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.

  • Agreed JNA. This woman Susan Desmond-Hellmann is useless as lots of her interview response contetnts are obsolete already. Diagnostic tests? Roche came through already in the US. Community spread? China succeeded in controlling its in Wuhan, right? CEPI? Never heard of it! What have they accomplished recently? Anything? Mortality rate? Very low in the US? Pretty high is Italy most likely due to their aging population. But the golbl average is only 3%. We all know annual seasonal flu kills a lot more than that EVEZRZY YEAR! Did she say she is equally worried about seasonal flu? Don’t think so! Why not? Does she get annual flu shots?

    IMHO she should just focus her attention for the Gates Foundation money and ramp up to contribute hundreds of millions for either an antiviral drug or vaccine and shut her mouth!

  • The virus is not alarming. What’s alarming is alarmist nonsense like this article. That’s what’s most alarmingly alarming. I’m alarmed.

  • Did Wuhan health authorities panic? Absolutely. DId Wuhan rsidents panic? yes. Did Wuhan helath workers panic? Most likely.

    But did the draconian measures (quarantine, mandatory testing, social distancing and isolation, virtual citywide lockdown) in Wuhan work Absolutely!

    We must replicate and emilate what worked and not merely what we think or hope would work.

    • John you don’t really think anyone believes a thing the Chinese government says do you? China deserves international censure and sanctions over this. China has long been choking the planet with CO2 emissions and billions of tons of plastic waste in the oceans. It’s 3rd major export after these is viruses. Its cities are filthy and its people ignorant of the dangers of consuming exotic wildlife. China must either clean up its act and stop lying to the world, oppressing it’s people and raping the environment or suffer the consequences. It’s the whole planet against China now. You have nothing to be proud of. Your fascist government has brought shame on your entire country. Full stop.

  • The panic to COVID-19 is causing more problems than the virus itself. More people die of flu virus every year than will die of COVID-19. This isn’t Ebola virus. Sure the very young, the very old, and the immuno compromise are at more risk as they are with any disease. Don’t be a chump, Don’t fall prey to panic. Do be reasonable, do be rational, do be of sound mind and treat this virus as you would any cold or flu, cover your cough with your elbow, wash your hands, and keep your fingers out of your eyes, nose, and mouth

    • Please cite the last time a national state of emergency was declared due to any strain of the flu?

      The callous and irresponsible like you are the reason community spread is on the rise.

  • I’m really really scared about coronavirus. I want to keep all my family members away from it. My dad works at Medical City Plano and has to work with all patients with COVID_19. I’ve been praying every night and every hour I’m on Google looking for updates. I can’t stop worrying and I just want this all to be over. Lord bless you all and I agree with this article.

  • Thank you Jane for your comments and I am very happy for you to share my post on your facebook . I do apologise for some poor typing errors !

  • Why is there never a mention of the “root problem” coronavirus is yet another pandemic all caused by humans who gather animals together to eventually kill for food to sell to humans to make money. They are “flu factories” they animals are fed growth hormones , routine antibiotics in order to address the infections caused by their confinement. Then the activities at the killing house where the animals are slit open whilst writhing in terror and pain and blood and more germs released all to be cut up and packed neatly into plastic packets to be sold to humans. Humans who then eat animal products round the clock which “glues” up their arteries then become obese, developing heart disease, diabetes, dementia, cancer etc. the list is endless. Not forgetting the devastating ramifications of animal agriculture on the planet the greatest emissions of CO2 more than cars, planes and trains put together! the poisoning of the water and air. The dramatic climate change and coronavirus pandemic both inevitable and predicted. It is time to educate humans in basic biology! If you study biology the anatomy and physiology of humans is that of a frugivore! In the UK the livestock industries receive vast subsidies from the govt. the plant growers receive nothing. It is very simple, HUMANS ARE DESIGNED TO EAT A PLANT DIET !!!!!! Tuberculosis acquired from goats, Measles and smallpox from cattle viruses, whooping cough from pigs and sheep typhoid fever from chickens and turkeys, influenza from ducks, eprosy/distemper from water buffalo, cold virus/common cold from horses HIV from butchering primates in Africa caused AIDS. with every breath you take you u inhale 1,000 s of bacteria and with every bit you ingest millions more.

    • Hi Anne- This is a great write up and I cannot agree more to this. I see a lot of disappointment and helplessness in this message. I myself have felt this many times and have stopped discussing this with folks because it causes social unrest. People don’t want to be challenged about their personal choices which are not clearly personal anymore and have a larger impact. Its a topic of debate but non will bring it up. Let’s hope for the best!

    • Hi Anne,I agree with everything you have written here and would like your permission to share your write up on my Facebook page. It’s brilliantly written and straight to the point!

    • Excellent points you have made in your short article. Eat plants and celebrate the lives of animals by not eating them, or exploiting them in any way! In that way, we ourselves BECOME MORE HUMAN AND INDEED MORE HUMANE!
      All glories to the Creator who provides endless plants to be minimally used for the abuse -less feast of Vegan Dinners!

  • Anyone who has A brain cell knows the CDC is in control of everything that goes on the world health organization is in control of what goes on there is virtually unlimited funding provided by the US government everything that can be done to contain and control this virus is being done the best minds in the world are working with the CDC and everything that is being done so people need to just relax take a breath of air Do as they are instructed by the CDC number one calm down number to clean your house clean all surfaces of everything around you chances are they need to be cleaned anyway keep yourself clean try to avoid close contact with others and go about your daily lives

    • You are very gullable, Mr. Gallagher. Learn to read between the lines. There is a shortage of test kits and God knows what else in the US. How does that jive with what you are writing? Good luck with your spring cleaning.

  • Why can’t anyone actually say exactly what the virus does, what it is doing and how many are impacted. What is the median age for contraction and death? Is it only affecting younger people, are only 20 somethings dying from this virus? Why should we all panic over hype? I am very serious, what is it about this virus that makes it so very much different than say the run of the mill rangy awful flu? Nobody is saying.

    • From what I am understanding from several sources is that the virus isn’t necessarily targeting any one age group. What is more likely is that younger and healthier people may be experiencing very mild symptoms so may not even know they have COVID 19 . They may think they just have a common cold or mild flu. The population that is more likely to have symptoms that put up a red flag for testing are those who have compromising health conditions and those 60+ years old that typically have age related conditions that put them at risk of more noticeable and serious symptoms that cannot go unnoticed. Therefore, there are probably 100’s of thousands of people who have very mild symptoms who never get tested, but are passing it around their communities. This is why, for a period of time, it is wise to reduce as much Community contact as possible early on so that we can stop as much of the rapid spread as possible as soon as possible. The problem is that it appears to be easily passed on and more serious symptoms for the older and health compromised. No need to panic. Just be wise and take measures to reduce behaviors that put yourself & others at unnecessary risk. This will lso help to also reduce the spread of the more common cold & flus. WASH YOUR HANDS FREQUENTLY & DON’T AVOID TOUCHING YOUR FACE!!!

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