USA TODAY International Edition
‘ We are constantly learning more’
Hopkins epidemiologist: The coronavirus will be with us until there’s a vaccine
Amid concerns about coronavirus spikes caused by reopenings or mass protests, USA TODAY’s Editorial Board spoke Tuesday with 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?
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 Saturday in Tulsa, Oklahoma. Is that a good idea?
A. Indoor mass gatherings are not my recommendation, particularly if the people coming might be from communities that are heavily affected. If a mass gathering is to go ahead, I would personally make masks required, and I would make hand hygiene a requirement. To enter into the building, you should have to ( apply) Purell because the risks of those events are very high. And social distancing, of course, maybe having people sit every other or every third seat.
Q. In Arizona, the governor has linked the increase in COVID- 19 cases to increased testing. Does he have a point?
A. It’s true that testing and cases are correlated. But in places, including Arizona, where you also see rising hospitalizations and a high or rising percent of tests that come back positive, those are signs of trouble. And that is not just attributable to testing.
Q. As a public health official, what message do you have for places that didn’t take the virus too seriously?
A. It’s not too late to put in place the stringent public health practices that I know are really hard for people and for the economy and for political leaders to pursue. But it’s not too late to do the diagnostic testing, the contact tracing and isolation. That option is still open to us.
Q. What can we learn from other countries?
A. South Korea, Singapore, New Zealand, Iceland, Australia and Germany have used these practices to control their outbreaks. And now they have a lot more freedom to do things in the community, to see their elderly relatives, to kind of regain some of their normal life. We don’t really have that option right now.
Q. Are we at risk of seeing a never- ending series of spikes in locations around the country?
A. I do believe that we will continue to have to manage this virus until we have a vaccine. We’ll still have to spend a little bit more time at home, wear masks, hand hygiene, avoiding mass gatherings. Those are activities we’re going to have to pursue.
Q. How concerned are you, from a public health perspective, about this hodgepodge approach that we’re seeing from state to state?
A. There is room to improve on the leadership of the federal response in closing those gaps. But there is also, I think, room to continue to support state and local officials who are on the front lines.
Q. Let’s talk about reopening schools. Can we be making that decision right now?
A. Communities will continue to have to reevaluate the burden of illness in their communities. They should be ready to be flexible and adaptable. In other countries that have reopened schools, sometimes that goes fine, and sometimes there is an outbreak that means they will reclose the schools. So we should all be prepared to be flexible and responsive to our local conditions.
Q. What about college campuses?
A. The advantage that college campuses have is they’re able to control the population a little bit more. They can set requirements that say you must be in routine diagnostic tests once a month, or you’ve got to wear masks. But the truth is that we haven’t ever faced this pandemic before, and so there are a lot of legitimate questions about how it’s all going to work.
Q. Maybe you can control some of these things on campus, but the reality is, young people get together off campus. They go out, they go to bars and they hang out.
A. That’s a complicating factor for sure. And you’re right, it’s difficult to imagine how colleges would be able to influence the behavior or practices of their students who are off campus. The good news is that college- age people are at low risk of severe illness, so that’s a mitigating factor. But it’s a difficult question.
Q. According to the Centers for Disease Control and Prevention, 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. There has been a lot of discussion about the degree to which hot, humid summer weather might tamp down the pandemic. 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. 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. 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. The latest model from the University of Washington projects 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.