A former director of the Centers for Disease Control and Prevention said health officials need to be ready to change their coronavirus strategy if the first cases seen this week of illness in people not directly connected to China trips develop into “sustained local transmission.”
“There is not a fire yet, but those sparks are what’s really worrisome today,” former CDC Director Dr. Julie Gerberding, now an executive vice president at Merck, said Monday at a Hudson Institute forum on challenges in containing the coronavirus, dubbed COVID-19 by health officials.
Former Sen. Joe Lieberman (I-Conn.), co-chairman of the Bipartisan Commission on Biodefense (formerly the Blue Ribbon Study Panel on Biodefense, which is co-chaired by former Homeland Security Secretary Tom Ridge), noted that “most of the infectious diseases we’re dealing with are zoonotic in the sense that they are transmitted to humans by various animal species, and how we deal with that is a really important question.”
“Once an infectious disease epidemic starts, it’s already in one sense too late; the effort is focused on containing it,” he said. “But if you start to scamper around as we’re doing right now to find treatments or vaccines, it’s just about impossible to do that quickly — so then you do what we’re doing now, which is to try to contain the spread of the disease.”
Lieberman called the National Biodefense Strategy issued in September 2018 “a good document,” but said the commission is concerned that “implementation of it has slowed a bit more than it should be.”
The CDC today confirmed the 15th case in the United States. More than 60,000 cases have been reported globally with most in China, and more than 1,300 deaths. “The numbers change every day, but they’re really quite stunning and worrying,” Lieberman said, adding that “we have to approach this as something that’s happened in China now, but that could happen in the U.S. or anywhere else in the country, in the world.”
In addition to medical countermeasures, Lieberman said emergency planning and response has “got to remember the need for essential medical supplies, basic stuff — there’s no point, for example, in developing vaccines that need to be injected if we don’t have enough needles.”
“There’s no point in telling hospitals and other healthcare deliverers to provide supportive care if we don’t have supplies like saline. There’s no point in urging everyone to take great care in protecting themselves if we don’t have enough masks and gloves to go around,” he said. “In fact, one expert we had appear before our commission a while back said that the world has only about a two-day surge capacity for these basic medical supplies. That is, items ordered and already manufactured but have not reached their destination. Just two days and the world, including particularly our friends in China, are dealing with this need on an urgent basis right now.”
Congress recently established a CDC fund with more than $100 million to combat infectious disease outbreaks, “but today, as of today, just a little more than a month since our country began responding to the coronavirus, that rapid response fund is totally depleted, and the CDC is having to take money away from other programs to keep funding novel coronavirus efforts,” Lieberman said.
Dr. William Karesh, executive vice president of the EcoHealth Alliance and a veterinarian, showed video he took of a live-animal slaughter market in Indonesia that sells about 6,000 bats per week along with rats.
“This mixing of blood and material, respiratory pathogens, they are all coming to the market; people are walking around in flip-flops, no one is wearing gloves, the consumers, the customers are handling it with their bare hands, the vendors are handling it with their bare hands, and then they touch their face, they bring in more live animals, that spreads more virus, bacterial pathogens, and the scale of this, as I said, there are thousands of these markets, just in Asia alone,” Karesh said.
One key factor in battling the existence of these markets is the cultural shift — the younger generation, he noted, would rather go to Pizza Hut or McDonald’s than consume bats or snake blood.
“I think that there is an opportunity for the social behavior to change,” Karesh continued. “Especially with social media, that’s rapidly growing in these parts of the world. That we can shift away from that. The other thing is modernizing the food safety programs. And that is really about refrigeration, cold storage, food safety.”
Even after the severe acute respiratory syndrome (SARS) outbreak in 2002-03, “we don’t seem to be learning lessons.”
“We saw this with SARS. It came out of wildlife. We know that was linked to bats. We know Ebola is linked back to bats. We know some of these new — the MERS coronavirus really looks like its origin was in bats and then got into camels,” Karesh said. “Even influenza, we learned years ago that if we better monitor or actually close down a lot of live bird markets, we reduce the risk of avian influenza in the United States. I think in New York there were 20 or 30 live bird markets just a few years ago, and now I think it is down to just three or four.”
“So once again, I think our culture is changing. There is an opportunity to reduce that risk,” he added. Not much can be done about migratory birds’ role in spreading influenza, but “the wildlife trade, though, is purely driven by people.”
Dr. Daniel Chertow, head of the Emerging Pathogens Section at the National Institutes of Health, said that the novel coronavirus “emerged from its natural reservoir in nature, likely bats… and likely passed into humans via an intermediate animal host, which has yet to be established.”
“Regardless, once the infection in humans was established, the virus has proven to result in efficient human-to-human spread, within communities, households and in the healthcare setting,” he said. “…Based upon available WHO data among laboratory-confirmed cases, approximately 15 percent of infected individuals develop signs and symptoms of lower respiratory tract infection consistent with pneumonia. Approximately 2 percent of the reported confirmed cases result in a lethal outcome.” Among hospitalized individuals with confirmed infections, the reported fatality rate goes up to around 4 percent. It’s also to be expected that “more mild or asymptomatic cases are likely going undetected.”
“Preliminary estimates indicate that this virus is at least as transmissible as influenza, with every case infecting, on average, two or more individuals,” Chertow noted.
Gerberding said the coronavirus crisis has produced “the most sophisticated and complete containment effort that has ever been invoked.”
The world has already seen “the spillover phase,” she said, with hundreds of infections detected outside of China.
“When you move into this phase of trying to slow down, that is where the social distancing becomes important, early school closures, avoidance of mass congregations, etc., etc. The goal isn’t necessarily to keep it out, because it is probably too late for that, but the goal becomes, can we slow the progression, smooth the curve, reduce the overall stress on the system? And hopefully, save lives in the process of all of that,” Gerberding said.
The former CDC chief noted that “when people are infected, and how long they remain infected, is very worrisome.”
“Particularly, if there does prove to be more of the asymptomatic transmission, which, by the way, does happen every year with influenza,” Gerberding said. “So, we really are desperately seeking the parameters that define the speed of spread, and the risk of transmission, at various stages of illness and, candidly, I am worried about that.”
Karesh noted of pathogens with zoonotic origins that “one became HIV-AIDS, it hasn’t gone away yet; one became SARS — most of them, they are happening, all the time, most of them are dead ends and, luckily for us, they don’t go anywhere.
“I will have to admit that when SARS emerged and the wet markets were not any better than they are now, it seemed almost impossible to me that it wouldn’t be back,” Gerberding said. “…We really didn’t see SARS again. Very mysterious; it tells you we have a lot to learn.”
President Trump told a campaign rally this week that “in theory” that once April rolls around coronavirus will “miraculously” go away. Gerberding addressed “the conversation about seasonality,” noting that common cold coronaviruses that are winter viruses in the northern climates see “less seasonality” in the more tropical areas. “So we have to remember not to be falsely reassured by this, just because many people living in colder temperatures are not plagued with respiratory viruses when it’s warm outside,” she said. “Lots of people that live south of the equator, lots of people will continue to be at risk for nonseasonal infections. So, just much more to learn. And I really would hesitate to look in the crystal ball on this one.”
Gerberding also stressed that future antibiotic resistance “of course will be a major bottleneck if we actually do end up with a very large outbreak and have sick people in a hospital with complicating bacterial infections.”
“I think that the government needs to step away from our current mindset about the nature of the threat and really think about it in the same frame that we think about other issues of national defense,” she said.
“There is no substitute for investments in preparedness for the next response, and when it comes to some of the real big investment items like developing broad-spectrum antiviral vaccines or treatments, it’s really a worldwide concern and our funds ought to be pooled with funds from other countries around the world to see if we can’t combine our intelligence, our technology and our shared need as citizens of the same planet to be better ready for the next infectious disease epidemic when it breaks out,” Lieberman said.