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Brian Lehrer: It's The Brian Lehrer Show on WNYC, good morning again, everyone. The election may be over, the pandemic is not. Yesterday, the United States recorded over 100,000 new COVID-19 cases in a single day. It was the first time that has happened. According to the COVID tracking project, more than 50,000 people are currently hospitalized for the virus across the country. That includes more than 1000 in New Jersey, that hasn't been the case in a while, and it's an increase nationally of 64% since the beginning of last month. Deaths per day have increased by 21% in the last two weeks nationwide.

In New York, Mayor de Blasio is also warning about concerning increases in all the metrics. The Washington Post COVID tracker now puts the total number of deaths at 230,000. The immediate concern is that hospitalizations and deaths are increasing, not decreasing right now, and the record number of new cases suggests things will continue to get worse, as we know a certain percentage of cases eventually become serious. Back with us, is Dr. Leana Wen Emergency Physician and Public Health Professor at George Washington University, contributing columnist for The Washington Post and former Health Commissioner of Baltimore. Dr. Wen, welcome back to WNYC, hi.

Dr. Leana Wen: Thank you, Brian, always glad to join you.

Brian: What does 100,000 new COVID-19 cases in a single day, for the first time, mean?

Dr. Wen: It means that we are surpassing all of our previous records, and there is no end in sight. What's different about this current surge, this third surge, if you will, from previous surges is that it is all over the country. It's not just in the New York City area, in the northeast, or across the Sun Belt as we saw in June and July, and we now have a firestorm of COVID-19 all across the US. The rate of spread is accelerating. Last week, for the first time within 14 days, we had 1 million new cases of COVID-19.

This week, we added 600,000 new cases in just one week. We're seeing hospitalizations rise, and we know what happens after that too, which is that deaths will begin to rise too. This surge is not going to stop on its own, its individual actions-- Really what we need is federal action, but in the absence of that, it's the actions by state and local officials, also by individual actions, that's going to make a difference.

Brian: Let's talk about government action. Here we are, on the precipice of Joe Biden being declared the president-elect of the United States, if that were to come about, what would change on day one of his administration, as you understand it?

Dr. Wen: I think that if there were to be a new president declared, the work should begin immediately. It cannot wait until day one because by that time, by the time January comes around, we'll have hundreds of thousands, potentially, more Americans dead. I think the moment that a president-elect, Biden, let's say, is declared, he should convene a taskforce to begin to do the work so that they're ready to go on day one. That task force should also be delivering press conferences, briefings every day, because frankly, that's what the Trump administration should have been doing all along.

We should have been hearing from the CDC, from Dr. Fauci, from Dr. Birx, every single day on the state of the pandemic, on actions that people should be taking aware of the problem, hotspots are across the country, what the recommended policies should be, that work can begin right now. In the absence of leadership from the Trump administration, there is a vast vacuum, and that vacuum has currently been filled by misinformation, active disinformation, and if there were to be a new Biden administration, they have an obligation to step in and fill that vacuum.

Brian: Let me ask you about the Trump administration's approach, which, as you say is, it's going to continue till at least January 20th, and then maybe it's going to continue for more years, we don't know. The administration has focused on reopening the economy by letting COVID-19 spread more. They acknowledge it would spread more among, they say, mostly young, healthy people, so-called "herd immunity" eventually, as the young weren't getting any more, and therefore, the old would start not getting it anymore, or people with serious underlying conditions.

They say they're working on protecting vulnerable people in that scenario, like in nursing homes, and that the impact of more aggressive lockdown. If the economy starts to approach being just as bad in terms of public health, as the virus itself, for you as a public health person, is there anything to that, in your opinion?

Dr. Wen: This whole idea of herd immunity is a tempting hypothesis. If it were true, it would be wonderful, because it makes sense for all the reasons that you mentioned, except it's defied by science. In order for us to reach that level of protection across the community, we need 60% to 80% of people to be infected. When you think about what that means for the American population, and the death rate that we have, that means that we could be looking at 2 million Americans dead, for us to reach that level of protection in the community.

Also, we don't know that the protection is something that lasts. In fact, all the evidence that we have suggests that the protection for coronavirus may not last for more than several months or a year. Millions of people may have to die every year for this concept to occur, which is something that just is beyond the pale. This is something that's never been employed in the history of humanity, to use herd immunity through natural infection as a method for preventing from getting a virus.

Actually, that is a worst-case scenario, millions of people die every year. I also do think, though, that you bring up such an important point about this framing that President Trump and others have been using, about somehow this is public health versus the economy. I think this false choice is just what it is, which is false, it should not be framed as, either we shut everything down, or we let the virus run rampant without doing anything.

There's actually a large middle ground, and that large middle ground is where almost all public health officials that I know stand, which is, we need to be employing mask wearing, physical distancing, restricting indoor crowded gatherings, targeted restrictions, that actually allow our economy to come back and kids to be back in school.

Brian: How should we think about these numbers of deaths that are taking place, and I think it was over 1,000 in one day, for the first time in a while? Yesterday, or the day before, it's been averaging 700 per day, through the summer. Now, it's up to 800 per day, over the last few weeks as cases and hospitalizations and deaths are rising again. Every time I talk about the current death rate on the show, I now get comments on Twitter or wherever, from people more on the Trump-approach side saying, "Aha, but what about comorbidities?"

I've seen this in conservative media too, where the argument is that we're too concerned about deaths because very few people who are otherwise in good shape are dying from COVID-19, the people who are dying or close to death anyway, with serious underlying conditions. Does the research back that up?

Dr. Wen: It is true that those who have underlying medical conditions, and those who are older, tend to get more severely ill and do represent the bulk of individuals who have succumbed to COVID-19. Just because somebody is older, or has a chronic medical condition, doesn't mean that they should die from COVID-19 or any other cause. I've seen individuals who are trying to play down the seriousness of the virus, say things like, "Why should it matter?" Because these are individuals who are older, or have medical illnesses, but if you look at what that means, you're looking at a third of the US who have chronic underlying conditions, or older, and could predispose to COVID-19.

Are we saying that a third of Americans are somehow disposable, as a result of their having underlying issues? That is not the country that we are, especially because there are actually things that we can do. I think that that's the biggest danger of all these efforts to say that somehow we're rounding the corner on the virus, that the virus isn't serious, playing down the severity of COVID-19, or somehow making it sound like the outcome is inevitable. It makes it such that we are not taking the precautions that we actually can and should be taking, in order to protect ourselves because there are things that we can do.

I will stress this, that the trajectory of where we are looking in the winter is really grim. To your question about where we are, we're looking at more than 2,000 deaths per day in the US by midwinter, but that is not inevitable. We can prevent that from happening, if we only took this virus as seriously as actually many Americans have already.

Brian: The other part of that argument that- again, I've seen it in major media in ways that have surprised me. I want you to respond to it as a public health expert that the death statistics are exaggerated, the president said this himself, because a lot of the deaths attributed to COVID-19 are people who were dying of their comorbidities, but they also had COVID-19 at the time.

Dr. Wen: That's like saying somebody who has cancer, who also got run over by a car, actually died of their cancer. It's just not true. I think what some of the individuals for trying to discredit the real data, they are looking at a CDC report that found that a large percentage of the death certificates that had COVID-19 on them also reported something else, but that person would not have died from these other conditions. Many Americans have obesity, many Americans have high blood pressure, or diabetes, or heart disease. That doesn't mean that they were going to die from that illness right at that point.

They could have lived 30, 40 more years as a result of having that illness. COVID-19 is what killed them, not these other illnesses, and so to conflate them, again, I think is being incredibly disrespectful to the individuals who died and the suffering that their families are going through. It also spreads this misinformation that's leading to people not taking the precautions that they need to, especially coming into the holiday season, when I really am so worried about this, that people are already letting down their guard, it's going to be colder and so it'll be harder for people to socialize outdoors.

During the holidays people want to get together understandably, but we have to remember that there is a very dangerous contagious virus among us, and also that people have been making so many different sacrifices. We cannot let those sacrifices go in vain.

Brian: We have time, listeners, for a few phone calls for Dr. Leana Wen, Emergency Physician and Public Health Professor at George Washington University, contributing columnist for The Washington Post, and former Health Commissioner of Baltimore, 646-435-7280, 646-435-7280. Dr. Wen, did you learn anything from the president's own disease? Like, he got that Regeneron polyclonal antibody treatment, which he touted so much afterwards, and he got steroids and he got other things as well. He had oxygen, and he seems to be doing quite well quite quickly. Is there anything to learn from the president's case? He's obese, he's 74 years old. Is there anything to learn from his case that can be applied broadly?

Dr. Wen: It's hard to say because we still don't know the full circumstances behind the president's illness. We don't know whether he had pneumonia, we don't know exactly how ill he was. We don't know when he tested positive. We really just don't know about the time course of the president's illness to make any generalizations.

I will say that I learned that the White House is not taking contact tracing seriously, which is very concerning because when we, as public health experts and physicians, are asking patients to disclose the contacts that they've had, and also to them if somebody was around, someone else who tested positive to them quarantine for 14 days, it's very difficult to get people to comply with these recommendations, as it is.

When you have the president of the United States and the White House, not taking these recommendations seriously, it makes our jobs in public health even harder. I think what I've learned from the president's of illness, more than anything else, is the importance of role modeling that the president had this unique opportunity to tell the American people how serious COVID-19 is, how frightening it is for individuals and their family members to be going through this and how these public health measures like mask wearing, quarantining, et cetera, are so critical, and that was not done. I see that as a major loss opportunity that I wish did not happen.

Brian: What do you think the state of therapeutics is?

Dr. Wen: I am actually optimistic about both vaccines and therapeutics. I think that we have this winter to get through by the end of this winter, by early next year. Hopefully, we will have at least one, maybe even multiple vaccines that will be approved, that can then be distributed. There are therapeutics we know already that dexamethazone, that critical steroids reduce mortality. We know that other medications, including remdesivir, the antiviral that President Trump also received that it reduces the time to recovery, reduces the time that one is hospitalized.

There are other potential therapies, including these monoclonal antibodies that may reduce the severity of the illness. We'll probably have even better therapeutics by early next year. I'm confident, or at least very optimistic about both vaccines and therapeutics coming on the horizon. The key, though, is, we really need to get through this winter, because at the moment we are projecting more than half a million people who will die before the end of this winter. I know we're eager to see our loved ones over the holidays, but we really should think about the medium to longer term. We have to get through this winter, and then we can see everyone alive next winter.

Brian: Vicky in Manhattan, you're on WNYC with Dr. Leana Wen. Hi, Vicky.

Vicky: Oh, hi. Thank you so much for the show. I've seen the doctor on CNN so many times. Thank you for all the work you've been doing. I just wanted to ask you if you could please put to bed this notion of immunity that the president keeps touting with respect to his experience with COVID, because it keeps going to rallies and saying, "Now I'm immune." He puts the question in the arena that because of all of the treatments that he had, not only because he had COVID, but because of the treatments, that immunity is a possibility, and I just don't think that's true. I wanted you to comment on that if you would.

Dr. Wen: Yes. Vicky, I think this is a great question. Just like we are not rounding the turn on COVID-19 just like, there is no cure for COVID-19. We also need to speak the truth about immunity, which is to the best of our knowledge thus far, we do not believe that there is long-term immunity after someone gets and they're recovered from COVID-19.

There is almost certain to be some level of short-term immunity, but we don't know how long that lasts. There was a research study that just came out last week from researchers in Britain, still a preprint. Not peer reviewed and published yet, but that showed that antibodies that people get after COVID-19 will last for a matter of months, which is consistent with what we know from other coronaviruses.

Coronaviruses caused the common cold, and you know that you can get the common cold season after season. Probably you get some degree of immunity for a few months. We don't know how long that immediately lasts. We also don't know how complete it is. There are definitely cases that have been reported thus far of re-infection of somebody getting COVID-19 again after several months, and it is certainly not only possible but almost certain that one gets immunity for a short time, but not for a long time, and therefore one is not immune permanently as somehow the president and others are suggesting is the case.

Brian: Is that a consensus position though now? Because what I've heard is these few cases of people getting it a second time have been so few that we shouldn't jump to the conclusion that you're only immune for a few months.

Dr. Wen: I think the jury is still out as a whole, and you're right, Brian, that there have been relatively few. We're talking about dozens of cases of reinfections that have been documented in the grand scheme of things, given the many millions of COVID infections around the world, that is a small percentage, very small percentage, but we have to consider that these are the documented cases. As in, in order to document these cases, researchers have to have paired samples, both during the first infection and the second infection, and to look at the genetic composition of the viruses both times and trace their genetic footprint.

That already is a small number that's been traced in this way, but also we still are talking about a novel coronavirus. We only started having COVID-19 really spread throughout communities starting from February, March in the US, which was not even a year ago. I think most people, then the public health community would agree that immunity lasts for a period of time, but natural immunity is not something that's going to last for a long time, in terms of years. Again, this really underscores why a vaccine is so important, but also puts into perspective what a vaccine may actually look like as an, it may be something that we get booster shots like tetanus, or even annual shots of a vaccine, like the flu.

Brian: Moshe in Brooklyn, you're on WNYC with Dr. Leana Wen. Hi, Moshe.

Moshe: Yes, hello.

Brian: Hi there. You're on the air.

Moshe: Yes, hi. Thanks for taking my call. I had a question for the doctor. First of all, there's a notion of the, I know people that come in, let's say, with a heart attack or stroke, anything like that, and they're also tested positive for COVID. On the death certificate, I know if the patient dies, they write COVID. They officially- I know, is that the hospitals get a certain amount of money if the patient died of COVID, so the hospitals are really pushing for that. Is there any truth to that?

Brian: Moshe, thank you, and yes, that addresses another one of the things the president has claimed, that doctors or hospitals get reimbursed more because of some kind of formula now, if the cause of death is listed as COVID, Dr. Wen, to anything Moshe said?

Dr. Wen: Yes, so I appreciate the question because there's also an opportunity to debunk a myth while explaining what's actually happening. Congress did pass in the Cares Act, a increased reimbursement for hospitals that are going through tremendous strain right now as a result of coronavirus. Actually, many hospitals are facing significant hardships, private practices have had to close in all of this, in part because treating patients with coronavirus takes many additional resources.

Think about all the personal protective equipment that they have to have, the isolation rooms that have to take place, the illness, also severity of the illness associated with coronavirus. The fact that healthcare workers themselves have gotten sick and have had to be on a leave, et cetera. The Cares Act, in order to compensate hospitals for the additional care that they are providing, do have an increased rate of reimbursement for patients who have a diagnosis of coronavirus. That does, though, mean that somehow doctors are trying to line their own pockets as a result of this.

We have seen organizations like the American Medical Association and many other medical organizations coming out and saying that it's frankly really offensive to somehow suggest that doctors are making up diagnoses. In fact, when doctors are themselves losing their lives and risking everything in order to care for them, and not just doctors, but all front-line workers are risking everything in order to care for patients with COVID-19.

Brian: Dr. Leana Wen, Emergency Physician and Public Health Professor at George Washington University, contributing columnist for The Washington Post, and former Health Commissioner of the city of Baltimore. Thank you for your clarity, Dr. Wen.

Dr. Wen: Thank you very much, Brian.

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