SVA Speaker Series: COVID-19 Discussion with Dr. Larry Brilliant

We’re pleased to share the first in a series of webinars that we are developing for our portfolio company founders. On Tuesday, June 23rd, Dr. Larry Brilliant joined us to discuss the COVID-19 pandemic. Dr. Brilliant was a key member of the successful WHO Smallpox Eradication Programme for SE Asia, as well as the WHO Polio Eradication Programme, and shared his unique perspective on the pandemic, informed by his experience and expertise in public health, virology, and infectious diseases, as well as his extensive work as an entrepreneur and philanthropist.

Summarized notes and a recording of the conversation are shared below. We hope that you will enjoy the discussion as much as we did, and stay tuned for future installments of the webinar series over the coming months.

Dr. Brilliant’s Go-To Sources for COVID Information

Johns Hopkins Coronavirus Resource Center

Covidly.com

Conversation Takeaways — Summarized and lightly quoted from parts of the interview

There have been 30 zoonotic diseases (diseases of animals) like COVID in the last 30–50 years. They continue to jump at the rate of 1 to 3–4 every year. Familiar examples — SARS, MERS, Ebola, Zika, West Nile, Bird flu, Swine flu, Dengue, and even HIV/AIDS if you go back 50 years. We are now living in an age of pandemics, so this situation is not unexpected, but it’s always a question of how lucky we will get on the genomic roulette wheel — lethality, speed of transmission.

Measures for Evaluating a Pandemic:

  • How serious is it? (mortality/morbidity) - COVID-19 kills at a very high rate — ~5% of people who get sick with symptoms, 1 out of 20 will die.
  • How rapidly does it spread? - COVID-19 spreads exponentially speed of 2–4 R0 (every 6–7 days)
  • What countermeasures do we have? - None currently. Vaccines and antivirals in development.

Not comparable to previous pandemics. 1968 Asian Bird Flu killed 700K-1M people; 1918 Spanish Flu (Great Influenza) killed 20–100M, far more than COVID-19, but didn’t have the knock on effects.

COVID-19 is the worst pandemic that modern epidemiologists have ever experienced. In his recent testimony before the House, Bob Redfield, Director of CDC, said this is the absolutely the worst pandemic in the last 100 years, if not more.

Global Response - In Dr. Brilliant’s opinion, the most important thing to think about is this: We are all in this together. Like a chain is only as strong as its weakest link, in a pandemic, ultimately all the countries in the world will only do as well as the country that does the poorest job. Even after a vaccine is available, the virus will ping pong around for several years. We will continue to have a pandemic until the most remote and poorest country has extinguished the virus. We are seeing the impact of Nationalism in the global response, and it is truly detrimental. We have at least a dozen countries right now saying the equivalent of, “America First,” when we should all be planning collaboratively today for the distribution of a vaccine.

Worst Response: United States, UK (initial response), and Sweden.

In 2006 when Dr. Brilliant first joined Google after winning the TED Prize, they modeled a hypothetical pandemic and the results were incredibly similar to what we are seeing today. The only thing that they didn’t predict was the incompetence of the federal government in the United States. This is the main reason that the death rate has been as high as it is (in addition to the inherent bad qualities of the virus).

Mid-grade Response: Italy, Spain, France, huge outbreaks that roared and were then contained. The UK has also recovered from a stumbling start.

Best Response: Island Republics led by women seem to have fared exceptionally well — Iceland, New Zealand, Taiwan. Singapore and Germany also had excellent initial responses and Germany continues to do well.

Early Response, Infection & Mortality Numbers

The states that locked down early had far better outcomes than those that waited. California went into SIP on 3/13, New York on 3/20.

  • CA 184K cases / ~5,500 deaths — We are still benefiting from our early lockdown.
  • NY 388K cases /~ 31K deaths — Disparity can be attributed to population density and slower response/declaration of emergency protocol.

There is great disparity in infection and mortality rates in minority communities and aged populations:

  • Georgia: 85% of all deaths are African American individuals
  • Michigan: 40% of all deaths are African American individuals
  • Philadelphia: 70% of all deaths are in nursing homes
  • In the US: More than 40% of all deaths are in nursing homes

Testing & Contact Tracing

The way in which you control a communicable disease is to find every case and interrupt transmission. In the case of COVID, if we could find every case and trace backward to where they might have been exposed, and forward to where someone who has been in contact with them might have gone, and then provide an incentive for those individuals to quarantine for 14 days, the disease would be ended. If 80% of people wore masks all the time, we could achieve the same thing. We know what to do.

If we followed this contract tracing practice, which has been the epidemiological standard for 50 years, we could end up quarantining only ~2% of the country, which means the other 98% would not have to be locked down. We’ve created self-inflicted problems (economically). This is not a result of the public health response. It’s the result of a political response, one of failure to empower the public health response.

A bipartisan group led by former FDA Chief Scott Gottlieb and Andy Slavitt, former director of Medicare and Medicaid, have proposed legislation that would fund 150K human contact tracers, training software, and per-diem and hotel room for identified contacts to quarantine themselves for 14 days. It is a 50B proposal, which is substantial, but it is enough to stop the pandemic.

Hotspots, Reopening, Returning to the Office/School

We are currently seeing spikes in the South — GA, FL, Carolinas, AZ, OK — following Memorial Day activities. These are states that opened up early and then over Memorial Day 100 million people went out and spread the virus. We will likely see the same after 4th of July and Labor Day, +3 weeks.

Data indicates that there is not much spread caused by the ongoing protests. Although hundreds of thousands of people have been protesting over several weeks, 70–80% of participants are wearing masks, and it is a fraction of the number of people who broke their isolation over Memorial Day weekend.

Reopening and returning to normal activities will be a slow process. It’s inevitable that the disease will continue to spread unless we clamp down on it with contact tracing and isolation or have a vaccine or antiviral, and we’re going to have to be patient.

Virtual learning will probably be the norm on college campuses for at least another semester. Elementary schools and preschools are not as high risk (with appropriate protocols) as children don’t seem (still a lot of research to be done) to be the source of many additional outbreaks in the way they are for influenza. However, they are not without risk. 60% of people who contract COVID are under 60, and it is not true that COVID does not affect children.

Vaccines

We’re looking at an 18-month timeframe for a COVID vaccine. To date, the fastest vaccine ever produced took 4 years (Mumps). The only reason this expedited time frame is now possible, is that we are going to invest a lot of money in producing a vaccine much earlier than typical — before we know if they are safe and effective. Bill Gates has said that he will fund 6 vaccine production lines. We will be wasting a lot of vaccine and money, but are doing so consciously because anything less would be medical malpractice.

We have 160 vaccines at various stages of development today. Of those, six are already in trials (have already been injected in humans), but we don’t know if any of them will prove to be safe, effective, easy to administer, and practical to manufacture. Dr. Brilliant believes that we will have vaccine candidates (have been through trials) by the end of the year.

What does mass vaccination look like?

  • It will likely look a lot like the Polio eradication program.
  • We’ll have to do it in 200 countries and have to reach remote locations.
  • Longterm, multi-year process.

Of important note: in every one of the last three meetings where nations are discussing the development of a vaccine, there has been one notable absence: the United States. This would have been unthinkable at any other time in history.

Convalescent Serum/Plasma (After someone has recovered, they donate blood and the plasma is extracted)

We can now create hyper-immune serum by enriching the serum with the specific antibodies that have been found to be neutralizing antibodies, or the antibodies that are produced in response to COVID. This is exciting because until we have a hyper-immune serum that will save you from death or serious illness, we won’t be able to make much progress on vaccines and antivirals due to the risk to study participants (how do you infect a participant without a way to save them if they become seriously ill?) Likewise for vaccines (can’t test against high-risk populations without a way to save them if the vaccine is ineffective).

Scale is not as much of a problem as we might think. 2.5 million people have had the virus in America and more than 90% have donated convalescent serum, allowing us to stockpile and study it.

Dr. Brilliant’s Closing Thoughts

This is the worst pandemic of our lifetime.

Everyone is going through a hard time.

Be easy on them, and be easy on yourself.

Be kind to the people around you and find a way to help.

Look around and find the cracks in society and think about the ways you can help — donating to a food bank is a great start. — SF/Marin Food Bank, Second Harvest Food Bank of Silicon Valley

Stay in touch with what’s going on.

Talk to your friends and colleagues about it.

Keep healthy yourself — Model good behavior, always wear a face mask, practice social distancing.

SV Angel is a San Francisco-based seed fund.