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Fauci: aerosol transmission of COVID-19 is likely

Preventive Medicine Specialist & True Health Initiative President Dr. David Katz joins Yahoo Finance’s Kristin Myers to break down the latest coronavirus developments, as Gilead says Remdesivir reduces Covid-19 death risk.

Video Transcript

KRISTIN MYERS: And on the coronavirus front, the United States closing in on 3.2 million positive cases now, as Florida, as I mentioned earlier, one of the hardest hit states, saw their case counts rise by over 11,000. So to chat more about this, I want to bring in Dr. David Katz, preventive medicine specialist and True Health Initiative president.

Thanks so much for joining us, Doctor. So we have the news now that we're hearing roughly 60,000 cases a day. That's up from the 50,000 that we previously had. As you're hearing this news and as you're seeing case count spike all across the country, how likely is it, do you think, that we're going to hit that estimate that Dr. Fauci provided, that we could be seeing 100,000 new cases a day?

DAVID KATZ: Well, I think we have a lot more cases in the country, Kristin, than we ever detected. Let's be clear. We never went out looking for cases with enough test kits to find what was out there. And given what we know from global data about the likely fatality rate of COVID, there are 10 times more cases in the United States than we ever detected.

So to some extent, we're seeing record case counts because we're testing more every week. That is part of the explanation. If the virus has been out there at much higher levels than we ever detected, and we're doing a better job of looking for it, we're going to find more of it. We also have better performing test kits now than we had at the beginning. There were a lot of false negatives.

When I did my brief stint on the frontlines, one day we admitted about 20 people with COVID. 19 of them tested negative. We knew they had it. 19 out of 20 tested negative. So the tests are better. More positive results. Were testing many, many more people. We're finding more of it. What I'm more interested in knowing is what's happening to hospitalization rates, what's happening to the death rate.

So if we find 100,000 cases a day, honestly it just means we're catching up with where the pandemic was all along. If we don't see a concomitant rise in hospitalization, it means we are getting a better handle on how many people have had this thing. Sadly, in certain states, we absolutely are seeing a rise in hospitalization, and that's a clear indication it's not just more and better testing. More people are getting it. And the very people who can least afford to get it, because they're most vulnerable to severe outcomes, older people, people with chronic disease, are getting it too.

KRISTIN MYERS: So on that point of the hospitalizations, how worrying is it when you hear this news? I feel like at the beginning of the pandemic we got a lot of doomsday scenarios right up front. You know, that hospitals were going to be overrun, no one else would be able to enter, whether you have coronavirus or any other accident or illness that you needed to go to the hospital to treat.

But I'm starting to see now, really worrying statistics. I mean, in Florida, almost 60 hospitals said they had no more ICU beds. So I mean, I'm not a doctor. You know this far better than I. But when I hear that, that sounds terrifying. So I mean, are we reaching that doomsday scenario? Is that on the horizon if we don't get a handle on these case numbers?

DAVID KATZ: So from altitude, Kristin, I'm seeing a complex pattern. First of all, I think the northeast, my home state of Connecticut, certainly New York City, to some extent New York state, maybe New Jersey, but this general part of the country, we had our first wave. And there are certainly still vulnerable people who are hiding away from the virus, and if we're not careful, more people in this part of the country can get it. But mostly case counts are declining here.

We had our first wave. Because we tried to close the barn doors here, but we did it after the horses were out. There was already widespread virus in New York City. It was riding the subway by the time the lockdown took place. So a lot of people who were going to get the virus in New York City got it. Other parts of the country are having their first wave now. I see a split in how they're experiencing it. There are states that both came out of their lockdown haphazardly and had a hefty dose of denial.

In other words, states that didn't take the pandemic seriously, where the prevailing view is this is not a serious disease, we never should have shut down the economy, they are the very states that are most prone now to have a rise, not just in cases, but in hospitalization, because in states where you have an element of this isn't a serious disease, even older people are not being careful. Younger people are not being careful about exposing their parents and grandparents, and it's the older people, people with chronic disease, who are the ones filling up hospitals. And we're seeing that in a number of states. We're seeing it in Alabama, Georgia, Arkansas, Florida, other states.

But then there are other elements to this pattern too. So for example, California, the prevailing view is we need to take the virus seriously. But they also opened up somewhat haphazardly. But the spread there seems mostly to be among younger, healthier people, a rise in case counts without the rise in hospitalization. If we quickly rally, and look around at the common experience and say, actually, spread of the virus per se among younger, healthier people isn't so bad, they mostly get it, get over it, no real harm done, we have to carefully protect older people, people who are vulnerable because of chronic disease, we can actually make our way toward herd immunity without overloading our hospitals, and we can put an end to the nightmare scenario. But if we're not careful about our older loved ones, we will fill up the nation's hospitals.

KRISTIN MYERS: So I was seeing news that the virus is now mutating to become more infectious. It's possible that it was airborne. I'm not going to lie to you, I thought it was already airborne, so this was almost news to me.

DAVID KATZ: Same here.

KRISTIN MYERS: How difficult is that going to make it, you know, to fight the virus, I mean, to get everyone to herd immunity if the virus just keeps mutating into something else?

DAVID KATZ: Well first of all, I had the same reaction you had about it being airborne. It's a respiratory virus. It was always airborne. That's how it got spread. So actually all the debate-- and to some extent, Kristin, this really is the media milking every drop of drama out of this thing, it's a debate about the size of the droplets, right? So water droplets versus vapor. Vapor is smaller, but you know, I mean really, it's a trivial distinction as far as I'm concerned. The debate really is how long can viral particles circulate in indoor air, and how infectious is it? But we already know most of the transmission is occurring as a result of super spreader events anyway.

On the matter of mutation, all viruses mutate all the time. The mutations that take hold are the ones that favor survival. Not our survival, alas, but survival of the virus. In other words, the virus, the mutations that spread the best are the ones that take over. Well, think of it this way. If I am a virus and I make you extremely sick, you go to bed and you interact with nobody, you're not going to share me very effectively.

If I am a mutated version of that virus and I make you less sick so you're out and about and interact with lots of other people, actually I will spread much more readily and I will take over. So what mutations tend to result in is yes, easier transmission, but generally they result in less severe disease. So we will see new viral strains take over if they are better at spreading, and in all probability that will mean they are less severe in terms of the complications of the infection. So that's not necessarily a bad thing.

So again, this is just sort of characteristic of all infectious diseases. They are mutating all the time. Whether or not the mutation makes a difference in the prevailing strains has something to do with how well the virus transmits itself, and actually making people less sick. Sick enough to sneeze and cough, that's good, because you helped to spread me. Sick enough to be in the hospital or in bed so you're not interacting with other people, that doesn't help me spread. So mutation tends to move in the direction of better spread, less severe.

KRISTIN MYERS: So I want to talk about a point of optimism for us all. As I mentioned a little bit earlier, when it comes on the treatment front, Gilead saying that Remdesivir reduced the risk of death for severely sick patients by 62%, and then when it comes to the vaccine front, we got news from Beyond Tech that says they're confident they'll actually be able to seek regulatory approval by the end of the year.

When you hear all of this combined news, Beyond Tech not the only vaccine maker out there that's been producing news. We also have Regeneron and Moderna that have also been coming out with news. How optimistic are you that by the beginning of the year that we will have a vaccine and be able to control coronavirus?

DAVID KATZ: Well, let me throw something else in the mix, and then address the vaccine and the treatments. I'm optimistic for another reason. I see evidence from multiple studies, both looking at mechanism and populations, that a significant percent of us, maybe 50%, are natively resistant to this germ because of prior coronavirus exposures. Coronaviruses are common. They cause the common cold. Most of us have had them, and we have partial immunity to this. So a lot of people with modest exposure don't get this at all.

Then some people get to immunity, but don't show up on our antibody tests, and it's a little complicated to explain, but it's because they're reacting with what's called secretory IgA, and not making IgM and IgG, they have immunity, we just aren't measuring it. But they contribute to herd immunity. And then 20% of the population that is exposed makes antibodies. When you add all that up, parts of the country that have had their first wave may be at herd immunity already, or at least much closer than we had reason to think. I'm optimistic about that.

In terms of a vaccine, honestly I have no idea. Until a vaccine has been tested through all of its stages and we know it's effective and safe, we really don't know that it's going to be ready. So there are all these projections about when we'll get a vaccine, and it all sounds like record breaking speed, but again, we need safety, we need effectiveness, we need mass production, we need wide distribution, we need everybody willing to get it, it has to be affordable. This is a marathon, not a sprint. It's not clear to me when it's going to end.

Treatment's another story. Remdesivir is effective. So are many other things. Dexamethasone is effective. In desperate situations pooled antibody treatment is effective. Some nutrients are clearly effective when people are relatively deficient, vitamin D, zinc, both helpful. And then there are other innovations as well. And probably the most important one is not putting people on ventilators, giving them high flow oxygen and repositioning them. That makes a huge difference.

We have learned a massive amount about treatment in a short amount of time, and it is absolutely changing outcomes for people who get sick enough to wind up in the hospital. And I'm very, very optimistic that will continue.

KRISTIN MYERS: Great. Well that sounds like some positive news, a positive note to end his conversation on. Dr. David Katz, True Health Initiative president. Thanks so much today.

DAVID KATZ: Good to be with you.