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Tom Frieden, a former director of the Center for Disease Control in Atlanta as well as a former Commissioner of Health for New York City, was interviewed about coronavirus yesterday by reporter Helen Branswell. Branswell, who used to work for the Canadian Press, now writes for STAT, an online news daily specializing in health, medicine, and drug research. I sat in on that videoconference. Here, in brief, are a few of Frieden’s comments.
What should health authorities be doing now?
“Use the time to prepare for the next wave of the virus. Like Wayne Gretzky used to say, skate toward where the puck is going, not where it is now. This will mean testing more widely, isolating all infected people, aggressively tracing all of their contacts, and quarantining for 14 days.”
If these things are executed properly, Frieden suggested we may be able to “box in” or contain the virus to small clusters and avoid re-imposing the strict physical distancing measures we are living with today. That said, when we re-emerge, the future will look different from the past.
“You will see lots of hand sanitizer at public places; we still have to figure out what to do about elevators,” said Frieden. “There will be no more shaking of hands and there will be fewer face-to-face business meetings. Work days or work hours may have to be staggered to reduce the number of people congregating.”
When will the world be ready to re-open?
“A vaccine is still at least a year away so the virus is still going to be here,” said Frieden. To keep it “to a simmer,” three things must happen: 1) the number of deaths must come down; 2) health care workers must be able to be protected; and 3) the public health system must be able to test, isolate, trace, and quarantine people who have been infected.
“Right now in the United States, we aren’t moving fast enough to get the test capacity up,” said Frieden. “In terms of contact tracing, that army of people is just beginning to get organized. Seven thousand people have already died in my city of New York.”
What percentage of COVID-19 transmission is resulting from people who don’t have any symptoms (asymptomatic) or people before they show any symptoms (pre-symptomatic)?
“Information on this is emerging. Some of the best information we have is coming from the Diamond Princess cruise ship. Initially, between 40% and 50% of the people who had the virus didn’t have any symptoms. That was shocking. But as time went on, most of those people developed symptoms and only about 18% turned out never to have symptoms. Spread could be either from the pre-symptomatic or the asymptomatic person. There is one well-done study from Singapore which estimates 6.4% of their transmission came from people who did not show any symptoms.”
How are the serology tests working?
“There are tests for the virus and also tests for the antibodies, called serology, which is a blood test. There are many serology tests on the market and many of them are junk. There is an enormous amount we don’t know. We don’t know if everybody who gets infected with the virus develops antibodies, although it’s looking that way. We don’t know if the antibodies protect against future infections and that’s a crucial question. In theory, if antbodies are protective, that person has a “get out of jail free card” and could go back to normal activities and help with the response.”
What is your opinion on wearing cloth masks?
The Center for Disease Control has recommended that healthy people wear cloth masks whenever they go out but the World Health Organization has not.
“The CDC recommendation was thoughtful and reasonable. It is a judgment call. The reasoning is as follows. In a place with lots of spread, some people will be pre-symptomatic or asymptomatic and therefore potentially spreading the virus. We do know if people who have the virus wear a home-made mask, they are less likely to give it to others. There are some “buts” here. You don’t want to be taking supply away from healthcare workers. You don’t want to be touching your face more because you are sweaty. And you want to make sure it doesn’t give you false confidence to go out because if you are ill, stay home.”
Is there a silver lining?
“For all the terrible death and economic depression we are in, in fact, we are seeing some silver linings. We are seeing a future where despite conflicts among (and within) countries, we are all connected and that we can work together. That there is interest in global solidarity. It matters to us if the nursing home residents are safe, if the prisoners are safe, if the homeless are safe. This is the time to build our public health entities to keep us safer from other conditions beside coronavirus that are needlessly causing illness and disability. So I remain optimistic we will come out of this stronger.”
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