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April 11, 2020 - Rudy Giuliani
51:09
TIME IS OF THE ESSENCE: Cure for COVID-19
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It's our purpose to bring to bear the principle of common sense and rational discussion to the issues of our day.
America was created at a time of great turmoil, tremendous disagreements, anger, hatred.
There was a book written in 1776 that guided much of the discipline of thinking that brought us to the discovery of our freedoms, of our God-given freedoms.
It was Thomas Paine's Common Sense, written in 1776, one of the first American bestsellers in which Thomas Paine explained by rational principles the reason why these small colonies felt the necessity to separate from the powerful Kingdom of England and the King of England.
He explained their inherent desire for liberty, freedom, freedom of religion, freedom of speech, and he explained it in ways that were understandable to the people, to all of the people.
A great deal of the reason for America's constant ability to self-improve is because we are able to reason, we're able to talk to each other, we're able to listen to each other, and we're able to analyze.
We are able to apply our God-given common sense.
So let's do it.
Hello, this is Rudy Giuliani with Rudy Giuliani's Common Sense.
Another episode, and this one concentrated again on this horrid scourge all over America and all over the world.
COVID-19, the new coronavirus, Whatever you want to call it, this terrible disease that's spreading at ridiculously fast rates and killing so many people.
So I think it's our obligation to learn as much about it as we can, and therefore to be in the front lines of trying to turn it back as quickly as we can.
Today we have two guests that are right in the middle of the battle.
We're in the middle of the most important part of the battle, which is the research that is necessary to try to find ways to identify it, try to find ways to deal with the symptoms, try to find ways to cure it, and then try to find ways to prevent it through vaccines.
And the first of our guests is Peter Polisi.
And Peter, could you please tell us your very, very distinguished background?
Because this is an area that you've been an expert in for many, many years, this area of virus and these particular kinds of viruses.
Thank you, Mr. Mayor.
I am chairperson of the Department of Microbiology at Mount Sinai here, Mount Sinai Medical School, and I am a virologist.
I have been working all my life on viruses, and the coronavirus is certainly a virus which has really caused us a lot of problems.
And I think, Mr. Mayor, this is like a 9-11, but a global 9-11.
We need people like you who have experience in those dire situations and guide us out of this.
This is a very, very difficult situation and, as you know, we are Trying to keep the virus away.
Unfortunately, in terms of what we can do at this point, it's mostly that we are trying to have social distancing, that we are trying to isolate ourselves and that we are trying not to contaminate and to transmit the disease from one person to the other.
Doctor, can you describe to us laymen why this particular virus is so Contagious?
I mean, we've had viruses for a very, very long time.
And they kill a lot of people.
Not to say they aren't extremely dangerous.
Probably more dangerous than we realize.
But this one seems to be moving at a speed that... Has this ever happened before?
Has it ever moved this fast?
This is a very good question, Mr. Mayor.
Why has this virus behaved so differently?
And many of us didn't believe this would be such a dangerous... I mean, many of us in the field didn't believe this was such a dangerous virus.
And it has to do that we unfortunately do not have any antibodies.
We, meaning all the people in this world, have never seen this particular coronavirus.
We all have had exposure to different coronaviruses when we were young and in different countries, but this one is different.
So we have no protection against this virus.
And it has found, I don't want to say a niche, But we have no experience, meaning immunological experience, in the world and that is the reason this virus can infect people and be transmitted from one person to the other in such a fast way.
And this is really the reason, the reason is that we have no experience, prior experience, that we are not immune, that we do not have any antibodies against this virus.
So, if I understand that correctly, Doctor, in many cases, even though a virus might be somewhat different, or somewhat new, we at least have some antibodies from other viruses that will help us with that.
Correct, absolutely correct.
But this one is actually bird immunity, like with cows, yeah, a herd immunity.
We have some prior experience, maybe not with the exactly same Asian, but close enough so that we are not completely without any immunological fighting possibility.
So this is very, very different from other experiences.
And unfortunately, it's almost a, I mean, it's bad luck, obviously,
but we are very, very surprised that we do not have any prior experience.
And is that why it is so hard to come up with either a remedy or a vaccine
or something that will really slow it down?
Exactly.
That's exactly the reason.
Yes.
So, can you give us a prediction on, and I know it would almost be a guess, but can you give us a prediction as to how long we're going to go through this first part of it?
Are we going to get some relaxation at some point?
You know our Yogi Berra.
It's always difficult to make predictions, especially about the future.
But, I mean, As we are going towards the summer, maybe, and it's only maybe, we have some what we call seasonality.
Influenza, for example, is mostly in the wintertime and in the northern hemisphere.
And so it might be that this coronavirus also has some a sort of seasonality that it may be more common in February, March, April and less common as we go to the summer months.
But this is, I think there is some possibility that this is the case, but there's also a lot of hope.
Correct.
lot of hope because again we have no experience with this particular.
Correct.
So we have never had a summer or winter with this particular virus.
So right now before we get to the medical possibilities the only defense we really have
is our act our behavior right the.
Absolutely correct yes.
So unfortunately and as you all also know those of us who have a couple of more birthdays
than the others we are real in a much more difficult situation because infection with
this virus causes more disease in the older more senior population.
Is that always true of a.
Coronavirus or a flu-like virus is it only worse than the old?
Mr. Mayor a very good question It is always true if there is no experience in the
population So if no one has seen it, then the older ones are also more susceptible, not against this coronavirus, but also against other viruses.
If you have a population which has never seen measles virus, and suddenly measles virus gets into that population, the older people are more affected than the younger ones.
Now, just go over for us what the behavioral patterns are that we have to observe to give ourselves a chance to, you know, to defeat this.
What we can do, you mean?
Yeah, yeah.
What can we do?
What's in our power to do to try to keep this down to as little as we can hold?
Unfortunately, these are very old measures of keeping away from other infected, treating everyone basically as if he or she would be infected, keeping the distance.
It appears that keeping 8-10 feet distance between two people really
cuts down on transmission, so it is really the only possible
way we have at this particular point in terms of non medical interventions.
So that's that that should be done.
Obviously, if you're outdoors, but even inside even indoors.
If you can, if you can separate people who are indoors, it would very much help.
And what about the mask?
We hear a lot about wearing the mask, not wearing the mask.
Should we wear a mask?
Shouldn't we wear a mask if we're not infected?
Yeah, a very good point again.
And there is some evolution in our thinking.
The reason is that wearing a mask allows you to maintain a what we call social distancing, a physical distancing because we are not getting as close if someone has a mask but more importantly It also, and that has only been sort of come to the forefront, is that when we are touching a doorknob, for example, which has the virus, and then we touch our face, we touch our nose, we touch our mouth or the eyes,
There is a big possibility of transmitting the disease from an environmental surface, from a doorknob, into our own faces.
And a mask prevents us from doing that.
We are not touching our faces as often if we're wearing a mask.
So wearing a mask has this very, very important Yes.
You know, Doctor, I've seen, and I've done it myself, I've seen people giving lectures on this, talking about it, explaining how important it is not to touch their face, and while they're doing it, they're touching their face.
It's such an involuntary action.
It doesn't need to be one of these fancy N95 masks.
It could be really some cloth you put over the face.
Things like that would be very helpful.
So, Doctor, when we talked earlier, you were pretty certain, and I don't think there's much doubt about it, as to the origin of this.
I mean, this virus emerged sometime in 2019.
And most often they say December of 2019.
Is that your thinking or do you think it goes further back than that?
I think there is some evidence from Chinese colleagues that this virus was already circulating before that time.
This is obviously a very sensitive area for the communist regime.
They really do not want to sort of admit and don't want to be completely transparent.
But it is very clear that this virus originated in China and then found its way out of China,
infecting Europe, the United States, etc. And did it originate with a bat?
And we have, so I'm in this business of comparing sequences and we have meaning in
in those banks of sequences, we have bat viruses from one, two, three years earlier,
which are very close to the virus which causes the disease right now.
So it is very likely.
That this is a bat virus which made its way into humans.
And made its way into humans because they eat bats?
And unfortunately, it is very likely that in some cultures, particularly the Chinese, bats and pangolins are used, a delicatessen kind of thing for them.
It's something really they like to eat.
And with that, if those bats and pangolins are infected, then this can jump into the human.
Largely because they're not cooked, I gather, right?
or not cooked enough. Yes.
Right. So now what, what, what, tell us what you're working on that gives us some hope that
we're going to see the end of the tunnel here, doctor. I know you are working on
two exciting projects.
So a very important aspect is diagnostic and Mount Sinai is very much involved in
developing diagnostic tests, particularly for antibodies.
And that means we can identify people who have been infected and are now protected.
They cannot be reinfected.
So these tests are very very important because they identify people who can go back to work but also could give some serum which is referred to as convalescent plasma or serum transfer, people who have been infected
have antibodies, are protected, and they can share it with other people.
It is a way of protecting some people and diagnostic tests such as antibody tests, which
we are developing at Mount Sinai, are very important in this respect.
How close are we to being able to use these tests, or are we actually using them already?
Yes, and that is a little bit of the problem.
We are using them already, but they are not geared and it's not possible to ramp it up, to scale it up, to have hundreds of thousands of people.
This would only be for very few people who are in the first line, healthcare workers, firemen, policemen, etc.
But this is going to develop and we will, as the weeks go on, not months, As weeks go on, we will have some of the treatment or prevention will be possible by using serum from using blood from people who have been infected and who are now immune and are protected against reinfection.
If I understand this correctly, this is a blood test.
You draw blood, you examine the blood and you find the antibodies.
Correct.
Correct.
Exactly.
That's what it is.
Number one, that tells you this person is immune and therefore can go back into the workforce.
Yes.
But it also gives you the possibility of using some of that to give someone what you call like a temporary immunity.
Yes, it is.
Absolutely.
It's not for a lifetime.
It is only as long as these antibodies are present in the other patient.
And that is maybe six weeks, two months, three months.
And after that, one can give that again and protect the person.
But it is not a lifelong It is called passive immunization.
One gives the antibody which is now neutralizing the coronavirus and that is referred to as passive immunization.
Correct.
And roughly how much time do you get out of that?
It's weeks and months, not years, okay?
It is depending on the titer.
Obviously, if that person who had the infection had a very bad infection, then the titer would be higher and his serum would be better, unfortunately.
The poor fellow who had a serious disease, coronavirus infection, was probably not happy, but such blood is more valuable.
And how can you be sure That it will give you immunity to this particular virus since we don't have experience with this virus.
Yeah, yeah.
No, it's a very good point.
However, this is a I don't want to call it methodology, but it has been used in the past.
You know, that people who have gotten a particular disease serum was used to protect other people.
So, it is not something which is completely new.
And also, there is some evidence from Asian countries now, where they have actually done this, that it does really work.
Again, the real problem is you cannot use it to protect 100,000, 200,000 people.
Unfortunately, that is not the case.
It's not the case because you can't develop enough of this serum, is that it?
You have to take serum, you have to be in the hospital, there's a process of getting the plasma.
This is not something which can be done for the general population, unfortunately not.
So this has to be done for people with extremely important roles to play, security, medical, that kind of thing, right?
Correct, correct.
And military and police.
Of course, military, national security.
Now, I know you're also working on a vaccine.
Yes, and we are working on what we call an active immunization that we are injecting, like a measles vaccine, like a mumps vaccine, that we are injecting basically that pathogen, that virus, and we ourselves make antibodies against it and therefore we are protected.
But this is a process which also takes months And many different companies and laboratories in the country are working on it.
We're getting very good support from philanthropy.
Really, thank you, thank you, thank you.
It is absolutely impossible to pivot into this direction in such a brief period of time without The active support of many, many philanthropy donors.
And this, I think, should be really stressed that this will help.
And I'm absolutely positive, Mr. Mayor, that we will find something, but it will take some time.
And I'm very positive that we will have something which will, as a vaccine, an active vaccination, will protect us and will make this a virus of the past.
But tell us the approximate length of time realistically it would take to get to that point of having a vaccine that at least you're relatively comfortable with.
Yes, I think this last point is a very important one.
If we give this vaccine to 10 million, 50 million people, we want to be really sure that I want to be more than comfortable.
We want to be absolutely certain that this does not cause any other side effects or problems.
And to answer your question, how long will it take?
Again, this is something looking into the future, but I think Dr. Tony Fauci had it right when he was talking about a year to six months, maybe can shave off one or two months, but basically we are talking about those times because it takes that long to make a vaccine, do the toxicology, find out whether it's toxic, Well, doctor, I can't tell you how illuminating this conversation has been.
I think it clears up for people so many things that have been so confusing.
any problems, but it won't protect us either.
Well, Doctor, I can't tell you how illuminating this conversation has been.
I think it clears up for people so many things that have been so confusing.
You have a remarkably clear way of describing what I know are very complex scientific principles.
So, I think it's been very, very useful and we hope we can check back with you as we move along.
And thank you very, very much, Doctor, for your exceptional work in this area.
Thank you, Mr. Mayor.
God bless you.
Thank you.
Well, that was a very, very interesting interview and we'll be back very shortly with another follow-up interview on this very important subject.
Welcome back to Rudy Giuliani's Common Sense.
Once again, we're going to go to someone in The fight in the field, someone who is working very, very hard to develop remedies, approaches, ways to deal with this virus that hit us out of nowhere, as I think we just heard described.
And I think it's remarkable that we've developed so many possibilities so quickly.
But it is confusing and I think very, very helpful, particularly this next guest who is very articulate in describing this area.
Dr. Nicole Bouvier is a certified infectious disease physician at Mount Sinai Hospital here in New York.
And she joins us to help us understand this terrible nightmare that we're all going through.
Dr. Bouvier, thank you for joining us.
Thank you.
So, Doctor, how best to describe what this is that has descended on us, this virus, and why it is so different than the ones that we seem to have every year that are dangerous, but certainly not at this worldwide level.
Yeah, I think we're still working out a lot of that on a research perspective, but one thing that we do know about coronaviruses is that there are a lot of different animals who can be infected with them.
And, you know, they aren't necessarily good at infecting humans.
Some of them might be.
And, you know, we saw that back in 2003 with the SARS epidemic and then in 2012 with MERS, that sometimes coronaviruses are, even though they're best suited for their animal host, they can infect humans as well.
What we're seeing with this virus is that it seems to be very exquisitely suited to infecting humans, which is not always the case with animal viruses.
Sometimes they could be, but usually they aren't.
One of the issues with this virus is that it is new, and so it hasn't been circulating in humans.
We don't have antibodies.
We don't have any immune responses from prior infections to help protect us from this one.
So all of these things together are sort of Conspiring to make it much worse than ordinary, say, seasonal influenza.
Is this the fastest spreading virus that you've seen in your experience, Doctor?
So, I mean, pandemic influenza can spread quite quickly like this as well.
So that's an animal influenza virus that is also suited to infect humans.
And that can spread very quickly, too.
You know, certainly this is the largest pandemic that, you know, we've seen certainly in my lifetime and probably in Dr. Palazzi's lifetime as well.
You know, it's sort of on the scale of, say, the 1918 influenza pandemic, which You know, spread throughout the world with record speed and caused a lot of sickness and a lot of deaths.
You know, in some ways it's just, it's a chance, whether an animal virus just happens to be good at infecting humans too, and infecting, not only infecting, but spreading from human to human.
Now, what about this virus gives us an opportunity to attack it and kind of reverse it?
How do you approach How do you approach dealing with what's going to be needed?
Remedies for the symptoms?
Remedies for the disease?
Vaccines?
All these things have to be developed from nowhere, basically like we would say from scratch, because you had no experience with it.
That's a difficult job.
Yeah, it sure is.
You know, we don't have experience with this particular virus, but we do have experience with other respiratory viruses like influenza.
We have some experience from the SARS epidemic.
And a lot of science builds on what we know about similar, but maybe not identical pathogens.
So a lot of the therapeutics and the vaccines and that kind of research, we're drawing on what we know from other pathogens and at the same time trying to learn how well that applies to this particular one.
So give us some examples of how you apply one to the other so we can kind of figure out how this moves along.
So for instance, you know, one of the things that I'm working on right now at Mount Sinai is convalescent plasma and that is... Convalescent plasma?
Yes, so plasma is the liquid part of blood.
So a person who's been infected with this virus and has recovered will have started producing antibodies that recognize the virus and can prevent it from reinfecting that person.
We believe it will prevent reinfection of that person.
So if that person then goes to the blood bank and donates blood, and we can take the plasma from the blood, which contains the antibodies that that person is producing, we can then give that plasma to a sick person in hopes of just giving their immune system a little boost with the antibodies from somebody who's already recovered.
So this is very old therapy.
You know, it was tried in the 1918 influenza pandemic.
It was tried in SARS.
You know, we have some experience with the 2009 influenza pandemic, where it was studied in sort of a rigorous fashion.
And it seems to be something that can help.
And so that's why we're sort of exploring this right now for this new virus.
And did it work then, when it was tried way back in the last century?
Yep, so there are cases where we know it has worked.
For instance, plasma therapy was developed in the 1880s for diphtheria, actually.
So basically, diphtheria is a bacterium that secretes a toxin that causes a lot of chaos with the infected person's immune system.
And so what scientists did is they took the toxin from this bacteria and injected into the horses and let horses make antibodies to it.
And then they would take the plasma from horses and treat children with diphtheria.
And it was amazingly successful.
That was a Nobel Prize winning discovery.
So, you know, more than 100 years ago.
It was tried in the 1918 influenza pandemic, and the standards for medical literature are a lot stricter now than they were then, but to the extent that we can generalize from that old literature, there were certain situations in which it worked.
And we saw that in the 2009 influenza pandemic, where if people were treated relatively quickly, when they were, you know, relatively recently infected with the virus, that actually they tended to get better faster than people who weren't treated with plasma.
So, you know, there are definitely signals that suggest that this might work, but we have to try it with this virus to make sure.
So how does this differ from stem cell approach, the use of stem cells that is taken from blood or taken from placenta or whatever?
So antibodies are basically proteins and they're made by cells.
They're made by cells that are called B-cells and they're basically secreted into the bloodstream and an antibody is sort of designed so that it can recognize and bind to a virus or a bacterium, anything that the B-cell does not recognize as belonging to the person that it's inside of.
And so it's not really a cell, it's a piece of protein separated from a cell that's doing the work.
And that differs from a stem cell?
It does.
So a stem cell is a complete cell that has, you know, a lot of machinery for doing things like making more copies of itself, for doing a lot of the housekeeping that a cell needs to do, making proteins, reading its DNA, and things like that, that an antibody being just a protein doesn't have.
So once the protein's made, it's just made.
It's there.
It can't change.
A cell is constantly in a process of making things that it needs for its daily existence and for making more of itself.
So the research with regard to convalescent plasma and with regard to stem cell, that's two separate... It's two separate things.
Two separate possibilities.
Yes.
And are they both moving along?
Yeah, both moving along.
You know, we here in New York have only had a few weeks of experience with this.
So, you know, we're moving as fast as we can.
But yeah, I mean, there's lots of different research efforts that are being directed at, you know, therapeutics or prevention, not just sort of the basic science of what the virus is, but actually Things that are designed to help people either avoid getting infected or to get better if they do get infected and get sick.
So that's all, you know, it's a very multi-pronged approach.
It's happening in lots of different places all at the same time.
And, you know, we're trying to keep abreast of all of the discoveries that other colleagues are making around the world so that we can all sort of focus our best efforts on this virus.
Would you use plasma now?
I mean, would you use the convalescent plasma now or is it still too soon?
We are using it.
So, the Food and Drug Administration has issued what's called an emergency independent new drug process.
So, it's sometimes called compassionate use.
Oh, right, right, right, right.
So if somebody's very, very sick and there are no therapeutic options for them, we can apply to the FDA for permission to give them convalescent plasma.
And so far we've treated 19 patients here at Mount Sinai, and doing a lot of data collecting and research to figure out whether, not only whether it's benefiting the patients who have gotten it, but whether we can learn anything from these patients to figure out who responds best to this treatment and who may not.
So that's an actual area that we're doing right now.
Since you told us at the beginning that this works best at an early stage, but you're using it near the end, how have the results have been?
Does that make the results more difficult?
I imagine, right?
We're actually focusing on people who are relatively early in illness.
And the reason is because this is a treatment that works directly on the virus.
Once the virus is gone and, you know, lung damage has happened, we don't think that the plasma is going to be able to help.
What we're trying to do is get rid of the virus faster so that a lot of the harmful things that can come from being infected don't happen in the first place.
And how has it done?
How would you regard it without, you know, I know it's not a scientific test and I know there's a lot more research that can be necessary, but so far does it look good?
Does it look bad?
Is it a possibility?
No, I think we really need more data to know for sure.
You know, so far we have not lost anybody yet, so that's always a good signal.
You know, but it is sort of a, we don't have a control group, for example, so we don't know if we had allocated this treatment randomly, if we would randomly expect everyone to be surviving at this point.
So there's still a lot of scientific unknowns, but that's part of what we're trying to do is learn some of these, you know, Get some of these unknowns to become known so that as other parts of the country start getting to be where we are now, we have some advice that we can give them about how to treat this infection.
And how could you scale this up if you really had to use it on a major number of people?
Is it difficult to do?
It really depends on blood donors.
It depends on people who and recovered, being willing to get their blood screened to
see how much antibody they have in their bloodstream, and then being willing to go to the
blood donation center and donate blood.
And so far, we've had thousands of people who have volunteered to be tested as blood donors,
and we're sending in more and more people every day. So here in New York, we're seeing an
amazingly generous response from the people who've recovered to donate plasma to people
who are sick right now. It's been really, really impressive.
Do you have to be cured when you do it, or can you do it while you're still ill?
You need to be cured, and the reason is because it takes your body a while to sort of ramp up its antibody-making process.
And we don't know for sure, but we think that people are probably producing maximal antibodies at like three to four or maybe even longer weeks after they first got sick.
So, you know, people who are feeling better maybe a week after they got sick, they actually haven't made enough antibodies yet to be a good donor.
So we have to postpone them for a few more weeks until their bodies had a chance to make enough of these antibodies that could potentially be curative for somebody else.
How do you see the progression?
I know all of this is guesswork because this is new and no one has a crystal ball, but how do you see this moving along?
Is it still going to get worse?
Is there a point at which we get some relief from it?
Will we get relief in the summer because of the seasonal nature of some flus?
What should we expect?
Honestly, we don't know a lot.
We don't know about the seasonal issue.
You know, some viruses don't seem to mind summer the way influenza virus does.
So, you know, we're not sure whether this virus is one that, you know, is not going to be good at transmitting in the summer like flu, or if it's going to be like another virus that doesn't mind summer.
So, you know, that's sort of an unknown.
I think there's been a lot of sophisticated computer modeling sort of looking at the rate of change of cases, how many people are being diagnosed and getting sick and going to the hospital and trying to sort of mathematically figure out where the peak might be and when we may be on the downslope.
Hopefully the modeling suggests that maybe we're heading towards the peak and it may be getting better soon, at least for those of us here in New York.
But then there are other places around the country that are just starting to, you know, see a lot of cases and they're going to be sort of behind us and, you know, they're going to have to reach their own peak and then You know, Mount Sinai is a great hospital and a gigantic hospital.
And it's my hospital.
It is!
It's where I was treated for prostate cancer and my mother was treated there and my family.
So I have great confidence in Mount Sinai.
But how are, what's happening to your resources?
How strained are you?
And how much of an effect does it have on the other illnesses that people have that can be just as severe or worse?
So, you know, it is a strain on the resources just because this is many more patients than this hospital was designed to accommodate.
So, you know, we're expanding into, you know, areas that used to not be patient care areas are being turned into patient care areas.
You know, we're building patient rooms inside of the atrium of our hospital.
You know, we have patients in post-operative care units that normally just You know, take a patient who just had surgery and make sure they're better before sending them to a regular bed.
So, you know, we're sort of putting patients in every nook and cranny that could possibly be adapted for patient care.
You know, it is a strain on on the staff.
I mean, people are working very hard around the clock.
I, you know, I personally haven't had a day off in over two weeks.
So, you know, it's a lot of people are putting a lot of effort that we normally aren't required to do.
But you know that their healthcare workers are amazing people.
You are amazing people and of course they're being affected by this at a disproportionate rate.
Isn't that true?
I mean they're getting this disease more often than We've actually been pretty happy.
We've been doing a lot of health care worker testing to see whether they've been exposed to the virus, and we're actually seeing fairly low rates at this point, which suggests that our personal protective equipment, our PPE, is working, that we're keeping people safe.
You know, we have had health care workers who have gotten infected, and there are certain health care specialties that are more at risk.
For instance, the anesthesiologists Who are putting in breathing tubes, the pulmonologists who might be doing procedures on a patient's respiratory tract.
You know, those are sort of higher risk areas to be in, but everybody's been just pulling together and doing what they need to do.
Does it remain an illness like it sort of was at the beginning that is disproportionately dangerous for people over the age of 60 as opposed to younger people?
Is that still holding true?
I mean, in New York, you know, the burden of not only illness but also death is higher in older people.
You know, younger people are catching this virus.
They just tend not to get as sick with it.
So, yeah, I mean, that's sort of what we're seeing on city-level data from the Department of Health as well.
So, Doctor, before we finish, could you just tell me what's your ideal solution to this, I mean, that if it could be developed you would feel like, oh my goodness, we really got control of this.
What's the dream that you have?
It's a dream!
Well, I think, you know, the big dream is to learn from this and to, you know, get a sense of what we need to do to prevent it from being so bad the next time.
Because with infectious diseases, there tends to be a next time.
It's hard to predict when the next time may be.
It may be a century from now.
But still, you know, learning the lessons that from this pandemic about, you know, surge capacity and things like that, I think we could do a better job of in the future.
In sort of the immediate area, I would like to see a lot fewer patients in the hospital and a lot fewer patients being severely ill.
And, you know, at this point, all we can do is wait, you know, apply the tincture of time and support people through illness and hopefully get them to a point where, you know, they're getting themselves better.
You know, it's not much we can do right now aside from that, but I would love to see people not getting quite as sick.
Is there some treatment that's done at a very, very early stage, even before the test is back, just based on the doctor's review of the symptoms or intuition, because it's so important to be treated early?
Yeah, there are some experimental treatments that we are trying.
For example, there's a malaria drug that was suggested to maybe have some effect on the virus.
And it's a pretty benign drug, so we've been giving it to people.
Which one is that?
There's two versions.
The malaria drug is called chloroquine, and there's a drug called hydroxychloroquine.
We don't know if it works.
We're still sort of sorting through the data on that, but it's a fairly benign drug to most people, so we've been trying it, and we'll see if it helps, but we don't know yet.
And that's in an effort to keep them out of the hospital, pretty much?
Right now we've been treating hospitalized patients and that's in an effort to keep them from getting sicker.
And there's no prophylactic that's been developed yet?
So there is a study at Johns Hopkins which will be, I think, getting up soon, if not already, to look at convalescent plasma as a prevention.
So giving convalescent plasma to healthcare workers to prevent them from getting infected on the job.
And again, there's no real big downside to that?
No, I mean, some people have allergic reactions to blood transfusions, but in general, plasma is really well tolerated, which is why we feel comfortable giving it as an investigational treatment.
Obviously, if something were investigational and it gave you a 50% chance of dying from the treatment, we wouldn't want to do that.
But plasma is pretty benign, so if it makes a difference, that's great, and if it doesn't hurt the patient, that's even better.
Well, Doctor, I must say, you seem very, very energetic and very awake and very sharp for somebody that's worked for two straight weeks without much hope of any rest.
Talk to me at nine o'clock and you'll see a different person.
I can't thank you enough for, first of all, sharing with us what you know.
It's so helpful for people to understand it.
Can't thank you enough for explaining it in a way that we can understand it, which you did remarkably well.
And I wish you really well, and I hope we can check back as we move along.
I think this is going to be with us for some time, unfortunately.
Yep, probably will.
But I'm glad we have people like you and your colleagues at Mount Sinai working on this.
Thank you.
Thanks.
So, we've heard two very Enlightening interviews, some overlap, mostly moving in slightly different directions.
You can see how many different things are being tried to get control of this.
It should give you, it should give all of you out there some real hope that we're getting control of this and that we're beginning to see some daylight here.
No definitive answer yet, but answers.
And some of these answers will turn out to be definitive answers.
So I hesitate to list all of the things that are available.
I'm not a doctor, and if I leave one out, somebody's going to get angry, but you can see from the discussion that we had that as of now, as opposed to, let's say, a month ago, the treating doctor has many, many, many more things available to him, many more weapons available to him than he had at the beginning.
I mean, at the beginning, he was fighting a war with no weapons, and now he's got He's got a group of weapons, none of them perfect, none of them, you know, the one weapon that can end the whole battle, but things that can reduce symptoms, things that can hopefully keep people out of the hospital, things that can ease some of the pain, and things that have real hope of working long term.
So let's think of a few that were mentioned, so if you're in this situation you can ask your doctor about it.
Hydroxychloroquine with with azithromycin and zinc is, as this doctor just said and others have said, commonly used.
It's not approved because it hasn't gone through the trials necessary to get it approved, but of course that would be unrealistic.
Those trials take a year or two and we can't wait a year or two otherwise.
The numbers would be staggering.
That's had success.
Plasma, as she was talking about, has had some success.
They're working very furiously on stem cells now.
They are, particularly at Mount Sinai, stem cell research.
Hopefully some approval will come in the next few days in which stem cells are taken from the placenta and then they are used, they're called killer cells, to go after the virus.
There's the drug remdesivir that I think was used against SARS That's in very late stage trials.
It's now being used for compassionate use.
I know of a situation in which it was used for compassionate use a few days ago where it worked very, very well because that's just one case.
It's not going to tell you everything.
And then there's this research that we discussed the last episode before this in which it's identification of antibodies that have been developed that will Allow you to be certain that the person is immune and therefore the person can go back into the workforce and then also that that plasma can be used to help other people.
Well, we've left out a lot of other possibilities.
I bring these to you, one, to give you hope and two, to create a source of discussion with your doctor when and if, and hopefully it doesn't happen, you or one of your family members is confronted with, I have a sore throat, I have a fever, my chest feels a little tight, or any of the things that would, you know, bring... Those are the main things, by the way.
Fever, a dry cough, a funny sensation in the mouth, I think it was described as sort of a metallic taste in the mouth, and the most telling of all, pain in the chest.
Any of those things, on the phone to the doctor right away.
Because each one of these doctors, both the two that we interviewed and the many that I talked to during the day, will emphasize early treatment.
Whether you're 90 or 9, early treatment is going to make a very, very big difference.
So, thank you again for listening.
I hope this has been helpful in organizing your thinking about What is a terrible, terrible pandemic that's affecting us.
It strikes me that it's significant that it's going to be one of the worst weeks this week and this is Holy Week.
This is the week of Palm Sunday.
This is the week of Holy Thursday and the week that commemorates the crucifixion of Jesus, Good Friday and the resurrection of Jesus.
And it's also the week of Passover.
Just think of how significant Passover is this year.
Passover was a holiday, is a holiday that commemorates the time in which the Pharaoh was going to kill the newborn males that were Hebrew.
And the angel came and put blood on the doors of those who are spared.
And how many, how many are sitting at home right now praying that they're spared, that they're spared
from the angel of death.
So yes, all these treatments are enormously valuable.
And we shouldn't take time away from them because, as John Kennedy said, you know, on earth the work of God
is truly our own, but there's also the work of God.
And it would be worth a week like this to pray and ask for help because this is beyond us.
Thank you very much and we'll be back Very soon with another episode and I'm sure it will be about coronavirus because I don't think we're going to be beyond it very soon.
And we're going to try as much as we can to bring you very helpful and useful advice about it.
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