In this episode, we talk with infectious disease epidemiologist Dr. Michael Frieden about the devastating toll from the new outbreak of the H1N1 virus in China, and the implications for the spread of the virus around the world. We also talk about the potential link between the virus and the aging population, and why we should be worried about it. And we talk about what we can do to prevent it from spreading, and what we should do about it if it does. This episode is brought to you by the Center for Infectious Disease Research and Policy at the University of Minnesota and the National Institute of Allergy and Infectious Diseases at the National Center for Immunization and Vaccination. Our theme song is Come Alone by The Weakerthans, courtesy of Lotuspool Records, and our ad music is by Suneatersound. We are produced by Riley Bray. Music by PSOVOD and tyops. Additional music by Zapsplat and the Electric Light Orchestra. Thank you to our sponsor, Caff Monster Jam! and our patron, Dr. John Rocha, for making this episode possible. If you like what you hear, please leave us a five star review on Apple Podcasts! Subscribe to our new podcast, Rate/subscribe in iTunes, review us on Podchaser, and tell a friend about what you think of the episode and share it on social media! We'll be listening to it on Anchor.fm/AskAmy, and we'll be looking out for you in next week's episode on the next week on PodChad, and other places you care about the episode of the podcast. . Thanks again, Amy, too! - Amy, Amy, John Ralden, John Casperson, Sarah, Sarah, Caitie, and Michael, Michael, and Sarah, Jack, and Jack, John, and Mike, Mike, and so much more! -- Thank you so much, John, the PodCharity -- thank you, Mary, -- Sarah, Mike, etc. -- - Thank you, Michael, Sr. and Joe, Sr., Sr. & Joe, etc, etc., etc., , etc. etc. -- etc. & so much so much & so on and so on, etc.. etc. Thank you for listening to this episode.
00:00:12.000I'm, for a lack of a better term, a medical detective.
00:00:14.000I've spent my whole career tracking infectious diseases down, trying to stop them, trying to understand where they come from so we can make sure they don't happen in the first place, but most of all, trying to respond to situations just like this.
00:00:37.000Well, first of all, you have to understand the timing of it in the sense that it's just beginning.
00:00:42.000And so, in terms of what hurt, pain, suffering, death has happened so far, it's really just beginning.
00:00:49.000This is going to unfold for months to come yet, and that's, I think, what people don't quite yet understand.
00:00:55.000What we saw in China, I'm convinced as are many of my colleagues, as soon as they release all of these social distances, these mandated stay in homes, haven't left your home in weeks and weeks kind of thing, when they go back to work, they're on planes, trains, subways, buses, crowded spaces,
00:01:11.000manufacturing plants, even China is going to come back again.
00:01:15.000And so this really is acting like an influenza virus, something that transmits very, very easily through the air.
00:01:20.000We now have data to show that you're infectious before you even get sick.
00:01:24.000And in some cases, quite highly infectious, just breathing is all that you need to do.
00:01:28.000So from this perspective, I can understand why people would say, well, wait a minute, flu kills a lot more itself every year than this does.
00:01:34.000And I remind people this just was beginning.
00:01:37.000Probably the best guesstimate we have right now on what limited data we have would say this is going to be at least 10 to 15 times worse than the worst seasonal flu year we see.
00:01:46.00010 to 15 times worse in terms of fatalities?
00:01:52.000We conservatively estimate that this could...
00:01:54.000And require 48 million hospitalizations, 96 million cases actually occurring, over 480,000 deaths that can occur over the next three to seven months with this situation.
00:02:10.000And I think that's what I can understand if you say there's only been 10 deaths or 20 deaths or 50 deaths.
00:02:15.000Just remember, two weeks ago, we were talking about almost no cases in the United States.
00:02:19.000And now that we're testing for it and watching the spread as it's unfolding, those numbers are going up astronomically.
00:02:25.000Three weeks ago, Italy was just living life just fine.
00:02:29.000Now they're literally at a virtual shutdown in the northern parts of Italy.
00:02:32.000And that's the challenge with an infectious disease like this.
00:02:35.000It can spread very quickly, and it also can affect people.
00:02:39.000I think maybe to put this into modern terms, because this is something we think of often when we think of, you know, pre-antibiotic days, you know, the old-time medicine.
00:02:47.000We have an employee at our Center for Infectious Disease Research and Policy at the University of Minnesota, and she has a dear friend who lives in Milan, Italy, and she works at a hospital there, and she texted us to this employee of ours last night.
00:03:01.000And this was an email that came out yesterday from one of their physicians in Milan at the largest hospital there, and he said...
00:03:34.000He says that they're seeing an alarming number of cases in the 40-something age range, and these are horrible cases.
00:03:43.000So we need to stop thinking that this is only an old person's disease.
00:03:47.000This is what's going to unfold, not just in Wuhan, it's unfolding in Milan, it's unfolding here in Seattle, and this is what's going to continue to rollingly unfold throughout the world.
00:03:59.000Yeah, where did this rumor come from that it's an old person's disease?
00:04:03.000Is it just because the majority of the people that have died from it so far have been older?
00:04:34.000Now, the challenge we have is that that's the Chinese data.
00:04:37.000But there are a series of risk factors that we worry about that if they overlay on this disease are going to cause bad outcomes.
00:04:44.000And we happen to be right at ground zero for one of the major ones here in this country, and that's obesity.
00:04:49.000We know that obesity is just like smoking in terms of its ability to really cause severe life-threatening disease, and 45% of our population today over the age of 45 in this country are obese or severely obese, men and women.
00:05:03.000So one of the concerns we have is we're going to see more of these, what I guess I would call, very serious and life-threatening cases occur in our country because of a different set of risk factors than we saw in China.
00:05:16.000Now, you mentioned that there's some sort of an incubation period before people become sick, they're still contagious.
00:05:23.000What is this incubation period and how do we know about it?
00:05:27.000When we call something an incubation period, we're talking about from the time you and I got exposed, meaning I was in a room breathing the air that somebody else who was infected with the virus was expelling out, I breathed it in.
00:05:39.000How long from that time period till the time period that you get sick?
00:06:35.000And this is what's unfolding here, and this is where I think it's such an important, and I said why the timing is so important, because, you know, Joe, we've really got to get information out to the public.
00:06:43.000There is so much misinformation right now, and, you know, we're going to be doing this for a while.
00:06:47.000This is not going to happen overnight, and I worry.
00:06:50.000I keep telling people we're handling this like it's a corona blizzard, you know, two or three days, we're back to normal.
00:06:55.000This is a coronavirus winter, and we're going to have the next three months or more, six months or more.
00:08:07.000In studies in Germany, which just have been published literally in the last 24 hours, they actually followed a group of people who had been exposed to somebody in an automobile manufacturing plant.
00:08:18.000And then they had nine people that, with this exposure, said, if you have any symptoms at all, contact us.
00:08:37.000And they found that at that very moment when they first got sick, they had incredibly high levels of virus, sometimes 10,000 times that we saw with SARS in their throats, meaning they were infectious at that point already, and they hadn't even had symptoms yet of really any nature.
00:08:53.000And that's where we're concerned because that's the kind of transmission, you know, I always have said, trying to stop influenza virus transmission likes trying to stop the wind.
00:09:01.000You know, we've never had anything successfully do that other than vaccine, and we don't have a vaccine here.
00:09:07.000So what's happening is that people in public spaces are getting infected.
00:09:11.000And the way you need to address that is, unfortunately, if you're older, over 55, you have some underlying health problems, which unfortunately a lot of Americans do.
00:10:45.000So do we close schools or not if we're not really spreading the disease?
00:10:49.000Because it turns out that if we close schools, a recent study done showed that 38% of nurses today in this country who are working in the medical care area have kids in school.
00:10:59.000And if suddenly we're closing schools for two or three months, who's going to take care of those kids?
00:11:03.000One-fourth of the American population has no sick leave.
00:11:06.000If we close schools, they don't get paid if they have to stay home.
00:11:09.000So when you ask what can we do, we have to really be thoughtful about what we do.
00:11:13.000Are we doing more harm than good by closing schools, for example, even though everybody will say, oh, we've got to do everything we can, or do we just tell people, you know, it's going to be limiting your contact as much as you can, and that's really about what we can do.
00:11:27.000And limiting the contact, is that really going to help?
00:11:29.000It does, because it's like putting rods in a reaction.
00:11:32.000If you don't have as much close contact, you can not transmit as much.
00:11:36.000If I'm sitting in a room with 100 people and we're kind of sharing air, the transmission is remarkable.
00:11:43.000Right here, off the coast of California, you've got your cruise ship.
00:11:46.000Cruise ships are notorious for recirculating air inside the inner cabins.
00:12:04.000Well, they can put them in quarantines of some kind if they want and follow up on them, but you're guaranteed they're all going to keep getting infected day after day.
00:12:10.000It seems like we're not really prepared for something like this, although the CDC has been telling us for a long time that we should be.
00:12:16.000You know, we are not prepared at all, in the sense.
00:12:20.000You know, I wrote the book, Deadliest Enemies, that was published in 2017. Thank you, ladies and gentlemen.
00:13:04.000And Then I showed a picture of a building in Puerto Rico, a nondescript building, and I said, this is our next big disaster.
00:13:09.000It turns out that 85% of all the world's production of IV bags, the saline that we need desperately, were made in these plants in Puerto Rico.
00:13:18.000And all we needed was one Category 5 hurricane to come through and take it out.
00:13:22.000Maria came through a year and a half ago, and the world went into a major crisis with a shortage of IV bags.
00:13:27.000Now, that was so obvious that was going to happen, and yet we don't prepare.
00:13:34.000And that's what, hopefully, this is a wake-up call.
00:13:36.000The business community hopefully will wake up.
00:13:38.000You know, one of the other things we're doing right now, Joe, this is really one of the things that has me most concerned about this whole situation is our group has been studying for the last year and a half with support from the Walton Family Foundation looking at critical drug shortages.
00:13:53.000It turns out that we identified 153 drugs in this country.
00:14:24.000If I came to you and said the Defense Department was going to outsource all this munitions production to China, you'd look at me and say, come on.
00:14:32.000The U.S. Defense Department has no more access to these drugs than anybody else.
00:14:36.000They are beholden to China for these drugs.
00:14:39.000690,000 Americans have end-stage renal disease right now.
00:14:43.000Most of their primary drugs are coming from China.
00:14:45.000And now with the shutdown, and what's happening with this, and this is what I talked about in the book why I was so concerned, because we are at risk.
00:14:53.000So even this situation unfold, it's not just about what the virus does to you, it's about what the entire system is rigged up to be, and what this virus does once it gets into it.
00:15:21.000Sorry, let me ask you something about sauna use.
00:15:24.000One of the things that I read was that if you are in contact, that 20 minutes in a sauna, in a really hot sauna, is very good for killing some of the virus.
00:16:11.000So what happens is just from the time you breathe it in and what you mix it with the air there, it's kind of like taking a cup of hot water and putting it into a bathtub of cold water.
00:16:21.000And so what happens by the time you get done, it's not that hot.
00:16:24.000And so in this case, your lungs couldn't stand even 110 to 20 degree heat without causing real severe damage.
00:16:31.000And so it doesn't kill the virus at all.
00:16:33.000So the virus would have to be just in your mouth or something like that?
00:17:10.000In other words, you have so much air in your lungs already, when you breathe out, you breathe just a little bit of it out, and each time you bring more in, out, in and out.
00:17:17.000And so when this mixes in, the hot air like that, or the very cold air, you know, in Minnesota, when you're 45 below zero, we have the same problem.
00:17:25.000You know, when we breathe in, it may feel cold.
00:17:27.000And so it's just, there's so much in there that it mixes with the other air, and it ultimately doesn't, the temperature of your lungs don't change.
00:17:33.000Even if you're doing some crazy deep breathing exercises where you slowly exhale all the air out until there's nothing left and then breathe it all the way in?
00:18:23.000And let me just give a little bit of background more to my career.
00:18:26.000Back in the early 1990s, I got very involved in the whole area of biodefense and bioterrorism, biowarfare.
00:18:34.000It turned out I was involved with helping to interview and get information from some of the Russian bioweaponiers.
00:18:42.000After the wall fell and Russia collapsed, we had all these experts coming out who had been spending their whole lives making bioweapons.
00:18:49.000And it became very clear to me this was really a serious challenge.
00:18:52.000And as part of my work, I spent a lot of time in this area, and I actually, through a series of serendipitous events, became a personal advisor to His Majesty King Hussein of Jordan before he died on this topic.
00:19:06.000I wrote a book that was published on 9-11 of 2000 called Living Terrors, What Our Country Needs to Notice 5, The Coming Bio-Terrorist Catastrophe, and I think I bought 8 of the 12 copies that were sold that year afterwards.
00:19:17.000And then when 9-11 happened, of course, then it became really prominent.
00:19:21.000And then I went on to serve on a group here in the United States that was basically the National Science Advisory Board on Biosecurity Safety Issues.
00:19:28.000So I've had a lot of experience in this area.
00:19:31.000And so I bring that to the table and I tell you there is no evidence whatsoever that this is a bioweapon or that it was accidentally released from the Wuhan lab.
00:19:39.000Today, with the genetics we have on these viruses and how we can do testing, we can almost date them, almost like carbon testing.
00:19:46.000You know, so radiocarbon and you want to know how old a block is or something like that.
00:19:51.000This thing clearly jumped from an animal species probably the third week of November to humans.
00:19:57.000And pangolins, you know, these scaly, anteater-like animals, are a very good source because we have coronaviruses just like those in these animals.
00:20:07.000So, you know, we've surely had a lot of challenges with that, but I don't believe that there's any evidence linking those to, one, an intentional release or an accidental release, or that it's an engineered bug.
00:20:18.000My friend Duncan and I did a show back in 2012-ish, somewhere around there, with Sci-Fi, where we went to the CDC in Galveston, and we talked to them about that very thing, and they said the real concern, the real concern is just actual diseases.
00:21:19.000Brian Richards who explained the science behind it.
00:21:22.000And there are so many people that are dismissing this because either they enjoy deer hunting or they want captive cervids to be something that are still something that you could be released on private property because people grow and breed deer and then sell them to ranchers who want deer in their properties,
00:23:01.000And they're getting more human-like all the time.
00:23:03.000And one of the things our center is doing is working on that very issue of trying to help people understand that the studies that were done 15 or 20 years ago looking at how infectious these might be for humans were really well done.
00:23:15.000They were good, but they had different strains.
00:23:17.000And over time, these strains are looking to be more and more like they could infect humans or they could even infect cattle.
00:23:42.000So these people have these prions in their system now, but then currently they're not making the jump to cause, what is it, Jakob Kreutzfeldt disease?
00:23:52.000We don't know that humans are getting infected.
00:23:55.000One of the challenges, we don't have a test unless you die.
00:23:58.000And then that's a heck of a way to have to get a test.
00:24:01.000So one of the challenges, you don't know this until you actually show up with the signs and symptoms.
00:24:06.000And so one of the things that we're looking at carefully is doing surveillance or disease detection among people that might present with this.
00:24:13.000If it's going to happen, I suspect the naturally occurring prion-related diseases, Leitz-Kreutz-Fallt-Yakub's disease you just mentioned, occurs typically in older people, over 70. If you suddenly start seeing a 40-year-old or a 50-year-old or 60-year-old even with this disease, then you got to start thinking what else is going on.
00:24:29.000And so that'll help us detect it in cases.
00:25:00.000But we've got to make sure that people aren't getting infected.
00:25:03.000And one of the things that our group at the University of Minnesota is working on is tests now that are almost like point of detection tests.
00:25:09.000So if you shoot an animal, could you know very quickly that it's positive or not?
00:25:14.000And then you'd know not to process that animal or eat it.
00:25:33.000When they're sanitizing medical equipment that they've used on mad cow patients, or whether it's cows or humans with these prions, They've been able to do it three times.
00:25:46.000Like the sterilization process, what is the temperature that they do it for?
00:25:50.000Well, they do it both temperature and pressure, but it's in the hundreds of degrees and it's under high pressure.
00:25:55.000And I've actually been involved with several cases where these very equipment you're talking about were accidentally used on somebody who had Creutzfeldt-Jakub disease.
00:26:10.000That's why we want to make sure that if you're eating deer cervids right now, that we have to make sure they're tested.
00:26:17.000And I think the other point you raised is a good one.
00:26:18.000We've been very concerned about the movement of this disease by cervid farming.
00:26:23.000We've had far too many examples, and Doug has shared that with you, just the extent to which...
00:26:28.000We see state by state by state slowly getting picked off because somebody moved a trophy deer from state A to state B and it was infected and it got out or others got out of the pens and then it infects locals.
00:26:41.000Now, has that made the jump to bison or elk or any of those other animals yet?
00:27:09.000So the one we worry about right now is getting into the caribou in northern Canada.
00:27:15.000Right now, the range of the deer that are infected in the provinces of Canada is right budding up next to caribou.
00:27:22.000And of course, if you're not a hunter, you wouldn't know this, but caribou, obviously, the herds are remarkable, unlike, you know, white tails, or to that matter, elk.
00:27:29.000If you got it into caribou, it would likely spread very quickly.
00:27:32.000And as you know, the native populations, caribou are key.
00:28:09.000If we're going to see a big movement, it's humans are doing it.
00:28:12.000As our good friend Doug Duren has been doing all this work to try to alert people about it, and also they're putting up these testing places where hunters can bring in a deer and have the deer tested.
00:28:31.000And that's what we need to work on is if you don't make it easy and convenient, as you know, it's not going to get done.
00:28:37.000And so, you know, it's hard enough to convince people that there's really a problem because people don't want to believe it, even if they know that there's, you know, CWD in deer in the area and we have some like that.
00:28:56.000Well, in some cases, they get so busy.
00:28:58.000Because, you know, unlike laboratory testing for an entire year, where I do one 12th in January, one 12th in February, etc., etc., you know, deer season typically is very concentrated in just a couple of weeks to a month in the fall.
00:29:12.000And so the problem is all the animals come in at that time, so your lab capacity has to handle that huge surge all at one time.
00:29:18.000And so sometimes it takes a while to get it back.
00:29:20.000So these hunters just hope they don't take a bite during that time.
00:29:25.000Yeah, and we hope that these prions don't ultimately infect people and jump.
00:29:30.000But if they do, I worry what will happen to deer hunting as we know it, because probably a lot of people will not continue, and we need that desperately for herd management.
00:29:42.000Well, what they're doing in Doug's area is they're actively trying to eliminate a lot of deer and try to drastically lower the numbers, particularly of bucks, which I guess they wander more.
00:30:11.000Now, these what we call humanized mice, or mice that are basically much more like a human, we're now seeing that jump occurring.
00:30:18.000And these new strains, see, the strains that, again, were around 20 years ago are not the same ones today.
00:30:23.000Because as these When prions continue to pass from animal to animal to animal, they go through these little minor mutations.
00:30:29.000And they're getting more and more and more like what a human transmissible prion might look like.
00:30:35.000So in these mice studies now that are really made to mimic a human, we're starting to see that jump.
00:30:41.000Yeah, and folks, if you've never seen a deer with CWD, you should go and Google it because it's terrifying.
00:30:47.000The idea that that could make that jump to human beings and people pouring saliva out of their mouths and their whole body just wasted away to skin and bones.
00:31:44.000So, for the average person that is sitting around reading these articles that say, don't worry, or reading these articles that say, this is the end of humanity, what could these people do?
00:31:59.000Like, what could they do and what do they do if they get infected?
00:32:02.000Well, first of all, neither of those kind of articles are correct.
00:32:06.000And we have to make sure that we get that message out to people that it's there.
00:32:10.000You know, and part of it is it's so hard to hear from people who suppose experts, what's this going to happen or not happen?
00:32:16.000You know, and let me just give you an example, because we've heard a lot about, well, it's going to go away with the coronavirus with the seasons.
00:32:26.000Okay, when it warms up, it'll go away.
00:32:28.000Well, you know, the other coronaviruses that we have that we've had to worry about was SARS, which appeared in 2003 in China.
00:32:36.000And when that came out of China in February 2003, it took us a little while to figure out that these people really aren't that infectious till day five or six of their illness.
00:32:46.000And then they really crash and burn and many of them would die.
00:32:50.000But what we did was basically, by knowing that, identify these cases in their context quickly.
00:32:56.000So if they had symptoms, brought them in, put them in these isolation rooms so they wouldn't infect anybody else.
00:33:01.000And it took until June to bring that under control.
00:33:05.000That had nothing to do with the seasons.
00:33:06.000MERS, which is another coronavirus that's in the Middle East, it's in the Arabian Peninsula, The natural reservoir for that is camels.
00:33:15.000By the way, SARS, it was palm civets, a type of animal food that we got out of the markets there.
00:33:22.000In the Arabian Peninsula, we're not going to euthanize 1.7 camels to try to get rid of MERS. And there, it's 110 degrees out, and this virus is transmitted fine, thank you.
00:33:33.000I mean, it goes from animals to people.
00:33:48.000Because how does something like SARS run through a population and then stop being around anymore?
00:33:54.000Well, it wouldn't have, but we had good public health.
00:33:56.000Had we had, you know, the same kind of transmission we're seeing with this coronavirus where you're infectious before you ever get sick, where you're highly infectious.
00:34:05.000Remember with SARS now, you didn't really get infectious until you're in six days of illness, and you knew that you were in trouble.
00:34:18.000MERS stops because we don't get rid of the camels, so it keeps hitting humans day after day.
00:34:23.000But then when they go to the hospital, we no longer allow those individuals to transmit to others in the hospital because we do what we call good infection control.
00:34:31.000As soon as they get there, they're in special rooms with special masks and all this kind of thing.
00:34:35.000And so in that regard, these coronaviruses can be stopped.
00:34:57.000Well, I think as I laid out to you before, you know, this could be 10 times worse than a really bad seasonal flu year.
00:35:02.000And I'll grant you it will hit, you know, primarily the older population and those underlying health problems.
00:35:08.000But as I mentioned also, you know, we have a lot of people who have other risk factors, obesity, high blood pressure is another risk factor where you can have a really bad outcome with this.
00:35:16.000And so we don't quite know what it's going to do yet.
00:35:19.000I think, you know, we've been right on the mark predicting where it's going to be to today.
00:35:23.000I think from here on out, I can tell you it's going to stay around for months.
00:35:40.000I think the big thing is that eventually enough people will get infected where it'll be like putting reactors in the rods, you know, rods in the reaction, I should say, and then that stops it by itself.
00:35:51.000Because if two of the three of us in this room were immune right now to it because we'd had it and recovered and had protection because of natural protection, then I couldn't transmit to anybody.
00:36:01.000So that's what's going to happen if you get enough people who get infected.
00:36:05.000Ultimately, then it'll slow down and stop transmission that way, but that's a heck of a price to pay to get there.
00:36:11.000Is it safe to say that we're fairly fortunate that this isn't something like the Spanish flu or something that's really ruthlessly deadly?
00:36:19.000Well, that's where I think we have to be really careful.
00:36:23.000Just to back up, about 0.1% of people who get seasonal flu die.
00:36:29.000And granted, it's mostly older or younger people, okay?
00:36:42.000But again, and they say that because we didn't pick up all the milder illnesses, okay?
00:36:47.000But on the other hand, we have a lot of additional people in countries like ours that have even more risk factors for having bad outcomes than China.
00:36:55.000And so Spanish flu, the one you mentioned, 1918, that was about a 3 to 3.2% case fatality rate.
00:37:02.000Now, it did preferentially impact 18 to 25-year-olds.
00:37:08.000Well, you know, it has to do with your immune response again, we think.
00:37:11.000That what happened is when this virus got into you, it created what we call a cytokine storm, which is an antibody response in your body that's out of control.
00:37:21.000And it basically, you destroy yourself.
00:37:23.000And it sets this thing up to trigger it off.
00:37:25.000So the healthier people had the more adverse reaction to it.
00:38:12.000So it's somewhere between a really bad flu year at 0.1%, and it could be as high up here, you know, getting closer to 1918-like.
00:38:20.000And that's the numbers I just gave you a few minutes ago from the American Hospital Association of, you know, 480,000 deaths here in this country over the next 6 to 12 months.
00:38:31.000What can someone do to shore up their immune system while this is all going on?
00:38:43.000You know, I'm getting up there right now where, you know, it becomes more and more of a challenge to stay, you know, in good shape.
00:38:49.000You know, the more you can do to do that, something you know all about, you know, is keeping in shape is really important.
00:38:55.000The second thing is if you're on medications, like for high blood pressure, don't miss them.
00:39:01.000Take those drugs because they're really important, even though they may not appear, you know, you don't have any symptoms of high blood pressure or something like that.
00:39:07.000And then I think just, you know, getting sleep and eating a healthy diet.
00:39:11.000And that's about what we can do today to help get you prepared for this.
00:39:18.000Is there anything else one could do, like maybe IV vitamin drips or anything that's going to really boost your system?
00:39:26.000You know, when you look at all the things that might be there, and I'm happy and willing to accept any and all that might help, but we don't really have any data that those substantially impact on your immune system to make it that much better.
00:39:40.000Is that the case because not that many people do it though?
00:39:54.000Turns out that we've studied this with regard to antibiotic resistance and does it help your gut, etc.
00:40:00.000And it turns out that the probiotic users were no different than the non-probiotic users.
00:40:04.000In terms of recovery from antibiotics?
00:40:06.000No, and the issue of if you're going to kind of compete out the bad bugs, so by getting a good healthy gut flora, the bugs there, you would actually reduce the chance of picking up a bad bug and it turned out there was no difference.
00:40:19.000But how would they do a study like that?
00:40:20.000The only way I think they would do a study like that accurately is infect someone that is the same person, like have the same person with no Probiotics and then have them with probiotics.
00:40:32.000And the studies that have been done are very close to that.
00:40:35.000But what they did is they used two different groups of people.
00:40:37.000Those people used probiotics, this group did not.
00:40:39.000And then they looked at all their illnesses and they got stool samples on everybody.
00:40:52.000But I think the key message here is that we're going to get through this, but right now we do have some real challenges before us.
00:41:00.000What we can't tell people is it's all safe.
00:41:04.000Every time I hear people say the risk is low right now, it reminds me of what would happen if there was this huge low-pressure system five days off the coast, the Gulf.
00:41:14.000And there was 90-degree water between that system and the beach.
00:41:18.000And there was no wind shears in the northern hemisphere that's likely going to knock it off.
00:41:21.000But we tell the people standing on the beach that day we have low risk of anything.
00:41:25.000Well, we know five days from now it's coming.
00:41:27.000And so what we need to do is help this American population or the world, for that matter, understand we're going to be in some hurt for the next few months.
00:41:34.000And we have got to get better prepared.
00:43:32.000But the whole issue of using your hands touching your face that people all concentrate on Yes.
00:43:38.000The data is actually very weak that this kind of virus is going to be transmitted that way.
00:43:42.000So I wouldn't tell you to stop using hand sanitizer, but don't think it's going to have a big impact on this bug.
00:43:46.000Do you see that viral video that's going around of that woman who was giving the address at the behest of the White House and she tells people not to touch their face and then immediately licks her finger and turns the page?
00:44:00.000Well, why is she telling people not to touch their faces?
00:44:02.000Well, the thought was is that there are receptors around your eye right here that actually for this virus could get in and then get into your body.
00:44:11.000And, you know, the data we have on this is so sparse to say that that's the case.
00:44:16.000I think the primary thing about handwashing is legitimate, but one of the things people want to do something.
00:44:22.000They want to be able to think they're doing something, and so we tell them, wash your hands often to prevent this disease.
00:44:29.000And I feel like we're not being really honest with the people.
00:44:32.000That the data, and we've looked at this very carefully, really is about just breathing air.
00:44:47.000Basically the surgical mask, which just fits over.
00:44:50.000And the reason it's called a surgical mask is because it's loose fitting, just fits, you know, kind of ties behind you.
00:44:55.000It was worn by surgeons so that they don't cough or drip into your wound.
00:45:01.000And it was never made to protect you from bugs coming in.
00:45:05.000So those little spaces on the sides, that's not a problem if I'm breathing into the cloth right in front of my nose.
00:45:10.000But in terms of the air coming in on the side, they're not effective at all.
00:45:15.000So people wear them, they look like they're doing something, they're not.
00:45:18.000Now, if you are sick, they may help a little bit from you transmitting because if you cough, then you cough right into that cloth and some of it will embed in there and not get out around.
00:45:28.000The other one, though, is called an N95 respirator.
00:45:31.000But for all intents, it looks like a mask.
00:45:58.000The problem is we have a big shortage.
00:46:00.000You know, right now we have hospitals that are down to just a couple days worth of these masks, the respirators, and it's because we don't stockpile anything in this country.
00:46:10.000You know, we don't have, hospitals don't have the money to do that.
00:46:13.000Those preppers right now are so excited.
00:46:20.000And you know, but this is really important because how healthcare workers go is how the country, I think, will see where we're going.
00:46:27.000You know, there have been over 4,000 healthcare workers in China who were infected, many of them on their job, and a number of them died.
00:46:35.000And if in this country we have a real challenge delivering healthcare because we're overwhelmed, and then we have healthcare workers picking up the infection, like we talked about the group in Milan, And we don't have the protection for them.
00:46:50.000I really believe that's when the public will say, wait a minute, what's going on here?
00:46:55.000And that's where I think the challenge.
00:46:57.000So we really have to protect our healthcare workers.
00:47:30.000We have no capacity to make lots of them all of a sudden.
00:47:35.000Prior to this event, the hospital purchasing agent would go online, click a button, send me 5,000 of these, and it would be there the next morning.
00:47:42.000Has anyone contacted you before this or since, in particular, and asked for your advice as to how they can better prepare?
00:47:53.000Like, in terms of, like, the President?
00:47:55.000The President hasn't, but I know a number of the people who are working in the White House...
00:48:16.000And so, you know, I've never had a partisan, you know, I'm just a private in the public health army.
00:48:21.000And so I actually served as a science envoy for this administration in the State Department last year, you know, still in my full-time job at the university.
00:48:29.000And so I've never been, I mean, I'm there to give the best advice I can.
00:48:33.000And so I've talked to a lot of these people there at the CDC, at Health and Human Services, etc.
00:49:23.000No, you know, this is the challenge we have is today in this environment, everything's just-in-time delivery.
00:49:27.000I mean, look at when you go online and whatever place you're outing from, Amazon, wherever, you expect it there the next day.
00:49:34.000People forget that we don't have that capacity today to suddenly make lots of things.
00:49:39.000So right now, all the mass manufacturers in North America are working 110% time.
00:49:44.000But if they were trying to fill all the orders they've gotten just in the last few weeks, it would take them years and years with the capacity they have.
00:49:52.000And you can't go build these new machines to make masks overnight.
00:49:56.000So this is something that should be set in advance of anything like this, any pandemic happening, like long in advance, we should be prepared.
00:50:03.000You know, think about the issue with defense.
00:50:06.000You know, we prepare all the time well in advance.
00:50:09.000We don't build an aircraft carrier at the moment we think we're going to go into battle.
00:50:40.000So what we need to do is take a step back after, we can start now, but we're not going to fix it now, is to say, what are the key things that we should do?
00:50:51.000If we had been serious about this, we might very well have had a coronavirus vaccine, whether it worked specifically for this strain, whether it worked for SARS or MERS. But right after SARS happened in 2003, everybody was hot on a new vaccine.
00:51:05.000And then when it went away, the interest waned.
00:51:08.000Is it something like the flu where, you know, sometimes when they come up with a flu vaccine, it doesn't necessarily address the current strain?
00:54:03.000Well, I seek the advice of experts whenever possible, and what I was seeing was that there was a lot of weird misinformation and conflicting information.
00:54:14.000A lot of people saying, don't worry, and a lot of people that were terrified.
00:54:17.000I'm like, okay, I've got to talk to an expert, and luckily you were willing to sit down with us and help us out.
00:54:23.000Well, you know, and the other thing I think that, you know, maybe it's a function of age, but, you know, straight talk is so important today.
00:54:30.000You know, I'm so tired of having people say to me, oh, if you tell them this stuff, they're going to panic.
00:54:36.000Have you seen anybody riding in the streets yet?
00:54:38.000Have you seen cars turned over, smashed?
00:54:40.000Have you seen people hurting themselves over this issue?
00:54:42.000They're concerned, but they want legitimate information.
00:54:46.000And so what you need to do is just tell them the truth.
00:54:48.000And we have many experiences like that.
00:54:49.000A few years ago, when I was at the State Health Department in Minnesota, we had a big outbreak of meningitis, a type of brain infection, bacterial brain infection.
00:54:57.000And a number of high school students were very sick.
00:55:00.000All of a sudden, in one day, they were in a hospital.
00:55:02.000And this community of 20-some thousand people were on edge.
00:55:09.000And I addressed them and gave them everything I knew about meningitis, what we're going to do about it, etc., And then towards the end of the talk, I said, and I just need to let you know, about one out of every seven cases of this dies.
00:55:20.000And people looked at me and said, why did you tell them that?
00:55:23.000And I said, because they needed to know it.
00:55:54.000You know, I would be really bad at you if I thought you were a hurricane forecaster and you knew this was coming, but you kept telling me, oh, it's low risk.
00:56:54.000And it's not only the vaccines themselves, but it's the prioritization of vaccines.
00:57:00.000I mean, you know, one of the real tragic stories right now in Africa is we are just finally bringing to a close this outbreak of Ebola in the Democratic Republic of the Congo, far northeast part of the Congo.
00:57:11.000You know, 2800 people have died from this, okay?
00:57:35.000So, I mean, I think that's, you know, I have to say, and, you know, I'm already on this show, so I'm not trying to thank you for what you do say about vaccines, because people listen to you, and we need every positive voice, because we have so many crazy voices out there right now.
00:58:22.000And you know, that's one of the challenges you know today between the anti-science misinformation that's out there, but then when they don't see it.
00:59:31.000And the reason why people don't do it is because they're paranoid of vaccines and they get that information from some wacko website or some person who really has no business talking about it.
00:59:41.000Whether it's the people out there that think it causes diseases or that it's a government plot or that it's a medical scam because it's just trying to raise...
00:59:56.000You know, the human beings, for whatever reason, there's a percentage of us that lean towards conspiratorial thinking and they lean towards thinking that there's some sort of a plot against them or the government's against them and it's just...
01:00:13.000You've got to listen to the medical experts.
01:00:15.000You know, and I hope that if there's any good to come out of this terrible coronavirus situation is that there's a wake-up call.
01:00:21.000If we'd had a vaccine for this, or one that even worked partially, think how different we'd be.
01:02:01.000Did you put that in there because you really thought that a lot of this stuff was going to come out of China or was that just because it's a great world?
01:02:10.000Because they have this incredibly large population, 2 billion.
01:02:15.000They've got this food supply that is largely wildlife that comes into these markets where there's this incredible contact between people and these animals.
01:02:25.000And the crowded nature of that society, I mean, I think one of the things that surprises people when they go to China, 15 million population cities are common over there.
01:02:34.000I mean, we think of the United States, we think of LA and New York, and that's big, okay?
01:02:38.000Over there, I mean, in Wuhan, a city of 15 million, the entire metropolitan area is 60 million.
01:02:45.000And so you have people crowded so closely together that if you add in the bugs coming from these animals and then the potential for this kind of contact where it spreads quickly, China has been a bacterial and viral soup vessel for a long time.
01:03:03.000That's, again, why we have to protect ourselves here because a bug anywhere in the world today can be a bug everywhere tomorrow.
01:03:29.000I could never have imagined the animals – you know, I've spent time in these markets.
01:03:34.000I remember one day spending a day in the Bangkok, Thailand market, and it was about a mile by a mile and a half while big, I mean, in these tight isles.
01:03:43.000Every animal imaginable to humans, and I swear to God, there were some out of the movies, I think, that were in there.
01:03:48.000And they're all just right on top of each other.
01:03:51.000And I actually have a picture that I show in some of my lectures.
01:03:55.000There was a situation where there was all these chickens in a cage, I don't know, 15 or 20 of them, okay, in a big wire cage, and it sat on top of a wire cage full of ferrets.
01:04:05.000And ferrets are actually an animal model from a flu standpoint that they do really well in getting infected with flu viruses.
01:04:11.000If you wanted to create the perfect experiment that no university, you know, research group would let you do, is you'd put birds and ferrets like that together.
01:04:31.000And so these markets, and I don't know what's going to happen here, but for the first time, we really saw the Chinese, after this outbreak in Wuhan, really start to put down some markers on what they're going to do to supervise these markets.
01:04:44.000I mean, they still have to eat, but I think this is a dangerous practice where we see it.
01:05:22.000We think of the flu virus is the same way.
01:05:24.000And that's why we need new and better flu vaccines.
01:05:27.000You know, this could just as easily be a flu pandemic, the same thing, like 1918. So these wet markets, they just have all these animals hanging out and some of them are still alive.
01:08:15.000It's like, how do you tell them that they've been doing this for who knows how long?
01:08:20.000How do you tell them to stop doing it?
01:08:21.000Or is that impossible, and is it more possible to just accelerate our vaccine program and try to preemptively create something to address coronaviruses, to address...
01:08:36.000What other viruses are we concerned about other than coronaviruses?
01:08:40.000I think the next most, not even next, it's a co-virus you might call influenza.
01:08:46.000I mean, you know, there have been 10 influenza pandemics in the last 250 years.
01:08:52.000And each one of them was a little different, but some of them have been horribly bad.
01:08:56.000You know, back in the 1500s even, there was a major pandemic that occurred where Spanish cities were described as almost totally depopulated.
01:09:06.000And so these viruses pop out, and that's why we need new and better flu vaccines.
01:09:09.000And we're all actually working on one now, but it's still a ways off.
01:09:12.000But having those would really prevent the big calamities, meaning, you know, some of the things are going to happen.
01:09:19.000They're not good, but they're not going to Bring down supply chains and threaten governments and so forth.
01:09:25.000And so I think the priority vaccines we need to get are for those diseases that we know could.
01:09:29.000Is the flu injection the most effective way or is a mist as effective?
01:09:34.000Like I know they do the mist up the nose.
01:09:37.000Turns out that what research we have and our group was involved with some of it, the flu mist in the nose works really well in children mostly.
01:09:45.000Because they haven't been infected yet themselves.
01:10:12.000And, you know, I'm happy to report that although I'm not happy to report, being an old man, now I can even get the high-dose vaccine over age 60. So they are actually, you know, the best we have.
01:11:22.000And then I think the other key piece, though, is if you do get the flu and you have really bad muscle aches, one of the things about real influenza is not just sniffles.
01:11:31.000You feel like you got hit by a Mack truck.
01:11:34.000If after several days you still are really feeling bad, really bad, And you haven't seen a physician by then, you should.
01:11:41.000Because that's when you get the complications occurring, the bacterial pneumonias that occur subsequent.
01:11:46.000And if you get those treated earlier than later, you can actually do a lot to keep somebody from dying.
01:11:51.000So, you know, if you don't feel a lot better in two days, I mean, if you catch it really early, you can get a medication for flu.
01:11:58.000There's actually a medication that will reduce your illness a bit.
01:12:01.000But if you're sick for more than a couple of days, it's not better.
01:12:04.000You absolutely should see a doctor so you don't have these other complications.
01:12:19.000They would likely give you an antibiotic based on what you had because you are then...
01:12:24.000The problem with flu is it's not just the flu virus but then you get secondary bacterial pneumonia from the damage in the lungs and so they can prevent that.
01:12:31.000A lot of older people in particular will Die from actually what we call secondary pneumonia to having had influenza.
01:12:38.000They wouldn't have gotten the pneumonia if they had not had the flu, but then they do.
01:12:42.000Now, we were talking earlier about probiotics.
01:12:45.000Is there a benefit of probiotics once you've taken antibiotics to reflourish your gut flora?
01:12:52.000You know, that's where the studies really at this point have demonstrated that it's very temporary.
01:12:57.000In other words, if you're taking probiotics, you can get a boost initially, but it doesn't sustain itself over time.
01:13:04.000And then the natural flora comes back.
01:13:06.000I mean, the gut microbes will come back as they've been reduced.
01:13:11.000What I'm saying is, is it beneficial to people if they do take a probiotic after antibiotics?
01:13:18.000Because antibiotics do have a devastating effect on your flora.
01:13:21.000It kills the bad stuff, but it also kills a lot of the good stuff, right?
01:13:24.000So is it beneficial for people, once they have taken an antibiotic, to take probiotics to sort of re-flourish, at least temporary?
01:13:32.000Yeah, and that's what I'm saying is that the data don't support that it stays.
01:13:38.000In other words, you get a short-term boost and it gives you some of the new good bacteria, but they don't stay around.
01:13:45.000Even then, they just don't stay around.
01:13:47.000Your normal gut flora will come back and take over.
01:13:50.000So the probiotics in and of themselves are not giving you that long-term boost.
01:13:55.000So you don't think there's any benefit to having even a short-term boost?
01:13:58.000Well, you know, it's again, surely I'm not going to profess to be the expert on probiotics, but I'll tell you that the data we have doesn't show that they have a big boost and that they actually help you long-term or short-term, meaning that it makes any difference.
01:14:13.000Now, there's one exception to that where I would say, and this is a very different thing than probiotics, but...
01:14:19.000We actually have a disease called Clostridium difficile, which is a bad bacteria that happens when you've taken way too many antibiotics and it colonizes your gut because you don't have competing organisms there.
01:14:52.000And there is clear evidence that if you take those, those fecal transplants as opposed to just probiotics as such, that that can have a major positive impact on your recovery from things like clostridium difficile infection.
01:15:04.000And so more and more institutions now actually are doing fecal transplants, which you'd never thought that that would be one thing you'd do one day.
01:15:11.000But for those who've had this problem, they're life-saving.
01:16:24.000Well, Lyme disease in of itself is a fascinating story.
01:16:28.000I've actually been involved with it since its early discovery in the 1980s.
01:16:32.000And Minnesota, Wisconsin was a big focus, the upper Midwest.
01:16:35.000And this is a story that I think you'll find interesting is that Even though it was discovered primarily in the eastern part of the United States, named after Lyme, Connecticut, it's a disease that actually probably originated in the upper Midwest.
01:16:49.000And I tell you that because it turns out that there is a focus in northern Wisconsin and east-central Minnesota where there's Lyme disease, there's another disease called anaplasmosis, there's another disease, babesia, etc., that all seem to have a similar kind of tick,
01:17:45.000Where, up in northern Wisconsin, as deer would come into the check station, they would actually measure the number of ticks that were attached to the nape of the neck, okay?
01:17:57.000And they asked hunters, who were driving back to Madison and Milwaukee, If they would be willing to check in at a station down there for just a second, and then they were going to count the ticks again.
01:18:08.000And it turned out that as the vehicles come rolling down from Highway 51 from northern Wisconsin, get on the Interstate 90-94 and go to Milwaukee or Madison, the ticks just kept falling off.
01:18:21.000By the time they got to Madison or Milwaukee, the ticks were almost all gone.
01:18:25.000Well, yes, lo and behold, where all the Lyme disease and so forth started to show up right along the interstate corridor.
01:18:49.000The challenge we have is that there's a lot of people that assume that they have chronic Lyme infection.
01:18:56.000And, you know, the data on that is just really, really not there to support that these people are chronically infected, but they do have An immune response, likely, that occurs where it sets up this trigger.
01:19:31.000I have a challenge because when people take IV antibiotics at extended periods of time for Lyme disease, You know, the data, there's four different studies now that have been done where people have had what we call a double-blind placebo-controlled trial,
01:19:46.000where half got the drug, half got IV, but no drug.
01:19:51.000And it turned out all four of these studies in Lyme disease, the people who got just the placebo did just the same as the people who got the drug.
01:20:00.000And I worry that we're using antibiotics a lot there.
01:20:02.000And this is where I just mentioned earlier about clostridium difficile.
01:20:05.000We actually had a patient in Minnesota that died from the IV treatment for what was chronic Lyme disease and wouldn't have been helpful.
01:20:13.000And so we need a lot more research in this area to figure out what are these people getting?
01:20:18.000What is it that we can shut off so that they don't have this chronic Lyme disease picture, knowing that it's not actually just you got to treat them more.
01:20:27.000Treatment's not going to help them with the antibiotics anymore.
01:20:29.000And so I think that that's an area that we just need a lot more work in.
01:20:34.000And the numbers are growing, as you know.
01:21:02.000That's why a lot of these people are dying right now, is this over-vigorous immune response.
01:21:06.000And Lyme disease is kind of that same inciting event where we have evidence now that you could be infected with the bacteria, but if we treat you, It's like every other bacteria.
01:21:18.000But you still have this chronic illness that's occurring.
01:21:21.000And what I think is hard is that we see people who have this, who are desperate to have somebody understand what they have, and they end up going to people who take real advantage of them.
01:21:33.000Clinicians who charge them an arm and a leg for things that are not going to help them.
01:21:38.000And what we need is a lot more research on what is actually going on and what kind of drugs can we use to reverse this immune system disorder.
01:21:46.000I have a friend of mine who's a UFC fighter, Jim Miller, and he's got Lyme disease and it's pretty bad.
01:22:04.000I mean, I'm not, you know, without knowing what's there.
01:22:06.000But again, more often than not, if he's been adequately treated, it's not that the bacteria is still growing in him like it might be for a lot of days.
01:23:05.000And with that, it would open up so much of the forest that you'd have a very different kind of mammals, population, deer, etc., etc.
01:23:15.000And with the suppression of fire, what's happened is we now have, instead of having these old growth forests, we have all this younger, you know, non-pine or...
01:23:25.000Any kind of—like the oak trees of the upper Midwest are all disappearing because oak trees need sunlight.
01:23:31.000And fire is what kept—they were very resistant to fire.
01:23:34.000And so the old oak forest and so forth would survive because of fire.
01:23:39.000Whereas today, with no fire, you know, the elms and the maples and everything else comes in and the buckthorn and all that kind of stuff and takes over.
01:23:47.000So what's happening is, in our state of Minnesota, is we have a really good example of this is we're losing our moose.
01:23:55.000And the big primary reason is brain worm.
01:24:14.000It has moved farther and farther north in Minnesota because of lack of fire because the forest is changing.
01:24:20.000So now, where there only used to be moose, we're seeing deer and moose, and where that intersection is, we're starting to see moose develop this brain worm infection because it's from the deer.
01:24:30.000So, the tick population has changed too, and it's largely due to the fire.
01:24:35.000In the Northeast, never used to be like it was.
01:24:38.000We had fire all the time that would clear out these areas, and it was just part of natural everything.
01:24:44.000So one of the challenges we have with ticks is they're here.
01:24:46.000We're not going to change how we live, suburbs and trees and all of that.
01:24:51.000Could controlled burns eliminate a lot of them?
01:24:54.000They do, because what they do is they just don't eliminate the ticks, but what they do is they eliminate, for example, the whitefield mice and all these different species that are important to the ticks.
01:25:04.000And then they bring in different species that will be there.
01:25:08.000So, I mean, this is a big debate in Minnesota right now.
01:25:10.000I mean, we're losing all these moose to brainworms.
01:25:13.000Ironically, the moose's population is expanding dramatically in Isle Royale.
01:25:27.000So fire actually has helped the moose.
01:25:29.000In areas in northern Minnesota where there's been a lot of fire, The moose population is growing because the deer are not there because exactly those mammals, those rodents, and so forth are very different in burnt-out areas than they are in non-burnt-out areas.
01:25:43.000Well, they do control burns in some states.
01:25:46.000I had a friend who was hunting in Washington State a couple years ago, and he said it was really weird because there's these massive fires in the distance that were actually being controlled.
01:26:21.000That's where we really have to have vaccines and treatments for these diseases.
01:26:25.000We're not going to get rid of the ticks.
01:26:26.000So what we have to do is figure out, I mean, wouldn't it be incredible if we have a cocktail vaccine for, you know, Babesia, for Lyme disease?
01:26:46.000And that's another issue, you know, for some of the larger mammals, as you know, tick predation can get so heavy, particularly in certain times of the year, that it really, literally takes a lot of blood out of these large animals, even though they're so big.
01:26:59.000Yeah, I went down a rabbit hole the other day online, and I saw this one deer that was covered in these frisbee-sized patches of ticks.
01:27:28.000It's not affecting me until someone in your family has it.
01:27:31.000There's a guy that I know who was a former UFC fighter, Marcus Davis.
01:27:37.000His wife got Lyme disease and he spent hundreds of thousands of dollars trying to help her and do something about it and treatments and all these different things for it.
01:27:50.000And this is another area, again, you know, when you think of the amount of money we lose in just lost time, let alone pain and suffering, what an investment to make in this.
01:28:06.000We pulled up a chart of the United States where they showed the areas that are affected by these ticks and what percentage of ticks carry Lyme disease they've tested.
01:28:16.000And some places in the Northeast, it's in the 60%.
01:29:05.000Dan Flores, who has been a guest on the podcast before, has a great book called Coyote America that sort of details how this came to be and how these coyotes have...
01:29:22.000But coyotes, about how when they got rid of the wolves and they tried to do the same to the coyote, they just actually expanded their territory.
01:29:31.000They're sneaky, very clever little animals.
01:29:39.000Is there anything else that we should cover?
01:29:41.000No, I mean, I thank you for covering this issue on infectious diseases.
01:29:45.000We can use all the help we can to get people to be aware of what's out there and what's coming and just keeping the message straight.
01:29:53.000And we're going to get through this, but at the same time, it's going to be a challenge.
01:29:56.000You know, today you have an underlying health problem.
01:29:59.000And you're particularly over age 50-55, I'd say avoid big crowds if you can.
01:30:04.000And that's going to be really important.
01:30:06.000And know that we're going to work on the critical drug supply to make sure that people aren't without drugs that save their lives every day.
01:30:41.000So some of this research is going to have to be basic to that.
01:30:44.000The second thing we have to worry about is safety.
01:30:46.000There's a condition in humans called antibody-dependent enhancement, ADE. And it turns out that if you have no antibody or immune response, you'll get the disease.
01:30:57.000But if you have this in-between level, and then you get the disease, it actually enhances the disease.
01:31:04.000Immune response is really destructive.
01:31:06.000And in fact, there was just a couple years ago a major recall of dengue vaccine, a type of vaccine we use for mosquito infection in the Philippines where kids who got the vaccine actually made just a little bit of antibody.
01:31:19.000And when they got the real disease, it made them a lot sicker.
01:31:22.000And so we found with the 2003 SARS vaccine that there was an ADE component to it when we made it in animals.
01:31:29.000And so we're going to have to really study this to be sure it's safe.
01:31:32.000And as you said earlier, you know, we can surely make mistakes.
01:31:36.000We don't, you know, we need to do everything we can not to.
01:31:38.000And so I think between getting the effectiveness and the safety data together, we're years out.
01:32:04.000You know, it's like we start on something and then we forget that it's important because it kind of goes away for a while, but only to come back.
01:32:12.000And so this is part of that picture we talked about.
01:32:14.000And this is what Peter Hotels talks a lot about.
01:32:16.000You know, we got to finish the job on these things.
01:32:19.000You know, I worry that we'll get through this situation and then people say, oh, we're done.
01:32:23.000And then we'll forget until the next one comes along.
01:32:25.000And so this is where vaccine research and development is really important.
01:33:07.000So anyway, the bottom line, though, is that then they gradually work their way up to larger studies where, you know, if something happens one every thousand people, you have to study a lot of people before you know the chance that you might find that.
01:33:20.000So that's why it's going to take a while.
01:33:21.000And, you know, they'll test it on more and more people.
01:33:23.000And they're going as fast as they can.
01:33:25.000It's not like there's anybody dragging their feed.
01:33:28.000It's just that, you know, I jokingly say it's like if the Iowa farmer wanted to harvest his corn in half the time, it doesn't mean by planting twice as many acres he can do that.
01:33:36.000You know, plant in April, you still can't harvest until October.