(upbeat music)
Hello, happy Monday
and welcome back to another edition of B-Well Together.
I hope you're really able to unplug
and relax a little bit this weekend.
We are kicking this week off with one of my favorite guests,
who is an incredibly important voice
during this whole COVID-19 pandemic
and that is of course the brilliant Dr. Larry Brilliant.
For those of you who are unfamiliar with his work,
he is a leading expert on epidemics.
He focused his work
with the World Health Organization
and actually helped eradicate smallpox.
He's the CEO of the Pandefense Advisory
and chair of the advisory board of the NGO Ending Pandemics.
He's written for everybody.
You've seen him in the Wall Street Journal.
You've seen him in Forbes, you've seen him in The Guardian.
He's written a couple of books, one's called
"Sometimes Brilliant"
And the other
"The Management of Smallpox Eradication"
So, today, Larry is obviously going to be here
talking to us about the latest with COVID-19.
And if you have questions, and you are an employee,
then I would encourage you to go ahead and post those up
in the camp B-Well chatter group.
And with that, Dr. Brilliant,
thank you so much for joining us again today.
I've really been looking forward to this.
Jody, it's always nice to see you.
Thank you for having me.
So I'm eager to just jump into this
because I personally have a lot of questions.
I'm sure others do too.
So why don't you maybe start by just giving us
the kind of current state of the state
and where your head is at these days.
Let me, I'd like to just briefly touch on three things.
What's gonna happen in the next four months,
I think that's what I get asked the most.
Then I wanna talk a little bit about the global south,
the rest of the world
that we don't talk about very much and then
some of the dangers that are facing the Trump administration
and the temptations that we have to choose policies
and maybe explain what some of the downside risks are
of things that seem rather innocent on the surface.
So first of all the next four months,
we are currently experiencing thankfully,
a dip in cases in the United States,
about a 10%, 15% drop.
We had reached a peak of 70,000 cases.
Today we have 33,000 cases in the last 24 hours.
I hope that that will last,
of course, I always hope that that will last
but I don't think it will.
The reason for the humps in our curve in the past.
It takes a very big event to change the course of a disease
that's in every county in the United States
and such a big country we are.
And the biggest things that we've seen affect us
up until now are the reopening with the closing,
the reopening.
And then Memorial Day, Fourth of July
and of course now we're going to have
Labor Day, four day weekend.
And Labor Day weekend will itself bring about
all sorts of virus producing increased case count behavior.
So I expect to see a large increase in cases
three weeks after Labor Day and unfortunately,
that means hospitalizations,
perhaps ICU and inevitably some deaths.
So I expect to see the deaths go back up
probably about six weeks after Labor Day weekend,
we have been averaging 1000 deaths a day,
even though today's death count
is less than half of that average.
That's a huge amount and maybe we should take a step back
and say 180,000 of our fellow Americans of all colors, ages,
races, everything, have have died from this disease,
180,000 that every week, we have two,
the number of deaths of two nine elevens.
So let's think about that.
So as we go into the fall,
we'll get the, the trough right now,
until we see the effect of Labor Day,
that increase in cases than deaths unfortunately,
we're also going into the flu season
and this is extremely dangerous.
I actually believe the flu season will be muted this year
because of all the face mask wearing
that we'll have in the United States.
But the combination of flues and colds
and other respiratory diseases
and COVID will mean there'll be misdiagnosis
and chaos and too many demands on tests.
That will also increase the number of cases as well.
The reason that we have flu season,
which is the reopening of schools historically.
And the fact that the weather starts to get cooler
and we spend more of our time crowded inside,
and in our homes in small gatherings,
all of that will increase cases
and ultimately increasing deaths.
And I do think that
by the time we get to the end of October,
we will be back at 1000 deaths a day
and have well exceeded 200,000 deaths,
be on our way to a quarter of a million total deaths.
And that's a huge number of deaths,
many of which, of course, were completely avoidable,
had we acted sooner and had acted
with more global health kind of policies in place.
Speaking about the globe.
Let me mention the global south, because early on,
we heard things like, why doesn't India have more cases?
You know, why doesn't Africa have more cases?
There was some suspicion that the younger age group
in those regions would mean fewer cases.
Some suspicion that they had used BCG,
a vaccine against tuberculosis and that had
mysteriously dropped the case count,
there was some suspicion as they're always in India,
about turmeric.
I say this as someone who loves India
and lived in India for 10 years.
Sadly, India is now at the top of our list,
and I'm afraid it will continue.
As of today,
India has had 3.6 million cases
and I'm certain that's an under count by at least 50%.
And this week, actually today 78,000 cases,
India is about to, if it hasn't already
set the world's record for the number of cases
in a country in a day.
And the deaths in India are now 64,000.
India had the highest number of deaths
of any country in the world today,
almost a thousand deaths.
And India, Brazil, Colombia,
Peru, Argentina, Russia, Mexico,
Iraq, Philippines, Indonesia, South Africa, Bangladesh
are all in the top number of cases
and cases per million population.
So unfortunately, when we think of a pandemic,
we think of a worldwide campaign.
I envision if we get a good vaccine
that fits a eradication program,
such a vaccine would require one dose,
it will be droplets or nasal sprays instead of an injection.
It will not require a booster shot.
It will not require a cold chain
and be inexpensive and readily available.
If we get a vaccine like that,
I do believe we will have a global campaign
if not to eradicate but to control COVID,
that means 10s of thousands of jeeps.
Hundreds of thousands of jeeps
and millions and millions of vaccinators.
But we need to get that vaccine first.
But until then I'm afraid that we're gonna be seeing
the global south and its economies shattered by this,
this virus going forward and it breaks my heart.
But I think that is the reality we'll face.
Lastly, I just wanna talk about four things
that the Trump administration has been talking about
or experimenting with,
and why they are so, cause so much distraught
in the epidemiological community.
Let's talk first about the obvious one, rushing a vaccine.
Rushing a vaccine and cutting corners
is a understandable desire that we all have,
in fact, well over 30,000 people have volunteered
to take the vaccine right now, irrespective of risk,
but bear in mind 40% to 50% of Americans say
they'll never take the vaccine
because of the anti vaxx concerns so.
Is it really that high, It's 50%?
Yes in surveys, as many as 50% of Americans
say, no, I'm not going to take the vaccine.
Now that may change if we get good news about the vaccine,
and particularly if we have trust and confidence in it,
and how can you erode trust?
Well, you can cut corners and then you can have accidents,
you can have early on people who take the vaccine
and have side effects.
And here's the problem with vaccines,
you don't really see a one in a million side effect
until you've done a million vaccinations.
You don't see a one and 100,000 side effect
till you've done 100,000 vaccines and I guarantee you
that the focus of the media will be on those side effects
and all of us will be worried about those side effects
because just like the mirror that you have,
it says that things are larger than they appear
in your rear view mirror.
It's actually they're smaller than they appear
in your rear view mirror,
but we don't look about that, we don't think that way
when we're dealing with side effects.
The second thing I want to mention
is rushing convalescent plasma,
cutting corners and bringing it to the market fast.
We are all eager to see convalescent plasma.
The idea that people who've had the disease
donate blood at the Red Cross or wherever they donate it,
it's spun down, the cells are removed.
And that plasma as rich with antibodies
is then used to treat and save the life very often,
of people who have COVID.
We want that to be there.
But when you rush it right now,
you not only bear the risk of not knowing,
will it work in different age groups, demographic groups,
'cause we haven't tested it.
In fact, this may shock you when you think that
the FDA has given it an emergency use authorization.
There has not been a single proper case control test
or placebo control test of convalescent plasma.
That's one of the bad things.
The second bad thing is that once you say it's great,
like Trump said about oleander and he said about
hydroxychloroquine.
And he said about bleach, but with hydroxychloroquine,
there was a rush on the market,
and people who legitimately needed it for lupus and malaria
couldn't get it.
And it's useless for Coronavirus and that mythology spreads.
So we have to be really careful.
Also, we need convalescent plasma
as a get out of jail free card if it works,
so that if we're doing large vaccine trials,
we can use it in case there's a bad reaction
to redeem the life of someone who's been in that trial.
The last thing I wanna mention,
is there is now if you read the New York Times
a push from a new member of the Coronavirus task force
to adopt the Swedish model,
which is essentially a rush towards herd immunity.
I just want to remind everybody,
we have 180,000 going on 200,000 deaths.
That is, with only a grand total of 6 million cases.
If you rush towards herd immunity,
you're saying we're gonna rush towards 60 million,
or 100 million or 200 million cases very quickly
before there's a vaccine to prevent it.
If you do that you're talking about millions of deaths
in the United States.
Bear in mind, they rush towards herd immunity.
Sweden has the highest death rate
of all of its peer countries, sometimes by two or three X.
A rush towards herd immunity is reckless.
The only herd immunity that I wanna rush to
is the herd immunity you would get from
vaccinating everybody with a good vaccine,
properly tested and safe.
And those are my introductory remarks.
Amen to that.
Okay, my head's spinning in a couple of ways.
Let's start with, so you talk about how you're gonna,
you expect to see a spike six weeks after Labor Day,
which puts us right around the time of Halloween,
which puts, you know, kids and parents
trying to have some sort of a normal and being out.
And then that puts us a couple weeks into Thanksgiving.
And that puts us a couple of weeks into Christmas.
And so I guess I'm kind of curious to hear from you about,
I know that we're working on a vaccine
and I know we don't want to rush either.
But when do you think like
ballpark figure, that we would be in a position to start
safely administering a vaccine, is it next summer?
Is it next winter, is it January?
Like what, from where you sit,
what does it look like to you?
Well I, of course, I don't know.
But to you know, extrapolate what we do know.
I'm hundred percent sure we will see
the President standing in front
of warehouses full of boxes of vaccines.
And we will see them soon.
We just won't know if what's inside those boxes
is a vaccine that is safe and competent.
And the reason I say that is we've placed orders
for 100 million doses
of vaccine from each of five or six different manufacturers,
we will get those doses made before we know
if it's a good vaccine or not.
I think that's a really good strategy,
I'm not saying anything.
I like that strategy.
I'd rather waste money and speculate on vaccines
and have that portfolio theory
that some of those vaccines will have been adjudicated
as being competent and safe.
The problem that we will have is that those vaccines
when we have them,
we will get them before we know
are these safe in elderly people?
Are their ethnic groups that they're not safe for?
How many doses do you really need to get
in order to have them?
I think those answers will not come with
reasonable scientific scrutiny peer review,
to give us the confidence to not increase
the anti vaxx movement by bad anecdotes.
I don't think we'll get that till the first quarter.
But I think it'll be pretty early January, February.
But you're right, we will have gone through Thanksgiving,
we'll have gone through Halloween,
we'll have gone through Christmas and New Years
before we have vaccine that is,
I think that's gone through any kind of reasonable
process of peer review
and the kind of placebo controlled study,
case control study, natural experiment
that we're doing right now.
And that's a problem, that's problematic.
And so when you are on
like a real layman side of this, okay, and you're seeing,
you know, the vaccines are out there
and they're all widespread and you know,
how do you kind of, what would you advise us to look for
to know that there's a level of certainty
that proper testing has been done,
that we have had those one in a million opportunities
to discover and to, you know, tweak the formula?
Like how do you know when it's safe?
Not just you wanna rush and get it,
but when it's truly safe to take you and your family
and go and go down this path?
Oh, Jody, this is gonna be a hard answer.
You know, normally, I would say
you look at what the FDA has said.
You know, the FDA approval is still a gold standard
but the FDA is not approving anything.
It's giving these emergency use authorizations.
And I have to say in many cases,
they're not worth the paper they're printed on.
An FDA approval means it's gone through a rigorous
case control study,
scientists have looked at it's peer review.
And that that has been,
the process has been signed off on by the FDA,
an FDA emergency use authorization
means you've submitted a couple of page application.
And there's a little paragraph at the bottom that says.
I want you to know that I have tested my product myself
and it's good.
That's the thinnest of misleading
of things that you could possibly have.
I would look at a committee
of the National Academy of Sciences
that is co-chaired by Helene Gayle,
who was the head of care.
And Bill Foege, who was the head of CDC.
This committee is called
the Ethical Use a Vaccine Committee.
And we will be hearing from them shortly
on how they think the vaccine should be distributed.
Who should get it first?
Would it be first responders or the elderly
or using it in a kind of ring vaccination approach
where there are cases
and I'm certain that in between the lines
there will be some comments
about what is an effective and a safe vaccine.
I think we'll be hearing that a lot.
I would pay attention to the epidemiologists
and the public health professionals
who are not in the administration
as much as those in the administration.
And that doesn't matter what administration it is.
I'm not talking about the election.
Yeah, okay.
All right, let's swap,
let's let's change a little bit of our focus from vaccines
to I'm kind of curious about people
who are getting COVID and you know,
we've all learned you know, you gotta wash your hands,
you got to wear your masks, got to do all those things.
And we know that those are good protective measures
that we can take for ourselves
but I'm also seeing things about how,
things, like what can we do to better prepare our bodies
if we are to get it, right.
There's narratives around general inflammation
and like, and things that like tend to make it seem worse
in some people,
because there's many people who get and survive it
or didn't even know that they had it.
And I guess like if there was advice that you could give
for my, here's what you should be doing
for your overall general health,
so that if you get it,
you have a better propensity to survive it.
Yeah, I mean, we know that
there are pre existing conditions
that increase your risk of having a bad outcome.
But there are also pre existing conditions
that decrease your risk.
Right.
Having a bad outcome and certainly,
general health is really important.
Getting your exercise, eating a good diet.
But even more than that, it's, you know,
obviously avoid those pre existing conditions.
And they are obesity, they are diabetes,
they are hypertension.
There are many of these that you can avoid.
There's some that you can't avoid.
If you have cancer and you're being treated
you know, with chemotherapy
that knocks down your immune system
or if you have an auto immune system,
those are not things you cannot avoid,
but you can treat them, you can keep your blood sugar
under control.
You can keep your weight under control.
All the things that we know,
if you've heard that something is a pre existing condition
ask yourself how you could avoid it.
There is another pre existing condition
that does seem to give some immunity, cross immunity.
It's speculative right now.
Remember the Coronavirus that we call Coronavirus,
this COVID-19 is one of a family of seven different viruses
that have already hit us as people over the past many years.
Two of those MERS and SARS,
don't go out and go get those for sure.
Of course can't get them, they're not around right now.
MERS is percolating a little bit.
But there are four other coronaviruses that are colds
and you may get them this season.
There may be some cross immunogenicity
from people who have had one of those colds recently.
That may be why children appear to have a lower,
have an easier way of dealing with the this COVID-19,
'cause they may have more recently had another Coronavirus.
Likewise, I think people who've been recently immunized
against anything seem to have an easier time
of dealing with coronavirus.
This is speculative,
that's also one of the reasons that's been offered
to think about, why do kids get off a little bit easier?
Well, they've more recently
had this battery of vaccinations.
These are all speculative,
I wouldn't go to the bank on any of them,
but that's what we're looking at.
So, make yourself as healthy as you can, get exercise.
Wear your mask, wear your mask, wear you mask,
wear the right mask.
Don't go out there and wear a mask that's one ply.
Get a mask that's five ply.
If you can get a KN95 mask.
That's not the one that competes with the first responders
but it gives you as good protection as a N95
especially if you're in a smoky area.
Okay, along those lines,
if I'm curious to try to understand,
I'm hearing about people who have had this,
and then they seem to have, you know,
these really terrible ailments
that stay with them long after the, you know,
the heart of the disease has passed.
And I'm curious to know what we know about
some of these things.
And are these kind of,
do you have a lifelong sentence of asthma or, you know,
other things that are pretty serious
that I don't feel like gets as much attention.
And, you know, just kind of,
what can you tell us about like,
what are some of the potential things that
maybe you survive it but now you,
you know, you have these other issues to deal with?
Well, let me let me first disabuse us all
about the most recent fear that's going around,
which is that you can get it a second time.
We now have four or five case reports
of people who've had COVID a second time.
You know, does that mean that,
you know, you're gonna get COVID a second time?
No, of course not.
They've been 25 million cases.
And we have for humans out of 25 million,
who've had it a second time.
I had an experience when I was running the smallpox program
in India, where I had a wonderful young vaccinator,
who I was very fond of, and I had trained him.
He was vaccinated dozens of times, and he died of smallpox,
the only case in history where the smallpox vaccine
failed to protect somebody.
He had multiple cases of smallpox,
because he had congenital absence of immunoglobulin IGM.
He didn't have any,
he would have died from measles or a cold
if he had gotten that.
So of four people who getting the disease a second time,
I believe that that's probably true.
But what the virus can do
is different than what the virus does do.
And it sure does lead to these long haul
kinds of cases, people who continue to get effects
that are different than a respiratory disease.
We've seen, autopsy reports
that as many as half or more of people
have some cardiomyopathy.
If they've had COVID,
even if they've died from something differently
long after they've had it.
We should be worried about the rare but very dangerous,
autoimmune diseases that follow.
We should be looking at kidney diseases that follow.
You're right about the asthma.
Again, asthma is a pre existing condition.
One thing you can do to keep yourself safer,
is keep your asthma under control.
But it's,
it is, this is a terrible disease.
In many ways, it's like smallpox.
Again smallpox was worse,
it killed one out of three, it was,
it sped through the population
with twice the arenot of COVID.
But smallpox was a total system disease
and COVID is also nose to toes.
Calling it a respiratory disease is misleading.
It is a route of infection, the respiration route,
but this disease affects pretty much every cell in the body
and I wouldn't fall prey to thinking about it
as a mild disease
because it is mild for a small number of people.
Larry in the beginning of,
when we were all first starting to find our way,
our footing here you were very outspoken
about the need for more testing in the United States
and I know that there's been a lot of progress here,
you know, where do you think we're at now?
Do you think we're, have we hit the satisfactory mark
or are we still?
No we're nowhere near the satisfactory mark.
In fact, if I could, I won't do it.
But if I can show
the graph of testing thats actually gone down
in the United States.
I think we're something around 600,000 cases,
600,000 tests a day,
we should be at three, 5 million tests a day.
If you think about it, if we had these rapid tests,
and they were $5,
and you could get a result in five minutes,
which many of the new tests offer as a promise,
we'll see if indeed they come through like that.
And we could all be tested every day,
then clearly, we'd be able to find anyone who had
a case and isolate them very quickly.
And we could end the disease pretty abruptly,
even without a vaccine
or we want a vaccine adjunctively
with rapid testing for everybody.
Harvard said Global Health Institute estimates
5 million tests a day, is what it will really take.
we're nowhere near that it's 700,000.
And I know you hear that
we've done the most tests in the world per capita,
even that's not true.
We're so far behind and because we lost two months
with almost no testing, you can't get those two months back.
But what we can do is we can test in the right places.
You know, if you're gonna go to a party in the Hamptons,
and there's 200 people there,
and they're all gonna be tested twice
before they can get in the door.
That's 400 tests that are not being done
in our nursing homes.
That's 400 tests, I mean, I don't actually know if.
Of course.
Wealthy people paying $300 for a test.
It depletes or increases the total number of tests
that are made, it could go either way.
But we're not testing in the right places.
And even looking at this formula
of the percent of tests that are positive is problematic,
because we should be looking at
what number of tests are given.
Where are they given?
Are they given in the right places?
And I would argue, the most important place
is the diagnosis of a disease in the high risk communities,
and then specifically, in contact tracing,
we should be finding every case, testing every case,
and then doing contact tracing
and finding 100% of the contacts.
We're only finding about 10%.
Vietnam, which went until two weeks ago
without having a single death,
did so because they traced 100% of all contacts.
We are so far away from the optimal disease response
with contact tracing.
That's where our testing should be located.
If we did that, we would not be seeing these huge numbers
that we see in the United States today.
And so what is preventing us from really getting our arms
more around contact tracing?
What do you think that we could do as individuals
or as businesses to try to help, you know, promote that?
Talk to your congressman, your congresswoman,
talk to your state representatives.
We have a,
probably the most incompetent response to any disease
that I've ever seen in my entire lifetime.
Which is saying something.
I can't yet because I'm old.
I was going more for your brilliance,
but we can go with that, you go wherever you need to go.
Come on now we're 4% of the population of the world,
and we're 20 to 25% of all the deaths.
I mean, America has always been historically the leader.
CDC is the gold standard.
The FDA is looked up to and admired,
every country that could has followed
CDC and FDA and built one of their own.
The Chinese version of the CDC is called China CDC.
The Indian version to the CDC is called India's CDC.
The African version is called the African CDC.
And we've messed it up terribly
because of incompetent leadership, political interference,
and demoralization of the agencies.
Can you imagine how it feels to work at the FDA,
and to have made a decision about convalescent plasma
or have made a decision about hydroxychloroquine
and have that overruled by the president, United States?
I don't want this to be a political statement.
I'm just talking about a management statement.
What if the CEO of your company
came down to an area that you're working on,
and your the world's expert and said to you, nope,
I don't like it that way, I want it green.
You say it should be blue, nope.
I mean, those are the things that management 101 tells you.
Do not disavow, do not distract,
do not deceive,
and do not depress the workers who upon whom you depend.
And we're in a rough, rough situation right now.
The core scientists at CDC, where I trained and at FDA
are, the world's greatest.
We need to support them as we support first responders,
honor them but understand
they're under incredible political pressure right now
and those agencies are suspect.
Larry I want you to know from the depths of my soul
how incredibly grateful I am
for all of the work you're doing.
I know you do it because it's what's right.
And I know you do it because you're passionate about it,
but I just feel like all of us are very lucky beneficiaries
to have someone like you out there,
you know, fighting the good fight.
And I really wanna thank you for that.
And I'm very, very grateful that you always make time for us
here on B-Well Together.
So thank you for coming back.
I really appreciate it.
Anytime, I love Salesforce, I am part of the Ohana.
You couldn't get me.
Indeed you are.
I'm delighted to be here, thank you so much for having me.
Absolutely, absolutely.
So everyone, thank you.
I know we're all sending our thanks to Dr. Larry Brilliant.
Please be safe.
Please be smart and please be well
and we will see you back here later this week, bye bye.
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