Dr. Eric Topol: What Lies Between Now and COVID-19 Vaccine

Dr. Eric Topol

[ Music ]

Female : Welcome to Conversations on Health Care with Mark Masselli and
Margaret Flinter, a show where we speak to the top thought leaders
in health innovation, health policy, care delivery, and the great minds
who are shaping the hea lthcare of the future.

This week Mark and Margaret speak with Dr. Eric Topol , Founder and
Director of the Scripps Translational Institute . He is a renowned
cardiologist, author, and health data evangelist who designed the AI
platform for the All of Us Precision Medicine Initiative of the NIH as
well as the platform for the Apple Heart Study. He is using that
platform to conduct real time data surveillance on the COVID - 19
pandemic.

Lori Robertson also checks in, the Managing Editor of F act C heck.org
looks at misstatements s poken about health policy in the public
domain, separating the fake from the facts . We end with a bright idea
that's improving health and well being in everyday lives. If you have
comments, please e - mail us at chcra [email protected] or find us on
Facebook or Twitter or wherever you listen to podcast. You can also
hear us by asking Alexa to play the program Conversations on Health
Care . Now stay tuned for our interview with Dr. Eric Topol here on
Conversations on Health C are.

[ Music ]

Mark Masselli: We're speaking today with Dr. Eric Topol Founder and Director of the
Scripps Translational Institute. He's the Executive Vice President . Dr.
Topol, is globally renowned cardiologist, health technologist and
innovator who help le ad the Cleveland Clinic to a first place global
ranking for the treatment of heart disease. He's awarded a large NIH
grant to build a digital platform for the All of Us Precision Medicine
Initiative and has assisted the UK ’s National Health Service with t h e
adoption of AI technologies.

Margaret Flinter: Dr. Topol has published more than 1200 peer reviewed papers and a
number of bestselling books including T he Creative Destruction of
Medicine and Deep Medicine: How AI can make Healthcare Human
Again . He is t he e ditor in - c hief of the online publication Medscape
and hosts a popular podcast with Dr. Abraham Verghese Medicine
and the Machine . Dr. Topol, we are so pleased to welcome you back
to Conversations on Health C are .

Dr. Eric Topol: Oh , thanks so much for h aving me.

Mark Masselli: Yeah, Dr. Topol the global pandemic has really impacted our
scientists, our infectious disease experts, health care delivery systems.
COVID - 19 is a crafty deadly pathogen, really shaking the world in
America in particular . I'm wond ering, as you look at the impact of

Dr. Eric Topol

COVID - 19 around the world here in the United States, how would you
assess the depth of the crisis we're in right now? Do you have a
prescription for how we should move forward from this point?

Dr. Eric Topol: Well, we're in a crisis unfortunately, in fact, a good part of it is self -
induced and that’s the sad aspect. It all started , of course , when we
didn't have testing capacity when the first patient came here . T hat
went off for two months , so that led to the first remar kable surge. But
then when we reopened early in May where most of the states were
reopening in the middle of cases going up, no less not having achieved
suppression. Now, what we've seen is a most hospitalizations since
the pandemic started . W e've also are seeing the death start to rise
again . Most of this is because of not being patient with the stay at
home , measures that were equivalent to a lockdown.

Interestingly, we've seen great success within the US even in places
like New York and New Jersey that w ere so hard hit in other places in
the northeast , and of course we learn from other countries . All
throughout Europe, the worst hit places like Belgium and France and
Spain, Italy , they all waited before they reopened and they've had
great continued suppre ssion. It really is a dilemma about how long
you can wait in terms of the economy versus preserving health and
t rying to keep the virus at bay . W e made some very bad choices
u nfortunately in this country , now we have to try to dig out of this .

Margaret Fli nter: Dr. Topol, in the background there ’s always this issue of reliable data
or the lack thereof of about the pandemic here in the US. I think you
recently tweeted the d ata is inconsistent, incomplete, and
inaccessible in all 50 states , so no wonder we're failing at this. The
testing infrastructure in many places is still problematic. You are many
things , but one of them is a believer in data in AI in real time
monitoring . What ’s your thoughts on how we get more ti mely data to
manage the crisis?

Dr. Eric T opol: So in order to do any great analytics you got to have good inputs, and
we don't have a lot of the inputs. The CDC basically failed. There was a
no show here and so that led to this volunteer COVID - 19 t racking
p roject that the Atlantic put together. T his is a team of pure
volunteers that are collating the data throughout the states as best
they can , but we don't have a lot of data that we should. It was only in
recent days that the third most populous state in the country , Florida ,
was willing to give their daily hospitalization data but we need to
know much more than that. We know that many ICU stuff, these
states that have had severe explosive growth in new cases have also
now stripped their hospital resources and beds and particularly ICU
beds. This is just amazing to have to fail in this respect. We can't really
do artificial intelligence when you have such compromise inputs.

It's really unfortunate that we don't have our finger on the pulse

Dr. Eric Topol

because we're starved for data. When I was involved with th e review
of the NHS I learned about how they put an emphasis on this. T hey
have a group that has every single hospital admission throughout the
UK. They basically , in real time , are tracking every patient in the
country. Now, obviously the UK is not as big as the US but that
country and many others has real time data , Germany does , South
Korea and so many other places . W hy can't we do that , b ecause then
you know how to allocate resources, you know how to plan, all the
things that you need to do when you're facing a crisis like this.

Also, the issues about suppression knowing that you want to get
down to around 10 cases per million , and we were still going forward
with opening states when we ’ re 50 , 70 million now we're 400 , 500
million cases. The lack of the data is so critical to making major
decisions, particularly when they were relegated to states rather than
done as a national coordinate d plan that is absent.

Mark Masselli: Yet, I think the crisis has provided some un foreseen benefits here in
the States . H ealth institutions are , as I said earlier, rapidly adapt ing,
but we ’re seeing this include s this widespread adoption of telehealth.
You've adapted the smart watch technology you created for the Apple
Heart Study to now help volunteers contribute data to t he COVID - 19
surveillance program. I'm wondering if you've been keeping an eye on
new technologies as they impact the health care ecosystem. I'm also
interested in the observation on the research side, we have a couple
of vaccine candidates that were using a new platform . Y ou have
almost all of the research institutes focused in on this virus. I'm just
wondering with all that activity, is anyone looking at collateral
discoveries or is it too early to assess?

Dr. Eric Topol: Right, well, let me first start of f with two technologies that I'm very
excited about , because I am remaining optimistic. Firstly, you touched
on the fact that 100 million people in America have either a smart
watch or a fitness band of some kind. It gives heart rate and physical
activity. It turns out that's a very crisp signal to be able to pick up
COVID - 19 as we already published for flu earlier this year. W e
adapted an app called Detect Study and we have 40,000 Americans all
every state is covered, although we need hundreds of thousands to
do better.

Fatigue is a very important part of early COVID - 19, as is a resting heart
rate . F atigue is subjective. But when you're sleeping more and you're
having less physical activity, along with a resting heart rate that
increases, you can now at a d iagnosis at least in a group and a cluster
is likely. That technology we think is really vital because if we get into
digital surveillance it's very complimentary to testing because testing
you can't do in 3 30 million people on a frequent basis. You have a one
off measurement, whereas a smart watch that people have or fitness

Dr. Eric Topol

ban d all they have to do is put it on and keep the battery charged and
you have a way to have surveillance of the country .

Germany has already initiated that in over 560,000 people, th ey call it
the National Fever Curve , and they can look anywhere in the country
to see if there's anything lighting up. T hat technology is exist today ,
it’s basically just analytics and participation. Since we have no CDC to
support this, unlike Germany, wh ich its CDC have got fully behind it,
and that's why they have such a large participant group.

Now, the second technology that I think is coming in the next couple
of months, which is transformative are the rapid diagnostic test .
These are 15 minutes, pret ty darn accurate, relatively inexpensive,
even down to $1 no less $5 and you get the answer like on a paper
strip, just like a pregnancy test, and then you know you're good for
the day. T hose are two technologies that have nothing to do with
drugs or vacci nes.

Now , you asked about the vaccines and I think we have many that are
looking very promising mRNA types there are a couple of those and
there's many others . B ut I'm not so worried about we're going to have
vaccines to choose from. I'm much more concerne d about getting
people to take the vaccine. We have a problem with getting people to
use a mask and that doesn't even require a shot . Vaccine , the risk is
going to be small , it’s like the unknown , there’s going to be some
risks, no matter what vaccine . B ut we have an anti - va x, anti - science ,
subcult of this country , i t's a sizable group. We've got to work on that
because we can't achieve this herd imm unity artificially, if you will,
vaccine , herd immunity without getting m ost people to have the
vaccine.

Marg aret Flinter: Well, Dr. Topol on a serious note six months into this pandemic, even
walking down Main Street in our local community, people just don't
seem to have gotten the memo . As Dr. Fauci t old you recently on your
podcast , it is not like it's rocket science , we ’re asking people to wear a
mask. What are your thoughts on how we scale up this call to action
for everybody in this country to do the right thing to protect each
other? What are your thoughts about how we protect our students
and our teachers who may be ordered back to school or may not have
the opportunity to go back to school? We all , I think , fear the
potential for a dramatic rise. What are your thoughts on that?

Dr. Eric Topol: Well, the first part is pretty easy if we had a real president that was
modeling that this is important. Right from the get - go in March, that
mask, it’s a respiratory virus and a mask will help and we don't want
people to get sick or to die . R ather than saying you don't need a mask ,
making fun of people that were wear ing mask and saying that it's 99%
harmless, which you couldn't be further from the truth. We have
problems with leadership and that has set off this mask problem to be

Dr. Eric Topol

much worse.

We can have the person that a lot of people look up to a good 30% of
the cou ntry and they're being told you don't need to have mask.
That’s for people that are -- I don't even want to go there too far .
Okay, now the second part of your question was about schools,
which, there's where we could put some signs. We have low risk
place s in Maine and even New York, New Jersey, Connecticut, places
that have really figured out how to keep this su ppression in check of
new cases. They're at the 1% level positive test, which is where you
want to be . We have parts in the country that are at 20 % to 30%.
Anyway, there's where you start. You open schools in a very careful
way. You have your testing, rapid testing ideally, you have your
tracing, and you have isolation if need be.

Now when you do that, and you'll also get samples for genomics to
tra ck transmission. I know that this child gave this staff person or this
grandparent precisely this virus, that's what we need to do to show
what is safe b ecause we don't know about children transmission that
much. We know it happened , we don't know how ofte n , that mode is
very fuzzy right now. If we did that, we were careful about it in low
risk zones. Be patient a month to learn from that and then get that
word out to other places and then scale up to places that have mild
spread and moderate . W e don't wind up with what has happened in
Israel right now and South Africa and many places that opened
schools and then wound up having very serious outbreaks.

Now, there are places that have had terrific school reopen ing , but
there are places that have had very good control contain ed their
outbreak , so we're not in that position. We only have some places
within the US that fit the bill. But it is absurd to demand that all
schools open . We're not in a position for that , and hope fully at some
point we will be.

Mark Mas selli: We're speaking today with Dr. Eric Topol, Founder and Director of the
Scripps Translational Institute. He's Executive Vic e President at Scripps
Research. He ’s been named one of modern healthcare ’s mos t
influential physician leaders. Dr. Topol, I wan t to go back and pull the
thread on the conversation about vaccines. Obviously, the
government is spending billions of dollars. It announced a purchase
with Pfizer the other day . There are dozens of other viable vaccines in
the queue that look quite promis ing. I think the public is very anxious
that this happened , but I think as a scientist we ha ve never had a
successful c oronavirus vaccine outside for livestock.

We didn't develop one for SARS and MERS , the early phase one and
two. But what do you worry abo ut , or you have enough confidence
that we've heard leading scientists say they're confident, but you
know those phase three trials are going to be very important. T alk

Dr. Eric Topol

about your confidence level and what if we don't get a vaccine , wh at
if we're like SARS and MERS and we can't identify one?

Dr. Eric Topol: First, let me say that why I'm optimistic. Structural biology, we're
going to be all knowing about structural biology in the months ahead.
Many people don't even know what cryo - EM is and the fact that you
can have a crystal structure of the antibodies and the virus , and you
can go atom by atom to fashion a vaccine . N o less what -- we can talk
about the neutralizing monoclonal antibodies, which are even more
imminent than vaccines and probably quite a bit s afer. But the vaccine
is so likely because we have science moving at a velocity we've never
seen before. T he vaccines knowing so much about the virus and the
way to attack it, all the different business sites that are -- every single
atom of this virus we' ve never -- this is not like what was in 1918. This
is 2020. What's really interesting what you're bringing up is, we've
been so pathetic in our public health response, and our lack of
national coordination, but our science is excelling. I'm just so
impres sed with it.

We have four different vaccine programs imported out and they all
have great neutr alizing antibodies. They have T - cell specific response.
We're seeing a really good mimicking the SARS and that's very
promising . I think we will get there. I'm m ore upbeat on the vaccine
and when I talked to Tony Fauci and he's told a story last week, about
they got the Chinese virus in January. Within five days they had a
template for a vaccine. Within 62 days they were in clinical trial. That
tells you that they took off years of normal effort. T he acceleration on
top of the science, the m anage d competition, that's a good one .
When I have a problem with this, why there's 10s of billions of dollars
being invested in these programs, when there's almost nothing bein g
invested in rapid diagnostics, which is we need that to o. We need that
badly and that's more than here now.

The other thing I just want to mention is, the monoclonal antibodies
don't get enough attention. They're going to cap in more quickly than
vaccine , they're in clinical trials multiple. We've already seen how
they block or they prevent in a non human primate and they also can
abort the infection in the early phase. That is as potent as you can get.
It last for many weeks and it can be used for high r isk people and even
there's a possibility of s elf - injection without having to go to a clinic. I
think the monoclonal is particularly excitement .

Margaret Flinter: Dr. Topol, while COVID is getting the focus of our attention, we want
to draw our listeners ’ attention to another we think very important
long term research project underway at the NIH that you've been very
engaged with as well led by Dr. Francis Collins , and t hat's the All of Us
Precision Medicine Initiative to amass the genomic and real time
hea lth data writ large of a million volunteers in this country to help

Dr. Eric Topol

scientists and citizen researchers, as they say , gain deeper insights
into population health across all ethnicities. Your team at Scripps is
deeply engaged in this project . W e would really welcome you talking
a little bit about the research and the platform that you've developed
for the All of Us project and your vision of the potential power of this
new approach to personalized medicine. Not only in how we treat
disease but hopefully impro ve populati on health by preventing
disease. I would add to that in these last painful months where we've
been so focused in equity, by race, by income, this may really offer
some tremendous benefit that we've not seen before , so we'd l ove
for you to commen t on that.

Dr. Eric Topol: Well, I think the All of Us is something we should be proud of as a
country, that commitment. It a ctually, it was four years ago when the
grantees were announced , so it didn't enroll for at least another year
and a half. We have over 350,000 people who are participants who
are partners in the project , and more than a half are
underrepresented minorities. There ’s never been a clinical research
project in American history and no less I don't think any history of that
size with minor ity representation like that , so we're very proud of
that. Now, that's going to eventually be many decades of follow up
st
like a Framingham study that was started in 1950, but this is a 21
century version .

We ’re going to learn a lot about individualized me dicine because
these people are going to not just have genomics, sensors, likely their
microbiome, all sorts of assessments. What happens over time, that
is, can we prevent illnesses that people might be at risk for? Can we
better manage those chronic cond itions that either they already have
or develop over the course of time? To get us out of this mode that
there's this one way to treat people to learn about what it takes to be
effective at the individual level . This term of precision medicine which
I pref er individualized medicine, but it's very exciting because it turns
out that we don't respect the fact that we're unique . If we now can
determine what is it that makes us so different than other person in
terms of risk or in terms of prevention or treatmen t or whatever it is ,
we can do much better for preservi ng health in the future.

Mark Masselli: Well , that's great. Our organization which provides care to the
underserved as part of the IRB process with the All of Us set up and
we think it's a very importa nt program. I'm wondering, as a visionary,
a realist and optimist, you should sort of think about this inflection
point in the healthcare delivery system. Think about some of the
advances that we've made in genomics and AI, real health time
monitoring . W ha t opportunities you see about redesigning a system
of healthcare delivery that really reaches all of us, regardless of
income that the proverbial healthcare is a right and not a privilege for
all people. What are your thoughts as you sor t of look at that p ath

Dr. Eric Topol

forward?

Dr. Eric Topol: Right, well, I think that was another thing I learned spending so much
time with the NHS and an e gal itarian health system , which is highly
revered. It's up there with the BBC and the royal family in terms of the
highest level o f respect. What I learned about that was that people
feel so good about it because everyone is cared for. We have to feel
badly that we have tens of millions of people who don't fit the bill
here and that has to get changed. We're seeing trillions of dolla rs
spent for things like this PPP and fuzzy things , we don't even know
where the money's going . We could have used that money and had a
national healthcare system where everybody was getting care. It's
funny how that became a debate, when in fact all this -- now we're
spending that kind of funds, in a seemingly reckless or if not foggy
fashion .

As you will know, we are the only country of industrialized nations
that don't do that for all of its citizens. I do believe it's a human right.
We've seen the conse quences of it not being human right . If you just
look at what's happening in the COVID - 19 pandemic to Blacks to
Latinos to all the underrepresented groups, they've really suffered.
They've taken far more hits and damage from this than the people
who have h ealth care coverage , and t he other thing is the fact that we
rely our health care on employers, and now we have some 30 plus
million people 40 million people, whatever it is, who are unemployed.
I mean, my son lost his job and he lost his health care and t his is a
classic situation that is widespread throughout the country . We have
to do better. This is just not acceptable , the model th at is being used
in this country.

Margaret Flinter: We've been speaking today with Dr. Eric Topol, the Founder and
Director of the Scripps Translational Institute, Executive Vice
Pre sident of Scripps Research, inventor, author of multiple bestsellers,
including his latest Deep Medicine : How AI can make Healthcare
Human Again . Learn about his very important work by going to
dr. erictiopol.com or follow him on twitter @Eric Topol. Dr. Topol we
want to thank you for sharing your thoughts and your insights, for
giving us both guidance and some cause for optimism as we navigate
this exceedingly difficult moment in our history, and of course for
joining us again on Conversations on Health C are .

Dr. Eric Topol: Well , thanks for having me. I know we'll get through this.

[ Music ]

Mark Masselli: At Conversations on Health Care we want our audience to be truly in
the know when it comes to th e facts about healthcare reform and
policy. Lori Robertson is an award winning journalist and Managing
Editor of FactCheck.org, a nonpartisan, nonprofit consumer advocate

Dr. Eric Topol

for voters that aim to reduce the level of deception in US politics. Lori,
what have you got for us this week?

Lori Robertson: In an interview with Fox News Sunday host Chris Wallace, President
Donald Trump made misleading and false claims about COVID - 19. The
President claimed other countries later mentioning Europe are only
testing for CO VID - 19 if someone is “ really sick ” . He said the massive
testing in the US “ skews the numbers ” . But testing data show many
countries including in Europe have conducted more tests per
confirmed case than the US . If other countries have tested more
people tha n have actually had the disease compared with the United
States that suggest those countries couldn't have been only testing
the really sick. In the interview, Trump singled out Europe and
dismissed the possibility that the European Union doesn't have as b ad
of an outbreak as the US does now , “ it's possible that they don't test
that's what's possible ” , he said .

According to the University of Oxford based project Our World in
Data, several European countries testing policies are open testing for
anyone, incl uding those without any symptoms. Those countries
include Germany, Austria, Switzerland, Denmark, Portugal, Greece
and Iceland. Many other countries in Europe including Spain, Italy,
France and the United Kingdom, test anyone with symptoms. Experts
have to ld us before that looking at the test positivity rate the
percentage of conducted tests that are positive shows whether a
country is doing enough testing. By that measure, nearly all European
countries as well as many other countries around the globe are d oing
better than the United States.

Trump also claimed that states were backpedaling on reopening “ on
purpose ” . There is no evidence that California or other states are
halting or reversing the reopening for political reasons. Multiple
states have concerni ng trends such as increases in COVID - 19 cases
and test positivity that p ublic health experts including those on the
White House's Coronavirus Task Force s ay warrant business closures
and other precautions. That's my fat check for this week. I'm Lori
Robert son, Managing Editor of FactCheck.org.

Margaret Flinter: F act C heck.org is committed to factual accuracy from the country's
major political players and is a project of the Annenberg Public Policy
Center at the University of Pennsylvania. If you have a fact that you'd
like checked, e - mail us at www.chcradio.com . We'll have
FactCheck.org’s Lori Robertson check it out for you here on
Conversations on Health Care.

[ Music ]

Margaret Flinter: Each week Conversations highligh ts a bright idea about how to make
wellness a part of our communities and everyday lives. Each year,

Dr. Eric Topol

more than one million babies die at birth and another three million
die within the first few weeks of life. When babies are born
prematurely the risks esca late. Newborns and particular ly preemies
have a considerable amount of difficulty regulating their own body
temperature , and without access to incubators, babies in the third
world often succumb to hypothermia . [Inaudible 00:28:06] former
Stanford MBA stud ent Jane Chen thinking, how do we develop a low
cost solution to the problem .

Jane Chen: My team and I realized what was needed was a local solution,
something that could work without electricity. We needed something
that was portable, som ething that could be sterilized and reused
across multiple babies, and something ultra low cost , compared to the
$20,000 that an incubator in the US costs.

Margaret Flinter: Chen said that they developed a cocoon like device called Simply
Embrace a thermal body wrap that e ncases the baby and helps
regulate body temperature for up to six hours.

Jane Chen: It looks like a small sleeping bag for a baby. It's waterproof. There's no
seams inside so you can sterilize it very easily. But the magic is in this
pouch of wax. This is a phase change material. It's a wax like
substance with a melting point of human body temperature 37
degrees Celsius. You can melt this simply using hot water and then
when it melts it's able to maintain one constant temperature for four
to six hours at a time, and it creates a warm micro environment for
the baby.

Margaret Flinter: Chen and her developers have managed to keep the cost of the
Embrace Baby Warmer at around $25 per unit, a low cost high tech
portable temperature regulator designed to regulate preemie’s body
temperatures to ensure that they not only survive premature birth,
but ultimately thrive as well. Now that's a bright idea.

[ Music ]

Mark Masselli: You've been listening to Conversations on Health Care. I'm Mark
Masselli.

Margaret Flinter: An d I'm Margaret Flinter.

Mark Masselli: Peace and Health.

Female : Conversations on Health Care is recorded at WESU at Wesleyan
University, streaming live at www.chcradio.com , iTunes, or wherever
you listen to podcast s. If you have comments, please e - mail us at
[email protected] , or find us on Facebook or Twitter. We love
hearing from you. This show is brought to you by the Community
Health Center.

Dr. Eric Topol
[Music]