The following is a transcript of an interview with former FDA Commissioner Scott Gottlieb that aired October 11, 2020, on “Face the Nation.”
MARGARET BRENNAN: And we’re back with former FDA commissioner Dr. Scott Gottlieb, who is in Westport, Connecticut. Good morning to you.
DR. SCOTT GOTTLIEB: Good morning.
MARGARET BRENNAN: The president said yesterday the virus is disappearing. The numbers tell a different story. Friday, we saw the largest one day increase in new cases in two months. How prepared are we as a country for what’s about to happen?
DR. GOTTLIEB: I think we’re going to face a difficult fall and winter. What we thought might be just a bump after Labor Day, clearly is a resurgence in a virus heading into the fall and the winter. You’re seeing cases build across the entire country. There’s now about 15 states with a positivity rate above 10 percent. About 40 states have an Rt, a rate of transfer above 1.0, which means they have an expanding epidemic. And most concerning is hospitalizations are building. People look at the number of cases and they tend to discount that. They say that because we’re testing more, we’re turning over more cases. But the hospitalizations are the clearest objective measure of rising infection around the country. And also, remember, we test more not just because we test more, we test more because we have more virus. Some people get tested because they’re just the worried well. But most people get tested because they’re either having symptoms or they’re in touch with someone who is known to have COVID. So testing is going up because more infection is spreading around the country. So we’re in a difficult situation heading into the fall. I think the only- the only caveat is in terms of us being better prepared for this wave is that we have dramatically improved clinical care in hospitals. So I think we’re going to have better outcomes overall, but we’re still going to have a lot of death and disease between now and the end of the year.
MARGARET BRENNAN: Well, I ask you that because you’ve been on this program warning since August that the Midwest is trending in the wrong direction, trending upwards. This- this week, this past week, the Wisconsin governor started setting up a field hospital because the ICU units and hospitals are getting overwhelmed. Why aren’t those states better prepared?
DR. GOTTLIEB: Well, in many respects, the states are better prepared in terms of the capacity in their health care system, I think the reality is that the preparation includes building field hospitals. You have to build surge capacity. The hospitals themselves just physically don’t have the infrastructure to deal with the magnitude of the infection once this becomes epidemic within a local region. So this is part of the preparation. I think when you look at the hospitals and talk to hospital executives, and I’ve been talking to them, they feel a lot more confident about their preparations in terms of stockpiling ventilators, stockpiling protective equipment. But when this does roll through a region and becomes densely epidemic, it’s going to look like this. They’re going to have to build surge capacity, swing capacity. They’re going to have to suspend elective surgeries. That’s the system being prepared. That’s the reality of this virus. And the other thing is, you know, the parts of the Midwest and the northern states around the Great Lakes, which is where the infection is building right now, are the parts of the country that are getting colder more quickly. We also see it starting to build in the southern states. And so for those who thought that this had swept through Florida and Texas and Arizona and other states may have achieved some level of immunity and it wasn’t going to come back again, you look at Texas right now and there are concerning signs that they’re having a resurgence in infection that is quite dramatic.
MARGARET BRENNAN: And something to watch as we head towards Election Day. The president himself, you saw this letter released by his physician last night. It didn’t explicitly say that the president has tested negative. At this point in his recovery, what are you concerned about? Is he contagious?
DR. GOTTLIEB: Probably not, and he’s not going to test negative for a period of time, because we know that people continue to shed virus for a long period of time, but that’s dead virus. It’s a virus that doesn’t grow in a culture, can’t really pass on the infection. There are indications that the president’s no longer infectious. They released data on what we call sub genomic RNA, which is an intermediate piece of viral genetic material that you really typically only see when the virus itself is replicating. So that’s an indication that he no longer has replication-competent virus, meaning that it’s not live virus. But he’s going to continue to shed for a while. Now based on classic criteria, he’s about 10 days out from the onset of symptoms. He’s been symptom free, as best we know, for a number of days now. He’s been afebrile, without a fever, for more than one day. That should make him no longer contagious. The only confounding variable here is the drugs he received. The steroids could cause him to shed virus for a longer period of time. But I think on the whole, it’s probably a safe assumption that he’s no longer contagious. I think the question now is, has his health been restored?
MARGARET BRENNAN: Yeah.
DR. GOTTLIEB: And we know that a lot of patients have lingering effects from COVID.
MARGARET BRENNAN: You heard the Regeneron CEO talk about his drug and he said he wasn’t sure about supply and Regeneron can’t do it alone. You’ve been saying on this program since July that there needs to be more manufacturing of therapeutics in case we find they work. Well, this one looks like it may work. Why don’t we have more supply, given that taxpayers have already invested in this drug?
DR. GOTTLIEB: We would have needed to take different steps in April and May to ramp up manufacturing capacity to have the drug available in larger quantities right now. It’s too late for this year. I think we could still take steps to do it for 2021. But we’re stuck with the doses we have. This has been a monumental achievement in terms of the time frame in which these companies pivoted to develop these antibody drugs. These drugs always looked promising and they were always believed to be a bridge to a vaccine. We’re not going to have it in the quantities we need. I would estimate, just based on current infection rates, if you look at everyone who’s above the age of 65, you probably need anywhere between 300 and 400,000 doses a month to supply it just for people who are indicated based on age alone. And there are a lot of other people who’d be indicated for this drug. We’re going to have nowhere near those quantities. So we will have to ration it. And that’s assuming the infection doesn’t continue to expand, which I think it will. So we’re not going to have as much drug as we should have. Remember, we could also have used these drugs as a prophylaxis, as Len mentioned, to prevent people from getting the infection. And in fact, the data has shown in the past that they’re most effective in that setting. We’re not going to have the supply to do that, unfortunately.
MARGARET BRENNAN: So when the president promises to make this available for all, you’re saying, he had the chance, but the administration missed the window?
GOTTLIEB: Well, we definitely missed the window. And this was raised many times. I wrote about it. Others raised it to the administration, including myself, about trying to commandeer more manufacturing back in April and May. Pay companies not to manufacture certain non-essential drugs. Most companies freeze about 12-24 months of their bulk stock of their biologics. So some companies could have suspended manufacturing of non-essential biologics and turned over their manufacturing capacity to the production of these drugs and been paid for it. The money was there to do it, but it would have taken a lot of planning. That didn’t really occur. Lilly and Regeneron did a lot to free up their own manufacturing,–
MARGARET BRENNAN: Yeah.
DR. GOTTLIEB: –so they’re producing a lot of drug, but not enough for the entire population.
MARGARET BRENNAN: Dr. Scott Gottlieb, thank you for your analysis. We’ll talk about the economy when we come back. So stay with us.
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