Going to get out of this mass at a biological mess at a biological level. This is how you protect yourself against Infectious Diseases, and antibodies are how people who are infected with the virus and survive, how they are protected against secondary challenge and how a vaccine works. Host the collection of data on anybodys, how does that work, and what type of numbers do you have to see to make a good estimation of where we are at . You just asked two questions, how to we use antibodies to understand how people are infected, and how do we understand whether those antibodies in those people are and how can we use that information moving forward. I think we know a lot more about the first question that the second, because that is what we have been doing at a population level these days. We have been rolling out tests and trying to use those to understand who has seen the virus. ,n some places in massachusetts like chelsea, where they go out on the Street Corner and test antibodies from people they find , 30 of people who think they have been well, 30 of those people have seen the virus. That told us a lot about where we are in the epidemic. Host how accurate are the tests for antibodies generally . Guest that is a superb question. It turns out it is all over the map. There are over a dozen different Antibody Tests on the market, and some are superb, and some are not so superb. All of them have utility. It is important we understand the characteristics of any given Antibody Tests and trying to understand how we use it. Host is there a way to determine how the superbness from one test to the other . Guest of course. We do that in a lab. , basicallytest blood, from people you know who have had covid and blood from andle that has been stored you know they dont have covid because it is from like five years ago, and you run the Antibody Tests and see how well they do. Have error rates around 1 , so it gets the answer wrong about 1 . Some of them have rates around 10 . Those are really different, in terms of whether you are trying to make an individual decision about what you should do about that information, or a population level decision about what you should do with that information. Host i guess one of the things in the last couple of days about this false positives about these types of things. Guest right. Is not the first coronavirus in the world, and we have all been infected with many coronaviruses. It turns out our body has a memory of seeing those coronaviruses. We have antibodies to those viruses, and they can create a background in those test results. Distinguishrd to some of these lowlevel positives to the new coronavirus from that background. But, those errors really have enormous implication for their data, the data that you as an individual are trying to use to decide whether you are safe to go back, say to work in a hospital or a nursing home, because 10 error rate for you means, if there are 100 of you, 10 times, that Antibody Test will tell you you are safe and you are not. And that is unacceptable. Ist doctor sarah fortune our guest, talking about the response of the coronavirus pandemic. You can call in, eastern and central time zones, 202 7488000. If you live in mountain and pacific, it is 202 7488001. For medical professionals, 202 7488002. You can text us at 202 7488003. Dr. Fortune, in the discussions about the developments of vaccines, the new efforts talked about the house yesterday, from Anthony Fauci about the rapid pace of trying to develop a vaccine, i want to play a little about what he said about this operation on the todays show. Of theobviously part team that is involved in that, and the question is, you always have to say you want to get a vaccine that is safe and effective, and that you can scale up rapidly. What the plan is right now, as i mentioned a couple of times on this show, we are in the early stages of a trial phase one. When you go into the next phase, we will safely and carefully, but as quickly as possible, try to get an answer as to whether it works and is safe. If so, we will ramp up protection production with companies involved. You do that at risk, in other words you do not risk weight until you start manufacturing. You proactively start making it, assuming it will work. And, if it does, you can scale up and hopefully get to that timeline. We want to go quickly, but make sure it is safe and effective. I think that is doable. Host that was part of dr. Faucis sharing of what they are doing. Dr. Fortune, what do you think about the approach they are taking . Guest i think its a streaming it is externally important, and im impressed we are taking that on, because that is an ambitious and risky effort, but without it, we are not going to get to a vaccine in the timeframe we need to really save peoples lives and save the economy. Host in the process of developing a vaccine, what is the importance of tests, whether it be trial tests, small simple, large sample. Where does that fall into the administrations desire to get a vaccine . sest i think dr. Fauci framing of the process for developing a vaccine helps you understand that, so the first thing you try to understand is whether a vaccine is effective. You can do that in relatively small numbers of people. Do that first by measuring the antibodies in those individuals, how well that vaccine generates an antibody response. Then, you have to worry about safety. That really is a different problem, and that probably requires a combination of animal testing and larger numbers of people, because we know most people who get covid are going to be fine. So that safety signal is trying to convert actually a little more of a needle in a haystack. You need larger testing to do that. At the same time, what he is doing in terms of capacity to manufacture a vaccine, that, in and of itself, is a huge hurdle. That infrastructure now is making a bet on our future. Host this is dr. Sarah fortune of harvards school of public health. Our first caller is greg in new jersey. Go ahead with your question or comment. Caller good morning, doctor and rank you for appearing on cspan. Doctor, and thank you for appearing on cspan. A question to these Antibody Tests, is there any rating system, lets say from one to 10, in terms of their reliability . And the people who are tested, of they actually informed the problems or shortcomings of any particular test or the strengths, relative strengths of the certainty of the results and so forth . And, i had one other question, which is interesting. And ier from hayfever, usually get a call during the winter. I am wondering if it is something about what happens in your nasal passages when this occurs that may actually protect inhaling this molecular enemy. Host thank you. Guest i will answer both questions. I love the second question, but let me answer the first question because it is a little easier. Yes, there are comparative studies of all of these Antibody Tests. Scientists dont make that data easy to digest. They dont write everything on a one to 10 scale, but there are comparatives, so they give you a of how it attacks people and the specificity. It gives you those numbers. The question about how the test is being used tests are being used is interesting. In the population studies im aware of, people are not actually being told what the results of those tests are, because they are used at a population level. In part because we do not know what the result of the tests thoseor people, so studies are not actually set up to return that information to people, but i think you raised an important point about how people are informed about the strengths and failings of those tests, in terms of using the data. The second question of your hayfever is super interesting, because it speaks to a certain may of immune response that be good or, sorry to say, may be bad in terms of why people tend to get sick from covid. There are different flavors of immunity, sort of allergy was implicated in sars in terms of people who got sick from the infection. That is part of what makes a vexing complicated, trying to get the wrecked the right flavor of immunity. Host the next color is from maryland. Hi. Caller good morning. My sister and her husband both contracted the coronavirus. He died a couple days ago, her husband. Me, his wifeelow died from the coronavirus. Both were in nursing homes. See howy bothers me to our president misleads the American People with this garbage he talks. We need some real people like dr. Fauci and the lady doctor that comes on this news conference. I dont understand why most American People is listening to mr. Trump in the garbage he talks every day. Hes an embarrassment to this country. Host thank you. Guest im very sorry about your family members and neighbors. It speaks to the fact this virus attacking communities equally. Some communities are suffering much more heavily from this virus than others. And, it would be nice to see more coordinated and consistent messaging at a federal level, although, as you say, dr. Fauci hero, and folk is doing a fantastic job. Its nice to have him at the helm of the nih. Host we go to john in pennsylvania in johnstown. Caller thank you for taking my call. I have two questions for the doctor. , have theyhemselves waived fda approval for these tests in a rush to get them available to be used, and my second question used . My second question is, i am at a loss to understand why the Trump Administration has decided to and severalwho things they are trying to do. I think it sends a message the world message to the world that the poor people of the world do not matter. Thank you. On the first question, the tests are being approved. They are being trialed and approved. It is important to recognize that different test characteristics are useful in different situations. If you are going to survey an000 people, you might want easier test and except a higher error rates. If it is you making the decision on what you should do, you might want a different test with a lower error rate. The tests have different use profiles, which makes them all valuable, but it is important to know what they are. I 100 agree with you about the who. If we think this is a terrible burden for our country, which it is, it is important to realize there are countries with many fewer medical resources for whom this is just an incredible catastrophe. Host dr. Fortune, you have seen the numbers, im sure, about the United States surpassing 60,000 deaths related to covid19. How does that compare to deaths from influenza . Im sure you hear the comparisons as well as this one and influenza. The 20182019 flu season, which the flu season is weirdly not the calendar year, it can be longer than the calendar year. There are about 60,000 deaths in the United States as well. I think it is important to realize, in the United States, our 60,000 covid deaths have occurred in the past six weeks, eight weeks. Whereas those influenza deaths occurred over a period of about 12 months. Up, we are in pace to rapidly outstrip influenza, is easy towhile it equate this to numbers, i dont think that comparison is fair. Host dr. Fortune, at the time we are talking, several states have decided to reopen portions of their business and allow some transactions to happen that way as way. As an epidemiologist when it comes to social behaviors, what do you think we might see when it comes to rise of cases . Guest from an Infectious Disease level, the more people interacting with each other, the more covid transmission we will see. I am very sympathetic to states needing to do this, and i think the dialogue around flattening somehow, implied that by flattening the curve we will make the virus go away. Ist we are really doing limiting the rate at which the virus transmits to the population, such that our medical establishment can take care of people. It is not inherent of the logic of flattening the curve, is understanding we will have to we will have to relax social distancing, and the virus will inevitably transmit through the population. Just need to do it at such a rate that we can take care of people. Then, make sure people who are really high risk are protected. Host lets hear from linda in sharon, pennsylvania for our guest, dr. Sarah fortune. Go ahead. Caller hi. [laughter] i love you, cspan. I was just wondering about mosquitoes. If somebody has the virus, can mosquitoes transmit it to somebody else after they take the blood from that person to spread to another person . Guest that is an excellent question, and there we are lucky. This is not transmissible via mosquitoes. There are other viruses that are, but this is not one of them. Host what about this idea that someone talked about on this program and other places about the transmission being capable through air instead of through contact . Guest yeah. Notfor people who are thinking about viral transmission all the time, there is this distinction between droplet born transmission and airborne transmission. Droplet transmission is when you sneeze and cough and droplets fly out, and they are kind of big. If people are in the trajectory, they can get infected, or they land on surfaces and get infected. On tbansmission, i work as my primary focus, and it is an air pathogen. What happens there, the droplets dehydrate into these little tiny droplets that can hang in the air for hours and hours and float around. Anybody who happens to come into the dust cloud, even a much longer time later, can be infected. That is much harder to protect yourself against, so, when people are saying airborne transmission, they are invoking morespecter of a much difficult to contain pathogen. I think the epidemiologic and biologic data suggests airborne transmission is probably possible but not the dominant way this virus spreads. Is most of the spread through droplets and surfaces. That is really because of where most of the risk is, that is where we should focus our efforts. Which is not to say in a hospital where there is a huge cloud of droplets people dont need to be worried about droplets or airborne transmission, but it is probably not where the general populaces efforts should be focused. Host this is lisa in charlottesville, virginia. Caller hi, doctor. Thank you for taking my question. What i wanted to know, do we know, if someone has the antibodies, does that mean they will not get covid19 again . Guest another excellent question. Course, what scientists like to equivocate about, technically we do not know. That is really because all antibodies are not equal. Antibodies,k about numbers matter. To haveple are going lots of anybodys that are really good and will probably be highly protective. Others might not have so many antibodies or antibodies that are not quite as good or highly protective. Level, at a population having antibody responses means most people will not get as sick , if they get sick at all. For a given individual, we dont know that answer. Host dr. Fortune, how do you factor in those who are a symptom attic as far as the future spread of this disease . Guest as what makes this pathogen so complicated. It is estimated about 40 of transmission occurs through people who do not have symptoms. Obviously, if you dont have symptoms, you dont know to get tested. It is hard to find you, and it is hard to protect people against that form of transmission. Day whenenvision a viral testing is widely available, and we can do testingance viral and find people who are a symptom attic transmits thing a symptom attic transmitting symptomatic transmitting. We are really not there yet so difficult to protect ourselves against asymptomatic transmission. Host is there a way to understand what triggers from one from being asymptomatic to symptomatic. Guest there is a way but we dont know it yet. There are pretty good guesses. That, clearly, some people have what you will obesity and diabetes. It is likely those people are not getting sicker because they have other illnesses but because of all of these, their immune response system has altered, and it is not the virus per se that is making people sick when they get really sick. Their immune response is causing more damage than having the virus itself. That gets to the earlier. Allers question people have different qualities of immune response and sometimes that works in your favor and sometimes it works against you. You would like to be able to predict that and help people understand the risks, and understand risks early in some of these trajectories, but we do not have the tools or understanding to do that yet. Host from kentucky, we hear from randy for our guest, dr. Sarah fortune of the Harvard School of public health. Caller good morning. Thank you. Over 10 states, there were such a high rate of Health Care Professionals contracting or getting this virus, and they did have adequate ppe, the report said. So what is going on with the sterilization techniques, or is this such an easily contracted , the that the people common person out in public, doesnt have the professional Training Like the professionals have . What will happen there when this all blows up . Guest thank you for the question, randy. Im from kentucky as well, so it is nice to hear from somebody from kentucky. The complexity of protecting yourself against this illustrated inis this question of why healthcare workers who are wearing n95 masks are still getting infected. We have learned it is very hard to not touch things and not touch her face your face. Settinga health care where people understand they are high risk and services are dirty , as people are taking off their yourthe art of taking off ppe is complicated, especially if it is covered with a high density of covid viruses. Healthcare settings can easily infect themselves as they are taking off their ppe. In our hospitals, we have dedicated people who are standing there, helping doctors take off their ppe, so they do not infect themselves. That does speak to the problem of trying to stop transmission. Healthcare settings are special. There are lots of people with covid and there in there. There is a my daughter works in a bank, five years ago she worked with a chinese woman and her husband was a chinese scientist. And she told my daughter that the Chinese Government was doing something that they were going to destroy the world. My daughter thought that she was a nut, and she said, come on. They said that she is creating something, i do not know what it is, but they are creating something, and when they are going to do it, i do not know. My daughter just let that go, because she thought, she did not believe it. And look what is happening now. And it was not an accident that th