A science and health reporter, Donald McNeill, who specializes in “plagues and pestilences”, consulted “more than 20 experts in public health, medicine, epidemiology and history” and then wrote a long article for The New York Times. It’s called “ The Coronavirus in America: The Year Ahead”. It’s received a lot of praise. These are the parts (2,200 words or so) I found most interesting. The article has many links that aren’t included below.
What follows is divided into sections:
How Many Will Die
The Lockdowns Will End, But Haltingly
Immunity Will Become an Advantage in Society
A Vaccine Is Not Coming Soon
Treatments Are Likely To Arrive First
We Will Need International Cooperation
[ How Many Will Die ]
In fast-moving epidemics, far more victims pour into hospitals or die at home than doctors can test; at the same time, the mildly ill or asymptomatic never get tested. Those two factors distort the true fatality rate in opposite ways. If you don’t know how many people are infected, you don’t know how deadly a virus is.
Only when tens of thousands of antibody tests are done will we know how many silent carriers there may be in the United States. The C.D.C. has suggested it might be 25 percent of those who test positive. Researchers in Iceland said it might be double that.
China is also revising its own estimates. In February, a major study concluded that only 1 percent of cases in Wuhan were asymptomatic. New research says perhaps 60 percent were. Our knowledge gaps are still wide enough to make epidemiologists weep.
“All models are just models,” Dr. Anthony S. Fauci, science adviser to the White House coronavirus task force, has said. “When you get new data, you change them.”
There may be good news buried in this inconsistency: The virus may also be mutating to cause fewer symptoms. In the movies, viruses become more deadly. In reality, they usually become less so, because asymptomatic strains reach more hosts. Even the 1918 Spanish flu virus eventually faded into the seasonal H1N1 flu.
At the moment, however, we do not know exactly how transmissible or lethal the virus is. But refrigerated trucks parked outside hospitals tell us all we need to know: It is far worse than a bad flu season.
[ The Lockdowns Will End, But Haltingly ]
The next two years will proceed in fits and starts, experts said. As more immune people get back to work, more of the economy will recover.
But if too many people get infected at once, new lockdowns will become inevitable. To avoid that, widespread testing will be imperative.
Dr. Fauci has said “the virus will tell us” when it’s safe. He means that once a national baseline of hundreds of thousands of daily tests is established across the nation, any viral spread can be spotted when the percentage of positive results rises.
Detecting rising fevers as they are mapped by … smart thermometers may give an earlier signal…
But diagnostic testing has been troubled from the beginning. Despite assurances from the White House, doctors and patients continue to complain of delays and shortages.
To keep the virus in check, several experts insisted, the country also must start isolating all the ill — including mild cases.
In this country, patients who test positive are asked to stay in their homes, but keep away from their families.
Television news has been filled with recuperating personalities like CNN’s Chris Cuomo, sweating alone in his basement while his wife left food atop the stairs…
But even Mr. Cuomo ended up illustrating why the W.H.O. strongly opposes home isolation. On Wednesday, he revealed that his wife had the virus.
“If I was forced to select only one intervention, it would be the rapid isolation of all cases,” said Dr. Bruce Aylward, who led the W.H.O. observer team to China.
In China, anyone testing positive, no matter how mild their symptoms, was required to immediately enter an infirmary-style hospital — often set up in a gymnasium or community center outfitted with oxygen tanks and CT scanners.
There, they recuperated under the eyes of nurses. That reduced the risk to families, and being with other victims relieved some patients’ fears…
Still, experts were divided on the idea of such wards. [One called for] mandatory but “humane quarantine processes.”
By contrast, [a Harvard epidemiologist] opposed the idea, saying: “I don’t trust our government to remove people from their families by force.”
Ultimately, suppressing a virus requires testing all the contacts of every known case. But the United States is far short of that goal.
Someone working in a restaurant or factory may have dozens or even hundreds of contacts. In China’s Sichuan Province, for example, each known case had an average of 45 contacts.
The C.D.C. has about 600 contact tracers and, until recently, state and local health departments employed about 1,600, mostly for tracing syphilis and tuberculosis cases.
China hired and trained 9,000 in Wuhan alone. [It’s been] estimated that the United States will need at least 300,000.
[ Immunity Will Become an Advantage in Society ]
Imagine an America divided into two classes: those who have recovered from infection with the coronavirus and presumably have some immunity to it; and those who are still vulnerable.
“It will be a frightening schism,” … a World Health Organization special envoy on Covid-19, predicted. “Those with antibodies will be able to travel and work, and the rest will be discriminated against.”
Already, people with presumed immunity are very much in demand, asked to donate their blood for antibodies and doing risky medical jobs fearlessly.
Soon the government will have to invent a way to certify who is truly immune. A test for IgG antibodies, which are produced once immunity is established, would make sense… Many companies are working on them.
Dr. Fauci has said the White House was discussing certificates like those proposed in Germany. China uses cellphone QR codes linked to the owner’s personal details so others cannot borrow them….
As Americans stuck in lockdown see their immune neighbors resuming their lives and perhaps even taking the jobs they lost, it is not hard to imagine the enormous temptation to join them through self-infection, experts predicted. Younger citizens in particular will calculate that risking a serious illness may still be better than impoverishment and isolation.
“My daughter, who is a Harvard economist, keeps telling me her age group needs to have Covid-19 parties to develop immunity and keep the economy going,” said Dr. Michele Barry…
It would be a gamble [since] even slim, healthy young Americans have died of Covid-19.
[ A Vaccine Is Not Coming Soon ]
Even though limited human trials of three candidates — two here and one in China — have already begun, [Dr. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases] has repeatedly said that any effort to make a vaccine will take at least a year to 18 months.
All the experts familiar with vaccine production agreed that … that timeline was optimistic… The record is four years, for the mumps vaccine.
Researchers differed sharply over what should be done to speed the process. Modern biotechnology techniques using RNA or DNA platforms make it possible to develop candidate vaccines faster than ever before.
But clinical trials take time, in part because there is no way to rush the production of antibodies in the human body.
Also, for unclear reasons, some previous vaccine candidates against coronaviruses like SARS have triggered “antibody-dependent enhancement,” which makes recipients more susceptible to infection, rather than less….
A new vaccine is usually first tested in fewer than 100 young, healthy volunteers. If it appears safe and produces antibodies, thousands more volunteers — in this case, probably front-line workers at the highest risk — will get either it or a placebo in what is called a Phase 3 trial.
It is possible to speed up that process with “challenge trials.” Scientists vaccinate small numbers of volunteers, wait until they develop antibodies, and then “challenge” them with a deliberate infection to see if the vaccine protects them.
Challenge trials are used only when a disease is completely curable, such as malaria or typhoid fever. Normally, it is ethically unthinkable to challenge subjects with a disease with no cure, such as Covid-19.
But in these abnormal times, several experts argued that putting a few Americans at high risk for fast results could be more ethical than leaving millions at risk for years….
As arduous as testing a vaccine is, producing hundreds of millions of doses is even tougher, experts said.
Most American vaccine plants produce only about 5 million to 10 million doses a year, needed largely by the 4 million babies born and 4 million people who reach age 65 annually…
But if a vaccine is invented, the United States could need 300 million doses [assuming 30 million of us are immune] — or 600 million if two shots are required. And just as many syringes.
“People have to start thinking big,” [one doctor] said. “With that volume, you’ve got to start cranking it out pretty soon.”
Flu vaccine plants are large, but those that grow the vaccines in chicken eggs are not suitable for modern vaccines…
European countries have plants but will need them for their own citizens. China has a large vaccine industry, and may be able to expand it over the coming months. It might be able to make vaccines for the United States…
India and Brazil also have large vaccine industries. If the virus moves rapidly through their crowded populations, they may lose millions of citizens but achieve widespread herd immunity well before the United States does. In that case, they might have spare vaccine plant capacity.
Alternatively, [another doctor said] the government might take over and sterilize existing liquor or beer plants, which have large fermentation vats: “ any distillery could be converted”.
[ Treatment Is Likely To Arrive First ]
In the short term, experts were more optimistic about treatments than vaccines. Several felt that so-called convalescent serum could work.
The basic technique has been used for over a century: Blood is drawn from people who have recovered from a disease, then filtered to remove everything but the antibodies. The antibody-rich immunoglobulin is injected into patients.
The obstacle is that there are now relatively few survivors to harvest blood from [note: in New Jersey at least, you have to be under 60, among other requirements]….
[A treatment involving] monoclonal antibodies … recently came very close to conquering the Ebola epidemic in eastern Congo, [and] are the most likely short-term game changer…
The most effective antibodies are chosen, and the genes that produce them are spliced into a benign virus that will grow in a cellular broth.
But, as with vaccines, growing and purifying monoclonal antibodies takes time. In theory, with enough production, they could be used not just to save lives but to protect front-line workers….
Having a daily preventive pill would be an even better solution, because pills can be synthesized in factories far faster than vaccines or antibodies can be grown and purified.
But even if one were invented, production would have to ramp up until it was as ubiquitous as aspirin, so 300 million Americans could take it daily.
[Some keep suggesting] hydroxychloroquine and azithromycin… All the experts agreed … that no decision should be made until clinical trials are completed.
Some recalled that in the 1950s inadequate testing of thalidomide caused thousands of children to be born with malformed limbs. More than one hydroxychloroquine study has been halted after patients who got high doses developed abnormal heart rhythms.
“I doubt anyone will tolerate high doses, and there are vision issues if it accumulates,” [one doctor] said. “But it would be interesting to see if it could work [like pills used to prevent H.I.V.].
Others were harsher… “It’s total nonsense,” said … a former director of medical and biodefense preparedness at the National Security Council. “I told my family, if I get Covid, do not give me this combo.”
Chloroquine might protect patients hospitalized with pneumonia against lethal cytokine storms because it damps down immune reactions, several doctors said.
That does not, however, make it useful for preventing infections, as [some have] implied it would be, because it has no known antiviral properties.
Several antivirals, including remdesivir, favipiravir and baloxavir, are being tested against the coronavirus; the latter two are flu drugs.
Trials of various combinations in China are set to issue results by next month, but they will be small and possibly inconclusive…
[ We Will Need International Cooperation ]
A public health crisis of this magnitude requires international cooperation on a scale not seen in decades. Yet [the president] is moving to defund the W.H.O., the only organization capable of coordinating such a response.
And he spent most of this year antagonizing China, which now has the world’s most powerful functioning economy and may become the dominant supplier of drugs and vaccines. China has used the pandemic to extend its global influence, and says it has sent medical gear and equipment to nearly 120 countries [including the United States]….
“If [the president] cares about stepping up the public health efforts here, he should look for avenues to collaborate with China and stop the insults,” said … an economic historian… [A doctor added:] “What if they come up with the first vaccine? They have a choice about who they sell it to. Are we top of the list? Why would we be?”
Once the pandemic has passed, the national recovery may be swift…
The psychological fallout will be harder to gauge. The isolation and poverty caused by a long shutdown may drive up rates of domestic abuse, depression and suicide.
Even political perspectives may shift…. In the periods after both wars, society and incomes became more equal. Funds created for veterans’ and widows’ pensions led to social safety nets, measures like the G.I. Bill and V.A. home loans were adopted, unions grew stronger, and tax benefits for the wealthy withered.
If a vaccine saves lives, many Americans may become less suspicious of conventional medicine and more accepting of science in general…