Bob Nelsen was right.
The co-founder and managing partner of Arch Venture Partners is one of biotech’s most successful venture capitalists. He’s also deeply wary of unchecked viruses, a fear he shares regularly with friends, family, and his Twitter followers. “Flu. Get shot. Get antivirals. Don’t die,” Nelsen tweeted right before Christmas.
Most people don’t worry about viruses the way Nelsen does, so when his tweets started to take on a much darker tone in January, I paid little attention. It was just Bob being Bob.
“Very scary,” he warned on Jan. 20, linking to a report of human-to-human transmission of a novel coronavirus in China. A day later, he likened the emerging outbreak to the video game Plague and said he was shorting airline stocks.
And then on Jan. 31, there was this Nelsen tweet, which at the time seemed overly alarmist, but now reads eerily prescient:
Estimates: multiple sources: 500,000+ infected:China. R0 2.5-3+ Doubling time 3 days. Unprecedented speed. Fatality rate range .1-1%+: truly unknown. 2-14 day incubation. 20% diagnosed at hospital need critical care. If sustained transmission, could infect 15-20 percent world.
— Robert Nelsen (@rtnarch) January 31, 2020
“By tomorrow, Bob will be living in a bunker,” I slacked to my STAT colleagues.
Sure enough, there was this Nelsen tweet in late February: A photo of his Costco shopping cart loaded with bottled water, Frosted Flakes cereal, a small generator, plastic bins, and six large bottles of Grey Goose vodka.
Look closely pic.twitter.com/zF9kIkK89N
— Robert Nelsen (@rtnarch) February 25, 2020
I regret not listening to Nelsen sooner. I wanted to tell him that, and hear more about where he thought the pandemic was going and how we get out of it. Here is a condensed and lightly edited transcript of our conversation.
You were right, pretty much from the beginning, and I get the sense that you still believe the pandemic is being under-estimated and not taken seriously enough by some people.
Yeah, that one tweet that I sent out in January. That was, I still believe, pretty close to being right. I said that there were something like 500,000 infected people in China. And it was doubling in three to five days with a [case fatality rate] of 0.5 to 1. And 20% of people were in the hospital. I still believe that is probably about right. And I got that from a bunch of really smart people who were in places where they couldn’t say it publicly because it might be viewed as alarmist.
There’s a lot that is sad about all of this. Obviously, the human cost is sad and it’s only going to get sadder. The devastation in some countries that we haven’t even seen yet, like India or throughout Africa is going to be profound, I think.
And the failure of our public institutions. And even some, you know, large private institutions. I would say that complete and utter failure of almost any of us to learn the lessons from what was happening, even from city to city. It’s amazing, every city seems to repeat the errors of every other city, even in the U.S. In New York, you have [Mayor Bill] de Blasio telling everybody to go out and party on March 2nd, and people in Seattle are going. What … are you doing? Are you kidding me?
Early in the epidemic, you argued for total lockdowns of cities in order to stop the spread of the coronavirus. What did you see that worried you so much?
We know there are asymptomatic spreaders. You have to do asymptomatic quarantine or self-isolation. And even when we re-emerge, we’re going to have to figure out a way if we’re in close proximity to other people in the workplace to reduce the probability of asymptomatic spread, which means you have to test like crazy and you probably have to wear masks.
Are Americans ready to wear masks in public?
The first thing is we don’t have enough masks because the supply was never replenished. There’s plenty of criticism of the current administration that can be made and plenty of criticism of the last administration for not refilling the supply. Our bureaucracies are failing, everywhere.
So we don’t have any masks. Therefore, they’re not going to tell everybody that wearing a mask is the right thing to do. Right now, all the masks need to go to health care workers. But really, everyone in an enclosed space needs to have a mask.
The U.S. is still not testing enough people.
We need to go to a system of rapid testing, and that’s going to happen, especially with this new Abbott machine. And some of the other machines, there’s several other efforts that are happening. After that, we need really fast home antibody tests. Nobody wants to go out, anywhere. If you’re healthy you need to get confirmed that you had it. We need to figure out the extent of community spread. My guess is a lot more people have had it. And we need to get those people back to work. We need to have an app that says, you’re clear.
How do you feel about the efforts right now to develop both treatments and vaccines? One the biotech companies you helped start, Vir Biotechnology, is working on antibody-based treatment against Covid-19.
I mean, I’m biased, but I think antibodies are probably the highest probability to work. I hope some mRNA works. I think if you ask scientists, they’re more skeptical. But I hope it works, especially in populations that tend to have weak immune systems. When you get skepticism about mRNA, it tends to be, ‘Yeah, it might work in a young person, but how is it going to work in the populations at risk?’ My own gut feeling is that mRNAt works a little and I hope it works a lot. And even then, there’s a role for all of the systems.
If mRNA works, it bides us time to develop more potent, longer term vaccines. Antibodies will likely work and have the highest probability of working. There are multiple companies pursuing antibody therapy. So you hope that mRNA and antibiotic therapy start ramping up by the fall.
I think we’re going to get lucky on some stuff. I don’t know that it’s any of the things we’ve been talking about yet, but it could be. The Chinese really believe in chloroquine. The Japanese believe in favipiravir but they’re not letting anybody have it.
Any thoughts on the Gilead Sciences antiviral remdesivir?
I have no idea, but if I had the virus, I would absolutely take it. I mean, I have chloroquine and if I get the virus, I’m going to take chloroquine and Kaletra. But the idea that chloroquine is the answer — I mean, you have to be really careful with some of the side effects of chloroquine.
But getting back to antibodies, you can use them as a therapy and as prophylaxis. You can imagine a system where you’re using mRNA and antibodies as a ring prophylaxis. Going after health care workers, nursing homes, retirement homes. So if we could insulate the weakest people with underlying health conditions and the weakest in our society with the prophylaxis, they would have a lot less of a problem for round two.
What is the development timeline for antibodies right now?
I think what Vir and Regeneron have said is that they will be in the clinic this summer and have something in the fall, if everything goes well.
How do we get through this pandemic?
Social distancing is number one; contact tracing and antibody testing are number two; and therapeutics in the fall are number three. And then vaccines. We’re going to be fine. And I know this because the Chinese are asking me all kinds of questions about business stuff that I don’t want to answer because we’re in the middle of a pandemic.
Arch has not shut down.
We expect to close deals in the next few weeks of at least $500 million. None are Covid-19 related.
How are you doing?
I’m driving my wife crazy because I’m Covid-19 24-7. I’m highly motivated. I live in an industry that gets a lot of [criticism], but working on this is their sense of purpose like I’ve never seen, ever, with anything else. We have a common purpose, which is a wonderful thing. I mean, it’s a scary thing and it’s a wonderful thing.