Q&A: What's Next for the Coronavirus Pandemic?

Hello, I'm Nicholas Thompson.

I'm the editor in chief of Wired.

Thank you for joining us here today

for our live conversation about coronavirus.

It's a grave time.

There are now more than million cases worldwide,

which means there are actually many more than that,

more than 50,000 deaths.

In my home city of New York,

people are dying every two minutes.

So we're in the midst of a worldwide tragedy.

This is a story that Wired has been covering

since the beginning.

Our science desk started writing about

what was happening in China in early January.

We started raising major alarms in February.

We devoted pretty much our entire editorial resources

to it in March,

in the beginning of March.

And one of the people who has been doing the most intense,

thorough, fantastic work is my colleague, Adam Rogers,

who's here with me today.

He's broken all kinds of stories.

He's written incredibly informative guides.

He's been deep in many of the questions.

And he was incredibly early

at making everybody at Wired

and everybody reading his work aware

of what was gonna happen

and what we needed to do

to both mitigate the risks for ourselves personally,

but also to play a role

in helping civic understanding of what was happening.

So I'm delighted that he's here with me today.

So Adam and I are gonna answer your questions for an hour.

If you have more questions,

please put them into the Q&A.

Adam and I will look at them.

We'll answer them as best we can.

We had about 1,500 people register,

and a lot of them sent in questions,

so we have a large queue

of questions that we're gonna go through,

so we may not to get all the questions that come in,

but fire away, and thank you ever so much for joining us.

Thank you for trusting Wired.

Thank you for joining our newsletter.

And let's get going.

So hello, Adam, how are you?

I'm all right.

It's nice to see your face, even in a tiny rectangle.

[laughs] I think that maybe we should start.

Why don't you give a...

What I want you to do at the beginning

is I want you to lay out where we are

on three of the big questions:

where we are on testing,

where we are on treatments,

where we are on vaccines.

All right. Three of the big questions.

You've written about all of them.

Why don't you start,

give us a little bit of the lay of the land,

and then go into each of those categories,

and then we'll start going through the specific questions.

So, thanks, Adam. Sure.

And I think dealing with a pandemic

has kind of phases that are pretty well understood,

whether they get executed the way people

would hope they would be in public health or not.

There's kind of a containment phase,

then a mitigation phase, and then a management phase,

as you try to move through the way a country

or a location responds to those things.

And one of the hallmarks of a containment phase

and the one that continues is testing,

is trying to figure out who's infected,

and whether they have symptoms or not,

who actually has the virus.

Initially, in the early phases of the pandemic,

when it was starting in China and in Asian countries,

they were doing really well at testing.

There are stories about how South Korea

was testing hundreds of thousands of people,

more than 10,000 a day in some cases,

whereas the United States,

we really failed at that abjectly at the beginning

for a lot of bureaucratic reasons,

and perhaps some other ones, and those are things

that pretty much every media organization,

including ours, has dedicated a lot of person hours

to trying to untangle.

In recent days, the United States kind of plateaued

at about 100,000 tests per person.

The way those tests work right now

is what's called RT-PCR.

They're molecular tests.

They look for the genetic material of the actual virus

in, forgive me, like spit or snot

in the back of the throat

or way back inside your nose, nasopharyngeal tests.

And those initially,

apparently some inaccuracies of those delayed them.

Then there were problems with the supply chain

for the parts for them.

There are a lot of companies making them right now.

The test numbers seem to have plateaued

at about 100,000 a day, like I said.

One of the issues here is that the data on those stats

is not very good.

The federal government

has not been really forthcoming with them,

so it's patchy about what anybody can really know

about how many tests are being done and where.

And we can talk a little bit later

about why you wanna do those tests,

but at the beginning, for kind of tracking

where the infections are,

and then as we move through the phases of a pandemic,

for dealing with some therapies and responses,

which is the stuff you're asking about next.

Initially, there were no, because it's a new virus,

initially, there were no therapeutics at all.

So for a while, people were talking about chloroquine

and hydroxychloroquine, these old malaria drugs

that are also used for immune disorders today,

because they seem to have some efficacy

against the virus in Petri dishes in the lab.

People got very excited about that,

including in Silicon Valley, on social media,

and one researcher in France

who's been pretty active in trying to promulgate the idea.

Real randomized controlled trials have just begun on those,

even though doctors on the front lines

were using them as compassionate use drugs very early

as they started to see the first patients.

For example, at Montefiore in New York,

they were using hydroxychloroquine, and other places.

There are ongoing tests for a drug called remdesivir

that was developed, actually, to use against Ebola.

So there's a trial going on about that drug now.

Physicians on the front lines, again,

are able to use, via something called compassionate use,

which is a approval to say

if somebody is in grave condition,

that you can use a drug that's approved for something else,

but not necessarily for this.

So physicians are using antivirals,

antiretroviral therapies like those used on HIV.

Nobody knows what works.

Those tests are still happening.

The idea is that somebody is in such grave condition

that they might well die.

The potential side effects or inefficacy of a drug

is immaterial compared to that outcome.

And then in terms of the vaccine,

people have bandied around numbers,

like a year to 18 months away.

That's a guess.

What you have to do to get a vaccine

is understand the immunology of the virus.

It's a new virus,

so people are still trying to figure that out,

then figure out essentially what the pieces

of virus that hang on the outside of the kinda shell,

the coat on the outside of the virus are,

that the immune system in a human responds to.

Then synthesize that, turn it into something

that works as a drug, see if it works,

then start giving it to people.

There's at least one test,

a trial of a vaccine going on already in humans.

I think in China, they had more candidates than we did.

It's very hard to get scientific data

from China to the West,

so that's an ongoing issue as well.

And they had multiple candidates

for both therapeutics and vaccines.

And that vaccine work will be ongoing.

I just saw this morning, in fact,

another candidate and some really good immunology

about another way that the virus exposes itself

to the human immune system.

That might be another place that you can grab hold of,

literally and metaphorically, in terms of the science,

and make a vaccine out of that.

But all that work takes time,

and you want it to take time

because you want the drugs to be both safe and effective.

And there's some other work, too, going on

that I think is really exciting,

and I know we'll talk about it later with you,

using the blood of people

who've recovered from the disease

to try to treat people who still have it.

That's pretty cool, and I'm kind of hopeful for that

as a next phase.

Did Nick drop off?

Am I not hearing Nick on purpose, or?

[Nicholas] I'm here.

Oh, sorry.

I was just gonna add on the question of the vaccines,

I do believe there are two human trials,

one in China, one, the Moderna one,

and I was just reading in the World Health Organization

that they're doing a summary.

I read the summary,

and it was 54 possible candidates for a vaccine,

so I would imagine that given the value of vaccines,

a lot of work will be coming very quickly.

Let's go to the first question from the audience.

This is a question that was asked in advance,

and also something that Elena and Moto Seven have asked,

which is, What percentage of people

infected with the coronavirus are asymptomatic?

How infectious are they, and for how long?

And then also in the live chat,

How big a problem is this?

So, Adam?

Yeah, this is a huge

and scientifically fascinating question

and kind of scary one

because what does seem to be emerging

from early research is that people

who are maybe presymptomatic

is a better word than asymptomatic.

So right when you get infected,

a way to think about this broadly

is there are sort of populations of people who are divided,

the way epidemiologists think about this

when you're modeling, divided into like susceptible,

exposed, infected, and then recovering or basically,

if you go out the other side.

You've either recovered or you've died.

And so when somebody who is infectious

comes into contact with somebody who's susceptible,

they may well get infected.

And the question is

how much time passes between when you have the virus in you,

when you're infected,

and then when you are able to give it to other people?

What it does seem like, in studying the early parts

of the outbreak in particular places,

is that from like somewhere between one and five days,

depends on the paper you're reading,

before you start to show kind of overt signs

that would make you realize you're sick,

you are still able to transfer the virus to other people

through droplets that you either cough out

or when you're speaking and the droplets come out

of your mouth and nose.

And the question is whether you don't feel sick at all

or whether you might feel a little bit sick,

but you're still, you're sort of the walking ill.

I think probably all of us have had the experience

of feeling not great,

but maybe taking some medicine and going to work,

or being out in the world and you have a cold,

and sorta people know how to do that.

And in fact, one of the researchers who studied this said

that he thinks those numbers, just from data,

this isn't a model, like up to 10% at any given moment

of all people are walking around,

feeling not really that good or feeling like [groans],

maybe I am starting to feel some muscle aches,

something like that.

He did a model that suggested that in China,

in the early days of the outbreak there,

possibly as many as 86% of the infections

were from people who were

what he described as undocumented infections,

so that they might have had symptoms.

They might not necessarily have been asymptomatic,

but nobody had checked them out,

and they hadn't gone to anybody else.

There have been some other numbers that said like

in Singapore, where they've been very, very good

at tracking the individual clusters of cases,

that I'm just gonna look at the number again,

that 6% of the locally acquired cases,

so the ones that pass around in their community,

6% of their cases were from asymptomatic

or presymptomatic people.

So it's really important,

because if you have people who don't know that they're sick

and they're out in the world,

who might be spreading the disease around,

that's one of the ways they're passing most quickly.

If you know you're sick,

you're basically home at this point, right?

Because you don't feel good.

But if you feel okay to be out, that's how it spreads.

So that's why that's a concern.

And then the flip side,

which another reader asked, Darryl,

which is, If you think you have had it,

how long until you're no longer infectious?

And then what we're hearing is 14 days,

stay isolated for 14 days,

but we don't know that for sure.

There was a study in Wuhan

that says you can share the virus up to 37 days

after you've been infected.

So if you have had it

and you go out in the world, you should, of course,

still follow social distancing and proper practices,

and wash your hands thoroughly, and be very careful

about who you come in close contact with.

And another reader asked,

I've been in isolation for 14 days.

I don't have any symptoms.

What happens when I go out?

And the answer there is, well, it means you haven't had it,

and so you're vulnerable, so be careful.

You're still in that susceptible group.

Yeah, that's right.

This is one of the reasons that not having enough tests

is such a problem, is that the course of the illness

is different for different people as well.

And it's very possible, in fact, very likely

that some people get sick with this

to such a mild extent

that they might have felt like they were sick

earlier in the year and got over it,

that they might never have had symptoms.

That is very possible, and nobody knows,

and without the right testing, you can't find out.

Let me ask you a question from Gabrielle A.,

but it's also one that my wife and I talk about,

I think, every single night.

Let's talk real about how long we're gonna be isolated.

Until next year, when there's a vaccine?

This is a huge question

that public health experts,

epidemiologists, modelers, and public officials,

political folks are trying to answer all the time,

because if you remove social distancing measures

essentially before society is ready,

when the disease is still out there,

then the disease comes back.

So you flatten the curve once,

and then the curve goes back up.

So one recent study that said that this could be going on

in kind of an oscillating frequency, basically.

Social distancing, disease lifted, disease comes back,

social distancing again, and so on,

out as far as 2022, which is a chilling date

to give to those of us who've been inside, basically,

for a couple months.

So one thing that you might start to see,

and I think this is probably what happens

on the other side of the,

right now, we're riding this exponential curve up.

What you might start to see as we start to get

to the other side of that,

which nobody knows how tragic that ride's gonna be,

but it's going on,

is some kind of intermediate version of social distancing,

where some things are not allowed,

but some things begin to be allowed,

just to slow things down enough

so that you can start to see cases more clearly,

so that you're not in pandemic response mode,

that you can get back to something more like containment

and follow that up.

And that's sort of what's going on

in some of the Asian countries right now.

So what we're seeing in China, Taiwan,

Singapore, and other countries, correct me if I'm wrong

since you've written extensively about these,

is people are starting to go outside again,

are starting to go back to work,

but everybody is wearing masks.

There are thermal imaging sensors as you go into buildings.

People's temperature is being checked all the time.

Everybody is following social distancing.

They are very aware of the possibility that it comes back.

That's right.

Part of the reason that many of those regions

were very aware of the possibility

it was coming in the first place

was that they had been through this with SARS,

which killed far fewer people,

but had significant effects on places like Singapore,

Taiwan, as you say.

And so this time,

and sorry, one of the reasons this story is late

is that we're doing this, but also, I apologize,

but one of the things

that's happening in those countries now

is that while they were able to do containment,

as they started to lift

some of their social distancing measures,

they started to get re-importation of cases

from other places as they opened their borders again a bit.

So now they're having to do containment again

to respond to that.

So you do see, even in that case,

that's not even the kind of second wave

of exponential growth coming back when social distancing.

They're still on the upswing, essentially.

They're still in wave one

of the way those countries are handling the disease.

Yeah, let me pause for a second and say once again,

thank you everybody who's joined this call.

Thank you for joining our newsletter.

I'm Nick Thompson, the editor in chief for Wired.

This is Adam Rogers, senior correspondent

covering the coronavirus crisis.

Please also subscribe to Wired and support our journalism

at wired.com/subscribe,

and ask your questions in the Q&A.

Press the Q&A button, you can put your questions there.

We have a ton of them.

Let me ask one that's come up a couple times.

This is from Gyan and others.

Are Trump's projections of 100,000 to 250,000 deaths

based on everyone following social distancing

and staying at home,

or are they based on the mixed application we see now?

Yeah, great question.

The White House did, for a long period

of either underplaying what most public health researchers

thought was going to happen,

were not discussing projections

with any kind of specificity,

they released these numbers at a briefing,

but then they were not really forthcoming

about where they had gotten those numbers from.

So other public health researchers

and folk, reporters like us,

my colleague, Megan Molteni, talked to these folks,

think that that estimation

probably comes from a group in Washington state,

and that's sort of,

if you can believe those sort of horrifying numbers,

that's kind of a best case outcome

with almost Wuhan-like lockdown

and social distancing measures,

with everybody in every state following those.

And immediately after producing those numbers,

releasing those numbers,

the White House has still been

reticent to the point of not doing it,

to say like a nationwide lockdown.

Terrifying terminology, but that's the kind of thing

that those numbers do ask for.

There are other, like there are worst case curves

from other models,

like the ones that come out of Imperial College in the UK,

that get up to numbers, like if nobody does anything,

if you just let the virus run wild

and it has the worst kind of epidemiology you could ask for,

or the numbers get into the millions,

and the two million people in the United States.

But the White House didn't say

where their data was coming from,

they didn't say which model they were using,

they didn't say which estimations

of what outcomes they were looking at,

so it's very hard to know what thing they actually meant

at that moment.

The best guess,

I suppose the informed speculation is that yes,

that is a number that requires every state,

every locality to essentially do what the Bay Area has done

and is doing and what other places are starting to do now.

People need to stay home if they can.

One of the consequences of this crisis

is that at the end, ideally,

we will all be a lot better at math, exponential modeling.

Let me ask a question that I think I've got

from about three or four people, and it's a variation.

I'll ask 'em together 'cause I think they go together,

which is can the virus mutate,

and if you get it once, can you get it again?

So that comes from Addan and David.

Yeah, also a great question.

So far, as a reminder, this is a novel coronavirus.

Coronavirus is the kind of virus it is.

Novel means this is the first time anybody's had it.

Nobody knew it could infect people.

The first time people saw it,

people understood that human beings could get it

was in December, I guess late November in China.

So these questions are still kind of unknown

because the science is still being done.

So far, what it looks like

is that it is a very slow mutating virus,

and what that means is that once you have it,

you probably have immunity for some amount of time.

Is that a year, is that several years?

Nobody knows yet 'cause no human being

has ever had this virus for a year or several years.

That kind of science, though,

really bodes well for developing therapeutics,

and a vaccine especially,

to say like, well, once you've had it and recovered,

that recovery seems permanent.

There were case studies that suggested

that people could be reinfected,

and it seems more likely that those were a result

of some error in testing or a mistake in the methodology.

So far, there's nothing that says that people,

once they've recovered, get it again.

And there appears to be evidence

that the virus mutates less than other viruses,

suggesting there's a decent chance, if you get it once,

you will remain unable to get it,

and secondly, that it will not mutate into something worse.

Though I suppose the flip side,

and you can counter me here,

is one of the things that optimists have been saying

is that they expect over time,

it will mutate into something less dangerous.

Yeah, I mean, I don't know how to calculate the odds

of how bad or good a mutation might be,

and which kind of subpopulations of the virus

would go in which direction, right?

Because it's not,

some of you watching might remember the end

of The Andromeda Strain, the Michael Crichton story

about a virus from space,

where at the end, if I remember right,

it all evolves into something

that doesn't hurt people anymore,

is a lucky break at the end.

And one of the things that makes epidemiologists crazy

about that famous science fiction story

is that all of the virus evolves

into something at the same time.

So I suppose there could be different populations,

but the thing is that the most infectious population

of those would be the one that would spread, right?

Just sort of by definition.

And the thing that happens with the flu, for example,

every year, is that it mutates and changes.

It has these regions, this H region and this N region,

right, you might remember from the H1N1 or H5N1,

when depending on which one you have,

those change on a kind of a seasonal basis.

The seasonal flu vaccine

attempts to keep up with those sorts of changes.

Sometimes it does better, sometimes it does worse.

But so far, this virus,

this SARS-CoV-2, causes COVID-19,

does seem to act a little bit more like chickenpox,

and very different kind of virus, right?

But in the sense that once you have it,

you don't get it again, it looks like.

That's what it looks like now.

Let me ask you my favorite question so far

from Randall Hayes.

Do viruses have sentience?

Hmm, this is so great.

Forgive me for getting all excited at a grim time,

but this is the kind of thing

that drives like the most basic of this research.

A virus is a package of genetic material

inside an envelope that helps it get into the things

that can then get hijacked to make more virus.

But the kinda language that,

I've used it myself in writing

and that many people often use is like,

well, the virus wants to infect people,

and what the virus is trying to do

is infect as many people as possible,

to make more of itself, to reproduce.

But of course, the virus doesn't want anything.

A virus is a verb.

A virus does a thing,

and what it does is it infects other cells,

and then those cells make more virus.

So there's no collective intelligence at work here.

Viruses are infinitesimally smaller even than bacteria,

which are infinitesimally smaller than us.

There's some notion that like the entire microbiome

in a person is more cells of them than us,

and so there's some collective version of sentience

that makes up who we are as humans.

But viruses exist almost in a world unto themselves.

They are riding us to do something,

but mostly, all we ever see of it is

they take over our cells to make more virus.

I don't think they're thinking about it when they do it,

which is kind of implacable and terrifying

when you think about it as well.

Let's go to one of the big trade-offs

in questions that certainly Wired will be covering

for months and years, which is the trade-off between

how we respond to the virus and our privacy.

So I read a paper in Science,

I mean I read it, I think it came out on Tuesday,

and it said quarantines aren't gonna work,

social distancing isn't gonna work.

What we recommend

is that somebody design an app that tracks your location,

and that sends you an automatic alert

when you have been near someone who has tested positive.

And so there are a couple steps before this could happen,

but we see in other countries, Israel has debated, right,

can the federal government get access

from the phone companies, right?

The phone company knows where your phone is at all times.

It has a harder time tracking people indoors

than it does outdoors,

but the phone will know who you've been near,

and therefore, if it knows who's been exposed

and can tag that to your phone,

it could determine your risk.

So there are a couple steps before this could happen.

Do you think it will happen

and would you be okay with it happening?

And it's already happening.

Hong Kong, you get a smartphone app when you come in.

And many of the Asian countries and regions

are instituting 14-day quarantines

when you show up in the country,

even if you're from there,

and part of the thing you have to do

is you register on your phone

and they monitor your location.

Would I be okay with it?

I have to think that

the thing that innovators in this country

have been so good at for the last 20 years,

for all of the time that you and I have spent at Wired,

is coming up with useful solutions

to these exact kind of problems.

There has to be a way to anonymize enough privacy,

but also let people know something is going on.

I have to think there's a technological solution

to this specific issue.

I will say that what we've seen over the last 20 years

is they're very good at coming up with solutions

in the public, and also very good at eroding our privacy

in ways that we don't care about for no good.

And so this would be eroding privacy for good.

Yeah, that's right,

and that's the next jump to it too,

is that like I'd much rather they erode my privacy for this

than to sell me stuff.

Yeah, so that was a question from Shawn.

Oh, let's go to this one.

This is a big thing that's in the news today.

This is from Garrett.

Please provide the latest on research

about the virus spreading via breathing and talking.

Right, we know it spreads when you cough,

but if it spreads while we talk,

that's a whole 'nother problem.

Yeah.

There's a cluster of cases famously now

of a singing group, right?

Nobody was symptomatic

and they practiced social distancing,

they were all six feet apart,

but many, if not all of them are sick.

A couple of them have died.

And the idea, the hypothesis here

is that when you're singing, one of the things you're doing

is making sure you expel as much air as you possibly can

out of your lungs.

Part of what happens in the early phases

of infection here seems to be

that the virus gets most resonated

in the upper respiratory system.

So as you're talking, as you're expelling air from the lungs

and through the mouth, that it carries droplets

that have the virus in them.

That does seem to be the latest thinking.

Especially in the early presymptomatic phase,

the virus is also in the exact place

where when you're talking and breathing,

you're expelling it.

Now the kind of implication of that question

is asking like, well, does that mean this virus

is airborne, right?

That like you can just get it when you're outside,

breathing, is that what we're saying?

And then the question also is whether everybody

should be waring some kind of mask as well,

and what those masks could do.

These are all very, very controversial,

and still, let's say cutting edge science,

I think is probably the best way to think about that.

People are trying to understand these things

at the same time as they're trying to institute measures

that control the spread of the virus,

and that's why I think there's some social pressure now,

cultural pressure to switch toward people wearing masks

to keep whatever is in you, if you don't know about it,

as much as possible from getting out.

So I think that probably the question

of whether like it could be in anybody at any time,

and just talking to them from six feet away

makes you vulnerable,

more vulnerable than you would have been otherwise,

that doesn't seem to be where this is,

but the concerns about it are there far enough

that it's starting to look like many state governments,

local governments, and perhaps even the White House,

that's what some leaks are saying,

are gonna say people need to be wearing masks

when they're outside to keep whatever's in them

from going outward.

All right, we got a follow-up

and we have a number of questions about masks.

Robert has asked very bluntly, Do we need masks?

So, Adam Rogers,

obviously, there's a shortage of masks.

They need to go to medical professionals.

They need them first.

At some moment, God willing,

you will be able to buy masks again

whenever and wherever you want.

When that moment comes, should we wear them when we go out?

Yeah, and people, rightly I think, made a...

Two things happened.

First, people rightly made a connection

between the places in the world

that did a better job early on

in dealing with the pandemic than the United States did,

and also said that in those places,

a lot of people do wear masks, too.

Mostly like the surgical kind, the cloth kind,

not the N95 masks which are highly specialized,

the filtration textiles,

electrostatically-charged, mouth-blown,

nonwoven, very technical textile.

And people sort of expect that those should be saved,

reserved for use as personal protective equipment,

PPEs for healthcare workers.

Great, but surgical masks

or cloth masks that you make at home,

cloth masks with any number of inserts

that you could put in them.

We had fights.

Yeah, we had fights about this on the Wired Slack

about what to say about these things.

Some of us, and I tend to be in this camp,

find that science more equivocal than others did.

And then the question's like, well,

how equivocal does it have to be

before you just say people should wear masks anyway,

and if it helps, it's probably not gonna hurt,

whether the question is for some small fragment of people,

that the act of taking it on or off

may make them more likely to be infected,

if keeping the mask on keeps other people

from being infected, maybe that's the right trade-off.

I think that probably,

rather than let myself get put on the spot,

because like I said, I'm much more equivocal about this

than even some of my colleagues,

much less people out in the world,

I think we're gonna end up wearing masks anyway.

I think that is about to become a social change

that COVID-19 has on American society.

I will say that personally,

I think that when masks are available,

I will be wearing one in public.

We have a question from Jan Rasmussen,

which is closely followed by a question

from Verdiana Irena Ramirez.

At first people were saying the elderly

were most vulnerable.

Now we're seeing that's not the case.

Do we know who is the most vulnerable

beyond the immunosuppressed?

Is it truly random?

Thank you.

And then Verdiana asks,

How come we have had more and more reports

of younger people dying in Europe and North America?

In fact, even more specifically in the South

of the United States

in the recent news compared to in the beginning

in the reports in Asia?

Well, so, it's increasingly difficult

to keep up with the demographics.

It is still, as I understand it, the case

that the majority of deaths

are in older people in our population, sadly enough.

What has changed, seemingly, in Europe and the United States

are that the hospitalizations, the critical cases

have started to include younger people

into their 30s and 40s.

And then also, coverage has emphasized

some outliers as well.

So for example, tragically, an infant,

a child younger than one year old died,

a teenager in California.

But I think there's some difference

between critical case curves and death curves here.

Now that's terrifying in itself.

And what people don't understand yet,

researchers, scientists don't understand yet

is so why do some people have a worse course

of disease than others?

Are they preexisting conditions?

Is it immunosuppression?

Is it differences in lung capacity?

There are hypotheses that involve the way

that the virus actually gets into cells,

that perhaps some people's cells express more

of the proteins that provide sort of the gateway

into the cells than others, and why might that be,

and those things are still not known.

Those different populations of who ends up

in a critical case and then who ends up dying

are differing from country to country,

and that may be because people

experience different conditions in those countries,

which populations are more likely

to have been smokers, perhaps,

because the critical course involves syndromes in the lungs

and then sometimes, ultimately, in the heart,

which populations live in cities

and have been exposed to more pollution.

Nobody knows any of this yet.

I think those numbers are gonna change

also because the populations are getting bigger.

So initially, if you think about this,

like the population that people had that they could study

to try to understand what was going on

was just Wuhan, really, and the surrounding areas,

which was huge, but it was just them.

So then you start to expand to other parts of the world,

and now European people in Western Europe,

people in the United States,

and the vast number of those people,

the majority of the people who have the disease now

are in the United States.

So just having a bigger population

changes the way the population responds

because you have different conditions.

I mean, and this leads to

a really thorny ethical question, right?

So as we learn more about who is most likely to die

or these terrible conditions, right?

It seems like younger people are the less susceptible.

Though the data in the West may be worse than the East,

it seems like men are more likely to die than women, right?

So as we learn more about this,

there comes a question of whether we should do

what are called challenge trials, right?

Whether you should have people who volunteer

for the service of vaccine testing to be given the virus

as a way to accelerate the way vaccine testing happens.

And so I read a paper about this and the hypothesis

or the theory or the argument,

argument would be the better way to put it,

is that this will be a good thing.

It would accelerate vaccine development,

which seems indisputable.

Maybe slightly disputable, but seems likely.

And then the paper says and actually,

it wouldn't really increase risk of death

if you were to limit it

in people who are likely to get the virus anyway

'cause they live in urban areas

and may get it at some point,

and are likely to not have a terrible reaction

because they're in a low risk group,

and then therefore, by volunteering for the test,

will be given the best possible healthcare.

So actually, the volunteers may not be at any more,

they may not have a higher risk of death

from the virus than non-volunteers.

That's the argument in the paper.

Adam, respond to it both logically and morally.

So, logically, what you would like to be able to do

is have an interestingly diverse population

of people exposed to the virus in a controlled setting

so that you can trace the course of how the virus proceeds

through them as a population, and also, individually,

and then potentially, use those outcomes for research,

pursuing a virus.

And also, immunological therapies,

monoclonal antibodies especially, which I think,

and we'll talk about this, I think are actually,

for right now, the thing, as I said, I'm more hopeful about.

And even ethically, if you could find a way

to really feel like everybody had the most possible,

the most informed consent as possible for this,

then to really explain to people,

like look, there's a chance

because of who you are and what we think how this works,

you could die from this or get really, really sick.

You may be able to think about an ethical way

to consent to those folks.

It may be an IRB, an institutional review board

that reviews how we're gonna do human trials,

would say, well, I mean, the situation's pretty grave,

maybe we can do it.

Now, I do think that part of the argument

that you're seeing as well is like,

well, do you really learn what you need to learn

from that kind of experiment?

Do you need to do that kind of experiment

to learn what we need to learn,

which is the virology here, immunology of the response?

And I think that that's why, for example,

some of the molecular approaches

to coming up with vaccines and other therapies

are interesting to folks

because they suggest that you don't have to do that,

that kind of a challenge testing,

like building the most sophisticated clinic in the world

and putting those people in it

to say we're gonna give you a virus and see what happens,

especially because bioscience has a really bad history

of those kind of things

where people didn't have informed consent about it.

The evolution of bioethics as a field

came in large measure out of doing those kind of experiments

in less than ethical ways,

and the horrible outcomes that result.

Yeah, I've been listening, an audiobook,

to this book called Ten Drugs,

tracing the history of drug development through time,

and one of the things that's so extraordinary,

both is that much of drug development

comes from the wealthy and the famous,

testing potential drugs on their children

in dire situations,

whether it's Franklin Roosevelt, for example,

but also, the number of tests that are carried out

on prisoners and orphans,

which is not what you want to have happen.

Let me go to a big question here from Raza Mithani.

What country has had the best response to the virus so far,

and what lessons can we learn from them?

South Korea I think is probably the far and away winner,

looking at that curve.

One thing that you can learn is that it's good

to have scientists in positions

of political authority as well.

I believe, if I'm not mistaken,

their vice president is an epidemiologist.

Do I have that one right?

But also, they,

South Korea, Singapore, Hong Kong, Taiwan,

these places that experienced the brunt of SARS

built a public health infrastructure

that was ready for a respiratory pandemic

to emerge out of China and would come to them first.

The United States knew that was possible as well.

I've said this before on social media.

I've got reports going back 20 years

that say this is what's gonna happen,

and what will happen when it does

is we won't have enough PPEs,

we won't have enough ventilators,

there won't be centralized authority,

and a lot of people are gonna get sick and die.

Those reports go back to before anthrax

after September 11th.

They certainly happened to a great extent

after SARS and MERS and H1N1.

What's different is that the United States didn't listen

or listened and then stopped listening.

And those other countries,

as soon as this started to happen,

all of their alarms went off.

And so places like Taiwan, for example,

linked their national healthcare database

to their immigration database.

In South Korea, as soon as they started to have cases,

they did huge contact tracing efforts.

Singapore posted data on every single cluster,

and followed like, here's the person who we followed,

here's who they infected, here's who they followed.

You can follow these trees

and see like what part of the city-state they live in.

South Korea got almost everybody.

They missed one, which is what happens

when you do contact tracing.

Some always get through the cordon sanitaire.

They missed one and that person turned out

to be a super spreader.

So they had another blossoming of cases.

And now they're seeing more cases too,

especially re-importation,

and then some community spread again.

But the unfortunate thing about this

is that the lessons that those places teach,

we're now past that time,

because what they were able to do

was effectively handle containment.

They saw this thing coming and they contained it.

The phase that we're in now is mitigation or management.

That's what we're trying to do.

That's what social distancing is.

We're past the containment.

We'd like to get back there.

But containment is still potentially a policy

in cities where there have not been breakouts.

Yeah, potentially, that's right.

And that requires a few things to be in place

in advance, though.

One of them is testing, which places don't have.

One of them is a funded

and trained-up public health infrastructure,

to have people who actually go out,

like into the community and interview people,

like knock on doors, and say, Hey,

we think this person was in contact with you.

Were they?

And those people have to be in like PPEs.

You have to have that ready to go as well.

And the public health infrastructure,

public health in the United States

is largely run through the states

and then through localities,

and I've seen reports that it's been denuded

in the last 10 years of funding and personnel.

They've lost hundreds of millions of dollars

and tens of thousands of people.

So that infrastructure doesn't exist

to do that kind of containment.

You'd have to build that in as well.

And right now, those cities

are trying to get ready for the wave.

Those cities, cities all over the country,

if they're preparing correctly,

are focusing their attention

on getting their hospitals ready,

on building tent hospitals,

on building shelters for the homeless

and potential emergency pop-up hospitals

in convention centers.

So they're getting prepared for a mitigation response,

not the containment response that they would have to do

in advance of that.

Let me get to a very Wired question, right?

Wired has traditionally very much

been a magazine publication about optimism, right?

About change is good, you know?

We cover an area west of California called the future,

and of course, that has not been our role, right?

The optimists are the ones who downplayed it

in January, February,

and Wired has very much been extremely realistic here,

and in fact, has been warning since very early on

about the dire threats and the needs we need to take.

So the question that comes from Mark,

What do you see as the potential silver linings

in the tragedy of the coronavirus 19 pandemic?

What are the long-term societal health benefits

that may come out of this tragedy?

I'd expand the question, right?

I mean, like, clearly at Wired,

we've all learned how to work from home, right?

We are able to run a print publication

without a single person coming to the office, right?

We have learned all kinds of things

that will be adaptable to our future work as journalists.

We have learned how to be journalists

without leaving our apartments.

It is not something we ever would have advised,

but that's a tiny thing.

Tell me about the big things that are gonna come to society

that may be positive after this incredible tragedy.

I do have some hopes here.

One of them is to see a remaking,

a reimagining of our health and public health systems

in the same way that the Asian countries

and regions did after SARS,

to understand now the vulnerabilities are stark,

the fact that people don't have access to care,

the fact that public health and prevention

is not a priority,

the fact that we don't have enough resources

for the people who need them, the fact that not only

are the poorest and oldest and sickest the most vulnerable

and most likely to be harmed financially and physically,

but all of us are vulnerable,

like all of us are vulnerable because of systems,

not just because of a scary new virus.

There are ways to build systems

that would make this virus not as scary,

and we haven't built those.

So maybe now we will.

Maybe we understand that we need those systems.

I also think that what we're seeing

because of the economic consequences of the shutdown,

widespread shutdown, have been tremendous, obviously.

Huge numbers of unemployment,

and small business is especially being affected

and going out of business,

and that is tremendously painful.

But this has also allowed people to see cities

in a new light, I think,

and you know this is a particular interest of mine.

It'll be to understand, for example,

what happens when cities don't have as many cars,

and so a story that I have up this week,

and understand that you can design a city

so that people can get around it.

One of the problems with social distancing

is when we've told people

you have to put six feet between each other,

is now, when people go outside,

they realize there's not enough room on sidewalks

to put six feet between each other

because the sidewalks are narrow

'cause we've built all these places for cars.

Now that the cars are less plentiful

and the bridges are less full

and the congestion is not as bad

and the air is cleared up over cities like Los Angeles,

famously had air pollution, you start to understand

that we've built these entire infrastructures

around dangerous technologies,

and they don't have to be that way.

So I think maybe we can start to see structuring a society

that's more resilient for smaller businesses

rather than these giant transnational companies

that wanna send things to us in boxes,

that's more resilient for public health reasons.

And I also, and this is,

maybe this is me being kind of emotionally vulnerable

after the last many weeks,

but I have these hopes that now,

we can all be understanding of what it is

to have a more tenuous connection to our society,

a more tenuous connection to what government can offer

and should offer as a safety net for all of us,

to understand how hard it is

when you don't know where a paycheck is coming from,

when we don't know if we're gonna be able

to take care of our loved ones,

when we're scared that we're gonna be sick

and won't be able to do anything about it.

This is something that the most vulnerable members

of our society, and that frankly, that the poor

and people of color have experienced to a greater extent

than people in kind of the overclasses.

And now all of us are experiencing it together,

and I hope that the sensitivity to those things

will change our psychologies as well as our systems.

I hope so, I hope so, too.

I also will add that there are a couple of industries

that will be completely transformed, right?

I mean, the way we practice medicine,

the rise in telemedicine has been fascinating to watch

and will be extremely beneficial, right?

One of the grave mistakes that we seem to have made,

certainly in New York,

was having everybody come into hospitals,

had a cold to get tested,

and many of them caught the coronavirus there, right?

And as we all become more comfortable with telemedicine,

will be extremely useful, right?

Online education, right now, my kids,

three little kids, right there,

homeschooling on iPads,

on Zoom with their teachers right now,

but the fact that none of them has come

charging in on this call in a penguin costume

suggests that that is actively working.

So online education seems to be another thing

that will be transformed.

As I mentioned, journalism will be transformed,

which gives me another moment to say

please subscribe to Wired,

www.wired.com/subscribe

because we're clearly both supported

by subscriptions and advertising,

and I think everybody can see

where the advertising market is coming.

Let me ask you a small, specific question

that is very particular to my life, Adam.

This comes from Lourdes Berho.

When we were running in the woods

and crossed over with another runner,

since we are both breathing,

can we get infected by the air?

Should we run with masks?

Would you be able to?

I mean, you are a world-class long-distance runner.

Would it work?

I think you probably could run

with a bandana over your mouth.

I think you would probably be getting in enough oxygen.

You could certainly breathe through your nose.

I mean, obviously, it's gonna limit your ability

to breathe well.

I actually have never tested it.

What do you think, should I wear a mask when I run?

Should Lourdes?

If you're distance running by yourself out in the forest,

I'd probably not,

but I've seen the kinda crowds that exist for you

at the beginning of a marathon.

They're much more spaced out for you

by the end of a marathon,

but those are very close together.

Will we be able to have those kind of events?

Can a starting line at a marathon,

you've been in enough of those,

can we ever see any of those again?

There's no way that the starting line of a major marathon

could exist in anything like the stage we're in,

but you could also have staggered starts.

I do other mountain races where you have staggered starts.

All right, let's get to questions

that more people are concerned about.

So Kishani De Silva asks,

Tell me a little bit more about herd immunity.

There's a very brief moment where the UK government said,

We'll just do herd immunity,

and then they quickly changed course.

But what does it mean and how do we get it?

Yeah, it means something a little different, I think,

than national leaders and the leaders in the UK

and the United States have meant.

What it means is that if you have, in a population,

if you have enough people who are immune to a pathogen,

then it doesn't spread as quickly or as widely.

So the people who are vulnerable to it,

who don't have that immunity for whatever reason,

because they're old or because they're young

or because we're different individually,

the pathogen doesn't jump as quickly

from individual to individual,

so it doesn't get to the ones who are the most vulnerable.

The herd that all of us are in with each other,

the togetherness of the world

protects itself as a collective.

What they meant in the UK

and what President Trump meant here when he said,

Maybe we can ride it out,

is that you would just let the,

in this case, SARS-CoV-2,

let COVID-19 spread as widely as possible,

because what we don't know,

because we haven't had the testing

is we don't know what the denominator is.

We don't know how many people had it already.

We don't know how many people have the disease,

so all we know is kind of confirmed cases

and how many people get critically ill and die,

and that it's really, really bad, it looks terrible.

But it is possible, and no one knows,

so I don't know how possible to say this is,

but it's possible that in fact,

many, many, vastly more of us had it in January

and we're fine and we're okay.

And so the idea there is, well,

maybe you should let the disease spread as it would,

without doing anything,

and some number of people will recover

and then the herd, all of us would have some immunity,

and then it would be less likely to spread later.

And the reason, what seems to be the case,

is that the reason the UK turned away from that

is that the modelers at Imperial College

said if you do that, two million people will die,

20 million, millions and millions of people in the UK

will die when you do that,

looking at the numbers that we have so far.

It was a model, that was a worst case.

Models have projections, they have all kinds of assumptions,

but when you bring that model to a national leader,

they go, Okay, maybe we're not gonna do it that way.

Let's try to hold things back.

Let's hold the line

until we can get a therapy and a vaccine.

And the same thing, that same model seems to have been put,

again, they haven't said,

and so there's been great reporting

that has suggested that this would happen,

that same model or some version of it

got put in front of the president

and the Coronavirus Task Force,

and they were like, whoa, whoa, whoa,

we're not gonna do that here.

Yeah, let me ask you a question

that's come up a couple times here,

Pedro Silva and others, and it's about viral load.

So, and also ties to a question I asked you in Slack

at the very beginning.

So the way I've often thought about it

is that you have a chance to avoid the virus

by social distancing.

Maybe you won't get it on you

if you don't touch the subway pole,

or you're less likely to get it if you wear gloves, right?

So there's a whole set of things you can do to reduce it

getting on you.

Then there's a whole bunch of things you can do to reduce,

once it gets on you, from getting in you, right?

You wash your hands, you don't touch your face, right?

All of those things.

Then once it gets in you,

there's a chance it won't get down to your lungs

and it won't start replicating, right?

Maybe it's based on your immune system.

Maybe it's based on luck.

But then I've always assumed that if it does get down

and it does start replicating, it's pretty much the same.

But now I've been reading more about viral load,

and if you've been exposed to a lot of it,

you're likely to have a worse case.

So it's not just it gets in, starts replicating,

but if it's more of it gets in, you're in a worse situation.

Is that correct, and is the way I described it

in the last 30 seconds also correct?

Yeah, I think so.

I'm really,

I hesitate to use these kind of metaphors

because they can lead you astray in all sorts of ways,

but there is a difference between if you have a fortress,

an encampment that you're trying to defend,

if the bad guys send two people,

and even if they make it inside,

you can maybe deal with them versus sending 20,000 troops.

It's the difference between sending like one spy

versus all the orcs.

So, and there is some response

that the immune system can mount,

can deal with some low number of the virus,

or you'd get less there than if you are,

and this is part of the implication of the question,

healthcare workers who are exposed to huge amounts

of people who are very sick and who are doing procedures

that potentially expose them to a lot of the virus,

like an intubation exposes you to a person

who coughs up a lot of stuff.

It's why they need good PPEs.

So yes, it does seem to be the case,

that if you end up in a situation

where you're getting a lot of virus on board,

where you have a lot of droplets filled with a lot of virus,

it becomes harder for the body to fight it off,

and potentially, the infection gets worse more quickly,

and then there are variations in how your immune system

responds to it,

how susceptible you are as an individual,

how responsive your immune system is,

and then part of the problem too, on the other end of this,

is that one of the ways that this disease kills people

is that a person's immune system becomes hyperactive.

So there's a hyperactive immune response at the other end,

cytokine storm, they call it.

Cytokines are a molecule in the immune system

that can potentially also be bad.

So the immune system gets over-triggered.

So that is true, but the viral load question

is probably one that the answer to which is

that's why we need really, really good PPEs

for healthcare workers.

I think less for you and me, that's speculation.

We have about five more minutes.

Again, I'd like to thank everybody for coming.

We've had a extraordinary stable number of people watching,

which is fantastic.

And again, thank you so much for joining our newsletter.

Thank you so much for joining me and Adam.

I wanna ask you a question that comes from an arena that is,

I know very much in your passion area.

Peer review is so important in science,

but most of the papers that are coming out on this

are not peer reviewed.

How is this gonna change publication, collaboration

in scientific literature?

What are the risks and the benefits?

Give it a quick answer, and then we'll wrap up.

Yeah, this has been tremendous

for something called preprints.

Tremendously good scientists

have been publishing tremendously good work

and putting it out there very quickly, before peer review,

essentially having post-publication peer review.

They put out work,

and the rest of the scientific community has read it

and decided whether or not to use it.

Some of those papers have been retracted.

Some of those papers have turned out not to be solid.

That's what happens in science.

Often, that happens behind the curtain.

That curtain has been opened here.

I don't think it closes again.

And I think in a fascinating situation like this,

you know this too,

the scientific situation is different at the end of a day

than it was at the beginning of the day,

most days of the week,

and that's because of the preprint infrastructure

and an online infrastructure that allows researchers

to get their work out there very, very quickly

in a time of emergency.

And as I say, I don't think that's gonna change

and that's not going back.

All right, well, we have a lot of the later comments

are thanking us and asking whether this

will be recorded and transcribed.

It is being recorded.

We will share out the recording.

We can also transcribe it.

And then there are a couple people asking

if we can do these on a more regular basis.

Adam, are you free next week?

I would be happy to do it,

and I will say that many of my colleagues

have been doing just tremendous work too,

and I hope we can get some of them here too.

This has been, as you said, an all-hands piece of work.

It's the story of our time.

All right, thank you so much for joining.

This is one of the absolutely critical issues for our time.

We're doing our best at Wired

to give you the information you need.

I'm gonna go through all these questions,

see if there are other assignments.

I've also started a Twitter thread.

You can go to nxthompson,

where I've asked what we should be covering

and how we should be covering it.

May have a limited number of reporters,

but they're all working lights out

to do the best they can on this.

So thanks for joining, thanks for joining the newsletter.

Please do subscribe, and stay safe, stay healthy,

and Adam and I will be back here in not so long.

Cheers. Take care, folks.