Not safe. Just because numbers are going down doesnt mean we can stop efforts. How testing is key to the balance between Economic Health and Public Health. Could this lead to unnecessary deaths . There is a danger of a rebound. The scientific race for answers. A vaccine may be far off but what are we learning today about a cure for covid. People with antibodies can donate blood for the pla sma. The lessons overseas, classes back in session in europe. What does it mean for students here. This is a special edition of the last word life in the time of coronavirus. Welcome to another night of life in the time of coronavirus. We have come to a moment of growing restlessness in the United States as some people begin to protest what they see as oppressive, unnecessary closures of businesses and schools and others are protesting what they see as inaction and a lack of Straight Talk by administration. Doctors, scientists, experts and Public Health, they all say the country cannot return to normal until we have adequate testing for the virus and treatment for the disease. We dont have either one. Nor do we have the ultimate solution, a vaccine. But there are reasons for hope. Tonight, were going to look at one attempt to develop a treatment. Were going to get the latest when and how kids might return to school and talk to microsoft founder bill gates on his efforts to Speed Development of treatments and the all important coronavirus vaccine. With me once again for the hour, dr. Zeke emanuel. Dr. Emanuel is a physician who served as the Health Policy advisor in the obama administration. Hes the vice for global initiatives at the university of pennsylvania. Dr. Emanuel is also an nbc news and msnbc senior medical contributor. Zeke, good to see you again today. Lets start things off with you gives us a sense where we are in this crisis. Your vital signs for this moment in our national life. Nice to be here with you, ali. I have three vital signs that stand out for me tonight. First, were not going to get out of this crisis without testing. And right now were not going nearly enough testing compared to other countries when it comes to how much of our population can get a coronavirus test. You can see in this slide were behind. Second, in places where were able to test a lot like the navys uss Theodore Roosevelt they found 17 of the crew got the virus and an amazing 60 of the positives had no symptoms at all. Well, they are sailors. But if they hadnt been tested, they never would have known that they had the virus, which shows you how important it is that we be able to test people so we can find the virus and stop its spread. And the third vital sign because we dont have nearly enough testing, the only way to contain the virus has been to shut everything down. As a result, 26 million americans in the last four weeks have filed for unemployment. That is a crazy painful number. We dont know that were through with it because last week we had 4. 4 million after more than six million in the previous week. We may be looking at adding millions to that number and i dont want to drag you into politics, zeke but 2020 and everything these days seems to be a little political. I want to get your take as a medical professional on something donald trump said yesterday at the white house. L lets listen together. So supposedly we hit the body with a tremendous whether its ultraviolet or just very powerful light and i think you said that hasnt been checked but youre going to test it and then i said suppose you brought the light inside the body which you can do through the skin or in some other way. And then i see the disinfectant where it knocks it out in a minute, one minute and is there a way we can do Something Like that by injection inside or almost a cleaning because you see it gets in the lungs and it does a tremendous number on the lungs so it would be interesting to check that. Youre going to have to use medical doctors but it sounds interesting to me. So zeke, here is the thing. Hes not entirely wrong on both fronts, right . We know these disinfectants kill the germs and uv light from the sun kills the germ but what do you make of how trump put that all together . Well, i react to it as if i were a parent and im a parent. You know, you are in constant dread your kid is going to get into the bleach or the lysol or the fantastic so you lock it under the sink and you make sure that theres a secure lock on that cabinet and you have the poison control number on your refrigerator and you just hope that you never leave the cabinet open and the kid gets into it and now you have the president telling people, well, maybe we should take, you know, bleach or something, those disinfectants to treat this. Everything parents fear is in that statement, its just, you know, blood curdling that someone would advocate this on television where kids could hear it. Now here is the thing, zeke. Im going to talk tomorrow morning to ed who is studying uvc light and these sorts of things. Theres a sense that the president said today was being sarcastic if you watch that video it doesnt seem like s sarcasm. There is a danger about the president of the quite leadiuni leading that charge. Hes not an expert on how we assess whether things work or as you can tell from the clip how we actually get therapeutic idem te items into the body. I dont want to say people should stay in their lane but it doesnt take expertise to deliver it to people and we shouldnt be talking about it casually. Right. The president is also talked about other treatments and one of them is a Combination Treatment that includes hydroxychloroquine. This week there is a panel at the National Institute of health that recommended against having doctors prescribe that combination. Are we any closer this week to having either a scientifically sound treatment that doctors can draw on or some other form of therapeutic . We should be clear about the hydroxychloroquine and why they recommended against it. In studies, weve seen some rare complications heart arrhythmia where the heart electrical system doesnt cause the heart to beat properly and that can be dangerous and fatal. Are we closer to a therapy . Well, a few weeks ago it was rem d rem d remdesivir was ththat was p. It doesnt seem to be a home run. The important thing is to try them in controlled trials. Some people get the treatment and some dont so we can compare them headtohead otherwise we dont get comprehensive data and information that allows us to make a decision. We have a lot of stories and you cant rely on the stories to tell you whether the treatment is working or not. The patient recovered but you dont know was it the treatment or was the patient going to recover anyway . As a cancer weve seen that many, many times and been frustrated by it and you can only prove what works when you do the right trial and get the data. The frustrating thing as oncologists is you see the trials take time and the answer doesnt come quickly as we see it and in the search for coronavirus treatments and a coronavirus vaccine, much of the work is being done by private companies and by foundations with an interest in Public Health and among them is the bill and Melinda GatesFoundation Funding seven different teams all of whom are working toward the production of a possible vaccine. Now, bill gates published a paper yesterday called pandemic one. It is 16 pages long and a good read. It outlines the challenges ahead in terms of testing, treatment and ultimately a vaccine, which is something bill gates knows a thing or two about. He sat down with zeke and me to talk about it and here is the first part of our conversation. Joining us, microsoft cofounder and the cochair of the bill and Melinda Gates foundation. Bill gates, mr. Gates, welcome. Thank you for joining us. Zeke, lets get it kicked off. Thank you, ali. Bill, you and i have known each other for more than a decade now. One of the things in this covid19 pandemic that a lot of people are worried about is that if we discover a vaccine the bottleneck may turn out to be production, distribution and administration of the vaccine. What are you personally prepared to do to accelerate the process of production and distribution . Well, because were in a rush to get the vaccine done, we need to back up to Ten Companies because were not sure which one will work. Its a novel virus. Weve never done a vaccine like this before. There are some things in common like the last stage manufactu manufacturing, if you want to make 7 billion or 14 billion doses, that will be a bottleneck so were funding that will work for all the vaccines and together with the governments, well fund the different manufacturing plants. Unfortunately, theyre not the same because the process of making these things like you makelipids and big 15 liter tanks. These are the balls that we need to save to stop spending trillions in economic relief. So id say between the rich World Governments and the gates foundation, the financing of this should not be a bottleneck. We should be able to allow the most promising efforts to go at full speed. Are you building or going to begin building plans to actually produce vaccines whether its for the rna vaccines or for some of the other big fermenting plants . Yeah, at this point a lot of what were doing is funding the early stage research, you know, so people can get into phase one where you will actually see particularly if you go to the elderly, enough antibody response to understand which are the most promising and compare that antibody response to the natural disease immune system response. So most of the grants weve done so far are not in the manufacturing piece as we get further along, even in the next month, we want to do that, as well. Figuring out this coordination where its across many countries and you have to apply judgment which of these are the ones to go for, theres over 100 different efforts and, you know, some are being championed by the country that theyre in. So were within a few weeks of having a clear construct for prefunding manufacturing plants. Bill gates, youve wrote this great paper thats about 16 pages and a worthwhile read for everybody. You talk about these pcr machines. The machines that would test the swabs and shortage of them and something you wrote caught my attention. You said there will be a temptation for companies to buy testing machines for their employers or customers. A hotel or cruise ship operator would like to test everyone even if they dont have symptoms. They want the pcr machines that give quick results or rapid diagnostic tests and the companies can bid high prices well above what the Public Health system would bit. How do we prevent this from being a bidding war where only those who can afford it get the testing and the rest of the world sits around and wait. The things im most surprised about the federal government response, the unwillingness to get involved in test priorization is the most amazing. You know, other countries who wrote their pandemic plans, the idea of getting the pcr capacity up and making sure its going to the right people with quick results, that was their day one thing. And it shouldnt be that hard. Still to this day we have pcr machines that arent being used that well. Understanding the bottleneck. Our foundation is driven the work to get the front end, the swabbing greatly simplified so you can actually have cheap swabs you can have out everywhere so as soon as you feel symptoms, you can get the swab, take it and then send it in to have the pcr machine test it. Today a lot of the tests you get the results so late or its the wrong person being tested. So our capacity when people look at the numbers, the u. S. Is the worst at tests prioritization and if were not careful, it will get worse because of course, people want to an employer wants to make sure nobody is coming in and infecting people so if we had infinite Testing Capacity, hallelujah, go ahead and test asymptomatic employees every day but that, you know, we have 330 Million People in our Testing Capacity is under 200,000 a day right now, and so, you know, you cant test a meaningful percentage of the population even in, say, a week. You cant even do 1 or about a third below that. So its kind of in the same that were not prioritizing the Testing Capacity even as it grows to go to the right applications. Maybe, bill, i can follow up on that question, which is you in your paper that ali referred to, you are advocating testing symptomatic people. Some of us like myself and others have recommended testing people who are trying to find asymptomatic spreaders who really meet with a lot of other people because we think thats the most serious threat and the most serious way that we might spread the disease. Why do you think testing symptomatic people is should be our top priority . Well, there are asymptomatics who have antibodies. Thats being vastly over stated in most cases because of false positives. All these tests shouldnt be a b value. Pcr gives you the ct value and what you see in asome evymptomas reduced viral load and they show about 6 of the infections coming from asymptomatics. We need to understand the role of asymptomatics in that because the degree to which you can open up is greatly affected by how much of the force of infection comes from people who would never seek out a test, but we dont have unless there is a breakthrough and were working on a pefew, we dont have the ability to test asymptomatic. We need to understand a statistical sense, understand these sources of infection but where thats been done like the singapore study was the best on that, its not a huge percentage in this case of the infections taking place. So i want to switch now to talk about treatment for a second. And in your white paper you released yesterday, you have a sentence that struck me as interesting. You said we need a treatment that is 95 effective in order for people to feel safe in big public gatherings. Im a little curious how you got to the 95 and what do you think is a timeline to get to any kind of treatment that the going to be 95 fe effective to give peop confidence going out in public is a good idea . Well, people have a mental model about, you know, fear of death and what things they particularly worry about. Some that are statistically modest like airplane crashes loom larger, some like car crashes that are greater. You know, in the extreme you could say we dont when we have flu, which is often, say, 40,000 deaths a year, we dont close schools in a typical flu season. We dont empty the football stadiums. And so if you take the extreme case where you really are letting the infection spread throughout the population and yet, you have the therapeutic that greatly reduces the deaths, how much below the seasonal flu level would you have to get before it isnt the dominant thing affecting peoples willingness to travel and do activities . So i dont know what that percentage number is, but there is some level at which people realize okay, even if you let the growth take place, the bound of what is at risk which without the therapeutic 1 death rate would be 3 million in the u. S. Alone, you know, if you got that down to typical flu season levels, you know, would that, you know, encourage the idea that okay, Economic Activity is appropriate. All right. Well have more of our conversation with bill gates coming up this hour including his reaction to states like georgia beginning a partial reopening today and the pressures that President Trump is putting on those states. Well examine the question as well of when the nations children are going to be able to go back to school and zeke is going to explain one of the coronavirus treatments that are under development that is offering some promise, life in the times of coronavirus. Well be right back. S of coronas well be right back. I just love hitting the open road and telling people that Liberty Mutual customizes your insurance, so you only pay for what you need [squawks] only pay for what you need. Liberty. Liberty. Liberty. Liberty. Does that mean they have to grow apart from their friends, or from the things they love to do . With right at home, it doesnt. Right at homes professional team thoughtfully selects caregivers to help with personal care, housekeeping, meals and most of all, staying engaged in life. Oh, thank you, thank you. Youre welcome. Are you ready to go . Oh, i sure am. We can provide the right care, right at home. Welcome back to life in the time of coronavirus. Im here with dr. Zeke emanuel. We heard from bill gates about the hunt for a treatment that would work for 95 of the population. Now zeke, there is one idea of a treatment that comes from the blood of people whove had the virus and recovered. Its called convalescent plasma and ill show you how it works with some of our images from our good friends at bio digital. Lets remember how the virus works. Using the spike protein on the outer shell of the svirus, the coronavirus enters a healthy cell in your lungs through a receptor and it then hijacks its machinery to replicate. From there your experience depends on part in your immune reaction and any under lying conditions you may have. Though we just passed 50,000 deaths in the United States, the vast majority of poi shaenatien the disease will recover. When they do, we hope they will to ses antibodies and other key immune molecules and cells that are specifically built to fight the coronavirus. These antibodies can be safely donated and potentially used to help other patients with coronavirus. For that, we extract the convalescent plasma from the patients. The process is like giving blood but with a twist. Whole blood which contains red blood cells, white blood cells, antibodies and molecules is drawn from your arm and immediately put into a center. The spinning causes various cells and molecules to separate. Everything but the plasma is sent right back into the body of the person who donates. The plasma eventually goes to a patient sick with covid19. Now different anti bodies are targeted at different proteins. But the ones for the coronavirus know their mission. They attach to the spike protein on the outside and that prevents the virus from binding to the receipt tors on your healthy lung cells. So the antibody may tag the virus for targeting by the big guns that are killer cells fr