WEBVTT - The People Who Get Covid Twice 0:00:03.760 --> 0:00:08.800 Welcome to Prognosis. I'm Laura Carlson. It's day one and 0:00:08.880 --> 0:00:14.760 ninety six since coronavirus was declared a global pandemic. Today's 0:00:14.800 --> 0:00:19.680 main story. We're now learning that having had COVID nineteen 0:00:20.360 --> 0:00:24.600 doesn't mean you can't get it again. We'll discuss what 0:00:24.640 --> 0:00:28.520 that means for stopping the outbreak spread and for the 0:00:28.560 --> 0:00:34.159 development of a vaccine. But first, here's what happened in 0:00:34.320 --> 0:00:51.600 virus news today. COVID nineteen could wipe out an estimated 0:00:51.840 --> 0:00:56.680 five hundred million jobs globally. That's a bigger hit to 0:00:56.720 --> 0:01:01.880 the labor market than economists anticipated. According to the International 0:01:02.160 --> 0:01:07.160 Labor Organization, the i l O also predicts a much 0:01:07.360 --> 0:01:12.080 slower recovery. At the end of this year. The i 0:01:12.440 --> 0:01:16.360 l O said that global working hours were seventeen percent 0:01:16.480 --> 0:01:21.440 lower than the end of equivalent to almost five hundred 0:01:21.480 --> 0:01:27.360 million jobs. That's up from four hundred million projected in June. 0:01:30.360 --> 0:01:34.240 Johnson and Johnson has begun dosing up to sixty thousand 0:01:34.400 --> 0:01:39.280 volunteers in a study of its COVID nineteen vaccine. It's 0:01:39.319 --> 0:01:43.000 the first big US trial of an inoculation that may 0:01:43.160 --> 0:01:48.240 only require one shot. J and J is the fourth 0:01:48.320 --> 0:01:52.120 vaccine maker to move its candidate into late stage human 0:01:52.200 --> 0:01:57.240 studies in the US. If enrollment goes as expected, the 0:01:57.320 --> 0:02:00.120 trial could yield results as soon as the end of 0:02:00.160 --> 0:02:04.840 the year, allowing the company to seek emergency authorization early 0:02:05.000 --> 0:02:10.680 next year if it proves effective. Finally, the Trump administration 0:02:10.840 --> 0:02:14.519 has shifted billions of dollars away from public health programs 0:02:14.680 --> 0:02:18.560 for testing and mask funds into its Operation Warp Speed 0:02:18.639 --> 0:02:23.560 vaccine effort. It's a sign the US government is increasing 0:02:23.600 --> 0:02:28.840 its focus on a medical solution to the pandemic. The transfers, 0:02:29.080 --> 0:02:32.840 disclosed in the government audit reported by Bloomberg News and 0:02:33.000 --> 0:02:36.880 described by Congressional Aids, have increased the budget of the 0:02:36.880 --> 0:02:40.920 Warp Speed program to as much as eighteen billion dollars, 0:02:41.600 --> 0:02:45.520 much larger than the ten billion dollar figure the administration 0:02:45.720 --> 0:02:56.919 has routinely cited in public and now for today's main story, 0:02:58.240 --> 0:03:01.280 scientists in Hong Kong were ar died last month. What 0:03:01.520 --> 0:03:06.480 many Headlong suspected could happen. Someone who had recovered from 0:03:06.520 --> 0:03:12.480 COVID nineteen caught the coronavirus again. Since then, about a 0:03:12.520 --> 0:03:17.560 dozen cases of reinfection have been reported worldwide. These cases 0:03:17.600 --> 0:03:22.360 demonstrate that a natural infection doesn't lead to lasting protection, 0:03:22.919 --> 0:03:26.640 and that the pandemic could persist in the human population. 0:03:27.840 --> 0:03:32.000 Bloomberg New Senior editor Jason Gale talked to health experts 0:03:32.080 --> 0:03:35.320 about what this means for our ability to stop the 0:03:35.400 --> 0:03:45.120 virus and to produce an effective immunization. Anecdotes of people 0:03:45.120 --> 0:03:48.320 being infected by the coronavirus twice have appeared in the 0:03:48.320 --> 0:03:51.960 media since at least February, but these cases went proven. 0:03:52.520 --> 0:03:56.760 To demonstrate reinfection, scientists have to isolate the microbial culprit 0:03:56.800 --> 0:04:00.240 at each time, check it's genetic, think a print, show 0:04:00.280 --> 0:04:04.000 that each infection was caused by a different virus. Scientists 0:04:04.000 --> 0:04:06.880 in Hong Kong reported the first confirmed reinfection almost a 0:04:06.880 --> 0:04:10.640 month ago. I asked an infectious diseases physician, he's worked 0:04:10.640 --> 0:04:13.720 on a lot of outbreaks, how we should interpret that finding. 0:04:14.600 --> 0:04:18.800 I'm Dr Tom friedan president and chief executive officer of 0:04:18.960 --> 0:04:23.000 Resolved Saved Lives and former director of both the Centers 0:04:23.000 --> 0:04:26.080 for Disease Control and Prevention and Commissioner of the New 0:04:26.160 --> 0:04:29.840 York City Health Department. Well, first, we're continuing to learn 0:04:29.880 --> 0:04:35.000 more every day, but it's clear now that reinfection can happen, 0:04:35.520 --> 0:04:39.840 how often it happens, and what the implications are for 0:04:39.960 --> 0:04:46.320 both natural infection and vaccine induced immunity really are still unclear. 0:04:47.200 --> 0:04:50.320 Reinfections have now been confirmed in Asia, Europe, and North 0:04:50.360 --> 0:04:53.839 and South America. That all up, these cases probably number 0:04:54.000 --> 0:05:00.040 less than a dozen, which is reassuring. Right, globally we 0:05:00.200 --> 0:05:02.960 certainly had more than a hundred million infections. Now if 0:05:02.960 --> 0:05:05.479 we haven't seen a lot of reinfection, it must be rare, 0:05:06.000 --> 0:05:07.960 or you can say, you know, we're really not looking 0:05:08.320 --> 0:05:11.320 and until we look, we're not going to find. I 0:05:11.360 --> 0:05:14.240 think most of us believe that there is some level 0:05:14.320 --> 0:05:17.600 of immunity for some period of time in some people, 0:05:17.920 --> 0:05:22.159 but those are very vague qualifiers is some ten percent 0:05:22.320 --> 0:05:25.520 or eighty percent, and really until we get better dead 0:05:25.560 --> 0:05:32.520 and we won't know. This first case reported by doctors 0:05:32.560 --> 0:05:34.719 at the University of Hong Kong occurred in at thirty 0:05:34.720 --> 0:05:36.920 three year old nine t worker who had a mild 0:05:36.920 --> 0:05:40.000 case of COVID nineteen in March last month. He was 0:05:40.160 --> 0:05:42.760 screened for the coronavirus at the airport after we return 0:05:42.800 --> 0:05:45.039 from a works trip to Europe. The man didn't have 0:05:45.040 --> 0:05:48.160 any symptoms, so it was no doubt a surprise when 0:05:48.160 --> 0:05:50.640 the test came down't positive. The fact that he was 0:05:50.760 --> 0:05:54.920 infected without symptoms suggested to some scientists that his memory 0:05:54.920 --> 0:05:59.279 immune response prevented any symptomatic disease. In other words, that 0:05:59.480 --> 0:06:03.080 natural infection protected him from getting the cough soil throughout 0:06:03.160 --> 0:06:06.000 favor and headache he experienced four and a half months earlier, 0:06:06.360 --> 0:06:10.360 but it didn't prevent him being infected again. I asked Tom, 0:06:10.480 --> 0:06:13.320 is this what we might expect from a subsequent infection 0:06:13.680 --> 0:06:17.360 with the Sasko et virus. Well, one theory is that 0:06:17.600 --> 0:06:21.320 you're not likely to get severe disease twice. There is 0:06:21.480 --> 0:06:24.479 a reported case of someone who had mild disease the 0:06:24.520 --> 0:06:28.640 first time and then moderately severe disease the second time, 0:06:28.920 --> 0:06:32.480 and someone else who had moderately severe disease the first 0:06:32.520 --> 0:06:36.360 time and mild disease the second time. And the theory 0:06:36.440 --> 0:06:40.479 here is that it's the more severe disease that's more 0:06:40.560 --> 0:06:45.080 likely to result in protective antibodies. We know that there 0:06:45.080 --> 0:06:47.280 are some people who have very mild disease who don't 0:06:47.320 --> 0:06:51.000 seem to mount an antibody response, and that may correlate 0:06:51.120 --> 0:06:54.159 with being able to get infected again. It also seems 0:06:54.160 --> 0:06:58.080 antibodies don't always stick around that long. Last Thursday, researches 0:06:58.160 --> 0:07:00.840 at the Vanderbilt University Medical Center published a study in 0:07:00.880 --> 0:07:03.320 which they found more than half of the health care 0:07:03.360 --> 0:07:05.960 workers who have been infected with sansko vie too and 0:07:06.000 --> 0:07:10.280 had detectable antibodies in early April didn't have detectable antibodies 0:07:10.520 --> 0:07:13.680 two months later. The researchers said they didn't know whether 0:07:13.840 --> 0:07:17.080 the decline and antibodies increases risk of reinfection and disease. 0:07:17.640 --> 0:07:20.480 It's at least helping us understand what the limitations of 0:07:20.520 --> 0:07:25.760 immunity against COVID nineteen might be. I think it's unlikely 0:07:25.840 --> 0:07:31.160 that immunity to COVID is going to be as dramatically 0:07:31.200 --> 0:07:35.000 effective as to say, immunity to measles is. If you 0:07:35.080 --> 0:07:39.240 get measles naturally once in your life, you will in 0:07:39.320 --> 0:07:43.880 all likelihood never get it again. In contrast, if you 0:07:43.960 --> 0:07:48.400 get influenza or malaria or lots of other conditions, you 0:07:48.480 --> 0:07:52.679 may get them again, but perhaps less Seriously, we really 0:07:52.720 --> 0:07:57.160 don't know at this point enough about COVID. But what 0:07:57.560 --> 0:08:03.720 has emerged is that um certain antibodies known as neutralizing antibodies, 0:08:03.800 --> 0:08:08.240 do appear that they may be protective and that's why 0:08:08.640 --> 0:08:12.680 we're hopeful that vaccination may be possible, But until that's proven, 0:08:13.440 --> 0:08:21.280 that's just the theory. There's a possibility that immune protection 0:08:21.360 --> 0:08:25.120 against the coronavirus might be cumulative. The more times are 0:08:25.120 --> 0:08:28.440 immune system says the virus, the better and faster it 0:08:28.480 --> 0:08:31.680 could be in awarding it. Tom says, we don't know 0:08:31.760 --> 0:08:35.680 that for sure, though. Well, there's something called an anamnastic response, 0:08:36.080 --> 0:08:39.600 where when someone is exposed again and again to a 0:08:39.640 --> 0:08:44.520 pathogen it strengthens their immune system. That's one theory, but 0:08:44.640 --> 0:08:47.800 we really don't know what the reality is with COVID. 0:08:47.880 --> 0:08:50.880 What we do know is that there's a wide variety 0:08:50.920 --> 0:08:54.760 of illness. Some people get infected and it's quite mild. 0:08:55.080 --> 0:08:57.760 Other people will get infected and they can get severely 0:08:57.800 --> 0:09:01.640 ill or died, and we're not sure what the difference is. 0:09:03.160 --> 0:09:05.920 One of the key questions around reinfection is whether someone 0:09:05.920 --> 0:09:09.280 who has called the virus again is capable of transmitting it. 0:09:09.880 --> 0:09:12.920 Some pointed to one example that indicated someone could be 0:09:12.960 --> 0:09:17.080 infectious and another example that suggested they might not be. 0:09:18.240 --> 0:09:21.640 At this point, um there are theories but no proof. 0:09:22.160 --> 0:09:24.640 For example, someone who has had a mild infection before 0:09:24.840 --> 0:09:28.079 has very little immunity may behave just the same as 0:09:28.120 --> 0:09:31.199 someone who is infected for the first time. In contrast, 0:09:31.280 --> 0:09:34.320 someone who was very ill and has a high level 0:09:34.360 --> 0:09:38.320 of neutralizing antibody may indeed reduce their viral load and 0:09:38.400 --> 0:09:41.480 be less infectious. It's something that we need to figure out. 0:09:42.559 --> 0:09:45.560 So what do these reinfections mean for our ability to 0:09:45.640 --> 0:09:48.960 reach herd immunity where the virus is potential to spread 0:09:49.360 --> 0:09:51.959 is mitigated by a high level of immune protection in 0:09:52.000 --> 0:09:57.359 the community, all bets are off still um the likelihood 0:09:57.520 --> 0:10:02.360 is that herd immunity is going to involve well over 0:10:02.520 --> 0:10:07.319 half of the population getting infected, but there's still many unknowns, 0:10:07.360 --> 0:10:09.959 And one thing that's important to keep in mind is 0:10:10.000 --> 0:10:13.480 that herd immunity is not a dichotomy. It's not her 0:10:13.559 --> 0:10:17.320 immunity on off. The more people who are immune in 0:10:17.360 --> 0:10:22.720 a community to slower the virus spreads. What is certainly 0:10:22.760 --> 0:10:26.319 the case is that in all likelihood, getting to herd 0:10:26.440 --> 0:10:31.199 immunity for COVID in the US would require an infection 0:10:31.320 --> 0:10:37.040 rate of something like currently we're at about we have 0:10:37.120 --> 0:10:40.839 two d thousand deaths, So in all likelihood, getting to 0:10:41.040 --> 0:10:44.960 herd immunity in the US would involve another six hundred 0:10:45.040 --> 0:10:49.720 thousand deaths. We're talking about more than almost any war 0:10:49.960 --> 0:11:00.600 in US history. When does all this slave vaccine for COVID? 0:11:00.880 --> 0:11:03.720 Dr Chip School, the professor in the Division of Infectious 0:11:03.720 --> 0:11:07.160 Diseases that you see San Diego School of Medicine, says, 0:11:07.400 --> 0:11:09.960 we have to be careful about going down the AIDS 0:11:10.080 --> 0:11:13.760 vaccine hole. As you remember, we're gonna have an age 0:11:13.840 --> 0:11:18.439 vaccine and we never got one. But we've done pretty 0:11:18.480 --> 0:11:21.280 well with ADS, and we did it with drugs, and 0:11:21.320 --> 0:11:24.160 we did it with behavioral changes, and we may be 0:11:24.200 --> 0:11:29.360 in the same boat with Yeah. I mean, these reinfections 0:11:29.840 --> 0:11:33.760 have to give you pause about thinking that you can 0:11:33.800 --> 0:11:35.800 do better with a vaccine and you can do with 0:11:35.880 --> 0:11:40.600 natural infection. Chip says previous research with vaccines suggests that 0:11:40.640 --> 0:11:44.000 the immunity isn't long and it may not be the 0:11:44.160 --> 0:11:48.640 silver bullet many of us being included, hoping it will be. 0:11:49.320 --> 0:11:53.120 That's why I think it's important to try to UM 0:11:53.559 --> 0:11:59.200 optimize non vaccine interventions UM and get back to business. 0:11:59.280 --> 0:12:00.959 I think we really have to get on with it 0:12:01.040 --> 0:12:05.040 about how to operate in the in the colvid era 0:12:05.160 --> 0:12:08.319 where the virus is kind of gonna be looking over 0:12:08.320 --> 0:12:12.400 our shoulder for a wild to come. There's so much 0:12:12.440 --> 0:12:15.560 we don't know about the coronavirus, including our ability to 0:12:15.679 --> 0:12:19.480 produce a safe, effective and durable immune response with the vaccine, 0:12:20.000 --> 0:12:22.280 But there are things we do know we can do 0:12:22.480 --> 0:12:26.360 to stop the pandemic. While we push ahead with developing vaccines, 0:12:26.720 --> 0:12:30.000 we also have to develop better treatments and keep practicing 0:12:30.000 --> 0:12:34.880 physical distancing, hand washing, mask wearing, and everything else we 0:12:34.960 --> 0:12:55.160 can to prevent infections. That was Jason Gale, and that's 0:12:55.160 --> 0:12:57.800 it for our show today. For coverage of the outbreak 0:12:57.800 --> 0:13:01.880 from one beers around the world, visit Bloomberg dot com 0:13:02.080 --> 0:13:06.320 slash coronavirus and if you like the show, please leave 0:13:06.400 --> 0:13:09.880 us a review and a rating on Apple Podcasts or Spotify. 0:13:10.520 --> 0:13:13.120 It's the best way to help more listeners find our 0:13:13.160 --> 0:13:17.720 global reporting. The Prognosis Daily edition is produced by Toph 0:13:17.760 --> 0:13:22.880 for foreheads Jordan Gaspoure, Magnus Henrickson, and me Laura Carlson. 0:13:23.640 --> 0:13:28.320 Today's main story was reported by Jason Gale. Original music 0:13:28.360 --> 0:13:32.839 by Leo Sedrin. Our editors are Rick Shine and Francesco Levi. 0:13:33.600 --> 0:13:38.439 Francesco Levi is Bloomberg's head of Podcasts. Thanks for listening.