Unique. Take hiv. E, lets we showed hiv was the cause of aids. This was hard because the virus is hard to find, hard to grow, and the disease does not show up until years later. Establishing strong evidence to get people to say, this is it was not easy. Number this virus, sars 2 it is easy to find. It replicates so much that it is obvious and quick to cause disease. You do not argue about whether this is the cause. They present different challenges. People have said they have never seen anything like this. Yes in terms of the social angle but of course there has been epidemics like this. We just have to broaden our Knowledge Base or just read over the course of history of medical science. The great flu of 1918 was worse. It killed a quarter of the world. Rnae are viruses that carry dna that are subject to more mutation. Infectiousways more so each one is a problem. What is unique . The social impact in our lifetime. The magnitude of it. What is unique it is not unique but what a special and unusual is the extreme infectious nature. It is targeting a molecule on the surface of human cells that has a great affinity to latch onto. Molecule on that the surface of cells is not limited to a specific cell type. With hiv, it is restricted to a few types. In particular, a lymphocyte we call the t cell. Also a subset of those. It can infect other cells but that is mainly it. Virus isem with this it infects a large number of cells with great affinity. It spreads very fast and because it infects so many types and numbers the infection can be very serious. Still, percent wise it is not a high percent of people but older people are the ones in the biggest trouble and young people in only unusual circumstance with other conditions. Until very recently, the blood l agwa coagulation disorder i do not understand it yet if there is 1 the special angle is how infectious it is. That does present more of a political,nomic, nonscientific and scientific challenge. Host when it comes to the responses federal and state governments have taken in response to what they have seen or the concerns that had, do you think those were appropriate with stayathome orders . Guest i do. What was the choice . Who has not done that around the world . They say sweden has not they do it on their own anyway. When i heard a Swedish Health official talking he was ok butng on an airplane said you shouldve six feet distance. How can you do that . What would that look like . There would be a lot of criticism. Locally they said that should be more controlled. As i was waiting i heard one listener say that and i understand. It seems sensible but when you think about it what if you have a governor who is extremely incompetent . We do not have a choice other than social distancing when you have no answer. Says, go to the scientists, go to the medical people, but we do not have the answers. Especially not the social ones. You need the epidemiology people particularly need laboratory scientists. You really need the Epidemiology Public Health people but you also need political leaders. The have to be involved and strong. They have to listen to the best advice they can. But some of the things are, you know, social, political decisions. We need to solve the problem. We have not done if you want to think we have done great, we have not. You could say why were we not better prepared . I saw an article in the Washington Post from a french leader saying america was preparing for another 9 11 and it did not happen. They got hit instead by this virus. They did as well and they said we should have prepared. How could you prepare for the . There are things we could have done better early on. We could have responded more quickly to the chinese phenomenon. My view is we do not have enough internationalism. A Global Pandemic requires global collaboration. We have the Global Network which i am involved in. I cofounded that in 2011 and the purpose is to stay informed. We talk to each other all over the world every week and a half or so. I recruited the president and he is quite effective in keeping the knowledge flowing. All governments should be seriously less nationalistic. I do not mean that in hostility but self absorption and only preoccupied with self. It will come back like a boomerang and hit us in the head. We have to be international, collaborative, and speak the truth. Those are the only things we can do with a pandemic. Preparedness . China knew things were going on in november. They already had sequences of the genome. It is easier to make vaccines today. Everyone is going to have a candidate vaccine because the sequence is known and you can make proteins that correspond. Happen but i am not sure they are going to be right. We can talk about that in a moment if we have time. We do not know yet what is going to be right. Some things could make matters more difficult. We have got to be careful. We do small animal studies, then larger animal studies. I think what people do not know is the chinese scientists predicted a year ago i think thererch of 2019 would be another bad coronavirus and it would cause respiratory disease. I have read that since the pandemic. They predicted it because they study coronavirus. We were not paying attention. There were a few labs but not many. They said bats have these coronavirus. Sars is coronavirus and therefore common cold coronavirus is. Es. They burned out quickly. We do not know why. Mers killed a lot of people. It started in saudi arabia and when it hit south korea, it caused a lot of death. And now his gun away. Lets hope the same is true is this. Host let me take a second and invite our viewers into the conversation. Eastern and central time zones 2027488000 , mountain pacific 2027488001 , if you are infected and want to give your experience 2027488000 as well. You can also text us at 2027488003 . What level of testing does the United States have to see in order to get the information we need to develop the vaccine . One i pedro, from day said one of the singler most important things we could do was widescale testing of antibodies. A lot of times people will convert that in discussions to we will know if summary is protected. We do not know until you have the experience then you see the antibodies are doing anything. Protective you would like to know that but we need more tracing. What does that mean . How can we trace this without Antibody Testing . We cannot. If we thought there was a delay in early response, that might be true. You would like to see at the beginning you know who is infected and trace who the contacts were by having a good Antibody Test. You know the contacts, you test them, will it spread to them, seeing the rate of spread and then you try and have those people who are infected really be isolated for a while until they are no longer infectious. How long is that . We dont know. You base it on previous experiences and say some weeks. Some viruses are staying around in the sputum or fecal but mainly saliva. Maybe beoing to surface transmitted. It can be transmitted with no symptoms. Viruses are in a way that are mysterious. The chinese were saying early on people with no symptoms would be able to transmit the virus. How much testing is enough . Too much testing is enough. We need as quick as we can get. Keep saying a good Antibody Test so what am i saying . This is not an easy blood test for antibodies. Because there is at least the high ofave seen too false positivity. There is 5 false positives. Why is that . Because the other Coronavirus Infections that cause the common cold like symptoms are four of them. Should that be a permanent problem . I dont think so. The sophisticated studies of pieces of different proteins of the virus will give regions that are unique and you hope you will have antibodies that can be detected against these unique regions and get more specific positivity. Therefore you will not crossreact and reduce the present of false positives below 1 . Then it starts to become extremely helpful. I think that will be solved. I dont criticize the fda for approving these less accurate tests or the companies for developing them because they had to get something out. Now is the time for Academic Centers and the big diagnostic Companies Like abbott to get into making this test more refined as rapidly as possible. That should have begun months ago and in fact, it was begun months ago. This is not so easy to make as specific as we want. That is what we need. Specific and sensitive and get it out widely and rapidly. Guest lets go to some calls. Zach is first up from maryland. Go ahead. Caller ive a quick twopart question. I am not a medical professional but is there a difference v2, and sars, co covid19 . Guest yes. Lets go to the second part of the question. Caller is there a demographic breakdown . I have heard so many different things. Most people the that go to the hospital are or 50n 30 and 40 depending. Just because you do not die from it you can have longterm consequences. I am wondering if you could answer those questions . Host thank you. Guest everything you said or implied is true even though youre making it a question. Whether there is a difference, there are. Virus talk about the verse the disease. You dont have to get it really straight but covid19 is a disease. That is what they are using. The virus is the second sars. It is highly related but with some differences including it is far more infectious. I civilly call it sars2. Simply call it sars2. The disease covid19 follows. In terms of demographics, it is all true. It is older people to get the worse trouble and i will come back to that. Younger people can have problems of significance but they are much more unusual. That is why you read about Nursing Homes not only because they are relatively captive and will together like on a boat, because thisr but aging population is suffering greater to fight the virus. Infected probably get even easier. Established100 they are infected easier as far as i know. For why womenns are less susceptible because the receptor to molecule on cell surfaces comes in different forms and the women it is on the x chromosome. They have more variation so one is less targetable. What is the story with older people . Disease, lungd disease where you are suffocating because of the inflammatory cells, we call it a cytokine storms. They have all sorts of inflammatory cells leading to a gradual inability to Exchange Oxygen from the lungs into our blood vessels because of the stuff that is blocking in between. It is a slow suffocation. Not only that way because it infects more widely but theres something fishy. That was stuck in my mind from the beginning. If we turn to the great 19171918, people died of cytokine storms. That is where our past information came from but who was it . They were young people. The immune system was hyperactive. Old people not so much impacted with death. The opposite is true today. There is something more going on with the lung problem and i saw one study where there was a lot of virus still replicating in the lungs. I did not expect that. I dont think anybody did. We would have thought the virus would have been under control and not so much of the virus direct effect of killing cells. Problem is very complex. It isical scientists interesting and complicated and i am not 100 sure, when that state occurs, what is the best way of dealing with it. We were thinking it was to block one of the molecules important in a cytokine storms in the lung. So a lot of the therapy was targeting that. It is not working well and that is not an answer per se. Apologize but i want to get other calls in. Guest i am so sorry. I go on and on. [laughter] host kent from california your next. Caller thank you for taking my call. My question concerns blood thinners. I was wondering if blood thinners guest i could not hear. Host blood thinners. Caller if they are being used due to thetients high levels of blood clots, and how the thinness of blood helps keep the virus from connecting to tissues. I was wondering what your thoughts were. Guest i do not have many. The best thing i can be in any interview is to try and be frank. When i dont know something i have to say i dont know and that is my answer. We have a clinical director who is in the hospital right now. He would know this answer but yes, i agree. It makes sense. I suppose it is being done. Certainly when you see the problems he would go to an anticoagulant or blood thinner. I imagine the answer to that question is yes but is it being done routinely . No. Host arkansas this is tim. Caller good morning. Note for cspan, you covering a lot of medical stuff and very little economy stuff. Disease but i am concerned about 20 million out of work. Hadnt to ask the doctor, we random testing of the population and we find out 15 of those tested are positive. 10 ou cut that back to even of the population being infected, we have 30 Million People who are infected in this country and have only had this country that is no worse than the regular flu. Why are we shutting down the government . I have an answer. We have incompetent governors who wanted to use their power to expand power. The one in new york decided to tell people to go to the saint pattys parade, to cut down the number of trains so you had concentrated people on the subway, he decided not to buy ventilators and instead would buy solar panels and now cries the federal government to bail him out because he shut down his economy. He put people out of work, him and new jersey. Host ok. You made your point. We will let the guest answer. Guest this is an economical question of which i can give my opinion. It is certainly an attack on Governor Cuomo but i think he has been active in trying to do the right things and explaining it well. I am not of the same viewpoint exactly but he has some point. You cannot compare this to influenza. In some years, influenza is worse. It killed a fourth of the whole human race. It was much worse in 1918. Today, this is certainly worse than the typical flu season. First, it is lasting longer. Second, it is unknown. You have no idea how long this is going to last or the second and third waiver coming. We dont know what disaster. May come to the southern hemisphere. These are all unknowns. Furthermore, an average year with influenza does not kill the number of people this is killing. You never sign nursing home get wiped out or 25,000 people in an Apartment Building in singapore get infected. That is not a typical influenza season. Yes they can infect worldwide but the percent on the average influenza is nowhere near this level. Certainly not near look at north italy where you have the total experience with a lot of migrants coming in to work in the fashion industry. They carried the virus and look at the percent of older people that died. And those that are dying in the United States, we do not see that with influenza. We have a bad year where we may see it. That this isfall still here and we have influenza. You would be wishing for strong Government Action and governor action. I am not an expert. We all see that is a huge problem but if you are a leader friday, what do you do . Maybe Governor Cuomo made mistakes but i think acting strong is not one of them. Host we have a viewer of twitter who asked, when it comes to older victims is there any vaccineon the pneumonia has helped ease symptoms . Guest i do not know the answer to that. I have not heard but we can get into that in a moment. Host you said it was the right vaccine that ultimately is the question. What you mean by that . Guest you want to discuss vaccines period . Host for a little bit before the next call. Guest it is not an easy 20 seconds. Your show is not a sound bite. The new system is complicated. When we think of a vaccine we are thinking about the adaptive immune system that mainly, but not solely, involves the lymphatic system. Cells make the antibodies. Cells that killer t can knock off virusinfected cells which is a great part of protecting us in these infections. The adaptive immune response can be longlasting or lifelong. The measles vaccine is lifelong. Others are a few years. Some, like everything we try in trying to get an hiv vaccine for reasons we are beginning to understand are rather shortlived. Even if we have the right adaptive vaccine, the antibodies do not last very long. We have to rely more on killer t cells. It is one of the complications for hiv but that is the adaptive immune response. There are many ways of approaching it. Somexample, china recorded positive results with a vaccine. You may have heard about it. It worked in a few animal models and their beginning to get interesting results in humans. What is the vaccine . It is an adaptive immune response that takes weeks to make. Away fromfew months having an Effective Response and nothing in the first few months but once you have it, you should have memory. It should last a long time so that if you see this again, you are adapting from the beginning. What did they use . Virusimply used a dead like jonah did with the inactivated polio vaccine that requires injection into our tissue. You build an immune response that is rather longlasting for sure and you get certain antibodies and killer t cells with the mechanism. How it protects is not completely known. That is true with a lot of vaccines. We dont really understand how they work. We know how they should work and that is often nothing case and we let it go because it works. They just use the dead virus. What happens . When the dead virus comes in, the proteins are chopped up in the cells into fragments. They are presented on the cell surface. This is not going to induce antibodies but inducing, on the cell surface, the killer t cells to respond to pieces of the protein. It will recognize it as something it needs to attack. That can become protective. The vast majority of vaccines prepared, the trigger for the immune system are vaccines that are really simple. We have known the gene sequences of the virus from the chinese medical scientists since i dont know the exact date but i think it was december. It was very fast and easy. Not a lot of genes in this virus. Once you have the sequence anybody can buy a vaccine. You can get the complement of the gene sequence as a messenger molecule. Messenger by the injection into my muscle. Protein. Encode the it will make the protein correspond. Most people are doing this if my hand is the coronavirus, the spike is my finger which is coming at the cell. People want to target that so you do not get infected. Up for gettingal mess