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U.S. Surgeon General Jerome Adams On The Path Of The Virus And America’s And World’s Medical Response

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I was joined by Surgeon General Dr. Jerome Adams this AM:

Audio:

03-24hhs-adams

Transcript:

HH: I am joined by the United States Surgeon General, Admiral Dr. Jerome Adams. Admiral Adams, welcome. It’s great to have you on the program. Thank you for all you have been doing.

JA: Great to talk with you again, Hugh. I’ll tell you, the last time we talked about opioids. Now, it’s Coronavirus. Hopefully, one time we can talk about something that’s positive and that’s going well in this country. But I’ll tell you, we’re in Day 9 of our 15 days to stop the spread push. And to their credit, many people in places are following the guidelines. They’re hunkering down. But what I want everyone to understand is that you’re only two weeks away from being New York City. Two weeks ago, New York City had less than 20 cases. And now, they have an attack rate equivalent to Italy. And that’s why we need everyone to be taking aggressive steps and not waiting until we see more cases before they decide to stay at home.

HH: Thank you for that message, Admiral. How is your health? How is your family’s health?

JA: Well, thank you for asking about that. It’s tough. I’ve got three kids at home, and I’m trying to keep my wife and kids from killing each other. We’re trying to stay busy. One of the most important things I tell people is that being socially distant doesn’t mean you have to be socially disengaged. So they’re going out and they’re hiking. They’re staying six feet apart. We’re trying to keep a schedule around the house. We’re trying to do things that you need to do to stay mentally and physically healthy, because we know the healthier you are, the more resistant you will be to the complications of Coronavirus.

HH: Excellent. Now I’m going to plunge into some new drug application technical stuff that as a journalist, I need to know, and I think the country needs to know. Before I do that, a couple of quick process questions. When I see you up in front, and Ambassador Birx and Dr. Fauci, I’m cheered. I never want to see all three of you together, because I never want you to get each other infected. Who is deciding who shows up when for the daily briefings?

JA: Well, that’s a great question. And it’s funny, because we can’t win. When one of us is missing, the media asks where is Dr. Fauci, where is Dr. Adams, where is Dr. Birx. But when we’re all up there together, everyone says we’re not modeling good behavior. It’s important for people to know that the White House checks all of us for symptoms and for temperature before we come in. And we are doctors. We will definitely, as Ambassador Birx did this weekend, stay at home if we at all feel that there is a concern. But we decide based on the news of the day and what we think people need to know. So for instance, last week, we knew that there was a potential shortage of blood, and we felt that I was the best messenger, so I was up there telling America it’s still safe to go out and give blood. When we need to talk about medications and the virus itself, you want Tony Fauci, who is the number one person in the world to talk about the virus. And so we pick and choose based on who they need, but also to try to better practice social distancing.

HH: I appreciated the message on the blood drives. The Nixon Foundation, of which I am also the head, will be running four as a response to your request that we do so, because we have the facility, and I hope everyone else in America. Now let me ask you about two things. I spent two hours talking to a retired PhD toxicologist who had left Big Pharma two years ago on Saturday to try and get smart. I know how much I don’t know. But it also occurred to me, do you have a registry of recently-retired toxicologists and epidemiologists? And are you considering gathering them someplace remote from D.C. to get their collective wisdom on this?

JA: Absolutely. Believe you me, I am getting emails, texts, phone calls, LinkedIn, from people, colleagues all over the country and all over the world. Tony Fauci has that network of people. He’s been doing this since back before HIV. And so we are listening to people. We are trying to bring the best advice together. We are really the conduits for that information. Please don’t think, America, that it’s just me and Dr. Birx and Dr. Fauci that are deciding everything. It’s really taking the best medical information. And Dr. Birx has been really good at making sure that every taskforce meeting starts with a review of the latest scientific information.

HH: Now I have only one recommendation, and it’s on behalf of me and my friends in the media. Would you and Dr. Birx and Dr. Fauci run a seminar on clinical trials and safety testing, both on the efficacy of the treatments and the long-term impacts of COVID interventions so that we are smarter? We’re not very smart about this. People are asking dumb questions all the time. They need a couple of hours’ education. Will somebody give it to us collectively?

JA: I don’t know if you’ve been listening in on our taskforce meetings or not, Hugh, but that’s exactly what we’ve been talking about trying to do moving forward, once we can get into a steady groove. And it’s important for people to know that us going to FEMA 1 level of activation, which the President did earlier this week, brings in new resources. Every state is activated, their emergency operations center at the request of the President. And that then frees us up to be able to do more of the educational things that we would like to do for the community. So the answer is yes, we are looking at trying to figure out how to get the information out to the American people so they can make informed decisions. And the President has said he’s hopeful these medications will work. We are hopeful these medications will work. And big trial starting today in New York City. But we also need to collect the data. So it’s trust, but also make sure we gather the data to protect people. And please, people, don’t, do not, do not drink fish cleaner, fish tank cleaner. We are not out there telling people to get this stuff anyway that you can, because it can be dangerous and poisonous to you, particularly if it’s not from a medical doctor or a pharmacy. But we hope to have more information in the next coming days and weeks about how things are going in New York.

HH: Now Dr., I am at ClinicalTrials.gov. There are 119 different clinical trials underway right now. How are you prioritizing these, by those that can be completed more rapidly, those with a more immediate obvious impact, or those designed for emergency critical care patients?

JA: Well, there’s a couple of things. There is great technology out there in the lab, and Dr. Fauci, when he’s not on the podium, he’s at NIH still working on vaccines and working on therapeutics where they can test hundreds or thousands of different products at one time to see if they work. So you can do it in the lab. That’s not the same as doing it in a human. One of the bright spots to this unfortunate outbreak being global is that we’re seeing trials in Italy, trials in China, trials in South Korea. And we’re constantly getting this information back in so that we can learn from what’s worked. And one thing that has worked is social distancing. And I want people to understand this. There’s good news here. The good news is that China is reopening their country. Six to eight weeks of really being aggressive with social distancing, with staying at home, with limiting large gatherings, and their country is opening back up again. That’s the good news. We want to be like China. We don’t want to be like Italy where cases are still going up. And unfortunately, New York has an attack rate that is equivalent to Italy. So cities and states across America need to decide do we want to be like China, or do we want to be like Italy? And if we want to be like China, we need to lean into the next six days of this 15 days to stop the spread initiative. That’s the best practice we’ve learned from across the country and across the planet.

HH: I’m back to, I want to go back to science, though, Dr.

JA: Yes, sir.

HH: There are four categories, as I understand it – previously approved small molecules…

JA: Yes.

HH: Previously approved biologics, new small molecules, and new biologics, non-approved ones, non-approved small molecule. Which one do you think has the most promise right now for treating patients?

JA: Well, the previously-approved non-biologics seem to have the most promise, only because we have the most experience with them. It’s one thing to say a single person actually had a better outcome. It’s another thing to say that we want to scale this up to massive numbers of people and we expect that it will be safe. And so when you look at drugs like hydroxychloroquine and chloroquine, those are drugs that we’ve seen in people for a long period of time, for decades. And so we know that they have a safety profile that is acceptable. When you talk about those other drugs that haven’t been around as long or have not been approved at all, those are going to be a little bit harder, and we’re going to be looking at months to even years before we can say with certainty that they are safe in people. So that’s important for people to know.

HH: There is this clinical trial of chloroqine and erythromycin on COVID-19 patients that both the governor and the President seem, Governor Cuomo and President Trump, seem optimistic about. Do you share their optimism? And when would a scientist like you, a doctor like you, pronounce a clinical trial like that satisfactory to your best practices level?

JA: Well, I share their hope. And we have to remember, when you go back to the HIV days, we were trying, we were in the same situation. We were trying things over and over and over again, because the other option was just letting people die. And so from a compassionate use standpoint, I am hopeful, but we need to make sure. We’ve seen this play out over and over again in history where something looks promising, but it ended up either not working or harming people. But also important to remember, and people don’t get this, you are not going to treat your way out of this crisis. You need to prevent people from getting it and prevent the spread. The best treatment is actually prevention. And while we focus on supply, while we focus on therapeutics, while we focus on developing a vaccine, we also need to focus on the tried and true methods of handwashing, social distancing, staying at home to prevent the spread in the first place, because I’d rather not get COVID in the first place, than to get it and have to reply on an experimental drug to save my life.

HH: 100% agree, Doctor, but I’m trying to establish, because the taskforce never gets this question, is there a group that is prioritizing trials and following it ruthlessly to identify the most efficacious, and inform the taskforce of these 119 trials, which ones are most promising…

JA: Yes, sir.

HH: And coupled it with, is the FDA and the CDC breaking down regulatory barriers that would normally inhibit the rapid distribution of anything deemed efficacious by the scientific community?

JA: So the very specific answer to your question are absolutely. Like I said, Tony Fauci’s group at NIH is looking at all of these things. We also know that there’s going to be a big trial starting in New York today where they’re going to make the drug available, and we’re going to be tracking that very closely to find out whether or not some of these new combinations that people are talking about actually work. And as far as the FDA is concerned, oh, my gosh. They have literally removed every barrier in record time for testing, for the people to be able to try new treatments on a compassionate use basis, or approval of vaccine trials. It has been, and when I say record, I mean, these are things that usually take years, and we’re doing them in months or days, sometimes hours. They approved a test for testing Coronavirus in five hours. That’s something that usually takes well over a year to get done. So yes, the FDA has removed every barrier. If something works, we want to find out as soon as possible.

HH: Are the regimens being studied being used in the different hospitals across standardized protocols so that the drugs will yield clinical results applicable across large populations?

JA: Well, that’s what we’re seeing happen in New York right now. And you bring up an important point. One of the good things about people doing it all over the world is you get to see it done multiple different ways. One of the bad things about it is you can’t compare apples to oranges. And so what’s going on in New York is they’re going to be using a standard drug combination and standard dosages so that we can actually say with certainty, hopefully, in a few days to weeks, that hey, this is promising and we should do more of it, or it’s not really giving us the results we want.

HH: Is that data being shared on access platforms to scientific professionals so that they, so that the international power of science, which is enormous if it’s harnessed, Dr., is it all coming to bear on the same data sets? And do those data sets have similarities that allow them to be compared and contrasted?

JA: Well, the medical publication field has been tremendous throughout this. We’re getting data out of China, South Korea, Singapore, Italy, literally by the day. And folks are really open sourcing this information, not holding onto this data to try to make sure they can get their promotion to PhD. I’ve been very impressed. And the information that comes out of New York will be made available not just to the rest of the country, but to the rest of the world as soon as something either promising or something that looks like it’s harmful to people is noted.

HH: So Dr., I want to close. I hear you on social distancing. We need to do it. I keep sending that message. Give the public some sense of the treatment horizon that you see. How optimistic are you that we will find interventions that will at least reduce the time on ventilator so that we can increase the capacity of ventilator.

JA: So let’s go backwards. A vaccine is still about a year off…

HH: Right.

JA: Because we need to make sure before you massively scale up a vaccine, you test therapeutics. When you talk about biologics, when you talk about non-approved drugs, we’re still looking at summertime before you would have something like that where we feel comfortable. When you look at pre-approved drugs, if the trial in New York is efficacious and it proves to be safe in large numbers of people, because just because the safe in one group of people with the disease doesn’t mean it’s safe in another group. But if it looks efficacious and safe, you could be talking about just a couple of weeks before we’re telling the rest of the world you should be doing something like this. But we don’t want to hang our hat on that. Right now, we don’t want places to become the next New York City, and the most effective thing we can do is wash our hands and social distance. And I’ve just got to give you a shout out, Hugh, because you mentioned what you were doing to promote blood donations. And I wanted to say to you, you literally have saved lives by doing that. One blood donation can save up to three people, and it’s something positive we can do mentally while we’re at home and feeling isolated.

HH: Dr., we are going to do that four times in the next couple of weeks at the Nixon Foundation, Nixon Library in Yorba Linda. And I’m sure other Americans will step up. Surgeon General Jerome Adams, keep coming back, Admiral. We need you, and I appreciate you being on that stage every night, and I’m glad you cleared up that we should not read into your absence anything.

JA: Absolutely. Thank you, Hugh, for all you do, and I look forward to talking to you again soon.

HH: Thanks, Admiral.

End of interview.

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