Special Edition: The Next Year of the Virus

Hospitalizations have reached a level never seen before, and more than ten million people have been infected eight months into the pandemic. We are looking back at how exactly we got here. We're also looking ahead to what's next for the outbreak. In a wide ranging interview, I asked reporters Michelle Fake Cortiz and Robert Langreuth to break down what

we can expect in the year ahead. They touched on everything from the dangers of the coming winter to the promise of an effective vaccine and the effect of a new presidential administration. With ten million cases and exponential growth rates in so many areas, where does the US and

really the world stand in terms of COVID nineteen. We are seeing exponential growth in the United States and we're trailing Europe still by a little bit here, so we can see what our future is going to look like, which is continued rising number of cases followed by rising hospitalizations and deaths as well. It is not looking good

in the United States. We do have some examples from Asia, particularly where they have done a much better job of locking down and keeping the virus under control, but we are not seeing that in Europe or the US yet. As a result, we are going to need to start doing things in order to get the virus under some kind of a manageable condition. The challenge is going to be that the virus is so widespread across every part of the United States and the European continent that the

threats are coming for every person from every angle. So it's not just a large gathering of people that puts you at risk. You might just be at your own family's Thanksgiving dinner with ten people and one of those people can be infected, and there's still no way to know on the day whether anyone present at your table is infected. So almost everything that we're going to be

doing throughout this winter is going to be a calculated risk. Yeah, I would say that this is exactly what epidemiologists, public health experts were worried about that as we go into the fall months, and as it gets colder and drier and then and more people spend more time indoors, the virus is going to be able to spread more easily. In cases, we're going to rise. And this is exactly the scenario that epidemiologists were worried about or worried that

would happen. And now it's upon us UH and and exactly kind of the worst case scenarios are unfolding in terms of rapid transmission, rapid increase in hospitalizations, and uh an increase in deaths. We're closing in rapidly on a quarter of a million deaths in the United States and they're likely to go up from there. So we're just not in the position that authorities I hope we would be on. The hope was that we'd get cases down lower over the summer and put us in a better

position for the fall, but that's not what happened. So many hopes have been pinned on the development and availability of a safe and effective vaccine to COVID nineteen. And of course this week there has been news of Visor's vaccine candidate a very high efficacy in its late stage trials. So what does this change, if anything, in terms of a timeline to a vaccine. This news about Fiser's vaccine

is quite dramatic. It's much better than anybody was expecting early on when they were just starting to develop the immunization. Dr Fauci said that it's extraordinary and it's been heralded by public health officials across the US and the world.

The idea that we could have something that's more than effective at preventing healthy people from becoming infected with coronavirus is important not only for its ability to protect people, but it's also really critical to help people get through this next period, this very deadly and dangerous winter that we're looking at, when people need to be inside their houses, social distancing, masking, and continuing to take these isolating practices that it's hard for everyone to do. But there is

light at the end of the tunnel here. We do know that there looks to be a vaccine that's on the horizon, and it would be really a shame if people weren't able to get through this last bit before we can start getting some help externally, getting some immunity from something other than falling sick. Yeah, So what's important to keep in mind though, while this is undeniably promising under annimally a good you know, first step in terms of initial efficacy, there's just a lot we don't know yet.

What we have right now is essentially a press release of top line results. We have no scientific study or not even presentation of the full scientific data, not even fire scene of that because the trial is still ongoing. So there's lots of questions that we still have less left. Or the safety of the vaccine, and even the longevity of the effect. We really know next to nothing right now.

But the duration of the effect of this vaccine or even you know, how it works in certain certain key subsets of the population, like the elderly or people with pre existing conditions, we really don't know. You know, what is driving this very strong overall ethicacy result, is are being driven by younger or older patients. All these key details we don't know. So there are several steps that are going to happen as this unfolds over the next

several weeks. The first thing next week, we're looking for a FIGHTSER to get two months safety follow up data of patients in their big trial, and that is a key metric that the US Food and Drug Administration is looking for UH in order to give an emergency authorization for any vaccine. Since vaccines are given to millions of healthy people, it's very very important that vaccines have an extraordinarily high level of safety, and so this is UH.

This is the next crucial data that fighter is going to get next week, and if that goes as plan, then FIGHTSER should be able to apply for emergency use authorization to the FDA. And what the FDA says, they're not going to just review it behind closed doors in the back room. In addition to reviewing it internally, they're gonna bring all the data into a public hearing with

a committee of top advisors to the agency. This is a committee of outside doctors and experts at universities around the country that are going to review all the data in public to make sure that there's confidence in the vaccine and the data before any vaccine is granted an emergency authorization. And then the final step is there's gonna once this comes out, which could possibly happen in December,

there's gonna be a huge shortage of supply. There's not gonna be remotely near enough supply relative to the population that could need it. So what's going to happen is a second committee of experts outset experts and doctors affiliated with the Centers for Disease Control and Prevention. That committee is gonna take all the data and decide basically who should get it first. And basically a very small percentage of the population is likely to have access to a

vaccine first. It's probably gonna be either people that are very high risk for getting an infection, such as healthcare workers, or people are very high risk uh if they get infect of getting severe complications, such as the elderly. So will probably be if it gets an emergency authorization, this vaccine do not you should not expect it to be available for you, you and me. This is a vaccine, it's going to be available for kind a very small

subset of high risk people. Initially, so Bob took us up to the point of distribution, but you have to realize that that's only the beginning of what's happening with the vaccine. Especially with many of these vaccines, you need those two doses. So you get your first dose, you wait three weeks or a month, then you get your second dose. So that's going to take some time. And then your body has to respond to the vaccine to create that immunity inside of you. That's also going to

take some time. So we're looking to, you know, at least the summer before we start seeing substantial numbers of people who have been able to get the vaccine, who have been able to get the two doses, who have had their immune systems ex bosed, and are now creating some kind of protection. And of course at that point in the summer, we should be seeing a drop naturally in the amount of viruses out there anyway, especially in the northern part of the country, as people start going

back outside. So the bottom line from where I'm sitting is that we're not going to know whether or not we've got this under control until about this time next year. That's where my mind is. In addition to vaccines, of course, we are also seeing the development of therapeutics, the approval of drugs to treat the symptoms of COVID nineteen. Those are in use now increasingly, how do you see these

playing role? How are these helping if at all? Uh So, there's really only one drug that's conclusively shown to like lower death rates from the coronavirus, and that's a very old drug, decks of metha zone, a steroid drug, and that's this helps very people, very advanced cases of the coronavirus in the I c U who are having trouble breathing. And it's a it's a steroid basically suppresses the immune system.

And what is thought that the late stages of the disease, what really happens is that the outer control immune system response to the virus become actually becomes harmful, and that's what puts people over the edge and actually kills them in the end. So this steroid, this old old drug, which is one of the drugs that Donald Trump got

when he was treated for coronavirus. Thought that this steroid can suppress the immune response that helped keep people alive, and that was showing pretty definitively to lower the death rate in the universe of Oxford study. That's the only drug that's shown to clearly lower the death rate. Now there's another drug, of course, everyone's heard about ram desiviere from Gilliatt Sciences, and that did is the first drug in the US to officially be fully approved by the

FDA for the coronavirus. But it's been shown mainly to speed up the rate of improvement, the rate people get better who are hospitalized. But what it hasn't been shown to do, uh is lower the death rate from the coronavirus. So even though it gut full approval, it's contribution is still and is still controversial over how well it works and what it's doing. But it did get full approval and is a widely used drug even though its role

is still somewhat controversial. While ramdesivier might not be a Lazarous like product, it does help people recover more quickly. It does help people get out of the hospital, and that is something that's worthwhile to have. So, Bob, what's happening right now with antibody therapies. Yeah, so, and a

lot of therapies are very important type of therapy. They thought to be a kind of a bridge to a vaccine, a bridge together to this very difficult period we're in right now, until we get to the point where a vaccine is widely available and that's why there is excitement about that. And the first of these antibody therapies just received a earnency authorization from the U S. Food and

Drug Administration. That's the antibody therapy from Eli Lily that was developed in in the collaboration with a Canadian biotech company. And basically what it does is if you get it can get it early enough in your of course the disease, it can help keep you out of the hospital, keep you from going to the emergency room. But basically if you take it early, you can help it from progressing into a more severe case. But you do need to get it be treated early on with this to have

an effect. It didn't in a trial. It did not work once you're impossibilized patients. That was too late. Uh. And the problem we have right now with these there are these antibodies are very hard to produce and aren't going to be quite short supply. Literally was talking about shipping out its first doses of this this week and that is just not enough, so that that is a real problem. Nobody anticipated that would be in such bad

shape in terms of coronavirus cases. Yeah, I think a few months ago, and so while this therapy helps, there's just not enough of it to go around relative to the number of people that may benefit from it. I think that there is a silver lining when we're looking at the coronavirus outbreak, which is generally a very black, bleak, negative picture right now with rising cases, rising hospitalizations, rising depths, and that is that we know an awful lot more

now about how to treat those people. Not only that we actually have things that can make a difference. And so in addition to the drugs and the therapeutics, I wanted to ask about another method um for example, contact tracing, and especially now with the exponential growth rate of cases in the US, is contact tracing, in your opinion, even possible? I mean, how effective is this as as a method of let's say, approaching this pandemic or attempting to send

the further spread of COVID nineteen. Contact tracing is a challenge even in good times. It requires an awful lot of effort, both on the part of the government or the public health agency that's doing the contact tracing, and it requires an awful lot from the people who have been infected in terms of sharing where they've been and then it also takes a lot of openness on the part of the people who are getting the information that

they might have been exposed. And we have seen over and over again in our country that there is reluctance on every single part of this tryad that will have to be overcome in order to make contract tracing rise to the level of its potential promise. We're seeing in some states contact tracing isn't even being done. They're asking people to let their own sources, to let their own

contacts know that they're infected. And where I am sitting, we're hearing a lot of people are saying, well, I know that I've been exposed, but I feel fine, and I don't think that I've got it. So people are still going out and living their lives. Perhaps are being a little bit more careful in terms of wearing masks and social distancing, but they're certainly not quarantining in their houses for fourteen days the way that people have originally

been asked. And we've heard over and over again that a lot of people aren't even willing to answer their phones for the health department. So if you don't know, you are potentially exposed, or you know you're exposed and you're not willing to do anything about it, or you know you're positive and you don't know everybody you might have been in contact with. It is just a recipe for disaster. So I am not personally hopeful about the ability for contact tracing to make a significant difference in

this outbreak. Maybe I'm pessimistic. Contact tracing works best when you have a limited number of cases. Are you have, you know, clusters of significant numbers of cases linked to you know, certain locations in certain places like a meatpacking plant or a cruise ship or you know, a big wedding. But when you have cases that are just all over the place, linked to all sorts of gatherings and use numbers, if you or I get a case, you know it could be from all and we're we've been out and about,

it could be from all sorts of contacts. That makes contact tracing, you know, next to impossible. So it's a very difficult situation we're in right now, with spread this widespread in many parts of the country. That makes contract tracing, you know, so much more difficult. So we can't forget about the political angle to this pandemic. President elect Biden has already announced a COVID nineteen task force, And so how do you think the Biden administration hopes to change

the course of the US's response to COVID nineteen. In President elect Biden really did run an awful lot of his campaign based on how to manage the coronavirus outbreak. It's clear that he wants to lead from the front with a national approach to everything from testing, to tracing, to masking, to geting states and governors and local public health officials the information and the supplies that they need

in order to get this virus under control. That is a huge shift from how President Trump approached the challenge. It's going to be some dislocation that happens here as each individual states adjusts to President elect Biden's approach. So President elect Biden has announced a Coronavirus task Force. The three co leads of this panel are David Kessler, Vivic Murphy, and Marcella Nunia Smith. They are a very established group of leaders. David Kessler was the FDA Commissioner appointed by

President George Herbert Walker Bush back in. Vivic Murphy was the former surgeon general Marcella Nunia Smith is the founding director of the Equity Research and Innovation Center at Yale School of Medicine. So to them are taking a different tact when it comes to coronavirus. The other person that's uh, we definitely should mention on this task forces Michael Osterholm, who is the director the Center for Infectous As These

Research and Policy the Universe in Minnesota. And he is you know, a longstanding uh big thinker, a top expert you know on infectious disease and particularly on potential future pandemics. And you know, most things that he said about this pandemic from the beginning of ben you know, spot on as as anyone else in the country. So he is

a real top expert to have on this panel. Biden has already said that he is committed to dramatically increasing the number of tests that are available and that are conducted, and that are available easily and freely for the American public. Knowing whether or not you are infected is going to be the best way to help people implement these social distancing, non pharmaceutical approaches to getting the virus under control. That

is something that has to happen very quickly. And it has to be an all of government effort where steps are made in order to make sure that these tests are available to people and that they can get them easily and freely, and then they can take action based on what they're finding. I personally believe that that will be the biggest impact that Biden would be able to have on this outbreak. Yeah, I think that on vaccines, you know that that's one era of Biden and Trump

aren't that far apart. They're all far vaccines. I think a Biden administration might try to just enhance the public trust in a vaccine with some additional reviews, but that probably you know, wouldn't make an enormous difference and the time from the vaccine. They just do some things to have some additions, have some additional scientific review to make increased confidence in the vaccine and increase confidence that is

not political interference. But basically, you know, the FDA has already been moving in that direction even under the Trump administration, and so that vaccine timeline probably there isn't an enormous difference between the administrations because basically, once vaccine seeing this effective and safe, there's going to be tremendous incentive to get them out as quickly as possible, and the endgame there, it's just going to be how efficient is the distribution system,

you know, in terms of the rest of the virus and social distancing. I think, you know, Biden administration certainly will make much anymore of an effort to have you know, broader national policies and our guidelines, you know, on what to do in terms of social distancing and mask wearing. Biden, I'm sure I'll use the bully pulpit to promote whatever his recommendations are, and you know, and people follow that that could help. There's no doubt about it. President Biden

might move to a nationwide mask mandate. President Biden might move towards nationwide shutdowns, restrictions, recommendations that would further these non pharmaceutical interventions, all of these things that we have not seen President Trump being willing or wanting to do. President Trump's focus on reopening the economy will almost definitely be dialed back under President Biden. You know, we've been talking about what had been projected for the fall that

certainly seems to be coming to pass. But in terms of what public health officials are looking ahead to the end of the beginning of have projections changed at all And what are we to expect now in the coming

weeks and months. Well, public health authorities, you know, expect this to be rough next few months in terms of coronavirus, because what you're seeing in the northern parts of the country, such as Wisconsin that had got the cold is whether first that's gonna increasingly those rates the potential to spread

to the rest of the country. That means, you know, we're gonna have to make it through this winter essentially on social disc and seeing mass wearing and cleanliness, you know, other basic measures alone and perhaps with some help from some of these antibody drugs, but even those will be in very very short supply, so you know, it's gonna be it's gonna be a rough, difficult, you know, a winter, and we have to kind of, you know, I think,

hunker down for it. Public health officials are saying that we're going to see these rising rates continue for at least the rest of November and December, and then they're saying that things might start coming down, that November and December are going to be really bad. But in all honesty, I personally don't see the change coming. The way that the virus works. We all know the way the virus works. It goes from one person to the next, and as long as there are vulnerable hosts to get infected, the

virus will continue to pass from person to person. And the number of people while horrifying at ten million infections in the United States, you have to remember we have three hundred and thirty million people here. We're talking about her immunity at the six level. Even if you made it really simple and low for the math and said people have to be infected in order to reduce the risk,

that's still a hundred and sixty five million people. There's millions and millions of people who are out there who are vulnerable to this virus. It's become clear in recent ones is that the vast, vast majority of the US population is still vulnerable to this virus. Uh. There was a study out the other day that estimated perhaps of people in New York City had been exposed to virus. So that's New York City is one of the most heavily exposed parts of the country to the virus because

of the just the incredible epidemic it had. You know, early on. It started very early in rage for in April and early May until it was finally gotten under control. But even there in this dense, crowded part of the country is still only that's really saying something about, you know, the low levels of much lower levels likely in the

rest of the country. So most people, you know, are still vulnerable and there's just a lot of book could spread to Still when we're talking about case rates of a hundred thousand new cases a day, just remember the reports of hospitalizations and deaths. Those are those are lagging indicators.

Those lagged that a lot the death reports are several weeks behind that, it looks like according to the data from the COVID Tracking Project and all time peak offer hospitalizations and the whole pandemic, so that it's really really worrisome. The one good thing is that intensive care units and hospitals are better at keeping people alive. Now there's better care, So the death rate has gone down because of things like the steroid decks of method zone and just generally

better hospital care. With this many people who are still potentially vulnerable to the virus, we do know that we can flatten the curb and we can get the virus under control with our social distancing efforts. Because we've done that already, we know that it can be done, but think about what we had to do in order for that to happen. My expectation is that we're going to continue seeing these cases increase until we start seeing being

some pretty substantial lockdowns. And I think that is something that public health officials and politicians have not been willing to say. But in my mind, I think that we're either going to accept a phenomenal number of deaths and increasing cases, or we're all going to spend a pretty significant amount of our time inside our houses again this winter.

What do you think, Bob Right? I mean, if you look at Europe, a lot of countries in Europe there are already, you know, reimposing various types of lockdowns, somewhat temporary, and they may they vary from country to country, but you see those happening again in you know, major European countries which are ahead of us in terms of the surge, and in the US generally speaking, there's been little appetite

for that. It's even temporary ones that are limited to say, you know, bars and restaurants and and and some other types of businesses. It just not clear what the appetity is, but it does seem clear, you know, without you know, some more measure of intense social distancing. Yes, that hospitalizations and deaths are going to continue to rise. Unfortunately, Michelle, you already mentioned Thanksgiving, but do you think there's a willingness in the US to essentially not have a normal

holiday season? Um, what can we do or what can government officials do to try and tamp down some of these these more worrying trends that we're seeing With the holidays coming up, we already are seeing people say make sure that you don't put your loved ones, your family members, your friends who are at high risk in a dangerous

situation over the holidays. You don't want to bring somebody who is elderly, overweight, has other health conditions into your home and expose them to even small groups of people, because you could be transmitting the virus. That's something that we're seeing already, because the virus is so widespread across the country that even small groups of people are including people who are asymptomatically positive and you have no idea

that they are putting your loved one at risk. That being said, just like the point we were making earlier that people are tired of social distancing, they're tired of wearing masks. They want to get together with their loved ones. Thanksgiving is a huge issue in the United States. People want to be with their families. That's what this is all about. And it's already been you know, months and months and months of isolation. People really want to get together.

It's going to be an interesting phenomenon what people decide to do to what extent they want to balance having their families and their friends together versus keeping their families and friends safe. It's hard to tell what's going to happen, you know, during Thanksgiving. I imagine this country is so split, uh that that it will just be a different situation in different states and among different groups of people, and some parts of the country maybe much more cautious and

other parts of the country. So yes, if there are very large Thanksgiving gatherings where people haven't been cautious, that's

almost certain to increase the spread of the virus. People don't tone down their Thanksgiving celebrations and you know, keep them to you know, smaller groups than usual, or find ways to do effectively, you know, quarantine or isolate ahead of those gatherings if they are doing a somewhat bigger gathering, especially in cases where there's a lot of interstate travel, and that is often what happens around these holidays, is that there's interstate travel. People come from different states for

big Thanksgiving dinner somewhere. But that does the virus is that, you know, spreads the virus from one part of the country, one county to the next. So the more people you have at your Thanksgiving celebration coming from the more disparate parts of the state or different states, you know, the more likely it is to spread the virus, just by the sheer mathematics of the likelihood someone has acquired something

and they don't know it yet. That was Michelle fig worked his and Robert Langrid and that's it for our show today. For coverage of the outbreak from one and around the world, visit Bloomberg dot com slash coronavirus and if you like the show, please leave us a review and a rating on Apple Podcasts or Spotify. It's the best way to help more listeners find our global reporting. The Prognosis Daily edition is produced by Topher Foreheads Jordan Gaspoure,

Magnus Henrickson, and me Laura Carlson. Today's main story was reported by Michelle Fake Cortes and Robert Langreth. Original music by Leo sidrin Our Editors are Rick Shine and Francesco Levi. Special thanks to John Frauher and Creighton Harrison. Francesco Leviy is Bloomberg's head of podcasts. Thanks for listening.