Dr. Marjorie Pollack has spent a lifetime fighting infectious diseases all around the world, but now the world has come to her doorstep. Pollack sent the first detailed global alert late last December about a pneumonia-like outbreak in Wuhan, China, which would spread like wildfire across much of Asia and Europe. Today her hometown, New York City, is ground zero of the COVID-19 pandemic.
She and her colleagues at ProMED, a largely volunteer program of the International Society for Infectious Diseases, are tracking the disease’s progression as well as efforts by researchers to develop treatments and a vaccine. Nothing could be more urgent. The highly contagious coronavirus they spotted has infected three million people as of April 27, according to confirmed counts, and claimed 208,000 lives, including 55,000 in the United States.
A New York-based physician epidemiologist who has worked in more than 50 countries for the US Centers for Disease Control and Prevention, the World Health Organization, and other public health bodies, Pollack now rarely ventures outside because of her workload and desire to follow New York state’s lockdown requirements. She recently had her first sit-down dinner in more than two months with her husband at home. Pollack updated us about what’s happened since speaking in late February with Partha Bose, a partner at Oliver Wyman and a leader of the Oliver Wyman Forum, and Jilian Mincer, its managing editor.
How has life changed since we last spoke?
I live a block and a half from a medical emergency room. When I’m working in my study, I hear the sirens constantly. You don’t hear people walking by. You don’t hear cars very much. What you hear is ambulances. It takes a toll when the only sound you hear is sirens.
I don’t scare easily, but this one has me scared on a global level and on a personal level. It is going to take a lot longer to feel more comfortable about global and personal safety.
What are you and your colleagues at ProMED focusing on?
We’re taking a multi-focused approach. We’re still looking for an intermediary host for SARS-CoV-2, the virus that causes COVID-19. There’s a general sense in the global community as well as our community that there was an intermediary host that was infected by bats and then infected humans, but it could have come directly from infected bats.
We’re focusing on daily updates, keeping a finger on the pulse of what is happening globally, looking at all country reports. We’ve honed-in on some places like South Korea and China, where the controls seem to be working and transmission has been interrupted in many clusters and locations. One of the things we have been looking at a lot is how China and South Korea are now shifting from local transmission of the coronavirus to imported transmissions, where the majority of their newly confirmed cases are importation related, and how they are handling that.
We’re looking at other aspects as well. We’re focusing on research efforts and trying to put it out (in our updates) if there are major new findings on research related to the epidemiology of the disease, clinical spectrum, clinical management, and vaccine development.
The pandemic has been ruthless. Is anything working?
Social distancing has been working. It has been slowing things down and permitting the health services to function with more normalcy. It definitely looks that way in Italy. The number of cases is still high there, but they are dropping on a daily basis. And in South Korea, they were hovering at around 100 cases a day and implemented more stringent social distancing, and now they are hovering around 10 cases a day. And in New York City, where I was hearing sirens every 10 to 15 minutes, I’m now hearing them every two to three hours.
By social distancing, you are lowering the curve – the curve being the number of confirmed new cases, which could go on to become a severe disease, a percentage of hospitalizations, a percentage of morbidity.
We have seen a lot of additional deaths because the medical services are overwhelmed. You want time to decompress the pressure on services so there are enough doctors, there are enough nurses, there are enough respiratory therapists, there are enough ancillary staff, and there are enough supplies. Flattening the curve could improve survival chances and impact morbidity markedly by buying more time to identify therapies that work and finally get a vaccine.
What are you doing to protect yourself?
I do online ordering of groceries and vie for delivery slots.
When I go out, I wear a mask and gloves, but I’ve observed people who are not wearing masks and are not observing social distancing. I see millennials and those in their 30s and 40s without masks. They think they are invincible, but they’re an age group that is dying. I cannot stress that enough.
Are people sharing data?
Yes, it’s phenomenal what’s going on. There’s sharing of everything – results, impressions, observations, a lot of anecdotal reports, which is good because that provides the first indication of something that needs to be looked at.
There are lessons to be learned. We’re now sharing a lot of information before it has been reviewed by peers, and there’s good and bad to that. The good is that you’re getting to see the stuff sooner, but you’re also getting papers that won’t make it through the peer review stage. The double-edged sword is that people are quoting papers as if they are dogma when that may not be the case.
How quickly can we get back to work and life as normal?
Unfortunately, it will take longer than politicians like. Many in the public health world feel we need much more. We need useful testing to identify acute infections as well as serology to know who was infected already and didn’t know it. That will be integral to helping to decide when you can go back to work and how you do it. High-risk people should be kept home for much longer.
We’re dealing with a very smart and nasty virus. It manages to be transmitted when you don’t know you are ill, and you don’t know you’re infected.
Are you surprised by anything since we last spoke?
I’m very disappointed with the disconnect between the public health sector and the political sector in many countries. There were warning signals on the ease of transmission coming out of China and other countries, and the incident with a cruise ship off the coast of Japan. The Chinese didn’t have that luxury. They were the first to go through it. They learned the hard way about community transmission. The public health sector watched Wuhan and raised an alert, public health watched what happened in South Korea as an example how to manage the virus. There was time to prepare, alerts and warnings weren't taken seriously until it was too late.
What should we do now?
Listen to your public health people who know what they are talking about. Look at states that are taking serious actions. What states are doing a good job? New York, Washington, California, New Jersey, Massachusetts, to mention a few. The coalitions (of states) on the west coast and the east coast are doing a very good job. They are looking at the economic implications and the public health implications.
If you open purely based on economics, it will ultimately cost a lot more. There will be a resurgence. There will be more death, more morbidity. With this coronavirus people are sick upward of a month. More cases mean more loss to the economic sector.
What needs to be done in the United States so we can do testing at the same levels as South Korea and Germany?
We need sufficient kits and supplies including the PPE (personal protective equipment) for the testers. The countries that have prioritized testing all suspected cases and their contacts are countries with lower case fatality ratios, lower hospitalization rates, and lower severe case rates. Look to them for guidance. Hire and train personnel who can safely and accurately do testing and contact tracing. There are many currently unemployed healthcare workers who could fill these positions. Learn from mistakes made and from successes.
What’s changed at ProMED in recent months?
We’ve gotten many more subscribers. We’re a hand to mouth not for profit. It’s great that more people are following us so they can get real information.
Our followers are a combination of scientists, medical professionals, veterinarians, environmentalists. We have professionals, and we have interested lay parties, and they are helpful too. They find things in their local communities and alert us to them. It is helpful. (You can follow the organization at Promedmail.org.)
Is there any good news?
I’m hopeful that reason and science will come up with answers, sooner rather than later. I hope that clinical trials will come up with good drugs, good treatment modality so we could deal with the severity and mortality. People are looking at different phases of treatment. Some drugs might be good for one phase but not another.
I would love to hear one day that a clinical trial was stopped because it obviously was so good. We haven’t heard that yet, but what has me feeling more comfortable is that good, solid clinical trials are being done as opposed to just anecdotal reports. You have the drugmakers, the clinicians, the academic institutions. The people you want are involved.