 Okay, we're back. We're live. We used to call this Corona Watch. Now we've called it Coronaville. What's next? Coronaville. That's where Corona lives. And Coronaville was the whole world, as a matter of fact. You can trust me on that. Anyway, we have Mike DeWert, our chief scientist, to talk about the second wave. We need to understand the second wave. Clearly, you know, we have been in the first wave. And this afternoon with Mike, we're going to try to understand the second wave, where, when, and how serious will it be? Welcome to the show, Mike. Aloha, Jay. It's good to be here, even under the circumstances. Well, I appreciate you coming on. As I was saying before the show, this is really the center point of the whole conversation. You know, we are in the second wave. Arguably, we're down the other side in some places for some reason. And then the question is opening the economy, which actually, you know, I have to say, it started out with Trump, didn't it? He started making noises like we have to open the economy, which I thought at the time was really a cold shower because we hadn't finished the first thing. It's like building rail when you haven't fixed the potholes. Right. It's the same thing. Sorry. And so, you know, like, let's take stock of where we are. We haven't, and it's not only we, it's not only the United States, it's Europe too, to some degree. We haven't gotten supply of PPE. For the average person, it's very hard to get a mask. Everybody tells us we got to wear a mask. So what's that? You think that somebody would step in and provide a mask. And when they tell us, oh, yeah, yeah, we can go get tested, but we don't have a quick test. And if a lot of people don't have a test at all, and what is remarkable is, and Rachel, we're talking about this yesterday. So the CDC expanded the list of symptoms. Right. Okay. But a lot of places you can't get a test unless you have the primary list, which was, what is it? Can't breathe. Yeah, breath, fever, there's three or four things. Now there's like six or seven things, but they don't count. The only ones that count is the first CDC list. And again, to the amazement of the public, the CDC did not actually publish this list of additional symptoms. They just slipped it in one of their bulletins, and the press didn't catch it. And neither did the people who are enforcing the rules about testing. But then they want to keep it narrow, those people, because they don't have enough test kits. Okay. So here we are on the first wave, not enough masks, not enough tests. All we got is quarantine and isolation and distancing. And it would appear that those things have helped. I want to talk about that for a minute. Okay. So back in March when we first talked, I'd been tracking this virus for a month, and it was doubling every four days throughout the world. China looked like they had shut theirs down pretty much, but in the rest of the world, the United States was doubling every four days and looked on track to do that in Hawaii. Now, with social distancing, it looks like the world and the United States as a whole have reduced the doubling time from four days to 20 days, which is a huge slowdown. In the United States, we've probably saved a million and a half lives, or cases already. We've delayed a million and a half cases in the world. We've probably delayed 10 million cases. In Hawaii, it looks like we've been so effective with the social distancing that maybe we have actually gotten off of any kind of exponential curve or actually choking the first wave off. It is way premature, though, for the rest of the world in the United States to say that we are through the first wave. Most places have not even seen the first wave yet. In Hawaii, we choked our first wave off before it really got started. We are still very vulnerable to a real first wave, which would be hundreds of thousands of people having caught the disease. Well, yeah. Can we talk about that for a minute? If you say that we have, to some extent, choked off the first wave, but other places haven't really seen it develop yet, aren't we going to be infected by the first wave that works in other places? I mean, isn't that what happens? This is one planet. Right. We're very lucky. We've bought ourselves time. You know, in Hawaii to develop herd immunity, we need about a million people to have had the disease or have been vaccinated for. There's no vaccine available, and there won't be one for about a year and a half. If you watched Bill Gates' presentation on Fareed Zakaria's show on Sunday, it was very clear that they're not going to be careless about how they roll out the vaccine. It'll be a year and a half before it's available. We could try to do what they did in Sweden, which is let the herd immunity develop, meter the rate at which cases came into the healthcare system. They think in Stockholm, by the end of May, they will have herd immunity, 60% of the residents having had the disease. That's a hard game to play, especially with a discordant national spot. That's what Boris wanted to do too. I think he changed his mind after he spent some time in the ICU, but Boris was saying the same thing. Let's let everybody get it that will have herd immunity, rich in business. Yeah, that's not what you want to do, because if you just let it start doubling again every four days, it'll go out of control. So you want to let it ramp up to below a level where it overwhelms the healthcare system. I know why we have maybe 1,000 beds that we could press into service for COVID-19. If the serious cases take 20 days or so in the hospital and about 5% of COVID-19 cases are serious enough for hospitalization, that means we can tolerate a new case rate of 1,000 cases a day. That's all we can handle. At that rate, it's 1,000 days, three years before we achieve herd immunity. So we either need to say nothing about the people who die in the process. Right. Well, let's hope what we want is to not overwhelm the healthcare system, so fewer people die. And we want to buy time for better treatments. I mean, they're finding out, for example, hydrochloroquine may not be the thing, because in the Veterans Administration study, it killed more people than it saved. But there are other treatments, some antivirals that are looking like they might be effective. The more time we can buy ourselves in Hawaii, the rest of the world to try these things out, the better our chances of being able to ramp up a herd immunity response when an effective treatment is available. Well, we don't have that. We don't have that yet. And a lot of people are working in that. In fact, we're interviewing a number of them here and elsewhere on a lot of technology, but so far, no. What interests me, and I want to throw this at you, is that hospitals are getting more sophisticated, especially in New York, where they have so much medical talent, and they have so many cases, and they learn it's painful. I mean, a New York doctor committed suicide already yesterday for that, that they learn about testing oxygen, with an oxygen meter. They learn about turning them on his back or otherwise. They learn about avoiding all those secondary things that happen when you can't breathe. There's so many things they're learning. They're probably reducing the death toll by way of all these hospital tricks and systems that they're inventing on the fly. And I keep thinking, well, I hope that the doctors here, even though they don't have an overwhelming situation right now, I hope they're talking to the guys in New York. So they get these tricks, because that's going to mean a lot if we have an overwhelming number of cases. Yeah, and there's a problem. You want the tricks to be communicated rapidly, but sometimes a trick just works by accident, and it's a correlation, not a causation. So you want all those rapid communications to be followed up with some kind of a peer review process, to make sure that it wasn't just a fluke. Yeah, right. So here we are, and we have that to the extent that it helps. It may not help that much. And we have this social distancing, which we have come to believe does help. FYI, just a point of information, Lenai, with whom we spoke this morning, has never had a case. Lenai is basically isolated. I had one. Well, according to the one person I spoke to, they have. Okay, well, that's one only. And so distancing does help, but I wonder if the numbers that you're talking about would be different. If we had all the masks we wanted. You know, my feeling is that if we could build a B124 in a day on the assembly line with Rosie the Riveter back in 1943, how come we can't manufacture masks? Have we lost the ability to manufacture the simple things? I wonder how we do with a B24 right now. Honestly, I don't think we do very well. But if we had the masks, and if we had the tests as much as you want, you know, no holds barred, don't worry about competitive buying, don't worry about paying too much. If we had them all, how would that affect the curve that you spoke of? With Peds and how rational our government is, you know, we could continue a lockdown at horrendous cost to our economy. I mean, it's going to be farmers that commit suicide because they don't have a market for their food. There's going to be, there's already doctors committing suicide because they're overwhelmed. There's going to be people who can't pay their bills and develop diseases and despair, you know, alcoholism, heart disease, those kinds of things. So we need to actually kind of balance economic activity with the virus, which is what they tried to do in Sweden. And Sweden have like a death rate that's like half a percent. I mean, they really, they tried to, they tried to manage their herd immunity developments that it went around the old folks home. So they're completely successful. A lot of old folks died in Sweden, but they're trying to actually manage it so that it moves around the vulnerable population as much as possible. And everyone else develops herd immunity, and then that spread then becomes slower. That is a hard game to play. How do you throttle up to where you can develop herd immunity in a reasonable time? Like a few months in Sweden, less than a year, the rest of the United States maybe, or the rest of the world maybe, but that's hard because you want to throttle it up. Like in Hawaii, you'd want to throttle up to where we got 500 to 1,000 cases a day, which would probably not overwhelm the healthcare system with the serious cases, especially with what we're learning from other countries and other states. And then keep it there. Keeping it there is the hard part. It's easy for it to run away again. And it's easy for you to do what they did in a couple of cities during the 1918 pandemic. They, the cases went way up. They had a first peak. They had a crash that, hey, social distancing worked. They took it all off and had a second peak that was worse than the first. You know, in 1918, half a percent of the population died of the United States died of the disease. In Hawaii, there'd be 5,000 people, 6,000 people dying of this disease. And this disease at least has deadly as the 1918 flu. So we know we're going to face a horrendous toll. We want to manage it and give ourselves a chance with the treatments to come on to make it less horrendous. And we want to manage it in a way that lets people survive, you know, not starve, not be forced to emigrate to other states, you know, to find work, what work there might be, there may be no work anywhere. If we continue this lockdown, we're forced to this lockdown because our incompetent delayed response in the first place aren't ready. And our healthcare system wasn't ready. We didn't have any excess capacity at all. It was basically a just-in-time system barely meet the need they can foresee in the short term. And that is, that's not appropriate when you have the possibility of a pandemic. And we've known about this for years, the possibility of a pandemic. You know, we let our healthcare system be fragile, no spare capacity, not much surge capacity in case things went down downhill for us. And we didn't take the steps to have the masks or the tests or the tracking systems or anything. I find it remarkable that the only tracking system that's automated in the pipeline is between Google and Apple. And that was their initiative, not the government. The government didn't ask them to do it. It didn't tell them to do it. It didn't even encourage them. They just did it on their own motion. And it'll be good, but it's not ready yet. And that's too bad. You know, if you and I sat in a room for an hour, we could develop a good GPS tracking system to Bluetooth, GPS, all that. And the big thing about it would be the psychology, because we can't force people like in China. We'll have to get them to do it voluntarily. Maybe give them a discount on Amazon products. You know, you could get them to do it that way. But anyway, I'm just thinking that, you know, one of the things that has a huge effect on this, that is a continuation or an increase of the first wave, or going to a second wave, is this whole thing about restarting the economy. And it strikes me. It's only my observation. It strikes me. This didn't even get discussed until your president got up there in a rose garden and said, we have to restart the economy. The economy's seriously changed. I'm originated. He'd read an article and I think it was a Wall Street journal or somebody said the cure is worse than a disease. And right, right, right. He took that all the way. And then of course, everybody in the country started, I mean, it's really great to be a leader. As Mel Brooks said it, it's great to be king. Everybody in the country was listening, you know, all of a sudden, the national conversation turned to restarting the economy. Right. And now he's trying to sue the states that are continuing to lock down, you know, for through your attorney general. He's not my attorney general either. Yeah. So I mean, that's serious because, you know, well, it's a serious contradiction of a contradiction of a contradiction. First, he said, you do it. Then he said, no, I'm going to do it. Then you do it. And now he's got the attorney general and telling him that he's going to make them do it or not do it. Anyway, so what I get is, you know, how do you restart an economy? Right now, that whole initiative is in shambles around the country. Nobody knows haircut, no haircut, tattoo, no tattoo. I mean, it goes on and on. It's, you know, crossing a state line is going into another world. Yeah. Oh yeah. Oh yeah, it's crazy. And you know, Hawaii is lucky we're islands. We can meter the rate at which people come in and we can require them to be self quarantined for two weeks after they come in. I think New Zealand is in a similar situation. New Zealand is prematurely declared victory. Yeah. So the question will be when countries and states start reopening our economy, which ones do it in a way that is starts metering the rate at which cases develop? And that's, I keep saying that because it's only going to be the way we're only going to develop herd immunity if we can control the rate at which cases enter the healthcare system. If we can't control the rate at which they enter there, they're going to come up all of a sudden, then we're going to get panicky, close everything down again, then we'll just do the cycle of boom, bust, boom, bust, boom, bust. That would be harmful for years. This is the economy at least. Yeah, yeah, yeah. So yeah, so I mean, but don't we, you say we're going to have to manage this. We have to manage this. Don't we need these fundamental tools to manage it? We have to get through that for we have to do the testing, the masks, the PPE. We have to do the tracking systems. We haven't done that. It's not done. I don't understand why we talk about restarting the economy when we can't manage what happens. Oh, that's true. Yeah. The prerequisite is a test that takes minutes, not days to tell you whether you had the disease or have the disease. Now, the antibody test that came out, the government said, oh, you go ahead and develop antibody tests. The manufacturer certifies it's it's a efficacy. It's a specificity and sensitivity. And you don't know what they test it on. It's not FDA approved. There's no peer review. They just put it out there. And so then you do this antibody test and say if an antibody test has, say, a 95% specificity, it means that 5% of the time it's wrong. Well, if you have a thousand people and the true rate at which the disease is in the population is one in a thousand, this antibody test will give you 50 false positives, 50 times the number of true positives. It's useless for tracking the rate at which you have disease in the population. So if you take an antibody test, take an antibody test and presumably, logically, I'm not inductively, but logically, it'll tell you what, whether you have antibodies that demonstrate you had the disease. But we know, or at least we are coming to know, that doesn't necessarily mean you can't get the disease again. That's also true. Right. Right. Right. Some evidence that you can get it more than once. We don't know whether having this particular coronavirus gives you one week, one year, one decade of immunity following on or how that might be variable from person to person, depending upon their own personal immune system. It might be that I'm immune for life after I get it if I'm not dead and somebody else might be immune for a week. We don't know those answers yet. Britain's taking a big gamble because they're assuming that 160% of the population hits has had the disease, herd immunity will kick in. That's a guess. So we're watching them. We should watch them see how it works out. Yeah. So yeah. Okay. So however we learn it, what is the ideal environment? She could be more specific that we need to be comfortable about before we can start going to the flower shop and getting a haircut and maybe a tattoo as well. I'd be literally a tattoos anyway. Strupulous about hygiene. What would make you comfortable? If you were the mayor of the governor and you had to make a decision like that, what would make you comfortable to say, okay, I'm good. We're going to take a chance now because there's always a certain amount of risk no matter what. That's true. That particular point, that intersection, what is it? I'd like to see the hospitals have built a surge capacity to handle at least a, you know, if we have a thousand new cases of COVID-19 a day, handle the serious ones that have to be hospitalized. I'd like to see us build that surge capacity and the higher the better because we can easily let it get out of control a little bit and have like 2,000 cases in a day with the 100 cases going to the hospital instead of 50. I'd like to see better therapeutics. You know, we need some validated verified therapeutic things that actually reduce your risk of dying or reduce your risk of having to be intubated and put on an respirator. I mean, once you're on a respirator, your eyes go way down of surviving it. It's being on a respirator itself is hard on your lungs. Then we need, if we're going to do antibody testing, we all need to follow up with PCR to make sure that you don't have a current active infection because there's an overlap time when you've dealt with antibodies but when you're still contagious. Then you could spread the infection with your antibody or your serum anyway. Right, and we got to recognize that until we've got a case rate that's higher than one in a thousand, those antibody tests aren't going to be very helpful in engaging how bad the infection is because they're going to have false positive rates that are higher than one in a thousand. What does the second wave look like? You made it, you suggested that it was worse than the first wave. What does it look like? Can you describe the picture of how that starts and how it proceeds? Well, so what happened in 1918 from what I've read, and there's a very excellent article National and Geographic about this, is that cities got panicked after the first wave, instituted lockdowns and social distancing, and then got overconfident when those measures worked and so they led up. In some cities, then the exponential growth started full force again. In this case, it'd be a doubling of every four days, and so by the time you realize that that's what's going on, it may be too late to control it and you'll be back to where they were in Wuhan or where they were in Italy or where they were in New York and you'll be in panic mode and have to lock everything down again. I think what we have to understand, what I'm getting from this as I'm interested in your thought about it, is there's a lag feature operating here that we don't know if what we're doing is successful for a certain period of time, and that is a big risk period of time. Yeah, that's a big risk period of time. That's why you want to keep up the testing. You want to implement contact tracing. That's the other thing. If somebody has the disease, you want to find out everybody they've been in contact with and test them and suggest they quarantine or get them to quarantine for two weeks themselves to make sure that you can control the rate at which this spreads. We're not going to stop this disease until there's a vaccine, if that's possible, but we can try to control the rate at which it spreads, and that's what the goal should be, and that's going to take testing, contact tracing, quarantining, and a lot of people doing their civic duty when they're told they've been exposed, they need to stay home, stay home. Yeah, so it's a matter of perfecting the tools that you've been describing, and then it's a matter of coordinating people on how they deal with social distancing and how those tools are deployed, and that, and this is my closing suggestion to you, that cannot be done in a given jurisdiction without clear, unambiguous leadership. I agree. Yeah, I mean it's too bad the states are on their own. We really need a national strategy. We need a national surge capacity built. We need the healthcare system to be supported by the federal government where we can build the surge capacity, because small states or poor rural areas can't triple their number of beds and hospitals to handle this surge without help. Yeah, and without that, without all of those things, the second wave, is it could be worse in terms of the number of cases, but worse than that even the whole economy now collapses, and people have less confidence than they did before, and the administration of an economy is based on public confidence. No confidence, no economy. So that's how it would be worse. Yeah, that's how it'd be worse. Yeah. Mike DeWerth, thank you very much for joining us. We'll swing back again and find out more as we go down the trail. Thank you so much. Thank you. Okay, okay. Bye-bye, DeWerth.