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MAY 18, 2020 | EYEWORLD DAILY NEWS | 3 DAILY NEWS ASCRS VIRTUAL ANNUAL MEETING Dr. Kim then asked about testing, the accuracy of rap- id antibody tests, and how antibody tests and antigen tests will be used together. Dr. Gottlieb said he thinks anti- body tests have limited utility. Though they have a high spec- ificity, he said they have a high false-positivity rate. If you're going to have an antibody test to give yourself confi- dence that you've already had COVID-19, he said you should repeat the test (have two tests with a positive result). Across the population, Dr. Gottlieb said it's likely about 5% of the population has had COVID-19, outside of select cities or pro- fessions that might have higher percentages. For the full discussion and Q&A with Dr. Gottlieb, view GS-2 in the ASCRS Virtual An- nual Meeting. Editors' note: Dr. Gottlieb is a part- ner with New Enterprise Associates, a venture capital firm, and is a member of the Board of Directors of Pfizer and Illumina, among others. is identified, there wouldn't be an extensive effect on the office as whole, Dr. Gottlieb said. In addition to point-of- care testing, Dr. Gottlieb said pooled sample testing could be coming as well. If there is a positive case in a pooled sample, then individual PCR testing would be conducted. Dr. Gottlieb said this technique could facilitate mass screening on a more routine basis, and it could be especially useful for the workforce that can't social- ly distance. Dr. Gottlieb also discussed where we're at with clinical learning and why it seems like that was a slow process with SARS-CoV-2 and COVID-19. He said we've learned that patients shouldn't be incubated as aggressively, that patients do better in prone positions, and that the virus seems to activate coagulopathy. More specifically, he said there are case reports showing that some patients, who are rapidly de- compensating, are experiencing pulmonary emboli. The other thing that's been coming out more recently are pediatric syndromes. Reports of a Kawasaki-like syndrome that appears to be related to COVID-19 seems to be pre- senting as post-viral sequalae. It mirrors some of the odd sequalae seen in young people (unusual rashes, swelling in toes, etc.), which Dr. Gottlieb said suggests some post-viral, immune-mediated response. Overall, Dr. Gottlieb said data suggests that children are one- third as susceptible as adults. While they are getting sick from COVID-19, they seem to be getting sick at a lower rate. The problem, Dr. Gottlieb said, is we don't know how many children have had COVID-19, thus it's unclear if the Kawasa- ki-like inflammatory response is a rare condition associated with this coronavirus or more common. Dr. Gottlieb pivoted to talk about the race for a vaccine. He said there are a lot of vaccines in development now, led by larger companies and also smaller academic groups. Some of the complexity for the vaccine will deal not just with safety and efficacy, but the abil- ity to scale-up and produce this commercially. One potential vaccine is taking an adenoviral approach and in early data has shown in monkeys to prevent full-blown pneumonia, but it didn't prevent them from get- ting sick, Dr. Gottlieb said. This might be where a lot of vac- cines settle out, he explained. They might protect you from getting sick, but they don't protect you from getting the infection. He said some devel- opers are taking novel vaccine approaches, while others are taking more traditional ap- proaches, such as the approach used with the flu vaccine. Dr. Gottlieb noted other challenges with a vaccine as well. He said it's most likely that it will require two dos- es, bringing the issue to scale and manufacturing again. He recalled with the H1N1 vaccine that multidose vials with pre- servatives were used due to a lack of vaccine equipment. He said people are probably not going to want to use multidose vials, in this case, due to con- cerns with preservatives. "We need to plan for these rudimentary things right now … getting enough vaccine- delivery equipment," such as glass vials, he said. Dr. Gottlieb said he's opti- mistic that we'll get a vaccine. He thinks that by the second half of 2021, there could be a vaccine of sufficient quantity, having cleared significant safe- ty and efficacy trials, to begin vaccination in select groups at high risk. He said a vaccine for COVID-19 might be more likely used for those who could suffer bad outcomes were they to get the virus, not necessarily to create herd immunity. The discussion then moved on to include a panel of oph- thalmologists: Natalie Afshari, MD, San Diego, California, Terry Kim, MD, Durham, North Carolina, John Berdahl, MD, Sioux Falls, South Dakota, and Richard Lindstrom, MD, Min- neapolis, Minnesota. Dr. Afshari began by asking Dr. Gottlieb about N95 avail- ability. Dr. Gottlieb said that there is a good supply of N95s entering the market right now, but the federal government is stockpiling a significant num- ber. He said medical societies and states should be advo- cating to get more of these supplies to doctors now, espe- cially for the fall. He also noted that KN95 and FFP2 masks are available in the market and are equivalent to N95s. A Level 3 procedure mask is an option as well, although a suboptimal one, Dr. Gottlieb said, adding that he thinks doctors "really should be wearing N95 masks." continued from page 1 Dr. Gottlieb speaks during the ASCRS Sunday Session about the current status of COVID-19, vaccine development, and more. Source: Screenshot from ASCRS Virtual Annual Meeting livestream

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