COVID-19: ‘This Epidemic Can Go Two Ways’.
Davidson Hamer has been busy for the last few months, as a new kind of coronavirus disease, now called COVID-19, arose in China and spread throughout that country and around the world.
A professor of global health at the School of Public Health, professor of infectious disease at the School of Medicine, and faculty in the National Emerging Infectious Disease Lab (NEIDL), Hamer has been following developments closely.
On March 4, he testified at the Massachusetts State House before the Joint Committee on Public Health, saying that the state is well-prepared for COVID-19, but stressing the importance of greater testing capacity, and tempering hopes for a vaccine. “The fastest any vaccine has gone was during the Zika epidemic, and it took 12 months to get to clinical trials in humans. I think 12-18 months is optimistic, and 18-24 months is more realistic,” he said. “We might have more luck with treatment, and get a treatment that’s effective for serious illness before that.”
On March 12, Hamer will join a panel of experts for the Dean’s Seminar—Coronavirus: What Do We Know? What Do We Not Know? What Should We Be Doing?.
Hamer is himself also working on ways to better track the spread of COVID-19, as the co-principal investigator for GeoSentinel.
GeoSentinel is a surveillance network of 68 sites in 28 countries around the world that gathers health data from returning international travelers and from immigrants and refugees. As GeoSentinel identifies more and more COVID-19 cases, the network is developing protocols to identify new outbreaks in countries without known cases, and in countries that may not have the healthcare infrastructure to quickly identify and contain the disease.
Ahead of his statehouse testimony and the March 12 panel, Hamer talked to SPH about tracking the new coronavirus, and how prepared health systems are in Boston and the US.
Is GeoSentinel seeing many new COVID-19 cases?
We had a flurry of four cases last week: a French traveler to Spain, a British traveler who had been in northeast Asia who turns out to have been on the quarantined Diamond Princess cruise ship, and a UK traveler infected after travel to Spain.
How is GeoSentinel addressing COVID-19?
With support from the CDC emergency COVID-19 funds, we’re developing two new protocols. The first is for enhanced surveillance to identify travelers coming from areas of the world where there are no known COVID-19 cases, to see if we can pick up some of the first cases.
And then the second protocol we’re developing is a pre- and post-travel evaluation, where we’ll collect biological samples from people before they travel to a set of countries—mostly low- and middle-income countries—and then see them again shortly after they return and assess whether they picked up the virus. We’ll then do a natural history study for those who are found to be infected, and follow them and collect serial clinical and laboratory data.
Besides simply identifying individual cases, what is GeoSentinel’s goal with these efforts?
Our concern is that the new coronavirus may end up in a country that does not have a surveillance system that’s very effective, that does not have the laboratory resources to diagnose it, and, therefore, it could start circulating and causing local outbreaks, and it may take that country weeks or even months potentially to identify the outbreak.
Whereas, if somebody travels there, comes back to Western Europe or the United States, and is tested for the coronavirus and determined to be positive, we might be able to trace back and say, ‘It looks like there’s an outbreak going on in this country, or in this region.’
How do you think of your role in the international work to contain COVID-19?
This is my job. Part of my job is to be able to identify outbreaks early through sentinel surveillance, and then to be ready to help manage outbreaks and to try and help control them.
I think it is important to reassure the public, to try and make it clear that there are measures that are being taken to try and reduce spread. Japan is closing schools, South Korea has had a lot of things shut down, meetings are being canceled in certain parts of the world, the CDC now has an advisory again nonessential travel to Italy… all these efforts are to try and reduce the risk of spread and prevent people from being infected.
My part may also be with the coming response, if it comes to our town.
How prepared is Boston?
The hospitals in Boston have been working hard on preparedness plans—I’ve been reviewing the Boston Medical Center plan and have been informed that Massachusetts General Hospital has detailed plans, which are based on existing plans for a surge of any respiratory illness including influenza.
The state lab is also now going to be able to test for the new coronavirus, so samples won’t have to be sent to the CDC for diagnosis. That’s a step forward, because one of my main concerns is really just the availability of testing and how long it’ll take. For samples sent to the CDC, it could take 24 or 48 hours to get an answer, but if they can go to the state lab, then it will be faster.
The state testing is going to have to be more focused on high-risk populations because of capacity—as opposed to the GeoSentinel protocols we’re developing, where we’ll be working with labs that can test a much broader range of patients so that we can pinpoint where the cases are coming from. The recent decision that certain ‘high-complexity’ labs throughout the US can begin testing without prior FDA approval should also greatly help to alleviate the problem of access to testing and the volume of tests that are going to be needed.
How concerned are you about COVID-19 in the US?
We have a good chance of keeping it under fairly good containment in the United States. The question is going to be how widespread it is. I think that the public health authorities in most states, if not all states, are preparing for it. Major hospitals where these patients are going to be staying are preparing for it.
But then, if it spreads more widely, the question is going to be, how bad is this disease? And I don’t think we fully know.
What is known at this point about the severity of COVID-19?
There’s a spectrum of disease from completely asymptomatic to mild illness to severe illness to death. Based on the available COVID-19 data, individuals getting severe illness and death are mostly older individuals, individuals with underlying medical diseases, or both, while younger, healthier adults and children are less likely to become sick from it, although not completely safe.
The case-fatality rate is hard to define. The best data are from China, but they’re really only counting the severe cases, so it looks like a fairly high fatality rate because they have not included all of the milder cases in their calculations. So, we don’t really know how bad this is—although clearly in high-risk populations it’s a bad disease.
What can individuals do to protect themselves?
Keep your distance from anybody who’s coughing or sneezing—ideally at least three if not six feet.
Frequent handwashing is important, especially when you’ve been out in public and have had contact with surfaces on buses, subways, taxis, restaurants, wherever. Wash your hands with either soap and water or with alcohol-based hand rub, which does disinfect and kill the COVID-19 virus causative agent.
And think about your co-workers. If you are sick with a respiratory tract infection (especially if you have fever and/or cough), if possible, stay home until your symptoms have resolved.
What about face masks?
Basically, the consensus is that face masks in health care settings are important for health care workers to protect themselves. If somebody who is sick and symptomatic is out in public, it’s probably good for them to wear a face mask because they will then capture a lot of their secretions and virus in the face mask and will be less likely to transmit the virus to others.
But if you’re healthy and you’re not a health care worker, wearing a face mask really doesn’t help. There’s this whole culture that’s developed very quickly that wearing a face mask is protective, so there’s been a little bit of panic and a run on face masks. The availability of face masks may be limited from that, and may need to be carefully managed.
What about a vaccine?
There may be some vaccine prospects sooner rather than later, and there’s certainly a lot of work going into it, but it may take at least 12-18 months if not longer.
But I think this epidemic can go two ways. China appears to be getting COVID-19 under control, but they’ve had to do massive quarantines and restriction of movements that would be difficult for a country like the United States or, say, Nigeria. Nigeria just had an infected Italian person arrive, and if they have an outbreak there, it’s going to be a lot harder to control the spread of disease.
So, we may see a growing outbreak in many different parts of the world outside of China, while China gets it under control. Then, who knows? We may see it reimported back to China.
Dean’s Seminar—Coronavirus: What Do We Know? What Do We Not Know? What Should We Be Doing? will be on March 12, free and open to the public via livestream. Register here.