While President Trump pushes pharmaceutical companies to “cure” coronavirus, healthcare experts are making sure to temper expectations—by warning the public that a vaccine could be months or even years away.
During Trump’s meeting with pharmaceutical representatives on Monday, Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, cautioned the public not to expect a quick vaccine. “He’s asking the question: When is it going to be deployable?” he said, referring to the president, “and that is going to be at the earliest a year to a year and a half.”
Certainly, therapeutics are critical in the long term, and at least a dozen pharma companies and biotech firms are working on developing a vaccine. Moderna has already shipped a potential vaccine to health officials at the National Institute of Allergy and Infectious Diseases, which will begin clinical trials in April. Gilead Sciences has also launched clinical trials for a medicine called remdesivir that has been shown to be effective against coronaviruses in animal studies. In the short term, however, public health officials are focused on containing the new virus, not curing it.
Coronavirus, after all, is spreading rapidly. There are over 93,313 confirmed cases worldwide and 3,118 deaths as of this writing, with at least 108 cases in the U.S. So far, the Centers for Disease Control and Prevention is recommending minor precautions such as frequent hand washing and keeping hands away from your face. It also counsels that people who are feeling sick should stay home. Despite the CDC’s straightforward advice, some are taking more extreme measures to avoid contagion. Groups such as Mobile World Congress and the American Physical Society have canceled large conferences, and SXSW is facing pressure to do the same. While these cancellations may seem like an overreaction, avoiding large crowds where people shake hands is probably a good thing.
Expert opinion is divided on the efficacy of these interventions. “There is a lot of debate in the public health community as to actually how effective those kinds of social distancing interventions are,” says Dr. William Schaffner, medical director of the National Foundation for Infectious Diseases. He envisions two potential scenarios for how the disease will move next. The first is that the initial cases in the U.S. will stay relatively local and then come to a close fairly quickly. The other possibility is that as more health systems become able to test for the coronavirus, they’ll discover that COVID-19 has actually spread much more widely than previously thought. At that point, he says, health officials will start recommending social distancing, “which will cause a fair amount of turmoil, discomfort, and economic loss, as people are urged to become semi-hermits.”
Still, he says, there is evidence that these tactics buy time. “From a medical care perspective I would rather have the epidemic stretched out a bit, because then there won’t be quite as many people coming immediately to healthcare facilities and swamping them out,” Schaffner told me. Considering that there is yet no COVID-19 vaccine or “cure,” in Trump’s words, time is a crucial tool in managing public health.
Preparation is one of the best ways to mitigate future shocks to healthcare or economic systems. “Prepping gets a bad name,” says Aubree Gordon, associate professor of epidemiology at the University of Michigan School of Public Health. “It’s actually a social wide responsibility.” She says that it’s not a bad idea to prepare for spending two weeks to a month at home. Stocking up on food and medicines now means that the shelves will be stocked for people who, for whatever reason, were not able to do so earlier.
Health experts agree that if you are experiencing symptoms—high fever, coughing—rather than rushing to a clinic, you should call your doctor and ask for their opinion. If you do not have a primary care doctor, you can call a medical nurse line or schedule a tele-health visit with a doctor online. Most people who contract COVID-19 will experience mild symptoms that can likely be managed from home. However, people who are above the age of 65 or have compromised immune systems are likely to experience more aggressive symptoms. If a person starts experiencing shortness of breath, they should get in touch with a health professional immediately. “One of the big signs you’re developing pneumonia is difficulty breathing,” says Gordon.
How to contain the fallout
It’s important, in particular, for businesses to prepare for how efforts to contain coronavirus will impact day-to-day operations. Companies should think about how to enable their staff to work or other alternative arrangements in the event that federal and local governments begin enforcing travel restrictions.
As public health officials start recommending some level of isolation, companies will have to figure out how they are going to provide for workers who do not have paid time off. “We should be careful to understand this is not just a matter of government. This is the whole community that has to respond,” said Scott Burris, director of Temple Law School’s Center for Public Health Law Research, on a press call sponsored by the ACLU. Burris is one of 45o health officials that have signed an open letter describing what measures the government should take to ensure everyone gets access to equitable care during an outbreak and that public safety is maintained.
“Companies that at the moment don’t have paid sick leave policies, or at the moment are not thinking about their responsibilities for responding, should be thinking about how they’re going to keep paying their employees even if their employees can’t come to work because they’re complying with public health orders,” says Burris. He emphasizes that you can’t put people in economic jeopardy for protecting public health.
One way or another, businesses will have to find a way to keep sick workers home. Allowing them to work risks spreading the disease to other workers. It is also possible that under emergency circumstances the government could step in and either provide for workers or force businesses to provide some sort of sick leave, Burris says.
“In this one for the long haul”
There is hope that amid these efforts to contain COVID-19, a treatment such as the one Gilead Sciences is working on will become available sooner than expected and may further slow the disease, with health officials determining its effectiveness based upon some key criteria.
“The major question now is: Does it work against coronavirus disease, and if so how much? Does it provide a marginal benefit, or does it provide a lot? Is it better to treat later the sick people or earlier—people who are not as ill?” says Schaffner of the National Foundation for Infectious Diseases. Any potential drug has to be evaluated for side effects, he notes, adding that even if they are minimal, it will take time to ramp up production of a treatment.
Unlike with SARS and MERS, two very deadly coronaviruses that have caused similar levels of panic, COVID-19 may not go away. “I don’t think this virus is going away. I think it will probably recur,” says Ian Lipkin, director of the Center for Infection and Immunity at Columbia University’s Mailman School of Public Health, in a video published in February. He started working in China during the 2003 SARS outbreak. SARS killed a high percentage of people who came into contact with the virus, but it died off quickly over the course of eight months. COVID-19 is expected to be more flu-like and may never totally disappear. While that may seem scary, it actually incentivizes pharmaceutical companies to continue working on both treatments and vaccines.
“We have to be in this one for the long haul,” he says.