I think by and large worked I saw a piece in the New York Times this. This morning that suggested the government support programs actually held down the poverty rate I think that's remarkable and I know. The income increased a lot in April and probably will continue in Maine you so I think that package worked. were proud of it I. Think now I'd love to see us. Move this just me talking from the rescue mission you know through the transition of the reopening into medium and long-term economic growth incentives, so we can really have. Great rebound in the second half, but twenty twenty one could be a big bang year and so twenty twenty two We did it once we had it going great guns. It's fundamentally sound economy as the emergency passes in the opening occurs so That's my view. I'd like to slant it towards economic growth incentives as much as possible. Larry, thank you. It is great to see you this morning and we hope you come back with updates as these conversations progress. John Thanks Becky. Thank you Andrew. SQUAWK POD we'll be right back. That's the podcast for today. Thank you for listening. squawk box is hosted by Joe Kernan Becky quick and Andrew. Ross sorkin tune in weekday mornings on CNBC at six Ham Eastern and subscribe to Squawk pod wherever you listen to podcasts. Sheriff's with a friend and tweet US at squawk. CNBC we'll meet you back here tomorrow. This CNBC podcast is sponsored by capital group home of American funds. Nearly Ninety years of experience helps you say I can partner with this firm to navigate tough times visit capital group DOT com slash market volatility American Funds Distributors Inc...

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Mark Cubans Tips for TikTok Traders; Dr. Scott Gottlieb on Covid Testing

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Mark Cubans Tips for TikTok Traders; Dr. Scott Gottlieb on Covid Testing

"Today every answer matters more than ever before, because whether it's about health deliveries or finance. Some things just can't wait. That's why IBM is helping. Businesses manage millions of calls texts and chats with Watson Assistant. It's conversational AI designed to help your customers find the answers. They need faster, no matter the industry. Let's put smart to work visit. IBM Dot Com Slash Watson Assistant to learn more. This is squawk pod. I'm CNBC producer. Katie Kramer Today on our podcast Kovic case numbers climbing in forty states Dr. Scott Gottlieb former FDA cheese on what we missed before. The pandemic are a lot of gaps in our preparedness ministers. Sort of new problem this has been building over many years. There's still not enough of we haven't invested in infrastructure, so we don't have the ability to surge testing capacity in this country took US minds and minds to get where we are, and we still have enough testing and Mark Cuban's tips for day, traders, patients and historical perspective are key to success. I think we're very similar to what's going on in the one thousand nine hundred. Look at my portfolio have to keep reminding myself that the Internet bubble last multiple years. It's Monday July twentieth twenty. Twenty squawk pod begins right now. Good morning, everybody welcome to Squawk box on CNBC. I'm becky. Quick along with Joe Kernan and Andrew Ross Sorkin here we go. The vaccine. News, do sure this is important, though and it could be one way or another. We're expecting more detailed results or results from phase one trials of the vaccine candidate. The Oxford, university and Astra Zeneca Candidate, it's already they've already begun large scale face three human trials, but we still don't know yet much about the phase. One results which would show whether it's safe, and whether it includes an immune response, and this is very prestigious journal results are being published in the Lancet the British publication. It's GonNa. Come out some time today. Huge question here's. A scientist, who's actually published in the past on this, would you normally publish your results in one of these publications and make a big deal about it was a failure, or do they only do that? If it's generally good news, or wouldn't you generally just put out? Publish on. It's an important. You'd have to do it either way. If it really sucked. He'd still have to put out. Obviously to publish it and put it in a big. Public Buddy. No, that's the way it works so otherwise. Positive things people would repeat the experiment or something like that. It doesn't work you. Think it's. It's not to take I guess this is the one eight leading candidate along with. Their four five leading candidates with this is definitely you know top through what I didn't realize. There's about two hundred candidates out there. For one of these vaccines and obviously only a few of them are going to be brought to market, so these analysts were saying. You've got a lot of these stocks that are incredibly overvalued at this point, because the market is played up every single one of them is come down it great to get multiple ones of these that actually work because he's have such a huge global population that needs to be vaccinated. You would need to get that out and get. It produced very quickly, but you're not going to get two hundred of them. And that was just their point looking through some of this. We have a lot of hopes riding on this. Every company's going to be successful. I saw another anecdotal story about a sixty four year old God at died like two days later was awful. Read about this can I just say one positive thing I heard over the weekend watching the Memorial Great Jack Nicklaus Tournament. In Columbus Ohio, at Muirfield Jon Rahm number one in the world now Jack Nicklaus, and his wife both head cove it, they disclose. Both head Kovin, Jack? Jack is eighty his wife. She's quite eighty but similar interests. She was symptomatic. He had a sore throat and the coffee a week and it was so. Blessed exactly anything we were very lucky and everything else, but you know for for I don't know if we hear about those stores I mean. It's tragic and there's. Just read about a sixty four year old God. Doesn't happen with flu normally obviously unless you've got. A CO morbidity. Just, hearing I was like Jack Yes. You know eighty no problem with covert so. We want to have him around. Obviously for for as long as we. As we possibly can. Tough course showed its teeth very tough. An update now on the coronavirus pandemic by the numbers, the US case total has passed three point seven million with one hundred forty thousand deaths in this country from covid nineteen. Florida reported more than twelve thousand cases yesterday. The Fifth Straight Day above ten thousand over the last week around eighteen percent of all tests came back positive and Florida, the state's Governor Rhonda Santa's urges perspective. I messages fears our enemy. Understand I mean there's obviously things burnings are doing that work doing whether it's work with hospitals whether to some of the other stuff but there is at the end. I think the other thing that gets missed with the cases is the sheer number of people who are testing are sick, because I think most people see you know cases and they're like they think that that many people are in the hospital or we're going to go and the way this disease is largely particularly repeatable under six knee, either minimally or a symptomatic. And Ohio Governor Mike. Dewine who has thus far resisted calls for statewide mask order warned over the weekend, his State with seventy, three thousand total cova cases could be going in the wrong direction. When we reopened put in place, we were on the first put in place very sophisticated. Policy about how you and that has included a mass requirement for every every employee. As far as customers now coming in as you pointed out weird sixty percent frankly were. We've seen that. Go Up as our counties of turn red. We're going the wrong way where crucial. Time until this week you may see. A lot more counties under under that a mass requirement, so we certainly would not rule out doing. Statewide. These numbers seventy, three, thousand three point seven million can boggle the mind in his latest OP. Ed In the Wall Street Journal Former FDA Commissioner Dr Scott Gottlieb dives into the disagreement on who reports those numbers, and when between the cabinet, Department of Health and human. Services and the Centers for Disease Control Gottlieb says the few demonstrates the inadequacy of US efforts to prepare for endemic. Here's becky doctor. Thanks for being here and it's good to talk to you about this new ad that you have out. Becky. Let let let's dive into this because this is an issue that we discussed a couple of times last week. Why these two agencies are feuding what they're doing about it how they're collecting information and I think probably pretty importantly what what this means overall in terms of the strategy we take. In the months to come if things get worse here in the United States, are we prepared? This has been a long-standing. Dispute or discomfort between the administration and the CDC from what I can glean talking to people on the inside. There's been frustration with the CDC in terms of the inability to get timely information inaccurate information out of the agency. Some of that's legitimate. Probably some of its you know little stretched, but the final Straw came last week when the administration some administration officials had asked to see, give them data on age breakdown of people being hospitalized South Dakota and CDC told them that they wouldn't be able to provide that information until late August or September and that that's. That's when the decision was made to more fully take away. data aggregation from CDC CDC would still be involved in analyzing data, but they'd no no longer be the lead agency collecting the data I still think preferable path would have been trying to support the CDC I think the city should be the lead agency, but clearly we need to invest more in their capabilities to both collect and disseminate information. We're at a point right now. Where some hospitals literally faxing in information to the agency, the agency needs to rebuild his data systems and and to the agencies. Credit! They've asked for resources for many years to do that. And so this has been something that's been recognized for a long time. The Washington Post had an article this week, and said the White House is seeking to block billions of dollars for states to conduct testing and do contact tracing and then also additional money to go to the CDC, and and to be used. Used internationally to try and fight this pandemic The Post said that this is creating problems even with Republican senators at this point. What what do you here on this? What do you think about this? And just in terms of what should be done with the testing policy? Should that a nation and national policy or should that be something where the state's picking up themselves? Themselves talked to people on Capitol Hill and I think funding was going to be there. you know Congress is going to provide that funding including Republicans I talked to Republican staffers on the Senate side I think in part this this for flex some of the frustrations. We talked about the outset I think the White House and others need ministration. have some frustrations. Frustrations with the CDC and don't WanNa more resources and SORTA double down on agency's role right now, but it also reflects an inability to come up with a plan to really reform the agency because of funding bill would be a good place to try to come up with a different approach to how CDC engages on these issues and they haven't been able to do that. That obviously something hard to do in the setting of of a crisis to try to rebuild aspects of an agency that have been long ignored, but that would be probably preferable way to go you know. I just think it reveals that there are a lot of gaps in our preparedness. Mrs. Clinton sort of new problem. This has been building over many years and. And that was sort of the point of my op Ed this morning. The intelligence community has been recommending in public documents for many years that we treat. The risk of pandemics as a national security threat on par with the reds from weapons of mass destruction, cyber attacks, and terrorism and we haven't done that. We haven't invested in infrastructure, so we don't have the. The ability to surge testing capacity in this country. It took US months and months to get where we are, and we still don't have enough testing. We don't have the domestic capacity to manufacture vaccines and biologics at the scale that we would need adding into the fall. Particularly the biological drugs, the antibody based drugs, and we don't have the data systems. We need to both. Both collect and track the EBBS and flows epidemic. My colleague at Johns Hopkins. Caitlin, rivers has proposed the idea of creating a national tracking service from the national weather forecasting service that would be in charge of collecting and disseminating information and analyzing it. We don't have that kind of capability here in the United States. Scott could prepare for the Oxford Astra Zeneca What do we know so far? What? There's so many just want to know exactly. What is the mechanism Agana of this one? This is not a messenger Aren a one, is it? Is this a? How does is this a more classic one or Adenoviruses? Which one is this? It's a semi and adenoviruses. and there's been data released on it already. That was encouraging. I think with all you know what I would call a little bit of hype heading into the announcement, saying most people probably expect results to be positive. It's just a phase one phase two study Richard. Richard Horton. The editor in chief of the land, put out a very unusual tweet last night, that was basically three words that seem to be intimating. Some some positive news on the on the vaccine. He said tomorrow period vaccines period just saying period, so not not the typical kind of tweet you see from the chief of a major medical journal. That's believable. That's. That almost. is a friend of you. Almost seems like frightening your. Doctor. Two questions for you. One was what you made of this study that came out over the weekend out of south about sixty five thousand people, looking at children and their role as potential spreaders, and this idea that between ten and one thousand, nine, hundred older than ten years old that you're no different than if you're thirty forty or fifty years old, in terms of your ability to it, and what that if that's right, what that means of course, four school openings, and therefore the economy here in the United States that debate with teachers, unions and all of it. So this was an exquisite study has a South Koreans Saddam done throughout this epidemic, they looked at about sixty thousand contacts of around almost four thousand people who are infected with covert and tracked how those infected people. The index cases went on to infect other people. Now they only followed symptomatic people so these children who had become symptomatic from covert, and what it showed was that the kids age ten to nineteen they were the most likely to infect other household members that I leave eighteen point. Six percent children younger than that were less likely to infect other household members, but the. The kicker here is that it was only a very small number of children so I think there are about a hundred and fifty kids, and all that had become symptomatic, and we'll follow this study, so what it suggests is that kids are less likely to become symptomatic from covert because a number of kids in history that were caught. with Cova that has Kobe was relatively small, but when they do get symptomatic ovid. Perhaps they're just as likely if not more likely to spread the virus not might not be because they shed more virus might be behaviors. You know when kids are sick. We're still going to catch. And go close boom versus adult the second household, they might be more likely to self quarantine. Does that mean you're less likely to spread? The information I would take away from what you just said. Is that not accurate it? Didn't didn't speak to that one way or the other, but it does, but there is a belief that a lot of children get sort of sub clinical infections. Confection and they're less likely to shed virus when racing dramatic, there are some studies showing that when you're a dramatic, you're less likely to spread the virus. CDC's website when CDC's give gives guidance to modulars. They asked to make certain assumptions. Assumptions right now that they're asking models to make. A. Dramatic people are believe fifty percents likely spread the viruses those who have symptomatic so there's already general belief that when you're ancient, immaculate, likely spread it. There's a general belief that most kids when I do get infected with corona virus symptomatic. What South Korean studies suggested is that when when they get infected and it gets symptomatic. They're just as likely to spread it as an adult. He's got one last question, which is obviously the the news and you guys were talking about it earlier. Testing and tracing. With the trump administration, saying that they they don't want to spend or one block the twenty, five, billion, four, some of the testing tracing questions actually reverse the whole idea. How much would it cost if we said we wanted to do? Five million tests a day and we're doing less than a million a day now. Five million tests today ten million tests today. How long would it take to ramp up? And how long? How much would it cost well? It's for a price tag on how much it would cost to ramp up You know. The tests run about fifty dollars costs of goods on a test that scale it's GonNa come down what needs to happen the real swing capacity in this country so twenty five percent Tessa appointed care tests done quickly. Twenty five percent of tests are in hospital tests. Those turned around quickly by hospital labs. The other fifty percent are largely being run by the commercial labs, and that's what's getting overwhelmed and what needs to happen. Those commercial apps need to make significant capital expenditures to build out there lab capacity so they can expand. The use of their laboratory developed tests. My hunch is that they're reluctant to make tremendous. Tremendous capital expenditures because covert testing the market. That's like me to go away. At some point. They can't reconvert that capacity to other uses that there might be a role for the government to inject money quickly to try to expand that lab. CAPAC- recognizing that. We're going to have to mothball at some point now doing that. You can't just switch that on overnight so investments we make right now. It'll take a couple of months to get those labs validating up and running and the biggest bottleneck quite frankly hiring lap tax, you need an army of lab. Techs do the sample prep and naturally the bottleneck getting those skilled personnel on board. Dr Guy Lead. With almost every morning for I think four and a half months maybe longer now We appreciate having you here. They've been trying to wrap us for five minutes. And obviously we still have questions to keep your hair, so we'll talk to very soon and we'll do. This morning ticker. Next on Swapan pod, Dallas Mavericks owner and Entrepreneur Mark Cuban on the pandemic, the markets and trading up this market. You can't be a traitor, but longer term traders typically end up losing all their money. Cubans dose of Wisdom for traders, even the ones on Tiktok. Everybody's a genius in a poll market. We'll be right back. CNBC'S WORKFORCE Executive Council is the premier group sweet human resources executives from leading companies across the country. It offers a members, only portal and chart plus exclusive industry contact with access to breaking news calls and digital networking experiences. The networking resources HR leaders need now applying to the workforce Executive Council at CNBC COUNCILS DOT com slash WC. This is what. Welcome squawk box here and CNBC I'm Joe Kernan along with Becky quick and Andrew Ross Sorkin. Let's stick with the corona virus, and the surging number of cases around the country Texas among states, seeing a spike in deaths and hospitalizations with they're now pleading for the use of masks. Joining us right now to talk about business in the lone star state and what needs to do to get the current outbreak under control is Mark Cuban he's an entrepreneur. He's a philanthropist, and of course you know he's also the owner of the NBA's Dallas Mavericks. Mark it's great to have you on again. It's been a while since we've spoken. For having me. Give us an update the last time we talked with you. You were kind of going around seeing how many of the different businesses that were slowly starting to open up. We're actually following the CDC guidelines. At that point you had hired mystery shoppers to go out and find out some of this information, but a lot has happened since then so just get us up to speed on what you're seeing and your home state. Served in the last couple of weeks. But just anecdotally driving around and trying to business here in Dallas more businesses. Shut down. It's not worth it for them to stay open. You see a lot more people becoming more concern going into a restaurant. People are wearing masks now in the restaurant where in June and early July when we first opened up. That wasn't the case and so people recognizing that this is scary. I get a daily report from the mayor's office and fortunately last night was the first time in weeks that the ICU, Liz ation rate in Dallas was under seventy percent and the number of cases down minimally. So hopefully, that's a trend that will continue. Said something really interesting there. There are businesses you can say anecdotally that that are closing, not because they've been told to. Not because they've been required by the government, but because it's just not worth staying open and I think that's the question that so many people are trying to figure out because that could be really huge impact on the economy. Is there a point where it's just not even worth to open your doors because you're losing more money than you're taking at? Copies because because of the by right, they weren't actually doing enough business to stay open, but they were able to sustain their business and keep employees on payroll because of the PGA funds, and you saw a lot of those companies also be able to sustain themselves minimally because we saw a surge in personal income and people were spending a lot of that. That money savings rates was very. I even were spending that money online, and so there was a little bit of equilibrium, but I think now with people becoming more concerned here thousand particular. You're seeing a drop off in that retail component and businesses just don't feel it's worthwhile to keep the retail side of their businesses open I. Know My Shark tank companies. We pivoted, but evolved a lot of their business to be as much online as possible, and that's really made a huge difference, so I can't say why. The businesses are closing whether it's because they just can't do enough business period, and they closed their entire businesses whether they just evolved to be online so that that is really the focus of the business now. Archive two questions for you. One is giving the renewed efforts at maybe the next version of. Or. WHATEVER WE'RE GONNA get in terms of stimulus. What were you thinking trying to tie that money to? Rules of the road, health standards, maybe mandatory masking and the like, so we don't situation where we're throwing good good money after bad all over again. No I! Don't think you can him to wear masks and protocols, because there are no protocols for businesses right if they really don't know what they're supposed to. The has kind of fallen off the math and trying to support particularly small businesses, so I don't think you can tie it, and so you know. I think it's really got to be on the demand side. It's going to be very difficult to extend. A when there's already a hundred billion dollars. They're just saying okay. Come back and apply again. I don't know that that's targeted enough. But on the flip side I think we do need to do stimulus again for consumers, and it's gotta be user. Lose it because that. At that point you'll see an increase in demand because of that avowed available cash, and I think that's what's going to keep companies in business. Mark I also wanted to raise a tweet that you sent out in the past twelve hours. That's trending on twitter this morning. You responded to a talk show host who said that their site for the Mavericks this year. Year, but said the minute one player kneels during the anthem I'm out, and they basically went after you and said that that you should deal with this. You wrote back. The national anthem police in this country are out of control. If you WANNA, complain, complain to your boss and ask why they don't play the national anthem every day before you start work. What are you anticipating? This season's going to be like an. And what do you say those folks out there? Who share the opinion of Mark Davis? You responded to on twitter. Here, look, everybody has the right to. Choose. You know this is a bigger issue. Trying to this hopefully is going to be a pivotal time in our history and trying to end systemic racism, using the platform that we have with the NBA to try to really get people to understand the challenges of African Americans in this country is paramount. That's more important than anything else we do. And you know when people talk about. Shut up the dribble or I don't turn sports to hear politics. It's not like in the middle of an NBA game we're going to. To start having interviews about political issues, that's not the case at all that you know the information or the the perspective that people get on our political stances where they may occur doesn't come from the him. Be a comes from all the commentary outside the NBA so you don't want to hear about politics. Turn off all the political networks you know just turn on the game and I think you're going to enjoy some great NBA basketball. We have scrimmages starting next week or game star July thirtieth the NBA. Is on course to be back and I think that's great for us, great for fans and great for the country. Mark anything that could interrupt that. Neither is must be watching very closely. Testing very closely kind of seeing what's happening and other sports. As. Well, what? What are you doing to make sure that you do get there? One of the concerns you have that you might not. Obviously you have four, hundred, zero, three hundred, some individuals, four hundred in total with staff. Your you have to be very careful about their health, but the interesting thing. This is one big psychological experiment where we're quarantining professionals. And, they're really adapting well. I can only speak for the mafs, but guys get along great. They're following the rules or wearing their mass, if people in the real world outside of the NBA followed, you know the masking protocols the same way MBA players are we re dealing with this virus and be way ahead of where we are now, and probably in a much better place you've heard the pushback from some of the marquee players in the NFL saying what what is the NFL doing to protect me and my family signing a letter writing some of these things? What do you think you are doing differently in the NBA Fan. Well, we have sixty seventy players now pertain as opposed to fifty three, plus all the staff and their staffs are much larger than ours, so they've got a different challenge than we do. It'd be very difficult for them to quaranteed in one location I haven't heard anything suggesting that they're trying to do that. Whereas with us, we have one location. You know we're able to keep everything under control. There's perimeters that we watch. There's protocols that we enforce very strictly and so I think we have the advantage there that the NFL doesn't have so I can't speak for them, but I think it's a little bit easier for us. Hey, let's turn back to the markets a little bit and just. The. The trend that we've seen recently of the Nasdaq very recently and I just made in the last week. The Nasdaq gave back some of the gains that it had picked up. It was the and p. and the Dow did better last week. What do you think about technology stocks here? What do you think about growth stocks versus value stocks? Every people just chasing performance I mean it's a momentum based market. You Know I. Don't think this is the fundamentals driven market, and it hasn't been since the Fed intervene. You know I think people are trying to say what's next. Where's all the money going to go next? And then they try to get ahead of that? Then that plays out then they go back to where they were check. We've seen this many many times before. Part of what happens in a bull market. You lived through nine, hundred ninety nine out. You think this is anything like that. When you say momentum and just tasting momentum and getting away from it, or is this very different because you see a lot of these companies like Microsoft and Amazon that really have have been putting up numbers to. You know in some respects is different because of the Fed and liquidity they've introduced and the inflation for financial assets that comes with that, but on a bigger picture. It's so similar I had my eighteen year old niece asking me what shock stock she should invest in because her friends are making thirty percent per day. You know and other people just randomly asked me never look at stocks at all what stocks they should invest in? Everybody's a genius in a bull market, and everybody's making money right now because you've got the Fed foot and that brings people in. In who otherwise produce participate? You've got all the three traders you know. That would have been the analysis analogous to the day traders of the late nineties that can come in and trade for free they can trade fractional is stock, so it's easy for them to you know. Put in a little bit of money. Look and see that they're up thirty percent. You know that they've made relatively speaking a lot of money for themselves, and that's going to keep them participating so yeah I think we're very similar to what's going on in the one thousand, nine hundred and. Look in my portfolio, which is still very heavy on. Amazon and Netflix I have to keep on reminding myself that the Internet bubble lasted multiple years. You know it went from one thousand, nine, hundred, ninety, five to early two thousand, and so it wasn't like we're in a bubble. Then all of a sudden the bubble is over months later lasted for years, and so it's difficult to have patient sometimes and recognize that there's still a lot. Lot of money that come in and change that performance. You know people tell their friends. Hey, look at how much money I'm making my niece and her friends, other kids that I know are asking me questions on Tiktok about stocks, and so it's different, but it's still an allergist and so many ways, but we still have to be patient. It doesn't mean it's going to end tomorrow. So what did you tell your eighteen year old needs to do? I said there's a reason why people sell you that stock, and it's not because they think the price is going up. You know and so you've always got to be careful and understand what you're doing. And then the second thing I told her. If you do it and you make money the only way you get to keep that money by cashing out, don't get crazy that hawks get slaughter and so I, said you know this is a little bit different, but this is also a chance for you to learn how the market works, and how companies work, so if you are willing to take the time, I'm happy to help you. WANT TO BE AN investor, not a trainer, though right yet. This market you can't be a trader, but longer term traders typically end up losing all their money, so you want to be an investor, longer term and understand what you're doing. Mark, thank you. It's great to see you and I hope to talk. Always, thanks for having me on. We'll be right back. And? That's the show for today. Thanks for listening to this podcast. squawk Fox is hosted by Joe. Kernan becky quick and Andrew Ross Sorkin tune in weekday mornings on CNBC. Eastern and to get the smartest takes and analysis from our TV. Show right into your ears. To squawk pod wherever you get your podcasts when we be back here tomorrow. CNBC'S WORKFORCE Executive Council is the Premier Group C. Suite human resources executives from leading companies across the country. It offers a members, only portal chart plus exclusive industry contact with access to breaking news calls and digital networking experiences the networking resources. HR leaders need now apply to the workforce Executive Council at CNBC. COUNCILS DOT com slash WNYC.

United States CDC CNBC NBA Kernan becky Dr Scott Gottlieb Mark Cuban WORKFORCE Executive Council Andrew Ross Sorkin CNBC IBM Fed government FDA Dallas Mavericks Astra Zeneca Candidate CDC CDC flu Watson Lancet
COVID-19 Roundup: Case Tally, School Outbreaks, Flu Shot, Vaccine Wait

NPR's Story of the Day

00:00 sec | Last month

COVID-19 Roundup: Case Tally, School Outbreaks, Flu Shot, Vaccine Wait

"We learned some important lessons from Memorial Day July fourth this year after those holidays, there was a surge in Cova cases both times. So as we go into Labour Day public health experts are watching carefully the news on the virus right now is mixed. The number of new cases is going down in the US but there are new hot spots in the mid west NPR's Aubrey is with us she has the latest Morning Alison Good Morning, Noel. So. This is our regular Monday check in where do we stand on this Monday in the US. Well. After weeks of about a thousand deaths a day that number has declined to about eight hundred and fifty deficit. That's still a lot of people dying Noel, but it's an improvement and the number of new cases is about forty thousand per day a significant decline compared to the sixteen thousand cases back in July. But of course, it's Labor Day weekend. So it with people have been out and about in crowds as we saw Memorial Day, this could really set us back and there are already hot spots throughout the Midwest and the south. We're new cases remain high the DAKOTAS. Louisiana and infectious disease experts I talked to say this coming fall people spending more time indoors people back to work or school. There will likely be a bump in cases given how widely the virus has been circulating and the change in seasons. And we have already seen this happen in some schools and on some college campuses students come back have any of them found it possible to contain outbreaks to prevent them. Well. You know there's a range of strategies being used in group settings in schools and daycares. CDC Director Robert Redfield has pointed to evidence from Rhode Island where hundreds of daycare facilities open to this summer. There were some students and teachers who got infected by identifying them and isolating them. They were able to limit community spread there. So he says that's success. Of course, to do this, effectively, you got to identify people quickly. Right? Weiss on college campuses have mandated. Entry testing is booked to Eric Lander, he's the director of the Institute of Mit and Harvard which has kind of overseeing testing program for about one hundred college campuses in new. England. Some of these schools are testing students and faculty two times a week. And so far this seems to be paying off testing is identified already four, hundred, fifty infected people because we know that they're not out there spreading to other people on the campus. That's the case for testing right now, that information is immediately actionable by knowing, we can cut off the sprint. So when students test positive that can be isolated of course to. Prevent outbreaks need more than testing, right everybody's got to do this social distancing in masking and sometimes more stringent measures at University of Illinois where there's a very rigorous testing program. The school announced a temporary lockdown for undergraduates given they were able to quickly detect a rising cases. So the goal here is to quickly turn it around before it gets out of control. Something I've been curious about we obviously don't have a covid nineteen vaccine yet, but there seems to be a big push for people to get the flu vaccine I keep getting mails from my doctor, my pharmacy what's going on? Doctors are concerned because people have put off routine visits during the pandemic. So for instance, child immunizations were way down this spring according to an analysis by Komodo health they've bounced back some but the message from doctors and pediatricians is this come in and get your vaccine. The flu vaccine if you ended up getting flu and Cuvette, which is possible, you could get really sick I spoke to Michael Eisen. He's an infectious disease doctor at Northwestern University, Feinberg, school of Medicine in Chicago. If you get sick with what you think maybe the flu, you can't differentiate that based on symptoms from nineteen and so that'll mean those people are going to be seeing their doctor asking for tests needing healthcare. And this could really overburdened the healthcare system. That's why we're all being asked to keep up the social distancing the masking the handwashing because the same strategies that help prevent it also help prevent the flu. Now in the meantime, we have a presidential election in two months. What's the latest? Guidance on how to vote safely. If you can vote by mail that is a good option, but bottom line polls need to be open on election day for other people who will vote in person. There's a lot of thought being given to big venues to maximize social distancing. For instance, in Baltimore, Camden yards, the baseball stadium has been considered as a possible voting site. Some NBA Arenas may be used as book to Mirror Net. Perez, he's the director of the voting rights and Elections Program at the Brennan Center for Justice. That's at the Nyu School of law. She says another challenge year more poll workers are needed November. Many of our countries poll workers have traditionally been people that are over sixty five, which are at greater risk of covid complications. For that reason, we have people who either don't want to sign up to be a poll worker again or shouldn't be signing up to be a poll worker again, an as such. We need to expand who is serving as a poll worker, which means Roy need a lot of people volunteering hopefully younger people at lower risk of serious illness. So given that the virus is still circulating and we don't yet have a vaccine that could be a good thing to do. Yeah. Yeah. Sure. Last week allison the CDC told states to be ready to distribute vaccine by November. Now, there's some concern over this right people are worried that there's political pressure to get a vaccine done because the election is coming up the trump administration would like to win that election. Let's leave the politics aside and talk about the science. Are we likely to get a vaccine this year? You know if there is any kind of approval or emergency use authorization this year, it would likely start with a very narrow group of people likely healthcare workers or people in nursing homes. Now, former FDA Commissioner Scott Gottlieb spoke about the timing yesterday on CBS. I think the likelihood that we're going to have a vaccine for widespread use and twenty twenty is extremely low. I think we need to think of that as largely twenty, twenty, one event, and if we do have a vaccine available twenty twenty s likely to be using a much more targeted fashion almost in a therapeutic says to protect very high risk populations. The current FDA administrators even Hahn has said it is possible the agency May Review a vaccine makers application, and make some kind of determination based on the evidence so far before trials are complete, but again, it will likely be many many months before all of us can be vaccinated. Twenty twenty one event as Scott Gottlieb says Ellison Aubrey. Thanks so much for your reporting. We appreciate it. Thank you, Noel.

flu vaccine Noel twenty twenty flu Ellison Aubrey US CDC director Commissioner Scott Gottlieb FDA Louisiana NPR Director Robert Redfield Cova Nyu School of law Midwest
Friday-The Complete Shutdown of The Murican Economy MUST End Now Before The Destruction Is Too Great To Repair!

CRUSADE Channel Previews

00:00 sec | 8 months ago

Friday-The Complete Shutdown of The Murican Economy MUST End Now Before The Destruction Is Too Great To Repair!

"Back to the Wall Street Journal. If this government ordered shutdown continues for much more than another week or two the human cost of job losses and bankruptcies will exceed what most Americans can't imagine. This won't be popular to read in some quarters but federal and state officials need to adjusting their anti virus strategy now to avoid an economic recession that will dwarf the harm from two thousand two thousand nine. Where have I heard that before? Here is my Arctic Hal. Yesterday at the daily caller DOT COM church coronas virus lockdowns are ultimately assaults on freedom. Gee I never would've imagined it. Do you know and they told me this yesterday editor. Hey I started to tell you this and I got off. The subject told me that this is supposed to be on the front page Biz. Another gun. Slinging shutdown owner was going to write the counter argument about the wonders of the shutdown chicken. Down he sends me an email yesterday afternoon. Goes a King Dude? I'm just GONNA go ahead and run this because the author that was going to submit the the opposed opposing piece has pulled out. I'm like why do you think that is because it's a dumb idea? That's why who in the hell wants to be in a position. Unless you're Steve. Sco Jack who the hell wants to being the position of promoting and defending this it's indefensible. Let's not let the perfect be the enemy of the good. Let's let the perfect destroy the good. That's what's going on here. Folks are calling on line telephone for four or five to seven eight seven. Two three the journal continues know. Put the link to colour in the chat room there. If you want to click it. This won't be popular to read in some quarters but fertilizer state officials due to start adjusting their anti virus strategy. Now who told you this beginning when last week I told you this there is a reasonable rational. Not Irrational human centered with care towards those who are going to be economically and that means in their ability to care for their family and the same geezers that There's a they're trying to protect. There's a way to do this without breaking the bank as they say. Is anyone listening to the King Dude? No maybe they'll listen to the Wall Street Journal editorial board the vast social distancing project or the last ten days or so has been necessary and has done much good warnings about large gatherings of more than ten people and limiting access to nursing homes will save lives. The public has received a crucial education in hygiene and disease prevention. By the by I have something to say about that. That's not correct renegade into that and even young people may get the message with any luck. This behavior change will reduce the corona virus spread announced in our house. Hospitals won't be overwhelmed with patients. Anthony FAUCI SCOTT GOTTLIEB another disease experts or buying crucial time for government and private industry tomorrow resources against the virus yet. The cost of this national shutdown are growing by the hour and we don't mean federal spending. We mean a Su- Nami of economic destruction that will cost tens of millions to lose their job. I told you this I told you I told you it. Look I'm a genius? Makes Common Sense Common Sense? This will cause millions to lose their jobs as commerce and production simply cease. Many large companies can restraint a few weeks without revenue but that isn't true of millions of small and mid size farms firms even cash-rich businesses operate on thin margin and can bleed through reserves in a month. I it will lay off employees. No no they can't now you can't lay a mock you lay them off. You GotTa give them thirty days families seeking medical lead. You can't lay them off. That's the worst thing you can do. Thanks trump for signing stupid bill. That Pelosi sent you then. They will shut after they do the layoffs there no shutdown another month like this week and allows will be measured in millions of people. Hey Wall Street Journal. It's not going to take a month. You got about five six days to fix this governors. Don't come to their senses and start altering these policies in five by the by this time. Next week you'll have unemployment through the roof. Millions will already be out of work. Did you know that the governor is actually telling me waiters and waitresses and fry cooks and hostesses and Bar Bax and bartenders than anyone else that works in the service industry notices are being sent out through their do their restaurants. And what have you to go ahead? And file for unemployment benefits. He plans to keep them shuddered for months. They can't survive this. You'RE GONNA put two-thirds of every restaurant and state of Louisiana out of business if you extend this beyond a couple of weeks they were simply shut down and they won't re-open they'll be buildings it'll be. It'll be driving through town. There looked like a ghost town. I have an anecdotal tidbit. Add this this morning. I've been doing a little sensors in my head. Every morning I pass a very popular very well visited gas station slice subway slash cre crispy fried chicken joint on my way right when I get on I twelve. It's called the joint is called on the run. They got two restaurants in their kind of built into inconvenience store gas station right so I don't know how you treat those restaurants. I mean everything is kind of take out there so I would imagine there's still operating it. Actually shut down their sandwich counter But their fried chicken is still open and they do offer breakfast biscuits in the morning. But that's it. It's not the bigger ray that they normally have. And you can't get fountain drinks anymore. They've closed down all the fountains. Everything just manage disclosing everything so I been doing a little sense in my head on Monday. There were seventeen vehicles and of Oregon lot today zero zero Tuesday there about fifteen Wednesday. There were still still double digits ten or so yesterday five today. None Matt a car on a Friday. You KNOW PEOPLE WANNA get up early. Go to work early. Get done early kick in to slide into the all weekend right. None Zero Point Freaking Zero Wall Street Journal. The dead weight loss and production will be profound. And we'll take years to rebuild in a normal recession the US loses about five percent of national output over the course of a year or so in this case we may lose that much or twice as much in just a month. Are Fred at our friend. Ed Hyman the Wall Street economists on Thursday adjusted the estimate for second-quarter to an annual loss of GDP of minus twenty per cent. I think that I think you're low ball on it. I think it's closer to sixty to seventy percent treasury secretary Steven mnuchin assertion Box Fox business news Thursday at the economy will power through all. This is happy. Talk of this continues for much longer. Can you tell? The Journal's editors are starting to get nervous after all they do cover Wall Street Wall Street Journal. Does it sound like they're still singing a happy to endorse.

Wall Street Journal Arctic Hal editor US Su- Nami Anthony FAUCI SCOTT GOTTLIEB Ed Hyman Steve Louisiana Oregon Fred Bar Bax Pelosi editorial board Steven mnuchin The Journal
Morning Brief for Wednesday, March 6th

WSJ Minute Briefing

01:52 min | 1 year ago

Morning Brief for Wednesday, March 6th

"Discover Milan Italy with WSJ magazine and into Garay. Join WSJ magazine editors for behind the scenes access in Milan. As you meet the city's most influential taste makers dine at top restaurants. Visit the private villas of lake coamo and much more book. This once in a lifetime trip at Indy. Gory dot com slash WSJ magazine or call six four six seven eight zero eight three eight three. I'm Anne Marie for totally in the newsroom at the Wall Street Journal, the resignation of Scott Gottlieb, the head of the food and Drug administration leaves the future of some of his initiatives. In question Gottlieb who worked to crack down on cigarette makers has also proposed a ban on menthol cigarettes. He also took steps during his tenure to speed up the approval process for generic drugs. Gottlieb's expected to leave his post within the next month. Two new studies say US consumers have been the hardest hit by trade tariffs. Researchers say importers pass costs onto consumers who bore an added sixty nine billion dollars in costs last year. Wednesday brings the latest international trade data for the month of December amid ongoing trade tensions between the US and China will also see the Federal Reserve's beige book on Wednesday, including anecdotes from small businesses across each of the Fed's twelve districts, plus we'll have earnings reports from dollar tree Abercrombie and Fitch NB Jay's wholesale among others. Retailer and jeans maker diesel has filed for bankruptcy. The company hopes to reemerge from chapter eleven quickly with fewer stores and a revamped business plan diesel launched in the US in nineteen ninety five. It was founded overseas in nineteen seventy eight for more details. Head to wsJcom or the w s j app.

Scott Gottlieb Wall Street Journal US Milan Italy Milan Federal Reserve Anne Marie Fitch NB Jay lake coamo food and Drug administration Garay China sixty nine billion dollars
Sen. Chuck Schumer On New York, The Response So Far And A Possible Fourth Relief Bill

NPR's Story of the Day

00:00 sec | 7 months ago

Sen. Chuck Schumer On New York, The Response So Far And A Possible Fourth Relief Bill

"Former FDA head Scott GOTTLIEB issued this warning to Americans last month March eighth. The next two weeks are really going to change the complexion this country. We'll get through this but it's going to be a hard period. We'RE LOOKING AT TWO MONTHS. Probably have difficulty as has become painfully clear. Gottlieb was right that the complexion of daily life in America has changed dramatically. Tens of thousands of people have been sickened by the corona virus. Millions of lost their jobs and doctors and governors are warning about American hospitals at a breaking point last night in the White House briefing room. President trump warned about another critical two week period. I want every American to be prepared for the hard days that lie ahead. We'RE GONNA go to a very tough two weeks. The president flanked thereby his public health advisors. Dr Deb IRKS. Dr Anthony said one hundred thousand to two hundred forty thousand could die from the corona virus. And that's the best case scenario. So how will? America's leaders help Americans navigate this period and beyond well. Let's bring in one of those leaders. Senate Minority Leader Chuck Schumer Democrat of New York. Senator Schumer welcome good afternoon. Mary Louise I know you are joining us on the line from your home in Brooklyn would you start there? What what does it look to New York right now? The epicenter as it were it's eerie because the streets are empty We I only seen four people in since I got back from Washington a week ago Wednesday and got in my car midnight. I wanted to get out of Washington. Get Home Quick. Got Home at four thirty and I've seen four people my wife my daughter and son-in-law because their apartment smaller living with us in my one and a half year old grandson I do get to 'em on for two hours a day and chasing him around is as exhausting as anything but is in there. Yeah social thing like not that Yes yes I do go out for a walk in. My doctor said just a six feet away from anyone. I probably make it twelve feet so I'm walking the street a lot of the time and I hope people don't think I'm upset with them when they see people I know and I just crossed the street now rather quickly remarkable at the isolation for New York is particularly confounding. Because we're people who like to be together after nine eleven. We hugged each other and clung to each other. We ride the subways and we're in close contact with people of different backgrounds and every different type and here. We are were isolated. We don't know how long this is going to last. We know where the center but there are a few things that you know. I'm on the phone. Almost twenty four seven today. I asked the president to give us a hundred percent of the FEMA aid. He said he'd look at it I'm calling on the president also to have as czar for distribution of these hospital Of THE SUPPLIES. We need the. Ppe's and the masks and the ventilators they have pointed someone under the defense production. Act The act that allowed during the Truman administration the government to take over factories and produce. And they're starting to do that but they're not distributing it well so our mayor had a call. Sweden to try and get ventilators. The governor had a call to someone in California. They said well. We're sending them overseas. The president should appoint probably a general. Who's an expert at quarter mastering getting supplies from one place to the other to take over the supplying and giving the places that need The ventilators in the mass the preference of everybody just catches catch Kellyanne. Let me I think the other thing. The one other thing I've asked for is that the federal government today I asked the president to Pay Hazard pay to all of those on the front linus lines. These nurses these doctors The healthcare workers they're risking their lives. I'm sure when they walk to work or take the subway to work. They still have to get there. They're wondering will I catch this virus? They're like the firefighters and police officers and construction workers where heroes of nine eleven. These are our heroes today and they should get hazard. Pay The federal government every federal worker as it paying. I think in the next co Bill. We should require it for everyone. Shifts your senator to the news of the day and the possibility of a fourth rescue package speaker. Pelosi's been talking about this all week Over in the Senate though Senate Majority Leader Mitch. Mcconnell says hey. It's way too early to talk about another package. We haven't even got the programs we funded in the one. We signed last week up and running the land on that. I think they're both right. We should be focusing right away. We passed to use package. We Democrats played the major role in shaping at the Republican. Bill did not help average folks and did not have a Marshall Plan for hospitals. We did and so getting those unemployment checks you know. The Federal Government under are unemployed on. Steroids has said that we will pay every worker. Their full salary for four months and the company doesn't have to fire them they can follow them. Stay on the payroll so when God willingness crisis is over these companies restaurants manufacturing places can reassemble having not lost their workers right because they're getting paid and getting followed. Well we need those unemployment checks to be out in two weeks and I've asked the president to make sure that happens. The President President. Yeah the the the president calling in this next package for another two trillion dollars. Yeah aimed at and don't let me just put a question which is do we have another two two trillion minutes two trillion here two trillion. There can we afford this already opposite. Look I think we'll do a covert for we have to and there are certain things we must. We have to look at election reform. How are people going to vote and we need to lay out? How and we may have to look lay out. How Congress is GonNa vote if we can't you know the Senate? They have to fly the house from all over the country. I think we have do things with paid leave. Paid sick leave. Paid family leave as for an infrastructure package. When you start looking down the road and you say how do we get our economy going? And how deep is the hit to our economy. There is no better thing than infrastructure. But I think that that the first job is to beat this healthcare crisis and deal with people who have their immediate problems and I would not at all be adverse to infrastructure package. I wanted to be quite green looking at the future. As well as the traditional infrastructure it does from the question of how infrastructure work would even get done. When when much of the country's on lockdown exactly so it's a it's a longer-range view of getting the economy back but job number one get that those materials to our hospitals into our healthcare workers. Get the unemployment checks out to people who need it. Make sure that thousand dollar payment. I talked to the president today and I said you know not the President Mnuchin. Rather getting treasury secretary moved into each other. Yeah make sure that people who don't have Who Haven't paid taxes or don't have some kind of job pay. Everyone on social security should get one of these checks just in the moments we have left. Senator Can Congress do anything about that about getting those checks to people who need to pay their bills to pay rent. I think we did a very good job. Not Perfect meet. Occulted for On on on laying out what has to happen now. It's up to the administration to get it done but we have to watch them like a hawk because this administration is not good at administering senator. Thank you nice to talk to you Mary. Louise Senate Minority Leader Chuck Schumer tacking to us there from his home in Brooklyn.

president President Chuck Schumer senator federal government New York Senate America Senator Schumer Scott GOTTLIEB White House Bill Congress Brooklyn Washington Louise Senate Minority Truman administration FDA
Special Report | Markets in Turmoil

Squawk Pod

00:00 sec | 5 months ago

Special Report | Markets in Turmoil

"Today every answer matters more than ever before because whether it's about health deliveries or finance some things just can't wait that's why IBM is helping. Businesses manage millions of calls texts and chats with Watson. Assistant it's conversational. I designed to help your customers find the answers. They need faster no matter the industry. Let's put smart to work visit. Ibm Dot Com Slash Watson Assistant to learn more I NBC producer. Katie Kramer. One of the voices behind the CNBC. Podcast Squawk Pot in these times of uncertainty. We WanNa make sure we're bringing you our listeners. As much information as possible as quickly as we can. That's why we're sharing with you now a CNBC special report markets in turmoil. Listening good evening. I'm Scott Wapner on day. One hundred fifty of the coronavirus crisis the death toll in the US tops. One hundred thousand but tonight there is optimism for the future of jobs in America two night new signs of a comeback. It's another step in the return to some degree of normalcy from the world of sports to the Great American Job Market. Plus Disney makes its pitch. It's ready to open the magic kingdom believe Shirley for improving the number of guests that we can accommodate five tonight. A key player in the decision making chain is with us live. And we'll take you to one great American Beach Towns Main Street to show you how businesses are trying to fight their way back this. Cnbc special report begins right now. Here's Scott Wapner. Welcome good to have you with us on this Wednesday night after stocks rally again. Let's give you your first look at the futures very early of course and we are mixed the Dow and the S&P would open higher s for today more optimism over the economy reopening. Was the story on Wall Street. The Dow rising more than five hundred fifty points closing above twenty five thousand for the first time since March the P five hundred climbing one and a half percent so far this week. The Dow is up almost four and a half percent the Russell. Two thousand small cap index up. Almost six percent jobless claims tomorrow morning expected to be yet another reminder of the toll this pandemic has taken on the employment market but are there. Signs of coming turnaround viewers will know. Evan sewn is the man behind the sewn investment conference but he also runs recruiting dot com. His firm works with tens of thousands of recruiters throughout this country and they are releasing a new monthly survey tonight showing reason for optimism. We welcome Evan in evidence. Sight to see you. We normally this time of year would be at your investment conference raising a lot of money for a great cause but here is where we find ourselves. What are you seeing on the employment standpoint? First of all great to see you Scott and again we look forward to many years in partnership with CNBC on the phone conference foundation. Recruited DOT COM technology platform combining more than twenty five thousand small independent recruiters with AI powered job sourcing and talent matching and recruiter comes spilling the jobs with employees across the country so with this platform of twenty five thousand recruiters. We realized we have this unique opportunity to hear from the job market from people with the years to the ground really the recruiters we created the recruiter index as a Ford Looking Data. Set on hiring job trends that we can use to steer are focused internally. We publish those last month. And now we're showing the May recruiter index with you today. And we'll be on our website tomorrow. So give us an idea what are the highlights what we said we were seeing some optimism. Tell us how. Yeah that's correct. So we're seeing some positive trends one of the biggest trends that we saw in April. The average recruit was working on twelve jobs and it may we saw jumped to fifteen jobs just to give that context in a good market. Your average could be working on twenty to thirty jobs so we're seeing a real nice increase in April only nineteen percent of the recruiters that we serve eight felt. The job market was staying stable our approving and in May that number jumped from sixteen percent to forty one percent so again a very big bounce back in a very short period of time and optimistically this really points to a healthy recovery as the majority of recruiters across all sectors about over sixty percent believed that the job requirements are going to increase over the next ninety days and this compares to only thirty eight percent last month in April when we did the survey what. What's interesting is the predictions of the top sectors or industries. If you will have changed a bit from April into may tell us about that. What kinds of jobs? Specifically we're talking about sure so healthcare is now eight hundred. Eighty nine percent see demand increasing the next ninety days. It and taxi seventy two percent and then really interesting last month. We didn't have construction manufacturing at all on the index and now sixty seven percent of the recruiters surveyed in those sectors in the manufacturing those jobs increasing and ninety days and sixty percent in the construction space so again new new sectors. I received a demand for in the next ninety days. I'm wondering how much you yourself are. Sort of thinking about the future of employment how structurally may change work from home and and things like that and the different kinds of jobs. We may have future. Yeah look there's no doubt that. Millions of lives really disrupted by cove nineteen and we empathize with everyone. Who's really lost their job and has the largest platform for small independent recruiters. It's really our mission. And our responsibility to not only report from the front lines but to really leverage recruited dot com to help these businesses of all sizes filter open roles as fast as possible and get people back to work whether those are fulltime jobs gig economy or part time jobs. Evan we wish you well. It's nice to see you again. We'll see a down the line next got all right. That's Evans sewn joining US tonight. Now let's bring in CNBC contributor. Dr Scott Gottlieb is the former head of the FDA now a CNBC contributor so Dr Gottlieb this job recruiting data is good news. How should companies be thinking about the safest way to bring people back? Well really depends on the company and this is very good news. I think companies where it's an office job where people faced lower risk have different sets of circumstances that they need to consider. Then think of a job where it's a shop floor and industrial job and many of those stayed open but jobs where employees don't have the ability to social distance and protect themselves can't really wear proper. Ppc protective equipment throughout the day. I think they need to take more aggressive steps to screen employees more regularly and screen them coming back to work then perhaps a job. That's an IT service type of setting where people can socially distanced week. Densify the office and create more safeguards within the office environment itself. And I'm seeing a lot of companies. I'm talking to a lot of companies right now. They're talking about bringing testing into the worksite. Not JUST TO TEST PEOPLE COMING BACK WHICH. I don't think we need to do but implement more regular screening. What you really trying to guard against the risk that a single introduction of the virus into the workspace can cause an outbreak. We know there's going to be cases we know there's going to be cases at work. We want to prevent as a single case from getting into a worksite setting and creating an outbreak of any size. So gimme the blueprint. Then docker GOTTLIEB. I'm to put you in the chair in the corner office of the sweet. You're the CEO of a fortune. Five hundred what exactly would you do? Well you WANNA densify the office. You want to try to create some social distance within the office environment. You want to try to segregate employees as much as possible into groups that not everyone is intermingling with each other. But you have people in cohorts if you can so you have shifts that are more more spread apart. You want to close common areas or if you have to keep common areas open and you need people to have room to take a break. You want to stagger the break time so not everyone's coming together at once and in terms of testing you want to implement testing in some kind of protocol. We're testing representative sample of your employees on a regular basis. You can either. Test the entire workforce and ways to do that at scale. That could be relatively inexpensive. If you're starting to pull samples you don't test each individual employee. You take samples from each individual employee and you pull them together and you test the entire pool of samples so you you can only you can test one hundred people at once or fifty people at once. That's actually how China manage to test ten million people in a week. They didn't test ten million individual people. They took samples from ten million. People may tested a million samples because they pulled them into pools of ten. So there's ways to do this to leverage some of the platforms to do it more efficiently. But you want to get in place some kind of testing regime. I think at most workplaces where people are going to be congregating together in close contact when you're getting a representative sample. So there are cases spreading in the workplace. You're going to identify them. There are mildly symptomatic recent places and finally for people who are symptomatic. You WanNa have good protocols in place where they can go and get tested. You WanNa have generous benefits that allow them to self. Isler at home if they have covid to not come into work. You also want to designate someone inside the office environment to give advice to people who are worried about the fact that they might have been exposed or might have covert nineteen so many differences to to consider the difference between a corporate office park in suburban America versus the Office Tower in the early large urban centers. Many different things have to be considered right right and remember. A lot of the risk isn't just in the office environment. I mean there's risk in closed environments where people are going to have sustained contact. Not that describes a lot of workplaces and so you want to reduce that risk of sustained contact in a closed environment but a lot of risk getting to and from work as well and so you want to provide for measures that help people reduce their risk of getting to work and from work so people have to take mass transit. Maybe stagger the workday in ways in which people could get to work and get from works and not traveling during rush hour. Maybe for vans if you can or other kinds of travel to work provide for car pooling ways to sort of densify. The trip to to work as well on these are the kinds of things. Businesses should be thinking about you want you want to reduce risk in knocking to eliminate risk. There's still going to be risk. They're still going to be infection. There's going to be infection and workplace. Finally another point on that is you need to have the tools in place to do good contact tracing in the workplace so if someone does have a case of covert and workplace. You WANNA be able to quickly identify who they might have been in contact with. And there's actually technology that you can use in the workplace a lot of these APPs that track. We might have been touch with that. We might feel uncomfortable. Deploying a sort of wide setting in the general public in a workplace that might be acceptable. People might be comfortable with that. Want to ask you about the tools and contact tracing plays into it Dr Filed. She said something interesting this morning. Dr Godly Bundy said. A second wave of the virus isn't inevitable. That's the word that he used that we can still take the right steps to prevent it now. Contact tracing obviously comes into that. I'm wondering what you think about the statement he made and whether you agree with it well. I'm not sure exactly what he meant by that. I think some pervasive spread of this virus is inevitable. I don't think it's just GonNa go away. That doesn't mean a second epidemic or large outbreaks in the fall faller inevitable that we can mitigate I mean I think this virus is going to continue to circulate around the world. I think this is going to become endemic. It's probably going to become one of the circulating strains of covert and ultimately. We're going to need a vaccine to this to really fully vanquish the risk for good. But we don't need to have another epidemic certainly not on this scale but even large outbreaks outbreaks in cities and states. Going into the fall. We do the tools and the capacity is if we plan well to mitigate that a lot of it's going to depend on what people do in the workplace. I mean trying to get testing into the workplace is very important because I think people are GonNa have a challenge getting access to testing in the community so the worksite might be someplace that people can get much more ready access to Cova testing and also testing mildly symptomatic asymmetric people. We can't just people who have clear symptoms of covid because we know a lot of the spread is for mildly. Symptomatic recent dramatic people that if we're not testing them on a routine basis we might not catch them talk about tools and capacity. That's great do. We have the political wherewithal Dr Gottlieb to follow through on some of these more necessary steps. Contact tracing it's a great question. I mean I think that some states are doing this very well and investing in this. I think other states are hesitant. And you're seeing some political concerns around contact tracing as well because it seems to have taken on a political dimension where it's perceived as sort of government intruding into people's personal lives. I don't think it needs to be that way. I think that there's a perception that there's going to be so much infection that if we try to do contact tracing we're basically going to have the government tracking down. Everyone that doesn't need to be the case. I think that we can keep infection. Blower a certain level that we can do efficient contact tracing and it's not going to be intrusive into everyone's lives not everyone's going to get a tap on the shoulder and say you were in touch with someone who had covert you now need to go for testing and you might need to sell vice late. I think we can keep the group. The number of people who have this infection are exposed with down to a manageable level. Certainly South Korea was able to do that. Singapore was Japan was these are big countries and so as we come off the summer if we can get infection down and I think we will heading into the summer and we head into the fall. We could try to keep up with this. There's no reason why we can't be optimistic and think that we're going to have the tools to keep up with us. Not sure hope you're right. Stay with me if you would Dr Gottlieb again this evening at Disneyworld. A magical step closer to reopening. It was given approval today from the mayor of Orange. County Florida. Disney now needing the final sign off from Florida's Governor Orange County mayor. Jerry demings with us once again this evening mayor. Welcome back did even Scott. I'm glad to be back. So you've approved the plan for Disney. What do you think the governor's going to do? And what will you recommend to him? I recommend to the governor that he allow Disney to reopen on June eleventh. And I believe that he will prove that So we're waiting on confirmation at this point. We don't have any word from Disney at on. What sort of capacity requirements are going to be put into place but in your own mind? What makes sense to you? In terms of the number of people that you'll feel comfortable with inside that park others in the region. Obviously Disney is a large attraction itself and so the total capacity for business one of those things that they consider like a trade secret will but suffice it to say I believe that. They're likely looking APP when they initially reopen a be it when if. I TOOK ACID. And what are you thinking about when it comes to hotels both on property which may be Disney in charge of versus those in in your in your county. How should we think about hotels? And the safety and the security of the visitors believe that has taken all of the measured steps to ensure the safety of this guest. Wow a visiting there either. Resorts are the parts attractions They have put in an abundance of screening. That would take place not only for the guests before they employee's whale then they have numerous sanitary admitted that they have put in place and then They have created an engineer. Social distancing within the various rise attraction. Sin If you couple that with Referring all of their employees as well is there guests to wear masks. We believe that it'll be a safe environment. They will have numerous ambassadors if you will sanitation ambassadors that will be located throughout the are that will constantly remind people of the need to create distance between themselves. And I believe that if you look at it from the perspective of of and dealing with this pan-demic is like a war. Between earning clean a Disney has really focused on a lot of linens of measures. That will hopefully keep everybody safe in the process. You wonder and think about if not even worry about whether anybody's is going to show up. I believe people will show up If not just our local community of the Delighted data's that they that will really all look forward to seeing their at Park itself and a soda. Some pinup that man. I believe from those hills in central Florida and really those within driving distance. Oh we expect to have a significant Number of people who will be attending. But there'll be spread out is such a large are. You likely will not see people really on top of each other and so I feel very comfortable about the measure. The Post they have used a real. You are certainly in if not the epicenter one of them in this country when it comes to Family Entertainment Wendy you in your own mind feel like things will get back to some semblance of what you thought normal was think we're a ways away from seeing what we all believe with What was normal re cove nineteen days free? I'M GONNA early March for us. It's going to take some months to get back to that level because of virus astill a amounts us is alive even though he within this community we have a beverage small positivity rate we have a rate of about a two point eight percent. We've done a some. Approximately sixty seven thousand individuals have been tested and out of that number one thousand eight hundred seventy seven have tested positive and so eighty four eighty five percent of those who have untested have fully recover so when I community the Department of Health estimates that we have maybe three hundred people who are still active now because we have three hundred people that needs at three hundred individuals can spray the virus very rapidly if we don't really Adhere to the CDC guidelines on all of these sanitation measures. That have been put in place. So I feel really comfortable. Because we see significant compliance from our residents here within our area where they are wearing masks near all those things have auditor of feel comfortable with reengaging. We know from a consumer confidence survey that we did here with in Orange County. A we have a population of about one point. Four million and over fifteen thousand people participated and I'm consumer confidence survey and from that survey what they said to us Nearly two-thirds of them said that in order for the field Engaging they WANNA see these senator measures in place and so for businesses to be successful live the launch theme park. They're gonNA have to display that kind of Sanitary measures that placed Lastly Mayor of would you take your own family to Disneyworld or one of the other theme parks. I look forward to taking my family and you know my wife is the United States House of Representatives and she spent a Lotta time in Washington. Dc and our tease all those but at some point I think as she deals with the business of the nation Joe Return and I look forward to some point this summer going at this taking. Yeah a little little downtime and experiencing with our attractions have off. Well we wish you well and certainly Wish you the best in your counties. Path FORWARD. Very much That's mayor demings joining us from orange. County Florida Dr Gottlieb. Turn back to you now as we're thinking about many of these theme parks within the next handful of weeks are going to be reopened in some capacity. How we think about that. Look anyone who's been at Disney and I've been at Disney. It's a carefully controlled environment. I think they had the capacity to reduce risk within the park. It's an outdoor activity. They can use ultraviolet light deep cleaning on the rides they can beat densify the food service. There's a lot that they can do within the context of the theme park and I really suspect strongly. They're thinking this through you. You saw some of a preview of it in terms of what they didn't Disney Springs. Which will they would create a lot of distancing between people how they were queuing people up. I think consumers need to think about the risk not just within the activity but along the journey getting to Disney and getting from Disney the risks. You're taking in the travel and how you reduce those wrists. The issue of the infection rate in Florida really isn't the operative question. Florida very low infection rate. The issue is what's the infection rate nationally. Because the thing like Disney you're bringing together people from all over the nation in some cases all over the world although I think international travels can be reduced for awhile and so it really becomes a question of what is the background rate of transmission around the country and if it sufficiently low these activities become relatively safe especially heading into the summer. I think we will get transmission down as we head into the summer so I think there's a lot of things that we're going to get back to doing doing differently. But we'll be able to get back to doing it as a consumer you need to think about the risk across the whole journey not just within the theme park theme parks a controlled environment. I think that there's a lot that they can do to reduce the risk within the park itself. That time again for some twitter questions. I've got a few four. Tonight's thank you for obliging us. There are viewers are looking forward to this Kathy. Jones writes Dr Gottlieb if my adult children test positive for the COVID nineteen antibody can. They visit their parents. Well it depends. It's probably not satisfying answer. There's two different antibodies. You develop in response the infection. I the first one peaks after about ten days. The second antibody peaks after about twenty days if the test probably test for both of them and and definitely looking for I d Jays so if if you have a high level of the second antibody which peaks after twenty days. You probably don't have the virus more you've cleared the virus. You developed a long-term antibodies that provide immunity. And you probably. Are you know safe to go out at that? Point of really looks like he wants. People aren't symptomatic for a period of about two weeks. They seem to have cleared the virus and are no longer. Contagious was interesting. Something that you flagged today as well the CDC saying the companies shouldn't use antibody tests on decisions related to going back to work. That's interesting right. And we've said that on his show first of all the tests themselves aren't reliable. There's a lot of invite tests that that. Fda has said aren't reliable. The agencies allowed him to stay on the markets. You really need to be cognizant of what test you're using the Abbott. Abbott has a good test out in the market. Roche has a good test out in the market. There's another test that's going to be partner with. Montesano reliable has high sensitivity and specificity. Meaning that if you have. Antibodies it's going to tell you. Have ANTIBODIES ALL? These tests have a high sensitivity. Not all of them have a high specificity which means that in a certain number of cases. They're going to say that. You have antibodies when you really don't and so what? I would do if I got. An antibody test is repeated if you had a positive hit on test I would want to repeat it because test with a specificity of ninety nine percents. That sounds really high but that means one out of one hundred times that you use that test. It's going to say that you have antibodies when you really don't and if only one in one hundred people have antibodies and use a test like that that means in one case out of one hundred. Have antibodies when you do and in one case out of one hundred is going to say. You have antibodies when you. That's a fifty percent error rate. That's pretty high error rate. And that's the problem with using tests without perfect specificity to test for low probability events and that low probably being having antibodies speaking of testing and lastly tonight for victory one ninety five. I recently was tested for Covid and have had to wait five to seven days for results. Wire testing results still taking that long. And what efforts are being made to improve our testing. We've heard about this before it. Apparently we're still hearing about it now. Yeah really shouldn't Labcorp attorney around these tests much more quickly. I would call you. Doctor AND PRECEDENT TRY to get those results more quickly. It should be within twenty four hours. Dr Gottlieb is always appreciate your time gets you tomorrow night. Thank thought that's Dr Scott Gottlieb former head of the FDA now a CNBC contributor. We do have breaking news tonight by the way from the White House in the world of social media. Are Julia Boston following that force? Live Tonight. Julia. Yes I'm the president is going to be signing executive order on Social Media Tomorrow But we don't know what that executive order is going to entail what is going to include. I've reached out to facebook and twitter for their response to this. They both said they have not seen the tax and without getting the tech. They cannot have any comment so no comment yet from facebook and twitter. And we don't know what this With executive order will entail. But I do WanNa know at this comes. After trump has a president trump has been in a bit of a standoff with twitter. It started when twitter put some warnings that there might be misleading. Potentially misleading information to of the president's tweets. This is the first time a twitter twitter's ever done this and Response. The president tweeted threatening to shutdown social media platforms are being biased and silencing the voices and he tweeted the big action was to come so this could be the big action. But it's unclear whether it's executive order will entail Scott. We'll see what happens tomorrow. We'll be following it. No you will as well Juliette. Thank you Julia for out in Los Angeles also on the Social Front Andrew. Sorkin speaking with facebook. Ceo Mark Zuckerberg tomorrow on squawk box. A very big interview starting at six am. There's a lot more ahead meantime on this. Cnbc special report. Finally a plan from big sports one commissioners plan to get the place laced up and ready to go next. Plus restaurant bookings are making a comeback. One business owners surprise when he opened the doors and we are going to using Effectively honored that for the car. A ride with Elon. Musk before the break images from around the United States on the One Hundred Fiftieth Day of Corona virus crisis Today every answer matters more than ever before because whether it's about health deliveries or finance some things just can't wait that's why IBM is helping. Businesses manage millions of calls texts and chats with Watson. Assistant it's conversational. Ai Designed to help your customers find the answers. They need faster no matter the industry. Let's put smart to work. Visit IBKR DOT COM Slash Watson Assistant to learn more welcome back day. One hundred fifty of the crisis here are some more headlines on the virus tonight. Boeing is laying off thousands of employees as part of its plan to cut ten percent of its workforce by the end of the year following the collapse and travel the European Union proposing a two trillion dollar Corona Response Plan for its twenty seven member countries. Nissan plans phase restart of its. Us manufacturing operations starting on June first and the NHL is one step closer to getting back on the ice as the League approved a return to play plan questions of course still remain on a return date. Nhl Commissioner Gary Bettman joining us. Now Mr Commissioner. It's nice to see you. I hope you're well. Thank you for coming on tonight. You're well also it's always good to be with you. Tell me about this plan at least the framework as you have it and how flexible you think you might have to be with well. Everything we've been doing for the last hundred and fifty days was to prepare model every possible alternative. In option we might have as circumstances were unfolding And this plan that that we ultimately agreed upon with the players in the players association on was intended to take into account fairness integrity of the competition so we can ultimately were the Stanley Cup. Make sure and perhaps not perhaps but actually most importantly account for players safety and health and wellbeing and for the players and for other personnel and for the communities in which we play so the notion is. We're going to open our training facilities. Let our players get back. Start working out. Many of them have never gone without skating this long. And then when we see what's developing in how they're feeling than move to the next phase which would be training camps will decide when and how long whence we see how the phase of training facilities goes and then once training camps over. We'll go into a a playoffs. That has a qualifying round and the play. It out obviously will be playing with summer and into the early. All a this gives the clubs who were still in contention for the playoffs when we add to a pause on more twelve an opportunity to see whether or not they actually would made playoffs. Nothing of course is date certain date though in your mind that says we have to start playing by such and such time or we won't be able to do it at all it's really more the other way We will probably open our training facilities the first week in June. It'll give players and opportunity to get back to the markets in which they play particularly players. Who may have to be quarantine such as those coming back from? Outside of North America I will move probably in some point in July baby Mitchell. I'd be in our training training camp mode and then we'll move in depending on how long the players think that they need for training camp. Then start playing. See our health issues for the players to fault. One is obviously covid. Nineteen and the other is our players. Have to get back in game shape up because we don't want them risking injury Coming back to it was going to ask you about the international players. You you probably have the most international rank and file and in all of Professional Sports. Do you know how many players at least percentage wise have stayed in? North America during the pandemic. Actually the last time I got the count soon forty. Four percent of our players are currently in the markets in which they play and roughly seventeen percent of our players are outside North America right now based on the list headcount I got. How do you deal with with sponsors and the kind of deals that you had in place in things that need to be renegotiated? How are you thinking about that? You know from all of our constituents whether or not it's the league dealing with the players and the Players Association. The level of cooperation and constructive dialogue has been outstanding been very collaborative in the same is true of our business partners whether it's our media partners or our sponsors at a licenses so we we're all in this together and we're going to all get out of this together and that's the way we've been approach you know. Lastly I realized that not all teams played the same number of games before you stopped. How will you deal with stats and the leaders in goals? And what are we? Because it factors into player contracts and incentives and things like that though as relates to impacting player contracts and potential bonuses that something will will work out with the players. Association of the factor. The matter is the regular season a has been concluded because not all the teams are going to be participating in the plan round in the playoffs. But we're no matter what team you root for an affinity for. They'll probably be something in this plan that you wish was a little different but when you look at the whole plan on balanced it's fair. It has integrity. It'll justify whoever ultimately wins the Stanley Cup And we're doing the best. We can under extraordinary circumstances that nobody any business says every bite experience. We wish you well can't wait. I really can't wait and hope to see hockey this year. Thank you thanks for having with you and I hope you and all your viewers stay out now commissioner Bettman. We certainly appreciate that very much. We'll talk to you soon. That's Gary Bettman. He is the Commissioner of the National Hockey League. There's a lot more ahead tonight on this. Cnbc special report next reopening Charleston South Carolina style. See how one business owner got a huge surprise when he opened his doors. Plus One person's down your neighbor is there to help main street. Usa Banding Together to turn the corner and it's going to have an option to have rocket thrusters rocket thruster yet. Take a drive. With Tesla's we're back in two minutes support for this podcast and the following message come from Stanford small if you're a small business owner head to stand for small dot Com for resources offers and tools from a growing group of Companies. That want to help your business get back to business visit. Stanford small dot Com to get started. Welcome back on a day when the Dow closes above twenty five thousand for the first time since March. Let's see right now. We're future stand as we take a look at how things could open up tomorrow fairly mixed picture. The Nasdaq would be under a slight amount of pressure off the open down. Snp positive comes after another rally on Wall Street the Dow rising five hundred and fifty three points the S&P five hundred and Nasdaq also ending. Higher financials were the best performing sector yet again. And the biggest gainers. Dour American Express Goldman Sachs and JP Morgan well. Us restaurant bookings are on the uptick since being shut down during the covert closures. According to open table in the last couple of days the number of seated diners in restaurants nationwide is up. It is good news tonight. We're speaking with chef. Mike Ladda he is the CO owner of to Charleston South Carolina restaurants fig and the ordinary opened his doors yesterday chef Ladda. It's nice to have you on our program. Welcome thank you for having me. I hear I hear some noise in the background. Is that tell me that you've got some people in your restaurant? Yeah so the ordinary right now. It's our first night. We launched fig last night and we're about fifty percent occupancy right now so how does it look like how people seated table maneuvers? Did you have to do? What's the atmosphere like? So there are several protocols suggested by our state governments to have tables eight feet of arts No seats closer than sixty two parts so basically like our bar typically as about twenty seats right now. We have six people barnes for eighteen people seeking imagine. It's relatively empty and like every other table full and honestly going from nothing for the last ten meets. It feels like very fifty percent capacity. I granted it's not what you what you want. Frankly that sounds a little bit better than I might have expected when you hear restaurants talking about maybe twenty five percent capacity where it becomes much harder as you know chef to turn a profit will this fifty percent capacity. We're not gonNA make any money either. But hopefully we're kind of meeting on the hell which ours is about to run out anyway so we didn't get a chance to utilize the funds the way they were intended than. I think most restaurants are having that struggled return a balance public safety in our financial responsibility. So you know opening up. Fifty percent allows us to utilize the hopefully pay some bills. Stay solvents get back to you. Know Guess consultant bills that we left behind. We close by moving forward. Once that money runs out which is only three weeks away for us. We'll be faced with a pretty steep payroll middle in our our rents our mortgage insurance or interest is really going to be kind of difficult for us right now. We have a full staff right now. We have you save fifty people in the restaurants in both digging the ordinary right now but once the payroll squarely lies on our shoulders without the of the text program. It's going to be near impossible to make ends meet. Honestly if what I what I hear you saying and correct me if I'm wrong is that you might not have moved forward to opening your restaurant again right now at least because you can't be profitable but you're up against the deadline of having to use the P P P so you felt compelled to do it. Is My story sound straight so it could be more accurate so what really happened here for us. We were giving money several weeks ago. I think we're about eight weeks into it and so the clock is ticking. Of course you know. I'm a member of the infant restaurant. Coalition there's a great group busted have been trying very hard to get to defeat. Bts is typically with egg date of when we start using those funds and because there hasn't really been any movement yet however his of some of the stations right now obviously the theory will be extended where we utilized funds outside of that eight weeks so our date where we after wrap up intended use for anything fees June ten. So after June. Tenth we're going to have payroll burden that that will never be able to meet right at fifty percent occupancy however if we were given some median see on the dates and the window of which we can apply it. Well then we have a fighting chance to get up running at the community. Feel good about it but I don't think we would have opened it all in the midst of this You know endemic. Yeah if we know I it's it's interesting. It's a challenge for certain we wish you well. We know the struggles at all of y'all are going through and we wish you the best. Thank you all right chef. Mike Ladder joining US tonight. Along Musk's SPACEX had to scrub it's manned mission to space this afternoon. Because of weather problems the new plan is to launch. Either Saturday or Sunday it will be the first manned mission to space from US soil and just about a decade. Even though. Musk didn't get to show off the rocket ship. He is showing off his cyber truck. Tonight on Jay Leno's garage right here on NBC. But we didn't change on whenever finally reached production. What do you think you would do? We're five percent too big and if we just take all proportions and drop them by about five percents all the way around your favorite person of how are we? I think you're looking good on the side. Okay going into the tunnel says going pretty good you kind of have rocket thrusters yes. And what will provide the thrust? There's no fuel in the car. No WE'RE GONNA use ultra high pressure. Compressed Air oh I see okay so called Gas Roster. Okay all right. The main thrust will be like Behind the license plate so WH- for acceleration drifts license. And just that behind license plate as rocket thruster. You can catch more of your lawn on Jay Leno's garage looks fun tonight. Ten P M eastern time. There is more ahead right here on this. Cnbc special report. It's definitely GONNA be a big morale to see he things from a lab tonight main street in a classic American Beach Town. See how they're trying to turn the corner next tonight before the break what our world looks like on the One Hundred Fiftieth Day of this historic pandemic welcome back. Businesses and resort. Towns are hoping for a summer boost. Cnbc's Andrea Day talks to three entrepreneurs on main street in Morehead city North Carolina on how they've adapted in the face of this crisis. City is truly the crystal heads and has become a major destination spot for a lot of bugs. We don't have a lot of big business here. It's mostly small town. The community really sources other literally. We had maybe a clough to kind of change our way of life and we made the decision to close for two weeks. People were sending me facebook messages and text messages. Saying I'm almost out copy. You'd need to open up so I can get some more offi so we made the decision to a off day. I'll put it out on facebook and some people just want to make fresh. Ruth offing given us a chance to stop. Take a breath revisit. What we're doing this. Continue things that we were not owning successful on amp up the things that were good. And just kind of like have a reboot down. The street of pet shop is hoping for a summer boost. Used to they would come in and buy a dog food but they'd also buy toys and treats and stuff like that. Now it's a lot more buying just just in his are lungfuls around here. Really support us but that summer boost gives the extra to put back in. The store are to their local beaches out of flight or cruising. Well they just opened our beaches fully this past weekend. It was crazier than July fourth small businesses. We'll also get a big boost. From the town's fishing tournament I literally called every participant from last year. And we asked them about the males who you feel. We're not going to be able to hold the events still WANNA fish and everybody was just like thumbs up one hundred percent. Let us fish last year. We gave away eight hundred thousand dollars to charity in our community so you can imagine in a small town. That's very important. It means a lot to the charities that are here because other than grant writing there is really no one else to get. The money won't gathering we won't have the parties but the base can go out fishing. That's about the best social distancing you can people look after each other and that's what they do cross small communities across the United States. One person's now. Your neighbor is there to help. It's definitely GonNa just the a big morale things to see. He thinks from alive on Main Andrea Day. Cnbc we of course wish everybody well up next tonight. Honoring America's restaurants from coast to coast as you know each night. We give shout outs to restaurants across the country. You can tweet me at Scott Wapner. Cnbc please use the HASHTAG. Thanks for the GRUB with the name and town of your favorite restaurant. You can send us a picture as well tonight. We honor Colton steakhouse and Grill in Cabot Arkansas. The Rod and reel peer in Anna. Maria Florida the Rock Restaurant in normal Illinois Waltz pub and grill in West Lafayette. Indiana and GINO'S EAST CHICAGO PIZZERIA DOWN IN ARLINGTON Texas on Day. One hundred fifty of the crisis here are the latest headlines Tonight. The number of Americans that have now died from the virus topping. One hundred thousand Boeing resumes production of. It's seven thirty seven Max. The Dow up more than five hundred fifty points. Don't Miss Tonight Elon. Musk on Jay. Leno's garage is coming up here on. Cnbc a couple of hours for all of us here at CNBC. I'm Scott Wapner. I'll get you tomorrow on the halftime before noon. Eastern Shark tank coming up next today. Every answer matters more than ever before because whether it's about health deliveries or finance some things just can't wait that's why. Ibm is helping. Businesses manage millions of calls. Texts and chats with Watson. Assistant it's conversational is designed to help your customers find the answers. They need faster no matter the industry. Let's put smart to work visit. Ibm Dot Com Slash Watson Assistant to learn more.

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Special Report | Markets in Turmoil: Remdesivir Challenges

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00:00 sec | 6 months ago

Special Report | Markets in Turmoil: Remdesivir Challenges

"For businesses around the world today isn't a restart it's a rethink that's why they're partnering with. Ibm retailers are keeping their systems up as millions of orders move online. Paul centers are using IBM Watson to manage an influx of customer questions with a I and solutions built on the IBM cloud are helping doctors care for patients remotely today. We're rethinking how business moves forward. Let's put smart to work visit. Ibm DOT com slash thing to learn more I NBC PRODUCER. Katie Kramer. One of the voices behind the CNBC podcast squawk pot. In these times of uncertainty we WANNA make sure we're bringing you our listeners as much information as possible as quickly as we can. That's why we're sharing with you now a CNBC special report markets in turmoil. Listening good evening. I'm Scott Wapner on day. One thirty seven of the corona virus crisis the nation's former vaccine chief tonight with an ominous warning for the country. Twenty twenty could be darkest winter in modern history. The doctor charged with finding a vaccine for the virus. Demoted by the White House. Speaks out our window of opportunity is closing tonight his plan and what the CDC is proposing plus new fears. This country is in for a shortage of a drug. Many think. We'll stop the virus and we need to be six feet. Apart this table got to real ranging America this CNBC. Special report markets in turmoil starts right. Now here's Scott Wapner. It is good to have you with us on this Thursday night after the Dow snap three straight days of losses. Let's get our first look this evening at futures right now. It is early of course and they are modestly lower across the board stocks though. Shrugging off more dismal unemployment numbers and erasing early day losses. Today the Dow rose more than three hundred seventy five points after being down more than four hundred. Fifty early on financials were the best performing sector for a change. American Express rising more than seven percent late this afternoon. The New York Stock Exchange said it will reopen the trading floor to some of its brokers on May Twenty six today in Washington ousted vaccine official rick. Bright taking center stage testifying before the House health subcommittee. Warning the government's current response to the corona virus could lead to even deadlier months ahead. We are facing a highly transmissible and deadly virus which not only claims lives but also disrupts the very foundations of our society. The American healthcare system is being taxed to the limit. Our economy is spiraling downward and our population is being paralyzed. By fear stemming from a lack of a coordinated response and a dearth accurate clear communication about the path forward. I fear the pandemic will get worse and be prolonged. They'll be likely a resurgence of Kobe. Nineteen this fall. It'll be greatly compound at by the challenges of seasonal influenza without better planning twenty twenty could be the darkest winter in modern history. First and foremost we need to be truthful. With the American people. Americans deserve the truth. The truth must be based on science. There is no master coordinated plan on how to respond to this outbreak. We don't have a strategy or plan in place that identifies each of those critical components and we don't have a designated agency that is sourcing those critical components and coming up with a strategy to make sure that we have those supplies when we need them. Cnbc CONTRIBUTOR DR Scott Gottlieb with us once again he is the former head of the FDA. Of course Dr Gotlib. Welcome back the explosive testimony from Dr. Bright is where we begin tonight. What was your biggest takeaway today? Well look I think Rick's right in so far as we face challenges ahead with this pathogen. It's not going away. This is likely to come endemic. I think the tools we're going to have in the fall a very different terms of dealing with this. We're GONNA know how to contain outbreaks in the fall. Hopefully we'll have much better testing in place. Certainly we'll have one more drugs available to US eventually. We'll have a vaccine probably towards later in the fall that will be able to use but this is going to circulate and as this collides with flu season will likely face challenges trying to differentiate corona virus from flow and. This is more contagious than the flu. So if this is left unchecked which it won't be but if it's left unchecked we could face another epidemic heading into the fall now. I think we're GONNA be in much better shape to try to grapple with that and prevent it but those are the risks. Do we need a moore master and coordinated plan as Dr Bright suggested today up till now most of the critical decision making Dr Gotlib has been left as we know to the states. Do we need a moore master coordinated plan from the Federal Government? Well look I think at this point. The states have done a good job. I think it's likely to remain. A state led effort and I think the states are in a much better position going into the fall to know what they need. What we're likely to see in the fall is rolling out breaks. I don't think that we're to have another national epidemic. I hope not. I think we're in a position to try to contain spread but we're likely to see rolling outbreaks where cities become epidemic or states have large outbreaks. And then it becomes incumbent upon local officials to implement to try to control those outbreaks. And so it's not necessarily a national response. It's going to be a state by state response. My one concern is that no state wants to go first and so if you're a city that has now braked you want to be the city that shuts down your airport or your economy to try to contain spread within your city to put to create safety for the nation as a whole and we saw with. Seattle. Seattle is very reluctant to take those measures when they should have. San Francisco is really the first city to implement those tough measures and so hopefully by the fall. Governors and mayors will be in a position to take more aggressive action earlier to try to contain spread. If they're the ones that have that outbreak we're finally getting the CDC reopening guidelines. We've been waiting for those a Dr Gotlib to deal with schools and workplaces camps childcare mass transit bars and restaurants. How strictly should states be following those? Well they're they're greatly scaled back in terms of what we were expecting. And what the draft documents said that were leaked unfortunately to the Washington Post but we gotta look at those draft because the reporters got a hold of them and what was essentially released. Were some of the figures if you will in those documents some of the flow charts and so it's not very specific guidance system businesses and I've been talking to a lot of business leaders who are now developing their own guidelines on their return to work what they plan to do in the workplace and what they're generating is far more specific far more granular more detailed and frankly more aggressive than what's outlined in those flowcharts. Cdc It's not clear this represents the totality of what CDC is going to put out but if it does. This is pretty much top-line guidance what the businesses are going to do is GonNa go well beyond this. You use the word greatly scaled back. Does that put more people at risk doctor. Well it's it's not as helpful as it could be. I mean I think what you want. From public. Health officials is more detailed guidance that provides more granularity more specificity. To businesses businesses now need to make decisions about how to implement hygiene and workplace how to implement social distancing how to how to create a staggered workforce. So that you're not bringing people together in groups how to implement testing in the work site if you want or make it available the guidances would put out tonight really the flow charts. That will put out tonight. All make those recommendations they say. Businesses should engage these activities. But they don't provide a lot of specificity on how to do that now they link back to Information Soriano. Cdc website so that's a little bit more granular but it's not specific to the workplace and so businesses now need to go beyond these flowcharts. He's flowcharts are sort of top lying. These are the things you should be thinking about now. Business need to implement more detailed plans on how to achieve these goals. Sounds like business is going to be left to itself much like the states where to try and figure this out on their own including how to deal with children back to school. Which New York's Governor? Cuomo today said he's unsure whether schools will be able to open in September. Do you think they will? I think it's too early to tell. Look it's going to depend on what July and August look like and if we head into July and August and the infection rate does come down. There's a seasonal here. We believe that will be a seasonal effect. We don't know how powerful it will be but if the infection rate does come down heading into July and August and we'll coming off of August where there's not a lot of background infection. I think there's going to be an attempt to reopen schools in the fall now. Schools may take certain measures to try to reduce the risk. They may stagger classes. They may have students work from home one or two days a week. They're going to try to create physical separation. They may try to expand their campus. So there's things schools are going to do but I think they'll attempt to reopen schools. And then we'll have to see how this progresses if we have outbreaks around the country in certain regions in certain cities in certain states. I think you'RE GONNA see rolling school closures. Hopefully we don't get to the point where there's a national epidemic again and you see simultaneous closures across the whole country. But I think we're likely to see rolling closures in different parts of the country as you have local infection in a city or state. We're seeing China. South Korea Hong Kong all facing new clusters tonight as they reopen even more. Is that a preview. Dr Gotlib of what may happen here as we open up more states. We're GONNA have as we reopen. Now we're going to have more infection now. If you look at the data the date is actually encouraging hospitalizations. Coming down cases of coming down even as we're testing more positively rates coming down so the national trend actually looks encouraging right now. But if you put if you follow the states that are reopening I would expect. Cases are going to go up and hospitalizations will go up. That's what we expected all along so that shouldn't surprise. You don't want them to go up a lot. You want to continue to monitor that. That's why we want to reopen slowly. So you can implement mitigation steps to prevent more outbreaks but heading into the fall. We're GONNA have cases we're GONNA have a spread of this virus. It's not going away. This corona virus. It's highly contagious. It's more contagious than the flu is going to be with us. It's going to be with US until we get the vaccine. Frankly it's going to be with US until after we get a vaccine that's going to become probably an endemic virus. That circulates each year. Now over time it will become far. Less fearsome will have drugs that treat it. We'll have immunity to it. Many of us will have been exposed. We'll have a vaccine so it's going to become something that we can deal with much more effectively but this is going to probably become a virus. That circulates around the globe on an annual basis. Let's talk about how we may deal with that. Dr Gotlib you stand with me just for a second here tonight. A warning over the supply of the potentially lifesaving drug Rendez Aveer. Cnbc's farmer reporter. Meg Terrell is with Dr Bryan Abrams. He is the CO head of Biotech Equity Research. Rbc Capital Markets. Meg Good evening. Hi Scott and Brian. It's great to have you joining us. I've been following your research now for more than a decade and I believe this is your first TV appearance of thank you for making a loss. But we're talking with you about a topic. That is a little scary. You know the first drug that shown any benefit in treating covert nineteen in. There might not be enough. What does your modeling show? I'm wondering if you can hear if he can hit his microphone. Maybe yes yes back so so yes so. Gilead has about one and a half million vials of deaths available about forty percent of that looks like it's going to be allocated to the US that's not going to be nearly enough. Based on our calculations with the updates recently from hhs around allocation it looks like the initial ruined versus by is going to cover only about half the patients who need this smart with up to three hundred thousand patients eligible for the drug through the summer not able to receive it until production begins to catch up to demand this fall. Now I know Gilead is working really hard to try and address this. It's not a trivial drug to produce. It takes time it takes specific raw materials. They've just signed several license. Agreement with generic license agreements with generic manufacturers to help ramp up production and we would expect more to become available globally in the coming months willing basis. O'brien tell us your assessment of the strength of the data Dr Fouled. She has been talking about it more recently. He's been calling the benefit pretty modest and he compared to the earliest days of treating issue. Which is sort of an implication that you know. It's just the first drug. It's not a be all end. All how would you assess the data and your expectation that as this drug potentially gets combined with other drugs as being tested now. Will it show more benefit with them? Yeah absolutely so this gets to the question of not only. How well does the drug actually work? But how does an the strongest a large study conducted anti where Endesa shorten the recovery time for severely affected patients from about fifteen to eleven days trended towards lowering the death rate modestly? We've also seen some less conclusive data the drug coming out of China where it did not reach its primary endpoint but they did look like there were some positive signals there now. There's several studies are going to be reading out of the next several weeks. And I think that's really gonNA help tell US exactly how this drug works where it might fit in. And who could benefit most from it? And that's going to be important to its usage given the to by now in terms of your your question about combinations. I think that's a really important point. So there's several different approaches that companies looking for corona treatments or taking the first of the direct acting antiviral Caesar drugs that work by preventing the virus from replicating spreading throughout the body and from infecting ourselves. And that's the category. That Rendez severe falls into another main category or the anti-inflammatories our immune modulators on a list category are the antibody treatments that are designed to mimic own immunity on those either derives from patients who've recovered from the virus or synthetically. There's definitely tangible or different drugs. In different categories to be used in combination. A Lot more. We still need to learn about how these drugs can use. Just as an example it was thought that the antiviral drugs are only going to work well in the early stages of disease if really immune reaction starts to cause lung damage but it turns out that that might be a misnomer so still a lot left to learn but combinations including the decimeter are certainly feasible. Well Brian we really appreciate the time you took with US tonight. And we look forward to continuing to follow your research on this as you've been really out in front of the pack in terms of modeling how much we'll be able to access this drug. Thanks for being with us. Appreciate it very much. Thank you for that interview Dr Gotlib. How concerned should we be about a possible reservoir of your shortage? We're not gonNA have as much of the drug as we want the. Nih study looked at this drug in the setting of severe patients and showed a benefit in that setting. But ideally. You'd probably want to move this drug earlier you'd want to use it more than a frontline setting and that's how doctors are going to want to use it so that when a patient who has corona virus who co morbidity has conditions that would predict that they might have a worse outcome comes into the emergency room. This is a drug. You Might WanNa hang right in the emergency room and start the patient on it right away. We're not GONNA have enough supply heading into the fall to do that. So there's not gonna be as much drug as we would want. I think later on in the fall towards the end of the year more supplies coming online. My understanding is and I think supplies gonNA build all through the fall. Julia has done a good job of changing the manufacturing process here making it more efficient use to be a nine month process. It got it down to six months. They reduced the number of steps. They've sourced more raw material for this. And so I think you're gonNA see supply ramp all through the summer into the fall. But ideally this is a drug you might want to use a bigger cohort of patients than what's going to be available. Dr Wants you to stay with me again because it. Rendez of your shortage. Not The only cause for concern tonight. Despite all of the ways you can now get tested for covert nine hundred thousand. Not all of those tests. Apparently are accurate. Make you have the latest now on the state of testing around this country as rates. Nasr testing has ramped up. Modeling groups are still saying. We're not doing enough. In fact one really prominent group from Harvard. Saint testing levels need to be at least three times higher per day than we're currently doing around nine hundred thousand tests right now as you can see in the last seven days we've been averaging around three hundred thousand tests per day also are taking a look at this on a state by state basis and data from the Cova tracking project show on a per capita basis states like New York Rhode Island Massachusetts. They're doing the most. But if you look at the Harvard groups modeling numbers they show. There are several states that are still not at the threshold. They need to be based on the size of their outbreaks about fourteen states and Washington. Dc Not hitting that testing level. They need to be testing and also showing percent positive rate of the tests getting returned a more than ten percent which the. Who is suggested means? They're potentially missing infections. And of course as testing is expanding there are also concerns. You mentioned about the test's accuracy three different kinds of tests on the market in the United States all have potential possibilities for false negatives for the most common tests called. Pcr tests that rate is estimated to be about five thirty percent for antibody test which tests for prior infection that can go as high as ten percent under the as tightened guidelines and for the newest kind of tests. Those are antigen tests. The FDA says that negative results do not rule out infection and in fact one test getting a lot of attention around that this week is Abbott's ide- now tests as there was an nyu study. That just came out suggesting that can miss a third to half of positive samples however people are coming out saying that might not be the best analysis in Abbott in a new statement tonight saying we're seeing studies being conducted to understand the role. The idea now test in ways they say it was not designed to be used then. Y YOU study results. They say are not consistent with other studies and relied on a small sample size. Still Scott this is causing a lot of concern as this is the main test that we've heard being used in the White House. I talked with Dr Michael Oester home about this infectious diseases expert at the University of Minnesota. Who said using this test to screen at the White House would be like giving squirt guns to the secret service. Scott Meg appreciated. Well bring back in Dr Gotlib Dr Gotlib. It sounds like in some respects. We're taking two steps forward and one step back when it comes to testing go back to what Dr Bright said. Today about the outbreak itself would quote get worse and be prolonged if we didn't quickly have a national testing strategy. Is this too much of a free for all well? I think we're going to have a lot of testing capacity heading into the fall and really heading into the summer. I think we'll conduct millions of tests a week and probably heading towards ten million brick. Gerard testified before Congress yesterday and said we'll be able to do ten million tests a week heading into September. That's probably right because that's that's owing to a lot of new technology is gonNA come on the market more point care tests more energy based tests doctors contest right in their offices Very inexpensively I think what we need to do is make sure one testings accessible. We have sites that can offer testing. That's going to be the challenge not the testing platforms and to that. We're using the right testing platform for the right purpose. And so the machines like the Abbot Machine. The rapid machine that the White House is using or the energy based tests like the one that was approved by Kaieda over the weekend. We'll have millions of those tests available though should really be using a doctor's office because are specific. Meaning that if they say you have corona virus you do but they're not uniformly sensitive so they will tell some patients they don't have the virus when they do now in a doctor's office that's okay because the doctors probably going to send off a confirmatory test anyway just to be sure if they get a negative result so if you can rapidly screen out eighty five or ninety percent of people and say they do have corona virus for the ten percent. Says they don't you might test them with something else. Pcr's good if you want more sensitivity and specificity more reliable test but you can't do it at scale in a manufacturing site or a workplace. You WanNa do things at scale. Look pooled pooled samples. We might take fifty employees and have them spit in a cup and test the whole cup at once. And if you get a positive in your test employees for that there's different platforms available including next generation sequencing. Which is a good tool for that. I'm on the board of aluminum. Company makes those tools but there's different technologies for different purposes. We need to make sure we're fitting the right technology to the right purpose. Don't WanNa let you go before I get your comment on another concerning story. Certainly to everybody especially parents now more than one hundred cases of that new syndrome affecting children in New York and now some disturbing new details Dr Gotlib about a new report out of Italy. What can you tell us well? There was a paper published in the Lancet that looked at thirty cases of what appears to be the same syndrome in Italy. About twenty of them occurred just in the last month or so and intent occurred the five years prior. So it looks like you know this sort of a preponderance of these cases more recently which is certainly suggestive that it's happening coincident with the corona virus outbreak and suggested that there might be a relationship we haven't been able to establish a relationship but the fact that we're seeing so many of these cases and usually these are pretty rare conditions. Kawasaki Syndrome in particular and in fact that the people who are presenting the kids who are presenting or either positive for corona virus active infection or have antibodies indicating that they had prior infection is certainly suggestive. And that's why everyone's is so concerned that there's a relationship between these cases and the virus but we haven't established that yet last question. A new study suggesting that speaking can produce droplets that. Stay in the air for at least eight minutes. That sounds much different than what we learned from the outset or at least what we thought we knew about this virus from the beginning. Yeah you know get to the question of how does this become airborne in the sense that small respiratory droplets. That can sit stay suspended for longer. Periods of time can transmit the infection. I mean it's certainly on the continuing possibility but the the thinking right now among most people is it's classically respiratory droplets. You need to be in close proximity to someone for an extended period of time and if you look at most of the studies where we've seen clusters of infection caused by a single individual. It was a situation where that individual was in close proximity to the infected person for an extended period of time so a lot of the infections for example happening in the home where you have one sick individual infecting other people in the home. So you're always gonNA find these outlier cases and studies that demonstrate that this is more transmissible in certain circumstances but I don't think that that's the overwhelming majority of the infection. That's happening relieve it. There we covered a lot. Dr Thanks as always. We'll see you tomorrow night. Thanks a lot Dr Scott Gottlieb. Cnbc contributor the former head of the FDA. Here's what's coming up next a new proposal from a top airline passenger's rights group about how the airlines should seat people to avoid. Seems like this when we come back? What's realistic and what's never going to happen. And all the seats at the bar have to be free. A RESTAURANT OWNER. Lets US inside as he rearranges his seating chart menu and everything else first photos from around the United States on the one hundred thirty seven th day of the corona virus crisis If you WANNA learn more about one of the fastest growing trends in investing we've got the podcast for you. It's ETF edge. I'm Bob Johnny. Join me as I'm joined by talk. Market participants help you build your best portfolio and the end of each episode stick around for our markets one two segments where we round out the conversation to help you better understand. Etf listen now and subscribe for exclusive content not heard on television you want even more tweet us at ETF EDGE CNBC. Welcome back. We have breaking news right now. Let's go right down to Washington. Dc where Kayla Tau. She is standing by Kayla. Scott much of the House Democrats three trillion dollar stimulus. Bill that will see a vote. Tomorrow is a non starter for Republicans in the White House. But I've learned that there is one piece of it that could see some support in the White House and that is another round of direct stimulus checks to Americans to senior administration. Officials told me that there is support in the White House at this moment for another round of stimulus checks and to be sure the Treasury Department's original blueprint did include a second check. But that did not get appropriated in the cares act back in March to sure there are many conservatives like Kevin Hassett Larry Kudlow and Mark Meadows. Who Do not believe that the US can spend its way out of this crisis. So support is not uniform. But I'm told by these. Two senior administration officials that there isn't acknowledgement privately. That more money will need to get into the hands of Americans directly as unemployment remains high and business. Revenues are slow to return the White House at this hour. Provides this statement from spokesman Judd Deer. He says as president trump has said. We're going to ensure that we take care of all Americans so that we emerge from this challenge healthy stronger and with economic prosperity. Which is why. The White House is focused on Pro-growth Middle-class tax and Regulatory Relief Scott when these talks beginning ernest in just a couple of weeks. This could be something that is on the minds of many Americans and could be on the negotiating table with support at this moment for another round of stimulus checks from the White House. As we know now Kayla we're still planning on a vote in the house tomorrow. That is the plan as for now but Scott. It's worth noting this is dead on arrival in the Senate Senate Majority Leader Mitch. Mcconnell has said that he does not believe that anything near a blank. Check is what we're going to see this time around at least in his chamber. Appreciate that very much Kayla. Thank you very much for your breaking news tonight. The National Association of Airline Passengers Meantime Petitioning the FAA and Department of Transportation This evening to force airlines to limit capacity to prevent the spread of the virus. They want flights to be no more than half full. Seedings should be arranged for safe social distancing. They say they want airlines to give passengers and crew protective gear as well and they're also calling cleaning standards key member of Congress also weighing in on the path forward for the airlines. Get to fill the bowl with more on what is possible and what is not fill Scott. We're talking about representative Peter Defazio. And he's an important person in Congress because he heads the House Transportation Committee so when he speaks the airlines listen and today he is speaking loudly about the fact that he thinks these airplanes that are flying right now. We've seen these pictures. Should not be as full as as some of them have been in the letter he sent to the Airlines for America. That's the trade group that oversees the airline industry. He writes who among the CEO of a four carriers would want a member of their own family to be assigned to a middle seat between potentially contagious passengers. In the middle of a global pandemic. These are some of the images we've seen over the last several days especially on high traffic route. Let's from New York to San Francisco. I heard from a friend flying from Dallas to Chicago last night. He was outraged at how many people were on his flight. As the airlines have dropped flights from their schedule. They have consolidated when people are flying in particular routes and those planes have been many times seventy seventy five percent. Full people are saying they're completely full. The problem is this the. Us passenger levels right now are still down ninety three percent so the airlines are not making any money at in the few times that they can fill up a plane so that it is a quote profitable flight. That's what they're doing on average however the average number of passengers on a plane right now is about seventeen and the problem is this you get too many planes and too much staff for the airlines. Take a look at Delta today. It said it's going to be retiring. All of the Boeing triple seven planes that they fly those are primarily on their international routes. They're also telling their pilot. They have fourteen thousand of them. They have seven thousand too many for the schedule that they are setting for the fall. Scott peter defazio would love to see the airlines. Make sure that the middle seat is always unoccupied and limit the number of people on a plane to no more than two thirds of the seat. If that were to be the case a hundred percent across the board the airlines would not make money. Fill a somewhat sympathetic. You know many are to the plight of the airlines right now. It just seems completely unacceptable. Some of those photos coming out of airlines. That are packed and people are clearly uncomfortable. There's not social distancing at all it just making people really uncomfortable and that's the point representative Defazio and that's why he's saying at a minimum. You need to have the middle seat. Empty so the question then becomes. How did the year lines turn a profit? Well if you're going to keep that middle seat empty and represented the Facia says go ahead and charge more for an airfare ticket for a plane ticket but you know how much more you'd have to charge Scott anywhere between forty fifty and sixty percent so now the the fair that might be a hundred eighty dollars turns into three hundred dollars and that has the impact of telling making people say I do. I Really WanNa take this light. Yeah maybe not right now. And that's the last thing the airlines need right now. Yeah I'll tell you what though could also though these sorts of pictures that we're looking at right now could backfire on the airlines in and of itself fill in that people who are seeing this right now are going to say you know. I was thinking about taking a flight but now I'm not if that's what the airlines are doing. So they're missing out on the money anyway. If people see these photos and don't fly absolutely it's all about comfort level in right now very very few people comfortable flying in the US if some of these planes though are packed the photos don't lie. Phil appreciate it very much. Thank you Philip Tonight. Here's what else is coming up on this. Cnbc special report this table. One thanks to go one. Restaurant owner rearranging seeds for reopening. Shows us? How he's doing it plus a first look at what your office will look like when you go back doctor now. Making arrangements for offices big and small shows us his strategy. We're back in two minutes rearranging America from offices. We need to be feet apart to restaurants what it will all look like. It's the new path forward for America this. Cnbc special report continues once again. Here's Scott Wapner. Welcome back. Let's get another check of futures at this hour after today's Wall Street rally. Pretty good turnaround on the street today. And we're turning around the futures as well a B. It slightly. We are in the green though across the board as four today. Those same green arrows. The Dow rising three hundred seventy seven points up for the first time this week. The strongest sector today add to be financials FIF- gains for American Express. Wells Fargo J. P. Morgan and Goldman Sachs all for a change helping the Dow. Well when restaurants open for sit-down service. We're going to see big changes. Of course tonight. What one owner is doing to get ready for that? It's a scene playing out behind closed. Doors at thousands of America's restaurants here's Andrea Day armed with an infrared temperature gun chef Rafael. A run is ready for the day. He can do business again when somebody gets into the door temperature. The needle never fever unwise. They're not it into your business. This chefs to New York restaurants. Shut DOWN TO DINERS BACK in March. This one is located in Westchester County. One of the state's earliest hotspots. He's okay you can work in any seven points. It's all part of the new protocol guidelines for re opening after Cova nineteen a documentary just received from his town's Chamber of Commerce. It's all designed to help virus proof every inch of his three thousand square foot eatery menu that everyday we used to clean sanitized. Make sure they were Nice presentable. Now throw away just like paper that once you know somebody touches declined touches it. It's just toss out in the garbage so this used to be our check presenter. No more because it's plastic. You cannot have. It uses the new way of presenting. Check your you go. All staff have to wear masks while they're working on when we all the seats at the bar have to he free fourteen barstools get carried away protocol. We need to be six feet apart. This Day passed the move forward. The restaurants tables are also getting the Cova treatment to have to go seeing shrinking down by chairs number of tables. It's quite diverse. It just hurts your heart. We need to do all this changes to lakeshore than our clients. Come out and feel safe. In the end chef Rafael carries away. Eleven of the nineteen tables and more than half. The chairs are gone total seats on the front of the restaurants. Where Ninety seats now. We're at forty one and this new normal will be tough on the business expenses that we have we would have. We would have to move out two hundred people a day so you have to turn this four times which is almost impossible to see because everybody wants to between six thirty thirty. The numbers are stacked against him but he says he's ready for the challenge. This is a new business plan. We're going to give one hundred ten percent sure that we survive and see the light of the other side of the. We have only one choice to succeed. We're rooting for you. Chef I'm Andrea Day. Cnbc Andrea thank. You we certainly are rooting for everybody. So that's the restaurant side of the story. Now Dr who is rearranging office space. Dr Robert Quigley is the senior vice president and Regional Manager for the Americas at International SOS. It's a company that provides medical consultations and services to workplaces DR quickly. Good to have you on our program tonight. We actually have blueprints of an office space from before and sort of after an ongoing project that you're working on. I'M GONNA put those on the screen. I'd like you to talk us through. What the new office so to speak is going to look like on the other side of this certainly and this office is clearly representative of many offices across America right now and the request that we are getting international last from organizations in every sector is. What do we do how to reopen up and we always begin by saying look? It's it's GonNa be like a dimmer light switch. He's not going to be an on off and what you see on the screen in front of you is a before. And after appearance of basic layout that we have proposed to mitigate against transmission of the corona virus in the new office but that is just a static picture wrapped to understand that there will be many protocols procedures that are shared between us and our clients with regards to practices. And what we've done is we've broken down the project if you like for all of our clients into employees infrastructure and then guest visitors vendors and we address each of those groups of people all of whom are potentially at risk as carriers. You look at the screen in the after appearance you can see how we encourage a single point of entry represented by Poe on the screen when one walks through that single point of entry. There's a screening station which may or may not be a manned by a healthcare professional. Typically not we do suggest to set the organization Alexa Hygiene Ser. Who is at least up to speed on? What are the appropriate questions? It should be asked in the event the individual comes in and they have a fever. We also have a room near that point of entry which we call the red zone and that's a room where one would be delegated if one at a fever and from there we have connected. Medical Emergency Response plans vigil to be assisted out of the workplace or going through ems. What I what I notice from from looking at these pictures it appears to me. Is that the office. Space itself is the same size. We just have a fewer number of people within that space as we have been thinking about. What the office itself would look like in the future and whether companies would actually be taking smaller footprints in a commercial building this suggests otherwise. Well it doesn't. It doesn't if you look at it closely. You can see that what we've done is we've tried to maintain that fundamental principle of the social distancing. So we've separated. What might be a quadrangular desk arrangement down with double or if you have a desk arranger that are long tables and chairs. We alternate Seats and we have been able to do that already in a variety of places and that seems to work very well so we don't necessarily have to cut down on the top graphic square footage as much as we have to carve out pathways and opportunities where one is not going to breach the basic at two meters six foot social distance principle which we know is so fundamental obviously in the context of universal precautions wearing a mask and washing one's hands and having sanitizer which we have located all over that particular blueprint in front of interesting work ahead for all of us as we think about this. Daca quickly. We appreciate your time so much. Thank you very much. Thank you I appreciate you joining US tonight. Here's what's next on this. Cnbc special report. He's demand behind one of the world's most iconic clothing brands. Joseph Abboud is with US next on the future of retail before the break images from around the world on the one hundred thirty seven day of the global pandemic Welcome back according to the National Retail Federation the retail sector employs twenty nine million Americans but the two point five trillion dollar. Fashion Industry is at a dangerous crossroads with US tonight. Is the fashion icon. Joseph Abboud. He is the founder of a. Apparel Joseph. Welcome to our programs. Nice to see you you to Scott. Thanks for having me. You've seen so much of retail over the years. How would you characterize tonight the trouble that that industry is in well? It's unprecedented really We've been through recessions but clearly there's never been excuse me healthy shoe on the other side of it so the fashion industry isn't quite sure how it's going to reinvent itself but for sure fashion is always creative in. We'll find a way to get through it. Do you worry that we're GONNA see more bankruptcies we're just coming off of a filing by Neiman Marcus about a week ago. Barney's here in New York a some months ago Nordstrom closing a bunch of a bunch of its stores. How bad do you think it gets? Well I think the companies that were struggling financially before the crisis are going to struggle even more and it's it's fortunate Survival of the fittest and a lot of the retailers are consolidating where you may see a company like Hudson Bay owners of saks fifth avenue acquire parts of Neiman markets. So I think we'll see less stores. There are three point six million retail stores in all price points across this country. So I think we are over stored and I think the relevance now is not about price. That's a great myth. That's been perpetrated on the retail industry. It's about value quality storytelling relevance for retailers especially with the new generations with the with the millennials and certainly Gen Z. Right behind I'm thinking of so many different issues facing the industry working at home for example having the obvious impact of who needs to go out and buy a suit either male or female. How should we be thinking of that? And when you do go out how can you try anything on in the age of Mid Nineteen? That's right and all of those questions are unanswered is trying to be innovative about how we fit men to suits now. Think about it. Think about that intimate relationship of a guy coming up and trying a jacket on you or taking measurements. That's uncomfortable for the moment. So we don't have the answers for that. In virtual fittings and online fittings don't really work so I think what's going to happen with retail is that people are going to look for more intimate settings to shop smaller retail environments with more space where people are more comfortable and they're familiar with the owners so it's a new paradigm for us and I think the great part of our industry is what we do find a way. We will find a way to get through this but there are a lot of unanswered questions was going to ask you. If it's this is all bad for the mom and pop retailer but what you just said actually had me thinking that maybe in this new environment where it's more personalized as you just suggested they could actually do. Okay I think the greatest creativity we habits with the small shops where you find new product new ideas the service that people really love to have so. I'm hoping that there will be this. this growth of the small specialty store where service and quality really become important in. That price is not the only driving factor. The other piece to Scott is that I think people will start to look at healing fabrics like pure cashmere pure wool pure linen pure cotton. It's not the time for sensationalist fashion. It's fashion always finds a way it's a mirror of society and we have to look inward now and I think it's dressing for the inside literally and figuratively not for the outside interesting thought there and finally a thought from you on something that was wants near and dear to your heart and your business and you ever hold a fashion show again. Well you know that's really interesting. We both know the energy and excitement of a fashion show being in proximity close proximity to so many people the Paparazzi cameras energy models. I don't know I think virtual fashion shows will happen but I don't think in the near future. We're going to see that excitement. At least on the runway. We may see it on the screen but not on the runway but we lose some energy from that. Yeah that's that's sad to hear. Fashion ICON JOE booed. We appreciate your time. We wish you will thank you. Scott stay will well are. We do have more breaking news tonight right now. Let's get back to Kayla towel. She Kayla Scott. The trump administration has drafted an executive order that would mandate essential drugs be produced here in the US according to two sources familiar with the matter one of whom says this executive order could be released as soon as tomorrow but is awaiting the President? Sign up this comes amid multiple supply chain shortages amid the havoc that has been wreaked by the corona virus crisis. The administration has multiple efforts underway to try to move supply chains to the US to try to avoid those supply chains shortages in the future at Bloomberg News which was first to report this news. Notes that there would be exceptions if the US production isn't in the public interest or if it would raise prices of those drugs by more than twenty five percent one of my sources. Scott says that this order would direct hhs to study the supply chain identify weaknesses and in ninety days. Deliver report to the president. Scott appreciate it. We'll follow that tomorrow. Our nightly salute to restaurants is next our nightly salute to restaurants from Alaska to New York. Thanks for being with us. Shark tank is coming up next if you WANNA learn more about one of the fastest growing trends in investing we've got the podcast for you. It's ETF edge. I'm Bob Johnny. Join me as I'm joined by top market participants help you build your best portfolio and the end of each episode stick around for our markets one two segments where we round out the conversation to help you better understand. Etf listen now and subscribe for exclusive content not heard on television you want even more tweet us at ETF EDGE CNBC.

US CNBC Kayla Scott Dr Gotlib New York White House America Dr. Bright DR Scott Gottlieb FDA Scott Wapner Washington CDC flu American Express Ibm China Dr Dc
Special Report | Markets in Turmoil: Healthcare & Reopening

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Special Report | Markets in Turmoil: Healthcare & Reopening

"So if you want to learn more about one of the fastest growing trends in-investing we've got the podcast for you. It's ETF edge. I'm Bob Hasan. Joined the as I'm joined by top market participants to help you build your best portfolio. Listen and subscribe today I am. Cnbc producer Katie Kramer. One of the voice behind the CNBC. Podcast Squawk Pot in these times of uncertainty. We WanNa make sure we're bringing you our listeners. As much information as possible as quickly as we can. That's why we're sharing with you now a CNBC special report markets in turmoil. Listening good evening. I'm Scott Wapner on day. One hundred twenty three of the corona virus crisis new information tonight on a key drug to fight the virus as the nation moves closer to reopening stocks are under pressure the best month for stocks since. Nineteen eighty-seven comes to an end but questions persist about the rally and our ability to stop the virus. What we found out is just a little piece of the puzzle. Also tonight when we take a step forward we don't want to take two steps back. One business owners plead to his State. We're not ready to reopen this. Cnbc special report markets in turmoil begins right. Now here's Scott Wapner. Welcome good to have you with us on this Thursday night after the biggest month for stocks in a decade. Let's get to our first look futures right now early but they are lower following lackluster earnings from some big tech names. After the bell today stocks were lower across the board the Dow losing nearly three hundred points but the real story was the month of April. The Dow gaining eleven percent S. and P. Five hundred almost thirteen percent. That was its best performance. Since nineteen eighty-seven you see the major averages putting in that mark tonight the Nasdaq adding more than fifteen percent. It's best month since June of the year. Two thousand there is also new information tonight and the path towards vaccine drug maker AstraZeneca teaming up with Oxford University information on phase. One of their testing is due very soon our farmer reporter make to route following the details for US tonight. High Bank Scott. Well it is. One of the most advanced vaccine programs in development fur-coated nineteen right now. Researchers at the University of Oxford started the first phase of human clinical trials last week and five different centers in southern England with data expected to be available next month. They say if all goes well a later stage trial could begin by the middle of this year. A key question for any successful vaccine though will be the ability to manufacture it at a large enough scale that is where a partner like Astra. Zeneca comes in under the agreement with Oxford. The British drugs giant will be responsible for development and worldwide manufacturing and distribution if the clinical trials. Prove that the vaccine works. Now it's not the only experimental vaccine already in human studies one from dern and the National Institutes of Health in the. Us began testing in healthy volunteers. In March well small biotech company and no view has also said it's begun tests. Several vaccines in China have also entered the first phase of human testing whilst Pfizer and bio tech began trials in Germany last week. And they're expected to start. Us trials imminently a key question for all these potential vaccines will be whether the course of the pandemic will enable efficacy to be proven. It often happens and outbreak scenarios that the science is too slow to keep up with the disease. Many times in the past outbreaks have subsided before a vaccine could be ready to be tested. The development and manufacturing of new drugs and vaccines is also an expensive endeavor and Gilead who's drug desa. There yesterday showed positive results in an NIH. Trial said it spent fifty million dollars on the drug in the first quarter and may spend up to a billion dollars this year. The company's pledged to donate it's available supply of the drug and hasn't commented on pricing plans. After that Daniel Day was asked on a conference call with analysts tonight. Why covert nineteen is different from other diseases? The company does profit from treating like HIV. Hepatitis and flew. There's been no other time like this in the history of the planet than any of us about live. In terms of the far-reaching reaching effects of this pandemic so medically from a patient perspective most importantly but also economically and so I think there is no guidebook out there. There is no rule book out. There and day will join us tomorrow morning to discuss that and more on squawk box Scott Meg. We'll look forward to that very much in the morning on squawk box. That's Meg Terrell reporting tonight on the money as always joining us now. Cnbc CONTRIBUTOR IS DR Scott Gottlieb. The former head of the FDA. Dr Dot leaves good to talk to you again. You must first your reaction to this story about Oxford and AstraZeneca teaming up good news. We're going to need more than one vaccine developer to be successful here and the fact that Oxford's teaming up with Astra Zeneca which has the ability to manufacture this product at scale. Because the big challenge here isn't just going to be demonstrating that these products are safe and effective and running the clinical trials but also engaging in a large scale manufacturing this can be required to produce these in quantities sufficient to provide them to an entire population. Astrazeneca has heft. They have that ability so this is a positive development. We need more than one vaccine developed. It'd be successful here. We need multiple vaccine to be successful across the world if we're GONNA have enough doses to supply the entire world and also the low and middle income countries that locked out of this race right now. There's a lot of exuberance last evening. Plenty of opportunity today for some maybe to walk back. Some of the expectations of having a vaccine ready as quick as some of the timelines have said through this operation warp speed for example though Dr Falcone this morning on the today show certainly didn't back down. Is it really possible to have a vaccine Dr Gotlib by January? Well we're probably GONNA have by January. Is Vaccines in sufficient quantities to run very large scale trials. So we have outbreaks in American cities. We'll be able to deploy thousands probably hundreds of thousands of vaccines in those cities. I run kind large trials that we're going to need to do to prove that these vaccines not just are effective. But that they're safe. In terms of having sufficient quantities to inoculate the entire population. That's really a twenty twenty one event and hopefully we'll we'll have it in time for twenty twenty one but it's unlikely to be available before the end of this year but we could have tens of millions of doses before the end of this year if you if you see multiple manufacturers being successful because each manufacturer could probably produce millions if not upwards of around ten million doses and so you have involved fires of the company that I'm involved with. You have a couple of small biotech companies engaged to no fee. Gsk's engaged now you have Astra Zeneca J. and J. Working on an ad no viral vaccine. These are large companies that know how to manufacture at significant scale overall. How would you describe your own level of optimism about where we are in our fight against this virus tonight? I'm very optimistic. And we're making very rapid progress and trying to drug this this virus and there's nothing particularly complex about a corona virus. That would suggest that. We're not going to be able to develop an effective therapeutic vaccine against it. We haven't had a vaccine against the corona virus before but we haven't tried really except for SARS emerge typically corona viruses caused common colds. And we haven't really sought vaccines for them. We already probably have one antiviral drug. That's effective not a home run but a drug that looks effective in severe. I think we're GONNA have antibody drugs by the fall. At some point this fall that starts to be the makings of a pretty potent toolbox. Those are the first generation products and so we'll see second and third generation drugs come online. The entire by pharmaceutical sectors really focused on this intently. And I think we're making very rapid progress and so I'm optimistic that we're going to have therapeutics. Never seen anything like it really. Let's move from Therapeutics and vaccines to talk about more reopenings Georgia now set to lift a most shelter in place restrictions tomorrow. Is that a good idea. Well look I think what's taking shape in this country is that we've reached a plateau in the number of infections at about thirty thousand a day. We're bouncing around. But is that about three thousand a day so you have to assume about three hundred thousand infections a day in this country because we're probably diagnosing one in ten infections to one in twenty infections and the number of deaths has plateaued as well. I think we're likely to bounce around on that plateau for a sustained period of time and the risk we face by reopening isn't necessarily that we have very rapid surge in infections and run into another epidemic but we never really snuff out the infections that we have smoldering infections all through the summer. And if that's the case if we continue to have three hundred thousand infections a day by the time you reach September first upwards of fifteen percent of the US population will have had corona virus. And so you starting to get pretty significant proportion of the population. I think that's the risk we face by some of the reopenings that we're seeing when you still see cases going up now Georgia. The cases are going down in recent days. But they're still not testing a lot and so you don't know how reliable those that data is but they haven't seen the kind of sustained declines that we've all said at the outset that you'd want to see to try to safely reopen an economy. We've had this conversation about Georgia. Numerous occasions you tweeted a few days ago that they were still having an epidemic there that cases were on the rise. Though I saw today you did say that. They've seen a big improvement. It seems like a fairly short period of time to have some level of improvement. No improvement was in the model that model that everyone looks at from Washington state and that model is just based on trends. And so what they're doing is they're looking at current trends fitting lines curves so they're trying to project from what the current trends are so. Georgia has shown in the last week of reduction in the number of new cases on a daily basis. Some events probably improvement some of. It's probably under testing Georgia ranks in the lower echelon of states in terms of the testing that. They're doing their population. So it's unclear whether or not the epidemic Israeli subsiding in that state. When you look across the country you see a lot of states probably about twenty five states. Where the epidemic is rising in terms of the number of new cases on a daily basis. So the number of cases being diagnosed on a daily basis is actually going up. Some of that's a function of the fact that we're testing a lot more so we're capturing more cases but some of it's also a function of our seeing expanding epidemics in a lot of states. Now that's said many of these states are states with a very low number of infections. So they're going from one hundred infections of data one hundred ten to one hundred twenty so they're not states that had a big epidemic to begin with but nonetheless it just shows that we're really not through the woods yet when it comes to this national epidemic New York showing a lot of improvement and that distorts the national figures but nationally. You still see a lot of states with a lot of spread. What do you think about New Jersey's plan to open golf courses and parks this weekend? Is that a good idea. I think it sound for the states to try to contemplate what they can do to give people a sense of normalcy again. And the first thing you can do is try to open back up. Recreational activity done outdoors. We know the risk of spread is lower. I've been advocating and talked to a number of local officials about the idea of trying to move things that are traditionally done indoors outdoors and so two extent that we want to restart religious services holding them outside. We want to restart gym classes holding those outside. Even as we contemplate reopening restaurants lifting local ordinances that make it easier to businesses to try to move some of that business outside maybe closing blocks and sectioned off more real estate more public real estate for businesses to try to open up at venues outside. That's not going to be foolproof but holding these things outside does reduce risk and. I think it's important that we try to start reintroducing activities that give people a sense of normalcy about their lives and the first thing to do really is to put the nets backup in parts. Let's let's finish by discussing the origin of this virus If we could. Our Intel is apparently ruling out now that the virus was either man made or genetically modified. They're still said though to look at whether the virus was accidentally released from that lab in Wuhan. Where are you tonight in your own mind on that topic? We might never know if we can't get access to the source strains or the early index cases. We might never know where this virus came from. We know that lab in Wuhan was doing experiments with Corona virus retrieved from bats. We know that lab was sloppy. There's been a lot of published articles going back years about that lab calling into question their procedures and so the possibility that someone might have accidentally infected themselves with a virus and walked it out of that lab by accident certainly will remain and I don't know that we'll ever be able to fully dispel that. I don't know that it's the leading theory but is going to remain the theory. China's certainly has some capacity to dispel that. They don't seem to have taken steps to do that. You would know probably if this was engineered and it would be bad bioweapon. I don't think anyone engineer a bug like this as a bio weapon but we would probably be able to tell from the sequence if there were changes made that look man maiden deliberate but the possibility that this was an accident a lab accident that somewhat accidentally infected themselves then went on to propagate the infection. I don't know that we'll ever fully exclude that. Appreciate your time as always Dr Gotlib. Well thanks a lot Scott Gottlieb busy. Cnbc contributor of course the former head of the FDA. Let's give you more details now on exactly what? George is doing Georgia's Governor Today. Signing an executive order allowing the states shelter in place mandate to expire tonight for most residents and allowing all businesses to reopen tomorrow with certain restrictions. Georgia was one of the first states to reopen some businesses last week and now more than half of the United States will be reopened in some form by the end of this week. Well some businesses in Texas will reopen tomorrow as well but some owners say it's just too soon or is the owner of local Doro a restaurant in Austin Texas. He met with the city's mayor earlier today as one of the leaders of a coalition to discuss the challenges of reopening Adams. Good to talk to you tonight. Thank you so much for being here. Thanks for having me Scott. When are you prepared to reopen? Do you think well we're definitely going to give it a couple of weeks to see what this twenty five percent capacity? Rule does in restaurants and in the state I think a lot of people are looking at may eighteenth which is when the governor announced he would be moving into phase. Two and restaurants would be open at fifty percent capacity. It's likely that even at that point we'll start at twenty five and slowly ramp up just to make sure that we're following all the protocols and all the guidelines that we're trying to develop now some of the conversations center around if you can only have twenty five percent capacity as a restaurateur is it even worth opening for all that you'll have to deal with. How do you address that? Our restaurant would not make a whole lot of sense at twenty five percent a lot of restaurants where you are Buying perishable products where you're cooking things to order Where there is any where there's that are service based models are not GonNa make sense at twenty five percent you you have to have too much labor and there's too much food cost and there's too much risk things going bad on so no it's it's not worth it financially. It's not really worth it financially. At fifty percent either there are some businesses where it does make sense. I think places that are You know that are doing a lot more reheating that are cooking. That are that are that are using a lot of frozen food. So they're not They're not as concerned about things being perishable. That are doing things from a salad bar. Set up or from counter service setup There are some places where twenty five percent makes more sense I think those tend to be places that are concepts that can be that are more franchise that are more changeable and that that have a better capacity you've dealt with us on a number of things down there obviously you've got a university that's closed. That's probably a considerable amount of business. You get south by southwest was canceled. Can you just give us an idea of how your business has coped since all of this happened? What's happened to your employees and how you've dealt with it if you applied for assistance from the government sure We closed for We went down. Take out the day before the mayor. The mayor's order to go take out and then we did that for nine days And it was just we weren't it didn't feel safe. It felt like we were making too many decisions on our own. There had been no guidelines About what to do with landlords what to do with utilities what to do with taxes. There were no there were very few health and sanitation guidelines. At that point everybody was. We were still in the period of You know Don't touch your face And and Wash your hands so we stopped To try and gather some more information and figure out a better way to run the business that would decrease contact. We have a We use a direct primary care provider for our for all of our employees and we consulted with our Dr to talk about what he thought made sense so we opened up again three weeks later in a different takeout model. We had laid everybody off and I'm in constant contact with my employees trying to make sure that they're getting their unemployment insurance which is just about a full-time job. And and we did. Apply for assistance We have appea- loan but that is definitely not a cure all And I'm happy to talk about some of the issues with the loans. Well we've certainly been following it from the very beginning. We know the challenges that restaurant owners and operators like you have faith. Just ask quickly before I go. Will You pay rent tomorrow? May I? We are trying to We HAVE RTP LOANS. And we're we're trying to make sure that we keep up with with our expenses. We if we open when we do reopen we want to be in as we WANNA be in his little as possible. We understand we feel your pain. We spoke with a number of restaurant tours. We know what you're going through. We wish you well. We'll check in with you again soon. All righty thank. You got all right. Adam you take care that's Adam Orman broken down in Austin Texas this NBC special report markets in turmoil is just getting started next tonight. A company that advises stadiums like Madison Square Garden and Yankee Stadium on what they have to do to make sure the fans are safe when this is all over plus a comedy club owner with nothing to laugh about in their own words next before the break images from around the United States on the one hundred twenty third day of the Perron virus crisis if you WANNA learn more about one of the fastest growing trends in investing. We've got the PODCAST for you. It's ETF edge. Bob Is Johnny. Join me as I'm joined by top market participants help you build your best portfolio at the end of each episode stick around for our markets one. Oh segment where we round out the conversation to help you better understand. Etf listen now and subscribe for exclusive content not heard on television. You want even more tweet us at he edge. Cnbc have you back with us. Husband and wife Entrepreneurs Vicki and Vinnie brand run restaurant comedy clubs in New Jersey and Connecticut. They shut their doors. Seven weeks ago laying off sixty employees including Vicki zone. Mother a couple now shares. Their story tonight in their own words this one of the biggest tests that we have ever been under both professionally and personally rigo. Ms Be very intensively that we were when he gets Roman. This is going to be one of the tests. In order to run. The storm wear layer months having to lay off your seventy one year. Old Mother is a difficult and heartbreaking task to undertake a lot of our employees live. We tweak so to come to them with notice and say we have to shut our doors for the greater good while everyone understands it is really a a painful emotional message to bring everybody very very comfortable where the storm and we've got the brands. Tell us they applied for the first round of SBA loan money with no luck. They are holding out. Hope though a lifeline might come in this round two well here are the headlines on the virus on Day. One hundred twenty three of this crisis. Macy's planning to open some of its stores on Monday. Expecting all seven hundred seventy five will be opened in six weeks British prime minister. Boris Johnson says the U. K. Is passed the peak of its outbreak and starting Monday United Airlines will require all employees and passengers to wear masks or face coverings onboard all of its planes and the Navy Hospital Ship Comfort leaving New York City earlier today exactly one month after arriving the ship which treated one hundred eighty two covert patients during. Its stay heading back now to its base in Virginia April. Usually one of the busiest months pro sports baseball begins as the NHL and NBA. Get closer to play off time this year. Of course everything is different tonight. We're learning about what sports will look like as the pandemic eases. Dr Andrew Bazo says the founder and managing director of Crowd. Rx which provides medical services and advice at live events of Mr as good to have you here. You know what seemed like such a normal exercise just a short time ago now seems impossible. How are we going to deal with the path? Forward the other side of this crisis as it relates to attending sporting events. Well we're going to Trenton to apply some science in place of reason and help ultimately help the business vehicle in Stadium. Operators make the right decision With the informed consent from all the medical at expertise that we have to offer on cracks is invented medical company. And Right now. There are no events going on so we had hinted to position of trying to get our venues and stadiums in workforces. Back safely to what we do. In Normal Times fortunately our parent company Global Medical Response Roaches thirty thousand first responders across the country. Is there on the frontline helping us every day until we get the front line situation Restored we can't move forward with fun events. I know we're talking about getting back to sports entertainment but there's nothing funny about what are our staff is during on the front lines right now. No matter what side of the curve. Were on so Before we go into a the event side of this I just want to send my thanks to all fellow. Boys that are going through step for We do as well. Do you anticipate crowds being able to go into arenas or even a willingness to go until there's a vaccine to treat this virus well I think there's different levels. I we have to get a government approvals and go with our federal and state and local leaders in their restrictions in their return to a game on game on a plan of first and foremost depends upon of these phases that the government will outlay. But we're trying to get ahead of them with protocols that once it happens we will meet standards set by the state in municipalities but have higher standards internally. Because I think you hit on the head. We need to make spectators comfortable coming events. Even if you're allowed to go we want people to feel comfortable as such. We formed this comprehensive platform to do everything. Cancer Mitigate the risks of being in a crowd what. What's the experience? GonNa feel and look like do you think I think there will be more rigorous screening techniques right. Now everybody's familiar with magnetometers. The familiar with drugs. They think dogs. I think there is definitely going to be another component to that right now. We're doing a lot of thermal screening lifting for fevers in in the workforce people returning to work Large companies drink a lot worth large companies. That want to get a safe workforce end so I think we'll see a component of thermal screening I think we'll see a component of checking other parameters for example oxygen. Saturation is been used as a hallmark for underlying disease. That may be there. But I'm hopeful that we will have some rapid screening techniques available to us and I know it's been talked about testing testing testing. I do think that is going to happen in a big part of clearing the way for spectator sports to zoom looking at your clients. Madison Square Garden the Yankees the US openness may sound like a trivial question. But could you imagine? Could you have concessions in an arena? Would you recommend that? Is that something that could could happen. Well first and foremost and medical companies so we will be using medical reasoning ironically. I'm training a major. College was molecular biology. I never thought used again. But we're going to support business decisions with science and medicine and we're not going to be making those decisions about where you can have a beer. Take a mask off. I'm we're going to lay out. The risks and the benefits of all those activities in concert with governments in municipalities are recommending. I as a sports and entertainment AFICIONADO and hopeful that we will get back to all of that and get all act all of it quickly but there will be some risks and there will be some blips on the screen as we do that. We will see how it all shakes out. The duct obeys us. We so much appreciate your time and the work and that of your employees. Thank you very much. We'll talk to you. Dr Andrew Bezos joining US tonight. Here's what's coming up on the CNBC special report markets in turmoil. Don't expect to be back to normal until we think it is safe to go back to work. There are going to be changes to How we run a restaurant. America's corporate leaders. Ceo's from major companies. On what they think is next for this country's economic path forward plus a top leader of one of the biggest public school systems in the world on where they stand and whether summer school for all is a possibility and incomplete. Here one woman story of how the viruses forcing her to pick up and leave her dreams behind this. Cnbc special report markets in turmoil is coming right back. It's safe to say that there are going to be changes to nine. Top CEOS on the path forward plus. Everybody remembers going to the school cafeteria. What happens when you change the clad? Everyone's all marching up and down the hallway problem our schools ready to open their doors and Bindi back window here just in survival mode one woman's flight from the virus and a path forward to a very different life this CNBC special report continues once again. Here's Scott Wapner. Welcome back stock futures sharply lower this hour following some tepid earnings results from the likes of apple and Amazon. After the bell comes after a down day for stocks the last one of April it was though the best monthly gain in thirty three years for the Dow and the S&P since two thousand four. The Nasdaq those. Strong April gains clawing back a lot of the big losses through March. The averages are all more than thirty percent off of their march. Twenty third lows at this point another big day for many of the country's biggest chief executives on this very network. Here's what they're saying. Now about the state of the American economy and our path forward. We're considering a phase in at the right time again. We gotTA harmonize Federal State and local kind of responses and what our actual experiences to the corona virus. But we have a phased in approach and I look forward to the day things get back to normal. We're working safely. We're sharing those best practices with governments around the world. We think it is safe to go back to work and and we're going to start to demonstrate that. I think it's safe to say that there are going to be changes to how we run a restaurant coming out of this to make sure that we're able to provide a safe environment having purposeful program where people will stay with our brands as things. Get back to normal when they get back to normal and how quickly that happens. Obviously it's going to be staged. Nobody really knows but we can expect that people will be eating. More meals at home For quite some period of time we don't expect to be back to normal until at least September first and we're not going to expect or hire employees to come to the office. The Governor of Texas is starting to slowly reopen the Texas economy. It will slowly start phasing in people back into the office. Been Coaching them to continue to work from home. Dunkin's been a business. That's again low touch high frequency affordable ticket and we think whatever the reality is going to be that model plays well with what the consumer is going to be looking for in addition to those safety measures which we view is really investments. In the future meantime California Governor Newsom saying the state is considering a late July or early August restart date for students who've been practicing distance learning since mid-march due to the virus with tonight Stephanie. Gregson she is California Department of Education. Chief a deputy superintendent. Dr Grayson's good to have you tonight. Thanks so much for being with US thank you for having me so July or August restart that would be earlier than a September start. Well a lot of our schools in California actually do start in August some the beginning some of the middle in some of the end interesting. How has distance learning been going distance? Learning I six point. Two million students across a very large state is always a complex approach to take and so one of the main issues. We've been working through is digital divide ensuring that all of our students have access to devices and broadband seat superintendent. Tony Thurman created an Ad Hoc Committee on closing the digital divide. It's a task force. That is really working with Internet. Service providers are legislative members to work through how to decrease the barriers for students to have access to devices and broadband You know we know that broadband access needs to flow like literacy for all of our students to engage in distance. Learning approach for a challenge. Are there some children within your district? Who who don't have ipads laptops desktops. Things they need to to communicate. Yes we have over three hundred thousand students without devices and over two hundred ninety thousand students without access to broadband across the state and that is why we are working so diligently to get devices into their hands and to really send that message to Internet service providers to work with our low income families to decrease the barriers for that access. Trying to wonder how you have such a monumental task as you look towards the new school year of even thinking about how you'll send your kids to school. How will all send our kids back to school through transportation? How teachers will be thinking about that with classrooms will look like how are you tackling all of that? So first and foremost we're working with our partners. We're working with the governor's office the California State Board of Education all of our education partners and really looking at. What are the questions that we need to answer in order to be able to open school safely because that is first and foremost for us is to open schools in a safe manner where students families and teachers feel comfortable walking on campus and being able to learn? What's the average class size in in the state? Do you know that number off hand? It ranges from elementary grades to having twenty students to high school classes that may have forty students. It really is a range. You thinking at this point about how you'd be able to distance students from one another with inside a classroom. Well I think we're all know that kindergarteners first graders will have a really hard time staying six feet away from each other so we really have to think through what that would look like and in order for them to be safe at school in for their their teachers as well. I was GonNa ask you about the teachers. How are they coping with all of this? And how do they feel about a return to school? What would you do to ensure their safety? You know. Our teachers are amazing. A pivoted on a dime to be able to provide connections in opportunities for their students to continue learning and they miss their students. You know as a former teacher that that student teacher connection was always first and foremost in my mind and it is for our teachers across the state so they are anxious to see their students again but also want to ensure that everyone's safe that includes themselves and the students. We wish you well big task ahead of you Dr Stephanie Grigson. We'll talk to you again soon. Thanks so much. Thank you so much. There's more ahead on this. Cnbc special report markets in turmoil. Next tonight what one. Emergency Room doctor. Not far from a mid western meat packing plant is seeing. We'll take you out of America's big cities to show you. What's happening next class? I who murdered a woman. One of many who's making a permanent lifestyle change because of the virus before the break images from around the world on Day. One hundred twenty three of this global plan back health officials in Nebraska trace more than two hundred thirty corona virus cases to a meat packing facility in Grand Island Nebraska. That's where we find Dr. Nick Kill Jagan. He is a critical care specialist at Saint Francis Hospital. Dr Jagan appreciate you being with US tonight. Absolutely thank you for having me on. We mentioned you're near this meat packing plant. What have you seen? Have you seen patients who've gotten sick at that plant? I'm not going to go into specifics. Wide Variety ruled what? Yeah we've been seeing folks from all walks of life work in different places and all age groups so let me ask you this. Based on what you've seen. The president has described. The industry is being thrilled and even Gung Ho at his order that they must stay open. Do you think the plant near you should stay open if that many people are getting sick. Obviously I'm I'm not not an expert when it comes to what stays open and what stays close but at least from what I've been seeing ill patients in the ICU. When when they do get sick they get. They get really really sick. And that's what we've been seeing over the last or divide weeks but at least over the last few days an light at the end of the tunnel where we've seen things slow down a little bit more folks get better folks get off ventilators. So cautiously optimistic. Say Yeah I mean just describe for me. The scene of we talked so much here. We're in the New York area. We talk a lot about New York New Jersey Connecticut the East Coast and we talk about the West Coast for for obvious reasons. Given the size of the economy and the states of their. GimMe a real world view though of what it's like on the front lines in a state like Nebraska. What a hospital looks like right now so it is? It's a very dynamic process it. It changed pretty much on within a few days and it's on a day to day basis and we will well prepared we. We had all the planning in place that if this did happen what we would do and we went from maybe one to ventilators to pretty much filling up the ice you within a few days fourteen to sixteen Patients ON VENTILATORS. People get very sick and it's very way everybody has very little oxygen levels and and kind of happens very rapidly so we we adapted quickly. It was a lot of learning and and it was kind of way and it happened. And it's been it was ongoing over the last few weeks so in terms of ages of the patients you're seeing are. Can you tell us a little bit about that? A lot of younger patients. How's it look? It is very surprising. We've seen all age groups. I've seen folks in their twenty s to folks in the sixties and seventies which kind of initially where we're seeing a little more of the older folks who have a lot more bettys but in the last few weeks we've been seeing younger as well. It equally ASCARI. No doubt now let me ask you. Lastly a lot of optimism in the last twenty four hours and maybe a couple of weeks on Gilead reservoir a possible therapeutic to treat corona virus. What do you think about it? And would you prescribe it yourself based on what you know now looking at the data and what's been coming out has been encouraging so definitely as with any study you've got to go into the details associated with it the pros and cons and I think it's got to be tailored to every patient because every patient's inference that we've got to look at the risks and benefits though I'm still waiting on more data come out and I think it is very very important. We appreciate your time so much Dr J. We wish you well your colleagues as well grateful for all that you're doing absolutely thank you take care while she came to New York with a dream but the virus is forced her to make a big change. One woman's path forward is coming up. Next the United States air force band performing I'll be seeing you with allies across the world including Japan Brazil and Australia on this International Jazz Day Song popularized during World War Two and was chosen to send a message of quote conviction and hope cross the world tonight. One woman's path forward is due west after trying to make it in New York. The viruses now forcing her out. Diana Olek has her story tonight. Lindsey Martin will move to New York City. Because in her words you go big or go home. Now she's going home to Tulsa Oklahoma. She had turned down a program last year called. Tulsa remote that pays professionals to relocate there. Last week she changed her mind. I I heard about Tulsa remote last summer and I decided to fire hall and then was a finalist and accepted and just kind of got cold feet now. New York obviously has so much to offer And so I. I decided not to do it. And then cove nineteen happens Brooklyn and became a really scary place fee. I found that was still the same. And you know what what am I paying for? Everything is closed and so I reached out again and said Hey would. Would you all You know give me a chance to to to make this move And they said yes packed up on that I actually still need a schedule to get sent. Its full and I bought a car. I mean I was living in complete here and I'm realizing that even more so now that I'm away was I was driving away from the city. I just felt this overwhelming relief. I mean I was so tense and scare. I mean my neighbor died. Who was always telling my dog high. I mean friends were seeing bodybags from their windows. You know and you're just in the survival mode and I just I just was You know things in New York are not easy. And that's some of the the charm you know even mailing a letter you have to kind of. It's not so easy and so With this interesting just became way too difficult and just absolutely just terrifying. How do you justify paying that rent? When like I said everything's closed or your Even go to the grocery store and so people are going you know if they have access to like vacation home or Just family members or whatever you know. They're trying to get get out and leave now. Tulsa remote says applications for the program have doubled in just the last month Diana Olek. Cnbc on day. One hundred twenty three of the corona virus crisis here are the latest headlines Tonight. Nearly four million more Americans filing for unemployment last week making it more than thirty million in the past six weeks. Gilead says it can produce several million rounds of. It's possible treatment. Room does aveer next year and the Dow and the S&P five hundred posting their best monthly gains since one thousand nine hundred eighty seven. We'll take a look at how may may get underway with. Give some back if it opened right now from all of us here at CNBC. I'm Scott Wapner. Please stay well and be safe. The Air Force Band is GonNa play us out tonight and then shark tank is next Free these honest if you want to learn more about one of the fastest growing trends in investing we've got the podcast for you. It's ETF edge. I'm Bob Azzoni. Join me as I'm joined by top market participants help you build your best portfolio at the end of each episode stick around for our markets one segment where we round out the conversation to help you better understand. Etf listen now and subscribe for exclusive content. Not On television. You want even more tweet us at. Etf EDGE CNBC.

CNBC US Scott Wapner Georgia New York City NIH Scott Gottlieb Oxford China Texas FDA Bob Hasan New Jersey partner University of Oxford Zeneca Austin Texas Astra Zeneca
AP One Minute Headlines Nov 15 2018 11:00 (EST)

AP Radio News

02:00 min | 2 years ago

AP One Minute Headlines Nov 15 2018 11:00 (EST)

"Entertainment design, just for you, then checkout, customizable, streaming TV from finishing. It makes your life simple easy. Awesome. Expended? He gives you, customizable, streaming TV options. Enjoy the most free shows anywhere on any device and even access your streaming apps right on your TV with x one. Go to expend dot com. A one eight hundred spineta or visit a store today. To learn more restrictions apply. Welcome to winter. I'm Ed Donahue with an AP news minute on November fifteenth the northeast is getting a blast of winter forecaster, Pat Burke, says some areas could get significant snow Syracuse, and then the Adirondacks in northern New York should pick up again five to ten inches. And maybe even a couple of spots up to a foot of snow that will eventually overnight into the into Friday include parts of northern New England moving west eight more sets of human remains were found in northern California in the area around a huge wildfire. Eight of those human remains were found in the paradise area. Six found inside structures to were found outside of structures. Number of dead in northern California is at least fifty six there's a new wildfire in southern California. And the other Ventura County city of Santa Paula FDA, administrators Scott Gottlieb is pledging to ban menthol from regular cigarettes outlaw flavor of all cigars and titan sales on e cigarettes. I'm Ed Donahue. Have you heard metro by t mobile now includes Amazon price. Yes, enjoy the best of shopping and entertainment movies, TV shows music, free shipping and much more all included for just forty dollars per line for three lines all on the T mobile network. Discover the smarter way metro by t mobile that's genius one offer per account offers subject to change twelve ninety nine per month. Value offer valid for new Amazon prime members at your customers may notice reduce speeds versus some t mobile customers video at forty p capable device required. See store for details and terms and conditions.

Ed Donahue California Amazon t mobile New England New York Ventura County forecaster Pat Burke Syracuse Santa Paula FDA Scott Gottlieb AP forty dollars ten inches
2008 Crisis Lesson: Be Greedy When Others Are Fearful

P&L With Pimm Fox and Lisa Abramowicz

27:36 min | 1 year ago

2008 Crisis Lesson: Be Greedy When Others Are Fearful

"Welcome to the Bloomberg PNL podcast. I'm Paul Sweeney along with my co-host these Abramowicz each day, we bring you the most noteworthy in useful interviews for you and your money whether at the grocery store or the trading floor. Find the Bloomberg PL podcast on apple podcasts or wherever you listen to podcasts as well. As at Bloomberg dot com. March ninth will Mark the tenth anniversary of the market bottom during the global financial crisis on that day, the intra-day low and the s&p five hundred touch six hundred and sixty six since then the market is up over three hundred percent. So to give us a sense of kind of what has been driving the market and what to look forward to going forward. We welcome Charlie Brisco, Charlie's vice-chairman ahead of of the investment group at Ariel investments over close to fourteen billion dollars under management areas based in Chicago. But Charlie joins us here in our Bloomberg. Interactive brokers studio, Charlie welcome to our studios next family. What looking back what were some of the lessons that you guys at area you folks at aerial take from the financial crisis. And then what's happened sits over the last ten years. Yes. Some of its relearning old lessons. The biggest one is that you have to be greedy. When others are fearful and people were very fearful in two thousand and nine and it was the best time to be a buyer. But boy, it didn't feel like it. At the time. People felt great about stocks in two thousand and one. And it was a terrible time do invest in stocks. So by when others or selling cell when others you're buying greedy. Who knows if you're those are the lessons, we relearned so and right now, unfortunately, possibly for investors. Invest for for those seeking those values retail investors, don't seem either particularly greedy or particularly fearful they just kind of our following. What's going on there being almost dare I say it prudent? I'm just wondering from your perspective. Is there alpha left is there a place for an active manager to really generate significant returns? So when we make presentations to investment committees at institutional investors, they're still pretty nervous. They keep asking questions about. When is this going to end hasn't this rally gone onto long we're going to have a recession here any day? There's been a shift to fixed income L D I investing pension plans. We think the institutional investor is still pretty nervous. A lot of questions. We get about our earnings recession coming. The first two quarters. We don't see it. So I'm going to just say that the market in general is still pretty nervous. So Charlie it's interesting because the markets up the SNP is up over eleven percent this year in one of the stats that that really caught my eye is just as this round trip. We've had since early December that thirty seven percent move roughly, and yes and p from the so when you think about that one could argue that gee, maybe today now now's the time sell that kind of made eleven percent. Isn't that good enough in what's your view for the remainder major this year, for example? Yeah. So are the flexible fund of areas the area fund, which is actually up eighteen percent. When the SNP was up eleven on Tuesday. And I will say it was cheap after the drop last quarter. At the beginning of the year. We were at thirteen times forward earnings. We're not at dirty anymore. We're probably close to fair value. But there are still pockets of cheapness, and there's pockets of overvalued. We think there's still a safety bid stable, stocks are considered stable stocks. Utilities high paying consumer. Staples are still overpriced what's not expensive are anything. That's considered cyclical. Still have a lot of people thinking recessions coming. Global growth is going to close is going to slow down. So we love the alternative asset managers KKR Blackstone, which are considered a high beta and cyclical and they're very cheap right now. As are a lot of industrials sound like right now at SAP five hundred that's up more than eleven percent year to date, including reinvested dividends. How much does it have to go? What's going to be the full year return for twenty nineteen? So we think neither wean or anybody else can have good prediction on that. We can at any given time give you view on relative value. But we don't think anybody's any good at at predicting the short term, we think of frankly, the secret to investing is focusing on the long term and not spending too much time worrying about the short term. However, I certain times, however, here is an exact number for the one hundred year. But it is actually true that that market. Multiples are pretty good predictor of returns. And so when you had at the beginning of the year, our value stocks at around thirteen times that was cheap and low p es do tend to produce a high returns, even in the short term is a great statistic that when the PM ratio drops by twenty percent in the market. It's often a very good period of time to invest for even the next twelve months does aerial invested on PEOs, not usually in the reason is because we want to invest in companies that have a proven sustainable competitive advantage. We're value investors. So we look at earnings a lot of the companies are going to be coming public. This year. Have no earnings people talking about multiples of sales. So we would be very cautious on some of the valuations that we're seeing for companies that are coming Charlie. What do you feel about concentration because I've been hearing about more funds that are going into say fifteen names, and that's it? Yeah. We're very concentrated. We believe in focus. We have in the area fund on forty stocks buffet talks about why it's so much better to invest in your top twenty ideas, rather than putting money into your thirty s bet thirtieth best idea, we think it's if you're really diversified with one hundred stocks, very hard to beat the index is after fees. So we believe in focus, you can know those names better. Frankly, there's stocks like Qiqihar that are very cheap. And we'll put a lot of money into kickoff. Five percent of a position. When did you start that bet in two thousand and thirteen when the US government, downgraded when SNP downgraded the US government from AAA everybody thought, the high yield market was going to close and kick air stock went from eighteen to twelve and it became a wonderful opportunity because of the two and twenty didn't go away. But the stock reduced in price by thirty three percent. It's gone now from twelve to Twenty-three in one of the reasons was it was a partnership that index funds camp by and kick your converted into a. A corpse. And now everybody combine them vanguard. Just bought eight percent of the company in the last quarter. And I'm looking at the shares right now KTAR shares have risen more than sixty seven percent since March two thousand thirteen Charlie abo- prince, quite thank you so much for being with US Vice chair and head of the investment group in portfolio manager at Ariel investments, which is in New York City to celebrate the ten year anniversary of the financial crisis rather seller. Celebrate what's come after the financial crisis. The crisis itself. It wasn't so long ago that things were starting to look up a little bit for General Electric. There is a sense that there was going to be a restructuring path forward. What happened GE the shares having? It's their biggest two day decline right now since November in the red by more than four percent today. Care nubile heart of Bloomberg intelligence joining us here in our interactive brokers studios. Karen covers industrials here. What's going on now? Well, you know, we've had a lack of disclosure on twenty nineteen. So it has been anybody's guess, we've had no guidance for over nine months, and we are long awaiting the fourteenth where they would give us twenty nine hundred and yesterday gave a little preview of what they're going to announce next week and said that negative that cash flow, which was four point eight billion positive this year was going to be in the negative column next year, and it was a total surprise. So what's driving? This negative surprising casual which of. The remaining businesses. I know they've sold off a lot of businesses. They've really focused what's causing the problems now at all power. But in addition to that, and this is one of the problems with GE last year. The apparently got a billion plus in prepayments from their little renewable business. Okay. Which they didn't mention when cash let was better than expected. Right. This year. They have to start delivering that stuff that business at little tiny businesses going to shift from a billion positive to probably, you know, I don't know up to a billion negative. So that's two billion of the shortfall. Why didn't they tell us? There was a one time last year. But this raises another question, right? One sort of hallmark of General Electric's problems has been I don't know if accounting issues is sort of a strong way of putting it but the in accurate, accounting, statements or statements that have not fully disclosed the depth of the problems at the organization for a variety of reasons. Does this just sort of confirmed that nothing on that front has dramatically changed and that these surprises will keep coming? Well that that is. Is part of it. People are hanging their hat on. You know, this is this is a, you know, an honest guy a really good operator. He's going to he's going to give us the details. And this was like dropping a bomb, and but the second one is power power. You know, it's gonna it's taking longer to get his arms around it. I don't have any doubt that he will. But power is going to be worse this year. And again, some of that could is disclosed they these are very long term contracts. They did very bad contracts over the last few years just to get orders on the books, and guess what? Now, they've got to ship them, and they're shipping. Very probably some some deals at at losses, and that's going to be a multi year workout, you know, kinda like an engineering construction company a bad contract and takes years to work through the backlog. Right. But then also, you know, the cost structure is not anywhere near in line with where revenues revenue today, and that's ongoing. He they laid off twenty four thousand people not divisional almost year. They've cut a number of plant. It's not enough. So that's what he's telling us. They have to do more. Okay. So let's now they've done. That in terms of the the the restructuring and the company, do you think that they are done with that in terms of selling I guess people call non-core assets are the assets that GE has today is that it now they still have about fourteen billion in stock ownership of Baker Hughes that businesses already off line. It's being run independently. But they have a fourteen billion dollar ownership there. They have about another four billion that they can get out of the web tech business that they sold and then it's going to be smaller units. I think from here, but even in the power division. There's two pieces now that the the non gas piece their stuff in there that they can sell. But I think the big stuff is is probably behind us. So all right. So I, of course, I'm sorry. I I'm very focused on the debt side of this just because that is the nature of my DNA. That is I'm sorry. It is who I am. I'm looking right now General Electric perpetual, bonds five percent debt is the biggest loser. Among the investment grade universe today. Another decline in price that means higher. Implied borrowing costs how crucial is it. The General Electric gets its act together, and is able to give better disclosure, and frankly, a better view into just how much more Consol in the valuations that'll be able to achieve in order to avoid paying criminally high interest rates are prohibitively high interest rates and potential downgrade. Well, I think they bought some time with that twenty billion dollar asset sale that they announced last week that will significantly help the debt burden. They're not going to get the money until the fourth quarter of next year. But you know, there's a good shot that the credit agency agencies will say, look, we got a lot of cash common. And it's the the deal with Danaher. And I think that really bought them time the sales at selling something for three billion or five billion or four billion. There was still a lot of a worry. And now this they got a chunk of change coming which will I think alleviate some of those fares the one risk is what if some of these these unknown liabilities are much bigger than we think. There's a lot of lawsuits out there. You know, there's a number. There's a long-term healthcare insurance thing that do they really have their arms around that. So I think they're okay with this big asset sale if nothing big hit some, you know unexpectedly, but there's room for that. There's room for the unexpected here. All right. Let's no, Leslie, let's talk about the dividend. I'm looking on the Bloomberg terminal. Now, there's a forty two assent dividend. Yielding about three point eight eight percent is that safe. No, they cut the dividend to a penny. Okay. Because. Yeah. So so they had they and they're saving four billion dollars by doing that will actually it's an eight billion annual cost. That's now nothing like eight hundred million. So this this is not the GE week Rupp with building growing buying dividends for widows and orphans. That's that those desert on right? I you know, he said down the road he wants to be two and a half times leverage and competitive dividend. But that's really quite a bit down the road, so renewable heart. Thank you so much current heart senior industrial analysts been covering GE forever. Not edge you she's our best and Bloomberg intelligence. So thanks so much. As usual. There is a lot of news in the healthcare space. First. We have the announcement that the FDA has approved Johnson and Johnson nasal spray that works to alleviate symptoms of depression. And we also have news of the sudden resignation of the food and drug administration's Commissioner Scott Gottlieb, the help us break down. All that's going on healthcare. We bring in our friend, max niece and Max's biotech pharma and healthcare columnist for Bloomberg opinion. He joins us here in our Bloomberg eleven three oh studios. Max a welcome. Once again, this Johnson and Johnson news story seems like a big deal is it it deathly is. So it's the first kind of real novel depression medicine in more than a decade. And it's the first one in even longer time that has kind of genuinely different way of working on the brain. And then kind of the third differentiating factors that it's fast acting what we have generally takes weeks to kick in. You have to build a concentration of time. So this has the potential be used in a lot of interesting different ways spur for people that are kind of in an acute moment of crisis or who just don't respond to existing therapies, and that that is a pretty big population. So you know, what else is fast acting cocaine Fenton? All I mean is this ketamine is this potentially the next opioid crisis. So, you know, it's it's a it's a relative of ketamine and a close one. And I think the potential for abuse of something that the FDA definitely considered as opposed to, you know, whether it's the equivalent of just giving someone a party drug that they did run kind of you know, randomized you'll late stage trials in an controlled trials in really sick patients in it did have an impact. Well, flip it on its head. Right. Have there been studies done of people who let's say took ketamine or took other party drugs like ecstasy, and that actually helped with depression, you know, that there have been a lot of attempts to. Study this, but not in kind of the the scale and rigor of of this trial, and beyond the fact that it has this kind of psychoactive effects that that people have chased. There does seem to be some kind of you know, scientific evidence that there is an effect on the brain that, you know, there's there's like a a medical thesis that they're chasing here for why might help people with depression. It's not let's give people a happy drug and see if they get happy them some acts. I know the antidepressant market in general is a monster market. Is there a sense of how big this sub part of it is so that that's the big question, you know, treatment resistant population is potentially millions of people. The question is how many of them are going to end up getting a getting Johnson Johnson drugs. And that's that's trickier question. This is in you know, you just get a pack of pills and take them you have to go to a licensed office, take it. And then sit there for two hours. A while you're monitored for symptoms of disown. Station today Shen than you're not supposed to operate heavy machinery for the rest of the it's gotta find someone to give you a ride. So that that's a really hard thing for for people that are working to do. And then, you know, this isn't something that your average psychiatrists is quick to handle. So that that is likely to kind of keep it from reaching its full addressable market at least anytime soon, and I just want to be very clear. I mean, I've sort of been talking about this with a light tone. But it's really not frankly underscores how much the epidemic of suicides in this country has absolutely been exploding especially among the younger populations. I do want to shift gears a little bit to the food and Drug administration or just basically the the chief of the US food and Drug administration. Scott, Gottlieb resigned. Suddenly, it seems like there is nothing untoward in why he resigned there was no kind of push. It was a personal issue. How big of a loss is this an how much does it affect the industries? I think it's. Pretty significant everyone likes sky. He he, you know, there's. Even even me, you know, obviously, there's some such people that really like, you know, selling tobacco and vape pens, less spans because he eats kind of an aggressive regulatory stance on them. But he was seen as someone that understood the industry worked really hard and pushed on a lot of significant public health issues in a way that you hadn't really seen from a previous commissioners. It can be quiet job. You know, it's a technical administrative posts, but he turned into something. There was a lot more communicative in an active on the policy front us. So I think he will be missed and not just by by drugmakers who saw someone that was really pushing to modernize the agency and and make it easier for innovative therapies to make it to market, but but for for the country's a whole, you know. It is really the exception when you have kind of a relatively drama free and competent leader agency in in the stained age relative to the past. So is there any sense of who's going to replace Gottlieb in just in general, the the big farm on all their lobbyists? Do they have an influence on who gets selected? You know? I imagine we're we're not gonna get someone that they really hate just because that is a big lobby, and it's one that has a lot of influence in congress. But there is a chance that we could get a left field candidate. And I'm just thinking of, you know, the people that were rumored to be considered a long side, Scott leave I will that was could've Peter the'll affiliated investor who has some some pretty out of the mainstream. I'll save us on on regulation of medicines. Which is to say that they they shouldn't be regulated very much. That's a position that you might think that drug makers are in favor of but actually would. Potentially be pretty chaotic so that that's a potential negative. But we could just get, you know, a pretty mainstream bureaucrat as well. We'll be excited. He's got leap, but probably won't cause any harm. So we'll see you didn't you started off talking about this with respect that tobacco companies. And in vaping companies were not that excited about him being there and are more excited about him leaving. We did see a pop in their shares. Do you expect that to last or do you think that any successor would would adopt the same kinds of policies? Oh, you know. I wouldn't be surprised if they at least continue Gottlieb's efforts. Maybe they won't be as publicly energetic about them. But you know, I don't think there's much of a a push that these these companies can make to to kind of combat the general rise of kind of further regulations. Intersex on the public health impact is is pretty obvious. You don't want people getting addicted to tobacco or nicotine products one way or another, and it's the role of the FDA in one way or another to take a role nuts. So how is the FDA today's generally perceived as a good bipartisan view, or is it really in the lap of big pharma or on consumers. Where's the FDA is kind of proceed right now? You know, I think the God leave FDA lease was was kind of respected to a certain extent by by people on both sides of the aisle, which is an achievement in itself. I think you'll find people that do feel that it tends to lean too much in the way of pharma, and that was a criticism colleague who who had some industry experience. But at the same time he did things that were kind of to the detriment of industry calling people out for kind of abuses of the generic approval system for pricing things like that. And on the other hand, you have people that want to push you have to you'd have more of an active role. So we'll see Maxine said, thank you so much for being with us max Niessen biotech, pharma and healthcare communist with glimmer opinion. We always value your perspective. Good morning. Well, it as Lisa said earlier, the market seems to be discounting that the fed is done raising rates at least for the near term. But there is a interesting column out this morning by former New York fed President Bill Dudley that said don't assume that there may be room for the fed to perhaps even raise rates at some point later this year to help us dig into this issue and outlooks for rates for twenty nine thousand nine we bring in Carl Riccadonna Carl's a chief economist for Bloomberg economics. He joins us live barely in the Bloomberg eleven three oh studios here in New York. You gonna take that sitting down? Very much alive. Just ease one floor wave and he made it with the second spirit. Thanks carl. So what do you make Carl of Bill Dudley's column about rates and the outlook for twenty nine thousand nine I agree with what the former New York fed president is saying, and we've maintained that view as well. This is a pause not a peak for interest rates. We can look at the, you know, the the grand scope of history and the economy has never rolled over with interest rates as accommodative as they are at the moment. And so we look at real GDP growth, relative to real interest rates and real interest rates are essentially zero that the rise significantly higher. Maybe two hundred basis points higher to actually be depressing economic growth. All right. So let's take a little bit more into what Bill Dudley said he said that probably the economy would underperform for the first half of this year. He thinks that patients indicates the fed won't be raising rates in the first half of twenty nine thousand nine. However, he expects the economy to reaccelerate. In the second half, and basically prompt the fed to rethink its patients. Do you agree with that? I agree with that. And here's a story. So break it down for the economy grew on break it down the economy grew about three percent last year. That's well above trend growth when you grow above trend two things happen one the unemployment rate move slower and to generate inflation pressures. So you get an acceleration in inflation. We saw both of those things last year the economy is moderating this year. So we're going from two point nine or three percent growth down to my teams expecting something close to two point four percent still above trend. You get exactly what you got last year just in a slightly smaller dose. And so the expectation is right. The earning seasons. Not looking that great. If you've talked to chief equity strategist Gina Martin Adams, she'll say that we may even be potentially contending with an earnings recession not an economic recession, but an earnings recession or at the very least to solve. Patch in the first part of this year. And so we have this, you know, equity market correction in Q four soft patch for corporate earnings residual seasonality issues with the GDP numbers where we get a Asaf Prenton Q one. Once we get to mid year and central bankers. Sit back in the sense what's happening in the economy. They're going to see that we still have growth that is above trend. We have an unemployment rate heading into mid three percent territory. And the way that pressuring running it. So hottest of the cycle. They'll say in that environment. We're not done we have to keep hiking. How surprise with markets be if when the fed if the fed hikes again this year? Well, the fed doesn't want them to be surprised. So while the fed kind of lead the market to this point in terms of the rate increases, we've seen the fed got burned in Q four. This means now the fed is going to follow not lead the market to interest rates. So the Fed's going to let the market beg for it. And then be happy to oblige them in by letting the market beg for it. It means that we'll see a steepening of the yield curve the fed let's the market price in more inflation expectations. You see a bear steepening of the yield curve. And then the feds steps in and says, we'll help you address the inflation problem and layer some rate hikes in give us a sense of timing. Here is this a third quarter type environment because I think if you look at them, I think the market's discounting really nothing for twenty nine the market is saying nothing economists are saying they're still high. Coming the market better than economists. But go ahead. They're gonna beg for it. Those rate hikes go on the way, the timing of this works out, right? We have to wait until we have a sense that we're in the clear from this earnings recession, which means probably by the time. We get the cue to GDP numbers, which would be the end of July. That would be the time where you'll start to see both market participants and fed policymakers say, okay, the economy still running a little hot a little bit of additional accommodation is warranted. And so I think we see two hikes in the back half of the probably at the September meeting in the December meeting, the December is a boulder call, and so the risk is not symmetric around that the risk is we would only get one height this year. But we do have the view that we're going to be contending with a still robust economic environment in the Fed's going to have to do more. They'll just speak really fast than meeting to indicate that they're not patient any longer. I just have. I just have to ask you really and thirty seconds put how much of the slowdown that we're seeing in the first half is due to the trade skirmish at it's been going. On. That's an interesting question. I think you've have thirty seconds element to that. I think it's just a confluence of factors. I think were were blaming trade too, much and will realize it domestic economic fundamentals are still very strong, and I keep going back to that unemployment rate generating wage pressures that is a backstop to consumer spending and the domestic economic outlook is still very robust. Correct. Donna talent. Like it is here in the Bloomberg interactive brokers students. Correct Donna chief economist for Bloomberg economics talking about that Bill Dudley com. Really interesting to me the idea that the market right now has completely written off rate hikes. And yet we have a former fed officials coming out and saying you guys are. You guys are being a little premature. Thanks for listening to the Bloomberg PNL podcast. You can subscribe and listened to interviews at apple podcasts, or whatever podcast platform, you prefer on Paul Sweeney. I'm on Twitter at PT Sweeney and Lisa Abramowicz. I'm on Twitter at Lisa Abramowicz. One before the podcast. You can always catch us worldwide on Bloomberg radio.

Bloomberg fed Charlie Brisco GE FDA Commissioner Scott Gottlieb General Electric Bill Dudley New York City US Johnson Johnson SNP Paul Sweeney ketamine Bloomberg economics depression Lisa Abramowicz
Special Report | Markets in Turmoil

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Special Report | Markets in Turmoil

"Today every answer matters more than ever before because whether it's about health deliveries or finance some things just can't wait that's why IBM is helping. Businesses manage millions of calls texts and chats with Watson. Assistant it's conversational. I designed to help your customers find the answers. They need faster no matter the industry. Let's put smart to work visit. Ibm DOT COM SLASH WATSON ASSISTANT TO LEARN MORE. I the NBC producer. Katie Kramer one of the Voice of behind the CNBC podcast squawk pot. In these times of uncertainty we WANNA make sure we're bringing you our listeners as much information as possible as quickly as we can. That's why we're sharing with you now a CNBC special report markets in turmoil. Listening good evening. I'm Scott Wapner on day. One hundred forty nine of the coronavirus crisis reopening optimism sent stocks surging. But is your safety still at risk strong confidence on the part of our scientists that we can get a vaccine against the virus moves forward with Merck making a major move the NYSE reopens for business. Today one hundred more apple stores reopening stocks respond as more of the economy opens up Roy. Competitor them down a new questions tonight from the market was closing down the economy. The right thing to do this. Cnbc special report starts right now. Here's Scott Wapner. Welcome good to have you with us on this Tuesday night as we off a week where we're starting to see more of this country reopening apple announcing today it will reopen one hundred more stores in the US this week the NHL Unveiling Summer playoff format to end the shortened season. An airline ridership picking up big time this holiday weekend the TSA screening their highest number of passengers in months. And just this morning. The New York Stock Exchange reopened. It's icon of trading floor after being closed for two months. Traders wore masks and followed social distancing rules. The optimism spilled over into Wall Street today. The Dow rising five hundred thirty points the SNP was up one point point. Two three percent a modest gain for the Nasdaq today. We start this evening with CNBC. Contributor Dr Scott Gottlieb former head of the FDA Dr Gottlieb Hope. You had a good holiday weekend. It's nice to see you thanks. Let's reassess the reopening tonight. How do you feel where we are right now? Well look I think. I think it's been so far so good. We're seeing a bump up in cases and hospitalizations but we expected that certain states. You look at what's happening in District of Columbia Virginia Maryland. You see a slight increase Alabama Mississippi Florida and Georgia. Showing bump ups. The data was flat over the weekend reporting around. The weekends is notoriously unreliable. You get under reporting around the weekend so you really need to look at this on a week by week. Basis and smooth out the data. We did see an uptick last week after two weeks of declines in hospitalizations. And that's really what we're focused on and we're probably going to see some increases going into the summer but I think as we get into the summer and a seasonal effects starts to take hold. Hopefully that's going to be a backstop against spread. We can do this successfully. Why governors prescribed doing this in stages that we can look at the data and adjust. If we need to. You said today that you were concerned that some are looking at this. As if it's an all-clear we're you referring to those photos and some of them over the weekend of large crowds gathering in some places shoulder to shoulder no masks. Well look I think. The biggest risk right now is that we become complacent people feel pent-up. They WANNA get out. I understand that we I did too over the weekend but we need to be careful when we go out. We need to try to reduce the number of times we go out. We need to be careful of our social interactions. We should be wearing masks and practicing good hygiene if people do that on a wide basis that could really have an impact on the spread of this continue. Spread this virus but if people become complacent about those kinds of steps that's when we could start to see the viral transmission. Really start to pick up. Professor Jeremy Siegel Dr Gottlieb of the Wharton School University of Pennsylvania was on my noon show earlier today. Said the following about the shutdowns. I'd like you to listen to that. And then if we could respond to that on the other side I think. In retrospect we will look at the lockdown. As as as as as the wrong policy social distancing mats were were right and the CDC was really slow off the mark on that and You know we could have kept many more enterprises open and and relieved some of much of the seriousness. Not all of it. Of course the history will show that that we really unfortunately did not follow the right policy wondering what you think of that Dr Gottlieb whether lockdowns went too far. Well look I think history is going to show something else. I think in the cities like New York Detroit Chicago New Orleans. There was really epidemic spread. It was out of control. We had no choice but to put in place to stay at home. Mortars in very stringent measures that we took the healthcare system effectively overwhelmed New York City for a period of time was a covert only healthcare system. You couldn't get Medicare outside of an emergency or Cova illness. And so we needed to break the epidemic in the cities where it was. I think the challenge was. We didn't know where it was spreading. We didn't know where the epidemic was going to go to next because we just didn't have good information. We didn't have the testing in place. We didn't have reliable data so we had to reach for simultaneous national shutdown effectively. Because we couldn't target those inventions. Hopefully going into the fall. We're going to have outbreaks in a fallen will probably have cities that become epidemic. Hopefully we can target our interventions much more effectively. Because we'll know where the virus is spreading. I will know where it isn't and we'll be able to titrate our approach based on how much background transmission there is and we'll be in a better position that's what we should be focusing on trying to get those tools and interventions in place so that we don't have to reach for a simultaneous national shutdown. When we have five six seven cities become epidemic. Perhaps in the fall trump talked about Georgia Georgia earlier. Seeing a small uptick in hospitalizations. George of course was the first State Dr Gottlieb to reopen. Since late April the growth in new cases there is actually pretty flat and somewhat say. That's evidence that perhaps we did go too far. Well look there are states that have done this successfully. And if you look at Georgia and Florida. You saw an uptick in hospitalizations. In the last week we have to see what the data shows over the weekend but you haven't seen a major surge and infections. Could this could be a seasonal effect because you're seeing across the sun belt and in the South infections not really go up as those states reopen. An infections never really took off in certain states. We'll have to wait and see. I'm hopeful that you know these states can pull this off successfully. We want to see that happen across the entire country. I think as we go into this summer as we go into July and August we are going to see transmission break off and we can all take a little bit of a breather. That's what happened in two thousand nine with h one n one which was also epidemic. Going into June. We really saw cases collapse in July and August. They came back in the fall. But we were all able to take a breather over that summer. And hopefully we'll be ready for it this time Versus the the the onset of this from the beginning. You said today that we need to define what a quote a new normal is and wondering what your definition of of a new normal is tonight. Well I think. Initially we need to implement the measures that we're doing right now the social distancing the mask wearing people cutting down on their activities trying to group shopping visits being mindful of who they who's in their social circle hopefully as we continue and as we get a better sense of where this virus and isn't spreading and as transmission comes down. We can all relax a little bit more. But I think there's certain things that we're GONNA do in perpetuity going forward. I think mass wearing is going to come far more common. We're GONNA densify offices. I think we're GONNA look for ways to try to identify schools and maybe not have entire populations of students intermingle but keeps kids in smaller groups within the schools tell. Works going to become more popular more than norm. I think you're GONNA see office. Space WORKS START TO DIMINISH PEOPLE OF GONNA not want to go into cities office space work. I think you're going to see a lot of things change in terms of what we do. Some of that's GonNa probably be permanent and some of it's going to be a temporary phenomenon until we get to a vaccine and we can get to a point where we have more immunity in the population and this is less of a threat. We will get there. This will eventually be less of a threat. But we're probably going to have to get through one more cycle with this in the fall and maybe going into the winter until we get to the other side interesting later this evening fact going to have a conversation with the former Chicago Mayor Rahm Emanuel about the very issue. You're speaking about about the future of what our cities are going to look like what you to stay with me at once again. Dr Gottlieb tonight if you could big reason for today's Wall Street rally was new optimism. Drugmakers are closing in on a vaccine with Merck now joining that hunt. Cnbc's farm report make Terrell speaking today with the CEO earlier this evening. Good evening to you. Hi Scott when it comes to this race with a tremendous amount of credibility experience and vaccine development announcing today. Three different moves in cove. Nineteen one is in licensing an antiviral drug from ridgeback bio. That's in phase one human trials and then to different deals On vaccines for COVID. Nineteen first of which they plan to start human trials with in just a few weeks. Now they said they were very measured in the way that they approached how they wanted to get into. This can freeze. You're telling me today. They wanted a vaccine. That could be deployed. Broadly one that has just a single dose needed to confer protection so no booster shots needed and one where the technology has already been proven in people and he said he found that with these two different vaccines. He also said he's already starting to feel pressure from different governments around the world. Here's what he said about that. There is now geopolitical pressure. There are other countries that are asking for us to make sure that they are included. In the first we think the right thing to do is to look at population risk groups so for example frontline healthcare workers for example elderly people people who have co Morbid conditions. We want to make sure that this vaccine gets the people who are at highest risk now. Of course Merck is not the only one developing a vaccine. It plans to be in human trials by July with its first project but there are already eight or vaccines already in human testing including the latest. Today Novak's started human trials in Australia so quite a few shots on goal and and Scott. History would tell us. That's what's needed because not all of these vaccines are GonNa make it through the development process. Hopefully we get many scores of with those shots. Mega appreciate it. Thank you Dr Dot by bringing you back in now so how. `Bout that you heard megs report. Where do we stand? Do you think tonight. It's really remarkable. Moment every single major pharmaceutical company capable of developing a vaccine is now in the hunt and many of them are pretty far along. Merck is using their bowl of vaccine platform to try to develop as one of the platforms are using to try to develop a vaccine against covert. The next big milestone is going to be a data car that we turn over on Oxford. Probably sometime in June. So we're going to get a look at some clinical data from that vaccine. That's the one that AstraZeneca's because now partnered with and so we're going to start getting data all through June and into July of clinical data on these vaccines. That's going to give us a real clear indication of which ones look like. They're generating robust immunity. But we've already seen enough data from some of the early clinical studies with these scenes and the animal studies suggest that one or more of these is going to work with the Merck approaches using a virus to deliver the protein that the body then develops antibodies against that protein. That's spike protein. That we've talked about. Before one of the downsides of using a viral vector to deliver that protein inside the body might be that. You can't dose the vaccine so we're going to see is a lot of these vaccines are gonNA come along. They'll be used once and then we'll have to reengineer the vaccines for the subsequent season. But that's okay we're GONNA get one or more vaccines I think heading into the fall in the winter and probably be ready to mass inoculate the population some sometime twenty twenty one if we have multiple vaccines coming online at the same time. How do we decide which ones are actually used on on different people? If you have multiple vaccines in your toolbox. How do you decide which one to take out? It's a good question. I think what's going to happen. Is We'll probably multiple vaccines get approved at the same time. I think that these vaccines are largely coming through development at the same time the notion that one companies ahead of the other by two or three weeks. That's really not operative once you start running the big clinical trials so we're probably going to have more than one vaccine. We hope we well. We really need to have more than one vaccine because I don't think one manufacturer can supply the entire globe. Let alone the entire United States and what we might find is different. Vaccine's might be indicated for different populations. So you might reserve certain vaccines for a younger population certain vaccines for an older population in an older population where older individuals might have a harder. Time developing an immune response to a vaccine. You might want the vaccine that that's more immuno-genetic in an older person as opposed to a younger person so I think that we're going to start to see some differentiation between these vaccines but we have other markets where there's multiple entrance in the market niche vaccine slightly differentiated and they used somewhat interchangeably. There's certain advantages and disadvantages to different vaccines. But they're all relatively operative used relatively interchangeably. What do you make of the comments? That can frazier. The Merck CEO was was discussing about already hearing from different governments around the world. Saying hey you know. Make sure we get ours. I how are we going to deal with that issue? We'll look we've seen this before in two thousand and nine with h one n one. When when nations effectively nationalized their supplies nationalizes supplies it would destined for other countries so we got back scene for the US being produced in Canada Australia and they held onto those supplies until they were able to vaccinate their populations and then they released the supplies to the United States. We did the same thing to the United Kingdom. We were manufacturing so h one n one vaccine here in the in the United States for the UK and we held onto that it required a phone call from UK officials to the White House to get that released. So you see this kind of behavior. I suspect you're going to see some of this again. It's important that nations have a supply. Domestic manufacturing capacity and a lot of nations are are seeking to do that right now. I think that it is important that we make equitable distribution Ken. Remarks Right on point. We need to make sure that we get the vaccine. First and foremost and the highest risk populations globally and the places where there's epidemics. We might not be experiencing epidemic. At the time that the vaccine comes online another country might be and we need to make sure there's allocation to account for that but but by and large countries are going to want to make sure they have enough supply vaccinate their own populations and. I don't know that we would be surprised by that behavior. Certainly what's happened in the past interesting part of the conversation For certain have some twitter questions once again for a Dr Gottlieb and some good ones at that. Our first question for you. I had the corona virus I also tested positive for the antibodies had a high antibody reading and my now immune and or if I do get it again would it be less severe. Have there been incidents of healthcare workers getting sick recovering and then getting sick again. I think most people who've had the virus and recovered can expect a period of immunity probably around a year. This virus behaves like every other virus in every other coronavirus. And certainly if you get tested for antibodies and you have a high tighter that suggested that you'll have residual immunity. Let me ask you another question about a vaccine that plays off what we were just talking about. Nelson writing to you with so many companies around the world in this race to a vaccine. What will happen when the first one quote wins the race? Can't there be various levels of efficacy among the competition? So what do you do with the efficacy? Efficacy issue? Well I think what we're likely to say it's a good question. I mean we don't know what we're going to see frankly but I think what we're likely to see is vaccines that perform better in certain groups. So there's going to be differentiation and might be one vaccine that sort of an overall winner in terms of its absolute efficacy. Its ability to produce them. You know genetically but it might have other downside so for example the viral vector vaccines might might be more immuno-genetic might produce more robust immune response but people who've been exposed to those viruses in the past might have antibodies to the virus itself and they also might not be dosed with those vaccines. So that's a potential downside. So you might not WanNa take that vaccine. I know you can only take it once. So I think there's going to be trade-offs with these vaccines and I'm hopeful. We'll see more than one vaccine succeed. We really need to see more than one. Get over the finish line. And lastly as we continue to talk about the path forward and the reopening of business in this country some are asks you about the transmission of the corona virus by secondhand smoke. I have relatives who work on the casino floor. Well there's nothing suggests that that the secondhand smoke would be any different than any other kind of respiratory droplet transmission. There is data to suggests from mostly from influenza that secondhand smoke reduces your immune response and makes you more susceptible to respiratory pathogens. So if you're getting a lot of secondhand smoke you might be more susceptible to viruses has actually been clinical studies looking at kids in particular and flew that have demonstrated that interesting. Dr Gottlieb appreciate your time as always we'll see you tomorrow night. Scott Gottlieb joining us once again tonight. The special reports just getting started next tonight. How hospitals are tackling the problem of not having enough equipment when they need it most see what they learned and how they're fixing it plus our meeting between eight and nine hundred families six days we getting and giving help in a place where it's needed most and the future of the great American city I would this country. Looks like on the one hundred forty ninth day of this global pandemic Today every answer matters more than ever before because whether it's about health deliveries or finance some things just can't wait that's why. Ibm is helping. Businesses manage millions of calls. Texts and chats with Watson. Assistant it's conversational is designed to help your customers find the answers. They need faster no matter the industry. Let's put smart to work visit. Ibm Dot Com Slash Watson Assistant to learn more welcome back on day. One hundred forty nine of the crisis here are some more headlines on the virus tonight. Google plans to reopen its offices starting July sixth for up to ten percent of its workers and looks to increase capacity to thirty percent by September barbershops and hair salons will be allowed to reopen in parts of California with guidelines like requiring masks for both customers and employees and tomorrow Disney and seaworld present their plans to reopen their Orlando theme parks to a local task force. Well during the crisis hospitals around the country found themselves in bidding wars with other hospitals desperate for protective gear. Today hospital supply premier struck a deal with a key maker of surgical masks. Make Terrell with US tonight with premieres. Ceo Susan Divorce Mega. Send it back to you. Thanks so much and Susan divorce. Thank you for being here with us. It's a really fascinating deal because it's not just you who's buying this minority stake but also fifteen of your members who are health systems hospitals. I mean really. Buying an ownership stake in the largest domestic supplier of face masks. Just tell us about how this deal came together. You Know Meg Premier serves four thousand hospitals one hundred and five thousand other providers of care and it is really important for us to be able to help them get all the supplies. They need to protect their employees and protect their patients in their communities. Fifteen of our healthcare systems representing hundreds of hospitals across the country and came together and said we need to. We need to take control here and we need to bring more of this manufacturing back to the US. We found this company in Texas a few months ago and we've been in discussions with them ever since on the idea is these health systems make long term commitments to buy the supplies from this company. This company increases their production capacity a prestige. Ameritech only sells to the US. So it's a hundred percent. Us US-BASED and they manufacturer critical face masks and and ninety five masks and surgical masks and so we felt like it was really important. Push this forward well sitting where you said. You have a view that most people don't into the supply chain tell us what you observed sort of the height of these bidding wars between states between hospitals trying to get the supplies that they needed and in some cases. Did you observe this necessity really to bid against one another making the situation worse because it was driving prices up? All of that is true when you only get five percent of your face masks in the US manufactured in the US then supplies to pharmaceutical ingredients to where less than twenty percent is manufactured in the US and you have a pandemic and you have over two hundred countries that all need the same stuff everybody. We were competing with countries. We were competing with states. Government was competing with private sector and the challenge for hospitals and healthcare systems. Is They just needed to take care of patients and there was not a lot of transparency. About how decisions were being made where that scarce product was going and the demand increased from normal loads to seventeen to thirty times of the normal level of demand. And so our goal here in doing it with the provider. Health SYSTEMS IS WE'RE GONNA brain transparency to all of it. We're going to bring commitment to all of it. Price did go up. These masks used to cost thirty. Five to forty five cents apiece in its heyday. That price went up as high as eight dollars. It's now come down to around three to six dollars. But we had a problem with too much of our manufacturing offshore and we need to have a diversified supply chain in the US but also near shore and some diversification is. We think it's a mistake to bring it all to the US so this is part of a bigger strategy. Yeah I mean there is such a push right now to create more of a supply chain that is domestic within the United States. And as you mentioned we're seeing that also in the pharmaceutical industry and seeing a lot of pushback to that a great story in Stat News today about how. The pharmaceutical lobby is pushing back against potential legislation trying to Encourage or require these companies to make their products in the US. What kinds of moves are you observing across the healthcare industry in terms of trying to get supply From the United States. Where else will we see this? You know I think that we do need some involvement of governments to incent manufacturing back to the US. But I don't think we need to put all our eggs in one basket because then you'd just be natural disaster away from compromising the supply chain if it were all manufactured in the US so our our idea and at a premier we are talking to all of our manufacturers as well as federal and state governments about adding at least one domestic supplier having at least three suppliers global and domestic near shore offshore for critical products. That are always going to be necessary in any kind of epidemic pandemic bioterrorism. And so. I think it's going to be valance. And I think we need to be thoughtful about how we spread it out and how we make sure we have a diversified access to product and I think manufacturers want that to do. I think the worry is that we might swing the pendulum too far in one direction. And of course you know this. This guarantees long-term supply given perhaps a steady supply. Are there solutions in place or being put in place if there is again a massive spike in demand for this appointment if we face another pandemic scenario or another spike in the fall potentially well? We are bracing for future rounds of Kobe. Nineteen all our health. Systems are reopening all of their surgeries. The demand for these products is going to increase to give you some context. These fifteen health systems alone have committed to forty six million masks a year. Forty six million units of product. And we'll be wrapping up to one hundred million to serve many of our other members and so I think that as this plays out it will play out in waves. And even with a vaccine we are going to have syringe shortages we've already got gown shortages and and you know the approaches to get in front of it figure out what the next wave of demand is going to be and try to ramp up that production all around the world but a lot more of it domestically to to meet the needs of our. Thanks for being here with US tonight. Thank you back over to make. We appreciate it very much. Thank you a Susan divorce. Well well since. The lockdown beginning March nearly thirty nine million Americans have filed for unemployment. A devastating number. Never seen before in this country tonight. We want to show you what these unprecedented job losses mean for communities tonight food pantry. Volunteers at a church in Queens New York in their own words. Normally we'd be feeding about. I've hundred families in a weekend. Which for us was you know. Putting a dent in the hunger in the community and our feeding between eight and nine hundred family six days a week in the past four weeks. We'd given out close to three quarters of a million which for our small little operation is insanity and we probably could have done closed double that if we had. Our food is increased from here to here but are needed increased Off The screen and the food extends all the way into different parts of well-being into the classroom since if you want to Tori cafeteria gym. We're actually raking doubt wall to make. Roofer investor goes out to create a whole old bank upstairs under ringing off the hook zoo system so many people online and so many people online that we would never see online normally lined up. Because they're they need food for their grandma that can't afford to get for them so many different different people hearing sometimes. I have to just look at the map of people we have delivered to say. Hey we're making a difference. You certainly are more good people doing extraordinary things. We of course wish them well. There is a lot more ahead tonight on this special report next tonight the future of the American metropolis once the crisis spades. The former mayor of Chicago Rahm Emmanuel is with US tonight. Plus inside of Miami hotspot forced to close the doors see how the owner is managing now. The customers are allowed back in once again. We're back in two minutes tonight. The future of America's cities former Chicago Mayor Rahm Emanuel is with us live plus business face to face one owners comeback story once again. Here's Scott Wapner. We welcome you back after a rally on Wall Street today. Let's get you caught up on. Where futures are currently trading early? Of course we are slightly. Greenville across the board today. Investors growing optimistic about the economy reopening and the prospects for a vaccine corona virus the Dow rising more than five hundred points the S&P five hundred adding more than one percent and at one point hit its highest level. Since the beginning of March financials were the best performing sector of the day with big gains from Goldman Sachs J. P. Morgan and American Express leading the way from the top tonight. The CEO of Winnebago and to owners of Big League sports teams all on their pets forward. Small Business of being active and being in employing people. I think the league is being thoughtful in creative about ways to get up to get guess playing again with schedules and may be involved little less travel but we WANNA play in our own hearts. We don't WanNa put in tournament set in the NHL or be looking at you know. Obviously what's driving? This are people are are coming out of the stay at home or shelter in place restrictions that were put on in the month of April and early May and and they wanNA socially distance in safe But yet memorable wave as long as we open up the country in a very a safe way I think they are ready to deliver for their customers. And many of them have actually changed their business models to able to work in this virtual world. That's the view from the top tonight. Big City mayors meantime throughout the country. Have a lot to deal with as you know right now. The immediate problems caused by the outbreak. Enacting rules to prevent the spread and finding a path forward for economically besieged cities. We're talking about more of that tonight with the former Mayor of Chicago Rahm Emanuel Mayor. Welcome back it's nice to see you again. Thanks Nice to see you Scott. How much do you think our cities are going to be changed by all of this for first of all? They're going to be changed. But you know. This is still a fundamental. Cities are where people like to gather economic intellectual cultural energy of their economies and they have a gravitational pull. That won't be loss. There will be adjustment through this period of time. But the core central purposes cities will still exist and making adjustments. Moving forward is going to be something. That's cities will do and that's how they'll survive comeback but a lot of people. I mean said he just let me say this why city he's been around for over two thousand years? They survived a lot worse. Rebuilt income back reinterpret themselves. Reimagined what they can be. They've gone from steel industrial to attack medical centers etc the universities that anchor cities the diversity of economy and populations that anchor cities. That's going to still be the strength going forward. The question is is whether that's changed in and of itself. I want to read you something from a piece. I saw today on on medium that I thought was quite poignant for our conversation tonight quote on the nation's current trajectory one of the most probable postcode at future scenarios in our cities is star-crossed territory with empty coffers for the very services and qualities that make for an appealing urban life. Well paying jobs. Robust public transportation concerts museums. Good schools varied restaurants boutiques well swept streets and modern office space. The glossy mega-cities blueprint will need serious modification. What do you make of that statement? Well you know I think. Let me take on the austerity side. I think that's why the debate in Washington is going to be very key. I have a theory of what I would call a grand bargain Which is that. The federal government should take over like they do in these crises Medicaid and unemployment insurance in a big way that would free up annual two hundred and fifty billion dollars at the state level on annual basis but the bargain is the states invest in education they invest in transportation infrastructure. That are starving for resources and to me that's the right kind of rebalancing that should happen here. I do think You know one of the great things like in a city Chicago. It's known as a city in the garden. We have parts throughout the city of Chicago that make the quality of life as Burnham originally plan a great public health integrated benefit the cultural scene. We'll come back and it will be reinterpreted. Hide you do it an classic way? We did this thing. In the summers called theater was actually a night out in the park where you had dance performances. You had theater excetera rather than close space. You reinterpret how you do it. That's what and cities are very good at reimagining reinterpreting and they will get through. This will not be just a flip of the switch. There will be a process that happens. That will actually allow cities to get that and I do think though and the piece that you just read really quickly. You're going to need resources to do this. You cannot do it trying to starve. A city of financial resources. Universities will play a central role. The diversity of the workforce as I said we'll play a central role and I think Re Bargain between Washington in the states and localities would also help where they take on other responsibilities. Freeing up resources so cities can make those critical investments. In both human capital and physical capital that make a city much more livable. And a where we can call it where you live work and play this. You'll also learn. I'm sorry no finish your thought your thought. I do think though you're gonNA find you're not just going to go back as if this was a period of time. Zap and your back. You are you yourself myself. We're GONNA work at different hours. We're GONNA work from different places how we Seek entertainment and partnership and social we are ultimately social beings. And that's why cities are the longest serving kind of political and social structure. That's been around since the beginning of time and so the idea that. Oh cities are going to empty out. It's not true they're going to go through a reinterpretation Rieti and they will survive not only and they'll probably if they do it right with a game. Plan a blueprint. They can come out of this much much stronger. Do want to discuss with you. The future of of what work may look like. And I'd like you to listen to a comment made earlier this evening by Dr Scott Gottlieb in a conversation we had. I thought it was perfect for your appearance tonight. Let's listen to Dr Gottlieb a Mr Mayor. We can react on the other side and people are to not want to go into cities for office work. I think you're going to see a lot of things change in terms of what we do. Some of that is going probably be permanent. And some of it's going to be a temporary phenomenon. Told get to a vaccine and we can get to a point where we have more immunity in the population. And this is less of a threat. We will get there. This will eventually be less of a threat. But we're probably going to have to get through cycle with this in the fall and maybe going into the winter until we get to the other side. How about that? Here's how I look at it here. What Scott says. And he's probably right about that from a medical standpoint. There's been no pandemic when you go through the last twenty years we've had four or five of these that doesn't have another second kind of kick to it one of the things. My view is what are we doing to prepare? What do you say to the JC? Penney worker the Neiman Marcus worker. That is not gonNA come back to that job. My view is you want to have unemployment. Great I want you to use the six months here at home. Reskill is a computer coder. Reskill is a cyber security analyst and writer. Those are jobs that are always going to be a need and have somebody come out of this process with a career. So we're using the time not just merely to give them unemployment checks which are needed but also with the skillset so they can thrive in the future. I think to me the question is in the same way for those individuals we would say the businesses. I one of the things that has struck me here. Look target's GONNA BE FINE. Walmart's going to be fine Amazon's GONNA be fine but to the small businesses. The families that have three generations working in a restaurant. That's going to be the nest egg. That's always going to send the kids to college. What are we provide them to come back to? And it just flipping switches. The restaurants won't be the same. So how do they thrive and continue to offer their services in which are so vital and to me? Those are essential things that we have to ask ourselves. And how do we make that rebuilding effort possible and invest in both the skills infrastructure in the opportunity to create a? Whether it's your business or your opportunity to succeed going forward and I think we should have a strategy so we come out of this much much stronger than we did going into it. And I think it's revealed some weaknesses but it also revealed some great opportunities to move forward a lot. More people are doing college online. There's a PRI- there's a skill set. You can also do six months certificates that give people an opportunity to go back into the economy with not just the opportunity for a job but a career they can make a lifetime of income and economic opportunity for them and their family. That's how I would look at this matter. I appreciate your time. You'd be well. We'll see against soon youtube. Scott that's rahm Emmanuel joining us. Here's what else is coming up. He has a brewery in the heart of Miami forced to shut down at the start of the crisis. See where things Stan next inside the tank plus one NBA Stars Slam Dunk. Move before the break. What our world looks like on the one hundred forty nine day of the pandemic American businesses are reopening bringing companies. Now face to face with customers once again back with US tonight as Carlos for drone is the founder of the tank brewing company. Down in Miami Florida Carlos. Welcome back. It's nice to see again. Scott. Thank you for having us back. Tell me how you doing down there well other than this weekend. It's been raining torrential rain for three literally for three days out here. It feels like we're slowly coming back right More importantly the dishes to us. You know a lot of our accounts are starting to open up again tomorrow in my head city of Miami. You're a lot of restaurants. Bars are opening so really happy for them. Bit Happy you know. See people getting hopefully getting their jobs back done. I think a small smile on your face. So that's certainly good to see you back in business. You're doing what you love. How do you think it's going to go from here? Nope we think to we look at it as a to battle in the first battle is was know the legal battle making sure to beat all the requirements. Now it's the second battle making sure that our customers feel comfortable coming back. Bright Luckily Again. In our case we didn't follow any order employs. Aol stayed around. They've been working extremely hard. The last sixty seventy days. So they're they're comfortable eat. They've been working doing deliveries doing everything. So now it's just So we feel comfortable that our employees. It'd been part of our process and establishing all the procedures that were having so they feel comfortable. So now it's you know making sure that the customers feel comfortable about it and And slowly slowly. We're starting to see that combined with all the roles that the county has set for us. Tell me a little bit about that. I mean I think I see some of the changes behind. You looks like you can't be up against the Bar Clearly. A Red Line on the floor over your left shoulder along with some tape on the floor. What's the experience going to be like? When you're when you're in you're in the tank so so to be honest made me we think into an extra excrete. Scream I would tell you you know. We have a new. Pc Rheumatic your and Michael. We've been working even before the rules. Were set down here studying. What other country states were doing it? And so we literally have have gone. Probably more than what the rules require. We're taking temperature of the customers as they come in. We're setting the white that you see is kind of what we're saying. Is the data of the safe. So right once they get in. They have to wear masks. Once her. In that wide area they could remove their BASS. That's where they'll be served dirt dinner or and in addition to the beers they go out of that area. We're asking them put on their masks. Begin the rents area right now. It's a rule that you know. Know Bar seating so you don't go into those areas and so there's a lot of AIDS individuals just as a constant reminder to our guest To not only for their safety or employ safety but also to be respectful of other gasping. And so probably a little bit more but luckily our space allows us to. Do I think the last time we spoke you had applied for the PGA loan? But you're still waiting on the money. Did you ever get it? We did we got it like a day or two after being on on on your show right and in addition to on your show I must say that you know other in addition to getting a lot of support from local chains. Such as Milo total. Why it's That we've got whole foods fresh market you. Don't we after being on your show? Thank you for that You Know Public Exceed Sodano. Also you know. We've been able to talk to them. I think they're going to help aside and I think it's GonNa be a great support right to help us sell and and what. We call the off premise situation stores. I'm glad to hear it and I certainly wish you. Well we'll check in with you again. Soon Scott thank thank you very much and thank you for everything you've ads highlighting us and and helping us out and by whom banchory great show. I think you today in the afternoon with the professor. We joined it a lot staying at your halftime report. So you're a good man. I I appreciate that so much. We certainly stand with you okay. You be well and we'll talk to you again soon. Thank you very much. Thank you very right. That's Carlos drone a tank joining us today. Nba Stars idea of helping. A restaurant is coming up next back a big time. Assist FROM CLEVELAND cavs center. Andre Drummond has US applauding tonight. He left a waitress at the chair restaurant in Delray Beach Florida. A one thousand dollar tip on one hundred sixty four dollars bill. Now that is a good tip. It's a great way to help a restaurant and other way to do it. You can tweet me at Scott Wapner. Use the HASHTAG. Thanks for the GRUB with the name town of your favorite restaurant you can even send us a picture and we'll show it on TV tonight. We give shout outs to the following restaurants Sante in Matthews North Carolina. The Caribbean Grill in Boca Raton Florida Galveston House in East. Hatem Connecticut the Twin Lakes in and twin lakes Colorado and Luma. Luminary not too far from here midtown Manhattan. Use the HASHTAG. Thanks for the GRUB by the way and please keep those coming on day one hundred forty nine of the crisis here are the latest headlines Tonight. Senate Majority Leader Mitch. Mcconnell says Congress will likely decide on a new stimulus bill in the next month consumer confidence rose in May as the economy began to reopen. The Dow was up more than five hundred points today for all of us here at CNBC. I'm Scott Wapner. Please stay well. I'll see you tomorrow at noon on the halftime report right now stay tuned for Shark tank which is next today. Every answer matters were than ever before because whether it's about health deliveries or finance some things just can't wait that's why IBM is helping. Businesses manage millions of calls texts and chats with Watson. Assistant it's conversational. Ai Designed to help your customers find the answers. They need faster no matter the industry. Let's put smart to work visit. Ibm Dot Com Slash Watson Assistant to learn more.

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