--:-- Sean Rameswaram: It's Monday, April 6th, 2020, and a tiger at the Bronx Zoo has the rona. I'm Sean Rameswaram, and this is your coronavirus update from Today Explained.
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--:-- Sean Rameswaram: The tiger's name is Nadia. She's a four-year-old Malayan tiger, and she's got a dry cough. She evidently got it from a Bronx Zoo employee. The good news is she's expected to recover soon.
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--:-- Sean Rameswaram: In bad news, the country's Surgeon General Jerome Adams said the nation should prepare for the hardest and saddest week of most Americans' lives. He said it's about to feel a lot like Pearl Harbor or 9-11. He called on all Americans to do their part to flatten the curve.
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--:-- Sean Rameswaram: New York's governor Andrew Cuomo says they might be flattening the curve there. The state's daily death toll has dropped slightly since a Friday peak with 630 lives lost. The governor pointed out that the drop could be a blip.
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--:-- Sean Rameswaram: China did New York a solid this weekend and donated 1,000 ventilators. That news came just after President Trump said he was unwilling to get New York all the ventilators it requested. But the president and his son-in-law did help New York City get some masks. The city recently received something like 600,095 masks from the federal government.
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--:-- Sean Rameswaram: Elsewhere, Boris Johnson has been hospitalized due to complications from COVID-19. The BBC is reporting he's in intensive care. As of publishing, he's still in charge of the government.
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--:-- Sean Rameswaram: Meanwhile, the almost 94-year-old Queen of England gave a rare televised address over the weekend saying, "We should take comfort that while we may have more still to endure, better days will return. We will be with our friends again. We will be with our families again. and we will meet again."
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--:-- Sean Rameswaram: Two giant pandas in Ocean Park, Hong Kong, met again this morning. Yingying and Lele mated naturally for the first time in 10 years. The chance of pregnancy is apparently better when mating happens naturally. Maybe they just needed the humans to stay six feet away.
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--:-- Sean Rameswaram: You can get closer digitally to Today Explained, though. We're on Twitter at today underscore explained or at Ramas for them. You can call us and leave a message to. The number is 202-688-4944. And there's always email todayexplained at vox.com.
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--:-- Sean Rameswaram: Support for this show comes from ServiceNow. AI is only as powerful as the platform it's built into, don't you know? That's why it's no surprise that more than 85% of the Fortune 500 use the ServiceNow AI platform.
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--:-- Sean Rameswaram: While other platforms duct tape tools together, ServiceNow seamlessly unifies people, data, workflows, and AI, connecting every corner of your business. And with AI agents working together autonomously, anyone in any department can focus on the work that matters most.
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--:-- Sean Rameswaram: I've never met an AI agent. Learn how ServiceNow puts AI to work for people at servicenow.com.
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--:-- Sean Rameswaram: Everyone wants to know when this ends. June, August, Halloween. No one seems to know it hinges on a vaccine, right? But a vaccine is still a ways away.
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--:-- Sean Rameswaram: Some say the pandemic will have peaked and even declined before we get a vaccine. In the meantime, we're going to get serious about something called serological testing.
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--:-- Sean Rameswaram: And it's okay if you have no idea what that is, because Umair Irfan has been writing about it for Vox.
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--:-- Sean Rameswaram: Well, a serological test tests the blood serum, and it looks for antibodies or proteins that are made specifically to target the virus by our own immune systems. So it's like testing for immunity.
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--:-- Sean Rameswaram: That's right. And this is happening all over the world right now? In other countries, they've been using these kinds of serological tests for several months throughout this pandemic, but the Food and Drug Administration just recently approved the first serological test that can be used for diagnosing COVID-19.
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--:-- Sean Rameswaram: The concern, though, is that looking for antibodies is not a surefire way of identifying the virus. It can take several days for an infection to start generating antibodies by the immune system. So there's the concern that early on in an infection, this test won't pick up the virus.
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--:-- Sean Rameswaram: That said, given that we have such a huge testing shortage, public health officials need all the help they can get, and this might be a step towards that.
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--:-- Sean Rameswaram: Okay, so these are not the tests for COVID-19 that we keep hearing about, the tests that we don't have enough of. This is a totally different kind of test.
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--:-- Sean Rameswaram: That's right. The main test we're using right now to look for active infections looks for the virus's genome. It looks for the RNA molecules that the virus uses to replicate itself. And right now that test shows whether or not you have an active infection. But it doesn't really give you a sense of who has had the virus or who may have fought it off and has had the virus clear their system.
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--:-- Sean Rameswaram: And that where serological testing comes in. How does it work exactly?
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--:-- Sean Rameswaram: So it a blood test you give your blood then what happens
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--:-- Umair Irfan: There are different kinds of techniques but some of the techniques that are approved are basically you put a few drops of blood with some reagents and diluting solution into a cartridge. And essentially, it just runs through the cartridge and you see lines pop up showing whether or not you have the antibodies to the virus.
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--:-- Umair Irfan: It looks kind of like a pregnancy test. And if you see a positive line, it basically shows that you have antibodies to the virus. Now, it doesn't mean that you've fought off the virus. You could still be infected and produce antibodies. Or you could have the antibodies without the virus.
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--:-- Umair Irfan: But it's a sign that the virus has been present in your system. And then you'll know whether or not you're immune?
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--:-- Sean Rameswaram: Well, antibodies are a key step towards generating immunity. And so it's likely that having these antibodies means that you're immune. But scientists are still trying to figure that out.
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--:-- Sean Rameswaram: They're looking at basically our experience with past coronaviruses like SARS and MERS. And many of them do believe that there is some immunity that can be gained if you survive a COVID-19 infection.
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--:-- Sean Rameswaram: But I feel really confident that if this virus acts like every other virus that we know, once you get infected, get better, clear the virus, that you'll have immunity that will protect you against reinfection.
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--:-- Sean Rameswaram: But right now, they don't know how long that immunity will last and how robust that immunity is. So it's a little early to start, you know, telling people who have positive antibody tests to go right back to work.
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--:-- Sean Rameswaram: That said, in emergency situations in places like hospitals where there's a shortage of health workers that are urgently needed, you know, some people that were infected that might be needed back in action, they could get this test and potentially, you know, swallow the risks and get back to work.
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--:-- Sean Rameswaram: And that's one place where a test like this could be very useful.
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--:-- Sean Rameswaram: A question I have here, and I think we've seen from listeners, as well as co-workers and even my brother, is, is it possible that these tests might help us determine whether people had this virus back in January?
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--:-- Sean Rameswaram: People maybe had COVID-19 in December before it was even called COVID-19 because we've heard time and again people saying, I have had these exact same symptoms around the holidays, around the new year.
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--:-- Sean Rameswaram: And I was flat on my back and had no idea what was going on. I thought it was the flu, but it wasn't the flu. Will this help us clear any of that up?
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--:-- Umair Irfan: Absolutely. That's one of the main functions of a test like this. It lets you kind of look back in the past or get like a picture of how the virus has been spreading through a population.
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--:-- Umair Irfan: One of the things that we've noticed about this virus is that people can spread it before they show symptoms. And many of the infected people don't show symptoms at all.
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--:-- Umair Irfan: And we really don't have a good sense of who those people are or how many there are unless we do these kinds of serological tests to see whether their bodies have mounted an immune response to it.
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--:-- Sean Rameswaram: This is a key test that can answer those kinds of questions and help us get a better understanding of the virus and also understand things like symptoms because the symptoms can vary quite a bit from person to person.
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--:-- Sean Rameswaram: Some people get very seriously ill. People have been hospitalized. People have died from this. And there are people who just barely noticed they were infected at all.
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--:-- Sean Rameswaram: So how do you know you've been sick or not? How can you tell you need a test?
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--:-- Sean Rameswaram: That's a question we can answer more readily if we have this kind of information by looking back at past cases and past infections.
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--:-- Sean Rameswaram: And you said the FDA has just started executing these serology tests. How long is this process going to take?
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--:-- Umair Irfan: Well, there have been doctors across the U.S. who have been using serology tests sort of off the books for a while now. On COVID-19? On COVID-19, yes.
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--:-- Umair Irfan: Because, you know, they were so desperate for tests that they were willing to use these kinds of things to, as one element, to try to diagnose the infection, if not the sole element.
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--:-- Sean Rameswaram: The fact that the FDA approved this, though, for diagnosis shows that there's still an urgent demand and that they think that this test is robust enough, even with all the caveats, that it is something that we can use to diagnose the infection.
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--:-- Sean Rameswaram: And there are a bunch of other companies that are also seeking authorization for using these kinds of tests to diagnose the infection and then potentially later in the future to start screening the population at large to trace the history of this virus in our population.
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--:-- Sean Rameswaram: But we're not the only ones doing this. Is it plausible that another country, another organization makes a ton of progress and then shares that information with the FDA, with the United States, and there's some sort of greater global effort?
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--:-- Umair Irfan: Well, other countries have already been developing and using these tests for some time. You know, Singapore, South Korea, and in China, they've been deployed quite widely.
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--:-- Umair Irfan: Germany has broached the idea of actually certifying people who have positive serology tests, basically showing that they have the antibodies to the virus, potentially as a way to show that these are people that are okay to return to work.
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--:-- Sean Rameswaram: The problem we been having in the U is we been struggling to get any kind of testing done at all at any level of scale.
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--:-- Sean Rameswaram: And so doctors and hospitals have been rationing these tests mainly for people who have been admitted to emergency rooms and ICUs or for medical personnel who may have been exposed.
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--:-- Sean Rameswaram: We can't really do the widespread contact tracing unless we have much more testing capabilities. Just more great news.
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--:-- Sean Rameswaram: Yeah, it's been a pretty frustrating experience just to get a handle on the number of cases in the United States.
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--:-- Sean Rameswaram: That said, the U.S. is also making a lot of progress on treating the virus and working its way toward a cure. And they actually had a bit of a head start when it came to this particular virus.
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--:-- Sean Rameswaram: More with Umair after the break.
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--:-- Sean Rameswaram: Support for Today Explained comes from Built Rewards. These days, it seems like everybody has a rewards program. You swipe your card and you get one cent on the hundred dollars.
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--:-- Sean Rameswaram: But with your rent, frequently, you just pay month after month. You never get anything from it other than that roof over your head. Not anymore, says Built Rewards.
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--:-- Sean Rameswaram: Built Rewards says it lets you earn points on your rent. By paying rent through Built, they say you can earn flexible points that can be redeemed toward hundreds of hotels and airlines, perhaps a future rent payment, your next Lyft ride, and so much more.
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--:-- Sean Rameswaram: Your home isn't just where you sleep, it's your community. And Built wants you to go out and do things in the community. You can eat at your favorite local restaurants, then earn more points.
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--:-- Sean Rameswaram: You can get VIP treatment at certain fitness studios. You can enjoy exclusive experiences just for Built members. every month.
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--:-- Sean Rameswaram: When you're ready to travel, they say Built Points can be converted to miles or hotel points all around the world. You can earn points on rent and around your neighborhood wherever you call home by joining built.com slash explained.
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--:-- Sean Rameswaram: That's J-O-I-N-B-I-L-T dot com slash explained.
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--:-- Sean Rameswaram: Support for this show comes from Macy's. It's almost fall, and that means it's time to cycle your wardrobe to the cold setting.
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--:-- Sean Rameswaram: Because while everyone loves a breezy summer outfit, let's be real, layering is even more fun. That's why Macy's Fall Fashion Guide has everything you need to piece together the perfect look for you.
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--:-- Sean Rameswaram: It's your one-stop shop for fall's latest trends and must-haves, curated by their experts. Add a statement shoe to your collection, like the calf hair loafers from Steve Madden.
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--:-- Sean Rameswaram: Or tap into your romantic side with flowy dresses from Cece and sheer pieces from INC. You can even throw in some textural layers for contrast, like a faux fur bomber jacket from Karl Lagerfeld Paris.
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--:-- Sean Rameswaram: Whether your old favorite sweater or coat is on its last threads, or you're just craving a new vibe to switch things up, Macy's has got you covered this season.
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--:-- Sean Rameswaram: Find the perfect layering pieces for you by exploring the Macy's Fall Fashion Style Guide. Shop in-store or online at Macy's.com.
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--:-- Sean Rameswaram: Okay, Umair, we talked about serological testing and how it's going to help us better figure out who's immune and maybe even why.
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--:-- Sean Rameswaram: But then you broke the bad news that we don't have a ton of testing capability there either. What's up with treatment? Is there better news there?
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--:-- Umair Irfan: Right now, there's a sort of throw everything at the wall and see what sticks approach to this. There are so many people infected and everybody's kind of pulling out all the stops to see what can work.
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--:-- Umair Irfan: The one upshot here is that this novel coronavirus fits within a family of other coronaviruses that the world has had some experience treating.
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--:-- Umair Irfan: And so there's been a little bit of a head start here in terms of trying to figure out what could potentially work. We have experience with illnesses like SARS and MERS, kind of seeing what worked there and what didn't.
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--:-- Sean Rameswaram: How about here in the United States? Is the United States developing anything independent of the rest of the world?
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--:-- Umair Irfan: Well, most of these efforts are international. They're working across borders. The companies that are developing it are multinational companies.
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--:-- Umair Irfan: But yes, there are a number of clinical trials undergoing here in the United States. One of the more notable ones is a drug called remdesivir.
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--:-- Umair Irfan: This is developed by a company called Gilead. Remdesivir. The way it works is that it interferes with the way the virus replicates itself. And it interferes with the virus, but not with any human cells.
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--:-- Umair Irfan: So it has a very targeted effect. And this was a drug that was in development to deal with previous coronaviruses or previous infections.
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--:-- Sean Rameswaram: What about the one that the president keeps hawking in press conferences? What was that one called again?
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--:-- Umair Irfan: Hydroxychloroquine. Yeah, it's like a malaria treatment?
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--:-- Sean Rameswaram: That's right. It's a powerful drug on malaria. And there are signs that it works on this, some very strong signs.
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--:-- Sean Rameswaram: And in the meantime, it's been around a long time. It also works very powerfully on lupus.
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--:-- Sean Rameswaram: Lupus. A drug like this is pretty tempting because, one, it's already an approved therapy for other kinds of illnesses. It's an off-the-shelf drug. There are generics available. It's pretty cheap
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--:-- Umair Irfan: The concern though is that it really hasn't been tested robustly against COVID Some laboratory tests looking at cells in a Petri dish showed that it could be effective at preventing the virus from entering cells
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--:-- Umair Irfan: But the human trials have been much more mixed. There was a study that was done in France where researchers were quite optimistic, and they said that the results were pretty promising.
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--:-- Sean Rameswaram: But that particular study was not a randomized trial. and the doctor who was running it was Notorious Crank.
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--:-- Sean Rameswaram: Some follow-up studies from research groups in China and another research group in France found it was really hard to distinguish whether this was actually making a difference for people who are sick.
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--:-- Sean Rameswaram: And there are some serious downsides to this drug too. Like this has some pretty serious side effects. It can cause nausea, vomiting, and headaches.
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--:-- Sean Rameswaram: And some people with heart conditions, it can cause some serious heart problems and it can cause some neurological symptoms as well.
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--:-- Sean Rameswaram: One of the concerns, though, is that since the president has been promoting this, this drug has been flying off the shelves in pharmacies.
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--:-- Sean Rameswaram: There are now shortages for people who do need this drug for illnesses that are actually conditioned for this. Patients with lupus and patients with rheumatoid arthritis have had a hard time filling their own prescriptions because other people are trying to get prescriptions for hydroxychloroquine to prevent COVID-19.
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--:-- Sean Rameswaram: Is there anything other than remdesivir and hydroxychloroquine that we should be thinking about?
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--:-- Umair Irfan: Well, doctors are also looking at other kinds of drugs that have been approved to treat other illnesses.
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--:-- Umair Irfan: So some researchers are experimenting with drugs that were used to treat HIV, for instance, those antivirals.
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--:-- Sean Rameswaram: But the trials so far have been also pretty mixed.
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--:-- Sean Rameswaram: There's also a treatment that's kind of related to the serology testing that we were talking about earlier.
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--:-- Sean Rameswaram: The idea is you can harvest antibodies from somebody who has recovered from the virus and use it to treat somebody who is sick, or even potentially give it to somebody to prevent them from getting sick, sort of as like a prophylactic.
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--:-- Sean Rameswaram: This blood plasma transfer treatment is something that's actually being used in extreme emergency scenarios, but researchers are also investigating whether this could be used more broadly as a therapy.
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--:-- Sean Rameswaram: Once we can identify people who have had the virus and have built up the antibodies to it.
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--:-- Sean Rameswaram: The drugs and treatments we've talked about so far, they fit broadly into the category of antivirals.
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--:-- Sean Rameswaram: These are drugs and treatments that look at the virus directly and try to eliminate the threat that way.
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--:-- Sean Rameswaram: But then there are more generic treatments as well that we can use, and these are mainly immune system boosters.
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--:-- Sean Rameswaram: These are the drugs and other kinds of pharmaceuticals that can boost our body's own natural defenses to the virus.
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--:-- Sean Rameswaram: What are we talking about, like orange juice?
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--:-- Sean Rameswaram: No, there's more like drugs like interferons.
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--:-- Sean Rameswaram: These are signaling proteins that your body uses to indicate that there's an infection.
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--:-- Sean Rameswaram: And when your body detects this, it ramps up its immune response and it also makes cells harder to infect.
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--:-- Sean Rameswaram: The downside is that when you're using these kinds of immune system boosters, it's kind of easy to tip the body to overreact.
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--:-- Sean Rameswaram: Once your body's immune system gets ramped up, then you can have these other side effects like inflammation and fever, and it can actually end up causing more damage to the body than the virus itself.
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--:-- Sean Rameswaram: And that's why you have to have a very careful calibration of these kinds of treatments.
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--:-- Sean Rameswaram: How much do we know so far about, you know, how well these antivirals and immune system boosters can help with treating COVID-19 and how much is yet to be determined?
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--:-- Sean Rameswaram: I mean, there's some anecdotal evidence that shows that certain combinations can be effective.
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--:-- Sean Rameswaram: But right now we're in a situation where we have an urgent public health need.
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--:-- Sean Rameswaram: And so there's a lot of emergency uses of this, but also an urgent need to do the research.
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--:-- Sean Rameswaram: And so researchers and doctors are trying to balance this, like the need to do a careful clinical control trial over several months versus having a patient in your ICU right now who needs treatment.
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--:-- Sean Rameswaram: And that's kind of making it a little bit difficult to answer some of these fundamental research questions.
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--:-- Sean Rameswaram: So this is sort of a trial by fire. we're actually seeing these real-world uses of these drugs, of doctors experimenting in their own clinics trying to figure out what could potentially work.
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--:-- Sean Rameswaram: And it will just take some time to see, you know, what actually pans out as an effective treatment.
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--:-- Sean Rameswaram: There was sort of an expectation or sort of this idea that this kind of thing couldn't happen here.
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--:-- Sean Rameswaram: Or if it could, it was not something that people realized that they needed to plan for.
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--:-- Sean Rameswaram: And now we have a better sense that this is possible and there are tangible things that we could be doing to prepare for the next pandemic, from disease surveillance to having stockpiles of valuable medical equipment that could be necessary.
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--:-- Sean Rameswaram: It is a learning experience. It's a hard lesson to learn.
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--:-- Sean Rameswaram: We could have been better, but hopefully we'll be in better shape for the next fight.
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--:-- Sean Rameswaram: But we're not out of this one yet. That's Umair Irfan. He's a science reporter at Vox. I'm Sean Rameswaram for him.
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--:-- Sean Rameswaram: This is Today Explained.
