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tv   QA Dr. Siddhartha Mukherjee The Coronavirus Pandemic and the U.S. Response  CSPAN  July 5, 2020 7:59pm-8:59pm EDT

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journal. every day we are taking your calls on news of the day to help discuss policy issues that impact you. coming up monday morning, director of the george mason university center for vanity project will discuss how the coronavirus pandemic is impacting cities. alzheimer'sof the association will discuss how covid-19 is affecting nursing homes and alzheimer's patients. watch c-span's washington journal live at 7:00 eastern monday morning. and join the discussion with your phone calls, facebook comments, text messages, and tweets. [captions copyright national cable satellite corp. 2020] [captioning performed by the national captioning institute, which is responsible for its caption content and accuracy. visit] announcer: next, physician and pulitzer prize-winning author siddhartha mukherjee talks about the u.s. response to the coronavirus pandemic, and the medical science that is being used to combat it. at not :00, prime minister's questions from the ridge house of commons with boris johnson. after that, from today's
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washington journal, lincoln scholar and author discusses the national debate over removing confederate symbols and monuments. ♪ >> all of the decades that i have been involved in chasing infectious diseases, i have never seen anything that is so protean to -- there's no other infectious disease that goes from 40% of the people having no symptoms, to some having mild symptoms, to some having severe, some
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requiring staying at home for weeks, someone going to the hospital, some getting intensive d,re, some getting intubate some getting ventilated, and some dying. so depending on where you are in that spectrum, you have a different attitude for this particular thing. but anyone who gets infected or is at risk of getting affected, to a greater degree, is part of the dynamic of the dynamic process of the outbreak. susan: that is dr. anthony faucher discussing the various outcomes so far of covid-19. yousiddhartha mukherjee,m won the pulitzer prize for a book on cancer. how is covid-19 shaping up as a biological foe? prof: mukherjee: as dr. fauci described it, it is a protean -- are -- in the long span of
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human history we have just basically encountered this novel coronavirus. and we are still learning things which are really fascinating, somewhat counterintuitive, things we have not thought about before. i'm an oncologist but really my training is an viral immunology. virology arees of very familiar to me. i would echo dr. fauci's opinion on this. in my lifetime i have seen influenza pandemics in mumabi. i saw from a distance, sars. i worked on influenza is a graduate student. i have never seen anything like this. the strain features of this virus are truly something that are out of the ordinary. how do strange creatures
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affect our ability to conquer it? prof: mukherjee: let's talk about these strange features. the first strange feature is the degree of asymptomatic and pre-symptomatic their ears. you might be -- carriers. you might be walking in the community, and there might be someone in a closed space or closed environment who is not really symptomatic but is carrying the virus. -- you may get some somatic days after. some of them do not even have. they have extraordinarily mild symptoms. so that space is actually challenging because you cannot simply isolate and contact trace these people based on symptoms if they do not even have symptoms or they are pre-symptomatic. that means the only thing that will work if you are in close proximity with them in a closed space, the only thing that will
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really work is masking and social distancing. so that is one feature. the second feature is we don't know what the relationship is between why some people seem to get infected and some people don't seem to get infected. there has been a series of extraordinary reports. the one that struck me the most re-strain, that p i read from a crew that went to the antarctic. on that crew, one person was infected to start with. they were isolated to the best of their ability, but unfortunately the virus is extreme he contagious and it spread. and if i'm remembering the numbers correctly, 50% of the people on the cruise got infected. here's what is interesting about it. there were couples sharing the same room in which one couple, one of the couples infected,
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while the other was not infected. in a closed travel space, for reasons that we still do not understand, we have now accumulating evidence that some of this may have to do with previously existing, cross-reactive immunity against other coronaviruses. that could be one explanation. that is probably not the only other expo nation. there are -- probably not the only explanation. three is, how much virus is required to have an infection. so, i wrote a piece in the new yorker, which i would encourage people to read, called how kona run a virus -- how coronavirus acts in the patient. there's a relationship between the dose of the virus you receive and the chance that you will get infected, and also
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potentially the severity of the disease you have. it's a dynamic battle between your immune system and the amount of viral exposure you're getting. which is again to emphasize why it is important to reduce that viral load, and to reduce the viral load, as i said, masking, social distancing, and the three c's. avoid close spaces, avoid close contact, avoid crowds. that is yet another conundrum. now let's get to the facts. when the virus is actually in your body, it of course affects the lungs. we knew that. it seems that the virus, the infection really has two phases. phase one of the infection is when the infection is being driven primarily by the viral infection itself. are is when your lung cells being destroyed, and you may
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have a fever, you may have chills, and the famous loss of smell, loss of taste, loss of appetite, etc. but then that moves to, in some patients but not all, we don't know why, but in particularly men, it moves to the second phase of the infection where it is being driven by the immune response to the virus, and to dead cells that are accumulating. that phase is very dangerous because your air sacs fill up debris,unological debris from dead cells, and fluid, inflammatory consequences of the virus. so, why this virus haze in these two phases -- behaves in these two phases is a mystery. there are two or three other
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mysteries i would like to highlight. then comes the question of what else the virus infects. it turns out the infected or the virus uses on human cells has been identified. the major receptor has been identified. the virus, for reasons that we do not understand, causes a diffused set of symptoms. i will name some of the symptoms. in children, in a small number of children, it causes an autoimmune disease of the blood vessels and the arteries. calledmilar to a disease kawasaki's arthritis. thoseis virus is causing symptoms, we do not know. but yesterday there was a big case report of all these children. it has also become clear it causes a state in which your
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blood tends to clot more. this blood clotting can lead to strokes, it can lead to cardi at attacks, it -- to cardiac attacks, it can lead to blood clots being spread to various parts of the body, including the lungs, where it can be life-threatening. and just to make one last point, we still do not know what the long-term consequences of the infections are in people who survive. so, let's say you do recover hopefully from the coronavirus infection, and let's say you have a severe infection. what the long-term effects are. people are finding kidney problems, arthritis problems. some of these may or may not be related. some may be related to the fact if they went to the icu. right up from exposure to the end of the disease, a series of truly interesting, and
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devastating things that we just did not understand. we are beginning to understand some of it. as i said, i gave you some clues as to what we are understanding and what we are not understanding. as we understand each of these phases, it' importants to recall that different interventions will work in different phases. so obviously once you are in the worker'shealth care need to be protected from you in terms of viral exposure. but depending on what phase of the infection you are in, the so-called virological phase in which you have exuberant viruses -- the medicines that work for one do not work for the other. antivirals like remdesivir and new antibody cocktails from several companies, they are
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likely to work and we know they work based on good trial data in that first phase of the infection when you want to kill the virus. but these have no effect whatsoever in the second phase you had that inflammatory. there, it's anti-inflammatories such as steroids and a bunch of other medicines that seem to work, where is the antivirals do not seem to be doing much in that phase. i would say that we are involved in two or three projects to address both phases of this infection. susan: so, as complicated as this is, it sounds like really only time, lots of its peer mentation, and a lot of infirmity -- lots of experimentation is key to understanding and attacking this disease. prof: mukherjee: and i should that this -- i have not seen spirit of collaborative
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within the scientific community of this ilk or stature in my life. that is very encouraging to me. things have moved as fast as it can possibly move. we will have, hopefully by the end of this month, two to three, to maybe four potential drugs including antibodies that will attack the virus. they are still in studies as to whether they work or not, or what settings they work on. and we will also have four or five or six new modalities to treat the inflammatory phase of the virus, including, as i said, steroids, but also protein-based ares and, in my cawsse, we experimenting with a certain kind of t cell called regulatory t cells. so, this is moving as fast as we
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can. of course we will have to wait for the vaccine, and optimistically, i think most people think that will take about 15 to 18 months. susan: focusing on the united states, we are talking at the very end of june here, and at the moment there are 2.6 million cases known in the u.s., 120,000 on --, and deaths are excuse me, cases are on the rise in as much as 29 state. how would you assess the u.s. response to this virus? prof: mukherjee: again, i would encourage people to read a very long piece dissecting some of this that i wrote for the new yorker called what coronavirus has exposed about american medicine. through piece by piece by piece every step of the response. i think it is, despite best efforts, i must say that the initial response in the united
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states was abjectly problematic. --annot describe to you the what might have happened if we had taken faster and more decisive action against the virus when we knew that there was a pandemic brewing in china, cases were knew that already spreading into parts of europe, including spain and italy. crucial mistakes were made during that time. two examples. the lack ofwas testing in the early phases. now it is extremely late, but in the early phases, testing and isolation, strategy that worked in wuhan and more recently in beijing, could have worked and
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would've worked if the number of cases had been low. there was a 42 day delay. i am going to report that. there was a 42 day delay from the day that the first coronavirus patient appeared in ar seattle and washington state, to the day that commercial testing for the virus became available. 42 days in the lifespan of a highly contagious virus may as well be a century, because by that time, people have taken flights, people have moved all around the united states, and parts of the original virus were spread all over. that is one example. the second example is that the cdc and other authorities made what i think was a crucial error in not asking people to isolate, mask, and maintain social , evencing as soon as while the tests were being made.
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ad secondly, in particular, particular tragedy is that we were desperately unprepared not just for testing, isolation, quarantine, but to give health-care workers, particularly front-line workers, sorry, not the- ppe, but the n95 masks, which truly do protect against small aerosol particles. we saw many health-care workers die in this pandemic, and i feel extraordinarily sorry for them. but at the same time, encouraging the public to avoid ,", three c's -- crowds close -- wearing it early in the pandemic and mandating that would have
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been a successful solution. we have now, i would say, strong to sufficient data to suggest that that strategy works. of course it does not work 100%. no one expects it to work 100%. but in virology and epidemiology, the reduction of spread of a virus from one person infecting five people, to one person infecting less than one person, in other words, driving the infectious spread, is of great consequence. so you do not need a strategy to work 100%. all you need to do is to decrease that famous number of -- the or the are not rnaut. there are two pieces of good news. the number of deaths in the united states has actually tapered off and is plateauing
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and is showing signs of decreasing. i do not know why. again come it is a mystery. -- again, it is a mystery. this is the absolute number. i did not -- i do not know why. they are taking better care of patients, there is more awareness, less spreading because of masks, etc.. but the number of deaths is decreasing. but as you know in places like houston, dallas, florida, arizona, the number of cases is increasing. most datas - most -- it would suggest it is because we are doing more testing. of course if you test more, you will find more. but the majority of data shows it is also because the infection is increasing in its spread. so i would not rest on laurels, although there is good news. i would not rest on laurels.
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i would continue to watch, because the wave of deaths usually is about two to three weeks after a wave of infection. susan: you mentioned masks several times. i want to show you a clip from very recently in a congressional hearing of a debate between the chairman and a member about the wearing of masks. let's watch. >> we have to be consistent. and if you say i want you to wear a mask, i will wear a mask. you are the chairman of the committee. but i want us to make decisions paste on sound data and information. >> yes sir, i will. >> are you arguing that we should not meet in person? >> no sir. not at all. >> sounds like it to me. because there is no certainty. the masks may not work. we know how the disease is transmitted. mask has a low probability of working. maybe we ought not to be meeting in person. >> if you are asking me my
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clinical opinion, my opinion is that patients who are at high anyonetegories, those -- 65 years or older, with comorbidities, should wear a mask. if you don't, i am telling people in tennessee, it not required. susan: that member is also a doctor. the chairman is wearing a mask. my question to you is the debate over wearing masks is happening in the halls of congress. are we surprised that people nationally are at odds about wearing a mask or not? prof: mukherjee: well, i am disappointed in the sense that i do not understand -- i really, really have a hard time understanding why this is such a major issue. sides inion by both that debate were absurd questions. the first question is you
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suggest we stop meeting. no one is suggesting that. meet, wear a mask while the mask is happening. you can communicate with perfect fidelity. it is not the most comfortable thing, but being infected by a deadly virus and ending up in the icu is not the most comfortable thing either. so the line of questioning is absurd. the second thing that is absurd about the line of questioning is we cannot run a randomized trial of masks versus not masks. although some have been run. but right now we cannot run easily randomized trial of asking, sequestering half of the population, asking have to wear masks and half not to wear masks, for lots of reasons. some ethical, and some logistic. in therwhelming evidence scientific community suggests
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masks work. they do not work 100%, but like i said, in order to reduce the virus, you need to decrease the so-called rnaut of b virus, which is the -- of the virus, which is the amount of the virus spread from one person to another. if you make absurd strawmen then it is -- work 100% so i am not going to wear one, that is an absurd strawmen. again, the idea is to decrease the load of infection by a person who is symptomatic or pre-symptomatic, and it is simplified by the fact that the wearer who may not be infected was also protected. so if you ask absurd questions and say masks do not work 100%, should we stop meeting, this is not the mechanism -- all of
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which are factually incorrect -- then you will get absurd answers. we should have a consistent, simple, mandated policy, and i have encouraged over and over again for the president to lead on this. we should have a simple policy that applies across, and governors should apply that policy. still have a long way to go before this epidemic abates, and the last thing that we want to do is to have inconsistencies from people about this. especially, the troubles that you have to go through to mask yourself in a closed, credit space where you are having contract -- contact, is minimally tricky.
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sometimes we have to make decisions based on evidence wher patientcumbrance to the or to the user is minimal, and the potential gain is there, and may be quite large. we err on beside of caution. and this is one example of airing on the side of caution. -- of erring on side of caution. there are many things where we can say, gosh, a seatbelt is an affront to my liberty, i am not going to wear a seatbelt. but we have mandated the wearing of seatbelts. so similarly, i do not think it is a far spread to mandate the wearing of masks. and of course if you have a medical condition that is not about you to wear a mask for whatever reason, then you may in exception to that. susan: so in states where the incident rates are rising are
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generally the states that have opened up their societies. i know you are serving on governor cuomo's commission on reopening the economy in new york state. can you talk to us about new york city, and as it opens up, and how you prevent it from worse,g like houston, or like beijing has experienced? prof: mukherjee: again, i think what is going to happen is the best case scenario that i think will happen in new york city is that we will open in phases and watch every phase. the good news right now is that i think to the extent possible, phase one is going well. i was just outside. virtually every person who is entering a store is wearing a mask. legal immunity for a store worker to deny a person not wearing a mask entry to that
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store if that store owner can so decide. that is, i would sayu after a very long period in time we are seeing a dramatic decrease of deaths in our icu. work is slowly resuming. i think the way to move forward is due next ask the question, at what phase are states opening? the particular concern is schools, restaurants, and bars. i would say we have a very crucial three month window when public schools will be naturally closed. it is during this window of time when i think we have to act very decisively, and to bring that asut tdown to as low
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possible. what will happen at the end of that period is i think what will happen in places like beijing and south korea. there will be local outbreaks. there will be look up breaks, because you can never -- local outbreaks, because you can never predict where things will come. they will have to be contained using a combination of isolation, contact tracing, and potentially the use of prophylactic medicine to prevent the virus from going, and prevent people from expelling that virus into other people's respiratory symptoms -- systems. has ad add that new york particular special challenge which many cities don't, which is that we have a very busy subway system. the subway system is the lifeblood of the city. we have to keep it open and functioning. the only way to keep it opening
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and functioning is, again, masking, hand hygiene, and limiting the number of people -- limiting the crowds of people that are coming in. so it is a long road ahead. phase one is moving as well as it could. there has not been agenda -- there is not been a gigantic spike so far. phase two will be a big challenge, but we are moving toward it. susan: i want to spend a bit of time on genes and covid-19. folks will see your book will be her shoulder and you recently finished a book -- a documentary with ken burns. covid-19, decoding of how has it advanced our understanding of the disease? prof: mukherjee: it was absently crucial because without the teste, the covid-19 swab is based on the covid-19 genome. covid-19's genome to figure out how to test it.
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essentially it is detecting the secretionse virus in from the nose. genome, we could not have devised that test. that technology relies on genetic technology that has appeared over the last two decades. he was one of the fastest genomes to be sequenced, and therefore led to tests. ofondly, the production virtually all the antibodies against covid-19 relies on genetic engineering technology. so if you want to make an antibody against the protein the virus uses to attach itself to cells, so that you can block and
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potentially clear an antiviral drug, the production of that antibody requires dna technology and other technologies that rely on the last 50 years of genetic research. and finally, to determine why some patients are more susceptible than others, what is the receptor that the virus attaches to any cell, why we are having complications such as the one that i told you, the blood clotting applications, etc. -- complications, etc., all of these require widespread genetic technologies. so there is, no, i cannot think of one arena of virology for covid, starting from the antibody test, contact tracing, all the way to the production for new medicine, for as is aid, both phases, i cannot think of
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any one of those which has not been affected, or not been progressed by the 50-odd years during this time we have been looking and examining an understanding how genes work and how to sequenced them and how to understand them. susan: i'm sure people have read that viruses can mutate. so how do researchers keep up with those mutations? prof: mukherjee: again, we use genetic technologies. we sequenced the virus and try to identify with the mutations are. you can use the sequence of the virus to figure out where the strain is coming from. strain, anopean asian strain, an american strain, the spanish strain? once again, you use the technology that has really emerged from the last 50 years of genetic sequencing. susan: you talked about therapeutic medicines.
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is the understanding of the gene necessary to the development of a vaccine? prof: mukherjee: absolutely it is crucial to the development of a vaccine. i do not want to push things that i write, but those other ones i am most familiar with. on theany, many pieces coban vaccine that should be read. there are many, many pieces on the covid vaccine that should be read. those vaccines are hard to make. they are hard to scale, i should say. they are easy to make but they are hard to scale up to hundreds of millions, of to billions of doses. because in order to produce them, you have to produce a live virus. virus, you weaken the which was done in the case of polio, you run the risk of some
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patients getting infected by the virus because it has not been completed or there is a batch problem. on geneticends less engineering technology. new generations of vaccines that we are producing are basically dependent on genetic technologies, and i will tell you some of them. there is one platform for making vaccines that depends on taking some covid proteins and stitching them genetically into the backbone of a homeless virus -- a harmless virus that causes a common cold does not replicate. using genetics, that virus has exceptstly inactivated for making the body react in making antibodies. so that is a platform, and in
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byt virus is in trials oxford university, by jnj, and by several other countries using that technology to deliver the viral protein into the cells. there is a third platform for viruses, i am not going to go into all of them. the rna from the virus, that is a genome of the virus, or part of the genome of the virus, coats it with something to deliver it into cells, and that is the basis of the mode during a vaccine, with -- the moderna vaccine. all three of these technologies aside from the extenuating viral strategy, these modern vaccines are cleaner, easier to produce,
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safer, and they all depend on genetic engineering technologies that have emerged from the last 15 years. thalberg won the nobel prize for figuring out how to stitch two pieces of dna and a piece of the covid virus that will not -- paul, becausenow these technologies invented in the 1970's and 1980's have now become commonplace, they are widely usable, and they can be used to make these vaccines. a proud moment for science if we make a vaccine in this new way, this new genetic vaccine. susan: you recently moderated a panel that brought people from a number of different disciplines together for the new york times. what did you learn through that conversation?
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prof: mukherjee: let me just remind you who was on the panel. i moderated and led the panel. hamburg wasg, dr. the former fda commissioner. baroque --, dr. dan i should say dr. for everyone, because everyone has a phd. virologist at a harvard, and one of the leaders of the production of one of these genetically modified vaccines. of a company head called regeneron, which has taken the lead in making therapeutic antibodies against covid-19, and just published a major paper in science showing
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that it works in animal models. dr. susan rice is a coronavirus expert. she has worked on all es,-- on all coronaviruses. did i miss anyone? five people. the important thing i think that we learn from that, many important, pieces of information. everyone had an important perspective in all of this. i think there are two messages that stand out. or i should say, there are three messages that stand out. vaccines do not magically appear out of nowhere. they take time to develop, and the safety bar for vaccines is extraordinarily high, because we
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are giving the vaccine to people whoare otherwise not -- otherwise wwell. so -- well. so, the safety bar is enormous. vaxxeris a big anti- universe and there is a lot of suspicion about vaccines. which is all the more reason to make sure that once he vaccine does appear and is proven to be safe, and is safe, that we actually vaccinate people against this deadly, deadly disease. the second thing that we learned is that because there is some time, most people say 16 months, 18 months, 12 months, if everything goes well and on schedule, we have to do something in the meanwhile. what do we do in the meanwhile? we bring things right back to where we started. we mask, we isolate, we try to
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persuade our governors not to be cavalier, as i think many governors have been, and thereby responsible for an increase in hospitalizations and potentially deaths. lethal,valier about a deadly infectious disease, you know, these governors have really answered for themselves. what is the evidence that allowed them to be as cavalier as they were in opening up, for instance, bars, restaurants, and other closed, credit spaces, -- crowded spaces, where infection was inevitable? so i am extraordinarily, extraordinarily disappointed in the cavalier attitude any politicians -- many politicians took to this. so what do we do? we talk about we go through
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protection measures, but also best medicine. but weot have a vaccine can put medicines in trial. they can include antivirals such as remdesivir, which is not a great drug, at least up to now, but it does work. and it is now being moved into further trials, combining it and making it into a cocktail so that potentially the drugs will work. vaccines.dies are not these are man-made antibodies that give you one-month immunity potentially, and may be able to treat the early phases of the viral infection. those are being made and are in advanced trials. regeneronust saw that went into phase three trials. other companies are also moving to phase three trials. what other medicines work?
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asl, there medicines such drugs that will lock the immunological response. in fact, i am involved in two or three such efforts. company thatcit a found a cofounded -- we mechanism to elicit a response against covid-19, and that is in early trials at duke university. that is a company called myeloid. another one that i collaborate with, i use it, regulatory t cells. these are t cells to dampen the immune response. there are new drugs including a drug from cuba. and i should say, for full
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disclosure, i am collaborating for it. am an advisor it's in trial for the inflammatory phase of the virus. that is the second thing. this is not a time to sit back and relax. this is a time to actively put into trial medicines that we have invented or others have invented that work, or that potentially can work on covid. the final and the thing thing -- and the third thing that we learned is that having a vaccine is useless. being vaccinated is useful. this is a point brought up by dr. hamburg. that means that there is a fourth phase. getting that vaccine out to widespreadly and as distribution, is itself, a
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mammoth, logistical problem. like, does the vaccine have to be frozen? can it be shipped? what is the formulation? how many doses are required? will it protect the elderly? if you do all your trials in young people and you find out the most susceptible people do not raise a good immune response in the vaccine will not be useful. story,e's an entire back as it were, of not just developing any vaccine, but developing and deploying that vaccine and actually vaccinating people in large numbers to be able to get to the point that you want to get to. susan: on that last point, let me bring two voices in on the manufacturing distribution, and then we will have you comment on it. >> i think we all believe that by 2021, we will have the vaccine. we are working ahead of time with the manufacturers and with
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the pharmaceutical companies to try to actually have manufacturing capability ready to go so that as soon as those trials are finished, the vaccine can go immediately into manufacturing. and the whole reason we got involved in this vaccine was to make sure there's equitable disruption. >> tremendous -- distribution. >> tremendous progress is being made. we are ready to go in terms of transportation and logistics. we have over 2 million ready to go if a check suffer safely. susan: there we have both the federal government represented by president trump, and melinda gates, private philanthropy, involved in setting up dissipation. will it take globally accommodation of public and private resources to do this equitably? prof: mukherjee: i think that is very likely to be the case. thathing to remember is data from new york city suggests
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and clearly that minorities frontline workers are disproportionately affected. -- the to be able to word you use is very important -- we need to have equitable distribution and vaccination. we need to ensure that people who have generally not been included in health care are included in vaccinations. and i do not doubt that a public/private enterprise will be useful. susan: we have 15 minutes left. global public health experts of raised the alarm that the focus on covid-19 has depressed the immunization of diseases such as polio around the globe. what will be the overall effect on public health of that outcome? prof: mukherjee: unfortunately, it will be doubtless unfortunate. have been urging and
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continue to urge people to seek andcal care for diseases, continue their vaccinations. timeok a long, long, long to vaccinate and ensure immunity against these deadly diseases. and to give up now, it would be a terrible thing. so as long as these vaccines can be given in places that are safe, and we really need to think about ensuring that those places are safe, that vaux -- both the vaccine giver and recipient does not get accidentally infected by covid, and re-insuring people we are taking the best possible precautionary measures is important. it would be a terrible thing to have a vaccine against covid and realize that we are losing ground against diseases such as polio,measles, rubella,
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and other diseases we have vaccines for. susan: here in the u.s. where the diseases have been mostly eradicated or contained, we have seen impressive statistics on the amount of care for emergency rooms or medical care that americans have been taking over the past five months. what specifically has been the effect on your field, your specialty of cancer, over this time? prof: mukherjee: let me say one thing before you say that. let's not be cavalier about in the united states that these diseases are on the backswing. we know of communities where vaccination was not appropriately used, and there were outbreaks of measles. i mean, in the united states. so i would just advise people to not be cavalier in the u.s. and think we live in a safe environment, and therefore vaccinations are more optional or little more -- so let's remove that
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misconception. now let's talk a little about cancer. we have tried our best to make sure that the cancer care that we have been giving patients on gone on, or will go with the least amount of disruption and interruption. now, that's virtually impossible. so what has happened is that there's been a strong degree of prioritization. openingile, we were not new clinical trials, which was obviously a difficult delay. nowre up again, so we are reopening clinical trials. but for the routine care of tried patients, we everything we could, including testing them before and after we reopened testing facilities to
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make sure they were not infected. as you know, many of these patients are immunocompromised. and i am proud to say that most at leased we avoided, at columbia, we avoided most of the cup occasions of covid in immunocompromised patients with cancer, and we have mostly avoided interruption of vital anyer care, and obviously less urgent surgeries have been pushed back in the relevance of safety. but we are now slowly entering a phase and the trials are open, patients are back, infusions are occurring on time, testing is widespread, and the number of deaths that people experienced beencovid have not disheartening. susan: will there be an impact
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on cancer research funding? prof: mukherjee: well, i would hope not. ope that if would h there is one thing that comes out of this terrifying tragedy, it is the fact that we recognize once again that science is of crucial importance. is still id still -- full of deadly, dangerous diseases that have the capacity to paralyze economies, and that a billion-dollar investment, whatever it might be, in theenings, technology, production of medicine, may well lead to trillions of dollars of savings. of money, but more importantly, of the human lives which are
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invaluable. no value can be put on the 128, that haveaths occurred in the u.s. i would hope that this would persuade congress, rather than drawing from international and rather thanies throwing suspicion at them, and rather than destroying their integrity and their funding, it would in fact increase funding. and that would be felt all across the world. by way -- by the way, i should give you one example. the covid-19 vaccine platform for t cell immunity that i am working on with a company called myeloid, with full disclosure, was initially devised for cancer . we re-adapted that, because we realized he could very rapidly induce a response, a t cell
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swift t cellery response, and that may be very crucial for vaccinations. so that's one example in which there was a decent level of cross-fertilization between these fields. drug screening against covid depends on very much the same facilities that do drug screenings against cancer cells. are not silos.y these are very interrelated. i would imagine, and i would hope, just like genetics has -- continuation of science funding will do the same. prof: mukherjee: how do you -- prof: mukherjee: one of the major pushes of the governor's committee, governor cuomo's
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committee, is to understand and to explore the use of medicine in the future. we have made -- there's --committee a telemedicine is very much a part of that. one of the things covid will remind us all is telemedicine is one of the major ways we will proceed in the future. just to be very clear, telemedicine is not the same as facetiming with your doctor. it requires platforms, it requires platform building, confidence building, a lot of regulation. because you have to be able to bill, you have to be able to understand how the visit works. and so my own feeling is that a hybrid model will move forward, in which you combine elements with a face-to-face visit, and
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maybe that ratio -- the ratio is unclear. but we are still figuring that out. but to remind people, telemedicine is not face time with your doctor. it requires platform, integration with the existing medical system, and integration with the existing medical records. it requires a whole series of things to occur, including a series of regulations by the state and federal government that allow govern -- doctors to have a tele-visit and to bill for that tele-visit in a manner that is compatible with the rest of the practice. so that is what is happening in telemedicine. prof: mukherjee: -- susan: throughout our conversation you have emphasized the importance of data and hard research on tackling covid. but you said that in the short term, it's not the hard
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sciences, but the social sciences that are our best option. what are you saying there? prof: mukherjee: this goes right back. first of all, i should say that not --- i do not and di ad did not want to make distinction. the hardest sciences and the harder sciences. by social sciences i merely meant behavioral change. one of the things covid has pointed out is we need widespread behavioral change, we need widespread trust in science. behavioral change is one of the hardest things to enforce or connect. just to give you one example from my own field, we knew that cigarettes caused lung cancer in the 1950's and 1960's. but it was not until the 1980's
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and 1990's through a series of behavioral changes, federal and state intervention, as well as a social, cultural alterations, that we really began to see, in this country, a the motion of smoking, especially by young people. i do not of all, iloieve that there's a s between the hard sciences and social silences -- sciences. what i meant is to be able to address what is going on with covid, we very much need to understand how people behave, and what the limits -- how to change that behavior. the same with telemedicine. telemedicine is, on the one hand, a software platform, but on the other hand it is a behavioral platform. people have to be able to use it. what prevents them from using it? why are patients reluctant or not reluctant? are remaking their lives easier
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or harder? vaccine,ibution of the how to get a vaccine out to billions of people, and how to vaccinate them, is a combination of biological sciences, the making of the vaccine, as well as the distribution and campaign around the vaccine. is not ae it that this hard science, soft science distention. it is a distinction between what i would say laboratory science and field science, both of which are really hard. susan: we are out of time. as we close, we want to encourage people to find the new yorker article you referenced about covid-19. if they would like to see other of your work, your books. thank you for so much for spending one hour with me. prof: mukherjee: thank you so much. ♪ [captions copyright national cable satellite corp. 2020] [captioning performed by the national captioning institute,
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