HomeMy WebLinkAbout03/18/20 - NYSE Webinar with Scott GottliebStephanie Bush
From:Leah Charette <ldamon@thornrun.com>
Sent:Wednesday, March 18, 2020 2:08 PM
To:All Staff
Subject:NYSE Webinar with Scott Gottlieb
All,
I covered a New York Stock Exchange webinar with former FDA Commissioner Scott Gottlieb this morning. He was very
informative on the modeling projected for the epidemic in the U.S., as well as necessary action before the fall to
mitigate against a second surge in cases when the temperature drops. Interestingly, he advocated against “shelter in
place” actions, instead noting that mandates to wear procedure masks could stop the spread of transmission without
taking away liberties. Notes from the webinar can be found below:
Hitting steeper part of the epidemic curve right now and cases will build quickly.
o Going to start to see days where hot spot cases grow exponentially.
o Exhibiting sustained community transmission.
o Thought by this Friday we will be at 10,000 cases, might be below that, limiting factor is screening and
testing.
Rate limiting factor will be components in screening:
o shortage of swaps, tips on pipettes and plastic cartridges to run samples - supply chain can’t keep up.
o Lowest factor is critical chokepoint, weak link.
Modeling circulating around Washington — one shows peaking out late April, one shows late May peak. Thinks we
will peak out in late April.
Was concerned we would have a larger outbreak than we have now, was concerned about not having political will to
stop transmission.
o State and local leaders have taken corrective action.
o Will start coming down epidemic curve, cases break off end of June.
o Possibility we will get into hundreds of thousands cases, don’t think we will get to millions of cases because
not enough transmitting.
100-page report circulating, 18 months long for epidemic to run course, might have epidemic afterwards like
Spanish flu.
o Lots of pathogens that circulate in population but don’t freak about them because we know we have tools
to treat them.
Tools will be available to mitigate in fall if we start working on it now.
o Need point of care diagnostics that could rapidly diagnose C19; will allow early detection in community to
prevent large outbreak. Capabilities in development and no reason why we would have it.
o Therapeutics — number of promising products in development and no reason we couldn’t have one in fall.
Antivirals (Gilead, Fuji drug Avalon, ect); know how to target components aspects of this drug and should be
able to repurpose some existing therapies. Also have antibodies in development like regeneron drug, and
you would have to get it monthly. Regeneron successfully developed something like this for Ebola, and had
one for MERS too. As long as target aiming antibody at is right target, it should work and be safe. Could have
something available by early fall and produce it at scale. Would use in front line health workers and most
susceptible.
o Developing massive screening capability right now — if we had all equipment could screen several million a
month. Won’t need these capabilities in later summer, and in fall redeploy screening capacity as surveillance
system. CDC already does this: those who present influenza symptoms but test negative for flu A and B,
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would test them for lots of things that could present as a pandemic-flu. Could massively expand to many
more cities and rural areas, test tens of thousands a week. Low tens of millions of dollars to build out this
system, not billions.
o Put these components together, becomes something manageable until we get vaccine. Won’t be something
that happens again in winter if we take action.
China acknowledged that there was sustained community transmission six weeks after it started, probably more
than we knew, and then implemented lock-down in Wuhan. From time of lockdown, cases continued to build for
another four weeks, and peaked four weeks after lockdown. We are about two weeks into that journey.
o We probably identified our community spread earlier than China did, and we’ve been doing a lot of things
right. China did a lot of things wrong.
o Reason to believe we will be successful here and prevent bad outcome.
o China, Italy, South Korea had geographic isolation, and our challenge will be that we are a much more
mobile population.
o July and August should be backstop against rapid transmission, temperature and time outside will help us.
No city can handle the surge in cases predicted.
o Critical care and hospital beds needed don’t exist in any city.
o Over 5,000 critical care beds probably needed in city.
o Would overwhelm state and need to bring in surge capacity. Why we are seeing governors asking for
military to build field hospitals to handle surge capacity.
o Starting to look at surge in admissions, those who are unstable being admitted currently with comorbidities.
o Build out capacity to handle discharges for patients who could be handled in other health care facilities or at
home. Build out skilled nursing facilities that act as dedicated c19 facilities so we don’t have cross
contamination.
Think we lost opportunity to be like South Korea, didn’t have testing capabilities.
o Mistake because even if 25 YO seeking testing, giving that 25 YO positive result and telling them to self-
isolate — they’re much more likely to self-isolate than if they just think they have it.
o Can enforce quarantine with positive test result.
o Think we are unlikely to have catastrophic situation like Italy, over half diagnosed are hospitalized. Italy
made a lot of mistakes, they didn’t have robust primary care system.
o We’re working to keep people out of hospitals and tested out of hospitals. Have much better infection
control, younger population, less comorbidities like smoking.
We are oddly complacent about the flu without taking stepped up actions.
o Complacent because we have a vaccine and antiviral drugs.
o Seasonal flu isn’t that deadly, about.1%
o Distribution, bulge in deaths in very young and very old. Fatality driven by older individuals who are more
susceptible to flu.
o Fatality for c19 is about 1%, gets much higher for older populations, but no one is being spared. Older
populations driving fatality rate, but only population really spared is under 10 YO.
o Ten times more deadly than flu, more contagious than flu as well without action. 2-3 new infections for
every case of c19.
o Modeling inconceivable if action not taken, casualties could be in millions, why you’re seeing aggressive
response
When will we be back to normal?
o Shelter in place — will compel other cities to do it now that SF has done it.
o Skeptical of it, don’t like doing things that deny people liberty. More effective ways to do this without
mandating it.
o Maybe mandate people to wear procedure masks to stop spread of droplets, can do this in lieu of lockdown
of city. Clarified not N95 masks.
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o Very hard to say after 15 days we “take foot off the breaks,” will be hard to restart until we reach peak of
epidemic and demonstrated drop in cases.
o Think schools will be out for rest of school year.
o Don’t think we will start to “wake up” until June.
o We will have regions of outbreak, instead of nation-wide outbreak like flu.
If something (therapeutic) shows promise, will likely see larger scale trials where data is being shared, and not
smaller private clinical trials.
L EAH C HARETTE
Senior Legislative Associate, Thorn Run Partners
100 M Street, SE | Ste. 750 | Washington, DC 20003
(770) 653-7182 (Cell)
Connect with TRP:
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