[00:03.760 --> 00:09.580]  All right. All right. Well, welcome. Welcome back to the CypherCon podcast, Michelle. It's
[00:09.580 --> 00:17.000]  great to have you back. It's great to be here. Thanks for having me on our special COVID-19
[00:17.000 --> 00:26.440]  episode. So we talked last year, we had a nice conversation about PDCS and CRISPR,
[00:26.440 --> 00:31.540]  if I remember correctly. And I remember that being a really fascinating conversation.
[00:31.540 --> 00:40.040]  And a lot has changed since then. Yeah. CypherCon today is April 5th. CypherCon was supposed to
[00:40.040 --> 00:47.360]  happen April 2nd and 3rd. So two days ago, we would be wrapping up CypherCon. But that's not
[00:47.360 --> 00:51.900]  the case. And you were supposed to give a talk at CypherCon this year, right? Yeah, I was really
[00:51.900 --> 00:59.780]  excited. CypherCon is always like a really fun time. Love speaking there. The audience is always
[00:59.780 --> 01:08.940]  very, very nice. But I can't argue with the decision to cancel it. I'd be a real huge
[01:08.940 --> 01:14.720]  hypocrite. Yeah, definitely. And yeah, what were you going to talk about? What was the
[01:16.960 --> 01:24.060]  thumbnail of what your talk was going to be on? So I was originally, when I pitched this talk,
[01:24.060 --> 01:31.020]  it was in January. And the public was just barely starting to get wind of this
[01:31.020 --> 01:39.900]  novel coronavirus, is what they called it in the early stages. And I was like,
[01:39.900 --> 01:47.340]  it would be real interesting to give a talk about pandemics, and how information spreads,
[01:47.340 --> 01:57.380]  all of these conspiracy theories that are cropping up. But after a month or so,
[01:57.380 --> 02:06.000]  I was like, there is too much information about this novel coronavirus floating around,
[02:06.000 --> 02:13.300]  and I think that I should honestly just be giving honest-to-God facts talk about coronavirus from
[02:13.300 --> 02:23.460]  someone who's in the public health sphere. And then it got cancelled. So now we're doing the
[02:23.460 --> 02:33.520]  talk. More of a conversation rather. But yeah, let's dig right into it. Let's start at the
[02:33.520 --> 02:42.480]  beginning. What is COVID-19? So COVID-19 is the name for the disease caused by the virus
[02:42.480 --> 02:49.640]  SARS-CoV-2. So that stands for Severe Acute Respiratory Syndrome Coronavirus 2.
[02:50.460 --> 03:01.980]  We named it that because it's similar to SARS-1 in certain ways, like it's also a coronavirus,
[03:01.980 --> 03:08.700]  it also causes Severe Acute Respiratory Syndrome, and we're trying to stay away from names of
[03:08.700 --> 03:18.080]  people or places as a disease and virus names. And SARS-1 was what we saw the SARS, you know,
[03:18.080 --> 03:23.080]  the SARS disease. It must have been like eight, ten years ago or something like that. It was
[03:23.080 --> 03:31.500]  actually longer than that. It was like, I think, I feel like early 2000s. So like almost 20 years
[03:31.500 --> 03:40.780]  ago. Really? Was that long? Yeah. But so this is like a different version of that. You're saying
[03:40.780 --> 03:48.680]  that this is the virus that causes this disease. Yeah, so SARS-CoV-2 is a different virus than
[03:48.680 --> 03:54.960]  SARS-Coronavirus, like the original. I'll just refer to it as SARS-1, even though that's not
[03:54.960 --> 04:04.520]  its official name, just to delineate the two. Sure. So SARS-2 is of the same family of viruses.
[04:04.520 --> 04:12.840]  So they're both coronaviruses. They're both beta coronaviruses. So that's a subset of the,
[04:12.840 --> 04:20.780]  you know, family Coronaviridae. They're both RNA viruses. They have a similar,
[04:21.530 --> 04:28.340]  you know, genomic structure, not identical. And there are some
[04:29.180 --> 04:34.920]  interesting differences on a molecular level, but that's sort of like a bit too technical.
[04:35.460 --> 04:47.800]  But so it's a RNA virus, which means that it is a single strand of a genetic material as
[04:47.800 --> 04:57.540]  opposed to double strand, and also that it is much more mutatable than DNA viruses and much newer.
[04:59.520 --> 05:06.960]  There are some interesting, you know, biological reasons because, uh, that this is true, but,
[05:06.960 --> 05:11.260]  you know, it's not really important for what we're talking about.
[05:11.260 --> 05:18.440]  Coronaviruses are named because they have a crown. So corona means crown.
[05:19.040 --> 05:27.100]  And that these are these little, like, spikes embedded in the membrane of the virus, if you will.
[05:27.100 --> 05:33.720]  So it's like a ball with a bunch of little, like, spike proteins and other proteins on the surface.
[05:34.520 --> 05:41.280]  Okay. All right. And then, uh, and one of the things that I forgot to mention and touch on,
[05:41.280 --> 05:47.700]  so since we last talked, you moved out to Berkeley, and you're going to grad school, correct?
[05:48.000 --> 05:57.370]  Yeah, I'm an infectious disease master's student in the School of Public Health. So, you know...
[05:57.800 --> 05:59.660]  So you're right in the thick of it.
[05:59.660 --> 06:09.540]  Yeah! It's, uh, it was so surprising, uh, that, that, uh, people were, like, asking me my opinions,
[06:09.540 --> 06:16.920]  like, unsolicited about things going on in the world, and, you know, I was, I was in a,
[06:16.920 --> 06:22.740]  I, I went on a ski trip, um, a few months ago, you know, before I started social distancing and all
[06:22.740 --> 06:27.300]  that, and people would be like, oh, where are you from? And I'd tell them that I'm at Berkeley
[06:27.300 --> 06:32.000]  because I'm doing grad school. They'd be like, oh, what do you study? And I'd be like, infectious
[06:32.000 --> 06:38.000]  diseases. And they'd be like, what about that coronavirus? What do you think about that?
[06:38.360 --> 06:46.100]  And that was crazy, um, not used to it. Yeah, sure, you're, yeah, you're, you're the expert
[06:46.100 --> 06:53.680]  here. So, uh, what, uh, so what, what's changed since then? I guess, like, as far as, like,
[06:53.680 --> 06:57.800]  your school studies and stuff, you talked a little bit about how you're kind of mobilizing to do,
[06:58.300 --> 07:05.320]  uh, some, some work for, you know, figuring out what to do with the pandemic, right? So...
[07:05.320 --> 07:12.000]  Yeah, so I know that labs in Berkeley and, you know, around the globe are mobilizing to fight
[07:12.000 --> 07:18.080]  coronavirus, COVID-19 rather, sorry, on a large scale. And there's just, like,
[07:18.080 --> 07:24.060]  incredible scientific collaboration and conversation going on. Um, it's actually
[07:24.060 --> 07:31.040]  incredible to watch. Uh, I know that, you know, labs at, on Berkeley campus are lending equipment,
[07:31.040 --> 07:38.340]  like RT-PCR machines, QT-PCR machines, trying to supplement the testing capacity. Um, they're,
[07:38.340 --> 07:43.800]  you know, donating time on their lab equipment, so they're like fume hoods and stuff. Um, I know
[07:43.800 --> 07:51.700]  that there's interesting work on diagnostic tests, like serology tests, um, versus, you know,
[07:51.700 --> 08:01.400]  the existing, uh, RNA detection PCR tests. Um, there's also really cool work going on, uh,
[08:01.400 --> 08:07.480]  looking at the mechanism of the disease and trying to identify therapeutic targets.
[08:08.070 --> 08:13.380]  I know that, like, in most of my classes, we spend, like, half the time just talking about,
[08:13.380 --> 08:21.900]  uh, COVID-19 and SARS-CoV-2. So it's, I, I would just, like, talk about COVID-19, like,
[08:21.900 --> 08:27.880]  five hours a day at this point. Yeah. What do you mean by therapeutic targets? What does that mean?
[08:27.880 --> 08:38.680]  Um, so, for example, uh, you could, there, there are a lot of ways that you could look at this.
[08:38.680 --> 08:47.180]  Um, you could look at this, like, what about this virus creates an antibody response? Um,
[08:47.180 --> 08:55.420]  so if we look at, like, a mouse model, um, we could look at what parts of the virus create
[08:55.420 --> 09:03.820]  an immune response and how to, you know, make that more efficient in ways. Uh, and, um, that
[09:03.820 --> 09:08.740]  would give us clues on, you know, vaccine development. There are already vaccines in
[09:08.740 --> 09:14.180]  the works. Um, by the way, there are already vaccines in clinical trials. Um, but, uh.
[09:14.180 --> 09:17.380]  Wow. I, I didn't realize that they had them in clinical trials already. That's,
[09:17.380 --> 09:20.340]  that's fast, right? Like, usually it takes a lot longer.
[09:21.160 --> 09:29.000]  Like, it normally takes multiple years, sometimes like 10 years to push out a vaccine. The
[09:29.000 --> 09:35.280]  timeline that they've given us with 12 to 18 months, incredible.
[09:35.580 --> 09:43.480]  Wow. Um, so anyways, we were talking about, uh, what would you call it? Therapeutic, uh,
[09:43.480 --> 09:48.560]  target. Yeah. Therapeutic target. So that's basically the looking for a cure kind of a
[09:48.560 --> 09:54.980]  thing. Is that what I'm hearing right? Um, so let's step back a little bit. Uh,
[09:55.580 --> 10:02.420]  tell me what you mean by cure. Uh, yeah, that's a good question. Um,
[10:02.420 --> 10:08.160]  cure, I guess, I guess a vaccine, you know, something that would make it so that, uh,
[10:08.160 --> 10:11.840]  it's preventable, like you, you wouldn't get it or something like that. Like, I guess that's what
[10:11.840 --> 10:18.540]  I'm thinking about. Yeah. Yeah. So like, see, I, I asked this question because most people,
[10:18.540 --> 10:26.340]  cure, uh, they either mean treatment of the disease or they mean like prevention or
[10:26.340 --> 10:37.820]  prophylaxis or some sort of combo of, you know, those two things. Uh, it's sort of, it's sort of,
[10:37.820 --> 10:47.600]  um, a little bit nuanced because of course no treatment and no, you know, prophylactic measure
[10:47.600 --> 10:55.560]  is without, um, side effects. Um, and the thing that we are looking at is first of all, what
[10:55.560 --> 11:03.240]  works or what could work. Uh, so we would look at how, you know, these, it works in vitro. So
[11:03.240 --> 11:09.660]  in test tube, and then we would scale up to, you know, mouse models and we'd, we'd scale,
[11:09.660 --> 11:16.040]  and then we'd scale up to, you know, human trials. And that's normally how it works with vaccines.
[11:16.040 --> 11:22.760]  Um, for treatments, sometimes we can look at things that we already have. So you, you might
[11:22.760 --> 11:29.180]  have heard about remdesivir, uh, which is a drug that Gilead has, you know, had in the works for
[11:29.320 --> 11:38.360]  a while and is in trials to be used, uh, for treatment of COVID-19. Um, is that, that's a
[11:38.360 --> 11:45.560]  current drug that's out there right now? Um, I'm not sure if it's, I'm not sure exactly, uh,
[11:46.600 --> 11:55.740]  what it's used for, but it is a drug produced by Gilead and they are looking into using it
[11:55.740 --> 12:04.740]  in COVID-19 patients. I know that, uh, also the combination ritonavir, loponavir, uh,
[12:04.740 --> 12:13.580]  which is a medication used for HIV AIDS, um, it was in trials, but that, that didn't show
[12:13.580 --> 12:22.700]  very promising results from what I saw. So that was unfortunate. Um, and it's, it's all sort of
[12:22.700 --> 12:30.940]  like incredible to see how all of these different, all of these different like parts of the healthcare
[12:30.940 --> 12:36.740]  system and the research pipeline are all like working sort of together to try to like
[12:38.500 --> 12:45.280]  mitigate this crisis. Sure. Yeah. It sounds like a really great collaboration. Um,
[12:45.280 --> 12:49.640]  since we're talking a little bit about some of the treatments, what do you think about like the
[12:50.760 --> 12:55.540]  chloroquine? Am I saying that right? Hydroxychloroquine. Yeah. Hydroxychloroquine. Uh,
[12:55.540 --> 13:00.280]  the malaria treatment. I've heard that there might be some promising things there and I don't,
[13:00.280 --> 13:06.080]  I mean, I don't know. I only know what I hear, right? Yeah. Yeah. And part of it is because
[13:06.080 --> 13:13.800]  it's such a polarizing thing right now, especially with recent political events.
[13:14.960 --> 13:23.120]  Right now, I'm kind of sorry to say this, but it's just too early to tell if it really works or not.
[13:23.120 --> 13:31.660]  And the study in France, the preliminary study that was referenced for that showed
[13:32.920 --> 13:39.620]  benefit, but it had like serious methodological flaws. Like first of all, it was not randomized.
[13:39.880 --> 13:45.160]  Um, and when you look at their data, the, the, the people who got the treatment already had
[13:45.160 --> 13:51.440]  lower viral loads than people who didn't get the treatment. So maybe they were further along in the
[13:51.440 --> 13:56.400]  disease. Maybe they were already like clearing it by themselves already. And second of all,
[13:56.400 --> 14:04.760]  it's got a very small, uh, you know, treatment group. It's 26 treatment patients and only 20 of
[14:04.760 --> 14:12.060]  those 26 treatment patients were included in the end analysis. Uh, one was excluded because they
[14:12.060 --> 14:17.260]  stopped treatment due to nausea. Three were excluded because they were transferred to the
[14:17.260 --> 14:25.040]  intensive care unit, the ICU. So, and one of them just fucking died. So they didn't include them.
[14:25.040 --> 14:33.320]  So they didn't include some of the worst outcomes in their end analysis. Um, there's, you know,
[14:33.320 --> 14:37.200]  other small studies that say, yeah, there's, there's small, there's, there's some benefits,
[14:37.200 --> 14:42.700]  but there's also other studies that say that there's no difference. Um, so we just don't
[14:42.700 --> 14:51.800]  have conclusive evidence and, you know, there are, I know a lot of ongoing trials on this.
[14:51.800 --> 14:56.000]  I was reading an article that was published a few days ago, uh, that said that there was
[14:56.000 --> 15:02.900]  10 and I'm sure there, there might even be more. Um, so we are still looking into it. Um,
[15:02.900 --> 15:07.940]  but we just don't know if it works yet. And there, we do know that there are significant risks like
[15:07.940 --> 15:17.040]  cardio toxicity, arrhythmia. Um, so, you know, anyone who says definitely yes or no is not really
[15:17.040 --> 15:24.940]  speaking off the scientific evidence. Um, and that being said, uh, hydrochloroquine is a
[15:24.940 --> 15:32.700]  treatment for some immune mediated conditions like lupus. Um, so shortages of hydrochloroquine,
[15:32.700 --> 15:38.020]  like we are starting to see now because people are hoarding and acquiring the medication when
[15:38.020 --> 15:44.380]  it might not even work could lead to dramatic exacerbation of these people's illnesses,
[15:44.380 --> 15:51.160]  potentially leading to death. It's, there's no data to support that there's a prophylactic,
[15:51.160 --> 15:58.900]  uh, sort of use. So protection in the future. Um, everything that we're looking at right now is
[15:58.900 --> 16:03.140]  do is looking at treatment in people who already have the disease.
[16:03.360 --> 16:10.460]  What about, uh, NSAIDs? Uh, I guess like your, your ibuprofens and your, your kind of pain
[16:10.460 --> 16:15.200]  relieving kind of things. I had a, I put out a, before we did this podcast, I just kind of put
[16:15.200 --> 16:19.880]  out some questions to people. Like if anyone had questions to ask and a nurse, a friend of mine,
[16:19.880 --> 16:23.100]  she was like, what about, what about that kind of stuff? Does that help?
[16:24.380 --> 16:28.580]  So all of the data that I've seen right now says that there's, you know, again,
[16:28.580 --> 16:34.600]  no conclusive evidence, but, uh, we have a lot of sort of anecdotal, you know,
[16:34.600 --> 16:40.200]  accounts from doctors abroad saying that, you know, if you use ibuprofen, you might
[16:40.200 --> 16:47.740]  see an exacerbation of the disease. It might get worse. Um, it might slow down the, you know,
[16:47.740 --> 16:56.260]  getting better. It might slow down recovery. Um, and you know, we're sort of, you know, the, I.
[17:01.020 --> 17:11.960]  Oh, it looks like you froze on my end. All right. We got cut off, but you're back. And, uh,
[17:11.960 --> 17:20.220]  we were talking about the NSAIDs and, uh, it sounds to me like you heard that they actually
[17:20.220 --> 17:30.660]  prolong the disease itself. So there's, you know, the jury's still out scientifically. Um, there's
[17:30.660 --> 17:35.320]  not conclusive scientific evidence to say that it's definitely bad, but we have heard a lot of
[17:35.320 --> 17:41.700]  anecdotal data from, you know, doctors abroad saying that you shouldn't use ibuprofen
[17:41.700 --> 17:49.100]  specifically. Um, but acetaminophen is fine. Um, you know, I, I was talking about this with some
[17:49.100 --> 17:55.360]  of the people in my lab and we were sort of like, well, you know, it's, is it scientific? No. But,
[17:55.360 --> 18:01.220]  you know, if, uh, if doctors, you know, on the front lines are saying, don't use ibuprofen,
[18:01.760 --> 18:06.880]  you know, use acetaminophen instead. Acetaminophen works just as well then.
[18:07.460 --> 18:10.260]  So I'll listen to them. What do you got to lose?
[18:11.180 --> 18:16.720]  Gotcha. Um, can we talk maybe a little bit about how, how does this disease actually
[18:16.720 --> 18:20.780]  infect people? Like how does it work? Like what does it actually do to somebody?
[18:20.780 --> 18:23.080]  Okay. Um, so
[18:26.860 --> 18:35.720]  basically you have these, um, receptors, uh, called ACE2 receptors. Uh, you might've heard
[18:36.160 --> 18:42.940]  mention of them in the news or something, but they are in your respiratory system. They are
[18:42.940 --> 18:50.460]  in your kidneys. They're in specific tissues in your body, basically. Um, and the
[18:53.200 --> 19:02.920]  SARS virus, um, essentially has with, with this little like spike proteins on the outside, um,
[19:02.920 --> 19:10.240]  connects its protein to that ACE2 receptor. Um, and you know, there's a whole process,
[19:10.240 --> 19:17.460]  but essentially what this leads to is the internalization of the virus into the cell.
[19:17.760 --> 19:25.760]  Um, and then the virus releases its genetic material, its RNA, and that gets transcribed
[19:25.760 --> 19:34.160]  into and translated into proteins. Um, actually it's not transcribed because it's RNA, but it gets
[19:35.080 --> 19:44.520]  made into proteins. The host cell machinery, uh, just makes all of this, you know, stuff that then
[19:44.520 --> 19:52.380]  gets packaged into more virus and then, you know, kind of comes out of the cell and the cell dies.
[19:52.380 --> 20:01.000]  Um, but what really, uh, is the problem with these, with this virus is actually our immune
[20:01.000 --> 20:09.960]  response to it. Um, that severe acute respiratory, uh, distress syndrome. Um, and that's likely
[20:09.960 --> 20:18.060]  mediated by actually inflammation reactions, uh, from the infection in our lungs. Um,
[20:18.060 --> 20:25.360]  and that is what causes, you know, the shortness of breath, the scarring, the extensive damage.
[20:25.360 --> 20:33.260]  Our immune system works very, very well, but it is incredibly powerful and it does, you know,
[20:33.260 --> 20:40.480]  harm our own cells, um, when it gets to, when it, when it, when it gets sort of out of control.
[20:40.560 --> 20:47.520]  Um, and that is, you know, that severe disease that we see with SARS-CoV-2.
[20:47.520 --> 20:50.920]  And then what I've been hearing is that people will get pneumonia and it's actually the pneumonia
[20:50.920 --> 20:55.360]  that they die from. Is that correct? And some people do, not everyone.
[20:55.400 --> 21:01.840]  Oh yeah, certainly, certainly like, uh, secondary pneumonia or that is what you would call it,
[21:01.840 --> 21:09.800]  I think, secondary bacterial infection. Um, so basically you, you clear, you know, SARS-CoV-2
[21:09.800 --> 21:19.440]  from your system, but you know, in doing so, uh, you're, you're, you're sort of at this point in
[21:19.440 --> 21:25.700]  time where your immune system response is sort of depleted and that makes it, and that plus,
[21:25.700 --> 21:32.100]  you know, the damage caused to your lung tissue allows bacteria to start growing in there and
[21:32.100 --> 21:41.980]  cause pneumonia. Um, and that can be a reason why people die, you know, related to COVID-19,
[21:41.980 --> 21:50.240]  even if it's not directly caused by COVID-19. And you see this also with like the flu, um,
[21:50.240 --> 21:55.840]  with, with pneumonia caused by the flu. Oftentimes it's not the flu itself that
[21:55.840 --> 22:00.020]  causes the pneumonia, it's the secondary bacterial infection.
[22:01.420 --> 22:06.680]  And why is it that some people are more affected? Like I've heard that some people don't even get
[22:06.680 --> 22:11.320]  symptoms and some people it's very severe. Like what's, what's the difference between the people
[22:11.320 --> 22:18.780]  that, you know, have, uh, mild symptoms or no symptoms and the ones that, you know, have very
[22:18.780 --> 22:26.260]  severe symptoms? Yeah. Okay. That, that is a very good question. Um, let's step back a little bit
[22:26.260 --> 22:33.660]  and talk more about the idea of an asymptomatic person. Um, so when we think asymptomatic,
[22:33.660 --> 22:42.660]  we're thinking no symptoms ever, you just feel fine. Um, but in practice, when we look at,
[22:42.660 --> 22:46.580]  you know, people who are labeled as asymptomatic, it's because they don't have symptoms
[22:46.580 --> 22:52.980]  at the time of testing, even though they tested positive or they like don't report those symptoms.
[22:52.980 --> 23:00.740]  So, so when we follow those people over time, we, we find that they maybe aren't asymptomatic,
[23:00.740 --> 23:07.640]  they're pre-symptomatic. So they don't have the, they don't see any disease manifestation at the
[23:07.640 --> 23:14.140]  time of testing, but later on they develop symptoms. Um, and you also have a problem with
[23:14.140 --> 23:19.200]  recall. Um, so maybe they have symptoms that they didn't think it was a problem. So, you know, for
[23:19.200 --> 23:25.320]  example, oh, I don't know, I've been, you know, my throat's a little dry, but also I've been working
[23:25.320 --> 23:29.740]  from home the past few days. So I've been, you know, drinking beer throughout the day. I'm a
[23:29.740 --> 23:34.400]  little bit dehydrated, that's probably it. You know, like, I don't have a cough, I just have
[23:34.400 --> 23:40.100]  sniffles when I'm outside, it's probably allergies. Or like, I have a stomach ache, but, you know,
[23:40.100 --> 23:45.460]  it's probably just cause I ate something weird. Um, and so a lot of the times when you, you, when
[23:45.460 --> 23:51.000]  you follow up, you find that people have either developed symptoms later or did have symptoms,
[23:51.000 --> 23:58.700]  didn't think it was a big deal, but, you know, when we talk about, like, true asymptomatic people,
[23:58.700 --> 24:04.980]  there's a lot of things that you can talk about there, a lot of factors that might play into that.
[24:05.460 --> 24:08.700]  That's really interesting, because I think about that, like, when I was in college,
[24:08.700 --> 24:15.000]  I used to drink like crazy and I smoked, and all winter I was sick, and that was just normal for
[24:15.000 --> 24:19.520]  me, right? So I'm wondering how many people that might be in that situation that it's normal for.
[24:19.520 --> 24:23.660]  Now, now I drink a beer and I, like, realize that I have trouble sleeping at night. I'm like,
[24:23.660 --> 24:27.580]  you know, like, I really, I can tell the difference, like, I'm more in tune,
[24:27.580 --> 24:32.720]  attuned to my body, and I'm just older too, I think. And so that's interesting. So that could
[24:32.720 --> 24:39.000]  be a difference that, you know, some people just maybe a lot of times they're sick or they get
[24:39.000 --> 24:43.120]  sick frequently, so they don't really notice that, you know, it's, it's, it's really a big difference
[24:43.120 --> 24:49.160]  kind of a thing. Yeah, I've heard a lot of reports of, like, people testing positive for COVID-19
[24:49.160 --> 24:55.980]  and being like, I thought this was just allergies. Like, I didn't think this was a problem. And,
[24:55.980 --> 25:04.340]  you know, maybe it is, maybe it isn't. There's a lot of diverse symptoms for COVID-19. Some people
[25:04.340 --> 25:10.320]  are reporting, you know, diarrhea, you know, stomach aches, and those things, you know, people
[25:10.320 --> 25:16.460]  might not think about when they're asked to report their symptoms. If they test positive, they're
[25:16.460 --> 25:22.360]  like, well, that's not a symptom. That was just me eating something weird last night. Sure. And then
[25:22.360 --> 25:33.460]  why is this one more contagious than other diseases that we've seen? So, this is a really
[25:33.460 --> 25:38.840]  salient question right now. And I think that we need to lay some groundwork. So let's, let's talk
[25:38.840 --> 25:45.260]  about the R naught, the R zero, as you've probably seen it, you know, in the news, it's pronounced R
[25:45.260 --> 25:51.900]  naught. This is an important measure in epidemiology. It's called the basic reproductive rate.
[25:51.900 --> 25:59.940]  So, in essence, the number of people that one infectious person will, on average,
[25:59.940 --> 26:06.240]  infect in a naive population. So, this is estimated by, you know, complex mathematical models done on
[26:06.240 --> 26:13.200]  current data. The nature of the model itself does affect the R naught value. So, one, you know,
[26:13.200 --> 26:19.380]  that might be why you see so, such different, you know, R naughts, anywhere from like two to four.
[26:20.000 --> 26:25.240]  And it's used to... And that's two to four is the number of people that someone will infect,
[26:25.240 --> 26:30.800]  is that what you're saying? On average, yes. And it's used, so the R naught is used to describe
[26:31.360 --> 26:39.620]  contagiousness. And it's very easy to misinterpret because it's not entirely static in practice.
[26:39.800 --> 26:46.820]  Because, you know, you're, you know, people don't exist in a vacuum. There's cultural things in
[26:46.820 --> 26:52.420]  place. There's personal things in place. And so, in practice, the R naught is affected heavily by
[26:52.420 --> 26:59.520]  biological and social and environmental factors. So, for example, how big in the population you're
[26:59.520 --> 27:05.120]  looking at is your personal space bubble? You know, we in America love our personal space,
[27:05.120 --> 27:09.760]  but I know some European countries, you know, don't really care that much. You know,
[27:09.760 --> 27:15.180]  how much intermixing does the population do? How healthy is your population? And how old?
[27:15.180 --> 27:22.120]  How many people smoke? How many people have diabetes or hypertension? So, it's not a biological
[27:22.120 --> 27:34.100]  constant. It's highly situational. And when we, when we talk about, you know, COVID-19 being more
[27:34.100 --> 27:41.780]  infectious than the flu, for example, there's, there's a lot of things in place for the flu that
[27:41.780 --> 27:50.560]  affect this, the flu's, like, transmissibility, the flu's contagiousness. So, for example,
[27:51.460 --> 27:56.680]  people who are most often at risk for respiratory illness are the elderly,
[27:56.680 --> 28:02.600]  the immunocompromised, and young children, although for reasons we still don't really know,
[28:02.600 --> 28:10.760]  their young children aren't as affected by COVID-19. But for the flu, we have things in place
[28:10.760 --> 28:20.040]  to protect our most vulnerable population from the virus and the disease. So, we have vaccines,
[28:20.040 --> 28:26.380]  like, PSA, always get your flu vaccine if you can, unless a doctor tells you not to,
[28:26.380 --> 28:33.020]  because the vaccine could either prevent you from getting it, or it could shorten the duration and
[28:33.020 --> 28:39.000]  intensity of the sickness. And that is important because it means that there's less time that
[28:39.000 --> 28:47.820]  you're infectious. We also have prophylaxis for the flu. So, your doctor might prescribe
[28:47.820 --> 28:54.900]  members of your household, like Tamiflu, I think it is, if, if one member of your household is sick,
[28:54.900 --> 29:03.360]  and that's supposed to be protective, so that people who aren't sick don't get sick. So,
[29:03.360 --> 29:08.280]  even if you are around an infected person, we have protective measures in place. And, you know,
[29:08.280 --> 29:14.200]  the last sort of salient point is that the flu circulates every single year. So, you're
[29:14.760 --> 29:21.140]  real likely to have some sort of prior exposure, and that sort of prior exposure to the influenza
[29:21.140 --> 29:27.500]  virus might be cross-protective, depending on the strain. So, it's thought that in 2009,
[29:27.980 --> 29:33.660]  the H1N1 pandemic wasn't as bad in the United States as it could have been for us,
[29:34.200 --> 29:46.100]  because it is theorized that maybe the United States population, you know, experienced a
[29:46.100 --> 29:56.060]  flu strain that was similar enough that we had some sort of cross-immunity to it. In, in, in
[29:56.060 --> 30:02.660]  2009 to 2010, only 12,000 people died, and that's, you know, still a lot of people
[30:04.080 --> 30:10.800]  for H1N1. But, you know, when we talk about current statistics, I was looking it up before
[30:10.800 --> 30:18.740]  this conversation, and there are over 8,000 people currently dead from COVID-19 in the
[30:18.740 --> 30:26.540]  United States. Jeez, wow. And we just don't have that for SARS-CoV-2. We don't have that for COVID-19.
[30:26.540 --> 30:32.640]  We don't have treatments. We don't have the vaccine. Our entire population is, you know,
[30:32.640 --> 30:37.680]  sort of naive to this. There's not good evidence of cross-reactivity between
[30:38.480 --> 30:47.160]  this coronavirus and other coronaviruses that we've seen. So it's certainly a different,
[30:48.620 --> 30:56.810]  you know, landscape for this disease. And when we compare it to another coronavirus, another,
[30:56.810 --> 31:03.690]  you know, important coronavirus, SARS, the original, so I'm just going to call that SARS-1,
[31:03.690 --> 31:17.790]  even though it's just called SARS. You see infection more for SARS-2 than SARS-1.
[31:18.670 --> 31:25.370]  Paradoxically, because SARS-1 was a worse disease, it had a 10% mortality rate. I think
[31:26.810 --> 31:37.690]  some estimates were like 10 to 15. And it was just, you know, a horrible disease. But on the
[31:37.690 --> 31:43.810]  other side, it was very easy to find the cases and diagnose them and isolate them from the population.
[31:44.370 --> 31:55.130]  And also, you know, with SARS-1, you were not infectious in the 24 to 36 hours
[31:55.870 --> 32:08.770]  before, you know, your symptoms started. But in COVID-19, because the disease can present so mild,
[32:09.570 --> 32:14.350]  you know, you don't often see it. It's not as easy to detect.
[32:14.690 --> 32:18.910]  Yeah. And I also heard that it'll be like a seven-day
[32:18.910 --> 32:25.110]  incubation period where you might not show symptoms for seven days. Is that correct?
[32:25.130 --> 32:27.930]  Yeah. And why is that?
[32:27.990 --> 32:35.850]  So I think the infectious period is like two to 14 days, median of five. But basically,
[32:37.750 --> 32:46.790]  it's interesting because infection is, you know, sort of a slower process. You know,
[32:46.790 --> 32:54.550]  biological processes are kind of slow. You know, again, like I said before, a lot of the symptoms
[32:54.550 --> 32:59.550]  you see are due to your immune response to the infection. So there's a number of steps you have
[32:59.550 --> 33:06.210]  to go through before you even get to that point. So you need to, you know, have the virus invade
[33:06.210 --> 33:13.950]  your cells. The virus needs to repurpose the cell machinery, replicate and spread to other cells.
[33:13.950 --> 33:19.770]  And it needs to have a large enough effect that your immune system mounts a large enough response
[33:19.770 --> 33:27.230]  that you start on a whole organism level, start seeing the effects. And I mean, there's 37,
[33:27.740 --> 33:36.150]  I think, trillion cells in our body. So it does take a while, often,
[33:36.730 --> 33:43.310]  for us to mount an immune response that, you know, we can physically tell.
[33:43.690 --> 33:46.690]  36 trillion. Wow. I didn't know that.
[33:46.690 --> 33:54.150]  There's a lot of cells. Not all of them can be infected by SARS-2. But, you know,
[33:54.150 --> 34:02.410]  it's just giving you an idea of how large of a dissemination it would have to have before it
[34:02.410 --> 34:10.270]  starts, you know, making a dent. But with SARS-1, you get it and then you pretty much see the
[34:10.270 --> 34:13.530]  effects immediately. You have that response a lot quicker.
[34:14.130 --> 34:24.570]  So SARS-1 was, you know, a much more virulent disease. It was a lower respiratory as opposed
[34:24.570 --> 34:31.370]  to an upper respiratory tract infection. So we see mostly upper respiratory tract infections
[34:31.370 --> 34:39.290]  with COVID-19. So like coughing, sneezing, it's, you know, really concentrated up here.
[34:40.470 --> 34:49.090]  It can go to the lungs, but, you know, SARS-1, in my understanding, was almost exclusively the
[34:49.090 --> 34:55.250]  lungs. And there are, you know, some molecular reasons why this might be true. It might be
[34:55.250 --> 35:06.450]  because the binding domain of the spike protein in SARS-2 is a much better binder. And there's
[35:06.450 --> 35:13.610]  much less ACE2 receptors up here. So because it's so good at binding, it binds to these
[35:13.610 --> 35:21.470]  receptors up here and maybe doesn't, you know, infect all the way down here. But SARS-1 wasn't
[35:21.470 --> 35:27.050]  as good at binding, so it didn't really affect, you know, your upper respiratory tract. It really
[35:27.050 --> 35:31.550]  only affected where there was a lot of ACE2 receptors, you know, in your lower respiratory
[35:31.550 --> 35:38.930]  tract. Lower respiratory tracts, in general, are more severe than upper respiratory tract
[35:38.930 --> 35:48.390]  infections. Not always, but mostly. Gotcha. So your first talk that you gave at CypherCon,
[35:48.390 --> 35:54.790]  it was on bioweapons, right? Is that correct? Yeah. Is this a bioweapon? You know, I think one
[35:54.790 --> 36:02.090]  of the things I've heard is, you know, where this emerged in Wuhan, there is a bioresearch facility
[36:02.090 --> 36:07.070]  that's like 20 miles away from there. So some people are saying they could have just made it
[36:07.070 --> 36:18.730]  and then said that it was in this wet market. Could that be the case? No. Short answer, no.
[36:19.370 --> 36:27.490]  There has been real interesting work on the genome of SARS-CoV-2 and looking at it and trying to see
[36:27.490 --> 36:36.310]  if there is any sort of, you know, biological fingerprints, you know, the clues that someone
[36:36.310 --> 36:42.010]  might have been messing around in there. There's not. What would you look for? So
[36:44.090 --> 36:49.630]  a lot of things that you would look for are, you know, similar things to other viruses that you
[36:49.630 --> 37:01.910]  don't see in the native circulating coronaviruses. We did see that, like, there was 96, I think,
[37:01.910 --> 37:11.190]  percent genetic identity with another coronavirus isolated from pangolins. And, you know,
[37:11.870 --> 37:20.530]  also very high genetic similarity to a virus isolated from bats. We think that this
[37:22.590 --> 37:30.470]  specific coronavirus SARS-CoV-2 started in bats and then jumped to humans.
[37:33.050 --> 37:40.970]  And it's just, you know, the thing with the biology research facility is that, yes,
[37:40.970 --> 37:48.140]  there is a BSL-4 lab in Wuhan. What does BSL mean? BSL means biosafety level.
[37:49.170 --> 37:58.150]  So it has an increasing, you know, order of severity, which sort of means, like, at BSL-1,
[37:58.150 --> 38:04.870]  these are things that don't cause disease in humans. BSL-2, maybe it causes disease or even
[38:04.870 --> 38:10.870]  severe disease in humans, but it's real, real hard to contract if you're working with it.
[38:10.870 --> 38:17.770]  BSL-3 are, you know, diseases that are, can cause severe disease and can be transmitted
[38:17.770 --> 38:26.470]  through inhalation. BSL-4 is for research on things that, you know, are, that can cause
[38:26.470 --> 38:36.370]  severe disease and don't really have a good treatment. But we have multiple BSL-4 laboratories
[38:36.370 --> 38:42.550]  in the United States. The existence of a BSL-4 laboratory doesn't prove anything. And
[38:42.550 --> 38:50.910]  from what we have, you know, investigated on the virus itself, there's no evidence of it being
[38:52.550 --> 39:00.090]  a bioweapon. And also, you know, it would be real bad practice for the Chinese government to just
[39:00.090 --> 39:08.090]  release a bioweapon on themselves. Um. Yeah. I did see, like, this Russian conspiracy theory,
[39:08.090 --> 39:14.230]  uh, early on, that, like, it was actually the United States that created this bioweapon and
[39:14.230 --> 39:20.870]  released it in China, but, like, you know, that would be kind of stupid, considering,
[39:20.870 --> 39:29.390]  like, how we responded to, uh, COVID-19 in the United States. Um. Well, my thought was,
[39:29.390 --> 39:33.570]  you know, if it was China and they were doing this, like, yeah, it'd be a bad move to do it
[39:33.570 --> 39:38.890]  on their own people. China also plays the long game, though. They, like, they, like,
[39:38.890 --> 39:45.690]  plan things out for, like, a really long time. And so my thought was, if it was the case,
[39:46.170 --> 39:51.190]  um, they would, they would, you know, they would, I mean, obviously they would have,
[39:51.190 --> 39:57.130]  and they have had, you know, horrible repercussions on their population. However,
[39:57.130 --> 40:01.910]  they, being a communist government, they're able to contain it, I think, a lot better than the
[40:01.910 --> 40:07.950]  United States could. So, you know, if that was the case, you know, they could potentially, uh,
[40:07.950 --> 40:14.190]  know this ahead of time and realize that, you know, they would be better off to contain it than,
[40:14.190 --> 40:22.250]  you know, our country, for example. And, uh, that would be kind of a, I don't know,
[40:22.250 --> 40:27.290]  strategic advantage, I guess, um, being a communist country. You know, the strategic
[40:27.290 --> 40:35.090]  advantage kind of fades away when you really look at the immense economic impact that this pandemic
[40:35.090 --> 40:42.510]  has had globally, and especially on China. Right, exactly. Yeah, so they, yeah. All their stuff's
[40:42.510 --> 40:51.510]  made in China. Yeah. So, you know, it's, I don't think anybody's really a winner in all this. No.
[40:51.510 --> 40:56.290]  Maybe, maybe the virus itself. Yeah. Well, and that, that could be the case too, you know,
[40:56.290 --> 41:01.990]  like a lot of people think that this is the earth being like, hey, stop it, like, chill out. And
[41:01.990 --> 41:10.310]  like, this is our, you know, mother nature's way of saying, hey, like, take a, take a time out.
[41:11.410 --> 41:20.490]  So, um, I will say that, like, as a scientist, I don't really subscribe to that sort of idea.
[41:21.890 --> 41:32.790]  That being said, um, we've seen, you know, several zoonotic, zoonotic jumps of coronaviruses from,
[41:32.790 --> 41:41.470]  you know, bats to humans, and this is likely not the last. I mean, two in 20 years is super common
[41:41.470 --> 41:48.290]  for, for, you know, on a, like, zoonotic level, because that's, that's an incredibly, like,
[41:48.290 --> 41:56.130]  difficult thing for a virus to do. Um, you know, it's not necessarily that nature is,
[41:56.130 --> 42:02.730]  has a vendetta against us, but I think especially with our global society that we have now,
[42:03.610 --> 42:10.970]  and, you know, the interconnectedness that we have, it's in, it's incredibly salient now to
[42:10.970 --> 42:17.030]  start building up, you know, global public health infrastructures so that, you know,
[42:17.030 --> 42:23.130]  these sorts of things can be responded to in a timely way. Yeah, I wanted to ask you about that,
[42:23.130 --> 42:29.290]  like, what, what do you think about the United States and the world's response to this pandemic,
[42:29.290 --> 42:35.610]  and what would you do if you were in charge? What would you do differently? All right, um,
[42:36.150 --> 42:43.230]  so on sort of a global scale, we see very different responses. Um, the, the United States
[42:43.230 --> 42:53.770]  didn't really acknowledge the problem until, you know, late February, early March, um, but I know
[42:53.770 --> 43:02.350]  that in my classes and in, you know, the, with the, you know, people who have been working in
[43:02.350 --> 43:11.590]  the field for a long time, uh, I was hearing that SARS-2, or, uh, was going to be the next pandemic
[43:11.590 --> 43:20.670]  in mid, late January. Wow. Um, we knew about this for a long time. Um, and, you know, we should have
[43:20.670 --> 43:28.870]  been taking that time to ramp up our testing capacity, develop diagnostics, you know, start,
[43:28.870 --> 43:35.390]  you know, preparing for the worst here, um, you know, screening and isolating cases. I know that,
[43:35.390 --> 43:41.510]  you know, people coming back from, uh, China were told to quarantine, but not people coming back
[43:41.510 --> 43:50.870]  from Italy after, uh, even after Italy started experiencing some really bad outbreaks. Um,
[43:52.070 --> 43:58.250]  when you compare what's going on the, in the United States to what happened in, for example,
[43:58.250 --> 44:05.510]  South Korea, where they had widespread drives through testing, they, you know, tested a huge
[44:05.510 --> 44:12.310]  population. They had great public health response. They didn't really do shelter in place or
[44:12.310 --> 44:20.470]  quarantine, you know, sort of practices that we see. And yet they, they really managed to, you
[44:20.470 --> 44:27.290]  know, mitigate a lot of the transmission that was going on. Um, you know, just by testing early,
[44:27.290 --> 44:33.790]  like that was a big thing. It's just, just, just, hey, you know, detecting these cases and,
[44:33.790 --> 44:41.810]  you know, having proper isolation of those cases. Cause if you look at the phylogenetic tree,
[44:41.810 --> 44:48.350]  so the genetic tree, like the family tree, if you will, of these, of the viruses that we have
[44:48.350 --> 44:57.230]  sequenced in the United States, um, you will see that a good chunk of cases can be directly traced
[44:57.230 --> 45:07.170]  back to one case in late January in Seattle from one person who had returned from China.
[45:07.430 --> 45:14.450]  Wow. So if we had, you know, for example, caught that case or, you know, had
[45:16.170 --> 45:23.750]  a little bit better surveillance, um, maybe we could have stopped that entire, you know,
[45:23.750 --> 45:34.990]  branch of viruses, of, of coronavirus, um, uh, SARS-CoV-2, um, infection here. And, you know,
[45:34.990 --> 45:44.770]  there are other, there are other, um, events where people brought, uh, COVID-19 over from
[45:44.770 --> 45:54.010]  other places as well, for sure. But, you know, once it's in the population and circulating,
[45:54.010 --> 46:01.390]  it's incredibly hard to get a handle on it, especially if you're not testing. Because,
[46:01.390 --> 46:06.610]  you know, people, like I said before, people who don't have symptoms or have mild symptoms,
[46:06.610 --> 46:10.790]  they were just going about their day. They didn't realize that anything was wrong.
[46:10.790 --> 46:14.670]  And at that point, you can't, you can't trace it back and figure out, okay, well,
[46:14.670 --> 46:20.330]  who are all these people that you interacted with? And like, who were they interacting with? And so
[46:20.330 --> 46:25.090]  who has it? Who doesn't have it? And so, yeah, that's just the hard thing about this one, right?
[46:25.090 --> 46:31.590]  Because, because of the mild, severe symptoms, we don't know. And so like the, the only way to
[46:31.590 --> 46:39.170]  really fight it is to sit on the couch, right? Yeah. So right now, um, for the average person,
[46:39.170 --> 46:47.570]  like the best thing you can do is stay the fuck home. Like, don't go out. Don't, you know, run the
[46:47.570 --> 46:53.470]  risk that you might be infected and bring it home to your loved ones. And don't run the risk that
[46:53.470 --> 47:02.070]  you transmit this disease to someone who might be immunocompromised or, you know, might have
[47:02.070 --> 47:10.010]  any number of factors that lead to them having severe disease. Yeah. Yeah. I've seen this meme,
[47:10.010 --> 47:15.190]  like on the internet, like your, your grandparents went to war. You're being called to sit on the
[47:15.190 --> 47:21.770]  couch. Like you can do this. Yeah. And of course it's, it's important to remember that it's okay
[47:22.470 --> 47:28.490]  right now to be stressed out. It's okay to be a little bit scared. It's a scary time. Like
[47:29.970 --> 47:36.270]  social distancing is incredibly stressful. Humans are social creatures, but this is important.
[47:37.130 --> 47:43.410]  Yeah. Yeah. So, uh, can you tell me a little bit about like the quarantine, like how,
[47:43.410 --> 47:48.030]  so, I mean, the, the goal is to flatten the curve, right? So that we don't like
[47:48.030 --> 47:57.050]  overwhelm the hospital system and the healthcare system. Um, how do you, so, so how does, um,
[47:57.050 --> 48:03.610]  how does a quarantine affect the numbers? Okay. So a quarantine, um,
[48:05.030 --> 48:13.590]  would affect the numbers in that, you know, each person, if they are actually quarantined,
[48:13.590 --> 48:18.110]  being quarantined, they're less likely to come in contact with an infectious person.
[48:18.250 --> 48:27.030]  And if they are infectious, you know, conversely, they are less likely to come into contact with a
[48:27.030 --> 48:33.730]  so when you quarantine and you, you know, practice social distancing, um,
[48:35.110 --> 48:43.510]  you really lower that potential rate of infection. And when I was talking earlier about the, are not
[48:43.510 --> 48:50.230]  being a sort of plastic measurement, uh, when you put quarantine measures in place,
[48:50.230 --> 48:55.500]  you're essentially lowering the, you know, real time are not, if you will,
[48:55.500 --> 49:00.500]  you know, like, because you're less likely to come into contact with people, you're less,
[49:00.500 --> 49:09.540]  the number of people that you would infect goes, goes down. Um, so you really see when you factor
[49:09.540 --> 49:21.840]  in, you know, sort of the, the, like, the exponential growth of, uh, of, of a pandemic.
[49:21.840 --> 49:27.680]  When you, if you get this, you know, early, if you, if you start social distancing, start
[49:27.680 --> 49:35.360]  quarantining early, you can prevent hundreds of cases down the line over multiple rounds of
[49:35.360 --> 49:40.800]  transmission. Yeah. That's what I, um, actually early on, like, I think it was like the beginning
[49:40.800 --> 49:46.140]  of March Gutsman actually shared with me this, uh, video that showed like the exponential growth.
[49:46.140 --> 49:51.000]  And like, as humans, we don't really understand exponential. We don't take an exponential terms.
[49:51.000 --> 49:54.660]  We're thinking like linear terms. So like, you know, a couple of people are getting sick and
[49:54.660 --> 49:58.740]  people are like, what's the big deal, you know? And, but if you look at this exponential curve
[49:59.080 --> 50:04.520]  and if, and it's like that rate of change from day to day. So like, I think at the time it was,
[50:04.520 --> 50:07.660]  and I don't know what it is now. And I don't know if you have these numbers, but like,
[50:07.660 --> 50:15.200]  it was a 30% increase from the one day to the next. And if it stayed at that rate, it was like
[50:15.200 --> 50:19.960]  after, I can't remember the numbers. It was either 60 days or a hundred, I think it was 60 days. It
[50:19.960 --> 50:23.860]  was a hundred million people that would be infected. But if they changed that rate down to
[50:23.860 --> 50:29.300]  like 5% per day, that hundred million number went down to, and I'm probably getting these numbers
[50:29.300 --> 50:35.520]  wrong, but it went down to like 400,000. So it's just a huge difference. And that's really what
[50:35.520 --> 50:49.940]  we're attempting to do with the quarantine, right? Yeah. So we're trying to, you know, stop,
[50:50.640 --> 50:58.700]  so that hundreds of infections don't happen tomorrow, essentially. And, you know,
[50:58.700 --> 51:05.220]  this is, it's so vital because you talk about flattening the curve, but what does that really
[51:05.220 --> 51:14.820]  mean? I mean, so a few weeks ago, I was talking to a professor at Berkeley, professor of infectious
[51:14.820 --> 51:23.680]  diseases. And he gave me the numbers. He said in the United States, there are 62,010 hospitals.
[51:23.800 --> 51:33.440]  In those hospitals, there are 909,200 staffed beds. 10% of those are ICU beds. So the beds
[51:33.440 --> 51:40.100]  that you would want to be in, if you are, you know, needing to be intubated, you need,
[51:40.100 --> 51:44.280]  you're having very severe symptoms, you're having very severe disease.
[51:45.640 --> 51:51.960]  That, of course, that number is likely changed by now because, you know, hospitals are repurposing
[51:51.960 --> 51:59.000]  conferences and lobbies to act as makeshift wards or repurposing, like, sports stadiums to act as,
[51:59.000 --> 52:06.480]  like, emergency hospitals. But, you know, those were the numbers a few weeks ago. And, you know,
[52:06.480 --> 52:14.160]  if you, if you, even if you were able to staff all of those available ICU beds,
[52:16.240 --> 52:25.940]  if you saw, you know, if you saw more than 90,000 or so cases of severe diseases that needed that,
[52:25.940 --> 52:32.060]  you know, that equipment and that treatment, then you'd have to make a very, very tough ethical
[52:32.060 --> 52:40.320]  decision of who gets the treatment that might save their life and who doesn't. And, you know,
[52:40.320 --> 52:46.020]  each person, for each person, that treatment may or may not save their lives, but if they
[52:46.020 --> 52:53.300]  don't get that treatment, they are likely to die. And so that is the sort of thing that we're trying
[52:53.300 --> 52:58.840]  to steer away from. That is the worst case scenario, because then you'll see what we see
[52:58.840 --> 53:06.100]  right now in Italy, with, you know, incredibly high death rates, because their health care system
[53:06.100 --> 53:12.380]  is just overwhelmed. How do you think the health care system is going to change as a result of this?
[53:13.460 --> 53:25.140]  So, I can only hope. But I hope that there is a push to invest in public health. You know,
[53:26.040 --> 53:33.940]  public health is one of those things where it's invisible, if it's doing its job.
[53:34.440 --> 53:40.820]  You can't, this is not, especially in, you know, times when there's not a pandemic going on,
[53:40.820 --> 53:47.280]  these things are important, because having that, you know, global surveillance, looking at,
[53:47.280 --> 53:54.480]  you know, the potential things that might spill over into humans, creating infrastructure for
[53:54.480 --> 54:00.300]  widespread testing, these are things that can only happen over time. I mean, it's like,
[54:00.300 --> 54:06.820]  it's sort of like brushing your teeth, right? You know, you can sort of meander along until you start
[54:06.820 --> 54:13.840]  having a toothache, and then after you start having that toothache, you can brush five times a day,
[54:13.840 --> 54:22.500]  and it won't really, you know, do all that much. You need to go to a dentist, you need to get it
[54:22.500 --> 54:29.060]  taken out, you need to get it, you need to get it, you know, addressed. And so right now,
[54:29.640 --> 54:34.680]  a lot of the problem with our public health system in the United States is that we're just
[54:34.680 --> 54:43.000]  so understaffed. There's not enough people working in the CDC to do the things that we need to.
[54:43.060 --> 54:52.260]  We don't have the testing capacity that we, you know, should have in this scenario. We can't test,
[54:52.260 --> 54:59.440]  the population. We have to save our tests for people who have severe disease, or who like,
[54:59.440 --> 55:07.100]  present with, you know, symptoms in a hospital. And this is a problem, because now we don't know
[55:07.100 --> 55:14.420]  how widespread it is in the population. We don't know if, you know, you know, a few months from now,
[55:14.420 --> 55:19.580]  if we see the case number goes, go down, and we, if we still haven't tested by then, and we don't
[55:19.580 --> 55:25.500]  know the prevalence in the community, how do we know that if we let up our quarantine, that we
[55:25.500 --> 55:34.640]  won't just get sustained transmission again? These are things that would be helpful to do as early as
[55:34.640 --> 55:40.640]  possible. Yeah, you can't, I guess, once you start losing your teeth, you can't brush them, and then
[55:40.640 --> 55:46.180]  hopefully they grow back, right? It's like, yeah, you got to do the prevention stuff beforehand.
[55:46.180 --> 55:51.360]  So yeah, hopefully we learn this as a lesson, and start putting in some of those, that
[55:51.360 --> 55:58.800]  infrastructure in place, so that we're able to contain these things in the future. Any predictions
[55:58.800 --> 56:08.040]  that, you know, when we might sort of get back to normal? So this is probably going to be
[56:08.040 --> 56:13.560]  disappointing, but it's just, I'm gonna say what all the other public health professionals are
[56:13.560 --> 56:21.680]  saying, it's too early to tell. I do know that, you know, I was talking with a professor of mine
[56:21.680 --> 56:28.080]  who worked in the CDC for decades, and he was saying that he would be surprised if all of this
[56:28.080 --> 56:35.600]  was all over by, like, August. Now, what exactly that means is, you know, another question, like,
[56:35.600 --> 56:41.520]  does that mean that some people can go back to work? Does that mean that, you know, we,
[56:41.520 --> 56:48.800]  you'd be surprised if, like, all of it was over, so we don't have COVID-19 anymore, or what? You
[56:48.800 --> 56:56.420]  know, I don't know, but there's, it's, there's, there's a lot of important questions there. For
[56:56.420 --> 57:05.640]  example, is it seasonal? Is, is it going to, you know, start to ramp down a little bit as
[57:05.640 --> 57:15.520]  the weather gets warmer? We don't know that yet. And even if it does,
[57:15.520 --> 57:23.300]  will it, like other seasonal diseases, like the, the flu, for example, just come back
[57:23.300 --> 57:30.000]  once it gets cold in the winter again? You know, I think that if it does, if it is seasonal, then
[57:30.000 --> 57:37.440]  it is likely to come back. But, you know, I could be wrong.
[57:38.820 --> 57:43.460]  There are several, several things that we don't know.
[57:44.260 --> 57:52.560]  Yeah, well, yeah, this has been kind of doom and gloom. I'm gonna try to maybe,
[57:52.560 --> 57:59.420]  try to end this on a little bit of a positive note. My, I know for me, personally, like,
[57:59.420 --> 58:04.880]  it's just been so weird. And like, I've had like this weird anxiety that I've been like,
[58:04.880 --> 58:08.940]  you know, just, it's just, it's just so bizarre, because I don't want to go out and help. But like,
[58:08.940 --> 58:13.280]  people are telling me the best thing you can do is stay inside. So that's what I've been doing.
[58:13.280 --> 58:18.020]  But I've been getting out on my bike every day. I've been going for a bike ride, so I stay sane.
[58:18.020 --> 58:22.960]  So I just want to give, you know, some suggestions to folks. If you're feeling antsy, like,
[58:22.960 --> 58:27.100]  you know, you can go outside, go for a walk, go, like, get some exercise.
[58:27.780 --> 58:33.060]  Make sure that, you know, if you have a meditation practice, or maybe you don't. And for me,
[58:33.060 --> 58:38.960]  meditation really is grounding. And it's been very helpful for my life. So I want to recommend
[58:38.960 --> 58:45.760]  to folks that, you know, find some, some quiet time to pause and reflect, because this is a good
[58:45.760 --> 58:51.680]  time to do it. Because a lot of the things that we we've been normally been able to do and go out
[58:51.680 --> 58:58.160]  and do and we're, we're not able to. So, so those are a couple pieces of advice I have. And do you
[58:58.160 --> 59:03.000]  have anything that you'd like to share with people? Yeah, I mean, it's important to remember
[59:03.000 --> 59:11.220]  that you are not alone in all of this. And everybody is, is feeling these feelings. You
[59:11.220 --> 59:18.000]  know, I've been Skype calling, you know, video chatting with friends. I've been playing video
[59:18.000 --> 59:25.600]  games online with friends. I've been, you know, reconnecting with people. My lab does a weekly
[59:26.860 --> 59:34.960]  journal club where we read recent articles about COVID-19. And we also like, you know, have a drink,
[59:34.960 --> 59:44.740]  talk about them. It's important to reach out right now. Yeah, for sure. And it's, you know,
[59:45.140 --> 59:49.960]  a struggle for everybody. And, you know, we don't talk enough about how, how much of a struggle it
[59:49.960 --> 59:54.920]  is for, you know, the essential workers out there. You know, not just the healthcare workers,
[59:54.920 --> 01:00:00.060]  although certainly the healthcare workers are weathering a lot of it themselves. But,
[01:00:00.060 --> 01:00:05.360]  you know, the grocery store employees, the like, people making your food that you order on
[01:00:05.360 --> 01:00:10.560]  Grubhub or whatever. The truck drivers are delivering the food. The postal workers. Right,
[01:00:11.060 --> 01:00:20.080]  you know, like, the, it is a stressful and, you know, very scary time right now. And it's
[01:00:20.080 --> 01:00:24.600]  important that, you know, you're a, you can, you reach out. And it's important that you connect
[01:00:24.600 --> 01:00:30.400]  with other people in ways that you, you can, in ways that are safe for you. Definitely get outside
[01:00:30.400 --> 01:00:39.960]  and like, take a walk, you know, stay six feet apart from people, but do that. You know,
[01:00:42.560 --> 01:00:48.280]  it's stressful, but this is doing a lot. Like, people out there who are, you know,
[01:00:48.280 --> 01:00:52.740]  stressed out and in their homes and feel trapped, you are making a difference.
[01:00:53.300 --> 01:01:00.840]  That's a good thing to remember. Yeah. So I think that's what we can take away is stay the fuck
[01:01:00.840 --> 01:01:06.460]  home and you are making a difference. Have your digital happy hours, you know, you can get creative
[01:01:06.460 --> 01:01:12.360]  with things, you know, ways to stay in touch with people. We, at least we live in an age right now
[01:01:12.360 --> 01:01:17.120]  where, you know, we do have the digital technology that is allowing us to connect with people. We do
[01:01:17.120 --> 01:01:23.600]  have that. So it's not the same by any means, but it's, you know, it's a, it's better than not being
[01:01:23.600 --> 01:01:32.140]  able to connect with people. So yeah, it is certainly better than it could be. All right,
[01:01:32.140 --> 01:01:39.660]  Michelle. Well, yeah, thank you so much for taking the time to kind of walk us through the
[01:01:39.660 --> 01:01:48.360]  whole COVID-19 and learn about everything that you're doing and enlightening us with your wisdom
[01:01:48.360 --> 01:01:55.240]  and intelligence. So much appreciated. Thank you for having me. It's always a pleasure.
[01:01:56.400 --> 01:02:00.440]  All right. Well, hopefully we'll see you next year at CypherCon.
[01:02:00.880 --> 01:02:06.800]  Yeah, we'll see. We'll see what happens. You know, if CypherCon is going on next year, I will be there.
[01:02:06.800 --> 01:02:10.180]  All right. All right. Well, thanks a lot, Michelle. Okay.