Moving Forward

While the sight of empty streets, stores, parks, and restaurants may feel like the United States has turned into one giant eerie movie set, it’s important to remember that for now, this is a good thing. The empty streets illustrate that we are not only listening to health and medical experts, but that we are looking out for one another — as Americans always do in times of crisis.

While you valiantly continue to take care of your families in the best ways you know how, know that your Members of Congress are working to take care of our country’s needs right now. Yet we are also looking forward and we are making plans to get America moving again. Here is what that might look like.

As Americans practice isolation and social distancing, we cannot ignore the anxiety that is rising over the effects it is having on our way of life and our economy. In three weeks, nearly 17 million Americans have lost their jobs. Small businesses across the country are holding on with everything they have to keep the lights on. In just a week, the Paycheck Protection Program processed over $125 billion in loans for 30,000 new users with 3,900 lenders participating, illustrating the extraordinary demand for this relief. Congress is already working to increase funding of this program to give every small business the lifeline it may need.

So it is natural to wonder when life might return to normal. Americans need to be safe and stay healthy, but it is right to still seek purpose, and a paycheck.

Hence the delicate balancing act of statecraft in a global pandemic: we must prioritize the public health crisis and mitigate the spread of COVID-19, but we cannot allow what is the greatest economy in our lifetime to wilt permanently in the face of this virus. As President Trump says, we cannot let the cure be worse than the disease.

We have to avoid at all costs an outcome of mass fatalities from the virus, a devastated economy where the U.S. cannot afford medications at all, far fewer jobs for Americans to return to, and the sense of purpose work provides being lost.

Already, studies show Americans’ alcohol, marijuana, television, and food consumption has increased since isolation. Domestic violence, suicide, and addiction are on the rise. Exercise and fitness are down. Aside from the general stress of the circulating virus, these habits are a recipe for tragic physical and mental unwellness.

This is an inflection point for our country: how we respond in the next six months will set the course for our generation.

Our citizens need to know there is a path forward, one that leads to a strong economy and a healthy country.

Congress has responded so far with the largest relief effort in our history, which includes:

• Access to free testing
• Expansion of telehealth services
• Direct relief in cash payments to families and workers
• Ensuring needed resources, such as ventilators and personal protective equipment (PPE), are getting to the health care professionals and patients who need them

The Paycheck Protection Program, along with Economic Injury Disaster Loan (EIDL) emergency grants, created under the Coronavirus Aid, Relief, and Economic Security (CARES) Act was the most ambitious small business relief effort in history. Renowned business investors have taken note:

• Phase 3 “is literally the best stimulus bill ever for small businesses.” — Mark Cuban, entrepreneur and investor
• “This is a $10,000 grant that makes it so you’re nuts not to keep your business open. I’m not kidding. You got to keep your business open.” — Jim Cramer, CNBC

Keeping American companies open, as this legislation does, will keep us afloat through the storm. But Americans have never been known to remain static. We need to get our dynamic economy thriving again. And as health care experts and economists have noted, technology will provide us the tools to open up the economy and keep people safe.

Once new infections have subsided and quarantine measures are slowly lifted, the American people need to have the confidence to start going out and engaging in commerce. And that when they do, they won’t get sick. And, if they get sick, they will recover. I agree with former Food and Drug Administration (FDA) Commissioner Dr. Scott Gottlieb, who said that this confidence will depend on therapeutics, health monitoring systems, and ultimately, a vaccine.

Therapeutics

Some experts expect COVID-19 to dissipate nationwide in the summer, but it is possible, perhaps even likely, that it could emerge again in the fall. While progress is being made expeditiously on a vaccine, it is realistic to acknowledge that a vaccine may not be available for at least another year. And then it will need to be made en masse and distributed around the world for full efficacy. In the meantime, we will need therapeutics to severely reduce the threat this virus presents.

According to Dr. Gottlieb and many medical experts, some potential therapeutics could be antiviral drugs that target the virus and block its replication, such as those used to treat influenza and even cold sores, or antibody drugs that can be used to fight an infection and reduce the risk of contracting COVID-19. Antibody treatments to transfer and replicate the antibodies in COVID-19-immune patients into sick patients are something doctors have already begun to attempt via blood plasma transfusions. The hope is that these antibodies could be replicated synthetically and employed by this fall.

Regeneron, Vir Biotechnology, Amgen, and Eli Lilly have promising antibody treatments in the pipeline. Additionally, the Mayo Clinic will lead an effort on a type of antibody treatment called convalescent plasma, along with the FDA and American Red Cross. Convalescent plasma treatments take blood from patients who have recovered and transfuse that blood into sick COVID-19 patients. Takeda, CSL Behring and other companies are collaborating to accelerate the investigational development of one, unbranded plasma-derived therapy with the potential to treat individuals with serious complications from COVID-19.

On the antiviral side, there are many promising treatments in the works, such as Gilead Sciences Inc.’s Remdesivir, which could be made en masse. Others are hydroxychloroquine and chloroquine, which are oral prescription medications traditionally used as antimalarial drugs. Patients around the country are already using hydroxychloroquine, and the National Institutes of Health (NIH) has launched a clinical trial to examine the effectiveness of the drug in treating COVID-19.

Antiviral and antibody drugs “are two promising approaches, and both could be available soon if government and private industry do things right,” Dr. Gottlieb wrote in the Wall Street Journal. “It’s time to place some firm bets and put resources behind these experimental treatments.”

The good news is, there is movement on this necessary collaboration.

President Trump announced Monday that after speaking with leaders of America’s top biopharmaceutical companies, there are 10 therapeutic agents in active trials and another 15 in plans for a clinical trial. A list of clinical trials offered state-by-state can be found here.

Additionally, the FDA created an emergency program to expedite drug trials to treat COVID-19, called the Coronavirus Treatment Acceleration Program (CTAP). Once we have these therapeutics off the ground, Oracle has developed a platform to gather information from providers about how patients respond to potential therapeutics. This system will act as a bridge to clinical trials, and will allow physicians to report data rapidly.

It must be our goal that effective treatments are rapidly cultivated, assessed, approved when safe and effective, and mass manufactured so that Americans have access to them at the hospital, doctor’s office, and at the pharmacy. For Americans to be confident again, the potential of getting sick with coronavirus must be met with available and effective treatments.

Health Monitoring System

President Trump has rightly described COVID-19 as the invisible enemy. We cannot see, hear, or smell it. To defeat this virus, we have to know where it is and where it might be going.

Serological tests and antibody surveillance could play a key role in showing us who has contracted the virus as well as who might have immunity to it. Developing such a system of widespread virus detection will allow us to begin the transition from isolating entire populations to a more targeted, case-by-case isolation while loosening restrictions for others.

The system I am describing is not to be misinterpreted as anything similar to the Chinese authoritarian surveillance state. Rather, think of it more as creating a map of every COVID-19 infection — especially those who might have been asymptomatic or demonstrated very mild symptoms — which will depend on widespread testing capabilities, to then enable case and region-based interventions.

Data privacy and health privacy will always and must always be a high priority in any system that is utilized.

Coronavirus Response Coordinator Dr. Deborah Birx has said this data would reassure health care workers on the frontline, for example, because it would tell them if they were exposed and have the antibodies to protect themselves. Dr. Birx also urged universities to develop ELISA (enzyme-linked immunosorbent assay) tests to identify antibodies in blood. “It’s easy to do. We’ve all developed ELISAs. In a day or two after development, they could screen their entire hospital,” Birx said.

The Centers for Disease Control and Prevention (CDC) has already begun conducting antibody tests using one approved by the FDA and developed by Cellex Inc. In California, thousands of volunteers donated blood to a Stanford University study aiming to identify the ubiquity of COVID-19 in the area.

Similar networks have been created in the past to track flu cases nationwide, as Microsoft co-founder Bill Gates alluded to in an interview with CNBC before expounding on a surveillance network that is gathering data right now in his home area of Seattle, Washington.

“We are the first community with a thing called the Seattle Coronavirus Assessment Network (SCAN). We’re doing the first surveillance to see what cases were missed, the age structure and understanding that transmission. And the data back from that will be a key input to designing those opening up policies,” Gates said.

Gates says this network will be pivotal in understanding just how many asymptomatic people are walking around with the virus and infecting others. “We need to know that number because that deeply affects rebounds when opening up,” he added.

So far, more than two million people in the United States have been tested for COVID-19 and between 118,000 and 120,000 individuals are being tested per day. Congress has made those tests — and any future tests — free for all Americans. As we transition away from triaging, we must plan for widespread testing for populations beyond those who are demonstrating the most severe effects of the virus. Increased coordination between Congress, the Administration, and the private sector has shown great progress in expanding access to testing for all Americans.

This type of observation helps us know who has had the virus. But what if we could predict who might have the virus before visible symptoms emerge? Anecdotally, users of wellness wearables and web applications who have contracted coronavirus have identified trends in their respiratory rate, resting heart rate, and heart rate variability that indicated they were getting sick days before the rest of their body caught up. These diagnostics are usually hidden from everyday life, but with increased technology, they are now visible and can inform an individual of their true wellness and necessary responsibility to quarantine so as not to infect others. Companies like Whoop and Oura are teaming up with researchers to understand this relationship more and help us see the virus before the rest of the world does.

Defeating this virus will require a full-scale creative approach, and we will only win together if technology is our signal.

Vaccines

As Director of the National Institute of Allergy and Infectious Diseases (NIAID) Dr. Anthony Fauci has noted, we will never be able to return to a fully normal life until we have access to a safe and effective vaccine. Moderna is in Phase 1 vaccine trials with the NIH, and its chairman, Noubar Afeyan, said he expects Phase 2 trials could begin this spring or early summer. This process is happening at “record speed” according to Dr. Fauci.

There is also welcomed developments in the philanthropic sector, namely from the Bill and Melinda Gates Foundation, which announced it will spend billions of dollars to fund the construction of factories for the seven most promising COVID-19 vaccines.

“Our early money can accelerate things,” Bill Gates said in the announcement. “Even though we’ll end up picking at most two of them, we’re going to fund factories for all seven, just so that we don’t waste time in serially saying which vaccine works and then building the factory.”

Gates, who has spent decades devoting his time and resources to disease eradication around the world and is now redirecting his vaccination work on polio, HIV, and tuberculosis to COVID-19, explains why a vaccination is likely 18 months away: “Understanding the safety [of a vaccine] at a gigantic scale of all age ranges, pregnant, male, female, undernourished, existing comorbidities — it’s very, very hard. And that actual decision of ok, let’s go and give this vaccine to the entire world — governments will have to be involved because there will be some risk and indemnification needed before that can be decided on.”

Still, as Dr. Fauci and leading health experts note, vaccine development is happening at a faster than normal pace, and makes maintaining these partnerships between government agencies and private enterprises a crucial component in the fight against COVID-19 and beyond.

Moving Forward

Our country is facing a test that cannot be solved by printing money or taking the fight to a known and visible enemy. The uniqueness of this challenge must be met with clarity and conviction.

As the curve begins to flatten in some areas, we must prepare our next steps to get back some semblance of regularity and our economy moving again. Technology will help us do that. We must also prioritize the tried and true measures of compulsive hand-washing, practicing social distancing, and wearing masks.

For the road ahead, whether it’s COVID-19 in the fall, or another pandemic in the future, we need to make sure the United States has the resources necessary to fight. We are clearly too reliant on foreign suppliers — including China — for our medicine and other critical PPE. We must prioritize our PPE stockpile and critical supplies, such as pharmaceuticals, medical supplies, food, and critical minerals, and grow domestic and diverse sourcing so we are less vulnerable when the status quo supply chains fail. When the nation gets back to work, that must be a national priority.