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This video was recorded on 12/8/2020.

Hank and our content manager, Alexis, interviewed Dr. Howard Bauchner, the Editor in Chief of the JAMA network of medical journals. They discussed some of the surprising things that we've learned since the beginning of the pandemic and how we should approach vaccine hesitancy.

JAMA Network YouTube Channel https://www.youtube.com/user/TheJAMANetwork
And other JAMA COVID Content: https://jamanetwork.com/journals/jama/pages/covid-19-interviews

Hosted by: Hank Green and Alexis Dahl

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Sources:
Novel Vaccine Technologies Viewpoint
https://jamanetwork.com/journals/jama/fullarticle/2676502

mRNA vaccines
https://www.bbc.com/news/health-54986208

Corticosteroids
https://www.covid19treatmentguidelines.nih.gov/immune-based-therapy/immunomodulators/corticosteroids/
https://www.covid19treatmentguidelines.nih.gov/therapeutic-management/

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 (00:00) to (02:00)


[Intro] 

[Hank] 

Hello everybody!

Welcome to a special episode of SciShow - I'm Hank Green. We are always trying to bring you science news, but these days the news comes fast and there is a lot of it in a lot of different shapes and forms.

And it's good to be curious about the world generally, but also at a time when science news is more important than ever, it's good to get a little deeper and get into some more context. So, I'm always excited to be able to talk to people who are at the edge of important science that's going on right now.

And today I am joined by Alexis Dahl our Content Manager and Dr. Howard Bauchner the Editor in Chief of the Journal of the American Medical Association (JAMA).

Hello Dr. Bauchner. It's very good to talk to you, and I imagine that it's been a wild time.

[Dr. Bauchner]
It has, Hank, but first, please call me Howard - I'm perfectly comfortable with that.  

[Hank]
Okay. *laughs*

[Dr. Bauchner]
It has been a wild time - I think since February first we've had almost eleven thousand submissions to JAMA that have been related to the pandemic. They come in different forms - original research reports, research letters, what we call 'A Piece of My Mind' or narrative -

[Hank]
Mmhmm. 

[Alexis]
Have you slept at all this year?  

*laughter*

[Dr. Bauchner]
It's been a long year, but sadly gratifying from a scientific standpoint because so much interesting information has come into the journal. It's - It's really just a remarkable privilege.

I lead a remarkable group of individuals - you know, Associate Editors who are all in practice in academic medical centers around the United States and then our full time staff, so it's a privilege and an honor.  You know, one of the changes is no travel -  

[Alexis]
Mmhmm.

[Dr. Bauchner]
I usually take quite a few trips each year, and that travel's all gone, so I think I've been able to utilize much of that time to do a lot of reading.

 (02:00) to (04:00)



[Hank]
Yeah. As a journal, do you just expand until(?) an expansion is necessary, or are you still publishing them roughly the same amount?

[Dr. Bauchner]
No, we've changed a bit about how we publish, so

[Hank]
Yeah

[Dr. Bauchner]
I would say clearly there's been a shift to much more of our content being related to the pandemic.

We've published about 150 more opinion pieces, viewpoints. We've doubled or tripled the number of research letters. And around original investigation, there's been a shift to COVID-19 content.

I think the other major change - the very very major change - is we've done quite a few interviews with prominent scientists around the world. We call them 'Conversations with Dr. Bauchner', and we've doubled the number of podcasts we've done.

So we've tried to change the way in which we communicate.

[Hank]
Yeah. And that's - that's a different vibe for you, I get the sense, and a lot of learning had to happen pretty fast.

[Dr. Bauchner]
Yeah, well we had always been doing podcasts, and we had begun to experiment with these kind of livestream events 

[Hank, Alexis]
Mmhmm.

[Dr. Bauchner]
- that can then be made into a podcast, and they've become quite popular. I've been very fortunate - Tony Fauci and I are colleagues, and Tony's been on the show eight or ten times -

*laughter*

[Hank]
Yeah

[Dr. Bauchner]
And whenever he's on the show, people tend to wake up and listen. He's probably the most important voice in American medicine at this point.

And then, you know, I've been able to interview people who are experts in vaccines, experts in epidemiology. So it's been a broad range of individuals, and people have told me it's gotten a nice following. People like the style of the interviews.

They're conversations, they're not prerecorded or pre-rehearsed. It's not meant to be confrontative.

[Hank]
Mmph.

[Dr. Bauchner]
or political,

[Hank]
Yeah

[Dr. Bauchner]
I do think people have liked the conversations.

[Hank]
So, where could we find those things if we want to listen to some of your livestreams or podcasts?

[Dr. Bauchner]
Well, pretty easy now. If you just go to one of the search boxes - usually Google - just put in 'JAMA network video' and it'll come up. You can come to our website - they're all free...

 (04:00) to (06:00)



[Dr. Bauchner]
...All of our COVID-19 are free on our website or YouTube. Just put in 'JAMA network' and up will come all the videos.

[Hank]
Do you have a sense - and this is going back and deep a bit - do you have a sense of the work that has been done over the last few decades that has led to

[Alexis]
Mmhmm

[Hank]
the development of mRNA vaccines, because this is

[Dr. Bauchner]
Yeah, it's really -

[Hank]
 - I think these are the - you know, this is fairly new stuff.

[Dr. Bauchner]
Yeah, it's a really interesting concept, Hank. So, you know sometimes you are just so lucky who you talk to, so I'll just give you a couple of examples. So, two and a half years ago, Tony Fauci wrote a viewpoint for us about the new vaccine platforms.

[Hank]
Mhmm

[Alexis]
Hmm

[Dr. Bauchner]
This was two and a half years ago. 

[Hank]
Mhmm

[Dr. Bauchner]
And one of the platforms he talked about was mRNA.

*Hank laughs*

[Dr. Bauchner]
Tony was very excited that he thought we could take vaccine development from you know ten years, from five years to three years - I don't think he ever imagined nine or ten months.

*Alexis laughs*

[Dr. Bauchner]
And he wrote about that three or four years ago in JAMA. So, I think there had to be certain basic scientific breakthroughs to allow us to use the platform, and that's occurred over about ten years.

I don't know all the details of the scientific advances, and mRNA has been tried before, but not on this scale or this importance because of the -

[Hank]
Mmhmm

[Dr. Bauchner]
- size of this pandemic. So, I think it's been coming for three or four years and then obviously the pandemic really accelerated the scientific portion of discovery.

[Hank]
Wow. So, mRNA vaccines can just be developed more quickly - like that's one of their main advantages.

[Dr. Bauchner]
Right. You're not manipulating the virus in any - in some regards. Your inducing an immunologic response 

[Hank]
Right.

[Dr. Bauchner]
By allowing the host - the human being - to produce the protein itself, and then the body makes antibodies to it, creates memory cells so that when it sees it again,

[Hank]
Mmhmm.

[Dr. Bauchner]
it protects against infection. So, it's an entirely different approach...

 (06:00) to (08:00)



[Dr. Bauchner]
...to the traditional inactivated virus or the heat-killed virus. 

[Hank]
Right. And so in those situations, you would - you'd heat up the virus until it was dead or mostly dead and then you'd give that to people. Or, you'd put it in some kind of system that isn't the human body to sort of evolve it

[Alexis]
Mmm

[Hank]
to be not as harmful.

[Dr. Bauchner]
Right, so an entirely different approach with the mRNA, DNA, and the viral vector vaccines.

[Hank]
Wow. I mean that's wild. It - you know one of the things I said at the beginning of this is like, you know, now is always a better time to have a pandemic than last year. Because we always know a little bit more than we did the year before.

And, just hearing you talk about that makes me feel like it's even more true than I felt.

[Dr. Bauchner]
Yeah, and there's been some gauge. You know, it's been a very difficult fall. When I talked to so many people over the summer, people were really concerned about the fall, but I don't think anyone predicted or thought we'd have numbers in the 200,000 range in terms of cases a day, and back to over 2,000 deaths.

So, clearly the fall has been far worse than people anticipated. In addition, there hasn't been much circulating flu, so the initial concern would be that you'd have some COVID-19 with flu. This is not related to flu at all.

So, I'd asked - interestingly enough I had asked Tony about a month before Thanksgiving because we talked about Thanksgiving and Christmas, and once again he was prescient in saying 'Can we just get through Thanksgiving, and then I'm willing to come and talk about Christmas', and he couldn't have been more... more right, I think.

You know, there's a 100,000 patients in ICUs. Now, the good news is it's around the country, it's not concentrated in a number of states. But still, the numbers are enormously concerning. More and more medical centers are beginning to close once again for elective procedures.

The other good news is that care has gotten better. We're clear about what to do and what not to do, and so mortality rates for those who are not intubated, not critically ill have come way down, so, so that's encouraging news.

 (08:00) to (10:00)


[Hank]
Has that been something that has been a big part of what y'all have been publishing? Has there been a lot of, you know, care and understanding what the right systems of care are?

[Dr. Bauchner]
So, there's been a shift of the types of articles that the major journals are publishing. So, early on it was really the epidemiology of the disease - 'How did people get infected? Who got infected? What could we do to prevent people getting infected?'

We published two or three epidemiology papers in February, and the major epidemiology hasn't changed. We know, in general, we know who's at high risk - the elderly with co-morbid conditions. That has not changed in nine or ten months.

We also came to understand pre-symptomatic and asymptomatic spread, and I think that has been without doubt the greatest surprise of the pandemic has been the power of asymptomatic spread, and now people have this term 'pre-symptomatic spread'.

We had a research letter in February about asymptomatic spread as did a number of other journals, and I think we could have done perhaps a better job of touting what that really meant.

And then through the early portions of the pandemic when many different drugs were tried, some of the antivirals - Remdisivir - people began to experiment with some of the inhibitors of the inflammatory cascade IL-6. There were concerns about potential coagulation abnormalities, so people experimented with anticoagulants.

And surprise, surprise, the one drug for those who were seriously ill that clearly reduces mortality is corticosteroids. And corticosteroids have been used for decades and have been proven to be effective. So, I think there has been some surprise.

The good news is when used for individuals with COVID-19 they don't have many side effects...

 (10:00) to (12:00)



[Dr. Bauchner]
... And they're widely available, and they're inexpensive. And that's -

[Hank]
Right.

[Dr. Bauchner]
- in contrast to some of the other drugs which have not proven to be very effective. 

[Hank]
Right, we also know what the - you know, we know all about steroids. We know what the side effects are -

[Dr. Bauchner]
Correct.

[Hank]
- We know the impacts they have on various different populations because we use them all the time for all kinds of things.

[Dr. Bauchner]
Right.

[Alexis]
Yeah, and with steroids, that's just basically fighting the body's kind of like overzealous response? Is that the goal there?

[Dr. Bauchner]
Well, I think the one thing it, it's interesting  - steroids affect many different portions of the biochemistry physiology of the body. It's kind of a a pleiotropic drug.

[Hank, whispering]
Pleiotropic

[Dr. Bauchner]
And so I think people are a bit surprised that it's worked so well because it's not precise. 

Like, if someone has diabetes, you give them insulin. We know precisely how -

[Alexis]
Mmhmm.

[Dr. Bauchner]
- insulin works. 

[Hank]
Mmmhmm.

[Dr. Bauchner]
Steroids work in a much broader way, and I think it may speak to that this disease has different manifestations, and it may be why single drugs that have a very specific action have not worked as well. so the antivirals haven't worked as well. Certainly hydroxychloroquine didn't work very well. 

And I think it's because the individuals critically ill with COVID-19, his or her body may have many different biological or physiologic manifestations, so you needed a drug that worked more broadly.

[Alexis]
Hmmm.

[Hank]
I have this very weird sense that this disease has just a lot of different surprising effects. You know, we sort of like - there's a lot of coronaviruses out there, and most of them are very similar to one another.

But then we've got like, you know, research showing that there's, you know, neurological effects, there are blood effects, there's -

Like, it seems very broad, and like part of me is worried that we're just doing so much research right now that we're finding things. Because maybe we're getting false positives here and there, maybe upon more peer review or more data, these effects will be less strong...

Is - or am I just, like... talking out of my butt?

 (12:00) to (14:00)



[Dr. Bauchner]
No, there have been surprises -

[Hank]
Yeah

[Dr. Bauchner]
I just mentioned too, I think the extent of asymptomatic spread has been a very substantial surprise.

[Hank]
Yes.

[Dr. Bauchner]
And then I think the effect of corticosteroids has been a surprise. Now, we've gotten a lot of papers on the so-called 'Long-Haulers'.
And the first time I heard the term, our news section had written a wonderful piece about it. Someone said to me, 'What do you think about Long-Haulers?' and I jokingly said - jokingly said, because I wasn't sure what they were asking, 'Why are we talking about truck drivers?'

[Hank]
Yeah. *laughter*

[Dr. Bauchner]
And then they explained, 'No, we're not talking about truck drivers, we're talking about people who seem to have  long-term effects.'

[Hank]
Mmhmm.

[Dr. Bauchner]
Now, at the moment we have quite a few case series about them, but we don't have denom - we call it 'denominator data'. So, we know we may have a report of fifty people who seem to have long-term effects, but we don't know how many that got infected, so we don't know is that fifty over five hundred, fifty over a thousand, or fifty over fifty thousand.

So we don't really have a sense of it yet.

[Hank]
Right.

[Dr. Bauchner]
People who are in the ICU with Acute Respiratory Distress Syndrome and sepsis, we know they have long-term complications.

[Hank]
Yeah

[Dr. Bauchner]
And so I don't think we yet have a lot of clarity if the side effects that are affecting these individuals are substantially different than those that have affected people in the past -

[Hank]
Right.

[Dr. Bauchner]
- who get admitted to the Intensive Care Unit with serious illness.

[Hank]
Right, that makes sense.

[Alexis]
Yeah.

[Hank]
It's just - that's been like bumping around in there, and I just haven't said it out loud until now and I appreciate you walking it through with me.

[Alexis]
*laughter*

[Hank]
I think that one of the things that we feel weird about studying, or we don't know how to study, but like has become a tremendous health problem is people not trusting the advice of -

[Dr. Bauchner]
Yeah

[Hank]
- doctors, but also just the scientific community in general. It feels to me that vaccine hesitancy and that both in terms of like, just people who are hesitant...

 (14:00) to (16:00)



[Hank]
... and who like, you know aren't really that involved don't think about this all that often - like that group of people is bigger, and so are - but so are the people who are like vehemently, sort of like part of their identity is that they are anti-vaccination.

[Alexis]
Hmm.

[Hank]
Like all that seems to be growing to me. I don't know what to do about it. I know that you were working on it - like working on these conversations, working on - like you have a successful series of videos too that talks about -

[Dr. Bauchner]
Right.

[Hank]
-  Covid-19. And obviously we are working on it as well. But I think that we need to think really hard about how to reach these people.

[Dr. Bauchner]
Well, you know it's a topic that crosses my desk every day

[Hank]
I'm sure

[Dr. Bauchner]
Whether it's research reports, or viewpoints, or people who I talk to.

[Hank]
Mmhmm.

[Alexis]
Hmm.

[Dr. Bauchner]
It's a struggle, I mean it's probably a dozen surveys that I've now seen where it appears as though about fifty percent of the people are comfortable with the idea of being vaccinated, about fifty percent aren't. It's somewhat related to education, political affiliation, race, and ethnicity.

I think those numbers or those percentages may change as different people speak out we have more information.

[Hank]
Mmhmm.

[Dr. Bauchner]
I think it may - people may be influenced by a long winter and being inside.

[Alexis]
Hmm

[Dr. Bauchner]
On the other hand, I do think it's going - it's critically important that we tell the public what we know and what we don't know.

In the data that was released today from Pfizer, where the average follow-up for patients who have been vaccinated for about two months there were no particular serious adverse side effects that showed up in the group that got immunizations versus the group that got placebo.

[Alexis]
Hmm.

[Dr. Bauchner]
That's two months.

[Hank]
Mmhmm.

[Dr. Bauchner]
It's not four months, it's not six months, it's not ten months, it's not twelve months. Now, if you talk to vaccinologists...

 (16:00) to (18:00)



[Dr. Bauchner]
... they will tell you through the history of vaccination, in general, the serious adverse events that will show up, generally show up in the first two or three months. But they're quite rare. And so you need a hundred thousand people vaccinated, or two hundred thousand people vaccinated.

So you may not see it in forty thousand people. And in addition, that's the traditional vaccine. This is the new vaccine. So, we can't be sure of what six months or eight months or ten months or twelve months will bring. 

The early data are very, very encouraging, but I think it's incumbent on the scientific community to really speak honestly -

[Hank]
Mmhmm

[Dr. Bauchner]
- about what we know and don't know. People are incredibly impressed with the robust immunologic response to both of these vaccines, particularly in the younger populations.

[Alexis]
Mmhmm.

[Dr. Bauchner]
The lack of any signal about harm is encouraging.

[Hank]
Mmhmm.

[Dr. Bauchner]
Now, the other thing that people need to remember is every day people die from myocardial infractions - heart attacks. Every day people have strokes.

So what's going to happen when people begin to vaccinate five or ten or twenty million people - someone's going to get vaccinated on a Monday and have a heart attack on Wednesday - or a stroke on Friday.

[Hank]
Mmhmm.

[Dr. Bauchner]
That's not going to be caused by the vaccine, but simply because heart attacks and strokes occur every day.

When you begin to vaccinate not forty thousand people, but when you begin to vaccinate a hundred thousand people - or a million people or two million people - there will be these events that are associated with getting the vaccine.

But that does not mean that the vaccine has caused that event. And that is incredibly important. And again, this is going to take a great deal of education.

[Alexis]
Mmhmm

[Hank]
Yeah, it's - it's so hard in a world where any event can be a story so easily and so quickly where people are - you know, some people are in bad faith...

 (18:00) to (20:00)



[Hank]
... trying to create those narratives because it's good for their subscription revenue or whatever - or for selling t-shirts or what have you.

But then you have people who absolutely hear that story and are, you know, worried about it.

And I think it's also important to recognize like where we sit is often really easy to sort of lump all anti-vax - where I sit, not where you sit - easy to lump all anti-vaccination people into sort of like a group of unreachable nuts. And that's just not the case.

Like as you just said, like it makes sense when this is very new for some people to be hesitant. And like, in allowing them to have that hesitancy, early on, when we only have two months of data, actually probably is the right thing to do because we've got fifty percent of people who could take it now.

And then over time that hesitancy might like like like when it becomes, you know, less logical to have that hesitancy as it has been taken more by more people, we haven't seen negative impacts, and we see that we can end this pandemic.

Then, without confronting those people and like, like sort of affirming that this is a really us versus them thing -

[Alexis]
Mmhmm

[Hank]
- and they need to be on one side or the other, we can just sort of like invite them in to, you know, become sixty percent of the people who are okay with it, and then seventy, and then you know maybe seventy-five and then that's as far as we get. *laughter*

[Dr. Bauchner]
It was interesting, I was home - I was home for Thanksgiving and my family was talking about vaccines and what we knew and didn't know, and I was listening, I was in the other room because I wanted to just hear their discussion

[Hank]
Mmhmm.

[Dr. Bauchner]
And I could see what issues came up, like how long is the vaccine going to last. We don't know.

[Hank]
Yeah.

[Dr. Bauchner]
Okay?

[Alexis]
Mmhmm.

[Dr. Bauchner]
And that's the honest answer. Early data says you get a great immunologic response - we'll know in six months or a year if it's still lasting. You know, people are guardedly optimistic that it'll be more effective than flu and you won't need the flu vaccine. It's not like you'll need the flu vaccine -

[Hank]
Yeah.

 (20:00) to (22:00)



[Dr. Bauchner]
- every year. You know, they wanted to know what happened to the mRNA after it's injected. Well, the nice thing is after it induces the DNA, it goes away. It doesn't change your genetics at all.

[Hank]
Yeah.

[Dr. Bauchner]
So it was just interesting within my own family to -

[Hank]
Mmhmm

[Dr. Bauchner]
- to hear what the discussions were. And I don't really want to confront people who don't want the vaccine. I want to try to help educate them about what we know and what we don't know.

[Alexis]
Mmhmm, yeah. Hank, you were mentioning the kind of thought of, you know as more and more people take the vaccine, or get it, more people might grow more accepting of it.

[Dr. Bauchner]
I think Hank's right, you know, we're going to see healthcare workers get it first -

[Alexis]
Mmhmm

[Dr. Bauchner]
- that's very clear in the US. We - Their priority's going to be  healthcare workers and the elderly, particularly those in skilled nursing homes, and hopefully it'll go well so that, you know, you'll have seen another five or ten million people get it and there'll be reports about whether or not any adverse events are occurring.

And I think that will be - that will be reassuring to people.

[Alexis]
Yeah. Also, Howard, I love the idea of like, your family's in the other room - like 'What are they saying over there?'

[Dr. Bauchner]
Oh no, I was just listening because I was really - it's important to me - for me to think about what people think what the issues are.

Now there are one or two odd things about the vaccines that I think people really need to try to understand. And it goes to some points that many of the people I've spoken to have tried to talk about.

And it's why the need for masking isn't going to go away anytime soon.

[Alexis]
Hmm

[Dr. Bauchner]
So the early reports on both vaccines suggest that they protect against the individual who's being vaccinated getting disease, okay? That's really important.

But if either of you get vaccinated, we know that you'll be protected from disease. But we still don't know if you can give the infection to someone else.

[Alexis]
Hmmm.

[Dr. Bauchner]
That's a different scientific question.

[Hank]
Mmhmm.

[Alexis]
Hmmm.

[Dr. Bauchner]
That is unanswered.




 (22:00) to (24:00)


[Dr. Bauchner]
And that is very very important. We think the likelihood that you can transmit the virus is high but that effectiveness against transmission is going be a different number than the effectiveness against disease. 

[Alexis]
Hmm

[Dr. Bauchner]
It's not always the same

[Hank]
Right

[Dr. Bauchner]
These vaccines are injected. They are not given in the nose, where some vaccines are given and we know they're much more effective against transmission.

[Hank and Alexis]
Hmm

[Dr. Bauchner]
So that difference is not yet known and so this concept of herd immunity, we're really far away from understanding what number of people need to be vaccinated to get to herd immunity.

[Hank]
Right, and that seems like oh if I don't have a bunch of like sickness coming out of me then I shouldn't be able to get someone else sick, but we've already seen with this disease that that's not always the case.

[Dr. Bauchner]
And Hank you'eve brought it up before, strange things have happened, you know, this is a journey and there have been twists and turns and potholes and so you know people are optimistic that the person who gets vaccinated not only will be protected against disease but is much less likely to less likely to transmit but the question is how much less likely to transmit.

[Hank]
Right, when you've started to vaccinate a million people and you're starting to see these, well, people get sick, they have heart attacks, will it happen the day after you get a vaccine. How can you tell if that's related to the vaccine or not related to the vaccine? Is that something that you expect to see papers on?

[Dr. Bauchner]
So there's different ways of trying to understand it and I'm largely quite familiar with it. I'm a pediatrician by training so since so many immunizations are given to children, the literature around kind of background noise of disease has always been something that people have been acutely aware of. So the best example in young children is when they get immunized and then they get a fever and they get a febrile seizure and so the question has always been is the febrile seizure related to the immunization or is it just the background noise.

 (24:00) to (26:00)



[Dr. Bauchner]
We know what the background noise is of heart attack or stroke and so what people will is that they'll compare the background noise of what occurs to what's occurring in those who are being immunized and try and understand the difference. 
Also, we do know that between the two studies, almost 70,000 people have been immunized and so they do have some data already on whether or not there would have been an increase in the rates of myocardial infarction, heart attack or stroke, there's other disease. 

[Hank]
Hmm

[Dr. Bauchner]
I think we will know very quickly and it's hugely unlikely that either of those two are going to be a consequence of being vaccinated. But on the other hand I think we know that when we vaccinate a million people, this is going to happen and we're going to have to try to educate people that that's ust the expected rate and it's not increased with immunizations, if that's true.

[Alexis]
Yeah that's fascinating. I'd just like to answer questions about this. We have to build on this knowledge of the human body that we've acquired over years and years and years to keep answering more things.

[Dr. Bauchner]
Right and there have been many other vaccine trials that have and then they'll be a whole area of post-vaccination follow-up where we'll really want to know what happens to the individuals who've been vaccinated over time. Is it safe at two months? Do they look good at six months? In a year? Do they still have a robust response?
And so follow up is going to become critical and a number of systems are under development to try to understand post'vaccination issues of efficacy and safety.

[Hank]
How are you feeling? Not like how burned out and stressed out are you but how are you feeling about our ability to sort of move forward from where we are at in America right now which is a pretty bad spot but with vaccines coming on line, emergency use authorization and then you know, next step, you know hopefully a lot of distribution.

 (26:00) to (28:00)



[Dr. Bauchner]
What I'll say is not very different from what people have been talking about in the popular press, you know, Dr. Fauci, Dr. Redfield. It's going to be a tough three or four months, we know that. You know, the numbers are around 200,000 a day of cases, 100,000 people are hospitalized. It's very unlikely that that will go down anytime soon. Hopefully, it wouldn't go up as more and more states begin to really talk about masking, social distancing, hand washing. 
So I anticipate that December, February, March are going to be difficult months. Now by April it gets warmer in some parts of the Nothern portion of the United States so people can go outside again. In addition, more and more people will have been vaccinated. Now the numbers are easy, I don't know what Ptizer and Moderna are saying now, and they'll give pretty good numbers for availability for the early part of next year but after that, whatever numbers they give, there will be uncertainty because of the chain of production, distribution. We'll be good on the first 20 million because that's going to be hospital based. It's the next 100 million that everyone is concerned about. That's a much larger number and it will not necessarily be hospital-based, I think people are well aware that one of the vaccines has to be stored at very cold temperatures, the other one just at cold temperatures. So there's going to be supply chain issues; not for the first 15 or 20 million but fo the next 100 million. But the next few months, December, Janurary, February are going to be difficult. I hope people can really hear the message: please mask, please practice social distancing. You know, people are going to go into stores, stay away from other people. I hope stores limit the number of people that they allow in.

 (28:00) to (30:00)



[Dr. Bauchner]
I know this has become political. To me, it's not around the politics, it's about protecting yourself, protecting your neighbor and protecting health care workers. You know everyone called them heroes and they're getting frustrated, you know it's hard for them to take care of people who aren't doing the common sense public health measures that we know work. And so I think out of respect for your colleague, your friend, your family, and health care workers who may have to take care of you or police or firemen or the grocery store person, I think it really is incumbent upon us to try and mask and keep social distance.

[Hank]
Yeah, very much agree and it's going to be a rough few months for all of us but I think the healthcare workers on the front line, it's going to be especially rough for them so anything we can do to look out for them, to help them out.
Well, we've only got you for a little bit longer but I'm very curious to ask this to anybody who knows more than I do, do you think we'll be better at this next time?

[Dr. Bauchner]
I am less sure than other people about that. You know, I think we know what the blueprint needs to be, getting there may not be so easy. 
We had a report about a month or two ago that summarized a report from the School of Public Health at John Hopkins that looked at preparedness at the international level. I think they graded out 180 or 190 countries and the US was actually graded number 1, the country most prepared for a pandemic. But I think what they didn't do when they looked back on it, and is emphasized in the viewpoint, is the extraordinary importance of leadership, and that has been a tremendous struggle in the United States.
It's interesting when you go around and talk to people in Thailand or Korea about why they've done so well, they go that's because of the Center for Disease Control, they came here, they taught us what to do, they told us what the playbook is and I don't think we did as good a job as we might have in following the playbook that the CDC actually wrote and helped other countries around the world implement.

 

 (30:00) to (32:00)



[Dr. Bauchner]
There were early mistakes with the CDC and the FDA and I think they really, particularly the CDC, struggled to recover.

[Hank]
Yeah, I mean there's been a lot of great work that has had a tremendous impact among our medical community and the scientific community. And I'm glad to have it, but it has been a frustrating and difficult 9 months.

[Dr. Bauchner]
Oh absolutely, for everyone, its disrupted life as we know it. I think everyone who's alive now will remember, I call it GP2020 - the great pandemic of 2020. By Janurary 1, there will be more than half a million excess deaths in the United States, probably 300,000 or 350,000 attributable directly to COVID19, another 150,000 or more attributable to just to the pandemic itself. Steve Wolf's done a lot of high class work for us. It will be more than half a million, more than World War II. Much of that was clearly preventable. On the other hand, I can't compliment the scientists at Pzifer and Moderna and other companies for the development and I want give Steve Hahn and Peter Marks a shout out for really doing what they needed to do at the FDA, to look at the data nd hopefully approve a vaccine in the next couple of weeks. They didn't want to rush, I don't really care that Britain has a vaccine and it may be a week before we do, what I want to make sure is that the vaccine that ultimately, hopefully is approved by the FDA meets their criteria and the criteria of the advisory board.

 (32:00) to (32:57)


[Dr. Bauchner]
So, I really want to acknowledge that I think that Steve and Peter have done a fabulous job.

[Hank]
Well and thank you for all of the work that you have done; you know, paying attention, reading late every night. I know we all feel like we are insignificant in this, we all feel that people are doing more than we are.

[Dr. Bauchner]
Yeah

[Hank]
But we are all doing our part.

[Dr. Bauchner]
Yeah and for me it's just, there's about 250 people between editing and publishing who work on the journals, it's not just JAMA but all of our journals. And I think people have taken it as a challenge to publish important information for physicians and clinicians and the public everyday and to make sure we get it right.

[Hank]
That's great. Thank you very much.

*Scishow music plays*