The billionaire surgeon-entrepreneur details his plans to use his considerable resources to combat COVID-19.
The ongoing pandemic caused by coronavirus disease 2019 (COVID-19) has drawn the attention of some of the world's most wealthy and influential businessmen.
Soon-Shiong, a surgeon and entrepreneur, is CEO of Nantworks, a health technology company based in Culver City, California, which is a creditor in the bankruptcy proceedings for Verity Health System, a nonprofit health system based in El Segundo, California.
Last month, Soon-Shiong bought St. Vincent Medical Center in a private sale with the purpose of using the campus as a surge hospital for patients infected with COVID-19 as well as researching the progression of the disease.
Soon-Shiong spoke with HealthLeaders about how he is leading several projects aimed at curbing the spread of the coronavirus and developing an effective vaccine.
This transcript has been lightly edited for brevity and clarity.
HealthLeaders: Can you walk through the sale of St. Vincent and what your plans are to use it in the fight against the coronavirus?
Soon-Shiong: I think the idea is that this surge hospital is consistent with the entire strategy that I have: we need to understand this [virus] collectively, not just from a clinical practice perspective—because we've never seen this before—but understand how to treat the disease in its entire progression from early onset all the way to high fatality when [a patient] is on a respirator.
You need a collection of excellent practicing physicians: respiratory therapists, doctors, infectious disease experts, etc. At the same time, you need molecular biologists and people who understand the genetics of this disease, because I look upon this COVID virus as no different from cancer. In fact, I've just written a paper on that and submitted it to a publication, because I consider what people call the cytokine storm much more than just cytokine storm. I call it the 'cytopathic storm,' and the reason for that is it is a convergence in every organ of the body that has an A2 receptor.
While we may see [the virus] in the lungs, you can still see it in the brain, the kidney, the heart, and the vasculature. To understand how the virus works and how it progresses, you need what I call a center of excellence (COE). It's not a COE in the conventional sense of having a transplant center; you have a COE where you're seeing all COVID patients at all stages of their progression.
We had the fortunate opportunity to understand that St. Vincent's Medical Center was available because it was shut down. We started this process with Gov. Gavin Newsom in February, back when the sequence of this virus came out. I felt at that time this was going to be some pandemic that we've never seen before, like the Spanish Flu. I urged Newsom, along with [Dr.] Mark Ghaly MD, MPH, [Secretary of the California Health and Human Services], to think through creating this COE, one in northern California and one in southern California. Thankfully, they listened to that advice and moved fast. When the governor took on the closed hospital with no staff, it became clear we needed to find partners, somebody with an incredible strength in operational skills and that was Kaiser [Permanente]. Kaiser came on board quickly and put in their operational skills for managing care.
We are looking at the rest of this facility to figure out how to bring in sophisticated molecular medicine and cell therapy around it. This will lead into how I see what COVID is and how you could treat a COVID patient from the point of an uninfected patient to the patient who is asymptomatic but infected, and how do you pick that up. [And] to the patient that is symptomatic and infected and how you treat that. To the patient that now requires hospitalization but not in the intensive care unit (ICU), to the patient that is in the ICU and how do you treat that.
This is what I think we need to understand about COVID, like you understand cancer: you have a primary disease, early on diagnosis, and you prevent the tumor from growing to a first line metastatic disease where it's infected the entire body. This virus acts exactly that way.
HL: What are your expectations for producing an antiviral therapy or vaccine? Are you optimistic about meeting a deadline within 2020 or 2021?
Soon-Shiong: For the past 10 years, [Nantworks] has been focusing on developing a vaccine for cancer. When we say that, we had developed an adenovirus vaccine and a yeast vaccine, in which we put in the sequences of a cancer patient. If you have cancer, you could have a sequence called a 'CDA.'
In cancer patients, we have successfully generated what we call 'T-cell mediated immunity,' specifically to those sequences. The COVID sequence is an ideal sequence; it’s a well-known sequence analogous to the SARS-CoV in 2003.
For us, since January, we have jumped on these sequences and created and constructed a multitude of sequences. Very quietly, we went into our Good Manufacturing Practice (GMP) facilities that make both the adenovirus and the yeast platform, and now have successfully created these sequences in both platforms and successfully generated information for ourselves that these vaccines recognize the COVID sequences.
These delivery systems of yeast and adenovirus have already been put into hundreds of patients. More importantly, [the vaccines] have not only shown to be safe but have shown to be effective in terms of delivering T-cell mediated immunity.
What I worry about with COVID is that we must make sure that we can generate what we call 'cellular immunity,' because it's one of the rare viruses, like measles—which is the only other one that is like this and well known—that wipes out your T-cells. What that means, is it could give you what we call 'immunological amnesia.'
That means the only solution to this is a vaccine that will generate not just antibodies, which everybody is focusing on, but also T-cell memory. That's not inconsistent with what I have been trying to do in cancer. We have had complete response from patients with triple negative breast cancer and pancreatic cancer, and it's all based on our knowledge of how T-cell memory works.
I'm pretty confident that working with the FDA and the [National Institute of Allergy and Infectious Diseases], (we've already been working closely with [National Cancer Institute] for the last five-to-eight years), that we could move fast and it will not be a problem of scale of sufficient material for the United States population.
It's not unrealistic to believe that based on our ready-to-produce scale—depending on the dose, and that is why this becomes critical, what is needed for the patients is to achieve immunity—we could have 100 million doses available within the next six to eight months.
HL: What are some of the trends that you expect to emerge post-pandemic, and how will healthcare change to meet the demands of consumers?
Soon-Shiong: In a funny way, while COVID-19 has been a nightmare, it has exposed deficiencies in our healthcare [system].
I have been pushing for two decades for the generation of what I call the 'NORAD of healthcare,' where there is an opportunity to use the Internet, video conferencing, and the Internet of Things [IoT]. I think this [pandemic] will now accelerate that.
On the other hand, I don't think the world will ever get back to normalcy until you truly have a vaccine. Once you have a vaccine, we will have gone through this episode of lessons learned. I think the NORAD of healthcare centers, whether it be for cancer, diabetes, or chronic disease, will be there. But I think a vaccine could return us to the need of human-to-human contact, patient interaction, and the touch and feel of an examination.
HL: Do you have advice for hospital leaders about disaster preparedness or being able to anticipate something of this scale in the future?
Soon-Shiong: The lessons [leaders] should take are from Taiwan. I've been working with the Industrial Technology Research Institute in Taiwan for two decades, and when you look at the healthcare system and the influx of patients from China, and you look at how [Taiwan] handled their first pandemic, it was a magnificently handled. [Taiwan] had healthcare cards that they were able to see and touch every patient and know their location. Every patient got four masks a week for free through their healthcare card early on in January.
[Taiwan] was able to do what we call public health contact testing and isolation. If you look at the numbers in the first wave, it was remarkable: few infections and few deaths, yet they probably had 10 to 20 million visitors from China.
[The coronavirus] is going to come again; COVID is now human-to-human. It is one of the most infectious agents to take on the A2 receptors in the human body, which are lungs, colon, heart, blood vessels, and brain. It's a vicious virus and it will mutate.
The only thing that we should do now is think about the workflow of a patient, doctor, or nurse coming into a hospital where real-world, point-of-care testing could be done for a "yes" or "no" answer if the patient's positive or not positive so they may self-isolate.
One of the things our company is working on is a novel test, which I’m not ready yet to discuss, which will give you a "yes" or "no" answer like a pregnancy test and then a confirmatory answer the day after. I think that's what's going to be needed as we prepare for the future, which is October, November, and December; it’s not far off.
Correction: An earlier version incorrectly referred to a 'cytopathic storm' as a 'psychopathic storm.' This article has been updated to reflect that change.
Jack O'Brien is the finance editor at HealthLeaders, a Simplify Compliance brand.