Published on Nov 08, 2020

Video Transcript

JOHN WHYTE: Thank you all for joining me. I'm Dr. John Whyte. I'm chief medical officer at a Web MD. Today marks a grim milestone, 10 million cases of COVID. To help provide insight as to how we got here and where do we go. I've asked Dr. William Schaffner from Vanderbilt University to join me. Dr. Schaffner, Thanks for taking time today.

WILLIAM SCHAFFNER: Good to be with you, John. I say good to be with you, but this is a sad day indeed.

JOHN WHYTE: It is. You and I last talked at the 5 million mark, and it took many months to get to 5 million. Not so much to get to 10. And I want to just put it out there. Some people have argued well, you know, we're at 10 million because of testing. It's really not that bad. It's just more testing. Help explain to our viewers why that simply doesn't make sense.

WILLIAM SCHAFFNER: It actually makes a little bit of sense, obviously. The more you look, the more you'll find. But what you find is out there, and what we've found actually isn't all of what's out there. So this virus, clearly is spreading in a very unrestrained fashion in our communities.

And given that, the more that the virus spreads, the more people will become ill. The more ill, the more hospitalized. The more hospitalized, the more in intensive care units. And then the lagging indicator, there come the deaths. We're doing better in treatment John, but there will be more deaths. This is very sobering.

JOHN WHYTE: And that's what we're also really looking at. But you're right, the number of cases is partly due to testing. But what we're also looking at, which is of concern, is the increase in the hospitalization rates. The increase in the number of deaths. And even though we've made progress, we're still not on the right course.

So I want to ask you, why are we at this point? Is it because of fatigue and people are saying, you know what I'm just tired of it. I need to get on with my life. Is it confusion? As to what they're supposed to be doing. Is it just a disregard of science? What do you think is the main reason that that's driving this continue increase in the number of cases and the number of hospitalizations?

WILLIAM SCHAFFNER: John, it's a combination of things. All the things that you have mentioned. Let me just add a couple more. The first is, that we really haven't had a national approach to this infection. It's recognition, and then a determination that we were going to reduce its spread.

We did not take a population, a view of all of this. It has been recently recognized that we were not trying to interrupt the spread of the virus. What we're trying to do is, put more research into therapy, more research into vaccines. It's almost as though we're taking a clinical patient by patient approach as opposed to trying to protect communities, large communities, states, our whole country.

You know, Benjamin Franklin did say, an ounce of prevention is worth a pound of cure. And so the public health community, and we, infectious disease doctors have been very frustrated because we love taking care of patients. But we would have preferred to have a national determination that we were going to reduce the spread of this virus as much as possible.

JOHN WHYTE: Do we need a more comprehensive national strategy recognizing at the same time? We need to direct resources to local levels and base decisions on what's happening in your community versus my community.

WILLIAM SCHAFFNER: Well clearly, we need a national strategy. And we need to-- it's as though we have an orchestra at the moment, and the tympani is doing something different than the piano, then the violins, then then the horns. We need a national conductor that brings all those disparate elements together so we can get a harmonious approach.

At the moment, to mix metaphors, we have a crazy quilt state by state and even within state differences. Is there any wonder? As you suggest that there's confusion out there. And I have to tell you, I don't like to get into the politics. But the response to this virus has been much politicized.

And if we had just put the public health people in front, the politicians stand back a little bit, we would be much better off. We would not have reached 10 million, John.

JOHN WHYTE: You always give us good practical advice. We've talked before about the COVID bubble associating with a group of people that have the same risk tolerance, and/or doing the same safeguards. Some people have been talking now about-- you can perhaps go visit elderly loved ones depending upon what everyone's underlying health conditions are if you get tested.

What do you think is the role of some of these rapid antigen testing? And even we're making some progress on PCR, should we do more testing or consider a test? Before we visit people, if that's what we feel we need to do.

WILLIAM SCHAFFNER: We can consider testing, but then we have to consider the test. The test has some limitations as we all know. It tends to give you the rapid tests to false negatives. So you're really infected, but the test gives you a get out of jail free card. You know it tests negative.

So I think testing can help us and give us some reassurance, but we have to do all those other things in addition. We have to do the social distancing and the mask wearing, and being very, very careful when we meet our loved ones, the grandparents, uncle Frank who's got bad diabetes, and the like. And still be very, very careful. John, this virus is going to be with us for a long time. There's no quick fix here.

JOHN WHYTE: And there's no real new advice either, it's the same things that you and I have been saying for many months. It's that physical distance saying, it's avoiding large crowds, it's the hand washing, and it's the mask wearing. There's really nothing else, right?

WILLIAM SCHAFFNER: Nothing else for the moment. But let's just assume we get a vaccine. One of my concerns is that, when I speak to my late colleagues and friends, they think a vaccine is going to be 100% effective. And once they get vaccinated, they'll be wearing a suit of armor against this virus. They can do what they want.

That's a misapprehension because the vaccines are going to be a little bit more like the flu vaccines than the measles vaccine. In other words partial protection. If we had a vaccine, that were 70% effective, we in public health would be happy. But that would mean is, of every 10 people vaccinated, three would be of uncertain protection. And we don't know who those three are.

So even when we're vaccinated, we're still going to have to wear our masks. And that gets lots of people grumpy. I'm afraid. But it's a hard reality.

JOHN WHYTE: We know this is the third time that I've spoken to you over these seven, eight months. I remember early on, when we talked about vaccines, you were somewhat lukewarm recognizing how long it takes. And there seemed to be some preliminary encouraging data. But now, we're at the point where, some of these may only be 50% effective for approval or authorization.

And then as many people are saying they won't take the vaccine, certainly not early on. And if they're 50% effective, and only 50% of people take them, you know that's 25% protection in the community. That's way below what we need to think about returning to some sense of normal.

And at the same time, I wanted to ask you, it seems like a lot of-- this is just the reality I think of medicine. Even on Remdesivir, the data, in terms of who it's going to impact and the magnitude of impact isn't as great as we originally thought. Isn't that right? in terms of who is going to most likely benefit.

WILLIAM SCHAFFNER: As more data come in, we've become a little bit more cautious, it's beneficial. But as Dr. Fauci said right at the beginning, it's not a miracle drug. We're awaiting the results of other therapeutic trials. But let me say this, we need a little bit of a note of optimism here, a little light at the end of the tunnel.

Countries such as New Zealand, Australia, South Korea, Japan, China itself, they have instituted a comprehensive national program. Everybody's pitched in. They've worn their masks. They've been socially distant. And now, even before vaccines they're opening up safely, gradually, but safely. We haven't done that. We could do that. We know how to do this. These behavioral interventions so-called really do work.

JOHN WHYTE: And we see it in Singapore, and South Korea, as well. I do want to ask you before we go about monoclonal antibodies, they've been in the news. There was some encouraging data. Now, there's been some mixed data. What are your thoughts on the role of monoclonal antibodies for-- especially early on in infection or people?

WILLIAM SCHAFFNER: See? Cross fingers. We're waiting for the results of those trials. I actually am guardedly optimistic of course. I'm influenced by a colleague right here at Vanderbilt, who's done a huge amount of the basic science, Dr. Jim Crow, my hat's off to him.

And we hope that these monoclonal antibodies are one of the therapies that may if given early, can event progression to more serious disease. Even if we had that, that would be a terrific therapeutic advance that would help a lot. It would mitigate a lot of those deaths.

JOHN WHYTE: So let's end with, I hope we'll talk again. But I hope we won't talk it 15 million. How do we get people to that point where, we start to see that curve going down and instead of continuing to go up?

WILLIAM SCHAFFNER: I think, we need to keep giving good science based recommendations. You know, Mark Twain said, you bring a reluctant man down from the second floor one step at a time. Provide information, provide reassurance. And then if we can get parts of the country to really adapt this, and the rest of the country could see it working, then I think good news might spread. So I keep trying to be optimistic about this, John. And determined at the same time.

JOHN WHYTE: And we all need a little bit of that optimism. And I appreciated Benjamin Franklin being from the Philadelphia area. As well as Mark Twain. I didn't think we'd get those in.

But Dr. Schaffner, I want to thank you for all that you're doing to help educate the public for always providing a nice practical advice and telling us like it is. We need that candid, transparent perspective that you've been giving us throughout this crisis. So on behalf of everyone, I want to thank you for what you're doing.

WILLIAM SCHAFFNER: You're very kind, John. Thank you very much, and let's keep trying to get the good word out together.

JOHN WHYTE: Absolutely. And thank you for watching.