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Dr. Fauci Says, How Much Suffering Are You Willing To Accept; Race For A Vaccine Intensifies; FDA Cracks Down On Coronavirus Antibody Tests. Aired 7-7:30a ET
Aired May 5, 2020 - 07:00 ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
JOHN BERMAN, CNN NEW DAY: Just how the nation's top infectious disease doctor, Anthony Fauci, stated it overnight.
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DR. ANTHONY FAUCI, DIRECTOR, NATIONAL INSTITUTE OF ALLERGY AND INFECTIOUS DISEASES: It's the balance of something that's a very difficult choice, like how many deaths and how much suffering are you willing to accept to get back to what you want to be some form of normality sooner rather than later.
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BERMAN: So what is the death toll that, as a society, we are willing to reach? That's the question Dr. Fauci asked. And this morning it really does seem that the answer from at least some Americans and some leaders is more. We are willing to accept more death in order to leave our houses and open some businesses. Most people won't state it so clearly and honestly, but that's the tradeoff that has been made and those are the consequences that are coming, at least according to leading researchers.
ERICA HILL, CNN NEW DAY: The most talked about model on the coronavirus impact is now doubling its predicted death toll to more than 134,000 by August 1st. And perhaps even more sobering, pair that with internal projections from the CDC and FEMA which show that by the end of this month, as many as 3,000 American lives could be lost every day along with 200,000 new cases per day.
The White House is actually pushing back on that report in The New York Times, saying it has yet to be analyzed by the coronavirus task force. Today, the president is traveling to Arizona to visit a company that manufactures protective masks. It is not yet clear if the president will be wearing one.
BERMAN: All right. Joining us now is CNN Chief Medical Correspondent Dr. Sanjay Gupta and Dr. Ashish Jha, he is the Director of the Harvard Global Health Institute.
Sanjay, I want to start with you. We've seen these models adjust overnight. The model out of the University of Washington nearly doubled its projected death count. They say the reason why, we can put these four things up on the screen so people can see, the first two are increased mobility. People are moving around more. This isn't what will happen, this is what they say is happening. People are moving around more. And the second thing on that list is relaxed social distancing.
What the model is saying is that people are not doing the things that they were supposed to be doing as part of the social distancing. They are not doing the things they were supposed to be doing as part of the CDC guidelines for reopening. What are you seeing here?
DR. SANJAY GUPTA, CNN CHIEF MEDICAL CORRESPONDENT: Yes. Well, first of all, you know, these models are all over the place. So people would be right to say, look, I'm looking at different numbers every day, what do they mean? And some of these inputs are certainly relevant and were driving it.
I could tell you, it felt like the numbers were already going up even outside of the anticipated reopening of some of these states now. So that was the mobility, I guess, maybe people were starting to move around more. When we talked to Chris Murray, he said, initially, the mobility data suggested people were actually doing a pretty good job of staying at home. And the way that they got this data, they were looking at cell phone carriers, anonymous data when they added in four cell phone carriers, a different picture started to emerge. People moving around more than they thought.
But, right, it's no surprise, to your point, that the numbers are anticipated to go up as these states start to reopen. There will be more infections, there will likely be more hospitalizations and more deaths. And, you know, one thing I'll just say, and maybe it goes without saying, is there are criteria to open up the states.
The conversation right now in the United States seems to be not only do we want to open, we want to do it now and not even abide by the criteria that were set out. There were criteria. And so people are really, as Dr. Fauci put it, leap frogging. Everybody wants things to open, but now no one even seems to want to pay attention to the pretty easy to read criteria that were laid out a couple of week ago.
HILL: Well, even some of that easy to read criteria, if we look at even just pulling a few states here, the 14-day trends, right, we know part of the guidance from the White House was that there should be a 14-day decline in cases, Dr. Jha. If we look at, again, just putting up a couple of states here, Wisconsin, Tennessee, Texas, we're certainly not seeing a 14-day decline downward in that trend there.
Does the science still -- I mean, I know the science matters. I don't mean that in a flip manner. But as we look at these numbers, to Sanjay's point, in a lot of cases this seems to be more about public sentiment than it is about public health.
DR. ASHISH JHA, DIRECTOR, HARVARD GLOBAL HEALTH INSTITUTE: Yes. So, good morning. Let me say a couple of quick things on that. On the issue around the IHME, The Washington State -- University of Washington model, we know that their model was way too conservative. I'm pleased to see Chris and his team update it. I still think it's too conservative. It assumes that somehow the virus is going to go away by the end of June, which it's not.
So I think, unfortunately, even those numbers are still too low. And -- but now if we move to what the states are doing, it's really clear that the most states are not following official guidelines.
And those official guidelines, many of us have been advocating, that those are the rules we've got to follow. And, you know, if you decide to ignore the science, you don't get to get away with it. The virus is going to come back. More people will get sick. More people will, unfortunately, die. We don't really have a choice on that.
So I'm really, you know, sort of saddened to see people ignoring the guidance, ignoring the science and just moving ahead.
BERMAN: It is interesting though, Sanjay, because it does seem you are hearing more people say out loud, this is the choice we are willing to make.
I want you to listen to Chris Christie. Now, Chris Christie is no longer governor of New Jersey. He is not making life and death decisions for anyone besides himself and his family. Still, he does raise the question about why isn't this like World War II, he says. Listen to this.
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FMR. GOV. CHRIS CHRISTIE (R-NJ): We sent our young men during World War II over to Europe, out to the Pacific knowing, knowing that many of them would not come home alive. And we decided to make that sacrifice because what we were standing up for was the American way of life. In the very same way now, we have to stand to stand up for the American way of life.
What are those lives going to be worth if people can't go to work, if they can't support their families, if they're going to become homeless, if they have to go to food banks every week to be able to feed their families? That's not sustainable either.
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BERMAN: I don't know if that's a reasonable way to frame it. I don't know if the American way of life needs to be set up as something opposed to saving lives, but you do hear him asking the question, Sanjay.
GUPTA: John, we could reopen the country at some point. I mean, it's not -- the choice is a little bit of a false choice. I mean, as Ashish was just talking about, I mean, there are criteria in place. What we're saying right now, and people should understand, the conversation has become, we don't even want to follow the criteria. We just want to do it now. I mean, it's just really -- it's sort of a strange dissidents that's happening. Of course, people want the country to reopen and I think everyone is sensitive to the pain economically and financially. But there are criteria in place. We have to abide by some of these guidelines in order to do this as safely as possible. And, by the way, there are countries around the world that are models to do this.
New Zealand, which is obviously a much smaller country, I get that, but they've essentially gone down to a zero case count now. So they had a strict, stringent plan in place when they executed it. It seems to have worked. So, you know, there will be infections as places start to reopen, but there were criteria in place.
Also, I don't know what Dr. Jha thinks of this, but the World War II analogy seems a little bit off to me. I mean, sacrifice is one thing. This is an infectious disease. So I am going to sacrifice on behalf of you, on behalf of people I don't even know, people who are sick already have preexisting conditions who are elderly, is that what we're really saying? I'm not sure that I would use that as an apt metaphor for an infectious disease.
HILL: It's also interesting too based on the conversations that we keep having about personal responsibility and what that means in a time of coronavirus and how it's actually responsibility to your community. Sanjay sort of pulling off of that, we talk so much, Dr. Jha, about I'm wearing a mask, right, to protect you, not just to protect myself. So it's fascinating that we hear that narrative on the heels of there has to be some sacrifice in the terms of lives lost.
JHA: Yes. So let me build on Sanjay's point and talk about what Governor Christie said. So I believe in shared sacrifice. I believe in getting the American way of life back. We keep setting up the false choice. Here is the bottom line. We all want to open, and we can open. And we could do it if we were smart about how we did this.
So it's really straightforward. We've got to keep things shutdown until the cases decline. We started letting up too soon. We've got to get testing and tracing in place, and that brings the caseloads down and it lets us reopen safely.
Here is the bottom line. If we don't do these things, it's not like we get to have our American way of life back and some people die. We're going to have to shut down again because the number of cases is going to explode.
So this is not about, you know, the American way of life or not, this is about doing it smartly versus doing it stupidly, sorry to use that word, and we're going the wrong way on this. We can do this smartly, get our lives back and save lives. I don't understand why we just aren't doing that and that's what we really should be focused on.
BERMAN: Sanjay, there have been a couple of medical developments over the last 24 hours. One, we heard from France that they have gone back and retested some samples, I guess they were still around, and they had someone in the hospital they think in December with coronavirus. What does that tell you? GUPTA: Yes, I mean, this is -- I guess what I would say is it's a bit stunning but maybe not surprising at the same time, if that makes sense.
I mean, I don't think that we ever thought that for sure we had found the first patients in any country with coronavirus, not even in China probably. There were probably patients who had this before, you know, they were confirmed by testing.
You remember back in February 6th, I guess there was a patient in California who had died of coronavirus. They found out subsequent. And that means that it was already spreading in the community probably several weeks earlier. So this is quite a bit earlier.
I mean, In Europe, I think the first case was confirmed end of January, community transmission was confirmed end of February. So now we're seeing maybe there was community transmission in December. We don't know that for sure, this patient was a fish monger, so worked with animals, may have come in contact with people from China. We don't know. But this really sort of backs the timeline a bit.
I don't know that it means anything necessarily different going forward, but it is interesting to look at the timeline of this now around the world.
HILL: Dr. Jha, I find it fascinating too, and maybe this is because I'm not a doctor, that they had these frozen samples that were available and decided to go back and check them. How much does that happen around the U.S.? If there is a case that seems to not fit the bill of something that we know about, how often are those samples preserved for later testing?
JHA: They often are. You know, obviously, most samples are discarded after they're tested for whatever they came for. But there are samples that go back, blood banks, others have samples to go back weeks or even months.
On this one, I'm not totally surprised either, as Sanjay said. We know the outbreak started in November in China, or that's what we think. It's possible there were people traveling to France in December and somebody gave it to this person. It's not a total surprise, but it is much earlier than we were expecting.
I wouldn't be surprised if we find a few of those cases, even from December in the U.S. or in other European countries.
BERMAN: Really, it's interesting to go back and think about how you felt as far back as December. I know a lot of people are doing that now. And some of these questions may never be answered. Dr. Jha, Dr. Gupta, it is really an education to get to speak with you every morning, so thanks for being with us.
JHA: Thank you. BERMAN: This morning, the Trump administration is calling it Operation Warp Speed, the race to find a vaccine, they say, within months. But is that even possible? We're going to speak to a top doctor involved in this vaccine development, next.
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BERMAN: New this morning, the World Health Organization says there are 108 potential coronavirus vaccines in the work. Eight of them are now in clinical trials. How long, if ever, then until we see a vaccine?
Joining me now is Dr. Peter Hotez. He is the Dean of the National School of Tropical Medicine at Baylor College of Medicine involved in vaccine development.
So, Dr. Hotez, you're sort of like a human decoder ring for to us here to understand the terminology and understand how things really are proceeding. So when we talk about things in clinical trial, you say we should expect to see vaccines get through this level, but what does that mean exactly?
DR. PETER HOTEZ, DEAN, SCHOOL OF TROPICAL MEDICINE, BAYLOR COLLEGE OF MEDICINE: Well, what it means is if you really want a vaccine as fast as possible, you want to have as we call it many shots on goal as possible.
And the actual principle of making a vaccine against COVID-19 is not that complicated. What you need is an immune response against the spike protein. If you've ever looked at a cartoon of a coronavirus and you've seen that donut with a piece of RNA stuffed in the middle with a bunch of spikes sticking out all around it, that spike protein is what binds with our tissues, our host receptors. So if you make an immune response to it, you block the infection.
The question is how to best and most safely block that and create the immune response to block that spiked protein. And so we're looking at a diverse array of technologies because we don't know which is going to be the most effective in terms of inducing that best immune response and doing it safely.
So if you really want to have that accelerated timeline, one of the best ways do it is to get as many candidates out there. And that's what we're doing in the U.S. We're hearing different numbers of six to eight or 14. And remember, it's not just in the U.S. this is going out, it's going on in China, it's going on in England, it's going on in Europe and elsewhere.
So some people call it a race. I don't like using that term because I think sometimes it implies that we're going to rush things to the point where we're going to make a vaccine that's not as effective as it could be or not as safe.
So this is where we get into the bottleneck of getting all of those candidates hopefully including ours, hopefully ours will go into clinical trial sometime this summer, bringing all those candidates along and then collecting enough data in terms of showing that it works, that we can all efficacy data and showing that it's safe before we consider licensing vaccine.
BERMAN: Those are two key questions there, and you say that's where the difficulty is, getting it into clinical trial isn't the incredibly high bar here. You say proving that it works and proving that it's safe, that's another matter. Why is that tough and how is that bar so high?
HOTEZ: Well, it takes time. You have to recruit human volunteers. You have to identify the populations you want to immunize. You have go through a series of steps. Usually, we begin what's called a phase one trial which is healthy volunteers, often between the ages of 18 and 45, make sure nothing untoward happens.
And then you start expanding your list of people that you want to immunize. For instance, we know we're going to want to make a vaccine to help older people, so bringing and old enrolling older Americans, or healthcare providers. So that's what's done in those expanded safety studies for phase two.
And then you want to do it in an area where there's lots of ongoing transmission of the virus, because you want to show that it works. So you have to immunize people in areas where the virus is circulating to show that, compared to people who are not vaccinated, the vaccinated ones are not getting infected.
And all this time you're collecting safety data. So it ultimately will involve thousands of individuals per vaccine candidate. And when you start talking about 15 or 20 candidates, you can see that the numbers go up pretty quickly. That takes time to collect, takes time to analyze.
And that's what I'm a little worried about not rushing things. That's why I don't like when people start saying by the end of this year or using these science fiction metaphors, like Operation Warp Speed. It implies that we're doing something untoward, doing something that's rushed, and that's really important we don't give that impression.
BERMAN: In fact, out of Oxford, out of this Oxford study, they're saying they will know whether it works in the clinical trial by June, and they think they could be widely available, they suggest, as early as September. How realistic does that sound to you?
HOTEZ: Yes, I've heard that as well. I don't see a path by which that happens. That's not how it works.
Again, the science behind it is not terribly complicated. It's showing that you have a vaccine that works and is safe. And some of these technologies have been around for a while, like the Oxford technology, like Moderna and others, and those have never resulted in a licensed vaccine before. So that's high it doesn't make sense to me why you can be so confident saying you're going to have a vaccine by such and such a date.
I think the other point to mention is history tells us something very interesting, which is that the first couple of vaccines that get licensed are usually not the ones we wind up with. Meaning, that over a period of a couple of years, by a couple of years later, we wind up discarding that vaccine for something that works even better or is even safer.
And we've seen this with the haemophilus influenza type B vaccine, the polio vaccine, the rotavirus vaccine, the HPV vaccine. So also be careful what you wish for, because chances are that's not the one with we're going to wind up with.
BERMAN: Well, talk a little bit more about. What does that mean exactly? Because I think people have this notion that when a vaccine gets test and ultimately approved, that that's the shield, that that changes everything. So why is it then that it may not be the one that sticks because it's not effective with everybody, because there are side effects that are dangerous?
HOTEZ: Well, it's because you're learning as you go along. And we're learning exponentially with a new vaccine. So, for instance, with the HIB, haemophilus influenza type B vaccine, the first vaccine worked but it did not -- was not very effective in immunizing children under the age of one year, immunizing infants. And that was a problem because most of the disease was occurring among infants. So it was licensed for, I think, it was over the age of two.
But then scientists at the NIH and up in Rochester in Boston independently found if they modified it by sticking the capsule of the bacteria in the protein, now it worked anyone infants under the age one year of age and basically eliminated that disease from the United States. That was something that I watched from a pediatric resident to being a junior faculty attendant at Yale, a disease that disappeared over a period of three years.
So it's a good thing the fact that we're willing to learn and refine, and that's how vaccine science works.
BERMAN: Thanks for helping us understand this, Dr. Hotez, and creating reasonable expectations for what we can watch over the next several months. I appreciate you being with us.
HOTEZ: Thanks so much.
BERMAN: All right. Easing restrictions and reopening businesses, it does come with a human toll. Apparently, a growing human toll.
Up next, we're going to speak with a modeler about what the next month could look like.
HILL: New this morning, a change that tightens the rules on antibody testing for coronavirus. Now, the hope is those tests could help doctors understand how the virus spreads.
CNN's Elizabeth Cohen explains.
DONALD TRUMP, U.S. PRESIDENT: Thank you very much.
ELIZABETH COHEN, CNN SENIOR MEDICAL CORRESPONDENT: Just weeks ago, President Trump was so proud of removing regulatory barriers in the fight against coronavirus.
TRUMP: We've cut through the red tape to give doctors and patients unprecedented freedom to make their own healthcare decisions.
COHEN: But on Monday, his administration reversed course. It has to do with this, an antibody test. It tells you if you've already had COVID-19 and might possibly be immune to it.
In mid-March, the Food and Drug Administration started allowing companies to sell tests without first proving they got actual got accurate results. The outcome, dozens of companies started selling these tests and many of them often gave false results.
Monday, the FDA reversed course and said now test developers do have to show their test work accurately.
How would you describe what the FDA did back in March?
REP. LLOYD DOGGETT (D-TZ): A real breach of the public trust, yielding to President Trump instead of remembering its traditional responsibility to protect the public health.
COHEN: FDA Commissioner Dr. Stephen Hahn said it was all part of an evolution. We are continuing to adapt approach based on real world experience and data, he said Monday. This has all informed the changes to our policy regarding antibody tests.
But Representative Lloyd Doggett, a Texas Democrat who chairs the House Ways and Means Health Subcommittee, said it was obvious that relaxing the regulations was a bad idea.
DOGGETT: It seems to have come as a surprise to the FDA that if it does not do its job, who authorizes (ph).
COHEN: Recently, earning FDA authorization, this test by Roche, they do have data and their data shows it has almost 100 percent accuracy.
SEVERIN SCHWAN, CEO, ROCHE GROUP: And so this is pretty extraordinary. And what that allows us is to really reliably test whether a person has been infected by the coronavirus.
COHEN: Even with a nearly perfect test, there is a problem. If the test shows you've previously been infected and have antibodies, you might have some degree of immunity to the novel coronavirus, but maybe not. SCHWAN: There're still open questions on how long will this immunity be. Will it be for one year, two years, several years? Will it, you know, be full immunity or is the reinfection just less severe?
COHEN: Scientists still need to work that out, another mystery of the virus.