What No One Knows About COVID-19, with Larry Brilliant

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If there is one expert Andy could talk with about coronavirus and how we are really doing, it is epidemiologist Larry Brilliant. Larry, who helped eradicate smallpox and is hard at work on coronavirus, grades our performance on a scientific, sociological, and political basis. He also shares everything that science knows, and doesn’t know, about the way the novel coronavirus is transmitted and infects us. Larry doesn’t mince words about political leadership or the CDC. 

Show Notes 

Keep up with Andy on Twitter @ASlavitt and Instagram @andyslavitt.

Follow Larry Brilliant on Twitter @larrybrilliant.

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[00:39] Larry Brilliant: Probably there’s a special place in hell for some of the people who are lying about how dangerous this disease is.

[00:50] Andy Slavitt: Welcome to In the Bubble. This is Andy Slavitt. We’ve a great show to bring you today. You just heard from Larry Brilliant, who is someone that, since we began the podcast in April, has been high on my list to have join the show. He is, I think it’s safe to say, one of the world’s leading experts on global pandemics. He is the person who helped to cure smallpox. And he’s just an incredibly getable, relatable person. Larry and I worked on a few things early on in the pandemic, where he helped put together some things that we use to advise the White House. He is very outspoken. I think you will see that he has very strong opinions, but also says some things in this episode that you just can’t miss in large part because you have to know them. Not all of them, I warn you, not all of them are happy news. Some of it is challenging news. But I think there are things that you’re going to wish and be happy that you listen to. Let me do one more topic before I go to Zach for his facts. You know, I think this last week or so, I’ve gotten the sense from people of the real cost that the virus and the sustained uncertainty is causing people. I did a thing on Twitter where people submitted pictures of the one picture that best described the last few months for them. And a lot of them were pictures of people that they weren’t getting to see. A grandparent, a new grandchild, a parent, some friends. And while people are economically stressed, and there’s all sorts of anxiety, what was abundantly clear to me is one of the costs of this is people are missing each other. And so I think that’s something we’ve got to acknowledge and we’ve got to work on, because we very much can control our relationships with others. We can be there and be present for others. And it’s something we just desperately need. I also have an announcement that we’re going to make in a second about the donation that we’re going to make from the podcast. But first, before I do that, we’ll turn it over to Zach for your fact this week.


[03:40] Zach Slavitt: I have more good news from the Oxford vaccine trials from STAT News, who released a summary about some of the phase one and two Oxford trials. A good summary can also be found from Dr. Eric Ding on Twitter. But some of the key points that I noticed were the positive signs of immunity, where people are getting not only the antibodies, but also T-cells, which basically means that there’s some evidence there could be long-term immunity, at least relative to what people initially thought could happen. And other good news is they’re saying two billion doses could be made by the end of the year with the vaccine, with it being probably revealed whether or not it was going to work by October. And so the WHO has come out and said that they think it’s good. Dr. Ding said the results bode well for a long-term immunity. And just overall, it’s really good news. And this is in thousands of people over a span of 14 days and 28 days. And they’re showing no side effects with significant immunity. 


[05:02] Andy Slavitt: So good news notwithstanding, they are having difficulty enrolling people in the phase three trial. They have a website and they need to get a lot more people signed up if they’re going to have that vaccine to combat the virus more quickly. So we’ll put on the show notes a link if people want to participate in the vaccine trial. Unfortunately, it’s not happening as quickly as it should or could. And of course, we need to then have those folks exposed to the virus. The other thing, Zach, I would just say color me very skeptical about the two billion doses or anything close to it. I think the right expectation for people is middle of next year, not end of this year. But you may have a different lens on that. 


[05:47] Zach Slavitt: I just believe that if we find a vaccine, I don’t see why every resource wouldn’t be going towards creating as many doses as possible. 


[05:54] Andy Slavitt: Well, we don’t have enough tests in this country, so every resource possible, we’ve yet to even put in place the Defense Production Act for masks. So I’m not super confident. 


[06:05] Zach Slavitt: Yeah, this is just a more international thing. And I think the U.S. is going to be wanting to get at the table. I think Trump, this will be his one chance to save face and say that he did everything he could to get the vaccine in the U.S.’s hands. So I think it’s different from that. And I think he’s going to realize he messed up.


[06:23] Andy Slavitt: Well, you have the last word. But that’s certainly the topic that people will be hearing a bunch about. Now, for our exciting announcement. We’re making a $14,000 donation thanks to your listenership. We are all collectively making it to the Navajo and Hopi Families Covid 19 Relief Fund. People may know the Navajo and Hopi communities have been devastated. They’ve been among the hardest hit in the country, in the world. This particular fund is one that goes to an all-volunteer indigenous-led group organization that allows people to stay at home by bringing them groceries at the group’s expense, as well as water, health supplies and keeping exposure as contained as possible. The reservations there have no running water, and it means people have to leave home just to do basic survival things that we take for granted if you don’t live on the reservation. This group is providing immediate relief and it’s prioritizing elderly, it’s prioritizing single parents and it’s prioritizing other at-risk groups. So based upon your input, we felt like this was the right cause. Thanks everybody for listening. OK, so now let’s talk to the great scientist, Larry Brilliant. 


[07:55] Larry Brilliant: Andy and Zach. How the hell are you? 


[08:00] Andy Slavitt: I am pretty good for a global pandemic. And how are you doing? 


[08:04] Larry Brilliant: Are you grading on a curve? Are you grading an absolute scale? 


[08:09] Andy Slavitt: Gotta grade on a curve. That’s the only thing we know. 


[08:14] Larry Brilliant: On a curve, given that I’m an epidemiologist in the middle of a pandemic, we’re doing good. We’re lucky. We live in a beautiful part of the world. We can go outside and walk in the woods. And I have something that I can do every day that I can talk myself into thinking is meaningful and helpful.


[08:33] Andy Slavitt: You are someone who, out of a very small handful of people, kind of knew this was coming. Now, of course, there are probably thousands of people now who can lay claim to the fact that they knew this was coming. But you’re one of the few people that actually knew something like this was coming. Is it what you thought it would be? And are we doing better or worse at it than you pictured? 


[08:55] Larry Brilliant: So the TED talk that I gave in 2006, which I think predicted a pandemic, has uncanny resemblance to this. But that’s not because I had any prior knowledge or wisdom. It’s because every epidemiologist I knew in 2006 was worried about a pandemic like this. The movie that we made in 2012, Contagion, that I was the science advisor on, predicted a pandemic like this. But that’s not because I deserve any credit. It’s because every epidemiologist I know was predicting a pandemic like this. The thing we did not predict is incompetent government. And that’s the problem. Having had consensus in the epidemiological community in those prior years, and working for administrations after administration, I actually, although I’m a Democrat, certainly I worked for George W. Bush and I chaired a commission that he set up by presidential directive to help prepare us for a pandemic. It was bipartisan. There was no question that a pandemic is simply not a partisan issue. There was not one breath or a hint of it being a partisan issue. And under Obama, while there were stirrings of partisanship in the reaction to Ebola, a kind of racism and the denigration of people in Africa who had the disease, there was still certainly bipartisan agreement that this is something that rose above politics. That’s not the case now. 


[10:37] Andy Slavitt: Yeah. And look, you helped persuade President Bush, if I recall correctly, that this was something very important to take seriously, because he listened and he listened to someone like you. You know, as I observe things, you know, I mean, I see the reaction at three levels. I see the scientific reaction, how are we doing from a scientific standpoint? I look at the sociological reaction, I’ll call it, how are we as individuals relating to one another, to job loss, all of the things? And then there’s the political leadership reaction. I’m wondering — and those may not be the right categories to you — if you were going to give us a one to 10, a scale of one to 10 and grade us on how are we doing from our scientific response near as you can tell, how are we as humans doing, and how has our political leadership responded? What would you say? 


[11:29] Larry Brilliant: Again, we were going to grade on a curve, but I don’t know how you do that on the humanitarian side. But let’s grade on a curve. I think the science gets an A-minus. I would give us an A-plus in terms of quantity of science, just like the virus is moving at exponential speed, I think science is moving at an exponential speed. And we all saw the M.I.T. Media Lab’s calculation that there were 3,000 peer reviewed science articles done by whatever it was in June sometime, and that there are now 5,000 new articles a week. So the quantity of science is certainly an A-plus. I think that the way in which we have worked on getting the vaccine preparations — giving that this is a grade of a class that’s still, you know, in progress — I would give us an A again on vaccine speed for sure. The jury’s out on whether these vaccines scientifically will work or not. But, you know, to date, I think we get a high grade. I don’t give us a very good grade in antivirals. I think remdesivir is a weak tea. But you and I, if we were in the hospital right now, we’d ask for it, wouldn’t we? So it’s certainly better than nothing. And it shows that there is a way to have an antiviral against this vaccine. I’m really super excited about the reaction to convalescent plasma, convalescent serum. But we’ve had that for 100 years. We expected that to work. 


[13:12] Andy Slavitt: Will that make a bigger difference than vaccines will, ultimately?


[13:16] Larry Brilliant: Well, I think if you look at the convalescent plasma as being a silo, where you go from blood to serum to convalescent plasma to specific antibodies to high-quantity specific antibodies to hyper-immune serum to isolating the antibodies to cloning them and creating monoclonal antibodies, I think that is a track that’s likely to be more successful sooner than the kind of vaccine that we need. Let me just say I have a very high bar for a successful vaccine, because it is insufficient for it to only work. It has to work for a large enough number of years, long enough period of time that we can mount a global vaccination program and get it to 200 countries to the most remote areas. And I think we’ll have a monoclonal antibody before we’ll have that kind of vaccine. And your second question was on how are we doing as humans? I see heroes every single day. You know, I worry about my friends who are emergency room doctors, or working in ICUs. I have a friend who had 80 patients in a row in an ICU die. And this guy, a good guy, he was just ready to jump off of a roof. If you contrast the image of these selfless servants, the nurses, the aides, the doctors who are working in hospitals, the first responders who are going to give mouth-to-mouth without knowing whether the person giving mouth-to-mouth is actually carrying the virus. These are heroes of the first class. They deserve whatever heroic medals we would give to someone fighting in war. And they’re not killing anybody. They deserve better medals than we give in war. 


[15:16] Larry Brilliant: Now, I contrast the reality of their life and the heroism of what they do with, you know, some of these bloviating talking head politicians, even some of the governors, who have all this power and are dismissing the virus as if it was some kind of a walk in the park. And encouraging people by the words of having Covid parties and deliberately infecting themselves, some of whom are dying. That contrast makes it impossible to give a very high grade to our civilization. Specifically an A-plus for the first responders. But I would give a D-minus, and probably there’s a special place in hell for some of the people who are lying about how dangerous this disease is. 


[16:20] Andy Slavitt: Zach, did you have a follow up? 


[16:23] Zach Slavitt: Yeah, I was just wondering, what’s the timeline looking like? What are you hearing and seeing about the timeline for the plasma treatment you were just talking about? 


[16:31] Larry Brilliant: Oh, we have it now. We have some small quantities of hyper-immune plasma, but we have fairly good quantities of convalescent plasma. We’ve had about, at this point, 13 million cases globally and three million cases in the U.S. And so these are all people who when they recover, the question has always been what percentage of them would give blood for plasma? The answer is almost 100 percent. I mean, the Red Cross is surprised, the blood banks are surprised, county health officers are thrilled that pretty much everybody who’s recovered is donating their blood to make into convalescent plasma. The problem that we have is it’s not enough to give to everybody who wants it early in the disease, but it probably is enough to give to people who are seriously ill in hospital. As more cases occur, which they inevitably will, there will be more convalescent plasma. We will get more efficient. Right now, it’s one recovered case can provide enough blood to give enough plasma to maybe two or three. As we get more efficient, that’ll become one to five. Then that will become halfway on the way to monoclonal antibodies. And we will wind up getting a pharmaceutical that we can use that will deliver the same efficacy. I’m very hopeful. I shouldn’t say optimistic because I don’t have any data on which to be optimistic, but I certainly believe and I’m hopeful that we will find something that route. 


[21:01] Andy Slavitt: One of the things that you convinced me of, Larry, a couple months ago, was how little we knew at the time and how much value we would have in simply learning about the virus by gathering data. And so I think it’s useful to maybe go back and sort of capsulize some of the things that we’ve learned. I think for the public as a whole, it’s got to be quite maddening because to be in the middle of a scientific process, when you’re not a scientist, and you hear something in January, and you hear something that’s to the contrary in March, and to the contrary in April, you may not realize that that’s exactly what’s supposed to happen, that we are dealing with the best information we have at the time. Hopefully we’re listening to sources who are telling us that there’s certain things we know and don’t know and there’s gaps in our knowledge, etc., but maybe we can cover some of the ground. So, for example, starting with how close we are to really understanding how this spreads compared to where we were when this first came to the U.S.? 


[22:04] Larry Brilliant: Well, let me first agree with you that being in the middle of science is messy. It is the reason peer review is so important. And it’s a reason why science has adopted a radical transparency, medical transparency approach to the way that scientists freely share information and make everything public, and print as much as possible. And that’s the key, because this is a novel disease. That means nobody’s ever seen it before. On day one, we knew nothing about this virus. We knew something about its siblings, its cousins, SARS and MERS and the four coronaviruses that contribute to the pool of viruses that cause colds. That’s all. We’ve got a couple of hypotheses about what a coronavirus does. But that’s a very small number of viruses from which to draw inferences about this new one. So one of those things that we learned from the previous two coronaviruses that jumped in one case from bats, in another case on either camels or bats or both, to humans, this virus spreads as a respiratory disease. And the problem with that, that becomes defining a virus by its mode of transmission, which is probably not the best way to categorize viruses.


[23:34] Larry Brilliant: Because we think of respiratory viruses, we think of the things that come most easily to mind, which are colds and the annual flu, which are fairly mild. We don’t think of other respiratory diseases. How about measles and chickenpox and mumps, they’re respiratory diseases? What about smallpox? That’s a respiratory disease that kills one out of three. And it is only one of the modes of transmission, respiratory. But this virus can spread by almost any route, can spread — I’m going to separate can from does, if I could. I’m sure it spreads by blood. I’m sure it spreads sexually, I’m sure it can spread by feces. I’m sure it can spread by fomites that have left behind by touch. It’s probably hard to imagine a way in which it is not capable of spreading. It can spread via aerosols, it can spread airborne, but it doesn’t in the sense of what’s the 80-20 rule — 80 percent probably are spread by droplet infections that do not hang in the air farther than six or 12 feet, depending on whether you’re yelling or screaming at a soccer match, or a baritone in an operatic voice or you’re just talking quietly. 


[24:57] Andy Slavitt: OK, so what I think you’re saying is that, let me know if I get this wrong, we know the primary way it transmits, which is through these large droplets. We know also that it can spread through a variety of other means, but they are to one degree or another less likely. And, you know, right now as we speak, the conversation is around aerosolization and it is around ventilation and it is around do you have windows open and doors open and fans and things like that? I guess I’m just trying to pinpoint, are we just at one spot in the lily pond where we’re now on that one? And that seems the most important? Or is that we are making too much of that? And is it just part, we’re just midway through a learning process?

[25:50] Larry Brilliant: The clusters that characterize the way that COVID spreads probably don’t exist, if at all, in very large numbers, to people walking alone in a national park. On the other hand, if you’re in a place that looks like a cruise ship — and nursing homes are like a cruise ship, jails look like a cruise ship — if you’re living packed next to each other, cubicles are so close and you’re indoors, then, yes, that provides an opportunity for much more intense respiratory spread of droplets, much more creation of airborne transmission, and all of the above. And that’s probably what creates these clusters where the replication value that we talk about all the time, the R or the R-naught, or the RS for situational, and the RE for effective, that those change. And so what you think of is a virus where one case infects 2 or 2.4, others that can’t explain San Quentin, where five weeks ago there were no cases and 12 or 13 people were imported in and now we have 1,500 cases. You can’t explain that. You can’t explain Wuhan with an R-naught, the first R, the replication of two. You can’t. The numbers make you lean towards a replication value closer to five, if you can’t account for all the cases that get infected in Wuhan and then went to other parts of China as some of the subsequent articles have done.


[27:41] Larry Brilliant: This virus is like a Tesla. It goes very fast, if you buy an ordinary Tesla, but you can also buy a Tesla that’s able to go up to audacious speeds. And if you put out a lot of money or you put them on a cruise ship that Tesla, you’ve got a ludicrous speed. And that’s one of the reasons we’re having a problem dealing with this disease. 


[28:03] Andy Slavitt: OK, a second category of things. How much do we know about susceptibility? And maybe that’s not the exact word. It seems like when you look at the data around, say, household spread, that if someone in the household has coronavirus, some people in the household get it and some people don’t, presumably with the same amount of contact. There’s theories based upon gender, based upon age. There’s something going on there. Now, as far as I know, we all have lungs. We all have nostrils. We all have eyes. So it seems mysterious. How much do we understand about this? And by the way, please correct anything I said that’s a myth. 


[28:47] Larry Brilliant: Well, we don’t know and I don’t know. My impression is that this virus is an equal opportunity infector, but it is not an equal opportunity killer. And therein maybe I can parse the differences that we’re talking about by individual differences. So we know, for example, or we have data that if you have type A blood as opposed to type O blood, you have a slightly greater risk of getting the disease and a slightly moderate risk of having a more serious disease. That’s probably also true male gender. It’s most of all true for people who have preexisting conditions. And those include hypertension, diabetes, obesity, or being immunocompromised, either because of a disease or treatment, and age. Where age is by far the greatest preexisting condition that determines not so much your risk of getting the disease, but certainly your risk of getting very sick and dying.


[29:57] Andy Slavitt: So now another mystery: what this virus does to the human body — and it’s one of the things that to me feels the most mysterious and maybe to a lot of people feels the scariest. We know, obviously, that it can cause at least three major side effects. It can cause an overstimulation in the immune system, can cause blood clots, deprive the body of oxygen. But we also are learning that it can go into various organ systems, brain, heart, kidney, potentially others. And then we see these interesting symptoms in some children. And then we see people who have got this sort of long-tail coronavirus where after months and months, they’re having problems, some of them neurological, et cetera. So what do we know? And if we don’t know very much, when will we know it?


[30:52] Larry Brilliant: This is why I wish that we didn’t call it a respiratory virus. It is a respiratory virus, but I wish that there were another way to categorize it. It’s as different from colds as smallpox is from flu. And in some ways, it reminds me of smallpox. Of course, smallpox killed one out of three. And it had a replication rate quite a bit higher. So in both the important ways, smallpox was worse than this disease. However, COVID is a disease that affects you nose to toes. I mean, literally, you lose your sense of smell. You may. And you can get COVID toes, the swellings that you get in your fingers and toes that look a lot like frostbite. And you’re right. While initially what we worried about was ARD, acute respiratory distress, and these CAT scans and x-rays we saw with huge circular holes right in the lung. Now we know that when the virus enters the body, it can enter via several routes, not just the ACE-2 receptor, which everyone talked about. 


[32:03] Larry Brilliant: In that case, you would have seen the virus entering the body wherever there were these receptors. And the lining of the respiratory tract is one, but the lining of the circulatory system is another. But what we’re seeing is that through a kind of dendritic process, extending all of its appendages, the virus can then go from cell to cell the cell, regardless of the type of the cell. And particularly the circulatory system and the clotting system is affected. So micro clots, micro-blood clots, micro emboli, micro thrombosis are found all over the body in many patients who have COVID. And this explains a set of symptoms that otherwise you would not believe could be caused by one disease. Stroke, heart attack, kidney failure, liver failure. Numbing of the appendages, loss of smell and taste and all the respiratory symptoms that we’re finding. Tony Fauci said this is the most widespread disease he’s ever encountered in his long career. I was quoted as saying that if I would not be disbarred and lose my license as a scientist, I would call this virus evil because of the way it attacks of the cells of the body. I can’t call it evil because I’m not allowed to impugn motives to an RNA sac enclosed in a bunch of fat. But it certainly is not a very friendly virus. And for the doctors on the front line, to the people who get it, for the families who lose a loved one, it feels certainly like evil.


[33:50] Andy Slavitt: Do you feel like there’s some gaps in knowledge that if we were having this conversation three months from now, six months from now, that there are mysteries yet to be explained about how it does all of that that would cause us, if we were looking at the data dispassionately, to understand it better. In other words, are there are a couple of missing truths that one year, two year, three years, five years from now — or do you feel like we pretty much got it? And it’s just this is the way it’s going to feel? 


[34:22] Larry Brilliant: Absolutely. I mean, the science of what we’re just talking about is, or the description of it, is pathophysiology. And there are lots of specialists and incredibly smart scientists who spend their life trying to understand disease processes. And they may be pathophysiologists in some other world. And I do believe that there’s some missing links to describe the plethora of different organ systems attacked. When we learned, which we learned from earlier coronaviruses, that their preferential attack is in the ACE-2 receptors. That allowed us to make a map of the bodies to find where are those ACE-2 receptors. And we found, surprisingly, that they were in cells and organs we didn’t expect them to be. And that helps explain the distribution of anomalies better. But the more we understand about what this virus does to the circulatory system, which is everywhere in the body, that also helps us understand why we see end-stage kidney disease so early in a process that we wouldn’t have expected to take place that soon. Yes, I believe three months from now, six months from now, we’ll be getting reports that will surprise us and illuminate this process. And hopefully it will lead to the discovery of vulnerabilities in this virus that we can exploit as we create countermeasures. 


[35:55] Andy Slavitt: Right. It’s also quite clear there’s one other thing we couldn’t possibly know, which is the long-term effects, whether something appears to go away and it’s just really dormant and it comes back. Whether something is going to be chronic for someone’s entire life. Or whether something is going to just be a nagging issue, but which will eventually get better, and that the body or some medicine or a combination of the two will figure out how to deal with it. 


[36:20] Larry Brilliant: Yeah, I mean, my major diseases that I’ve spent a lot of time working with are polio and smallpox. And in polio, there’s a tremendous number of asymptomatics, what we think of as asymptomatics. In fact, it’s not like five to one asymptomatic. It’s 999 nine asymptomatic for every one case. So out of a thousand people who serologically look like it had polio, 999 appear to be asymptomatic. Yet years and years later, people can develop something called post-polio syndrome. There are now clubs and organizations of people who have post-polio syndrome because they can’t explain to people, you know, how could a disease that affected them decades ago be causing these effects? 


[37:10] Andy Slavitt: I read something which is the most dangerous way to start a sentence these days, because you don’t know if it was something peer-reviewed or pre-print or what have you, which said that a decade or whatever it is after SARS-Co-V1, that some large percentage of people were experiencing neurological/mental health as well as chronic fatigue. And I think the number was like 40 percent. First of all, is that anything you’ve heard? And secondly, should we be worried about this — if you had to guess, would you say we should be worried about this as a chronic condition, even for people who’ve had very mild or asymptomatically cases? 


[37:52] Larry Brilliant: And you’re not even mentioning PTSD and all of the post-traumatic and psychological effects down the line, which clearly will be the case for anybody who’s been in an ICU. Remember the case count in MERS and SARS in each case for less than 10,000 cases, certainly compared to what we have now, a very small sample size. Given that we’ve had millions of cases of COVID and we’re going to have tens or hundreds of millions of cases more, we will find out soon enough what the distribution of disease is. And over time, we’ll find out what the after-effects are. But, yeah, I’m very worried. The friends I have who work in COVID hospitals, one in Los Angeles, he says of the people who come into his ICU out of 100, hardly a handful leave as the same person who came in. And that’s scary. 


[38:56] Andy Slavitt: That is scary. Given that 20 percent of the world think that people like you and I are fear mongers, who are out to create panic in the country, and that we somehow must be secretly profiting off of coronavirus. You know, when I think of the path out — we have this conversation about things we don’t know. I mean, it’s bad enough to try to convince people of things that we’ve seen with our own eyes, let alone to talk about things that are risks and dangers that are going to come from here. And we’ve got to this sort of various suspecting portion of the public just won’t hear anything like that, that’s my worry.


[39:37] Larry Brilliant: First of all, I am a fear monger in the same sense that a fishmonger is selling real fish. We tend to use that term to mean somebody who’s selling snake oil. But I’m not a snake oil salesman. I’m fearful of this disease. It is a frightening disease. I’m also fearful of the people who, either out of ignorance or malice, misrepresent the seriousness of this disease to the detriment of their friends and loved ones. How will they feel when they tell their mother or father, sister or brother, that it’s fake, it’s a hoax, and one of them dies, which is happening more? There’s now a Twitter column that lists all the 20 and 30 and 40 year olds who died at COVID parties, or who deliberately infected themselves and whose last words are, “oh, my God, I made a horrible mistake.” That’s a burden that I don’t wish on anybody. This is a serious time. It requires a far more serious response than we’ve had so far. We can’t joke or slough this off. This is not something that’s going to go away in April. It’s not going to disappear in the heat. It’s not under control. It’s not a hoax. It’s not those things. It is a pandemic, and it is the worst pandemic in any of our lifetimes. And we’re learning about it every day, as you would for any novel virus. By the way, there have been 50 novel viruses in the last several decades. There are two or three new ones every year. Get used to it. We are in the age of pandemics. This only happens to be the latest and the worst, but it’s certainly not going to be the last. 


[43:58] Andy Slavitt: So today versus the first day of March, or whenever, or middle of towards the end of February, when we started to see this coming, when the ship docked here, do you feel — all things equal, all of our scientific progress and all of the things we’ve learned about the disease — better or worse, more scared or less scared than you did back then? 


[44:19] Larry Brilliant: I feel worse. I feel better in that we are three months closer to a vaccine, and three months closer to monoclonal treatments. I feel better about that. I feel much worse in the fact that my beloved CDC, which for all of us who fancy ourselves epidemiologists, CDC is a little bit like Mecca. We’ve all gone there at one time or another believing that that was the center of such integrity and great science. And still has phenomenal scientists and great integrity. It is either forgotten that or it is being suppressed, and I believe it’s being suppressed. So we don’t have the kind of leadership from the scientific committee. Even the, you know, FDA, which at one time we could be really sure that if you got FDA approval, it was like pulling teeth to get it. Now you can get an emergency use authorization, which requires you only to sign a paper that you’ve tested your own product, and it’s OK, don’t worry about me. This is OK. We’ve lost these two great arms of our scientific response and our political response has been abysmal, historically bad. So, yes, on balance, the epidemic has reached a level I didn’t expect it to. Not because the virus is worse than I expected, but I expected our counter measures in this great, wonderful country that we love, America, that our counter measures would be at least as good as Vietnam, at least as good as Spain, Italy, France. 


[45:59] Larry Brilliant: But when you contrast the epidemic curve, the number of cases in those three countries compared to ours, first, it’s horribly embarrassing. Second, hidden in those line graphs are so many tragic stories that didn’t have to happen. So many deaths that are not necessary, that should not have happened. So much suffering could have been avoided by the kind of response that we are used to as Americans and we deserve as Americans. 


[46:32] Andy Slavitt: So that’s that’s an indictment. But there’s something that’s really significantly optimistic, buried in what you just said, I think. And let me pull it out and tell me if you agree with this. If you solve the political equation and the people involved, the fact that across the world, whether it’s the Czech Republic or Greece or Italy or Hong Kong or Vietnam or New Zealand or indeed China, people have figured out how to keep this virus at bay. Contain it to the point where they recognize a small number of cases and can jump on them. Doesn’t that indicate that it’s not as if the virus is so evil, or whatever word you’d use, that it can’t be controlled with the right leadership, let alone science? These are just non-pharmaceutical interventions. 


[47:29] Larry Brilliant: Let me help you in a way. During the Cold War, under Gorbachev’s rule, a billion dollar, five year plan was created to create a superbug called a chimera. It would be half smallpox and half Ebola. To be either used against the United States and kill 100 million people, or to threaten its use against the United States. That would be a virus that would spread as fast as smallpox, kill as badly as Ebola. This is not that disease. This is not the zombie apocalypse. This is not a mass extinction event. I offer as proof, not necessarily New Zealand and Taiwan and Iceland, three island republics run by wonderful women. I offer as a real example, New York, run by a governor who was a skeptic at first, who believed the virus wasn’t as bad, and that we shouldn’t close down the economy. Who had trouble, in fact, beginning the necessary steps to stop this disease until he saw firsthand with his own eyes how bad it was in the hospitals that had no more room for other patients to come into the ICU.


[48:46] Larry Brilliant: And he turned and he switched, like every politician who I hear speaking today, who has been a skeptic and who’s saying that’s a hoax, who’s downplaying it. When Governor Cuomo changed, New York changed. And if you look just at the epidemic curve, you see almost a Mount Fuji. You see almost on Mount Shasta. A curve that incline slope is almost equal to its decline slope. That’s the perfect example of what we can do in every other state, in every other city that is now subject to both bad governance and a bad virus. We are facing a really bad coronavirus. It’s just a virus. It’s just a sack of RNA surrounded by a bunch of fat. And it has no intentionality. It is not trying to kill us, defeat us. It is programmed to infect us. We are smarter than it is. Our science is better than it is. And if it was just our science and the goodwill of American people, absent bad governance, we would have defeated it already. I don’t mean we would have eradicated it, but we would have been much further along into kicking it into the dustbin of history, which is what we will do when we gather our wits about us. 


[50:08] Andy Slavitt: I had another question, but there is almost no better way I’d rather end. At least what people take away from this show, with this episode, this fantastic conversation with you, which is our fate is much more in our hands even in the face of something that we don’t yet fully understand. Well take care. I won’t keep you any longer. Thank you so much. 


[50:32] Larry Brilliant: All the best. Bye bye. 


[50:40] Andy Slavitt: Thanks to Larry Brilliant. I hope you enjoyed that. I learned a lot. I learn a lot every time I talk with him. We have a great set of podcasts coming up next week. We have our third Toolkit podcast next week, we’re going to play the game of safe or unsafe with two of the country’s leading epidemiologists. And we’re going to ask them all kinds of your questions and put them in interesting situations and force them to tell us how safe those activities are without copping out. And then on Wednesday, we have Ambassador Susan Rice. Ambassador Rice, for those of you who don’t know, was the national security adviser to President Obama. Before that, she was the ambassador to the United Nations. If you’re hearing her name a lot recently and saying, where do I know that name from? She is talked about as being on the shortlist for vice president for the ticket with Joe Biden. And you will get to hear our conversation about that, as well as everything else. So have a great rest of the week. And I hope you find a way to stay close to your loved ones.


[51:54] Andy Slavitt: Thanks for listening In the Bubble. Hope you rate us highly. We are a production of Lemonada Media. Kryssy Pease is our producer. Ivan Kuraev is our editor. Jessica Cordova Kramer and Stephanie Wittels Wachs executive produce the show and run our lives. My son Zach Slavitt is my cool co-host and onsite producer. Music is by Dan Molad and Oliver Hill. You can find out more about our show on social media @LemonadaMedia. And you can find me at a @ASlavitt on Twitter or @AndySlavitt on Instagram. If you liked what you heard today, please, please, please tell your friends to come listen, but from a distance. And for now, stay safe. Share some joy. And we will get through this together. And #StayHome.


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