This is a special episode of Mindscape, thrown together quickly. Many thanks to Tara Smith for joining me on short notice. Tara is an epidemiologist, and a great person to talk to about the novel coronavirus (and its associated disease, COVID-19) pandemic currently threatening the world. We talk about what viruses are, how they spread, and a lot of the science behind virology and pandemics. We also take a practical turn, talking about what measures (washing hands, social distancing, self-isolation) are useful at combating the spread of the virus, and which (wearing masks) are probably not. Then we look to the future, to ask what the endgame here is; Tara suggests that the kind of drastic measure we are currently putting up with might last a long time indeed.
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Tara Smith received her Ph.D. in microbiology from the University of Toledo. She is currently Professor of Epidemiology at the Kent State University College of Public Health. She has researched and written extensively about diseases such as ebola and MRSA. She is an active science communicator, and writes regular columns for SELF magazine.
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0:00:00 Sean Carroll: Hello everyone, and welcome to the Mindscape Podcast, I’m your host Sean Carroll. This is a special bonus episode outside the usual weekly numbered episodes, and you can guess why we’re having this episode. It’s because of the Coronavirus pandemic that the world is struggling with right now, and I thought it would be… It would be useful, even if very quickly and without much preparation, to get some of the information out about the science behind it, and also the steps that are being taken, and that individuals should take. There’s already a huge amount of information out there of course, so there’s plenty of places to get it, I don’t think that I’m saying anything, or my guest Tara Smith, will be saying anything on this episode that is completely surprising to anyone who has been following sensible, reliable sources out there, but it’s very helpful to put it into context, to get it all into one place, and there’s a lot of unreliable sources out there that maybe this can act as a corrective to.
0:00:58 SC: So, to put things in context, I’m recording this on the morning of Wednesday, March 18th, for those of you in the future who might be listening to this episode, the first case, as far as I can tell, the first case of the disease, which is called COVID-19, associated with this novel Coronavirus, was discovered in China, I think the day before New Years last year, December 31, 2019. The first case in the US was January 20, 2020. Right now, worldwide, according to the website I’m looking at, worldometers.info, there are 212,799 known Coronavirus cases that have been found, of course, in the world, and about 7,700 in the United States. Of course, that’s only things that we’ve found, literally as I’m typing this, a story came up on my feed from the New York Times, saying that for every known case of the Coronavirus, another five to ten cases might be out there undetected.
0:02:06 SC: So, we’re still in the exponential growth phase of this virus, it’s growing very, very quickly. Here where I am in Los Angeles, a week ago people were going to the gym, people were going to the restaurants, we knew there was an issue, already colleges and schools had begun to close, people were trying to do a little bit of social distancing, but life was still almost normal. Since then, all the restaurants have shut down, the gyms have shut down, people are trying to get food delivered, people are stocking up from the grocery stores. At least, the grocery stores are still open as of Wednesday, March 18th, but places like San Francisco have an even sterner set of rules that have been put down, sheltering in place, don’t leave your house unless it’s absolutely necessary.
0:02:52 SC: And it’s a weird situation because, you know, not everyone dies, right? There’s different levels of fatality and injury associated with this, but you can get the virus, not die, and yet spread it to someone else who might actually pass away because of it. So it absolutely makes super duper sense to take these social distancing and self-quarantining, self-isolating steps seriously. So, I had this wonderful conversation with Tara Smith, who is an epidemiologist, she’s a professor at Kent State University, to be honest, mostly studies bacterial infections, not viral infections like this is, but the idea of infections and pandemics and what to do about them, she’s very much up on, and she’s also a wonderful communicator about these things. So, it’s a very clear, very, you know, clear-eyed and helpful, useful, practical set of comments that she offers, and also, you know, we talk about the underlying science, ’cause you know, if you’re Mindscape listeners, you want to know what’s the difference between a bacterial and a viral infection. You want to know that there are some RNA-based viruses and DNA-based viruses and so forth, so here’s where you’re gonna learn that. Look, I hope everyone is staying safe out there, doing what you can, you know, I hope that none of my listeners are out there partying with thousands of people just to show the virus who’s boss, because that’s not how it works.
0:04:21 SC: There’s little we can do in a practical way, maybe, when we’re far apart to help each other, but it’s important to maintain contact with other people. Call up your friends, send them emails, especially people who you might have lost touch with, people who are in higher risk groups, things like that. I’m about to start to doing a little series of videos, where I talk about big ideas in physics, not because this has anything to do with viruses or pandemics, but it’s something for me to do, and there’ll be Q&As, so share with other people, because we have to be very, very safe and careful, but we also have to live our lives, and what better thing to do, than to use this terrible, terrible situation as an excuse to come out the other side better informed about the universe in which we live. That’s why we’re here, so let’s go.
[music]
0:05:27 SC: Tara Smith, welcome to Mindscape Podcast.
0:05:29 Tara Smith: Thank you for having me.
0:05:30 SC: Well, thank you for doing this, short notice. Bonus episode for our listeners, because of course, the conditions are a little strange, a little surreal.
[laughter]
0:05:40 SC: I mean, you’re a professional epidemiologist. Is something like this… Was this in your space of things you wondered about before, or is this something totally different?
0:05:51 TS: Oh, sure. I mean, when I was at University of Iowa in the early-to-mid 2000s, we were thinking about pandemic influenza, and avian influenza particularly, and so we did a bunch of what we call tabletops, where you have a scenario, you know, usually a bad one.
0:06:09 SC: Yeah.
0:06:10 TS: And you try to figure out what would happen, and what departments you need to call in, what people you need to call in, who will do this, who will do that, looking exactly at things that are in the news right now. How many ventilators do we have? How many ICU beds? How can we triage people into the right places so that we don’t overwhelm healthcare? But then we had the swine flu pandemic in 2009, which ended up being more mild than typical influenza pandemics are. And then with this administration, I think, pandemic preparedness has not been a big…
0:06:49 SC: A priority? Yeah.
0:06:49 TS: Right, right, a big priority. So it’s definitely something that’s epidemiologists and people who do these types of work have thought about, but I think it’s gotten back burnered in the last few years, unfortunately.
0:07:03 SC: Yeah. Well so let’s, I do wanna get to the nitty-gritty of how we might cure it, what we should be doing in the meantime. But let’s back up a little bit, we have time to get a slightly deeper understanding. So talk to me about viruses, and even epidemics, pandemics, in general. What’s the difference between epidemic and a pandemic? What’s the difference between viruses and bacteria? All that good stuff.
0:07:25 TS: Yeah, so let’s start with viruses and bacteria. So viruses are basically just nucleic acids that replicate within a host. So there’s the big argument, are they alive or, are they not? Which we’re not gonna answer today ’cause even microbiologists can’t agree.
0:07:43 SC: We’ve done that in another podcast, actually. So don’t worry about it, yeah.
0:07:46 TS: Yeah, I have. I’ve done that all over. And I’m not a virologist, I would say, my work is on bacteria. But viruses basically hijack the host’s machinery. So they enter into a cell, they force that host cell to replicate copies of the viral nucleic acid be it RNA or DNA, and then the host cell basically spits those out so they can go to other cells and replicate and do the same thing. And so, we generally do consider them live because then we have what we call killed virus vaccines where we basically inactivate that nucleic acid so it can no longer replicate. So we use those for things like influenza. So you can, at least, chemically speaking, kill a virus.
0:08:31 SC: Sorry. Is that by literally changing its DNA, or by just changing its chemical structure?
0:08:37 TS: Right, so a little bit of both. So it depends on the way you inactivate it. So you can inactivate it with chemicals like formaldehyde that will basically stop it from replicating. You can also inactivate it with UV that will basically do the same thing. It’ll introduce mutations, it can’t replicate any longer.
0:08:54 SC: Okay.
0:08:55 TS: So viruses… So those are the viruses. And then bacteria, of course, are alive on their own. They can grow outside of the body. They have nutritional requirements, they have their own metabolism which makes them different from viruses, which again, just take the host’s metabolic machinery and use that to replicate. So bacteria… Yeah, tend to be ones that can live outside the body, and yeah. [chuckle] I’m not sure that’s what…
0:09:29 SC: Are we… Is the threat from… Just to the future, is the threat from bacterial pandemics just as big, or virus is really the enemy here?
0:09:39 TS: Right. We have bacterial pandemics, as well. I think they don’t get as much attention because they don’t seem to come on quite as dramatically, and they’re ones that we’re often more familiar with. So, of course, Tuberculosis is a bacterium.
0:09:52 SC: Okay.
0:09:53 TS: One of the leading infectious disease killers across the globe, especially, in combination with HIV virus. But people are familiar with TB. Again, it’s an ancient disease. So I think there’s not the fear of that, there’s not the exotic system about it, there’s not the novelty. And then, of course, I research antibiotic resistance.
0:10:16 SC: Yeah.
0:10:16 TS: We are seeing increasing amounts of antibiotic resistance, including in bacteria like tuberculosis, which makes many of these bacterial species essentially untreatable or very difficult to treat, very expensive to treat. And so, we’re concerned about returning to this pre-antibiotic era. But that seems like, I think, it’s more like climate change. It’s a slow burn versus the obviously…
0:10:47 SC: Yeah, not quite dramatic.
0:10:48 TS: Very dramatic, a thing that is this viral pandemic. So I think people just don’t fear that as much, aren’t concerned about that as much because it’s not that kind of rapid onset like we’ve seen with influenza pandemic in 2009, or with SARS in 2002 and 3, which we got under control, but was still very dramatic and very frightening. And then, of course, Coronavirus right now.
0:11:17 SC: And is the reason why the antibiotic resistance is going down is that, in part, because people are sanitizing their hands far too much?
0:11:27 TS: That’s one way, not a big driver. It’s not the sanitizing the hands that there are some formulations that really aren’t made anymore as far to my knowledge that contains a antimicrobial called Triclosan.
0:11:42 SC: Okay.
0:11:42 TS: And that has the potential to drive antibiotic resistance. But most of the hand sanitizers out now just have alcohol, rubbing alcohol, basically. So it’s not quite the same selective pressure as some of those that did contain that anti-microbial product, which is still present in some things like toothpaste and other types of cleaning products.
0:12:06 SC: Yeah, I’m gonna be happy with it being in toothpaste. That’s okay. [chuckle] That’s okay with me. I’m not gonna object to that.
0:12:11 TS: That’s fine.
0:12:11 SC: Okay, so let’s get into the… That’s actually very helpful. I do have a better understanding now of why it’s viruses that seem to be popping up in these scenarios. So let’s talk about this one in particular. The simplest question is, what should we be calling it? There’s the Coronavirus, the SARS Coronavirus, the Novel Coronavirus, COVID-19. Can you distinguish between the nomenclature?
0:12:33 TS: Right, right. So the nomenclature is a bit of a mess even in professional circles. So COVID-19 is a name for the disease. So when you are ill with this, you have COVID-19. SARS Coronavirus 2 is the official name for the virus which many people aren’t happy about because they didn’t really want to bring back in the spectra of SARS. But that’s the official name for now which is, it’s kind of a mouthful and it’s very formal. So I have gone to using hashtag just Coronavirus because that’s what I see most commonly used. I’m not a big fan of that either because, of course, there are other Coronaviruses. There are four different mild Coronaviruses that circulate that ’cause just common colds. And then, of course, there was the MERS Coronavirus and SARS Coronavirus which caused the more serious diseases as well. So Coronavirus is a family.
0:13:29 SC: I think maybe, that’s worth emphasizing ’cause I think that maybe not everyone completely knows this. The Coronavirus is like a family that’s been around for a while, that we’ve known about. This is a particular kind that we’re dealing with right now.
0:13:41 TS: Right, exactly. So that’s why, initially, it was just called the Novel Coronavirus to distinguish it from all those other ones that we had already known about before. So this particular genomic sequence is new to us. We had not seen this particular lineage, this particular virus infect people before, but we did know about others in that Coronavirus family previously.
0:14:05 SC: And we do have the complete genome of the new one, is that right?
0:14:09 TS: We do, we have many, which is one of the things they are looking at to try to figure out how it’s spreading and also potentially, where it came from.
0:14:18 SC: Okay, so where did it come from?
[laughter]
0:14:20 SC: It’s a whole story, right? Yeah.
0:14:23 TS: So that’s what we’re looking at, right. So the animal that looks most responsible right now are bats. So we know that bats harbor a huge amount of viruses, including things like Ebola and Marburg and Nipah and Hendra, which are some of these viruses that emerged in the 2000s and 2010s. And we knew before that bats were implicated in the emergence of some of these other highly pathogenic Coronaviruses. So SARS in the early 2000s, and then MERS in the last decade. But with SARS and MERS, they also had intermediate animals involved. So that means that even though they ultimately originated in a bat, they jumped into another animal before they jumped into humans. So with SARS, we think it was a civet cat, which is kind of a Weasley type of animal. And we think that was the one that really transmitted it to people. And with MERS, we’ve seen this over and over again, that it seems to be camels, that camels are infected with this.
0:15:33 SC: Oh. Hadn’t heard that one.
0:15:33 TS: And then people… Yeah, people in… So Saudi Arabia and other places that have close contact with camels, they are most likely to be infected. So that’s what we’re…
0:15:42 SC: And when it… Sorry, when it jumps, is it exactly the same virus, or does it need to modify to jump from species to species?
0:15:47 TS: Right. They seem to be what we call pre-adapted to make those jumps. So these are ones that do not have to undergo extensive evolution like human-to-human-to-human to become transmissible within people, but they are ready to go from the outsets. They already bind to receptors on the host in the humans so they can go, they are ready to go. And so, that’s what we’re trying to figure out with this one is, is there an intermediate animal involved here? And of course, there were some evidence that maybe pangolins can be involved, but they’re still trying to figure that out. They don’t have a smoking gun there quite yet.
0:16:36 SC: And how are they doing this? Is this like boots on the ground in China trying to test a bunch of animals?
0:16:41 TS: Right, yeah. And looking retrospectively, so there was already a paper out about a year ago or so, that had actually tested some Coronavirus is coming out of pangolins, and then there was previous ones on bats. So some of this has been done already. And then they can take the new viruses and compare them to those databases, and they’re finding pretty similar matches. Again, the best match so far are to bat Coronaviruses, but some of the pangolin ones are not an exact match, but decent. So they’re trying to figure out whether those could be that Intermedia species or not, but that requires more sampling.
0:17:23 SC: Are viruses just especially good at mutating? Is their DNA a little bit loosey-goosey compared to more evolved animals?
0:17:32 TS: Yeah, it depends. So some viruses really don’t have a rapid evolution. Measles virus is very similar. You can take ones from the 1960s, and they’re very similar to the ones we use, that we see today. That’s why the vaccine has been so successful and long-lasting because they haven’t really changed that much. But then you have something like influenza, that’s why we have to get our vaccines every year.
0:18:01 SC: Every year.
0:18:02 TS: Right, ’cause it mutates a little bit. It drifts is what we call it just enough. So that those who were exposed the year before, their immune system no longer recognizes those virus after they change in that subsequent year. So it really depends. Coronavirus seems to be a little bit in the middle. It’s also an RNA virus like influenza, but it has some correcting mechanisms so that all of the mutations it has, some of them are corrected. So it doesn’t mutate as fast as influenza.
0:18:41 SC: Actually, maybe I think, I’m getting this wrong. So it’s an RNA virus, so that means it doesn’t have DNA.
0:18:47 TS: Right. So the nucleic acid is RNA. So it would be… Oh, boy. You’re making me go back to my, all my molecular biology. So it would be translated to DNA in the host cell.
0:19:00 SC: Yeah, okay. Got it.
0:19:01 TS: Right, but it infects the cell as an RNA virus.
0:19:04 SC: And there are some viruses that are DNA viruses directly and others are not?
0:19:08 TS: Right, exactly.
0:19:09 SC: Okay.
0:19:09 TS: And again, I’m not a virologist.
0:19:10 SC: Yeah.
0:19:11 TS: I wanna put that out there once again.
0:19:12 SC: Yeah, neither am I. That’s okay. Good [0:19:13] ____ slugging.
0:19:13 TS: From recollections, I think small pox is a DNA virus. So there are some that have DNA, as there are nuclei acid and others that have RNA.
0:19:21 SC: And when you mentioned influenza, I’ve never actually looked into this, but of course, every year, there’s sort of a different strain of the flu that goes around and you get your vaccine. Sorry, vaccine? Yeah.
0:19:36 TS: Yeah, yeah.
0:19:37 SC: And is it just one, or why is it sort of everywhere in the world there’s the same flu going around, or is it more subtle than that?
0:19:46 TS: Right. So what we do is, is they have laboratories that will examine influenza all year round. And so, they’ll take samples and see what’s circulating in the population. And so, of course, influenza has seasonality, so you see peaks in the fall and winter. So while we’re having our influenza season. Those in the Southern Hemisphere are looking very closely at what viruses are circulating here and then vice-versa when it’s our summer and we’re looking at their viruses that are circulating during their influenza season. So we usually determine what viruses will go in the vaccine. I think, usually, the meeting occurs in February, I believe. But again, it’s based on that surveillance what is going on in the Southern Hemisphere and what do we think is going to be circulating here then during our winter. So they will choose usually four strains. There are two types of influenza that are in the yearly vaccine. So Influenza A which is usually the worst one, usually can the most virulent. And then influenza B as well, which is the one that usually hits kids harder. So they’ll pick strains for each of those that will be included in the vaccine for the fall, and then they spend basically the rest of that spring and summer making the vaccine, getting it ready for distribution, and then so it’s ready to be injected into your shoulder by fall.
0:21:17 SC: So I hadn’t realized that the vaccine is actually sort of a cocktail that picks out what it thinks are the most likely strains. It’s not just that there’s one strain universally, but there’s a few, and you’re aiming for the biggest impact.
0:21:29 TS: Right, exactly. So the most common vaccine is what we call quadrivalent. So it would have four strains of those so that you’re protected against the most common types that are circulating.
0:21:39 SC: Okay, alright. And what is the difference then between the COVID-19, this Novel SARS Coronavirus, and the typical influenza?
0:21:49 TS: Right. So they cause similar symptoms, they’re both respiratory viruses, they’re transmitted in similar ways through what we call large droplets. So you’re coughing, you’re sneezing. The virus comes out in those coughs and sneezes, lands on surfaces, you touch things, you pick it up on your hands, you touch your face, you touch your eyes, you touch your nose, and basically inoculate yourself. So transmission and some of the symptoms are similar. So influenza, you tend to get hit with usually a high fever that comes with a, usually, a pretty rapid onset body aches what we call malaise, just that general feeling miserable. Cough, runny nose, upper respiratory issues, sore throat. So with COVID-19, you see typically a fever and a dry cough. You don’t see as many of the other upper respiratory symptoms like a runny nose. Those types of symptoms seem to be less common with COVID-19. You just see a sore throat, you can have some body aches, but that also seems to be less common. So they’re similar in a lot of ways, but of course, with influenza, we know much more about it. We have vaccines, we have treatments. With COVID-19, we are in our infancy understanding any of that there. So even though, superficially, they are similar in some of those ways. The knowledge base for those is just so much deeper for influenza than we have for Coronavirus.
0:23:28 SC: So even though the symptoms share some relationship, the actual virus is a very different kind of thing.
0:23:35 TS: Right, right, exactly, yeah. But even that there are, again, some similarities, they both do have RNA for their nucleic acids. But as I mentioned before, Coronaviruses, at least this one, do have some proofreading that they can use, so it doesn’t seem to mutate as quickly as influenza.
0:23:56 SC: Some error correction or something like that.
0:23:57 TS: Yeah, exactly.
0:23:58 SC: Yeah, alright. Now you make me think about quantum error correction, which is entirely different thing, which we should not get distracted by. So don’t let me do that. But good, this is… So maybe, we’re at the point where I can dig in a little bit more to what it means when you say, when you get the disease. So the difference between this particular virus and COVID-19 which is the disease. Talk me through the steps of getting the virus in me, getting infected, getting the disease, showing symptoms. These are all different things, right?
0:24:28 TS: Right. And that’s where things we’re honestly still figuring out is exactly the pathology of this. So what does it do to the body when the virus enters and causes damage? And we’re just starting to learn that. Again, with influenza, we know the basics. It attacks the lung cells. Usually, what you get are secondary infections, like secondary bacterial infections. So the lungs get damaged from the virus, bacteria are able to take advantage of that, they settle in. That’s usually where you get a lot of your serious infections. With influenza, they tend to be mostly bacterial pneumonias and sometimes even sepsis, where the bacteria can enter the blood.
0:25:10 TS: So that’s what you see with flu. With COVID-19, some of the reports are all over the map. So you still seem to have these serious respiratory symptoms. So one of the reasons this was identified in China, initially, was that these patients were getting what they call Acute Respiratory Distress Syndrome or ARDS, but they were negative for influenza. So they tested them for flu and they were negative, but they were seeing these really extreme respiratory symptoms. In some cases, they needed to be put on ventilators, and of course, in some cases, people passed away from this. So that’s what we’re trying to figure out is exactly how the virus does that, how it’s damaging the cells in the lungs, what is the role of secondary infections? Because many cases have been seen with some of these secondary bacterial infections kind of like flu, but others haven’t.
0:26:08 TS: So it’s just the virus alone causing this pathology? And then some people have had serious cardiac effects. So we don’t see that as much with flu. Flu can aggravate heart conditions as well, but in this case, I haven’t seen reports, at least yet, about exactly how the virus is causing those heart conditions. If it is directly causing a viral heart infection or myositis. Boy, I’m obviously not a clinician. But basically, in infecting the hearts with the virus itself. So I suspect, we’re gonna be seeing a lot more of those case reports and analysis coming out once physicians have time to do some of these analysis from some of the cases in the United States.
0:27:00 SC: Sure. Right now, they’re trying to stop people dying, yeah.
0:27:03 TS: Right, exactly. Priorities, right?
0:27:04 SC: Yeah.
0:27:06 TS: So we’ve seen some case reports, some of these… Again, not only case reports, but large aggregates of this data from thousands of cases in China, but some of those can you find granular details, we’re still figuring out. And some of those, we won’t be able to figure out wholly from human infections because of course, you don’t always follow them through, sometimes you get a person come in at the last minute, they’re very ill, they die in the hospital. So people are trying to establish animal models for this infection as well, where they can purposely infect animals and be able to detail that pathology a little bit more again, in granular detail.
0:27:49 SC: Okay. Can I have the virus in me and be completely asymptomatic?
0:27:56 TS: We think so, and that’s another big question, and one that we don’t have great data on yet. We… The evidence does show that you can transmit the virus while you are still incubating it but don’t show symptoms yet, so we call this the incubation period which is the time between when you were exposed to the virus, so someone had it, someone was expelling it from their nose and throats, and you picked it up somehow, and then the time that you develop symptoms, so when you first start to feel that cough coming on, or that headache, or that sore throat, that fever. So it does appear that you can spread the virus while you are not showing symptoms, but whether someone can do it and be completely asymptomatic so they never show symptoms, they never develop that fever or cough or anything like that, that’s still kind of a black box.
0:28:57 SC: Okay.
0:28:57 TS: We’re not 100% sure that those people, they’ll never develop symptoms, there’s some evidence for that, but what we really need to prove that is to do good serological testings, so to go out in the population, take people’s blood, look for antibodies to this in people who never had symptoms, and those are starting in China, but again, priorities.
0:29:19 SC: Yeah. There’s other things going on. Yeah.
0:29:21 TS: Yeah. Exactly.
0:29:22 SC: So that was the sort of Typhoid Mary kind of thing, right? Where one person could be just have no symptoms of the disease, be perfectly healthy looking, and yet be spreading it all over the place.
0:29:31 TS: Right. Exactly. And we think that’s kind of happened again in that pre-symptomatic phase. So there are some reports of people who were, by their accounts, not yet symptomatic, they didn’t feel ill yet, but they were interacting with lots of people, and probably spread it to them too, but then they got sick like the day later or something like that. So again, there’s been a lot of questions about this in the media and even in science circles. And so, I think the better phrase for that is pre-symptomatic rather than asymptomatic. So we’ll see how that pans out.
0:30:12 SC: I mean I have seen some claims on Twitter, which I take to be entirely reliable.
[chuckle]
0:30:17 SC: That kids have apparently been able to carry the virus around without showing any ill effects. Is that something I just… Couldn’t be [0:30:25] ____?
0:30:25 TS: And yeah, that’s another big question. So again, it’s a contrast that with flu. With influenza, children are huge drivers of the infection, I mean anyone who has kids…
0:30:37 SC: Yeah.
0:30:37 TS: Knows kids are so germy and you’re always sick when you’re a parent, and they’re just starting daycare, kindergarten or something, and oh, it’s horrible. And so, with flu, that’s why… Especially during a flu pandemic, that’s why shutting down schools is so important because the kids are the ones… They can be again, infectious well before they show symptoms, and then even after they recover after they have been sick, and now they’re not feeling ill anymore, they can still be shedding virus, so they can still go out and spread that to grandma or somebody else even if they feel fine. With the new virus, the new Coronavirus, we just don’t know. We know that kids do not seem to be showing a lot of serious symptoms. There were some studies in China that suggested that if you do more testing in kids and look for more mild infections, you do find them in kids.
0:31:33 SC: Right.
0:31:34 TS: But again, how much they’re actually driving that spread, and whether they’re doing it when they have a mild infection, or during that pre-symptomatic phase, or if they may be completely asymptomatic are infected with the virus and never show symptoms is something also we’re still trying to figure out, and that’s a key question because again, many places have shut down schools.
0:31:57 SC: Yeah.
0:31:58 TS: We are in a complete shutdown throughout the state of Ohio with all of our K-12 schools for an indefinite period of time.
0:32:07 SC: Yeah.
0:32:07 TS: And whether that will help or not, we really honestly don’t know yet.
0:32:12 SC: But it might. It might help a huge amount.
0:32:14 TS: It might. It might. We hope it will. We hope it will.
0:32:17 SC: And I mean I’ve also… I’ve heard reports that some people get it, and if they are relatively young and healthy, it’s not so bad for them, whereas I’ve heard other reports like “No, no, no. It’s really bad.” Can you give us a feeling for the spread of virulence I guess. No, probably not virulence, but the severity of the symptoms once you do get it.
0:32:41 TS: Right. So and again, looking primarily at Chinese data, but also some that’s coming out now from Italy and South Korea, does show that again, young people can get this, but their case fatality rate, so if the percentage of those who die out of the percentage of those who get it, does seem to be very low, not zero, not non-existent, definitely they can still die from it, but compared to older age groups, and unfortunately, it seems to increase starting at about 40, which is bad for me.
0:33:16 SC: I know.
[chuckle]
0:33:17 SC: I remember back when I would have laughed at this, but okay.
0:33:20 TS: Right, right. But yeah, they are just much lower than those who are even a couple of decades older than they are. So it’s not zero, it’s not like you can just put kids, or teenagers, or 20-year-olds out on the frontline, and that they will never get it and they could never pass away. It can happen, but we are definitely seeing much lower fatality rates in those groups than in older ages.
0:33:45 SC: And it seems, again, correct me if I’m wrong, but it seems like this correlation with age is more than just… Well, older people are more frail, or have other respiratory infections. It seems like it’s just, for some reason, it hits older people much more severely.
0:34:02 TS: Right. And again, that’s one of the things we’re trying to work out right now. In China also, we also saw this gender skew. So that it wasn’t only older people, but it was especially older men who were getting this. And so, there were some thoughts there. And I think, they’re seeing that in a little bit of the data from Italy as well. But there were some thoughts, especially in China, it may be related to smoking. So that if you have more older men and they’re more likely to be smokers, they’re more likely to have some lung damage already, then maybe, that’s the reason why it is hitting that group so much harder even compared to women of the same age.
0:34:38 SC: Okay.
0:34:39 TS: So I don’t know. I haven’t seen any tests of that hypothesis where they’re digging that out yet. They may be out there, but it has been such a flood of research papers. It’s hard to keep up.
0:34:48 SC: Sure.
0:34:49 TS: But that definitely was one thing they were looking at. And then, of course, there are also attendant heart issues. As you age, you are more likely to have high blood pressure or other issues with cardiac function. And so, if this is a virus that truly does also independently cause heart problems, as well, that could be another reason why you’re seeing that in those of older ages as well.
0:35:16 SC: But I guess, that makes sense to me the idea that it’s not actually technically the age that matters, but there’s some sort of accumulated low-level damage to your lungs and maybe your cardiac system that makes you more susceptible to getting severe symptoms of this disease.
0:35:34 TS: Right. And again, we are still figuring all of that out [0:35:38] ____.
0:35:38 SC: No, that’s just a wild speculation. Do not trust me. I am not an epidemiologist, much less a clinical practitioner, or anything like that. And so, that was great information, but I just wanna sort of boil it down a little bit. So people can get, can be infected. By the way, does the technical definition of infected just mean, I have the virus in my body, or is it something more definite?
0:36:03 TS: Right. It means it’s replicating in your body.
0:36:05 SC: Okay, got it. So I can be infected, I have the disease replicating in my body before I show symptoms, and that’s one… And then I can start showing symptoms. So one transition is, I’m not infected to I’m infected. Another is, I’m not showing symptoms to I am. But the third one is, I can become contagious. And one of the issues here with this particular strain is that you can become contagious before you show symptoms.
0:36:31 TS: That’s what it seems to be showing. And we don’t know, again, how much those individuals are driving transmission versus those who are symptomatic and are coughing and sharing this with others and being in close contact with their families and things like that. So that’s again, one of the other things that we’re trying to figure out. And there was a model out a couple of days ago that suggested the pre-symptomatic transmission. So those people who are out walking around, still feeling well, but can spread the virus are accounting from maybe a quarter or more of new cases. So you have about a one in four chance that that person who is not yet symptomatic but is infected is replicating the virus, is shedding the virus into the environment that they may be driving a quarter of the cases or so.
0:37:23 SC: Right. Wow, it’s a lot.
0:37:25 TS: And that could be updated tomorrow, who knows? ‘Cause we’re working out of all this incomplete information.
0:37:26 SC: Yeah, of course. No, no, exactly. Very, very rapid. Well, I would like… I’ll mention to people it’s funny, but also obviously in retrospect, true. Just a couple days ago, when I asked you to do this, I said, “Is there anything I should read up?” And you’re like, “Everything will be outdated by the time we have the conversation.” That’s how fast things are moving.
0:37:44 TS: It’s so hard to keep up with this. ‘Cause the thing, again, some of these gaps that we have, there are papers coming out every day that are starting to fill some of those, but trying to keep up with this. And most of it is in pre-prints which I know for physics, you guys have been doing that forever. But for biology and medicine, that’s still pretty new to us. And so trying to get a hold of how, what the best way is to and filter some of this information has been one of the challenges of this outbreak.
0:38:09 SC: Well, this is getting ahead of ourselves a little bit, but I think that it’s a good example of the ways in which, I don’t wanna put a positive spin on it, but people are jolted out of their complacency by things like this. And sometimes, you can actually learn something by that, right? You should have emergency kits and first aid in your house and things like that, but you shouldn’t have to go through something like this to get there.
0:38:34 TS: Right. And plans, plans for this too, yeah.
0:38:36 SC: And plans, yeah. Yeah, exactly. If I were a super villain and designing a virus to wipe out all my enemies, and my enemies were everybody, what I would want to do is have it keep people as asymptomatic for as long as possible while they were still contagious. And then eventually, after being asymptomatic for several months, it would turn on and kill everybody, right?
0:38:58 TS: Right.
0:39:00 SC: And this isn’t quite that because it doesn’t turn on and kill everybody, but it does… It is able to spread amazingly effectively because of this contagion before you’re symptomatic.
0:39:09 TS: Right. It does seem that way. And that has been one of the key issues when we’re talking about… So we’re talking about how to respond to this.
0:39:18 SC: Yeah.
0:39:18 TS: And usually what we tried to do, and what we did with SARS, was containment. So that means that you can basically stop the spread if you identify all those cases, you identify who has not only been infected, and who is showing symptoms, and who is potentially spreading it to others. You get those infected people into isolation so they aren’t around other people.
0:39:40 SC: Yeah.
0:39:40 TS: But then you also do really good, basically shoe leather epidemiology, you ask them, “Okay, so who did you have contact with? What stores did you go into? What locations did you visit?” And you contact trace all of those people they had, they were in touch with, anyone who was at those stores between certain hours or things like that, and you have them go into quarantine, which means they have been exposed, but they are not yet ill themselves. So, that’s really how we extinguished SARS, but SARS was a little bit different in that it didn’t seem to spread efficiently during that incubation period, during that time when you’re not yet showing symptoms. So that’s what we try to do initially with this. And when you saw cases elsewhere, but really, that pre-symptomatic transmission is What is messing everything up. So that is why we have gone from containment to mitigation to just trying to stop the effects of this and trying to use things like social distancing, and school closures, and increasing hygiene. Just to try to blunt the effects of this virus on society basically, knowing that containment is gonna be difficult to impossible, because of that pre-symptomatic transmission.
0:41:00 SC: Yeah, I wanna get into the details of the strategies we’re taking against it. So the last question, before we get there is, how… There seemed to be… How long does it take to become symptomatic? There seems to be a range, like some people are saying, well, they got it just a couple of days after exposure. Some people are saying as long as 14 days or longer. For the person out there who’s wondering, “I was on a plane, a certain number of days ago. I’m worried now.” At what point can they say, “Okay, I haven’t gotten it”?
0:41:28 TS: Right. And it’s always a range because it will depend on a lot of things. It will depend on what your exposure was to the virus. What dose of virus were you exposed to? So, did somebody hack on you in close quarters or something like that, where they could have expelled a lot of that virus onto you, or did you touch something that had just a small amount of virus on it? And so it will take a lot longer for that virus, to replicate in your body to the point where you get symptoms? And also just, is your immune system robust? Are you immuno-compromised? That can also play a role in the length of that time period. So, we always give it in a range. From what I’ve seen, this is an average of maybe six to seven days or so, but it can definitely go up to at least 14. We’ve had0 some case reports, where it goes up to maybe 21 days, but that seems to be pretty rare. So they do say usually about 3 to 14 days is the typical range with 6 or 7 being the most common, most common point.
0:42:35 SC: Interesting, yeah. So I was on a plane two-and-a-half weeks ago, so I think that I’m okay, but it was coming from Australia, before things really got hot. But you do, it is psychologically… It’s tough, you wonder, right?
0:42:49 TS: Right.
0:42:50 SC: If something has happened. So let’s move into what we should be doing. I know that the online conversation is constantly evolving. There was a big wave of flatten the curve, which is just slow down the rate of infections, so the hospitals don’t get overwhelmed, but now we’re getting the backlash against flattening the curve, and it’s all about testing now. So do you have a… Well, before you even have an opinion what we should be doing, like what are we doing and is it a good set of things we’re doing?
0:43:23 TS: Right. So again, the emphasis has been on the hand washing, not touching your face, which I know once people said that, everyone realized how difficult that is.
0:43:34 SC: I don’t even try that, I cannot, I’m sorry, I try to be a good citizen, but touching my face is going to happen. And by the way, so soap right? People are really into the anti-bacterial disinfectants, but soap is apparently even better, for this particular virus.
0:43:48 TS: Yes, soap is better in general, for any kind of hand hygiene. So we recommend, if you’re around soap and water, do that, if you have access. I carry around hand sanitizer but it’s for those places where I don’t have access to a sink. And so if I’m going in a building and touching elevator buttons or something like that, and there’s not a restroom close, then you can use hand sanitizer, it’s okay, but soap and water is definitely preferred.
0:44:16 SC: 20 seconds?
0:44:17 TS: 20 seconds, wash all the surfaces of your hands get under your nails, all of that.
[chuckle]
0:44:24 TS: Absolutely. Whatever [0:44:26] ____ you choose I know there have been so many circulating.
0:44:28 SC: There are, a lot of little songs to sing. I do have a slightly contrary and take here that maybe you can dis-abuse me of, which is the following. I worry that the emphasis on washing your hands for 20 seconds can be counterproductive if it makes people wash their hands less frequently, like if it’s so much of a burden to wash your hands, could you at least make the argument that it’s just better to be constantly washing your hands, whenever you get the chance, rather than twice a day just doing a really good job?
0:45:00 TS: Oh yeah, so I’m a bacteriologist, I’ve worked in a lab for 20-25 years. My view of the world is that everything is contaminated.
[chuckle]
0:45:09 TS: So anything you touch basically, if you just washed your hands, but now you touch that doorknob and you’ve contaminated yourself again, so I do it as often as possible, especially when I’m in public spaces and especially during a pandemic, so I also often carry a little bottle of lotion with me because I know that it can be hard on the hands to wash them very frequently. But when you’re out there in public, you just don’t know. So I just assume that every surface is contaminated, then go from there.
0:45:37 SC: Good, and there’s a whole bunch of questions that I can be asking, like are masks useful? Social distancing? But why don’t I let you talk for a second about what do you think is going on and how effective it could be?
0:45:49 TS: Right. So the biggest goal of course is to just decrease that number of contacts every person has every day. So we know that… On average, each person who is incubating this virus, who has it, and can spread to others, will spread it to somewhere between two to three people on average, okay? Some people, again, have spread it to like 50. Some people will be infected and will not be in contact with anyone else, they will spread to zero, but that’s why we go with that average number, right?
0:46:19 SC: Yeah.
0:46:20 TS: So what we’re trying to do with this social distancing is to decrease the number of contacts you have per day. So if you’re only in your house, only with your family, at least you will have a minimal number of contact with other individuals who could potentially spread that virus. So that’s the goal, and the goal is to, again, not necessarily extinguish this, because that’s gonna be really difficult.
0:46:47 SC: Yeah.
0:46:48 TS: But it’s to slow it. And again, not only to… Just because we want to decrease transmission of the virus but because we want to mitigate those serious infections, so the people especially again elderly and older people and those with pre-existing conditions, who might have really serious infections and spread those out more over time so that there will be enough beds in the ICU, and so that there will be enough ventilators and other types of medical equipment. So that we can respond to those people who need serious care, and also of course have the healthcare workers available to respond to that over time. So, that’s the basics behind the extreme social distancing we’re seeing. And the mantra of flatten the curve.
0:47:34 SC: So just to be clear, we’re in favor of social distancing. We’ve all seen these pictures online of people saying, “Alright I’m healthy, it won’t hurt me to go out on a pub crawl, or whatever, to go to a concert”, which is a little bit crazy. Am I not wrong? [chuckle]
0:47:52 TS: Right. Yeah, so at Kent State University, we decided, everything is planned together, a week ago or more, that we were going to move the rest of our semester to completely online classes, so that again, we can reduce lectures of 400-500 students, and reduce all of these transmissions. But then this past weekend, one of our local taverns, had a Coronavirus party.
0:48:17 SC: Oh my goodness.
0:48:17 TS: So there were a lot of students there. There were some of the frats that held parties. So we had pictures from just this past weekend after all of this has been going on with lots of students together, so I understand that they’re not typically in these higher risk groups, they’re obviously not because of their age, but they can spread it to others who are. So yeah, so we’re trying to get that through, especially to the younger people, I think that even if they will probably be okay, they could be coming in contact with their elderly neighbor or start a chain of transmission from themselves to their mother to their grandmother or something like that. And could end up with somebody seriously ill or dying. So I think we have to think about how we are all in this together. And even if your individual risk may be low, if we can break some of those chains of transmission, you could be protecting other people that you love.
0:49:17 SC: Yeah, even just a week ago, I thought… Of course I didn’t want to fly on airplanes or be in large lecture halls or concerts, but I figured like going to a restaurant, or going to the gym, would probably be okay and now I’m like, “Yeah, that was just crazy. Why would I have thought that?”
0:49:33 TS: Well, it’s evolved so fast. A week ago, we didn’t have as many cases, and now, New York just announced a 1000 more over night. So we’re seeing this real jump in cases everywhere, and states that are reporting cases and things. So I think it feels much more real maybe, to people this week than it did even a week ago.
0:49:58 SC: Well the NBA has ended its season, right? With celebrities, Tom Hanks, Idris Elba, And others have said that they have tested positive. I think it brings it home to people in a different way.
0:50:11 TS: I do, I do, too. I agree.
0:50:14 SC: But okay, so how far should we go? So, you’re in favor of shutting down all the restaurants here in LA, we’ve done that. There’s no more restaurants, you can… Which is obviously gonna be devastating to the restaurant industry and the service industry more generally. You can get take out, and you can even get delivery. We’ve also shut down all the gyms and things like this, but we do… The supermarkets are still open right? People kind of waiting in line. Do you think we’re at a sensible level of restrictions now, or should we go further? Have we gone too far?
0:50:47 TS: Yeah, I think it’s so hard ’cause I completely understand that this is people’s livelihoods in the balance, and that even if we do mitigate the spread of the virus, and the physical effects that that has on individuals, there are a lot of things that is gonna worsen right? A lot of the people’s mental health already, I feel bad for the extroverts. I’m an introvert so I can handle this. [chuckle]
0:51:10 SC: Yeah.
0:51:11 TS: But already after three days, people are missing that contact. And so I feel really bad for them. And I have an uncle who owns a cafe, and he is trying to do everything with take-out, that’s gonna take a big hit to him and his employees. So again, I wish we had had a good plan for this beforehand, so that we knew what people in those financial situations could do, and we didn’t have to worry about them as much as kind of collateral damage for some of this, but we don’t, so we’re trying to figure out as we go. And some of these places are just… We need the supplies. You can’t completely shut down grocery stores for 8 weeks. Because even those who were kinda prepared for this, the general recommendation was to be prepared to hunker down for about two weeks. I mean how many people can have two months worth of supplies just sitting at home?
0:52:02 SC: Nope, not here.
0:52:03 TS: Right? That’s just not reasonable to expect. So obviously, we still need a lot of those services, we still have to have people bringing in paychecks, and buying their own food and paying their own rent. So I think we have to figure out a way and something quickly to really help people who are affected by this in other ways. I do think it’s the right thing as far as controlling virus spread, but we have to do that in such a way that it doesn’t harm individuals in other ways, and I think that’s the part that’s still trying to be worked out. I will say in Ohio, I was really glad that before they shutdown the K-12 schools, lots of places did have things set up so that these kids who were getting lunches and breakfast at schools, they are still able to get those, lots of them have kind of a pickup, come and pick up a boxed lunch or something, so that they can still get that, they’re still getting fed. We… Our school took a survey and gave laptops and internet hotspots to people who have no internet access at home, and no computer at home. So I think some of those things are being done, again, kind of figure out maybe a little bit last minute.
[chuckle]
0:53:15 TS: But that’s what the types of things that you have to do to try to do this over time. And again, we’re really basically one week into this, and I have no idea how all of this is gonna go, and how long people are gonna be able to do this type of thing.
0:53:29 SC: Well, I think you make a good point because clearly, there’s a sort of a continuum, right? There’s a spectrum, like of course, if we just insisted, which is almost what San Francisco is doing right now, but if we just insisted everyone just stay home, then we could in fact, limit the propagation of the virus. On the other hand, there’s negative effects to doing that, right? Both health and physical health, and mental health, I mean let me give you an example. So food delivery is supposed to be good, right? ‘Cause we’re not all congregating together in a restaurant, but I’ve heard recommendations that ask the delivery person to just set down the food on your doorstep, and then you come pick it up without ever touching them, or at least holding the bag at the same time as they’re touching it. Is that kind of just like going a little bit too far, or is that actually completely prudent and wise?
0:54:19 TS: I mean I think that’s prudent if you can do it. Because again, I mean those delivery people, if you have face-to-face contact with every single person that they’re out delivering food to, that’s gonna put them at risk, and then that’s also gonna put potentially all those customers at risk. So I think as much as possible to try to mitigate that person-to-person interaction, it’s gonna help us in the long run. I know it’s so hard for some people to hide… I totally understand they wanna chat up the delivery person or something instead of just get their food at the doorstep.
0:54:49 SC: Yeah. Yeah. Okay. Good. No, I think that’s a good point. It’s a… Even though it seems maybe a little precious, it is a simple thing to do compared to other things, right?
0:54:57 TS: Right. Exactly. It’s easy to implement.
0:55:00 SC: Right. So, good. So I have a few other examples of things that we’re trying to do and you can tell me whether they’re good ideas or not, and I predict ahead of time, you’re gonna tell me they’re all good ideas.
[chuckle]
0:55:10 TS: Okay.
0:55:11 SC: Forgetting about restaurants, just like having friends over to your house, that’s probably something we should try to minimize as much as possible, right?
0:55:18 TS: Yeah. At first, ’cause again you just never know if somebody has been exposed, or somebody could be incubating that virus, you just don’t know.
0:55:24 SC: Yeah. What about touching surfaces [chuckle] at various places? Like I know we have to go to the supermarket, you do have to get food, and there is a sensible recommendation buy as much as you can every trip to minimize your number of trips, but how much should I worry about the fact that you know, even knowing it or not, I’m touching the shelves, I’m touching a bag, something like that. Are some kinds of surfaces more dangerous?
0:55:51 TS: Right. Well, things that are… So when we think about environmental surfaces, we think for the most part about high touch surfaces. So those are the ones that are shared by a lot of people. So the shelves themselves, people are probably not gonna be running their hands along the whole shelf. But things like at the register, the… If you have a pen pad or a pen to sign things, those are the things a lot of people are going to have shared and touched as they check their food out. So again, I’d recommend once you’re done with that, once you’re done in the supermarket, again throw your hand sanitizer or something, if they don’t have a… Maybe you can’t go in the bathroom and wash your hands, if you have a cart full of food, carry your hand sanitizers so that you can at least rub that on your hands before you get into your car and touch your steering wheel and everything else. And then we have put in the ritual, especially with my kindergartener that every time we come home, first thing we do, we got a bathroom right inside the door, you wash your hands. So I think we’ve just been trying to make that normal now. No matter where we were, you come in, you wash your hands.
0:56:51 SC: Well, you mentioned the touch pads, apparently phones are another place, even if you’re not sharing your phone around, your phone has been all over the place. Does it make sensible to be disinfecting your phone screen?
0:57:03 TS: Yeah. I mean the phones can get really gross. And most of it is that germs, mostly bacteria that come from you typically, but you definitely… If you’re at the grocery store, and you text somebody, you’re on the way home, now you transmitted some of that to your phone. So yeah, they… And I know there is a thing… There have been a couple of articles about how to disinfect your phone. I usually just… I just have my alcohol wipe that I will use. But I have a screen protector, so it just goes on that, so I don’t have to worry about it damaging my phone. But there are… I know there are a lot of articles out there about how to disinfect your phones and different types, and if you don’t have a screen protector, what do you do. So I would refer people to those, but do think about that because your phones are definitely germy.
0:57:46 SC: And what about when we’re… We’re told that we’re allowed to walk outside with our friends on a nice walk to the countryside but as long as we keep six feet away from them.
[chuckle]
0:57:57 TS: Right.
0:57:57 SC: Is that good advice?
0:58:00 TS: That’s the recommended distance based on again, droplet transmission. So how far those droplets would really travel if you’re just talking with another person. So I think especially for those people who really crave those interactions, that if you can go outside and do a hike and keep your distance and things like that, that… Again, we can’t say anything is risk-free, you just don’t know. But if you’re looking for something to do that has minimal risk probably, those are the types of activities that you could do and still be with other people but have less of a risk of transmitting the virus between your groups.
0:58:38 SC: And what about wearing masks while we’re on these walks? Does that make any sense?
0:58:42 TS: Yeah. So not really. [chuckle] The masks that most people will have access to are the paper surgical masks, and were helpful if you are infected and you’re trying to keep your spray from coughs and talking, and things like that to yourself. So you put on a mask so that captures a lot of those droplets and keeps it from spreading to other people. But in general those types of things are not helpful. We don’t have any evidence that for the average person, masks really help. And for the ones that are certified to keep out viral particles, the N95 respirators, most people don’t use them correctly. You have to be tested which is a whole thing you have to go through, it’s not pleasant.
0:59:34 TS: And honestly I mean if… A lot of the people who are talking about them probably have never worn them for an extended amount of time because they’re uncomfortable. The whole point is they filter the air, and as you have them on for hours, that makes it hard to breathe. So some people who have risk factors like asthma or things like that, they’re not gonna be able to wear them for a very long time anyway, just because of that difficulty. And then I think normal people who aren’t trained on those, you don’t realize how often you’re touching those masks and basically contaminating the masks from the outside. So people don’t think about that. I’ve used them in laboratories, but again, it’s under conditions where often I’m also wearing gloves, and so I’m very aware of everything that I’m touching, including my face. And I know how to take them off and on correctly without again, contaminating yourself with potential virus that may be on the mask. So I think for an average person masks sound good, but I don’t think they really do much to help. And could potentially even put you at greater risk if you’re not using them correctly, and you’re using them as something to make you maybe feel better.
1:00:41 SC: Yeah.
1:00:42 TS: But then, you’re just using them incorrectly. I mean a friend of mine shared… Go ahead.
1:00:47 SC: I was gonna say, I’m in favor of feeling better, but not if it makes things worse off in actuality.
1:00:52 TS: Right. A friend of mine shared some pictures. She was actually in the airport a couple weeks ago, and a woman had a mask and gloves on. And then she took the mask and the gloves off ’cause she was in a restaurant at the airport eating, sat them down on her table, proceeded to eat, and then put them back on afterwards. At which point, they had been sitting on the table so they are potentially contaminated, and then she put them just back on. And so I think, you would see those types of things anyway. And she probably just increased her risk rather than just eating, going to the bathroom, washing her hands and getting on her flight.
1:01:23 SC: So she increased her risk because she basically allowed contamination to crawl onto her mask and then attached it to her face, right?
1:01:31 TS: Exactly, exactly. And the same thing on her gloves. I guarantee she probably thought those gloves were sterile or something like that. Not realizing that as soon as you touch anything, those gloves are no longer sterile. So it’s the type of thing that again, I don’t think the average person thinks about, but those of us who are trained in Microbiology, we are hyper aware of that. So we know how to use this correctly, but most people don’t.
1:01:54 SC: It was interesting that masks and toilet paper were the first things sold out. I’m not quite sure I understand the toilet paper thing, but I know that there isn’t any available here in Southern California right now. Do you have… This is a little bit outside of your area I know, but do you have advice for what people should make sure they have available other than the obvious things? Is there something we’re missing or something we’re wrongly hoarding?
1:02:18 TS: Oh, yeah. I don’t know. Yeah, we don’t have any toilet paper around here either. It’s really weird. And we went out to get just some of the basics the other day, and milk was almost gone too. So it’s those things that I… We bought and we keep on hand a lot of dry goods, pastas and things like that. And canned meat, that again, may also be difficult if the Deli shuts down or something like that. So we try to get things just that will last for the long haul. And even if we don’t… Even if we don’t eat them right now, that’s great. Then we’ll just have a year’s worth of pasta. [chuckle]
1:02:52 SC: Yeah, there’s nothing wrong with that, right.
1:02:53 TS: Right, exactly.
1:02:57 SC: Okay, so that’s sort of the present day. Except I guess the one thing that I haven’t quite addressed, is what happens if you are infected? Number one, what does the testing regime involve? I know that in China and elsewhere they tried, and I think somewhat successfully, to implement all sorts of preliminary tests just by taking your temperature remotely, just to see if… And your temperature goes down if you are infected, is that right? Or does it go up?
1:03:28 TS: I have not seen that it goes down. It should go up ’cause you have a fever.
1:03:31 SC: It should go up ’cause you have a fever, okay. Maybe I just got that wrong. But then, the test is one of the ways of which here in the US, we’ve been sort of falling down on, right?
1:03:40 TS: Right.
1:03:41 SC: But what does it mean to get tested?
1:03:43 TS: Right. So what we have available now is a PCR test. So that means that you’re looking for pieces and parts of the virus, alright? So we take samples typically from at least two, maybe three bodily samples. So one is a nasopharyngeal swab. So it’s a cotton swab that goes up your nose really far back, really far back. It’s not pleasant to be honest.
1:04:08 SC: It’s supposed to be quite unpleasant, right.
1:04:10 TS: Yes, yes. So they’ll take that, they’ll take a throat swab, like if you’ve had a strep test. And then for people who are actively coughing up, loogies basically, they’ll take a sputum sample. So two or three of those samples, and then they will extract the RNA from those samples and run it in a machine. And so basically, what it will tell you is if you have viral RNA present in any of those samples. And so if you do, then you’re positive obviously. If not, then you’re negative. But one of the things this is trying to figure out in the optimal time for sampling, ’cause most people of course, are only gonna get tested if they’re showing symptoms. But what if you have people who are exposed to those individuals? And right now, we really aren’t doing a lot of that testing. But ideally, we could test some of those people, and what is the best time to test them so that we don’t have a false negative that they are affected, but maybe the virus is at too low of a level to be detected. So we call them negative, but then three days later, they come back with symptoms. So we’re still trying to optimize all of that basically. What are the best places to test and at what time periods?
1:05:27 SC: And I do know that we don’t have nearly as many tests or other things as we need, how quickly can we get that stuff? Is it something where if we really put our collective will together, then two weeks from now, we’ll have more than enough tests?
1:05:41 TS: Yeah. In theory, yes. But now, we’re starting to see, so not only were the tests late in being rolled out… And the tests are just… I mean they’re just simple chemical compounds you have. They have some what we call primers, which are again, just short sequences of nucleic acid, that will bind to the viral RNA to allow them to be amplified in this test. So there’s some of those, there’s some salts and things like that. And a mix of just free nucleic acid, so that they can come in and be amplified. So they’re not hard to make, but some of…
1:06:18 TS: We’re running out of some test kits apparently to do RNA extraction, so when you get the sample, you have to extract the RNA from that. We’re running low on test… On kits for that. We’re running low on swabs, so the cotton swabs that people need to do these testings, we’re running out of those too. So it’s become a place where it’s not now only how can we ramp up manufacturing of those test kits, but how do we make sure that people have all of these supplies that they need to do these tests overall. And we are just botching it on so many different levels. And so people are trying to figure out, “Okay, so where do we go to get these swabs?” And I have not seen a great answer for that. Some of them… Apparently now that a lot of the colleges are shut down, they’re going to the biology labs and saying, “Okay if you’re not gonna use those swabs, can we have them?” [chuckle] And that’s such a bad stop-gap ’cause what happens then when all those are gone?
1:07:12 SC: Yeah.
1:07:12 TS: So I just don’t know. It seems like it should be really simple to ramp all of this up, but every time we figure out how to do something, it seems like we have another step back somewhere else.
1:07:23 SC: Okay, this is a sobering thought. Obviously, this is at the very least an educational incident for planning for the next time around. The idea of running out of swabs never would have occurred to me, but clearly it’s kind of important.
1:07:38 TS: Yeah. There are gonna be so many papers written on this when all is said and done, on all of the things that went wrong.
1:07:43 SC: And can we predict… Right now is, as we speak, in most countries, we are still on the exponential curve. There’s a certain time it takes to double the number of cases, between two and three days. Some countries have turned that over. China certainly has done quite an effective job. Japan and South Korea, and Hong Kong maybe. But I’ve heard predictions that something like half of the world’s population will eventually be infected by this virus. Is that a reasonable kind of statement, or is that just alarmist to shake us up a little bit?
1:08:25 TS: I think it’s both. It all depends on what we do. And that’s the thing, that’s why I think those numbers typically are quoted coming from Marc Lipsitch, he was an epidemiologist at Harvard and has been one of the leading scientists on this. And it has a range, I think the last one he released was about 20-60% of the population. And so that depends on what we do and how long we do it for. So that’s one of the big questions right now, is, okay, we’re in this mitigation phase and maybe we can slow this down. And so then if we slow it down, what happens then when we relax our social distancing, when we open restaurants back up? Is it just gonna peak back again? And that’s why we’re watching so closely what’s happening in China and in South Korea, and to watch when they open things back up again, is this just gonna spike again? So those are some…
1:09:17 TS: Again, some of those questions that we just don’t know. I don’t think it’s completely unrealistic to think that if we go back to basically just our normal routines, that more people are gonna be infected. But I don’t know that we can maintain this type of social distancing. There’s a report from Imperial College, and they said us that this may be necessary for 18 months or basically until we get a vaccine to do this type of social distancing. I don’t know that that’s gonna work either. So all of those predictions on total number of cases, total number of deaths, total number of people infected over the course of this pandemic are really dependent on what we do.
1:10:04 SC: Right.
1:10:04 TS: So it’s kind of up to us, how low or how high those numbers can be, and what we can take and what society can take. And I don’t think we know any of that right now.
1:10:17 SC: Yeah. No, I can absolutely imagine… You just said this, but I’m gonna say it again, ’cause it’s so important. We do all these wonderful things, we lower the rate of infections substantially, and then we relax and it all comes roaring back. And it sort of doesn’t go away for much longer. But it’s also, at the same time, important to realize that these measures that we’re taking have their own deleterious effects. It’s not an easy balance to strike. We have to be respectful of the fact that we need to sort of think carefully about this, and not scream at people who disagree with us about what the appropriate measures are I think.
1:10:54 TS: Right, right. And there is a lot of disagreement even within the scientific community, whether we acted too quickly, whether we acted too slowly, whether this is gonna help, whether it’s not. Especially around the aspect of schools, so I don’t think there is anything where everyone completely agrees, besides the fact that we need to do something about this, but what is the right thing to do?
1:11:18 SC: I know this is an incredibly unfair question, but are there any… What are the prospects for either cures and/or vaccines? Or is that something that science is going great guns any minute now? Or it could be years?
1:11:32 TS: Right, I’m…
1:11:32 SC: Or anywhere in between?
1:11:32 TS: I’m honestly a little bit more… [chuckle] Right, right. I’m a little bit more hopeful about treatments. Maybe just because that’s the area I know less about, so I can be more optimistic.
1:11:42 SC: Exactly, let’s do it.
1:11:43 TS: But it looks like they’re [chuckle] right there… There are some drugs out there that may be helping. Some drugs that have been used for Ebola previously, or that were developed for Ebola, that are being used to treat this, for Coronavirus. They are in clinical trials. There’s a malaria drug that has been used for this, that is in clinical trials. So the nice thing about those is that we already have information about those, we already know a little bit about their safety, about side effects and things like that. So those are able to move much more quickly. When it comes to vaccines, we are at square one basically. There were some vaccines that had been started for SARS, but then SARS, we were able to contain it and it went away. And so no one cares anymore, and the funding went away. And the expertise in some cases went away.
1:12:33 TS: So we have some of those that were developed, that they’re hoping to get back into clinical trials. We have one… A new one that they’re developing that clinical trials are already underway, in Washington State. But even those, for vaccines, we have to do several different phases. So right now the one that is taking place in Washington, it is solely a study for safety, ’cause you have to have a safe vaccine first. So they’re injecting it into people to look for those types of side effects. And you can’t just do this in a week. Some of these things that a vaccine may cause potentially could be delayed for months, if you have an auto-immune reaction or something like that. So they’ll be looking at that first for safety and then the test if it actually works to protect people from the infection.
1:13:22 SC: Right.
1:13:23 TS: And then even now, we again, follow those for a very long period of time. So vaccines just are not easy and they’re not quick, and we don’t want them to be quick because we don’t want people to be injured from them. Or have things happen that we didn’t see in those first trials. So of course I’ve seen the predictions for 12 to 18 months for vaccine. And I just don’t… I think those are the most optimistic projections.
1:13:46 SC: The most optimistic. Okay, good.
1:13:48 TS: Yeah, and I just don’t know that we’re gonna hit those targets or not.
1:13:52 SC: So a little bit of room for optimism about treatment, not so much about vaccines. And just to be clear, I take it that if it’s treatment that is what we have for the next two years, then we’ll still have to do everything we can to slow and limit the rate of transmission?
1:14:10 TS: Right, exactly, ’cause we’re still not… We still have another way besides social distancing and hand washing and all of the things we’re doing now, to prevent infections. So treatment, obviously, is for those who are already potentially in the ICU or very ill otherwise, or something, so that they would get the drugs, but of course, that’s after they’ve already experienced this severe infection.
1:14:30 SC: So, just to focus the mind a little bit, it’s right now, Wednesday, March 18. I’ve seen people in all good-hearted sincerity, think that, “Okay, two weeks from now, we’ll be getting back to normal.” But I don’t see any reason for that. I would say… I would guess that everything we’re going through right now, up to including the sort of shelter in place in the worst places and the shut down of restaurants and things here in LA, or in Ohio, at least two months, right?
1:15:00 TS: Yeah, that’s what… So one of the lead scientists on this for the White House has been Tony Fauci, who is the Director of the National Institute For Allergy and Infectious Diseases. And he has suggested at least eight weeks. So I think people need to get into that mindset that yeah, this is not gonna be over in two weeks. You’re not gonna be able to pick up and go to your concerts that are in early April or something, that’s just not gonna be on the radar at that point.
1:15:25 SC: And what is the… What does the end game look like? If we don’t get a vaccine, at what point would you personally… Again, I’m putting a lot of responsibility on you, don’t feel bad about that. At what point could we relax a little bit? Or is there a threshold, a test, or some criterium by which we can say, “Okay, things are getting better”?
1:15:47 TS: Right, and that’s one of the things the Imperial College report looked at too, is trying to figure out what level of disease in the population can you relax things a little bit. But then do you have to be prepared to, okay, once it gets above that threshold again, then you go through these things all over. So you’re basically kind of cycling through this and there are no great answers to that either. We also have still the unanswered question of, “Will warmer weather help with this?” And I don’t think there’s a lot of good evidence that it will, but I noticed that people are definitely at least clinging to that bit of hope that when it warms up across the country, that maybe transmission will decrease due to higher temperatures and things like that. So I don’t know, I don’t know if summer will help us or not, if we could relax some of those, if we saw transmission decrease and viral survival outside of the body decrease because of the heat and humidity in the summer… So I just don’t know. And the problem with some of those thresholds too, is that that assumes you’re doing a lot of testing, so you really know how it is circulating in the population. And of course we still don’t have that yet. So all of those really require some things that again, we’re either not doing, or we don’t have in place, or we’re guessing about as far as some of the effects it may have on the virus in coming weeks.
1:17:09 SC: So what I might guess…
1:17:10 TS: So yeah, we just don’t know yet.
1:17:13 SC: Yeah, it might be the case that then things are more or less like they are now, or even more shut down for the next two months. And then we undergo some sort of cycle of relaxing a little bit and then tightening back up when… If and when things get worse again, and that could last for a while.
1:17:33 TS: Right, we might… And I have not seen any of the US, either scientific or political leaders respond to that yet, so I don’t know what their thoughts are as far as doing that type of cycling, I just don’t know.
1:17:46 SC: And so okay, so I guess the final big picture question… People have said that the virulence of this particular pandemic is kind of a once-in-a-century thing. Does that mean we’re probably gonna be okay against things like this for a while, just probabilistically? Or are we entering a new phase when things like this happen all the time?
1:18:13 TS: Yeah. Snd I don’t know, probabilistically… I was in Iowa for a long time, and we had several 500-year floods within a five-year period, so… [chuckle] So statistically you shouldn’t have that but yeah, we did, right?
1:18:27 SC: Well, because the underlying conditions were changing.
1:18:30 TS: Right, exactly, exactly, based on… Those were all based on calculations from decades ago and now they’ve switched. And so the same thing here, I think we were lucky with SARS, we were lucky that I think that didn’t have that transmission during the incubation period or at least very little of it. And so we were able to put that genie back in the bottle. We’ve been able to contain MERS, this one got out of hand. And we just really don’t know how many of those other types of Coronaviruses, or other viruses, that maybe aren’t on our radar could be lurking in animals around the globe and could have the potential to do this to the human population. So I don’t think we should get comfortable. I think we need to think of this not as a once-in-a-century event, but what if it’s once in a decade event. We just don’t know, but we need to have more of those preparations in place so that we can be more nimble to respond to these types of things when they happen. And not be completely behind the curve as we have been with every step for this one.
1:19:31 SC: Well, I think that we’re doing our part here in this episode to make people not comfortable, [chuckle] and not relax.
1:19:37 TS: [chuckle] Perfect. Fantastic.
1:19:41 SC: I know. But look, life does continue on. I think that we’re resilient, we will find ways to live under whatever conditions we have, and it might be… We might suffer a little bit, but we gotta continue on doing things like the work you’re doing, and even I’ll go so far as to say conversations like this are very helpful to get people informed. So thanks so much for being on the podcast at very short notice, I really appreciate it.
1:20:09 TS: Absolutely, thanks for having me. [/accordion-item][/accordion]
I was hoping you would post something like this. Thanks so much – you da man!
I have been following Tara Smith, Helen Branswell, and Maryn McKenna for some time. All so smart. Thanks for all you do to educate us. Very informative interview – this helped me.
Thank you Sean for this podcast! I want to take advantage of this opportunity to thank you for the fantastic material that you are putting online. I enjoy your profound and valuable conversations with all the experts. Keep doing what you are doing. With so much free time on our hands, we need now, more than ever, to listen to your enlightening podcast.
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FIRST …THANKS to Sean and Tara
SECOND:
The early days of China’s coronavirus outbreak and cover-up
that begins before Dec 31 and has a more complete version available on :
Axios China
By Bethany Allen-Ebrahimian ·Mar 18, 2020
Here’s an abbreviated timeline (full version here), compiled from information reported by the Wall Street Journal, the Washington Post, the South China Morning Post, and other sources.
It shows that China’s cover-up and the delay in serious measures to contain the virus lasted about three weeks.
Dec. 10: Wei Guixian, one of the earliest known coronavirus patients, starts feeling ill.
Dec. 16: Patient admitted to Wuhan Central Hospital with an infection in both lungs but resistant to anti-flu drugs. Staff later learned he worked at a wildlife market connected to the outbreak.
Dec. 30: Ai Fen, a top director at Wuhan Central Hospital, posts information on WeChat about the new virus. She was reprimanded for doing so and told not to spread information about it.
Dec. 31: China tells the World Health Organization’s China office about the cases of an unknown illness.
Jan. 1: Wuhan Public Security Bureau brings in for questioning eight doctors who had posted information about the illness on WeChat.
Jan. 2: Chinese researchers map the new coronavirus’ complete genetic information. This information is not made public until Jan. 9.
Jan. 7: Xi Jinping becomes involved in the response.
Jan. 11–17: Important prescheduled CCP meeting held in Wuhan. During that time, Wuhan health commission insists there are no new cases.
Jan. 13: First coronavirus case reported in Thailand, the first known case outside China.
Jan. 15: The patient who becomes the first confirmed U.S. case leaves Wuhan and arrives in the U. S., carrying the coronavirus.
Jan. 18: Annual Wuhan lunar new year banquet. Tens of thousands of people gathered for a potluck.
Jan. 19: Beijing sends epidemiologists to Wuhan.
Jan. 20:
The first case announced in South Korea.
Zhong Nanshan, a top Chinese doctor who is helping to coordinate the coronavirus response, announces the virus can be passed between people.
Jan. 21:
The U.S. Centers for Disease Control and Prevention confirms first coronavirus case in the United States.
China’s top political commission in charge of law and order warns that “anyone who deliberately delays and hides the reporting of [virus] cases out of his or her own self-interest will be nailed on the pillar of shame for eternity.”
Jan. 23: Wuhan and three other cities are put on lockdown. Right around this time, approximately 5 million people leave the city without being screened for the illness.
Jan. 24–30: China celebrates the Lunar New Year holiday. Hundreds of millions of people are in transit around the country as they visit relatives.
Jan. 24: China extends the lockdown to cover 36 million people and starts to rapidly build a new hospital in Wuhan. From this point, very strict measures continue to be implemented around the country for the rest of the epidemic
The bottom line: China is now widely claiming that its actions to combat the coronavirus bought the world time to prepare. In January, the opposite was true.
Thanks for the much-anticipated episode. It is good to hear from someone who knows the literature. 🙂
About the masks, I thought it was a bit misleading to say that it is not useful for combating the spread of the virus. If masks prevent infected people from spreading the virus, and if a lot of infections are asymptomatic (or “pre-symptomatic” as you put it nicely), then surely wearing a mask will reduce the overall transmission rate significantly?
One side-note is that I feel when we talk about combating the spread of the virus, we should distinguish between egocentric measures (i.e. measures which will protect “me” from infections) and social measures (i.e. measures which might not protect “me” specifically but would help reduce the overall rate of transmission in a society). We can then say that masks are ineffective from an egocentric perspective but effective from a social perspective.
If any of the above sounds wrong then I would love to learn how and why. Thanks again for the great work!