1 00:00:03,560 --> 00:00:06,760 Speaker 1: On this episode of Newts World. As the COVID nineteen 2 00:00:06,800 --> 00:00:11,440 Speaker 1: global pandemic unfolded, my guest today was in regular contact 3 00:00:11,480 --> 00:00:14,760 Speaker 1: with all the key players in Congress, the Trump Administration, 4 00:00:15,160 --> 00:00:18,960 Speaker 1: and the drug and diagnostic industries. He has an insider's 5 00:00:19,079 --> 00:00:23,680 Speaker 1: knowledge of how level after level of American government crumbled 6 00:00:23,920 --> 00:00:27,640 Speaker 1: as the COVID nineteen crisis advanced. In his new book, 7 00:00:28,040 --> 00:00:31,360 Speaker 1: Uncontrolled Spread, Why COVID nineteen crushed Us and How We 8 00:00:31,400 --> 00:00:35,080 Speaker 1: can Defeat the Next pandemic, physician and former Food and 9 00:00:35,159 --> 00:00:40,159 Speaker 1: Drug Administration Commissioner, doctor Scott Gottli shows how COVID nineteen 10 00:00:40,800 --> 00:00:45,080 Speaker 1: was able to overtake America's pandemic preparations and outlines the 11 00:00:45,120 --> 00:00:48,320 Speaker 1: steps we must take to protect against the next outbreak. 12 00:00:48,760 --> 00:00:53,159 Speaker 1: I'm very pleased to welcome my guest, doctor Scott Gottli. 13 00:00:53,520 --> 00:00:56,160 Speaker 1: He is a former Commissioner the Food and Drug Administration, 14 00:00:56,520 --> 00:00:59,880 Speaker 1: a Senior Fellow at the American Enterprise Institute, a regular 15 00:01:00,040 --> 00:01:04,440 Speaker 1: contributor to CNBC and the CBS news program Face the Nation. 16 00:01:04,920 --> 00:01:08,600 Speaker 1: He's a healthcare investing partner at the venture capital firm 17 00:01:08,959 --> 00:01:13,679 Speaker 1: New Enterprise Associates and a director of fisor Ink and Illumina, Inc. 18 00:01:14,080 --> 00:01:17,800 Speaker 1: Doctor Gottlieb is an internal medicine physician and a member 19 00:01:17,840 --> 00:01:30,119 Speaker 1: of the National Academy of Medicine. And if I might, Scott, 20 00:01:30,200 --> 00:01:34,400 Speaker 1: let me open with what led you to lay this 21 00:01:34,520 --> 00:01:36,960 Speaker 1: out as a book? Thanks for having me. What I 22 00:01:36,959 --> 00:01:40,880 Speaker 1: tried to do in the book was identify what went wrong, 23 00:01:40,920 --> 00:01:43,280 Speaker 1: but look more at the structural features of government that 24 00:01:43,480 --> 00:01:47,360 Speaker 1: I think made us excessively vulnerable to this pandemic and 25 00:01:47,960 --> 00:01:49,840 Speaker 1: allowed this to be as bad as it was. This 26 00:01:49,920 --> 00:01:51,760 Speaker 1: was always going to be a pandemic. We were never 27 00:01:51,800 --> 00:01:54,040 Speaker 1: going to escape this, But did it need to be 28 00:01:54,080 --> 00:01:58,040 Speaker 1: this bad? And whether things that happened and structural features 29 00:01:58,040 --> 00:02:00,880 Speaker 1: of government that allowed us to be more vulnerable than 30 00:02:00,880 --> 00:02:04,240 Speaker 1: we thought we would be, and then identify what we 31 00:02:04,280 --> 00:02:06,480 Speaker 1: could do differently, how we need to change, how we 32 00:02:06,520 --> 00:02:08,720 Speaker 1: can build better resiliency, and how we need to look 33 00:02:08,720 --> 00:02:11,360 Speaker 1: at public health preparatives through a lens of national security, 34 00:02:11,960 --> 00:02:15,480 Speaker 1: which will change our orientation about how we make investments 35 00:02:15,480 --> 00:02:18,200 Speaker 1: to prepare better for the future. I thought that the 36 00:02:18,200 --> 00:02:21,480 Speaker 1: book would come out in the time period when Congress 37 00:02:21,480 --> 00:02:23,840 Speaker 1: and others would be taking up how we're going to 38 00:02:23,919 --> 00:02:27,200 Speaker 1: reform government and reform agencies and build new institutions and 39 00:02:27,240 --> 00:02:29,680 Speaker 1: make investments to make sure we're better prepared for the future. 40 00:02:30,320 --> 00:02:32,040 Speaker 1: So I thought that would be going on right now, 41 00:02:32,040 --> 00:02:33,800 Speaker 1: and I thought the timing of this book would be 42 00:02:33,919 --> 00:02:36,480 Speaker 1: part of that debate. I still hope this book will 43 00:02:36,520 --> 00:02:39,079 Speaker 1: be part of that debate. What surprises me is we 44 00:02:39,080 --> 00:02:41,440 Speaker 1: really haven't taken up that discussion yet, And part of 45 00:02:41,440 --> 00:02:43,240 Speaker 1: me says, well, maybe it's too early. We're still in 46 00:02:43,240 --> 00:02:45,080 Speaker 1: the setting of the current pandemic, so it's hard for 47 00:02:45,080 --> 00:02:47,120 Speaker 1: people to focus on how do we prepare better for 48 00:02:47,160 --> 00:02:49,640 Speaker 1: the next pandemic. But I'm not sure as ever too early. 49 00:02:49,720 --> 00:02:51,960 Speaker 1: I really think we should be having this discussion right 50 00:02:51,960 --> 00:02:54,680 Speaker 1: now because there were clearly things that didn't work. There 51 00:02:54,720 --> 00:02:57,760 Speaker 1: were agencies like the CDC we thought we're prepared to 52 00:02:57,760 --> 00:03:00,920 Speaker 1: take on certain logistical aspects of the response. Clearly worret 53 00:03:01,040 --> 00:03:04,680 Speaker 1: and many Americans were surprised about the lack of capacity. 54 00:03:04,720 --> 00:03:07,160 Speaker 1: But when you look at how these agencies are organized 55 00:03:07,160 --> 00:03:10,000 Speaker 1: and what they were doing before the pandemic, it becomes 56 00:03:10,000 --> 00:03:13,520 Speaker 1: obvious now that we really didn't have an agency equipped 57 00:03:13,560 --> 00:03:16,680 Speaker 1: to deal with a public health disaster of this magnitude. 58 00:03:17,480 --> 00:03:20,800 Speaker 1: Should we have something comparable to the nine to eleven 59 00:03:20,840 --> 00:03:24,080 Speaker 1: Commission you know, after nine to eleven we paneled a 60 00:03:24,280 --> 00:03:28,440 Speaker 1: very broad group of senior people who were used to 61 00:03:28,520 --> 00:03:31,960 Speaker 1: looking at things and making tough judgments. And I'm very 62 00:03:32,000 --> 00:03:36,200 Speaker 1: struck that the different ways in which the system did 63 00:03:36,240 --> 00:03:39,640 Speaker 1: not work somehow need to be surfaced. And then we 64 00:03:39,720 --> 00:03:42,480 Speaker 1: have to think about the kind of system we need 65 00:03:42,480 --> 00:03:46,320 Speaker 1: and the kind frankly, that modern electronics and modern information 66 00:03:46,400 --> 00:03:50,760 Speaker 1: systems make possible. And that of course cuts right across 67 00:03:50,840 --> 00:03:54,680 Speaker 1: the traditions of public health and the kind of highly 68 00:03:54,760 --> 00:03:59,680 Speaker 1: decentralized you know, people faxing in information, etc. Than doing 69 00:03:59,720 --> 00:04:02,960 Speaker 1: so with wildly different standards. I sort of agree with you. 70 00:04:03,000 --> 00:04:05,000 Speaker 1: I think it may be that you've got to get 71 00:04:05,000 --> 00:04:07,920 Speaker 1: through this last wave, which you have said is probably 72 00:04:07,960 --> 00:04:11,520 Speaker 1: the last major surge of the infection. I think we 73 00:04:11,560 --> 00:04:14,960 Speaker 1: have to get through that, just both psychologically and emotionally, 74 00:04:15,360 --> 00:04:18,560 Speaker 1: before we can really get a grip on ourselves. But 75 00:04:18,680 --> 00:04:21,240 Speaker 1: don't you think we need some kind of pretty comprehensive 76 00:04:21,279 --> 00:04:25,040 Speaker 1: and tough minded review of what didn't work and then 77 00:04:25,080 --> 00:04:29,000 Speaker 1: a proposal for the kind of investments and changes we 78 00:04:29,080 --> 00:04:32,240 Speaker 1: need because there will be future pandemics. I mean, this 79 00:04:32,320 --> 00:04:35,159 Speaker 1: is something which happens on a regular basis, not often 80 00:04:35,200 --> 00:04:38,400 Speaker 1: as big as nineteen eighteen or this particular version. But 81 00:04:38,839 --> 00:04:41,000 Speaker 1: I can remember a number of times and you know 82 00:04:41,080 --> 00:04:44,919 Speaker 1: well when CDC has had to deal with stopping a 83 00:04:45,040 --> 00:04:49,240 Speaker 1: potential pandemic by intervening very very early. So what is 84 00:04:49,279 --> 00:04:52,520 Speaker 1: your sort of thought, your reaction to the idea of 85 00:04:52,560 --> 00:04:56,120 Speaker 1: a comprehensive review. Hey, look, there will be future pandemics. 86 00:04:56,120 --> 00:04:58,719 Speaker 1: Probably the next pandemic is going to be an influenza. 87 00:04:58,920 --> 00:05:01,039 Speaker 1: That's what we always prepare. And part of the reason 88 00:05:01,080 --> 00:05:03,280 Speaker 1: we were so weak in our response to this pandemic 89 00:05:03,480 --> 00:05:05,719 Speaker 1: is because a lot of our preparations were focused on flu, 90 00:05:05,920 --> 00:05:08,680 Speaker 1: and we found that those flu based plans weren't as 91 00:05:08,839 --> 00:05:11,840 Speaker 1: applicable in the setting of coronavirus as we thought they'd be. 92 00:05:11,880 --> 00:05:14,159 Speaker 1: And we also never really surmise that we'd be struck 93 00:05:14,200 --> 00:05:16,240 Speaker 1: with a pandemic strain of coronavirus, although it should have 94 00:05:16,240 --> 00:05:18,840 Speaker 1: been a little bit more obvious that the coronaviruses were 95 00:05:18,839 --> 00:05:21,800 Speaker 1: evolving in ways that we're becoming more threatening to humans 96 00:05:21,839 --> 00:05:24,679 Speaker 1: with the advent of Stars one and also the merge. 97 00:05:24,720 --> 00:05:27,200 Speaker 1: In terms of a comprehensive review, I think you're absolutely right. 98 00:05:27,240 --> 00:05:30,280 Speaker 1: We need something that is a much more deliberate process 99 00:05:30,400 --> 00:05:35,720 Speaker 1: for trying to identify the shortcomings, the systemic features of 100 00:05:35,920 --> 00:05:39,240 Speaker 1: government that we're ill prepared for this and in proposing 101 00:05:39,320 --> 00:05:41,280 Speaker 1: a comprehensive set of solutions. And I don't think that 102 00:05:41,279 --> 00:05:43,760 Speaker 1: that's going to be able to be done in a 103 00:05:43,880 --> 00:05:47,800 Speaker 1: normal legislating process. And the Biden administrations put forward sort 104 00:05:47,839 --> 00:05:52,080 Speaker 1: of a framework for how we need to build better 105 00:05:52,120 --> 00:05:54,440 Speaker 1: preparedness for the future, but it's just a framework. It's 106 00:05:54,480 --> 00:05:57,400 Speaker 1: basically the outline of a strategic plan. It's not a 107 00:05:57,400 --> 00:05:59,680 Speaker 1: true plan. We need something like what we did have 108 00:05:59,680 --> 00:06:01,719 Speaker 1: to eleven. And if you remember what we did immediately 109 00:06:01,720 --> 00:06:04,440 Speaker 1: after nine to eleven, we started to reorganize government and 110 00:06:04,440 --> 00:06:07,640 Speaker 1: make investments. You know, the reason we did that was obvious. 111 00:06:07,760 --> 00:06:11,599 Speaker 1: The risk was omnipresent, The risk was immediate, and we 112 00:06:11,720 --> 00:06:16,000 Speaker 1: needed to come up with solutions that addressed an immediate 113 00:06:16,120 --> 00:06:18,320 Speaker 1: threat to the country and threat to the homeland. So 114 00:06:18,360 --> 00:06:22,040 Speaker 1: we started to immediately reform government and make different investments. 115 00:06:22,279 --> 00:06:25,240 Speaker 1: I think there's a perception here that the risk of 116 00:06:25,279 --> 00:06:28,120 Speaker 1: the next pandemic isn't immediate, and so there's not as 117 00:06:28,160 --> 00:06:31,360 Speaker 1: much urgency around engaging that planning. I worry about two things. 118 00:06:31,400 --> 00:06:33,960 Speaker 1: Number One, the risk is more immediate than we perceive. 119 00:06:34,480 --> 00:06:36,599 Speaker 1: And the fact that we haven't put flu immunity in 120 00:06:36,600 --> 00:06:39,200 Speaker 1: the population for one and maybe two years also is 121 00:06:39,240 --> 00:06:41,159 Speaker 1: going to make us more vulnerable to the spread of 122 00:06:41,160 --> 00:06:43,240 Speaker 1: a flu pathogen. So it's going to make us more 123 00:06:43,320 --> 00:06:46,320 Speaker 1: vulnerable to the potential pandemic with a new novel flu 124 00:06:46,800 --> 00:06:49,320 Speaker 1: because we now have a population that hasn't seen flu 125 00:06:49,360 --> 00:06:51,680 Speaker 1: in a couple of years, because the mitigation we've been 126 00:06:51,680 --> 00:06:55,520 Speaker 1: doing for the coronavirus has dramatically reduced flu prevalence. The 127 00:06:55,600 --> 00:06:57,800 Speaker 1: other is, if we get too far away from this, 128 00:06:58,360 --> 00:07:01,440 Speaker 1: it may be harder to engage age the policy making 129 00:07:01,520 --> 00:07:03,640 Speaker 1: process and focusing on these risks. You know, if we 130 00:07:03,680 --> 00:07:06,159 Speaker 1: start this process two years from now, people may not 131 00:07:06,360 --> 00:07:08,279 Speaker 1: want to really focus on this is going to be 132 00:07:08,320 --> 00:07:12,160 Speaker 1: other national priorities, and so I would urge policymakers to 133 00:07:12,200 --> 00:07:14,880 Speaker 1: start taking up this discussion in a more systematic way 134 00:07:15,000 --> 00:07:17,360 Speaker 1: right now. I think the best time to make policy 135 00:07:17,920 --> 00:07:20,320 Speaker 1: is when these ideas are fresh in our minds and 136 00:07:20,440 --> 00:07:23,560 Speaker 1: there's an immediacy to trying to solve some of the problems. 137 00:07:23,920 --> 00:07:27,280 Speaker 1: I think that the further you get from a crisis, 138 00:07:27,640 --> 00:07:31,360 Speaker 1: the more the energy drops and the more the willingness 139 00:07:31,400 --> 00:07:35,840 Speaker 1: to invest resources drops and the greater the resistance to reform. 140 00:07:36,520 --> 00:07:38,560 Speaker 1: Given the scale of your knowledge and the depth of 141 00:07:38,600 --> 00:07:44,560 Speaker 1: your understanding, were you surprised at just the whole difficulty 142 00:07:44,600 --> 00:07:47,360 Speaker 1: of getting accurate information, not just out of China, but 143 00:07:47,480 --> 00:07:50,320 Speaker 1: getting accurate information out of our own systems here in 144 00:07:50,320 --> 00:07:54,400 Speaker 1: the United States. I was surprised by the lack of 145 00:07:54,520 --> 00:07:57,960 Speaker 1: reliable information. But when you actually take a step back 146 00:07:58,000 --> 00:08:00,560 Speaker 1: and you look at the structures in place gathering that 147 00:08:00,600 --> 00:08:05,760 Speaker 1: information and informing policymakers and also informing consumers with public 148 00:08:05,760 --> 00:08:08,840 Speaker 1: health information on how to reduce their risk, the systems 149 00:08:08,880 --> 00:08:11,440 Speaker 1: that we rely on are inadequate for a crisis. I mean, 150 00:08:11,520 --> 00:08:15,440 Speaker 1: CDC was primarily tasked with the job of collecting information, 151 00:08:15,520 --> 00:08:19,840 Speaker 1: doing the analytical work, and surfacing conclusions that could inform 152 00:08:19,880 --> 00:08:22,440 Speaker 1: policymaking and informed consumers about how to reduce their risk. 153 00:08:22,480 --> 00:08:25,559 Speaker 1: But CDC does not collect information from the healthcare market. 154 00:08:25,560 --> 00:08:27,720 Speaker 1: They have these sort of bespoke feeds of data that 155 00:08:27,760 --> 00:08:29,800 Speaker 1: they rely on that are collected just for the CDC 156 00:08:30,240 --> 00:08:33,240 Speaker 1: that are largely a sample of healthcare information derived from 157 00:08:33,240 --> 00:08:37,240 Speaker 1: a small subset of healthcare institutions in this country. They 158 00:08:37,280 --> 00:08:41,079 Speaker 1: do modeling to try to derive national estimates on questions 159 00:08:41,080 --> 00:08:43,360 Speaker 1: like how many people are being hospilized with COVID every day, 160 00:08:43,400 --> 00:08:46,600 Speaker 1: how many people are dying from COVID, and then they 161 00:08:46,640 --> 00:08:50,960 Speaker 1: take months sometimes to formulate analysis based on their data 162 00:08:51,080 --> 00:08:54,959 Speaker 1: to form conclusions. They're deeply analytical organization, high science. They're 163 00:08:55,120 --> 00:08:58,480 Speaker 1: accustomed to being the definitive word on an important clinical question, 164 00:08:58,520 --> 00:09:00,560 Speaker 1: not the first word in a christ We need an 165 00:09:00,600 --> 00:09:02,880 Speaker 1: agency that can give us the first word because we 166 00:09:02,960 --> 00:09:05,520 Speaker 1: have to make decisions in real time. Those decisions are 167 00:09:05,520 --> 00:09:08,000 Speaker 1: better informed if we have partial information and no information 168 00:09:08,040 --> 00:09:11,319 Speaker 1: at all. CDC's culture is, let's wait, let's analyze it, 169 00:09:11,360 --> 00:09:13,480 Speaker 1: let's study it, let's publish it, let's peer review it, 170 00:09:13,520 --> 00:09:15,599 Speaker 1: and then finally, four months later, we're going to have 171 00:09:15,640 --> 00:09:18,800 Speaker 1: an answer on whether this is spreading through droplets or aerosols, 172 00:09:18,880 --> 00:09:21,760 Speaker 1: or whether or not contaminated surfaces are spreading the virus. 173 00:09:21,800 --> 00:09:25,400 Speaker 1: And so you didn't have real time information to inform 174 00:09:25,840 --> 00:09:28,360 Speaker 1: actions that had to be taken, and then when CDC 175 00:09:28,520 --> 00:09:31,640 Speaker 1: ultimately published these things, they were oftentimes incomplete. One of 176 00:09:31,640 --> 00:09:33,439 Speaker 1: the studies they keep pointing to was the study that 177 00:09:33,559 --> 00:09:36,079 Speaker 1: CDC did in the summer where they looked at what 178 00:09:36,160 --> 00:09:39,040 Speaker 1: people had done in the two weeks preceding their COVID infection, 179 00:09:39,040 --> 00:09:40,880 Speaker 1: and they found that a very high percentage of people 180 00:09:40,880 --> 00:09:43,319 Speaker 1: had eaten out at a restaurant, And so they concluded 181 00:09:43,559 --> 00:09:45,920 Speaker 1: that eating out at a restaurant is a risk factor 182 00:09:45,960 --> 00:09:49,480 Speaker 1: for contracting COVID seemed reasonable. In the survey, they forgot 183 00:09:49,480 --> 00:09:51,880 Speaker 1: to ask people if they ate indoors or outdoors. That 184 00:09:52,000 --> 00:09:54,360 Speaker 1: was an important question. It was a summertime, so was 185 00:09:54,400 --> 00:09:56,320 Speaker 1: it eating out at a restaurant that was a risk factor? 186 00:09:56,360 --> 00:09:58,040 Speaker 1: Was it eating indoors at a restaurant that was a 187 00:09:58,120 --> 00:10:00,680 Speaker 1: risk factor? And in the same survey, they also grouped 188 00:10:00,960 --> 00:10:03,040 Speaker 1: going to a bar and going to a restaurant in 189 00:10:03,040 --> 00:10:05,280 Speaker 1: the same category. And when I asked him the question, 190 00:10:05,360 --> 00:10:07,880 Speaker 1: why did you group bars and restaurants in the same category, 191 00:10:07,920 --> 00:10:10,480 Speaker 1: they said, well, they're very similar environments and people do 192 00:10:10,559 --> 00:10:13,360 Speaker 1: similar things in those environments. Well, that was a flaw 193 00:10:13,440 --> 00:10:15,920 Speaker 1: in the methodology because I think most people would disagree 194 00:10:15,960 --> 00:10:17,920 Speaker 1: that going to a bar as the same as going 195 00:10:17,960 --> 00:10:20,480 Speaker 1: to a restaurant. That makes me wonder about the life 196 00:10:20,520 --> 00:10:24,840 Speaker 1: experience of the people who made that decision has certainly 197 00:10:24,840 --> 00:10:29,280 Speaker 1: not been my experience. Having gone occasionally, I emphasize occasionally 198 00:10:29,559 --> 00:10:54,320 Speaker 1: to bars and often to restaurants. You know, I did 199 00:10:54,360 --> 00:10:59,040 Speaker 1: a podcast February ninth last year, in twenty twenty with 200 00:10:59,280 --> 00:11:02,720 Speaker 1: doctor Foucher, and he said at the time, quote, I 201 00:11:02,760 --> 00:11:05,080 Speaker 1: do not believe that the death rate is going to 202 00:11:05,080 --> 00:11:07,320 Speaker 1: stay at two percent. I think it's going to be 203 00:11:07,480 --> 00:11:10,960 Speaker 1: less because as this disease spreads more, you get more 204 00:11:10,960 --> 00:11:15,360 Speaker 1: people who are minimally symptomatic or asymptomatic. He also in 205 00:11:15,360 --> 00:11:17,920 Speaker 1: the Wall Street Journal the same month said the risk 206 00:11:18,040 --> 00:11:21,320 Speaker 1: is relatively low. In fact, I would take the relatively 207 00:11:21,400 --> 00:11:24,680 Speaker 1: out and say the risk is low for Americans. That's 208 00:11:24,720 --> 00:11:27,599 Speaker 1: the good news. I think it's somewhat concerning news is 209 00:11:27,640 --> 00:11:30,200 Speaker 1: that this could change because this is a moving target. 210 00:11:30,640 --> 00:11:34,280 Speaker 1: It's an evolving situation. Well, I mean, Fauci's one of 211 00:11:34,320 --> 00:11:37,520 Speaker 1: the greatest scientists of his generation and somebody I've worked 212 00:11:37,520 --> 00:11:40,920 Speaker 1: with way back on HIV AIDS in the eighties, so 213 00:11:41,000 --> 00:11:44,520 Speaker 1: you have to have considerable respect. But it seems to 214 00:11:44,559 --> 00:11:47,480 Speaker 1: me that it was part of that same process of 215 00:11:47,600 --> 00:11:52,120 Speaker 1: underestimating that this was a genuine pandemic, and the genuine 216 00:11:52,120 --> 00:11:56,280 Speaker 1: pandemics spread very fast and are very dangerous. I mean, 217 00:11:56,320 --> 00:11:58,720 Speaker 1: am I missing something? No? I think in the early 218 00:11:58,800 --> 00:12:00,560 Speaker 1: days it was sort of the fog of viral war, 219 00:12:00,760 --> 00:12:03,600 Speaker 1: and the fact that we didn't have a diagnostic test 220 00:12:03,679 --> 00:12:06,920 Speaker 1: to identify the early spread and really understand how that 221 00:12:07,040 --> 00:12:10,040 Speaker 1: spread was occurring left us with a false sense that 222 00:12:10,160 --> 00:12:12,880 Speaker 1: community transmission wasn't underway, when in fact it was. There 223 00:12:12,920 --> 00:12:15,880 Speaker 1: was community transmission underway in January, and certainly by February 224 00:12:15,880 --> 00:12:19,120 Speaker 1: there was widespread transmission tens of thousands of cases, when 225 00:12:19,120 --> 00:12:21,760 Speaker 1: we were still making pronouncements that there was no community spread. 226 00:12:22,000 --> 00:12:24,760 Speaker 1: I think the fault was not having the tools to 227 00:12:24,800 --> 00:12:27,240 Speaker 1: identify the spread. That was certainly a shortcoming, but that 228 00:12:27,280 --> 00:12:30,800 Speaker 1: was a structural shortcoming. I think the bigger shortcoming was 229 00:12:31,000 --> 00:12:35,120 Speaker 1: not recognizing that there was more uncertainty than what we 230 00:12:35,120 --> 00:12:37,120 Speaker 1: were perceiving. You know, if we didn't have a test 231 00:12:37,160 --> 00:12:39,840 Speaker 1: to actually turn over cases, how could we be so 232 00:12:39,920 --> 00:12:43,040 Speaker 1: confident that community spread wasn't underway. Should we have been 233 00:12:43,080 --> 00:12:46,920 Speaker 1: more circumspect about this and been warning the public more 234 00:12:47,080 --> 00:12:50,679 Speaker 1: and warning providers more. Because patients were coming in with 235 00:12:50,800 --> 00:12:55,600 Speaker 1: unusual respiratory diseases back in February, they were testing negative 236 00:12:55,600 --> 00:12:58,079 Speaker 1: for flu. Doctors didn't know what they have. How many 237 00:12:58,120 --> 00:13:00,400 Speaker 1: doctors treated those patients without putting on a mask. But 238 00:13:00,440 --> 00:13:02,120 Speaker 1: if they had a warning that they may be community 239 00:13:02,120 --> 00:13:03,920 Speaker 1: transmission this coronavirus on the way, we would have been 240 00:13:03,960 --> 00:13:06,400 Speaker 1: taking more precautions, and that was my concern back then. 241 00:13:06,480 --> 00:13:09,320 Speaker 1: I aired it publicly. If you remember the famous press 242 00:13:09,320 --> 00:13:13,040 Speaker 1: conference with doctor Nancy Messenia from CDC when President Trump 243 00:13:13,120 --> 00:13:16,199 Speaker 1: was famously an India traveling back and she gave a 244 00:13:16,240 --> 00:13:19,880 Speaker 1: press conference saying community transmissions inevitable, and the stock markets 245 00:13:19,880 --> 00:13:21,880 Speaker 1: sold off. That's when the President was prompted to put 246 00:13:22,240 --> 00:13:24,440 Speaker 1: Vice President Pence in charge of the task force. That 247 00:13:24,520 --> 00:13:26,840 Speaker 1: was sort of a story that gets told if you 248 00:13:27,040 --> 00:13:29,800 Speaker 1: listen to her press conference, she was lauded for being 249 00:13:29,800 --> 00:13:32,360 Speaker 1: brave and going forward with the statement that community transmission 250 00:13:32,360 --> 00:13:34,599 Speaker 1: was inevitable. If you listen to that press conference, she 251 00:13:34,679 --> 00:13:37,760 Speaker 1: started out by saying, community transmission has not begun in 252 00:13:37,800 --> 00:13:41,000 Speaker 1: the US, and to date, our containment efforts have been successful. 253 00:13:41,520 --> 00:13:43,880 Speaker 1: That's not true. I mean, in retrospect, we now know 254 00:13:43,960 --> 00:13:46,439 Speaker 1: that's not true. Community transmission was underway and our containment 255 00:13:46,440 --> 00:13:49,840 Speaker 1: efforts weren't successful. But that was a pretty definitive statement 256 00:13:49,880 --> 00:13:53,040 Speaker 1: at the time and probably influenced how people behaved in 257 00:13:53,080 --> 00:13:56,640 Speaker 1: ways that probably potentiated further spread. Now there's not much 258 00:13:56,679 --> 00:13:58,120 Speaker 1: we could have done about it because we didn't have 259 00:13:58,160 --> 00:13:59,839 Speaker 1: a diagnostic test. And I'd talk a lot in a 260 00:14:00,000 --> 00:14:02,120 Speaker 1: book about the failures to feel that diagnostic, because I 261 00:14:02,160 --> 00:14:05,240 Speaker 1: think it's a metaphor for some of our more important shortcomings. 262 00:14:05,280 --> 00:14:08,040 Speaker 1: But I think the flaw wasn't that we didn't know. 263 00:14:08,120 --> 00:14:10,360 Speaker 1: The flaw was that I think we didn't express enough 264 00:14:10,440 --> 00:14:13,640 Speaker 1: humility about what we didn't know at that time. To 265 00:14:13,800 --> 00:14:18,880 Speaker 1: what extent was the Chinese unwillingness to cooperate important? And 266 00:14:18,920 --> 00:14:21,280 Speaker 1: to what extent would we have been about the same 267 00:14:21,280 --> 00:14:24,600 Speaker 1: place even if they'd cooperated, if we had gotten more 268 00:14:24,640 --> 00:14:27,640 Speaker 1: information earlier, we would have been in a better place 269 00:14:27,680 --> 00:14:30,560 Speaker 1: at that point in time. The activity of the Chinese 270 00:14:30,560 --> 00:14:36,119 Speaker 1: government and concealing critical facts clearly contributed to the information 271 00:14:36,240 --> 00:14:37,920 Speaker 1: void that we had here in the US. What did 272 00:14:37,920 --> 00:14:41,120 Speaker 1: the Chinese know that they didn't surface? Well? By mid December, 273 00:14:41,200 --> 00:14:44,200 Speaker 1: we now know it's public that there were multiple samples 274 00:14:44,200 --> 00:14:46,880 Speaker 1: of blood and speed and being sent off to sequencing, 275 00:14:46,960 --> 00:14:49,240 Speaker 1: and that the results were coming back, that there was 276 00:14:49,280 --> 00:14:51,880 Speaker 1: a novel coronavirus spreading in Wuhan, So that information by 277 00:14:51,880 --> 00:14:54,080 Speaker 1: mid December would have been helpful. We didn't really know 278 00:14:54,200 --> 00:14:58,680 Speaker 1: that until early January, when the first sequence was formally published, 279 00:14:58,680 --> 00:15:00,880 Speaker 1: that this was a stars like So there was indications 280 00:15:00,880 --> 00:15:02,840 Speaker 1: a little bit earlier that there was a stars like 281 00:15:02,920 --> 00:15:06,240 Speaker 1: coronavirus spreading in China. They had evidence of a symptomatic 282 00:15:06,280 --> 00:15:09,440 Speaker 1: transmission much earlier than it was disclosed. They had evidence 283 00:15:09,520 --> 00:15:12,640 Speaker 1: of widespread human and human transmission much earlier than it 284 00:15:12,720 --> 00:15:15,880 Speaker 1: was disclosed. It wasn't until around mid January that they 285 00:15:15,960 --> 00:15:19,360 Speaker 1: disclosed that they were about a dozen or a couple 286 00:15:19,440 --> 00:15:22,600 Speaker 1: dozen healthcare workers infected. When healthcare workers get infected with 287 00:15:22,600 --> 00:15:26,320 Speaker 1: a novel virus, it's clear evidence of human human transmission 288 00:15:26,320 --> 00:15:28,840 Speaker 1: because the healthcare workers got it from their patients. That's 289 00:15:28,880 --> 00:15:32,000 Speaker 1: a critical piece of evidence. They didn't disclose it until 290 00:15:32,000 --> 00:15:34,800 Speaker 1: mid January. They had that evidence back in December. So 291 00:15:35,040 --> 00:15:36,920 Speaker 1: those are key details that could have given us a 292 00:15:36,960 --> 00:15:40,440 Speaker 1: two or three week headstart on building some awareness here 293 00:15:40,480 --> 00:15:43,520 Speaker 1: in the US that maybe would have instigated certain actions earlier. 294 00:15:43,600 --> 00:15:46,280 Speaker 1: Now political officials would have needed to make the right 295 00:15:46,320 --> 00:15:48,920 Speaker 1: decisions based on that information, But the fact that information 296 00:15:49,000 --> 00:15:52,720 Speaker 1: was withheld certainly set us back. When we did be indulos. 297 00:15:52,760 --> 00:15:55,360 Speaker 1: It was a problem I thought it was very odd 298 00:15:55,600 --> 00:16:00,239 Speaker 1: the CDC was reluctant to let anybody else do test, 299 00:16:00,880 --> 00:16:04,720 Speaker 1: and that they were virtually hostile to other people developing 300 00:16:04,760 --> 00:16:07,800 Speaker 1: tests at a time when the CDC test for at 301 00:16:07,880 --> 00:16:10,720 Speaker 1: least two weeks didn't work. Do you have any insight 302 00:16:10,800 --> 00:16:15,160 Speaker 1: into what was going on bureaucratically. Well, I get into 303 00:16:15,160 --> 00:16:16,920 Speaker 1: a lot of detail in this in the book because 304 00:16:16,960 --> 00:16:18,720 Speaker 1: I think that the testing again is sort of a 305 00:16:18,720 --> 00:16:20,840 Speaker 1: metaphor for our larger issues. I mean, CDC is a 306 00:16:20,880 --> 00:16:24,160 Speaker 1: very insular organization. The old playbook is that when there's 307 00:16:24,160 --> 00:16:26,920 Speaker 1: a novel pathogen, CDC is first to get the samples 308 00:16:26,920 --> 00:16:29,480 Speaker 1: of the pathogen. Because samples get sent to them, they're 309 00:16:29,480 --> 00:16:32,240 Speaker 1: the first to develop a test they foe would deploy 310 00:16:32,320 --> 00:16:34,160 Speaker 1: that test of the public health labs. The public health 311 00:16:34,200 --> 00:16:36,280 Speaker 1: lab starts scaling up testing, and then if that's not 312 00:16:36,400 --> 00:16:38,640 Speaker 1: enough testing, then the academic labs getting the game, and 313 00:16:38,720 --> 00:16:43,000 Speaker 1: eventually the commercial manufacturers. This is a highly sequential process. 314 00:16:43,120 --> 00:16:47,000 Speaker 1: We used it in Zeka with mixed success. But we 315 00:16:47,000 --> 00:16:49,760 Speaker 1: were following that playbook and there wasn't a recognition that 316 00:16:49,840 --> 00:16:51,880 Speaker 1: this was going to be a fast moving pathogen and 317 00:16:51,920 --> 00:16:53,800 Speaker 1: we needed an all of the above approach. Right at 318 00:16:53,800 --> 00:16:56,600 Speaker 1: the outset. Instead, we were following a playbook that I 319 00:16:56,640 --> 00:16:59,080 Speaker 1: got a copy of the plan. The plan unfolded over 320 00:16:59,120 --> 00:17:01,880 Speaker 1: six months. We didn't six weeks. We probably didn't even 321 00:17:01,920 --> 00:17:04,479 Speaker 1: have six days, let alone six months to scale testing 322 00:17:04,480 --> 00:17:07,480 Speaker 1: in this country. But we were following that model and 323 00:17:07,600 --> 00:17:10,919 Speaker 1: CDC was very jealously guarding its turf. They didn't give 324 00:17:10,960 --> 00:17:13,000 Speaker 1: away the samples of the virus to other labs. So 325 00:17:13,040 --> 00:17:15,600 Speaker 1: if manufacturer wanted to develop their own diagnostic tests, they 326 00:17:15,640 --> 00:17:18,640 Speaker 1: needed access to the viral samples. CDC didn't start making 327 00:17:18,640 --> 00:17:21,400 Speaker 1: those samples available to the end of February because they 328 00:17:21,440 --> 00:17:25,520 Speaker 1: maintain custody of those samples. If a manufacturer said, Okay, 329 00:17:25,640 --> 00:17:27,399 Speaker 1: I can't design my own test because I don't have 330 00:17:27,440 --> 00:17:30,480 Speaker 1: the virus, so I'm going to just copy the CDC's 331 00:17:30,520 --> 00:17:33,320 Speaker 1: test design, well, CDC would put in front of companies 332 00:17:33,359 --> 00:17:39,080 Speaker 1: these complicated legal agreements to compel the company to basically 333 00:17:39,359 --> 00:17:42,359 Speaker 1: give away any intellectual property rights to the test. And 334 00:17:42,920 --> 00:17:44,560 Speaker 1: I talked to companies at the time, they said, look, 335 00:17:44,560 --> 00:17:47,600 Speaker 1: we can't negotiate these IP rights with CDCCDC wants to 336 00:17:47,640 --> 00:17:50,359 Speaker 1: maintain patents and intellectual property over a test that we 337 00:17:50,400 --> 00:17:52,919 Speaker 1: would be developing. That we'd be kind of innovating. This 338 00:17:53,000 --> 00:17:55,280 Speaker 1: will take months to negotiate, a weeks to negotiate. We're 339 00:17:55,280 --> 00:17:57,000 Speaker 1: just going to wait and save CDC has the ball, 340 00:17:57,000 --> 00:17:59,200 Speaker 1: we'll see what happens. So, you know, there was sort 341 00:17:59,200 --> 00:18:01,280 Speaker 1: of a catch. Twent two companies couldn't design their own test. 342 00:18:01,320 --> 00:18:04,720 Speaker 1: Companies couldn't copy the CDC test design because CDC sort 343 00:18:04,720 --> 00:18:07,119 Speaker 1: of jealously guarded this turf that was the culture of 344 00:18:07,160 --> 00:18:09,960 Speaker 1: the organization. Nobody stepped in and said, you know what, 345 00:18:10,200 --> 00:18:12,879 Speaker 1: we needed all the above approach. CDC is doing their thing, 346 00:18:12,920 --> 00:18:14,560 Speaker 1: but we need to get everyone else into this game. 347 00:18:14,600 --> 00:18:16,399 Speaker 1: This is how we're going to do it. That needed 348 00:18:16,400 --> 00:18:18,680 Speaker 1: to happen in January because the lead time on a 349 00:18:18,680 --> 00:18:22,240 Speaker 1: commercial manufacturer coming up with a diagnostic test is in 350 00:18:22,320 --> 00:18:25,880 Speaker 1: a crash situation is at least six weeks. It's hard 351 00:18:25,920 --> 00:18:27,200 Speaker 1: to do in less than a month. You've got to 352 00:18:27,240 --> 00:18:29,240 Speaker 1: build and validate the tests, figure out how to mass 353 00:18:29,240 --> 00:18:31,439 Speaker 1: produce it. So if you want to have enough testing 354 00:18:31,440 --> 00:18:33,800 Speaker 1: in place by March, you had to get these commercial 355 00:18:33,840 --> 00:18:36,800 Speaker 1: manufacturers in the game in January. But as it were, 356 00:18:36,880 --> 00:18:39,000 Speaker 1: we never had enough testing really until we got to 357 00:18:39,000 --> 00:18:42,320 Speaker 1: the fall of the winter and the final point on this. 358 00:18:42,480 --> 00:18:45,159 Speaker 1: You know, the testing was important, not just because it 359 00:18:45,240 --> 00:18:47,720 Speaker 1: would have told us where the virus was, but it 360 00:18:47,760 --> 00:18:49,840 Speaker 1: would have told us where the virus Wasn't remember when 361 00:18:49,840 --> 00:18:51,760 Speaker 1: we did the fifteen days to slow the spread and 362 00:18:51,760 --> 00:18:53,639 Speaker 1: then't followed by the thirty days to slow the spread, 363 00:18:53,880 --> 00:18:56,520 Speaker 1: historic burden on the American people to shut down non 364 00:18:56,600 --> 00:19:00,160 Speaker 1: essential activity. We did it nationally. The two thousand five 365 00:19:00,200 --> 00:19:03,080 Speaker 1: pandemic planet we came up with which contemplated this mitigation 366 00:19:03,119 --> 00:19:04,960 Speaker 1: for the first time. The idea of closing businesses and 367 00:19:05,000 --> 00:19:08,440 Speaker 1: closing schools always contemplated it on a very targeted basis. 368 00:19:08,760 --> 00:19:12,440 Speaker 1: You would deploy those measures where the virus was already epidemic. 369 00:19:12,840 --> 00:19:15,480 Speaker 1: But back in March, we had no idea. We knew 370 00:19:15,480 --> 00:19:18,040 Speaker 1: where it was. We knew New York was engulfed with infection, 371 00:19:18,080 --> 00:19:20,680 Speaker 1: but we didn't know it hadn't traveled to Bozeman, Montana, 372 00:19:20,720 --> 00:19:23,240 Speaker 1: and Texas and Florida. But those parts of the country 373 00:19:23,320 --> 00:19:27,800 Speaker 1: still had the capacity to use case based inventions, testing, tracing, tracking, 374 00:19:27,920 --> 00:19:30,400 Speaker 1: quarantine as a way to control spread. They weren't yet 375 00:19:30,480 --> 00:19:33,639 Speaker 1: engulfed in infection. This was a highly regionalized epidemic for 376 00:19:33,680 --> 00:19:37,040 Speaker 1: a very long time. And so you could have preserved 377 00:19:37,080 --> 00:19:40,679 Speaker 1: the political capital to implement the mitigation for when the 378 00:19:40,760 --> 00:19:42,920 Speaker 1: virus eventually got to those parts of the country. But 379 00:19:42,960 --> 00:19:45,399 Speaker 1: when the virus eventually got to those parts of the country, 380 00:19:45,400 --> 00:19:48,399 Speaker 1: when the South had their epidemic in the summer, a 381 00:19:48,440 --> 00:19:51,160 Speaker 1: lot of people there said, we're not shutting down again. 382 00:19:51,200 --> 00:19:53,760 Speaker 1: We did this already, we did it probably when we 383 00:19:53,760 --> 00:19:55,480 Speaker 1: didn't have to. When we're not doing it again, And 384 00:19:55,560 --> 00:19:58,600 Speaker 1: so you lost the ability to target the mitigation the 385 00:19:58,680 --> 00:20:02,600 Speaker 1: most onerous tools to the time when the spread actually 386 00:20:02,680 --> 00:20:04,800 Speaker 1: was occurring in different parts of the country, because you 387 00:20:04,840 --> 00:20:07,440 Speaker 1: didn't have the diagnostic to tell you where the virus 388 00:20:07,440 --> 00:20:11,680 Speaker 1: hadn't spread yet. How do you interpret the Swedish experience 389 00:20:11,720 --> 00:20:14,080 Speaker 1: if you've looked at that at all, where they did 390 00:20:14,080 --> 00:20:17,479 Speaker 1: not go to shutdowns and they don't seem to have 391 00:20:17,480 --> 00:20:21,640 Speaker 1: had a dramatically larger death rate than anybody else. Yeah, Look, 392 00:20:21,680 --> 00:20:24,120 Speaker 1: if you actually dig into the Swedish policy, they did 393 00:20:24,119 --> 00:20:27,159 Speaker 1: implement pretty owners from mitigation. They restricted events to a 394 00:20:27,920 --> 00:20:30,399 Speaker 1: certain small number of people. There were a lot of 395 00:20:30,440 --> 00:20:33,400 Speaker 1: things that they did there that were contours of what 396 00:20:33,440 --> 00:20:35,720 Speaker 1: we did here. The argument that the Swedish didn't do 397 00:20:35,760 --> 00:20:38,040 Speaker 1: any mitigation and we did a lot of mitigation. I 398 00:20:38,080 --> 00:20:40,959 Speaker 1: think there's more there that they did. They suffered very 399 00:20:41,040 --> 00:20:43,240 Speaker 1: high death rate relative to other parts of that world. 400 00:20:43,320 --> 00:20:46,440 Speaker 1: When you look at the other Nordic nations, Sweden had 401 00:20:46,480 --> 00:20:49,679 Speaker 1: a much worse experience than the other Nordic nations. And 402 00:20:49,720 --> 00:20:53,480 Speaker 1: so I think comparing you know, Sweden to the US, 403 00:20:53,800 --> 00:20:57,760 Speaker 1: it's a much different culture, different density of cities, you know, 404 00:20:58,119 --> 00:21:00,679 Speaker 1: different customs. I think you have to compare Sweden to 405 00:21:00,760 --> 00:21:03,359 Speaker 1: countries that are similar to Sweden, and relative to their peers, 406 00:21:03,760 --> 00:21:05,879 Speaker 1: they had a very difficult experience with this. It's like 407 00:21:05,960 --> 00:21:08,480 Speaker 1: you can't compare the US to Australia. I mean Australia 408 00:21:08,520 --> 00:21:10,920 Speaker 1: locked down the island. When New Zealand locked down the island. 409 00:21:10,960 --> 00:21:11,879 Speaker 1: We were never going to be able to do that. 410 00:21:11,920 --> 00:21:14,440 Speaker 1: I mean, we were never going to prevent a US epidemic. 411 00:21:14,480 --> 00:21:17,480 Speaker 1: We weren't going to seal the United States. But I 412 00:21:17,520 --> 00:21:19,800 Speaker 1: think the question is did it have to be as 413 00:21:19,840 --> 00:21:21,640 Speaker 1: bad as it was? And I think if we had 414 00:21:21,680 --> 00:21:25,359 Speaker 1: had a better response early in terms of the structural 415 00:21:25,359 --> 00:21:29,920 Speaker 1: features of government, better tools, access to diagnostic testing, access 416 00:21:29,960 --> 00:21:32,960 Speaker 1: to better guidance and information to inform decision making by 417 00:21:32,960 --> 00:21:35,600 Speaker 1: consumers about how to reduce their risk. I think it 418 00:21:35,640 --> 00:21:38,400 Speaker 1: didn't have to be this bad. At least that initial 419 00:21:38,440 --> 00:21:41,000 Speaker 1: wave didn't need to be this bad. The subsequent waves 420 00:21:41,040 --> 00:21:44,640 Speaker 1: were determined more by the different variants that emerged. I mean, 421 00:21:44,680 --> 00:21:49,480 Speaker 1: you look at systems like Walmart or McDonald's, where in 422 00:21:49,600 --> 00:21:53,879 Speaker 1: McDonald's case, I think they get thirty seven thousand store 423 00:21:54,000 --> 00:21:59,479 Speaker 1: results by midnight worldwide every day, and you look at 424 00:21:59,480 --> 00:22:02,280 Speaker 1: the way in which they've adapted to use modern technology. 425 00:22:02,840 --> 00:22:06,600 Speaker 1: I was really surprised at how much the public health 426 00:22:06,640 --> 00:22:10,480 Speaker 1: structure at every level had failed to modernize and was 427 00:22:10,520 --> 00:22:14,840 Speaker 1: still in many ways very parochial and very traditional in 428 00:22:14,880 --> 00:22:18,120 Speaker 1: some ways, sort of pre information system and how they 429 00:22:18,119 --> 00:22:23,040 Speaker 1: were dealing with things. As COVID nineteen evolves, it strikes 430 00:22:23,080 --> 00:22:25,960 Speaker 1: me and I think you take the same position in 431 00:22:26,000 --> 00:22:29,359 Speaker 1: the book that it's going to become like the flu, 432 00:22:29,760 --> 00:22:32,280 Speaker 1: or like measles, or like chicken. Probably it's going to 433 00:22:32,359 --> 00:22:35,040 Speaker 1: be one of the things which is endemic, but which 434 00:22:35,119 --> 00:22:40,560 Speaker 1: is manageable. And you suggest that ultimately, particularly with the 435 00:22:40,600 --> 00:22:45,240 Speaker 1: development by fiz Or and others of vaccinations appropriate for 436 00:22:45,320 --> 00:22:48,840 Speaker 1: very young children, that autimately it will become very similar 437 00:22:49,160 --> 00:22:51,160 Speaker 1: to the way we deal with a number of other 438 00:22:51,800 --> 00:22:56,960 Speaker 1: viruses by simply having mass inoculation as a routine. I mean, 439 00:22:57,320 --> 00:23:00,600 Speaker 1: I just got my flu shot, and I expect every 440 00:23:00,640 --> 00:23:03,320 Speaker 1: year to get a flu shot because it mitigates the 441 00:23:03,440 --> 00:23:07,080 Speaker 1: risk of my getting the flu and then maybe getting pneumonion, 442 00:23:07,480 --> 00:23:10,320 Speaker 1: maybe being in real trouble. I mean, what's your sense 443 00:23:10,359 --> 00:23:13,320 Speaker 1: of the degree to which this will become sort of 444 00:23:13,359 --> 00:23:16,440 Speaker 1: a normal pattern and will adjust to it. It will 445 00:23:16,440 --> 00:23:18,960 Speaker 1: adjust to us in five or ten years from now. 446 00:23:19,200 --> 00:23:21,960 Speaker 1: It'll be part of the background noise, but most people 447 00:23:22,000 --> 00:23:26,000 Speaker 1: will just accommodate it and go on with their lives. Yeah. 448 00:23:26,000 --> 00:23:29,000 Speaker 1: I think that this is going to become an endemic virus. 449 00:23:29,040 --> 00:23:30,920 Speaker 1: I don't think that this is going away. I think 450 00:23:30,960 --> 00:23:32,880 Speaker 1: the virus is going to continue to evolve in ways 451 00:23:32,880 --> 00:23:35,320 Speaker 1: it will continue to threaten us and become sort of 452 00:23:35,320 --> 00:23:37,240 Speaker 1: an omnipresent risk. But it's not going to threaten us 453 00:23:37,280 --> 00:23:39,320 Speaker 1: like it's threatening us now. I think this delta wave 454 00:23:39,440 --> 00:23:42,080 Speaker 1: is the last major surge of infection. On the back 455 00:23:42,160 --> 00:23:43,720 Speaker 1: end of this, we're going to have enough immunity in 456 00:23:43,720 --> 00:23:47,240 Speaker 1: the population, either through vaccination or through naturally acquired infection 457 00:23:47,600 --> 00:23:49,360 Speaker 1: that's going to be a back stop against the kind 458 00:23:49,400 --> 00:23:51,920 Speaker 1: of spread we're seeing now the virus will mutate, the 459 00:23:52,000 --> 00:23:54,520 Speaker 1: virus will find ways to partially evade the immunity that 460 00:23:54,560 --> 00:23:57,200 Speaker 1: we've acquired. But we'll update our vaccines. We're going to 461 00:23:57,280 --> 00:24:01,080 Speaker 1: have the monoclone anybody. Drugs will be available subtutaneously so 462 00:24:01,080 --> 00:24:02,960 Speaker 1: they'll be able to be delivered more easily. We're gonna 463 00:24:03,000 --> 00:24:05,280 Speaker 1: have orally available drugs, a pill that you could take 464 00:24:05,520 --> 00:24:07,080 Speaker 1: to mitigate the risk, so we're gonna have a much 465 00:24:07,080 --> 00:24:10,240 Speaker 1: different toolbox of therapeutics. We're going to have more widely 466 00:24:10,280 --> 00:24:12,639 Speaker 1: accessible at home tests, so people are going to be 467 00:24:12,640 --> 00:24:14,879 Speaker 1: able to test when they think they have flu or COVID. 468 00:24:15,160 --> 00:24:18,199 Speaker 1: The whole culture around diagnosis has changed dramatically in a 469 00:24:18,200 --> 00:24:20,280 Speaker 1: setting of this epidemic. People now are going to be 470 00:24:20,320 --> 00:24:22,199 Speaker 1: self swabbing at home for a lot of things, not 471 00:24:22,240 --> 00:24:24,480 Speaker 1: just COVID. We're gonna be home testing for flu and 472 00:24:24,560 --> 00:24:26,960 Speaker 1: strep throat. The idea of going to a doctor's office 473 00:24:26,960 --> 00:24:29,399 Speaker 1: to get a routine diagnostic test is probably going to 474 00:24:29,520 --> 00:24:31,919 Speaker 1: change dramatically. You're gonna do that through telehealth and an 475 00:24:31,960 --> 00:24:33,840 Speaker 1: at home test. So we're going to have much different 476 00:24:33,880 --> 00:24:37,400 Speaker 1: tools to mitigate this risk going forward, and COVID will 477 00:24:37,400 --> 00:24:40,600 Speaker 1: become a manageable threat. Now that's said, if COVID becomes 478 00:24:40,600 --> 00:24:43,439 Speaker 1: a second circulating flu, which is I think we're we're heading, 479 00:24:43,760 --> 00:24:47,159 Speaker 1: and causes as much death and disease as flu. We 480 00:24:47,240 --> 00:24:49,560 Speaker 1: already have a flu, and if we now have two flus, 481 00:24:49,600 --> 00:24:52,680 Speaker 1: I think the overall impact on life, on productivity is 482 00:24:52,680 --> 00:24:55,160 Speaker 1: going to be too great for us to bear and 483 00:24:55,480 --> 00:24:57,520 Speaker 1: conduct business as usual. So I do think we're going 484 00:24:57,560 --> 00:24:59,399 Speaker 1: to have to do some things differently, particularly in a 485 00:24:59,400 --> 00:25:03,399 Speaker 1: wintertime when pathogens circulate, to reduce the cumulative impact of 486 00:25:03,480 --> 00:25:05,919 Speaker 1: respiratory diseases in the winter. But that doesn't mean shutting 487 00:25:05,920 --> 00:25:07,960 Speaker 1: things down. It means, you know, we're gonna have to 488 00:25:08,000 --> 00:25:12,040 Speaker 1: retrofit confined spaces with better air filtration and hospital grade filters. 489 00:25:12,040 --> 00:25:13,960 Speaker 1: Everyone's going to be encouraged to stay home if you're 490 00:25:13,960 --> 00:25:16,240 Speaker 1: not feeling well. I have a sick relative. We're probably 491 00:25:16,240 --> 00:25:18,760 Speaker 1: going to find ways to try to dedensify certain spaces 492 00:25:18,760 --> 00:25:21,600 Speaker 1: so you're not crowding people, especially in the height of 493 00:25:21,840 --> 00:25:24,040 Speaker 1: COVID seas. And I think the idea of wearing masks 494 00:25:24,040 --> 00:25:27,080 Speaker 1: in public on a voluntary basis not mandated, but on 495 00:25:27,119 --> 00:25:29,240 Speaker 1: a voluntary basis, is going to become more routine. I 496 00:25:29,240 --> 00:25:31,560 Speaker 1: think it's going to become more culturally acceptable to have 497 00:25:31,600 --> 00:25:33,800 Speaker 1: a mask on if you're walking through an airport, and 498 00:25:33,800 --> 00:25:35,240 Speaker 1: you're going to see people doing that because they want 499 00:25:35,240 --> 00:25:37,720 Speaker 1: to protect themselves, because they feel vulnerable. So things are 500 00:25:37,720 --> 00:25:39,639 Speaker 1: going to change, I think, but not change in a 501 00:25:39,680 --> 00:25:41,960 Speaker 1: way where we're not going to be functioning normally. We're 502 00:25:42,000 --> 00:25:45,639 Speaker 1: just gonna have this sort of layer of vigilance around 503 00:25:45,640 --> 00:25:48,280 Speaker 1: the risk of respiratory diseases. And quite frankly, the payoff 504 00:25:48,359 --> 00:25:51,199 Speaker 1: may be that we have less flu, we have less RSV, 505 00:25:51,680 --> 00:25:55,000 Speaker 1: we have less other viral pathogens, and we're healthier overall 506 00:25:55,080 --> 00:25:59,000 Speaker 1: because we reduce the density of these epidemics. Before COVID, 507 00:25:59,040 --> 00:26:00,960 Speaker 1: we will oddly complain and about flu, we let it 508 00:26:00,960 --> 00:26:03,480 Speaker 1: an effect far too many people and kill too many people. 509 00:26:03,680 --> 00:26:06,520 Speaker 1: With some simple interventions, we could have more dramatically reduced 510 00:26:06,560 --> 00:26:08,920 Speaker 1: flu incidents. I think we're going to have to do that. Now. 511 00:26:09,359 --> 00:26:12,560 Speaker 1: Are you going to spend holidays with your family this year? 512 00:26:13,240 --> 00:26:15,199 Speaker 1: I plan to spend the holidays with my family at 513 00:26:15,240 --> 00:26:18,679 Speaker 1: Thanksgiving and Christmas time. I think people can come together 514 00:26:18,760 --> 00:26:22,520 Speaker 1: for sure. Look, I think people need to judge their circumstances. 515 00:26:22,520 --> 00:26:25,280 Speaker 1: What is the prevalence of infection in their community. Are 516 00:26:25,280 --> 00:26:28,359 Speaker 1: they bringing young kids who are unvaccinated together with older 517 00:26:28,400 --> 00:26:32,040 Speaker 1: individuals who may be more vulnerable despite vaccination. And if 518 00:26:32,040 --> 00:26:34,879 Speaker 1: the circumstances are that it could be a risk to 519 00:26:35,200 --> 00:26:38,600 Speaker 1: someone who's going to be joining you use diagnostic testing, 520 00:26:38,640 --> 00:26:41,240 Speaker 1: but get a buynax now and test before you bring 521 00:26:41,240 --> 00:26:44,159 Speaker 1: people together. There's things you can do to reduce the 522 00:26:44,280 --> 00:26:47,359 Speaker 1: risk to those who might be vulnerable in a congregate setting. 523 00:26:47,520 --> 00:26:49,720 Speaker 1: That doesn't mean you have to cancel Christmas. I mean, 524 00:26:49,760 --> 00:26:52,199 Speaker 1: I think families can and should come together. We're in 525 00:26:52,200 --> 00:26:54,520 Speaker 1: a much different situation this year than we wore last year. 526 00:26:54,840 --> 00:26:58,320 Speaker 1: We have better tools for identifying spread, we have better 527 00:26:58,320 --> 00:27:01,800 Speaker 1: tools for protecting the vulnerable. The circumstances are far different, 528 00:27:01,840 --> 00:27:04,680 Speaker 1: and I just think people need to, you know, look 529 00:27:04,680 --> 00:27:07,760 Speaker 1: at what the individual risk is and make decisions about 530 00:27:07,800 --> 00:27:11,000 Speaker 1: how they can reduce that risk. Yeah. Klist and I 531 00:27:11,040 --> 00:27:14,520 Speaker 1: had the experience first of coming back from Italy this 532 00:27:14,720 --> 00:27:16,920 Speaker 1: summer and then going to an event a few weeks 533 00:27:16,960 --> 00:27:22,080 Speaker 1: ago where we basically had a self applied diagnostic tool 534 00:27:22,520 --> 00:27:26,000 Speaker 1: and it was amazing. I mean, it's astonishing how rapidly 535 00:27:26,040 --> 00:27:48,639 Speaker 1: we're learning to decentralize this sort of thing because of 536 00:27:48,720 --> 00:27:52,920 Speaker 1: your unique background as Food and Drug Administrator, plus your 537 00:27:53,600 --> 00:27:56,080 Speaker 1: knowledge of the system, and the fact that you now 538 00:27:56,119 --> 00:27:58,840 Speaker 1: serve on the FISER board. How big a deal was 539 00:27:58,880 --> 00:28:03,240 Speaker 1: Operation warps speed and did it actually make a difference. 540 00:28:03,960 --> 00:28:06,520 Speaker 1: I think it made a difference. You know. Operation warp 541 00:28:06,560 --> 00:28:09,960 Speaker 1: speed was a recognition in my view of what didn't 542 00:28:09,960 --> 00:28:11,760 Speaker 1: work in the beginning. You know, in the beginning we 543 00:28:11,760 --> 00:28:13,640 Speaker 1: talked a lot about CDC and some of the shortcoms 544 00:28:13,680 --> 00:28:18,080 Speaker 1: too CDC. CDC didn't have the logistical capacity to operationalize 545 00:28:18,080 --> 00:28:21,440 Speaker 1: a response to a crisis of this magnitude. Operation warp 546 00:28:21,480 --> 00:28:23,639 Speaker 1: speed was a recognition that we didn't have a government 547 00:28:23,680 --> 00:28:26,760 Speaker 1: agency that could help jump start the development and production 548 00:28:26,760 --> 00:28:31,440 Speaker 1: of vaccines. ANDIH had certain key assets, FDA had certain 549 00:28:31,520 --> 00:28:34,639 Speaker 1: key assets, The Department of Defense had certain key assets 550 00:28:34,640 --> 00:28:38,120 Speaker 1: in terms of understanding how to scale a manufacturing enterprise 551 00:28:38,160 --> 00:28:40,400 Speaker 1: and a distribution enterprise and an Operation warp Speed was 552 00:28:40,440 --> 00:28:43,479 Speaker 1: a recognition that we needed to bring together components of 553 00:28:43,520 --> 00:28:46,920 Speaker 1: all those entities to create some hybrid process to be 554 00:28:46,960 --> 00:28:49,360 Speaker 1: able to accomplish this mission. We should have done that 555 00:28:49,360 --> 00:28:52,120 Speaker 1: from the outset. We should have married maybe CDC with FEMA, 556 00:28:52,240 --> 00:28:54,400 Speaker 1: right at the outset we didn't do that. We thought 557 00:28:54,440 --> 00:28:58,160 Speaker 1: CDC had the capacities that FEMA had. An Operation warp Speed, 558 00:28:58,200 --> 00:29:01,160 Speaker 1: I think was a recognition that we needed different kind 559 00:29:01,200 --> 00:29:04,200 Speaker 1: of structures in government. Now, what did Operation warps we do. 560 00:29:04,240 --> 00:29:07,560 Speaker 1: They certainly helped scale the development and production of the 561 00:29:07,600 --> 00:29:10,720 Speaker 1: Madurana vaccine. Biaser didn't take the initial grant money and 562 00:29:10,720 --> 00:29:13,200 Speaker 1: participate in the same way, but there were certainly benefits 563 00:29:13,440 --> 00:29:15,640 Speaker 1: that Operation Warpspee was able to provide in terms of 564 00:29:15,640 --> 00:29:19,400 Speaker 1: the development I think where Operation warp Speed didn't have 565 00:29:19,520 --> 00:29:22,440 Speaker 1: as much focus and in retrospect it was the wrong 566 00:29:22,480 --> 00:29:25,320 Speaker 1: decision was on the therapeutics, on making investments in the 567 00:29:25,400 --> 00:29:29,160 Speaker 1: rapid scaleup of therapeutics and trying to get early on 568 00:29:29,240 --> 00:29:31,360 Speaker 1: the manufacturing capacity to be able to produce things like 569 00:29:31,400 --> 00:29:34,880 Speaker 1: the Monoclona antibody drugs that massive scale. We never had 570 00:29:34,960 --> 00:29:37,160 Speaker 1: enough of those drugs. Even the mirk drug, which looks 571 00:29:37,240 --> 00:29:40,520 Speaker 1: highly promising, the small molecule drug an oral inhibitor of 572 00:29:40,600 --> 00:29:44,120 Speaker 1: viral replication, we only procured one point seven million doses. 573 00:29:44,160 --> 00:29:46,520 Speaker 1: To put that in perspective, there's somewhere between fifty and 574 00:29:46,560 --> 00:29:50,600 Speaker 1: eighty million doses of flu drugs in the strategic national 575 00:29:50,640 --> 00:29:54,120 Speaker 1: stockpile as a hedge against a feared pandemic flu. So 576 00:29:54,160 --> 00:29:56,800 Speaker 1: we have maybe eighty million doses of flu drugs stockpiled, 577 00:29:56,800 --> 00:29:59,000 Speaker 1: and we procured one point seven million doses of this 578 00:29:59,120 --> 00:30:03,040 Speaker 1: mirk drug, which looks to be highly promising. One point 579 00:30:03,080 --> 00:30:05,360 Speaker 1: seven million doses is about enough to carry you through 580 00:30:05,400 --> 00:30:07,720 Speaker 1: three weeks of the delta surge if you gave it 581 00:30:07,760 --> 00:30:10,680 Speaker 1: to the indicated population. So we didn't make enough investments 582 00:30:10,680 --> 00:30:14,760 Speaker 1: in the therapeutics. As you look ahead, is a your expectation. 583 00:30:14,840 --> 00:30:20,160 Speaker 1: I mean, we've had a number of epidemic diseases come 584 00:30:20,160 --> 00:30:24,040 Speaker 1: out of animals, particularly in South Asia. We've been very 585 00:30:24,080 --> 00:30:27,120 Speaker 1: fortunate most of the time and either stopping it or 586 00:30:27,160 --> 00:30:30,160 Speaker 1: containing it. You had mentioned earlier you think we're more 587 00:30:30,200 --> 00:30:34,480 Speaker 1: likely to be with an influenza pandemic in the next cycle. 588 00:30:35,000 --> 00:30:38,280 Speaker 1: But aren't there a whole range of these kind of 589 00:30:38,480 --> 00:30:43,240 Speaker 1: viruses drifting around but have waiting for the opportunity to 590 00:30:43,840 --> 00:30:48,920 Speaker 1: evolve into something which transmits easily from ducks or pigs 591 00:30:49,000 --> 00:30:52,360 Speaker 1: or bats or whatever to humans. Yeah, look, no question, 592 00:30:52,480 --> 00:30:56,240 Speaker 1: there's threats everywhere in nature. There's also threats in labs. 593 00:30:56,280 --> 00:30:58,360 Speaker 1: I mean, we're doing things in laboratories and we're not 594 00:30:58,400 --> 00:31:00,920 Speaker 1: securing our research and we're doing higher risk research, and 595 00:31:00,960 --> 00:31:03,760 Speaker 1: there's a persistent risk is something escapes from a lab 596 00:31:03,800 --> 00:31:05,920 Speaker 1: as well, and we need to get better governance around labs. 597 00:31:05,960 --> 00:31:07,960 Speaker 1: And that's why it's so important, I think, to better 598 00:31:07,960 --> 00:31:10,080 Speaker 1: ascertain did this come out of nature or a lab, 599 00:31:10,360 --> 00:31:12,520 Speaker 1: because if we assess that there's a probability that this 600 00:31:12,600 --> 00:31:14,240 Speaker 1: might have come out of a lab as an accident, 601 00:31:14,680 --> 00:31:17,360 Speaker 1: that changes how we govern research going forward to or 602 00:31:17,360 --> 00:31:19,239 Speaker 1: it should change how we govern research. Frankly, I think 603 00:31:19,280 --> 00:31:22,280 Speaker 1: we should change how we govern research anyway. But there's 604 00:31:22,360 --> 00:31:26,080 Speaker 1: risks everywhere. Flu is the most likely pandemic in the future, 605 00:31:26,480 --> 00:31:28,760 Speaker 1: but it's not the only risk. And what we really 606 00:31:28,760 --> 00:31:32,160 Speaker 1: need to be focused on are the category of viruses 607 00:31:32,280 --> 00:31:35,720 Speaker 1: that spread through respirations, either through droplets or aerosols, and 608 00:31:35,840 --> 00:31:39,479 Speaker 1: replicate through RNA. A virus that replicates through RNA has 609 00:31:39,520 --> 00:31:42,800 Speaker 1: the capacity to mutate very rapidly, and a virus that 610 00:31:42,880 --> 00:31:46,080 Speaker 1: spreads through respiratory droplets or aerosols has the capacity is 611 00:31:46,120 --> 00:31:49,360 Speaker 1: spread very quickly. And if you look at the category 612 00:31:49,400 --> 00:31:52,680 Speaker 1: of viruses that encompass those two features, they replicate through 613 00:31:52,800 --> 00:31:55,760 Speaker 1: RNA and they spread through droplets or aerosols. You have 614 00:31:55,760 --> 00:31:58,719 Speaker 1: a much broader universe of threats. It includes flu, It 615 00:31:58,720 --> 00:32:01,840 Speaker 1: includes coronavirus, but all so includes nippovirus, and it includes 616 00:32:01,880 --> 00:32:03,840 Speaker 1: a whole host of other things. And I think we 617 00:32:03,920 --> 00:32:05,840 Speaker 1: need to think more broadly, because even if we have 618 00:32:05,920 --> 00:32:08,520 Speaker 1: a flu as the next pandemic, it may be a 619 00:32:08,520 --> 00:32:10,880 Speaker 1: flu with characteristics that are very different in influence. It 620 00:32:10,920 --> 00:32:13,560 Speaker 1: may have a long incubation period, it may spread through 621 00:32:13,600 --> 00:32:17,840 Speaker 1: a symptomatic transmission, It may present with neurological features and 622 00:32:17,920 --> 00:32:20,320 Speaker 1: not just respiratory features. I mean, we've got to just 623 00:32:20,600 --> 00:32:24,480 Speaker 1: understand that just because something has presented a certain way before, 624 00:32:25,400 --> 00:32:29,480 Speaker 1: we can't prepare for future risks against those features. Because 625 00:32:29,520 --> 00:32:31,720 Speaker 1: what's probably going to present the greatest risk is something 626 00:32:31,760 --> 00:32:34,400 Speaker 1: that falls outside of convention, and the reason why it's 627 00:32:34,480 --> 00:32:37,280 Speaker 1: risky is because it falls outside convention. So we need 628 00:32:37,320 --> 00:32:39,680 Speaker 1: to be prepared against a broader set of sort of 629 00:32:39,720 --> 00:32:42,680 Speaker 1: features of viruses and not just a specific pathogen, which 630 00:32:42,720 --> 00:32:44,680 Speaker 1: is how we prepped in the past. I mean, we've 631 00:32:44,680 --> 00:32:46,680 Speaker 1: been sort of lucky in a sense, haven't we. The 632 00:32:47,240 --> 00:32:51,480 Speaker 1: things like ebola, which are extraordinarily dangerous, but they don't 633 00:32:51,480 --> 00:32:54,360 Speaker 1: seem to spread very rapidly, and they seem to be 634 00:32:54,520 --> 00:33:00,800 Speaker 1: much more containable than things like the flues or the 635 00:33:00,960 --> 00:33:05,560 Speaker 1: COVID nineteen. But there are some, particularly in Africa, some 636 00:33:05,800 --> 00:33:10,160 Speaker 1: really unpleasant things that if you do get it, you're 637 00:33:10,160 --> 00:33:13,760 Speaker 1: in really really deep trouble. Yeah, things like a bold 638 00:33:13,920 --> 00:33:18,120 Speaker 1: Those pathoges never required. The capacity is spread through aerosols, 639 00:33:18,120 --> 00:33:20,320 Speaker 1: and it's actually in virology, and I'm going to go 640 00:33:20,400 --> 00:33:23,320 Speaker 1: outside my expertise here, but I think it's probably more 641 00:33:23,400 --> 00:33:27,360 Speaker 1: difficult for a pathogen to change its mode of transmission 642 00:33:27,800 --> 00:33:31,200 Speaker 1: than for a pathogen to change some feature on its 643 00:33:31,600 --> 00:33:35,320 Speaker 1: viral surface that elicits a different kind of response in 644 00:33:35,400 --> 00:33:37,440 Speaker 1: a human like so ebola is going to have a 645 00:33:37,440 --> 00:33:39,920 Speaker 1: hard time figuring out how to spread through aerosols because 646 00:33:39,960 --> 00:33:43,040 Speaker 1: it's got to fundamentally change too many of its features 647 00:33:43,120 --> 00:33:45,960 Speaker 1: to spread through a completely different mode of transmission. But 648 00:33:46,080 --> 00:33:50,520 Speaker 1: could an influenza strain pick up some protein that, when 649 00:33:50,960 --> 00:33:55,720 Speaker 1: exposed to a human, elicits a much more devastating immune 650 00:33:55,720 --> 00:33:59,280 Speaker 1: reaction in our bodies. That's a possibility. That's what you 651 00:33:59,400 --> 00:34:03,880 Speaker 1: worry about. Something that already spreads efficiently acquires a feature 652 00:34:04,480 --> 00:34:09,160 Speaker 1: that causes it to have some significantly more delitarious effect 653 00:34:09,280 --> 00:34:12,600 Speaker 1: on people. And you know, even this coronavirus can pick 654 00:34:12,640 --> 00:34:15,640 Speaker 1: something up that we aren't thinking about right now, where 655 00:34:15,680 --> 00:34:18,439 Speaker 1: all of a sudden, its impact is very different instead 656 00:34:18,480 --> 00:34:20,880 Speaker 1: of causing a primary respiratory infection, and it causes some 657 00:34:21,120 --> 00:34:25,080 Speaker 1: neurological features. And that's what you worry about with these viruses, 658 00:34:25,080 --> 00:34:27,800 Speaker 1: that they mutate in ways that they cause different kinds 659 00:34:27,800 --> 00:34:31,160 Speaker 1: of disease. Something that's already efficient to spreading mutates in 660 00:34:31,160 --> 00:34:34,000 Speaker 1: a way that it becomes much more pathogenic and a sense, 661 00:34:34,040 --> 00:34:37,959 Speaker 1: that's what happened in nineteen eighteen, that you had sort 662 00:34:37,960 --> 00:34:41,520 Speaker 1: of a traditional flu, but it suddenly required a virility 663 00:34:42,040 --> 00:34:45,360 Speaker 1: in which one of the reasons younger people died in 664 00:34:45,440 --> 00:34:49,040 Speaker 1: abnormally large percent of all deaths was that the flu 665 00:34:49,200 --> 00:34:52,760 Speaker 1: was actually triggering their immune system, and their immune system 666 00:34:52,800 --> 00:34:55,960 Speaker 1: was actually overwhelming them, so that in a sense, they 667 00:34:55,960 --> 00:34:58,640 Speaker 1: were being killed by their own immune system because it 668 00:34:58,719 --> 00:35:01,600 Speaker 1: had such an aggressive response to the flu. I mean, 669 00:35:01,800 --> 00:35:05,600 Speaker 1: that would be very hard to model in advance, and 670 00:35:05,719 --> 00:35:09,200 Speaker 1: you'd almost have to find it in real time once 671 00:35:09,200 --> 00:35:12,319 Speaker 1: it started to occur. That's what happened with this coronavirus too. 672 00:35:12,320 --> 00:35:14,840 Speaker 1: A lot of the people who get very sick from COVID. 673 00:35:15,480 --> 00:35:18,680 Speaker 1: People are getting infected, they're not mounting an appropriate early 674 00:35:18,719 --> 00:35:21,120 Speaker 1: immune response and fighting off the infections, so they build 675 00:35:21,160 --> 00:35:23,560 Speaker 1: up high levels of the virus in their bodies, and 676 00:35:23,600 --> 00:35:26,480 Speaker 1: then when their immune systems finally kick in, they have 677 00:35:26,520 --> 00:35:29,520 Speaker 1: so much virus on board that it triggers an overreaction 678 00:35:29,560 --> 00:35:32,480 Speaker 1: by the immune system and you get that intense inflammatory 679 00:35:32,520 --> 00:35:35,959 Speaker 1: response that's so called cytokind storm in the second week 680 00:35:36,000 --> 00:35:38,440 Speaker 1: of the virus, and that's what gets people into trouble. 681 00:35:38,680 --> 00:35:42,360 Speaker 1: So it is an untoward, inappropriate immune response to this 682 00:35:42,480 --> 00:35:44,279 Speaker 1: virus that gets a lot of the people in trouble. 683 00:35:44,320 --> 00:35:48,120 Speaker 1: It's not the initial infection and the initial symptoms caused 684 00:35:48,120 --> 00:35:51,000 Speaker 1: by the virus, it's the immune systems inappropriate response to 685 00:35:51,040 --> 00:35:54,160 Speaker 1: the virus later. And there's other viruses that when you 686 00:35:54,200 --> 00:35:57,080 Speaker 1: have a novel virus that the body's never seen before, 687 00:35:57,680 --> 00:36:00,319 Speaker 1: the body overreacts to it. And that's exactly what we 688 00:36:00,440 --> 00:36:03,160 Speaker 1: presume happening with the Spanish flu, that people were getting 689 00:36:03,160 --> 00:36:06,200 Speaker 1: infected with the virus that was so novel that people 690 00:36:06,239 --> 00:36:09,600 Speaker 1: were having an overactive immune response, and it was the 691 00:36:09,600 --> 00:36:13,080 Speaker 1: immune response it was actually destroying their tissue in their lungs, 692 00:36:13,080 --> 00:36:15,520 Speaker 1: their own immune systems started to attack their own bodies. 693 00:36:15,960 --> 00:36:19,680 Speaker 1: I want to thank you. I hope this conversation convinces 694 00:36:19,680 --> 00:36:24,000 Speaker 1: a number of our listeners to get Uncontrolled Spread by 695 00:36:24,080 --> 00:36:26,480 Speaker 1: COVID nineteen Crush Us and How We Can Defeat the 696 00:36:26,520 --> 00:36:29,080 Speaker 1: Next Pandemic, which is currently number six on the New 697 00:36:29,120 --> 00:36:31,760 Speaker 1: York Times bestseller lists. We will be on our show 698 00:36:31,800 --> 00:36:35,160 Speaker 1: page at newsworld dot com. Scott, I really want to 699 00:36:35,200 --> 00:36:37,479 Speaker 1: thank you for taking the time out of your busy 700 00:36:37,520 --> 00:36:40,520 Speaker 1: schedule to help all of us have a better understanding 701 00:36:40,840 --> 00:36:42,879 Speaker 1: of what has happened and what we need to do. 702 00:36:43,239 --> 00:36:46,200 Speaker 1: And I want to encourage you to continue to speak 703 00:36:46,200 --> 00:36:49,200 Speaker 1: out on behalf of the kind of reforms that I 704 00:36:49,239 --> 00:36:51,640 Speaker 1: think you articulate as well as anybody in the country. 705 00:36:51,960 --> 00:36:56,279 Speaker 1: Thanks a lot, Thanks for having me today. Thank you 706 00:36:56,320 --> 00:36:59,120 Speaker 1: to my guests, Doctor Scott Gottlieb. You can get a 707 00:36:59,160 --> 00:37:03,160 Speaker 1: link to buy his new book, Uncontrolled Spread by COVID 708 00:37:03,280 --> 00:37:06,080 Speaker 1: nineteen Crushed Us and How We Can Defeat the Next 709 00:37:06,080 --> 00:37:10,279 Speaker 1: Pandemic on our show page at Newtsworld dot com. News 710 00:37:10,320 --> 00:37:13,759 Speaker 1: World is produced by Gingwish three sixty and iHeartMedia. Our 711 00:37:13,840 --> 00:37:18,160 Speaker 1: executive producer is Debbie Myers. Our producer is Garnsey Sloan 712 00:37:18,520 --> 00:37:22,200 Speaker 1: and our researcher is Rachel Peterson. The artwork for the 713 00:37:22,239 --> 00:37:26,120 Speaker 1: show was created by Steve Penley. Special thanks to the 714 00:37:26,120 --> 00:37:29,480 Speaker 1: team at Gingrich three sixty. If you've been enjoying Newtsworld, 715 00:37:29,800 --> 00:37:32,839 Speaker 1: I hope you'll go to Apple Podcast and both rate 716 00:37:32,920 --> 00:37:35,799 Speaker 1: us with five stars and give us a review so 717 00:37:35,920 --> 00:37:39,320 Speaker 1: others can learn what it's all about. Right now, listeners 718 00:37:39,320 --> 00:37:42,080 Speaker 1: of news World can sign up for my three free 719 00:37:42,160 --> 00:37:46,960 Speaker 1: weekly columns at Gingwich three sixty dot com slash newsletter. 720 00:37:47,480 --> 00:37:49,920 Speaker 1: I'm Newt Gingridge. This is Newtsworld.