The Daily Beast Podcast - BONUS - Extended Interview With The Atlantic's James Hamblin

Episode Date: May 3, 2020

Surprise! As a bonus for our listeners, we have released an extended interview culled from our second episode of The New Abnormal with Dr. James Hamblin. Dr. Hamblin goes further in-depth on the COVID-19 crisis and the effects it can have on the body. Hosted on Acast. See acast.com/privacy for more information. Learn more about your ad choices. Visit podcastchoices.com/adchoices

Hey folks. As a special for our Beast Inside listeners, we'd like to offer you this extended interview with James Hamblin from the Atlantic Magazine and Yale University. James gave us more than we could possibly use in our podcast interview about the coronavirus crisis, treatments for COVID-19, and how the administration has mishandled the entire crisis. We hope you'll enjoy it. James was a brilliant guest, and we learned a lot. So James, I'm going to lead with this because I'm a ray of sunshine, but then I'll ask the alternative version two. What's your worst case scenario for COVID and Corona in the next year? And contrary, what's your best case scenario? This is only based on me speaking regularly with disease modelers who know more than I do. The worst case is that the antibody tests you're seeing are not actually very accurate.

They're not picking up true coronavirus. They're picking up coronavirus antibodies that refer to other coronaviruses and they don't confer immunity. We've lost 30,000 or so Americans in the last about a month. Right, more. We might continue to have society shut down to a degree that it is, which is really devastating to people financially and emotionally and in other health ways. You know, we're canceling elective surgeries. People can't go see their doctors for things they want to go see them for.

And yet we continue to have this sort of steady but still tragic rate of losses of people in the tens of thousands month after month after month until we get a vaccine, which could be as much as two years, three years before we actually have, it's actually distributable and is able to be given to everyone. So that would mean losses in the millions of lives. That is really, really bad to me. That's the worst case scenario. I don't think that's going to happen.

I'm much more hopeful that there is some degree of immunity out there. I don't know what it is, but that there are enough people out there who will have immunity for maybe, in a best case scenario, many years, and who have had asymptomatic cases and who can move about the world without fear that they're spreading or at risk of contracting the disease. And those people can feel no concern and do their jobs.

I think that's very unlikely. That would be a probably best case scenario that we have a lot of asymptomatic cases. And we approach herd immunity of 60% of people getting those antibodies within a matter of months. But again, I don't think that is like that. So you think it's somewhere in between? Yes. I literally just got off a call with two modelers from Yale. and I couldn't get them to give me anything.

Right. There's so little information. The two big variables are that we don't have a testing capacity to know exactly who has had it, and we don't know exactly what these antibody tests mean, if a person really is immune, and how long that would last, whether it would really protect you. Those could change things radically. If it turns out, we have huge rates of asymptomatic cases, and if you had an asymptomatic case, you turn up to be completely protected, that would be glorious and that would radically change

projections. You know, it's pretty universal that most people get pretty sick. And then those people don't even, aren't even guaranteed to be immune. That's a different world. Is that some of the reason that the California results were so interesting to folks about this idea that there was a much broader infection earlier in the process than we were aware of? And that's why I think there's skepticism there. It just doesn't quite make sense that that many people were infected. And yet we weren't seeing our hospitals and our morgues filling up until very recent. So wait, why would that cause skepticism? Those could have been other coronavirus cases, right?

Other forms of coronavirus. In numbers like that would assume that you had maybe even more than half of the people were completely unaware they even had it. Oh, okay. And had been spreading it for a while. So this disease is pretty unique. When doctors see it, they're seeing things that they have not seen before. Something is very weird.

People are staying in the ICU for weeks at a time, young healthy people. That's what first raised the alarm in China is saying this is not right. Something here is infecting this person in a way we're not used to. There would have been clinical identification of cases like that sooner if, in fact, it was spreading asymptomatically all around much earlier than we thought. So you think those people may have just not died of coronavirus either? February 24th death or February 6th death in California? I think that's when it started to be community spread in the U.S. If there was some idea that the presence of these antibodies

suggested that actually had been spreading for long before that, right? That doesn't make sense because you would have seen some severe cases as well. You wouldn't just be seeing a bunch of asymptomatic cases, and then all of a sudden the severe cases come later. That's my skepticism there. So obviously, I guess that's why Gavin Newsom is doing the autopsy. Yeah, that will help us understand how many cases there were earlier on. In the places that are really hard hit by this virus right now, the doctors

are not uncertain of what they're seeing. They are seeing a huge number of an abnormal respiratory illness that is putting young healthy people in the ICU for weeks at a time. They would know if that had been happening at a large scale in their area. It's possible that they had a few cases that they didn't identify before that. But there wasn't widespread long before. they were aware. Yeah. I know a lot of people have had it now because I live in New York. I've had friends die, but only one in his 50s. Most of the people I've known who've died have been in their 70s. And that's just anecdotal. You really don't do well if you're 70s, 80s, 90s. That's true. You've seen this with there are certain bad flu strains that cause a similar effect where if even a small percentage of young healthy people or middle-aged, moderately healthy people are dying, it panics everywhere. Right. Because of the arbitrariness of it. Because when you get sick, you don't have this certainty that, you know, we're used to getting sick and feeling like, oh, well, this sucks. And I feel bad, but I don't, that's the extent of it. I don't think, am I going to become unable to breathe? Am I going to die? And even if there's only a 1% chance for you or less than 1% chance, that's enough to really, really change the calculus of people's risk perception. And kill the economy. Yeah.

As long as people have that fear, as long as we don't have good treatment, a reliable way to make sure we can say, listen, you're going to live. Even if you lift every regulation and you have every governor saying, go ahead, do what you feel. There's going to be a lot of fear and people are going to stay home. And even if 30% of people don't go see Broadway shows or don't go out to restaurants, those places are still going to go out of business. They don't have that sort of margin. What treatments are you seeing that you think are promising?

The most recent story I wrote for The Atlantic was about modulating the immune response. A lot of what you've been hearing is about antiviral drugs, like the one President Trump, well, hydroxychloroquine has been proven in petri dishes to apparently inhibit the reproduction and multiplication of the virus. Right. That raises multiple questions about whether that would actually work in humans and whether that would influence the clinical course. But that and other drugs were targeted at the virus itself. like how do you kill this virus? How do you stop it from replicating? And that's one way. The other way is to tamp down the immune overreaction, which ultimately is what ends up killing. But that comes later usually, right?

Does. That's like day seven, right? Right. So you maybe heard of this with some of your friends who've had it. There's sort of a familiar phase of a few days or a week or more where you feel feverish and achy and bad, but not in ways you're totally unfamiliar with. But then there's this crash. where you're short of breath and your heart is racing, people hallucinate, and it's all of a sudden, like, what is going on? I should have been feeling better right now, and instead I feel acutely way, way, way worse. That's this thing called the cytokine storm where your immune system is suddenly reacting to the virus in a way it should have been reacting to a while ago, and it's behind the ball, so it's going into overdrive.

And that's what kills people. Yeah, that's the paradox, right? You don't want to totally shut down that reaction, which is partly helpful. Yeah, it's like going into shock. It ultimately is not sustainable. And so people are finding ways to moderate that modulate that immune response in ways that you could survive and survive without so much agony or without three weeks in an ICU. And to me, that would really change the course of things if people felt like there was a treatment. Yeah, you might have to go to the hospital.

You might have to go to the ICU for three days. It might be bad. But you were not going to be there for three weeks. you were not going to be constantly in fear of death. You were not going to have oxygen hunger or feel like you were suffering. This was going to be like a familiar bad illness. Right. Yeah.

That's my hope. And what do you think about the convalescent plasma? That's interesting. I'm optimistic about it, that that might help sort of neutralize the virus itself. So you could do three things. You can have a drug that's targeting the virus and trying to kill it. You can have a... Those are the antivirals.

Yeah, the antivirals. And then you could have the plasma that's trying to kind of float around and neutralize the virus, slowing the spread. And then you could have immune modulators that are preventing that catastrophic crash. And all of those things combined, if we had a, you know, really functional health care system and people had access to it, those drugs could be distributed and produced, could make this a survivable thing that just changes the calculus. That's where there's hope for me right now. That's great. So James, as someone who is deeply knowledgeable about the mechanics of public health management in these kind of circumstances.

People are getting a lot of disinformation, like we talked about in the very beginning. They're getting a lot of conflicting and politicized messages. What are the two or three things that Americans need to know, still obtain the hard facts, what they should be doing right now in order to play their part in mitigating this and to keep themselves safe? It's become almost impossible to speak to all Americans because you have these silos, right, where some people have been hearing over and over again and are doing a really wonderful job,

social distancing and wearing masks and washing hands. Like, we've never washed hands before. To those people, it can be tiring to hear anything other than, like, you're doing great. Thank you so much for your work. And to those people, I would say that. And to others who think that this is overplayed, I think the really important thing for them to hear

is that we in the public health community absolutely understand and appreciate the health effects of economic hardships and shutdown. No one is trying to pretend like that doesn't matter. During normal times, public health is very concerned with things like basic income and housing and making sure people can afford good food. And suddenly, the whole community understands it's worth risking those things because this disease is so bad. Everyone is weighing very bad options and no one is ignoring effects of the shutdown or taking them lightly. Do you have any thoughts on restarting the economy, things that could be testing, tracing, where are you on this?

A lot of what you're hearing is a false dichotomy. There is a false option out there where there's this utopian world where suddenly, if the government tells you that you can go back to work, the economy will start functioning like normal. And that is just not an option. There will be too many people who are sick or afraid of this virus for good reason. And either, you know, they've had a family member who was sick, have been sick themselves. They don't want to take the risk.

And so we'll still have tremendous economic hardship, even if you try to open the economy. But, I mean, even if you lifted all restrictions, it might be more efficient to help out those businesses and those workers through a time of unemployment. If the government orders you to shut down, there's an obligation there to create a safety net or something, whereas if they just say, okay, you're on your own, good luck. those businesses would just fail in the free market. And I think people should be considering that there is no option on the table where 100% of people go back to their consuming and socializing habits overnight.

People won't do that. It's like a hurricane happening. And you can say, okay, we're going to reopen all the businesses. Go back, open your shops during the middle of a category for a hurricane. You'd be like, some people will go do it, but will they make money? Right. No, people won't go out in the hurricane. That's something that I'm thinking about a lot.

It's just like this sort of false option that people seem to be. be protesting over. That makes a lot of sense. So James, is there anything else we need to know? Anything else on your mind or any pieces you've got coming up that you want to tell us about? I would just say that there's no return to normal. We're going to be a changed world after this. Anyone who acts like there's an overnight cure or a switch we can flip that will turn life back to normal is lying or misleading you or misunderstands the situation. So I would just be extremely skeptical of anyone who's pretending that that is an option. What's your vaccine timeline? I'm really optimistic that the scientific community is galvanized around this and working really hard on it.

And actually, this is something where the capitalist free market really aligns. I mean, some people are going to make a lot of money off of that. I think there will be really interesting questions ahead of us in terms of how much risk we're willing to tolerate with vaccines, because you'll have questions ahead of you. Like, if you want to try something in a year, but it might have kind of some risk of side effects. Do we roll it out? Or do we wait? two years and wait until we know it's 99.99% going to have no side effect. And those will be things we have to think about. In either case, we would be producing a vaccine far ahead of anything we've done in history. The other issue is the infrastructure to actually produce that

vaccine and distribute it that we don't have right now. We're not used to providing our whole country with medications, let alone any one given medication all at the same time. We need to be thinking more about do we have just the production facilities to do this? It will be a real shame if we have the technology and then we start having to think about, okay, we have 10,000 doses. Who gets it? Right. Okay, we'll have another 10,000 in two weeks. And there's 320 million of us wanting it. There'll be a lot of interesting ethical questions ahead. It involves more than just how long the science takes. Do you think it's realistic to think that there'll be vaccine trials on health care workers in the fall? Yeah, absolutely. So that could be good. I think so. I'm hopeful about any trial,

but I think people hear the term clinical trial and they think it means we have a thing that will either help you or will have no effect. Right. And they forget the fact that clinical trials sometimes mean a lot of harm. They sometimes mean we made something that killed people. Right. That's all that they mean. It doesn't mean that we're like really necessarily close. But I'm optimistic that people will be willing to participate and that it will be done safely and as judiciously as possible. You don't want to suddenly give 100,000 people the vaccine all at once and realize that there was a big problem with it. Yet you want to get it going on large scales as quickly as possible. It's going to be a lot of interesting discussions about what the most ethical way forward is. I'll be here and I'll be

following your podcast. But you have to come back, James. We would definitely would like to have you back, James. Thank you again so much for joining us today. Oh, sure. Want more great listens? Check out our comedy podcast, The Last Laugh, and our star-studded The Daily Beast podcast at the Daily Beast.com slash podcasts. If you enjoyed this episode, consider becoming a Daily Beast subscriber. Subscribing is the best way to feed the beast and support all of your podcasts as we cover what might become the darkest timeline.

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