Ask The Experts: What Will The Next Few Months Of The COVID-19 Crisis Look Like?
The U.S. continues to be inundated with coronavirus and with the fall season come cooler temperatures, the flu, and holiday celebrations — all of which could exacerbate already alarming pandemic trends in a majority of states, including Texas where hospitalizations are up sharply from early October.
This interview has been edited for length and clarity.
Will cold weather make people more susceptible to COVID-19?
It's not just about the body; it's also about how our behavior changes. We don't like the cold, so we go indoors. And we know that the virus transmits more efficiently when people are in close quarters indoors, where social distancing is harder. It's also true that the less sunny it is, the less hot it is, the less humid it is, that favors transmission of this type of virus. There's a lot of different reasons why we see respiratory viruses exhibit seasonality. But this was something that we knew would happen as it got cold. That's why we all emphasize getting this under better control before we entered the fall.
Will we have to cancel holiday plans?
I don't think that we have to cancel things, but you have to remember that this is not going to be something with zero risk. This is something where you're going to have to gauge everyone's risk tolerance — knowing that when you sit around that table, the virus is going to be there with you, especially if you're inviting people from other parts of the country, other parts of the state or wherever it might be that you haven't mixed with yet.
So it's important to plan for this. Think about it, make sure that you're not having people there that might be sick or might be still contagious, if they've recovered. It's important just to go through that kind of checklist with all the people that you're inviting. If you're in a place where you can do some of this outdoors, do it outdoors, try to set the table to keep people who haven't mixed yet six feet apart. We know that small gatherings are driving cases in many parts of the country right now, so this is going to be something that we're going to have to make individual risk calculations. And unfortunately, we're not very good at those individual risk calculations. There are some common sense measures you can take to try and minimize the risk, but it's never going to be zero.
Does the U.S. just have a lot of cases because it’s doing more testing than other countries?
Sure, if we didn't test anybody, we would have no cases. Right? I mean, of course, we would have cases, but they wouldn't be identified as cases. We are doing enough testing; that is not the issue. That is not why we're seeing such a high percentage of cases in the United States. The United States has 4.4% of the world's population, and about 20% of the cases, and 20%, more or less of the death. This is a public health failure. And the test positivity rate is going to vary around the country. Some places, it's much higher than others. It's hard to compare overall. If you looked at the average for the United States, that doesn't give you a good picture of what's happening in individual areas.
Is herd immunity effective?
In getting a herd immunity, we would need to get 60–70% of the people in the population that have the disease process to develop antibodies to try and protect people that haven't had it yet. And as we know, there'll be a lot of cases of severe infection and deaths associated with that. The other thing is that a lot of people have persistent symptoms that last for a long time, and there may be some long-term damage to both the heart and lungs from having a severe case of COVID-19.
If you don't have lifelong immunity, then that's really not a feasible solution. If you're only going to have immunity for a few months, and you can still get the disease again, then you really haven't accomplished anything. The other part that doesn't make any sense with promoting herd immunity at this point is that we're so close to having some potential vaccines available that might provide more robust and durable immune responses. It doesn't make sense now to let down our guard when we're closer to vaccines that might provide another way to get to having more people protected and potentially protected longer than they would with natural infection.
How can we be sure that a vaccine will be safe?
The nice thing is that the FDA has put together a protocol to make sure that they are not just issuing a vaccine without enough study, not just issuing an emergency use authorization order early to allow the vaccines enough time to be vetted, because we need to make sure that vaccines are safe and effective.
There are some vaccine candidates that will be ready by the end of this year and early next, but they must still be approved and distributed. It's going to take a while to mobilize and produce a vaccine, and then mobilize and get it to all the areas that need it, which with a global pandemic, obviously, that's a huge challenge.
- Dr. Amesh Adalja, MD, senior scholar with the Johns Hopkins Center for Health Security
- Dr. Jason Bowling, MD, fellow of the Infectious Diseases Society of America, associate professor of internal medicine and infectious diseases in the Joe R. and Teresa Lozano Long School of Medicine at UT Health San Antonio and director of hospital epidemiology for University Health System
- Dr. Catherine Troisi, Ph.D., infectious disease epidemiologist at UTHealth School of Public Health in Houston
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*This interview was recorded on Tuesday, October 27.