How Do Emerging Threats Compare to COVID-19?

[MUSIC PLAYING] Welcome, everyone. I'm Dr. John Whyte, the chief medical officer at WebMD. And you're watching Coronavirus in Context.

I know everyone wants to wish coronavirus away, but there are still hundreds of deaths a day. I had the opportunity to chat with my good friend Dr. Eric Topol a little while ago about where we are in the pandemic in terms of where we think cases might be going, what the fall could look like, as well as what do we have to do now to continue to protect ourselves and protect our families and our communities? You'll want to take a listen.

So, Dr. Topol, I want to bring up the issue of a public health emergency. And some people are saying, you know what? There's 100,000 cases of COVID a day, right, and no one's paying attention to that. And now we're saying there's monkeypox, which even though it's in many areas of the country, in terms of the magnitude, in terms of cases, in terms of fatality, it's not the same. What's your response to that?

Well, that's a loaded one to unpack it. So remember back in February 2020, when we had a few cases of COVID?

We're trying to forget about back then.

[LAUGHTER] Yeah, yeah. And then it goes through exponential growth curves. And then you start to see the same for deaths or hospitalizations or long COVID. So with monkeypox, obviously, it's not nearly as fatal. But this virus could go through evolution, just like what we saw with COVID.

But right now, of course, it's going through that early exponential growth curve. And we'll see a lot of cases of monkeypox. And we'll see spillover from what was originally more gay and bisexual men to many other groups, including what we're seeing now in children. So it's not going to get better. That's why containment of the virus, just like as we saw with COVID, is so essential so that you can try to prevent-- get that exponential curve, try to get it to go flat as you can, minimize the spillover as best you possibly can.

And some people could argue the mode of transmission is very important as it's changing, because it originally, in many areas of the world, it started in rodents. And now we're seeing it in men having sex with men. And now we're seeing it through transmission of linens and close contact, and maybe even respiratory as well.

But there are some out there, to change it to the other side, that are suggesting that, you know what? We already lost our chance to contain it. It's another crisis that has not been managed well. Do you feel we're past the point of being able to contain it in any realistic manner?

Oh, I'm very optimistic. John, as you know, I would never say we've lost that potential to contain it. I'm still trying to contain COVID, right, and two and a half years later.

No, we can do better. The vaccines will help. We're getting those out broadly. We're not keeping up, of course, with their demand at all. The testing was a little bit late in starting. But it's moving along.

I mean, we always should strive towards containment. Anything we can do to try to limit that exponential growth of the virus, which as you're well aware, with that growth, the potential for further evolution of the virus to more-- I mean, that's what viruses want to do. They want to find hosts. They desperately are seeking hosts. And what we need to do is prevent them from being successful.

Is the public just tired of listening about pandemics?

Yes, yes. They're tired.

I mean, many people are tuned out.

The idea of another pandemic, I mean, help me. We can't even deal with the one we have right now. We're trying to will it away.

But that's not the way these things work, unfortunately. You can't just make believe it's not there. The virus is there. We're still got very high circulating BA.5 in this country. And we're going to see more monkeypox, unfortunately, probably with a better name eventually.

Have we learned nothing from COVID? Wouldn't you think we'd be in a better place today, with emerging threats, which monkeypox is one?

Well, I would say we haven't learned as much as we could have, right? I mean, if we were going to be in ultimate preparedness, we know there are several viruses on the radar screen. And this is one of them. We'd have stockpiles of vaccines ready to go as soon as we started to see it surface.

And so now that's one of the ideas going forward, is we shouldn't wait for the magical 100 days, which was being discussed right now. It'll take 100 days to get a new vaccine. Fortunately for this virus, monkeypox, there were vaccines that were being made in Denmark. But it was just short supply.

The point is that if you want to have ultimate preparedness, you have tests that are ready for any of the high-candidate viruses that we're likely to get hit. Remember, too, John, we're unfortunately going to see more pandemics, because the climate change issue is a big one. I mean, it's just-- it's not just climate. It's about changing the face of pathogens.

So the years ahead will bring us more. We can't get tired of this point. This is, unfortunately, what we have to be confronting and being prepared for. And always, if you have the test from the get go, which we didn't have, certainly in the United States for COVID-- we went months, months before we had wide-scale testing. If you don't have the test and you don't have the vaccine ready, then you pay a big price.

Eric, how do we make people less jaded? Because I want to point out, as you know, we have at least 400 people dying every day from COVID. And if that was the case at the beginning, we would never find that acceptable. But for some reason now that's not even a point of discussion, as if that's fine.

So how did we get to that point, where the attitude is OK, well, at least it's not thousands of people a day, as it was during the height of the pandemic? But somehow it's OK if it's 300 to 400 people a day. Doesn't that get you a little mad, too, that somehow we're at this point?

Yeah, I'm very upset about it, John. And we're numbified. When it happens like this over such a long period of time, you just get numb. You don't realize it, instead of just being immersed. All of a sudden, there's 400 people dying every day.

We've been up to 4,000 people dying each day, right? So this seems like, oh, this is good. No, it's not good. And remember, the deaths are one thing. But multiply that times a whole other order to get the number of people suffering from long COVID, right, just so many millions. And the more we let cases go unbridled, the more we have that to contend with, too.

So yeah, we're numb. We're looking at things out of fatigue and fantasy that somehow the virus is going to get more mild as the pandemic proceeds. No. We've already seen with BA.5 it can get worse. We saw that with Delta, worse than Alpha. How many times do you have to see that the virus as it evolves can get worse? And so we have to be much more cognizant of the fact that we're not out of this yet and not be numb.

What do listeners need to know today about monkeypox that they haven't quite got right in their thinking?

Well, I mean, I'm certainly-- I've been devoting my attention to COVID. So I would defer to the real monkeypox experts on that. I do think, though, we haven't got this contained. We haven't been as aggressive as ideal.

It's better than how we handled COVID. The testing did occur early. Ring vaccinations were starting. More orders for really good vaccines hopefully are on the way. So it isn't as desperate a situation as the way we handled COVID. And fortunately, it's not as lethal.

How do you get people to listen? There's not as many cases. It's not as lethal. The attitude is, hey, Dr. Topol, I want to live my life. I don't want to hear any of this anymore. So how do you get them to change the mindset?

Well, like we talked about, go back to 2020 when COVID just got started and you see numbers. And then they start going orders of magnitude higher and higher. This is different because that, of course, was throughout the entire population. This is seeded in a different subgroup, of course.

But it will spill over. It already has increasingly so. So I think right now, people think if you don't die then it's not so bad. But that's wrong. All you have to do is talk to a person who's been affected and how incredibly painful this is, how it can be leading to hospitalization and can be life threatening.

So no, this is something that people do need to take much more seriously. I do think the CDC has done better with it. But they still could do far better as well. But unfortunately, if this was being the only thing that we were working on in terms of emergency pathogen response, but we're still-- we've got-- we've got a big juggling act. And it's really stressing the system.

But is there a problem, Eric, of who's in charge? Is it Dr. Fauci? Is it the CDC director? Is it the NIH director? Is it the White House coordinator? Is it the secretary? Is it the president? Who's in charge? Is it the FDA commissioner?

We're already talking about when boosters may be available. And the FDA still has to look at the data. Do sometimes we get ahead of ourselves? Who's in charge? Is that part of the problem?

John, you're bringing up a critical point, and that is that there's been terrible infighting between these agencies, right? The CDC was fighting with the NIH about boosters and the White House Response Team. The White House Response Team wanted to use the shots we have right now that are going to be discarded or BA.1 shot, but other agencies didn't. I mean, all this infighting.

We don't have this sense of unity. And in a pandemic, we need unity. If we need anything, we need these groups all work together. And the same message comes, and that if we had done that, our booster rate wouldn't be what it is today.

It's a year later now after boosters were validated with Delta first in July of 2021. And we have 67th in the world for boosters, behind Sri Lanka, Rwanda, Iran, and many other countries, that you say what? Is this possible? We make these vaccines, right? And we validated them. But that's really on the infighting it goes back to. We can't have that.

Now, who should be the leader? Well, right now, the real leader should be the HHS secretary, because that person, Secretary Becerra, oversees FDA, NIH, CDC, and this potential new agency. But Secretary Becerra only recently has shown up, which is good. I mean, I wrote a Science editorial about where is Secretary Becerra.

He has shown up more. He's certainly been more active with the monkeypox outbreak, for sure. But we don't have coordination. And that's essential, coordination. And we can't tolerate any longer this dissension among the different agencies. And the leader who has the authority over them really should be the one to coordinate, harmonize any differences.

Yeah. Well, it's a good point, as always, Dr. Topol. Thanks for taking time today.

Thank you.