Infectious disease expert Myron Cohen discusses the beginnings of SARS-CoV-2, the virus that causes the COVID-19 disease with hosts Jonathan Weiler and Matthew Andrews. Cohen has studied infectious diseases, including AIDS for 40 years, and also discusses the ways communities have tried to tackle new pandemics. Cohen is the Yeargan-Bate Eminent Distinguished Professor of Medicine, Microbiology and Immunology at the UNC-Chapel Hill Gillings School of Global Public Health and School of Medicine.
Music by Blue Dot Sessions.
Transcript
Myron Cohen: All these things that took almost 40 years in HIV are going to be accelerated over 12 months in the United States. And that’s pretty inspiring. It’s just tragic that where we are right now, and I don’t know any infectious disease specialist who’s not preaching and preaching about masks…
Jonathan Weiler: Hey, Matt, how’s it going?
Matthew Andrews: Jonathan, I’m doing okay, all things considered. How are you?
JW: I’m doing okay. We’re we are recording this about 10 days before the fall semester begins.
MA: Yeah, I’m both excited and terrified about the fall semester starting, but I gotta admit, I’m kind of excited to get back to work.
JW: Good. Yeah. It’ll certainly be nice to see the students in whatever form.
MA: Yeah, that’s right.
JW: And then we’ll keep our fingers crossed and hope for the best.
MA: So, my name is Matthew Andrews. I am a teaching professor and the undergraduate advisor in the Department of History here at UNC-Chapel Hill.
JW: And I’m Jonathan Weiler. I’m a teaching professor in Global Studies and the director of undergraduate studies for Global Studies here at UNC-Chapel Hill.
MA: And this summer, Jonathan and I were the host of “COVID Conversations” in which we talked to faculty members in the College of Arts & Sciences. And we’ve been asked by the university to be part of this project starting in the fall of 2020 COVID-19 Investigations. These podcasts are going to be part of the curriculum for a number of different graduate student-led seminars investigating different aspects of the effects of COVID on the United States and in the world.
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MA: Our first guest and I think it’s appropriate that he was our first guest was Dr. Myron S. Cohen, Mike Cohen. Mike Cohen is a professor in the Department of Medicine, division of infectious diseases and the Institute for Global Health and Infectious Diseases at the University of North Carolina at Chapel Hill. He is in the news, on the radio, on TV a lot talking about this virus. Jonathan, we talked to Mike about where COVID-19 comes from, sort of a refresher course. We talked about the links between COVID and HIV. We kind of asked him to look in his crystal ball a little bit. I was struck by the optimism. He said he’s an infectious disease expert. He does nothing but studies disease, but yet he’s a very optimistic individual.
JW: He is. He’s been studying infectious diseases for 40 years now, really since the dawn of the AIDS era in 1980 through today he told us that he had been hoping to retire but COVID-19 has called him out of retirement. But he provided us with just a tremendous, both medical and historical, and really kind of public health perspective, on how it is that societies at their best and not at their best go about trying to tackle new pandemics.
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MA: Mike, thank you so much for being here with us.
Myron Cohen: My pleasure.
MA: I think we’re going to start with some general questions just to sort of get our feet grounded. What I’ve been struck with over the last few months are the different names that people are calling this virus. The name of the virus is so politicized. So just to get us started, what do you call this virus? And can you maybe explain to us why you call it that?
MC: Sure. There are the class of viruses that we’re dealing with are called coronaviruses. They’ve been around a long, long time. And they infect many species, including humans. And they have been the source of the common cold for generations — a common cold — for generations and generations. Almost 20 years ago now, one of the coronaviruses developed lethality by causing severe respiratory infection. And that was called SARS and everyone kind of remembers the temperatures in the airport and such. And SARS turned out to be a flash in the pan for a whole bunch of reasons we can get into. So SARS went away, but the Chinese and the Asians suffered painful, very fatal epidemic and it went away, and the Canadians. Then another coronavirus, called MERS-SARS or we could call it MERS-SARS was discovered in the Middle East. That was coming from camels to humans. And that turned out to be even more lethal than SARS. Like 30% of the people who got MERS-SARS died, but it turned out not to be transmissible at a level to attract our attention. So then the coronavirus we’re suffering now, which pretty clearly started in China is called SARS dash CoV (coronavirus) dash two and so, that is the name of this virus: SARS-CoV-2. Now, the disease that it causes, or the spectrum of disease that causes, are called COVID-19 because it’s a coronavirus-causing disease, we’re calling it COVID, and 19 because of the year 2019 is when it surfaced. I hope that’s pretty clear.
MA: That’s pretty clear. Jonathan, did you know that it’s COVID-19 because it surfaced in 2019?
JW: I did actually know that.
MA: I did not know that. Okay, so I —
JW: Can I just ask a quick follow up? I know Matt has another question he wants to ask but can you just say a little bit about why — you said coronaviruses are the source of common colds. Why this version of coronavirus is so lethal?
MC: Well, we’re still learning about it. But I think we can use the word lethal and highly transmissible, and those are two things that we should focus on. Let’s deal with the lethal first. The other coronaviruses have not used quite the same receptor that this coronavirus is using. It’s using a receptor that’s distributed around the body in a particular way. And so when that virus can escape from the nose and into the lungs and into the systemic circulation, it finds these receptors everywhere. And once it finds these receptors, it can do harm by replicating and, and the harm not just the virus itself, it’s the body’s attempt to eliminate the virus. So as the body is trying to eliminate this virus, it’s now ubiquitous and spread all over the body. It’s causing both clotting and inflammation. And so if you look at the medical care that’s evolved in the last few months, what we focus on is preventing clotting and preventing inflammation. So most people who acquire this virus, they’ll do well. About half the people will be asymptomatic, which is an issue we’ll talk about in a second. And most people who become symptomatic are not going to go in the hospital. But those people who go in the hospital because the virus is spread and bound in the way it’s bound to a receptor called ACE-2 that virus is then causing inflammation and clotting which turns out to not infrequently be very morbid, if not fatal. Just yesterday, we learned that in follow up to people who get COVID-19 that there are a substantial number of otherwise healthy people whose hearts are sub clinically inflamed. So a test was done to look at the heart, and in a shocking 78% of people who recovered from COVID, their hearts were not normal. Now, this got a lot of attention in the medical community. And why is it so important for me to talk about in this podcast, I’m dealing with students, some of whom might think well, I’m going to do fine, you know, I’m gonna get this infection and recover. And that’s true, but recovery may not be complete. There may be chronic, what we call sequelae, of acquiring this infection. So our main goal is don’t acquire the infection. Don’t acquire the infection. The second thing I just want to mention is the other SARS viruses as we talked about the other two — SARS and MERS-SARS. They turned out to be transmitted primarily by symptomatic people. And the concentration was a little bit different than the concentration required in SARS-CoV-2. SARS-CoV-2 is transmitted pre-symptomatically and asymptomatically. So that drives up the epidemic. It really helps to spread; if you don’t know who has it, and the person sitting next to you has it can infect you, they go on to remain asymptomatic, you go onto the hospital. So, hence the transmissibility.
MA: Okay, that information about the damage it’s doing to people’s hearts and what we’re starting to learn about that is chilling. Jonathan, cancel your RSVP to that COVID party that you were thinking about going to. [laughter] Mike, I was wondering if we could reconstruct the timeline a little bit. Jonathan and I were talking about this yesterday and we’ve seen movies like “And the Band Played On” — and I know we’re going to talk about HIV in just a little bit — and there’s that there’s that moment in books about viruses and epidemics and movies where the doctors realize, “Oh my god, I mean, this is this is huge. We have something unprecedented here.” When did you realize that this virus was going to be, you know, at the scope that it was, that it was going to become this global pandemic?
MC: I’d say around January, between January 14 and 18th. We knew we knew of this infection. And one of the big issues that has attracted a lot of press is who’s responsible for an emerging pathogen? And it’s pretty hard to assign responsibility. This is a virus that lives in the wild. It’s in our species. It was going to get there one way or the other. And now we have to deal with it. So, China — I think the first infection was observed in late December, we knew about this. We actually have all day long infectious disease specialists have a communication network, that where we communicate with each other all over the world, all day long. And so I know the content is shocking, but you know, we see ourselves under constant attack from the microbial world, so every day there’s something. So we knew about this in December. And then by mid-January, we could see that the Chinese were scurrying, and we were talking to our Chinese colleagues, they were scurrying to try and control this outbreak. And it was pretty clear it wasn’t, it could not remain just in China. That’d be almost no way for that to work out. That’s not… viruses don’t respect borders. They don’t care what state you live in. They don’t care what country you live in. They’re looking for a new host. Okay, they will… and this is like a zombie movie. You know, they want the next host. So mid-January is the answer.
JW: And Mike, just on that score, was it in mid-January that you realized, ‘Oh, this is much more transmissible than viruses like this usually are.’ Was it the severity of some of the cases you were hearing about? What were the things that made you realize that this was not going to be normal?
MC: I think the… Well, first we didn’t have all the… the idea of the transmissibility, we have a way of calculating transmissibility. And for a student, there’s math involved in this. And I’ll just summarize it, we call this the R0, R sub-zero. And people do newspapers love this. Now, they love that number, the R sub-zero. And what that number is, is, if one person is infected, how many additional people will they infect? Now for viruses that are very contagious, like chickenpox, and measles that are in the air that R0 number is like 15 to 20. So one person with chickenpox in a room can infect 15 other people. Huge numbers, but the R0 is calculated by multiplying the few variables I won’t go into the math too much the R0 are calculated and we could start seeing pretty quickly that the R0 coming out of China was going to be between two and three. That’s a pretty big number. Every symptomatic person is going to affect two or three other people and people started fighting about what’s the true R0, but all those numbers were in that same range. And then when we saw the Chinese locking down Wuhan, you know, a city of 10s of millions of people. And during Spring Festival, the highlight of all China. We knew this was a bad, bad thing because the Chinese are very smart. And they had suffered SARS. I was helping the Chinese during the SARS epidemic. I’m old. Unfortunately, my voice doesn’t sound it but I am. And during the SARS epidemic, I was visiting the hospitals in China that were taking care of SARS patients and many of the doctors died and many of my friends actually got SARS. And they had these plaques, they gave me one of the plaques. It’s a plaque that says “Buyao Haipa”, which means “Don’t be Afraid”. “Buyao” is don’t be afraid. So, the Chinese when they saw a new coronavirus, it wasn’t like oh, let’s think about it for a while. They leapt into action. Having dealt with SARS. The United States, which virtually never dealt with SARS, was really not as psychologically prepared to deal with how serious this is.
JW: I want to tell a very quick story, which is relevant to what you just said, Mike. I was in Iowa covering the caucuses at the beginning of February, at an event for people to judge, I was sitting next to a journalist from South Korea. This is about 12 days after they reported their first case, we reported our first case, and I said to the journalist, “Oh, so South Korea must be very interested in the presidential elections.” And she said, “We weren’t till two weeks ago, and now the coverage is 100%. This new pathogen, and I remember thinking like she might as well have been on Mars, it had, it felt like it had no relevance to my life as an American.” And I think about that conversation all the time now.
MC: Well, that’s a very good segue to belie like what you do. And I’m gonna take over your interview and just say, you know, there are three things you can do. And we have trouble in the United States, kind of with entirely rational behavior for a variety of reasons, not a single reason. It’s a big country, we’re all spread out. But there’s only three things you can do. You can inspire or mandate behavior change, we’ll come back to that in a second. Or you can make drugs that treat something or cure it so you don’t suffer the consequences. Or, you can make a vaccine or other ways of modulating immunity so that you either will not get the infection or the infection will not progress. Those are our three options. And I think one of the problems in the United States is our fierce independence and our politicization of a lot of different things. Sometimes, and not infrequently, force creates conditions where behavior changes that should occur do not occur and that is the worst consequence of this epidemic. The Chinese were telling me in late January mask work just wear masks because the hand washing, social distancing, and all that I think that’s good. I think it’s important, not bad. But as far as I can tell the number one thing is you’re wearing a mask and your neighbors wearing a mask, you’re not going to transmit the infection. Now how do I know that? Because, once masks got really introduced into hospitals, health care worker infections went from a huge number down to close to zero. UNC Systems have had thousands of cases of SARS-Cov-2 that we’ve managed by wearing masks, with an entirely masked hospital. To my knowledge, we’ve had no healthcare workers infected. So we know masks work. It’s a simple thing, but inspiring people to wear masks has proven very difficult for a bunch of reasons. So instead, what we did was leapt to a biological strategy, and the biological strategy was we’re going to make a vaccine, which almost certainly will. But that takes a lot longer than wearing masks. So what’s heartbreaking to me is the delay and the magnitude of our epidemic, which is just truly heartbreaking. It can be offset with masks. Now, why is this so important for this podcast? Because UNC, for its students, has an attestation, you must wear masks on campus for all our employees, you must wear masks. And so it’s just mandated, you know, on campus, and I think we will be very strict and see off campus behavior that represents a threat to our reopening plans. And we’re doing our very best to try and create an environment where people are comfortable that you’re going to wear masks. We’re going to make vaccines, we’re going to make drugs. This isn’t forever, the first some window of time. These masks are unbelievably critical to the health of the campus and the health of the nation.
JW: One of your areas of expertise is HIV AIDS and I’m interested to know, thinking back on when you first came to understand AIDS as a serious public health crisis. When was that? And how do you reflect back now on that when you think about how we’re approaching Coronavirus?
MC: So, HIV surfaced in the United States in 1980. In 1981, I had the opportunity I’ll call it, but, I saw the first patient at UNC with an infection that I thought was HIV — remember, we had no test for it. And for UNC, this became an emergency instantly. It wasn’t like it was not like a moment like oh, this might be a big deal, because we were fairly certain there was a transmissible agent in the blood supply and we were managing 5,000 patients with hemophilia or more. Why were all those people with hemophilia living in Chapel Hill? Because UNC was one of the leaders of development of blood products to reverse bleeding from hemophilia. So hemophiliacs and their families moved to Chapel Hill to have better access. So we knew that this was, I knew instantly this was a big deal. And so I arranged actually this emergency meeting with the most — probably Dr. Harold Roberts, one of the most famous blood clotting guys in the country was running our program — and the head of the hospital and a bunch of other people. And we discussed what are we going to do? And as the months progressed, our people in our community with hemophilia acquired HIV, because there was no option. We didn’t know how to get this out of the blood supply. And we lost most of those people to this infection between 1980 and 1985. By 1985, about 15% to 20% of all admissions to UNC Hospital were for AIDS. So, full blown — you would call full blown AIDS. So this was a big, big deal. It was never a little thing in Chapel Hill. Now, I’ve worked on this then for 40 years, right? That’s a long time to work on one problem. And I’ve seen them the evolution of this infection. Behavior change is the first thing and that behavior change, as was very rapid insofar as it could control the sexual transmission of HIV. It wasn’t sustained, but we saw massive behavior change in the first few years of the HIV epidemic. Then we saw the development of drugs, and those drugs have rendered HIV a treatable disease, not a curable disease, but a disease with a normal lifespan. So somebody with HIV-infected who, you almost certainly know somebody, they live in normal lifespan. They take one pill a day, but that took years for us develop those pills, and even now we’re still striving to make a vaccine. So behavior change, treatment, and vaccines. What’s the message for COVID, or SARs-CoV-2? It’s pretty simple. Behavior change will give us instantaneous relief tomorrow. If everyone in this company started wearing a mask tomorrow, it would make a big difference. Treatment: we will almost certainly have treatments of some sort or another — better treatments, antiviral treatments — this year. And that will be Earth shaking, because then somebody would go to a doctor’s office and say, I think I have COVID. And they’ll say, ‘Okay, I’ll do a test.’ If it’s positive, they’ll give them a treatment, the same as you would get a treatment if you had a skin infection or something of that nature. And lastly, we will have vaccines this year. We can’t be sure how well they work. We can’t be sure everyone’s going to take them. But all these things that took almost 40 years in HIV are going to be accelerated over 12 months in the United States. And that’s pretty inspiring. It’s just tragic, where we are right now. And I don’t know any infectious disease specialist who’s not preaching and preaching and preaching about masks. Now, this is about public trust. Somehow, we violated the public trust not any single person. Somehow we’ve created confusion about what we should do. And that confusion has worsened our epidemic and that confusion has to be ended by the time we have a vaccine. Because we make a vaccine and no one takes it, that’s a big problem. And even if we make a vaccine, it’s… we’re not going to eliminate masks, okay? Learning about using masks on a variety of conditions, that’s going to be a lesson we’re going to have to learn. It’s not just going away. Where does this lead? We call this combination prevention. So let’s just talk about that for a second. Combination prevention means you don’t — there is no magic bullet. You do all three things at once. You have behavior change, you inspire ever better behavior changes — and that the high point of that is masks. You make treatments and when you treat someone early enough, treatment serves as prevention because you rendered the treated person no longer contagious. This is what we did an HIV in 2011. That was very successful. And lastly, the vaccines. We’ll make vaccines, we have to distribute them with equity. And we have to have people take them, and we have to follow. So we have combination prevention is coming for private. It’s not going away overnight. It’s not just going to disappear. The species will deal with it. And the only question to me is, is the United States going to be a laggard, or a leader? And we would prefer the United States become a leader.
MA: I listen to you talk about behavior changes during, you know, the rise of AIDS, I’m guessing, you know, 18, 19 and 20-year-old incoming UNC students might not know exactly what we’re talking about here. But you know, I was 16, 17 and 18, in the middle of the 1980s. And we were talking about wearing condoms, right. I mean, this notion of safe sex. This was a new term. This was new behavior, and of course, young people today, they’ve grown up with this idea, and I was for the first time thinking about, I was growing up in the San Francisco Bay Area, and the fight over closing bathhouses in San Francisco, which a lot of people were identifying as primary places of transmission, particularly among gay men, and the politicization of closing those areas. But this is the same thing we’re talking about, right? I mean, closing bars, closing restaurants, closing the places where transmission occurs is akin to closing the bath houses in San Francisco in the middle of the 1980s.
MC: You’re entirely correct. We just have trouble learning lessons. You know, that the Jim Curran, who actually was the leader then who closed the bathhouses, he was vilified by the gay community for closing these facilities, but he was trying to save lives. Now, masks, I would argue are easier than condoms. Okay. I don’t know anyone who can’t wait to use a condom. But I don’t know anyone who would think that a mask would be unbelievably undesirable. It’s a very simple device that and if two people are wearing a mask, the transmission probabilities probably come very close to zero. You know, so I just think all of us are it’s masks, masks and more masks and you don’t hear any public health person who doesn’t start out talking about masks. We still don’t really completely understand the handwashing; we don’t really understand how much transmission is occurring from hand to eye, but it’s a feasible thing. So it kept can’t be bad to wash your hands just generically. We still don’t completely understand about distance. And people want to fight about three feet versus six feet versus three and a half feet. We don’t really understand that. It’s very arcane. The simple thing is wear masks. And then, again, I don’t — I wouldn’t say I have trouble understanding where we are. I just think we need a mid-course correction. I know why we are where we are, we need to correct this. And I’m hoping the students returning eventually, I’m hoping that they’re smart and they see this as a way to keep the campus open. When it opens, and when other campuses open, I think it’s a lot harder in K-1 through 12. As small children, we don’t really understand that. We’re going to have to figure out very quickly the kind of, and be transparent, about exactly what happens in grammar schools. Our trouble, to some extent is lack of transparency. So we really need to say what we know what we don’t know and what we need to learn and be very transparent, because we really need to rebuild public trust.
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MA: We’re here with Mike Cohen, an infectious diseases expert at the University of North Carolina at Chapel Hill. We’re having a conversation about many things but particularly the links between COVID, HIV and the reopening of campus.
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JW: I wanted to ask you — back to treatments. You had sent us an article about monoclonal antibody treatments. And first of all, I think we’d like you to explain what that is. And as, as Denzel Washington would say, in “Philadelphia,” like we’re six-year-olds. But in addition to that, I’m interested to know why… we’re hearing a lot about vaccine trials. But you mentioned in one of the pieces you sent, monoclonal antibody trials, which we’re hearing much less about. So I’m just interested to know that sort of the difference in coverage and your reflections on those approaches.
MC: Sure. Okay. This is going to have to be a little longer-winded answer than I like. So you have to kind of step back and we’re gonna step back a giant step in my simplification. And we’re going to talk about, like somebody gets COVID. And there’s this idea, which is a very ancient idea. Let’s take the blood, the serum, the blood plasma, from somebody who’s already had COVID and just infuse it into the new COVID patient, and it’s going to be magical juice. Okay, the magical juice called convalescent plasma is going to save the next person’s life. All over the country, people are donating plasma who’ve recovered from COVID. Why are they doing that? What’s the magical juice? So what the assumption is, is that some of the people but not all of, the people who’ve recovered from COVID have in their blood antibodies, and those antibodies are going to then find the virus in the next COVID guy, bind the COVID and prevent the COVID from replicating or binding to the receptor that it needs to get into the cell to replicate. Remember, we talked about the AC receptor. Okay, not everybody’s plasma has these magical antibodies. They’re called neutralizing antibodies. But that’s where it all begins. Now, we know that these antibodies are made from B cells, that’s the cell in your body that makes the antibodies. So there’s two ways we can go with this. We can do a thing called active immunity, which is we can understand what the magic juice has. And we can make a vaccine that stimulates the same antibodies as in the magic juice, this blood plasma. That’s what these vaccines are all about. They’re trying to stimulate antibodies that will bind the virus before it can bind to the ACE-2 receptor. Okay, we have 100 vaccines, seven are being tested. Six are trials right now. We’re going to seven in the United States in the next few months. And that’s called active immunity. And the good news is if it lasts a long time, it’s great in macaques and animals. We can prevent a macaque from getting infected or we can prevent a macaque from getting disease. That’s how these antibodies got into play. But it takes a couple of shots and about a month before you get enough immunity. Okay, so that’s the vaccine part of this. But what if what if your significant other has COVID today? Or what if the nursing home in Raleigh has 10 cases of COVID? And we want to go with a vaccine to your household and we want to go to it with a vaccine to Raleigh, is that really going to be a benefit? No, it takes a month for immunity to occur. So why don’t we do something else? Well, we could give convalescent plasma, but we don’t know what’s in it, right? So let’s do something even more clever. Let’s take, let’s find out what the what’s the most special magic juice? What’s the best neutralizing antibody? And get the single B cell that makes that antibody. And let’s take that B cell and put it into a giant vat and have the B cell replicate itself. So now you got a huge number of B cells, and what are they making? One antibody. So we’re going to call that one antibody, cleverly, a monoclonal antibody. And so we already have at least seven monoclonal antibodies or cocktails of monoclonal antibodies ready to go. So it’s bookends — the vaccine is for an entire population, the monoclonal antibodies might be for treatment if they can work and we’ll see very soon, or for urgent prevention. So the trial that I’m involved with which… trials I’m involved with are doing monoclonal antibodies for urgent prevention, if that makes sense.
MA: So it’s like like when a when a water tube in your in your car engine burst and, rather than take it to the shop to get fixed, you grab duct tape and you just sort of quickly wrap it around. I mean, it’s a it’s a quick fix.
MC: I don’t love that metaphor.
MA: Okay.
MC: But I think it is a bridge and it is it is has urgency to it. That is, when you put this monoclonal antibody and if it works, you get an immediate benefit. You now have what a vaccine was supposed to do, over a month.
MA: I see.
MC: Furthermore, if you’ve got somebody who’s infected, and you’re treating them fairly early, and the monoclonal antibody binds the virus, you can stop viral replication, and you can stop progression of disease. So what’s going on? So next, UNC which I’ll brag about, that seems appropriate for a UNC podcast. You know, UNC helped to develop many of these things in different ways and UNC is doing trials of all these things. Okay, so the monoclonal antibodies are one kind of medicine drug to prevent replication of HIV. Another idea is an antiviral drug, the one antiviral drug that’s been discussed a lot as a drug called remdesivir made by Gilead, but other investigators are working on other antiviral drugs and we’re testing other antiviral drugs, some of which we think could be better than remdesivir. So there’s a lot of movement here. And all of this is heavily supported by the federal government and Operation Warp Speed. Operation Warp Speed has a very large amount of money and all the best scientists in the country in one way or the other, many of the best scientists, are involved in one way or the other and try to help move this forward.
MA: Well, Mike, I think all duct tape metaphors are spot on, first of all, but that’s all right here. We can agree to disagree there. [Cohen laughs] But I’m wondering about these monoclonal antibodies. And are these something that you would take as a preventative measure? Or is it only something, and I say take, because I don’t even imagine how this how this gets into your body. Is it a pill? Is it intravenous? What are we —
MC: Now you you’ve asked me… I’ve taken the big picture, the convalescent plasma to the vaccine to the mono– And now you want to get more granular. What are we going to do with these monoclonals? And we have two really great options. One idea is we can give them to people at high risk of getting COVID. So somebody comes to UNC, and they’ve got COVID and we say, who do you live with? And they say, I’ve got five people I’m living with, and we say, Well, you know, there’s about a 10% chance that somebody is already infected, but the others probably aren’t infected. We’re gonna go to your house and give them a monoclonal antibody. And we have three ways we might be able to do it. We can give it IV into your vein, that gets the drug everywhere instantly. We can give it subcutaneously, like into your soft tissue, that takes a few days to get everywhere. Or you can give an IM shot of intramuscular shots. We have three routes, and each company is using different routes. It depends a lot on how fast you want to go where it’s got to go and its potency. Now, that’s the prevention part. We’re going to use this to prevent infection. It’s going to be as if you had a vaccine that was fully beneficial. However, you’ve asked another question, you said, well, could they use us for treatment? And the answer is we hope yes. So if we give them early enough before people get inflammation and blood clotting, and we can stop viral replication by infusing these antibodies, they may stop viral replication and disease progression. We’ve already done this in our hospital we’ve given what’s called the Lilly, Eli Lilly monoclonal antibody in the hospital. Another company called Regeneron has already produced their product and made many doses and that’s already being given in the hospital. So we’re in the middle of experiments to see does this stuff work? As we know, you would say, Oh, well, you know how, why are you even doing this? What evidence do you have? Well, remember there’s steps. First, we put it in a test tube, and we kill the virus with a smidgen of these drugs. Next, we put it in a, we take a mouse, we give the mouse the drug, then we try and infect the mouse and the mouse can’t be infected. Then we give it take a macaque, we take the macaque, we give the macaque the drug, the macaque can’t be infected. So we go through a whole bunch of stages before we ever get to humans. Once we get to humans, we say Well, all right, we better be sure it’s safe. So now we give 40 humans the drug, and no one has a side effect. And we say, well, this looks pretty safe. Let’s just go for it and see does this stuff work? And that’s really where we are.
MA: Wow.
MC: I know, it is kind of daunting.
MA: Yeah.
MC: I would say I’ve spent 13 hours on the phone for the last six months every day.
JW: I want to ask a follow up, Mike, just to that, which is what you just described about the testing protocol. A few minutes ago, I thought I heard you speak reasonably optimistically, about a timeline for the development of a vaccine. I understand that this is a much more accelerated timeline than we’ve ever had in human history for any other vaccine. Can you just speak a little bit more directly? We’re not going to hold you to a prediction. But can you just speak a little bit more directly to what sort of your hopeful range for when a vaccine might be ready to go and introduced into the population?
MC: Okay, well, it’s… my timelines are much more exacting, I think. So now, by way of disclosure, not a financial disclosure. All the… many of the leaders of HIV were repurposed to be COVID guys, right? So I’m like one of these repurposed COVID guys. So we’re all we’re all pretty old and the repurposed COVID guys are working with the NIH in what’s called the COVID Prevention Network. So I’m one of the leaders of the COVID Prevention Network. And in the COVID Prevention Network, we have two tools: vaccines and monoclonal antibodies. So we have pretty firm timelines beyond what you would think for what we’re going to learn. So we’re starting with the companies, because they’re the ones there that — we’re the middlemen. The companies made these drugs, so with the company Moderna, for example, that trial started. With Pfizer, that trial started. So those two very new kinds of vaccines they started and each need to enroll 30,000 people, and so far on a website, 160,000 people have signed up to be vaccinated. So we’re pretty optimistic with 100 sites around the United States, that we’ll be able to vaccinate 50-60,000 people in the next two months. There are five more vaccines behind those. So, and now if we’ve vaccinated 60,000 people in two months, then our ability to see a benefit should come in the fall, like late fall. We should be able to measure a benefit if they work. And if we vaccinate the right people. We need to vaccinate people with sufficient exposure who have risk. Now with monoclonal antibodies, we’ve started two trials already. Those trials are focused on households and skilled nursing homes. Quite different trials, but each have the same plan, prove that you’re going to prevent infection with the monoclonal and if we enrolled — and those trials are much smaller, they’re just a couple of thousand people. So and we have a lot of sites. We have more than 100 sites for our monoclonal study. And so — the one that’s ongoing. So we hoped that we would have an answer to the monoclonal antibody success by late September. If we enroll the subjects, the altruism of the population is the most critical thing, the trust and altruism people have to volunteer, you know, and if there we have to create a trust and altruism in order to succeed. So our timelines are pretty exact, depending on enrollment.
MA: And then I maybe this is too optimistic, just sort of looking beyond COVID-19, you know, when when we get COVID-19 under control. But I’m just wondering what your thoughts are on what the state of infectious diseases is going to be like after COVID-19. Is COVID-21 just coming down the pike? I mean, should I not put my mask, you know, deep deep into the cupboard or in into my dresser?
MC: I hope.. Yeah, you’ve asked such a great question. Yes. Really a great question. We will obviously dissect this backwards and forwards and people are writing about this all the time. They’re writing about how over the last 10 years, or 20 years really, have we compromised our public health infrastructure so greatly. How have we created a population of Americans who are so unwilling to trust public health messaging? So the first issue is we’re going to have to really focus on our infrastructure. That’s a critical thing. We need to understand how our infrastructure and if you look at how we tried to get our testing strategies under control, we’ve done a good job in the private sector and getting vaccines ready. And in collaboration with the public center sector moving forward. We’ve done a terrible job in testing and contact tracing and masks. So we really need to focus on rebuilding our public health infrastructure. That’s the first point. Second, we need to understand there are going to be other emerging pathogens, whether it’s another coronavirus. It is argued that there are two or three coronaviruses that are ready to jump to humans. I mean, some people are worrying about this already. What features would allow the jumping? There’s also concern about coronavirus mutation away from what we’re making, right? We have to be prepared for this virus to change like influenza so that whatever we made now isn’t going to be good enough in 2021, the year you focus on. But I would hope that that we can have a memory of what we’re going through this year. We’re seeing unbelievable suffering, death, economic tragedy, by any definition. So I hope we remember. Now, the National Academy of Medicine, certainly during the Ebola– after the Ebola crisis, they wrote a very excellent report about managing Ebola in the middle of the pandemic. They certainly will do a similar report as it relates to COVID. And that’ll be an important report for us to read and think about. One question you didn’t ask me but it’s worth noting, because I saw somebody talking about it, if we do make it… when we make a vaccine, I am optimistic. I’m very optimistic because if science works, all this stuff is going to work, right? We didn’t just, you know, it’s not like voodoo. Right? It all this has gone through a lot of stages to get where we are. But how are we going to distribute the vaccine, the National Academy of Medicine and also World Health Organization are already talking about equitable distribution of the of the first vaccines, so it’s not going to be ‘Oh, come to my clinic and if you have enough money, you’re going to buy the vaccine,’ there’s going to be a distribution plan well before we announce the availability of these vaccines.
JW: Just to find our question from me, Mike, for the undergrads who are listening to this. Those who are going to be interested perhaps in going into medicine and infectious diseases, medicine and epidemiology, in addition to taking their pre-med courses, their bio and chem and so forth — are there courses, fields of study just broadly you would recommend or things they just ought to be thinking about in their undergrad years as they take all this in?
MC: Yeah, I guess I guess my attitude… Well, first of all, I’ve done now infectious diseases for more than 40 years and I’ve never been bored for a day and I always thought it was a really interesting specialty. And I always criticized all the other specialties of medicine, you know, for a whole bunch every known reason, you know, why study a specimen — why be a nephrologist for there’s two kidneys? I mean, teasing, of course. Everybody loves their own specialty. Infectious disease is interesting because it blends public health and education. And in fact, and in the microbial world, writ large and patient care, and it’s really an interesting field. And you’re never, you’re never really bored. So anybody who’s interested in that I congratulate them. And I think, to answer your question that I think that from my point of view, the most important thing is to study, take courses you really want to take, because the information that’s going to be transmitted, I don’t… It can be musicology as far as I’m concerned, and you can still go to medical school, but be passionate about what you’re studying. That’s my first point. My second point is that for those interested in public health, I know that the public health school intends to start… I believe they’re developing an undergraduate major, it may not be this year, but eventually they’re going to have more undergrads in public health than just making a graduate specialty because interest has been so great. Third, for people interested in public health and infectious diseases, there are no borders so global health is local health, right? So a lot of students minor in or participate in activities about global health, which will continue even though we’re not traveling. So to know what’s going on all over the planet, it’s a lot easier to understand China’s methods of controlling COVID if you’ve worked in China, and you know, Chinese people, and so on and so forth. So I think I think there’s a lot of ways to benefit from your from undergraduate education, I don’t see one road to any professional school, I see… The characteristics and I’m always looking for people to work with me are passion and tenacity, and perseverance, and team play. Those things are really important in medicine nowadays.
JW: And curiosity, of course.
MC: And intellectual curiosity would really help. Although, although, you know, it’s funny because… I don’t want to diminish too much of me and my colleagues, but we’re really in the middle. We’re not the people are going to sell drugs or distribute them. We’re not the people who made the discoveries — at least I’m not. Other people on our campus have made discoveries that are really critical — we’re kind of middlemen, and you have to kind of enjoy making your contribution in the middle. But it’s possible to do that.
JW: Mike, thank you so much for joining us today. This was an incredibly edifying discussion.
MC: First, thanks for having me. Second, welcome back to the students, either whether they’re hearing this at home or whether they’re coming to campus. I know this is an unbelievably stressful time for the university, as well as for the students and their families. This is not going to be forever, there is an alternative normal. But this is not forever. The kind of speed with which we’re moving forward is really worth noting. We are capable of bringing this under control in a variety of ways. And things will look different in some window of time. Maybe not exactly the same they looked beforehand. So I would really encourage the students not to get so frustrated with their education, they feel their education is just compromised forever. Or their families are so stressed that they can’t, you know, live with it. And for the faculty, our faculty who I doubt are going to listen to the podcast, I think it’s hard for them. You know, not everybody does this for a living, you know. Infectious diseases are scary, but automatically and so I think the caution and the concerns are very valid. So I would just hope people listening to this podcast would see would feel my optimism. That there will… things will look different in 2021.
[Music]
JW: This has been another episode of “COVID Conversations.” We want to thank Dean Rudi Colloredo-Mansfeld, the Senior Associate Dean for Social Sciences in the College of Arts & Sciences at UNC-Chapel Hill, whose brainchild the “COVID Conversations” series and the COVID-19 Investigations classes was, so thank you, Rudi. And thanks to our producer and editor extraordinaire, Klaus Myer. And wherever you are, we hope you stay safe and please wear a mask.
Music by Blue Dot Sessions.
Original transcript provided by Otter.ai and edited by College of Arts & Sciences staff. It may contain errors.