Susan Desmond-Hellmann has a unique set of experiences. Until February, she was the CEO of the Bill & Melinda Gates Foundation, where part of her job was thinking up new ways to battle infectious disease. Before that, she was the chancellor of the University of California, San Francisco. In the 2000s, she was one of the most prominent people in the pharmaceutical industry, running drug development at Genentech during its time as one of the most closely watched biotechnology companies.

That made her a perfect person to speak to about the risks posed by the novel coronavirus that causes Covid-19. STAT caught up with her earlier this week. The transcript below has been lightly edited for length and clarity.

My first question about Covid-19 is simple: How worried are you?

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I’m very worried. I’m very worried for a couple of reasons. With pandemic preparedness, a respiratory-borne illness was always the big worry. And here we are. The efficiency of spread of Covid-19 has me worried. The fact that individuals who are infected may be mildly symptomatic or asymptomatic and yet transmit the virus makes normal procedures, like telling people to stay home if you’re ill, or taking someone’s temperature as they walk through the airport, ineffective. That puts testing and, really, labor-intensive public health at a premium. 

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Can we still control community spread at this point? 

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I’m not confident that we know the answer to that yet. I think the next several weeks will be very important. But I think it is very reasonable to be concerned that in fact we won’t be able to control community spread. We don’t enforce the kind of control measures that we’ve seen enforced in China. 

How much do you trust the data coming from other countries on things like transmissibility and mortality?

I think the numbers should all be treated as estimates. It isn’t that I have a trust issue because of anything nefarious. But [data] have to be amended with the expectation that there are many, many mild or asymptomatic cases. And, so even when the number 2% mortality was widely discussed in my mind, I amended it to likely 1% or less. 

I still have a big question about young people. Are kids somehow more immune or are they just not at all getting sick? Are they transmitting the infection? But with regard to the high mortality rate in folks with underlying medical conditions, or who are over 60: Those numbers, I think, we need to believe. 

What should people do now? We’ve had a really dramatic change in how people are reacting. What is prudent, and what is panic?

I think very simple public health measures are the best thing for the general public to do. The Centers for Disease Control and Prevention website offers steps that are very good: avoiding nonessential travel, especially to high-risk areas; hand-washing, serious hand washing, 20-second hand-washing. Or use those hand sanitizers, but I think people over-rely on hand sanitizers. Really good hand washing is very effective, you just don’t always have access to soap and water. Avoiding touching your face is very important.

If you are sick, call your health care provider. Don’t show up unless you’re very sick. Many workplaces are now banning non-essential travel, which I see as very reasonable. There’s a push to work from home. I also agree with the tenet that schools need to start to talk to parents about what they would do if they had to teach kids at home.

I’ll tell you personally, I’m not stocking up on groceries. And I’m not buying masks. I agree with the surgeon general that we should have masks available for health care providers.

At the Gates Foundation, you were involved in trying to set up a system for developing therapeutics in a pandemic. Where do you think we are with regard to therapeutics and vaccines?

I’m so glad that we invested in CEPI [the Coalition for Epidemic Preparedness Innovations], which is funding aggressive efforts in vaccines. I’m really grateful once again for multinational pharmaceutical companies who are racing to look at vaccines, antibodies, and therapeutics. 

But there are two other things I would emphasize. We need to put more emphasis on diagnostics. Diagnostics are under-invested, they’re under-reimbursed and right now, the diagnostics are a bottleneck in public health measures. The second thing is we need to have funding for our local public health departments. This is classic basic shoe-leather epidemiology. And having an effective staffed funded public health department is essential. 

The timelines for therapeutics and vaccines are very fast – therapeutics within a year, vaccines within two.  Does that sound realistic?

I think it’s reasonable. There needs to be human testing, especially for safety because many, many people won’t have a high mortality or even morbidity, which is why it’s not faster. And everyone wants it even faster. Look at Ebola. With Ebola, there was a very effective vaccine. It wasn’t ready the first time, but it was ready in the recent epidemic and, and made a big difference. In the meantime, therapeutics are also very important.

The high levels of mortality — as high as 15% — being seen in patients who are older than 60 is surprising.

Yes, I’m surprised how high it is. But as we get more cases, I think we’ll see whether or not that’s the truth. But there’s no doubt about it that that over 60 — in some of the cases recently reported out of Washington state, people were in their fifties, but had additional medical conditions — have a very high spike in mortality rates.

There was recently a study of the genetics of the viruses in Washington state that indicated there could be hundreds of cases that went undetected there. How does that change your mental model of what’s happening?

That’s the kind of thing that the Gates Foundation has been doing with partners and collaborators for polio. It’s extremely helpful for disease tracking and understanding an epidemic. You have to make sure you remember that it’s modeling, not truth. But I found it incredibly compelling. What my mental model is moving to is when you have someone very, very sick who goes on a ventilator, that’s probably your evidence that you do have community spread, and there are many, many more cases than you’d think on the surface. Many more. Like hundreds of cases.

Do you have any closing thoughts?

It’s frightening for people to have an unknown virus. And it feels very scary. It is true that most people will be able to protect themselves and their families, and they’re not going to have something that makes them very, very sick. But really think about how sad it is for those people who did get sick and die, and their families. To think that you were in a nursing home, or somebody who was traveling and got sick. … This is really sad. So I do hope we can ramp up the testing and get this thing under control. It’s always good to remember that there are people behind all this.

  • Please stop trying to calm people! you are doing disservice and putting people in harms way! US has been warned repeatedly and was given more than a month to prepare for it, and yet we are doing so badly and now it’s widespread in multiple metro areas. Why? there are many reasons but fundamentally it’s the kind of attitude and message expressed in this interview.

    This is a very serious disease and a virus with R0 much higher than flu. If people are not scared yet, they need to get scared now. Only when scared, they will take note and do the right things to stop the spread. Only when everyone is scared, we as a society will be safe. The more people who do not take this seriously, the faster the virus spread. Envision the spreading virus as a wild fire, each person who gets sick provides additional fuel to this fire.

    I will finish by saying that if you don’t care about your own safety, be scared for your loved ones. The data says if you are sick, more than 80% chance your loved ones will be sick as well.

    Sean

    • Business and school closures, canned food items delivered once a day, gas station shutdown for one month, will probably take care of this, otherwise its only a meaningless chatter

  • I also read an article a few years ago that explained the source of the following list of diseases all began when humans began “farming these animals”
    Tuberculosis from goats which now infects nearly 1/3 of humanity
    Measles and smallpox from mutant cattle viruses
    Whooping cough from pigs
    typhoid fever from chickens
    influenza from ducks
    leprosy from water buffalo
    even cold virus from horses
    shocking reading but not surprising

    • I worked in a university’s college of veterinary medicine and research for a decade. We had many animal models of human diseases, which was fortunate as human subjects are limited for study. I am not surprised by your words re animals — we are all mammals and to think that transmission may not occur would surprise me more than believing it does.

  • as a child in school I loved Biology and I never forget the day we studied the anatomy and physiology of humans and it resonated so deeply in me that we were frugivores. That we required plants nuts and seeds etc NOT the flesh and secretions of animals ! Is it any wonder that Humans have created flu factories by breeding animals on a grand scale and keeping them herded together feeding them growth hormones, routine antibiotics to fight disease because of the conditions they have kept them . Then the appalling conditions of a killing house where they murder millions of animals 24 hours a day imagine the contamination, the bacteria the viral infections. then all the humans ingesting the body parts and the secretions eg. milk which was designed for a calf not for a human who is lactose intolerant by 4 years of age. These humans consuming a diet that then makes them ill and bingo they also need pharmaceutical drugs. So only the livestock and pharmaceutical companies are the winners. I read the other day about Oprah Winfrey’s 5 year long case when the American cattle ranchers took her to court absolutely shocking . We are all at great risk at this moment and unless someone is bold enough to stop the production and movement of all animal products this will never be resolved.

  • Blessings to you and your family
    Thank you very much for the wonderful update and comments. I was extremely upset recently concerning the recent Temple University announcement concerning the cancellation of their student overseas Italian program, and allowing their students to independently return to the United States on their own recognizance. Also the 14 day self quarantine that was mandated. These Universities have an enormous obligation to play a better roll in educating their student body concerning the Coronavirus real potential.
    I believe that specific programs should be set up and monitored at Colleges, Universities and high schools throughout the United States, starting immediately.
    Also, the students just returning from Temple University, should be very closely watched and restricted due to their previous experience in Italy.
    I spoke with 990 radio station on the air during drive time around 7:20AM, the day after Temple announcement. The radio announcer didn’t realize that this had taken place. Possibly you could be better connected to reach the University to see what they are doing about this situation.
    I just wanted to bring this to your attention. I appreciate very much your ideas!
    Respectfully submitted
    JohnDarnall

    • It is most likely already there – remember that during community spread, everything you read or hear on the news is two to four weeks behind the virus.

  • Is it not counter-productive, with all her experience, to step down as CEO of a well-funded infectious disease oriented Foundation – in the middle of a serious outbreak? I do not believe in what she says now. Harsher methods are needed to delay the spread in support of developing treatments and vaccines. As this virus spreads air-borne, just simplisting handwashing does not cut it. If there are coronavirus concentration areas, then travel from there MUST be curbed, to buy time. And I really hate to say this, but if need be, that includes no Olympic Games, not this year, not in Tokyo.

    • I agree fully Chris M.

      Draconian and authoritarian and drastic as it may be, quaranteeing 11+ million Chinese people in Wuhan City and Hubei province is working!.

      Simply assuming it is not workable or practical in our more liberal democratic countries is simply stupid and unwise and shows lack of will and determination! Don’t you want to survival? What is the price for a few weeks’ inconvenience and lack of liberty? Has western democracies learned anything from what happened in China?

    • Dr. Desmond-Hellmann announced December 5 she was stepping down for health and family reasons, after five years of leadership at the Gates Foundation. The first Covid-19 patient in China reported symptoms locally December 1; the rest of the world was unaware of this new virus until later in December or January. Dr. Desmond-Hellmann has done more for humanity every day of her stellar professional career in medicine, drug development, and public health than most people in their entire lifetime. She is a role model for her lifelong dedication and contributions to improving health outcomes of patients throughout the world.

    • John Chu – we learned that keeping wet markets around for 20 years after SARS was a really bad idea. Does that count? How about learning that detaining people who warn about new infectious diseases because they embarrass the CCP is counterproductive. Next I think we’ll learn that rushing vaccines to the market causes a lot of damage.

      The actions China took following their initial response will be proven after people start going back to work. It could be that the massive blow to their economy was actually a prudent investment in public health. We’ll know by the end of April.

  • my closing remarks are yes we are all human yes there is great suffering yes there are very many sicknesses and diseases and no we cannot control everything somethings are beyond our control but with wisdom unity science and faith we will overcome and survive to an even brighter and better future

  • Desmond-Hellman ends the discussion with a valuable message. We must remember that the victims of this virus are other human beings, not just statistics.

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