Bent Curve Isn’t Enough: the Path to Reopening Needs a Steady Hand

Without testing up to speed, experts say the country could see a faster spread of the novel coronavirus if it relaxes social-distancing guidelines too soon.

Rows of patient beds are shown at a military field hospital last week at the CenturyLink Field Event Center in Seattle. (AP Photo/Ted S. Warren)

WASHINGTON (CN) — When cases of Covid-19 began cropping up four months ago, Dr. Robert Gallo, the preeminent virologist who co-discovered HIV and pioneered the development of the blood test used to diagnose it, thought to himself: “Uh oh.” 

“Was I shocked? No,” Gallo told Courthouse News in an interview last week. “We thought it would spill away from China. But did I expect it to be this bad in most places on earth? No.” 

Deemed a global pandemic in March, the respiratory disease caused by the novel coronavirus has killed over 110,000 people worldwide and infected over a million. In the U.S., more than 530,000 cases of Covid-19 are confirmed, and 20,000 are dead, according a Johns Hopkins tracker. 

The White House initially forecast the U.S. death toll to reach between 100,000 to 240,000, but after three weeks of mostly state-led social-distancing efforts, both the Centers for Disease Control and Prevention and those counseling the White House, like Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Disease, have lowered the estimate to 60,000. That prediction is also based on data compiled by the Institute for Health Metrics and Evaluation, part of University of Washington Medicine. 

The revision still paints a bleak picture, however, and compounding anxieties are the uncertainties around how Americans will emerge from various states of lockdown, stay healthy and reduce the likelihood of infection, or worse, reinfection, as the possibility of vaccination is far off, many months if not years away. 

A U.S. Centers for Disease Control and Prevention illustration of COVID-19, a novel coronavirus.

What unsettles Dr. Gallo today are the memories coronavirus brings to the surface. 

“Unfortunately, this virus looks like HIV. This guy too has, it’s like spike proteins,” he said, noting the thorny protuberances of the Covid-19 virus structure. “These are important targets for both viruses, because those are the things coming at your healthy cells. It’s what your immunity sees first.”

Gallo’s assessment is supported by new research in the peer-reviewed journal Cellular and Molecular Immunology. Relying on data from New York and Shanghai, the study published Sunday reveals how healthy immunity building T-cells were rendered uncharacteristically defenseless after being injected with coronavirus genes.

This does not typically occur to T-Cells in similar strains, like the SARS virus that hammered Asia in 2003, but it does occur with HIV.

For experts like Gallo, such similarities should humble those deciding how to jumpstart society, as more diverse virus testing capability comes online. 

Most tests issued to Americans now are diagnostic, unable by themselves to determine a presence of antibodies, or cells created after a virus invades.

Diagnostic tests do little to get ahead of a widespread outbreak, so antibody detection through the blood, or serological testing, is a critical coupling to testing when establishing a community’s infection rate and how immunity plays out in the herd.

Knowing this makes reopening school, work and business floodgates exponentially safer, Gallo explained, and reduces the risk of restarting restrictions on public gatherings.  

Ideally, people would receive a suite of tests — both diagnostic and serological — before more guidelines were lifted. People would also need to be tested at multiple points in time, he said. 

Dr. Robert Gallo co-discovered the human immunodeficiency virus as the agent responsible for the AIDS virus. Today he is the Homer and Martha Gudelsky distinguished professor in medicine at the University of Maryland Baltimore, where he is also co-founder and director of the school’s Institute of Human Virology. (Photo courtesy of Dr. Robert Gallo.)

For those who contracted Covid-19, they would be tested not just 24 to 72 hours after the first negative result, but again two to four, or even eight weeks later. This significantly reduces the possibility of false positives. 

“If there were 100 people who were infected, and they got better, and you were able to show two weeks from the time they were feeling better that they were virus-free — and not just with an antibody test, but with a viral RNA test, too — I would feel comfortable saying, go back to work,” Gallo said. “And remember just because you are antibody positive doesn’t mean you are virus-free. … I would like to be sure you don’t find the virus in saliva or the blood.” 

Anna Yeung-Cheung, a professor of biology, virology and infectious disease at Manhattanville College in New York, agreed.

“HIV takes about six weeks to produce antibodies,” Yeung-Cheung said. “Some get in more quickly. In the beginning [of the AIDS epidemic], a lot of patients did not know they had it because the only test they received was an antibody test. They missed the window because they tested too early.”

The National Institutes of Health announced on April 10 it opened coronavirus-antibody testing for 10,000 volunteers from around the U.S.

Serological testing has been underway sporadically since April 2 since the FDA approved Cellex to produce the first rapid antibody test for Americans. 

The developments are encouraging, Yeung-Cheung acknowledged, but ultimately, it does little to change the holding pattern for untested Americans who must turn to the CDC’s interim work strategy for guidance. 

Anna Yeung-Cheung is a biology professor at Manhattanville College in New York.

The CDC recommends excluding employees from work for at least three days or up to seven since Covid-19 symptoms first appear.

But Yeung-Cheung noted how this doesn’t realistically account for how people’s immune systems uniquely react to viral infections. 

After clearing a virus, immunity is fragile, and this is prime time for secondary bacterial infections.

Feeling sick and recovering for at least 10 days, at minimum, is key to stemming the flow of spread for those who cannot socially distance. 

Dr. Jose Vazquez, chief of the infectious disease division and professor of medicine at the Medical College of Georgia at Augusta University, called the CDC’s return-to-work guidelines a redundancy at best. 

Appropriate spatial distancing, regular disinfecting, not sharing supplies, staying home if sick — it’s all the same information states have already been following for weeks now, Vazquez said. 

“These new guidelines are a bogus placebo,” he said. 

It may make people feel better to receive some type of direction, especially in hard-hit areas, but how life functions moving forward will vary widely. 

Dr. Jose A. Vazquez is division chief and professor of medicine and infectious diseases at Augusta University.

“You can’t set a single deadline for the whole country. You have to launch different parts in different phases,” he said before noting the surge that is now hitting metro Atlanta. 

“We’re seeing a surge, yes, but we’re also flattening the curve with social distancing, so, maybe by May 1, we could be OK,” he said. “But that’s if we’re maintaining the same practices. We have to do this logically.”

Restaurants with 100 tables, for example, may consider starting with 30 tables and spacing guests out. 

“You have to do intelligent things, right? In general, most people in the U.S. are reasonably intelligent and don’t want to die or get sick. They will follow what they’re told to do. We can do this in phases and recognize at the same time, in a month or two more, we could see [an outbreak] happen again.” 

On CNN’s “State of the Union” on Sunday, Dr. Fauci said he hoped to know by the end of this month whether it was safe to begin pulling back restrictions. 

“If so, do it. If not, then just continue to hunker down,” he said. 

While Atlanta’s curve could be on a downward trajectory by May 1, the story could be different elsewhere, like in Ohio. 

Zachary Jenkins, professor of pharmacy practice at Cedarville University in Ohio, noted in a recent interview how that state is predicted to peak at the start of next month, just as others are expected to be coming down. 

May 1 could be “realistic” he said, if social-distancing efforts remain a constant, and health care resources meet the ongoing demand. Much like certain areas of Italy lagged behind others, the U.S. is doing the same. 

“The short of it is that our personal decisions and efforts under each state’s regulations directly influence how quickly things will be able to return to normal,” Jenkins said. “This isn’t flipping a switch. If everything returns to normal immediately, we would likely see a large surge of cases with unknown consequences,” he said.

Zach Jenkins is an associate professor of pharmacy practice at Cedarville University in Ohio.

Reports of reinfection for now, often upon closer inspection, are frequently tied to low quality or incomplete testing.

Joining a chorus of existing expert voices, Jenkins lauded antibody and randomized testing as the key to breaking the pandemic’s grip.

“This should provide public health officials and other authorities with the data they need to determine which regions are considered high risk versus low risk, which would directly impact policy decisions. … This would also be especially helpful with determining how healthcare resources should be allocated,” Jenkins said. “Reinfection is not our chief concern at this time. Instead, our big concern would be if we turned everything back on at once and caused a sudden surge of cases.”

Considering what lies ahead, the virologist Gallo noted how there is a wellspring of interest in infectious disease during a crisis but, as things settle, attention recedes.

“I came to the conclusion that everyone remembers epidemics for 20 years, but somewhere in the 25- to 30-year window, you forget,” Gallo said. “New York Governor Andrew Cuomo said recently, ‘we’ll never forget.’ I don’t agree. We won’t forget going through it, but in about 30 years, without another epidemic, we’ll forget again.”

When HIV first exploded in America, very little was known and few virologists were even available, Gallo recalled. It was this experience that prompted him to launch the independent nonprofit Global Virus Network in 2011. 

Unfettered by governmental bureaucracy and budgeting, the network integrates the research of virologists and infectious disease experts the world over, Russia or China included, despite the tendency of those countries to otherwise limit information with outside governments. 

This sharing of information has come in handy in epidemics past, and, as states move forward with plans to lift restrictions, it will be crucial to remember that a virus knows no borders and holds no one residence or citizenship.  

“We need each other in a pandemic. We need to be together on this, not cursing at each other,” he said, before noting President Donald Trump’s frequent early references to Covid-19 as the “Chinese virus.”

In the next pandemic, this is one of the first things that must never be repeated, Gallo said.

Not only is it “offensive and outrageous,” he said, but it also threatens a priceless resource at a time when most feel isolated or unsure how much longer life will be disrupted.

“It blocks collaboration,” he said.

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