Ep 2: Rethinking The Pandemic Playbook

Eric Schmidt
September 2, 2020
37
 MIN
Listen to this podcast on your favorite platform!
September 1, 2020
37
 MIN

Ep 2: Rethinking The Pandemic Playbook

Our second guest, Former Commissioner of the Food and Drug Administration Dr. Scott Gottlieb, one of the earliest voices to predict the power of the novel coronavirus, what he calls the perfect pathogen.

How can the United States be ready to fight future pathogens? Former Commissioner of the Food and Drug Administration Dr. Scott Gottlieb explains why pandemic preparedness needs to be a matter of national security and how data and public-private partnerships can help us combat the next virus.

Episode Transcript

Scott Gottlieb (00:03):

Well, I think we need to rethink our pandemic preparedness and think of public health and investment in public health infrastructure as a manner of our national security, and not just an issue of public health.

Eric Schmidt (00:16):

The coronavirus pandemic is a global tragedy. But it's also an opportunity to rethink the world, to make it better faster for more people than ever before. I'm Eric Schmidt, former CEO of Google and now co-founder of Schmidt Futures, and this is Reimagine, a podcast where trailblazing leaders imagine how we can build back better.

Eric Schmidt (00:52):

So much of success or failure comes down to preparation. America failed to prepare for this pandemic. Our nation did not foresee the bottlenecks that hobbled our testing, the data gaps that led to imprecise lockdowns, nor the consequences of uncoordinated state responses in the middle of a crisis that has us playing whack-a-mole across our country to try to suppress this deadly virus. That's why I'm so excited to talk to our guest today, Dr. Scott Gottlieb, because he foresaw many of these things. A physician, an investor who's served as the commissioner of the Food and Drug Administration, he was one of the earliest voices to predict the power of the novel coronavirus, what he calls the perfect pathogen, and the need to prepare. For his relentless advocacy of policies that save lives, Dr. Gottlieb has been called the face of truth telling about the coronavirus pandemic.

Eric Schmidt (01:48):

As he points out in our conversation, we have to reimagine public health moving forward as a matter of national security. Because our ability to prosper as a nation depends first and foremost on our ability to be healthy as a nation. We didn't heed Dr. Gottlieb's warnings before COVID spread across the US and the world. But if anyone has a comprehensive view of American health care that can help us reimagine and prepare moving forward, it's him.

Scott Gottlieb (02:15):

Thanks for having me.

Eric Schmidt (02:16):

To me, you're famous in my world for, in January, calling the future correctly. You wrote an article on January 28th in the Wall Street Journal which talked about the danger COVID pressed. And you pointed out that pandemics are different from other things, that they have a, sort of my words, a numerical superiority, they grow very quickly, you need a coordinated policy response, these sorts of things. The title was Act Now to Prevent an American Epidemic. I personally believe that it will go down in history as our most prophetic warning. What made you, in January, write that?

Scott Gottlieb (02:53):

Well, I think that this pathogen, I had been talking about it on, on some of my CNCB hits and in some earlier articles. I think it really was in many respects th- this sort of, quote, "perfect pathogen" in, in terms of it combined enough lethality to cause a lot of death and disease with a lot of ease of spread. A lot of the other pathogens that we thought had pandemic potential or we were worried about, they were very lethal, like SARS and MERS, but they didn't spread efficiently. Or we had pandemic pathogens that spread very efficiently like H1N1 swine flu, in 2009, but turned out not to be nearly as lethal as we first, uh, worried when that pathogen first emerged. But this one seemed to occupy that sweet spot where it had enough lethality that, on a mass scale, could cause a lot of casualties, but it had the potential to spread very easily. And when you looked at what was happening in China and was starting to spread outside of China, and you saw the ease at which it was spreading and the reaction that the Chinese government was taking, you certainly had the perception that this had the potential to race around the world very quickly, which in fact it ended up doing.

Eric Schmidt (04:00):

The initial R0 was thought to be around five. And the initial cases were doubling every two to three days. And that led us to, to real fear during that period in, especially in late February and early March. In hindsight, we didn't fully understand the nature of the spread, in particular that it's largely essentially from aerosol, uh, large concentrations of, of high-density aerosol over indoor sur-, uh, indoor spaces. In hindsight, had you known that, would you have done anything different?

Scott Gottlieb (04:34):

I'm not sure we were capable of doing anything different at that point in time. What we needed to do was set up a sentinel surveillance program where we were actually testing people in the United States who were presenting with unusual respiratory illnesses to try to detect spread before it became fully manifest. Uh, th-, it looks li- like the cases, the first cases that arrived in the US arrived sometime in January. They started to spread. It seems like some of the, the big chains of transmission that got lit got lit at some point in, um, sort of mid-February, particularly the Seattle outbreak. What we lacked was diagnostic tests that would've allowed us to start testing samples at a wide scale to try to detect that spread early when we still had the potential to intervene. So, we were late, weeks late, to intervene with the mitigation with some of the targeted efforts.

Scott Gottlieb (05:22):

Um, but it would've required the deployment of diagnostic tests that we just didn't have because we, we hadn't developed them quickly enough. And there was some initial problems with rolling out the test from CDC. What you would've been wanting to was, for people who were presenting with flu-like symptoms to emergency rooms and doctor's offices but testing negative for flu, you would've wanted to test some proportion of those samples for COVID to see if COVID was, was spreading, uh, surreptitiously. You know, I think, in hindsight, the whole pandemic playbook needs to be re- rethought. And the pandemic playbook envisions that when you have an emerging pathogen, CDC is gonna be the first to develop a test to that pathogen. And then, CDC's going to engage in manufacturing diagnostic kits that can then be provided to the public health labs, who can then start screening for the pathogen. That process isn't very robust.

Scott Gottlieb (06:14):

First of all, it takes time for CDC to develop those tests. CDC isn't a device manufacturer so they're not in the business of developing test kits at a mass scale that can be commercialized and rolled out and run by other labs. And the public health labs themselves don't have a lot of infrastructure. At most, they were able to run 10,000 tests a day. What we needed was capacity to run hundreds of thousands of tests a day and, and scale it very quickly. And really, the only entities capable of doing that are the large commercial labs. So, I think, in the future, we need to envision as part of our pandemic preparedness playbook the idea of engaging the commercial labs very early and getting the scale much more quickly.

Eric Schmidt (06:51):

Well, it's interesting that you've also called for a national disease forecasting center and basically a whole program around dealing with these things in the future. So, you have been thinking about a coordinated response. Another surprise I think for many people when you read about pandemics and you read about disease is there's the, the normal concerns about spread and this question about lethality versus contagion, et cetera, that you've articulated, but no one in my view, until you, really talked about the economics of this. And when we were facing shutdowns, all of a sudden the reality of shutting down a country, a city, a government became real. Of course, China was doing this in a particularly brutal way. As you know, they shut down travel between the cities. People had surveillance on their phones. They were not allowed to go outside for up to 30 days. In some cases in Wuhan longer than that. Do you think that we need to rethink how the economics will work in a pandemic as well?

Scott Gottlieb (07:51):

Well, we had to, we had to adopt very broad mitigation steps where we effectively implemented shelter-in-place orders and, and shut down all commercial activity, particularly in the hot zones, because we really didn't have the tools to combat the spread in a more targeted fashion. And we also didn't have enough visibility to understand what the true scope of the spread was. I mean, in retrospect, the epidemic was far more dense in the cities like New York but probably a lot less dense in other parts of the country. And so, you, you perhaps could've had more measured approaches in certain parts of the country and might've required more robust approaches in others where it was spreading more. But we didn't have enough data and visibility and diagnostic capacity to know where it was and wasn't spreading.

Scott Gottlieb (08:33):

I think going forward, there's not a lot of popular support for broad-based mitigation, the kinds of shutdowns that we did in April and May. And I think we need to find some socially and culturally and economically ac- acceptable middle ground between the strict mitigation and just sort of hapless spread, just allowing this to run its course. And that's gonna be some combination of universal precautions, people implementing the use of masks and, and taking precautions in, in their own activity, and some targeted mitigation, shutting down venues that aren't essential to our way of life but end up being sources of spread. And at the top of that list you think of indoor bars where you have sort of indoor congregate settings, people are in closed quarters, you have an air conditioned venue which probably potentiates spread.

Scott Gottlieb (09:25):

If we want to get to a point where we can maintain some business activity and office-based activity and reopen our schools, even amidst the setting of continued spread of this pathogen at some level, we're gonna have to find that, that middle ground. And I think that that's what we, we haven't found yet at a national level. We don't really have a national approach to that.

Eric Schmidt (09:46):

Well, it's interesting that the consensus that has emerged is roughly the following: social distancing, wear a mask, wash your hands a lot, and try to be outdoors, the spread outdoors is much, much less than indoors for all the reasons that you know. Sort of think of it as there's a wind.

Eric Schmidt (10:03):

[inaudible 00:10:00] for all the reasons that you know, sort of think of it as there's a wind. And I'm surprised that we haven't been able to uniformly apply that across the country, 'cause those, by the way, are the same tools we had in 1918, right, to deal with the unseen threat at the time.

Eric Schmidt (10:15):

Furthermore, it seems to me that given the way the disease works, if you're above 65, basically, there's different rules for you because of the danger of it, but for people who are working age, it seems to me that you could find some compromise, where, as you pointed out, the key super-spreader businesses, these are the meet docking type businesses, are forcibly shut down, but the other ones are allowed to open. Why has that precision not been possible?

Scott Gottlieb (10:41):

Or with the super-spreader businesses, you implement measures to protect the workers.

Eric Schmidt (10:45):

Sure.

Scott Gottlieb (10:45):

You give them proper protective equipment, N-95 masks, you implement testing at the work site to help protect the workers and prevent introductions of the virus. I mean, there's ways we can get resources into businesses where you have employees who are more at risk of contracting the virus because of the nature of the work that they do, and we haven't been able to do that. We haven't been able to get resources to help support testing, for example, in those environments. I think what we have in this country right now is state led efforts that are producing regional effects, regional epidemics.

Scott Gottlieb (11:17):

We ha... we don't have a national consensus around even the playbook you outlined, let alone some additional steps that we might take, like, you know, uniformly agreeing that we're gonna limit congregate indoor settings that are for entertainment purposes, like bars and restaurants, for the duration of some period of time until we get to, you know, either better therapeutics or a vaccine. We're probably six months away from I think having a better armamentarium of therapeutics and maybe having a vaccine at least available for certain select populations.

Scott Gottlieb (11:48):

So we need to find a way to get through another six months to this. We've gotten through six months already. We probably have another six months to go. And I think to control this, to keep this from becoming a more widespread epidemic and a confluent epidemic across the country, we're gonna have to come to some consensus around the steps that you outlined, along with some targeted mitigation that we adopt at the very least when we see indications that the virus is spreading more rapidly in a local population.

Eric Schmidt (12:14):

So, I'm assuming that this is gonna go on for a long time unless there is really a national focus on common mitigation measures, like you described. And that unless there's reasonably rapid action at the federal and state level, this will go on for at least six months, and perhaps longer, certainly through the winter, especially as people are inside. Do you agree with that?

Scott Gottlieb (12:37):

I frame it a little differently. I think we have six hard months ahead of us, and I think we should do everything we can to keep the virus at bay over those six months and preserve the things that are most important to us, like sending our kids to school, like trying to keep essential and important businesses open and- and restore as much of the GDP as we can. I think we have to come together and try to get through the next six months.

Scott Gottlieb (13:00):

I think on the other end of that six months, we're likely to have a degree of exposure in the population that reduces the rate of transfer and we're also likely to have more therapeutics. We either are gonna have one or more therapeutic antibodies that can be used as both a treatment and as a prophylaxis and as a preventative, maybe as a bridge to a vaccine. And maybe, at some point late this year, and hopefully, certainly in early 2021, we'll have one or more vaccines available.

Scott Gottlieb (13:25):

I'm on the board of Pfizer. They're developing one vaccine, but there's many other companies in the hunt for a vaccine against COVID. And hopefully, one or more of them's gonna be successful and we'll have a vaccine that, at the very least, is authorized for use by certain higher risk populations to help mitigate the impact of this.

Eric Schmidt (13:42):

So to be precise, at the moment, the Northeast, which had it terribly, is now really quite safe from a testing perspective, and the disease spread seems quite low. And the Southern states, uh, in particular, Florida and Texas and Southern California seem to have real infection rates that are unknowable because of the test positivity rates. Do you have a sense of how big the problem is in the South?

Scott Gottlieb (14:05):

We're probably diagnosing somewhere between one in five and one in e- eight infections nationally. So if you think we're turning over about 70,000 infections a day, maybe at the high end, you multiply that by eight to get a sense of what the overall infection rate is in the population. But in parts of the country where the epidemic is more dense, we're probably diagnosing less than that because, as you said, the high positivity rate, we're not turning over a lot of cases 'cause we just don't have enough testing.

Scott Gottlieb (14:29):

I think the challenge right now is that the South has been the new epicenter of the epidemic in the United States. Southern California, Texas, Arizona, Florida, there are indications that those states is starting to plateau, particularly Arizona and Texas where you see the positivity rate starting to come down. Florida's a little bit more iffy, as well as Southern California. But as those states start to plateau, first of all, I think it's likely to be an extended plateau. I didn't... don't think you're gonna see them come sharply down the epidemic curve like we saw in New York, but you're also seeing other states heat up.

Scott Gottlieb (15:01):

Mississippi, Alabama, Idaho, Nevada, the District of Columbia, Georgia all have positivity rates over 15%, and there's a lot of other states that aren't far behind. Uh, Kansas, Missouri have a rising positivity rate, and Arkansas in the sort of the 10% range. And so I think the risk is that we see a rotating series of regional epidemics that as soon as one region seems to get some control over their epidemic, other parts of the country heat up. And the Midwest right now is looking like it's suspect, like, more infections spreading there.

Scott Gottlieb (15:32):

And so this is likely to be the situation as we roll through the fall and the winter if we don't come up with a more uniform approach across the country that we can just start to crush this virus. Because we're just gonna keep reinfecting ourselves. I mean, even the Northeast, I'm in Connecticut right now, we've gotten the positivity rate down very low, that's gonna be hard to maintain because it's hard to restrict travel between states.

Scott Gottlieb (15:54):

You know, I think the question that we don't know yet is can the combination, for states that have crushed the virus, can the combination of universal masking, people being more vigilant about their own personal engagements, with some targeted mitigation, bars here are closed, big congregate settings, weddings, things like that, are still restricted, with some targeted mitigation to restrict the venues that are the most risky, can that combination keep the virus at bay, keep the virus from reigniting in these parts of the country? And we're gonna find out because, you know, Connecticut and some of those other states that have achieved control for the time being are continuing with certain mitigation steps, and you do see more adherence to masking.

Eric Schmidt (16:38):

It's worth saying right upfront that the way to get to control of the virus is to stop the spread of the virus. Fewer people infected means fewer people get infected. The quicker we can focus on that, the quicker we can get back to the America that we love. Corporations are enforcing mask rules in every business entity in America. Cities and mayors, counties are enforcing mask rules, social distancing because the leaders above them are not. People are taking the defense against the virus into their own hands. Elderly are not leaving their homes. Parents are worried about their children.

Eric Schmidt (17:17):

Because there's a failure of direction, a failure of leadership at pretty much every level of our government, people are left to make their own calculations as to what they should be doing. Most of them are choosing to act conservatively, which is the right thing. And the people who are reckless, in addition to endangering themselves, which is terrible, they're endangering others because much of the spread of this virus appears to be from people who are asymptomatic.

Eric Schmidt (17:42):

It's one thing to say you don't wanna wear a mask, it's another thing to say I don't wanna wear a mask and I want the ability to infect you with me not knowing I'm infecting you. How is that defensible on an ethical or moral basis? Wear a mask. Get over it.

Eric Schmidt (17:56):

We have this crisis throughout. Dr. Gottlieb talks about this at great length. If you can't build confidence around real facts in the healthcare system, you can't build back your economy. It's a false choice to think it's healthcare versus the economy, you have to solve both. I don't hear a plan to solve the COVID crisis in the United States. Dr. Gottlieb explained that the moment we're in the midst of a series of rotating regional pandemics, different in nature but not in substance, each of which is going to keep us tough, tight, in trouble at least six months, and perhaps longer.

Eric Schmidt (18:36):

America is better than this. Our leaders and our citizens are better than this. With the right message, our citizens can respond and get R naught, that is the transmission rate of the virus, well below one, to the point where we can extinguish it much more quickly than the government is currently doing.

Eric Schmidt (18:55):

For COVID, people are making up solutions because they haven't heard the lengthy and powerful explanations from scientists, for whatever reason. We know, for example, that a set of- of routines, mask wearing, social distancing work. We've known this a long time. It's fine to speculate for everything else, but what the government needs to do is have uniform and federal level policies in this areas. This includes things like schools, exposure, treatment times, testing. Without it, the combined response of the nation is delayed.

Eric Schmidt (19:29):

It's fine to talk about the power of the states and the individual nature of our states, but unlike the federal government, the states can't print money. We can't build quickly. They can't get access to the funds to build the solutions that I'm talking about. This requires federal and state collaboration that we've just not seen.

Eric Schmidt (19:48):

When I think about the hardest problems, and there are many hard problems with this pandemic, I think the schools are the hardest. If the schools don't open, then, adults, in particular, women, find it much more difficult to go back to work, uh, economic activity is suppressed, et cetera, et cetera.

Eric Schmidt (20:03):

... it's more difficult to go back to work, uh, economic activity is suppressed, et cetera, et cetera. How would you open the schools?

Scott Gottlieb (20:08):

I think it's critical we try to open the schools for in-class learning. You know, it's exceedingly important for the, the social and education benefit of children. I think like the first key to reopening the schools is get your spread under control in the local community. All of the other countries that successfully reopened schools with maybe the sole exception of Sweden, had control over their epidemics. Um, they also took targeted mitigation steps to keep outbreaks from occurring in the schools. So the wearing of masks, keeping students in defined cohorts or pods, small, small groups, and, and not allowing large groups of students to intermingle, but keeping them within defined groups so if there is in... a single introduction of the virus into the school, it doesn't infect the whole population, it just infects that pod. Making sure teachers have proper protective equipment so they can protect themselves. They're at higher risk. Trying to create social distancing in the schools where you can. It's not always possible, different schools have different physical infrastructure and different ability to do that.

Scott Gottlieb (21:02):

Retrofit the HVAC systems. We know indoor congregate settings become sources where this can be aerosolized more easily. So trying to have good air handling, a good air filtration is important. That's something a lot of schools can do. Perhaps staggered start times to de-densify the school, or to make sure that transportation to the school isn't crowded. Outdoor classes where we can in the fall until the weather cools. Those are all things I think schools can do that are reasonable steps to try to reduce the risk of outbreaks in the school setting. And that needs to be our goal. Uh, we have two goals here, one is to restart schools, the other goal has to be to prevent outbreaks in school. Because now we're seeing the fact that the conventional wisdom is that kids are m- less likely to get infected and less likely to become symptomatic.

Scott Gottlieb (21:47):

We now believe that when they do become symptomatic, they might be just as likely to spread the virus as adults. And even though they're, they're less likely to ha- become symptomatic and have severe outcomes, the bottom line is we have seen children have severe outcomes. And while we know the numerator, we know the number of kids who've been hospitalized and have had bad outcomes with COVID, we really don't have a sense of what the denominator is. We really don't have a sense of how many kids have been infected. And it's probably a small number because we've been deliberately sheltering the children. Flu each year and flu in 2018, 2019 influenza caused 11.8 million cases of symptomatic illness in kids. It probably caused another three or 4 million cases of asymptomatic illness and kids.

Scott Gottlieb (22:31):

So if you figure about 15 million kids were infected with flu in 2018 and 2019, we haven't, I- I don't believe we've infected anywhere near that number of children with COVID because we've been sheltering the children from this virus. I don't want to infect that many kids. I think it could be, you know, disastrous if this infection is able to spread that widely in children, and we need to prevent that from happening. We can, but we need to pay attention to what we can do to prevent outbreaks in the schools to achieve that.

Eric Schmidt (22:58):

Suggesting that you... The list is fantastic. You mentioned, uh, HVAC systems, air conditioning, and one possible explanation for the spread in the south is related to the fact that everyone's indoors-

Scott Gottlieb (23:08):

Right.

Eric Schmidt (23:08):

... 'cause it's so hot. It turns out there is quite a list of things you can do to improve your air conditioning system. There's a standard called MERV, which you can just upgrade the filters. You can increase the rate at which the airflow is turning over in the building and things like that, that are relatively inexpensive to do and people should do that. Let's think a little bit about the lessons learned here. You've talked about the need to be prepared and have a preparedness playbook. There are some things that have gotten better. For example, CMMS restricted, relaxed restrictions on physicians operating across state lines, right? Telehealth is now beginning to emerge, which is clearly a very good thing. Do you have some opinion now about how to reimagine all of this? Assuming we get through the six months that you're describing without horrific impact, and assuming that either some form of antiviral or, or other solutions emerge, what, what happens next year and the following few years?

Scott Gottlieb (24:03):

I think we need to rethink our pandemic preparedness and think of public health and investment in public health infrastructure as a matter of our national security, and not just a p- an issue of public health. We need to make sure we have, for example, reserve testing capacity in this country. So if a large lab, I think we should be paying the large commercial labs to develop some reserve capacity that could be used in a national emergency. We do this in other contexts where we, for example, pay companies to maintain domestic manufacturing facilities for vaccines, recognizing a strategic priority. We pay certain companies to make sure they have hardened manufacturing sites for certain critical drugs that can be used, for example, in response to a dirty bomb attack. We should also be paying for some reserve testing capacity, Knowing that diagnostic testing is essential to the early days of an outbreak to trying to get control.

Scott Gottlieb (24:52):

And so if, you know, LabCorp runs their typical lab, they have 5,000 platforms running in one of their large labs at 80% capacity for maximum efficiency. Maybe we say, "You know what, we're going to compensate you. We're going to contract with you like we do with other, you know, national security providers to have 7,000 machines running at 60% capacity so there is some reserve capacity in your system." We know that's not the most efficient way to operate. And so the government is going to compensate for that excess capacity and basically own that excess capacity in the event of a public health crisis. We need to think about this across the board. Also how we have more domestic manufacturing capacity for some of these critical healthcare components. We ran out of protective equipment. We ran out of reagents for diagnostic testing. We- we're finding we don't have enough domestic biological manufacturing capacity to produce a therapeutic antibody.

Scott Gottlieb (25:45):

So across the board, I think we need to think about this kind of preparedness as a matter of our national security, recognizing the really dramatic implications it's had for our security and our economic health and just our population health. We can't allow this to happen again. So those, those are some of the things I think we need to think about. In terms of the delivery side which you touched on, I think that this crisis accelerated sort of six years worth of evolution in the delivery system in six months. I think the, the rapid migration we made towards the use of telehealth and, and distance medicine, that's here to stay now.

Scott Gottlieb (26:22):

I think it drove adoption of those tools and acceptance among providers and consumers in a way that it would have taken years to achieve that through, you know, sort of marketing and, and other commercial efforts by these companies. And so now that people have been socialized to this, they like getting care through those systems for certain things. I think they're gonna stay on this platforms in the same way that, you know, we might think of board meetings and other kinds of meetings differently going forward because Zoom actually ends up working, you know, quite efficiently for a lot of meetings that we would have otherwise have done in person.

Eric Schmidt (26:53):

Let's just review one more time. What should individuals do right now? Wear a mask, what else?

Scott Gottlieb (27:00):

Wear a mask, you know, try to keep your social circle a little bit more narrow with people you trust, avoid indoor congregate settings where you can. Don't have parties, don't have big gatherings, um, where you can expose yourself to a lot of people, particularly people you're not familiar with. Just sort of condense your life a little, take it simple for the next six months. Try to stay home a little more, try to stay with people that you know, so you can reduce the number of social interactions. Instead of going shopping twice a week, try to condense your shopping into one trip. If everyone did that on a large scale, that would have a dramatic impact on the rate of transfer. There has been studies that have sort of evaluated this. There was one study out of, uh, University of Pennsylvania looking at what would happen if everyone went shopping, grocery shopping once a week, instead of twice a week? And the impact that would have.

Scott Gottlieb (27:49):

So these little, little simple interventions can reduce your individual risk. And that's what we need to think about doing. The mask becomes very important, and the better the quality of the mask that you can wear, the more protection it's going to afford you. A cloth mask affords you some level of protection. Uh, level three procedure mask is going to afford you a much higher level of protection. And then obviously an N95 mask is going to afford you the best level of protection. If you can get your hands on a better quality mask or maybe have a high quality mask and use it in certain high risk settings that you might go into, that's going to give you a better degree of protection. So, you know, when I travel on an airplane now, or, you know, on a train, I wear an N95 mask, knowing that it's going to give me a better level of protection in a setting that otherwise is probably a higher risk setting for me to be in.

Eric Schmidt (28:35):

Dr. Gottlieb, thank you for helping us navigate this crisis, for doing everything you're doing and being here with me today.

Scott Gottlieb (28:41):

Thanks for having me.

Eric Schmidt (28:46):

So where are we now? This pandemic has shown us how quickly a virus can overwhelm our health response systems, especially if we don't have the ready main capacity to diagnose and contain disease spread at the start. A pandemic is like a war, you need to move quickly, decisively, and you need to get it under control quickly. We've done none of those things. People have died unnecessarily because government was slow to react to common and simple things like mask wearing and social distancing. And even today, we're having name debates over the most basic thing that we can do to help other people and prevent the spread of the virus.

Eric Schmidt (29:27):

There's recent good news, that the daily infection rate has begun to decline from a high. There's great concern about the fall when people are back inside, but we know what it takes to get this virus under control. It's mostly spread in airborne ways, it's mostly spread from people who are in dense and close encounters. So if our citizens spend their time wearing masks and avoiding large crowds and behaving in a sane way, we can get through this and we can get through it in six months. If we don't, the rotating pandemics that Dr. Gottlieb speaks about, are going to continue until the summer of next year. That's a lost year of GD...

Eric Schmidt (30:03):

... you until the summer of next year. That's a lost year of GDP growth, of wealth and healthcare, of student's education, of people seeing their friends, of going to football games, and all the things that we took for granted before January. If we don't act now, we'll lose another year. So as Dr. Gottlieb said, we need to rethink our whole pandemic playbook. And he's given us some excellent places to begin.

Eric Schmidt (30:28):

We need an observatory that observes for rare events. The arch of history is changed not by our normal behavior, but by unexpected and strange things that we're not prepared for, that somehow become accelerated, and they take over a group of people, a country, a part of the world. And then we're dealing with it. We need to know early when these phenomena are happening. Pandemics are just one example of this sort of thing.

Eric Schmidt (30:58):

With the observatory, we should be able to spot these trends early, and then in a proper functioning government, whether it's an autocracy or democracy, the alert is raised, the country can decide what they want to do about it. We were caught flatfooted because we didn't have integrated data systems across our healthcare systems, and it took a great deal of work by an awful lot of people to integrate all the data and understand for example the number of hospital beds, the number of people in ICUs, as people were scrambling. That's not okay.

Eric Schmidt (31:31):

We have the ability in an observation system, to see these things happen and react more quickly. A pandemic is the perfect storm for this. It's doubling quickly, [inaudible 00:31:43] terrifying results. The government was confused. The people are trying to do the right thing, they didn't have the right data. Let's get them the right data.

Eric Schmidt (31:50):

A friend of mine served in World War Two and is still alive, and I asked him what 1943 was like, and he said it was terrible. Because I imagine that in World War Two, after you got the basic idea of the conflict, you wanted it over, but it went on and on and on. We need to avoid that. We need to collectively get ourselves to act more quickly. We need a plan that will ultimately cause this to be a series of outbreaks as opposed to a national pandemic.

Eric Schmidt (32:17):

If you get a number of scientific thinkers, they can usually forecast the outline of the next decade, although they'll get the timing wrong. They won't know when the discovery will happen, but they can say, "We think there's going to be a discovery over here." Synthetic biology is such an example. The ability to use AI in the ways it's being used, to fight the virus, to come up with antivirals, to literally automate things which have been done by hand for years. All of those are forecast.

Eric Schmidt (32:49):

The thing that's hardest to forecast is the surprises. The ones where it's a combination of things that we don't know. And the delight of what we do is speculating. Will there be thinking robots? Will there be cures to diseases? A good example is in an MIT project. They started working on seven different drugs for seven different problems that had never been broken through before, and they came up with one, which is called [inaudible 00:33:15], using a completely different approach.

Eric Schmidt (33:18):

Many people think that this is the first major antibiotic drug built in years. This is not a COVID drug, but it's an example of the kind of thing that can be done with the creativity of our scientists, and a fair amount of computing power. It's crucial that our leaders approach this problem with humility, as Dr. Gottlieb said, "This is the perfect opponent. This opponent evolved to both be hard to trace, hard to see, easily caught in a crowd, and terribly, terribly dangerous." We're only now coming to understand the details of how this all happens.

Eric Schmidt (33:54):

I am optimistic that the combination of people acting independent of the confusion of their government, and the necessary liability that's being forced on corporations, will enforce many of these places where people have been unwilling to enforce them. I'm also of a belief that as people begin to understand that the scientists were right, that the doctors did not lie to them, that the world is not a large conspiracy to prevent them from having fun, that this is a very, very dangerous pandemic. I'm confident that they too will come to understand that they need to listen to science, and they need to listen to experts. There's something about humans, where we don't want to believe that science binds us. We want to be optimistic. But I want to deal with facts, and the facts are that this virus is extremely dangerous. It's already killed far more people than were killed in, for example, the Vietnam War, and it's on its way to killing more people than Americans killed in World War Two, and on its way to perhaps killing the number of people that were killed in the Civil War. This is a horrific outcome. We need to address it.

Eric Schmidt (34:56):

Over the next few episodes, we'll continue this conversation around reimagining the pandemic playbook. We'll look at the economics and science of pandemic responses. We'll talk with a Nobel Prize winning economist, reimagining how to end poverty. A pioneering biologist revolutionizing medicine by leading an effort to map every cell in the human body. And others. We'll assemble the tools that can help us reimagine our communities and build a more prepared and prosperous world.

Speaker 1 (35:24):

We're putting out a call to the world students about how to reimagine our post pandemic world. We call this the reimagine challenge 2020. As many as 20 of you who submit winning ideas will be eligible to receive up to $25,000 each in scholarship funding, plus $25,000 for your school. We are seeking your ideas on one of two powerful ways to make our world better. You can find all the information about judging and how to submit at reimaginepod.com.

Eric Schmidt (35:56):

Next week, we'll speak with Nobel Prize winning economist [inaudible 00:36:00], and the former Minister of Finance of Chile, Andreas [inaudible 00:36:05], about the pandemic's toll in developing countries, and reimagining global prosperity. That's the next time on Reimagine.