The Wolf Of All Streets - Eric Feigl-Ding, Epidemiologist at Harvard and Media Darling on Being First to Recognize the Threat of Covid-19, How This Virus is the "Perfect Storm," Testing and 50% False Negatives, Contact Tracing, The Importance Of Social Distancing and More

Episode Date: April 16, 2020

Eric Feigl-Ding is the leading voice in the United States on the COVID-19 epidemic and was the first epidemiologist to publicly sound the alarm on the dangers of the virus. He was painted as an alarmist but was ultimately proven right. In this episode, Feigl-Ding and Scott Melker discuss the early warning signs of the pandemic, why COVID-19 is the "perfect storm," how testing is the biggest problem, including 50% false negatives, the importance of contact tracing, the possibility of reinfection, how the porn industry could accidentally be showing the way on testing, the difficulties of shutting down the United States, the complicity of the US government in the epidemic and more. This is the ENTIRE story on COVID-19. --- ROUNDLYX RoundlyX allows you to dollar-cost-average into crypto with our spare change "Roundup" investing tool, manage multiple crypto exchange accounts in one dashboard and access curated digital asset content and services. Visit RoundlyX to learn more about accumulating your favorite digital assets when making everyday purchases. --- VOYAGER This episode is brought to you by Voyager, your new favorite crypto broker. Trade crypto fast and commission-free the easy way. Earn up to 6% interest on top coins with no lockups and no limits. Download the Voyager app and use code “SCOTT25” to get $25 in free Bitcoin when you create your account --- If you enjoyed this conversation, share it with your colleagues & friends, rate, review, and subscribe.This podcast is presented by BlockWorks Group. For exclusive content and events that provide insights into the crypto and blockchain space, visit them at: https://www.blockworksgroup.io

What's up, everybody? This is your host, Scott Melker, and you're listening to the Wolf of All Streets podcast. Every week, I'm talking to your favorite personalities from the worlds of Bitcoin, finance, trading, art, music, sports, politics, and basically anyone else with an interesting story to tell. So sit down, strap in, and get ready, because we're going deep. Let's go. I'd like to thank my sponsors, Round the X and Voyager, for making today's episode possible. We'll hear much more about them later on in the episode. This podcast is powered by BlockWorks Group, the only events and podcast production company I trust. For access to the premier digital asset conferences and in-depth podcast content, visit them at blockworksgroup.io.

I promise you will not be disappointed. Today's guest is a fixture in the media recognized as one of the most prominent voices on the COVID-19 epidemic. In fact, he was arguably the first American publicly sounding the alarm on the seriousness of the virus. He's an epidemiologist and health economist at the Harvard Chan School of Public Health and a senior fellow at the Federation of American Scientists in Washington, D.C. His work focuses on the intersection of public health and public policy, so he's the perfect guest to help bridge the gap between what we're hearing from politicians and the actual facts of the pandemic. I am beyond excited to welcome Eric Feigl-Ding to the show. Thank you so much for taking the time out of your busy schedule

to join us. Thanks. Happy to be here. So, as I said, you were the first person that I saw, certainly, who was warning the CDC and WHO about the global risks of COVID-19. As a result, you were painted as an alarmist with your tweets being reused by conspiracy theorists to advance their own narratives. You were obviously proven right. Can you talk a bit about your feelings in January, why you had them and how that situation progressed? Yeah. First of all, I'm not, you know, I've never endorsed any conspiracy theories. So, it's just people take things out of context. And in this day and age, bad information spreads faster. Whenever there's any signs of anything, people really just can go off on the deep end. It's the Internet after all. But at the same time, that's the power of the Internet. So when I first, you know, I first read this paper in mid-January,

but that wasn't the first time I've heard about this epidemic. I have relatives in China. And they've been telling me since early January about this really mysterious outbreak of this weird pneumonia, and how a lot of people are getting sick, a lot of people are dying. And it's really strange, and it's disrupting a whole range of things in central China. And, you know, it lit up because normally, you know, you don't hear that much chatter. China is a very big country. So for something to grow to that level of chatter online,

especially on their social networks, and there's no censorship whatsoever, it means that there is seriously something happening. And so it's kind of like, you know, it's one thing if you flip a coin three times or four times, you get heads each time. But if you flip a coin 20 times, you get heads each of your 20 flips in a row, you know that there's something amiss in terms of all the data that's coming out. And we knew that this epidemic is becoming really serious, but we didn't have any, like, publishable thing to actually shout and, you know, yell with a loudspeaker on until mid-January when I found this new study that showed the R0, the reproductive number of this virus, SARS-CoV, of being 3.8. Now, a reproductive number, the R-naught, means that for every infected person,

that infected person will infect an additional 3.8 people. Right. Normally, for context, the seasonal flu has a 1.3. Some people say it's 2.5, but whether it's 2.5 or 3.8, it's at least two times, if not three times more infectious. And that's just on the first cycle, Because by the time this spreads to 10 additional cycles, you know, three additional people, each of those three are three additional people. You're talking about almost 50,000 to 60,000 additional cases than the traditional flu. So this is why it's very dangerous. And so I saw this and I was like, holy mother of God, I have to shout about it. But the issue was like, you know, my Twitter was only 20,000, or was only, sorry,

2,000 followers. I was never a big Twitter person. My Facebook page is like 98,000. And I have another Facebook page I own with 5.5 million. I was thinking about it. If you want to get the attention of global leaders and journalists, you don't go on Facebook, because that's just not the medium to do it, even if I have a 5.5 million person Facebook page. The medium to do it is on Twitter. And the other thing is you can't speak in a whimper if you're trying to get people's attention on something, especially when no one's paying attention to this. It was near the Super Bowl.

It was near impeachment season. Many other things were happening. So long story short, I decided to shout at the top of my lung, do a big tweet. I made one mistake in my tweet thread chain that some people criticized me on. But the message still stood. And that one mistake was a misreading of a paper. Long story short, it blew up. And I try to convince as many people as possible. I've been on many TV shows before in the past. And I've gone on CNN, you know, over eight times and ABC News, like six times and Newsmax about five or six times as well and a whole bunch of different shows and it's just people were just not getting the message uh that how serious it is even when it was marching across the world to different countries you know the cruise ship Italy Italy, America did not wake up until truly it hit our shores. So here we are. You know, it's bittersweet that I'm right. But, you know, I would much rather and you know, be wrong 1000 more times about something as apocalyptic as this.

So why do you why do you think that nobody here took it seriously? I just, it's, it's like, we've never had an epidemic of that scale. Most Americans have never seen anything of that scale in their life. It's, it is one of those, you know,

apocalyptic movies like contagion or outbreak. And, and, you know, it's, people can't imagine what they can't have never seen before, right? And Steve Jobs once said this, you know, people don't know what they want if they've never seen anything like this before. He was referring to the first iPhone at the time, which was kind of true. People have a very extreme lack of imagination.

And so, you know, it's a doomsday scenario, but it was bound to happen. And, you know, public health scientists have been warning it for years. And in certain way, this virus is the perfect storm. Let's go through, you know, all the different ways. If this was as deadly as Ebola, which kills anywhere between 50 and 80, it would have flamed out quickly because it would have killed too quickly. If it was limited infectiousness like the old SARS, by the way, we defeated the old SARS in 2007 without even a

virus, without even a vaccine, I'm saying. We did it in nine months, no vaccine. That one, it actually had a 10% mortality. MERS has 30% mortality, never needed a vaccine. So we have all these previous examples of never needing a vaccine but those viruses did not spread asymptomatically like it does now it's it doesn't have this weird potential where a lot of people never did have any symptoms also yet they are infectious uh it has at the same time, you know, the fact that it doesn't kill many young people quickly, it hospitalizes them, it maims them for sure, but it doesn't kill as many means that there's a ready pool of very socially engaging spreaders who can keep spreading the virus to susceptible people. And, you know, this virus has a median duration of illness around 20 days,

but will keep shedding viruses for 37 days. All these things you add together with a relatively low mortality, relatively, but still 10 times or 20 times higher than the flu, makes it like the perfect killer. Because in order to spread as vast and as quickly to the vast corners of the world, you can't kill too quickly, and you need asymptomatic spreading, and you need something to be relatively easy and airborne. And a small, teeny, tiny amount will need to be infectiously effective to infect someone, which it does. And then a best anecdote is like the Japanese quarantine officer who was visiting the cruise ship diamond princess off the coast of Yokohama. He's a quarantine officer.

He's fully protected with PPEs gets on the ship. Two hours later, he comes off the ship. The next few days he tests positive. Same with another Japanese firefighter transporting these patients off the ship to a hospital, wearing PPEs, knows that they're sick with this virus, tests positive a few days later after transporting them. It's just that infection is a virus. And that is the reason it has kind of conquered the world in many ways. And this is why we're here. So adding to that perfect storm, there's been quite a bit of anecdotal evidence of reinfection. You recently tweeted a thread about low antibody levels in a number of recovered COVID-19 patients,

which is obviously frightening. And actually today, there was a report that 91 patients in South Korea who had previously tested negative had tested positive once again. Of course, that could be poor testing. There's a lot of reasons. But how much evidence do we actually have of the possibility of reinfection? It's hard to say whether it's reinfection or reactivation of an existing infection that was never cleared out of a person's body. Okay.

So, I want to be clear that we're not quite sure on all these details yet. Because, you know, we know that there's, in HIV, for example, if you take your HIV meds, you will suppress the HIV levels below limits of your laboratory detection. Right. Which doesn't mean you test negative, you have zero HIV viral load. But we know from HIV now that that doesn't mean you've cleared it. It just is dormant at a very low level, hiding inside your cells somewhere. Now, the issue with this virus is, is it the reinfection or reactivation? I'm not sure. But the fact that someone, you know, and also Korea has really good testing. So I don't think it's like Korea is like the US where they miss it easily, right? Korea has one of the best testing paradigms in the world. The fact that

people are retesting positive in 55, then 71. And as you mentioned, 91 cases today of people who were previously sick with it and then cleared of it, got better, and now retested positive. It's also a function possibly of the testing flaw. The test in itself is only 50% accurate, as in 50% in terms of sensitivities, as in there are 50% of false negatives. Of all the total cases, you're only picking up 50%. And this could also be a reason where these people got better,

tested negative twice, but they still could have had it because of this test limitation. And then test positive once again, once their immunity drops, which your immunity level changes day to day. If you are a little sleep deprived, if it's extra cold outside, your immunity drops a little bit or some vitamin levels. So it's possible. And the antibody test is another interesting thing.

The antibody test, in one German town, 14% of this epidemic-ravaged town tested positive for having antibodies, which is promising because antibodies are your own body's natural immune markers that recognizes the virus. By the way, the antibodies has to be trained to find, we have to find an antibody that recognizes it. And just for a little basic on biology, you create a lot of naive antibodies, and then they all have slight permutations on the tip, we call it the epitope tag of the antibody. It's shaped like a Y, where the tip, the tag of it,

will try to find something that recognizes the virus. And once it does, it recruits a huge immune response. So having this SARS-CoV-2 specific antibody is a really good sign. But at the same time, they also tested a lot of previous cases. And one in five had really, really low levels of them. And many of those people also had no antibodies whatsoever to this virus, even though they previously had this illness and had tested positive and had gotten better, recovered. So, we don't know what to make of that. Maybe that

was just a small sample size. But normally, it's supposed to tell you that if you tested positive in the past with the illness, this will tell you if you've ever had it in the past. Even if you've never tested positive, it'll tell you if you've ever, like if you were asymptomatic at one point, if you've ever had it. So the antibody test is really interesting. And it tells you if you likely have immunity from it. If you have the antibody at a sufficiently high level, which not everyone does, but at least tells you if you've been affected. And the people are thinking about using these antibody tests as an immunity passport. Basically, it's like a certificate of having been previously infected and therefore having been immune to it and therefore okay to go back to work. Right.

I'm not sure about that yet. That would be wonderful. A lot of countries are doing these antibody, we call them serologies, serum, serum antibody testing, serology testing. The CDC is going to start rolling them out soon next month. Several other countries have already rolled them out, like in Europe. But we still have to learn a lot whether it's truly an immunity passport, shall we say. Sounds a bit dystopian, doesn't it? Yeah. Do you have your papers? Are you code green to go out and work and mingle? Or are you code

red? It really is very Hollywood. It is. So really quick, so you just touched on that 50% of the tests can be false negatives. We've heard countless stories of positive patients being sent home because the ER is too full or patients dying at home and not being counted and asymptomatic people roaming among us spreading the disease without ever being tested. So how can we possibly trust any of the data that we're making our assumptions on? The ones that do test positive are really positive. There's almost no false positive, I would say. There's a chance, but I would say if you sample in the right way and they have symptoms, they have positive. And so you can still see a trend now is our absolute numbers correct no

is our are not absolutely correct i'm not sure um you know for example there was another uh uh are not a number that published recently this week called it a 5.7 which is much higher than 3.8. We know already it's infectious. At this point, we know. And we know that to have herd immunity, you need, for example, 5.7 in 82%. For 3.8, you need 74% of people being immune. And we're not even ever going to be close to that right now without a vaccine. Herd immunity should be a vaccine strategy only. But in terms of the numbers, we know that the real numbers are where we can trust is hospitalizations. Right. How many people show up at hospitals? New York City, the hospitalizations are dropping. That's a good thing. Mortality is still going up. And mortality, you know, there's different signals. Obviously, mortality from hospitals that we can measure directly, as well as, say,

there's home deaths. New York, for example, has 25 home deaths previously on an average day. Now it has 250. Now, not all of them are COVID. Some of them, for example, are heart attack patient who never made it to hospital and died at home. Is that COVID related? In certain ways, it is COVID related because the hospitals are completely slammed up with COVID patients. And if you have a heart attack or stroke and you can't get to the hospital and you die at home, I would say that is COVID related in terms of health systems being related. Yeah, they were saying it can take two and a half to three hours to get an ambulance in New York City right now. I know. That's why people die at home. And is that a result of the epidemic?

I would say it's a result of the epidemic. It's not a result of the virus itself. It is that result of the epidemic? I would say it's result of the epidemic. It's not a result of the virus itself. It's a result of the epidemic. And so now in terms of the mortality numbers, you know, home deaths, really high. Hospitalizations still dropping, but are we still overloaded in the hospital? Yes. And again, even if it drops for now, there can easily be a resurgence because we have, New York has pretty strict quarantine, like lockdown, but many other states don't. It's one thing that Italy shuts its borders because Italy can shut its borders from France, from other countries. But the problem is, it's really hard for New Jersey to close its borders from New York or Pennsylvania.

Just like Pennsylvania and Maryland are connected, Delaware is connected, and D.C. is connected to Virginia and Maryland. It's really hard to close borders. And some states do have lockdowns. By the way, you should know, some of these lockdowns. Although, by the way, you should know some of these lockdowns, if you read the document, the lockdown is half a page directive. Of course, exemptions are a page and a half, two pages. I'm in Florida. Trust me. I know I'm in Florida. Yeah. If you want to visit your mom, sure. If you want to go visit a caretaker, sure. If you

want to go to the park, sure. That's not a real lockdown like China had. And then the other problem is, like, for example, Kansas, the governor put in a lockdown order that her legislature actually vetoed her and overruled her order. And so now Kansas doesn't have a lockdown. And the other thing is, you have to think of US because it's so porous. We're one single big ship. If you have 50 holes that's leaking out a continual epidemic, and you plug 30 or 40 holes, you still have like 10 or 20 holes that are leaking. The ship is still going down, right? And so this leaky ship analogy is probably the best.

And it's like, yes, one state has a lockdown. Yes, New York is improving. But you know what? All you have, all you need is a few neighboring states. And again, New York is one of the most heavily traveled cities in the world. The moment

you let off the gas, the lockdown in New York, more flights into New York, again, you can easily import cases from anywhere else, and then you can restart the cycle over again. So how do we explain a place like New York absolutely exploding with cases when we had places with real disease like Washington State that actually seemed to have flattened the curve quickly or didn't have that same level of disease spread? Yeah, Washington actually, you know, it did have community transmission. But if you actually follow the history, Washington had something called the Seattle flu study. And this doctor, Helen Chu, she was like a true American hero because she knew that there's something amiss.

Because she was looking at the influenza-like illness data. And you can tell by those data, it's not influenza-specific, but influenza-sympt influenza symptoms specific, that it was very high. It's unusually high. And she wanted to use her Seattle flu study to test for the coronavirus, but she was blocked by the FDA and the NIH and CDC from doing so because that was not under the original authorization of her project, which was a flu study. And so she said, you know what? This thing is, the signals are flu study. And so she said, you know what, this thing is, the signals

are really bad. Screw it, I'm gonna do it. So she went against federal directives and tested for the coronavirus. And lo and behold, it was there. It was right under everyone's nose. The CDC testing was frozen for the longest time and they had faulty kits. I can go into a 10-minute rant about why that happened and why it shouldn't have happened. But Washington State, because of Dr. Helen Chu's early actions, they found the epidemic early. And now she's hailed as a hero. And so Washington State was much more aggressive. I pushed for them to cancel Seattle Comic Con, which up until the point, they really wanted to hold. And a lot of people online were angry about it. But like, I actually think Seattle dodged a huge bullet by canceling that Comic Con convention, because that would have been really really bad but meanwhile other parts of the country were still holding conventions

they were still holding meetings like boston they had the biogen conference that one biogen conference uh three people that were sick there infected 70 other people and those 70 other people. And those 70 other people were across the country, and also in Norway. And flew. As well as in Norway. So that one conference led to huge. And similarly, in Singapore, that one Singapore conference at a Grand High in Singapore, that infected actually the French Alps case, as well as Spain, as well as Britain, that one person flew to three different countries. And so it was actually it was two people, but it was just that one, these super spreading events of these conventions and conferences, you have to stop these mass

gatherings. And, and, you know, Seattle put a ban against that pretty early, ending it all, and tried to talk the common count out of it. And now I think Seattle, Seattle's not out of the woods. Seattle, instead of doubling every two or three days, Seattle's doubling every week in terms of cases. Right. That's a good sign, I guess. Lesser of two evils. They're doing better at doing poorly.

Yeah. lesser of two evils they're they're doing better at uh doing poorly yeah it's i would say it's not a runaway train right now in in in seattle or washington area but uh but yeah it's it's bad and um you know health care workers you know oftentimes are quarantined out and and and a lot of the early responders for example firefighters and police that responded to that nursing home in seattle um you know they lost a quarter of their fire department for 14 days to be quarantined out same in uh uc davis uc davis lost 128 healthcare workers out of put a commission lost didn't die but they were put out of commission because they were all close contacts of that one woman in california it's just been really bad yeah so it sounds like early intervention was really the key at least to some performing better oh yeah like south korea

had their first case the same day as the u.s did south korea right, their epicenter, Daegu, now has, for the first time, zero cases yesterday in their epicenter city. And actually, South Korea actually never went into a full lockdown like other countries did. They just did massive testing

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how many people did you see? Who were you closest to? Where did you go? Basically, a little detective shoe leather work of where you went. It's very tedious, though. That's the problem. And so the best thing is to use a digital contact tracing app. Because, look, I could be in a restaurant and talking and chatting. And when you talk, even if you're healthy, you're spitting saliva into the air. It's just, it's a fact of life. But the thing is, I don't know who's at my adjacent table, right? And so the problem is, without knowing that,

I can only list people who I've shaken hands with and know on a first-name basis. But if I don't know these people, I wouldn't be able to warn them that, hey, I tested positive. You should test positive. You should test yourself, too, or you should be careful, too. So that's why we needed a mobile app. And a mobile app basically means if you have this available to contact and trace where you've been and see in the past two, five days, seven days,

who you've interacted or intersected in proximity with. And assuming both of you have location data shared, the other person, upon you being tested positive later, the mobile app can find those who intersected paths

with you in the past and then send them a push notification. But of course, with apps, it's always like a chicken and the egg. And in 2014, when we approached investors to, hey, we want to develop this app, we were kind of laughed out the room because it's 2014, and what's the chance a plague would hit San Francisco and New York City? You know, it was just, again, very inconceivable because people can't imagine what they've never seen before, right?

And we have not seen an epidemic like this in over 100 years. And it's just trying to imagine the worst thing happen. You know, people are always trying to allay fear, panic, don't worry. It's never going to be that bad. Well, every once in a while, it will be that bad. Every century, we will have a storm of the century. We will have an earthquake of the century. We will have a volcanic eruption of the century. And we will have a pandemic of the century we will have a volcanic eruption of the century and we will have

an a pandemic of the century um and here we are and so now this contact tracing app obviously my old app was kind of like um just left out as open source for whoever wanted to access it on github but um but now google and apple, because Google phones, Android phones, and Apple iPhones are the two largest phone manufacturers, by pooling the resources and creating a contact tracing option where you can be notified, it could be a game changer because there was a study that actually says this virus spreads so fast that you will never be able to contact trace enough via shoe leather

detective work and we will never have just for perspective Wuhan had 1,800 teams of 5 person per team to contact trace everyone that's almost 10,000 people right 800 teams of five person per team to contact trace everyone. That's almost 20,

there's almost 10,000 people, right? Who are like contact tracing workers. We have no, and Wuhan is like a, you know, it's like a city state. No city has that kind of labor resource right now to contact trace, not to mention if it's even safe or not to do

to send out 10,000 people to chase after all these cases. So I think a digital app is where we need to go. The issue and the main concern is privacy. A, you know, is this a backdoor path? Or is this a Trojan horse for the government to someday spy on you they already are right yeah in certain ways they are um if they really want to know by the way you know they if you ever if they ever wanted to know if if you committed a murder all they have to check is, okay, at the crime scene, whose SIM cards were registered by the nearby cell phone tower? Of course. You know, they would already know by your phone, cell phone.

And that's just the brute force way. They would know that you're within range of the same cell phone tower where the person was killed. The government knows a lot more about you than you think. And so with the proximity thing, again, they've already successfully used this in South Korea and Singapore, which that helped them contain the epidemic. This is a multi-trillion dollar economic calamity.

So in certain ways, we have to exchange a little bit of privacy for the public health sake that will save a lot of lives. And so, and the other thing is, in the Singapore version,

they vow to delete all data within, I think, one or two months. Well, basically, you're never going to contact trace more than a month back, I don't think. Right. So you can easily delete this data in three months and it won't matter. You won't need it. You know, it's just who are you in proximity with in the last few weeks or a week or two.

And the other thing is if you use Bluetooth alone, Bluetooth actually doesn't tell you your GPS. Bluetooth just tells you if two phones, I have two phones here, if they come into proximity with each other, that phone A and phone B are in proximity of each other at time, Friday afternoon,

uh, you know, as we're taping right, uh, right now, they know these two phones. We don't need to know the exact geolocation, right? We just need to know that the phone,

two phones were close to each other. So I think that's, that's enough. Um, by the way, I have, I have three cell phones here. I'm looking at them.

I know. So, you know, the world already knows way more than you think. And again, this is for public health's sake. And this is, they will be deleted in the near future. And the Bluetooth signal in itself does not reveal your location. The one loophole is that if you have location active at all times, all times, you know, that you have all times while using app or never, if you have location active at all times and Bluetooth, dual permission granted the same app,

theoretically you can deride the location of the other phone. But it's extreme, right? And at the same time, we have a really critical public health crisis. So everyone, I feel like just suck it up to some degree and, you know, just have the greatest strictest rules around deleting the data later on. And right now we're trying to save lives and reopen the economy. So, right. It starts that interesting sort of talk about, you know, big brother and personal freedom. Americans hate any infringement on their freedoms, obviously.

And I think Asian culture, obviously, they trust their governments a little more. And that has led to probably better control of this. Anecdotally, this is a description I heard from someone about arriving in China recently, coming back to China. Six hours in the Shanghai airport, sprayed with disinfectant while disembarking by officers, empathic in gear, escorted to a quarantine hotel, tested, sent home after negative, and then a volunteer in gear, met them at their house, set up a camera outside their house, 14 days with the camera monitoring their front door, and they could only open their door for, you know, three separate reasons like receiving food or putting garbage outside. Really extreme measures. And then we have the United

States where you get off a flight and they don't even ask you where you came from. So, considering the extreme differences between China, Europe, USA on how ongoing quarantine measures are being taken, what country's current policy is the best example of what we deem necessary to limit the spread when accounting for also that personal freedom, I guess? Or do we just sacrifice that? No, I don't want to say we need to entirely sacrifice. Like, South Korea has a really good model. Taiwan has a really good model. And Singapore has really good. And those are countries that are incredibly, incredibly aggressive in contact tracing.

And they actually do all – Singapore already does serology testing of the antibodies to find people, as well as many other European countries. I think those Asian countries have been some of the best. There's also in Faroe, I love the story, the Danish territory of Faroe Islands, which is like literally just a hair off of the Arctic Circle above Norway. It's an island archipelago. There was this one fish virologist, like a fish veterinarian. He studies salmon viruses. And he decided, you know what, we should prepare for this pandemic. He heard about this epidemic in China and said, we need to switch. pandemic he heard about this epidemic in china it's like we need to switch so he studies salmon viruses so he just swaps his lab instead of salmon viruses he does uh um swapped it to uh this this new coronavirus and all the you know sequences are

published online and you can easily request it from the WHO for these tests. He got the tests. Boom. Tested. His one lab tested 10% of the entire island. It's an island of about 50,000, 60,000 people. 10% of the entire island, and he does 1,000 tests a day. Every day.

One guy who is testing salmon. Yeah, he's a salmon virologist. And he decided, you know, I'm just going to swap up a few things for my lab. Tests thousands and thousands of people. And now, on a constant basis, there's no more viruses. Originally, they had some. So just for context, even though they're a remote island, they had like over 150 cases on this remote island alone.

Think about it. A remote island near the Arctic Circle had 150 cases last month. That just shows you how bad the U.S. probably has it right now. Anyways, long story short, this one guy did massive testing, contact tracing of every single 150, in some cases, now the island has nothing, schools are

open, kids are playing soccer, life is normal, everything's great. And what would we do to kill for that right now? Right? And it's just that he was, he was prepared. They were ready. We were not. And that's just a clear night and day difference. So what do you I mean, I guess it's complete conjecture. But we let's say we have 500k

positives right now, you just touched on how bad it must be in the United States. Is there any data we can use to extrapolate what the actual numbers might be? Well, we try to estimate, well, we have well over, I think, are we at over 200,000 cases yet? I think we are, right? I can't even, honestly, I can't even get up. I can check in two seconds. While I'm checking, I think the underdiagnosis

is so, so insane right now. Because in New York City, you know, they actually said, you know, New York City Health Department actually says, stop offering the test to outpatients, only save for healthcare workers and inpatients. Don't even advertise to the outpatients. Which means unless you show up at the hospital or if you have some extreme shortness of breath or some sort of connections, you're not getting a test. Right. U.S. currently has, oh, wait, 494,000 cases. Yeah, I threw 500 out there because I knew we were close.

Yeah, yeah, yeah. And by the time we released this. I was thinking about New York. New is is almost at 200 000 right new york is 172 cases and increasing 10 000 cases a day in the new york alone which is about almost half of the u.s daily increase so yeah now um new y York also has a mortality fatality, a naive fatality percentage of 4.6, which is much higher than normal. What we expect of 1 to 2% as the optimal. So, do 10 times as many people as we think have this? It's possible. Like, here's, it's, we will ultimately know from serology testing.

If we do a census, kind of like, you know, upholsters and census sample, and census directly do it. We will know eventually if we do a census type kind of thing of New York. But I would say that it's probably at least 4x, 5x, if not 10x. China, they were saying there's 10 to 20x, which again, also speaks to China's deaths also being really low. Right. And they were on top of it more than us. So yeah. And also in New York, as I was mentioning, New York, on average, has 25 daily deaths a day at your home, at home deaths. New York now has 250 home deaths a day. That's 10x more, right? Now, granted, they're not all, they're not all, maybe all COVID, some are heart attacks, but.

Yeah, but even if two times as many people are dying of heart attacks, you still have 200 more unexplained deaths. I think it's fair to- Even if we say half of those are not COVID, it is still a lot. It's still 5X. It's still 5X. So I actually think that we potentially, and those are not counted right now in the New York City death count. I told Anderson Cooper about this yesterday. He said,

Eric, are you sure those home deaths are not counted? It's like, yes, there's an article about this. And New York City Health Department actually announced it. Until the Gotham has actually reported on it, New York just did not, just completely ignored it. And then after some reporters, some local New York papers reported on, they said, okay, okay, we'll put them into probable. And okay, okay, we'll do some testing on them. Because previously, they just buried them without any testing. Rarely did home deaths actually get testing. But now we're like, okay, we need to count them. So, yeah, New York debt tally is definitely – it's good that the hospitalization is dropping, but I think the testing is still woefully inadequate.

Yeah, I think that's clear. And some states – and New York is actually, by the way, on a per capita basis, New York testing is approaching like South Korea, but New York is the highest. It's too late. In the U.S. nationwide, there are some states like Oklahoma that are doing less tests than

Bangladesh or India. Unbelievable. And I don't even want to talk about some of the other states right now, but basically, so many states are in the dark. And again, we've already talked about lockdowns being very loosey-goosey and non-existent in some states, and the lack of testing. We're just asking for another outbreak. And this is

why Louisiana is also really worrisome. And the other factor is, you know, it's not just age. Age is just one thing. The main thing also is that it's chronic disease risk factors. If you have any lung disease, and lung disease is just one example, but if you have heart disease, diabetes, high blood pressure, liver disease, you're also at significantly high risk of hospitalization, ICU, and death. And just for context, I think the best is, there was a CDC report out last week. If you compare people with diabetes and people with not just not diabetes, because they include other heart disease, other risk factors, diabetes versus people with no risk factors whatsoever, no smoking, no lung disease,

no immunodiseases, nothing, purely healthy people, diabetics have 17-fold higher odds of being admitted to the ICU. 17. To put To put that in context, you know, you don't even see relative risk-odds ratios for lung cancer and smoking of that scale. Like, smoking is about, depending on how much you. And it's almost unheard of to see relative risks bigger than 10 or even 15. So this is why I'm worried about the stroke belt, because the US has so much diabetes in the South. And this is also part of the African-American inequality thing is the diabetes rates in minorities are much higher than in others. It's partly poverty, of course, but diabetics and hypertensive and heart disease have enormously higher risk of ICU emission and likely,

if ICU emission, of mortality. And so this is why we're, I'm really worried once this epidemic leaves, you know, pretty healthy New York for the most part. New York has one of the lowest BMI and lowest diabetes rates for Manhattan compared to, say, Louisiana, Alabama, Mississippi, or any part of the Deep South. So the U.S. – and they've actually seen this – U.S. youth mortality and morbidity is also much higher than other countries, likely because of these risk factors. So, we have a lot of things to worry about, not just the absolute epidemic and testing, but our chronic disease that we suffer, the obesity in America, the stroke belt, the heart disease epidemics that we have. Every one of these things that we've neglected in our public health is going to come back and hit us with this epidemic. Right. And those patients who don't even get sick from this are going to be woefully underwhelmed when they try to go to a hospital and can't get admitted for their actual problems as well. Right. We have this second secondary issue. Yeah, and exactly. Once the hospital is over capacity, you know, once we're over the curve that we're trying to bend, flatten, once we're over the capacity limits, that's when people start dying. Like, you know, at some point, if we run out of oxygen, which by the way, many hospitals are run low on ventilators oxygens these easily savable cases will die that's the truth um hot and if nurses so when doctors are also come down with it and put out

a commission the capacity drops even more um and again on top these hypertension diabetes heart disease smoking liver disease kidney disease kidney disease, all these things, all these diseases put you at higher odds of hospitalization, ICU, and death. All of them are going to come back and hit us. I know we're up against it here, but I just want to really quickly talk about the future. We've seen a number of potential treatment options discussed, often politicized in the media, of course, over the past months. Can you just give a very quick summary of the most promising treatments and then also just talk about what our new normal looks like when we actually escape any of this? Yeah. So, treatments. There's a lot of drugs on the horizon.

Remdesivir is obviously one of the most talked about, and we're going to have some Remdesivir is obviously one of the most talked about. And we're going to have some remdesivir trials finishing in the next three weeks, four weeks. So I'm hopeful. But at the same time, this is not a cheap drug. You know, a lot of these other drugs we're testing, I'll get to hydroxychloroquine in a minute. A lot of the other drugs we're testing are HIV hepatitis C drugs. And just so you know, HIV hepatitis C drugs are among the most expensive drugs ever out there. You know, it's not just mass production wise. It's just the markups on them are insane.

And can everyday Americans afford them? I don't know. Now, hydroxychloroquine, which by the way, up until now is a very rare drug for malaria, which doesn't exist in the U.S., or for lupus, which is a pretty rare autoimmune disease, has a lot of side effects. I'm not saying it won't work. I actually do think it could work.

It could have some... I don't think it's't work. I actually do think that could work. It could have some, I'm not, I don't think it's gonna be like a slam dunk thing. But I do think the drug likely will work eventually once the trials finish. And there are many trials on this. But the problem is, I think their adverse events will be pretty high and tolerability. Again, a lot of people have risk factors that may not be able to tolerate this drug. So I'm worried about how it's – hydroxychloroquine is not going to be a magic bullet. And remdesivir, favivipir, and many of the other protease inhibitors and basically HIV and hep C drugs are expensive. China actually said that one Chinese company is like, we know how to make the drug directly.

We know how to synthesize it directly. We're just going to synthesize it. Patent, you know, screw the patents, basically. And they have a good case, we have a global pandemic. Is Gilead really going to enforce the patent on a drug that has potential to save a lot of people? I don't know. And again,

it's really expensive. So, you know, trying to withhold the drug for more people is actually killing people. Right. So I don't think they have the social capital to enforce some of these kind of alternative things if the drug does work. As opposed to vaccines, it'll be a one year to 18 months. If?

If. So first of all, I'm pretty sure we'll get a vaccine. Okay, so that's the bright side. Now the issue is how effective is the vaccine? So just for perspective, we have a flu shot this year. Flu shots are on average 60% to 80% effective on typical years. This year's flu shot was misdesigned. It's only 48% effective.

We know that in order to have any meaningful immunity, which depends on the R0, which if it's a 3.7, you need 74%. If it's a 5.7, you need 82% immunity for herd immunity. You need to get to that level of effectiveness. We need to really, really clamp down on containment, and containment in itself won't bring it there. So the vaccine will be the magic bullet, but the vaccine must be effective in the 90 plus range, preferably 95 to 99% range of effectiveness. Because if it's not, it's not going to be enough by itself. Maybe with other things, but it's not going to be enough by itself. And we're already skipping animal trials in some of these vaccine treatments.

We're going straight to phase one safety testing. And hopefully after we find some, we'll go into phase two but and maybe maybe just maybe if the vaccine is super effective later on in phase two a dsnb board which is stands for data safety monitoring board could terminate a trial early and release it for the general public what generally there's only two situations you terminate a trial early. One, if it kills more people back for some unknown reason that wasn't anticipated. Or if it's so extremely effective that withholding it from the control group, once you know that it works, becomes unethical, then you'll terminate a trial.

Which would be a good sign. In certain ways, if the trial terminated early, that would be a signal that they found a really good one. The bad thing is that if it doesn't terminate early, that's an early sign that the vaccine is not working as perfectly as we hope it would be that's above 95%. Does that make sense? It does. So in certain ways, if we don't get a vaccine, if we don't get a trial that terminates early, that means we only found a mediocre vaccine. But that said, there's many

vaccine groups around the world. And so one of of these days we will get a vaccine bill gates is already ramping up vaccine factories in anticipation of once we find one so that's a good sign so what's that new normal then look like i mean normal is gosh this this virus is like time it march on. And countermeasures like social distancing, lockdowns, capacity limits for events, those are mitigation measures. They're not containment measures. Mitigation means they're slowdown measures. Think of a wildfire. You can never put out a wildfire by just air dropping water from a tanker flying above.

You always need boots on the ground to dig the trenches to truly put out every last fire and every last spark. And to do that, you need testing and contact tracing. So we will be in a state in which once the mitigation, it's like a downhill. Once you take your foot off the brake, once you stop air dropping water on it, on a wildfire, it will keep burning. It will keep going downhill. This virus is like that. So we're going to probably be in a cycle of containment and release and containment release. And even when we reopen businesses, it will not be the same. Restaurants will have new capacity limits, every other table or something, maybe in still no restaurant eating and

movie theaters every every third seat I don't know sports games half capacity I don't know maybe it will be we won 2020 will never be like any other year and we are in some ways even after the, our society will never be the same again, because we've clearly learned the dangers of this pandemic risk. And no one will underappreciate a pandemic ever again. But this year will be a tough year for sure, because we're going to keep going through these cycles. we will maybe plateau in june new york maybe sooner but other parts of the country will be much worse it's so hard to say whether the u.s will plateau anytime soon because it's such a big country and it's such a leaky porous country because people travel domestically everywhere. And it's really hard to put down any domestic state bans from travel.

So we're going to have the problems for the rest of the year. And maybe by the summer, it will slow down a little more, but we'll definitely get a very strong fall resurgence. And we're definitely going to need the vaccine. But by then, maybe in the fall we'll have better technology we'll understand serology more to have these antibody immunity passports or certificate of approval to travel and work it's so crazy i know it will be in the world and and in certain ways um you know uh i hate to invoke this but the porn industry actually

has a system of testing and workplace uh basically every week they have testing in their workplace and um if you are and you are tested right before work and you're tested right after work on a weekly basis or even on a daily basis. And we might have to need that in order to clear people to make sure that they're healthy enough to work in consumer retail jobs. Because that's the reality of where we're headed. We need a lot of testing. We need a lot of hopefully serology. The countermeasures won't work. We'll go up and down, up and down all the time. It will be a whack-a-mole this year for sure. Just a very strange world to think about raising my children. You know, three months ago, it was all fun and games

and what we're used to. And now I envision this world where like my kids wear a mask forever and are afraid of people. You know, it's just, it's really, really sad for me. Yeah. My son did three hours of zoom on, on, on Saturday. He knows how to use zoom better than me now. Like, he's like, daddy, daddy, no, you have to hit this button. If you want to talk to people, he's like, you zoom better than me now. Like, he's like, Daddy, Daddy, no, you have to hit this button. If you want to talk to people, he's like, you have to unmute yourself, Daddy. Oh, gosh. Really amazing. I know. Well, hopefully we'll get through it. It's just and so many things are changing so quickly. You know, new technologies on the horizon, new scientific understanding of the virus, new genetic research, new drugs on the horizon, new vaccine on the

horizon, new technology and apps on the horizon. This year will, I think I'll just leave it here. There are years and decades in which nothing happens. And then there are weeks in which decades happen. And I feel like every week that we live through feels like another year in my lifetime. So it's just been that crazy. I think that's a perfect way to conclude. So where can people find you after this? Twitter is probably the best. I'm doing six hours of tweeting a day these days.

Aren't we all? Trying to keep abreast of everything. My Twitter is at Dr. Eric Ding, at D-R, Eric, E-R-I-C, Ding, D as in Delta, I-N-G. I sometimes post on Facebook as well, but my Twitter is definitely more active. And yeah, I sometimes answer lots of questions on there, but I also do happy to come back for another podcast in a month or two. And whenever we feel like we're at a different stage of this epidemic,

and we know a lot more than what we know now. So let's fingers crossed till then. That would be spectacular since I probably had a thousand more questions in 10 hours more of conversation that we could have had. So I'll look forward to that. Thank you again so much for taking the time. I think people are going to really be mind blown by what you shared. Yeah. Well, best of luck to really be mind blown by what you shared. Yeah. Well, best of luck to everyone listening. Take care.

Let's go. Hey, everyone. Thanks for listening. New episodes go live every Tuesday at 7 a.m. Eastern Standard Time. Links to our Apple

and Spotify channels are in the show notes. You can also follow me on Twitter at Scott Melker to continue the conversation. See you next week.