We're six months and more than 200,000 deaths into the coronavirus pandemic. We check in with an epidemiologist and a virologist about the latest on COVID-19.
On the U.S. death toll reaching 200,000
Tara Smith: “I'm still astounded and a bit nauseated that we let this happen to this country. And remember, the 200,000 are just confirmed deaths. There are plenty more that never got diagnosed and never really made it onto the radar as COVID deaths. So, I'm still astonished that we've hit that number.”
Angie Rasmussen: “After I got over my initial sadness, I primarily now feel anger, because every single one of those deaths, as well as the deaths that haven't been counted, has really been preventable. If we had controlled transmission in this country within communities months before, we would not be looking at this number right now.”
"If we had controlled transmission in this country within communities months before, we would not be looking at this number right now.”Angie Rasmussen
On what we can expect from the pandemic this fall
Tara Smith: “Unfortunately, I think we’re going to see [the spread] increasing. We've seen that Florida of course is lifting all of their restrictions on inside dining and things like that, and that seems to be a bad omen. I hope other states don't follow that. I know there's been a lot of pressure here in Ohio for our governor also to reduce restrictions on indoor dining and other types of gatherings. I'm concerned that's going to be the trend, as those of us in the scientific field are very concerned about the fall and the winter and increasing spread as people do move indoors and have less opportunities to distance outside and have that additional ventilation. So, I am very concerned about what we're going to be seeing over the next two or three or three months or so as we start to get into cold weather in many places in the country.”
Angie Rasmussen: “ I think that as we move inside and as businesses reopen, as schools in many places reopen, there's just not going to be those opportunities to keep people away from each other. And since we also simultaneously, in many communities, don't have the testing capacity to conduct adequate surveillance, we're going to miss a lot of cases and that's going to unfortunately result in more transmission.”
On where we would be if everyone wore a mask
Tara Smith: “I think it would reduce a lot of transmission. One of the issues we're seeing is, of course, transmission within households, which would not be completely mitigated by masks. But what you would do is you would reduce that risk of acquiring the virus outside of the household and bringing it into the home where, of course, you wouldn't be wearing masks among your family members. So I think, you know, if we had done that really consistently for 8 to 12 weeks, that would really put a dent into this. And it would get us to the point where, again, we could implement testing and tracing for those few remaining cases like many other countries have already done, in order to control what is left of that kind of remaining transmission.”
On the virus’ shift from urban to rural areas
Tara Smith: “Here in [Ohio], we are seeing more cases per capita in our rural communities right now than in our larger urban areas. So while early in the pandemic, we had outbreaks in Cleveland and Columbus and Toledo and in some of our large urban settings, right now, of our 10 highest counties that have the highest per capita incidents of coronavirus, 8 of those are rural counties with populations of, you know, 20 to 30 thousand. But we're really seeing spread in those in part because of lack of mask wearing, and really kind of resistance to even believing that the pandemic is happening at all.
“I think what we’re going to see is this will really hopscotch across not only the state, but what we're seeing is that it happens across the country; that it ends up in one of these, you know, little areas and spreads there. And one of the big concerns right now is that, while we're still not seeing our hospitalizations go up rapidly, the concern, of course, is that these rural areas do not have hospitals that are well prepared. They're still understaffed. They're underfunded. You know, they're relatively sparse in some areas of the country, especially the rural areas in the south that really lack these rural hospitals. So the worst case scenario, of course, is that you get a really large outbreak in one of these counties and you don't have the facilities that can handle those types of outbreaks. And so the fatality rate will increase in many of these areas.”
On whether we should be worried about potential virus mutations
Angie Rasmussen: “This all goes back to a paper that was published a few months ago that showed that there was a mutation in the spike protein — the spike protein is a protein that's on the surface of the virus particle and binds to the receptor to allow the virus to enter and infect a cell. It wasn't really known what was going on with this in terms of how it changed the spike protein’s function. And currently, we still have no evidence of that. This paper made the conclusion that, because this mutation was more common in Europe and in North America, including in the U.S., that it was somehow more transmissible, but that that can actually be explained by a number of other things; it could just be that more of that variant was imported from Europe. And so there were already larger numbers of viruses with that mutation circulating. It doesn't necessarily mean that it's making the virus more transmissible or that if you're infected with a variant that has what's called the D.614 gene mutation — which some of my colleagues have started calling Doug — if you have a Doug spike protein, it doesn't necessarily indicate that you're going to be more contagious. That said, it's really important that virologists start doing the work in animal models and experimental systems to see if that mutation has any effect. But right now, we don't know that for sure. There's no indication, really strong indication that it's doing anything. And it doesn't appear that it alters vaccine specificity for the virus, for the spike protein. So there's more work to be done, but right now, it's nothing to be alarmed about. Viruses mutate anyways. That's just what they do.”
"I am feeling pretty pessimistic about what we're doing now. It's really kind of putting our fingers in our ears and pretending that there is not a pandemic going on."Angie Rasmussen
On whether we’re likely to gain herd immunity before a vaccine is released
Angie Rasmussen: “What herd immunity means to me and Tara is — herd immunity is when you have enough people in the population who are immune to a virus that it can't spread within that population, because viruses need hosts. They can't replicate without a host. So if enough people are resistant to it or immune to it, then that virus won't be able to spread anymore. We've always achieved this, historically, through vaccines and not through natural infection. What herd immunity is being used to describe by Senator [Rand] Paul, is the concept that we could achieve this by natural infection, which again, is something we've never really managed to do with any other pathogen, and [he is saying] that 22% of people having antibodies to the virus in New York City because of the large outbreak there last spring means that herd immunity has been achieved. I don't think anybody thinks that 22% positivity or antibody positivity would ever lead to herd immunity.”
On how we could beat the virus — and why we probably won’t
Angie Rasmussen: “If we had done what some countries in Europe have done, if we got community transmission down to a manageable level and simultaneously increased our testing and surveillance capacity, we would be able to live relatively normal lives, albeit with some changes. I mean, we'd have to be monitoring community spread, but it's really only when you have low enough transmission in the community that you can put into place these tried and true epidemiologic measures for controlling outbreaks. That includes being able to test enough people that you can catch these cases early on, since we know this virus is driven by pre-symptomatic transmission or transmission by people who aren't yet aware that they're sick. If we are able to identify those cases and if we have so few of them that it becomes manageable to isolate them, to contact-trace and quarantine their contacts, we could be breaking those chains of community transmission and we would be able to go out in public and interact with our communities in a in a more normal way. But we haven't done that. And unfortunately, as we talked about earlier, Florida is opening up bars and restaurants for indoor dining. They actually have higher levels of community transmission than when some states did that back at the beginning of the summer. And we all know that the result of that was the summer surge. So I am feeling pretty pessimistic about what we're doing now. It's really kind of putting our fingers in our ears and pretending that there is not a pandemic going on when in reality, if we had controlled this months ago, we would be able to do this and do it safely.”
On why Americans seem unique unwilling to follow public health guidance
Tara Smith: “I read the comments of our local news and it's always, you know, fake pandemic. And even those who are on the right, and we have, again, a Republican governor in Ohio who did put in this mask mandates, and some of the other control measures, and some have sought his impeachment already. They want him out of office. They don't like him any longer. So it is kind of a bizarre thing to look at that people, from his own party even, who are really decrying the measures that he has put in place to try to keep Ohioans safe. And so I really think this is something that needs to come from a strong federal response, which we have completely lacked. But we've seen in most other countries that that has really been the thing to kind of turn the tide, that everyone in the country is doing the same thing. They're following the same rules. They're under the same, you know, lockdowns or other rules, whatever it may be. And we have completely lacked that. So we've put it onto the governors, or in some cases even local mayors have had to be the ones to make these decisions. And when you have such a patchwork of different rules for different areas without any kind of central, strong response, I think that's just led to a lot of disillusionment. You know, why can they do this in this other border city, but I can't go out to a bar in mine? Or something. So I think we're missing that leadership that really could have gotten us through this.”
"When you have such a patchwork of different rules for different areas without any kind of central, strong response, I think that's just led to a lot of disillusionment.Tara Smith
From The Reading List
Washington Post: "Massive genetic study shows coronavirus mutating and potentially evolving amid rapid U.S. spread" — "Scientists in Houston on Wednesday released a study of more than 5,000 genetic sequences of the coronavirus that reveals the virus’s continual accumulation of mutations, one of which may have made it more contagious. The new report, however, did not find that these mutations have made the virus deadlier or changed clinical outcomes. All viruses accumulate genetic mutations, and most are insignificant, scientists say."
The Atlantic: "A Failure of Empathy Led to 200,000 Deaths. It Has Deep Roots." — "Sometime this week, alone on a hospital bed, an American died. The coronavirus had invaded her lungs, soaking them in fluid and blocking the exchange of oxygen and carbon dioxide that makes up our every breath. Her immune system’s struggle to fight back might have sparked an overreaction called a cytokine storm, which shreds even healthy tissue. The doctors tried everything, but they couldn’t save her, and she became the 200,000th American taken by COVID-19 — at least according to official counts."
Washington Post: "We’ve reached 200,000 deaths. Our response has gotten even worse than it was at 100,000." — "The United States has reached the grim milestone of 200,000 deaths from covid-19. We are in a much worse place than we were when we crossed the 100,000-death threshold in May. Why? Start with the numbers. In late May, we had about 20,000 new infections per day. Now we are at double that, with around 40,000 new daily infections. This is a high baseline to have entering the fall and winter, when the combination of quarantine fatigue and cold weather could drive people to congregate indoors and substantially increase transmission."
National Geographic: "Why misinformation about COVID-19’s origins keeps going viral" — "Twenty years ago, data scientist Sinan Aral began to see the formation of a trend that now defines our social media era: How quickly untrue information spreads. He watched as false news ignited online discourse like a small spark that kindles into a massive blaze. Now the director of the MIT Initiative on the Digital Economy, Aral believes that a concept he calls the novelty hypothesis demonstrates this almost unstoppable viral contagion of false news."
This article was originally published on September 28, 2020.
This program aired on September 28, 2020.