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Brian: Brian Lehrer on WNYC. We've been doing a lot of coverage of new coronavirus hotspots in New York State and around the country. There's also a resurgence in Europe. Here are some of the revealing numbers. In New York State despite the new cases, the number of deaths has not really been going up, at least not yet. According to the New York Times COVID Tracker, there were an average of 12 deaths a day in New York State over the past week and 12 people is 12 people every day, but it's barely higher than at the low point in the summer.

Nationwide, there have been a stubbornly high 710 deaths on average per day, over the last week. As I've been saying, that's 5,000 people dying from coronavirus a week, still about the same as about a month ago, no progress nationwide. You can look at the curve on The Times site or other places. It is just flat at about 700 deaths a day, week after week, recently in the United States.

In the UK, as an example of Europe, a month ago, and I was on the show comparing Europe favorably to the United States, a month ago, the UK was seeing around 10 deaths a day. In the past week, it's been more than 80. This is not done with, by any means. But different places are different. Now here's some good news. Back in the winter, when this was just beginning, we had New York Times health and science correspondent, Donald McNeil, Jr. on the show with dire predictions that turned out to be largely accurate about how bad this could be based on his reporting in our country.

Now, Donald McNeil, Jr. is out with a new article called A Dose of Optimism, as the Pandemic Rages On. The months ahead will be difficult But the cavalry is coming and the rest of us know what we need to do. Donald, thanks for coming on again, welcome back to WNYC.

Donald McNeil: Very much for inviting me back on.

Brian: In your new article, you remind us that you have been a consistently gloomy Cassandra, as you describe yourself, your words, since you first started reporting on the virus in January, can you briefly remind people of your early articles and the alarm bells that were ahead of the curve and rightly freak people out?

Donald: Yes. I started worrying about this virus when I first heard about it on a site called ProMed back on the last day of December, because it sounded like SARS, just a virus that was in Southern China transmitted in cases of mysterious pneumonia. As we followed it, I thought it was going to be like SARS, which is to say very dangerous, but very limited. By the end of January was really clear once the Chinese got PCR tests going, that there were 10,000 cases, that's nothing like SARS and 10,000 cases in it, and a handful of deaths at the time. and I thought immediately, "This is going to go pandemic."

I ended up calling 12 infectious disease experts to see what they thought. It was basically, eight said, "Yes", two said, "No," and two didn't want to commit, but one of those eight was Tony Fauci. That's when I started writing articles saying, "Hey, this is going to go pandemic and things are going to go bad." I did that. I wrote about mask cording, and things like that and many of those things have come true, unfortunately.

Brian: Before we get to your longer-term or medium-term dose of optimism, I want to establish so that people don't get complacent hearing what you're going to tell them the importance of vigilance in the present as you do in the article. We heard Dr. Fauci this week, encourage people to have virtual thanksgivings, at least as pertains to extended family. Can you talk about the current situation and why you're right that the fall and winter may be grim?

Donald: Yes. Look, I do not want to go from being a gloomy Cassandra to being a daffy Pollyanna. I'm very pessimistic about the fall and winter and I see it happening right now. In fact, I'm getting the same feelings that I did back in March, when I began to hear-- As soon as New York City got tests, I began to hear about one infected person there and five people in the hospital there and stuff. I got on my email lists for my softball team and my squash team of squash players and then family and said, "Get inside. I think the city is hot with virus right now. You can't tell, because it's a beautiful spring weather, but I just had the feeling from the number of positives."

I'm getting that feeling again now because I'm hearing about events. My girlfriend's son just was invited to a party on Saturday night and he didn't go because he's a smart guy and cares about his mom and five people at that party got infected. It was a superspreader event and it was meant to be outdoors on a terrace, but the weather is getting colder so people were partially indoors.

That's how this happens. CDC put out on notes yesterday saying small parties are the spreader events right now, people having family dinners. They're very clearly warning that Thanksgiving and Christmas could easily turn into superspreader events. Unfortunately, your family might be fine, but the family next door has a problem and somebody died, but it might be the family next door is fine and you're not, you don't know.

Brian: I don't know if you saw the breaking news just before you came on, but Kamala Harris has now canceled campaign travel. I'm not sure for how long. I'm not sure she's sure for how long, but because two people connected to her campaign have tested positive and I can just see the political hay that President Trump is going to make out of this, "Oh, they make such a big deal about me, superspreader events, blah, blah, blah and they get it too," but from a medical standpoint, even people who aren't COVID virus deniers stand to be at risk depending on how they behave individually.

Donald: Yes. This is proving that the people who believe in herd immunity are in dreamland because you can take a-- the whole concept of herd immunity as absurd as it is, is premise on the idea that you can protect the vulnerable, hide them away somehow but really depending on where you set your parameters on how old you have to be to be vulnerable and how obese you have to be to be obese. Something like between 30 and 40% of this country is considered vulnerable.

Look at a semi-typical American family where you have a 14-year-old, a 50-year-old and a 74-year-old, all in the same household and nobody protected the 74-year-old. He got infected too and this is the Trump family. Once the disease gets into your network, you are likely to get it. Things like Thanksgiving dinners, where people go from network-to-network are potential superspreader events. This is not the optimistic part of my article by the way.

Brian: I was just going to say, we've spent the first third of our time together on the grim part of what we invited you on for us, an optimistic article. Frankly, I think it's really important that we did spend this time because, people, vigilance in the present is still so required but if you're just joining us, my guest is New York Times health and science reporter, Donald McNeil, Jr., his new article is A Dose of Optimism, as the Pandemic Rages On. The months ahead will be difficult But the cavalry is coming and the rest of us know what we need to do. How much of this is based on treatments? Maybe like the ones President Trump got.

Donald: A lot of it is. I should make clear. Some of my optimism is about the lessons we already learned. If you looked at the original model that the White House used back in March, that said, what would happen this pandemic? If we had done nothing and I mean, really nothing. If we had just let this virus wash through us, the epidemic would be basically over by now that, the model called it for be mostly over by October and 2.2 million Americans would be dead.

One-tenth of that number of Americans are dead. That's 220,000 Americans almost, it’s not good news, but its better news than what could have happened. People who get the disease are still as likely to be hospitalized as they were before but people who are hospitalized are much less likely to die and the age of people who are getting sick and hospitalized is going down dramatically because young people were being careless, but old people are not being careless. If you look at polls, it used to be no Americans who wore masks back in March.

Now, depending on which poll you look at, 85 to 90% of Americans say they wear masks, not at all times, but when they go into dangerous environments like stores. People are protecting themselves much more. Then of those who get hospitalized not only they're mostly younger, so the more likely to survive, but you've also got, people are now using pulse oximeter so they recognize that they've got pneumonia a little bit earlier. They get dexamethasone if they ended up having a cytokine storm so they're more likely to survive the cytokine storm.

They're getting Remdesivir, which maybe gives you about a third better chance of living. We're doing things like proning people and being a little more cautious in our use of ventilators and so more people are surviving. Even before we get to the big advances that are coming, we're doing better with the people who are being hospitalized now. The death rate is falling.

Brian: How much of your cautious optimism is based on new kinds of tests. I've been hearing a lot about rapid self-administered tests that could become so widespread people would be able to prevent spread person by person day by day, like taking their tests before they go out, assuming they stay home if they actually test positive. Have you reported on those?

Donald: I've reported on it and my colleagues have reported on a lot. We haven't gotten to the point where we've distributed enough tests. The rapid tests are kind of accurate, but not really accurate enough. We thought at one time the temperature checks is going to make a big difference but now there's so many asymptomatic that temperature checks are really more of a psychological barrier against letting people come to work sick rather than actually catching people. The rapid tests are not widely enough distributed to do that. That was a thought, but we don't have enough of them and they're not really accurate enough to do that.

Tests are false security. I know somebody who had a slumber party with teenage girls recently and I remonstrated, and the answer I got was these girls have all been tested recently, not at the party, but recently. I thought, "If the danger was that those girls were going to get pregnant, would you just distribute pregnancy tests?" No, because tests don't prevent COVID anymore than pregnancy tests prevent pregnancy. You've got to take protective measures. Depending on what kind of a parent you are, you would either hand out condoms or lock the door or get your shotgun if a boy showed up on the porch. With this disease, masks are very protective and social distancing is very protective. Those are the equivalent of condoms and shotguns.

I don't think a testing regimen is going to protect us. It seems clear that masks really work and they'll-- whether we have 300,000 dead or 400,000 dead by the end of this winter may depend, probably will depend, on how well we use masks and social distancing and protect ourselves. Then the monoclonal antibodies should be ready pretty soon. The early tests on them have looked good, really good.

The monoclonal antibodies have been amazing in ebola. I've been following them for years because they develop them for ebola. Same company that did the regimens the President makes. If you get them within the first three days of getting infected, they're about 90% protecting you from dying of Ebola. Obviously, Ebola is a far more lethal disease than this one, and you die much faster of it I have very high hopes for monoclonal antibodies.

What I think is going to be the problem is that there's just not going to be enough. They're slow to grow and they're expensive and right now they're talking about 50,000 doses at the moment and somewhere between 300,000 and a million doses by the end of the year, depending on how big a dose you give to somebody. The size of the dose President got is about eight grams. That's the big protective dose for somebody who's already infected. The prophylactic dose that you could use like the vaccine is about less than 1/10 of that. They can make a big difference depending on how you use them, but there aren't going to be enough for all Americans.

Brian: We've been hearing the word polyclonal antibodies for what the president got, but you're talking about the same thing. If you give two different kinds then monoclonal antibody becomes a polyclonal antibody.

Donald: It's a cocktail of antibodies, like AIDS drugs come in a cocktail of three different drugs. This one has a cocktail of two different antibodies.

Brian: Does that mean if they can ramp up production that basically anybody who gets diagnosed with coronavirus or anybody over a certain age or a certain risk factors who gets diagnosed with coronavirus should get polyclonal antibodies, monoclonal antibodies right away?

Donald: Yes. The tests are very close to ending, but assuming those tests do as well as people think they're going to do, or if they do as well as they do with Ebola, Yes. That would be ideal. If you had enough, you could use tiny doses for healthcare workers, for doctors, for people who live in nursing homes, as protection, and for anybody infected, you could give them a dose as soon as possible.

That may have been why the President recovered. We don't know because he got three different treatments, but he recovered remarkably quickly for somebody who presumably had evidence of pneumonia because they were giving him dexamethasone and he recovered amazingly fast that may have been what did it. You don't ever do a study that uses one study subject.

When I heard he was sick, he tweeted at one o'clock in the morning that he was infected and I woke up at 5:00 because I don't sleep much and heard it and literally jumped out of bed and wrote to our White House reporters Maggie Haberman and Peter Baker, asked if they give him monoclonal antibodies. Because if I was his doctor, that's what I do.

Brian: They did.

Donald: They did. Ethically you shouldn't be given these things outside of a clinical trial, but if you're the President, you can get things done that the average American can't get.

Brian: Listeners, any questions for New York Times health and science correspondent, Donald McNeil, Jr. on his cautious optimism for ending the pandemic in this country, by the middle of next year? His article, maybe you saw it in the times or what has to happen to make that possible. (646) 435-7280. How about vaccines?

Donald: We have paid about $11 billion or committed about $11 billion for seven different vaccines. If just three of them work, we will have enough doses for all Americans to be vaccinated by the middle of next year. We won't have enough doses in January, even if the vaccines are approved by late November or sometime in December, we won't have enough doses then, but they are going to roll out and they're going to be rolling out 20 million per vaccine per month or more. I have very high hopes that some of these vaccines are going to work.

The phase one and phase two data looked pretty good. The monkey data looked good. No vaccine is without any side effects at all and no vaccine is a hundred percent effective, but when you've got seven candidates and we've learned a lot about making vaccines in the last few years and the guy who's in charge of it, Moncef Slaoui, has been in charge at GlaxoSmithKline for many years and some amazing vaccines were made by them, the Cervarix and Shingrix, the single shot, and Mosquirix, the malaria shot, which only provides short term immunity because malaria is a very complicated disease, but it's an amazing vaccine.

I'm pretty confident these vaccines are going to be-- He suspects that they'll have 75% to 90% efficacy rather than 50%, which is the floor that the FDA put on it.

Brian: Let's take a phone call. Peter, in Norwalk, you're on WNYC with Donald McNeil, Jr. From the New York Times. Hi, Peter.

Peter: Hi, Brian. Thanks for taking my call. Doctor, I'm horrified.

Brian: He is not a doctor by the way. As far as I know, he's a reporter.

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Peter: I apologize. My question and my comment is that I'm horrified by indoor dining. I walk into restaurants and I'm in Norwalk and I see 20 people indoor and they're socially distant. Don't get me wrong. They're 6 to 8 feet apart but because the virus is airborne, every single one of those people is exposed if somebody in that restaurant has COVID. How can we be responsibly allowing indoor dining when the numbers are going up? I understand it's an economic issue. I get it, but it just seems like it's really dangerous. My wife and I refuse to go out to eat. We'll get, take out and eat outside, but not inside the restaurant. It's crazy.

Donald: I agree. I won't eat inside a restaurant. I do eat outdoors. I have recently, but I don't go inside. There are plenty of studies even from China that showed that the virus can travel quite a bit more than six feet through the air and infect diners sitting at a distance from the infected person. There have been studies in call centers in South Korea. There've been a lot of studies that showed that the virus can travel a lot more than six feet in an enclosed space even with air conditioning blowing it around and people get infected. There's the potential for super spreader events, literally inside any restaurant or bar.

Brian: Interesting. Olivier or is it Oliver in Brooklyn? You're on WNYC. Thank you for calling.

Olivier: Hi, thank you for having me. Mr. McNeil, I relied on your reporting at the start of this. Thank you for your vigilance. I do have a comment and a bit of a criticism, which is that you seem to be a little fatalistic about New York having a second wave. I was in New York in the spring and in the summer, and then I went to France last month and the fact that Europe is having a second wave is not at all surprising simply because they don't seem to have shifted behaviorally the way that we have. In New York people wear masks, almost everybody on the street does and it seems like we're collectively traumatized by the virus.

Whereas in Europe, when I went, a lot of people didn't know somebody that had the virus and they treated things sort of as recommendations. They were subject for the magical thinking that we see in some red states in the US. I don't know, I just think that New York is has a long enough memory that will be vigilant through the winter.

Donald: Well, I like to hope you're right. I hope you're right, and I'd like to believe it, but we're seeing upticks in a bunch of neighborhoods right now. I take long bicycle rides in a lot of mornings, and I see who wears masks, I mean, different neighborhoods and then their masking habits. By and large, you're absolutely right, New Yorkers are pretty good, but it varies neighborhood by neighborhood. There are nine zip codes right now, where the cases are taken up for sure mostly in Hasidic and Orthodox communities, but no disease stays within any community. There were always nodes of communication with other communities, and there's another 20 zip codes where things are beginning to tick up.

Even if people wear masks on the street, they're not always wearing masks at all times indoors. People have created pods, people have decided to go back to indoor dining, people have little parties and get-togethers, like the one I described earlier, and things go wrong. That's a disease that is as communicable as this one, and it's still very communicable.

There's a dispute about how many New Yorkers have been infected, whether it's 20%, or 33%, but neither one of those is enough to produce herd immunity. It can spread and because we can't all be outdoors in Central Park as we were in the summer for meetings. If people hold parties indoors, each one of these can be a superspreader, that really makes viral spread more quickly.

Brian: Because you're so in the weeds on personal risk factors, I'm curious, do you wear a mask when you go on your bike rides?

Donald: No. Not when I'm on the bike. I wear a mask-- because I also swing the bike more than six feet away from people. I wear a mask when I cannot maintain six feet of distance and when I'm indoors.

Brian: On Europe, which came up in that phone call, what do you make of the resurgence in Europe right now? I mentioned some UK stats at the beginning of the segment, but around Europe, they don't have any denying Donald's running their response. Of course, I'm not referring to you, I'm referring to that other Donald. Do you ever take on Europe?

Donald: Yes. Well, first of all, Europe's a big place that different countries have different situations. They reopened tourism in some countries again, which is asking for trouble. Some countries, the British have gone from out of control to back in control to out of control again. They encourage everybody to go eat indoors and the government even paid half the cost of the meals and the tradition of everybody going into the pub and having a pint.

The social distancing things they're doing are not very strict. If changing last call to 10 PM doesn't take away the number of people who get infected between five o'clock or whatever-Brian: Right. That's what Boris Johnson just ordered pubs in the UK, last call at 10 o'clock.

Donald: Right. That's not the same as closing down the pub. You created an opportunity for super spreading up until 10 PM. It's not like always disease only transmits after 10.

Brian: Meredith in Madison, New Jersey. You're on WNYC with Donald McNeil, Jr., health and science correspondent for The New York Times. Hi, Meredith?

Meredith: Hi, Brian, love your show. Just wanted to say that my husband and I were going to try for a third child, but then COVID hit. I'm just wondering because we're coming back around to the idea of it because it doesn't seem like the pandemic is going away anytime soon. My question is, are there any options for pregnant women for a vaccine on the horizon? Or do we just have to hide from the pandemic? I have two small kids who go to preschool, so there's always that risk factor. We're just wondering if there's any option coming.

Brian: Do you know the research at that level of detail, Donald?

Donald: There is no research on this vaccine and for pregnant women. We know that pregnant women should get flu shots because it's much more protective because you could have a very bad outcome with you get a bad flu while you're pregnant, but unfortunately, with vaccines, the last group you test them on is pregnant women. You start with young healthy adults, and then you go to seniors, and then we definitely need to test this vaccine on children because we're going to need to give it to children, but pregnant women because they're literally the most fragile, they and the baby are the most fragile. That's always a group that gets vaccines tested on them last.

I don't expect that to happen in time to do any good this-- I don't know, I haven't heard anybody discuss when the schedule is for an extending the trials after the vaccines have been approved. They're already doing tests in healthy adults and in older adults, they're not doing testing children yet, and I'm sure that pregnant women will come after children.

Brian Lehrer: Meredith, I wish we had better news for you on that, but thank you for your call, and good luck with you and your family. I'm curious to get your take since you have this cautiously optimistic projection of where the science is headed. On the importance of this story of the first case of reinfection of COVID confirmed in the United States, do you think that this is an indicator of something more widespread? That we aren't headed toward eventual herd immunity, if that's the right term, because people could just get it again and can start all over again? Or do you see this as for some reason, a medical outlier?

Donald: Okay. Yes, I think it's a medical outlier, but not a totally unexpected one. In any disease, including measles and chickenpox, where you think everybody the conventional wisdom is it provides immunity for life, there are the occasional people who get it twice. My daughter when she was in kindergarten, my older daughter, she had a classmate who got chickenpox twice. I heard that from her father. I said, "That's impossible," and he said, "No, it's not. I checked with a doctor, and she had it twice," but it's rare.

We know it's probably happening a lot more than the number of cases. I was looked at my computer notes right now trying to find, there's a website that tracks all the reinfection cases, I can't remember the name of it right now, but there is a website that does that. This has happened a number of times in different countries around the world. It's probably happened a lot more than we know because it's rare that we catch these cases, and that they actually have the genetic sequences, so they know the person, instead of having what's called recrudescence, where the disease just appears and comes back again, instead, you've got a separate infection

But it can't be happening too much because if it was, we'd see all sorts of people getting reinfected again, and again, and again. The whole set of communities, which were very heavily infected, in the spring would be having the same wave all over again, all of our first responders would be getting infected again, and again, the people who were at high risk.

We know that for relatively benign coronaviruses, you can get again. Usually not for a year or two, but you can get them again. Your immunity wanes. That does imply that these--

Brian: Like common cold kinds of viruses you're talking about, right?

Donald: Yes. Coronavirus is the cause of common cold, but the fact that there are reinfections kind of adds to what a lot of doctors think, which is that we're basically going to be stuck with this disease probably going forward the same way we've been stuck with influenza for all of our lives, but it probably will be become somewhat less virulent and we will probably have to be revaccinated against it.

It's too early to know these things, but biologists are saying, from what we know about other coronaviruses and what we can see about this virus is the possibility that it's going to be endemic and we're just going to have to have coronavirus shots the same way we have flu shots. Because it mutates more slowly than flu maybe we'll only have to have the shots every three years instead of every one year. All this is unknowable right now, but it's what it implies that it's not going to disappear.

Brian: All right, listeners for the moment, vigilance. That story of a super-spreader Sweet 16 in Suffolk County, indoors, probably lots of masklessness, but it's those little parties like that as Donald McNeil, Jr. has been telling us, these little bit of openings that you think are probably okay by now that in some cases aren't that may make this winter really tough, but then maybe, as he says, the cavalry is coming. Donald McNeil, Jr's article in The New York Times, A Dose of Optimism, as the Pandemic Rages On. The months ahead will be difficult But the cavalry is coming and the rest of us know what we need to do.

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