The Daily - Where We Stand on the Pandemic

Episode Date: August 25, 2020

In the U.S., emergency-use authorization has been granted for convalescent plasma, the efficacy of which is yet to be robustly tested. For some, this echoes the situation with hydroxychloroquine and the government’s subsequent U-turn on its rollout.Meanwhile, America’s infection rate appears to be flattening out — but at tens of thousands of cases per day. This stands in stark contrast to China, where daily cases are under 40.Overseas, a Hong Kong resident has been reinfected with the virus, the first recorded instance of a second bout. And Russia and China have begun distributing vaccines, sidestepping Phase 3 safety trials to the incredulity of immunologists and vaccine executives.We check back in with Donald G. McNeil Jr. on the coronavirus and the impact of these developments.Guest: Donald G. McNeil Jr., a science and health reporter for The New York Times For more information on today’s episode, visit nytimes.com/thedaily Background reading: A 33-year-old man in Hong Kong was infected with the coronavirus for a second time. It is unclear how often people might become reinfected, and how soon after the first bout.Despite flattening, America’s infection rate remains one of the highest in the world.The F.D.A. has permitted the expansion of convalescent plasma treatment after pressure from President Trump.Russia has approved a coronavirus vaccine and is set to begin mass vaccinations in the fall. China has reportedly been giving experimental vaccines to high-risk groups since July.

From The New York Times, I'm Michael Barbaro. This is The Daily. Today, my colleague Donald G. McNeil Jr. on four new developments in the treatment and understanding of the coronavirus. It's Tuesday, August 25th. of the coronavirus. It's Tuesday, August 25th. Donald, we wanted to check back in with you because the summer is drawing to a close and there have been a few major developments

in the pandemic that we wanted to better understand by talking to you, our resident expert on the coronavirus. And the first development involves a new treatment in the U.S. So tell us about that. Thank you very much. It's good to see you all. So just in time for the Republican convention, the Food and Drug Administration director on the podium

with his boss, the head of HHS, and his boss, the president of the United States. Today, I'm pleased to make a truly historic announcement in our battle against the China virus that will save countless lives. Gave emergency use authorization. A powerful term, emergency use authorization for a treatment known as convalescent plasma. To a therapy called convalescent plasma. Because the FDA really stepped up, and especially over the last few days in getting this done, the results have been incredible. And I think you'll see the results even go up very substantially. So we appreciate it.

And Donald, what is convalescent plasma? Convalescent plasma is the serum from blood that's taken from people who are convalescing, who are recovering from having had COVID. You draw out about a pint of their blood, you spin it down to take off the red blood cells and white blood cells, and then you keep the serum that contains a lot of things, including the antibodies. I probably shouldn't admit this, but I used to sell plasma when I was in college. Wait, I'm sorry.

Whose plasma did you sell? Mine. Huh. Yeah, $5 for the first donation a week, $15 for the second. I paid my rent for part of the time in college that way. And I assume, although I never asked back then, that they wanted it for the clotting factors, for hemophilia, actually.

And just to be clear, who were you selling it to? Presumably not like somebody off the street. No, no, to a blood bank. And why would anyone pay for your plasma or anyone else's plasma, for that matter? What is so special about blood plasma? It contains your antibodies, and antibodies is what they need to kill the virus as it's going through them. Got it. And so this is now being applied to COVID-19. Yes. People who have had COVID and are immune to it are in very high demand for their plasma, which has antibodies in it, which is what the president and the FDA approved for emergency

youth authorization this weekend. And today I once again urge all Americans who have recovered from the virus to go to coronavirus.gov and sign up and donate plasma today, please. And what was the evidence that the Trump administration cited in granting this emergency youth authorization for blood plasma? granting this emergency youth authorization for blood plasma? There is a program to distribute plasma and analyze the results run by the Mayo Clinic, and they are aiming to give the plasma out to 70,000 patients and see how they do.

And the result was that people who got plasma did not do better across the board. But if you splice out a subgroup of people who were under 80 years old, hospitalized, but not on ventilators, were given a high dose of plasma, not a low or medium dose, a high dose of plasma, not a low or medium dose, and were given it within three days of diagnosis, those people did better. And better was defined as,

they seemed to have a 35% lower chance of dying. Hmm. So a narrow slice of that overall group of people who got this blood plasma did 35% better. And that was the basis for this emergency authorization. Yes. But some doctors, some experts are unhappy with the way this is done because they would want to know a lot more things. Even in the context of this trial, they would like to know what other treatments those patients got, just in case they got something like the steroids that we already know save people or the remdesivir that we already know saves people. And really what they'd like to see is a real randomized

clinical trial done in which half the people got plasma and the other half of the people got placebo and neither the doctors nor the patients knew who was getting which. Because that's really the only way in order to prove something really works. So why not undertake such a clinical trial now? The Tony Fauci's and Francis Collins would love to. The problem is that people are so excited about the idea of plasma because it's been talked up that they refuse to go into a clinical trial because they would get a 50% chance of getting the placebo. And once you're sick, you don't want that.

You want, hey, if you think it saves me, give it to me. Oh, that's interesting. So the government's decision, the Trump administration's decision to talk up blood plasma as a potential treatment, even though there's not a ton of evidence for it, might actually make it harder to do the kind of gold standard clinical trial test that lots of doctors, it sounds like including Anthony Fauci, would want to know whether or not plasma really is a serious therapy for COVID-19. Yeah, and it's exactly what happened with hydroxychloroquine. It was talked up so much that people wanted it. And so it became hard to do the clinical trials in which they got a 50% chance of getting a placebo because they didn't want it. They heard the president say it's a miracle drug, so they insisted on it. And of course, in the case of hydroxychloroquine, that too was granted an emergency authorization

from the Trump administration as a treatment, but then subsequent testing showed it was not considered effective and it was not considered so safe, and that emergency authorization was eventually rescinded. It was not considered effective at all, and it was definitely dangerous. And so emergency authorization was rescinded. Hmm. So this potentially could be a similar situation. Yes. In fact, a doctor said that to me yesterday. Exactly. This feels like hydroxychloroquine all over again. I mean, the president is hoping to be able to announce a miracle, and that's the tone. The calls to the press conference on Sunday were, you know, gigantic therapeutic breakthrough going to come through this evening.

And then everybody was saying, I think he's going to talk about convalescent plasma, which we've known about since the 1890s. And what this really is, is it's a bureaucratic breakthrough because hospitals are going to find it easier to use plasma than they did before because they don't have to go to the Mayo Clinic for permission to enroll in the trial. But that's all. And what Tony Fauci and Francis Collins and Clifford Lane and the others at the NIH said just in the last week or so, we don't think an emergency use authorization should be granted. And the president basically just reversed them. Or overruled them. Yeah.

The president basically just reversed them. Or overruled them. Yeah. Okay, so Donald, the second big recent development in the pandemic involves a case of reinfection out of Asia. Tell us about that. Researchers in China say a 33-year-old man living in Hong Kong is the first person confirmed to have been reinfected with the coronavirus. So the case is about a man who gets infected in Hong Kong early in the year,

recovers. Four and a half months later, goes to Spain, gets sick again, recovers. And so doctors know that he got infected twice. Which is kind of the nightmare situation. Yeah. Right, well, this is a potentially serious setback tonight in our war against coronavirus. This new case you mentioned out of Hong Kong really does put into question that belief that so many of us have had

that if you got coronavirus once, you couldn't get it again. The reason that would worry people is because, well, that would imply that we're never free of the disease and maybe a vaccine wouldn't work because if you've got a vaccine, you were protected. And then, you know, a couple of months later, you got infected again. Then, you know, the vaccine's a bust. Right. Infection is supposed to equal immunity. Infection is supposed to produce immunity. Yes. Infection is supposed to produce immunity, yes.

Now, in this case that was just reported out of Hong Kong, this doesn't shock immunologists. Why not? Well, because it's been known that even with some diseases where you think getting it provides lifetime immunity, some people get it again. And what happened in this guy's case was his first bout of the disease was mild, and his second bout was so mild it was asymptomatic. He didn't realize he had it. And what may have happened in this case is that he had such a mild infection the first time

that he got over it, but he really didn't produce enough long-lasting immunity in the form of antibodies to prevent him from getting a second infection. So the reaction of doctors is, well, this is a curiosity, and it's kind of the exception that proves the rule, but it's not something to panic about. This is not common. This is not something we're seeing all over the place. Millions and millions and millions of infections

around the world. And we've only seen one proven case. So don't worry that this means the end of the vaccine or the vaccine won't work or anything like that. So this does not fundamentally change our understanding of immunity from a COVID-19 infection. We're still in the gray area where we don't know how long immunity lasts,

but we suspect it lasts for a year or more, although that's impossible to prove because this disease is only, it didn't come into existence before December. Got it. But looking at other diseases like it, that's what the best immunologists expect is to happen. Donald, immunity for a year or so would probably imply that whenever a vaccine is ready, it might last just a year, or is that too big a logical leap?

So the answer is, nobody knows yet. Because we don't have the vaccine, and we don't have a year's experience with the virus. Because we don't have the vaccine and we don't have a year's experience with the virus. But we know that some viruses mutate so fast that you need a vaccine every year, typically the flu virus. We know that this virus mutates at about one third the rate of flu. So maybe if it, you know, hangs around, we'll need a new shot every three years rather than every, as you do with flu. But this is all a big gray area. It's really hard to say. No expert is going to say we know what's going to happen. We'll be right back. and National Pharmaceutical Group, two soldiers and employees traveling overseas. That still, though, is in the phase three testing. It's experimental. Russia is claiming victory in the worldwide race for a coronavirus vaccine.

The government is clearing a vaccine for use despite not putting it through a third round of testing on humans. President Vladimir Putin insists the vaccine is safe and says one of his daughters has been inoculated. Dalit, our third development relates to the progress that we are making in the battle for a vaccine. And the biggest of these developments seem to be occurring overseas in Russia and in China. And I was hoping you could update us on those. Yeah. Both the Russians and just recently the Chinese say they have started distributing their vaccines

without having done the phase three safety and efficacy trials that we are doing here. And those are the ones that are double blind with the placebo like we talked about before. Right. And more importantly, they recruit tens of thousands of people. I think for these trials, we're recruiting 30,000 people per vaccine. So immunologists and vaccine executives here say, this is crazy what the Russians and the Chinese are doing. You don't release a vaccine before you've done the big safety trial. Because problems that you did not find earlier could crop up. And the big dangerous problem, the one that everybody is worried about, is that the vaccine makes you more likely to have a bad outcome if you do have the virus,

as in more likely to get hospitalized and die. So doctors here think that Russians and the Chinese are very responsible to do this. It looks like they may be doing it for competitive reasons. The Russians want to, they call their vaccine Sputnik. They want to brag that, hey, we beat the United States, we beat the world at this, you know, as they did with Sputnik back in 1957 or whatever it was for satellite and space. So what they're really doing is using their own population as the guinea pigs for doing the safety and efficacy testing on the vaccine. And one hopes that, you know, they are following those first 30,000 guinea pigs really carefully to see if they pick up any danger signals that are there. You want to make sure that the vaccines go to people you

think are likely to do well, you know, help the young people, and then you move it out into the risk groups. doing with hydroxychloroquine and blood plasma, which is starting to authorize the delivery of it to people before it's gone through those kind of gold standard double blind placebo tests. It's similar and yet it's different. It's similar because we are letting it be generally distributed before it's been proven that it works and is totally safe. It's different because hydroxychloroquine did have a long safety record. Convalescent plasma does have a long safety record. These vaccines that the Chinese and the Russians are using have no safety record other than the tests they've done just in the last two or three months, presumably on maybe you know, maybe a thousand people. Another important difference between what the Russians and

Chinese are doing with their vaccines and what we're doing with treatments here is that treatments are given to people who are already sick and in trouble. Like, you can take wild chances with cancer treatments when you have patients who are on the brink of death, and there's nothing else that will save them. Whereas vaccines are given to healthy people, even sometimes to babies and pregnant women. So you do not want something that is at all unsafe because you turn someone from healthy into unhealthy, you've done more damage than if you just left them alone. to unhealthy, you've done more damage than if you just left them alone.

So our risky emergency authorizations are less risky than what China and Russia are doing with vaccines because our emergency authorizations are going into sick people, theirs are going into healthy people. Correct. Okay, so Donald, finally, the fourth development here in the United States is a somewhat happy one for a change, and that centers around the current infection rate in the United States, which is flattening. Yes, it's flattening, but I don't see this as a happy story. What are we flattening at? About 40,000 cases a day? You know, even in our good period, back in June, we thought we were doing well. We had 20,000 new cases a day. None of this has been really a good news story. We have an out-of-control epidemic in this country. And the fact that we brought it down by 10,000 cases is good-ish news, you know, relative to how bad it was getting. But I don't

think we should pat ourselves on our national back over 40,000 cases a day. And what are the implications of us even staying at such an infection rate? The implications are that a lot of people are going to continue to die. This is like climbing a mountain, and you get up to 14,000 feet, and you stay at 14,000 feet because you're walking through a meadow. It's still hard to breathe up at that altitude. It's not a happy situation. We're not going back down to zero. We're going back down to a few hundred cases a day, which some other countries have gone to. The implication is that we're going to have more people hospitalized, more people die. We're going to see our death numbers go up beyond 200,000, definitely on the way to 300,000. Don't know exactly when it's going to reach that, but we're steadily plotting day after day up that peak of deaths. I don't want to let that slide by.

You're saying that it feels likely that the United States will hit 300,000 before the pandemic's over. Oh, before it's over? Yeah, the question is when before it's over? Oh, before it's over? Yeah, the question is when before it's over. I mean, it's not just me, it's the models. Some models suggest that this is going to be, you know, well before Christmas. 300,000 American dead before Christmas would be absolutely horrific. Yeah, it would. And we can avoid that by being smart, using masks, socially distancing, all the usual things. But we have to do it. And of course, the fall in the U.S. beyond everything we're talking about means something else, which is the flu. The flu is now about to kind of merge with the coronavirus, and I know that that has raised

some fears. Is that something you worry about? No. Why not? And I'm kind of an outlier on this, but there are doctors who agree with me. Flu doesn't sit around, hide in the country during the year. Flu travels. It migrates to the southern hemisphere and hits them in the middle of their winter, and then it comes back in the fall. But flu transmission went to zero in this country in the third week of April during lockdown. It just went, boom, right down to zero. And then it did not really go south.

Because people aren't really flying south. Right. It turns out that flu in Australia is down by 99% this year. And in the rest of the southern hemisphere, it's way, way, way down too. You know, Chile, Argentina, New Zealand. If it isn't big there, and there are no flights from there to here, you can't recede flu here. And also, practicing social distancing, as we are now, cuts down flu transmission in any year. So I don't expect a big flu season, but I still think everybody should get their flu shot, and I got mine in case I'm wrong. So it sounds like another incentive to abide by all the rules around the coronavirus

is that it has very nicely diminished the flu. And other respiratory diseases. RSV and the cold coronaviruses and things. Any respiratory disease, they get knocked out. All those diseases have dropped in this country. those diseases have dropped in this country. But still, I'm hearing you say in your role as our collective conscience that everyone should still get the flu vaccine just in case in order to kind of take it off our plate. And here I should say, Donald, and I've always wanted to be your A student in this respect, I got the flu vaccine just a few days ago.

you're a student in this respect. I got the flu vaccine just a few days ago. Good. Excellent. I got mine. I got the senior shot, the four times as powerful one that you can't get unless you're over 65. I don't think I got that one. I've had people ask me, how do I get one of those? And I'm like, no, insurance will not pay for it until you're over 65. And I got a slightly sorer arm than usual, I think, but that's actually a good sign. It means the shot's working. Well, Donald, thank you very much. We appreciate it.

You're welcome. reported that many scientists have been startled by the way that the FDA has interpreted and communicated data about the effectiveness of blood plasma in treating COVID-19. Several of them, including those who worked on the Mayo Clinic study cited by the Trump administration, said they cannot figure out the origins of the claim that it reduced deaths by 35% and are highly doubtful of that figure. We'll be right back. Here's what else you need to know today. Unrest in the city of Kenosha, Wisconsin, turned violent on Monday night as protests over the police shooting of a black man there, Jacob Blake,

gave way to fires, destruction, and looting. By early Tuesday morning, a strip of stores in Kenosha's downtown was consumed by flames. Blake was shot repeatedly by a white officer as he tried to get inside his car. The shooting appeared to be unprovoked and was immediately condemned by Wisconsin's governor. The officers involved in the encounter have been placed on administrative leave

as an investigation continues. And... Madam Chairman, Louisiana proudly casts its 46 votes for President Donald J. Trump. Michigan, the Great Lakes state, is going to cast all 73 votes for President Donald J. Trump. In order to keep America first, the state of Arizona casts our 57 votes for President Donald J. Trump. During the opening night of the Republican National Convention in Charlotte, President Trump was nominated for a second term

after an in-person roll call by delegates. More, more years! More more years! If you want to really drive him crazy, you say 12 more years. In a short speech accepting the nomination, Trump sought to cast doubt on this fall's election by attacking mail-in voting and accusing Democrats without evidence of seeking to steal the election. Last time, Joe's boss was Obama. This time, it would be Pelosi, Sanders, and the squad.

Their vision for America is socialism, and we know that socialism has failed everywhere. They want to tell Americans how to live and what to think. Later in the night, a series of speakers, including Trump's first ambassador to the United Nations, Nikki Haley, claimed that Joe Biden, a moderate, would pursue a left-wing agenda that would undermine American values at home and overseas. This president has a record of strength and success. The former vice president has a record of weakness and failure. Joe Biden is good for Iran and ISIS, great for communist China, and he's a godsend to everyone who wants America to apologize, abstain, and abandon our values. Donald Trump takes a different approach.

He's tough on China. And he took on ISIS. And won. And he tells the world what it needs to hear. That's it for The Daily. I'm Michael Barbaro. See you tomorrow.