CNBC’s Meg Tirrell Answers The Questions Everyone’s Asking About Cures And Treatments

Steve Pomeranz: With coronavirus all over the news, I wanted to get a good idea of what drug companies may be doing in order to create new treatments for this virus, so I’ve asked Meg Tirrell from CNBC to join me. Meg has tracked public health emergencies from Ebola to Zika, so I think she has something to add to the discussion, and she’s with me on the phone right now. Hey, Meg, welcome back to the show.

Meg Tirrell: Hi, happy to be here.

Steve Pomeranz: Happy to have you. Last we spoke on February 19th when at that time the virus had not truly entered the US on a large scale. So I wanted to get caught up with regards to medical research, possible vaccines or cures, and where you see us today. Let’s start with testing, actually.

Meg Tirrell: Sure.

Steve Pomeranz: There seem to be different kinds of tests from antibody tests to tests where you can be swabbed and have the results back in a week or so. What’s the state of the art with that right now?

Meg Tirrell: Well. Testing capacity has ramped up dramatically in the United States from where it was. It got off to a really rocky start, of course, with the CDC-provided tests having some issues. Now commercial companies have come in, commercial labs have come in, and the US is running something like more than a hundred thousand new tests per day. That’s still not enough. What everybody says is we need to have a much greater testing capacity if we’re going to be starting the economy back up again. We need to be able to know who’s infected, where the outbreaks are.

Even though we have the tests themselves, there are a lot of reports of shortages in the materials needed to run the tests from even the simple things like nasal swabs, those long Q-tip like things they stick really far up your nose to be able to take the test. Also, the protective equipment for the people who are administering the tests, they need to be protected because when they stick those things so far up your nose, sometimes you can cough or sneeze.

Steve Pomeranz: Yeah, oh boy.

Meg Tirrell: So they have to be protected from that. So just a lot of issues. There’s a real clunkiness in our testing infrastructure in this country being revealed by the great need we all have for tests right now.

Steve Pomeranz: Well, there’s also a reluctance, I’ve read, to switch platforms, meaning that once a hospital or a group starts using some kind of tests, whether they’re the most efficient or not, it’s hard to get them to switch to another test. Have you seen that?

Meg Tirrell: Yeah. That was something that Dr. Debbie Birx mentioned in one of the coronavirus taskforce briefings from the White House—she’s one of the coordinators of this response. She pointed out that there are all of these tests provided by Abbott that can be run, millions of tests out there, but they’re not getting run because a Roche test was available first. And so, people were just used to ordering the Roche test. But there are backlogs, not making the switch to where the capacity is. And that just goes to more of that sort of clunkiness in the system. We need to be swifter because the capacity is there, but we’re not optimizing it.

Steve Pomeranz: Does this process require strong top-down leadership or is bottom-up leadership, county by county, state by state, the way to handle this?

Meg Tirrell: Well, it seems like what a lot of people are pointing out is that there just isn’t visibility into where the capacity is and where the shortages are happening. So if there were a top-down oversight of this, there could be coordination to try to say, “Hey, this site has shortages of this, but here we have capacity over here.” So I think a lot of people are kind of calling for more of a national coordination that could help a lot to just iron out these kinks that are causing backlogs.

Steve Pomeranz: Are you seeing that coordination and it’s just taking a little bit longer to get going or does there seem to be a lack of coordination?

Meg Tirrell: People I’m talking to definitely cite a lack of a national plan. You do see states having some successes. New York is doing incredible amounts of testing. Louisiana has done a lot of testing as well. In California, in Los Angeles, the mayor just said anyone in LA County can get a test if they have symptoms the same day or the next day. So trying to understand why did they have that capacity, whereas other places you have to be hospitalized in order to get a test. So there’s certainly a lot of inequity around the country.

Steve Pomeranz: Well, I know in my area—I live in Palm Beach County, Florida—there are two testing facilities. One is brand new and it just doesn’t seem like enough to me. I was wondering, I’ve been quarantined myself for five weeks now. It’s not as if this is something we’re just hearing about. We’ve seen it coming on, and yet again, the testing facilities are just… They don’t seem to be as available as I would have guessed that they would be. How do you think Palm Beach County public services are handling the situation?

Meg Tirrell: Well, certainly you want to be at a place where everybody who needs a test can get one. So, if that’s not the situation, then we’re not where we need to be. I will say, as an outsider, a reporter who is depending on the public health reporting from different municipalities around the country, I have actually found Florida’s to be really great, at least in terms of the state’s reporting of their cases. They provide these amazingly comprehensive reports of the characteristics of every case in the state.

They also provide really comprehensive reporting on who’s doing the testing and how much, and it’s just a really great source of information that you don’t see from every state. And I’ve just been really impressed by Florida in that way.

Steve Pomeranz: Oh, it’s good to hear.

Meg Tirrell: Florida also does a lot of great public health work on mosquitoes and mosquito-borne diseases. So I’ve just been impressed by Florida over the years in terms of that public health response.

Steve Pomeranz: Well, we sure do get mosquitoes down here. No lagging of those. Also, when we spoke last in February, we mentioned biotechs, giant biotechs that are trying to come up with vaccines. And I know a lot has transpired. One company we talked about is a Regeneron, and they have such an interesting business model, an interesting testing model. I’d like you to tell us a little bit about that and tell us what the latest results are from what they’re finding.

Meg Tirrell: So Regeneron has a couple of different approaches, and they’re moving incredibly quickly. The one we probably talked about in February was this antibody approach where they’re actually developing a brand-new drug for COVID-19. The way they’re doing that is they have these mice that they’ve genetically engineered to have human immune systems, and they essentially expose these mice to one of the proteins on the novel coronavirus to get them to develop an immune response. The same way when we are infected with the coronavirus, we develop antibodies to those.

What they’re doing is taking those antibodies that the mice generate and sifting through them to find the best ones that could be a potential medicine. And this medicine could work either to prevent the disease if you give it to somebody in advance, possibly a healthcare worker who’s at high risk, or it could also be used to treat the disease. And this is an approach that they did successfully for Ebola. So there is a lot of hope they’ll be able to do it again here. And since we talked, they’ve accelerated their timelines on being able to get into human trials.

Now they’re saying, by early summer, they hope to be testing this drug in people. But Regeneron is also doing another thing, which is using an existing drug for rheumatoid arthritis to treat the most severe patients with COVID-19 because they get that inflammation in their lungs that can really be terrible. And so, what they’re doing is running clinical trials to see if this rheumatoid arthritis drug, which tamps down that inflammation, can help those patients. And we should see those data within the next couple weeks. Pretty soon.

Steve Pomeranz: Speaking about clinical trials, there’s been talk from the president about chloroquine. I don’t know if I’m saying that correct or hydroxychloroquine. I read that news recently in a trial in Brazil indicated that they had to stop the trials because the high dose was associated with an irregular heartbeat. I think that’s a pretty controversial drug, but where do we stand on that?

Meg Tirrell: Yeah. We know that drug is being very widely used both in clinical trials and just in patients who have COVID-19. The heart side effects are known about that drug, so it’s not a completely benign drug. Doctors are warning if you have heart issues, that wouldn’t be a good patient to try to use this drug for. There are other questions about just, is this doing anything? And what a lot of experts have said is that it is being so widely used, if it were really a silver bullet, we’d probably be seeing that, and we’re not.

But there are clinical trials ongoing. And what Dr. Anthony Fauci keeps saying is everything’s anecdotal until you see the results of these controlled clinical trials that can really tell us if the drug’s working.

Steve Pomeranz: Right. Now, there are other companies that are at work at this. I’m just going to name a few: Moderna, Johnson and Johnson, Sanofi, and Gilead Sciences, and I’m familiar with Gilead Sciences. Tell us what they’re producing and what stage their particular antiviral is at right now.

Meg Tirrell: Right. So Gilead has this drug called remdesivir which it discovered basically during Ebola and tested for Ebola. Well, it didn’t really work very well for Ebola, but they have seen promise in it for the novel coronavirus. They just reported results from 53 patients who had received the drug on compassionate use. So that’s for very sick patients who weren’t included in clinical trials. So you have to take that data with a grain of salt because it was not a controlled clinical trial.

But what doctors are saying is that the data looked hopeful. It showed that 68% of the patients who received the drug showed clinical improvement in terms of how much oxygen support they required. 17 out of 30 patients who were intubated on ventilators in the study were able to come off that support, but seven patients included in this group did die. So we’re waiting to see the clinical trial data, which Gilead says should be coming later this month. That’s the first clinical trial data.

Steve Pomeranz: That is a drug that is a hope to cure the virus or cure the person who has the virus and kill the virus while they have it. There’s also a lot of talk about vaccines, of course, which are prophylactic in nature. Where do we stand? Now, you mentioned Regeneron and their antibody approach. What other studies, what other drugs, are out there to try to solve the vaccine issue?

Meg Tirrell: There are about 79 vaccines in development for COVID-19. That’s according to the Milken Institute, which has this great tracker of all the treatments and vaccines in development. But only a couple of started human clinical trials already. Moderna is this young biotech company that’s using a totally new approach called messenger RNA to develop a vaccine. They’re partnered with the NIH. They were the first to start human studies. They dosed their first patient in the middle of March, and we should get the data on how safe the vaccine is probably early summer.

Then they’re going to be starting the next stage of trials to determine whether the vaccine is generating an immune response to be able to protect people against infection. So Moderna says if all goes well, they could have vaccine to use in high-risk groups like healthcare workers by the fall. And that’s incredibly fast. It takes years normally to get vaccines ready to be used. And that would be before you would get a broader FDA approval. That they think could come potentially in 2021.

Steve Pomeranz: You mentioned these trials, and I know these trials go in phases—phase one, two, and so on. Describe those phases for us.

Meg Tirrell: Typically, phase one is a really small study just to look at safety, so you’re enrolling healthy people. Although when you’re doing a vaccine trial, everybody is healthy and you’re just trying to prevent them from getting sick. So that’s phase one. And then, typically, phase two you’re starting to try to determine the correct dose. You’re trying to make sure there’s actually an effect that you want to be seeing that is a greater number of patients. And then, typically phase three is that gold standard clinical trial, sometimes multiple clinical trials, that the FDA wants to see to ensure the drug is both safe and effective and that can involve thousands of patients. It really depends on the indication. So if it’s a big thing like a cholesterol drug, that’s thousands and thousands of patients. If it’s a rare disease, it can be fewer. But the FDA is being pretty flexible here because we need to move so quickly. So a lot of these timelines are getting overlapped and abridged, and a big question is going to be, how long do we need to be evaluating these vaccines to really be sure that they’re safe?

Steve Pomeranz: I’m speaking with Meg Tirrell. She covers the pharmaceutical industry and health emergencies and the like for CNBC. Now, of those 70 or so companies that are trying to create a vaccine, three companies are in trials. There’s one large Chinese company that’s in phase two, now that we know what phase two is, and then there’s two US companies in phase one. So that phase one is very, very early. Moderna is the one that you just mentioned. And Inovio Pharmaceuticals is also in phase one. It seems like so few have gotten really not that far. Why is it taking so long to get even into phase one trials?

Meg Tirrell: Well, they need to develop these new vaccines and get them to a place where they feel comfortable injecting them into a human. So I would say the timelines are faster than we’ve ever seen before. I mean, I think for Moderna, it was something like 41 or 42 days between when they had the sequence of the virus and between when they shipped the first batches to be dosed into humans. That’s amazing. Johnson and Johnson is another giant company working on this, and they plan to be in human trials in September,and that’s an accelerated timeline from what they initially saw too.

But what they have to do is design the vaccine, the thing that they’re going to inject into people, to show the immune system this protein that they want to train it against so that when it encounters the virus, it already has its antibodies, its immune soldiers all primed up and ready to be looking for it, to be able to neutralize the virus.

Steve Pomeranz: Wow. It does sound like a war. Actually, the terminology is warlike as well, right? Get the soldiers ready. Now, I have also read that these vaccines… we’re used to getting a vaccine maybe for life, like the polio vaccine, those kinds of vaccines. But these vaccines would have to be administered quite more frequently. How would that work?

Meg Tirrell: Well, it’s not totally clear yet how often that would have to be done. But for Regeneron’s, for example, it’s not a typical vaccine. So it’s creating these antibodies, and they don’t know how long the antibodies will last yet. I mean, it’s another question that we’re trying to understand about our own immune response to this virus, how long will our immune response last? And if we’re exposed, does that mean we’re really immune? We don’t know that yet.

But for Regeneron’s, George Yancopoulos, the chief scientific officer was saying perhaps a month, then you’d have to be dosed again every month. They’re figuring that out now. In terms of the other more traditional vaccines in development, we’ll have to see that too. How long do these antibodies last that we generate in response to this vaccine? We just don’t know yet.

Steve Pomeranz: You also interviewed a CEO of a German company, Qiagen, that seemed to be working on a different kind of program. Tell us about that.

Meg Tirrell: Well, Qiagen is a testing company, and so they provide the tests to see if you have the coronavirus. They also provide the materials to run the test, and that’s been a really big question because we hear from labs that the materials are in shortage and that’s one of the reasons why we can’t get these tests.

Steve Pomeranz: What kind of tests are they? Is there something about the test that makes them more attractive? Is the results time shorter? Is the administering of the test a little bit easier on the patient?

Meg Tirrell: Well, so there are all kinds of different tests out there. The Qiagen ones, in particular, you don’t hear about them being as widely used as things like the Abbott test, for example. The Qiagen test, it’s a PCR test used to determine whether you currently have the infection. I believe that they can do the turnaround time in about an hour, so that’s good. You don’t hear that these tests are as widespread as tests like the Abbott tests. Abbott has these instruments in tons of labs around the United States, and they’re providing thousands or millions of these tests. So those are a little bit more accessible.

What’s kind of interesting about some of the Abbott ones is, of course, we’ve heard about this point of care test that can give you a result in five to 13 minutes. That can be really amazing for people who need to know right away. For example, in the doctor’s office, trying to make a decision about what to do with somebody.

Steve Pomeranz: So much of reopening this economy, I think, is going to have to be a factor of testing, of being able to get tests often. I was thinking maybe even having a QR code on your phone, which shows you when you were tested and that you were cleared, in order for businesses to open up for people to do transactions again. Are we seeing anything coming on that strongly. You mentioned the Abbott labs. I think five to 15 minutes turn around is fantastic. Any more technology being used in this particular area to get us up and running again?

Meg Tirrell: Well, that’s a really great question. When it comes to the test to determine if you’re currently infected, the problem is the capacity, that we just don’t have the ability to run enough of these tests to be able to do what you said, which would be amazing. One of the new areas of technology that’s emerging is antibody tests. So that’s a test to determine if you’ve been infected in the past and you have these antibodies. A lot of people see that as basically an immunity test. Like if I’ve already had the infection, I’m immune. We just don’t know if that’s true yet.

It’s expected it will be true, but it needs to be proven that you can’t be reinfected right away with this coronavirus. But again, Abbott, a huge test maker, just announced today that it’s going to be launching an antibody test tomorrow, and it’ll be supplying millions of tests by June to the US. So I think a lot of people are very hopeful that that will be kind of a passport showing you have immunity, you can be back out in the world. And we all hope that’s the case.

Steve Pomeranz: So the timeline is June, early summer. We heard earlier when you were mentioning Regeneron. So really probably talking fall or maybe later this year before anything of consequence happens. Finally, one point you wrote about was that Massachusetts plans to hire a thousand people to conduct coronavirus contact tracing. What is contact tracing?

Meg Tirrell: Yeah, this is really interesting. So contact tracing is public health 101, figuring out who has come into contact with people who’ve been infected and getting in touch with those people and assessing their risk, and telling them if they need to, to potentially isolate or get tested themselves

So, Massachusetts has hired or is hiring, along with partners in health and nonprofit group, up to a thousand of these contact tracers, essentially trying to put into place what could be a surveillance system that a lot of public health experts say we need for when we are starting to come out of this, being able to keep an eye on who might be infected and making sure people stay home if they’re at risk and really just trying to keep a lid on potential outbreaks. You’re hearing people saying we’re going to need hundreds of thousands of these kinds of folks doing this in the US, so it would be a really big effort.

Steve Pomeranz: Well, I want to thank you for coming on today and giving us such a comprehensive look at the state of the art. Hopefully, we can have you on in another 30 days or so and we can kind of keep track with this. My guest is Meg Tirrell. Thanks, Meg. Appreciate it.

Meg Tirrell: Thank you.

Steve Pomeranz: Okay. Thank you so much. Thank you for your time. It was great.