David Ho is in a race against time to find a treatment for COVID-19. Fortunately it's the kind of race he's run before.
Ho, the famed virologist and director and CEO of the Aaron Diamond AIDS research center at Columbia University, rose to prominence decades ago with his HIV research. Now he's working to develop a drug that can interrupt the coronavirus' ability to replicate, which, if successful, could lead to a treatment for COVID-19. His team is also studying antibody responses to the virus and is among dozens of labs racing to develop treatments.
His HIV research in the 1990s also shed light on how the virus replicates. That led to new understandings of how to stop the virus from spreading inside the body. Ho, who was named Time magazine's Man of the Year in 1996, became one of the first people to advocate for administering drugs to stop HIV early on, before the patient got sick. The discoveries transformed HIV/AIDS from a death sentence to a chronic but manageable condition.
The Jack Ma Foundation recently gave Ho and other researchers at Columbia University a $2.1 million grant to support their efforts to identify antiviral drugs and antibodies that can be used to fight the coronavirus.
NBC Asian America spoke with Ho last week about his research, the misnomer "Chinese virus" and what it'll take for the United States to safely reopen.
NBC Asian America: What is your research focused on right now?
Ho: My group is not so much working on a vaccine. We're trying to discover small-molecule drugs or develop antibodies that can be used either as prophylactics or therapeutics. We think the timeline for antibodies in particular can be much faster. We know we have the technology to fish out and construct very powerful antibodies that can be used to treat the infection, as well as prevent the infection.
How far along are these treatments?
Ho: Let's just say we have very interesting results in the lab that are obviously not ready for testing in humans, but they're promising leads we're chasing. We're trying to take these leads and optimize them into drug or antibody candidates.
You have these promising leads, but it typically takes up to 18 months, after multiple rounds of testing, to get it out to the public, is that correct?
Ho: Yes, exactly.
You've been very critical of the U.S.'s testing capabilities. Where are we now?
Ho: Various academic groups and commercial groups have stepped up to fill the void that was left by the federal government. Obviously, the CDC made monumental mistakes that were inexcusable. They fixed it, but rather late.
The private sector has taken over. We're ramping up capacity for PCR testing [the most common type to determine if someone currently has coronavirus]. But we're still not doing enough testing.
If you look at the PCR-positive rate for this country, it's way too high, compared to other countries. That means we're not testing a lot of people with mild cases or no symptoms. It's just not right.
Of the total number of tests you've done [in New York City], a huge percentage, something like 50 to 60 percent, are positive. That tells the experts that we're simply not testing enough, we're only picking up the severe cases that are showing up. If you do extensive population testing to find out where you stand, that PCR-positive rate should be much, much lower.
I should mention, too, antibody testing. The federal government completely gave up their responsibility there, left it to academic institutions and the commercial sector to handle. So now we have lots of competing tests out there for antibodies. The government is all hands off. Again, another inexcusable lack of responsibility.
Is it too early to start reopening the country?
Ho: As a scientist, I look at data, utilize what the data tells me. If you look at China and South Korea, which had success in controlling the epidemic, they opened up once new case numbers reached zero or near zero. Now, life in Wuhan is not completely normal, but it's quite normal compared to the life that we all live here.
If you look at Western Europe, Germany, France and Italy kept the pressure on, and the curve continues to bend down. They're on the decline. But Spain, on the other hand, as soon as they entered the decline, they let up. So that tells you something.
The other situation that's informative is what's happening in Japan and Singapore. Both countries had done a pretty good job in the initial phase in terms of keeping the numbers low. They had exceedingly low numbers compared to our daily numbers here. But then, they tried to relax. Look at what happened in Japan and Singapore. It's a pretty substantial surge.
I think everybody would like to get back to business, but the easiest way to get back to business is not to go through this in cycles. It is just to contain it to a low level, and society, collectively, should debate what level that should be. Do we need to go as low as China or South Korea? Or can we do something at a low level but still do a lot of testing and contact tracing, as well as social distancing?
The data out there are telling us it would be unwise to let up so soon. We're quite a bit behind Western Europe in terms of the epidemic curve. We're still at the crest, maybe coming down a little bit. But it's not time to let up. You're just begging for trouble.
How widespread does testing have to be to start reopening places like restaurants to the public?
Ho: I think for some place like New York City, where I live, you really need to test, try to aim for at least 1 percent, if not several percent, of the population to get a clear view of where we actually are. How many people, based on the antibody test, have been infected already? And how many people, based on the PCR test, are actually carrying the virus and still infected? We need a clear view of those numbers before we know how to open up.
If you ask the mayor of New York City, he'd like to test 10 percent of the population. That means a million tests. That's a million PCR and antibody tests.
Are we close to that?
Ho: No, but if there's a will, the technology is there to scale up. You obviously need the participation of many, many laboratories to carry this out. But it's doable.
What would you say to the vocal minority of Americans out and about, protesting social distancing and shelter-in-place measures?
Ho: I would say we all have the same goals. But if we're just coming down on the curve – the U.S.'s numbers account for one-third of the global total right now – that's how bad it is. We have 10 times the cases that China had. And China went to zero before opening up.
We're just ignoring other people's experiences. There are enough examples out there teaching us that by going back too soon, you actually delay the ultimate return to normality.
What are your thoughts when you hear very powerful people in this country refer to the novel coronavirus as the "Chinese virus"?
Ho: It's not the kind of nomenclature we would use nowadays. In past cases, viruses were named after the locations that they were found. But that's not what we do nowadays. We don't call H1N1 [which caused the swine flu] the American virus. We're beyond that by now. That's not appropriate.
Does it remind you of how HIV was originally, and inaccurately, called GRID, "gay-related immune deficiency"?
Ho: Yeah. It was called GRID for quite a while. Some other names that are much worse. There's no place for that.
One place that seems to have some control over the coronavirus is your native Taiwan. What did they do right, and what can the U.S. learn from them?
Ho: First of all, it helps when you had experience dealing with SARS and MERS. Taiwan learned from that and applied that experience.
Also, they acted very, very quickly. Within days of the outbreak in Wuhan, they closed their border and monitored people returning from mainland China very, very closely. That really made a huge difference.
Everybody who tested positive was followed very, very closely by an app and by monitors who would track these people, check in with them on a twice-a-day basis. Should they leave the house with their phone, that would be picked up, a reminder would be sent.
I think, of all the places out there, I cannot think of a country that has done a better job of keeping it low and sustaining it.
Life is not normal, but it's much better than what we're experiencing here. For example, they have sports leagues playing, albeit without fans. But their society is much more back to normal than we are.
Is it too late for the U.S. to replicate Taiwan's success?
Ho: Yes. Our problems are too big compared to theirs. So it's not the same situation. But some of the techniques can be the same.
That is, if we do bring it down and keep it at a low number, then we could apply some of the same methods of contact tracing and quarantine isolation.
Obviously, we pay more emphasis on civil liberties than perhaps they do, even though Taiwan is pretty open and free. But I think the citizenry is much more compliant there than Americans here. (laughs)
What could China have done better in the earliest stages of this crisis?
Ho: First of all, China could've been more transparent earlier on, particularly in Wuhan. If they made a mistake about human-to-human transmission in the first few weeks of January, they could say so. They obviously made a mistake there by focusing on the marketplace, thinking that it was some common source of transmission.
The other mistake that China is making right now is they're letting the U.S. dominate the narrative about where this virus came from. We all know it came from Wuhan. But where did it actually come from?
I don't, for a minute, believe that it was leaked intentionally from a laboratory. But they know something.
We know these viruses typically come from bats. But why Wuhan? Wuhan is a metropolis with very few bats around. But of course, it has [one of two] biosafety level 4 laboratories out there in China. It has all the research groups chasing after bat coronaviruses.
So the question is, did some of their scientists get infected by the virus while exploring bat caves? That's a discussion that should be had openly with the scientific community.
Many scientists suspect something like that – nothing malicious, nothing intentional – but 'why Wuhan?' is a question that must be asked.
It's a distinct possibility. There are lots of videos you could look at online, hosted by the same Chinese scientists, exploring bat caves without a lot of protection.
There's no doubt in my mind the Chinese government has already looked into that possibility. Their findings should be shared.
Thank you for your time, Dr. Ho. Last question: I know you and your team are working pretty much around the clock to discover treatments. But what do you do to unwind?
Ho: (laughs) There's not much time to unwind the last few months. I do like to go out and play golf, but the governor has closed all the golf courses. So like many people, I stay at home and watch movies. But I have too much reading to do. Trying to catch up on new information.