← Lex Fridman

Vincent Racaniello: Viruses and Vaccines

第216期2021-09-01English

嘉宾:Vincent Racaniello

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§01Transcript · 00:00–09:20

00:00The following is a conversation with Vincent Recaniello,

00:03professor of microbiology and immunology at Columbia.

00:08Vincent is one of the best educators in biology

00:10and in general that I've ever had the pleasure

00:12of speaking with.

00:14I highly recommend you check out his

00:16This Week in Virology podcast

00:19and watch his introductory lectures on YouTube.

00:22In particular, the playlist I recommend

00:24is called Virology Lectures 2021.

00:28To support this podcast,

00:30please check out the sponsors in the description.

00:32As a side note, please allow me to say a few words

00:36about the COVID vaccines.

00:38Some people are scared of a virus hurting

00:41or killing somebody they love.

00:43Some are scared of their government betraying them,

00:46their leaders blinded by power and greed.

00:49I have both of these fears.

00:52And two, I'm afraid, as FDR said, of fear itself.

00:57Fear manifests as anger and anger leads to division

01:01in the hands of charismatic leaders

01:03who then manufacture "truth" in quotes

01:06that maximize controversy and a sense of imminent crisis

01:10that only they can save us from.

01:12And though I'm sometimes mocked for this,

01:16I still believe that love, compassion, empathy

01:20is the way out from this vicious downward spiral

01:23of division.

01:25I personally took the vaccine

01:27based on my understanding of the data,

01:29deciding that for me,

01:30the risk of negative effects from COVID short-term

01:33and long-term are far worse than the negative effects

01:37from the mRNA vaccine.

01:39I read, I thought, I decided, for me.

01:44But I never have and never will talk down to people

01:48who don't take the vaccine.

01:50I'm humble enough to know just how little I know,

01:53how wrong I have been and will be

01:56on many of my beliefs and ideas.

01:59I think dogmatic certainty and division

02:02is more destructive in the long-term than any virus.

02:05The solution for me, personally, like I said,

02:08is to choose empathy and compassion

02:10towards all fellow human beings,

02:13no matter who they voted for.

02:15I hope you do the same.

02:17Read, think, and try to imagine

02:20that what you currently think is the truth

02:22may be totally wrong.

02:24This mindset is one that opens you to discovery,

02:27innovation, and wisdom.

02:29I hope my conversation with Vincent Racaniello

02:33is a useful resource for just this kind of exploration.

02:36He doesn't talk down to people,

02:38and he's the most knowledgeable virologist

02:40I've ever spoken to.

02:42He has no political agenda,

02:44no desire to mock those who disagree with him.

02:47He just loves biology

02:49and explaining the fundamental mechanisms

02:51of how biological systems work.

02:54That's a great person to listen to

02:55and learn from with an open mind.

02:58I hope you join me in doing so,

02:59and no matter what,

03:01try to put more love out there in the world.

03:03This is the Lex Friedman Podcast,

03:06and here is my conversation with Vincent Racaniello.

03:10You mentioned in one of your lectures on virology

03:14that there are more viruses in a liter of coastal seawater

03:17than people on Earth.

03:20In the Nature article titled "Microbiology by Numbers,"

03:25it says there are 10 to the 31 viruses on Earth.

03:29Also, it says that the rate of viral infection in the ocean

03:34stands at 10 to the 23 infections per second,

03:39and these infections remove 20 to 40%

03:42of all bacterial cells each day.

03:45There's a war going on.

03:46What do you make of these numbers?

03:50Why are there so many viruses?

03:52- So the numbers you're quoting,

03:54they're in my first virology lecture, right?

03:57'Cause people don't know these numbers,

04:00and they get, whoa, they get wowed by them,

04:02so I love to give them.

04:04- By the way, sorry to interrupt,

04:05but as I was saying offline,

04:08you have one of the best introductory lectures on virology

04:12that I've ever seen, introductory lectures period,

04:14so I highly recommend people find you on YouTube

04:17and watch it if you're curious at all about viruses.

04:20Yeah, there's a lot of times throughout watching it,

04:25I felt like, whoa.

04:26- Yeah, that's my goal is to,

04:28and it's what my students tell me.

04:29One student once said, "Every day after every lecture,

04:33"I could go home and tell my roommate something

04:35"she didn't know and blew her away."

04:38So the number of viruses is really an amazing number.

04:42So that number, 10 to the 31,

04:44is actually just the bacterial viruses in the ocean.

04:48So there are viruses that infect everything on the planet,

04:51including bacteria.

04:52There are a lot of bacteria in the ocean,

04:54and so 10 to the 31 is from basically

04:57particle counts of seawater all over the world.

05:00So there are more viruses than 10 to the 31,

05:02but just in the ocean, and that number is so big.

05:06First of all, the mass exceeds that of elephants

05:10on the planet by a thousandfold.

05:12And if you lined up those viruses end to end,

05:15they would go 200 million light years into space.

05:19It's so big a number.

05:21It's amazing.

05:23And then, yes, 10 to the 20-some infections per second

05:27of these viruses killing bacteria

05:30and releasing all this organic matter,

05:32and that's part of this,

05:34what we call the biogeochemical pump,

05:37cycling of material in the ocean.

05:39The bacteria die, they start to sink,

05:42and then they get metabolized and converted

05:46to compounds that are needed.

05:48A lot of it gets released as carbon dioxide and so forth.

05:51So these are actually really important cycles

05:52that are catalyzed by the virus.

05:54- Well, it's so wild that nature has developed

05:56a mechanism for mass murder of bacteria.

05:59- That's one way to look at it,

06:00but it's just what happened, right?

06:02- It's interesting.

06:03I mean, I wonder what the evolutionary advantage

06:06of such fast cycling of life is.

06:10Is it just an accident of evolution

06:13that viruses are so numerous,

06:16or is it a feature, not a bug?

06:20- So the fast is, it's not all fast.

06:25Not all viruses are fast.

06:26Some are 20 minutes per cycle.

06:28Some take weeks per cycle.

06:31But that's just per second.

06:34There's so many viruses in the ocean

06:36that that's what you get per second,

06:37no matter how fast the cycle is.

06:40But I look at it this way.

06:42Viruses were probably the first organic entities

06:47to evolve on the planet.

06:49Long ago, billion years ago,

06:51just as the Earth cooled and organic molecules

06:54began to form, I think these self,

06:58we call them self-replicators.

07:01They're just short things that today would look like RNA,

07:05which is the basis of many viruses, right?

07:08They evolved and they were able to replicate.

07:10Of course, they were just naked molecules.

07:13They had no protection.

07:14And it was just RNA-based.

07:17And that's tough because RNA is pretty fragile in the world,

07:21and it probably didn't get very big as a consequence.

07:25But then proteins evolved,

07:28and I'm skipping like hundreds of millions

07:30of years of evolution.

07:31Proteins evolved maybe without a cell,

07:34maybe with a cell.

07:36But then to make a cell,

07:38there probably were some RNA-based cells early on,

07:41but they were pretty simple.

07:42But the cells that we know of today,

07:44even bacteria and single-celled eukaryotes,

07:48they have very long DNA genomes.

07:51And you need a lot of DNA to make a complicated cell.

07:55And so we think at some point, the RNA became DNA.

08:00And probably one of the earliest enzymes that arose

08:04is the enzyme that could copy that RNA into DNA,

08:06which we now know today as reverse transcriptase,

08:09which my former boss, David Baltimore

08:11and Howard Temin co-discovered.

08:14And that enzyme arose and copied RNA to DNA,

08:19and then you could build big cells with,

08:22'cause DNA can be millions and millions

08:23of bases in length.

08:25And RNA, the longest RNA we know of is 40,000 bases,

08:30not much bigger than the SARS-CoV-2.

08:32- What would you say is the magic moment along that line?

08:36I saw it was one or two billion,

08:39maybe three billion years it took to go from bacteria

08:44to the complex organism.

08:49It seems like Earth had a very long time,

08:52but not a very long time without life,

08:54and then a very long time with very primitive life.

08:59Maybe I'm discriminating, calling bacteria primitive life.

09:03- Yeah, people would object to you doing that for sure.

09:06- But it seems like complex organisms,

09:07when it starts becoming something like,

09:11I don't know what's a good, not animal-like,

09:13but more complexity than just like a single cell.

09:16What do you think is the magic there?

09:20What's the hardest thing?

§02Transcript · 09:21–17:29

09:21If you were trying to engineer Earth and build life

09:23and build the simulations,

09:25obviously we're living in a video game, what this is.

09:27So if you were trying to build this video,

09:29what's the hardest part along this evolution pathway?

09:32- So bacteria are mostly single cells.

09:36They do make colonies, they get together in biofilms,

09:39which are really important,

09:41but they're all single bacteria in that,

09:43and the key is making an organism

09:46where cells do different things.

09:49We have skin cells and eye cells and brain cells.

09:51Bacteria never do that, and the reason is probably energy.

09:55Bacteria can't make enough energy to do that.

09:58And so there was another cell existing at the time,

10:03the archaea,

10:04and the idea is that a bacteria went into an archaea

10:10and became the modern-day mitochondria,

10:13the energy factory of the cell,

10:15and that now let that cell develop

10:17into more and more complicated organisms

10:19like we have today.

10:20It was all about energy.

10:21- So the mitochondria, the energy,

10:23the mitochondria is the magic thing.

10:26- I think so.

10:27It's actually not my idea, it's Nick Jones.

10:29Have you heard of Nick Jones?

10:30He's an evolutionary biologist in the UK,

10:33and he's done experimental work on this,

10:36and it's his idea that the defining point

10:39was the ability to make a lot of energy,

10:41which a mitochondria can do.

10:43It's basically a whole bacteria inside of a bigger cell,

10:46and that becomes what we now call eukaryotes,

10:48and that they can get more and more complicated.

10:51So let me bring you back to the viruses.

10:53I wanna finish that story.

10:54- Yeah, which points of viruses come along?

10:56- So remember, we have these precellular,

10:58they're called precellular replicons, right?

11:01And so we have a precellular stage

11:05where we have these self-replicating molecules,

11:08and then cells arise,

11:10and then the self-replicating molecules invade the cells.

11:15Why?

11:16Because it's a hospitable environment.

11:18I mean, they didn't know that.

11:19They just went in,

11:20and it turned out it was beneficial for them,

11:21so it stuck, and they replicate inside the cell now

11:25where they have pools of everything they need.

11:27They get more and more complicated,

11:29and then they steal proteins from the cell

11:31to build a protective shell.

11:34And then they can be released as virus particles.

11:37They're now protected.

11:37They can move from host to host,

11:40and because they're at the earliest stages

11:43of cellular evolution,

11:45they can diversify to infect anything that arises,

11:48and that is why I think there's so many of them,

11:52and everything on the planet is infected

11:54because the ancestor of everything

11:56was infected many years ago.

11:57- So it's easier to steal than to build from scratch.

12:01So it's easier to sort of break into somebody else's thing

12:05and steal their proteins.

12:06- Yes.

12:07My colleague, Dixon de Pommier, calls viruses safe crackers.

12:11- Safe crackers.

12:12So it's just, from an evolutionary perspective,

12:15yeah, it's easier to steal because you can select,

12:20but then you have to figure out mechanisms for stealing,

12:23for breaking into, for cracking the safe.

12:25- Well, you don't have to figure out.

12:26It just happens, right?

12:28Because molecules are so diverse

12:30that a molecule gets into a cell,

12:33and if there's a protein that sticks to it,

12:35it's gonna stick, and that gives an advantage.

12:39There's no planning.

12:41There's no thinking about it, right?

12:43It just happens.

12:45- Oh, we'll return to that.

12:46(Lex laughing)

12:48But these numbers are crazy.

12:50So what, as these more complex organisms evolved,

12:55let's take us humans as an example,

12:58should we be afraid of these high numbers?

13:01Should we be worried that there's

13:02so many viruses in the world?

13:04- Well, to a certain extent.

13:06I mean, it's twofold.

13:08They're good and bad, right?

13:09Viruses are no, there's no question they can be bad,

13:12and we know that because they've infected

13:14and caused disease throughout history,

13:15but we're also, you and I are full of viruses

13:17that don't hurt us at all and probably help us,

13:20and every organism is the same,

13:21so they are clearly beneficial as a consequence.

13:25So I think, so every living thing on the planet

13:30has multiple viruses infecting everything you can see,

13:35and most of them I think we don't worry about

13:39because they can't infect us.

13:41They're unable.

13:42In fact, now you can actually take your feces

13:46and send them to a company,

13:47and they will sequence your viruses in your feces for you,

13:49your fecal virome, right?

13:52And the most common virus in human feces

13:57is a plant virus that infects peppers.

14:00It's called pepper model mosaic virus,

14:03and that's 'cause people eat a lot of peppers,

14:05and it just passes right through you.

14:06Cabbage is full of viruses from the insects

14:09that walk on the cabbage in the fields.

14:10We eat them.

14:12They just pass us.

14:13So I think most of the viruses we don't need to worry about

14:16except when we're talking about species

14:19that are closest to us, mammals, of course.

14:22And I think the most numerous ones

14:25are the most concerning.

14:26They're viruses like bats.

14:28Bats are 20% of mammals, and rodents are 40% of mammals.

14:33And we humans live nearby, right?

14:37And we know throughout history,

14:38many viruses have come from bats and from rodents to people,

14:41no question about it.

14:42- So there's a proximity in terms of just living together

14:44and a proximity genetically too,

14:46so it's more likely a virus will jump from a bat

14:49than a rodent.

14:50- And birds too.

14:51Birds can give us their viruses.

14:52That's happened.

14:53Influenza viruses come from birds mainly.

14:57So I think those are the three species,

15:00not species, it's higher than species obviously,

15:02but those are the three I would worry about

15:04in terms of getting their viruses.

15:05And we don't really know what's out there, right?

15:09We have very little clue about what viruses.

15:12And I've for years wanted to capture wild mice

15:16in my backyard and see what viruses they have

15:18'cause no one knows.

15:19And it's an easy--

15:21- We can't ask them, so you mean map,

15:23like is there a way to--

15:24- I can't ask them, yeah.

15:25No, I would have to sacrifice them and take tissue

15:27and then bring it in the lab and do genome sequencing.

15:30- So you can do a thorough sequencing

15:32to determine which viruses.

15:33Is there a sufficiently good categorization of viruses

15:37where you'd be--

15:38- That's a very good question.

15:40So whenever you do sequence, right?

15:42You get some environmental sample

15:44and you extract nucleic acid and you sequence it.

15:47What you do is you run it past the database.

15:49The gold standard is the GenBank database

15:52which is maintained here in the US.

15:54And you see if you get any hits.

15:56And then you can say, ah, look,

15:58this sequence is similar to this virus

16:01and you can classify all the viruses you see.

16:03The problem is 90% of your sequence is dark matter.

16:08It doesn't hit with anything.

16:11It's probably a lot of it is unknown viruses

16:14and that's gonna be hard to figure out

16:16'cause someone's gonna have to go after it

16:17and sort it through.

16:18So yes, you can find a lot of viruses

16:21and the numbers you get are astounding.

16:22You can find thousands of new viruses

16:25just by looking in various life forms.

16:28But there are many more that we don't pick up

16:30because they're not in the database.

16:32- Maybe this is a good time to take a quick tangent.

16:36What do you think about AlphaFold2?

16:38I don't know if you've been paying attention to that.

16:40With them, DeepMind solving the protein folding problem

16:44and then also releasing, first of all,

16:47open sourcing the code,

16:49which is for me as a software person, I love.

16:52And then second of all,

16:53also making like 300,000 predictions or something like that

16:57for different protein structures and releasing that data.

17:01On the side of, 'cause you're saying there's dark matter.

17:06Is there something, first, what are your general thoughts,

17:12level of excitement about their work?

17:15And second, how can that be applied to viruses?

17:19Do you think we'll be able to explore the dark matter

17:21of virology using machine learning?

17:24- Absolutely, 'cause in all this dark sequence,

17:26you can translate it and make a protein.

17:29You can see what a protein looks like.

§03Transcript · 17:31–26:16

17:31It has what we call an open reading frame, right?

17:34A start and a stop.

17:35And right now it's just a bunch of amino acids.

17:37But if we could fold it,

17:39maybe the fold would be like something we already know,

17:43some protein fold, which gives you a lot of clues, right?

17:46'Cause there are only so many protein folds in biology

17:49and that dark matter is probably one of them.

17:52So I think that's very exciting because for years,

17:55I followed structural biologists for years.

17:59And in the beginning,

18:01we couldn't even solve structures of viruses.

18:04They're too big.

18:04We could do small molecules like myoglobin.

18:06That was the first one done.

18:07Took years to do that.

18:09Then as computational power increased,

18:13then they could start to do viruses, but it took a long time.

18:16X-ray crystallography,

18:18depending on getting crystals of the virus, right?

18:21And now we can do cryo-electron microscopy,

18:24which is much faster.

18:26You could solve, the spike of SARS-CoV-2

18:28was solved in two months by Jason McClelland here

18:31in Austin, actually, at the beginning of the pandemic.

18:34But you're limited.

18:35You can't do huge proteins.

18:38You can only do moderately sized ones.

18:41So, or actually, you can do viruses,

18:45but you can't do small proteins.

18:47So that's speeded it up, but it's still too fast to solve.

18:50You get a new protein, you want to solve its structure.

18:52So if we could predict it,

18:53and I know from talking to structural biologists,

18:55this has been their holy grail from day one.

18:58They want to be able to take a sequence of a protein,

19:00put it in a computer and have the structure put out

19:03without having to do all the experiment.

19:05So that's why this is very exciting that you can predict it.

19:08I mean, it's not finished, obviously,

19:10and there's more to do, but I think it will be a day

19:12where you could take any amino acid sequence

19:15and predict what it's going to look like.

19:17- See, but aren't structural biologists going to get greedy?

19:20So once you have that,

19:21don't you want to go more complicated then?

19:24Don't you want to go,

19:25'cause that's just the first step, right?

19:27To go from amino acid to structure,

19:29then there's multiple protein interactions.

19:32Like, how do you get to the virus?

19:34- Well, so that's what the ultimate goal

19:37of getting a structure is, that then you can do experiments

19:39and figure out what the structure means, right?

19:42So many, in the old days,

19:44structural biology was a career in itself.

19:48You worked with people who had a system

19:49and just solved proteins for them,

19:51and then you moved on to another one.

19:52You didn't really do any experiments.

19:54The other people got to do all the interesting experiments.

19:56Now, young structural biologists are multifaceted.

20:01They solve the structure, and then they say,

20:04"What happens if we change this amino acid?

20:06"Oh, look, it blocks binding to the receptor.

20:08"This must be the receptor binding interface."

20:11So that's the exciting stuff, absolutely,

20:13is doing the experiment.

20:14- I wonder if you can do some kinds of simulations

20:18of different proteins or multi-protein systems

20:23going to war against each other,

20:26like to try to figure out...

20:29Reinforcement learning is used in AlphaZero, for example,

20:35to learn chess and Go,

20:37and that's using the self-play mechanism,

20:39where the thing plays against itself

20:41and learns better and better.

20:42I wonder if you can simulate almost evolution in that way

20:46for primitive biological systems,

20:49have them in simulation fight each other,

20:52and then see what comes out,

20:53like a super dangerous virus comes out,

20:55or super Chuck Norris type of thing

20:58that defends against the super dangerous virus,

21:00and it's all in simulation.

21:01- So an example would be,

21:04we have all these variants of SARS-CoV-2 arising, right?

21:07Which look to be selected by immune responses,

21:12but we know what amino acids are changing in the spike,

21:17and how they block antibody binding.

21:19You could simulate that.

21:20You could say, "What is the antibody looking at?"

21:24Where antibodies bind on proteins are called epitopes,

21:27right?

21:28You could map them all and change them in a simulation

21:30one by one, and go back and forth

21:32between the antibody and the virus.

21:33So all these, evolution is what we call an arms race, right?

21:38The virus changes, and then it evades the host,

21:41and then the host can change.

21:43The host takes longer to change though, unfortunately.

21:45It takes geological time, but it can,

21:47and then the virus can change,

21:49and it can go back and forth.

21:50And we can see evidence of this in genome sequences

21:54of both viruses and their hosts.

21:56And so you can take a protein in a host

22:00that is a receptor for multiple viruses,

22:02and you can see all the impacts of virus pressure on it,

22:05and you could simulate that for sure.

22:07And that's just one thing that you could do.

22:08You could simulate changes in, say, an enzyme

22:13that makes it resistant to a drug,

22:15and predict all the drug resistance.

22:17But the problem is, people like me,

22:21the experimental virologist, don't know how to do

22:23any of that, so we need to collaborate with people.

22:27I guess-- - Oh, with other humans.

22:29- We do that, we do that. - Okay.

22:31- But with people from a field that we're not used to,

22:35I suppose people who, would it be AI, I suppose?

22:39- Yeah, machine learning people.

22:39- Machine learning people, and you would say,

22:42"Look, this is the biological problem.

22:44"Is there a way we can use your tools to attack it?"

22:46- The problem is those people are antisocial introverts

22:51that have a place like this, and try to hide

22:55from other people in the world.

22:57It's very difficult to find in the wild.

23:00- Okay, so outside of doing amazing,

23:02brilliant lectures online, you host and produce

23:07five, I would say, related podcasts,

23:10including my favorite this week in virology,

23:14also this week in parasitism,

23:17this week in microbiology, and so on.

23:19So you're a good person to ask,

23:21"What are the categories of small things,

23:24"small biological things in this world that can kill you,

23:27"kill us humans?"

23:30- You said most viruses are friendly,

23:34or at least not unfriendly,

23:36but let's look at the unfriendly ones,

23:39in viruses and bacteria and those kinds of things.

23:42When you look at the full spectrum

23:43of things that can kill you,

23:45can you kind of paint a brief picture?

23:47- Yeah, I think the big picture is that

23:50the things that can kill you are a minority

23:52of everything that's out there.

23:54And we're talking about molecules.

23:57So we have in us proteins that can kill us,

24:00prions, that are just, it's a protein in us,

24:04and if it misfolds, it makes all of its other copies

24:08misfold, and then you die of a neurological disease.

24:11That's pretty rare.

24:12So there are proteins, there are viruses.

24:16As I said, only certain ones can kill us.

24:20But even if we get those from animals,

24:23it's not straightforward.

24:24If you look at SARS-CoV-2, right?

24:26This is probably a once in 100 year pandemic, I would say.

24:31Equivalent to 1918 in its devastation.

24:34And in between there have been smaller pandemics

24:36of other viruses, but it doesn't happen all that often.

24:39So we have a lot of viruses, we have a lot of bacteria

24:42of various sorts that can cause infections in us.

24:46And it's a limited number, right?

24:49You're streptococci and staphylococci and clostridia,

24:52we could go on and on.

24:54But we know how to handle those,

24:56as long as we have antimicrobials.

24:58It's just that we abuse them and we get resistance,

25:00so that can be a problem.

25:02Then we have fungi.

25:04Not mushrooms, but much smaller fungi

25:06that multiply submicroscopic,

25:09or just at the microscopic level.

25:11They can, in dry climates of the US,

25:13you can inhale their spores and they can grow in your lung

25:16if you're immunosuppressed and so forth.

25:18So those are the tiny guys.

25:21And then we have parasites,

25:22which we do this week in parasitism,

25:24where single cells, even worms of various sorts,

25:29can invade you and cause all sorts of problems.

25:33- I was kind of terrified to listen to that podcast.

25:37What's it like?

25:39- What you learn is that you travel somewhere

25:46and you can get infected and bring it back home.

25:48Here in the US, we do have certain kinds of parasites,

25:52but because of our lifestyle,

25:54we more or less have avoided them.

25:56For example, there's a parasite called toxoplasma,

26:00which is infected most of the world, actually,

26:03because a lot of people like to eat raw meat

26:06and you would get it from raw meat.

26:08And we're not as fond of that here in the US.

26:12We like to cook our meat,

26:13but that could be a consequence of eating raw meat.

26:16- Is that what leads to, what is it called, toxoplasmosis?

§04Transcript · 26:19–34:09

26:19- Yeah, so toxoplasmosis,

26:22it's mainly a big issue is if you're pregnant

26:27and you get toxo,

26:28then your fetus is gonna be very badly malformed.

26:32It's gonna have brain defects and so forth.

26:35And animals can get it as well.

26:39So there are a lot of parasites of that nature,

26:41which you often acquire by food,

26:43eating food of different sorts.

26:45And it usually happens elsewhere.

26:46We just, on this week in parasitism, we do a case.

26:50So Daniel Griffin is a resident physician.

26:54He's a doctor, a real doctor, right?

26:56And every month he comes up with a case.

26:58Okay, this is a person I saw.

27:00And last month this young lady had traveled somewhere

27:05and she ate raw fish.

27:09It was somewhere Southeast Asia or something.

27:11And she ended up with red bumps all over her skin.

27:15And it turned out it was a parasite from the fish

27:17that moved around in her.

27:19And they're very easy to cure.

27:21We have the right doctors and the right drugs.

27:23You can cure all these.

27:24- What about diagnose?

27:26Like connect the red spots to the fact that it's a parasite?

27:28- Very easy if you have the right diagnostics.

27:31Now Daniel often goes to parts of the world

27:33where they don't have diagnostics

27:34and he has to use other mechanisms.

27:37He may have to take a bit and look at it under a microscope.

27:40And then he may not be able to get the drug

27:41depending on where he is.

27:43But often he sees patients who come back to the US

27:47and they get diarrhea or they have a fever.

27:49And he says, "Where have you been?"

27:50And he can put two and two together.

27:52And so we let our listeners do that

27:53and they all send in guesses.

27:55And it's wonderful to hear them go through this.

27:57So there are a lot of parasites--

27:58- Solve the puzzle and solve the case study.

27:59- That can get you.

28:00You have to be careful about eating when you go overseas.

28:03- And water too?

28:04- Water as well.

28:05And in parts of Africa there are parasites in the lakes.

28:09And if you go swimming they can invade you.

28:11And in fact they can go into your hair follicles

28:14and burrow in and get into your bloodstream.

28:15- That's exciting.

28:16So Daniel is interesting 'cause he's very adventurous

28:20and he's not afraid of any of this.

28:22So there's a famous lake in Africa, Lake Malawi,

28:26which harbors a lot of these parasites.

28:28And he said, "Oh yeah, yeah, I just make sure

28:30"I towel off vigorously when I get out."

28:32(laughing)

28:33- Vigorously.

28:34- Get rid of them.

28:34And that was the name of an episode.

28:37But you know food is--

28:38- Towel off vigorously?

28:38- You know sushi, you can get worms from sushi.

28:43And the solution is to freeze it.

28:46And many sushi restaurants now have liquid nitrogen.

28:49They snap freeze their sushi

28:51and that kills all the parasites.

28:53And a study was actually done in Japan

28:56showing that freezing does not alter the taste of sushi

28:59because it's--

29:00- Uh-oh.

29:00- Except for you see a big industry there.

29:01- Wow, that's brilliant.

29:02(laughing)

29:03That's brilliant.

29:04Yeah, I was thinking about, you know,

29:07I'm so boring and bland,

29:09especially when I'm now in Texas here

29:12and I've been eating quite a bit of barbecue.

29:14I realized I really haven't explored the culinary world.

29:18And I've been curious to travel and taste different foods.

29:22Is there something you can say by way of advice,

29:25you know, channeling Daniel, I guess,

29:28if you were to travel in the world,

29:31if eating is the thing that gets you the parasites,

29:34what's good advice for eating in strange parts of the world,

29:39Mongolia, India, China?

29:41Is there something you could say by way of advice?

29:43- I think Daniel would say

29:45make sure your food is cooked, right?

29:47- Cooked, but that's so boring.

29:49- Yeah, it's unfortunate.

29:50And he would agree with you

29:52because, you know, many vegetables are delicious.

29:55Salads even are delicious, not cooked,

29:57but they can have parasites in them.

29:59Meats, fish, people like to have uncooked fish.

30:04So if you wanna be really safe and boring,

30:06just make sure everything is cooked.

30:07Now we have a case this week on Twip

30:11of a young man who went,

30:13I forgot where he went, but he stayed in a hotel.

30:15I think, oh, Oaxaca, Mexico.

30:17- Mm-hmm.

30:18- Stayed in a hotel.

30:19And he said, he came back with diarrhea and fever.

30:23And he said, "I don't know where, I stayed in the hotel.

30:26"I just ate hotel food, lots of vegetables and fruits."

30:30And probably they weren't washed with clean water,

30:32you know, he got something from that.

30:34The bottom line is most of these infections

30:38with parasites can be diagnosed,

30:40and you can be treated, and you'll be fine.

30:42So if you really wanna experience the cuisine,

30:47I don't think you should worry about it.

30:49That's what Daniel would say.

30:50- Let's return to the basics.

30:51We're gonna jump around all over the place.

30:54What are the basic principles of virology?

30:58Maybe a good place to start is what is a virus?

31:02- That's great.

31:03I mean, I talk in my first lecture for 20 minutes

31:05before I get to that.

31:06And I wonder if I should put it up front,

31:10but it's kind of a boring definition.

31:12So if you do that, first people will turn off.

31:14So first you tell them about all the millions

31:17and billions of viruses around.

31:18So a virus, we have a very specific definition,

31:22'cause it's different from everything else on the planet.

31:25'Cause first of all, it's a parasite.

31:28A parasite means you take something from someone else.

31:33You know, we have human parasites

31:35who take money from others, right?

31:36But in biological terms, a parasite takes something

31:40from the host that the host would otherwise use energy

31:44or some building block or something.

31:46- There's never really a symbiotic relationship

31:48between a virus and a host.

31:50- Well, there can be.

31:51So that's the dichotomy, I think,

31:53is that we define them as parasites.

31:55Yet, I just told you 20 minutes ago

31:58that many viruses are probably beneficial.

32:01So I think what it means is at some point

32:04we're gonna have to change our definition, right?

32:06Because after all, definitions we make

32:10are just constructs that make it easier for us to study,

32:14that don't necessarily represent what's right.

32:16- Yeah, like Pluto was a planet at first,

32:20and now it's not a planet anymore,

32:21and a lot of people are very upset.

32:23- But it's only according to us.

32:24There may be another race living somewhere else

32:27who thinks it's a planet, right?

32:28- Well, maybe that's why viruses are attacking humans.

32:30They're very angry.

32:31They weren't calling them parasites.

32:33- So right now our definition includes parasite

32:37because a virus cannot do anything without a cell.

32:41If this mug were full of viruses,

32:44it would not do anything for years.

32:46It would eventually probably lose its infectivity,

32:49but it's not gonna reproduce here.

32:50It needs cells.

32:52And to the first people who discovered viruses,

32:54that was astounding that they didn't just reproduce,

32:57divide on their own like bacteria.

32:59So a virus needs to get inside of a cell, inside the cell.

33:03It can't just hang around on the surface.

33:05It needs to get in in order to make more of itself.

33:09And so we call it an obligate intracellular parasite

33:13because it needs to get in a cell,

33:15and then it takes things from the cell

33:17in the form of all kinds of molecules and processes

33:20and energy and so forth to make new viruses.

33:23- Obligate means it's obligated to be inside the cell.

33:26- Absolutely.

33:27It will not reproduce outside of the cell.

33:30So this mug of viruses can in no way be living,

33:35in my opinion.

33:36However, once it gets inside of a cell,

33:39now the cell is a virus-infected cell.

33:41It's alive.

33:42So a virus, in my view, has two phases, right?

33:45It's this non-living particulate phase

33:48that everyone is used to.

33:49I'll send you, you need a virus for your table.

33:52I'll send you a nice model.

33:54I think it would look good here.

33:55- Which, yes, definitely.

33:56- You don't have to go with all this other stuff.

33:57- Yeah, well, these are all mechanical.

33:59There's no biology here.

34:01- So you wouldn't want a virus here?

34:02- No, I'd want a virus, of course.

34:04- I'll send you one and then you can look at it.

34:06'Cause now that we have the three-dimensional structures

34:09solved by structural biologists,

§05Transcript · 34:12–42:20

34:12we take the coordinates and we put it in a 3D printer

34:14and you can make amazing models, right?

34:16Of any virus.

34:18- And so there's a huge variety of viruses?

34:21- Huge, that we know of,

34:23which is only a fraction of what's out there.

34:24- What's the category?

34:25So there's RNA, there's DNA viruses.

34:27What are those?

34:29What's DNA and RNA?

34:30- Two broad categorizations.

34:33RNA, these are genetic material.

34:36Can be two different chemicals.

34:39So RNA, everything else on the planet besides viruses

34:43is all DNA-based.

34:44You and I are DNA-based.

34:45Everything on the planet today is DNA-based,

34:47except some viruses are RNA-based.

34:50And that's because, as I mentioned earlier,

34:53the first life that arose on the planet was RNA-based.

34:57- Yeah, so these are like old school viruses.

34:59- These are old school.

35:00We call relics, yeah.

35:02Relics, and this has got a name.

35:04It's called the RNA world, which I think is great.

35:06- Is it big still, or are the relics dying out?

35:09- Oh no, the relics, in my opinion,

35:11are the most successful viruses, the RNA viruses.

35:14And SARS-CoV-2 is an RNA virus.

35:16We can talk about why they're so successful.

35:19But you have, broadly speaking, viruses with RNA,

35:22genetic information, which are relics.

35:24Of course, they're contemporary.

35:26They have adapted to the modern world

35:28and the modern organisms living in it.

35:31And then we have DNA-based viruses,

35:33which are extremely conservative and slow.

35:36They're very successful.

35:37Everyone has a herpes virus infection,

35:40but they don't get the news like the RNA viruses do.

35:44The HIVs and the influenza viruses

35:46and the SARS coronaviruses, they get all the press,

35:49and they're RNA-based,

35:51'cause RNA lets you change more so than DNA.

35:54- So they evolve much faster, the RNA viruses.

35:57- Much faster.

35:58And in fact, when I have a lecture on evolution,

36:01I don't know if you've listened to that when you should.

36:04It's really, I think it's really interesting.

36:06RNA viruses exist at their error threshold,

36:12which means they can't make any more mutations

36:17when they reproduce, otherwise they're dead.

36:19They would go extinct. - Wow.

36:20- They're evolving at their error threshold.

36:23DNA viruses are hundreds of times lower

36:26than their error thresholds.

36:28And we know this.

36:29We can do an experiment to find that out.

36:31Now, why that is is a good question.

36:33But that's the reason why RNA viruses

36:38are far more successful.

36:39They infect many more hosts,

36:41and they're very, I would say, slippery.

36:44They can change hosts really quickly,

36:46because in any animal harboring an RNA virus,

36:49like let's say a bat in some cave somewhere,

36:52it's not just one genome.

36:55It's millions of different genomes of all kinds,

36:58all within the framework of, say, coronavirus,

37:01but they're all different.

37:02And one genome in there might just be right

37:04for infecting a person if it ever encountered that person.

37:08I mean, that's the thing that--

37:09- Or there could be a large number.

37:11There's a tiny fraction, but a large number of them.

37:15And they're all operating at the threshold of error.

37:18- That's right. - That's fascinating.

37:19It's like little, it's like startups,

37:21little entrepreneurs, like a startup world.

37:23- Yes, and many of them fail.

37:25- Yeah, many of them fail. - Many of the changes fail.

37:26- And then there's the DNA viruses

37:27that are like the IBM and the Google.

37:29- Exactly, exactly. - The big corporations.

37:31- It's very good, I like that. - They become conservative

37:33with the bureaucracies and all that kind of stuff.

37:35- And a lot of baggage. - Yeah.

37:36- Yeah, it's expensive for them to reproduce, yeah.

37:39And they don't move quickly.

37:40Yes, the RNA viruses are the fast-moving members.

37:43So that's what a virus is.

37:45We call them oddly intracellular parasites.

37:48And then I told you there's DNA and RNA,

37:50but then let's go further.

37:52The nucleic acid's not naked,

37:54because naked nucleic acid in the world isn't good.

37:59I mean, it existed in the pre-cellular world,

38:03but there probably weren't a lot of threats to it then.

38:07Naked nucleic acid doesn't last long in the environment.

38:09So they're covered, the nucleic acid is covered.

38:12It can be covered with a protein shell, a pure protein shell,

38:15or it can have a membrane around it,

38:19which would be lipids from the host cell.

38:22- So lipids, so it's a fatty membrane.

38:26- Fatty membrane, yeah.

38:27So our cells are coated with fatty membranes, right?

38:30Our cells, the outer plasma membrane, right?

38:32That's the same-- - But viruses can be too.

38:34So they're kind of like cells,

38:35but without the ability to do the mitochondria stuff.

38:38- Some are, some are.

38:39They don't have nuclei, they don't have mitochondria.

38:42But they do have a nucleic acid, they have a membrane.

38:46And then, of course, there's spikes in the membrane

38:48that allow them to attach to cells.

38:51And so that completes our two different kinds of viruses.

38:53- So they all have attachment mechanisms,

38:55like ways to, like keys into the--

38:59- They all have to get into cells.

39:01There are a couple of exceptions, though.

39:05There are viruses of fungi and plants.

39:10So let's do the fungi.

39:11Fungi would be like yeast.

39:14The yeast cell wall is pretty hard to get through.

39:18So viruses typically don't attach to a yeast

39:22and get inside.

39:22Rather, they just live in the yeast forever.

39:25And they multiply as mostly nucleic acids,

39:28and as the yeast divide, they go into the daughter cells.

39:31And that's how they exist.

39:32Plant viruses, also the plant cell wall,

39:35would be very hard to get across by binding a protein.

39:40So plant viruses get into plants

39:42either by pests that inject them in.

39:47They're sucking sap out,

39:48and they inject virus at the same time.

39:49Or farmers, they have contaminated farm equipment,

39:52and they roll over the plants and introduces viruses.

39:55So those fungi and plant viruses,

39:57they don't have this specific receptor binding

40:00to get them into the cell.

40:01But everything else, yeah, the virus binds

40:03to something on the surface, very specific.

40:05It's taken into the cell, because that's what cells do.

40:09When things bind their exterior, they take it in.

40:12'Cause in most cases, it's good.

40:14It's something they need.

40:15And so the virus slips in.

40:17I guess you'd call that a Trojan horse, right?

40:19- Trojan horse.

40:20It's so hard to not anthropomorphize this whole thing.

40:23- It is hard.

40:24- So obviously, they don't know any of this.

40:26It's not an actual Trojan horse.

40:29So they're not getting actually tricked

40:32in the way humans trick each other.

40:34- No, it's all passive.

40:35And it's just, through so many years of evolution,

40:38you select something that works, and it continues.

40:42And what survives then goes on

40:44with perhaps a slightly different approach.

40:48- I love this idea of passive.

40:49Of course, according to Sam Harris,

40:52so for a sufficiently intelligent alien civilization

40:54observing humans, our behavior might seem passive too,

40:58'cause they understand fully exactly what we're doing.

41:00And then there's no free will,

41:02and we're all just operating in the same way a cell does,

41:05but just a much higher level of complexity.

41:07- Yeah, so I love the distinction

41:10between active and passive.

41:11- I mean, the point is, I think anthropomorphizing

41:14to a certain extent is fine,

41:15'cause it helps people understand.

41:17But when you start to say,

41:19I think the virus is doing that

41:21because then you're putting a human lens on it,

41:24and you may be wrong.

41:26Because you don't know why things happen for a virus.

41:29So right now, we have variants emerging,

41:33and people say, well, I think it's because the antibodies

41:35are selecting for variants.

41:38That's a good idea,

41:39but it may not be the only thing that's going on.

41:41- You start imagining them coming to the table negotiating.

41:44Yeah, you get into trouble with that.

41:48- That's why I tell my students,

41:49be careful about the anthropomorphizing,

41:51because you're gonna apply your values to a virus,

41:55and you have different value.

41:57You're a human, and what you think is the reason

42:00for this outcome may not be right, that's all.

42:02Just be open-minded about it.

42:04- In both directions.

42:05I actually, one of the things I push back on

42:08is in the space of robotics,

42:10most people in robotics try to not anthropomorphize.

42:14For example, they don't give a gender or a name to robots.

42:17They really try to see it as a machine.

42:20And to me, that makes sense in one way,

§06Transcript · 42:23–50:41

42:23but it totally doesn't make sense in another.

42:25If that robot is to interact,

42:27operate in the human world and interact with humans,

42:30we have to anthropomorphize it

42:33in order to understand as an engineering problem,

42:37how should it operate in a human world?

42:42Now, the difference with viruses, the scale of operation,

42:46it doesn't make sense to treat them as human-like,

42:49'cause the scale of operation is much smaller.

42:51But with robots, you're in the same time scale,

42:54the same spatial scale.

42:55- Of course, in the movies,

42:56they always give them names and personalities.

42:58- Yeah, well, yeah, that's the,

43:00but that's my argument, is we should do the same

43:03when you're trying to solve

43:03the engineering problem of robotics too.

43:06It's not just for the movies.

43:07Well, let me ask you this,

43:08because you've said controversially, not really,

43:12that viruses are not living.

43:14Defend yourself.

43:18(laughs)

43:19So are viruses alive or not?

43:20- So I've seen many people say, oh, they have to be.

43:22They have nucleic acids, they evolve, they mutate.

43:27That's all true, but they don't do it on their own.

43:29The particles in my mug are just not doing any of that

43:32unless they get into a cell.

43:33So a virus-infected cell is alive.

43:36I totally agree with that,

43:37because in fact, when a virus gets in a cell,

43:40it converts it into a virus-making factory, if you will.

43:45It's no longer a cell.

43:47Some people call it a virus cell.

43:48I don't really like that, but it's fine.

43:51So that's what I'm talking about.

43:53The particle is not alive.

43:54You can have your virus-infected cell as alive,

43:57but the particle, it just would not do anything

44:01forever without getting inside of a cell.

44:03But once it's in a cell, it is alive then,

44:07but it's no longer a particle.

44:08It's taken apart and nucleic acid is moving

44:10around the cells, making proteins.

44:12Eventually it makes new particles.

44:14And then those particles released from the cell,

44:16they're not living anymore.

44:17So I think it's kind of like a spore,

44:21a spore of a, or a seed.

44:25Although the seed doesn't work because the seeds,

44:28the cells in the seed have the ability

44:29to make their own energy and so forth.

44:31But a bacterial spore, and it's the same thing,

44:34doesn't do anything unless you add water and nutrients

44:36and then it starts to divide.

44:37But it doesn't need to get into a cell.

44:39It's very different from a virus.

44:40So that's why the particle.

44:42And when people think of virus,

44:44they're always thinking of the particle.

44:47And that's why I say it can't be alive,

44:49'cause the particle can't do anything on its own.

44:51But if you think of a virus as an organism

44:53with a particle phase in a cell,

44:55then it makes sense to be alive.

44:58- And by the way, when you say particle,

44:59you're referring to that structure

45:01that you've been mentioning, some kind of membrane or not,

45:03that has been called, what is that,

45:05a viron particle or something?

45:06- Virion. - Virion.

45:07- So what you should have here, I'll send you one,

45:10and then you can refer to it.

45:11- What's the sexiest one to have?

45:13Like what, in terms of particles to have on a table?

45:17- Well, unfortunately the ones that you can 3D print.

45:21- Oh, they're not going to be super--

45:23- They're the ones that we know the structures of, right?

45:26So someone sent me last year a 3D model of SARS-CoV-2,

45:31and it's beautiful.

45:32It's actually cracked open so you can see the RNA,

45:34and the spikes are sticking out,

45:37and they even put some antibodies sticking onto the spikes.

45:40- That's super cool. - I mean, when I show this

45:42on a livestream, people love this.

45:43They go, "Oh my God, that's beautiful."

45:44It is, it's absolutely gorgeous.

45:46I have that, I have my virus that I worked on

45:49most of my career, poliovirus, I have a 3D model of that,

45:52which I actually just had made.

45:54It's gorgeous, and you can have it made

45:56in any color you want, right?

45:57- What would you say is the most fascinating,

46:01terrifying, surprising, beautiful virus to you?

46:05So of all the viruses you looked at,

46:08sometimes when you just sit late at night

46:10with a glass of wine, looking over the sunset,

46:13which virus do you think about?

46:16- So fulfilling all of those adjectives is hard, right?

46:21Fascinating, exciting, terrifying.

46:24- Well, the terrifying is an optional one, I think,

46:27'cause maybe that puts a lot of pressure.

46:30- I'd say terrifying, to me, I'm not terrified

46:34because I think we can handle most viruses,

46:37as you see with this brand new one

46:39that emerged a year ago, we can handle it.

46:42- From a virology perspective.

46:44- Yeah, I mean, the human perspective

46:45is a different story, right?

46:46That's always an issue, but.

46:49So I think there are a couple

46:52of different categories of virus.

46:55So we could do the terrifying,

46:57and I think rabies is a terrifying virus

47:00because unless you're vaccinated,

47:02100% certainty you're gonna die.

47:04So you get bitten by a rabid raccoon or bat or dog,

47:09whatever, and there's still 70,000 deaths a year

47:14of rabies throughout the world

47:16because there are a lot of feral dogs running around

47:18that are infected, unless you're vaccinated,

47:20you're gonna die, there's nothing we can do.

47:23But we do have a vaccine which we can actually give you

47:26even after you've been bitten,

47:27which is the only vaccine that works that way.

47:31It's a therapeutic, right?

47:32It will treat your illness

47:34'cause the disease takes so long to develop.

47:37Eventually you get all kinds of neurological issues

47:41and paralysis and so forth, but it takes time

47:44and you can be vaccinated,

47:45it will prevent that in the meanwhile.

47:47So people always say, what's the most lethal virus?

47:50Is it Ebola?

47:51I said, no, it's actually rabies.

47:53Unless you're vaccinated, it will kill you.

47:55- Maybe it's good to linger,

47:57'cause we'll talk about vaccines a few times today.

48:01It's good to linger on cases where vaccines

48:05have clearly, undoubtedly helped human civilization.

48:10And it seems like rabies is a good example.

48:15- No, rabies is great because everyone knows

48:18what happens when somebody gets rabies, right?

48:21You have fear of water, hydrophobia,

48:24your body becomes spastic and stiff and jerks around

48:31and you lose consciousness, you can't, no more--

48:35- It's not a fun ride to death.

48:36- It's horrible, it's a horrible way to die.

48:39So I think most people know that,

48:40it's been popularized enough in media, right?

48:44So that nobody would probably object to getting,

48:47oh, I was just bit by this raccoon and it ran off.

48:51Okay, well, we should assume it's rabid,

48:53we should immunize you, and most people are okay with that.

48:56'Cause they know the consequences.

48:57And it's also pretty rare, right?

48:59It's not like something that you're trying

49:01to get into the arms of 250, 300 million Americans,

49:06that's hard, but the few thousand every year, it's easy.

49:11- So the transmissibility is difficult, right?

49:13It has to, oh, it's not airborne, so--

49:16- It's not airborne, it just, you have to be bitten.

49:19Although some people claim you could walk into a cave

49:24and the bats breathing out rabies virus could infect you,

49:28but I don't really think that's well substantiated.

49:32I think it's a bite.

49:33- How would you do a study on that?

49:34- Yeah, it's very hard to do.

49:36You'd have to collect the vapors in the cave

49:38and show that they're infectious, which,

49:40and by the way, someone emailed me the other day,

49:43you'll like this, they said,

49:44"Why can't we just immunize all the bats in the world

49:47against these viruses?"

49:49And I said, "Well, how would you do that?

49:50There are caves everywhere, right?"

49:52- Yeah.

49:53- He said, "Well, maybe you could just go and aerosolize."

49:56- Yeah.

49:57- It's pretty dangerous.

49:58- And then all the bats should have vaccine passports

50:01to make sure that they're all--

50:02- Yeah, and so you have to get their consent

50:03before you do it.

50:05But we do immunize wildlife against rabies.

50:12We have rabies vaccines for wild animals.

50:15There are a whole bunch of them that get rabies.

50:17And we put it in bait and drop it

50:20from helicopters in the woods,

50:21and it drops down the incidence of rabies in people.

50:24- Wow.

50:25- You know, people hiking get bitten and so forth.

50:27It drops the incidence, so we can do that.

50:28- I didn't know that.

50:30I always wondered how much medical care

50:32we're doing for animals in the wild,

50:34because I've recently become more and more aware

50:37that animals are living in extreme poverty.

50:41- Mm-hmm.

§07Transcript · 50:41–59:03

50:41- Like, you don't know, you think, like, natural,

50:44it's great, you know, like,

50:47like when animals are living on a farm, it's terrible.

50:51But then you also have to compare to, like,

50:53what life is like in the, or like the zoo.

50:56You have to compare what life is like in the wild.

50:58- Well, life in the wild is very tough, I think.

51:01Most animals have to, well, the carnivores anyway,

51:03they have to catch their food every day, right?

51:06- And then there's the viruses there.

51:08- They have viruses as well.

51:09- So the rabies immunization is the only

51:12one I'm aware of for wild animals.

51:16We do immunize lots of other animals.

51:20We immunize chickens and pigs and cows,

51:24even fish, farmed fish, we pick each fish up

51:28and give it an injection, you know, when it's a small fish.

51:31But that's mostly so that the farmers get a good yield.

51:36We don't really care about the animals, right?

51:38We want a good yield for market.

51:41And then there's some examples where we immunize animals

51:46to prevent spillovers into people.

51:48So there's a disease called Hendra in Australia,

51:53which was discovered in the '90s,

51:57and it turns out there are bats,

51:58fruit bats, that have this virus.

52:01The bats are fine, but sometimes they fly into horse stalls

52:05and the horses get infected.

52:06These are, in Australia, it was initially race horses,

52:09which are very expensive, right?

52:11The horses got infected and they died,

52:12and the humans who would take care of them would die also.

52:15So now they immunize the horses to prevent,

52:19well, to save the horses.

52:20Probably that's the motivation,

52:21'cause these horses are hundreds of thousands of dollars.

52:24And then the people don't get sick

52:25because the horses don't get sick.

52:27You don't wanna immunize all the people

52:29because it's too rare, but that approach

52:31is called the one world health approach,

52:33which means everything's connected on the planet,

52:37and we have to think of everything in the grander scheme,

52:39not just us.

52:40- Yeah, so you can immunize some things

52:42along the trajectory that a virus would take.

52:44- Exactly.

52:45- So not some things, some living beings.

52:48- In the Arabian Peninsula,

52:49they have a MERS coronavirus issue every month.

52:52There are a couple of cases where a camel

52:55will infect a human, and the human can get very sick.

52:59It's a respiratory disease, very much like COVID.

53:03And so camels are very common there.

53:05They're raced, they're used as pets, they're eaten.

53:10So there's a lot of human-camel contact,

53:12but the number of cases are rare to a month,

53:15so you don't wanna immunize all the humans,

53:16so the idea would be to immunize the camels.

53:18So--

53:21- (laughs) I like it.

53:21So, okay, so you put rabies,

53:23but Ebola also is a famously deadly one.

53:28- Right.

53:30- What is it?

53:31I don't know, 50, 60% of it's--

53:33- Could be 50 to 90, but that's in Africa,

53:37where the healthcare isn't great.

53:38You saw when cases of Ebola came to the US,

53:42we could take care of it.

53:43We knew how to take care of it.

53:45We had fancy hospitals and so forth,

53:46and now we have a vaccine.

53:47So we can, and the vaccine is really good,

53:52but there are many governments in Africa

53:54that are suspicious of us,

53:56and they don't wanna use our vaccine, so they--

53:58- So there's a vaccine for Ebola.

54:00- There is, yeah.

54:01- And the effectiveness and safety of it,

54:05how much is understood?

54:06- So this is difficult because there's not a lot of Ebola.

54:11It's not a continuous, ongoing thing.

54:14There are sporadic outbreaks here and there.

54:16- Of a few thousand people.

54:17- At most, at most, usually a few hundred,

54:19and the biggest ever, in fact,

54:23this is why we didn't for years have an Ebola vaccine.

54:25The US military, together with Canada,

54:27developed an Ebola vaccine for service people.

54:30They wanted to say, "Well, we're sending people

54:32"into these Ebola areas.

54:33"We want a vaccine for them."

54:34So they had developed it through all the preclinical,

54:38which means before it goes into people,

54:41and that stopped because there was no money

54:43to do a phase one and a phase two and a phase three.

54:46In fact, for phase two and three,

54:47you need to have infections going on

54:49'cause you're looking at how well

54:50the vaccine prevents infections, right?

54:53So then there was a West African outbreak in 2015,

54:572013, 2015.

54:58The most cases ever, 25,000.

55:00So they got to test the vaccine,

55:02but they only put it in a few thousand people.

55:07It's not like it's been in hundreds of thousands of people

55:10like the COVID vaccines has been.

55:12So it looks like it has high efficacy,

55:15but we'd like to have more data.

55:18Side effects maybe are not so great.

55:21There are a couple of different available vaccines.

55:23Some have been tested more than others.

55:25I would say this would probably not be

55:28widely accepted in the US.

55:31- But then neither would be something

55:34over 50% deadliness of a virus.

55:38- No, I think if you were,

55:39in fact, many physicians work in countries

55:42that have Ebola, so they get vaccinated

55:44because they understand the choice.

55:46- Yeah, right, it's always about the choice.

55:48So--

55:49- So then one more thing to answer the interesting,

55:53what are some of the viruses you really are fascinated by?

55:57There are a number of viruses that have clearly been shown

56:01to alter host behavior, and that's how they spread.

56:04I think those are fascinating.

56:05For example, there's some viruses of plants

56:09that are spread by aphids,

56:13and the aphid bites the plant,

56:16the virus reproduces in the plant,

56:18then it somehow engineers the plant

56:21to give off volatile organics to attract more aphids,

56:26which will spread the virus.

56:28Isn't that amazing?

56:31- Yeah.

56:32- So that's altering the behavior.

56:34(laughing)

56:35Altering because somehow the virus infecting the plant cells

56:38gives off these organics and attracts aphids.

56:40And furthermore, somehow when the aphid bites,

56:44it tastes horrible, so they immediately leave

56:47with the virus they've just picked up

56:49and go to another plant to spread it.

56:51So they're attracted and then repulsed at the same time.

56:53- And obviously you don't want to anthropomorphize this,

56:55like a strategy they're taking on.

56:57Somehow this worked out.

56:58- It worked out this way.

56:59It just evolved.

57:00And you know, evolution is sometimes hard to trace, right?

57:04Like Darwin famously said, he could never figure out

57:07how an eye evolved from a single cell, right?

57:09But it did.

57:11- The more complicated, complex the holistic organism is

57:16that the virus invades, the less able it is

57:19to control that organism, right?

57:21So I wonder if there's viruses that can control

57:23human behavior, you know, to induce more spread of the virus.

57:28- Well, I don't see why not.

57:34- There's not enough humans, I suppose,

57:35to like evolve through.

57:37- Well, we can't do the experiment to test it, right?

57:39We have to observe.

57:40And that's always hard when you're observing

57:41'cause there's so many things that can confound

57:45what you're looking at.

57:45- Yeah, change human behavior, yeah.

57:47- I mean, there's so many things that impinge

57:49on our behavior, but yeah, I think it's possible.

57:54I think it's highly possible.

57:56If it does it in a plant, why not change

57:59some other organism's behavior?

58:00I think it's fine.

58:01Anyway, those fascinate me.

58:02There are lots of examples of those that are fascinating

58:06and how they work, people are trying to figure out.

58:08But there's not a lot of money to work on, you know,

58:10insect and plant viruses unless you're going to the USDA.

58:13So they don't get a lot of work moving forward.

58:17- Well, if you understand some of those viruses,

58:19is that transferable to human viruses, that understanding?

58:23- I think some of it could be, sure.

58:25I think the general principles, for example,

58:28how does the virus cause volatile organics to be made?

58:32It must be turning on some genes.

58:34And you could learn principles from that,

58:37how the virus might do that, sure.

58:39I think everything is broadly applicable.

58:41So to say it's not useful to study viruses

58:45of insects and plants is just wrong.

58:48Because in science, you probably know this,

58:50maybe in your field it's the same.

58:52If you're curious, you're gonna run into interesting things

58:55that you never planned on, right?

58:57- That's why people, like, you can criticize,

58:59why do we want to go on Mars?

59:01Why do we want to colonize Mars?

59:03Well, it's like, why do you want to go to the moon?

§08Transcript · 59:06–1:07:51

59:06The reality is when you do really difficult things,

59:10engineering things, like all these inventions

59:13along the way are created.

59:14It's kind of fascinating how basically just,

59:17pick a thing that everyone can agree is kind of cool

59:22and is really hard and do that.

59:24And then you'll have like thousands of inventions

59:26that have nothing to do with the thing.

59:28- That's right.

59:29I think you should let curious scientists

59:32just follow what they're interested in to a certain extent.

59:35You can't, you know, in science we say,

59:37we have translational research where we say,

59:39okay, here's some money, go cure cancer or diabetes

59:42or heart disease, whatever, right?

59:43And that's fine.

59:44But that often doesn't work out very well.

59:46What works better is to say, you have a good lab,

59:49you have a good track record, here's some money,

59:52do something, and that's where PCR, CRISPR,

59:55recombinant DNA, all that stuff

59:58which has made the field explode, that's all it came from.

60:00Not from people saying, I want to cure genetic diseases

60:04by gene editing, but by saying, what are these repeated

60:07things in this bacterium doing?

60:09- Yep.

60:11Can I ask you a big philosophical question?

60:13So there's these deadly viruses

60:17that are not very transmissible, Ebola, rabies,

60:21and then there's these less deadly viruses

60:23that are very transmissible, like COVID,

60:28I guess kind of borderline, but why isn't there

60:34super transmissible, super deadly viruses?

60:37- I think if you compare SARS-1 and 2,

60:40you get somewhat of an answer, right?

60:42SARS-1 was more deadly.

60:45In fact, over half of the time when people were infected,

60:50they ended up in the hospital 'cause they were that sick.

60:53And then the peak of virus shedding from them happened

60:58long after they went in the hospital.

60:59So it's easy to contain the infection

61:02when you're in a hospital, right?

61:04There was not much pre-symptomatic or asymptomatic shedding

61:10with SARS-1.

61:11- And shedding means you become infectious.

61:14- So in a respiratory virus, you inhale the droplets

61:17of the virus and they reproduce

61:19in your upper respiratory tract,

61:20what we call the nasopharynx, right?

61:22The nose and going back to that little cavity

61:24just above your mouth.

61:27So the virus reproduces really well.

61:28And then as you talk and sneeze and cough,

61:30you expel droplets and then those are inhaled

61:32by other people and then they reproduce.

61:35And for SARS-2, we now know there's a lot of reproduction

61:39just before you feel anything, if at all.

61:42So there's a lot of shedding and transmission

61:45before you get symptomatic.

61:47And as many people don't ever get symptomatic, right?

61:50So they spread really easily.

61:52So that explains why some viruses can transmit

61:56a lot better than others.

61:57And if one happens to knock you out,

62:00then you're never gonna transmit

62:01'cause you're in the hospital like SARS-1.

62:03- But why can't you have both?

62:05Why can't you just wait a while before it knocks you out?

62:08But when it knocks you out, it really kills you.

62:11- That is a philosophical question, right?

62:13Because we could talk about why we haven't observed it.

62:16I mean, one issue is that if you're killed too quickly

62:21by a highly lethal virus,

62:25you're not gonna transmit it very well, right?

62:28So Ebola can kill you quite rapidly.

62:31And most of the transmission occurs

62:33when people are being cared for at home or in hospitals.

62:38Doctors and nurses get virus, but people walking around,

62:41you're not walking around when you have Ebola,

62:43you're too sick.

62:45You have black bloody diarrhea, you're vomiting,

62:48you're bleeding from your skin and mucus membranes.

62:53You're not walking around, you're not going to parties.

62:55So I think that's part of it,

62:57that if the infection is too lethal,

63:00you're simply not a good transmitter.

63:02And I think transmission is probably

63:05one of the most powerful selection forces for viruses,

63:09because a virus always has to find a new host.

63:12If it doesn't, it's a startup that fails, right?

63:16If it doesn't find a new host, it's gone.

63:18And so anything that makes the virus transmit better

63:22is gonna help it.

63:23And if killing you, being less lethal is part of that,

63:27that works too.

63:28- So there's a strong selection pressure

63:30against being lethal.

63:32- I think there's a strong selection pressure

63:34against being lethal and being more transmissible.

63:38Those two seem to work in opposite ways.

63:41And now we don't have a lot of data to support this.

63:43This is kind of a thought experiment,

63:46but there is one experiment done in Australia

63:49many years ago.

63:51I don't know if you know this, but in the 1800s,

63:54the hunters in Australia imported a rabbit from Europe

63:57so they could hunt it,

63:58because the native rabbit in Australia

64:01was too fast for them, they couldn't shoot them.

64:03So they brought in this European rabbit

64:05and they reproduced out of control.

64:07Within a couple of years, they were everywhere,

64:10millions of rabbits in all the watering holes,

64:13and now they had a problem.

64:14So they decided to use a virus

64:16to get rid of these excess rabbits.

64:19And they used a virus, a pox virus called myxoma virus,

64:22which is a natural virus of a different kind of rabbit.

64:26But for these European rabbits, it was quite lethal.

64:28And it's spread by mosquitoes.

64:30So they said, "Okay, let's release this virus."

64:33And the first year, 99.2% of the rabbits were killed.

64:38But that 0.8% that were left had some form of resistance.

64:45They were variants.

64:46Every organism, not just viruses, makes mutants.

64:49And there were some variants of the rabbits

64:51that could survive infection.

64:52And then in subsequent years, the virus became less lethal,

64:56and then the mosquitoes had a better shot

64:59of transmitting it from one rabbit to another

65:01if the rabbit lived longer.

65:02That's the selection, probably.

65:04And so in the end, the rabbits lived on.

65:06The virus was there.

65:07It evolved to be more transmissible and less lethal.

65:11So that's the only-- - Life is amazing.

65:13- That's the only data. - Life on Earth is amazing.

65:15- It is, it is.

65:15If you take the time to look at it and see what's happened,

65:19it is amazing.

65:20- It's also humbling that it just makes you realize

65:22humans are just a small part of the picture.

65:25- Of course.

65:26And we're wrecking it, aren't we?

65:28- Well, I mean, that's, we're not really,

65:32I mean, viruses are wrecking it in some ways.

65:34Part of this, we're not really wrecking anything.

65:36It's all part of it.

65:38- But you know when, the ways that humans exist

65:41encourages viruses to infect us, right?

65:43When we were hunter-gatherers,

65:45living in bands of 100 people, very few viruses,

65:49because it was hard for the virus to go

65:51from one band to another.

65:53And perhaps a hunter would, one of these humans

65:55would get an animal and bring a virus into camp,

65:58and some people would die,

65:59but it would never spread to another.

66:02And then when we started to congregate in cities,

66:04we figured out agriculture and so forth

66:06and how to harvest animals.

66:07Then we could get bigger and bigger populations,

66:09and the viruses went crazy.

66:10And they went from animals to us.

66:12So measles went from cows to humans

66:15when humans learned to domesticate cows

66:17and started gathering in big cities.

66:20- Yeah, but now that humans are able to communicate

66:24and travel globally, the virus has become

66:28more and more dangerous, transmissible.

66:30Thereby, if you look at Earth as an organism,

66:33thereby pushing humans to be more innovative,

66:36create Alpha, Fold 2, and 3, and 4, and 5,

66:39create better systems, and eventually there's rockets

66:41that keep flying from Earth.

66:43And eventually the virus is becoming super dangerous

66:47and threatening all of human civilization,

66:49will force it to become a multi-planetary species,

66:52and its organism starts expanding.

66:54So I think it's a feature, not a bug.

66:55I don't know.

66:57- Well, I think that we have our early,

67:00probably most of the, we're studying viruses since 1900.

67:05Most of that time was because of diseases they caused.

67:09The first viruses discovered, yellow fever,

67:12virus smallpox, polio virus, influenza virus,

67:17those were all because people got sick,

67:21and they said, "Oh, look, this is a virus

67:22"that's associated with it."

67:24And so we got good at learning how to take care

67:28of these infections, making vaccines, and so forth

67:31over the years, and it's only in the last 20 years

67:33that we recognize that there are more viruses out there

67:36that are far more interesting, perhaps,

67:38but we've learned how to deal with the bad ones, for sure.

67:41- So we talked about what is a virus.

67:43We talked about some of the most dangerous

67:45and deadly viruses.

67:47Can we zoom in and talk about COVID-19 virus?

67:51- Sure.

§09Transcript · 1:07:52–1:16:54

67:52- What your preferred name is, but maybe for this--

67:53- Well, there's two names, right?

67:54The virus is SARS-CoV-2, which is hard, it's long, right?

67:58And then COVID-19 is the disease.

68:00So you could say the virus of COVID-19, that's fine.

68:03- The virus of COVID-19.

68:04But for the purpose of this conversation,

68:06we'll every once in a while just say COVID.

68:08- It's fine, no problem.

68:10- What is this virus from,

68:12I don't know how many ways we can talk about it.

68:16I think from a basic structural,

68:19like the very end structure,

68:22biological structure perspective, what is it?

68:25What are its variants?

68:28Can you describe the basics,

68:30the important characteristics of the virus?

68:32- So viruses are classified by humans,

68:35just to make it easier to keep track of them, right?

68:38So this is a coronavirus,

68:40which is because when they were first discovered,

68:45I think the first ones were animal coronaviruses.

68:48They looked at them in the electron microscope

68:50and it looked like the solar corona,

68:51and that's all there is to it.

68:53And I have to say that early in the outbreak,

68:56the place with the highest seropositivity in the US

69:00for a while, 68% was a working class neighborhood

69:03in New York City called Corona.

69:05Can you beat that, right?

69:08- That's crazy, yeah.

69:09- So coronaviruses, they have membranes, right?

69:12We talked about membranes,

69:13they have spike proteins in the membrane

69:15so they can attach to cells.

69:16And inside, they have RNA.

69:19And they are the viruses with the longest RNA

69:22that we know of.

69:23None other comes close.

69:25For some reason, they're able to maintain 30,000,

69:29so SARS-CoV-2 RNA is 30,000 bases of RNA.

69:33And some of the other coronas are even longer, 40,000.

69:37- This is a, coronas are family of viruses

69:40that included the one you mentioned before, version one.

69:46- So SARS-CoV-1, yeah.

69:47- CoV-1 and I guess other ones as well.

69:49- So the first, we first learned of them in animals.

69:52A lot of animals, pigs and cows and horses

69:56have coronaviruses.

69:58And then in the '60s, we discovered a couple

70:01of human coronaviruses that just cause colds,

70:05very mild colds that you wouldn't even think twice about.

70:08And then suddenly, in 2003, there's this outbreak

70:14of severe respiratory disease in China.

70:18And it started in November

70:21and they didn't tell the world until February.

70:24And that was really bad because it was already spreading

70:27by the time they told people about it.

70:30But this went to 29 different countries.

70:34Only 8,000 people were infected and then it stopped.

70:37And that was the first time we saw an epidemic coronavirus

70:43and what they did afterwards is they said,

70:45okay, it looks like it came from the meat markets.

70:48They have live meat markets in Guangzhou

70:50in the south of China where you can go and pick out

70:54an animal and the guy will slaughter it for you

70:56and give it to you.

70:57And then of course, there's blood everywhere

70:58and that's how they got infected.

71:00And they figured out that there's this animal

71:02called a palm civet that was the source of virus.

71:05The palm civets are shipped in from the countryside

71:08and the palm civets somehow in the countryside

71:10got it from a bat.

71:11So they went looking in caves in the countryside

71:13and they found in one cave all the viruses

71:16that could make up SARS-1.

71:19And that was 2000, I would say took about five,

71:22eight years after that outbreak.

71:24So that was the first hint that bats have coronaviruses

71:29that can infect people and cause problems, right?

71:32And after that, we should have been ready.

71:35- So didn't they already start developing vaccines

71:38after then? - Yes.

71:39So some people started making vaccines.

71:41They tested them in mice, but they never got into people.

71:46And some people started working on antiviral drugs.

71:50Nothing ever came of them because industry,

71:55there's no disease, it's gone.

71:57Why should we make vaccines and drugs?

71:59And NIH in the US, you submit a grant and they say,

72:03"Ah, it's too risky.

72:03"There's none of this virus around."

72:05So people were really short-sighted

72:07because I always say we could have had antivirals

72:10for this, absolutely, for sure, no question.

72:14In fact, the one antiviral that's in phase three,

72:17it's called molnupiravir.

72:20It's the only one that you can take orally, it's a pill.

72:23It looks really good.

72:24That was developed five years ago,

72:26but never taken into humans.

72:28It could have been ready.

72:29So we dropped the ball.

72:31And then the next decade, 2012, MERS coronavirus

72:35comes up in the Arabian Peninsula.

72:38This comes from camels and infects people,

72:41but probably the camels got it from bats originally

72:44some time ago.

72:46But that never transmits from person to person, very rarely.

72:50Every new little outbreak is a new infection from a camel.

72:54So that was 2012.

72:57And now here we are, 2019,

72:59the new outbreak of respiratory disease in China.

73:02And this one really goes all over the world

73:06where SARS-1 could not.

73:07It's a coronavirus.

73:09It's different enough from SARS-1

73:11that it has very different properties.

73:13- But it still has a membrane,

73:14it still has a very long RNA in the middle,

73:17and then it still has the spike proteins.

73:19- That's right.

73:20- What are the little unique things

73:24that make it that much more effective?

73:27- That make it cause a pandemic of millions of people

73:30as opposed to SARS-1?

73:32Well, the genome is 20% different from SARS-1.

73:38And in those bases, there are things

73:40that make it different from SARS-1.

73:42It binds the same receptor, ACE2, on the cell surface.

73:45That's remarkable.

73:48It has a lot of the same proteins.

73:50They look similar.

73:51If you look at the structure of the spikes,

73:53they look similar,

73:54but there's enough amino acid differences

73:57to make the bio...

73:58And what it is, we don't know

74:00because how do you figure that out?

74:03You need to study animals 'cause you can't infect people.

74:06And the animal models aren't great.

74:08- So the way you figure that out

74:11is you figure out how those differences,

74:14what functional, like how the difference in the amino acids

74:18lead to functional difference of the virus.

74:20- That's right. - Like how it attaches,

74:22how it breaks the cell wall.

74:23- Exactly.

74:24- And how the hell do you figure that out?

74:26I guess there's models of interaction.

74:29- You need to, first you need an animal

74:31of some kind to infect, right?

74:33You can use mice.

74:34People have used ferrets, guinea pigs, non-human primates,

74:39all of the above, non-human primates are very expensive,

74:43so not many people do that.

74:44And then you can put the virus in the respiratory tract.

74:48But in fact, none of them get sick like people do.

74:51Many people with COVID get a mild disease,

74:55but 20% get a very severe, longer lasting disease

74:59and they can die from it, right?

75:00No animal does that yet.

75:03So we have no insight into what's controlling that.

75:05But if you just wanna look at the very first part

75:07of infection and the shedding and the transmission,

75:10you can do it in any one of several animal models.

75:14Ferrets are really good for transmission.

75:16They have nasal structures like humans

75:19and you can put them in cages next to each other

75:22and they'll transmit the virus really nicely.

75:24So you can study that.

75:26But the other thing that's important that we should mention

75:29is how do you manipulate these viruses?

75:33So these are RNA viruses.

75:35You can't manipulate RNA.

75:38We don't know how to do it.

75:40But DNA, because of the recombinant DNA revolution

75:45that occurred in the '70s, we can change DNA any way we want.

75:50We can change a single base, we can cut out bases,

75:53we can put other things in really easily.

75:56And if I may give it a personal aspect,

76:01when I went to MIT as a postdoc in 1979,

76:05David Balthamer said, "Here's what I want you to do.

76:08"The moratorium on recombinant DNA experiments

76:12"on viruses has just been lifted.

76:14"I want you to make a DNA copy of polio

76:18"and see if you put that in a cell,

76:19"whether it will start an infection."

76:21So okay, so I made a DNA copy of polio virus.

76:27It's only 7,500 bases, it's much smaller than corona.

76:31And I took that DNA and I put it in a piece of DNA

76:35from a bacteria called a plasmid.

76:38And you can grow plasmids in many, many bacteria,

76:41make lots of them and purify the DNA really easily.

76:44And I took that DNA and I sequenced it

76:48because we didn't know the genome sequence

76:50of polio at the time.

76:52And that took me a year, by the way,

76:54'cause the techniques we had were really archaic

§10Transcript · 1:16:57–1:25:31

76:57and nowadays you could do it in 15 minutes, right?

77:00It's amazing.

77:01And I took the DNA, I put it into cells and out came polio.

77:05So that's the start.

77:08Now, since then, everybody has taken that technique

77:10and used it for their virus.

77:11You can now do it with SARS-CoV-2.

77:13You make a DNA copy of any RNA virus,

77:16you can modify it and you put it back into cells

77:19and you'll get your modified virus out.

77:21So that's an important part of understanding

77:23the properties of the virus, let's say, in an animal.

77:26By changing the virus, you're changing a DNA copy,

77:28you're making the virus then and putting it into the animal.

77:32- Can you clarify, so even an RNA virus,

77:35you can take and turn it into DNA?

77:38- Yes.

77:38- And then that allows you to modify it?

77:41- Yes.

77:41- What's that mapping?

77:44Well, no, no, no, what's the process

77:46of going from RNA to DNA?

77:48- Reverse transcription.

77:49- That's reverse transcription.

77:51Oh, so you actually go through the process

77:53of reverse transcription to do this?

77:54- Yes, remember David Baltimore and Howard Timmons

77:57had discovered this enzyme in the '70s.

78:00They got the Nobel Prize for that.

78:01And when I went to David's lab at MIT,

78:04he had the enzyme in the freezer.

78:06He said, "Here, take this and make a DNA copy of polio."

78:08- Yeah, I didn't make the connection

78:10that you can use that kind of thing for an RNA virus.

78:14- And so that's--

78:14- And then modify it.

78:15- See, any DNA virus already exists as DNA,

78:18so you can modify it.

78:19But for RNA viruses, it was difficult.

78:22And so then from that point on, for influenza,

78:25every other RNA virus and coronaviruses,

78:28people made DNA copies,

78:29and that's what they used to modify

78:31and ask questions about what things are doing, right?

78:34What's this gene doing?

78:35What if we take it out, what happens?

78:36- Can you do the same thing with COVID?

78:39Is it take the RNA and then--

78:41- Of course, and in fact, in January 2020,

78:44as soon as the genome sequence was released from China,

78:47the labs all over were synthesizing

78:50this 30,000 base DNA and getting--

78:54- What can you figure out without infecting anything?

78:58Just turning into, with the reverse transcription,

79:01turning it to DNA, modifying stuff,

79:03and then putting it into a cell.

79:05What can you figure out from that?

79:08- Well, you could, let's say you can cut out a gene.

79:11You see some genes in the sequence.

79:13I don't know what these genes do.

79:14Let's cut them out.

79:15And then you could cut them out of the DNA.

79:18You put the DNA in cells and maybe you get virus out.

79:22And you go, oh, clearly that gene's not needed

79:25for the virus to reproduce, at least in cells, right?

79:27Or maybe you take the gene out

79:29and you never get any virus, so it's lethal.

79:31- Is there a nice systematic ways of doing this?

79:33Do people kind of automate it?

79:35- Absolutely, and we, I mean, the problem with SARS,

79:40the COVID virus is it's 30,000 bases.

79:42There's a lot of stuff there.

79:44And what makes it more difficult is that you have to,

79:48it's been classified as a BSL-3 agent,

79:52biosafety level three.

79:54And so not everyone has a lab that's capable of doing that.

79:58So it limits the number of people who can do experiments.

80:02We're lucky to have a few in New York City,

80:05but not every place has them.

80:07So you cannot work with a virus just out on the bench

80:11like we do with many other viruses.

80:13You have to wear a suit and have to have special procedures

80:15and containment and so forth.

80:16So it makes it difficult to do basic experiments

80:19on the virus.

80:20- But when it's a pandemic, there's a lot of money,

80:22there's a lot of incentive to work on it harder.

80:25- And also you don't need to work on the virus.

80:27You can take bits of it and work.

80:29You could take, say, just the spike, right?

80:31And say, can we make a vaccine with just the spike?

80:33'Cause that doesn't require BSL-3.

80:36So yes.

80:36- So like building a vaccine requires you to figure out

80:40how, or antiviral drugs,

80:42how to attack various structural parts of the virus

80:45and the functional parts of the virus.

80:47- Right.

80:47You have to decide on a target.

80:50- Yeah.

80:50- Like, I'm gonna make an antiviral.

80:52What am I gonna target in the virus?

80:55And there are a few things that make more sense than others.

81:00Usually we like to target enzymes.

81:03I don't know if you remember your biochemistry,

81:05but enzymes are catalytic.

81:07You don't need a lot of them to do a lot of things.

81:10So they're typically in low concentrations

81:12in a virus-infected cell.

81:14So it's easier to inhibit them with a drug.

81:17And the coronas have a couple of enzymes that we can target.

81:20So you have to figure that out ahead of time

81:23and decide what to go after.

81:25And then you can look for drugs that inhibit

81:27what you're interested in.

81:28It's not that hard to do.

81:29- There's just something beautiful about biology,

81:34about the mechanisms of biology.

81:36And I kind of regret falling in love

81:40with computer science so much

81:41that I left that biology textbook on the shelf

81:46and left it behind.

81:47But hopefully we'll return to it now.

81:49'Cause I think one of the things you learn

81:51even in computer science,

81:53that studying biology and certainly neurobiology,

81:58you get inspired.

82:02Here's a mechanism of incredible complexity

82:05that works really well, is very robust,

82:07is very effective, efficient.

82:09It inspires you to come up with techniques

82:11that you can engineer in the machine.

82:13- That's what drives the field forward

82:15when people improvise and come up with new technologies

82:20that really make a difference.

82:22And we have a bunch of those now.

82:25- What's the difference between the coronavirus family

82:28and the other popular family, influenza virus family?

82:33(laughing)

82:35I mean, if I were, 'cause you mentioned

82:37we should have done a lot more

82:38in terms of vaccine development,

82:39that kind of thing for coronaviruses.

82:42But if I were back then, from my understanding,

82:46the thing we should all be afraid of is influenza.

82:49Like some strong variants coming out from that family.

82:53That seems like the one that will destroy

82:55human civilization or hurt us really badly.

83:00I don't know if you agree with this sense,

83:02but maybe you can also just clarify

83:06what to use as the difference between the families.

83:09- So it's an interesting difference.

83:11They both have membranes, right?

83:14So then they have spike proteins embedded in them.

83:18And they're different spikes.

83:20In fact, for influenza, there are two main ones.

83:24They're called the HA and the NA.

83:26But what's inside is RNA, but it's very different RNA.

83:32And here we have to explain that.

83:35So viruses with RNA can have three different kinds of RNA.

83:40They can have what we call plus RNA.

83:44They can have minus RNA, or they could have plus minus,

83:49actually two strands hybridized together.

83:54The plus RNA simply means that if you put

83:59that plus RNA in a cell, your cell has ribosomes in it

84:03that make the proteins that you need.

84:05The ribosomes will immediately latch onto the plus RNA

84:08and begin to make proteins.

84:09A minus RNA is not the right strand to make proteins.

84:15So it has to be copied first.

84:17And then the plus minus is both together.

84:19So the SARS coronaviruses,

84:22all the coronaviruses have plus RNA.

84:25So as soon as that RNA gets in the cell,

84:26boom, it starts an infectious cycle.

84:28Same thing with poliovirus, by the way, which I worked on.

84:31Influenza viruses are negative stranded.

84:34So they cannot be translated when they get in the cell.

84:37So that's tough for the virus

84:40because the cell actually cannot make plus RNA

84:45from minus RNA.

84:47It doesn't have the enzyme to do it.

84:49So the virus has to carry it in, inside the virus particle.

84:53And then when the minus RNA is in the cell,

84:55the virus enzyme makes plus RNAs and those get translated.

84:59So it's a big difference.

85:00And then in the influenza viruses,

85:03not only is it minus RNA, but it's in pieces.

85:07It's in eight pieces.

85:09We call that segmented,

85:10whereas the corona is in one long piece of RNA.

85:14- So what is that?

85:15Is that they're like floating separately?

85:17- Yeah, so the genes are on separate pieces.

85:19They're all packaged inside that virus particle

85:21of influenza virus, but they're in pieces.

85:23And why that's important is because

85:26if two different influenza viruses

85:29infect the same cell,

85:31the pieces as they reproduce can mix

§11Transcript · 1:25:33–1:33:42

85:33and out can come a virus with a new assortment of pieces.

85:38And that allows influenza virus

85:40to undergo extremely high frequency evolution.

85:43That's why we get pandemics.

85:45When we have a new flu pandemic,

85:47it's because somewhere in some animal,

85:49two viruses have reassorted and made a new virus

85:53that we hadn't seen before.

85:55- So you're talking about kind of biological characteristics,

86:00but what, am I incorrect in my intuition

86:03that are from the things I've heard

86:05that the influenza family of viruses is more dangerous?

86:09Like what makes it more dangerous to humans?

86:12- Well, it depends on the,

86:16there are many flavors or vintages of influenza virus.

86:19Some are dangerous and some are not, right?

86:21It depends on which one.

86:22Some, like the 1918 apparently was very lethal,

86:26killed a lot of people.

86:28But more contemporary viruses,

86:30we had a pandemic in 2009 of influenza.

86:35That wasn't such a lethal virus.

86:39We don't know exactly why,

86:40but it didn't kill that many people.

86:42It transmitted pretty well.

86:43- Is that the bird flu one?

86:45- They're all deriving,

86:47that one was called swine influenza.

86:49- Swine, that's right, swine, yeah.

86:50- It seemed to have started in a pig,

86:52but it had bird, it had RNAs from bird influenza viruses.

86:57These viruses are all reassortants of different viruses

87:00from pigs and birds and humans.

87:03But influenza can cause pneumonia

87:07and can kill you as does SARS-CoV-2.

87:10So it depends on the virus.

87:11So there is another influenza virus

87:13that's currently circulating.

87:15So right now we have the 2009 pandemic virus,

87:18that's still around.

87:20And then the 1968 pandemic virus,

87:23which was the one before 2009,

87:25that one is still around too.

87:27And that's more lethal.

87:29And depending on the season,

87:30some seasons the 2009 virus predominates,

87:33some seasons the 1968.

87:36And when the '68 is around, you get more lethality.

87:38- So we're living with an influenza family.

87:41We haven't exterminated them.

87:44- Right, we never will, never exterminate them.

87:46- Why?

87:47- Well, because every shorebird in the world

87:49is infected with them.

87:50You know, gulls and terns and ducks

87:53and all sorts of things.

87:54- Why can't we develop strong vaccines

87:58that defend against--

87:59- Oh, we could do that, sure.

88:01But that would not eliminate them from humans.

88:04Even if you had the best vaccine,

88:06you would never get rid of it in people

88:08because there would always be someone

88:11who's not vaccinated or in which the vaccine didn't work.

88:14No vaccine is 100%.

88:16- Right.

88:17Well, you just contradicted yourself.

88:18You said the perfect vaccine.

88:20- Imperfect, imperfect.

88:23- But then you said, even if you had the perfect vaccine,

88:26yeah, some people wouldn't get vaccinated.

88:29But I understand what you mean.

88:30I actually was asking, how difficult is it

88:32to make vaccines like that?

88:35It seems like it's very difficult to do that

88:36for the influenza virus.

88:38- So it's really easy to make an old-school vaccine.

88:43So the way the first influenza vaccines were made,

88:47it was actually Jonas Salk worked on them in the '40s.

88:51You just grow lots of virus,

88:53and you grow it in eggs, by the way, chicken eggs.

88:55- Nice.

88:57Literally?

88:57Wait, wait.

88:58- Yeah, chicken, embryonated, so they get fertilized,

89:00and there's a 10 or 12-day embryo in it,

89:03and you put virus in it, it grows up,

89:04and then you harvest it.

89:05You get about 10 mLs of fluid.

89:08And then you take that, you treat it with formaldehyde

89:11or formalin, and it inactivates the virus

89:14so it's no longer infectious.

89:16And you just inject that into people.

89:18And that was the first flu vaccine

89:19that was made for the US Army, actually,

89:22and then it got moved over to people.

89:24We still use that old-school tech today.

89:27- So you're taking, can you help me out here?

89:30Okay, so this is a good time to talk about vaccines.

89:34Okay, so you're talking about,

89:37you're taking the actual virus,

89:39you put it in an egg, you let it grow up.

89:42It's very funny that you put it in an egg.

89:44It's very poetic.

89:46And then how do you make it not infection,

89:51not effective or whatever?

89:53- Not infectious.

89:54- Not infectious, is that the right term here?

89:56- Yeah.

89:57- So how do you make it not infectious?

89:58- You can treat it with any number of chemicals

90:02that'll disrupt the particle so it no longer infects.

90:05- So that step of disrupting the particle,

90:09is that very specific to a particular variant particle?

90:12- No, the same collection of chemicals

90:14you can use for all kinds of,

90:16and which have been used for SARS-CoV-2 vaccines also.

90:19Same technology.

90:20- Okay, so what are, there's several things to ask.

90:23So you called it old-school in a way

90:25that's slightly dismissive,

90:27like people talk about Windows 98 or something.

90:30(both laugh)

90:31So is there risks involved with it,

90:34or is it just difficult to produce large amounts?

90:37Does it take a lot of eggs?

90:38- It's very easy.

90:40I mean, you could do it in cells and culture,

90:41but eggs were convenient.

90:43And in the 1940s, we didn't have cells in culture.

90:46We didn't know how to do that,

90:47so we had to use something else.

90:49It's easy to do,

90:52but the process of inactivating the virus with a chemical

90:56makes it not the best vaccine you can make.

90:59The flu vaccines that we have today,

91:02which are mostly based on this inactivation,

91:05is called inactivated virus vaccines.

91:08- Oh, so like the kind of thing it presents

91:12to the immune system to train on

91:14is not close to the actual virus.

91:19- Yes, that's what we think.

91:20So that's why probably the flu vaccines

91:22are just not very good.

91:2360% efficiency at the best, right,

91:29which is not really good.

91:30- What does it mean?

91:31What is the measure of efficiency for a vaccine?

91:33- Well, how it does in the general population

91:37at preventing influenza.

91:38- At preventing?

91:40- Illness, not infection.

91:41We usually don't measure infection

91:44when we're testing a vaccine.

91:46We just measure sickness.

91:47That's really easy to score, right?

91:50You do a trial and you say,

91:52"If you feel sick, give us a call."

91:53We'll tell you what to do.

91:55- So yeah, I mean, what's sickness?

91:58Sickness is the presence of symptoms.

92:01- So this is good time to say what a symptom is, okay?

92:04A symptom is what you only can feel.

92:08Only you can feel an upset stomach

92:11or a sore throat or that sort of thing.

92:13- It's the lived experience of a symptom.

92:15- Whereas a sign is something that someone could measure

92:19and tell that you're infected,

92:20like virus in your nasopharynx or something else, right?

92:25Signs and symptoms.

92:27And so in a vaccine trial,

92:28they tell you if you have any of these symptoms,

92:31they give you a paper with the exact symptoms listed

92:35to make sure you're picking them up, right?

92:36So for flu, it would probably be fever, sore throat, cough.

92:41You call them and then they will do a PCR

92:44and make sure you've got flu and not some other virus

92:46that makes similar symptoms.

92:48And then they would say,

92:50"Are you a vaccine or non-vaccine arm?"

92:53And they count up all the infections

92:55and see how the vaccine did, basically.

92:57- That's so fascinating because the reporting,

93:02so symptom is what you feel.

93:03- Yes, for sure.

93:04- And certainly the mind has the ability

93:08to conjure up feelings.

93:10- Oh yes, absolutely.

93:11- And so like culturally,

93:13maybe there was a time in our culture

93:16where it was looked down upon to feel sick

93:21or something like that, like toughen up kind of thing.

93:25And so then you probably have very few symptoms

93:28being reported.

93:29- Absolutely, absolutely.

93:31- And now is like much more, I don't know,

93:34perhaps you're much more likely to report symptoms.

93:37Now it's fascinating 'cause then it changes.

93:40- Oh, it is definitely a perception

93:42because your symptom may be nothing to me

§12Transcript · 1:33:45–1:42:10

93:45or vice versa, right?

93:46And so when you're doing this,

93:47it's a little bit of a imprecise science

93:51because and even it's a cultural thing.

93:54In some countries, something that would make us feel horrible

93:57they wouldn't even bother reporting.

93:59No, I didn't have any symptoms.

94:00So it's a little bit imprecise and it clouds the results.

94:03So if you can measure things, it's always better.

94:05But you start out with a symptom.

94:07And if you say, if someone tells you this virus,

94:1120% of the people are asymptomatic,

94:15they don't report symptoms,

94:18that number is probably not a constant.

94:22It depends where you did the study.

94:24It could be different in China versus South America,

94:26Europe, et cetera, yeah.

94:28- I mean, I was trying to,

94:29so I took two shots of the Pfizer vaccine.

94:32I had zero symptoms.

94:34- Wow.

94:35- So and I was wondering,

94:36well, see, but that's my feelings, right?

94:38This is not, 'cause I felt fine.

94:41I was waiting.

94:42- Did you have pain at the injection site?

94:44- No, it was kind of pleasant.

94:48- You felt nothing the next day, no?

94:50- Nothing. - Okay.

94:51- No tightness, no exhaustion, no.

94:53But see, like I have an insane sleeping schedule.

94:56I already put myself through crazy stuff.

94:59That said, maybe I was expecting something really bad.

95:03Like I was waiting and therefore didn't feel it.

95:06But I also got allergy shots.

95:10And those, I was out all next day,

95:14like exhausted for some reason.

95:16So that gave me like a sense like,

95:19okay, at least sometimes I can feel shitty.

95:22That's good to know.

95:24- Sure, sure.

95:25- And then with the vaccine, it didn't.

95:27But the question is like,

95:29how much does my mind come into play there?

95:32The expectations of symptoms,

95:34the expectations of not feeling well,

95:39how does that affect the sort of the self-reporting

95:41of the symptoms?

95:42- I think it's definitely a variable there,

95:44but there's certainly many people

95:46that don't feel anything after the vaccines.

95:48And there's some that have a whole range of things

95:52like soreness and fever, et cetera.

95:54Yeah.

95:55- So, okay, you were talking about

95:56the old school developments like the egg.

95:58- Right.

95:59- What's better than that?

96:02- So then the next generation of vaccines

96:04which arose in the '50s were what we call

96:07replication competent, where the virus,

96:11you take it and it's actually reproducing in you.

96:13- Yeah, that sounds safe.

96:16- And it can be somewhat problematic, yes,

96:19as you might imagine, 'cause once you put that virus in you,

96:22you have no more control, right?

96:24It's not like you have a kill switch in it,

96:25which actually would be a great idea to put in.

96:28- Like nanobots?

96:31What composite?

96:32- No, you could just put something in there.

96:34If you added a drug, you would shut it off, right?

96:37And people are thinking about that

96:39because now we're engineering viruses

96:41to treat cancers and other diseases.

96:44And we may wanna put kill switches in them

96:46just to make sure they don't run away.

96:48- Oh, interesting, so you can like deploy a drug

96:50that binds to this virus that would shut it off in the body.

96:55Something like that.

96:56- Something like that, yeah, that would be the idea.

96:58You'd have to engineer it in.

96:59Anyway, these were, the first one was yellow fever vaccine

97:03that was made because that was a big problem.

97:06And this virus, and the way you do this,

97:08back in the old day, was empirical.

97:12So Max Tyler, who did the yellow fever vaccine,

97:15he took the virus, which is a human virus, right?

97:18And he infected, I think he used chick embryos.

97:23And he went from one embryo to another

97:26and just kept passing it, did that hundreds of times.

97:29And every 10 passages, he would take the virus

97:32and put it in a mouse or a monkey, whatever his model was.

97:36And then eventually he got a virus

97:38that didn't cause any disease after 200 and some passages.

97:41And then that was tested in people

97:43and it became the yellow fever vaccine that we use today.

97:46He selected for mutations that made the virus

97:50not cause disease, but still make an immune response.

97:55So those are called replication competent.

97:57We now have the polio vaccine,

97:59which was developed in the '50s after the yellow fever.

98:03Then we had measles, mumps, rubella.

98:05Those are all replication competent vaccines.

98:09And you mentioned that's a good idea.

98:12They are all safe vaccines.

98:15The only one that has had an issue

98:18is the polio replication competent vaccine.

98:21It was called Sabin vaccine or oral polio virus vaccine,

98:26because you take it orally.

98:28It's wonderful because you don't have to inject it.

98:31This is the perfect delivery.

98:33Either intranasal for a respiratory virus

98:37or orally for polio.

98:38It goes into your intestines, it reproduces,

98:40and it gives you wonderful protection against polio.

98:43However, you do shed virus out.

98:48And that virus is no longer a vaccine.

98:52It's reverted genetically in your intestine.

98:55- So you can infect others with polio.

98:57- You can take that virus and then put it into an animal

98:59and give it polio.

99:00And in fact, the parents of some kids

99:04in the '60s and '70s who were immunized

99:06got polio from the vaccine.

99:08The rate was about one

99:09in one and a half million cases of polio.

99:13So it's called vaccine-associated polio.

99:15And I always argue that we may not have

99:19picked the right vaccine.

99:21There was a big fight in the US and other countries

99:25between the inactivated polio

99:27and the infectious polio vaccines,

99:29which ones we should be using,

99:31because we found out that the infectious vaccine

99:33actually caused polio.

99:35And eight to 10 kids a year in the US alone

99:38got polio from the vaccine,

99:39which looking back is really not acceptable in my view,

99:43although the public health community said it was

99:46to get rid of polio.

99:47So now we're close to eradicating polio globally,

99:51but this vaccine-derived polio is a problem.

99:55So now we have to go back to the inactivated vaccine,

99:59which is tough 'cause it's injected.

100:01- So, okay, so the basic high-level,

100:05how vaccines work principle is

100:08you want to deploy something in the body

100:11that's as close to the actual virus as possible,

100:13but doesn't do nearly as much harm.

100:15- That's right.

100:16- And there's like a million, not a million,

100:17but there's a bunch of ways you could possibly do that.

100:19- So those are two ways.

100:20And now, of course, we have modern ways

100:21we can make mRNA vaccines, right?

100:25- What are the modern ways?

100:26Do you want to look mRNA vaccine?

100:29- So that's the most modern,

100:31but even before mRNA vaccines,

100:33we learned that we could use viruses

100:36to deliver proteins from a virus that you want to prevent.

100:40And so the Ebola vaccine,

100:43we took the spike gene of Ebola virus

100:46and put it in a different virus,

100:47and we deliver that to people,

100:49and that's called a vectored vaccine.

100:51And some of the COVID vaccines are vectors

100:54of different kinds, the most famous are adenovirus vectors

100:57carrying the spike gene into the cell.

101:00- Can you explain how the vector vaccine works again?

101:03- So we take a virus that will infect humans,

101:08but will not make you sick.

101:11In the case of adenovirus,

101:13the years and years of people studying it

101:16has told us what genes you could cut out

101:18and allow the virus to infect the cell,

101:21but not cause any disease.

101:22- So instead of doing selection on it,

101:24you actually genetically modify it.

101:27- Yes, you modify the vector, yeah.

101:29So you'd be much more precise about it.

101:30- You'd be very precise,

101:31and then you splice in the gene for the spike,

101:34and then you use that to deliver the gene,

101:37and it becomes produced as protein,

101:39and then you make an immune response.

101:40- And vector is the term for this modified.

101:43- Right.

101:44So we're now using viruses at our bidding.

101:47We're using them as vectors, not just for vaccines.

101:50We can cure monogenic diseases.

101:52That is, if you're born with a genetic disease,

101:55you have a deletion or a mutation in a gene,

101:57a single gene, we can give you the regular gene back

102:02using a virus vector.

102:03Cancers too, we can cure cancers with vectors.

102:07- Wow, really?

102:09Interesting.

102:10- I think in 10 to 15 years,

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102:12most cancers will be treatable with viruses, yeah.

102:15Not only can we put things in the vector to kill the tumor,

102:21we can target the vector to the tumor specifically

102:25in a number of ways,

102:26and that makes it less toxic, right?

102:28It doesn't infect all your other cells.

102:30- But it takes time to develop a vector

102:33for a particular thing,

102:34'cause it requires a deep understanding.

102:37- Yeah, in fact, we have about a dozen different

102:40virus vectors that have been studied for 20 years,

102:42and those are the set of vaccine vectors that we're using.

102:46So it includes adenovirus, vesicular stomatitis virus,

102:50which is a cousin of rabies, but doesn't make people sick.

102:55Influenza virus is being used as a vector,

102:58and even measles virus.

103:00So we're familiar with how to modify those to be vectors,

103:04and those are being used for COVID vaccines.

103:07And then of course, we have the newest,

103:10which is the nucleic acid vaccines.

103:12So years ago, people said,

103:15"Why can't we just inject DNA into people?

103:17"Take the spike and put it in a DNA and inject it."

103:22So people tried many, many different vaccines,

103:25and in fact, there are no human licensed vaccines

103:28that are DNA vaccines,

103:29although there is a West Nile vaccine for horses

103:33that's a DNA-based vaccine.

103:35So if you have a horse, you can give it this vaccine,

103:38but no human.

103:39- Can you clarify, does a DNA vaccine

103:42only work for DNA viruses?

103:44- No, it can work for DNA or RNA,

103:46'cause remember, for an RNA virus,

103:48we can make a DNA copy of it.

103:50And it will still, when you put that DNA in a cell,

103:53it goes into the nucleus.

103:55- Okay, right.

103:56So you're just skipping a step.

103:58- You get proteins.

103:59- RNA vaccines, you're giving, okay, I got it.

104:02- So those didn't work for human vaccines,

104:04and there were many HIV/AIDS vaccine trials

104:07that used DNA vaccines, didn't work.

104:10And then, a number of years ago,

104:13people started thinking, "How about RNA, RNA vaccines?"

104:17And I first heard this, I thought, "What?"

104:20I've worked with RNA my whole career.

104:22It's so fragile.

104:24If you look at it the wrong way, it breaks.

104:26I mean, that's being facetious, right?

104:29But you have to be very careful,

104:31'cause your hands are full of enzymes that will degrade RNA.

104:35So I thought, "How could this possibly work,

104:38"injecting it into someone's?"

104:40It's an example of, I was skeptical, and I was wrong.

104:43It turns out that if you modify the RNA properly

104:47and protect it in a lipid capsule,

104:51it actually works as a vaccine.

104:52And people were working on this years

104:54before COVID came around.

104:57They were doing experimental mRNA vaccines,

105:00and there were a couple of companies

105:01that were working on it.

105:02And so at the beginning of 2020, they said, "Let's try it."

105:07And I was skeptical, frankly,

105:09'cause I just thought RNA would be too labile,

105:12but I was wrong.

105:13- So this is, as we're saying offline,

105:16one of the great things about you

105:18is you're able to say when you're wrong

105:20about intuitions you've had in the past,

105:22which is a beautiful thing for a scientist.

105:25But I still think it's very surprising

105:28that something like that works, right?

105:30- Yeah, I am surprised.

105:31- So you're just launching RNA in a protective membrane.

105:35- Yeah.

105:36- And then, now, one thing is surprising,

105:39that the RNA sort of lasts long enough, right?

105:43- That's right.

105:44- In its structure.

105:45But then the other thing is,

105:49why does it work that that's a good training ground

105:53for the immune system?

105:56Is that obvious?

105:58- Well, I don't think it's obvious to most people,

106:01and it's worth going into, 'cause it's really interesting.

106:04I mean, first of all, they wrap the RNA in fats,

106:09in lipid membranes, right?

106:10And the particular formulation,

106:12they test for years to make sure it's stable,

106:16it lasts a long time after it's injected.

106:17And the two companies that make the current COVID vaccines,

106:22right, Moderna and Pfizer,

106:23they have different lipid formulations, to get to the same.

106:26So that's a real part of it.

106:29And it's not simple.

106:30There are quite a few different lipids

106:31that they put into this coating.

106:34And they test to see how long they protect the RNA

106:37after it's injected, say, into a mouse.

106:39How long does it last?

106:40And the way it works is,

106:41apparently, these lipid nanoparticles,

106:46they get injected into your muscle,

106:48they bump into cells, and they get taken up.

106:52So lipid fat is sticky.

106:55It's greasy, we like to say.

106:59And so your cells are covered with a greasy membrane also.

107:03So when these lipid nanoparticles bump into them,

107:06they stick, and they eventually get taken up.

107:08And they figured this out right at the beginning.

107:11If we put RNA in a lipid nanoparticle,

107:13will it get taken up into a cell?

107:15And the answer was yes.

107:16It was just, let's try it, and it worked.

107:18- So it's basically experiment.

107:20It's not like some deep understanding of biology.

107:22It's experimentally speaking, it just seems to work.

107:25- Yeah, well, they had some idea

107:26that lipids would target this to a cell membrane.

107:30And remember, there's no receptor involved.

107:33Like, the virus has a specific protein

107:36that it attaches to a receptor.

107:39It's not efficient enough to just bump around

107:41and get into a cell.

107:43That's what these things are doing.

107:44And they probably optimize the lipids

107:47to get more efficient uptake.

107:49But it's not as efficient as a virus would be

107:51to get into a cell.

107:52- Right, so you have no specific,

107:54I mean, which is why it's surprising

107:57that you can crack into the safe with a hammer.

108:02(laughs)

108:04Or with some fat.

108:06I mean, that's kind of surprising.

108:08It's kind of amazing that it works.

108:11But so, maybe let's try to talk about this.

108:16So, one of the hesitancies around vaccines,

108:21or basically around any new technology,

108:24is the fact that mRNA is a new idea.

108:27And it's an idea that was shrouded in some skepticism,

108:32as you said, by the scientific community.

108:35'Cause it's like, it's a cool new technology.

108:40Surprising that it works.

108:42What's your intuition?

108:44I think one nice way to approach this

108:46is try to play devil's advocate and say both sides.

108:51One side is why your intuition says

108:56that it's safe for humans.

108:59And what arguments can you see,

109:02if you could steal man,

109:03an argument why it's unsafe for humans.

109:06Or not unsafe for humans,

109:09but the hesitancy to take an mRNA vaccine is justified.

109:14- So, many people are afraid because it's new technology

109:19and they feel it hasn't been tested.

109:22I mean, in theory, what could go wrong?

109:25This is, the nice thing about mRNA

109:29is that it doesn't last forever.

109:30As opposed to DNA, which doesn't last forever,

109:35but it can last a lot longer.

109:38And it could even go into your DNA, right?

109:40So, mRNA has a shorter lifetime,

109:44maybe days after it's injected into your arm,

109:47then it's gone.

109:48So, that's a good thing,

109:49because it's not gonna be around forever.

109:52So, that would say, okay,

109:54so it's sticking around for your lifetime,

109:57it's not happening.

109:58But what else could happen?

110:00Well, let's see the protein that's made,

110:03could that be an issue?

110:05And again, proteins don't last forever,

110:08they have a finite longevity in the body.

110:12And this one also lasts, perhaps, at the best, a few weeks.

110:17- This is a protein that's made

110:18after the RNA gets into the cell.

110:22- Yeah, so the lipid nanoparticles taken up into a cell

110:25and the mRNA is translated and you get protein made.

110:27- And there's also a question, I'm sorry to interrupt,

110:30where in the body,

110:32so because it's not well targeted,

110:35or I don't know if it's supposed to be targeted,

110:38but it can go throughout the body,

110:39that's one of the concerns. - Right, so it's injected

110:41deep into your deltoid muscle, right here, shoulder.

110:45And the idea is not to put it in a blood vessel,

110:49otherwise it would then, for sure, circulate everywhere.

110:52So, they go deep in a blood vessel

110:55and it's locally injected.

110:57And they did, before this even went into people,

111:00they did experiments in mice,

111:01where they gave them 1,000 times higher concentrations

111:05than they would ever give to people.

111:06And then, when you do that, it can go everywhere, basically.

111:09You can find these nanoparticles

§14Transcript · 1:51:11–2:00:29

111:11in every tissue of the mouse.

111:14But that's at 1,000-fold higher concentration, right?

111:17So, I think at the levels that we're using in people,

111:21most of it's staying in the muscle,

111:22but sure, small amounts go elsewhere.

111:26- And could there be a lot of harm caused

111:28if it goes elsewhere?

111:30Like, let's say ridiculously high quantities.

111:33I'm trying to understand what is the damage

111:35that could be done from an RNA just floating about.

111:39- So, the RNA itself is not gonna be a problem.

111:41It's the protein that is-- - The protein.

111:42- Encoded in it, right?

111:43This is a viral RNA, which has no sequence in us.

111:48So, there's nothing that it could do.

111:50It's the protein that I would say,

111:52you could ask, what is that gonna do?

111:56And the one property we know about the spike

112:00is that it can cause fusion of cells.

112:06That's how the virus gets in in the beginning.

112:09The spike attaches to the cell by this ACE2 receptor,

112:14and it causes the virus and the cell to fuse.

112:19And that's how the RNA gets out of the particle.

112:21- But so, wait, I'm a bit confused.

112:24So, with this mRNA vaccine with lipids and the RNA,

112:28there's no spike, right?

112:30- The mRNA codes for the spike.

112:33- Oh, the mRNA codes, so it creates the spike.

112:35- Creates a spike.

112:36- And so, that spike could cause fusion of cells.

112:39- Yes, except they modified the spike so it wouldn't.

112:43- Got it.

112:45- They made two amino acid changes in the spike

112:46so it would not fuse.

112:47- So, they understand enough which amino acids

112:49are responsible for the fusion.

112:51- That's right.

112:51- Interesting.

112:52This is so cool.

112:53- So, they modified, so now it's not gonna cause fusion,

112:55so that's not an issue.

112:57It's called the pre-fusion stabilized spike.

112:59- Cool.

113:01- So, the spike, when it binds ACE2,

113:04that top falls off and the spike,

113:06and the part of the spike that causes fusion is now exposed.

113:09And that doesn't happen in this mRNA vaccine.

113:12So, those are the things that could have happened,

113:14but I think they're ruled out by what we've just said.

113:18But there's no better test than putting it into people,

113:21right? - Right.

113:22- And doing phase one, phase two, and phase three,

113:25and increasing numbers of people,

113:26and asking, what do we see?

113:28Do we have any concerns?

113:30And so, now it's been in many millions of people,

113:35and we don't see, most of the effects you see in a vaccine,

113:40you see in the first couple of months.

113:43Things like the myocarditis with some of the vaccines,

113:46the clotting issues with the AstraZeneca vaccine,

113:49EMBRA, you see those relatively quickly.

113:53And we've seen small numbers of those occur,

113:58but other things we haven't seen,

114:01and you never say never, right?

114:04- Right, so, I mean, this is fascinating, right?

114:07It's like, I drink, I put Splenda in my coffee,

114:14and has supposedly no calories, but it tastes really good.

114:19And despite what, like, rumors, and blogs, and so on,

114:26I have not seen good medical evidence

114:28that it's harmful to you.

114:31But it's like, it tastes too good.

114:34So, I'm thinking, like,

114:35there's gotta be long-term consequences,

114:37but it's very difficult to understand

114:40what the long-term consequences are.

114:44And there's this kind of, like,

114:46distant fear or anxiety about it.

114:49Like, this thing tastes too good, it's too good to be true.

114:53There's gotta be, there's no free launch in this world.

114:55This is the kind of feeling that people have

114:57about the long-term effects of the vaccine.

115:00That you mentioned that there's some intuition

115:04about near-term effects that you want to remove,

115:08like, the diffusion of cells, and all those kinds of things.

115:11But they think, okay, this travels to other cells

115:14in the body, it travels to neurons, or that kind of stuff.

115:18And then, what kind of effect does that have long-term

115:20that's yet to be discovered?

115:22What do you make, I mean, for this vaccine,

115:25but in general, in science, about making statements

115:28about long-term negative effects?

115:32Is that something that weighs heavy on you?

115:34Is that something we can kind of escape

115:36through just large-scale experimentation

115:39with animals and humans?

115:41- Well, if you're really,

115:42if you're concerned about long-term,

115:44then you have to do a long-term experiment, right?

115:46And maybe you don't see something for 50, 60 years.

115:50So, if someone says to you, there are no long-term effects

115:54of the COVID vaccines, they can't say that

115:57because they haven't done the long experiment, right?

116:00There's always the possibility, but you have to weigh it.

116:02It's always, there's no free lunch, right?

116:06There's always a risk-benefit calculation you have to make.

116:10- You can have the study, it goes for 50 years,

116:12and then decide, but I guess what you're doing is,

116:15just like we said, I forget with which one,

116:20with polio, with rabies, I forget,

116:22but you're weighing the side effects of the vaccine

116:27versus the effects of the virus.

116:31And both of them, you don't know long-term effects,

116:34but you're building up intuition as you study,

116:38which, what are the long-term effects?

116:41Like, there's a huge number of people

116:45that have, I don't want to say experts

116:51'cause I don't like the word,

116:52but people have studied it long enough

116:54to where they build up intuition.

116:56They don't know for sure.

116:57There's basic science being done, there's basic studies,

117:00but you start to build up an intuition

117:03of what might be a problem down the line

117:07and what is not, biologically speaking.

117:09And so, given that map, then considering the virus,

117:14there seems to be a lot of evidence for COVID

117:16having negative effects on all aspects of the body,

117:21and not just even respiratory,

117:23which is kind of interesting.

117:24So, the cognitive stuff, that's terrifying.

117:27- All kinds of systems evolve, yes.

117:28- And then you look at the same thing with the vaccine,

117:32and there seems to be less of that.

117:34But of course, you don't know

117:36if it's some kind of dormant thing that's just going to--

117:39- You won't know.

117:40You have to make a judgment,

117:42and for a lot of people, they can't, right?

117:44'Cause they don't have the tools to make the judgment.

117:47I totally understand that.

117:49And we have let people down a few times in medicine, right?

117:54And I know two very specific examples.

117:59The first polio vaccine ever made,

118:01the Salk vaccine was released in 1955.

118:05Immediately, within months,

118:07few hundred cases of paralysis in kids who got it,

118:10because it was not properly inactivated.

118:14Now, you have to understand,

118:16parents were dying for a polio vaccine,

118:19'cause kids were getting paralyzed every summer,

118:2130,000 kids a year.

118:23And so, they went and took it.

118:26They took the word of the medical establishment

118:28that it was safe, and it wasn't.

118:30Big letdown.

118:32Never going to forget something.

118:33Although, I think a lot of people today

118:35aren't aware of that.

118:37I think that was a big problem that's everlasting.

118:39Then, the attenuated vaccine that we talked about,

118:43the infectious, causing polio.

118:46Yet, parents continued to bring their kids to be vaccinated,

118:51because they were said, "This is the right thing to do."

118:53And I have to say, I was involved in several lawsuits

118:55where parents of a kid who got paralyzed

118:59from the polio vaccine decided to sue the manufacturer

119:02and get some money for their kid.

119:05And so, they got mad.

119:08And I think you could not,

119:10the first issue could have been prevented,

119:15could have been prevented by inactivating it properly.

119:19I think the company just did the wrong thing.

119:22The second, we had evidence for,

119:24and we should probably have not used that vaccine any longer,

119:26but I think that destroys public confidence.

119:29- But those are-- - They're not long-term.

119:30- That's the minority of cases.

119:31- It's a minority, this is a very rare event, yeah.

119:33- But nevertheless, science as an institution

119:35didn't make corrections in that case.

119:40- No, they didn't.

119:40- And so, what do you make of that?

119:45I mean, it's very unfortunate

119:46that those few things can destroy trust.

119:49- But I don't think that lasts 'til today.

119:51I think today is a different era, right?

119:54- Yeah. - And most people

119:55don't know about those stories.

119:56I tell them to you because that's what could happen.

119:59I think it could happen today.

120:01- Yeah.

120:02- If you look at the history of the polio vaccine,

120:06the US Public Health Service wanted kids to be vaccinated.

120:11So they did things that probably weren't correct

120:14to get the vaccine back online, right?

120:16But they did it and they pushed it through.

120:19So the question is, what do we do today?

120:23So I can look at, as we just said,

120:27I can look at what might happen

120:29and I can make reasonable decisions

§15Transcript · 2:00:33–2:09:52

120:33about the likelihood of them happening.

120:35And I can also say, I don't wanna get COVID of any kind

120:39because I've seen how nasty it can be.

120:41And I decide I'm taking the risk,

120:44whatever small of a long-term effect,

120:46I'm gonna take the risk.

120:47My family took the risk and many other people did.

120:50- Of a vaccine.

120:50- Of getting vaccinated 'cause I think it's very small.

120:54But I understand where people can't make that decision.

120:56And that begs the question, what would they need

121:00to make a decision?

121:01So if you're concerned about an effect in 40 years,

121:05we're not gonna know for 40 years.

121:09- Yeah, so I think if I were to speak,

121:11'cause I talked to, like I mentioned,

121:13offline to Joe Rogan and his podcast yesterday,

121:15I talked to him all the time about this.

121:18I think the concern is less about the long-term effects

121:23on paper, it's more about the,

121:28people like Anthony Fauci and people at the top

121:36are simply misrepresenting the data

121:39or are not accurately being transparent,

121:42not collecting the data properly,

121:45not reporting on the data properly, not being transparent,

121:48not representing the uncertainties,

121:50not openly saying they were wrong two months ago,

121:55like in a way that's not like dramatic,

121:58but revealing the basic process of science

122:00when you have to do your best under uncertainty,

122:03just also just being inauthentic.

122:06There's a sense, especially with like a younger generation

122:09now, there's a certain way on the internet,

122:11like the internet could smell bullshit

122:14much better than previous generations could.

122:16And so they see there's a kind of inauthenticity

122:21that comes with being, like representing authority.

122:26Like I am a scientist, I'm an expert, I have a PhD,

122:30I have four decades of work,

122:31therefore everyone should listen to me.

122:34And somehow that maps to this feeling of,

122:38well, what are they hiding?

122:40If they're speaking from authority like this,

122:43if everyone is in agreement like this,

122:45that means they all have emails between each other.

122:48They said, we're gonna tell this,

122:49this is the message we're gonna tell the public.

122:51Then what is the truth, the actual truth?

122:54Maybe there's a much bigger uncertainty.

122:57Maybe there's dead people in the basement

122:59that they're hiding from bad mRNA vaccine experiments.

123:03Maybe they're, and then the conspiracy theories

123:06start to grow naturally when there's this kind of mistrust

123:10of that.

123:11So it's less about kind of,

123:14like a deep concern about long-term effects.

123:18It's a concern about long-term effects

123:22if we find out that there's some secret stuff

123:27that we're not being told.

123:28It all lends on that.

123:30So what the heck, I mean,

123:31so I put the blame not on the data,

123:33but basically on the leaders

123:35and the communicators of the science at the top.

123:39- Well, to that, I would say all the data,

123:43as far as I know, are made public.

123:46So you can dive into it.

123:48And I know a lot of people ask me questions,

123:51and I just say, it's right here in the data.

123:54And I know a lot of people can't do that.

123:55They can't dive into it.

123:57But that's one solution for people who are able.

124:00Now, you could argue, well, maybe they've left data out.

124:03Well, then not even I can help

124:05because then they're hiding it from me too.

124:07And I think that's highly unlikely.

124:08I think for the most part,

124:09the FDA requires the release

124:11of all the clinical trial data, right?

124:14- So, okay, so this clinical trial data, that's one thing.

124:17So that's the data that we should be focusing on, right?

124:20So there's a lot of different data sets here.

124:24- So there's preclinical data,

124:25which is everything that was done in the lab

124:28before this vaccine ever went into a human arm.

124:30It's all the cell culture work

124:32that we talked about a little, experiments in animals.

124:35All of that is publicly accessible.

124:38Most of it gets published.

124:39And then there's the initial drug filing,

124:42which is huge, the books of diet.

124:45You can get that and look at it, right?

124:46- This is me sort of asking sort of difficult questions here.

124:49So there's a lot of money to be made by makers of the vaccine.

124:56So for these companies,

124:59obviously there's a distrust of those folks too.

125:02They've done a lot of really good things in this world,

125:04but the incentives are such

125:07that you want to sweep stuff under the rug

125:09if you're not 100% pure in your ethics.

125:14And how hard is it for that data to be fabricated,

125:20manipulated?

125:22Like what's your intuition for the pre-trial stuff?

125:26- I think when you start fabricating,

125:29then you get inconsistencies,

125:31which are pretty easy to pick up.

125:34- When you're talking about some large scale

125:36things of this nature.

125:38- Because then you can look through the data very,

125:40you're gonna, I mean,

125:41we require looking very carefully,

125:43but you'll see inconsistencies from one trial to another.

125:46And that may ring a bell that something's been done.

125:50- Yeah.

125:51It's like the moon landing thing.

125:55Sometimes like going to the moon is easier than faking.

125:58(laughs)

125:59- Right.

126:00- In the sense it might be easier to do large scale trial

126:03and get an effective vaccine versus faking it.

126:05- But you know, when you brought up the for-profit issue,

126:08I think that has always been an issue.

126:11I've always felt that having your health depend

126:15on for-profit industry may not be the best solution.

126:20And I don't know how else to do it.

126:23People tell me I'm a dreamer,

126:25thinking that all medicines could be non-profit.

126:28But I also think that the world should have

126:30one health system that takes care of everyone, right?

126:32Because there are some countries that can't

126:34and other countries have an excess like us.

126:37So I wish we could do that.

126:40- Well, the argument is the speed of which the vaccines

126:44for COVID were produced would never happen

126:47in a non-profit system,

126:49would never happen in a non-capitalist system.

126:51- Oh, I could set up a vaccine production institute

126:56in the US that would get the vaccines done

126:58because you just need to put money into it.

127:00That's what made these vaccines get done, money.

127:03They poured billions of dollars

127:05and they got it done quickly.

127:06But if I set up a non-profit institutes of vaccines

127:09throughout the US, staffed with really talented people,

127:12pay them well, keep them motivated,

127:15you'll get your vaccines.

127:15- No, but that's the thing with capitalism

127:18is that the selection of who to hire,

127:22when you say good people,

127:24capitalism has a machine that fires people

127:28who are not good and selects people that are good.

127:30Coming from the Soviet Union,

127:32the dream of communism is similar to what you're saying,

127:36broadly defined.

127:37It certainly doesn't work in the broad,

127:40the question of whether it works in the healthcare space.

127:44There is some aspect to the machine of capitalism

127:49being the most effective way to select for good people

127:53to effectively produce the thing.

127:55But then of course, a lot of people would argue

127:59even the current healthcare is not,

128:01with regulations, there's some weird mix

128:03where there's a lot of opportunities for inefficiencies,

128:07there's a lot of opportunities for bureaucracy.

128:09So you have the worst of all worlds.

128:11- Can't there be some intermediate that works?

128:14I mean, the other issue that we haven't mentioned

128:17is that politics gets thrown into this

128:19and that really messes up

128:21and it should never be mixed with healthcare,

128:23but it is because a lot of funding comes from the government

128:26so that's another confounding factor.

128:29But I really think I could make a vaccine institute

128:33that if someone didn't do well, I'd fire them.

128:36No, you're not gonna stay if you can't do your job

128:39and do it well, you don't give them incentives,

128:41but it doesn't have to be the two extremes, I think.

128:44There has to be a solution that people don't have

128:47this mistrust for a company making huge profits

128:51off of a drug.

128:52But you know what, it's funny.

128:54It seems that vaccines and antivirals

128:57bear the brunt of this criticism,

128:59yet there are many other pharmaceuticals

129:01that people rely on of all sorts.

129:04They don't seem to question and have issues with those

129:06and they have far more side effects than vaccines.

129:09- It's very strange how we're picking that way,

129:11but I should also say that if you have one big

129:16vaccine institute, one of the other sets of

129:24vaccine conspiracies, I mean, I would say they're

129:28a little farther out into the wild set of ideas,

129:32but that's one way to control the populace

129:37is by injecting substances into them.

129:40People, I mean, part of that, funny enough,

129:44it probably has to do with needles

129:46versus something you put in your mouth.

129:48But there's something about the government,

129:50especially when it's government mandated,

129:52injection of a substance into you.

§16Transcript · 2:09:54–2:19:44

129:54I don't care what the science says,

129:57if it's 100% effective, 100% safe,

130:00there's a natural distrust of what,

130:03like even if this is effective and safe,

130:07giving the government power to do this,

130:11aren't they gonna start getting ideas down the line for,

130:15you know?

130:15- I think that they can barely govern.

130:20I don't think they're gonna do that,

130:22but you don't have to take, unless you're a federal employee,

130:26you don't have to take a COVID vaccine.

130:27- Yeah, but that largely has to do,

130:31not largely, but there is an individualistic spirit

130:36to the American people.

130:41There's this, like, you're not gonna take my gun away

130:44from me, you're not going, and I think that,

130:51that's something that makes America what it is.

130:56Just coming from the Soviet Union,

130:57there's a power to sort of resisting

130:59the overreach of government.

131:01That's quite interesting, 'cause I'm a believer,

131:04I hope that it's possible to have,

131:08to strive towards a government that works extremely well.

131:11I think at its best, a government represents the people

131:14and functions in a similar way that you're mentioning.

131:17But that, like, pushback,

131:20even if it turns into conspiracy theory sometimes,

131:22I think is actually healthy in the long arc of history.

131:25It can be frustrating sometimes,

131:28but that mechanism of pushing back against power,

131:30against authority, can be healthy.

131:33- I agree, I think it's fine to question the vaccines.

131:36What I have issue with is that many people

131:39put out incorrect information,

131:43and I'm not sure what their motivations are,

131:45and it's very hard to fight that,

131:47because then it's my word versus theirs,

131:50and I'm happy to talk with people

131:52about any of their concerns,

131:54but if you start getting into the stuff

131:56that just isn't true, then we have a problem.

131:59- The thing I struggle with is conspiracy theories,

132:03whatever language you wanna use,

132:04but sort of ideas that challenge

132:09the mainstream quote-unquote narrative.

132:12Given our current social media and internet,

132:16like, the way it operates,

132:17they can become viral much easier.

132:20There's something much more compelling about them.

132:22Like, I have a secret about the way things really work.

132:27That becomes viral, and that's very frustrating,

132:30because then you're not having a conversation

132:32on level ground.

132:33When you're trying to present scientific ideas,

132:38and then there's conspiracy theories,

132:39the conspiracy theories become much viral much faster,

132:42and then you're not just having a discussion

132:44on level ground.

132:47That's the frustrating part,

132:49that it's not an even discussion.

132:51- Can I just say one more thing?

132:53I mean, the internet is here to stay,

132:54so we're gonna have to figure out

132:56how to deal with it, right?

132:57But from my perspective,

132:59I was skeptical that any COVID vaccine

133:03would be ready within a year.

133:05That's amazing. - Me too.

133:07- Plus, the way I look at the mRNA vaccine as a scientist,

133:12it's gee whiz to me.

133:13It's amazing that it worked,

133:15and I think the data are great, so I want it.

133:18As a scientist, I want it.

133:21- One of the really sad things, again, with me too,

133:23as a scientist or as an admirer of science,

133:26I don't know if it's politics,

133:31but one of the sad things to me about the previous year

133:34is that I wasn't free to celebrate

133:38the incredible accomplishment of science with the vaccines.

133:42I was very skeptical that it's possible

133:44to develop a vaccine so quickly.

133:47So it's unfortunate that we can't celebrate

133:50how amazing humans are to come up with this vaccine.

133:54Now, this vaccine might have long-term effects.

133:57That doesn't mean this is not incredible.

133:59- Why couldn't you celebrate?

134:04- Because I would love to inspire the world

134:08with the amazing things science can do.

134:11And when you say something about the vaccines,

134:14they're not listening to the science.

134:15A lot of people are not listening to the science.

134:17What they hear is, oh, you're a Republican

134:22or you're a Democrat, and you're social signaling,

134:25doing some kind of signaling.

134:26- No, I think that the vaccine you're talking about

134:28is injecting something into you,

134:30and maybe you're right that the rhetoric is like,

134:33you better take this or you're dumb.

134:36It's not the right approach.

134:38- I've seen, actually, it's kind of interesting.

134:40I've seen both sides kind of imply that.

134:42So the people who are against the vaccine

134:47are dumb for not trusting science,

134:52and the people who are for the vaccine

134:55are called dumb for trusting science,

134:59the scientific institutions. - And nobody wins, yeah.

135:01- And they both kind of have a point.

135:03'Cause you can always, it's like,

135:08is the glass half full or half empty?

135:10Because you can always look at science

135:15from a perspective of certain individuals

135:18that don't represent, perhaps, not greatest leaders,

135:23almost like political leaders.

135:25There's a lot of, yesterday I went on a whole rant.

135:29Again, I said a lot of positive things

135:32about Anthony Fauci before I went on a rant against him.

135:37'Cause ultimately, I think he failed as a leader,

135:42and I know it's very difficult to be a leader,

135:44but I still wanted to hold him accountable for that

135:47as a great communicator of science and as a great leader.

135:50- But what do you think he didn't do right?

135:52I'm curious.

135:53- So the core of the problem is the several characteristics

136:00of the way he was communicating to the public.

136:06So one is the general inauthenticity.

136:09Two is a thing that, it's very hard to put into words,

136:14but there's certain ways of speaking to people

136:18that sounds like you're hiding something from them.

136:21That sounds like you're full of shit.

136:23That's the authenticity piece.

136:25Like it sounds like you're not really speaking

136:30to the full truth of what you know,

136:34and that you did some shady shit in your past

136:38that you're trying to hide.

136:40So that's a way of communicating

136:42that I think the internet and people in general

136:45are becoming much better at detecting.

136:46- Yeah, it's like you said, they're good BS detectors.

136:48- Yeah, good BS detectors.

136:50But contributing to that is speaking from authority.

136:54Speaking with authority and confidence

137:01where neither is deserved.

137:04So first of all, nobody's an authority on this new virus.

137:09We're facing a deadly pandemic,

137:12and especially in the early stages,

137:15it was unclear how deadly it would be.

137:17It was unclear, probably still unclear,

137:19fully how it's transmitted.

137:22The full dynamics of the virus,

137:24the full understanding of which solutions work and not,

137:28how well masks of different kinds work,

137:31how easy or difficult it is to create tests,

137:34how many months or years it's gonna take

137:36to create a vaccine, how well in history

137:40or currently do quarantine methods

137:43or lockdown methods work.

137:44What are the different data mechanisms

137:48that are, data collection mechanisms

137:50that are being implemented?

137:52What are the clear plans that need to happen?

137:55What the epidemiology that's happening?

137:58What is the uncertainty around that?

138:00Then there's the geopolitical stuff with China.

138:05You know, like what, I personally believe

138:10there should have been much more openness

138:12about the origins of the virus,

138:15whether a leak from a lab or not.

138:17I think communicating that you're open to these ideas

138:21is actually the way to get people to trust you,

138:25that you're legitimately open to ideas

138:28that are very unpleasant, that go against the mainstream.

138:31Showing that openness is going to get people to trust you

138:35when you finally decrease the variance in your uncertainty,

138:40like decrease uncertainty and have,

138:42we still have a lot of uncertainty,

138:44but this is the best course of action.

138:46Vaccines still have a lot of uncertainty around them.

138:49mRNA is a new technology,

138:51but we have increasing amounts of data

138:53and here's the data sources

138:54and like laying them out in a very clear way

138:58of this is the best course of action that we have now.

139:01We don't know if it's the perfect course of action,

139:04but it's by far the best course of action.

139:06And that would come from a leader

139:09that has earned the capital of trust from people.

139:13- I mean, I think in recent history,

139:15the worst pandemic is 1918 flu, right?

139:19But that's mainly 'cause we didn't know what to do.

139:22We didn't have many tools at our disposal.

139:24- And that was tied up with World War I.

139:26- That's right, that's right.

139:27- So the leadership there, I mean--

139:30- But I don't know what is a lot of deaths, right?

139:32And any one person is someone's family,

139:35so to them it's a lot, right?

139:37- But that logic, we don't apply that logic generally

139:41because there's a lot of people suffering

139:43and dying throughout the world

139:44and we turn the other way all the time.

§17Transcript · 2:19:47–2:28:58

139:47And that's the story of history.

139:49So saying you all of a sudden--

139:51- What bothers me though, I mean,

139:53personally, I don't like anyone dying anywhere,

139:56but especially considering what technology

140:00we're able to muster, yet we still kill each other.

140:02It's just dichotomy to me.

140:04- Yeah, but I mean, this is the, what is it, Paul Farmer?

140:07There's these great stories.

140:10I mean, that's the burden of being in healthcare,

140:15being a doctor, is you have to help.

140:23You can't help but help a person in front of you

140:25who's hurting.

140:26- Sure, sure.

140:26- But you also are burdened by the knowledge

140:30that you helping them, you spending money and effort

140:33and time on them means you're not going to help others.

140:36And you cannot possibly allocate

140:38that amount of time to everybody.

140:40So you're choosing which person lives

140:42and which person dies.

140:43- Sure.

140:44- And you're doing so, the reason you're helping

140:46the person in front of you

140:47is because they're in front of you.

140:49And so the reason right now we care a lot about COVID

140:53is because the eye of the world has turned to COVID,

140:56but we're not seeing all the other atrocities

140:59going on in the world.

141:00They're not necessarily related to deaths,

141:02they're related to suffering, human suffering,

141:05which you could argue is worse than death,

141:07prolonged suffering.

141:08- Of course.

141:09- So there's all of these questions.

141:11And the fundamental question here is,

141:15are we overreacting to COVID in our policies?

141:19So this is the, when we turn our eye

141:23and care about this particular thing and not other things,

141:26are we dismissing the pain that business owners

141:29who've lost their businesses are going to feel?

141:31And then the long, talking about long COVID,

141:35the long-term effects, economic effects

141:38on the millions of people that will suffer,

141:40that suffer financially, but also suffer from their dreams

141:44being completely collapsed.

141:46So a lot of people seek, gain meaning from work.

141:50And if you take away that work,

141:52there's anger that can be born, there's pain.

141:55And so what does that lead to?

141:57That can lead to the rising up of charismatic leaders

142:01that channel that anger towards destructive things

142:05that's been done throughout history.

142:06So you have to balance that with the policies

142:10that you have in COVID.

142:12And then, I mean, very much my main opposition

142:16to Fauci is not on the details, but the final result,

142:20which is, I just observe that there's a significant decrease

142:25in trust in science as a, not the institution,

142:30but the various sort of mechanisms of science.

142:32I think science is both beautiful and powerful.

142:35And the reason why we have so many amazing things

142:38and such a high quality of life and distrust in that,

142:42that the thing we need now to get out

142:44of all the troubles we're in,

142:46continue getting out of the troubles we're in,

142:48is science, the scientific process, broadly defined,

142:51like innovation, technological innovation,

142:54scientific innovation, all of that.

142:56Distrust in that is totally the wrong thing we need.

143:02And so anybody who causes a distrust in science, to me,

143:07carries the responsibility of that.

143:14And should be, because of the responsibility,

143:17I mean, should be fired, should be, or at least openly

143:21have to carry the burden of that,

143:24of having caused that kind of level of mistrust.

143:27Now, it's maybe unfair to place it on any one individual,

143:30but you have to, I think in your pockets,

143:33the buck stops at the top, like the leaders have to-

143:37- Sure, no, no, there's a clear leader here, yes,

143:40absolutely.

143:40- So even if it's not directly his fault,

143:43you know, he has to carry the price of that.

143:48- Do you think we should, at this point, say,

143:50okay, we have vaccines, you can decide

143:54whether you take 'em or not, let's move forward?

143:57- Maybe you can help me understand this,

143:59because it seems like, why is that not the right solution?

144:04Completely open society, the vaccines,

144:07at least in the United States, as I understand,

144:11are widely available, so this is the American way,

144:16you have the decision to make.

144:18If you have conditions that make you worried to get COVID

144:23and go to the hospital, then you should get vaccinated,

144:26because here's the data that shows that it's much less

144:29likely for you to die, right, if you get vaccinated.

144:34If you don't want to get vaccinated because you're worried

144:36about long-term effects of vaccine, then you don't have to,

144:40but then you suffer the consequences of that, and that's it.

144:44- So here's what I think is driving,

144:47I think it's all about kids, right,

144:50because they're gonna go back to school in the fall,

144:51and many of them can't be vaccinated, right,

144:54so if they get infected, they do have less frequency

144:59of disease, but it's not zero.

145:01They do get sick, and they can have long-term consequences,

145:04and at that age, it would be a shame, right,

145:09and it's not even their choice.

145:10They can't decide to get vaccinated or not,

145:13because they can't have access to it,

145:15so I think that's what would drive my efforts

145:19to try and get more people, at least in schools, vaccinated,

145:22but I might be wrong.

145:23It may not be that.

145:24- Can you kind of dig into that a little bit?

145:26So there's,

145:27so you're saying that there should be an effort

145:33for increased vaccinations of kids going to school,

145:37just not for societal benefit,

145:39but for the benefit of each individual kid, right?

145:42- So right now, kids under 12, right,

145:46are not yet vaccinated.

145:47Is that correct?

145:48- Yeah, I think so.

145:49- And it's not gonna be in time for school opening,

145:53that they get vaccinated,

145:54and then, I suppose the teachers

145:59are all gonna be vaccinated.

146:01Makes sense for them to do that,

146:02but I'm just worried the kids are gonna be transmitting it

146:05amongst them, and many states don't allow

146:07a mask mandate in school,

146:08so I think that's what's driving the larger narrative

146:13in the US to protect kids.

146:16It's kind of what I hear from Daniel Griffin,

146:19'cause increasing numbers of kids

146:21are being admitted to hospitals now,

146:24because they're becoming the major unvaccinated population.

146:28They're hanging out over the summer,

146:29and that's just gonna get worse in the fall,

146:32and so you could have a lot of kids with long COVID

146:35and disabled their entire lives, right?

146:38- And of course, hearing from people

146:40who are vaccine-hesitant,

146:42I hear exactly the kids' statement,

146:44but they're saying they don't want the long vaccine,

146:49the long-term effects of the vaccine to affect the kids.

146:53That's of this new vaccine.

146:56- Which I would say is, as I said before,

146:58you can't say never,

147:00but we do know that long COVID exists.

147:05We don't know for how long,

147:06'cause we've only looked out six or eight months.

147:09We know that exists, and the frequency is increasing.

147:12It certainly exists in young kids,

147:14and we have no idea about long vaccine effects,

147:16so I think they have to make their decision based on that.

147:20- But, yeah.

147:24- But your question is, why don't we just open up society,

147:28say, "Here, we have these vaccines.

147:29"If you want to protect yourself."

147:30I think it's mainly the school

147:32that's driving the whole narrative.

147:34That's my opinion.

147:35- In which direction, not to open up, or?

147:37- No, to open up, but to try and get,

147:40you know, their efforts at the federal level

147:42to get people vaccinated, right?

147:44- But see, how high are the risks for kids?

147:46I mean, my understanding was it's,

147:48I mean, yes, it's non-zero, but it's very low.

147:50- But what is the numbers?

147:53Now, 70,000 hospitalizations so far in kids

147:58as of last week, so yes, it's low,

148:01but polio was low.

148:05Polio was 20, 30,000 kids a year paralyzed,

148:08and many people have actually argued

148:11that that vaccine wasn't necessary, you know?

148:13That it wasn't a substantial enough health problem.

148:17- But paralyzed is different than hospitalized,

148:19so what does hospitalized mean?

148:20- Long COVID.

148:21- But this is the long COVID question.

148:23I mean, this is the open question.

148:24It was long COVID in kids.

148:26What is that?

148:27Well, a lot of the same issues,

148:30cognitive issues, motor issues,

148:34respiratory, GI dysfunction.

148:37How long?

148:39We don't know.

148:40I mean, it could end in a year.

148:43As you know, there are other post-acute

148:46infectious sequelae that we know about,

148:48you know, chronic fatigue, ME/CFS.

148:51It's thought to be a post-infectious sequelae,

148:53which has gone for many decades now

148:55in many millions of people.

148:56This could be another one of those.

148:58So I'm just saying it might be worth erring on the side

§18Transcript · 2:29:02–2:38:20

149:02of not letting the kids get infected.

149:05- Yeah, well, I'm trying to keep an open mind here,

149:09and I appreciate you doing the same.

149:12Of course, I lean on definitely not requiring people

149:17to get vaccinated, but I do think getting vaccinated

149:21is just the wiser choice,

149:24looking at all the different trajectories before us.

149:28Getting vaccinated is,

149:29seems like from the data,

149:33it seems like the obvious choice, frankly.

149:35But I'm also trying to keep an open mind.

149:38There's some things in the past that seemed obvious

149:40would turn out to be completely wrong.

149:42So I'm trying to keep an open mind here.

149:44So for example, one of the things,

149:48I'd love to get your thoughts on this,

149:50is antiviral ideas.

149:52So ideas outside of the vaccine.

149:55So ivermectin, something that Brett Weinstein

150:00and a few others have been talking about.

150:02There's been a few studies.

150:03Some of them have been shown not to be very good studies,

150:07but nevertheless, there seems to be some promise.

150:11And I wanted to talk to Brett about this particular topic

150:16for two reasons.

150:17One, I was really bothered by censorship of this.

150:19That's a whole nother topic.

150:22I just, I'm bothered by censorship.

150:25There's a gray area, of course,

150:27but it just feels like that should not have been censored

150:32from YouTube, like discussions of ivermectin.

150:34We can set that aside.

150:36The other thing, I was bothered by the lack

150:39of open-mindedness on exploring things like ivermectin

150:44in the early days, especially when,

150:48at least I thought the vaccine would take a long time.

150:51I mean, it's not just ivermectin.

150:53It's really seriously, at a large scale,

150:57rigorously exploring the effectiveness of masks.

151:01And the big one for me is testing.

151:03Like the fact that that wasn't explored aggressively

151:07to lead to mass manufacturing, like May 2020, is absurd.

151:11Anyway, so I was bothered by these solutions

151:14not being explored and not,

151:16by now having really good ivermectin studies.

151:19- So can I talk about ivermectin?

151:20- Yeah, I would love that, yeah.

151:21- Sure, so full disclosure,

151:23my wife worked on ivermectin at Merck for 20 years.

151:26(Lex laughing)

151:27Okay, so they just want people to know,

151:30but I didn't, don't talk to her all the time about it.

151:34And anyway, she hasn't been at Merck for a long time.

151:37As you know, ivermectin is a very safe drug

151:39used to treat certain parasitic infections, right?

151:43And it is approved, it's amazing.

151:47You can take one dose a year

151:48and be protected against river blindness in Africa,

151:51in certain parts of Africa.

151:52It's remarkably effective.

151:54And so it's quite a safe drug

151:57at the doses that are approved.

152:01Now, early last year, a study was done,

152:04I believe in Australia, which showed in cells in the lab,

152:07if you infect with SARS-CoV-2 and then put ivermectin in,

152:11it would inhibit the virus production substantially.

152:13It was quite clear, right?

152:16But the concentrations they were using were rather high

152:19and could not be achieved by the approved dosing.

152:24So you would need to do a dosing study

152:27to make sure it's safe.

152:29And the reason is that ivermectin

152:31binds to receptors in your brain,

152:32and it can have high doses.

152:34Some people take high doses inappropriately,

152:37and they have neurological consequences.

152:39So if you needed 10 times more ivermectin,

152:42you'd have to make sure it would be safe.

152:44- So this is a question of safety too.

152:46- Right.

152:47So I think it has always been the case

152:51that it should have been properly studied, but it wasn't.

152:54There were lots of trials here and there,

152:56lots of improperly controlled trials

152:58where someone would just treat some patients and say,

153:00"Hey, they all did fine, but have no control arm."

153:03And there were some controlled trials,

153:05but they were very small.

153:06So right now, a 4,000 person trial is enrolling

153:12to test in a randomly controlled trial setting,

153:16whether it works or not.

153:17There's still plenty of cases that you can do that.

153:20So you can ask whether there are any side effects.

153:23I think that's completely fine.

153:24And if it says it works, then we should use it.

153:28In the meantime, I always tell people,

153:31if you wanna use ivermectin, you can do it off-label.

153:33It's FDA approved.

153:35And if your physician says,

153:36"I'm gonna give you this off-label,"

153:38I don't have any objection,

153:41but I don't know if it's gonna work.

153:43Now, a friend of ours last week in New Jersey got COVID.

153:48He went to his local hospital

153:50and their regimen was remdesivir, dexamethasone, ivermectin.

153:55It's written, that's what they do for every COVID patient.

153:59They just give it to them automatically.

154:01And so he recovered.

154:04So who's to say it was or was not ivermectin, right?

154:08So I don't have any strong ideological opposition.

154:12I just think it should be tested

154:14for what you wanna use it for.

154:16And that's being done, and I think that's fine.

154:19- Is it strange to you that ivermectin

154:23or other things like it weren't tested

154:25aggressively in the beginning?

154:27From a broad scientific community aspect,

154:32I can be a little bit conspiratorial,

154:36and this is what people talk about with ivermectin,

154:39is with the vaccines, there's quite a lot of money

154:41to be made.

154:42With ivermectin, there's not as much money to be made.

154:45Is that too conspiratorial?

154:48Like, why didn't we try more solutions in the beginning?

154:51- Well, all the money was put into vaccines, right?

154:55Very little was put into antivirals.

154:57Because the decision was made at a very high level,

154:59probably involving Dr. Fauci.

155:01We're gonna put 24 billion into vaccines, right?

155:04- Yeah.

155:06- And I think part of the reasoning is

155:08they give you years worth of protection,

155:10whereas an antiviral works,

155:11and you have to keep dosing and so forth.

155:13But ivermectin is not trivial in this.

155:16I agree, it should have been tested early on,

155:18but we had a really bad experience with hydroxychloroquine,

155:21which we can talk about too.

155:23Ivermectin is very hard to synthesize.

155:28Most drugs you synthesize chemically.

155:31You devise a formulation and a synthesis,

155:34and they do it, they scale it up, and it's fine.

155:36Ivermectin's really hard.

155:38And so what they do instead is they take the culture

155:41of the bacterium that makes it,

155:43and they grow it up, and they ferment it,

155:45and then they purify it.

155:47And Merck owns the bacteria.

155:50A number of years ago, two employees of Merck stole it

155:55and left the company and tried to market it,

155:58and they were arrested, and they got put in jail.

156:00So they protect it very carefully.

156:02So you can't just make it.

156:05If you do, it's incredibly expensive.

156:07And now India, it's very cheap apparently.

156:10They use it quite liberally there.

156:12And I don't know how they're making it.

156:14Maybe they've licensed it from Merck and so forth.

156:16But that's why it hasn't been tested more widely, I think.

156:21- There's complexities in terms of getting a lot of it

156:24and manufacturing a lot of it.

156:25- Yes. - Okay.

156:26So what was the other, the hydro--

156:28- Hydroxychloroquine was also shown early on

156:32to inhibit virus in cell culture.

156:34And that's not surprising.

156:37Hydroxychloroquine, of course, is used for malaria.

156:41And what it does, when your cell takes up things

156:46from the plasma membrane, including viruses,

156:49it goes through a pathway called the endocytic pathway,

156:52which involves a vesicle moving through the cell.

156:54And as it moves through the cell, its pH drops.

156:57And that lets a lot of viruses out actually.

157:00And hydroxychloroquine blocks that.

157:01So it blocks infection with a lot of viruses.

157:04So the problem with those early studies that were published

157:10is that they were done in kidney cells and culture,

157:14where the only way the virus can get in

157:16is through the endosome.

157:17And hydroxychloroquine inhibits that,

157:20and that's why it inhibits in kidney cells and culture.

157:24But lung cells and respiratory cells of humans

157:28where the virus reproduces can get in two different ways.

157:31It can get in from this endocytic pathway,

157:34which is inhibited by hydroxychloroquine,

157:37or it can get in at the cell surface,

157:40which is not inhibited by hydroxychloroquine.

157:43So when you treat patients, it has no effect in the lung

157:46because the virus can just bypass it.

157:50And all the usage initially were based

157:53on the studies done in kidney cells and culture.

157:57So that was just wrong, scientifically incorrect,

158:00yet it drove a lot of, and today,

158:02many people still think they should be taking it.

158:05- So that not panning out kind of resulted

158:09in a loss of optimism about other similar things panning out?

158:14- Well, that and many other drugs,

158:15repurposed drugs were tried, right?

158:17A lot of HIV antivirals were tried.

158:20I think the problem with hydroxy,

§19Transcript · 2:38:22–2:47:26

158:22I think hydroxychloroquine influenced

158:24the ivermectin narrative, right?

158:26People thought that data was being hidden

158:29about hydroxychloroquine, so they said,

158:30well, they must be doing the same thing with ivermectin.

158:33But with hydroxychloroquine,

158:34it just scientifically could not work as an antiviral.

158:39The other problem that is more broad

158:42that is important to point out is that

158:44when you have COVID and you need an antiviral,

158:49it's usually because you can't breathe

158:50when you go in a hospital.

158:52'Cause if you're mildly ill,

158:53you're never gonna go to your doctor

158:55and ask for an antiviral.

158:56And the problem is when you can't breathe,

158:58it's no longer a viral issue.

159:00It is now an inflammatory issue,

159:02and no antiviral in the world is gonna help you.

159:05So that's why remdesivir doesn't work very well,

159:09'cause it's mainly given intravenously

159:10to people who go in a hospital.

159:12If you get ivermectin in the hospital,

159:16it's not gonna do anything for reducing virus,

159:19because by that time, you have very little virus

159:20to begin with.

159:21You have an inflammatory problem

159:23that you need to treat in other ways.

159:24So this is why a lot of the antivirals failed,

159:28because they're used too late.

159:30What you need is a pill you take

159:33on that first positive test,

159:34when you have a scratchy throat.

159:36You get a PCR in 15 minutes, I'm positive,

159:39take a pill, boom, that's gonna inhibit it.

159:42If you wait 'til you can't breathe,

159:44and that's why the monoclonals even don't work

159:47if you're in a hospital that well,

159:49'cause it's too late.

159:50And the approach now is, if you're in a high-risk group,

159:54if you're over 65, if you are obese,

159:57or have diabetes, or any other comorbidities,

160:00your first sign of a scratchy throat positive,

160:03you get monoclonals.

160:06Then they might help you.

160:07But if you wait 'til you go in a hospital, it's too late,

160:09'cause the viral curve drops.

160:12After that first symptom, within three days,

160:15you're no longer shedding enough virus to transmit.

160:19It drops really quickly.

160:20So that's the reason a lot of these antivirals failed,

160:23'cause they were tested in hospitalized patients.

160:25And we have nothing but remdesivir now, unfortunately.

160:29So it was the wrong approach.

160:30We should have been giving it to people

160:33who just tested positive from the start.

160:35- Or just even for preventative and see--

160:38- You could do that too.

160:39But I have to say, the other issue is,

160:42this monopiravir is a drug in phase three now.

160:45It's an oral antiviral, it looks good.

160:48If we go ahead with just one,

160:51we're gonna get resistance within a few months,

160:53and it will be useless.

160:54We need to have at least two or three drugs

160:56that we can give in combinations.

160:58And we know that, 'cause that's what took care of HIV,

161:01that's what took care of HCV, hepatitis C virus.

161:05It really reduces the emergence of resistance.

161:08- Joe Rogan got quite a bit of heat recently

161:11about mentioning a paper and a broader idea,

161:16which I don't think is that controversial,

161:19but maybe we can expand on it.

161:21And the idea is that vaccines create selective pressure

161:27for a virus to mutate and for variants to form.

161:34First of all, from a biological perspective,

161:40can you explain this process?

161:42And from a societal perspective,

161:45what are we supposed to do about that?

161:47- So let's get the terminology right.

161:49So as we talked about earlier, viruses are always mutating.

161:54So no vaccine or no drug makes a virus mutate.

161:58- That's the wrong perspective in which to look at it.

162:01- What the immune response is putting pressure,

162:05selection pressure on the virus.

162:07And if there's one particle with the right mutation

162:11that can escape the antibody, that will emerge.

162:15So that's what happens with influenza virus, right?

162:17We vaccinate every year and there are not a lot of people

162:21that get infected, so they get natural immunity.

162:23And then the virus is incredibly varied.

162:28It mutates like crazy.

162:30And there's in some person somewhere,

162:32there's one variant that escapes the antibody,

162:34which has been induced either by infection or vaccination.

162:37It can be both.

162:38And that drives the emergence of the new variants.

162:41So the next year we need to change the vaccine.

162:43So I would say both natural infection and vaccination,

162:48sure, select for variants.

162:51Absolutely, there's no question,

162:53because they're inducing immunity.

162:55Now, what happened last year was at the beginning of 2020,

163:00very few people in the world were immune

163:02as the virus first started spreading.

163:04But you can see in the sequences of those isolates

163:09from the beginning of 2020,

163:11you can see all of the changes that are now present

163:14in the variants of concern at very, very low frequencies.

163:17They were already there,

163:18but there was no selection for them to emerge.

163:21Until November, when we now had many millions of people

163:25who had mostly been infected, but also some vaccinated,

163:29then we saw the alpha variant emerge in England,

163:33probably because of immune selection.

163:35Now the virus that had the change

163:38that evaded the antibody had an advantage,

163:41and that virus drove through the population.

163:44So that's what we're seeing.

163:44We're seeing all these variants

163:46are simply antigenic selection.

163:47- So the variants, the mutations that are at the core

163:52of these "variants," they were always there all along.

163:56The vaccine or the infections did not create them.

164:00- No, the infections don't create them, they're selected.

164:02- It's like the vaccine wipe out a lot of the variants,

164:08right, and then by making your body immune to them,

164:13but some of them survive.

164:15- Yeah, exactly.

164:16- And then there's another tree that's built,

164:19and it's unclear what that tree leads to.

164:22I mean, it could make things much worse or much better.

164:27We don't know.

164:28- Well, with flu, we see year after year, the virus changes.

164:31We change the vaccine, we deal with it,

164:33we change it again, there's an unending series.

164:35- But see, that's a very different story.

164:37Do you think COVID will be,

164:40with some likelihood, like the flu,

164:45where it's basically variants,

164:47we'll never be able to eradicate it?

164:52- It will never eradicate it in any case, ever.

164:57- Well, come up with a vaccine

164:59that makes you immune to enough variants

165:03where there's not enough evolutionary room.

165:07- Well, if you cut down the number of infections,

165:09then you reduce the diversity, sure, right?

165:12The problem is, let's say you're a cynic,

165:15and you say, "Well, vaccination is just selecting

165:18"for variants, so let's stop it."

165:20But then you're gonna have infection,

165:21and that's gonna select for variants,

165:23and you're more likely to get very sick,

165:26because we know the vaccines are really good

165:28at preventing you from dying.

165:30So that's why it still makes sense to use vaccines,

165:34because they prevent you from dying.

165:36That's the bottom line.

165:38But can we ever make a vaccine

165:41that deals with all variants?

165:44Absolutely.

165:45And the reason I say that is because people

165:49who get naturally infected with SARS-CoV-2,

165:53they develop COVID, they recover.

165:55If you give them one vaccine dose,

165:59they make an immune response

166:01that handles all the variants that are around right now.

166:05All of them, much better than people

166:07who've gotten two doses of vaccine.

166:10For some reason, their immune response

166:12has suddenly broadened after the infection vaccination,

166:16and they can handle all the variants

166:18that we know of so far.

166:19So that tells me we can devise a strategy

166:22to do the same thing with a vaccine

166:24that makes a really broad vaccine

166:26that'll handle all the variants.

166:27- Well, you actually, on the virology blog,

166:30I don't know if you're the author of that, but--

166:32- I am, yes.

166:33Oh, the blog, yes, but there's a particular post

166:36that was talking about reporting on a paper

166:39that a mix and match strategy--

166:40- Oh, yes, that's one of my co-writers, Trudy Ray, yeah.

166:44- Yeah, it's an interesting idea

166:46that there's some early evidence now

166:49that mixing and matching vaccines,

166:52like one shot of Pfizer and one of like Moderna or something,

166:56that creates a much better immunity

167:00than does two shots of Pfizer.

167:02- I think that's worth exploring, absolutely.

167:05And this is relevant, that what we're doing with influenza,

167:08instead of having to vaccinate people every year,

167:11why can't we devise a vaccine

167:12which you'd get once in your lifetime,

167:14or maybe once every 10 years, okay?

167:17So the spike of influenza, it's a long protein,

167:22kind of like the spike of SARS-CoV-2,

167:24it's stuck in the virus membrane,

167:26and the very tip, that's the part that changes every year.

§20Transcript · 2:47:31–2:56:00

167:31That's where the antibodies bind.

167:33But the stem doesn't change.

167:36And if you make antibodies to the stem,

167:39they can also prevent infection.

167:41It's just that when people are infected

167:44or with the current vaccines,

167:45they don't make many antibodies to that stem part.

167:48But we're trying to figure out how to make those,

167:51and we think they would be broadly protective,

167:53and you'd never be able to, or more rarely be able to,

167:57have a variant emerge that escaped it.

168:00And I think we can do the same thing

168:02with coronavirus too, for sure.

168:05- Can I ask you about testing?

168:08- Sure, sure.

168:10- You mentioned PCR, what kind of tests are there?

168:13The antigen test, what are your thoughts on each?

168:18Maybe this is a good place to also mention viral load,

168:22and the history of the virus

168:26as it passes through your body,

168:27in terms of what's being tested for,

168:31and all those kinds of things.

168:33- So the first tests that were developed were PCR,

168:38polymerase chain reaction,

168:40they're basically nucleic acid amplification tests.

168:43And the very first ones,

168:44they stuck the swab all the way up into your brain, almost.

168:47(laughing)

168:49I had that done a couple weeks ago.

168:50Oh my gosh, it's really nasty.

168:53But now they do an anterior nares swab.

168:56They get a bunch of cells and some mucus,

168:59which has virus and parts of virus,

169:02stick it in a test tube,

169:04and then they run a reaction,

169:05which by the way, involves reverse transcriptase,

169:09'cause it converts the viral RNA to DNA,

169:11and then you amplify it.

169:14And you can specify what part of the viral RNA

169:18you want to amplify.

169:20And then a machine will detect it,

169:22and it can be done in 15 minutes.

169:25But you're detecting pieces of RNA, not infectious virus.

169:29So we're measuring viral RNA loads, right?

169:32And a common mistake that many people who should know better,

169:36you know, physicians and scientists of all kinds,

169:40they think that indicates how much virus you have.

169:42It doesn't.

169:44It's a diagnostic of whether you have bits of RNA in you,

169:48and it probably means you're infected.

169:51But you can't use it to shed light on what's going on.

169:55And I'll tell you why in a bit,

169:56but first we have to explain some other things.

169:59So until you get to about a million copies of RNA,

170:06so you can measure the copy number in this test,

170:08this PCR test.

170:09It's a number called CT, or cycle threshold.

170:13The test, the way the machine works,

170:15it goes through cycles.

170:16In every cycle, it amplifies what you put in.

170:19And the more cycles you need to see something,

170:23that means there's not a lot of RNA there.

170:26So if you do a test and you have a cycle threshold of 35,

170:31you have very little RNA in you.

170:33Contrary, if you have a cycle threshold of 10,

170:36you have a ton of RNA,

170:37and you only took 10 cycles to detect it.

170:39And you can extrapolate from that number

170:42the number of copies you have per sample, say per swap.

170:46And if you don't have a million, you're not infectious.

170:49You're not gonna infect anyone.

170:50So in the early days, no matter what PCR result you had,

170:54they would quarantine you.

170:56And that was wrong because you're not shedding.

170:58You don't need to be quarantined,

171:00but it wasn't thought through properly, right?

171:02- And that's where you had like 14 days

171:04or something like that.

171:05- 14 days, which is now we know is too long

171:07because you don't shed for that long in a normal infection.

171:11Now it's 10 days should be fine.

171:14So what happens is you get infected.

171:16You don't know it, of course.

171:17The virus starts to grow very quickly.

171:19And within four or five days, you reach a peak of shedding.

171:24You're making a lot of RNA and you may be asymptomatic.

171:28You're shedding, you can infect others.

171:30And then you may or may not have your symptom onset.

171:32So you shed for a couple of days before symptom onset.

171:36And then within three days, four days,

171:38the viral RNA crashes and you're no longer shedding.

171:41You're no longer transmitting.

171:42So that's the one kind of test we have.

171:44It can tell you if you're infected at the moment,

171:47but it won't tell you if you're gonna be infected tomorrow.

171:51'Cause if you're negative today,

171:52you could be positive tomorrow.

171:54You just might be in a different part

171:56of the incubation period.

171:58So that's one test been used the most.

172:01You can now get 15 minute versions of them

172:05in a walk-in or whatever.

172:06Then there are antigen tests,

172:08which look for the proteins that the virus is making.

172:11So as it's reproducing in your nose,

172:13it's not only making genomes, it's making proteins.

172:16And so these you can buy in the drug store.

172:18And these would have been great if they had,

172:22Michael Mina last year had the idea

172:24that if we could make a little stick,

172:26a little piece of paper that you would suck on

172:28and it would tell you if you're infected or not,

172:30if this could cost less than a buck,

172:32everybody could test themselves.

172:34- Which they can cost less than a buck, by the way.

172:37- Yeah, but they were never made, right?

172:39- They're never mass manufactured.

172:42So his idea is to do like daily tests.

172:44- Yeah, daily, and then the kid's going to school,

172:47he's positive or she's positive.

172:49Well, if it's cheap enough, you just take another test

172:51'cause they have a certain error frequency.

172:53If it's positive twice, you stay home

172:55and the next day you try again.

172:57And I think this would have revolutionized

172:59because the PCR tests are more expensive at the time

173:02and they take longer to do and so forth.

173:05But that never happened.

173:07But now we do have $20 BinaxNOW and others that you can buy

173:10and people buy them.

173:12- See, but that can still happen, right?

173:13And this is the very frustrating thing to me

173:16because I'm worried about variants,

173:18but I'm also worried about future,

173:20much more deadly pandemics.

173:22I know we kind of said, yes, COVID, lots of deaths,

173:28but it could be a lot worse too.

173:31So I'm thinking what is going to be the right response

173:35for the future pandemic of its kind?

173:38And what's the right response

173:39for continued number of variants

173:41and some of the variants might be deadlier

173:44or more transmissible?

173:45- Well, the antigen tests will pick up the variants.

173:50That's not a question.

173:52The PCR may be influenced by changes,

173:55but you can quickly adapt the primers that you use.

173:58- But that's what I mean.

173:59Like to me, all these discussions about vaccines and so on,

174:03vaccines, we got very lucky that they took so little time.

174:06- Right.

174:07- And you have to be aware, no matter what,

174:10that there's hesitancy with the vaccines in this country.

174:13Before, I mean, yeah, that's a reality.

174:15You can't just be like magically saying that

174:18you're going to overcome that.

174:20And I don't think there's any hesitancy

174:22and cheap tests at home.

174:24- I agree.

174:24I think if someone, so the question is,

174:27if someone tested positive, would they stay home?

174:29That's the question.

174:30What if their job depends on them going in?

174:32I mean, that's-

174:33- Well, you have to look at sort of aggregate

174:36how many people would decide.

174:38And I think, again, a lot of that is in leadership,

174:43but I think a lot of them,

174:45I would say most people would stay home.

174:47- I think that Mena had the idea

174:49and it would have changed the whole situation for sure

174:53if it could have been made when we talked to him last spring,

174:56I think, or summer.

174:57We would have gotten around a lot of the issues

175:00that we're in today because I think people

175:02would have stayed home and not transmitted.

175:04And I think it's still valuable to this day.

175:06In the fall, if we don't have vaccine uptake,

175:09we could just test kids every day

175:12and keep them home when they're infected.

175:14And we don't have it.

175:17But I think, and I'm not privy to what was going on,

175:20but I don't think a lot of emphasis

175:23was put on testing early on.

175:25The CDC developed the first one.

175:27It was flawed.

175:27They had to recall the kits.

175:29I mean, that was a fiasco.

175:30They should have had 100 companies

175:32making the tests initially, right?

175:34So for the future, I think what we have learned

175:37is we need to have a rapid antigen test

175:40right off the bat that's doable.

175:43You can't do it in a day like you can for PCR

175:46because you need to make antibodies

175:49to the protein that you're looking for

175:51and you need to do those in animals.

175:52But you can do it in weeks and we should be ready for that.

175:57- Yeah, I mean, to me, that's obvious.

176:00That's obviously the best solution.

§21Transcript · 2:56:02–3:04:46

176:02Second to that, if we understood how well masks work.

176:06Like, maybe let me ask you this question.

176:11Let's put masks aside.

176:13How well do we understand how COVID is transmitted?

176:18There's droplets of different sizes, aerosols,

176:23tiny, tiny droplets.

176:24It seems like that's a very difficult thing

176:28to understand thoroughly.

176:30So it seems like it's transmitted both ways.

176:34It's unclear how exactly.

176:36So how much do we understand

176:39and why is it so difficult to understand fully?

176:41- I think it's clear that it's transmitted

176:43through the air mostly.

176:45It's not touching.

176:47We thought initially it would be a lot of touch

176:48but very little of that.

176:50It's through the air and when you talk,

176:53mainly when you talk, you expel a lot of droplets, right?

176:57Even the plosives that your foam thing here

177:00are meant to pee, right?

177:02That you send out little sprays

177:03and those have viruses in them.

177:05The big drops fall to the ground

177:07and the little ones can go 100 feet or more, right?

177:12But the little ones also have less virus in them.

177:14So I'm not sure, well, we certainly do not know

177:19how much virus you need to be infected.

177:22But it's probably at least several thousand particles,

177:25if not more.

177:26And it could be that for most people,

177:30the tiny droplets don't have enough virus

177:33to infect someone else.

177:34But there's one observation about this virus

177:37that's really interesting.

177:39And that is that 80% of transmissions

177:42are done by 20% of the people, of the infected people.

177:47Not every infected person transmits.

177:50That's been borne out in multiple studies.

177:52And in fact, there's a study at University of Colorado

177:56where they quantified the viral RNA loads

177:59in all the swabs that had been done of students

178:01for like a six month period.

178:03And most of the infectious virus,

178:08most of the RNA copies were found in 15 to 20% of the people.

178:13The rest had really low and they probably,

178:16that's probably why they don't transmit.

178:18So those are the ones that might get enough virus

178:22in the tiny droplets to be able to infect someone

178:25at a distance.

178:27And I think that's entirely possible.

178:29Why is it hard to study?

178:31You can't do it in real life

178:33because you don't know who's infected.

178:35And if you do this, there's not a controlled environment

178:38to measure droplets and so forth.

178:39You'd have to do it in a laboratory situation.

178:42If you use an animal, you just don't know

178:44what the relevance of that is to people.

178:47You'd have to use human and do challenge experiments.

178:50And we don't do that at this point,

178:52at least not for this virus.

178:53So that's why it's hard to know what's going on.

178:55So we have to make inferences

178:58from epidemiological associations

179:01where you're studying say transmission in a household

179:03where people are stuck in the same rooms together

179:06and you can get an idea

179:07of what kind of droplets were involved.

179:09- So that makes it much harder to,

179:11if you're leaning on epidemiological stuff

179:14as opposed to like biophysics or something like that.

179:17- Very hard.

179:18- So that makes it, but that makes it really hard

179:21to then develop solutions like masks,

179:24to ask the question, how well do masks work?

179:26Because then to answer that question,

179:28you can lean on epidemiological stuff again,

179:32like looking at populations that wear masks

179:34versus don't wear masks,

179:36as opposed to actually saying,

179:38like from an engineering perspective,

179:41like what kind of material and what kind of tightness,

179:46by which amount decreases the viral load

179:50that's received on the other end?

179:52- But some experiments have been done with masks

179:55and just droplets with no virus in them, right?

179:58- Yes.

179:59- And you can measure the efficiency

180:01of different mask materials at keeping those in.

180:04- So if I say that this mask stops 70%

180:09of this or larger size droplet,

180:12that leads to this percent decreased transmission.

180:19And also on both the generation

180:23and the receiving end and the giving end.

180:27- Sure.

180:28- So how well do masks protect you from others?

180:30How well do you do mask protect others from you?

180:34Like all of those things seem like

180:36they could be more rigorously studied.

180:40- There's no doubt about it.

180:41And now is the time because once this is over,

180:46nobody's going to do it.

180:47- Nobody's going to care.

180:48- No.

180:49- But it seems like to me, so tests is one thing,

180:52but masks, like good masks, whatever the good means,

180:57whatever that means, like some level of a quality

181:01of material on your face, if it's shown to actually

181:05like thoroughly shown to work well,

181:09that seems like an obvious solution

181:10to reopen society with, if you have a good understanding

181:16of how well they work.

181:17Because if you don't have a good understanding,

181:20if there's a lot of uncertainty, that's when you get,

181:23and you have people speaking from authority,

181:25that's when you start getting the politicization

181:27of the solution.

181:28- Of course, of course.

181:29No, the data, there are some data,

181:32most, they're mostly epidemiological,

181:36and they show some effect in some countries, right?

181:39But they could be way better.

181:40- Yeah.

181:41- And, but the fact that they're not perfect,

181:44then people take advantage of and say,

181:46well, look, they don't work that well,

181:48so I'm not gonna wear it.

181:49I think, as you said, people can use it as an excuse.

181:53But even if it works, so Daniel always says it,

181:56a mask will cut down transmission by 50 to 60%,

182:00and then distance will do another 30%.

182:03- Yeah, those numbers are made up, though.

182:05I mean, they're not made up, but they're estimates.

182:08- Absolutely.

182:09And many of them are made based on models, right?

182:12- Yeah.

182:13- We will make this model, and let's say the mask

182:15cuts down this much, what will be the effect on it?

182:17I mean, yeah, they're models,

182:19and it's for the same reason.

182:20I don't believe the transmission of the variants,

182:25because it's all based on statistical models as well,

182:27not biological experiments done in the lab.

182:29- So in that sense, vaccine data's much better

182:32than mask data.

182:33- For sure, for sure.

182:34- So my problem with the mask data,

182:37which I always thought was fascinating,

182:38I stopped talking about it, I was in a paper about masks.

182:41I stopped talking about it because what started happening

182:45is masks created assholes on both sides.

182:48The people that were in Silicon Valley,

182:50the friends of mine that were wearing masks,

182:52the way they look at others who don't is like--

182:56- That's a whole 'nother issue, right, yeah.

182:58- But that's what-- - I understand.

182:59- That happens when you don't have solid science.

183:02- Understood.

183:03- They now start judging you like you're

183:05a lesser human being.

183:07You're not only dumb, but you're just,

183:10you're almost like evil.

183:11You're doing bad for society by not wearing a mask.

183:14And then the people looking in the other way

183:17are seeing you for the asshole that you're being

183:19for judging them unrightfully.

183:22So they almost wanna say F you by not wearing the mask.

183:24And there's this division that's created

183:26that was heartbreaking to me because masks, like testing,

183:30is a solution that was available early on.

183:33And if understood well, it could be deployed

183:36in a mass scale.

183:37And it seems like there's some historical evidence

183:39for other viruses where it does very well.

183:41- That's correct.

183:42- And so the fact that this was politicized,

183:45yeah, was a little bit heartbreaking.

183:48- You can find in the literature studies,

183:51mostly of healthcare workers and influenza,

183:54where you can actually, 'cause you see the people every day,

183:57they can sample them, you can actually see what masking does

184:00and some of them show an effect and others do not.

184:04Then that's the problem.

184:05Like any trial, sometimes if it's not big enough

184:08and then people latch onto that, see,

184:10it doesn't really work.

184:11But I think the main issue is that in January,

184:15both CDC and WHO said, "Masks don't work, don't use them."

184:20That was the kiss of death for masks.

184:22Because when they then changed their mind,

184:25they didn't say, "We screwed up."

184:28They just said, "Wear masks."

184:29If they had said, "We made a mistake, we were wrong,"

184:33I think more people would have worn masks, but they didn't.

184:36And like you said, admitting you're wrong

184:39is like a real big part of it.

184:41- I also think almost the better way

184:43is not just saying you're wrong,

184:46but in January revealing the uncertainty

§22Transcript · 3:04:51–3:12:49

184:51under which we operate.

184:52Like actually reveal what was done with the Spanish flu

184:57at the beginning of the previous century,

184:59'cause there's a lot of mask controversy then too.

185:03It went back and forth and that was actually the source

185:05of a lot of distrust there too.

185:06So, and then look at influenza,

185:09like how is it effective with that

185:11and just reveal this, we don't know.

185:13But with some probability,

185:17this is the best option we got currently.

185:20And then in a month or two, adjust it,

185:23saying that, you know what,

185:25our uncertainty decreased a little bit,

185:27we have a better idea.

185:29That was an incorrect estimate,

185:32but reveal that you're struggling.

185:34It's not like this weird binary clock

185:36that goes one direction or the other.

185:38You're struggling with uncertainty.

185:41And like trusting, people maybe criticize me sometimes

185:44with this, but I think most people are actually intelligent.

185:48Like trusting the public to be intelligent

185:51with if you give them, if you have transparent

185:54and give them information in a real authentic way.

185:57Like don't look like you're hiding something.

185:59I think they're intelligent enough

186:01to use that data to make decisions.

186:03It's the same thing as with the testing,

186:05is if you put that power in the people's hands

186:07to know if they're sick or not,

186:08they're gonna make, en masse, the right decision, I think.

186:12The masks and the testing has been a bit heartbreaking.

186:17- I think it's a good point, though,

186:19that most people don't seem to have an objection to testing.

186:23It's a good point.

186:23- Yes. - Yeah.

186:24- And then obviously, Makumena makes that point brilliantly.

186:28And still, there's very little excitement around that.

186:31- But he said he was going to do it.

186:35I don't understand.

186:35I mean, I haven't spoken to him since then.

186:37So I don't know what--

186:38- He's pushing it.

186:39Well, I mean, but he can't do it alone.

186:41He has to get, so one of the resistances,

186:44FDA doesn't like cheap things.

186:48- Yeah.

186:49- They don't wanna approve it.

186:50So that makes the mask manufacturer,

186:53like with the emergency exceptions,

186:55all those kinds of things, very difficult.

186:57And then there's not much money to be made on it

186:59without that.

187:00I don't know.

187:01I think there's just economic pressures against it.

187:04And because so much investment was placed on the vaccines,

187:09and obviously there's an incentive mechanism there

187:13where the companies, lobbyists and all those,

187:16there's this machine that says,

187:18arguing for tests is difficult

187:22because the thing that's worked for most severe viruses

187:25in the past is vaccines.

187:27Now we have vaccines, why the hell would you need tests?

187:30At that time, like, why the hell do you need tests

187:34when we can be working on vaccines?

187:36It seems like the obvious thing to be working

187:37is the vaccines from their perspective,

187:40but it's not obvious at all to me.

187:43- I think you should have both.

187:44I think have vaccines and good testing,

187:46and that covers you really well

187:48because you're always gonna have people

187:50who don't get vaccinated.

187:52- I don't know if you've been paying attention to this.

187:54There's a guy named Brett Weinstein,

187:55there's a guy named Sam Harris.

187:57They have good representation, I would say,

188:01of two sides of a perspective on vaccines.

188:06So from Sam Harris's perspective,

188:09it's obvious that everybody should get vaccinated

188:13and it's irresponsible to not get vaccinated.

188:18I think he represents a lot of people's belief in that.

188:22And then Brett talks a lot about ivermectin,

188:28but also talks about a hesitancy towards the vaccine

188:32for people who are healthy,

188:35for people who are younger, that kind of thing,

188:37and saying we should consider long-term effects

188:40of the vaccine in making this calculation.

188:45What do you make about this conversation?

188:47Some of it happens on Twitter,

188:49some of it happens in the space of podcasts.

188:52Do you pay attention to this kind of thing?

188:56What's your role in this?

188:58What do you hope is the way to resolve this conversation?

189:02Do you think it's healthy?

189:04- Well, a conversation is always healthy,

189:05but to make definitive statements is not

189:09because it suggests you have information

189:11that you don't have.

189:12So we talked about long-term effects.

189:16I think you need to balance those

189:18versus long-term effects of the disease,

189:20and you can make your decision.

189:22I don't think you need to tell everybody to get vaccinated.

189:26I think you need to present the case.

189:28You say, "Here, we made good vaccines.

189:30"Here's the safety profile.

189:32"Here's the risk-benefit balance,"

189:34and you should decide.

189:35You're a smart person.

189:36You should decide.

189:37Now, companies are gonna do differently, right?

189:41Companies may say, "You have to be vaccinated to work here."

189:43My employer, Columbia, said,

189:45"We have to be vaccinated to work in the fall,

189:47"and if you wanna be a student, you have to be vaccinated."

189:49So you decide whether you wanna go or not.

189:52But the idea that you should make a decision

189:57based on long-term effects, there is no evidence, right?

190:02So how can you make a decision when we don't have evidence,

190:05whereas we do have evidence

190:06that there are long-term effects of getting COVID?

190:08So I don't think that's a fair argument,

190:10and it just makes people scared to say that.

190:13But on the other hand, for someone to say it's a no-brainer

190:16and to denigrate people for not being vaccinated,

190:19that's not the approach either

190:20because they're gonna dig in and say,

190:23"I'm not doing this 'cause you tell me to," right?

190:25I think the middle ground is to say,

190:28take a bit of both and say,

190:31"Here are the potential issues, and here are the benefits,

190:34"and this is what I would do,"

190:37and you have to just decide on your own.

190:38I'd leave it to them.

190:39I say, "You decide, and if you don't want to,

190:40"you know, it's up to you.

190:42"You don't have to get vaccinated.

190:44"And you'll probably get infected at some point,

190:46"and maybe you'll be okay."

190:47(Luke laughs)

190:50But here's the best available data,

190:51and it looks like the vaccines are a pretty damn

190:55smart solution.

190:56They seem to work.

190:57- I think you tell people what you did

191:00and present both sides calmly,

191:01and I think digging in, you know, like in a debate,

191:04I don't think that's terribly useful.

191:06So that's my view.

191:08I mean, people come to me all the time and ask me,

191:11"I'm worried.

191:14"What should I do?"

191:14And I say, "What are you worried about?

191:16"Let's talk about it and go through it calmly."

191:19And if they want to still take ivermectin,

191:20I say, "It's fine, it's your choice.

191:22"I don't have a problem with that."

191:23- I love that.

191:25I love that's the way you think.

191:26People should definitely listen to "This Week in Virology"

191:30and follow your work.

191:33It's brilliant.

191:33I've been really enjoying it lately.

191:35It's like, it's my favorite way to stay in touch

191:38with the happenings of COVID.

191:42Obviously, you put in a lot of other stuff in there, but.

191:45- We used to do other viruses before COVID.

191:47It was quite interesting.

191:49And I'm trying to slip other viruses in

191:52because I think they're informative in many ways,

191:56and we're gonna do more and more of that.

191:57But I have to say, I canceled,

191:58usually I record on Tuesday and Friday,

192:00and I canceled today so I could be with you.

192:02- It's a huge honor.

192:03I appreciate that.

192:05- No, no, it's fine.

192:06I think a couple of other people

192:07were gonna be away anyway, so.

192:10So I do a lot of different pods.

192:12They're all on YouTube.

192:13I also do a live stream on Wednesday nights on YouTube,

192:17which you can find,

192:18and that's where people can come and ask questions.

192:21We don't have an agenda.

192:22We just start, and by 30 minutes in,

192:25there's 700 people with questions

192:27that I can't even get through

192:28'cause there's so many of them.

192:29And I'm actually astounded that so many people

192:33have really good questions.

192:35Most of them are reasonable,

192:37and they come back every week.

192:39So it's a great, it's turning into a great forum

192:41to have a nice discussion.

192:43- And the YouTube channel's called what?

192:46- So you could search for my name,

192:49which is Vincent Draconello.

§23Transcript · 3:12:50–3:21:31

192:50It'll turn up.

192:51Or my handle on YouTube is profvrr,

192:56P-R-O-F-V-R-R.

192:58- Have you read The Plague by Camus by any chance?

193:03- Years ago, years ago.

193:05I have to read it again.

193:07That's really relevant, yeah.

193:08- Let me sort of ask you a question about it.

193:10It describes a town that's overtaken by a plague,

193:14and it's blocked off from the rest of the world.

193:16And it kind of reveals the best and worst of human nature.

193:19That's like how people respond to that,

193:21sort of the encroaching, their own mortality,

193:25their own death on the horizon.

193:27I think one of the messages in the book

193:28that ultimately, like love for others.

193:33So it's like a lot of people wanna become isolated,

193:36and they hide from each other.

193:38But ultimately the thing that saves you is love,

193:42which is one of the things I've,

193:44just watching this pandemic,

193:46you know, with the distance, with the masks,

193:48that's all fine.

193:50But there's a distancing from people,

193:53of that tension, the breaking of the common humanity

193:58between people.

193:59That's one of the reasons I,

194:00when I came to Austin earlier this year, just to visit,

194:05I fell in love with the city,

194:06because even with the masks and the distance,

194:09there was still a camaraderie,

194:12like, I don't know, just a love for each other,

194:15just a kindness towards each other.

194:18And that's what I took away from the plague.

194:20Mostly it's told the story of the doctor,

194:23who basically gives in,

194:27and just gives himself as a service to others.

194:30And that love is the thing that liberates him

194:33from his own conception of mortality.

194:34The fact that he's here, he's going to die.

194:37What do you think about this, the effect of the virus?

194:41We talked a lot about biology,

194:43but the effect of the virus on the fabric

194:48of the common humanity that connects us.

194:50- That's what a pandemic does.

194:54It really cuts that, right?

194:56'Cause small outbreaks are local,

194:58they don't have global effects.

195:00But when you have something this big,

195:03where pretty much nobody escapes,

195:07and not just making people sick,

195:10it changes your life, right?

195:12People lose jobs, they change jobs,

195:14they move somewhere else.

195:16They have all kinds of disruptions.

195:20Kids can't go to school.

195:22Really shows you, I mean, I always like to say,

195:25a tiny virus can bring earth to its knees.

195:30A tiny virus that you can't even see,

195:31and that most people don't even think about

195:33most of the time.

195:34And the real effect is not just sickness,

195:37it's what it does to people.

195:39Because in the end, we are animals,

195:42and most animals like each other.

195:45And they interact, they have great social structures,

195:47and that makes them do well.

195:49I guess the exception is people in AI, right?

195:54They can be on their own.

195:56- Well, that's why you build robots

195:57that you fall in love with.

195:59- That's right.

195:59And so I think when a,

196:02the real story is what it does to society, for sure.

196:06Which has ramifications way beyond

196:08the number of people dying,

196:10and the vaccines, and the tests, and all of that.

196:12And this one has really made a big rupture.

196:15And you could tell, not now so much,

196:17I think being out and about now,

196:18things look pretty normal,

196:21except for some people wearing masks.

196:23You would never know.

196:25I mean, the airport this morning was completely jammed.

196:28People going, and they're all on vacation,

196:29they're all wearing shorts, right?

196:31So they're back to normal, it's August.

196:34But last year is really different.

196:36In New York, where you're used to lots of people

196:39on the street, it was eerie.

196:41It was just quiet.

196:43But under it all, people are still,

196:46most people help each other when they have to, right?

196:49Most people are willing to,

196:52if something happens to someone,

196:53to reach out and help them.

196:55There are always exceptions where people are meaned,

196:58and that's just the way animals are.

197:01We're not the only ones that can be meaned

197:03to our own species.

197:05But I think most of the motivation

197:08for everything that was done is to help other people.

197:12I mean, I do think that the vaccine manufacturers,

197:15maybe not the leaders, but the people working in the labs,

197:18really wanted to get this out quickly and help people.

197:21I think at every level, people who are contributing

197:26really wanted to help other people,

197:28and feel proud that they're able to do that.

197:30So I view it as, we're never gonna be 100% good

197:35because animals are not.

197:37Evolution made us, I mean, we're lucky.

197:40We somehow rose above by having

197:42incredible brain and so forth.

197:44But a lot of our base instincts are animals.

197:47They chase each other and have alpha males

197:50and all that stuff.

197:51And we always have a little bit of that in us.

197:53But we do have some humanity that this really ripped up.

197:58It really did.

198:00And I think, for me, someone who studied viruses

198:05for over 40 years, it's just amazing

198:07that an invisible thing can do that, right?

198:11- It goes back to the thing you found fascinating,

198:13which is a virus affecting human behavior.

198:15- Yes. - Or behavior of the organism.

198:17- Yes, so humans can make weapons and do harm,

198:22and you can see that, but this you can't even see.

198:25You can't, and look what it has done.

198:27And it'll do it again.

198:28There'll be more.

198:29I just, I wish we would be more prepared,

198:32because we know what to do.

198:34We know we should be making antivirals, vaccines, masks,

198:38testing masks, making test modalities

198:42that we can really quickly redesign.

198:46But after SARS-1, all that went out the door.

198:49People didn't do anything,

198:50and that's why we're in this situation.

198:51So people ask me this all the time.

198:54Are we gonna be ready for the next one?

198:57And I always say, we should be.

198:59We have all the information we need to know what to do.

199:03But somehow, I think people forget.

199:05- That said, sometimes we really step up

199:12when the tragedy is right in front of us.

199:14- We do. - On the catastrophe.

199:16So I don't know.

199:17Somehow humans have still survived.

199:18The fact that we had nuclear weapons for so many decades,

199:21and we still have not blown each other up,

199:23whether by terrorists or by nation,

199:24is quite surprising. - It's amazing.

199:27That's always, after reading the Pentagon Papers,

199:30it's even more amazing, right?

199:32So I don't know how we do it.

199:34I tend to believe there's that,

199:38at the surface, you notice the greed, the corruption,

199:42the evil, but the core of human nature,

199:45of the human spirit is,

199:46one, in the scientific realm, is curiosity,

199:50and more deeply is kindness, compassion,

199:54and wanting to do good for the world.

199:56I believe that desire to do good

199:59outpowers all the other stuff

200:02by a large amount, and that's why we don't,

200:04we have not yet destroyed ourselves.

200:06There's a lot of bickering.

200:08There's a lot of wars on the surface,

200:10but underneath it all, there's this ocean

200:13of love for each other.

200:16I mean, I think there's an evolutionary advantage to that,

200:20and it would be a good explanation

200:23why we still haven't destroyed ourselves.

200:25- God, we had so many opportunities.

200:27If you look at all the wars in history, so many.

200:30I was just, my son was telling me

200:33about the Ottoman Empire, right?

200:35I mean, it's just, you know, war after war,

200:39and then other countries splitting up countries

200:42with no regard to who's living where, right?

200:45It's just, how can these people do this?

200:49- Yeah, it's fascinating.

200:50Human history's fascinating,

200:52and we're still young as a species.

200:54We have a lot-- - Very young, yeah.

200:56- More time to go, and a lot more ways

200:59to destroy ourselves.

201:00Do you have advice, like you said,

201:02you have many decades of research

201:03and an incredible career and life.

201:06Do you have advice for young people

201:08about career, about life, people in high school,

201:11people in college, of how to live a life

201:15they can be proud of?

201:16- So, what I like to do is tell people,

201:20don't plan it, because I didn't plan anything.

201:22Everything I did was one step at a time.

201:25You don't have to plan.

201:26I just found things that were interesting to me.

201:31So, my father was a doctor,

§24Transcript · 3:21:33–3:28:34

201:33and he wanted me to be a doctor,

201:35but I was not interested in taking care of people.

201:39I learned that, but I couldn't say no to him.

201:43So, I was a biology major in college,

201:46and I graduated, and I didn't have anything to do.

201:51So, I liked science, so I got a job in a lab.

201:56It was very exciting, and that led to everything else

202:00that I've done, one step at a time.

202:02And I think the most important thing you can do,

202:05well, there are two important things.

202:06You can be really curious all the time.

202:08You mentioned curiosity.

202:10I think curiosity is essential.

202:12You have to be curious about everything,

202:15and if you are, you're never gonna be bored.

202:18And so, people who say they're bored,

202:20I say, you are not curious.

202:22You should just think about things

202:24and say, look at something and say, how does that work?

202:27Or what is it doing, and how do they get there?

202:29And you'll never be bored.

202:30And the other thing is when you find something,

202:32which may take time, it's fine.

202:35You have to be passionate about it.

202:38You have to put everything into it,

202:40and that's what I did with viruses.

202:42So, I think they're amazing, and I tell my classes,

202:47I love viruses.

202:51They're amazing, and people think I'm morbid

202:53because obviously they kill people,

202:55and I shouldn't love something.

202:56But that's not the point.

202:57That's not what I mean.

202:58I love them in the way they have emerged

203:00and how they work and so forth

203:03and all that we don't know about them.

203:04So, you need to be curious and passionate

203:06and don't plan too much.

203:07And just find something that you don't call a job.

203:11As someone said on the livestream last week,

203:14I wish I had a job I liked as much as you.

203:17I said, it's not a job.

203:18I never looked at it as a job.

203:20It's my vocation, it's my passion.

203:23If it's a job, then you're not gonna like it.

203:25- Yeah, something that doesn't feel like a job.

203:28So, you said viruses are kind of passive,

203:33non-living, you could say, or even cells are passive.

203:38And humans are kind of active.

203:39We seem to be making our own decisions.

203:42So, let me ask you the why question.

203:44What do you think is the meaning of this life of ours?

203:48- Oh, there's no meaning, it just happened.

203:51It's an accident.

203:52I think there's no life elsewhere

203:55because this is just a rare accident that happened

203:57in the right conditions.

203:58I mean, people all think I'm wrong

204:00because there are billions and billions

204:01of stars out there, right?

204:02So, there's a lot of opportunity.

204:05There's no meaning.

204:06It's just, what do they call it?

204:10A perfect storm of events that led

204:13to molecules being formed and eventually,

204:15I mean, it took a long time for life to evolve, right?

204:19But it's just driven by conditions.

204:24If something emerged that worked,

204:25it would then go on to the next step.

204:27There's no meaning other than that.

204:29The only difference is that we,

204:31and I think many other animals can probably,

204:34we have the ability, we're sentient, right?

204:36We can influence what happens to us.

204:38We can take medicines, right?

204:41We can alter what would normally happen to us

204:44so we can remove some of the selection pressure.

204:47But I think everything else on the planet just goes,

204:52looks for food and give a lot of offspring

204:55so you can perpetuate.

204:56It's just a natural biological function.

204:58- Yeah, they're much more directly concerned with survival.

205:01I think humans are able to contemplate their mortality.

205:04We can see that even if we're okay today,

205:08we're eventually going to die

205:10and we really don't like that.

205:13So we try to come up with ways

205:14to push that deadline farther and farther away.

205:17- Well, we have really,

205:18I mean, we used to die in our 30s, right?

205:20Now it's 70s, 80s.

205:22- Well, most of us used to die in the first few weeks.

205:26- That's true.

205:27Yeah, infant death.

205:29I always tell people the only thing

205:31that's 100% is death.

205:34It's the only thing in the world that's 100.

205:36- Do you think about your own mortality?

205:37- No, I never think about it.

205:39I'm just enjoying day to day and I don't think about it.

205:42- Really?

205:43You work on viruses,

205:44you don't contemplate your own mortality

205:47given the deadliness of the viruses around us?

205:51- I never thought COVID would kill me.

205:53No, I never was afraid of that, not at all.

205:56I mostly feared for other people getting sick,

206:00especially people who could die.

206:02I didn't want that to happen to them.

206:03But I always thought that,

206:04it's obviously not a realistic viewpoint not to be worried

206:11because many people are.

206:13But I've been relatively healthy.

206:16They should sequence my genome

206:18because it works really well and I have a good immune system.

206:21- Maybe you'd be the first immortal person.

206:24- I don't think so. - There's gotta be a first.

206:25- I don't think so.

206:27I think that biologically you just can't,

206:31the ends of our chromosomes keep getting shorter

206:33and shorter and that's eventually what kills us.

206:36So you just can't keep going on.

206:39But that's fine, I don't need to.

206:42I understand from the vampires

206:43that it's not good to live forever.

206:45- I guess make the most of the time you got.

206:50That's the, bacteria live a much shorter time

206:53so we got that on bacteria.

206:55- Bacteria are just little bags of chemicals that split.

207:00So they have no stake in the matter at all.

207:05I think you have to go a long ways

207:08before you get into some kind of consciousness.

207:13- Yeah, it's weird that this bag of chemicals

207:15has a stake in the matter.

207:17Like our human body is, consciousness is a weird thing.

207:21- Not just in us, but they make half of the oxygen

207:23on the planet, 20% of the oxygen comes from bacteria.

207:26And they made, in the beginning of Earth,

207:29they made enough oxygen to start oxygenation going,

207:34life going, I mean, they have an incredible role.

207:36It's all an accident, just happened.

207:38- Well, Vincent, like I told you, I'm a huge fan.

207:44It's a big honor that you were talking with me today.

207:47Thank you so much for coming down.

207:48Thank you for spending so much time with me.

207:50And thank you for everything you do

207:53in terms of educating about viruses,

207:54about biology, microbiology and everything else.

207:57I can't wait, everybody should check out

207:59Vincent's YouTube, watch his lectures,

208:01listen to the podcast, it's truly incredible.

208:05Thank you so much for talking to me, Vincent.

208:06- My pleasure.

208:08- Thanks for listening to this conversation

208:10with Vincent Recaniello.

208:12To support this podcast, please check out

208:13our sponsors in the description.

208:16And now, let me leave you with some words

208:18from Isaac Asimov.

208:21The saddest aspect of life right now

208:23is that science gathers knowledge

208:25faster than society gathers wisdom.

208:27Thank you for listening and hope to see you next time.

208:31(upbeat music)

208:34(upbeat music)

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