Pushkin from Pushkin Industries. This is Deep Background, the show where we explore the stories behind the stories in the news. I'm Noah Feldment. Ever since COVID nineteen broke out, I have been extremely eager to hear the thoughts of Partis Zabetti. Partis has actually been on the show before this outbreak, talking about her extraordinary work on ebola. She's a computational biologist in the Harvard Biology Department in the Broad Institute. She's also a professor in the Department of Immunology and Infectious Disease at the Harvard chance School of Public Health. In short, Pardis is the person who knows the most of anybody that I know about the complexity of developing understanding of a virus and what you do under circumstances of outbreak. I knew that whatever Partis was thinking about right in this moment would be fascinating and significant and would shed new light on the circumstances that we're facing, how we reopen, how we track the virus, and how we reach a vaccine. And sure enough, Parties said extraordinary things to say on all of the above. Partis, thank you so much for being with me when we last spoke, which is just a few months ago, but it was before the coronavirus really hit. We talked extensively about your experience in addressing pandemics in Africa, and in just a moment, I want to ask you about Africa and coronavirus, but first I want to ask you about what it means for you that suddenly the work that you've been doing for years is literally in your front yard right here in Massachusetts. I've actually been working with the Massachusetts Department of Health for many years, and in fact actually do as much work in my own backyard. We've been seeing outbreaks in our own backyards for many, many years, and I became really passionate about as part of the Harvard Outbreak Response Committee, started seeing cases of momps in the sports teams at Harvard University that then moved into the residential homes, and then to the freshman dining hall where staff were infected, and to health services where nurses were infected. And so I have long been passionate about the spread of infectious diseases here in Massachusetts and in residential colleges more generally, knowing that they're one of the places where you have the most high risk of infection spreading because you have lots of students from around the country who don't know each other now living with each other on top of each other. So this is something we have been concerned about and thinking about for a long time. So none of this is news to you, but at least in the United States, many people are really for the first time waking up to the realities of pandemic effects for them immediately at home. Does that strike you as an opportunity to change people's perspectives on something that has been one of your central research vocide for many years. Um, you know it is, But when the way I think about things, uh, it's not. That's like not where my head is at. You know, my head is at what is this lockdown doing to our communities? Seeing the rise of suicide rates and you know, eight hundred percent, like increase in suicide line usage and domestic violence being up and mental health being up. I find myself just very in the here and now of the existential threat that we're facing to our entire way of life, and it is frustrating to you know, have been one of many people who have been calling for more attention to this for many many years. Um, there's there's all of that frustration from the past and all of that. Know that there's an opportunity in the future to try to change this, but right now we have to deal with this crisis, um, and just I'm just spending all of my mental capacity just trying to figure out how to best help navigate and right now just even thinking about how do we bring how do we or if we bring college kids back to campus. I mean, there's just so many very specific needs that we have right now. Is there any way to bring college kids back to campus in September anywhere in the United States right now? Is there a credible path that you can see where that happens. Well, that's what I'm thinking through. Before the outbreak, I had actually written a number of proposals that I sent around and actually couldn't get funded. But I actually had a piece of it that was a mobile app that students use at trace contacts and that help them help us stop infections happening on college campuses and in a lot of ways, like if you think about a college campuses, their contacts are most known. You know, they're going to be in the interno genetics class and back in their dorm and on their sports team. There's like three places they can be, and so it's actually a place where I actually in the proposal I always had, I said that college campuses are the best place to model outbreak response. They're the most vulnerable, but they're also really a great audience in which to try to build such a system. The path would be extraordinary surveillance campuses. Like one of my students went to Middlebury, and you know, Middlebury is thirty four miles away from the nearest other city. She sort of argues, why did they even send the students home when there was no cases of a coronavirus at Middlebury and only one in the state of Vermont. You just put them at more risk. Or if they happen to be infected unbeknownst to them, you just sent their parents at risk. Right, There's there's a lot of questions about that. I do think that if we had extraordinary amounts of surveillance and real buy in from the students who wanted to be there on how to manage and test for COVID and protections for the staff who would be engaged with them, you could bring them back. I would imagine that it. The way that it would have to happen is not by creating social distancing between individuals, but creating a circuit around those people. Right. A closed loop, in my mind, is the way we don't actually need to all social distance from each other. We need to have closed circuits and a lot of close monitoring amongst those closed circuits. I think that would be the way. It's almost like a tribal or communal version of it. It's really fascinating, and it's counterintuitive because one thing that I've heard from some university administrators is the dorms. The dorms, we have the problem that we can't really have students back to campus potentially because we might get rapids spread of the virus in the dorms. It would be one thing some of them have said, if we could have social distancing and people lived off of campus, but if they all live together, that makes it worse than what you're saying is one hundred and eighty degrees the opposite. You're saying that it's precisely the fact that you could have a relatively self contained college community or university community, and that that might even be easier to do in relatively rural liberal arts colleges than it is to do a new, major urban university. That's basically the premise, right is like, because people we're talking about it right now in the laboratories, and I'd sort of originally reached out to laboratories that I know have residences on campus, saying, hey, what's the chance we could commedy er your lab and just create an institute there where you have a closed circuit and you just make sure the infection doesn't get in. A few investment banks did this with their traders. They thought, well, our trading operation is absolutely crucial, and they took over hotels, fancy hotels, but they took over the whole hotel and isolated everybody and said here's where the team is going to sit. And of course they got a lot of bad publicity for that on the theory that somehow they were putting capital first. And maybe that was true, But what you're saying is that's actually not at all an irrational way to think about it. If those folks never leave, they become an isolated community and they can actually be there and be relatively safe provided that the virus isn't coming in. Yeah, and for me, from the standpoint of for like a research scientist, I thought about this, and there is bad press that you get from it, of like, oh wait, the researchers have all hold themselves up and protected themselves from others. It's more that I know that my lab, for example, works on diagnostics or sequencing, and I think that's important for the response. But if I'm to do that work, the only way I could actually do it in isolation putting myself in some sort of like a protected shield, is to actually have a blogger who every day says, this is what's going on. Let's open this up to the entire world and say, let's move as fast as we can. Let's bring everybody on board of how fast we're trying to work. Can I ask you to put on your virus tracker hat and think about the virus as a strategic opponent, as you often do. And I want to ask you about the way that this particular coronavirus is spreading, first domestically in the United States and then more broadly globally. Why are we seeing such outsized outbreaks in certain locations New York and maybe increasingly Boston, New Orleans, and less severe attacks in places where it looked initially like things might be just as bad. San Francisco is a good example. Why don't we see a much broader degree of outbreaking? Is that just a response to these social distancing measures? And if so, why didn't it work as fast or as effectively in places like Boston and New York. I think that there's so many different parameters you have to think about it. I mean, in some of the places where you don't we're out seeing cases, it might actually be that we're just not testing for them and there is enough asymptomatics that we don't really have a good perspective of what's going on. That said, you know, places like Boston and New York have a lot of cases because they are really dense populations, and I'll know San Francisco's one. But I'll give a counterpoint to that in a second, Like big cities are places where you're going to see a lot of cases happen, because you know, people don't want to be siloed in a tin can kind of a room. Also, I mean I think Boston. When I think about Boston, I think the first cases were actually isolated very very well. The tipping point was this Biogen conference, and I mean, I think that was just one of those things. Conferences are places you bring a lot of people in from all around the world, have them all like hang out together in all crazy ways, and then send them out into the world. And so a lot of the outbreaks that were very bad just had a bad entry event. So the Biogen conference set off something in big motion. If I hear you correctly, what you're saying is that there can be a lot of contingent luck, good or bad in these circumstances. One event where there may have been a super spreader or where people we're all clumped together and then went to the four corners of the Earth can really have a tremendous impact. Yeah, Like you know when we talk about the sort of can we come bring back residential colleges, I'm less worried about residential colleges all as long as you because you have this like longer time frame to think about people going in and out as I am about conferences. This is an existential threat to conferences, right, because conferences do the perfect thing. They bring a lot of people from around the world together, they read something for a while, shake it up, and then send it out everywhere, and so people will really have to think about those in a very different way. And there's a chance that conferences will come back for some time. I would be very sad if we lost residential colleges, not to mention out of a job, but if we lost academic conferences for some period of time, I for one, but I will not be profoundly crushed. Let me ask you about basically the developing world. One way of thinking about this is that we're not hearing about massive outbreaks of this particular coronavirus in the developing world because there's not testing, but it's in fact happening on a major scale right now, we don't know about it. The other possibility is that for some set of reasons, that hasn't happened yet, not that it may not happen, but that it hasn't happened. Do you have an instinct between those two answers, and if so, which one? I don't have an answer, and I could probably say it's like some of it's all of the above. There. You know the fact that there's not testing, ubiquitous testing is a lot of why you don't see things. And we know that, like my group wrote a paper in twenty twelve. It was a perspective in Science magazine that said emerging disease or diagnosis question mark, and it posed the question, are these diseases we think are emerging actually emerging? Are we just emergingly? Do we have emergent technologies to detect them? And have these things been circulating for a long time? Because most viruses can be asymptomatic or mildly symptomatic and just fly under the radar, And so there COVID and other viruses could be breeding and coming in even to patients at the hospital not being detected because they didn't make enough of a statement for us to be aware of them. So it's hard to say. Are my collaborative, Christian Happy and his team in Nigeria sequence the first case of COVID in Africa and is part of a large group of people working with the Nigerian CDC and others surveying what's going on in Nigerian and their cases and their cases all throughout the country. So it's definitely emergent. The one thing on the other side I just want to make a point of is should kind of come back to your first question of like is it surprising to you that the United States now is seeing this and experiencing this working in Africa, and I was like, no, I've been more worried about the United States than anywhere for a long time, because actually, those other countries have been thinking about infectious diseases for a long time, and they have an entire network to manage this to some degree, So we shouldn't. I'm not saying that there's not a lot that needs to happen in those healthcare systems, but there's a lot that they do have that we should appreciate, Like the idea of healthcare workers to go out into people's homes. They know that it's a bad idea to bring COVID or a bowl of patients to the hospital in order to be detected for a virus the way we do. Like the hospitals are probably the breeding ground for most of the infections. Somebody came in just to check in on one thing and they left with COVID. The massive health system that we have here is a problem for infectious diseases. We'll be back in just a moment. Well, the genomics work that you're doing now being most useful for tracking, will be most useful for potential cure. What are the different angles from which genomes can contribute going forward. So there's genomics large and then there's genome sequencing, and so for genome sequencing there are multiple great values. I wrote an article early in the outbreak to say, actually, we are in a good place because the folks in Wuhan had identified the virus very early and had sequenced the virus and made that data available to the community, and the genome sequencing told us that the virus hadn't been around very long, because it can give you a sense of date how long a virus has been the population, and the evidence from the genome sequencing tools it had just recently urged into the human population. And then we already had this genome sequencing data for it, which made it possible so that labs all over the world, including my own and many you know, my colleagues, had working diagnostics within days of the paper being published, Like that's sort of that's what we do. And as the virus changes, it can improve, Like we're already seeing that a lot of the diagnostics out there, the virus has already mutated against them, so that the diagnostics actually tag the genome sequence, and the diagnostics have to be kept updated. So that's an important piece of that is that we didn't use that information the right way because then we waited for a long time and there are a lot of regulatory barriers to having hospitals around the country have those diagnostics available. But also it is really important for understanding transmission events, understanding how many cases there are, where they're coming from, where the introductions. It gives you a lot of information, particularly as we try to wind down. It'll give us a sense about how many cases are likely circulating in this population. It can really inform epidemiology and how we how we think about our response. As you watch the speed with which this particular virus is evolving, does that give you an intuition Obviously you can't make a firm prediction, but does it give you an intuition about the question of vaccine. So one of the great things that we have going for us here many people believe that SARS or stars like virus is going to be a next big pandemic, and for that reason, a lot of the vaccines that have had an early start and we really got off to the races were people who had been working for some time on Stars, and this virus is not that different from SARS, and so we're already in a really good position having spent time developing vaccines, diagnostics, other things for Stars. And as far as you know, will we have a long term vaccine that will capture all of COVID forever? Probably not, But will we have something that will make a big difference in people's lives right now and kind of stop the major event? I think so. The fact that there weren't really good animal models for COVID early on was a bonus because companies like Maderna, who are being vaccines got to skip animal trials, which is a really can slow the vaccine development process. So they went straight to human clinical trials, which is unheard of. Hopefully the human clinical trials go well and they're safe, because that is a risk jumping straight to human trials. But whatever that outcome, it did move things forward much much more quickly, and so we may say vaccine that can help to really stem the tide soon, and when it will be manufactured and when it will get to all the corners of the earth, that's a whole different question, and that's why people are talking about the fact that we may be social distancing to twenty twenty two, because that might be how long it takes to really get you know, where we need to be. And there's obviously a lot of debate on that too, but it's something as a possibility perdue in the best case scenario where we do get to a functional vaccine relatively quickly, what are the barriers to getting it out to the world that push us into this possible twenty twenty two scenario. Are such vaccines just very difficult to manufacture at scale? Is that the challenge? Yeah? I think that in general, it does take a while to manufacture vaccines. There's a lot of work that's been done toward improving a vaccine manufacturer. But take, for example, the flu vaccine. It takes six months to a year to really create enough of that vaccine to make available to everybody. Couldn't that be scaled up though very substantially. I mean the reason I say this is I had Larry Summers on the show the other day and he was saying, it's costing the United States economy eighty billion dollars a week every week that we're shut down. He said, so anything that you spent that is not more than eighty billion dollars a week is money saving. We're definitely not talking about that scale. So I mean, are there actual bottlenecks here that could be overcome? Well, I mean, that's again coming back to the whole point of the other part of our conversation, which is how do we get people back to work if they're social distancing at work? And we I mean, I only have about a third of my team able to work right now. That's why I started being obsessed with the idea of how do I comedy or somebody's lab with residential housing and how to put people in because that is the interesting dance that we have, which is that we are trying to do it in the midst of a lockdown, So how do we get essential personnel back and running? So no, we actually are going to be going slower right now based on the practices we have of getting things back up to speed. And so you know, I was actually talking about because diagnostics are one of the first things we need to get to be able to get surveillance to move things forward. And so I was like, the diagnostics groups that are building and manufacturing the new diagnostics that are FDA approved. One may argue that they should be test doing their own testing and using something testing on their own people on a regular basis, because if they shut down then they can't get more diagnostics to the world. So we are and I agree with you that we should be trying to move it forward. There are some just infrastructurally, we can't go much much faster unless we build new plants altogether, and so I think we could all be thinking about that right how to create plants that themselves have an ecosystem where they can keep running. Let me ask you about the future, the post COVID future. We may never be a fully post COVID, but you've done a huge amount of work on early detection. That's been one of your central goals. What kinds of plans and programs do you have in the works, because my guess as those will now be extremely popular and likely to be very well funded. Yeah, so my lab has been really passionate about early detection for a very very long time. Began with our work on lass of fever, but then really was really came to bear during the able epidemic, seeing that this outbreak likely happened in some remote village in Guinea, you know, with one boy, and if it had been detected there, the outbreak might have been averted. But instead it was four months later with cases across the country where we became aware of ebola, and the same thing here in the United States. I mean many many cases and time passed before we were aware of COVID, and with COVID we saw things faster. But COVID moves so much faster that it really does show you you need very rapid detection. And so we have been envisioning with our partners in Africa something called Sentinel, which is essentially this idea that each of us stand guards over the other, and if we create a system by which every person is cared for within the system, that will allow us to stand guard on each other and identify what we have share that information with everybody. And so we help and partner with a lot of different groups developing very creative diagnostic tools and then sequencing to be able to identify new things that are just completely unheard of and just kind of keep characterizing what's out there. And then a dashboard that includes these mobile applications that allow you to report to healthcare when you're sick and to get diagnostic information and share that with your community through the healthcare system. Also dashboards that allow everyone to immediately see where clusters of cases are emerging and beyond. And so that is the world we see that. The idea behind all of it is empowering every actor in the system, empowering every individual to be able to get to the care they need immediately, empowering the healthcare workers to engage with them and to get the best information in real time. And that will be the world, you know, where everyone is engaged, everyone feels empowered, everyone has the information that they need, and we can have that. I mean, the technology is there, the funding has not been historically and that may change, and I think the will seems to be clear, and definitely the case has been made. COVID has made that case for us of the value of having something like this perde Before I let you go, what am I not asking you that's really salient to you? I mean, you already were my go to pandemic person before any of this happened, and I'm thrilled to have you here for the moment. What do you want to tell the listeners about the situation that we're in and about where we might go. Gosh, a lot of things that I want to hear from a lot of your listeners. I mean, I think that to me, actually, like the listening part is so important, and I realize like most of my ideas and thoughts that I have is just by trying to be a good listener and learning from people. And this is a moment in which it's like it's one of the most human moments because there's this existential threat that binds us all that requires every person to think of each other to do it right. You know, you can, you can do the thing where we distance each other and hate on each other, but actually to really do it, it's a cooperative game against a common enemy. And in my mind, I think the thing I just really want is about thinking about our communities, thinking about how to engage everybody and to work together. You'll actually do your best work and probably get the most reward by being the most generous. I made my probably my best professional success was by sharing data which I did not to get credit, and that got me credit. And so this is a moment to not think about getting credit, and that's how we will all get the most benefit and the most credit. And I just hope that for the world that we just hone our skills by thinking about each person, each of our neighbors, and each of our fellow citizens on the earth. Thank you, Bertie. That's a truly inspiring vision of how we ought to go. And it's a ray of sunshine and what is otherwise a very time thank you. Thanks though I was such a pleasure to do this, wish wasn't under these circumstances right now. Well, we'll see each other in persons soon enough, before twenty twenty two, hope. So all right, take care, take care bye. As always, Partise is thinking outside the box about viruses and how to fight them. Unlike just about everybody else who thinks dorms are the danger, Pardise raises the possibility that university campuses might be ideal circumstances for us to begin the fight against coronavirus by using contact tracing and a high degree of voluntary surveillance. Academic conferences, she says, are the enemy, not for the reason that they make you crazy, but for the reason that they spread disease. Those, she says, may not be back for the foreseeable future. And I for one am not going to mourn that, But perhaps most significantly, partis wants us to remember that the way we succeed in fighting COVID is by viewing ourselves as engaged in a cooperative endeavor where we all together have to defeat a common enemy. That's a message that's all too easy to miss in our current political moment, and yet it's vastly significant, and for me, that's the most powerful takeaway of what parties had to share with us today. Deep Background is brought to you by Pushkin Industries. Our producer is Lydia gene Conn with research help from Zoie Dwynn. Mastering is by Jason Gambrel and Martin Gonzalez. Our showrunner is Sophie mckibbon. Our theme music is composed by Luis Guerra. Special thanks to the Pushkin Brass, Malcolm Gladwell, Jacob Weisberg, and Mia Lobel. I'm Noah Feld. I also write a regular column from Bloomberg Opinion, which you can find at Bloomberg dot com slash feld. To discover Bloomberg's original slate of podcasts, go to Bloomberg dot com slash Podcasts. You can follow me on Twitter at Noah r. Feld. This is deep backward

Pushkin from Pushkin Industries. This is Deep Background, the show where we explore the stories behind the stories in the news. I'm Noah Feldment. Ever since COVID nineteen broke out, I have been extremely eager to hear the thoughts of Partis Zabetti. Partis has actually been on the show before this outbreak, talking about her extraordinary work on ebola. She's a computational biologist in the Harvard Biology Department in the Broad Institute. She's also a professor in the Department of Immunology and Infectious Disease at the Harvard chance School of Public Health. In short, Pardis is the person who knows the most of anybody that I know about the complexity of developing understanding of a virus and what you do under circumstances of outbreak. I knew that whatever Partis was thinking about right in this moment would be fascinating and significant and would shed new light on the circumstances that we're facing, how we reopen, how we track the virus, and how we reach a vaccine. And sure enough, Parties said extraordinary things to say on all of the above. Partis, thank you so much for being with me when we last spoke, which is just a few months ago, but it was before the coronavirus really hit. We talked extensively about your experience in addressing pandemics in Africa, and in just a moment, I want to ask you about Africa and coronavirus, but first I want to ask you about what it means for you that suddenly the work that you've been doing for years is literally in your front yard right here in Massachusetts. I've actually been working with the Massachusetts Department of Health for many years, and in fact actually do as much work in my own backyard. We've been seeing outbreaks in our own backyards for many, many years, and I became really passionate about as part of the Harvard Outbreak Response Committee, started seeing cases of momps in the sports teams at Harvard University that then moved into the residential homes, and then to the freshman dining hall where staff were infected, and to health services where nurses were infected. And so I have long been passionate about the spread of infectious diseases here in Massachusetts and in residential colleges more generally, knowing that they're one of the places where you have the most high risk of infection spreading because you have lots of students from around the country who don't know each other now living with each other on top of each other. So this is something we have been concerned about and thinking about for a long time. So none of this is news to you, but at least in the United States, many people are really for the first time waking up to the realities of pandemic effects for them immediately at home. Does that strike you as an opportunity to change people's perspectives on something that has been one of your central research vocide for many years. Um, you know it is, But when the way I think about things, uh, it's not. That's like not where my head is at. You know, my head is at what is this lockdown doing to our communities? Seeing the rise of suicide rates and you know, eight hundred percent, like increase in suicide line usage and domestic violence being up and mental health being up. I find myself just very in the here and now of the existential threat that we're facing to our entire way of life, and it is frustrating to you know, have been one of many people who have been calling for more attention to this for many many years. Um, there's there's all of that frustration from the past and all of that. Know that there's an opportunity in the future to try to change this, but right now we have to deal with this crisis, um, and just I'm just spending all of my mental capacity just trying to figure out how to best help navigate and right now just even thinking about how do we bring how do we or if we bring college kids back to campus. I mean, there's just so many very specific needs that we have right now. Is there any way to bring college kids back to campus in September anywhere in the United States right now? Is there a credible path that you can see where that happens. Well, that's what I'm thinking through. Before the outbreak, I had actually written a number of proposals that I sent around and actually couldn't get funded. But I actually had a piece of it that was a mobile app that students use at trace contacts and that help them help us stop infections happening on college campuses and in a lot of ways, like if you think about a college campuses, their contacts are most known. You know, they're going to be in the interno genetics class and back in their dorm and on their sports team. There's like three places they can be, and so it's actually a place where I actually in the proposal I always had, I said that college campuses are the best place to model outbreak response. They're the most vulnerable, but they're also really a great audience in which to try to build such a system. The path would be extraordinary surveillance campuses. Like one of my students went to Middlebury, and you know, Middlebury is thirty four miles away from the nearest other city. She sort of argues, why did they even send the students home when there was no cases of a coronavirus at Middlebury and only one in the state of Vermont. You just put them at more risk. Or if they happen to be infected unbeknownst to them, you just sent their parents at risk. Right, There's there's a lot of questions about that. I do think that if we had extraordinary amounts of surveillance and real buy in from the students who wanted to be there on how to manage and test for COVID and protections for the staff who would be engaged with them, you could bring them back. I would imagine that it. The way that it would have to happen is not by creating social distancing between individuals, but creating a circuit around those people. Right. A closed loop, in my mind, is the way we don't actually need to all social distance from each other. We need to have closed circuits and a lot of close monitoring amongst those closed circuits. I think that would be the way. It's almost like a tribal or communal version of it. It's really fascinating, and it's counterintuitive because one thing that I've heard from some university administrators is the dorms. The dorms, we have the problem that we can't really have students back to campus potentially because we might get rapids spread of the virus in the dorms. It would be one thing some of them have said, if we could have social distancing and people lived off of campus, but if they all live together, that makes it worse than what you're saying is one hundred and eighty degrees the opposite. You're saying that it's precisely the fact that you could have a relatively self contained college community or university community, and that that might even be easier to do in relatively rural liberal arts colleges than it is to do a new, major urban university. That's basically the premise, right is like, because people we're talking about it right now in the laboratories, and I'd sort of originally reached out to laboratories that I know have residences on campus, saying, hey, what's the chance we could commedy er your lab and just create an institute there where you have a closed circuit and you just make sure the infection doesn't get in. A few investment banks did this with their traders. They thought, well, our trading operation is absolutely crucial, and they took over hotels, fancy hotels, but they took over the whole hotel and isolated everybody and said here's where the team is going to sit. And of course they got a lot of bad publicity for that on the theory that somehow they were putting capital first. And maybe that was true, But what you're saying is that's actually not at all an irrational way to think about it. If those folks never leave, they become an isolated community and they can actually be there and be relatively safe provided that the virus isn't coming in. Yeah, and for me, from the standpoint of for like a research scientist, I thought about this, and there is bad press that you get from it, of like, oh wait, the researchers have all hold themselves up and protected themselves from others. It's more that I know that my lab, for example, works on diagnostics or sequencing, and I think that's important for the response. But if I'm to do that work, the only way I could actually do it in isolation putting myself in some sort of like a protected shield, is to actually have a blogger who every day says, this is what's going on. Let's open this up to the entire world and say, let's move as fast as we can. Let's bring everybody on board of how fast we're trying to work. Can I ask you to put on your virus tracker hat and think about the virus as a strategic opponent, as you often do. And I want to ask you about the way that this particular coronavirus is spreading, first domestically in the United States and then more broadly globally. Why are we seeing such outsized outbreaks in certain locations New York and maybe increasingly Boston, New Orleans, and less severe attacks in places where it looked initially like things might be just as bad. San Francisco is a good example. Why don't we see a much broader degree of outbreaking? Is that just a response to these social distancing measures? And if so, why didn't it work as fast or as effectively in places like Boston and New York. I think that there's so many different parameters you have to think about it. I mean, in some of the places where you don't we're out seeing cases, it might actually be that we're just not testing for them and there is enough asymptomatics that we don't really have a good perspective of what's going on. That said, you know, places like Boston and New York have a lot of cases because they are really dense populations, and I'll know San Francisco's one. But I'll give a counterpoint to that in a second, Like big cities are places where you're going to see a lot of cases happen, because you know, people don't want to be siloed in a tin can kind of a room. Also, I mean I think Boston. When I think about Boston, I think the first cases were actually isolated very very well. The tipping point was this Biogen conference, and I mean, I think that was just one of those things. Conferences are places you bring a lot of people in from all around the world, have them all like hang out together in all crazy ways, and then send them out into the world. And so a lot of the outbreaks that were very bad just had a bad entry event. So the Biogen conference set off something in big motion. If I hear you correctly, what you're saying is that there can be a lot of contingent luck, good or bad in these circumstances. One event where there may have been a super spreader or where people we're all clumped together and then went to the four corners of the Earth can really have a tremendous impact. Yeah, Like you know when we talk about the sort of can we come bring back residential colleges, I'm less worried about residential colleges all as long as you because you have this like longer time frame to think about people going in and out as I am about conferences. This is an existential threat to conferences, right, because conferences do the perfect thing. They bring a lot of people from around the world together, they read something for a while, shake it up, and then send it out everywhere, and so people will really have to think about those in a very different way. And there's a chance that conferences will come back for some time. I would be very sad if we lost residential colleges, not to mention out of a job, but if we lost academic conferences for some period of time, I for one, but I will not be profoundly crushed. Let me ask you about basically the developing world. One way of thinking about this is that we're not hearing about massive outbreaks of this particular coronavirus in the developing world because there's not testing, but it's in fact happening on a major scale right now, we don't know about it. The other possibility is that for some set of reasons, that hasn't happened yet, not that it may not happen, but that it hasn't happened. Do you have an instinct between those two answers, and if so, which one? I don't have an answer, and I could probably say it's like some of it's all of the above. There. You know the fact that there's not testing, ubiquitous testing is a lot of why you don't see things. And we know that, like my group wrote a paper in twenty twelve. It was a perspective in Science magazine that said emerging disease or diagnosis question mark, and it posed the question, are these diseases we think are emerging actually emerging? Are we just emergingly? Do we have emergent technologies to detect them? And have these things been circulating for a long time? Because most viruses can be asymptomatic or mildly symptomatic and just fly under the radar, And so there COVID and other viruses could be breeding and coming in even to patients at the hospital not being detected because they didn't make enough of a statement for us to be aware of them. So it's hard to say. Are my collaborative, Christian Happy and his team in Nigeria sequence the first case of COVID in Africa and is part of a large group of people working with the Nigerian CDC and others surveying what's going on in Nigerian and their cases and their cases all throughout the country. So it's definitely emergent. The one thing on the other side I just want to make a point of is should kind of come back to your first question of like is it surprising to you that the United States now is seeing this and experiencing this working in Africa, and I was like, no, I've been more worried about the United States than anywhere for a long time, because actually, those other countries have been thinking about infectious diseases for a long time, and they have an entire network to manage this to some degree, So we shouldn't. I'm not saying that there's not a lot that needs to happen in those healthcare systems, but there's a lot that they do have that we should appreciate, Like the idea of healthcare workers to go out into people's homes. They know that it's a bad idea to bring COVID or a bowl of patients to the hospital in order to be detected for a virus the way we do. Like the hospitals are probably the breeding ground for most of the infections. Somebody came in just to check in on one thing and they left with COVID. The massive health system that we have here is a problem for infectious diseases. We'll be back in just a moment. Well, the genomics work that you're doing now being most useful for tracking, will be most useful for potential cure. What are the different angles from which genomes can contribute going forward. So there's genomics large and then there's genome sequencing, and so for genome sequencing there are multiple great values. I wrote an article early in the outbreak to say, actually, we are in a good place because the folks in Wuhan had identified the virus very early and had sequenced the virus and made that data available to the community, and the genome sequencing told us that the virus hadn't been around very long, because it can give you a sense of date how long a virus has been the population, and the evidence from the genome sequencing tools it had just recently urged into the human population. And then we already had this genome sequencing data for it, which made it possible so that labs all over the world, including my own and many you know, my colleagues, had working diagnostics within days of the paper being published, Like that's sort of that's what we do. And as the virus changes, it can improve, Like we're already seeing that a lot of the diagnostics out there, the virus has already mutated against them, so that the diagnostics actually tag the genome sequence, and the diagnostics have to be kept updated. So that's an important piece of that is that we didn't use that information the right way because then we waited for a long time and there are a lot of regulatory barriers to having hospitals around the country have those diagnostics available. But also it is really important for understanding transmission events, understanding how many cases there are, where they're coming from, where the introductions. It gives you a lot of information, particularly as we try to wind down. It'll give us a sense about how many cases are likely circulating in this population. It can really inform epidemiology and how we how we think about our response. As you watch the speed with which this particular virus is evolving, does that give you an intuition Obviously you can't make a firm prediction, but does it give you an intuition about the question of vaccine. So one of the great things that we have going for us here many people believe that SARS or stars like virus is going to be a next big pandemic, and for that reason, a lot of the vaccines that have had an early start and we really got off to the races were people who had been working for some time on Stars, and this virus is not that different from SARS, and so we're already in a really good position having spent time developing vaccines, diagnostics, other things for Stars. And as far as you know, will we have a long term vaccine that will capture all of COVID forever? Probably not, But will we have something that will make a big difference in people's lives right now and kind of stop the major event? I think so. The fact that there weren't really good animal models for COVID early on was a bonus because companies like Maderna, who are being vaccines got to skip animal trials, which is a really can slow the vaccine development process. So they went straight to human clinical trials, which is unheard of. Hopefully the human clinical trials go well and they're safe, because that is a risk jumping straight to human trials. But whatever that outcome, it did move things forward much much more quickly, and so we may say vaccine that can help to really stem the tide soon, and when it will be manufactured and when it will get to all the corners of the earth, that's a whole different question, and that's why people are talking about the fact that we may be social distancing to twenty twenty two, because that might be how long it takes to really get you know, where we need to be. And there's obviously a lot of debate on that too, but it's something as a possibility perdue in the best case scenario where we do get to a functional vaccine relatively quickly, what are the barriers to getting it out to the world that push us into this possible twenty twenty two scenario. Are such vaccines just very difficult to manufacture at scale? Is that the challenge? Yeah? I think that in general, it does take a while to manufacture vaccines. There's a lot of work that's been done toward improving a vaccine manufacturer. But take, for example, the flu vaccine. It takes six months to a year to really create enough of that vaccine to make available to everybody. Couldn't that be scaled up though very substantially. I mean the reason I say this is I had Larry Summers on the show the other day and he was saying, it's costing the United States economy eighty billion dollars a week every week that we're shut down. He said, so anything that you spent that is not more than eighty billion dollars a week is money saving. We're definitely not talking about that scale. So I mean, are there actual bottlenecks here that could be overcome? Well, I mean, that's again coming back to the whole point of the other part of our conversation, which is how do we get people back to work if they're social distancing at work? And we I mean, I only have about a third of my team able to work right now. That's why I started being obsessed with the idea of how do I comedy or somebody's lab with residential housing and how to put people in because that is the interesting dance that we have, which is that we are trying to do it in the midst of a lockdown, So how do we get essential personnel back and running? So no, we actually are going to be going slower right now based on the practices we have of getting things back up to speed. And so you know, I was actually talking about because diagnostics are one of the first things we need to get to be able to get surveillance to move things forward. And so I was like, the diagnostics groups that are building and manufacturing the new diagnostics that are FDA approved. One may argue that they should be test doing their own testing and using something testing on their own people on a regular basis, because if they shut down then they can't get more diagnostics to the world. So we are and I agree with you that we should be trying to move it forward. There are some just infrastructurally, we can't go much much faster unless we build new plants altogether, and so I think we could all be thinking about that right how to create plants that themselves have an ecosystem where they can keep running. Let me ask you about the future, the post COVID future. We may never be a fully post COVID, but you've done a huge amount of work on early detection. That's been one of your central goals. What kinds of plans and programs do you have in the works, because my guess as those will now be extremely popular and likely to be very well funded. Yeah, so my lab has been really passionate about early detection for a very very long time. Began with our work on lass of fever, but then really was really came to bear during the able epidemic, seeing that this outbreak likely happened in some remote village in Guinea, you know, with one boy, and if it had been detected there, the outbreak might have been averted. But instead it was four months later with cases across the country where we became aware of ebola, and the same thing here in the United States. I mean many many cases and time passed before we were aware of COVID, and with COVID we saw things faster. But COVID moves so much faster that it really does show you you need very rapid detection. And so we have been envisioning with our partners in Africa something called Sentinel, which is essentially this idea that each of us stand guards over the other, and if we create a system by which every person is cared for within the system, that will allow us to stand guard on each other and identify what we have share that information with everybody. And so we help and partner with a lot of different groups developing very creative diagnostic tools and then sequencing to be able to identify new things that are just completely unheard of and just kind of keep characterizing what's out there. And then a dashboard that includes these mobile applications that allow you to report to healthcare when you're sick and to get diagnostic information and share that with your community through the healthcare system. Also dashboards that allow everyone to immediately see where clusters of cases are emerging and beyond. And so that is the world we see that. The idea behind all of it is empowering every actor in the system, empowering every individual to be able to get to the care they need immediately, empowering the healthcare workers to engage with them and to get the best information in real time. And that will be the world, you know, where everyone is engaged, everyone feels empowered, everyone has the information that they need, and we can have that. I mean, the technology is there, the funding has not been historically and that may change, and I think the will seems to be clear, and definitely the case has been made. COVID has made that case for us of the value of having something like this perde Before I let you go, what am I not asking you that's really salient to you? I mean, you already were my go to pandemic person before any of this happened, and I'm thrilled to have you here for the moment. What do you want to tell the listeners about the situation that we're in and about where we might go. Gosh, a lot of things that I want to hear from a lot of your listeners. I mean, I think that to me, actually, like the listening part is so important, and I realize like most of my ideas and thoughts that I have is just by trying to be a good listener and learning from people. And this is a moment in which it's like it's one of the most human moments because there's this existential threat that binds us all that requires every person to think of each other to do it right. You know, you can, you can do the thing where we distance each other and hate on each other, but actually to really do it, it's a cooperative game against a common enemy. And in my mind, I think the thing I just really want is about thinking about our communities, thinking about how to engage everybody and to work together. You'll actually do your best work and probably get the most reward by being the most generous. I made my probably my best professional success was by sharing data which I did not to get credit, and that got me credit. And so this is a moment to not think about getting credit, and that's how we will all get the most benefit and the most credit. And I just hope that for the world that we just hone our skills by thinking about each person, each of our neighbors, and each of our fellow citizens on the earth. Thank you, Bertie. That's a truly inspiring vision of how we ought to go. And it's a ray of sunshine and what is otherwise a very time thank you. Thanks though I was such a pleasure to do this, wish wasn't under these circumstances right now. Well, we'll see each other in persons soon enough, before twenty twenty two, hope. So all right, take care, take care bye. As always, Partise is thinking outside the box about viruses and how to fight them. Unlike just about everybody else who thinks dorms are the danger, Pardise raises the possibility that university campuses might be ideal circumstances for us to begin the fight against coronavirus by using contact tracing and a high degree of voluntary surveillance. Academic conferences, she says, are the enemy, not for the reason that they make you crazy, but for the reason that they spread disease. Those, she says, may not be back for the foreseeable future. And I for one am not going to mourn that, But perhaps most significantly, partis wants us to remember that the way we succeed in fighting COVID is by viewing ourselves as engaged in a cooperative endeavor where we all together have to defeat a common enemy. That's a message that's all too easy to miss in our current political moment, and yet it's vastly significant, and for me, that's the most powerful takeaway of what parties had to share with us today. Deep Background is brought to you by Pushkin Industries. Our producer is Lydia gene Conn with research help from Zoie Dwynn. Mastering is by Jason Gambrel and Martin Gonzalez. Our showrunner is Sophie mckibbon. Our theme music is composed by Luis Guerra. Special thanks to the Pushkin Brass, Malcolm Gladwell, Jacob Weisberg, and Mia Lobel. I'm Noah Feld. I also write a regular column from Bloomberg Opinion, which you can find at Bloomberg dot com slash feld. To discover Bloomberg's original slate of podcasts, go to Bloomberg dot com slash Podcasts. You can follow me on Twitter at Noah r. Feld. This is deep backward