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From The New York Times, I'm Michael Borrow, this is The Daily. Today, my colleague, Donald McNeil, Jr. on four new developments in the treatment and understanding of the coronavirus.


It's Tuesday, August 25th. Donald, we wanted to check back in with you because the summer is drawing to a close and there have been a few major developments in the pandemic that we wanted to better understand by talking to you, our resident expert on the coronavirus and the first development involves a new treatment in the US. So tell us about that.


Thank you very much. It's good to see you all. So just in time for the Republican convention.


The Food and Drug Administration director on the podium with his boss at the head of HHS and his boss, the president of the United States, today, I'm pleased to make a truly historic announcement in our battle against the China virus that will save countless lives, gave emergency youth authorization, a powerful term emergency use authorization for a treatment known as convalescent plasma to a therapy called convalescent plasma.


Because the FDA really stepped up, and especially over the last few days in getting this done. The results have been incredible. And I think you'll see the results even go up very substantially. So we appreciate it.


And and what is convalescent plasma? Convalescent plasma is the the serum from blood that's taken from people who were convalescing, who are recovering from having had Cauvin. You draw out about a pint of their blood, you spin it down to take off the red blood cells in white blood cells, and then you keep the serum that contains a lot of things, including the antibodies.


I probably shouldn't admit this, but I used to sell plasma when I was in college. I'm sorry, whose plasma did you sell? Mine, huh?


You know, five dollars to the first donation a week. Fifteen dollars for the second. I paid my rent for part of the time in college that way.


And just to be clear, who are you selling it to? Presumably not like somebody off the street. No, no. To a to a blood bank.


And why would anyone pay for your plasma or anyone else's plasma for that matter? What is so special about blood plasma?


It contains your antibodies and antibodies is what they need to kill the virus as it's going through them.


Got it. And so this is now being applied to covid-19.


Yes, people who have had covid and are immune to it are in very high demand for their plasma, which has antibodies in it, which is what the president and the FDA approved for emergency with authorization this weekend.


And today I once again urge all Americans who have recovered from the virus to go to coronavirus dot gov and sign up and donate plasma today, please.


And what was the evidence that the Trump administration cited in granting this emergency youth authorization for blood plasma?


There is a. Program to distribute plasma and analyze the results run by the Mayo Clinic, and they are aiming to give the plasma out to 70000 patients and see how they do.


And the result was that. People who got plasma did not do better across the board, but if you splice out a subgroup of people who were under 80 years old. Hospitalized but not on ventilators, were given a high dose of plasma, not a low or medium dose, and were given it within three days of diagnosis. Those people did better and better, was defined as they seem to have a thirty five percent lower chance of dying.


Hmm. So a narrow slice of that overall group of people who got this blood plasma did thirty five percent better. And that was the basis for this emergency authorization.


Yes, but some doctors, some experts are unhappy with the way this is done because they would want to know a lot more things, even in the context of this trial. They would like to know what other treatments those patients got just in case they got something like the steroids that we already know save people or the that severe that we already know saves people. And really what they'd like to see is a real randomized clinical trial done in which half the people got plasma and the other half of the people got placebo.


And neither the doctors nor the patients knew who was getting which.


Right, because that that's really the only way in order to prove something really works.


So why not undertake such a clinical trial now? The Tony forces and Francisco would love to, the problem is that people are so excited about the idea of plasma, kids have been talked up that they refuse to go into a clinical trial because they would get a 50 percent chance of getting the placebo.


And once you're sick, you don't want that. You want. Hey, if you think it saves me, give it to me.


Oh, that's interesting. So the government's decision, the Trump administration decision to talk up blood plasma as a potential treatment, even though there's not a ton of evidence for it, might actually make it harder to do the kind of gold standard clinical trial tests that lots of doctors, it sounds like, including Anthony Fauci, would want to know whether or not plasma really is a serious therapy for covid-19.


Yeah, and it's exactly what happened with hydroxyl chloroquine. It was talked up so much that people wanted it. And so it became hard to do the clinical trials in which they got a 50 percent chance of getting a placebo because they didn't want they heard the president say it's a miracle drug. So they insisted on it.


And of course, in the case of hydroxy chloroquine, that, too, was granted an emergency authorization from the Trump administration as a treatment. But then subsequent testing showed it was not considered effective and it was not considered so safe and that emergency authorization was eventually rescinded. It was not considered effective at all and it was definitely dangerous, and so emergency authorization was rescinded.


Hmm. So this potentially could be a similar situation. Yes. In fact, the doctor said that to me yesterday. Exactly. That this feels like Hydroxycut one all over again.


I mean, the president is hoping to be able to announce a miracle.


And that's the tone, the calls for the press conference on Sunday where, you know, gigantic therapeutic breakthrough going to come through this evening.


And then everybody was saying, I think he's going to talk about convalescent plasma, which we've known about since the 80s, 90s.


And what this really is, is it's a bureaucratic breakthrough because hospitals are going to find it easier to use plasma than they did before because they don't have to go to the Mayo Clinic for permission to enroll in the trial.


But that's all.


And what Tony Fauci and Francis Collins and Clifford Lane and the others at the NIH said just in the last week or so, we don't think an emergency use authorization should be granted and the president basically just reversed them or overruled them.


Yeah, OK, so the second big recent development in the pandemic involves a case of reinfection out of Asia. Tell us about that.


Researchers in China say a three year old man living in Hong Kong is the first person confirmed to have been reinfected with the coronavirus.


So the case is about a man who gets infected in Hong Kong early in the year, recovers four and a half months later, goes to Spain, gets sick again, recovers. And so doctors know that he got infected twice, which is kind of the nightmare situation. Yeah, right.


Well, this is a potentially serious setback tonight in our war against coronavirus. This new case you mentioned out of Hong Kong really does put into question that belief that so many of us have had, that if you got coronavirus once, you couldn't get it again. The reason that would worry people is because, well, that would imply that we're never free of the disease and maybe a vaccine wouldn't work because if you got a vaccine, you were protected and then, you know, a couple of months later, you got infected again.


Then, you know, the vaccine's a bust, right?


Infection is supposed to equal. Immediate infection is supposed to produce immunity. Yes. Now, in this case, it was just reported out of Hong Kong, this doesn't shock immunologists. Why now? Well, because it's been known that even with some diseases where you think getting it provides lifetime immunity, some people get it again. And what happened in this guy's case was his first bout of disease was mild and his second bout was so mild it was asymptomatic.


He didn't realize he had it. And what may have happened in this case is that he had such a mild infection the first time that he got over it, but he really didn't produce enough long lasting immunity in the form of antibodies to prevent him from getting a second infection. So the reaction of doctors is, well, this is a curiosity and it's kind of the exception that proves the rule, but it's not something to panic about.


This is not common. This is not something we're seeing all over the place. Millions and millions and millions of infections around the world. And we've only seen one proven case. So don't worry that this means the end of the vaccine or the vaccine won't work. And it's like that.


So this does not fundamentally change our understanding of immunity from a covid-19 infection.


We're still in the gray area where we don't know how long immunity lasts, but we suspect it lasts for. A year or more. Although that's impossible to prove, because this disease is only it didn't come into existence before December. Got it. But looking at other diseases like it, that's what the best immunologists expect to happen.


Don't immunity for a year or so would probably imply that whenever a vaccine is ready, it might last just a year. Or is that too big a logical leap?


So the answer is nobody knows yet because we don't have the vaccine and we don't have a year's experience for the virus.


But we know that some viruses mutate so fast that you need a vaccine every year. Typically, the flu virus. We know that this virus mutates at about one third the rate of flu. So maybe if it, you know, hangs around, we'll need a new shot every three years rather than every year, as you do with flu. But this is all a big gray area. It's really hard to say. No expert is going to say we know what's going to happen.


We'll be right back. Support for the Daily comes from BBC America's Killing Eve, now nominated for eight Emmy Awards, including Outstanding Drama Series, Outstanding Lead Actress, in a drama series for Jodie Comar and Sandra Oh and outstanding supporting actress in a drama series for Fiona Shaw. This season was hailed by critics as deliciously watchable, genre defying and a bloody good time. BBC America congratulates killing Eve on its Emmy nominations. Chinese military is actually giving doses of the vaccine developed by a unit of the China National Pharmaceutical Group to soldiers and employees traveling overseas, that's still, though, is in the phase three testing.


It's experimental. Russia is claiming victory in the worldwide race for a coronavirus vaccine. The government is clearing a vaccine for use despite not putting it through a third round of testing on humans. President Vladimir Putin insists the vaccine is safe and says one of his daughters has been inoculated.


Our third development relates to the progress that we are making in the battle for a vaccine. And the biggest of these developments seem to be occurring overseas in Russia and in China. And I was hoping you could update us on those.


Yeah, both the Russians and just recently, the Chinese say they have started distributing their vaccines without having done the Phase three safety and efficacy trials that we are doing here.


And those are the ones that are double blind with the placebo, like we talked about before. Right. And more importantly, they recruit tens of thousands of people, I think, for these trials were recruiting thirty thousand people per vaccine.


So immunologists and vaccine executives here say this is crazy with the Russians and the Chinese are doing you don't release a vaccine before you've done the big safety trial because problems that you did not find earlier could crop up. And the big dangerous problem, the one that everybody is worried about, is that the vaccine makes you more likely to have a bad outcome if you do have the virus as it's more likely to get hospitalized and die.


So doctors here think the Russians and the Chinese are very responsible to do this. It looks like they may be doing it for competitive reasons.


The Russians, what they called their vaccine, Sputnik, they want to brag that, hey, we beat the United States, we beat the world at this, you know, as they did with Sputnik back in 1957 or whatever it was for satellite in space.


So what they're really doing is using their own population as the guinea pigs for doing the safety and efficacy testing of the vaccine.


And one hopes that they are following those first three thousand guinea pigs really carefully to see if they pick up any danger signals that are there. You want to make sure that the vaccines go to people you think are likely to do well, you know, help the young people and then you move it out into the risk groups model.


And maybe I'm being unnecessarily provocative here. But how different is what China and Russia are doing with these vaccines from what the United States and our FDA is doing with hydroxy chloroquine and blood plasma, which is starting to authorize the delivery of it to people before it's gone through those kind of gold standard, double blind placebo tests?


It's similar and yet it's different. It's. Similar because we are letting it be generally distributed before it's been proven that it works and is totally safe. It's different because hydroxy chloroquine did have a long safety record. Convalescent plasma does have a long safety record, these vaccines that the Chinese and the Russians are using have no safety record other than the tests they've done just in the last two or three months, presumably on, you know, maybe a thousand people.


Another important difference between what the Russians and Chinese and doing with their vaccines and what we're doing with treatments here is that treatments are given to people who are already sick and in trouble.


Like like you can take wild chances with cancer treatments when you have patients who are on the brink of death and there's nothing else that will save them.


Right. Whereas vaccines are given to healthy people, even sometimes the babies and pregnant women.


So you do not want something that is at all unsafe because you turn someone from healthy into unhealthy. You've done more damage than if you just left them alone. Mm hmm.


So our risky emergency authorizations are less risky than what China and Russia are doing with vaccines because our emergency authorizations are going into sick people there are going into healthy people.


Correct. OK, so finally, the fourth development here in the United States is a somewhat happy one for a change. And that centers around the current infection rate in the United States, which is. Yeah, it's flattening, but I don't see this as a happy story. What are we flattening at thirty thousand cases a day?


You know, even in our good period back in June when we felt we were doing well, we had twenty thousand cases a day with none of this has been a good news story. We have an out of control epidemic in this country. And the fact that we've brought it down by 10000 cases is goodish news relative to how bad it was getting.


But I don't think we should pat ourselves in our national back over getting down to 30000 new cases a day. And what are the implications of us even staying at such an infection rate? It the implications are that a lot of people are going to continue to die. You know, this is like climbing a mountain and you get up to 14000 feet and you stay at 14000 feet because you're walking through a meadow. It's still hard to breathe up at that altitude.


It's not a happy situation.


We're not going back down to zero.


We're going back down to a few hundred cases a day, which some other countries have gone to that the implication is that we're going to have more people hospitalized, more people die. We're going to see our death numbers go up beyond two hundred thousand, definitely on the way to three hundred thousand.


Don't know exactly when it's going to reach that, but we're steadily plodding day after day of that peak of deaths.


And I don't want to I don't want I don't want to let that slide by you. You're saying that it feels likely that the United States will hit three hundred thousand before the pandemics over? Oh, before it's over.


Yeah. The question is when before it's over.


I mean, it's not just me, it's the models. Some models suggest that that this is going to be, you know, well before Christmas.


Three hundred thousand American dead before Christmas would be absolutely horrific. Yeah, it would. And we can avoid that by being smart, using masks, socially distancing all the usual things, but we have to. Do it. And, of course. The fall in the US beyond everything we're talking about means something else, which is the flu, the flu is now about to kind of merge with the coronavirus. And I know that that has raised some fears.


Is that something you worry about?


No. More not and I'm kind of an outlier on this, but there are doctors who agree with me. Flu doesn't sit around, hide in the country during the year flu travels, it migrates to the southern hemisphere and hits them in the middle of their winter and then it comes back in the fall. But flu transmission went to zero in this country in the third week of April during lockdown.


It just went boom, right down to zero.


And then it did not really go south because people aren't really flying south.




It turns out that flu in Australia is down by ninety nine percent this year.


And in the rest of the southern hemisphere, it's way, way, way down to Chile, Argentina, Zealand. If it isn't big there and there are no flights from there to here, you can't reseed flu here. And also practicing social distancing as we are now cuts down flu transmission in any year, so. I don't expect a big flu season, but I still think everybody should get their flu shot and I got mine in case I'm wrong.


So it sounds like another incentive to abide by all the rules around the coronavirus is that it is very nicely diminished, the flu. And other respiratory diseases, RSV and the cold coronaviruses and things, any respiratory disease they get knocked out by all those diseases have dropped in this country.


But still, I'm hearing you say, and your role as our collective conscience, that everyone should still get the flu vaccine just in case in order to kind of take it off our plate. And here I should say, Donald, and I'm always wanted to be you're a student in this respect. I got the flu vaccine just a few days ago. Good. Excellent. I got mine. I got the senior shot. The four times as powerful one that you can't get 60, 65 people ask me, how do I get one of those?


And I'm like, now, insurance will not pay for it until you're over 65. And then that's kind of slightly sore arm than usual, I think. But but I you know, that's actually a good sign.


It means the shots working model. Thank you very much. We appreciate it. You're welcome. On Monday night, The Times reported that many scientists have been startled by the way that the FDA has interpreted and communicated data about the effectiveness of blood plasma in treating covid-19 several of them, including those who worked on the Mayo Clinic study cited by the Trump administration, said they cannot figure out the origins of the claim that it reduced deaths by 35 percent and are highly doubtful of that figure.


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Unrest in the city of Kenosha, Wisconsin, turned violent on Monday night as protests over the police shooting of a black man there, Jacob Plake, gave way to fires, destruction and looting. By early Tuesday morning, a strip of stores in Kenosha as downtown was consumed by flames. Blake was shot repeatedly by a white officer as he tried to get inside his car. The shooting appeared to be unprovoked and was immediately condemned by Wisconsin's governor. The officers involved in the encounter have been placed on administrative leave as an investigation continues.


And, Madam Chairman, Louisiana proudly casts its 46 votes for President Donald J. Trump, Michigan. The Great Lakes State is going to cast all 73 votes for President Donald J.


Trump in order to keep America first. The state of Arizona casts are fifty seven votes for President Donald J.


Trump during the opening night of the Republican National Convention in Charlotte. President Trump was nominated for a second term after an in-person roll call.


My delegates are more and more. Have you want to really drive him crazy? You say 24 years.


In a short speech accepting the nomination, Trump sought to cast doubt on this fall's election by attacking mail and voting and accusing Democrats without evidence of seeking to steal the election. Last time, Joe's boss was Obama. This time it would be Pelosi, Sanders and the squad. Their vision for America is socialism, and we know that socialism has failed everywhere. They want to tell Americans how to live, what to think. Later in the night, a series of speakers, including Trump's first ambassador to the United Nations, Nikki Haley, claimed that Joe Biden, a moderate, would pursue a left wing agenda that would undermine American values at home and overseas.


This president has a record of strength and success. The former vice president has a record of weakness and failure. Joe Biden is good for Iran and ISIS, great for communist China. And he's a godsend to everyone who wants America to apologize, abstain and abandon our values. Donald Trump takes a different approach. He's tough on China. And he took on ISIS and won. And he tells the world what it needs to hear. That's it for the daily unlikeable Borro see tomorrow.


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