How the pandemic will shape our future

The amount of asymptomatic spread and the fact that there's not a coughing element is not a major piece like the flu or TB.

The amount of presymptomatic and never symptomatic spread and the fact that it's not coughing, where you would kind of notice, "Hey, I'm coughing" -- most respiratory diseases make you cough.

There's still a few trials ongoing, but the list of things being tried, including, eventually, the monoclonal antibodies, we will have some additional tools for the fall.

And so, clearly, younger people have come out of mobility more than older people have increased their mobility, so the age structure is right now very young, but because of multigenerational households, people work in nursing care homes, unfortunately, that will work its way back, both the time lag and the transmission, back up into the elderly, will start to push the death rate back up, which, it is down -- way down from 2,000 to around 500 right now.

05:01 CA: OK, so in May and June in the US, the numbers were slightly better than some of the models predicted, and it's hypothesized that that might be partly because of the warmer weather.

The innovation track, which probably we'll touch on -- diagnostics, therapeutics, vaccines -- there's good progress there, but nothing that would fundamentally alter the fact that this fall in the United States could be quite bad, and that's worse than I would have expected a month ago, the degree to which we're back at high mobility, not wearing masks, and now the virus actually has gotten into a lot of cities that it hadn't been in before in a significant way, so it's going to be a challenge.

The thing that makes this tough is that in every other global health problem, the US totally leads smallpox eradication, the US is totally the leader on polio eradication, with key partners -- CDC, WHO, Rotary, UNICEF, our foundation.

06:24 CA: And is that partly because there's a three-week lag between case numbers and fatality numbers?

This one, in its early stages, it's not coughing, it's singing, laughing, talking, actually, still, particularly for the super-spreaders, people with very high viral loads, causes that spread, and that's pretty novel, and so even the experts have to say, "Wow, this caught us by surprise."

17:22 BG: Well, the innovation tools are where I and the foundation probably has the most expertise.

The innovation track, which probably we'll touch on -- diagnostics, therapeutics, vaccines -- there's good progress there, but nothing that would fundamentally alter the fact that this fall in the United States could be quite bad, and that's worse than I would have expected a month ago, the degree to which we're back at high mobility, not wearing masks, and now the virus actually has gotten into a lot of cities that it hadn't been in before in a significant way, so it's going to be a challenge.

I would say this: Laura Ingraham, you owe Bill Gates an apology and a retraction.

Now, collaborative philanthropy that you're helping to facilitate through Audacious, there's four or five other groups that are getting philanthropists together, that is fantastic, because then they learn from each other,...

The transmission dynamics of this disease are more difficult than even the experts predicted.

29:12 BG: Well, it's fascinating that, besides early action, there are definitely things where you take people who have tested positive and you monitor their pulse ox, which is the oxygen saturation level in their blood, which is a very cheap detector, and then you know to get them to the hospitals fairly early.

06:43 BG: Yeah, certainly your fatality rate is always lower when you're not overloaded.

But it's not a conspiracy.

The innovation track, which probably we'll touch on -- diagnostics, therapeutics, vaccines -- there's good progress there, but nothing that would fundamentally alter the fact that this fall in the United States could be quite bad, and that's worse than I would have expected a month ago, the degree to which we're back at high mobility, not wearing masks, and now the virus actually has gotten into a lot of cities that it hadn't been in before in a significant way, so it's going to be a challenge.

The thing that makes this tough is that in every other global health problem, the US totally leads smallpox eradication, the US is totally the leader on polio eradication, with key partners -- CDC, WHO, Rotary, UNICEF, our foundation.

04:31 CA: Aided perhaps a bit by being easier to isolate and by less density, less population density.

28:39 And so the worst thing, the withdrawal from WHO, that is a difficulty that hopefully will get remedied at some point, because we need that coordination through WHO.

29:12 BG: Well, it's fascinating that, besides early action, there are definitely things where you take people who have tested positive and you monitor their pulse ox, which is the oxygen saturation level in their blood, which is a very cheap detector, and then you know to get them to the hospitals fairly early.

And also, perhaps, partly because there have been some effective interventions, and we're actually seeing the possibility that the overall fatality rate is actually falling a bit now that we've gained some extra knowledge?

A study that our foundation funded in the UK found the only thing other than remdesivir that is a proven therapeutic, which is the dexamethasone, that for serious patients, is about a 20 percent death reduction, and there's still quite a pipeline of those things.

But to what extent is he just hamstrung?

So the world -- and on HIV, under President Bush's leadership, but it was very bipartisan, this thing called PEPFAR was unbelievable.

Or should the world's donors, and especially the world's really rich donors, start to almost commit to a schedule, like, "Here's a percentage of my net worth each year that, as I get older, maybe that goes up. If I'm to take this seriously, I have to give away -- somehow, I've got to find a way of doing that effectively."

22:08 Those three will be gated by the safety and efficacy trial.

03:42 And we see in the Southern Hemisphere, you know, Brazil, which is the opposite season, now all of South America is having a huge epidemic.

...in the picture here that market dynamics would likely lead to a situation where, as soon as a promising vaccine candidate emerged, the richer countries would basically snap up, gobble up all available initial supply -- it just takes a while to manufacture these, and there would be nothing for the poorer countries -- but that what, effectively, you're...

You walk this narrow path of trying to juggle so many different things, and the amount of time that you dedicate to the betterment of the world at large, and definitely the amount of money and the amount of passion you put into it -- I mean, it's pretty awesome, and I'm really grateful to you for spending this time with us now.

It's about a five-year setback in terms of these countries moving forward, and in a few cases, it's tough enough that the very stability of the country is in question.

26:15 CA: I mean, I wish I could be a fly on the wall and hearing you and Melinda talk about this, because of all of the ethical ... "crimes," let's say, executed by leaders who should know better, I mean, it's one thing to not model mask-wearing, but to not play a role in helping the world when faced with a common enemy, respond as one humanity, and instead ... you know, catalyze a really unseemly scramble between nations to fight for vaccines, for example.

Now we have the expertise to look at each of the constructs and say, "OK, where is there a factory in the world that has capacity that can build that? Which one should we put the early money into? What should the milestones be where we'll shift the money over to a different one?"

Using this pulse ox as an early indicator, that'll probably catch on broadly, but Germany was a pioneer there.

If you stay fairly isolated, you don't run much risk, and it's when you're getting together with lots of other people, either through work or socialization, that drives that risk, and particularly in these communities where you have increased cases, even though it's not going to be mandated, hopefully, the mobility numbers will show people responding and minimizing those kind of out-of-the-house contacts.

Weirdly, patients don't know things are about to get severe.

The value of masks, the fact that the medical masks was a different supply chain than the normal masks, the fact you could scale up the normal masks so well, the fact that it would stop that presymptomatic, never symptomatic transmission, it's a mistake.

00:51 BG: Well, the range of scenarios, sadly, is quite large, including that, as we get into the fall, we could have death rates that rival the worst of what we had in the April time period.

You know, you've started this Giving Pledge movement, recruited all these billionaires who have pledged to give away half their net worth before or after their death.

You walk this narrow path of trying to juggle so many different things, and the amount of time that you dedicate to the betterment of the world at large, and definitely the amount of money and the amount of passion you put into it -- I mean, it's pretty awesome, and I'm really grateful to you for spending this time with us now.

And now, of course, dexamethasone -- fortunately, it's cheap, it's oral, we can ramp up manufacture.

And so it's possible, but it's unfortunate, and the vacuum here, the world is not that used to, and a lot of people are stepping in, including our foundation, to try and have a strategy, including for the poorer countries, who will suffer a high percentage of the deaths and negative effects, including their health systems being overwhelmed.

In retrospect, was that a terrible mistake that they made?

05:20 BG: That's right, it's -- In, say, the New York area, the cases continue to go down somewhat, but in other parts of the country, primarily the South right now, you have increases that are offsetting that, and you have testing-positive rates in young people that are actually higher than what we saw even in some of the tougher areas.

Now, collaborative philanthropy that you're helping to facilitate through Audacious, there's four or five other groups that are getting philanthropists together, that is fantastic, because then they learn from each other, they get confidence from each other, they feel...

But nonetheless, smart policies down there.

Bill, I dream of the day where you are appointed the coronavirus czar with authority to actually speak to the public.

Now, collaborative philanthropy that you're helping to facilitate through Audacious, there's four or five other groups that are getting philanthropists together, that is fantastic, because then they learn from each other, they get confidence from each other,...

The innovation tools, that's where the foundation's work on antibodies, vaccines, we have deep expertise, and it's outside of the private sector, and so we have kind of a neutral ability to work with all the governments and the companies to pick.

19:51 BG: Dr. Fauci has emerged where he was allowed to have some airtime, and even though he was stating things that are realistic, his prestige has stuck.

04:31 CA: Aided perhaps a bit by being easier to isolate and by less density, less population density.

You know, we see certain hotspots and things, but that's a huge question with the vaccine: Will it, besides avoiding you getting sick, which is what the trial will test, will it also stop you from being a transmitter?

The US has put more money out to fund the basic research on these vaccines than any country by far, and that research is not restricted.

That may just be quite random.

02:36 CA: So there are scenarios where in the US, like, if you extrapolate those numbers forward, we end up with, what, more than a quarter of a million deaths, perchance, even this year if we're not careful, and worldwide, I guess the death toll could, by the end of the year, be well into the millions, with an "s."

In some ways, he has become, taking the broad advice that's the epidemiology advice and explaining it in the right way, where he'll admit, "OK, we may have a rebound here, and this is why we need to behave that way."

19:51 BG: Dr. Fauci has emerged where he was allowed to have some airtime, and even though he was stating things that are realistic, his prestige has stuck.

This mode of transmission, if you're in a room and nobody talks, there's way less transmission.

It'll help you be down, but it's too overwhelming.

Using this pulse ox as an early indicator, that'll probably catch on broadly, but Germany was a pioneer there.

So it's kind of charming that, in terms of your personal expenditure, you stay at the level you were at before.

42:20 CA: Well, Bill, I'm in awe of what you and Melinda have done.

That just seems -- surely, history is going to judge that harshly.

So it's kind of charming that, in terms of your personal expenditure, you stay at the level you were at before.

40:22 CA: I mean, most philanthropists, even the best of them, find it hard to give away more than about a percent of their net worth every year, and yet the world's richest often have access to great investment opportunities.