Mixed messages and misinformation aren’t out of the ordinary in the Trump administration. But at a time when the U.S. faces a looming threat from a novel virus, public health experts warn that the administration’s mixed messages aren’t just confusing — they’re dangerous.
On Tuesday, a top official from the Centers for Disease Control and Prevention said the agency expects the virus will begin spreading at a community level in the United States and that disruptions to daily life could be “severe.” But President Trump and members of his administration have also said this week that U.S. containment of the virus is “close to airtight” and that the virus is only as deadly as the seasonal flu. Their statements range from false to unproven, and in some cases, underestimate the challenges that public health officials must contend with in responding to the virus.
“It’s really important for the U.S. government to be speaking with one common voice about these issues right now,” said Tom Inglesby, an infectious diseases physician and director of the Center for Health Security of the Johns Hopkins Bloomberg School of Public Health.
Without that, experts caution, the public will be left confused about their risks and what they can do to help curb the spread of the virus, such as staying home when sick.
Inglesby noted that health officials are working hard to prepare and plan for the spread of the virus within the U.S. But that work needs to be regularly and clearly communicated to the public — without conflicting statements from other officials.
“It will erode confidence in the effort if one part of the government says something in the beginning of the day, and another part of the government says something contradictory at the end of the day,” he said.
STAT took a look at what President Trump and other top administration officials have said about the virus — and what’s actually true.
Containment is ‘pretty close to airtight’
— Larry Kudlow, director of the National Economic Council, in an interview with CNBC Tuesday
There have been just 14 cases of the coronavirus diagnosed in the U.S., 12 in people who had recently traveled to China and two in close contacts of those initial cases.
But experts say it’s difficult to know whether that’s actually the case — and warn that it’s possible some cases might be going undetected due to a lack of widespread testing.
As of Feb. 23, the CDC had tested just 479 people, not including those who were evacuated from other countries. Testing kits sent out by the CDC nationwide turned out to be faulty, which means that just 12 labs across the country can currently run tests outside of the CDC.
The CDC is also still only recommending testing for people who have recently traveled to China or been in close contact with someone infected. But as the disease has started to spread in other countries, some public health experts think it’s necessary to broaden the criteria for testing or run the risk of missing other cases.
To Cody Meissner, a Tufts Medical Center pediatrician who specializes in infectious disease, there’s simply not enough information to be certain just how severe the outbreak will turn out to be. The number of infected people could be several-fold higher than current data suggest, he said, but the virus could also prove to be less deadly than officials believe.
“The CDC has taken one position and said we have to get ready for a pandemic,” Meissner said Wednesday at the SVB Leerink health care conference in New York. “The president has said this is going to pass, that it’s not a big deal. And I think it’s somewhere in between.”
The fatality rate is ‘similar to seasonal flu’
—Chad Wolf, acting secretary of the Department of Homeland Security, in testimony before Congress Tuesday
At this point, the novel coronavirus appears to be deadlier than the seasonal flu, though experts caution it’s difficult to pinpoint the case fatality rate at this stage.
The case fatality rate — the percentage of known infected people who die — is between 2% and 4% in Hubei province, where the outbreak began. In other parts of China, the case fatality rate is 0.7%, a World Health Organization expert said Tuesday. The seasonal flu, by comparison, has a case fatality rate of about 0.1%. The flu is estimated to kill between 290,000 and 650,000 worldwide each year.
Ronald Klain, who oversaw the Ebola response under the Obama administration, responded to Wolf’s comments on Twitter, noting the fatality rate isn’t clear at this point.
“The responsible answer is ‘we don’t know yet,'” he said.
‘There’s a big difference between Ebola and coronavirus’
—Trump, in remarks in India Tuesday, when asked about decision to evacuate ill Americans from the Diamond Princess cruise ship, given his past criticism of the evacuation of an American health worker infected with Ebola
This is correct — there are multiple big differences between Ebola and the coronavirus, which Trump called “like day and night.”
It’s true that the case fatality rate for Ebola was substantially higher than the estimated fatality rate of the coronavirus. Many U.S. hospitals are also now better prepared to deal with special pathogens than they were in 2014.
But it’s also true that the coronavirus appears to spread far more easily than Ebola does. To contract Ebola, a person must come into contact with the bodily fluids of an infected person. It can’t be transmitted simply by being in the same area as a person with Ebola. The coronavirus, in contrast, can spread through coughs, sneezes, or close contact with someone infected.
‘We’re very close to a vaccine’
—Trump, also in remarks in India
Trump’s remark about being “very close” to a vaccine, made while discussing the outbreak at a press conference, was initially interpreted as a reference to a coronavirus vaccine. The White House later told reporters the president was referring to an Ebola vaccine being near completion, though the FDA already approved a vaccine to protect against Ebola in December.
There are several groups racing to develop a coronavirus vaccine, but there is still a long road ahead. The CDC has estimated that a vaccine is unlikely to be ready in the next 12 to 18 months.
The National Institutes of Health is working with the biotech company Moderna to develop a vaccine against the virus. In a press conference Tuesday, Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said that work is going on schedule.
“A vaccine may not solve the problems of the next couple of months,” he acknowledged.
If the NIH’s vaccine proves effective, it would need to be produced at large scale. No major pharmaceutical company has come forward to say it would manufacture that vaccine.
Johnson & Johnson has also said it’s interested in developing its own vaccine. The company’s vaccine division, Janssen, has said it will partner with Biomedical Advanced Research and Development Authority, an agency of the Department of Health and Human Services, on that work.
New drugs to treat patients infected with the virus are likely to emerge much more quickly than vaccines, a top Food and Drug Administration official told STAT Wednesday.
“The development of a vaccine is not going to prevent a pandemic here,” said Peter Marks, the director of the FDA’s Center for Biologics Evaluation and Research.
The virus might go ‘away in April, with the heat’
—Trump, speaking at a governor’s meeting earlier this month
The arrival of spring — and warmer weather — in the Northern Hemisphere typically means the transmission of cold and flu viruses will dramatically slow down. Though the novel virus isn’t related to flu viruses, it is similar to a new flu virus in some ways. When a new flu virus emerges, it can circulate outside of flu season, simply because so many people are susceptible to the new infection.
It’s not clear whether this is also the case with the new coronavirus. But it’s possible the virus will keep spreading beyond flu season. Most people across the globe are likely vulnerable to infection. There isn’t widespread immunity against the virus. It’s also spreading in Singapore, where the temperatures are equivalent to those seen in summertime in the U.S.
That suggests higher temperatures might slow transmission of the virus, but probably won’t stop it, according to infectious diseases epidemiologist Marc Lipsitch of Harvard. “I think the fact that Singapore is seeing cases transmit is also kind of evidence that it’s not a matter of yes or no,” Lipsitch told STAT earlier this month. “It’s a matter of degree.”