The editor-in-chief of the New England Journal of Medicine talks about what we’re learning about the coronavirus and how that might shape the month to come.
On the prospects and timeline for a successful vaccine
Eric Rubin: “Vaccination would be the ultimate tool. We certainly aren't going to have vaccines [right away], but we're going to start to get animal studies and such that tell us whether the vaccine candidates that are in trials now look like they have a good chance of working. Now, don't get me wrong, it's still going to take a very long time for a vaccine, even if it looks effective to get out there, because the big issue with vaccines is whether or not they're safe. And the only way to test that is by testing progressively larger numbers of people over time. But that would be, obviously, the game changer in all of this.”
"Right now, it's kind of a big black box.”Dr. Eric Rubin
On the need to expand testing
Harvey Fineberg: “The most critical next point is: get widespread testing available. If we do not have the core intelligence about where the virus is, who is affected by the virus, who may already be recovered and partially or fully immune to illness, then we cannot make the most intelligent decisions. The irony is, the earlier you start in the course of a pandemic, the more success you're likely to have. But in order to generate the will to start early, you will have to be able to show a governor, a mayor, a county supervisor, this is what's happening in your town right now. And that's the intelligence that we most sorely need to mobilize effectively against coronavirus.”
Eric Rubin: “We're going to have more testing. The question about tests is, how do we use them appropriately? Right now, we're in a position where we are testing people who are already sick. And that's valuable for those individuals, but not so valuable from a public health standpoint. And I think what's going to be important is to test people who aren't sick, people who are asymptomatic or minimally symptomatic, so we can start to implement strategies such as quarantine and have the surveillance to figure out what's going on out there. Right now, it's kind of a big black box.”
"We do not have a unified command structure, which is the basic element of strategy in fighting any war. "Dr. Harvey Fineberg
On adopting a wartime strategy for combating coronavirus
Harvey Fineberg: “At this point we have not really adopted a military, war-like strategy in what the president has correctly described as a war. In fact, it's a two-front war on the economic side and on the virus side. We do not have a unified command structure, which is the basic element of strategy in fighting any war. That unity of command has to start at the top and go all the way through every aspect of the parallel activities you need to do to win a war like this against a disease as hard to beat as coronavirus.”
Eric Rubin: “In wartime, we do extraordinary things and we change some of the norms that we've established. I think we're seeing a lot of that right now. I don't think that people are so resistant to the idea that dramatic times call for dramatic measures. That means we need some will, and my sense is the will is there, and we need some leadership — and that is a little more variable right now.”
On the wisdom of instituting a “smart quarantine”
Harvey Fineberg: “Smart quarantine means applying a graded separation so that you can take the steps necessary to protect people from others who may have the infection. We need to have more capacity for separate facilities to house quarantine patients. Everybody who lives in a congregate arrangement like a nursing home or a dormitory, they need to have a place to go that is safe, well-managed and has medical attention in case they do begin to develop any symptoms. So the smart quarantine idea is to put in place these facilities that could serve as the repository, the location where any of us who want to protect our families, who want to be good citizens and not endanger others, we can comfortably and with proper medical supervision stay for a period until we can be confident that we did not contract.”
"I don't think that people are so resistant to the idea that dramatic times call for dramatic measures."Dr. Eric Rubin
On the sacrifices medical workers are making every day
Eric Rubin: “People go into health care because they believe in it. And many people now are working incredible hours, putting themselves at risk, in many cases separating themselves from their families because of their concerns about infectiousness, and doing all of this under really not so great circumstances, under conditions where some hospitals have been withholding pay because their economics are bad right now, because everything is closed down. I'm really impressed with this. Now, don't get me wrong, this is happening in other sectors, too. I'm very thankful for people who are working in grocery stores, or for that Amazon delivery guy. I think that there are people putting themselves at risk for the rest of us and that there is a lot of nobility out there.”
From The Reading List
The New England Journal of Medicine: "Ten Weeks to Crush the Curve" — "The economy is in the tank, and anywhere from thousands to more than a million American lives are in jeopardy. Most analyses of options and trade-offs assume that both the pandemic and the economic setback must play out over a period of many months for the pandemic and even longer for economic recovery. However, as the economists would say, there is a dominant option, one that simultaneously limits fatalities and gets the economy cranking again in a sustainable way."
The New England Journal of Medicine: "Emerging Tools in the Fight against Covid-19" — "The rapid spread of SARS-CoV-2, a novel coronavirus that emerged in late 2019, and the resulting Covid-19 disease has been labeled a Public Health Emergency of International Concern by the World Health Organization. What physicians need to know about transmission, diagnosis, and treatment is the subject of ongoing updates from infectious disease experts at the Journal."
The New England Journal of Medicine: "Developing Covid-19 Vaccines at Pandemic Speed" — "The need to rapidly develop a vaccine against SARS-CoV-2 comes at a time of explosion in basic scientific understanding, including in areas such as genomics and structural biology, that is supporting a new era in vaccine development. Over the past decade, the scientific community and the vaccine industry have been asked to respond urgently to epidemics of H1N1 influenza, Ebola, Zika, and now SARS-CoV-2."
The New England Journal of Medicine: "Transmission of 2019-nCoV Infection from an Asymptomatic Contact in Germany" — "The novel coronavirus (2019-nCoV) from Wuhan is currently causing concern in the medical community as the virus is spreading around the world.1 Since identification of the virus in late December 2019, the number of cases from China that have been imported into other countries is on the rise, and the epidemiologic picture is changing on a daily basis. We are reporting a case of 2019-nCoV infection acquired outside Asia in which transmission appears to have occurred during the incubation period in the index patient."
The New England Journal of Medicine: "Ensuring and Sustaining a Pandemic Workforce" — "Current efforts to fight the Covid-19 pandemic aim to slow viral spread and increase testing, protect health care workers from infection, and obtain ventilators and other equipment to prepare for a surge of critically ill patients. But additional actions are needed to rapidly increase health workforce capacity and to replenish it when personnel are quarantined or need time off to rest or care for sick family members. It seems clear that health care delivery organizations, educators, and government leaders will all have to be willing to cut through bureaucratic barriers and adapt regulations to rapidly expand the U.S. health care workforce and sustain it for the duration of the pandemic."
This program aired on April 10, 2020.