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I'm Guy Kawasaki and this is remarkable people. On May 6, 2020, I moderate a panel of three professors from UC Santa Cruz for an organization called Santa Cruz Works. This organization's mission is to make Santa Cruz a great place to start sust and grow businesses. The topic of this panel was the research that the UC Santa Cruz community is doing regarding COVID 19. This special episode is an audio recording of the panel. I am publishing it because it answers many lay questions about COVID 19 tests and vaccines. The three scientists are Jeremy Sanford Jeremy Sanford is a professor of molecular, cell and Developmental Biology. He focuses on understanding the role of RNA binding proteins in regulating gene express. He has recently launched a C19 testing lab with 24 hour turnaround. Rebecca Dubois Rebecca Dubois is an Assistant professor in Biomolecular Engineering. She studies the molecular mechanisms of human virus surface proteins. She uses her discoveries to design novel vaccines and antiviral therapeutics. David Haussler David Haussler is a Distinguished professor in Biomolecular Engineering. He is a Scientific Director at the UC Santa Cruz Genomics Institute. He is well known for his work leading the team that assembled the first human genome sequence in the race to complete the Human Genome Project.

Jeremy, let's just, let's not keep us in suspense. What exactly did you announce today or this week?

We currently have been approved to run the RNA based molecular diagnostics tests for the SARS CoV2 virus. And yeah, so this is pretty much the test that's being used across the world. We're running the CDC based assay that's been developed and yeah, and so we're now, I guess FDA approved and approved by the California Department of Health to run these tests and report back findings on people in the community. So it's pretty exciting.

A part of my ignorance, but is your test the swab test or the blood test?

Yeah, this is a nasal swab. So it's the very conventional nasal swab. Deep to the back of your sinus passage There kind of swished around a little bit and then dunked into a vial. It's not nearly as bad as it sounds.

Okay. Having done it, so backing up a little, maybe, Rebecca, you can take this one. Just to establish a baseline of knowledge. Why is testing important?

Yeah, it's really important, especially what Jeremy's lab is doing to identify active infections so that we can do contact tracing and isolate contacts. And serology testing or blood testing is looking for evidence of past infections. And that can really inform us in terms of what percentage of our population has already been exposed. How many people were sick and were never able to get that nasal swab test?

I have to admit, I've never done sort of monitoring a group of people virtually. Usually when you do this in person, you can make eye contact. I know someone's, like, jumping out of their chair. I want to say something not so easy here. So I'm going to just float the questions and whoever feels compelled, just jump in. Can you, one of you basically explain the kinds of tests that. That there are and how are they done? What's the use case for each of them, again, to build up a sort of general base of knowledge for us.

Jeremy, take it away with the virus. Active viral infection.

Yeah. So I think one of the key tests that are out there are what they call the NAT, or the nucleic acid test. And this is a measure of whether or not the viral genome is present. It doesn't necessarily mean that there's a particle there. You're not measuring the active particle, but it's clear that this is reflecting viral genomes that are being shed by the infected person. The swab basically collects both the human cells from the sinus passage as well as virus that's being shed, and as well as intracellular virus. That sample is collected and the particles are denatured. The cells are denatured, the viral particles are denatured. So that means you break all of the intramolecular interactions between them so that you can have just the individual bits of biomolecules floating around in solution. And then we use a really sensitive and specific test based on polymerase chain reaction, or pcr, which is a way to program nucleic acid amplification or replication. And so we go in looking for specific parts of the viral genome, and we're able to amplify it from very. Really just a single RNA molecule is sufficient for us to measure. And we create in the test tube billions of copies, which enable us to measure that with a great deal of accuracy and precision.

How long between the test and the results?

The test is actually at this point in our hands. That is the fast part. Purifying the nucleic acid, running the test and getting the data. The slow parts are definitely bringing the samples into the lab, taking good care of all the information that comes with those samples because that comes from a patient, and then reporting those back to the provider who requested the test. So from the time that the samples hit the lab to the time that we can have the data is about three hours.

And does the person who took the test find out the result through the.

CLIA certification of that laboratory? The person who requested the test, the healthcare provider generally, they will receive a report back that gives them our interpretation of the test and what we think it means and they'll be able to report back to the patient.

And so that might occur within the first 24 hours.

Yeah, that's our goal, is to provide, especially for people who are acutely ill. It would be a 24 hour turnaround. I think that there's an increased ability across the state now to begin to test people who may just have a fever or maybe a little bit sick. And they would have been excluded from testing early on. But now the criteria for being tested are dropping. And I think for asymptomatic people or people who are just a little bit sick, we might prioritize the more acute samples or cases ahead of them. So I think it's 24 to 48 hours is what we're looking at.

At the point of testing, what if the virus had not yet replicated and reached the throat or the nose, or if the med tech had not happened to swab where there's enough virus to detect.

Yeah, that's one of the key things, is that being able to have a good biospecimen is critical. And so it's clear that there's going to be false negatives because of either the type, the viral life cycle, the course of the disease, or how the sample was collected. That comes with the territory. And I think often patients are being tested multiple times until virus is detected.

That's the PCR test. Can someone explain the serological test?

Sure. So when you get infected, your immune response, a big part of your immune response is the production of antibodies. These are little Y shaped molecules that are floating around in our blood and they recognize a specific germ like coronavirus. So that is this molecular trace that our bodies have and show us what we've been infected with in the past. We know that the type of antibody it's called IgG. This antibody develops over time, about one to three weeks post infection. And we can detect people that have had coronavirus in the past with a small finger prick, a drop of blood, we can detect those antibodies in people.

Could you have the antibodies and still be actively able to infect others?

That is something we're not sure about yet. What we know so far is that different people that have had coronavirus really have different levels of antibodies. And so what we right now can say, it seems like yes, you had it or no, you didn't have it yet. But whether those antibodies protect you from reinfection or protects you, you might be able to be reinfected, but asymptomatically spreading it. And so these are things that we.

Don'T know yet other than for the statistical analysis of the part of the population that has the antibody. What good does it do for a person to get this test? Because if I get the test and I'm positive, and let's just say there's no false positives or false negatives, but get the test and I'm positive, I know I had it. I don't know if I'm still activ and I don't know if I'm getting immunity. So what did I just learn?

Well, it shows that you had an antibody response. And what we know from other coronaviruses, like the common cold coronaviruses, is those antibodies do give you protection, but we don't know that for sure yet. With this coronavirus, all the vaccine development we're doing, we're trying to build that antibody response. But it's going to take testing to really follow people that have had an infection and see if they are able to be reinfected again.

So wouldn't the ultimate test suite be that I get the PCR and I get the serological, so I know that I'm active and I had it in the past? I mean, don't you want to cover both bases?

Yeah, yeah. Most people that have PCR confirmed most likely have antibodies. So an antibody test would be confirmatory. But there's a lot of unknowns in terms about your potential for reinfection.

And is there a role for syndromic surveillance? I mean, besides these molecular kind of tests?

Definitely. My understanding of syndromic surveillance is just understanding general outbreaks of disease and things that can happen in communities. So if everybody know if there's spikes and lots of people in Santa Cruz have fevers, then we know from syndromic surveillance that something is happening in Santa Cruz.

Okay, so Zooming out of the molecular level. Tell me, so there's 40 million Californians. I mean, how many tests do we need to make testing effective?

So I think one way to do this is to back calculate from the number of deaths in California on a given day. And so we know the general kinetics of the disease progression and we know that you can estimate from the tests that have been positive and the fatality rate how many cases there were likely to have been. Looking backwards. So say 21 days ago, for example, if you look from today's date and then from there you can say, well, I just did this for my class the other day. From there, after you've got the total number of possible infections that day, you can ask what was the probability that if you had tested someone that would have been positive, so there's a success rate associated with that test, then you can come up with how many tests you would have needed to, to calculate to capture those particular cases. And currently, I mean, as of, I gave this lecture a few days ago and there were 44 new deaths in California. And if you went back 21 days, you could have estimated how many cases there could have been and the number was somewhere around 80,000. And that's very consistent per day. 80,000 tests per day is very consistent with what Gavin Newsom had called for. And currently we're testing about a rate of 36,000 per day. And so there's a big discrepancy of 50,000 tests per day gap. Now, one of the earlier questions that you had posed was do we need both serological testing and PCR based testing? And wouldn't I want both? And there's an important distinction. The first is that in the course of the disease, the earliest indicator is going to be obviously the symptoms and things, but you're going to be able to measure the shedding virus by nucleic acid testing. First. This seroconversion which happens, the antibody response is a much later response. So if your mission is to stop the transmission of the dise, you really have to focus on the nucleic acid testing because the sooner you can identify a case, the sooner you can quarantine them and cut off that transmission on.

A more behavioral thing. So let's say we need 100,000 tests per day. How do you get people to test? You could make the case that if I find out this, it's going to, you know, do I want to not know? Am I now going to be a pariah and is it going to affect me now? I, I can't Go to work. How do you motivate people to get something that may have negative consequences?

That's a good question. I would guess, you know, if you're civic minded and you want to help protect your family members, especially if you're living in a multi generational household or you have people who might be at risk living with you, you might want to know. So yeah, it's a good question. I mean, I think one of the things that could eventually help potentially is one of the ways is if you have a less invasive test. I think there's a lot of people who don't a swab shoved to the very back of their sinuses. So if you had saliva based testing or throat swabs, things like that, that you could do yourself, that might increase participation.

I heard a no pun intended, novel idea, which is that if you got a test, which I think is good for society, if you get tested, that you were entered into a lottery and the size of the lottery was something like a billion dollars a week, and the person calculated that paying a billion dollars a week for more people to get tested is a drop in the bucket compared to the effects of a pandemic. So is that guy nuts?

I mean.

I mean that does motivate people. I mean, there is some reward there, I guess.

Okay, let's say that God, as the case may be, says to you, you are the testing czar of the United States.

You're it.

You tell us what to do with testing. So what would each of you do as the newly empowered czar of testing of the United States or Tsarina?

I think if it was up to me, one of the sort of mottos that we're kicking around amongst the team that's working in this diagnostics has been go big or stay home. And I think you hear that a lot in extreme sports, but really it's go big or go home. This is stay home. If we don't test extensively, this lockdown is going to continue indefinitely. I think we really need to be able to cut off the transmission of this disease and be able to contact trace and test everyone who is contact traced. And so I think that number of 80,000 tests per day needs to go up by 100 at least. So a hundred fold.

100 fold like 100 times 80,000.

Yeah, I think we need. Well, that's too big. Sorry, but I mean we need to really be at millions of tests a day. That's what I would say. If we really wanted to stop the spread. I don't think we're going to be able to implement that in Santa Cruz or at UC Santa Cruz in our laboratories. But if I had my way, it might be something like that.

Rebecca?

Yeah, I agree. Testing is we just need to be able to monitor and know the number of people in our communities that have it. And so that if we begin reopening and we start to see that spike, we know the exact numbers and contacts. And so we're going to be able to have a better idea if we can stay open or if we're going to have to shelter again.

Do we, in practical terms, do we have the ability to produce that many tests, millions per day? And for the medical personnel to administer those tests, Are those things in place or can they be?

I mean, I think at the nucleic acid level testing, there are innovative ways to approach those numbers using high throughput sequencing, an approach like splopseq. And there's a bunch of different high throughput assays that would allow you to pool hundreds of thousands, if not millions of samples at a time. I think combining even the tests that we have with self swabbing, automated sample collection and processing could allow us to scale from the capacity that we're at now to thousands to tens of thousands per day. With a small investment in automation, that seems very feasible. Yes.

Rekha, you got any thoughts about that?

I'm going to let David jump in and give.

Okay, David, jump in.

I think the. I think we do want to get to extreme testing of the kinds of numbers that we're talking about here. And I do think the only way we'll really get there is home testing. There will be a barrier to the really big numbers if we don't allow, if we don't get to the technological milestone of home testing. And this has been something of a holy grail for a while now. The Gates foundation has a home test flu kit. They've been working very, very hard to develop this technology. Again, when you're deployed in the third world and some other places, it has to be very simple technology. We heard from companies like Ontaria that are trying to build a very simple device. There are many, many companies going after this and there are lots of problems in terms of quality control. And what do people do with this knowledge if it isn't filtered through a physician? As Jeremy explained, right at this point, your physician orders the test and then interprets the result for you. What will people do when they can go wild and test themselves and test their dogs every day? And, you know, what conclusions will they come to without a human Professional to be able to discuss this with that is a genuine fear, I think. But again, we're advancing a lot in terms of telemedicine and ways of being interconnected. So these things are inevitably going to go small, go cheap, go individualized, and go fully networked and electronic. Other issue that comes in with this is privacy, of course. And this has been a wake up call to some of the discussions about privacy versus protection of the interests of the community. And this is a classic case with an epidemic like this where there is a clash between privacy and the needs of the community to protect itself. And I think people are starting to come to grips with those. So the technology is conceivably there. There hasn't been as much a push for it. But I think with this incident now, this is the time where we need to get off our butts and build that technology and deploy it.

Where do you fall on this spectrum of privacy and societal need?

I am very sympathetic to the issues of privacy and the answer in my mind is not to lock away information or make it difficult or impossible to get information, but to make sure that we can prosecute people who violate the information that we do share. It really isn't an option for us to go back, all of us, to choose to be kind of outback, off the grid kind of people. You shouldn't have to be forced to make that choice because you're convinced that your information is going to be abused. Otherwise we need to really crank down on these people who are abusing this information so we're not forced into this, into this horrible situation. I can't tell you how many times over the last years that I've worked with international agencies. I was a co founder of the Global alliance for Genomics and Health, for example, trying to move research forward, trying to move treatment forward in an era where everybody was paranoid about sharing any kind of DNA information with anybody else. And what frustrates me is we haven't really calculated the harm that comes from that paranoia, from shutting down that information, from making it impossible or extremely difficult to get that information. We really haven't calculated the opportunity loss in terms of what would be improved health and balanced it against the genuine, very genuine privacy questions and the harms that are done on that side of it. This is a classic ethical question where there is a serious conflict of interest here. There are harms both ways that have to be balanced. And we have not faced up to that. We basically shoved it under the rug and said, okay, fine, our system of medical informatics is Completely stone age. It's completely inadequate for what it could be doing. We're not rising to the challenge at all. But nobody's really making a body count for what that actually costs you. And so nobody has the will to confront this issue head on and say, well, maybe we do need to design the right kind of sharing and the right kind of prosecution for people who violate the rules. Now we have a body count.

In practical terms, how does it happen?

Contact tracing is a classic thing. So contact tracing has been more effective in countries where, where you have an established procedure and people are more willing to share information with the government. Not everybody completely distrusts the government to the point where they won't share information. And all of these barriers are not as high. And so it's fairly easy to do contract tracing. It's very hard in an open society like ours where we're so sensitive to privacy issues. And if you look at just sharing databases, you run this all the time. You have the community health database, you have the database of kids in the school system, the educational system, and you want to do an intersection. Oh, does this kid have something? And you can't. There's immediately legislation, barriers and so forth. You can't even intersect those two databases. So it makes information worthless. The way we set up these walls, it's not true in other countries. And those countries have been way more successful in doing contract tracing and controlling this virus.

And would you say that the interesting juxtaposition to follow now to see how it goes, is maybe Sweden versus Singapore?

Could be. Could be. Now, I want to add that I'm not in favor of the kind of draconian control over information you see in a place like mainland China. And I think that is really a warning from the other end. Do we really want to give up that much? But we do have to recognize that it is a real trade off.

Can you take us back a little bit and just tell us how your browser is used in CV19 research and what's the connection there for us?

Let me just segue into this by saying that the basic scientific information about the structure of the virus is wonderfully the kind of information that we can openly exchange without any international barriers, without any legal barriers. And that has been a huge step forward. There is an enormously accelerated exchange of scientific information at this point. I have been watching the fast publication site called BioRxiv and MedRxiv. These are two new venues where you can take your scientific paper and publish it in 24 hours. The number of papers on this virus and this disease has gone from a trickle to an avalanche. We're getting hundreds of papers per day. Now this in a sense is information overload. But with the right tools like the UCSC SARS CoV2 Genome Browser, we can take that information and consolidate it into a one stop shopping kind of Google Maps site, as was described by John. Thank you. So imagine you need to go somewhere on the virus. Oh, I need to go visit the spike protein because I'm working with Rebecca and she's interested in in antibodies that might interact with this, or she's interested in immune response that a little piece of this protein might kick off in a person. You can literally just ride down the road of the virus genome until you get there and then see that information. And we try to update it as fast as possible as it's coming out of the scientific literature. This cuts the typical scientific turnaround time from months to days. And this is exactly what we need in a case like this, standard scientific publishing, you do your work, you present to a journal, they go through an elaborate reviewing process, months to even sometimes many, many months later it gets published. And then people dig out those tables and convert them to some piece of information technology that they can use and compare and it's all very slow and laborious. What you want is an instant click that will tell you what the information you need is. And that's what we're trying to provide.

Will this make the gating item actual? Phase one, phase two, Phase three testing. We're going to accelerate your part of it, or this part of it, but it doesn't make a vaccine happen in January of 21, does it?

No.

Basic science doesn't make any particular applied medical product happen all by itself. It just lays the groundwork for that. And the browser is in support of understanding and idea generation. But it's also increasingly now part of tracking the virus. John mentioned that there were thousands of viruses and I wanted to give a shout out to my colleague Mark Akeson, who's now in the process of setting up the lab to sequence viruses that Jeremy collects. For people who are interested in knowing what is the whole genome of my virus now, it's not so much for them to know, but scientists might be interested in that right now. You may be aware that there was a controversy in the last couple of days over whether there was a genetic variant of the virus now circulating that might be a bad actor compared to one of the other versions of the virus. We call them different strains when they actually, when it makes a Difference right in the course of the disease. This is a case where we really need to have open literature and we need everybody to have instant access to the data and we need to have everybody have access to all of the data. And some extraordinary groups have collected thousands of genomes. They've shared them with the international community and those genomes can be viewed on our browser and many other sites and we can detect when variants come up that may be significant to look at. But it's a very complicated process. And by our analysis over the last few days, it looks like this group that announced this jumped to a conclusion that really isn't justified in the data. So it turns out there are some gotchas in the data that may be due to some kind of molecular weakness in terms of the way these genomes were sequenced. Possibly, we think maybe one sample contaminated another or something like that, and it made it look like this site was more evolutionarily active than it actually is. Only by careful scrutiny of open data would you see this kind of thing. So here you have legitimate good labs jumping to conclusions and needing to be checked by other scientists. And I noticed today there were some back and forth where more sober virologists are looking at this and saying, hey, wait a minute, we don't really see the evidence that this is a bad acting mutation.

Can you be a little fortune teller here and tell us how this vaccine will proceed? I mean, from a.

That's Rebecca. I talked enough, but please tell us.

Rebecca.

I read a lot of news and one day it says there's 85 things and somebody says, oh, there's this miracle thing that happened, like what do you believe anymore about this vaccine? Give us the gist of what's happening.

The problem is we don't have an established way to make a coronavirus vaccine at this point. If this were an influenza pandemic, we know how to make flu vaccines and we'd be able to, to adjust our technology to the new strains. But for coronavirus vaccine, we don't know which technology is the right way. Do we grow the virus and inactivate it? Do we isolate just the spike protein and use that as a vaccine? And there's all sorts of really promising and very exciting new vaccine technologies that have not been proven yet. And so this is an opportunity to test those new technologies and see if they work. They could have a big impact on all sorts of vaccines. But it also is just pushing many different options forward at the same time and seeing who hits the finish line first.

So hearing that there's 85 or 100 things being pushed down at once is good. The more the better. More likely infinite monkeys. We're gonna hit the solution faster this way.

I think we're gonna have to make some decisions about which ones go into the clinic or into pre, you know, in clinical trials. In humans, most of those hundred or so vaccines right now are in pre clinical trials, so testing in the lab, but we certainly have some going into humans now.

So now let's assume that a few, or maybe, you know, one is identified. Don't we need hundreds of millions, if not billions of doses? How do we make all that?

We do. And so there's a lot of investment in basically manufacturing facilities to scale up whatever one works. And so instead of just scaling up one type of facility, we have to do that in parallel also with our manufacturing capabilities.

And when you say we, is this we the US pharmaceutical or the worldwide.

We the world, we scientists. Yeah, pharmaceutical companies. And so there's the investment right now is in manufacturing facilities for vaccines that may not work, but we really need to invest in multiple platforms with the hope that one or two will make it to the finish line and we'll be ready to scale up.

And is big pharma stepping up? Are they going to make this investment?

I just wanted to jump in. This is a brilliant thing and I totally agree with you, Rebecca. But I would just want to acknowledge that I'm surrounded with howls at this point. And this is a shout out to the care providers in the front lines. People up in my community, in my neck of the woods really take this seriously. And everyone is out on their porch howling now at 8:00'.

Clock.

So I think we should all howl out to our people on the front lines.

I have one more question. It seems to me that herd immunity without a vaccine, is that not saying sort of survival of the lucky or the fittest? How do you have herd immunity without a vaccine? In a humanistic way, we're gonna get.

Herd immunity either through the majority of our population being exposed to the virus or being able to develop a vaccine and vaccinate people that haven't gotten the virus. And so I guess I'm not exactly sure what you're asking about, but we do need herd immunity in order to have the potential to be fully back to normal without having exponential virus spread again.

Sweden says they're going for herd immunity, but there's no vaccine. So are they saying, okay, we're okay with 30% of the country dying, Is that right?

So they are saying we're going to let the virus spread through the community, but that's a really risky idea. You certainly have to have the medical facilities to handle that kind of capacity of infected people at any given time.

Before we go on, we need to discuss a little bit that 30% number that you threw out.

Okay.

The death rate from infection is nowhere near 30%.

Let's get into some questions. Now we have 37 questions. So thank you, guy and the whole panel. You're going to stay here all night, correct? We'll be here for a while. No, we'll fill through some of them first. One, I have read that false negatives in Abbott's quick COVID 19 test are near 15%. What do you expect the accuracy of your test on campus will be? What is the acceptable level of an accuracy to you?

Well, I think that for us the accuracy is there's nothing particularly special about the test that we're running. We're running the CDC based test. And what we're really concerned about primarily is the sensitivity and the specificity of that test. And this was developed by the cdc. And so we've simply implemented it here. I think we're going to see similar results that other molecular diagnostic labs have seen, which depends. Which suggests that your positive signal is going to depend on the point at which you're at in the disease and when you're being sampled and the quality of that sample. I think that the number of samples that are coming up positive, even from symptomatic people, is still fairly low because there's a lot of challenges with getting those samples.

Next question. What did South Korea do different to be able to test so many people so quickly and widespread? It seems they created the gold standard for testing and tracing.

From the discussions that I've had with our wonderful collaborator Marm Kilpatrick, it seems that the aggressive testing and contact tracing followed by quarantining and testing of the people that have been contact traced has been extremely powerful. And they've also tested a significant fraction of the population. Okay.

It's a great example of how this worked. I think mainly it was good decisions made on the government's part and a good cooperation from the populace. And one thing you do have to take into account is they had a scare with this earlier, right? So the SARS, the original 2003 SARS virus did hit only in the east. And so there have been some incidents and they've responded and set up appropriate preparedness. Again, their government was functional enough to set up a system and be prepared and our government is less functional in that sense.

Nancy has a question. How will UCSC decide who on campus gets the first test, first come, first served? Or are there certain kind of criteria.

On the RC at rt, the nucleic acid test? We are allowing the student health center to identify people that need to be tested based largely on symptomatic criteria and healthcare providers. So these sort of the essential workforce at UCSC are going to be tested as well. And so, yeah, the lab itself has no say in who's being tested, that we just get the samples and process them.

Here's an interesting question from Adam. Do we know why certain infected individuals don't express any symptoms of the virus?

We really don't know.

Thank you.

That's accurate.

That's good.

That sort of just reminds me just one little point that I think earlier I made a comment when you said, if you were suddenly the national czar for COVID testing, and I said we had to test huge numbers. And part of that, the rationale, like, I didn't say why. Why do we need to do that? And that's because of this hypothesis about asymptomatic transmission. Additionally, despite the lockdown, the prevalence, and probably because of the lockdown, the prevalence in the community anywhere is going to be very low. And so in order to capture those positives, and remember, any one of these positives could lead to an outbreak in a nursing home or someplace like that. To capture those, you need to test, to test broadly. So that was kind of the why the prevalence is still low and you have asymptomatic transmission.

Dagmar asks, do you know yet if the antibodies will stay in the body forever or if they will disappear over time? Rebecca's smiling on that point.

I'm sorry, but we don't know yet. But what we know from other coronaviruses that cause the common cold is that you tend to have antibodies for one to two years, and then it wanes over time.

Dean has another good question. If I am asystematic, how long can I be contagious?

That is a good question. Some of the data suggests there are cycles of viral shedding. So I don't remember exactly the details, but early in the asymptomatic phase, there can be viral shedding, and then a bit later, if symptoms begin to appear as much as four to five days later, there can be additional viral shedding. It. Yeah, there's probably an answer. I don't know it.

Okay, let's see.

Next question here. I've heard about some very promising Studies of monitoring wastewater for COVID 19 to understand how much it is in the community. Is that something that you've heard about?

Absolutely, yes. For the nucleic acid testing in the environment, for sure, that's a big concern. We were on a call with a pathologist from UCSD and they're taking very aggressive testing measures in order to hopefully open the campus in the fall. And that involves testing of faculty, staff, students, the environment and water. And gray water in particular was a key target. So, yeah, there's interest in that. We haven't got that far yet.

I'm going to kind of bunch a few questions together now. People are asking, how do they get tested? Some people have symptoms and they've called the hospital and they've said, okay, I want to get tested, but they said, okay, just stay at home. Other people, they're not. They don't have any symptoms, but they have somebody that's high risk in their house. What's the best way to get tested or that just not going to happen right now for some people.

As far as the nucleic acid testing goes, it appears that the state has loosened restrictions on testing. And so we're out of the period where only the most acute symptomatic people are being tested. And so there is a movement towards catching people with more mild symptoms as well as the asymptomatic group. So I think there will be increased access to testing, most likely even in Santa Cruz.

What is the panel's opinion of ICELAND's response to COVID 19?

Just the study that was published on Bioarchive early on, where they were able to test again a significant fraction of the population. And there were interesting numbers related to the number of asymptomatic people who had the disease as well as some of the symptomatic people. I think one of the interesting bits there, if I recall, was that the genomes of many of these viruses were tested and there were some differences that appeared to be interesting, but there's been so many papers, it's hard to keep up at the moment.

Speaking of genome differences is the other thing we need to emphasize, not just in Iceland, but in all the outbreaks, is that this is the first time we've been able to real time track the transmission of the virus from region to region. If you look back, even in 2003, there were only a few genomes sequenced and it was a long time before you got data and you could actually analyze the data. You know, handful versus we are now over 10,000 virus genomes that have been sequenced from different cases just over the last few weeks. And with that level of genetic analysis, and I commend everybody to Carl Zimmer's wonderful little piece in the New York Times just last week. You can do genetic detective work, right? You can look at the subtle details of the mutations that you see in the virus. And again, these are mutations that probably, based on everything we know, really don't matter much for how the virus is going to behave. But they are like a signature. They're almost like a zip code from where the genome came from. And that has been useful. And we have these extraordinary maps where you see things that look like basically plane flights that took a version of the virus from one country to another. And you can see it actually evolve. You can see the pandemic spreading globally in a movie. This is unprecedented surveillance we've never ever had the opportunity to do before.

Susan has a question for Jeremy. Have you looked at RNA DNA shield as a way to circumvent the supply chain issue with viral transport media?

Oh, yeah, that's exactly what we're doing. And the main reason is that the reason we like the RNA shield, DNA shield solution, it's something called a chaotropic detergent. So it's a viral inactivation solution. And so that causes that viral particle to fall apart. At the moment at UC Santa Cruz, we don't have a BSL3 facility. And the most important thing for us, because we're all relatively new to this, is that we want to make sure that the students and staff and faculty that are participating in this work, that they're safe and they're working in a safe environment. So for us, it's critical to, to collect those nasal swabs or whatever biospecimen that we're getting into DNA and RNA shield from the beginning. And that way, when we bring it into the lab, we're confident that we're dealing with a sample that is no longer infectious. And so that's a big part of our safety routine. And I think as our testing expands and we get more partners, either from the county or from wherever, the one thing that we're going to continue to do is provide test kits that have this RNA shield solution in there.

But we do have a question. Here is one from Andrea. Given that there is an animal coronavirus vaccine, what can we learn from this and could it support fast tracking human vaccine development?

We don't have an annual coronavirus vaccine, and that's the problem.

Animal? Did you say animal?

We do have an animal like canine.

Is what she actually.

Oh, I'm sorry, I thought you said annual.

Oh, animal, sorry.

Well, I would say the bar for safety is higher for humans and so that the method of making that coronavirus vaccine is almost certainly one of the hundred in our panel that we're considering for human testing.

Can you test saliva samples?

Right now that's a research question that we're hoping to be able to address are sort of EUA based tests. So that's the emergency youth use authorization that we have from the California Department of Health. It's still focused on the nasal pharyngeal swab. But what's interesting is that it's clear that saliva can be used as a good biospecimen in the literature that we've looked at. The only problem is that you don't see a lot of studies where you have from a patient a nasal swab, saliva, a throat swab, so that you can really do these side by side comparisons. So yeah, we are really interested in both developing a self swab test as well or a saliva test that's going to be extremely useful when the virus mutates.

Could the current test pick up the mutation or will there be a new strain that will be undetected?

Comment quickly on that. So we track all of the mutations that become established and the good news is that the virus sequence itself is not mutating as fast as some other sequences from other viruses like flu, certainly nowhere near as fast as HIV, aids. So there are many, many places in the virus that are so far quite stable. And we also have many shots at this. Right. So you can do your testing and your interactions with the virus at multiple sites and it's unlikely that all of them will be mutated in any new variant anytime soon.

Last question, this is from Rex. Are there historical viral precedences that showed the same asystematic transmission? Anything we've learned from those and been able to hypothesize on Covid as a.

Result.

There are certainly, I think sars, the original SARS had some asymptomatic transmission. I'm looking at a figure from a medical archive paper right now that's comparing the seasonal flu to SARS to the current COV2 hypotheses. And yes, there's definitely mechanisms and models that we can propose that could infer this. And the point of this article was to try to estimate what the distribution of onset of this infectiousness looks like in this pre symptomatic period and what they're showing kind of is that the shapes of SARS from 2003 and the seasonal influenza are potentially very different than the. The distribution in this particular coronavirus. I think the bottom line is that for our lab and for my colleagues that are normally interested in gene regulation and questions about molecular biology, we're learning an awful lot about viruses. So it's a really learn as you go kind of situation.

Thank you so much for all your good questions, attendees, really. So I wish we got to all of them, but we just didn't have time. And thank you for the panel for answering them so well. Now we'll zoom it back right over to Doug.

Thank you so much. It looks like we still have 52 questions and again, we just don't have enough time tonight, so we'll try to get to it over the next week. Well, first of all, I want to thank everybody for attending, but I want final comments from each of our panelists. And Guy, I'm going to start with you. I think you might have had one last question that you wanted to ask yourself.

Yes. So, first of all, thank you very much. I found this very informative and very helpful in understanding and I hope the people who attend this watch the archives also find it very helpful. I want to give up my time to David because I want to ask David the question I forgot to ask, which is if you were the vaccine czar, what would you do?

Yeah, vaccines are. I'm not a vaccinologist, certainly not an expert. I would defer my time to Rebecca as she's really the expert. But what I understand is happening, which is trying every type of vaccine all at once is really the correct thing to do. And you need to invest in each one. Even though we expect that only one is going to be the globally used vaccine, maybe at most 2. It's well worth it right now, everybody, to invest in trying to develop 100 vaccines at once, because we do not know which one is going to be the one that is the most successful.

Great. Are there final comments from you, David? And then we'll go to Rebecca.

Sure. I would just like to say that this has been an extraordinary opportunity for technology to step forward and really have a positive impact. This situation would have been horrible if you go back decades. Many of the technologies we've developed recently have come to our rescue in this situation. And at the same time, we realize that we've missed opportunities. So we could have been doing extensive surveillance for all the kinds of viruses that may infect humans, but are currently circulating in bats and other species. Then we failed to find the will to do that. So we could have been warned ahead. We could have developed potentially more preparedness and countermeasures. But we did some amazing things. So we developed this genome sequencing technology, we developed this global pandemic rapid awareness technology. And so. And we've also developed the Internet and frankly everybody is using that quite extensively at this point. So technology has been an enormous factor in us getting through this. And it's also showed us that there's way more potential from that technology if we have the will to develop it.

Great. Rebecca.

Yep. I just want to say thanks for listening and support science.

Yes, indeed.

Yeah. So I'm just going to probably take a minute to say something that I think is super important. The first is that I'm really excited to be a part of this project at UC Santa Cruz. And truly it's a massive team effort. And that goes from administrators to people working in procurement, to our facilities crew. And then you have the scientists who've been absolutely incredible. We have this remarkable team of faculty, I think it was mentioned before, Michael Stone, Elena Vaski, just absolute professionals, incredible attention to detail. And then we're supported by an incredible network of faculty here that have been really pushing us onwards. I think the thing that I'd really like to get across is that it's the people in the trenches right now, like our graduate students and our staff that are putting on the PPE and going into the biosafety cabinets and doing the work. It's not very fun. They have their masks and their visors and if you come into any molecular biology lab. I'm sorry, eh, you almost never see that level of equipment in our laboratories. And so they're really, really just giving everything they have to try to make a difference to the community. I feel like my main job has been to be a cheerleader and to kind of say we should do this. Let's go, let's go. And it's been amazing. And I just thank our chancellor, our executive vice chancellor and those folks. And then lastly, there are some amazing people in this community who have stepped up for us. Santa Cruz Works making visors and 3D printing material for Joby Aviation has been an incredible collaborator on this project. Who knew that they not only are experts at aviation, but also at laboratory automation. I mean, it's really, really remarkable the way this community has come together. And lastly, I think we're going to have some amazing collaborations going forward with our county. And they've been a really willing and exciting partner. And it's been great to watch that part develop. It's very rare that I think we can see an academic, government and private sector sort of collaboration that has the potential to impact our community. And that's, you know, so I'm just saying let's go. That's going to be great. So just thank you.

Thank you. Let me have a chance. Am I still on or.

Yes?

Yeah. So we have an amazing team, and I have never seen such team spirit. The students immediately started helping not only with the software to track data, but also in Mirce Tedarescu's Lab to do 3D printing, things that were needed by the hospital. In fact, Jeremy, we sent you some swabs and it is just one of these things where everyone is chipping in and I'm nothing but a figurehead. All I do is worry and. And try to urge people on to do the best they can. And really, that's an easy job. Everyone, from faculty all the way down to undergraduate students has just done an amazing job on this campus.

Great.

Thank you, David. Thank you, Guy. Thank you, Rebecca. Thank you, Jeremy and Bill and John, everybody here. And thank you so much to UC Santa Cruz for all the work that you're doing. That's been just amazing to see how you jumped in and did all this work. And then again, as you said, David, the community springing forward to also help however they can. These are dark times, but in other ways. They're just amazing to see how much cooperation is going on in our community as well as internationally. I want to thank everybody for attending today. And this is the end of our webinar, so we'll see you next time.

I hope that listening to this panel has furthered your understanding of the issues and challenges of COVID 19. I learned more from this panel than any other panel in my career. The most important outcome for me was the reassurance of learning that such intelligent and diligent people are making such incredible efforts to control the pandemic. I'm Guy Kawasaki and this is remarkable, people. Thank you to the awesome scientists of UC Santa Cruz who participated in this event, and to Doug Erickson and the Santa Cruz works ohana who made this panel happen. Be healthy, be safe. Certainly we learned about COVID 19. So wash your hands and keep your distance until next time.

Mahalo and aloha.

This is remarkable people.