In this week’s episode, Michael Brown, co-editor of The Deal, and veteran financial reporter Charlie Paikert discuss the pandemic’s impact on corporate mergers and acquisitions.

TRANSCRIPT

Jeffrey Freedman: Hello and welcome to the RP HealthCast by RooneyPartners. I am your host, Jeffrey Freedman. The public health and economic fallout from the coronavirus has been well documented but the pandemics impact on other financial areas such as mergers and acquisitions is not as well understood. So we’re going to talk about that and to help shed light on the state of play for business purchases and mergers, we’re joined by Michael Brown, co-editor of The Deal and Charlie Paikert, veteran financial reporter who currently contributes to RIABiz and Family Wealth Report. Charlie’s also been a senior editor at Financial Planning and Investment News and a contributor to the New York Times, to Barons and to Reuters. And is the co-author of a book on college basketball entitled ‘Madness: The Ten Most Memorable NCAA Basketball Finals’.

Gentlemen, it’s great to have you here with us today.

Michael Brown: Thank you, Jeff.

Charlie Paikert: Thanks Jeff. Glad to be here.

Jeffrey: Great. So Michael, let’s start with you. Why don’t you give us the broad strokes and some data points on the pandemics impact on the deal industry.

Michael: Sure. So, I think so far in in 2020 since mid-March, we’ve seen both deals being announced that is pulled back and then the deals that were announced prior to the pandemic, a lot of those have been redrawn. So you’ve seen a few deals fall through. I think Victoria Secrets, L brands that sealed the Sycamore was one of the bigger ones that fell through but I think others have gotten now renegotiated. So, it’s changed the scale of deals as well reduce those evaluations obviously and at the same time the announcements volume is half of what it was this time last year. I think especially at the top of the room, you are not seeing a hundred billion dollar transactions, you are seeing those companies kind of look inward and say, “How can we fix what we have and deal with what we’re going through” as opposed to write a hundred billion dollar M&A deal, check.

Jeffrey: Right. To most people, these are numbers, right? Fantastically large numbers and big figures, hundred billion dollars, we can’t– I personally can’t wrap my mind around how much money that is, right? But why should our listeners really care about a healthy deal market? What does that matter to people right now?

Michael: Well, look. I think deals are what powers change and innovation in a lot of ways. Whether it’s a large company looking at an encore division that they haven’t been investing in. They can use M&A to sell that division to an investor that can appreciate and grow and scale that business. At the same time, I think from a markets perspective, it’s another catalyst for stocks. It’s another place where debt can be offered and at a healthy price and again, these things you need liquidity, you need these markets moving. You have no deal activity, there’s a pretty big bottleneck within a lot of the markets out there.

Jeffrey: Right, and it makes a lot of sense and as you know, this is the RP HealthCast, my business fellow Healthcare and Pharma and BioTech companies and I know for them, from a deal scenario, it’s still quite frothy, right? So, have any other sectors of the economy been spared from this downturn?

Michael: So I think, similar to what you see in the public markets. I think the Technology companies have held up a little bit better. You’ve seen some Tech deals. You’ve seen sort of the consumer Tech business in Postmates, GrubHub. Those deals have been going on and continuing I think the urgency and sort of the switch to some of these consumer trends that we were already doing pre-COVID only accelerated and now companies such as Uber are seeing the value in having that delivery service in the scale of that delivery service. And then Healthcare as you mentioned, I think a lot of companies are– there hasn’t been a slowdown in a lot of Investments there whether it’s new drugs or new applications for existing drugs. I think people are still putting money to work in the Healthcare, in the Pharma and BioTech space at least.

Jeffrey: Yeah, so that’s where deals certainly are getting done in the Technology and high-Tech and BioTech and Healthcare. But you mentioned before, a couple retail establishments, manufacturers some of those deals that were expected to close were pulled hold as Myers saw to either back out. And can you walk us through some of the high-profile transactions that were scrapped due to the coronavirus?

Michael: Sure. So I think again, like I said the Victoria Secrets sale to L Brands was probably the most high profile and Sycamore pretty prolific retail private equity firm. They’ve done a lot of good, a lot of bad some– but some would say in retail over the years but I think that is probably the quintessential deal. You’ve seen a few others that I think are on the ropes. Probably the most interesting and maybe not the most high-profile but Simon Properties and Tubman. They’re two mall operators that were merging and that as far as I know still going on but there’s going to be I think some jostling over the price there whether those guys should continue with that deal. So yeah, those are probably the two that I am most interested in have been–

Jeffrey: Yeah. I mean it’s fascinating. So much goes on as part of the M&A. So, as part of the transaction, right? So you are negotiating the price but as part of that you have to assess the risk and to assess the risk, you have to a heck of a lot of due diligence not just on the markets and comparables but on the company itself and usually do that by going into a data room, going through file cabinets, going through all sorts of material. Now, how are companies and investment banks handling that due diligence process? They’re not able to visit plants and facilities and go into these data rooms are this–?

Michael: Yeah, you can’t have you know dinner with the executive team of a particular target you are looking at. So I’ve heard a couple of funny anecdotes that I’ve heard over the last couple of months on the– I think on a grander scheme, we’ve seen a few investment banks employ drones to do due diligence and whether you are going through a factory or a plant and the foreman is walking you through with a drone saying hey, can you fly it into that corner of the factory? Can I check out this piece of equipment? And we actually have a middle market. The Deal has a middle market event going on and we were talking to a couple of investment banks that work with smaller companies, family-owned companies and they were saying how they’re still doing the due diligence having the zoom calls and that but for their local businesses, they’re looking– they’re driving a couple hours and meeting a guy or gal that they would have had dinner with. They’re meeting them in their driveway for a drink and doing take out, having a sort of conference call in a socially distance sort of way. So a couple of I thought, those were pretty interesting. But it’s tough. I think Tech and BioTech, the physical space– BioTech maybe a little bit different but Tech, the physical space is not as important. It’s a human capital business. I think there’s a lot of industries that are human capital. So there’s– not as affected by some of this but with the manufacturing that kind of thing. Some interesting tactics being employed.

Jeffrey: That is I mean, necessity is the mother of all invention, right? That’s fantastic with the drones.

Michael: Yeah.

Jeffrey: Alright. So from very broad point of view, before we bring Charlie in. What’s your expectation for the remainder of 2020? As companies navigate the business challenges around the pandemic, do you think that M&A activity will soon begin to increase? And what sort of pressure are some of these funds going through by their investors?

Michael: I mean, I think that you are going to see continued status quo for M&A. I think it’s going to stay very similar. You’ll have a few drips and drabs of big transactions that make the second page of the front page of a Newspaper but I think it’s going to be pretty subdued for the rest of the year. I think the smaller sides of transactions company selling smaller divisions to concentrate on core. Smaller businesses where founders have to sell. Those kind of deals will continue but I do think it’s going to be tough to see a lot of large cap deals. Potentially some take private opportunities out there in the market for private equity. But yeah, I think it’s going to be a tough second half if I had to guess but barring a dramatic shift, but I do think things will remain relatively steady or be it maybe not the trajectory we had seen in 1819.

Jeffrey: Yeah. Great. Absolutely makes sense. Now Charlie, from your side of the business and you deal in something called RIA for the most part and now I want you to describe kind of what that is for our audience. Have you seen that sector slow down as much as Michael alluded to with the others?

Charlie: All right. All right, it is a registered investment advisors and they are otherwise known as independent advisors. They are fee-based for the most part. They’re different from brokerage firms like the Merrill Lynch’s of the world and they have a higher fiduciary duty to their clients. They’re the fastest-growing sector of the financial advisory business. They’re gaining I think at double-digit percentage increases and eating into the market share of the wire houses or brokerage firms. There has been a slowdown in the second quarter. Up for the last six years, the M&A market for RIAs has been going straight up. It’s been one increase after another. Quarterly and certainly annual increase but the second quarter of this year for the first time had a big double-digit decline–
a 17 percent decline in deals. This is according to the Devoe and Company statistics. There are an industry consultancy for M&A. And it was the slowest quarter I believe in deal volume in two years. Notably, the activity for smaller firms with less than one billion dollars in AUM assets under management declined dramatically. However, the activity– more than a billion in assets. The deal volume for those firms actually increased a bit. So that was interesting. Devoe thinks that this is what he calls the lull phase of M&A for this year impacted by COVID of course, and he does think a surge is coming but it all depends of course on the severity of how the virus is impacting the economy because advisers especially smaller advisors who do not have somebody who’s just focused on business, they’re busy dealing with clients. Whether it’s retail clients or smaller businesses. They need to spend a lot of time with clients and of course COVID is also impacting projections for the future and for a while anyway, it was impacting assets of the advisory firms, which is the lifeblood of advisory firms. So, still very uncertain times.

Jeffrey: Absolutely, and thank you for that. That was very broad. So, in a nutshell, deals are slowing down right? Due to the pandemic this [crosstalk] advisors.

Charlie: For now. Yeah.

Jeffrey: Smaller advisor, there’s a lot of hand-holding but it seems that while deals have slowed down, the structure of those deals have changed dramatically. So from what I understand, they used to be very rich upfront payments. You are paying for a book of business. And since this is changing, how are the deals now being structured in this pandemic world?

Charlie: So because of COVID, deal structure is changing, upfront payments were as high as seventy to even sometimes over ninety percent. Sellers were getting that cash up front and that has now gone down to around fifty percent more or less. Buyers want to mitigate the risk they’re taking and they want to share risk with sellers. So that’s a big change. The sellers are no longer as much in the driver seat. There’s more emphasis on what’s called contingent payments or earn outs where the seller has to hit certain targets in the metrics that they are expected to generate for the buyer. So, one other change in deal structure is that those contingent payments are now stretching out to three or four years. Whereas in the bull market up until March had been compressed to sometimes as short as one year or two years, but as John Fury whose prominent industry consultant has said the emphasis now in M&A is shared risk based on shared outcome.

Jeffrey: Right. And that makes sense. Certainly with more risk in the marketplace. Now, what about the negotiations between the buyers and the sellers? Is a negotiation more protracted, is it more difficult to bring a deal over the finish line now?

Charlie: I think it is. The negotiations are more difficult. I did a story recently for our RIABiz and one of the big buyers in the industry used the term, use the phrase ‘heightened tensions’. It’s not as casual. It’s obviously not in person anymore. And as I mentioned earlier, there’s a lot more risk. They are negotiating exactly what are their earn out incentives going to be? Before the pandemic, it sometimes didn’t really matter as much if the sellers didn’t meet their earn out targets. Buyers either let it go or was actually in the negotiations there was some cushion, but now as Corey Kupfer who’s a prominent attorney in the field told me for that article, sellers are not in the driver seat as much. The sellers are not in the driver’s seat as much anymore. So, it’s a different ball game, but it’s also mitigated by the fact that seemingly the supply, the demand exceeds the supply. There are more buyers than sellers. One negotiator told me that he is seeing as many as ten buyers for every seller. I think that might be a bit exaggerated, but there does seem to be agreement that it still is a seller’s market. So, that makes things very interesting.

Jeffrey: No, absolutely. Well that bodes well for sellers, but it doesn’t excuse the risk that is still at the marketplace right now.

Charlie: Right.

Jeffrey: Switching topics for one quick sec. So, I want to talk about one non deal question. Something that is kind of affecting everybody in this pandemic. It seems a number of financially secure RIA firms received a number of funds from the Payroll Protection Program the PPP and like a large firm like Ritholtz Wealth. I think it was written that they accepted 1.3 billion dollars or something from the Payroll Protection Programs. Were you surprised that wealth managers would seek money is meant for small business owners at the risk of losing their businesses?

Charlie: Oh, that’s been a huge topic in the industry. I wrote an opinion piece in RIABiz a week before last and the point that I think a lot of people kidded on was– So on the one hand, wealth managers were telling reporters, myself included, that they were doing great. They were getting new clients. They were getting new business. Everything was good. And I believe they were telling clients similarly that they were doing well. However, a lot of them it turns out at the same time, who were applying for and received PPP loans had to certify. Certify to the government that the funds that they were seeking were quote “necessary to support ongoing operations”. Wow! So, which is it? Right?

Uhhh wait a minute, you told me you are doing great? But to get the money you told the government that you needed the money to keep in business. So that was a big point of contention. The other point of contention, and this was raised by Dan Weiner who is the chairman of Advisor Investments. He’s an RIA who originally applied for a PPP loan, but then withdrew and decided not to because he thought that small businesses were more deserving and he pointed out that wealth managers who emphasize of course financial planning to their clients and tell clients that they need a rainy day fund of six odd months of cash on hand. Apparently didn’t have one themselves. So… what’s going on? Why weren’t they better managed?

Now, from their point of view, the RIAs would argue that they need liquidity like everyone else and at the time in March when– perhaps in April, early April when the loans were originally being applied for. There was a severe market downturn and their profit margins and ability to pay was presumably in question. However, that market downturn of course turned out to be very short, but from a business point of view, if you can get low-cost working capital from the government that is available, perhaps you can argue as they do that you should take advantage of that as a going concern. But again, someone like Wiener would argue that if these loans are forgivable as they could be if advisors spend sixty percent of the loans on salaries within twenty-four weeks, Weiner would argue that that’s double-dipping, that their advisors are charging client fees and they’re also ultimately getting another slice of money from clients through their tax dollars. And then I think the final argument is that however much the RIAs wanted and we’re able to receive this money, the fact is that unlike restaurants and hair salons and other small businesses, their business never closed. It always stayed open and demand for their business by all measures seemingly never went down. And recurring fees kept coming and the conclusion of the article, the opinion piece that I wrote, I quoted “Another industry consultant Jamie McLaughlin who said that this is not a glorious chapter in the history of the RIA industry.”

Jeffrey: Well, thank you. Now, one last question for the both of you actually. Before time runs out on us. During the past five months of the pandemic, where have you seen the smart money quote unquote “smart money”, the private equity and venture capital financing’s go? Michael, let’s start with you. Where are people putting their money? Where’s the M&A? Where are these– if cash are being stockpiled right now, where is that little bit being spent today and where do you expect to being spent by the end of the year?

Michael: Sure. So, I think there’s a couple of places I think. Like I said earlier the sort of small and mid-cap areas of the world are going to continue to see deal activity. I think sort of across all sectors, but I think if you are watching the public markets and you are watching some of these companies like Norwegian Cruise Lines or Dave & Buster’s, they’ve done what are called ‘pipe deals’ where they’re selling these big swaths to private equity firms. I think you are going to see more of those transactions going on. And I think that when you look at those companies that private equity firms are investing in in the public markets at a reduced evaluation, that’s going to be something that I think a retail investor might want to take a look at and say “Oh, why are they putting the money into this company that seemingly has no end in sight to their troubles.” Sort of zigging when everyone else is a zagging or zagging everyone else is zigging if you will. So I would look to those types of industries and things that people are really aren’t looking at right now from a retail perspective.

Jeffrey: The smart money you feel is kind of being contrarian or will be contrarian for the end of the year?

Michael: Yeah.

Jeffrey: Okay. And Charlie, from your side of the business?

Charlie: In the advisory business, we are seeing private equity still continue to invest in RIA, M&A when they can. Now, as we discussed previously, there is a slowdown for the reasons we discussed because of the pandemic and advisers have a lot of other things to do, but when they can invest they are Mercer advisors is one of duh big RIA firms who is controlled by certainly backed by one of the big PE firms. They are aggressive buyers. We’ve seen over the last few months. We’ve seen PE firms takes stakes in big RIAs who are also buyers themselves like Beacon Point, Creative Planning both have sold stakes to private equity. And one of the biggest RIAs, Hightower, that is controlled by TH Lee, a big PE firm. Just today they announced that they have taken a minority stake in a three billion dollar Texas Firm Frontier Investment Management. So, PE is full steam ahead when they can.

Jeffrey: Got it. Well gentlemen, thank you so much. This has been really interesting and very enjoyable. So thank you for joining me.

Michael: Thank you Jeff.

Charlie: Yeah, Jeff. Thanks for everything.

Jeffrey: We hope you enjoyed this week’s podcast. If you have any questions comments, or future story suggestions, please reach out to us on social media. Thank you, and we hope you enjoyed the RP HealthCast.

We talk with our guest this week, Julie Hyman of YahooFinance, about companies big and small having to manage their businesses and employees around the complexities of the coronavirus—and now finally—a larger focus on social justice issues.

TRANSCRIPT

Jeffrey Freedman: Hello and welcome to the RP HealthCast by RooneyPartners. I am your host, Jeffrey Freedman. To say that our lives have been turned upside down this year, it’s an understatement. Between worrying about our health, worrying about our jobs, our finances in the economy, worrying about who to trust, worrying about our family, and getting our kids back to school. It is a wonder we are still able to function in society, but we must and we are. As we adapt, our economy must continue to open safely and while doing that, companies as well, they have to learn to adapt to this new normal. Both for their employees and for their customers, and for attracting new customers. But what is that new normal? Not only do corporations have to change the way they do business due to the coronavirus but as importantly, our country has reached an inflection point due to a groundswell of focus on civil liberties and social justice. How is Corporate America going to respond to this hopefully new norm? And have more of a focus on social and racial equality. To talk about this with us today is Julie Hyman. Julie is an on-air anchor at Yahoo finance, and she co-hosts the program: On The Move. Julie has covered financial markets for over 20 years and spent the bulk of her career at Bloomberg television, as an anchor and Senior markets correspondent. Julie, it is so great to have you here with us today. 

Julie Hyman: Thanks for having me. 

Jeffrey: Before we get into the heavy topics of how companies are responding to what I am terming the new normal. I would like to introduce you to the audience and explain your background a little bit. From your time as a reporter at the Washington Times to working at the Paris Bureau for Bloomberg and then as a Bloomberg television host and now co-hosting On the Move, your show at Yahoo Finance, it seems you have always been on the business finance and corporate reporting side of the news. For doing this for so long, what do you enjoy about that? How is your industry changed over the past 20 years? 

Julie: Wow, that is a big question. I enjoy following how markets, finance, business, kind of intersects with everything else, right? Because what I have discovered during my time covering all of these topics is that they do kind of intertwine with politics, with regular people’s lives in ways that people are not even cognizant of. So it is nice to draw those connections. What I also really like about it is the sort of education piece and explanation piece. If you will, sort of explaining to people how markets work, how businesses work, and why they should care for that matter as well. In terms of how the business has changed during my career, I think it is like many businesses, it has become a lot more digital. That has been a big change. This just has been happening in journalism generally, not just business journalism, of course. A lot less locally-based, but what has also been interesting in business news in particular is the increased transparency. I find that when I started, there were sort of more scoops. There was more inside information one could gain as a reporter. Not the sort of SCC not allowed inside information. But to find out stuff that other people did not know. Just because of disclosure because of social media, you have to work harder to sort of find those kinds of nuggets and stories that are not widely available and known.

Jeffrey: It has changed the digital aspect of it. It kind of brings it a little quicker. The news gets to people a lot faster and you have to be more on top of it, I guess from that aspect. 

Julie: Yeah, you have to be more on top of it. But there is also because of that in part, there has always been a good space for analysis. I think now it is more important than ever because things come so quickly. It is very important to sort of take a step back and explain things to people. Rather than, you have to have your sort of first blush analysis, but you also have to take a beat and say “Okay, this is what this means.” 

Jeffrey: I think you guys did that well. So we have mentioned before you host a show on Yahoo Finance called On The Move and you have been doing that for a couple of years. And you talk about localization but you guys moved into a brand new studio last year, I believe. 

Julie: We did. 

Jeffrey: Yes, and Kevin Chupka was telling us about that a couple of months ago. But you are now producing and co-hosting the show from home, right? 

Julie: Yes, I am. My normal home is New York City, but we have had a place in the Catskills for about eleven years. So when this began we came up here and so I have been doing this show from our spare bedroom here for the past several months. 

Jeffrey: What have you, I mean, working from home we all have similar experiences. I was telling you about the construction across the street. What are the learnings that you have now on producing live television from home? What do you think when you get back to normal, whatever that is. Are you going to keep any of these learnings? Do you think any of this will be ongoing for you? 

Julie: That is a great question. I think some of the things that serve you well anytime, serve you well now, being nimble. I think we have dealt with a lot of technical difficulties as everyone has. I think we have learned to sort of deal with those and talk through them. I think there is a certain level of transparency that you did not necessarily have in the studio. In other words, if a guest needs to unmute themselves, you just say “Can you please unmute yourself?”. Whereas in the studio there would be people, sort of audio people frantically working behind the scenes to repair that stuff. I personally as a consumer of news and also as a maker of news programming, I kind of like it when the behind the scene shows. So I would not mind preserving some of that when we get back to it. That has been interesting and educational and it has also been an equalizer in a nice way.mA CEO can forget to unmute him or herself as equally as a fellow reporter or anchor can. We are all sort of in the same boat right now. We are all operating under pretty stressed conditions in some cases. We are all concerned about becoming ill. We are concerned about people we know who have become ill or even died in some cases. We do not know what the economy is going to do. We are all sort of experiencing this together. I hope that we can retain some of that feeling and empathy as we go forward. That just goes for regular life and being fellow humans, but I hope it also goes for the workplace and sort of trying to see into what our colleagues and what our interview subjects might be going through as well.

Jeffrey: I think that is, not only is it a fantastic segway, but it is a fantastic sense of it. I mean I think this whole aspect makes us more human. It shows our humanity and it takes a part of that veil. I want to segway into the topic of this podcast, about companies. Companies both big and small, now that we are coming back to work, we have to manage our businesses, we have to manage our employees around a lot of new complexities. So we have the coronavirus right now. Finally a larger focus on social justice issues. Companies have to manage both of these dynamic issues simultaneously. As you have been speaking with all the CEOs out there and different work, you know from the C-suite. What do you think has been the cumulative impact of these two situations and this historic moment in time, both in brand image and personas of these large corporations. How have these companies been able to adapt? 

Julie: I would say first of all sort of by way of a backdrop. I think over the past several years, there has been this corporate movement to sort of take on some of the roles that were traditionally more governmental. You see this in places like Davos, but you also see it in just everyday corporate operations. I think, to be frank, this is particularly true because the Trump Administration has not been as active perhaps on some of those issues. For example climate activism, you have seen corporations try to pick up that mantle over the past several years as the US has withdrawn from the Paris Climate Agreement. We are already seeing some movement in that direction. Some of that movement has been not genuine, to be honest, and some of it has been more genuine and more real. But there has been that sort of shifting movement and self-perception on the part of companies. You saw that reflected in The Business Roundtable adoption, late last year, that companies were going to focus more on all stakeholders not just shareholders of the company? I think now that has been put to the test in a lot of new and interesting ways during coronavirus. You have seen several companies when this first started happening who said, particularly retailers, whose folks were still going to work. “We are still going to pay people if they decide that they do not feel safe. Or we are going to give them a bonus for coming to work under these conditions.” You’ve even seen it health-wise much more recently now, Target, Walmart, CVS, Starbucks. All of these companies have been saying the federal government is not having a mask mandate, but we are going to have a mask mandate for anyone coming into the stores. So on the health side, it has been happening. And now it is happening on the social justice side as well. Wherein companies, I think over the past several years, it was more sort of consumer pushing, right? The consumer said, “I expect certain things from the companies I buy from and deal with.” Now the companies themselves are starting to finally become a little more proactive on these issues as well.Just sort of getting back to what I was saying earlier, I think part of what may be happening also, is that leaders of companies again are experiencing this if not equally. We know for example coronavirus has affected people of color in a higher percentage than it has non-minorities. However, I think that even captains of the industry if you will, they have been stuck at home too. They have been seeing what has been going on. They probably have people in their families who have been affected by all of this. Their employees are affected by this. I think in a way it has been an equalizer. Maybe that has also created more of an empathetic response. Maybe I am viewing that naively in thinking that. That it is entirely altruistic because I am sure it is not entirely altruistic right? Some of these companies want to have a good image and image of social justice and image of caring about people’s health, or maybe it is a combination of both. 

Jeffrey: I think it has to be a combination of both because I think we started by saying we are all human and we all have these same issues. We are all going through this together. I think that is what is showing right now and I think that is great. But have you found any industry sectors or companies that you think are making these pivots better than others? 

Julie: I mentioned some of the retailers and some of the actions that they have been taking. I have been pleasantly surprised by a company like Walmart, which was you know, used to be the Boogie Man. That would come in and shut down all the local businesses and in town. In some cases now on issues of social activism have been a little bit more out front. I think financial services which traditionally have not been that inclusive, I think they still have a ways to go. I mean listen Corporate America in general still has a ways to go when it comes to diversity and inclusion. I do not know that this is industry-specific rather than sort of company-specific of companies that are pushing ahead and doing a little bit better with it. 

Jeffrey: We are certainly seeing this from the PR side. People have been stepping up and saying great things. You mentioned Walmart, right? So now masks are necessary and all Walmarts and I think that is fantastic. But what about from a kind of a fundamentalist systemic change like a change in hiring practices, more diversity in the c-suite? Do you think at this time, this actually will lead to more sustainable systemic change? 

Julie: I hope so. I mean if you listen to Barack Obama, for example when he made comments about this and if you listen to some other folks who have been watching this fight for years, they will say well the difference now is that you also have a lot of white people who are taking to the streets who were participating in these protests. We have seen a little bit of loss of momentum perhaps or at least not as many protests going on as this has progressed. We have still been having a lot of conversations with people whose job it is to improve diversity and inclusion. I think they have been very busy filling these calls and trying to improve things. I think it is an open question. We are not going to know until we know, I mean a lot of companies right now also are not hiring. It is tough to tell if they are going to change their hiring practices because they are not hiring anybody right now. Technology, which has been one of the industries, I guess about industries that are doing it right. I think Tech has pretty clearly been an industry that is not doing it right over the past several years in terms of inclusivity. They are hiring in many cases. So we will see what happens. It is really difficult to know right now. A lot of companies are saying the right things, but I think we are going to have to just wait and see what the proof is.

Jeffrey: As you mentioned a lot of companies are not hiring and that brings me to another topic here. That is our economy. So when we take a look at the market and economic impacts that the pandemic has had versus if we look back at the 2008 recession there, what parallels do you see if any, and what are some of the tangible differences? 

Julie: I think that you do not necessarily have a systemic financial risk as you did then. There are some issues with, are we going to see some credit losses when we have just recently had the banks’ report right? All of them are setting aside more money for credit losses, but I have not seen any suggestion that that is going to become more of a systemic problem. So I tend to think there are more differences than there are similarities between that situation and this situation. One lesson from the financial crisis is to be careful. Be careful of diminishing the risks and something I have learned as a journalist for all these years is that you should not talk in absolutes. So to say, “Okay, it is completely different”. There are no systemic risks, which is what I just said. I am going to hedge a little bit and say, “Of course, we do not know.” There is always the Black Swan. There is always the thing that maybe you do not see. What I do think is going to be one of the big effects of this economic crisis is that once again, we are going to see a much more dramatic widening of the Wealth Gap in this country, for several different reasons. Corporate America is going to be fine. Yes, you are going to have some casualties. Yes, you are going to have particular pain in industries like the airline industry, and the hospitality and leisure industry. Corporate America in general I think is going to be just fine. Small businesses are going to go under in pretty unprecedented numbers, especially if we have more rolling closures going on throughout the United States. Businesses have already gone out of business, you know, restaurants and such. That is going to widen the gap. We are going to see because of what is happening with schooling, a widening in the education gap which then exacerbates the wealth gap as well. Because as I mentioned we are seeing communities of color that are more adversely impacted by a coronavirus. I think that the US economy, you know, it might take a couple of years to come back to where it was before as a whole. I am always interested in economic stories. And yes, you talk about the whole but you gotta be interested in the individual stories. Whether it is individual companies and individual people. Because those are interesting and that is good to get back to the human stuff. That is the human stuff. So I think that is going to be one of the biggest takeaways is the widening of that gap in the wake of all of this. 

Jeffrey: The only thing you know going forward as you said is we are driving down this road and all we have is a rearview mirror, right? So we do not know what the future looks like. Certainly from a small business point of view, I would have to imagine that is going to trickle down and it has to affect the economy. The economy over the next couple of years along with this election. From working On The Move as a co-host you speak to all these market and economic experts every day, name a couple like one or two insights that struck you the most from your interviews recently. 

Julie: We have been talking a lot about the so-called work from home trade. That as more of us migrate to working from home, in some cases perhaps over the longer term, right? Because a lot of the tech firms, in particular, are saying they are going to allow people to work from home for a long time. I think the idea that there are companies that are going to benefit from that is an interesting one. Whether it is the classic ones like Zoom, that so many people are communicating on right now to other sorts of cloud-based companies that are helping people work at home in greater numbers. I think it makes sense to think that there is going to be a longer-term trade for that. We also talked to a strategist today who said another effect perhaps of the longer-term work from home trade is that there is not going to be inflation anytime soon. It is just that it is a lower-cost way to operate. So that is an interesting concept to me. Sort of related to that I think is the idea that the FED is still pumping so much stimulus into the economy. Something Mohamed El-Erian, who we speak to as a regular guest on the show, has sort of hammered over and over again is as long as the FED is out there propping things up, the market is likely to behave as it has to some extent barring a shock-like we saw when this pandemic first came to be. Until the FED starts to pull back, it is hard to imagine things from a market perspective are going to change significantly. That makes sense to me and that is kind of an interesting idea. It also means it is going to be perhaps tougher for people in the market to make money, to sort of differentiate themselves. Then you also have this trend that I think has been interesting, the so-called Robin Hood Trader. I think a lot of strategies have said, “Well that is not affecting the overall Market. It’s affecting individual stocks.” That is not so much a market inside, I am just interested to see how that trend is going to evolve. And whether those people are going to sort of stick around and keep trading at home as the country gets back to work. 

Jeffrey: You do not think ten thousand new accounts per hour for Tesla is going to make a difference? It is crazy. 

Julie: Well it makes a difference to Tesla but maybe not to things overall. 

Jeffrey: I agree. That is the economic aspect of it. What about if we could talk and finish on maybe the social justice aspect of it. The different guests that you come on, it is a very powerful and very topical aspect to discuss. What has been your takeaway from these issues? And where do you think we go from here? 

Julie: I think when everyone, “everyone,” I am exaggerating. When how to be an anti-racist is like on the bestseller list for multiple weeks in a row, I have to hope that things will get better. Listen to people who are bigots and who are racists are going to remain bigots and racists. It is people, probably like myself, who have done things over the years because of unconscious bias that now we are hoping to work on a remedy. I am hopeful that those things will get better. I am hopeful that companies, my company, for example, has been having a lot of discussions about these issues in a way that it did not before. I think other companies are doing the same. Maybe it would not be the big dramatic one year, two year change, but you know if my kids are learning about this stuff. I hope that there will be generational change both on an individual and on a corporate level. 

Julie: I do think that you know when for example, we talked to a company recently that provides services to corporate boards. They are starting a new effort where all of the board members who are in their network when there is a new position on a board that opens up, they are going to ask everyone to nominate minorities; women, people of color to the boards. Because the old canard is that “oh, well, we cannot find anybody qualified who is a woman or who is a person of color.” And so I think that kind of effort helps put that canard to rest and helps populate these boards with diverse individuals. Things like that do give me some hope that things are indeed going to change even if I am not under the illusion that It is going to be overnight. 

Jeffrey: I think that is great. I think you struck upon a great word about that education. And what we could do for our children has been better done for us. I think that is the greatest gift that we can give going forward. Julie, thank you so much for your time today. This has been great. I very much appreciate you being here with us. 

Julie: It is my pleasure. I enjoyed it. 

Jeffrey: We hope you enjoyed this week’s podcast. If you have any questions, comments, or future story suggestions, please reach out to us on social media. Thank you, and we hope you enjoyed the RP HealthCast.

Melinda Wenner Moyer writes a column for Slate and is a contributing editor at Scientific American magazine – she writes for the New York Times, Mother Jones, and a number of women’s magazines.

TRANSCRIPT

Jeffrey Freedman: Hello and welcome to the RP HealthCast by Rooney Partners. I am your host Jeffrey Freedman. So there is an old saying and it goes: “the more you learn, the less you know.” That may sound paradoxical but unfortunately, it is part of the issue we are having with really understanding the coronavirus. You see each day brings about new findings, and that is great. But these new findings are raising new questions. Now, for example, we are finding out that the disease is not just a respiratory illness, but it is causing a lot of other issues like stroke and brain damage as well. So to break this down and to talk about some of the other neurological issues caused by COVID-19, we have with us Melinda Wenner Moyer. Melinda is a science writer and she is a visiting scholar at NYU’s Arthur L Carter Journalism Institute. Melinda writes a column for SLATE and she is a contributing editor at Scientific American Magazine. She also writes for the New York Times, for Mother Jones, and a number of other women’s magazines. Melinda, it is a pleasure to have you here with us today. 

Melinda Moyer: Thank you so much for having me. 

Jeffrey: Now before we discuss your recent New York Times op-ed piece. I just want to set the stage to introduce you to our listeners. So in 2006, you earned a Master of Arts in Science Health and Environmental Reporting from my alma mater, New York University. Since then you have been the recipient of numerous awards and citations for your Science and Healthcare reporting and you even received a fellowship from the Alicia Patterson Foundation for Journalism. Did you always want to be a science and healthcare journalist and can you tell us about this fellowship? 

Melinda: Sure. So no, I think I had a very roundabout way of becoming a science journalist. So I mean, I have always loved to write but I never really knew what to do with that and I actually studied music, piano performance and music composition in college and molecular biology. 

Jeffrey: Because they go together. 

Melinda: Yes. I was a busy college student and really did not know what I was doing when I graduated from college, and I ended up working in biotech for a few years in the UK in marketing. I realized that I was doing some writing for the marketing literature for this company and it kind of reinvigorated my love of writing and I realized I love science. I love writing. I kind of gave up the music stuff at that point and I thought, I wonder if there is a way to marry these two things and write about science and I was reading a lot of New Scientist magazines at the time. It just kind of dawned on me one day. Maybe I could be a science journalist and that is when I applied to NYU and moved to New York and did that program and I am so happy in my job. I love my job and the fellowship that I got that you mentioned the Alicia Patterson Foundation Fellowship was also just wonderful. So this Foundation is named in honor of Alicia Patterson who was the editor and publisher of Newsday for more than twenty-two years, and this Fellowship essentially is awarded to a handful of journalists around the country every year and I decided to apply and I wanted to do a fellowship on vaccines. I have always been really attracted to controversial and complicated scientific topics. So, this seemed like a natural choice for me and it was amazing. So with the money from the foundation, I went to West Africa to report a piece and just learned a ton. So it was amazing.

Jeffrey: Wow, that is incredibly interesting. I want to get into the vaccines and talk more about that. We will do that in a little bit, but on June 29th to New York Times published an op-ed piece under your byline. It was entitled “Can COVID Damage the Brain,” right? So it is interesting. We always talk about it as a respiratory illness. So I would like to walk through some of the different cases and patients you wrote about regarding these brain issues. One case I particularly probably start with was the case of Chelsea Eleanor and what was our experience? 

Melinda: So Chelsea is thirty-seven years old and she lives in Oregon. She was previously just a very healthy young woman. On March 9th she got essentially the worst headache of her life and she told me she gets migraines. She has had a lot of headaches but this was a headache like no other and she did not know what it was. She did suspect maybe this is COVID, maybe it is just a weird symptom of COVID and she tried to get a test but back then as you may remember it was very hard to get COVID tests. So she was not able to get a test until more than a month later and when she did it came back positive but throughout her COVID experience, which is still ongoing. She is still not well. She had dizziness, lightheadedness, blurry vision, she falls down sometimes, she is confused and forgetful. She says it kind of feels like she has early dementia and she’s also lost her sense of taste and smell which is something we have heard about with some coronavirus patients. She said she lost almost thirty pounds over the course of forty-five days because she just did not want to eat. She said numbness in her fingertips and in her toes and she says she has gone deaf in her left ear for the last month. So it is just a crazy constellation of terrible debilitating symptoms a lot of which seem to affect her nervous system. 

Jeffrey: That is a crazy story. It is awful. You wrote the op-ed. Actually I quoted it earlier, “The more we learn about the coronavirus, the more we realized it is not just a respiratory infection.” So I would like for you to elaborate a little bit on that thought and describe what you found as the evolution of reported medical conditions associated with the virus. 

Melinda: Yes. Sure. So there is now a lot of evidence that the coronavirus even though it infects the lungs first, it is really not a respiratory disease or not just a respiratory disease at least. Most people who are developing really serious symptoms and who are dying or not dying from pneumonia or other respiratory complications. This is in part because it has largely been found actually to be a blood vessel disease, a vascular disease. So this cellular receptor that the virus uses to get into cells, this receptor is found on endothelial cells which line the blood vessels and this means that the virus can infect cells in many different organs and systems that are rich with blood vessels. So kidneys, liver, the circulatory system and the nervous system. It can directly infect cells in these different systems, but also indirectly affect them through the kind of widespread inflammation that then harms parts of the body, even if they are not directly infected with the virus. So this all makes sense considering that the symptoms that people are reporting with the coronavirus are not just respiratory systems. They are kind of all over the place as Chelsea’s example illustrates. 

Jeffrey: So it is kind of like inflammation and hypoxia, like all together 

Melinda: Yes. It is a lot of stuff. So many organs are getting harmed in the process. 

Jeffrey: Yes. All right, so as the virus’s impact is on the brain. What have you been hearing from the medical authorities and other people about the neurology nightmare that they are experiencing?

Melinda: Yes. So right now there are still so many more questions than there are answers about how COVID affects the brain but again, we can certainly get hints from the symptoms that patients are experiencing. So in addition to the ones that Chelsea has experienced there are a lot of patients with brain fog, with seizures and confusion and many of these are persisting for a lot longer than the respiratory symptoms are. There have been studies that have shown that these kinds of nervous system issues are pretty common. So there was one study that evaluated patients who had been hospitalized for coronavirus in China and found that more than a third of patients had nervous system symptoms, which included seizures and even impaired consciousness. In France, there was a study that found that eighty four percent of COVID patients who have been admitted to the ICU also have neurological problems and a lot of them continue to have neurological problems after they were discharged. So these all collectively tell us the nervous systems being affected and there is also some growing evidence that we were starting to understand a piece together how this happens and how the virus is doing this but there is controversy too. When we think about a virus directly infecting cells in the nervous system, this is one claim that is a little bit controversial. There is some evidence that suggests that the virus can directly infect nerves because nerves also express receptors, I mentioned before. Some researchers think that actually the virus is traveling along nerves as it moves to different parts of the body. So one piece of evidence is case reports and there was a case report of a woman in Los Angeles who was found to have the virus in her cerebral spinal fluid. The reason this is controversial is because there are not a lot of studies yet showing that the virus can directly get into nerve cells. There are a few studies here in their case studies here and there but that is in part because it is really hard to get direct evidence of viruses inside the nervous system infecting the nervous system. You cannot just do a biopsy of somebody’s brain in an outpatient clinic and then send them home. So often this evidence comes from post-mortem brain studies and there are not a lot of those and even if we think the virus does get inside these brain cells, we do not know what it then does. There is really not a lot of information yet so researchers are speculating based on what we know can happen when viruses infect brain cells. It might affect the function of these brain cells and might even affect the structure of the brain but ultimately we do not know. We know there are reasons to be concerned. We know we need to be doing more research but when it comes to what is actually happening inside the brain, it is really hard to tell. 

Jeffrey: Yes, so your op-ed piece, you talk a lot about the trauma as you just mentioned, the brain inflammation and cellular inflammation. We have also heard a lot in the news about this inflammation leading to cytokines storms. So can you explain a little bit about what that is and how it affects the brain? 

Melinda: Yes. Sure. So separate from this question of whether the virus is getting inside brain cells and affecting brain cells directly. One thing we are pretty sure of, scientists are pretty sure of right now is that the virus is leading to a kind of widespread inflammation throughout the body and including the brain and we know inflammation is very bad for the brain. So when people have systemic like really serious infections these infections can kind of poke at the brain and nervous system, communicate with it and activate immune molecules outside the brain that then travel into the brain. These immune molecules are helpful and that they are trying to fight off the infection, but they are also kind of like a double-edged sword. They are also very harsh and abrasive and they damage a person’s own brain cells. So they are meant to be killing just the virus that is not supposed to be there but they are also inevitably damaging and killing some brain cells. We know even if the virus is not getting directly into the brain that the systemic inflammation that happens as a result of the virus is affecting the brain through this inflammation, through these immune molecules and in really severe circumstances this inflammation can lead to a cytokine storm which we have all heard about. Cytokines are a class of immune molecules that are important for fighting off infections. There are a bunch of different kinds and they are harsh and abrasive and can harm somebody’s own body in the process of fighting off an infection. So what happens with the cytokine storm is that your body’s cytokine production just goes haywire. It goes into overdrive and essentially attacks your own body and tissues and organs along with the virus and your body essentially becomes this kind of collateral damage. It can lead to organ failure, blood pressure drops and racing heartbeat. I guess the other thing that is important to mention — a lot of great news here, right? The other thing that is important to mention about inflammation is that it also leads to blood clots, which we have heard a lot about with coronavirus. So blood clots occur, and this is again because coronavirus is largely a vascular disease. Blood clots occur in as many as thirty percent of critically ill COVID patients. These clots can get into the brain and affect how it functions and they can also lead to strokes and strokes are very bad for the brain because they starve it of oxygen. All these different ways that inflammation itself regardless of whether the virus is getting into the brain, this inflammation affects the brain. 

Jeffrey: Yes. The cytokine storm aspect is scary stuff. So there was a group quote in your op-ed. It was from Dr. Majid Fotuhi, a neurologist and neuroscientist affiliated with Johns Hopkins. You quoted him as saying, “It is like the defense system is called to a quiet small riot in one neighborhood, and all of a sudden the whole military’s ticked off and they do not know what is going on so they just bomb everything.” I thought that was a pretty powerful description and kind of summed it up really well for me to understand that, so thank you for sharing that. Another health condition that you wrote about that has been triggered by the coronavirus, and I hope I am pronouncing it right, Guillain-Barre syndrome. Can you talk about the case of Michele Heart in this instance? 

Melinda: Yes. So Michelle is a forty-one-year-old psychotherapist who lives in Colorado and on April 25th she started having really bizarre symptoms. High blood pressure, racing heart, pins and needles, shooting nerve pain and like a burning sensation in her skin along with other weird brain-related issues like memory loss and brain fog. When she first went to the ER she was kind of dismissed by doctors. She thought maybe this is coronavirus and they said, “No, this does not sound like the coronavirus. Go home and get some rest.” They did not give her a COVID test, even though she asked for one because again her symptoms were atypical and as we are learning a lot of these symptoms are atypical but back then the doctors really did not flag it. She ended up back in Urgent Care back in the ER and was diagnosed about a week later and had coronavirus. Very soon after that she was hospitalized because those symptoms of the nerve pain, burning sensations, high blood pressure were getting worse and she was given a lot of tests and she was diagnosed with Guillain-Barre syndrome, which I also cannot say, which is an autoimmune disease in which the body basically starts attacking its own nerves. In fact, she was back in the hospital last week. I was in touch with her. She is getting more treatment for this autoimmune disease. So this is thought to be incited by the coronavirus in rare cases. There have been COVID patients that have developed these kinds of neurological autoimmune diseases, which may again be triggered by inflammation kind of going crazy and the body suddenly just starting to attack its own nervous system tissue.It is really scary.

Jeffrey: So it is different types of cytokines storms with a body just starting attacking things regardless of where the infection is? 

Melinda: Right. 

Jeffrey: So all right to go back then to actually where we started with vaccines and what you like to study. You have studied and reported on the anti-vaxxer movement and I saw a Washington post poll last week that twenty-seven percent of those people surveyed do not intend on getting a coronavirus vaccine when it is available. Now, how do you feel about this? Are you concerned that once we have approved vaccines that resistance can mount to take the vaccine, so that would leave a lot of people exposed to the coronavirus kind of making the vaccine negligible in its effect. What do you think? 

Melinda: Yes, that poll is really terrifying. I hope that it does not turn out to be twenty-seven percent of people who reject the vaccine, that would be hugely problematic because I mean ideally with a vaccine like this you want to reach herd immunity so that we minimize the transmission of the virus. So once enough people are immune, it really stops spreading as easily. One of the reasons it is so important to reach this herd immunity is because there are a lot of people in the country who cannot get vaccines because they are immunocompromised. They have other medical issues that prevent them and those are people who are going to be at very high risk for serious complications with the coronavirus. So ideally we want to be protecting people who cannot get a vaccine. The other thing is, I mean vaccines are amazing, but none of them are a hundred percent effective. Once we get a vaccine for coronavirus we do not know at this point whether it will be ninety percent effective protecting people or eighty percent. Hopefully, it is ninety-nine percent but a lot of people I think have this idea of, well, it does not matter if other people do not get vaccinated because if I get vaccinated and my family gets vaccinated, then it will be fine. There is no risk to us of getting the coronavirus and that is not necessarily true because vaccines are not a hundred percent. So ideally you want to have everybody getting this vaccine. So even though it may not be a perfect vaccine it will get to this herd immunity threshold and really just slow down and stop coronavirus transmission. 

Jeffrey: I hope so, but I think we are several months away still until we find out about vaccines. So with that, I would love to talk further as we get closer to these vaccines. Maybe have you back to talk more about vaccines and the thought about herd immunity, but thank you so much for your time today. This has been really, really informative. 

Melinda: You are welcome. My pleasure. Thanks for having me. 

Jeffrey: We hope you enjoyed this week’s podcast. If you have any questions, comments, or future story suggestions, please reach out to us on social media. Thank you, and we hope you enjoyed the RP Healthcast.

Misinformation about COVID-19 seems to spread faster than microbes. In this episode, Emmy-award winning journalist, author, professor and epidemiologist, Dr. Seema Yasmin, helps separate the fact from the fiction.

TRANSCRIPT

Jeffrey Freedman: Hello and welcome to the RP HealthCast by Rooney Partners. I’m your host, Jeffrey Freedman. For several weeks on this podcast, we’ve been learning more and more information about the Coronavirus in terms of the disease, things to be aware of, potential ways to stay safe, and drugs and development to treat it. I keep saying that the more we find out, the more we realize what we don’t know. While I still believe this is absolutely accurate, there’s something else we need to be careful of. With the amount of new information that’s being put out into the public, sometimes that information gets misunderstood or twisted to meet different agendas. Part of the problem we’re having in this country right now is that at times we don’t know who we can turn to for unbiased truth and we start to question some of the information coming from our leadership. Our guest this week has spent her entire career searching for and communicating the unbiased truth about diseases ranging from Ebola to the Coronavirus. Dr. Seema Yasmin is a trained medical doctor, an epidemiologist, a university Professor, a sought-after lecturer, an on-air medical analyst for CNN, an author and she hosts a YouTube series for wired that debunks myths about diseases such as the Coronavirus. Dr. Yasmin has spent her whole career researching diseases and communicating about them today. Seema, it’s a privilege to have you here with us today. 

Dr. Seema Yasmin: Thank you so much. 

Jeffrey: Now, before we start discussing the Coronavirus and your work in the space, I’d like to spend a couple of minutes talking about your journey into science journalism. Your professional journey is just fascinating and you were or are a medical doctor and then you went into public health at the Centers for Disease Control and Prevention where you studied outbreaks of diseases in prisons, border towns in American Indian reservations, can you share with our listeners this part of your career journey? 

Dr. Yasmin: Yeah, sure. So I trained in medicine. I went to medical school in England, worked as a hospital doctor there, and became really interested in epidemics and so about ten years ago, I moved to America just for this job at the CDC. I served as an officer in the epidemic intelligence service. So what I was doing then was I was part of a team that was deployed whenever there was an epidemic and that could be in the US, it could be in other parts of the world and my job really was to try and contain an epidemic before it became really really bad and to try and understand how it spread, why it spread, and who it was affecting. So, interestingly, a lot of what I do now, I think people are more familiar with because they know terms like contact tracing, for example, people know more about epidemic investigations right now because of what we’re going on, but that was the bread and butter of my work. But then what I noticed is every time I got sent to a Hot Zone whether it was a viral outbreak, a bacterial one, I had a very singular focus on containing the disease and what I saw each and every time was that disease was not spreading alone; disease was spreading alongside misinformation and disinformation. So that it could be a virus that was contagious but there were also these medical myths and health hoaxes and rumors that were just as contagious and helped diseases spread. So I thought why in public health are we not very good at addressing that part of it when information can fuel viral contagion? Why do we kind of dismiss the information part of it? And I became really interested in that. I had a big eureka-moment during an outbreak of flesh-eating bacteria in the Navajo Nation. And I thought, “I think I need to train as a journalist because I think I need to understand how journalism is part of the public health ecosystem and besides just being a public health doctor, I need to know how I can make a compelling argument to make people care about these epidemics, make people care about public health.” So I felt a bit weird at that time, so I thought medical school, then being an EIS officer, and then going to journalism school like that last part, that’s not a normal trajectory. But I told my supervisors at CDC, don’t write me a reference on my next job, write me a reference for journalism school and actually people were really really supportive. So I went to journalism school. I then got hired straight out of j-school as a newspaper reporter, moved to Dallas, Texas, a place I never thought I would live and arrived there just as Ebola arrived in Dallas. This is in 2014, so that’s a small part of my journey. 

Jeffrey: That is something movies are made of. That’s unbelievable. So, then, all right, so let’s fast forward. So you got into communications. You became a reporter. You were a medical analyst or maybe still are for CNN. You were a professor at the University of Texas, not just working there. I think you gave a TEDx Talk and then I believe now you move from Texas to California. You’re at Stanford now. Can you tell us a little about the Stanford Health Communication Initiative and your work as Director of Research and Education there? 

Dr. Yasmin: Yes, so I direct the Stanford Health Communication Initiative where we run educational programs and do research around health communication. So we do the micro which is how can a doctor be a better communicator with their patient in a one-on-one interaction, but then how does all of this information factor into how diseases spread on a global level? And so it’s really amplifying my discoveries as an EIS officer, kind of, amplifying the work I’ve been doing as a health and science reporter to kind of plug-in all those different pieces. Because, journalists play a really important part in how we understand disease, how we understand our own bodies and our health. Journalism is part of the public health information ecosystem and you may have even heard people talk about journalism as the immune system of a democracy. So we study that, we support that and we’re really tracking not just disease but also my interest, which is misinformation and disinformation about disease, and then trying to figure out innovative ways to counter it. Because as I said in public health, we’ve been really good at focusing on disease, but not at the medical myths and the health hoaxes. So we’re trying to change that. 

Jeffrey: Right. So, speaking of this, I guess in your part-time job now since you sound like you have so much free time, you were nominated for an Emmy, right? 

Dr. Yasmin: I won an Emmy. 

Jeffrey: You won an Emmy, okay. That’s for the Chagas disease? 

Dr. Yasmin: Yes. I did a TV news series as well as a written series about neglected tropical diseases in the US, the kind of diseases that you think would happen in faraway places but actually are infecting Americans and are not being counted because public health agencies don’t think they are a concern and therefore aren’t doing surveillance. So, yeah, I was very, very surprised to win an Emmy for that but really happy that public health work was kind of getting that platform and something as important as neglected diseases in the US was being profiled. 

Jeffrey: Yeah, that’s incredible. You’re also an award-winning author and you have a new book that’s coming out. It’s on pre-order on Amazon and also at Johns Hopkins University Press. I love it. So, the new book it’s entitled, “Viral BS: Medical Myths and Why We Fall For Them.” It explores how as you said misinformation can spread faster than microbes. Now you started a little, you talked a little bit about this but explain the thesis, and what prompted you to write this book? 

Dr. Yasmin: So this book started off as a regular newspaper column I used to write, where readers would send in all sorts of questions about, should I starve a fever and feed a cold? Should I be worried about chemtrails? Do vaccines actually cause autism? And so every week I get to dig into these questions and say, “Look, here’s the evidence, here’s how you can make up your mind about this.” And then an editor was like, “This is really cool and it’s reaching a lot of people, turn it into a book.” So I started working on this about three, maybe even four years ago, you know before we thought a pandemic would hit us. It just kind of gets into the nitty-gritty of about fifty very common, very relevant questions, whether it’s to do with taking a Statin, whether it’s to do with the “detox cleanses” we keep hearing about. But really at the center of the book, we’re asking “why is it people often don’t trust science and scientists.” Because being in the scientific world, you can get kind of very prideful and a bit complacent that we have science on our side, we have facts, we have evidence. And you can see just during COVID-19 how that can fall flat, how you can have incredible evidence and really good studies and still people will refuse to wear a mask. So even though I started working on this a long time before the pandemic, it really gets to those central questions of what are facts? Who develops facts? And why is it the facts don’t always work at countering misinformation? 

Jeffrey: Yeah, and I guess even to emphasize this, I’ve been watching you on YouTube, and you have a series with Wired about medical myths and about coronavirus myths, and some of these things are addressed on the YouTube series, correct?

 Dr. Yasmin: That’s right. 

Jeffrey: Yes, so, I think it’s great. Let’s talk about more of these Coronavirus– I don’t call them myths but for the purpose of this, more about misunderstandings and communication and things that are going on that people don’t necessarily hear about or haven’t heard about yet. Let’s talk about this one thing that I’ve been tracking, which is the coronavirus mutating. There’s a doctor, Michael Worobey, he’s an evolutionary biologist at the University of Arizona. He said a second, like a mutant second virus, may have been responsible for the spread that we’re currently witnessing there. And also, virologists at Scripps Research from Florida, they found a mutation of the Coronavirus called D614G, which they said is far more infectious. Can you share your understanding of the existence of mutant variants of the Coronavirus, have you seen this? Have you been shown this? And what could be the issue or the effects of these?

 Dr. Yasmin: So the first thing to know is that this is really predictable because viruses replicate at such a high rate and as they make more copies of themselves, they make mistakes if you want to call it that. So that’s how you end up with these viruses that are almost like cousins of one another instead of absolute clones and what we’re seeing primarily is some of this research coming out of the US and out of Europe as well, where scientists are looking specifically at the spike protein of the Coronavirus. That’s that bit that sticks out and gives it that halo shape which is why we call it Coronavirus because Corona is Latin for Crown and it’s that spike protein that is really good at latching on to some of our cells and enabling the virus to get inside. The spike protein, in doing that, in that latching process and getting in, sometimes can break and what some scientists have found is a version of the Coronavirus where there’s just one amino acid chain in that spike protein. So the spike protein is made up of about 1,300 amino acids, which are the building blocks of proteins. And in this version where there’s just one amino acid that’s different, it makes this spike protein a bit stronger and a bit tougher. So it doesn’t seem to break as easily. And what scientists are saying is that in some experiments, this slightly mutated version of the Coronavirus, it can be about three to eight times more infectious. But that doesn’t necessarily mean that people infected with that type of the virus are getting more sick. And in fact, there isn’t data to support that. So I think we need to do a lot more research. I want to make sure people don’t get scared, you know, the term mutant virus can sound a bit sensationalist and frightening, right? A very Hollywood. But as far as we know at the moment, this slightly evolved version of the virus doesn’t seem to be increasing hospitalization rates or increasing the severity of the disease. So, it’s to be watched for sure but right now we think it might make for a more infectious version of the virus, but maybe not a more serious one. 

Jeffrey: Okay, that’s scary, fascinating, scary. New topic – super spreaders. Okay. Now I’ve read different reports that suggest an average, let’s say 2% of the people could be responsible for 20% of all Coronavirus infections, right? Why is that? You know, why are some people more infectious and are they doing anything different, and is it their fault? What’s the information with this?

 Dr. Yasmin: So, again, this is not anything new. We see this in some diseases that about 20% of the infected people are responsible for about 80% of the infections, and we don’t fully understand why that is and I think it’s because it’s complicated. Partly, it’s probably to do with some biological factors. Maybe in some people, a virus is able to replicate more efficiently. Maybe in some people, the immune system doesn’t control the infection as well. But then I think that there are more behavioral and less biological factors at play too. Maybe some people are able to transmit more infections because of the kind of lifestyle they have. Maybe they are like kindergarten teachers or maybe they’re really popular and they’re always going out, versus somebody who’s really reclusive. So I think probably there are these multiple things at play, but I do want to say that the term “super spreader” has been criticized by some anthropologists as being a term that we should be careful about using because it already adds some stigma to this idea of a person as being responsible for so many infections perhaps through no fault of their own. The reason we worry about that is because stigma can be very harmful to an individual person but also to public health efforts, because the last thing you want to do is single-out people for being infected, for being contagious. That often can make it more difficult to do public health containment work. But add to that the fact that as I said, we don’t fully understand what it is about some people that could mean that they transmit the infection on to many more. It’s just a phenomenon we’ve seen over and over again. In fact, we saw it with SARS and MERS and from an information perspective, I’ll tell you something really interesting because I’m very interested in the parallels between how disease spreads and how information spreads. Actually you see in the same way that a virus is transmitted from person to person so is information and actually, in the context of information, you also have people who can be “super spreaders”. Maybe it’s because they are a celebrity, they have a massive platform. Maybe it’s because they’re an influencer and they have a lot of Instagram followers, but there are some people who also are really good at getting misinformation out very far and very wide. 

 Jeffrey: So that’s incredibly interesting. So super spreaders. We don’t know why it could be genetic but what about if we turn it around a little bit. Why have we found that there’s a hugely disproportionate impact on people of color? And why would people of color or minorities be more affected by the Coronavirus? 

Dr. Yasmin: So this is also something that’s not surprising. Unfortunately, in fact, if you’d asked scientists and sociologists and anthropologists like a year ago if a pandemic virus, a respiratory pathogen was to hit America, where would infection rates and death rates be highest? It would have been very easy to find evidence to say actually it’ll be people of color or be queer people, disabled people, people living on the margins of society who will suffer the most. And it’s exactly what we’ve seen and so it’s actually really tragic I think that we haven’t fixed those kinds of societal problems that caused so much suffering and so much needless death during the pandemic. I saw one analysis that showed: had there been equity across the death rates in the US, if equal proportions of White Americans and Black Americans had died, then something like 15,000 Black Americans would still be alive, but they died from COVID-19 because of these disproportionate rates. Overall, we’ve seen from The New York Times and other researchers have also published data that shows that in the US, Black Americans and Latinx, people are about three times more likely to get infected and get sick with COVID-19 than their white neighbors and twice as likely to die. But actually it’s a lot more serious and a lot worse in some places. In Kansas, black Kansans are about seven times more likely to die from COVID-19 than their white neighbors and a lot of this comes down to structural inequality and racism. Unfortunately, people often don’t want to hear this or they think that that sounds like not a reasonable explanation, but we have so much evidence of how it is that systemic racism causes people of color and black people and indigenous people to suffer disease more, to receive treatment a lot later, to have really poor health care experiences where doctors dismiss their pain and dismiss their suffering which explains exactly what we’re seeing now. 

Jeffrey: Now, to combat misinformation, we need data. You mentioned this before about the New York Times and about the article that they wrote and the data that they’ve been provided, but they were only able to receive that data from the CDC because they had to sue the CDC to get the data. 

Dr. Yasmin: Right. So. all that talk about transparency of the Chinese scientists and Chinese officials, which is a question I was getting a lot early in the pandemic – are Chinese scientists sharing all the information? But then you look here at the US and we haven’t had transparency in terms of data, very basic data. So as you mentioned, the New York Times had to sue the CDC to get about one and a half million case records of people who had had COVID-19, but even after they sued and they got the information, there were only race and ethnicity data for about half of those, one and a half million records. So even at that level, we’re still missing these really important data points that help us figure out in the crisis, who needs help? How do we respond to the crisis? And then, afterward, helps us look back and make sure this kind of thing doesn’t happen again. But we are sorely lacking in even the most basic access to data. 

Jeffrey: Do you have any insight as to why that would be from CDC? 

Dr. Yasmin: I think we’re seeing it’s not a secret and you don’t have to look very hard to see how much political pressure is being exerted on scientists across the board, but especially scientists employed by a federal agency, the CDC. We’ve seen a few times, CDC scientists spend hundreds if not thousands of hours developing reports and guidelines to help lawmakers make policy and then we’ve seen their reports censored. We’ve seen their reports delayed or be sent back for revision. So I think that’s what’s happening is that the scientists at the CDC do about 11,000 of them within the US are trying to do the best work with the best available data, but politicians especially the administration has its own agenda and so isn’t letting scientists do the work and is exerting this political pressure so that they can spin the information and it’s very dangerous and detrimental to the public health response. It’s partly why we’ve seen America continue to smash records in terms of the number of new cases and deaths. 

Jeffrey: Okay. All right. So then about vaccines, what’s your opinion on the likely timeline of a vaccine reaching the global population, and do you think it’ll be just one vaccine, or do you think it will be a one and done shot? Or do you think it’ll be an annual vaccine like the flu? 

Dr. Yasmin: I think the fastest we’ve ever developed a vaccine previously is for mumps and that took four years and that was a record but we are working at a massively accelerated rate. It’s just amazing to me how far we’ve come along in the vaccine development process already, which is what happens, I think when you have more than a hundred groups of scientists looking at like a hundred and something different vaccine candidate and you have drug companies using completely brand new, never before approved technology and strategies for developing a COVID-19 vaccine. However, none of that is a guarantee that we’ll have even one successful vaccine. Although I hope we have multiple vaccines that make it through clinical trials and that are approved. I have to think about things like malaria and HIV where we just haven’t after decades of work been able to develop safe and efficient vaccines. Like I said, I hope that’s different now because we desperately need one and I’m looking very closely at Pfizer’s work, also the University of Oxford in the UK seems quite the furthest along I would say. If you ask those scientists, I’ve been interviewing different Drug Company CEOs and vaccine scientists around the world. If you ask them, some of them will say, “We plan to have a vaccine available by the end of the year, even or by early 2021,” and the US government itself has Operation Warp Speed which has a very ambitious goal of developing millions of doses of vaccines by January 2021. I’m hopeful and cautiously optimistic that that happens, but I think we have to be really open with people that vaccine science is tricky and sometimes what happens is you end up with something that’s amazing in clinical trials. But then you stumble at the stage of scaling up to millions of doses that in itself can take years and millions of dollars. So my hope is that we end up with a few vaccine candidates that give a long-standing immunity but there’s just no guarantee of that. What we wanted to see is governments, especially collaborating and continuing to invest in vaccine research.

Jeffrey: All right. Last question, somewhat related though. We’ve heard the term herd immunity as this relates. Can you explain what this means? And do you think we can ever achieve that in the United States?

 Dr. Yasmin: So, herd immunity is this concept where when you have a specific proportion of a population whose immune to a disease, it stops outbreaks of disease occurring in that community just because there are so many people who are immune, the virus can’t get a hold of that community and cause an outbreak. The proportion of people that need to be immune to achieve herd immunity, that proportion is different for different diseases depending on how contagious they are. So measles is like one of the most contagious viruses on the planet for humans and you need to have like more than 90% of people immune in a population to have herd immunity to measles. For COVID-19, we’re thinking it’s more like 60 to 80% of people need to be immune. It’s unlikely we’re going to get that with natural infection, because what we’re seeing is that with people who get COVID-19 when you check their blood a few months afterward, the levels of antibodies are dropping. That’s not to say they don’t have any immunity, but we still need to understand what level of protection that gives them. On the other hand though, vaccine-induced immunity can be quite different to natural immunity. So say you get COVID-19 and then you have antibodies but they go away versus you get a COVID-19 vaccine and hopefully it gives you so many antibodies that they stick around for a really long time. So we still don’t know which vaccine will be able to do that. With Pfizer, we saw some very early data that showed that people who get their vaccine end up with antibody levels that are higher than people who get the infection naturally. So that is promising but in terms governments early on saying, “We’re going to have a herd immunity approach.” The British government even said, “We kind of let the virus just run through.” That clearly doesn’t work and also it’s really dangerous because then people suffer, get sick and we have no treatment for this disease. So we do really need a vaccine. But time will tell if that’s possible and also what kind of immunity and for how long a vaccine will confer. 

Jeffrey: Thank you. This has been incredibly educational, informational, and highly interesting. So thank you so much for joining us today.

Dr. Yasmin: Of course. Thanks for having me.

Jeffrey: We hope you’ve enjoyed this week’s podcast. If you have any question, comments or future story suggestions, please reach out to us on social media. Thank you, and we hope you enjoyed the RP HealthCast. 

As the United States continues to see record-breaking new coronavirus cases, the country’s reopening has become one of today’s most critical topics. We discuss the issue with Forbes’ reporter Alexandra Sternlicht and examine the unsettling resurgence, complications with testing, and the disproportionate impact of the virus on communities of color.

TRANSCRIPT

Jeffrey Freedman: Hello and welcome to the RP Healthcast by RooneyPartners. I am your host Jeffrey Freedman. New York up until a few weeks ago was the epicenter of the coronavirus activity in the United States, but with increased testing and social distancing and a slow and methodical reopening, we seemed to have turned the corner and our infection rates have dropped dramatically. But, unfortunately we cannot say the same for other parts of the country where States like, Florida, Arizona and Texas are hitting all-time highs in terms of infections, hospitalizations and even deaths from COVID-19.  

To talk about this and other issues related to these rising figures is Alexandra Sternlicht. Alex is a breaking news reporter for Forbes. Prior to this role she was the under 30 editorial community lead at Forbes and she’s worked for the New York Times as well as the New York Observer. Alex, thank you so much for joining us today. 

Alexandra Sternlicht: Thank you so much for having me, I am thrilled to be here.  

Jeffrey: Great! Now Alex you have been a prolific writer about the coronavirus for Forbes. For the purposes of today’s interview, I want to focus on three important topics that you cover. That is the apparent resurgence in the number of coronavirus cases in the U.S., issues surrounding testing and virus detection and the disproportionate impact to the virus on communities of color. But, before we jump into all that, I would like to start with a question about you and your role as a breaking news reporter for Forbes.

Alex: Oh, thank you. 

Jeffrey: Yes. Now you have been on staff with Forbes for almost two and a half years and during that time you have written on a variety of topics besides coronavirus and as a breaking news reporter, how do you decide what to write about?  

Alex: Oh well thank you so much for having me. I am really excited to get into those topics with you today. So there are three main things I focus on for sourcing breaking news. The first is, I look at notable leaders’ addresses, people like Bill Gates or Governor Andrew Cuomo. The second is subject matter experts such as Dr. Aaron Bernstein who is the Director of the Harvard School of Public Health who can comment on studies and complex topics like you know coronavirus, and the third is social media as this is where movements form from conversation. So I will talk a little bit about that. I look at Twitter, Instagram or Tik Tok and I will see what people are talking about, and then I will figure out how I can best insert facts into these popular conversations. As I believe this is really the role of journalists in this day and age. So, an example of this, a couple days ago I found Jimmy Kimmel trending on Twitter as people called for him to be cancelled due to his black face impersonation from the 90s. Upon further examination and discussion with my editor, I found that conservatives were at least in part leading that movement, including Donald Trump Jr.. Kimmel has been an outspoken anti-Trumper and so this seems like an important thing to add to the conversation. 

Jeffrey: That is really interesting. You also mention something while Tik Tok, all of a sudden that has been a leading form of news so it is not just my teenage daughter trying to make a video? 

Alex: Right totally, one really interesting story I found on Tik Tok is you know primarily teens were talking about saving Baron Trump for the White House and they had all these theories that he actually does not like his father and he is actually a really cool guy. So, there is a whole Tik Tok campaign with I think it was like twenty six point two million views on it to rescue Baron Trump for the White House, which was hilarious and amazing.  

Jeffrey: That is a lot of eyeballs. Wow! All right, but back to the coronavirus and your coverage there. Now, across the world the outlook for containing the spread of the coronavirus has worsened, right? Recorded cases had spiked and here in the United States many states that reopened are experiencing either surges or record-breaking new cases. Can you provide some color and details on which states are having the most issues right now?  

Alex: Absolutely! It changes on a daily basis, but I felt half the states in the US are seeing a surge in cases. We are seeing really troubling statistics in Florida, California and Texas. Florida and Texas did not have shutdowns that were as severe as places like New York and those dates were some of the first to reopen. That’s not so much been the case with California which is interesting to note. One area that’s been particularly fascinating to me is Florida’s Miami-Dade County, where a lot of officials are saying that the lack of social distance practices and eating and drinking is leading to a spike in cases. You know, now experts are saying that Florida may be the new global epicenter of the virus which is quite concerning, and today we heard from both the governors of Texas and Florida who said that all bars will have mandatory shutdowns.  

Jeffrey: Florida and Texas, if they had shut down the same time New York did and really clamp down, don’t you think they would still be having, or let me rephrase that, would they still be having the same issues now? I mean, are they not on such a lag, I mean New York is opening now, was it really expected that they could stay closed for that long?  

Alex: Yes I mean that question is, it is a great one, but unfortunately it is truly impossible to answer. So you know we are just looking at what we have now and with all the differences in states, we are seeing some really troubling things in Florida and Texas.  

Jeffrey: Yes I mean, I think they are doing the right thing now by holding back and certainly if they have to start closing they have to start closing. It is definitely getting scary.

Alex: Absolutely!  

Jeffrey: What is even scarier though you have reported that the number of covid-19 cases and deaths could escalate further in the fall months. So while we are at the epicenter, while we are at the peak right now, the fall is just a few months away, why? What about the fall? 

Alex: Yes so that is another great question. So the IHme model. The Institute for health metrics and evaluation which is used by the White House and other decision making bodies has three predictive models to predict the future of coronavirus. So the first model that they use is the current production which you know, I will give you the definition of, so they say mandates are re-imposed for six weeks when every daily death reaches eight per million. The second is mandate easing, meaning that we continue to lift social distancing mandates and those don’t come back no matter what happens. The third is universal masks, which is really really interesting and that is a scenario in which 95% mask usage in public is mandated in public in every location and same thing as the current projection, mandates reimposed for six weeks if daily does reach 8 per million. So under both the current and mandates easing projections, the models have coronavirus steadily rising until October. Those cases will rise in the fall, but the thing that is fascinating is that the third projection, the universal mask one, though cases will still rise, it will be much much flatter until October 1st. Which suggests the power of PPE with something, so that will be maybe so easy as wearing a mask and you know, nothing is for certain, we have seen that across the board throughout this pandemic, but scientists do point to the virus rising in the fall due to historical precedent where you know, every single fall we see seasonal influenza rise and they believe that coronavirus will be similar in that way. 

Jeffrey: Alright so they think it is going to be cyclical in that regard. That is really interesting, but you mentioned that something as simple as wearing a mask will help flatten the curve. Now compare that to my next topic, you know where you reported on the disproportionate number of covid mortality rates among minorities right? So can you walk us through the facts and figures and explain why the virus is having such a devastating effect in these communities? 

Alex: Absolutely! Yes, very sad the virus disproportionately affects black, hispanic and other minority groups due to the nature of systemic racism which impacts housing, community, health and all the other conditions that lead to increased fatality from the virus. One of the aspects of this that I would like to focus on that I have written about is the exposure of air pollution as it relates to severe covid-19 outcomes. So Harvard School of Public Health on this issue, Dr. Aaron Bernstein said that ‘people who live in cities and next to freeways are disproportionately black population and those people are more likely to have more severe outcomes from covid-19 as they are more exposed to air pollution that creates the pre-existing respiratory conditions known to make covid-19 fatal.’ So this is not nearly all encompassing of why covid-19 disproportionately affects minority communities, but it is something to think about as we think about climate change and systemic racism. Another community that I would like to talk about and that I have written about is Navajo Nation and Indigenous Americans. So, Navajo Nation is home to some a hundred and seventy three thousand Indigenous Americans and it is the location of America’s worst coronavirus outbreak in terms of infections per capita, which is awful. The reason that the disease has hit this the largest Native American Reservation so hard is multifaceted. Many residents live in multi-generational homes, so that makes it nearly impossible to stop the spread within a home because there are just so many people living there. More than 30 percent of residents do not have access to running water so that makes things like hand washing which we know can curve coronavirus really, really hard. Also, the Navajo Nation has very few grocery stores and the grocery stores are used by so many people so that means that grocery stores turn into virus hot beds and that is really, really devastating that community. 

Jeffrey: It really is. There have been a number of different articles. I mean you have done a great job reporting on this. The New York Times Magazine, Linda Villarosa wrote a very powerful narrative of one family’s tragedy in New Orleans during Mardi Gras and the article is entitled ‘who lives, who dies’ and it puts a face on the statistics. She wrote about this gentleman, Dickey Charles, whose only 51 and he was a Zulu Club member in New Orleans and according to the Times article, titled ‘eight weeks after Mardi Gras at least 30 members of the club have been found to have covid-19 and eight would be dead’ and there is just been too many Dickey Charles. I mean, is there anything you have found that could be done differently in the African-American or minority communities that could make a difference? 

Alex: You know it is absolutely horrible and there have been way too many stories of family birthdays, graduations, pool parties and more that ended with such deep sadness. I truly do not have an answer to your question because again, you know hindsight is 20/20, but yes it is so sad.  

Jeffrey: Yes I guess going back to the basics when you can wear a mask, stay socially distant and hand wash but in a lot of these communities they can’t as you say, because they are multi-generational and they are all living together.  

Alex: Exactly. 

Jeffrey: It is very tough. All right switching topics to testing and the related issue of contact tracing. You have reported several times actually that some people believe increased testing is the reason while others refute the notion that testing explains the spike in new cases. Can you explain what the facts are here? 

Alex: That is such a good question and it is so pertinent to what we are seeing right now in the rise cases in the United States. So while increased testing can help explain this rise because you can’t, you obviously cannot be confirmed positive for coronavirus without taking a test, but we no longer have a test shortage in this country. So at the beginning of the pandemic when tests were hard to come by in the United States there were likely under reported cases. The side note, we have seen this to be true from recent studies that actually measure coronavirus levels from sewage of all things. I recently wrote about this, so they did a test on the sewage in Erie County in New York, and that showed that there were almost three times the amount of positive cases as those reported, and that gets back to testing and potentially test storage and asymptomatic cases. But, with increased testing, should come increased contact tracing, those things are hand in hand. So epidemiologists argue that you actually see a decrease in positive cases as testing increases because you should be able to contact those in close proximity to those testing positive for COVID-19 and say ‘hey you have likely been exposed to a COVID-19, please self-quarantine or take a test.’

Jeffrey: You mentioned contact tracing and how that is supposed to help, but I live in New York and while we were the epicenter and there are so many positive corona cases around here, I haven’t seen any contract tracing. I know I have been in contact with people and thank goodness I did not get the virus but why is it that I find in the definitely New York or the United States even, why are we so against contact tracing where it is pretty popular outside of the United States?  

Alex: Yes, Jeff, that is such a good point. I think a lot of issues around contact tracing and why you are seeing what you just described is the fact that contact tracing has become really politicized in the United States where people are saying it’s hardcore surveillance, it violates citizens rights. So that is why it has been such a contentious issue here and why some would argue that our contact tracing efforts are not where they need to be. Where if you look at South Korea, which has been a really interesting place for the virus as they have pretty much avoided doing any sort of major shut down basically due to large-scale testing and contact tracing, they have pretty much successfully curved the virus. But their contact tracing efforts many would say in the United States, they just totally violate privacy because it is surveillance of citizens and the government mandates that they would be monitored in order to trace where they are going and trace the virus. So there is a lot to unpack there.

Jeffrey: So personal privacy versus public health conflicts. 

Alex: Exactly. Exactly. 

Jeffrey: All right so if contact tracing is out, testing is our only way then. So, in April the Rockefeller Foundation published a roadmap for the U.S. to reach 3 million tests per week by late June and to quote from their report, this is their report, ‘testing is our way out of the crisis, instead of ricocheting between an unsustainable shutdown and a dangerous uncertain return to normalcy, the United States must mount a sustainable strategy with better tests and contact tracing and stay the course for as long as it takes to develop a vaccine or a cure’. Now, what is your reaction to this and is this plausible?  

Alex: That sounds right to me. Again, I go back to South Korea, it is not perfect and cases do continue to occur there but they have increased testing and contact tracing to such an extreme where anywhere you go, you take a test. Yes we just talked about their contract tracing methods maybe being too invasive for the United States but you know, it is up for debate and they have been really successful. So it makes me very hopeful to see other countries effectively combating COVID-19 and the fact that we have these precedents around us in our surrounding nations. I hope that our leaders will draw from this and bring America to a comfortable new normal.  

Jeffrey: I agree with you. I hope so. Alexandra this has been great, it has been so informative. Thank you so much for your investigative reporting and for joining us here today.  

Alex: Thank you so much for having me. It’s been a real pleasure. 

Jeffrey: We hope you enjoyed this week’s podcast. If you have any questions, comments or future story suggestions, please reach out to us on social media. Thank you and we hope you enjoyed the RP Healthcast. 

In this week’s episode, journalist Christina Farr gives her shortlist of the companies to watch from CNBC’s Disruptor 50, relays riveting first-hand accounts from heroes on the front lines of the pandemic, and weighs in on why the road to effective contract tracing in the United States is proving to be a not-so-simple path.

TRANSCRIPT

Jeffrey Freedman: Hello and welcome to the RP HealthCast by RooneyPartners. I am your host, Jeffrey Freedman. As we continue our Novel Coronavirus Series, today we are going to take a look at the pandemic coverage from a different angle. While biopharmaceutical companies continue to work on the front lines to find a cure or vaccine for COVID-19, there is a whole set of medtech and AI companies that are developing technologies to assist in everything from patient care, to access to medicine, to speeding up drug discovery, and to modernize in clinical trials. And to talk about this, I am excited to say we have as our guest this week, Christina Farr.

Jeffrey: Christina is an award-winning technology and healthcare reporter for CNBC, based in San Francisco. Prior to joining CNBC three years ago, she was a senior writer at Fast Company covering biotech and health tech and she was a reporter at Reuters News. Christina, thank you so much for joining us today.

Christina Farr: Thanks for having me.

Jeffrey: Yes, so before- while preparing for our interview, I did my usual homework, but I ran across an interesting fact that I had to ask you about before we talked about your reporting. Now, you are an award-winning health tech and medtech reporter based in Silicon Valley. You are at the heart of high technology, the discovery and all the funding. But the interesting fact was, you are an amateur historian, from what I read. That is kind of ironic, right? A paradox. Can you tell us a little bit about that?

Christina: Yes, absolutely. So I actually, originally, I am from the UK, if you cannot already tell. So I had aspirations to be a historian when I was younger, and I went to University [inaudible] in history and I did a masters in 19th century history. So, that was going to be my career, and then I ended up getting involved with the university magazine and newspaper. Basically, had a change of heart where I decided that I was really passionate about journalism, and so I ended up doing- pursuing that. Somehow ended up in California, just being here exposed me to the tech scene and particularly the Medtech scene which from the beginning, I found most interesting. That kind of led me down that path but I still love history. I read a ton of biographies. It’s definitely my first love. I think it’s good to have kind of a mix of things and to look into the past as well as kind of focusing on the future.

Jeffrey: It’s true because it seems like we come full circle in life. I mean, what’s past is also becoming the future again. Alright, so let’s talk about some of your recent stories. Every year, CNBC issues a list entitled the ‘Disruptor 50’. It’s CNBC’s annual take on the private venture backed companies, the ones that transform our economy and the way we live. Now, you wrote about a company called ‘GoodRX’. It was really interesting, you drew out the following quote from the CEO and I’ll quote, “If America as a country decided to keep all Americans healthy and things were up-front and transparent, there would be no need for GoodRX.” Now to me, that’s really interesting and it’s also really sad that same time. Can you discuss a little more about everything, about the Disruptor 50, why GoodRX qualified and explain how the list is developed.

Christina: Yes, of course. So we do this Disruptor 50 list every year and this year was a bit different because we couldn’t do any in-person events to celebrate some of the folks that made it onto the list, but they saw the opportunity to be on TV and talk about their businesses and also we did kind of some profiles on the reporting side of the companies that we knew [inaudible] and found most interesting. So there’s a lot of things that go into choosing these companies. There’s judging panels and the reporters also get involved and it’s a whole process. It’s something that CNBC takes really seriously and they invest in. I think they’ve definitely picked out some good ones in the past and we’ve seen them go on to become big public companies. So it’s sort of our way to make sure that we know some of the founders before they end up as public companies and that CNBC has those relationships early on.

In GoodRX, which you mentioned, I definitely think it’s going to be an IPO contender on the very near future. It’s a company that’s been profitable for a long time actually since 2013 in the drug supply chain, essentially just offering kind of drug discount cards and coupons that people can use at the pharmacy. I love that quote that you brought up because that actually is true of a lot of healthcare technology. It exists because the US healthcare system is so messed up. Many of these companies wouldn’t exist in other countries. You couldn’t take the GoodRX model and bring it to the UK because we have the NHS and we have a single-payer health care system. So everything is a lot more transparent and accessible and you just go to the pharmacy and pick up your free medication. So that obviously, that wouldn’t work there. So I like that they acknowledge that and I like that they said, “Frankly, if the system does get better and there isn’t a need for GoodRX, we’ll move on. We’ll go do the next company.” I appreciate that kind of– that frankness and that kind of honesty from founders. It’s not what you usually hear but I think it’s extremely true.

Jeffrey: It is refreshing, but it’s interesting that their business model whereas, they make a good percentage of its revenue from PBMs, pharmacy benefit managers, right? And these PBMs, they’re kind of the middlemen in the pharmacy to pharmaceutical world. Some people say they’re one of the main reasons pharmaceutical prices are so high. So, isn’t it a bit ironic though that GoodRX’ business model is based on getting patients lower-cost prescriptions, but they’re making their money from the people that are raising the prices? They’re the reason why the prices are high. So wouldn’t they be like contributing to part of the problem rather than the solution or am I looking at it incorrectly?

Christina: Yes. This is a really interesting point. I actually did– I talked to someone who’s a drug supply chain expert, who completely agreed that the PBMs are a huge part of the problem of why drug prices are so high and it’s not just them I think, every entity within the system has a vested interest in drug prices going up every single year, except for obviously the consumer. So, there is a little bit of an irony there. Unfortunately, I mean, without GoodRX, if you go to a pharmacy and you do not have health insurance or you have a super high deductible plan, you could end up paying the sort of UNC price which is kind of that highly inflated price that you get quoted if you show up and say you do not have insurance. Most people can’t–what if people can’t afford that? They’ll simply turn around and walk out. So that’s the GoodRX value problem.

The pharmacy side is they essentially tell pharmacies, “We’ll make the drugs affordable enough that at least you can start to even have a transaction…” rather than having the patient simply walk out. On the PBM side, they’re happy to work with companies like GoodRX for the most part although some are starting competing services because it means that people that are outside of the insurance system can still flow through the PBM and they can take a cut of that transaction, and the cuts are obviously very big. In some cases, pharmacies will even lose money when a patient uses a discount card. So, it’s all just very convoluted and complex. I think that’s why they freely recognize that if things weren’t that way, then there wouldn’t be a need for them to exist.

Jeffrey: But they’re helping out the consumer at the end of the day. So I think that’s great. What other Health Tech or Medtech companies that are also on the Disruptor 50 list that stood out to you?

Christina: Yes, great question. I did a few more profiles of different companies that I– for me, it’s just great because I have an excuse to kind of dig into some of these businesses when the rest of the year there’s news. So Ginkgo Bioworks is another one, really interesting company in the synthetic biology world, which I have covered kind of on and off. This a company that sees themselves as doing a lot, I think during this COVID-19 pandemic and they’ve really kind of shifted their focus to that. So, I talked to them about how they’re going to use their technology that previously was primarily for things like Agriculture and Cosmetics to now, is there a way in which they could ramp up to developing half a million COVID-19 test per day? And I think that it’s very possible they achieve that. They’ve got a lot of money behind it and they’re absolutely correct in thinking that we do need a lot more COVID-19 tests, a lot and lot more. I think we’re at something like half a million a day now. We need way more than that, especially as the country starts to reopen.

So that was another business and then I also looked at Healthy.io, which does at home urine analysis tests and things like that which people kind of bucket into this whole idea of remote patient monitoring. I think is going to explode during this pandemic because any way that you can keep people at home and getting the diagnostic tests and doing the monitoring is much better than having them come in unnecessarily and risk exposure. So we definitely look to add a lot of those sorts of companies as well to the list.

Jeffrey: Yes, I think the more that we get used to doing stuff at home like Telemedicine as well, I think vast majority of this stuff is going to stick and people are acknowledging and enjoying the aspect of the freedom of doing it that way. So I think those are great. Yes. All right. So let’s switch over to some of your Coronavirus coverage right now. You recently wrote a very moving piece about a handful of San Francisco doctors from the University of California, San Francisco Hospital System who flew here to New York during the peak of our COVID-19 outbreak. You reported though that they mentioned this was some of the most horrifying and challenging experiences that they ever had. Can you talk about some of the stories they shared with you and what they learned from this experience?

Christina: Oh yes, I mean just talking to them, at one point I kind of broke down into tears, honestly. Just hearing some of their stories, it was so harrowing. The fact that they would choose to get on a plane and go over there in the height of a pandemic, when we know that doctors and nurses and other hospital personnel are dying. I mean, that’s just incredible. It’s heroic frankly. I think that’s another reason why I wrote this because they’re out there risking their lives and this at a time when a lot of people just refuse to do the simplest things that they’re being advised to do by public health. When you contrast that to some of these doctors, it’s scary. So their stories was just very sad.

The thing that stood out to me in all of it was, some of the patients that they saw we’re just to learn for a lot of this process because at that time especially in New York, there was a shortage of PPE. So, doctors were having to reuse it and so nobody would be able to visit a COVID patient and just sit with them and keep them company because that would require using PPE. Their family members couldn’t see them either. So one of the doctors told me that they had one iPad on the floor that was just being passed around and all the doctors would just do their best to call up the patients’ families and give them updates by this one iPad and sometimes they’d have to share that the patient had died. Oftentimes, the families hadn’t even seen them in weeks.

So yes, I mean it was, it’s just awful and most of us have no idea what would COVID really looks like because we’ve never had to see it. But for these physicians, many of which– they were trained, they’re pulmonary and critical care docs. So they’re trained to see people in a really terrible, very sick, like extreme stuff, they’ve seen it all. But having to treat people in a pandemic situation where the virus is so new that we’re still learning what treatment protocols can even work. I mean, they felt helpless a lot of the time which is different than most of the experiences that they have. This I think was harder for them than almost anything else.

Jeffrey: Yes. I mean when I spoke to some of the other hospital workers and– it was so appreciative to people that were coming from out of town, out of state. And yes, you did use the right word in heroic and that they were. Did they think, did they express to you that the experiences that they had in New York were kind of a harbinger of what they thought was coming to other parts of the country? Or was New York more of an unusual Battle Zone, offering them a chance to a whole new skills before they return back to California?

Christina: Yes, so I asked all of them that question and they stressed to me that they’re not public health professionals, they’re doctors. So, they couldn’t tell you by looking in the data what were likely to see but they all expressed concerns about in New York happening again. As I was interviewing them, we were starting to see in certain States, just spikes and more cases being reported in record numbers. I mean, there’s definitely States now that a very worrying including Florida and Texas and a few others.

So there was a massive concern that something like New York could happen again. The thing about New York that was so terrible is just that these health systems were completely overwhelmed. There’s only so much capacity. There’s only so many beds, and there’s limited space within the ICU. So this is something that I think we’re all tracking now is, is there enough capacity within the hospitals for these patients in some of the States where you are seeing an uptick in cases? And then, what does this look like come the fall and winter? Is there a second wave? And no one can really know yet, but the predictions that were seeing do not look great and we’re going to be asking these doctors to go out and risk their lives again, and they all said that they are all very willing.

Jeffrey: That’s incredible. Yes, I mean, were three months in and all we know is that we do not know enough and it’s scary, it is crazy. All right, last topic. Switching around a little bit. In April, you wrote a very in-depth piece reporting that Apple and Google were joining forces to create a partnership designed to bring contact tracing to our smartphones. I think you said Apple called it ‘project bubble’. Okay.

Christina: Yep.

Jeffrey: Now, it was pretty big news at that time and in fact our podcast here, we talked about it back then. But that was two months ago and I haven’t really heard anything further about this technology. At that time, two months ago, we were led to believe that contact tracing was necessary and it was the only way we might be able to quickly get back to a normal lifestyle without a vaccine. Now, what is contact tracing as a technology? Where does that stand? Is anyone using it?

Christina: Yes, I mean, I think the reason that you haven’t heard that much about it is because you are in America. So, in other countries, contact tracing, especially using smartphones is really full steam ahead. Especially in Europe and in parts of Asia, you are seeing literally millions of contact tracing apps. I just saw a story from two days ago that when Germany introduced its contact tracing app, it was downloaded six point five million times within the space of several days. I believe even the first twenty-four hours since the launch.

In America, things are just not moving particularly quickly and only a few states have even started to build contact tracing apps. For those who do not know what that is, it’s basically a method of trying to understand who’s been exposed to COVID-19 by– if you have someone diagnosed positive, who have they been in close enough contact with that they may have given them the virus and then trying to sort of ask those people to get tested and potentially to also quarantine themselves.

So it’s a method that has been around for a very long time. In the HIV/Aids era it was used–that we use a term more of a partner notification, which is a bit softer sounding but it was essentially the same idea, who’s potentially been exposed? Now we have this way of sort of upgrading it by using smartphones to see who’s been in close proximity using kinds of technologies like Bluetooth to see who’s been within– who’s not been social distancing. We do not know yet whether these electronic methods are going to be more successful, if they’re going to work better than just traditional contact tracing which is just boots-on-the-ground epidemiology. I think it holds a lot of promise and it’s unfortunate that in the US, almost no States have really made significant progress. Whereas in other parts of the world, they’re full steam ahead and people are kind of eagerly downloading these apps just to do their part.

Jeffrey: Yes. I mean you are talking about in our country, unfortunately, we have people that won’t wear face masks on airplanes, people that are not happy to come on board for the social good of others– certain people, certainly the very small minority. But do you think Americans’ views in general on privacy rights are so different than the rest of the world and that’s the reason for lack of adoption?

Christina: [Inaudible] piece of it, there’s also been some challenges along the way just with science communication. The whole issue of wearing masks has been fairly confusing to people because they got some of the guidelines have shifted. There hasn’t been like a great amount of education on just the fact that it’s actually okay for scientists to change their minds. I mean, this sort of part of the scientific method. You are allowed to say, “Based on new evidence, I am shifting. I am shifting my point of view and I am now recommending this when I wasn’t previously.” So that’s kind of been part of the issue as well. People just think it’s inconsistent, it’s unreliable. They do not know who to trust.

We also haven’t seen from the federal government here in the US, kind of as much of a sort of clear, like I said, communication as you would expect. In prior pandemics and epidemics, you definitely saw the CDC take a really active role. Daily briefings, constant updates with the press. In this pandemic, we went about three months without hearing really anything from the CDC. Most people in this country couldn’t even tell you who the director of the CDC is because they’ve been so quiet. So I think that’s been a problem that we sort of left it up to the States and each State will have their different sort of political views and each State will have their own challenges. What we really need is something very science-driven and centralized like you’ve seen in other countries in order to have kind of a strategy that will work across the country, because we can’t just do state-by-state, people are moving around and going from one state to another. So I think we need both.

Jeffrey: It is such a confusing topic for people but there’s some simple answers or simple things that we could do that hopefully everybody will undertake. It’s just common sense a lot of it, but Christina, thank you so much for your time today. This is really interesting, and it was great to have you here.

Christina: Thank you so much for having me.

Jeffrey: We hope you enjoyed this week’s podcast. If you have any questions, comments or a future story suggestions, please reach out to us on social media. Thank you, and we hope you enjoyed the RP HealthCast.

Biotechs around the world are sprinting to develop a viable coronavirus vaccine. But which will get to the finish line first? In this episode, Business Insider’s healthcare reporter Andrew Dunn takes us through the myriad of concurrent trials taking place and what this all means for potentially changing the course of the pandemic.

TRANSCRIPT

Jeffrey Freedman: Hello, and welcome to the RP HealthCast by RooneyPartners. I am your host Jeffrey Freedman. It seems like every day now we hear of promising new discoveries or potential cures for the novel coronavirus. Just last week, there was a study that came out of the UK out of Oxford University, about an older, inexpensive steroid that had preliminarily been shown to help patients on respirators, but it has not been shown to have any effect for people with milder symptoms. In fact just the opposite, it could potentially be harmful to those people with milder symptoms. The much-touted remdesiver, it’s been shown to have the opposite effect actually. It’s been shown to help people with milder symptoms recover quicker, but it has not been shown to help severely ill patients. The one thing we know for sure is that we just do not know enough about the disease and because of that we cannot find a potential cure right now. To make sense of all this, our guest this week is Andrew Dunn. Andrew is a healthcare reporter at Business Insider, covering the pharmaceutical and biotechnology industries. For the past several months, Andy has been reporting exclusively on the current coronavirus pandemic. His stories have taken an in-depth look at vaccine discovery and clinical trials for potential new therapies. Andy, it is a pleasure to have you with us here today. 

Andrew: Yes, thanks for having me. Happy to do it. 

Jeffrey: Great. Now before we get started on your in-depth novel coronavirus reporting. I want to take a step back and discuss how you got here. You join Business Insider from a solely healthcare-focused organization. A great organization called BioPharma Dive, was this a tough or weird transition being able to carve out a healthcare niche at Business Insider which covers everything? 

Andrew: Yes, it’s been an interesting transition. BioPharma Dive is more on the trade publication side for business news. At Business Insider, one thing that was helpful as far as making a smoother transition was that I am still covering the same industry, so I am still covering the drug industry, pharmaceutical biotech companies, just the audience has changed. 

Jeffrey: You joined Business Insider at a crazy time, I mean, it was a pivotal time. It was right before the coronavirus reached our shores here in the US and I think your first article or one of your first articles was back on January 23rd. It was entitled and I quote, “A vaccine for Wuhan Coronavirus could take years to develop based on our experience trying to fight Zika and Ebola.” Now, what were your thoughts back then? Starting with a new publication and then stepping into this global issue. At the time of that reporting, they are only six hundred thirteen people infected. Did you think it was a global issue back then?

Andrew: You mentioned that article, January 23rd that was my first week on the job. So I was going through a lot of the orientation stuff, what you typically know when you start up at a new company and basically between those moments I reported out that story. Basically that the gist of it was we were hearing some level of discussion about some vaccine efforts for this novel coronavirus and basically I was saying based on how Ebola went, Zika went if you look at other infectious diseases, vaccine development takes multiple years and many billion dollars usually to get something over the finish line. Sometimes it does not happen like Zika. There is no approved vaccine for that yet. Ebola there is one now, but I mean as far as the global issue in realizing how big of a new story this would turn out to be, I definitely did not realize that in late January early February. I think I was aware of the potential but it was hard for me to imagine how widespread it would become.  

Jeffrey: Yes, and it really hits corona all the time in the news cycle and it has to be, but I think that experience you have or that interest you had in gene therapy, in gene-drug development probably led you into discovering and following Moderna who is working on that, right? 

Andrew: Yes. 

Jeffrey: Also you started early on, first reporting on Gilead and they were repurposing their experimental drug, which is now Remdesivir. So how do you get dialed into following these companies? You mentioned the gene therapy, what about Gilead and Remdesivir back in January?

 Andrew: Yes, I mean I think that these were on my radar really early on. I think both those companies before this virus happened are just particularly fascinating companies. Moderna has been one of the buzz startups and biotech for the last decade and they have just raised these massive funding rounds to off of this vision really for a new modality of medicines. MRNA is the name of their platform, which is still an unproven technology, but they have raised these mask evaluations and just record funding rounds over the last ten years based on the potential for its platforms. So, that was a really interesting story before that COVID vaccine effort even began that I was interested in. Gilead likewise is one of the biggest biotechs in the industry. I think their market value is something like ninety billion dollars and they obviously have a really interesting business story. Again before coronavirus, they develop these transformative medicines for HIV and hepatitis C and are now sort of at a crossroads where a lot of their focus has shifted to immuno-oncology, some cell therapy medicines for cancer. I was really curious in a business story how do you transition from one of these focus areas to another and then obviously with remdesivir they are antiviral here. It is playing a fundamental role and immediate response to coronavirus. So that quickly became the focus too. 

Jeffrey: All right, so let us fast forward almost five months or six months later to today. Now in these short few months, we went from as you said January six hundred and thirty confirmed cases worldwide and eighteen deaths to approximately eight million confirmed cases and half a million deaths worldwide over a quarter that number coming from the United States alone. Now, aside from face masks and social listening, I hope we are further along, for protecting ourselves from this. Now, where do we stand with these, it was back in January, promising medical discoveries and I would love to be able to unpack them one at a time. Now first, can you define the difference between a vaccine and a treatment?

Andrew: Yes, so vaccine and treatment, it might be helpful, there are three big buckets that at least I think through as far as distinctly different when you think about the pharmaceutical industries response to this virus. So first you have repurposed treatments, which are basically medicines that already exist. We already know their safety profile. They are used in other indications. So, this is something like remdesivir would fit in this group. It was tested against the Ebola virus in humans several years ago. It did not work on Ebola very well, but it did show that it was safe which was valuable and being able to quickly test this in COVID. The second bucket is sort of these therapeutics where you are crafting drugs to fight this virus. That is kind of a middle ground approach of repurposed drugs you are going to have available immediately and we could start testing in January, February and March. Therapeutics are just now entering the clinic. So we are seeing some antibody-based drugs. Some drugs are based on the blood of COVID-19 survivors. These medicines are now sort of entering human testing in June, July, August with the goal of some of the earlier efforts being available this fall or later this year. The third major bucket is obviously vaccines ideally will prevent infections, massive administer vaccines to healthy groups of people. It gives them the immune response or prepares them with an immune response if they are exposed to the virus, their bodies can fight it off and not become infected and even a partially effective vaccine would be massively helpful and a partially effective vaccine will be something that reduces the severity of the disease. So taking that vaccine you might still be infected but there is a much lower chance that you will end up in the hospital and hopefully that can weigh down to mortality rates with this virus. So those are kind of the three main buckets and I am happy to go into more detail on each of those if you want and we could start with repurpose treatments and kind of go lay the land there. 

Jeffrey: Yes, that is great. So, I mean we spoke about your initial reporting back in January on Remdesivir, right? So especially in light of this week’s announcement of the dexamethasone trial and the FDA’s decision to discontinue testing hydroxychloroquine. Where does Remdesivir stand? 

Andrew: Yes, so Remdesivir, again the antiviral developed by Gilead Sciences. That showed in late April a positive result, a modest benefit for hospitalized COVID patients. That was a massive deal, it showed that this virus is druggable to some extent. It gave doctors something in their tool kit that they could use to try to help some of the sickest patients and it is shown some level of antiviral activity so actually fighting the virus itself instead of getting the other repurposed drug that just showed a clinical benefit. The other day, a UK ran study came out and said dexamethasone which is a type of steroid, which is a cheap generic pretty widely available medicine that showed a mortality benefit. That kind of went a step beyond remdesivir as showing for a specific group of patients specifically COVID patients who need oxygen support, it lowered the risk of death for them. So that seems to be potentially a very effective treatment for very late stage critically ill patients. One caveat that is very important with dexamethasone is this was all from a press release from these researchers. We have not seen any peer-reviewed published data, but even with that said, the UK’s National Health Services already approved the drug for use in the UK at least for COVID patients. So, science is moving from remarkably quick at times on stuff like that but when you look at the landscape overall, these are not game-changing medicines, remdesivir and dexamethasone. There is a lot of talk about hydroxychloroquine, which is a malaria pill that was first approved in the 1950s and a lot of people with arthritis or lupus use it, that is gotten a lot of attention because President Trump has brought it up time and again throughout March and parts of April I believe. Many studies now have shown that to not be effective in treating COVID-19. There’s also been some research that suggests. It is not effective in preventing COVID-19. So there are still a lot of studies going on for each of these medicines. That is kind of the lay of the land and I think doctors are now kind of trying to figure out the best way to use these. If remdesivir and dexamethasone are both in the toolkit, does that lend itself to a combination of the two? Or, would it be better to treat earlier with remdesivir? If they progress to a later stage then start using dexamethasone? So these decisions of sort of clinical decisions are being worked out in real time just as sort of the clinical research is coming in, which is completely unusual. Normally you have the clinical research happen, the findings are published in a journal, doctors have the time to really study those results, chew them over to bait them internally at medical conferences and among themselves and then they make clinical practice decisions. We have really seen that process eliminated. We see stuff published in a press release now and then the same exact day, it is pressed released, the UK government approves the medicine and says they are going to treat all patients in clinical practice with this new medicine. It’s been fascinating to watch. It is a very fast-moving space and I expect that will only continue over the next months. 

Jeffrey: Yes. Now you mentioned you did not think any of these were game-changers. Have you seen anything out there that has caught your eye that might be?

Andrew: I think this is kind of that second bucket. I think the repurposed treatments have a vital role here as their immediate options. Remdesivir, dexamethasone, some of the other treatment theories around IL 6 Inhibitors or Jak Inhibitors. These are immediately available and I think anyone with realistic expectations was hoping for something that could slightly help patients. I think the game changers are going to come from some of these therapeutics that are crafted against the virus based on several months of research, really understanding how the coronavirus works with the spike protein. We have a much better understanding now of antibodies, these virus fighting proteins as far as which ones really help fight the virus, which ones do not do as much. So, these therapeutics are now starting human testing and I think if some of them are successful, they are aiming to be ready this fall, which I think those are kind of the game changers, so you look at antibody therapeutics. These are companies like Regeneron, Eli Lilly, Vir Biotechnology, kind of leading the way with these and starting clinical testing. 

Jeffrey: So on one hand, you have some fantastic vaccines. So like polio, mumps, rubella, things that have pretty much wiped out diseases as we know them and then, on the other hand, you have like influenza, which you need the vaccine every year because you get a different strain of flu every year and then you have other diseases like HIV that after twenty years of trying to create an HIV vaccine were unsuccessful. Why are we so sure we can create a successful vaccine for the coronavirus? 

Andrew: That is a question I ask a lot of the vaccinologists that I talked with on kind of a daily regular basis and that it is an open question. I mean, I think there is a growing level of optimism the more we learn about this virus, that we will be able to vaccinate against it, that this is not HIV or Hepatitis C which are also RNA-based viruses like the coronavirus. But, something like HIV has some really complicated, this kind of goes above my pay grade, these mechanisms that it uses to kind of adapt to whatever situation it is in. At least from talking with a lot of researchers in the labs with these coronavirus vaccines, they are hopeful and they are not seeing signs like that. They are not seeing these red flags that suggest these efforts just would not work at all. So with that said then the question kind of becomes what level of effectiveness can we get with these vaccines. Are we going to end up with something like the flu market for vaccines where we have a lot of partially effective influenza vaccines and you already see most Americans are well aware of that and I think the vaccination rates for flu are fifty-sixty percent something like that. About half the country does not get flu shots anyways, and if they do it, they are usually partially effective but that kind of has some unique elements too as far as how the flu changes year-to-year and so on. The complicated thing is we do not know. This is a new virus. We will see how it plays out. It is hard to think too much ahead but there are a lot of reasons for optimism as far as there’s one hundred twenty-five plus vaccine research programs ongoing. I think about twelve right now are already in human testing. So this is moving remarkably quick and some really big pharmaceutical companies that have done this before have put forward pretty aggressive timelines as far as saying that they think they could have effectiveness data for a vaccine by maybe as early as this fall, if not early 2021. 

Jeffrey: Okay, so if they have effectiveness data, that means that they came out with the trial at the end of this year. They are saying it could be effective, now they have to make it for a billion people or three hundred fifty million in the United States. How is that going to be distributed? Is it going to be a priority list? Is it going to be staggered? Is there any indication of this yet?

 Andrew: Well, so recently at least for the US Government standpoint, some Senior Administration officials working on operation warp speed which is the Trump administration’s ambition to get three hundred million doses ready by January 2021, which is a timeline without precedent and vaccine development. It would just be historically quick, but with that said that these administration officials have said that they are planning to use a tiered distribution approach. So, you are looking at vaccinating the elderly people with pre-existing conditions, health care workers, people in roles like that would have a higher tier. 

Jeffrey: Thank you so much for joining us today. This has been great.

Andrew: Well, thanks for having me, Jeff. I really appreciate it. 

Jeffrey: We hope you enjoyed this week’s podcast. If you have any questions, comments, or future story suggestions, please reach out to us on social media. Thank you, and we hope you , enjoyed the RPHealthCast.

In this week’s episode we speak with Bailey Lipschultz of Bloomberg to discuss the outlook for the biotech industry and the industry’s recent winners and losers in these turbulent markets.

TRANSCRIPT

Jeffrey Friedman: Hello, and welcome to the RP HealthCast by RooneyPartners. I am your host, Jeffrey Friedman.

Investing in the stock market these days takes a strong stomach, especially with these thousand points swings we’re seeing both up and down, and investing in healthcare stocks takes a keen understanding of both healthcare technology and market dynamics.

To break all of this down for us, our guest this week is Bailey Lipschultz. Bailey is a journalist for Bloomberg News focusing on healthcare equities. He reports on breaking news across the healthcare industry from small medical device manufacturers to big pharma. Bailey it is great to have you here with us today.

Bailey Lipschultz: Yeah, of course. Thanks for having me.

Jeffrey: So Bailey, as a graduate of Syracuse University’s Newhouse School of Public Communications, you certainly have the right pedigree for journalism. But, how did you get into covering healthcare for Bloomberg? How did you get up to speed so quickly on all the science?

Bailey: Well, I had always been interested in either covering healthcare or tech just rapidly advancing Industries. And a role opened up on our equity’s team covering healthcare, and I was able to slide over and get caught up to speed on everything around the science. You just read as much material as you can, as many sell-side notes or journal submissions as you can to try to get a real good grasp on it.

I talked to a lot of people all day and just try to better understand the entire landscape from the perspective of people like bankers and analysts all the way to patients and the doctors that are treating patients in the real world.

Jeffrey: Yeah, that is great. But healthcare investing, it is not for the faint of heart, right? Along with a million other market dynamic issues, you need to really understand the clinical trial process and what it takes to bring a product to market, or what a deal structure could look like if a company is going to partner that product with another company.

Now, just a couple weeks ago, you wrote an article. It is titled, “Analyst Pitch Up to 1,000% Returns in Biotech Beyond Covid-19.” And in the article, you said that Wall Street Analysts expect a hundred and five of the two hundred nine members of the NASDAQ Biotechnology Index to double over the next twelve months. Now, in normal market conditions, these are unprecedented returns. But with the markets so upside down right now, how can these analysts justify these predictions?

Bailey: Well, there are really big swings within the Biotech Sector in particular. A lot of these companies are built on one or two drugs, or even a broader platform. So, some of those returns and some of those big calls for these massive swings in the stocks, can be as little as a smaller dataset reading out positively or a positive patent update for these drug makers. While they do seem kind of unprecedented and crazy, as much as the Biotech Sector is exposed to the broader market, these smaller names are more insulated and protected and have their own fundamentals that will drive these potential returns that these analysts are really playing up.

Jeffrey: Alright. So that is the index. A lot of people do not understand indexes too well. Can investors buy the index instead of individual stocks? And if stocks are supposed to have 1,000% returns, what is the projection for the index over all over the next twelve months?

Bailey: We do not necessarily track the index per se, but investors certainly can invest in things like ETFs that track the index. So you look at something well-known like the iShares, NASDAQ, Biotech, ETF, it’s tickers IBB. It is well-known because it follows the bellwether of investor sentiment, which is the NASDAQ Biotech Index.

Another play that investors can get into is something called the XBI, which is a SPDR ETF that is an equal-weighted index. The difference between the two is the IBB is exposed to larger companies on a greater scale. Whereas, the XBI is an equal-weighted index. So when a small stock like Moderna, who is developing a vaccine for the Covid-19, that ETF will see a greater swing as opposed to the IBB given how it is weighted towards individual stocks.

Jeffrey: So, that one is a little more conservative in nature because of the heavy weighting to the bigger pharma.

Bailey: Exactly. You will see it is more drawn towards the bigger companies, the Gileads of the world, the Regenerons of the world. Whereas, these smaller stocks, they can see more volatile swings on make or break binary data who have a larger read-across two things like the XBI. Exactly.

Jeffrey: Got it, okay. That is the index. Can you give us some examples of some of the top picks that these analysts were talking about on the individual basis?

Bailey: A lot of these companies are big calls, but when you want to look at things that are more consensus plays or examples that the broader Wall Street is swooning over. The first one that comes to mind is a gene therapy company known as Sarepta Therapeutics. A couple others looked at a drug maker, a cancer focus name like ALAgene, or even smaller names like Arcus Therapeutics and Compugen. It is really a broad range just given how widespread Biopharma is. So some of these names are very small, microcap stocks. Now, there is a bigger place like Disreptor, which is well into billions in terms of market value.

Jeffrey. Okay, so I guess you really have to know what you are doing there. Switching topics slightly, two thousand and nineteen was the largest year ever for Biotech M&A. But today is twenty-twenty and we know the world is a very different place. You recently wrote an article titled, “Biotech Packs, Leave Wall Street Salivating for M&A.” Great title. So what is the current state of Biopharma Partnerships and activity now, here in twenty-twenty?

Bailey: Well, we have been seeing, given the unknown with the pandemic, we have been seeing more and more of a push towards things like partnerships. So you are seeing less outright M&A where a large drug maker will go ahead and buy a smaller drug maker for its platform or its pipeline at a marketed premium. You are seeing companies go ahead and team up.

Even announced earlier today, AbbVie is in partnership with Genmab to focus on a broad cancer R&D pack that could bring well over three billion dollars. So we are seeing companies like Gilead Sciences, we are seeing companies like AbbVie shift more towards partnerships in a way from the M&A that really was the keystone over a year ago when we saw AbbVie buy Allergan, the maker of Botox, we saw Bristol-Myers go out and buy Celgene at the beginning of the year. So we are seeing a shift towards more partnerships and being able to walk in step, as opposed to some of the riskier and bigger BioBucks deals.

Jeffrey: Right, with the Amgen and the Celgene.

Bailey: Right.

Jeffrey: So with the market being crazy, you would think investors may shy off a little bit with these big swings. But I am seeing a lot of fundraising, right? There is a lot of cash going into the Biopharma industry right now. Are these companies building war chest right now for these M&A programs?

Bailey: Well, a lot of the fundraising you are seeing is for smaller companies because of how euphoric and how high the stock market in Biotech, in particular, has been running as of late. So these smaller companies are able to raise cash and issue equity, so that they can continue to fund their pipelines, which actually would draw away from a need to strike a deal.

In that sense, these smaller companies are able to fund their research and not have to worry about selling in a weakened position to a larger company looking to take advantage, if that makes sense.

Jeffrey: It does make sense. But as we know, the smaller companies are even more speculative. So I guess investors have a stomach for this sector as opposed to certainly retail right now.

Bailey: Yeah.

Jeffrey: There is not a flight to safety, but a flight to change the sector and what the future may hold. In terms of Biopharma, do you see any sectors in particular that are seeing more activity or specific areas?

Bailey: We are seeing a lot of excitement in terms of cancer research for Next Generation Technologies, like gene therapy or things like CRISPR gene editing. Those are areas that we have seen a lot of investors rush to. We have seen so many of these IPOs take off compared to what has been a rocky market landscape, because investors want to be on the cutting edge of science and be looking at what is next, what can be the next blockbuster drug, or the next billion dollar therapy and opportunity.

And a lot of that is coming from cutting edge sciences and things like cancer research or other areas looking at things like gene editing and gene therapies that were only an idea many years ago, and then now are really quickly being brought to the forefront.

Jeffrey: Interesting. Now, you mentioned cancer. In our last topic, a couple weeks ago at ASCO’s American Society of Clinical Oncology’s Annual Meeting, it’s the Super Bowl of cancer research meetings, right? So all of Biotech’s elite met to talk about their advancements in cancer research and talk about their clinical trials, the good, the bad, and the ugly of it. You wrote an article entitled, “Traders Sift Through Virtual Cancer Meeting’s Winners and Losers.” And in this article you talked about how investors view data coming out of ASCO. Can you tell us about some of these winners, and why did the Wall Street analysts favor these companies?

Bailey: Yeah. As you have said, ASCO is very much the Super Bowl of cancer research in this year with the ongoing pandemic. It was pretty interesting to see it shift to a fully virtual experience. But looking at some of the winners adapting to immune therapeutics, is this small cap that we saw more than double in the trading after unveiling some data and that company, in particular, had early stage results from a group of trials and a range of cancers in showing that its technology, it can work. And that comes back to the point that a small patient group seeing a benefit can really drive some wild swings.

Other companies that were really crowned winners by Wall Street, one was a company named Trillium Therapeutics, which is an originally Canadian company that is loved by hedge funds. It showed its cancer treatment was also shrinking patients with lymphoma, and that could lead to potential upside and other indications. And another company that was a big winner was AstraZeneca, which is a global pharmaceutical giant based in London. It had a terrific conference where it unveiled updates for a trio of its drugs and its blockbuster TIGRIS, a cut risk of small cell lung cancer or lung cancer death, and then, another couple of other cancer studies showcase some pretty strong benefits. So analysts were really key on those three among a couple others.

Jeffrey: Now, there were also some darlings that put out some inconsistent data. Subsequently, they got punished a little bit by Wall Street. Can you talk about any of those?

Bailey: Yeah. Two of them that really come to mind, one is Arvinas, Inc. ASCO for this company, in particular. It is based out of New Haven, Connecticut. ASCO was a big stage for the company to showcase its potential cancer platform in prostate cancer. Obviously, prostate is a very tough cancer to treat. But the benefits it saw in the first twenty patients that were treated, failed to meet the bar that sell side analysts had set. Another company that comes to mind is MacroGenics, Inc. It did not really meet some of the updates that Wall Street really had been looking for. But stock has been on an absolute tear this year, in particular. We have seen their stock price well more than double at some point this year. So it really was one of those that the company was running red hot into the meeting, and maybe it did not meet the high bar that investors were looking for.

Jeffrey: Well, the virtual meeting was certainly different. They did a great job, ASCO. But I have been attending for the past ten years in my annual trip to Chicago to attend the meetings and they will be missed. Hopefully, we will be able to get there again next year.

Bailey: Yeah. I am looking forward to that. I know IHA, which is based in San Diego, they are trying to march forward towards being able to have that conference in person in San Diego. So hopefully, we will be back to some form of normal as soon as possible.

Jeffrey: Yeah. I think that will be a combo. I think it will be a hybrid of that as well. Bailey, thank you so much for your time today. And as I said earlier, healthcare investing is not for the faint of heart, but I guess that is what makes your job so interesting.

Bailey: Every day is certainly a new day. It is what keeps me going and keeps me coming back to work.

Jeffrey: That is great. Bailey, thank you.

Bailey: Thank you.

Jeffrey: We hope you enjoyed this week’s podcast. If you have any questions, comments, or future story suggestions, please reach out to us on social media. Thank you, and we hope you enjoyed the RP HealthCast.

In this week’s interview we speak with Shawn Tully, Senior Editor At Large for Fortune Magazine, where we discuss the intersection of public policy, public health and government spending as it relates to the coronavirus and the huge cost we are shouldering by keeping the economy closed.

TRANSCRIPT

Jeffrey Freedman: Hello and welcome to the RP HealthCast by RooneyPartners. I am your host, Jeffrey Freedman.


The intersection of public policy, public health and government spending as it relates to the coronavirus is the subject of this week’s interview with Shawn Tully, Senior Editor at Large for Fortune Magazine. This topic is almost tailor-made for Shawn given his career and his education. you see, Shawn joined fortune in 1979 and in 1983, became the magazine’s first Paris Bureau Chief. Shawn was also an on-air reporter for CNBC from 1996 to 1998 when he returned to Fortune and he is now approaching his fortieth year with Fortune. Shawn received an MBA from the University of Chicago, a Masters in Applied Economics from the Université Catholique de Louvain in Belgium and holds a Bachelor of Arts degree from Princeton University

Shawn, it is a pleasure to have you join us today to share your thoughts and insights and discuss some of your recent coverage about the policy and financial implications of the US federal and state governments response to the Coronavirus.

Shawn Tully: Sure, my pleasure.

Jeffrey: Great. Now before we dive into this extraordinarily important topic though, I would like to post a couple of career track questions if I may. At first, your decision to dedicate your life to journalism. Now, if I were only studying your education pedigree, the logical conclusion is this is someone destined for the C-suite or Wall Street? Why the noble path of journalism, Shawn?

Shawn: Actually, I started at what was then called First National City Bank. So I was an MBA student and had also gone to graduate school in Belgium in economics and right after I finished in Belgium, I went to work for First National City, which is now Citigroup and they were in the building on Park Avenue. I think it is 390 Park Avenue and I was in the real estate lending division and I was there for about a year, but I did not love it. And then, I just started freelance writing and I work for New Jersey Monthly and then, the editor there said, “You really should concentrate on business writing. Your stock will go up.” And it was the best advice that I ever got because I had kind of the technical background to understand business subjects, but I also like writing so when you put the two together, I was able to succeed as a freelancer, initially. And then, go do more and more business stories and then go on to get hired by Fortune and then, work with some great writers as their reporter; the likes of Carol Loomis, who recently retired in early 80s and is a legend in the business. I worked under her, learned a lot from her. Roy Rowan, covering the Hunt Brothers trying to corner the silver market back in the 1980.

So just working for these greats even though I was not writing at the time. I was just taking notes for them and doing reporting for them really prepared me and then, I was promoted to being a writer within a couple of years and had been at Fortune the entire time, except for a year and a half when I worked at CNBC as a TV reporter. But I spend the entire career as a business writer and trying to do as many types of stories as possible. Some about drama personalities takeovers. It is kind of yarn style stories. Others that are much more about the markets and numbers based, but the good thing is business reporting gives you the ability to use all of those skills and tell a variety of stories.

Jeffrey: Yeah, but I think you have interviewed more Fortune 500 CEOs over your almost forty years span of Fortune than any other business journalists. When you are conducting an interview with a captain of industry, you know, based on your pedigree, do you ever think that could have been your job. I mean, let me put it another way. What goes through your mind when you are sitting face-to-face with a CEO subject.

Shawn: Well, no, I would never want to run a company or to have wave or be qualified to run a company, but normally I am… You cannot fake it. When I interview for CEO, I have read up on the company. I have done a lot of homework. I am intensely interested in how he manages and deals with a crisis which, of course, has been a big subject recently. So my interest is strictly from a journalistic standpoint and trying to take a lot of what is often highly technical information or covered up with lots of cliches and explanations. You cannot understand which is often what the companies put out and make it understandable and colorful for readers. And therefore, the background, the personalities, the styles of these CEOs become very important to getting people to read the more serious stuff because the more fun you can make it, the broader the audience becomes.


Jeffrey: Right. That is a great insight. Thank you. This is a healthcare podcast. So if you do not mind, well let us turn to coronavirus. In late April, the Fortune published the story under your byline. It was entitled “Pandemic economics. The U.S. is learning why limiting hospital beds carries a steep cost.”

Shawn: Right.

Jeffrey: All right. As New Yorkers, recalling the erection of the field hospitals in Central Park at the arrival of the USNS comfort and other measures to boost bed capacity, the issue of hospital shortage remains an open wound. Sorry, forgive the expression. But you identified an arcane government regulation as responsible for effectively blocking the construction of new hospitals. Now, can you explain the certificate of need laws and its role in capping hospital bed capacity?

Shawn: Yes. These are state laws. These are not federal laws, but they are very widespread. You have them in over half the states. These laws force hospital companies or companies that want to get into the hospital business or expand to go to the state authorities, which are often controlled by the existing industry in order to get permission and get the permits to add beds, which would involve either adding more beds to an existing facility or building new facilities. Now, the industry, obviously, the existing players want to have all their beds full all the time. So they resist construction of new hospitals, which would add to the surge capacity that we need to fight this virus. And that was the rationale for most of the lockdowns, was that we were going to swap our hospital capacity and not being able to treat the people who were in serious need of respirators and hospitalization due to the virus.

So, what really worked was the suspension of the certificate of need laws in many states, then enabled hospitals to add beds and to move beds between hospitals. Under most of these certificate of need laws, hospitals are not able even to move beds from one part of a hospital chain to another part of the hospital chain, if you can believe it. So, they are extremely restrictive and they prevent the market from determining how many hospital beds you really need and they leave it in the hands of the industry and the entrenched players who want to shrink the supply to keep the prices higher and keep the capacity lower. It is not unusual. You see it in OPEC or any cartel and it is not healthy, right? So, my objection to it was that first of all, it is never a good thing because it just simply raises prices and does not allow hospital beds. There is a view that you cannot have more beds in rural areas. That is not true. It simply caps the total number of hospital beds. You have fewer beds everywhere than you really need and this was brought into bright relief by the virus where we needed a lot more capacity and we are only able to get it because these laws were suspended.

Jeffrey: Okay, so I get the concept of permitting the free market to dictate need. But as I understand that the CEO and programs help distribute care to disadvantaged populations or geographic areas that new and existing medical centers may not serve, right? So, according to some policy experts, the removal of CON well actually favor for profit hospitals because they may be less willing to provide indigent care. So, given the disproportionate impact of the coronavirus on communities of color, are you not concerned that the dreadful death data we have experienced would have been even worse without the CON laws.

Shawn: No, and the proof is that they were suspended. In other words, if you have a shortage of capacity in a crisis as what we had and it were a good thing, why did they not shrink the number of beds and strengthen this thick certificate of need laws? Not at all. In other words, what… The reason they were able to serve underprivileged populations was that they got rid of the laws. If you are in a densely populated urban area and you cannot move beds from one facility to another or add more beds in an existing facility. What is the good of a Certificate of Need law? It freezes and place the number of beds. So it was the suspension of these laws that opened up the capacity needed to serve underserved populations and to take care of the surge. They should be suspended indefinitely. And one of the mysteries of the entire crisis is why this is not a major topic of discussion and of a policy point that would be extremely helpful in solving this surge problem that we have. 

Jeffrey: Okay. Thank you. Switching topics a little bit, still staying in our home state though. Last week, Fortune posted another thought-provoking article by you entitled “New York City’s lockdown is costing $173 million per day. Is it still worth it?” All right. That is quite interesting. Now, clearly the trade-off of public health and economic health, it is a Hopson choice. But what struck me was your estimate that New York City shutdown has cost the economy a staggering sixty-three billion dollars. Now, I am having a census taker shot. That is a big number. So, walk me through those numbers.

Shawn: Yes. So the hit too… Well, okay what the… You have to start with how big is New York’s economy to figure out how big the hit is. This is not an easy task because you never see a number for New York City’s GDP or gross urban products. There is a couple of names for it, but essentially, it is the output of goods and services annually that the city itself of 8.4 million people produces. But you can find the number. Interestingly, it is usually referred to only by how much it is going to grow or shrink every year and they never tell you how big the dollar number is. But I was able to get it by going through the websites from the US Commerce Department that do give that number by county so you can add it up. So it is nine hundred billion dollars approximately. The projections of the shrinkage in GDP this year from Boston Consulting which did a study for the state of New York for the city is seven percent, which is much higher than for the country as a whole. Because the country as a whole is a 5.6 percent according to the Congressional Budget Office. So the sixty-three billion is an annualized number based on the seven percent of shrinkage in GDP that we are going to experience because of the coronavirus outbreak and the lockdown that is is brought on by the outbreak.

Now, that is an annualized number. The daily amount is actually much bigger because the shrinkage and GDP in the middle of the year is more like ten percent or eleven percent , but I use the annualized number. Now, what we do not know is how much of that would be restored if New York were opening much more quickly. Part of it would, but that number is impossible to come up with accurately. But we do know it is a lot of money and given that eleven percent of GDP in this crisis period is more like ninety billion a year. Would that be fifty billion? Would you save… Sorry, a million per year. It is ninety billion per year. Would you, with the daily amount drop by thirty million from one hundred seventy-five to one hundred forty-five? We do not know that number, but we do know that it is a big number. And my point in the story was that, again, there is a… Definitely, New York has been very successful in getting these numbers down as Dr. Scott Gottlieb, the former FDA commissioner, cites it has got the best track record in the country. Yesterday, they were three hundred and forty cases that tested positive in the entire city. That is a one percent positive rating. It is one quarter of the national average. We are way below the national average at this point, and we have been getting closer to fantastic results for several weeks. But the lockdown has been very severe and remains very severe.

So, the question becomes you are getting extremely small incremental improvements in the various metrics that the state has been using and the city has added to those metrics. There is ten altogether, three from the city and seven from the state. You know, if you are within one percentage point of reaching some of these metrics and you have acing almost all the other ones, question is what is the objective? Where do you want to get to before you open up? Because staying locked down is not getting you a lot of progress on the margin, but the costs on the margin are extremely high. So, I would like to see more discussion of what does it really costing and are there ways of dealing with the virus that would be less damaging to the economy and at the same time, protect the health of these few people now, who are getting the virus where at levels that are extremely small by national standards. Now, the virus is very contagious and I leave it to the experts to find ways that you can find hot spots and do tracking and treat the virus in tailored ways that do not lock down the entire economy. So the question I was raising is not to say that it has not been worth it, or even that it is not worth it now, but to point out what is really costing which is a subject that I had never seen addressed. 


Jeffrey: Right. So your argument, you know, is that we have already met most of the arguments set by Governor Cuomo and which perhaps we are taking too cautious in approach by delaying the restart. The numbers that you mention are staggering. So, yes, economic impact is significant. But New York has been victim number one, right? Seventy percent of total New York State coronavirus deaths are in Manhattan. I am sorry, New York City. And you know, we have had almost seventeen thousand New York City residents passed away due to COVID-19 so that equates to about fifteen percent of nationwide fatalities. So, you know, I think it might be understandable why New York is taking a more prudent approach to the reopening and you do not feel that way or you are…?

Shawn: I think there is going to be [crosstalk]. I think there are going to be some very interesting studies on this subject. The debate is really a little different. Clearly, New York was the hardest hit, but it clearly New York is the quickest to come out or the most successful in coming out. So, the question is how much do you want to spend to get to instead of three hundred and forty people yesterday testing positive; one percent to get to three hundred and twenty people. In other words, at what point do you want to… Have you reached all of the metrics that would justify a reopening. Now, you have reached them, the issue is that there are very long delays between the different phases of reopening that can be pushed back and there is not even any guidelines now for reopening restaurants, which do not even possibly open until Phase 3, which would be mid-July and that could be pushed back. So, the question is where do you need to get to to open up? And are you are you that much better off if there are three hundred people instead of three hundred and forty people getting it if you open that. Right? You are at such low levels that for whatever that improvements to come are going to be tiny. There is no other way because you are already at such excellent, excellent levels. So the cost per metric of improvement or unit of improvement is very high. That was the point that I was making, not that I think that the state has made a huge mistake or is taking the wrong course.

Jeffrey: Got it. Got it. I mean, at this point, what you are saying is it is not a health debate. It is not an economic debate. It may be more of a philosophical debate and I would love to actually have that in a future episode. All right, let us conclude where we began a little bit and by more of a personal look. Now, you live in New York City. And since the death of George Floyd in late May, the streets your neighborhood have been teaming with protesters and the medical community has voiced concern that these crowds are going to lead to another bout of coronavirus cases and, like you mentioned before, we may have to delay opening. Do you think that the results will lead to a further delay in the reopening in New York?

Shawn: Well, there is a lag in the statistics between when you have a dangerous signal such as people congregating in the streets and not respecting social distancing and when you get a spike in positive cases. Certainly, there has been no spike. The opposite, we have gone from four percent positive results to one percent in the last several days. Now, that does not mean it is not going to spike back up. I think it is going to take another week or so before we know. So it is possible. There is two dangers. One is that you get an additional spike which would lead to possibly to more delays, which is disastrous. Because from an economic standpoint, because as I said, you are probably looking at ten percentage points shrinkage in GDP during this crisis period that would have been counter balanced by coming out of it when we open up. So if you delay the opening up, the depth of the damage becomes much worse, the economic damage.

And the other problem is that these demonstrations tend to shut down clinics that are doing a lot of testing and New York state is doing a tremendous amount of testing. We were testing around between fifty and eighty thousand people per day. They are testing half a million people per week. It is tremendous and it has really helped and the great news is that despite much higher testing, the number of daily cases is dropping which means that the positivity rate is going way down. So, if those things are reversed, if you cannot test as much and more people have it, that is a bad situation. So you have a double hit, potentially coming in the form of people not respecting social distancing in these demonstrations and also the possibility that some of the testing clinics will have to close down.

Jeffrey: Now, if we do not see a increase, would it not warrant or do you think it would warrant a moving forward of the reopening of the different phases?

Shawn: Again, I think the city and the state have decided to stick to a preordained plan that sets a timetable so I do not think that Mayor de Blasio or Governor Cuomo are going to try to to accelerate the reopening schedule, which is I say pushes restaurants back to around July 8th. And then we do not have any guidelines on what the capacity would be in restaurants and that is assuming that there is no pushback in that fourteen-day difference between Phase 2 and Phase 3. So I do not anticipate that they would move it up. They seem to be determined to stick to the schedule that was settled long time ago. I do not know that that is from the economy standpoint. That stretches this out a very long time when you have very, very good metrics. So it definitely stretches the damage to the economy much longer which may or may very well be justified. It is just a fact. It just does. But I think the question then becomes more will they stretch out these interim periods between the phases and pushback the reopening? For example, theaters do not even reopen until Phase 4, which would be back getting close to August and that is if everything goes great. And as you said, you may be in a situation where the protests led to a spike, which given the extremely cautious stance that New York state and city are taking would conceivably push it back more.


Jeffrey: All right. Shawn, this has been a very enlightening and interesting conversation. So, I want to thank you so much for joining us today, and good luck in New York City. And we hope that everything comes back on board very quickly. So , thank you.

Shawn: Great, my pleasure. Thank you.


Jeffrey: We hope you enjoyed this week’s podcast. If you have any questions, comments, or future story suggestions, please reach out to us on social media. Thank you, and we hope you enjoyed the RP Healthcast.

In this week’s episode, we speak with Sara Harrison of Wired.  Sara discusses the issues our senior population have with the coronavirus and why they are more at risk for serious health complications than the rest of us.

TRANSCRIPT

Jeffrey Friedman: Hello and welcome to the RP Health Cast by RooneyPartners. I am your host, Jeffrey Friedman.


Jeffrey: As her country begins to move forward from the pause we took due to the pandemic. We must try to find a balance between safety and normalcy as we open up our economy. We still have a large highly vulnerable population. That is at high risk of serious illness if they get infected and this includes her senior citizens.


Jeffrey: To talk more about this is our guest this week, Sara Harrison. Sara’s a healthcare reporter for Wired and has been covering health and technology-related stories there for the past four years.

Jeffrey: Sara recently wrote a fantastic piece about the serious risk issues our elderly have and why they are so vulnerable and more at risk than the rest of us.


Jeffrey: Sara, it is great to have you with us today.

Sara Harrison: Thank you so much. I am happy to be here.


Jeffrey: So your recent story for Wired about COVID-19 severe impact on seniors was a fantastic piece but before we dive into this. Let us talk a little bit about how you got here, and how you started covering health care.

Jeffrey: In the past, you have written about many different topics. What is it like refocusing your coverage almost exclusively on health care during the pandemic?

Sara: Yes. It has been really interesting. I do not have a science background. I was an English major in college but I love writing about science. I love learning about it.

Sara: It has been really challenging. I think especially during the pandemic because the information is coming so quickly and it has been really challenging to weed out, what is important. What is a big discovery and what is maybe just a theory?

Sara: So I think especially for people who are non-scientists like me, it feels very challenging and that is one of the things I try to focus on. My coverage is providing some actionable easy-to-understand information for people who are not trained in the sciences but really need to understand what is going on around us.

Sara: That is something that I tried to do in all my reporting but I think it is particularly important now.

Jeffrey: Yeah, absolutely and you bring an almost humanistic, if I will, humanistic approach to the writing and if we could turn now to the article you wrote about the COVID-19’s overwhelming impact on seniors.

Jeffrey: Now, it is a topic that hits home for everyone with elderly loved ones. The subhead to your story really summarizes the issue and I quote, “It is not one thing. It is everything. Older people are more likely to catch the disease to suffer from it more severely and to have a tougher recovery.”


Jeffrey: Now, let us take all that in smaller bites by having you start with why seniors are more at risk of contracting COVID-19.

Sara: Yeah. Seniors are at risk for two reasons: One is biological, and one has more to do with their social living situations. The first is that they are just more physically vulnerable. Many seniors who are more likely to have comorbidities like hypertension or diabetes, which have been linked to increase susceptibility to coronavirus.

Sara: They also generally have weaker immune systems which we can go into more depth later but they are not as able to mount a really strong immune response to this virus. They are also, you know, carrying around all these other physical ailments that make them more at risk.

Sara: The other issue is that not only are they more physically vulnerable but they are also more likely to live in congregate living settings like a nursing home or an assisted living facility.

Sara: So that means that they are just around more people. Many of them, even if they live at home, they need physical help with basic tasks like feeding themselves; going to the bathroom; taking a bath; walking around, and none of that care can be delivered through a Telehealth call.

Sara: It all has to be done, you know, physically by someone else and so it is really hard for them to physically isolate or socially distance. It is basically impossible and so that makes it more likely that they will contract the virus just because of where they are living and what kinds of health needs they have.

Jeffrey: You use a term and I hope I am pronouncing it correctly, Immunosenescence. What is that? What is its role in contributing to the vulnerability of the seniors?

Sara: Yeah. So Immunosenescence is a natural part of the aging process. It happens for different people at different times. So I should specify that being like more talking about seniors. It does not necessarily mean somebody in their eighties or nineties. It really depends on what you are sort of physical well-being is. This could be true of people in their seventies

Sara: Immunosenescence is basically the slow deterioration of the immune system. So when the immune system sort of grows in three phases. When we are young, you know small children. We are full of T and B cells. These are the frontliner of our immune defense there. They recognize foreign pathogens and viruses and bacteria and they gobble them up and they protect us from them.

Sara: And when you are young, you have a huge reservoir of what are called naive T and B cells. Basically, they have not specified to a specific pathogen or infection. So you may get more sick; more colds; imminent infections; things like that but you are able to ammount an immune response and yourselves learn.

Sara: So by the time you are in your twenties and thirties, you have this full healthy and immune system. That is ready to fight off lots of imminent infections and also still has lots of naive cells that are ready to learn and adjust to new pathogens.

Sara: But starting in your fifties or sixties, generally, there starts to be this decline where you run out of naive cells and you just cannot adapt as quickly as you might have. So the older you get the fewer cells you have basically, to pull on and it is harder to adapt.

Sara: So for seniors, that means that they are just much slower to mount an immune response and their immune response will be much weaker.

Sara: It also means that their symptoms will look very very different because the virus will be reacting to their immune system in different ways.

Sara: So instead of, say, having a very high fever. Most seniors do not get high fevers in general. They might present as being like, very confused or delirious, or eating more and eating less, and sleeping more.

Sara: And so, it can be very difficult to diagnose coronavirus in those patients because they have these very atypical symptoms.

Jeffrey: Well, now besides the immune response. I know that chronic low-grade inflammation is another health condition found predominantly in seniors, and use a term called, Inflamm-aging. Explain how that affects the body.

Sara: Yeah. This is another sort of part of the dysregulation of the immune system as people age. Again, it is not true for all people and it can happen at different times in their life for different people but essentially, inflamm-aging is a condition under which you stop being able to control or there is a dysregulation in the control of cytokines, which are these very small things and among other tasks that they perform. They help regulate the immune system.

Sara: That means that basically, you are always sort of releasing cytokines and you are always at the sort of like chronic low level inflammation. That can potentially and I should specify that there is still a lot we do not know about coronavirus.

Sara: And so I do not want to say that this is like an absolutely proven fact. One of the thoughts, is that these cytokines have also been associated with some very severe COVID infections where patient’s immune systems will sort of spiral out of control. And they will have these very big overreactions in the immune system will start attacking healthy organs.

Sara: At that point the body is not just fighting off the infection, it sort of attacking itself. And so, if you are a senior and you have more cytokines already in your system that may make you more susceptible to these cytokines storms.


Jeffrey: Got it. Now, in the news we hear about the coronavirus and the need for respiratory and respirators respiratory equipment, but it is not just a respiratory disease. It is a lot more complicated you write about.

Jeffrey: So, you want to talk about how it can affect the vascular system or other organs and different ways that the COVID-19 can attack?

Sara: Yes. Yes. The more that we learn about this virus, the more complicated it becomes. I think. There have been reports, you know, in addition to all of the respiratory problems. 

Sara: There have been reports of like very young people who have mild infections or may not even know they have infections suddenly having a stroke.

Sara: There have also been these reports of something called COVID Toe which is like where your toes become very swollen and red. It looks kind of like chilblains and the thought is that the virus, in addition to attacking the respiratory system. It is also getting into the vascular system and attacking your blood vessels.

Sara: They have also found and there have been quite a few papers and autopsies showing lots of blood clots in COVID patients. So that means that the virus is affecting so many other parts of your body. It is not just your lungs. This is pressing cause problems in your toes; in your brain; in your heart.

Sara: There are lots of lots of scary scenarios, and this can be especially dangerous for seniors because many seniors already have wear-and-tear on their blood vessels. They may already have hypertension or other vascular issues. And so this is just like yet another way in which the virus could affect them or severely than younger populations. 

Jeffrey: Yeah, I guess it just shows how little we still know about this disease and how it affects us.

Sara: Yeah. It is pretty incredible like given how much it has changed our lives. How little we understand about what it is doing inside our bodies.

Jeffrey: Yeah. Now, you touched upon this a little bit earlier. Public health officials have been requiring social distancing as part of the regime to protect us from contracting the coronavirus but seniors as you said, they need caregivers, some.

Jeffrey: They may be residents in nursing homes, or they have family members that are needed to be able to check in on them and help take care of them.

Jeffrey: This does not work with social distancing, right? The elderly, they cannot do this. So, how do we square the circle here?

Sara: Yes. This is a very very complicated question and that I should specify that I do not have a clear answer and I do not think that many people do.

Sara: I think there are some basic things, you know, like we need to make sure there is enough PPE in nursing homes and assisted living facilities. Enough so that all the staff and residents can wear their in a mask so that they do not have to worry about, you know, when to put on a full kit to protect themselves.

Sara: So that is one big thing. Another thing is that in long-term care facilities. They have started in some cities, universal testing where they will test the staff and the residents whether or not they show symptoms and this is potentially another way that we could sort of make sure that nobody in that setting is infected and that they can touch each other and provide the care that people need without this constant fear of getting infected.

Sara: Commonly, with something like the flu for example. They will often, you know, nursing home vaccinate the entire staff and so whenever there is a vaccine, that would be a great way to protect people as vaccinating caregivers. Vaccinating the seniors in the facility but also like all of the staff.

Sara: Anyone who helps out, family members if they are caregivers. But honestly, I do not think that there is a very simple solution to this, and when I talked to geriatricians, especially people who work in long-term care facilities. They are very very scared and they are very worried about reopening their facility to the public because it is hard.

Sara: It is virtually impossible to sort of keep a distance and provide good quality of care and make sure that everyone is safe.


Jeffrey: It is scary. It really is. You mentioned vaccines and about vaccinating the staff and we are all waiting the day when a vaccine is available. It is considered probably the optimal way to reach herd mentality in the community but your reporting reminds us that seniors are not apt to benefit substantially from the development of a vaccine.

Jeffrey: Now, from the seniors that are patients but why is that the case?

Sara: It goes back to this, if you would reduced immune response because seniors do not melt this like big immune response and do not have like lots of cells that are ready to learn this new disease.

Sara: They sometimes do not respond to vaccines in the same way that younger populations do. That is not to say that we could not create a vaccine that would work for older people.

Sara: They have created, you know, food doses that have a higher dose of the actual flu that sort of elicits a greater immune response. Older adults also respond very well to the shingles vaccine but the big issue is that.

Sara: In order to create those specialized vaccines for older populations. We need to include older people in clinical trials and that often does not happen and I will quote one of the doctors I talked to.

Sara: He’s a geriatrician at UCSF. His name is Eric Widera, and he said that one of their big worries is that we will be looking at potential treatments and vaccines but not actually testing them on the people who are most at risk of developing this disease.

Sara: So that is all to say that, he is not that they could not benefit but we have to be mindful about making sure that they do benefit and including them in the research that we do now.


Jeffrey: Yes. Well, then let us talk about recovery and you report that despite high mortality rates, many seniors do recover but their recovery is going to take a lot longer and it is much more difficult than younger or healthier people.

Jeffrey: Why is that? Is that the immuno suppression issue?

Sara: It is a little different. I mean, I think in general like seniors just have, they are less resilient than younger populations. So, yes. Many do recover.

Sara: I think we have all seen like heartwarming videos of hundred-year-old people who survived and it is great to see but you know? The longer that they are in the hospital, the longer that they are stuck in bed and are not able to move around. That reduces their overall health.

Sara: So people who spend a lot of time in the hospital usually if they are seniors, they will be weaker. They will lose muscle mass more quickly and they need a lot of time and rehab to regain the skills that they had before they started their hospitalization.

Sara: And as one person I talk to, you mentioned like that can be really challenging in the hospital setting right now because you know, the hospital gyms are closed. The physical therapy centers might be closed. Some long-term care facilities which is where someone who has been in the hospital for a long time and need some rehab might go.

Sara: They are afraid to take COVID positive patients because they do not want to bring an infection into their facility. So that can make it really, really hard for someone to make the transition from the hospital to home safely.

Jeffrey: Now, the issue you talked about with their being in the hospital or in bed or isolated so long. I mean that is part of what we are told, right? As citizens, be socially distant, you know? Be isolate. Keep isolated. Reduce your activity. Stay inside but that is so bad for seniors, right?

Sara: Yes. It is really, really hard for them. I mean, if I take a day and I lie down in bed. My muscles will be fine but for a senior though, their muscles will deteriorate faster. And so, they really need to be active.

Sara: The other issue is that you know, whether you are in a nursing facility or not. I should phrase this a different way. In nursing homes, a lot of nursing homes have sort of reduced the amount of mobility that people have because they are trying so hard to reduce the spread of the virus.

Sara: So that means that people are spending more time in their rooms and less time walking around which obviously is not great for their physical health but for also, for people who live at home, like most of the places they would go to socialize or exercise like a senior center or a library or like a church or temple or synagogue. They are all closed.

Sara: So not only are they losing like the sort of fit impetus to get up and go out and be out in the community, but they are also very isolated.

Sara: Isolation and depression are, I mean, they are bad for everyone but they are very very bad for seniors and they are linked to a host of very big health problems including worst cognitive function, higher blood pressure, higher risk of heart disease.

Sara: So even though it seems like kind of a nicety but it is actually very much part of their physical health that seniors are able to get out. To be active. To be intellectually simulated and connected to people around them and not stuck in home alone.

Jeffrey: Right. Well, as we all start to come out of this quarantine and emerging to society. We all have to bear in mind that they are our most vulnerable and we do need to always keep guard against that.

Jeffrey: Sarah, this has been very educational, very thought-provoking. Thank you so much for taking the time to be with us today.

Sara: Thank you for having me.


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Jeffrey: Thank you, and we hope you enjoyed the RP HealthCast.