CAMBRIDGE, Mass. — For a veteran epidemiologist, an authority on homeland security, and a global health reporter, the outbreak of the novel coronavirus is the type of emergency they had long anticipated. But now that it is here, the three experts said Friday, they still couldn’t help but feel the monumentality of what they were watching unfold.
“It’s the most daunting virus that we’ve contended with in half a century or more,” Michael Mina, an epidemiologist at Harvard’s T.H. Chan School of Public Health, said at a panel discussion Friday at Harvard’s Kennedy School of Government.
Helen Branswell, STAT’s infectious diseases and public health reporter, has covered emerging pathogens since the 2003 SARS outbreak.
But with the new coronavirus, Branswell said during the panel, “It’s bizarre but I find myself startled. Having written about the possibility of something like this for years, I still find myself really startled that it’s happening, and I don’t know why that is.”
She compared the circumstances now to the summer of 2014, when Ebola was racing through West Africa and the world didn’t seem to have a plan to stop it. “Except that I never worried then about Ebola spreading in the city I lived in,” she said. “It’s different now.”
As the panel was occurring, the Cambridge-based drug company Biogen said that top executives had been at a meeting at a Boston hotel last week that was also attended by eight people who later tested positive for the coronavirus, which causes a disease that authorities have named Covid-19. The company asked many employees to work from home for the next two weeks.
In introducing the Harvard panel, Mark Gearan, director of the Kennedy School’s Institute of Politics, which hosted the event, directed students and others at Harvard to new travel policies the university issued on Friday, just before the panel started. They included a ban on university-related international travel and “non-essential” university-related domestic air travel, and discourage personal international travel. “We strongly discourage any non-essential meetings or events of 100 people or more,” the email to the campus read. (Institute of Politics staff members also put more than the usual space between chairs in the audience.)
Panel moderator Rick Berke, STAT’s executive editor, asked the crowd of roughly 100 people if any of them had considered not coming to the event. A few raised their hands.
“Do I think that this is a bad idea?” Mina said when asked if the panel should be held. “I think we’re hitting the time in the course of this epidemic where we might consider that this should be one of the last types of events like this.”
Here are some highlights from the event.
Why this virus is different
The spread of the new coronavirus has been compared to influenza, which also causes a respiratory illness. But, as the panelists pointed out, there are no drugs or vaccines yet for treating or preventing the virus, known as SARS-CoV-2, as there are for flu. In addition, we are exposed to different flu strains throughout our lives, which help us build immunity. No one had immunity to this new virus.
“We have an entirely susceptible population,” Mina said. “The potential for this to burn through a population very quickly is very high without extraordinary measures.”
As researchers race to study the virus, they are finding that it does not seem to be infecting great numbers of children, or at least making them very sick. (Experts around the globe are still trying to figure out just how broadly the infection has spread, given that many mild cases are likely to be missed.) But it is causing serious harm to older people and those with underlying diseases or weakened immune systems.
“This virus, on the one hand, there’s a saving grace that it doesn’t seem to be impacting our young, and that is amazing,” Mina said. “But the mortality rate among people who are getting infected above 80 years old is 15-plus%.”
How to mentally prepare for this pandemic
If you plan for the disruptions that the response to the pandemic could require, it will seem less unexpected when schools are canceled or you’re told to work from home, advised panelist Juliette Kayyem, the faculty chair of the Kennedy School’s homeland security program and a former homeland security official at the state and federal level.
“Get your head around this is practical,” she said. “It’s here, there are going to be massive disruptions to our social fabric in terms of your day to day. All of you have a part in stopping the spread of this … but we have to treat this as part of the plan. We’re at that stage now.”
Unlike with a natural disaster or terrorist attack, “we don’t have a boom moment,” she said, and the virus was more slow rolling. “When do you activate?” she said. “That’s sort of the challenge right now.”
Kayyem, who worked in the Obama administration, also made the point that the response will be a patchwork. Some schools will close, others will remain open.
Tracking the U.S. response
The federal government’s bungled rollout of testing for SARS-CoV-2, which has limited how many people can get tested for the virus but is now being remedied, did not inspire much confidence in the U.S. response initially. But Kayyem said that as cases are detected in more places, it will largely be on local and state agencies. She described the action as “locally executed, state managed, and federally supported.”
As for how to judge whether the response is working: “The bad thing has happened, it’s coming, it’s here,” she said. “We’re in the response phase. Our measure of success is not containment anymore. Our measure of success now is, will fewer people die or get severely sick because of our efforts?”
It’s not just the government that has a role to play, she said. Universities, the media, and employers need to act responsibly. Individuals also have to get involved, whether it’s staying home if they are not feeling well or making sure they have had the flu shot. After all, if they can avoid getting the flu, that frees up space for health care providers to deal with Covid-19 cases.
Mina said the fragmented U.S. health care system leaves him worried about the cohesion of a response.
“I don’t want to sound defeatist here, but the state of our health care system, the way we have privatized everything about it for the most part, is going to seriously impact our ability,” he said, adding that, “we have no ability to create out of the blue new hospital beds. We can’t even test appropriately.”
“If we can’t figure how to run some PCR instruments because we can’t work together as a society — this is within networks, within hospitals, within the national government, everything — I really am very concerned about this in a way that far exceeds our concerns for other viruses and other pathogens, and the most vulnerable are the elderly.”
What’s happened in China
The response in China, where the virus first emerged and cases quickly exploded, included the unprecedented steps of essentially quarantining tens of millions of people in and around Wuhan, the city at the center of the outbreak. There were concerns about people with other diseases being able to get the care they needed and the trampling of individual liberty. But from a raw epidemiological perspective, global health authorities have argued that such drastic measures gave the world more time to prepare. The interventions in China, they say, delayed the wave of cases in other places around the world.
“I think it was absolutely the right thing,” Mina said. “They truly bought the rest of the world at least a month. The U.S. wasted it, in my opinion, but many countries did not.”
Kayyem agreed about the initial U.S. response.
“When the story is written about U.S. preparedness for this, Chapter 1 will be called ‘Squandered Time.’ Not just on the medical side, but on the preparedness side,” she said. “What were we doing? And now, how do we make up for lost time? It’s not just the kits. It’s why this week we seemed so flat-footed and surprised by things like school closings. School closings were inevitable the second we had the first patients.”
Where this could go from here
Branswell noted that some people, based on both biology and socioeconomics, will be able to weather the outbreak more safely and less disruptively than others.
“I’m very worried right now about vulnerable populations,” she said.
“I’m really concerned about people living in long-term care facilities. If this virus gets into long-term care facilities [as it has in the Seattle area], it will be really bad. I’m worried about people who stay in homeless shelters. I’m worried about people who work in retail. I’m worried about people who don’t have the money to stockpile food because they don’t have extra money. I’m worried about the fact that there isn’t much social cohesion right now. People seem to be really angry at each other a lot and this is a time when we’re really going to need to help each other.”
Kayyem said that organizers of large events, including the presidential nominating conventions and the Olympics, need to start coming up with Plan Bs. The decisions about whether to actually go with these alternate plans can’t be made yet, but it is crucial to start developing contingencies.
“I cannot tell you when we’re going to activate and when it’s going to impact, but if the parties are not thinking about how you pick your nominee in a different manner, shame on them,” she said about the conventions.
“We don’t know where we will be at that moment,” she added. “I think we need to be comfortable making decisions in week allotments.”
After the event, Harvard officials said they were considering cancelling a full roster of Kennedy School Forums for next week, making Friday’s potentially their last public event at the Kennedy School for quite a while.
Correction: A photo caption in this story previously misspelled Juliette Kayyem’s first name.