USA TODAY International Edition
Expert Q& A on what’s to come
Epidemiologist: To tamp down COVID- 19, the 50 states should act in concert
Epidemiologist who helped eradicate smallpox predicts the world will be dealing with the coronavirus for “many, many years.”
With nearly 156,000 Americans dead and the novel coronavirus continuing to spread across wide swaths of the United States, USA TODAY’s Editorial Board spoke Monday with
Dr. Larry Brilliant, a noted epidemiologist who helped eradicate smallpox. Brilliant, 76, is chairman of the advisory board of the organization Ending Pandemics and CEO of Pandefense Advisory. Questions and answers have been edited for length, clarity and flow:
Q. The United States has 4% of the world’s population but more than 22% of the reported deaths. We live in a wealthy country with many of the world’s leading doctors and scientists. Why are we having so much trouble getting our act together? A.
This is an inconvenient pandemic. Or said another way, an inconvenient time for a pandemic in our own troubled political, and now electoral, cycle. The rising numbers of cases and hospitalizations and deaths are perceived by the Trump administration, perhaps rightly so, as related to falling numbers in the polls. Therefore, there has been so much denial, obfuscation, distraction, inattention and disingenuous throwaway lines. We all want to rally around our president, but there is an abysmal lack of leadership, unprecedented in my lifetime.
Q. Does a state- by- state approach work in an epidemic like this?
A.
Traditionally and historically, the Centers for Disease Control and Prevention has taken control. We should have had a long time ago a federal plan. We should have had every one of our national leaders lined up behind it. It should have urged everyone to wear masks and practice social distancing and to do hand- washing. And we should have been clear that surveillance and containment — which we now call testing and tracing and isolation — was the right approach. That’s just good epidemiology.
Q: How would you describe the current situation across the USA?
A.
We had the East Coast and the West Coast outbreak. Then it coalesced in New York. And then all of a sudden it showed up in the states that had been the most irresponsible in the South. Then California caught on fire again. And now it’s going in the Midwest. That whack- a- mole, that’s going to be the future of this epidemic.
Q. Do you support reopening schools?
A.
I want schools to be opened as much as everybody else. But when I look at a school — especially a high school, or junior high school or a college — I look at an indoor cafeteria, an indoor gymnasium, often indoor swimming pool, indoor locker rooms, indoor theater, to which you’ve added children. And the addition of the children does not make that place safer. So opening up a lot of schools, right on the heels of Labor Day and going into the flu season, and then the political silly season … I think we’re in for a bad and rocky, rocky ride.
Q. Isn’t there promising progress on therapeutics?
A.
There is great news, I think, on, convalescent plasma ( as a treatment for COVID- 19). And monoclonal antibodies. I’m really optimistic that will be the get- out- of- jail- free card that will allow us to speed up progress.
Q. Testing is still a problem, right? A.
We have tests that have 20%, 30%, 40% false negatives. Which is terrifying. We don’t have a tester of tests. But other than the testing part of it, we’re doing really well on the antivirals. We’re doing really well on progress toward monoclonal antibodies. And on vaccines, I think we’re doing well. So, it’s not all doom and gloom.
But if we want to turn things around in the next three months, it’s what we do today that matters.
Q: What do you predict is going to happen when schools open in person?
A.
I think a lot of schools will be able to open just fine. But the models all say that the single most important factor in the safety of an internal area that you’re trying to make safe — whether it’s a convention or a company or movie production or a theater — is the ambient viral burden. How bad are the incidence and the prevalence and the death rates in hospitals right outside that school? There will be schools that are located in fortunate places that have, at this point, very low incidence. But this virus hopscotches around.
Q. Even if relatively few kids get seriously ill, don’t they spread the disease?
A.
The school season has been, historically, the place that sets off the fall set of respiratory diseases. We talk about it as the spark that begins the American portion of influenza season. Respiratory viruses begin with the kids going to school and sharing viruses and then taking them home. And then a few weeks later, I’m sure you’ve had this experience: Your kids go to kindergarten and two weeks later, you’re getting a cold. So, I think it will help the virus to continue its growth, and it will spread it everywhere around the country that doesn’t already have it.
Q: Are we on the verge of the perfect storm?
A.
Well, it can get really bad. If the epidemic isn’t stopped, it’ll just keep going. Right now maybe 10% of ( the 330 million) Americans have had the disease. That means you got 300 million more customers for this disease who have not bought it yet.
Q: What’s to stop it? A.
We need synchronized swimming. We need all 50 states swimming toward the same goal at the same time, for the same period of time. That’s what will stop it. And if we don’t do it before the election, the ( fatality) numbers at the time of the election will be horrific.
Q: How do you get to a 50- state approach?
A:
Even though CDC has let us down, it has to be CDC, it should be CDC, maybe with different leadership. CDC is like mecca for every epidemiologist. I trained there. We all have gone back to CDC at times and paid homage. CDC still has some phenomenal scientists who are being repressed, suppressed, worked around. It’s got to come from expertise and be given political power and agreed upon by everybody.
Q: What could be accomplished? A:
If you’ve ever seen the water in an area after a dam is built, the part that’s sucked out, the water gets very shallow. The fish are very obvious. You can see where they are. And that’s sort of what you get when you knock down an outbreak and you get it down to such low levels, then you can easily do traditional epidemiology.
Q: How do you respond to people who think mask- wearing mandates are infringements on their personal freedom?
A:
I would have to say to them, please turn in your seat belts and please do not travel on any taxpayerfunded roads, and you should not pay any attention to those red lights that you see when you come up to a fourway intersection because you haven’t participated in funding it. Look, it’s a pain in the ass to wear a mask. ( But) compare that to the Greatest Generation that gave their lives for freedom. The paradox is, you have to give up a little freedom to earn freedom.
Q. What’s the best kind of mask? A:
I would encourage two- way masks, so that we don’t have to sell the idea of masks are only an act of charity or benevolence at this moment in such a divided world. We should have a clear- cut understanding that some masks protect you as well as they protect others. And we should find the ability in this great, wonderful country of ours to make enough of those available for free or cheap enough that they could be everywhere. A mask that’s bidirectional will help us a lot more than a mask that’s mostly unidirectional.
Q. Does the virus spread more efficiently indoors than outdoors?
A.
We know that this virus does not spread when one person is walking alone in Yosemite. You can add a second person, and they’re 10 feet away, and that’s not going to spread. And probably you can add several more. We also know that taking off your mask to eat or drink in a crowded bar or restaurant or school cafeteria, with a low ceiling and poor ventilation, is an invitation to the virus to infect everybody.
Q: When will things return to normal, or some semblance of normalcy?
A:
This virus is all over the world. It is going to be with us. It is now endemic. It will be with us in many, many years. We’ll be feeling the effect of this for decades. There will be vaccines, dozens of them, from five or six different countries of varying abilities. Many of them will require booster shots or a shot every year. When you get a vaccine, you do not get rainbows and unicorns. You get a vaccination campaign.
Q. So which wins, the virus or humankind?
A.
We often say the virus is traveling at exponential speed. So is science. The virus just had a head start. It’s just a bunch of RNA and a fat sack. And we’re smarter than it. It’s not intentionally trying to kill us. It’s just programmed by its evolutionary genomics to survive and infect as many people as it can. And we’re a hell of a lot smarter. Our science is better. And we will defeat it once we get our wits about ourselves.
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