00:08

we're excited to have you join us

00:10

for the first edition of talk polymath

00:12

focusing on how coven 19 pandemic is

00:16

both

00:16

similar to yet different from previous

00:19

pandemics

00:20

i'm michael goldblatt one of the

00:22

co-founders of

00:23

polyplexus and it's my pleasure to be

00:25

able to introduce to you this evening's

00:27

guests

00:28

doctors william warren and jose ramon

00:31

fernandez pena

00:32

jose ramon has been in public health

00:34

since graduating medical school

00:36

most of his work focuses on workforce

00:39

diversity

00:40

and cross-cultural communications and

00:42

health

00:43

he has created programs to integrate

00:45

foreign educated health

00:47

care professionals into the us medical

00:49

system

00:50

and serves as an advisor to the white

00:52

house domestic policy council

00:54

on the economic integration of foreign

00:56

trained health care professionals

00:59

in addition to being a director of

01:01

health professions

01:02

advising in northwestern jose ramon is

01:05

also

01:05

president of the american public health

01:07

association

01:08

and is 25 000 members whose motto is

01:12

for science for action for health

01:16

bill warren's path has been less linear

01:19

starting professional life as a

01:20

mechanical engineer

01:22

and became one of if not the youngest

01:25

program manager

01:26

at the defense advanced research agency

01:29

he left darpa to become a biomedical

01:31

entrepreneur

01:32

building a company focused on the

01:34

real-time mass customization of body

01:37

parts on demand in vivo

01:40

ultimately his company focused on

01:42

constructing ex vivo fully human immune

01:45

systems

01:45

for the prediction of both vaccine

01:47

efficacy and adverse reactions

01:50

and as sometimes happens in the

01:52

entrepreneurial world

01:53

his success led to his company's

01:55

acquisition by sanofi pasteur

01:58

more than a decade later doctor

02:02

where he is vice president and

02:05

ex-biotech focusing on broadly

02:07

protective influenza vaccine

02:11

now polyplexus is all about

02:13

conversations intent of focused

02:14

discussion through the lens of what we

02:16

already know

02:17

in pursuit of what we might discover and

02:20

bill

02:20

and jose ramon are going to discuss the

02:23

evidence from prior pandemics

02:25

to shed light on what is different this

02:27

time and what is the same

02:30

please use the chat feature to ask any

02:32

questions you might have

02:33

i will be organizing the questions for

02:35

bill and jose ramon

02:37

to respond to during the last 10 to 15

02:40

minutes of their conversation

02:42

but before i disappear also let me add

02:45

that earlier today

02:46

barda the biomedical advanced research

02:49

and development authority

02:51

posted an incubator on polyplexus

02:53

focused on gaining

02:54

feedback from the community on the

02:56

clinical need for development of

02:58

and utility of infection severity tools

03:02

for future adoption and implementation

03:06

to put that question in the context of

03:08

tonight's discussion

03:09

consider that in the current pandemic

03:12

most individuals infected with sars cov2

03:15

have mild illness about twenty percent

03:17

of the infected patients experience

03:19

severe outcomes

03:20

and about six percent of those

03:22

individuals require critical care due to

03:24

complications

03:25

such as acute respiratory distress or

03:27

sepsis

03:28

hence the just potent just posted bar to

03:31

incubator

03:32

is interested in tools enabling

03:34

hospitals that are overwhelmed with

03:36

patients

03:36

and limited in resources to accurately

03:39

identify

03:40

patients who will require supervised

03:42

medical care versus those who are at low

03:44

risk for complications that can be sent

03:46

home

03:47

if interested in participating please

03:49

check out this incubator

03:51

and now i'll go on mute and turn the

03:53

control over to bill and jose ramon

04:02

thank you michael um and thank you jose

04:04

ramon for

04:05

uh agreeing to work with us today and

04:09

so why don't we start off with the very

04:10

first question

04:12

or the very first topic that michael had

04:14

raised about pandemics past and present

04:17

and then later we can segue into the

04:18

future and sort of discuss

04:21

really what has changed in what

04:24

what has anything changed and if it has

04:27

or has not what what are the things that

04:29

are similar what are some of the things

04:31

that are different than past pandemics

04:33

i think that's a great uh way to start

04:35

this conversation

04:37

and i also i'm very excited to hear what

04:39

you have to say

04:41

from your perspective from the vaccine

04:43

development side

04:44

versus my perspective as a prevention

04:47

and health education

04:48

perspective so from my side i would say

04:50

that

04:52

the messages are pretty consistent

04:54

across the centuries

04:55

the notion of maintaining distance

04:59

from people who may be infected the

05:01

notion of washing your hands often

05:04

the notion of wearing masks has been

05:06

clearly

05:08

a recommended since the 1917 flu

05:11

pandemic

05:12

and if we go further back in history the

05:14

notions of washing and distancing are

05:16

pretty consistent

05:20

yeah i i i completely agree in fact

05:24

one of the publications that was in

05:26

science

05:27

in 1919 which was following the 1918

05:31

pandemic

05:32

by uh professor george soper

05:35

i actually wrote this and i'm just going

05:36

to give a direct quote he said the

05:38

measures which were introduced for the

05:39

control the pandemic

05:41

were based upon the slenderous of

05:43

theories

05:44

respiratory diseases were not under

05:46

control

05:47

and then he went over and said what

05:49

stands in the way of prevention

05:51

and the first thing that he mentioned

05:52

jose ramon is actually in your court he

05:55

said the first thing that stands in the

05:56

way of prevention

05:57

is public indifference people do not

06:00

appreciate the risk they run

06:01

do you think anything's changed

06:06

no i mean it's it's uh it's sad to see

06:09

that especially in the environment where

06:12

we've been living for the last couple of

06:14

years

06:16

the notion of individualism seems to

06:18

prevail over the

06:20

feeling or an interest in the common

06:22

goodness or in the

06:23

common wellness so

06:26

because something is inconvenient for me

06:29

i'm not going to wear a mask or because

06:31

something i really want to get together

06:33

with my friends i'm going to have a

06:34

dinner party

06:35

or i really must go see my distant

06:37

relatives and i'm going to travel to

06:39

another location

06:41

and as we have not been able to speak

06:44

with one voice

06:45

as a nation we have not been able to

06:47

convey

06:48

one message of concern and clarity

06:51

regarding

06:52

this is serious this is how it doesn't

06:54

need to get any worse

06:56

has allowed for many different

06:57

conversations going in different

06:59

directions

07:00

and it's important to question

07:03

what we are told but to question

07:06

everything that comes

07:07

out from a so-called scientific basis

07:11

because i just want to question it has

07:13

led to a place that is

07:15

is not very good right now

07:18

yeah in fact jose roman one of the

07:20

things that we talked about

07:22

when getting prepared for this is that

07:24

the importance of the word and

07:27

and it seems like uh i won't even say

07:30

in the us i'd say globally it looks like

07:33

everybody's

07:34

about using the word or it is this way

07:36

or

07:37

that way is it pandemic real or is it

07:40

political

07:40

right and what we're talking about is

07:43

that the word and

07:45

where it's both just coming back to what

07:47

you were talking about

07:48

it is about public health and individual

07:51

health

07:52

and did you want to expand upon that

07:54

just a little bit because i think it is

07:56

about

07:57

there is an element of individual health

07:59

and public health

08:01

and it seems like we have two camps

08:03

absolutely unnecessarily so

08:06

and let me just go back to the first

08:09

pandemic of my lifetime the

08:11

hiv aids pandemic

08:14

where not unlike this time

08:19

it was a matter of choosing where to

08:20

allocate resources do we

08:22

focus on developing treatment and a

08:24

vaccine

08:25

versus do we focus on health education

08:27

and prevention

08:29

so the moment the conversation starts

08:31

with an ore

08:32

we lose half of the battle already

08:36

so the idea that we put

08:39

we we approach a public health crisis

08:41

from a uniquely medicalized

08:43

angle defeats the outcome immediately

08:47

so i think it's important to frame this

08:49

conversation and we need to do this and

08:51

we need to do that piece not one at the

08:53

expense of the other

08:55

yeah who do you agree i completely agree

08:58

in fact that one expanded

09:00

a little bit more so for certainly it is

09:02

about public health

09:03

and individual health because it's well

09:06

known that

09:07

during the pandemic some people's

09:09

individual health

09:11

actually began to suffer and depression

09:12

went up as an example and just sort of

09:14

preventative

09:16

diagnostics you know whether it be

09:18

mammograms or

09:20

as one example were really uh or cancer

09:23

screenings any cancer screenings were

09:25

down

09:26

but the other end in this is it is also

09:28

about micro

09:29

and macro economics at the same time

09:32

one of the things that i saw that sonic

09:35

kind of frightened me a little bit

09:37

is that according to the international

09:39

monetary fund

09:40

the debt is over 100 of the gdp globally

09:44

now

09:45

okay so it's over 11 trillion dollars

09:48

spent

09:48

on the pandemic so you know it seems as

09:52

though

09:52

we have to think about public health and

09:54

the economics so we don't

09:56

devastate economies globally at the same

09:59

time

10:00

and i i i think you know one of the

10:03

things we're talking about is we're

10:04

missing sort of

10:05

a real model that incorporates all of

10:07

these elements together

10:09

and so from a public health point of

10:12

view

10:12

do you see similarly absolutely i mean

10:15

right here in illinois where i live

10:18

we're just going to

10:19

reopen indoors dining because you know

10:22

when it's 10 degrees outside you cannot

10:24

have

10:24

outdoors dining anymore and the need to

10:27

have

10:28

some kind of economic engine moving

10:30

forward that allows people to stay

10:32

housed that allows people to buy food

10:34

that allows people to continue to send

10:36

their kids to school

10:38

is essential so what is the balance

10:40

between

10:41

we have to to allow for economic

10:44

activities to continue

10:47

and at the same time protect the

10:48

public's health

10:50

yeah and that's easier said than done if

10:53

we're going to be sitting at a

10:54

restaurant at a table and i'm going to

10:55

eat

10:56

i'm going to necessarily have to lift my

10:58

mask to eat and then put it down so

10:59

every

11:00

bite up and down and up and down it's

11:02

difficult it's complicated

11:04

so we need to be very careful on how we

11:06

craft our messages

11:08

to ensure that we take into account

11:10

people's fears concerns

11:12

but we're nonetheless firm and clear

11:15

about the importance to adhering to

11:17

certain behaviors

11:20

so i'm glad you mentioned the word that

11:24

uh we've got to keep it clear okay

11:27

so there's different quadrants uh that

11:30

a person could be located one would be

11:32

that your life is simple and easy

11:35

well wouldn't that be nice there's no

11:36

such thing but then there's the complex

11:38

and complicated and complicated means

11:40

that there's so many processes

11:42

right and complex simply means that

11:43

there's many unknowns

11:45

i think we've made ourselves in the

11:47

complex and

11:48

complicated and perhaps we should be in

11:50

the simple

11:51

clean messages even though the pandemic

11:54

is complex there's many unknowns

11:57

and i think from when i think about just

12:00

messaging from a public health point of

12:02

view and even from

12:03

many different from many researchers

12:06

i think they made it complex and

12:08

complicated and

12:09

that is when they lost the trust of the

12:11

public right i mean i mean you can

12:14

please talk about this but certainly in

12:16

the entire process of vaccine

12:18

development

12:19

and now they're rolling out the vaccines

12:23

what is the message that we're getting

12:24

at what how do we address the

12:27

fears and the concerns and the the

12:31

misinformation that prevails and that

12:33

gets disseminated perhaps even faster

12:36

than the actual science-based

12:38

evidence-based information

12:40

yeah yeah i i i

12:45

you know they they just did a um a study

12:48

using machine learning

12:49

using natural language processing of

12:52

social media

12:53

and how they want to deal with a vaccine

12:56

and roughly about

12:57

80 percent of the people were neutral

12:59

about 13

13:00

were negative and about 7 percent were

13:02

relatively positive

13:04

and the thing i find interesting is that

13:05

the megaphone of the 13

13:07

that are negative is the loudest right

13:10

and then they actually what it said is

13:12

that they're starting to affect the

13:14

neutrals

13:15

right and making them less uh you know

13:19

more of an anti-vaxxer as an example so

13:21

how do we address that

13:23

from the from the scientific and you

13:26

know heart science of science

13:27

the overall health

13:31

group how do we try to

13:33

[Music]

13:35

correct their incorrect information how

13:38

are we able to use those channels those

13:42

the media the social media to convey

13:45

information that is timely

13:47

easy to understand accurate and that

13:51

provides people with information they

13:52

need to make intelligent choices

13:55

yeah i'm going to come back to what we

13:57

talked about is that

13:58

instead of just focusing on just the

14:01

economy

14:02

and sort of denying the pandemic or just

14:05

instead of focusing on the pandemic and

14:07

scaring everybody

14:08

right that they won't even leave their

14:09

house and then they're not even

14:11

consuming

14:12

and they're not helping the economy

14:14

we're not

14:15

finding that middle ground in

14:18

in in in any conversation anymore we're

14:21

missing the and

14:23

right that i think it's easy to like i

14:25

can speak so i'm in florida right now

14:27

and in florida things are actually

14:28

pretty easy going

14:30

uh with respect to restrictions you know

14:32

we have to wear masks but

14:34

most uh companies are open most

14:36

restaurants are open

14:38

so i'm not in florida you're not seeing

14:40

the economic devastation

14:41

when people family members are visiting

14:44

from uh pennsylvania there it's much

14:48

uh this the state is more closed

14:51

and so really the cli it's probably

14:54

somewhere in between

14:55

florida and pennsylvania is where we

14:56

need to be as an example

14:58

right we don't need the whole economy we

15:01

don't need a lot of the economy closed

15:02

down but we don't need it

15:04

free willy-nilly where there's i mean

15:06

the outdoor malls here

15:08

were you wouldn't know it was any

15:10

different than uh from 2019

15:12

it was just so crowded i mean i didn't

15:14

go believe me i didn't go

15:16

but you could just see it from the car

15:18

on the highway right um

15:20

but it's just it's just amazing the two

15:22

extremes and where is the and

15:25

i think that's what we're missing

15:26

absolutely

15:28

and in that uh image that you present

15:30

between the

15:31

similarities or differences between

15:33

pennsylvania and florida or illinois in

15:35

this case

15:36

yeah i think we need to also acknowledge

15:39

that the the distribution of the

15:41

pandemic like in previous cases is an

15:44

uneven distribution of the burden of

15:46

disease right

15:48

there are certain communities that are

15:49

much more affected

15:51

both in their health in their economics

15:53

and their

15:54

ability to continue to be housed to feed

15:57

themselves etc

15:59

how do we go about it's not different

16:03

from previous pandemics we see it again

16:05

what is the bottom line why is this the

16:07

way it is

16:10

well you know i think that we were a

16:13

little bit too late

16:14

in identifying i think what we needed is

16:17

a common sense approach

16:18

by defining what are the hot spots

16:21

where you know this area is a hot spot

16:24

which would be probably more densely

16:27

populated cities and that's where you

16:29

have to take more severe measures

16:31

whereas more and more rural areas we

16:34

don't need

16:35

these uh you know strict uh measures on

16:38

how you know uh with respect to the

16:41

pandemic and i think it just depends

16:43

uh where because now they're using

16:45

machine learning to actually

16:47

predict and and actually apps on your

16:49

phone where they could predict where the

16:50

hot spots are well

16:52

if someone knew that there were hot

16:54

spots like for instance

16:55

in our community we actually knew where

16:57

there were some hot spots

16:59

and in fact they mapped it at various

17:01

different counties within the state of

17:03

florida so we

17:04

knew where there were problems and so

17:06

you just say okay i'm not going to go

17:08

near there or if you knew that there

17:09

were outbreaks at this particular

17:10

walmart or this target

17:12

right you wouldn't go there and i think

17:14

that it's just the information

17:16

access the information because everybody

17:18

has a mobile phone now

17:21

for better or worse yes for better for

17:24

work but that could be one way of

17:25

dealing with it it's just really

17:27

clear i think what you said is it's

17:28

clear information because

17:30

one of the things that you and i were

17:31

talking about before is in

17:33

epidemiology they have the sir model the

17:36

susceptible infectious recovery model

17:38

and this is basically where you can get

17:40

the r naught of the reproductive

17:44

oh my gosh i i'm having a hard time with

17:46

my words today

17:47

the the are not basically the reason how

17:50

fast the virus

17:51

actually um transmits from person to

17:53

person

17:55

and the thing that's interesting is they

17:57

found that

17:58

as an example r naught for justin bieber

18:00

is

18:01

24. okay the r naught for

18:04

sars cove 2 is about 2.4 so if justin

18:07

bieber

18:08

has a a an r naught of 10 times

18:12

and social media has taken both

18:15

information good information

18:16

and misinformation and misinformation

18:19

has

18:20

seems to have a very high r naught and

18:22

that's

18:23

you know we don't want a police language

18:26

because that's not

18:27

what we believe in but somehow we've got

18:30

to police

18:31

um somehow we've got to counter

18:34

misinformation

18:35

with truth absolutely

18:41

how do we make then the population of

18:44

uh a more educated

18:47

consumer or better able to discern

18:52

the truth from the rumor or the

18:54

speculation

18:56

yeah and to be honest i think

19:00

it it's at an individual level when you

19:03

actually have conversations

19:05

and i think sometimes people um

19:09

insult one group versus another group

19:12

and that's not the way of doing it

19:14

i think it's more of let's have the

19:15

discussion let's have an honest

19:17

discussion or an honest debate

19:19

and we should probably publicize these

19:21

types of things as well

19:22

so that there can so you know people can

19:25

hear both sides

19:26

here one with the evidence and hear one

19:29

with

19:30

well this is what i believe i believe

19:34

yeah i want to yeah it's a tough one

19:38

i wanna pick up on something that you

19:40

mentioned about the

19:42

the different areas that had higher

19:45

prevalence or whether it was

19:46

easier to acquire the the virus etc it

19:50

could be in larger urban areas or it

19:51

could be in meat packing factories in

19:53

iowa

19:54

so it was a density of the population

19:56

right it doesn't necessarily have to be

19:58

in the subway in new york city

20:00

so with that in mind now that we find

20:04

ourselves with a vaccine with a real

20:06

tool

20:07

and i'd like to equate that to a degree

20:09

with

20:10

back in the 80s if you had one less

20:12

condom

20:14

who did you give it to you gave it to

20:16

the person that was hiv positive

20:19

so if we have to decide on how to

20:22

allocate vaccines

20:24

who should we be prioritizing as we have

20:26

decided that we're prioritizing

20:29

frontline workers and then age groups

20:31

essential workers etc

20:33

is that from your perspective the best

20:36

way to go about it

20:40

um that is a loaded question and a very

20:43

good one okay

20:44

because it really gets into do we want

20:47

to follow

20:49

the math or do we want to follow or or

20:51

do we want to deal with the ethics of it

20:53

right

20:54

right and so if you follow the ethics of

20:57

it

20:58

you know you sort of the way that most

21:01

states have

21:03

enrolled the distribution of the vaccine

21:05

it's the healthcare workers first

21:06

because they're putting their lives in

21:08

line to help

21:08

and then it's the elderly because

21:10

they're the ones that truly

21:11

suffer from the pandemic have a greater

21:15

risk probability of suffering from the

21:18

pandemic more than the young

21:20

however if you there's a thing called

21:24

the prevention paradox

21:25

which basically says that you that the

21:28

people that you should work with

21:30

are the ones of low and moderate risk

21:32

not of high risk and you'll have the

21:34

biggest

21:34

impact on controlling the disease

21:37

epidemic

21:39

and that that probably falls within your

21:41

realm of public health

21:43

right but to control the pandemic it

21:46

mathematically i think it argues that

21:48

you want to deal with more of the people

21:50

that are spreading it

21:51

which are the ones that are low to

21:53

medium risk

21:54

of getting the disease as opposed to the

21:56

ones that are

21:57

high risk of actually of having

21:59

mortality

22:01

i think you're you're absolutely right

22:03

it's an it's an ethical question

22:05

and i don't think that anybody questions

22:07

the value of

22:08

uh vaccinating first the people that are

22:10

taking care and trying to control this

22:13

this pandemic but also we're dealing

22:16

with

22:17

a limited availability of vaccines right

22:20

now if we had

22:21

trillions of doses available right now

22:23

perhaps we would make different choices

22:26

i would like to think yeah

22:31

yeah because i was just looking at a few

22:33

numbers and i'm just going to go over

22:34

some right now because

22:36

the the challenge with this pandemic

22:39

you know from what you just talked about

22:40

is who should get the vaccine first

22:42

there's an ethical question and then

22:44

they're sort of like thinking about the

22:46

statistics of it

22:47

and who you should vaccinate which

22:49

they're not necessarily aligned

22:51

okay and the other thing that's not

22:53

aligned is that we have spreaders

22:55

and sufferers and the spreaders

22:58

are not the sufferers and that ends up

23:01

making this pandemic

23:03

kind of unique compared to the 1918

23:06

because in 1918 the um

23:09

the people that actually preferentially

23:11

died were the young people the

23:13

in their 20s in this case it's the older

23:16

people that died but

23:17

if you if you if you just look at the

23:18

numbers most of the people that spread

23:20

the disease

23:21

are between 15 and 54.

23:24

most of the people that suffer between

23:26

55

23:28

and over 85. wow and that's the

23:31

challenge of this one is between

23:33

the spreaders and the sufferers yeah and

23:36

this

23:36

is what is different from that pandemic

23:40

but yet the similarity remains on the

23:43

lack of the distribution in and of

23:48

itself was uneven people that lived

23:50

under

23:51

conditions in which they were more

23:53

clustered together perhaps were more

23:55

deeply affected that those who had

23:57

the ability of the the space available

24:00

to not be together at the same time

24:02

right among other things

24:07

yeah the other big difference between

24:09

previous pandemics and this one

24:11

is between asymptomatics and

24:13

symptomatics

24:15

uh the asymptomatics roughly are now

24:18

believed to comprise

24:19

of at least at least 20 percent of the

24:22

population

24:23

are believed to be asymptomatic so that

24:26

means that they have had the virus

24:28

and they probably spread it and didn't

24:30

even know

24:31

and that's that's a huge challenge

24:33

compared to other pandemics because

24:35

people are spreading it and they don't

24:37

even know

24:38

yes and yes this is also an airborne

24:41

transmission as opposed to others that

24:43

required vectors or intimate contact to

24:46

spread the

24:47

pandemics i think that what is common

24:51

as well is the

24:55

i think the fear and the misinformation

24:57

and back to this

24:58

not only disseminates faster but

25:02

sometimes trumps the adequate

25:03

information and people even people who

25:05

want to make the right choices are at a

25:08

loss as to what advice to follow

25:11

yeah and i'm still i mean in my head i'm

25:14

still

25:15

struggling with that when i say how do

25:16

we become

25:18

not only more aware but more proactive

25:23

about jumping faster

25:26

in order to not find ourselves in the

25:28

spot we

25:29

have found ourselves historically it's

25:31

like oops what happened

25:34

yeah yeah yeah you know

25:37

you mentioned the um aids pandemic

25:41

epidemic a few times and i just wanted

25:44

to go over

25:45

a few um different um

25:49

pandemics and with their death toll

25:53

and how long it took to develop a

25:55

vaccine

25:56

so if you think about the 1918 pandemic

25:59

the death toll was somewhere around 50

26:01

million people it took about 25 years

26:04

before they could actually deal with it

26:06

right

26:07

[Music]

26:08

sars which uh is the cousin to sarskov

26:13

um only about a thousand people have

26:15

died

26:16

and it's 17 years and ongoing without a

26:18

vaccine

26:19

right ebola about 11 000 people

26:23

um and it took 43 years to develop a

26:26

vaccine

26:27

aids it's around 25 to 35 million people

26:31

and no vaccine mostly because the virus

26:34

mutates so much

26:35

and then this covid19 we have somewhere

26:38

north

26:38

we're getting close to 2 million people

26:40

dying and we had a vaccine

26:42

in 11 months it's amazing and

26:46

so this so when even though we talked

26:49

that

26:50

nothing many things haven't changed from

26:52

social distancing to masks to

26:55

uh misinformation and public

26:57

indifference

26:58

one of the things that really changed

27:00

this time is

27:01

technology can you talk about that why

27:04

were we able

27:05

to get here so fast it's really like

27:07

light speed

27:09

it really is light speed and i think

27:12

it's due to a number of things right

27:14

um one is uh and

27:18

this sounds kind of silly but it's due

27:20

to money

27:21

uh you know uh operation warp speed in

27:24

the us provided a significant amount of

27:27

money

27:28

and that actually fueled a lot of things

27:30

and at the end it

27:31

fueled a lot of the advances so we even

27:33

have a vaccine now

27:34

how significant we're going to try to

27:36

interrupt you how significant is that

27:37

amount of money

27:40

i think it was extremely significant

27:42

because it took

27:43

what it did is the government bore the

27:45

risk

27:46

to develop the vaccine but more

27:48

importantly

27:49

even if people if certain companies

27:51

didn't take money to develop it

27:53

they could they they actually could

27:55

manufacture at risk

27:57

because the government was essentially

27:58

saying i will buy x you know

28:00

200 million doses from you at this price

28:03

so that was a huge incentive for the

28:06

pharmaceutical companies

28:07

and the biotech companies to actually

28:09

participate

28:10

and money fuels things so i think that's

28:12

one big difference

28:14

but that's not a technology the other

28:15

technology that really came in

28:17

were um basically sequencing technology

28:22

um so we can do deep level sequencing so

28:25

the

28:26

uh the sars code two uh

28:29

virus was sequenced within days if it

28:31

probably even faster

28:33

and sent out to the entire public and

28:34

then the the next thing that came

28:36

in is that we started bringing in

28:38

messenger

28:39

rna vaccines mrna vaccines and

28:42

they had never been tested before and or

28:45

approved before for a vaccine

28:47

but it ended up that they could uh there

28:50

were companies that went from

28:51

sequence to gmp material to start a

28:54

phase one

28:55

within 42 days was unprecedented

28:58

never been occurred before because of

29:00

technology so

29:01

there's a lot to be said that a lot of

29:03

people sort of poo poo poo

29:05

technology but it's because of

29:06

technology that we have a vaccine now

29:09

is there something to say for the

29:10

international cooperation behind this

29:15

you know um i i i'm

29:20

i'm i'm gonna say that the international

29:22

cooperation

29:24

was not very good okay

29:27

um i i can give multiple examples but i

29:30

probably won't

29:31

i i'll just give one right the us

29:34

dropped out of the whl

29:35

right but it wasn't largely countries

29:39

that were cooperating it was actually

29:41

multinational

29:42

companies because they're the only ones

29:45

that could actually move between various

29:48

countries

29:49

and they're profit driven i hate to say

29:52

it but again

29:52

money comes in and they were profit

29:55

driven and could move it through

29:57

now where some other things have come in

29:59

which have been really nice is there's

30:01

been things

30:02

uh the bill melinda gates foundation the

30:05

welcome trust

30:06

right um kovacs where they're trying to

30:08

say let's give

30:09

access to the vaccines to developing

30:12

countries as well

30:14

and that's where there's been more

30:15

international cooperation

30:17

but largely there hasn't been as much

30:20

international cooperation it's been a

30:22

little bit nationalistic and i think

30:24

we'll start to see that many

30:25

countries after this will say i want to

30:28

have vaccine manufacturing plants in my

30:30

country

30:31

right do you see similarly or

30:34

differently no i i agree with you

30:37

but i i recall in the beginning the big

30:40

talk about

30:41

the international corporation and this

30:43

german laboratory working with spicer

30:46

and then

30:47

the oxford astrazeneca piece and the

30:50

modern

30:51

and this international scientist but i

30:54

think you

30:54

you hit it in the head again it's it has

30:57

been

31:00

multinational industries that have been

31:03

the

31:04

the the catalysts to get this so fast

31:07

and

31:08

also i think we see it now that

31:11

there is again an uneven distribution of

31:14

resources

31:15

as to who's getting how much vaccine so

31:18

i think of my

31:19

native mexico where there's you know 130

31:22

million

31:23

people living and i think that the

31:25

supply of vaccine available is very

31:27

limited

31:28

and i imagine that in other parts of the

31:30

world the supply of vaccine is even

31:32

further limited and the

31:34

ability to distribute the

31:37

vials that we had to be at temperatures

31:41

of minus 60 degrees

31:42

is going to be very challenging yeah

31:47

i agree so just getting back to some of

31:50

the other things it wasn't just

31:51

technologies but as you mentioned it was

31:53

about partnerships

31:55

um it was also about health authorities

31:59

working with the companies and whether

32:02

it be

32:03

in europe or whether it be the fda in

32:05

the us

32:06

or other health authorities it's been a

32:09

about

32:10

global epidemiology which has been very

32:12

good um it's been about logistics

32:15

and we're going to talk about logistics

32:17

next because that's sort of the um

32:20

that's the that's the tall pull of the

32:23

tent

32:23

but i think it's been sort of a lot of

32:26

things from

32:27

technologies to partnerships to you know

32:32

to mrna to manufacturing

32:36

to funding to the science to health

32:38

authorities to epi i think

32:40

a lot of things have sort of come and

32:41

they've all converged at one time

32:43

which has been really comforting to see

32:46

that

32:47

globally we can pull together with

32:50

actually science and technology

32:51

sort of being the the uh the way to pull

32:54

it together

32:55

so are there no

32:58

things then because of

33:02

where we are in history

33:05

so none of these things would have been

33:08

possible

33:09

40 years ago because we didn't a have

33:12

the technology we didn't have the means

33:13

of communication we didn't have the

33:15

ability to create

33:16

so how much of the of the new of how we

33:20

deal with pademics is due to the

33:22

we are living in the 21st century the

33:24

second decade of the 21st

33:25

or third decade of the 21st century

33:28

versus we're better better human beings

33:31

we've learned from the past

33:34

is there a kumbaya moment that is not

33:36

happening here i'm

33:38

and i'm thinking towards the future how

33:41

we're gonna deal

33:42

with sars three

33:49

so it's interesting you mentioned that

33:51

because uh

33:52

just today or yesterday i got a

33:54

bipartisan

33:55

uh report uh called the apollo report

33:58

they talked about

33:59

what we could do in the future right and

34:02

one of the things that they which i

34:04

thought was really good and

34:07

but i'm just going to talk about one of

34:08

the things that they mentioned because i

34:10

think it's one of the more important

34:12

ones

34:12

is right now there's a difference

34:15

between a vaccine

34:16

and vaccination okay

34:20

so we understood before what i said is

34:22

how fast it took to develop

34:24

vaccines great we record speed now

34:28

because of technologies

34:30

the tall pole in the tent is vaccination

34:33

getting it to the people

34:34

right and so one of the things

34:37

so there's issues with cold chain uh

34:40

there's issues with two administrations

34:43

um you know there's just who gets it

34:45

first that we talked about before one of

34:48

the things that the apollo

34:50

committee came up with is that they

34:52

really want

34:54

a needle-free sort of oral

34:56

administration

34:58

and therefore it could be

34:59

self-administered

35:01

that would overcome a big bottleneck if

35:04

we start focusing on sort of mucosal

35:06

delivery

35:07

um and not needing a cold chain and i

35:11

think that's going to be

35:12

i think in the that that can help

35:16

the vaccination side of the equation if

35:19

that becomes real

35:20

so that's just one idea that i thought

35:22

was worth mentioning is that

35:24

that's such a big topic right now

35:27

is who's getting it um the long lines

35:30

and then there's all these charlatans

35:31

that have fake websites and they try to

35:33

get your information

35:34

and they're and so the idea is how do

35:37

you get it for the people well the

35:38

easiest way to get it to the people

35:40

is for them to administer it themselves

35:41

for an oral administration

35:43

like polio like polio exactly

35:48

um and uh so that would be one

35:51

i think that could be one way to help

35:53

with vaccination in the future

35:56

so if you were invited today to sit on a

35:59

panel

36:00

that is going to you know develop the

36:03

strategy

36:05

to prevent or to address the next

36:07

pandemic

36:09

what what would you bring from your

36:11

experience to date

36:13

in the area of vaccine development for

36:16

example and all the

36:17

conversations and all the operations

36:20

that happen behind the scenes what do

36:21

you

36:22

what would you want everybody to know

36:24

going forward

36:28

that um

36:32

the the the first thing i'd say is just

36:35

as

36:36

tesla has become an automobile company

36:39

because it

36:40

changed it into being a software company

36:43

right tesla at the end of it is a

36:45

software company

36:47

and we need to make this

36:50

make vaccine development and vaccination

36:53

more like software

36:55

where we can move at the speed of

36:56

electrons and not at the speed of humans

37:00

and i i would try to digitize everything

37:03

so sequencing is digitized now

37:06

then we have to think about how do we

37:08

synthesize

37:09

rapidly and so we can actually make

37:12

plasmid dna

37:13

um and then mrna is much is very fast

37:17

and then how do we actually think about

37:19

having

37:20

real having so much real world data that

37:23

we can actually have computer generated

37:25

clinical trials that are

37:26

just as predictive right so then you can

37:29

think about how do you digitize

37:31

everything and and and how do you

37:34

digitize a human

37:35

and predict how a human will respond

37:38

right

37:39

um all in all within computers all in

37:41

silicon and that's how you can do it in

37:43

rapid time

37:45

is and we're right at the precipice of i

37:48

think

37:49

really being able to engage upon that um

37:52

we're not there yet

37:53

but we're starting to get there i mean

37:55

there's been some really fascinating

37:57

um studies which have just come out

38:01

recently where they're

38:02

believe it or not it's kind of funny um

38:04

they're they're actually trying to

38:06

understand

38:07

uh the role of just repurposing drugs

38:10

and they're using machine learning to do

38:11

it

38:12

and they actually found that melatonin

38:14

of all things

38:15

has a probability of lower risk of covet

38:19

by like

38:20

20 to 30 percent than people who don't

38:22

take melatonin

38:23

it really gets into the importance of

38:25

sleep in fact when the pandemic came up

38:27

this is not a pr thing but i bought this

38:30

aurora ring

38:32

okay and this is basically a fully

38:35

uh uh it's a ring that actually has all

38:38

these electronics it measures your heart

38:39

rate variability it measures your core

38:42

temperature measure how many steps

38:43

right it measures your sleep patterns

38:45

whether you're in rem sleep

38:47

or uh deep sleep or light sleep and

38:50

this is an aside but my wife just got a

38:53

case of c

38:54

diff and when we knew that we had to do

38:57

something because this ring actually

38:59

gave out

39:00

warning signals about what's happening

39:02

with her heart rate variability

39:04

so we could actually take care of it

39:05

before it became really bad

39:07

we're taking care of it before it became

39:09

really bad so

39:11

i think you know just technologies

39:13

digitizing sensing

39:14

where you're you know all this

39:16

information starting to come in where we

39:18

can actually start to integrate all this

39:20

data together

39:21

and the idea of actually having you know

39:24

in silico humans right which we can

39:28

predict how how different subsets of the

39:30

population will

39:32

respond i think is uh is

39:35

within uh 10 10 to 15 year reach

39:39

that's one thought i don't know if you

39:40

agree or if you see a difference

39:42

i mean i'm a big fan of star trek and

39:44

have always been so i kind of envisioned

39:47

sickbay in star trek with a device to

39:50

scan a person and be able to tell these

39:51

things which

39:53

many of those things are becoming real

39:55

in my lifetime

39:56

yeah and it's it's it gives me hope for

40:00

the future because this is not

40:01

a pipe dream this is actually we're

40:04

almost there we're very close to those

40:06

kinds of things what i would add to this

40:08

is i would want to be invited to that

40:12

same group

40:12

and table and talk about the the

40:16

non-futuristic

40:17

still valid truths of today the

40:20

importance of a consistent message the

40:22

importance of trying to

40:23

alleviate the conditions that actually

40:25

create the basis for disparities and the

40:28

uneven distribution of disease

40:30

i would like to to ensure that there are

40:33

people that can come from different

40:35

angles and different perspectives and

40:36

can

40:37

offer why that would not work in this

40:40

particular community or that community

40:42

and that will be that awareness

40:44

in the development and distribution of

40:46

the out

40:47

of the prevention messages and of the

40:50

vaccine vials

40:52

so that kind of a more holistic approach

40:54

it's not the

40:55

or it would be really the end and have a

40:58

conversation that supports

41:00

both pieces so that we can have a real

41:03

positive outcome

41:07

so one of the things really important

41:10

about vaccination

41:12

is it's not just about protecting you

41:14

it's about protecting others

41:17

so the whole thing is it's about you and

41:20

me right again and thing

41:24

how do we get the message that

41:28

vaccination is about being others

41:30

focused

41:32

from a public health point of view right

41:34

because we're so

41:36

self-centered anymore and

41:39

i think we need to learn to be others

41:42

focused

41:42

and perhaps that's part of the challenge

41:45

absolutely

41:46

we've been working at apha on guidelines

41:50

with other partners to convey

41:54

messages that are vaccine positive

41:58

so rather than going what you said a

42:01

couple of minutes ago it's not about

42:02

punishing anybody

42:04

it's about helping people understand the

42:08

importance of this is something i do

42:10

for myself and for my community this is

42:13

something i do so that my neighbor can

42:15

return to

42:16

work this is something that i do so my

42:17

grandmother doesn't have to be

42:19

hospitalized this is something that

42:21

is not unprotected i'm good you figure

42:24

it out on your own

42:25

yeah it's really how are we a system

42:28

that is interdependent and that your

42:31

wellness is my wellness how can we make

42:34

it

42:35

a so that it's understood that way

42:38

is it's a task it's a task

42:42

yeah because if we're going to get hurt

42:45

immunity

42:46

you know the number depending on what

42:48

numbers you

42:49

listen to it's got to be somewhere

42:50

between 60 and 80 percent

42:52

of the people need to be vaccinated if

42:54

we don't get that hurt immunity then

42:56

these

42:57

mutants are going to start creeping up

42:59

more and more and then

43:01

you know the coronavirus could become

43:03

like a seasonal

43:04

uh vaccine that you have to take just

43:06

like influenza in which it mutates all

43:08

the time so

43:09

if if everyone's kind of participates in

43:11

this we could get the cured immunity

43:14

and actually try to stop the virus or at

43:17

least try to contain it a little bit

43:18

more than what we have that's what we

43:20

would hope for

43:20

right yeah yeah

43:24

yeah i'm just yeah i'm just i i guess

43:27

i'm just sort of

43:28

at a loss at uh

43:31

the idea of the misinformation

43:34

that not wanting to be others focused

43:37

and

43:38

what what have uh what are we turning

43:40

into

43:42

yeah i mean

43:46

i was speaking with some friends a

43:47

couple of months ago

43:49

and one of them was in charge of the

43:52

simulation disaster simulation

43:54

plans you know this tabletop exercises

43:57

where they

43:58

they envision crises and she was saying

44:01

that

44:02

in their exercises they have factored

44:04

everything for the outbreak and this and

44:06

you know where you go the hazmat suits

44:08

everything else

44:09

but one thing they had not factored into

44:12

that scenario was politics

44:16

politics was what sorry politics and

44:21

this has been a lesson this has been a

44:23

lesson because i think this is

44:25

new relatively new i mean you could

44:28

argue also that

44:29

i i would argue that during the eighth

44:31

span the mx politics had a lot to do

44:33

with the neglect

44:36

but it's certainly a factor that need i

44:39

don't know that it was a factor in in

44:40

1918

44:44

but certainly there's if we did a

44:46

regression analysis of all the variables

44:48

that have gotten us to the point where

44:49

we are i think that that variable

44:51

politics would account for

44:53

quite a degree of the variation of the

44:56

spread of the disease

45:01

i i agree i agree i think especially

45:05

initially

45:06

the first and then and then uh

45:09

and then things started to change slowly

45:11

but you're right and it

45:13

let it go but it's almost um this one

45:16

i think there was a little bit of

45:17

indifference uh you know i i have to

45:20

admit i'm in the vaccine world and i

45:22

heard about this in china and i

45:23

i actually sort of uh this is me

45:26

personally i sort of stuck my head in

45:27

the sand for a little bit and said well

45:29

you know

45:29

i just wonder if this is going to be

45:31

another uh

45:33

you know right zika right which

45:36

which uh sort of was really bad

45:39

because it caused microcephaly but at

45:40

the end it sort of just puffed away

45:43

and i was sort of half wondering you

45:45

know uh

45:46

is the sky falling is the sky falling

45:48

and is this going to be like another

45:50

zeke and do it i need to really think

45:51

about it

45:52

and uh i mean i was always watching it

45:55

but you know you never really pay

45:56

attention and

45:57

you you watch it and then all of a

45:59

sudden it hits and it's just like oh

46:01

i saw this coming why didn't i do

46:02

anything about it mr

46:04

in the vaccine world the rest of us mere

46:06

mortals

46:08

like what do we have to go with

46:11

right yeah i mean

46:14

it's uh i think we're going to be much

46:16

more aware and this gets into i see that

46:18

steven morris is asking a question about

46:20

surveillance

46:21

and some of this gets into surveillance

46:24

and

46:24

some of it is we need better

46:26

surveillance i completely agree

46:28

but some of it is we can't be too

46:32

lazy fair and we can't be too much of an

46:34

alarmist

46:36

and how to know which one is when to be

46:38

which one

46:40

uh can be kind of difficult and uh he

46:44

actually

46:44

his question was about the prevention

46:46

paradox you mentioned

46:48

um and would it require identifying the

46:51

spreaders first

46:52

without a good surveillance strategy you

46:55

can do that

46:56

period and that has been another problem

46:59

that there were so many surveillance

47:01

tools out there not consistent not

47:03

reliable

47:04

and everybody was doing whatever they

47:06

could be but there was not a loca uh

47:08

one repository of accurate information

47:12

yeah yeah if you can find the super

47:14

spreaders

47:15

those are the ones to get first

47:17

absolutely

47:18

and uh you know and i think some of the

47:21

surveillance that's out there

47:23

you know that at least that i'm aware of

47:25

g said

47:26

has been doing a really good job um and

47:29

they do it for flu

47:30

and for covet 19 but what would be

47:32

really nice is if we actually had

47:35

you know better surveillance for

47:36

respiratory diseases in general

47:39

and you know more holistically and not

47:42

but including rsv

47:44

um and just really monitoring these so

47:46

we can actually know but

47:48

but we still have to be careful of the

47:49

alarmist versus laissez-faire and to

47:51

know

47:52

when because if if we're too much of

47:55

alarmists all the time people are going

47:56

to get lacks and not believe

47:58

and uh and if we're too lazy fair

48:01

something's going to hit like it did

48:02

this time

48:03

and since you've gone to the questions

48:06

uh

48:06

in the time we have left there's some

48:08

really interesting questions here

48:10

uh one of which concerns clinical trials

48:12

and ways to

48:14

accelerate clinical trials you mentioned

48:16

earlier that in silico's where you want

48:19

to be

48:20

but is there a challenge studies both

48:24

ethically and technically

48:26

before we get to in silico

48:32

a good question so i'm gonna answer that

48:35

one in two parts if that's okay michael

48:36

so the first thing is to increase it

48:38

one of the things that they've done is

48:40

they've tried to find

48:42

what's known as predictive epidemiology

48:44

where they're using machine learning to

48:45

find

48:46

where the hot spots are and that's where

48:48

they would put up the clinical trial

48:50

site

48:50

and that's how you could really and so

48:53

some companies are actually using that

48:55

to

48:55

increase uh the phase three efficacy

48:58

trials and that's what's been

49:00

very unique about this pandemic is the

49:02

efficacy trials have been very fast

49:04

number one because it's a pandemic but

49:06

number two because they're trying to

49:08

put the clinical trial sites at hot

49:11

spots so they can get more cases

49:13

in the placebo group and hopefully less

49:15

cases in the vaccinated group to show

49:17

that there is atlaxian efficacy

49:19

now getting back to human challenge

49:21

models um

49:25

[Music]

49:26

yeah um that

49:30

human challenge models are typically

49:33

easier to do

49:34

when you have a therapy against it

49:38

okay so for instance there's human

49:41

efficacy trials against

49:42

influenza well it's because we have

49:44

antivirals against influenza that we

49:46

could have these

49:48

okay uh ethically we can have these

49:51

but for a pandemic when we didn't know

49:54

what if there was a therapy again now

49:56

there are some therapies but we didn't

49:58

know what the therapies were so it would

49:59

have been difficult to have a human

50:01

challenge model

50:02

if somebody got sick and you couldn't uh

50:05

first of all you didn't know if they

50:06

were gonna die or not which we don't

50:08

know

50:09

and then if we couldn't treat them so i

50:11

think if there

50:12

are for a pandemic if there is an

50:14

antiviral or therapeutic that could

50:16

reduce the disease severity after the

50:18

fact

50:19

um i think ethically you could do it but

50:21

otherwise i would

50:22

personally say there is

50:26

okay there is another question here

50:28

somebody's been doing their homework

50:30

because uh

50:31

in my rush to catch up with the the

50:33

seven minutes that we

50:34

had a late start i forgot to say that

50:36

that you were with sanofi

50:38

and in particular that you're in charge

50:40

of flu necks

50:41

and so somebody here has asked about a

50:44

broadly

50:44

uh protective influenza vaccine how do

50:46

you go about developing that

50:50

is there anything you can say

50:56

what would you look for in in any say

50:59

take

50:59

covet for example you now have mutations

51:02

coming about

51:03

you've indicated that you hope to slow

51:05

the rate of mutation with hurt immunity

51:07

but uh what would an approach be that a

51:10

technical community might be taking or

51:12

might consider taking

51:14

in order to create a broadly a broad

51:17

spectrum

51:18

anti-cova vaccine

51:22

so the first thing that they may want to

51:24

look at is

51:26

the antigen design and

51:29

which antigens are are conserved and

51:32

which ones are

51:33

more susceptible to mutations

51:38

the second thing is they may want to

51:40

look at the manufacturing platform

51:43

because just as an example if one was to

51:46

use mrna

51:48

you would get both t cell or

51:52

cellular mediated immunity as well as

51:55

antibody immunity

51:57

so you could actually get both arms of

51:59

the immune system versus a recombinant

52:01

which would largely be antibody based

52:03

now put in just to realize that most

52:06

vaccines that are out there are antibody

52:08

based

52:09

but covent as an example they believe

52:11

that the

52:13

protection comes from t cells and from

52:15

antibodies

52:16

so you could look at that you could look

52:18

at your clinical trial design

52:20

which by the way will become important

52:22

for covert in the future because for flu

52:24

as an example

52:25

most people are have already experienced

52:27

immunity to it

52:29

and so that will actually impact your

52:32

immune response if you've already had

52:34

uh immunity against it versus if you're

52:37

a naive host

52:39

so there's just a whole host there's a

52:40

lot of things from looking at

52:42

the role of the host looking at

52:44

effective mechanisms

52:45

looking at the antigen design or antigen

52:48

selection

52:49

to even thinking about how you want to

52:51

conduct your clinical trials

52:54

you know you mentioned about human

52:55

challenge models i think that's going to

52:58

become

52:58

very important for a broadly protected

53:00

because you want to see that

53:02

you know first of all you have to if

53:04

you're going to go to a regulatory

53:06

authority how are you going to define

53:08

universal how many strains which strains

53:11

are going to show

53:13

how how were these strains selected

53:15

right you have to show that they were

53:16

selected unbiased right

53:18

so there's a whole host of various

53:20

questions that

53:21

one has to grapple with you know which

53:24

host

53:25

uh you know in a immunocompromised host

53:28

an immunosuppressed host such as the

53:30

elderly

53:31

and a very naive host as in the

53:34

pediatrics or infants

53:36

so you have to when people use people

53:38

use the word

53:39

universal too loosely um

53:43

there's no such thing as a universal

53:45

anything really

53:46

i hate to say that but i mean

53:51

it's it's easy to use the word universal

53:53

it's hard to do it

53:54

so it's probably better to think about

53:56

something like a next generation

53:59

vaccine or a broadly protective but

54:02

universal

54:03

um if you i mean maybe that is possible

54:07

but

54:07

it's really hard to prove a universal

54:09

it's almost like trying to prove a

54:11

negative

54:11

point okay

54:15

um well we're we're sort of at the end

54:18

of time but uh we have a couple more

54:20

questions here if you don't mind hanging

54:21

around

54:22

we'll see what happens if the if if

54:25

riverside gives us back our seven

54:26

minutes or if they cut us off

54:28

but um uh there's a question here uh

54:32

richard garwin hypothesized that about

54:34

five to ten percent of the sars

54:36

kov2 infected individuals with the

54:39

highest viral loads

54:41

could be responsible for 90 to 95 of the

54:44

transmission

54:46

what do you think of that the hypothesis

54:52

do you want to take that word i think

54:55

i have that jose romano on the surface

54:58

it would seem like an easy yes

55:01

but i would want to know who those five

55:03

to ten percent

55:04

are and how much in contact with the

55:08

rest of the population they are

55:10

so if we were talking for example about

55:13

college students

55:14

that living in dorms then that could be

55:18

the super spreading opportunity is right

55:20

there

55:21

so depending on the context and

55:23

depending on the behaviors that these

55:25

[Music]

55:27

individuals are engaging in could be

55:30

easily responsible for that percentage

55:32

of the population

55:33

if they were a bus driver that was not

55:36

wearing protection correctly or the bus

55:39

was not well ventilated that could be

55:42

a different very different situation

55:44

from somebody that works from home

55:48

okay yeah just to follow up with that

55:52

question you know i i use the word

55:55

universal and i don't believe it but i

55:56

am gonna say that i

55:57

believe in one universal law which is

56:00

the 80 20 rule

56:01

you know some people say that 20 percent

56:03

giving 80

56:05

of the givings right but i've heard

56:08

that 20 of the population are giving

56:12

rise to 80

56:13

of the infections i think richard garwin

56:16

is sort of taking that sort of 10 to 90

56:18

percent

56:18

okay he's believing the 1090. um but i

56:21

think

56:21

i i think there's probably some truth to

56:23

it because that 80 20 rule seems to hold

56:26

all the time it really does and it's

56:28

really due to the role of these massive

56:30

super spreaders

56:31

uh so i think there could be some truth

56:33

to that okay

56:36

well thank you very much i think this

56:38

was absolutely awesome i could have

56:39

interrupted you

56:40

earlier but the conversation was so good

56:43

i felt we ought to let it go

56:45

and and we'll identify the rest of the

56:47

questions and uh

56:49

i'll try and figure out how to get

56:51

answers to those people who didn't get

56:53

their questions answered

56:54

um but in the interim uh thank you uh

56:57

this was our

56:58

first talk polly plexus i mean a

57:02

talk uh and and i am absolutely

57:04

delighted

57:05

uh i think it was wonderful the two were

57:07

marvelous guests

57:09

and uh i appreciate the time and the

57:11

energy and the thought that went into it

57:13

so so thank you very much