The Pandemic’s Prophet
Air Date: June 15, 2020
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HEFFNER: I’m Alexander Heffner, your host on The Open Mind at home. I’m really honored to welcome our guest today, Laurie Garrett. She is the Pulitzer Prize winning science journalist, who, and she’s mad as hell because she predicted the looming crisis. She is author of “The Coming Plague.” The crisis we’re in now Laurie, you had the most foresight of any active journalist or scientist on this planet. You had that foresight because of years in the trenches covering infectious disease. What struck you so much from the early news reports that you knew this was this coming plague; this was the present plague of the new millennia.
GARRETT: Well, I was in the SARS epidemic in 2003 in China and Hong Kong, and I was in the wet market in Guangzhou before they closed it and saw the actual spread going on inside the market, saw the conditions in the market and saw the whole way that the restaurants were linked in, the dormitory conditions that the workers lived in who were exposed. And so when I started getting the first hints of things in December, coming out of reports from Wuhan, I said, ooh, déjà vu all over again. This looks like SARS. Then they very emphatically said in their official statements from Wuhan, the government said this is not SARS and anybody who says it is SARS is going to be in big trouble. And of course when we saw certain key scientists and physicians be reprimanded by the secret police in Wuhan for saying it looked like SARS, I was immediately perked up and said, oh, it’s either SARS or something very close to SARS. And it looks already like it’s more contagious than SARS was. You know, SARS spread from human to human. But primarily in hospitals, it was really what we call a nosocomial infection, meaning if you took proper infection control practices inside your hospitals and separated patients according to who had SARS, who was suspected of SARS, and then who was in hospital for completely other reasons, so that you didn’t get cross-contamination, you could pretty much control the spread of SARS. This did not look like that. This looked like something much more contagious, much more difficult to control and clearly was spread in the community. So that by the first week of January it was pretty obvious Wuhan had a real serious catastrophe on its hands.
HEFFNER: How much of the difference between SARS original and this 2.0, which is more lethal in the way that it paralyzes our health infrastructure, was do you think a primary difference in the transmission or the global transmissibility the much more hyper-modern travel system. And it would have possibly been as much of a calamity as we had today if there had been the same access to intercontinental travel, of course the modern train system in China, I’m sure is vastly enhanced and that would have seeded a more significant crisis probably 20 plus years ago. How much of it is that environmental factor compared to the disease itself?
GARRETT: Well, you know, SARS spread to 31 countries and did so very quickly. It was spread inside Hong Kong at a hotel, the Metropol by people pressing an elevator button for the ninth floor. And that happened to be a travelers’ business hotel. And that ninth floor was occupied by people who then went on to Vietnam, to Canada, to the United States, to a variety of places in the mainland of China and spread the virus, all because one person from Guangzhou was on that floor, sick with SARS. So that’s pretty darn contagious. That spread pretty darn fast. I would give your point that the interconnectedness of China to the rest of the world between 2003 and 2020 clearly escalated. They built the belt road system to some degree connecting China all over the world to more than 60 countries. And they clearly took great steps to enhance high-speed rail inside of China. And of course Wuhan is the center of the entire high-speed rail system of the Chinese network. So yes there is enhanced travel and enhanced risk, but I really think first of all that the original SARS spread pretty darn widely. And secondly that this SARS is much more contagious.
HEFFNER: Much more contagious and folks confused it terribly because they
thought that if it was not a disease where you die instantaneously, it just doesn’t matter. And in fact the opposite is true in preserving the integrity of health systems. If you have patients who are extremely contagious and require many resources: the ventilators, the respirators, the protective personal equipment, that was this case now that we are where we are and of course you’re prescience noted both in terms of predicting the crisis and also telling American science, Twitter, decide where you want to shelter in place maybe for the next year. Frank Bruni wrote an amazing profile of you in the New York Times that I will alert our viewers and listeners to check out. Now that we are where we are. Laurie, I was struck by a tweet thread by Tom Frieden recently that scientists still haven’t determined with respect to community spread, whether or not it is the potence of an individual particle of virus or whether it is the amount you are exposed to, or whether it is genetics. Those three seem to be the underlying variables in getting to the bottom of a public health response in the absence of a vaccine or therapeutic. So as of this moment in those three areas of transmissibility, what, do we know anything more than we do in January that, that is how potent an individual virus can be from touch or cough or whether the volume of the virus matters. And then ultimately, you know, whether or not communities are going to be able to sustain sheltering in place without a vaccine or therapeutic.
GARRETT: Well, there’s a lot to unravel in that question. Let me take a few key pieces of it. Yes, we know a great deal more about the virus today and how it spread than we did in January. And almost every day there’s another revelation. I mean the volume of literature in science pouring out; one of my colleagues likened it to sticking a fire hose down your throat. It’s just unbelievable and it’s almost impossible to keep track even for somebody like myself who’s doing a 24/7. What we do know is a couple of key points. First of all this virus can transmit in micro droplets, meaning volumes of liquids so small they can’t be seen by the human eye. And we know that that level of micro droplet transmission occurs in normal speech. You don’t have to be coughing; you don’t have to be shouting in the volume that I’m speaking at right now. If I were infected, I could conceivably be passing virus in micro droplets. Now the key thing about micro droplets versus those sort of thicker droplets that spread a common cold. For example, when you see your three-year-old start coughing and stuff is visibly spreading about. The thing about micro droplets is that they’re very, very light and in dry air they can be suspended for periods of time and they can sit on surfaces for hours at a time, so that the possibility of transmission is pretty high. There’s an interesting study using laser lights in order to visualize the micro droplets. One can see that an individual can be infected, walk into a cocktail party type setting, have normal conversation, not touch anyone. And actually spread virus from throughout the cocktail party and we virus suspended so that even after that individual leaves the room, the virus is still in the air. All of this begs for the use of masks, and early on in the epidemic, perhaps one mistake I did make was drawing from my SARS experience, I said, there’s really no good reason to wear a mask if you’re not infected and you’re not at risk of spreading to others, unless you’re in fairly intimate settings. But with this virus, we now know that it can even be spread outdoors between individuals if there’s no wind and there’s no sunlight.
HEFFNER: And critically, Laurie, people who don’t have symptoms, people who are asymptomatic or pre-symptomatic,
GARRETT: Well the, the incubation time is very long with this virus and it looks like individuals can remain carriers of virus after they have personally healed and consider themselves to be well. So,
HEFFNER: But at that point they can’t transmit it if they’ve, if you know, the virus that they have is the antibodies, but at a certain point of recovery there they can go back into society.
GARRETT: Well, that’s not really clear. There have been some studies that have shown individuals continued to infect others
HEFFNER: Post recovery, right?
GARRETT: Post recovery.
HEFFNER: That, I mean, come on. That has to be like a laser. We need to be saying that we don’t know that, in the same way people refuse to believe in this city health department and it’s in this state, including our Governor, Governor Cuomo, we’re both in New York at the epicenter here. They refuse to believe that pre-symptomatic transmission was possible that three days before someone themselves would experience symptoms, they could be infecting people. And that was not emphasized enough. But let me focus on the micro droplets, the micro droplets, so we, what Frieden was asking is in a given micro droplet, is it going to be more pernicious virus, like there are elements out there that are more pernicious, more dangerous versus the amount of those micro droplets. We don’t know that whether it’s the sort of breed of virus, if you will, or the amount that you’re exposed to, right?
GARRETT: Well, no, let me clarify, I think there’s a few things confused here so back on the question of is a post recovery person potentially infectious? Let me just say that that’s extremely rare. We have isolated examples of that. On the other hand, the pre-symptomatic individual being contagious, that is well documented and unfortunately is not rare. As for how you’re exposed and what might dictate the nature of the risk to you as an individual of acquiring full-fledged disease, we know that the dose of exposure matters. So that’s just pure statistical odds,
GARRETT: You are exposed to thousands of droplets completely saturated with virus. That’s one risk. And boy, that’s the kind of level of exposure healthcare workers get. If you’re exposed to you know, some random droplets, single droplet that happens to have some viruses in it, it’s quite possible that droplet never makes it into your nose to latch onto an Ace-2 receptor and thereby be absorbed into the body. And so you’re, you luck out. We don’t have any evidence at this time, of any example of a virus, which is genetically significantly different from any of the other COVID-19 causing viruses out there in terms of transmissibility. So yeah,
HEFFNER: Got it, that’s helpful. In terms of genetics, Laurie, people have attributed greater fatalities to socioeconomics exposure in hospitals of course too, but also to genetics. At this juncture, what do we know about how genetics plays into the, the lethality of infection?
GARRETT: I know of absolutely no, a scientifically valid example of one individual being more susceptible to COVID death than another based on that individual’s personal genes. What we do know is that certain populations, particularly in a homogeneous society like the United States are more prone to key underlying diseases that affect the exact receptors, these Ace-2 receptors on the outside of the virus and the outside of your cells and that they are at higher risk. So what are we talking about? Well, the Ace-2 receptor is also used as a modulator of hypertension. Hypertension happens to run far more frequently in African American populations than in any other particular ethnic group. Is it genetic? I doubt it. I think we can see, for example, huge differences in hypertension levels between Africans and African Americans. So it is likely that the high rates of hypertension are a marker for lack of access to consistent healthcare. Hypertension is one of the easiest things possible to identify, one of the easiest things possible to treat in routine medicine. But if you don’t have a consistent access to a personal physician, you don’t get a proper workup and you don’t get subsequent follow up to see if your medication is working. If your diet changes are working in order to bring down your blood pressure, then you’re likely to end up with a whole range of cardiovascular diseases that are associated with high blood pressure and high blood pressure goes hand in hand with diabetes and kidney failure and obesity. So you put that sort of vicious combination together and then add to that not having routine access to the healthcare system, you are at higher risk when along comes a virus that just happens to use the very same receptor, this Ace-2 receptor in order to gain entry into the cells as is the regulating mechanism for angio tension and thereby hypertension. So this is a vicious combination. And for the African American community, it has been devastating. And I think it’s been correctly ascribed as being associated with a kind of institutional racism in our healthcare system. But I would say that we have a possible antidote and nobody’s using it. And that antidote is if we’re going to have widespread testing for COVID, let’s couple that testing with doing blood pressure tests. Everybody should get a routine blood pressure test alongside a COVID test. It’s so easy. It’s so cheap. You just put the cuff on, you know, I mean, you can train someone with no medical background to take a routine blood pressure test and anyone who comes up with high blood pressure or moderate to severe should be set to the side and given some education about blood pressure, some workup for possible medication, free access to medication, we could lower the death rate if we would just incorporate into all our COVID control, blood pressure control.
HEFFNER: Wow. Given those co-morbidities, given the vastness of the health disparity, health outcome disparity, looking towards a therapeutic or a vaccine, what is the greatest hope you’ve been the soothsayer I want you to be the constructive voice now that is going to have the foresight to predict the treatment advances beyond taking blood pressure with testing and the drugs that we know exist right now. But what confidence can you give our listeners and viewers that if any at all, that the scientists and the scientific community are diligently at work on something that will be promising, not as an extreme measure once you are near death like the Gilead drug, but something that will be employed and protect the vast majority of people including the African American population.
GARRETT: I’m probably not going to be able to give you the answer you’re hoping for. I don’t know of anything out there in the pipeline right now that looks like a cure. I don’t know of anything in the pipeline at this moment that looks particularly exciting as a sort of equivalent to PrEP. PrEP is a kind of treatment modality that individuals can take who have had sex with someone who’s HIV positive and are worried that they might have acquired HIV infection. They can take PrEP while they’re involved in unprotected sexual activity and greatly reduce if not nearly eliminate their likelihood of becoming infected with HIV. We won’t have something like that for COVID, at least there’s nothing in the pipeline at the moment that looks that way. And as far as a cure goes, once you have a really florid infection that’s multi organ, involves your lungs, your, your cardiovascular system, your kidneys, your liver and your whole immune system is engaged, it’s very hard to come up with anything that can be a game changing reversal of that process. And what we’re seeing now is that a lot of people after they have recovered, are suffering what may be permanent damage to some of their organ systems so that, you know, this is a really pernicious virus that has impacts on your kidneys, on your liver, on just all over the body. Now what I do think is going to come down the pipeline will be immunoglobulin treatments. What this involves is identifying what is the nature of effective neutralizing antibodies that actually do kill the virus. That is found in patients that have recently recovered from their infection have recovered from a full blown, you know, outbreak in their bodies and have developed appropriate antibodies that kill the virus, by making copies synthetically of those antibodies to formulate a treatment, an immunoglobulin treatment, we may make the disease process itself a very short one and limit this sort of secondary damage to all the organ systems of the body. And that that could in fact be right around the corner. There are many, many companies working on this right now. There’s a lot of promise. It may actually pan out much faster and with greater efficacy and safety than any of the vaccines that are currently in the pipeline, even though they’re all seeking the same thing, which is neutralizing antibody capacity.
HEFFNER: And how could that be, how can the delivery of that be streamlined constructively or effectively in an environment politically where we’re back on the, on the side of science and scientific literacy. What needs to happen from the point of view of public health governance to have an impactful, a make an impactful difference?
GARRETT: Well, the immunoglobulins, for example, that I’m talking about are already the subject of much discussion at the World Health Organization. There was a new pact signed between I believe 30 nations. They’re trying to get all the nations of the world to sign on as the so-called Costa Rica Agreement, which just was announced today. So the Costa Rica Agreement commits companies and countries to sharing at affordable prices, any innovations that make a fundamental difference in survival and can, you know, enhance the ability of countries and populations to tough out this new virus and this pandemic. So that’s a very positive sign. Of course, it doesn’t mean that every country is on board. The United States is not on board. And China is not on board. So we do have a very difficult global landscape right now, worse than any I have seen in many years, if not in my entire life. It’s reminiscent of the Cold War in the sense that Soviet advances were not shared with the West and vice versa. But ironically in the days of the Cold War, because both sides wanted to claim scientific superiority and to say that capitalism or communism were the better systems in terms of enhancing science and the shot to the moon and what have you, there was a lot of sharing of advances with the rest of the world, the sort of middle ground world, if you will. What we’re in now in the U S – China fight is really ugly and it is absolutely devastating cooperation between the nations. It’s making it very difficult for scientists to collaborate and share findings. And it does mean that there’s going to be a kind of race to the top, who is going to be the first to be able to lay claim to a vaccine, lay claim to a cure, a treatment, what have you, and this is ugly.
HEFFNER: Final question, we only have 60 seconds left, but what about the public health infrastructure in our own country because what you described with the United States and China that’s happening right now with New York and Florida and Georgia and respecting the scientific data or not, and reporting accurately COVID versus some mysterious pneumonia that goes undiagnosed or is reported in a way that’s not fair. So what are we going to do about that here at home?
GARRETT: Well, in my second book, “Betrayal of Trust, The Collapse of Global Public Health,” I devoted a very large section of the book to analyzing the history of public health in the United States and how this very fragmented system that puts states at odds with each other and cities at odds with each other developed and what we have to do about it and how we work around it. And sadly, the answer is you need a very, very strong Centers for Disease Control, with really strong support from its own federal government and its own institutions in Health and Human Services and the White House. And sadly, we’ve seen the CDC sidelined in this epidemic. It is not in the driver’s seat and it’s not carrying out policies to all.
HEFFNER: Laurie Garrett. You have had such clarity in foresight. Thank you. Follow Laurie on Twitter, author of “The Coming Plague,” Pulitzer Prize winning science journalist. Appreciate your time today.
GARRETT: Thank you.
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