Covid19 on the front lines. A digital event cast from the atlantic. We are going to be talking for the next hour or so about the latest science, about the latest treatments, and will be looking forward about what we can expect in the weeks and months ahead. Before get underway, a moment to thank our underwriter pharma, who is making the conversations possible. First, lets take a look at where we are right now. As of last night, more than 580,000 americans have been diagnosed with covid19. And over 23,000 have died of covid19related complications. There are some signs of improvement in places like new york. The curve appears to be flattening, but some other hot spots are emerging, and at the moment, 316 million americans are still under stayathome orders. This is an evolving situation, of course. The atlantic has been moving along with it, publishing articles like the technology that could free america from quarantine, and the coronaviru unique threat to the south. Another article which you may have heard about because it was tweeted about by president obama is, how the pandemic will end. It was written by the atlantics ed yong. Ed joins us here today. You have another article out this morning called, our pandemic summer. So, im judging from the name of the new article that we are not going to get over this any time in the near future. What are you reporting . Mr. Yong yeah, thats right. I think, at the moment, everyones attention, quite rightly, is on the current wave of the pandemic, which one would hope would peak within the coming weeks or months. But it is clear too from the experts i spoke to, that this is going to be a longrunning problem that continues for the rest of the year and possibly even longer as we await a vaccine that is going to be the real endgame that changes how we cope with the pandemic. Until then, we should expect multiple waves of the virus as it recedes and then resurges again. And we will need to steel ourselves medically and psychologically for what is going to be a protracted confrontation with this new virus. Ms. Meserve the goal has been to lift the stayathome orders by april 30. Feasible or not . Mr. Yong i think that looks very unlikely. And thats probably because most of the measures that we would need to actually keep the virus in check or to steel ourselves against future surges are not going to be in place in time. We do not have widespread testing. The u. S. Stalled, delayed on that, and those delays cost us dearly. Were still not in a position where we can recover the lost time in testing because of supply chain problems that are affecting the entire world. Hospitals, as you say, in some places might be going past the curve, but even then, places in different parts of the country will have problems. Hospitals are encountering new problems like drug shortages. So, there is no sign that this is going to be over very shortly. Ms. Meserve you mentioned testing. There is diagnostic testing. Were way behind the curve on that, as you mentioned. There is a lot of hope put on serological testing, which will test for antibodies. How hopeful are you about that . Mr. Yong not very hopeful at all, unfortunately. So, the thing about serological testing is that it looks at antibodies in peoples blood that might signify that they have been exposed to the virus and might have some degree of immunity. That is going to be really useful for the population working out what portion of the u. S. Has been infected. On an individual level there are huge problems. You dont know where the antibodies you find are actually protective against the virus. And there are very few ways of checking that without more sophisticated tests. You do not know what level of antibodies can prevent infection. And crucially, if you do Antibody Testing at an individual level at a point where most of the country has not been infected, your number of false positives, so, number of people who are wrongly told they have those antibodies, are going to be massively larger than the number of true positives, people who actually have those antibodies. So at this stage, if you do Antibody Testing, if you get a positive result, there is only a very small chance that you actually have the antibodies this question. And then you have all the social implications like youre incentivizing people to basically get infected as quickly as possible so they can return to work, and youre creating new forms of discrimination between people who are immunologically privileged and people who are not. All of those things mean that this is not going to be an easy solution and one we need to consider very, very carefully. Ms. Meserve there have been some thoughts that this was going to be seasonal. That perhaps in warm weather months we would see a lessening. What is the current thinking on that . Mr. Yong most of the the virologists and epidemiologists i spoke to are not hopeful that that is going to make a substantial difference to the course of the pandemic. It is likely that in the future the coronavirus may be seasonal in the way that many other respiratory viruses and influenza are. But for the moment, the world is just full of immunologically naive people. There is just too many people who have never seen this virus before for it to burn through. It is like hoping that the summer will quench that is like hoping that a gentle rain will put out a raging wildfire that still has acres of kindling to scorch its way through. Ms. Meserve you write in your article that what is needed is an all hands on deck approach to what is going on. Are you seeing that in the United States . Mr. Yong unfortunately, no. There are some promising signs for sure. The countrys research and biomedical enterprise is working overtime to try and find different types of countermeasures. Certain groups of states are banding together to try and find their own local solutions to how to reopen the country. So, all of that is promising, but really what is needed is some massive apollo programstyle initiative that is coordinated by the federal government to get our readiness to a point where we can deal with future waves of the virus. And either the administration has no plan, or is not disclosing its plan. And in the absence of that, other people are having to make do with their own bespoke local level measures. Whether that is going to be enough, im not sure. Certainly i think that solution will be less than the sum of its parts and will lead to wide disparities across the country. Ms. Meserve you are talking from a science perspective, but clearly there are other factors in play, economic and political. How is that going to influence the course Going Forward . Mr. Yong yeah, the matter of how to Balance Health and economy and the influence of economy on our health and our health on the economy is obviously a huge question. Also really relevant i think is the successive epidemics that we might see after the covid19 surge is over, there will be waves of Mental Health problems , there will be waves of other Health Problems related to the swamping of the Healthcare System, to people having to stay at home for so long and not getting treatment for illnesses that they should have gotten treatment to. And this is again why i think this is going to be a longterm problem that we need to start steeling ourselves for now. It is not just the case that death also start decreasing and things will go back to normal. Once we flatten this curve, well have many other curves we need to deal with. Ms. Meserve devin from new york city asks, do you think the cdcs initial recommendation to stop buying masks has affected its credibility. I would like to broaden that and ask, where is the cdc . Mr. Yong yeah, so, just very quickly on masks. The guidance on masks has certainly changed. The idea that we need to save liver Health Care Workers because they are hard to find is absolutely right, and then society is changing how it views masks, not as a way of preventing yourself from getting sick but as a way of preventing other people from getting sick from you inadvertently. That is a much larger discussion. On the issue of the cdc, i think that the fact that the cdc has been absent from White House Press briefings for a long time now is certainly causing problems, and this has been supposedly one of the greatest Public Health agencies in the world and the one that many similar agencies around the world are modeled on. Thats why there is the china cdc, the nigeria cdc, and yet they are not in a position where they can provide advice to people at a local and state level who desperately need it. And i have heard from Public Health experts that they are getting calls from mayors and governors asking them for advice when they would normally go to the cdc. And i think that is going to have a lasting consequence on americas ability to prepare for these kinds of threats. Ms. Meserve you say in the article that you wrote this morning, that when do we get back to normal is the wrong question. How should we be framing this . Mr. Yong so, i think the way to look at it is, how do we go forward . What kind of new society do we want to craft in the aftermath of this . We know that were not going to go back to a position where we have mass gatherings, for example, for probably the summer and probably for the rest of the year. So, our lives are going to look very different. I think the pandemic has revealed a lot of fault lines in society. Vulnerabilities among people who dont have the choice to social distance because they have because they are underpaid in jobs that demand their presence. We are seeing large social changes that companies and institutions dragged their heels on like remote working, proper sick pay, child care assistance, that now suddenly are manifesting very quickly in the wake of this big global crisis. So, i think there is a huge there is going to be lot of tragedy in our future, but there is also lots of potential for reevaluating what norms in society we perhaps became too accustomed to, and how we can build something that better cares for the needs of the vulnerable and marginalized among us. Ms. Meserve thank you. Check out ed yongs new article, our pandemic summer. Great to have you with us. Well let you get back to reporting on this story. Mr. Yong thank you. Ms. Meserve we do want all of you in the audience to be part of this, so please ask your questions using the q a function you see on your screens. Try and keep your questions short and concise and please keep them on topic, and let us know where youre watching from. Well try to incorporate as many as we possibly can. Now let me bring in ron klain. Ron is the executive Vice President at revolution, and was the white house Ebola Response coordinator in 2014 and 2015. Ron, it is great to have you with us here today. Mr. Klain thanks for having me. Ms. Meserve you are of course an advisor to the biden campaign. I would like to talk about politics just a little bit. Obviously, physical campaigning is just a nogo. You cant go out there and kiss the babies and shake hands. Is that going to radically transform the nature of this president ial race . Mr. Klain obviously it changes it for how all americans having to campaign now. They have to campaign distantly. I think it is changing nature of the campaigns, but i dont think it changes the substance of the president ial campaign. I think we have seen over the past couple of months a pretty clear difference develop between Vice President biden and President Trump on how they would approach fighting the coronavirus, on what they would do in response for it, and what their ideas are for the economic response, and their styles of leadership. I think that choice is before the American People very squarely. It is a very start and really sharp choice between these two men and the kind of presidency they would have. And i think that is coming through loud and clear on whatever mediums it is allowed to be transmitted by right now. Ms. Meserve but the president has two hours of television time, sometimes more, virtually every day at the white house. How does joe biden, even through the wonders of digital communication, counter that kind of free media . Mr. Klain again, i think it is not a question of quantity, it is a question of quality. I think when the president uses that time to mislead the American People and mislead people about his record, to thrash out at his reporters, and make almost everyone the enemy except the virus, im not sure he is doing himself any good politically. I know he is doing any good in terms of fighting the virus. With all situations with an incumbents president , he is going to be judged on his record. His record on fighting coronavirus is one of long delays, downplaying it, denying advice,uing scientific advice,ing scientific not listening to his Public Health advisors, and us paying the price for it. Ed was speaking to we have a tremendous gap in our country on testing. Why do we have that gap when korea doesnt and other countries dont . That is because of choices and the kind of leadership President Trump made. I think the record is going to speak for itself. I think that contrast is going to be very, very clear. Ms. Meserve the Vice President laid out the nuts and bolts of his plan in an oped yesterday. It was very nationally focused. You know better than most that this is a global pandemic. Does he had to have a global strategy to deal with this. And does the president . Mr. Klain yeah, so Vice President biden laid out his plan to deal with the virus in midmarch, march 12. People can go to joebiden. Com and read it. That included an approach on Global Health security, something that he and president obama have been focused on since 2012 when they first launched the Global Health security agenda, and of course was expanded by the Ebola Response in 2014, and the ways we built on that. Right now, we in america understandably are focused on the impact that this virus is having on us, on our health, on our families, and on our economy. But it has to be seen in a global context. It will do us no good to fight this virus in the ways ed was talking about a few minutes ago, here at home, if it rages overseas, because in that case it is just going to come back. It is an interconnected world. As we pursue solution, they are about protecting the american peopling taking care of us, but in long run what makes america safe is Global Health security. What protects us is doing a better job of detecting diseases overseas, isolating them, and responding to them quickly, and as a failure to have that system in place and engage the chinese aggressively enough about that, that is one of the key failures of what happened with the coronavirus. Ms. Meserve was it also a failure of the World Health Organization . Mr. Klain i think the World Health Organization had some things right and some things wrong. And i think certainly they i publicly said at the time they did not declare this a Public Health emergency of International Concern as early as they should have. They should have done that more quickly. They should have pressed china for more transparency and more answers. And i think that has to be looked at when all of this is over. I do think there are weaknesses in the w. H. O. One of those weaknesses is really not the w. H. O. s fault. One of those weaknesses is they are not really a response agency. They are a regulatory agency. They identify problems, they report on problems. But i think one thing that this is exposing, which we saw back in ebola, is when you have a major problem, not so much in china, but as this is going to spread in africa, asia, south america, in poor countries, there is no International Resource to go help fight this disease overseas. We are incredibly dependent on n. G. O. s. Brave, amazing, fantastic n. G. O. s, but underresourced, underempowered, understaffed n. G. O. s, and we will see the pinch of this as this disease spreads in africa and other poor parts of the world. Ms. Meserve are you suggesting that such an organization be formed, and under whose auspices . Mr. Klain yeah, so back in 2016 i wrote a piece where i laid out the pandemic threat and made six specific recommendations. One of those was to create a global battalion. At that time the idea was was put forth by the germans and to do it under the auspices of the e. U. The u. N. Looked at a similar idea. Did some of this during ebola, but ultimately it wasnt that successful, their efforts. We need a capable, International Response force that has the ability to deal with these kinds of pandemics, particularly in the developing world. And one of the problems were seeing, if you look at the current outbreak of ebola in the congo, what happens is even though we have a vaccine and even though we have all kinds of countermeasures to fight that disease now that we did not have in 2014, the presence of violence there, the fact that responders are getting killed, has really impeded the response. So, as this disease moves around the world, there is going to have to be a security component to fighting this disease in unstable areas, in areas with civil conflict, in areas with large refugee populations. It is a combination of a Global Health response and a Security Response to protect the people who are victims and to protect the responders who are fighting the disease. Ms. Meserve and in many parts of the world, including the United States, there are people who oppose vaccines. They do not want to see them deployed. If that is in fact the solution to covid19, how do we get that message across . How do we persuade people that vaccination is a must . Mr. Klain it is a fantastic question. I have said elsewhere that i think the greatest Public Health challenge were going to face in this country in 2021 is going to be manufacturing, distributing, and getting people to take this vaccine. Right now were focused on the science challenge. Can we develop a vaccine . Can we get it tested . Can we get it proven . What will be the prevailing vaccine candidates . And that is an amazing challenge. I alluded to this before, the Scientific Community is doing incredible historic work on this front. But that is really just the first step. Making hundreds of millions of doses of this vaccine without displacing the manufactured other critical, lifesaving vaccines is going to be a huge manufacturing challenge, and as you alluded to, once we get it made, we have to get people to take it. Now, this disease is so infectious, were going to need a very high rate of vaccine compliance, perhaps as high as 90 , to get the kind of immunity youd want, the herd immunity you would want in this country. To get 90 of the people to take this vaccine is going to be a real challenge. It is going to be a challenging distribution. Were used to this this country getting children to take vaccines at doctors visits. Using School Attendance as a way of compelling that. This is going to be much bigger and broader than that. You see the level of vaccination rates for the flu vaccine at 50 . Were going to have to obviously do a lot, lot better. And that means overcoming the kind of Vaccine Hesitancy and resistance youre talking about, it means persuasive messages from Public Health communicators, from nontraditional communicators. It is going to be an incredible civil and civic effort to get the vaccine made, distributed, and into peoples arms. Ms. Meserve and of course, we dont have a vaccine at this point in time. You are familiar with the Health Infrastructure and Living Conditions in other parts of the world. What kind of impact is covid19 going to have in africa, in central and south america . Mr. Klain yeah, i think that, as i said earlier, we are living through this here in the u. S. Now and suffering from it and i understand we should be focused on it. And we should be focused on it. It should be our First Priority as americans. I understand that. But as hard as this has been for us, but when this starts to ravage countries that have much less advanced Healthcare Systems and fewer doctors and nurses, even less protective gear than we have, it is going to be devastating on those countries and devastating on those societies. You know, when we fought ebola in 2014, one in every 10 people who died in west africa was a healthcare worker. And that had a dramatic impact on the ability to fight the disease. It had a dramatic impact on the societies in the long run. It means other Healthcare Services are still suffering in those countries years after the epidemic because of a lack of doctors, a lack of nurses. Not a renewable resource. We cant just instantly make more doctors and nurses. It takes time to replenish those losses, beyond obviously the human toll of that. And so were going to see really catastrophic impacts in places where is this disease becomes widespread in the developing world. Certainly until there is a vaccine, and then again, with the vaccine, they are going to have to make literally billions of doses and get it to all kinds of places. Now, the Global Vaccine Alliance has said that they are interesting in taking on this project but it is going to be a huge, huge project. Ms. Meserve i would like to get to a couple questions from the audience if i could. Ryan hayden is asking, how does our response change if the president is reelected versus biden winning . What is your response . Mr. Klain as i said before, im a biden partisan. I wear that on my sleeve. There is no objectivity here. But i think that there is a big difference between the two men and their approaches. It starts with their willingness to put science first. Vice President Biden said very clearly that scientific knowledge, medical advice will drive his approach to it. He has impaneled a group of leading medical experts who advise him. He talks to them every single day about updates on the disease and the policies he is putting forward. I think that is a big difference. At times, you see the president trying to replace his scientific advisors, announcing that now an Economic Team will advise him on reopening the economy. I think there is a difference in terms between the belief in science as the touchstone of the response. A second big difference is the belief in the role of the federal government. President trump ironically both proclaims his unilateral and absolute power to shut and open the economy, but on the other hand, when it really matters in terms of driving this testing solution, driving the collection and distribution of protective gear for our healthcare workers, helping hospitals build response, his answer is that is a state problem. It is up to the states to get testing and protective gear. Vice President Biden has been very clear, he would use the defense production act to take control of the supply chain, to have the federal government oversea the manufacturing and the tests and the gear that we need and making sure it is getting to the front line. I think that is a big difference in their approach to handling this crisis. Ms. Meserve i want to ask you one more question. Why has the cdc been sidelined during the Coronavirus Crisis . We heard ed yongs thoughts. Quickly, what are yours . Mr. Klain yeah, i think it is a shame. I think that the cdc is our nations leading Public Health agency. As ed said, it is really the worlds leading Public Health agency. When i worked for president obama we were proud we helped launch an african cdc. All over the world countries model what they are doing compared to our cdc. And so, to take this great resource and put it on the sidelines, i think it is a real shame. I hope the Trump Administration will change its approach to that. Ms. Meserve ron klain, thanks so much for joining us here today. Mr. Klain thanks. Ms. Meserve and now i would like to turn to a message from steve ubl, the president and c. E. O. Of pharma, who is our underwriter for todays event. Steve . Mr. Ubl thanks so much. Pharma is pleased to be sponsoring todays atlantic digital event featuring speakers at the front line of fighting covid19. I must say, one of the bright spots has been to see the entire ecosystem rally on so many fronts, whether it is the f. D. A. Expediting approval with diagnostic tests, or hospitals and frontline healthcare workers selflessly treating those infected by the disease, and policy makers who are acting to address the economic fallout caused by the virus. For our part, our companies are really working literally around the clock on four key fronts. First, our companies are partnering with other Life Sciences companies to enhance our testing capacity. One of our member companies, youll hear from doctor lee in a moment, is running thousands of tests on their roche platform. Those companies are also donating Laboratory Equipment and supplies. One of our companies tapped their inhouse capabilities to create a drive through testing center. So, testing is one area where our companies are very focused. Secondly, our companies are screening their vast global libraries of existing medicines. These are medicines that have already approved by the f. D. A. For other conditions, to repurpose those treatments, for the purpose of treating covid19. And there are already more than 300 such trials underway and many of these medicines are being made available to patients today in the auspices of Clinical Trials. And there are really three key areas that are the focus of much of this research. Whether it is antimalarials, antivirals that have been developed for ebola or h. I. V. Example, or immuno agents that are used to try to modulate the bodys overactive immune system, what compromises the lungs during a respiratory illness. Further, our companies are looking to develop new therapies and treatments. One of the most promising areas of focus there is antibodybased treatments. There are two main aspects of that, which you will hear from our additional speakers. You are taking antibodies from individual who is have already been exposed and infected and have recovered, using that plasma that contains the antibodies to help those infected fight the disease. The other approach, which is quite similar, would be to genetically create these antibodies, and they would be used as a biologic medicine, and there is very promising work underway on both of those fronts. And then finally our companies, as you know, are very focused on developing a vaccine. There are now more than 70 programs underway, with several already in human trial. And that is really important. Were going to need a lot of shots on goal to make sure that we find a vaccine that is very effective, given the vast number of individuals who are going to need to be inoculated. And i must say, as you think about those four fronts, i am cautiously optimistic that the industry is going to deliver for three key reasons. The first is the industry has decades of experience and deep scientific knowledge regarding similar viruses and diseases. So, think about sars and mers and zika, ebola. And our companies are tapping that vast scientific knowledge to address this current covid19 crisis. Our companies have also invested for years in cuttingedge analogies that are shortening the amount of time it takes to get from the bench to the bedside, from the preclinical stage to actually having a new therapy or vaccine available to patients. You may recall that during the sars virus a decade ago, it took almost two years to get the first candidate vaccine into human trials, whereas today with covid19, as i said, you already have a few candidate vaccines already in human trials less than two or three months from the first known case. And then finally, as ron mentioned, manufacturing is going to be a key challenge in and our industry alone has the unique capability to scale and manufacture any new treatment or vaccine. So in closing, i did want to also mention affordability. I must say, our industry is keenly aware of what is at stake in this environment and is deeply committed to providing these new treatments and a vaccine, making them affordable and broadly accessible to patients who need them. In previous pandemics, affordability has not been an issue and i do not expect it will be an issue this time around. So jeanne, thank you very much. Thanks to the atlantic for the opportunity to sponsor todays discussion. Ill turn it back to you. Ms. Meserve thanks again to pharma for underwriting this event. Let me introduce now dr. Brendan carr, the chairman of emergency medicine at new yorks Mount Sinai Health system. And also dr. Patrice harris, she is president of the american medical association. Thank you both for being with us today. Dr. Carr, we heard Governor Cuomo say yesterday that he believes that new york may be past the worst of this. Does that match what you are seeing in your Health System . Dr. Carr thank you very much for having me. It does. You know, the thing that is clear about this disease is that it has a very long course, and we have seen a decrease daytoday in the number of patients and the number of critically ill patients presenting to our hospitals across the system. But our hospitals are very, very full because there are so many patients who are still recovering, who are still receiving Critical Care services and other medical services. Ms. Meserve do you have the supplies that you need . Dr. Carr we have been very, very lucky. We have had the supplies. Our ventilator utilization never got above 80 or so, in part because we had an evergrowing denominator. Other guests have talked about the private sector showing up in lots of different ways. It was astounding to see now t only people that were ramping up production and people helping us with the engineering and converting a cpap machine that could serve as a ventilator. Ms. Meserve at this point in time, how many of your employees are testing positive, and how many have you been able to test . Dr. Carr as you probably may remember, in the early days of new york we were testing a lot. And then we stopped and were only testing people that are sick enough to be admitted to the hospital. Ms. Meserve i wanted to ask about your employees. Dr. Carr were testing our employees if they are sick enough to be admitted to the hospital. So just recently we have been allowed to start to test our employees who are moderately sick, rather than using their symptoms to dictate whether or not they could come back to work. Ms. Meserve and what kind of numbers are you seeing . Dr. Carr it is literally days that we have been testing employees. I am sorry. Ms. Meserve dr. Harris, there are so many questions here for doctors, for nurses, for other Health Professionals. They have to weigh whether to do their job versus keeping their families safe. Are they prepared to make those kinds of judgments . How do they make those judgments . Dr. Harris certainly, and thank you for the opportunity to be here. Physicians, nurses on the fronts lines of this pandemic are exhausted. Dont always have the ppe. Im so glad to see and hear they have the ppe at mount sinai but of course across this country we have to make sure that ppe is available. You know, physicians went into this profession, chose this profession with some level of risk, accepting some level of risk for infection. But i have to say that there is also an expectation. I call that an accountability contract that physicians and nurses and other healthcare workers on the frontline have the equipment they need. There is a variability across the country. Thats why in the beginning the a. M. A. Called on the president to develop a marshall plan, manhattan project, you can use whatever analogy works but we really need an all hands on deck approach to this. And while some areas have the ppe they need, there is a concern that we dont have that across the board. Ms. Meserve there are some doctors and nurses who have been disciplined for speaking out about not having enough supplies. Is that the way medical institutions should be handling the situation . Dr. Harris we are hoping and have always had a partnership across the spectrum. And certainly the ama was quite concerned regarding any nurse or physician being disciplined for certainly speaking what was a known fact, that they didnt have enough equipment. Now, we certainly get that we have our media policies, the ama and institutions do, and those are appropriate, but certainly we do not feel it is appropriate to discipline or punish physicians and nurses in any way for speaking up about what their needs are. Ms. Meserve we have some questions coming in. Gary ricard asks, what we have in patientent care that saves the lives of caring for covid19 patients . Dr. Carr we have learned a lot. The idea that the Delivery System needed to respond to something it was not prepared to respond to, for most people, it was something never imaginable. That needs to be included. What we have learned about how to effectively care for people is critical and deserves attention. On the critical side, this disease met the American Health care system and the American Health care system did what it does, which is instantly start to function in a learning way and learn and learn and learn. So everything from the stuff that is happening with convalescent plasma, which we talked about, certainly conversations around Critical Care interventions, how to ventilate them, how to oxygenate them, how to position them, all the work around the clotting problems that we are seeing. It is a long, long list of amazing, amazing science that has been happening. Ms. Meserve i know mount sinai has done work on plasma donation. Talk a little bit about that, and if you are seeing anything one way or another on the effectiveness of that kind of therapy . Dr. Carr it is sadly too early to know about the effectiveness. But the numbers have been extraordinary. We were lucky to have a couple of laboratories in house that got in front of this very, very early and had the capability to detect the antibody and turn them into the convalescent serum, and it has been infused into dozens of patients at this point in time. As anyone who follows this knows, it always feels like you are making headway, it always feels like you are making a difference, and we are always really reluctant until we actually get to the right number of patients and do the math to determine whether or not it has been helpful. Ms. Meserve we have a question for dr. Harris. Perhapsnges in waivers, regarding telehealth, do you hope to see become permanent after this crisis is over . Dr. Harris that is a very important topic on two levels. First of all, the ama and physicians across the country are very appreciative of the work of cms to expand opportunities for telehealth. Of course, that required loosening some restrictions, even allowing visits via the telephone. Because you know what . Not everyone has Broadband Internet access. Not everyone has an Internet Data plan. And some folks, like my father who is 86, they are not proficient. So, relaxation of some of those regulations were very helpful. But here is what i want us to all think. Certainly in the midst of this pandemic, we need to have an all hands on deck approach and do whatever we need. Going forward, after we get around the acute phase of this pandemic, we are going to have to be very thoughtful about the learnings from this pandemic. And so some of the things we should probably continue and some of the things were doing now that are appropriate for the emergency, we should perhaps discontinue. And we are going to have to have those thoughtful conversations. We are going to have to look at the data and the evidence. I know the ama will be willing to lead those conversations, so i dont want to get ahead of those very thoughtful conversations that we absolutely have to have after we get beyond the acute phase. And i also want to remind everyone that certainly new york may be on the others and other side, and may be on the down slope, but there are other areas of the country who still may not have yet reached their peak, so we really need to appreciate new information that different regions will hit their peak at different times, but again, once we are past this, we need to have these thoughtful conversations, and what we continue to do and what we have dont in telemedicine and telehealth very important, but not a panacea, and we will certainly have to find the appropriate role and place for that Going Forward. Ms. Meserve someone asks a related question. Is there sufficient medical infrastructure to meet the needs of Rural America in the event of serious outbreaks there . Dr. Harris certainly that has been a concern and that is why everyone has been physically distancing i like to use that term because i want to make sure we stay socially connected but i think people forgot the main reason we did that, i guess two main reasons, number one, was to slow the spread of the infection, but so the rate of rise, so we would not reach a level where it would overwhelm the Health System. Certainly in new york there were assets that we might not have in the rural parts of georgia, where i live. So we have to look at those under resourced and low Resource Areas because it would be very easy to overwhelm the resources of hospitals in rural areas that may have only one or two ventilators. That is why actually social distancing, physical distancing continues to be a piece of that puzzle. And another issue when we get on the other of this is to look at underresourced areas, which could be rural areas and sometimes even urban areas, and make sure we have adequate access to health care. Aboutserve if i could racial disparities, africanamericans and latino americans have been disproportionately infected and dying of covid19. We know, we have heard from medical professionals like yourselves, that these populations are more likely to suffer from from of the underlying conditions. We know that they may not have access to health care. But is there another factor here . Is there also a distrust of medical institutions and government . And is that playing a part . Dr. Harris yes, you mentioned the Underlying Health inequities and disproportionate impact of hypertension which in this case caused increased mortality and covid19. And also another point to raise is that black and brown people are overrepresented in some of those essential jobs. Not everyone has the privilege of being able to stay home, and those essential jobs and those workers are continuing to go out, and of course, they are continuing to be exposed, so that is another issue. But the third issue is misinformation. I said that the first two weeks of this pandemic i spent my time really not in my role as ama president , but as a Family Member and a friend dispelling myths. And a part of that whole issue actually is distrust i have to say, as the first africanamerican woman to be president of the ama, i talked bringing talked about bringing all of who i am. And i know my personal experience with Family Members and that worry and distrust from a history ago, the tuskegee experiment and other issues that have occurred in this country. And so that is why it is so critical that we make sure theres credible, trusted sources of information out there for all communities, and we respect the needs of the communities about how to get information, trusted, credible information to the various communities. Ms. Meserve dr. Carr, i have a question for you from George Matthew asks, are you prepared for a second surge before or after summertime, and do you have enough Health Professionals and resources . Will you be able to retain them through the expected financial losses . Dr. Carr those are both good questions. Regarding a second surge, i would ask, of what . In part of course we are talking about covid, but it is eerily quiet in our Emergency Services at times because of all the patients who are not there. The next covid surge will be all the folks who stay home with Heart Failure and emphysema and renal failure and other things that in one way or another mask that chronic condition. Then presumably after that there will be another surge, or several more surgeries. The 1918 flu pandemic did not several more surges. The 1918 flu pandemic did not end until 1920. We dont think were looking at a couple weeks or couple months, we are looking at a very long term. And the other question baked on the end about what this will do to the health care workforce. And we have not talked about this quite so much during this conversation, but this is extraordinarily hard on the workforce. Its wonderful to see the celebrations at 7 00 at night that people cheer and we feel it, and people send gifts and food and are trying to do what they can to support, but its also terrifying. A lot of our employees are living in hotels, are living in apartments because they are afraid of infecting their loved ones, their partners, their children, grandparents that are living with them. And they bring that to work with them. It is not normal to watch people die at this pace all the time, and that is making a huge impact and likely will have an impact on our workforce, as suggested by the question. Ms. Meserve are you having people quit . Dr. Carr actually, no, i would say. We are having a shocking number of people showing up asking if they can help. This,eople are drawn to volunteers, people who say they dont need to be paid, they have a job at home, but they want to take a couple of the overnights so the regular staff can go home and sleep. It is extraordinary, the best of people show up. Ms. Meserve i am sure you are well aware of the told this is taking on the medical profession . What is the longterm impact going to be . Dr. Harris i could not agree with dr. Carr that we really have to talk about this more. Precovid19, we had a woefully inadequate Mental Health system, and i think thats going to be worse, actually, after we get through this, so we are going to have to make a concerted effort to make sure that, again, the Mental Health needs of not only my colleagues, our colleagues, but also of the country are met, and so that is a critical point and we have to begin to talk about that. The other issue, and again, dr. Carr mentioned this, is there is going to be a lot of pentup demand. People are delaying visits, well child visits even, and missing their vaccinations. The last thing we need right now is an Infectious Disease outbreak on top of covid19. So there will be a demand for that. As you are aware, many physicians have reduce their hours or closed their practices. Telehealth is making up some of that, but again, some things cannot occur through a telehealth visit, so we will need to be ready. Even get back to ppe and the shortages of medications, as we open up our sector from large systems to small, we are going to need even more equipment. And another issue we have not talked about yet is the shortage of medications. I was also chair of the amas opioid task force, and we have seen some shortage in the ability of some of the medications to treat some of these disorders. So, we have a lot of work to do. Certainly, we will all be ready, willing, and able to do that. And physicians and nurses, we are running toward this problem, and i again thank all the physicians and nurses and Health Care Workers, but we also have to make sure that they are supported now and in the future. Dr. Carr can i had one piece add one piece on there . When we think about what it takes to recover from this and what it takes the Healthcare System to be ready for the next, this is a sophisticated audience listening to this dialogue. This cannot be about grantbased bailout programs. This has to be about a decision to include in the fundamental way that we pay for health care the concept of readiness. We have a justintime system and we have a situation now about if we want to change that. Ms. Meserve doctors, thank you both for your insights this afternoon. We appreciate it. We will have to leave it there. For our next conversation, lets bring dr. Levi garrway, in the chief medical officer of Biotech Company genentech and roche that are working on treatments for covid19. Good afternoon, dr. Garraway. Do you hear me . Dr. Garraway yes, i do. Ms. Meserve there are Clinical Trials under way for drugs for covid19. Can you give us an update . Where are you in that process . Dr. Garraway we have a Clinical Trial underway for medication that was originally developed for, for example, Rheumatoid Arthritis. Way,eason for this, by the is for patients with covid19 who develop problems, for example, the pneumonia that can cause respiratory failure and the need for intubation and even death, that it is believed part of the reason why that pneumonia happens, at least, it is not continued viral replication, but the immune response or the inflammatory response of the patient to the virus that becomes excessive. So the recognition of that led , initially, several investigators tested the idea that actemra, which was designed to inhibit that type of inflammation, the thought was maybe that would help patients with covid19 pneumonia. And so that led us, eventually, to start a phase three Clinical Trial to test whether or not actemra together with standard care in patients who are hospitalized with covid19 pneumonia might benefit. So, we initiated enrollment of that study in early april, april 3, actually, so we are actively enrolling. We intend to enroll 330 patients at sites across the u. S. And around the world, and we would expect to have final results from that study in the summer, but of course, we will have opportunities to take earlier looks as the data emerges. So, we are well underway in enrollment. Ms. Meserve but it is still months away . Dr. Garraway lets say weeks at a minimum, and it could be months. Of course it depends on the time of enrollment and what the data looks like. Ms. Meserve im curious because this is a drug already in use for certain medical conditions. Is there the potential there will be shortages for those people already using it if it proves to be an effective therapy for covid19 . Dr. Garraway certainly for all of our medicines, we have been mindful of the importance of supplying the world and maintaining that through this. So we have taken aggressive steps, as you might imagine, to ensure that we will have enough supply, not just for the surge that could be needed, if indeed this medicine proves effective and safe against covid19 pneumonia, but also to continue to supply our patients who have Rheumatoid Arthritis and other ailments that require use of actemra. So, this is obviously an area of top concern, but we have taken a number of steps to ensure supply for the world. Ms. Meserve i want to pivot from talking about therapies to talk about vaccines. As i understand, there are no existing vaccines for any of the coronaviruses. Is that correct, and does that make this a steeper hill for researchers to climb . Dr. Garraway you are correct that there are no vaccines for this type of coronavirus. Thisinly the needs in pandemic, vaccine, as you have already heard from others on this program, are a big solution over the longterm to really finally conquer this, but thats one prong of several prongs that are needed. Therapies that will attack the virus directly are needed, and then therapeutics that may help people recover or get through the Critical Care mode if they find themselves in that situation, are also needed. So really, it is a spectrum of therapeutics and vaccines that are going to be needed to really rid this world of this enormous crisis. Ms. Meserve ron klain brought this up earlier, the problem with making as much as we need. Will the industry be able to ramp up production in a hugely significant way to make sure medicines once they are proven can get to the people who need them . Dr. Garraway well, as was also mentioned, one of the bright lights in this crisis, if there is a bright light in this crisis, is the extent to which we have seen the pharmaceutical sector come together and partner not only amongst ourselves, but also with governments and regulatory authorities to do everything that we can to make sure we are up for the challenge. We are doing everything we can we have the capacity to produce medicines that are needed to fight the pandemic but of also, ted
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