Coronavirus is not done with us until we have a vaccine for COVID-19: Q&A
Pressure to create a coronavirus vaccine is increasing by the day, but for a safe vaccine to enter the market, it takes time. USA TODAY
Do George Floyd protests risk politicizing epidemiologists? Is President Trump resuming rallies a good idea? Dr. Caitlin Rivers of Johns Hopkins answers.
Amid concerns about Dr. Caitlin Rivers, a senior scholar at the Johns Hopkins Center for Health Security, about the state of the pandemic. Questions and answers have been edited for length, clarity and flow:
Q. Since Memorial Day weekend, it seems like many Americans have decided they're so done with the coronavirus. Is the virus done with us?
A. Unfortunately, no. I think we are going to be managing our outbreak until we have a safe and effective vaccine, which could be another year or longer, depending on how things unfold.
Q. What does the big picture around the country look like at this point?
A. Some places in the country are doing quite well. New York and New Jersey, which were extraordinarily hard hit and were hit early in the outbreak, have now really turned the corner and are looking quite good. But a number of other states either never really turned the corner or they had a period of relative quiet and are now resurging.
Q. What impact are we seeing from states reopening their economies?
A. Some states are struggling. Arizona, South Carolina, Arkansas, Florida and Texas are states that, again, either never really turned the corner or had a period of quiet and are now starting to look a little bit worse. It does stand to reason that some of that is attributable to reopening.
Q. And the mass protests against police brutality?
A. I think it's probably a little bit early to say that the protests are playing a big role. The time from infection to ICU admission is about three weeks. It's mid-June now, (so) maybe (we’ll know more) by the end of the month or early July.
Q. How worried are you?
A. Some factors about the protests mitigate the risk. They're outdoors. And for many people, from what I gather, it was possible to social distance. Not everyone did. You certainly saw clusters. And so, although crowds are our concern for transmission, certainly it's a little bit less concerning to me than large indoor gatherings would be. We'll learn more as we see what happens over the next month of what the risk of those activities is.
Q. Earlier this month, more than 1,200 public health experts signed a letter saying that the protests were "vital to the national public health." Do statements like that risk politicizing epidemiologists, making you less trustworthy?
A. Public health has always been political, and it has been political in ways that are aligned with public health values. There are individuals who happen to be public health professionals who also are passionate about some political element. We all live in our communities, and we all advocate for our communities. I do worry, though, that the public hasn't been given a clear explanation for why some public health professionals support the (racial justice) protests when those same people spoke out against protests to reopen. There is a lot of room for public health professionals to more clearly communicate how their own values and how their public health priorities are aligned with the risk messages they are sending.
Q. Speaking of politics, President Donald Trump plans to resume his rallies, starting this people from 15 to 24 years old account for 125 out of over 100,000 COVID deaths. So what message do we need to send to young people?
A. It's true that younger people are at lower risk of severe illness, but nonetheless young people are a bridge. We are all bridges to people who are more vulnerable. And so even if young people themselves do not feel that they are at high risk of severe illness, by getting infected and by putting themselves at risk and by remaining in that network, it allows the virus to spread.
Q. Why is the virus disproportionately hitting the African American community?
A. It is absolutely true that people of color experience high rates of infection, and when they do become infected, they have worse outcomes on average. I would love to have clearer data about where and how people are becoming infected, because that would allow us to tailor our mitigation efforts more specifically.
Q. How so?
A. If people are becoming infected because they live in congregate living settings or crowded housing, well, then you might start to think about interventions that would allow people to space out a little bit more. If people are becoming infected at work because they are essential workers, then we should be doing more to protect our essential workers. It's so important to understand why people of color are at high risk of infection so that we can actually intervene.
Q. There has been a lot of discussion about the degree to which hot, humid summer weather might tamp down the pandemic. When you look around the world and the United States, what conclusions can you draw about seasonality?
A. I don't see strong evidence for seasonality. There are places, including in the United States, that have very summery weather that are still experiencing intense transmission, and we see that across the world as well. That being said, there's a lot of very genuine open questions. I don't think that we know enough about seasonality to really say whether we will experience a fall wave.
Q. Why did you change your mind about the value of masks?
A. I was one of the experts, early in the outbreak, that did not recommend masks, and then in March, I moved to recommending masks.
Q. How come?
A. Early in the outbreak, I looked to (Asian nations’) experiences and saw that they were having a much better time controlling their outbreak. So I changed my recommendation. That was my evolution, and I try to talk about that when the opportunity arises, but I'm not sure that evolution at the national level was ever clearly laid out. I don't blame people for being a little bit confused by that. I do feel that masks help, and so I now firmly recommend them.
Q. What would you like the public to know about the shifting science?
A. We are constantly learning. This is a brand new pathogen that the world had never seen before December, and so we are starting from scratch. Even what we know today is a tiny piece of the puzzle, and we are constantly learning more.
Q. Is there a risk that people will conclude that the experts don’t know what they’re talking about?
A. Unfortunately, as we are experiencing this pandemic, we're having to make decisions without having all of the data and all of the analysis that we wish we could have. But there's just no way we can really move any faster to get that data together. There are times when we will get things wrong and that we will have to make a choice, and we will later learn that we need to update that choice. I think constantly communicating that uncertainty — what's known and what's not known and what's best guess — is really important to the public.
Q. What are the biggest unknowns at this point?
A. For me, the biggest unknowns are the role of children and transmission. There’s a really important open question about whether children who are asymptomatically infected, or are very mildly infected, are as infectious as adults. That, for me, is a big open question.
Q. What about the pregnancy risks?
A. I have not seen any data that suggests that pregnant women are at different risk of infection than their nonpregnant, but demographically similar, counterparts. I also have not seen anything that would suggest they are more likely to experience severe outcomes. The limited evidence suggests that pregnant women are not at elevated risk.
Q. A new study shows that a steroid called more than 200,000 COVID-19 deaths by Oct. 1 in the United States. Does that seem plausible to you?
A. There is an interesting phenomenon happening right now that I was diving into just this morning. The number of new cases in the United States has been largely flat, but the number of deaths has been declining. That is great news, but it is a little bit puzzling.
Q. What do you think is going on?
A. What I think is happening is that New York and New Jersey, which were very hard hit, were registering a lot of the deaths in the country. Now that their outbreak has come under control, they're not contributing, if you will, as many deaths to our national totals. If you look at the other states, though, their deaths are mostly flat. Some of them are drifting up or drifting down, but largely flat. Will we hit 200,000 by October? I think it's plausible, but I think it will depend on the trends that we are seeing in states that are experiencing more cases. October is a long time from now, so it is difficult to say for sure.