Fighting COVID-19 Is Like 'Whack-A-Mole,' Says Writer Who Warned Of A Pandemic
Two years ago, science writer Ed Yong wrote an article for The Atlantic in which he warned that a new global pandemic was inevitable — and that the world would be unprepared for it when it arrived. Now, with the outbreak of COVID-19, much of what Yong warned about in his reporting has come true.
Yong says scientists are still working to understand how the novel coronavirus travels through air. His latest article for The Atlantic concerns whether or not people beyond health care workers and other front-line personnel should be wearing some sort of mask to help prevent spread of the coronavirus.
Yong notes that there are two ways in which respiratory viruses typically travel through air: as droplets of fluid and as evaporated specks of fluid called "aerosols."
Yong describes aerosols as "far-drifting" and "long-lasting" viral specks. "There is some growing evidence that aerosol transmission — what people would traditionally describe as being 'airborne' — does apply, to some extent, to the new coronavirus," he says.
He adds that it's not yet clear whether live infectious viral particles remain in the air where infected people have been: "That's the crucial thing to know," he says. "And then really, crucially, are there enough of those viral particles to actually start an infection? We don't know the answer to that yet."
Yong says the experts he has consulted have not come to a consensus regarding whether or not the general population should wear some sort of mask, when in public places. "There is a lot of movement towards recommending widespread mask usage from different countries," he says. "The CDC appears to be considering it. Health experts I've spoken to who were once dismissive about mask use are now edging towards recommending it."
But Yong adds that the short supply of N-95 respirator masks, and even professionally made surgical masks complicates matters.
"We're currently in a situation where masks are already running out in hospital settings and for health care workers, who are the people who need them the most. So any masks — any protective equipment — should go to health care workers as a matter of priority. And only then should we think about whether the general population should be considering wearing masks."
Looking ahead, Yong says that even if masks, frequent hand-washing and social isolation strategies are effective in slowing the virus' spread, the end to the pandemic is still a long way off: "We are in for this long, protracted game of whack-a-mole with the virus where different places will stamp it out at different times. It will surge back. It will need to be controlled again."
On what we know about how the virus travels through the air and how we're susceptible to inhaling it
There was one study that just shot virus-laden fluids into a rotating cylinder to create a cloud of aerosols. And they found that within that cloud, the virus remained stable for several hours, which suggests that it can at least survive in the air around us. Now, that's a pretty artificial setup. That's probably closer to a medically invasive procedure like intubation, rather than someone just breathing when they're walking down the street or sitting in a room. So it's hard to know what to make of that outside the health care setting.
But there are other studies that suggest that the coronavirus can be released into the air in less dramatic ways. For example, a new [study] released by the University of Nebraska Medical Center looked for traces of the virus' genetic material in the rooms of several patients who had COVID-19 — many of whom only had mild symptoms. So they found traces of that genetic material on lots of different surfaces, including hard to reach spots like ventilation grates and the floors beneath beds. That's consistent with the idea that the virus is moving through the air over distances longer than a droplet might land.
What we don't know is whether there are actually live infectious viral particles in the air. The presence of genetic material doesn't indicate that. It's like finding a fingerprint in a crime scene. It means that the culprit was once there, but they might have long gone. So that's the crucial thing to know. ... And, [in each case], are there enough of those viral particles to actually start an infection? We don't know the answer to that yet. And that's a really crucial piece of the puzzle.
On how thinking about masks for the general population might be changing
Confusion is completely understandable, because even among the experts who I've spoken to — including people who've studied airborne transmission and its possibility — opinion is divided on the role of masks and how much protection they can provide. There's just a mess of data on whether masks worn by the general population will provide protection against respiratory illnesses in general; whether masks prevent you, if you are infected, from infecting other people. I think that's a little clearer, both from the evidence and just through common sense. And that might matter a lot for a disease like COVID-19.
We know that the virus behind it can spread from one person to another before they show symptoms, and that is perhaps the strongest argument for widespread usage of masks. Even if you aren't currently coughing or sneezing or breaking into a fever, you might not know that you have a virus, and wearing a mask might stop you from spreading that virus to someone else.
On why touching your mask negates its protection
One of the reasons why some people are still on the fence about recommending widespread mask usage is this idea that people who wear masks and aren't used to them kind of futz around with them. They fidget with the masks, they touch their faces. There's not a huge amount of data on this ... but almost everyone I've spoken to who has experience of actually using the masks properly, whenever they've seen people use them in more casual ways, people almost always get it wrong. They pull the mask over their chin, wipe their faces. They touch the masks constantly. They're always adjusting it. And that carries a risk, and maybe the risk is that you do lure yourself into a false sense of security, thinking you're safe, but in a situation when you're actually increasing the likelihood of infection.
On how American hubris and exceptionalism have contributed to the slow response
[A virus] has no interest in people's terror, only their cells. It just wants hosts to infect and doesn't care whether you're feeling brave or not. And I think that some aspects of America's national character do seem to have made it harder for people to take the necessary measures to slow the spread of the pandemic. And not just this sense of resilience, of being brave in the face of fearful threats, but also the sense of individualism and exceptionalism. This idea that "I have the freedom to do what I want to do," which stops people from just staying indoors and heeding advice about isolating yourselves when it's necessary. And I think that the country's famed exceptionalism — the idea that this is the greatest country in the world — that, I think, contributed to a delay in the nation's response.
The [U.S.] could have sprung into action ready for this, for the virus to eventually reach it. But if anything, America more or less sat idle. It was sluggish. And I do wonder if that propensity to think of itself as being truly exceptional, that slight hubris, left it more unprepared than it needed to be.
COVID-19 was taking off in China for at least a month before it first reached U.S. shores. And during that month, not much actually happened [in the U.S.]. A lot of preparedness measures could have been launched. The country could have sprung into action, ready for this, for the virus to eventually reach it. But if anything, America more or less sat idle. It was sluggish. And I do wonder if that propensity to think of itself as being truly exceptional, that slight hubris, left it more unprepared than it needed to be. And I think that even though many people had warned about this for a long time, the underwhelming nature of America's response to this threat has really surprised even people who had been warning, who had been issuing alarms.
There is a thing called the Global Health Security Index, which ranks different countries according to their levels of preparedness for pandemics, according to 140 different criteria, based on regulations from the World Health Organization. And out of all the countries that were assessed, the United States has the highest score — 83.5, a solid B. But if you look at how the country has actually reacted to the pandemic, I think we probably get something like an F. This nation that was meant to be the most prepared of all has really flubbed its response, and I think, to a degree, that has shocked even the most alarmed or pessimistic people who I'd spoken to before, in my earlier reporting.
On what happened to the medical supply chain for masks and swabs
The medical system runs on a just-in-time economy, much like the rest of the world, and products are made to order and they depend on these very long international supply chains, many of which have fractured in this pandemic. So, for example, Hubei Province, where the pandemic first took off in China, is also one of the world's leading centers for manufacturing medical masks. So the fact that the pandemic hit that region first and hardest really exacerbated the shortage of medical supplies. There's also now a shortage of the swabs that people used to collect viral samples as the very first step of testing. And one of the companies that leads the manufacture of those swabs is based in northern Italy, which is one of the centers of the pandemic in Europe. ...
It's really bad luck that both of those regions were particularly hit, but you could envisage the same problems for all sorts of other areas. I think this is what happens when you rely on a medical system that depends on these large international chains and that really don't have a lot of capacity to flex and surge in the event of a crisis. And that's especially bad now, because the pandemic has spread so quickly that the entire world is facing down the same problem at the same time and is after the same supplies at the same time — which really has stretched many of these supply chains to a breaking point. Everyone is after the same supplies and there aren't enough of those supplies to go around. Everyone is competing with each other instead of cooperating, because the crisis has spread so quickly.
On rolling out a COVID-19 vaccine
The first steps so far have actually been encouragingly quick. A vaccine candidate has already entered early safety trials after a record-breakingly short time from actually identifying and sequencing the genome of this new virus. But the journey from these first trials to actually having a product that you can shoot into people's arms is very long and hard to shortcut. You need to know whether the vaccine is safe, whether it triggers an immune reaction. Then you need to know whether it's actually effective at preventing infections. You need to know what dose to use, how many doses to use, whether it also works in elderly people who are more at risk. All of these steps take time, and if you don't go through them, you might run the risk of creating a product that has really severe side effects or that is rolled out widely but just doesn't work.
So the experts I've spoken to feel that it will probably take between 12 and 18 months to even develop a working vaccine, let alone then to create the manufacturing capacity to create enough doses and then to distribute those doses and to actually inject them into people. This is not going to be a fast process. And until that process is complete, COVID-19 is going to be a part of our lives.
On the different methods being used to develop a vaccine for COVID-19
Most existing vaccines [against other viruses] use a dead or weakened virus or a fragment of that virus. So the idea is, you show that to the immune system, [and] the immune system can prepare defenses ahead of time. [One new vaccine candidate in development against the coronavirus] works in a slightly different way. It uses a piece of the virus' genetic material, its RNA. You inject that up into a person in the hope that that person then can build their own fragments of the virus using the instructions in that genetic material and that those sorts of homegrown fragments can then train the immune system. These RNA vaccines are a new technology. They have the potential to be really important and to be much faster. But the caveat is that no such vaccines have ever been taken to the market before. So we're breaking new ground and there aren't facilities already available that can manufacture such vaccines in the quantities that are needed.
By contrast, other teams are using more traditional approaches. For example, there's one group in France that is trying to repurpose the existing measles vaccine to instead target the new coronavirus. That might take a longer time at the front end. But on the plus side, if that actually works, then the world knows how to make measles vaccines in large quantities. So it's unclear which of ... these solutions will end up being quickest. But it's certainly reassuring that a lot of different options are being tried — not just these two, but but many others. And we'll just have to wait and see which gets to the finish line soonest.
On the idea that the spread of the coronavirus might slow down in the summer
So, traditionally, coronaviruses and a lot of other respiratory viruses, like flu, do go away in the summer, and there are many possible reasons for that. Certainly, humidity and heat makes it easier for the cells of our airways to clear out a virus, and some of the immune response to these respiratory viruses appear to be stronger under those climatic conditions.
Now, is this new coronavirus going to behave in the same way? Possibly. Is that going to make a difference with the pandemic? I'm not sure. And the reason for that is that the virus is circulating through a global population that is completely immunologically naive to it. Our immune systems are not ready to deal with something like this. And so the virus has a large proportion of hosts among whom it can easily spread. To hope that the summer is going to downplay those dynamics far enough to contain the pandemic is, I think, wishful thinking. ... We're seeing transmission in places like Australia, which is just coming out of its summer, or Singapore, which is hot and humid in the tropics. And what that tells us is that it's probably wishful thinking to hope for heat and humidity to be the things that contain this virus. They may help, but only if we can slow its spread in other ways, such as through social distancing.
On being prepared for COVID-19 to come back
I think that's very likely. I think most experts would expect some kind of resurgence once current social distancing measures are released. That's sort of in the nature of these viruses. It's definitely likely because the pandemic is now so widespread that unless the entire world simultaneously brings the virus to heel, there are always going to be pockets where outbreaks are still ongoing, and that can seed [and] can reignite sparks of infection in places where outbreaks had already been extinguished. ...
And so we're likely looking at multiple rounds of social distancing, multiple bouts of social upheaval. Now, it's possible if we get our act together and if we do well in this first wave, that those subsequent bouts will be less dramatic and less uprooting than this current period of time has been, and that may well just be because of that uneven spread. So currently the virus is everywhere. It's hitting everywhere ... at more or less the same time. If different places can get it under control, there might be less potential for that sort of explosive worldwide spread. And then, over time, one would hope that surveillance measures would be better. We become better at testing for the virus and working out who's immune to it, at building up the necessary supplies to protect health care workers. All of those measures might mean that we can get a little bit more sophisticated in where social distancing is being rolled out, in the nature of those measures. But I think it's very clear that that is going to be a long game.
Pandemics often expose existing fault lines in societies, and they reveal whom a society cares about and whom it often ignores.
On how the pandemic has hit society's most vulnerable
Clearly, the economic implications of this are going to be profound. I think, as with many disasters, it's going to hit people in different ways that are magnified by existing inequalities; people from low income groups, people from marginalized groups are going to feel the effects of this far more.
Pandemics often expose existing fault lines in societies, and they reveal whom a society cares about and whom it often ignores. The people who are still having to serve on the front lines of society while everyone else is sheltering indoors, people like grocery store workers, janitors, they are currently risking their lives because many of them don't have a choice. The elderly who have often been marginalized in the fringes of society are now [being asked to] isolate themselves even more, deepening the loneliness that many of them have already felt. People with mental health disorders, people with anxiety and obsessive compulsive disorder who have long been grappling with worries about infection and cleanliness, are now seeing some of their worst nightmares playing out around them and are struggling in a context where they don't have access to their usual support networks or therapists.
So a lot of societal dynamics which were already being overlooked and which were already fraying are going to fray even more. I think it's important to be wary of [that unraveling] and to look out for the people who are most going to need help. A pandemic causes a wave of physical suffering, but following that, there is also economic suffering, mental suffering, emotional suffering. We will need to be wary of all of those things when society rebuilds in the wake of this crisis.
On the potential of the pandemic to inspire positive change
I think that this is the time to be imagining what a better world might look like and to start actively working towards it. These periods of great social upheaval carry with them great risk and tragedy, but also great potential. So on a very simple level, after HIV spread throughout the world and the '80s, it led to better awareness of sexual health that led to mainstreaming of condom use, of testing [for sexually transmitted infections]. And perhaps the COVID-19 pandemic will lead to a normalization of health behaviors that have been quite difficult to get people to take up, like regular hand-washing for 20 seconds — sometimes a rarity even in hospital settings, let alone in homes. And now all of us — well, many of us, hopefully — [are] washing our hands on a regular basis every day. Hopefully that will become a normal part of our culture in the future.
I also really hope that a lot of the ethic of cooperation that we're starting to see, of people in communities looking out for each other, coming together at a moment of crisis, will continue through the rest of this long-haul pandemic and beyond. I think we're going to need that if we're going to be better-prepared for what's to come. We need that sense of cooperation between neighbors in a community, between states, in a country and between countries — an international community.
Amy Salit and Seth Kelley produced and edited the audio of this interview. Bridget Bentz, Molly Seavy-Nesper and Deborah Franklin adapted it for the Web.
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