The following is an edited transcript of an MDAdvantage podcast with Steve Adubato, PhD, and David S. Perlin, PhD, that was recorded on April 9, 2020. Dr. Perlin is the Chief Scientific Officer and Senior Vice President at Hackensack Meridian Health Center for Discovery and Innovation, as well as a Professor of Medical Sciences at Hackensack Meridian School of Medicine at Seton Hall University. The discussion covered topics ranging from future vaccines for the COVID-19 epidemic to new rapid testing procedures, care for patients and physicians and our nation’s preparedness in the face of such an outbreak.
ADUBATO: We are honored to be joined today on the MDAdvantage podcast by a real leader in the medical community, Dr. David S. Perlin, Chief Scientific Officer and Senior Vice President, Hackensack Meridian Health Center for Discovery and Innovation and Professor of Medical Sciences, Hackensack Meridian School at Seton Hall University. Dr. Perlin, as always, it is great to speak with you.
DR. PERLIN: Pleased to be with you.
ADUBATO: Doctor, you’re the inaugural Chief Scientific Officer for Hackensack Meridian Health Center for Discovery and Innovation—CDI. You and I have talked offline about a COVID-19 test that’s been developed at CDI. What is it? And why is it so significant in the context of the COVID-19 pandemic we’re facing?
DR. PERLIN: We developed one of the earlier molecular tests, the so-called RT PCR test, to directly detect virus. It detects the RNA in the virus. The test is rapid, and it’s point of care. We could employ it in the hospital and get from a patient presenting with a specimen to a result within three to four hours. In many ways, this was game-changing for our hospital group, because we have to be able to detect virus early and accurately. Before our test or others were available, this just was not possible in real time. We had to wait three, four, sometimes five days to be able to get results, and that was just absolutely crushing to the healthcare environment and to the hospitals, having patients wait, not knowing what you’re dealing with. You had to put them in isolation. You had to mobilize resources that you just didn’t have available, so having a rapid test was really, really critical here.
ADUBATO: The slowness in receiving COVID-19 test results was devastating on many levels, not just for patients but also for healthcare workers. How accessible and available is COVID-19 testing? How much better is it today as we’re doing this MDAdvantage podcast than it was a month ago?
DR. PERLIN: It’s night and day better. There’s no question. We have more molecular tests out there. We have a much higher capacity to be able to test individuals, but people have to recognize who we are testing now. We’re really testing only people who present to the hospitals critically ill. This is largely because people have heeded our advice when we said, “If you’re not feeling well, if you have a fever, stay home, take care of it, treat it like a bad cold.” Most people will get better, but there is that subset of individuals, 20 percent or so, who develop respiratory distress symptoms. They have trouble breathing. They’re presenting to the emergency department, and they’re almost all positive right now.
Before we had widespread testing, we just couldn’t manage those patients. We didn’t know exactly what we were dealing with. Did they have influenza? Did they have some other infection? Did they have COVID-19? You treat them as if they have COVID-19. You have to mobilize resources. You have hospital staff who don’t know what they’re dealing with. The patients, their families, their contacts—it was just an absolute nightmare to be able to manage, and it is much better today. There’s no question about that. But still we’re testing only a limited number of individuals.
ADUBATO: I want to follow up on that. We keep hearing about this quick-turnaround COVID-19 test that can provide results within 15 minutes or so. Is there such a test?
DR. PERLIN: Absolutely. The new test from Abbott Laboratories that was approved can detect a positive result in just about five minutes. That’s true. It’s not as sensitive as some of the other tests, the molecular tests that are currently available, but it takes advantage of the fact that patients present with a lot of virus. When you have a lot of virus, you don’t need the type of sensitivity that you would for some of the molecular tests like, for example, the ones that we developed for our hospital system. And that’s fine, at least from my perspective. From a positive standpoint, if you detect a positive, then you know what you’re dealing with. If you have a negative, now you have to be a little careful: Is it a true negative? Or is it below the threshold for detection? Or is something else going on? We’ll stick with the positives, and that’s a plus. However, there is no question that the Abbott test and the Sefia test are all becoming available, and they’re having an important impact on our ability to manage patients.
ADUBATO: Can you describe how physicians are dealing with this pandemic?
PERLIN: My clinical colleagues are overwhelmed. They’re working very, very long, long days. They’re trying to deal with a clinical situation that many of them have never experienced before, meaning that they have patients with advanced respiratory distress syndrome, but it’s a little bit different, because these patients are not chronic. When these patients go south, they crash very quickly, and it’s very, very difficult to manage them.
Some of the patients are crashing because they have the so-called cytokine storm, this massive inflammatory response that is basically uncontrollable. In some cases, patients’ lungs are so badly damaged by the virus that they just cannot get good oxygenation through their lungs. So, physicians are dealing with a situation that, in many cases, they have never dealt with before. Many of them, most in fact, are not infectious disease specialists. They’re not pulmonologists. They’re clinicians who have been brought in from other specialties to treat patients, and so, it’s a challenge.
It’s a challenge for them and everybody around them—the entire healthcare infrastructure, from nurses all the way down to those trying to manage this. Then realizing that if you become infected, you’re putting yourself at risk. You may develop serious disease, and we have a number of clinicians and healthcare workers in our system who have become infected and have succumbed to the disease. So it’s a very challenging situation for my colleagues.
“Nobody wants to be right about this, but you should always prepare for the worst. We were not prepared for the worst.”
ADUBATO: Did you ever anticipate a pandemic hitting the world so hard and so quickly in the manner it has? Could we have prepared differently?
DR. PERLIN: Should we have expected this? Of course, we should have expected it. Saying we could never have anticipated it is total nonsense because all of us in the infectious disease community understand that we have epidemics all the time. We see pandemic strains of influenza circumnavigate the globe. We had the SARS (severe acute respiratory syndrome) epidemic in 2003, when my colleagues were taking care of patients in China round the clock for three months, living in the hospital. We understood what happened there.
We understood what happened in Toronto when SARS spread there, and it closed Mount Sinai Hospital. I had colleagues who passed away from treating patients with SARS. And we had MERS (Middle East respiratory syndrome). Every year, it seems we have another type of pandemic. So, for anyone in the infectious disease community to say, “Well, we had no idea that this could happen” is total nonsense. Many of us have been talking about this for a very, very long time. Josh Lederberg talked about this back in the 1980s and 1990s. So, this is not new for any of us.
Did we expect the U.S. to be brought to its knees? No. But it really just highlights how woefully unprepared that the U.S. was. In fact, many of us knew this and had written about it, and have spoken about it, so this was a disaster waiting to happen. It’s quite unfortunate. Nobody wants to be right about this, but you should always prepare for the worst. We were not prepared for the worst.v
ADUBATO: How far off do you think we are from having a vaccine for COVID-19?
DR. PERLIN: Based on what I can see and what I hear from my colleagues who are working on vaccines, it sounds like some of them are going to phase one trials as we speak. We’re hoping to mount a strong antibody response with some of those so-called DNA vaccines that express viral proteins, but that will take some time. We’re hopeful that by the end of this year or early next year, a vaccine will be available. That’s the hope. That’s really an accelerated development process. Could it be sooner? Possibly. I think if the early trials look really, really promising and they’re safe, there will a push to move them forward. But quite honestly, although I think that we need a vaccine, we need therapeutics. Right now, our priority has to be antivirals. This is how we control HIV. This is how we control hepatitis C. This is how we control tuberculosis and other diseases for which we don’t have vaccines, and this is what we need to do.
We need to prioritize a vaccine, yes, but we also need to prioritize for antivirals, and that has to be a major part of the conversation. I think that’s why you’re hearing so much about convalescent serum as a way to address antivirals.
ADUBATO: Beyond the clinical side, what is the most significant leadership lesson you’ve taken away from this experience so far that will be helpful moving forward as a leader in the community?
DR. PERLIN: First, everybody shares blame here. As a country, we need to be better prepared. Despite all the tremendous accomplishments we’ve had in so many fields, and our preeminence in so many fields, we’ve really been humbled and brought to our knees by nature. The East Asian countries really understood much better how powerful these forces are, and that you have to prepare. A lack of preparation can kill you, and that’s what we’re experiencing firsthand.
“We have to all work together. And so it’s time to change the way we approach science and medicine, and the way we create solutions that protect ourselves, our friends, colleagues, family, everybody around us, and just make us all safer as a nation.”
We need our public health officials—the National Institutes of Health (NIH) and others and even my own colleagues in the scientific profession—to understand that while we want to do research, we have to utilize our skills and talents right now, and we have to develop counter-measures, better diagnostics. We need better therapeutics, and the time is now.
We’re probably only years away from the next major epidemic, so let’s invest now. Let’s do it now, and make it a national priority so that we will be prepared for the future. That means we have to engage everyone, and we have to change the way we deliver solutions. For example, right now we have a funneled approach where we rely on the Centers for Disease Control and Prevention (CDC) and the federal government. We then rely on state health departments, and then it trickles down to local health. Well, that’s just not the way all of us live our lives. We go to our doctors; we go to our local hospitals. We have to empower those groups to take a more active and proactive role in protecting their patients, and we have to take these things into our own hands. We cannot just rely on the federal government or state government to solve our problems. We have to all work together. And so it’s time to change the way we approach science and medicine, and the way we create solutions that protect ourselves, our friends, colleagues, family, everybody around us, and just make us all safer as a nation. This is about health security as a nation, and we have to fundamentally change that.
ADUBATO: Well said, Dr. Perlin. I want to thank you for taking the time to speak with us. Most importantly, to you and your colleagues, be safe and be well.
DR. PERLIN: Thank you, too. It was my pleasure.